MICS Household Questionnaire

[BiH]
Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and code

HH4. Supervisor name and code:

HH5. Day/month/year of interview

HH6. Settlement type

HH7. Region
FBiH Canton:

We are from the Ministry for Human Rights and Refugees of Bosnia and Herzegovina. We are conducting a survey concerned with family health and education. I would like to talk to you about these subjects. The interview will take up to 20 minutes. All the information we obtain will remain strictly. May I start now?

Once all questionnaires for the household have been completed, fill in the following information:
[Note: for question HH8 to HH18]

HH8. Name and surname of head of household: ____

HH9. Result of household interview:

HH10. Respondent to household questionnaire:

HH11. Total number of household members: _ _

HH12. Number of women age 15-49 years: _ _

HH13. Number of completed questionnaire for women aged 15-49: _ _

HH13A. Number of men aged 15-49: _ _

HH13B. Number of completed questionnaire for men aged 15-49: _ _


HH14. Number of children under age 5: _ _

HH15. Number of completed under-5 questionnaires: _ _

HH16. Control carried out by (name and code)

HH17. Date entry clerk (name and code)

HH18. Record the interview start time

Household Listing Form: HL

First, please tell me the name of each person who usually lives here, starting with the head of the household.
Enter data for the head of the household in line 01. List all household members (HL2), their relationship to the household head (HL3), and their gender (HL4)
Then ask: Are there any other persons who live here, even if they are not at home now?
If yes, complete listing for questions HL2-HL4. Then, ask questions starting with HL5 for each person, one person at a time.
Use an additional questionnaire if all rows in the household member listing form have been used.

HL1. Line number: _ _

HL2. Name: ____

HL3. What is the relation-ship of (name) to the head of household?

HL4. Is (name) male or female?

HL5. What is (name's) date of birth?

HL6. How old is (name)?
Record in completed years. If age is 95 or above, record '95'
HL7. Circle line no.
If woman is aged 15-49 (for women aged 15-49)

HL7A. Circle line no.
If man is aged 15-49 (for men aged 15-49 godnia)

HL8. Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (for children aged 5-14.)
HL9. Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker (for children under age 5)
For children aged 0-17 years [HL11 to HL14]

HL11. Is (name's) biological mother alive?

HL12. Does (name's) biological mother live in this household?
Record line number of mother or 00 for no
HL13. Is (name's) biological father alive?

HL14. Does (name's) biological father live in this household?
Record line no. of father or 00 for "no"
[] tick here if additional questionnaire was used.
Ask again if there are any additional household members. Probe especially for any infants or small children not listed, and others who may not be members of the family (such as servants, friends) but who usually live in the household. Enter the names of additional members in the list of household members and complete the form according to the instructions.
Now for each woman aged 15-49 years, write her name and line number and other necessary information in the information panel of a separate Questionnaire for Women Aged 15 to 49. For each man aged 15-49 years, write his name and line number and other necessary information in the information panel of a separate Questionnaire for Men Aged 15 to 49. For each child under age 5, write his/her name and line number and the line number of his/her mother or caretaker in the information panel of a separate Under-5 questionnaire. You should now have a separate questionnaire for each eligible woman, each eligible man, and each child under five in the household.

Codes for HL3. Relationship to the head of household

Education: ED

For household member aged 5 and above [ED1 to ED4B]

ED1. Line number: _ _

ED2. Name and age
Copy from Household Member Listing Form, HL2 and HL6
ED3. Has (name) ever attended school or a preschool institution?

ED4A. What is the highest education level (name) has attended?
If level=0, skip to ED5
ED4B. What is the highest grade/year (name) completed at this level?
If less than 1 grade/year, enter 00
For household members age 5-24 years [ED5 to ED8]

ED5. During this (2011-2012) school year, did (name) attend school/university or preschool at any time?

ED6. During this school/academic year, which level and grade/year is (name) attending?
If level=0, skip to ED7
ED7. During the previous school/academic year, that is (2010-2011), did (name) attend school or preschool at any time?

ED8. During that previous school year, which level and grade/year did (name) attend?
If level=0, go to next person
Water and Sanitation: WS

WS1. What is the main source of drinking water for members of your household?

WS2. What is the main source of water used in your household for other purposes such as cooking and washing hands?

WS3. Where is that water source located?

WS4. How long does it take to go to the water source, collect water, and come back?

WS5. Who usually goes to this source to collect the water for your household?
Probe: Is this person under 15 years of age? What gender?

WS6. Do you do anything to the water to make it safer for drinking?

WS7. What do you usually do to make the water safer for drinking?
Probe: Anything else? Record all items mentioned.
WS8. What kind of toilet facility do members of your household usually use?
If "flush" or "pour flush", probe: Where does it flush to? If necessary, ask permission to observe the facility.
WS9. Do you share this facility with others who are not members of your household?

WS10. Do you share this facility only with members of other households that you know, or is the facility for public use?

WS11. How many households in total use this toilet facility, including your own household?

Household characteristics: HC

HC1B. What is the mother tongue/native language of the head of this household?

HC2. How many rooms in this household are used for sleeping?

HC3. Main material of the dwelling floor
Record observation
HC4. Main material of the roof
Record observation
HC5. Main material of the exterior walls.
Record observation
HC6. What type of fuel does your household mainly use for cooking?

HC7. Is the cooking usually done in the house, in a separate building, or outdoors?
If 'In the house', probe: is it done in a separate room used as a kitchen?

HC8. Does your household have:

A. Electricity?

B. A radio?

C. A television?

D. A fixed telephone (non-mobile)?

E. A refrigerator?

F. Bed?

G. Electrical cooker?

H. Computer/laptop?

I. Internet connection?

J. Air-conditioning?

K. Digital camera?

L. Washing machine?

M. Clothes dryer?

N. Dishwasher?

O. Vacuum cleaner?

P. DVD player?

Q. Jacuzzi bathtub?

R. Video security system (CCTV)?

HC9. Does any member of your household own:

A. A watch?

B. A mobile telephone?

C. A bicycle?

D. A motorcycle or scooter?

E. An animal drawn cart?

F. A car or truck?

G. A tractor?

HC10. Do you or someone living in this household own this dwelling?
If "No", then ask: Do you rent this dwelling from someone not living in this household? If "Rented from someone else", circle "2". For other responses, circle "6".
HC11. Does any member of this household own any land that can be used for agriculture?

HC12. How many dunums of agricultural land do members of this household own altogether?
If less than one, record "00". If 95 or more, record '95'. If unknown, record '98'.
HC13. Does this household own any livestock, herds, other farm animals, or poultry?

HC14. How many of the following animals does this household own?
If none, record '00'. If 95 or more, record '95'. If unknown, record '98'.

A. Heifers, milk cows, or bulls?

B. Horses, donkeys, or mules?

C. Goats?

D. Sheep?

E. Chickens, chicks or roosters?

H. Other poultry?

F. Pigs?

G. Bee hives?

HC15. Does any member of this household have a bank account?

Child Discipline: CD

Table 1: Children Aged 2-14 Years Eligible for Questions on Child Discipline
List each of the children aged 2-14 years below in the order they appear in the household member listing form (module HL). Do not include any household members outside of the age range 2-14 years.
Record the line number, name, gender, and age for each child.
Then record the total number of children aged 2-14 in the box provided (CD6).
If there are no children aged 2-14 years in the household, skip to next module.
If there is only one child aged 2-14 years in the household, then skip table 2 and go to CD8; enter '1' and continue with CD9.

CD1. Rank Number: _

CD2. Line number from HL1: _ _

CD3. Name from HL2: ____

CD4. Gender from HL4

CD5. Age from HL6: _ _

CD6. Total children aged 2-14 years: _ _

Table 2: Random Selection of Child for Questions on Child Discipline
Use Table 2 to select one child between the ages of 2 and 14 years, if there is more than one child in the household within the specified age range.
Check the last digit of the household number (HH2) from the cover page. This is the row number you should go to in the table below (CD7).
Check the total number of eligible children (2-14) at CD6 in Table 1 above. This is the column number you should go to.
Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the child (CD1) for which the questions will be asked.

CD7.
Total number of eligible children in the household (CD6) [Column 1 to 8+]
Last digit of household number (HH2) [Row 0 to 9]

CD8. Record the rank of the selected child from Table 1 (CD1): _

CD9. Write the name and line number of the child selected for the module from CD3 and CD2, based on the rank number in CD8.
CD10. Adults use certain ways to teach children proper behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.

CD11. Took away privileges, forbade something (name) liked or did not allow him/her to leave the house.

CD12. Explained why (name)'s behavior was wrong.

CD13. Shook him/her.

CD14. Shouted, yelled at or screamed at him/her.

CD15. Gave him/her something else to do.

CD16. Spanked, hit or slapped him/her on the bottom with bare hand.

CD17. Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.

CD18. Called him/her dumb, lazy, or a similar name.

CD19. Hit or slapped him/her on the face, head or ears.

CD20. Hit or slapped him/her on the hand, arm, or leg.

CD21. Beat him/her up, that is hit him/her repeatedly as hard as one can.

CD22. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?

Hand washing: HW

HW1. Please show me where members of your household most often wash their hands.

HW2. Observe presence of water at the specific place for washing hands.
Verify by checking the tap/pump, or sink, bucket, water container, etc., for presence of water.
HW3. Record if soap or detergent is present at the specific place for washing hands.
Circle all that apply.
Skip to HH19 if any soap or detergent code has been circled (A, B, C or D). If "None" is circled (Y), continue with HW4.
HW4. Do you have any soap, detergent or any other cleaning agent in your household for washing hands?

HW5. Can you please show it to me?
Record the observation. Circle all that apply.
HH19. Record the interview end time

HH20. Thank the respondent for his/her cooperation and check the Household Member Listing Form:

Return to the cover page and make sure that all information is entered, including the number of eligible women (HH12), children under 5 years of age (HH14) and eligible men (HH13A).
Organise the administration of the remaining questionnaire(s) in this household.

Interviewer's observations ________

Controller's observations ________

Supervisor?s observations ________