Assessing the Availability and Utilization of Nutrition Interventions for Preventing Childhood Malnutrition
Targets parents and guardians. Data is routed directly to the Caregiver Response Sheet via Google Forms.
For offline data collection (Arial 14/12)
Targets Health Facility Workers. Data is routed directly to the Staff Response Sheet via Google Forms.
For offline data collection (Arial 14/12)
Institution: Ngwerere Rural Health Centre
Investigator: Martin Ndoma (BSPH22215254)
Date: ____________________ Interviewer ID: ____________________
1. Age of caregiver (years):
18-24 25-34 35-44 45+
2. Sex of caregiver:
Male Female
3. Relationship to the child:
Other:
4. Level of education:
No formal education Primary Secondary Tertiary Other
5. Occupation:
Farmer Trader Employed (Formal) Unemployed Other
6. Monthly household income (ZMW):
< 1,000 1,000-2,999 3,000-4,999 5,000-10,000 20,000+
7. Number of children under 5 in household:
8. Which services have you ever received? (Tick all that apply)
Immunization RUTF (Plumpy Nut) Vitamin A Nutrition Counselling Growth Monitoring
9. How would you rate availability of services? (1=Never available, 5=Always available):
| Service Category | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|
| Growth Monitoring (Weight and Height) | |||||
| Nutrition Counselling | |||||
| Micronutrient Supplements (Vitamin A) | |||||
| Ready-to-Use Therapeutic Food (RUTF) |
10. Are these services provided free of charge? Yes No
11. How often do you bring your child for growth monitoring?
Monthly Every 2-3 months Yearly Only when the child is sick
12. Have you received nutrition education or counseling? Yes No
13. Do you follow feeding recommendations provided? Always Sometimes Rarely
14. What barriers prevent you from using services regularly? (Tick all apply):
Long distance to facility
Lack of transport money
Long waiting times
Negative staff attitude
Supply shortages (e.g. no RUTF)
Cultural/Religious beliefs
15. How would you rate the quality of service received?
Excellent Good Fair Poor
16. Has your child ever been diagnosed with malnutrition? Yes No
17. If yes, what was the diagnosis?
Underweight Stunting Wasting (Acute Malnutrition)
18. Is your child currently on RUTF (Plumpy Nut)? Yes No
19. Age of child (in Months):
20. What has your child received in the past 6 months? (Tick all apply):
Vitamin A Deworming Nutrition Advice Food Supplements
Location: Ngwerere Rural Health Centre
Principal Investigator: Martin Ndoma (BSPH22215254)
Date: ____________________ Interviewer ID: ____________________
21. Your current role at this facility:
22. How long have you worked at this facility?
< 1 year 1–3 years 4–6 years 7+ years
23. Have you received formal training in child nutrition services? Yes No
24. Rate availability of the following supplies (1=Never, 5=Always):
| Supply Item | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|
| Vitamin A Capsules | |||||
| Iron / Folic Acid Supplements | |||||
| Ready-to-Use Food (RUTF) | |||||
| MUAC Tapes | |||||
| Weighing Scales & Height Boards | |||||
| Growth Monitoring Charts (Under 5) |
25. How often does this facility experience stock-outs of essential nutrition supplies?
Never Rarely Sometimes Often Very often
26. Are there enough staff trained to provide nutrition services? Yes No
Thank you for contributing to this research.
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