BIOMARKER QUESTIONNAIRE
PAKISTAN
NATIONAL INSTITUTE OF POPULATION STUDIES
PROVINCE/REGION
SINDH 2
KPK 3
BALOCHINSTAN 4
GB 5
ICT 6
AJK 7
FATA 8
DISTRICT ___________
TEHSIL ___________
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER ________
HOUSEHOLD NUMBER ________
HOUSEHOLD SELECTED FOR MAN'S SURVEY?
NO 2
FIRST VISIT
FIELDWORKER'S NAME _____
NEXT VISIT DATE _______
TIME_______
SECOND VISIT
FIELDWORKER'S NAME _____
NEXT VISIT DATE _______
TIME_______
THIRD VISIT
FIELDWORKER'S NAME _____
FINAL VISIT
MONTH ______
YEAR _______
TOTAL NUMBER OF VISITS _____
NOTES: ______________
TOTAL ELIGIBLE CHILDREN ________
LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF QUESTIONNAIRE** ENGLISH
LANGUAGE OF INTERVIEW** ______
NATIVE LANGUAGE OF RESPONDENT** __________
TRANSLATOR USED
NO 2
**LANGUAGE CODES
URDU 02
SINDHI 03
PUNJABI 04
SARAIKI 05
BALUCHI 06
PUSHTO 07
OTHER 08
NUMBER ___________
FIELD EDITOR
NUMBER ______
KEYED BY
WEIGHT AND HEIGHT MEASUREMENT FOR CHILDREN AGE 0-5
101) CHECK COLUMN 11 IN HOUSEHOLD QUESTIONNAIRE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE CHILDREN 0-5 YEARS IN QUESTIONS 102; IF MORE THAN SIX CHILDREN, USE ADDITIONAL QUESTIONNAIRE(S).
102) CHECK HOUSEHOLD QUESTIONNAIRE: LINE NUMBER FROM COLUMN 11.
NAME ________
103) IF MOTHER INTERVIEWED: COPY CHILD'S DATE OF BIRTH (DAY, MONTH, AND YEAR) FROM PREGNANCY HISTORY. IF MOTHER NOT INTERVIEWED, ASK: What is (NAME)'s date of birth?
MONTH ______
YEAR _______
104) CHECK 103: CHILD BORN IN 2012-2018?
NO 2 (GO TO 114)
NOT PRESENT 9994
REFUSED 9995
OTHER 9996
NOT PRESENT 9994 (GO TO 108)
REFUSED 9995 (GO TO 108)
OTHER 9996 (GO TO 108)
107) MEASURED LYING DOWN OR STANDING UP?
STANDING UP 2
108) MEASURER: ENTER YOUR FIELDWORKER NUMBER
114) GO BACK TO 103 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF THE NEXT PAGE; IF NO MORE CHILDREN, GO TO 201.
WEIGHT AND HEIGHT MEASUREMENT FOR WOMEN AGE 15-49
201) CHECK COLUMN 9 IN HOUSEHOLD QUESTIONNAIRE. RECORD THE LINE NUMBER AND NAME FOR ALL ELIGIBLE WOMEN IN 202. IF THERE ARE MORE THAN THREE WOMEN, USE ADDITIONAL QUESTIONNAIRE(S).
202) CHECK HOUSEHOLD QUESTIONNAIRE: LINE NUMBER FROM COLUMN 9.
NAME ________
NOT PRESENT 99994
REFUSED 99995
OTHER 99996
NOT PRESENT 9994
REFUSED 9995
OTHER 9996
206A) CHECK 226 IN WOMEN'S QUESTIONNAIRE, OR ASK: Are you pregnant?
NO 2
DON'T KNOW 8
207) MEASURER: ENTER YOUR FIELDWORKER NUMBER.
233) GO BACK TO 202 IN NEXT COLUMN OF THIS QUESTIONNAIRE OR IN THE FIRST COLUMN OF AN ADDITONAL QUESTIONNAIRE.
FIELDWORKER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING BIOMARKERS
_______________
SUPERVISOR'S OBSERVATIONS
___________
EDITOR'S OBSERVATIONS
__________
YEAR OF FIELDWORK: 2017
FIVE YEARS BEFORE SURVEY: 2012
CHILD OLDER THAN 5: 2011
CHILD UNDER 4: 2014
CHILD UNDER 3: 2015
CHILD UNDER 16: 2002