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Angola 2006
Angola 2011
Angola 2015
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Angola 2006
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IDENTIFICATION

PLACE NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER

REGION

URBAN/RURAL

URBAN 1
RURAL 2

MALARIA ENDEMIC REGION

Hyperendemic (Cabinda, Uige, K. Norte, Malange, L. Norte, L. Sul) 1
Mesoendemic Stable (Zaire, Luanda, Bengo, Benguela, K. Sul, Huambo, Bié) 2
Mesoendemic Unstable (Moxico, K. Kubango, Kunene, Huila, Namibe) 3
INTERVIEWER VISITS

FIRST VISIT

DATE

INTERVIEWER'S NAME

RESULT

COMPLETED 1
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

COMPLETED 1
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


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Angola 2011
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IDENTIFICATION

NAME OF LOCALITY

REGION

PROVINCE

MUNICIPALITY

CLUSTERED NUMBER IN AMIS

URBAN / RURAL

URBAN 1
RURAL 2

HOUSEHOLD NUMBER

NAME OF HOUSEHOLD HEAD

MARK "X" IN CIRCLE IF HOUSEHOLD WAS SELECTED FOR MALARIA TESTING


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Angola 2015
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IDENTIFICATION

PLACE NAME ________
NAME OF HOUSEHOLD HEAD_______
PROVINCE_______
MUNICIPALITY_____
COMMUNITY_______
NEIGHBORHOOD/VILLAGE______
CENSUS SECTION______
AREAS OF RESIDENCE

URBAN 1
RURAL 2

CLUSTER NUMBER (ID. IIMS)______
HOUSEHOLD NUMBER_______
NAME AND LINE NUMBER OF WOMAN_______
THE WOMAN WAS SELECTED FOR THE DOMESTIC VIOLENCE MODULE

YES 1
NO 2