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MICS Household Questionnaire


Monitoring the Situation of Children and Women

In the Kosovo* MICS four different questionnaires were administered, the: Household questionnaire; Questionnaire for Individual Women (age 15-49); Questionnaire for Individual Men (age 15-49); Questionnaire for Children Under Five. In addition a Questionnaire Form for Vaccination Records at Health Facility was administered for all children age 0-2 years with a completed Questionnaire for Children Under Five.

Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer's name and number

Name ____
Number _ _

HH4. Supervisor's name and number:

Name ____
Number _ _

HH5. Day/month/year of interview

_ _ / _ _ /201 _

HH6. Area

[] 1. Urban
[] 2. Rural

HH7. Region

[] 1. Gjakova
[] 2. Gjilan
[] 3. Mitrovica
[] 4. Peja
[] 5. Prizren
[] 6. Pristina
[] 7. Ferizaj

HH8. Is the household selected for questionnaire for men?

[] 1. Yes
[] 2. No

We are from the Kosovo* Agency of Statistics. We are conducting a survey about the situation of children, families and households. I would like to talk to you about these subjects. The interview will take about 15 minutes. All the information we obtain will remain strictly confidential and anonymous. 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 (Circle 04 in HH9. Discuss this result with your supervisor.)

HH9. Result of household interview:

[] 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/address not a dwelling
[] 06. Dwelling destroyed
[] 07. Dwelling not found
[] 96. Other (specify) ____

After the household questionnaire has been completed, fill in the following information:
HH10. Respondent to household questionnaire:

Name: ____ _ _

After the household questionnaire has been completed, fill in the following information:
HH11. Total number of household members: _ _

After the household questionnaire has been completed, fill in the following information:
HH12. Number of women age 15-49 years: _ _

After all questionnaires for the household have been completed, fill in the following information:
HH13. Number of women's questionnaires completed: _ _

After the household questionnaire has been completed, fill in the following information:
If the household is selected for Questionnaire for Men

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

After all questionnaires for the household have been completed, fill in the following information: If the household is selected for Questionnaire for Men
HH13B. Number of men's questionnaires completed: _ _


After the household questionnaire has been completed, fill in the following information:
HH14. Number of children under age 5: _ _

After all questionnaires for the household have been completed, fill in the following information:
HH15. Number of under-5 questionnaires completed: _ _

HH16. Field editor's name and number:

____ Name
_ _ Number

HH17. Main data entry clerk's name and number:

____ Name
_ _ Number

HH18 Record the time

_ _ Hour
_ _ Minutes

List of Household Members: 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 List of Household Members have been used.

HL1. Line number: _ _

HL2. Name: ____

HL3. What is the relationship of (name) to the head of household?

Relation: _ _

HL4. Is (name) Male or Female?

[] 1. Male
[] 2. Female

HL5. What is (name's) date of birth?

Month (98 DK): _ _
Year (9998 DK): _ _ _ _

HL6. How old is (name)?

Record in completed years. If age is 95 or above, record '95':
Age: _ _

For women age 15-49
HL7. Circle line no. if woman age 15-49

For men age 15-49
HL7A. Circle line no. If man age 15-49 and the household is selected for Questionnaire for men.

For children age 0-4
HL7B. Circle line no. If age 0-4.

HL11. Is (name)'s biological mother alive?
For children age 0-17 years
[] 1. Yes
[] 2. No (Go to HL13)
[] 8. DK (Go to HL13)

HL12. Does (name)'s biological mother live in this household? _ _
If "Yes", record line no. of mother and go to HL13. Record 00 for "No".

HL12A. Where does (name)'s biological mother live?

[] 1. In another household in this country
[] 2. Institution in this country
[] 3. Abroad
[] 8. DK

HL13. Is (name)'s biological father alive

[] 1. Yes
[] 2. No (Go to HL15)
[] 8. DK (Go to HL15)

HL14. Does (name)'s biological father live in this household? _ _
If "Yes", record line no. of father and go to HL15. Record 00 for "No".

HL14A. Where does (name)'s biological father live?

[] 1. In another household in this country
[] 2. Institution in this country
[] 3. Abroad
[] 4. DK

HL15. Record line no. of mother from HL12 if indicated.
If HL12 is blank or '00' ask: who is the primary caretaker of (name)?
For children age 0-14
Number: _ _

[] Tick here if 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.

Codes 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
[] 96. Other (not related)
[] 98. DK

Education: ED

ED1. Line number: _ _

ED2. Name and age
Copy from HL2 and HL6.
Name: ____
Age: _ _

ED3. Has (name) ever attended school or preprimary school?
For household members age 5 and above
[] 1. Yes
[] 2. No (Go to next line)

ED4A. What is the highest level of school (name) has attended?
For household members age 5 and above. If level=0, skip to ED5
Level:
[] 0. Pre-primary
[] 1. Primary
[] 2. Lower secondary
[] 3. Upper secondary
[] 4. Higher
[] 8. DK

ED4B. What is the highest grade/year (name) completed at this level?
For household members age 5 and above. If the first grade/year at this level is not completed, enter "00".
Grade/year: _ _
[]98. DK

ED4C. Check ED4A
[] If level is 4 or 8 (Go to ED5.)
[] If level is 1, 2 or 3 (Continue with ED4D)

ED4D. Is the highest level (name) has attended part of the old or the new school system?

[] 1. Old
[] 2. New
[] 8. DK

ED5. During the current school year, that is 2013-2014, did (name) attend school or pre-primary school at any time?
For household members age 5-24 years
[] 1. Yes
[] 2. No (Go to ED7)

ED6. During this school year, which level and grade/year is (name) attending?
For household members age 5-24 years. If level=0 skip to ED7
Level:
[] 0. Pre-primary
[] 1. Primary
[] 2. Lower secondary
[] 3. Upper secondary
[] 4. Higher
[] 8. DK
Grade/year:
_ _
[] 98. DK

ED6C. Check ED6
[] If level is 4 or 8 (Go to ED7.)
[] If level is 1, 2 or 3 (Continue with ED6D)

ED6D. Is the highest level (name) is attending part of the old or the new school system?

[] 1. Old
[] 2. New
[] 8. DK

ED7. During the previous school year, that is 2012-2013, did (name) attend school or pre-primary school at any time?
For household members age 5-24 years
[] 1. Yes
[] 2. No (Go to next line)
[] 8. DK (Go to next line)

ED8. During that previous school year, which level and grade/year did (name) attend?
For household members age 5-24 years
If level=0, go to next line
Level:
[] 0. Pre-primary
[] 1. Primary
[] 2. Lower secondary
[] 3. Upper secondary
[] 4. Higher
[] 8. DK
Grade/year:
_ _
[] 98. DK

ED8C. Check ED8
[] If level is 4 or 8 (Go to next line.)
[] If level is 1, 2 or 3 (Continue with ED8D)

ED8D. Is the highest level (name) has attended part of the old or the new school system?

[] 1. Old
[] 2. New
[] 8. DK

Selection of One Child For Child Labour/Child Discipline: SL

SL1. Check HL6 in the list of household members and write the total number of children age 1-17 years.
Total number: _

SL2. Check the number of children age 1-17 years in SL1:
[] Zero (Go to household characteristics module.)
[] One (Go to SL9 and record the rank number as "1", enter the line number, child's name and age.)
[] Two or more (Continue with SL2A.)

SL2A. List each of the children age 1-17 years below in the order they appear in the List of household members. Do not include other household members outside of the age range 1-17 years. Record the line number, name, sex, and age for each child.

SL3. Rank number: _

SL4. Line number from HL1: _ _

SL5. Name from HL2: ____

SL6. Sex from HL4

[] 1. Male
[] 2. Female

SL7. Age from HL6: _ _

SL8. Check the last digit of the household number (HH2) from the cover page. This is the number of the row you should go to in the table below.
Check the total number of children age 1-17 years in SL1 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 circle the number that appears in the box. This is the rank number (SL3) of the selected child.
Last Digit of Household Number (from HH2): _
Total Number of Eligible Children in the Household (from SL1): [2 to 8+] _

SL9. Record the rank number (SL3), line number (SL4), name (SL5) and age (SL7) of the selected child.
Rank number: _
Line number: _ _
Name: ____
Age: _ _

Child Labor: CL

CL1. Check selected child's age from SL9:
[] 1-4 years (Go to next module)
[] 5-17 years (Continue with CL2)

CL2. Now I would like to ask about any work children in this household may do.
Since last (day of the week), did (name) do any of the following activities, even for only one hour?

A. Did (name) do any work or help on his/her own or the household's plot/farm/food garden or looked after animals? For example, growing farm produce, harvesting, or feeding, grazing, milking animals?

[] 1. Yes
[] 2. No

B. Did (name) help in family business or relative's business with or without pay, or run his/her own business?

[] 1. Yes
[] 2. No

C. Did (name) produce or sell articles, handicrafts, clothes, food or agricultural products?

[] 1. Yes
[] 2. No

D. Since last (day of the week), did (name) engage in any other activity in return for income in cash or in kind, even for only one hour?
If "No", Probe: Please include any activity (name) performed as a regular or casual employee, self-employed or employer; or as an unpaid family worker helping out in household business or farm.

[] 1. Yes
[] 2. No

CL3. Check CL2, A to D
[] There is at least one "yes" (Go to CL4)
[] All answers are "No" (Continue with CL3A)

CL3A. Even though (name) did not do any of these activities since last (day of the week), does he/she have a job, business, or other economic or farming activity that he/she will definitely return to?
(For agricultural activities, the off season in agriculture is not a temporary absence)
[] 1 Yes
[] 2 No (Go to CL8)

CL3B. Does the activity/do these activities require carrying heavy loads?

[] 1 Yes (Go to CL7A)
[] 2 No

CL3C. Does the activity/do these activities require working with dangerous tools (knives etc.) or operating heavy machinery?

[] 1 Yes (Go to CL7A)
[] 2 No (Go to CL7)

CL4. Since last (day of the week) about how many hours did (name) engage in this activity/these activities, in total?
If less than one hour, record "00"
Number of hours: _ _

CL5. Does the activity/do these activities require carrying heavy loads?

[] 1. Yes (Go to CL7A)
[] 2. No

CL6. Does the activity/do these activities require working with dangerous tools (knives etc.) or operating heavy machinery?

[] 1. Yes (Go to CL7A)
[] 2. No

CL7. How would you describe the work environment of (name)?

[A] Is (name) exposed to dust, fumes or gas?

[] 1. Yes (Go to CL7A)
[] 2. No

[B] Is (name) exposed to extreme cold, heat or humidity?

[] 1. Yes (Go to CL7A)
[] 2. No

[C] Is (name) exposed to loud noise or vibration?

[] 1. Yes (Go to CL7A)
[] 2. No

[D] Is (name) required to work at heights?

[] 1. Yes (Go to CL7A)
[] 2. No

[E] Is (name) required to work with chemicals (pesticides, glues, etc.) or explosives?

[] 1. Yes (Go to CL7A)
[] 2. No

[F] Is (name) exposed to other things, processes or conditions bad for (name)'s health or safety?

[] 1. Yes
[] 2. No

CL7A. Describe the main job/task (name) was performing since last (day of the week).
Probe: By jobs/tasks I mean, for example, cutting trees, selling items, harvesting food, etc. (Main refers to the work on which (name) spent most of the time during the week.)
____ Response
_ _ _ _ Occupation code Do not fill in code - for Central Office only

CL7B. Describe briefly the main activity i.e. Goods produced and services rendered where (name) is working since last (day of the week).
(Main refers to the work on which (name) spent most of the time during the week.)
____ Response
_ _ _ _ Industrial code Do not fill in code - for Central Office only

CL7C. When did (name) usually carry out his/her main work since last (day of the week)?
(Main refers to the work on which (name) spent most of the time during the week.)
[] 1 During the day (between 6 a.m. and 6 p.m.)
[] 2 In the evening or at night (after 6 p.m.)
[] 3 During both the day and the evening (for the entire day)
[] 4 On the week-end
[] 5 Sometimes during the day, sometimes in the evening

CL8. Since last (day of the week), did (name) fetch water or collect firewood for household use?

[] 1. Yes
[] 2. No (Go to CL10)

CL9. In total, how many hours did (name) spend on fetching water or collecting firewood for household use, since last (day of the week)?
If less than one hour, record "00"
Number of hours: _ _

CL10. Since last (day of the week), did (name) do any of the following for this household?

[A] Shopping for household?

[] 1. Yes
[] 2. No

[B] Repair any household equipment?

[] 1. Yes
[] 2. No

[C] Cooking or cleaning utensils or the house?

[] 1. Yes
[] 2. No

[D] Washing clothes?

[] 1. Yes
[] 2. No

[E] Caring for children?

[] 1. Yes
[] 2. No

[F] Caring for the old or sick?

[] 1. Yes
[] 2. No

[G] Other household tasks?

[] 1. Yes
[] 2. No

CL11. Check CL10, A to G
[] There is at least one "yes" (Continue with CL12)
[] All answers are "no" (Go to next module)

CL12. Since last (day of the week), about how many hours did (name) engage in this activity/these activities, in total?
If less than one hour, record "00"
Number of hours: _ _

Child Discipline: CD

CD1. Check selected child's age from SL9
[] 1-14 years (Continue with CD2)
[] 15-17 years (Go to next module)

CD2. Write the line number and name of the child from SL9.

Line number: _ _
Name: ____

CD3. 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 anyone else 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.

[] 1. Yes
[] 2. No

[B] Explained why (name)'s behaviour was wrong.

[] 1. Yes
[] 2. No

[C] Shook him/her.

[] 1. Yes
[] 2. No

[D] Shouted, yelled at or screamed at him/her.

[] 1. Yes
[] 2. No

[E] Gave him/her something else to do.

[] 1. Yes
[] 2. No

[F] Spanked, hit or slapped him/her on the bottom with bare hand.

[] 1. Yes
[] 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.

[] 1. Yes
[] 2. No

[H] Called him/her dumb, lazy, or another name like that.

[] 1. Yes
[] 2. No

[I] Hit or slapped him/her on the face, head or ears.

[] 1. Yes
[] 2. No

[J] Hit or slapped him/her on the hand, arm, or leg.

[] 1. Yes
[] 2. No

[K] Beat him/her up, that is hit him/her over and over as hard as one could.

[] 1. Yes
[] 2. No

CD4. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?

[] 1. Yes
[] 2. No
[] 8. DK/no opinion

Household Characteristics: HC

HC1A. What is the religion of the head of this household?

[] 1. Islamic
[] 2. Orthodox
[] 3. Catholic
[] 4. Prefer not to answer
[] 6. Other religion (specify) ____
[] 7. No religion

HC1B. What is the mother tongue/native language of the head of this household?

[] 1. Albanian
[] 2. Serbian
[] 3. Turkish
[] 4. Bosnian
[] 5. Romani
[] 6. Other language (specify) ____

HC1C. To what ethnic group does the head of this household belong?

[] 1. Albanian
[] 2. Serb
[] 3. Turk
[] 4. Bosniak
[] 5. Roma
[] 6. Ashkali
[] 8. Egyptian
[] 9. Goran
[] 96. Other ethnic group (specify) ____

HC2. How many rooms in this household are used for sleeping?

Number of rooms: _ _

HC3. Main material of the dwelling floor.
Record observation.
Natural floor
[] 11. Earth/sand
Rudimentary floor
[] 21. Wood planks
Finished floor
[] 32. Linoleum
[] 33. Ceramic tiles
[] 34. Cement
[] 35. Carpet
[] 36. Parquet
[] 37. Polished wood (laminate)
[] 96. Other (specify) ____

HC4. Main material of the roof.
Record observation.
Natural roofing
[] 11. No roof
Rudimentary roofing
[] 21. Rustic mat
[] 23. Wood planks
[] 24. Cardboard
[] 25. Nylon
[] 26. Tent material
Finished roofing
[] 31. Metal/tin
[] 32. Wood
[] 33. Calamine/cement fibre
[] 35. Cement
[] 36. Roofing shingles
[] 37. Clay tiles
[] 96. Other (specify) ____

HC5. Main material of the exterior walls.
Record observation
Natural walls
[] 11. No walls
[] 13. Dirt
Rudimentary walls
[] 22. Stone with mud
[] 23. Uncovered adobe
[] 24. Plywood
[] 25. Cardboard
[] 26. Reused wood
[] 27. Tent material
[] 28. Wood with mud
Finished Walls
[] 31. Cement
[] 32. Stone with lime/cement
[] 33. Bricks
[] 34. Cement blocks
[] 35. Covered adobe
[] 36. Wood planks/shingles
[] 37. Plaster
[] 96. Other (specify) ____

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

[] 01. Electricity (Go to HC8)
[] 02. Liquefied petroleum gas (LPG) (Go to HC8)
[] 06. Coal/lignite
[] 07. Charcoal
[] 08. Wood
[] 09. Straw/shrubs/grass
[] 11. Agricultural crop residue/corn stalk
[] 95. No food cooked in household (Go to HC8)
[] 96. Other (specify) ____

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?

In the house
[] 1. In a separate room used as kitchen
[] 2. Elsewhere in the house
[] 3. In a separate building
[] 4. Outdoors
[] 6. Other (specify) ____

HC8. Does your household have:

[E] A refrigerator?

[] 1. Yes
[] 2. No

[F] A bed?

[] 1. Yes
[] 2. No

[G] A table and chairs?

[] 1. Yes
[] 2. No

[H] Internet?

[] 1. Yes
[] 2. No

[I] A clothes dryer?

[] 1. Yes
[] 2. No

[J] A vacuum cleaner?

[] 1. Yes
[] 2. No

[K] An air conditioner?

[] 1. Yes
[] 2. No

[L] A jacuzzi tub?

[] 1. Yes
[] 2. No

[M] A water heater?

[] 1. Yes
[] 2. No

[N] A laptop computer?

[] 1. Yes
[] 2. No

[O] A PC computer?

[] 1. Yes
[] 2. No

[P] A dish washer?

[] 1. Yes
[] 2. No

[Q] A clothes washing machine?

[] 1. Yes
[] 2. No

[R] A flat screen/LCD TV?

[] 1. Yes
[] 2. No

HC9. Does any member of your household own:

[D] A motorcycle or scooter?

[] 1. Yes
[] 2. No

[E] An animal-drawn cart?

[] 1. Yes
[] 2. No

[H] A car?

[] 1. Yes
[] 2. No

[I] A truck?

[] 1. Yes
[] 2. No

[J] A tractor?

[] 1. Yes
[] 2. No

[K] A cell phone?

[] 1. Yes
[] 2. No

[L] A phone with a touch screen or keyboard?

[] 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". If "Temporary housing", circle 3. For other responses, circle "6".
[] 1. Own
[] 2. Rent
[] 3. Temporary housing (no rent paid)
[] 6. Other (specify) ____

HC11. Does any member of this household own any land that can be used for agriculture?

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

HC12. How many hectares or ares of agricultural land do members of this household own?
(1 hectare = 100 ares) If 1 hectare or more, circle ?1? and record hectares. If 95 or more hectares, circle ?1? and record ?95?. If less than 1 hectare, circle ?2? and record in ares. If 1 are or more, circle ?2? and record ares. If 9950 or more ares, circle ?2? record ?9950? If less than 1 are, circle ?2? and record ?0000?. If unknown, circle ?99998?.

[] 1 Hectares: _ _
[] 2 Ares: _ _ _ _
[] 99998 DK

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

[] 1. Yes
[] 2. No (Go to HC15)

HC14. 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] Cattle, milk cows, or bulls?

Numbers: _ _

[B] Horses?

Numbers: _ _

[C] Goats?

Numbers: _ _

[D] Sheep?

Numbers: _ _

[E] Chicken?

Numbers: _ _

[F] Pigs?

Numbers: _ _

[G] Turkey?

Numbers: _ _

[H] Donkeys or mules?

Numbers: _ _

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

[] 1. Yes
[] 2. No

Water and Sanitation: WS

WS1. What is the main source of drinking water for members of your household?

Piped water
[] 11. Piped into dwelling (Go to WS6)
[] 12. Piped into compound, yard or plot (Go to WS6)
[] 13. Piped to neighbour (Go to WS6)
[] 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)
Water from spring
[] 41. Protected spring (Go to WS3)
[] 42. Unprotected spring (Go to WS3)
[] 51. Rainwater collection (Go to WS3)
[] 61. Tanker-truck (Go to WS3)
[] 71. Cart with small tank/drum (Go to WS3)
[] 81. Surface water (river, stream, dam, lake, pond, canal, irrigation channel) (Go to WS3)
[] 91. Bottled water
[] 96. Other (specify) ____(Go to WS3)

WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing?

Piped water
[] 11. Piped into dwelling (Go to WS6)
[] 12. Piped into compound, yard or plot (Go to WS6)
[] 13. Piped to neighbour (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
[] 51. Rainwater collection
[] 61. Tanker-truck
[] 71. Cart with small tank/drum
[] 81. Surface water (river, stream, dam, lake, pond, canal, irrigation channel)
[] 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. How long does it take 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?
Probe: is this person under age 15? What sex?

[] 1. Adult woman (age 15+ years)
[] 2. Adult man (age 15+ years)
[] 3. Female child (Under 15)
[] 4. Male child (Under 15)
[] 8. DK

WS6. Do you do anything to the 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 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, etc.)
[] 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?
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
[] 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
[] 41. Bucket
[] 95. No facility, bush, 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 next module)

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 next module)

WS11. How many households in total use this toilet facility, including your own household?

Number of households (if less than 10): 0_
[] 10. Ten or more households
[] 98. DK

Handwashing: HW

HW1. We would like to learn about the places that households use to wash their hands.
Can you please show me where members of your household most often wash their hands?

[] 1. Observed
Not Observed
[] 2. Not in dwelling/plot/yard (Go to HW4)
[] 3. No permission to see (Go to HW4)
[] 6. Other reason (specify) ____ (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.

[] 1. Water is available
[] 2. Water is not available

HW3A. Is soap, detergent or ash/mud/sand present at the place for handwashing?

[] 1. Yes, present
[] 2. No, not present (Go to HW4)

HW3B. Record your observation.
Circle all that apply.
[] A. Bar soap (Go to HH19)
[] B. Detergent (powder/liquid/paste) (Go to HH19)
[] C. Liquid soap (Go to HH19)
[] D. Ash/mud/sand (Go to HH19)

HW4. Do you have any soap or detergent or ash/mud/sand in your house for washing hands?

[] 1. Yes
[] 2. No (Go to HH19)

HW5A. Can you please show it to me?

[] 1. Yes, shown
[] 2. No, not shown (Go to HH19)

HW5B. Record your observation.
Circle all that apply.
[] A. Bar soap
[] B. Detergent (powder/liquid/paste)
[] C. Liquid soap
[] D. Ash/mud/sand

HH19. Record the time

Hour and minutes: _ _:_ _

HH20. Thank the respondent for his/her cooperation and check the list of household members:
[] A separate questionnaire for individual women has been issued for each woman age 15-49 years in the list of household members (HL7).
Check HH8. If the household is selected for questionnaire for individual men:
[] A separate questionnaire for individual men has been issued for each man age 15-49 years in the list of household members (HL7A).
[] A separate questionnaire for children under five has been issued for each child under age 5 years in the list of household members (HL7B).

Return to the cover page and make sure that the result of the household interview (HH9), the name and line number of the respondent to the household questionnaire (HH10), and the number of eligible women (HH12), men (HH13A), and under-5s (HH14) are entered. Make arrangements for the administration of the remaining questionnaire(s) in this household.

Interviewer's Observations ________

Field Editor's Observations ________

Supervisor's Observations ________