MICS Household Questionnaire

[Nepal]
Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and code number

HH4. Supervisor name and code number:

HH5. Day/month/year of interview in BS:

HH6. Area

HH7. Region

We are from Central Bureau of Statistics (a bureau of Nepal government under the National Planning Commission), in Kathmandu. We are working on a survey concerned with family health and education in Mid and Far Western Region of the country (NMICS). I would like to talk to you about these subjects. The interview will take about 45 minutes. All the information we obtain will remain strictly confidential according to the Statistics Act 2015 BS and your answers will never be shared with anyone other than our project team. Shall we start now?

After all questionnaires for the household (household, women and children) have been completed, fill in the following information:
[Note: for question HH8 to HH18]

HH8. Name of head of household: ____

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 individual woman's questionnaires completed: _ _

HH14. Number of children under age 5: _ _

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

HH16. Field edited by (name and code number)

HH17. Date entry clerk (name and code 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?
If yes, complete listing for questions HL2-HL4. Then, ask questions starting with HL5-HL14 for each person in the household at a time.
Use an additional questionnaire if all rows in the household listing form have been used.

HL1. Line number: _ _

HL2. Name, last name: ____

HL3. What is the relation-ship of (name) to the head of household?
Write appropriate code
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, record '95'
HL7. Circle line no.
If woman is age 15-49 (for women age 15-49)

HL8. Who is the mother or primary caretaker of (name)?
Record line no. of mother/caretaker (for children age 5-14.)
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?
Record line number of mother 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 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 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 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 age 15-49 and each child under five in the household.

Codes for HL3. Relationship to head of 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 according to line number.
ED2A. Does (name) know to read and write?

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

ED4B. What is the highest grade (name) completed?
If less than 1 grade, write 00
For household members age 5-24 years [ED5 to ED8B]

ED5. During the current school year 2067, did (name) attend any preschool, school or college at any time?

ED6B. During school year 2067, which grade is/was (name) attending?
If less than 1 grade, write '00'.
ED7. During the previous school year, that is 2066, did (name) attend any preschool, school or college at any time?

ED8B. During the previous school year 2066, which grade did (name) attend?
If less than 1 grade, write '00'.
Water and Sanitation: WS

WS1. What is the main source of drinking water for members of your household?

WS1A. Where is drinking water source located?

WS1B. how long does it take to go there, stay in a queue, get drinking water, and come back?

WS1C. Who usually goes to this source to collect the water for your household?
Probe: Is this person under age 15? What sex?

WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing?

WS3. Where is the water source for cooking and hand-washing located?

WS4. How long does it take to go there, stay in a queue, get water for cooking and hand-washing, and come back?

WS5. Who usually goes to this source to collect the water for cooking and hand-washing in your household?
Probe: Is this person under age 15? What sex?

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

WS7. What do you usually do to make the water safer to drink?
Probe: Anything else? Circle all the ways mentioned by the respondent.
WS7A. Do you store your drinking water?

WS7B. May I see the main container where you store drinking water drinking water?

WS7C. Based on the observations of container's mouth, spigot and lid circle the appropriate response code.
Interviewer should observe by him/herself and circle the appropriate response codes.
WS7D. Is this container used only for storing drinking water?

WS8. What kind of toilet facility do members of your household usually use?
If "flush" or "pour flush", probe: Where does it flush to? 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?

WS11A. Can you use this facility at all hours of the day and night?

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?

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

HC3. Main material of the dwelling floor
Record observation
HC4. Main material of the roof
Record observation.
HC5. Main material of the exterior walls.
Record observation.
HC6. What type of fuel does your household mainly use for cooking?

HC7. Is the cooking usually done in the same 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 (things/facilities):

A. Electricity?

B. A radio?

C. A television?

D. A non-mobile telephone?

E. A refrigerator?

F. An improved cooking stove (ICS)?

G. Table

H. Chair

I. Bed/cot

J. Sofa

K. Wardrobe

L. Computer

M. Wall clock

N. Electric fan

O. Dhiki/jato

P. Microwave oven

Q. Washing machine

HC9. Does any member of your household own (things):

A. A watch?

B. A mobile telephone?

C. A bicycle/rickshaw?

D. A motorcycle or scooter?

E. An animal drawn cart?

F. A car/truck/bus/jeep?

H. A tractor?

I. A boat?

HC10. Do you or someone living in this household own this dwelling or is it rented or have any other arrangement?
If own the household circle "1" if not owned, probe for whether it is rented or under what
terms and conditions is the household using this dwelling? 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 area of agricultural land do members of this household own?

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. Cow/ox?

H. Yak,nak,chauri?

G. Male/female buffalo?

C. Goats/Tibetan goat?

D. Sheep?

F. Pigs/swines?

B. Horse, ass, mules?

E. Chickens/ducks/pigeons?

X. Other animals?

Y. Other poultry?
If none, record '00'/ If 95 or more, record '95'. If unknown, record '98'.

HC15. Does any member of this household have an account in any bank or financial institution?

Child Labour: CL

To be administered for children in the household age 5-14 years. See household listing form and copy the name and age of the person aged 5-14, years according to the line numbers in the Household Listing Form. For household members below age 5 or above age 14, leave rows blank.
Now I would like to ask about any work children aged 5-14 years in this household may do.

CL1. Line number: _ _

CL2. Name and age copy from Household Listing Form, HL2 and HL6

CL3. During the past 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 past 7 days 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 7 days, did (name) fetch water or collect firewood for household use?

CL6. During the past 7 days about how many hours did (name) fetch water or collect firewood for household use?

CL7. During the past 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 for his/her family or himself/herself?
Include work for a business run by the child, alone or with one or more partners.
CL8. During the past 7 days about how many hours did (name) do this work for his/her family or himself/herself?

CL9. During the past 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 past 7 days about how many hours did (name) spend doing these chores?

De-worming: DW

To be administered only for children in the household age 6-11 years. For household members below age 6 or above age 11, leave rows blank.
Now I would like to ask about the de-worming tablets your children of age 6-11 years have received in the last one year.

DW1. Line number: _ _

DW2. Name and age copy from Household Listing Form, HL2 and HL6

DW3. Has (name) received re-worming tablet at least once at. any time during the last one year?

DW4. from where has (name) received de-worming tablet during the last one year?

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 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. Male/female from HL4

CD5. Age from HL6: _ _

CD6. Total 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: _

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 one month.

CD11. In the past one month, took away privileges, forbade something (name) liked or did not allow him/her to leave house.

CD12. In the past one month, explained why (name)'s behaviour was wrong.

CD13. In the past one month, shook (name).

CD14. In the past one month, shouted, yelled at or screamed at (name).

CD15. In the past one month, gave (name) something else to do.
Probe: This means distracting the child or helping the child pay attention to something else.
CD16. In the past one month, spanked, hit or slapped (name) on the bottom with bare hand.

CD17. In the past one month, hit (name)on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.

CD18. In the past one month, called (name) dumb, lazy, or another name like that.

CD19. In the past one month, hit or slapped (name) on the face, head or ears.

CD20. In the past one month, hit or slapped (name) on the hand, arm, or leg.

CD21. In the past one month, 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

HW1A. Please mention all the occasions when is it important to wash your hands.
Circle all mentioned.
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.
HW2A. Check the distance of the hand-washing place from the toilet in paces and circle appropriate code.
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.
HH19. Record the time

Salt Iodization: SI

SI1A. What type of salt do you usually use at home? Could you show me the salt you regularly use for cooking?
(Observe the salt in use in the household; if packed salt is used and if packet is available at home, check if it has the mark of a girl and a boy child or not and tick the appropriate answer.)
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?
Use the provided salt test kit to test the iodine content in the salt sample. Once you have tested the salt, circle number that corresponds to test outcome.
HH20. Is there any woman in the age group of 15-49 years in the household who need to be administered the questionnaire?
Check the presence of any woman in the age group of 15-49 years in the Household who need to be administered the questionnaire in column HL7 of the HH Listing form.
There must be a separate questionnaire with the Woman's Information Panel (WM) for Personal Questionnaire for Women for every woman in the age group of 15-49 years in the Household.
HH21. Is there any child in the household below 4 years?
Check the presence of any boy/girl child below 5 years in the Household that is to be administered the questionnaire in column HL9 of the HH Listing form.
There must be a separate questionnaire filled up with introductory information section UF for every girl/boy child below 5 years in the Household.

Compile all the questionnaires filled up in this HH and fill in HH8 to HH15 on the cover page. After filling up all information in the covering envelop, keep the filled HH questionnaire in this envelop.

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________