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A planned IPUMS system update is scheduled for Monday, December 9. The maintenance window is 10am to 1pm CST. Within that window, each site will have a brief outage of 10 or fewer minutes. This notice will be removed as soon as the update is complete.

UGANDA MINISTRY OF HEALTH DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE 1988/1989

ENGLISH VERSION

IDENTIFICATION

DISTRICT _____________
SUBCOUNTY/TOWN _____________
PARISH/WARD _____________
SUBPARISH/RC2 _____________
CLUSTER NUMBER
HOUSEHOLD NUMBER

INTERVIEWER VISITS

FIRST VISIT
DATE __________
INTERVIEWER'S NAME __________
RESULT __________

NEXT VISIT:
DATE __________
TIME __________

SECOND VISIT
DATE __________
INTERVIEWER'S NAME __________
RESULT __________

NEXT VISIT:
DATE __________
TIME __________

THIRD VISIT
DATE __________
INTERVIEWER'S NAME __________
RESULT __________

FINAL VISIT
MONTH
YEAR

TOTAL NUMBER OF VISITS

*RESULT CODES:

1 COMPLETED
2 HOUSEHOLD PRESENT BUT NO COMPETENT RESPONDENT AT HOME
3 HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) ___________

TOTAL IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN

FIELD EDITED BY

NAME
DATE

OFFICE EDITED BY

NAME
DATE

KEYED BY

NAME
DATE

KEYED BY

HOUSEHOLD SCHEDULE

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

NUMBER

1)

USUAL RESIDENTS AND VISITORS

2) Please give me the names of the persons who usually live in your household or are staying with you now, starting with the head of the household.

________________

RESIDENCE

3) Does (NAME) usually live here?

YES 1
NO 2

4) Did (NAME) sleep here last night?

YES 1
NO 2

SEX

5) Is (NAME) male or female?

MALE 1
FEMALE 2

AGE

6) How old is he/she?

IN YEARS

FOSTERING (ONLY FOR CHILDREN UNDER 15 YEARS OLD)

7) Do any of his/her parents usually live in this household?

YES 1
NO 2

ELIGIBILITY

8) CIRCLE LIN E NUMBER OF WOMEN ELIGIBLE FOR INDIVIDUAL INTERVIEW

Just to make sure that I have a complete listing:

1. Are there any other persons such as small children or infants that we have not listed?

YES (ENTER EACH IN TABLE)
NO

2. In addition, 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 (ENTER EACH IN TABLE)
NO

3. Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?

YES (ENTER EACH IN TABLE)
NO

TICK HERE IF CONTINUATION SHEET USED
TOTAL NUMBER OF ELIGIBLE WOMEN ON THIS SHEET [first sheet]
TOTAL NUMBER OF ELIGIBLE WOMEN ON THIS SHEET [second sheet]
TOTAL NUMBER OF ELIGIBLE WOMEN ON BOTH SHEETS