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MICS-6
Questionnaire for children age 5-17


Iraq, 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

_ _ / _ _ / 2018 _

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 Central Statistical Office(CSO) and Ministry of Health. 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 [number] 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. 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) ____

[p. 2]
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):

[] 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?

[] 0 Kindergarten _ _
[] 1 Primary _ _
[] 2 Intermediate
[] 3 Diploma (5 yrs. After intermediate) _ _
[] 4 Secondary _ _
[] 5 Diploma _ _
[] 6 Bachelors degree _ _

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

[] 1 Yes
[] 2 No

CB7. At any time during the [current] school year (2017-18) did (name) attend school or any early childhood education programme(kindergarten)?

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

CB8. During this [current] school year(2017-18), which level and grade or year is (name) attending?

[] 0 Kindergarten _ _
[] 1 Primary _ _
[] 2 Intermediate _ _
[] 3 Diploma (5 yrs. After intermediate) _ _
[] 4 Secondary _ _
[] 5 Diploma _ _
[] 6 Bachelors degree _ _

CB9. At any time during the [previous] school year (2016-17) did (name) attend school or any early childhood education programme?

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

CB10. During that [previous] school year(2016-17), which level and grade or year did (name) attend?

[] 0 Kindergarten _ _
[] 1 Primary _ _
[] 2 Intermediate _ _
[] 3 Diploma (5 yrs. After intermediate) _ _
[] 4 Secondary _ _
[] 5 Diploma _ _
[] 6 Bachelors degree _ _

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

[] 1 Yes
[] 2 No (Go to next module)

[p. 3]
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) ____

[p. 4]
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, 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

[p. 5]
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)

[p. 6]
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 functioning: FCF

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)

[p. 9]
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
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M/Y at all

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

[p. 10]
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

[p. 11]
Parental involvement: PR

PR1. Check CB3: Child's age?

[] 1 Age 5-6 years (Go to FS11)
[] 2 Age 7-14 years
[] 3 Age 15-17 years (Go to FS11)

PR3. Excluding school text books and holy books, how many books do you have for (name) to read at home?
Check any type of holy books like Quran, Bible, etc.

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

PR4. Check CB7 and ED9 in HH questionnaire: Did the child attend any school?

[] 1 Yes, CB7/ED9=1
[] 2 No, CB7/ED9=2 or blank (Go to FS11)

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 or school management committee / parents association]?

[] 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

[p. 12]
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 next module)

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

[p. 13]
FS11. Record the time.

Hours and minutes _ _ : _ _

FS12. Language of the Questionnaire.

[] 1 Arabic
[] 2 Kurdish (Sorani)
[] 3 Kurdish (Badini)

FS13. Language of the Interview.

[] 1 Aranic
[] 2 Kurdish (Sorani)
[] 3 Kurdish (Badini)
[] 4 Turkman
[] 5 Asserian
[] 6 Other language (specify) ____

FS14. Native language of the Respondent.

[] 1 Aranic
[] 2 Kurdish (Sorani)
[] 3 Kurdish (Badini)
[] 4 Turkman
[] 5 Asserian
[] 6 Other 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.

[p. 20]
Interviewer's observations

Supervisor's observations