IDENTIFICATION

PROVINCE

DISTRICT __

TEHSIL __

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

IS HOUSEHOLD SELECTED FOR:

NAME OF HOUSEHOLD HEAD ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE __
INTERVIEWERS NAME ___
RESULT* __

NEXT VISIT:
DATE ______
TIME _______

FINAL VISIT
DAY __
MONTH __
YEAR ___
INT. NUMBER ___
RESULT* __

TOTAL NUMBER OF VISITS __

TOTAL PERSONS IN HOUSEHOLD __

DEATHS UNDER 5/SBs FROM Q. 38 __

FEMALE DEATHS AGE 12-49 FROM Q. 39 __

LINE NO. OF RESPONDENT __

LANGUAGE OF QUESTIONNAIRE: URDU

SUPERVISOR
NAME__
DATE__

FIELD EDITOR
NAME__
DATE__

OFFICE EDITOR__

KEYED BY __

SIGNATURE OF INTERVIEWER: _____
DATE: __

HOUSEHOLD SCHEDULE

Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NUMBER __

2) USUAL RESIDENTS AND VISITORS
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 NAMES, RELATIONSHIP AND SEX FOR EACH PERSON, ASK Qs. 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK QUESTIONS IN COLUMNS 5-11 FOR EACH PERSON.

3) RELATIONSHIP TO HEAD OF THE HOUSEHOLD
What is the relationship of (NAME) to the head of the household?

4) Is (NAME) male or female?

5) Does (NAME) usually live here?

6) Did (NAME) stay here last night?

7) How old is (NAME)?
IF LESS THAN 1 YEAR, WRITE 00
IF AGE 96 YEARS OR MORE, WRITE 96

IF AGE 12 OR OLDER
MARTIAL STATUS

8) What is (NAME'S) current marital status?

ELIGIBILITY

9) CIRCLE LINE NUMBER OF ALL WOMEN AGE 12-49 WHO ARE MARRIED, WIDOWED OR DIVORCED OR SEPARATED

IF AGE 5 YEARS OR OLDER

EDUCATION
10) Has (NAME) ever attended school?

11) What is the highest class of school (NAME) completed?

IF AGE 5-24 YEARS
CURRENT SCHOOLING

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

13) During this school year, what class/grade is/was (NAME) attending?

SCHOOLING DURING LAST YEAR
14) Did (NAME) attend school at any time during the previous year 2005?

IF AGE 0-17 YEARS
SURVIVORSHIP OF BIOLOGICAL PARENTS

15) Is (NAME)'s natural mother alive?

16) Is (NAME)'s natural father alive?

FOR ALL AGES
REGISTRATION WITH NADRA

17) Has (NAME) been registered with NADRA?
IF YES- PROBE: Does (NAME) have NIC card or name entered onto a 'bay' form, or nothing at all?

Just to make sure that I have a complete household listing:

2A) Are there any other persons such as a small child or infants that we have not listed?

2B) Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here?

2C) Are there any guests or temporary visitors staying here, or anyone else who slept here last night, who have not been listed?

IF NO MORE MEMBERS, GO TO COLUMN 5.

INFORMATION ABOUT BIRTHS AND DEATHS IN THE HOUSEHOLD IN THE PREVIOUS 3 YEARS.

18) Now I would like to ask you about all the births that occurred in this household in the last 3 years, whether they were born alive or dead. Since January 2003, did any woman who was a usual resident of this household at that time give birth? I am interested in any birth, even stillbirths and children who did not survive.

19) How many births occurred in this household in the last 3 years?

20) LINE NUMBER

21) What are the names of the babies born in the last three years?
IF STILL BORN, WRITE 'BABY'

22) Is (NAME) a boy or girl?

23) In what month and yeah was (NAME) born?
IF MONTH DON'T KNOW, RECORD '98'

24) Was (NAME) born alive?

25) Is (NAME) still alive?

26) LINE NUMBER FROM HOUSEHOLD ROSTER (RECORD '00' IF CHILD NOT LISTED IN HH ROSTER)

27) Now I would like to ask you about any death that occurred in this household in the last 3 years. Since January 2003, God forbid, has any usual member of this household died?

28) How many deaths occurred to usual residents in this household in the last three years?

29) LINE NUMBER

30) What were the names of the people who died in the last three years?

31) Was (NAME) male or female?

32) In what month and year did (NAME) die?
IF MONTH DON'T KNOW, RECORD '98'

33) How old was (NAME) when he/she died?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN 2 YEARS' OR YEARS

34) CHECK 31 AND 33: WAS THIS A WOMAN AGE 12-49 WHEN SHE DIED?

FEMALE, 12-49 YEARS OLD:

35) Was (NAME) pregnant when she died?

36) Did (NAME) die during childbirth?

37) Did (NAME) die within 6 weeks after delivery?

38) CHECK COLS. 32, 33, AND 23/24: NUMBER OF DEATHS TO CHILDREN UNDER 5 YEARS AND STILLBIRTHS IN 2005 OR AFTER

39) CHECK COLUMN 34 AND 32: NUMBER OF DEATHS TO WOMEN AGE 12-49 YEARS OLD IN 2003 OR AFTER

HOUSEHOLD CHARACTERISTICS

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

102) How long does it take to go there, get water, and come back?

103) Do you treat your water in any way to make it safer to drink?

104) What do you usually do to the water to make it safer to drink?
Anything else?
RECORD ALL MENTIONED.

105) What kind of toliet facility do members of your household usually use?

106) Do you share this toilet facility with other households?

107) Does your household have:

108) What type of fuel does your household mainly use for cooking?

109) MAIN MATERIAL OF THE FLOOR:
RECORD OBSERVATION

110) MAIN MATERIAL OF THE ROOF:
RECORD OBSERVATION.

111) MAIN MATERIAL OF THE WALLS:
RECORD OBSERVATION.

112) How many rooms in this household are used for sleeping?

113) Is this house rented, rent-free, mortgaged, or owned by a member of the household?

114) Does any member of this household own:

115) Does any member of this household own any land that can be used for agriculture?

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

117) How many of the following animals does this household own?
IF NONE, WRITE '00'. IF LESS THAN 95, WRITE '95'. IF UNKNOWN, WRITE '98'

118) Does your household have any mosquito nets that can be used while sleeping?

119) How many mosquito nets does your household have?

ASK THESE QUESTIONS FOR ONLY TWO BEDNETS:
120) When you got the net, was it already treated with an insecticide to kill or repel mosquitos?

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

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

123) Did anyone sleep under this mosquito net last night?

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

125) GO BACK TO 120 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 126

126) Does your household do anything (else) to avoid mosquitos?

127) What do you do?
CIRCLE ALL MENTIONED.

128) Do you have any medicines for treating malaria in your house now?