MICS5, Bangladesh 2012-13

Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and number

HH4. Supervisor name and number:

HH5. Day/month/year of interview

HH6. Area

HH7. Division

HH7A.District name and code _____

HH7B. Is the household selected for water testing?

HH7C. Is the household selected for additional water testing?

We are from (country-specific affiliation). We are conducting a survey about the situation of children, families and households. I would like to talk to you about these subjects. The interview will take about (insert number) minutes. All the information we obtain will remain strictly confidential and anonymous. May I start now?

HH8. Name of head of household:

HH9. Result of household interview:

After the household questionnaire has been completed, fill in the following information:
HH10. Respondent to household questionnaire:

After the household questionnaire has been completed, fill in the following information:
HH11. Total number of household members: _ _

After the household questionnaire has been completed, fill in the following information:
HH12. Number of women age 15-49 years: _ _

After all questionnaires for the household have been completed, fill in the following information:
HH13. Number of women's questionnaires completed: _ _

After the household questionnaire has been completed, fill in the following information:
HH14. Number of children under age 5: _ _

After all questionnaires for the household have been completed, fill in the following information:
HH15. Number of under-5 questionnaires completed: _ _

HH16. Field editor's name and number:

HH17. Main data entry clerk's name and number:

HH17A. Data entry clerk (Second) name and number:

HH18 Record the time

List of Household Members: HL

First, please tell me the name of each person who usually lives here, starting with the head of the household.
List the head of the household in line 01. List all household members (HL2), their relationship to the household head (HL3), and their sex (HL4)
Then ask: Are there any others 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 at a time. Use an additional questionnaire if all rows in the household listing form have been used.

HL1. Line number: _ _

HL2. Name: ____

HL3. What is the relationship of (name) to the head of household?

Code for HL3 Relationship to head of household

HL4. Is the (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 '95':

HL7. Circle line no. If woman age is 15-49

For children age 5-14
HL8. Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker
For children age 0-5
HL9. Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker
HL11. Is (name)'s natural mother alive
For children age 0-17 years
HL12. Does (name)'s natural mother live in this household? _ _
If "Yes", record line no. of mother and go to HL13. If "No", record 00.

HL12A. Where does (name)'s natural mother live?

HL13. Is (name)'s natural father alive

HL14. Does (name)'s natural father live in this household? _ _
If "Yes", record line no. of father and go to HL15. If "No", record 00.

HL14A. Where does (name)'s natural father live?

[] Tick here if additional questionnaire used

Probe for 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. Insert names of additional members in the household list and complete form accordingly.

Now for each woman age 15-49 years, write her name and line number and other identifying information in the information panel of a separate individual women's questionnaire.
For each man age 15-49 years, write his name and line number and other identifying information in the information panel of a separate individual man's questionnaire.
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.

Education: ED

ED1. Line number: _ _

ED2. Name and age
Copy from HL2 and HL6.
ED3. Has (name) ever attended school or pre-school, primary school, secondary school, college or university ?
For household members age 5 and above
ED4A. What is the highest level school (name) has ever attended?
For household members age 5 and above. If level=0, skip to ED5
ED4B. What is the highest grade (name) completed at this level?
For household members age 5 and above. If the first grade at this level is not completed, enter "00".
ED5. During the 2012 school year did (name) attend pre-school, primary school, secondary school, college or university at any time?
For household members age 5-24 years
ED6. During this/that school year, which level and grade is/was (name) attending?
For household members age 5-24 years. If level=0 skip to ED7
ED7. During the previous school year, that is 2011, did (name) attend pre-school, primary school, secondary school, college or university at any time?
For household members age 5-24 years
ED8. During that previous school year, which level and grade did (name) attend?
For household members age 5-24 years
If level=0 skip to ED7
Water and Sanitation: WS

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

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

WS3. Where is that water source located?

WS4. How long does it take to go there, get water, and come back?

WS5. Who usually goes to this source to collect the water for your household?
Probe: is this person under age 15? What sex?
WS6. Do you do anything to the water to make it safer to drink?

WS7. What do you usually do to make the water safer to drink?
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 not possible to determine, 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 open to the use of the general public?

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

Household Characteristics: HC

HC1A. What is the religion of the head of this household?

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

HC1C. Does the head of this household belong to any small ethnic group?

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 non-mobile telephone?

[E] A refrigerator?

[F] An electric fan?

[G] A cot/bed?

[H] A table?

[I] An almirah/wardrobe?

[J] A sofa set?

[K] A water dispenser?

[L] A water pump?

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 boat with a motor?

[H] Rickshaw/van?

[I] Nasiman/kariman/votbati?

[J] Easy bike/auto bike (Battery driven)?

[K] A computer?

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 hectares of agricultural land do members of this household own?
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 have?
If none, record '00'. If 95 or more, record '95'. If unknown, record '98'.

[A] Cattle, milk cows, or bulls?

[B] Horses, donkeys, or mules?

[C] Goats?

[D] Sheep?

[E] Chickens?

[F] Pigs?

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

HC16. Do you do anything to get protection from mosquito bites?

HC17. What are you doing to get protection from mosquito bites?
Circle all that apply.
Selection of One Child For Child Discipline: SL


SL1. Rank number: _

SL2. Line number from HL1: _ _

SL3. Name from HL2: ____

SL4. Sex from HL4

SL5. Age from HL6: _ _

SL6. Total number of children age 1-14 years: ____

SL7. Check the number of children age 1-14 years in SL6:

SL8. Check the last digit of the household number (HH2) from the cover page. This is the number of the row you should go to in the table below.
Check the total number of children age 1-14 years in SL6 above. This is the number of the column you should go to in the table below.
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 selected child(in SL1).
SL9. Record the rank number (SL1), line number (SL2), name (SL3) and age (SL5) of the selected child.
Child Discipline: CD

CD2. Write the line number (SL12) and name (SL19) of the child selected

CD3. Adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used. Please tell me if you or anyone else in your household has used this method with (name) in the past month.

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

[B] Explained why (name)'s behaviour was wrong.

[C] Shook him/her.

[D] Shouted, yelled at or screamed at him/her.

[E] Gave him/her something else to do.

[F] Spanked, hit or slapped him/her on the bottom with bare hand.

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

[H] Called him/her dumb, lazy, or another name like that.

[I] Hit or slapped him/her on the face, head or ears.

[J] Hit or slapped him/her on the hand, arm, or leg.

[K] Beat him/her up, that is hit him/her over and over as hard as one could.

CD4. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?

Handwashing: HW

HW1. We would like to learn about where members of this household wash their hands. Can you please show me where members of your household most often wash their hands?

HW2 Observe presence of water at the place for handwashing. Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water
HW3 Record if soap or detergent is present at the specific place for handwashing
Circle all that apply. Skip to HH19 if any soap or detergent code (A, B, C or D) is circled. If "None" (Y) is circled, continue with HW4.
HW4 Do you have any soap or detergent or ash/mud/sand in your house for washing hands?

HW5 Can you please show it to me?
HH19. Record the time
Salt Iodization: SI

SI1. We would like to check whether the salt used in your household is iodized. May I see a sample of the salt used to cook the main meal eaten by members of your household last night?
Once you have tested the salt, circle number that corresponds to test outcome.
HH20. Thank the respondent for his/her cooperation and check the list of household members:

Return to the cover page and make sure that all information is entered, including the number of eligible women (HH12) and under-5s (HH14). Make arrangements for the administration of the remaining questionnaire(s) in this household.

Interviewer's Observations ________

Field Editor's Observations ________

Supervisor's Observations ________