1
Scaling Up Early Childhood Development 
in Zambia
Right to Care Zambia
Final Endline Assessment Report
[Contract/Agreement] Number: 72061119FA00001
Sponsoring USAID office: Health Office 
Development objective: Health Office Development Objective 3
Milestone Number: 29
Milestone Due: December 31st, 2021
 
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Table of Contents
1. Executive Summary 5
Introduction 5
Outcome Evaluation Objectives 5
Evaluation Design & Methods 5
Results & Conclusions 6
2. Introduction 7
3. Intervention Description 8
a. Community-based Parenting Groups 8
b. Zambian Folklore Children’s Book 9
c. Logic Model 9
4. Evaluation questions 11
a. Outcome Evaluation Questions 11
5. Evaluation Design & Methods 12
a. Overall Study Design 12
b. Study Sites 12
c. Endline Data Collection Methods 13
d. Cluster Eligibility and Randomization to Study Arm 14
e. Eligibility Criteria 15
f. Sampling Methods 15
g. Data Collection, Management, and Storage 15
h. Sample Size 16
i. Measures 16
j. Data Analysis 17
k. Study Approvals and Permission 18
6. Findings for objective 1 19
a. Study Profile & Sample Characteristics 19
b. Evaluation Questions 1 & 2 24
c. Evaluation Question 3 26
7. Findings for objective 2 30
a. IDELA Sample Characteristics 30
b. Evaluation Question 4 31
c. Evaluation Question 5 32
8. Discussion 34
a. Key Findings for Objective 1: To assess the outcomes and effects of the intervention on early 
childhood development outcomes (as assessed through the index children) 34
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b. Key Findings for Objective 2: To describe and document the degree to which the 
Government-supported Zambian Folklore Children’s Book affects child development (as assessed 
through the older siblings) 35
9. Conclusion 36
10. References 36
11. Annexes 38
a. Endline Household Survey Instrument 38
b. Endline In-Depth Interview Instrument 38
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List of Abbreviations
CBPG Community-Based Parenting Group
CREDI Caregiver Reported Early Childhood Development Instrument
BUSPH Boston University School of Public Health
BU IRB Boston University Institutional Review Board
DHS Demographic Health Survey
ECD Early Childhood Development
GCC Grand Challenges Canada
HFCA Health Facility Catchment Areas
IDI In-Depth Interview
NHRA National Health Research Authority
RHC Rural Health Centre
RTC-Z Right to Care-Zambia
SMAGs Safe Motherhood Action Groups
SUpErCDZ Scaling Up Early Childhood Development in Zambia
UNZABREC University of Zambia Biomedical Research Ethics Committee
USAID United States Agency for International Development
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1. EXECUTIVE SUMMARY
Introduction
Poor nutrition, delays in treatment of acute infections, untreated chronic infections, and lack of 
stimulating activity during childhood contribute to deficits in Early Childhood Development (ECD), 
including deficits in fine motor, verbal, and math skills. Early childhood interventions are critical to offset 
the negative impacts of early adversity and to ensure children can reach their developmental potential. 
Teaching parents play-based activities to stimulate children and providing nutrition supplements for 
children have been shown to improve physical growth and cognitive and motor development and 
delivering these interventions as a joint package holds great promise. Community-based Parenting Groups 
(CBPG) have shown beneficial impacts in some settings, and may be an effective, low-cost platform for 
delivering interventions to improve ECD at scale.
Through the Scaling Up Early Childhood Development in Zambia (SUpErCDZ) project, Right to Care Zambia 
(RTC-Z) in partnership with Boston University School of Public Health (BUSPH) and the Swiss Tropical and 
Public Health Institute (Swiss TPHI) delivered a previously piloted ECD curriculum through a CBPG 
intervention at scale in rural Zambia. The CBPG curriculum was designed to be theatre- and interaction￾based with lessons on nutrition, stimulation, play, cognitive development, and child illness appropriate to
the age range of the children in each group. Groups were run within rural villages, facilitated by selected 
group participants, and supervised by community health volunteers.
Additionally, RTC-Z distributed the Zambian Folklore Children’s Book targeted at increasing pre-grade 
reading comprehension and school readiness in rural Zambia. The Zambian Folklore Children’s Book 
contains 22 Zambian folklore stories with culturally relevant illustrations and an annex designed to support 
the reader, offering creative ideas to better engage and interact with the child while reading.
Through a nested, cluster-randomized controlled design, an outcome evaluation was conducted to 
determine the effects of the CBPG and Zambian Folklore Children’s Book interventions on the physical, 
cognitive, and motor development of young children, as well as the emergent literacy of slightly older 
children, for each intervention separately and when combined.
Outcome Evaluation Objectives
The aims of this study were:
Objective 1: To assess the outcomes and effects of the intervention on early childhood development 
outcomes (as assessed through the index children)
Objective 2: To describe and document the degree to which the Government-supported Zambian 
Folklore Children’s Book affects child development (as assessed through the older siblings)
Evaluation Design & Methods
To estimate the effect of the parenting groups on key indicators of child development, we conducted a 
prospective longitudinal study using a cluster-randomized controlled design, with clustering and 
randomization at the health facility zonal level. We collected data at pre- and post-intervention 
timepoints. The intervention was implemented in 10 health facilities catchment areas (HFCAs) that had 
6
previously received a maternity waiting home intervention in Southern and Eastern Provinces Zambia.
Seventy-five zonal clusters were randomized to the parenting group treatment and control arms using a 
co-variate constrained randomization process to ensure balance in the characteristics of the zones and 
populations. A second covariate-constrained randomization process was run to sub-randomize each zonal 
cluster into the book treatment and control study arms. Within the 75 study zones, villages were randomly 
selected for inclusion in the study with probability for inclusion in the study proportionate to population 
size. Eligible households (with children 0-5 months of age at baseline) were approached in random order 
for participation in the study until village targets were met.
Baseline and endline tools assessed sample characteristics, child physical growth (index and older siblings), 
child development (index and older siblings), caregiver-child interactions, child health and nutrition, 
caregiver mental health and social support. 
We estimated the impact of the intervention on the primary outcomes of interest using an intention-to￾treat approach. The primary independent variable of interest is assignment to the intervention. We 
measured impact on two primary outcomes: 1) Child linear growth (height-for-age z-scores and stunting); 
and 2) Malawi Development Assessment Tool z-scores overall and for each sub-domain: gross motor, fine 
motor and performance, language and hearing, and social. For older children in the households, 
International Development and Early Learning Assessment (IDELA) tool z-scores were calculated overall 
and for each sub-domain: motor, literacy, numeracy, and social emotional.
Results & Conclusions
We observed no differences in characteristics of the households, caregivers, or index children between 
control and treatment groups. A final sample of 934 index children was reached at endline, (515 and 419 
intervention and control respectively). Though the evaluation showed that the intervention had no 
significant impact on the odds of stunting (aOR 1.37 [95% CI 0.94 to 1.98]; p=0.102) nor on height-for-age 
z-scores (β = -0.99 [95% CI -0.27, 0.09]; p=0.326), the intervention had significant positive effects in all 
intermediary and many secondary outcomes for the index child including caregiver-child interactions (β = 
-0.59 [95% CI 0.26 to 0.91]; p=<0.001), on child diet diversity (β = -0.25 [95% CI 0.05 to 0.44]; p=<0.012) 
and on caregiver mental health. 
Among the older siblings, 852 (383 and 469 book treatment and control respectively) were sampled at 
endline data collection. Analysis showed a modest impact of the Zambian Folktales Children’s Book on the 
overall IDELA z-scores (β = 0.11 [95% CI -0.01 to 0.23]; p=<0.061) of older children and on their social￾emotional z-scores (β = 0.11 [95% CI 0.00 to 0.23]; p=<0.053) after controlling for child age, child sex, 
caregiver age, and household wealth. There was no significant impact on motor, literacy, or numeracy 
domains of the IDELA, though results are positive and trending toward significance.
The CBPG intervention had a positive spillover effect on older sibling IDELA scores (β = 0.12 [95% CI 0.01 
to 0.24]; p=<0.039). Most notably, older siblings in the CBPG treatment group had improved numeracy (β 
= 0.13 [95% CI 0.02 to 0.25]; p=<0.022) compared to the control group.
Additional analysis of endline data could further explain these results.
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2. INTRODUCTION
Poor nutrition, delays in treatment of acute infections, untreated chronic infections, and lack of 
stimulating activity during childhood contribute to deficits in Early Childhood Development (ECD), 
including deficits in fine motor, verbal, and math skills1
. According to the latest estimates, 249 million 
(43%) children in low- and middle-income countries are at risk of poor development today1
, and 37% of 
children aged 3 to 4 years have deficits in cognitive or social-emotional development2
. Besides the near￾term negative impact of these deficits on child development, there is increasing recognition that health 
and nutrition during the earliest years of life are key determinants of later life outcomes, including success 
in academic and job performance3
. 
Impaired child development, in terms of both cognition and linear growth, continues to limit the capacity 
of Zambian children to reach their full developmental potential. Nationwide, 35% children under age 5 are 
stunted (range, 29-46% by province; 29% in Southern Province and 34% in Eastern Province)1
and 17% are 
severely stunted (14% in Southern Province and 17% in Eastern Province)4
. In addition to a high burden of 
stunting and other forms of malnutrition (e.g., vitamin A and zinc deficiency), access to early education is 
limited in Zambia with only 32% children receiving early childhood care by age 62
. There are ongoing 
efforts to address the country’s burden of malnutrition, most notably through the Scaling Up Nutrition 
funding mechanism5
. Moreover, several ongoing efforts are underway to increase access to early 
childhood care and education. However, none of these are being done at scale, and, besides the 
intervention package developed for this project, no programs have been rigorously tested or evaluated. 
Early childhood interventions are critical to offset the negative impacts of early adversity and to ensure 
children can reach their developmental potential. Teaching parents play-based activities to stimulate 
children and providing nutrition supplements for children have been shown to improve physical growth 
and cognitive and motor development, and delivering these interventions as a joint package holds great 
promise6–8
. Providing parents with the knowledge, motivation, and tools that they can use to interact with 
their children, including toys and books, may increase psychosocial stimulation and ultimately improve 
child development outcomes. Moreover, home-based reading with parents and children has been shown 
to improve reading fluency scores for kindergarten and Grade 1 children9
. However, as highlighted in a 
recently published review of ECD interventions, the best methods for delivering these interventions 
effectively and efficiently in early childhood in resource-limited settings like Zambia remain unclear, 
limiting their large-scale uptake10. Community-based Parenting Groups (CBPG) have shown beneficial 
impacts in some settings, and may be an effective, low-cost platform for delivering interventions to 
improve ECD at scale11–17
.
Through the Scaling Up Early Childhood Development in Zambia (SUpErCDZ) project, Right to Care Zambia 
(RTC-Z) in partnership with Boston University School of Public Health (BUSPH) and the Swiss Tropical and 
Public Health Institute (Swiss TPHI) delivered a previously piloted ECD curriculum through a CBPG 
intervention at scale in rural Zambia. Additionally, RTC-Z distributed the Zambian Folklore Children’s Book 
targeted at increasing pre-grade reading comprehension and school readiness in rural Zambia.
Through a nested, cluster-randomized design, an outcome evaluation was conducted to determine the 
effects of the CBPG and Zambian Folklore Children’s Book interventions on the physical, cognitive, and 
motor development of young children, as well as the emergent literacy of slightly older children, for each 
intervention separately and when combined. 
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3. INTERVENTION DESCRIPTION
a. Community-based Parenting Groups
The intervention assessed in this study is an ECD curriculum delivered through CBPGs at scale in rural 
Zambia. The curriculum was designed to be theatre- and interaction-based with lessons on nutrition, 
stimulation, play, cognitive development, and child illness appropriate to the age range of the children in 
each group. Groups were run within villages in the intervention zones by a locally selected “head mother.” 
The groups were facilitated twice monthly, with separate groups for the primary caregivers of children 
aged 0-11 months, 12-23 months, 24-42 months, and 42-60 months. 
This project implemented a validated ECD curriculum to caregiver-child pairs through the community￾based parenting intervention using a trainer of trainers (TOT) model (Figure 1). The activity trained 
community health volunteers, largely made up of Safe Motherhood Action Group (SMAG) members, on 
the full ECD curriculum. Each SMAG member in turn trained and supervised the cadre of head mothers for 
their zone. SMAGs trained the head mothers every six weeks on the components of the curriculum 
delivered to caregiver-child pairs during fortnightly parenting group meetings. The SMAG members 
provided the head mothers with resources according to the planned meetings on a regular basis. Since 
SMAGs are well known within their communities, integrating them into the implementation of the project 
was important for adoption and continuation of the intervention long-term.
Figure 1: Training-of-Trainers Model for the SUpErCDZ Program
Guided by the Information-Motivation-Behavior Skills Model (IMB Model)18, the CBPG curriculum aimed 
to provide parents of young children with: 1) information about the benefits of proper nutrition, 
stimulation, play, and reading for children’s development; 2) methods to use local resources to create 
nutritious meals and toys for children; and 3) the motivation to do so. The IMB Model demonstrates that 
information and motivation (personal and social) lead to obtaining behavior skills and are critical 
determinants in achieving health behavior change; one without the other is insufficient and have a much 
lower likelihood of change. 
To implement a sustainable intervention, the project was designed: 1) based on evidence from a CBPG 
intervention piloted in rural Zambia; 2) to be delivered through evidence-based MWH and SMAG 
platforms, both integrated into the existing health systems at the health facility level with overall oversight 
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provided by health facility staff; and 3) to utilize participatory methods to engage key stakeholders in the 
project design and implementation. 
b. Zambian Folklore Children’s Book
Within the overarching CBPG study, RTC-Z distributed the Zambian Folklore Children’s Book, a children’s 
book developed by Zambian psychology and ECD experts in collaboration with USAID. The children’s book 
contains 22 Zambian folklore stories with culturally relevant illustrations and an annex designed to support 
the reader, offering creative ideas to better engage and interact with the child while reading. Book 
distribution was conducted February – August 2020. The book was distributed by SMAGs to all households 
with a child aged 9 and under within the book intervention zones in RTC-Z project health facility catchment 
areas, and by health facility staff in health facility catchment areas not part of the RTC project. Recipients 
of the book were encouraged to read to children in the households. Reading by older siblings was also 
encouraged. The book was developed for household use (non-curriculum reading) with the aim of 
increasing caregiver-child interactions, stimulating pre-grade children and ultimately improving children’s 
cognitive development. 
c. Logic Model
The logic model describing the CBPG and Zambian Folklore Children’s Book interventions is presented in 
Figure 2 below. The model includes the activities, outputs, and outcomes for both target (caregivers of 
young children) and non-target (project staff, MOH, SMAGs, health mothers) individuals involved in the 
program.
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Figure 2. Logic model describing the CBPG and Zambian Folklore Children’s Book interventions
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4. EVALUATION QUESTIONS
a. Outcome Evaluation Questions
The aims of this study were (1) to understand the outcomes and effects of the parenting groups on child 
development outcomes when delivered at scale and (2) to understand the effects of the Zambian Folklore 
Children’s Book on child development and school readiness outcomes. Below are the specific objectives 
for the study and the relevant evaluation questions: 
Objective 1: To assess the outcomes and effects of the intervention on early childhood development 
outcomes (as assessed through the index children)
1) What was the effect of the intervention on child linear growth of children as measured by height￾for-age z-scores?
2) What was the effect of the intervention on cognitive and language development in children as 
measured by the MDAT?
3) What was the effect of the intervention on key intermediate outcomes: caregiver-child interactions 
and child diet diversity?
Objective 2: To describe and document the degree to which the Government-supported Zambian 
Folklore Children’s Book affects child development (as assessed through the older siblings)
1) How did the delivery of the Zambian Folklore Children’s Book change caregiver-child and child-child 
interactions within households? 
2) How did the Zambian Folklore Children’s Book affect the cognitive development and school 
readiness of children within the household? 
3) What were the perceptions of Zambian Folklore Children’s Book and cultural preferences for other 
children’s books in rural Zambia?
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5. EVALUATION DESIGN & METHODS
a. Overall Study Design
To estimate the effect of the parenting groups on key indicators of child development, we conducted a 
prospective longitudinal study using a cluster-randomized controlled trial, with clustering and 
randomization at the health facility zonal level. We collected data at pre- and post-intervention 
timepoints.
b. Study Sites
The intervention was implemented in 10 health facilities catchment areas (HFCAs) that had previously 
received a maternity waiting home intervention in Southern and Eastern Provinces Zambia (Figure 3 and 
Table 1).
Figure 3. Map of study sites in Southern and Eastern Provinces, Zambia
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Table 1: SUpErCDZ study sites in Southern and Eastern Provinces, Zambia
Province District Facility name
Eastern Nyimba Kacholola
Eastern Nyimba Mkopeka
Southern Choma Masuku
Southern Choma Mbabala
Southern Choma Simakutu
Southern Kalomo Siachitema
Southern Kalomo Mukwela
Southern Kalomo Kanchele
Southern Kalomo Chilala
Southern Pemba Jembo
c. Endline Data Collection Methods
Using mixed methods, data were collected at baseline from two main sources: a quantitative household 
survey among primary caregivers of children aged 0-5 months and a qualitative in-depth interview (IDI) 
with a sub-set of surveyed households. The household survey measured all constructs in Table 2.
Table 2. Household survey instrument topics for the baseline and endline evaluations
Household Survey Instrument Components
a) Basic demographics of household, caregiver, and index child
b) Household member characteristics and socioeconomic status
c) Schooling and early education programs of all children in household
d) Index child birthweight, vaccinations, and clinic visits (extracted from child health card)
e) Index child nutrition and diet diversity
f) Recent illness and healthcare seeking for index child
g) Age-relevant questions of the Caregiver Reported Early Childhood Development Instrument (CREDi)
h) Availability of toys, books, and other reading material at home
i) Time spent by caregivers playing with the child
j) Time spent by caregivers reading to the child 
k) Caregiver perspectives on early child development activities
l) Caregiver depression using the Self Reporting Questionnaire 20-item (SRQ-20)
m) Caregiver social support
n) Caregiver experiences with intimate partner violence*
o) Caregiver participation in CBPGs, other social groups, and other ECD programs in the community
p) Caregiver perspectives on curriculum content and skills development*
q) COVID-19 perceptions and behaviors*
* Assessed at endline only
Ten percent of the sampled households were randomly selected to participate in an IDI. The interview 
guide was developed to expand on and gain in-depth information on the main evaluation constructs in 
the household survey. The interview with the primary caregiver elicited information on caregiver-child 
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interactions, stimulation, nutrition, and health-seeking behavior, barriers and facilitators to core aspects 
of ECD, as well as perspectives on each intervention. 
d. Cluster Eligibility and Randomization to Study Arm
The catchment areas around the ten study health facilities were pre-subdivided by the health system into 
79 zones. The following inclusion criteria was used to identify zones eligible for inclusion:
- At least one village has 4 or more children aged 0-5 months; or
- At least one group of villages whose centers are within 3km and combined have 4 or more children 
aged 0-5 months.
Seventy-five (75) zones were identified as eligible for inclusion in the study based on their estimated 
number of children aged 0-5 months1
. The 75 zonal clusters were then randomized - meaning each had 
equal probability of being assigned to the treatment or control arms for the CBPG intervention - using a 
co-variate constrained randomization process to ensure balance in the characteristics of the zones and 
populations19
. The randomization was conducted in SAS® v9.4 and covariates included zone population 
size, number of villages in the zone, average village distance to the health facility, and average birthweight 
of babies born at the health facility between January 2016 and July 2018. When health facilities had an 
odd number of zones, the majority were randomized into the treatment arm to ensure the 
implementation goal of reaching 10,000 children with CBPGs could be met. 
A second covariate-constrained randomization process was run to sub-randomize each zonal cluster into 
the book treatment and control study arms. When the health facility had an odd number of zones, the 
odd zone had a 50% chance of being randomized into either study arm. After both randomization 
procedures were run, each zonal cluster fell into one of four study arms: 1) CBPG and book treatment (20 
clusters); 2) CBPG treatment only (20 clusters); 3) book treatment only (15 clusters); 4) pure control (20 
clusters). CBPGs will be constituted in all zones randomized to the CBPG treatment arm (Figure 4). Control 
zones implemented the current standard of care which includes any ECD programs or initiatives that the 
government or other implementing partners may be offering in the study areas. Additionally, some CBPG 
control zones also implemented the book program.
Figure 4: Study arms with numbers of assigned zones
1
The number of children aged 0-5 months was estimated as 2.0% of the village population, as collected from village headmen in mid￾2019, based on the 2013/2014 Zambian Demographic and Health Survey household population figures for Southern and Eastern 
Province.
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e. Eligibility Criteria
Caregiver-child dyads recruited into the study outcomes cohort met the following eligibility criteria: 
● Children aged 0-5 months at baseline in the catchment areas of the ten selected health facilities 
in Southern and Eastern Provinces will be eligible to participate
● Child’s primary caregiver must be 15 years or older
● Child’s primary caregiver must be a female (because the participants in the women’s group may 
feel uncomfortable discussing certain issues if a man is present)2
Within the eligible households, all available children between the ages of 3-6 years at baseline were
assessed for school readiness and early learning using the International Development and Early Learning 
Assessment (IDELA) tool.
f. Sampling Methods
To ensure a sample that was representative of the intervention target population was selected, multi￾stage random sampling procedures were employed. Within the 75 study zones, villages were randomly 
selected for inclusion in the study with probability for inclusion in the study proportionate to population 
size. Within the selected villages, all households with children aged 0-5 months and women in their third 
trimester of pregnancy were listed by local community health volunteers. Eligible households were 
approached in random order for participation in the study until village targets were met. If there was more 
than one caregiver-child dyad in a household, the electronic data capture software (SurveyCTO Collect 
Software) randomly selected the dyad to be surveyed. Approximately 10% of households were randomly 
selected to participate in an IDI in addition to the household survey.
On average, 15 villages were sampled per zone with approximately 3 respondents per village. In some 
cases, there were insufficient villages to meet the sample, so all the villages in the catchment area were 
selected. While we targeted 16 households per zone, due to the varying population sizes of the zones, 
those with much larger populations were oversampled. 
g. Data Collection, Management, and Storage
A local team of enumerators literate in the appropriate local language(s) and in English was trained in 
research ethics and human subjects’ protection, quantitative research methods, sampling methods, and 
the household survey instrument at baseline and again at endline. Written informed consent was obtained 
from each respondent. Informed consent and household surveys were completed in the local languages 
of respondent – Chitonga or Chinyanja. Survey data were captured on encrypted tablets using SurveyCTO 
Collect Software (Dobility, Inc, Cambridge, MA, USA). Survey data were uploaded nightly to a secure server 
administered by SurveyCTO and downloaded onto password-protected computers.
2
This is anecdotal information. From conversations with the communities during the formative phase, there are very few, if any, male 
caregivers within the communities. If a man is left as a widower or his wife is not able to take care of her children for any reason, 
female relatives typically take on the responsibility of taking care of his children. Through qualitative data collection however, we are 
asking the communities about ways to get men involved with caregiving responsibilities. With this information, we plan to develop a 
strategy targeted at men which we will implement during the SUpErCDZ project.
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A subset of data collectors with previous experience in qualitative data collection were trained in interview 
techniques and the IDI instrument. IDIs took an additional 47 minutes to complete on average. IDIs were 
audio recorded, translated into English, and transcribed using Microsoft® Word. 
h. Sample Size
The baseline target sample was 1,200 caregiver-child dyads and the actual sample was 1,108. After 
accounting for the clustered sampling design (intra-class correlation coefficient = 0.05; Design Effect = 1.55 
with 12 children per cluster at endline), and assuming an alpha of .05, we have 80% power to detect a 
minimum of a 0.25 standard deviation (SD) improvement in height-for-age Z score (HAZ) over a 24-month 
intervention period, assuming an attrition rate of 20% (households enrolled at baseline were visited at 
endline). The study profile presented on page 19 presents the study sample at endline. After determining 
endline attrition and higher-than-expected ICCs, the study was powered to detect a 0.33 SD difference in 
standardized developmental outcomes with 80% power, and an effect size of 0.39 SD with power 90%.
i. Measures
Sample Characteristics
For this outcome evaluation, the key demographic variables of the index child, primary caregiver, and 
household were collected at baseline. Wealth quintiles were constructed based on a short series of 
household asset questions taken from the 2013/2014 Zambian Demographic and Health Survey (DHS). 
Dependency ratios were calculated as a total of the household members under 18 divided by the total 
number of adults aged 18 to 64 years. Distance from village to assigned rural health center was calculated 
using the GPS coordinates of the geographic center of the village (as identified by a senior community 
member) to the assigned rural health center by most direct route via pathway and road networks. Distance 
was calculated using ArcGIS® Online (ESRI, Redlands, CA, USA).
Child Physical Growth
The height, weight, and mid-upper arm circumference were collected using a height board, scale, and 
MUAC tape at baseline and endline, respectively. Child height-for-age z-scores, weight-for-age z-scores, 
and weight-for-height z-scores are normalized to WHO standards20. Underweight is defined as weight-for￾age z-score < -2
20. Wasting is defined as weight-for-height z-score < -2
20
.
Childhood Development
Early childhood development was assessed in the index children at baseline and endline using the CREDI. 
The CREDI was created in 2017 to measure the motor, cognitive, language and social emotional skills of 
children under three years21, and has been tested and validated in 16 low, middle, and high income 
countries21,22. The CREDI contains 109 items, which are scored as ‘1’ if the caregiver reports that the child 
has achieved the milestone by the time of the interview, and ‘0’ otherwise. The responses to these 109 
items are used in an item-response theory-based algorithm to compute overall development scores, as 
well as scores in the motor, language, cognitive and socio-emotional domain23
. 
Additionally, at endline only early childhood development was assessed in the index children using the 
Malawi Development Assessment Tool (MDAT), a culturally relevant developmental assessment tool 
created for use in low-resource, rural African settings.24 The MDAT was created in 2010 to measure gross 
motor, fine motor, language, and social emotional skills in children zero to six years of age using 136 items, 
a combination of direct observation of the child and caregiver report. 24
Early learning and development in older siblings were assessed at baseline and endline using the IDELA. 
The IDELA was created by Save the Children to measure four domains—motor, literacy, numeracy, and 
17
social emotional—in children 3.5 to 6 years of age. It has been tested and validated in several low- and 
middle-income countries 25
. The IDELA includes 102 items across the four domains, including recognition 
of self and location, identification of numbers and letters, drawing a person, completing a simple puzzle, 
counting, and hopping multiple times, among others. Prior to administration, we adapted the IDELA 
slightly to the rural Zambian context based on similar adaptations made for a recent assessment in Malawi. 
Caregiver-Child Interactions
Caregiver-child interactions were assessed at endline using the Multiple Indicator Cluster Survey (MICS) 
abbreviated home stimulation questionnaire26. This questionnaire collects information on six broad 
activities household members aged 15 or older can do with children: reading books to child or looking at 
picture books; telling stories; singing songs to or with children; taking the child outside the home; playing 
with the child; and naming, counting or drawing things. The MICS stimulation score (ranging from 0-6) 
captures the total number of activities household members report to have engaged in during the 3 days 
preceding the survey.
Child Health and Nutrition
Key variables of child health, including birthweight, disabilities, and immunizations received were 
extracted from the child’s Under-5 Card. Birthweight and disabilities were extracted at baseline. 
Immunizations were extracted at baseline and endline. For the children without a card, the primary 
caregiver provided this information. Immunizations received were compared to the schedule for 
immunizations by the Zambian Ministry of Health, to determine if the child was fully immunized for their 
age. Based on DHS questions27, caregiver health care seeking behaviors for children were assessed by 
asking the caregiver to report on where if at all they sought treatment if the child had been ill in the 
previous two weeks with symptoms of fever, diarrhea, or difficulty breathing.
Caregiver mental health and social support
Caregiver mental well-being and presence of depression were assessed at baseline and endline using the 
20-item WHO Self-Reporting Questionnaire (SRQ-20)28. Responses are scored as 1 or 0 and added 
together. Caregiver SRQ z-scores are normalized within the study population. Lower SRQ scores and z￾scores indicates better mental health. An SRQ score of greater than 7 indicates possible depression in the 
respondent, but is not a clinical diagnosis and is not intended as such. 
Social support for the caregiver was assessed using the Multidimensional Scale of Perceived Social 
Support29. Caregivers self-reported their level of agreement (Likert scale: very strongly disagree to very 
strongly agree) with 12 statements that address different sources of support, such as family and friends. 
j. Data Analysis
Results presented in this report were analyzed using a dataset cleaned as of 20 December 2021. The 
dataset may require additional cleaning which may result in a change to the numbers. We do not expect 
any additional cleaning will significantly alter the core findings. 
Quantitative Data
All quantitative cleaning was conducted in SAS version 9.4 (SAS Institute, Cary, NC, USA) while the primary 
analyses were conducted in Stata version 17 (StataCorp, College Station, TX, USA). First, descriptive 
characteristics for the index child, caregiver, and household were calculated for the full study sample and 
each CBPG study arm. Proportions, means, standard deviations (SD), medians, and inter-quartile ranges 
(IQR) were calculated. We compared participant characteristics across study arms at baseline to assess 
18
balance Chi-squared test of association was used for proportions and ANOVAs for means and standard 
deviations, and Wald’s Rank test for medians and IQR; all tests were clustered by zones. 
The primary independent variable of interest is assignment to the intervention. Impact on two primary 
outcomes: 1) Child linear growth (HAZ and stunting); and 2) MDAT z-scores overall and for each sub￾domain: gross motor, fine motor and performance, language and hearing, and social was measured.
the impact of the intervention on the primary outcomes of interest was estimated using an intention-to￾treat approach. A set of mixed-effects models with cluster-level random effects and robust standard errors 
will be fit to estimate unadjusted and adjusted impacts. Adjusted models included the following control 
variables to increase precision: stratification variables, child age (in months), child gender, height-for-age 
z-score measured at baseline, baseline score of early childhood development as measured by the 
Caregiver Reported Early Childhood Development instruments (CREDi), caregiver age, caregiver 
education, and household wealth. 
IDELA scores were calculated for older siblings assessed during endline. First, data were cleaned and all 
items with missing values were coded as ‘0’. Next, percentage correct scores were calculated for each 
subtest by summing total items achieved and dividing by the total score possible for that subtest. Next, 
four domain scores were calculated by averaging subtest percentage correct scores within each domain. 
Finally, overall IDELA score was calculated by averaging the four domain scores. A set of mixed-effects 
models with cluster-level random effects, household random effects, and robust standard errors will be 
fit to estimate unadjusted and adjusted impacts. Adjusted models included the following control variables 
to increase precision: child age at endline; child sex; caregiver age; and household wealth quintile.
Qualitative Data
All qualitative data were coded and analyzed in NVivo version 12© (Doncaster, Australia). A mixed 
inductive and deductive approach was used30; codes were identified a priori according to the evaluation 
questions and IDI guide. Additional codes were included as new themes emerged. We ran a Matrix Coding 
query and conducted a content analysis31 to compare topics discussed in the treatment and control groups 
and to facilitate interpretation of results. 
Stratified by study arm, data will be triangulated with quantitative household survey data. The 54 of the 
108 total IDIs (50%) coded for this report were randomly selected from every study HFCA to ensure each 
HFCA was represented in the qualitative data. If final analysis using the full sample shows different results, 
the difference will be highlighted in the end of activity report.
k. Study Approvals and Permission
Ethical approvals were obtained from the Boston University Medical Campus institutional review board 
and the University of Zambia Biomedical Research Ethics Committee. Official governmental approval was 
granted by the National Health Research Authority, which is responsible for oversight of all research 
conducted in Zambia. Additional approvals were granted by the Ministry of Health at the National, 
Provincial, and District levels, as well as the Ministry of Community Development and Ministry of 
Agriculture. The study was explained to the traditional chiefs overseeing the local areas, who all provided 
their endorsement. Prior to baseline data collection and the start of implementation, project staff visited 
all villages within the study catchment areas (both treatment and control zones) to introduce the program 
and the study to the local health authorities and village-level traditional leaders to ensure the study goals 
and procedures were acceptable to the local communities and to reduce mistrust of data collectors. 
19
6. FINDINGS FOR OBJECTIVE 1
a. Study Profile & Sample Characteristics
KEY MESSAGES: SAMPLE CHARACTERISTICS OF HOUSEHOLDS, CAREGIVERS, & INDEX 
CHILDREN 
● A final sample of 934 index children was reached at endline; 419 children in the control 
group and 515 in the treatment group, for a follow-up rate of 85.5% and 83.3% at 2-year 
follow-up, respectively.
● The study population is generally remote and poor with limited access to improved water 
sources, improved toilet facilities, or electricity, consistent with the characteristics of the 
rural populations of Southern and Eastern Provinces, Zambia, according to the Zambian 
DHS.
At baseline, 1,529 households were approached for participation in the study (Figure 5). In total, 1,108 
infants (index child) aged 0-5 months old were enrolled in the study at baseline and their primary caregiver 
completed a household survey for an 82.8% response rate. Among the total baseline sample, 44.2% 
(n=490) were allocated to the control arm (standard of care), while 55.8% (n=618) were allocated to the 
treatment (intervention) arm of the study.
At endline two years later, 70 (14.3%) control and 101 (16.3%) treatment index children could not be 
followed up due to relocation of the household, unavailable households, death of the index child (Table 
3), and refusals to participate. Due to incomplete data, one and two control and treatment households,
respectively, were excluded from the analysis. We analyzed a final sample of 934 index children, 44.9% 
(n=419) control and 55.1% (n=515) treatment for a response rate of 85.5% and 83.3% at 2-year follow-up, 
respectively.
Table 3: Cause 
of death for 
index children 
during endline 
observation as 
reported by 
householdHFCA
Event
Mkopeka
Child, born 28/6/2019, died December 2019 due to "lack of breastfed milk." The mother 
was sick and not producing as much milk and the child died. No positive covid test at 
time of death. No further description could be ascertained from the respondent.
Kacholola
Child, born 6/6/2019, died on approximately March 2020 due to pneumonia/respiratory 
illness. The child first had a fever then difficulty breathing. No positive covid test at time 
of death.
Objective 1: To assess the outcomes and effects of the intervention on early childhood 
development outcomes (as assessed through the index children)
20
Kacholola Child died at 4 months old. He was not eating and refused to be breastfed for a week. 
Was only taking water for a week be he died. No positive COVID-19 test at time of death. 
Kacholola Child died at 18 months old of spina bifida. No positive COVID-19 test at time of death. 
Kacholola Index child deceased. Details not provided
Mbabala Child, born 24/04/2019, died at 19 months of age (November 2020). Child drowned in a 
bucket of water in the kitchen while caregiver stepped out of the room.
Kanchele Child died at 8 months old of diarrhoea. No positive COVID-19 test at time of death. 
Chilala Index child died at 8 months of pneumonia or other respiratory illness.No positive COVID 
test at time of death.
Siachitema Index child deceased. Details not provided
Figure 5. Preliminary results: study profile of SUpErCDZ outcome evaluation cohort
As shown in our Outcome Evaluation Baseline Analytic Report, there was no differences pbserved in 
characteristics of the households, caregivers, or index children between control and treatment groups. 
The households followed up at endline had a median of approximately 6 members and were on average 
21
8km (SD 5.0) away from their assigned rural health center (RHC). Almost one-third had an unimproved 
water source, while nearly three-quarters had an unimproved toilet facility and a house with earth or sand 
floors. Nearly all had no electricity (94%) and used charcoal or wood as their cooking fuel (100%). These 
findings are consistent with the characteristics of the remote, rural population of Southern and Eastern 
Provinces, Zambia, according to the Zambian DHS4
.
The primary caregivers of the index children were on average 26 years old at baseline and three-quarters 
of the caregivers were married or cohabiting. The majority (72%) of caregivers had completed primary 
school and are considered literate. Over one-third could not read any words in the sentences provided. 
Approximately 11% of caregivers were over 60 years of age at baseline, disabled, or seriously ill. Caregivers 
had an average mental health score of 2.8 out of 20.
Table 4. Preliminary results: baseline characteristics of study households and caregivers 
followed up at endline, stratified by study arm
Control
(N=419)
Treatment
(N=515)
Household characteristics at baseline
Household wealth quintilea
, mean (SD) 3.0 (1.5) 3.0 (1.4)
Number of children under 5, mean (SD) 1.9 (0.82) 1.9 (0.81)
Dependency ratiob
, mean (SD) 1.6 (0.8) 1.7 (0.9)
Household size (persons), median (IQR) 6.0 (5.0, 9.0) 6.0 (5.0, 8.0)
Distance from village to assigned rural health 
center (km)c
, mean (SD)
7.7 (4.2) 8.0 (5.5)
Non-improved water sourced
, n (%) 124 (29.4) 155 (29.7) 
Non-improved toilete
, n (%) 280 (66.5) 389 (74.7)
No electricity, n (%) 394 (93.6) 494 (94.8) 
Charcoal or wood cooking fuel, n (%) 420 (99.8) 521 (100.0)
Caregiver characteristics at baseline
Femalef
, n (%) 419 (99.5) 520 (99.8)
Age (years), mean (SD) 25.6 (7.3) 25.8 (7.5)
Married/cohabiting, n (%) 327 (77.7) 400 (76.8)
Completed primary school, n (%) 304 (72.2) 338 (64.9)
Literacyg
, n (%)
Could not read at all 152 (36.1) 193 (37.0)
Able to read only part of a sentence 53 (12.6) 54 (10.4)
Able to read a whole sentence 214 (50.8) 274 (52.6)
Caregiver over 60 years, disabled, or very ill, n (%) 48 (11.4) 60 (11.5)
Mental health (SRQ score)h
, mean (SD) 2.8 (2.6) 2.8 (2.7)
a Wealth quintiles were constructed based on a short series of household asset questions taken from the 2013/2014 
Zambian Demographic and Health Survey (DHS)
b Dependency ratios were calculated as a total of the household members under 18 divided by the total number of 
adults aged 18 to 64 years.
c Distance measured from village geographic center (as identified by community member) to assigned rural health 
center by most direct route via pathway and road networks; calculated using ArcGIS® Online.
d Non-improved water source: unprotected dug well, unprotected spring, tanker truck, cart with small tank, surface 
water
e Non-improved toilet: pit latrine without slab/open pit, bucket toilet, hanging toilet/latrine, no facility/bush/field
f All caregivers interviewers were female; only female primary caregivers were invited to participate in the community￾based parenting groups based on pilot study findings.
g Literacy was assessed at endline by asking the respondent to read as much as they could of one of four sentences in 
the language of their choice. The 2018 Zambian Demographic and Health literacy card was used. Two (0.48%) 
respondents were blind or visually impaired so their literacy level could not be assessed.
h Caregiver mental health was assessed at using the 20-item World Health Organization Self-Reporting Questionnaire 
(SRQ-20)
22
Baseline characteristics and outcomes measured for the index children followed at endline are presented 
in Table 5. Approximately 50% of the index children followed up at endline were female. The average age 
of the children at baseline was approximately 2.5 months (SD 1.7) and they weighed 3.1 kilograms (SD 0.6) 
at birth. Almost all babies in the sample (91.8%) were delivered at a health facility or hospital and over a 
three-quarters were exclusively breastfed at baseline.
Children in the control and treatment arms also had similar rates of stunting, underweight, and wasting, as 
well as similar rates of cognitive development, as measured using the CREDI. Lastly, children at baseline 
were reported to have similar rates of diarrhea, fever, and cough in the 2 weeks prior to the household 
survey being conducted.
Table 5. Preliminary results: characteristics of study index children followed up at 
endline, stratified by study arm
Control 
(N=419)
Treatment 
(N=515)
Index child characteristics at baseline
Female, n (%) 212 (50.4) 276 (53.1) 
Age (months) at enrollment, mean (SD) 2.4 (1.7) 2.5 (1.7)
Birthweight (kg), mean (SD) 3.1 (0.58) 3.1 (0.57)
Low birthweight (<2.5 kg), n (%) 45 (10.7) 47 (9.0)
Birth at health facility or hospital, n (%) 379 (90.0) 484 (92.9)
Exclusively breastfed at time of assessment, n (%) 339 (80.5) 437 (83.9)
Index child physical characteristics at baseline
Height-for-age (z-scores)a
, mean (SD) -0.95 (1.7) -0.94 (1.9)
Weight-for-age (z-scores)a
, mean (SD) 0.24 (1.4) 0.34 (1.4)
Weight-for-height (z-scores)a
, mean (SD) 1.2 (1.8) 1.3 (1.8)
Stuntingb
, n (%) 104 (24.7) 136 (26.1)
Underweightc
, n (%) 26 (6.2) 28 (5.4)
Wastingd
, n (%) 16 (3.8) 24 (4.6)
Index child cognitive characteristics at baseline
Motor development (z-scores)e
, mean (SD) -0.07 (1.1) -0.05 (1.1)
Cognitive development (z-scores)e
, mean (SD) -0.20 (1.1) -0.20 (1.1)
Language development (z-scores)e
, mean (SD) -0.59 (0.77) -0.63 (0.68)
Socioemotional development (z-scores)e
, mean (SD) -0.03 (1.1) -0.03 (1.1)
Index child health characteristics at baseline
Diarrhea in previous 2 weeks, n (%) 79 (18.8) 85 (16.3)
Fever in previous 2 weeks, n (%) 92 (21.9) 118 (22.6)
Cough in previous 2 weeks, n (%) 20 (4.8) 20 (3.8)
a Child height-for-age z-score, weight-for-age z-score, and weight-for-height z-score are normalized to WHO standards
b Stunting is defined as height-for-age z-score < -2
c Underweight is defined as weight-for-age z-score < -2
d Wasting is defined as weight-for-height z-score < -2
e Motor, cognitive, language, and socioemotional development indicators were assessed using the Caregiver Reported 
Early Development Index (CREDI).
 Z-scores are normalized within the study population.
23
24
b. Evaluation Questions 1 & 2
KEY MESSAGES: EVALUATION QUESTIONS 1 & 2 
● Preliminary results suggest the intervention had no significant impact on the odds of stunting 
or height-for-age z scores two years after implementation.
● Preliminary results suggest the intervention had no significant impact on cognitive and language 
development as measured by the MDAT, two years after implementation.
● Results are preliminary and must be interpreted with caution; a more detailed analysis is 
currently underway.
After controlling for a set of baseline characteristics (Table 6), preliminary results suggest the intervention had 
no significant impact on the odds of stunting (aOR 1.37 [95% CI 0.94 to 1.98]; p=0.102) nor on height-for-age 
z-scores (β = -0.99 [95% CI -0.27, 0.09]; p=0.326). While no significant impact was observed on the MDAT 
overall score or subdomains, a significant impact was observed in the overall CREDI score (β = 0.14 [95% CI 
0.01, 0.27]; p=0.029) as well as in the sub-domains of motor and language. Results are preliminary; not all 
control variables have been accounted for. A more in-depth analysis is currently underway.
What was the effect of the intervention on child linear growth of children as measured by 
height-for-age z-scores?
What was the effect of the intervention on cognitive and language development in children as 
measured by the MDAT?
25
Table 6. Preliminary results: primary outcomes for index children at endline, stratified by study arm
n (%) or mean (SD) at endline ICC Unadjustedc Adjustedd
Control Treatment OR or β
(95% CI) p-value OR or β
(95% CI) p-value
Height-for-age z-scoresa
, mean (SD) -1.55 (1.04) -1.67 (1.12) 0.03 -0.11 (-0.29, 0.08) 0.259 -0.09 (-0.27, 0.09) 0.326
Stuntingb
, n (%) 129 (33.5) 183 (39.6) <0.01 1.42 (0.99, 2.02) 0.054 1.37 (0.94, 1.98) 0.102
MDAT “development adjusted z-scores”, mean (SD)
Gross Motor 1.51 (1.23) 1.53 (1.33) 0.25 -0.06 (-0.23, 0.11) 0.499 -0.04 (-0.20, 0.13) 0.651
Fine Motor 0.94 (1.10) 0.96 (1.47) 0.23 0.02 (-0.14, 0.17) 0.837 0.02 (-0.13, 0.17) 0.810
Language 0.97 (1.48) 0.89 (1.64) 0.30 0.10 (-0.10, 0.29) 0.341 0.10 (-0.09, 0.28) 0.300
Social-emotional 1.25 (1.02) 1.35 (1.06) 0.36 0.09 (-0.04, 0.22) 0.182 0.08 (-0.04, 0.21) 0.200
Overall 1.43 (1.22) 1.49 (1.47) 0.32 0.11 (-0.08, 0.29) 0.260 0.11 (-0.09, 0.30) 0.282
CREDI z-scores, mean (SD)
Cognitive -0.47 (0.94) -0.29 (0.96) 0.24 0.12 (-0.01, 0.26) 0.080 0.11 (-0.03, 0.24) 0.115
Motor -0.46 (0.95) -0.17 (0.95) 0.26 0.17 (-0.01, 0.35) 0.060 0.16 (-0.01, 0.34) 0.065
Language -0.20 (0.69) -0.10 (0.78) 0.20 0.12 (0.02, 0.22) 0.020 0.12 (0.02, 0.21) 0.019
Social-emotional -0.27 (0.97) -0.06 (0.98) 0.24 0.14 (0.00, 0.28) 0.056 0.12 (-0.02, 0.26) 0.101
Overall -0.28 (0.90) -0.13 (0.94) 0.20 0.15 (0.02, 0.29) 0.025 0.14 (0.01, 0.27) 0.029
a Child height-for-age z-score are normalized to WHO standards. 
b Stunting is defined as height-for-age z-score < -2.
c Unadjusted models control for the stratifying variables used in the randomization procedure (health facility catchment area fixed effects; health zone population size; health zone average birthweight); and 
endline assessor fixed effects.
d Adjusted models control for the following additional variables: child age at endline; child sex; child height-for-age z-score at baseline; child CREDI overall z-score at baseline; caregiver age and education; 
and household wealth quintile.
26
c. Evaluation Question 3
KEY MESSAGES: EVALUATION QUESTION 3 
● Preliminary results suggest the intervention had significant effects on all intermediary and 
secondary outcomes for the index children, including increases in caregiver-child interactions 
and child diet diversity in the treatment group compared to the control group
● Preliminary results suggest caregivers reported better mental health and increased social 
support scores in the treatment group compared to the control group
● Preliminary analysis of the qualitative data corroborate quantitative data; respondents 
mentioned the importance of nutrients to help the child grow strong and to protect them from 
illness and the importance of taking children to the clinic when they are unwell.
Quantitative Results
Two years after implementation, preliminary findings suggest the intervention had significant positive effects 
on all intermediary and many secondary outcomes for the index children (Table 7). After controlling for 
potential confounders, the preliminary findings suggest the intervention had a significant positive impact on 
caregiver-child interactions (β = -0.59 [95% CI 0.26 to 0.91]; p=<0.001), on child diet diversity (β = -0.25 [95% 
CI 0.05 to 0.44]; p=<0.012) and on caregiver mental health. Additionally, the treatment group had higher 
odds of having attended well baby visits (p=0.051) and of having toys in the house (p<0.001). 
What was the effect of the intervention on key intermediate outcomes: caregiver-child 
interactions and child diet diversity?
27
Table 7. Preliminary results: intermediary and secondary outcomes for index children at endline, stratified 
by study arm
n (%) or mean (SD) at 
endline ICC Unadjustedh Adjustedi
Control Treatment OR or β
(95% CI) p-value OR or β
(95% CI) p-value
Intermediary Outcomes
Caregiver-child interaction 
scorea
, mean (SD)
3.05 
(1.74)
3.66 
(1.71) 0.24 0.61 
(0.29, 0.92) <0.001 0.59 
(0.26, 0.91) <0.001
Child diet diversity scoreb
, 
mean (SD)
3.41 
(1.32)
4.10 
(1.48) 0.26 0.28 
(0.08, 0.48) 0.006 0.25 
(0.05, 0.44) 0.012
Caregiver mental health 
symptom scorec
, mean (SD)
4.83 
(4.64)
4.69 
(5.04) 0.22 -0.91 
(-1.53, -0.29) 0.004 -0.90 
(-1.52, -0.29) 0.004
Caregiver social support 
scored
, mean (SD)
68.70 
(15.24)
72.64 
(13.81) 0.18 2.58 
(0.17, 4.99) 0.036 2.36 
(-0.06, 4.79) 0.056
Secondary Outcomes
Up to date on age 
appropriate vaccinese
, n (%)
279 
(74.0)
352 
(74.9) 0.13 1.09 
(0.69, 1.74) 0.705 1.08 
(0.68, 1.71) 0.745
Vitamin A supplementation, 
n (%)
269 
(81.5)
372 
(87.1) 0.23 1.55 
(0.81, 2.98) 0.184 1.59 
(0.80, 3.16) 0.185
Well-baby visits attendedf
, 
mean (SD)
15.41 
(7.79)
18.30 
(7.72) 0.34 1.77 
(0.03, 3.51) 0.047 1.65 
(-0.10, 3.31) 0.051
Children’s toys in 
householdg
, mean (SD)
0.76 
(1.19)
1.38 
(1.72) 0.17 0.44 
(0.23, 0.66) <0.001 0.40 
(0.20, 0.60) <0.001
Slept under a bed net prior 
night, n (%)
201 
(48.3)
236 
(46.1) 0.17 0.94 
(0.64, 1.38) 0.748 0.92 
(0.63, 1.35) 0.687
a Caregiver-child interaction was assessed using the Multiple Indicator Cluster Survey (MICS). Activities with child could be performed by the primary 
caregiver, the father, or any other individual at least 15 years of age.
b Based on Demographic and Health Survey methodology
c Caregiver mental health was assessed using the World Health Organization Self-Reported Questionnaire (WHO SQR). Lower SRQ score indicates better 
mental health.
d Caregiver social support assess using the Multidimensional Scale of Perceived Social Support (MSPSS). Questions asked about social support from a 
significant other, family, and friends.
e Immunizations received based on child’s under-5 card or reported by primary caregiver. Immunizations received compared to Zambian Ministry of Health 
immunization schedule appropriate for child’s age.
f Well-baby visits measured by caregiver report and corroborated through review of the Under-5 Clinic Card
g Includes store-bought and homemade toys.
h Unadjusted models control for the stratifying variables used in the randomization procedure (health facility catchment area fixed effects; health zone 
population size; health zone average birthweight); and endline assessor fixed effects.
i Adjusted models control for the following variables: child age at endline; child sex; child twin status; and household wealth quintile
Qualitative Results
Participants in the control and treatment groups were asked to elaborate on their nutrition and healthcare 
seeking behaviors regarding the index children during the qualitative IDIs (Table 8). When asked about good 
nutrition practices, the majority of respondents from both treatment and control groups discussed giving young 
children porridge with groundnuts, with some respondents from both groups also discussing the addition of 
vegetables. While some control respondents discussed the importance of children eating nutritious foods to grow 
well, in the treatment group in particular, many respondents mentioned the importance of a “balanced diet” 
with a variety of nutrients to help the child grow strong and to protect them from illness. Some treatment 
respondents criticized their community members who do not feed their children enough throughout the day or 
do not give their children diverse foods.
28
When asked about good healthcare seeking practices, the majority of respondents from both treatment and 
control groups discussed taking their child to the clinic promptly whenever the child was not feeling well, with 
some mentioning the need to bring the child when they have an elevated temperature. A few control 
respondents mentioned the importance of taking the child to the clinic prior to searching for herbal remedies.
Treatment respondents were also asked about the usefulness of the CBPGs. Respondents widely described the 
groups being helpful, with many mentioning that they learned good childcaring practices from participating in 
the groups.
Table 8. Preliminary results: endline qualitative IDI responses for primary caregivers of index children, 
stratified by study arm
Themes Control Treatment
Nutrition
Practices
1. Good nutrition practices: serving 
children porridge or nshima with 
groundnuts; adding vegetables or 
relish, such as okra; ensuring children 
eat nutrients to grow well
2. Nutritious foods mentioned included: 
oranges, bananas, carrots, eggs, milk, 
fish/kapenta, beans, biscuits, soup 
(cabbage and beef)
1. Good nutrition practices: serving children porridge 
with groundnuts; adding vegetables; importance of 
a balanced diet with a variety of nutrients to help 
children grow strong and/or protect them from 
illness
2. Bad nutrition practices: criticized community 
members who do not feed their children enough 
throughout the day or do not give their children 
diverse foods
3. Nutritious foods mentioned included: pumpkins, 
sweet potatoes, eggs, fish/kapenta, milk, bananas, 
beans, nshima with vegetables
Healthcare 
Seeking
Practices
1. Good healthcare seeking practices: 
take child to clinic promptly whenever 
they are feeling sick; take to the clinic 
when they have an elevated 
temperature; take child to clinic prior 
to searching for herbal remedies
1. Good healthcare seeking practices: take child to 
clinic promptly whenever they are feeling sick; take 
to the clinic when they have an elevated 
temperature
Usefulness of 
Groups
Not applicable 1. Groups are helpful: caregivers learned good 
childcaring practices
Illustrative Quotes
Feeding Practices
a. “In the past we just knew to cook Nshima for them as long as she has eaten. Only a little porridge was cooked. 
Again you cook Nshima in the evening. Same food over and over. So after lessons we learnt even porridge was 
good for the child when you add pounded groundnuts.” – Primary caregiver, female, treatment group
b. “What makes us different is that others would prepare porridge for the child with plain mealie meal, with salt 
and serves the child but that is not the case with me, I add cooking oil and vegetables. That way the porridge 
is rich, vegetable have vitamin A, sugar has energy and ground nuts has energy.” – Primary caregiver, female, 
treatment group
c. “Good nutrition is that porridge which has groundnut powder and sardines, or if you want even veggies. Those 
things are good to put for the child. Because they are the ones which have nutrition, and they make the child 
to grow properly.” – Primary caregiver, female, control group 
d. “In the morning, you can cook porridge for her, there is nothing I am putting. Then again in the afternoon, 
when I cook nshima for her, she is eating plain relish. Then again in the evening, she eats okra, then in the 
29
night she just sleeps she doesn't even eat, then again in the morning when she wakes up, I give her leftovers 
from yesterday.” – Primary caregiver, female, control group
Healthcare Seeking Practices
e. “I take her if her temperature is high and for the under-five clinic, I take her every month.” – Primary caregiver, 
female, treatment group
f. “There are certain diseases that do not raise the body temperature so if a child looks powerless in a certain 
way. Sometimes she starts to cry frequently then you will know that she is not feeling well and you will start 
walking to the clinic even if the body temperature is normal.” – Primary caregiver, female, control group
g. “So we are supposed to hurry, when you feel the way you feel to rush to the clinic so that they quickly protect 
you so that the child does not get a bad life, it should have a good life.” – Primary caregiver, female, control 
group
Usefulness of CBPGs 
h. “They just put more effort in caring for children and you see the change in their growth.” – Primary caregiver, 
female, treatment group
i. “What is most helpful to them is the motivation of wanting the child to be very intelligent all the time.” –
Primary caregiver, female, treatment group
j. “According to the education that you gave us and that we also educated our children have really improved 
our lives and also our wellbeing than before.” – Primary caregiver, female, treatment group
30
7. FINDINGS FOR OBJECTIVE 2
a. IDELA Sample Characteristics
Among all households followed up at endline, 890 children were found within the appropriate age ranges 
(5-8 years of age) within 643 households sampled. Among them, 26 (3.0%) children were unavailable for 
assessment due to: being away from the household (n=23, 88.5%), having a disability that precluded 
participation (n=2, 7.8%), or other reason (n=3, 3.8%). After assenting, 10 (1.2%) children refused to 
engage with the interviewer. Overall, the 852 children between five and eight years of age were assessed 
at endline using the IDELA for a response rate of 95.7% among eligible children. Among the 852 older 
siblings, 383 (45.0%) and 469 (55.0%) children were sampled in the book control and treatment zones, 
respectively (Table 9).
Balance was achieved between the book control and treatment groups among the older sibling 
characteristics at endline and their associated household characteristics at baseline. At endline, children 
were on average 6.5 years of age, approximately 50% were female, and they had one year of early 
education. Less than a third of children were currently enrolled in primary school, which generally starts 
in Grade 1 at age 7. 
Households where these children lived at baseline had a median of 6 members, with a mean dependency 
ration of 1.6, and approximately 1.8 children under the age of 5. They had less than one children’s book 
each in the household on average and approximately 4 books total in the household.
Table 9. Preliminary results: older sibling characteristics at endline for the IDELA sample with 
their associated baseline household characteristics, stratified by study arm
Control Treatment
Child Characteristics at Endline N = 383 N = 469
Age (years), mean (SD) 6.5 (1.3) 6.4 (1.3)
Female, n (%) 195 (50.9) 230 (49.0)
Years of early education, mean (SD) 1.1 (0.99) 0.96 (0.80)
Currently in primary school, n (%) 113 (29.5) 122 (26.0)
Household Characteristics at Baseline N = 279 N = 345
Household wealth quintilea
, mean (SD) 3.1 (1.5) 3.0 (1.4)
Dependency ratiob
, mean (SD) 1.6 (1.0) 1.7 (0.93)
Household size (persons)c
, median (IQR) 6.0 (5, 9) 6.0 (5, 8)
Number of children under 5, mean (SD) 1.8 (0.85) 1.9 (0.79)
Children’s books in household, mean (SD) 0.69 (1.6) 0.78 (2.3)
Total books in household, mean (SD) 3.8 (6.3) 4.7 (7.1)
a Wealth quintiles were constructed based on a short series of household asset questions taken from the 
2013/2014 Zambian Demographic and Health Survey (DHS)
b Dependency ratios were calculated as a total of the household members under 18 divided by the total 
number of adults aged 18 to 64 years.
Objective 2: To describe and document the degree to which the government-supported 
Zambian Folklore Children’s Book effects child development outcomes (as assessed 
through the older siblings)
31
b. Evaluation Question 4 
KEY MESSAGES: EVALUATION QUESTION 4
● Preliminary findings suggest the community-based parenting group intervention had a 
significant positive effect on sibling IDELA scores when controlling for key confounders.
● Preliminary findings from the Zambian Folktales Children’s Book intervention suggest a 
modest impact in the overall z-score and the social-emotional z-scores in the book 
intervention arm.
● Results are preliminary and must be interpreted with caution; a more detailed analysis is 
currently underway.
Preliminary findings suggest the CBPG intervention had a significant positive effect on sibling IDELA 
scores when controlling for child age, child sex, caregiver age, and household wealth (β = 0.12 [95% CI 
0.01 to 0.24]; p=<0.039). Most notably, the CBPG treatment group had improved numeracy compared 
to the standard of care (β = 0.13 [95% CI 0.02 to 0.25]; p=<0.022). Motor, literacy, and social-emotional 
domains alone were not impacted among older siblings in the CBPG intervention arm. 
Preliminary findings from the Zambian Folktales Children’s Book intervention suggest a modest impact 
on the overall z-scores (β = 0.11 [95% CI -0.01 to 0.23]; p=<0.061) and social-emotional z-scores (β = 
0.11 [95% CI 0.00 to 0.23]; p=<0.053) in the book treatment arm. Preliminary analysis suggests that 
there was no significant impact on motor, literacy, or numeracy domains of the IDELA, though results 
are positive and trending toward significance. These results are preliminary; not all control variables 
have been accounted for, nor have children’s IDELA z-scores at baseline. A complete analysis is 
underway.
Table 10. Preliminary results: primary outcomes for older siblings at endline, stratified by study arm
Community-Based Parenting Groups Book Distribution
Unadjusteda Adjustedb Unadjusteda Adjustedb
OR or β
(95% CI) p-value OR or β
(95% CI)
p￾value
OR or β
(95% CI)
p￾valu
e
OR or β
(95% CI)
p￾value
IDELA z-scores of older siblingsa
, mean (SD)
Motor 0.03 
(-0.08, 0.15) 0.581 0.08 
(-0.04, 0.20) 0.166 0.09 
(-0.04, 0.23)
0.17
7
0.08 
(-0.04, 0.20) 0.174
Literacy 0.03 
(-0.10, 0.17) 0.648 0.07 
(-0.06, 0.21) 0.292 0.10 
(-0.06, 0.26)
0.23
7
0.10 
(-0.04, 0.23) 0.157
Numeracy 0.07 
(-0.05, 0.20) 0.250 0.13 
(0.02, 0.25) 0.022 0.11 
(-0.03, 0.25)
0.12
5
0.09 
(-0.03, 0.21) 0.123
Social 
emotional
0.06 
(-0.05, 0.19) 0.280 0.11 
(0.00, 0.23) 0.060 0.13 
(0.00, 0.25)
0.04
4
0.11 
(0.00, 0.23) 0.053
Overall 0.05 
(-0.07, 0.18) 0.384 0.12 
(0.01, 0.24) 0.039 0.12 
(-0.02, 0.26)
0.09
1
0.11 
(-0.01, 0.23) 0.061
a Unadjusted models control for the stratifying variables used in the randomization procedure (health facility catchment area fixed 
effects; health zone population size; health zone average birthweight); and endline assessor fixed effects.
b Adjusted models control for the following additional variables: child age at endline; child sex; caregiver age; and household wealth 
quintile.
6. What is the status of the older children’s cognitive development as measured by 
the International Development and Early Learning Assessment (IDELA)?
32
c. Evaluation Question 5
KEY MESSAGES: EVALUATION QUESTION 5
● Preliminary results suggest that most respondents in the book treatment arm reported 
consistently making the time to read with the young children in their households from the 
Zambian Folktales Children’s Book.
● According to preliminary results, when asked whether they had difficulties making the time to 
read due to competing priorities, most respondents stated that they did not have trouble 
finding time to read.
● According to preliminary results, when asked about the usefulness of the book, most 
respondents described the book as being helpful in preparing their children for school.
Respondents in the book treatment arm were asked to describe their experiences so far with the Zambian 
Folktales Children’s Book. The majority of respondents reported consistently making the time to read 
with the young children in their households. They describe reading as having become a common practice 
in their home and that different families will find different times throughout the day to read with the 
children – such as just after eating lunch or before bed. Several respondents also mentioned that other 
family members in the household, such as older children, are excited to read the book themselves and 
to the younger children. 
When asked whether they had difficulties making the time to read due to competing priorities, the 
majority of respondents stated that they did not have trouble finding time to read. Two respondents 
discussed some challenges with finding the time to read to young children due to competing priorities, 
with one stating that when they personally do not have time to read to the children, the children’s 
grandmother will read to them.
When asked about the usefulness of the book, the majority of respondents described the book as being 
helpful in preparing their children for school. Several respondents stated that the children’s book is 
helping children to learn reading and writing, while others described it as helping young children learn 
vocabulary and to identify animals from the drawings in the book.
5. How does the Zambian Folktales Children’s Book effect caregiver-child and child-child 
interactions within the household?
33
Table 11. Preliminary results: endline qualitative IDI responses regarding Zambian Folktales 
Children’s Book among respondents in the book treatment arm
Themes Treatment
Incorporation 
Into Home Life
1. Reading as a common practice: consistently making the time to read to children in the 
household; reading has become a common practice in their home; other family 
members, such as older children, are also excited to read the book themselves and to 
younger children
Competing 
Priorities
1. No issue finding time to read
School 
Preparedness
1. Book helps prepare children for school: helps children learn reading and writing; helps 
children learn vocabulary and to identify animals 
Illustrative Quotes
a. “The stories which are inside which drives you to be reading more and more.” – Primary caregiver, 
female, book treatment group 
b. “Even when I am not available, her older siblings read the book for her. Sometimes on her own she gets 
the book and starts calling my name so that I read the book for her. She will be like, ‘Mum read for me 
that part where people are eating something bitter’. Once I start reading, she will be smiling and very 
excited. When the friends come, she insists they read for her as well. There is a lot of goodness and 
knowledge in this book.” – Primary caregiver, female, book treatment group
c. “The book has helped us because there are a lot of things that we learn it is not just me. There are many 
who can learn as we stay in this family, what we need to do.” – Primary caregiver, female, book 
treatment group
d. “This book helps to prepare children for school, if you continue teaching the child even at their time of 
enrollment, they can be well informed already on some subject especially with reading.” – Primary 
caregiver, female, book treatment group
e. “It helps very much because the child will know what is in the book and the child will become intelligent 
if you teach them how to read and tell stories. Even at school when the teacher will be asking questions 
the child will be smart.” – Primary caregiver, female, book treatment group
f. “In reading the book, there is no challenge. Anytime you want to read, you can read. Sometimes just 
after eating lunch, you get the book and start reading. Even at night before you go to bed, you just get 
the book and start reading.” – Primary caregiver, female, book treatment group
34
8. DISCUSSION
This report details the key quantitative and qualitative findings from the endline evaluation of the SUpErCDZ 
project, implemented by RTC-Z in partnership with BUSPH and Swiss TPHI. Using a cluster-randomized
controlled design, in 2019 we enrolled a cohort of 1,108 children aged 0-5 months from unique households
and followed them prospectively over a two year period. We were able to follow-up 934 (84.3%) of the 
children enrolled at baseline two years later in 2021. We sought to determine differences in the primary, 
intermediary, and secondary outcomes between the control and treatment groups. At endline we also 
enrolled a sub-cohort of 852 older siblings within the same households to assess the impact of delivering the 
Zambia Folklores Children’s Book intervention on school readiness. 
a. Key Findings for Objective 1: To assess the outcomes and effects of the 
intervention on early childhood development outcomes (as assessed through the 
index children)
There were no statistically significant differences between the control and treatment groups at baseline 
regarding characteristics of the index children, primary caregivers, or households. Additionally, there were no 
differences between the groups in the child’s physical development as measured by height-for-age z-scores, 
cognitive development as measured by the CREDI, child-caregiver interactions, or caregiver mental health 
status at baseline. At endline, we were able to successfully follow 934 index children, with 15.4% loss to follow￾up for the study sample. 
Preliminary findings of our intention-to-treat analysis at endline suggest no significant impact of the 
intervention on our primary outcomes of stunting or cognitive development scores. However, significant 
impacts was observed in our key intermediary and secondary outcomes including child dietary diversity and 
caregiver-child interactions, both important behavioral indicators on the theoretical pathway to improved 
development. Data cleaning and analysis is ongoing to ensure that all control variables are captured and 
accounted for in our findings. 
Because the study was randomized at the zonal level, some contamination was anticipated, meaning that 
members in the control group may have attended parenting group meetings or heard lessons from friends or 
relatives that had attended. It is also possible that people in the treatment zones did not attend lessons. 
Therefore, with continued analysis, the effect of the intervention on those that participated in it (not just living 
in zones randomized to the intervention) will be examined by looking both at self-report from the impact data, 
but also by critically examining our process data and attendance records. This analysis will help better 
understand and interpret the impact findings, identify predictors of participation at the individual level, and 
understand the dose delivered and received at the individual level. These are all important implementation 
science analyses critical for understanding in a more nuanced manner if the intervention worked and if so, 
how to better deliver it. 
35
b. Key Findings for Objective 2: To describe and document the degree to which the 
Government-supported Zambian Folklore Children’s Book affects child 
development (as assessed through the older siblings)
At endline a cohort of 852 older siblings was enrolled between the ages of five and eight to assess the impact 
of delivering the Zambia Folklores book on school readiness. Overall, there were no statistically significant 
differences in endline child characteristics and baseline household characteristics between the control and 
treatment groups. 
Preliminary findings suggest that the community-based parenting group intervention had a significant positive 
impact on siblings’ IDELA z-scores. The Zambian Folktales Book intervention had a modest impact on the social￾emotional domain of the IDELA and had no impact on the other domains or overall assessment score. We have 
not yet controlled for children’s scores at baseline, and plan to control for other relevant covariates as we 
continue analysis. 
As noted previously, we intend to examine the effect of the intervention on the treatment group by comparing 
those that participated in it to those who did not. We plan to use attendance records to triangulate self￾reported attendance to parenting groups to understand the treatment received. We also intend to triangulate 
self-reported book receipt with distribution records. Some individuals in the control group report receiving a 
book from a friend, family member, or other member of the community, thus receiving the intervention. 
Study Strengths and Limitations
This study employed a rigorous design for a two-intervention, four-arm cluster-randomized controlled trial 
following a cohort of children prospectively over a two-year period. This design allowed for assessment of two 
different ages of children within the same households to determine the effect of two separate interventions 
targeted at different age-groups: a parenting group intervention targeted at children 0-5 years of age, and a 
culturally appropriate children’s book intervention targeted at children before entering Grade 1. Our zonal 
randomization procedures to study arm (control vs. treatment), combined with the multi-stage random 
sampling procedures employed at baseline ensured that the cohort of households enrolled into the study were 
balanced on all potential confounders (see Baseline Report for further information). Additionally, extensive 
household, caregiver, and child-level data to measure primary, intermediary, and secondary outcomes were 
collected at baseline and endline. Lastly, an extensive mixed methods process evaluation was conducted to 
understand implementation fidelity, barriers and facilitators to implementation, and community and 
implementer perception and adoption of the program. These data are not reported on here, but their results 
have been distributed in previous reports. 
While strong in design, a few limitations to this study remain. Due to the unforeseen and ongoing global 
COVID-19 pandemic, there were multiple instances of intervention interruption to adhere to Ministry of 
Health guidelines. At multiple timepoints, national guidelines restricted any gatherings, including parenting 
groups established through this intervention. However, this only delayed program implementation slightly. 
When restrictions were lifted, parenting groups resumed meetings, gathering more frequently if needed to 
cover all curriculum lessons. Additionally, to ensure confidence, safety, and continued participation in the 
program among group participants, measures were instituted during parenting groups to prevent 
transmission of COVID-19, including use of handwashing stations and hand sanitizer, meeting outdoors or in 
well-ventilates spaces, mask wearing, and change of any touch-based activities to no longer require touch.
To increase participant safety during endline data collection and reduce the possibility of transmitting COVID￾19 to these dispersed rural communities, data collections were limited to specific geographic areas (assigned 
specific health facility zones) for the duration of their activities. This may have contributed to the higher-than-
36
expected ICCs for the main outcome indicators. However, these higher ICCs were likely partially driven by high 
population correlations generally for these indicators. Additionally, assessor fixed effects were controlled for 
in the regression models, and the ICCs did not substantially affect the power of the study.
9. CONCLUSION
The preliminary results suggest: (1) no significant impact of the CBPG intervention on primary outcomes 
stunting and cognitive development, but they do suggest significant impact on all intermediary and many 
secondary outcomes including child dietary diversity, caregiver-child interactions, and caregiver mental 
health; (2) modest impact of the Zambian Folktales Book intervention on social-emotional domain of the IDELA 
with no impact on the other domains or overall assessment scores.
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11. ANNEXES
a. Endline Household Survey Instrument
b. Endline In-Depth Interview Instrument
1
Instrument ID: 
The SUpERCDZ Project
Endline Impact Evaluation – Household Survey ENGLISH
Target Audience: Caregiver or guardian of child 24 to approximately 29 months old, enrolled in the 
baseline impact cohort. Caregive must be currently ≥ 15 years of age and must have lived within the
study catchment areas at baseline.
Data Collector Name: _______________________
Data Collector ID: ______________
Today’s Date (DDMMYYYY): 
INSTRUCTIONS: Ensure you and any adult participant are wearing a face mask, that it is worn correctly (covering 
both nose and mouth), and that you are practicing social distance (at least 1 meter apart from any other person). 
Children are not required to wear masks.
Introduction to Household
INTERVIEWER: “Your household is being approached because we are following up on a survey that you or 
someone in this household participated in about two years ago when a child in the household was between 0-5 
months of age. At the time, you or someone in this household enrolled in our research study to learn about 
knowledge and practices related to early childhood development within your community and understand if 
parenting groups are helpful. This is the follow-up visit we discussed then. We are asking you to voluntarily give 
us some more information on the child and household.
We will first confirm that you or someone in your household are enrolled in the study and that you or they had 
previously given informed consent. Are you willing to answer a few short questions to confirm your household 
previously participated in this study? If we confirm, you will then have the choice to continue with a longer survey 
either now or at a time that is more convenient for you.
Saying yes to this screening does not mean you have to continue your participation in the study. If you have any 
questions, please ask them now or at any time you can contact Miss Thandiwe Ngoma at +260-211-253515.”
2
CONFIRMATORY SCREEN
INSTRUCTIONS: For the confirmatory screen questions below, if you are using SurveyCTO on 
tablets, the names should be pulled from a preloaded database. If you are using a paper list, find 
the names of the household head, caregiver, and index child associated with the UID for this 
household. You must ensure you are at the correct household and interviewing the correct 
caregiver before proceeding with the survey.
SS0 Please enter the UID for this 
household that you are attempting to 
contact today
SS0a Have you been notified by the SMAG 
or someone else in the village that this 
household has shifted outside of the 
current zone?
YES (1)
NO (0)
If (0), skip to SS1
SS0b Are the following individuals still part 
of the HH in this new location?
HH HEAD
CAREGIVER
INDEX CHILD
If index child selected, skip to SS2b
If index child not selected, ask SMAG where index 
child now resides. Restart new form when index 
child is identified and provide new household 
member infromation.
SS1 Is this the household of [HH 
head name]?
YES, STILL HEAD OF HOUSEHOLD (1)
YES, NO LONGER HEAD OF HOUSEHOLD (2)
NO (0)
If (1), skip to SS2
SS1a What is the name of the 
current household head?
SS2 Is [index child name] born in
[month and year of DOB]
currently part of this 
household?
If possible confirm DOB from 
child’s Clinic Card. Confirm 
UID on child’s Clinic Card 
matches what you have.
YES (1)
NO, NEVER PART OF HOUSEHOLD (2)
NO, SHIFTED (3)
NO, CHILD DECEASED (4)
If (1) or (2), skip to SS3.
If (3), go to SS2a
If (4) skip to SS2f
SS2a When did this stop being 
where [index child name] 
stayed?
WITHIN THE LAST MONTH (1)
WITHIN THE LAST 6 MONTHS (2)
WITHIN THE LAST 12 MONTHS (3)
WITHIN THE LAST 24 MONTHS (4)
OTHER (SPECIFY) (5) ____________________________
DON’T KNOW (96)
SS2b Where does [index child name] stay (now)?
If within a study district, ask for HFCA, zone, 
and village name.
If outside of study district, ask for province, 
district, and village name.
SS2c What is the name of the household head 
where [index child name] (now) stays?
SS2d Would you be willing to give me the contact 
details for someone in the household where 
the child (now) stays?
Continue to question 
SS3
SS2e When did [index child name]
die?
WITHIN THE LAST MONTH (1)
WITHIN THE LAST 6 MONTHS (2)
WITHIN THE LAST 12 MONTHS (3)
3
WITHIN THE LAST 24 MONTHS (4)
OTHER (SPECIFY) (5) ____________________________
DON’T KNOW (96)
SS2h How old was [index child 
name] when s/he died?
Include age in months
MONTHS
SS2i What did [index child name]
die from?
ASPHYXIA (SUFFOCATION) (1)
PNEUMONIA/RESPIRATORY ILLNESS (2)
COVID-19/CORONAVIRUS DISEASE (3)
SEPSIS (BLOOD INFECTION) (4)
DIARRHEA (5)
HYPOTHERMIA (TOO COLD) (6)
MALARIA (7)
ACCIDENT (8)
OTHER (SPECIFY) (9) ______________________________
DON’T KNOW (96)
SS2j Did [index child name] have a 
positive COVID-19 test before 
s/he died?
YES (1)
NO (0)
DON’T KNOW (96)
SS3 Is [caregiver name] still the 
primary caregiver for [index 
child name]?
YES, STILL PRIMARY CAREGIVER (1)
NO, PRIMARY CAREGIVER CHANGED (0)
If (1) skip to SS4
If (0) go to SS3a
SS3a What is the name of the 
primary caregiver for [index 
child name]?
SS3b When did [new caregiver 
name] become the primary 
caregiver for [index child 
name]?
WITHIN THE LAST MONTH (1)
WITHIN THE LAST 6 MONTHS (2)
WITHIN THE LAST 12 MONTHS (3)
WITHIN THE LAST 24 MONTHS (4)
OTHER (SPECIFY) (5) ____________________________
DON’T KNOW (96)
If (1) ask to speak 
with [cargiver name].
If (2), (3), or (4), ask 
to speak with [new 
caregiver name]
SS3c Is [caregiver name] available 
to speak with me?
YES (1)
NO (0)
If (1) continue to 
SS3d with [caregiver 
name]. If (0) skip to 
SS4 with [new 
caregiver name]
SS3d May I please to speak with [caregiver name]? 
INSTRUCTIONS: re-read Introduction to Household Survey above to the current caregiver of the 
index child.
SS4 You are eligible to participate 
in a longer survey. Would you 
be willing to learn more 
through informed consent? 
YES (1)
NO (0)
If (0), skip to SS5
PROCEED WITH CONFIRMING INFORMED CONSENT.
PLACE A UNIQUE ID STICKER ON THE CONSENT/ASSENT FORM FOR STUDY RECORDS.
INSTRUCTIONS: Make sure to obtain consent (or assent and guardian consent if the caregiver is 15, 16 or 17 
years old) from the caregiver, including a signature. If the caregiver is not able to sign, please have the 
caregiver provide a thumbprint.
SS5 Was consent granted? YES (1)
NO (0)
If consent was granted, 
skip to Module A. 
If consent was NOT 
granted, ask to reschedule 
to a more convenient time.
4
SS6 Would you consider scheduling a 
more conventient time for us to 
return to conduct the survey?
YES (1)
NO (0)
If (1), reschedule 
household visit. 
If (0), continue to SS7.
SS7 If the caregiver has refused to 
participate in the study and will 
not reschedule for a more 
convenient time, please provide 
the reason why.
Select all that apply
NOT INTERESTED (1)
HUSBAND NOT AVAILABLE TO PROVIDE 
PERMISSION (2)
DOES NOT HAVE THE TIME (3)
UNWILLING BECAUSE OF ANTHROPOMETRY (4)
OTHER, SPECIFY (5): 
___________________________
If consent was not 
given, thank the 
caregiver and end the 
survey.Do not continue 
with the rest of the 
survey. 
CONTINUE ONLY IF CONSENT FROM THE CAREGIVER WAS CONFIRMED.
If the participant withdraws from the study at any point, go to question J4 and then enter the 
reason for withdrawal. Then finalize the work as completed and report the withdrawal to your field 
coordinator.
5
MODULE A. LOCATION
INSTRUCTIONS: Complete this section before administering the rest of the survey.
NO. FIELD POTENTIAL RESPONSES
A0 Is this household still located in [village] in 
[zone]?
YES (1)
NO (0)
A1 Province EASTERN (1)
SOUTHERN (2)
A2 District CHOMA (1)
KALOMO (2)
PEMBA (3)
NYIMBA (4)
A3 Health 
Facility 
Catchment 
Area
CHOMA DISTRICT
MASUKU MISSION (05)
MBABALA (06)
SIMAKUTU (10)
KALOMO DISTRICT
CHILALA HC (01)
KANCHELE HC (04)
MUKWELA HC (08)
SIACHITEMA HC (09)
PEMBA DISTRICT
JEMBO (02)
NYIMBA DISTRICT
KACHOLOLA RHC (03)
MKOPEKA RHC (07)
A4 Health 
Facility 
Zone
CHILALA (01)
CHIKANTA (01)
HANZEMBWE (02)
KAMINYA (03)
LUKWATA (04)
MOONDE (05)
MUFUMBILA (06)
MWAPANA (07)
MWEEBO (08)
NANYEMU (09)
SICHIMBWALI (10)
STATIC (11)
JEMBO (02)
BULANDA (12)
JALILA (13)
JEMBO (14)
MAAMBO (15)
MICHELO (16)
KACHOLOLA (03)
CHINYATI (17)
KALIUTA (18)
KAMILEMBO (19)
MAILESI (20)
MALILANGWE (21)
MOMBE (22)
MWANSANIKA (23)
MWENGELELE (24)
SIVILI (25)
TANZYA (26)
KANCHELE (04)
CHAWILA (27)
CHINTAMBA A (28)
CHINTAMBA B (29)
KALA FARMS (30)
KALIDA (31)
KALUNDU (32)
KANCHELE (33)
MABELE (34)
MWIITA (35) 
ZIBANGA (36)
MASUKU MISSION (05)
CHIPANGA (37)
CHUULU (38)
MATEMENA (39)
MAYAKAYAKA (40)
MBULUMWIINGA (41)
MUCHENJE (42)
SIAMAKANDO (43)
SIKAKWA (44)
SIKANCHALI (45)
SINGUWA (46)
MBABALA (06)
CENTRAL (47)
CHISIKILI (48)
HALUMBA (49)
KABUMBWE (50)
KASAMU (51)
MANDAL (52)
MAUBWE (53)
ROSS (54)
MKOPEKA (07)
CHOWA (55)
KAKWEBE (56)
KAPAKASA (57)
LUPALA (58)
MILLIASI (59)
MKOPEKA (60)
MTAUSI (61)
VIZIMUMBA (62)
MUKWELA (08)
CONTINENTAL (63)
MILDERTON (64)
MUKAZIWA (65)
MUKWELA (66)
SAMONA (67)
SOUTH HILL (68)
SIACHITEMA (09) 
CHIBOMBOMA (69)
KALISOWE (70)
KAPONDO (71)
KATETE (72)
KATUNDULU (73)
NJEZYA (74)
SIACHITEMA (75)
SIAMABELE (76)
SIMBUNJI (77)
SIMAKUTU (10)
MUCHINDU (78)
MWANACHILENGA (79)
PATASI (80)
SIAMALUBA (81)
SIANDIBUBI (82)
A5 Village name
INSTRUCTIONS: Take the GPS coordinates twice using your tablet.
GPS COORDINATES, TAKE 1
A6 Latitude (decimal degrees format)
A7 Longitude (decimal degrees format)
GPS COORDINATES, TAKE 2
A8 Latitude (decimal degrees format)
A9 Longitude (decimal degrees format)
A10 Start time of interview 
(24:00 format)
:
6
MODULE B. HOUSEHOLD ENUMERATION
INTERVIEWER: “I am now going to ask you some basic information about you and the members of your 
household. For the purposes of the following questions, let us define a household as a group of related or 
unrelated people who usually live together on a premise, acknowledge the same person as the head of the 
household, and who have a common cooking and eating arrangement.”
NO. QUESTION POTENTIAL RESPONSES SKIP
B1 What is your current role in the household? HOUSEHOLD HEAD (1)
ACTING AS HOUSEHOLD HEAD WHILE HE/SHE IS 
AWAY/UNAVAILABLE (2)
NOT HOUSEHOLD HEAD (3)
If (1), skip to B4. 
B2 What is your relationship with the head of 
the household? 
The household head is my _____.
SPOUSE (1)
FATHER/MOTHER (2)
GRANDFATHER/GRANDMOTHER (3)
SON/DAUGHTER (4)
UNCLE/AUNTIE (5) 
OTHER, SPECIFY (6): _________________
B3 Sex of current household head? MALE (0)
FEMALE (1)
INSTRUCTIONS: Only complete B4 through B9 below if SS3 = (0), i.e. the primary caregiver of the index child 
has changed since baseline. 
B4 Sex of current respondent MALE (0)
FEMALE (1)
B5 How old were you at your last birthday?
Unit of response in years. 
B6 Have you ever attended school? YES (1)
NO (0)
DON’T KNOW (96)
If (0) or (96), 
skip to B8
B7 What is the highest grade you completed?
Write grade level (i.e. 03 for grade 3).
If <1 year completed, write down 00.
If >12 years completed, write down 13. DON’T KNOW (96)
B8 What is your religion? CATHOLIC (1)
PROTESTANT (2)
SEVENTH DAY ADVENTIST (3)
PENTECOSTAL (4)
OTHER (SPECIFY) (5): _________________
NO RELIGION (6)
B9 What tribe do you belong to? TONGA (1)
NSENGA (2)
NGONI (3) 
CHEWA (4) 
BEMBA (5)
OTHER (SPECIFY) (6): ________________
INSTRUCTIONS: Complete B10 through B25 for all respondents.
B10 What is your marital status? MARRIED/COHABITING (1)
DIVORCED (2)
SEPARATED (3)
WIDOWED (4)
NEVER MARRIED (5)
For the next question, I will ask you to try to read as much of a sentence as you are able to. Some people will be able 
to read all or part of the sentence, others won’t be able to read any of it. It is okay if you are unable to read it. Please 
do not feel embarrassed. Please try to read whatever you are able to. You can choose which of the four sentences 
you would like to try to read.
7
B11 I would like you to read one of these 
sentences to me.
Show literacy card to respondent. Respondent can 
choose any sentence to read. If respondent cannot 
read one whole sentence, probe with: Can you 
read any part of the sentence to me?
CANNOT READ AT ALL (1)
ABLE TO READ ONLY PART OF
THE SENTENCE (2)
ABLE TO READ WHOLE SENTENCE (3)
NO CARD WITH REQUIRED LANGUAGE (4)
BLIND/VISUALLY IMPAIRED (5)
B12 How many times have you been pregnant?
B13 How many live births have you had?
B14 For how many children under 18 years of age 
are you currently the primary caregiver?
B15 Have you been very sick for at least 3 months 
in the last 12 months that you were too sick 
to work or do normal activities?
Note: These do not have to be consecutive or 
continuous months.
YES (1)
NO (0)
If (0) skip to B17
B16 Did this illness prevent you from providing 
adequate care to [name]?
YES (1)
NO (0)
B17 Do you have any disability? 
Select all that apply
NO (0)
BLINDNESS/VISUAL IMPAIRMENT (1)
HEARING LOSS/HEARING IMPAIRMENT (2)
ABNORMAL LIMB (3) 
CLEFT LIP/PALATE (4)
HEART DEFECT (5)
NEURAL TUBE DEFECT (E.G. SPINA BIFIDA, ETC) (6)
EPILEPSY/SEIZURES (7)
DOWN SYNDROME OR OTHER DEVELOPMENTAL 
PROBLEM (8)
MENTAL ILLNESS (9)
OTHER (SPECIFY) (10):_______________________
REFUSED TO ANSWER (11)
DON’T KNOW (96)
If (0) skip to B19
B18 Does this disability prevent you from 
providing adequate care to [name]?
YES (1)
NO (0)
B19 How many boys and girls under the age of 5 
usually live in your household? 
Include children who are in boarding school at the 
moment. If none, write down 00. 
BOYS 
GIRLS
B20 How many boys and girls between 5 and 17 
years of age usually live in your household? 
Include yourself if applicable.
Include children who are in boarding school at the 
moment. If none, write down 00.
 BOYS
 
 GIRLS
B21 How many men and women 18 years or older 
usually live in your household? Include 
yourself if applicable.
 MEN
WOMEN
B22 Count and record the total number (B19 to B21) of 
household members. 
8
B23 Confirm with respondent: There are a total of 
[number] people in your household, is that 
correct? 
YES (1)
NO (0) 
9
INTERVIEWER: “Now I am going to ask some additional questions about the children who are 17 years of age and under (ages 0-17) in your household. I will also ask to look at each 
child’s Under-5 card if they are available.”
INSTRUCTIONS: Start with column A – list all the children 17 years of age and under in the household. Start with the index baby randomly selected before. Then complete the rest 
of the columns. Follow the skips as relevant.
B24 A B C D E F G H I J K L
Name
First Name & 
Surname
Sex
MALE 
(0)
FEMALE 
(1)
Age
What is the 
birthweight 
for [name]?
For children 
under 2 years 
of age, ask to 
see the child’s 
clinic card.
Early Childhood Education
Month and 
year of 
birth
(MM/YYYY)
When
possible, 
extract from 
Child’s Clinic
Card
Age in 
months
For children
under 2 years 
only
Write 00 if 
child less than 
1 month
Skip to F
Age in 
years
For 
children
2 to 17 
years of 
age
Skip to G
Has [name] ever 
attended formal care 
(early nursing or 
education programs) 
prior to entering school
(Grade 1)?
YES, NURSERY SCHOOL (1)
YES, COMMUNITY SCHOOL (2)
NO PRE-GRADE EDUCATION (0)
DON'T KNOW (96)
IF (0) or (96),
skip to column M 
What is the 
name of the 
early nursing 
or education 
programs
[name]
attends/ 
attended?
List all attended
At what age did 
[name] begin 
formal care 
(early nursing 
or education 
programs)?
If <1 year, write 
00. If don’t know, 
write 96.
How many 
years of formal 
care (early 
nursing or 
education 
programs) did 
[name] attend?
If <1 year, write 00
How many 
hours per 
week did 
[name] 
attend 
formal care 
(early 
nursing or 
education 
programs)?
If <1 hour, 
write 00
Is [name] 
currently 
attending 
early nursing 
or education 
programs?
YES (1)
NO (0)
DON’T KNOW 
(96)
Only to be asked 
for children <8 
years
1 
(Index)
2
3
4
5
6
7
8
9
10
INSTRUCTIONS: For B25, look at question B24 (household roster) above. Copy the names of all children aged 0-9 in the household in the tables below.
INTERVIEWER: “I have a few additional questions about the children in the household aged 0 to 9 years old.”
B24 A (same as above) M N O P Q R S T U
Name
First Name & 
Surname
Schooling (Skip for children <7 years) Nutrition Program Participation
Are you the 
primary caregiver 
to [name]?
YES (1)
NO (0)
How long has 
[name] been a 
usual member of 
this household?
< 1 MONTH (1)
1 TO 6 MONTHS (2)
7 TO 12 MONTHS (3)
MORE THAN 12 
MONTHS (4)
DON’T KNOW (96)
Has [name]
ever attended 
school?
YES (1)
NO (0)
IF NO (0), skip to 
column R
What is the 
name of the 
school [name]
attends/ 
attended?
List all attended
At what age 
did [name] 
begin 
attending 
school?
What is the 
highest grade 
[name] 
completed?
Write 03 for grade 3.
If <1 year completed, 
write 00.
Is [name] 
currently in 
school?
YES (1)
NO (0)
DON’T KNOW 
(96)
In the last 7 days, 
was [name] given 
micronutrient 
powders, pills, 
sprinkles, or syrup?
YES (1)
NO (0)
DON’T KNOW (96)
In the last 7 days, 
was [name] given 
ready to use 
therapeutic food, 
such as Plumpy’nut?
YES (1)
NO (0)
DON’T KNOW (96)
1 
(Index)
2
3
4
5
6
7
8
9
11
B25 A B C D E F
Name
First Name & 
Surname
On a typical day (24-hour 
period), how much time does
[name] spend using
any electronic screen device 
(i.e.smart phone, tablet, 
video game), or watch 
television, or movies/videos 
on the internet?
Please record this as accurately 
as you can to the nearest minute
How many hours of sleep 
does [name] get in a typical 
24-hour day (including 
naps)?
On a scale of 1 to 7, with the 
higher number indicating higher 
quality, how would you rate the
quality of this child's sleep?
1 indicates very difficult to settle, wakes 
many times during the night for 
prolonged periods and is very restless 
(tosses and turns, throw off bedclothes) 
while 7 indicate settles and drifts off to 
sleep within a few minutes, sleeps right 
through the night, and has a very sound, 
deep sleep. Write 96 for don’t know.
On an average DAY (24 hour
period) in the past week, how 
much time did [name] spend in 
a variety of physical
activities, spread throughout the 
day?
E.g. playing, running, walking, 
swimming, etc.
On an average DAY (24 hour 
period) in the past week, how 
much time did [name] spend in
energetic play that causes
him/her to “huff and puff” and 
increases his/her heart rate?
This would be part of the total time 
spent in a variety of activities
that you just mentioned
1 
(Index)
Hours Minutes Hours Minutes Hours Minutes Hours Minutes
2
Hours Minutes Hours Minutes Hours Minutes Hours Minutes
3
Hours Minutes Hours Minutes Hours Minutes Hours Minutes
4
Hours Minutes Hours Minutes Hours Minutes Hours Minutes
5
Hours Minutes Hours Minutes Hours Minutes Hours Minutes
6
Hours Minutes Hours Minutes Hours Minutes Hours Minutes
12
MODULE C. HOUSEHOLD ASSETS
INTERVIEWER: “Now let’s discuss some information about your house and things you own.” 
NO. QUESTION POTENTIAL RESPONSES SKIP
C1 Does the household have any soap in 
the house now for handwashing?
YES (1)
NO (0)
DON’T KNOW (96) 
C2 Did all pregnant women sleep under 
a mosquito net last night?
YES (1)
NO, BUT SOME DID (2)
NO, NONE DID (3)
N/A, NO PREGNANT WOMEN IN HOUSEHOLD (97)
DON’T KNOW (96)
C3 Did all children <5 years of age sleep 
under a mosquito net last night?
YES (1)
NO, BUT SOME DID (2)
NO, NONE DID (3)
N/A, NO CHILDREN <5 YEARS IN HOUSEHOLD (97)
DON’T KNOW (96)
C4 In the past 30 days was there ever no 
food to eat of any kind in your house 
because of lack of resources to get 
food?
YES, THERE WERE DAYS WITHOUT FOOD (1)
NO, WE ALWAYS HAD FOOD (0)
If (0), skip to 
C6
C5 If Yes to C4, how often did this 
happen in the past 30 days?
RARELY (1-2) (1)
SOMETIMES (3-10) (2)
OFTEN (11+) (3)
DON’T KNOW (96) 
C6 In the past 30 days did you or any 
household member go to sleep at 
night hungry because there was not 
enough food?
YES (1)
NO (0)
DON’T KNOW (96)
If (0), skip to 
C8
C7 If Yes to C6, how often did this 
happen in the past 30 days?
RARELY (1-2) (1)
SOMETIMES (3-10) (2)
OFTEN (11+) (3)
DON’T KNOW (96)
C8 Does your household have any of the 
following?
Note: item must be functioning usually
YES (1) NO (0) DON’T KNOW (96)
A ELECTRICITY □ □ □
B MOSQUITO NET □ □ □
C TELEVISION □ □ □
D MOBILE PHONE □ □ □
E BICYCLE □ □ □
F MOTORCYCLE/MOTOR SCOOTER □ □ □
G ANIMAL-DRAWN CART □ □ □
H CAR/TRUCK □ □ □
NO. QUESTION POTENTIAL RESPONSES SKIP
C9 If your household wanted to borrow 
money from a bank or other formal 
financial service provider, would 
your household be able to borrow 
money?
Note: not including friends or relatives
NO (0)
PROBABLY NOT (1)
PROBABLY YES (2)
DEFINITELY YES (3)
DON’T KNOW (96)
13
MODULE D. CHILD HEALTH AND NUTRITION (INDEX CHILD)
INSTRUCTIONS: Use the Under-5 Card to answer questions D1 through D11. If the caregiver is not able to provide 
the Under-5 card, choose ‘No’ for D1, but get as much information from the primary caregiver regardless. Start 
with the first section on the card “CHILD PARTICULARS” and follow through the other card sections.
INTERVIEWER: “Now I’m going to ask you some questions about [index child name]. Do you have [index child 
name]’s Under-5 Card (clinic card) that I may look at?”
NO. QUESTION POTENTIAL RESPONSES SKIP
D1 Interviewer: Are you able to look at 
the child’s Under-5 (Clinic) Card? 
YES (1)
NO (0)
D2 What was [name]’s place of birth? HEALTH FACILITY/HEALTH POST (1)
HOSPITAL (2)
YOUR HOME (3)
ANOTHER’S HOME (4)
ON THE WAY TO A FACILITY/ON THE ROAD (5)
OTHER (SPECIFY) (6) __________________________
D3 What was [name]’s birth weight?
Note: Choose unit of measurement
Grams (1)
Kilograms (2)
D4 At time of birth, was the following 
present?
Based on Under-5 card tick box 
YES (1)
Ticked on Under-5 Card 
and/or caregiver 
response
NO (0)
Not ticked on Under-5 
Card and/or caregiver 
response
DON’T KNOW (96)
No card/missing/ 
caregiver doesn’t know
A
Birth weight less than 2.5 kgs □ □ □
D5 Has [name] received any deworming 
treatments?
YES, 1 treatment (1)
YES, 2 treatments (2)
YES, more than 2 treatments (3)
NO (0)
INSTRUCTIONS: If available, use the Under-5 card to confirm the vaccines received and mark below. If card 
is unavailable, ask mother which vaccines the child has received. For our purposes it does not matter if the 
child received the vaccine late.
D6 Did [name] receive:
RECEIVED
On under-5 card or 
caregiver response
NOT RECEIVED
Not on under-5 card or 
caregiver response
DON'T KNOW (96)
No card/missing/ 
caregiver doesn’t know
A BCG (TB Vaccine) □ □ □
B
Polio (OPV-0) (Oral Polio 
Vaccine) □ □ □
C Polio (OPV-1) □ □ □
D Polio (OPV-2) □ □ □
E Polio (OPV-3) □ □ □
F Polio (OPV-4) □ □ □
G
Pneumococcal (PCV-1)
(Pneumonia Vaccine) □ □ □
H Pneumococcal (PCV-2) □ □ □
I Pneumococcal (PCV-3) □ □ □
J
DPT-HepB-Hib-1 (Diptheria, 
Pertussis, Tetanus, Hepatitis B,
Haemophilus influenzae type b)
□ □ □
K DPT-HepB-Hib-2 □ □ □
L DPT-HepB-Hib-3 □ □ □
14
M Measles 1 □ □ □
N Measles 2 □ □ □
O Rotavirus-1 □ □ □
P Rotavirus-2 □ □ □
NO. QUESTION POTENTIAL RESPONSES SKIP
D7 Did [name] receive any vitamin 
A supplementation?
YES (1)
NO (0)
NO CARD/MISSING/CAREGIVER DOESN’T KNOW (96)
If (0) or (96), 
skip to D10
D8 If yes, how many times did 
[name] receive vitamin A 
supplementation?
Count the number of dates entered for 
Vitamin A supplementation on the clinic 
card. If NO CARD OR MISSING FROM 
CARD, AND CAREGIVER DOESN’T 
KNOW, record 96.
If (00) or 
(96), skip to 
D10
D9 Based on the number provided 
in D8, include the associated 
dates:
Use the date format: dd/mm/yy
1.
2.
3.
4.
5.
D10 Approximately how many times have you brought 
[name] to the clinic for a well-baby check-up? This 
includes for vaccines and growth monitoring but does 
not include visits when [name] was ill.
D11 Instructions: Count the number of growth monitoring 
entries on child’s clinic card and record the number.
If no card 
available, 
skip to D12
INSTRUCTIONS: Ask the next set of questions to the primary caregiver. No more questions require the 
Under-5 card.
INTERVEIWER: “I would now like to ask you about whether [name]’s relatives are currently alive. These may 
be hard for you. Please take your time to respond and we can pause at any time.”
NO. QUESTION POTENTIAL RESPONSES SKIP
D12 What is your relationship to 
[name]?
I am [name]’s _____________.
MOTHER (BIOLOGICAL) (1)
GRANDMOTHER (2)
AUNTIE (3)
SISTER (4)
COUSIN (5)
FAMILY FRIEND/NEIGHBOR (6)
OTHER (SPECIFY) (7) ______________________________
If (1), skip to D16
D13 Is [name]’s mother currently 
alive? 
YES (1)
NO (0)
DON’T KNOW (96)
If (1) or (96), skip 
to D16
D14 If no, when did she die? ON DAY OF CHILD’S BIRTH (1)
WITHIN 1 MONTH AFTER CHILD’S BIRTH (2)
15
WITHIN THE LAST 12 MONTHS AFTER CHILD’S BIRTH (3)
WITHIN 24 MONTHS AFTER CHILD’S BIRTH (4)
OTHER (SPECIFY) (5) ___________________________
DON’T KNOW (96)
D15 What was her cause of death?
If illness, probe for type of illness 
and positive COVID-19 test before 
death; record.
ILLNESS (SPECIFY) (1)___________________________
ACCIDENT (2)
ACT OF VIOLENCE (3)
OTHER (SPECIFY) (4) ____________________________ 
D16 Is [name]’s father currently 
alive? 
YES (1)
NO (0)
DON’T KNOW (96)
If (1) or (96), skip 
to D19
D17 If no, when did he die? BEFORE DAY OF CHILD’S BIRTH (1)
WITHIN THE LAST 12 MONTHS AFTER CHILD’S BIRTH (2)
WITHIN 24 MONTHS AFTER CHILD’S BIRTH (3)
OTHER (SPECIFY) (4) ___________________________
DON’T KNOW (96)
D18 What was his cause of death?
If illness, probe for type of illness 
and positive COVID-19 test before 
death; record.
ILLNESS (SPECIFY) (1)___________________________
ACCIDENT (2)
ACT OF VIOLENCE (3)
OTHER (SPECIFY) (4) ____________________________
INTERVEIWER: “I would now like to ask you some questions about [name’s] nutrition and eating.”
NO. QUESTION POTENTIAL RESPONSES SKIP
D19 Was [name] ever breastfed?
YES (1)
NO (0)
DON’T KNOW (96)
If (0) or (96), skip 
to D25
D20
How long after birth was [name] first put
to the breast?
If less than 1 hour, record ‘00' hours; if less than 24 hours, 
record hours; otherwise, record days. If not applicable, 
record ’97;’ If don’t know, record ’96.’
Hours Days 
D21
In the first three days after delivery, was
[name] given anything to drink other
than breast milk? (ie: water, cooking oil, 
formula, etc)
YES (1)
NO (0)
DON’T KNOW (96)
D22 Is [name] still breastfeeding?
YES (1)
NO (0)
DON’T KNOW (96)
D23
How old was [name] when you first gave 
him/her water or other liquids?
If child <1 month old, write 00. If don’t know, write 96.
Months
D24
How old was [name] when you first gave 
him/her porridge, fruits, or other food?
If child <1 month old, write 00. If don’t know, write 96.
Months
INSTRUCTIONS: Read the questions below. Read the list of liquids to the caregiver one by one and mark yes, 
no, or don’t know, ACCORDINGLY. 
INTERVIEWER: “Next I would like to ask you questions about liquids or foods that [name] may have had 
yesterday during the day or night. “
D25 Did [name] have any item from list? YES (1) NO (0) / DON’T KNOW
A Plain water? □ □
B Juice or juice drinks? □ □
16
C Clear broth? □ □
D Milk such as tinned, powdered, or fresh animal milk? □ □
E Infant formula? □ □
F Any other liquids? □ □
G Light/thin porridge? □ □
H Yogurt or sour milk? □ □
I Any Provita, Delight, Cerelac, Soya Porridge? □ □
J
Bread, rice, noodles, porridge, nshima or other foods 
made from grains? □ □
K
Pumpkin (not including leaves), carrots, squash or 
sweet potatoes that are yellow or orange inside?
□ □
L
White potatoes, yams, cassava, or any other foods 
made from roots?
□ □
M
Any dark green, leafy vegetables, cassava leaves, 
rape, sweet potato leaves, or spinach?
□ □
N Ripe mangoes, paw paw, apricot, or watermelon? □ □
O Any other fruits or vegetables? □ □
P Liver, kidney, heart or other organ meats? □ □
Q
Any meat such as beef, pork, lamb, goat, chicken, 
duck, field mice, or soya pieces?
□ □
R Eggs? □ □
S Fresh or dried fish or shellfish? □ □
T
Any foods made from beans, peas, lentils, 
groundnuts, or other nuts?
□ □
U Cheese or other food made from milk? □ □
V
Any caterpillars, other insects or other small proten 
foods?
□ □
W Any other solid, semi-solid, or soft food? □ □
X
Oil, vegetable oil, or butter (including food made 
with it)? □ □
INTERVIEWER: “I will now ask you questions regarding health services [name] may have recently received.” 
NO. QUESTION POTENTIAL RESPONSES SKIP
D26 Has [name] had fever in the 
past two weeks?
YES (1)
NO (0)
DON’T KNOW (96) 
If (0) or (96), skip to D30
D27 If Yes to D26: Did you take
[name] anywhere to address the 
fever?
YES (1)
NO (0)
DON’T KNOW (96)
If (1), continue to D28
If (0), skip to D29
If (96), skip to D30
D28 If Yes to D27: Where did you 
first take [name] for care?
HEALTH FACILITY/HEALTH POST (1)
HOSPITAL (2)
COMMUNITY HEALTH WORKER/SMAG (3) 
PHARMACY (4)
TRADITIONAL HEALER (5)
OTHER (SPECIFY) (6): ________________
Skip to D30
D29 If No to D27: Why did you not 
seek care for [name]?
Select all that apply
NO MONEY (1)
NO TIME (2)
DIDN’T THINK IT WAS SEVERE (3)
DIDN’T KNOW WHERE TO GO (4)
OTHER (SPECIFY) (5) ________________
17
D30 Has [name] had diarrhea in the 
past two weeks?
YES (1)
NO (0)
DON’T KNOW (96)
If (0) or (96), skip to D35
D31 How was child fed/breastfed 
during the diarrhea?
MUCH LESS THAN USUAL (1)
SOMEWHAT LESS (2)
ABOUT THE SAME (3)
MORE THAN USUAL (4)
D32 Did you take [name] anywhere 
to address the diarrhea?
YES (1)
NO (0)
DON’T KNOW (96)
If (1), continue to D33
If (0), skip to D34
If (96), skip to D35
D33 If Yes to D32: Where did you 
first take [name] for care?
HEALTH FACILITY/HEALTH POST (1)
HOSPITAL (2)
COMMUNITY HEALTH WORKER/SMAG (3) 
PHARMACY (4)
TRADITIONAL HEALER (5)
OTHER (SPECIFY) (6): ________________
D34 If No to D32: Why did you not 
seek care for [name]?
Select all that apply
NO MONEY (1)
NO TIME (2)
DIDN’T THINK IT WAS SEVERE (3)
DIDN’T KNOW WHERE TO GO (4)
OTHER (SPECIFY) (5) ________________
D35 Has [name] had difficulty 
breathing and/or cough in the 
past two weeks?
YES (1)
NO (0)
DON’T KNOW (96)
If (0) or (96), skip to D39
D36 If Yes to D35: Did you take
[name] anywhere to address the 
difficulty breathing/cough?
YES (1)
NO (0)
DON’T KNOW (96)
If (1), continue to D37
If (0), skip to D38
If (96), skip to D39
D37 If Yes to D36: Where did you 
first take [name] for care?
HEALTH FACILITY/HEALTH POST (1)
HOSPITAL (2)
COMMUNITY HEALTH WORKER/SMAG (3) 
PHARMACY (4)
TRADITIONAL HEALER (5)
OTHER (SPECIFY) (6): ________________
Skip to D39
D38 If No to D36: Why did you not 
seek care for [name]?
Select all that apply
NO MONEY (1)
NO TIME (2)
DIDN’T THINK IT WAS SEVERE (3)
DIDN’T KNOW WHERE TO GO (4)
OTHER (SPECIFY) (5) ________________
D39 Did [name] sleep under a bed 
net last night?
YES (1)
NO (0)
DON’T KNOW (96)
18
MODULE E. CHILD DEVELOPMENT & STIMULATION (INDEX CHILD)
INSTRUCTIONS: If caregiver provides 5 “NO” responses in a row in the list below, skip to E2 (next table).
INTERVIWER: “Now I am going to ask you about the types of thing [name] is currently able to do. Please answer 
"YES" or "NO" to these questions. If you are unsure, you can also answer by saying “DON’T KNOW.” Please keep 
in mind that children learn and grow at different rates, so it is fine if [name] can't yet do these things. Some of 
these skills children only achieve at older ages. If there is any question you feel uncomfortable answering, please 
let me know and we can move to the next question.”
E1 Please respond to the following questions about what [name] is 
currently able to do: YES (1) NO (0) DON'T KNOW 
(96)
A Can the child sit or play on his/her own for at least 20 minutes? □ □ □
B
Can the child walk several steps on his/her own, without holding on 
or receiving support?
Show illustration
□ □ □
C
Can the child bend down to the ground and stand up again
without falling and without holding onto a person or object?
Show illustration
□ □ □
D
Does the child ask you for help using signs or words when
he/she cannot do something on his/her own (e.g., to reach an 
object up high)?
□ □ □
E Does the child try to repeat sounds or words said by other people? □ □ □
F
Can the child climb onto an object such as a chair or
bench?
Show illustration
□ □ □
G
Can the child figure out how to turn a spoon or object if
you give it to him/her the wrong way around? □ □ □
H
Does the child stop at least briefly when told “no” or “stop
that"? □ □ □
I
Can the child kick a ball or other round object forward
using his/her foot?
Show illustration
□ □ □
J
Can the child point to a person or object when asked (e.g.,
“Where is mama?" or "Where is the ball?")? □ □ □
K
Can the child drink from a cup (without a lid) on his/her
own without spilling?
Show illustration
□ □ □
L
Does the child imitate animal or other sounds (e.g.,
"vroom" for a car, "moo" for a cow)? □ □ □
M
Can the child run more than a few steps without falling or bumping 
into objects?
Show illustration
□ □ □
N
Can the child draw a line or shape on paper with a pen or crayon, or 
in the dirt with a stick?
Show illustration
□ □ □
O
Can the child answer simple questions (e.g., “Do you want water?”) 
by saying "yes" or "no", rather than nodding? □ □ □
19
P
Can the child stack three or more small objects (e.g., blocks, cups, 
bottle caps) on top of each other?
Show illustration
□ □ □
Q
Does the child imitate others' behaviors (e.g., washing hands or 
dishes)? □ □ □
R
Does the child sometimes share things (e.g., food, toys) with others 
without being told? □ □ □
S
Can the child follow orders or instructions that have more than one 
part (e.g., "Go get water and go to bed")? □ □ □
T
Can the child say five or more separate words (e.g., names like 
"Mama" or objects like "ball")? □ □ □
U
Is the child kind to younger children (e.g., speaks to them nicely and 
touches them gently)? □ □ □
V
Can the child walk on an uneven surface (e.g., a bumpy or steep 
road) without falling?
Show illustration
□ □ □
W Does the child listen to someone telling a story with interest? □ □ □
X
Can the child ask for something (e.g., food, water) by name when 
he/she wants it? □ □ □
Y
Does the child involve others in play (i.e., play interactive games 
with other children)? □ □ □
Z
Can the child correctly name at least one family member other than 
mom and dad (e.g., name of brother, sister, aunt, uncle)? □ □ □
AA
Does the child play by pretending objects are something
else (e.g., imagining a bottle is a doll, a stone is a car, or a spoon is 
an airplane)?
□ □ □
AB Does the child show sympathy or look concerned when others are 
hurt or sad? □ □ □
AC Can the child walk backwards? Show illustration □ □ □
AD
Does the child show curiosity to learn new things (e.g., by
asking questions or exploring a new area)? □ □ □
AE
Can the child feed him/herself using a spoon or other
utensil without spilling?
Show illustration
□ □ □
AF
Can the child concentrate on one task (e.g., playing with
friends, eating meal) for 20 minutes? □ □ □
AG Does the child know the names of at least two body parts
(e.g., arm, eye, or nose)? □ □ □
AH If you show the child an object he/she knows well (e.g., a
cup or animal), can he/she consistently name it? □ □ □
AI
Can the child speak using short sentences of two words
that go together (e.g., “Mama go” or "Dada eat”)? □ □ □
AJ
Can the child use a tool (e.g., a stick or spoon) to reach
objects that are far away? □ □ □
20
AK
Can the child indicate when he/she needs to go to the
toilet? □ □ □
AL Can the child say ten or more separate words (e.g., names
like "Mama" or objects like "ball")? □ □ □
AM Can the child remove an item of clothing (e.g., take off
his/her shirt)? □ □ □
AN Can the child tell you when he/she is tired or hungry? □ □ □
AO Does the child usually finish an activity he/she enjoys (e.g.,
a game or book)? □ □ □
AP
Can the child easily switch back and forth between
activities (e.g., go back to a game after being interrupted)? □ □ □
AQ Can the child sing a short song or repeat parts of a rhyme
from memory by him/herself? □ □ □
AR Can the child jump with both feet leaving the ground? □ □ □
AS
Can the child speak using sentences of three or more words
that go together (e.g., "I want water" or "The house is
big")?
□ □ □
AT Can the child whisper? □ □ □
AU
Does the child greet neighbors or other people he/she
knows without being told (e.g., by saying hello or gesturing hello)? □ □ □
AV Can the child unscrew the lid from a bottle or jar? □ □ □
AW
Can the child correctly ask questions using any of the
words "what," "which," "where," or "who"? □ □ □
AX Can the child correctly use any of the words "I," "you,"
"she," or "he" (e.g., "I go to store," or "He eats rice")? □ □ □
AY Does the child pronounce most of his/her words correctly? □ □ □
AZ Can the child count up to five objects (e.g., fingers,
people)? □ □ □
BA Does the child ask about familiar people other than parents
when they are not there (e.g., "Where is the neighbor?")? □ □ □
BB
If you show the child two objects or people of different
size, can he/she tell you which one is the big one and
which is the small one?
□ □ □
BC Can the child stand on one foot for several seconds without
holding on to a person or object (e.g., wall or furniture)? □ □ □
BD
Can the child identify at least one color (e.g., red, blue,
yellow)? □ □ □
BE Does the child regularly use describing words such as
"fast," "short," "hot," "fat," or "beautiful" correctly? □ □ □
BF
If you point to an object, can the child correctly use the
words "on," "in," or "under" to describe where it is (e.g.,
"The cup is on the table" instead of "The cup is in the
table.")
□ □ □
21
BG Can the child explain in words what common objects like a
cup or chair are used for? □ □ □
BH Can the child dress him/herself (e.g., put on his/her pants
and shirt without help)? □ □ □
BI Does the child ask "why" questions (e.g., "Why are you
tall?")? □ □ □
BJ
If you ask the child to give you three objects (e.g., stones,
beans), does the child give you the correct amount? □ □ □
BK Does the child usually put objects or toys back where they
belong after using them? □ □ □
BL Does the child frequently act impulsively or without
thinking (e.g., running into the street without looking)? □ □ □
BM
Does the child sometimes save things like candy or new
toys for the future? □ □ □
BN
Can the child say what others like or dislike (e.g., "Mama
doesn't like fruit," "Papa likes football")? □ □ □
BO Can the child fasten and unfasten buttons without help? □ □ □
BP
Can the child talk about things that will happen in the future using 
correct language (e.g., "Tomorrow he will
attend school" or "Next week we will go to the market")?
□ □ □
BQ
Can the child talk about things that have happened in the
past using correct language (e.g., "Yesterday I played with
my friend" or "Last week she went to the market")?
□ □ □
BR Does the child know the names of any letters (e.g., A, B,C)? □ □ □
INTERVIEWER: “We are interested in knowing the kinds of things you and your children do in the home on a 
regular basis. I'm going to ask you questions about you and [name].”
NO. QUESTION POTENTIAL RESPONSES SKIP
E2 How many children’s toys are there in your household 
in total?
Toys can be store-bought or homemade. Store-bought 
means anything purchased outside of the house. This can 
be a wire car purchased from a market, not only factory 
made toys.
If 0, skip to 
E2
E3 Are the toys store-bought or homemade? PRIMARILY STORE BOUGHT (1)
HALF STORE BOUGHT/HALF 
HOMEMADE (2)
PRIMARILY HOMEMADE (3)
DON’T KNOW (96)
E4 Children play with a lot of different things. What kinds 
of things do you have that children play with?
YES
(1)
NO
(0)
DON’T KNOW
(96)
A. Toys made by an adult □ □ □
B. Household objects □ □ □
C. Materials from outside the house (e.g. sticks, 
rocks, animals, shells, leaves, etc) □ □ □
D. Toys that make music □ □ □
E. Toys for building things □ □ □
22
F. Things for drawing and writing □ □ □
G. Things for moving a lot, like balls, rattles, bat, 
hopping rope □ □ □
H. Toys for pretending like dolls, sticks for animals, 
pretend cups, plates □ □ □
I. Other thing child plays with
SPECIFY: _________________________ □ □ □
E5
In the past 3 days, did you or 
any household member engage 
in any of the following activities 
with [name]? 
Select all that apply
YES, 
MOTHER 
(1)
YES, 
FATHER
(2)
YES, OLDER 
SIBLING 15+ 
YEARS
(3)
YES, 
SOMEONE 
ELSE 15+ 
YEARS
(4)
YES, 
SOMEONE 
ELSE LESS 
THAN 15 
YEARS
(5)
NO 
ONE
(6)
A
Read books or looked at picture 
books with [name]?
□ □ □ □ □ □
B Told stories to [name]? □ □ □ □ □ □
C
Sang songs to or with [name], 
including lullabies? □ □ □ □ □ □
D
Took [name] outside the home, 
compound, yard, or enclosure? □ □ □ □ □ □
E Played with [name]? □ □ □ □ □ □
F
Named, counted, or drew 
things to or with [name]?
□ □ □ □ □ □
E6
In the past 7 days, on how many days did you or any other adult family member do the following 
with [name]? 
If no one did this activity in the past 7 days, record 00. If the caregiver doesn’t know, record 96.
A Read books or looked at picture books with [name]?
Days
B Told stories to [name]?
Days
C Sang songs to or with [name], including lullabies?
 Days
D
Took [name] outside the home, compound, yard, or 
enclosure?
Days
E Played with [name]?
Days
F Named, counted, or drew things to or with [name]?
Days
INTERVIEWER: “I am interested in knowing more about the books you have in your household. Would you 
please collect all of the books (including children’s school books) in the household for me to look at briefly?”
INSTRUCTIONS: Answer the following questions based on the books you were provided
NO. QUESTION POTENTIAL RESPONSES SKIP
E7 About how many children’s books or picture 
books do you have for [name]?
NONE (1)
1-2 BOOKS (2)
3-5 BOOKS (3)
6-9 BOOKS (4)
10-19 BOOKS (5)
20 OR MORE BOOKS (6)
23
E8 How many other books are there in the 
household?
e.g school books, adult-focused books, bibles and 
other religious books
NONE (1)
1-2 BOOKS (2)
3-5 BOOKS (3)
6-9 BOOKS (4)
10-19 BOOKS (5)
20 OR MORE BOOKS (6)
E9 Do you know about the Zambian Folktales 
Children’s Book?
Check to see if the children’s book is included in 
the ones provided
YES (1)
NO (0)
DON’T KNOW (96)
If (0) or (96) 
skip to 
Module F
E10 Did you ever receive a copy of the Zambian 
Folktales Children’s Book?
YES (1)
NO (0)
DON’T KNOW (96)
If (0) or (96) 
skip to 
Module F
E11 If yes to E10, how many copies did you receive?
E12 If yes to E10, who did you receive the book(s) 
from?
If more than one copy, select all that apply
COMMUNITY-BASED VOLUNTEER (E.G. 
SMAG, CHW, ETC) (1)
HEAD MOTHER/FATHER IMPLEMENTING 
THE PARENTING GROUPS (2)
FAMILY MEMBER (3)
NEIGHBOR/FRIEND (4)
DON’T KNOW (96)
E13 Do you still have (at least one) copy of the book
in the house today?
YES (1)
NO (0)
DON’T KNOW (96)
IF (1) GO TO 
E14, IF (0) OR 
(96) SKIP TO 
E15
E14 What condition is the book currently in? INTACT AND USABLE (1)
TORN, MISSING PAGES, OR SLIGHTLY
DAMAGED (2)
SIGNIFICANTLY DAMAGED/UNREADABLE (3)
OTHER (SPECIFY) (4) ________________
DON’T KNOW (96)
SKIP TO E16
E15 If No to E13, what happened to the copy of the 
book your received?
SEVERELY DAMAGED (1)
LOST/STOLEN (2)
LENT TO OTHER HOUSEHOLD (3)
OTHER (SPECIFY) (4) _________________
DON’T KNOW (96)
SKIP TO E17
E16
In the past 3 days, did you 
or any household member 
engage in any of the 
following activities with 
any children under 10?
Select all that apply
YES, 
MOTHER (1)
YES, 
FATHER
(2)
YES, 
OLDER 
SIBLING 
15+ YEARS
(3)
YES, 
SOMEONE 
ELSE 15+ 
YEARS
(4)
YES, 
SOMEONE 
ELSE LESS 
THAN 15 
YEARS
(5)
NO 
ONE
(6)
A
Read from the Zambian 
Folktales Children’s Book? □ □ □ □ □ □
B
Looked at pictures from 
the Zambian Folktales 
Children’s Book?
□ □ □ □ □ □
C
Sang songs from the 
Zambian Folktales 
Children’s Book?
□ □ □ □ □ □
D
Told stories from the 
Zambian Folktales 
Children’s Book?
□ □ □ □ □ □
NO. QUESTION POTENTIAL RESPONSES
E17 How is the book primarily used in this household? NO ONE READS (1)
24
Select all that apply 
If the household no longer has the book, ask how 
the book was primarily used when they had it.
I READ TO MY CHILD(REN) (2)
MY HUSBAND/PARTNER READS TO MY CHILD(REN) (3)
ANOTHER ADULT IN THE HOUSEHOLD READS TO MY 
CHILD(REN) (4)
MULTIPLE READ TOGETHER AS A GROUP WITH THE 
CHILD(REN) (5)
NEIGHBORS/FRIENDS/FAMILY OUTSIDE THE HOUSEHOLD 
READ TO MY CHILD(REN) (6)
OLDER CHILD(REN) READ THE BOOK TO YOUNGER 
CHILD(REN) (7)
YOUNG CHILD(REN) LOOK AT THE PICTURES TOGETHER (8)
MY CHILD(REN) LOOKS AT THE PICTURES ALONE (9)
OTHER (SPECIFY) (10) _________________
E18 To what degree do you agree or disagree with 
the following statements about the Zambian 
Folktales Children’s Book?
DISAGREE 
COMPLETELY
(1)
DISAGREE 
A LITTLE 
BIT 
(2)
AGREE A 
LITTLE BIT 
(3)
AGREE 
COMPLETELY 
(4)
A
The stories are engaging to the child(ren) and 
adults in my household □ □ □ □
B
My child(ren) learn a lot of good things from the 
stories □ □ □ □
C
I like that the stories have morals and teach life 
lessons □ □ □ □
D
The stories in the book remind me of ones my 
ancestors told □ □ □ □
E
I have read the stories to my child(ren) multiple 
times □ □ □ □
F
The instructions and questions at the back of the 
book are useful □ □ □ □
G
I could easily understand the language used in the 
books □ □ □ □
H My child(ren) like the pictures in the book □ □ □ □
I
My child(ren) have shown more interest in 
reading since the book arrived □ □ □ □
J
My child(ren) have been read to more frequently 
since the book arrived □ □ □ □
K
The exterior of the book is easily torn and worn 
out □ □ □ □
L
My book is still in good condition even if we use it 
very often □ □ □ □
M I would like a more durable book cover □ □ □ □
N
I find it difficult to find time to read to my 
child(ren) □ □ □ □
O
Even if I had a busy schedule, I would 
create time to read the stories with my 
children
□ □ □ □
P
Those who are unable to read have difficulties 
using this book with their children □ □ □ □
Q I would buy a book like this if I saw it in a shop □ □ □ □
R
I would recommend this book to another 
caregiver □ □ □ □
NO. QUESTION POTENTIAL RESPONSES SKIP
25
E19 Do you have ideas for other folk tales or stories 
to include in the Zambian Folk Tales Children’s 
Book?
YES (1)
NO (0)
IF (0) SKIP TO 
MODULE F
E20 Could you please provide the name of the folk 
tale(s) or story(ies) and/or a brief description?
MODULE F. CAREGIVER PERSPECTIVES & WELLBEING
INTERVIEWER: “This next section asks about your perspectives and opinions as a caregiver. I am going to ask you 
whether you agree or disagree with some statements about looking after young children. There are no right or 
wrong answers, we just want to know what you think or feel. You can also ask me to repeat the statements.”
INSTRUCTIONS: WHILE ALL OTHER SCALES IN THIS INSTRUMENT BEGIN WITH THE NEGATIVE (DISAGREE), BE 
AWARE THAT THIS SCALE BEGINS WITH THE POSITIVE (AGREE). PLEASE READ IT TO THE RESPONDENT THE WAY 
IT IS WRITTEN.
F1 To what degree do you agree or disagree with the 
following statements?
AGREE 
COMPLETELY
(1)
AGREE A 
LITTLE BIT 
(2)
DISAGREE A 
LITTLE BIT 
(3)
DISAGREE 
COMPLETELY 
(4)
A Too much love and attention will spoil a child. □ □ □ □
B
A parent needs to spank or beat young children 
when they are rude or they will grow up to be 
bad.
□ □ □ □
C
It is important that a busy mother spend plenty 
time talking with her little baby. □ □ □ □
D
It is not necessary / important for parents to 
look at picture books with children less than 2 
years old.
□ □ □ □
E
The best way to get a child to behave is to praise 
him/her when s/he is good. □ □ □ □
F
It is important that a busy mother should spend 
plenty time playing with her young child. □ □ □ □
G
There is no need to give toys to children less 
than 1 year old. □ □ □ □
H A time for play is important for young children. □ □ □ □
I
Singing and chatting with your baby will help 
him/her learn. □ □ □ □
J
Children should not be given crayons until they 
are ready to learn to write. □ □ □ □
K
Young children should not be held when they cry 
because this will make them want to be held all 
the time.
□ □ □ □
26
L
How a parent behaves with her child when s/he 
is young affects how well s/he will learn in 
school.
□ □ □ □
M
It is important that I do all of my chores and 
work before playing, singing or interaction with 
my children.
□ □ □ □
N
The way my child feels (sad, happy, withdrawn) 
should not matter to me as a parent if I am 
providing food for his physical growth
□ □ □ □
O
A parent can stimulate speech development in 
their children by talking and reading to/with them. □ □ □ □
P Hygiene is part of ensuring I have healthy children □ □ □ □
INTERVIEWER: “Now I would like to ask a few questions about how you are feeling. The following questions 
are related to certain pains and problems that may have bothered you in the past 30 days. If you think this 
question applies to you and you had the described problem in the past 30 days, answer YES. If the question 
does not apply to you and you did not have the problem in the past 30 days, answer NO. Do not discuss these 
questions with me. If you are unsure about what to answer just give the best answer you can.”
F2 In the past 30 days… YES (1) NO (0) REFUSED TO 
ANSWER (98)
A Have you had headaches often? □ □ □
B Have you had a poor appetite? □ □ □
C Have you slept badly? □ □ □
D Have you been easily frightened? □ □ □
E Have your hands shaken? □ □ □
F Have you felt nervous, tense, or worried? □ □ □
G Have you had poor digestion? □ □ □
H Have you had trouble thinking clearly? □ □ □
I Have you felt unhappy? □ □ □
J Have you cried more than usual? □ □ □
K
Have you found it difficult to enjoy your daily 
activities? □ □ □
L Have you found it difficult to make decisions? □ □ □
M Has your daily work suffered? □ □ □
N Have you feltunable to play a useful role? □ □ □
O Have you lost interest in things? □ □ □
P Have you felt that you are a worthless person? □ □ □
Q
Has the thought of ending your life been on your 
mind? □ □ □
27
R Have you felt tired all the time? □ □ □
S
Have you had uncomfortable feelings in your 
stomach? □ □ □
T Have you been easily tired? □ □ □
INTERVIEWER: “We are interested in how you feel about the following statements.”
F3 How to you feel about the 
following statements?
VERY 
STRONGLY 
DISAGREE
(1)
STRONGLY 
DISAGREE
(2)
MIDLY 
DISAGREE
(3)
NEUTRAL
(4)
MIDLY 
AGREE
(5)
STRONGLY 
AGREE
(6)
VERY 
STRONGLY 
AGREE
(7)
A
There is a special person who 
is around when I am in need □ □ □ □ □ □ □
B
There is a special person with 
whom I can share my joys 
and sorrows.
□ □ □ □ □ □ □
C
My family really tries to help 
me. □ □ □ □ □ □ □
D
I get the emotional help and 
support I need from my 
family.
□ □ □ □ □ □ □
E
I have a special person who is 
a real source of comfort to 
me.
□ □ □ □ □ □ □
F
My friends really try to help 
me. □ □ □ □ □ □ □
G
I can count on my friends 
when things go wrong. □ □ □ □ □ □ □
H
I can talk about my problems 
with my family. □ □ □ □ □ □ □
I
I have friends with whom I 
can share my joys and 
sorrows.
□ □ □ □ □ □ □
J
There is a special person in 
my life who cares about my 
feelings
□ □ □ □ □ □ □
K
My family is willing to help 
me make decisions. □ □ □ □ □ □ □
L
I can talk about my problems 
with my friends. □ □ □ □ □ □ □
28
INTERVIEWER: “For the following questions, please respond only if you feel comfortable doing so. I will be asking 
about your HIV status, current use of antiretroviral therapies (ART), and disclosure of HIV status”
NO. QUESTION POTENTIAL RESPONSES SKIP
F4 What is your current HIV status? NEGATIVE (0)
POSITIVE (1)
DON’T KNOW (96)
PREFER NOT TO ANSWER (98)
If (0), (96), or (98), 
skip to Module G
F5 Are you currently using ART? YES (1)
NO (0)
DON’T KNOW (96)
PREFER NOT TO ANSWER (98)
F6 Have you disclosed your current status to any of 
the following?
Select all that apply
HUSBAND/PARTNER (1)
FAMILY MEMBER (2)
RELIGIOUS LEADER (3)
FRIEND (4)
OTHER (SPECIFY) (5) _________________
Module G: Group Participation & Perspectives
INTERVIEWER: “This next section asks about your participation and perspectives on community groups. There are 
no right or wrong answers, we just want to know what you do and percieve.”
NO. QUESTION POTENTIAL RESPONSES SKIP
G1 Have you ever attended a parenting group 
about child care?
Probe to ensure we do not miss caregivers who have 
attended the community-based parenting groups
YES (1)
NO (0)
DON’T KNOW (96)
If (1), skip 
to G4
G2 Has [name] ever been brought to a parenting 
group about child care by another individual?
YES (1)
NO (0)
DON’T KNOW (96)
If (0) or 
(96) skip to 
Module H
G3 Who has brought [name] to a parenting group 
about child care?
Answer the question in relation to [name], meaning 
[name]’s _________.
PARENT (1)
GRANDPARENT (2)
AUNTIE/UNCLE (3)
OTHER RELATIVE/HOUSEHOLD MEMBER (4)
OTHER (SPECIFY) (5) __________________
Skip to 
Module H
G4 If Yes to G1, what village does the parenting 
group usually meet in? 
G5 If Yes to G4, what is the name of the head 
mother who usually runs the parenting group?
G6 Are you currently attending this group (i.e. 
have attended within the last 2 months)?
YES (1)
NO (0)
G7 How often does the group meet per month? < 1 TIME PER MONTH (1)
1 TIME PER MONTH (2)
2-3 TIMES PER MONTH (3)
4 TIMES PER MONTH (4)
5+ TIMES PER MONTH (5)
G8 How often do you attend the group? EVERY TIME IT MEETS (1)
MOST TIMES IT MEETS (2)
ABOUT HALF THE TIME (3)
ONLY RARELY (4)
29
G9 What is your main challenge in attending the 
group? 
Select only one
DISTANCE OR TRANSPORT (1)
BUSY WITH CHILDREN (2)
BUSY WITH WORK/CHORES (3)
HUSBAND/OTHERS DO NOT ALLOW (4)
OTHER [SPECIFY] (5) _____________________
NONE (6)
INTERVIEWER: “We are interested in how you feel about the following statements.”
G10 How to you feel about the following 
statements?
STRONGLY 
DISAGREE
(1)
DISAGREE
(2)
NEUTRAL
(3)
AGREE
(4)
STRONGLY
AGREE
(5)
A
The activities in each parenting group lesson 
were relevant to the subject of the day □ □ □ □ □
B
The information in the parenting group lessons 
was relevant to my family and me □ □ □ □ □
C
The games, activities, and short plays in the 
lessons helped me to understand the material □ □ □ □ □
D
It is okay to have a male lead the parenting 
groups □ □ □ □ □
E
It is okay to have men learn together with 
women in parenting groups □ □ □ □ □
F
The information in the lessons was culturally
appropriate. □ □ □ □ □
G
I could easily understand the language the head 
mother used during the parenting group 
lessons
□ □ □ □ □
H
I would prefer if the lessons were also 
conducted in another language □ □ □ □ □
I
The information provided during the lessons 
was too difficult/complicated □ □ □ □ □
J
The meeting time for the parenting group 
lessons was convenient for me □ □ □ □ □
K
The location for our parenting group meetings 
was convenient for me □ □ □ □ □
L
I would like to continue attending parenting 
group meetings □ □ □ □ □
M
I would encourage other people to join 
parenting group meetings □ □ □ □ □
N
I missed parenting group meetings because 
they did not seem as valuable as other things □ □ □ □ □
O
I helped select the head mother who taught us 
during the parenting group meetings □ □ □ □ □
P
The head mother(s) who taught our parenting 
group meetings was knowledgeable □ □ □ □ □
Q
The head mother(s) encouraged us to 
participate during parenting group meetings □ □ □ □ □
30
R
The head mother(s) asked us questions during 
parenting group meetings □ □ □ □ □
S
The head mother seemed to enjoy teaching the 
parenting groups □ □ □ □ □
T
I feel prepared to provide my child with highly 
nutritious meals from none to low cost □ □ □ □ □
U
I feel prepared to make toys for my child using 
readily available materials □ □ □ □ □
V
I feel prepared to make simple clothes for my 
child □ □ □ □ □
W
I regularly completed the tasks I was given at 
parenting group meetings such as the village of 
dreams homework
□ □ □ □ □
X
I have learned new ways of raising my child 
from the parenting group meetings □ □ □ □ □
Y
The parenting group lessons reminded me of 
the knowledge I already knew □ □ □ □ □
Z
I have become more attentive to my child's 
well-being because of attending the parenting 
groups
□ □ □ □ □
AA
I have learned new ways of cooking from 
parenting groups □ □ □ □ □
AB I enjoyed the songs and games played during 
the parenting group lessons □ □ □ □ □
AC
My husband/partner has attended one or more 
parenting group meetings □ □ □ □ □
AD I have made new friends through this group □ □ □ □ □
AE I enjoy spending the group time with other 
women who also have young children □ □ □ □ □
AF I felt supported by the other caregivers in the 
parenting group □ □ □ □ □
AG
I spend time with other caregivers from the 
parenting group outside of the parenting group 
meeting times
□ □ □ □ □
AH In general I am satisfied with the parenting 
groups □ □ □ □ □
AI If given the opportunity, I would continue 
attending the parenting groups □ □ □ □ □
NO. QUESTION POTENTIAL RESPONSES SKIP
G11 I found the length of each parenting group 
meeting to be:
TOO SHORT (1)
IDEAL (2)
TOO LONG (3)
G12 I found the number of times a month the 
parenting groups met to be:
TOO FEW (1)
IDEAL (2)
TOO MANY (3)
31
Module H: COVID-19-related Behaviors
INTERVIEWER: “This next section asks about your perspectives and behaviors related to COVID-19. There are no 
right or wrong answers, we just want to know what you do and percieve.”
NO. QUESTION POTENTIAL RESPONSES SKIP
H1 In your opinion, what is your risk of catching COVID-19 
disease?
Select one
VERY LOW (1)
LOW (2)
MODERATE (3)
HIGH (4)
VERY HIGH (5)
H2 From where do you primarily receive information 
about COVID-19 and prevention methods?
Select top 3
HEALTH CENTER STAFF (1)
COMMUNITY-BASED VOLUNTEERS (2)
TRADITIONAL LEADERS (3)
OTHER COMMUNITY LEADERS (4)
OTHER FAMILY MEMBERS (5)
FRIENDS/NEIGHBORS (6)
SOCIAL MEDIA (7)
RADIO (8)
TV (9)
OTHER (96), SPECIFY: ____________________ 
INSTRUCTIONS: Ask questions H3-H13 only at households attending community-based parenting groups 
(G1=1). If G1=0 or 96, skip to H14.
H3 Where was your last parenting group meeting 
located?
Select all that apply
INDOORS IN A BUILDING (1)
IN A TENT (2)
OUTDOORS (3)
H4 Approximately how many other people were at the 
parenting group while you were there?
H5 Did you wear a mask when you went to the parenting 
group? 
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
If (0) or (96), 
skip to H8
H6 While at the parenting group, did you wear the mask 
over your mouth?
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
If (5) or (96), 
skip to H8
H7 While at the parenting group, did you were the mask 
over both your mouth and nose?
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
G13
The three most useful skills I developed during 
the parenting group meetings include:
Read the options to the respondent and have 
then select their top three choices.
SING TO MY CHILD (1)
PLAY GAMES WITH MY CHILD (2)
READ TO MY CHILD (3)
COOK NUTRITIOUS FOOD FOR MY CHILD (4)
MAKES CLOTHES FROM AVAILABLE MATERIALS (5)
MAKE TOYS FROM AVAILABLE MATERIALS (6)
IDENTIFY SIGNS OF ILLNESS IN MY CHILD (7)
OTHER (SPECIFY) (8) _______________________
32
H8 Were other people at the parenting group wearing 
masks most or all time?
Select one
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
If (5) or (96), 
skip to H10
H9 Were other people at the parenting wearing the mask 
over both their mouth and nose most or all of the 
time?
Select one
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
H10 While at the parenting group, did you sit or stand one 
meter apart from other people?
Select one
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
H11 Were other people at the parenting group sitting or 
standing one meter apart from each other most or all 
of the time?
Select one
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
H12 What handwashing facilities were available for 
participants at the parenting group?
Select all that apply
NOTHING WAS AVAILABLE (0)
WATER (1)
SOAP (2)
ASH (3)
HAND SANITIZER (4)
OTHER (5) SPECIFY:____________
If (0), skip to 
H14
H13 Approximately how many times did you use one of 
those handwashing options while at the parenting 
group?
DID NOT USE THEM (0)
USED ONCE (1)
USED TWICE (2)
USED THREE OR MORE TIMES (3)
DON’T KNOW (96)
33
H14 HEALTH FACILITY 
(ANY SERVICES)
CHURCH/
RELIGIOUS SERVICE FUNERAL OTHER
SPECIFY: _________
A In the last two 
weeks, did you 
attend [gathering]?
NO (0)
YES (1)
DON’T KNOW (96)
If (0) or (96), skip to next 
type of gathering
NO (0)
YES (1)
DON’T KNOW (96)
If (0) or (96), skip to next 
type of gathering
NO (0)
YES (1)
DON’T KNOW (96)
If (0) or (96), skip to next 
type of gathering
NO (0)
YES (1)
DON’T KNOW (96)
B Where was the 
[gathering] 
located?
INDOORS IN A BUILDING (1)
IN A TENT (2)
OUTDOORS (3)
INDOORS IN A BUILDING (1)
IN A TENT (2)
OUTDOORS (3)
INDOORS IN A BUILDING (1)
IN A TENT (2)
OUTDOORS (3)
INDOORS IN A BUILDING (1)
IN A TENT (2)
OUTDOORS (3)
C Approximately how 
many other people 
were at the 
[gathering] while 
you were there?
D While at the 
[gathering], did you 
wear a mask? 
NO (0)
YES (1)
DON’T KNOW (96)
NO (0)
YES (1)
DON’T KNOW (96)
NO (0)
YES (1)
DON’T KNOW (96)
NO (0)
YES (1)
DON’T KNOW (96)
E While at the 
[gathering], did you 
wear the mask over 
your mouth?
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
F While at the 
[gathering], did you 
were the mask over 
both your mouth 
and nose?
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
G At the [gathering], 
were other people 
wearing masks?
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
H At the [gathering], 
were other people 
wearing masks over 
both their mouth 
and nose?
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
I While at the 
[gathering], did you 
sit or stand one 
meter apart from 
other people?
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
YES, THE WHOLE TIME (1)
YES, MOST OF THE TIME (2)
YES, SOME OF THE TIME (3)
YES, BUT RARELY (4)
NO (5)
DON’T KNOW (96)
J At the [gathering], 
were other people 
sitting or standing 
one meter apart 
from each other 
most or all of time?
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
YES, EVERYONE (1)
YES, MOST PEOPLE (2) 
YES, ABOUT HALF (3)
YES, BUT VERY FEW (4)
NO, NONE (5)
DON’T KNOW (96)
K What handwashing 
facilities were 
available at the 
[gathering]?
Select all apply
WATER (1)
SOAP (2)
ASH (3)
HAND SANITIZER (4)
OTHER (5) 
SPECIFY:_____________
NOTHING WAS AVAILABLE (6)
WATER (1)
SOAP (2)
ASH (3)
HAND SANITIZER (4)
OTHER (5) 
SPECIFY:_____________
NOTHING WAS AVAILABLE (6)
WATER (1)
SOAP (2)
ASH (3)
HAND SANITIZER (4)
OTHER (5) 
SPECIFY:_____________
NOTHING WAS AVAILABLE (6)
WATER (1)
SOAP (2)
ASH (3)
HAND SANITIZER (4)
OTHER (5) 
SPECIFY:_____________
NOTHING WAS AVAILABLE (6)
L Approximately how 
many times did you 
use one of those 
handwashing 
options while at the 
[gathering]?
DID NOT USE THEM (0)
USED ONCE (1)
USED TWICE (2)
USED THREE OR MORE 
TIMES (3)
DON’T KNOW (96)
DID NOT USE THEM (0)
USED ONCE (1)
USED TWICE (2)
USED THREE OR MORE 
TIMES (3)
DON’T KNOW (96)
DID NOT USE THEM (0)
USED ONCE (1)
USED TWICE (2)
USED THREE OR MORE 
TIMES (3)
DON’T KNOW (96)
DID NOT USE THEM (0)
USED ONCE (1)
USED TWICE (2)
USED THREE OR MORE 
TIMES (3)
DON’T KNOW (96)
 SURVEY ID 
34
MODULE I. INTIMATE PARTNER VIOLENCE
INTERVIEWER: “This is our last series of questions. I would like to ask you questions about some other important 
aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial 
for helping to understand the condition of women in Zambia. We will make sure again that no one nearby can 
overhear these questions or your responses to these questions. If I ask you any question you don't want to answer, 
just let me know and I will go on to the next question. Please respond only if you feel comfortable doing so. If you 
need a break during these questions or would like to stop, please let me know. As a reminder, I will refer you to 
resources if you need them.”
I1
First, I am going to ask you about some situations 
which happen to some women. Please tell me if these 
apply to your relationship with your (last) 
husband/partner?
YES (1) NO (0) REFUSED TO 
ANSWER (98)
A
He (is/was) jealous or angry if you (talk/talked) to 
other men? □ □ □
B
He frequently (accuses/accused) you of being 
unfaithful? □ □ □
C
He (does/did) not permit you to meet your female 
friends? □ □ □
D
He (tries/tried) to limit your contact with your 
family? □ □ □
E
He (insists/insisted) on knowing where you 
(are/were) at all times? □ □ □
I2 INTERVIEWER: “Now I need to ask some more questions 
about your relationship with your (last) 
husband/partner.”
Did your (last) (husband/partner) ever do any of the 
following things to you?
IF YES… How often did this happen during the 
last 12 months: often, only sometimes, or 
not at all?
YES (1) NO (0) OFTEN (1) SOMETIMES 
(2) 
NOT IN LAST 12 
MONTHS (3)
A Say or do something to 
humiliate you in front of 
others?
□ □ □ □ □
B Threaten to hurt or harm you 
or someone you care about? □ □ □ □ □
C Insult you or make you feel bad 
about yourself? □ □ □ □ □
D Push you, shake you, or throw 
something at you? □ □ □ □ □
E Slap you? □ □ □ □ □
F Twist your arm or pull your 
hair? □ □ □ □ □
G Punch you with his fist or with 
something that could hurt you? □ □ □ □ □
H Kick you, drag you, or beat you 
up? □ □ □ □ □
I Try to choke you or burn you 
on purpose? □ □ □ □ □
 SURVEY ID 
35
J Threaten or attack you with a 
knife, gun, or other weapon? □ □ □ □ □
K Physically force you to have 
sexual intercourse with him 
when you did not want to?
□ □ □ □ □
L Physically force you to perform 
any other sexual acts you did 
not want to?
□ □ □ □ □
M Force you with threats or in any 
other way to perform sexual 
acts you did not want to?
□ □ □ □ □
INSTRUCTIONS: If (0) to I1 A-E AND (0) to I2 A-M, skip to Module J.
NO. QUESTION POTENTIAL RESPONSES
I3 How long after you first (got married/started living 
together) with your (last) (husband/partner) did 
(this/any of these things) first
happen?
If less than one year, record '00'. For single women who have a 
partner but have never been married and have not lived with 
their partner, ask ‘how long after the relationship started did any 
of these things first happen?’
YEARS
BEFORE MARRIAGE/BEFORE LIVING 
TOGETHER (95)
I4 Did the following ever happen as a result of what your (last)
(husband/partner) did to you? YES (1) NO (0)
A. A You had cuts, bruises, or aches? □ □
B. B You had eye injuries, sprains, dislocations, or burns? □ □
C. C
You had deep wounds, broken bones, broken teeth, 
or any other serious injury? □ □
 SURVEY ID 
36
MODULE J. SURVEY COMPLETION
INTERVIEWER: “Thank you for taking the time to take our survey. We have now reached the end of the survey.” 
J1 Would you be willing to have someone come back and follow up on a few 
questions from the survey in the next couple of days to check my work?
YES (1)
NO (0)
J2 Do you have 
any additional 
comments you 
might like to 
add?
INSTRUCTIONS: Below questions are for the interviewer only. Do not read to participant.
NO. QUESTION POTENTIAL RESPONSES SKIP
J3 Is this person 
participating in an 
IDI?
YES, ASSIGNED AND AGREED AND AGREE TO PARTICIPATE IN IDI (1)
NO, NOT ASSIGNED (2)
NOT, ASSIGNED BY REFUSED (3)
DON'T KNOW (96)
J4 Did any of the 
following adverse 
events occur during 
the interactions with 
this household?
Select all that apply
Please be honest and 
record all adverse 
events so they can be 
reported to the ethics 
committees. Adverse 
events do not reflect on 
you as an enumerator, 
so report everything 
that has occurred.
HOUSEHOLD WITHDREW AFTER CONSENTING (1)
PARTICIPANT PHYSICALLY INJURED DURING INTERVIEW (2)
PARTICIPANT VISIBLY UPSET/DISTRESSED DURING INTERVIEW (3)
HOUSEHOLD OR COMMUNITY MEMBER UPSET BY YOUR PRESENCE (4)
LOSS OF CONFIDENTIALITY (TABLET OR PAPER FORM LOST) (5)
LOSS OF PRIVACY (SOMEONE UNAUTHORIZED BY PARTICIPANT 
OVERHEARS INTERVIEW) (6)
CURRENT SERIOUS CHILD ILLNESS, SUSPECTED MALNUTRITION, OR 
SUSPECTED DEVELOPMENTAL DELAY (7)
SUSPECTED CHILD ABUSE OR NEGLECT (ESPECIALLY ANY HARM TO A 
CHILD) (8)
MISSING/TAKEN CHILD (9)
LIKELY PHYSICAL OR PSYCOLOGICAL ABUSE OF CAREGIVER (10)
HHS TOOK LONGER THAN 1.5 HOURS TO COMPLETE (NOT INCLUDING 
CONSENTING OR IDI) (11)
OTHER UNDUE HARM CAUSED BY INTERVIEW OR YOUR PRESENCE (12)
NO ADVERSE EVENTS TO REPORT (13)
If (13), 
skip to 
end
INSTRUCTIONS: If (7) refer SMAG to household for follow-up. If (7), (8), (9), or (10) discuss with Field 
Coordinator – referral to appropriate authorities may be required.
J5 Please elaborate 
on the adverse 
events selected in 
J4.
 SURVEY ID 
37
END OF SURVEY
INSTRUMENT REVIEW 
Enumerator Initials: Data Entry Initials:
Date (DD/MM/YYYY) Date (DD/MM/YYYY)
Supervisor Initials: Supervisor Initials:
Date (DD/MM/YYYY) Date (DD/MM/YYYY)
1
Instrument ID: 
The SUpERCDZ Project 
Baseline Impact Evaluation – In-Depth Interview ENGLISH
Target Audience: 
Caregiver or guardian of child 24 to approximately 29 months old, who are ≥ 15 years of age, and who live 
within the study catchment areas. 
Was verbal informed consent (or assent/consent if age 15-17) obtained for this interview during the 
process of informed consent for the household survey? 
□ YES
□ NO – STOP! Thank the participant for their time. Do NOT proceed with the interview.
Step 1: Read the following statement. Please repeat the statement translated into the local language based on primary 
languages.
“Thank you for agreeing to participate in this interview. My name is ______. I will be asking you questions during this 
interview and recording your responses on this machine.”
“We want to understand in greater detail your views on early childhood development. We would also like to 
understand your perspectives on and behaviors related to COVID-19. Please feel free to tell us only what you feel
comfortable sharing. There are no right or wrong answers, so please be honest and help us to understand what is true 
for you. Are you ready to begin?”
Step 2: Ensure you and any adult participant are wearing a face mask, that it is worn correctly (covering both nose and 
mouth), and that you are practicing social distance (at least 1 meter apart from any other person).
Step 3: Proceed to the interview guide. Please probe to obtain as in-depth and specific information you can. 
.
Interviewer Name: ____________________ 
1. Interview Date: 
2 0 2 1
MM DD YYYY
2. Time Start: 
:
H H M M
3. Time Finish: 
:
H H M M
THIS FORM MUST BE TURNED IN TO YOUR FIELD COORDINATOR FOR EVERY IDI 
YOU CONDUCT!
INTSTRUCTIONS: READ THE DATE, UNIQUE ID, AND INTERVIEWER NAME ON THE 
RECORDING BEFORE YOU BEGIN THE INTERVIEW!
SURVEY ID
2
Theme 1: Caregiver-Child Interactions 
INTERVIEWER: “Thank you for agreeing to speak with me today. I’m going to ask you some questions about 
your experiences as a caregiver.”
1a. On a normal day, who generally provides care to the children in your household?
1b. During the household survey, we were talking about [name]. As a caregiver, what things do you do with 
[name] on a typical day from the time he/she wakes up until he/she goes to bed?
o After respondent answers, probe for: 
o Waking up
o Feeding/breastfeeding
o Activities
o Playing
o Singing songs
o Reading books/telling stories
o Caregiver’s work
o Caregiver’s other responsibilities
1c. What do you do with [name] when you need to do tasks such as housework?
Follow-up question:
i. What about when you need to leave the house to fetch water, go to the market, etc.?
1d. How does caregiving for the other children in the household differ from how you care for [name]?
o Why does it differ? 
o Prompt if needed: age, sex of child, relationship to child
1e. What types of things do other caregivers in your community do with children the same age as [name]
that you think are good?
o Prompt if needed:
o For example, what are some good nutrition practices?
o For example, what are some good play practices?
o For example, what are some good practices to prepare children for school?
o For the above, ask: Why they think these things are good?
1f. What types of things do other caregivers in your community do with children the same age as [name]
that you think are bad?
o Prompt if needed:
o For example, what are some bad practices regarding nutrition
o For example, what are some bad practices regarding punishments 
1g. As a caregiver, do you feel you know how to make sure [name] grows healthy and strong? Why or why 
not?
• If No, what would you like to learn more about?
3
1h. As a caregiver, do you feel you have the resources to make sure [name] grows healthy and strong? Why 
or why not?
• After respondent answers, probe for:
o Money
o Food
o Time
o Energy
1i. How do you make decisions on what [name] eats? 
Follow-up: 
• What is good nutrition in children [name’s] age? ***Please be specific***
• How do your choices on what [name] eats differ from what other caregivers in your community do
for their children of the same age as [name]?
1j. How do you make decisions on when to seek health care for [name]?
Follow-up: 
• When is it important to seek health care for children [name’s] age? ***Please be specific***
• How do your choices on when to seek care for [name] differ from what other caregivers in your 
community do for their children of the same age as [name]?
Theme 2: Male Involvement
2a. What do you believe is the role of male caregivers in caring for young children?
2b. In general, what are the roles of male caregivers in caring for young children in this community?
2c. In the last 12 months, has the perception of male involvement with caring for young children changed
in your community? If yes, how has it changed?
2d. What do you suggest should be done to increase male involvement in caring for young children within 
your communities?
Theme 3: Barriers & Facilitators 
INTERVIEWER: “We know critical milestone happen in child development in the first 5 years. Your child is 
approximately 2 years old right now, so the next 3 years are very important. Please answer the next few 
questions by thinking about the next 3 years, assuming the household remains similar to how it is today.”
In the next 3 years, what will be easy to do to ensure that your child grows healthy and strong? Why? 
Please give me specific examples. 
Follow-up questions:
i. What will make providing nutritious food to [name] easy to do?
ii. What will make accessing health care for [name] easy to do?
4
iii. What will make playing with [name] easy to do?
iv. What will make reading books to [name] easy to do?
v. What will make singing songs to [name] easy to do?
vi. What will make giving toys to [name] easy to do?
vii. What will make having [name] interact with other children easy to do?
In the next 3 years, what will be hard to do to ensure that your child grows healthy and strong? Why? 
Please give me specific examples. 
Follow-up questions:
i. What will make providing nutritious food to [name] hard to do?
ii. What will make accessing health care for [name] hard to do?
iii. What will make playing with [name] hard to do?
iv. What will make reading books to [name] hard to do?
v. What will make singing songs to [name] hard to do?
vi. What will make giving toys to [name] hard to do?
vii. What will make having [name] interact with other children hard to do?
3i. As a caregiver, what else would you need to make [name] grow healthy and strong? 
3j. As a caregiver, what do you wish you could do more of for/with [name]? 
Theme 4: Perception of Parenting Groups
INTERVIEWER: “I am now going to ask you to describe the parenting groups in your zone and answer general 
questions about them.”
4a. Tell me about the parenting groups for women in your zone (If applicable)
4b. Have you attended the parenting groups for women? Why or why not? (INTERVIEWER: If no, make sure 
to get explanation of why not then skip to next section)
4c. What were the top three things you liked? Why? ***PLEASE BE SPECIFIC****
Prompts if needed: content, frequency, social aspects
4d. What were three things you didn’t like? Why? ***PLEASE BE SPECIFIC****
4e. Tell me a story about a memorable experience during the parenting group.
5
4f. Tell me a story about how meeting with other women raising children the same age has affected you?
Prompt if needed: Has meeting with other women raising children the same age been helpful or not 
helpful for your own experience? How?
4g. Think back to the toy making skills sessions, please tell us a story about something you found interesting 
or useful.
4h. Think back to the cooking skills sessions, please tell us a story about something you found interesting or 
useful.
4i. Do you think the parenting groups are useful for the mothers? Why/why not?
Follow-up questions
i. Give specific examples of what might be useful for the mothers 
ii. Give specific examples of what might not be useful for the mothers.
4j. Do you think the parenting groups are useful for male caregivers? Why/why not?
Follow-up questions
i. Give specific examples of what might be useful for the male caregivers
ii. Give specific examples of what might not be useful for the male caregivers.
4k. What would you suggest to improve the parenting groups for women? 
Follow-up questions
i. Give an example of one thing you would change
ii. Give an example of one thing you would not change
4l. Tell us about how your group selected the head mother(s). 
Prompts if needed: What was the process? Did you participate?
4m. What types of things do you think makes a good head mother?
6
Theme 5: Zambian Folktales Children’s Book
INTERVIEWER: “I am going to ask you about stories told to children in this community and the Zambian 
Folktales Children’s Book.”
5a. In general, what types of stories do people in this community tell their children, if any? Please give me 
an example.
5b. Can you tell me what you know about the Zambian Folktales Children’s Book, if anything?
Follow-up questions
i. Have you received a book? (if no, skip to next theme)
5c. Tell us about a memorable experience you had with the book?
5d. How, if at all, have you incorporated reading into your home life? 
5e. Can you give me examples of how households without a literate caregiver use the book?
5f. What are your three favorite things about having the book?
5g. What do you think is easy about using the book? Please give examples.
**** (Facilitator: MAKE SURE TO PROBE!) ****
5h. What do you think is challenging about using the book? Please give examples.
**** (Facilitator: MAKE SURE TO PROBE!) ****
5i. Are you finding time to read or competing priorities a challenge? How do you handle this? Please provide 
specific examples.
Follow-up question: What could be done to address those challenges?
5j. How if at all does this book help prepare children for school? 
7
Theme 6: COVID-19
INTERVIEWER: “I am going to ask my last few questions about the COVID-19 pandemic in Zambia.”
6a. Tell me, how concerned are you about getting COVID-19?
Follow-up questions:
i) Why do you feel that way?
ii) How likely do you think it is?
iii) How severe do you think it would be?
6b. What do you hear about COVID-19 from people in your community that you don’t believe or that you 
think is wrong?
6c. How do you protect yourself from catching COVID-19?
6d. Did you, someone in your family, or someone close to you ever had or were exposed to COVID-19? If so, 
please tell me the story about what happened and what the outcome was.
6e. How, if at all, has COVID-19 impacted your daily life? For example, think about school, health visits, 
stress, attendance at social gatherings/church/parenting groups, etc.
Follow-up questions (Ask for things they don’t address initially):
i. How it affected your children going to school? Please give an example.
ii. How has it affected your attendance to groups/meetings? Please give an example.
iii. How has it affected your likelihood of visiting the health center? Please give an example.
iv. How has it affected your well-child visits to the clinic? Please give an example.
v. How has it affected your social support? Please give an example
vi. How has it affected your stress? Please give an example
6g. What have you heard about the COVID-19 vaccine(s)?
Follow-up questions:
i. Have you heard anything that worries you?
ii. Who did you hear this from?
iii. Do you think it’s true? Why?
6h. Have you thought about getting a COVID-19 vaccine? What did you decide? Please explain why you 
made that decision.
8
Follow-up Questions:
i. Who influenced your decision about whether or not to get the COVID-19 vaccine? (Family and 
friends, religious and community leaders, HF staff)
ii. What did they say that influenced you?
iii. What other factors influenced your decision about whether or not to get the COVID-19 vaccine?
(Availability of vaccine, distance, perception of risk, close experience)
6i. Would most people in your community want to get the vaccine if it were easily available? Why or why 
not?
6j. What would make it easier for you or people in your community to get a COVID-19 vaccine? 
6k. What would make it harder for you or people in your community to get a COVID-19 vaccine?
INTERVIEWER: “I have finished with this in-depth interview. Is there anything you would like to add before we 
end?”
Thank you for your time.