MICS Household Questionnaire
Kenya 2009
Household Information Panel: HH
HH1. Cluster number: _ _ _
HH2. Household number: _ _
HH3. Interviewer name and number
Number: _ _
HH4. Field edited by (name and number):
Number: _ _
HH5. Day/month/year of interview
HH6. Area
[] 2 Rural
[] 3 Slum (informal settlement)
HH7. Region:
HH7A. District:
HH8. Name of head of household: ____
After all questionnaires for the household have been completed, fill in the following information:
HH9. Result of household interview:
[] 2 Not at home
[] 3 Refused
[] 4 Household not found/destroyed
[] 6 Other (specify) ____ ____
HH10. Respondent to household questionnaire:
Line No: _ _
HH11. Total number of household members: _ _
HH12. Number of women age 15-49 years: _ _
HH13. Number of women age 15-49 years completed: _ _
HH14. Number of children under age 5: _ _
HH15. Number of under-5 questionnaires completed: _ _
Interviewer/editor/supervisor notes: Use this space to record notes about the interview with this household, such as call-back times, incomplete individual interview forms, number of attempts to re-visit, etc.
HH15A. Supervisor:
Number: _ _
HH16. Data entry clerk:
Number: _ _
We are from Kenya National Bureau of Statistics (KNBS). We are working on a project concerned with family health and education. I would like to talk to you about this. All the information we obtain will remain strictly confidential and your answers will never be identified. May I start now?
Household Listing Form: HL
HL0. Record the time
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? (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 is not enough room on this page. Tick here if continuation sheet is used [].
HL1. Line number: _ _
HL2. Name: ____
HL3. What is the relation-ship of (name) to the head of the household?
HL4. Is the (name) male or female?
[] 2 Female
HL5. How old is (name)?
Probe: How old was (name) on his/her last birthday? Record age in completed years
HL6. Circle line no.
If woman is age 15-49
HL7. For each child age 5-14: Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker
HL8. For each child under 5: Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker
HL8A. Has (name) been very sick for at least 3 months during the past 12 months?
[] 2 No
[] 8 DK
For children age 0-17 years [HL9 to HL12A]
HL9. Is (name's) natural mother alive?
[] 2 No (Go to HL11)
[] 8 DK (Go to HL11)
HL10. If alive:
Does (name's) natural mother live in this household?
Record line number of mother or 00 for no
HL10A. If mother does not live in household:
Has (name's) mother been very sick for at least 3 months in the past 12 months?
[] 2 No
[] 8 DK
HL11. Is (name's) natural father alive?
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
HL12. If alive:
Does (name's) natural father live in this household?
Record line number of father or 00 for no
HL12A. If father does not live in household:
Has (name's) father been very sick for at least 3 months in the past 12 months?
[] 2 No
[] 8 DK
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 name and complete form.
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 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.
Code for HL3. Relationship to head of household
[] 02 Wife/husband
[] 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
[] 14 Adopted/foster/stepchild
[] 15 Not related
[] 98 Don't know
Education: ED
For household member age 5 and above
ED1. Line number: _ _
ED1A. Name and age
Copy from Household Listing Form, HL2 and HL6
Age: _ _
ED2. Has (name) ever attended school, preschool or any non-formal education?
[] 2 No (Go to next line)
ED3. What is the highest level of school (name) has attended?
What is the highest grade (standard/form/class) (name) completed at this level?
If less than 1 grade, enter 00. If level=0 or 6, leave grade blank
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 6 Non-formal education
[] 8 DK
[] 98 DK
For household members age 5-24 years
ED4. During the current (2009) school year, did (name) attend school, preschool or non-formal education at any time?
[] 2 No (Go to ED7)
ED5. Since last (day of the week), how many days did (name) attend school?
Insert number of days. Exclude the day of interview.
[] 8 DK
[] 9 School closed
ED6. During this school year, which level and grade (standard/form/class) is (name) attending?
If level=0 or 6 leave Grade blank
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 6 Non-formal education
[] 8 DK
[] 98 DK
ED7. Did (name) attend school, preschool or non-formal education at any time during the previous school year, that is 2008?
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
ED8. During that previous school year, which level and grade (standard/form/class) did (name) attend?
If level=0 or 6, leave grade blank
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 6 Non-formal education
[] 8 DK
[] 98. DK
Water and Sanitation: WS
WS1. What is the main source of drinking water for members of your household?
[] 12 Piped into compound, yard or plot (Go to WS5)
[] 13 Piped to neighbor (Go to WS5)
[] 14 Piped to water kiosk (Go to WS3)
[] 15 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, dam, lake, pond, canal, 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 WS5)
[] 13 Piped to neighbor (Go to WS5)
[] 14 Piped to water kiosk
[] 15 Public tap/standpipe
[] 32 Unprotected well
[] 42 Unprotected spring
[] 61 Tanker-truck
[] 71 Cart with small tank/drum
[] 81 Surface water (river, stream, dam, lake, pond, canal, irrigation channel)
[] 91 Bottled water
[] 96 Other (specify) ____
WS3. How long does it take to go there, get water, and come back?
[] 995 Water on premises (Go to WS5)
[] 998 DK
WS4. 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
WS5. Do you do anything to the water to make it safer to drink?
[] 2 No (Go to WS7)
[] 8 DK (Go to WS7)
WS6. 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
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.
[] 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) ____
WS8. Do you share this facility with others who are not members of your household?
[] 2 No (Go to next module)
WS8A. 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)
WS9. How many households in total use this toilet facility, including your own household?
[] 10 Ten or more households
[] 98 DK
Household characteristics: HC
HC1A. What is the religion of the head of this household?
[] 2 Other Christian
[] 3 Muslim
[] 4 No religion
[] 6 Others (specify)
HC2. How many rooms in this household are used for sleeping?
HC3. Main material of 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 observations
[] 12 Grass/Thatch/Makuti
[] 13 Sod
[] 14 Dung/Mud
[] 22 Tin cans
[] 32 Concrete
[] 33 Tiles
HC5. Main material of the walls.
Record observations
[] 12 Cane/palm/trunks
[] 13 Dirt
[] 22 Stone with mud
[] 23 Uncovered adobe
[] 24 Plywood
[] 25 Cardboard
[] 26 Reused wood
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement bricks
[] 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 t)
[] 03 Natural gas (Go to HC9)
[] 04 Biogas (Go to HC9)
[] 05 Kerosene (Go to HC9)
[] 06 Coal/lignite
[] 07 Charcoal
[] 08 Wood
[] 09 Straw/shrubs/grass
[] 10 Animal dung
[] 11 Agricultural crop residue
[] 96 Other (specify) ____
[] 97 No food cooked in household (Go to HC9)
HC8. Is the cooking usually done in the indoor living space, in a separate kitchen/building, or outdoors?
[] 2 In a separate room used as kitchen
[] 3 In a separate building used as kitchen
[] 4 Outdoors
[] 6 Other (specify) ____
HC9. Does your household have:
A. Electricity?
[] 2 No
B. Radio?
[] 2 No
C. Color television?
[] 2 No
D. B and W television?
[] 2 No
E. Mobile telephone?
[] 2 No
F. Non-mobile telephone?
[] 2 No
G. Refrigerator?
[] 2 No
H. Blender or mixer?
[] 2 No
I. Water heater?
[] 2 No
J. Washing machine?
[] 2 No
K. Computer?
[] 2 No
L. Internet connection?
[] 2 No
M. VCR, VCD or DVD?
[] 2 No
N. Air conditioner?
[] 2 No
O. Sewing machine?
[] 2 No
HC10. Does any member of your household own:
A. A watch?
[] 2 No
B. A bicycle?
[] 2 No
C. A motorcycle or scooter?
[] 2 No
D. An animal drawn cart?
[] 2 No
E. A car or truck?
[] 2 No
F. A boat with a motor?
[] 2 No
HC10A. Do you or someone living in this household own this dwelling, or do you rent this dwelling?
[] 2 Rent
[] 6 Rent free/squatter/other
HC11. Does any member of this household own any land that can be used for agriculture?
[] 2 No (Go to HC13)
HC12. How many hectares of agricultural land do members of this household own?
If less than one, record "00". If more than 97, record '97'. If unknown, record '98'.
HC13. Does this household own any livestock, herds, or farm animals?
[] 2 No (Go to next module)
HC14. How many of the following animals does this household have?
If none, record '00'. If more than 97, record '97'. If unknown, record '98'.
A. Cattle?
B. Milk cows or bulls?
C. Horses, donkeys, or mules?
D. Goats?
E. Sheep?
F. Chickens?
Indoor Residual Spraying: IR
IR1. At any time in the past 12 months, has anyone sprayed the interior walls of your dwelling against mosquitoes?
[] 2 No (Go to next module)
IR2. How many months ago was the house sprayed?
If less than one month, record "00".
IR3. Who sprayed the house?
[] 2 Private company
[] 3 Household member
[] 6 Other (specify) ______
[] 8 DK
ITN: TN
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?
TN2A. Ask the respondent to show you the nets in the household. If unable to observe the net(s), ask the respondent to determine the brand/type of net. If more than 3 nets, use additional questionnaire(s).
Tick here if additional questionnaire is used []
TN3. Mosquito net observed
[] 2 Not observed
TN4. How many months ago did your household obtain the mosquito net?
If less than one month record "00"
[] 95 37+ months ago
[] 98 Not sure
TN5. Observe or ask the brand/type of mosquito net.
[] 12 Olyset
[] 13 Supernet
[] 16 Other (specify) ____
[] 18 DK brand
[] 26 Other (specify) ____
[] 28 DK brand/type
[] 98 DK brand/type
TN5A. Where did you get the mosquito net?
Name of place"
[] 12 Govt. health centre
[] 13 Govt. health post/Dispensary
[] 14 Village health worker
[] 15 Mobile/outreach clinic
[] 16 Other public (specify) ____
[] 22 Private physician
[] 23 Private pharmacy
[] 25 Mobile clinic
[] 26 Other private medical (specify) ____
[] 32 Shop
[] 33 Trad. practitioner
[] 98 DK
TN5B. How much did you pay for the mosquito net?
[] 9995 Free
[] 9998 DK
TN6. Check TN5 for type of net
[] Pre-treated (Go to TN8)
[] Else (Continue)
TN7. When you got the net, was it treated with an insecticide to kill or repel mosquitoes?
[] 2 No
[] 8 DK/not sure
TN8. Since you got the mosquito net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?
[] 2 No (Go to TN10)
[] 8 DK/not sure (Go to TN10)
TN9. How many months ago was the net last soaked or dipped?
If less than one month, record "00"
[] 95 More than 24 mo ago
[] 98 DK/not sure
TN10. Did anyone sleep under this mosquito net last night?
[] 2 No (Go to TN12)
[] 8 DK/not sure (Go to TN12)
TN11. 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
_ _ Line number
TN12.
1st Net: Go back to TN3 for next net. If no more nets, go to next module.
2nd Net: Go back to TN3 for next net. If no more nets, go to next module.
3rd Net: Go back to TN3 in first column of a new questionnaire for next net. If no more nets, go to next module.
Child Orphaned and Made Vulnerable by HIV/AIDS: OV
OV1. Check HL5: any children 0-17?
[] No (Child Labour Module)
OV2. I would like you to think back over the past 12 months. Has any usual member of your household died in the last 12 months?
[] 2 No (Go to OV5)
OV3. (Of those who died in the past 12 months) were any of these people between the ages of 18 and 59?
[] 2 No (Go to OV5)
OV4. (Of those who died in the past 12 months and were between the ages of 18 and 59) were any of these people very sick for 3 of the 12 months before he/she died?
[] 2 No
OV5. Return to the Household Listing and check the following:
OV5A. Check HL9 and HL11.
[] No mother or father dead
OV5B.Check HL8A:
[] No adult aged 18-59 very sick 3 of last 12 months
OV5C. Check HL10A and HL12A:
[] No mother or father very sick 3 of last 12 months (Go to Child Labour Module)
OV8. List all children aged 0-17 below. Record names, line numbers and ages of all children, beginning with the first child and continue in order in which listed in the household listing module. Use an additional questionnaire if there are more than 4 children age 0-17 in the household Ask all questions for one child before moving to the next child. Tick here if additional questionnaire is used []
Line number (from HL1) _ _
Age (from HL5) _ _
I would like to ask you about any formal, organized help or support that your household may have received for (name) and for which you did not have to pay. By formal organized support I mean help provided by someone working for a program. This program could be government, private, religious, charity, or community-based. Remember this should be support for which you did not pay.
OV10. Now I would like to ask you about the support your household received for (name). In the last 12 months, has your household received any medical support for (name), such as medical care, supplies or medicine?
[] 2 No
[] 8 DK
OV11. In the last 12 months, has your household received any emotional or psychological support for (name), such as companionship, counseling from a trained counselor, or spiritual support, which you received at home?
[] 2 No (Go to OV13)
[] 8 DK
OV12. Did your household receive any of this support in the past 3 months?
[] 2 No
[] 8 DK
OV13. In the last 12 months, has your household received any material support for (name), such as clothing, food or financial support?
[] 2 No (Go to OV15)
[] 8 DK
OV14. Did your household receive any of this support in the past 3 months?
[] 2 No
[] 8 DK
OV15. In the last 12 months, has your household received any social support for (name), such as help in household work, training for a caregiver, or legal services?
[] 2 No (Go to OV17)
[] 8 DK
OV16. Did your household receive any of this support in the past 3 months?
[] 2 No
[] 8 DK
OV17. Check OV8 for age of child:
[] Age 5-17 (Go to OV18)
OV18. In the last 12 months, has your household received any support for (name's) schooling, such as allowance, free admission, books or supplies?
[] 2 No
[] 8 DK
Child Labour: CL
To be administered for children in the household age 5-14 years. For household members below age 5 or above age 14, leave rows blank.
Now I would like to ask about any work children in this household may do.
CL1. Line number: _ _
CL2. Name and age
_ _ Age
CL3. During the past week, did (name) do any kind of work for someone who is not a member of this household?
If yes: For pay in cash or kind?
[] 2 Yes, unpaid
[] 3 No (Go to CL5)
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?
If more than one job, include all hours at all jobs.
CL5. During the past week, did (name) fetch water or collect firewood for household use?
[] 2 No (Go to CL7)
CL6. If yes:
Since last (day of the week), about how many hours did he/she fetch water or collect firewood for household use?
CL7. During the past week, did (name) do any paid or unpaid work on a family farm or in a family business or selling goods in the street?
Include work for a business run by the child, alone or with one or more partners.
[] 2 No (Go to CL9)
CL8. If yes:
Since last (day of the week), about how many hours did he/she do this work for his/her family or himself/herself?
CL9. During the past week, did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people?
[] 2 No (Go to next line)
CL10. If yes:
Since last (day of the week), about how many hours did he/she spend doing these chores?
Child Discipline: 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, and age for each child. Then record the total number of children aged 2-14 in the box provided (CD7)
If there is only one child age 2-14 years in the household, then skip table 2 and go to CD9; write down the rank number of the child and continue with CD11.
CD1. Rank Number: _
CD2. Line number from HL1: _ _
CD3. Name from HL2: ____
CD4. Sex from HL4
[] 2 Female
CD5. Age from HL6: _ _
CD7. Total children age 2-14 years: _ _
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 (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 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.
CD8.
Total number of eligible children in the household [Column 1 to 8+]
Last digit of household number (HH2) [Row 0 to 9]
CD9. Record the rank number of the selected child: _
Identify eligible child aged 2 to 14 in the household using the tables on the preceding page, according to your instructions.
CD11. Write name and line number of the child selected for the module from CD3 and CD2, based on the rank number in CD8.
_ _ Line number
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.
[] 2 No
CD12B. Explained why something (the behaviour) was wrong.
[] 2 No
CD12C. Shook him/her.
[] 2 No
CD12D. Shouted, yelled at or screamed at him/her.
[] 2 No
CD12E. Gave him/her something else to do.
[] 2 No
CD12F. Spanked, hit or slapped him/her on the bottom with bare hand.
[] 2 No
CD12G. Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.
[] 2 No
CD12H. Called him/her dumb, lazy, or another name like that.
[] 2 No
CD12I. Hit or slapped him/her on the face, head or ears.
[] 2 No
CD12J. Hit or slapped him/her on the hand, arm, or leg.
[] 2 No
CD12K. Beat him/her up with an implement (hit over and over as hard as one could).
[] 2 No
CD13. Do you believe that in order to bring up (raise, educate) (name) properly, you need to physically punish him/her?
[] 2 No
[] 8 Don't know/no opinion
Disability: DA
To be administered for all children 2 through 9 years old living in the household. For household members below age 2 or above age 9, leave rows blank
I would like to ask you if any children in this household aged 2 through 9 has any of the health conditions I am going to mention to you.
DA1. Line no.
DA2. Child's name and age
Age _ _
DA3. Compared with other children, does or did (name) have any serious delay in sitting, standing, or walking?
[] 2 No
DA4. Compared with other children, does (name) have difficulty seeing, either in the daytime or at night?
[] 2 No
DA5. Does (name) appear to have difficulty hearing? (Uses hearing aid, hears with difficulty, completely deaf?)
[] 2 No
DA6. When you tell (name) to do something, does he/she seem to understand what you are saying?
[] 2 No
DA7. Does (name) have difficulty in walking or moving his/her arms or does he/she have weakness and/or stiffness in the arms or legs?
[] 2 No
DA8. Does (name) sometimes have fits, become rigid, or lose consciousness?
[] 2 No
DA9. Does (name) learn to do things like other children his/her age?
[] 2 No
DA10. Does (name) speak at all (can he/she make him or herself understoof in words; can say any recognizable words)?
[] 2 No
DA11. (For 3-9 year olds):
Is (name)'s speech in any way different from normal (not clear enough to be understood by people other than the immediate family)?
[] 2 No
DA12. (For 2-year-olds):
Can (name) at least one object (for example, an animal, a toy, a cup, a spoon)?
[] 2 No
DA13. Compared with other children of the same age, does (name) appear in any way mentally backward, dull or slow?
[] 2 No
Hand washing: HW
HW1. We would like to see the place where members of your household most often wash their hands? May I see this place?
[] 2 No specific place for hand washing (Go to HW5)
[] 3 No permission to see (Go to HW5)
HW1A. Place where household members most often wash their hands?
Ask to see and observe. Record only one hand washing place. This is he hand washing place most often used by household members. Estimate the distance of "within 10 paces".
[] 02 Kitchen/Cooking place
[] 04 Toilet facility (but farther from kitchen)
[] 05 Kitchen (but farther from toilet facility)
[] 07 Elsewhere outside the yard
HW2. Water available at the place for hand washing?
If there is a tap or pump at the specific place for handwashing, open the tap or operate the pump to see if water is coming out. If there is a bucket, basin or other type of water container, examine to see whether water is present in the container. Record observation.
[] 2 Water is not available
HW3. Soap or detergent present at the specific place for hand washing?
Record observation. Circle all that apply.
[] B Detergent (powder/liquid/paste) (Go to next module)
[] C Liquid soap (Go to next module)
[] Y None
HW5. Do you have any soap or detergent in your household for washing hands?
[] 2 No (Go to next module)
HW6. Can you please show it to me?
Record observation. Circle all that apply.
[] B Detergent (powder/liquid/paste)
[] C Liquid soap
[] Y Not able/does not want to show
Salt Iodization: SI
SI1. We would like to check whether the salt used in your household is iodized. May I see a sample of the salt used to cook the main meal eaten by members of your household last night?
Once you have examined the salt, circle number that corresponds to test outcome.
[] 2 Less than 15 PPM
[] 3 15 PPM or more
[] 6 No salt in the house
[] 7 Salt not tested
SI1A. Record the time.
SI2. Does any eligible woman age 15-49 reside in the household? Check household listing, column HL6. You should have a questionnaire with the Information Panel filled in for each eligible woman.
[] No (Continue.)
SI3. Does any child under the age of 5 reside in the household? Check household listing, column HL8. You should have a questionnaire with the Information Panel filled in for each eligible child.
[] No (End the interview by thanking the respondent for his/her cooperation. Gather together all questionnaires for this household and tally the number of interviews completed on the cover page.)
Remarks and Observations
Supervisor ________
Field editor ________
Field monitors/co-ordinators ________
Office editor ________