Panama 2013

Province _ _
District _ _
Prefecture _ _
Stratus _ _
UPM_ _
Visit number _ _
Questionnaire number _ _
Household number _ _
Week number _ _

Household Information Panel: HH

HH1. Primary Unit: _ _ _

HH2A. Questionnaire number: _ _

HH2. Household number: _ _

HH3. Interviewer name and number

HH4. Supervisor name and number:

HH5. Day/month/year of interview

HH7. Province or state

HH7A. District:

HH7B. Prefecture:

HH7C. Populated area or neighborhood:

HH7D. Street or avenue (number or name):

HH7E. Building or house (number or name):

HH7F. Room or apartment number

HH8. Is the household selected for questionnaire for men?

We are from National Institute of Statistics and Census. We are conducting a survey about the situation of children, families and households. I would like to talk to you about these subjects. The interview will take about (insert number) minutes. All the information we obtain will remain strictly confidential and anonymous. May I start now?

HH9. Result of household interview:

After the household questionnaire has been completed, fill in the following information:
HH10. Respondent to household questionnaire:

HH10A. Telephone number: _ _

HH10B. Respondent line number: _ _

HH10C. How many homes are there in this household? Considering home to be formed by people sharing a common living space and budget.: _ _

After the household questionnaire has been completed, fill in the following information:
HH11. Total number of household members: _ _

After the household questionnaire has been completed, fill in the following information:
HH12. Number of women age 15-49 years: _ _

After all questionnaires for the household have been completed, fill in the following information:
HH13. Number of women's questionnaires completed: _ _

After the household questionnaire has been completed, fill in the following information:
If the household is selected for Questionnaire for Men


After the household questionnaire has been completed, fill in the following information:
HH14. Number of children under age 5: _ _

After all questionnaires for the household have been completed, fill in the following information:
HH15. Number of under-5 questionnaires completed: _ _

HH17. Main data entry clerk's name and number:

List of Household Members: 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':

For women age 15-49
HL7. Did (name) stay here last night

HL7A. Circle line no. If man age 15-49 and the house-hold is selected for Questionnaire for men.

HL8. For children aged 5-14: Who is -name's- mother or main caretaker? Write the person's line number [Rows 01 to 15] _ _

HL8. For children under five: Who is -name's- mother or main caretaker? Write the person's line number [Rows 01 to 15] _ _

HL11. Is (name)'s natural mother alive
For children age 0-17 years
HL12. Does (name)'s natural mother live in this household? _ _
If "Yes", record line no. of mother and go to HL13. If "No", record 00.

HL12A. Where does (name)'s natural mother live?

HL13. Is (name)'s natural father alive

HL14. Does (name)'s natural father live in this household? _ _
If "Yes", record line no. of father and go to HL15. If "No", record 00.

HL14A. Where does (name)'s natural father live?

HC1A. What is -name's- religion?
For all household members
HC1B. What is the mother tongue/native language of the head of this household?

HC1C. Does -name- belong to any indigenous group?

HC1D. To what ethnic group does the head of this household belong?

HC1F. Does -name- think of themselves as being black or of African descent

HC1G. Is -name- considered to be:

[] Tick here if additional questionnaire used [After HL1 to HL4 questions]

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

Education: ED

ED1. Line number: _ _

ED2. Name and age
Copy from HL2 and HL6.
ED3. Has (name) ever attended school or pre-school?
For household members age 5 and above
ED4A. What is the highest level school (name) has ever attended?
For household members age 5 and above. If level=1 OR 2, skip to ED5
ED4B. What is the highest grade (name) completed at this level?
For household members age 5 and above. If the first grade at this level is not completed, enter "00".
ED5. During the current school year, that is 2013-2014, did (name) attend school or preschool at any time?
For household members age 5-24 years
ED6. During this/that school year, which level and grade is/was (name) attending?
For household members age 5-24 years. If level=1 OR 2 skip to ED7
ED7. During the previous school year, that is 2012-2013, did (name) attend school or preschool at any time?
For household members age 5-24 years
ED8. During that previous school year, which level and grade did (name) attend?
For household members age 5-24 years
If level=1 OR 2 skip to ED7
Child Discipline: CD

Table 1: Children from 1-14 years of age that are eligible for the Child Discipline Module
A. Register in the chart below every child aged 1 to 14 in the order that they appear in the household members' line number. Do not include any other household member outside the age range.
B. Register the line number, name, sex, and age of every child.
C. Then register the total number of children aged 1-14 in the corresponding box (CD6)
D. If there are no children in the age range, continue to the next module.
E. If there is a single 1-14 child in the household, skip Table 2, go to CD8 and register "1". Continue with CD9.

CD1. Order number [rows 1-8] 1 ? 8

CD2. HL1 Line number [rows 1-8].

CD3. HL2 name [rows 1-8].

CD4. HL4 sex [rows 1-8]

CD5. HL6 age

CD6. Total number of children aged 1-14:

Table 2: Random child selection for the Child Discipline questionnaire
A. Use chart 2 to select a child aged 1-14, if there is more than one in that age range in the household.
B. Check the last digit of the household number (HH2) that appears on the cover. This is the line number that you must use in the following chart.
C. Check the total number of eligible children aged 1-14 in CD6 above. This is the number in the column you must refer to.
D. Look for the box in which the row and column intersect and circle the number in the box. This is the line number (CD1) for the child that will be questioned.

CD7. Last household number digit in HH2 [rows 0-8] 0-8 [this is next to the 0-8 column in CD7]

Total number of eligible children in the household: [8 columns numbered 1-8, 9 rows]

CD8. Register the order number of the selected child _ _

CD9. For the selected child, register the name and line number from CD3 and CD2, according to the order number from 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. Please tell me if you or anyone else in your household has used this method with (name) in the past month.

CD11. Took away privileges, forbade something (name) liked or did not allow him/her to leave the house.

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

CD13. Shook him/her.

CD14. Shouted, yelled at or screamed at him/her.

CD15. Gave him/her something else to do.

CD16. Spanked, hit or slapped him/her on the bottom with bare hand.

CD17. Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.

CD18. Called him/her dumb, lazy, or another name like that.

CD19. Hit or slapped him/her on the face, head or ears.

CD20. Hit or slapped him/her on the hand, arm, or leg.

CD21. Beat him/her 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?

HH18 Record the time

Household Characteristics: HC

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

HC2A. How many rooms does this household have (do not include kitchen, service, and bathroom)?

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
HC8. Does your household have:

[A] Electricity?

[B] A radio?

[C] A television?

[D] A non-mobile telephone?

[E] A refrigerator?

[F] Computer?

[F] Internet access?

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, milk cows, or bulls?

[B] Horses, donkeys, or mules?

[C] Goats?

[D] Sheep?

[E] Chickens?

[F] Pigs?

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

Water and Sanitation: WS

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

WS1A. The water pumps or faucets in this household are located in:

WS1B. How consistently is your drinking water provided during:

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
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 not possible to determine, 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?