MICS Household Questionnaire
Multiple Indicator Cluster Survey (MICS) 2014
Number _ _ _
HH3. Interviewer name and number
Number _ _
HH4. Supervisor name and number:
Number _ _
HH5. Day/month/year of interview
[] 2 Rural
HH8. Is the household selected for questionnaire for men?
[] 2 No
Good ____! My name is ____ and I am working for the Zimbabwe National Statistics Agency (ZIMSTAT). We are working on a nationwide survey concerned with the situation of children, families and households. Your household was selected for the survey. Firstly, I would like to speak with a knowledgeable adult member of the household for about 35 minutes and later on women (and men) as well as mothers or primary care givers of children in the household. We would very much appreciate your participation in this survey. All the information we obtain will remain strictly confidential and your answers will never be identified. May I start now? If permission is given, begin the interview.
[] No, permission is not given (Complete HH9. Discuss this result with your supervisor.)
HH9. Result of household interview:
[] 02 Not at home
[] 03 Household absent for an extended period
[] 04 Refused
[] 05 Dwelling vacant
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 96 Other (specify) ____
HH10. Respondent to household questionnaire:
HH11. Total number of household members: _ _
HH12. Number of women age 15-49 years eligible for interview: _ _
HH13. Number of women's questionnaires completed: _ _
HH13A. Number of Men age 15-49 years eligible for interview:_ _
HH13B. Number of man's questionnaires completed: _ _
HH14. Number of children under age 5: _ _
HH15. Number of under-5 questionnaires completed: _ _
_ _ Number
HH17. Main data entry clerk's name and number:
_ _ Number
HH18 Record interview start time (hour and minute) _ _ _ _
First, please tell me the name of each person who usually lives here, starting with the head of the household.
List the head of the household in line 01. List all household members (HL2), their relationship to the household head (HL3), and their sex (HL4)
Then ask: Are there any others who live here, even if they are not at home now?
If yes, complete listing for questions HL2-HL4. Then, ask questions starting with HL5 for each person at a time. Use an additional questionnaire if all rows in the household listing form have been used.
HL2. Name: ____
Record the name(s) of the member(s) of the household in the following order: 1. Head 2. Spouse 3. Unmarried children 4. Married children, their spouses and their children 5. Relatives of head 6. Non relatives.
Code for HL3 Relationship to head of household
[] 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 DK
[] 2 Female
Year (9998 DK): _ _ _ _
HL6. Age
Record in completed years. If age is less than 1 year record 00 and if 95 years or above '95':
HL6A. Member stay in the house last night
[] 2 No
HL7. Circle line no. if woman age 15-49
For women age 15-49
HL7A. Circle line no. If man age 15-49 and the house-hold is selected for Questionnaire for men.
For men age 15-54
HL7B. Circle line no. If children age 0-4.
For children age 0-4
HL11. Is (name)'s natural mother alive
For children age 0-17 years
[] 2 No (Go to HL13)
[] 8 DK (Go to HL13)
HL12. Does (name)'s natural mother live in this household? _ _
For children age 0-17 years
If "Yes", record line no. of mother and go to HL13. If "No", record 00.
HL12A. Where does (name)'s natural mother live?
For children age 0-17 years
[] 2 Institution in this country
[] 3 Abroad
[] 8 DK
HL13. Is (name)'s natural father alive
For children age 0-17 years
[] 2 No (Go to HL15)
[] 8 DK (Go to HL15)
HL14. Does (name)'s natural father live in this household? _ _
For children age 0-17 years
If "Yes", record line no. of father and go to HL15. If "No", record 00.
HL14A. Where does (name)'s natural father live?
For children age 0-17 years
[] 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
[] Tick here if additional questionnaire used [After HL1 to HL4 questions]
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.
ED2. Name and age
Copy from HL2 and HL6.
Age: _ _
ED3. Has (name) ever attended school or pre-school?
For household members age 3 and above
[] 2. No (Go to next line)
ED4A. What is the highest level of school (name) has attended?
For household members age 3 and above. If level=0, skip to ED5
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 8 DK
ED4B. What is the highest grade (name) completed at this level?
For household members age 3 and above.
Codes:
10 - Special primary
11 - 17 for primary
20 - Special secondary
21 - 26 for secondary
30 - attended/currently attending higher education
31 - completed higher education
If the first grade at this level is not completed, enter "00".
[]98. DK
ED5. During the current school year, that is 2013/2014, did (name) attend school or preschool at any time?
For household members age 3-24 years
[] 2. No (Go to ED7)
ED6. During this/that school year, which level and grade is/was (name) attending?
For household members age 3-24 years.
Codes:
10 - Special primary
11 - 17 for primary
20 - Special secondary
21 - 26 for secondary
30 - attended/currently attending higher education
31 - completed higher education
If level=0 skip to ED7
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 8 DK
[] 98 DK
ED7. During the previous school year, that is 2012-2013, did (name) attend school or preschool at any time?
For household members age 3-24 years
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
ED8. During that previous school year, which level and grade did (name) attend?
For household members age 5-24 years
Codes:
10 - Special primary
11 - 17 for primary
20 - Special secondary
21 - 26 for secondary
30 - attended/currently attending higher education
31 - completed higher education
If level=0 skip to ED7
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 8 DK
[] 98. DK
Selection of One Child For Child Discipline: SL
SL1. Check HL6 in the list of household members and write the total number of children age 1-14 years.
SL2. Check the number of children age 1-14 years in SL1:
[] 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 1-14 years below in the order they appear in the List of household members. Do not include other household members outside of the age range 1-14 years. Record the line number, name, sex, and age for each child.
SL4. Line number from HL1: _ _
[] 2 Female
SL8. Check the last digit of the household number (HH2). This is the number of the row you should go to in the table below.
Check the total number of children age 1-14 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.
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.
Line number: _ _
Name: ____
Age: _ _
CD2. Write the line number and name of the child from SL9.
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.
[] 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
CD4. 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
HC1A. What is the religion of the head of this household?
[] 12 Protestant
[] 13 Pentecostal
[] 14 Apostolic Sect
[] 15 Other Christian
[] 16 Islam
[] 17 Traditional
[] 96 Other religion (specify) ____
[] 97 No religion
HC1B. What is the mother tongue/native language of the head of this household?
[] 2 Ndebele
[] 3 English
[] 6 Other language (specify) ____
HC2. How many rooms in this household are used for sleeping?
HC3. Main material of the dwelling floor.
Record observation.
[] 12 Dung
[] 32 Vinyl or asphalt strips
[] 33 Ceramic tiles
[] 34 Cement
[] 35 Carpet
HC3A. Type of dwelling unit.
Record observation.
[] 12 Mixed
[] 13 Detached
[] 14 Semi-detached
[] 15 Flat/town house
[] 16 Shack
[] 96 Other (specify) ____
HC4. Main material of the roof.
Record observation.
[] 12 Thatch/palm leaf
[] 23 Wood planks
[] 24 Cardboard
[] 32 Wood
[] 34 Tiles
[] 35 Cement
[] 36 Roofing shingles
[] 37 Asbestos
[] 96 Other (specify) ____
HC5. Main material of the exterior walls.
Record observation
[] 12 Cane/trunks
[] 14 Mud (pole and dagga)
[] 24 Plywood
[] 25 Carton/cardboard
[] 26 Reused wood
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement bricks
[] 36 Wood planks/shingles
HC6. What type of fuel does your household mainly use for cooking?
[] 02 Liquefied petroleum gas (LPG) (Go to HC8)
[] 03 Natural gas (Go to HC8)
[] 04 Biogas (Go to HC8)
[] 05 Kerosene (Go to HC8)
[] 06 Coal/lignite
[] 07 Charcoal
[] 08 Wood
[] 09 Straw/shrubs/grass
[] 10 Animal dung
[] 11 Agricultural crop residue
[] 12 Saw dust
[] 13 Gel
[] 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?
[] 2 Elsewhere in the house
[] 4 Outdoors
[] 6 Other (specify) ____
HC8. Does your household have:
[A] Electricity that is connected?
[] 2 No
[B] A radio in working condition?
[] 2 No
[C] A television in working condition?
[] 2 No
[D] A non-mobile telephone in working condition?
[] 2 No
[E] A refrigerator in working condition?
[] 2 No
[F] Satellite dish in working condition?
[] 2 No
[G] Computer/laptop in working condition?
[] 2 No
[H] Deep freezer in working condition?
[] 2 No
[I] DVD/VCD player in working condition?
[] 2 No
[J] A battery/generator for power in working condition?
[] 2 No
[K] A solar panel for power in working condition?
[] 2 No
HC9. Does any member of your household own:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2. No
[] 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 or the dwelling is provided by employer?
If "Rented from someone else", circle "2". If provided by employer, circle "3". For other responses, circle "6".
[] 2 Rent
[] 3 Tied accommodation
[] 6 Other (specify) ____
HC11. Does any member of this household own any land that can be used for agriculture?
[] 2 No (Go to HC13)
HC12. How many acres/hectares of agricultural land do members of this household own?
If less than one, record "00". If 95 or more, record '95'. If unknown, record '98'.
Hectares 2 _ _
HC13. Does this household own any livestock, other farm animals, or poultry?
[] 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?
[B] Horses, donkeys, or mules?
HC15. Does any member of this household have a bank account?
[] 2. No
TN1. Does your household have any mosquito nets that can be used while sleeping?
[] 2 No (Go to next module)
TN2. How many mosquito nets does your household have?
TN3. Ask the respondent to show you the nets in the household. If more than 3 nets, use additional questionnaire(s).
TN4. Mosquito net observed?
[Ask up to 3 Nets]
[] 2 Not observed
TN5. Observe or ask the brand/type of mosquito net.
If brand is unknown and you cannot observe the net, show pictures of typical net types/brands to respondent.
[] 12 Permanet
[] 16 Other (specify) ____
[] 18 DK brand
[] 22 Iconet
[] 26 Other (specify) ____
[] 28 DK brand
[] 98. DK Brand/type
TN6. How many months ago did your household get the mosquito net?
If less than one month, record '00'.
[] 95 More than 36 months ago
[] 98 DK/not sure
TN7. Check TN5 for type of net
[] Pre-treated (21-28) (Go to TN9)
[] Else (Continue with next question)
TN8. When you got the net, was it already treated with an insecticide to kill or repel mosquitoes?
[] 2 No
[] 8 DK/not sure
TN9. Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitos?
[] 2 No (Go to TN11)
[] 8 DK/not sure (Go to TN11)
TN10. How many months ago was the net last soaked or dipped?
If less than one month, record "00".
[] 95 More than 24 months ago
[] 98 DK/not sure
TN11. Did anyone sleep under this mosquito net last night?
[] 2 No (Go to TN13)
[] 8 DK/not sure (Go to TN13)
TN12. Who slept under this mosquito net last night?
Record the person's line number from the list of household members. If someone not in the list of household members slept under the mosquito net, record "00".
_ _ Line number
TN13.
1st Net: Go back to TN4 for next net. If no more nets, go to next module.
2nd Net: Go back to TN4 for next net. If no more nets, go to next module.
3rd Net: Go back to TN4 in first column of a new questionnaire for next net. If no more nets, go to next module.
IR1. At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitoes?
[] 2 No (Go to next module)
[] 8 DK (Go to next module)
IR2. Who sprayed the dwelling?
Circle all that apply.
[] B Private company
[] C Non-governmental organization
[] X Other (specify) ____
[] Z DK
WS1. What is the main source of drinking water used by members of your household?
[] 12 Piped into yard or plot (Go to WS6)
[] 13 Piped into neighbour (Go to WS6)
[] 14 Public tap/standpipe (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 42 Unprotected spring (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?
[] 12 Piped into yard or plot (Go to WS6)
[] 13 Piped into neighbour (Go to WS6)
[] 14 Public tap/standpipe
[] 32 Unprotected well
[] 42 Unprotected spring
[] 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?
[] 2 In own yard/plot (Go to WS6)
[] 3 Elsewhere
WS4. How long does it take to go there, get water, and come back?
[] 998 DK
WS4A. What is the distance of the water source from your household (in meters)?
[] 2 500 metres to 1km
[] 3 More than 1 km
[] 8 DK
WS5. Who usually goes to this source to collect the water for your household?
Probe: is this person under age 15? What sex?
[] 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?
[] 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
[] B Add bleach/chlorine(jik/water guard)
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, etc)
[] E Solar disinfection
[] F Let it stand and settle
[] G Add water treatment tablet
[] 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.
[] 12 Flush to septic tank
[] 13 Flush to pit (latrine)
[] 14 Flush to somewhere else
[] 15 Flush to unknown place/not sure/DK where
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 24 Upgradable Blair Ventilated Improved Pit latrine (UBVIP)
[] 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?
[] 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?
[] 2 Public facility (Go to next module)
WS11. How many households in total use this toilet facility, including your own household?
[] 10 Ten or more households
[] 98 DK
HW1. We would like to learn about the places that household use to wash their hands. Can you please show me where members of your household most often wash their hands?
Not Observed
[] 3 No permission to see (Go to HW4)
[] 4 Run to waste (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
[] 2 Water is not available
HW3A. Is soap, detergent or ash/mud/sand present at the place for handwashing?
[] 2 No, not present (Go to HW4)
HW3B Record you observation
Circle all that apply
[] 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?
[] 2 No (Go to HH19)
HW5A. Can you please show it to me?
[] 2 No, not shown (Go to HH19)
HW5B Record your observation
Circle all that apply
[] B Detergent (powder/liquid/paste)
[] C Liquid soap
[] D Ash/mud/sand
SI1. We would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals in your household?
Once you have tested the salt, circle number that corresponds to test outcome.
[] 2 More than 0 PPM and less than 15 PPM
[] 3 15 PPM or more
[] 4 No salt in the house
[] 5 Salt not tested (specify reason) ____
HH20. Thank the respondent for his/her cooperation and check the list of household members:
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 ________