Multiple Indicator Cluster Survey and Household Expenses ("MICS-ELIM" 2009) Household Questionnaire

[Mali]
Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH2a. Household selected for Light Integrated Household Survey "ELIM"

HH3. Interviewer name and number

HH4. Field editor name and number:

HH5. Day/month/year of interview

HH5a. Day/month/year of check

HH6. Area

HH7. Region: ____

HH7A. Circle: ____

HH7B. Commune: ____

We are from the Ministry of Health and the Ministry of the Economy and Finance. We are working on a project concerned with family health, education, nutrition and household expenses. I would like to talk to you about these subjects. The interview will take some time. 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 now?

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: ____

HH8A. Head of household's employment status:

HH8B. Sector of activity in which head of household worked:

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: _ _

HH14. Number of children under age 5: _ _

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

HH16. Field edited by team leader (name and number)

HH16A. Field edited by supervisor (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, 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?
If yes, complete listing for questions HL2-HL4. Then, ask all the 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.

Order of listing household members:
Head of household
Head of household's unmarried children whose mother does not live in household.
Spouse(s) of head of household followed by unmarried children from youngest to oldest.
Other relatives of head of household or his spouse(s).
People unrelated to head of household

HL1. Line number: _ _

HL2. Name: ____

HL3. What is the relationship 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 '95'
HL7. Circle line no.
If woman is age 15-49 (Eligibility for Woman's Interview)

HL8. For age 5 - 14: Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (mother or caretaker for child aged 5-14 years)

HL9. For children under age 5: Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker (eligibility for the interview of under 5s)
For all household members:
HL10A. What is (name)'s residential status?

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 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 and each child under five in the household.

Code for HL3. Relationship to head of household

Education/Literacy: ED

For household members age 5 and above [ED1 to ED5A]

ED1. Line number: _ _

ED2. Name and age

ED3. Has (name) ever attended school or pre-school?

ED4. What is the highest level of school (name) has attended? What is the highest grade (name) completed at this level?
If level=0, skip to ED5. If less than 1 grade, enter 00.
For household members age 5-25 years [ED5 to ED8]

ED5. During the (2009-2010) school year, did (name) attend school or preschool at any time?

ED5A. Why isn't (name) going to school now?

ED6. During this/that school year, which level and grade is/was (name) attending?
If level=0, skip to ED7. If less than one grade, record 00.
ED7. During the previous school year, (2008-2009), did (name) attend school or preschool at any time?

ED8. During that previous school year, which level and grade did (name) attend?
If level=0, skip to ED9 if age 15 or older. If less than one grade, record 00.

ED9. Does (name) know how to read and write in any language?

Codes for ED5A:

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 drinking-water source located?

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

WS4A. How far away is this source?

WS4B. Is this drinking-water source available throughout the 12 months of the year?

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 can anyone use this toilet?

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?

HC1D. What is the marital status of the head of this household?

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

HC3. Main material of 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?

HC7A. What is your main source of light?

HC8. Does your household have:

A. Electricity (refer to manual)?

B. A radio?

C. A television?

D. A non-mobile telephone?

E. A refrigerator?

F. A computer?

G. Internet connection?

H. An air conditioner?

I. A fan?

J. A parabolic antenna/decoder?

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?

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

B. Horses, donkeys, or mules?

C. Goats?

D. Sheep?

E. Poultry?

F. Pigs?

G. Camels/dromedaries?

HC15. Do you have any reading books in the household?

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.
[Repeat questions from modules 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?

TN11A. Reasons for not using 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'
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.

Child Labour: CL

To be administered for children in the household age 5-17 years. For household members below age 5 or above age 17, 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

CL2A. Migrant child?

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?

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 that apply.
HW4. Do you have any soap or detergent (or other locally used cleansing agent) in your household for washing hands?

HW5. 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 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.
HH19. Record the time

HH20. Are there any eligible women age 15 - 49 who live in the household?
Check the household listing, column HL7 for each eligible woman.
You should have a questionnaire with the information panel filled in for each eligible woman.

HH21. Are there any children under the age of 5 who live in the household?
Check the household listing, column HL9 for each eligible child under the age of 5.
You should have a questionnaire with the information panel filled in for each eligible child.

Interviewer's observations ________

Field editor's observations ________

Team leader's observations ______

Supervisor's observations ______