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2000 Uganda Demographic and Health Survey Household 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
Countryside 4

Household number ___
Name of household head __________
Household selected for male survey?

Yes 1
No 2

Household selected for Vitamin A testing?

Yes 1
No 2

Interviewer visits (for 1, 2, 3 and final visits)

Date _____
Interviewer's name __________
Result __________
Time __________

Final visit

Day __________
Month __________
Year _____
Name __________
Result __________
Total number of visits ___
Total persons in household ___
Total eligible women ___
Total eligible men ___
Line number of respondent to household questionnaire ___

*Result codes:

1 Completed
2 No household member at home or no competent person at home at time of visit
3 Entire household absent for an extended period
4 Postponed
5 Refused
6 Dwelling vacant or address not a dwelling
7 Dwelling destroyed
8 Dwelling not found
9 Other (specify) __________

Supervisor:
Name __________
Date _____

Field editor:
Name __________
Date _____

Office editor __________
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.

1 Line number (1-20) ___

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 (first and last name in capital letters).

3 Relationship to head of household: What is the relationship of (name) to the head of the household? *Codes for question 3: Relationship to head of 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 Co-wife
10 Other relative
11 Adopted/foster/stepchild
12 Not related
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 Residence: Did (name) stay here last night?

Yes 1
No 2

7 Age: How old is (name)?

Years ___

8 Eligibility: Circle line number of all women age 15-49.

1 2 3 4 5 6 7 8 9 10

9 Eligibility: Circle line number of all children under age 6.

1 2 3 4 5 6 7 8 9 10

10 Eligibility: Circle line number of all men age 15-54.

1 2 3 4 5 6 7 8 9 10

11 Eligibility: Circle line number of all children age 5-17.

1 2 3 4 5 6 7 8 9 10

Parental survivorship and residence for persons less than 18 years old:
12 Is (name)'s natural mother alive?

Yes 1
No 2
Don't know 8

13 If alive: Does (name)'s natural mother live in this household? If Yes: What is her name? Record mother's line number.

Yes 1
No 2
Name __________
Line number ___

14 Is (name)'s natural father alive?

Yes 1
No 2
Don't know 8

15 If alive: Does (name)'s natural father live in this household? If Yes: What is his name? Record mother's line number.

Yes 1
No 2
Name __________
Line number ___

16 Education: If age 4 years or older: Has (name) ever attended school?

Yes 1
No 2

17 Education: If age 4 years or older:What is the highest level of school (name) has attended? What is the highest grade (name) completed at that level?
Level

0 Preschool
1 Primary
2 Secondary
3 Post secondary
8 Don't know

Grade

00 Less than 1 year completed
98 Don't know

18 Education: If age 4-24 years: Is (name) currently attending school?

Yes 1 (GO TO 20)
No 2

19: Education: If age 4-24 years: During the current school year (2000), did (name) attend school at any time?

Yes 1
No (GO TO 21)

20 Education: If age 4-24 years: During the current school year (2000), what level and grade (is/was) (name) attending?
Level

0 Preschool
1 Primary
2 Secondary
3 Post secondary
8 Don't know

Grade

00 Less than 1 year completed
98 Don't know

21 Education: If age 4-24 years: During the previous school year (1999), did (name) attend school at any time?

Yes 1
No 2

22: Education: If age 4-24 years: During that school year (1999), what level and grade did (name) attend?
Level

0 Preschool
1 Primary
2 Secondary
3 Post secondary
8 Don't know

Grade

00 Less than 1 year completed
98 Don't know

Tick here if continuation sheet used ___
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 ___
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 ___
No ___

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

Yes ___
No ___

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

Piped water
Piped into dwelling 11 (GO TO 25)
Piped into yard/plot 12 (GO TO 25)
Public tap 13
Water from open well
Open well in yard/plot 21 (GO TO 25)
Open public well 22
Water from covered well
Protected well in yard/plot 31 (GO TO 25)
Protected public well 32
Water from borehole
Borehold in yard/plot 33 (GO TO 25)
Borehold public 34
Surface water
Spring 41
River/stream 42
Pond/lake 43
Dam 44
Rainwater 51 (GO TO 25)
Tanker truck 61
Bottled water 71 (GO TO 25)
Gravity flow scheme 81
Other (specify) __________ 96

24 How long does it take you to go there, get water, and come back?

Minutes ___

25 What kind of toilet facility does your household have?

Flush toilet 11
Pit toilet/latrine
Traditional pit toilet 21
Ventilated improved pit (VIP) latrine 22
No facility/bush/field 31 (GO TO 27)
Other (specify) __________ 96

26 Do you share this facility with other households?

Yes 1
No 2

27 Does your household have:

Electricity?
Yes 1
No 2
A radio?
Yes 1
No 2
A television?
Yes 1
No 2
A telephone?
Yes 1
No 2
A refrigerator?
Yes 1
No 2
A lantern?
Yes 1
No 2
A cupboard?
Yes 1
No 2

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

Electricity 01
LPG/natural gas 02
Biogas 03
Kerosene 04
Charcoal 05
Firewood, straw 06
Dung 07
Other (specify) __________ 96

29 What type of fuel does your household mainly use for lighting?

Electricity 01
LPG/natural gas 02
Biogas 03
Kerosene 04
Charcoal 05
Firewood, straw 06
Dung 07
Other (specify) __________ 96

30 Main material of the floor: Record observation.

Natural floor
Earth/sand 11
Dung 12
Finished floor
Parquet and polished wood 31
Vinyl or asphalt strips 32
Ceramic tiles 33
Cement 34
Other (specify) __________ 96

31 Main material of the roof: Record observation.

Thatched 01
Iron sheets 02
Asbestos 03
Tiles 04
Tin 05
Cement 06
Other (specify) __________ 96

32 Main material of the wall: Record observation.

Thatched 01
Mud and pole 02
Unburnt bricks 03
Burnt bricks with mud 04
Burnt bricks with cement 05
Timber 06
Cement blocks 07
Stone 08
Other (specify) __________ 96

33 Does any member of your household own:

A bicycle?
Yes 1
No 2
A motorcycle or motor scooter?
Yes 1
No 2
A car or truck?
Yes 1
No 2
A boat or canoe?
Yes 1
No 2
A donkey?
Yes 1
No 2

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

Yes 1
No 2 (GO TO 38)

35 Check columns 6 and 7:
Number of children under age 5 who slept in the household last night.

None ___ (GO TO 38)
One ___
Two or more ___ (GO TO 37)

36 Did (name) sleep under a mosquito net last night?

Yes 1
No 2 (GO TO 38)

37 Did all, some or none of the children under age 5 who slept in the household last night sleep under a mosquito net?

All children 1
Some children 2
None 3

38 Where do you usually wash your hands?

In dwelling/yard/plot 1
Somewhere else 2 (GO TO 40)
Nowhere 3 (GO TO 40)

39 Ask to see the place and observe if the following items are present.

Water/tap
Yes 1
No 2
Soap, ash or other cleansing agent
Yes 1
No 2
Basin
Yes 1
No 2

40 Ask respondent for a teaspoonful of salt. Test salt for iodine.
Record PPM (parts per million).

0 PPM (no iodine) 1
Below 15 PPM 2
15 PPM+ 3
No salt 4

Child Labour Module for Children Ages 5-17

1 Line number (from column 11) ___

2 Name (from column 2) __________

3 At any time during the past year, did (name) do any kind of work for someone who is not a member of this household?

Yes 1
No 2 (GO TO 10)

4 Worked at any time in the past year: Describe briefly the main work of job that (name) did.

__________

5 Worked at any time in the past year: Was (name) a regular paid employee, a casual labourer, paid per piece or unpaid?

__________

6 Worked at any time in the past year: Where did (name) carry out the work?

__________

7 Since last (day of the week) did (name) do any kind of work for someone who is not a member of this household?

Yes 1
No 2 (GO TO 10)

8 Describe briefly the main work or job that (name) did.

___

9 Since last (day of the week) how many hours did (name) do this work?

Number of hours ___

10 Since last (day of the week) did (name) regularly help with household chores such as cooking, shopping, cleaning, washing cloths, fetching water or caring for animals?

Yes 1
No 2 (GO TO 12)

11 Since last (day of the week), how many hours a week did (name) spend doing these chores?

Number of hours ___

12 Since last (day of the week), did (name) do any other family work (on the farm or in a business)?

Yes 1
No 2

13 Since last (day of the week), how many hours did (name) do this work?

Number of hours ___

Tick here if continuation sheet used ___
Codes for column 4 and 8

01 Sales, services
02 Unskilled manual
03 Household/domestic
04 Crop farming
05 Livestock rearing
06 Fishing
07 Manufacturing
08 Other

Codes for column 5

1 Regular paid employee
2 Casual labourer
3 Paid at piece rate
4 Unpaid

Codes for column 6

01 At family dwelling
02 At employer's house
03 On the street
04 Shop/market/kiosk
05 Industry/factory
06 Plantation/farm/garden
07 Construction/quarrying sites
08 Other

Weight, Height and Hemoglobin Measurement

1 Measured
2 Not present
3 Refused
4 Disabled
6 Other

41 Check columns 8 and 9: Record the line number, name and age of all women age 15-49 and all children under age 6.

Women 15-49
Line number from column 8

Line number ___

Children under age 6
Line number from column 9

Line number ___

Men age 15-54
Line number from column 10

Line number ___

42
Women 15-49
Name from column 2

Name __________

Children under age 6
Name from column 2

Name __________

Men age 15-54
Name from column 2

Name __________

43
Women 15-49
Age from column 7

Age ___

Children under age 6
Age from column 7

Age ___

Men age 15-54
Age from column 7

Age ___

44
Women 15-49
What is (name)'s date of birth?

Day ___
Month __________
Year _____

Children under age 6
What is (name)'s date of birth

Day ___
Month __________
Year _____

45
Weight and height measurement of women 15-49
Weight (kilograms)

Weight ___

Weight and height measurement of children born in 1995 or later
Weight (kilograms)

Weight ___

46
Weight and height measurement of women 15-49
Height (centimeters)

Height ___

Weight and height measurement of children born in 1995 or later
Height (centimeters)

Height ___

47
Weight and height measurement of women 15-49
Measured lying down or standing up

Lying down 1
Standing up 2

Weight and height measurement of children born in 1995 or later
Measured lying down or standing up

Lying down 1
Standing up 2

48
Weight and height measurement of women 15-49
Result

Result __________

Weight and height measurement of children born in 1995 or later
Result

Result __________

Tick here if continuation sheet used ___

*Record '00' if not listed in household schedule

**Consent statement
As part of this survey, we are studying anemia (and vitamin A deficiency) among women, men and children. This (these) problem(s) often result from poor nutrition.
This survey will assist the government to develop programs to prevent and treat anemia (and vitamin A deficiency).
We request that you (and all children born in 1995 or later) participate in the anemia (and vitamin A deficiency) testing as part of this survey and give a few drops of
blood from a finger. The tests use disposable sterile instruments that are clean and completely safe. For anemia test, the blood will be analyzed with new equipment
and the results of the test will be given to you right after the blood is taken. (The vitamin A test has to be done in a laboratory so you will not be given the results). The
results of the (both) test(s) will be kept confidential.
May I now ask that you (and name of child(ren)) participate in the anemia (and vitamin A deficiency test). However, if you decide not to have the test done, it is
your right and we will respect your decision. Now please tell me if you agree to have the test(s) done.

1 Measured
2 Not present
3 Refused
6 Other

49
Hemoglobin and Vitamin A Measurements of women 15-49
Check column 43

Age 15-17 1
Age 18-49 2 (GO TO 51)

Hemoglobin Measurement of men 15-54
Check column 43

Age 15-17 1
Age 18-54 2 (GO TO 51)

50
Hemoglobin and Vitamin A Measurements of women 15-49
Line number of parent/responsible adult *

Line number ___

Hemoglobin and Vitamin A Measurements of children born in 1995 or later
Line number of parent/responsible adult

Line number ___

Hemoglobin Measurement of Men 15-54
Line number of parent/responsible adult

Line number ___

51
Hemoglobin and Vitamin A Measurements of women 15-49
Read consent statement to woman/parent/responsible adult **
Circle code (and sign)

Granted 1 (sign) __________
Refused 2

Hemoglobin and Vitamin A Measurements of children born in 1995 or later
Read consent statement to woman/parent/responsible adult **
Circle code (and sign)

Granted 1 (sign) __________
Refused 2

Hemoglobin Measurement of Men 15-54
Read consent statement to woman/parent/responsible adult **
Circle code (and sign)

Granted 1 (sign) __________
Refused 2

52
Hemoglobin and Vitamin A Measurements of women 15-49
Tested for Vitamin A deficiency

Yes 1
No 2
NA 3

Hemoglobin and Vitamin A Measurements of children born in 1995 or later
Tested for Vitamin A deficiency

Yes 1
No 2
NA 3

53
Hemoglobin and Vitamin A Measurements of women 15-49
Hemoglobin level (G/DL)

___

Hemoglobin and Vitamin A Measurements of children born in 1995 or later
Hemoglobin level (G/DL)

___

Hemoglobin Measurement of Men 15-54
Hemoglobin level (G/DL)

___

54 Hemoglobin and Vitamin A Measurements of women 15-49: Currently pregnant?

Yes 1
No/don't know 2

55
Hemoglobin and Vitamin A Measurements of women 15-49

Result ___

Hemoglobin and Vitamin A Measurements of children born in 1995 or later

Result ___

Hemoglobin Measurement of Men 15-54

Result ___

55 Check 52 and 53:
Number of persons with hemoglobin level below the cutoff point *

One or more ___ (give each woman/man/parent/responsible adult result of hemoglobin measurement, referral letter and end the interview)
None ___ (give each woman/man/parent/responsible adult result of hemoglobin measurement and end the interview)

56 We detected a low level of hemoglobin in (your blood/the blood of name of child(ren)). This indicates that (you/name of child(ren)) have developed severe anemia, which is a serious health problem.

You should seek medical assistance for this problem. We will give you a letter of referral which you can take to the doctor or health facility you consult. It provides information on the results of your test that will help the doctor or health facility.

* The cutoff point is 9 g/dl for pregnant women and 7 g/dl for children, women who are not pregnant (or who don.t know if they are
pregnant), and men.

** If more than one woman, man or child is below the cutoff point, read the statement in Q.56 to each woman who is below the cutoff point
and each woman/parent/responsible adult for whom a child is below the cutoff point.

To be filled in after completing interview
Comments about measurement

__________
__________
__________