Caregiver
1. Name and code	What is your name?
1. Name and code	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
4. Caregiver’s age	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 ⁭
6. Geographical characteristics	Where do you live? Adapt to the local geographical characteristics: district, city, village, section, tribe, etc.	⁭District ___________________ ⁭City ___________________ ⁭Village ___________________ ⁭Section ___________________ ⁭Other ___________________
7. Educational level	Have you ever attended school? If yes, continue asking: What is the highest level of school you attended?	None ⁭ Primary school ⁭ Secondary school ⁭ Higher ⁭
7. Educational level	What is the highest grade/form/year you completed at that level?	Grade _ _