NIGERIA MALARIA INDICATOR SURVEY
HOUSEHOLD QUESTIONNAIRE
NATIONAL POPULATION COMMISSION
NATIONAL MALARIA CONTROL PROGRAM
STATE __
LOCAL GOVT. AREA __
ENUMERATION AREA __
URBAN/RURAL (URBAN = 1, RURAL = 2) __
CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD HEAD NAME/NUMBER __
FIRST VISIT
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
TIME __
SECOND VISIT
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
TIME __
THIRD VISIT
INTERVIEWER'S NAME __
RESULT* __
FINAL VISIT
MONTH __
YEAR 2010
INT. NUMBER __
RESULT __
TOTAL NUMBER OF VISITS __
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
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER 9 (SPECIFY) __
TOTAL PERSONS IN HOUSEHOLD __
TOTAL ELIGIBLE WOMEN __
TOTAL ELIGIBLE CHILDREN AGE 0-5 YEARS
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __
LANGUAGE OF QUESTIONNAIRE** ENGLISH
LANGUAGE OF INTERVIEW** __
NATIVE LANGUAGE OF RESPONDENT** __
TRANSLATOR USED (1 = NOT AT ALL, 2 = SOMETIME, 3 = ALL THE TIME)
**LANGUAGE CODES:
YORUBA 2
IGBO 3
ENGLISH 4
OTHER 6 (SPECIFY) __
SUPERVISOR/EDITOR
NAME __
DATE __
OFFICE EDITOR __
KEYED BY __
Greetings. My name is _______________________ and I am working with National Population Commission. We are conducting a national survey that asks women and men about various health issues. This study has been reviewed and granted approval by the National Health Research Ethics Committee, assigned number NHREC/01/01/2007, for the study period of September 2010 to September 2011. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 20 and 30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. Should you have any questions, feel free to call any of the following contact person(s):
2010 NMIS Contact Person, NPC: Project Director; Email:; Phone: 08033708115
NMCP Contact Person: National Coordinator; Email; Phone: 08037860784
NHREC Contact Person(s): Secretary, NHREC; Email:; Phone: 08033143791; Desk Officer, NHREC; Email:; Phone: 08065479926
As part of the survey we would first like to ask some questions about your household. All of the answers you give will be confidential. As part of this survey, we are asking that children all over the country take an anemia test. Anemia is a serious health problem that usually results from poor nutrition,, we are asking that children all over the country take a test to see if they have malaria. Malaria is a serious illness caused by a parasite transmitted by a mosquito bite. If the malaria test is positive, treatment will be offered. This survey will help the government to develop programs to prevent malaria. Participation in the survey is completely voluntary. If we should come to 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. However, we hope you will participate in the survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: ________________________________________ Date: ____________
Signature/thumb print of respondent _______________________________ Date: ____________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
LINE NO.
(1) 01
USUAL RESIDENTS AND VISITORS
(2) 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, RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-14 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, like 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
RELATIONSHIP
(3) What is the relationship of (NAME) to the head of the household?
SEE CODES BELOW
CODES FOR Q.3: RELATIONSHIP TO HEAD OF 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
NIECE/NEPHEW BY BLOOD = 09
NIECE/NEPHEW BY MARRIAGE = 10
OTHER RELATIVE = 11
ADOPTED/FOSTER/STEP CHILD = 12
NOT RELATED = 13
DON'T KNOW = 98
__
SEX
(4) Is (NAME) male or female?
FEMALE 2
RESIDENCE
(5) Does (NAME) usually live here?
NO 2
Did (NAME) stay here last night?
NO 2
How old was (NAME) at his/her last birthday?
WOMEN AGE 15-49
(8) CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49 YEARS
(9) Is (NAME) currently pregnant?
NO/DK 2
CHILDREN 0-5
(10) CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5 YEARS
IF AGE 5 YEARS OR OLDER
EVER ATTENDED SCHOOL
(10A) Has (NAME) ever attended school?
NO 2 (GO TO 11)
(10B) 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 Q.10B: EDUCATION
EDUCATION LEVEL:
PRIMARY = 1
SECONDARY = 2
HIGHER = 3
DON'T KNOW = 8
EDUCATION YEAR:
YEARS AT PRE=PRIMARY/KINDERGARDEN LEVEL = 01-03
YEARS 1-6 AT PRIMARY LEVEL = 01-06
YEARS 1-6 AT SECONDARY LEVEL = 01-06
TOTAL NUMBER OF YEARS AT HIGHER LEVEL* - 01
LESS THAN 1 YEAR COMPLETED = 00
DON'T KNOW = 98
*FOR "HIGHER", TOTAL THE NUMBER OF YEARS AT THE POST-SECONDARY LEVEL
CLASS/YEAR __
FOR EVERYONE
FEVER AND TREATMENT
(11) In the last 2 weeks, has (NAME) been sick with a fever at any time?
NO 2 (NEXT LINE NO.)
DK 8 (NEXT LINE NO.)
(12) Did (NAME) get any treatment for the fever in the last 2 weeks?
NO 2 (NEXT LINE NO.)
DK 8 (NEXT LINE NO.)
(13) Where did (NAME) first seek treatment?
USE CODES BELOW
CODES FOR Q.13: PLACE OF TREATMENT
GOVERNMENT HEALTH CENTER = 02
GOVERNMENT HEALTH CLINIC = 03
PRIVATE HOSPITAL/CLINIC = 04
PHARMACY = 05
PRIVATE DOCTOR = 06
MOBILE CLINIC = 07
CHEMIST/PMV = 08
SHOP = 09
TRADITIONAL PRACTITIONER = 10
ROLE MODEL CAREGIVER/COMMUNITY WORKER = 11
DRUG HAWKER = 12
SELF TREATMENT AT HOME = 13
OTHER = 96
DOES NOT KNOW = 98
__
(14) How much did the treatment cost?
INCLUDE COST OF DOCTOR, NURSE, DRUGS, TESTS.
IF > 99990, WRITE '99990'.
IF FREE, CIRCLE CODE '99995'.
FREE 99995
15. What is the main source of drinking water for members of your household?
PIPED INTO YARD/PLOT 12
PUBLIC TAP/STANDPIPE 13
UNPROTECTED WELL 32
UNPROTECTED SPRING 42
TANKER TRUCK 61
CART WITH SMALL TANK 71
SURFACE WATER/RIVER/LAKE/STREAM 81
BOTTLED WATER 91
WATER SACHETS (PURE WATER) 92
OTHER 96 (SPECIFY) __
16. 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
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61
OTHER 96 (SPECIFY) __
17. Does your household have the following items which are in good working order:
A radio?
A television?
A mobile telephone?
A non-mobile telephone?
A refrigerator?
A cable TV?
A generating set?
Air conditioner?
A computer?
Electric iron?
A fan?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
18. What type of fuel does your household mainly use for cooking?
LPG/COOKING GAS 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 HOUSHOLD 95
OTHER 96 (SPECIFY) __
19. MAIN MATERIAL OF THE FLOOR OF THE HOUSEHOLD.
RECORD OBSERVATION.
IF DIFFERENT ROOMS HAVE DIFFERENT FLOOR MATERIAL, CIRCLE THE CODE FOR THE MOST COMMON, i.e. WHAT COVERS THE LARGEST AREA.
FLOOR MAT, LINOLEUM, VINYL 32
CERAMIC TILES 33
CONCRETE, CEMENT 34
CARPET 35
20. MAIN MATERIAL OF THE ROOF OF THE HOUSEHOLD.
RECORD OBSERVATION
WOOD PLANKS 22
TARPAULIN, PLASTIC 23
WOOD 32
CERAMIC TILES 34
CONCRETE, CEMENT 35
ASBESTOS SHEETS, SHINGLES 36
21. MAIN MATERIAL OF THE OUTSIDE WALLS OF THE HOUSEHOLD.
RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
STRAW, THATCH MATS 13
PLYWOOD, REUSED WOOD 22
CARDBOARD, PLASTIC 23
BRICKS 32
WOOD PLANKS/SHINGLES 33
21A. How many rooms in total are in your household, including rooms for sleeping and all other rooms?
INCLUDE ALL STRUCTURES BELONGING TO THE HOUSEHOLD DWELLING.
21B. How many rooms are used for sleeping in your household?
21C. How many sleeping facilities are currently in use in this household, including any beds, mattresses, mats, or rugs?
ASK FOR BOTH INSIDE AND OUTSIDE OF DWELLING.
22. Does any member of this household own:
A bicycle?
A motorcycle or motor scooter?
An animal-drawn cart?
A car or truck?
A boat with a motor?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
23. At any time in the past 12 months, has anyone come into your dwelling to spray the interior walls against mosquitoes?
NO 2 (SKIP TO 25)
DON'T KNOW 8 (SKIP TO 25)
PRIVATE COMPANY 2
OTHER 6 (SPECIFY)
DON'T KNOW 8
25. Does your household have any mosquito nets that can be used while sleeping?
NO 2
26. Why doesn't your household have any mosquito nets?
CIRCLE ALL MENTIONED.
NOT AVAILABLE B (SKIP TO 40)
DON'T LIKE TO USE NETS C (SKIP TO 40)
TOO EXPENSIVE D (SKIP TO 40)
OTHER X (SPECIFY) (SKIP TO 40)
27. How many mosquito nets does your household have?
IF 7 OR MORE NETS, RECORD '7'.
28. ASK RESPONDENT TO SHOW YOU THE NETS. IF MORE THAN 3, USE ADDITIONAL QUESTIONNAIRE(S).
OBSERVED, DOES NOT HAVE HOLES 2
NOT OBSERVED 3
28A. OBSERVER OR ASK IF NET IS HANGING.
NOT HANGING 2
NOT HANGING 4
29. How many months ago did your household obtain the mosquito net?
IF LESS THAN ONE MONTH, WRITE '00'.
MORE THAN 36 MONTHS AGO 95
NOT SURE 98
29A. Where did you obtain this mosquito net?
PRIMARY HEALTH CENTER/HEALTH POST 02
GOVERNMENT HOSPITAL 03
PRIVATE HOSPITAL 04
NGO/MISSION CLINIC 05
MOSQUE/CHURCH 06
PHARMACY 07
PATENT MEDICINE STORE 08
SHOP/SUPERMARKET 09
OPEN MARKET 10
HAWKER 11
DON'T KNOW 96
OTHER (SPECIFY) __
30. Did you buy the net or was it given to you free?
FREE 2 (SKIP TO 32)
DON'T KNOW 8 (SKIP TO 32)
31. How much did you pay for the net?
IF DK, WRITE '99998'.
32. OBSERVE OR ASK THE TYPE AND BRAND OF MOSQUITO NET.
IF BRAND IS UNKNOWN, AND YOU CANNOT OBSERVE THE NET, SHOW PICTURES OF TYPICAL NET TYPES/BRANDS TO RESPONDENT.
OLYSET 12 (SKIP TO 36)
ICONLIFE 13 (SKIP TO 36)
DURANET 14 (SKIP TO 36)
NETPROTECT 15 (SKIP TO 36)
BASF INTERCEPTOR (SKIP TO 36)
OTHER/DK BRAND 17 (SKIP TO 36)
UNTREATED NET 31 (SKIP TO 34)
OTHER 96 (SPECIFY) __
DON'T KNOW 98
33. When you got the net, was it already factory-treated with an insecticide to kill or repel mosquitoes?
NO 2
NOT SURE 8
34. Since you got the mosquito net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?
NO 2 (SKIP TO 36)
NOT SURE 8 (SKIP TO 36)
35. How many months ago was the net last soaked or dipped?
IF LESS THAN ONE MONTH, RECORD '00' MONTHS. IF LESS THAN 2 YEARS AGO, RECORD MONTHS AGO. IF '12 MONTHS AGO' OR '1 YEAR AGO'; PROBE FOR EXACT NUMBER OF MONTHS.
MORE THAN 24 MONTHS AGO 95
NOT SURE 98
36. Did anyone sleep under this mosquito net last night?
NO 2
NOT SURE 8 (SKIP TO 39)
37. Why didn't anyone sleep under this net?
NO MALARIA 02 (SKIP TO 39)
TOO HOT 03 (SKIP TO 39)
DIFFICULT TO HANG 04 (SKIP TO 39)
DON'T LIKE SMELL 05 (SKIP TO 39)
FEEL 'CLOSED IN' OR CONSTRAINED 06 (SKIP TO 39)
NET TOO OLD OR TORN 07 (SKIP TO 39)
NET TOO DIRTY 08 (SKIP TO 39)
NET NOT AVAILABLE LAST NIGHT (WASHING) 09 (SKIP TO 39)
FEEL ITN CHEMICALS ARE UNSAFE 10 (SKIP TO 39)
ITN PROVOKES COUGHING 11 (SKIP TO 39)
USUAL USER(S) DID NOT SLEEP HERE LAST NIGHT 12 (SKIP TO 39)
NET NOT NEEDED LAST NIGHT 13 (SKIP TO 39)
OTHER 96 (SPECIFY) __ (SKIP TO 39)
DON'T KNOW 98 (SKIP TO 39)
38. Who slept under this mosquito net last night?
RECORD THE PERSON'S LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.
LINE NUMBER __
39. GO BACK TO 28 FOR NEXT NET; OR, IF NO MORE NETS, GO TO 40.
ANEMIA AND MALARIA TESTING FOR CHILDREN AGE 6-59 MONTHS
40. CHECK COLUMN 10. WRITE THE LINE NUMBER AND NAME FOR ALL CHILDREN 0-5 YEARS IN Q. 41 IN ORDER BY LINE NUMBER. IF MORE THAN 6 CHILDREN USE ADDITIONAL QUESTIONNAIRES. BE SURE TO FILL QS. 50 AND 52. IF NO CHILDREN AGE 0-5 YEARS IN HOUSEHOLD, END HOUSEHOLD QUESTIONNAIRE AND START WOMEN'S QUESTIONNAIRE.
41. LINE NUMBER FROM COLUMN 10
NAME FROM COLUMN 2
LINE NUMBER __
NAME __
42. IF MOTHER INTERVIEWED, COPY CHILD'S MONTH AND YEAR FROM BIRTH HISTORY AND ASK DAY; IF MOTHER NOT INTERVIEWED, ASK:
What is (NAME)'s birth date?
MONTH __
YEAR __
43. CHECK 42: CHILD BORN IN JANUARY 2005 OR LATER?
NO 2 (GO TO 42 FOR NEXT CHILD, OR, IF NO MORE, GO TO 56)
44. CHECK 42: IS CHILD AGE 0-5 MONTHS, I.E., WAS CHILD BORN IN MONTH OF INTERVIEW OR FIVE PREVIOUS MONTHS?
OLDER 2
45. LINE NUMBER OF PARENT OR ADULT RESPONSIBLE FOR CHILD.
RECORD '00' IF NOT LISTED.
LAB SCIENTIST COMPLETE THIS SECTION
46. READ ANEMIA CONSENT STATEMENT TO PARENT OR OTHER ADULT RESPONSIBLE FOR CHILD.
CONSENT STATEMENT FOR ANEMIA TEST
As part of this survey, we are asking that children all over the country take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or disease. This survey will help the government to develop programs to prevent and treat anemia.
We request that all children born in 2005 or later participate in the anemia testing part of this survey and give a few drops of blood from a finger. 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.
The blood will be tested for anemia immediately and the result will be told to your right away. The result will be kept confidential.
Do you have any questions about the anemia test?
You can say yes to the test or you can say no. It is up to you to decide.
Will you allow (NAME(S) OF CHILD(REN)) to participate in the anemia test?
47. LAB SCIENTIST SIGNATURE
VERIFYING INTERVIEWER READ ANEMIA CONSENT TO THE RESPONDENT.
CIRCLE THE APPROPRIATE CODE.
_____________________________
LAB SCIENTIST SIGNATURE
GRANTED TEST, REFUSED SIGNATURE THUMB PRINT 2 (SKIP TO 48)
REFUSED TEST 3 (SKIP TO 48)
OTHER 6 (SKIP TO 48)
47A. RESPONDENT SIGNATURE/THUMB PRINT
IF RESPONDENT GRANTS TEST, HAVE RESPONDENT SIGN OR PLACE THUMB PRINT ON THE LINE.
_______________________________________
SIGNATURE/THUMB PRINT
48. READ MALARIA CONSENT STATEMENT TO PARENT OR OTHER ADULT RESPONSIBLE FOR CHILD.
CONSENT STATEMENT FOR MALARIA TEST
As part of this survey, we are asking that all children all over the country take a test to see if they have malaria. Malaria is a serious illness caused by a parasite transmitted by a mosquito bite. This survey will help the government to develop programs to prevent malaria.
We request that all children born in 2005 or later participate in the malaria testing part of this survey and give a few drops of blood from a finger. 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. (We will use blood from the same finger prick made for the anemia test).
The blood will be tested for malaria immediately and the result will be told to you right away. The result will be kept confidential.
We will also take (NAME)'s temperature to see if s/he has a fever.
Do you have any questions about the malaria test?
Will you allow me to take (NAME'S) temperature?
You can say yes to the test or you can say no. It is up to you to decide.
Will you allow (NAME(S) OF CHILD(REN)) to participate in the malaria test?
49. LAB SCIENTIST SIGNATURE
VERIFYING INTERVIEWER READ MALRIA CONSENT TO THE RESPONDENT.
CIRCLE THE APPROPRIATE CODE.
____________________________________
LAB SCIENTIST SIGNATURE
GRANTED TEST, REFUSED SIGNATURE THUMB PRINT 2 (SKIP TO 50)
REFUSED TEST 3 (SKIP TO 50)
OTHER 6 (SKIP TO 50)
49A. RESPONDENT SIGNATURE/THUMB PRINT
IF RESPONDENT GRANTS TEST, HAVE RESPONDENT SIGN OR PLACE THUMB PRINT ON THE LINE.
_____________________________________________
SIGNATURE/THUMB PRINT
CONDUCT TESTS FOR WHICH CONSENT IS GRANTED AND CONTINUE TO 50
50. RECORD RESULT CODE OF ANEMIA TEST
NOT PRESENT 2 (SKIP TO 52)
REFUSED 3 (SKIP TO 52)
OTHER 6 (SKIP TO 52)
51. RECORD HEMOGLOBIN LEVEL HERE AND IN THE ANEMIA PAMPHLET.
52. RECORD RESULT CODE OF MALARIA TEST
NOT PRESENT 2 (SKIP TO 56)
REFUSED 3 (SKIP TO 56)
OTHER 6 (SKIP TO 56)
PUT THE 1ST BAR CODE LABEL HERE.
BARCODE
PUT THE 2ND BAR CODE LABEL ON THE THICK BLOOD SMEAR SLIDE, THE 3RD ON THE THIN BLOOD SMEAR SLIDE, THE 4TH ON THE PARACHECK 5TH ON THE TRANSMITTAL FORM.
POSITIVE 1
NEGATIVE 2 (SKIP TO 56)
OTHER 6 (SKIP TO 56)
54A. CIRCLE CODE IN FRONT OF BOXES TO RECORD WHETHER CHILD HAS A FEVER AND RECORD TEMPERATURE.
IF TEMPERATURE IS 37.5C OR HIGHER, RECORD TEMPERATURE UNDER CODE 2, HAS FEVER
HAS FEVER 2 __
54B. RESULT OF TEMPERATURE MEASUREMENT
NOT PRESENT 2
REFUSED 3
OTHER 6
54C. IF MALARIA TEST IS POSITIVE:
READ INFORMATION FOR MALARIA TREATMENT AND CONSENT STATEMENT TO PARENT OR OTHER ADULT RESPONSIBLE FOR THE CHILD. ASK ABOUT ANY TREATMENT THE CHILD HAS ALREADY RECEIVED.
CONSENT STATEMENT FOR MALARIA TREATMENT
The malaria test shows that (NAME) has malaria. We can give you free medicine. The medicine is called ACT. ACT is very effective and in a few days it should get rid of the malaria and other symptoms.
You do not have to give (NAME) the medicine. This is up to you. Please tell me whether you accept the medicine or not.
BEFORE PROVIDING ACT, FIRST ASK:
Is (NAME) already taking any other drugs or medicine to treat malaria?
IF YES, ASK TO SEE THE MEDICINE. IF CHILD IS ALREADY TAKING ACT, CHECK ON THE DOSE ALREADY AVAILABLE. BE CAREFUL NOT TO OVERTREAT THE CHILD.
55. NURSE SIGNATURE
VERIFYING INTERVIEWER READ TREATMENT CONSENT TO THE RESPONDENT.
CIRCLE APPROPRIATE CODE.
______________________________
NURSE SIGNATURE
ACCEPTED MEDICINE, REFUSED SIGNATURE THUMB PRINT 2 (SKIP TO 56)
REFUSED 3 (SKIP TO 56)
ALREADY HAS ACT 4 (SKIP TO 56)
NOT ELIGIBLE 5 (SKIP TO 56)
OTHER 6 (SKIP TO 56)
55A. RESPONDENT SIGNATURE/THUMB PRINT
IF RESPONDENT ACCEPTS MEDICINE, HAVE RESPONDENT SIGN OR PLACE THUMB PRINT ON THE LINE.
______________________________
SIGNATURE/THUMB PRINT
55B. RECORD CHILD'S WEIGHT IN KILOGRAMS
55C. RESULT OF WEIGHT MEASUREMENT
NOT PRESENT 2
REFUSED 3
OTHER 6
56. GO BACK TO 42 IN NEXT COLUMN IN THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE ADDITIONAL QUESTIONNAIRE(S); IF NO MORE CHILDREN, END INTERVIEW.