MICS Household Questionnaire
Household Information Panel: HH
HH3. Interviewer's name and number
Number _ _
HH4. Supervisor's name and number:
Number _ _
HH5. Day/month/year of interview
[] 2 Rural
[] 2 Pomeroon-Supenaam
[] 3 Essequibo Islands-West Demerara
[] 4 Demerara-Mahaica
[] 5 Mahaica-Berbice
[] 6 East Berbice-Corentyne
[] 7 Cuyuni-Mazaruni
[] 8 Potaro-Siparuni
[] 9 Upper Takutu-Upper Essequibo
[]10 Upper Demerara-Berbice
[] 2 Interior
HH8. Is the household selected for questionnaire for men?
[] 2 No
We are from the Bureau of Statistics. We are conducting a survey about the situation of children, families and households. The data collected will be used by policy makers to make decisions that will benefit your household. I would like to talk to you about these subjects. The interview will take about 50 minutes. All the information we obtain will remain strictly confidential and anonymous. May I start now?
[] No, permission is not given (Circle 04 in HH9. Discuss this result with your supervisor.)
HH9. Result of household interview:
[] 02 No household member or no competent respondent at home at time of visit
[] 03 Entire household absent for extended period of time
[] 04 Refused
[] 05 Dwelling vacant/address not a dwelling
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 96 Other (specify) ____
After the household questionnaire has been completed, fill in the following information:
HH10. Respondent to household questionnaire:
After the household questionnaire has been completed, fill in the following information:
HH11. Total number of household members: _ _
After the household questionnaire has been completed, fill in the following information:
HH12. Number of women age 15-49 years: _ _
After all questionnaires for the household have been completed, fill in the following information:
HH13. Number of women's questionnaires completed: _ _
After the household questionnaire has been completed, fill in the following information:
If the household is selected for Questionnaire for Men
HH13A. Number of Men age 15-49 years:(if household is selected for questionnaire for men):_ _
After all questionnaires for the household have been completed, fill in the following information:
HH13B. Number of men's questionnaires completed: _ _
After the household questionnaire has been completed, fill in the following information:
HH14. Number of children under age 5: _ _
After all questionnaires for the household have been completed, fill in the following information:
HH15. Number of under-5 questionnaires completed: _ _
HH16. Field editor's name and number:
_ _ Number
HH17. Main data entry clerk's name and number:
_ _ Number
_ _ Minutes
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?
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.
HL3. What is the relationship of (name) to the head of household?
Code for HL3 Relationship to head of household
[] 02 Spouse/partner
[] 03 Son/daughter
[] 04 Son-in-law/daughter-in-law
[] 05 Grandchild
[] 06 Parent
[] 07 Parent-in-law
[] 08 Brother/sister
[] 09 Brother-in-law/sister-in-law
[] 10 Uncle/aunt
[] 11 Niece/nephew
[] 12 Other relative
[] 13 Adopted/foster/stepchild
[] 14 Servant (live-in)
[] 96 Other (not related)
[] 98 DK
HL4. Is (name) Male or Female?
[] 2 Female
HL5. What is (name's) date of birth?
Year (9998 DK): _ _ _ _
HL6. How old is (name)?
Record in completed years. If age is 95 or above '95':
HL6A. Did (name) stay here last night?
[] 2 No
HL6B. To which ethnic group does (name) belong?
[] 02 African
[] 03 Portuguese
[] 04 Amerindian
[] 05 Mixed Race
[] 06 Chinese
[] 96 Other
[] 98 DK
For women age 15-49
HL7. Circle line no. if woman age 15-49.
For men age 15-49
HL7A. Circle line no. If man age 15-49 and the house-hold is selected for Questionnaire for men.
For children age 0-4
HL7B. Circle line no. If children age 0-4.
For children age 0-17 years
HL11. Is (name)'s natural mother alive?
[] 2 No (Go to HL13)
[] 8 DK (Go to HL13)
For children age 0-17 years
HL12. Does (name)'s natural mother live in this household? _ _
If "Yes", record line no. of mother and go to HL13. If "No", record 00.
For children age 0-17 years
HL12A. Where does (name)'s natural mother live?
[] 2 Institution in this country
[] 3 Abroad
[] 8 DK
For children age 0-17 years
HL13. Is (name)'s natural father alive
[] 2 No (Go to HL15)
[] 8 DK (Go to HL15)
For children age 0-17 years
HL14. Does (name)'s natural father live in this household? _ _
If "Yes", record line no. of father and go to HL15. If "No", record 00.
For children age 0-17 years
HL14A. Where does (name)'s natural father live?
[] 2 Institution in this country
[] 3 Abroad
[] 8 DK
For children age 0-14 years
HL15. Record line no. of mother from HL12 if indicated.
If HL12 is blank or '00' ask: who is the primary caretaker of (name)?
[] Tick here if additional questionnaire used [After HL1 to HL4 questions]
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) 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.
For each man age 15-49 years, write his name and line number and other identifying information in the information panel of a separate individual man'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 a separate under-5 questionnaire.
You should now have a separate questionnaire for each eligible woman, each eligible man, and each child under five in the household.
ED2. Name and age
Copy from HL2 and HL6.
Age: _ _
For household members age 5 and above
ED3. Has (name) ever attended school or nursery?
[] 2. No (Go to next line)
For household members age 5 and above
ED4A. What is the highest level school (name) has attended?
If level=0, skip to ED5
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 8 DK
For household members age 5 and above
ED4B. What is the highest grade/year (name) completed at this level?
If the first grade at this level is not completed, enter "00".
[]98. DK
For household members age 5-24 years
ED5. During the current school year, that is 2013-2014, did (name) attend school or nursery at any time?
[] 2. No (Go to ED7)
For household members age 5-24 years
ED6. During this/that school year, which level and grade/year is/was (name) attending?
If level=0 skip to ED7
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 8 DK
[] 98 DK
For household members age 5-24 years
ED7. During the previous school year, that is 2012-2013, did (name) attend school or nursery at any time?
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
For household members age 5-24 years
ED8. During that previous school year, which level and grade/year did (name) attend?
If level=0 go to next line
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 8 DK
[] 98. DK
Selection of One Child for Child Labour/Child Discipline: SL
SL1. Check HL6 in the list of household members and write the total number of children age 1-17 years.
SL2. Check the number of children age 1-17 years in SL1:
[] One (Go to SL9 and record the rank number as '1', enter the line number, child's name and age.)
[] Two or more (Continue with SL2A.)
SL2A. List each of the children age 1-17 years below in the order they appear in the List of household members. Do not include other household members outside of the age range 1-17 years. Record the line number, name, sex, and age for each child.
SL4. Line number from HL1: _ _
[] 2 Female
SL8. 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 children age 1-17 years in SL1 above. This is the number of the column you should go to in the table below.
Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number (SL3) of the selected child.
Total Number of Eligible Children in the Household (from SL1): [2 to 8+] _
SL9. Record the rank number (SL3), line number (SL4), name (SL5) and age (SL7) of the selected child.
Line number: _ _
Name: ____
Age: _ _
CL1. Check selected child's age from SL9:
[] 5-17 years (Continue with CL2)
CL2. Now I would like to ask about any work children in this household 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, milking animals?
[] 2 No
B. Did (name) help in family business or relative's business with or without pay, or run his/her own business?
[] 2 No
C. Did (name) produce or sell articles, handicrafts, clothes, and food or agricultural products?
[] 2 No
D. 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?
If "No", Probe: Please include any activity (name) performed as a regular or casual employee, self-employed or employer; or as an unpaid family worker helping out in household business or farm.
[] 2 No
[] All answers are "No" (Go to CL8)
CL4. 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"
CL5. Does the activity/do these activities require carrying heavy loads?
[] 2 No
CL6. Does the activity/do these activities require working with dangerous tools (knives etc.) or operating heavy machinery?
[] 2 No
CL7. How would you describe the work environment of (name)?
[A] Is (name) exposed to dust, fumes or gas?
[] 2 No
[B] Is (name) exposed to extreme cold, heat or humidity?
[] 2 No
[C] Is (name) exposed to loud noise or vibration?
[] 2 No
[D] Is (name) required to work at heights?
[] 2 No
[E] Is (name) required to work with chemicals (pesticides, glues, etc.) or explosives?
[] 2 No
[F] Is (name) exposed to other things, processes or conditions bad for (name)'s health or safety?
[] 2 No
CL8. Since last (day of the week), did (name) fetch water or collect firewood for household use?
[] 2 No (Go to CL10)
CL9. In total, how many hours did (name) spend on fetching water or collecting firewood for household use, since last (day of the week)?
If less than one hour, record "00"
CL10. Since last (day of the week), did (name) do any of the following for this household?
[] 2 No
[B] Repair any household equipment?
[] 2 No
[C] Cooking or cleaning utensils for the house?
[] 2 No
[] 2 No
[] 2 No
[F] Caring for the old or sick?
[] 2 No
[] 2 No
[] All answers are 'no' (Go to next module)
CL12. 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"
CD1. Check selected child's age from SL9
[] 15-17 years (Go to next module)
CD2. Write the line number and name of the child from SL9.
Name: ____
CD3. 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 anyone else in your household has used this method with (name) in the past month.
[A] Took away privileges, forbade something (name) liked or did not allow him/her to leave the house.
[] 2 No
[B] Explained why (name)'s behaviour was wrong.
[] 2 No
[] 2 No
[D] Shouted, yelled at or screamed at him/her.
[] 2 No
[E] Gave him/her something else to do.
[] 2. No
[F] Spanked, hit or slapped him/her on the bottom with bare hand.
[] 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.
[] 2 No
[H] Called him/her dumb, lazy, or another name like that.
[] 2 No
[I] Hit or slapped him/her on the face, head or ears.
[] 2 No
[J] Hit or slapped him/her on the hand, arm, or leg.
[] 2 No
[K] Beat him/her up, that is hit him/her over and over as hard as one could.
[] 2 No
CD4. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?
[] 2 No
[] 8 DK/no opinion
HC1A. What is the religion of the head of this household?
[] 2 Hindu
[] 3 Muslim
[] 4 Rastafarian
[] 5 Bahai
[] 6 Other religion (specify) ____
[] 7 No religion
HC2. How many rooms in this household are used for sleeping?
HC3. Main material of the dwelling floor.
Record observation.
[] 12 Dung
[] 22 Palm/bamboo
[] 32 Vinyl or asphalt strips
[] 33 Ceramic tiles
[] 34 Cement
[] 35 Carpet
HC4. Main material of the roof.
Record observation.
[] 12 Thatch/palm leaf
[] 22 Palm/bamboo
[] 23 Wood planks
[] 24 Cardboard
[] 32 Wood
[] 33 Calamine/cement fibre
[] 34 Ceramic tiles
[] 35 Cement
[] 36 Roofing shingles
[] 37 Roof tiles
[] 96 Other (specify) ____
HC5. Main material of the exterior walls.
Record observation
[] 12 Cane/palm/trunks
[] 13 Dirt
[] 22 Stone with mud
[] 23 Uncovered adobe
[] 24 Plywood
[] 25 Cardboard
[] 26 Reused wood
[] 27 Finished (wooden) walls
[] 31Cement
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement blocks
[] 35 Covered adobe
[] 36 Wood planks/shingles
HC6. What type of fuel does your household mainly use for cooking?
[] 02 Liquefied petroleum gas (LPG) (Go to HC8)
[] 03 Natural gas (Go to HC8)
[] 04 Biogas (Go to HC8)
[] 05 Kerosene (Go to HC8)
[] 06 Coal/lignite
[] 07 Charcoal
[] 08 Wood
[] 09 Straw/shrubs/grass
[] 10 Animal dung
[] 11 Agricultural crop residue
[] 95 No food cooked in household (Go to HC8)
[] 96 Other (specify) ____
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?
[] 2 Elsewhere in the house
[] 4 Outdoors
[] 6 Other (specify) ____
HC8. Does your household have:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[F] Stove that works with solar energy
[] 2 No
[G] A computer (desktop, laptop, tablet)
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC9. Does any member of your household own:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2. No
[] 2. No
[] 2 No
HC10. Do you or someone living in this household own this dwelling?
If "No", then ask: Do you rent this dwelling from someone not living in this household?
If "Rented from someone else", circle "2". For other responses, circle "6".
[] 2 Rent
[] 6 Other (specify) ____
HC11. Does any member of this household own any land that can be used for agriculture?
[] 2 No (Go to HC13)
HC12. How many acres 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'.
HC13. Does this household own any livestock, herds, other farm animals, or poultry?
[] 2 No (Go to HC15)
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?
HC15. I do not want to know how much money is in the account; does any member of this household have a bank account?
[] 2 No
[] 3 DK
TN1. Does your household have any mosquito nets that can be used while sleeping?
[] 2 No (Go to next module)
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).
TN4. Mosquito net observed?
[Ask up to 3 Nets]
[] 2 Not observed
TN5. Observe or ask the type of mosquito net.
If type is unknown and you cannot observe the net, show pictures of typical net types to respondent.
[] 21 Pre-treated net
[] 36 Other net (specify) ____
[] 98 DK type
TN6. How many months ago did your household get the mosquito net?
If less than one month, record '00'.
[] 95 More than 36 months ago
[] 98 DK/not sure
TN7. Check TN5 for type of net
[] Pre-treated (21) (Go to TN9)
[] Else (Continue with next question)
TN8. When you got the net, was it already treated with an insecticide to kill or repel mosquitoes?
[] 2 No
[] 8 DK/not sure
TN9. Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitos?
[] 2 No (Go to TN11)
[] 8 DK/not sure (Go to TN11)
TN10. How many months ago was the net last soaked or dipped?
If less than one month, record "00".
[] 95 More than 24 months ago
[] 98 DK/not sure
TN11. Did anyone sleep under this mosquito net last night?
[] 2 No (Go to TN13)
[] 8 DK/not sure (Go to TN13)
TN12. Who slept under this mosquito net last night?
Record the person's line number from the list of household members
If someone not in the list of household members slept under the mosquito net, record "00".
_ _ Line number
TN13.
1st Net: Go back to TN4 for next net. If no more nets, go to next module.
2nd Net: Go back to TN4 for next net. If no more nets, go to next module.
3rd Net: Go back to TN4 in first column of a new questionnaire for next net. If no more nets, go to next module.
WS1. What is the main source of drinking water used for members of your household?
[] 12 Piped into compound, yard or plot (Go to WS6)
[] 13 Piped to neighbour (Go to WS6)
[] 14 Public tap/standpipe (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 61 Tanker-truck (Go to WS3)
[] 71 Cart with small tank/drum (Go to WS3)
[] 81 Surface water (river, stream, lake, pond, canal, creek/stream irrigation channel) (Go to WS3)
[] 91 Bottled water
[] 96 Other (specify) ____(Go to WS3)
WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing?
[] 12 Piped into compound, yard or plot (Go to WS6)
[] 13 Piped to neighbour (Go to WS6)
[] 14 Public tap/standpipe
[] 32 Unprotected well
[] 42 Unprotected spring
[] 61 Tanker-truck
[] 71 Cart with small tank/drum
[] 81 Surface water (river, creek/stream, lake, pond, canal, irrigation channel)
[] 96 Other (specify) ____
WS3. Where is that water source located?
[] 2 In own yard/plot (Go to WS6)
[] 3 Elsewhere
WS4. How long does it take to go there, get water, and come back?
[] 998 DK
WS5. Who usually goes to this source to collect the water for your household?
Probe: is this person under age 15? What sex?
[] 2 Adult man (age 15+ years)
[] 3 Female child (under 15)
[] 4 Male child (under 15)
[] 8 DK
WS6. Do you do anything to the water to make it safer to drink?
[] 2 No (Go to WS8)
[] 8 DK
WS7. What do you usually do to make the water safer to drink?
Probe: Anything else? Record all items mentioned
[] B Add bleach/chlorine
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, etc)
[] E Solar disinfection
[] F Let it stand and settle
[] X Other (specify) ____
[] Z DK
WS8. What kind of toilet facility do members of your household usually use?
If "flush" or "pour flush", probe: Where does it flush to?
If not possible to determine, ask permission to observe the facility.
[] 12 Flush to septic tank
[] 13 Flush to pit (latrine)
[] 14 Flush to somewhere else
[] 15 Flush to unknown place/not sure/DK where
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 41 Bucket
[] 51 Hanging toilet, hanging latrine
[] 95 No facility, bush, field (Go to next module)
[] 96 Other (specify) ____
WS9. Do you share this facility with others who are not members of your household?
[] 2 No (Go to next module)
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?
[] 2 Public facility (Go to next module)
WS11. How many households in total use this toilet facility, including your own household?
[] 10 Ten or more households
[] 98 DK
HW1. We would like to learn about the places that households use to wash their hands. Can you please show me where members of your household most often wash their hands?
Not Observed
[] 3 No permission to see (Go to HW4)
[] 6 Other reason (specify) ____ (Go to HW4)
HW2 Observe presence of water at the place for handwashing. Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water
[] 2 Water is not available
HW3A. Is soap, detergent or ash/mud/sand present at the place for handwashing?
[] 2 No, not present (Go to HW4)
HW3B Record you observation
Circle all that apply
[] B Detergent (powder/liquid/paste) (Go to HH19)
[] C Liquid soap (Go to HH19)
[] D Ash/mud/sand (Go to HH19)
HW4 Do you have any soap or detergent or ash/mud/sand in your house for washing hands?
[] 2 No (Go to HH19)
HW5A. Can you please show it to me?
[] 2 No, not shown (Go to HH19)
HW5B Record your observation
Circle all that apply
[] B Detergent (powder/liquid/paste)
[] C Liquid soap
[] D Ash/mud/sand
SI1. We would like to check whether the salt used in your household is iodized/iodated. May I have a sample of the salt used to cook meals in your household?
Test salt for iodine using the iodate test kit. Remember to use the re-check solution on a fresh sample is no reaction is observed.
Once you have tested the salt, circle number that corresponds to test outcome.
[] 2 More than 0 PPM and less than 15 PPM (Go to HH20)
[] 3 15 PPM or more (Go to HH20)
[] 4 No salt in the house (Go to HH20)
[] 5 Salt not tested (specify reason) ____ (Go to HH20)
SI2. As the first test was negative I will need to repeat it using another method. May I have another sample of the same salt?
Test salt for iodine using the iodate test kit.
Once you have tested the salt, circle number that corresponds to test outcome.
[] 2 More than 0 PPM and less than 15 PPM
[] 3 15 PPM or more
HH20. Thank the respondent for his/her cooperation and check the list of household members:
Return to the cover page and make sure that the result of the household interview (HH9), the name and line number of the respondent to the household questionnaire (HH10), and the number of eligible women (HH12), men (HH13A), and under-fives (HH14) are entered. Make arrangements for the administration of the remaining questionnaire(s) in this household.
Interviewer's Observations ________