Healthy Food for Healthy Family
Proportion of children 6-23 months of age who receive a Minimum Acceptable Diet (MAD)



Questionnaire only applicable to children age 6 – 23 months!

1. Age of child (Required)     (age in months)
2. Sex of child (Required)   
3. Has your 6-23 month child ever been breastfed? (Required)   
4. Was the child breastfed yesterday during the day or at night? (Required)   
Dietary Diversity
Please describe everything that this child ate yesterday during the day or night, whether at
home or outside the home. For each food type mentioned, mark the corresponding food group.
Enumerator should read all the food included in the list below
A. Porridge, bread, rice, noodles, or other foods made from grains (Required)   
B. Pumpkin, carrots, squash, or sweet potato that are yellow or orange inside (Required)   
C. White potato, white yams, manioc or any other foods made from roots (Required)   
D. Any dark, green leafy vegetables (Required)   
E. Ripe mangoes, ripe papaya, apricot, ripe cantaloupe, peaches, any fruit that is yellow ororange inside (Required)   
F. Any other fruits or vegetables (Required)   
G. Liver, kidney, heart or other organ meats (Required)   
H. Any meat, such as beef, pork, lamp, goat, chicken, or duck (Required)   
I. Eggs (Required)   
J. Fresh or dried fish, shellfish, or seafood (Required)   
K. Any foods made from beans, peas, lentils, nuts or seeds (Required)   
L. Milk, cheese, yogurt, or other milk products (Required)   
M. Any oils, fat, or butter (Required)   
N. Any sugary foods, such as chocolates, sweets, candies, pastries, cakes, or biscuits(Required)   
O. Condiments for flavour, such as chilies, spices, herbs, or fish powder (Required)   
P. Supplemental Nutritious Foods (List name of foods used for programme or available) (Required)   
Q. Foods made with red palm oil, red palm nut, or red palm nut pulp sauce (Optional, depending on context) (Required)   
Meal Frequency
A. How many times did the child eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night (Required)   
B. How many times yesterday did the child consume any milk such as fresh animal milk or milk mixed in foods? (Required)   
C. How many times yesterday during the day or at night did the child consume any sour milk or yoghurt? (Required)   
D. How many times yesterday during the day or at night did the child consume any infant formula? (Required)