MICS Household Questionnaire

[Kenya]
Household Information Panel: HH

HH-A. Province name and code:

HH-B. County name and code:

HH-C. District name and code:

HH1. Cluster number: _ _ _ _

HH2. Household number: _ _ _

HH3. Interviewer name and number

HH4. Supervisor name and number:

HH5. Day/month/year of interview

HH6. Area

HH8. Name of head of household: ____

After all questionnaires for the household have been completed, fill in the following information:
[Note: for question HH9 to HH15]

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 age 15-49 years forms 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.
[Note: for question HH16 to HH17]

HH16. Field edited by (name and number)

HH17. Date entry clerk (name and number)

We are from Kenya National Bureau of Statistics (KNBS). We are conducting a family health and education survey. 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?
If permission is given, begin the interview.

HL0. Record the time

Household Listing Form: HL

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 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. 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 (eligibility for women's interview)

HL7. For each child age 5-14:
Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (mother or caretaker of child 5-14.)
HL8. For each child under 5:
Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker (eligibility for under-5 interview)

HL8A. Has (name) been very sick for at least 3 months during the past 12 months?
Ask if age 18-59 years
Ask if age 0-17 years [HL9 to HL12A]

HL9. Is (name's) natural mother alive?

If alive:
HL10. Does (name's) natural mother live in this household?
Record line number of mother or 00 for no
If mother does not live in household:
HL10A. Has (name's) mother been very sick for at least 3 months during the past 12 months?

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

If alive:
HL12. Does (name's) natural father live in this household?
Record line number of father or 00 for no
If father does not live in household:
HL12A. Has (name's) father been very sick for at least 3 months during the past 12 months?

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.
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 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 the Under-5 questionnaire. You should now have a separate questionnaire for each eligible woman and each child under five in the household.

Codes for HL3. Relationship to head of household

Education: ED

For household members age 5 and above [ED1 to ED3]

ED1. Line number: _ _

ED1A. Name and age

ED2. Has (name) ever attended school, pre-school or any non-formal education?

ED3. What is the highest level of school (name) 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.
For household members age 5-24 years [ED4 to ED8]

ED4. During the current (2011) school year, did (name) attend school, preschool or non-formal education at any time?

ED5. Since last (day of the week), how many days did (name) attend school?
Insert number of days. Exclude the day of interview.
ED6. During this school year, which level and grade (standard/form/class) is (name) attending?
If level=0 or 6, leave grade blank
ED7. Did (name) attend school, preschool or non-formal education at any time during the previous school year, that is 2010?

ED8. During the previous school year, which level and grade (standard/form/class) did (name) attend?
If level=0 or 6, leave grade blank
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. How long does it take to go there, get water, and come back?

WS4. Who usually goes to this source to collect the water for your household?
Probe: Is this person under age 15? What sex?

WS5. Do you treat your water in any way to make it safer to drink?

WS6. What do you usually do to the water to make it safer to drink?
Probe: Anything else? Record all items mentioned.
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.
WS8. Do you share this facility with other households?

WS8A. Do you share this facility only with other households that you know, or is the facility open to the use of the general public?

WS9. How many households in total use this toilet facility?

Household characteristics: HC

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

HC2. How many rooms in this household are used for sleeping?

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

HC8. Is the cooking usually done in the indoor living space, in a separate kitchen/building, or outdoors?

HC9. Does any member of your household have:

A. Electricity?

B. Radio?

C. Color television?

D. B and W television?

E. Mobile telephone?

F. Non-mobile telephone?

G. Refrigerator?

H. Blender or mixer?

I. Water heater?

J. Washing machine?

K. Computer?

L. Internet connection?

M. VCR, VCD or DVD?

N. Air conditioner?

O. Sewing machine?

HC10. Does any member of your household own:

A. A watch?

B. A bicycle?

C. A motorcycle or scooter?

D. An animal-drawn cart?

E. A car or truck?

F. A boat with a motor?

HC10A. Do you or someone living in this household own this dwelling, or do you rent this dwelling?

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

HC12. How many acres 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?

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. Local cattle (indigenous)?

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?

IR2. How many months ago was the house sprayed?
If less than one month, record "00".
IR3. Who sprayed the house?

ITN: TN

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

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
[Repeat questions from modules TN3-TN12 for each net]

TN3. Mosquito net observed?

TN4. How many months ago did your household obtain the mosquito net?
If less than one month, record "00"
TN5. Observe or ask the brand/type of mosquito net.

TN5A. Where did you get the mosquito net?
(Name of place) ____

TN5B. How much did you pay for the mosquito net?

TN6. Check TN5 for type of net
TN7. When you got the net, was it treated with an insecticide to kill or repel mosquitoes?

TN8. Since you got the mosquito net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?

TN9. How many months ago was the net last soaked or dipped?
If less than one month, record "00"
TN10. Did anyone sleep under this mosquito net last night?

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
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 for next net. If no more nets, go to next module.

Orphaned and Vulnerable Children: OV

OV1. Check HL5: any children 0-17?
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?

OV3. (Of those who died in the past 12 months) were any of these people between the ages of 18 and 59?

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?

OV5. Return to the household listing and check the following:
OV5A. Check HL9 and HL11.
OV5B. Check HL8A.
OV5C. Check HL10A and HL12A.
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
[Repeat questions from modules OV10-OV18 for each child]
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?

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?

OV12. Did your household receive any of this support in the past 3 months?

OV13. In the last 12 months, has your household received any material support for (name), such as clothing, food or financial support?

OV14. Did your household receive any of this support in the past 3 months?

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?

OV16. Did your household receive any of this support in the past 3 months?

OV17. Check OV8 for age of child:
OV18. In the last 12 months, has your household received any support for (name's) schooling, such as allowance, free admission, books or supplies?

Child Labour: CL

To be administered for children in the household age 5 through 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

CL3. During the past week, did (name) do any kind of work for someone who is not a member of this household?
If yes: Probe for (pay in cash or kind) or unpaid?
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?

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 ?
Include work for a business run by the child, alone or with one or more partners.
If yes:
CL8. 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?

If yes:
CL10. 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

CD5. Age from HL5: _ _

CD7. Total children aged 2-14 years: _ _

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 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 [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 CD9.
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.

CD12B. Explained why something (the behavior) was wrong.

CD12C. Shook him/her.

CD12D. Shouted, yelled at or screamed at him/her.

CD12E. Gave him/her something else to do.

CD12F. Spanked, hit or slapped him/her on the bottom with bare hand.

CD12G. Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.

CD12H. Called him/her dumb, lazy, or another name like that.

CD12I. Hit or slapped him/her on the face, head or ears.

CD12J. Hit or slapped him/her on the hand, arm, or leg.

CD12K. Beat him/her up, with an implement (hit over and over as hard as one could).

CD13. Do you believe that in order to bring up (raise, educate) (name) properly, you need to physically punish him/her?

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 number: _ _

DA2. Child's name and age

DA3. Compared with other children, does or did (name) have any serious delay in sitting, standing, or walking?

DA4. Compared with other children, does (name) have difficulty seeing, either in the daytime or at night?

DA5. Does (name) appear to have difficulty hearing? (Uses hearing aids, heard with difficulty, completely deaf?)

DA6. When you tell (name) to do something, does he/she seem to understand what you are saying?

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?

DA8. Does (name) sometimes have fits, become rigid, or lose consciousness?

DA9. Does (name) learn to do things like other children his/her age?

DA10. Does (name) speak at all (can he/she make him or herself understood in words; can say any recognizable words)?

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 in the immediate family)?

DA12. (For 2-year-olds): Can (name) name at least one object (for example, an animal, a toy, a cup, a spoon)?

DA13. Compared with other children of the same age, does (name) appear in any way mentally backwards, dull or slow?

Handwashing Facility: HW

HW1. We would like to see the place where members of your household most often wash their hands? May I see this place?

HW1A. Place where household members most often wash their hands?
Ask to see and observe. Record only one hand washing place. This is the hand washing place most often used by household members. Estimate the distance of "within 10 paces".
HW2. Water available at the place for hand washing?
If there is a tap or pump at the specific place for hand washing, 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.
HW3. Soap or detergent present at the specific place for hand washing.
Record observation. Circle all that apply.
HW5. Do you have any soap or detergent in your household for washing hands?

HW6. Can you please show it to me?
Record observation. Circle all that apply.
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? May I test a sample of this salt?
Once you have examined the salt, circle number that corresponds to test outcome.
SL1A. 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.
SI2. 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.
Remarks and Observations

Supervisor ________

Field editor ________

Field monitoring/Co-ordinators ________

Office editor ________