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290 Appendix 2: Impact Evaluation Measuring Instrument: A report on the Impact of the Pre-school Feeding Programme in Gauteng Province, South Africa SOCIO-DEMOGRAPHIC QUESTIONNAIRE This questionnaire covers certain aspects of your life, including work and personal details, health and illness, lifestyle and social life that is relevant to health. The answers to these questions will be kept strictly confidential and the information will not be identifiable from any reports or publications. 1. GENERAL INFORMATION Date:…………………………………………………………………………... Subject ID number:……………………………………………………………. Pre-school name:……………………………………………………………… Please answer all questions by marking the correct answer with X, except where otherwise indicated. Example: In what town do you live? Johannesburg Bloemfontein Cape Town Vanderbijlpark Durban 2. PERSONAL INFORMATION 2.1 Your role in the family Mother Grandmother Caregiver Other, specify…………………….. 2.2 When were you born? Year: Month: Day: 2.3 How old are you? __________________years 2.4 Gender: 3. ACCOMMODATION AND FAMILY COMPOSITION Male Female