HOUSEHOLD QUESTIONNAIRE
IDENTIFICATION
DISTRICT ____
LOCATION/TOWN ____
SUBLOCATION ____
NASSEP CLUSTER NUMBER ____
KDHS CLUSTER NUMBER ____
HOUSEHOLD NUMBER ____
NAME OF HOUSEHOLD HEAD ____
IS HOUSEHOLD SELECTED FOR WOMEN'S SECTION 14?
NO 2
FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT*
SECOND VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT*
THIRD VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT*
NEXT VISIT
DATE ____
TIME ____
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
INT. NUMBER ____
RESULT ____
2 NO HOUSEHOLD MEMBER AT HOME / NO COMPETENT RESIDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _________
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE___
TOTAL ELIGIBLE WOMEN___
TOTAL ELIGIBLE MEN___
LANGUAGE OF QUESTIONNAIRE 17/ENGLISH
02 EMBU
03 KALENJIN
04 KAMBA
05 KIKUYU
06 KISII
07LUHYA
08 MARAGOLI
09 LUO
10 MAASAI
11 MERU
12 MIJIKENDA
13 POKOT
14 SOMALI
15 SWAHILI
16 TURKANA
17 ENGLISH
18 OTHER
NATIVE LANGUAGE OF RESPONDENT___
02 EMBU
03 KALENJIN
04 KAMBA
05 KIKUYU
06 KISII
07LUHYA
08 MARAGOLI
09 LUO
10 MAASAI
11 MERU
12 MIJIKENDA
13 POKOT
14 SOMALI
15 SWAHILI
16 TURKANA
17 ENGLISH
18 OTHER
NO 2
FIELD EDITOR
NAME ____
OFFICE EDITOR ____
KEYED BY ____
Hello. My name is _______________________________________. I am working with the Kenya National Bureau of Statistics. We are conducting a survey about health all over Kenya. 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 60 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.
In case you need more information about the survey, you may contact the person listed on this card.
GIVE CARD WITH CONTACT INFORMATION
Do you have any questions?
May I begin the interview now?
SIGNATURE OF INTERVIEWER: _______________________
DATE: ____
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
HOUSEHOLD SCHEDULE
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 5-20A FOR EACH PERSON.
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?
NO
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?
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 household?
SEE CODES BELOW.
CODES FOR Q. 3: RELATIONSHIP TO HEAD OF HOUSEHOLD
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 OTHER RELATIVE
10 ADOPTED/FOSTER/STEPCHILD
11 NOT RELATED
98 DON'T KNOW
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
IF 95 OR MORE, RECORD '95'
8) MARITAL STATUS:
What is (NAME)'s current marital status?
DIVORCED/ SEPARATED 2
WIDOWED 3
NEVER-MARRIED/LIVED TOGETHER 4
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 0-5
SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS:
12) Is (NAME)'s natural mother alive?
NO 2 (GO TO 14)
DK 8 (GO TO 14)
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'.
SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS:
14) Is (NAME)'s natural father alive?
NO 2 (GO TO 18)
DK 8 (GO TO 18)
15) Does (NAME)'s natural father usually 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'.
EVER ATTENDED SCHOOL:
16) Has (NAME) ever attended school?
NO 2 (GO TO 20)
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.
CODES FOR Qs. 17, 19, AND 19B: EDUCATION
1 PRIMARY
2 POST-PRIMARY, VOCATIONAL
3 SECONDARY/ "A" LEVEL
4 COLLEGE (MIDDLE LEVEL)
5 UNIVERSITY
8 DON'T KNOW
98 DON'T KNOW
CURRENT/RECENT SCHOOL ATTENDANCE:
18) Did (NAME) attend school at any time during the 2014 school year?
NO 2 (GO TO 19A)
19) During the 2014 school year, what level and grade [is/was] (NAME) attending? SEE CODES BELOW.
1 PRIMARY
2 POST-PRIMARY, VOCATIONAL
3 SECONDARY/ "A" LEVEL
4 COLLEGE (MIDDLE LEVEL)
5 UNIVERSITY
8 DON'T KNOW
19A) Did (NAME) attend school at any time during the 2013 school year?
NO 2 (GO TO 20)
19B) During the 2013 school year, what level and grade did (NAME) attend? SEE CODES BELOW.
1 PRIMARY
2 POST-PRIMARY, VOCATIONAL
3 SECONDARY/ "A" LEVEL
4 COLLEGE (MIDDLE LEVEL)
5 UNIVERSITY
8 DON'T KNOW
98 DON'T KNOW
BIRTH REGISTRATION:
20) Has (NAME) ever been registered with the civil authority?
IF YES: With a birth certificate?
2 YES, REGISTERED WITHOUT BIRTH CERTIFICATE (GO TO NEXT LINE)
8 DON'T KNOW (GO TO NEXT LINE)
3 NOT REGISTERED (GO TO 20A)
20A) Why was (NAME) never registered?
2 NO MONEY
3 NOT AWARE
4 NOT NECESSARY
5 NOMADIC LIFE, DIFFICULT TERRAIN, INSECURITY
8 OTHER
SELECTION OF WOMEN FOR SECTION 14: DOMESTIC VIOLENCE QUESTIONS
101A) ONLY ONE INDIVIDUAL (ONE WOMAN OR ONE MAN SHOULD BE SELECTED FOR DOMESTIC VIOLENCE QUESTIONS)
CHECK COVER PAGE:
HOUSEHOLD SELECTED FOR WOMEN'S SECTION 14?
NO__ (GO TO 101B)
HOW TO USE THE TABLE FOR SELECTION OF A RESPONDENT:
LOOK AT THE LAST DIGIT OF THE HOUSEHOLD QUESTIONNAIRE SERIAL NUMBER ON THE COVER PAGE. THIS IS THE ROW NUMBER YOU SHOULD GO TO. CHECK THE TOTAL NUMBER OF ELIGIBLE WOMEN (COLUMN 9) IN THE HOUSEHOLD SCHEDULE. THIS IS THE COLUMN NUMBER YOU SHOULD GO TO. FOLLOW THE SELECTED ROW AND COLUMN TO THE CELL WHERE THEY MEET AND CIRCLE THE NUMBER IN THE CELL. THIS IS THE NUMBER OF THE WOMAN SELECTED FOR THE DOMESTIC VIOLENCE QUESTIONS FROM THE LIST OF ELIGIBLE WOMEN IN COLUMN 9 OF THE HOUSEHOLD SCHEDULE. WRITE THE NAME AND LINE NUMBER OF THE SELECTED WOMAN IN THE SPACE BELOW THE TABLE.
EXAMPLE: THE HOUSEHOLD QUESTIONNAIRE SERIAL NUMBER IS '716' AND THE HOUSEHOLD SCHEDULE COLUMN 9 SHOWS THAT THERE ARE THREE ELIGIBLE WOMEN AGE 15-49 IN THE HOUSEHOLD (LINE NUMBERS 02, 04, AND 05). SINCE THE LAST DIGIT OF THE HOUSEHOLD SERIAL NUMBER IS '6' GO TO ROW '6' AND SINCE THERE ARE THREE ELIGIBLE WOMEN IN THE HOUSEHOLD, GO TO COLUMN '3'. FOLLOW THE ROW AND COLUMN AND FIND THE NUMBER IN THE CELL WHERE THEY MEET ('2') AND CIRCLE THE NUMBER. NOW GO TO THE HOUSEHOLD SCHEDULE AND FIND THE SECOND WOMAN WHO IS ELIGIBLE FOR THE WOMAN'S INTERVIEW (LINE NUMBER '04' IN THIS EXAMPLE). WRITE HER NAME AND LINE NUMBER IN THE SPACE BELOW THE TABLE.
SELECTION OF MEN FOR SECTION 10: DOMESTIC VIOLENCE QUESTIONS
101B) ONLY ONE INDIVIDUAL (ONE WOMAN OR ONE MAN SHOULD BE SELECTED FOR DOMESTIC VIOLENCE QUESTIONS)
CHECK COVER PAGE:
HOUSEHOLD SELECTED FOR WOMEN'S SECTION 14?
NO__ (GO TO 102)
HOW TO USE THE TABLE FOR SELECTION OF A RESPONDENT:
LOOK AT THE LAST DIGIT OF THE HOUSEHOLD QUESTIONNAIRE SERIAL NUMBER ON THE COVER PAGE. THIS IS THE ROW NUMBER YOU SHOULD GO TO. CHECK THE TOTAL NUMBER OF ELIGIBLE MEN (COLUMN 10) IN THE HOUSEHOLD SCHEDULE. THIS IS THE COLUMN NUMBER YOU SHOULD GO TO. FOLLOW THE SELECTED ROW AND COLUMN TO THE CELL WHERE THEY MEET AND CIRCLE THE NUMBER IN THE CELL. THIS IS THE NUMBER OF THE MAN SELECTED FOR THE DOMESTIC VIOLENCE QUESTIONS FROM THE LIST OF ELIGIBLE MEN IN COLUMN 10 OF THE HOUSEHOLD SCHEDULE. WRITE THE NAME AND LINE NUMBER OF THE SELECTED MAN IN THE SPACE BELOW THE TABLE.
EXAMPLE: THE HOUSEHOLD QUESTIONNAIRE SERIAL NUMBER IS '716' AND THE HOUSEHOLD SCHEDULE COLUMN 10 SHOWS THAT THERE ARE THREE ELIGIBLE MEN AGE 15-54 IN THE HOUSEHOLD (LINE NUMBERS 02, 04, AND 05). SINCE THE LAST DIGIT OF THE HOUSEHOLD SERIAL NUMBER IS '6' GO TO ROW '6' AND SINCE THERE ARE THREE ELIGIBLE MEN IN THE HOUSEHOLD, GO TO COLUMN '3'. FOLLOW THE ROW AND COLUMN AND FIND THE NUMBER IN THE CELL WHERE THEY MEET ('2') AND CIRCLE THE NUMBER. NOW GO TO THE HOUSEHOLD SCHEDULE AND FIND THE SECOND MAN WHO IS ELIGIBLE FOR THE MAN'S INTERVIEW (LINE NUMBER '04' IN THIS EXAMPLE). WRITE HIS NAME AND LINE NUMBER IN THE SPACE BELOW THE TABLE.
HOUSEHOLD CHARACTERISTICS
102) What is the main source of drinking water for members of your household?
PIPED TO YARD/PLOT 12 (GO TO 105)
PUBLIC TAP/STANDPIPE 13
TUBE WELL OR BOREHOLE 21
UNPROTECTED WELL 32
WATER FROM SPRING
PROTECTED SPRING 41
UNPROTECTED SPRING 42
TANKER TRUCK 71
CART WITH SMALL TANK 61
SURFACE WATER (RIVER DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
BOTTLED WATER 91
OTHER __________ 96
103) Where is that water source located?
IN OWN YARD/PLOT 2
ELSEWHERE 3
104) How long does it take to go there, get water, and come back?
IF 995 OR MORE, ENTER '995'.
DON'T KNOW 998
104A) Who usually goes to this source to fetch the water for your household?
ADULT MAN 2
FEMALE CHILD UNDER 15 YEARS OLD 3
MALE CHILD UNDER 15 YEARS OLD 4
OTHER _________ 6
105) Do you do anything to the water to make it safer to drink?
NO 2
DON'T KNOW 8
106) What do you usually do to make the water safer to drink?
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
COVER THE WATER CONTAINER G
OTHER ___________ X
DON'T KNOW Z
107) What kind of toilet facility do members of your household usually use?
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
COMPOSTING TOILET 31
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
OTHER _______________ 96
108) Do you share this toilet facility with other households?
NO 2 (GO TO 110)
109) How many households use this toilet facility?
10 OR MORE HOUSEHOLDS 95
DON'T KNOW 98
110) Does your household have:
A) Electricity?
B) A radio?
C) A television?
D) A mobile telephone?
E) A non-mobile telephone?
F) A refrigerator?
G) A solar panel?
H) A table?
I) A chair?
J) A sofa?
K) A bed?
L) A cupboard?
M) A clock?
N) A microwave oven?
O) A DVD player?
P) A cassette or CD player?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
110A) Does this household receive a cash transfer or any social assistance from the government?
NO 2 (GO TO 111)
110B) For what reason does the household receive a cash transfer or social assistance?
Any other reason?
RECORD ALL MENTIONED
ELDERLY PERSON B
PERSON WITH SEVERE DISABILITY C
URBAN FOOD SUBSIDY D
FOOD AID FOR PERSONS IN ARID AND SEMI-ARID LANDS E
HEALTH VOUCHER F
FOOD/CASH FOR WORK G
SCHOOL FEEDING H
HUNGER SAFETY NET PROGRAMME I
OTHER _________ X
111) What type of fuel does your household mainly use for cooking?
LPG/NATURAL GAS 02
BIOGAS 04
PARAFIN/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 114)
OTHER _________ 96
112) Is the cooking usually done in the house, in a separate building, or outdoors?
IN A SEPARATE BUILDING 2 (GO TO 114)
OUTDOORS 3 (GO TO 114)
OTHER ______ 6 (GO TO 114)
113) Do you have a separate room which is used as a kitchen?
NO 2
114) MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
115) MAIN MATERIAL OF THE ROOF. RECORD OBSERVATION.
THATCH/GRASS/MAKUTI 12
DUNG/MUD/SOD 13
TIN CANS 22
CONCRETE 32
TILES 33
116) MAIN MATERIAL OF EXTERNAL WALLS. RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
DUNG/MUD/SOD 13
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD 26
IRON SHEETS 27
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
117) How many rooms in this household are used for sleeping?
118) Does any member of this household own:
A) A watch?
B) A bicycle?
C) A motorcycle or motor scooter?
D) An animal-drawn cart?
E) A car or truck?
F) A boat with a motor?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
118A) Does you household own this structure (house, flat, shack), do you pay rent, or do you live here without paying rent?
PAYS RENT/LEASE 2
NO RENT W. CONSENT OF OWNER 3
NO RENT, SQUATTING 4
118B) Does your household own the land on which the structure (house, flat, shack) sits?
PAYS RENT/LEASE 2
NO RENT W. CONSENT OF OWNER 3
NO RENT, SQUATTING 4
119) Does any member of this household own any agricultural land?
NO 2 (GO TO 121)
120) How many acres or hectares of agricultural land do members of this household own?
ACRES/HECTARES: IF 995 OR MORE, RECORD '995.0' IN APPROPRIATE BOX
PLOT SIZE (SQ) FT: IF 99995 OR MORE, RECORD '99995.0' IN APPROPRIATE BOX
HECTARES _____.___ 2
PLOT SIZE (SQ FT) _____________.______ 3
DON'T KNOW 999998
121) Does this household own any livestock, herds, other farm animals, or poultry?
NO 2 (GO TO 123)
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'.
A) Local cattle (indigenous)?
B) Exotic/grade cattle?
C) Horses, donkeys, or camels?
D) Goats?
E) Sheep?
F) Chickens?
123) Does any member of this household have a bank account?
NO 2
DON'T KNOW 8
123A) In the past 7 days were there days when your household did not have enough food or money to buy food?
NO 2 (GO TO 123C)
123B) How many days did your household have to:
A) Rely on less preferred, less expensive food?
B) Rely on borrowed food from friends or relatives?
C) Reduce the number of meals eaten per day?
D) Reduce the portion size of meals?
E) Reduce the quantities eaten by adults in order for small children to eat?
123C) How often does anyone smoke inside your house?
WEEKLY 2
MONTHLY 3
LESS THAN MONTHLY 4
NEVER 5
124) 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 126)
DON'T KNOW (GO TO 126)
124A) How many months ago did someone spray your dwelling against mosquitos?
125) Who sprayed the dwelling?
PRIVATE COMPANY B
NONGOVERNMENTAL ORGANIZATION (NGO) C
OTHER ________ X
DON'T KNOW Z
126) Does your household have any mosquito nets that can be used while sleeping?
NO 2 (GO TO 137)
127) How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD '7'.
128) ASK THE RESPONDENT TO SHOW YOU ALL THE NETS IN THE HOUSEHOLD. IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRES(S).
NOT OBSERVED 2
NOT OBSERVED 2
NOT OBSERVED 2
129) 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 98
130) 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.
PERMANENT (SUPA-NET EXTRA) (GO TO 134) 12
NETPROTECT (GO TO 134) 13
OTHER/ DK BRAND (GO TO 134) 26
SUPANET (GO TO 132) 22
UNBRAIDED RURAL NET 23
DK BRAND __ 98
131) When you got the net, was it already treated as an insecticide to kill or repel mosquitoes?
NO 2
NOT SURE 8
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
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
NOT SURE ____98
133A) The last time the net was treated, was a liquid from a packet like this added to the treatment solution?
SHOW SACHET FOR K-O TAB 1-2-3 BINDING AGENTS.
NO 2
NOT SURE 8
133B) The last time the net was treated, was it treated as part of a net retreatment campaign?
NO 2
NOT SURE 8
135) Who slept under this mosquito net last night?
RECORD THE PERSON'S NAME AND LINE NUMBER FROM THE HOUSEHOLD SIGNATURE.
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.
NOT OBSERVED, NOT IN DWELLING/YARD/PLOT 2 (GO TO 139A)
NOT OBSERVED, NO PERMISSION TO SEE 3 (GO TO 139A)
NOT OBSERVED, OTHER REASON 4 (GO TO 139A)
138) OBSERVATION ONLY. OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT.
WATER IS NOT AVAILABLE 2
139) OBSERVATION ONLY: OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT.
ASH, MUD, SAND B
NONE C
139A) Do members of your household wash their hands with soap?
NO 2 (GO TO 139C)
139B) When do they wash their hands?
Any other time?
RECORD ALL MENTIONED.
BEFORE COOKING B
BEFORE EATING C
AFTER CLEANING BABY'S BACKSIDE D
BEFORE FEEDING BABY E
OTHER _________ X
139C-A) Now, I would like to talk to you about the food consumed in your household during the past 7 days. How many days during the past 7 days, did members of your household consume the following food items, prepared or eaten at home?
139C-B) What was the main source of the (NAME OF FOOD ITEM)? SEE SOURCE CODES BELOW.
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
22 FISHING, HUNTING, GATHERING
23 LOANED, BORROWED
24 PURCHASED
25 BEGGED
26 EXCHANGED FOR LABOR
27 GIFT FROM FAMILY, FRIENDS
28 FOOD AID FROM CIVIL SOCIETY, NGO, GOVERNMENT
96 OTHER
140) ASK RESPONDENT FOR A TEASPOON OF COOKING SALT. TEST SALT FOR IODINE.
NO IODINE 2
NO SALT IN HOUSEHOLD 3
SALT NOT TESTED (SPECIFY REASON) ______________ 6
WEIGHT AND HEIGHT 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 AND YEAR OF BIRTH HISTORY AND ASK DAY, IF MOTHER NOT INTERVIEWED, ASK: What is (NAME)'s birth date?
204) CHECK 203: CHILD BORN IN JANUARY 2009 OR LATER?
NO 2 (GO TO 203 FOR NEXT CHILD OR, IF NO MORE CHILDREN, GO TO 214)
NOT PRESENT 9994
REFUSED 9995
OTHER 9996
NOT PRESENT 9994
REFUSED 9995
OTHER 9996
207) MEASURED LYING DOWN OR STANDING UP?
STANDING UP 2
NOT MEASURED 3
213) 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 214.
WEIGHT AND HEIGHT MEASUREMENT FOR WOMEN AGE 15-49
214) CHECK COLUMN 9 IN HOUSEHOLD SCHEDULE.
RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 215.
IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONAL QUESTIONNAIRE(S).
215) LINE NUMBER FROM COLUMN 9:
NAME FROM COLUMN 2:
NOT PRESENT 99994
REFUSED 99995
OTHER 99996
NOT PRESENT 9994
REFUSED 9995
OTHER 9996
242) GO BACK TO 216 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITIONAL QUESTIONNAIRE; IF NO MORE WOMEN, END INTERVIEW