MICS Household Questionnaire

[Kazakhstan]
Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Name and number of interviewer:

HH4. Name and number of supervisor:

HH5. Day/month/year of interview

HH6. Area

HH7. Region/oblast

HH7A. Was this household selected for interviewing men aged 15 - 59?

We are from the Agency of statistics, RK. We are working on a project related to family health, education, status of women and children. I would like to talk to you about these subjects. The interview will take about 20 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. May I start?

After all questionnaires for the household have been completed, fill in the following information:
[Note: for question HH8 to HH18]

HH8. Name of head of household: ____

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 woman's questionnaires completed: _ _

HH12A. Number of men age 15-49 years: _ _

HH13B. Number of man's questionnaires completed: _ _


HH14. Number of children under age 5: _ _

HH15. Number of under-5 questionnaires completed: _ _

HH16. Field edited by (name and number)

HH17. Date entry clerk (name and number)

HH18. Record the time

Household Listing Form: HL

First, please tell me the name of each person who usually lives here, except students, soldiers being on a military service for a regular period, and those staying out of home for more than 12 months. Please start 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.

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. What is (name's) date of birth?

HL6. How old is (name)?
Record in completed years. If age is 95 or above, record '95'
HL7. Circle line no.
If woman is age 15-49 (for women age 15-49)

HL7A. Circle line no.
If man is age 15-59 (for men age 15-59)


HL8. Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (for children age 2-14.)
HL9. Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker (for children under age 5)
For children age 0-17 years [HL11 to HL14]

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

HL12. Does (name's) natural mother live in this household?
Record line number of mother or 00 for no
HL13. Is (name's) natural father alive?

HL14. Does (name's) natural father live in this household?
Record line no. of father or 00 for "no"
[] tick here if additional questionnaire used.
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, other relatives) 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. Now for each man age 15-59 years, write his name and line number and other identifying information in the information panel of a separate individual men's questionnaire. For each child under 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 age 15-49, selected man age 15-59, 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 ED4]

ED1. Line number: _ _

ED2. Name and age
Copy from Household Listing Form, HL2 and HL6
ED3. Has (name) ever attended school or pre-school?

ED4A. What is the highest level of school (name) attended?
What grade (name) completed at this level?
If level=0, skip to ED5. If 1st grade not completed, write 00
For household members age 5-24 [ED5 to ED8]

ED5. During the current (2010-2011) school year, did (name) attend school or preschool at any time?

ED6. During this school year (2010-2011), which level and grade is (name) attending?
If level=0, skip to ED7
ED7. During the previous school year, that is (2009-2010), did (name) attend school or preschool at any time?

ED8. During that previous school year (2009-2010), which level and grade did (name) attend?
If level=0, go to next line
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. Where is that water source located?

WS4. How long does it take to go there, get water, and come back?

WS5. Who usually goes to this source to collect the water for your household?
Probe: Is this person under age of 15? What sex?

WS6. Do you do anything to the water to make it safer to drink?

WS7. What do you usually do to make the water safer to drink?
Probe: Anything else? Circle all items mentioned.
WS8. What kind of toilet 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 toilet.
WS9. Do you share this facility with others who are not members of your household?

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?

WS11. How many households in total use this toilet facility, including your own household?

Household characteristics: HC

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

HC1B. What is the mother tongue/native language of the head of this household?

HC1C. To what ethnic group does the head of this household belong?
Probe: What is the ethnicity of the head of household?
HC3. Main material of the dwelling floor
Record observation
HC4. Main material of the roof
Record observation

HC5. Main material of the exterior walls.
Record observation
HC6. What type of fuel does your household mainly use for cooking?

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?

HC8. Does your household have:

A. Electricity?

B. A radio?

C. A television?

D. A non-mobile telephone?

E. A refrigerator?

G. A washing machine?

H. A vacuum cleaner?

J. DVD player?

K. Dishwasher?

L. Microwave oven?

HC9. Does any member of your household own:

B. A mobile telephone?

C. A bicycle?

D. A motorcycle or scooter?

F. Light vehicle/truck/tractor?

G. A boat with a motor?

H. A personal computer/laptop?

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

HC12. How many hectares 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?

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?

C. Goats?

D. Sheep?

E. Poultry: chickens/geese/ducks and others?

F. Pigs?

X. Other?

HC15. Does any member of this household have an accumulation account or a bank deposit?

Child Discipline: CD

Table 1: Children Aged 2-14 Years Eligible for Child Discipline Questions
List each of the children aged 2-14 years below in the order they appear in the household listing form. 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 (CD6).
If there is only one child age 2-14 years in the household, then skip table 2 and go to CD8; write down'1' and continue with CD9.

CD1. Rank Number: _

CD2. Line number from HL1: _ _

CD3. Name from HL2: ____

CD4. Sex from HL4

CD5. Age from HL6: _ _

CD6. Total number of children aged 2-14: _ _

Table 2: Selection of Random Child for Child Discipline Questions
Use Table 2 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.
Check the last digit of the household number (HH2) from the cover page (from 0 and 9). 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 CD6 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 (CD1) about whom the questions will be asked.

CD7.
Total number of eligible children in the household (CD6) [Column 1 to 8+]
Last digit of household number (HH2) [Row 0 to 9]

CD9. Write the name and line number of the child selected for the module from CD3 and CD2, based on the rank number in CD8.
CD10. 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.

CD11. Took away privileges, forbade something (name) liked or did not allow him/her to leave house.

CD12. Explained why (name)'s behavior was wrong.

CD13. Shook him/her.

CD14. Shouted, yelled at or screamed at him/her.

CD15. Gave him/her something else to do, to take his/her attention from incorrect behavior.

CD16. Spanked, hit or slapped him/her on the bottom with bare hand.

CD17. Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.

CD18. Called him/her dumb, lazy, or another name like that.

CD19. Hit or slapped him/her on the face, head or ears.

CD20. Hit or slapped him/her on the hand, arm, or leg.

CD21. Beat him/her, that is hit over and over as hard as one could.

CD22. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?

HH19. Record the time

Salt Iodization: SI
SI1. We would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals in your household?
Once you have tested the salt, circle number that corresponds to test outcome.
Instruction for Selection of Women Age 15-49

For interviewing using a module "Domestic Violence" of women's individual questionnaire

HH20A. Does any eligible woman age 15-49 reside in the household? Check household listing, column HL7 for any eligible woman.
You should have a questionnaire with the information panel filled in for each eligible woman.
Table 1: Women age 15-49 eligible for domestic violence module
List each of the women aged 15-49 years below in the order they appear in the household listing form. Do not include other household members outside of the age range 15-49 years.
Record the line number, name and age for each woman.
Then record the total number of woman aged 15-49 in the relevant box HH20AA.

Rank Number: _

Line number from HL1: _ _

Name from HL2: ____

Age from HL6: _ _

HH20AA. Total number of women aged 15-49 years: _ _


Table 2: Random Selection of a Woman for Domestic Violence Module
Check the last digit of the household number (HH2) (from 0 to 9) 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 women (15-49) in HH20AA 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 woman (HH20AB) about whom the questions on domestic violence will be asked.

Total number of eligible women in the household [Column 1 to 8+]
Last digit of household number (HH2) [Row 0 to 9]

HH20AB. Record the rank number of the selected woman: _

HH20AC. Write down name and line number of the women selected for this module
Instruction for Selection of Men Age 15-59

For men's individual questionnaire

HH20B. Does any eligible man age 15-59 reside in the household? Check household listing, column HL7A to identify any eligible man.
You should have a questionnaire with the information panel filled in for each eligible man.
Table 1: Men aged 15-59 years eligible for men's individual questionnaire
List each of the men aged 15-59 years below in the order they appear in the household listing form. Do not include other household members outside of the age range 15-59 years.
Record the line number, name and age for each man.
Then record the total number of men aged 15-59 in the relevant box (HH20BA).

Rank Number: _

Line number from HL1: _ _

Name from HL2: ____

Age from HL6: _ _

HH20BA. Total number of men aged 15-59 years: _ _


Table 2: Random Selection of a Man for Men's Individual Questionnaire
Use table 2 for selection of one man within the age range of 15-59 if there are several men of this age group living in this household
Check the last digit of the household number (HH2) from the cover page (from 0 to 9). This is the number of the row you should go to in the table below.
Check the total number of eligible men (15-59) in HH20BA 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 man (HH20BB) selected for men's individual questionnaire.

Total number of eligible men in the household [Column 1 to 8+]
Last digit of household number (HH2) [Row 0 to 9]

HH20BB. Record the rank number of the selected man: _

HH20BC. Write down name and line number of the men selected for the men's individual questionnaire
Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________