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MICS-6
Questionnaire for children age 5-17


Central African Republic, 2018

5-17 Child information panel: FS

FS1. Cluster number: _ _ _

FS2. Household number: _ _

FS3. Child's name and line number:

Name ____ _ _

FS4. Mother's/caretaker's name and line number:

Name ____ _ _

FS5. Interviewer's name and number:

Name ____ _ _

FS6. Supervisor's name and number:

Name ____ _ _

FS7. Day/month/year of interview

_ _ / _ _ / 201 _

FS8. Record the time

Hours : minutes_ _ : _ _

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) or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in FS17. 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?

[] 1 Yes, interviewed already (Go to FS10B)
[] 2 No, first interview (Go to FS10A)

FS10A. Hello, my name is (your name). We are from [National Statistical Office]. We are conducting a survey about the situation of children, families and households. I would like to talk to you about (child's name from FS3)'s health and well-being. This interview will take about 30 minutes. All the information we obtain will remain strictly confidential and anonymous. 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 in more detail. This interview will take about 30 minutes. Again, all the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?

[] 1 Yes (Go to child's background module)
[] 2 No/not asked (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.
[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for mother/caretaker age 15-17
[] 96 Other (specify) ____

Child's background: CB

CB0. Check the respondent's line number (FS4) in 5-17 child information panel.

[] 1 FS4=90, Emancipated (Go to end)
[] 2 FS4 does not equal 90

CB1. Check the respondent's line number (FS4) in 5-17 child information panel and the respondent to the household questionnaire (HH47):

[] 1 FS4=HH47 (Go to CB11)
[] 2 FS4 does not equal HH47

CB2. In what month and year was (name) born?
Month and year must be recorded.
Date of birth
_ _ Month
_ _ _ _ Year

CB3. How old is (name)?
Probe: How old was (name) at (his/her) last birthday? Record age in completed years. If responses to CB2 and CB3 are inconsistent, probe further and correct.
Age (in completed years) _ _

CB4. Has (name) ever attended school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to CB11)

CB5. What is the highest level and grade or year of school (name) has ever attended?

[] 000 Preschool (Go to CB7)
[] 1 Fundamental 1_ _
[] 2 Fundamental 2 _ _
[] 3 General secondary _ _
[] 4 Technical secondary _ _
[] 5 Superior _ _

CB6. Did (he/she) ever complete that (grade/year)?

[] 1 Yes
[] 2 No

CB7. At any time during the 2018-2019 school year did (name) attend school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to CB9)

CB8. During this 2018-2019 school year, which level and grade or year is (name) attending?

[] 000 Preschool
[] 1 Fundamental 1_ _
[] 2 Fundamental 2 _ _
[] 3 General secondary _ _
[] 4 Technical secondary _ _
[] 5 Superior _ _

CB8AA. Verify ED9: School attendance for the current school year (2018-2019) in the household questionnaire
[] 1 ED9=1
[] 2 ED9=2 (Go to CB11)

CB8A. At any time during the 2017-2018 school year, was (name) absent for any reason?

[] 1 Yes
[] 2 No (Go to CB11)

CB8B. What was approximately the length of (name)'s absence from school at any time during the 2018-2019 academic year?

[] 1 1 day
[] 2 2-3 days
[] 3 4-5 days
[] 4 More than a week

CB8C. What was the main reason for (name)'s absence from school at any time during the 2018-2019 academic year?

[] 1 Illness
[] 2 Cultural or family event
[] 3 Absence of teacher
[] 4 Problems of security on the path to school
[] 5 Problems of security at the school
[] 6 School is occupied by armed forces or groups
[] 7 School is closed
[] 8 Menstruation/periods
[] 9 Voluntarily / without reasoning
[] 96 Other reason (specify)
[] 98 DK

CB8D. Check the respondent's line number (FS4) in the 5-17 child information panel and the respondent to the household questionnaire (HH47):

[] 1 FS4=HH47 (Go to CB11)
[] 2 FS4 does not equal HH47

CB9. At any time during the 2017-2018 school year did (name) attend school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to CB11)

CB10. During that 2017-2018 school year, which level and grade or year did (name) attend?

[] 000 Preschool (Go to CB7)
[] 1 Fundamental 1_ _
[] 2 Fundamental 2 _ _
[] 3 General secondary _ _
[] 4 Technical secondary _ _
[] 5 Superior _ _

CB11. Is (name) covered by any health insurance?

[] 1 Yes
[] 2 No (Go to end)

CB12. What type of health insurance is (name) covered by?
Record all mentioned.
[] A Mutual health organization/community-based health insurance
[] B Health insurance through employer
[] C Social security
[] D Other privately purchased commercial health insurance
[] X Other (specify) ____

Child Labour: CL

CL0. Check the respondent's line number (FS4) in the 5-17 child information panel.
[] 1 FS4=90, Emancipated (Go to end)
[] 2 FS4 does not equal 90

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, grazing or milking animals?

Worked on plot, farm, food garden, looked after animals
[] 1 Yes
[] 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?

Helped in family/relative's business/ran own business
[] 1 Yes
[] 2 No

C. Did (name) produce or sell articles, handicrafts, clothes, food or agricultural products?

Produce/sell articles/handicrafts/clothes/food or agricultural products
[] 1 Yes
[] 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?

Any other activity
[] 1 Yes
[] 2 No

CL2. Check CL1, [A]-[X]:

[] 1 At least one 'yes'
[] 2 All answers are 'no' (Go to CL7)

CL3. Since last (day of the week) about how many hours did (name) engage in (this activity/these activities), in total?
If less than one hour, record '00'.
Number of hours _ _

CL4. (Does the activity/Do these activities) require carrying heavy loads?

[] 1 Yes
[] 2 No

CL5. (Does the activity/Do these activities) require working with dangerous tools such as knives and similar or operating heavy machinery?

[] 1 Yes
[] 2 No

CL6. How would you describe the work environment of (name)?

A. Is (he/she) exposed to dust, fumes or gas?

[] 1 Yes
[] 2 No

B. Is (he/she) exposed to extreme cold, heat or humidity?

[] 1 Yes
[] 2 No

C. Is (he/she) exposed to loud noise or vibration?

[] 1 Yes
[] 2 No

D. Is (he/she) required to work at heights?

[] 1 Yes
[] 2 No

E. Is (he/she) required to work with chemicals, such as pesticides, glues and similar, or explosives?

[] 1 Yes
[] 2 No

X. Is (name) exposed to other things, processes or conditions bad for (his/her) health or safety?

[] 1 Yes
[] 2 No

CL7. Since last (day of the week), did (name) fetch water for household use?

[] 1 Yes
[] 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'.
Number of hours _ _

CL9. Since last (day of the week), did (name) collect firewood for household use?

[] 1 Yes
[] 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'.
Number of hours _ _

CL11. Since last (day of the week), did (name) do any of the following for this household?

A. Shopping for the household?

Shopping for household
[] 1 Yes
[] 2 No

B. Cooking?

Cooking
[] 1 Yes
[] 2 No

C. Washing dishes or cleaning around the house?

Washing dishes/cleaning house
[] 1 Yes
[] 2 No

D. Washing clothes?

Washing clothes
[] 1 Yes
[] 2 No

E. Caring for children?

Caring for children
[] 1 Yes
[] 2 No

F. Caring for someone old or sick?

Caring for old/sick
[] 1 Yes
[] 2 No

X. Other household tasks?

Other household tasks
[] 1 Yes
[] 2 No

CL12. Check CL11, [A]-[X]:

[] 1 At least one 'yes'
[] 2 All answers are 'no' (Go to end of module)

CL13. Since last (day of the week), about how many hours did (name) engage in (this activity/these activities), in total?
If less than one hour, record '00'
Number of hours _ _

Child discipline: FCD

FCD1. Check CB3: Child's age?

[] 1 Age 5-14 years
[] 2 Age 15-17 years (Go to end of module)

FCD2. Now I'd like to talk to you about something else.
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.

Took away privileges
[] 1 Yes
[] 2 No

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

Explained wrong behavior
[] 1 Yes
[] 2 No

C. Shook (him/her).

Shook him/her
[] 1 Yes
[] 2 No

D. Shouted, yelled at or screamed at (him/her).

Shouted, yelled, screamed
[] 1 Yes
[] 2 No

E. Gave (him/her) something else to do.

Gave something else to do
[] 1 Yes
[] 2 No

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

Spanked, hit, slapped on bottom with bare hand
[] 1 Yes
[] 2 No

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

Hit with belt, hairbrush, stick or other hard object
[] 1 Yes
[] 2 No

H. Called (him/her) dumb, lazy or another name like that.

Called dumb, lazy or another name
[] 1 Yes
[] 2 No

I. Hit or slapped (him/her) on the face, head or ears.

Hit/slapped on the face, head or ears
[] 1 Yes
[] 2 No

J. Hit or slapped (him/her) on the hand, arm, or leg.

Hit/slapped on hand, arm or leg
[] 1 Yes
[] 2 No

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

Beat up, hit over and over as hard as one could
[] 1 Yes
[] 2 No

FCD3. Check FS4: Is this respondent the mother or caretaker of any other children under age 5?

[] 1 Yes
[] 2 No (Go to FCD5)

FCD4. Check FS4: Has this respondent already responded to the following question (UCD5) for another child?

[] 1 Yes (Go to end of module)
[] 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?

[] 1 Yes
[] 2 No
[] 8 DK/no opinion

Child functioning: FCF

FCF0. Check the respondent's line number (FS4) in the 5-17 child information panel.
[] 1 FS4=90, Emancipated (Go to end)
[] 2 FS4 does not equal 90

FCF1. I would like to ask you some questions about difficulties (name) may have. Does (name) wear glasses or contact lenses?

[] 1 Yes
[] 2 No

FCF2. Does (name) use a hearing aid?

[] 1 Yes
[] 2 No

FCF3. Does (name) use any equipment or receive assistance for walking?

[] 1 Yes
[] 2 No

FCF4. In the following questions, I will ask you to answer by selecting one of four possible answers. For each question, would you say that (name) has: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (he/she) cannot at all.

Repeat the categories during the individual questions whenever the respondent does not use an answer category:
Remember the four possible answers: Would you say that (name) has: 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?

[] 1 Yes, FCF1=1 (Go to FCF6A)
[] 2 No, FCF1=2 (Go to FCF6B)

FCF6A. When wearing (his/her) glasses or contact lenses, does (name) have difficulty seeing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all

FCF6B. Does (name) have difficulty seeing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all

FCF7. Check FCF2: Child uses a hearing aid?

[] 1 Yes, FCF2=1 (Go to FCF8A)
[] 2 No, FCF2=2 (Go to FCF8B)

FCF8A. When using (his/her) hearing aid(s), does (name) have difficulty hearing sounds like peoples' voices or music?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all

FCF8B. Does (name) have difficulty hearing sounds like peoples' voices or music?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all

FCF9. Check FCF3: Child uses equipment or receives assistance for walking?

[] 1 Yes, FCF3=1
[] 2 No, FCF3=2 (Go to FCF14)

FCF10. Without (his/her) equipment or assistance, does (name) have difficulty walking 100 meters/yards on level ground?
Probe: That would be about the length of 1 football field. Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF12)
[] 4 Cannot walk 100 M/Y at all (Go to FCF12)

FCF11. Without (his/her) equipment or assistance, does (name) have difficulty walking 500 meters/yards on level ground?
Probe: That would be about the length of 5 football fields. Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M/Y at all

FCF12. With (his/her) equipment or assistance, does (name) have difficulty walking 100 meters/yards on level ground?
Probe: That would be about the length of 1 football field.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M/Y at all (Go to FCF16)

FCF13. With (his/her) equipment or assistance, does (name) have difficulty walking 500 meters/yards on level ground?
Probe: That would be about the length of 5 football fields.
[] 1 No difficulty (Go to FCF16)
[] 2 Some difficulty (Go to FCF16)
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 500 M/Y at all (Go to FCF16)

FCF14. Compared with children of the same age, does (name) have difficulty walking 100 meters/yards on level ground?
Probe: That would be about the length of 1 football field.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M/Y at all (Go to FCF16)

FCF15. Compared with children of the same age, does (name) have difficulty walking 500 meters/yards on level ground?
Probe: That would be about the length of 5 football fields.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M/Y at all

FCF16. Does (name) have difficulty with self-care such as feeding or dressing (himself/herself)?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all

FCF17. When (name) speaks, does (he/she) have difficulty being understood by people inside of this household?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all

FCF18. When (name) speaks, does (he/she) have difficulty being understood by people outside of this household?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all

FCF19. Compared with children of the same age, does (name) have difficulty learning things?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot learn things at all

FCF20. Compared with children of the same age, does (name) have difficulty remembering things?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember things at all

FCF21. Does (name) have difficulty concentrating on an activity that (he/she) enjoys doing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot concentrate at all

FCF22. Does (name) have difficulty accepting changes in (his/her) routine?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot accept changes at all

FCF23. Compared with children of the same age, does (name) have difficulty controlling (his/her) behaviour?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot control behaviour at all

FCF24. Does (name) have difficulty making friends?

[] 1 No difficulty
[] 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.
I would like to know how often (name) seems very anxious, nervous or worried.
Would you say: daily, weekly, monthly, a few times a year or never?

[] 1 Daily
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never

FCF26. I would also like to know how often (name) seems very sad or depressed.
Would you say: daily, weekly, monthly, a few times a year or never?

[] 1 Daily
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never

Parental involvement: PR

PR1. Check CB3: Child's age?

[] 1 Age 5-6 years (Go to end of module)
[] 2 Age 7-14 years
[] 3 Age 15-17 years (Go to end of module)

PR2. At the end of this interview I will ask you if I can talk to (name). If (he/she) is close, can you please ask (him/her) to stay here. If (name) is not with you at the moment could I ask that you now arrange for (him/her) to return? If that is not possible, we will later discuss a convenient time for me to call back.

PR3. Excluding school text books and holy books, how many books do you have for (name) to read at home?

[] 00 None
[] 0 Number of books _
[] 10 Ten or more books

PR4. Check CB7: Did the child attend any school?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 1 Yes, CB7/ED9=1
[] 2 No, CB7/ED9=2 or blank (Go to end of module)

PR5. Does (name) ever have homework?

[] 1 Yes
[] 2 No (Go to PR7)
[] 8 DK (Go to PR7)

PR6. Does anyone help (name) with homework?

[] 1 Yes
[] 2 No
[] 8 DK

PR7. Does (name)'s school have a school governing body in which parents can participate (such as parent teacher association, better known as "APE" in RCA)?

[] 1 Yes
[] 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 called by this school governing body?

[] 1 Yes
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)

PR9. During any of these meetings, was any of the following discussed:

A. A plan for addressing key education issues faced by (name)'s school?

Plan for addressing school's issues
[] 1 Yes
[] 2 No
[] 8 DK

B. School budget or use of funds received by (name)'s school?

School budget
[] 1 Yes
[] 2 No
[] 8 DK

PR10. In the last 12 months, have you or any other adult from your household received a school or student report card for (name)?

[] 1 Yes
[] 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?

Celebration or sport event
[] 1 Yes
[] 2 No
[] 8 DK

B. To discuss (name)'s progress with (his/her) teachers?

To discuss progress with teachers
[] 1 Yes
[] 2 No
[] 8 DK

PR12. In the last 12 months, has (name)'s school been closed on a school day due to any of the following reasons:

A. Natural disasters, such as flood, cyclone, epidemics or similar?

Natural disasters
[] 1 Yes
[] 2 No
[] 8 DK

B. Man-made disasters, such as fire, building collapse, riots or similar?

Man-made disasters
[] 1 Yes
[] 2 No
[] 8 DK

C. Teacher strike?

Teacher strike
[] 1 Yes
[] 2 No
[] 8 DK

X. Other?

Other
[] 1 Yes
[] 2 No
[] 8 DK

PR13. In the last 12 months, was (name) unable to attend class due to (his/her) teacher being absent?

[] 1 Yes
[] 2 No
[] 8 DK

PR14. Check PR12[C] and PR13: Any 'Yes' recorded?

[] 1 Yes, PR12[C]=1 or PR13=1
[] 2 No (Go to end)

PR15. When (teacher strike / teacher absence) happened did you or any other adult member of your household contact any school officials or school governing body representatives?

[] 1 Yes
[] 2 No
[] 8 DK

Foundational learning skills: FL

FL0. Check CB3: Child's age?
[] 1 Age 5-6 years (Go to end)
[] 2 Age 7-14 years
[] 3 Age 15-17 (Go to end)

FL1. Now I would like to talk to (name). I will ask (him/her) a few questions about (himself/herself) and about reading, 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, including other parents or the school. You will not benefit directly from participating and I am not trained to tell you how well (name) has performed. The activities are to help us find out how well children in this country are learning to read and to use numbers so that improvements can be made. This will take about 20 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I talk to (name)?

[] 1 Yes, permission is given
[] 2 No, permission is not given (Go to FL28)

FL2. Record the time.
Hours and minutes _ _ : _ _

FL3. My name is (your name). I would like to tell you a bit about myself.
Could you tell me a little bit about yourself?
When the child is comfortable, continue with the verbal consent:
Let me tell you why I am here today. I am from [National Statistical Office]. I am part of a team trying to find out how children are learning to read and to use numbers. We are also talking to some of the children about this and asking them to do some reading and number activities. [Your mother/Name of caretaker] has said that you can decide if you want to help us. If you wish to help us, I will ask you some questions and give you some activities to do. I will explain each activity, and you can ask me questions any time. You do not have to do anything that you do not want to do. After we begin, if you do not want to answer a question or you do not want to continue that is alright.

Are you ready to get started?

[] 1 Yes
[] 2 No/not asked (Go to FL28)

FL4. Before you start with the reading and number activities, tick each box to show that:
[] You are not alone with the child unless they are at least visible to an adult known to the child.
[] You have engaged the child in conversation and built rapport, e.g. using an Icebreaker.
[] The child is sat comfortably, able to use the reading and numbers book without difficulty while you can see which page is open.

FL5. Remember you can ask me a question at any time if there is something you do not understand. You can ask me to stop at any time.

FL6. First we are going to talk about reading.

A. Do you read books at home?

Reads books at home
[] 1 Yes
[] 2 No

B. Does someone read to you at home?

Read to at home
[] 1 Yes
[] 2 No

FL7. Which language do you speak most of the time at home?
Probe if necessary and read the listed languages.
[] 1 Haoussa
[] 2 Sara
[] 3 Mboum
[] 4 Gbaya
[] 5 Mandja
[] 6 Banda
[] 7 Ngbaka/Bantou
[] 8 Yakoma/Sango
[] 9 Zande/Nzakara
[] 10 Sango Officiel
[] 11 French
[] 96 Another language (specify) ____
[] 98 DK

FL8. Check CB7: In the current school year (2018-2019), did the child attend school or any early childhood education programme?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 1 Yes, CB7/ED9=1 (Go to FL9)
[] 2 No, CB7/ED9=2 or blank

FL8AA. Check CB4 and CB5: Has the child already been in school for grade level "Fundamental 1" or hiher?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 1 Yes, CB4=1 ET CB5>0 (Go to FL9)
[] 2 No, CB5=000 or blank

FL8AB. Has the child already had another form of education, even if it's not a formal school or another literacy program?
[] 1 Yes (Go to FL9)
[] 2 No

FL8A. Check FL7: Is reading and numbers book available in the language spoken at home?
[] 1 Yes, FL7=01, 02, 03, 04, 05, 06, 07, 08, 09,10, 11 (Go to FL10B)
[] 2 No, FL7=96 or 98 (Go to FL23)

FL9. What language do your teachers use most of the time when teaching you in class?
Probe if necessary and name the listed languages.
[] 1 French (Go to FL10A)
[] 6 Another language (specify) ____ (Go to FL23)
[] 8 DK (Go to FL23)

FL10A. Now I am going to give you a short story to read in (Language recorded in FL9A/B). Would you like to start reading the story?

[] 1 Yes
[] 2 No (Go to FL23)

FL10B. Now I am going to give you a short story to read in (Language recorded in FL7). Would you like to start reading the story?

[] 1 Yes
[] 2 No (Go to FL23)

FL11. Check CB3: Child's age?
[] 1 Age 7-9 years (Go to FL13)
[] 2 Age 10-14 years

FL12. Check CB7: In the current school year, did the child attend school or any early childhood education programme?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 1 Yes, CB7/ED9=1 (Go to FL19)
[] 2 No, CB7/ED9=2 or blank

FL13. Give the child the reading and numbers book.
Open the page showing the reading practice item and say:

Now we are going to do some reading. Point to the sentence. I would like you to read this aloud. Then I may ask you a question.
Kossi is a boy. Yassé is a girl. Kossi is 5 years old. Yassé is 6 years old.

FL14. Did the child read every word in the practice correctly?

[] 1 Yes
[] 2 No

FL15. Once the reading is done, ask: How old is Kossi?

[] 1 Kossi is 5 years old (go to FL17)
[] 2 Other answers
[] 3 No answer after 5 seconds

FL16. Say: Kossi is 5 years old. (Go to FL23)

FL17. Here is another question: Who is older: Kossi or Yassé?

[] 1 Yassé is older (than Kossi) (Go to FL19)
[] 2 Other answers
[] 3 No answer after 5 seconds

FL18. Say: Yassé is older than Kossi. Yassé is 6 and Kossi is 5. (Go to FL23)

FL19. Turn the page to reveal the reading passage. Thank you. Now I want you to try this. Here is a story. I want you to read it aloud as carefully as you can. You will start here (point to the first word on the first line) and you will read line by line (point to the direction for reading each line). When you finish I will ask you some questions about what you have read. If you come to a word you do not know, go onto the next word. Put your finger on the first word. Ready? Begin.

Kossi is in second year. At noon, Kossi went home from school. He saw red flowers on the way. The flowers are near a tomato farm. He wanted to take some flowers for his grandmother. Kossi ran quickly across the farm to curl the flowers. He fell to the ground next to a banana tree. Kossi began to cry. The farmer saw him and came. He gave Kossi lots of flowers. Kossi is very happy now.



FL20. Results of the child's reading.

_ _ Last word attempted number
_ _ Total number of words incorrect or missed number

FL21. How well did the child read the story?

[] 1 The child read at least one word correctly
[] 2 The child did not read any word correctly (Go to FL23)
[] 3 The child 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. That is ok. We will move on.
Make sure the child can still see the passage and ask:

A. What class is Kossi in?

[] 1 Correct ((Kossi is) in class two)
[] 2 Incorrect
[] 3 No response/says 'I don't know'

B. What did Kossi see on the way home?

[] 1 Correct (he saw some flowers)
[] 2 Incorrect
[] 3 No response/says 'I don't know'

C. Why did Kossi start crying?

[] 1 Correct (because he fell)
[] 2 Incorrect
[] 3 No response/says 'I don't know'

D. Where did Kossi fall (down)?

[] 1 Correct ((Kossi fell down) near a banana tree)
[] 2 Incorrect
[] 3 No response/says 'I don't know'

E. Why was Kossi happy?

[] 1 Correct (because the farmer gave him many flowers/because he had flowers to give to his mother)
[] 2 Incorrect
[] 3 No response/says 'I don't know'

FL23. Turn the page in the reading and numbers book so the child is looking at the list of numbers. Make sure the child is looking at this page.
Now here are some numbers. I want you to point to each number and tell me what the number is.
Point to the first number and say: Start here.
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 say: What is this number?
Stop rule - If the child does not attempt to read 2 consecutive numbers, say: Thank you. That is ok.

A. 9

[] 1 Correct
[] 2 Incorrect
[] 3 No attempt

B. 12

[] 1 Correct
[] 2 Incorrect
[] 3 No attempt

C. 30

[] 1 Correct
[] 2 Incorrect
[] 3 No attempt

D. 48

[] 1 Correct
[] 2 Incorrect
[] 3 No attempt

E. 74

[] 1 Correct
[] 2 Incorrect
[] 3 No attempt

F. 731

[] 1 Correct
[] 2 Incorrect
[] 3 No attempt

FL23A. Check FL23: Did the child correctly identify two of the first three numbers (9, 12 and 30)?
[] 1 Yes, at least two correct
[] 2 No, at least 2 incorrect or with no attempt (Go to FL28)

FL24. Turn the page so the child is looking at the first pair of numbers. Make sure the child is looking at this page. Say:Look at these numbers. Tell me which one is bigger.
Record the child's answer before turning the page in the book and repeating 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 a 'Z' for the answer on the appropriate row on the questionnaire, turn the booklet page and show the child the next pair of numbers.
If the child does not attempt 2 consecutive pairs, say:
Thank you. That is ok. We will go to the next activity.

A. 7 5 ____

B. 11 24 ____

C. 58 49 ____

D. 65 67 ____

E. 146 154 ____

FL25. Give the child a pencil and paper. Turn the page so the child is looking at the first addition. Make sure the child is looking at this page. Say: Look at this sum. How much is (number plus number)? Tell me the answer. You can use the pencil and paper if it helps you.
Record the child's answer before turning the page in the book 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 a 'Z' for the answer on the appropriate row on the questionnaire, turn the booklet page and show the child the next addition.
If the child does not attempt 2 consecutive pairs, say:
Thank you. That is ok. We will go to the next activity.

A. 3+2= ____

B. 8+6=____

C. 7+3=____

D. 13+6=____

E. 12+24=____

FL26. Turn the page to the practice sheet for missing numbers. Say: Here are some numbers. 1, 2, and 4. What number goes here?
If the child answers correctly say: That's correct, 3. Let's do another one.
If the child answers incorrectly, do not explain the child 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.
Now turn the page to the next practice sheet. Say: Here are some more numbers. 5, 10, 15 and ___. What number goes here?
If the child answers correctly say: That's correct, 20. Now I want you to try this on your own
If the child answers incorrectly say: The number 20 goes here. Say the numbers with me. (Point to each number) 5, 10, 15, 20. 20 goes here. Now I want you to try this on your own.

FL27. Now turn the page in the reading and numbers book with the first missing number activity. Say: Here are some more numbers. Tell me what number goes here (pointing to the missing number).
Record the child's answer before turning the page in the book and repeating the question.
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 a 'Z' for the answer on the appropriate row on the questionnaire.
If the child does not attempt 2 consecutive activities, say:
Thank you. That is ok.

A. 5 6 7 ____

B. 14 15 ____ 17

C. 20 ____ 40 50

D. 2 4 6 ____

E. 5 8 11 ____

FL28. Result of interview with child.
Discuss any result not completed with Supervisor.

[] 01 Completed
[] 02 Not at home
[] 03 Mother/caretaker refused
[] 04 Child refused
[] 05 Partly completed
[] 06 Incapacitated
[] 96 Other (specify) ____

FS11. Record the time.

Hours and minutes _ _ : _ _

FS12. Language of the Questionnaire.

[] 1 French

FS13. Language of the Interview.

[] 1 French
[] 2 Haoussa
[] 3 Sara
[] 4 Mboum
[] 5 Gbaya
[] 6 Mandja
[] 7 Banda
[] 8 Ngbaka/Bantou
[] 9 Yakoma/Sango
[] 10 Zande/Nzakara
[] 11 Sango Officiel
[] 96 Another language (specify) ____

FS14. Native language of the Respondent.

[] 1 French
[] 2 Haoussa
[] 3 Sara
[] 4 Mboum
[] 5 Gbaya
[] 6 Mandja
[] 7 Banda
[] 8 Ngbaka/Bantou
[] 9 Yakoma/Sango
[] 10 Zande/Nzakara
[] 11 Sango Officiel
[] 96 Another language (specify) ____

FS15. Was a translator used for any parts of this questionnaire?

[] 1 Yes, the entire questionnaire
[] 2 Yes, parts of the questionnaire
[] 3 No, not used

FS16. Thank the respondent and the child for her/his cooperation.

Proceed to complete the result in FS17 in the 5-17 child information panel and then go to the household questionnaire and complete HH56.
Make arrangements for the administration of the remaining questionnaire(s) in this household.

For emancipated children, i.e., those between the ages of 15 and 17, the following
the following changes will be in effect at the time of administration of the
Questionnaire for children ages 15-17:


CB0A. Check HL20 in the household questionnaire for the line number of selected child (HL1=FS3).

[] 1 HL20 does not equal 90 (Go to CB1)
[] 2 HL20=90, emancipated

CB0B. Check the respondent's line number (FS3) in the 5-17 child information panel and the individual questionnaires (WM3) and MWM3) in this household: Have you or another member of your team interviewed this respondent for an individual questionnaire?

[] 1 Yes, interviewed (Go to module child labour (emancipated))
[] 2 No, not interviewed (Go to module child's background (emancipated))

FL28. Result of interview with the child. Codes refer to the respondent. Discuss any result not completed with supervisor.
Result of interview for child age 5-17 years Codes refer to the respondent. Discuss any result not completed with Supervisor.

[] 1 Completed (Go to FS11)
[] 2 Not at home (Go to FS11)
[] 3 Refused (mother/child's guardian) (Go to FS11)
[] 4 Refused (child) (Go to FS11)
[] 5 Partly completed (Go to FS11)
[] 6 Incapacitated (Go to FS11)
[] 96 Other (specify) ____ (Go to FS11)

Characteristics of emancipated children: ECB

ECB2. In what month and year were you born?
Month and year must be recorded.
Date of birth
_ _ Month
_ _ _ _ Year

ECB3. How old are you?
Record age in completed years. If responses to CB2 and CB3 are inconsistent, probe further and correct.
Age (in completed years) _ _

ECB4. Have you ever attended school or any early childhood education program?

[] 1 Yes
[] 2 No (Go to ECB11)

ECB5. What is the highest level and grade or year of school you have ever attended?

[] 000 Preschool (Go to ECB7)
[] 1 Fundamental 1_ _
[] 2 Fundamental 2 _ _
[] 3 General secondary _ _
[] 4 Technical secondary _ _
[] 5 Superior _ _

ECB6. Did you ever complete that (grade/year)?

[] 1 Yes
[] 2 No

ECB7. At any time during the 2018-2019 school year did you attend school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to ECB9)

ECB8. During this 2018-2019 school year, which level and grade or year are you attending?

[] 000 Preschool
[] 1 Fundamental 1_ _
[] 2 Fundamental 2 _ _
[] 3 General secondary _ _
[] 4 Technical secondary _ _
[] 5 Superior _ _

ECB8A. At any time during the 2018-2019 school year, were you absent for any reason?

[] 1 Yes
[] 2 No (Go to ECB11)

ECB8B. What was approximately the length of your absence from school at any time during the 2018-2019 academic year?

[] 1 1 day
[] 2 2-3 days
[] 3 4-5 days
[] 4 More than a week

ECB8C. What was the main reason for your absence from school at any time during the 2018-2019 academic year?

[] 1 Illness
[] 2 Cultural or family event
[] 3 Absence of teacher
[] 4 Problems of security on the path to school
[] 5 Problems of security at the school
[] 6 School is occupied by armed forces or groups
[] 7 School is closed
[] 8 Menstruation/periods
[] 9 Voluntarily / without reasoning
[] 96 Other reason (specify)
[] 98 DK

ECB9. At any time during the 2017-2018 school year did you attend school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to ECB11)

ECB10. During that 2017-2018 school year, which level and grade or year did you attend?

[] 000 Preschool (Go to ECB7)
[] 1 Fundamental 1_ _
[] 2 Fundamental 2 _ _
[] 3 General secondary _ _
[] 4 Technical secondary _ _
[] 5 Superior _ _

ECB11. Are you covered by any health insurance?

[] 1 Yes
[] 2 No (Go to end)

ECB12. What type of health insurance are you covered by?
Record all mentioned.
[] A Mutual health organization/community-based health insurance
[] B Health insurance through employer
[] C Social security
[] D Other privately purchased commercial health insurance
[] X Other (specify) ____

Reasons for Non-Frequentation (Emancipated): NSR

NSR0. Check ECB7 and ECB9: school attendance during 2018-2019 and 2017-2018.
Record all mentioned.
[] 1 ECB7=1 (Go to ECL1)
[] 2 ECB9=1 (Go to ECL1. Labor module for emancipated children)

NSR1. What is the main reason that you did not attend school during the current school year (2018-2019)?

[] 1 No school nearby
[] 2 Cost of the school very high
[] 3 Safety problem on the way to school
[] 4 Security problem in the school
[] 5 School occupied by armed forces or groups
[] 6 School closed
[] 7 Parents displaced by war
[] 96 Other (specify) ____

NSR2. What is the main reason that you did not attend school during the last school year (2017-2018)?

[] 1 No school nearby
[] 2 Cost of the school very high
[] 3 Safety problem on the way to school
[] 4 Security problem in the school
[] 5 School occupied by armed forces or groups
[] 6 School closed
[] 7 Parents displaced by war
[] 96 Other (specify) ____

Training for Occupations and Apprenticeships (Emancipated): VCT

VCT0. Check ECB4; ECB7 and ECB9
School attendance

[] 1 ECB4=1 (Go to ECL1)
[] 2 ECB7=1 (Go to ECL1)
[] 3 EBC9=1 (Go to ECL1, Module on work of emancipated children)

VCT1. Have you taken any vocational or technical training, whether it was in a training center or school or with a master craftsman?

[] 1 Yes, training school
[] 2 Yes, master craftsman (Go to VCT5)
[] 3 No (Go to VCT8)

VCT2. What professional or technical training(s) did you attend at this training center or school?

[] A Joinery
[] B Basework
[] C Mechanics
[] D Electrical
[] E Industrial refrigeration
[] F Welding and boiler making
[] G Secretariat
[] H Computing
[] I Accounting
[] J Sewing
[] X Other (specify) ____

VCT3. Did you complete this (these) training(s) at this training center or school?

[] 1 Yes (Go to VCT5)
[] 2 No

VCT4. What is the main reason why you did not complete this (these) vocational training at this training center or school?

[] 1 No school nearby
[] 2 Cost of the school very high
[] 3 Safety problem on the way to school
[] 4 Security problem in the school
[] 5 School occupied by armed forces or groups
[] 6 Schools closed
[] 7 Parents displaced because of war
[] 8 Did not want this training anymore
[] 96 Other (specify)

VCT4A. Check VCT1: Training school
[] 1 VCT1=1 (Go to ECL1, module on emancipated children's work)

VCT5. What training(s) did you receive with a master craftsman?

[] A Joinery
[] B Building
[] C Mechanics
[] D Electrical
[] E Industrial refrigeration
[] F Welding and boiler making
[] G Hairdressing
[] H Sewing
[] I Forge
[] J Basketry
[] X Other (specify) ____

VCT6. Did you complete this (these) training(s) with a master craftsman?

[] 1 Yes (Go to VCT8)
[] 2 No

VCT7. What is the main reason why you did not complete this vocational training with this master craftsman?

[] 1 Artisan left the area
[] 2 Parents displaced because of the war
[] 3 No means to buy tools
[] 4 Did not want this training anymore
[] 6 Other (specify)

VCT7A. Check VCT1: Master craftsman
[] 1 VCT1=2 (Go to ECL1, module on emancipated children's work)

VCT8. Would you be willing to take a vocational or technical training in a training center or school or with a master craftsman?

[] 1 Yes, training school
[] 2 Yes, master craftsman (Go to VCT10)
[] 3 No (Go to ECL1, module on emancipated children's work)

VCT9. What is your preferred vocational training that you would like to attend at this training center or school?

[] 1 Joinery
[] 2 Building
[] 3 Mechanical
[] 4 Electrical
[] 5 Industrial refrigeration
[] 6 Welding and boiler making
[] 7 Secretary
[] 8 Computer science
[] 9 Accounting
[] 10 Sewing
[] 96 Other (specify) ____

VCT9A. Check VCT8: Training school
[] 1 VCT8=1 (Go to ECL1, module on emancipated children's work)

VCT10. What is your preferred vocational training that you would like to do with a master craftsman?

[] 1 Joinery
[] 2 Basework
[] 3 Mechanical
[] 4 Electrical
[] 5 Industrial refrigeration
[] 6 Welding and boiler making
[] 7 Hairdressing
[] 8 Couture
[] 9 Forge
[] 10 Windows
[] 96 Other (specify) ____

Child Labour for Emancipated Children: ECL

ECL1. Now I would like to ask about any work you may do.
Since last (day of the week), did you do any of the following activities, even for only one hour?

A. Did you 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, grazing or milking animals?

Worked on plot, farm, food garden, looked after animals
[] 1 Yes
[] 2 No

B. Did you help in a family business or a relative's business with or without pay, or run your  own business?

Helped in family/relative's business/ran own business
[] 1 Yes
[] 2 No

C. Did you produce or sell articles, handicrafts, clothes, food or agricultural products?

Produce/sell articles/handicrafts/clthes/food or agricultural products
[] 1 Yes
[] 2 No

X. Since last (day of the week), did you engage in any other activity in return for income in cash or in kind, even for only one hour?

Any other activity
[] 1 Yes
[] 2 No

ECL2. Check ECL1, [A]-[X]:

[] 1 At least one 'yes'
[] 2 All answers are 'no' (Go to ECL7)

ECL3. Since last (day of the week) about how many hours did you engage in (this activity/these activities), in total?
If less than one hour, record '00'.
Number of hours _ _

ECL4. (Does the activity/Do these activities) require carrying heavy loads?

[] 1 Yes
[] 2 No

ECL5. (Does the activity/Do these activities) require working with dangerous tools such as knives and similar or operating heavy machinery?

[] 1 Yes
[] 2 No

ECL6. How would you describe the work environment of you?

A. Is (he/she) exposed to dust, fumes or gas?

[] 1 Yes
[] 2 No

B. Is (he/she) exposed to extreme cold, heat or humidity?

[] 1 Yes
[] 2 No

C. Are you exposed to loud noise or vibration?

[] 1 Yes
[] 2 No

D. Are you  required to work at heights?

[] 1 Yes
[] 2 No

E. Are you required to work with chemicals, such as pesticides, glues and similar, or explosives?

[] 1 Yes
[] 2 No

X. Are you exposed to other things, processes or conditions bad for (his/her) health or safety?

[] 1 Yes
[] 2 No

ECL7. Since last (day of the week), did you fetch water for household use?

[] 1 Yes
[] 2 No (Go to ECL9)

ECL8. In total, how many hours did you spend on fetching water for household use, since last (day of the week)?
If less than one hour, record '00'.
Number of hours _ _

ECL9. Since last (day of the week), did you collect firewood for household use?

[] 1 Yes
[] 2 No (Go to ECL11)

ECL10. In total, how many hours did you spend on collecting firewood for household use, since last (day of the week)?
If less than one hour, record '00'.
Number of hours _ _

ECL11. Since last (day of the week), did you do any of the following for this household?

A. Shopping for the household?

Shopping for household
[] 1 Yes
[] 2 No

B. Cooking?

Cooking
[] 1 Yes
[] 2 No

C. Washing dishes or ECLeaning around the house?

Washing dishes/ECLeaning house
[] 1 Yes
[] 2 No

D. Washing Clothes?

Washing clothes
[] 1 Yes
[] 2 No

E. Caring for children?

Caring for children
[] 1 Yes
[] 2 No

F. Caring for someone old or sick?

Caring for old/sick
[] 1 Yes
[] 2 No

X. Other household tasks?

Other household tasks
[] 1 Yes
[] 2 No

ECL12. Check ECL11, [A]-[X]:

[] 1 At least one 'yes'
[] 2 All answers are 'no' (Go to end of module)

ECL13. Since last (day of the week), about how many hours did you engage in (this activity/these activities), in total?
If less than one hour, record '00'
Number of hours _ _

Child functioning: ECF

ECF1. I would like to ask you some questions about difficulties you may have. Do you wear glasses or contact lenses?

[] 1 Yes
[] 2 No

ECF2. Do you use a hearing aid?

[] 1 Yes
[] 2 No

ECF3. Do you use any equipment or receive assistance for walking?

[] 1 Yes
[] 2 No

ECF4. In the following questions, I will ask you to answer by selecting one of four possible answers. For each question, would you say that you have: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (you) cannot at all.

Repeat the categories during the individual questions whenever the respondent does not use an answer category:
Remember the four possible answers: Would you say that you have: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (you) cannot at all?

ECF5. Check ECF1: Child wears glasses or contact lenses?

[] 1 Yes, ECF1=1 (Go to ECF6A)
[] 2 No, ECF1=2 (Go to ECF6B)

ECF6A. When wearing (his/her) glasses or contact lenses, does you have difficulty seeing?
ECF6B. Do you have difficulty seeing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all

ECF7. Check ECF2: uses a hearing aid?

[] 1 Yes, ECF2=1 (Go to ECF8A)
[] 2 No, ECF2=2 (Go to ECF8B)

ECF8A. When using (his/her) hearing aid(s), do you have difficulty hearing sounds like peoples' voices or music?
ECF8B. Do you have difficulty hearing sounds like peoples' voices or music?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all

ECF9. Check ECF3: Child uses equipment or receives assistance for walking?

[] 1 Yes, ECF3=1
[] 2 No, ECF3=2 (Go to ECF14)

ECF10. Without equipment or assistance, do you have difficulty walking 100 meters/yards on level ground?
Probe: That would be about the length of 1 football field. Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to ECF12)
[] 4 Cannot walk 100 M/Y at all (Go to ECF12)

ECF11. Without equipment or assistance, do you have difficulty walking 500 meters/yards on level ground?
Probe: That would be about the length of 5 football fields. Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M/Y at all

ECF12. With equipment or assistance, do you have difficulty walking 100 meters/yards on level ground?
Probe: That would be about the length of 1 football field.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to ECF16)
[] 4 Cannot walk 100 M/Y at all (Go to ECF16)

ECF13. With equipment or assistance, do you have difficulty walking 500 meters/yards on level ground?
Probe: That would be about the length of 5 football fields.
[] 1 No difficulty (Go to ECF16)
[] 2 Some difficulty (Go to ECF16)
[] 3 A lot of difficulty (Go to ECF16)
[] 4 Cannot walk 500 M/Y at all (Go to ECF16)

ECF14. Compared with children of the same age, do you have difficulty walking 100 meters/yards on level ground?
Probe: That would be about the length of 1 football field.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to ECF16)
[] 4 Cannot walk 100 M/Y at all (Go to ECF16)

ECF15. Compared with children of the same age, do you have difficulty walking 500 meters/yards on level ground?
Probe: That would be about the length of 5 football fields.
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M/Y at all

ECF16. Do you have difficulty with self-care such as feeding or dressing (himself/herself)?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all

ECF17. When you speak, do you have difficulty being understood by people inside of this household?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all

FCF18. When you speak, do you  have difficulty being understood by people outside of this household?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all

FCF19. Compared with children of the same age, do you have difficulty learning things?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot learn things at all

FCF20. Compared with children of the same age, do you have difficulty remembering things?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember things at all

FCF21. Do you have difficulty concentrating on an activity that (you) enjoy doing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot concentrate at all

FCF22. Do you have difficulty accepting changes in (his/her) routine?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot accept changes at all

FCF23. Compared with children of the same age, do you have difficulty controlling (his/her) behaviour? 

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot control behaviour at all

FCF24. Do you have difficulty making friends?

[] 1 No difficulty
[] 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.
I would like to know how often you seem very anxious, nervous or worried.
Would you say: daily, weekly, monthly, a few times a year or never?

[] 1 Daily
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never

FCF26. I would also like to know how often you seem very sad or depressed.
Would you say: daily, weekly, monthly, a few times a year or never?

[] 1 Daily
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never

Interviewer's observations

Supervisor's observations

Learning capacity assessment booklet (MICS RCA, 2018)

Kossi is a boy. Yasse is a girl. Kossi is 5 years old. Yasse is 6 years old.

P

Kossi is in second year. At noon, Kossi went home from school. He saw red flowers on the way. The flowers are near a tomato farm. He wanted to take some flowers for his grandmother. Kossi ran quickly across the farm to pick the flowers. He fell to the ground next to a banana tree. Kossi started crying. The farmer saw him and came. He gave Kossi plenty of flowers. Kossi is very happy now.

9
12
30
48
74
731

7 5

11 24

58 49

65 67

146 154

3+2=

8+6=

7+3=

13+6=

12+24=

1 2 ____ 4

P

5 10 15 ____

P

5 6 7 ____

14 15 ____ 17

20 ____ 40 50

2 4 6 ____

5 8 11 ____