Professional Documents
Culture Documents
quest_ interview caregiver edit 31 03
quest_ interview caregiver edit 31 03
A. Parents/guardian sociodemographic
No Questions Code
A1 Gender 1[ ] female 2[ ] male
A2 Date of birth (dd / mm / yyyy) (_____/________/________)
A3 Marital status 1[] single 2[] married 3[] widowed 4[] divorced
A4 Ethnicity ? 1[] Minangkabau 2[] Javanese 3[] batak 4[] other, specify ___________
A5 What is your highest education ? 1[] don’t have education 2[] primary school
3[] junior high school 4[] senior high school 5[] bachelor 6[] above bachelor
A6 what is your current occupation ? (multiple choice) 1[] housewife / house keeper
2[] entrepreneur / self employed 3[] agriculture /farmer 4[] fisherman 5[] lecturer 6[]
civil servant 7[] private employees 8[] retired 9[] other , specify___________
A7 How many hours of work per day________ hour
A8 Average monthly household income (IDR) ? 1[] < 1,000,000 2[] 1,000,000 – 3,000,000
3[] 4,000,000 – 5,000,000 4[] > 5,000,000
A9 Spending on food per month 1[] ≤ 600,000 2[] 600,000 – 1,000,000 3[] ≥ 1,000,000
A10 How many people living in your house including yourself ? ______ (specify)
A11 How many children <15 yo living there ? ______ (specify)
A12 What is your relationship with the child ?
1[] mother 2[] father 3[] grandparents 4[] relatives 5[] other, __________
A15 Have you ever received nutritional counselling? 1[] yes 2[] no 3[] not sure
B. Family eating characteristics
No Questions Code
B1 Who determines your main child daily menu ? 1[] mother 2[] caregiver 3[] father
4[] parents /in-laws 5[] helper 6[] Others, specify ________________
B2 How do you get your child daily menu ? 1[] cook at home 2[] buy ready made
3[] instant food 4[] Others, specify______________
B3 What are the considerations in choosing a menu for your child ? (multiple choices)
1[] nutrition 2[] finance 3[] ease of obtaining/food availability
4[] children’s tastes/likes 5[] Others, specify___________________
B4 How often does your family eat meals together at home?
a) Almost always; everyday b) Fairly often, not everyday
c) Occasionally, only when there an event d) Rarely, once a week
B5 How much time does your child typically spend on screens (e.g., TV, computer, tablet, smartp
hone) each day? 1[] <1 hour 2[] 1-2 hours 3[] 2-4 hours 4[] >4 hours
C. Feeding style
No Questions Code
C1 How you feed your child?
1[] I am authoritative, I set clear rules and support my child's needs
2[] I am indulgent, I let my child eat whatever they want.
3[] I am authoritarian, I enforce strict rules without much warmth.
C2 How do you react when your child expresses a preference for unhealthy snacks or treats?
1[] I allow my child to eat whatever they want, even if it's not nutritious.
2[] I try to balance treats with healthier options and encourage moderation.
3[] I ignore their preferences and insist they eat what I provide
D. Child eating behavior
No Questions Code
D1 How child's enjoy of eating food? 1[] They consistently excited and happy while eating.
2[] They rarely show enjoyment while eating and may seem disinterested.
3[] Their enjoyment depending on the meal or snack.
D2 Is your child a picky eater? 1[] They are not picky eaters. 2[] They are somewhat picky, sho
wing reluctance to try new foods 3[] They are very picky, often refusing certain foods
G. Index case medical record (if this section completed already by hospital based data, than skip)
No Questions Code
D1 Index case gender? [] 1 female [] 2 male
D2 His/her date of birth (dd / mm / yyyy) (_____/________/________)
D3 What is his/her relationship with the child ? 1[] mother 2[] father
3[] grandparents 4[] siblings 5[] relatives 6[] other, specify _______________
D4 Her/his treatment status? 1[] cure 2[] completion 3[] treatment interruption
4[] lost to follow up 5[] death 6[] not evaluated 88[] don’t know
D5 Do she/he have any following disease ? multiple choices
1[] Hypertension 2[] Diabetes 3[] COPD 4[]Asthma 5[] Cancer
6[] Psychiatric problem 7[] HIV 8[] Other (specify)_________ 9[] don’t have
H. Children Medical Record (if this section completed already by hospital based data, than skip)
No Questions Code
E1 Child gender 1[] female 2[] male
E2 Has your child previously received the BCG vaccine? 0 [] yes 1 [] no
Has your child ever been diagnosed with tuberculosis? 1[] yes 2 [] no
E3
E4 When was she/he diagnosed with tuberculosis? _______ month ________ year
4.1 If no, what type of milk/liquid you give to your child ? Multiple choices
[] 1 formula milk [] 2 evaporated milk [] 3 animal milk [] 4 plants / soy milk [] 5 plain
water [] 6 tea /coffee [] 7 fruit juice [] 8 honey [] 9 other ______
5 Are you continuing / will breastfeeding to your child until 12 – 23 months ?
[] 0 yes [] 1 no
6 What is your difficulties to give exclusive breastfeeding ? Multiple choices
[] 1 painful breast by anycause
[] 2 insufficient breastmilk production
[] 3 lack of support
[] 4 short maternity leave periods
[] 5 emotional stress
[] 6 lack of knowledge
[] 7 cultural influence
[] 8 mother unable to breastfeeding [] 9 other, specify________________
B. Complementary Food
NO Questions Code
1 At what time you give complementary food ? 1[] < 6 months 2[] > 6 months
2 How many times did (name of the baby) eat foods, that is meals and snacks other than liquids
yesterday? _______ number of times [] 88 don’t know
C Minimum Dietary Diversity (24 hr-recall)
Group Food lists code
Group 1 : Breast Milk Breast Milk (direct to mother breast or bottle feeding)
(only for infant parent) [] 0 yes [] 1 no
Group Food lists code
Group 2 : Grains, Porridge, bread, rice, lontong, noodles or other foods made from grains
roots and tubers [] 0 yes [] 1 no
White potatoes, white yams, cassava or any other foods made from roots
[] 0 yes [] 1 no
Group 3: Legumes Any foods made from beans, peas, lentils, nuts or seeds (beans, long
and nuts beans, gadang beans, soybeans, peanuts) [] 0 yes [] 1 no
Group 4: Dairy Infant formula, such as ®bebelac, ®dancow [] 0 yes [] 1 no
products How many times ? ____
Milk, such as tinned, powdered or fresh animal milk [] 0 yes [] 1 no
How many times ? ____
Cheese or other dairy products [] 0 yes [] 1 no
Group 5: Flesh foods Liver, kidney, heart or other organ meats [] 0 yes [] 1 no
Any meat, such as beef, lamb, goat, chicken or duck [] 0 yes [] 1 no
Fresh or dried fish (bandeng, nil/mujair, lele), seafood [] 0 yes [] 1 no
Snails [] 0 yes [] 1 no
Group 6: Eggs Eggs [] 0 yes [] 1 no
Group 7: Vitamin A Pumpkin, carrots, squash or sweet potatoes that are yellow or orange
fruits and vegetables inside [] 0 yes [] 1 no
Any dark green vegetables (kang kong, spinach, cassava leaves, broccoli,
mustard, cabbage, ) [] 0 yes [] 1 no
Ripe mangoes, papaya, banana, star fruit, langsat, watermelon (rich vit A
fruits) [] 0 yes [] 1 no
Group 8: Other fruits Any other fruits or vegetables [] 0 yes [] 1 no
and vegetable
Others (not counted in Any oil, fats, or butter or foods made with any of these (rempeyek,
the dietary diversity gorengan, karupuak) [] 0 yes [] 1 no
score)
Any sugary foods, such as chocolates, sweets, candies, pastries, cakes or
biscuits (martabak, donat, brownis, bolu) [] 0 yes [] 1 no
Condiments for flavour, such as chillies, spices, herbs or fish powder
[] 0 yes [] 1 no
Instant drinks (®popice, ®marimas, ®nutrisari) and Soft drinks
(®cocacola, ®sprite, ®fanta) [] 0 yes [] 1 no
No Questions code
4 What is your difficulties to give divers food ? Multiple choices
[] 1 financial difficulties
[] 2 child is picky eater
[] 3 lack of knowledge
[] 4 have no time / busy
[] 5 lack of child appetite
[] 6 unhealthy food preference
[] 7 other ________
D Food Frequency Questionnaire (FFQ) (within 1 year)
KNOWLEDGE
A. Breastfeeding
No Questions Code
1 Have you ever heard about exclusive breast feeding? [] 0 yes [] 1 no
2 Colostrum is important for baby [] 0 yes [] 1 no [] 88 don’t know
3 A neonate should start breastfeeding within 1 h of birth [] 0 yes [] 1 no [] 88 don’t know
4 An infant should exclusively breastfeed for the first 6 months
[] 0 yes [] 1 no [] 88 don’t know
5 Benefit of breastfeeding for baby
[] 1 baby will grow healthy [] 2 protects from diseases [] 3 other [] 88 don’t know
6 Benefit of breastfeeding for mother
[] 1 Delays fertility [] 2 Helps her lose the weight [] 3 Lowers risk of breast cancer
[] 4 Improves mother and baby relationship [] 5 Other [] 88 Don’t know
7 How long is it recommended that a woman breastfeeds her child?
1[] Six months or less 2[] 6–11 months 3[] 12–23 months
4[] 24 months and more 5[] Other 88[] Don’t know
B. Complementary Food
NO Questions Code
1 An infants should start complementary food at 6 months [] 0 yes [] 1 no [] 88 don’t know
2 Reason for giving complementary foods
[] 1 Breastmilk alone is not sufficient (enough)/cannot supply all the nutrients needed for
growth
[] 2 baby needs to know different flavour of foods [] 88 Don’t know
3 Which foods or types of food can be added to rice porridge make it more nutritious?
multiple choices
[] 1 protein-rich foods (meat, poultry, fish, liver/organ meat, eggs, etc.)
[] 2 Pulses and nuts: flours of groundnut and other legumes (peas, beans, lentils, etc.),
[] 3 Vitamin-A-rich fruits and vegetables (carrot, orange- yellow pumpkin, mango, etc.)
[] 4 Green leafy vegetables (e.g. kangkung, bayam, etc)
[] 5 rich sugary and strong flavor food
[] 6 Other, specify_________ [] 88 Don’t know
4 Why is it bad to eat too many sweets and candies?
[]1 Because they can cause tooth decay []2 Because they are not nutritious
[]3 Because they interfere with appetite []4 Other [] 88 Don’t know
C. Knowledge about malnutrition
No Questions Code
1 How can you recognize that your child is not having enough food/nutrition ?
Multiple choices
[] 1 Lack of energy/weakness: cannot work, study or play as normal (disability)
[] 2 Weakness of the immune system (becomes ill easily or becomes seriously ill)
[] 3 Loss of weight/thinness
[] 4 Children do not grow as they should (growth faltering)
[] 5 Other [] 88 Don’t know
2 What are the reasons why children are undernourished? Multiple choices
[] 1 Not getting enough food [] 2 Food is watery, not enough nutrients
[] 3 Disease/ill and not eating food [] 4 Other, [] 88 Don’t know
3 How can you (caregiver) find out if the baby is growing well or not?
̈ [] 1 Go to the health centre/ask a doctor or nurse (health professional)(seeking health-care
services for growth monitoring)
[] 2 measure yourself [] 3 never find out [] 4 Other [] 88 Don’t know
4 If the baby is not gaining weight, What could be the causes?
[] 1 The baby is not eating well/the baby does not want to eat
[] 2 The baby may be sick often [] 3 genetic [] 4 Other [] 88 Don’t know
5 What should you do to prevent your child from malnutrition?
[] 1 Breastfeed exclusively/give only breastmilk under 6 month
[] 2 Go to the health centre and check that the child is growing (growth monitoring services)
[] 3 give a lot of food [] 4 Other [] 88 don’t know