TECHNICAL PROTOCOL FOR SMART NUTRITION SURVEY

Rubkona County, Northern Liech State

SUBMITTED TO: Nutrition Information Working Group (NIWG) STUDY AREA: County, Northern Liech State STUDY PERIOD: 14-24th May 2018 IMPLEMENTING AGENCY: CARE

Table of Contents 1.0 Background information ...... 3 1.1 Introduction ...... 3 1.2 Purpose of the survey ...... 3 1.3 Survey objectives ...... 3 1.4 Specific objectives ...... 4 2.0 Survey timing ...... 4 2.1 Survey area ...... 4 3.0 METHODOLOGY ...... 4 3.1 Study Design ...... 4 3.2 Survey Target Population ...... 4 3.3Sample Size Determination ...... 4 3.3.1SAMPLING PROSEDURE ...... 5 3.3.2 First stage sampling – cluster selection ...... 5 3.3.3. Second stage sampling– Household selection ...... 6 3.3.4 Selection of children ...... 6 3.4 Survey team and training ...... 6 3.5 CASE DEFINITIONS OF THE VARIABLES ...... 6 3.5.1 Anthropometry survey ...... 6 4.0Data quality control ...... 8 4.1 Data entry and analysis...... 8

Table 2: Anthropometry and Mortality Sample Size ...... 5 Table 3: Proposed Survey Timeline ...... 8

Appendix 1: Survey questionnaires ...... 9

1.0 Background information CARE is a subsidiary of CARE International, a leading humanitarian and development agency fighting global poverty around the world. CARE’s operations in South Sudan dates back to the early 1980s, focusing on emergency and disaster relief to the conflict affected populations. Currently, CARE South Sudan works in three States, , Jonglei and Upper Nile States, addressing both humanitarian and recovery/development needs. In development/recovery programming, CARE South Sudan focuses on four broad areas namely governance and sustainable integrated livelihoods (Food security, health and Nutrition, WASH, protection of civilians and peace building) focusing on women and youth.

Rubkona County which was targeted for the Nutrition SMART Survey is made up of ten administrative Payams (Rubkona, Budang, Norlamwel, Ngop, Kaljak, Dhor Bor, Wathjak, , Panhiany and ). It is situated in northern part of South Sudan in the newly created state of Northern Liech. The county's population is estimated at 100,236 according to 2008 Sudan census. However majority of the inhabitants had been displaced across the county with some moving to Bentiu PoCs due to the protracted strife in the area that had started in December 2013. 1.1 Introduction CARE Emergency Nutrition Project Unity State aims to provide 60% of malnourished children and women nutritional therapies and contribute to 10% reduction in Global Acute Malnutrition rate in four counties in Unity State through health facility based Outpatient Therapeutic Program (OTPs) and supplementary feeding programme. One of the Project key activities is to conduct annual nutrition surveys/ assessment in project service delivery locations in order to monitor /determine the general nutritional status among the under-five children, boys and girls, pregnant and lactating mothers.

The Standardized Monitoring and Assessment of Relief and Transition (SMART) survey conducted in May 2017 by CARE in Rubkona County determined a GAM prevalence rate of 17.4% (12.9-23.0 95% CI), and a SAM rate of 3.9% (2.1-7.3 95% C.I). This level of malnutrition was classified as critical according to WHO 2006 classification.

1.2 Purpose of the survey The main purpose of conducting the SMART surveys is to determine the prevalence of acute malnutrition among the population in the survey area in order to allow comparison to prior year surveys. The survey is expected to provide robust data, in line with the recommendations and methodology developed by the national nutrition cluster in South Sudan. The result of the surveys will inform the program progress towards the project outcome as well as form a basis for adjusting the modalities of implementation of nutrition program in the county as will be necessary.

1.3 Survey objectives The overall objective is to determine the prevalence of acute malnutrition among children aged 6 to 59 months, estimate retrospective mortality rate of the population as well as to assess the food security situation and Infant and young children feeding practice (IYCF) in the county. 1.4 Specific objectives • To determine prevalence of Global and Severe Acute Malnutrition (GAM and SAM) among children aged 6 to 59 months in the County. • To determine retrospective crude mortality rates (CMR) and under five mortality rates (U5MR) • To estimate the coverage of measles vaccination (9-59 months), Vitamin A supplementation (6- 59 months) and deworming (12-59 months). • To determine the morbidity and health seeking behaviors in the county. • To determine infant and young child feeding practices • To assess the current household food security situation of the county • To assess the hygiene practices and access to water and sanitation.

2.0 Survey timing The surveys will be conducted from 14– 24th May 2018, inclusive of coordination with authorities, training and data collection.

2.1 Survey area The survey will be carried out in all payams in Rubkona County. The smallest geographical unit (village) in the County will be considered as a cluster. When on the ground if there are areas that are not accessible due to security and population movement/displacements they will be removed from the sampling frame.

3.0 METHODOLOGY

3.1 Study Design A cross-sectional two-stage cluster sampling following SMART methodology will be adopted. The first stage will involve selection of the clusters. The villages will be considered as the smallest geographical unit (clusters) in the host community while in the comp block/zone will be considered as the smallest geographical unit. Household1 will be considered as the basic sampling unit. The second stage will involve selection of households.

3.2 Survey Target Population The target population for this survey will be the children aged 6–59 months for the anthropometric and the health questionnaire, respondents will be the mothers or caregivers of the children. The household heads will be the respondents for individual mortality questionnaires which will include all members of the household. The sampling frame will contain only the list of villages considered secure and accessible. Only selected households will be surveyed.

3.3Sample Size Determination Emergency Nutrition Assessment (ENA) for SMART software updated version 9th July 2015 will be used for sample size calculation. The purpose of the sample calculation is to get a sample having the optimal units so that results are reliable; with reasonable precision. The sample size calculation takes into

consideration the most important indicators: the anthropometry and the mortality. The parameters for the sample size calculation are as outlined in table 1 and 2 below.

Table 1: Anthropometry and Mortality Sample Size Anthropometry Mortality Parameters value value Rationale/source Point prevalence (GAM) 17.4% (12.9-23.0) Estimated prevalence 17.4% 1.1 CARE Rubkona SMART survey result May (%) 2017.

Point prevalence CMR1.1 (0.77-1.6), CARE Rubkona SMART survey result, May 2017.The anticipated acute malnutrition as well as mortality situation is likely to be the same. Desired precision (%) 4.0 0.5 As per SMART guideline Design effect 1.2 1.3 CARE Rubkona May 2017 SMART survey result Recall period in days 95 Ninety five days recall period with possible correction at field during the training. Percent of U5 16.5% CARE Rubkona May 2017 SMART survey children (%) result Average HH size 6.3 6.3 CARE Rubkona May 2017 SMART survey result. Percent of non- 3 3 Anticipated non-response responsive HH (%) 451 children 2518 Sample size 497 HHs people 412 HHs

The sample size of households determined for Anthropometry and Mortality is different. In Mortality 412 households were obtained whereas in Anthropometry it was 497. Therefore, 497 households will be considered in both Anthropometry and Mortality for consistency. Taking in to account travel hours, introduction and household listing, time taken to administer a questionnaire in a household and lunch break, it was estimated that 14 households could be visited by each team per day. Thus, the total number of clusters was determined after dividing the total number of households (497/14) 35.5 rounds to 36 clusters.

3.3.1SAMPLING PROSEDURE

3.3.2 First stage sampling – cluster selection A cross sectional, two‐stage cluster survey will be employed to collect nutritional and mortality data as well as contextual data. The Emergency Nutrition Assessment (ENA) for Standardized Monitoring of Relief and Transitions (SMART), July 9th 2015 version will be used to determine the cluster assignment using the updated village‐level population data. The smallest geographic unit/villages included in the sample frame will be entered into the software with their population numbers. The SMART software then randomly assigned clusters, with the chance of each village being chosen proportional to its population size (PPS) and 36 clusters will be selected. This technique allows every village has the same probability of being selected. In order for a survey to be truly representative, every member of the population must have an equal chance of being chosen.ENA for SMART will also generate reserve clusters that will only be implemented if 10% of clusters cannot be included or 80% of sample size of children is not reached.

3.3.3. Second stage sampling– Household selection The second stage of sampling will be the household selection within the clusters/village. On arrival at the village, the survey team will introduce themselves and the objectives of the survey to the village leader. If the selected village/cluster is big which is more than 100 households then the team will segment the village into smallest sub villages/hamlets. Then the team will select one out of the smallest hamlet/sub villages using a lottery method. By asking the selected village leader, the team will list out all households residing in the village at the date of the survey. Then, using simple random sampling method (SRS) the team will select 14 household from the name listed between 1 and the last number which correspond the listed households. The team will start the survey from any convenient randomly selected household. If the household is missing, the survey team will return back to check for the household later in the day. If the household is still away then the team will consider as absent. No replacement of absent household.

3.3.4 Selection of children The mother of every household who have children 0-59 months will be interviewed. If a child is missing, the survey team will return to the household to check for the child later in the day. If the child is still away then the team will consider as absent. No replacement of absent children.

3.4 Survey team and training Six survey teams each comprising of 1 team leader and 2 enumerators will be involved in the survey.A four days training will be given for enumerators (measurer and assistant measurer), team leaders and supervisors. The first three days of training, the trainees will attend theoretical sessions on basic malnutrition, sampling and demonstration on body measurement, recognition of the signs and symptoms of malnutrition including nutritional bi-lateral oedema and how to fill the questionnaire, interview techniques and standardization test.The standardization test will include at least 10 healthychildren and will take place on the 4th day of the training. A field test will also be performed on a nearby purposively selected non-sampled cluster on the 4th day of the training. On both occasions feedback will be shared and notable gaps addressed sufficiently before proceeding toactual data collection.

3.5 CASE DEFINITIONS OF THE VARIABLES

3.5.1 Anthropometry survey The following data will be collected for all children aged between 6 and 59 months (children between 65 and 110 cm will be included in the survey).

Age: Children 6-59 months from the selected households are eligible for the survey. The team will ask mothers/caregivers to bring birth certificate, baptism certificate, immunization card and other documents to get accurate age of the child. If the child doesn’t have official documents the team will use a local event and seasonal calendar to remind the mothers or caregivers. A height stick can be used for selecting children who are shorter than 110 cm to determine their age and include them in the survey. In case the age of the child cannot be estimated, children measuring between 65 and 110 cm will be included in the survey. However, children who are above six months old but less than 65 cm will also be considered as eligible for the survey.

Weight: Electronics scale (SECA) will be used to take the weight of children 6 to 59 months of age.

Height: A height stick can be used for screening children shorter than 110cm, and for deciding whether the child should be measured standing up or lying down. This should consist of a simple stick measuring exactly 110cm, with a mark at 87 cm and 110 cm against which the child is set standing. Height/length measurements be taken as describe in the assessment guideline and read to the nearest 0.1 cm.

Children less than 24 months will be measured lying down, and children greater than or equal to 24 months will be measured in standing position. Where age cannot be estimated a height will be taken for children greater than or equal to 87.0 cm and length will be taken for those less than 87.0 cm in a lying position.

MUAC: Mid-upper arm circumference measurements will be made using a flexible and non-stretch tape. The MUAC is interpreted as both for graduated and color labeled. Red color (MUAC <115 mm) will be classified as severe and yellow color (MUAC >=115 cm and <125 mm) will be considered as moderately malnourished. While the green color (MUAC >= 125 mm) will be categorized as normal as per WHO classification. MUAC measurement will be taken on the midpoint of the left upper arm. All children in the selected households aged 6-59 months will be measured to the nearest 0.1 cm or 1.0 mm.

Oedema (Nutritional bi-lateral Oedema):to diagnose oedema, normal thumb pressure is applied to the tops of the feet for about three seconds (if you count “one thousand and one, one thousand and two, one thousand and three” in English, pronouncing the words carefully, this takes about three seconds). If there is oedema, an impression remains on both feet for some time (at least a few seconds) where the oedema fluid has been pressed out of the tissue.

Measles immunization: information will be collected from the records on the immunization card and if there is no card mother/caregiver recall will be considered. Mothers/care givers will be interviewed for their children between 9-59 months age. Finally both verbal (mother recall) and cards will be computed separately.

Vitamin A supplementation:When asking a mother about vitamin A supplementation, the team will bring a capsule and show the mother to check whether or not the child has taken vitamin ‘A’ in the past six months prior to the survey date. Mothers/care givers will be interviewed for their children between 6 and 59 months.

De-worming: Information will be collected from the records on the immunization card and if there is no card mothers/caregiver recall will be considered. Mothers/caregiver will be interviewed for their children between 12 and 59 months age.

Retrospective mortality: The number of deaths by age group (below five and above five years) during the recall period will be recorded retrospectively for all visited households. The information that will be collected in each individual household in the recall period may include total household size, total under five children in the household, joined and left in the household and join and left under five children, births and finally deaths for both under five and above five year old. The Mortality information will be collected on an individual level.

Retrospective morbidity:Two-weeks retrospective morbidity data will be collected from mothers/caregivers of all children (6-59 months) included in the anthropometric measurement. The mother/caregiver will be asked whether or not the child had had diarrhea, cough, fever, skin infection and eye infection in the two weeks preceding the survey. The operational definition of diarrhea, fever and cough will be clearly placed at the bottom of the data collection format. The survey teams will be trained about these operational definitions.

Other indicators: Food security and Livelihoods, WASH and IYCF will be collected

4.0Data quality control The high quality of the training coupled with standardization test, practical field exercise (pre-test survey questionnaires) and close supportive supervision, Calibration and use of faultless survey equipment and daily plausibility checks and sharing feedback with the teams every morning before proceeding to the field will ensure the quality of the data collected from the field.

4.1 Data entry and analysis ENA for SMART software will be used to manage and analyze anthropometric and mortality data. Data entry for immunization, Vitamin A supplementation & Morbidity will be entered on EPI Info 3.5.4 version7 and analysis will be done using EPI Info/SPSS.

Table 2: Proposed Survey Timeline Date Activity 14th May 2018 Travel to Rubkona and Planning and discussion with field program staff and relevant government officials 15th -18th May 2018 Four days training for enumerators, team leaders and supervisors 19th -24th Ma2018 Six days data collection 25th -27TH May 2018 Four days data cleaning, analysis and write up preliminary report

Appendix 1: Survey questionnaires Anthropometry

To be conducted in every selected HH with children 6-59 months

Date: _ _ /_ _/_ _ _ _ (dd/mm/yyyy) County: ______Payam: ______Boma: ______Cluster number: ____Team Number______

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Measles Vitami De- Has If yes, type Treatment Sought: Last nit, HHID Child ID Child Sex Date of Age in Weig Heigh MUAC Oedem BCG Vaccinatio n A in wor child of illness 1 = Not sought did the (ensure Full M= male Birth Months ht in t in in mm a scar n the last ming been ill 2 = Hospital child sleep this Name F= (DD/M kg cm (eg (9-59 6 in the 1 = Fever 3 =HF/clinic under the matche female M/YY) (eg (eg 126) N= No N= No months) months last two 2 = 4= Mobile /outreach mosquito s HH 12.4) 87.3) Y= Yes Y= yes N= weeks Diarrhoea clinic net questio Childre 0=Not vac 0= No No (14 3 = Cough 5= Village health care (LLITN) nnaire) To To n 6-59 Please 1= Yes 1= Yes Y= days) 4= Skin worker neares neares months check card card Yes infection 6= Private N= No t t both 2= Yes, 2= Yes, N= No 5= Eye physician/doctor Y= Yes 0.1kg 0.1cm lower Mother mother Y= Yes infection 7= Relative/friends arm Recall recall 6= Blood in 8= Traditional hands 3= DK If no go stool practitioner Ques. 24 7= Measles 9= Bought drug from Childre 8 = Other shop/market n 6-59 (specify) 10= Bought drug from months pharmacy 11= Other (Specify)

Two weeks prior to the survey period, has the child been sick? Diarrhea, Cough, Fever, Malaria, Measles and others...... ▪ Diarrhea (D), any episode of more than 3 stools in 24 hours (it can be bloody or not). ▪ Cough(C), cough or difficulty breathing; ▪ Fever (F), elevated body temperature; ▪ Measles (ML), fever and rash/measles can have red eyes also. ▪ Malaria (MR) High fever with other malaria symptoms ▪ Other (O), other illness two weeks prior to the survey. ** Measles: Has the child been vaccinated against Measles? 0= Not vaccinated. 1= Yes, with card, 2= Yes, with recall ** Vitamin A: Has the child received Vitamin A in the last 6 months? Y= Yes received a capsule, N= No, has not received a capsule. ** BCG: Check the BCG scar on the child upper arm (left/right). If the scar is present, answer “Y”, otherwise answer “N”. Oedema: can be diagnosed by placing a medium pressure (with a thumb) on the forepart of the leg/on the upper side of the foot for three seconds. Other symptoms e.g.skin change, hair loss, irritable weak mood etc. Mortality and household demography

DEMOGRAPHY AND MORTALITY QUESTIONNAIRE(To be administered every household)

Team Number [ ] Date …… Cluster No. [ ] Sector:………………….. Block:……….. HOUSEHOLD2 NO: [ ]

01 02 03 04 05 06 07 08 09 10 Joined on Left on or Born on or Died on or Cause of Location Sex Age or after: after: after: after: death of death No. Name (M/F) (years) (optional) (optional) 15th February 2018 – 20th May 2018 (95) days recall period WRITE ‘Y’ for YES. Leave BLANK if NO. a) List all the household members that are currently living in this household. 1 2 3 4 5 6 7 8 9 10 b) List all the household members that have left this household (out migrants) since the start of the recall period. 1 Y 2 Y 3 Y 4 Y 5 Y c) List all the household members who died since the start of the recall period. 1 Y 2 Y 3 Y

Was anyone in the household pregnant at the start of the recall period? No [ ] Yes [ ] If yes, how many? ______

Location and causes of death

CAUSE OF DEATH LOCATION OF DEATH CODE Disease CODE 1 Unknown 1 In current location 2 Injury/ Traumatic 2 During migration 3 Illness 3 In place of last residence 4 Insecurity/violence 4 Other

2Insert the household definition used in the survey in footnote here. WASH

Date (D/M/Y): …./….…/…..... Cluster No:……… Team No…..… County……..……. Payam:…………….Boma………..……….. Village:…………….. 29 30 31 32 33 34 35 36 HH Ref What is the How long How many When do you usually wash your hands What is done to the What do you Where does the Can you show me No. household's main does it take liters of water (more than one if appropriate - do not water before use to wash household usually where you wash drinking source of to collect HH did the HH use prompt) --- household’s hands? use the toilet (include your hands? water ? water yesterday in ------members drink it? ------more than one if 1: Inside/near ------(including total (excluding 1 = Never ------1 = Nothing necessary)? toilet facility 1=Borehole/hand travel to and water for 2= After defecating 1 =Nothing 2 = Water ------2= Inside/near pump from and washing clothes 3 = Before cooking 2 =Boiling only 1 = Undesignated kitchen/cooking 2= Protected waiting)? and for 4 = Before eating 5 3 =Filtering with a 3 = Water + open area place Shallow well ------animal)? = Before feeding the baby cloth Soap 2 = Designated open 3= Elsewhere in 3= Open shallow 1 = <30 min 6=After cleaning the baby 4=Letting it settle 4 = Water + area yard well 2 = >30min 7=other (specify) 5 =Water treatment Ash 3 = Hole 4= Outside of 4= Protected spring to < 1hr chemicals 5 = other 4 = Latrine yard 5= River /Stream 3 = >1hr to < 6 =Others(Specify) (specify) 5 = Communal 5= No specific 6= HH connection / 2hr latrine 6= Neighbor's place Stand pipe /Tanker 4 = more latrine 7= 6= No permission 7= Dam / Pond then 2 hr Others (Specify) to see 8= Other (specify)

FOOD SECURITY AND LIVELIHOOD QUESTIONNAIRE (continue questioning HH's where you have collected Anthropometry' & Health information) Date (D/M/Y): ……./….…/…..... Cluster No:……… Team No…..… County:……..……..payam:………………Boma………..…….. Village:………....……

HH Resident status Is there Is the HH What was your HHs What did your What was the Did you Does the HH Has your HH What is the main No* of HH: any IDP or head main source of income family eat in the main source of cultivat own any received any shock currently ------returnee male or in the last 30 days? last 7 days? (include food in the past e in the livestock, Humanitarian faced by the HH 1: Permanent currently female? ------0= more than one if 7 days recent herds or farm Assistance in the ------residents, living in ------None necessary) ( Tom to ------last animals? past 3 months? 1 = Insecurity 2: Returnees your 1 = Male 1 = Sale of crops Revise based on the 1 =Own season ------/violence 2 (returned househol 2 = 2 = Sale of livestock standard) production ? -- 0 = No 0 = None = Food too within the last d? Female 3 = Sale of animal ------2 =Work for food ------1 = Yes 1 = GFD expensive 12mths) ------product 1 = Cereals Roots 3 =Gifts from 0 = No 2= School meals /increased price 3: Nomads 0 = No 4= Sale of alcoholic and Tubers neighbors 1 = Yes /feeding 3 = Livestock 4: IDPs (in last 1 = Yes beverages 2 = Legumes/nuts 4 =Market/shop 3=TFP/SFP diseases 12 months) 5 = Sale of fish 3 = Meat purchase 4 = Seeds & 4 = Floods 5: IDPs (1-5yrs) 6 = Sale of natural /Poultry/Offals 5 tools 5 =Human sickness 6: IDPs (5yrs +) resources ( firewood; 5 = Fish & sea foods =Borrowing/debt 5=Fishing kits 7 =Returnee/IDP 7: Refugees (in charcoal; grass) 6 = Milk & Milk s 6 living with HH last 12mths) 7 = Sale of food aid Products =Food aid 8 =Late food 8: Refugees (1- 8 = Casual Labor 7 = Vegetables 7= Hunting distribution 5yrs) 9 = Skilled labor 8 = Fruits 8 = Fishing 9 = Social event 9: Refugees 10 = Salaried work 9 = Eggs 9 = Wild food 10 = Delay of rains (5yrs +) 11 = Petty trading 10 = Oil/ Fats 10= Others 11 = Weeds/ Pest 10: DK 12 = Family support 11 = Sugar & honey 12= Other( specify) 13= Remittance 12 = None 14=others (Specify)

Infant and Young Children Feeding practice (IYCF)

17.5 Describe what did (NAME) eat yesterday during the day or night, whether at home or outside the home since (NAME) woke up yesterday until NAME went to sleep? 11.8 Yesterday, during the day or at night, did [NAME] receive any of the

following liquids? a) Think about when (NAME) first woke up yesterday. Did (NAME) eat anything at that time? If yes: Please tell me everything (NAME) ate at that 17.1 17.2 17.3 17.4 17.5 time. Has How Did In the first Is 17.6. 17.6. 17.6. 17.6. 17.6 17.6.1 17.6.2 17.6.4 17.7 17.7.1 17.7.2 17.7.3 17.7.4 17.7.5 17.7.6 17.8 17.9 18 18.1 [NAME] long you 3 days after (Nam 3 5 6 7 ever after feed delivery - e) How How much Did been birth did this was this still Plain Infant Milk Sour Juice clear Thin Other Cereal legum dairy flesh eggs vitami other much food do you How [NA breastfed you first child child given breas water formul such as milk or Broth Porri water s, es and produc foods n-A fruits liquid do give this many ME] ? put with anything to tfeedi 1= Yes a tinned, or juice 1= dge base flours, nuts ts (meat, rich and you give child to eat times drink (EverBF [NAME colostr drink other ng 0 = No powdere Yogh drinks Yes 1= liqui grains, (Beans (milk, fish, 1= Yes fruits vegeta this child when did anyth ) ] to the um than now? 2= DK 1= Yes d, or urt 1= Yes 0 = Yes ds roots , Peas, yogurt, poultry 0 = No and bles to drink having [chil ing breast? breastmilk? 1= 0 = No fresh 0 = No No 0 = 1= and Lentils cheese and 2 = vegeta (Avoca when diarrhoea d's from 1= Yes 1 = 1 = no Yes 2 = animal 1= 2= DK 2= No Yes tubers , Nuts ) liver/o DK bles do, having compared name a 0 = No 1 = Yes (breastmilk 0 = DK milk Yes DK 2= 0 = and rgan (carrot, Banan diarrhoea to when ] eat bottle 2 =DK Never 0= No only) No 1= Yes 0 = DK No 1= Yes Seeds) 1= Yes meats) red a, compare s/he is solid with BF 2= DK 2 = plain 2= 0 = No No 2= 0 = No 0 = No pepper Appile d to healthy? or anipp water DK 2= DK 2= DK 2 = 1= Yes 2 = 1= Yes , , when ------semi- le 2= 3 = DK DK 0 = No Don’t 0 = No pumpk Grapes s/he is 1= Never solid yeste Immedia Sugar+Wat 2= DK know 2= DK in, , healthy? gave food food rday tely r Ripe Guava, ------2 = Much other or 3 =From 4 = Butter Mango Lemon 1 = less than than last 1-24 hr 5 = es, , Nothing normal liqui night 4= From Caw/Goat papaya Pinapp to drink 3 = ds ? 25-48 hr milk eale, 2 = Much Somewhat yeste 1= 5= After 6= Other 1= Yes Cabba less than less rday Yes 48 hr 7= Do not 0 = No ge, normal 4= About durin 2= rememeber 2 = onions, 3= the same g the No DK tomato Somewh 5= More day 3= es, etc at less than usual or at Don't 4 = 6= Stopped night know 1= Yes About food ? 0 = No the same 7 = Not 2 = 5= More been sick DK than 8 = Do not usual know / (num 6.= Not remember ber been sick of 7 =DK times )