REPUBLIC OF ANGOLA
MULTIPLE INDICATORS AND HEALTH SURVEYS

IDENTIFICATION

STATISTICAL CONFIDENTIALITY: BY THE TERMS GIVEN IN ARTICLE 11 OF THE LAW NO. 3/11, FROM THE 14TH OF JANUARY, LAW OF THE NATIONAL STATISTICS SYSTEM, ALL INDIVIDUAL DATA COLLECTED BY OFFICIAL STATISTICS ORGANIZATIONS, IN THIS CASE THE INE, ARE STRICTLY CONFIDENTIAL. COLLECTED DATA IS PROTECTED FROM ANY NON-STATISTICAL PURPOSES OR FROM ANY UNAUTHORIZED DISSEMINATION, ONLY TO BE USED FOR THE PRODUCTION OF OFFICIAL STATISTICS.

PLACE NAME/ADDRESS________
NAME OF HOUSEHOLD HEAD________
PROVINCE ____
MUNICIPALITY ____
COMMUNE ____
NEIGHBORHOOD/VILLAGE ____
CENSUS SECTION ____
HOUSEHOLD AREA ____

CLUSTER NUMBER (ID. IIMS) ____
HOUSEHOLD NUMBER ____
HOUSEHOLD SELECTED FOR MAN'S SURVEY?

HOUSEHOLD SELECTED FOR CHILDREN'S SURVEY?

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____
INTERVIEWER NUMBER_____
RESULT

TOTAL NUMBER OF VISITS_________

TOTAL PERSONS IN HOUSEHOLD_________
TOTAL NO. OF WOMEN AGES 15-49_________
TOTAL NO. OF MEN AGES 15-54_________
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE_________

LANGUAGE OF QUESTIONNAIRE:

TRANSLATOR USED:

SUPERVISOR
NAME_____
NUMBER_____

INTRODUCTION AND CONSENT

Good morning/good afternoon. My name is ________. I am an interviewer with the National Institute of Statistics and this is my identification card(SHOW YOUR ID CARD). We are conducting a national survey about a variety of health topics. The information we collect will help the government to plan and improve health services.
Your household was selected for the survey. All the answers you give will be confidential and will not be shared with anyone other than members of the survey team.
Your participation in the survey is voluntarily and if there is a question you don't want to answer, just let me know and I will go to the next question or you can stop the interview at any time. In case that you need more information about the survey, you may contact INE or any INE's Province Services.

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER__________ DATE_______

100) RECORD THE TIME WHEN YOU BEGIN THE INTERVIEW

SECTION 1: LIST AND BASIC CHARACTERISTICS OF MEMBERS OF HOUSEHOLD

1) LINE NUMBER____

2) USUAL RESIDENTS AND VISITORS
Please give 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 FILLING OUT THE NAMES, RELATIONS AND SEX OF EACH PERSON, ASK QUESTIONS 2A-2C, TO BE SURE THAT THE LISTING IS COMPLETE.
THEN ASK QUESTIONS FROM COLUMNS 5-20 TO 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?

5) RESIDENCE
Does (NAME) usually live here?

6) RESIDENCE
Did (NAME) stay here last night?

7) AGE
How old is (NAME)? IF 95 OR MORE, RECORD '95'.

8) FOR PEOPLE AGE 15 OR OLDER
MARITAL STATUS What is (NAME)'s current marital status?

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

10) ELIGIBILITY
IF HOUSEHOLD SELECTED FOR MAN'S SURVEY
CIRCLE THE LINE NUMBER OF ALL MEN AGE 15-54

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

11A) ELIGIBILITY
CIRCLE THE LINE NUMBER OF ALL CHILDREN AGE 5-17

2A) Just to make sure that the listing is complete: are there any other people such as small infants or babies that were not listed?

2B) Are there any other people who are not family members such as domestic servants, lodgers, or friends who usually live here?

2C) Are there any guests or temporary visitors staying here

SECTION 2: ORPHANAGE

FOR PEOPLE AGE 0-17 YEARS
SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS

12) Is (name's) biological mother alive?

13) Does (NAME'S) biological mother live in this house?
IF YES: What is her name?
RECORD THE MOTHER'S LINE NUMBER.
IF NO: RECORD '00'.

14) Is (NAME'S) biological father alive?

15) Does (NAME'S) biological father live in this household?
IF YES: What is his name?
RECORD THE FATHER'S LINE NUMBER.
IF NO: RECORD '00'.

SECTION 3: EDUCATION

FOR PEOPLE 3 YEARS OR OLDER
FREQUENCY OF ATTENDANCE IN SCHOOL

16) Has (NAME) ever attended school or daycare?

16A) What is the highest year or grade in school that (NAME) has attended?

17) Did (NAME) successfully complete this year?

17A) What level of schooling corresponds with year/grade?
SEE CODES BELOW.

FOR PEOPLE 3-24 YEARS OLD
CURRENT SCHOOL ATTENDANCE

18) For the current school year, is (NAME) enrolled in school or daycare?

19) At any time during the 2015/16 school year, has (NAME) attended school?

20) For the current school year, what grade (year) did (NAME) attend?

FOR PEOPLE 5-12 YEARS OLD
SCHOOL LUNCH
21) For the current school year, does (did) (NAME) receive free school lunch?

FOR PEOPLE 3-24 YEARS OLD
LAST YEAR'S SCHOOL ATTENDANCE
22) Did (NAME) attend school or daycare during last school year?

23) What grade (year) did (s)he attend during the last school year?

23A) What level of schooling corresponds to this grade (year)?

SECTION 4: DISABILITY

FOR PEOPLE 0 TO 17 YEARS OLD
24) PHYSICAL OR MENTAL DISABILITY: Does (NAME) have any type of physical or mental disability?

25) PHYSICAL OR MENTAL DISABILITY: What type of disability does (NAME) have?

SECTION 5: BIRTH REGISTRATION

FOR PEOPLE 0-17 YEARS OLD
26) BIRTH REGISTRATION: Does (NAME) have a birth certificate?
IF YES, ASK:
Please, may I see the certificate?

26A) Do you know what you need to do to register a child with the General Registry?

26B) What documents are required to register a child?
MULTIPLE CHOICE

TABLE FOR SELECTION OF WOMEN FOR DOMESTIC VIOLENCE SECTION

27) REVIEW 9: NUMBER OF WOMEN BETWEEN 15-49 YEARS OLD

EXAMPLE: THE SERIAL NUMBER OF THE QUESTIONNAIRE IS '716' AND COLUMN 9 OF THE HOUSEHOLD QUESTIONNAIRE INDICATES THAT THE HOUSEHOLD HAS THREE ELIGIBLE WOMEN OF AGE 15-49. THE LAST DIGIT OF THE SERIAL NUMBER IS '6' WHICH CORRESPONDS TO LINE '6'. IN THE SAME MANNER, THE HOUSEHOLD HAS THREE ELIGIBLE WOMEN THAT CORRESPOND TO LINE '3'. THE INTERSECTION OF LINE '6' AND LINE '3' IS THE NUMBER '2'. CIRCLE THIS NUMBER. GO BACK TO THE LIST OF THE HOUSEHOLD QUESTIONNAIRE AND SEARCH FOR THE SECOND WOMAN ELIGIBLE FOR THE DOMESTIC VIOLENCE MODULE. (IN THIS CASE THE WOMAN WITH LINE NUMBER '04'). RECORD THE NAME AND THE NUMBER OF ORDER BELOW.

[LINE 1] LAST DIGIT OF HOUSEHOLD'S NUMBER 0123456789

[NEXT EIGHT LINES] TOTAL NUMBER OF ELIGIBLE WOMEN OF AGE 15-49 IN THE HOUSEHOLD (COLUMN 9) [NUMBERED CHART]

28) NAME OF SELECTED WOMEN________
LINE NUMBER OF SELECTED WOMEN ___

SELECTION OF CHILD FOR CHILD LABOR SECTION

31) CHECK COLUMN 11A THE HOUSEHOLD LISTING AND RECORD THE TOTAL NUMBER OF CHILDREN AGES 5-17

32) CHECK 31: NUMBER OF CHILDREN AGES 5-17

32A) INCLUDE EACH CHILD AGES 5-17 IN THE ORDER OF APPEARANCE IN THE HOUSEHOLD LIST. DO NOT INCLUDE MEMBERS OF THE HOUSEHOLD OUTSIDE OF THE AGES 5-17. RECORD THE LINE NUMBER, NAME, SEX AND AGE OF EACH CHILD.

33) POSITION NUMBER

34) LINE NUMBER

35) NAME IN COLUMN 2

36) SEX IN COLUMN 4

37) AGE IN COLUMN 7

TABLE FOR SELECTION OF CHILD FOR CHILD LABOR SECTION

38) SEE THE LAST DIGIT OF LINE NUMBER OF THIS QUESTIONNAIRE, THIS DIGIT CORRESPONDS TO THE LINE NUMBER. CHECK TOTAL NUMBER OF ELIGIBLE CHILDREN IN QUESTION 31. THIS NUMBER CORRESPONDS TO THE NUMBER OF THE COLUMN. CIRCLE THE NUMBER THAT APPEARS AT THE INTERSECTION OF THE LINE AND THE COLUMN. THIS NUMBER INDICATES THE POSITION OF THE CHILD (QUESTION 31) SELECTED FOR CHILD LABOR SECTION. RECORD THE NAME, LINE NUMBER AND THE POSITION OF THE SELECTED CHILD OF QUESTION 39.

EXAMPLE: THE LINE NUMBER OF THE QUESTIONNAIRE IS '716' AND QUESTION 31 INDICATES THAT THE HOUSEHOLD HAS THREE ELIGIBLE CHILDREN AGES 5-17. THE LAST DIGIT OF THE SERIAL NUMBER IS '6', WHICH CORRESPONDS TO LINE '6'. IN THE SAME MANNER, THE HOUSEHOLD HAS THREE ELIGIBLE CHILDREN THAT CORRESPOND TO COLUMN '3'. THE INTERSECTION OF LINE '6' AND COLUMN '3' IS NUMBER '2'. CIRCLE THE NUMBER. GO BACK TO QUESTION 33 AND LOOK UP THE SECOND CHILD. RECORD THE NAME, LINE NUMBER AND POSITION OF THE CHILD IN THE QUESTION BELOW 39.

[LINE 1] LAST DIGIT OF HOUSEHOLD'S NUMBER 0123456789

[NEXT EIGHT LINES] TOTAL NUMBER OF ELIGIBLE CHILDREN AGES 5-17 IN THE HOUSEHOLD (QUESTION 31) [NUMBERED CHART]

39) NAME OF SELECTED CHILD________
LINE NUMBER OF SELECTED CHILD___
POSITION OF SELECTED CHILD____

SECTION 6: CHILD LABOR

40) RECORD THE LINE NUMBER AND THE AGE OF THE SELECTED CHILD

41) Now I would like to ask a few questions about the work some children in this household may do.

In the last 7 days (NAME OF CHILD):

Worked at least 1 hour in any remunerated activity in money or kind, including domestic labor?
Conducted any type of business by him/herself, or with other people?
Helped in a family business without receiving any type of payment?
Worked in any type of labor for the household's consumption without any remuneration?

42) CHECK 41A AND 41B

43) In the last 7 days, how many hours (NAME OF THE CHILD) worked in this (these) activity(ies) ?
IF LESS THAN ONE HOUR, RECORD '00'

44) Did (NAME OF CHILD) have to carry heaving things in those activities?

45) (In this activity/these activities) (NAME OF CHILD) used dangerous tools such as axe, knives or machetes, or did s/he operated heavy machinery in order to do the work?

46) How is the environment in which (NAME OF CHILD) works:

47) In the last 7 days, has (NAME OF CHILD) helped transporting water or collect firewood for household use?

48) In the last 7 days, how many hours did (NAME OF CHILD) helped transporting water or collecting firewood for household use?
IF LESS THAN ONE HOUR, RECORD '00'

49) In the last 7 days did (NAME OF CHILD) help with any of the following household chores in this household?

Go shopping for the household?
Fix a household device?
Cook, wash dishes or clean the house?
Wash clothes?
Take care of other children?
Take care of elder or sick members of the household?
Other domestic chores?

50) CHECK 49A THROUGH 49G:

51) In the last 7 days, how many hours did (NAME OF CHILD) work in this (those) activity (activities) ?
IF LESS THAN ONE HOUR, RECORD '00'

52) CHECK 40:

53) CHECK 41:

54) Even if the child has not work in the last 7 days, does (NAME OF CHILD) has a job to which s/he has to return to?

55) What is the main reason (NAME OF CHILD) was absent from the job these past 7 days?

56) What is the main activity in which (NAME OF CHILD) conducts his/her main job?

57) What is the main task of (NAME OF CHILD) in his/her main job?

58) In his/her main job, is (NAME OF CHILD) a permanent, temporary, seasonal or occasional worker?

59) In his/her job does (NAME OF CHILD) earn money, in kind or is not remunerated?

59A) Is (NAME OF CHILD) available to work if a job was offered in the last 7 days?

59B) Did (NAME OF CHILD) look for a job in the last 30 days?

59C) Is (NAME OF CHILD) looking for a new job or a first job?

SECTION 6A: WORK

60) CHECK THE AGE OF THE PERSONS IN COLUMN 7 IN THE LIST OF THE HOUSEHOLD QUESTIONNAIRE

60A) CHECK 40:
IF THE PERSON IS 15-17 YEARS OLD AND WAS SELECTED FOR THE CHILD LABOR SECTION, S/HE SHOULD NOT BE RECORDED IN THE LIST BELOW.

61) FOR EACH PERSON AGES 15-64 WRITE THE LINE NUMBER OF COLUMN 1 OF THE HOUSEHOLD QUESTIONNAIRE

62) COPY THE NAME OF THE PERSON FROM COLUMN 2 OF THE HOUSEHOLD QUESTIONNAIRE

WORK
63) In the last 7 days, did (NAME) work at least 1 hour in a remunerated work in money or kind?

64) In the last 7 days did (NAME) work by his/her own (by him/herself or with other people) at least during 1 hour?

65) In the last 7 days, did (NAME) helped in a family business without remuneration at least during 1 hour?

66) In the last 7 days, did (NAME) work for the household's consumption without remuneration at least during 1 hour?

67) Even if in the last 7 days (NAME) (has not worked in a remunerated job or by his/her own, or helped in the family business without payment), does s/he has a job to go back to?

68) What is the main reason (NAME) was absent (in a remunerated work, or his/her own business or helping in a family business without payment), in the past 7 days?

MAIN ECONOMIC ACTIVITY
69) What is the main activity in which (NAME) conducts his/her main job?

MAIN TASK
70) What is the main task (NAME) in his/her main job?

TYPE OF WORKER
71) In his/her main job, is (NAME) a permanent, temporary, seasonal or occasional worker?

REMUNERATION
72) In his/her job does (NAME) earn money, in kind or is not remunerated?

AVAILABILITY TO WORK
73) Is (NAME) available to work if a job was offered in the last 7 days?

LOOKING FOR A JOB
74) Did (NAME) look for a job in the last 30 days?

75) Is (NAME) looking for a new job or a first job?

SECTION 7: WATER, SANITATION AND OTHER HOUSEHOLD CHARACTERISTICS

101) What is the principal source of drinking water for members of your household?

102) What is the main source of water used by your household for other purposes such as cooking and handwashing?

103) Where is that water source located?

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

104A) Who in this household mostly gets the water?

105) CHECK 101 AND 102: CODE '14' CIRCLED?

106) In the past two weeks, was the water from this source not available for at least one full day?

107) Do you do anything to treat drinking water?

108) What do you usually do to treat drinking water?
Anything else?
RECORD ALL MENTIONED

109) Usually, what kind of toilet facility do members of your household use?

IF NOT POSSIBLE TO DETERMINE, ASK PERMISSION TO OBSERVE THE FACILITY.

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

111) Including your own household, how many households use this toilet facility?

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

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

115) What is the main source of lighting used in this household?

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

116A) How many rooms are in this household, not counting the bathroom or kitchen?

117) Does this household own any livestock such as cattle or poultry?

118) How many of the following animals does this household own?

IF NONE, RECORD '00'
IF 95 OR MORE, RECCORD '95'
IF UNKNOWN, RECORD '98'

Milk cows or bulls?
Goats?
Pigs?
Sheep?
Rabbits?
Chickens or ducks?

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

120) How many hectares of agricultural land do members of this household own?

IF 95 OR MORE, CIRCLE '950'

121) Does your household have?
Electricity?
A radio?
A television?
A non-mobile telephone?
A computer?
A refrigerator?
Internet access?

122) Does any member of this household own:

A watch?
A mobile phone?
A bicycle?
A motorcycle?
An animal-drawn cart?
A car or truck?
A boat with motor?

123) Does any member of this household have a bank account?

124) How often does anyone smoke inside your house? Would you say daily, weekly, monthly, less often than once a month, or never?

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

126) Who sprayed the dwelling?

127) Does your household have any mosquito nets for when you sleep?

128) How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD '7'

SECTION 8: MOSQUITO NETS

129) ASK THE RESPONDENT TO SHOW YOU THE NETS IN THE HOUSEHOLD
IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S)

130) How many months ago did your household obtain the mosquito net?
IF LESS THAN ONE MONTH, RECORD '00'

131) OBSERVE OR ASK THE BRAND/TYPE OF MOSQUITO NET.

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

131A) Since you got the net, was it treated to kill or repel mosquitoes?

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

133) How many months ago was the net last soaked or dipped?
IF LESS THAN ONE MONTH, RECORD '00'

134) Did you get the net through a national distribution campaign, during antenatal care visit or during an immunization visit?

135) Where did you get the net?

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

137) Who slept under this mosquito net last night?
RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.

138) GO BACK TO 129 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 139

SECTION 9: HOUSEHOLD CHARACTERISTICS

139) Can you please show me where the members of your household most often wash their hands?
Can I see it?

140) RECORD OBSERVATION:
OBSERVE PRESENCE OF WATER AT THE PLACE FOR HANDWASHING.

141) RECORD OBSERVATION:
OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANING AGENT AT THE PLACE FOR HANDWASHING.

142) OBSERVE MAIN MATERIAL OF THE FLOOR OF THE DWELLING
RECORD OBSERVATION

143) OBSERVE MAIN MATERIAL OF THE ROOF OF THE DWELLING
RECORD OBSERVATION

144) OBSERVE MAIN MATERIALS OF THE EXTERIOR WALLS OF THE DWELLING
RECORD OBSERVATION

145) I would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals in your household?
TEST SALT FOR IODINE

146) RECORD TIME

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:__________________

COMMENTS ON SPECIFIC QUESTIONS:_________________

ANY OTHER COMMENTS:___________

SUPERVISOR'S OBSERVATIONS _______________________________________