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I. I. Annexe, Certificat du Comité d'éthique SECTION A: Questionnaire sur le ménage

, Nom et prénom du chef de ménage : ???????????.???????????????? 2. Sexe du chef de ménage : Masculin=1 Féminin=2

, Trois principales occupations du ménage dans l'ordre décroissant d'importance : 1=Agriculteur 2=Elevage 3=Pêche 4=Exploitation forestière (cueillette/bois-charbon/chasse?) 5=Commerçant 6=Transporteur 7=Salarié Public 8=Salarié Privé 9=Ménagère 10=Elève 11=Retraité/Rentier 12=Artisanat, 13=Guide touristique 14=Guérisseur traditionnel 15=Maraboutage/féticheur 16=Autres indépendants 17=Arboriculture/plantation 18= Maraîchage

, Trois principales sources de revenus du ménage dans l'ordre décroissant d'importance : 1= Agriculteur 2= Elevage 3= Pêche 4=exploitation forestière (cueillette/bois-charbon/Chasse?) 5= Commerçant 6=Transporteur 7=Salarié Public 8=Salarié Privé 9 =Artisanat, 10 =Guide touristique 11= Guérisseur traditionnel 12=Maraboutage/féticheur 13= Autres indépendants 14=Arboriculture/plantation 15= Maraîchage, 16= Petit commerce, 17= transferts financiers des migrants, 18= dons et autres formes de solidarité

;. .. Dans-votre-ménage, avez-vous ? Oui=1 Non=0 Electricité (publique ou solaire)

. .. Puits-creusé-protégé,

.. .. Puits-creusé-non-protégé,

, Eau de surface (marigot, bas-fond, rivière)

. .. Eau-de-pluie,

. Robinet-ou-fontaine,

). .. Autre-(précisez,

M. Dans-votre,

. .. Bois,

. .. Charbon-de-bois,

.. .. Gaz,

. .. , Résidus agricoles (paille, branchages, herbes), vol.4

.. .. Pétrole,

, Autre (précisez) _____________________________ 6

.. .. Est-ce-qu'un-membre-de-votre-ménage-possède-;-motopompe??????????? and . ____-charrue?????????????, Charrette tirée par un animal ??.???____ Machine à coudre?????????, Oui=1 Non=0

. .. Bicyclette/-motocyclette,

, Est-ce que votre ménage possède des terres ? Oui=1 Non=0

, Est-ce que votre ménage cultive la terre (y compris le maraîchage et l'arboriculture) ? Oui=1 Non=0

, Est-ce que votre ménage utilise de la main d'oeuvre salariée pour ses activités agricoles ? Oui=1 Non=0

, Est-ce que votre ménage pratique le maraîchage ? si non passer à question 18

, Oui=1 Non=0

, Si oui, quelle est la principale source d'irrigation que votre ménage utilise pour le maraîchage ? (Encerclez l'observation) : Eau de pluie

. .. Eaux-de-décrues,

.. .. Calebasse,

). .. Autre-(précisez,

, Est-ce que votre ménage possède des animaux d'élevage ? Oui=1 Non=0

. Est-ce-que and . .. Bovins, Dépenses en biens de consommation courante alimentaires du ménage Pour chaque article, poser la question si le ménage a acheté un aliment ? Si oui, Oui=1 Non=0

, Lait

C. Beurre,

, Farine (mil, mais, autres céréales)

-. Graines and . Haricots,

, Sucre Chocolat, confiture, bonbons, etc

C. E. Epices and . Jus,

A. Aliment-non-listé and C. ,

, Section D : Volet stock alimentaire

, Avez-vous des stocks de récoltes dans votre ménage actuellement ? (1 =Oui, 0 =Non) si non passez à question 3

. .. , Dans combien de mois pensez-vous que les stocks de récolte seront finis ?

, Votre ménage va-t-il réservé des récoltes pour la semence de la prochaine saison pluvieuse (1 = Oui, 0 = Non)

, Comment vous faites face à la période de soudure, quand les greniers sont vides ?

, Tomates fraîches, gombo frais ou sec, aubergines, aubergines locales, courgettes, courges à chair claire, concombres, choux, oignons, échalote, poivrons verts, haricots verts, betteraves, fleurs de kapokié, laitue (salade à feuilles vert clair), petit pois, pulpe d'oseille

. Pastèque and . Dattes, sauvages (dattes, jujube, ananas, pomme, banane, goyave, avocats, fruits sauvages (raisin, pain de singe/fruit de baobab), pulpe de karité, fruit de liane, chair de fruit de rônier

, de mouton, de chèvre, de chameau, de volailles), viscères (soupe de viscères), sang coagulé Boeuf, mouton, chèvre, lapin, viande de brousse, poulet, pintades, chameau, oiseaux, gazelle, outarde, canard, varan, tortue, insectes, chenilles/vers, margouillats, rats sauvages, agoutis, écureuils, perdrix, serpent, souris, phacochères, biches, etc

, Poisson frais, poisson fumé, salé, séché (sauf pincée de poudre), conserves (sardines, thon, tous coquillages et fruit de mer (crevettes, calamar, poulpe, langouste?), poudre de poisson séchée ou fumée

. Haricots, datou (en grande quantité pour sauce), soumbala (en grande quantité pour sauce),noix de cajou, noix de boscia, noix sauvages, pois chiches, lentille, graine de nénuphar, autres légumes secs, farine enrichie Lait frais, lait en poudre, lait concentré (sucré ou non), lait caillé naturel, yaourt, fromage, préparation pour bébé à base de lait Huile végétale (d'arachide, de sésame, de coco, de dattier sauvage, etc. -pour sauces, assaisonnements, fritures, beignets, galettes...), beurre/huile de karité, beurre de vache, graisses végétales/margarine, mayonnaise, graisses animales, crème fraiche

. Dans-le-thé, vin de palme, miel, confiture, bonbons, biscuits sucrés. Epices, condiments : piment, poivre, vinaigre, ail, sachet d'épices, cannelle, sel, cube Maggi, Maggi blanc, laurier, tomate concentrée, condiment à base d'oseille (graine, feuilles ou pulpe), condiment à base d'oignon ou de feuilles d'oignon séchée/transformée ou d'échalotes séchées, « potasse », condiment à base de racines de navet, condiment à base de soja, noix de cola, jus de tige de boscia, poudre de graine d'alkafoune, Petite quantité de poudre de poisson, de poudre de gombo, poudre de feuilles de baobab séchées, poudre de poivron, de poudre de feuilles de lélé, poudre de soumbala, levure. Thé, Lipton, café, chikoré, choukolan, kinkeliba, jus de feuille ou de fruit de tamarin non sucré, jus de gingembre non sucré, boissons sucrées (boisson gazeuse/sucrerie, bissap, jus de gingembre sucré

, Est-ce que vous avez mangé quelque chose en dehors de la maison hier ? (1 =Oui

/. Nom,

, Date de naissance de l'enfant : Jour/Mois/Année de naissance : ???/???/???? Ou âge en mois

, Sexe de l'enfant 1= Masculin 2= Féminin

, Quelle personne était en charge des repas de l'enfant hier ? 1 =la mère, 2 =la grand-mère, 3= un autre membre adulte de la famille, 4= un membre de la famille de moins de 15 ans 5= des personnes extérieures

, L'enfant a été mis au sein dans la 1 ère heure qui suit sa naissance ? (1= Oui

, il bénéficié du colostrum à la naissance ? (1= Oui

, Est-ce que l'enfant a été allaité hier durant le jour ou la nuit ? (1= Oui

S. Oui, , p.10

, Si non, est-ce que l'enfant a reçu du lait maternel d'une façon différente qu'au sein maternel (lait maternel tiré, lait maternel donné à la cuillère ou dans bol, lait d'une autre mère) hier pendant le jour ou la nuit ? (1= Oui

. Hier,

, du Plumpy Nut ? (1= Oui, 0= Non)

B. De-la, 1= Oui, 0= Non)

, une décoction de feuilles ou de racines, etc (1= Oui

. .. , Est-ce que l'enfant a mangé hier des aliments solides, semi-solides ou mous dans la journée ou la nuit ?, vol.16

, Combien de repas lactés l'enfant a reçu hier ?

, Combien de fois l'enfant a mangé de la nourriture solide, semi-solide ou épaisse hier durant le jour ou la nuit ? 19. Est-ce qu'une maladie quelconque a empêché cet enfant de manger comme à son habitude hier ? (1= Oui, 0= Non) Si non passez à la question 21

, Si oui, est-ce que cette maladie qui a empêché l'enfant de manger comme à son habitude dure depuis plusieurs jours ? (1= Oui

, Est-ce que hier a été un jour de fête (baptême, mariage, décès) ou un jour de marché ? (1= Oui, 0= Non) Si non

S. Oui, 0= Non) Tomates fraîches, gombo frais ou sec, aubergines, aubergines locales, courgettes, courges à chair claire, concombres, choux, oignons, échalote, poivrons verts, haricots verts, betteraves, fleurs de kapokié, laitue (salade à feuilles vert clair), petit pois, pulpe d'oseille, est-ce que cette fête ou ce marché dure depuis plusieurs jours ? (1= Oui

. Dans-le-thé, jus de fruit de pain de singe, citronnelle), vin de palme, miel, confiture, bonbons, biscuits sucrés. Epices, condiments : piment, poivre, vinaigre, ail, sachet d'épices, cannelle, sel, cube Maggi, Maggi blanc, laurier, tomate concentrée, condiment à base d'oseille (graine, feuilles ou pulpe), condiment à base d'oignon ou de feuilles d'oignon séchée/transformée ou d'échalotes séchées, « potasse », condiment à base de racines de navet, condiment à base de soja, noix de cola, jus de tige de boscia, poudre de graine d'alkafoune, Petite quantité de poudre de poisson, de poudre de gombo, poudre de feuilles de baobab séchées, poudre de poivron, de poudre de feuilles de lélé, poudre de soumbala, levure. Thé, Lipton, café, chikoré, choukolan, kinkeliba, jus de feuille ou de fruit de tamarin non sucré, jus de gingembre non sucré, jus de pulpe d'oseille non sucré, eau fermentée de son de mil, jus de feuille de « niaman, boissons sucrées (boisson gazeuse/sucrerie, bissap, jus de gingembre sucré, jus de feuilles ou de fruits de tamarin sucré