We are working on a government project with the support of UNICEF. This project focuses on family health and education. I would like to talk to you about this. The interview will take a few minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. During this time I would like to speak with the household head and all mothers or others who take care of children in the household.
May I start now? If permission is given, begin the interview.

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:

HH6A. Area:

HH7. Region:

HH7A. Department: _ _

HH7B. Sub-prefecture: _ _

HH7C. Municipality: _ _

HH7D. Locality: _ _

HH7E. Z.D number (DR rgph 98): _ _

HH7F. Number of the block/or Cpt: _ _

HH8. Name of head of household: ____

After all questionnaires for the household have been completed, fill in the following information:
[Note: HH9 to HH16]

HH9. Result of HH interview:

HH10. Respondent to HH questionnaire

HH11. Total number of household members: _ _

HH12. No. of women aged 15-49: _ _

HH13. No. of women questionnaires completed: _ _

HH14. No. of children under age 5: _ _

HH15. No. of under-5 questionnaires completed: _ _

Interviewer/supervisor notes.

HH16. Data entry clerk code number: _ _

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? (These may include children in school or at work). If yes, complete listing.
Then, ask questions starting with hl5 for each person at a time. Add a continuation sheet if there are more than 14 household members.
[] Tick here if continuation sheet used

HL1. Line no.: _ _

HL2. Name: ____

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

HL4. Is (name) male or female?

HL5. How old is (name)? How old was (name) in his/her last birthday?
Record in Completed years
HL6. Eligible for women's interview

HL7. Eligible for child labour module
For each child age 5-14: Who is the mother or primary caretaker of this child (PCE)?

HL8. Eligible for under-5 interview
For each child under 5: Who is the mother or primary caretaker of this child (PCE)

For children age 0-17 years ask HL9-HL12

HL9. Is (name's) biological mother alive?

HL10. If alive: Does (name's) biological mother live in this household?

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

HL12. If alive: Does (name's) biological father live in this household?

Are there any other persons living here - even if they are not members of your family or do not have parents living in this household?
Including children at work or at school? If yes, insert child's name and complete form.
Then, complete the totals below.

Totals

Now for each woman age 15-49 years, write her name and line number and other identifying information in the information panel of the women'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 the questionnaire for children under five.
You should now have a separate questionnaire for each eligible woman (aged 15-49) and each child under five in the household.

Education Module: ED

Add another sheet if there are more than 14 members aged 5 and over in the household. Check here if another sheet on the Education Module is used []

For household members age 5 and above

ED1. Line no. Report line number of the child (HL1) _ _

ED1A. Name ____

ED2. Has (name) ever attended school or preschool?

ED3. What is the highest level of school that (name) has achieved? What is the highest grade (name) completed at this level?

For household members age 5-24 years

ED4. During this school year (2005-2006), did (name) attend school or preschool?

ED5. Since last (day of the week), how many days did (name) attend school?

ED6. During this school year, which level and grade is/was (name) attending?

ED7. Did (name) attend school or preschool at any time during the previous school year, that is (YEAR)?

ED8. During the previous school year (2004-2005), which level and grade did (name) attend?

Water and sanitation module: WS

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

WS1A. What other source of drinking water does your household use in case of pump failure?

WS1B. If the pump fails, how long does it take to repair it?

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

WS3. How long does it take to go there, get water, and come back?

WS4. Who usually goes to this source to fetch the water for your household?
Probe: Is this person under age 15? What sex?
Circle code that best describes this person.

WS5. Do you treat your water in any way to make it safer to drink?

WS6. What do you usually do to the water to make it safer to drink?
Anything else?
Record everything mentioned (multiple answers possible).
WS7. What kind of toilet facility do members of your household usually use?
If "flush" or "pour flush", probe: Where does it flush to?
If necessary, ask permission to observe the facility.

WS8. Do you share this facility with other households?

WS9. How many households in total use this toilet facility

Household characteristics module: HC

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

HC1C. What is the ethnicity (for Ivorians) of the head of household or the country of origin for non-Ivoirians?

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

HC3. Main floor material:
Circle the corresponding code according to the observation.
HC4. Main material of the roof.
Circle the corresponding code according to the observation.
HC5. Main material of the walls.
Ask the question and circle the corresponding code according to the answer given.
HC5A. Number of doors with trim
(ask the question and enter the number indicated)
HC5B. Number of doors and windows
(ask the question and enter the number indicated)
HC5C. Number of windows with trim
(ask the question and enter the number indicated)
HC5D. Daytime room lighting

HC6A. Do you cook in your household?

HC6. In your household, what type of fuel do you mainly use for cooking?

HC7. In this household, is food cooked on an open fire, an open stove or a closed stove?

HC7A. Does the fire/stove have a chimney or a hood?

HC8. Is the cooking usually done in the house, in a separate building, or outdoors?

HC9. Does your household have:










HC10. Does any member of your household own:










HC11. Does any member of this household own any land that can be cultivated?

HC12. How many hectares of agricultural land do members of this household own?
If more than 97, record '97'. If unknown, record '98'.

HC13. Does this household own farm/livestock animals?

HC14. How many of the following animals does this household have?

Module on insecticide-treated mosquito nets: ITN

TN1. In your household, do you have mosquito nets?

TN2. How many mosquito nets do you have in your household?
If 7 or more nets, record '7'.
TN2A. In your household, was the last mosquito net acquired:

TN3A. Where did you get mosquito net?

TN3B. How much did you pay for the mosquito net?

TN4. Check TN2A for the type of mosquito net(s). Check the corresponding box and follow the instructions below:
TN5. When you got the (more recent) mosquito net, was it treated with an insecticide to kill or keep away mosquitoes?

TN6. How long have you had the (most recent) mosquito net?
If less than 1 month, write '00'. If the answer is "12 months" or "1 year", probe to determine whether the net was obtained exactly 12 months ago or earlier or later.
TN7. Since you have had the mosquito net(s), have you dipped or soaked it in any liquid to kill/keep away mosquitoes?

TN8. How long has passed since the mosquito net was last soaked or dipped in an insecticidal liquid?
If less than 1 month, write '00'. If the answer is "12 months" or "1 year", probe to determine whether the net was obtained exactly 12 months ago or earlier or later.
Child labour module: CL

The questions in this module should be asked of the mother/primary caregiver of each child aged 5 to 14 in the household. For each eligible child (5-14 years old) enter the line number mentioned in HL1. Now, I would like to ask you questions about all types of work that children living in this household may have done.

CL1. Line no. mentioned in HL1 _ _

CL2. Name of the child: ____

CL3. During the past week did (name) any kind of work for someone who is not a member of this household?
If yes: Was he/she paid in cash or in kind?

CL4. If yes: 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?

CL5. At any time during the past year, did (name) do any kind of work for someone who is not a member of this household?
If yes: Was he/she paid in cash or in kind?

CL6. During the past week, did (name) help with household chores such as shopping, collecting firewood, cleaning, fetching water, or caring for children?

CL7. If yes: Since last (day of the week), about how many hours did he/she spend doing these chores? _ _

CL8. During the past week, did (name) do any other family work (on the farm or in a business or selling goods in the street)

CL9. If yes: Since last (day of the week), about how many hours did he/she do this work? _ _

Child discipline module: CD

Table 1: Children aged 2-14 years eligible for child discipline questions
Review the household listing and list each of the children aged 2-14 years below in order according to their line number (HL1). Do not include other household members outside of the age range 2-14 years. Record the line number, name, sex, age, and the line number of the mother or caretaker for each child. Then record the total number of children aged 2-14 in the box provided (CD7).

CD1. Rank no.

CD2. Line no. from HL1.

CD3. Name from HL2.

CD4. Sex from HL4.

CD5. Age from HL5.

CD6. Line no. of mother/caretaker from HL7 or HL8.

CD7. Total children aged 2-14 years _ _

If there is only one child age 2-14 years in the household, then skip table 2 and go to CD11 to administer the questions from the child discipline module for this child. If there are no children aged 2-14 in the household, move on to another questionnaire

Table 2: Selection of random child for child discipline questions
Use this table 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. Look for the last digit of the household number from the cover page. This is the number of the row you should go to in the table below. Check the total number of eligible children (2-14) in CD7 above. This is the number of the column you should go to. Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the child about whom the questions will be asked. Record the rank number in CD9 below. Finally, record the line number and name of the selected child in CD11 on the next page. Then, find the mother or primary caretaker of that child, and ask the questions, beginning with CD12.

CD8. Last digit of the questionnaire number 0-9
Total number of eligible children in the household 1-8+
[Table omitted]

CD9. Record the rank number of the selected child from table 2 above

Identify eligible child aged 2 to 14 in the household using the tables on the preceding page, according to your instructions. Ask to interview the mother or primary caretaker of the selected child (identified by the line number in CD6).

CD11. Write name and line no. of the child selected for the module from CD3 and CD2, based on the rank number in CD9.

CD12. All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.

CD12A. Took away privileges, forbade something (name) liked or did not allow him/her to leave house.

CD12B. Explained why something (the behavior) was wrong.

CD12C. Shook him/her.

CD12D. Shouted, yelled at or screamed at him/her.

CD12E. Gave him/her something else to do.

CD12F. Spanked, hit or slapped him/her on the bottom with bare hand.

CD12G. Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.

CD12H. Called him/her dumb, lazy, or another name like that.

CD12I. Hit or slapped him/her on the face, head or ears.

CD12J. Hit or slapped him/her on the hand, arm, or leg.

CD12K. Beat him/her up with an implement (hit over and over as hard as one could).

CD12L. Depriving him/her of food.

CD12M. Have fire or a hot instrument on his/her body.

CD12N. Make him/her sleep outside.

CD13. Do you believe that in order to bring up (raise, educate) (name) properly, you need to physically punish him/her?