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. Area

HH7A. Aimag/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. The interview will take about 40 minutes. According to the article 5, paragraph 4 of the Mongolian state law on confidentiality of an individual and article 22, paragraph 3 on the Mongolian state law on statistics. All the information we obtain will remain strictly confidential

Fill in HH8A-HH12, HH14, HH15A, and HH15C once you have completed the Household Questionnaire. Fill in HH13, HH15, HH15B, and HH15D once you have completed all individual interviews in the household.
[Note: for question HH8 to HH18]

HH8A. Address: ____

HH8. Name of household head: ____

HH9.

HH10. Respondent name and line number:

HH11. Total number of household members: _ _

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

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

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

HH15. Number of children under age of 5 years whose 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, 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 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 the (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 (for woman age 15-49)

HL7A. Circle line no.
If man is age 15-49 (for men age 15-49)

HL8. Who is the mother or primary caretaker?
Record line no. of mother/caretaker (for children age 5-14.)
HL9. Who is the mother or primary caretaker?
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 number 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 is 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) 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 man age 15-49 years, write his name and line number and other identifying information in the information panel of a separate individual man'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, each eligible man, and each child under five in the household.

Code for HL3. Relationship to head of household

Internal Migration: MI

MI1. Line number: _ _

MI2. Name and age
Copy from Household Listing Form, HL2 and HL6
MI3.What is (name)'s place of birth: _ _

MI4.In the present place of usual residence, have (name) lived since birth or moved in?___

MI5. What was the place of (name)'s previous residence?

MI6. What was the place of (name)'s usual residence in January 2007

Education: ED

For household member 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?

ED4. 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
For household members age 5-24 years [ED5 to ED8]

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

ED6. During school year 2011/2012, which level and grade is/was (name) attending?
If level=0, skip to ED5
ED7. During the school year 2010-2011, 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 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 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.
WS7A. On average, how many liters of water does your household use per day for drinking and other purposes?

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. Does the head of your household hold any religion?

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

HC1D. Type of dwelling

HC1E. What is the size of the living area of your dwelling?

HC1F. How many rooms in your dwelling are used for sleeping?

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

HC2A. How many walls does your ger have?

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
HC5A. What type of heating does your dwelling have?

HC5B. What type of heating 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 kitchen

HC8. Does your household have:

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:

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. Does any member of your household own this dwelling?
If "No", then ask: Do you rent this dwelling
HC11. Does any member of this household own any agriculture land?

HC12. what size of agricultural land do members of this household own?

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

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

C. Goats?

D. Sheep?

H. Camels?

E. Poultry

F. Pigs?

X. Other

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

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: For pay in cash or kind?
CL4. During the last 7 days how many hours did he/she 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 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. During the last 7 days, about how many hours did he/she do this work on a family farm or in a family business or selling goods in the street?

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 from appropriate columns in Module HL.
record the total number of children aged 2-14 in the box provided (CD6).
.

CD1. Rank Number: _

CD2. Line number from HL1: _ _

CD3. Name from HL2: ____

CD4. Sex from HL4

CD5. Age from HL6: _ _

CD6. Number of children age 2-14 years: _ _

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. 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(CD1): _

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.
CD11. Adults use certain ways to teach children the right behaviors or to address a behavior 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.

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

CD13. Shook (name)

CD14. Shouted, yelled at or screamed 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, hairbrush, 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 me where members of your household most often wash their hands.

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

HW5. please show it to me?
Record observation. Circle all that apply.
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.
SI1A. Where is the salt from?

SI1B. What kind of salt is this?

SI1C. The factory the salt was produced by?

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 age 15-49"

HH21. Check column HL9 in Module HL to see if there is at least one child under aged 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 15-49 years in the household, who is eligible for a "Questionnaire for man age 15-49"

HH21B. Check column HL6 in Module HL to see if there is at least one man aged 2-14 years in the household, who is eligible for a "Questionnaire for Child aged 2-14"

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

Interviewer's observations ________

Field editor's observations ________