REPUBLIC OF BURUNDI THIRD DEMOGRAPHIC AND HEALTH SURVEY 2016 HOUSEHOLD QUESTIONNAIRE
IDENTIFICATION
PLACE NAME
NAME OF HEAD OF HOUSEHOLD
PROVINCE
CLUSTER NUMBER
HOUSEHOLD NUMBER
HOUSEHOLD SELECTED FOR MEN'S SURVEY?
NO 2
INTERVIEWER'S NAME
RESULT
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) 9
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) 9
TOTAL NUMBER OF VISITS
TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE MEN
LINE NUMBER OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE
OTHER (SPECIFY) 96
OLD KIRUNDI (FROM PAPER)
LANGUAGE OF INTERVIEW
OTHER (SPECIFY) 96
OLD KIRUNDI (FROM PAPER)
NATIVE LANGUAGE OF RESPONDENT
OTHER (SPECIFY) 96
OLD KIRUNDI (FROM PAPER)
TRANSLATOR USED
NO 2
LANGUAGE OF QUESTIONNAIRE:
OTHER (SPECIFY) 96
OLD KIRUNDI (FROM PAPER)
Hello. My name is ___. I am working with the Institute of Statistics and Economic Study of Burundi, ISTEEBU. We are conducting a survey about health and other topics all over Burundi. 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 15 to 20 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. In case you need more information about the survey, you may contact the person listed on this card.
GIVE CARD WITH CONTACT INFORMATION
SIGNATURE OF INTERVIEWER________________
DATE___________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
MINUTES___
1) LINE NUMBER
________
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 5-20 FOR EACH PERSON.
Just to make sure that I have a complete listing:
2A) Are there any other persons such as small children or infants that we have not listed?
NO
2B) Are there any other people who many not be members of your family, such as domestic servants, lodgers or friends who usually live here?
NO
2C) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
NO
3) RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?
WIFE OR HUSBAND 02
SON OR DAUGHTER 03
SON-IN-LAW OR DAUGHTER-IN-LAW 04
GRANDCHILD 05
PARENT 06
PARENT-IN-LAW 07
BROTHER OR SISTER 08
OTHER RELATIVE 09
ADOPTED/FOSTER/STEPCHILD 10
NOT RELATED 11
DON'T KNOW 98
4) SEX: Is (NAME) male or female?
FEMALE 2
5) Does (NAME) usually live here?
NO 2
6) Did (NAME) stay here last night?
NO 2
7) AGE: How old is (NAME)? IF 95 OR MORE, RECORD 95.
8) MARITAL STATUS: What is (NAME)'s current marital status?
DIVORCED/SEPARATED 2
WIDOWED 3
NEVER MARRIED AND NEVER LIVED TOGETHER 4
9) CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49.
10) IF HOUSEHOLD SELECTED FOR MAN'S SURVEY: CIRCLE LINE NUMBER OF ALL MEN AGE 15-59
11) IF HOUSEHOLD SELECTED FOR MAN'S SURVEY: CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5
SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS:
12) Is (NAME)'s natural mother alive?
NO 2 (GO TO 13A)
DON'T KNOW 8 (GO TO 13A)
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.
13A) IF Q. 13 = 00: Where does (NAME)'s biological mother live?
INSTITUTION IN BURUNDI 2
COUNTRY BORDERING BURUNDI 3
OTHER COUNTRY 4
DON'T KNOW 8
13B) IF Q. 13 BLANK OR 00: Who is (NAME)'s primary guardian?
RECORD LINE NUMBER OF THE GUARDIAN.
14) Is (NAME)'s natural father alive?
NO 2 (GO TO 16)
DON'T KNOW 8 (GO TO 16)
15) Does (NAME)'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.
15A) IF Q. 15= 00: Where does (NAME)'s biological father live?
CODING:
INSTITUTION IN BURUNDI 2
COUNTRY BORDERING BURUNDI 3
OTHER COUNTRY 4
DON'T KNOW 8
EVER ATTENDED SCHOOL:
16) Has (NAME) ever attended school or nursery school?
NO 2 (GO TO 20)
17) What is the highest level of school (NAME) has attended? What is the highest grade (NAME) completed at that level?
IF THEY HAVEN'T COMPLETED ANY GRADE IN A LEVEL, RECORD 00.
GRADE___
SEE CODES BELOW.
CURRENT/RECENT SCHOOL ATTENDANCE:
18) Did (NAME) attend school or nursery school at any time during the (2016-2017) school year?
NO 2 (GO TO 20)
19) During the 2016-2017 school year, what level and grade (is/was) (NAME) attending?
GRADE___
SEE CODES BELOW.
PREVIOUS SCHOOL ATTENDANCE:
18A) Has (NAME) ever attend school or nursery school at any time during the 2016-2017 school year?
NO 2 (GO TO 20)
19A) During the 2016-2017 school year, what level and grade is/was (NAME) attending?
GRADE___
SEE CODES BELOW.
IF 0-35 YEARS:
20) Does (NAME) have a birth certificate?
IF NO, PROBE: Has (NAME)'s birth ever been registered with the civil authority?
REGISTERED 2
NEITHER 3
DON'T KNOW 8
21) What were the documents produced for the registration with the civil authority?
MEDICAL CERTIFICATE 2
REGISTERED WITHOUT BOOKLET OR CERTIFICATE 3
NOT REGISTERED 4
DON'T KNOW 8
CODES FOR Q 17, 19, AND 19A: EDUCATION
PRIMARY 1
SECONDARY 1ST CYCLE 2
SECONDARY 2ND CYCLE 3
HIGHER 4
DON'T KNOW 8
2ND YEAR 2
3RD YEAR 3
4TH YEAR 4
5TH YEAR 5
6TH YEAR 6
DON'T KNOW 8
8TH YEAR 2
9TH YEAR 3
10TH YEAR 4
DON'T KNOW 8
12TH YEAR 2
13TH YEAR 3
14TH YEAR 4
DON'T KNOW 8
2ND YEAR 2
3RD YEAR 3
4TH YEAR OR HIGHER 4
DON'T KNOW 8
TICK HERE IF CONTINUATION SHEET USED___
101) What is the main source of drinking water for members of your household?
PIPED INTO YARD/PLOT 12 (GO TO 106)
PIPED TO NEIGHBOR 13 (GO TO 106)
PUBLIC TAP/STANDPIPE 14 (GO TO 103)
UNPROTECTED WELL 32 (GO TO 103)
UNPROTECTED SPRING 42 (GO TO 103)
TANKER TRUCK 61 (GO TO 103)
CART WITH SMALL TANK 71 (GO TO 103)
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81 (GO TO 103)
BOTTLED WATER 91
OTHER (SPECIFY) 96 (GO TO 103)
102) Where is the main source of water used by your household for other purposes such as cooking and handwashing?
PIPED INTO YARD/PLOT 12 (GO TO 106)
PIPED TO NEIGHBOR 13 (GO TO 106)
PUBLIC TAP/STANDPIPE 14
UNPROTECTED WELL 32
UNPROTECTED SPRING 42
TANKER TRUCK 61
CART WITH SMALL TANK 71
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
BOTTLED WATER 91
OTHER (SPECIFY) 96
103) Where is the water source located?
IN OWN YARD/PLOT 2 (GO TO 105)
ELSEWHERE 3
104) How long does it take you to go there, get water, and come back?
DON'T KNOW 998
105) CHECK 101 AND 102: CODE 14 OR 21 CIRCLED:
NO (GO TO 107)
106) In the past two weeks, was the water from this source not available for at least one full day?
NO 2
DON'T KNOW 8
107) Do you do anything to the water to make it safer to drink?
NO 2 (GO TO 109)
DON'T KNOW 8 (GO TO 109)
108) What do you usually do to make the water safer to drink? Anything else?
RECORD ALL MENTIONED.
ADD BLEACH/CHLORINE B
STRAIN THROUGH A CLOTH C
USE WATER FILTER (CERAMIC/SAND/COMPOSITE/ETC.) D
SOLAR DISINFECTION E
LET IT STAND AND SETTLE F
OTHER (SPECIFY) X
DON'T KNOW Z
109) What kind of toilet facility do members of your household usually use?
IF NOT POSSIBLE TO DETERMINE, ASK PERMISSION TO OBSERVE THE FACILITY.
FLUSH TO SEPTIC TANK 12
FLUSH TO PIT LATRINE 13
FLUSH TO SOMEWHERE ELSE 14
FLUSH, DON'T KNOW WHERE 15
PIT LATRINE WITH SLAB 22
PIT LATRINE WITHOUT SLAB/OPEN PIT 23
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61 (GO TO 113)
OTHER (SPECIFY) 96
110) Do you share this toilet facility with other households?
NO 2 (GO TO 112)
111) Including your own household, how many households use this toilet facility?
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98
112) Where is this toilet facility located?
IN OWN YARD/PLOT 2
ELSEWHERE 3
113) What type of fuel does your household mainly use for cooking?
LPG 02
NATURAL GAS 03
BIOGAS 04
KEROSENE 05
COAL LIGNITE 06
CHARCOAL 07
WOOD 08
STRAW/SHRUBS/GRASS 09
AGRICULTURAL CROP 10
ANIMAL DUNG 11
NO FOOD COOKED IN HOUSEHOLD 95 (GO TO 116)
OTHER (SPECIFY) 96
114) Is the cooking usually done in the house, in a separate building, or outdoors?
IN A SEPARATE BUILDING 2 (GO TO 116)
OUTDOORS 3 (GO TO 116)
OTHER (SPECIFY) 6 (GO TO 116)
115) Do you have a separate room which is used as a kitchen?
NO 2
116) How many rooms in this household are used for sleeping?
117) Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (GO TO 119)
118) How many of the following animals does this household own?
IF NONE, ENTER 00. IF 95 OR MORE, ENTER 95. IF UNKNOWN, ENTER 98
119) Does any member of this household own any agricultural land?
NO 2
120) How many hectares of agricultural land do members of this household own?
95 OR MORE HECTARES 950
DON'T KNOW 998
121) Does your household have:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
122) Does any member of your household own:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
123) Does any member of this household have a bank account?
NO 2
123A) If you had to get to the closest health center, what mode of transportation would you use?
PUBLIC TRANSPORTATION (BUS, TAXI, MOTORBIKE) 2
BY FOOT 3
BIKE 4
OTHER (SPECIFY) 6
123B) How long would it take you to get to the closest health center using (MODE OF TRANSPORTATION FROM Q. 123A)?
DON'T KNOW 998
124) Does anyone in your household smoke? Would you say daily, weekly, monthly, less than monthly, or never?
WEEKLY 2
MONTHLY 3
LESS THAN MONTHLY 4
NEVER 5
125) At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitoes?
NO 2 (GO TO 127)
DON'T KNOW 8 (GO TO 127)
126) How sprayed the dwelling?
PRIVATE COMPANY B
NONGOVERNMENTAL ORGANIZATION (NGO) C
OTHER (SPECIFY) X
DON'T KNOW Z
127) Does your household have any mosquito nets?
NO 2 (GO TO 139)
128) How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD 7.
129) ASK THE RESPONDENT TO SHOW YOU THE NETS IN THE HOUSEHOLD. IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S).
NOT OBSERVED 2
130) How many months ago did your household get the mosquito net? IF LESS THAN ONE MONTH AGO, RECORD 00.
MORE THAN 36 MONTHS AGO 95
NOT SURE 97
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.
INTERCEPTOR 12 (GO TO 134)
PERMANET 13 (GO TO 134)
OTHER/DK BRAND 16 (GO TO 134)
DON'T KNOW BRAND 98
132) Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?
NO 2 (GO TO 134)
NOT SURE 8 (GO TO 134)
133) How many months ago was the net last soaked or dipped?
IF LESS THAN ONE MONTH AGO, RECORD 00.
MORE THAN 24 MONTHS AGO 95
NO SURE 98
134) Did you get the net through a) the distribution campaign in 2009, b) the campaign in 2010, c) the campaign in 2011, d) the campaign in 2014, e) during a prenatal consultation or during a delivery, f) while getting a vaccine for a child, or g) another occasion?
YES, THE CAMPAIGN IN 2010 2 (GO TO 136)
YES, THE CAMPAIGN IN 2011 3 (GO TO 136)
YES, THE CAMPAIGN IN 2014 4 (GO TO 136)
YES, DURING A PRENATAL CONSULTATION OR DURING A DELIVERY 5 (GO TO 136)
YES, WHILE GETTING A VACCINE FOR A CHILD 6 (GO TO 136)
YES, ANOTHER OCCASION 7 (GO TO 136)
NO 8
135) Where did you get the mosquito net?
PRIVATE HEALTH FACILITY 02
PHARMACY 03
SHOP/MARKET 04
CHW 05
RELIGIOUS INSTITUTION 06
OTHER 96
DON'T KNOW 98
136) Did anyone sleep under this mosquito net last night?
NO 2 (GO TO 138)
DON'T KNOW 8 (GO TO 138)
137) Who slept under the mosquito net last night?
RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.
LINE NUMBER___
138) GO BACK TO 129 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 139.
139) We would like to learn about the palaces that households use to watch their hands. Can you please show me where members of your household most often wash their hands?
OBSERVED, MOBILE 2
NOT OBSERVED, NOT IN DWELLING/YARD/PLOT 3 (GO TO 142)
NOT OBSERVED, NO PERMISSION TO SEE 4 (GO TO 142)
NOT OBSERVED, OTHER REASON 5 (GO TO 142)
140) OBSERVE PRESENCE OF WATER AT THE PLACE FOR HANDWASHING. RECORD OBSERVATION.
WATER IS NOT AVAILABLE 2
141) OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT AT THE PLACE FOR HANDWASHING. RECORD OBSERVATION.
ASH, MUD, SAND B
NONE Y
142) OBSERVE MAIN MATERIALS OF THE FLOOR IN THE DWELLING. RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
143) OBSERVE MAIN MATERIAL OF THE ROOF OF THE DWELLING. RECORD OBSERVATION.
THATCH/PALM LEAF 12
SOD 13
PALMS/BAMBOO 22
WOOD PLANKS 23
CARDBOARD 24
WOOD 32
CALAMINE/CEMENT FIBER 33
CERAMIC TILES 34
CEMENT 35
ROOFING SHINGLES 36
144) OBSERVE MAIN MATERIALS OF THE EXTERIOR WALLS OF THE DWELLING. RECORD OBSERVATION.
BAMBOO/CANE/PALM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
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.
NO IODINE 2
NO SALT IN HOUSEHOLD 3
SALT NOT TESTED (SPECIFY REASON) 6
SELECTION OF ONE CHILD FOR CHILDREN'S WORK/DISCIPLINE:
150) CHECK COLUMN 7 IN THE LIST OF HOUSEHOLD MEMBERS AND RIGHT THE TOTAL NUMBER OF CHILDREN AGE 1-17 YEARS.
151) CHECK THE NUMBER OF CHILDREN AGE 1-17 IN 150:
ONE (GO TO 159 AND RECORD THE RANK NUMBER AS 1, ENTER THE LINE NUMBER, THE CHILD'S NAME, AND HIS OR HER AGE.)
TWO OR MORE (GO TO 152)
152) LIST EACH CHILD AGE 1-17 YEARS FROM THE HOUSEHOLD SCHEDULE IN THE TABLE BELOW IN THE ORDER THEY APPEAR IN THE LIST OF HOUSEHOLD MEMBERS. DO NOT INCLUDE MEMBERS OF THE HOUSEHOLD WHOSE AGE IS OUTSIDE OF 1-17 YEARS. RECORD THE LINE NUMBER, NAME, SEX AND AGE FOR EACH CHILD.
154) LINE NUMBER FROM COLUMN 1
FEMALE
158) CHECK THE LAST DIGIT OF THE HOUSEHOLD NUMBER RECORDED ON THE COVER PAGE. THIS IS THE LINE NUMBER IN THE TABLE BELOW FROM WHICH YOU MUST CHECK THE TOTAL NUMBER OF CHILDREN (Q150) ON THE PREVIOUS PAGE. THIS IS THE COLUMN NUMBER FROM THE TABLE BELOW THAT YOU SHOULD GO TO.
FIND THE BOX WHERE THE LINE AND COLUMN INTERSECT AND CIRCLE THE NUMBER THAT APPEARS IN THE BOX. THIS IS THE NUMBER OF THE RANK NUMBER OF THE CHILD SELECTED FOR CHILD LABOR/DISCIPLINE FROM THE BOX OF ELIGIBLE CHILDREN IN Q. 153.
RECORD THE RANK NUMBER, THE LINE NUMBER, THE AGE, AND THE NAME OF THE CHILD SELECTED IN THE SPACE BELOW.
EXAMPLE: THE HOUSEHOLD NUMBER IS 716 AND Q 151 SHOWS THAT THERE ARE THREE ELIGIBLE CHILDREN AGED 1-17 IN THE HOUSEHOLD. SINCE THE LAST DIGIT OF THE HOUSEHOLD NUMBER IS 6, GO TO LINE 6 AND SINCE THERE ARE THREE ELIGIBLE CHILDREN, GO TO COLUMN 3. FIND THE BOX WHERE THE LINE AND THE COLUMN INTERSECT (2) AND CIRCLE THE NUMBER. NOW GO TO Q 153 AND FIND THE SECOND CHILD. WRITE THE NAME, AGE, LINE NUMBER, AND RANK OF THE CHILD IN THE SPACE BELOW.
LAST DIGIT FROM HOUSEHOLD NUMBER___
TOTAL NUMBER OF ELIGIBLE CHILDREN AGE 1-17 IN THE HOUSEHOLD FROM Q 151___
159) NAME OF CHILD SELECTED_____________
AGE OF CHILD SELECTED___
LINE NUMBER OF CHILD SELECTED___
RANK NUMBER OF CHILD SELECTED___
160) CHECK AGE OF CHILD SELECTED FROM 159:
1-4 YEARS (GO TO 172)
161) Now I would like to talk about all the work the children in this household can do. Since the last (DAY OF THE WEEK), did (NAME) do any of the following activities, even if it was just for an hour?
NO 2
NO 2
NO 2
NO 2
IF NO, PROBE: Please, include any type of activity that (NAME) could have done as a regular or temporary job, for his/her own business or as employee, or as unpaid family employee to help in household or farm work.
NO 2
NOT A SINGLE YES (GO TO 167)
163) Since last (DAY OF THE WEEK), approximately how many hours total did (NAME) do work in this activity/these activities? IF LESS THAN 1 HOUR, RECORD 00.
164) Does/do this activity/these activities require carrying heavy loads?
NO 2
165) Does/do this activity/these activities require working with dangerous tools (knives, etc.) or to operate heavy machinery?
NO 2
166) How would you describe (NAME)'s work environment?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
167) Since last (DAY OF WEEK), did name fetch water or firewood for the household?
NO 2 (GO TO 169)
168) In total, since last (DAY OF WEEK), how many hours did (NAME) spend fetching water or firewood for the household? IF LESS THAN ONE HOUR, RECORD 00.
169) Since last (DAY OF WEEK), did (NAME) do any of the following tasks for the household?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NOT A SINGLE YES (GO TO 172)
171) Since last (DAY OF WEEK OF INTERVIEW), about how many hours in total did (NAME) spend doing these activities?
172) CHECK AGE OF CHILD SELECTED FOR Q. 159:
15-17 YEARS (GO TO NEXT MODULE)
173) WRITE THE NAME AND LINE NUMBER OF THE CHILD FROM Q. 159.
NAME ____________
174) Adults use certain ways to teach children the right behavior or to address a behavior problem. I will read various methods that are use. Please tell me if you or anyone else in the household has used this method with (NAME) in the past month.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
175) Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?
NO 2
DON'T KNOW/NO OPINION 8
SELECTION TABLE FOR WOMEN AND MEN FOR THE DOMESTIC VIOLENCE MODULE
CHECK THE LAST DIGIT OF THE HOUSEHOLD NUMBER RECORDED ON THE COVER PAGE. THIS IS THE LINE NUMBER IN THE TABLE BELOW FROM WHICH YOU MUST CHECK THE TOTAL NUMBER OF WOMEN AND MEN ELIGIBLE (COLUMNS 9 AND 10) ON THE PREVIOUS PAGE. THIS IS THE COLUMN NUMBER FROM THE TABLE BELOW THAT YOU SHOULD GO TO.
FIND THE BOX WHERE THE LINE AND COLUMN INTERSECT AND CIRCLE THE NUMBER THAT APPEARS IN THE BOX. THIS IS THE ORDER NUMBER OF THE PERSON SELECTED TO RESPOND TO THE QUESTIONS ON DOMESTIC VIOLENCE FROM THE LIST OF ELIGIBLE WOMEN AND MEN IN COLUMN 9 OR 10 OF THE HOUSEHOLD TABLE.
RECORD THE NAME AND LINE NUMBER OF THE PERSON SELECTED IN THE SPACE BELOW THE TABLE.
EXAMPLE: THE HOUSEHOLD NUMBER IS 716 AND COLUMNS 9 AND 10 OF THE HOUSEHOLD SCHEDULE SHOWS THAT THERE ARE THREE ELIGIBLE PEOPLE (WOMEN AGED 15-49 AND MEN AGED 15-59) IN THE HOUSEHOLD (LINE NUMBERS 02, 04, AND 05). SINCE THE LAST DIGIT OF THE HOUSEHOLD NUMBER IS 6, GO TO LINE 6 AND SINCE THERE ARE THREE ELIGIBLE PEOPLE IN THE HOUSEHOLD, GO TO COLUMN 3. FIND THE BOX WHERE THE LINE AND THE COLUMN INTERSECT (2) AND CIRCLE THE NUMBER. NOW GO TO THE HOUSEHOLD TABLE AND FIND THE SECOND ELIGIBLE PERSON (WOMAN OR MAN).
LAST DIGIT OF THE SERIES NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE ____
TOTAL NUMBER OF ELIGIBLE WOMEN AND MEN IN COLUMN 9 OR 10 OR THE HOUSEHOLD TABLE_____
176) NAME OF PERSON SELECTED______________
LINE NUMBER IN THE HOUSEHOLD TABLE OF PERSON SELECTED___
MINUTES___
INTERVIEWER'S OBSERVATIONS TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT THE INTERVIEW:
____________________________________
COMMENTS ON SPECIFIC QUESTIONS:
____________________________________
ANY OTHER COMMENTS:
____________________________________
SUPERVISOR'S OBSERVATIONS:
____________________________________
EDITOR'S OBSERVATIONS:
____________________________________