MICS Household Questionnaire

Mongolia
Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and number

HH4. Supervisor name and number:

HH5. Day/month/year of interview

HH6. Location

HH7A. Aigmag/city name and code

HH7B. Soum/district name and code

HH7C. Bag/khoroo name and code

HH7D. Kheseg name and code

We are from The National Statistical Office Of Mongolia and working on a project concerned with family health, education, and living situation. I would like to talk to you about these subjects nearly 40 minutes. According to the article 5, paragraph 4 of the Mongolian state law on confidentiality of an individual? and article 22, paragraph 3 of the Mongolian state law on statistics all the information we obtain will remain strictly confidential. Shall we start the interview?

Fill in HH8-HH12, HH14, and HH15A once you have completed the Household Questionnaire. Fill in HH13, HH15, and HH15B once you have completed all individual interviews in the household.
[Note: for question HH8 to HH17]

HH8. Name of household head: ____

HH9. Result of interview:

HH10. Respondent name and line number:

HH11. Total number of household members: _ _

HH12. Number of women age 15-49 years: _ _

HH13. Number of women aged 15-49 years whose questionnaires are completed: _ _

HH14. Number of children under age of 5: _ _

HH15. Number of children under age of 5 whose questionnaires are completed: _ _

HH15A. Number of men age 15-54 years: _ _

HH15B. Number of men age 15-54 years whose questionnaires are completed: _ _

HH16. Field editor name and number

HH17. Date entry clerk name and number

HH18. Interview started at

Household Listing Form: HL

All members of the household are listed starting with the household head. List the household head in line 01 in HL2. List all other household members in the following lines and their relationship to the household head in HL3 and their sex in HL4. Starting with HL5, ask questions for each member at a time.

HL1. Line number: _ _

HL2. Please tell me the name of each member of the household, starting with the household head.
Probe: Are there any others who live here, even if they are not at home now?
HL3. Please tell me the relationship of (name) to the household head?

HL4. Is the (name) male or female?

HL5. Please tell me (name)'s date of birth?

HL6. How old is (name)?
Record in completed years. If age is 95 or above '95'
HL7. Circle line number if woman's age 15-49 (for woman aged 15-49)

HL7A. Circle line number if man's age is 15-54 (for men aged 15-54)

HL8. Who is the mother or primary caretaker of (name)?
Record line no. of mother/caretaker (for children age 5-17.)
HL9. Who is the mother or primary caretaker of (name)?
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?
If yes, record line number of natural mother. No = 00
HL13. Is (name's) natural father alive?

HL14. Does (name's) natural father live in this household?
If yes, record line number of natural father. No = 00
[] tick here is additional listing form used.
Probe to see if there are any other members of the household, especially infants or small children not listed, and others who may not be members of the family such as friends, servants but who usually live in the household. If there is any, insert names of the members and complete the listing form accordingly.
If there are more than 15 members in the household, use additional listing form
For each woman aged 15-49 years, copy her name, line number and other identifying information in the information panel of a separate ?Questionnaire for Woman aged 15-49?.
For each child under age of 5 years, copy his/her name, line number and other identifying information in the information panel of a separate ?Questionnaire for Child under 5?.
For each man aged 15-54 years, copy his name, line number and other identifying information in the information panel of a separate ?Questionnaire for Man aged 15-54?.

Code for relationship to household head

Education: ED

For household member age 5 and above [ED1 to ED4]

ED1. Line number: _ _

ED2. Name, age
Copy the information recorded in HL2 and HL6
ED3. Has (name) ever attended school/pre-school?

ED4. What is the highest level of school (name) attended? What is the highest grade (name) completed at this level of school?

For household members age 5-24 years [ED5 to ED8]

ED5. During the school year of 2010/2011, is (name) attending school/ pre-school at any time?

ED6. During the school year of 2010/2011, which level of school and grade is (name) attending?

ED7. During the school year of 2009/2010, did (name) attend school/preschool at any time?

ED8. During school year of 2009/2010, which level of school and grade did (name) attend?
If level=0, skip to ED5
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?

WS3. Where is that water source located?

WS4. On average, how many minutes does it take to go there, get the water, and come back?

WS5. Who usually goes to this source to collect the water from this source for your household?
Probe: How old is that person? Is that person male or female?

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

WS7. What do you usually do to make the water safer to drink?
Probe: Anything else? Record all items mentioned.
WS7A. On average, how many liters of water does your household use per day for drinking and other purposes?

WS8. What type of toilet facility does your household usually use?

WS9. Does your household share this toilet facility with others?

WS10. Does your household share this facility with members of other households that you know, or is the toilet facility open to the use of general public?

WS11. Including your household, how many households in total use this toilet facility?

Household characteristics: HC

HC1C. What is the ethnicity of the head of your household?

HC1A. Does the head of your household hold any religion?
If yes, probe: What is the religion of his/her?
HC1D. Type of dwelling?
Record observation.
HC1E. What is the size of the living area of your dwelling?
The size of kitchen, corridor/hallway, and bathrooms are included.
HC1F. How many rooms does your dwelling have?
Kitchen, corridor/hallway, and bathrooms are not included in the number of rooms.
HC2. How many rooms in your dwelling are used for sleeping?
Those rooms, which are not called as bedrooms, but used for sleeping in a regular basis are included.
HC3. Main material of dwelling floor
Record observation
HC4. Main material of dwelling roof
Record observation
HC5. Main material of dwelling walls.
Record observation
HC5A. What type of heating does your dwelling have?

HC5B. What type of fuel does your household mainly use for heating?

HC6. What type of fuel does your household mainly use for cooking?

HC7. Where do you usually cook?
If in own dwelling, probe: Do you cook in a separate room designated as a kitchen?
HC8. Does your household have the following things?

A. Electricity?

F. A renewable-energy generator?

G. A computer?

H. Internet connection?

C. A television?

B. A radio?

D. A non-mobile telephone?

E. A refrigerator?

J. A washing machine?

K. A vacuum cleaner?

L. A library?

HC9. Does any member of your household own the following things?

A. A watch?

B. A mobile telephone?

G. A camera?

C. A bicycle?

D. A motorcycle?

E. An animal drawn cart?

F. A car or truck?

H. A tractor?

HC10. Do you or someone living in this household own this dwelling?
If owned by others, probe: Do you rent this dwelling?
HC11. Does any member of this household own any agricultural land?

HC12. What size of agricultural land do members of your household own?

HC13. Does this household own any livestock or other farm animals?

HC14. How many of the following animals does your household have?
If none, record '0000'. If unknown, record '9998'.

A. Cattle?

B. Horses?

C. Goats?

D. Sheep?

H. Camels?

E. Poultry?

F. Pigs?

X. Others?

HC15. Does any member of your household have any savings, card or current accounts in a bank?

Child Labour: CL

Questions of this module are to be administered for children in the household aged 5-17 years. For household members under age of 5 years or aged 18 or more years, leave rows blank.
I would like to ask about any work children aged 5-17 years in your household may do

CL1. Line number: _ _

CL2. Name, age
Copy the information recorded in HL2 and HL6
CL3. During the last 7 days, 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?
CL4. During the last 7 days, how many hours did (name) work?
If more than one job, include all hours at all jobs.
CL7. During the last 7 days, did (name) do any paid or unpaid work on a family farm, family business or selling goods in the street?

CL8. During the last 7 days, how many hours did (name) work on family farm, family business or selling goods in street?
If more than one job, include all hours at all jobs.
CL8A. Even though (name) did not do any work during the last 7 days, does he/ she have a job or business to which he/ she will return to work?

CL8B. Per a week, how many hours does (name) work on average?
If more than one job, include all hours at all jobs.
CL8C. If did any work during the last 7 days, ask:
During the last 7 days, what primary occupation did (name) work in?
If have a job to return, ask:
What primary occupation do (name) work in?
If more than one job, ask the question for the main one.
CL8D. What is the employment status of (name)?

CL8E. If did any work during the last 7 days, ask:
During the last 7 days, what was the nature of work done or main product or service provided at the place where (name) worked?
If have a job to return, ask:
What is the nature of work done or main product or service provided at the place where (name) works?
If more than one job, ask the question for the main one.
CL5. During the last 7 days, did (name) fetch water or collect firewood or fuel for own household use?

CL6. During the last 7 days, how many hours did (name) spend fetching water or collecting firewood of fuel for own household use?

CL9. During the last 7 days, did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people?

CL10. During the last 7 days, how many hours did (name) spend doing these chores?

Child Discipline: CD

Table 1: List of all children in the household aged 2-14 years
List name of each child aged 2-14 years below in the order they appear in the household listing form.
Record the line number, name, sex, and age of each child from appropriate columns in Module HL..
Record the total number of children aged 2-14 years in CD6.
If there is only one child in the household aged 2-14 years, then skip Table 2, 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. Number of children aged 2-14 years: _ _

Table 2: Selecting a child randomly to administer the questions of this module
If there is more than one child in the household aged 2-14 years, use Table 2 to select one child.
Check the last digit of the household number (HH2) from the household information panel and find the row with that digit in CD7 and circle that number in the first column of Table 2 by looking vertically down.
Check the total number of children in the household aged 2-14years (CD6) from Table 1 and find the column with that number and circle that number in the top row of Table 2.
Find the cell where the row and column meet and circle the number that appears in the cell. Record the number you have found in CD8. This is the rank number of the child selected for the child discipline questions.

CD7.
Total number of eligible children in the household aged 2-14 years(CD6) [Column 1 to 8+]
Last digit of the household number (HH2) [Row 0 to 9]

CD8. Rank number of randomly selected child (CD1): _

CD9. Find the cell where the row and column meet and circle the number that appears in the cell. Record the number you have found in CD8. This is the rank number of the child selected for the child discipline questions..
CD11. Adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read some of these ways. Please tell me if you or anyone else in your household has used this method with (name) in the past month.
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 (name).

CD14. Shouted, screamed or yelled at (name).

CD15. Gave (name) something else to do.

CD16. Spanked, hit or slapped (name) on the bottom with bare hand.

CD17. Hit (name) on the bottom or elsewhere on the body with something like a belt, stick or other hard object.

CD18. Called (name) dumb, lazy, or another name like that.

CD19. Hit or slapped (name) on the face, head or ears.

CD20. Hit or slapped (name) on the hand, arm, or leg.

CD21. Beat (name) 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?

Hand washing: HW

HW1. Please show where members of your household usually wash their hands to me.

HW2. Observe if water is available at the place for hand washing. Verify by checking the tap, container, or bucket.
HW3. Observe if soap is available at the place for hand washing. Record observation.
HW4. Do you have any type of soaps in your household for washing hands?

HW5. Please show it to me.
Record observation..
HH19. Interview completed at

Salt Iodization: SI

SI1. I would like to check whether the salt used in your household is iodized. Please give me a sample of salt used to cook meals in your household.
Test the salt and record the result.
SI1A. Where is the salt from?

SI1B. What kind of salt is this?

SI1C. The factory the salt was produced by. Record observation.
HH20. Check column HL7 in Module HL to see if there is at least one woman aged 15-49 years in the household, who is eligible for a "Questionnaire for Woman aged 15-49".

HH21. Check column HL9 in Module HL to see if there is at least one child under age of 5 years in the household, who is eligible for a "Questionnaire for Child under 5".

HH21A. Check column HL7A in Module HL to see if there is at least one man aged 15-54 years in the household, who is eligible for a "Questionnaire for Man aged 15-54".

Gather together all questionnaires for this household and complete the relevant information on the household information panel.

Interviewer's notes ________

Field editor's notes ________

Supervisor's notes ________