MICS Household Questionnaire

Thailand
Household Information Panel: HH

HH1. EA number from the MICS sample: _ _ _

HH1A. Household cluster (from listing)

HH2. Household number: _ _

HH3. Interviewer name and number

HH4. Supervisor name and number:

HH5. Day/month/year of interview

HH6. Administrative Area

HH7. Region

We are from the National Statistical Office. We are working on the 2012 Survey of Children and Women in Thailand. I would like to talk to you about these subjects. The interview will take about 20-25 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone. May I start now?

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

HH8. Name of household: ____

HH9. Result of household interview:

HH10. Name of Respondent

HH11. Total number of household members: _ _

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

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

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

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


HH14. Number of children under age 5: _ _

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

HH15A. Household cluster

HH18. Starting time of the interview (hours and minutes)

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, 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?

Code for HL3. Relationship to 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'
HL7. Copy ordinal no. from HL1
If woman is age 15-49 (for woman age 15-49)

HL8. Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (for children age 5-14.)
HL8A. What nationality is (name)?

HL8B. What type of public health welfare does (name) have?

HL9. Who is the mother or primary caretaker of this child?
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 number or 00 for no
HL14A. Where does the natural father of (name) live

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"
HL14A. Where does the natural father of (name) live

[] tick here is 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 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.

Education: ED

For household member age 5 and above [ED1 to ED4B]

ED1. Line number: _ _

ED2. Name and age
Copy from Household Listing Form, HL2 and HL6
ED3. Has (name) ever attended school or pre-school?

ED4A. What is the highest level of school (name) has attended?
If level=0, skip to ED5
ED4B. What is the highest grade (name) completed at this level?
If less than 1 grade, enter 00
For household members age 5-24 years [ED5 to ED8]

ED5. During the (2012) school year, did (name) attend school or preschool at any time?

ED6. During this/that school year, which level and grade is/was (name) attending?
If level=0, skip to ED5
ED7. During the previous school year, that is (May 2011 - Mar 2012), did (name) attend school or preschool at any time?

ED8. During that previous school year, which level and grade did (name) attend?
If level=0, skip to ED5
Water and Sanitation: WS

WS1. What is the main source of drinking water for 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 necessary, 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?

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 dwelling floor
Record observation
HC4. Main material of the roof
Record observations
HC5. Main material of the exterior walls.
Record observations
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?

C1. A television (plain monitor)?

C2. A television (LCD/LED/Plasma monitor)?

D. A non-mobile telephone?

E. A refrigerator?

F. An Electric Fan?

G. A washing machine?

H. An Oven/Microwave oven?

I. A Computer?

J. A Video player?

K. An Air conditioner?

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?

H. A Two-wheeled tractor?

I. A Four-wheeled tractor?

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

HC15A. Does any member of this household have a credit card?

Activities of the Child: CL

To be administered for children in the household age 5-14 years. For household members below age 5 or above age 14, leave rows blank.
Now I would like to ask about any work children in this household may do.

CL1. Line number: _ _

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

CL3. During the past week, 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. Since last (day of the week), 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 week, did (name) fetch water or collect firewood for household use?

CL6. Since last (day of the week), about how many hours did he/she fetch water or collect firewood for household use?

CL7. During the past week, did (name) do any paid or unpaid work on a family farm or in a family business or selling goods in the street?
Include work for a business run by the child, alone or with one or more partners.
CL8. Since last (day of the week), about how many hours did he/she do this work for his/her family or himself/herself?

CL9. During the past week, did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people?

CL10. Since last (day of the week), about how many hours did he/she spend doing these chores?

HH19. Ending time of interview

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. Result of the test using iodide reagent:

HH20. Thank the respondent for his/her cooperation and return to HH9-HH15A on the cover page to check:

Return to the cover page and make sure that all information is entered, including the number of eligible women (HH12), under-5s (HH14) and men (HH13A).
Interviewer's observations ________

Field editor's observations ________