[page 1]

[UNICEF Version: 22 October 2013]
MICS Punjab 2014

Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and number

HH4. Team supervisor's name and number:

HH5. Day/month/year of interview

HH6. Area

HH7. District code __

HH8. Is the household selected for salt test sample?

We are from Bureau of Statistics, Planning and Development Department, Government of the Punjab, Lahore. 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 45 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:

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:
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: _ _

HH16. Field editor's name and number:

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

HH18. Record the time

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?
Write relevant codes from the list given below.
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, record '95':

Marital status of members age ten years and above.
HL6B. What is marital status of (name)?

For women age 15-49..
HL7. Circle line no. if woman age 15-49.

HL7B. Circle line no. if age 0-4.

HL10A. Can (name) read in any language with understanding?

HL10B. If yes in HL10A, in which language(s)?
Probe and circle all applicable.
HL10C. Can (name) write in any language with understanding?

HL10D. If yes in HL10C, in which language(s)?
Probe and circle all applicable.
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.
For children age 0-17 years.

HL12A. Where does (name)'s natural mother live?
For children age 0-17 years.
HL13. Is (name)'s natural father alive
For children age 0-17 years.
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
For children age 0-17 years. .

HL14A. Where does (name)'s natural father live?
For children age 0-17 years.
HL15. Record line no. of mother from HL12 if indicated.
If HL12 is blank or '00' ask: who is the primary caretaker of (name)?
For children age 0-14
For all household members.
HL16A. Had (name) been having cough and fever for last 3 weeks?

For all household members.
HL16B. Had (name) been diagnosed as having TB in the past year?

For all household members.
HL16C. Had (name) been diagnosed as having hepatitis in the past year?

[] Tick here if additional questionnaire

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 3 and above
ED4A. What is the highest level school (name) has attended?
For household members age 3 and above. If level=0, skip to ED5
ED4B. What is the highest grade (name) completed at this level?
For household members age 3 and above. If the first grade at this level is not completed, enter "00".
ED5. During the current school year, that is 2014-2015, did (name) attend school or preschool at any time?
For household members age 3-24 years
ED6. During this/that school year, which level and grade is/was (name) attending?
For household members age 3-24 years. If level=0 skip to ED7
ED6C. Is (name) attending a private or government school this year?
For household members age 3-24 years
ED7. During the previous school year, that is 2013-2014, did (name) attend school or preschool at any time?
For household members age 3-24 years
ED8. During that previous school year, which level and grade did (name) attend?
For household members age 3-24 years
If level=0 skip to ED7
ED8C. Is (name) attending a private or government school previous year (2013-2014)?
For household members age 3-24 years
Income and Employment: IE

Ask this module form all 5 years of age and older.
Starting with the head of the household, ask: did (name) work (or receive income) for pay, profit, or family gain in the last month? If 'yes', ask questions IE3 to IE7 from that person. If 'no' or 'don't know', probe any work or income even if it was given to the household. If 'yes', ask questions IE3 to IE7 from that person. If 'no', write no income code in IE3 and go to the next household member 5+ years of age.

IE1. Line number: _ _

IE2. Name and age
Copy from HH listing form HL2 and HL6.
A. Primary income source
IE3. What is the major type of income source of (name)?
Write code (see below). If no income (21-26), go to next person. If more than two sources of income, add extra to second income.
A. Primary income source
IE4. What is (name's) income on a daily, monthly, or yearly basis?
Write amount and M for monthly, Y for yearly, and D for daily basis. If more than two sources of income, add extra to second income.
A. Primary income source
IE5. Monthly on the average, how many months a year did (name) work for pay?
If more than two sources of income, add extra to second income.
A. Primary income source
IE6. Daily on the average, how many days a month did (name) work for pay?
If more than two sources of income, add extra to second income.
B. Additional income source
IE7. What is any other type of income source of (name)?
If no additional income write code 27 and go to next line. If more than two sources of income, add extra to second income.
B. Additional income source
IE8. What is the additional income of (name)?
Write amount and M for monthly, Y for yearly, and D for daily basis.
B. Additional income source
IE9. Monthly on the average, how many months a year did (name) work for pay?

B. Additional income source
IE10. Daily on the average, how many days a month did (name) work for pay?

Totals for each source: _ _

Grand total: _ _

Income codes (IE3, IE7):

No Income Codes (IE3, IE7):

Selection of One Child For Child Labour/Child Discipline: SL

SL1. Check HL6 in the list of household members and write the total number of children age 1-17 years.
SL2. Check the number of children age 1-17 years in SL1:
SL2A. List each of the children age 1-17 years below in the order they appear in the List of household members. Do not include other household members outside of the age range 1-17 years. Record the line number, name, sex, and age for each child.

SL3. Rank number: _

SL4. Line number from HL1: _ _

SL5. Name from HL2: ____

SL6. Sex from HL4

SL7. Age from HL6: _ _

SL8. 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 children age 1-17 years in SL1 above. This is the number of the column you should go to in the table below.
Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number (SL3) of the selected child.
SL9. Record the rank number (SL3), line number (SL4), name (SL5) and age (SL7) of the selected child.
[page 6]
Child Labor: CL

CL1. Check selected child's age from SL9:
CL2. Now I would like to ask about any work children in this household may do.
Since last (day of the week), did (name) do any of the following activities, even for only one hour?

A. Did (name) do any work or help on his/her own or the household's plot/farm/food garden or looked after animals? For example, growing farm produce, harvesting, or feeding, grazing, milking animals?

B. Did (name) help in family business or relative's business with or without pay, or run his/her own business?

C. Did (name) produce or sell articles, handicrafts, clothes, food or agricultural products?

D. Since last (day of the week), did (name) engage in any other activity in return for income in cash or in kind, even for only one hour?
If "No", Probe: Please include any activity (name) performed as a regular or casual employee, self-employed or employer; or as an unpaid family worker helping out in household business or farm.

CL3. Check CL2, A to D
CL4. Since last (day of the week) about how many hours did (name) engage in this activity/these activities, in total?
If less than one hour, record "00"
CL5. Does the activity/do these activities require carrying heavy loads?

CL6. Does the activity/do these activities require working with dangerous tools (knives etc.) or operating heavy machinery?

[page 7]
CL7. How would you describe the work environment of (name)?

[A] Is (name) exposed to dust, fumes or gas?

[B] Is (name) exposed to extreme cold, heat or humidity?

[C] Is (name) exposed to loud noise or vibration?

[D] Is (name) required to work at heights?

[E] Is (name) required to work with chemicals (pesticides, glues, etc.) or explosives?

[F] Is (name) exposed to other things, processes or conditions bad for (name)'s health or safety?

CL8. Since last (day of the week), did (name) fetch water or collect firewood for household use?

CL9. In total, how many hours did (name) spend on fetching water or collecting firewood for household use, since last (day of the week)?
If less than one hour, record "00"
CL10. Since last (day of the week), did (name) do any of the following for this household?

[A] Shopping for household?

[B] Repair any household equipment?

[C] Cooking or cleaning utensils or the house?

[D] Washing clothes?

[E] Caring for children?

[F] Caring for the old or sick?

[G] Other household tasks?

CL11. Check CL10, A to G
CL12. Since last (day of the week), about how many hours did (name) engage in this activity/these activities, in total?
If less than one hour, record "00"
[page 8]
Child Discipline: CD

CD1. Check selected child's age from SL9
CD2. Write the line number and name of the child from SL9.

CD3. 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.

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

[B] Explained why (name)'s behaviour was wrong.

[C] Shook him/her.

[D] Shouted, yelled at or screamed at him/her.

[E] Gave him/her something else to do.

[F] Spanked, hit or slapped him/her on the bottom with bare hand.

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

[H] Called him/her dumb, lazy, or another name like that.

[I] Hit or slapped him/her on the face, head or ears.

[J] Hit or slapped him/her on the hand, arm, or leg.

[K] Beat him/her up, that is hit him/her over and over as hard as one could.

CD4. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?

[page 9]
Household Characteristics: HC

HC1B. What is the mother tongue/native language of the head of this household?

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 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:

[A] Electricity?

[B] A radio?

[C] A television?

[D] A non-mobile telephone?

[E] A refrigerator?

[F] Gas?

[G] Computer?

[H] Air conditioner?

[I] Washing machine/dryer?

[J] Air cooler/fan?

[K] Cooking range/microwave?

[L] Sewing/knitting machine?

[M] An iron?

[N] Water filter?

[O] Dunky pump/turbine?

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 bus or truck?

[G] A boat with a motor?

[H] A car/van?

[I] A tractor/trolley?

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 acres 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'.
(1 acres = 8 kanal)
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, buffaloes, or bulls?

[B] Horses, donkeys, mules, or camels?

[C] Goats?

[D] Sheep?

[E] Chickens/duck/turkey?

HC15. Does any member of this household have an account in bank, post office, or national saving centre?

[page 12]
Insecticide Treated Nets: TN

TN1. Does your household have any mosquito nets that can be used while sleeping?

TN2. How many mosquito nets does your household have?

TN3. Ask the respondent to show you the nets in the household. If more than 3 nets, use additional questionnaire(s).

TN4. Mosquito net observed?
[Ask up to 3 Nets]
TN5. Observe or ask the brand/type of mosquito net.
If brand is unknown and you cannot observe the net, show pictures of typical net types/brands to respondent.
TN6. How many months ago did your household get the mosquito net?
If less than one month, record '00'.
TN7. Check TN5 for type of net
TN8. When you got the net, was it already treated with an insecticide to kill or repel mosquitoes?

TN9. Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitos?

[page 13]
TN10. How many months ago was the net last soaked or dipped?
If less than one month, record "00".
TN11. Did anyone sleep under this mosquito net last night?

TN12. Who slept under this mosquito net last night?
Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00".
TN13.
1st Net: Go back to TN4 for next net. If no more nets, go to next module.
2nd Net: Go back to TN4 for next net. If no more nets, go to next module.
3rd Net: Go back to TN4 in first column of a new questionnaire for next net. If no more nets, go to next module.
Water and Sanitation: WS

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

Remittances: RM

RM1. Is any member of this household, who does not usually reside in the household, working outside this village, city, or country?

RM2. How many members are working outside this village, city, or country?

RM3. Where are they working?

RM4. Did the household receive (from within the country and/or overseas any remittance (in cash) during the last year (money which will not be repaid)?
It should include remittances received from family member(s) or any other person(s)/ source(s) other than family member.
RM5. How much amount was received from inside the country during the past year?

RM5A. How much amount was received from overseas during the past year?

Pension benefits: PB

PB1. Did any members of the household receive any pension benefits during last year?

PB2. What was the source of the pension?

Safety nets: SN

SN1. Did the household receive any benefit from the government initiatives such as zakat, bait-ul-maal, sasta ration, BISP, watan card during last year?

SN2. What was the source?
Circle all responses given by the respondent.
SN3. Did the household receive any cash donations from zakat or other means during the past year?

SN4. How much money was received from zakat during the past year?

SN5. Did your household purchase any consumable items during last year?

SN6. Did the household purchase the consumable items form a utility store during last year?

SN7. Were the items purchased regularly from a utility store?

SN8. Do you feel that government initiatives are benefitting the low income groups?

Handwashing: HW

HW1. We would like to learn about where members of this household wash their hands.
Can you please show me where members of your household most often wash their hands?

HW2. Observe presence of water at the place for handwashing.
Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water.

HW3A. Is soap, detergent or ash/mud/sand present at the place for handwashing?

HW3B. Record you observation.
Circle all that apply.
HW4. Do you have any soap or detergent or ash/mud/sand in your house for washing hands?

HW5A. Can you please show it to me?

HW5B. Record your 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.
SI2. Check HH8A has the household been selected for additional salt testing
SI3. When you buy salt to cook meals in your household, do you normally look for or ask for iodized salt with a handi logo or labelled as iodized? Probe by showing picture of handi logo.
SI4. Was the salt that you provided for the test bought in a sealed package?

SI5. What is the brand of the salt that you provided for the test?

SI6. Can I please take a small sample of your salt for further testing of iodine content in the laboratory?

SI7. Collect one cup approximately 50gms of salt from the household into the plastic bag provided and label the sample with the cluster number and household number with the marker provided (CCC-HH). Record the results of sample collection.
SI8. Salt sample ID. Enter the cluster number followed by the household number
HH20. Thank the respondent for his/her cooperation and check the list of household members:

Return to the cover page and make sure that the result of the household interview (HH9), the name and line number of the respondent to the household questionnaire (HH10), and the number of eligible women (HH12), and under-5s (HH14) are entered. Make arrangements for the administration of the remaining questionnaire(s) in this household.

Interviewer's Observations ________

Field Editor's Observations ________

Supervisor's Observations ________