MICS 6: Household Questionnaire
Thailand 2022
Household Information Panel: HH
HH1. Cluster number: _ _ _ _
HH2. Household number: _ _
HH3. Interviewer's name and number:
Name ____
Number _ _ _
Number _ _ _
HH4. Supervisor's name and number:
Name ____
Number _ _ _
Number _ _ _
HH5. Day/Month/Year of interview:
_ _/_ _ /2565
HH6. Area
[] 1 Municipality
[] 2 Non-municipality
[] 2 Non-municipality
HH7. Region
[] 1 Bangkok
[] 2 Central
[] 3 North
[] 4 Northeast
[] 5 South
[] 2 Central
[] 3 North
[] 4 Northeast
[] 5 South
HH7A. Province _ _
HH8. Is the household selected for questionnaire for men?
[] 1 Yes
[] 2 No
[] 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.
HH11. Record the time.
_ _ Hours
_ _ Minutes
_ _ Minutes
HH12. Hello, my name is (your name). We are from National Statistical Office. 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 25 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?
[] Yes (List of household members)
[] No/not asked (Go to HH46)
[] No/not asked (Go to HH46)
HH46. Result of household questionnaire interview:
Discuss any result not completed with supervisor.
[] 01 Completed
[] 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) ____
[] 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:
Name ____
Line number _ _
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 5-14: __ __
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: __ __
HH56. Children age 5-14
[] 0 Zero
[] 1 One
[] 1 One
List Of Household Members: HL
First complete HL2-HL4 vertically for all household members, starting with the head of the household. 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: ____
HL1. Line number: _ _
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.
Name: ____
HL3. What is the relationship of (name) to (name of the head of household)?
Relation: _ _
HL4. Is (name) male or female?
[] 1 Male
[] 2 Female
[] 2 Female
HL5. What is (name)'s date of birth?
Month: _ _
[] 98 DK
Year: _ _ _ _
[] 9998 DK
[] 98 DK
Year: _ _ _ _
[] 9998 DK
HL6. How old is (name)?
Record in completed years. If age is 95 or above, record "95".
Age _ _
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: _ _
HL11. Age 0-17?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
HL12. Is (name)"s natural mother alive?
[] 1 Yes
[] 2 No (Go to HL16)
[] 8 DK (Go to HL16)
[] 2 No (Go to HL16)
[] 8 DK (Go to HL16)
HL13. Does (name)'s natural mother live in this household?
[] 1 Yes
[] 2 No (Go to HL15)
[] 2 No (Go to HL15)
HL14. Record the line number of mother and go to HL16: _ _
HL15. Where does (name)'s natural mother live?
[] 1 Abroad
[] 2 In another household in the same region
[] 3 In another household in another region
[] 4 Institution in this country
[] 8 DK
[] 2 In another household in the same region
[] 3 In another household in another region
[] 4 Institution in this country
[] 8 DK
HL16. Is (name)'s natural father alive?
[] 1 Yes
[] 2 No (Go to HL20)
[] 8 DK (Go to HL20)
[] 2 No (Go to HL20)
[] 8 DK (Go to HL20)
HL17. Does (name)'s natural father live in this household?
[] 1 Yes
[] 2 No (go to HL19)
[] 2 No (go to HL19)
HL18. Record the line number of father and go to HL20: _ _
HL19. Where does (name)'s natural father live?
[] 1 Abroad
[] 2 In another household in the same region
[] 3 In another household in another region
[] 4 Institution in this country
[] 8 DK
[] 2 In another household in the same region
[] 3 In another household in another region
[] 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".
Number: _ _
HL21. Only if HL14 is blank and HL20 does not equal 90, probe: What is the relationship of the primary caregiver to (name)?
Relation: _ _
Code for HL3. Relationship to head of household
[] 01 Head
[] 02 Spouse/partner
[] 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
[] 02 Spouse/partner
[] 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
Codes for HL21. Relationship to primary caregiver:
[] 01 Father
[] 02 Paternal grandfather
[] 03 Paternal grandmother
[] 04 Maternal grandfather
[] 05 Maternal grandmother
[] 06 Uncle, parents' older brother
[] 07 Aunt, parents' older sister
[] 08 Mother's younger brother/sister
[] 09 Father's younger brother/sister
[] 10 Older brother/sister
[] 11 Other relative
[] 96 Other (not related)
[] 02 Paternal grandfather
[] 03 Paternal grandmother
[] 04 Maternal grandfather
[] 05 Maternal grandmother
[] 06 Uncle, parents' older brother
[] 07 Aunt, parents' older sister
[] 08 Mother's younger brother/sister
[] 09 Father's younger brother/sister
[] 10 Older brother/sister
[] 11 Other relative
[] 96 Other (not related)
Education 1: ED
ED1. Line number: _ _
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.
Name: ____
Age: _ _
Age: _ _
ED3. Age 3 or above?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
ED4. Has (name) ever attended school or any early childhood education programme?
If "No", probe: Has (name) ever attended remotely?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
ED5. What is the highest level and grade or year of school (name) has ever attended?
Level
[] 0 ECE (Go to ED7)
(See codes at the end of the module)
(See codes at the end of the module)
Grade/year:
[] 95. Non-formal DK
[] 98. DK (Go to ED7)
[] 98. DK (Go to ED7)
ED6. Did (name) ever complete that (grade/year)?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
ED7. Age 3-24?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
ED8. Check ED4: Ever attended school or ECE?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
Education 2: ED
ED1. Line number _ _
ED2. Name and age
Name: ____
Age: _ _
Age: _ _
ED9. At any time during the 2565-66 school year did (name) attend school or any early childhood education programme?
If "No", probe: Did (name) attend remotely during the 2565-66 school year?
[] 1 Yes
[] 2 No (Go to ED15)
[] 2 No (Go to ED15)
ED10. During the 2565-66 school year, which level and grade or year is (name) attending?
Level
[] 0 ECE (Go to ED15)
(See codes at the end of the module)
(See codes at the end of the module)
Grade/year:
[] 95. Non-formal DK
[] 98. DK
[] 98. DK
ED10C. If ED10 (Level) is recorded 01-03 only, probe: Is (name) attending formal school, NFE, or home school?
[] 1 Attending NFE
[] 2 Attending home school
[] 3 Not attending both form
[] 8 DK
[] 2 Attending home school
[] 3 Not attending both form
[] 8 DK
ED15. At any time during the 2564-65 school year did (name) attend school or any early childhood education programme?
If "No", probe: Did (name) attend remotely during the 2564-65 school year?
[] 1 Yes
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
ED16. During the 2564-65 school year, which level and grade or year did (name) attend?
Level
[] 0 ECE (Go to next line)
(See codes at the end of the module)
(See codes at the end of the module)
Grade/year:
[] 95. Non-formal DK
[] 98. DK
[] 98. DK
Household Characteristics: HC
HC1A. What is the religion of (name of the head of the household from HL2)?
[] 1 Buddhism
[] 2 Islam
[] 3 Christianity
[] 6 Other Religion (specify) ____
[] 7 No Religion
[] 2 Islam
[] 3 Christianity
[] 6 Other Religion (specify) ____
[] 7 No Religion
HC1B. What is the native language of (name of the head of the household from HL2)?
[] 1 Thai (including local dialects)
[] 2 English
[] 3 Chinese
[] 4 Burmese
[] 5 Khmer/Kuy
[] 6 Malay/Jawi
[] 7 Lao
[] 8 Karen
[] 9 Hmong
[] 10 Lahu
[] 11 Mon
[] 12 Lawa
[] 13 Akha
[] 14 Nyeu
[] 15 Shan
[] 96 Other language (specify) ____
[] 2 English
[] 3 Chinese
[] 4 Burmese
[] 5 Khmer/Kuy
[] 6 Malay/Jawi
[] 7 Lao
[] 8 Karen
[] 9 Hmong
[] 10 Lahu
[] 11 Mon
[] 12 Lawa
[] 13 Akha
[] 14 Nyeu
[] 15 Shan
[] 96 Other language (specify) ____
HC3. How many rooms do members of this household usually use for sleeping?
_ _ Number of rooms
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.
Natural floor
[] 11 Earth/sand
Rudimentary floor
[] 21 Wood planks
[] 22 Palm/bamboo
[] 22 Palm/bamboo
Finished Floor
[] 31 Parquet or polished wood
[] 32 Vinyl or asphalt strips
[] 33 Ceramic Tiles
[] 34 Cement
[] 35 Carpet
[] 36 Laminate/engineered wood
[] 37 Marble/polished/granite stone
[] 32 Vinyl or asphalt strips
[] 33 Ceramic Tiles
[] 34 Cement
[] 35 Carpet
[] 36 Laminate/engineered wood
[] 37 Marble/polished/granite stone
[] 96 Other (specify) ____
HC5. Main material of the roof.
Record observation.
Natural roofing
[] 12 Thatch (e.g. nipa palm/sugar palm/palm/coconut leaf)
[] 13 Sod (e.g. cogon grass/vetiver grass)
[] 13 Sod (e.g. cogon grass/vetiver grass)
Rudimentary roofing
[] 23 Wood planks
Finished roofing
[] 34 Ceramic tiles
[] 35 Cement
[] 37 Zinc
[] 38 Steel/metal sheet
[] 39 Aluminum/other metal
[] 35 Cement
[] 37 Zinc
[] 38 Steel/metal sheet
[] 39 Aluminum/other metal
[] 96 Other (specify) ____
HC6. Main material of the exterior walls.
Record observation.
Natural walls
[] 12 Trunks
Rudimentary walls
[] 21 Bamboo
[] 24 Plywood
[] 26 Reused Wood
[] 24 Plywood
[] 26 Reused Wood
Finished Walls
[] 31 Cement
[] 32 Stone with cement
[] 33 Bricks
[] 34 Cement blocks/block bricks
[] 36 Wood Planks
[] 37 Tin
[] 38 Gypsum board
[] 39 Artificial wood/fiber cement board
[] 40 Steel/metal sheet
[] 32 Stone with cement
[] 33 Bricks
[] 34 Cement blocks/block bricks
[] 36 Wood Planks
[] 37 Tin
[] 38 Gypsum board
[] 39 Artificial wood/fiber cement board
[] 40 Steel/metal sheet
[] 96 Other (specify) ____
HC7. Does your household have:
C. A bed?
[] 1 Yes
[] 2 No
[] 2 No
D. A dining table?
[] 1 Yes
[] 2 No
[] 2 No
E. A sofa/living room furniture set?
[] 1 Yes
[] 2 No
[] 2 No
F. A wardrobe?
[] 1 Yes
[] 2 No
[] 2 No
G. A showcase?
[] 1 Yes
[] 2 No
[] 2 No
H. A pantry cabinet?
[] 1 Yes
[] 2 No
[] 2 No
I. A water tank/big water jar?
[] 1 Yes
[] 2 No
[] 2 No
J. A charcoal stove?
[] 1 Yes
[] 2 No
[] 2 No
HC8. Does your household have electricity?
[] 1 Yes, Interconnected gird
[] 2 Yes, off-grid (generator/isolated system)
[] 3 No (Go to HC10)
[] 2 Yes, off-grid (generator/isolated system)
[] 3 No (Go to HC10)
HC9. Does your household have:
A. A plain television set?
[] 1 Yes
[] 2 No
[] 2 No
B. An LCD/LED/plasma monitor television?
[] 1 Yes
[] 2 No
[] 2 No
C. A one-door refrigerator?
[] 1 Yes
[] 2 No
[] 2 No
D. A two-door refrigerator?
[] 1 Yes
[] 2 No
[] 2 No
E. A multi-door refrigerator?
[] 1 Yes
[] 2 No
[] 2 No
F. A top-load washing machine?
[] 1 Yes
[] 2 No
[] 2 No
G. A front-load washing machine?
[] 1 Yes
[] 2 No
[] 2 No
H. A clothes dryer?
[] 1 Yes
[] 2 No
[] 2 No
I. An air conditioner?
[] 1 Yes
[] 2 No
[] 2 No
J. An air purifier?
[] 1 Yes
[] 2 No
[] 2 No
K. A microwave oven?
[] 1 Yes
[] 2 No
[] 2 No
L. A water heater in bathroom?
[] 1 Yes
[] 2 No
[] 2 No
M. An electric water pump?
[] 1 Yes
[] 2 No
[] 2 No
N. An air fryer/convection oven?
[] 1 Yes
[] 2 No
[] 2 No
HC10. Does any member of your household own:
A. A wristwatch?
[] 1 Yes
[] 2 No
[] 2 No
B. A bicycle?
[] 1 Yes
[] 2 No
[] 2 No
C. A motorcycle or scooter?
[] 1 Yes
[] 2 No
[] 2 No
E. A car, truck or van?
[] 1 Yes
[] 2 No
[] 2 No
F. A boat with a motor?
[] 1 Yes
[] 2 No
[] 2 No
G. A 2-wheel tractor (walking tractor)?
[] 1 Yes
[] 2 No
[] 2 No
H. A 4-wheel tractor?
[] 1 Yes
[] 2 No
[] 2 No
I. A large sized motorcycle (big bike)?
[] 1 Yes
[] 2 No
[] 2 No
HC11. Does any member of your household have a computer or a tablet?
[] 1 Yes
[] 2 No (Go to HC12)
[] 2 No (Go to HC12)
HC11A. What kind of computer or tablet does any member of your household have?
[] A Desktop computer
[] B Laptop
[] C Tablet
[] B Laptop
[] C Tablet
HC12. Does any member of your household have a mobile telephone?
[] 1 Yes
[] 2 No (Go to HC13)
[] 2 No (Go to HC13)
HC12A. What kind of mobile telephone does any member of your household have?
[] A Smartphone
[] B Keypad mobile phone
[] B Keypad mobile phone
HC13. Does your household have access to internet at home?
[] 1 Yes
[] 2 No
[] 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 "96" and specify.
[] 1 Own
[] 2 Rent
[] 3 Hire-purchase
[] 4 Belong to relative not in household
[] 5 Welfare from work
[] 6 Dwelling built on public land
[] 7 Dwelling built on rented land
[] 96 Other (specify) _____
[] 2 Rent
[] 3 Hire-purchase
[] 4 Belong to relative not in household
[] 5 Welfare from work
[] 6 Dwelling built on public land
[] 7 Dwelling built on rented land
[] 96 Other (specify) _____
HC15. Does any member of this household own any land that can be used for agriculture?
[] 1 Yes
[] 2 No (Go to HC17)
[] 2 No (Go to HC17)
HC16. How many rais of agricultural land do members of this household own?
If the area is less than one rais, record '00'. If 95 or more rais, record '95'. If unknown, record '98'. For more details on conversions, please refer to manual.
_ _ Area (rais)
HC17. Does this household own any livestock, herds, other farm animals, or poultry?
[] 1 Yes
[] 2 No (Go to HC19)
[] 2 No (Go to HC19)
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 or bulls?
Number: _ _
B. Buffaloes?
Number: _ _
C. Horses, donkeys or mules?
Number: _ _
D. Goats?
Number: _ _
E. Sheep?
Number: _ _
F. Chickens?
Number: _ _
G. Pigs?
Number: _ _
H. Ducks or geese?
Number: _ _
HC19. Does any member of this household have a bank account?
[] 1 Yes
[] 2 No
[] 2 No
HC20. Does any member of the household have a credit card?
[] 1 Yes
[] 2 No
[] 2 No
Social Transfers: ST
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)?
A. State welfare card
[] 1 Yes
[] 2 No (Go to B)
[] 2 No (Go to B)
B. Old age allowance
[] 1 Yes
[] 2 No (Go to C)
[] 2 No (Go to C)
C. Child support grant
[] 1 Yes
[] 2 No (Go to D)
[] 2 No (Go to D)
D. Any retirement pension
[] 1 Yes
[] 2 No (Go to E)
[] 2 No (Go to E)
E. Social security fund
[] 1 Yes
[] 2 No (Go to X)
[] 2 No (Go to X)
X. Any other external assistance programme
[] 1 Yes (specify) ____
[] 2 No (Go to next module)
[] 2 No (Go to next module)
ST3. Has your household or anyone in your household received assistance through (name of programme)?
A. State welfare card
[] 1 Yes (Go to ST4)
[] 2 No (Go to B)
[] 8 DK (Go to B)
[] 2 No (Go to B)
[] 8 DK (Go to B)
B. Old age allowance
[] 1 Yes (Go to ST4)
[] 2 No (Go to C)
[] 8 DK (Go to C)
[] 2 No (Go to C)
[] 8 DK (Go to C)
C. Child support grant
[] 1 Yes (Go to ST4)
[] 2 No (Go to D)
[] 8 DK (Go to D)
[] 2 No (Go to D)
[] 8 DK (Go to D)
D. Any retirement pension
[] 1 Yes (Go to ST4)
[] 2 No (Go to E)
[] 8 DK (Go to E)
[] 2 No (Go to E)
[] 8 DK (Go to E)
E. Social security fund
[] 1 Yes (Go to ST4)
[] 2 No (Go to X)
[] 8 DK (Go to X)
[] 2 No (Go to X)
[] 8 DK (Go to X)
X. Any other external assistance programme
[] 1 Yes (Go to ST4)
[] 2 No (Go to next module)
[] 8 DK (Go to next module)
[] 2 No (Go to next module)
[] 8 DK (Go to next 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.
A. State welfare card
[] 1 Months ago _ _ (Go to B)
[] 2 Years ago_ _ (Go to B)
[] 998 DK (Go to B)
[] 2 Years ago_ _ (Go to B)
[] 998 DK (Go to B)
B. Old age allowance
[] 1 Months ago _ _ (Go to C)
[] 2 Years ago_ _ (Go to C)
[] 998 DK (Go to C)
[] 2 Years ago_ _ (Go to C)
[] 998 DK (Go to C)
C. Child support grant
[] 1 Months ago _ _ (Go to D)
[] 2 Years ago_ _ (Go to D)
[] 998 DK (Go to D)
[] 2 Years ago_ _ (Go to D)
[] 998 DK (Go to D)
D. Any retirement pension
[] 1 Months ago _ _ (Go to E)
[] 2 Years ago_ _ (Go to E)
[] 998 DK (Go to X)
[] 2 Years ago_ _ (Go to E)
[] 998 DK (Go to X)
E. Social security fund
[] 1 Months ago _ _ (Go to X)
[] 2 Years ago_ _ (Go to X)
[] 998 DK (Go to X)
[] 2 Years ago_ _ (Go to X)
[] 998 DK (Go to X)
X. Any other external assistance programme
[] 1 Months ago _ _ (Go to next module)
[] 2 Years ago_ _ (Go to next module)
[] 998 DK (Go to next module)
[] 2 Years ago_ _ (Go to next module)
[] 998 DK (Go to next module)
Household Energy Use: EU
EU1. In your household, what type of cookstove is mainly used for cooking?
[] 01 Electric stove (Go to EU5)
[] 02 Solar cooker (Go to EU5)
[] 03 Liquefied petroleum gas (LPG)/cooking gas stove (Go to EU5)
[] 05 Biogas stove (Go to EU5)
[] 09 three stone stove/open fire (Go to EU4)
[] 10 Charcoal stove
[] 96 Other (specify)____ (Go to EU4)
[] 97 No food cooked in household (Go to EU9)
[] 02 Solar cooker (Go to EU5)
[] 03 Liquefied petroleum gas (LPG)/cooking gas stove (Go to EU5)
[] 05 Biogas stove (Go to EU5)
[] 09 three stone stove/open fire (Go to EU4)
[] 10 Charcoal stove
[] 96 Other (specify)____ (Go to EU4)
[] 97 No food cooked in household (Go to EU9)
EU2. Does it have a chimney?
[] 1 Yes
[] 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.
[] 01 Alcohol/ethanol
[] 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) ____
[] 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.
In main house
[] 01 No separate room
[] 02 In a separate room
[] 03 In a separate building
[] 02 In a separate room
[] 03 In a separate building
Outdoors
[] 04 Open air
[] 05 On veranda or covered porch
[] 05 On veranda or covered porch
[] 06 Other (specify) ____
EU9. At night, what does your household mainly use to light the household?
[] 1 Electricity
[] 2 Solar lantern
[] 3 Rechargeable flashlight, torch or lantern
[] 4 Battery powered flashlight, torch or lantern
[] 5 Biogas lamp
[] 6 Gasoline lamp
[] 7 Kerosene or paraffin lamp
[] 8 Charcoal
[] 9 Wood
[] 10 Crop residue/grass/straw/shrubs
[] 11 Animal dung/waste
[] 13 Candle
[] 96 Other (specify) ____
[] 97 No lighting in 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 or paraffin lamp
[] 8 Charcoal
[] 9 Wood
[] 10 Crop residue/grass/straw/shrubs
[] 11 Animal dung/waste
[] 13 Candle
[] 96 Other (specify) ____
[] 97 No lighting in household
Water and sanitation: WS
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).
Piped water
[] 11 Piped into dwelling (Go to WS7)
[] 12 Piped to yard/plot (Go to WS7)
[] 13 Piped to neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole (Go to WS3)
[] 12 Piped to yard/plot (Go to WS7)
[] 13 Piped to neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole (Go to WS3)
Dug well
[] 31 Protected well (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 51 Rainwater (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
Packaged water
[] 91 Bottled water
[] 93 Packaged water: gallon sized water
[] 94 Packaged water: glass/cup water
[] 95 Coin-operated water dispenser
[] 93 Packaged water: gallon sized water
[] 94 Packaged water: glass/cup water
[] 95 Coin-operated water dispenser
[] 96 Other (specify) ____ (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.
Piped water
[] 11 Piped into dwelling (Go to WS7)
[] 12 Piped to yard/plot (Go to WS7)
[] 13 Piped to neighbour
[] 14 Public tap/standpipe
[] 21 Tube well/borehole
[] 12 Piped to yard/plot (Go to WS7)
[] 13 Piped to neighbour
[] 14 Public tap/standpipe
[] 21 Tube well/borehole
Dug well
[] 31 Protected well
[] 32 Unprotected well
[] 32 Unprotected well
[] 51 Rainwater
[] 61 Tanker-truck (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel)
[] 61 Tanker-truck (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel)
[] 96 Other (specify) ____
WS3. Where is that water source located?
[] 1 In own dwelling (Go to WS7)
[] 2 In own yard/plot (Go to WS7)
[] 3 Elsewhere
[] 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?
[] 000 Members do not collect (go to WS7)
_ _ _Number of minutes
[] 998 DK
_ _ _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.
Name: ____
Line number: _ _
Line number: _ _
WS6. Since last (day of the week), how many times has this person collected water?
Number of times: _ _
[] 98 DK
[] 98 DK
WS7. In the last month, has there been any time when your household did not have sufficient quantities of drinking water?
[] 1 Yes, at least once
[] 2 No, always sufficient (Go to WS9)
[] 8 DK (Go to WS9)
[] 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?
[] 1 Water not available from source
[] 2 Water too expensive
[] 3 Source not accessible
[] 6 Other (specify) ____
[] 8 DK
[] 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?
[] 1 Yes
[] 2 No (Go to WS11)
[] 8 DK (Go to WS11)
[] 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.
[] A Boil
[] 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
[] 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.
Flush/pour flush
[] 11 Flush to piped sewer system (go to WS14)
[] 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)
[] 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)
Pit latrine
[] 21 Ventilated improved pit latrine
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 95 No facility/bush/field (Go to next module)
[] 96 Other (specify) ____ (Go to WS14)
[] 96 Other (specify) ____ (Go to WS14)
WS12. Has your (answer from WS11) ever been emptied?
[] 1 Yes, emptied
[] 4 No, never emptied (Go to WS14)
[] 8 DK (Go to WS14)
[] 4 No, never emptied (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?
Removed by service provider
[] 1 To a treatment plant
[] 2 Buried in a covered pit
[] 3 To don't know where
[] 2 Buried in a covered pit
[] 3 To don't know where
Emptied by household
[] 4 Buried in a covered pit
[] 5 To uncovered pit, open ground, water body or elsewhere
[] 6 Other (specify) ____
[] 8 DK
[] 5 To uncovered pit, open ground, water body or elsewhere
[] 6 Other (specify) ____
[] 8 DK
WS14. Where is this toilet facility located?
[] 1 In own dwelling
[] 2 In own yard/plot
[] 3 Elsewhere
[] 2 In own yard/plot
[] 3 Elsewhere
WS15. Do you share this facility with others who are not members of your household?
[] 1 Yes
[] 2 No (Go to next module)
[] 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?
[] 1 Shared with known households (not public)
[] 2 Shared with general public (Go to next module)
[] 2 Shared with general public (Go to next module)
WS17. How many households in total use this toilet facility, including your own household?
0 _ Number of households (if less than 10)
[] 10 Ten or more households
[] 98 DK
[] 10 Ten or more households
[] 98 DK
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?
Record result and observation.
Observed
[] 1 Fixed facility observed (sink/tap) in dwelling
[] 2 Fixed facility observed (sink/tap) in yard /plot
[] 3 Mobile object observed (bucket/jug/kettle)
[] 2 Fixed facility observed (sink/tap) in yard /plot
[] 3 Mobile object observed (bucket/jug/kettle)
Not observed
[] 4 No handwashing place in dwelling/yard/plot (Go to HW5)
[] 5 No permission to see (Go to HW4)
[] 5 No permission to see (Go to HW4)
[] 6 Other reason (specify) ____(Go to HW5)
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.
[] 1 Water is available
[] 2 Water is not available
[] 2 Water is not available
HW3. Is soap or detergent or dishwashing liquid present at the place for handwashing?
[] 1 Yes, present (Go to HW7)
[] 2 No, not present (Go to HW5)
[] 2 No, not present (Go to HW5)
HW4. Where do you or other members of your household most often wash your hands?
Fixed facility (sink/tap)
[] 1 In dwelling
[] 2 In yard/plot
[] 2 In yard/plot
[] 3 Mobile object (bucket/jug/kettle)
[] 4 No handwashing place in dwelling/yard/plot
[] 6 Other (specify) ____
[] 4 No handwashing place in dwelling/yard/plot
[] 6 Other (specify) ____
HW5. Do you have any soap or detergent or dishwashing liquid in your house for washing hands?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
HW6. Can you please show it to me?
[] 1 Yes, shown
[] 2 No, not shown (Go to next module)
[] 2 No, not shown (Go to next module)
HW7. Record your observation.
Record all that apply.
[] A Bar or liquid soap
[] B Detergent
[] D Dishwashing liquid
[] B Detergent
[] D Dishwashing liquid
HH13. Record the time.
Hour and minutes: _ _:_ _
HH14. Language of the Questionnaire.
[] 1 Thai
[] 2 English
[] 2 English
HH15. Language of the Interview.
[] 1 Thai
[] 2 English
[] 6 Other language (specify) ____
[] 2 English
[] 6 Other language (specify) ____
HH16. Native language of the Respondent.
[] 1 Thai
[] 2 English
[] 3 Chinese
[] 4 Burmese
[] 5 Khmer/Kuy
[] 6 Malay/Jawi
[] 7 Lao
[] 8 Karen
[] 9 Hmong
[] 10 Lahu
[] 11 Mon
[] 12 Lawa
[] 13 Akha
[] 14 Nyeu
[] 15 Shan
[] 96 Other language (specify) ____
[] 2 English
[] 3 Chinese
[] 4 Burmese
[] 5 Khmer/Kuy
[] 6 Malay/Jawi
[] 7 Lao
[] 8 Karen
[] 9 Hmong
[] 10 Lahu
[] 11 Mon
[] 12 Lawa
[] 13 Akha
[] 14 Nyeu
[] 15 Shan
[] 96 Other language (specify) ____
HH17. Was a translator used for any parts of this questionnaire?
[] 1 Yes, entire questionnaire
[] 2 Yes, part of questionnaire
[] 3 No, not used
[] 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 5-14 years:
[] 0 No children (Go to HH29)
[] 1 1 child (Go to HH27)
2 or more children (number): _
[] 1 1 child (Go to HH27)
2 or more children (number): _
HH19. List each of the children age 5-14 years below in the order they appear in the list of household members. Do not include other household members outside of the age range 5-14 years. Record the line number, name, sex, and age for each child.
HH20. Rank number: _
HH21. Line number from HL1: _ _
HH22. Name from HL2: ____
HH23. Sex from HL4
[] 1 Male
[] 2 Female
[] 2 Female
HH24. Age from HL6: _ _
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 5-14 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.
Last digit of household number (from HH2): _
Total number of eligible children in the household (from HH18): _
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.
Rank number: _
Line number: _ _
Name: ____
Age: _ _
Line number: _ _
Name: ____
Age: _ _
HH27. (When HH18=1 or when there is a single child age 5-14 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.
Rank Number: _
Line Number: _ _
Name: ____
Age: _ _
Line Number: _ _
Name: ____
Age: _ _
HH28. Issue a questionnaire for children age 5-14 to be administered to the mother/caretaker of this child.
HH29. Check HL8 in the list of household members: Are there any women age 15-49?
[] 1 Yes, at least one woman age 15-49
[] 2 No (Go to HH34)
[] 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?
[] 1 Yes, at least one girl age 15-17
[] 2 No (Go to HH34)
[] 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?
[] 1 Yes, at least one girl age 15-17 with HL20 does not equal 90
[] 2 No, HL20 does not equal 90 for all girls age 15-17 (Go to HH34)
[] 2 No, HL20 does not 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?
[] "Yes" for all girls age 15-17. Continue with HH34.
[] "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.
[] "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?
[] 1 Yes, HH8=1
[] 2 No, HH8=2 (Go to HH40)
[] 2 No, HH8=2 (Go to HH40)
HH35. Check HL9 in the "List of household members": Are there any men age 15-49?
[] 1 Yes at least one man age 15-49
[] 2 No (Go to HH40)
[] 2 No (Go to HH40)
HH36. Issue a separate questionnaire for individual men for each man age 15-49 years.
HH37. Check HL6 and HL9 in the list of household members: Are there any boys age 15-17?
[] 1 Yes, at least one boy age 15-17
[] 2 No (Go to HH40)
[] 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?
[] 1 Yes at least one boy age 15-17 with HL20 does not equal 90
[] 2 No, HL20 does not equal 90 for all boys age 15-17 (Go to HH40)
[] 2 No, HL20 does not 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?
[] "Yes" for all boys age 15-17. Continue with HH40.
[] "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.
[] "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.
HH40. Check HL10 in the "List of household members": Are there any children age 0-4?
[] 1 Yes, at least one
[] 2 No (Go to HH60)
[] 2 No (Go to HH60)
HH41. Issue a separate questionnaire for children under five for each child age 0-4 years.
MICS plus consent
HH60. We may call you back to talk about you and your family in the coming months. This call will take about 10-15 minutes. Again, all the information you provide will be confidential and anonymous. Would you like to participate?
[] 1 Yes
[] 2 No (Go to HH66)
[] 2 No (Go to HH66)
HH61. Please give me all phone numbers at which we can easily get in touch with you, starting with your preferred number.
If ?No?, Ask, Can we reach you through somebody else?s phone number?
[] 1 Yes
[] 2 No phone (Go to HH66)
[] 2 No phone (Go to HH66)
HH62. Order: _
HH63. Telephone number: ____
HH63A. Is this landline or mobile
[] 1 Landline
[] 2 Mobile
[] 2 Mobile
HH63B. Who does this phone belong to?
Record the line number
Line number _ _
HH64. Is there any preferred or more convenient time of the day we could call you on this number?
[] A Mornings
[] B Afternoon
[] C Evenings
[] D Weekends
[] E Anytime
[] X Other (specify ____)
[] B Afternoon
[] C Evenings
[] D Weekends
[] E Anytime
[] X Other (specify ____)
HH65. Do you have another phone number?
[] 1 Yes (Go to next line)
[] 2 No (Go to HH66)
[] 2 No (Go to HH66)
Other codes for HH63B:
[] 40 Home phone
[] 50 Neighbour
[] 51 Friend
[] 60 Workplace/office
[] 90 Don't want to disclose
[] 50 Neighbour
[] 51 Friend
[] 60 Workplace/office
[] 90 Don't want to disclose
HH66. Check HH33: Is there any female(s) age 15-17 that consent was sought and ?Yes? response was received from this respondent?
[] 1 Yes, consent was given
[] 2 No, no female age 15-17 or consent not given (Go to HH68)
[] 2 No, no female age 15-17 or consent not given (Go to HH68)
HH67. For the same project, may we contact (name) in the coming months?
[] 1 'Yes' for all girls age 15-17
[] 2 'No' for at least one girl age 15-17 and 'Yes' to at least one girl age 15-17
[] 3 'No' to all girls age 15-17
[] 2 'No' for at least one girl age 15-17 and 'Yes' to at least one girl age 15-17
[] 3 'No' to all girls age 15-17
HH68. Check HH39: Is there any male(s) age 15-17 that consent was sought and ?Yes? response was received from this respondent?
[] 1 Yes, consent was given
[] 2 No, no male age 15-17 or consent not given (Go to HH70)
[] 2 No, no male age 15-17 or consent not given (Go to HH70)
HH69. For the same project, may we contact (name) in the coming months?
[] 1 'Yes' for all boys age 15-17
[] 2 'No' for at least one boy age 15-17 and 'Yes' to at least one boy age 15-17
[] 3 'No' to all boys age 15-17
[] 2 'No' for at least one boy age 15-17 and 'Yes' to at least one boy age 15-17
[] 3 'No' to all boys age 15-17
HH70. 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 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.
Interviewer's Observations ________
Supervisor's Observations ________