DEMOGRAPHIC AND HEALTH SURVEY IN MALI HOUSEHOLD QUESTIONNAIRE 1987
NX__
OF__
NUMBER OF HOUSEHOLD QUESTIONNAIRE__
REGION__
CLUSTER__
ARRONDISSEMENT/COMMUNE__
VILLAGE CODE__
VILLAGE NEIGHBORHOOD__
NAME OF HEAD OF COMPOUND__
NAME OF HEAD OF HOUSEHOLD__
INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
MONTH__
YEAR 1987
INTERVIEWER NAME____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
OTHER (SPECIFY)__ 6
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__
SUPERVISOR
NAME___
DATE___
FIELD EDITOR
NAME__
DATE__
OFFICE EDITOR__
KEYED BY___
CHARACTERISTICS OF HOUSEHOLD MEMBERS:
We would now like information on the persons who usually live in your household and who are currently living with you.
LINE NO. (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)
FEMALE 2
6 MONTHS AND INTENDS TO STAY 1
OTHER 2
6. RESIDENCE: Did (NAME) stay here last night?
NO 2