MICS Household Questionnaire

[Sudan]
Household Information Panel: HH

HH1. Codes: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and number

Name: ____
Number: _ _

HH4. Supervisor name and number:

Name: ____
Number: _ _

HH5. Day/month/year of interview

_ _ / _ _ / _ _ _ _

HH6. Area

[] 1 Urban
[] 2 Rural

HH7. Region

[] 1 County/Mahaliya _ _
[] 2 Payam/ Administrative Unit (AU) _ _
[] 3 Boma/ Popular AU _ _ _
[] 4 Enumeration Area _ _ _
[] 5 Town/village name ____

We are from the Sudan Household Health Survey 2M round which is concemed with family health and socioeconomic indicators. I would like to talk to you about these subjects. The interview will take about (will be decided after the pretest) minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team. During this time I would like to speak with the household head and all mothers or others who take care of children in the household. May I start now?

[] Yes, permission is given (Go to HH18 to record the time and then begin the interview.)
[] No, permission is not given (Complete HH9. Discuss this result with your supervisor.)

After all questionnaires for the household 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:

[] 1 Completed
[] 2 Not at home
[] 3 Refused
[] 4 HH not found/destroyed
[] 6 Other (specify) ____

HH10. Respondent to household questionnaire:

Name: ____
Line number: _ _

HH11. Total number of household members: _ _

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

HH13. Number of woman's questionnaires completed: _ _

HH13A. Number of men age 15-49 years: _ _

HH13B. Number of men's questionnaires completed: _ _

HH14. Number of children under age 5: _ _

HH15. Number of child questionnaires completed: _ _

HH16. Field editor name and number

Name: ____
Line number: _ _

HH17. Date entry clerk name and number

Name: ____
Line number: _ _

HH18. Record the time

_ _ Hour
_ _ Minutes

Household Listing and Education Module: HL and ED

Female Genital Mutilation/Cutting: FGM/C

FGM/C1. Has (name) been circumcised/cut?
Circle the number of the answer below

[] 1 Yes
[] 2 No (Go to next module)
[] 8 Don't know (Go to next module)

FGM/C2. Who has done the circumcision/cutting for (name)?
Record the number of the answer in the box below

Traditional personnel

[] Traditional midwives _ _
[] Others _ _

Health professionals

[] Doctor _ _
[] Nurse or midwife _ _
[] Other health professionals

[] Don't know _ _

Disability Module (2-9 years): DA

DA1. Is (name) suffering from any disabilities that hinders him/her from performing normal daily activities?

[] 1 Yes
[] 2 No (Go to next module)
[] 8 Don't know (Go to next module)

DA2. Which of the following types of disability the (name) is suffering from?

[] A Difficulty in seeing
[] B Blindness
[] C Difficulty in hearing
[] D Deafness
[] E Difficulty in speaking
[] F Mute/dumb
[] G Physical disability
[] H Mental retardation
[] I Epilepsy
[] Z Others (specify in the same row) ____

Water and Sanitation: WS

WS1. What is the main source of drinking water for members of your household?
If more than one source, record the main source that is mainly used

Piped water (network)

[] 11 Piped into dwelling (Go to WS6)
[] 12 Piped into yard or plot (Go to WS6)
[] 14 Public tap/standpipe (Go to WS3)

[] 21. Water yard/hand pump (Go to WS3)

Dug well

[] 31 Protected/covered well (Go to WS3)
[] 32 Unprotected well (Go to WS3)

Spring

[] 41 Protected spring (Go to WS3)
[] 42 Unprotected spring (Go to WS3)

Surface water

[] 51 Filtered (river, stream, dam, hafir, lake, pond,
canal or rain) water (Go to WS3)
[] 52 Unfiltered (river, stream, dam, hafir, lake, pond,
canal or rain) water(Go to WS3)

Transported water by tankers/carts:

[] 61 From the water sources with the following codes
(11,12,14,21,31,41,51(Go to WS6)
[] 62 From the water sources with the following codes
(32,42,52) (Go to WS6)

[] 91 Bottled water (Go to WS2)
[] 96 Other (specify) ____ (Go to WS3)

WS2. What is the main source of water used by your household for cooking and other purposes such as handwashing?
If more than one source, record the main source that is mainly used

Piped water

[] 11 Piped into dwelling (Go to WS6)
[] 12 Piped into compound, yard or plot (Go to WS6)
[] 14 Public tap/standpipe

[] 21 Tube well, borehole

Dug well

[] 31 Protected well
[] 32 Unprotected well

Water from spring

[] 41 Protected spring
[] 42 Unprotected spring

Surface water

[] 51 Filtered rainwater, hafir, dam, river water
[] 52 Unfiltered rainwater, hafir, dam, river, stream, lake, pond, channel water

Transported water by tankers/carts

[] 61 From the water sources with the following codes (11,12,14,21, 31, 41, 51)
[] 62 From the water sources with the following codes (32, 42, 52)

[] 96 Other (specify) ____

WS3. Where is that water source located?

[] 1 In own dwelling (Go to WS6)
[] 2 In own yard/plot (Go to WS6)
[] 3 Elsewhere

WS4. By foot, how long does it take to go there, get water, and come back?

Number of minutes: _ _ _
[] 998 DK

WS4A. What is the distance to the water source from your residence?

Distance to water source:
[] 11 Less than or equal to 1 km
[] 12 More than 1 km
[] 98 DK

WS5. Who usually goes to this source to collect the water for your household?
Probe: Is this person under age 15? What sex?
Circle code that best describes this person.

[] 1 Adult woman
[] 2 Adult man
[] 3 Female child (under 15)
[] 4 Male child (under 15)
[] 8 DK

WS6. Do you treat your water to make it safer to drink?

[] 1 Yes
[] 2 No (Go to WS8)
[] 8 DK (Go to WS8)

WS7. What do you usually do to the water to make the water safer to drink?
Probe: Anything else? Record all items mentioned.

[] A Boil
[] B Add bleach/chlorine
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, ect.)
[] E Solar disinfection
[] F Let it stand and settle
[] X Other (specify) ____
[] Z DK

WS8. What kind of toilet facility do members of your household usually use to ease themselves/dispose of waste?
If "flush" or "pour flush", probe: Where does it flush to? If necessary, ask permission to observe the facility.

Flush / pour flush

[] 11 Flush to piped sewer system
[] 12 Flush to septic tank
[] 13 Flush to pit (latrine)
[] 14, Flush to somewhere else
[] 15 Flush to unknown place/not sure/DK where

Pit latrine

[] 21 Ventilated improved pit latrine (VIP)
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit

[] 31 Composite toilet
[] 41 Bucket
[] 51 Hanging toilet, hanging latrine
[] 95 No facilities or bush or field (Go to next module)
[] 96 Other (specify) ____

WS9. Do you share this facility with others who are not members of your household?

[] 1 Yes
[] 2 No (Go to WS11A)

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?

[] 1 Other households only (not public)
[] 2 Public facility (Go to WS11A)

WS11. How many households in total use this facility?

[] 0 No. of households (if less than 10) _
[] 10 Ten or more households
[] 98 DK

WS11A. What do you do to get rid of household garbage?

[] 1 Through garbage collection trucks
[] 2 Dumping outside the whole residential area
[] 3 Throwing outside the house
[] 4 Burning
[] 96 Other (specify) ____

Household characteristics: HC

HC02. How many rooms/verandas/tukuls belong to this household?

Number of rooms/verandas/tukuls belong to this household: _ _

HC2. How many rooms/verandas/tukuls are used for sleeping?

Used for sleeping: _ _

HC2A. What type of dwelling does this household live in?
Record observation.

[] 01 Tent
[] 02 Dwelling of straw mats
[] 03 Tukul/gottiya - mud
[] 04 Tukul/gottiya - sticks
[] 05 Flat or apartments
[] 06 Villa
[] 07 House of one floor - mud
[] 08 House of one floor - brick/concrete
[] 09 House constructed of wood
[] 10 multi-storey house
[] 11 Incomplete
[] 96 Other (specify) ____

HC6. What type of fuel does your household mainly use for cooking?

[] 01 Electricity (Go to HC8)
[] 03 Gas
[] 04 Biogas
[] 05 Kerosene
[] 07 Charcoal
[] 08 Wood
[] 09 Straw/shrubs/grass
[] 10 Animal dung
[] 11 Agricultural crop residue
[] 95 No food cooked in household (Go to HC8)
[] 96 Other (specify) ____

HC7. Is the cooking usually done in the house, in a separate room/tukul, or outdoors?
If 'In the house', probe: is it done in a separate room used as a kitchen?

In the house

[] 1 In a separate room used as a kitchen
[] 2 Elsewhere in the house

[] 3 In a separate building
[] 4 Outdoors
[] 6 Other (specify) ____

HC8. Does your household have any of the following: (read aloud, and circle either "1" for yes or "2" for no for each item?)

A. Electricity?

[] 1 Yes
[] 2 No

B. A radio?

[] 1 Yes
[] 2 No

C. A television?

[] 1 Yes
[] 2 No

D. A non-mobile telephone?

[] 1 Yes
[] 2 No

E. A refrigerator?

[] 1 Yes
[] 2 No

F. A computer?

[] 1 Yes
[] 2 No

G. Internet?

[] 1 Yes
[] 2 No

H. A digital reciever?

[] 1 Yes
[] 2 No

HC9. Does any member of your household own: (read aloud, and circle either "1" for yes or "2" for no for each item?)

A. A watch?

[] 1 Yes
[] 2 No

B. A mobile telephone?

[] 1 Yes
[] 2 No

C. A bicycle?

[] 1 Yes
[] 2 No

D. A motorcycle or scooter?

[] 1 Yes
[] 2 No

E. An animal drawn cart?

[] 1 Yes
[] 2 No

F. A car or truck?

[] 1 Yes
[] 2 No

G. A boat with a motor?

[] 1 Yes
[] 2 No

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 "3".

[] 1 Own
[] 2 Rent
[] 3 Other; specify (not owned or rented)

HC11. Does any member of this household own land for farming, grazing, or fishing?

[] 1 Yes
[] 2 No (Go to HC13)

HC12. How many faddans 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'.

_ _ Fadans

HC13. Does this household own any livestock, herds, or farm animals?

[] 1 Yes
[] 2 No (Go to next module)

HC14. How many of the following does this household have?
Circle the corresponding answer.

A. Cattle?