Begin with welcoming: We are from the agency of the Republic of Kazakhstan on Statistic. We work on the family health and education project. I want to discuss this with you. All received information is strictly confidential; no one will learn below answers are yours. I want to speak with the household head and every mother or child caretaker in the household. Shall I start?
If yes, begin the interview.

Household Information: HH

HH1. Cluster number: _ _ _ _ _ _ _ _ _

HH2. Household Number _ _ _ _ _ _

HH3. Interviewer's name and number:

HH4. Supervisor's name and number:

HH5. Interview day/month/year: _ _ / _ _ / _ _ _ _

HH6. Location:

HH7. Oblast:

HH8. Name of household head: ____

After completing all household questionnaires enter the following:
[Note: HH9 to HH16]

HH9. HH interview outcomes:

HH10. HH questionnaire respondent:

HH11. Number of household members: _ _

HH12. No. of women eligible: _ _

HH13. No. of completed women's questionnaires: _ _

HH14. No. of under-5s: _ _

HH15. No. of completed under-5 questionnaires: _ _

Interviewer/supervisor's notes: Use this field for notes on household members interviews, such as: additional telephone calls, individual incomplete interview forms, number of visits for interview etc.

HH16. Data entry operator: _ _

Household listing form: HL

Please, name all people who usually reside here. Start from the household head.
Write down the name of the household head at line 01. List all household members (HL2), their relationship to the household head (HL3), and their sex (HL4).
Question: Do any other people, who are currently out, reside here? (These could be children or adults at school or work). If there are any, include them into the Questionnaire. Then, interview every person by turn, starting from HL5.

HL1. Line no.: _ _

HL2. Name: ____

HL3. Relationship to HH head
See codes below

HL4. Sex

HL5. Age: full years
If 97 or more, write "97"
HL6. Eligible for women's interview

HL7. Eligible for child labour module
For each child aged 5-14 year: Child's mother or caretaker

HL8. Eligible for child health
For each under 5 child: Child's mother or caretaker

For children age 0-17 years ask HL9-HL12

HL9. Is mother alive?

HL10. If alive: Does mother reside in this household?

HL11. Is father alive?

HL12. If alive: Does father reside in this household?

Question: Do any other children reside in your household, even if they are not your family members or orphaned (including those in school or at work)?
If yes, write down child's name and complete listing.
Then enter total number.

Totals

Education Module: ED

For household members age 5 and above

ED1. Line no. _ _

ED1A. Name ____

ED2. Has (name) attended preschool institution, school and other educational institution?

ED3. The highest level (name) attended grade/course (s)he completed at this level:

For household members age 5-24 years

ED4. Has (s)he attended education or pre-school institution during (2005/2006)?

ED5. Number of days (name) attended education facility since last day of school week (dow) (days)?

ED6. Level and grade (name) attended during this school year (2005/2006) level:

ED7. Has (name) attended educational institution previous school year - 2004/2005?

ED8. What level and grade/course attended (name) previous school year (2004/2005)?

Water and sanitation module: WS

WS1. What main source of drinking water do your household members use?

WS2. What main source of water do your household members use for cooking and handwashing?

WS3. How much time is needed to go to source of drinking water, get water and return?

WS4. Who usually goes to this source of water for your HH members?
Ask whether: This person is under age 15 and what sex?
Circle code describing this person.

WS5. Do you use any method for treatment of drinking water?

WS6. What method do you use for treatment of drinking water? Other
Write down all mentioned.
WS7. What type of toilet facility do your HH members usually use?
If "lavatory pan" or "flush", ask: where it flushes?
If necessary, ask to see the facilities.

WS8. Do other households use this toilet as well?

WS9. In total, how many households use this toilet facility?

Household characteristics module: HC

HC1B. Native language of the household head?

HC1C. Nationality of the household head?

HC2. How many rooms are used as bedrooms in the household?

HC3. Floor material
Write down your observations.
HC4. Roof material
Write down your observations.
HC5. Walls material
Write down yous observations.
HC6. Power (fuel) source household members usually use for cooking

HC7. Cooking in this household by type of stove or fire
Identify type.
HC7A. Availability of chimney or hood for fire/stove

HC8. Type of cooking: inside the house, in separate premises or outside

HC9. Is there in your household:











HC10. Does any member of your household own:

HC11. Where do you get the main information for your family from?

Child labor: CL

Questions to caretakers of children aged 5?14 years residing in the household.
Copy the line number of each eligible child from the Household Listing.
Now I shall inquire about the labor activity children might be involved in this household.

CL1. Line no. _ _

CL2. Name: ____

Job for non-member of this household
CL3. Was the child involved in labor activity during past week?
If yes: Was it paid?

Job for non-member of this household
CL4. Approximate number of hours worked during past week if more than one work done, specify total hours worked at all jobs?

Job for non-member of this household
CL5. Was (s)he involved in any labor activity during previous year?
If yes: Was it paid?

CL6. During past week was (s)he involved in household chores, such as shopping, collection of firewood, cleaning, carrying water or child care?

CL7. Approximate number of hours involved in this household chores during past week? _ _

CL8. During past week was (s)he involved in any other labor activity in the family (farm, family business)?

CL9. Approximate number of hours involved in this activity during past week? _ _

Tables for identifying children aged 2-14 for child discipline module: CD

Table 1: Eligible children aged 2-14 years
List below all children aged 2-14 years out of the Household Listing in accordance with the line number (HL1). Exclude other household members who are not aged 2-14 years. Write down line number, name, sex, age and line number for mother or each child caretaker. Then write down total number of children aged 2-14 years in the table below (CD7).

CD1. Rank no.

CD2. Line no. from HL1.

CD3. Name from HL2.

CD4. Sex from HL4.

CD5. Age from HL5.

CD6. Line no. of mother/caretaker from HL7 or HL8.

CD7. Total number of children aged 2-14 years _ _

If there is only one child aged 2-14 years in the household, go to CD9 and CD11, if more than one child - continue with CD8

Table 2: Random selection of child for discipline interview
This table should be used to select one child aged 2-14 years, if there is more than one child of current age group in the household.
See the last figure of the household number on the cover page. This is the line number to which you should go in the below table. Check the total number of eligible children in CD7(above).
This is the column number from the table to which you should go. Find the cell, in which line and column cross and circle the figure in the cell. This is the serial number of child you will question about.
Write down serial number in CD9 below. Finally, write down line number and name of selected child in CD11 next page. Then find mother/care-taker and start interview from CD12.

CD8. Last figure of questionnaire number 0-9
Total number of eligible children in household (from cd7) 1-8+
[Table omitted]

CD9. Write down serial number of selected child from Table 2

CD10. Identify eligible child in the household aged 2-14 years using tables in the previous page in accordance with instructions. Ask mother/caretaker about interview (identified by the line number CD6).

CD11. Write down name and line no. of a child selected for module from CD3 and CD2, on the basis of serial number in CD9.

CD12. Adults use different methods of disciplining the child.
I am going to list different methods and ask you if you or any member of your household used these methods during past month.

CD12A. Deprived (name) privileges, pleasures, banned anything or going out

CD12B. Explained to (name) incorrectness of such (action) behavior

CD12C. Shake him/her.

CD12D. Scream at him/her.

CD12E. Forced him/her acting against his/her will

CD12F. Slapped, beat or hit his back with your hand

CD12G. Beat his/her back or other parts of the body with any hard things such as belt

CD12H. Called him/her silly, lazy, or other similar words

CD12I. Beat his/her face, head or ears

CD12J. Beat his hands, shoulders, legs

CD12K. Beat him/her with any stuff (again and again stronger)

CD13. Do you believe that the child needs to be physically punished for proper discipline?

Maternal mortality module: MM

Applicable to each adult member of household aged 15 years or older. Copy the name and the line number of each adult (15 or older) member of household. Any adult member might give answers for missing adult member. In this case, put '1' in MM3, and specify line number of authorized respondent in MM4.
Leave blank lines for members of household aged 15 years or younger.

MM1. Line no.

MM2. Name

MM3. Is it "authorized" report?

MM4. Line no. of authorized respondent (from the HH listing HL1)

MM5. Number of sisters (from the same mother) you ever had

MM6. Sisters who reached age 15 years

MM7. Sisters (at the age at least 15 years) still alive

MM8. Sisters who reached age 15 or more and who died?

MM9. Number of dead sisters dying during pregnancy or delivery or within 6 weeks after pregnancy finished

Consumption of iodized salt: SI

SI1. We want to see if members of your household use iodized salt.
May I see salt the members of your household used for cooking and consumed last night?
After testing salt, circle the number, which corresponds to the test result.

SI2. Is there eligible woman aged 15-49 years in the household?
Check the HL6 column in the Household Listing. You must have questionnaire containing Informational Module completed for each eligible woman.
[] Yes (Go to women's questionnaire for interviewing the first eligible woman)
[] No (Continue)

SI3. Are there under-5 children in the household?
Check the HL8 column in the Household Listing. You must have questionnaire containing Informational Module completed for each eligible child.
[] Yes (Go to under-5 questionnaire for interviewing caretaker of the first eligible child.)
[] No (Finish the interview, thank respondent for cooperation.
Collect all questionnaires for current household and write down the total number of completed interviews on the cover page.)