QUESTIONNAIRE

Instructions
Please tick the corresponding brackets to the preferred answer to each question

Part one: Immunization/Vaccination

Section A: Background Information

1. Sex
Male [ ] Female [ ]
2. How old are you?
18 – 25yrs [ ] 26 – 36yrs [ ]
37 – 45yrs [ ] 46yrs and above [ ]
3. How many children do you have?
1 [ ] 2–3 [ ] More than 3 [ ]
4. What is your current marital status?
Married [ ] Unmarried [ ]
Separated [ ] Divorced [ ]
Widowed [ ] Others specify ____________________________________
5. What is your occupation?
House wife [ ] Civil servant [ ]
Casual employee [ ] Student [ ]
Unemployed [ ] Others specify ______________________________
6. What is your level of education?
No formal education [ ] Primary [ ]
Secondary [ ] Tertiary education [ ]
Others specify ____________________________________________________________
7. Where do you stay (urban or rural)?
Urban [ ] Rural [ ]
8. Socioeconomic Information:
What is the highest level of education attained by the child's primary caregiver?
No formal education [ ] Primary education [ ]
Secondary education [ ] Higher education [ ]

9. What is the primary source of income for the household?

Agriculture [ ] Wage labor [ ] Business [ ]
Other (please specify)…………………………..

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 SECTION B:
KNOWLEDGE OF MOTHER’S ON UPTAKE OF IMMUNIZATION
1(i). Have you ever heard of immunization?
Yes [ ] No [ ]
(ii) If yes what is immunization?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
2. If yes above, from whom did you get that information?
Family member [ ] Health worker [ ]
Friend [ ] Non-Governmental Organization [ ]
3(i). Have you ever immunized your child?
Yes [ ] No [ ]
(ii) Give reasons for your answer?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
(iii). At what age did yourn child hadve his or her first immunization?
…………………………
4(i). Do you know the immunizable diseases?
Yes [ ] No [ ]
(ii) If yes, mention them?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
5. Has your child ever suffered from or is currently suffering from any of these diseases?"Is
your child suffering from any of these or ever suffered from any of these diseases?
Yes [ ] No [ ]
6. Do you think that your child’s sickness is/was related to lack/inadequate immunization?
Yes [ ] No [ ]
7. When should a child get the first vaccine?
At birth [ ] At 6 weeks [ ]
At 6 months [ ] At one year [ ]
8(i). Do you think it is necessary to be educated about immunization?
Yes [ ] No [ ]
(ii) If yes, what is the best place to be educated on about immunization?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
9(i). Does routine immunization prevent children from some infectious diseases and its
complications?
Yes [ ] No [ ]
(ii) Give reasons for your answer
………………………………………………………………………………………………

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 ………………………………………………………………………………………………
………………………………………………………………………………………………
10. Do you know that most diseases against which children are vaccinated occur during the
first year of life?
Yes [ ] No [ ]
11. Do you know that multi-doses of the same vaccine given at intervals are important for
child immunity?
Yes [ ] No [ ]
12. And that more than one vaccine at the same time hasve no negative impact on child’s
immunity?
Yes [ ] No [ ]
13(i). Is it important to vaccinate children during immunization campaigns?
Yes [ ] No [ ]
(ii) Give reasons to support your answer
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
14(i). Do you know that common colds, ear infections and diarrhea are not contraindications for
immunization?
Yes [ ] No [ ]
(ii) Give reasons for your answer
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………

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 SECTION C:
PRACTICE OF MOTHER’S TOWARDS IMMUNIZATION UP TAKE
1.(i) Have you ever immunized your child?
Yes [ ] No [ ]
(ii) If yes, what type of vaccine did you get for your child?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
2. how many times was your child immunized with these vaccines?
Once [ ] Twice [ ]
Three times [ ] Four times and more [ ]
3(i). Have you ever been educated about immunization?
Yes [ ] No [ ]
(ii) If yes where?
At the health centre [ ] Village community centre [ ]
At the worshipping centre [ ] At home [ ]
On Social media [ ]
(ii) If yes, what did they teach about immunization?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
4. At what age did your last child start immunization?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
5. Where do you usually take your children for immunization?
Health centre [ ] Community outreach [ ]
6. At what age did your child/ children receive the measles vaccine?
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
7(i). Do you have any card where the child/ children’s immunizations were recorded?
Yes [ ] No [ ]
(ii) If yes what type of a card
Childs health card [ ] weighing book [ ]

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 Part two: Nutritional Status

First Section

A. Child Information:

Child's Age (in months):……………………….

Child's Gender
Male [ ]
Female [ ]

B. Feeding Practices:
What is the child's primary source of nutrition?

Breastfeeding [ ]
Formula milk [ ]
Solid foods [ ]
Combination of breast milk and solid foods [ ]
Other (please specify) ………………………………………………………………

C. How often is the child breastfed in a day?

Less than 6 times [ ]

6-8 times [ ]
More than 8 times [ ]
Not breastfed [ ]

D. At what age was the child introduced to solid foods?

Before 4 months [ ]
4-6 months [ ]
6-8 months [ ]
After 8 months [ ]

Second section
A. Dietary Diversity:
. In the past 24 hours, what types of foods has the child consumed? (Check all that apply)

Grains and cereals (e.g., rice, maize) [ ]

Tubers or roots (e.g., potatoes, yams) [ ]
Legumes, pulses and nuts (e.g., beans, lentils, groundnuts) [ ]
Dairy products (e.g., milk, yogurt) [ ]
Animal sources Meat, poultry, fish, or eggs [ ]
Fruits and vegetables (e.g., mango, pear, carrots, green leafy vegetables [ ]
Fats and oil (e.g,. sheanut oil, groundnut oil, shea butter)

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Other (please specify)………………………….

B. Anthropometric Measurements:
Has the child's weight and height been measured recently?

Yes [ ]
No [ ]
Unsure [ ]
If yes, please provide the following measurements:
Weight (in kilograms):……………………………..
Height (in centimeters):……………………………….

C. Health and Wellness:

Has the child experienced any health issues in the past month? (e.g., fever, diarrhea,
cough)
- Yes [ ]
- No [ ]

Is the child currently receiving any vitamin or mineral supplements?

Yes [ ]
No [ ]

D. Access to Healthcare:
How easily can you access healthcare services for the child in your community?
- Very easily [ ]
- Somewhat easily [ ]
- Not easily [ ]
- Not applicable [ ]

E. Additional Comments:

Is there anything else you would like to share about the child's nutritional status or any
challenges you face in providing adequate nutrition?

Conclusion:
Thank you for completing this questionnaire. Your input is valuable toin helping us.