| Check Box | |
| Exclusive breastfeeding (till 6 months of age) | |
| Yes |
|
| No |
|
|
Vitamin A
supplementation |
|
| Given |
|
| Not given |
|
| Measles | |
| No |
|
| Yes |
|
| Incomplete vaccination | |
| No |
|
| Yes |
|
| Kerosene ingestion | |
| No |
|
| Yes |
|
| Antibiotic treatment | |
| No |
|
| Yes |
|
| Hospitalization | |
| No |
|
| Yes |
|
| Acyanotic congenital heart disease | |
| Absent |
|
| Present |
|
| Home treatment tried (other than self-medication) | |
| Yes |
|
| No |
|
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