ETHIOPIA MINI DEMOGRAPHIC AND HEALTH SURVEYS 2019 ANTHROPOMETRY QUESTIONNAIRE
PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
IS THIS A FIRST VISIT OR A REMEASUREMENT?
REMEASUREMENT 2
DATE
FIELDWORKERS NAME
NEXT VISIT
TIME
FINAL VISIT
MONTH
YEAR
TOTAL NUMBER OF VISITS
NOTES:___
OROMIGNA 02
TIGRIGNA 03
ENGLISH 04
OTHER 06 _____
LANGUAGE OF INTERVIEW
OROMIGNA 02
TIGRIGNA 03
ENGLISH 04
OTHER 06 _____
NATIVE LANGUAGE OF RESPONDENT
OROMIGNA 02
TIGRIGNA 03
ENGLISH 04
OTHER 06 _____
TRANSLATOR
NO 2
NUMBER ___
CAPI SUPERVISOR
NUMBER ___
OFFICE EDITOR
KEYED BY
WEIGHT AND HEIGHT MEASUREMENT FOR CHILDREN AGE 0-5
101. CHECK COLUMN 11 IN HOUSEHOLD QUESTIONNAIRE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTION 102, IF MORE THAN SIX CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S)
102. CHECK HOUSEHOLD QUESTIONNAIRE: LINE NUMBER FROM COLUMN 11.
NAME ____
103. What is (NAME)'s date of birth?
MONTH __
YEAR ____
104. CHECK 103: CHILD BORN IN 2006-2011 E.C.?
NO 2 (SKIP TO 114)
NOT PRESENT 9994
REFUSED 9995
OTHER 9996
NOT PRESENT 9994 (SKIP TO 108)
REFUSED 9995 (SKIP TO 108)
OTHER 9996 (SKIP TO 108)
107. MEASURED LYING DOWN OR STANDING UP?
STANDING UP 2
108. MEASURER: ENTER YOUR FIELDWORKER NUMBER
114. GO BACK TO 103 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE NEXT PAGE. IF NO MORE CHILDREN, END INTERVIEW.
TO BE FILLED IN AFTER COMPLETING BIOMARKERS
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS