Household Questionnaire: English
2019 MICS
Zimbabwe 2019
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:
_ _/_ _ /201 _
HH6. Area
[] 1. Urban
[] 2. Rural
[] 2. Rural
HH7. Province:
[] 1. Manicaland
[] 2. Mashonaland central
[] 3. Mashonaland east
[] 4. Mashonaland west
[] 5. Matabeleland north
[] 6. Matabeleland south
[] 7. Midlands
[] 8. Masvingo
[] 9. Harare
[] 0. Bulawayo
[] 2. Mashonaland central
[] 3. Mashonaland east
[] 4. Mashonaland west
[] 5. Matabeleland north
[] 6. Matabeleland south
[] 7. Midlands
[] 8. Masvingo
[] 9. Harare
[] 0. Bulawayo
HH7A. District: _ _
HH8. Is the household selected for questionnaire for men?
[] 1. Yes
[] 2. No
[] 2. No
HH9. Is the household selected for water quality testing?
[] 1. Yes
[] 2. No
[] 2. No
HH10. Is the household selected for blank testing?
[] 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 Zimstat. 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 35 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 you want to stop the interview, please let me know. May I start now?
[] Yes, permission is given (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 at home 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 at home 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 5-17: __ __
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 5-17
[] 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 (DK98): _ _
Year (DK9998): _ _ _ _
Year (DK9998): _ _ _ _
HL6. How old is (name)?
Record in completed years.
If age is 95 or above, record "95".
Age _ _
HL7. Did (name) stay here last night?
[] 1. Yes
[] 2. No
[] 2. No
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 province
[] 3. In another household in another province
[] 4. Institution in this country
[] 8. DK
[] 2. In another household in the same province
[] 3. In another household in another province
[] 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 province
[] 3. In another household in another province
[] 4. Institution in this country
[] 8. DK
[] 2. In another household in the same province
[] 3. In another household in another province
[] 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: _ _
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
[] 14. Servant (live-in)
[] 96. Other (not related)
[] 98. DK
[] 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
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?
[] 1. Yes
[] 2. No (Go to next line)
[] 2. No (Go to next line)
ED5. What is the highest level and grade/form/year of school (name) has ever attended?
Level
[] 0. ECE (Go to ED7)
[] 1. Primary
[] 2. Vocational - National foundation certificate
[] 3. Lower secondary
[] 4. Upper secondary
[] 5. Vocational - certificate
[] 6. Vocat - apprenticeship/teacher college
[] 7. Tertiary - short cycle
[] 8. Tertiary - higher national diploma/bachelor/bachelor's honour
[] 9. Tertiary - master/doctorate medical courses
[] 10. Doctorate
[] 98. DK
[] 1. Primary
[] 2. Vocational - National foundation certificate
[] 3. Lower secondary
[] 4. Upper secondary
[] 5. Vocational - certificate
[] 6. Vocat - apprenticeship/teacher college
[] 7. Tertiary - short cycle
[] 8. Tertiary - higher national diploma/bachelor/bachelor's honour
[] 9. Tertiary - master/doctorate medical courses
[] 10. Doctorate
[] 98. DK
Grade/form/year:
[] 98. DK (Go to ED7)
Codes:
01-10
ED6. Did (name) ever complete that (grade/form/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 2018/2019 school year did (name) attend school or any early childhood education programme?
[] 1. Yes
[] 2. No (Go to ED15)
[] 2. No (Go to ED15)
ED10. During this 2018/2019 school year, which level and grade/form/year is (name) attending?
Level
[] 0. ECE (Go to ED15)
[] 1. Primary
[] 2. Vocational - National foundation certificate
[] 3. Lower secondary
[] 4. Upper secondary
[] 5. Vocational - certificate
[] 6. Vocat - apprenticeship/teacher college
[] 7. Tertiary - short cycle
[] 8. Tertiary - higher national diploma/bachelor/bachelor's honour
[] 9. Tertiary - master/doctorate medical courses
[] 10. Doctorate
[] 98. DK
[] 1. Primary
[] 2. Vocational - National foundation certificate
[] 3. Lower secondary
[] 4. Upper secondary
[] 5. Vocational - certificate
[] 6. Vocat - apprenticeship/teacher college
[] 7. Tertiary - short cycle
[] 8. Tertiary - higher national diploma/bachelor/bachelor's honour
[] 9. Tertiary - master/doctorate medical courses
[] 10. Doctorate
[] 98. DK
Grade/form/year:
[] 98. DK
Codes:
01-10
ED11. Is (he/she) attending a public school?
If ?Yes?, record "1". If ?No?, probe to code who controls and manages the school.
[] 1. Govt/public
[] 2. Religious/faith org
[] 3. Private
[] 6. Other
[] 8. DK
[] 2. Religious/faith org
[] 3. Private
[] 6. Other
[] 8. DK
ED12. In the 2018/2019 school year, has (name) received any school tuition support?
If ?Yes?, probe to ensure that support was not received from family, other relatives, friends or neighbours.
[] 1. Yes
[] 2. No (Go to ED14)
[] 8. DK (Go to ED14)
[] 2. No (Go to ED14)
[] 8. DK (Go to ED14)
ED13. Who provided the tuition support?
Record all mentioned.
[] A. Govt/public
[] B. Religious/faith org
[] C. Private
[] X. Other
[] Z. DK
[] B. Religious/faith org
[] C. Private
[] X. Other
[] Z. DK
ED14. For the 2018/2019 school year, has (name) received any material support or cash to buy shoes, exercise books, notebooks, school uniforms or other school supplies?
If ?Yes?, probe to ensure that support was not received from family, other relatives, friends or neighbours.
[] 1. Yes
[] 2. No
[] 8. DK
[] 2. No
[] 8. DK
ED14A. For the 2018/2019 school year, has (name) received any supplementary feeding at school?
[] 1. Yes
[] 2. No
[] 8. DK
[] 2. No
[] 8. DK
ED14B. At any time during the 2018/2019 school year, has (name) ever been turned away from school for non- payment of fees or levies?
[] 1. Yes
[] 2. No
[] 8. DK
[] 2. No
[] 8. DK
ED15. At any time during the 2017/2018 school year did (name) attend school or any early childhood education programme?
[] 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 that 2017/2018 school year, which level and grade/form/year did (name) attend?
Level
[] 0. ECE (Go to next line)
[] 1. Primary
[] 2. Vocational - National foundation certificate
[] 3. Lower secondary
[] 4. Upper secondary
[] 5. Vocational - certificate
[] 6. Vocat - apprenticeship/teacher college
[] 7. Tertiary - short cycle
[] 8. Tertiary - higher national diploma/bachelor/bachelor's honour
[] 9. Tertiary - master/doctorate medical courses
[] 10. Doctorate
[] 98. DK
[] 1. Primary
[] 2. Vocational - National foundation certificate
[] 3. Lower secondary
[] 4. Upper secondary
[] 5. Vocational - certificate
[] 6. Vocat - apprenticeship/teacher college
[] 7. Tertiary - short cycle
[] 8. Tertiary - higher national diploma/bachelor/bachelor's honour
[] 9. Tertiary - master/doctorate medical courses
[] 10. Doctorate
[] 98. DK
Grade/form/year:
[] 98. DK
Codes:
01-10
Household Characteristics: HC
HC1A. What is the religion of (name of the head of the household from HL2)?
[] 11. Roman Catholic
[] 12. Protestant
[] 13. Pentecostal
[] 14. Apostolic sect
[] 15. Zion
[] 16. Other Christian (specify) ____
[] 17. Islam
[] 18. Traditional
[] 19. No religion
[] 96. Other religion (specify) ____
[] 98. DK
[] 12. Protestant
[] 13. Pentecostal
[] 14. Apostolic sect
[] 15. Zion
[] 16. Other Christian (specify) ____
[] 17. Islam
[] 18. Traditional
[] 19. No religion
[] 96. Other religion (specify) ____
[] 98. DK
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
[] 12. Dung
[] 12. Dung
Rudimentary floor
[] 21. Wood planks
Finished Floor
[] 31. Parquet or polished wood
[] 32. Vinyl or asphalt strips
[] 33. Ceramic Tiles
[] 34. Cement
[] 35. Carpet
[] 32. Vinyl or asphalt strips
[] 33. Ceramic Tiles
[] 34. Cement
[] 35. Carpet
[] 96. Other (specify) ____
HC5. Main material of the roof.
Record observation.
[] 11. No roof
Natural roofing
Natural roofing
[] 12. Thatch
[] 13. Sod
[] 13. Sod
Rudimentary roofing
[] 21. Rustic mat
[] 23. Wood planks
[] 24. Cardboard
[] 23. Wood planks
[] 24. Cardboard
Finished roofing
[] 31. Metal/tin
[] 32. Wood
[] 34. Ceramic tiles
[] 35. Cement
[] 36. Roofing shingles
[] 37. Abestos
[] 32. Wood
[] 34. Ceramic tiles
[] 35. Cement
[] 36. Roofing shingles
[] 37. Abestos
[] 96. Other (specify) ____
HC6. Main material of the exterior walls.
Record observation.
[] 11. No walls
Natural walls
[] 12. Cane/trunks
[] 13. Dirt/mud (pole and dagga)
[] 13. Dirt/mud (pole and dagga)
Rudimentary walls
[] 22. Stone with mud
[] 24. Plywood
[] 25. Cardboard/carton
[] 26. Reused Wood
[] 24. Plywood
[] 25. Cardboard/carton
[] 26. Reused Wood
Finished Walls
[] 31. Cement
[] 32. Stone with lime/cement
[] 33. Bricks
[] 34. Cement blocks
[] 36. Wood planks/shingles
[] 32. Stone with lime/cement
[] 33. Bricks
[] 34. Cement blocks
[] 36. Wood planks/shingles
[] 96. Other (specify) ____
HC7. Does your household have:
A. A fixed telephone line?
[] 1. Yes
[] 2. No
[] 2. No
B. A radio?
[] 1. Yes
[] 2. No
[] 2. No
C. A sofa?
[] 1. Yes
[] 2. No
[] 2. No
D. A table?
[] 1. Yes
[] 2. No
[] 2. No
E. A chair?
[] 1. Yes
[] 2. No
[] 2. No
F. A bed?
[] 1. Yes
[] 2. No
[] 2. No
G. A cupboard/kitchen unit?
[] 1. Yes
[] 2. No
[] 2. No
H. A wardrobe?
[] 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 television?
[] 1. Yes
[] 2. No
[] 2. No
B. A refrigerator?
[] 1. Yes
[] 2. No
[] 2. No
C. DVD/VCD player?
[] 1. Yes
[] 2. No
[] 2. No
D. Water heater?
[] 1. Yes
[] 2. No
[] 2. No
E. Electric iron?
[] 1. Yes
[] 2. No
[] 2. No
F. Microwave?
[] 1. Yes
[] 2. No
[] 2. No
G. Deep freezer?
[] 1. Yes
[] 2. No
[] 2. No
H. Fan?
[] 1. Yes
[] 2. No
[] 2. No
I. Water pump?
[] 1. Yes
[] 2. No
[] 2. No
J. Electric jug?
[] 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
D. An animal-drawn cart?
[] 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 wheel barrow?
[] 1. Yes
[] 2. No
[] 2. No
H. A animal drawn plough?
[] 1. Yes
[] 2. No
[] 2. No
HC11. Does any member of your household have a computer or a tablet?
[] 1. Yes
[] 2. No
[] 2. No
HC12. Does any member of your household have a mobile telephone?
[] 1. Yes
[] 2. No
[] 2. No
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 "6" and specify.
[] 1. Own
[] 2. Rent
[] 6. Other (specify) _____
[] 2. Rent
[] 6. 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 hectares of agricultural land do members of this household own?
First record the unit of measurement. If size is less than 1, record "00". If 95 or ore, record "95". If unknown, circle "998".
_ _ 1 Hectares
_ _ 2 Acres
[] 998. DK
_ _ 2 Acres
[] 998. DK
HC17. Does this household own any livestock, herds, other farm animals, or poultry?
[] 1. Yes
[] 2. No (Go to HC18K)
[] 2. No (Go to HC18K)
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. Other cattle?
Number: _ _
C. Horses, donkeys or mules?
Number: _ _
D. Goats?
Number: _ _
E. Sheep?
Number: _ _
F. Chickens?
Number: _ _
G. Pigs?
Number: _ _
H. Turkeys?
Number: _ _
I. Guinea fowls?
Number: _ _
J. Rabbits?
Number: _ _
HC18K. Does any member of this household have a mobile phone money account, such as ecocash, telecash, onemoney, etc?
[] 1. Yes
[] 2. No
[] 2. No
HC19. Does any member of this household have a bank account?
[] 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. Cash transfer such as HSCT or usually provided to poor households, or those with elderly, disabled people or orphans
[] 1. Yes
[] 2. No (Go to B)
[] 2. No (Go to B)
B. Assistance for food such as drought relief, communal gardens or agricultural inputs
[] 1. Yes
[] 2. No (Go to C)
[] 2. No (Go to C)
C. Vouchers for health services such as amto and maternal vouchers
[] 1. Yes
[] 2. No (Go to D)
[] 2. No (Go to D)
D. Any retirement pension
[] 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 end of module)
[] 2. No (Go to end of module)
ST3. Has your household or anyone in your household received assistance through (name of programme)?
A. Cash transfer such as HSCT or usually provided to poor households, or those with elderly, disabled people or orphans
[] 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. Assistance for food such as drought relief, communal gardens or agricultural inputs
[] 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. Vouchers for health services such as amto and maternal vouchers
[] 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 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 end of module)
[] 8. DK (Go to end of module)
[] 2. No (Go to end of module)
[] 8. DK (Go to end of 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. Cash transfer such as HSCT or usually provided to poor households, or those with elderly, disabled people or orphans
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. Assistance for food such as drought relief, communal gardens or agricultural inputs
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. Vouchers for health services such as amto and maternal vouchers
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 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 end of module)
2. Years ago_ _ (Go to end of module)
[] 998. DK (Go to end of module)
2. Years ago_ _ (Go to end of module)
[] 998. DK (Go to end of 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)
[] 04. Piped natural gas stove (Go to EU5)
[] 05. Biogas stove (Go to EU5)
[] 06. Liquid fuel stove (Go to EU4)
[] 07. Manufactured solid fuel stove
[] 08. Traditional solid fuel stove
[] 09. Three stone stove/open fire (Go to EU4)
[] 96. Other (specify)____ (Go to EU4)
[] 97. No food cooked in household (Go to EU6)
[] 02. Solar cooker (Go to EU5)
[] 03. Liquefied petroleum gas (LPG)/cooking gas stove (Go to EU5)
[] 04. Piped natural gas stove (Go to EU5)
[] 05. Biogas stove (Go to EU5)
[] 06. Liquid fuel stove (Go to EU4)
[] 07. Manufactured solid fuel stove
[] 08. Traditional solid fuel stove
[] 09. Three stone stove/open fire (Go to EU4)
[] 96. Other (specify)____ (Go to EU4)
[] 97. No food cooked in household (Go to EU6)
EU2. Does it have a chimney?
[] 1. Yes
[] 2. No
[] 8. DK
[] 2. No
[] 8. DK
EU3. Does it have a fan?
[] 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) ____
EU6. What does your household mainly use for space heating when needed?
[] 01. Central heating (Go to EU8)
[] 02. Manufactured space heater
[] 03. Traditional space heater
[] 04. Manufactured cookstove
[] 05. Traditional cookstove
[] 06. Three stone stove/open fire (Go to EU8)
[] 96. Other (specify) ____ (Go to EU8)
[] 97. No space heating in household (Go to EU9)
[] 02. Manufactured space heater
[] 03. Traditional space heater
[] 04. Manufactured cookstove
[] 05. Traditional cookstove
[] 06. Three stone stove/open fire (Go to EU8)
[] 96. Other (specify) ____ (Go to EU8)
[] 97. No space heating in household (Go to EU9)
EU7. Does it have a chimney?
[] 1. Yes
[] 2. No
[] 8. DK
[] 2. No
[] 8. DK
EU8. What type of fuel and energy source is used in this heater?
If more than one, record the main energy source for this heater.
[] 01. Solar air heater
[] 02. Electricity
[] 03. Piped natural gas
[] 04. Liquefied Petroleum Gas (LPG)/cooking gas
[] 05. Biogas
[] 06. Alcohol/ethanol
[] 07. Gasoline/diesel
[] 08. Kerosene/paraffin
[] 09. Coal/lignite
[] 10. Charcoal
[] 11. Wood
[] 12. Crop residue/grass/straw/shrubs
[] 13. Animal dung/waste
[] 14. Processed biomass (pellets) or woodchips
[] 15. Garbage/plastic
[] 16. Sawdust
[] 96. Other (specify) ____
[] 02. Electricity
[] 03. Piped natural gas
[] 04. Liquefied Petroleum Gas (LPG)/cooking gas
[] 05. Biogas
[] 06. Alcohol/ethanol
[] 07. Gasoline/diesel
[] 08. Kerosene/paraffin
[] 09. Coal/lignite
[] 10. Charcoal
[] 11. Wood
[] 12. Crop residue/grass/straw/shrubs
[] 13. Animal dung/waste
[] 14. Processed biomass (pellets) or woodchips
[] 15. Garbage/plastic
[] 16. Sawdust
[] 96. 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
[] 12. Oil lamp
[] 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
[] 12. Oil lamp
[] 13. Candle
[] 96. Other (specify) ____
[] 97. No lighting in household
EU10. Check EU4, EU8 and EU9: Does household use wood for cooking, heating or lighting?
[] 1. Yes, EU4=06 or EU8=11 or EU9=09
[] 2. No (Go to end of module)
[] 2. No (Go to end of module)
EU11. Who usually fetches the wood 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 _ _
[] 00. Members do not fetch
Line number _ _
[] 00. Members do not fetch
Insecticide treated nets: TN
TN1. Does your household have any mosquito nets?
[] 1. Yes
[] 2. No (Go to end of module)
[] 2. No (Go to end of module)
TN2. How many mosquito nets does your household have?
_ _ Number of nets
TN3. Ask the respondent to show you all the nets in the household. [Up to three nets]
[] 1. Observed
[] 2. Not observed
[] 2. Not observed
TN4. How many months ago did your household get the mosquito net? [Up to three nets]
If less than one month, record "00".
Months ago: _ _
[] 95. More than 36 months ago
[] 98. DK/not sure
[] 95. More than 36 months ago
[] 98. DK/not sure
TN5. Observe or ask the brand/type of mosquito net. [Up to three nets]
If brand is unknown and you cannot observe the net, show pictures of typical net types/brands to respondent.
Long lasting insecticide treated nets (llin)
[] 11. Olyset
[] 12. Permanet
[] 13. Dawa plus
[] 14. Interceptor
[] 15. Duranet
[] 16. Lifenet
[] 17. Magnet
[] 18. Netprotect
[] 19. Royal sentry
[] 12. Permanet
[] 13. Dawa plus
[] 14. Interceptor
[] 15. Duranet
[] 16. Lifenet
[] 17. Magnet
[] 18. Netprotect
[] 19. Royal sentry
[] 26. Other brand (specify) ____
[] 28. DK brand
[] 36. Other type (specify) ____
[] 98. DK brand/type
[] 28. DK brand
[] 36. Other type (specify) ____
[] 98. DK brand/type
TN10. Did you get the net through a Malaria Control Programme campaign, during an antenatal care visit, or during an immunization visit? [Up to three nets]
[] 1. Yes, Malaria Control Programme campaign
[] 2. Yes, ANC
[] 3. Yes, Immunization
[] 4. No
[] 8. DK
[] 2. Yes, ANC
[] 3. Yes, Immunization
[] 4. No
[] 8. DK
TN11. Check TN10: Is TN10=4 or 8? [Up to three nets]
[] 1. Yes
[] 2. No (Go to TN13)
[] 2. No (Go to TN13)
TN12. Where did you get the net? [Up to three nets]
[] 01. Government health facility
[] 02. Private health facility
[] 03. Pharmacy
[] 04. Shop/market/street
[] 05. Community health worker
[] 06. Religious institution
[] 07. School
[] 96. Other
[] 98. DK
[] 02. Private health facility
[] 03. Pharmacy
[] 04. Shop/market/street
[] 05. Community health worker
[] 06. Religious institution
[] 07. School
[] 96. Other
[] 98. DK
TN13. Did anyone sleep under this mosquito net last night?[Up to three nets]
[] 1. Yes
[] 2. No
[] 8. DK/not sure
[] 2. No
[] 8. DK/not sure
TN14. Check TN13: Did anyone sleep under the net (TN13=1)? [Up to three nets]
[] 1. Yes
[] 2. No (Go to TN16)
[] 2. No (Go to TN16)
TN15. Who slept under this mosquito net last night? [Up to three nets]
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".
____ Name 1
_ _ Line number
_ _ Line number
____ Name 2
_ _ Line number
_ _ Line number
____ Name 3
_ _ Line number
_ _ Line number
____ Name 4
_ _ Line number
_ _ Line number
TN16. Is there another net? [Up to three nets]
[] 1. Yes (Go to next net)
[] 2. No (Go to end of module)
[] 2. No (Go to end of module)
[] Tick here if additional questionnaire used
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)
Spring
[] 41. Protected spring (Go to WS3)
[] 42. Unprotected spring (Go to WS3)
[] 51. Rainwater (Go to WS3)
[] 61. Tanker-truck (Go to WS4)
[] 71. Cart with small tank (Go to WS4)
[] 81. Surface water (river, dam, lake, pond, stream, canal, irrigation channel)(Go to WS3)
[] 42. Unprotected spring (Go to WS3)
[] 51. Rainwater (Go to WS3)
[] 61. Tanker-truck (Go to WS4)
[] 71. Cart with small tank (Go to WS4)
[] 81. Surface water (river, dam, lake, pond, stream, canal, irrigation channel)(Go to WS3)
Packaged water
[] 91. Bottled water
[] 92. Sachet water
[] 92. Sachet water
[] 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 into yard/plot (Go to WS7)
[] 13. Piped into neighbour
[] 14. Public tap/standpipe
[] 21. Tube well/borehole
[] 12. Piped into yard/plot (Go to WS7)
[] 13. Piped into neighbour
[] 14. Public tap/standpipe
[] 21. Tube well/borehole
Dug well
[] 31. Protected well
[] 32. Unprotected well
[] 32. Unprotected well
Spring
[] 41. Protected spring
[] 42. Unprotected spring
[] 51. Rainwater
[] 61. Tanker-truck (Go to WS4)
[] 71. Cart with small tank (Go to WS4)
[] 81. Surface water (river, dam, lake, pond, stream, canal, irrigation channel)
[] 42. Unprotected spring
[] 51. Rainwater
[] 61. Tanker-truck (Go to WS4)
[] 71. Cart with small tank (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 (jik/water guard/water treatment tablets)
[] 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 (jik/water guard/water treatment tablets)
[] 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 (go to WS12)
[] 13. Flush to pit latrine (go to WS12)
[] 14. Flush to open drain (go to WS14)
[] 18. Flush to DK where (go to WS14)
[] 12. Flush to septic tank (go to WS12)
[] 13. Flush to pit latrine (go to WS12)
[] 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 (go to WS12)
[] 31. Composting toilet (go to WS12)
[] 41. Bucket (Go to WS14)
[] 22. Pit latrine with slab
[] 23. Pit latrine without slab/open pit (go to WS12)
[] 31. Composting toilet (go to WS12)
[] 41. Bucket (Go to WS14)
[] 95. No facility/bush/field (Go to end of module)
[] 96. Other (specify) ____ (Go to WS14)
[] 96. Other (specify) ____ (Go to WS14)
WS11A. Observe or ask if the (answer from WS11) is an upgradable blair ventilated improved pit latrine (UBVIP)?
[] 1. Yes
[] 2. No
[] 8. DK
[] 2. No
[] 8. DK
WS12. Has your (answer from WS11) ever been emptied?
[] 1. Yes, emptied, within the last 5 years
[] 2. Yes, emptied, more than 5 years ago
[] 3. Yes, emptied, don't know when
[] 4. No, never emptied (Go to WS14)
[] 8. DK (Go to WS14)
[] 2. Yes, emptied, more than 5 years ago
[] 3. Yes, emptied, don't know when
[] 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 end of module)
[] 2. No (Go to end of 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 end of module)
[] 2. Shared with general public (Go to end of 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 (dish/bucket/jug/kettle)
[] 2. Fixed facility observed (sink/tap) in yard /plot
[] 3. Mobile object observed (dish/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 ash/mud/sand 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 (dish/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 ash/mud/sand in your house for washing hands?
[] 1. Yes
[] 2. No (Go to end of module)
[] 2. No (Go to end of module)
HW6. Can you please show it to me?
[] 1. Yes, shown
[] 2. No, not shown (Go to end of module)
[] 2. No, not shown (Go to end of module)
HW7. Record your observation.
Record all that apply.
[] A. Bar or liquid soap
[] B. Detergent (powder/liquid/paste)
[] C. Ash/mud/sand
[] B. Detergent (powder/liquid/paste)
[] C. Ash/mud/sand
Salt Iodisation: SA
SA1. 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?
Apply 2 drops of test solution, observe the darkest reaction within 30 seconds, compare to the colour chart and then record the response (1, 2 or 3) that corresponds to test outcome.
Salt tested
[] 1. 0 PPM (no reaction)
[] 2. Below 15 PPM (between 0 PPM and 15 PPM) (Go to HH13)
[] 3. Above 15 PPM (at least 15 PPM) (Go to HH13)
[] 2. Below 15 PPM (between 0 PPM and 15 PPM) (Go to HH13)
[] 3. Above 15 PPM (at least 15 PPM) (Go to HH13)
Salt not tested
[] 4. No salt in the house (Go to HH13)
[] 6. Other reason (specify) ____ (Go to HH13)
[] 6. Other reason (specify) ____ (Go to HH13)
SA2. I would like to perform one more test. May I have another sample of the same salt?
Apply 5 drops of recheck solution. Then apply 2 drops of test solution on the same spot. Observe the darkest reaction within 30 seconds, compare to the colour chart and then record the response (1, 2 or 3) that corresponds to test outcome.
Salt tested
[] 1. 0 PPM (no reaction)
[] 2. Below 15 PPM (between 0 and 15 PPM)
[] 3. Above 15 PPM (at least 15 PPM)
[] 2. Below 15 PPM (between 0 and 15 PPM)
[] 3. Above 15 PPM (at least 15 PPM)
Salt not tested
[] 6. Other reason (specify) ____
HH13. Record the time.
Hour and minutes: _ _:_ _
HH14. Language of the Questionnaire.
[] 1. English
[] 2. Shona
[] 3. Ndebele
[] 2. Shona
[] 3. Ndebele
HH15. Language of the Interview.
[] 1. English
[] 2. Shona
[] 3. Ndebele
[] 6. Other language (specify) ____
[] 2. Shona
[] 3. Ndebele
[] 6. Other language (specify) ____
HH16. Native language of the Respondent.
[] 1. English
[] 2. Shona
[] 3. Ndebele
[] 6. Other language (specify) ____
[] 2. Shona
[] 3. Ndebele
[] 6. 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 5-17 years:
[] 0. No children (Go to HH29A)
[] 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 5-17 years below in the order they appear in the list of household members. Do not include other household members outside of the age range 5-17 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 5-17 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 5-17 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 5-17 to be administered to the mother/caretaker of this child.
HH29A. Check HL8 in the list of household members and indicate the total number of women age 15-49:
[] 0. No women (Go to HH34)
[] 1. Woman (Go to HH30H)
2 or more women (number) _
[] 1. Woman (Go to HH30H)
2 or more women (number) _
HH30. Issue a separate questionnaire for individual women for each woman age 15-49 years.
HH30A. List each of the women age 15-49 years below in the order they appear in the list of household members. Do not include other household members outside of the age range 15-49 years. Record the line number, name and age for each woman.
HH30B. Rank number: _
HH30C. Line number from HL1: _ _
HH30D. Name from HL2: ____
HH30E. Age from HL6: _ _
HH30F. 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 women age 15-49 years in HH29A 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 woman.
Last digit of household number (from HH2): _
Total number of eligible women in the household (from HH29A): _
Total number of eligible women in the household (from HH29A): _
HH30G. Record the rank number (HH30B), line number (HH30C), name (HH30D) and age (HH30E) of the selected woman.
Rank number: _
Line number: _ _
Name: ____
Age: _ _
Line number: _ _
Name: ____
Age: _ _
HH30H. (When HH29A=1 or when there is a single woman age 15-49 in the household): Record the rank number as "1"and record the line number (HL1), the name (HL2) and age (HL6) of this woman from the list of household members.
Rank Number: _
Line Number: _ _
Name: ____
Age: _ _
Line Number: _ _
Name: ____
Age: _ _
HH30I. This woman has been selected to be administered the Domestic Violence module in the questionnaire for individual women.
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 equals 90 for all girls age 15-17 (Go to HH34)
[] 2. No, HL20 equals 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 HL8 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 equals 90 for all boys age 15-17 (Go to HH40)
[] 2. No, HL20 equals 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 HH42)
[] 2. No (Go to HH42)
HH41. Issue a separate questionnaire for children under five for each child age 0-4 years.
HH42. Check HH9 in the household information panel: Is the household selected for water quality testing questionnaire?
[] Yes, HH9=1
[] No, HH9=2 (Go to HH45)
[] No, HH9=2 (Go to HH45)
HH43. Issue a separate water quality testing questionnaire for this household
HH44. As part of the survey we are also looking at the quality of drinking water. We would like to do a simple test of your drinking water. A colleague will come and collect the water samples. May we do such a test?
If the respondent requests to learn the results, explain that results will not be shared with individual households but will be made available to local authorities.
[] 1. Yes permission is given
[] 2. No, permission is not given (Record 02 in WQ31 on the water quality testing questionnaire)
[] 2. No, permission is not given (Record 02 in WQ31 on the water quality testing questionnaire)
HH45. 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 and no water quality testing 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