MICS Household Questionnaire

[Madagascar]
Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and number:

HH4. Field editor's name and number:

Interviewers' visits
(Repeat for up to 3 visits)

HH6. Area

HH7. Region

After all questionnaires for the household have been completed, fill in the following information:
HH5. Final date of household interview:

Total number of visits: ______

HH8. Name of head of household: ____

HH9. Final 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: _ _

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)

We are from INSTAT. We are working on a project concerned with family health and education. I would like to talk to you about these subjects. The interview will take about 60 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 begin now?

HH18. 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 other people 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 relationship of (name) to the head of household?

Codes for HL3. Relationship to head of household

HL4. Is (name) male or female?

HL5. What is (name's) date of birth?

HL6. How old is (name)?

Probe: How old was (name) on his/her last birthday? Record in completed years.
If age is 95 or above '95'
HL6A. For men and women age 15 - 49.
In the last 4 months, has (NAME) worked with the Food-for-Work system "Vivre Contre Travail"?

HL7. Circle line no.
If woman is age 15-49 (for woman age 15-49)

HL8. Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (for children age 5-14.)
HL9. Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker (for children under age 5)
HL10. Did (name) stay here last night?
(for all household members)
For children age 0-17 years [HL11 to HL14]

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

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

HL14. Does (name's) biological 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 employees, 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 a separate individual woman'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, and each child under five in the household.

Education: ED

For household members age 5 and above [ED1 to ED4B]

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) has attended?
If level=0, skip to ED5
ED4B. What is the highest grade (name) completed at this level?
If less than 1 grade, enter 00

(Table)
[] 00 = Less than one year completed (all levels)
Level primary = 1

Level secondary 1st cycle = 2

Level secondary 2nd cycle = 3

Level higher = 4

For household members age 5-24 years [ED5 to ED8A-CS]

ED5. During the (2011-2012) school year, did (name) attend school or preschool at any time?

ED6. During this/that school year, which level and grade is/was (name) attending?
If level=0, skip to ED7(Table of Grade Levels)

Level primary = 1

Level secondary 1st cycle = 2

Level secondary 2nd cycle = 3

Level higher = 4

ED6A_CS. If primary level, does (NAME) have a school kit?

A school kit is a backpack with necessary school supplies for age, plus school fees
ED7. During the previous school year, that is (2010-2011), did (name) attend school or preschool at any time?

ED8. During that school year, which level and grade did (name) attend?
If level=0, skip to next row
ED8A_CS. If primary level, did (NAME) have a school kit?

Go to next row.
For household members age 5 and older (ED1 - ED10)
ED9. Has (name) ever attended an informal school, such as literacy education, special education, professional training, religious education or other?

ED10. What type of informal school did (name) attend? (Several answers are possible)

For household members age 5 - 24 (ED11 - ED20)

ED11. During the 2011-2012 school year, did (name) attend these types of informal schools at any time?

ED12. What type of informal school did (name) attend? (Several answers are possible)

ED13. Check ED5:

ED14. How many days or weeks did (name) miss school in the last 4 weeks, besides school holidays?

ED15. What is the main reason for missing school? (List off choices)

ED16. Did (name) eat at home before leaving for school on the last day he/she went to school?

ED17. Did (name) eat a meal provided by school the last day he/she went to school?

ED18. Check ED7:

ED19. In the last school year (2010-2011), how many days did (name) miss school?

ED20. What is the main reason for missing school? (List off choices)

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 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? Record all items mentioned.
WS8. 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.
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?

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

HC3. Main material of dwelling floor
Record observation
HC4. Main material of the roof
Record observations
HC5. Main material of the exterior walls.
Record observations
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?

F. A table?

G. A chair?

H. A bed?

HC9. Does any member of your household own:

A. A watch?

B. A mobile telephone?

C. A bicycle?

D. A motorcycle or scooter?

E. An animal drawn cart?

F. A car or truck?

G. A boat with a motor?

H. A plow?

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. What is the surface area of agricultural land owned by members of this household?
Circle the appropriate unit.
If 95 or more, record '95'. If unknown, record '998'.
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 . Milk cows or bulls?

B. Horses, donkeys, or mules?

C. Goats?

D. Sheep?

E. Chickens?

F. Pigs?

G. Zebus?

H. Ducks/geese/turkeys?

HC15. Does any member of this household have a bank account?

Insecticide Treated Nets: TN

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

TN2. How many mosquito nets does your household have?

TN3. Ask the respondent to show you the nets in the household. If more than 3 nets, use additional questionnaire(s).
[Repeat questions TN4-TN13 for each net]

TN4. Mosquito net observed

TN5. Observe or ask the brand/type of mosquito net.
If brand is unknown and you cannot observe the net, show pictures of typical net types/brands to respondent.
TN6. How many months ago did your household get the mosquito net?
If less than one month, record "00"
TN7. Check TN5 for type of net
TN8. When you got the net, was it already treated with an insecticide to kill or repel mosquitoes?

TN9. Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?

TN10. How many months ago was the net last soaked or dipped?
If less than one month, record "00"
TN11. Did anyone sleep under this mosquito net last night?

TN12. 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.
An additional questionnaire must be used if more than 4 people slept under the mosquito net (see manual)
TN13.
1st Net: Go back to TN4 for next net. If no more nets, go to next module.
2nd Net: Go back to TN4 for next net. If no more nets, go to next module.
3rd Net: Go back to TN4 in first column of a new questionnaire for next net. If no more nets, go to next module.
Indoor residual spraying: IR

IR1. At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitoes?

IR2. Who sprayed the dwelling?
Circle all that apply.
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
Copy from Household Listing Form, HL2 and HL6

CL3. During the past week, did (name) do any kind of work for someone who is not a member of this household?
If yes: Was he/she paid in cash or kind?
CL4. 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. 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.
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?

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
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 are no children age 2-14 years in the household, skip to next module.
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 children age 2-14 years: _ _

Table 2: Random Selection of 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. 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]

CD8. Record the rank number of the selected child: _

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 behaviour was wrong.

CD13. Shook him/her.

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

CD15. Gave him/her something else to do.

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 up, that is hit him/her 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?

Income and household expenses: IE

IE1. During the current school year (2011/2012), did the household pay for education, for example registration fees, tuition, Parents' Association, school supplies and school cafeteria?

IE2. How much did the household spend on registration fees (legal)?

IE3. How much did the household spend on tuition (schooling)?

IE4. How much did the household spend on the Parents' Association ("FRAM")?

IE5. How much did the household spend on school supplies (notebooks, pens, etc.)?

IE6. How much did the household spend on food for the child at school (school cafeteria, purchase of food)?

IE7. During the previous school year (2010/2011) did the household pay for education, for example, registration fees, tuition, Parents' Association, school supplies and school cafeteria?

IE8. How much did the household spend on registration fees (legal)?

IE9. How much did the household spend on tuition (schooling)?

IE10. How much did the household spend on the Parents' Association ("FRAM")?

IE11. How much did the household spend on school supplies (notebooks, pens, etc.)?

IE12. How much did the household spend on food for the child at school (school cafeteria, purchase of food)?

IE13. Did the household farm during the last farming season?

IE14A. What are the main crops that your household produces?

IE14B. How much (crop) did you produce last season?

IE14C. How much of your production did you sell?

IE14D. How long did your (crop)'s stock last?

IE15. Besides farming (and sale of your crops), does your household have any other revenue generating activities?

IE15A. What are the revenue generating activities besides farming (and sale of crops)?

IE15B. How much money did these activities bring in over the last 12 months?

Hand washing: HW

HW1. Please show me where members of your household most often wash their hands.

HW2. Observe presence of water at the specific place for handwashing.
Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water.
HW3. Record if soap or detergent is present at the specific place for handwashing.
Circle all mentioned.
Skip to HH19 if no soap or detergent code (A, B, C or D) is circled. If "Nothing" (Y) is circled, continue with HW4.
HW4. Do you have any soap or other cleaning products in your household for washing hands?

HW5. Can you please show it to me?
Record observation. Circle all mentioned.
HH20. Thank the respondent for his/her cooperation and check the Household Listing Form:

Return to the cover page and make sure that all information is entered, including the number of eligible women (HH12), and under-5 children (HH14).
Make arrangements for the administration of the remaining questionnaire(s) in this household.

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ______