IDENTIFICATION

DISTRICT

RESIDENCE STATUS

COUNTY

SUBCOUNTY/TOWN

PARISH/LC1 NAME

EA NAME

NAME OF HOUSEHOLD HEAD

HOUSEHOLD NUMBER

HOUSEHOLD SELECTED FOR MALE INTERVIEW, HEIGHT, WEIGHT, ANEMIA,VITAMIN A

HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE

HOUSEHOLD SELECTED FOR UNHS IV

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

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NUMBER __ __ __
RESULT __

TOTAL NUMBER OF VISITS __

*RESULT CODES:

TOTAL PERSONS IN HOUSEHOLD __ __

TOTAL ELIGIBLE WOMEN __ __

TOTAL ELIGIBLE MEN __ __

LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __ __

LANGUAGE OF THE QUESTIONNAIRE __ __

LANGUAGE USED IN THE INTERVIEW __ __

NATIVE LANGUAGE OF RESPONDENT __ __

TRANSLATOR USED

LANGUAGE USED:

SUPERVISOR

NAME ___________ __ __ __

FIELD EDITOR
NAME ___________ __ __ __

OFFICE EDITOR __ __

KEYED BY __ __

INTRODUCTION AND CONSENT

Hello. My name is _______________________________________ I am working with Uganda Bureau of Statistics. We are conducting a survey about health all over UGANDA. The information we collect will help the government to plan health services. Your household was selected for the survey I would like to ask you some questions about your household. The questions usually take about 30 to 45 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.

Do you have any questions?

May I begin the interview now?

SIGNATURE OF INTERVIEWER: ____________________
DATE: __________

START TIME

HOUSEHOLD SCHEDULE

1) LINE NO.

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 THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.

THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-29 FOR EACH PERSON.

3) RELATIONSHIP TO HEAD OF HOUSEHOLD

What is the relationship of (NAME) to the head of the household?

SEE CODES BELOW

4) SEX

Is (NAME) male or female?

RESIDENCE

5) Does (NAME) usually live here?

6) Did (NAME) stay here last night?

7) AGE

How old is (NAME)?

IF 95 OR MORE RECORD '95'

8) MARITAL STATUS
[IF AGE 15 OR OLDER]

What is (NAME'S) current marital status?

ELIGIBILITY

9) CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49

10) CIRCLE LINE NUMBER OF ALL MEN AGE 15-54

11) CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5

TICK HERE IF CONTINUATION SHEET USED ___

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

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?

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

CODES FOR Q 3: RELATIONSHIP TO HEAD OF HOUSEHOLD

[IF AGE 0-17 YEARS]

SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS

12) Is (NAME)'s natural mother alive?

13) Does (NAME)'s natural mother 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.

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

YES 1
NO 2 (GO TO 16)
DON'T KNOW 8 (GO TO 16)

15) Does (NAMES)'s natural father live in this household or was he a guest last night?

IF YES: What is his name?
RECORD FATHER'S LINE NUMBER.

IF NO, RECORD 00.

[IF AGE 3 YEARS OR OLDER]

EVER ATTENDED SCHOOL

16) Has (NAME) ever attended school?

17) What is the highest level of school (NAME) has attended?
SEE CODES BELOW.

What is the highest grade (NAME) completed at that level?
SEE CODES BELOW.

[IF AGE 3-24 YEARS]

CURRENT SCHOOL ATTENDANCE

18) Did (NAME) attend school at any time during the 2011 school year?

19) During this school year, what level and grade is/was (NAME) attending?

SEE CODES BELOW.

[0-4 YEARS]

BIRTH REGISTRATION

20) Does (NAME) have a birth certificate?

IF YES, ASK RESPONDENT TO SHOW CERTIFICATE.

IF NO, PROBE: Has (NAME) ever been registered for purpose of being given a birth certificate (by LC1 officials)?

[IF AGE 5-17 YEARS]

BASIC MATERIAL NEEDS

21) Does (NAME) have a blanket?

22) Does (NAME) have a pair of shoes?

23) Does (NAME) have at least two sets of clothes?

CODES FOR Qs 17 AND 19: EDUCATION

LEVEL

GRADE

[COMPLETE COLUMNS 24-29 FOR ALL HH MEMBERS AGED 5 OR OLDER]

DIFFICULTIES

24) Because of a physical, mental or, emotional health condition, does (NAME) have difficulty seeing even if he/she is wearing glasses?

25) Because of a physical, mental or, emotional health condition, does (NAME) have difficulty hearing even if he/she is using a hearing aid?

26) Because of a physical, mental or, emotional health condition, does (NAME) have difficulty walking or climbing steps?

27) Because of a physical, mental or, emotional health condition, does (NAME) have difficulty remembering or concentrating?

28) Because of a physical, mental or, emotional health condition does (NAME) have difficulty with self care such as washing all over, dressing, feeding, toileting?

29) Because of a physical, mental or, emotional health condition does (NAME) have difficulty
communicating for example understanding others or being understood by others?

TABLE FOR SELECTION OF RESPONDENT FOR THE VIOLENCE QUESTIONS

CHECK COVER PAGE TO SEE IF HOUSEHOLD IS SELECTED FOR DOMESTIC VIOLENCE SECTION

INSTRUCTIONS

LOOK AT THE LAST DIGIT OF THE QUESTIONNAIRE NUMBER ON THE COVER PAGE. THIS IS THE ROW NUMBER YOU SHOULD CIRCLE IF THE HH IS SELECTED FOR A FEMALE RESPONDENT, CHECK THE TOTAL NUMBER OF ELIGIBLE WOMEN ON THE COVER SHEET OF THE HOUSEHOLD QUESTIONNAIRE. THIS IS THE COLUMN NUMBER YOU SHOULD CIRCLE.

IF THE HH IS SELECTED FOR A MALE RESPONDENT, CHECK THE TOTAL NUMBER OF ELIGIBLE MEN ON THE COVER SHEET OF THE HOUSEHOLD QUESTIONNAIRE AND CIRCLE THIS COLUMN NUMBER. FIND THE BOX WHERE THE CIRCLED ROW AND THE CIRCLED COLUMN MEET AND CIRCLE THE NUMBER THAT APPEARS IN THE BOX. THIS IS THE NUMBER OF THE ELIGIBLE WOMAN/MAN WHO WILL BE ASKED THE VIOLENCE QUESTIONS.

THEN, GO TO COLUMN (9) IN THE HOUSEHOLD SCHEDULE IF THE HH IS SELECTED FOR FEMALE RESPONDENT OR COLUMN (10) IF THE HH IS SELECTED FOR A MALE RESPONDENT, AND PUT A * NEXT TO THE HOUSEHOLD LINE NUMBER OF THE SELECTED ELIGIBLE WOMAN/MAN AND RECORD THIS HOUSEHOLD LINE NUMBER IN THE TWO BOXES AT THE BOTTOM OF THIS TABLE.

FOR EXAMPLE, IF THE HOUSEHOLD QUESTIONNAIRE NUMBER IS '3716', GO TO ROW 6 AND CIRCLE THE ROW NUMBER ('6'). IF THE HH IS SELECTED FOR A FEMALE RESPONDENT TO THE DV SECTION AND THERE ARE THREE ELIGIBLE WOMEN IN THE HOUSEHOLD, GO TO COLUMN 3 AND CIRCLE THE COLUMN NUMBER ('3').

DRAW LINES FROM ROW 6 AND COLUMN 3 AND FIND THE BOX WHERE THE TWO MEET, AND CIRCLE THE NUMBER IN IT ('2'). THIS MEANS YOU HAVE TO SELECT THE SECOND ELIGIBLE WOMAN SUPPOSE THE HOUSEHOLD LINE NUMBERS OF
THE THREE ELIGIBLE WOMEN ARE '02', '03', AND '07'; THEN THE ELIGIBLE WOMAN FOR THE DOMESTIC VIOLENCE QUESTIONS IS THE SECOND ELIGIBLE WOMAN, I E , THE WOMAN WITH HOUSEHOLD LINE NUMBER '03'.

PUT A * NEXT TO THIS WOMAN'S LINE NUMBER IN COLUMN (9) OF THE HOUSEHOLD SCHEDULE AND ALSO ENTER THE TWO DIGIT LINE NUMBER IN THE TWO BOXES AT THE BOTTOM OF THIS TABLE.

[Lefthand column of table] LAST DIGIT OF THE QUESTIONNAIRE NUMBER (ROW).
Numbers 0 through 9 follow.

[Top row of table] TOTAL NUMBER OF ELIGIBLE WOMEN IN THE HOUSEHOLD (COLUMN)
Rows of numbers 1 through 8, 1 number in each column, follows.

HOUSEHOLD LINE NUMBER OF PERSON SELECTED FOR VIOLENCE MODULE __ __

HOUSEHOLD CHARACTERISTICS

101) Sometimes people smoke inside our houses for example our family members, our neighbors or even our friends. How often does anyone smoke inside your house? Would you say daily, weekly, monthly, less than monthly, or never?

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

103) Where is that water source located?

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

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

106) What do you usually do to make the water safer to drink?

Anything else?
RECORD ALL MENTIONED

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

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

109) How many households use this toilet facility?

109A) Does this toilet have any facility for washing hands after use?

110) Does your household have:

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

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

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

114) MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.

115) MAIN MATERIAL OF THE ROOF.
RECORD OBSERVATION.

116) MAIN MATERIAL OF THE EXTERIOR WALLS.
RECORD OBSERVATION.

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

118) Does any member of this household own:

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

120) How many acres of agricultural land do members of this household own?
IF 95 OR MORE, CIRCLE '950'

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

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'

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

125) Who sprayed the dwelling?

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

127) How many mosquito nets does your household have?

IF 7 OR MORE NETS, RECORD '7'

128) ASK THE RESPONDENT TO SHOW YOU THE NETS IN THE HOUSEHOLD.

IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S).

129) How many months ago did your household get the mosquito net?

IF LESS THAN ONE MONTH AGO, RECORD '00'.

130) OBSERVE THE BRAND/TYPE OF MOSQUITO NET.

IF NOT OBSERVED ASK: What brand is this net?

IF BRAND IS UNKNOWN AND YOU CANNOT OBSERVE THE NET, SHOW PICTURES OF TYPICAL NET TYPES/BRANDS TO RESPONDENT

132) Since you got the mosquito net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?

133) How many months ago was the net last soaked or dipped?

IF LESS THAN ONE MONTH AGO, RECORD '00'

134) Did anyone sleep under this mosquito net last night?

135) Who slept under this mosquito net last night?

RECORD THE PERSON'S NAME AND LINE NUMBER FROM THEHOUSEHOLD SCHEDULE

136) GO BACK TO 128 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 137.

137) Please show me where members of your household most often wash their hands

138) OBSERVATION ONLY:

OBSERVE PRESENCE OF WATER AT THE PLACE FOR HANDWASHING.

139) OBSERVATION ONLY:

OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT

140) ASK RESPONDENT FOR A TEASPOONFUL OF COOKING SALT.

TEST SALT FOR IODINE.

WEIGHT, HEIGHT, HEMOGLOBIN AND VITAMIN A MEASUREMENT FOR CHILDREN AGE 0-5

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

202) LINE NUMBER FROM COLUMN 11
NAME FROM COLUMN 2

203) IF MOTHER INTERVIEWED, COPY MONTH ANDYEAR OF BIRTH FROM BIRTH HISTORY AND ASK DAY;

IF MOTHER NOT INTERVIEWED, ASK: What is (NAME)'s birth date?

204) CHECK 203: CHILD BORN IN JANUARY 2006 OR LATER?

205) WEIGHT IN KILOGRAMS

206) HEIGHT IN CENTIMETERS

207) MEASURED LYING DOWN
OR STANDING?

208) CHECK 203: IS CHILD AGE 0-5 MONTHS, I.E., WAS CHILD BORN IN
MONTH OF INTERVIEW OR FIVE PREVIOUS MONTHS?

209) LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR THE CHILD (FROM COLUMN 1 OF HOUSEHOLD SCHEDULE).

RECORD '00' IF NOT LISTED

210) ASK CONSENT FOR ANEMIA TEST FROM PARENT/OTHER ADULT IDENTIFIED IN 209 AS RESPONSIBLE FOR CHILD.

As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anemia.

We ask that all children born in 2006 or later take part in anemia testing in this survey and give a few drops of blood from a finger or heel. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test.

The blood will be tested for anemia immediately, and the result will be told to you right away. The result will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Do you have any questions?
You can say yes to the test, or you can say no. It is up to you to decide.
Will you allow (NAME OF CHILD) to participate in the anemia test?

211) CIRCLE THE APPROPRIATE CODE AND SIGN YOUR NAME.

211A) ASK CONSENT FOR VITAMIN A TEST FROM PARENT/OTHER ADULT IDENTIFIED IN 209 AS RESPONSIBLE FOR CHILD.

As part of the survey we also are asking people all over the country to take a test for vitamin A deficiency. Vitamin A deficiency is a health problem that can result from poor nutrition. This survey will help the government to develop programs to prevent and treat vitamin A deficiency.

For the vitamin A test, we need a few more drops of blood from a finger. Again the equipment used in taking the blood is clean and completely safe. It has never been used before and will be thrown away after each test.

No names will be attached so we will not be able to tell you the test results. No one else will be able to know the test results either.

Do you have any questions?
You can say yes to the test, or you can say no. It is up to you to decide.
Will you allow (NAME OF CHILD) to take the vitamin A deficiency test?

211B) CIRCLE THE APPROPRIATE CODE AND SIGN YOUR NAME

211C) CIRCLE THE APPROPRIATE CODE

DON'T TAKE DBS IFRESPONDENT DOES NOT AGREE FOR VITAMIN A

212) RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET.

213) BAR CODE LABEL FOR VITAMIN A TEST

215) GO BACK TO 203 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE NEXT PAGE; IF NO MORE CHILDREN, GO TO 216.

WEIGHT, HEIGHT, HEMOGLOBIN AND VITAMIN A MEASUREMENT FOR WOMEN AGE 15-49

216) CHECK COLUMN 9 IN HOUSEHOLD SCHEDULE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 217.
IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONALQUESTIONNAIRE(S).

217) LINE NUMBER FROM COLUMN 9
NAME FROM COLUMN 2

218) WEIGHT IN KILOGRAMS

219) HEIGHT IN CENTIMETERS

220) AGE: CHECK COLUMN 7.

221) MARITAL STATUS: CHECK COLUMN 8

222) RECORD LINE NUMBER OF PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT

RECORD '00' IF NOT LISTED

223) ASK CONSENT FOR ANEMIA TEST FROM PARENT/OTHER ADULT IDENTIFIED IN 222 AS RESPONSIBLE FOR NEVER IN UNION WOMEN AGE 15-17

As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anemia.

For the anemia testing, we will need a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test.

The blood will be tested for anemia immediately, and the result will be told to you and (NAME OF ADOLESCENT) right away. The result will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Do you have any questions?

You can say yes to the test for (NAME OF ADOLESCENT), or you can say no. It is up to you to decide.
Will you allow (NAME OF ADOLESCENT) to take the anemia test?

224) CIRCLE THE APPROPRIATE CODE ANDSIGN YOUR NAME

225) ASK CONSENT FOR ANEAMIA TEST FROM RESPONDENT

As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease. This survey will assist the government to develop programs to prevent and treat anemia.

For the anemia testing, we will need a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. The blood will be tested for anemia immediately, and the result will be told to you right away. The result will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Do you have any questions?
You can say yes to the test, or you can say no. It is up to you to decide.

Will you take the anemia test?

226) CIRCLE THE APPROPRIATE CODE AND SIGN YOUR NAME.

227) PREGNANCY STATUS: CHECK 226 IN WOMAN'S QUESTIONNAIRE OR ASK:

Are you pregnant?

227A) AGE: CHECK COLUMN 7.

227B) MARITAL STATUS: CHECK COLUMN 8

228) ASK FOR CONSENT FROM PARENT/ OTHER ADULT IDENTIFIED IN 222 AS RESPONSIBLE FOR NEVER IN UNION WOMEN AGE 15-17.

As part of the survey we also are asking people all over the country to take a test for vitamin A deficiency. Vitamin A deficiency is a health problem that can result poor nutrition. This survey will help the government to develop programs to prevent and treat vitamin A deficiency.

For the vitamin A test, we need a few more drops of blood from a finger. Again the equipment used in taking the blood is clean and completely safe. It has never been used before and will be thrown away after each test.

No names will be attached so we will not be able to tell you the test results. No one else will be able to know the test results either.

Do you have any questions?

You can say yes to the test, or you can say no. It is up to you to decide.

Will you (allow NAME OF ADOLESCENT to) take the vitamin A deficiency test?

229) CIRCLE THE APPROPRIATE CODE AND SIGN YOUR NAME.

230) ASK CONSENT FOR VITAMIN A TESTING FROM RESPONDENT
As part of the survey we also are asking people all over the country to take a test for vitamin A deficiency. Vitamin A deficiency is a health problem that can result poor nutrition. This survey will help the government to develop programs to prevent and treat vitamin A deficiency.

For the vitamin A test, we need a few more drops of blood from a finger. Again the equipment used in taking the blood is clean and completely safe. It has never been used before and will be thrown away after each test. No names will be attached so we will not be able to tell you the test results. No one else will be able to know the test results either.

Do you have any questions?

You can say yes to the test, or you can say no. It is up to you to decide.
Will you take the vitamin A deficiency test?

231) CIRCLE THE APPROPRIATE CODE AND SIGN YOUR NAME AND ENTER YOUR
INTERVIEWER NUMBER

231A) AGE: CHECK COLUMN 7

231B) MARITAL STATUS: CHECK COLUMN 8

232 ASK CONSENT FOR ADDITIONAL TESTING FROM PARENT/OTHER ADULT IDENTIFIED IN 222 AS RESPONSIBLE FOR NEVER IN UNION WOMEN AGE 15-17.

We ask you to allow the Ministry of Health to store part of the blood sample at the laboratory to be used for testing or research in the future. We are not certain about what tests might be done.

The blood sample will not have any name or other data attached that could identify (NAME OF ADOLESCENT).

You do not have to agree. If you do not want the blood sample stored for later use, (NAME OF ADOLESCENT) can still participate in the vitamin A testing in this survey.

Will you allow us to keep the blood sample stored for later testing or research?

233) CIRCLE THE APPROPRIATE CODE AND SIGN YOUR NAME.

234) ASK CONSENT FOR ADDITIONAL TESTING FROM RESPONDENT

We ask you to allow the Ministry of Health to store part of the blood sample at the laboratory to be used for testing or research in the future. We are not certain about what tests might be done.

The blood sample will not have any name or other data attached that could identify (NAME OF ADOLESCENT).

Will you allow us to keep the blood sample stored for later testing or research?

235) CIRCLE THE APPROPRIATE CODE AND SIGN YOUR NAME.

236) ADDITIONAL TESTS

CHECK 233 AND 235:
IF CONSENT HAS NOT BEEN GRANTED WRITE "NO ADDITIONAL TEST" ON THE FILTER PAPER.

237) PREPARE EQUIPMENT AND SUPPLIES ONLY FOR THE TEST(S) FOR WHICH CONSENT HAS BEEN OBTAINED AND PROCEED WITH THE TEST(S).

238) RECORD HEMOGLOBIN LEVEL HERE AND IN ANEMIA PAMPLET

239) BAR CODE LABEL FOR VITAMIN A TEST

240) GO BACK TO 217 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE; IF NO MORE WOMEN, GO TO 241.

WEIGHT AND HEIGHT MEASUREMENT FOR MEN AGE 15-54

241) CHECK COLUMN 10 IN HOUSEHOLD SCHEDULE RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE MEN IN 242.
IF THERE ARE MORE THAN THREE MEN, USE ADDITIONAL QUESTIONNAIRE(S).

242) LINE NUMBER FROM COLUMN 10
NAME FROM COLUMN 2

243) WEIGHT IN KILOGRAMS

244) HEIGHT IN CENTIMETERS

245) GO BACK TO 242 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE; IF NO MORE MEN, END INTERVIEW.

END TIME