MICS Household Questionnaire

Belarus
Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer number

HH4. Supervisor number:

HH5. Day/month/year of interview

HH6. Area

HH7. Region

HH7A. Household is selected for men's interview:

We are from the Statistical Department of (city, region). Now the national household survey is organised in the Republic of Belarus to obtain objective information on the situation of children and women I would like to ask you several questions. The interview will take about 20 minutes. All the information we obtain will remain strictly confidential and will be used for statistical purposes only. May I start now?

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

HH8. Name 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 woman's questionnaires completed: _ _

HH13A. Number of men age 15-59 years: _ _

HH13B. Number of man's questionnaires completed: _ _


HH14. Number of children under age 5: _ _

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

HH16. Field edited by (number)

HH17. Date entry clerk (number)

HH18. Record the time of interview beginning:

Household Listing Form: 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.

HL1. Rank number: _ _

HL2. Name: ____

HL3. What is the relation-ship of (name) to the head of household?
See the codes below
HL4. Male or female?

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

HL6. How old is (name) in completed years?
If age is 95 or above record '95'
HL7. Circle line number if woman is age 15-49
For women age 15-49

HL7A. Circle line number if man is age 15-49
If man is age 15-49 (for men age 15-49)

HL8. Who is the mother or primary caretaker of this child?
For children age 5-14Record rank number of mother/caretaker
HL9. Who is the mother or primary caretaker of this child?
For children under age 5Record rank number of mother/caretaker
For children age 0-17 years [HL11 to HL14]

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

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

HL14. Does (name's) natural father live in this household?
Record rank number of father or 00 for "no"
[] tick here if additional HH questionnaire used.

Codes for HL3. Relationship to head of household

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 15-59 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.

Now, may I ask you few questions about the education of the members of this household.

Education: ED

For household members age 5 and above [ED1 to ED4B]

ED1. Rank number: _ _

ED2. Name and age
Copy from Household Listing Form, HL2 and HL6
ED3. Has (name) ever attended any education institution, including pre-school?

ED4A. What is the highest level (grade) of education has received / is receiving (name) at this educational institution?
See the codes below. If level=0, skip to ED5
ED4B. What is the highest grade (name) completed at this level/stage?
If less than 1 grade, enter 00
For household members age 5-24 years [ED5 to ED8]

ED5. During the (2011-2012) school year, did (name) attend any education institution, including pre-school?

ED6. During this school year, which level (grade) is/was (name) attending?
If level=0, skip to ED5
ED7. During the previous school year, 2010-2011, did (name) attend any education institution, including pre-school?

ED8. During that previous school year, what level (grade) did (name) attend?
If level=0, go to next person
Codes of levels (grades) of education to the questions ED4A, ED6, ED8:

Water and Sanitation Module: WS

WS1. What is the main source of drinking water for 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 from your household members usually goes to this source to collect the water?
Probe: What is the age and sex of this household member?

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? Continue to ask to get the information on all the measures and circle the codes of all mentioned measures.
WS8. What kind of toilet facility do members of your household usually use?
If "flush", probe: Where does it flush to?
WS9. Do you share this facility with other households?

WS10. Do you share this toilet 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

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

HC3. Main material of the dwelling floor
Circle the code of the main floor material.
HC4. Main material of the roof
Circle the code of the main roof material.
HC5. Main material of the exterior walls.
Circle the code of the main walls material.
HC6. What type of energy / 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 kitchen?

HC8. Does your household have:

A. Television?

B. DVD-player?

C. Stationary telephone?

D. Refrigerator?

E. Freezer?

F. Vacuum cleaner?

G. Microwave?

H. Personal computer?

I. Washing machine?

J. Dishwasher?

HC9. Does any member of your household own:

A. Mobile telephone?

B. Motorcycle/scooter?

C. Animal drawn-cart?

D. Car/truck?

E. Minibus?

F. Boat with motor?

HC10. Do you or someone living in this household own this dwelling?

HC10A. Does your family rent this dwelling from anyone who is not living in this household?

HC11. Does any member of this household own any land that can be used for agriculture?

HC12. How many ares of agricultural land do members of this household own?
If less than one, record "000". If 995 or more, record '995'. If unknown, record '998'.
HC13. Does your household own any livestock, 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. Cows or bulls?

B. Horses?

C. Goats?

D. Sheep?

E. Chickens?

F. Pigs?

G. Rabbits?

HC16. Does any member of this household have a bank deposit?

Now I would like to ask about any work children in this household may do.

Child Labour: CL

To be administered for children in the household age 5-14 years. For household members below age 5 or above age 14, leave rows blank.

CL1. Rank number: _ _

CL2. Name and age copy from Household Listing Form, HL2 and HL6

CL3. During the past week, did (name) do any kind of work for someone who is not a member of this household?
If yes: For pay in cash or kind?
CL4. Since last (day of the week), about how many hours did he/she do this work for someone who is not a member of this household?
If more than one job, include all hours at all jobs.
CL5. During the past week, did (name) fetch water or collect firewood for household use?

CL6. Since last (day of the week), about how many hours did he/she fetch water or collect firewood for household use?

CL7. During the past week, did (name) do any paid or unpaid in a family business or selling goods in the street?
Include work for a business run by the child, alone or with one or more partners.
CL8. Since last (day of the week), about how many hours did he/she do this work in a family business or selling goods in the street?

CL9. During the past week, did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people?

CL10. Since last (day of the week), about how many hours did he/she doing these household chores?

Child Discipline: CD

Table 1: Children Aged 2-14 Years Eligible for Child Discipline Questions
List each of the sequence number, name, sex and age of each child aged 2-14 years below.
Then record the total number of children aged 2-14 (CD6).
If there are no children age 2-14 years in the household, skip to SI2.
If there is only one child age 2-14 years in the household, then skip table 2 and go to CD8; write down '1' and continue with CD9.

CD1. Line Number: _

CD2. Rank number from HL1: _ _

CD3. Name from HL2: ____

CD4. Sex from HL4

CD5. Age from HL6: _ _

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

Table 2: Selection of Random Child for Child Discipline Questions
Use Table 2 to select one child between the ages of 2 and 14 years, if there is more than one child in that age range in the household.
Check the last digit of the household number (HH2) from the cover page. Find the line with such number in Table 2.
Check the total number of eligible children in CD6 above. Find the column with such figure in Table 2.
Circle the line number in the box where the row and the column meet. This is the line number of the child (CD1) about whom the questions will be asked.
Record the line number of the selected child in CD8.


CD7.
Total number of children aged 2-14 years (CD6) [Column 1 to 8+]
Last digit of household number (HH2) [Row 0 to 9]

CD8. Record the line number of the selected child, about whom the questions will be asked: _

CD9. Write the name and line number of the child selected for the module from CD3 and CD2, based on the line number in CD8.
CD10. Adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods 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. Forbade (name) doing something liked or did not allow him/her to leave house.

CD12. Explained why (name)'s behaviour/wickedness was wrong.

CD13. Shook him/her.

CD14. Shouted or screamed at him/her.

CD15. Gave him/her something else to do.

CD16. Hit or slapped him/her on the bottom with hand.

CD17. Hit him/her on the different parts of the body with hand or with something like a belt, beater, stick or other hard object.

CD18. Called him/her dumb, lazy, or another name like that.

CD21. Beat him/her as hard as one could.

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

Iodine Deficiency Prevention: SI

SI2. Do you know about the advantages of iodised salt consumption as cheap and one of the main means of IDD elimination?

SI3. Do you use iodised salt for cooking?
If the answer is "yes", probe: How often do you use iodised salt for cooking: constantly or sometimes?
HH19. Record the time

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

Return to the cover page and make sure that all information is entered, including the number of eligible women aged 15-49 (HH12), under-5 children (HH14) and men aged 15-59 (HH13A).

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________