MICS household questionnaire
Household Information Panel: HH
HH3. Interviewer name and number:
Number: _ _
HH4. Supervisor name and number:
Number: _ _
HH5. Day/month/year of interview _ _ / _ _ / _ _ _ _
[] 2 Aimag center
[] 3 Soum center
[] 4 Countryside
HH7A._ _ Soum/district
HH76._ _ Bagh/khoroo
HH7B. _ _ Household adress
HH8. Name of head of household: ____
After all questionnaires for the household have been completed, fill in the following information:
[Note: HH9 to HH16]
[] 2 Not at home
[] 3 Refused
[] 4 HH not found/destroyed
[] 6 Other (specify) ____
HH9A. Number of HH visit: _
HH10. Respondent?s line number: _
HH11. Total number of HH members: _ _
HH12. Number of women eligible for interview: _ _
HH13. Number of women questionnaires completed: _ _
HH14. Number of children under age 5 eligible to interview: _ _
HH15. Number of children of under-5 questionnaires completed: _ _
Interviewer/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.
HH16. Name and code of data entry clerk: _ _
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 are more than 15 household members.
[] Tick here if continuation sheet used
HL3. Relationship to head of household:
[] 02 Wife or husband
[] 03 Son or daughter
[] 04 Son or daughter in-law
[] 05 Grandchild
[] 06 Parent
[] 07 Parent-in-law
[] 08 Brother or sister
[] 09 Brother or sister-in-law
[] 10 Uncle/aunt
[] 11 Niece/nephew by blood
[] 12 Niece/nephew by marriage
[] 13 Other relative
[] 14 Adopted/foster/stepchild
[] 15 Not Related
[] 98 Don't know
HL4. Is (name) male or female?
[] 2 Female
HL4A. Year of birth _ _
HL5. Record in completed years:
[] 98 DK [See instructions: to be used only for elderly household members (code meaning "do not know/over age 50").]
HL6. Eligible for women's interview
HL7. Eligible for child labour module
For each child age 5-14: Who is the mother or primary caretaker of this child?
HL8. For each child under 5: Who is the mother or primary caretaker of this child
For children age 0-17 years ask HL9-HL12
HL9. Is (name's) natural mother alive?
[] 2 No (Go to HL11)
[] 8 DK (Go to HL11)
HL10. If alive: Does (name's) natural mother live in this household?
HL11. Is (name's) natural father alive?
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
HL12. If alive: Does (name's) natural father live in this household?
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 child's name and complete form.
Then, complete the totals below.
_ _ Children 5-14
_ _ Under-5s
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 questionnaire for children under five.
You should now have a separate questionnaire for each eligible woman and each child under five in the household.
For household members age 5 and above
ED2. Has (name) ever attended school or preschool?
[] 2 No (Go to next line)
ED3. What is the highest level of school (name) attended? What is the highest grade (name) completed at this level?
[] 1 General educational school
[] 2 Vocational
[] 3 Institute, college
[] 4 University
[] 5 Religious
[] 6 Non-standard curriculum
[] 8 DK
[] 98 DK
If less than 1 grade, enter 00.
For household members age 5-24 years
ED4. During the (2005-2006) school year, did (name) attend school or preschool at any time?
[] 2 No (Go to ED7)
ED5. Since last (day of the week), how many days did (name) attend school?
ED6. During this/that school year, which level and grade is/was (name) attending?
[] 1 General educational school
[] 2 Vocational
[] 3 Institute, college
[] 4 University
[] 5 Religious
[] 6 Non-standard curriculum
[] 8 DK
[] 98 DK
ED7. Did (name) attend school or preschool at any time during the previous school year, that is (2005-2006)?
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
ED8. During that previous school year, which level and grade did (name) attend?
[] 1 General educational school
[] 2 Vocational
[] 3 Institute, college
[] 4 University
[] 5 Religious
[] 6 Non-standard curriculum
[] 8 DK
[] 98 DK
Water and sanitation module: WS
WS1. What is the main source of drinking water for members of your household?
[] 12 Piped into yard or plot (Go to WS5)
[] 13 Public tap/standpipe (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 39 Pumped well (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 61 Tanker-truck (Go to WS3)
[] 71 Cart with small tank/drum (Go to WS3)
[] 81 Surface water (river, stream, dam, lake, pond) (Go to WS3)
[] 96 Other (specify) ____ (Go to WS3)
WS3. How long does it take to go there, get water, and come back?
[] 995 Water on premises (Go to WS5)
[] 998 DK
WS4. Who usually goes to this source to fetch the water for your household?
Probe: Is this person under age 15? What sex?
Circle code that best describes this person.
[] 2 Adult man
[] 3 Female child (under 15)
[] 4 Male child (under 15)
[] 8 DK
WS5. Do you treat your water in any way to make it safer to drink?
[] 2 No (Go to WS7)
[] 8 DK (Go to WS7)
WS6. What do you usually do to the water to make it safer to drink?
Anything else?
Record all items mentioned.
[] B Add bleach/chlorine
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, etc.)
[] X Other (specify) ____
[] Z DK
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.
[] 12 Flush to septic tank
[] 13 Flush to pit (latrine)
[] 15 DK
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab / open pit
[] 41 Bucket
[] 51 Hanging toilet/hanging latrine
[] 95 No facilities or bush or field (Go to next module)
[] 96 Other (specify) ____
WS8. Do you share this facility with other households?
[] 2 No (Go to next module)
WS9. How many households in total use this toilet facility
[] 10 Ten or more households
[] 98 DK
Household characteristics module: HC
HC1A. What is the religion of the head of this household?
[] 2 Islam
[] 3 Christianity
[] 6 Other religion (specify) ____
[] 7 No religion
HC1B. What is the mother tongue/native language of the head of this household?
[] 2 Kazakh
[] 3 Russian
[] 4 Chinese
[] 6 Other language (specify) ____
HC1C. To what ethnic group does the head of this household belong? Khalkha-01, Kazakh-02,Derved -03, Bayad-04, Buriad-05,Dariganga-06, Zahshin-07, Urianhai-08, Other-96
[] 2 House
[] 3 Dormitory
[] 4 Ger
[] 6 Other
HC1F. The size of your dwelling living area (sq.m)
HC2. How many rooms in this household are used for sleeping?
----
HC3. Main material of the dwelling floor:
Record observation.
[] 12 Dung
[] 22 Palm/bamboo
[] 32 Vinyl or asphalt strips
[] 33 Brick
[] 34 Cement
HC4. Main material of the roof.
Record observation.
[] 22 Palm/bamboo
[] 23 Wood planks
[] 32 Wood
[] 33 Calamine/cement fiber
[] 34 Ceramic tiles
[] 35 Cement
[] 36 Roofing shingles
[] 42 Double
HC5. Main material of the walls.
Record observation.
[] 22 Stone with mud
[] 24 Plywood
[] 26 Reused wood
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement blocks
[] 35 Covered adobe
[] 36 Wood planks/shingles
[] 42 Double
[] 02 Others?
HC6. What type of fuel does your household mainly use for cooking?
[] 02 Liquid propane gas (LPG) (Go to HC8)
[] 03 Natural gas (Go to HC8)
[] 04 Biogas (Go to HC8)
[] 06 Coal/lignite
[] 07 Briquette
[] 08 Wood
[] 09 Straw/shrubs/grass
[] 10 Animal dung
[] 11 Agricultural crop residue
[] 12 Saw dust
[] 96 Other (specify) ____
HC7. In this household, is food cooked on an open fire, an open stove or a closed stove?
Probe for type.
[] 2 Open stove
[] 6 Other (specify) ____ (Go to HC8)
HC8. Is the cooking usually done in the house, in a separate building, or outdoors?
[] 2 In a separate building / ger
[] 6 Other (specify) ____
HC9. Does your household have:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC10. Does any member of your household own:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC11. Does any member of this household own any land that can be used for agriculture?
[This question is from optional modules]
[] 2 No (Go to HC13)
HC12. How many hectares of agricultural land do members of this household own?
[This question is from optional modules]
If more than 97, record '97'. If unknown, record '98'.
[] 2 Hectares _ _
HC13. Does this household own any livestock, herds, or farm animals?
[This question is from optional modules]
[] 2 No (Go to next module)
HC14. How many of the following animals does this household have?
[This question is from optional modules]
To be administered to mother/caretaker of each child 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.
CL3. During the past week did (name) any kind of work for someone who is not a member of this household?
If yes: For pay in cash or kind?
[] 2 Yes, unpaid
[] 3 No (Go to CL5)
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?
Record response then (Go to CL6)
CL5. At any time during the past year, did (name) do any kind of work for someone who is not a member of this household?
If yes: For pay in cash or kind?
[] 2 Yes, unpaid
[] 3 No
CL6. During the past week, did (name) help with household chores such as shopping, collecting firewood, cleaning, fetching water, or caring for children?
[] 2 No (Go to CL8)
CL7. If yes: Since last (day of the week), about how many hours did he/she spend doing these chores? _ _
CL8. During the past week, did (name) do any other family work (on the farm or in a business or selling goods in the street)
[] 2 No (Go to next line)
CL9. If yes: Since last (day of the week), about how many hours did he/she do this work? _ _
CL10. Types of family business:
[] 2 Husbandry
[] 3 Agriculture
[] 4 Trade
[] 5 Service
[] 6 Other
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, age, and the line number of the mother or caretaker for each child. Then record the total number of children aged 2-14 in the box provided (CD7).
[] 2 F
CD6. Line no. of mother/caretaker from HL7 or HL8.
CD7. Total children aged 2-14 years _ _
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
Table 2: Selection of random child for child discipline questions
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. Then, find the mother or primary caretaker of that child, and ask the questions, beginning with CD12.
CD8. Last digit of the questionnaire number 0-9
Total number of eligible children in the household 1-8+
[Table omitted]
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. Ask to interview the mother or primary caretaker of the selected child (identified by the line number in CD6).
CD11. Write name and line no. of the child selected for the module from CD3 and line number ( CD2= HL1), based on the rank number in CD9.
_ _ Line number
CD12B. Explained why something (the behavior) was wrong.
[] 2 No
CD12D. Shouted, yelled at or screamed at him/her.
[] 2 No
CD12E. Gave him/her something else to do.
[] 2 No
CD12H. Called him/her dumb, lazy, or another name like that.
[] 2 No
[] 2 No
CD13. Do you believe that in order to bring up (raise, educate) (name) properly, you need to physically punish him/her?
[] 2 No
[] 8 Don't know/no opinion
CD14. Who cares of his/her development and discipline?
[] 2 Father
[] 3 Grandparents
[] 4 Brother/Sister
[] 6 Other (specify)
CD15. Have you obtained any information on his/her development and discipline in the last month?
[] 2 No (Haven't searched) Although I wanted, information (Go to CD17)
[] 3 Was not available (Go to CD17)
CD16. Where do you get information on child development and discipline?
[] 2 His/her teacher
[] 3 Other ( specify )
CD17. How often do you listen to his/her demand?
[] 2 Occasionally
[] 3 Hardly
[] 4 Never
CD18. How often do you listen to his/her demand?
[] 2 Occasionally
[] 3 Hardly
[] 4 Never
CD19. How often do you praise him/her?
[] 2 Occasionally
[] 3 Hardly
[] 4 Never
CD20. Do you buy him/her toys?
[] 2 No (due to financial problems)
[] 6 Other (specify)
CD21. Do you him/her with drawing materials?
[] 2 No (due to financial problems)
[] 6 Other (specify)
CD22. Has he/she had an accident in the last month?
[] 2 No available (Go to CD24)
[] 2 Hitting by or falling from an animal
[] 3 Falling from other things
[] 4 Caused by knife or sharp thing
[] 5 Hitting by someone
[] 6 Other (specify)
CD24. Does he/she feed regularly?
[] 2 Occasionally
[] 3 No
CD25. Does he/she sleep at regular time?
[] 2 Occasionally
[] 3 No
CD26. Does he/she brush his/her teeth in the morning?
[] 2 Occasionally
[] 3 No
CD27. Does he/she wash his/her hands before dining?
[] 2 Occasionally
[] 3 No
CD28. Does he/she wash his/her hand after using toilet?
[] 2 Occasionally
[] 3 No
CD29. Does he/she bath regularly?
[] 2 Occasionally
[] 3 No
CD30 Does he/she brush his/her teeth before he/she goes to bed?
[] 2 Occasionally
[] 3 No
CD31 Does he/properly dress for weather?
[] 2 Occasionally
[] 3 No
To be administered to caretakers of 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.
DA3. Compared with other children, does or did (name) have any serious delay in sitting, standing, or walking?
[] 2 No
DA4. Compared with other children, does (name) have difficulty seeing, either in the daytime or at night?
[] 2 No
DA5. Does (name) appear to have difficulty hearing? (uses hearing aid, hears with difficulty, completely deaf?)
[] 2 No
DA6. When you tell (name) to do something, does he/she seem to understand what you are saying?
[] 2 No
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?
[] 2 No
DA8. Does (name) sometimes have fits, become rigid, or lose consciousness?
[] 2 No
DA9. Does (name) learn to do things like other children his/her age?
[] 2 No
DA10. Does (name) speak at all (can he/she make him or herself understood in words; can say any recognizable words)?
[] 2 No
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 the immediate family)?
[] 2 No
DA12. (For 2-year-olds): Can (name) name at least one object (for example, an animal, a toy, a cup, a spoon)?
[] 2 No
DA13. Compared with other children of the same age, does (name) appear in any way mentally backward, dull or slow?
[] 2 No
Salary, wage, pension, and allowances
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
106. Child allowance
In the last 12 month ___
In the last 12 month ___
Income derived from household production and services
In the last 12 month ___
In the last 12 month ___
203 Other production and services
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
303. Premise rend, property leasing
In the last 12 month ___
304. Intellectual property, patent, copyright
In the last 12 month ___
305. Deposit withdrawal, repayment of money borrowed to others
In the last 12 month ___
306. Interests form deposit and money borrowed to others
In the last 12 month ___
307. Gifts and assistance from others
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
In the last 12 month ___
SI1. We would like to check whether the salt used in your household is iodized
[] 2 Less than 15 PPM
[] 3 15 PPM or more
[] 6 No salt in home
[] 7 Salt not tested
SI1A.What kind of salt do your family use?
[] 2 Local salt
SI1B. Have you ever heard about the enriched flour?
[] 2 No (Go to SI2)
SI1C. Have you ever heard about the enriched flour?
[] 2 No (Go to SI2)
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.
[] No (Continue)
SI3. 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.
[] No (End the interview by thanking the respondent for his/her cooperation.
Gather together all questionnaires for this household and tally the number of interviews completed on the cover page.)