| Infant/young children | ||
| 1. Child’s name | What is your child’s name? | |
| 2. Child’s sex | Is (the name of the child) male or female? | Male Female |
| 3. Child’s age | When is your child’s birthday? Probe if necessary: On what day and in which month and year was (name of the child) born? Does he/she have a health/vaccination card with the birth date recorded? If yes, record the date of birth as documented in the card | _ _ _ _/_ _/_ _ year month day |
| How old was (name of the child) at his/her last birthday? Record age in completed years and/or months | Age in completed years _ _ Age in completed months _ _ |