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>[Version: 04 June 2018]
Algeria, 2018


5-17 Child information panel: FS

FS1. Cluster number: _ _ _

FS2. Household number: _ _

FS3. Child's name and line number:

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

FS5. Interviewer's name and number:

FS6. Supervisor's name and number:

FS7. Day/month/year of interview

FS8. Record the time of beginning 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) 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 already interviewed this respondent for another questionnaire?

FS10A. Hello, my name is (your name). We are from the Ministry of health, population, and hospital reform. 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 10 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 10 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?


FS17. Result of interview for child age 5-17 years
Codes refer to the respondent. Discuss any result not completed with Supervisor.
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Child's background: CB

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

CB2. In what month and year was (name) born?
Month and year must be recorded.
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.
CB4. Has (name) ever attended school or any early childhood education programme?

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

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

CB7. At any time during the [current] school year did (name) attend school or any early childhood education programme?

CB8. During this [current] school year, which level and grade or year is (name) attending?

CB9. At any time during the [previous] school year did (name) attend school or any early childhood education programme?

CB10. During that [previous] school year, which level and grade or year did (name) attend?

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

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CB12. What type of health insurance is (name) covered by?
Record all mentioned.
CB13. Does (name) do any sports activity?

CB13A. What kind of sports activity does (name) do?
Record all the sports activities that (name) does.
CB13B. Where does (name) practice his/her sport?

CB13C. How many hours a week does (name) participate in this/these sports?

CB13E. Why doesn't (name) participate in any sports?

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Oral Health: BDH

BDH1. Does (name) brush his/her teeth?

BDH2. Does (name) use a toothbrush?

BDH3. What does (name) use to brush his/her teeth?

BDH4. Does (name) go to the dentist?

BDH5. Where did he/she receive his/her last dental care?

BDH6. Do you think that cavities can have an effect on a child's overall health?

BDH7. Does (name) wear orthodontic braces?

BDH8. In the last 12 months has (name) ever had to miss school for dental problems (pain, dental abscess ....)

BDH9. When (name) complains of a toothache, what does he/she usually take?

Child Labour: CL

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, vegetable garden or looked after animals? For example, growing farm produce, harvesting, or feeding, grazing or milking animals?

B. Did (name) help in a family business or a relative's business with or without pay, or run (his/her) own business?

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

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?

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

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

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

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

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

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

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

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

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

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

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

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?

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?

B. Cooking?

C. Washing dishes or cleaning around the house?

D. Washing clothes?

E. Caring for children?

F. Caring for someone old or sick?

X. Other household tasks?

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

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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'
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Child discipline: FCD

FCD1. Check CB3: Child's age?

FCD2. Now I'd like to talk to you about something else.
Adults use certain ways to teach children the right behaviour or how to behave. I will read a list of 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.

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

C. Shook (him/her).

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

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

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

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

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

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

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

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

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

FCD4. Check FS4: Has this respondent already responded to the following question (UCD5 or FCD5) for another child?

FCD5. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?

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Accident: AC

AC1. Now I would like to talk about something else.
As you know, children sometimes are victims of various serious accidents. Has (name) ever had a serious accident anywhere at any time in the past?

AC2. What kind of accident did (name) have?

AC3. How old was (name) at the time
Most recent serious accident type quoted in AC2?
AC4. How did this accident happen?

AC5. Where did this accident take place?

AC6. Where was (name) taken?

AC7. Why wasn't (name) treated in a hospital or by a doctor?

Child functioning: FCF

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

FCF2. Does (name) use a hearing aid/a hearing implant?

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

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 do the activity at all.

FCF5. Check FCF1: Child wears glasses or contact lenses?

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

FCF6B. Does (name) have difficulty seeing?

FCF7. Check FCF2: Child uses a hearing aid/implant?

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

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

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

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

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

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

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

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

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

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

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

FCF24. Does (name) have difficulty making friends?

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?

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?

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Parental involvement: PR

PR1. Check CB3: Child's age?

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 textbooks, extracurricular books, and religious books, how many books do you have for (name) to read at home?

PR4. Check CB7: Does the child attend any school?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
PR5. Does (name) ever have homework to do at home during the school year?

PR6. Does anyone help (name) with homework during the school year?

PR6A. Does (name) get any tutoring?

PR6B. If yes (PR6A), in how many subjects?

PR7. Does (name)'s school have a parent association that parents can participate in?

PR7A. Are you/the father members of the parent association?

PR7B. Is the parent association an active group?

PR8. In the last 12 months, have you or any other adult from your household attended a meeting called by this parent association?

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?

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

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

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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?

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

C. To discuss (name)'s progress with (his/her) counselors?

D. For a discipline-related question?

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, earthquakes, epidemics or similar?

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

C. Teacher strike?

X. Other?

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

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

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FS11. Record the time.

FS16. End the interview with this respondent by thanking the respondent and the child for her/his cooperation.

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Interviewer's observations

Supervisor's observations