Caregiver | ||
1. Name and code | What is your name? | |
Insert respondent code |
_ _ _ _ | |
2. Sex | Insert the sex of the caregiver | Male Female |
3. Relationship | What is your relationship with the child you take care of? | Mother Father Grandmother/Grandfather Other |
4. Caregiver’s age | When is your birthday? Probe if necessary: On what day and in which month and year were you born? | _ _/_ _ /_ _ _ _ day month year |
How old are you? Probe if necessary: What was your age at your last birthday? If the information conflicts with the previous question, determine which one is more accurate | Age in completed years _ _ | |
5. Parity (only for women) | How many children do you have? For pregnant women: ask if this is her first pregnancy | Number of children_ _ _ _ First pregnancy |