CM1 At any time in the last two weeks, has YES 1 (NAME) had an illness with a cough? NO 2 select other child select 98 DON’T KNOW other child CM2 When (NAME) had an illness with a YES 1 cough, did he/she breathe faster than NO 2 select usual with short, rapid breaths or have other child difficulty breathing? select 98 DON’T KNOW other child CM3 Was the fast or difficult breathing due to PROBLEM IN CHEST a problem in the chest or a blocked or ONLY………………………….1 select runny nose? BLOCKED OR RUNNY NOSE other ONLY………………2 child select other child OTHER (SPECIFY) select other child 98 DON’T KNOW CM4 Did you seek any advice or treatment for YES 1 the illness from any source? NO 2 CM7 98 CM7 DON’T KNOW CM5 How many days after the cough and fast breathing began did you first seek treatment for (NAME)? DAYS PROBE FOR EXACT NUMBER OF 98 DON’T KNOW DAYS AND RECORD IN THE BOX. IF SAME DAY THEN RECORD 00
CM1 At any time in the last two weeks, has (NAME) had an illness with a cough? YES 1 NO 2 DON’T KNOW 98 select other child select other child CM2 When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing? YES 1 NO 2 DON’T KNOW 98 select other child select other child CM3 Was the fast or difficult breathing due to a problem in the chest or a blocked or runny nose? PROBLEM IN CHEST ONLY………………………….1 BLOCKED OR RUNNY NOSE ONLY………………2 OTHER (SPECIFY) DON’T KNOW 98 select other child select other child select other child CM4 Did you seek any advice or treatment for the illness from any source? YES 1 NO 2 DON’T KNOW 98 CM7 CM7 CM5 How many days after the cough and fast breathing began did you first seek treatment for (NAME)? PROBE FOR EXACT NUMBER OF DAYS AND RECORD IN THE BOX. IF SAME DAY THEN RECORD 00 DAYS DON’T KNOW 98