2000 Uganda Demographic and Health Survey Women's Questionnaire
IDENTIFICATION
REGION __________
DISTRICT __________
COUNTY __________
SUBCOUNTY/TOWN __________
PARISH/LC2 NAME __________
EA NAME __________
UDHS NUMBER __________
URBAN 1
RURAL 2
RURAL 2
LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE ___
LARGE CITY 1
SMALL CITY 2
TOWN 3
COUNTRY SIDE 4
SMALL CITY 2
TOWN 3
COUNTRY SIDE 4
HOUSEHOLD NUMBER ___
NAME AND LINE NUMBER OF WOMAN __________
INTERVIEWER VISITS
DATE _____
INTERVIEWER'S NAME __________
*RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) __________
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE USED IN INTERVIEW __________
RESPONDENT'S LOCAL LANGUAGE __________
TRANSLATOR USED
NOT AT ALL 1
SOMETIMES 2
ALL THE TIME 3