MICS-6
Questionnaire for children age 5-17
5-17 Child information panel: FS
FS3. Child's name and line number:
FS4. Mother's/caretaker's name and line number:
FS5. Interviewer's name and number:
FS6. Supervisor's name and number:
FS7. Day/month/year of interview
Check respondent's age in HL6 in list of household members, household questionnaire:
If age 15-17, verify that adult consent for interview is obtained (HH33 or HH39) or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in FS17. The respondent must be at least 15 years old. In the very few cases where a child age 15-17 has no mother or caretaker identified in the household (HL20=90), the respondent will be the child him/herself.
FS9. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?
[] 2 No, first interview (Go to FS10A)
FS10A. 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 (child's name from FS3)'s health and well-being. This interview will take about 15 minutes. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
FS10B. Now I would like to talk to you about (child's name from FS3)'s health and well-being in more detail. This interview will take about 15 minutes. Again, all the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
[] 2 No/not asked (Go to FS17)
FS17. Result of interview for child age 5-17 years
Codes refer to the respondent. Discuss any result not completed with Supervisor.
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for mother/caretaker age 15-17
[] 96 Other (specify) ____
CB1. Check the respondent's line number (FS4) in 5-17 child information panel and the respondent to the household questionnaire (HH47):
[] 2 FS4 does not equal HH47
CB2. In what month and year was (name) born?
Month and year must be recorded.
_ _ _ _ Year
CB3. How old is (name)?
Probe: How old was (name) at (his/her) last birthday? Record age in completed years. If responses to CB2 and CB3 are inconsistent, probe further and correct.
CB4. Has (name) ever attended preschool (e.g. le koutteb, le jardin d?enfant)?
[] 2 No (Go to CB11)
CB5. What is the highest level and grade or year of school (name) has ever attended?
[] 1 Primary / premier cycle de l?enseignement de base _ _
[] 2 College/ deuxieme cycle de l?enseignement de base _ _
[] 3 Secondary _ _
[] 4 Higher _ _
[] 5 Trade school _ _
[] 6 Professional training CAP _ _
[] 7 Professional training BTP _ _
[] 8 Professional training BTS _ _
[] 9 Professional training _ _
CB6. Did (he/she) ever complete that (grade/year)?
[] 2 No
CB7. At any time during the 2017-2018 school year did (name) attend school or any early childhood education programme?
[] 2 No (Go to CB9)
CB8. During this 2017-2018 school year, which level and grade or year is (name) attending?
[] 1 Primary / premier cycle de l?enseignement de base _ _
[] 2 College/ deuxieme cycle de l?enseignement de base _ _
[] 3 Secondary _ _
[] 4 Higher _ _
[] 5 Trade school _ _
[] 6 Professional training CAP _ _
[] 7 Professional training BTP _ _
[] 8 Professional training BTS _ _
[] 9 Professional training _ _
CB9. At any time during the 2016-2017 school year did (name) attend school or any early childhood education programme?
[] 2 No (Go to CB11)
CB10. During that 2016-2017 school year, which level and grade or year did (name) attend?
[] 1 Primary / premier cycle de l?enseignement de base _ _
[] 2 College/ deuxieme cycle de l?enseignement de base _ _
[] 3 Secondary _ _
[] 4 Higher _ _
[] 5 Trade school _ _
[] 6 Professional training CAP _ _
[] 7 Professional training BTP _ _
[] 8 Professional training BTS _ _
[] 9 Professional training _ _
CB11. Is (name) covered by any health insurance?
[] 2 No (Go to end)
CB12. What type of health insurance is (name) covered by?
Record all mentioned.
[] D Private insurance
[] E Free public healthcare (white notebook/booklet)
[] F Healthcare at a reduced price (yellow notebook/booklet)
[] X Other (specify) ____
[] 2 Age 15-17 years (Go to end of module)
FCD2. Now I'd like to talk to you about something else.
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 any other adult 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.
[] 2 No
B. Explained why (name)'s behaviour was wrong.
[] 2 No
[] 2 No
D. Shouted, yelled at or screamed at (him/her).
[] 2 No
E. Gave (him/her) something else to do.
[] 2 No
F. Spanked, hit or slapped (him/her) on the bottom with bare hand.
[] 2 No
G. Hit (him/her) on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.
[] 2 No
H. Called (him/her) dumb, lazy or another name like that.
[] 2 No
I. Hit or slapped (him/her) on the face, head or ears.
[] 2 No
J. Hit or slapped (him/her) on the hand, arm, or leg.
[] 2 No
K. Beat (him/her) up, that is hit him/her over and over as hard as one could.
[] 2 No
FCD3. Check FS4: Is this respondent the mother or caretaker of any other children under age 5?
[] 2 No (Go to FCD5)
FCD4. Check FS4: Has this respondent already responded to the following question (UCD5) for another child?
[] 2 No
FCD5. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?
[] 2 No
[] 8 DK/no opinion
FCF1. I would like to ask you some questions about difficulties (name) may have. Does (name) wear glasses or contact lenses?
[] 2 No
FCF2. Does (name) use a hearing aid?
[] 2 No
FCF3. Does (name) use any equipment or receive assistance for walking?
[] 2 No
FCF4. In the following questions, I will ask you to answer by selecting one of four possible answers. For each question, would you say that (name) has: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (he/she) cannot at all.
Remember the four possible answers: Would you say that (name) has: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that (he/she) cannot at all?
FCF5. Check FCF1: Child wears glasses or contact lenses?
[] 2 No, FCF1=2 (Go to FCF6B)
FCF6A. When wearing (his/her) glasses or contact lenses, does (name) have difficulty seeing?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
FCF6B. Does (name) have difficulty seeing?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
FCF7. Check FCF2: Child uses a hearing aid?
[] 2 No, FCF2=2 (Go to FCF8B)
FCF8A. When using (his/her) hearing aid(s), does (name) have difficulty hearing sounds like peoples' voices or music?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
FCF8B. Does (name) have difficulty hearing sounds like peoples' voices or music?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
FCF9. Check FCF3: Child uses equipment or receives assistance for walking?
[] 2 No, FCF3=2 (Go to FCF14)
FCF10. Without (his/her) equipment or assistance, does (name) have difficulty walking 100 meters on level ground?
Probe: That would be about the length of 1 football field. Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 3 A lot of difficulty (Go to FCF12)
[] 4 Cannot walk 100 M at all (Go to FCF12)
FCF11. Without (his/her) equipment or assistance, does (name) have difficulty walking 500 meters on level ground?
Probe: That would be about the length of 5 football fields. Note that category 'No difficulty' is not available, as the child uses equipment or receives assistance for walking.
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
FCF12. With (his/her) equipment or assistance, does (name) have difficulty walking 100 meters on level ground?
Probe: That would be about the length of 1 football field.
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
FCF13. With (his/her) equipment or assistance, does (name) have difficulty walking 500 meters on level ground?
Probe: That would be about the length of 5 football fields.
[] 2 Some difficulty (Go to FCF16)
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 500 M at all (Go to FCF16)
FCF14. Compared with children of the same age, does (name) have difficulty walking 100 meters on level ground?
Probe: That would be about the length of 1 football field.
[] 2 Some difficulty
[] 3 A lot of difficulty (Go to FCF16)
[] 4 Cannot walk 100 M at all (Go to FCF16)
FCF15. Compared with children of the same age, does (name) have difficulty walking 500 meters on level ground?
Probe: That would be about the length of 5 football fields.
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk 500 M at all
FCF16. Does (name) have difficulty with self-care such as feeding or dressing (himself/herself)?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all
FCF17. When (name) speaks, does (he/she) have difficulty being understood by people inside of this household?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
FCF18. When (name) speaks, does (he/she) have difficulty being understood by people outside of this household?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot be understood at all
FCF19. Compared with children of the same age, does (name) have difficulty learning things?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot learn things at all
FCF20. Compared with children of the same age, does (name) have difficulty remembering things?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember things at all
FCF21. Does (name) have difficulty concentrating on an activity that (he/she) enjoys doing?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot concentrate at all
FCF22. Does (name) have difficulty accepting changes in (his/her) routine?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot accept changes at all
FCF23. Compared with children of the same age, does (name) have difficulty controlling (his/her) behaviour?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot control behaviour at all
FCF24. Does (name) have difficulty making friends?
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot make friends at all
FCF25. The next questions have different options for answers. I am going to read these to you after each question.
I would like to know how often (name) seems very anxious, nervous or worried.
Would you say: daily, weekly, monthly, a few times a year or never?
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
FCF26. I would also like to know how often (name) seems very sad or depressed.
Would you say: daily, weekly, monthly, a few times a year or never?
[] 2 Weekly
[] 3 Monthly
[] 4 A few times a year
[] 5 Never
[] 2 Age 7-14 years
[] 3 Age 15-17 years (Go to end of module)
PR2. At the end of this interview I will ask you if I can talk to (name). If (he/she) is close, can you please ask (him/her) to stay here. If (name) is not with you at the moment could I ask that you now arrange for (him/her) to return? If that is not possible, we will later discuss a convenient time for me to call back.
PR3. Excluding school text books and holy books, how many books do you have for (name) to read at home?
[] 0 Number of books _
[] 10 Ten or more books
PR4. Check CB7: Did the child attend any school?
[] 2 No, CB7/ED9=2 or blank (Go to end of module)
PR5. Does (name) ever have homework?
[] 2 No (Go to PR7)
[] 8 DK (Go to PR7)
PR6. Does anyone help (name) with homework?
[] 2 No
[] 8 DK
PR7. Does (name)'s school have a school governing body in which parents can participate such as Comité de parents d?élèves (COPA) or Conseil de gestion de l?école (COGES)?
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
PR8. In the last 12 months, have you or any other adult from your household attended a meeting called by this school governing body?
[] 2 No (Go to PR10)
[] 8 DK (Go to PR10)
PR9. During any of these meetings, was any of the following discussed:
A. A plan for addressing key education issues faced by (name)'s school?
[] 2 No
[] 8 DK
B. School budget or use of funds received by (name)'s school?
[] 2 No
[] 8 DK
PR10. In the last 12 months, have you or any other adult from your household received a school or student report card for (name)?
[] 2 No
[] 8 DK
PR11. In the last 12 months, have you or any adult from your household gone to (name)'s school for any of the following reasons?
A. A school celebration or a sport event?
[] 2 No
[] 8 DK
B. To discuss (name)'s progress with (his/her) teachers?
[] 2 No
[] 8 DK
PR12. In the last 12 months, has (name)'s school been closed on a school day due to any of the following reasons:
A. Natural disasters, such as flood, cyclone, epidemics or similar?
[] 2 No
[] 8 DK
B. Man-made disasters, such as fire, building collapse, riots or similar?
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PR13. In the last 12 months, was (name) unable to attend class due to (his/her) teacher being absent?
[] 2 No
[] 8 DK
PR14. Check PR12[C] and PR13: Any 'Yes' recorded?
[] 2 No (Go to end)
PR15. When (teacher strike / teacher absence) happened did you or any other adult member of your household contact any school officials or school governing body representatives?
[] 2 No
[] 8 DK
FM10. Verify from CB3 the age of the child:
[] 2 7-14 years old
[] 3 15-17 years old(Go to end)
FMT4. Have you ever used a computer or tablet - regardless of the place where you used it?
[] 2 No(Go to end)
FMT5. During the last three months, have you used a computer or tablet at least one time per week, less that one time per week, or not at all?
If at least one time per week, insist: Would you say that you use the computer/tablet almost every day?
If yes, record 3. If no, record 2
[] 1 Less than one time per week
[] 2 More than one time per week
[] 3 Almost every day
Foundational learning skills: FL
[] 2 Age 7-14 years
[] 3 Age 15-17 (Go to end)
FL1. Now I would like to talk to (name). I will ask (him/her) a few questions about (himself/herself) and about reading, and then ask (him/her) to complete a few reading and number activities. These are not school tests and the results will not be shared with anyone, including other parents or the school. You will not benefit directly from participating and I am not trained to tell you how well (name) has performed. The activities are to help us find out how well children in this country are learning to read and to use numbers so that improvements can be made. This will take about 20 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.
[] 2 No, permission is not given (Go to FL28)
FL3. My name is (your name). I would like to tell you a bit about myself.
Could you tell me a little bit about yourself?
When the child is comfortable, continue with the verbal consent:
Let me tell you why I am here today. I am from [National Statistical Office]. I am part of a team trying to find out how children are learning to read and to use numbers. We are also talking to some of the children about this and asking them to do some reading and number activities. [Your mother/Name of caretaker] has said that you can decide if you want to help us. If you wish to help us, I will ask you some questions and give you some activities to do. I will explain each activity, and you can ask me questions any time. You do not have to do anything that you do not want to do. After we begin, if you do not want to answer a question or you do not want to continue that is alright.
[] 2 No/not asked (Go to FL28)
FL4. Before you start with the reading and number activities, tick each box to show that:
[] You have engaged the child in conversation and built rapport, e.g. using an Icebreaker.
[] The child is sat comfortably, able to use the reading and numbers book without difficulty while you can see which page is open.
FL5. Remember you can ask me a question at any time if there is something you do not understand. You can ask me to stop at any time.
FL6. First we are going to talk about reading.
[] 2 No
B. Does someone read to you at home?
[] 2 No
FL7. Which language do you speak most of the time at home?
Probe if necessary and read the listed languages.
[] 2 Arabic
[] 6 Other (specify) ____
[] 8 DK
FL8. Check CB7: In the current school year, did the child attend school or any early childhood education programme?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 2 No, CB7/ED9=2 or blank
FL8B. Check FL7: Is reading and numbers book available in the language spoken at home?
[] 2 No, FL7=6 or 8 (Go to FL23)
FL9A. What language do your teachers use most of the time when teaching you in class?
[] 2 Arabic (Go to FL10A)
[] 6 Other (specify) ____ (Go to FL23)
[] 8 DK (Go to FL23)
FL9B. When you were in school, what language did your teachers use most of the time when teaching you in class?
Probe if necessary and name the listed languages.
[] 2 Language 2 (Go to FL10A)
[] 3 Language 3 (Go to FL10A)
[] 6 Other (specify) ____ (Go to FL23)
[] 8 DK (Go to FL23)
FL10A. Now I am going to give you a short story to read in (Language recorded in FL9A/B). Would you like to start reading the story?
[] 2 No (Go to FL23)
FL10B. Now I am going to give you a short story to read in (Language recorded in FL7). Would you like to start reading the story?
[] 2 No (Go to FL23)
[] 2 Age 10-14 years
FL12. Check CB7: In the current school year, did the child attend school or any early childhood education programme?
Check ED9 in the education module in the household questionnaire for child if CB7 was not asked.
[] 2 No, CB7/ED9=2 or blank
FL13. Give the child the reading and numbers book.
Open the page showing the reading practice item and say:
Now we are going to do some reading. Point to the sentence. I would like you to read this aloud. Then I may ask you a question.
Sam is a boy. Tina is a girl. Sam is 5. Tina is 6.
FL14. Did the child read every word in the practice correctly?
[] 2 No
FL15. Once the reading is done, ask: How old is Sam?
[] 2 Other answers
[] 3 No answer after 5 seconds
FL16. Say: Sam is 5 years old. (Go to FL23)
FL17. Here is another question: Who is older: Sam or Tina?
[] 2 Other answers
[] 3 No answer after 5 seconds
FL18. Say: Tina is older than Sam. Tina is 6 and Sam is 5. (Go to FL23)
FL19. Turn the page to reveal the reading passage. Thank you. Now I want you to try this. Here is a story. I want you to read it aloud as carefully as you can. You will start here (point to the first word on the first line) and you will read line by line (point to the direction for reading each line). When you finish I will ask you some questions about what you have read. If you come to a word you do not know, go onto the next word. Put your finger on the first word. Ready? Begin.
[IPUMS Note: See the form for the French language story. ]
FL20. Results of the child's reading.
_ _ Total number of words incorrect or missed number
FL21. How well did the child read the story?
[] 2 The child did not read any word correctly (Go to FL23)
[] 3 The child did not try to read the story (Go to FL23)
FL22. Now I am going to ask you a few questions about what you have read.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark 'No response' and say: Thank you. That is ok. We will move on.
Make sure the child can still see the passage and ask:
[] 2 Incorrect
[] 3 No response/says 'I don't know'
B. What did Madani see on the way home?
[] 2 Incorrect
[] 3 No response/says 'I don't know'
C. Why did Madani start crying?
[] 2 Incorrect
[] 3 No response/says 'I don't know'
D. Where did Madani fall (down)?
[] 2 Incorrect
[] 3 No response/says 'I don't know'
[] 2 Incorrect
[] 3 No response/says 'I don't know'
FL23. Turn the page in the reading and numbers book so the child is looking at the list of numbers. Make sure the child is looking at this page.
Now here are some numbers. I want you to point to each number and tell me what the number is.
Point to the first number and say: Start here.
If the child stops on a number for a while, tell the child what the number is, mark the number as 'No Attempt', point to the next number and say: What is this number?
Stop rule - If the child does not attempt to read 2 consecutive numbers, say: Thank you. That is ok.
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
[] 2 Incorrect
[] 3 No attempt
FL24. Turn the page so the child is looking at the first pair of numbers. Make sure the child is looking at this page. Say:Look at these numbers. Tell me which one is bigger.
Record the child's answer before turning the page in the book and repeating the question for the next pair of numbers.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark a 'Z' for the answer on the appropriate row on the questionnaire, turn the booklet page and show the child the next pair of numbers.
If the child does not attempt 2 consecutive pairs, say: Thank you. That is ok. We will go to the next activity.
FL25. Give the child a pencil and paper. Turn the page so the child is looking at the first addition. Make sure the child is looking at this page. Say: Look at this sum. How much is (number plus number)? Tell me the answer. You can use the pencil and paper if it helps you.
Record the child's answer before turning the page in the book and repeating the question for the next sum.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark a 'Z' for the answer on the appropriate row on the questionnaire, turn the booklet page and show the child the next addition.
If the child does not attempt 2 consecutive pairs, say: Thank you. That is ok. We will go to the next activity.
FL26. Turn the page to the practice sheet for missing numbers. Say: Here are some numbers. 1, 2, and 4. What number goes here?
If the child answers correctly say: That's correct, 3. Let's do another one.
If the child answers incorrectly, do not explain the child how to get the correct answer. Just say:
The number 3 goes here. Say the numbers with me. (Point to each number) 1, 2, 3, 4. 3 goes here. Let's do another one.
Now turn the page to the next practice sheet. Say: Here are some more numbers. 5, 10, 15 and ___. What number goes here?
If the child answers correctly say: That's correct, 20. Now I want you to try this on your own
If the child answers incorrectly say: The number 20 goes here. Say the numbers with me. (Point to each number) 5, 10, 15, 20. 20 goes here. Now I want you to try this on your own.
FL27. Now turn the page in the reading and numbers book with the first missing number activity. Say: Here are some more numbers. Tell me what number goes here (pointing to the missing number).
Record the child's answer before turning the page in the book and repeating the question.
If the child does not provide a response after a few seconds, repeat the question. If the child seems unable to provide an answer after repeating the question, mark a 'Z' for the answer on the appropriate row on the questionnaire.
If the child does not attempt 2 consecutive activities, say: Thank you. That is ok.
FL28. Result of interview with child.
Discuss any result not completed with Supervisor.
[] 02 Not at home
[] 03 Mother/caretaker refused
[] 04 Child refused
[] 05 Partly completed
[] 06 Incapacitated
[] 96 Other (specify) ____
FS12. Language of the Questionnaire.
[] 2 Arabic
FS13. Language of the Interview.
[] 2 Arabic
[] 6 Other language (specify) ____
FS14. Native language of the Respondent.
[] 2 Arabic
[] 6 Other language (specify) ____
FS15. Was a translator used for any parts of this questionnaire?
[] 2 Yes, parts of the questionnaire
[] 3 No, not used
FS16. Thank the respondent and the child for her/his cooperation.
Make arrangements for the administration of the remaining questionnaire(s) in this household.