29
30
31
32
WARTIME SOCIAL SURVEY
DIPHTHERIA IMMUNISATION
ENQUIRY (NEW SERIES) No. 21 (D.I)
NO QUESTION TO BE PROMPTED UNLESS OTHERWISE DIRECTED
Serial Number
Town or District.............
Urban.............1 Rural.............2
A.............1
B.............2
C.............3
D.............4
|
Parent Interviewed
|
Occupation
|
|
Mother
|
1
|
|
|
Father
|
2
|
|
|
Guardian (legal)
|
3
|
|
|
Guardian (evacuee)
|
4
|
|
|
Age of Parent:
|
Under 20
|
1
|
20-25
|
2
|
26-0
|
3
|
|
31 - 40
|
4
|
41-503
|
5
|
Over 50
|
6
|
|
Husband serving with Forces
|
1
|
|
Husband civilian in Home Guard
|
2
|
|
Husband civilian not in Home Guard
|
3
|
|
Income Group
|
|
£2 and under
|
£2 - £3. 12. 0
|
£3. 12. 1 - £5
|
£5 - £10
|
£10 and over
|
|
1
|
2
|
3
|
4
|
5
|
|
Total number of children 14 or under NOT IMMUNISED
|
|
|
Total number of children 14 or under IMMUNISED
|
|
|
Total number of children 14 or under in family
|
|
Investigator
Date 1942
1. What do you know about Diphtheria?
|
Cause
|
|
Does not know
|
0
|
|
Poor health; being run down
|
1
|
|
Bad sanitation, drainage, smells
|
2
|
|
Dirt
|
3
|
|
Contagious infection
|
4
|
|
Germs
|
5
|
|
Germs in throat, Bacillus Diphtheria
|
6
|
|
Other
|
|
Dangers
|
|
Does not know
|
0
|
|
Risk of death
|
1
|
|
Risk of serious after - effects
|
2
|
|
Serious illness
|
3
|
|
Painful illness
|
4
|
|
Other
|
|
Prevention
|
|
Does not know
|
0
|
|
Immunisation, inoculation
|
1
|
|
Does not believe prevention possible
|
2
|
|
Segregation
|
3
|
|
Keep children clean
|
4
|
|
Keep children healthy
|
5
|
|
Gargling
|
6
|
|
Other
|
2. Have any of your children had Diphtheria?
3. Have your children been immunised against Diphtheria?
(see page 2.)
(To follow question sequence - see Question 28)
|
|
IF IMMUNISED
|
HOURS ASLEEP for past 24 hours from time to interview
|
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
|
Child
|
Sex
|
Age
|
IMMUNISED
|
NOT IMMUNISED
|
Age when Immunised
|
If No. (2), why not see codes below
|
|
|
|
|
|
|
|
|
|
|
BOY
|
GIRL
|
0 to 1 year
|
1 + to 2 years
|
2 + to 4 years
|
4 + to 5 years
|
5 + to 10 years
|
10+ 14 years
|
0 to 1 year
|
1 + to 2 years
|
2 + to 4 years
|
4Z to 5 years
|
5+ to 10 years
|
10+ to 14 years
|
Was treatment (2 visits) completed
|
NOON to 1 PM
|
1 to 2
|
2 to 3
|
3 to 4
|
4 to 5
|
5 to 6
|
6 to 7
|
7 to 8
|
8 to 9
|
9 to 10
|
10 to 11
|
11 to 12
|
MID NIGHT to 1 AM
|
1 to 2
|
2t o 3
|
3 to 4
|
4 to 5
|
5 to 6
|
6 to 7
|
7 to 8
|
8 to 9
|
9 to 10
|
10 to 11
|
11 AM to NOON
|
Total hours sleep
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes
|
No
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
A
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
25
|
|
B
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
|
|
C
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
|
|
D
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
|
|
E
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
|
|
F
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
|
|
G
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
|
|
H
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
1
|
2
|
3
|
4
|
5
|
6
|
1
|
2
|
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
16
|
17
|
18
|
19
|
20
|
21
|
22
|
23
|
24
|
|
Codes for Question 10 (If immunization not completed)
|
Child away from school when Doctor visited
|
1
|
|
Child ill - waiting till better
|
2
|
|
Child disliked treatment - would not go again
|
3
|
|
Moved away from district
|
4
|
|
Doctor said one visit sufficient
|
5
|
|
Child tested and found immune
|
6
|
|
Other
|
|
IF IMMUNISED (Contd.)
12. How did you learn about the Immunisation Scheme?
|
Do not know
|
0
|
|
From School - leaflet, form, etc.
|
1
|
|
Welfare Centre, Clinic
|
2
|
|
Health Visitor
|
3
|
|
Film
|
4
|
|
Cinema slides
|
5
|
|
National press (see instructions)
|
6
|
|
Local press
|
7
|
|
Health Talks (Public Meetings)
|
8
|
|
Women’s Periodical
|
9
|
|
Other periodicals
|
10
|
|
Radio
|
11
|
|
Posters
|
12
|
|
Neighbours, friends relatives
|
13
|
|
Husbands/Wife
|
14
|
|
Leaflets
|
15
|
|
Doctor
|
16
|
|
Notices in P.O., Shops, etc.
|
17
|
|
Other
|
|
13. What decided you to have your children immunised?
|
Does not know
|
0
|
|
Knew consequences - to protect child
|
1
|
|
Form from school
|
2
|
|
Relative or friend had diphtheria
|
3
|
|
Food not good, necessary to fight infection
|
4
|
|
Neighbours etc. had immunised their child
|
5
|
|
Personal advice of Doctor, Nurse, etc.
|
6
|
|
Epidemic in area
|
7
|
|
Film impressed me
|
8
|
|
Radio
|
9
|
|
Newspaper or periodical
|
10
|
|
Other
|
|
13a. Did you pay for your children to be immunised by your own doctor or have it done free under your local council’s Scheme?
|
Paid own doctor
|
1
|
|
Free under Scheme
|
2
|
14. Did you ask for your children to be immunised yourself, or did you wait to consult your husband?
|
Own decision
|
1
|
|
Consulted husband
|
2
|
|
Don’t know
|
3
|
IF NOT IMMUNISED
15. Have you tried to get your children immunised?
If have tried
16. How did you learn about the Immunisation Scheme?
|
Does not know
|
0
|
|
From School - leaflet, form, etc.
|
1
|
|
Welfare Centre, Clinic
|
2
|
|
Health Visitor
|
3
|
|
Film
|
4
|
|
Cinema slides
|
5
|
|
National Press (see instructions)
|
6
|
|
Local Press
|
7
|
|
Health Talks (Public Meetings)
|
8
|
|
Women’s Periodical
|
9
|
|
Other Periodicals
|
10
|
|
Radio
|
11
|
|
Posters
|
12
|
|
Neighbours, Friends Relatives
|
13
|
|
Husbands/Wife
|
14
|
|
Leaflets
|
15
|
|
Doctor
|
16
|
|
Notices in P.O., Shops, etc.
|
17
|
|
Other
|
|
17. What decided you to have your children immunised?
|
Does not know
|
0
|
|
Knew consequences - to protect children
|
1
|
|
Form from School
|
2
|
|
Relative or friend had diphtheria
|
3
|
|
Food not good, necessary to fight infection
|
4
|
|
Neighbours etc. had immunised their child.
|
5
|
|
Personal advice of Doctor, Nurse, etc.
|
6
|
|
Epidemic in area
|
7
|
|
Film impressed me
|
8
|
|
Radio
|
9
|
|
Newspaper or periodical
|
10
|
|
Other
|
|
18. Why was immunization not carried out?
If have not tried
19. Do you know about the arrangements for free immunization against Diphtheria?
20. Have you ever thought about the possibility of your children having Diphtheria
21. Why do you not have them immunised?
|
Does not know
|
0
|
|
Unnecessary if child is strong and healthy
|
1
|
|
It does not prevent diphtheria, I don’t believe in it
|
2
|
|
Vaccination is not successful: nor is this
|
3
|
|
Injurious to child’s health
|
4
|
|
Frightens children
|
5
|
|
Have not bothered before, but I will do
|
6
|
|
Child has just been vaccinated, but I will do
|
7
|
|
Waiting to consult husband
|
8
|
|
Husband objects
|
9
|
|
Fatalism (If child is going to have it, it will)
|
10
|
|
Not sure that its worth while
|
11
|
|
Child not old enough yet
|
12
|
|
Waiting till child goes to school
|
13
|
|
Already had Diph. Could not get it again
|
14
|
|
I have no time to take child to be treated
|
15
|
|
Other
|
|
22. Will you be arranging for your children to be immunised?
23. If yes, what arrangements?
24. Do you find it difficult to take your children to be immunised?
25. If yes, why?
|
Distance to centre too great
|
1
|
|
Expense to centre too great
|
2
|
|
Too busy at home
|
3
|
|
Too busy at work
|
4
|
|
No one to mind my other children
|
5
|
|
Do not know of Centre
|
6
|
|
Other
|
|
26. (To Parents of children under 5)
Do you use a Child’s Welfare Centre or Maternity Clinic?
|
Usually
|
1
|
|
Sometimes
|
2
|
|
Never
|
3
|
26a. Reasons for 2 or 3
27. (To Parents of girls under 14)
Do you keep your daughter’s hair short?
27a. Do you have any difficulty in keeping her hair clean?
28. What sleep have your children had in past 24 hours? (Enter hours asleep on 11, page 2).
COMMENT:
