Codes and Frequencies
An 'X' indicates the category is available for that sample
Code | Label |
afghan
15
|
angola
06
|
angola
11
|
angola
15
|
bang
94
|
bang
97
|
bang
00
|
bang
04
|
bang
07
|
bang
11
|
bang
14
|
bang
18
|
benin
96
|
benin
01
|
benin
06
|
Code | Label |
benin
11
|
benin
17
|
burkf
93
|
burkf
98
|
burkf
03
|
burkf
10
|
burkf
14
|
burkf
18
|
burun
87
|
burun
10
|
burun
12
|
burun
16
|
camer
91
|
camer
98
|
camer
04
|
Code | Label |
camer
11
|
camer
18
|
camer
22
|
cenaf
95
|
chad
96
|
chad
04
|
chad
14
|
comor
96
|
comor
12
|
condr
07
|
condr
13
|
congo
05
|
congo
11
|
cotedi
94
|
cotedi
98
|
Code | Label |
cotedi
11
|
egypt
88
|
egypt
92
|
egypt
95
|
egypt
00
|
egypt
03
|
egypt
05
|
egypt
08
|
egypt
14
|
eswat
06
|
ethio
00
|
ethio
05
|
ethio
11
|
ethio
16
|
ethio
19
|
Code | Label |
gabon
00
|
gabon
12
|
gambia
13
|
gambia
19
|
ghana
88
|
ghana
93
|
ghana
98
|
ghana
03
|
ghana
08
|
ghana
14
|
ghana
16
|
ghana
19
|
guinea
99
|
guinea
05
|
guinea
12
|
Code | Label |
guinea
18
|
guinea
21
|
india
92
|
india
98
|
india
05
|
india
15
|
india
19
|
jordan
90
|
jordan
97
|
jordan
02
|
jordan
07
|
jordan
09
|
jordan
12
|
jordan
17
|
kenya
89
|
Code | Label |
kenya
93
|
kenya
98
|
kenya
03
|
kenya
08
|
kenya
14
|
kenya
15
|
kenya
20
|
lesoth
04
|
lesoth
09
|
lesoth
14
|
liber
86
|
liber
07
|
liber
09
|
liber
11
|
liber
13
|
Code | Label |
liber
16
|
liber
19
|
madag
92
|
madag
97
|
madag
03
|
madag
08
|
madag
11
|
madag
13
|
madag
16
|
madag
21
|
malaw
92
|
malaw
00
|
malaw
04
|
malaw
10
|
malaw
12
|
Code | Label |
malaw
14
|
malaw
16
|
malaw
17
|
mali
87
|
mali
95
|
mali
01
|
mali
06
|
mali
12
|
mali
15
|
mali
18
|
mali
21
|
moroc
87
|
moroc
92
|
moroc
03
|
moz
97
|
Code | Label |
moz
03
|
moz
11
|
moz
18
|
myan
15
|
namib
92
|
namib
00
|
namib
06
|
namib
13
|
nepal
96
|
nepal
01
|
nepal
06
|
nepal
11
|
nepal
16
|
niger
92
|
niger
98
|
Code | Label |
niger
06
|
niger
12
|
niger
21
|
nigera
90
|
nigera
99
|
nigera
03
|
nigera
08
|
nigera
10
|
nigera
13
|
nigera
15
|
nigera
18
|
nigera
21
|
pak
91
|
pak
06
|
pak
12
|
Code | Label |
pak
17
|
rwand
92
|
rwand
00
|
rwand
05
|
rwand
08
|
rwand
10
|
rwand
13
|
rwand
14
|
rwand
17
|
rwand
19
|
stome
08
|
seneg
86
|
seneg
92
|
seneg
97
|
seneg
05
|
Code | Label |
seneg
06
|
seneg
08
|
seneg
10
|
seneg
12
|
seneg
14
|
seneg
15
|
seneg
16
|
seneg
17
|
seneg
21
|
sleone
08
|
sleone
13
|
sleone
16
|
sleone
19
|
safrica
98
|
safrica
16
|
Code | Label |
sril
87
|
sud
89
|
tanz
91
|
tanz
96
|
tanz
99
|
tanz
04
|
tanz
10
|
tanz
15
|
tanz
17
|
togo
88
|
togo
98
|
togo
13
|
togo
17
|
tunis
88
|
ugand
88
|
Code | Label |
ugand
95
|
ugand
01
|
ugand
06
|
ugand
09
|
ugand
11
|
ugand
14
|
ugand
16
|
ugand
18
|
yem
91
|
yem
13
|
zambia
92
|
zambia
96
|
zambia
01
|
zambia
07
|
zambia
13
|
Code | Label |
zambia
18
|
zimbw
88
|
zimbw
94
|
zimbw
99
|
zimbw
05
|
zimbw
10
|
zimbw
15
|
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
01 | January | X | X | X | X | X | X | X | X | · | · | · | X | · | · | · | 01 | January | X | X | X | X | · | · | · | X | · | X | X | X | · | · | · | 01 | January | X | X | · | X | X | · | X | · | · | X | X | · | X | · | · | 01 | January | X | X | X | X | · | · | · | · | · | X | · | · | X | X | · | 01 | January | X | X | · | X | · | X | X | · | · | · | · | · | · | · | · | 01 | January | · | · | X | X | X | X | X | · | · | · | · | · | · | X | X | 01 | January | · | · | · | X | · | · | · | X | X | · | · | X | X | · | · | 01 | January | · | X | · | · | X | X | · | · | · | · | · | · | X | · | · | 01 | January | · | X | · | · | X | X | · | X | · | · | · | · | X | X | · | 01 | January | X | · | · | X | · | · | X | · | X | X | · | X | X | · | X | 01 | January | X | · | · | · | · | · | · | · | · | · | · | · | X | X | X | 01 | January | X | · | · | · | X | X | · | X | · | X | X | · | X | X | X | 01 | January | · | X | X | X | X | · | · | · | X | · | · | · | · | X | · | 01 | January | X | X | X | · | · | X | X | X | · | · | · | X | · | · | X | 01 | January | · | X | · | · | · | X | · | X | X | · | X | X | X | · | X | 01 | January | X | X | · | · | X | X | · |
02 | February | X | X | X | X | X | X | X | X | · | · | · | X | · | · | · | 02 | February | X | X | X | X | · | · | · | X | · | · | · | X | · | X | X | 02 | February | X | · | · | X | X | · | X | · | · | X | X | · | X | · | X | 02 | February | X | · | X | X | X | · | · | · | · | X | X | · | X | X | · | 02 | February | X | X | X | X | X | X | X | · | · | · | · | · | · | X | · | 02 | February | · | · | X | X | X | X | X | · | · | · | · | · | · | · | X | 02 | February | X | X | · | X | · | · | · | X | · | · | X | X | X | · | · | 02 | February | · | X | · | · | X | X | · | · | · | · | · | · | X | · | · | 02 | February | · | X | · | · | X | X | · | X | · | · | · | · | X | X | · | 02 | February | · | · | · | X | · | · | X | · | X | X | X | X | X | · | X | 02 | February | X | X | · | · | · | · | · | · | X | · | · | · | X | X | X | 02 | February | X | · | · | X | X | X | X | X | · | X | · | · | X | X | X | 02 | February | · | X | X | · | X | X | · | · | X | · | · | · | · | X | · | 02 | February | X | · | X | · | · | X | X | X | · | · | X | X | · | · | X | 02 | February | · | X | · | X | · | X | · | · | · | · | X | · | X | · | X | 02 | February | · | · | · | · | X | X | · |
03 | March | · | X | X | X | X | X | X | X | X | · | · | X | · | · | · | 03 | March | X | · | X | X | · | · | · | X | · | · | · | X | · | X | X | 03 | March | X | · | · | X | X | · | X | X | · | X | · | · | · | · | X | 03 | March | X | · | · | · | X | · | · | X | · | X | X | · | X | X | X | 03 | March | · | X | X | X | X | · | · | · | · | · | · | · | · | X | · | 03 | March | X | · | X | X | X | X | X | · | · | · | · | · | · | · | X | 03 | March | X | X | · | X | · | · | · | · | · | · | X | X | X | · | X | 03 | March | · | · | · | · | X | X | X | · | · | X | · | · | · | · | X | 03 | March | · | · | · | X | X | X | · | · | · | · | · | · | X | · | X | 03 | March | · | · | X | X | · | · | X | · | X | X | X | X | · | X | X | 03 | March | X | X | · | · | X | X | · | · | X | · | · | · | X | X | X | 03 | March | X | · | · | X | X | X | X | X | · | X | · | · | X | X | X | 03 | March | · | · | X | X | X | X | X | X | · | · | · | · | · | X | · | 03 | March | X | X | X | · | · | · | X | · | · | · | X | X | · | · | · | 03 | March | X | X | · | · | · | · | · | · | · | · | X | · | X | · | X | 03 | March | · | · | · | · | · | X | · |
04 | April | · | · | X | X | · | · | X | X | X | · | · | · | · | · | · | 04 | April | X | · | X | · | · | · | · | · | X | · | · | · | X | X | X | 04 | April | X | · | · | · | X | · | X | X | · | X | · | · | · | · | · | 04 | April | X | · | · | · | X | · | X | X | X | · | X | X | X | X | X | 04 | April | · | X | X | · | X | · | · | · | · | · | · | · | X | X | · | 04 | April | X | · | X | X | X | X | X | · | · | · | · | · | · | · | X | 04 | April | X | X | X | · | · | · | · | · | · | · | X | X | · | · | X | 04 | April | · | · | · | · | X | X | X | X | X | X | · | · | · | · | X | 04 | April | · | · | X | X | X | X | X | · | · | · | · | · | X | · | X | 04 | April | · | · | X | X | · | · | · | · | X | X | X | X | · | X | X | 04 | April | X | X | · | X | X | X | · | · | X | · | · | · | X | · | X | 04 | April | X | · | · | X | X | X | X | X | · | · | · | X | X | X | X | 04 | April | · | · | X | X | X | X | X | X | · | X | · | · | · | X | · | 04 | April | X | X | · | · | · | · | X | · | · | · | X | X | · | · | · | 04 | April | X | · | · | · | · | · | · | · | · | · | X | · | X | X | X | 04 | April | · | · | · | · | X | · | · |
05 | May | · | · | X | · | · | · | · | X | X | · | · | · | · | · | · | 05 | May | · | · | · | · | · | X | · | · | X | · | · | · | X | X | X | 05 | May | X | · | · | · | X | · | · | X | · | X | · | · | · | · | · | 05 | May | X | · | · | · | X | X | X | X | X | · | X | X | X | X | X | 05 | May | · | X | · | · | X | · | · | · | · | · | · | · | X | X | · | 05 | May | X | · | X | X | X | X | X | · | · | · | · | · | · | · | X | 05 | May | X | X | X | · | X | · | · | · | · | · | X | · | · | · | X | 05 | May | · | · | X | · | X | · | X | X | X | X | · | · | · | · | · | 05 | May | X | · | X | · | X | X | X | · | · | · | · | X | X | · | X | 05 | May | · | X | X | X | · | · | · | X | X | X | X | X | · | X | X | 05 | May | X | X | · | X | X | X | · | · | X | · | · | · | X | · | · | 05 | May | · | · | X | X | · | · | · | · | · | · | · | X | · | X | X | 05 | May | · | · | X | X | X | X | X | X | · | X | · | · | X | X | · | 05 | May | · | X | · | · | · | · | X | · | · | · | X | · | · | · | · | 05 | May | X | · | X | · | · | · | · | · | · | · | X | · | X | X | · | 05 | May | · | · | · | · | · | · | · |
06 | June | X | · | X | · | · | · | · | · | X | · | X | · | X | · | · | 06 | June | · | · | · | · | X | X | · | · | X | · | · | · | X | X | X | 06 | June | X | X | · | · | X | · | · | X | · | X | · | · | · | X | · | 06 | June | · | · | · | · | · | X | X | X | X | · | X | X | · | X | X | 06 | June | · | · | · | · | · | · | · | · | · | · | · | · | X | X | X | 06 | June | X | · | X | X | X | X | X | · | X | · | X | · | · | · | · | 06 | June | X | X | X | · | X | · | · | · | · | · | X | · | · | · | X | 06 | June | · | · | X | · | X | X | · | X | X | X | · | · | · | X | · | 06 | June | X | · | X | X | · | X | X | · | · | · | · | X | · | · | X | 06 | June | · | X | X | X | · | · | · | X | X | X | X | X | X | X | X | 06 | June | X | X | · | X | · | X | X | · | X | · | · | · | X | · | · | 06 | June | · | X | X | X | · | · | · | · | · | X | · | X | · | · | X | 06 | June | · | · | · | X | X | X | X | X | · | X | X | X | X | X | X | 06 | June | · | · | X | · | · | · | · | · | · | X | · | · | · | X | · | 06 | June | X | · | X | · | X | · | X | · | · | · | · | · | X | X | · | 06 | June | · | · | · | · | · | · | · |
07 | July | X | · | · | · | · | · | · | · | X | X | X | · | X | · | · | 07 | July | · | · | · | · | X | X | · | · | X | · | · | · | X | X | X | 07 | July | X | X | · | · | X | X | · | · | · | X | · | X | · | X | · | 07 | July | · | · | · | · | · | · | X | · | · | X | · | X | · | · | · | 07 | July | X | · | · | · | · | · | · | X | · | · | · | · | X | · | X | 07 | July | · | X | X | X | X | X | X | · | X | X | X | · | · | · | · | 07 | July | X | X | X | · | X | X | · | · | · | · | X | · | · | · | X | 07 | July | · | · | X | · | · | X | · | · | X | X | · | X | · | X | · | 07 | July | · | · | · | X | · | · | X | · | · | · | · | X | · | · | X | 07 | July | · | X | · | X | X | · | · | X | · | X | X | · | X | · | X | 07 | July | · | X | · | X | · | X | X | · | X | · | · | · | X | · | · | 07 | July | · | X | X | X | · | · | · | · | · | X | · | X | X | · | · | 07 | July | · | · | · | · | X | X | X | X | · | · | X | X | X | X | X | 07 | July | · | · | · | X | · | · | · | · | · | X | · | · | · | X | · | 07 | July | X | · | X | · | X | · | X | · | · | · | · | X | · | X | · | 07 | July | X | · | X | · | · | · | X |
08 | August | X | · | · | · | · | · | · | · | X | X | X | · | X | X | X | 08 | August | · | · | · | · | X | X | · | · | X | X | · | · | X | · | X | 08 | August | X | X | X | · | · | X | · | · | X | · | X | X | · | X | · | 08 | August | · | · | · | · | · | · | · | · | · | X | · | X | · | · | · | 08 | August | X | · | · | · | · | · | · | X | · | · | · | · | X | · | X | 08 | August | · | X | X | X | X | X | X | · | X | X | X | · | · | · | · | 08 | August | X | · | X | · | X | X | · | · | · | · | X | · | · | · | · | 08 | August | · | · | X | X | · | · | · | · | · | · | X | X | · | X | · | 08 | August | · | · | · | X | · | · | X | · | · | X | · | X | · | · | · | 08 | August | X | X | · | · | X | · | · | X | · | · | X | · | X | · | · | 08 | August | · | · | X | X | · | X | X | · | · | · | X | · | · | · | · | 08 | August | · | X | X | X | · | · | · | · | · | · | · | · | X | · | · | 08 | August | · | · | · | · | X | X | X | X | · | · | X | X | X | X | X | 08 | August | · | · | · | X | · | · | · | X | · | X | · | · | · | X | · | 08 | August | X | · | X | · | X | · | X | · | · | X | · | X | · | X | X | 08 | August | X | · | X | X | X | · | X |
09 | September | X | · | · | · | · | · | · | · | · | X | X | · | · | X | X | 09 | September | · | · | · | · | X | X | X | · | · | X | · | · | X | · | X | 09 | September | · | X | X | X | · | X | · | · | X | X | X | X | X | X | X | 09 | September | · | · | · | · | · | · | · | · | · | X | · | X | · | · | · | 09 | September | X | · | · | · | · | · | · | X | X | X | · | X | · | · | X | 09 | September | · | X | X | X | · | X | X | X | X | X | X | · | X | X | · | 09 | September | · | · | X | · | X | · | · | X | · | X | · | · | · | X | · | 09 | September | X | · | X | X | · | · | · | · | · | · | X | X | X | X | · | 09 | September | · | · | · | · | · | · | X | · | X | X | X | · | · | · | · | 09 | September | X | X | · | · | X | X | · | X | · | · | · | · | X | · | · | 09 | September | · | · | X | X | · | · | X | · | · | · | X | · | · | X | · | 09 | September | · | X | X | · | · | X | · | · | · | · | X | X | · | · | · | 09 | September | · | · | · | X | X | X | X | X | · | · | X | · | X | X | X | 09 | September | · | · | · | X | X | · | · | X | · | X | · | · | X | X | X | 09 | September | · | X | X | · | X | · | X | · | · | X | · | X | · | X | X | 09 | September | X | X | X | X | X | X | X |
10 | October | X | · | · | X | · | · | · | · | · | X | X | X | · | X | X | 10 | October | · | · | · | · | X | X | X | · | · | X | · | X | X | · | · | 10 | October | · | X | X | X | · | X | X | · | X | · | X | X | X | X | X | 10 | October | · | X | · | · | · | · | · | · | · | X | · | · | · | · | · | 10 | October | X | · | · | · | · | X | · | X | X | X | X | X | · | · | X | 10 | October | · | · | X | X | · | X | X | X | · | X | X | X | X | X | · | 10 | October | · | · | · | · | X | · | · | X | X | X | · | · | · | X | · | 10 | October | X | X | X | X | · | · | · | · | · | · | X | X | X | X | · | 10 | October | · | X | · | · | · | · | X | · | X | X | X | · | · | X | · | 10 | October | X | X | · | · | X | X | · | · | · | · | · | · | X | · | · | 10 | October | · | · | X | X | · | · | X | X | · | X | X | X | · | X | X | 10 | October | · | X | X | · | · | X | · | · | X | · | X | · | · | · | · | 10 | October | · | · | X | X | X | X | X | X | · | · | X | · | · | · | X | 10 | October | · | · | X | X | X | X | · | X | X | X | · | · | X | X | X | 10 | October | · | X | X | · | X | · | X | · | · | X | · | X | · | X | X | 10 | October | X | X | X | X | X | X | X |
11 | November | X | X | · | X | X | X | X | · | · | X | X | X | · | X | X | 11 | November | · | X | · | X | X | X | X | X | · | X | X | X | · | · | · | 11 | November | · | X | X | X | · | X | X | · | X | · | X | X | X | X | X | 11 | November | · | X | X | X | · | · | · | · | · | X | · | · | · | · | · | 11 | November | X | · | · | X | · | X | X | X | X | X | X | X | · | · | · | 11 | November | · | · | X | X | · | X | X | X | · | · | · | X | X | X | · | 11 | November | · | · | · | X | · | · | X | X | X | X | · | · | · | X | · | 11 | November | X | X | X | X | X | X | · | · | · | · | X | X | X | · | · | 11 | November | · | X | · | · | X | · | X | X | X | X | X | · | · | X | · | 11 | November | X | X | · | · | X | X | X | · | · | · | · | · | X | · | · | 11 | November | · | · | · | · | · | · | X | X | · | X | X | X | · | X | X | 11 | November | X | · | X | · | · | X | · | X | X | X | X | · | X | · | · | 11 | November | X | X | X | X | · | X | X | X | · | · | X | · | · | · | X | 11 | November | · | X | X | X | X | X | · | X | X | X | · | X | X | · | X | 11 | November | · | X | · | X | X | · | X | · | X | X | · | X | X | · | X | 11 | November | X | X | X | X | X | X | X |
12 | December | X | X | · | X | X | X | X | · | · | X | · | X | · | · | · | 12 | December | X | X | X | X | X | X | X | X | · | X | X | X | · | · | · | 12 | December | · | X | · | X | X | X | X | · | X | · | X | · | X | · | · | 12 | December | X | X | X | X | · | · | · | · | · | X | · | · | · | · | · | 12 | December | X | · | · | X | · | X | X | · | · | X | X | · | · | · | · | 12 | December | · | · | X | X | X | X | X | X | · | · | · | X | X | X | X | 12 | December | · | · | · | X | · | · | X | X | X | X | · | X | X | X | · | 12 | December | · | X | · | X | X | X | · | · | · | · | · | · | X | · | · | 12 | December | · | X | · | · | X | · | X | X | · | · | · | · | · | X | · | 12 | December | X | X | · | X | · | X | X | · | · | · | · | · | X | · | · | 12 | December | · | · | · | X | · | · | · | X | · | · | X | X | X | X | X | 12 | December | X | · | · | · | X | X | · | X | X | X | X | · | X | · | · | 12 | December | X | X | X | X | · | · | · | X | X | · | · | · | · | · | · | 12 | December | · | X | X | · | · | X | X | X | X | · | · | X | · | · | X | 12 | December | · | X | · | X | X | X | X | X | X | X | · | X | X | · | X | 12 | December | X | X | · | X | X | X | X |
Can't find the category you are looking for? Try the Detailed codes
Description
MONTHINT (V006) reports the month when the interview took place.
Comparability
Apart from universe differences, MONTHINT (V006) is largely comparable across samples. All samples in this variable utilize the Gregorian calendar. Samples utilizing country-specific calendars are excluded from MONTHINT but are included in country-specific variables.
The Ethiopian samples use a country-specific calendar, but for 2000 and 2005, the Ethiopian calendar dates were also converted into the Gregorian calendar by the DHS and are included in MONTHINT. For the remainder of Ethiopian samples, IPUMS has calculated the Gregorian calendar month for MONTHINT.
The month of interview according to the Ethiopian calendar is reported in the variable MONTHINT_ET, which is country-specific to Ethiopia. Similarly, Nepal and Afghanistan use country-specific calendars. Month of interview is reported for those countries in the country-specific variables MONTHINT_NP and MONTHINT_AF, respectively. IPUMS has calculated the Gregorian calendar month for MONTHINT for Nepal and Afghanistan.
[show more]The Ethiopian calendar is approximately 7 years, 8 months, and 11 days earlier than the Gregorian calendar. We used the Beyene-Kudlek algorithm to convert the Ethiopian days to Gregorian, which involves calculating the Julian Day Number (the number of days that have passed since January 1, 4713 BC), then converting from the Julian Day Number to Gregorian. For calculating the Julian Day Number from the Ethiopian calendar year, month, and day, we used the following formula:
Julian Day Number = 1723856 + 365 (year - 1) + âyear/4â + 30 (month - 1) + day + 12
For the second step of converting the previous result into the Gregorian year and month, we used the following expressions:
Gregorian year = int(Julian Day Number/365.25) - 4712
Gregorian month = int((Julian Day Number - Gregorian year*365.25 - 4712*365.25)/30) + 1
In which the function "int()" returns the integer "floor," which is the nearest integer less than the given value. For example, the integer floor of 2.8 is 2.
Nepal uses a country-specific calendar. For month dates expressed in terms of the Nepali calendar, see the country-specific variable MONTHINT_NP. To include Nepali samples in MONTHINT, IPUMS has calculated the Gregorian calendar month for Nepal samples.
[show more]Nepal uses a calendar called the Bikram Sambat, which is approximately 56.7 years later than the Gregorian calendar. The Bikram Sambat has 12 lunar months varying in length from 29 to 32 days and has solar sidereal years. A solar sidereal year is the period of time that Earth takes to return to the same point relative to "fixed stars", or celestial bodies so distant from Earth that they appear to not move relative to Earth. A sidereal year differs by about 20 minutes from a solar year, which is the period that Earth takes to complete an orbit around the Sun.
The Gregorian New Year (January 1st) occurs on the Bikram Sambat day Poush 17 (8th month). Between the Nepali New Year (Baishakh 1) until the Gregorian New Year (January 1st), a Bikram Sambat date is 57 years greater than a Gregorian date, and 56 years greater than a Gregorian date after the Gregorian New Year (approximately January to April). We calculated the Gregorian month (MONTHINT) by subtracting 8 months and 17 days from the Nepali Bikram Sambat date. There may be a few edge cases in which the wrong Gregorian month is assigned due to differences in the lengths of months.
Afghanistan uses a country-specific calendar. For month dates expressed in terms of the Afghanistan calendar, see the country-specific variable MONTHINT_AF. To include Afghanistan samples in MONTHINT, IPUMS has calculated the Gregorian calendar month for those Afghanistan samples.
[show more]At the time of its 2015 DHS survey, Afghanistan used the Solar Hijri calendar, which has 12 months of 30 or 31 days. The twelfth month has 29 days, except for 30 days on the leap year. The first day of a new year in the Solar Hijri calendar corresponds to March 21st (March 20th during Solar Hijri leap years) in the Gregorian calendar.
The Gregorian New Year (January 1st) usually corresponds to the 11th day of the month Jadi (10th month) in the Solar Hijiri calendar. Between that date until the end of a Solar Hijri year, the Gregorian year is 622 years later than the Solar Hijri year. Between the beginning of a Solar Hijri year and the last day of a Gregorian year, the Gregorian year is 621 years later.
The Gregorian month (MONTHINT) is either 2 or 3 months greater, depending on the day of the month. The number of days per month differs across Solar Hijri months, so we calculated the Gregorian month. There may be a few edge cases in which the wrong Gregorian month is assigned, due to leap years.
MONTHINT (V006) is included and consistent across all phases of the standard DHS questionnaire.
Universe
- Afghanistan 2015: Ever-married women age 15-49.
- Angola 2006: All women age 15-49.
- Angola 2011: All women age 15-49.
- Angola 2015: All women age 15-49.
- Bangladesh 1994: Ever-married women age 10-49.
- Bangladesh 1997: Ever-married women age 10-49.
- Bangladesh 2000: Ever-married women age 10-49.
- Bangladesh 2004: Ever-married women age 10-49.
- Bangladesh 2007: Ever-married women age 15-49.
- Bangladesh 2011: Ever-married women age 12-49.
- Bangladesh 2014: Ever-married women age 15-49.
- Bangladesh 2018: Ever-married women age 15-49.
- Benin 1996: All women age 15-49.
- Benin 2001: All women age 15-49.
- Benin 2006: All women age 15-49.
- Benin 2011: All women age 15-49.
- Benin 2017: All women age 15-49.
- Burkina Faso 1993: All women age 15-49.
- Burkina Faso 1998: All women age 15-49.
- Burkina Faso 2003: All women age 15-49.
- Burkina Faso 2010: All women age 15-49.
- Burkina Faso 2014: All women age 15-49.
- Burkina Faso 2018: All women age 15-49.
- Burundi 1987: All women age 15-49.
- Burundi 2010: All women age 15-49.
- Burundi 2012: All women age 15-49.
- Burundi 2016: All women age 15-49.
- Cameroon 1991: All women age 15-49.
- Cameroon 1998: All women age 15-49.
- Cameroon 2004: All women age 15-49.
- Cameroon 2011: All women age 15-49.
- Cameroon 2018: All women age 15-64.
- Cameroon 2022: All women age 15-49.
- Central African Republic 1995: All women age 15-49.
- Chad 1996: All women age 15-49.
- Chad 2004: All women age 15-49.
- Chad 2014: All women age 15-49.
- Comoros 1996: All women age 15-49.
- Comoros 2012: All women age 15-49.
- Congo (Democratic Republic) 2007: All women age 15-49.
- Congo (Democratic Republic) 2013: All women age 15-49.
- Congo Brazzaville 2005: All women age 15-49.
- Congo Brazzaville 2011: All women age 15-49.
- Cote d'Ivoire 1994: All women age 15-49.
- Cote d'Ivoire 1998: All women age 15-49.
- Cote d'Ivoire 2011: All women age 15-49.
- Egypt 1988: Ever-married women age 15-49.
- Egypt 1992: Ever-married women age 15-49.
- Egypt 1995: Ever-married women age 15-49.
- Egypt 2000: Ever-married women age 15-49.
- Egypt 2003: Ever-married women age 15-49.
- Egypt 2005: Ever-married women age 15-49.
- Egypt 2008: Ever-married women age 15-49.
- Egypt 2014: Ever-married women age 15-49.
- Eswatini (Swaziland) 2006: All women age 15-49.
- Ethiopia 2000: All women age 15-49.
- Ethiopia 2005: All women age 15-49.
- Ethiopia 2011: All women age 15-49.
- Ethiopia 2016: All women age 15-49.
- Ethiopia 2019: All women age 15-49.
- Gabon 2000: All women age 15-49.
- Gabon 2012: All women age 15-49.
- Gambia 2013: All women age 15-49.
- Gambia 2019: All women age 15-49.
- Ghana 1988: All women age 15-49.
- Ghana 1993: All women age 15-49.
- Ghana 1998: All women age 15-49.
- Ghana 2003: All women age 15-49.
- Ghana 2008: All women age 15-49.
- Ghana 2014: All women age 15-49.
- Ghana 2016: All women age 15-49.
- Ghana 2019: All women age 15-49.
- Guinea 1999: All women age 15-49.
- Guinea 2005: All women age 15-49.
- Guinea 2012: All women age 15-49.
- Guinea 2018: All women age 15-49.
- Guinea 2021: All women age 15-49.
- India 1992: Ever-married women age 13-49.
- India 1998: Ever-married women age 15-49.
- India 2005: All women age 15-49.
- India 2015: All women age 15-49.
- India 2019: All women age 15-49.
- Jordan 1990: Ever-married women age 15-49.
- Jordan 1997: Ever-married women age 15-49.
- Jordan 2002: Ever-married women age 15-49.
- Jordan 2007: Ever-married women age 15-49.
- Jordan 2009: Ever-married women age 15-49.
- Jordan 2012: Ever-married women age 15-49.
- Jordan 2017: Ever-married women age 15-49.
- Kenya 1989: All women age 15-49.
- Kenya 1993: All women age 15-49.
- Kenya 1998: All women age 15-49.
- Kenya 2003: All women age 15-49.
- Kenya 2008: All women age 15-49.
- Kenya 2014: All women age 15-49.
- Kenya 2015: All women age 15-49.
- Kenya 2020: All women age 15-49.
- Lesotho 2004: All women age 15-49.
- Lesotho 2009: All women age 15-49.
- Lesotho 2014: All women age 15-49.
- Liberia 1986: All women age 15-49.
- Liberia 2007: All women age 15-49.
- Liberia 2009: All women age 15-49.
- Liberia 2011: All women age 15-49.
- Liberia 2013: All women age 15-49.
- Liberia 2016: All women age 15-49.
- Liberia 2019: All women age 15-49.
- Madagascar 1992: All women age 15-49.
- Madagascar 1997: All women age 15-49.
- Madagascar 2003: All women age 15-49.
- Madagascar 2008: All women age 15-49.
- Madagascar 2011: All women age 15-49.
- Madagascar 2013: All women age 15-49.
- Madagascar 2016: All women age 15-49.
- Madagascar 2021: All women age 15-49.
- Malawi 1992: All women age 15-49.
- Malawi 2000: All women age 15-49.
- Malawi 2004: All women age 15-49.
- Malawi 2010: All women age 15-49.
- Malawi 2012: All women age 15-49.
- Malawi 2014: All women age 15-49.
- Malawi 2016: All women age 15-49.
- Malawi 2017: All women age 15-49.
- Mali 1987: All women age 15-49.
- Mali 1995: All women age 15-49.
- Mali 2001: All women age 15-49.
- Mali 2006: All women age 15-49.
- Mali 2012: All women age 15-49.
- Mali 2015: All women age 15-49.
- Mali 2018: All women age 15-49.
- Mali 2021: All women age 15-49.
- Morocco 1987: Ever-married women age 15-49.
- Morocco 1992: All women age 15-49.
- Morocco 2003: All women age 15-49.
- Mozambique 1997: All women age 15-49.
- Mozambique 2003: All women age 15-49.
- Mozambique 2011: All women age 15-49.
- Mozambique 2018: All women age 15-49.
- Myanmar 2015: All women age 15-49.
- Namibia 1992: All women age 15-49.
- Namibia 2000: All women age 15-49.
- Namibia 2006: All women age 15-49.
- Namibia 2013: All women age 15-64.
- Nepal 1996: Ever-married women age 15-49.
- Nepal 2001: Ever-married women age 15-49.
- Nepal 2006: All women age 15-49.
- Nepal 2011: All women age 15-49.
- Nepal 2016: All women age 15-49.
- Niger 1992: All women age 15-49.
- Niger 1998: All women age 15-49.
- Niger 2006: All women age 15-49.
- Niger 2012: All women age 15-49.
- Niger 2021: All women age 15-49.
- Nigeria 1990: All women age 15-49.
- Nigeria 1999: All women age 10-49.
- Nigeria 2003: All women age 15-49.
- Nigeria 2008: All women age 15-49.
- Nigeria 2010: All women age 15-49.
- Nigeria 2013: All women age 15-49.
- Nigeria 2015: All women age 15-49.
- Nigeria 2018: All women age 15-49.
- Nigeria 2021: All women age 15-49.
- Pakistan 1991: Ever-married women age 15-49.
- Pakistan 2006: Ever-married women age 15-49.
- Pakistan 2012: Ever-married women age 15-49.
- Pakistan 2017: Ever-married women age 15-49.
- Rwanda 1992: All women age 15-49.
- Rwanda 2000: All women age 15-49.
- Rwanda 2005: All women age 15-49.
- Rwanda 2008: All women age 15-49.
- Rwanda 2010: All women age 15-49.
- Rwanda 2013: All women age 15-49.
- Rwanda 2014: All women age 15-49.
- Rwanda 2017: All women age 15-49.
- Rwanda 2019: All women age 15-49.
- Sao Tome 2008: All women age 15-49.
- Senegal 1986: All women age 15-49.
- Senegal 1992: All women age 15-49.
- Senegal 1997: All women age 15-49.
- Senegal 2005: All women age 15-49.
- Senegal 2006: All women age 15-49.
- Senegal 2008: All women age 15-49.
- Senegal 2010: All women age 15-49.
- Senegal 2012: All women age 15-49.
- Senegal 2014: All women age 15-49.
- Senegal 2015: All women age 15-49.
- Senegal 2016: All women age 15-49.
- Senegal 2017: All women age 15-49.
- Senegal 2021: All women age 15-49.
- Sierra Leone 2008: All women age 15-49.
- Sierra Leone 2013: All women age 15-49.
- Sierra Leone 2016: All women age 15-49.
- Sierra Leone 2019: All women age 15-49.
- South Africa 1998: All women age 15-49.
- South Africa 2016: All women age 15-49.
- Sri Lanka 1987: Ever-married women age 15-49.
- Sudan 1989: Ever-married women age 15-49.
- Tanzania 1991: All women age 15-49.
- Tanzania 1996: All women age 15-49.
- Tanzania 1999: All women age 15-49.
- Tanzania 2004: All women age 15-49.
- Tanzania 2010: All women age 15-49.
- Tanzania 2015: All women age 15-49.
- Tanzania 2017: All women age 15-49.
- Togo 1988: All women age 15-49.
- Togo 1998: All women age 15-49.
- Togo 2013: All women age 15-49.
- Togo 2017: All women age 15-49.
- Tunisia 1988: Ever-married women age 15-49.
- Uganda 1988: All women age 15-49.
- Uganda 1995: All women age 15-49.
- Uganda 2001: All women age 15-49.
- Uganda 2006: All women age 15-49.
- Uganda 2009: All women age 15-49.
- Uganda 2011: All women age 15-49.
- Uganda 2014: All women age 15-49.
- Uganda 2016: All women age 15-49.
- Uganda 2018: All women age 15-49.
- Yemen 1991: Ever-married women age 15-54.
- Yemen 2013: All women age 15-49.
- Zambia 1992: All women age 15-49.
- Zambia 1996: All women age 15-49.
- Zambia 2001: All women age 15-49.
- Zambia 2007: All women age 15-49.
- Zambia 2013: All women age 15-49.
- Zambia 2018: All women age 15-49.
- Zimbabwe 1988: All women age 15-49.
- Zimbabwe 1994: All women age 15-49.
- Zimbabwe 1999: All women age 15-49.
- Zimbabwe 2005: All women age 15-49.
- Zimbabwe 2010: All women age 15-49.
- Zimbabwe 2015: All women age 15-49.
Survey Text
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER_________ 7
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER_________ 7
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER_________ 7
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER_________ 7
TOTAL NUMBER OF VISITS
LANGUAGE OF INTERVIEW
PASHTO 2
OTHER________6
NATIVE LANGUAGE OF RESPONDENT
PASHTO 2
OTHER________6
TRANSLATOR USED?
NO 2
PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
REGION
URBAN/RURAL
RURAL 2
MALARIA ENDEMIC REGION
Mesoendemic Stable (Zaire, Luanda, Bengo, Benguela, K. Sul, Huambo, Bié) 2
Mesoendemic Unstable (Moxico, K. Kubango, Kunene, Huila, Namibe) 3
FIRST VISIT
DATE
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
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
TOTAL NO. OF VISITS
TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
LINE NUMBER OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
LAST VISIT
DAY
MONTH
YEAR: 2011
CODE
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FIRST VISIT
DATE_________
DAY___
MONTH___
INTERVIEWER'S NAME_________
RESULT
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7
NEXT VISIT:
DATE_________
TIME_________
SECOND VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7
NEXT VISIT:
DATE____
TIME____
THIRD VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7
FINAL VISIT
DAY_________
MONTH_________
YEAR_____
INT. NO._________
RESULT
ABSENT 2
POSTPONED 3
REFUSED 4
INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) ________ 7
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
DATE__
INTERVIEWER'S NAME___
RESULT ____
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
RESPONDENT INCAPACITATED 6
OTHER (SPECIFY) 7
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
RESPONDENT INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
RESPONDENT INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY
MONTH
FEBRUARY 02
MARCH 03
APRIL 04
MAY 05
JUNE 06
JULY 07
AUGUST 08
SEPTEMBER 09
OCTOBER 10
NOVEMBER 11
DECEMBER 12
YEAR
CODE
RESULT
TOTAL NUMBER OF VISITS:
FIRST VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
NEXT VISIT:
DATE____
TIME____
SECOND VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
NEXT VISIT:
DATE____
TIME____
THIRD VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
FINAL VISIT:
DAY____
MONTH____
YEAR: 2007
INT. NUMBER____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
TOTAL NUMBER OF VISITS____
FIRST VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
NEXT VISIT:
DATE____
TIME____
SECOND VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
NEXT VISIT:
DATE____
TIME____
THIRD VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
FINAL VISIT:
DAY____
MONTH____
YEAR____
INT. NUMBER____
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME ___________
RESULT* _____
DATE__________
INTERVIEWER'S NAME_________
RESULT
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ____________
NEXT VISIT ________
DATE_____
TIME_______
FINAL VISIT
DAY________
MONTH________
YEAR_________
INT. CODE______________
RESULT
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ____________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME___
RESULT**
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME___
RESULT ____
NEXT VISIT
DATE___
TIME___
FINAL VISIT
DAY____
MONTH___
YEAR 2001
NAME___
RESULT ____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER NAME____
RESULT _____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE______
INTERVIEWER'S NAME_________
RESULT
NEXT VISIT
DATE________
TIME_________
FINAL VISIT
DAY_______
MONTH_______
YEAR 2011
INTERVIEWER CODE_______
RESULT _____
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. NO. __ __ __
RESULT* __
TOTAL NUMBER OF VISITS __
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______
INTERVIEWER'S NAME ______
NEXT VISIT
DATE ______
TIME ______
FINAL VISIT
DAY _____
MONTH _____
YEAR 2003
INT. NUMBER ______
RESULT __________
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
TOTAL NUMBER OF VISITS _____
FIST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY _____
MONTH _____
YEAR 2010
INT. NAME _____
RESULT _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
MONTH ______
YEAR 2014
INTERVIEWER NUMBER ______
RESULT ______
(Repeat up to 3 visits)
NAME OF INTERVIEWER ______
RESULT ______
TIME ______
MONTH ______
YEAR 2017
INTERVIEWER NUMBER ______
RESULT ______
TOTAL NUMBER OF VISITS ______
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE_____
INTERVIEWER'S NAME_____
RESULT
NEXT VISIT
DATE____
TIME____
FINAL VISIT
DAY_____
MONTH____
YEAR____
INT. NUMBER____
RESULT____
(Repeat up to 3 visits)
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
NEXT VISIT:
DATE ______
TIME ______
FINAL VISIT
DAY ______
MONTH ______
YEAR 20______
INTERVIEWER NUMBER ______
RESULT ______
TOTAL NUMBER OF VISITS ______
RESULT CODES
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______
LANGUAGE OF QUESTIONNAIRE (FRENCH AND KIRUNDI = 1)
LANGUAGE OF INTERVIEW
INTERPRETER (YES = 1, NO = 2)
LANGUAGE CODES
1 KIRUNDI
2 FRENCH
6 OTHERS
LANGUAGE OF QUESTIONNAIRE 1
INTERVIEW LANGUAGE ______
INTERPRETER ______
TEAM LEADER
NAME ______
FIELD EDITOR
(NUMBER) ______
DATA ENTRY BY
(NUMBER) ______
[###translator's note: Throughout this survey, all questions or statements that are directly addressed to the respondent are given in Kirundi language as well as French]
1 2 3
DATE
INTERVIEWER'S NAME
RESULT
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__
FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
INTERVIEWER NAME___
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__
FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__
NO HOUSEHOLD MEMBER AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY): ___ 7
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__
FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
UNABLE 6
OTHER (SPECIFY): ___ 7
DATE______
INTERVIEWER'S NAME_______
RESULT*________
NEXT VISIT
DATE_______
TIME_______
FINAL VISIT
DAY_______
MONTH_______
YEAR __2018__
INT. NO. _______
RESULT*_______
TOTAL NUMBER OF VISITS________
*RESULT CODES:
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)_______
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT: DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT: DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
FINAL VISIT
DAY
MONTH
YEAR 2022
INT. NO.
RESULT*
TOTAL VISITS
*RESULT CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)
LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF INTERVIEW**
NATIVE LANGUAGE OF RESPONDENT**
TRANSLATOR USED (YES = 1, NO = 2)
LANGUAGE OF QUESTIONNAIRE** ENGLISH
**LANGUAGE CODES:
01 ENGLISH
02 FRENCH
03 FUFULDE
04 PIDGIN
96 OTHER (SPECIFY)
TEAM
NUMBER
TEAM SUPERVISOR
NAME
NUMBER
DATE____
INTERVIEWER'S NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
FINAL VISIT
DAY____
MONTH____
YEAR____
NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
NEXT VISIT
DATE
TIME
FIRST INTERVIEWER VISIT
INTERVIEWER'S NAME__________
RESULT*
SECOND INTERVIEWER VISIT
INTERVIEWER'S NAME________
RESULT*
THIRD INTERVIEWER VISIT
INTERVIEWER'S NAME______
RESULT*
FINAL VISIT
MONTH____
YEAR 200__
NAME_______
RESULT___
NEXT VISIT
TIME_____
NO 2
HOUSEHOLD SELECTED FOR MEN'S SURVEY
IF YES (=1) CHECK Q. 403 OF HOUSEHOLD QUESTIONNAIRE: WOMAN SELECTED FOR THE "DOMESTIC VIOLENCE" MODULE? (YES=1, NO=2). IF THE HOUSEHOLD IS NOT SELECTED FOR THE MEN'S SURVEY, LEAVE THE SPACE BLANK.
WOMAN SELECTED FOR THE "DOMESTIC VIOLENCE" SURVEY
INTERVIEWER VISITS
1 2 3
DATE_____
INTERVIEWER'S NAME
RESULT*
FINAL VISIT
MONTH __ __
YEAR 201__
INT. NUMBER__ __ __
CODE RESULT __
NEXT VISIT
TIME________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME____
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT*
NEXT VISIT:
DATE ____
TIME ____
SECOND VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT*
NEXT VISIT:
DATE ____
INTERVIEWER'S NAME ____
RESULT*
THIRD VISIT DATE ____
INTERVIEWER'S NAME ____
RESULT*
FINAL VISIT
DAY ____
MONTH ____
YEAR 201_
INTERVIEWER CODE ____
RESULT
DATE____
INTERVIEWER'S NAME____
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE___
TIME_____
FINAL VISIT
DAY___
MONTH___
YEAR 94
NAME___
RESULT___
FIRST VISIT (REVIEW FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME __________
RESULT_____
NEXT VISIT
DATE _____
TIME ____
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT ____
INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE____ /201__
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 (REPEAT FOR INTERVIEWER 2)
DATE____ /201__
TIME______
FINAL VISIT
DAY_______
MONTH_______
YEAR 201___
INTERVIEWER CODE________
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
DATE____
TIME_____
FINAL VISIT
MONTH______
YEAR______
INTERVIEWER'S NAME____
RESULT____
ADDRESS IN DETAIL ______________
NAME OF WOMAN ______________
LINE NUMBER OF WOMAN ___________
GOVERNORATE ___
PSU/SEGMENT NO.___
HOUSEHOLD NO. ___
URBAN/RURAL ___
LOCALITY ___
LINE NUMBER ___
INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER'S NAME _____
SUPERVISOR 'S NAME_____
RESULT ______
NEXT VISIT: DATE _____ TIME ________
FINAL VISIT: DAY ____ MONTH ____ YEAR ____
TEAM ____
INTERVIEWER _____
SUPERVISOR _____
RESULT _____
TOTAL NUMBER OF VISITS ___
DATE _____
TEAM _____
INTERVIEWER _____
SUPERVISOR _____
ASSISTANT SUPERVISOR _____
RESULT ______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _______ 7
NEXT VISIT:
DATE _____
TIME ________
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
TEAM ____
INTERVIEWER _____
SUPERVISOR _____
ASSISTANT SUPERVISOR _____
RESULT _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _______ 7
TOTAL NUMBER OF VISITS __
ADDRESS IN DETAIL______
NAME OF WOMAN_______
LINE NUMBER OF WOMAN_________
INTERVIEWER VISITS (REPEAT FOR INTERVIEW VISITS 1 AND 2)
DATE_____
TEAM_____
INTERVIEWER_______
SUPERVISOR______
RESULT*______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7
NEXT VISIT
DATE_____
TIME______
TOTALVISITS_______
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
TEAM
INTERVIEWER
SUPERVISOR ASSISTANT
SUPERVISOR
RESULT
FIELD EDITOR
NAME
DATE
SIGNATURE
OFFICE EDITOR
NAME
DATE
SIGNATURE
CODER
NAME
DATE
SIGNATURE
KEYER
NAME
DATE
SIGNATURE
DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __
TEAM __ __
INT. NUMBER __ __
SUP. NUMBER __ __
RESULT __
TOTAL NUMBER OF VISITS __
ADDRESS IN DETAIL ______________
NAME OF WOMAN ______________
LINE NUMBER OF WOMAN ___________
GOVERNORATE_____
PSU/SEGMENT NO.____
HOUSEHOLD NO. _____
LINE NUMBER____
INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER _____
SUPERVISOR _____
RESULT ______
NEXT VISIT :
DATE _____
TIME ________
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
TEAM ____
INT. NUMBER _____
SUP. NUMBER _____
RESULT _____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS):
DATE__________
TEAM__________
INTERVIEWER_________
SUPERVISOR__________
RESULT____
NEXT VISIT (FOR INTERVIEWERS 1 AND 2):
DATE__________
TIME__________
FINAL VISIT:
DAY__ __
MONTH __ __
YEAR__ __
TEAM __ __
INT. NUMBER__ __
SUP. NUMBER__ __
RESULT__
DATE____
INTERVIEWER'S NAME____
RESULT____
NEXT VISIT:
DATE____
TIME_____
FINAL VISIT
DAY____
MONTH____
YEAR 2006
INT. NUMBER____
RESULT____
TOTAL NUMBER OF VISITS____
RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)_______7
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
DAY
MONTH
YEAR
INTERVIEWER'S NUMBER
RESULT*
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)
FIRST VISIT
DATE___
INTERVIEWER'S NAME___
RESULT* ___
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY INCOMPLETED
6 INCAPACITATED
7 OTHER (SPECFY) ___
NEXT VISIT
DATE___
TIME___
FINAL VISIT
DAY___
MONTH___
YEAR___
INT. NO.___
RESULT___
TOTAL NUMBER OF VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME____
RESULT
RESULT CODES
2 NO HOUSEHOLD MEMBER AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)
FINAL VISIT
DAY_____
MONTH_____
YEAR 2000
NAME_____
RESULT_____
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE____
TIME____
TOTAL NO. OF VISITS_____
DATE_______
INTERVIEWER'S NAME_______
RESULT
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)
NEXT VISIT
DATE_____
TIME______
FINAL VISIT
DAY_____
MONTH_____
YEAR ______
INT. NUMBER ______
RESULT
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
NO 2
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE CODES
MANDINKA 02
WOLLOF 03
FULA 04
JOLA 05
SARAHULE 06
SERERE 07
MANJANGO 08
CREOLE/AKU MARABOUT 09
BAMBARA 10
OTHER LANGUAGE (SPECIFY) 11
SUPERVISOR
NAME
CODE
INTERVIEW 1
DATE ____
INTERVIEWER'S NAME ____
RESULT** ____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 2
DATE _____
INTERVIEWER'S NAME ____
RESULT** ____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 3
DATE _____
INTERVIEWER'S NAME _____
RESULT** ____
FINAL VISIT
MONTH____
YEAR ____
INTERVIEWER'S NAME ____
INTERVIEW 1
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 2
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 3
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ___
DATE ___
INTERVIEWER'S NAME ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
NEXT VISIT:
DATE ___
TIME ___
INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
NEXT VISIT:
DATE ___
TIME ___
INTERVIEW 3
DATE ___
INTERVIEWER'S NAME ___
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
FINAL VISIT
DAY___
MONTH ___
YEAR _19__
NAME ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____7
NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE ____
TIME _____
FINAL VISIT
DAY _____
MONTH _____
YEAR 2014
INT. NUMBER _____
RESULT ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____7
VISITS 1, 2, AND 3
INTERVIEWER'S NAME ______________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ____________(SPECIFY) 7
NEXT VISIT:
TIME: ______________
FINAL VISIT
MONTH _________
YEAR 2016
INTERVIEWER NUMBER __________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER ____________(SPECIFY) 7
VISITS 1, 2, AND 3
INTERVIEWER'S NAME ________________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER __________________(SPECIFY) 7
NEXT VISIT:
TIME ______________
FINAL VISIT:
MONTH ________
YEAR 2019
INTERVIEWER'S NUMBER _____________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER __________________(SPECIFY) 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY _____
MONTH _____
YEAR 1999
NAME _____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY _____
MONTH _____
YEAR 2005
NAME _____
RESULT _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7
DATE______________
INTERVIEWER'S NAME___________
RESULT_____________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT_____________
DAY___________
MONTH___________
YEAR 2012
INT. NUMBER_____________
RESULT___________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT____________
DATE___________
TIME__________
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7
FINAL VISIT
DAY
MONTH
YEAR 2018
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7
NEXT VISIT
DATE
TIME
TOTAL NUMBER OF VISITS
(Repeat up to 3 visits)
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
NEXT VISIT:
DATE ______
TIME ______
FINAL VISIT
DAY ______
MONTH ______
YEAR 2020
RESPONDENT NUMBER______
RESULT CODE ______
TOTAL NUMBER OF VISITS ______
RESULT CODES:
2 NOT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______
LANGUAGE OF QUESTIONNAIRE 1
LANGUAGE OF INTERVIEW ______
NATIVE LANGUAGE OF RESPONDENT ______
INTERPRETER (YES = 1, NO = 2) ______
LANGUAGE OF QUESTIONNAIRE FRENCH
LANGUAGE CODES:
02 SUSU
03 PEUL
04 MALINKE
05 KISII
04 TOMA
07 KPELLE
08 OTHER (SPECIFY) ______
TEAM NUMBER ______
TEAM LEADER
NAME ______
NUMBER ______
CAPI SUPERVISOR
NAME ______
NUMBER ______
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ______
INTERVIEWER'S NAME ______
RESULT ______
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ______
INTERVIEWER'S NAME ________
RESULT _______
DATE ______
MONTH ______
YEAR ______
INT. NO. ______
RESULT CODE _____
FIRST VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7
SECOND VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7
THIRD VISIT
DATE______
INTERVIEWER'S NAME_____
RESULT CODE______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7
NEXT VISIT
DATE_______
TIME_______
FINAL VISIT
DAY ______
MONTH ______
YEAR _____
INT. NO ______
RESULT CODE ______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)________ 7
TOTAL NUMBER OF VISITS _______
SUPERVISOR'S NAME_______
SUPERVISOR NUMBER ________
FIRST VISIT
DATE __
INTERVIEWER'S NAME __
RESULT CODE* __
NEXT VISIT:
DATE __
TIME __
SECOND VISIT
DATE __
INTERVIEWER'S NAME __
RESULT CODE* __
NEXT VISIT:
DATE __
TIME __
THIRD VISIT
DATE __
INTERVIEWER'S NAME __
RESULT CODE* __
FINAL VISIT
DAY __
MONTH __
YEAR __
INT. NO. __
RESULT CODE* __
TOTAL NUMBER OF VISITS __
SUPERVISOR'S NAME __
SUPERVISOR'S NUMBER __
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR 1997
NAME
RESULT
TOTAL NUMBER OF VISITS
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR 2002
NAME
RESULT
TOTAL NUMBER OF VISITS
FIRST VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7
NEXT VISIT:
DATE__
TIME__
SECOND VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7
NEXT VISIT:
DATE__
TIME__
THIRD VISIT
DATE___
INTERVIEWER'S NAME___
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7
FINAL VISIT
DAY__
MONTH__
YEAR 2007
INT. NUMBER__
RESULT:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7
FIRST VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* ________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
NEXT VISIT:
DATE ________
TIME ________
SECOND VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
NEXT VISIT:
DATE _______
TIME _______
THIRD VISIT
DATE _______
INTERVIEWER NAME _______
RESULT* _______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
FINAL VISIT
DAY _______
MONTH _______
YEAR 2009
INT. NUMBER _______
RESULT* _______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) _______ 7
DATE __________
INTERVIEWER'S NAME __________
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY ____
MONTH _____
YEAR _____
INTERVIEW NUMBER _____
RESULT____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7
FIRST VISIT
DATE
INTERVIWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________________ 7
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________________ 7
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________________ 7
DATE_____
INTERVIEWER'S NAME_______
RESULT______
NEXT VISIT
DATE____
TIME_____
FINAL VISIT
MONTH______
YEAR______
TOTAL NUMBER OF VISITS___
FIRST VISIT (REVIEW FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME __________
RESULT_____
NEXT VISIT
DATE _____
TIME ____
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT ____
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
INTERVIEW VISIT 1 (REPEAT FOR INTERVIEW VISIT 2 AND VISIT 3)
DATE ______
INTERVIEWER'S NAME __________
RESULT** ____________
NEXT VISIT:
DATE _____________
TIME ______________
FINAL VISIT
DAY ____________
MONTH ____________
YEAR 2003 __________
INT. CODE __________
RESULT ___________
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
FIRST VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
SECOND VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
THIRD VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
NEXT VISIT
DATE ______
TIME ______
FINAL VISIT
DAY ____
MONTH _____
YEAR _____
INTERVIEW NUMBER _____
RESULT* ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
NOT AT HOME 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE: 01 ENGLISH
LANGUAGE OF INTERVIEW
KISWAHILI 02
BORANA 03
EMBU 04
KALENJIN 05
KAMBA 06
KIKUYU 07
KISII 08
LUHYA 09
MARAGOLI 10
LUO 11
MAASAI 12
MERU 13
MIJIKENDA 14
POKOT 15
SOMALI 16
TURKANA 17
OTHER 18
VISITS 1, 2, 3
INTERVIEWER'S NAME ___________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER __________________(SPECIFY) 7
NEXT VISIT:
TIME _____________
FINAL VISIT
MONTH _________________
YEAR _________________
INTERVIEWER NUMBER ____________________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER __________________(SPECIFY) 7
TOTAL NUMBER OF VISITS _____________________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME __________
RESULT* ________
NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE _______
TIME _______
FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER ______
RESULT _____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME____
RESULT___
NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE____
TIME____
FINAL VISIT
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
INT. NUMBER ___ ___ ___
FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT CODE**
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE ____
TIME ____
SECOND VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT CODE**
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE ____
TIME ____
THIRD VISIT
DATE ____
INTERVIEWER'S NAME____
RESULT CODE**
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
FINAL VISIT
DAY ____
MONTH ____
YEAR 2014
INT. NUMBER ____
RESULT CODE**
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
TOTAL NUMBER OF VISITS ____
DATE
INTERVIEWERS NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
SUPERVISOR
NAME
DATE
OFFICE EDITOR
KEYED BY
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
DATE ____
INTERVIEWER'S NAME _____
NEXT VISIT
DATE _____
TIME _____
FINAL VISIT
DAY _____
MONTH ____
YEAR ____
NAME ____
RESULT ____
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
INTERVIEW ONE (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____
NEXT VISIT
DATE ____
TIME ____
FINAL VISIT
DAY ____
MONTH ____
YEAR 1997
INT. NUMBER ____
RESULT ____
NOT AT HOME 2
DEFERRED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______
INTERVIEWER'S NAME ______
RESULT _____
2 NOT AT HOME
3 DEFERRED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)
NEXT VISIT
DATE ______
TIME ______
FINAL VISIT
DAY _____
MONTH _____
YEAR 2003
INT. NUMBER _______
RESULT ______
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
DATE _____
NAME OF INTERVIEWER ______
RESULT ______
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
INTERVIEWER'S NAME _________
RESULT* ____
NEXT VISIT
TIME ____
FINAL VISIT
MONTH ____
YEAR _____
TOTAL NUMBER OF VISITS ______
*RESULT CODES
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
UNABLE 6
OTHER (SPECIFY) ____ 7
QUESTIONNAIRE LANGUAGE** ____
QUESTIONNAIRE LANGUAGE** ____
LANGUAGE OF INTERVIEW** ____
NATIVE LANGUAGE OF RESPONDENT** ___
TRANSLATOR USED
NO 2
**LANGUAGE CODES
MALGACHE 02
OTHER (SPECIFY) ____ 03
SUPERVISOR
NUMBER ___
DATE: ____
INTERVIEWER'S NAME ______
RESULT* ____
NEXT VISIT
TIME ____
FINAL VISIT
MONTH ____
YEAR ____
INT. NUMBER ____
RESULT* ____
TOTAL NUMBER OF VISITS _____
*RESULT CODES:
NOT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
UNABLE 6
OTHER ____ (SPECIFY) 7
QUESTIONNAIRE LANGUAGE** ____ (LANGUAGE CODE)
QUESTIONNAIRE LANGUAGE** ____ (LANGUAGE NAME)
LANGUAGE OF INTERVIEW** ____
NATIVE LANGUAGE OF RESPONDENT** ___
TRANSLATOR USED
NO 2
**LANGUAGE CODES
MALAGASY 02
LANGUAGE 03
LANGUAGE 04
LANGUAGE 05
LANGUAGE 06
TEAM SUPERVISOR
NAME ____
NUMBER ____
DATE ____
INTERVIEWER'S NAME ___
RESULT* ___
DATE__
INTERVIEWER'S NAME___
RESULT ____
DATE__
INTERVIEWER'S NAME___
RESULT ____
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
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 __
INT. NUMBER __
RESULT __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPICATATED 6
OTHER 7 (SPECIFY) __
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:
TUMBUKA 2
YAO 3
ENGLISH 4
OTHER 6 (SPECIFY) __
SUPERVISOR
NAME __
OFFICE EDITOR __
KEYED BY __
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
TOTAL NUMBER OF VISITS
RESULT CODES
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7
LANGUAGE OF QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
SOMETIME 2
ALL THE TIME 3
LANGUAGE CODES
TUMBUKA 2
YAO 3
ENGLISH 4
OTHER (SPECIFY) 6
SUPERVISOR
NAME__
OFFICE EDITOR__
KEYED BY__
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS:
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
NO 2
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE CODES
CHICHEWA 02
TUMBUKA 03
OTHER (SPECIFY) 06
SUPERVISOR
NAME
NUMBER
DATE_____
INTERVIEWER'S NAME_______
RESULT______
NEXT VISIT
DATE____
TIME_____
FINAL VISIT
MONTH______
YEAR______
TOTAL NUMBER OF VISITS___
INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR 1996
INTERVIEWER NAME____
RESULT ____
INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE________
INTERVIEWER'S NAME____________
RESULT*______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____________ 7
NEXT VISIT
DATE________
TIME__________
FINAL VISIT
DAY____
MONTH____
YEAR 2012
INTERVIEWER______
RESULT*____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____________ 7
MONTH ______
YEAR 2015
INTERVIEWER'S NUMBER______
RESULT CODE ______
1 2 3
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY
MONTH
YEAR 2018
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT
DATE
TIME
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
NEXT VISIT:
DATE ______
TIME ______
FINAL VISIT
DAY ______
MONTH ______
YEAR 2021
INTERVIEWER'S NUMBER______
RESULT CODE ______
TOTAL NUMBER OF VISITS ______
RESULT CODES:
2 NOT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______
DATE OF VISIT: ____
INTERVIEWER'S NAME: ____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7 ____
NEXT VISIT INDICATED:
A) DATE: ____
B) TIME: ____
MONTH: ____
YEAR: ____
INTERVIEWER CODE: ____
FINAL RESULT: ____
TOTAL NO. OF VISITS: ____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD 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: (FOR INTERVIEWERS 1 AND 2)
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLD 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
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER NAME___
RESULTS
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 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) __________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE______
INTERVIEWER'S NAME_____
NEXT VISIT
DATE_____
TIME_____
FINAL VISIT
DAY_____
MONTH_____
YEAR_____
NAME______
RESULT_____
ABSENT 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED/INCOMPLETE 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER'S NAME______
NEXT VISIT
DATE_____
TIME_____
FINAL VISIT
DAY_____
MONTH_____
YEAR 2003
CODE_____
RESULT______
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE______
INTERVIEWER'S NAME_________
RESULT____
NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE_________
TIME_________
FINAL VISIT
DAY_________
MONTH_________
YEAR 2011
CODE_________
RESULT_________
DATE ____
INTERVIEWER'S NAME ____
NEXT VISIT: DATE ___
TIME: ____
NOTES ____
FINAL VISIT
MONTH __ __
YEAR __ __ __ __
TOTAL NUMBER OF VISITS ___
TOTAL NUMBER OF ELIGIBLE CHILDREN ___
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF INTERVIEW ___
NATIVE LANGUAGE OF RESPONDENT ___
TRANSLATOR USED (YES = 1, NO = 2) ___
LANGUAGE OF QUESTIONNAIRE: PORTUGUESE
LANGUAGE CODES:
02 ENGLISH
03 EMAKHUWA 08 CINYANJA 09 CINDAU
04 XICHANGANA 10 XITSWA
05 CISENA 11 CINYUNGWE
06 ELOMWE 12 CIYAO
07 ECHUWABO
96 SHONA
SUPERVISOR
NAME
NUMBER __ __ __ __
INTERVIEWER VISITS
FIRST VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER___(SPECIFY) 7
NEXT VISIT:
DATE___
TIME___
SECOND VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER___(SPECIFY) 7
NEXT VISIT:
DATE___
TIME___
THIRD VISIT
DATE___
INTERVIEWER'S NAME___
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER___(SPECIFY) 7
FINAL VISIT
DAY___
MONTH___
YEAR___
INT. NO.____
RESULT____
DATE_____
INTERVIEWER'S NAME_____
RESULT_____
NEXT VISIT:
DATE____
TIME_____
FINAL VISIT
DAY____
MONTH_____
YEAR_____
NAME_____
RESULT_____
INTERVIEWER 1(REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7
NEXT VISIT:
DATE ___
TIME ___
FINAL VISIT
DAY ___
MONTH ___
YEAR 20___
INT. COD ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7
DATE ___
INTERVIEWER'S NAME ____
RESULT____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE ___
TIME ____
INTERVIEWER VISIT 2
DATE ___
INTERVIEWER'S NAME ____
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE___
TIME ____
INTERVIEWER VISIT 3
DATE ____
INTERVIEWER'S NAME ____
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
FINAL VISIT
DAY __
MONTH ___
YEAR 200__
INT.NUMBER ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
NAME_____
RESULT____
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
DATE
MONTH __
YEAR ____
INTERVIEWER'S NAME ___________
INT. CODE ________
RESULT* ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7
NEXT VISIT
TIME ________
LANGUAGE
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE OF INTERVIEW
BHOJPURI 2
MAITHILI 3
THARU 4
OTHER 5
HOME LANGUAGE OF RESPONDENT
BHOJPURI 2
MAITHILI 3
THARU 4
OTHER 5
WAS A TRANSLATOR USED
NO 2
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLDAT 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
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLDAT 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
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLDAT 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
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NO HOUSEHOLD MEMBER AT HOME OR COMPETENT RESPONDENT IN HOUSEHOLDAT 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
VISIT 1
DATE _____________
INTERVIEWER'S NAME _____________
RESULT _____________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NEXT VISIT:
DATE _____________
TIME _____________
VISIT 2
DATE _____________
INTERVIEWER'S NAME _____________
RESULT _____________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NEXT VISIT:
DATE _____________
TIME _____________
VISIT 3
DATE _____________
INTERVIEWER'S NAME _____________
RESULT _____________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NEXT VISIT:
DATE _____________
TIME _____________
FINAL VISIT
DAY_____________
MONTH _____________
YEAR _____________
INT. NUMBER _____________
RESULT_____________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE OF INTERVIEW _____________
NATIVE LANGUAGE OF RESPONDENT _____________
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)_________ 7
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)_________ 7
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)_________ 7
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)_________ 7
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULTS___
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__
FINAL VISIT:
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULTS___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPABLE 6
OTHER (SPECIFY): ___ 7
NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__
FINAL VISIT:
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPABLE 6
OTHER (SPECIFY): ___ 7
DATE _____
DAY _____
MONTH _____
YEAR 2006
INTERVIEWER NAME __________
RESULT * __________
NO HOUSEHOLD MEMBER OR COMPETENT RESPONDENT 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) __________ 7
INTERVIEWER 2
DATE _____
DAY _____
MONTH _____
YEAR 1998
INTERVIEWER NAME __________
RESULT * __________
NO HOUSEHOLD MEMBER OR COMPETENT RESPONDENT 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) __________ 7
INTERVIEWER 3
DATE _____
DAY _____
MONTH _____
YEAR 1998
INTERVIEWER NAME __________
RESULT * __________
NO HOUSEHOLD MEMBER OR COMPETENT RESPONDENT 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) __________ 7
DATE _____________
INTERVIEWER'S NAME ______________
RESULT* ____________
FINAL VISIT
DAY _______________
MONTH ______________
YEAR 2012 ____________
INTERVIEWER _____________
RESULT _____________
NEXT VISIT
DATE _________
TIME _________
MONTH ______
YEAR ______
RESPONDENT NUMBER______
RESULT ______
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT***
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
TOTAL NUMBER OF VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT _____________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
DWELLING DESTROYED 7
OTHER (SPECIFY) ___________ 8
NEXT VISIT:
DATE __________
TIME ___________
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT _____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT _____________
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _________________
NEXT VISIT:
DATE __________
TIME ___________
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ____
RESULT _____
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _________________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT _____________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE __________
TIME ___________
FINAL VISIT
DAY ____
MONTH ____
YEAR 2008
INT. NUMBER ____
RESULT _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7
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 __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
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 __
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT*
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT*
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*
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 2015
INT NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
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 __
NUMBER __
OFFICE EDITOR __
KEYED BY __
VISIT 1
INTERVIEWER'S NAME_____
RESULT*_____
NEXT VISIT:
TIME_____
FINAL VISIT
MONTH_____
YEAR_____
INT. NO._____
RESULT*_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
INCAPACITATED 6
OTHER_____ 7
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED
NO 2
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE CODES:
HAUSA 02
YORUBA 03
IGBO 04
OTHER 06
TEAM NUMBER__
TEAM SUPERVISOR
NAME__
NUMBER__
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT***
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
TOTAL NUMBER OF VISITS
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
NAME_____
RESULT____
FIRST VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT DATE _____
TIME ______
SECOND VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT DATE _____
TIME ______
THIRD VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT ______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT DATE _____
TIME ______
FINAL VISIT
DAY _____
MONTH ______
YEAR _____
INT. NO. _______
RESULT _______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
TOTAL NUMBER OF VISITS _________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER NAME__________
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
OTHER (SPECIFY)_____ 6
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____
TIME____
FINAL VISIT
DAY__________
MONTH__________
YEAR_____
NAME__________
RESULT__________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
OTHER (SPECIFY)_____ 6
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER NAME____
RESULT*____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE___
TIME___
FINAL VISIT
DAY____
MONTH____
YEAR____
NAME____
RESULT*_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____
RESULT* _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE ____
TIME _____
FINAL VISIT
DAY____
MONTH___
YEAR 200__
CODE ____
RESULT ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT:
DATE:
TIME:
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
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 __
INT. NUMBER __
RESULT __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
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 9 (SPECIFY) __
TOTAL PERSONS IN HOUSEHOLD __
TOTAL ELIGIBLE WOMEN __
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __
SUPERVISOR
NAME __
OFFICE EDITOR __
KEYED BY __
FIRST VISIT
DATE____
INTERVIEWER'S NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE_____
TIME____
SECOND VISIT
DATE____
INTERVIEWER'S NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE____
TIME____
THIRD VISIT
DATE____
INTERVIEWER'S NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
FINAL VISIT
DAY____
MONTH____
YEAR____
INT. NUMBER____
RESULT____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
TOTAL NUMBER OF VISITS
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 __
INT. NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF INTERVIEW** __
NATIVE LANGUAGE OF RESPONDENT** __
TRANSLATOR USED (YES = 1, NO = 2) __
LANGUAGE OF QUESTIONNAIRE** ENGLISH
**LANGUAGE CODES:
KINYARWANDA 02
SUPERVISOR
NAME __
NUMBER __
OFFICE EDITOR
NUMBER __
KEYED BY
NUMBER __
FIRST VISIT
DATE __
INTERVIEWER'SNAME __
RESULT* __
NEXT VISIT:
DATE __
TIME __
SECOND VISIT
DATE __
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
DATE __
TIME __
THIRD VISIT
DATE __
INTERVIEWER'S NAME __
RESULT* __
FINAL VISIT
DAY __
MONTH __
YEAR __
INT. NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF INTERVIEW __
NATIVE LANGUAGE OF RESPONDENT __
TRANSLATOR USED (YES = 1, NO = 2) __
LANGUAGE OF QUESTIONNAIRE ENGLISH
LANGUAGE CODES:
KINYARWANDA 02
TEAM LEADER
NAME __
NUMBER __
FIELD EDITOR
NAME __
NUMBER __
OFFICE EDITOR
NUMBER __
KEYED BY
NUMBER __
FIRST VISIT
DAY____
MONTH___
YEAR 2008
INTERVIEWER'S NAME_________
AF.09- RESULT*_________
NEXT VISIT
DAY___
MONTH___
YEAR___
TIME___
SECOND VISIT
DAY____
MONTH ___
YEAR 2008
INTERVIEWER'S NAME_________
AF.09- RESULT*_________
NEXT VISIT
DAY___
MONTH___
YEAR___
TIME___
THIRD VISIT
DAY____
MONTH___
YEAR2008
INTERVIEWER'S NAME_________
AF.09- RESULT*_________
FINAL VISIT
DAY_________
MONTH_________
YEAR 2008
INTERVIEWER'S CODE ______
RESULT CODE*______
TOTAL NUMBER OF VISITS_________
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE____
INTERVIEWER NAME____
RESULT___
NO MEMBER OF THE HOUSEHOLD AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
OTHER (SPECIFY) ____ 6
NEXT VISIT
DATE____
TIME____
FINAL VISIT
MONTH ____
YEAR 1986
RESPONDENT CODE ____
INTERVIEWER CODE ____
FIRST VISIT (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
INTERVIEWER NAME____
RESULT*___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT
DATE_____
TIME_____
FINAL VISIT
DAY_____
MONTH_____
YEAR _____
INTERVIEWER_____
RESULT*_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ____ 7
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE______
INTERVIEWER NAME______
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____
TIME_____
FINAL VISIT
DAY_____
MONTH_____
YEAR _____
INTERVIEWER_____
RESULT_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ______ 7
INTERVIEW 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER NAME_____
RESULT*___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7
NEXT VISIT
DATE_____
TIME_____
FINAL VISIT
DAY_____
MONTH_____
YEAR 2005
INTERVIEWER_____
RESULT*_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
INCAPACITATED 6
OTHER (SPECIFY) ______ 7
(Repeat up to 3 visits)
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
NEXT VISIT:
DATE ______
TIME ______
FINAL VISIT
DAY ______
MONTH ______
YEAR 2006
INTERVIEWER NUMBER______
RESULT ______
TOTAL NUMBER OF VISITS ______
RESULT CODES:
1 COMPLETED
2 NOT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______
LANGUAGE OF QUESTIONNAIRE 1
LANGUAGE OF INTERVIEW ______
LANGUAGE CODES:
1 FRENCH
2 WOLOF
3 PULAR
4 SERER
5 MANDINKA
6 DIOLA
8 OTHERS
INTERPRETER (YES = 1, NO = 2) ______
TEAM LEADER
NAME ______
DATE ______
SUPERVISOR
NAME ______
DATE ______
OFFICE EDITOR ______
KEYED BY ______
(Repeat up to 3 visits)
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
NEXT VISIT:
DATE ______
TIME ______
FINAL VISIT
DAY ______
MONTH ______
YEAR 200______
INTERVIEWER NUMBER______
RESULT CODE ______
TOTAL NUMBER OF VISITS ______
RESULT CODES:
1 COMPLETED
2 NOT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
8 OTHER (SPECIFY) ______
LANGUAGE OF QUESTIONNAIRE 1
LANGUAGE OF INTERVIEW ______
LANGUAGE CODES:
1 FRENCH
2 WOLOF
3 PULAR
4 SERER
5 MANDINKA
6 DIOLA
8 OTHER
INTERPRETER (YES = 1, NO = 2) ______
TEAM LEADER
NAME ______
DATE ______
SUPERVISOR
NAME ______
DATE ______
OFFICE EDITOR ______
KEYED BY ______
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME____
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
NEXT VISIT
DATE____
TIME____
FINAL VISIT
DAY____
MONTH_____
YEAR 201___
INT. NUMBER _____
RESULT _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
DATE _____________
INTERVIEWER'S NAME _____________
RESULT____
FINAL VISIT
DAY ______________
MONTH __________
YEAR 201__
INT. NUMBER__________
RESULT ____________
NEXT VISIT
DATE ___________
TIME ___________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE_________
INTERVIEWER'S NAME___________
RESULT* ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
FINAL VISIT
DAY ____
MONTH ____
YEAR 201__
INT. NUMBER_____
RESULT* _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
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. NO. __ __ __
RESULT* __
TOTAL NUMBER OF VISITS __
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. NO. __ __ __
RESULT* __
TOTAL NUMBER OF VISITS __
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE: _______
INTERVIEWER'S NAME _________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
FINAL VISIT
DAY ____
MONTH ____
YEAR _____
INT. NUMBER ____
RESULT _____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
NEXT VISIT
DATE _____
TIME _____
(Repeat up to 3 visits)
DATE ______
NAME OF INTERVIEWER ______
RESULT ______
NEXT VISIT:
DATE ______
TIME ______
FINAL VISIT
DAY ______
MONTH ______
YEAR 202______
RESPONDENT NUMBER______
RESULT CODE ______
TOTAL NUMBER OF VISITS ______
RESULT CODES:
1 COMPLETED
2 NOT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ______
LANGUAGE OF QUESTIONNAIRE 1
LANGUAGE OF INTERVIEW ______
NATIVE LANGUAGE OF RESPONDENT ______
INTERPRETER (YES = 1, NO = 2) ______
LANGUAGE OF QUESTIONNAIRE FRENCH
LANGUAGE CODES:
01 FRENCH
02 WOLOF
03 PULAR
04 SERER
05 MANDINKA
06 DIOLA
07 OTHERS
TEAM LEADER
NAME ______
NUMBER ______
DATE ______
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 2016
INT. NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
LANGUAGE OF QUESTIONNAIRE** 01
LANGUAGE OF INTERVIEW** __
NATIVE LANGUAGE OF RESPONDENT** __
TRANSLATOR USED (YES = 1, NO = 2) __
LANGUAGE OF QUESTIONNAIRE** ENGLISH
**LANGUAGE CODES:
KRIO 02
MENDE 03
TEMNE 04
MADINGO 05
LOKO 06
SHERBRO 07
LIMBO 08
KISSI 09
KONO 10
SUSU 11
FULLAH 12
KRIM 13
YALUNKA 14
KORANKO 15
VAI 16
OTHER 96
SUPERVISOR
NAME __
NUMBER __
DATE___
INTERVIEWER'S NAME___
RESULTS___
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 DWELLING 6
NEXT VISITATION ___
TIME___
FINAL VISIT
DAY___
MONTH___
YEAR___
INT. NO___
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 DWELLING 6
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________________ 7
FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE ____
TIME ____
SECOND VISIT
DATE____
INTERVIEWER'S NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
NEXT VISIT:
DATE____
TIME____
THIRD VISIT
DATE____
INTERVIEWER'S NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
FINAL VISIT
DAY____
MONTH____
YEAR 201__
INT. NUMBER____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
TOTAL NUMBER OF VISITS____
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ______ 6
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ______ 6
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ______ 6
NEXT VISIT
DATE
TIME
FINAL VISIT
MONTH
YEAR
TOTAL NUMBER OF VISITS
INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
ID NO. ____
RESULT* ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
TOTAL NUMBER OF VISITS __
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
FINAL VISIT
DAY ____
MONTH ____
YEAR 96
ID NO. ___
RESULT ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME____
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)__________7
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE______
TIME______
FINAL VISIT
DAY____
MONTH____
YEAR 19___
INTER. ID NUMBER___
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)__________7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR 200_
INT. NUMBER
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE
TIME
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
INTERVIEWER'S NAME _____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
NEXT VISIT:
TIME: _____
FINAL VISIT
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) 7
TOTAL NUMBER OF VISITS _____
MONTH_
YEAR_
INT. NO._
RESULT*_
TOTAL NUMBER OF VISITS_
VISITS 1, 2, 3
DATE ____________
INTERVIEWER'S NAME ____________
RESULT ____*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____ 7
FINAL VISIT
MONTH ______
YEAR 2017
INTERVIEWER NUMBER _________
RESULT ____*
*RESULT CODES
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPLETED 5
UNABLE 6
OTHER _____ (SPECIFY) 7
NEXT VISIT:
DATE ___________
HOUR ____________
TOTAL NUMBER OF VISITS _______________
QUESTIONNAIRE LANGUAGE (LANGUAGE CODE) **: ____
QUESTIONNAIRE LANGUAGE (NAME OF LANGUAGE): ____
LANGUAGE OF INTERVIEW: ____
**LANGUAGE CODES
EWE/MINA 02
KABYE 03
KOTOKOLI/TEM 04
AKPOSSO/AKEBOU 05
IFE/ANA 06
MOBA-GOURMA 07
TCHOKOSSI 08
BASSAR/KONKOMBA 09
OTHER NATIONAL LANGUAGE ________________(SPECIFY) 96
OTHER FOREIGN LANGUAGE _______________(SPECIFY) 97
NATIVE LANGUAGE OF RESPONDENT: ____
EWE/MINA 02
KABYE 03
KOTOKOLI/TEM 04
AKPOSSO/AKEBOU 05
IFE/ANA 06
MOBA-GOURMA 07
TCHOKOSSI 08
BASSAR/KONKOMBA 09
OTHER NATIONAL LANGUAGE ________________(SPECIFY) 96
OTHER FOREIGN LANGUAGE _______________(SPECIFY) 97
TRANSLATOR USED?
NO 2
FIELD EDITOR
NAME _______________
NUMBER _____________
FIRST VISIT
5) DATE OF VISIT____
6) NAME OF INTERVIEWER____
7) RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPETED 5
OTHER (SPECIFY) 6
8) NEXT VISIT
TIME ____
SECOND VISIT
5) DATE OF VISIT____
6) NAME OF INTERVIEWER____
7) RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPETED 5
OTHER (SPECIFY) 6
8) NEXT VISIT
TIME ____
THIRD VISIT
5) DATE OF VISIT____
6) NAME OF INTERVIEWER____
7) RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY COMPETED 5
OTHER (SPECIFY) 6
8) NEXT VISIT
TIME ____
MONTH ____
YEAR 88
INTERVIEWER CODE
RESULT
NUMBER OF VISITS
NAME ____
DATE ____
FIELD EDITED BY ____
OFFICE EDITED BY ____
KEYED BY ____
CODE KEYED ____
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ___________ 6
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ___________ 6
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ___________ 6
FINAL VISIT
MONTH
YEAR
TOTAL NUMBER OF VISITS
FIRST VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
NEXT VISIT:
DATE ___________
TIME ___________
SECOND VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
NEXT VISIT:
DATE ___________
TIME ___________
THIRD VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
FINAL VISIT:
DAY
MONTH
YEAR
NAME
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
TOTAL NUMBER OF VISITS
DATE _____
INTERVIEWER'S NAME __________
*RESULT
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
NEXT VISIT:
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER NUMBER
RESULT
FIRST VISIT
2. INTERVIEWER'S NAME_
3. RESULT*
4. NEXT VISIT: DATE_
5. TIME_
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NUMBER __ __ __
RESULT __
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 ___
INT. NUMBER. ___
RESULT*___
TOTAL NUMBER OF VISITS ___
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPCITATED 6
OTHER (SPECIFY) 7
LANGUAGE OF THE QUESTIONNAIRE 7
LANGUAGE USED IN THE INTERVIEW ___
NATIVE LANGUAGE OF RESPONDENT ___
TRANSLATOR USED (NOT AT ALL =1, SOMETIMES = 2, ALL THE TIME = 3)
LANGUAGE OF QUESTIONNAIRE ENGLISH
LANGUAGE USED:
LUGANDA 2
LUGBARA 3
LUO 4
RUNYANKORE-RUKIGA 5
RINYORO-RUTORO 6
ENGLISH 7
OTHER 8 (SPECIFY)
SUPERVISOR
NAME ___
OFFICE EDITOR ___
KEYED BY ___
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT
COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07
NEXT VISIT:
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
COMPLETED 01
NOT AT HOME 02
POSTPONED 03
REFUSED 04
PARTLY COMPLETED 05
INCAPACITATED 06
OTHER _______ (SPECIFY) 07
NEXT VISIT:
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
FINAL VISIT:
DAY
MONTH
YEAR
INT. NO.
RESULT*
TOTAL NUMBER OF VISITS__
*RESULT CODES
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 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)
FIRST VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW
MINUTES____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY)____ 6
NEXT VISIT
DATE
TIME
SECOND VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEWER
MINUTES____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY)____ 6
NEXT VISIT
DATE
TIME
FINAL VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW
MINUTES____
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 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
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 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
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 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
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT 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
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) _________ 6
NEXT VISIT:
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT ____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISIT)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT*___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT* ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT*___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT:
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT* ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT*___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT:
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
INT. NUMBER ___
RESULT* ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
DATE_________
INTERVIEWER'S NAME______________
RESULT*_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) ___________________
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____________
TIME______________
FINAL VISIT
DAY________
MONTH__________
YEAR____________
INT. NUMBER__________
RESULT*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) ___________________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
INTERVIEWER'S NAME _______________
RESULT* _______________
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _______________
NEXT VISIT:
TIME _____
FINAL VISIT:
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____
TOTAL NUMBER OF VISITS _____
DATE_____
INTERVIEWER'S NAME_______
RESULT______
NEXT VISIT
DATE____
TIME_____
FINAL VISIT
MONTH______
YEAR______
TOTAL NUMBER OF VISITS___
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT***
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT***
FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT
DATE__
INTERVIEWER'S NAME___
RESULT ____
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT
SECOND VISIT
DATE
INTERVIEWER NAME
RESULT
THIRD VISIT
DATE
INTERVIEWER NAME
RESULT
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT
NEXT VISIT
DATE
TIME
TOTAL NUMBER OF VISITS
*RESULT CODES:
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT IN HOUSEHOLD 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) _________
INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
NAME_____
RESULT____
FIRST VISIT
INTERVIEWER'S NAME_____________________
RESULT*________________
SECOND VISIT
INTERVIEWER'S NAME_____________________
RESULT*________________
THIRD VISIT
INTERVIEWER'S NAME_____________________
RESULT*________________
NEXT VISIT:
TIME______________
FINAL VISIT
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __
RESULT*___
TOTAL NUMBER OF VISITS
TOTAL ELIGIBLE WOMEN __ __
TOTAL ELIGIBLE MEN __ __
LINE NO. RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __ __