Has [name] ever received a vitamin A capsule (supplement) like this one? This question asks if the child has received a supplement. Show the sample capsule or dispenser you were given to help the mother remember. (You may be instructed to show several different capsules, asking the mother to identify the correct one.) Circle the code for her answer. If the child has never received a vitamin A supplement, or the mother/caretaker does not know if he/she has ever received one, draw a line through this module and skip to the next one.
How many months ago did [name] take the last dose? If the answer to Q. 1 was “yes” record the number of months ago the last dose was given to the child. Circle 99 if the mother does not know.
