Multiple Indicator Cluster Survey (MICS) Punjab, 2017
Household Information Panel: HH
HH3. Interviewer name and number:
Number _ _ _ _
HH4. Supervisor's name and number:
Number _ _ _ _
HH5. Day/Month/Year of interview:
[] 2 Rural
HH8. Is the household selected for questionnaire for men?
[] 2 No
HH9. Is the household selected for water quality testing?
[] 2 No
HH10. Is the household selected for blank testing?
[] 2 No
Check that the respondent is a knowledgeable member of the household and at least 18 years old before proceeding. You may only interview a child age 15-17 if there is no adult member of the household or all adult members are incapacitated. You may not interview a child under age 15.
_ _ Minutes
HH12. Assalam O Alaikum, my name is (your name). We are 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. This interview usually takes about 40 minutes. Following this, I may ask to conduct additional interviews with you or other individual members of your household. All the information we obtain will remain strictly confidential and anonymous. If you do not wish to answer a question or stop the interview, please let me know. May I start now?
[] 2 No/not asked (Go to HH46)
HH46. Result of household questi(Go to HH46)onnaire interview:
Discuss any result not completed with supervisor.
[] 02 No household member or no competent respondent at home at time of visit
[] 03 Entire household absent for extended period of time
[] 04 Refused
[] 05 Dwelling vacant or address not a dwelling
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 96 Other (specify) ____
HH47. Name and line number of the respondent to household questionnaire interview:
Line number _ _
To be filled after the Household Questionnaire is completed
Total number
HH48. Household members: __ __
HH49. Women age 15-49: __ __
HH50. If household is selected for questionnaire for men (Men age 15-49): __ __
HH51. Children under age 5: __ __
HH52. Children age 5-17: __ __
To be filled after all the questionnaires are completed
Completed number
HH53. Women age 15-49: __ __
HH54. If household is selected for questionnaire for men (Men age 15-49): __ __
HH55. Children under age 5: __ __
[] 1 One
First complete HL2 for all members of the household. Then proceed with HL3 and HL4 vertically. Once HL2-HL4 are complete for all members, make sure to probe for additional members: Those that are not currently at home, any infants or small children and any others who may not be family (such as servants, friends) but who usually live in the household.
Then, ask questions HL5-HL20 for each member one at a time. If additional questionnaires are used, indicate by ticking this box: ____
HL2. First, please tell me the name of each person who usually lives here, starting with the head of the household.
Probe for additional household members.
HL3. What is the relationship of (name) to (name of the head of household)?
HL4. What is the sex of (name)?
[] 2 Female
[] 3 Transgender
HL5. What is (name)'s date of birth?
[] 98 DK
Year: _ _ _ _
[] 9998 DK
HL6. How old is (name)?
Record in completed years. If age is 95 or above, record "95".
HL7. Did (name) stay here last night?
[] 2 No
[] 2 No(Go to HL10)
HL7B. What is the marital status of (name)?
[] 2 Widowed
[] 3 Divorced
[] 4 Separated
[] 5 Never married
[] 8 DK
HL8. Record line number if woman and age 15-49: _ _
HL9. Record line number if man, age 15-49 and HH8 is yes: _ _
HL10. Record line number if age 0-4: _ _
[] 2 No (Go to next line)
HL12. Is (name)"s natural mother alive?
[] 2 No (Go to HL16)
[] 8 DK (Go to HL16)
HL13. Does (name)'s natural mother live in this household?
[] 2 No (Go to HL15)
HL14. Record the line number of mother and go to HL16: _ _
HL15. Where does (name)'s natural mother live?
[] 2 In another household in the same district
[] 3 In another household in another district
[] 4 Institution in this country
[] 8 DK
HL16. Is (name)'s natural father alive?
[] 2 No (Go to HL20)
[] 8 DK (Go to HL20)
HL17. Does (name)'s natural father live in this household?
[] 2 No (go to HL19)
HL18. Record the line number of father and go to HL20: _ _
HL19. Where does (name)'s natural father live?
[] 2 In another household in the same district
[] 3 In another household in another district
[] 4 Institution in this country
[] 8 DK
HL20. Copy the line number of mother from HL14. If blank, ask: Who is the primary caretaker of (name)?
If "No one" for a child age 15-17, record "90".
Code for HL3. Relationship to head of household
[] 02 Spouse/wife
[] 03 Son/daughter
[] 04 Son-in-law/daughter-in-law
[] 05 Grandchild
[] 06 Parent
[] 07 Parent-in-law
[] 08 Brother/sister
[] 09 Brother-in-law/sister-in-law
[] 10 Uncle/aunt
[] 11 Niece/nephew
[] 12 Other Relative
[] 13 Adopted/foster/stepchild
[] 14 Servant (live-in)
[] 96 Other (not related)
[] 98 Don't Know
ED2. Name and age
Copy names and ages of all members of the household from HL2 and HL6 to below and to next page of the module.
Age: _ _
[] 2 No (Go to next line)
ED4. Has (name) ever attended school or any Preschool/Katchi/early childhood education programme?
[] 2 No (Go to next line)
ED5. What is the highest level and grade or year of school (name) has ever attended?
[] 1 Primary
[] 2 Lower secondary
[] 3 Upper secondary
[] 4 Higher
[] 8 DK
[] 98. DK (Go to ED7)
ED6. Did (name) ever complete that (grade/class)?
[] 2 No
[] 8 DK
[] 2 No (Go to next line)
ED8. Check ED4: Ever attended school or Preschool/Katchi/ECE?
[] 2 No (Go to next line)
Class codes for ED5, ED10, and ED16
[] 01-03 Middle
[] 01-02 Matric
[] 01-07 Higher
Age: _ _
ED9. At any time during the current school year (2017-18) did (name) attend school or any Preschool/Katchi/early childhood education programme?
[] 2 No (Go to ED15)
ED10A. Is (name) currently going to any school?
Reference period is last seven days for at least 4-5 hours daily
[] 2 No(Go to ED15)
ED10. During this current school year (2017-18), which level and grade or year is (name) attending?
[] 1 Primary
[] 2 Lower sec.
[] 3 Upper sec.
[] 4 Higher
[] 8 DK
[] 98. DK
ED11. Is (he/she) attending a public school?
If "Yes", record "1". If "No", probe to code who controls and manages the school.
[] 2 Religious/missionary
[] 3 Private
[] 6 Other
[] 8 DK
ED12. In the current school year (2017-18), has (name) received any school tuition support?
If "Yes", probe to ensure that support was not received from family, other relatives, friends or neighbours.
[] 2 No (Go to ED14)
[] 8 DK (Go to ED14)
ED13. Who provided the tuition support?
Record all mentioned.
[] B Religious/missionary
[] C Private
[] X Other
[] Z DK
ED14. For the current school year (2017-18), has (name) received any material support or cash to buy shoes, exercise books, notebooks, school uniforms or other school supplies?
If "Yes", probe to ensure that support was not received from family, other relatives, friends or neighbours.
[] 2 No
[] 8 DK
ED15. At any time during the previous school year (2016-17) did (name) attend school or any Preschool/Katchi/early childhood education programme?
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
ED16. During that previous school year (2016-17), which level and grade or class did (name) attend?Pre
[] 1 Primary
[] 2 Lower sec
[] 3 Upper sec
[] 4 Higher
[] 8 DK
[] 98. DK
Class codes for ED5, ED10, and ED16
[] 01-03 Middle
[] 01-02 Matric
[] 01-07 Higher
_ _ Age
[] 2 No (Go to next line)
DA4. Does (name) wear glasses or contact lenses to help them see?
[] 2 No (Go to DA6)
DA5. I would like to know if (name) has difficulty seeing even when wearing glasses or contact lenses. Would you say that (name) has no difficulty seeing, some difficulty, a lot of difficulty, or cannot see at all?
[] 2 Some difficulty (Go to DA7)
[] 3 A lot of difficulty (Go to DA7)
[] 4 Cannot see at all (Go to DA7)
[] 8 Don't know (Go to DA7)
DA6. I would like to know if (name) has difficulty seeing. Would you say that (name) has no difficulty seeing, some difficulty, a lot of difficulty, or cannot see at all?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
[] 8 Don't know
DA7. Does (name) wear a hearing aid?
[] 2 No (Go to DA9)
DA8. I would like to know if (name) has difficulty hearing even when using a hearing aid. Would you say that (name) has no difficulty hearing, some difficulty, a lot of difficulty, or cannot hear at all?
[] 2 Some difficulty (Go to DA10)
[] 3 A lot of difficulty (Go to DA10)
[] 4 Cannot hear at all (Go to DA10)
[] 8 Don't know (Go to DA10)
DA9. I would like to know if (name) has difficulty hearing. Would you say that (name) has no difficulty hearing, some difficulty, a lot of difficulty, or cannot hear at all?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
[] 8 Don't know
DA10. I would like to know if (name) has difficulty communicating when using his/her usual language. Would you say that (name) has no difficulty understanding or being understood, some difficulty, a lot of difficulty, or cannot communicate at all?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot communicate at all
[] 8 Don't know
_ _ Age
DA11. I would like to know if (name) has difficulty remembering or concentrating. Would you say that (name) has no difficulty remembering or concentrating, some difficulty, a lot of difficulty, or cannot remember or concentrate at all?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember/concentrate at all
[] 8 Don't know
DA12. I would like to know if (name) has difficulty walking or climbing steps. Would you say that (name) has no difficulty walking or climbing steps, some difficulty, a lot of difficulty, or cannot walk or climb steps at all?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk or climb at all
[] 8 Don't know
DA13. I would like to know if (name) has difficulty washing all over or dressing. Would you say that (name) has no difficulty washing all over or dressing, some difficulty, a lot of difficulty, or cannot wash all over or dress at all?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot wash or dress at all
[] 8 Don't know
DA14. Has (name) taken any benefit from social protection scheme due to disability/functioning?
[] B Bisp
[] C Khidmat card
[] D Pension/retirement
[] E Watan/health card
[] F Not any
[] F Other
[] Z DK
HC1B. What is the mother tongue of (name of the head of the household from HL2)?
[] 2 Urdu
[] 3 Punjabi/Potohari
[] 4 Saraiki
[] 6 Other language (specify) ____
HC3. How many rooms do members of this household usually use for sleeping?
HC4. Main material of the dwelling floor.
Record observation. If observation is not possible, ask the respondent to determine the material of the dwelling floor.
[] 12 Dung
[] 32 Vinyl or asphalt strips
[] 33 Ceramic Tiles/marble/chips
[] 34 Cement
[] 35 Carpet
[] 36 Bricks floor
HC5. Main material of the roof.
Record observation.
Natural roofing
[] 13 Sod
[] 22 Palm/bamboo
[] 23 Wood planks
[] 32 Wood/wooden beams
[] 33 Calamine/cement fibre
[] 34 Ceramic tiles
[] 35 Cement
HC6. Main material of the exterior walls.
Record observation.
[] 13 Dirt
[] 22 Stone with mud
[] 23 Uncovered adobe
[] 24 Plywood
[] 25 Cardboard
[] 26 Reused wood
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement bricks
[] 35 Covered adobe
HC7. Does your household have:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
E. Sewing machine (without electric motor)?
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC8. Does your household have electricity?
[] 2 Yes, off-grid (generator/isolated system)
[] 3 No (Go to HC10)
HC9. Does your household have:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
J. A sewing machine (with electric motor)?
[] 2 No
HC10. Does any member of your household own:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC11. Does any member of your household have a computer or a tablet?
[] 2 No
HC12. Does any member of your household have a mobile telephone?
[] 2 No
HC13. Does your household have access to internet at home?
[] 2 No
HC14. 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", record "2". For other responses, record "6" and specify.
[] 2 Rent
[] 6 Other (specify) _____
HC15. Does any member of this household own any land that can be used for agriculture?
[] 2 No (Go to HC17)
HC16. How many acres of agricultural land do members of this household own?
If less than 1, record "00". 1 acre = 8 kanals
[] 95 95 or more
[] 98 DK
HC17. Does this household own any livestock, herds, other farm animals, or poultry?
[] 2 No (Go to HC19)
[page 8]
HC18. 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. Milk cows, buffalos or bulls?
C. Horses, donkeys, camel or mules?
HC19. Does any member of this household have an account in a bank, post office or National Saving Centre?
[] 2 No
[] 8 DK
ST1. I would like to ask you about various external economic assistance programmes provided to households. By external assistance I mean support that comes from the government or from non-governmental organizations such as religious, charitable, or community-based organizations. This excludes support from family, other relatives, friends or neighbours.
ST2. Are you aware of (name of programme)?
[] 2 No (Go to B)
[] 2 No (Go to C)
[] 2 No (Go to D)
[] 2 No (Go to E)
[] 2 No (Go to X)
[] 2 No (Go to end of module)
ST3. Has your household or anyone in your household received assistance through (name of programme)?
[] 2 No (Go to B)
[] 8 DK (Go to B)
[] 2 No (Go to C)
[] 8 DK (Go to C)
[] 2 No (Go to D)
[] 8 DK (Go to D)
[] 2 No (Go to E)
[] 8 DK (Go to E)
[] 2 No (Go to X)
[] 8 DK (Go to X)
[] 2 No (Go to end of module)
[] 8 DK (Go to end of module)
ST4. When was the last time your household or anyone in your household received assistance through (name of programme)?
If less than one month, record "1" and record "00" in Months. If less than 12 months, record "1" and record in Months. If 1 year/12 months or more, record "2" and record in Years.
[] 2 Years ago_ _ (Go to B)
[] 998 DK (Go to B)
[] 2 Years ago_ _ (Go to C)
[] 998 DK (Go to C)
[] 2 Years ago_ _ (Go to D)
[] 998 DK (Go to D)
[] 2 Years ago_ _ (Go to E)
[] 998 DK (Go to E)
[] 2 Years ago_ _ (Go to X)
[] 998 DK (Go to X)
[] 2 Years ago_ _ (Go to end of module)
[] 998 DK (Go to end of module)
Remittances and cash donation: RM
RM1. Has there been a member of this household who used to live here but is now working outside this country?
[] 2 No (Go to RM3)
RM2. How many members are working outside this country?
Number of persons
RM3. Did the household receive any remittance in cash from outside country/overseas during the last year?
Money which will not be repaid.
[] 2 No
[] 8 DK
RM4. Did the household receive any cash donation such as zakat or other means from within the country during the last year?
Money which will not be repaid. Support from family, other relatives, friends or neighbours
[] 2 No
[] 8 DK
EU1. In your household, what type of cookstove is mainly used for cooking?
[] 02 Solar cooker (Go to EU5)
[] 03 Liquefied petroleum gas (LPG)/cooking gas stove (Go to EU5)
[] 04 Piped natural gas stove (Go to EU5)
[] 05 Biogas stove (Go to EU5)
[] 06 Liquid fuel stove (Go to EU4)
[] 07 Manufactured solid fuel stove
[] 08 Traditional solid fuel stove
[] 09 Three stone stove/open fire (Go to EU4)
[] 96 Other (specify)____ (Go to EU4)
[] 97 No food cooked in household (Go to EU6)
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
EU4. What type of fuel or energy source is used in this cookstove?
If more than one, record the main energy source for this cookstove.
[] 02 Gasoline/diesel
[] 03 Kerosene/paraffin
[] 04 Coal/lignite
[] 05 Charcoal
[] 06 Wood
[] 07 Crop residue/grass/straw/shrubs
[] 08 Animal dung/waste
[] 09 Processed biomass (pellets) or woodchips
[] 10 Garbage/plastic
[] 11 Sawdust
[] 96 Other (specify) ____
EU5. Is the cooking usually done in the house, in a separate building, or outdoors?
If in main house, probe to determine if cooking is done in a separate room. If outdoors, probe to determine if cooking is done on veranda, covered porch, or open air.
[] 02 In a separate room
[] 03 In a separate building
[] 05 On veranda or covered porch
EU6. What does your household mainly use for space heating when needed?
[] 02 Manufactured space heater
[] 03 Traditional space heater
[] 04 Manufactured cookstove
[] 05 Traditional cookstove
[] 06 Three stone stove/open fire (Go to EU8)
[] 96 Other (specify) (Go to EU8)
[] 97 No space heating in household (Go to EU9)
[] 2 No
[] 8 DK
EU8. What type of fuel and energy source is used in this heater?
If more than one, record the main energy source for this heater.
[] 02 Electricity
[] 03 Piped natural gas
[] 04 Liquefied Petroleum Gas (LPG)/cooking gas
[] 05 Biogas
[] 06 Alcohol/ethanol
[] 07 Gasoline/diesel
[] 08 Kerosene/paraffin
[] 09 Coal/lignite
[] 10 Charcoal
[] 11 Wood
[] 12 Crop residue/grass/straw/shrubs
[] 13 Animal dung/waste
[] 14 Processed biomass (pellets) or woodchips
[] 15 Garbage/plastic
[] 16 Sawdust
[] 96 Other (specify) ____
EU9. At night, what does your household mainly use to light the household?
[] 2 Solar lantern
[] 3 Rechargeable flashlight, torch or lantern
[] 4 Battery powered flashlight, torch or lantern
[] 5 Biogas lamp
[] 6 Gasoline lamp
[] 7 Kerosene lamp
[] 8 Charcoal
[] 9 Wood
[] 10 Crop residue/grass/straw/shrubs
[] 11 Animal dung
[] 12 Oil lamp
[] 13 Candle
[] 96 Other (specify) ____
[] 97 No lighting in household
WS1. What is the main source of drinking water used by members of your household?
If unclear, probe to identify the place from which members of this household most often collect drinking water (collection point).
[] 12 Piped to compound/yard/plot (Go to WS7)
[] 13 Piped to neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 22 Motorized pump (Go to WS3)
[] 23 Hand pump (mechanical) (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 51 Rainwater (pond) (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 71 Cart with small tank/drum/cane (Go to WS4)
[] 72 Water kiosk (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
WS2. What is the main source of water used by members of your household for other purposes such as cooking and handwashing?
If unclear, probe to identify the place from which members of this household most often collect water for other purposes.
[] 12 Piped to compound/yard/plot (Go to WS7)
[] 13 Piped to neighbour
[] 14 Public tap/standpipe
[] 22 Motorized pump
[] 23 Hand pump (mechanical)
[] 32 Unprotected well
[] 42 Unprotected spring
[] 51 Rainwater
[] 61 Tanker-truck (Go to WS4)
[] 71 Cart with small tank (Go to WS4)
[] 72 Water kiosk (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel)
WS3. Where is that water source located?
[] 2 In own yard/plot (Go to WS7)
[] 3 Elsewhere
WS4. How long does it take for members of your household to go there, get water, and come back?
_ _ _Number of minutes
[] 998 DK
WS5. Who usually goes to this source to collect the water for your household?
Record the name of the person and copy the line number of this person from the list of household members module.
Line number: _ _
WS6. Since last (day of the week), how many times has this person collected water?
[] 98 DK
WS7. In the last month, has there been any time when your household did not have sufficient quantities of drinking water?
[] 2 No, always sufficient (Go to WS9)
[] 8 DK (Go to WS9)
WS8. What was the main reason that you were unable to access water in sufficient quantities when needed?
[] 2 Water too expensive
[] 3 Source not accessible
[] 6 Other (specify) ____
[] 8 DK
WS9. Do you or any other member of this household do anything to the water to make it safer to drink?
[] 2 No (Go to WS11)
[] 8 DK (Go to WS11)
WS10. What do you usually do to make the water safer to drink?
Probe: Anything else?
Record all methods mentioned.
[] B Add bleach/chlorine
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, etc)
[] E Solar disinfection
[] F Let it stand and settle
[] X Other (specify) ____
[] Z DK
WS11. 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.
[] 12 Flush to septic tank
[] 13 Flush to pit latrine
[] 14 Flush to open drain (go to WS14)
[] 18 Flush to DK where (go to WS14)
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 41 Bucket (Go to WS14)
[] 96 Other (specify) ____ (Go to WS14)
WS12. Has your (answer from WS11) ever been emptied?
[] 2 Yes, emptied, more than 5 years ago
[] 3 Yes, emptied, don't know when
[] 4 No, never required emptying (Go to WS14)
[] 5 Replaced when full (Go to WS14)
[] 8 DK (Go to WS14)
WS13. The last time it was emptied, where were the contents emptied to?
Probe: Was it removed by a service provider?
[] 2 Buried in a covered pit
[] 3 To don't know where
[] 5 To uncovered pit, open ground, water body or elsewhere
[] 6 Other (specify) ____
[] 8 DK
WS14. Where is this toilet facility located?
[] 2 In own yard/plot
[] 3 Elsewhere
WS15. Do you share this facility with others who are not members of your household?
[] 2 No (Go to next module)
WS16. 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?
[] 2 Shared with general public (Go to next module)
WS17. How many households in total use this toilet facility, including your own household?
[] 10 Ten or more households
[] 98 DK
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?
Record result and observation.
[] 2 Fixed facility observed (sink/tap) in yard /plot
[] 3 Mobile object observed (bucket/jug/kettle)
[] 5 No permission to see (Go to HW4)
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.
[] 2 Water is not available
HW3. Is soap or detergent or ash/mud/sand present at the place for handwashing?
[] 2 No, not present (Go to HW5)
HW4. Where do you or other members of your household most often wash your hands?
[] 2 In yard/plot
[] 4 No handwashing place in dwelling/yard/plot
[] 6 Other (specify) ____
HW5. Do you have any soap or detergent in your house for washing hands?
[] 2 No (Go to next module)
HW6. Can you please show it to me?
[] 2 No, not shown (Go to next module)
HW7. Record your observation.
Record all that apply.
[] B Detergent (powder/liquid/paste)
SA1. We would like to check whether the salt used in your household is iodised. May I have a sample of the salt used to cook meals in your household?
Apply 2 drops of test solution, observe the darkest reaction within 30 seconds, compare to the colour chart and then record the response (1, 2 or 3) that corresponds to test outcome.
[] 2 Below 15 PPM (between 0 PPM and 15 PPM) (Go to HH13)
[] 3 Above 15 PPM (at least 15 PPM) (Go to HH13)
[] 6 Other reason (specify) ____ (Go to HH13)
SA2. I would like to perform one more test. May I have another sample of the same salt?
Apply 5 drops of recheck solution. Then apply 2 drops of test solution on the same spot. Observe the darkest reaction within 30 seconds, compare to the colour chart and then record the response (1, 2 or 3) that corresponds to test outcome.
[] 2 Below 15 PPM (between 0 and 15 PPM)
[] 3 Above 15 PPM (at least 15 PPM)
HH14. Language of the Questionnaire.
[] 2 Urdu
HH15. Language of the Interview.
[] 2 Urdu
[] 3 Punjabi/Potohari
[] 4 Saraiki
[] 6 Other language (specify) ____
HH16. Native language of the Respondent.
[] 3 Punjabi/Potohari
[] 4 Saraiki
[] 6 Other language (specify) ____
HH17. Was a translator used for any parts of this questionnaire?
[] 2 Yes, part of questionnaire
[] 3 No, not used
HH18. Check HL6 in the "List of household members" and indicate the total number of children age 5-17 years:
[] 1 1 child (Go to HH27)
2 or more children (number): _ _
[page 21]
HH19. List each of the children age 5-17 years below in the order they appear in the list of household members. Do not include other household members outside of the age range 5-17 years. Record the line number, name, sex, and age for each child.
HH21. Line number from HL1: _ _
[] 2 Female
HH25. Check the last digit of the household number (HH2) from the household information panel. This is the number of the row you should go to in the table below.
Check the total number of children age 5-17 years in HH18 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 record the number that appears in the box. This is the rank number (HH20) of the selected child.
Total number of eligible children in the household (from HH18): _
HH26. Record the rank number (HH20), line number (HH21), name (HH22) and age (HH24) of the selected child.
Line number: _ _
Name: ____
Age: _ _
HH27. (When HH18=1 or when there is a single child age 5-17 in the household): Record the rank number as "1"and record the line number (HL1), the name (HL2) and age (HL6) of this child from the list of household members.
Line Number: _ _
Name: ____
Age: _ _
HH28. Issue a questionnaire for children age 5-17 to be administered to the mother/caretaker of this child.
[page 22]
HH29. Check HL8 in the list of household members: Are there any women age 15-49?
[] 2 No (Go to HH34)
HH30. Issue a separate questionnaire for individual women for each woman age 15-49 years.
HH31. Check HL6 and HL8 in the list of household members: Are there any girls age 15-17?
[] 2 No (Go to HH34)
HH32. Check HL20 in the list of household members: Is consent required for interviewing at least one girl age 15-17?
[] 2 No, HL20 equal 90 for all girls age 15-17 (Go to HH34)
HH33. As part of the survey we are also interviewing women age 15-49. We ask each person we interview for permission. A female interviewer conducts these interviews.
For girls age 15-17 we must also get permission from an adult to interview them. As mentioned before, all the information we obtain will remain strictly confidential and anonymous.
May we interview (name(s) of female member(s) age 15-17) later?
[] "No" for at least one girl age 15-17 and "Yes" to at least one girl age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on individual questionnaires for those adult consent was not given. Then continue with HH34.
[] "No" for all girls age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on all individual questionnaires for whom adult consent was not given. Then continue with HH34.
HH34. Check HH8 in the household information panel: Is the household selected for Questionnaire for Men?
[] 2 No, HH8=2 (Go to HH40)
HH35. Check HL9 in the "List of household members": Are there any men age 15-49?
[] 2 No (Go to HH40)
HH36. Issue a separate questionnaire for individual men for each man age 15-49 years.
HH37. Check HL6 and HL8 in the list of household members: Are there any boys age 15-17?
[] 2 No (Go to HH40)
HH38. Check HL20 in the "List of household members": Is consent required for interviewing at least one boy age 15-17?
[] 2 No, HL20 equal 90 for all boys age 15-17 (Go to HH40)
HH39. As part of the survey we are also interviewing men age 15-49. We ask each person we interview for permission. A male interviewer conducts these interviews.
For boys age 15-17 we must also get permission from an adult to interview them. As mentioned before, all the information we obtain will remain strictly confidential and anonymous.
May we interview (name(s) of male member(s) age 15-17) later?
[] "No" for at least one boy age 15-17 and "Yes" to at least one boy age 15-17. Record "06" in MWM17 (also in UF17 and FS17, if applicable) on individual questionnaires for those adult consent was not given. Then continue with HH40.
[] "No" for all boys age 15-17. Record "06" in MWM17 (also in UF17 and FS17, if applicable) on all individual questionnaires for whom adult consent was not given. Then continue with HH40.
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HH40. Check HL10 in the "List of household members": Are there any children age 0-4?
[] 2 No (Go to HH42)
HH41. Issue a separate questionnaire for children under five for each child age 0-4 years.
HH42. Check HH9 in the household information panel: Is the household selected for water quality testing questionnaire?
[] No HH9=2 (Go to HH45)
HH43. Issue a separate water quality testing questionnaire for this household
HH44. As part of the survey we are also looking at the quality of drinking water. We would like to do a simple test of your drinking water. A colleague will come and collect the water samples. May we do such a test?
If the respondent requests to learn the results, explain that results will not be shared with individual households but will be made available to local authorities.
[] 2 No, permission is not given (Record 02 in WQ31 on the water quality testing questionnaire)
HH45. Now return to the household information panel and,
Record "01" in question HH46 (Result of the Household Questionnaire interview). Record the name and the line number (from the list of household members) of the respondent to the household questionnaire interview in HH47. Fill the questions HH48 - HH52. Thank the respondent for his/her cooperation and then proceed with the administration of the remaining individual questionnaire(s) in this household.
If there is no individual questionnaire and no water quality testing questionnaire to be completed in this household thank the respondent for his/her cooperation and move to the next household you have been assigned by your supervisor.