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NATIONAL INSTITUTE OF POPULATION STUDIES PAKISTAN DEMOGRAPHIC AND HEALTH SURVEY 2012-13 HOUSEHOLD QUESTIONNAIRE

IDENTIFICATION

PROVINCE/REGION

PUNJAB 1
SINDH 2
KPK 3
BALOCHISTAN 4
GB 5
ICT 6

DISTRICT __

TEHSIL __

CLUSTER NUMBER __

HOUSEHOLD NUMBER __

LARGE CITY 1
SMALL CITY 2
TOWN 3
RURAL 4

HOUSEHOLD SELECTED FOR MEN INTERVIEW

YES 1
NO 2

PLACE NAME __

NAME OF HOUSEHOLD HEAD __

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS

DATE
INTERVIEWER'S NAME
RESULT*

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME
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)

NEXT VISIT:
DATE
TIME

FINAL VISIT:
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

TOTAL NUMBER OF VISITS __

LANGUAGE OF QUESTIONNAIRE: ENGLISH

TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
TOTAL ELIGIBLE MEN ___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __

SUPERVISOR:
NAME
DATE

FIELD EDITOR:
NAME
DATE

OFFICE EDITOR __

KEYED BY __

INTRODUCTION AND CONSENT

Asalum-o-Alaikum. My name is _________. I am working with National Institute of Population Studies. We are conduction a survey about health all over Pakistan. The information we collect will help the government to plan health services. Your household is selected for the survey. I would like to ask you some questions about your household. The questions usually take about 15 to 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you 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. In case you need more information about the survey, you may contact the person listed on this card.
Do you have any questions?
May I begin the interview now?
SIGNATURE OF INTERVIEWER: __________
DATE: ____

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

HOUSEHOLD SCHEDULE

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

1) LINE NO.

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 AS QUESTIONS IN COLUMNS 5-25 FOR EACH PERSON.

2A) Just to make sure that I have a complete household listing: Are there any other persons such as small children or infants that we have not listed?

YES (ADD TO TABLE)
NO

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?

YES (ADD TO TABLE)
NO

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

YES (ADD TO TABLE)
NO

3) RELATIONSHIP TO HEAD OF THE HOUSEHOLD
What is the relationship of (NAME) to the head of the 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 = BROTHER/SISTER IN LAW
10 = NIECE/NEPHEW
11 = GRAND PARENTS
12 = AUNTS/UNCLE
13 = OTHER RELATIVE
14 = ADOPTED/FOSTER/STEPCHILD
16 = DOMESTIC SERVANT
98 = DON'T KNOW

4) SEX
Is (NAME) male or female?

MALE 1
FEMALE 2

5) RESIDENCE
Does (NAME) usually live here?

YES 1
NO 2

6) Did (NAME) stay here last night?

YES 1
NO 2

7) AGE
How old is (NAME)?
IF LESS THAN 1 YEAR, WRITE '00'.
IF AGE 95 YEARS OR MORE, WRITE '95'.

AGE IN YEARS ___

MARITAL STATUS IF AGE 15 YEARS OR OLDER
8) What is (NAME'S) current marital status?

1 MARRIED
2 WIDOWED
3 SEPARATED/DIVORCED
4 NEVER MARRIED

9) ELIGIBILITY
CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49 YEARS WHO ARE MARRIED, WIDOWED, OR DIVORCED OR SEPARATED

10) CIRCLE LINE NUMBER OF ELIGIBLE MAN AGE 15-49 WHO ARE MARRIED, WIDOWED, OR DIVORCED OR SEPARATED

11) CIRCLE LINE NUMBER OF ELIGIBLE CHILD AGE 0-5

EDUCATION IF AGE 5 YEARS OR OLDER
12) Has (NAME) ever attended school?

YES 1
NO 2 (GO TO 17)

13) What is the highest class (NAME) completed?

00 LESS THAN 1 YEAR COMPLETED
01 CLASS 1
02 CLASS 2
03 CLASS 3
04 CLASS 4
05 CLASS 5
06 CLASS 6
07 CLASS 7
08 CLASS 8
09 CLASS 9
10 MATRIC, CLASS 10
11 CLASS 11
12 CLASS 12
13 CLASS 13
14 CLASS 14
15 CLASS 15
16 MASTER'S DEGREE OR MBBS, PhD, MPHIL, BCs (4 YEARS)
98 DON'T KNOW

CURRENT SCHOOLING IF AGE 5-24 YEARS
14) Did (NAME) attend school/college/university at any time during the 2012 year?

YES 1
NO 2 (GO TO 16)

15) During this year, which class/grade is (NAME) attending?

00 LESS THAN 1 YEAR COMPLETED
01 CLASS 1
02 CLASS 2
03 CLASS 3
04 CLASS 4
05 CLASS 5
06 CLASS 6
07 CLASS 7
08 CLASS 8
09 CLASS 9
10 MATRIC, CLASS 10
11 CLASS 11
12 CLASS 12
13 CLASS 13
14 CLASS 14
15 CLASS 15
16 MASTER'S DEGREE OR MBBS, PhD, MPHIL, BCs (4 YEARS)
98 DON'T KNOW

16) What is the main reason (NAME) is not attending school?
REASONS FOR NOT ATTENDING SCHOOL:

01 SCHOOL TOO FAR
02 TRANSPORT NOT AVAILABLE
03 FURTHER EDUCATION NOT NECESSARY
04 REQUIRED FOR HOUSEHOLD/FARMA WORK
05 GOT MARRIED
06 COSTS TOO MUCH
07 NOT INTERESTED IN STUDIES
08 REPEATED FAILURE
09 DID NOT GET ADMISSION
10 NOT SAFE
11 NEED TO WORK TO EARN
96 OTHER
98 DON'T KNOW

SURVIVORSHIP OF BIOLOGICAL PARENTS IF AGE 0-17 YEARS
17) Is (NAME)'s natural mother alive?

YES 1
NO 2 (GO TO 19)
DON'T KNOW 8 (GO TO 19)

18) Does (NAMES)'s natural 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'

____

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

YES 1
NO 2 (GO TO 22)
DON'T KNOW 8 (GO TO 22)

20) Does (NAME) have NIC card or name entered onto a 'bay' form, or nothing at all?
IF NAME IS ON BAY FORM, HAS (NAME) BIRTH CERTIFICATE?
IF NEITHER NIC NOR NAME ON NIC BAY FORM, HAS (NAME) BIRTH CERTIFICATE?

1 HAS NIC
2 NAME ON 'BAY' FORM AND HAVING BIRTH CERTIFICATE
3 NAME ON 'BAY' FORM AND HAVING NO BIRTH CERTIFICATE
4 ONLY BIRTH CERTIFICATE
5 NEITHER OF ABOVE
8 DOES NOT KNOW

MIGRATION FOR ALL USUAL MEMBERS
22) Was (NAME) born in this village/city?

YES 1 (GO TO NEXT)
NO 2

23) From where did (NAME) move to this village/city?

CITY (IF URBAN) 1
DISTRICT (IF RURAL) 2
OUTSIDE COUNTRY 3

24) In which year did (NAME) first move to this village/city?
(WRITE FOUR-DIGIT)

YEAR____
DON'T KNOW 9998

25) What was the primary reason for (NAME)'s move to this village/city?

01 BETTER ECONOMIC/OPPORTUNITIES
02 ACCUMULATE SAVING
03 TRANSFERRED
04 SCHOOLING
05 BETTER INFRASTRUCTURE
06 ACCOMPANIED FAMILY
07 JOIN THE FAMILY
08 ESCAPE DROUGHT/FLOOD
09 ESCAPE WAR/VIOLENCE
10 ESCAPE OTHER NATURAL DISASTER
11 MARRIAGE
12 SINCE CHILDHOOD
13 BIRTH FO POSTPARTUM
96 OTHERS
98 DON'T KNOW

OUT MIGRATION
26) Now I would like to ask you about members of this household who have lived here in the past 10 years but have since moved away.
Are there any members of your household who lived here in the past 10 years but who have since moved away?

YES 1
NO 2 (GO TO 34)
DON'T KNOW 8 (GO TO 34)

27) LINE NO.

_____

28) MIGRANTS
Please give me the names of the persons who are living outside of this household?
AFTER LISTING THE NAMES AND RECORDING THE SEX FOR EACH PERSON, ASK QUESTIONS 31-34 FOR EACH PERSON

_____

29) Is (NAME) male or female?

MALE 1
FEMALE 2

30) In what month and year did (NAME) move away?

MONTH ___
DON'T KNOW MONTH 98

YEAR ____
DON'T KNOW YEAR 9998

31) How old was (NAME) when he/she moved away?
IF AGE 95 OR MORE, RECORD '95'.
IF LESS THAN 1 YEAR OLD, RECORD '00'.

YEARS ___
DON'T KNOW 98

32) What was the main reason that (NAME) moved away?

01 BETTER ECONOMIC/OPPORTUNITIES
02 ACCUMULATE SAVING
03 TRANSFERRED
04 SCHOOLING
05 BETTER INFRASTRUCTURE
06 ACCOMPANIED FAMILY
07 JOIN THE FAMILY
08 ESCAPE DROUGHT/FLOOD
09 ESCAPE WAR/VIOLENCE
10 ESCAPE OTHER NATURAL DISASTER
11 MARRIAGE
12 SINCE CHILDHOOD
96 OTHERS

33) Where has (NAME) travelled to?
IF OTHER CITY OF PAKISTAN, ASK FOR NAME OF CITY AND CODE. IF OTHER PART OF PAKISTAN, AS FOR NAME OF DISTRICT AND CODE. IF OTHER THAN PAKISTAN, ASK FOR NAME OF THE COUNTRY
CIRCLE THE CODES AS PROVIDED.

1 CITY (IF URBAN)
2 DISTRICT (IF RURAL)
3 OUTSIDE COUNTRY

NAME _____
DON'T KNOW 9998

33A) TOTAL NUMBER OF MIGRANTS

___

34) CHECK THE IDENTIFICATION SECTION OF HOUSEHOLD QUESTIONNAIRE. IS HOUSEHOLD SELECTED FOR MEN INTERVIEW?

HOUSEHOLD SELECTED (GO TO 35)
HOUSEHOLD NOT SELECTED (GO TO 101)

35) TABLE FOR SELECTION OF RESPONDENTS FOR SECTION ON DOMESTIC VIOLENCE
LOOK AT THE LAST DIGIT OF THE HOUSEHOLD NUMBER ON THE COVER PAGE. THIS IS THE ROW NUMBER YOU SHOULD GO TO. CHECK THE TOTAL NUMBER OF ELIGIBLE FEMALE RESPONDENTS ON THE COVER SHEET OF THE HOUSEHOLD QUESTIONNAIRE. FOR EACH NON-ZERO NUMBER, THE IS THE COLUMN. YOU SHOULD GO TO THE CELL WHERE THE ROW AND COLUMN MEET; IS THE NUMBER OF THE SELECTED WOMAN FOR DOMESTIC VIOLENCE MODULE.
FOR EXAMPLE, IF THE HOUSEHOLD NUMBER IS '16', GO TO ROW '6'. IF THERE ARE THREE ELIGIBLE WOMEN AGE 15-49 YEARS IN THE HOUSEHOLD, GO TO COLUMN '3'. FIND THE NUMBER IN THE BOX WHERE THE ROW MEETS THE COLUMN ('2'). NOW GO TO THE HOUSEHOLD SCHEDULE AND CIRCLE THE LINE NUMBER OF THE SELECTED WOMEN.
TABLE FOR SELECTION OF RESPONDENTS FOR SECTION ON DOMESTIC VIOLENCE MODULE:
HEADER FOR THE LEFT-HAND COLUMN: "LAST DIGIT OF THE HOUSEHOLD NUMBER (ROW)" (VALUES 0-9 BELOW THIS)
HEADER FOR TOP ROW OF TABLE: "TOTAL NUMBER OF ELIGIBLE WOMEN 15-49 YEARS IN THE HOUSEHOLD" (COLUMN)
COLUMNS WITH 1's, 2's, 3's, 4's, 5's, 6's, 7's, AND 8's FILL THE CELLS OF THE TABLE.

Name of selected woman: _______

36) Line number of selected woman
(IF NO ELIGIBLE WOMAN WRITE '00' AND SKIP TO 101)

_____

SECTION 1. HOUSEHOLD CHARACTERISTICS

101) How often does anyone smoke cigarette/huqa/berri or pipe inside your house? Would you say daily, weekly, monthly, less than monthly, or never?

DAILY 1
WEEKLY 2
MONTHLY 3
LESS THAN MONTHLY 4
NEVER 5

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

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 105)
PIPED TO YARD/PLOT 12 (GO TO 105)
PUBLIC TAP/STANDPIPE 13
TUBE WELL OR BOREHOLE 21
HAND PUMP 22
DUG WELL
PROTECTED WELL 31
UNPROTECTED WELL 32
WATER FROM SPRING
PROTECTED SPRING 41
UNPROTECTED SPRING 42
RAINWATER 51 (GO TO 105)
TANKER TRUCK 61
FILTRATION PLANT 62
CART WITH SMALL TANK 71
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
BOTTLED WATER 91
OTHER (SPECIFY) _____ 96

103) Where is that water source located?

IN OWN DWELLING 1 (GO TO 105)
IN OWN YARD/PLOT 2 (GO TO 105)
ELSEWHERE 3

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

MINUTES ________

105) Do you do anything to the water to make it safer to drink?

YES 1
NO 2 (GO TO 107)
DON'T KNOW 8 (GO TO 107)

106) What do you usually do to make the water safer to drink? Anything else>
CIRCLE ALL MENTIONED.

BOIL A
ADD BLEACH/CHLORINE B
STRAIN THROUGH A CLOTH C
USE WATER FILTER (CERAMIC/SAND/COMPOSITE/ETC.) D
SOLAR DISINFECTION E
LET IT STAND AND SETTLE F
OTHER (SPECIFY) _____ X
DON'T KNOW Z

107) What kind of toilet facility do members of your household usually use?

FLUSH OR POUR FLUSH TOILET
FLUSH TO PIPED SEWER SYSTEM 11
FLUSH TO SEPTIC TANK 12
FLUSH TO PIT LATRINE 13
FLUSH TO SOMEWHERE ELSE 14
FLUSH, DON'T KNOW WHERE 15
PIT LATRINE
VENTILATED IMPROVED
PIT LATRINE (VIP) 21
PIT LATRINE WITH SLAB 22
PIT LATRINE WITHOUT SLAB/OPEN PIT 23
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61 (GO TO 110)
OTHER (SPECIFY) 96

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

YES 1
NO 2 (GO TO 110)

109) How many other households use this toilet facility?

NO. OF HOUSEHOLDS IF LESS THAN 10 __
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98

110) Does your household have: for example:

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
LANDLINE TELEPHONE
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
ALMIRAH/CABINET
YES 1
NO 2
CHAIR
YES 1
NO 2
ROOM COOLER
YES 1
NO 2
AIR CONDITIONER
YES 1
NO 2
WASHING MACHINE
YES 1
NO 2
WATER PUMP
YES 1
NO 2
BED
YES 1
NO 2
CLOCK
YES 1
NO 2
SOFA
YES 1
NO 2
CAMERA
YES 1
NO 2
SEWING MACHINE
YES 1
NO 2
COMPUTER
YES 1
NO 2
INTERNET CONNECTION
YES 1
NO 2

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

ELECTRICITY 01
LPG 02
NATURAL GAS 03
BIOGAS 04
KEROSENE 05
COAL, LIGNITE 06
CHARCOAL 07
WOOD 08
STRAW/SHRUBS/GRASS 09
ANIMAL DUNG 10
NO FOOD COOKED IN HOUSEHOLD 95 (GO TO 114)
OTHER (SPECIFY) 96

112) Is the cooking usually done in this house, in a separate building, or outdoors?

IN THE HOUSE 1
IN A SEPARATE BUILDING 2 (GO TO 114)
OUTDOORS 3 (GO TO 114)
OTHER (SPECIFY) 6 (GO TO 114)

113) Do you have a separate room which is used as a kitchen?

YES 1
NO 2

114) MAIN MATERIAL OF THE FLOOR

NATURAL FLOOR
EARTH/SAND/MUD 11
DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
CHIPS/TERRAZZO 36
BRICKS 37
MATS 38
MARBLE 39
OTHER (SPECIFY) 96

115) MAIN MATERIAL OF THE ROOF

NATURAL ROOFING
NO ROOF 11
THATCH/PALM LEAF 12
SOD/GRASS 13
RUDIMENTARY ROOFING
RUSTIC MAT 21
PALM/BAMBOO 22
WOOD PLANKS 23
CARDBOARD 24
FINISHED ROOFING
IRON SHEETS/ASBESTOS 31
REINFORCED BRICK CEMENT/RCC 32
METAL 33
WOOD/ T IRON/MUD 34
CALAMINE/CEMENT FIBER 35
CERAMIC TILES 36
CEMENT/RCC 37
ROOFING SHINGLES 38
OTHER (SPECIFY) 96

116) MAIN MATERIAL OF EXTERIOR WALLS

NATURAL WALLS
NO WALLS 11
CANE/PALM/TRUNKS 12
DIRT 13
MUD/STONES 14
BAMBOO/STICKS/MUD 15
RUDIMENTARY WALLS
UNBAKED BRICKS/MUD 21
CARTON/PLASTIC 22
BAMBOO WITH MUD 23
STONE WITH MUD 24
UNCOVERED ADOBE 25
PLYWOOD 26
CARDBOARD 27
REUSED WOOD 28
FINISHED WALLS
BAKED BRICKS 31
TENT 32
CEMENT 33
STONE WITH LIME/CEMENT 34
BRICKS 35
CEMENT BLOCKS 36
COVERED ADOBE 37
WOOD PLANKS/SHINGLES 38
OTHER (SPECIFY) 96

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

ROOMS ___

118) Does any member of this household own:

WATCH
YES 1
NO 2
MOBILE TV
YES 1
NO 2
BICYCLE
YES 1
NO 2
MOTORCYCLE/SCOOTER
YES 1
NO 2
ANIMAL-DRAWN CART
YES 1
NO 2
CAR/TRUCKS/BUS
YES 1
NO 2
TRACTOR
YES 1
NO 2
BOAT WITH MOTOR
YES 1
NO 2
BOAT WITHOUT MOTOR
YES 1
NO 2

119) Does any member of this household own any agriculture land?

YES 1
NO 2 (GO TO 121)

120) How many acres or kanals of agricultural land do members of this household own?
IF 95 OR MORE, RECORD '950' IN BOX.

ACRE 1 ____
KANAL 2 ____
DON'T KNOW 9998

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

YES 1
NO 2 (GO TO 123)

122) How many of the following animals does this household own?
IF NONE, ENTER '00'.
IF 95 OR MORE, ENTER '95'.
IF UNKNOWN, ENTER '98'.

A) MILK COWS OR BULLS __
B) HORSES/DONKEYS/MULES __
C) GOATS __
D) SHEEP __
E) CHICKENS __
F) BUFFALO __
G) CAMELS __

123) Does any member of this household have a bank account?

YES 1
NO 2

124) At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitoes?

YES 1
NO 2 (GO TO 126)
DON'T KNOW 8 (GO TO 126)

125) Who sprayed the dwelling?
(CIRCLE ALL MENTIONED)

GOVERNMENT WORKER/PROGRAM A
PRIVATE COMPANY B
NONGOVERNMENTAL ORGANIZATION (NGO) C
OTHER (SPECIFY) X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 131)

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

NUMBER OF NETS __

128) How many of these mosquito nets are insecticide treated?
CIRCLE '0' IF ANSWER IS 'NONE'
IF 7 OR MORE, RECORD '7'

NONE 0 (GO TO 131)
NUMBER OF NETS __
DON'T KNOW 8 (GO TO 131)

129) Do you usually soak the mosquito nets in a liquid that kill or repel mosquitos?

YES 1
NO 2 (GO TO 131)
DON'T KNOW 8 (GO TO 131)

130) Generally, after how many months mosquito nets are soaked or dipped?
IF LESS THAN ONE MONTH, RECORD '00'

MONTHS __
25 OR MORE MONTHS 95
NOT SURE 98

131) Do you think that the use of insecticide treated nets can reduce the incidence of Malaria?

YES 1
NO 2
NOT SURE 8

132) What else your household does to avoid mosquitos?

YES 1
NO 2 (GO TO 134)

133) What do you do? Anything else?
(CIRCLE ALL MENTIONED)

COIL A
MATS B
SPRAY C
ELECTRIC SPRAY REPELLENT D
INSECT REPELLENT E
INFRARED ELECTRIC DEVICE F
SMOKE G
MEMBRANCE H
OTHER (SPECIFY) X

134) Please show me where the members of your household most often was their hands?
OBSERVATION ONLY

OBSERVED 1
NOT OBSERVED, NOT IN DWELLING/YARD/PLOT 2 (GO TO 201)
NOT OBSERVED, NO PERMISSION TO SEE 3 (GO TO 201)
NOT OBSERVED, OTHER REASON 4 (GO TO 201)

135) OBSERVATION ONLY:
OBSERVE PRESENCE OF WATER AT THE PLACE FOR HANDWASHING

WATER IS AVAILABLE 1
WATER IS NOT AVAILABLE 2

136) OBSERVATION ONLY:
OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANING AGENT

SOAP OR DETERGENT (BAR, LIQUID, POWDER, PASTE) A
ASH, MUD, SAND B
NONE C

WEIGHT AND HEIGHT MEASUREMENT FOR CHILDREN AGE 0-5

201) CHECK IDENTIFICATION SECTION OF HOUSEHOLD QUESTIONNAIRE
HOUSEHOLD SELECTED FOR MEN INTERVIEW

YES (GO TO 202)
NO (END OF SECTION)

202) CHECK COLUMN 11 IN HOUSEHOLD SCHEDULE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTION 203. IF MORE THAN 6 CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S).

203) LINE NUMBER FROM COLUMN 11
NAME FROM COLUMN 2

LINE NUMBER __
NAME___

204) IF MOTHER INTERVIEWED, COPY MONTH AND YEAR OR BIRTH FROM PREGNANCY HISTORY AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK: what is (NAME)'s birth date?

DAY__
MONTH__
YEAR__

205) CHECK 204:
CHILD BORN IN JANUARY 2007 OR LATER?

YES 1
NO 2 (GO TO 204 FOR NEXT CHILD OF, IF NO MORE CHILDREN, GO TO 210)

206) WEIGHT IN KILOGRAMS

KG __.__
NOT PRESENT 9994
REFUSED 9995
OTHER 9996

207) HEIGHT IN CENTIMETERS

CM __._
CHILD NOT PRESENT 9994
REFUSED 9995
OTHER 9996

208) MEASURED LYING DOWN OR STANDING UP?

LYING DOWN 1
STANDING UP 2
NOT MEASURED 3

209) GO BACK TO 204 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE NEXT PAGE; IF NO MORE CHILDREN, GO TO 210.

WEIGHT AND HEIGHT MEASUREMENT FOR ELIGIBLE WOMEN

210) CHECK COLUMN 9 IN THE HOUSEHOLD SCHEDULE. RECORD THE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 211. IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONAL QUESTIONNAIRE(S).

211) LINE NUMBER FROM COLUMN 9
NAME FROM COLUMN 2

LINE NUMBER__
NAME___

212) WEIGHT IN KILOGRAMS

KG __.__
NOT PRESENT 99994
REFUSED 99995
OTHER 99996

213) HEIGHT IN CENTIMETERS

CM __._
NOT PRESENT 9994
REFUSED 9995
OTHER 9996

214) PREGNANCY STATUS:
CHECK 234 IN WOMAN'S QUESTIONNAIRE OT ASK:
Are you pregnant?

YES 1
NO 2
NOT PRESENT 4
NOT SURE/DON'T KNOW 8

215) GO BACK TO 212 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF ADDITIONAL QUESTIONNAIRE; IF NO MORE WOMEN, END OF HOUSEHOLD QUESTIONNAIRE