MODULE 4C: DIARRHEA

(7 DEC 2005 DRAFT)

Rapid Knowledge, Practices and Coverage (KPC) Survey

MODULE 4C: DIARRHEA
INTERVIEWER INSTRUCTIONS
ORGANIZATION OF THIS MODULE
The Diarrhea Module consists of 14 questions. The first 10 questions pertain to diarrhea case management. The remaining questions are
divided into two sub-modules, which provide information on 1) the mothers ability to prepare oral rehydration solution (ORS) and 2)
diarrhea prevention via hand washing. Question 3 of sub-module B is highlighted to indicate that it also appears in the KPC2000 Rapid
CATCH.
ASKING QUESTIONS AND RECORDING ANSWERS
In this module, most of the information that you will record is based upon answers directly provided by the mother. Two exceptions are
Question 1 in sub-module A, which assesses the mothers ability to prepare ORS, and Question 2 in sub-module B, which assesses the
quality of the households designated hand-washing facility. For these questions, you will make observations then circle the appropriate
responses on the questionnaire.
For all other questions, you will ask the mother for information about her child. It is very important that you ask each question exactly as it
is written on the questionnaire. In addition to the questions, there are statements that appear in all capital letters, indicating that they are
interviewer instructions and should not be read aloud to the mother.
Most questions in this module have precoded responses. It is important that you do not read these choices aloud to the mother. When
you ask a question, you should listen to the mothers response then circle the code next to the category that best matches her answer.
For some questions, an OTHER code is included in the list of precoded responses. If the mother provides an answer that does not fit into
any of the precoded categories, circle the OTHER code and write the mothers answer in the blank space provided.
FILLING IN IDENTIFICATION INFORMATION
Before you begin asking the mother questions, record the cluster, household, and record numbers at the top of the questionnaire. This is
the same information that you recorded on the cover page of the survey. In addition, record the childs age and sex in the second set of
boxes.
Q.1: DIARRHEA IN LAST TWO WEEKS
Diarrhea is common among children in many countries and can have serious effects on a childs health and nutritional status. A response
of YES to Question 1 is appropriate only if the child had diarrhea during the two weeks before the date of the interview. If the mother is
unsure what you mean by diarrhea, tell her that it means three or more watery stools on the same day, or blood in the stool. If the child
did not experience diarrhea in the last two weeks, do not ask the other questions in this section.
Q.2: TREATMENT OF DIARRHEA
This question asks the mother about the type of treatment her child received for diarrhea. The treatment may have been given by anyone,
not just the mother. Record all answers.
If (NAME) did not receive treatment, circle A (NOTHING). Fluid from ORS packet is a special treatment that consists of combining a
small packet of powder with water. The packets are usually available through health facilities, pharmacies, and field workers. Only circle
C (home-made fluid) if the mother reports a government-recommended home-made fluid, which may be a cereal-based mixture or it may
be made from sugar, salt, and water.
Q.3 and 4: FLUID INTAKE DURING THE DIARRHEAL EPISODE
Q.5: FOOD INTAKE DURING THE DIARRHEAL EPISODE
Mothers may change the amount of fluids or foods given to a child who has diarrhea. For Questions 3, 4, and 5 read the entire question
before accepting a response. Broths and clear soups are considered as liquids.
Qs.6, 7, 8, 9 and 10: ADVICE, TREATMENT, AND DECISION-MAKING FOR DIARRHEA
Question 6 asks if advice or treatment was sought for (NAMEs) diarrhea. If the mother answers YES, record the place where she sought
advice or treatment in Questions 7 and 9. If the mother sought advice or treatment from more than one source, circle the correct code for
each facility or person mentioned. Note that the response codes are letters instead of number to remind you that more than one response
is possible. In Question 8, we want to know if the respondent, by herself, can make the decision to take a seriously ill child for medical
treatment. If a respondent says I can but only when my husband is at work. If he is at home I must ask him first, then circle B for
HUSBAND/PARTNER.

KPC2000 SURVEY FOR PVO CHILD SURVIVAL

REVISED BY CHILD SURVIVAL TECHNICAL SUPPORT PROJECT (CSTS) AND CORE M&E WORKING GROUP

MODULE 4C: DIARRHEA

(7 DEC 2005 DRAFT)

SUB-MODULE A, Q.1: ORS PREPARATION

Mothers may have heard of ORS and may even use it during a childs diarrheal episode; however, they may not know the correct way to
prepare the solution. In this question, you will ask the mother to describe how she would prepare ORS.
You will then record whether the mother described ORS preparation correctly or incorrectly. Correct preparation involves the following:
a) combining the ORS packet with 1 liter (= 3 soda bottles) of clean drinking water
b) using the entire packet
c) dissolving the powder fully in the water.
If the mother does not do one or more of the above, circle 2 [INCORRECTLY] on the questionnaire.
SUB-MODULE B, Q.1: HOUSEHOLD HAND-WASHING FACILITY
Hand-washing practices are an indicator of cleanliness. Washing hands, especially before handling food, can protect persons from
various diseases such as diarrhea. In Question 1, ask the mother if the household has a special place where household members wash
their hands.
SUB-MODULE B, Q.2: QUALITY OF HOUSEHOLD HAND-WASHING FACILITY
If the mother reports that there is a special hand-washing facility, ask to see it and observe whether the following are present: A)
water/tap; B) soap, ash, or other cleansing agent; C) basin. For each item, circle 1 if it is present and 2 if it is absent.
SUB-MODULE B, Q.3: MOTHERS HAND-WASHING PRACTICES
Question 3 is asked of all mothers, even if the household does not have a hand-washing facility. Circle all answers mentioned. Once
again, letter codes are used to remind you that more than one response is accepted. This question also appears in the Rapid CATCH.
SKIP PATTERNS FOR DIARRHEA MODULE
It is very important that you ask the mother only those questions that are relevant to her childs situation. For example, a mother whose
child did not have diarrhea in the last two weeks should not be asked questions about fluid intake during a diarrheal episode. For certain
questions, you are instructed to skip to the next appropriate question if the mother gives a particular response. Skip instructions are
located in the far right-hand column of the questionnaire. The following list summarizes all skip patterns within the Diarrhea Module.
Question
DIARRHEA
TREATMENT

DIARRHEA
PREVENTION

Response

Instructions

Q.1. "Has (NAME) had diarrhea in the yes (1)

last two weeks?"
no (2); don't know (8)

Go to Q.2
END MODULE

Q.6. "Did you seek advice or

treatment from someone outside of
the home for (NAMES) diarrhea?

yes (1)
no (2)

Go to Q.7
END MODULE

Q.1. Does your household have a

special place for hand washing?

yes (1)
no (2)

Go to Q.2
SKIP TO Q.3

SUGGESTED QUALITATIVE RESEARCH QUESTIONS

Certain topics are better explored using qualitative research techniques rather than closed-ended questions. It is suggested that answers
to the following questions be obtained from key informants or focus group discussions:

How do children in this community get diarrhea?

What can a person do to avoid getting diarrhea?
What are some of the signs and symptoms of a child who has diarrhea?
What do mothers usually do when their children have diarrhea?
If your child had diarrhea, how would you know if the situation was serious enough to seek help or advice?
If your child had diarrhea, where would you go for advice on how to treat the diarrhea?
What is the purpose of ORS?

The qualitative research component will yield important information on community knowledge, beliefs, and normative practices related to
diarrhea. As a formative research technique, findings from focus group discussions could be used to modify the questionnaire to reflect
local terms, concepts, and customs. In addition, upon completion of the KPC study, there may be additional areas that need to be
explored. Thus, qualitative methods can be employed once again to provide explanations for phenomena that were identified but not
sufficiently explained by the KPC.

KPC2000 SURVEY FOR PVO CHILD SURVIVAL

REVISED BY CHILD SURVIVAL TECHNICAL SUPPORT PROJECT (CSTS) AND CORE M&E WORKING GROUP

MODULE 4C: DIARRHEA

(7 DEC 2005 DRAFT)

KPC2000 SURVEY FOR PVO CHILD SURVIVAL

REVISED BY CHILD SURVIVAL TECHNICAL SUPPORT PROJECT (CSTS) AND CORE M&E WORKING GROUP

IDENTIFICATION
CLUSTER NUMBER....................................................................................................................................
HOUSEHOLD NUMBER..............................................................................................................................
RECORD NUMBER......................................................................................................................................

AGE OF CHILD (IN MONTHS)..........................................................................................................................................

SEX OF CHILD (1=MALE, 2=FEMALE)......................................................................................................................................

DIARRHEA CASE MANAGEMENT

NO.

QUESTIONS AND FILTERS

CODING CATEGORIES

SKIP

|END

Has (NAME) had diarrhea in the last 2 weeks? 1

YES............................................................1
NO..............................................................2
DONT KNOW............................................8

What was given to treat the diarrhea? 2

NOTHING..................................................A
FLUID FROM ORS PACKET.....................B
HOME-MADE FLUID.................................C
PILL OR SYRUP, ZINC.....
..D
PILL OR SYRUP, NOT ZINC......................E
INJECTION................................................F
(IV) INTRAVENOUS..................................G
HOME REMEDIES/
HERBAL MEDICINES...........................H

Anything else?
If answer pill or syrup, show local packaging for zinc and ask if the child
received this medicine
RECORD ALL MENTIONED.

OTHER__________________________ X
(SPECIFY)
3

When (NAME) had diarrhea, did you breastfeed him/her less than usual,
about the same amount, or more than usual?

LESS..........................................................1
SAME.........................................................2
MORE........................................................3
CHILD NOT BREASTFED.........................4
DONT KNOW............................................8

When (NAME) had diarrhea, was he/she offered less than usual to drink,
about the same amount, or more than usual to drink?

LESS..........................................................1
SAME.........................................................2
MORE........................................................3
NOTHING TO DRINK................................4
DONT KNOW............................................8

Was (NAME) offered less than usual to eat, about the same amount, or
more than usual to eat?

LESS..........................................................1
SAME.........................................................2
MORE........................................................3
NOTHING TO EAT.....................................4
DONT KNOW............................................8

Did you seek advice or treatment from someone outside of the home for
(NAMES) diarrhea?

YES............................................................1
NO..............................................................2

Where did you first go for advice or treatment? 3

HEALTH FACILITY
HOSPITAL............................................01
HEALTH CENTER................................02
HEALTH POST.....................................03
PVO CENTER......................................04
CLINIC..................................................05

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE

EN
D

NO.

QUESTIONS AND FILTERS

THE NAME OF THE PLACE.
_______________________________________________________
(NAME OF PLACE)

CODING CATEGORIES

SKIP

FIELD/COMMUNITY HEALTH
WORKER.........................................06
OTHER HEALTH
FACILITY____________________ 07
(SPECIFY)
OTHER SOURCE
TRADITIONAL PRACTITIONER...........08
SHOP....................................................09
PHARMACY..........................................10
COMMUNITY DISTRIBUTORS.............11
FRIEND/RELATIVE..............................12
OTHER_________________________
(SPECIFY)

Who decided that you should go there for (NAMES) illness?

RECORD ALL MENTIONED.

88

RESPONDENT..........................................A
HUSBAND/PARTNER...............................B
RESPONDENTS MOTHER......................C
MOTHER-IN-LAW.....................................D
FRIENDS/NEIGHBORS............................E
OTHER _________________________ X
(SPECIFY)

Where did you go next for advice or treatment? 4

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE

THE NAME OF THE PLACE.
_______________________________________________________
(NAME OF PLACE)

HEALTH FACILITY
HOSPITAL............................................01
HEALTH CENTER................................02
HEALTH POST.....................................03
PVO CENTER......................................04
CLINIC..................................................05
FIELD/COMMUNITY HEALTH
WORKER.........................................06
OTHER HEALTH
FACILITY____________________ 07
(SPECIFY)
OTHER SOURCE
TRADITIONAL PRACTITIONER...........08
SHOP....................................................09
PHARMACY..........................................10
COMMUNITY DISTRIBUTORS.............11
FRIEND/RELATIVE..............................12
OTHER_________________________
(SPECIFY)

10

During the period when (NAME) was recovering from diarrhea, did you
give him/her less than usual to drink, about the same amount, or more
than usual to drink?

88

LESS..........................................................1
SAME.........................................................2
MORE........................................................3
NOTHING TO DRINK................................4
DONT KNOW............................................8

The term(s) used for diarrhea should encompass the expressions used for all forms of diarrhea, including bloody stools
(consistent with dysentery), watery stools, etc.
The response categories should be adapted to include the terms used locally for the recommended home fluid. The ingredients
promoted by the National Control of Diarrheal Diseases Program or by the Ministry of Health for making the
recommended home
fluid should be reflected in the categories.
3
PVOs are encouraged to modify response categories as necessary. However, the broad categories should be maintained.
2

SUB-MODULE A: OPTIONAL QUESTION ON ORS PREPARATION

NO.
1

QUESTIONS AND FILTERS

CODING CATEGORIES

Have you heard of ORS?

IF YES, ASK MOTHER TO DESCRIBE ORS PREPARATION FOR
YOU.
IF NO, CIRCLE 3 (NEVER HEARD OF ORS).
ONCE MOTHER HAS PROVIDED A DESCRIPTION, RECORD
WHETHER SHE DESCRIBED ORS PREPARATION CORRECTLY OR
INCORRECTLY.

DESCRIBED CORRECTLY.......................1
DESCRIBED INCORRECTLY....................2
NEVER HEARD OF ORS..........................3

SKIP

NO.

QUESTIONS AND FILTERS

CODING CATEGORIES

SKIP

CIRCLE 1 [CORRECTLY] IF THE MOTHER MENTIONED THE

FOLLOWING:

USE 1 LITER OF CLEAN DRINKING WATER (1 LITER=3

SODA BOTTLES)

USE THE ENTIRE PACKET

DISSOLVE THE POWDER FULLY

SUB-MODULE B: OPTIONAL MODULE ON PREVENTIVE BEHAVIORS FOR DIARRHEA

NO.
1
2

QUESTIONS AND FILTERS

Does your household have a special place for hand washing?
ASK TO SEE THE PLACE USED MOST OFTEN FOR HAND
WASHING AND OBSERVE IF EACH OF THE FOLLOWING ITEMS
ARE PRESENT

When do you usually wash your hands with soap/ash?

RECORD ALL MENTIONED.

CODING CATEGORIES

SKIP

YES............................................................1
NO..............................................................2
YES

NO

(A) WATER/TAP............................1

(B) SOAP, ASH, OR OTHER

CLEANSING AGENT.....................1

BASIN.........................................1

NEVER......................................................A
BEFORE FOOD PREPARATION..............B
BEFORE FEEDING CHILDREN................C
AFTER DEFECATION...............................D
AFTER ATTENDING TO A CHILD
WHO HAS DEFECATED..........................E
OTHER__________________________ X
(SPECIFY)

Note: The questions in sub-module B also appear in the Water and Sanitation Module (Module
1A)

TABULATION PLAN
This module is designed to find out about treatment and the changes in dietary intake during a recent diarrheal episode. The module is
not intended to yield a prevalence estimate of diarrhea in children. Table 4C-1 presents indicators that can be derived from the Diarrhea
Module.
TABLE 4C-1: DIARRHEA INDICATORS

INDICATOR

DESCRIPTION/DEFINITION

ORT Use
During a
Diarrheal
Episode

Percent of children aged 0-23 months with diarrhea in the last two weeks who received oral
rehydration solution (ORS) and/or recommended home fluids (RHF)

Increased
Fluid Intake
During a
Diarrheal
Episode

Percent of children aged 0-23 months with diarrhea in the last two weeks who were offered
more fluids during the illness

Increased
Food Intake
During a
Diarrheal
Episode

Percent of children aged 0-23 months with diarrhea in the last two weeks who were offered
the same amount or more food during the illness

Zinc
Treatment for
Diarrhea

No. of children with responses B or C for Q.2

_____________________________________
No. of children with responses to Q.2

No. of children with response= 3 for Q.3 or Q.4

_____________________________________
No. of children with response=1 for Q.1

No. of children with response=2 or 3 for Q.5

_____________________________________
No. of children with responses=1 for Q.1

100

100

100

Proportion of children aged 0-23 months with diarrhea in the last two weeks who were treated
with zinc supplements
No. of children with response=D for Q.2
_____________________________________
x 100
No. of children aged 2-23 months with responses=1 for Q.1

Care-seeking
for Diarrhea

Percent of children aged 0-23 months with diarrhea in the last two weeks whose mothers
sought outside advice or treatment for the illness
No. of children with response= 1 for Q.6
_________________________________
No. of children with responses to Q.6

100

Maternal
Competency
in ORS
Preparation

Percent of mothers who can correctly prepare ORS

Presence of
Household
Handwashing
Facility

Percent of households with a designated hand-washing facility

Presence of
Soap at
Handwashing
Facility

Percent of households with a designated hand-washing facility that has soap or other
cleansing agent present

Maternal
Hand
Washing
Before Food
Preparation

Percent of mothers who usually wash their hands with soap or ash before food preparation,
before feeding children, after defecation, and after attending to a child who has defecated

No. of mothers with response= 1 for Q.1, sub-module A

______________________________________________
Total no. of mothers with responses to Q.1, sub-module A

No. of mothers with response= 1 for Q.1, sub-module B

_____________________________________________
Total no. of mothers with responses to Q.1, sub-module B

No. of mothers with response= 1 for Q.2B, sub-module B

_____________________________________________
Total no. of mothers with responses to Q.2, sub-module B

100

100

100

No. of mothers with responses B through E for Q.3, sub-module B

______________________________________________ x
100
Total no. of mothers with responses to Q.3, sub-module B

Data from the KPC may be tabulated either manually or by computer. Below is an example of a manual (hand) tabulation table for Q.2.
For each child, a check mark () would be placed in the row of the category that matches his/her mothers response. The frequency
column indicates the number of children with a particular response (i.e., total number of check marks in a specific row), whereas the

percent column is the number of children with that response divided by the total number of children for whom the question was asked.
TABLE 4C-2: EXAMPLE OF HAND TABULATION TABLE FOR Q.2
(What was given to treat the diarrhea?)
CODE

CATEGORY

CHECK MARKS ()

NOTHING

ORS

HOME-MADE FLUID

PILL/SYRUP, ZINC

PILL/SYRUP, NOT
ZINC

INJECTION

IV

HOME REMEDIES

OTHER

FREQUENCY

TOTAL NUMBER OF CHILDREN WITH ANSWERS TO Q.2

PERCENT

100.0

OVERALL FINDING BASED ON THIS TABULATION:

In the above table, it is possible that the total number of responses will exceed the total number of children in the sample. This is due to
the fact that the child may have received more than one type of treatment for his/her diarrhea. Since the rationale for asking Q.2 is to
identify children with diarrhea who received ORT (i.e, oral rehydration solution or recommended home fluids), the data could be
reorganized as follows:
TABLE 4C-3: CROSS TABULATION TABLE FOR DIARRHEA IN THE LAST TWO WEEKS
AND WHETHER THE CHILD RECEIVED ORAL REHYDRATION THERAPY (ORT)
DID (NAME)
RECEIVE ORT (ORS
and/or RHF)?

CHECK MARKS ()

FREQUENCY

PERCENT

yes
no
TOTAL NUMBER OF CHILDREN WITH ANSWERS TO Q.2

100.0

OVERALL FINDING BASED ON THIS TABULATION:

In reorganizing the data in the above fashion, one may derive the ORT use indicator (as defined in Table 4C-1) directly from Table 4C-3.
The indicator is simply the percentage of children who fall into the YES category. In order to cross tabulate a question with childs age,
place questionnaires in different piles or folders according to the childs age group. Separate tabulation tables can then be calculated for
each age group. This process can be performed for a number of socio-demographic and behavioral variables.
====================================================================================================
REFERENCES FOR DIARRHEA-RELATED SURVEYS
Listed below are other surveys with questions, sections or modules on diarrhea prevention/care that may be of assistance when modifying
the KPC to meet the needs of your particular project.
(1) CARE (1999). Rapid Impact Evaluation Survey (Diarrhea Survey).
(2) Christian Childrens Fund-Angola (1999). KPC Questionnaire (Qs. PG07-PG12); Focus Group Questionnaire.
(3) ORC Macro (2000). MEASURE DHS+ Model A Questionnaire for High Contraceptive Prevalence Countries (Questions 475-483).
(4) UNICEF (1995). Multiple Indicator Cluster Survey (Care of Illness Module).