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NUTRITION AND CARE PRACTICES SURVEY
Introduce yourself, the survey, guarantee her answers will private, and verify the child is less than 6
months old before starting the questions.For response of “don’t know”, code 88 If no response, code
99 We are members of a survey team working with the Afghan Ministry of Public Health, UNICEF
and the Centers for Disease Control and Prevention, a public health agency from the United States
We are gathering information that we hope will help persons that have suffered physically and
mentally as a result of the war. Your answers will help the Ministry and UNICEF make good decisions
about health care programs in the future.
We want ask questions about your experiences during the recent war, by this we mean the time during
the past five years.
We are conducting the survey in many households in Afghanistan and have chosen your home
randomly. It is important that we have some privacy for our conversation because some of the
questions may be sensitive.
There is no risk to your health from being in this study. The survey will take approximately 15-60
minutes to complete.
Your answers are private and will not be shared with any other people.
The records of this study will be private. Only the people who are doing the study will be able to look
at the answers you give to the questions. Whether you choose to be in the study is up to you. Only
those people who are conducting the study will know whether you are in the study.
Are you willing to be in this study? Yes ( ) No ( )
Don’t tick “No” if the mother refuses to answer the question. But think, for each questionnaire to fill
the statistics form: if the mother refuses to answer, put a cross in the column “number of mother asked
to be interviewed”, and the column “number of mothers who refused to be interviewed”, and if she
agrees, put a cross in the column “number of mother asked to be interviewed”, and the column
“number of mothers interviewed”
If you do not understand a question, please ask me to explain it to you. You are free to stop at any time
during the interview. If a question makes you uncomfortable, we will skip the question and go to the
next question. Do you have any questions before we begin?
1. Date of interview (dd/mm/2005) : put the day first, than month
2. Interviewer code :
3. Survey team code :
1
4. Code of MCH :
5. Questionnaire’s number : start from 1, and remind everyday what was the last questionnaire’s
number you filled the day before. For example if Sunday you fill 10 questionnaires, you will
have questionnaires 1,2,3,4,5,6,7,8,9,10. Monday your first questionnaires will be number 11.
To help you to remind, you can use your statistics form.
CHILD
6. Weight:
7. Height:
8. W/H (not to be calculated for the under 49 cm):
9. Date of birth: / / (only children less than 6 months : no children born before nov 04)
10. Sex: 1. Girl ( ) 2. Boy ( )
11. Twins or triplets: 1.Yes ( ) 2.No ( ) If you face the case of twins or
triplets, interview the mother on her practices regarding only one child. Use alphabet to
choose the child (the one with the name closer to the letter A). Example two twins named
Adellah and Zarmina. You will interview the mother on Adellah.
Ask each question as if it was an opened question; don’t propose any of the answer written.
You wait for the mother to answer, and tick what is corresponding to her answer. If you
need more precision to do so, reformulate the question.
12. Has your child any handicap ? 1. Physical ( ) 2. Mental ( ) 3. None ( )
If yes, precise: _______________________________________________________________
_______________________________________________________________________________
Example: you ask to the mother “has your child any handicap?” She answers “yes, he has a cleft
palate”. Then you tick “Physical (X)”, and precise “cleft palate” below.
13. How would you say the health of your child is :
1.
Excellent ( ) 2. Very good ( ) 3. Good ( ) 4. Fair ( ) 5. Poor ( )
14. This last month, was your child ill?
1. Vomiting ( ) 2. Frequent diarrhoea ( ) 3. Respiratory problem ( )
4. Very weak ( ) 5. Always asleep ( ) 6. Other: specify: __________
_______________________________________________________________________
DEMOGRAPHIC DATA CONCERNING THE MOTHER
2
99 =
15. From which ethnic are you ?
1. Pashtun ( ) 2. Tajik ( ) 3. Hazara ( ) 4. Uzbek (
)
5. Turkmen ( ) 6. Other ( )
88 =, Precise: ______________________________________
16. What is your level of education?
1.None ( ) 2. Primary education ( ) 3. Secondary education ( )
4. High secondary ( ) 5. Universities/faculties ( )
17. What is your familial situation:
1. Married ( ) 2. Divorced ( ) 3. Separated ( ) 4. Widow ( )5.
Unknown
18. ( )
If married, is your husband: 1. Monogamous ( ) 2. Polygamous ( )
19. 9. Unknown ( )
If polygamous, What is your rank ? (out of):
20. If married, how is the difference of years between you and your husband? is:
1. Mmuch older than you ( ) 2. Oolder than you ( ) 3. Hhas the same age as you
( )
4. yYounger than you ( ) 5. Don’t know ( )
MOTHERHOOD HISTORY
21. Number of pregnancies: _______
22. Number of miscarriage: _______
22.23. Number of abortion: _______ Formatted: Bullets and Numbering
23.24. Number of children deceased: _______
24.25.
Among the children deceased, number of children who died during the first year of life: _____
These children dead during the first year of life are included in the number of children deceased in
total, meaning that the answer to question 24 must be a greater number than the one of question 25.
Example : a mother has lost 3 children, and among them 1 was less than 1 year old. You will write 3 to
“number of children deceased”, and 1 to “Among the children deceased, number of children who died
during the first year of life”
25.26. Mother presently pregnant:
3
1. Yes ( ) 2. No ( ) 3. Don’t
Unknown ( )
27. If yes, how many months? _______ Don’t know ( ) Formatted: Indent: Left: 0.25", First line:
0", Numbered + Level: 1 + Numbering Style:
1, 2, 3, … + Start at: 1 + Alignment: Left +
Aligned at: 0.25" + Tab after: 0.5" + Indent
PREGNANCY OF THIS CHILD even if the mother is pregnant, here you are talking of the less at: 0.5", Tab stops: 0.25", List tab + Not at
than 6 months child
28. Where you happy to be pregnant of this child ? Formatted: Indent: Left: 0.25", First line:
0", Numbered + Level: 1 + Numbering Style:
1. Yes ( ) 2. No ( ) 1, 2, 3, … + Start at: 1 + Alignment: Left +
Aligned at: 0.25" + Tab after: 0.5" + Indent
26.29. answerWhat kind of activities did you have during pregnancy: compared to before at: 0.5", Tab stops: 0.25", List tab + Not at
0.5"
1. Same activity as before pregnancy ( ) 2. Reduced activity ( )
3. More activity than before pregnancy ( )
27.30. Did someone help you for the housework or the care of other children during your
pregnancy?
1. Yes ( ) 2. No ( )
28.31. How were you feeling during your pregnancy?
1. Well ( ) 2. I was sick/ tired sometimes ( ) 3. I was sick/tired often ( )
4. I was sick/tired always ( )
29.32. How was your appetite during your pregnancy compared to usual?
1. Better ( ) 2. Worse ( ) 3. The same ( )
30.33. 36. Did you encounter specific life difficulties during your pregnancy (several Formatted: Bullets and Numbering
answer possible except 5)?
1. Economical ( ) 2. Emotional ( ) 3. Health ( ) 4. Relational ( )
5. None ( )
DELIVERY
37.34. Formatted: Bullets and Numbering
What was the place of delivery?
1. Hospital/maternity ( ) 2. At home ( ) 3. Other ( ), specify:____________
38.35. How your delivery was? Formatted: Bullets and Numbering
1. /wWithout specific difficulties ( ) 2. Fair ( ) 3. / Difficult ( )
36. 39. If difficult, why? Several answers are possible Formatted: Bullets and Numbering
1. T 1/too long ( ) 23. BYes, bleeding ( ) 4. FYes, fever ( ) 5.
Episiotomies ( )
4
6. Caesarean ( ) 7. Other ( ): Precise: _____________________________________
40.37. Formatted: Bullets and Numbering
What was the weight of your child at birth?
1. ________kg 2. Don’t know ( )
41.38. If don’t know, how your child seemed to you? Formatted: Bullets and Numbering
1. Normal ( ) 2. Big ( ) 3. Low birth weight ( )
42.39. Formatted: Bullets and Numbering
During the first week, was your child sick?
1. Yes ( ) Precise:_______________________________________________________
2. No ( )
43.40. Formatted: Bullets and Numbering
After delivery of the child, for how long did you rest ?
1.________days 2. No rest ( )
BREASTFEEDING INITIATION
44.41. Did you receive any advice during your pregnancy about breastfeeding practices? (If Formatted: Bullets and Numbering
yes by who?) several answers possible except 4
1. Yes, by medical staff ( ) 2. Yes, by family ( )
3. Yes, by neighbours and friends ( ) 4. No ( )
45.42. Formatted: Bullets and Numbering
Did someone help or teach you how to breastfeed your first baby? (If yes, who?) several
answers possible except 1
1. Nobody ( ) 2. Mother ( ) 3. Mother-in-law ( )
4. Sister-in-law ( ) 5. Medical staff ( ) 6. Neighbour ( )
7. Other: Precise: _____________________________________________
43. If it is not your first baby, did someone help or teach you how to breastfeed this baby? (If yes,
who?) several answers possible except 1
1. Nobody ( ) 2. Mother ( ) 3. Mother-in-law ( )
4. Sister-in-law ( ) 5. Medical staff ( ) 6. Neighbour ( )
5
7. Other: Precise:_____________________________________________
47.44. At birth, was the child able to suck? Only one answer:the main reason according to Formatted: Bullets and Numbering
the mother
1. YesGood ( ) 2. DifficultNo ( ), because your breast was not good ( )
3. No, because your child was crying ( ) 4. No, because your child was very weak ( )
5. No, because your child refused to suck ( )
6. No, because your child had difficulties to suck ( ) Precise:__________________________
__________________________________________________________________________
7. No, because your child had clip lip ( )
8. No, because your child had disease ( ) . 3. Not good at all
EPrecise: ____________________________
_________________________________________________________________________
9. No, other, Precise : _____________________________
_________________________________________________________________________
48.45. Formatted: Bullets and Numbering
If yes, how was the sucking of your child the days following birth?
1. Good ( ) 2. Fair ( ) 3.Not good ( )
BREASTFEEDING/ COMPLEMENTARY FEEDING
46. During the last 24 hours, did you give to your baby:
1. Breastfeeding only ( ) 2. Breastfeeding + Liquids only ( )
3. Breastfeeding + Semi-solids or solids ( )
4. Liquids and/or semi-solids and/or solids but no breastfeeding ( )
Liquids things are for example : tea, water, water where vegetables were boiled…
If the mother answered « Breastfeeding only », ask her the questions of Exclusive breastfeeding
part, otherwise go directly to Complementary feeding part.
Exclusive Breastfeeding Formatted: Bullets and Numbering
47. How many times a day (24 hours) is the child breastfed? __________ Formatted: Bullets and Numbering
48. Do you breastfeed your baby at night ?
1. Yes, one to two ( ) 2. Yes, two to three ( ) 3. Yes, three to four
6
4. More than four ( ) 5. No ( )
49. How many times a day does the baby urinate? Formatted: Bullets and Numbering
1. Two to four ( ) 2. Four to six ( ) 3. More than six ( )
50. Did someone help you for the housework or the care of other children because you are Formatted: Bullets and Numbering
lactating?
1. Yes ( ) 2. No ( )
Complementary feeding Formatted: Bullets and Numbering
54. 51. How many times a day (24 hours) is the child breastfed ? _________ if the baby is not Formatted: Bullets and Numbering
breastfeed, write 0
52. Why did you start to give something else to your child? several answers possible
1. Because of the age ( ) 2. Not enough milk ( ) 3. Poor quality of milk ( )
4.Someone advised me ( ), Precise: _______________________________________
5. Child doesn't want to suck your breast milk ( ) 6. Because you were ill ( )
7. You had problems with your breasts ( ) 8. Multiple births ( )
9. Child hospitalised ( )
10. Others ( ), precise:____________________________________________________
53. If the child is fed with formula or powder milk, do you use bottle feed : Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
54. Do you breastfeed your baby at night ? Formatted: Bullets and Numbering
1. Yes, one to two ( ) 2. Yes, two to three ( ) 3. Yes, three to four
4. More than four ( ) 5. No ( )
55. How many times a day does the baby urinate? Formatted: Bullets and Numbering
1. Two to four ( ) 2. Four to six ( ) 3. More than six ( )
56. Did someone help you for the housework or the care of other children? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
57. If lactating, Did someone help you for the housework or the care of other children because Formatted: Bullets and Numbering
you are lactating?
1. Yes ( ) 2. No ( )
CARE PRACTICES
58. Have you been separated from your child since birth ? the answers are counting the Formatted: Bullets and Numbering
consecutives days. For example if a mother has been separated several times one day, you will
only tick answer “3. For one day (X) ”
1. Never ( ) 2. For few hours ( ) 3. For one day ( )
7
4. Between 1 and 3 days ( ) 5. For more than 3 days ( )
59. Are you working outside home ? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
60. In general at home, does someone help you to take care of the child ? to ask to mother who Formatted: Bullets and Numbering
work and don’t as well
1. Yes ( ) 2. No ( )
61. Is the child swaddled at home ? Cross “No” only if the child is totally free. For example if the Formatted: Bullets and Numbering
child had his leg swaddled, you tick “Yes (X)”
1.Yes ( ) 2. No ( )
62. While you are doing your activities, is the child:
1. Always with you ( ) 2. Sometimes with you and sometimes with someone else ( )
3. Sometimes with you and sometimes alone ( )
4. Never with you and with someone else ( ) 5. Never with you and always alone ( )
63. If you breastfeed, do you have time to breastfeed your baby during the day ? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
64. During the night, where does your baby sleep ? Formatted: Bullets and Numbering
1. With you in the same bed( ) 2. With you in the same room ( )
3. In another room ( )
65. Are you bringing the child with you when you go out? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
66. Who does take the decision regarding the feeding of the child ? Formatted: Bullets and Numbering
___________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
LACTATION DIFFICULTIES
67. Do you have complaint about breastfeeding your baby (Several answers possible)? Formatted: Bullets and Numbering
1.Yes, not enough breast milk ( ) 2. Yes, it’s painful ( )
3. Yes, the quality of my milk is not good ( )
4. Other major complaint, Precise:_____________________________
5. No ( )
If “No”, go directly to General situation of the mother
68. Since when did your - - - - - - - appear? ______________________________________Repeat Formatted: Bullets and Numbering
the complaint(s) the mother told you the question just before
8
69. If you had previous baby, had you the same lactating difficulties?
1. Yes ( ) 2. No ( )
70. Is there a specific event happened before the lack of milk? Formatted: Bullets and Numbering
1.Yes. ( ) Make it clear: ________________________________________________
______________________________________________________________________
2.No ( )
70. How do you know that you have lactation difficulties ? Tick only one answer, the main reason Formatted: Bullets and Numbering
according to the mother
1. The baby wants to be fed very often ( )
2. The baby wants to be fed for a long time each time ( )
3. The baby is crying very often ( ) 4. The baby is becoming weak ( )
5. Other, Precise: _________________________________________________________
71. Where do you think your lactation difficulties come from (several answers possible) Formatted: Bullets and Numbering
Reasons coming from the mother: 1.Breasts’ problem, infection, sore, flooding, small size, etc ( )
2. Mother sick ( ) 3. Mother too tired ( ) 4. Not enough good food ( )
5. Mother too sad ( ) 6. Other ( ), precise:
Reasons coming from the baby: 1.Disease ( ) 2.Too weak ( ) 3.Unable to suck( )
4. Twinning ( ) 5. other ( ), precise: _____________________________________
Reasons coming from outside: 1. Djinns ( ) 2. Dreams/Nightmares ( )
You don’t have to tick answer in the 3 fields (mother/baby/outside), write only what the mother
say, whether it is in one field only, or in the three.
72. Did you ask advices for your breastfeeding difficulties? Several answers possible Formatted: Bullets and Numbering
1. Yes, to family or neighbours( ) 2. Yes, to mullah ( )
3. Yes, to medical staff ( ) 4. No ( )
GENERAL SITUATION OF THE MOTHER
73. Did you encounter specific life difficulties since birth of your child (several answer possible Formatted: Bullets and Numbering
except 5)?
1. Economical ( ) 2. Emotional ( ) 3. Health ( ) 4. Relational ( )
5. None ( )
74. Did you lose someone close in the last year ? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
75. Are there conflicts in your family? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
76. Are there physical violence in your family ? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
9
77. How do you feel amongst the people you are living with? Formatted: Bullets and Numbering
1.Isolated ( ) 2. Supported ( ) 3. It depends on people and/or situations ( )
78. How do you feel with the amount of work at home ? Formatted: Bullets and Numbering
1. It is too much ( ) 2. It is a lot but I can cope with ( ) 3. It is fine ( )
79. Compared to before, what would you say about the evolution of your family situation this last Formatted: Bullets and Numbering
year?
1. Improved ( ) 2. Deteriorated ( ) 3. No major change ( )
80. When you need, do you have a special support from someone ? Formatted: Bullets and Numbering
1. Yes ( ) 2. No ( )
81. In general, how would you say your health is : Formatted: Bullets and Numbering
1. Excellent ( ) 2. Very good ( ) 3. good ( ) 4 fair ( ) 5. poor ( )
82. Do you have chronic diseases nowadays ? (several answers possible)
1. Frequent headaches and body complains ( ) 2. Collapsing ( ) 3. Tiring feelings ( )
4. Gastritis ( ) 5. High blood pressure ( ) 6. Low blood pressure ( )
7. Bleeding ( ) 8. Anemia ( ) 9. Vomiting ( ) 10. Fever ( )
11. Pain ( ) 12. Others diseases – Precise :
13. None ( )
If pain, or bleeding, precise where: ________________________________________________
83. In the past 7 days : Frequently remind the mother that the 10 following question only Formatted: Bullets and Numbering
concern the last 7 days
1. You have been able to laugh and see the funny side of things
a. As much as you always could ( )
b. Not quite so much now ( )
c. Definitely so much now ( )
d. Not al all ( )
2. You have looked forward with enjoyment to things Formatted: Bullets and Numbering
a. As much as you ever did ( )
b. Rather less than you used to ( )
c. Definitely less than you used to ( )
d. Hardly at all ( )
3. You have blamed yourself unnecessarily when things went wrong Formatted: Bullets and Numbering
a. Yes, most of the time ( )
b. Yes, some of the time ( )
c. Not very often ( )
d. No, never ( )
10
4. You have been very anxious or worried for no good reason Formatted: Bullets and Numbering
a. No, not at all ( )
b. Hardly ever ( )
c. Yes, sometimes ( )
d. Yes, very often ( )
5. You have felt scared or panicky for no very good reason Formatted: Bullets and Numbering
a. Yes, quite a lot ( )
b. Yes, sometimes ( )
c. No, not much ( )
d. No, not at all ( )
6. Things have been getting on top of you Formatted: Bullets and Numbering
a. Yes, most of the time you haven’t been able to cope at all ( )
b. Yes, sometimes you haven’t been coping as well as usual ( )
c. No, most of the time you have coped quite well ( )
d. No, you have been coping as well as ever ( )
7. You have been so unhappy that you have had difficulty sleeping Formatted: Bullets and Numbering
a. Yes, most of the time ( )
b. Yes, sometimes ( )
c. Not very often ( )
d. No, not at all ( )
8. You have felt sad or miserable Formatted: Bullets and Numbering
a. Yes, most of the time ( )
b. Yes, quite often ( )
c. Not very often ( )
d. No, not at all ( )
9. You have been so unhappy that you have been crying Formatted: Bullets and Numbering
a. Yes, most of the time ( )
b. Yes, quite often ( )
c. Only occasionally ( )
d. No, never ( )
11
10. The thought of harming yourself has occurred to you Formatted: Bullets and Numbering
a. Yes, quite often ( )
b. Sometimes ( )
c. Hardly ever ( )
d. Never ( )
84. In your opinion, when can a child: Formatted: Bullets and Numbering
a. Hear sound _____________________________________________________
b. Smile at someone _____________________________________________________
c. First see something_____________________________________________________
d. Say first word_____________________________________________________
e. Understand “No” _____________________________________________________
f. Walk without support_____________________________________________________
g. Grab object with thumb and finger______________________________________________
h. Follow a simple instruction __________________________________________________
i. Feel happiness or sadness_____________________________________________________
85. According to you, what makes a child happy ? Formatted: Bullets and Numbering
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
86. According to you, what makes a child unhappy ? Formatted: Bullets and Numbering
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
87. What do you do when your child is unhappy ? Formatted: Bullets and Numbering
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
88. According to you, what is the most important thing your child needs ? Formatted: Bullets and Numbering
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
12
89. Ask the mother to breastfeed the child in front of you Formatted: Bullets and Numbering
1. The chin is touching the breast ( ) 2. The lower lip is turned outward ( )
3. The mouth is wide open ( ) 4. More areola above than below ( )
5. The child is facing the mother ( )
Sous paragraphe entre exclusive / not exclusive
If the baby is breastfed, hoIf the baby is not only or not at all breastfeeding, why did you start
to give something else to your child?
1. Because of the age ( ) 2. Not enough milk ( ) 3. Poor quality of milk ( )
4.Someone advised me ( ), Precise: _______________________________________
5. Child doesn't want to suck your breast milk ( ) 6. Because you were ill ( )
7. You had problems with your breasts ( ) 8. Multiple births ( )
9. Child hospitalised ( )
10. Others ( ), precise:____________________________________________________
If the child is fed with formula or powder milk, do you use bottle feed :
1. Yes ( ) 2. No ( )
Do you breastfeed your baby at night ?
1. Yes, one to two ( ) 2. Yes, two to three ( ) 3. Yes, three to
four
4. More than four ( ) 5. No ( )
How many times a day does the baby urinate?
1. Two to four ( ) 2. Four to six ( ) 3. More than six ( )
Did someone help you for the housework or the care of other children because you are
lactating?
1. Yes ( ) 2. No ( )A preciser
Did one of your other child die recently? 1. Yes ( ), precise: Sex: Age:
Reason: 2. No ( )
Who is supporting you in these difficult moments? 1. Husband ( ) 2. Mother ( )
3. Mother in law ( ) 4. Sister ( ) 5. Sister in law ( ) 6. Neighbour ( )
CARE PRACTICES
13
Have you been separated from your child since birth ?
1. Never ( ) 2. For few hours ( ) 3. For one day ( )
4. Between 1 and 3 days ( ) 5. For more than 3 days ( )
Are you working outside home ?
1. Yes ( ) 2. No ( )
In general at home, does someone help you to take care of the child ?
1. Yes ( ) 2. No ( )
Is the child swaddled at home ?
1.Yes ( ) 2. No ( )
While you are doing your activities, is the child:
1. Always with you ( ) 2. Sometimes with you and sometimes with someone
else ( )
3. Sometimes with you and sometimes alone ( )
4. Never with you and with someone else ( ) 5. Never with you and always alone ( )
Do you have time to breastfeed your baby during the day ?
1. Yes ( ) 2. No ( )
During the night, where does your babyis sleeping your baby sleep ?
1. With you in the same bed( ) 2. With you in the same room ( )
3. In another room ( )
Are you bringing the child with you when you go out?
1. Yes ( ) 2. No ( )
How many hours per day do you spend outside the house ?
Who does take the decisionecides about regarding the feeding of the child ?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
____________
LACTATION DIFFICULTIES
14
Do you have complaint about breastfeeding your baby (Several answers possible)?
1.Yes, not enough breast milk ( ) 2. Yes, it’s painful ( )
3. Yes, the quality of my milk is not good ( )
4. Other major complaint, Precise:_____________________________
5. No ( )
If “No”, go directly to General situation of the mother
Since when did your - - - - - - - appear? ______________________________________
If you had previous baby, had you the same lactating difficulties?
1. Yes ( ) Precise: ______________________________
2. No ( )
Is there a specific event happened before the lack of milk?
1.Yes. ( ) Make it clear
2.No ( )
How do you know that you have lactation difficulties ?
1. The baby wants to be fed very often ( )
2. The baby wants to be fed for a long time each time ( )
3. The baby is crying very often ( ) 4. The baby is becoming weak ( )
5. Other, Precise:
Where do you think your lactation difficulties come from (several answers possible)
Reasons coming from the mother: 1.Breasts’ problem, infection, sore, flooding, small size, etc
( ) 2. Mother sick ( ) 3. Mother too tired ( ) 4. Not enough
good food ( )
5. Mother too sad ( ) 6. Other ( ), precise:
Reasons coming from the baby: 1.Disease ( ) 2.Too weak ( ) 3.Unable to
suck( )
4. Twinning ( ) 5. other ( ), precise: _____________________________________
Reasons coming from outside: 1. Djinns ( ) 2. Dreams/Nightmares ( )
Did you ask advices for your breastfeeding difficulties ?
1. Yes, to family or neighbours( ) 2. Yes, to mullah ( )
3. Yes, to medical staff ( ) 4. No ( )
15
GENERAL SITUATION OF THE MOTHER
Did you encounter specific life difficulties since birth of your child (several answer possible
except 5)?
1. Economical ( ) 2. Emotional ( ) 3. Health ( ) 4. Relational ( )
5. None ( )
Did you lose someone close in the last year ?
1. Yes ( ) 2. No ( )
Are Ont elles eu des deuils récemment ?
Ont elles été visitées par Djinns dernierement ?
Did you learn about breastfeeding, children… in Iran / in pakistan ?
Feeling isolated ?
Special support form someone, friend …
there conflicts in your family?
1. Yes ( ) 2. No ( )
Are there physical violence in your family mily ,?
a
1. Yes ( ) 2. No ( )
At home do you feel ?
1.Isolated ( ) 2. Supported ( ) 3. It depends on people and/or situations ( )
How do you feel with the amount of work at home ?
1. It is too much ( ) 2. It is a lot but I can cope with ( ) 3. It is fine ( )
How did your family situation evolve this last year
1. Improved ( ) 2. Deteriorated ( ) 3. No major change ( )
When you need, do you have a special support from someone ?
1. Yes ( ) 2. No ( )
In general, would you say your health is :
1. Excellent ( ) 2. Very good ( ) 3. good ( )
4 fair ( ) 5. poor ( )
16
Do you have chronic diseases nowadays ? (several answers possible)
a. Frequent headaches and body complains ( ) b. Collapsing ( ) c. Tiring feelings ( )
d. Gastritis ( ) e. High blood pressure ( ) f. Low blood pressure ( )
g. Bleeding ( ) h. Anemia ( ) i. Vomiting ( ) j. Fever ( )
k. Pain ( ) l. Others diseases – Precise :
m. None ( )
If pain, or bleeding, precise where:
In the past 7 days :
You have been able to laugh and see the funny side of things
As much as you always could ( )
Not quite so much now ( )
Definitely so much now ( )
Not al all ( )
You have looked forward with enjoyment to things
As much as you ever did ( )
Rather less than you used to ( )
Definitely less than you used to ( )
Hardly at all ( )
You have blamed yourself unnecessarily when things went wrong
Yes, most of the time ( )
Yes, some of the time ( )
Not very often ( )
No, never ( )
You have been very anxious or worried for no good reason
No, not at all ( )
Hardly ever ( )
Yes, sometimes ( )
Yes, very often ( )
You have felt scared or panicky for no very good reason
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Yes, quite a lot ( )
Yes, sometimes ( )
No, not much ( )
No, not at all ( )
Things have been getting on top of you
Yes, most of the time you haven’t been able to cope at all ( )
Yes, sometimes you haven’t been coping as well as usual ( )
No, most of the time you have coped quite well ( )
No, you have been coping as well as ever ( )
You have been so unhappy that you have had difficulty sleeping
Yes, most of the time ( )
Yes, sometimes ( )
Not very often ( )
No, not at all ( )
You have felt sad or miserable
Yes, most of the time ( )
Yes, quite often ( )
Not very often ( )
No, not at all ( )
You have been so unhappy that you have been crying
Yes, most of the time ( )
Yes, quite often ( )
Only occasionally ( )
No, never ( )
The thought of harming yourself has occurred to you
Yes, quite often ( )
Sometimes ( )
Hardly ever ( )
Never ( )
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In your opinion, when can a child:
1. Hear sound ( ) 2. Smile at someone ( ) 3. First see something ( )
4. Say first word ( ) 5. Understand “No” ( ) 6. Walk without support ( )
7. Grab object with thumb and finger ( ) 8. Follow a simple instruction ( )
9. Feel happiness or sadness ( )
What makes a child happy ?
What makes a child unhappy ?
What do you do when your child is unhappy ?
What is the most important thing your child needs ?
Ask the mother to breastfeed the child in front of you
1. The chin is touching the breast ( ) 2. The lower lip is turned outward ( )
3. The mouth is wide open ( ) 4. More areola above than below ( )
5. The child is facing the mother ( )
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