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2000 Uganda Demographic and Health Survey Women's Questionnaire

IDENTIFICATION
REGION __________
DISTRICT __________
COUNTY __________
SUBCOUNTY/TOWN __________
PARISH/LC2 NAME __________
EA NAME __________
UDHS NUMBER __________

URBAN/RURAL

URBAN 1
RURAL 2

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE ___

LARGE CITY 1
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

TOTAL NUMBER OF VISITS ___

*RESULT CODES


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