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IDENTIFICATION

NAME AND CODE OF REGION* ______________
NAME OF VILLAGE/TOWN/CITY ________________
URBAN/RURAL (URBAN = 1, RURAL = 2) ______________
LARGE CITY/SMALL CITY/TOWN/RURAL _______________
(LARGE CITY=1, SMALL CITY=2, TOWN=3, RURAL=4) HOUSEHOLD NUMBER _____
NAME OF HOUSEHOLD HEAD _____________
IS HOUSEHOLD SELECTED FOR MAN'S SURVEY? (YES = 1, NO = 2) ________

INTERVIEWER VISIT 1

DATE ______
INTERVIEWER'S NAME ______
RESULT** _____
NEXT VISIT: DATE ____ TIME ____

INTERVIEWER VISIT 2
DATE ______
INTERVIEWER'S NAME ______
RESULT** _____
NEXT VISIT: DATE ____ TIME ____

INTERVIEWER'S VISIT 3
DATE ______
INTERVIEWER'S NAME ______
RESULT** _____

FINAL VISIT
DAY ___
MONTH___
YEAR 200__
INT. NUMBER___
RESULT___
RESULT

TOTAL NUMBER OF VISITS____

TOTAL PERSONS IN HOUSEHOLD___
TOTAL WOMEN 15-49___
TOTAL MEN 15-49___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___

**RESULT CODES:
1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT
HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _____

LANGUAGE OF QUESTIONNAIRE: ______
RESPONDENT'S LANGUAGE: ____________
LANGUAGE OF INTERVIEW*** ________
TRANSLATOR USED (NOT AT ALL=1; SOMETIMES=2; ALL THE TIME=3)_____
LANGUAGE*** CODES:
1 AFRIKAANS
2 DAMARA/NAMA
3 ENGLISH
4 HERERO
5 KWANGALI
6 LOZI
7 OSHIWAMBO
8 OTHER

SUPERVISOR
NAME ___
DATE ___

FIELD EDITOR
NAME ___
DATE ___

OFFICE EDITOR ____
KEYED BY ___

*REGION CODES:
CAPRIVI = 01
ERONGO = 02
HARDAP = 03
KARAS = 04
KHOMAS = 05
KUNENE = 06
CHANGWENA = 07
KAVANGO = 08
OMAHEKE = 09
OMUSATI = 10
OSHANA = 11
OSHIKOTO = 12
OTJOZONDJUPA = 1

INTRODUCTION AND CONSENT

Hello. My name is _______________________________________ and I am working with the Ministry of Health and Social Services.

We are conducting a national survey about various health issues. We would very much appreciate your participation in this survey. The survey usually takes between 10 and 15 minutes to complete.

As part of the survey we would first like to ask some questions about your household. All of the answers you give will be confidential. Participation in the survey is completely voluntary. If we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope you will participate in the survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer: ________ Date:_______

HOUSEHOLD SCHEDULE

LINE NO. (1)

USUAL RESIDENTS AND VISITORS (2)
Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.

THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-32 FOR EACH PERSON.

RELATIONSHIP TO HEAD OF HOUSEHOLD (3)
What is the relationship of (NAME) to the head of the household? SEE CODES
BELOW.

SEX (4)
Is (NAME) male or female?

RESIDENCE (5) (6)
Does (NAME) usually live here?

Did (NAME) stay here last night?

AGE (7)
How old is (NAME)?

IF AGE 15 OR OLDER:
MARITAL STATUS (8)
What is (NAME'S) current marital status?
1 = MARRIED OR LIVING TOGETHER
2 = DIVORCED/ SEPARATED
3 = WIDOWED
4 = NEVERMARRIED AND NEVER LIVED TOGETHER

ELIGIBILITY (9) (10) (11)
CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49

CIRCLE LINE NUMBER OF ALL MEN AGE 15-49

CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5

CODES FOR Q. 3: RELATIONSHIP TO HEAD OF HOUSEHOLD

01 = HEAD
02 = WIFE OR HUSBAND
03 = SON OR DAUGHTER
04 = SON-IN-LAW OR DAUGHTER-IN-LAW
05 = GRANDCHILD
06 = PARENT
07 = PARENT-IN-LAW
08 = BROTHER OR SISTER
09 = NIECE/NEPHEW BY BLOOD
10 = NIECE/NEPHEW BY MARRIAGE
11 = OTHER RELATIVE
12 = ADOPTED/FOSTER/STEPCHILD
13 = NOT RELATED
98 = DON'T KNOW

IF AGE 18-59 YEARS:
SICK PERSON (12)
Has (NAME) been very sick for at least 3 months during the past 12 months, that is (NAME) was too sick to work or do normal activities?

Q. 13-Q. 20 ARE ASKED ONLY IF AGE 0-17 YEARS:
SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS (13) (14) (15) (16) (17) (18) (19) (20)

Is (NAME)'s natural mother alive?

Does (NAME)'s natural mother usually live in this household or was she a guest last night? IF YES: What is her name? RECORD MOTHER'S LINE NUMBER. IF NO, RECORD '00'.

IF MOTHER NOT LISTED IN HOUSEHOLD:
Has (NAME)'s mother been very sick for at least 3 months during the past 12 months, that is she was too sick to work or do normal activities?

Is (NAME)'s natural father alive?

Does (NAME)'s natural father usually live in this household or was he a guest last night? IF YES: What is his name? RECORD FATHER'S LINE NUMBER. IF NO, RECORD '00'.

IF FATHER NOT LISTED IN HOUSEHOLD:
Has (NAME)'s father been very sick for at least 3 months during the past 12 months, that is he was too sick to work or do normal activities?

MOTHER AND/OR FATHER DEAD/SICK
CIRCLE LINE NUMBER IF CHILD'S MOTHER AND/OR FATHER HAS DIED (Q. 13 OR 16=NO) OR BEEN SICK (Q. 15 OR 18=YES).

BOTH PARENTS ALIVE
IF YES TO Q. 13 AND Q. 16 (BOTH ALIVE), CIRLCE '1'. FOR ALL OTHER CASES, CIRCLE '2'.

Q. 21-Q. 22 ARE ASKED ONLY IF AGE 0-17 YEARS
BROTHERS AND SISTERS (21) (22)
Does (NAME) have any brothers or sisters under age 18 who have the same mother and the same father?

Do any of these brothers and sisters under age 18 not live in this household?

Q. 23-Q. 24 ARE ASKED ONLY IF AGE 5 YEARS OR OLDER OR OLDER
EVER ATTENDED SCHOOL (23) (24)
Has (NAME) ever attended school?

What is the highest level of school (NAME) has attended? SEE CODES BELOW. What is the highest grade (NAME) completed at that level? SEE CODES BELOW.

Q. 25-Q. 28 ARE ASKED ONLY IF AGE 5-24 YEARS
CURRENT/RECENT SCHOOL ATTENDANCE (25) (26) (27) (28)

Did (NAME) attend school at any time during the (2006-2007) school year?

During this/that school year, what level and grade [is/was] (NAME) attending? SEE CODES BELOW.

Did (NAME) attend school at any time during the previous school year, that is, (2005 2006)?

During that school year, what level and grade did (NAME) attend? SEE CODES BELOW.

Q. 29- Q. 31 ARE ASKED ONLY IF AGE 5-17 YEARS.
BASIC MATERIAL NEEDS (29) (30) (31)

Does (NAME) have a blanket?

Does (NAME) have a pair of shoes?

Does (NAME) have at least two sets of clothes?

Q. 32 IS ASKE DONLY IF AGE 0-4 YEARS
BIRTH REGISTRATION (32)
Does (NAME) have a birth certificate? IF NO, PROBE: Has (NAME)'s birth ever been registered with the civil authority?
1 = HAS CERTIFICATE
2 = REGISTERED
3 = NEITHER
8 = DON'T KNOW

CODES FOR Qs. 24, 26, AND 28: EDUCATION

LEVEL
0 = PRE-SCHOOL (KG, DAY CARE)
1 = PRIMARY
2 = SECONDARY
3 = HIGHER
8 = DON'T KNOW

GRADE
00 = LESS THAN 1 YEAR COMPLETED (USE '00' FOR Q. 24 ONLY. THIS CODE IS NOT ALLOWED FOR QS. 26 AND 28)
98 = DON'T KNOW

HOUSEHOLD CHARACTERISTICS

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

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

103. Where is that water source located?

104. How long does it take to go there, get water, and come back?

105. Who usually goes to this source to fetch the water for your household?

106. Do you do anything to the water to make it safer to drink ?

107. What do you usually do to make the water safe to drink? Anything else? RECORD ALL MENTIONED.

108. What kind of toilet facility do members of your household usually use?

109. Do you share this toilet facility with other households?

110. How many households use this toilet facility?

111. Does your household have: Electricity? A radio? A television? A mobile telephone? A non-mobile telephone/ A refrigerator? Solar electricity?

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

113. In this household, is food cooked on an open fire, an open stove or a closed stove?

114. Does this (fire/stove) have a chimney, a hood, or neither of these?

115. Is the cooking usually done in the house, in a separate building, or outdoors?

116. Do you have a separate room which is used as a kitchen?

117. MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION.

118. MAIN MATERIAL ON THE ROOF. RECORD OBSERVATION.

119. MAIN MATERIAL OF THE EXTERIOR WALLS. RECORD OBSERVATION.

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

121. Does any member of this household own: A watch? A bicycle? A motorcycle or motor scooter? An animal-drawn cart? A car or truck? A boat with a motor?

122. Does any member of this household own agricultural land?

123. How many hectares of agricultural land do members of this household own?

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

125. How many of the following animals does this household own?
IF NONE, ENTER '00'.
IF MORE THAN 95, ENTER '95'.
IF UNKNOWN, ENTER' 98'.
Cattle? Milk cows or bulls? Horses, donkeys, or mules? Goats? Sheep? Chickens?

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

126A. What is the name of the nearest government health facility that provides health services to this community?

126B. If you were to go to (HEALTH FACILITY NAME), how would you go there?

126C. How long does it take from here to (HEALTH FACILITY NAME) by (MODE OF TRANSPORT IN 126B)?

126D. CHECK 126A: IS THE NEAREST FACILITY A HOSPITAL?

126E. What is the name of the nearest government hospital that provides health services to this community?

126F. If you were to go to (NAME OF HOSPITAL, how would you go there?

126G. How long does it take from here to (NAME OF THE HOSPITAL) by (MODE OF TRANSPORT IN 126F)?

126H. In the last 12 months, has anyone in this household stayed overnight in a hospital or other health facility other than to deliver a baby?

127. Does your household have any mosquito nets that can be used while sleeping?

128 How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD '7'.

[Q. 129-Q. 137 ARE ASKED OF NET #1, NET #2 AND NET #3 SEPARATELY.]

129. ASK THE RESPONDENT TO SHOW YOU THE NETS IN THE HOUSEHOLD.
IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S)

130. How many months ago did your household obtain the mosquito net?
IF LESS THAN ONE MONTH RECORD '00'.

131. OBSERVE OR ASK THE BRAND/TYPE OF NET.

132. When you got the net, was it treated with an insecticide to kill or repel mosquitos?

133. Since you got the mosquito net, was it ever soaked or dipped in a liquid to kill or repel mosquitos?

134. How many months ago was the net last soaked or dipped? IF LESS THAN ONE MONTH, RECORD '00'.

135. Did anyone sleep under this mosquito net last night?

136. Who slept under this mosquito net last night? RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

137. GO BACK TO 129 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 138.

138. At any time in the past 12 months, has anyone sprayed the interior walls of your dwelling against mosquitoes?

139. How many months ago was the house sprayed? IF LESS THAN ONE MONTH, RECORD '00' MONTHS AGO.

140. Who sprayed the house?

141. What is the reason your house has not been sprayed?

142. May I see a sample of the salt used for cooking last time?

143. What is the source of this salt: was it bought in a shop or from an open market or does it come from a salt pan?

SUPPORT FOR SICK PEOPLE

201. CHECK QUESTIONS 7 AND 12 IN THE HOUSEHOLD SCHEDULE:

202. ENTER IN QUESTION 203 THE LINE NUMBER AND NAME OF EACH SICK PERSON AGE 18-59, BEGINNING WITH THE FIRST SICK PERSON LISTED IN QUESTION 12 IN THE HOUSEHOLD SCHEDULE. IF THERE ARE MORE THAN 3 SICK PEOPLE, USE ADDITIONAL QUESTIONNAIRE(S).

READ THE INTRODUCTION THAT FOLLOWS. THEN ASK QUESTIONS 204-215 AS APPROPRIATE FOR EACH OF THE PERSONS AGE 18-59 REPORTED AS HAVING BEEN VERY SICK.

You told me that in your household one (some) of the members of your household has(ve) been very sick for at least three of the past 12 months. We are interested in learning about the care and support that may have been received for [that/each of those persons].
First I would like to ask you about any formal, organized help or support that your household may have been given for [that/ each of those] person(s) for which you did not have to pay.
By formal, organized support I mean help provided by someone working for a program. This program could be government, private, religious, charity, or community based.

[Q. 203-Q. 215 ARE ASKED OF 1ST SICK PERSON, 2ND PERSON AND 3RD PERSON SEPARATELY.]

203. NAME AND LINE NUMBER FROM COLUMNS 1 AND 2 OF THE HOUSEHOLD SCHEDULE.

204. Now I would like to ask you about any support you received for (NAME). In the last
months, has your household received any medical support for (NAME), such as medical care, supplies or medicine, for which you did not have to pay?

205. Did your household receive any of this medical support at least once a month while (NAME) was sick?

206. In the last 12 months, has your household received any emotional or psychological support for (NAME), such as companionship, counseling from a trained counselor, or spiritual support, for which you did not have to pay?

207. Did your household receive of this any emotional or psychological support in the past 30 days?

208. In the last 12 months, has your household received any material support for (NAME), such as clothing, food, or financial support, for which you did not have to pay?

209. Did your household receive any of this material support in the past 30 days?

210. In the last 12 months, has your household received any social support for (NAME), such as help in household work, training for a caregiver, or legal services, for which you did not have to pay?

211. Did you household receive any of this social support in the past 30 days?

212. Now I would like to ask about health problems (NAME) may have recently had. In the last 30 days, has (NAME) had severe pain, mild pain or no pain at all?

213. When (NAME) was in pain, was he/she able to reduce or stop the pain most of the time, some of the time, or not at all?

214. In the last 30 days, did (NAME) suffer from nausea, coughing, diarrhea, or constipation?
IF YES: Was this problem (were any of these problems) ever severe?

215. Was (NAME) able to reduce or stop this (these) problem(s) most of the time, some of the time, or not at all?

216. GO BACK TO 204 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF ADDITIONAL QUESTIONNAIRE(S); IF THERE ARE NO MORE SICK PEOPLE, GO TO 301.

SUPPORT FOR PERSONS WHO HAVE DIED

301. Now I would like to ask you a few more questions about your household. Think back over the past 12 months. Has any usual member of your household died in the last 12 months?

302. How many household members died in the last 12 months?

303. ASK 304-322 AS APPROPRIATE FOR EACH PERSON WHO DIED. IF THERE WERE MORE THAN 3 DEATHS, USE ADDITIONAL QUESTIONNAIRE(S).

304. What was the name of the person who died (most recently/before him/her)?

305. Was (NAME) male or female

306. How old was (NAME) when (he/she) died?

307. CHECK 306: AGE OF PERSON AT DEATH

308 Was (NAME) very sick for at least three of the 12 months before (he/she) died, that is was too sick to work or do normal activities?

309. I would like to ask you about any formal, organized help or support that your household may have received for [NAME] before (he/she) died, for which you did not have to pay. By formal, organized support I mean help provided by someone working for a program. This program could be government, private, religious, charity, or community based.

310. In the last 12 months, did your household receive any medical supplies for (NAME), such as medical care, supplies or medicine, for which you did not have to pay?

311. Did your household receive any of this medical support at least once a month while (NAME) was sick?

312. In the last 12 months, did your household receive any emotional or psychological support for (NAME), such as companionship, counseling from a trained counselor, or spiritual support for which you did not have to pay?

313. Did your household receive any of this emotional or psychological support in the last 30 days before (NAME)'s death?

314. In the last 12 months, did your household receive any material support for (NAME), such as clothing, food, or financial support, for which you did not have to pay?

315. Did your household receive any of this material support in the last 30 days before (NAME)'s death?

316. In the last 12 months, did your household receive any social support for (NAME), such as help in household work, training for a caregiver, or legal services, for which you did not have to pay?

317. Did your household receive any of this social support in the last 30 days before (NAME)'s death?

318. Now I would like to ask about the health problems (NAME) may have had. In the 30 days before (NAME) died, did he/she have severe pain, mild pain, or no pain at all?

319. When (NAME) was in pain, was he/she able to reduce or stop the pain most of the time, some of the time, or not at all?

320. In the 30 days before (NAME) died, did he/she suffer from nausea, coughing, diarrhea, or constipation? IF YES: Was this problem (were any of these problems) sever?

321. Was (NAME) able to reduce or stop the problems he/she had most of the time, some of the time or not at all?

322. GO BACK TO 304 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF ADDITIONAL QUESTIONNAIRE(S); IF NO MORE DEATHS, GO TO 401.

SUPPORT FOR ORPHANS AND VULNERABLE CHILDREN

401. CHECK COLUMN 7 IN THE HOUSEHOLD SCHEDULE: ANY CHILD AGE 0-17?

402. CHECK COLUMN 12 IN THE HOUSEHOLD SCHEDULE: ANY SICK ADULT AGE 18-59 WHO IS VERY SICK?

403. CHECK 306 IN THE PREVIOUS SECTION: ANY ADULT AGE 18-59 WHO DIED IN PAST 12 MONTHS?

404. CHECK COLUMN 19 IN THE HOUSEHOLD SCHEDULE: ANY CHILD WHOSE MOTHER AND/OR FATHER HAS DIED OR WHOSE MOTHER AND/OR FATHER IS NOT LISTED IN THE HOUSEHOLD SCHEDULE AND IS VERY SICK?

405. RECORD NAMES, LINE NUMBERS AND AGES OF CHILDREN AGE 0-17 FOR ALL CHILDREN WHO ARE IDENTIFIED IN COLUMN 19 AS HAVING A MOTHER AND/OR FATHER WHO HAS DIED OR HAS BEEN VERY SICK.

[Q. 406- Q. 416 ARE ASKED OF 1ST CHILD, 2ND CHILD, 3RD CHILD AND 4TH CHILD SEPARATELY.]

406. NAME FROM COLUMN 2
LINE NUMBER FROM COLUMN 1
AGE FROM COLUMN 7

407. I would like to ask you about any formal, organized help or support for children that your household may have received for which you did not have to pay. By formal, organized support I mean help provided by someone working for a program. This program could be government, private, religious, charity, or community based.

408. Now I would like to ask you about the support your household received for (NAME). In the last 12 months, has your household received any medical support for (NAME), such as medical care, supplies or medicine, for which you did not have to pay?

409. In the last 12 months, has your household received any emotional or psychological support for (NAME), such as companionship, counseling from a trained counselor, or spiritual support, which you received at home and for which you did not have to pay?

410. Did your household receive any of this emotional or psychological support in the past 3 months?

411. In the last 12 months, has your household received any material support for (NAME), such as clothing, food, or financial support, for which you did not have to pay?

412. Did your household receive any of this material support in the past 3 months?

413. In the last 12 months, has your household received any social support for (NAME) such as help in household work, training for a caregiver, or legal services for which you did not have to pay?

414. Did your household receive any of this social support in the past 3 months?

415. CHECK 406: AGE OF CHILD

416. In the last 12 months, has your household received any support for (NAME'S) schooling, such as allowance, free admission, books or supplies, for which you did not have to pay?

417. GO BACK TO 408 FOR NEXT CHILD; OR, IF NO MORE CHILDREN, GO TO 501.

Q. 406-416 ARE ASKED OF 5TH CHILD, 6TH CHILD, 7TH CHILD AND 8TH CHILD SEPARATELY.

406. NAME FROM COLUMN 2
LINE NUMBER FROM COLUMN 1
AGE FROM COLUMN 7

408. Now I would like to ask you about the support your household received for (NAME). In the last 12 months, has your household received any medical support for (NAME), such as medical care, supplies or medicine, for which you did not have to pay?

409. In the last 12 months, has your household received any emotional or psychological support for (NAME) such as companionship, counseling from a trained counselor, or spiritual support, which you received at home and for which you did not have to pay?

410. Did your household receive any emotional or psychological support in the past 3 months?

411. In the last 12 months, has your household received any material support for (NAME), such as clothing, food, or financial support, for which you did not have to pay?

412. Did your household receive any material support in the past months?

413. In the last 12 months, has your household received any social support for (NAME) such as help in household work, training for a caregiver, or legal services for which you did not have to pay?

414. Did your household receive any social support in the past 3 months?

415. CHECK 406: AGE OF CHILD

416. In the last 12 months, has your household received any support for (NAME'S) schooling, such as allowance, free admission, books or supplies, for which you did not have to pay?

417. GO BACK TO 408 FOR NEXT CHILD; OR, IF NO MORE CHILDREN, GO TO 501.

WEIGHT AND HEIGHT MEASUREMENTS FOR CHILDREN AGED 0-5.

501. CHECK COLUMN 11. RECORD THE LINE NUMBER AND AGE FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTION 502. IF MORE THAN SIX CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S). A FINAL OUTCOME MUST BE RECORDED FOR THE WEIGHT AND HEIGHT MEASUREMENT IN 508

[Q. 502-Q. 509 ARE ASKED OF CHILD 1, CHILD 2 AND CHILD 3 SEPARATELY.]

502. LINE NUMBER FROM COLUMN 11
NAME FROM COLUMN 2
AGE FROM COLUMN 7

503. IF MOTHER INTERVIEWED, COPY MONTH AND YEAR FROM BIRTH HISTORY AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK:
What is (NAME'S) birth date?

504. CHECK 502 AND 503: CHILD AGE 0-5 OR BORN IN JANUARY 2001 OR LATER?

505. WEIGHT IN KILOGRAMS

506. HEIGHT IN CENTIMETERS

507. MEASURED LYING DOWN OR STANDING UP?

508. RESULT OF WEIGHT AND HEIGHT MEASUREMENT

509. GO BACK TO 503 FOR NEXT CHILD IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE ADDITIONAL QUESTIONNAIRE(S); IF NO MORE CHILDREN, GO TO 510.

Q. 502-Q. 508 ARE ASKED OF CHILD 4, CHILD 5 AND CHILD 6 SEPARATELY.

502. LINE NUMBER FROM COLUMN 11
NAME FROM COLUMN 2
AGE FROM COLUMN 7

503. IF MOTHER INTERVIEWED, COPY MONTH AND YEAR FROM BIRTH HISTORY AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK: What is (NAME'S) birth date?

504. CHECK 502 AND 503: CHILD AGE 0-5 OR BORN IN JANUARY 2001 OR LATER?

505. WEIGHT IN KILOGRAMS

506. HEIGHT IN CENTIMETERS

507. MEASURED LYING DOWN OR STANDING UP?

508. RESULT OF WEIGHT AND HEIGHT MEASUREMENT

509. GO BACK TO 503 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF ADDITIONAL QUESTIONNAIRE(S); IF NO MORE CHILDREN, GO TO 510.

WEIGHT AND HEIGHT MEASUREMENT FOR WOMEN AGE 15-49

510. CHECK COLUMN 9. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 511. IF MORE THAN SIX WOMEN, USE ADDITIONAL QUESTIONNAIRE(S). A FINAL OUTCOME MUST BE RECORDER FOR THE WEIGHT AND HEIGHT MEASUREMENT IN 514.

Q. 511- Q. 514 ARE ASKED OF WOMAN 1, WOMAN 2 AND WOMAN 3 SEPARATELY.

511. LINE NUMBER (COLUMN 9) ___
NAME (COLUMN 2) ___

512. WEIGHT IN KILOGRAMS

513. HEIGHT IN CENTIMETERS

514. RESULT OF WEIGHT AND HEIGHT MEASUREMENT