MICS Household Questionnaire

[Ghana]
Household Information Panel: HH

HH1. Locality name Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and number

HH4. Supervisor name and number:

HH5. Date of interview

HH5A. Is the household selected for the male survey?

HH6. Area

HH7. Region

HH7A. District

HH7B. Dist-type _

HH7C. Sub-dist _ _

HH7D. Structure address:

HH7E. Contact No. of HH:

We are from the Ghana Statistical Service. We are conducting a survey that is concerned with family health and education. I would like to ask you a few questions on these areas. The interview will take about 45 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone. May I start now?

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

HH8. Name of head of household: ____

HH9. Result of household interview:

HH10. Respondent to household questionnaire:

HH11. Total number of household members: _ _

HH12. Number of women age 15-49 years: _ _

HH13. Number of women's questionnaires completed: _ _

HH14. Number of children under age 5: _ _

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

If household is not selected for the male interview (HH5A=2), leave HH15A and HH15B blank

HH15A. Number of men aged 15-59 years: _ _

HH15B. Number of men's questionnaires completed: _ _

HH16. Field edited by (name and number)

HH17. Date entry clerk (name and number)

HH18. Record the time

Household Listing Form: HL

First, please tell me the name of each person in your household 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 currently in school or at work.)
If yes, complete listing for questions HL2-HL4. Then, ask questions starting with HL5 for each person at a time.
Use an additional questionnaire if all rows in the household listing form have been used.

HL1. Line number: _ _

HL2. Name: ____

HL3. What is the relation-ship of (name) to the head of household?

HL4. Is (name) male or female?

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

HL6. How old is (name)?
Record in completed years. If age is 95 or above, record '95'
HL7. Circle line no.
If woman is age 15-49 (for women age 15-49)

HL7A. Circle line no.
Check if HH5A=1 If man is age 15-59 (for men age 15-59)

HL8. Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (for children age 5-14.)
HL9. Who is the mother/primary caretaker of this child?
Record line no. of mother/ caretaker (for children under age 5)
HL10. Did (name) stay here last night?
(for all household members)
For children age 0-17 years [HL11 to HL14]

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

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

HL14. Does (name's) natural father live in this household?
Record line no. of father or 00 for "no"
[] Check box if additional questionnaire is used.
Probe for additional household members. Probe especially for any infants or small children not listed, and others who may not be members of the family (such as servants, friends, physically challenged) but who usually live in the household. Insert names of additional members in the household list and complete form accordingly.
Now for each woman age 15-49 years, write her name and line number and other identifying information in the information panel of a separate individual women's questionnaire. Now for each man age 15-59 years, write his name and line number and other identifying information in the information panel of a separate individual men's questionnaire if the household is selected for the male interview. For each child under age 5, write his/her name and line number and the line number of his/her mother or caretaker in the information panel of a separate Under-5 questionnaire. You should now have a separate questionnaire for each eligible woman, man, and each child under five in the household.

Codes for HL3. Relationship to head of household

Education: ED

For household member age 3 and above [ED1 to ED4B]

ED1. Line number: _ _

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

ED4A. What is the highest level of school (name) has attended?
If level=0, skip to ED5
ED4B. What is the highest class/year (name) completed at this level?
If less than a class/year completed, enter 0
For household members age 3-24 years [ED5 to ED8]

ED5. During the (2011-2012) school year, did (name) attend school or preschool at any time?

ED6. During this/that school year, which level and class/year is/was (name) attending?
If level=0, skip to ED7
ED7. During the previous school year, that is (2010-2011), did (name) attend school or preschool at any time?

ED8. During that previous school year, which level and class/year did (name) attend?
If level=0, go to next person
Codes for Educational Level: ED4A, ED6, ED8

Water and Sanitation: WS

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

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

WS3. Where is that water source located?

WS4. How long does it take to go there, get water, and come back?

WS5. Who usually goes to this source to collect the water for your household?
Probe: Is this person under age 15? What sex?

WS6. Do you do anything to the water to make it safer to drink?

WS7. What do you usually do to make the water safer to drink?
Probe: Anything else? Record all items mentioned.
WS7A. Check WS1
WS7B. During the last month, how often did the water flow through the pipe?

WS7C. When was the last time the water facility broke down?

WS7D. Last time the facility water broke down, how long did it take to have it fixed and working again?

WS8. What kind of toilet facility do members of your household usually use?
If "flush" , probe: Where does it flush to? If necessary, ask permission to observe the facility.
WS9. Do you share this facility with others who are not members of your household?

WS10. Do you share this facility only with members of other households that you know, or is the facility open to the use of the general public?

WS11. How many households in total use this toilet facility, including your own household?

Household characteristics: HC

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

HC1B. To what ethnic group does the head of this household belong?
Refer to manual for ethnic classfications
HC2. How many rooms in this household are used for sleeping?

HC3. Main material of dwelling floor
Record observation
HC4. Main material of the roof
Record observation
HC5. Main material of the exterior walls.
Record observation
HC6. What type of fuel does your household mainly use for cooking?

HC6A. In this household, is food cooked on an open fire, a coal pot or a closed stove?

HC7. Is the cooking usually done in the house, in a separate building, or outdoors?
If 'In the house', probe: is it done in a separate room used as a kitchen?

HC8. Does your household have:

A. Electricity?

B. A radio?

C. A black and white television?

C1. A colour television?

D. A land/fixed telephone?

E. A refrigerator/freezer?

F. A washing machine?

G. A laptop computer?

H. A desktop computer?

I. A video deck?

J. A DVD/VCD player?

K. A sewing machine?

HC9. Does any member of your household own:

A. A watch?

B. A mobile telephone?

C. A bicycle?

D. A motorcycle or scooter?

E. An animal drawn cart?

F. A car or truck?

G. A canoe/boat with a motor?

H. A canoe/boat without a motor?

HC10. What is the occupancy status of your household in this dwelling?

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

HC12. How many (hectares poles/acres/plot) of agricultural land do members of this household own?
If less than one, record "00". If 95 or more, record '95'. If unknown, record '98' for number. If unit is not known, circle "998".
HC12A. Apart from the plot described in hHC11 above, does any member of this household own any piece of land that is used or can be used for residential and/or commercial purposes?

HC12B. How many (hectares poles/acres/plot) of residential plots do members of this household own?
If less than one, record "00". If 95 or more, record '95'. If unknown, record '98' for number. If unit is not known, circle "998".
HC13. Does this household own any livestock, herds, other farm animals, or poultry?

HC14. How many of the following animals does this household have?
If none, record '00'. If 95 or more, record '95'. If unknown, record '98'.

A. Cattle, milk cows, or bulls?

B. Horses, donkeys, or mules?

C. Goats?

D. Sheep?

E. Chickens?

F. Pigs?

G. Rabbits?

H. Ducks?

I. Others (specify)

HC15. Does any member of this household have a bank account?

HC16. Over the past 12 months, has any member of this household received any form of support (kind or cash) from non- household member?

HC17. Over the past 12 months, has any member of this household received any form of support (kind or cash) from government or other organization?

HC18. From which source did the household member(s) receive this form of support?
Circle all that apply.
HC19. Over the past 12 months, has any member of this household sent out any form of support (kind or cash) to non- household members?

Insecticide Treated Nets: TN

TN1. Does your household have any mosquito nets that can be used while sleeping?

TN2. How many mosquito nets does your household have?

TN3. Ask the respondent to show you the nets in the household. If more than 3 nets, use additional questionnaire(s).
[Repeat questions from modules TN4-TN13 for each net]

TN4. Mosquito net observed

TN5. Observe or ask the brand/type of mosquito net.
If brand is unknown and you cannot observe the net, show pictures of typical net types/brands to respondent.
TN5A. Where did you get this net?

TN6. How many months ago did you obtain net?
If less than one month, record "00"
TN6A. How much did it cost you to acquire this net (GH¢)?
If received free of charge, record "00"
TN7. Check TN5 for type of net
TN8. When you got the net, was it already treated with an insecticide to kill or repel mosquitoes?

TN9. Since you got the net, has it ever been soaked or dipped in a liquid to kill or repel mosquitoes?

TN10. How many months ago was the net last soaked or dipped?
If less than one month, record "00"
TN11. Did anyone sleep under this mosquito net last night?

TN12. Who slept under this mosquito net last night?
Record the person's line number from the household listing form
If someone not in the household list slept under the mosquito net, record 00
TN13.
1st Net: Go back to TN4 for next net. If no more nets, go to TN14.
2nd Net: Go back to TN4 for next net. If no more nets, go to TN14.
3rd Net: Go back to TN4 for next net. If no more nets, go to TN14.
TN14. During the last 12 months, has any member of your household disposed off any treated mosquito nets?

TN15. Now I want to talk about the last treated net that you disposed off.
How did you dispose off your last treated mosquito net?

TN16. How long did you use it before disposing it off?

TN17. What was the main reason for disposing off this net?

Indoor residual spraying: IR

IR1. At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitoes?

IR2. Who sprayed the interior walls of your dwelling?
Circle all that apply.
Child Discipline: CD

Table 1: Children Aged 2-14 Years Eligible for Child Discipline Questions
If there is no child aged 2-14 years in the household, skip to next module.
List each of the children aged 2-14 years below in the order they appear in the household listing form. Do not include other household members outside of the age range 2-14 years.
Record the line number, name, sex, and age for each child.
Then record the total number of children aged 2-14 in the box provided (CD6).
If there is only one child age 2-14 years in the household, skip table 2 and go to CD8; write down'1' and continue with CD9.

CD1. Rank Number: _

CD2. Line number from HL1: _ _

CD3. Name from HL2: ____

CD4. Sex from HL4

CD5. Age from HL6: _ _

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

Table 2: Selection of Random Child for Child Discipline Questions
Use Table 2 to select one child between the ages of 2 and 14 years, if there is more than one child in that age range in the household.
Check the last digit of the household number (HH2) from the cover page. 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 CD6 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 (CD1) about whom the questions will be asked.

CD7.
Total number of eligible children in the household (CD6) [Column 1 to 8+]
Last digit of household number (HH2) [Row 0 to 9]

CD8. Record the rank number of the selected child: _

CD9. Write the name and line number of the child selected for the module from CD3 and CD2, based on the rank number in CD8.
CD10. Adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods 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.

CD11. Took away privileges, forbade something (name) liked or did not allow him/her to leave house.

CD11A. Ignored/refused to communicate to (name).

CD12. Explained why (name)'s behavior was wrong.

CD13. Shook him/her.

CD14. Shouted, yelled at or screamed at him/her.

CD15. Gave him/her something else to do.

CD16. Spanked, hit, pushed or slapped him/her on the bottom with bare hand.

CD17. Hit him/her on the bottom or elsewhere on the body with something like a belt, comb, hairbrush, cane, stick or other hard object.

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

CD19. Hit or slapped him/her on the face, head or ears.

CD20. Hit or slapped him/her on the hand, arm, or leg.

CD21. Beat him/her up, that is hit him/her over and over as hard as one could.

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

Hand washing: HW

HW1. Please show me where members of your household most often wash their hands.

HW2. Observe presence of water at the specific place for handwashing.
Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water.
HW3. Record if soap or detergent or other traditional detergents are present at the specific place for handwashing.
Circle all that apply.
Skip to next module if any soap or detergent code (A, B, C, D, E or X) is circled. If "None" (Y) is circled, continue with HW4.
HW4. Do you have any soap or detergent or any other traditional detergents in your household for washing hands?

HW5. Can you please show it to me?
Record observation. Circle all that apply.
HH19. Record the time

Salt Iodization: SI
SI1. We would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals in your household?
Once you have tested the salt, circle number that corresponds to test outcome.
SI1A. Has the household been selected for male questionnaire?
Check HH5A=1
SI2. Has the salt sample been collected from this household?

HH20. Does any eligible woman age 15-49 reside in the household?
Check household listing form, column HL7 for any eligible woman. You should have a questionnaire with the information panel filled in for each eligible woman.

HH21. Does any child under the age of 5 reside in the household?
Check household listing form, column HL9 for any eligible child under age 5. You should have a questionnaire with the information panel filled in for each eligible child.

HH22. [If this household was selected for the male questionnaire] Does any eligible man age 15-59 reside in the household?
Check household listing form, column HL7A for any eligible man. You should have a questionnaire with the information panel filled in for each eligible man.

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________