MICS-6
Questionnaire for children age 5-17
5-17 Child information panel: FS
FS3. Child's name and line number:
Line Number _ _
FS4. Mother's/caretaker's name and line number:
Line Number _ _
FS5. Interviewer's name and number:
Number _ _
FS6. Supervisor's name and number:
Number_ _
FS7. Day/month/year of interview
Check respondent's age in HL6 in list of household members, household questionnaire:
If age 15-17, verify that adult consent for interview is obtained (HH33 or HH39). The respondent must be at least 15 years old. In the very few cases where a child age 15-17 has no mother or caretaker identified in the household (HL20=90), the respondent will be the child him/herself.
FS9. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?
[] 2 No, first interview (Go to FS10A)
FS10A. I am from Main Statistical Department of (city of Minks, regionWe are conducting a survey in the Republic of Belarus about the situation of children and women. In this regard I would like to ask you a few questions about (child's name from FS3)'s health and well-being. This interview will take about 20 minutes. All the information we obtain will remain strictly confidential and will be used only for statistical purpose. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
FS10B. Now I would like to talk to you about (child's name from FS3)'s health and well-being and other questions. This interview will take about 20 minutes. Again, all the information we obtain will remain strictly confidential and will be used only for statistical purpose. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
[] 2 No permission is not given (Go to FS17)
FS17. Result of interview for child age 5-17 years
Codes refer to the respondent. Discuss any result not completed with Supervisor.
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 96 Other (specify) ____
CB1. Check the respondent's line number (FS4) in 5-17 child information panel and the respondent to the household questionnaire (HH47):
[] 2 FS4 does not equal HH47
CB2. In what month and year was (name) born?
Month and year must be recorded.
_ _ _ _ Year
CB3. How old is (name) (in complete years)?
If responses to CB2 and CB3 are inconsistent, probe further and correct.
CB4. Has (name) ever attended education institution, including preschool?
[] 2 No (Go to CL1)
CB5. What is the highest level and grade or year of school (name) has ever attended?
[] 1 Primary _ _
[] 2 General basic _ _
[] 3 General secondary _ _
[] 4 Vocational technical _ _
[] 5 Secondary specialised _ _
[] 6 Higher _ _
CB6. Did (he/she) ever complete that (grade/year)?
[] 2 No
CB7. At any time during the 2018/2019 school year did (name) attend school or any early childhood education programme?
[] 2 No (Go to CB9)
CB8. During the 2018/2019 school year, which level and grade or year is (name) attending?
[] 1 Primary _ _
[] 2 General basic _ _
[] 3 General secondary _ _
[] 4 Vocational technical _ _
[] 5 Secondary specialised _ _
[] 6 Higher _ _
CB9. At any time during the 2017/2018 school year did (name) attend school or any early childhood education programme?
[] 2 No (Go to CL1)
CB10. During the 2017/2018 school year, which level and grade or year did (name) attend?
[] 1 Primary _ _
[] 2 General basic _ _
[] 3 General secondary _ _
[] 4 Vocational technical _ _
[] 5 Secondary specialised _ _
[] 6 Higher _ _
CL1. Now I would like to ask about any work (name) may do.
Since last (day of the week), did (name) do any of the following activities, even for only one hour?
A. Did (name) do any work or help on (his/her) own or the household's plot, farm, food garden or looked after animals? For example, growing farm produce, harvesting, or feeding or giving water to animals?
[] 2 No
B. Did (name) help in a family business or a relative's business with or without pay, or run (his/her) own business?
[] 2 No
C. Did (name) produce or sell articles, handicrafts, clothes, food or agricultural products?
[] 2 No
X. Since last (day of the week), did (name) engage in any other activity in return for income in cash or in kind, even for only one hour?
[] 2 No
CL2. Check CL1, [A]-[X]: Is there at least one "yes"?
[] 2 No (Go to CL7)
CL3. Since last (day of the week) about how many hours did (name) engage in this activity/these activities?
If less than one hour, record '00'.
CL4. (Does the activity/Do these activities) require carrying heavy loads?
[] 2 No
CL5. (Does the activity/Do these activities) require working with dangerous tools such as knives and saw or operating heavy machinery?
[] 2 No
CL6. How would you describe the work environment of (name)?
A. Is (he/she) exposed to dust, fumes or gas?
[] 2 No
B. Is (he/she) exposed to extreme cold, heat or humidity?
[] 2 No
C. Is (he/she) exposed to loud noise or vibration?
[] 2 No
D. Is (he/she) required to work at heights?
[] 2 No
E. Is (he/she) required to work with chemicals, or explosives?
[] 2 No
X. Is (name) exposed to other harmful and dangerous conditions bad for (his/her) health or safety?
[] 2 No
CL7. Since last (day of the week), did (name) fetch water for household use?
[] 2 No (Go to CL9)
CL8. In total, how many hours did (name) spend on fetching water for household use, since last (day of the week)?
If less than one hour, record '00'.
CL9. Since last (day of the week), did (name) collect firewood for household use?
[] 2 No (Go to CL11)
CL10. In total, how many hours did (name) spend on collecting firewood for household use, since last (day of the week)?
If less than one hour, record '00'.
CL11. Since last (day of the week), did (name) do any of the following for this household?
A. Shopping for the household?
[] 2 No
[] 2 No
C. Washing dishes or cleaning around the house?
[] 2 No
[] 2 No
[] 2 No
F. Caring for someone old or sick?
[] 2 No
[] 2 No
CL12. Check CL11, [A]-[X]: Is there at least one "yes"?
[] 2 No (Go to FCD1)
CL13. Since last (day of the week), about how many hours did (name) engage in this activity/these activities?
If less than one hour, record '00'
FCD1. Check CB3/HL6: Child's age?
[] 2 Age 15-17 years (Go to FCF1)
FCD2. Now I'd like to talk to you about your child's behaviour.
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 any other adult 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.
[] 2 No
B. Explained why (name)'s behaviour was wrong.
[] 2 No
[] 2 No
[] 2 No
E. Gave (him/her) something else to do.
[] 2 No
F. Spanked (him/her) on the bottom with hand.
[] 2 No
G. Hit (him/her) on the bottom or elsewhere on the body with something like a belt, stick or other hard object.
[] 2 No
H. Called (him/her) dumb, lazy or another name like that.
[] 2 No
I. Hit or slapped (him/her) on the face or head.
[] 2 No
J. Hit or slapped (him/her) on the hand, arm, or leg.
[] 2 No
K. Beat (him/her) up, that is hit him/her over and over as hard as one could.
[] 2 No
FCD3. Check FS4: Is this respondent the mother or caretaker of any other children under age 5?
[] 2 No (Go to FCD5)
FCD4. Check FS4: Has this respondent already responded to the following question (UCD5 in questionnaire for children under-five) for another child?
[] 2 No
FCD5. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?
[] 2 No
[] 8 DK/no opinion
FCF1. I would like to ask you some questions about difficulties (name) may have. Does (name) wear glasses or contact lenses?
[] 2 No
FCF2. Does (name) use a hearing aid?
[] 2 No
FCF3. Does (name) use any equipment or receive assistance for walking?
[] 2 No
FCF4. In the following questions, I will ask you to answer by selecting one of four possible answers: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (he/she) cannot at all.
FCF5. Check FCF1: Child wears glasses or contact lenses?
[] 2 No, FCF1=2 (Go to FCF6B)
FCF6A. When wearing (his/her) glasses or contact lenses, does (name) have difficulty seeing?
FCF6B. Does (name) have difficulty seeing?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
FCF7. Check FCF2: Child uses a hearing aid?
[] 2 No, FCF2=2 (Go to FCF8B)
FCF8A. When using (his/her) hearing aid(s), how difficult is for (name) to hear sounds like peoples' voices or music?
FCF8B. How difficult is for (name) to hear sounds like peoples' voices or music?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
FCF9. Check FCF3: Child uses equipment or receives assistance for walking?
[] 2 No, FCF3=2 (Go to FCF14)
FCF10. Without (his/her) equipment or assistance, how difficult is for (name) to walk 100 meters on level ground?
[] 3 A lot of difficulty (Go to FCF12)
[] 4 Cannot walk 100 M at all (Go to FCF12)
FCF11. Without (his/her) equipment or assistance, how difficult is for (name) to walk 500 meters on level ground?
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
FCF12. With (his/her) equipment or assistance, how difficult is for (name) to walk 100 meters on level ground?
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
FCF13. With (his/her) equipment or assistance, how difficult is for (name) to walk 500 meters on level ground?
[] 2 Some difficulty (Go to FCF16)
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 500 M at all (Go to FCF16)
FCF14. Compared with children of the same age, how difficult is for (name) to walk 100 meters on level ground?
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
FCF15. Compared with children of the same age, how difficult is for (name) tolty walk 500 meters on level ground?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
FCF16. How difficult is for (name) with self-care such as feeding, dressing (himself/herself) or other?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all
FCF17. When (name) speaks, how difficult is for (name) to be understood by people inside of this household?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
FCF18. When (name) speaks, how difficult is for (name) to be understood by people outside of this household?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
FCF19. Compared with children of the same age, how difficult is for (name) to learn things?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot learn things at all
FCF20. Compared with children of the same age, how difficult is for (name) to remember things?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember things at all
FCF21. How difficult is for (name) to concentrate on an activity that (he/she) enjoys doing?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot concentrate at all
FCF22. How difficult is for (name) to accept changes in (his/her) routine?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot accept changes at all
FCF23. Compared with children of the same age, how difficult is for (name) to control (his/her) behaviour?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot control behaviour at all
FCF24. How difficult is for (name) to make friends?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot make friends at all
FCF25. The next questions have different options for answers. I am going to read these to you after each question.
How often (name) seems very anxious, nervous or worried?
Would you say (name) seems like this: 1. daily, 2. weekly, 3. monthly, 4. a few times a year or 5. never?
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
FCF26. How often (name) seems very sad or depressed?
Would you say (name) seems like this: 1. daily, 2. weekly, 3. monthly, 4. a few times a year or 5. never?
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
PR1. Check CB3/HL6: Child's age?
[] 2 Age 7-14 years
[] 3 Age 15-17 years (Go to FL0)
PR3. Excluding school text books, how many books do you have for (name) to read at home?
[] 0 Number of books _
[] 10 Ten or more books
PR4. Check CB7: Did the child attend any educational institution?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 2 No, CB7/ED9=2 or blank (Go to FL0)
PR5. Does (name) ever have homework?
[] 2 No (Go to PR7)
[] 8 DK (Go to PR7)
PR6. Does anyone help (name) with homework?
[] 2 No
[] 8 DK
PR7. Does (name)'s school have a school governing body in which parents can participate [such as board of trustees or parent committee]?
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
PR8. In the last 12 months, have you or any other adult from your household attended a meeting at school?
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
PR9. During any of these meetings, was any of the following discussed:
A. Key education issues faced by (name)'s school?
[] 2 No
[] 8 DK
B. School budget or use of funds received by (name)'s school?
[] 2 No
[] 8 DK
PR10. In the last 12 months, have you or any other adult from your household received information on student's progress for (name)?
[] 2 No
[] 8 DK
PR11. In the last 12 months, have you or any adult from your household gone to (name)'s school for any of the following reasons?
A. A school celebration or a sport event?
[] 2 No
[] 8 DK
B. To discuss (name)'s progress with (his/her) teachers?
[] 2 No
[] 8 DK
Foundational learning skills: FL
[] 2 Age 7-14 years
[] 3 Age 15-17 (Go to FS11)
FL1. Now I would like to talk to (name). I will ask (him/her) a few questions about (himself/herself), and then ask (him/her) to complete a few reading and number activities. These are not school tests and the results will not be shared with anyone. I am not allowed to tell you how well (name) has performed. The activities are to help us find out how well children are learning to read and to use numbers. This will take about 20 minutes. Again, all the information we obtain will remain strictly confidential.
[] 2 No, permission is not given (Go to FL28)
I am from the Main Statistical Department of (city of Minsk, region). Your mother (caretaker) allowed to talk to you. I will ask you some questions and give you some number and reading activities to do. I will explain each activity, and you can ask me questions any time.
[] 2 No, permission not given (Go to FL28)
FL4. Before you start with the reading and number activities, tick each box to show that:
[] You have engaged the child in conversation and built rapport.
[] The child is sat comfortably, able to use reading and numbers cards without difficulty while you can see these cards.
FL6. First we are going to talk about reading.
[] 2 No
B. Does someone read to you at home?
[] 2 No
FL10. Now I am going to give you a short story to read. Would you like to start reading the story?
[] 2 No (Go to FL23)
FL11. Check CB3/HL6: Child's age?
[] 2 Age 10-14 years
FL12. Check CB7: In the current school year, did the child attend any education institution?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 2 No, CB7/ED9=2 or blank
FL13. Now I would like you to read these sentences out loud. Then I may ask you some question.
Give the child 1 card for reading (?Vas?ka is a cat. Zhuchka is a dog. Vas?ka is 5. Zhuchka is 6?).
FL14. Did the child read every word in the practice correctly?
[] 2 No (Go to FL23)
FL15. Once the reading is done, ask: How old is Vas'ka?
[] 2 Other answers
[] 3 No answer after 5 seconds
FL16. Say: Vas'ka is 5 years old. (Go to FL23)
FL17. Here is another question: Who is older: Vas'ka or Zhuchka?
[] 2 Other answers
[] 3 No answer after 5 seconds
FL18. Say: Zhuchka is older than Vas'ka. Zhuchka is 6 and Vas'ka is 5. (Go to FL23)
FL19. Now I want you to read me this small story. If you come to a word you do not know, go onto the next word. When you finish I will ask you some questions about what you have read.
Give the child card 2 for reading.
FL20. Results of the child's reading.
_ _ Total number of words incorrect or missed
FL21. How well did the child read the story?
[] 2 Did not read any word correctly (Go to FL23)
[] 3 Did not try to read the story (Go to FL23)
FL22. Now I am going to ask you a few questions about what you have read.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark 'No response' and say: Thank you.
and go to the next question.
[] 2 Incorrect
[] 3 No response/says 'I don't know'
B. What did Vania see on the way home?
[] 2 Incorrect
[] 3 No response/says 'I don't know'
C. Why did Vania start crying?
[] 2 Incorrect
[] 3 No response/says 'I don't know'
D. Where did Vania fall (down)?
[] 2 Incorrect
[] 3 No response/says 'I don't know'
[] 2 Incorrect
[] 3 No response/says 'I don't know'
FL23. Now I want you to point to each number and tell me what the number is.
Give the child card 3 (with numbers).
Look at this card, please, and point to each number starting from the first number.
If the child stops on a number for a while, tell the child what the number is, mark the number as 'No Attempt', point to the next number and ask to name it.
If the child does not attempt to read 2 consecutive numbers, say: Thank you.
and go to the next task.
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
FL23A. Check FL23: Did the child correctly identify two of the first three numbers (9, 12 and 30)?
[] 2 No, at least 2 incorrect or with no attempt (Go to FL28)
FL24. And now I want you to look at these cards with numbers. give the child cards 4-8 (with pairs of numbers).Please look at these numbers and tell me which one is bigger.
Record the child's answer before going to the next card and repeat the question for the next pair of numbers.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark as 'no attempt' for this pair of number and show the child the next pair of numbers.
If the child does not attempt 2 consecutive pairs, say: Thank you. and go to the next task.
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
FL25. And now I would like you to perform example on addition. Give the child cards 9-13 (with examples on addition) Look at this example, please and tell me how much is (number plus number)?
Record the child's answer before going to the next card and repeating the question for the next sum.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark as 'no attempt' for this example and show the child the next addition.
If the child does not attempt 2 consecutive pairs, say: Thank you. and go to the next task.
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
FL26. Now we go to the next task.
Give the child cards 14-15 with numbers.
Here are some numbers. 1, 2, and 4. What number goes here?
[] 2 Incorrect (Go to FL26B)
[] 3 No attempt (Go to FL26B)
FL26A. Say: That's correct, 3. Let's do another one. (Go to FL26C)
FL26B. Do not explain how to get the correct answer. Just say: The number 3 goes here. Say the numbers with me. (Point to each number) 1, 2, 3, 4. 3 goes here. Let?s do another one.
FL26C. Here are some more numbers. 5, 10, 15 and __. What number goes here?
[] 2 Incorrect (Go to FL26E)
[] 3 No attempt (Go to FL26E)
FL26D. Say: That's correct, 20. (Go to FL27)
FL26E. Do not explain how to get the correct answer. Just say: The number 20 goes here. Say the numbers with me. (Point to each number) 5, 10, 15, 20. 20 goes here.
FL26F. Check FL26: Was the answer correct?
[] 2 No, FL26=2 or 3 (Go to FL28)
FL27. Now I want you to try this on your own. Give the child cards 16 - 20 with set of numbers. Please look at those examples and tell me what number goes here.
Record the child's answer before going to the next report
and repeating the question for next task.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark as 'no attempt' for this task and go to the next task.
If the child does not attempt 2 consecutive patterns, say: Thank you. and go to FL28
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
FL28. Result of interview with child.
Discuss any result not completed with Supervisor.
[] 02 Not at home
[] 03 Mother/caretaker refused
[] 04 Child refused
[] 05 Partly completed
[] 06 Incapacitated
[] 96 Other (specify) ____
FS16. Thank the respondent and the child for her/his cooperation.
Make arrangements for the administration of the remaining questionnaire(s) in this household.