DDI_BGD_2006_MICS_v01_M Croft, Trevor James, Rhiannon 2008-02-07 NADA Bangladesh MICS 2006 v0.1 Slightly edited version of UNICEF's DDI ref. DDI-BGD-UNICEF-MICS2005/1.0-v0.6 Multiple Indicator Cluster Survey 2006 MICS 2006 BGD_2006_MICS_v01_M Bureau of Statistics UNICEF, Bangladesh Country Office Strategic Information Section, Division of Policy and Planning, UNICEF NYHQ NADA General Inquiries MICS Programme Manager Bureau of Statistics Multiple Indicator Cluster Survey - Round 3 [hh/mics-3] The Multiple Indicator Cluster Survey, Round 3 (MICS3) is the third round of MICS surveys, previously conducted around 1995 (MICS1) and 2000 (MICS2). Many questions and indicators are consistent and compatible with the prior round of MICS (MICS2) but less so with MICS1, although there have been a number of changes in definition of indicators between rounds. Details can be found by reviewing the indicator definitions. Version 1.0: Edited data used for final report Household members Education Water and sanitation Household characteristics Child labour Salt iodization Women's background Tetanus toxoid Maternal and newborn health Marriage and union HIV/AIDS Children's background Birth registration Early learning Vitamin A Breastfeeding Care of illness Immunization Support to children orphaned and made vulnerable by HIV/AIDS Child discipline Source and cost of supplies Attitudes towards domestic violence Child development Disability The Multiple Indicator Cluster Survey (MICS) is a household survey programme developed by UNICEF to assist countries in filling data gaps for monitoring human development in general and the situation of children and women in particular. MICS is capable of producing statistically sound, internationally comparable estimates of social indicators. The current round of MICS is focused on providing a monitoring tool for the Millennium Development Goals (MDGs), the World Fit for Children (WFFC), as well as for other major international commitments, such as the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS and the Abuja targets for malaria. Survey Objectives The 2006 Bangladesh Multiple Indicator Cluster Survey has the following objectives: - To provide up-to-date information for assessing the situation of children and women in Bangladesh; - To furnish data needed for monitoring progress toward goals established by the Millennium Development Goals, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; - To contribute to the improvement of data and monitoring systems in Bangladesh and to strengthen technical expertise in the design, implementation, and analysis of such systems. Survey Content MICS questionnaires are designed in a modular fashion that can be easily customized to the needs of a country. They consist of a household questionnaire, a questionnaire for women aged 15-49 and a questionnaire for children under the age of five (to be administered to the mother or caretaker). Other than a set of core modules, countries can select which modules they want to include in each questionnaire. Survey Implementation The survey was implemented by the Bangladesh Bureau of Statistics , with the support and assistance of UNICEF and other partners. Technical assistance and training for the surveys is provided through a series of regional workshops, covering questionnaire content, sampling and survey implementation; data processing; data quality and data analysis; report writing and dissemination. Bangladesh The survey is nationally representative and covers the whole of Bangladesh. Households (defined as a group of persons who usually live and eat together) De jure household members (defined as memers of the household who usually live in the household, which may include people who did not sleep in the household the previous night, but does not include visitors who slept in the household the previous night but do not usually live in the household) Women aged 15-49 Children aged 0-4 The survey covered all de jure household members (usual residents), all women aged 15-49 years resident in the household, and all children aged 0-4 years (under age 5) resident in the household. Sample survey data [ssd] The Bangladesh Multiple Indicator Cluster Survey included the following modules in the questionnaires: HOUSEHOLD QUESTIONNAIRE : Household characteristics, household listing, orphaned and vulnerable children, education, child labour, water and sanitation, child discipline, child disability and salt iodization. WOMEN'S QUESTIONNAIRE: Women's characteristics, tetanus toxoid, maternal and newborn health, marriage, and HIV/AIDS knowledge and domestic violence. CHILDREN'S QUESTIONNAIRE: Children's characteristics, birth registration and early learning, child development, vitamin A, breastfeeding, care of illness, source and cost fo supplies for oral rehydation therapy and immunization. Bangladesh Bureau of Statistics The primary objective of the sample design for the Bangladesh Multiple Indicator Cluster Survey was to produce statistically reliable estimates of most indicators, at the national level, for urban and rural areas, and for the six divisions of the country, municipal areas, city corporation's slum areas of two big cities and tribal areas. Rural areas, municipal areas, city corporation areas, slum areas and tribal areas were defined as the sampling domain. A multi-stage, stratified cluster sampling approach was used for the selection of the survey sample. Sample Size and Sample Allocation The target sample size for the Bangladesh MICS was calculated as 68247 households. For the calculation of the sample size, the key indicator used was the DPT immunization (3+doses) prevalence among children aged 12-23 months. The following formula was used to estimate the required sample size for these indicators: n = [ 4 (r) (1-r) (f) (1.1) ] [ (0.12r)2 (p) (nh) ] where n is the required sample size, expressed as number of households 4 is a factor to achieve the 95 per cent level of confidence r is the predicted or anticipated prevalence (coverage rate) of the indicator 1.1 is the factor necessary to raise the sample size by 10 per cent for non-response f is the shortened symbol for deff (design effect) 0.12r is the margin of error to be tolerated at the 95 per cent level of confidence, defined as 12 per cent of r (relative sampling error of r) p is the proportion of the total population upon which the indicator, r, is based nh is the average household size. For the calculation, r (DPT immunization 3+doses prevalence) was assumed to be 39.7 percent in the Rangamati districts. The value of deff (design effect) was taken as 1.5 based on estimates from previous surveys, p (percentage of children aged 12-23 months in the total population) was taken as 2.3 percent, and nh (average household size) was taken as 4.9 households. For the sub national level, the margin of error should be high which was also acknowledged in the MICS manual. Therefore, for sub national estimates the margin of error need to be relaxed considerably. If a rate of 30% of r is used this would give a margin of error ± 0.06 for prevalence rates of 0.20, ± 0.12 for prevalence rates of 0.40, and so on. Considering this phenomenon, in case of Rangamati 30% of r has been used. The resulting number of households from this exercise was about 900 households which is the sample size needed in each district - thus yielding about 68250 in total. The average cluster size in the Bangladesh MICS was determined as 35 households, based on a number of considerations, including the budget available, and the time that would be needed per team to complete one cluster. Dividing the total number of households by the number of households per cluster, it was calculated that the selection of a total number of 26 clusters would be needed in each district. Equal allocation of the total sample size to the 75 domains was targeted. Therefore, 26 clusters were allocated to each district with the final sample size calculated at 68250 households (1950 cluster X 35 households per cluster). In each stratum, the clusters (primary sampling units) were distributed to rural, municipal, city corporations, slum and tribal areas on PPS method. Sampling Frame and Selection of Clusters The 2001 census frame was used for the selection of clusters. Census enumeration areas were defined as primary sampling units (PSUs), and were selected from each of the sampling domains by using systematic pps (probability proportional to size) sampling procedures, based on the estimated sizes of the enumeration areas from the 2001 Population Census. The first stage of sampling was thus completed by selecting the required number of enumeration areas from each of the 5 strata namely rural, municipal, city corporations, slum and tribal areas. Listing Activities Since the sample frame of the 2001 Population Census was not up to date, household lists in all selected enumeration areas were updated prior to the selection of households. For this purpose, listing teams were formed, who visited each enumeration area, and listed the occupied households. The BBS officials working in the upazila were responsible for the listing of all households in the respective PSUs. Selection of Households Lists of households were prepared by the Upazila officials of BBS. The households were sequentially numbered from 1 to 100 (or more) households in each enumeration area at the where selection of 35 households in each enumeration area was carried out using systematic selection procedures. (Information extracted from the final report: BBS and UNICEF. 2007. Bangladesh Multiple Indicator Cluster Survey 2006, Final Report. Dhaka, Bangladesh: BBS and UNICEF) No major deviations from the original sample design were made. All sample enumeration areas were accessed and successfully interviewed with good response rates. Face-to-face [f2f] The questionnaires of MICS 2006 are based on the global format of MICS3 model questionnaire. From the MICS3 model English version, the questionnaires were translated into Bangla and were pre-tested in four sample areas of which two were in rural areas, one in City Corporation and one in the slum area during May 2006. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. The questionnaire for under-five children was administered to mothers or caretakers of under-five children living in the households. Normally, the questionnaire was administered to mothers of under-five children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The data were collected by 32 teams; each comprised of four interviewers and a supervisor. There was one quality control officer for every two teams of enumerators: two female & two male. Sample weights were calculated for each of the datafiles. Sample weights for the household data were computed as the inverse of the probability of selection of the household, computed at the sampling domain level (urban/rural within each region). The household weights were adjusted for non-response at the domain level, and were then normalized by a constant factor so that the total weighted number of households equals the total unweighted number of households. The household weight variable is called HHWEIGHT and is used with the HH data and the HL data. Sample weights for the women's data used the un-normalized household weights, adjusted for non-response for the women's questionnaire, and were then normalized by a constant factor so that the total weighted number of women's cases equals the total unweighted number of women's cases. Sample weights for the children's data followed the same approach as the women's and used the un-normalized household weights, adjusted for non-response for the children's questionnaire, and were then normalized by a constant factor so that the total weighted number of children's cases equals the total unweighted number of children's cases. Data editing took place at a number of stages throughout the processing (see Other processing), including: a) Office editing and coding b) During data entry c) Structure checking and completeness d) Secondary editing e) Structural checking of SPSS data files Detailed documentation of the editing of data can be found in the data processing guidelines Of the 68,247 of households selected for the sample, 67,540 were found to be occupied. Of these, 62,463 households were successfully interviewed for a household response rate of 92.5 percent. In the interviewed households, 78,260 of eligible women (age 15-49) were identified. Of these, 69,860 of women were successfully interviewed, yielding a response rate of 89.3 percent. In addition, 34,710 of children under 5 were listed in HH questionnaire. Of these, questionnaires were completed for 31,566 under-five children which correspond to a response rate of 90.9 percent. Overall response rates of 82.6 were for women's questionnaire and 84.1 for under-5 questionnaire. Estimates from a sample survey are affected by two types of errors: 1) non-sampling errors and 2) sampling errors. Non-sampling errors are the results of mistakes made in the implementation of data collection and data processing. Numerous efforts were made during implementation of the 2005-2006 MICS to minimize this type of error, however, non-sampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors can be evaluated statistically. The sample of respondents to the 2005-2006 MICS is only one of many possible samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differe somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability in the results of the survey between all possible samples, and, although, the degree of variability is not known exactly, it can be estimated from the survey results. The sampling erros are measured in terms of the standard error for a particular statistic (mean or percentage), which is the square root of the variance. Confidence intervals are calculated for each statistic within which the true value for the population can be assumed to fall. Plus or minus two standard errors of the statistic is used for key statistics presented in MICS, equivalent to a 95 percent confidence interval. If the sample of respondents had been a simple random sample, it would have been possible to use straightforward formulae for calculating sampling errors. However, the 2005-2006 MICS sample is the result of a multi-stage stratified design, and consequently needs to use more complex formulae. The SPSS complex samples module has been used to calculate sampling errors for the 2005-2006 MICS. This module uses the Taylor linearization method of variance estimation for survey estimates that are means or proportions. This method is documented in the SPSS file CSDescriptives.pdf found under the Help, Algorithms options in SPSS. Sampling errors have been calculated for a select set of statistics (all of which are proportions due to the limitations of the Taylor linearization method) for the national sample, urban and rural areas, and for each of the five regions. For each statistic, the estimate, its standard error, the coefficient of variation (or relative error -- the ratio between the standard error and the estimate), the design effect, and the square root design effect (DEFT -- the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used), as well as the 95 percent confidence intervals (+/-2 standard errors). Details of the sampling errors are presented in the sampling errors appendix to the report and in the sampling errors table presented in the external resources. A series of data quality tables and graphs are available to review the quality of the data and include the following: Age distribution of the household population Age distribution of eligible women and interviewed women Age distribution of eligible children and children for whom the mother or caretaker was interviewed Age distribution of children under age 5 by 3 month groups Age and period ratios at boundaries of eligibility Percent of observations with missing information on selected variables Presence of mother inthe household and person interviewed for the under 5 questionnaire School attendance by single year age Sex ratio at birth among children ever born, surviving and dead by age of respondent Distribution of women by time since last birth Scatterplot of weight by height, weight by age and height by age Graph of male and female population by single years of age Population pyramid The results of each of these data quality tables is shown in the appendix of the final report and is also given in the external resources section. The general rule for presentation of missing data in the final report tabulations is that a column is presented for missing data if the percentage of cases with missing data is 1% or more. Cases with missing data on the background characteristics (e.g. education) are included in the tables, but the missing data rows are suppressed and noted at the bottom of the tables in the report (not in the SPSS output, however). Users of the data agree to keep confidential all data contained in these datasets and to make no attempt to identify, trace or contact any individual whose data is included in these datasets. Bangladesh Bureau of Statistics, Bangladesh. Multiple Indicator Cluster Survey: Household , household listing, women and children's files, 2006 [Computer file]. Dhaka, Bangladesh: Bangladesh Bureau of Statistics [producer], 2006. Dhaka, Bangaldesh: Bangladesh Bureau of Statistics and New York: Strategic Information Section, Dvision of Policy and Planning, UNICEF [distributors], 2006. Survey datasets are distributed at no cost for legitimate research, with the condition that we receive a description of any research project that will be using the data prior to authorizing their distribution. Copies of all reports and publications based on the requested data must be sent to the Bangladesh Bureau of Statistics and UNICEF. Bangladesh Bureau of Statistics: Mr. Md. Shamsul Alam Project Director Monitoring the Situation of Children and Women Bangladesh Bureau of Statistics Planning Division Ministry of Planning Parishankhyan Bhaban E-27/A, Agargoan Sher-e-Bangla Nagar Dhaka, 1207 Bangladesh Email: salamstat@yahoo.com UNICEF Bangladesh: dhaka@unicef.org Requests for access to the datasets may be made through the website www.childinfo.org. The Bangladesh Bureau of Statistics and UNICEF provide these data to external users without any warranty or responsibility implied. The Bangladesh Bureau of Statistics and UNICEF accept no responsibility for the results and/or implications of any actions resulting from the use of these data. hh Data collected at the household level (MICS Household questionnaire: modules Household information panel, Water and sanitation, Household characteristics, , Child discipline, Salt iodization) 0 150 hl Data collected at the household member's level (MICS Household questionnaire: modules Household listing, Child labour, Support to Orphaned and Vulnerable Children, Child Disability) 0 197 wm Data collected at the women's level (MICS Women's questionnaire: modules Women's Information Panel, Tetanus toxoid, Maternal and newborn health, Marriage/union, HIV/AIDS, Attitudes towards domestic violence) 0 227 ch Data collected at the children's level (MICS Under Five Children's questionnaire: modules Under Five Child Information Panel, Birth registration and early learning, Vitamin A, Breastfeeding, Care of Illness, Immunization, Child development) 0 336 Cluster number Cluster number Cluster number Cluster number Cluster number We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. During this time I would like to speak with the household head and all mothers or others who take care of children in the household. May I start now? If permission is given, begin the interview. Cluster number: Enter the cluster number as instructed by your supervisor. Households Unique identifier for the cluster in which the household exists Household number Household number Household number Household number Household number Household number: Enter the household number as instructed by your supervisor. Households Houshold number within the cluster Interviewer number Interviewer number Interviewer number Interviewer number Interviewer number Interviewer name and number: Enter your own name and identification number provided to you at the time of training. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor name and number: Enter your supervisor's name and identification number. You will be provided with your supervisor's identification number as soon as you know who you will be working with. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Day of interview Day of interview Day of interview Day of interview Day of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Month of interview Month of interview Month of interview Month of interview Month of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households 6 June 7 July 8 August 9 September 10 October Year of interview Year of interview Year of interview Year of interview Year of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Area Area Area Area Area Area: Circle the code for area of residence as instructed by your supervisor. This will have been pre-determined; you will not be required to assess whether the household is in an urban or rural area. Households 1 Rural 2 Urban (Municipality) 3 Urban non-slum (Metro city) 4 Urban slum 5 Tribal Region Region Region Region Region Region: Circle the code for region. Households 1 Barisal 2 Chittagong 3 Dhaka 4 Khulna 5 Rajshahi 6 Sylhet District District District District District 1 Bagerhat 3 Bandarban 4 Barguna 6 Barisal 9 Bhola 10 Bogra 12 Brahmanbaria 13 Chandpur 15 Chittagong 18 Chuadanga 19 Comilla 22 Cox's Bazar 26 Dhaka 27 Dinajpur 29 Faridpur 30 Feni 32 Gaibandha 33 Gazipur 35 Gopalganj 36 Habiganj 38 Joypurhat 39 Jamalpur 41 Jessore 42 Jhalokati 44 Jhenaidah 46 Khagrachhari 47 Khulna 48 Kishorganj 49 Kurigram 50 Kushtia 51 Lakshmipur 52 Lalmonirhat 54 Madaripur 55 Magura 56 Manikganj 57 Meherpur 58 Maulvibazar 59 Munshiganj 61 Mymensingh 64 Naogaon 65 Narail 67 Narayanganj 68 Narsingdi 69 Natore 70 Nawabganj 72 Netrakona 73 Nilphamari 75 Noakhali 76 Pabna 77 Panchagarh 78 Patuakhali 79 Pirojpur 81 Rajshahi 82 Rajbari 84 Rangamati 85 Rangpur 86 Shariatpur 87 Satkhira 88 Sirajganj 89 Sherpur 90 Sunamganj 91 Sylhet 93 Tangail 94 Thakurgaon Sub-district Sub-district Sub-district Sub-district Sub-district Result of HH interview Result of HH interview Result of HH interview Result of HH interview Result of HH interview After all questionnaires for the household have been completed, fill in the following information: Result of HH interview: If the Household Questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the household after repeated visits, circle '2' for 'Not at home'. If the household refuses to be interviewed, circle '3' for 'Refused'. If you are unable to locate the household or if the dwelling is destroyed, circle '4' for 'HH not found/destroyed'. If you have not been able to complete the Household Questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Some examples of 'Other' codes might be: the household respondent is incapacitated; the questionnaire is partly completed; adult household members were not found at home after repeated visits. Households 1 Completed 2 Not at home 3 Refused 4 HH not found/destroyed 6 Other Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent to HH questionnaire: Enter the name and line number (from the Household Listing, columns HL1 and HL2) of the respondent to the Household Questionnaire. Households 99 Missing Number of household members Number of household members Number of household members Number of household members Number of household members Total number of household members: Count the number of household members recorded in column HL1 of the Household Listing and enter the total here. Households Total eligible women Total eligible women Total eligible women Total eligible women Total eligible women No.of women eligible for interview: Enter the total number of women eligible for interview for the Questionnaire for Individual Women - you will copy this from the row for totals at the bottom of the Household Listing, for HL6. Households Women interviews completed Women interviews completed Women interviews completed Women interviews completed Women interviews completed No.of women questionnaires completed: Once all of the Questionnaires for Individual Women have been completed for a particular household, enter the number completed here. Households Total children under 5 Total children under 5 Total children under 5 Total children under 5 Total children under 5 No.of children under age 5: Enter the total number of children under five eligible for inclusion in the survey from the row for totals at the bottom of the Household Listing, for HL8. You will be using the Questionnaire for Children Under Five to interview the mothers or primary caretakers of these children. Households Child interviews completed Child interviews completed Child interviews completed Child interviews completed Child interviews completed No.of under-5 questionnaires completed: Once all of the Questionnaires for Children Under Five have been completed for a particular household, enter the number completed here. Households Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk: Leave this space blank. The data clerk will enter his/her number in the space provided. Households 1 Rokan Mia 3 Jharna Datta 4 Rina 5 Ripon 6 Foysal 7 Shakil 8 Anwar 9 Ratan 10 Shahinul Islam 11 Moniruzzaman 12 Nazimuddin 13 Hafiz Total number of Women 15-49 Total number of Women 15-49 Total number of Women 15-49 Total number of Women 15-49 Total number of Women 15-49 Are there any other persons living here - even if they are not members of your family or do not have parents living in this household? Including children at work or at school? If yes, insert child's name and complete form. Then, complete the totals below. Households Total number of Children 5-14 Total number of Children 5-14 Total number of Children 5-14 Total number of Children 5-14 Total number of Children 5-14 Households Total number of Children Under 5 years Total number of Children Under 5 years Total number of Children Under 5 years Total number of Children Under 5 years Total number of Children Under 5 years Households Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water What is the main source of drinking water for members of your household? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- Circle the code for the most usual source. If several sources are mentioned, probe to determine the most usual source. If the source varies by season, record the source for the season of the interview. Note that the next question is only asked if the response to this question is 'Bottled water'. You should skip WS2 if the response to WS1 is other than 'Bottled water'. If the response is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise, skip to WS3. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 91 Bottled water 96 Other 99 Missing Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat What is the main source of water used by your household for other purposes such as cooking and handwashing? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- This question should only be asked to households that use 'Bottled water' for drinking. Circle the code for the most usual source. If the source varies by season, record the source for the season of the interview. If the most usual source of non-drinking water is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise continue to the next question. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 96 Other 99 Missing Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back How long does it take to go there, get water, and come back? This question is used to find out how convenient the source of water is to the dwelling. Note that the question is asked for water sources coded as '13-81' and '96' in WS1, or water sources coded as '13-96' in WS2. Fill in the estimated time (in minutes, converting from hours, if necessary) it takes by the usual mode of transport to get to the water source, wait to get water, and get back to the dwelling. Use zero(s) preceding the number if less than 100 minutes (for example, '060' or '005'). Then continue to the next question. If the water source is on the dwelling premises or if water is delivered to the dwelling by a vendor, circle '995' for 'Water on premises' and skip to WS5. If the respondent does not know how long it takes, circle '998' and continue on to the next question. Households 995 On premises 998 DK 999 Missing Person fetching water Person fetching water Person fetching water Person fetching water Person fetching water Who usually goes to this source to fetch the water for your household? Probe: Is this person under age 15? What sex? Circle code that best describes this person. The purpose of this question is to find out the age and gender of the person who usually performs the task of hauling water. This will provide an understanding of whether water hauling responsibilities are given to members of a particular sex or age group. Probe: "IS THIS PERSON UNDER AGE 15? WHAT SEX IS THIS PERSON?" Circle the code that corresponds with the response or '8' if the respondent does not know. Adult refers to anyone age 15 or over, regardless of whether he/she is a household member. Child refers to anyone under the age of 15, regardless of whether he/she is a household member. Households 1 Adult woman 2 Adult man 3 Female child (under 15) 4 Male child (under 15) 8 DK 9 Missing Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Do you treat your water in any way to make it safer to drink? The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle '1' if 'Yes', and continue to the next question. If 'No' or 'DK' (Doesn't know'), circle '2' or '8', respectively, and skip to WS7. Households 1 Yes 2 No 8 DK 9 Missing Boil Boil Boil Boil Boil What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing A Boil Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing B Add bleach/chlorine Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing C Strain it through a cloth Use water filter Use water filter Use water filter Use water filter Use water filter What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing D Use water filter Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing F Let it stand and settle Alum Alum Alum Alum Alum ? Missing G Alum Other Other Other Other Other What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing X Other DK DK DK DK DK What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing Z DK Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water 1 Yes 2 No 9 Missing Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body ? Missing A Black, white or red spot in body Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough ? Missing B Hand and feet become rough Legs swells up Legs swells up Legs swells up Legs swells up Legs swells up ? Missing C Legs swells up Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs ? Missing D Losing the feelings of hand and legs Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg ? Missing E Sore over hand and leg Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW ? Missing A Using water from arsenic free TW Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water ? Missing B Using boiled pond/river/canal water Using rain water Using rain water Using rain water Using rain water Using rain water ? Missing C Using rain water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water ? Missing D Using pond/sand filter water Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter ? Missing E Using SIDKO filter Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic 1 Not tested 2 Tested/marked red 3 Tested/marked green 9 Missing Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility What kind of toilet facility do members of your household usually use? If "flush" or "pour flush", probe: Where does it flush to? If necessary, ask permission to observe the facility. Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of this question is to obtain a measure of the cleanliness of the sanitary facility used by the household members. It may be necessary to observe the facility. If so, ask permission to do so. If the respondent answers or it is observed that the household members have no facilities or use the bush or field, enter '95' for 'No facilities or bush or field' and skip to the next module. If any of the flush or pour flush responses (11-15) are given, probe: "WHERE DOES IT FLUSH TO?" Circle the code corresponding to the response given. Definitions of various types of toilet facilities are as follows: A flush toilet uses a cistern or holding tank for flushing water and has a water seal, which is a U-shaped pipe, below the seat or squatting pan that prevents the passage of flies and odours. A pour flush toilet uses a water seal, but unlike a flush toilet, a pour flush toilet uses water poured by hand for flushing (no cistern is used). . '11' - A piped sewer system is a system of sewer pipes, also called sewerage, that is designed to collect human excreta (faeces and urine) and wastewater and remove them from the household environment. Sewerage systems consist of facilities for collection, pumping, treating and disposing of human excreta and wastewater. . '12' - A septic tank is an excreta collection device and is a water-tight settling tank normally located underground, away from the house or toilet. . '13' - A flush/pour flush to pit latrine refers to a system that flushes excreta to a hole in the ground. . '14' - A flush/pour flush to somewhere else refers to excreta being deposited in or nearby the household environment (not into pit, septic tank or sewer); excreta may be flushed to the street, yard/plot, drainage way or other location. . '15' - Flush to unknown place/not sure/DK where should be coded in cases when the respondent knows that the toilet facility is a flush toilet, but does not know where it flushes to. '21' - A ventilated improved pit latrine or VIP is a type of pit latrine that is ventilated by a pipe extending above the latrine roof. The open end of the vent pipe is covered with gauze mesh or fly-proof netting and the inside of the superstructure is kept dark. '22' - A pit latrine with slab uses a hole in the ground for excreta collection and has a squatting slab, platform or seat that is firmly supported on all sides, easy to clean and raised above the surrounding ground level to prevent surface water from entering the pit. '23' - A pit latrine without slab uses a hole in the ground for excreta collection and does not have a squatting slab, platform or seat. An open pit is a rudimentary hole in the ground where excreta is collected. '31' - A composting toilet is a toilet into which excreta and carbon-rich material are added (vegetable wastes, straw, grass, sawdust, ash) and special conditions maintained to produce inoffensive compost. '41' - Bucket refers to the use of a bucket or other container for the retention of faeces (and sometimes urine and anal cleaning material), which is periodically removed for treatment or disposal. '51' - A hanging toilet or hanging latrine is a toilet built over the sea, a river, or other body of water into which excreta drops directly. '95' - No facilities or bush or field includes excreta wrapped and thrown with garbage, the 'cat' method of burying excreta in dirt, defecation in the bush or field or ditch, and defecation into surface water (drainage channel, beach, river, stream or sea). Households 11 Flush to piped sewer system 12 Flush to septic tank 13 Flush to pit (latrine) 14 Flush to somewhere else 15 Flush to unknown place/not sure/DK where 22 Pit latrine with slab 23 Pit latrine without slab/open pit 41 Bucket 51 Hanging toilet/hanging latrine 95 No facilities or bush or field 96 Other 99 Missing Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Do you share this facility with other households? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- Circle the code corresponding to the response given. If 'No', go to the next module. Households 1 Yes 2 No 9 Missing Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility How many households in total use this toilet facility? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- The total number of households using this facility should include the household being interviewed. If less than ten households use this toilet facility, enter the number of households on the line provided. Circle '10' if ten or more households use this toilet facility. Note that '01' is not a valid response (since it means that this is the only this household that uses the facility; if that is the case, you should go back to WS8 and correct the response there). Circle '98' for 'DK' ('Doesn't know'). Households 10 Ten or more households 98 DK 99 Missing Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication 1 Only water 2 Water and soil 3 Water and ash 4 Water and soap 6 Others 9 Missing Religion Religion Religion Religion Religion What is the religion of the head of this household? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Islam 2 Hindu 3 Christian 4 Buddist 6 Others 7 No religion 9 Missing Ethnicity Ethnicity Ethnicity Ethnicity Ethnicity To what ethnic group does the head of this household belong? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Bangali 2 Chakma 3 Saontal 4 Marma 5 Tripura 6 Others 7 Garo 9 Missing Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping How many rooms in this household are used for sleeping? This information provides a measure of how crowded the house is, and reflects the socio-economic condition of the household. A room in this case refers to a special area with a permanent partition that is used for sleeping. It is not necessarily the number of rooms in the household that are called 'bedrooms', but rather how many rooms get used for sleeping on a regular basis. Exclude rooms that are used only for sleeping by visitors to the household, but include those rooms that may not be regular 'bedrooms' but may be regularly used by one or more of the household members for sleeping. Enter the number of rooms in this household that are used for sleeping. Households 99 Missing Main material of floor Main material of floor Main material of floor Main material of floor Main material of floor Main material of the dwelling floor: Record observation. Circle the correct code for the material of the dwelling floor based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the floor, record the main flooring material (the material that covers the largest amount of floor space). Households 11 Earth/sand 21 Wood planks 22 Palm/bamboo 31 Polished wood 33 Ceramic tiles/Mojaic 34 Cement 35 Carpet 96 Other 99 Missing Main material of roof Main material of roof Main material of roof Main material of roof Main material of roof Main material of the roof. Record observation. Circle the correct code for the material of the dwelling roof, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the roof, record the main roofing material (the material that covers the largest amount of roof). Households 12 Thatch/palm leaf 21 Rustic mat/Plastic sheet/Polythine 22 Palm/bamboo 31 Metal 32 Wood 34 Ceramic tiles 35 Cement 96 Other 99 Missing Main material of wall Main material of wall Main material of wall Main material of wall Main material of wall Main material of the walls. Record observation. Circle the correct code for the material of the dwelling walls, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the walls, record the main wall material (the material that covers the largest amount of wall space). Households 12 Cane/palm/trunks/Leaf/Jute stick/Sod 13 Dirt/Mud 21 Bambo with mud 22 Stone with mud 25 Carton/Tin sheet 31 Cement 33 Bricks 96 Other 99 Missing Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking What type of fuel does your household mainly use for cooking? Information on the type of fuel used for cooking is collected as another measure of the socio-economic status of the household. The use of some cooking fuels can also have adverse health consequences. Circle the code corresponding to the answer given. Remember that this question asks about fuel for cooking, not fuel for heating or lighting. If the household uses more than one fuel for cooking, find out which type of fuel is used most often. If electricity, liquid propane gas (LPG), natural gas, or biogas is mainly used, circle '01', '02', '03', or '04', respectively, and skip to HC8. If any fuel other than the pre-coded ones is reported as being the main fuel used for cooking, circle '96' and specify the type of fuel on the line provided. Definitions of some of the types of fuel are as follows: 'Biogas' includes gases produced by fermenting manure in an enclosed pit. 'Lignite' is a derivative of coal that produces more smoke when burned but produces less heat than coal. Households 1 Electricity 2 Liquid propane gas (LPG) 3 Natural gas 4 Biogas 5 Kerosene 8 Wood 9 Straw/shrubs/grass 10 Animal dung 11 Agricultural crop residue 96 Other 99 Missing Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire In this household, is food cooked on an open fire, an open stove or a closed stove? Probe for type. Probe for type of stove and circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '96' and specify the type of stove on the line provided. For 'Closed stove', skip the next question and ask HC8. Households 1 Open fire 2 Open stove 3 Closed stove 6 Other 9 Missing Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire/stove have a chimney or a hood? Circle the appropriate response. Households 1 Yes 2 No 9 Missing Cooking location Cooking location Cooking location Cooking location Cooking location Is the cooking usually done in the house, in a separate building, or outdoors? Circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '6' and specify on the line provided. Households 1 In the house 2 In a separate bulding 3 Outdoors 6 Other 9 Missing Electricity Electricity Electricity Electricity Electricity Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Radio Radio Radio Radio Radio Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Television Television Television Television Television Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Mobile phone Mobile phone Mobile phone Mobile phone Mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Refrigerator Refrigerator Refrigerator Refrigerator Refrigerator Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Electric fan Electric fan Electric fan Electric fan Electric fan 1 Yes 2 No 9 Missing Computer Computer Computer Computer Computer 1 Yes 2 No 9 Missing AC AC AC AC AC 1 Yes 2 No 9 Missing Washing machine Washing machine Washing machine Washing machine Washing machine 1 Yes 2 No 9 Missing Watch Watch Watch Watch Watch Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Bicycle Bicycle Bicycle Bicycle Bicycle Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Car or truck Car or truck Car or truck Car or truck Car or truck Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Boat with a motor Boat with a motor Boat with a motor Boat with a motor Boat with a motor Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Sofa Sofa Sofa Sofa Sofa 1 Yes 2 No 9 Missing Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van 1 Yes 2 No 9 Missing Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured 1 Yes 2 No 9 Missing Fall_Boy Fall_Boy Fall_Boy Fall_Boy Fall_Boy 9 Missing Fall_Girl Fall_Girl Fall_Girl Fall_Girl Fall_Girl 9 Missing Burn_Boy Burn_Boy Burn_Boy Burn_Boy Burn_Boy 9 Missing Burn_Girl Burn_Girl Burn_Girl Burn_Girl Burn_Girl 9 Missing Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy 9 Missing Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl 9 Missing Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy 9 Missing Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl 9 Missing Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy 9 Missing Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl 9 Missing Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy 9 Missing Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl 9 Missing Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy 9 Missing Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl 9 Missing Other_Boy Other_Boy Other_Boy Other_Boy Other_Boy 9 Missing Other_Girl Other_Girl Other_Girl Other_Girl Other_Girl 9 Missing Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy 9 Missing Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl 9 Missing Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy 9 Missing Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl 9 Missing Died_Boy Died_Boy Died_Boy Died_Boy Died_Boy 9 Missing Died_Girl Died_Girl Died_Girl Died_Girl Died_Girl 9 Missing Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household 1 No Marriage 2 Registered 3 Not registered 8 DK Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year 99 Missing Own or rent Own or rent Own or rent Own or rent Own or rent 1 Own 2 Rent 3 Rentfree/squatter/other 9 Missing Have title deed Have title deed Have title deed Have title deed Have title deed 1 Yes 2 No 9 Missing Certificate of occupation Certificate of occupation Certificate of occupation Certificate of occupation Certificate of occupation ? Missing A Certificate of occupation (or adjudication certificate) Property tax certification Property tax certification Property tax certification Property tax certification Property tax certification ? Missing B Property tax certification Utility bills Utility bills Utility bills Utility bills Utility bills ? Missing C Utility bills Other Other Other Other Other ? Missing X Other None/no document None/no document None/no document None/no document None/no document ? Missing Y None/No document Written rental contract Written rental contract Written rental contract Written rental contract Written rental contract 1 Yes 2 No 9 Missing Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) ? Missing A Informal agreement (written) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) ? Missing B Verbal agreement (no document) Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner ? Missing C Occupied rent free with knowledge of the owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner ? Missing D Occupied rent free without knowledge of the owner Other Other Other Other Other ? Missing X Other None/no document None/no document None/no document None/no document None/no document ? Missing Y None/No document Feel secure from eviction Feel secure from eviction Feel secure from eviction Feel secure from eviction Feel secure from eviction 1 Yes 2 No 8 DK 9 Missing Evicted during past 5 years Evicted during past 5 years Evicted during past 5 years Evicted during past 5 years Evicted during past 5 years 1 Yes 2 No 9 Missing Landslide area Landslide area Landslide area Landslide area Landslide area ? Missing A Landslide area Flood-prone area Flood-prone area Flood-prone area Flood-prone area Flood-prone area ? Missing B Flood-prone area River bank River bank River bank River bank River bank ? Missing C River bank Steep hill Steep hill Steep hill Steep hill Steep hill ? Missing D Steep hill Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile ? Missing E Garbage mountain/pile Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area ? Missing F Industrial pollution area Railroad Railroad Railroad Railroad Railroad ? Missing G Railroad None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Cracks/openings in the wall Cracks/openings in the wall Cracks/openings in the wall Cracks/openings in the wall Cracks/openings in the wall ? Missing A Cracks/openings in walls No windows No windows No windows No windows No windows ? Missing B No windows Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass ? Missing C Windows with broken glass/no glass Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof ? Missing D Visible holes in the roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof ? Missing E Incomplete roof Insecure door Insecure door Insecure door Insecure door Insecure door ? Missing F Insecure door Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) ? Missing G Squartter (Jhupri) None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Narrow passages Narrow passages Narrow passages Narrow passages Narrow passages ? Missing A Very narrow passage between house intead of road Too many power cables Too many power cables Too many power cables Too many power cables Too many power cables ? Missing B Too many power cables connecting to neighborhood's None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Salt iodization test outcome Salt iodization test outcome Salt iodization test outcome Salt iodization test outcome Salt iodization test outcome We would like to check whether the salt used in your household is iodized. May I see a sample of the salt used to cook the main meal eaten by members of your household last night? Once you have examined the salt, circle number that corresponds to test outcome. After you have completed all modules of the Household Questionnaire, administer the module on Salt Iodization. Note that in this module, you will most probably perform a test on a sample of salt provided by the respondent. This item is used to record the type of salt used to prepare the family's main meal the day before the questionnaire is administered, and the outcome of the test for salt iodization. Once you have a sample of salt, perform the test and circle the code that corresponds to the test outcome. Circle '1' if the test is negative (0 parts per million/no colour - not iodized). Circle '2' if the test shows less than 15 parts per million iodine (weak colour). Circle '3' if the test is positive (15 parts per million or more, strong colour). Circle '6' if there is 'No salt in home'. Circle '7' if the salt was present, but not tested for any reason. If the respondent indicates that no salt was used to cook the main meal last night, or that no meal was cooked, ask for a sample of the salt usually used for cooking in the household, and perform the test on this sample of salt. Households 1 Not iodized 0 PPM (no colour) 4 Iodized salt 6 No salt in home 7 Salt not tested 9 Missing In the Bangladesh MICS 2006 the standard salt test kit was not used. An iodine testing solution was used to test household salt for iodine and potassium iodate content using an iodine testing solution. The iodine testing solution is a quantitative test and cannot detect whether the salt is adequately iodized or not. Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Recoded variable De jure household members (usual residents) Wealth index score Wealth index score Wealth index score Wealth index score Wealth index score Recoded variable Children aged 0-4 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Recoded variable Children aged 0-4 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Education of household head Education of household head Education of household head Education of household head Education of household head Recoded variable De jure household members (usual residents) 1 None 2 Primary incomplete 3 Primary completed 4 Secondary incomplete 5 Secondary completed or higher 6 Non-standard curriculum 9 Missing/DK Education of household head Education of household head Education of household head Education of household head Education of household head 1 None 2 Primary 3 Secondary + 4 Non-standard curriculum 9 Missing/DK Sex of household head Sex of household head Sex of household head Sex of household head Sex of household head Recoded variable Households 1 Male 2 Female 9 Missing/DK Cluster number Cluster number Cluster number Cluster number Cluster number We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. During this time I would like to speak with the household head and all mothers or others who take care of children in the household. May I start now? If permission is given, begin the interview. Cluster number: Enter the cluster number as instructed by your supervisor. Households Unique identifier for the cluster in which the household exists Household number Household number Household number Household number Household number Household number: Enter the household number as instructed by your supervisor. Households Houshold number within the cluster Line number Line number Line number Line number Line number FIRST, PLEASE TELL ME THE NAME OF EACH PERSON WHO USUALLY LIVES HERE, STARTING WITH THE HEAD OF THE HOUSEHOLD. List the head of the household in line 01. List all household members (HL2), their relationship to the household head (HL3), and their sex (HL4). Then ask: ARE THERE ANY OTHERS WHO LIVE HERE, EVEN IF THEY ARE NOT AT HOME NOW? (THESE MAY INCLUDE CHILDREN IN SCHOOL OR AT WORK). If yes, complete listing. Then, ask questions starting with HL5 for each person at a time. Add a continuation sheet if there are more than 15 household members. Tick here if continuation sheet used A household is a person or group of persons who usually live and eat together. Any adult member of the household can serve as the respondent for this section. As described below, there are a number of modules in the Household Questionnaire that you have to administer to mothers or primary caretakers of children. Therefore, it can be an advantage if you begin the Household Questionnaire with a mother or primary caretaker. While you should not make a specific effort to ensure this, you will indeed start the interview with such persons in many cases, since, in practice, these persons are more likely to be at home than, say, male household heads. Note that the Household Listing Form includes HL1. Line No. This is the number used to identify each person listed. You must obtain a complete list of all persons who usually live in the household, but you do not need to fill in or do anything in this column since the numbers are already provided. This is a very important number, since once household members are assigned these line numbers as the Household Listing is being completed, they are identified with these line numbers throughout the questionnaires administered in this household. You should begin by saying: FIRST, PLEASE TELL ME THE NAME OF EACH PERSON WHO USUALLY LIVES HERE, STARTING WITH THE HEAD OF THE HOUSEHOLD. List the head of the household in line 01. List all household members (HL2), their relationship to the household head (HL3), and their sex (HL4). Then ask: ARE THERE ANY OTHERS WHO LIVE HERE - EVEN IF THEY ARE NOT AT HOME NOW? (THESE MAY INCLUDE CHILDREN AT SCHOOL OR AT WORK). If yes, complete the listing. Note that the household head is determined solely on the basis of what the respondent tells you. You are not required to assess who the household head is most likely to be, or whether the person stated as the household head has the necessary characteristics to be the household head. Also note that if there are more than 15 household members, you will need to use a continuation sheet to record the additional household members. Please remember to change the line numbers of household members on the continuation sheet to read '16', '17', '18', etc., and to tick the box provided at the top of the Household Listing indicating that a continuation sheet has been used. The Household Listing will be completed in two stages: first, names (HL2), relationship codes (HL3) and sex (HL4) of all household members are recorded until all household members are included in the list. When the respondent is asked to provide the names of persons living in the household, their relationship to the head of the household and their sex is naturally mentioned during the course of listing the names. For this reason, the list is completed vertically for HL2, HL3 and HL4 during the first stage. Then, questions from HL5 to HL12 are asked for each person before moving to the next person. Fill in the name of each household member, starting with the head of household (the person who is considered to be responsible for the household). It is up to the respondent to define who the head of the household is. The head of the household should always be on the first row of the list. Never contest the respondent's answer. Also note that the names of household members will never be used for analysis purposes. However, recording the names of all household members is important since you will be using these names to address the questions. De jure household members (usual residents) Line number Line number Line number Line number Line number Child's line number: Children aged 0-4 Relationship to the head Relationship to the head Relationship to the head Relationship to the head Relationship to the head What is the relationship of (name) to the head of the household? Enter the code corresponding to how the person listed is related to the head of the household. Use the codes at the bottom of the Household Listing. Be particularly careful in doing this if the respondent is not the head of the household. Make sure that you record the relationship of each person to the household head, not the relationship to the respondent. For example, if the respondent is the wife of the head of the household and she says that Sola is her brother, then Sola should be coded as '09' ('Brother or sister-in-law'), not as '08' ('Brother or sister'), because Sola is a brother-in-law of the head of the household. Be very careful in obtaining this information correctly, since respondents tend to provide the relationship of the person to themselves, rather than to the head of the household. If the head of the household is married to a woman who has a child from a previous marriage, that child's relationship to the head of the household should be coded as '14' ('Adopted/foster/stepchild'). If a household member is not related to the head of household, such as a friend who lives with the household, enter '15' ('Not related'). Enter '98' if the respondent doesn't know the relationship of a household member to the head of household. De jure household members (usual residents) 1 Head 2 Wife or Husband 3 Son or Daugher 4 Son/Daughter in law 5 Grandchild 6 Parent 7 Parent in law 8 Brother or sister 9 Brother/sister in law 10 Uncle/Aunt 11 Niece/nephew 13 Other relative 14 Adopted/foster/stepchild 15 Not related 97 Inconsistent 98 DK 99 Missing Sex Sex Sex Sex Sex Children aged 0-4 1 Male 2 Female 9 Missing Age Age Age Age Age How old is (name)? How old was (name) on his/her last birthday? Record in completed years 98=DK* * See instructions: to be used only for elderly household members (code meaning "do not know/over age 50"). Enter each person's age in completed years, that is, his/her age at his/her last birthday. Completed age is also defined as 'the number of completed solar years since birth'. With this definition, since a 6-month-old baby has not completed a full solar year, his/her age will be entered as '00'. Note that you will be obtaining more accurate estimates of children's ages later. This column should never be left blank. If you have difficulty obtaining the ages of very elderly members of the household, you may enter the code '98', meaning 'Doesn't know/over age 50'. For household members younger than 50, completed ages must be entered. De jure household members (usual residents) 97 97+ 98 DK 99 Missing Line number of eligible women Line number of eligible women Line number of eligible women Line number of eligible women Line number of eligible women Circle Line no. if woman is age 15-49 Circle the line number in this column if the household member is a woman 15-49 years of age (this includes those age 15 and age 49). You will not ask this question to the respondent. De jure household members (usual residents) Not eligible Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module For each child age 5-14: Who is the mother or primary caretaker of this child? Record Line no. of mother/caretaker If the household member is a child between 5 and 14 years of age (this includes those age 5 and age 14), record the line number of his/her mother or primary caretaker in this column. Ask this question to the respondent if necessary. De jure household members (usual residents) Not eligible Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module For each child under 5: Who is the mother or primary caretaker of this child? Record Line no. of mother/caretaker If the household member is a child under the age of five (this includes those just born and those age 4, but not children who have completed 5 years of age), record the line number of his/her mother or primary caretaker in this column. Ask this question to the respondent if necessary. De jure household members (usual residents) Not eligible Mother alive Mother alive Mother alive Mother alive Mother alive For children age 0-17 years ask HL9-HL12 Is (name's) natural mother alive? For all children under age 18, we want to know whether either of their own (natural) parents is listed in the Household Listing, and their survival status. This information can be used to measure the prevalence of orphanhood and child fostering in the population. For everyone age 18 and older, HL9-12 will be left blank. --- By 'natural' we mean the biological mother. In many cultures, people consider other people's children whom they are raising as their own, especially children of their husband or sisters, etc. You should be certain that the respondent understands that you are asking about the woman who gave birth to the child. Record whether or not the child's natural mother is still alive by circling the code corresponding to the response given. If the child's natural mother is not alive or if the respondent does not know, skip to HL11. Otherwise, continue to the question in the next column. De jure household members (usual residents) aged 0-17 (under 18) 1 Yes 2 No 8 DK 9 Missing Mother line number in HH Mother line number in HH Mother line number in HH Mother line number in HH Mother line number in HH For children age 0-17 years ask HL9-HL12 If alive: Does (name's) natural mother live in this household? Record Line no. of mother or 00 for 'No' For all children under age 18, we want to know whether either of their own (natural) parents is listed in the Household Listing, and their survival status. This information can be used to measure the prevalence of orphanhood and child fostering in the population. For everyone age 18 and older, HL9-12 will be left blank. --- If the natural mother is still alive, we want to know whether she lives in the household. If the mother does live in the household, ask who she is (she should be listed in the Household Listing if she lives in the household) and record her line number in the space provided. If the mother is not a member of the household (not listed in the Household Listing), record '00'. De jure household members (usual residents) aged 0-17 (under 18) 97 Inconsistent 99 Missing Father alive Father alive Father alive Father alive Father alive For children age 0-17 years ask HL9-HL12 If alive: Is (name's) natural father alive? For all children under age 18, we want to know whether either of their own (natural) parents is listed in the Household Listing, and their survival status. This information can be used to measure the prevalence of orphanhood and child fostering in the population. For everyone age 18 and older, HL9-12 will be left blank. --- Fill in these questions in exactly the same way as HL9 and HL10. This time, make sure to record the survival status and the line number of the natural (biological) fathers. If the father of the household member is not alive or his survival status is now known by the respondent, move to the next person on the list. De jure household members (usual residents) aged 0-17 (under 18) 1 Yes 2 No 8 DK 9 Missing Father line number in HH Father line number in HH Father line number in HH Father line number in HH Father line number in HH For children age 0-17 years ask HL9-HL12 Does (name's) natural father live in this household? Record Line no. of father or 00 for 'No' For all children under age 18, we want to know whether either of their own (natural) parents is listed in the Household Listing, and their survival status. This information can be used to measure the prevalence of orphanhood and child fostering in the population. For everyone age 18 and older, HL9-12 will be left blank. --- Fill in these questions in exactly the same way as HL9 and HL10. This time, make sure to record the survival status and the line number of the natural (biological) fathers. If the father of the household member is not alive or his survival status is now known by the respondent, move to the next person on the list. --- When you have completed the listing of all household members and all questions in the Household Listing, probe to see if there are any other household members you have not included in the list: "ARE THERE ANY OTHER PERSONS LIVING HERE - EVEN IF THEY ARE NOT MEMBERS OF YOUR FAMILY OR DO NOT HAVE PARENTS LIVING IN THIS HOUSEHOLD? INCLUDING CHILDREN AT WORK OR AT SCHOOL?" If yes, insert child's name and complete the form. After you have made sure that there are no other household members to be included in the list, complete the row at the bottom of the household list, 'Totals'. Calculate the number of eligible women in the household and record the number under 'Women 15-49', calculate the number of children aged 5-14 years in the household and record the number under 'Children 5-14' and, finally, calculate the number of children under five, and record the number under 'Under-5s'. The numbers recorded here for the women 15-49 and under-5s will indicate to you the number of individual women's and under-five questionnaires you should have in the household (see below). You will also record these numbers in HH12 and HH14 in the Household Information Panel. When you have completed the Household Listing Form for all household members, prepare the individual questionnaire forms for this household: . For each woman age 15-49 years, write her name and line number in the spaces provided (WM3 and WM4) at the top of her Questionnaire for Individual Women. . For each child under age five, write his/her name and line number and the name and line number of his/her mother or caretaker in the spaces provided (UF3-6) at the top of the Questionnaire for Children Under Five. You should now have a separate questionnaire for each eligible woman and child under five in the household, ready for use when you administer the questionnaires later on. De jure household members (usual residents) aged 0-17 (under 18) 97 Inconsistent 99 Missing swim swim swim swim swim 1 Yes 2 No 9 Missing Line number Line number Line number Line number Line number For household members age 5 and above Continue line by line, asking the questions for each household member who is eligible (age five or older), as you did when completing the Household Listing Form. Note that the lines corresponding to household members under five should remain blank. This is the number assigned to each person on the Household Listing Form. You do not need to fill in or do anything in this column since the numbers are already provided. Copy the names of each person age five and older from the Household Listing Form (HL2) to their corresponding line numbers. De jure household members (usual residents) Ever attended school Ever attended school Ever attended school Ever attended school Ever attended school For household members age 5 and above Has (name) ever attended school or preschool? For each household member age five or older, ask ED2 and ED3. These questions ask about educational attainment for all household members in this age group. (If children younger than five attend school or pre-school, this information will be recorded in the Questionnaire for Children Under Five.) Any adult member of the household may provide this information for those not present. --- Circle '1' if the answer is 'Yes'. If the answer is 'No', circle '2' and go to the household member on the next line. The term 'school' includes primary, secondary and post-secondary schooling, as well as any other intermediate levels of schooling in the formal school system. It also includes technical or vocational training beyond the primary-school level, such as long-term courses in mechanics or secretarial work. Schools that carry out non-standard curriculum are also included here. Ensure that respondents understand what is meant by 'non-standard curriculum'. A non-standard curriculum includes religious schools, such as Koranic schools, that do not teach a full, standard school curriculum. If a school teaches religious courses but also includes the standard curriculum - such as many Catholic schools - it would be coded as a standard school. 'Pre-school' is listed for children who do not attend grade 1 at age 5, but do attend some form of organized learning or early childhood education programme, whether or not such a programme is considered part of the school system. The definition of organized early learning programme does not refer to programmes offering only babysitting or child-minding. De jure household members (usual residents) 1 Yes 2 No 9 Missing Highest level of school attended Highest level of school attended Highest level of school attended Highest level of school attended Highest level of school attended What is the highest level of school (name) attended? Children aged 0-4 Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 6 NGO/Mosque based/Adult literacy programme 8 DK 9 Missing Highest grade at level Highest grade at level Highest grade at level Highest grade at level Highest grade at level What is the highest grade (name) completed at this level? Children aged 0-4 97 Inconsistent 98 DK 99 Missing Currently attending school during the school year (2004-2005 Currently attending school during the school year (2004-2005 Currently attending school during the school year (2004-2005 Currently attending school during the school year (2004-2005 Currently attending school during the school year (2004-2005 For household members age 5-24 years During the (2004-2005) school year, did (name) attend school or preschool at any time? For each household member 5-24 years of age (this includes those age 5 and age 24), ask questions ED4-ED8, which inquire about school attendance. While the ideal respondent for these questions would be the mother or primary caretaker, any adult member of the household may provide the information. Since questions from ED4 to ED8 refer to school attendance, they will have to be adapted to the situation at the time of the interview. All questions should be retained. However, the wording and coding will have to be changed. The objective of these questions is to capture the school attendance of household members in two consecutive school years. In the explanations below, information is provided on how this can be tackled. --- Circle the code corresponding to the answer given. If 'Yes', continue to the next question. If 'No', skip to ED7. If the interview is carried out during the school year, then the question should be worded to refer to the current school year. If the interview is carried out between school years, then the question should refer to the last school year that has ended. Take the example of a country where the school year ends in June and the new school year begins in September: If the interview is carried out in July 2005 (between school years), then the question should refer to the 2004-2005 school year; if the interview is carried out in October 2005 (during the new school year), then the question should refer to the 2005-2006 school year. De jure household members (usual residents) aged 5-24 1 Yes 2 No 9 Missing Days attended school in last week Days attended school in last week Days attended school in last week Days attended school in last week Days attended school in last week For household members age 5-24 years Since last (day of the week), how many days did (name) attend school? Insert number of days in space below. For each household member 5-24 years of age (this includes those age 5 and age 24), ask questions ED4-ED8, which inquire about school attendance. While the ideal respondent for these questions would be the mother or primary caretaker, any adult member of the household may provide the information. Since questions from ED4 to ED8 refer to school attendance, they will have to be adapted to the situation at the time of the interview. All questions should be retained. However, the wording and coding will have to be changed. The objective of these questions is to capture the school attendance of household members in two consecutive school years. In the explanations below, information is provided on how this can be tackled. --- When asking this question, insert the name of the day of the interview. For example, if the interview is taking place on a Tuesday, ask: "SINCE LAST TUESDAY, HOW MANY DAYS DID (name) ATTEND SCHOOL?" Note that the maximum number to be entered here should be '7' and not '8'. De jure household members (usual residents) aged 5-24 8 Interview during school holidays 9 Missing Level of education attended Level of education attended Level of education attended Level of education attended Level of education attended For household members age 5-24 years During this/that school year, which level and grade is/was (name) attending? For each household member 5-24 years of age (this includes those age 5 and age 24), ask questions ED4-ED8, which inquire about school attendance. While the ideal respondent for these questions would be the mother or primary caretaker, any adult member of the household may provide the information. Since questions from ED4 to ED8 refer to school attendance, they will have to be adapted to the situation at the time of the interview. All questions should be retained. However, the wording and coding will have to be changed. The objective of these questions is to capture the school attendance of household members in two consecutive school years. In the explanations below, information is provided on how this can be tackled. --- Circle the code for the level of school, and enter the household member's current grade. If it applies, circle '8' for 'DK' ('Doesn't know'). Probe to determine the type of school, particularly to make sure if it is a standard or non-standard curriculum. Then enter the highest grade number completed using '01', '02', etc. If a child is in pre-school or kindergarten, and grades are not used, omit the grade. If less than one grade was completed, enter '00'. Enter '98' for 'DK'. If the interview is conducted during the time between two school years, the question should refer to the school year that has ended, and you should use 'THAT' and 'WAS' in the question. If the interview is conducted during the school year, the question should refer to the current school year. Note that these questions should capture children who may have been attending at the beginning of the school year, but have dropped out since then. If necessary, past tense could be used to make sure that you obtain information on the level and grade of children who may have dropped out from school during the course of the school year. Questions ED4, ED5 and ED6 collect information on the school attendance of household members during the current school year (if the interview is conducted when schools are open) or the last school year that has ended (if the interview is conducted between school years). Questions ED7 and ED8 collect information on the school attendance of household members during the previous school year. De jure household members (usual residents) aged 5-24 Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 6 NGO/Mosque based/Adult literacy programme 8 DK 9 Missing Grade of education attended Grade of education attended Grade of education attended Grade of education attended Grade of education attended For household members age 5-24 years During this/that school year, which level and grade is/was (name) attending? For each household member 5-24 years of age (this includes those age 5 and age 24), ask questions ED4-ED8, which inquire about school attendance. While the ideal respondent for these questions would be the mother or primary caretaker, any adult member of the household may provide the information. Since questions from ED4 to ED8 refer to school attendance, they will have to be adapted to the situation at the time of the interview. All questions should be retained. However, the wording and coding will have to be changed. The objective of these questions is to capture the school attendance of household members in two consecutive school years. In the explanations below, information is provided on how this can be tackled. --- Circle the code for the level of school, and enter the household member's current grade. If it applies, circle '8' for 'DK' ('Doesn't know'). Probe to determine the type of school, particularly to make sure if it is a standard or non-standard curriculum. Then enter the highest grade number completed using '01', '02', etc. If a child is in pre-school or kindergarten, and grades are not used, omit the grade. If less than one grade was completed, enter '00'. Enter '98' for 'DK'. If the interview is conducted during the time between two school years, the question should refer to the school year that has ended, and you should use 'THAT' and 'WAS' in the question. If the interview is conducted during the school year, the question should refer to the current school year. Note that these questions should capture children who may have been attending at the beginning of the school year, but have dropped out since then. If necessary, past tense could be used to make sure that you obtain information on the level and grade of children who may have dropped out from school during the course of the school year. Questions ED4, ED5 and ED6 collect information on the school attendance of household members during the current school year (if the interview is conducted when schools are open) or the last school year that has ended (if the interview is conducted between school years). Questions ED7 and ED8 collect information on the school attendance of household members during the previous school year. De jure household members (usual residents) aged 5-24 97 Inconsistent 98 DK 99 Missing Type of School Type of School Type of School Type of School Type of School 1 Formal School 2 Non-formal School 3 Formal Madrasah 4 Non-Formal Madrasah 9 Missing Attended school last year (2003-2004) Attended school last year (2003-2004) Attended school last year (2003-2004) Attended school last year (2003-2004) Attended school last year (2003-2004) For household members age 5-24 years Did (name) attend school or preschool at any time during the previous school year, that is (2003-2004)? For each household member 5-24 years of age (this includes those age 5 and age 24), ask questions ED4-ED8, which inquire about school attendance. While the ideal respondent for these questions would be the mother or primary caretaker, any adult member of the household may provide the information. Since questions from ED4 to ED8 refer to school attendance, they will have to be adapted to the situation at the time of the interview. All questions should be retained. However, the wording and coding will have to be changed. The objective of these questions is to capture the school attendance of household members in two consecutive school years. In the explanations below, information is provided on how this can be tackled. --- If the child attended school at any time during the last school year, circle '1'. If the answer is 'No' or 'DK', circle the appropriate code and go to the household member on the next line. De jure household members (usual residents) aged 5-24 1 Yes 2 No 8 DK 9 Missing Level of education attended last year Level of education attended last year Level of education attended last year Level of education attended last year Level of education attended last year For household members age 5-24 years During that previous school year, which level and grade did (name) attend? For each household member 5-24 years of age (this includes those age 5 and age 24), ask questions ED4-ED8, which inquire about school attendance. While the ideal respondent for these questions would be the mother or primary caretaker, any adult member of the household may provide the information. Since questions from ED4 to ED8 refer to school attendance, they will have to be adapted to the situation at the time of the interview. All questions should be retained. However, the wording and coding will have to be changed. The objective of these questions is to capture the school attendance of household members in two consecutive school years. In the explanations below, information is provided on how this can be tackled. --- Circle the code for the level of school attended and fill in the child's grade or enter '8' if the respondent doesn't know the level and/or '98' if the respondent doesn't know the grade. If the child was in pre-school or kindergarten, and grades are not used, omit the grade. De jure household members (usual residents) aged 5-24 Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 6 NGO/Mosque based/Adult literacy programme 8 DK 9 Missing Grade of education attended last year Grade of education attended last year Grade of education attended last year Grade of education attended last year Grade of education attended last year For household members age 5-24 years During that previous school year, which level and grade did (name) attend? For each household member 5-24 years of age (this includes those age 5 and age 24), ask questions ED4-ED8, which inquire about school attendance. While the ideal respondent for these questions would be the mother or primary caretaker, any adult member of the household may provide the information. Since questions from ED4 to ED8 refer to school attendance, they will have to be adapted to the situation at the time of the interview. All questions should be retained. However, the wording and coding will have to be changed. The objective of these questions is to capture the school attendance of household members in two consecutive school years. In the explanations below, information is provided on how this can be tackled. --- Circle the code for the level of school attended and fill in the child's grade or enter '8' if the respondent doesn't know the level and/or '98' if the respondent doesn't know the grade. If the child was in pre-school or kindergarten, and grades are not used, omit the grade. De jure household members (usual residents) aged 5-24 97 Inconsistent 98 DK 99 Missing Line number Line number Line number Line number Line number To be administered to mother/caretaker of each child in the household age 5 through 14 years. For household members below age 5 or above age 14, leave rows blank. Now I would like to ask about any work children in this household may do. This module is to be administered to the mother or primary caretaker of each child resident in the household aged 5 through 14 years (this includes those age 5 and age 14). For household members younger than five or older than 14, rows should be left blank. --- This is the number assigned to each person on the Household Listing Form. You do not need to fill in or do anything in this column since the numbers are already provided. Explain, "NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO." Insert the child's name, copying from the Household Listing, column HL2. This is done to prevent confusion during the interview. Children aged 5-14 Worked in past week Worked in past week Worked in past week Worked in past week Worked in past week During the past week, did (name) do any kind of work for someone who is not a member of this household? If yes: For pay in cash or kind? 'Pay' refers to any compensation for work, including cash or goods or services provided to the child or his family. 'The past week' refers to the 7 days preceding the interview day. Note that the person indicated - someone who is not a member of this household - may be a relative or a family member who lives in a different household. If the answer is 'Yes', ask if the work was done for pay in cash or kind. Circle '1' if work was done for pay in cash or kind. Circle '2' if work was not done for any form of pay. If '1' or '2' is circled, continue to the next question. If no work was done by that child in the past week, circle '3' and skip to CL5. Children aged 5-14 1 Yes, paid 2 Yes, unpaid 3 No 9 Missing Hours worked in past week Hours worked in past week Hours worked in past week Hours worked in past week Hours worked in past week If yes: Since last (day of the week), about how many hours did he/she do this work for someone who is not a member of this household? If more than one job, include all hours at all jobs. Record the estimated number of hours the child spent doing work in the past 7 days and skip to CL6. Make sure the mother or primary caretaker understands what you mean by "SINCE LAST (day of the week)" - specify the name of today's weekday, as you did in the Education Module. If the child works more than one such job, include the total hours spent doing such work in all jobs. Children aged 5-14 98 DK 99 Missing Worked in past year Worked in past year Worked in past year Worked in past year Worked in past year At any time during the past year, did (name) do any kind of work for someone who is not a member of this household? If yes: For pay in cash or kind? CL5 is essentially the same question as CL3; this time the reference period is 1 year rather than the last 1 week. Continue with the next question after you have circled the response to this question. Children aged 5-14 1 Yes, paid 2 Yes, unpaid 3 No 9 Missing Helped with household chores in past week Helped with household chores in past week Helped with household chores in past week Helped with household chores in past week Helped with household chores in past week During the past week, did (name) help with household chores such as shopping, collecting firewood, cleaning, fetching water, or caring for children? As was explained in CL3, 'the past week' refers to the 7 days preceding the interview day. Circle '1' if 'Yes', and continue to the next question. If 'No', circle '2' and skip to CL8. Children aged 5-14 1 Yes 2 No 9 Missing Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week If yes: Since last (day of the week), about how many hours did he/she spend doing these chores? Insert the estimated number of hours the child spent doing household chores in the past 7 days. Make sure the mother/primary caretaker understands what you mean by 'since last (day of the week)' - specify the name of today's weekday, just as you did for CL4. Children aged 5-14 98 DK 99 Missing Did other family work in past week Did other family work in past week Did other family work in past week Did other family work in past week Did other family work in past week During the past week, did (name) do any other family work (on the farm or in a business or selling goods in the street?) As was explained in CL6, 'the past week' refers to the 7 days preceding the interview day. 'Other family work' means any work done other than household chores/housekeeping to help with family income generation or subsistence production. This may include raising livestock belonging to the household or working in a family business. Circle '1' if 'Yes', and continue to the next question. If 'No', circle '2' and go to the next line, corresponding to the next eligible child aged 5-14 years. Children aged 5-14 1 Yes 2 No 9 Missing Hours worked on other family work Hours worked on other family work Hours worked on other family work Hours worked on other family work Hours worked on other family work If yes: Since last (day of the week), about how many hours did he/she do this work? Insert the estimated number of hours worked. Again, make sure the mother/primary caretaker understands what you mean by 'since last (day of the week)' - specify the name of today's weekday, just as you did for CL4 and CL7. Children aged 5-14 98 DK 99 Missing Line number Line number Line number Line number Line number To be administered to caretakers of all children 2 through 9 years old living in the household. For household members below age 2 or above age 9, leave rows blank I would like to ask you if any children in this household aged 2 through 9 has any of the health conditions I am going to mention to you. Line no. This module is to be administered to the mother or primary caretaker of each child resident in the household aged 2-9 years (this includes those age 2 and age 9). For household members below age 2 or above age 9, rows should be left blank. DA1. Line No: This is the number used to identify each child eligible for this module. You do not need to fill in or do anything in this column since the numbers are already provided. DA2. Child's name: For each child in the household 2-9 years of age, insert the child's name in this column next to his/ her line number (from Household Listing HL1), copying from the Household Listing, column HL2. This is done to prevent confusion during the interview. For all other household members less than 2 years of age or older than 9, leave the space next to their line numbers blank. Now, read the introduction to this module to the mother or primary caretaker of each child by saying: "I WOULD LIKE TO ASK YOU IF ANY CHILD IN THIS HOUSEHOLD AGED 2 THROUGH 9 HAS ANY OF THE HEALTH CONDITIONS I AM GOING TO MENTION TO YOU." Next, ask the following questions DA3 through DA13 about each child, in turn. Ask the entire set of questions about the first child, and then go on to ask about the next child in the list, asking the entire set of questions about the next child, until you have recorded answers for each child listed. In cases when there is more than one mother/primary caretaker for children listed in the module, complete asking questions about the children of the first mother/primary caretaker, then move to the next mother/primary caretaker. De jure children aged 2-14 Delay in sitting, standing or walking Delay in sitting, standing or walking Delay in sitting, standing or walking Delay in sitting, standing or walking Delay in sitting, standing or walking Compared with other children, does or did (name) have any serious delay in sitting, standing, or walking? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. De jure children aged 2-14 1 Yes 2 No 9 Missing Difficulty seeing Difficulty seeing Difficulty seeing Difficulty seeing Difficulty seeing Compared with other children, does (name) have difficulty seeing, either in the daytime or at night? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. De jure children aged 2-14 1 Yes 2 No 9 Missing Difficulty hearing Difficulty hearing Difficulty hearing Difficulty hearing Difficulty hearing Does (name) appear to have difficulty hearing? (uses hearing aid, hears with difficulty, completely deaf?) Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. --- Do not mention the probing questions unless the respondent cannot answer the first question. De jure children aged 2-14 1 Yes 2 No 9 Missing Understands Understands Understands Understands Understands When you tell (name) to do something, does he/she seem to understand what you are saying? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. De jure children aged 2-14 1 Yes 2 No 9 Missing Difficulty walking Difficulty walking Difficulty walking Difficulty walking Difficulty walking Does (name) have difficulty in walking or moving his/her arms or does he/she have weakness and/or stiffness in the arms or legs? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. De jure children aged 2-14 1 Yes 2 No 9 Missing Fits, rigid or lose conciousness Fits, rigid or lose conciousness Fits, rigid or lose conciousness Fits, rigid or lose conciousness Fits, rigid or lose conciousness Does (name) sometimes have fits, become rigid, or lose consciousness? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. De jure children aged 2-14 1 Yes 2 No 9 Missing Learns like other children Learns like other children Learns like other children Learns like other children Learns like other children Does (name) learn to do things like other children his/her age? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. De jure children aged 2-14 1 Yes 2 No 9 Missing Speaks Speaks Speaks Speaks Speaks Does (name) speak at all (can he/she make him or herself understood in words; can say any recognizable words)? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. --- If needed, use the additional probing questions in parentheses, replacing he/she with the appropriate pronoun. De jure children aged 2-14 1 Yes 2 No 9 Missing Speech different Speech different Speech different Speech different Speech different For 3-9 year olds: Is (name)'s speech in any way different from normal (not clear enough to be understood by people other than the immediate family)? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. --- This question should be asked only for children aged 3-9 years (children age 2 should not be asked this question). Check Household Listing, HL5, for the child's age. If the child is 2 years of age, leave the question blank. If needed, use the additional probing questions in parentheses. De jure children aged 2-14 1 Yes 2 No 9 Missing Names objects Names objects Names objects Names objects Names objects For 2 year olds: Can (name) name at least one object (for example, an animal, a toy, a cup, a spoon)? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. --- This question should be asked only for children age 2. Check Household Listing, HL5, for the child's age. If the child is 3-9 years old, leave the question blank. If needed, use the additional probing questions in parentheses. De jure children aged 2-14 1 Yes 2 No 9 Missing Mentally backward Mentally backward Mentally backward Mentally backward Mentally backward Compared with other children of the same age, does (name) appear in any way mentally backward, dull or slow? Circle '1' for 'Yes' and '2' for 'No' for all questions in this module. Insert the child's name in the question. Read out the entire question as it is written. --- This question should be asked about each child listed in this module (that is, each child age 2 through 9). De jure children aged 2-14 1 Yes 2 No 9 Missing Interviewer number Interviewer number Interviewer number Interviewer number Interviewer number Interviewer name and number: Enter your own name and identification number provided to you at the time of training. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor name and number: Enter your supervisor's name and identification number. You will be provided with your supervisor's identification number as soon as you know who you will be working with. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Day of interview Day of interview Day of interview Day of interview Day of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Month of interview Month of interview Month of interview Month of interview Month of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Year of interview Year of interview Year of interview Year of interview Year of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Area Area Area Area Area Area: Circle the code for area of residence as instructed by your supervisor. This will have been pre-determined; you will not be required to assess whether the household is in an urban or rural area. Households 1 Rural 2 Urban (Municipality) 3 Urban non-slum (Metro city) 4 Urban slum 5 Tribal Region Region Region Region Region Region: Circle the code for region. Households 1 Barisal 2 Chittagong 3 Dhaka 4 Khulna 5 Rajshahi 6 Sylhet District District District District District 1 Bagerhat 3 Bandarban 4 Barguna 6 Barisal 9 Bhola 10 Bogra 12 Brahmanbaria 13 Chandpur 15 Chittagong 18 Chuadanga 19 Comilla 22 Cox's Bazar 26 Dhaka 27 Dinajpur 29 Faridpur 30 Feni 32 Gaibandha 33 Gazipur 35 Gopalganj 36 Habiganj 38 Joypurhat 39 Jamalpur 41 Jessore 42 Jhalokati 44 Jhenaidah 46 Khagrachhari 47 Khulna 48 Kishorganj 49 Kurigram 50 Kushtia 51 Lakshmipur 52 Lalmonirhat 54 Madaripur 55 Magura 56 Manikganj 57 Meherpur 58 Maulvibazar 59 Munshiganj 61 Mymensingh 64 Naogaon 65 Narail 67 Narayanganj 68 Narsingdi 69 Natore 70 Nawabganj 72 Netrakona 73 Nilphamari 75 Noakhali 76 Pabna 77 Panchagarh 78 Patuakhali 79 Pirojpur 81 Rajshahi 82 Rajbari 84 Rangamati 85 Rangpur 86 Shariatpur 87 Satkhira 88 Sirajganj 89 Sherpur 90 Sunamganj 91 Sylhet 93 Tangail 94 Thakurgaon Sub-district Sub-district Sub-district Sub-district Sub-district Result of HH interview Result of HH interview Result of HH interview Result of HH interview Result of HH interview After all questionnaires for the household have been completed, fill in the following information: Result of HH interview: If the Household Questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the household after repeated visits, circle '2' for 'Not at home'. If the household refuses to be interviewed, circle '3' for 'Refused'. If you are unable to locate the household or if the dwelling is destroyed, circle '4' for 'HH not found/destroyed'. If you have not been able to complete the Household Questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Some examples of 'Other' codes might be: the household respondent is incapacitated; the questionnaire is partly completed; adult household members were not found at home after repeated visits. Households 1 Completed 2 Not at home 3 Refused 4 HH not found/destroyed 6 Other Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent to HH questionnaire: Enter the name and line number (from the Household Listing, columns HL1 and HL2) of the respondent to the Household Questionnaire. Households 99 Missing Number of household members Number of household members Number of household members Number of household members Number of household members Total number of household members: Count the number of household members recorded in column HL1 of the Household Listing and enter the total here. Households Total eligible women Total eligible women Total eligible women Total eligible women Total eligible women No.of women eligible for interview: Enter the total number of women eligible for interview for the Questionnaire for Individual Women - you will copy this from the row for totals at the bottom of the Household Listing, for HL6. Households Women interviews completed Women interviews completed Women interviews completed Women interviews completed Women interviews completed No.of women questionnaires completed: Once all of the Questionnaires for Individual Women have been completed for a particular household, enter the number completed here. Households Total children under 5 Total children under 5 Total children under 5 Total children under 5 Total children under 5 No.of children under age 5: Enter the total number of children under five eligible for inclusion in the survey from the row for totals at the bottom of the Household Listing, for HL8. You will be using the Questionnaire for Children Under Five to interview the mothers or primary caretakers of these children. Households Child interviews completed Child interviews completed Child interviews completed Child interviews completed Child interviews completed No.of under-5 questionnaires completed: Once all of the Questionnaires for Children Under Five have been completed for a particular household, enter the number completed here. Households Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk: Leave this space blank. The data clerk will enter his/her number in the space provided. Households 1 Rokan Mia 3 Jharna Datta 4 Rina 5 Ripon 6 Foysal 7 Shakil 8 Anwar 9 Ratan 10 Shahinul Islam 11 Moniruzzaman 12 Nazimuddin 13 Hafiz Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water What is the main source of drinking water for members of your household? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- Circle the code for the most usual source. If several sources are mentioned, probe to determine the most usual source. If the source varies by season, record the source for the season of the interview. Note that the next question is only asked if the response to this question is 'Bottled water'. You should skip WS2 if the response to WS1 is other than 'Bottled water'. If the response is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise, skip to WS3. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 91 Bottled water 96 Other 99 Missing Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat What is the main source of water used by your household for other purposes such as cooking and handwashing? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- This question should only be asked to households that use 'Bottled water' for drinking. Circle the code for the most usual source. If the source varies by season, record the source for the season of the interview. If the most usual source of non-drinking water is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise continue to the next question. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 96 Other 99 Missing Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back How long does it take to go there, get water, and come back? This question is used to find out how convenient the source of water is to the dwelling. Note that the question is asked for water sources coded as '13-81' and '96' in WS1, or water sources coded as '13-96' in WS2. Fill in the estimated time (in minutes, converting from hours, if necessary) it takes by the usual mode of transport to get to the water source, wait to get water, and get back to the dwelling. Use zero(s) preceding the number if less than 100 minutes (for example, '060' or '005'). Then continue to the next question. If the water source is on the dwelling premises or if water is delivered to the dwelling by a vendor, circle '995' for 'Water on premises' and skip to WS5. If the respondent does not know how long it takes, circle '998' and continue on to the next question. Households 995 On premises 998 DK 999 Missing Person fetching water Person fetching water Person fetching water Person fetching water Person fetching water Who usually goes to this source to fetch the water for your household? Probe: Is this person under age 15? What sex? Circle code that best describes this person. The purpose of this question is to find out the age and gender of the person who usually performs the task of hauling water. This will provide an understanding of whether water hauling responsibilities are given to members of a particular sex or age group. Probe: "IS THIS PERSON UNDER AGE 15? WHAT SEX IS THIS PERSON?" Circle the code that corresponds with the response or '8' if the respondent does not know. Adult refers to anyone age 15 or over, regardless of whether he/she is a household member. Child refers to anyone under the age of 15, regardless of whether he/she is a household member. Households 1 Adult woman 2 Adult man 3 Female child (under 15) 4 Male child (under 15) 8 DK 9 Missing Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Do you treat your water in any way to make it safer to drink? The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle '1' if 'Yes', and continue to the next question. If 'No' or 'DK' (Doesn't know'), circle '2' or '8', respectively, and skip to WS7. Households 1 Yes 2 No 8 DK 9 Missing Boil Boil Boil Boil Boil What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing A Boil Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing B Add bleach/chlorine Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing C Strain it through a cloth Use water filter Use water filter Use water filter Use water filter Use water filter What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing D Use water filter Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing F Let it stand and settle Alum Alum Alum Alum Alum ? Missing G Alum Other Other Other Other Other What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing X Other DK DK DK DK DK What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing Z DK Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water 1 Yes 2 No 9 Missing Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body ? Missing A Black, white or red spot in body Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough ? Missing B Hand and feet become rough Legs swells up Legs swells up Legs swells up Legs swells up Legs swells up ? Missing C Legs swells up Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs ? Missing D Losing the feelings of hand and legs Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg ? Missing E Sore over hand and leg Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW ? Missing A Using water from arsenic free TW Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water ? Missing B Using boiled pond/river/canal water Using rain water Using rain water Using rain water Using rain water Using rain water ? Missing C Using rain water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water ? Missing D Using pond/sand filter water Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter ? Missing E Using SIDKO filter Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic 1 Not tested 2 Tested/marked red 3 Tested/marked green 9 Missing Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility What kind of toilet facility do members of your household usually use? If "flush" or "pour flush", probe: Where does it flush to? If necessary, ask permission to observe the facility. Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of this question is to obtain a measure of the cleanliness of the sanitary facility used by the household members. It may be necessary to observe the facility. If so, ask permission to do so. If the respondent answers or it is observed that the household members have no facilities or use the bush or field, enter '95' for 'No facilities or bush or field' and skip to the next module. If any of the flush or pour flush responses (11-15) are given, probe: "WHERE DOES IT FLUSH TO?" Circle the code corresponding to the response given. Definitions of various types of toilet facilities are as follows: A flush toilet uses a cistern or holding tank for flushing water and has a water seal, which is a U-shaped pipe, below the seat or squatting pan that prevents the passage of flies and odours. A pour flush toilet uses a water seal, but unlike a flush toilet, a pour flush toilet uses water poured by hand for flushing (no cistern is used). . '11' - A piped sewer system is a system of sewer pipes, also called sewerage, that is designed to collect human excreta (faeces and urine) and wastewater and remove them from the household environment. Sewerage systems consist of facilities for collection, pumping, treating and disposing of human excreta and wastewater. . '12' - A septic tank is an excreta collection device and is a water-tight settling tank normally located underground, away from the house or toilet. . '13' - A flush/pour flush to pit latrine refers to a system that flushes excreta to a hole in the ground. . '14' - A flush/pour flush to somewhere else refers to excreta being deposited in or nearby the household environment (not into pit, septic tank or sewer); excreta may be flushed to the street, yard/plot, drainage way or other location. . '15' - Flush to unknown place/not sure/DK where should be coded in cases when the respondent knows that the toilet facility is a flush toilet, but does not know where it flushes to. '21' - A ventilated improved pit latrine or VIP is a type of pit latrine that is ventilated by a pipe extending above the latrine roof. The open end of the vent pipe is covered with gauze mesh or fly-proof netting and the inside of the superstructure is kept dark. '22' - A pit latrine with slab uses a hole in the ground for excreta collection and has a squatting slab, platform or seat that is firmly supported on all sides, easy to clean and raised above the surrounding ground level to prevent surface water from entering the pit. '23' - A pit latrine without slab uses a hole in the ground for excreta collection and does not have a squatting slab, platform or seat. An open pit is a rudimentary hole in the ground where excreta is collected. '31' - A composting toilet is a toilet into which excreta and carbon-rich material are added (vegetable wastes, straw, grass, sawdust, ash) and special conditions maintained to produce inoffensive compost. '41' - Bucket refers to the use of a bucket or other container for the retention of faeces (and sometimes urine and anal cleaning material), which is periodically removed for treatment or disposal. '51' - A hanging toilet or hanging latrine is a toilet built over the sea, a river, or other body of water into which excreta drops directly. '95' - No facilities or bush or field includes excreta wrapped and thrown with garbage, the 'cat' method of burying excreta in dirt, defecation in the bush or field or ditch, and defecation into surface water (drainage channel, beach, river, stream or sea). Households 11 Flush to piped sewer system 12 Flush to septic tank 13 Flush to pit (latrine) 14 Flush to somewhere else 15 Flush to unknown place/not sure/DK where 22 Pit latrine with slab 23 Pit latrine without slab/open pit 41 Bucket 51 Hanging toilet/hanging latrine 95 No facilities or bush or field 96 Other 99 Missing Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Do you share this facility with other households? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- Circle the code corresponding to the response given. If 'No', go to the next module. Households 1 Yes 2 No 9 Missing Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility How many households in total use this toilet facility? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- The total number of households using this facility should include the household being interviewed. If less than ten households use this toilet facility, enter the number of households on the line provided. Circle '10' if ten or more households use this toilet facility. Note that '01' is not a valid response (since it means that this is the only this household that uses the facility; if that is the case, you should go back to WS8 and correct the response there). Circle '98' for 'DK' ('Doesn't know'). Households 10 Ten or more households 98 DK 99 Missing Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication 1 Only water 2 Water and soil 3 Water and ash 4 Water and soap 6 Others 9 Missing Religion Religion Religion Religion Religion What is the religion of the head of this household? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Islam 2 Hindu 3 Christian 4 Buddist 6 Others 7 No religion 9 Missing Ethnicity Ethnicity Ethnicity Ethnicity Ethnicity To what ethnic group does the head of this household belong? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Bangali 2 Chakma 3 Saontal 4 Marma 5 Tripura 6 Others 7 Garo 9 Missing Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping How many rooms in this household are used for sleeping? This information provides a measure of how crowded the house is, and reflects the socio-economic condition of the household. A room in this case refers to a special area with a permanent partition that is used for sleeping. It is not necessarily the number of rooms in the household that are called 'bedrooms', but rather how many rooms get used for sleeping on a regular basis. Exclude rooms that are used only for sleeping by visitors to the household, but include those rooms that may not be regular 'bedrooms' but may be regularly used by one or more of the household members for sleeping. Enter the number of rooms in this household that are used for sleeping. Households 99 Missing Main material of floor Main material of floor Main material of floor Main material of floor Main material of floor Main material of the dwelling floor: Record observation. Circle the correct code for the material of the dwelling floor based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the floor, record the main flooring material (the material that covers the largest amount of floor space). Households 11 Earth/sand 21 Wood planks 22 Palm/bamboo 31 Polished wood 33 Ceramic tiles/Mojaic 34 Cement 35 Carpet 96 Other 99 Missing Main material of roof Main material of roof Main material of roof Main material of roof Main material of roof Main material of the roof. Record observation. Circle the correct code for the material of the dwelling roof, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the roof, record the main roofing material (the material that covers the largest amount of roof). Households 12 Thatch/palm leaf 21 Rustic mat/Plastic sheet/Polythine 22 Palm/bamboo 31 Metal 32 Wood 34 Ceramic tiles 35 Cement 96 Other 99 Missing Main material of wall Main material of wall Main material of wall Main material of wall Main material of wall Main material of the walls. Record observation. Circle the correct code for the material of the dwelling walls, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the walls, record the main wall material (the material that covers the largest amount of wall space). Households 12 Cane/palm/trunks/Leaf/Jute stick/Sod 13 Dirt/Mud 21 Bambo with mud 22 Stone with mud 25 Carton/Tin sheet 31 Cement 33 Bricks 96 Other 99 Missing Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking What type of fuel does your household mainly use for cooking? Information on the type of fuel used for cooking is collected as another measure of the socio-economic status of the household. The use of some cooking fuels can also have adverse health consequences. Circle the code corresponding to the answer given. Remember that this question asks about fuel for cooking, not fuel for heating or lighting. If the household uses more than one fuel for cooking, find out which type of fuel is used most often. If electricity, liquid propane gas (LPG), natural gas, or biogas is mainly used, circle '01', '02', '03', or '04', respectively, and skip to HC8. If any fuel other than the pre-coded ones is reported as being the main fuel used for cooking, circle '96' and specify the type of fuel on the line provided. Definitions of some of the types of fuel are as follows: 'Biogas' includes gases produced by fermenting manure in an enclosed pit. 'Lignite' is a derivative of coal that produces more smoke when burned but produces less heat than coal. Households 1 Electricity 2 Liquid propane gas (LPG) 3 Natural gas 4 Biogas 5 Kerosene 8 Wood 9 Straw/shrubs/grass 10 Animal dung 11 Agricultural crop residue 96 Other 99 Missing Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire In this household, is food cooked on an open fire, an open stove or a closed stove? Probe for type. Probe for type of stove and circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '96' and specify the type of stove on the line provided. For 'Closed stove', skip the next question and ask HC8. Households 1 Open fire 2 Open stove 3 Closed stove 6 Other 9 Missing Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire/stove have a chimney or a hood? Circle the appropriate response. Households 1 Yes 2 No 9 Missing Cooking location Cooking location Cooking location Cooking location Cooking location Is the cooking usually done in the house, in a separate building, or outdoors? Circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '6' and specify on the line provided. Households 1 In the house 2 In a separate bulding 3 Outdoors 6 Other 9 Missing Electricity Electricity Electricity Electricity Electricity Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Radio Radio Radio Radio Radio Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Television Television Television Television Television Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Mobile phone Mobile phone Mobile phone Mobile phone Mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Refrigerator Refrigerator Refrigerator Refrigerator Refrigerator Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Electric fan Electric fan Electric fan Electric fan Electric fan 1 Yes 2 No 9 Missing Computer Computer Computer Computer Computer 1 Yes 2 No 9 Missing AC AC AC AC AC 1 Yes 2 No 9 Missing Washing machine Washing machine Washing machine Washing machine Washing machine 1 Yes 2 No 9 Missing Watch Watch Watch Watch Watch Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Bicycle Bicycle Bicycle Bicycle Bicycle Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Car or truck Car or truck Car or truck Car or truck Car or truck Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Boat with a motor Boat with a motor Boat with a motor Boat with a motor Boat with a motor Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Sofa Sofa Sofa Sofa Sofa 1 Yes 2 No 9 Missing Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van 1 Yes 2 No 9 Missing Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured 1 Yes 2 No 9 Missing Fall_Boy Fall_Boy Fall_Boy Fall_Boy Fall_Boy 9 Missing Fall_Girl Fall_Girl Fall_Girl Fall_Girl Fall_Girl 9 Missing Burn_Boy Burn_Boy Burn_Boy Burn_Boy Burn_Boy 9 Missing Burn_Girl Burn_Girl Burn_Girl Burn_Girl Burn_Girl 9 Missing Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy 9 Missing Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl 9 Missing Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy 9 Missing Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl 9 Missing Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy 9 Missing Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl 9 Missing Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy 9 Missing Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl 9 Missing Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy 9 Missing Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl 9 Missing Other_Boy Other_Boy Other_Boy Other_Boy Other_Boy 9 Missing Other_Girl Other_Girl Other_Girl Other_Girl Other_Girl 9 Missing Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy 9 Missing Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl 9 Missing Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy 9 Missing Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl 9 Missing Died_Boy Died_Boy Died_Boy Died_Boy Died_Boy 9 Missing Died_Girl Died_Girl Died_Girl Died_Girl Died_Girl 9 Missing Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household 1 No Marriage 2 Registered 3 Not registered 8 DK Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year 99 Missing Own or rent Own or rent Own or rent Own or rent Own or rent 1 Own 2 Rent 3 Rentfree/squatter/other 9 Missing Have title deed Have title deed Have title deed Have title deed Have title deed 1 Yes 2 No 9 Missing Certificate of occupation Certificate of occupation Certificate of occupation Certificate of occupation Certificate of occupation ? Missing A Certificate of occupation (or adjudication certificate) Property tax certification Property tax certification Property tax certification Property tax certification Property tax certification ? Missing B Property tax certification Utility bills Utility bills Utility bills Utility bills Utility bills ? Missing C Utility bills Other Other Other Other Other ? Missing X Other None/no document None/no document None/no document None/no document None/no document ? Missing Y None/No document Written rental contract Written rental contract Written rental contract Written rental contract Written rental contract 1 Yes 2 No 9 Missing Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) ? Missing A Informal agreement (written) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) ? Missing B Verbal agreement (no document) Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner Occupied rent free with knowledge of owner ? Missing C Occupied rent free with knowledge of the owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner Occupied rent free without knowledge of owner ? Missing D Occupied rent free without knowledge of the owner Other Other Other Other Other ? Missing X Other None/no document None/no document None/no document None/no document None/no document ? Missing Y None/No document Feel secure from eviction Feel secure from eviction Feel secure from eviction Feel secure from eviction Feel secure from eviction 1 Yes 2 No 8 DK 9 Missing Evicted during past 5 years Evicted during past 5 years Evicted during past 5 years Evicted during past 5 years Evicted during past 5 years 1 Yes 2 No 9 Missing Landslide area Landslide area Landslide area Landslide area Landslide area ? Missing A Landslide area Flood-prone area Flood-prone area Flood-prone area Flood-prone area Flood-prone area ? Missing B Flood-prone area River bank River bank River bank River bank River bank ? Missing C River bank Steep hill Steep hill Steep hill Steep hill Steep hill ? Missing D Steep hill Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile ? Missing E Garbage mountain/pile Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area ? Missing F Industrial pollution area Railroad Railroad Railroad Railroad Railroad ? Missing G Railroad None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Cracks/openings in the wall Cracks/openings in the wall Cracks/openings in the wall Cracks/openings in the wall Cracks/openings in the wall ? Missing A Cracks/openings in walls No windows No windows No windows No windows No windows ? Missing B No windows Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass ? Missing C Windows with broken glass/no glass Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof ? Missing D Visible holes in the roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof ? Missing E Incomplete roof Insecure door Insecure door Insecure door Insecure door Insecure door ? Missing F Insecure door Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) ? Missing G Squartter (Jhupri) None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Narrow passages Narrow passages Narrow passages Narrow passages Narrow passages ? Missing A Very narrow passage between house intead of road Too many power cables Too many power cables Too many power cables Too many power cables Too many power cables ? Missing B Too many power cables connecting to neighborhood's None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Stratum Stratum Stratum Stratum Stratum 1 Barisal city corporation 2 Chittagong city corporation 3 Dhaka city corporation 4 Khulna city corporation 5 Rajshahi city corporation 6 Sylhet city corporation 7 Chittagong slum 8 Dhaka slum 9 Chittagong tribal 10 Dhaka tribal 11 Rajshahi tribal 12 Barguna 13 Barisal 14 Bhola 15 Jhalokati 16 Patuakhali 17 Pirojpur 18 Bandarban 19 Brahmanbaria 20 Chandpur 21 Chittagong 22 Comilla 23 Coxs Bazar 24 Feni 25 Khagrachhari 26 Lakshmipur 27 Noakhali 28 Rangamati 29 Dhaka 30 Faridpur 31 Gazipur 32 Gopalganj 33 Jamalpur 34 Kishorganj 35 Madaripur 36 Manikganj 37 Munshiganj 38 Mymensingh 39 Narayanganj 40 Narsingdi 41 Netrakona 42 Rajbari 43 Shariatpur 44 Sherpur 45 Tangail 46 Bagerhat 47 Chuadanga 48 Jessore 49 Jhenaidah 50 Khulna 51 Kushtia 52 Magura 53 Meherpur 54 Narail 55 Satkhira 56 Bogra 57 Dinajpur 58 Gaibandha 59 Joypurhat 60 Kurigram 61 Lalmonirhat 62 Naogaon 63 Natore 64 Nawabganj 65 Nilphamari 66 Pabna 67 Panchagarh 68 Rajshahi 69 Rangpur 70 Sirajganj 71 Thakurgaon 72 Habiganj 73 Maulvibazar 74 Sunamganj 75 Sylhet Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Recoded variable De jure household members (usual residents) Wealth index score Wealth index score Wealth index score Wealth index score Wealth index score Recoded variable Children aged 0-4 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Recoded variable Children aged 0-4 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Mother's line number Mother's line number Mother's line number Mother's line number Mother's line number Recoded variable De jure household members (usual residents) Mother's education Mother's education Mother's education Mother's education Mother's education Recoded variable Children aged 0-4 1 None 2 Primary incomplete 3 Primary completed 4 Secondary incomplete 5 Secondary completed or higher 6 Non-standard curriculum 7 Mother not in household 9 Missing/DK Mother's education Mother's education Mother's education Mother's education Mother's education 1 None 2 Primary 3 Secondary + 4 Non-standard curriculum 5 Mother not in household 9 Missing/DK Father's line number Father's line number Father's line number Father's line number Father's line number Recoded variable De jure household members (usual residents) Father's education Father's education Father's education Father's education Father's education Recoded variable De jure household members (usual residents) 1 None 2 Primary incomplete 3 Primary completed 4 Secondary incomplete 5 Secondary completed or higher 6 Non-standard curriculum 7 Father not in household 9 Missing/DK Father's education Father's education Father's education Father's education Father's education 1 None 2 Primary 3 Secondary + 4 Non-standard curriculum 5 Father not in household 9 Missing/DK Education of household head Education of household head Education of household head Education of household head Education of household head Recoded variable De jure household members (usual residents) 1 None 2 Primary incomplete 3 Primary completed 4 Secondary incomplete 5 Secondary completed or higher 6 Non-standard curriculum 9 Missing/DK Education of household head Education of household head Education of household head Education of household head Education of household head 1 None 2 Primary 3 Secondary + 4 Non-standard curriculum 9 Missing/DK Cluster number Cluster number Cluster number Cluster number Cluster number We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. During this time I would like to speak with the household head and all mothers or others who take care of children in the household. May I start now? If permission is given, begin the interview. Cluster number: Enter the cluster number as instructed by your supervisor. Households Unique identifier for the cluster in which the household exists Household number Household number Household number Household number Household number Household number: Enter the household number as instructed by your supervisor. Households Houshold number within the cluster Line number Line number Line number Line number Line number Child's line number: Children aged 0-4 Cluster number Cluster number Cluster number Cluster number Cluster number Cluster number: Enter the cluster number from the Household Questionnaire, question HH1. Women aged 15-49 Household number Household number Household number Household number Household number Household number: Enter the household number from the Household Questionnaire, question HH2. Women aged 15-49 Woman's line number Woman's line number Woman's line number Woman's line number Woman's line number Woman's Line Number: Enter the woman's line number from the Household Questionnaire, column HL1 of the Household Listing. Women aged 15-49 Interviewer number Interviewer number Interviewer number Interviewer number Interviewer number Interviewer name and number: Enter your own name and identifying number. You will be provided with these identification numbers at the time of training. Women aged 15-49 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Day of interview Day of interview Day of interview Day of interview Day of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household to interview the woman again, revise and enter the final date of interview. In other words, the date here should be the date when you have either completed the woman's questionnaire, or when the interview has not been conducted but it has been decided that there will be no more attempts to interview the eligible woman. Women aged 15-49 Month of interview Month of interview Month of interview Month of interview Month of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household to interview the woman again, revise and enter the final date of interview. In other words, the date here should be the date when you have either completed the woman's questionnaire, or when the interview has not been conducted but it has been decided that there will be no more attempts to interview the eligible woman. Women aged 15-49 Year of interview Year of interview Year of interview Year of interview Year of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household to interview the woman again, revise and enter the final date of interview. In other words, the date here should be the date when you have either completed the woman's questionnaire, or when the interview has not been conducted but it has been decided that there will be no more attempts to interview the eligible woman. Women aged 15-49 Result of women 's interview Result of women 's interview Result of women 's interview Result of women 's interview Result of women 's interview Result of women's interview Complete this question once you have concluded the interview with the woman. Circle the code corresponding to the result of the interview. If the questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the woman after repeated visits, circle '2' for 'Not at home'. If the woman refuses to be interviewed, circle '3' for 'Refused'. If you were able to only partly complete the questionnaire, circle '4' for 'Partly completed'. If the woman is incapacitated, circle '5'. If you have not been able to complete this questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Make every attempt to carry out the woman's interview in privacy. Ask all other household members or anyone else who is present (including male members of the survey team) to leave in a courteous manner. If the respondent is a mother/caretaker, ask her to collect all the birth certificates and health/ immunization cards she has for her children or the children she cares for before you begin the interview. You will need these when you go on to interview her about her children under age five. Repeat greeting if not already read to this woman: "WE ARE FROM (country-specific affiliation). WE ARE WORKING ON A PROJECT CONCERNED WITH FAMILY HEALTH AND EDUCATION. I WOULD LIKE TO TALK TO YOU ABOUT THIS. THE INTERVIEW WILL TAKE ABOUT (number) MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND YOUR ANSWERS WILL NEVER BE IDENTIFIED. ALSO, YOU ARE NOT OBLIGED TO ANSWER ANY QUESTION YOU DON'T WANT TO, AND YOU MAY WITHDRAW FROM THE INTERVIEW AT ANY TIME. MAY I START NOW?" As with the similar sentence at the beginning of the Household Questionnaire, you may change the wording of these introductory sentences as appropriate. You must make sure, however, to include the following when you are introducing yourself: The name of the implementing agency; the topic of the survey; approximate duration of the interview; the issue of confidentiality; and with whom you would like to speak. If permission is given, begin the interview. If the respondent does not agree to continue, thank her and go on to the next interview. Later, discuss the refusal with your supervisor; you or another person from the team may attempt to interview the woman for a second time. This will depend on your description of the refusal. However, remember that a woman's participation in the survey must be on a voluntary basis, and potential respondents must never be forced to participate. Women aged 15-49 1 Completed 2 Not at home 3 Refused 4 Partly completed 5 Incapacitated 6 Other Month of birth of woman Month of birth of woman Month of birth of woman Month of birth of woman Month of birth of woman Repeat greeting if not already read to this woman: We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don't want to, and you may withdraw from the interview at any time. May I start now? If permission is given, begin the interview. If the woman does not agree to continue, thank her, complete WM7, and go to the next interview. Discuss this result with your supervisor for a future revisit. In what month and year were you born? Age (WM8 or WM9) is one of the most important questions in the interview, since almost all analysis of the data depends on the respondent's age. This question must be asked independently of the information on the Household Questionnaire. Even if you already asked the respondent her age when you were completing the Household Questionnaire, you must ask again for her date of birth and age on the Questionnaire for Individual Women. --- If the respondent knows her date of birth, write it in the appropriate spaces for 'Month' and 'Year'. You will need to convert the month into numbers. For this, January is '01', February is '02', March is '03', etc. If the month or day contains only one digit, use a leading zero to fill in the first space. For example, the month of March is coded as '03'. If she does not know her month of birth, circle '98' for 'DK month' and ask her for the year of her birth. If she knows the year, write it in the spaces for 'Year'. Try under all circumstances to obtain at least the year of birth. If the respondent is unable to provide this information, ask whether she has any documentation such as an identification card, horoscope, or a birth or baptismal certificate that might give her date of birth. If such documentation is available, ask the woman if the information on the document(s) is correct. Only when it is absolutely impossible to even estimate the year of birth should you circle '9998' for 'DK year'. Women aged 15-49 97 Inconsistent 98 DK 99 Missing Year of birth of woman Year of birth of woman Year of birth of woman Year of birth of woman Year of birth of woman Repeat greeting if not already read to this woman: We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don't want to, and you may withdraw from the interview at any time. May I start now? If permission is given, begin the interview. If the woman does not agree to continue, thank her, complete WM7, and go to the next interview. Discuss this result with your supervisor for a future revisit. In what month and year were you born? Age (WM8 or WM9) is one of the most important questions in the interview, since almost all analysis of the data depends on the respondent's age. This question must be asked independently of the information on the Household Questionnaire. Even if you already asked the respondent her age when you were completing the Household Questionnaire, you must ask again for her date of birth and age on the Questionnaire for Individual Women. --- If the respondent knows her date of birth, write it in the appropriate spaces for 'Month' and 'Year'. You will need to convert the month into numbers. For this, January is '01', February is '02', March is '03', etc. If the month or day contains only one digit, use a leading zero to fill in the first space. For example, the month of March is coded as '03'. If she does not know her month of birth, circle '98' for 'DK month' and ask her for the year of her birth. If she knows the year, write it in the spaces for 'Year'. Try under all circumstances to obtain at least the year of birth. If the respondent is unable to provide this information, ask whether she has any documentation such as an identification card, horoscope, or a birth or baptismal certificate that might give her date of birth. If such documentation is available, ask the woman if the information on the document(s) is correct. Only when it is absolutely impossible to even estimate the year of birth should you circle '9998' for 'DK year'. Women aged 15-49 9998 DK Age of woman Age of woman Age of woman Age of woman Age of woman How old were you at your last birthday? Age (WM8 or WM9) is one of the most important questions in the interview, since almost all analysis of the data depends on the respondent's age. This question must be asked independently of the information on the Household Questionnaire. Even if you already asked the respondent her age when you were completing the Household Questionnaire, you must ask again for her date of birth and age on the Questionnaire for Individual Women. --- Enter her age in completed years, that is, her age at her last birthday. If she knows her age, write it in the space provided. If she does not know the answer to either of these two questions, probe for clues that might indicate her age. Ask how old she was when she was first married or first gave birth. Try to find out how long ago she got married or had her first child. (You may be able to find out the age of her oldest child if the child is still living. You may be able to relate her age to someone else in the household whose age is known. You may be able to determine her age based on how old she was when an important event occurred, and the number of years that have elapsed since.) You MUST fill in this information. Do not leave this blank. Finally, before moving on to the next question, verify that the respondent is indeed eligible. If the woman is younger than 15 or older than 49, you have to terminate the interview. Do this tactfully by asking two or three more questions and then thank the respondent for her cooperation; write 'INELIGIBLE' on the cover page of the questionnaire, and correct the age and eligibility information for this woman on the cover page and in Columns HL5 and HL6 of the Household Questionnaire. Women aged 15-49 Marital status of women Marital status of women Marital status of women Marital status of women Marital status of women 1 Unmarried 2 Married 3 Divorced 4 Seperated 5 Widow Have you ever attended school Have you ever attended school Have you ever attended school Have you ever attended school Have you ever attended school Have you ever attended school? Questions WM10-WM14 are about the educational attainment and literacy of the woman. Note that you will have collected some of this information on the woman in the Education module of the Household Questionnaire, either from another household member or from the woman herself. You should still ask these questions. You will be collecting slightly different information with these questions. --- Circle the code corresponding to the response given. If 'No', skip to WM14. Otherwise, continue on to the next question. The term 'school' includes primary, secondary and post-secondary schooling, as well as any other intermediate levels of schooling in the formal school system. It also includes technical or vocational training beyond the primary-school level, such as long-term courses in mechanics or secretarial work. Schools that carry out non-standard curriculum are also included here. Ensure that the woman understands what is meant by 'non-standard curriculum'. A non-standard curriculum includes religious schools, such as Koranic schools, that do not teach a full, standard school curriculum. If a school teaches religious courses but also includes the standard curriculum - such as many Catholic schools - it would be coded as a standard school. Women aged 15-49 1 Yes 2 No 9 Missing What is the highest level of school you attended What is the highest level of school you attended What is the highest level of school you attended What is the highest level of school you attended What is the highest level of school you attended What is the highest level of school you attended: primary, secondary, or higher? Questions WM10-WM14 are about the educational attainment and literacy of the woman. Note that you will have collected some of this information on the woman in the Education module of the Household Questionnaire, either from another household member or from the woman herself. You should still ask these questions. You will be collecting slightly different information with these questions. --- Circle the code corresponding to the highest level ever attended, regardless of whether or not the year was completed. For example, if she attended Form/Year 1 of secondary school for only 2 weeks, record 'Secondary'. Women aged 15-49 Pre-school 1 Primary 2 Secondary (High school) 3 Higher Secondary(College/uneversity) 6 Non-standard curriculum 9 Missing What is the highest grade completed at that level What is the highest grade completed at that level What is the highest grade completed at that level What is the highest grade completed at that level What is the highest grade completed at that level What is the highest grade you completed at that level? Questions WM10-WM14 are about the educational attainment and literacy of the woman. Note that you will have collected some of this information on the woman in the Education module of the Household Questionnaire, either from another household member or from the woman herself. You should still ask these questions. You will be collecting slightly different information with these questions. --- For this question, record the number of years that the respondent successfully completed at that level recorded in WM11. For example, if a woman was attending grade 3 of secondary school and left school before completing that year, record '02'. Although grade 3 was the highest year she attended, she completed 2 years of secondary school. If less than 1 year, record '00' for completed years. For example, if she attended only 2 weeks of grade 1 of secondary school, record '00' for completed years. Women aged 15-49 97 Inconsistent 98 DK 99 Missing Can read part of the sentence Can read part of the sentence Can read part of the sentence Can read part of the sentence Can read part of the sentence Check WM11: Secondary or higher. Go to Next Module Primary or non-standard curriculum. Continue with WM14 Now I would like you to read this sentence to me. Show sentences to respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me? Example sentences for literacy test: 1. The child is reading a book. 2. The rains came late this year. 3. Parents must care for their children. 4. Farming is hard work Questions WM10-WM14 are about the educational attainment and literacy of the woman. Note that you will have collected some of this information on the woman in the Education module of the Household Questionnaire, either from another household member or from the woman herself. You should still ask these questions. You will be collecting slightly different information with these questions. --- If the respondent attended secondary school or a higher level, check the corresponding box and go to the next module. If the highest level the respondent attended was primary school, check the appropriate box and continue to WM14. To ascertain whether women are literate or not, you will be showing women you interview cards with pre-printed sentences on them, and asking women to read them. Note that this question will be asked only to women who have not attended school, or did not attend school beyond the primary level. We assume that women who have attended secondary school or higher are literate. However, it is also known that some women who have attended or even completed primary school may be functionally illiterate. Therefore, we need to ask this question to such women. Based on your knowledge of the respondent, choose the card with the language in which the respondent is likely to be able to read if she is literate. Show the first sentence on the card to the respondent. Give the respondent enough time to read the sentence; do not rush her. If the respondent cannot read the whole sentence, probe: "CAN YOU READ PART OF THE SENTENCE TO ME?" Record whether the respondent was not able to read the sentence at all, was able to read only parts of the sentence, or was able to read the whole sentence. If the respondent asks for the sentences in another language and you were provided a card with sentences in that language, show the respondent the appropriate card. If there is no card with sentences in the language required, circle '4', and specify the language. If the respondent is blind/mute or visually/speech impaired, circle '5'. It is important to avoid the problem of having other respondents in the household overhear the sentence being read. Subsequent respondents in the household might be able to repeat the sentence when they are interviewed, even if they are unable to read. If there is a second eligible woman in the household, show her the second sentence on the card. Show the third respondent the third sentence on the card, and the fourth respondent the fourth sentence. If there are more than five respondents, start again with the first sentence on the card. Women aged 15-49 1 Cannot read at all 2 Able to read only parts of sentence 3 Able to read whole sentence 4 No sentence in required language 5 Blind/visually impaired 9 Missing Ever given birth Ever given birth Ever given birth Ever given birth Ever given birth Now i would like to ask about all the births you have had during your life. Have you ever given birth? If "No" probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life - even if he or she lived only a few minutes or hours? This module is to be administered to all eligible women age 15-49. All questions refer only to live births. These questions are used to collect information about all births the woman has ever had (including births from earlier marriages). The answers are used to estimate childhood mortality rates. It is important that the respondent understands which events to include in these reports. We want to know about all of the woman's natural births, even if the child no longer lives with her and even if the child is no longer alive. We want to know about children who were born alive - ever breathed or cried or showed other signs of life - even if they lived only a few minutes or hours. We do not want you to record any stillbirths (children who were born dead), or miscarriages, or children adopted by the woman, or children of her present husband born to another wife (to whom the respondent herself did not give birth). The first question of the module is used to determine if the rest of the module and several subsequent modules should be administered to this woman. If the answer is 'Yes', circle '1', and continue with the next question. If the woman says she has never given birth, read out the probe to make sure the woman understands the meaning of 'birth', as described during your training. Explain:" I MEAN, TO A CHILD WHO EVER BREATHED OR CRIED OR SHOWED OTHER SIGNS OF LIFE - EVEN IF HE OR SHE LIVED ONLY A FEW MINUTES OR HOURS?" If her answer is still 'No', skip directly to the Marriage/Union module. Women aged 15-49 1 Yes 2 No Day of last birth Day of last birth Day of last birth Day of last birth Day of last birth Of these (total number) births you have had, when did you deliver the last one (even if he or she has died)? If day is not known, enter '98' in space for day. This question is used to ascertain the woman's eligibility for the subsequent two modules. Enter the date of the woman's most recent birth, even if the child is no longer alive, in the space provided. If the child has died, take special care when referring to this child by name in the following modules. If the woman does not remember the day of birth, you may enter '98' to the space provided for 'Day'. Note that you MUST obtain exact information on the month and year of the last birth; '98' is not allowed for month and year. Women aged 15-49 97 Inconsistent 98 DK 99 Missing Month of last birth Month of last birth Month of last birth Month of last birth Month of last birth Of these (total number) births you have had, when did you deliver the last one (even if he or she has died)? This question is used to ascertain the woman's eligibility for the subsequent two modules. Enter the date of the woman's most recent birth, even if the child is no longer alive, in the space provided. If the child has died, take special care when referring to this child by name in the following modules. If the woman does not remember the day of birth, you may enter '98' to the space provided for 'Day'. Note that you MUST obtain exact information on the month and year of the last birth; '98' is not allowed for month and year. Women aged 15-49 97 Inconsistent 98 DK 99 Missing Year of last birth Year of last birth Year of last birth Year of last birth Year of last birth Of these (total number) births you have had, when did you deliver the last one (even if he or she has died)? This question is used to ascertain the woman's eligibility for the subsequent two modules. Enter the date of the woman's most recent birth, even if the child is no longer alive, in the space provided. If the child has died, take special care when referring to this child by name in the following modules. If the woman does not remember the day of birth, you may enter '98' to the space provided for 'Day'. Note that you MUST obtain exact information on the month and year of the last birth; '98' is not allowed for month and year. Women aged 15-49 9997 Inconsistent 9998 DK 9999 Missing Live birth in last 2 years Live birth in last 2 years Live birth in last 2 years Live birth in last 2 years Live birth in last 2 years Check CM11: Did the woman's last birth occur within the last 2 years, that is, since (day and month of interview in 2003)? If child has died, take special care when referring to this child by name in the following modules. No live birth in last 2 years. Go to MARRIAGE/UNION module. Yes, live birth in last 2 years. Continue with CM13 Name of child_______________________ If the respondent's last birth occurred in the last 2 years, enter the name of the child on the line provided and check the box marked 'Yes'. Then continue with CM13. If the respondent's last birth did not occur in the last 2 years, check the box marked 'No' and go to the Marriage/Union module. Women aged 15-49 N No Y Yes Tetanus toxoid card Tetanus toxoid card Tetanus toxoid card Tetanus toxoid card Tetanus toxoid card This module is to be administered to all women with a live birth in the 2 years preceding date of interview. Do you have a card or other document with your own immunizations listed? If a card is presented, use it to assist with answers to the following questions. This module is to be administered to all women who have had a live birth in the 2 years preceding the date of the interview. If the woman has had no live births during the 2 years preceding the interview, you should leave this module blank and skip to the next module. The purpose of this module is to obtain information about protection from tetanus for infants through vaccination of their mothers. Neonatal tetanus is easily prevented if a woman receives the immunization while she is pregnant with the baby, or receives several vaccinations against it at an appropriate interval before the birth. Ask these questions, even if the most recent baby is no longer alive. --- First, ask whether she has a vaccination card or other documentary evidence of vaccination. Ask to see this evidence and record that you have seen it by circling '1'. If a card is presented, use it to assist with answers to the following questions. If the woman says she has a card but does not/cannot show it to you, circle '2'. If the card is not available ('2' or '3' circled in TT1), you must try to find out how long ago the last tetanus toxoid (TT) dose was received, and the total number of TT doses the mother has received in her lifetime. Use the probing questions, and record her answers in the spaces provided. Women who do not have immunization cards may have difficulty identifying whether injections they received were tetanus toxoid injections. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes (card seen) 2 Yes (card not seen) 3 No 8 DK 9 Missing Tetanus toxoid given in pregnancy Tetanus toxoid given in pregnancy Tetanus toxoid given in pregnancy Tetanus toxoid given in pregnancy Tetanus toxoid given in pregnancy When you were pregnant with your last child, did you receive any injection to prevent him or her from getting tetanus, that is convulsions after birth (an anti-tetanus shot, an injection at the top of the arm or shoulder)? Ask if she received any tetanus toxoid injection during her last pregnancy. Circle '1' for a 'Yes' response. If the answer is 'No' or 'DK', circle the code corresponding to the response and skip to TT5. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 8 DK 9 Missing Times given tetanus toxoid in pregnancy Times given tetanus toxoid in pregnancy Times given tetanus toxoid in pregnancy Times given tetanus toxoid in pregnancy Times given tetanus toxoid in pregnancy If yes: How many times did you receive this anti-tetanus injection during your last pregnancy? How many TT doses during last pregnancy were reported in TT3? At least two TT injections during last pregnancy. Go to Next Module Fewer than two TT injections during last pregnancy. Continue with TT5 Enter the number of doses she reports in the space provided and continue to TT4. If she does not know, circle '98' and skip to TT5. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 8 DK 9 Missing Given tetanus toxoid before pregnancy Given tetanus toxoid before pregnancy Given tetanus toxoid before pregnancy Given tetanus toxoid before pregnancy Given tetanus toxoid before pregnancy Did you receive any tetanus toxoid injection at any time before your last pregnancy? Check the box corresponding to the number of TT doses during last pregnancy. If she reported at least two TT injections during her last pregnancy, go to the next module. If she reported fewer than two TT injections during her last pregnancy, continue with TT5. --- Circle the code corresponding to her response. If she reports never having received any TT prior to her last pregnancy, or does not know, circle the code corresponding to the answer given and go to the next module. If 'Yes', continue with TT6. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 8 DK 9 Missing Times given tetanus toxoid before pregnancy Times given tetanus toxoid before pregnancy Times given tetanus toxoid before pregnancy Times given tetanus toxoid before pregnancy Times given tetanus toxoid before pregnancy How many times did you receive it? Ask about doses received during or before the next-to-last pregnancy or between pregnancies (at any time before the last pregnancy). Enter her response in the space provided, as in TT3. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 98 DK 99 Missing Month last given tetanus toxoid before pregnancy Month last given tetanus toxoid before pregnancy Month last given tetanus toxoid before pregnancy Month last given tetanus toxoid before pregnancy Month last given tetanus toxoid before pregnancy In what month and year did you receive the last anti-tetanus injection before that last pregnancy? Skip to next module only if year of injection is given. Otherwise, continue with TT8. Ask the mother the month and year in which she received the last dose of TT before her last pregnancy. You will need to convert the month to a number, as done earlier. If she cannot supply the month, circle '98' for 'DK Month'. If she can provide the year, fill in the year in the space provided and skip to the next module. If she does not know the year, circle '9998' and continue to TT8. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 97 Inconsistent 98 DK 99 Missing Year last given tetanus toxoid before pregnancy Year last given tetanus toxoid before pregnancy Year last given tetanus toxoid before pregnancy Year last given tetanus toxoid before pregnancy Year last given tetanus toxoid before pregnancy In what month and year did you receive the last anti-tetanus injection before that last pregnancy? Skip to next module only if year of injection is given. Otherwise, continue with TT8. Ask the mother the month and year in which she received the last dose of TT before her last pregnancy. You will need to convert the month to a number, as done earlier. If she cannot supply the month, circle '98' for 'DK Month'. If she can provide the year, fill in the year in the space provided and skip to the next module. If she does not know the year, circle '9998' and continue to TT8. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 9997 Inconsistent 9998 DK 9999 Missing Years ago last received tetanus toxoid before pregnancy Years ago last received tetanus toxoid before pregnancy Years ago last received tetanus toxoid before pregnancy Years ago last received tetanus toxoid before pregnancy Years ago last received tetanus toxoid before pregnancy How many years ago did you receive the last anti-tetanus injection before that last pregnancy? Ask her to estimate how long ago she received the last dose of TT (the dose before her last pregnancy), and enter her response in years. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 99 Missing Vitamin A dose after last birth Vitamin A dose after last birth Vitamin A dose after last birth Vitamin A dose after last birth Vitamin A dose after last birth This module is to be administered to all women with a live birth in the 2 years preceding date of interview. Check child mortality module CM12 and record name of last-born child here _____________________. Use this child's name in the following questions, where indicated. In the first two months after your last birth [the birth of name], did you receive a Vitamin A dose like this? Show 200,000 IU capsule or dispenser. This module is to be administered to all women who have had a live birth in the 2 years preceding the date of the interview. Check Child Mortality module CM12 and record the name of the last-born child in the space provided. Use this child's name in the following questions, where indicated. If the woman has not had any live births in the 2 years preceding the date of interview, leave this module blank and skip to the next module. The purpose of this module is to obtain information on the health of the mother and newborn child. The module asks about health and care received by the mother during pregnancy and during labour and delivery. We also ask about the weight of the child and breastfeeding at the time of birth. --- Vitamin A given to nursing mothers is transferred to her infant and can improve the health status of both mother and child. The recommended dose for post-partum women is 200,000 International Units (IU). Show the 200,000 IU vitamin A capsule or dispenser you were given to help the respondent remember. Circle the code corresponding to the response. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 8 DK 9 Missing Antenatal care: Doctor Antenatal care: Doctor Antenatal care: Doctor Antenatal care: Doctor Antenatal care: Doctor Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Antenatal care check-ups help to detect problems associated with pregnancy and delivery. All pregnant women should have routine check-ups. This question refers to any antenatal care received during the pregnancy - a check specifically for the pregnancy and not for other reasons. This is a three-part question. First, ask if she saw anyone for antenatal care for this pregnancy. Then, if the woman answers 'Yes', you must ask whom she saw for the check-up. Finally, ask if she saw more than one person and record all persons seen. If you are unsure how to code a person mentioned, write the words used to describe the person in the space provided 'Other' and circle 'X'. If she saw no one for antenatal checks, circle 'Y' and skip to MN7. Doctors, nurses, midwives and auxiliary nurse midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. 'Traditional birth attendants' may be trained or untrained. If the woman gives the name of a health facility, ask her to tell you who she saw there. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing A Doctor Antenatal care: Nurse/midwife Antenatal care: Nurse/midwife Antenatal care: Nurse/midwife Antenatal care: Nurse/midwife Antenatal care: Nurse/midwife Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Antenatal care check-ups help to detect problems associated with pregnancy and delivery. All pregnant women should have routine check-ups. This question refers to any antenatal care received during the pregnancy - a check specifically for the pregnancy and not for other reasons. This is a three-part question. First, ask if she saw anyone for antenatal care for this pregnancy. Then, if the woman answers 'Yes', you must ask whom she saw for the check-up. Finally, ask if she saw more than one person and record all persons seen. If you are unsure how to code a person mentioned, write the words used to describe the person in the space provided 'Other' and circle 'X'. If she saw no one for antenatal checks, circle 'Y' and skip to MN7. Doctors, nurses, midwives and auxiliary nurse midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. 'Traditional birth attendants' may be trained or untrained. If the woman gives the name of a health facility, ask her to tell you who she saw there. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing B Nurse/midwife Antenatal care: Traditional birth attendant Antenatal care: Traditional birth attendant Antenatal care: Traditional birth attendant Antenatal care: Traditional birth attendant Antenatal care: Traditional birth attendant Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Antenatal care check-ups help to detect problems associated with pregnancy and delivery. All pregnant women should have routine check-ups. This question refers to any antenatal care received during the pregnancy - a check specifically for the pregnancy and not for other reasons. This is a three-part question. First, ask if she saw anyone for antenatal care for this pregnancy. Then, if the woman answers 'Yes', you must ask whom she saw for the check-up. Finally, ask if she saw more than one person and record all persons seen. If you are unsure how to code a person mentioned, write the words used to describe the person in the space provided 'Other' and circle 'X'. If she saw no one for antenatal checks, circle 'Y' and skip to MN7. Doctors, nurses, midwives and auxiliary nurse midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. 'Traditional birth attendants' may be trained or untrained. If the woman gives the name of a health facility, ask her to tell you who she saw there. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing F Traditional birth attendant Antenatal care: Community health worker Antenatal care: Community health worker Antenatal care: Community health worker Antenatal care: Community health worker Antenatal care: Community health worker Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Antenatal care check-ups help to detect problems associated with pregnancy and delivery. All pregnant women should have routine check-ups. This question refers to any antenatal care received during the pregnancy - a check specifically for the pregnancy and not for other reasons. This is a three-part question. First, ask if she saw anyone for antenatal care for this pregnancy. Then, if the woman answers 'Yes', you must ask whom she saw for the check-up. Finally, ask if she saw more than one person and record all persons seen. If you are unsure how to code a person mentioned, write the words used to describe the person in the space provided 'Other' and circle 'X'. If she saw no one for antenatal checks, circle 'Y' and skip to MN7. Doctors, nurses, midwives and auxiliary nurse midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. 'Traditional birth attendants' may be trained or untrained. If the woman gives the name of a health facility, ask her to tell you who she saw there. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing G Community health worker (FWA /HA /MA /SACMO Antenatal care: Relative/friend Antenatal care: Relative/friend Antenatal care: Relative/friend Antenatal care: Relative/friend Antenatal care: Relative/friend Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Antenatal care check-ups help to detect problems associated with pregnancy and delivery. All pregnant women should have routine check-ups. This question refers to any antenatal care received during the pregnancy - a check specifically for the pregnancy and not for other reasons. This is a three-part question. First, ask if she saw anyone for antenatal care for this pregnancy. Then, if the woman answers 'Yes', you must ask whom she saw for the check-up. Finally, ask if she saw more than one person and record all persons seen. If you are unsure how to code a person mentioned, write the words used to describe the person in the space provided 'Other' and circle 'X'. If she saw no one for antenatal checks, circle 'Y' and skip to MN7. Doctors, nurses, midwives and auxiliary nurse midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. 'Traditional birth attendants' may be trained or untrained. If the woman gives the name of a health facility, ask her to tell you who she saw there. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing H Relative/friend Antenatal care: Other Antenatal care: Other Antenatal care: Other Antenatal care: Other Antenatal care: Other Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Antenatal care check-ups help to detect problems associated with pregnancy and delivery. All pregnant women should have routine check-ups. This question refers to any antenatal care received during the pregnancy - a check specifically for the pregnancy and not for other reasons. This is a three-part question. First, ask if she saw anyone for antenatal care for this pregnancy. Then, if the woman answers 'Yes', you must ask whom she saw for the check-up. Finally, ask if she saw more than one person and record all persons seen. If you are unsure how to code a person mentioned, write the words used to describe the person in the space provided 'Other' and circle 'X'. If she saw no one for antenatal checks, circle 'Y' and skip to MN7. Doctors, nurses, midwives and auxiliary nurse midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. 'Traditional birth attendants' may be trained or untrained. If the woman gives the name of a health facility, ask her to tell you who she saw there. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing X Other Antenatal care: No one Antenatal care: No one Antenatal care: No one Antenatal care: No one Antenatal care: No one Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Antenatal care check-ups help to detect problems associated with pregnancy and delivery. All pregnant women should have routine check-ups. This question refers to any antenatal care received during the pregnancy - a check specifically for the pregnancy and not for other reasons. This is a three-part question. First, ask if she saw anyone for antenatal care for this pregnancy. Then, if the woman answers 'Yes', you must ask whom she saw for the check-up. Finally, ask if she saw more than one person and record all persons seen. If you are unsure how to code a person mentioned, write the words used to describe the person in the space provided 'Other' and circle 'X'. If she saw no one for antenatal checks, circle 'Y' and skip to MN7. Doctors, nurses, midwives and auxiliary nurse midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications. 'Traditional birth attendants' may be trained or untrained. If the woman gives the name of a health facility, ask her to tell you who she saw there. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing Y No one Weighed Weighed Weighed Weighed Weighed As part of your antenatal care, were any of the following done at least once? Were you weighed? Ask about each procedure and record the response before asking about the next one. Circle '1' for 'Yes', or '2' for 'No' in each case. It may be necessary to explain some of the procedures. We want to know whether each of the procedures listed was performed during any of the antenatal check-ups during her last pregnancy. It does not matter if they were performed only once or more than once, or performed in the same visit or spread over several visits. The question asks for the following procedures: A. WERE YOU WEIGHED? Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 9 Missing Blood pressure measured Blood pressure measured Blood pressure measured Blood pressure measured Blood pressure measured As part of your antenatal care, were any of the following done at least once? Was your blood pressure measured? Ask about each procedure and record the response before asking about the next one. Circle '1' for 'Yes', or '2' for 'No' in each case. It may be necessary to explain some of the procedures. We want to know whether each of the procedures listed was performed during any of the antenatal check-ups during her last pregnancy. It does not matter if they were performed only once or more than once, or performed in the same visit or spread over several visits. The question asks for the following procedures: B. WAS YOUR BLOOD PRESSURE MEASURED? Blood pressure is measured with a medical instrument. A rubber cuff is wrapped around a person's upper arm and is inflated. While slowly releasing air from the cuff, the person measuring the blood pressure listens to the pulsing of the blood vessels with a stethoscope to determine the pressure. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 9 Missing Urine sample Urine sample Urine sample Urine sample Urine sample As part of your antenatal care, were any of the following done at least once? Did you give a urine sample? Ask about each procedure and record the response before asking about the next one. Circle '1' for 'Yes', or '2' for 'No' in each case. It may be necessary to explain some of the procedures. We want to know whether each of the procedures listed was performed during any of the antenatal check-ups during her last pregnancy. It does not matter if they were performed only once or more than once, or performed in the same visit or spread over several visits. The question asks for the following procedures: C. DID YOU GIVE A URINE SAMPLE? Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 9 Missing Blood sample Blood sample Blood sample Blood sample Blood sample As part of your antenatal care, were any of the following done at least once? Did you give a blood sample? Ask about each procedure and record the response before asking about the next one. Circle '1' for 'Yes', or '2' for 'No' in each case. It may be necessary to explain some of the procedures. We want to know whether each of the procedures listed was performed during any of the antenatal check-ups during her last pregnancy. It does not matter if they were performed only once or more than once, or performed in the same visit or spread over several visits. The question asks for the following procedures: D. DID YOU GIVE A BLOOD SAMPLE? A blood sample may be taken from the woman's fingertip or from a vein (usually from a vein near the elbow or on the wrist). The blood sample is used to test for various diseases, such as anaemia, parasite infestations or infectious diseases. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 9 Missing Counseled about AIDS or the AIDS virus Counseled about AIDS or the AIDS virus Counseled about AIDS or the AIDS virus Counseled about AIDS or the AIDS virus Counseled about AIDS or the AIDS virus During any of the antenatal visits for the pregnancy, were you given any information or counseled about AIDS or the AIDS virus? We want to know if someone spoke with the respondent about AIDS or the AIDS virus during any of her antenatal care visits. This covers topics such as babies getting the AIDS virus, things that you can do to prevent getting the AIDS virus, or getting tests for the AIDS virus. It does not matter whether the topic was discussed only once or more than once, or discussed in one visit or over several visits. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 8 DK 9 Missing Assistance at delivery: Doctor Assistance at delivery: Doctor Assistance at delivery: Doctor Assistance at delivery: Doctor Assistance at delivery: Doctor Who assisted with the delivery of your last child (name)? Anyone else? Probe for the type of person assisting and circle all answers given. When asking this question, be sure to use the name of the child you are referring to, so that there is no confusion. Probe for the type of person who assisted with the delivery. If the woman is not sure of the status of the person who attended the delivery, for example, if she doesn't know whether the attendant was a midwife or a traditional birth attendant, probe further. Circle the codes corresponding to all persons assisting at the delivery. If you are unsure where to code a person mentioned, write it in the space provided 'Other' and circle 'X'. If no one attended the delivery, circle 'Y'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing A Doctor Assistance at delivery: Nurse/midwife Assistance at delivery: Nurse/midwife Assistance at delivery: Nurse/midwife Assistance at delivery: Nurse/midwife Assistance at delivery: Nurse/midwife Who assisted with the delivery of your last child (name)? Anyone else? Probe for the type of person assisting and circle all answers given. When asking this question, be sure to use the name of the child you are referring to, so that there is no confusion. Probe for the type of person who assisted with the delivery. If the woman is not sure of the status of the person who attended the delivery, for example, if she doesn't know whether the attendant was a midwife or a traditional birth attendant, probe further. Circle the codes corresponding to all persons assisting at the delivery. If you are unsure where to code a person mentioned, write it in the space provided 'Other' and circle 'X'. If no one attended the delivery, circle 'Y'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing B Nurse/midwife Assistance at delivery: Traditional birth attendant Assistance at delivery: Traditional birth attendant Assistance at delivery: Traditional birth attendant Assistance at delivery: Traditional birth attendant Assistance at delivery: Traditional birth attendant Who assisted with the delivery of your last child (name)? Anyone else? Probe for the type of person assisting and circle all answers given. When asking this question, be sure to use the name of the child you are referring to, so that there is no confusion. Probe for the type of person who assisted with the delivery. If the woman is not sure of the status of the person who attended the delivery, for example, if she doesn't know whether the attendant was a midwife or a traditional birth attendant, probe further. Circle the codes corresponding to all persons assisting at the delivery. If you are unsure where to code a person mentioned, write it in the space provided 'Other' and circle 'X'. If no one attended the delivery, circle 'Y'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing F Assistance at delivery: Traditional birth attendant Assistance at delivery: Community health worker Assistance at delivery: Community health worker Assistance at delivery: Community health worker Assistance at delivery: Community health worker Assistance at delivery: Community health worker Who assisted with the delivery of your last child (name)? Anyone else? Probe for the type of person assisting and circle all answers given. When asking this question, be sure to use the name of the child you are referring to, so that there is no confusion. Probe for the type of person who assisted with the delivery. If the woman is not sure of the status of the person who attended the delivery, for example, if she doesn't know whether the attendant was a midwife or a traditional birth attendant, probe further. Circle the codes corresponding to all persons assisting at the delivery. If you are unsure where to code a person mentioned, write it in the space provided 'Other' and circle 'X'. If no one attended the delivery, circle 'Y'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing G Assistance at delivery: Community health worker (FWA/HA/MA) Assistance at delivery: Relative/friend Assistance at delivery: Relative/friend Assistance at delivery: Relative/friend Assistance at delivery: Relative/friend Assistance at delivery: Relative/friend Who assisted with the delivery of your last child (name)? Anyone else? Probe for the type of person assisting and circle all answers given. When asking this question, be sure to use the name of the child you are referring to, so that there is no confusion. Probe for the type of person who assisted with the delivery. If the woman is not sure of the status of the person who attended the delivery, for example, if she doesn't know whether the attendant was a midwife or a traditional birth attendant, probe further. Circle the codes corresponding to all persons assisting at the delivery. If you are unsure where to code a person mentioned, write it in the space provided 'Other' and circle 'X'. If no one attended the delivery, circle 'Y'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing H Relative/friend Assistance at delivery: Other Assistance at delivery: Other Assistance at delivery: Other Assistance at delivery: Other Assistance at delivery: Other Who assisted with the delivery of your last child (name)? Anyone else? Probe for the type of person assisting and circle all answers given. When asking this question, be sure to use the name of the child you are referring to, so that there is no confusion. Probe for the type of person who assisted with the delivery. If the woman is not sure of the status of the person who attended the delivery, for example, if she doesn't know whether the attendant was a midwife or a traditional birth attendant, probe further. Circle the codes corresponding to all persons assisting at the delivery. If you are unsure where to code a person mentioned, write it in the space provided 'Other' and circle 'X'. If no one attended the delivery, circle 'Y'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing X Other Assistance at delivery: No one Assistance at delivery: No one Assistance at delivery: No one Assistance at delivery: No one Assistance at delivery: No one Who assisted with the delivery of your last child (name)? Anyone else? Probe for the type of person assisting and circle all answers given. When asking this question, be sure to use the name of the child you are referring to, so that there is no confusion. Probe for the type of person who assisted with the delivery. If the woman is not sure of the status of the person who attended the delivery, for example, if she doesn't know whether the attendant was a midwife or a traditional birth attendant, probe further. Circle the codes corresponding to all persons assisting at the delivery. If you are unsure where to code a person mentioned, write it in the space provided 'Other' and circle 'X'. If no one attended the delivery, circle 'Y'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey ? Missing Y No one Place of delivery Place of delivery Place of delivery Place of delivery Place of delivery Where did you give birth to (NAME)? If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. The intent of this question is to identify births delivered in a health facility. If the woman gave birth in a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the place is in the public (run by the government) or private sector. If the place is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle '26'. Similarly, if the place is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle '36'. If the respondent answers that she delivered in another place not listed, write the description of the place in the space provided for 'Other' and circle '96'. Then write the name of the place in the space provided on the questionnaire 'Name of place' and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Places that are not health facilities, other than home, should also be coded as 'Other' and described. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 11 Respondent's home 12 Other home 21 Government hospital/clinic/health center 22 Govt. clinic/health center 26 Other public 31 Private hospital/clinic 32 Private clinic 33 Private maternity home 36 Other private medical 96 Other 99 Missing Size of child at birth Size of child at birth Size of child at birth Size of child at birth Size of child at birth When your last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small? Low-birthweight babies are at higher risk of serious illness or death than other babies. Mothers are asked to give the baby's birthweight, but since some babies are not weighed at birth, a mother's subjective assessment of the baby's size at birth is important. When the information from women who answer these questions is analysed, we can obtain an indication of what women mean by these subjective categories. This information can provide an estimate of the average birthweight. Read the entire question exactly as written before accepting an answer. This is the woman's own opinion about the size of her baby. Even if she knows the child's birthweight, tell her that you want to know her own idea of whether the baby was very large, larger than average, average, smaller than average or very small. If the respondent is unable to tell you, do not try to guess the answer based on the birthweight information or the appearance of the baby; circle '8' for 'DK'. In cases when the woman knows the birthweight of the baby and tells you the exact weight, do not use your judgement to influence her response in MN9. In other words, even if the woman tells you that her baby was smaller than average while the birthweight she is stating is quite large in your opinion, do not probe further to 'correct' the woman's perception of the size of the baby. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Very large 2 Larger than average 3 Average 4 Smaller than average 5 Very small 8 DK 9 Missing Child weighed at birth Child weighed at birth Child weighed at birth Child weighed at birth Child weighed at birth Was (name) weighed at birth? Circle the code corresponding to the response given. If the baby was not weighed at birth or the mother doesn't know, skip to MN12. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 8 DK 9 Missing Weight from card or recall Weight from card or recall Weight from card or recall Weight from card or recall Weight from card or recall How much did (name) weigh? Record weight from health card, if available. Ask the woman to show you her (or the child's) health card, if available. Record the birthweight in kilograms. If the weight is 'From card' or is recorded on another written document (such as a vaccination card, antenatal card or birth certificate), circle '1' and record the weight in the corresponding space. If the birthweight is reported by the mother, but no card or document is available, circle '2' for 'From recall' and record the weight in the corresponding space. Fill in the weight only once. Use zeros to fill in all digits if necessary. For example, if the woman tells you that the baby was 3.5 kilograms at birth; enter the information as '3.500'. Always record the birthweight from the card when possible. If there is no card, and the mother cannot remember the exact weight, record her best estimate. Only circle '99998' for 'DK' if she absolutely cannot remember even the approximate weight. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Card KG. 2 Card Ib. 3 Recall KG. 4 Recall Ib. 7 Inconsistent 8 DK 9 Missing Weight at birth Weight at birth Weight at birth Weight at birth Weight at birth How much did (name) weigh? Record weight from health card, if available. Ask the woman to show you her (or the child's) health card, if available. Record the birthweight in kilograms. If the weight is 'From card' or is recorded on another written document (such as a vaccination card, antenatal card or birth certificate), circle '1' and record the weight in the corresponding space. If the birthweight is reported by the mother, but no card or document is available, circle '2' for 'From recall' and record the weight in the corresponding space. Fill in the weight only once. Use zeros to fill in all digits if necessary. For example, if the woman tells you that the baby was 3.5 kilograms at birth; enter the information as '3.500'. Always record the birthweight from the card when possible. If there is no card, and the mother cannot remember the exact weight, record her best estimate. Only circle '99998' for 'DK' if she absolutely cannot remember even the approximate weight. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 9 Missing 99.998 DK Ever breastfeed Ever breastfeed Ever breastfeed Ever breastfeed Ever breastfeed Did you ever breastfeed (name)? Breastfeeding is important for a child's health and because it prevents pregnancy during the period when the mother is breastfeeding. For this question, it does not matter how long the respondent breastfed the child, only whether or not she ever gave the child the breast, even if the baby died very young. Circle the code corresponding to the response given. If the response is 'No' (she never breastfed the child), go to the next module. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 1 Yes 2 No 9 Missing Time baby put to breast (unit) Time baby put to breast (unit) Time baby put to breast (unit) Time baby put to breast (unit) Time baby put to breast (unit) How long after birth did you first put (name) to the breast? If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days. If the mother reports that the baby was put to the breast immediately after birth, circle '000'. Otherwise, record the time in completed hours or days. If less than 1 hour, circle '1' for 'Hours' and record '00' in the space provided. For example, if the woman said she began breastfeeding within 10 minutes of the birth, circle '1' and record '00' hours. If the mother began breastfeeding within 24 hours of the birth, circle '1' and record the number of hours that passed before the baby was put to the breast. If she began breastfeeding 24 hours or more after the birth, circle '2' and record the number of days. Record in completed number of days. For example, if the baby was first breastfed 30 hours after delivery, circle '2' and record '01' days. If the woman does not know or does not remember how long after birth she put the baby to the breast, circle '998'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey Immediately 1 Hours 2 Days 8 Dk/remember 9 Missing Time baby put to breast (number) Time baby put to breast (number) Time baby put to breast (number) Time baby put to breast (number) Time baby put to breast (number) How long after birth did you first put (name) to the breast? If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days. If the mother reports that the baby was put to the breast immediately after birth, circle '000'. Otherwise, record the time in completed hours or days. If less than 1 hour, circle '1' for 'Hours' and record '00' in the space provided. For example, if the woman said she began breastfeeding within 10 minutes of the birth, circle '1' and record '00' hours. If the mother began breastfeeding within 24 hours of the birth, circle '1' and record the number of hours that passed before the baby was put to the breast. If she began breastfeeding 24 hours or more after the birth, circle '2' and record the number of days. Record in completed number of days. For example, if the baby was first breastfed 30 hours after delivery, circle '2' and record '01' days. If the woman does not know or does not remember how long after birth she put the baby to the breast, circle '998'. Women aged 15-49 who gave birth to a child in the 2 years preceding the survey 98 DK 99 Missing Time first bathe your baby (Unit) Time first bathe your baby (Unit) Time first bathe your baby (Unit) Time first bathe your baby (Unit) Time first bathe your baby (Unit) 1 With in 24 Hours 2 1-3 Days 3 More than 3 days 4 Not bathed 8 Dk/remember 9 Missing Time first bathe your baby INumber) Time first bathe your baby INumber) Time first bathe your baby INumber) Time first bathe your baby INumber) Time first bathe your baby INumber) 98 DK 99 Missing Currently married or living with a man Currently married or living with a man Currently married or living with a man Currently married or living with a man Currently married or living with a man Are you currently married or living together with a man as if married? This module is to be administered to all women aged 15-49 years (including women age 15 and age 49). In the questionnaire and this manual, 'marriage' always refers to both formal and informal unions, such as living together. An informal union is one in which the man and woman live together for some time, intending to have a lasting relationship, but do not have a formal civil or religious ceremony. For example, if a woman went to live with her boyfriend and his family and stayed there for several years, they would be considered 'living together', whether or not they have any children. On the other hand, if a woman has a boyfriend but has never lived with him, she would not be considered in a union. Casual sexual encounters are not included here. --- The options here are currently married, living with a man, or not in union (the woman is neither married nor living with a man). Circle the code corresponding to the respondent's status at the time of the interview. If the woman is currently neither married or in a union, skip to MA3. Women aged 15-49 1 Yes, currently married 3 No Age of husband/partner Age of husband/partner Age of husband/partner Age of husband/partner Age of husband/partner How old was your husband/partner on his last birthday? If she knows the age of her current partner on his last birthday, enter his age in the space provided. If she does not know his age, circle '98'. Skip to MA5, irrespective of the response. Women aged 15-49 98 DK 99 Missing Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once Have you been married or lived with a man only once or more than once? As with MA1, we are interested in formal marriages as well as informal arrangements. If a woman was married or lived with a man and then was widowed, divorced, or separated from her husband or partner and is now either married to or living with someone else, record 'More than once'. If a woman is not currently married or in an informal union but was previously married or living with someone else two or more times, record 'More than once' by circling '2'. If she has married or lived with someone else only once, circle '1.' Note that the question refers to periods of marriage or informal unions, and not to numbers of husbands or partners. If a woman was married to a man and divorced him, and then married the same person again, she should be considered as having married 'More than once'. The same applies to informal unions with the same person. Women aged 15-49 1 Only once 2 More than once 9 Missing Month of first union Month of first union Month of first union Month of first union Month of first union In what month and year did you first marry or start living with a man as if married? If the respondent knows the date that she first married or started living with a man as if married, write it in the appropriate spaces for 'Month' and 'Year'. You will need to convert the month into numbers, as instructed earlier. For example, January is '01,' February is '02,' March is '03,' etc. If she does not recall the date that she first married or started living with a man as if married, ask whether she has any documentation that might give the date. If she does not know or have documentation of the month, circle '98' for 'DK month' and ask her the year that she first married or started living with a man as if married. Enter the year in the space provided. Once again, if she does not know and does not have documentation of the year that she first married or started living with a man as if married, circle '9998' for 'DK year'. Women aged 15-49 97 Inconsistent 98 DK 99 Missing Year of first union Year of first union Year of first union Year of first union Year of first union In what month and year did you first marry or start living with a man as if married? If the respondent knows the date that she first married or started living with a man as if married, write it in the appropriate spaces for 'Month' and 'Year'. You will need to convert the month into numbers, as instructed earlier. For example, January is '01,' February is '02,' March is '03,' etc. If she does not recall the date that she first married or started living with a man as if married, ask whether she has any documentation that might give the date. If she does not know or have documentation of the month, circle '98' for 'DK month' and ask her the year that she first married or started living with a man as if married. Enter the year in the space provided. Once again, if she does not know and does not have documentation of the year that she first married or started living with a man as if married, circle '9998' for 'DK year'. Women aged 15-49 9997 Inconsistent 9998 DK 9999 Missing Age at first union Age at first union Age at first union Age at first union Age at first union Check MA6: Both month and year of marriage/union known? Go to Next Module Either month or year of marriage/union not known? Continue with MA8 How old were you when you started living with your first husband/partner? If both the month and year are known, go to the next module. If either the month or the year is not known, continue to MA8. As with other age questions, if she does not know, probe. For instance, ask how old she was when her first child was born and then ask how long before or after giving birth she began living with her first husband or partner. Do not leave this question blank. Women aged 15-49 97 Inconsistent 98 DK 99 Missing Ever heard of HIV or AIDS Ever heard of HIV or AIDS Ever heard of HIV or AIDS Ever heard of HIV or AIDS Ever heard of HIV or AIDS Now I would like to talk with you about something else. Have you ever heard of the virus HIV or an illness called AIDS? This module is to be administered to all women aged 15-49 years (including woman age 15 and age 49). The purpose of this module is to obtain information to help programme managers and policy makers plan more effective programmes to prevent HIV infection. The questions assess knowledge, attitudes and behaviour related to AIDS transmission, prevention and testing for the virus that causes AIDS. First, questions are asked to estimate the respondent's basic knowledge about HIV transmission and AIDS. This question serves as an introduction and allows us to verify whether a respondent has heard of AIDS. If there is a local term for AIDS, use the local term in addition to 'AIDS'. If a respondent has never heard of the HIV virus or AIDS, go to the next module. Women aged 15-49 1 Yes 2 No 9 Missing Can avoid AIDS by having one unifected partner Can avoid AIDS by having one unifected partner Can avoid AIDS by having one unifected partner Can avoid AIDS by having one unifected partner Can avoid AIDS by having one unifected partner Can people protect themselves from getting infected with the AIDS virus by having one sex partner who is not infected and also has no other partners? The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. --- Women aged 15-49 1 Yes 2 No 8 DK 9 Missing Can get AIDS through supernatural means Can get AIDS through supernatural means Can get AIDS through supernatural means Can get AIDS through supernatural means Can get AIDS through supernatural means Can people get infected with the AIDS virus because of witchcraft or other supernatural means? The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. --- Women aged 15-49 1 Yes 2 No 8 DK 9 Missing Can avoid AIDS by using a condom correctly every time Can avoid AIDS by using a condom correctly every time Can avoid AIDS by using a condom correctly every time Can avoid AIDS by using a condom correctly every time Can avoid AIDS by using a condom correctly every time Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex? The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. --- Women aged 15-49 1 Yes 2 No 8 DK 9 Missing Can get AIDS from mosquito bites Can get AIDS from mosquito bites Can get AIDS from mosquito bites Can get AIDS from mosquito bites Can get AIDS from mosquito bites Can people get the AIDS virus from mosquito bites? The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. --- Women aged 15-49 1 Yes 2 No 8 DK 9 Missing Can get AIDS by sharing food with person with AIDS virus Can get AIDS by sharing food with person with AIDS virus Can get AIDS by sharing food with person with AIDS virus Can get AIDS by sharing food with person with AIDS virus Can get AIDS by sharing food with person with AIDS virus Can people get the AIDS virus by sharing food with a person who has AIDS? The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. --- Women aged 15-49 1 Yes 2 No 8 DK 9 Missing Can get AIDS by injection with needle already used by someon Can get AIDS by injection with needle already used by someon Can get AIDS by injection with needle already used by someon Can get AIDS by injection with needle already used by someon Can get AIDS by injection with needle already used by someon Can people get the AIDS virus by getting injections with a needle that was already used by someone else? The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. --- Women aged 15-49 1 Yes 2 No 8 DK 9 Missing Healthy-looking person can have AIDS Healthy-looking person can have AIDS Healthy-looking person can have AIDS Healthy-looking person can have AIDS Healthy-looking person can have AIDS Is it possible for a healthy-looking person to have the AIDS virus? The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. --- Women aged 15-49 1 Yes 2 No 8 DK 9 Missing AIDS from mother to child during pregnancy AIDS from mother to child during pregnancy AIDS from mother to child during pregnancy AIDS from mother to child during pregnancy AIDS from mother to child during pregnancy Can the AIDS virus be transmitted from a mother to a baby? During pregnancy? An understanding of more in-depth AIDS-related knowledge is obtained with this question, which aims to determine whether the woman knows that a mother who has AIDS can pass on the disease to her baby. Ask each item one at a time and circle the code for the response given. The items ask whether the respondent thinks that a mother with AIDS can transfer the disease to her baby 'During pregnancy', 'During delivery' or 'By breastfeeding' him/her. Circle '1' for 'Yes' and '2' for 'No' for each of the items. If the woman does not know the answer or is unsure, circle '8'. Women aged 15-49 1 Yes 2 No 8 DK 9 Missing AIDS from mother to child at delivery AIDS from mother to child at delivery AIDS from mother to child at delivery AIDS from mother to child at delivery AIDS from mother to child at delivery Can the AIDS virus be transmitted from a mother to a baby? During delivery? An understanding of more in-depth AIDS-related knowledge is obtained with this question, which aims to determine whether the woman knows that a mother who has AIDS can pass on the disease to her baby. Ask each item one at a time and circle the code for the response given. The items ask whether the respondent thinks that a mother with AIDS can transfer the disease to her baby 'During pregnancy', 'During delivery' or 'By breastfeeding' him/her. Circle '1' for 'Yes' and '2' for 'No' for each of the items. If the woman does not know the answer or is unsure, circle '8'. Women aged 15-49 1 Yes 2 No 8 DK 9 Missing AIDS from mother to child through breastmilk AIDS from mother to child through breastmilk AIDS from mother to child through breastmilk AIDS from mother to child through breastmilk AIDS from mother to child through breastmilk Can the AIDS virus be transmitted from a mother to a baby? By breastfeeding? An understanding of more in-depth AIDS-related knowledge is obtained with this question, which aims to determine whether the woman knows that a mother who has AIDS can pass on the disease to her baby. Ask each item one at a time and circle the code for the response given. The items ask whether the respondent thinks that a mother with AIDS can transfer the disease to her baby 'During pregnancy', 'During delivery' or 'By breastfeeding' him/her. Circle '1' for 'Yes' and '2' for 'No' for each of the items. If the woman does not know the answer or is unsure, circle '8'. Women aged 15-49 1 Yes 2 No 8 DK 9 Missing Interviewer number Interviewer number Interviewer number Interviewer number Interviewer number Interviewer name and number: Enter your own name and identification number provided to you at the time of training. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor name and number: Enter your supervisor's name and identification number. You will be provided with your supervisor's identification number as soon as you know who you will be working with. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Day of interview Day of interview Day of interview Day of interview Day of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Month of interview Month of interview Month of interview Month of interview Month of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Year of interview Year of interview Year of interview Year of interview Year of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Area Area Area Area Area Area: Circle the code for area of residence as instructed by your supervisor. This will have been pre-determined; you will not be required to assess whether the household is in an urban or rural area. Households 1 Rural 2 Urban (Municipality) 3 Urban non-slum (Metro city) 4 Urban slum 5 Tribal Region Region Region Region Region Region: Circle the code for region. Households 1 Barisal 2 Chittagong 3 Dhaka 4 Khulna 5 Rajshahi 6 Sylhet District District District District District 1 Bagerhat 3 Bandarban 4 Barguna 6 Barisal 9 Bhola 10 Bogra 12 Brahmanbaria 13 Chandpur 15 Chittagong 18 Chuadanga 19 Comilla 22 Cox's Bazar 26 Dhaka 27 Dinajpur 29 Faridpur 30 Feni 32 Gaibandha 33 Gazipur 35 Gopalganj 36 Habiganj 38 Joypurhat 39 Jamalpur 41 Jessore 42 Jhalokati 44 Jhenaidah 46 Khagrachhari 47 Khulna 48 Kishorganj 49 Kurigram 50 Kushtia 51 Lakshmipur 52 Lalmonirhat 54 Madaripur 55 Magura 56 Manikganj 57 Meherpur 58 Maulvibazar 59 Munshiganj 61 Mymensingh 64 Naogaon 65 Narail 67 Narayanganj 68 Narsingdi 69 Natore 70 Nawabganj 72 Netrakona 73 Nilphamari 75 Noakhali 76 Pabna 77 Panchagarh 78 Patuakhali 79 Pirojpur 81 Rajshahi 82 Rajbari 84 Rangamati 85 Rangpur 86 Shariatpur 87 Satkhira 88 Sirajganj 89 Sherpur 90 Sunamganj 91 Sylhet 93 Tangail 94 Thakurgaon Sub-district Sub-district Sub-district Sub-district Sub-district Result of HH interview Result of HH interview Result of HH interview Result of HH interview Result of HH interview After all questionnaires for the household have been completed, fill in the following information: Result of HH interview: If the Household Questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the household after repeated visits, circle '2' for 'Not at home'. If the household refuses to be interviewed, circle '3' for 'Refused'. If you are unable to locate the household or if the dwelling is destroyed, circle '4' for 'HH not found/destroyed'. If you have not been able to complete the Household Questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Some examples of 'Other' codes might be: the household respondent is incapacitated; the questionnaire is partly completed; adult household members were not found at home after repeated visits. Households 1 Completed 2 Not at home 3 Refused 4 HH not found/destroyed 6 Other Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent to HH questionnaire: Enter the name and line number (from the Household Listing, columns HL1 and HL2) of the respondent to the Household Questionnaire. Households 99 Missing Number of household members Number of household members Number of household members Number of household members Number of household members Total number of household members: Count the number of household members recorded in column HL1 of the Household Listing and enter the total here. Households Total eligible women Total eligible women Total eligible women Total eligible women Total eligible women No.of women eligible for interview: Enter the total number of women eligible for interview for the Questionnaire for Individual Women - you will copy this from the row for totals at the bottom of the Household Listing, for HL6. Households Women interviews completed Women interviews completed Women interviews completed Women interviews completed Women interviews completed No.of women questionnaires completed: Once all of the Questionnaires for Individual Women have been completed for a particular household, enter the number completed here. Households Total children under 5 Total children under 5 Total children under 5 Total children under 5 Total children under 5 No.of children under age 5: Enter the total number of children under five eligible for inclusion in the survey from the row for totals at the bottom of the Household Listing, for HL8. You will be using the Questionnaire for Children Under Five to interview the mothers or primary caretakers of these children. Households Child interviews completed Child interviews completed Child interviews completed Child interviews completed Child interviews completed No.of under-5 questionnaires completed: Once all of the Questionnaires for Children Under Five have been completed for a particular household, enter the number completed here. Households Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk: Leave this space blank. The data clerk will enter his/her number in the space provided. Households 1 Rokan Mia 3 Jharna Datta 4 Rina 5 Ripon 6 Foysal 7 Shakil 8 Anwar 9 Ratan 10 Shahinul Islam 11 Moniruzzaman 12 Nazimuddin 13 Hafiz Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water What is the main source of drinking water for members of your household? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- Circle the code for the most usual source. If several sources are mentioned, probe to determine the most usual source. If the source varies by season, record the source for the season of the interview. Note that the next question is only asked if the response to this question is 'Bottled water'. You should skip WS2 if the response to WS1 is other than 'Bottled water'. If the response is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise, skip to WS3. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 91 Bottled water 96 Other 99 Missing Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat What is the main source of water used by your household for other purposes such as cooking and handwashing? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- This question should only be asked to households that use 'Bottled water' for drinking. Circle the code for the most usual source. If the source varies by season, record the source for the season of the interview. If the most usual source of non-drinking water is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise continue to the next question. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 96 Other 99 Missing Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back How long does it take to go there, get water, and come back? This question is used to find out how convenient the source of water is to the dwelling. Note that the question is asked for water sources coded as '13-81' and '96' in WS1, or water sources coded as '13-96' in WS2. Fill in the estimated time (in minutes, converting from hours, if necessary) it takes by the usual mode of transport to get to the water source, wait to get water, and get back to the dwelling. Use zero(s) preceding the number if less than 100 minutes (for example, '060' or '005'). Then continue to the next question. If the water source is on the dwelling premises or if water is delivered to the dwelling by a vendor, circle '995' for 'Water on premises' and skip to WS5. If the respondent does not know how long it takes, circle '998' and continue on to the next question. Households 995 On premises 998 DK 999 Missing Person fetching water Person fetching water Person fetching water Person fetching water Person fetching water Who usually goes to this source to fetch the water for your household? Probe: Is this person under age 15? What sex? Circle code that best describes this person. The purpose of this question is to find out the age and gender of the person who usually performs the task of hauling water. This will provide an understanding of whether water hauling responsibilities are given to members of a particular sex or age group. Probe: "IS THIS PERSON UNDER AGE 15? WHAT SEX IS THIS PERSON?" Circle the code that corresponds with the response or '8' if the respondent does not know. Adult refers to anyone age 15 or over, regardless of whether he/she is a household member. Child refers to anyone under the age of 15, regardless of whether he/she is a household member. Households 1 Adult woman 2 Adult man 3 Female child (under 15) 4 Male child (under 15) 8 DK 9 Missing Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Do you treat your water in any way to make it safer to drink? The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle '1' if 'Yes', and continue to the next question. If 'No' or 'DK' (Doesn't know'), circle '2' or '8', respectively, and skip to WS7. Households 1 Yes 2 No 8 DK 9 Missing Boil Boil Boil Boil Boil What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing A Boil Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing B Add bleach/chlorine Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing C Strain it through a cloth Use water filter Use water filter Use water filter Use water filter Use water filter What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing D Use water filter Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing F Let it stand and settle Alum Alum Alum Alum Alum ? Missing G Alum Other Other Other Other Other What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing X Other DK DK DK DK DK What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing Z DK Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water 1 Yes 2 No 9 Missing Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body ? Missing A Black, white or red spot in body Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough ? Missing B Hand and feet become rough Legs swells up Legs swells up Legs swells up Legs swells up Legs swells up ? Missing C Legs swells up Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs ? Missing D Losing the feelings of hand and legs Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg ? Missing E Sore over hand and leg Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW ? Missing A Using water from arsenic free TW Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water ? Missing B Using boiled pond/river/canal water Using rain water Using rain water Using rain water Using rain water Using rain water ? Missing C Using rain water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water ? Missing D Using pond/sand filter water Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter ? Missing E Using SIDKO filter Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic 1 Not tested 2 Tested/marked red 3 Tested/marked green 9 Missing Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility What kind of toilet facility do members of your household usually use? If "flush" or "pour flush", probe: Where does it flush to? If necessary, ask permission to observe the facility. Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of this question is to obtain a measure of the cleanliness of the sanitary facility used by the household members. It may be necessary to observe the facility. If so, ask permission to do so. If the respondent answers or it is observed that the household members have no facilities or use the bush or field, enter '95' for 'No facilities or bush or field' and skip to the next module. If any of the flush or pour flush responses (11-15) are given, probe: "WHERE DOES IT FLUSH TO?" Circle the code corresponding to the response given. Definitions of various types of toilet facilities are as follows: A flush toilet uses a cistern or holding tank for flushing water and has a water seal, which is a U-shaped pipe, below the seat or squatting pan that prevents the passage of flies and odours. A pour flush toilet uses a water seal, but unlike a flush toilet, a pour flush toilet uses water poured by hand for flushing (no cistern is used). . '11' - A piped sewer system is a system of sewer pipes, also called sewerage, that is designed to collect human excreta (faeces and urine) and wastewater and remove them from the household environment. Sewerage systems consist of facilities for collection, pumping, treating and disposing of human excreta and wastewater. . '12' - A septic tank is an excreta collection device and is a water-tight settling tank normally located underground, away from the house or toilet. . '13' - A flush/pour flush to pit latrine refers to a system that flushes excreta to a hole in the ground. . '14' - A flush/pour flush to somewhere else refers to excreta being deposited in or nearby the household environment (not into pit, septic tank or sewer); excreta may be flushed to the street, yard/plot, drainage way or other location. . '15' - Flush to unknown place/not sure/DK where should be coded in cases when the respondent knows that the toilet facility is a flush toilet, but does not know where it flushes to. '21' - A ventilated improved pit latrine or VIP is a type of pit latrine that is ventilated by a pipe extending above the latrine roof. The open end of the vent pipe is covered with gauze mesh or fly-proof netting and the inside of the superstructure is kept dark. '22' - A pit latrine with slab uses a hole in the ground for excreta collection and has a squatting slab, platform or seat that is firmly supported on all sides, easy to clean and raised above the surrounding ground level to prevent surface water from entering the pit. '23' - A pit latrine without slab uses a hole in the ground for excreta collection and does not have a squatting slab, platform or seat. An open pit is a rudimentary hole in the ground where excreta is collected. '31' - A composting toilet is a toilet into which excreta and carbon-rich material are added (vegetable wastes, straw, grass, sawdust, ash) and special conditions maintained to produce inoffensive compost. '41' - Bucket refers to the use of a bucket or other container for the retention of faeces (and sometimes urine and anal cleaning material), which is periodically removed for treatment or disposal. '51' - A hanging toilet or hanging latrine is a toilet built over the sea, a river, or other body of water into which excreta drops directly. '95' - No facilities or bush or field includes excreta wrapped and thrown with garbage, the 'cat' method of burying excreta in dirt, defecation in the bush or field or ditch, and defecation into surface water (drainage channel, beach, river, stream or sea). Households 11 Flush to piped sewer system 12 Flush to septic tank 13 Flush to pit (latrine) 14 Flush to somewhere else 15 Flush to unknown place/not sure/DK where 22 Pit latrine with slab 23 Pit latrine without slab/open pit 41 Bucket 51 Hanging toilet/hanging latrine 95 No facilities or bush or field 96 Other 99 Missing Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Do you share this facility with other households? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- Circle the code corresponding to the response given. If 'No', go to the next module. Households 1 Yes 2 No 9 Missing Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility How many households in total use this toilet facility? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- The total number of households using this facility should include the household being interviewed. If less than ten households use this toilet facility, enter the number of households on the line provided. Circle '10' if ten or more households use this toilet facility. Note that '01' is not a valid response (since it means that this is the only this household that uses the facility; if that is the case, you should go back to WS8 and correct the response there). Circle '98' for 'DK' ('Doesn't know'). Households 10 Ten or more households 98 DK 99 Missing Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication 1 Only water 2 Water and soil 3 Water and ash 4 Water and soap 6 Others 9 Missing Religion Religion Religion Religion Religion What is the religion of the head of this household? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Islam 2 Hindu 3 Christian 4 Buddist 6 Others 7 No religion 9 Missing Ethnicity Ethnicity Ethnicity Ethnicity Ethnicity To what ethnic group does the head of this household belong? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Bangali 2 Chakma 3 Saontal 4 Marma 5 Tripura 6 Others 7 Garo 9 Missing Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping How many rooms in this household are used for sleeping? This information provides a measure of how crowded the house is, and reflects the socio-economic condition of the household. A room in this case refers to a special area with a permanent partition that is used for sleeping. It is not necessarily the number of rooms in the household that are called 'bedrooms', but rather how many rooms get used for sleeping on a regular basis. Exclude rooms that are used only for sleeping by visitors to the household, but include those rooms that may not be regular 'bedrooms' but may be regularly used by one or more of the household members for sleeping. Enter the number of rooms in this household that are used for sleeping. Households 99 Missing Main material of floor Main material of floor Main material of floor Main material of floor Main material of floor Main material of the dwelling floor: Record observation. Circle the correct code for the material of the dwelling floor based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the floor, record the main flooring material (the material that covers the largest amount of floor space). Households 11 Earth/sand 21 Wood planks 22 Palm/bamboo 31 Polished wood 33 Ceramic tiles/Mojaic 34 Cement 35 Carpet 96 Other 99 Missing Main material of roof Main material of roof Main material of roof Main material of roof Main material of roof Main material of the roof. Record observation. Circle the correct code for the material of the dwelling roof, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the roof, record the main roofing material (the material that covers the largest amount of roof). Households 12 Thatch/palm leaf 21 Rustic mat/Plastic sheet/Polythine 22 Palm/bamboo 31 Metal 32 Wood 34 Ceramic tiles 35 Cement 96 Other 99 Missing Main material of wall Main material of wall Main material of wall Main material of wall Main material of wall Main material of the walls. Record observation. Circle the correct code for the material of the dwelling walls, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the walls, record the main wall material (the material that covers the largest amount of wall space). Households 12 Cane/palm/trunks/Leaf/Jute stick/Sod 13 Dirt/Mud 21 Bambo with mud 22 Stone with mud 25 Carton/Tin sheet 31 Cement 33 Bricks 96 Other 99 Missing Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking What type of fuel does your household mainly use for cooking? Information on the type of fuel used for cooking is collected as another measure of the socio-economic status of the household. The use of some cooking fuels can also have adverse health consequences. Circle the code corresponding to the answer given. Remember that this question asks about fuel for cooking, not fuel for heating or lighting. If the household uses more than one fuel for cooking, find out which type of fuel is used most often. If electricity, liquid propane gas (LPG), natural gas, or biogas is mainly used, circle '01', '02', '03', or '04', respectively, and skip to HC8. If any fuel other than the pre-coded ones is reported as being the main fuel used for cooking, circle '96' and specify the type of fuel on the line provided. Definitions of some of the types of fuel are as follows: 'Biogas' includes gases produced by fermenting manure in an enclosed pit. 'Lignite' is a derivative of coal that produces more smoke when burned but produces less heat than coal. Households 1 Electricity 2 Liquid propane gas (LPG) 3 Natural gas 4 Biogas 5 Kerosene 8 Wood 9 Straw/shrubs/grass 10 Animal dung 11 Agricultural crop residue 96 Other 99 Missing Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire In this household, is food cooked on an open fire, an open stove or a closed stove? Probe for type. Probe for type of stove and circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '96' and specify the type of stove on the line provided. For 'Closed stove', skip the next question and ask HC8. Households 1 Open fire 2 Open stove 3 Closed stove 6 Other 9 Missing Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire/stove have a chimney or a hood? Circle the appropriate response. Households 1 Yes 2 No 9 Missing Cooking location Cooking location Cooking location Cooking location Cooking location Is the cooking usually done in the house, in a separate building, or outdoors? Circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '6' and specify on the line provided. Households 1 In the house 2 In a separate bulding 3 Outdoors 6 Other 9 Missing Electricity Electricity Electricity Electricity Electricity Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Radio Radio Radio Radio Radio Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Television Television Television Television Television Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Mobile phone Mobile phone Mobile phone Mobile phone Mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Refrigerator Refrigerator Refrigerator Refrigerator Refrigerator Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Electric fan Electric fan Electric fan Electric fan Electric fan 1 Yes 2 No 9 Missing Computer Computer Computer Computer Computer 1 Yes 2 No 9 Missing AC AC AC AC AC 1 Yes 2 No 9 Missing Washing machine Washing machine Washing machine Washing machine Washing machine 1 Yes 2 No 9 Missing Watch Watch Watch Watch Watch Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Bicycle Bicycle Bicycle Bicycle Bicycle Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Car or truck Car or truck Car or truck Car or truck Car or truck Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Boat with a motor Boat with a motor Boat with a motor Boat with a motor Boat with a motor Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Sofa Sofa Sofa Sofa Sofa 1 Yes 2 No 9 Missing Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van 1 Yes 2 No 9 Missing Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured 1 Yes 2 No 9 Missing Fall_Boy Fall_Boy Fall_Boy Fall_Boy Fall_Boy 9 Missing Fall_Girl Fall_Girl Fall_Girl Fall_Girl Fall_Girl 9 Missing Burn_Boy Burn_Boy Burn_Boy Burn_Boy Burn_Boy 9 Missing Burn_Girl Burn_Girl Burn_Girl Burn_Girl Burn_Girl 9 Missing Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy 9 Missing Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl 9 Missing Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy 9 Missing Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl 9 Missing Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy 9 Missing Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl 9 Missing Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy 9 Missing Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl 9 Missing Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy 9 Missing Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl 9 Missing Other_Boy Other_Boy Other_Boy Other_Boy Other_Boy 9 Missing Other_Girl Other_Girl Other_Girl Other_Girl Other_Girl 9 Missing Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy 9 Missing Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl 9 Missing Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy 9 Missing Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl 9 Missing Died_Boy Died_Boy Died_Boy Died_Boy Died_Boy 9 Missing Died_Girl Died_Girl Died_Girl Died_Girl Died_Girl 9 Missing Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household 1 No Marriage 2 Registered 3 Not registered 8 DK Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year 99 Missing Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin 1 Own 2 Rent 3 Rentfree/squatter/other 9 Missing Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th 1 Yes 2 No 9 Missing Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) ? Missing A Certificate of occupation (or adjudication certificate) Property tax certification Property tax certification Property tax certification Property tax certification Property tax certification ? Missing B Property tax certification Utility bills Utility bills Utility bills Utility bills Utility bills ? Missing C Utility bills Other Other Other Other Other ? Missing X Other None/No document None/No document None/No document None/No document None/No document ? Missing Y None/No document Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling 1 Yes 2 No 9 Missing Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) ? Missing A Informal agreement (written) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) ? Missing B Verbal agreement (no document) Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner ? Missing C Occupied rent free with knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner ? Missing D Occupied rent free without knowledge of the owner Other Other Other Other Other ? Missing X Other None/No document None/No document None/No document None/No document None/No document ? Missing Y None/No document Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling 1 Yes 2 No 8 DK 9 Missing Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years 1 Yes 2 No 9 Missing Landslide area Landslide area Landslide area Landslide area Landslide area ? Missing A Landslide area Flood-prone area Flood-prone area Flood-prone area Flood-prone area Flood-prone area ? Missing B Flood-prone area River bank River bank River bank River bank River bank ? Missing C River bank Steep hill Steep hill Steep hill Steep hill Steep hill ? Missing D Steep hill Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile ? Missing E Garbage mountain/pile Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area ? Missing F Industrial pollution area Railroad Railroad Railroad Railroad Railroad ? Missing G Railroad None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Cracks/openings in walls Cracks/openings in walls Cracks/openings in walls Cracks/openings in walls Cracks/openings in walls ? Missing A Cracks/openings in walls No windows No windows No windows No windows No windows ? Missing B No windows Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass ? Missing C Windows with broken glass/no glass Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof ? Missing D Visible holes in the roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof ? Missing E Incomplete roof Insecure door Insecure door Insecure door Insecure door Insecure door ? Missing F Insecure door Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) ? Missing G Squartter (Jhupri) None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Very narrow passage between house intead of road Very narrow passage between house intead of road Very narrow passage between house intead of road Very narrow passage between house intead of road Very narrow passage between house intead of road ? Missing A Very narrow passage between house intead of road Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's ? Missing B Too many power cables connecting to neighborhood's None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Women's sample weight Women's sample weight Women's sample weight Women's sample weight Women's sample weight Recoded variable Women aged 15-49 Wealth index score Wealth index score Wealth index score Wealth index score Wealth index score Recoded variable Children aged 0-4 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Recoded variable Children aged 0-4 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Date of interview women (CMC) Date of interview women (CMC) Date of interview women (CMC) Date of interview women (CMC) Date of interview women (CMC) Recoded variable Women aged 15-49 Date of birth (CMC) Date of birth (CMC) Date of birth (CMC) Date of birth (CMC) Date of birth (CMC) Recoded variable Women aged 15-49 Age Age Age Age Age Recoded variable Women aged 15-49 1 15-19 2 20-24 3 25-29 4 30-34 5 35-39 6 40-44 7 45-49 Age at first marriage/union Age at first marriage/union Age at first marriage/union Age at first marriage/union Age at first marriage/union Recoded variable Women aged 15-49 Marital/Union status Marital/Union status Marital/Union status Marital/Union status Marital/Union status Recoded variable Women aged 15-49 1 Currently married/in union 2 Formerly married/in union 3 Never married/in union Education Education Education Education Education 1 None 2 Primary 3 Secondary + 4 Non-standard curriculum 9 Missing/DK Education Education Education Education Education Recoded variable Children aged 0-4 1 None 2 Primary incomplete 3 Primary completed 4 Secondary incomplete 5 Secondary completed or higher 6 Non-standard curriculum 9 Missing/DK Cluster number Cluster number Cluster number Cluster number Cluster number We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. During this time I would like to speak with the household head and all mothers or others who take care of children in the household. May I start now? If permission is given, begin the interview. Cluster number: Enter the cluster number as instructed by your supervisor. Households Unique identifier for the cluster in which the household exists Household number Household number Household number Household number Household number Household number: Enter the household number as instructed by your supervisor. Households Houshold number within the cluster Line number Line number Line number Line number Line number Child's line number: Children aged 0-4 Cluster number Cluster number Cluster number Cluster number Cluster number Cluster number: Enter the cluster number from the Household Questionnaire, question HH1. Children aged 0-4 Household number Household number Household number Household number Household number Household number: Enter the household number from the Household Questionnaire, question HH2. Children aged 0-4 Child's line number Child's line number Child's line number Child's line number Child's line number Child's line number: Enter the child's line number from the Household Questionnaire, column HL1 of the Household Listing. Children aged 0-4 Caretaker's line number Caretaker's line number Caretaker's line number Caretaker's line number Caretaker's line number Mother's/Caretaker's Line Number: Enter the mother's/primary caretaker's line number from the Household Questionnaire, column HL1 of the Household Listing. Children aged 0-4 Interviewer number Interviewer number Interviewer number Interviewer number Interviewer number Interviewer name and number: Enter your own name and identifying number. You will be provided with these identification numbers during training. Children aged 0-4 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Day of interview Day of interview Day of interview Day of interview Day of interview Day/Month/Year of interview: Enter the date of the interview: day/month/year. If the interview is not completed on your first visit and you visit the household to interview the mother/caretaker again, revise and enter the final date of the interview. In other words, the date here should be the date when you have either completed the Questionnaire for Children Under Five, or when the interview was not conducted but when it was decided that there will be no more attempts to interview the mother or primary caretaker of the under-five child. Children aged 0-4 Month of interview Month of interview Month of interview Month of interview Month of interview Day/Month/Year of interview: Enter the date of the interview: day/month/year. If the interview is not completed on your first visit and you visit the household to interview the mother/caretaker again, revise and enter the final date of the interview. In other words, the date here should be the date when you have either completed the Questionnaire for Children Under Five, or when the interview was not conducted but when it was decided that there will be no more attempts to interview the mother or primary caretaker of the under-five child. Children aged 0-4 Year of interview Year of interview Year of interview Year of interview Year of interview Day/Month/Year of interview: Enter the date of the interview: day/month/year. If the interview is not completed on your first visit and you visit the household to interview the mother/caretaker again, revise and enter the final date of the interview. In other words, the date here should be the date when you have either completed the Questionnaire for Children Under Five, or when the interview was not conducted but when it was decided that there will be no more attempts to interview the mother or primary caretaker of the under-five child. Children aged 0-4 Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for children under 5 Complete this question once you have concluded the interview. Remember that the code refers to the mother or primary caretaker of the under-five child. Circle the code corresponding to the results of the interview. If the questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the mother/primary caretaker after repeated visits, circle '2' for 'Not at home'. If the mother/primary caretaker refuses to be interviewed, circle '3' for 'Refused'. If you were able to only partly complete the questionnaire, circle '4' for 'Partly completed'. If the mother/primary caretaker is incapacitated, circle '5'. If you have not been able to complete this questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Ask the mother/primary caretaker to collect all the birth certificates and health/ immunization cards she has for this child before you begin the interview. You will need these during the interview. Repeat greeting if not already read to this mother/primary caretaker: "WE ARE FROM (country-specific affiliation). WE ARE WORKING ON A PROJECT CONCERNED WITH FAMILY HEALTH AND EDUCATION. I WOULD LIKE TO TALK TO YOU ABOUT THIS. THE INTERVIEW WILL TAKE ABOUT (number) MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND YOUR ANSWERS WILL NEVER BE IDENTIFIED. ALSO, YOU ARE NOT OBLIGED TO ANSWER ANY QUESTION YOU DON'T WANT TO, AND YOU MAY WITHDRAW FROM THE INTERVIEW AT ANY TIME. MAY I START NOW?" As with similar sentences at the beginning of the Household Questionnaire and Questionnaire for Individual Women, you may change the wording of these introductory sentences as appropriate. You must make sure, however, to include the following when you are introducing yourself: The name of the implementing agency; the topic of the survey; the approximate duration of the interview; the issue of confidentiality; and with whom you would like to speak. If permission is given, begin the interview. If the respondent does not agree to continue, thank her/him and go to the next interview. Later, discuss the refusal with your supervisor; you or another person from the team may attempt to interview the respondent for a second time. This will depend on your description of the refusal. However, remember that the respondent's participation in the survey must be on a voluntary basis, and potential respondents must never be forced to participate. Children aged 0-4 1 Completed 2 Not at home 3 Refused 4 Partly completed 5 Incapacitated 6 Other Day of birth of child Day of birth of child Day of birth of child Day of birth of child Day of birth of child Repeat greeting if not already read to this respondent: We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don't want to, and you may withdraw from the interview at any time. May I start now? If permission is given, begin the interview. If the respondent does not agree to continue, thank him/her and go to the next interview. Discuss this result with your supervisor for a future revisit. Now I would like to ask you some questions about the health of each child under the age of 5 in your care, who lives with you now. Now I want to ask you about (NAME). In what month and year was (NAME) born? Probe: What is his/her birthday? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day. You will begin the interview with questions about the child's date of birth and age. These are two of the most important questions in the interview, since almost all analysis of the data depends on the child's exact age. While completed age in years is sufficient for women's interviews, we need to obtain accurate information on the child's age in months. This is necessary because some of the analysis of the information that you will be collecting can only be done on the basis of age in months. You will collect this information by learning the child's date of birth. It will then be possible to compare the date of interview with the date of birth of the child and, after the data is collected, calculate the child's age in months by comparing these two pieces of information. The questions on age and date of birth must be asked independently from similar questions on the Household Questionnaire and Questionnaire for Individual Women. The person you may be interviewing for this questionnaire may be the same woman you interviewed for the Questionnaire for Individual Women, and you may have obtained dates of birth of her children in that questionnaire. Also, you may have obtained the child's age in the Household Questionnaire. Even in such cases, you must ask these questions again. --- Note that you may modify the first sentence based on the number of children in the respondent's care. If this is the only child the respondent cares for, change the sentences to "NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH OF (name). IN WHAT MONTH AND YEAR WAS (name) BORN?" Ask the mother or primary caretaker for the child's date of birth. Probe: "WHAT IS HIS/HER BIRTHDAY?" It is important to record the child's month and year of birth accurately. If the mother/primary caretaker knows the exact birth date, including the day, enter the day of birth. Otherwise, circle '98' for 'DK day'. You do not need to probe further for day of birth. Convert the month to a number as you have done before. Enter the number in the space provided. If the month or day contains only one digit, use a leading zero. For example, the month of March is coded as '03'. Note that you are not allowed to enter DK for month or year of birth. You have to obtain month and year of birth of the child. Since all MICS3 surveys will be conducted in 2005 or 2006, the year of birth of the child cannot be earlier than 2000 (for surveys in 2005) or 2001 (for surveys in 2006). If the mother/primary caretaker is unable to provide the date of birth information, ask whether she/he has any documentation such as an identification card, health card, horoscope, or a birth or baptismal certificate that might give the date of birth of the child. However, confirm with the respondent that the date of birth recorded on such documents is indeed correct. Children aged 0-4 97 Inconsistent 98 DK 99 Missing Month of birth of child Month of birth of child Month of birth of child Month of birth of child Month of birth of child Repeat greeting if not already read to this respondent: We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don't want to, and you may withdraw from the interview at any time. May I start now? If permission is given, begin the interview. If the respondent does not agree to continue, thank him/her and go to the next interview. Discuss this result with your supervisor for a future revisit. Now I would like to ask you some questions about the health of each child under the age of 5 in your care, who lives with you now. Now I want to ask you about (NAME). In what month and year was (NAME) born? Probe: What is his/her birthday? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day. You will begin the interview with questions about the child's date of birth and age. These are two of the most important questions in the interview, since almost all analysis of the data depends on the child's exact age. While completed age in years is sufficient for women's interviews, we need to obtain accurate information on the child's age in months. This is necessary because some of the analysis of the information that you will be collecting can only be done on the basis of age in months. You will collect this information by learning the child's date of birth. It will then be possible to compare the date of interview with the date of birth of the child and, after the data is collected, calculate the child's age in months by comparing these two pieces of information. The questions on age and date of birth must be asked independently from similar questions on the Household Questionnaire and Questionnaire for Individual Women. The person you may be interviewing for this questionnaire may be the same woman you interviewed for the Questionnaire for Individual Women, and you may have obtained dates of birth of her children in that questionnaire. Also, you may have obtained the child's age in the Household Questionnaire. Even in such cases, you must ask these questions again. --- Note that you may modify the first sentence based on the number of children in the respondent's care. If this is the only child the respondent cares for, change the sentences to "NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH OF (name). IN WHAT MONTH AND YEAR WAS (name) BORN?" Ask the mother or primary caretaker for the child's date of birth. Probe: "WHAT IS HIS/HER BIRTHDAY?" It is important to record the child's month and year of birth accurately. If the mother/primary caretaker knows the exact birth date, including the day, enter the day of birth. Otherwise, circle '98' for 'DK day'. You do not need to probe further for day of birth. Convert the month to a number as you have done before. Enter the number in the space provided. If the month or day contains only one digit, use a leading zero. For example, the month of March is coded as '03'. Note that you are not allowed to enter DK for month or year of birth. You have to obtain month and year of birth of the child. Since all MICS3 surveys will be conducted in 2005 or 2006, the year of birth of the child cannot be earlier than 2000 (for surveys in 2005) or 2001 (for surveys in 2006). If the mother/primary caretaker is unable to provide the date of birth information, ask whether she/he has any documentation such as an identification card, health card, horoscope, or a birth or baptismal certificate that might give the date of birth of the child. However, confirm with the respondent that the date of birth recorded on such documents is indeed correct. Children aged 0-4 97 Inconsistent 99 Missing Year of birth of child Year of birth of child Year of birth of child Year of birth of child Year of birth of child Repeat greeting if not already read to this respondent: We are from (COUNTRY-SPECIFIC AFFILIATION). We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about (NUMBER) minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don't want to, and you may withdraw from the interview at any time. May I start now? If permission is given, begin the interview. If the respondent does not agree to continue, thank him/her and go to the next interview. Discuss this result with your supervisor for a future revisit. Now I would like to ask you some questions about the health of each child under the age of 5 in your care, who lives with you now. Now I want to ask you about (NAME). In what month and year was (NAME) born? Probe: What is his/her birthday? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day. You will begin the interview with questions about the child's date of birth and age. These are two of the most important questions in the interview, since almost all analysis of the data depends on the child's exact age. While completed age in years is sufficient for women's interviews, we need to obtain accurate information on the child's age in months. This is necessary because some of the analysis of the information that you will be collecting can only be done on the basis of age in months. You will collect this information by learning the child's date of birth. It will then be possible to compare the date of interview with the date of birth of the child and, after the data is collected, calculate the child's age in months by comparing these two pieces of information. The questions on age and date of birth must be asked independently from similar questions on the Household Questionnaire and Questionnaire for Individual Women. The person you may be interviewing for this questionnaire may be the same woman you interviewed for the Questionnaire for Individual Women, and you may have obtained dates of birth of her children in that questionnaire. Also, you may have obtained the child's age in the Household Questionnaire. Even in such cases, you must ask these questions again. --- Note that you may modify the first sentence based on the number of children in the respondent's care. If this is the only child the respondent cares for, change the sentences to "NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH OF (name). IN WHAT MONTH AND YEAR WAS (name) BORN?" Ask the mother or primary caretaker for the child's date of birth. Probe: "WHAT IS HIS/HER BIRTHDAY?" It is important to record the child's month and year of birth accurately. If the mother/primary caretaker knows the exact birth date, including the day, enter the day of birth. Otherwise, circle '98' for 'DK day'. You do not need to probe further for day of birth. Convert the month to a number as you have done before. Enter the number in the space provided. If the month or day contains only one digit, use a leading zero. For example, the month of March is coded as '03'. Note that you are not allowed to enter DK for month or year of birth. You have to obtain month and year of birth of the child. Since all MICS3 surveys will be conducted in 2005 or 2006, the year of birth of the child cannot be earlier than 2000 (for surveys in 2005) or 2001 (for surveys in 2006). If the mother/primary caretaker is unable to provide the date of birth information, ask whether she/he has any documentation such as an identification card, health card, horoscope, or a birth or baptismal certificate that might give the date of birth of the child. However, confirm with the respondent that the date of birth recorded on such documents is indeed correct. Children aged 0-4 9997 Inconsistent 9999 Missing Age of child Age of child Age of child Age of child Age of child How old was (NAME) at his/her last birthday? Record age in completed years. You will begin the interview with questions about the child's date of birth and age. These are two of the most important questions in the interview, since almost all analysis of the data depends on the child's exact age. While completed age in years is sufficient for women's interviews, we need to obtain accurate information on the child's age in months. This is necessary because some of the analysis of the information that you will be collecting can only be done on the basis of age in months. You will collect this information by learning the child's date of birth. It will then be possible to compare the date of interview with the date of birth of the child and, after the data is collected, calculate the child's age in months by comparing these two pieces of information. The questions on age and date of birth must be asked independently from similar questions on the Household Questionnaire and Questionnaire for Individual Women. The person you may be interviewing for this questionnaire may be the same woman you interviewed for the Questionnaire for Individual Women, and you may have obtained dates of birth of her children in that questionnaire. Also, you may have obtained the child's age in the Household Questionnaire. Even in such cases, you must ask these questions again. --- After having obtained the child's date of birth, ask the child's age in completed years, and record in the space provided. Remember, ages must refer to the last birthday. If the mother/primary caretaker does not know the current age of the child, try asking "HOW MANY YEARS AGO WAS (name) BORN?" You may help the respondent by relating the child's age to that of other children or to some important event or to the season of birth, by asking, for example, "HOW MANY WET SEASONS AGO WAS (name) BORN?" Ask UF10 and UF11 independently. Then, check for consistency between the date of birth and completed age. You have to be meticulous in checking for the consistency between the date of birth and age. You also have to be fairly quick in doing so. A good interviewer will perform the check without causing a lull in the conversation. Checking for consistency between date of birth (UF10) and completed age (UF11). After having obtained both date of birth and age, check for the consistency between the two. The child's age plus her year of birth must equal the year in which the child last had a birthday. Assuming that you were able to obtain a month and year of birth, you should check the consistency by following these steps: If the month of birth is before the month of interview (the child had his/her birthday this year), then her/his age plus her/his year of birth should equal the year of interview. . Example: A child who was born in October 2003, in a survey conducted in November 2005, should be age 2 (2003 + 2 = 2005). If the month of birth is after the month of interview (the child has not had his/her birthday this year), then her/his age plus year of birth should equal the previous year. . Example: A child who was born in December 2003, in a survey conducted in October 2005, should be age 1 (2003 + 1 = 2004). If the month of birth is the same as the month of interview, and the day of birth is not known, then a sum of either the current or the previous year is correct. . Example: A child born in November 2002, in a survey conducted in November 2005, could be age 3 or age 2. Probe further to see if the date of birth is correct and whether the child has completed age 2 or 3. If the month of birth is the same as the month of interview, and the day of birth is known, the sum of age and year of birth should equal the year of interview if the day of birth is before the day of interview, and the sum of age and year of birth should equal the previous year if the day of birth is after the day of interview. . Example: A child born on 8 February 2002, in an interview conducted on 15 February 2006, should be age four. A child born on 28 February 2002, in an interview conducted on 3 February 2006, should be age three, since this child will complete 4 full years on 28 February 2006. If you find that the date of birth and age are inconsistent, either the date of birth or the age, or both, are incorrect, and need to be corrected. Do not assume that one is more accurate than the other. Probe, using documents that may be available, dates of well-known events and ages of other children, of the respondent herself/himself, etc. Children aged 0-4 Age of child in months Age of child in months Age of child in months Age of child in months Age of child in months Child has birth certificate Child has birth certificate Child has birth certificate Child has birth certificate Child has birth certificate Does (name) have a birth certificate? May I see it? This question aims to provide an estimate of the extent of birth registration in your country. Respondents must be assured that the information about individual families will never be given to authorities, and that they cannot be identified in any way. Ask to see the birth certificate. Circle the appropriate corresponding code, noting whether or not the certificate was seen. If the child has a birth certificate and it was seen, circle '1' and skip to BR5. If the child does not have a birth certificate ('3'), or if the child has a birth certificate but the mother/primary caretaker is unable to show you the certificate ('2'), continue to the next question. Children aged 0-4 1 Yes, seen 2 Yes, not seen 3 No 8 DK 9 Missing Child registered Child registered Child registered Child registered Child registered Has (name's) birth been registered with the civil authorities? Circle the code corresponding to the response. If the answer is 'Yes', skip to BR5. If the child's birth has not been registered with civil authorities, continue to the next question. If the answer is 'DK', skip to BR4. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Reason birth not registered Reason birth not registered Reason birth not registered Reason birth not registered Reason birth not registered Why is (name's) birth not registered? This question aims to elicit the reason for non-registration. Circle the code corresponding to the response. Note that although there might be more than one reason for not registering a child, we need to get only one response - the most important one according to the mother/primary caretaker. If the response is definitely not one of the pre-coded responses, circle '6' for 'Other' and specify the response in the space provided. Children aged 0-4 1 Costs too much 2 Must travel too far 3 Did not know it should be registered 5 Does not know where to register 7 Don't feel it necessary 96 Other 98 DK 99 Missing Know how to register birth Know how to register birth Know how to register birth Know how to register birth Know how to register birth Do you know how to register your child's birth? The purpose of this question is to assess how important lack of knowledge (of the process of registering or, if applicable, the place to go to register) may be among the reasons for non-registration. This information can inform advocacy efforts and help in the formulation of education campaigns. Circle the code corresponding to the response. Children aged 0-4 1 Yes 2 No 9 Missing Place of birth registration Place of birth registration Place of birth registration Place of birth registration Place of birth registration 1 City corporation 2 Pourshava 3 Union Parishad 6 Other 8 DK 9 Missing Child attends early childhood education programme Child attends early childhood education programme Child attends early childhood education programme Child attends early childhood education programme Child attends early childhood education programme BR5. Check age of child in UF11: Child is 3 or 4 years old? Yes. Continue with BR6 No. Go to BR8 Does (name) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care? If the child is 3 or 4 years old, check the box marked 'Yes' and continue on to BR6. If not (if the child is 0, 1 or 2 years old), check the box marked 'No' and skip to BR8. --- This question aims to find out if the child is participating in early learning activities. Baby-sitting or child-minding, even if done in a special place such as a day-care centre, does not qualify as such a programme unless it includes organized learning activities. You must ensure that the mother or primary caretaker understands the meaning of 'Early Childhood Education Programme', explaining it as instructed. Circle the appropriate code. Skip to BR8 if the answer to this question is 'No' or 'DK'. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Hours attended education in last 7 days Hours attended education in last 7 days Hours attended education in last 7 days Hours attended education in last 7 days Hours attended education in last 7 days Within the last seven days, about how many hours did (name) attend? This question is asked if the child is attending an early childhood education programme. Record the estimated number of hours the child attended any organized learning or early childhood education programme in the last 7 days. Use a leading zero if necessary. Children aged 0-4 98 DK 99 Missing Books-Mother Books-Mother Books-Mother Books-Mother Books-Mother In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Read books or look at picture books with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing A Mother Books-Father Books-Father Books-Father Books-Father Books-Father In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Read books or look at picture books with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing B Father Books-Other Books-Other Books-Other Books-Other Books-Other In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Read books or look at picture books with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing X Other Books-No one Books-No one Books-No one Books-No one Books-No one In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Read books or look at picture books with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing Y No one Stories-Mother Stories-Mother Stories-Mother Stories-Mother Stories-Mother In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Tell stories to (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing A Mother Stories-Father Stories-Father Stories-Father Stories-Father Stories-Father In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Tell stories to (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing B Father Stories-Other Stories-Other Stories-Other Stories-Other Stories-Other In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Tell stories to (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing X Other Stories-No one Stories-No one Stories-No one Stories-No one Stories-No one In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Tell stories to (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing Y No one Songs-Mother Songs-Mother Songs-Mother Songs-Mother Songs-Mother In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Sing songs with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing A Mother Songs-Father Songs-Father Songs-Father Songs-Father Songs-Father In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Sing songs with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing B Father Songs-Other Songs-Other Songs-Other Songs-Other Songs-Other In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Sing songs with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing X Other Songs-No one Songs-No one Songs-No one Songs-No one Songs-No one In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Sing songs with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing Y No one Outside-Mother Outside-Mother Outside-Mother Outside-Mother Outside-Mother In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Take (name) outside the home, compound, yard or enclosure? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing A Mother Outside-Father Outside-Father Outside-Father Outside-Father Outside-Father In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Take (name) outside the home, compound, yard or enclosure? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing B Father Outside-Other Outside-Other Outside-Other Outside-Other Outside-Other In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Take (name) outside the home, compound, yard or enclosure? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing X Other Outside-No one Outside-No one Outside-No one Outside-No one Outside-No one In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Take (name) outside the home, compound, yard or enclosure? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing Y No one Play-Mother Play-Mother Play-Mother Play-Mother Play-Mother In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Play with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing A Mother Play-Father Play-Father Play-Father Play-Father Play-Father In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Play with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing B Father Play-Other Play-Other Play-Other Play-Other Play-Other In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Play with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing X Other Play-No one Play-No one Play-No one Play-No one Play-No one In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Play with (name)? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing Y No one Naming-Mother Naming-Mother Naming-Mother Naming-Mother Naming-Mother In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Spend time with (name) naming, counting, and/or drawing things? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing A Mother Naming-Father Naming-Father Naming-Father Naming-Father Naming-Father In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Spend time with (name) naming, counting, and/or drawing things? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing B Father Naming-Other Naming-Other Naming-Other Naming-Other Naming-Other In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Spend time with (name) naming, counting, and/or drawing things? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing X Other Naming-No one Naming-No one Naming-No one Naming-No one Naming-No one In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name): If yes, ask: who engaged in this activity with the child - the mother, the child's father or another adult member of the household (including the caretaker/respondent)? Spend time with (name) naming, counting, and/or drawing things? Read each items shown below. If 'No', circle 'Y' and move to the next item on the list. If 'Yes', ask: "WHO ENGAGED IN THIS ACTIVITY WITH THE CHILD - THE MOTHER, THE CHILD'S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT)?" For each activity, circle the code for every person who engaged in the activity with the child before proceeding to the next item. If someone other than the mother or father engaged in the activity with the child, circle 'X'. Note that in a household where there are no adults other than the child's mother and father, 'X' should not be circled. Adults who are not members of the household but who may have engaged in the listed activities with the child should not be coded here. Children aged 0-4 ? Missing Y No one Develop the Intelligence of this child? Develop the Intelligence of this child? Develop the Intelligence of this child? Develop the Intelligence of this child? Develop the Intelligence of this child? 1 Yes 2 No 9 Missing Give warm and responsive care Give warm and responsive care Give warm and responsive care Give warm and responsive care Give warm and responsive care ? Missing A Give warm and responsive care Encourage any participation Encourage any participation Encourage any participation Encourage any participation Encourage any participation ? Missing B Encourage any perticipation Let child play and socialize with others Let child play and socialize with others Let child play and socialize with others Let child play and socialize with others Let child play and socialize with others ? Missing C Let child play and socialize with others Set good example by modeling good behaviors and morals Set good example by modeling good behaviors and morals Set good example by modeling good behaviors and morals Set good example by modeling good behaviors and morals Set good example by modeling good behaviors and morals ? Missing D Set good example by modeling good behaviors and morals Discipline/punish the child physically Discipline/punish the child physically Discipline/punish the child physically Discipline/punish the child physically Discipline/punish the child physically ? Missing E Discipline/punish the child physically Scold the child Scold the child Scold the child Scold the child Scold the child ? Missing F Scold the child Stimulate attachment by providing consistent & responsive ca Stimulate attachment by providing consistent & responsive ca Stimulate attachment by providing consistent & responsive ca Stimulate attachment by providing consistent & responsive ca Stimulate attachment by providing consistent & responsive ca ? Missing G Stimulate attachment by providing consistent & responsive ca Development of learning abilities Development of learning abilities Development of learning abilities Development of learning abilities Development of learning abilities ? Missing H Development of learning abilities Don't Know Don't Know Don't Know Don't Know Don't Know ? Missing X Others Doing anything to prepare to go to school? Doing anything to prepare to go to school? Doing anything to prepare to go to school? Doing anything to prepare to go to school? Doing anything to prepare to go to school? 1 Yes 2 No 9 Missing Develop speaking Develop speaking Develop speaking Develop speaking Develop speaking ? Missing A Develop speaking Develop writing Develop writing Develop writing Develop writing Develop writing ? Missing B Develop writing Follow rules & regulations Follow rules & regulations Follow rules & regulations Follow rules & regulations Follow rules & regulations ? Missing C Follow rules & regulations Sending to school at appropriate age Sending to school at appropriate age Sending to school at appropriate age Sending to school at appropriate age Sending to school at appropriate age ? Missing D Sending to school at appropriate Prepare mentally Prepare mentally Prepare mentally Prepare mentally Prepare mentally ? Missing E Prepare mentally Opportunity for playing Opportunity for playing Opportunity for playing Opportunity for playing Opportunity for playing ? Missing F Opportunity for playing Encourage by comparing other children Encourage by comparing other children Encourage by comparing other children Encourage by comparing other children Encourage by comparing other children ? Missing G Encourage by comparing other children Development of learning abilities Development of learning abilities Development of learning abilities Development of learning abilities Development of learning abilities ? Missing H Development of learning abilities Others Others Others Others Others ? Missing X Others Child ever received vitamin A Child ever received vitamin A Child ever received vitamin A Child ever received vitamin A Child ever received vitamin A Has (name) ever received a vitamin A capsule (supplement) like this one? Show capsule or dispenser for different doses - 100,000 IU for those 6-11 months old, 200,000 IU for those 12-59 months old This question asks if the child has received a vitamin A supplement. Show the capsule or dispenser you were given to help the caretaker remember. You may be instructed to show different capsules, 100,000 IU for children 6-11 months old and 200,000 IU for children 12-59 months old, asking the caretaker to identify the correct one. Circle the code corresponding to the response. If the child has never received a vitamin A supplement or the mother/caretaker does not know if he/she has ever received one, skip to the next module. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Months ago child took last Vitamin A dose Months ago child took last Vitamin A dose Months ago child took last Vitamin A dose Months ago child took last Vitamin A dose Months ago child took last Vitamin A dose How many months ago did (name) take the last dose? If the answer to VA1 was 'Yes', record the number of months ago the last dose was given to the child. As you have done before, use a leading zero if necessary. If the child received the supplement during the 1-month period preceding the interview, record '00'. Circle '98' if the mother/primary caretaker does not know when the child took the last dose. Children aged 0-4 97 Inconsistent 98 DK 99 Missing Place child got last Vitamin A dose Place child got last Vitamin A dose Place child got last Vitamin A dose Place child got last Vitamin A dose Place child got last Vitamin A dose Where did (name) get this last dose? This question is meant to provide information for health programmes about where children are most likely to get their vitamin A dose. Circle the code corresponding to the answer given. If the dose was obtained during a routine visit to a health facility, circle '1'. If the child was taken to a health facility because she/he was sick, and the supplement was obtained during this visit, circle '2'. If vitamin A supplement was given during a National Immunization Campaign, circle '3'. If the supplement was obtained from a source not listed, write the description next to 'Other' and circle '6'. Children aged 0-4 1 On routine visit to health centre 2 Sick child visit to health centre 3 National immunization day campain 4 Vitamin A campaign 6 Other 8 DK 9 Missing Child ever been breastfed Child ever been breastfed Child ever been breastfed Child ever been breastfed Child ever been breastfed Has (name) ever been breastfed? This question asks if the child has ever been breastfed. It includes any breastfeeding experience of the child - not necessarily by the mother/primary caretaker. Circle the code corresponding to the response. Continue to the next question if the child was ever breastfed ('1'). If the child was never breastfed, circle 'No' and skip to BF3. Skip to BF3 in the case of a 'DK' response as well. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Give honey/suger water/mastered oil as pre lactial food Give honey/suger water/mastered oil as pre lactial food Give honey/suger water/mastered oil as pre lactial food Give honey/suger water/mastered oil as pre lactial food Give honey/suger water/mastered oil as pre lactial food 1 Yes 2 No 8 DK 9 Missing Timing of braest feeding after birth (Unit) Timing of braest feeding after birth (Unit) Timing of braest feeding after birth (Unit) Timing of braest feeding after birth (Unit) Timing of braest feeding after birth (Unit) Immediately 1 Hours 2 Days 8 DK 9 Missing Timing of braest feeding after birth (Number) Timing of braest feeding after birth (Number) Timing of braest feeding after birth (Number) Timing of braest feeding after birth (Number) Timing of braest feeding after birth (Number) 98 DK 99 Missing Child still being breastfed Child still being breastfed Child still being breastfed Child still being breastfed Child still being breastfed Is he/she still being breastfed? 'Being breastfed' is defined as putting the child to the breast at least once a day. Circle the code corresponding to the response. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received vitamin, mineral supplements or medicine Child received vitamin, mineral supplements or medicine Child received vitamin, mineral supplements or medicine Child received vitamin, mineral supplements or medicine Child received vitamin, mineral supplements or medicine Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Vitamin, mineral supplements or medicine? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received plain water Child received plain water Child received plain water Child received plain water Child received plain water Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Plain water? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received sweetened water or juice Child received sweetened water or juice Child received sweetened water or juice Child received sweetened water or juice Child received sweetened water or juice Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Sweetened, flavoured water or fruit juice or tea or infusion? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received oral rehydration solution Child received oral rehydration solution Child received oral rehydration solution Child received oral rehydration solution Child received oral rehydration solution Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Oral rehydration solution (ORS)? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received infant formula Child received infant formula Child received infant formula Child received infant formula Child received infant formula Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Infant formula? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received milk Child received milk Child received milk Child received milk Child received milk Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Tinned, powdered or fresh milk? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received other liquids Child received other liquids Child received other liquids Child received other liquids Child received other liquids Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Any other liquids? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child received solid or mushy food Child received solid or mushy food Child received solid or mushy food Child received solid or mushy food Child received solid or mushy food Since this time yesterday, did he/she receive any of the following: Read each item aloud and record response before proceeding to the next item. Solid or semi-solid (mushy) food? This question asks about what the child was fed in the preceding 24 hours. The purpose of this question is to determine what liquids or foods the child was given. Prompt by asking each listed item in turn, such as: "DID (name) RECEIVE VITAMIN OR MINERAL SUPPLEMENTS OR MEDICINE?" or "DID HE/SHE RECEIVE PLAIN WATER?" and so on through the list. Read each item aloud and record the response before proceeding to the next item. Use the local terms for these liquids or foods. Make sure that the respondent understands the question, particularly what is meant by 'since this time yesterday'. Specify to the mother/primary caretaker: mid-morning, mid-afternoon, etc., depending on the time of the interview. Circle the code corresponding to the response. If the mother/primary caretaker does not know the answer, repeat the question using other local words for the fluid or food. If the answer is still not known, circle '8' for 'DK' Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Time ate solid, semisolid or soft food other than liquids Time ate solid, semisolid or soft food other than liquids Time ate solid, semisolid or soft food other than liquids Time ate solid, semisolid or soft food other than liquids Time ate solid, semisolid or soft food other than liquids Check BF3H: Child received solid or semi-solid (mushy) food? Yes. Continue with BF5 No or DK. Go to Next Module Since this time yesterday, how many times did (NAME) eat solid, semisolid, or soft foods other than liquids? If 7 or more times, record '7'. If the child received solid or semi-solid (mushy) food (BF3H=1), check the box marked 'Yes' and continue to the next question. If 'No' or 'DK', check the corresponding box and go to the next module. --- In this question, we want to find out how many times the child was given non-liquid foods in the 24 hours prior to the interview. Record the number of times in the space provided. If the number is seven or more, record '7'. If the respondent does not know, circle '8'. Children aged 0-4 7 7+ 8 DK 9 Missing Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks Has (name) had diarrhoea in the last two weeks, that is, since (day of the week) of the week before last? Diarrhoea is determined as perceived by mother or caretaker, or as three or more loose or watery stools per day, or blood in stool. These questions aim to find out if the child has recently had diarrhoea or any other illness and, if so, what treatments, drinks and foods the child took during the episode. Diarrhoea is determined by the perception of the mother or caretaker, or by three or more loose or watery stools per day, or by blood in stool. When asking this question, insert the name of the day of the interview. For example, if the interview is taking place on a Tuesday, ask: "HAS (name) HAD DIARRHOEA IN THE LAST TWO WEEKS, THAT IS, SINCE TUESDAY OF THE WEEK BEFORE LAST?" Record the mother's/primary caretaker's answer by circling the corresponding code. If a respondent is not sure what is meant by diarrhoea, tell her/him it means "THREE OR MORE LOOSE OR WATERY STOOLS PER DAY, OR BLOOD IN THE STOOL." Make sure the respondent understands what is meant by 'in the last 2 weeks'. If the child has not had diarrhoea in the last 2 weeks or the caretaker doesn't know, skip to CA5. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Drank fluid made from special packet (ORS) Drank fluid made from special packet (ORS) Drank fluid made from special packet (ORS) Drank fluid made from special packet (ORS) Drank fluid made from special packet (ORS) During this last episode of diarrhoea, did (name) drink any of the following: Read each item aloud and record response before proceeding to the next item. A fluid made from a special packet called (local name for ORS packet solution)? We want to know if and what type of oral rehydration solution (ORS) the child took during the last episode of diarrhoea. Ask each question separately: "WAS (name) GIVEN A FLUID MADE FROM A SPECIAL PACKET CALLED (local name for ORS packet solution)? WAS HE/SHE GIVEN GOVERNMENT-RECOMMENDED HOMEMADE FLUID?" and so forth. Read each item aloud and circle the code corresponding to the response before proceeding to the next item. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Government-recommended homemade fluid Government-recommended homemade fluid Government-recommended homemade fluid Government-recommended homemade fluid Government-recommended homemade fluid During this last episode of diarrhoea, did (name) drink any of the following: Read each item aloud and record response before proceeding to the next item. Government-recommended homemade fluid? We want to know if and what type of oral rehydration solution (ORS) the child took during the last episode of diarrhoea. Ask each question separately: "WAS (name) GIVEN A FLUID MADE FROM A SPECIAL PACKET CALLED (local name for ORS packet solution)? WAS HE/SHE GIVEN GOVERNMENT-RECOMMENDED HOMEMADE FLUID?" and so forth. Read each item aloud and circle the code corresponding to the response before proceeding to the next item. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Pre-packaged ORS fluid for diarrhea Pre-packaged ORS fluid for diarrhea Pre-packaged ORS fluid for diarrhea Pre-packaged ORS fluid for diarrhea Pre-packaged ORS fluid for diarrhea During this last episode of diarrhoea, did (name) drink any of the following: Read each item aloud and record response before proceeding to the next item. A pre-packaged ORS fluid for diarrhoea? We want to know if and what type of oral rehydration solution (ORS) the child took during the last episode of diarrhoea. Ask each question separately: "WAS (name) GIVEN A FLUID MADE FROM A SPECIAL PACKET CALLED (local name for ORS packet solution)? WAS HE/SHE GIVEN GOVERNMENT-RECOMMENDED HOMEMADE FLUID?" and so forth. Read each item aloud and circle the code corresponding to the response before proceeding to the next item. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness During (name's) illness, did he/she drink much less, about the same, or more than usual? For those children who had diarrhoea in the past 2 weeks, 'illness' in this and the next question refers to the diarrhoea episode. Disregard any additional illness these children might have had. If dehydrated, a child may take more fluids than usual. We want to know if the pattern of fluid consumption changed during the illness. The focus in this question is on how much fluid was actually consumed by the child. Ask the question just as it is worded here. Read out the entire question and circle the appropriate code for the caretaker's response. Get the respondent's best judgement of the relative amount of total fluids actually consumed by the child. All fluids are included, not just special ones given during diarrhoea. For example, water, tea, fruit juice, breastmilk and formula are included as well as special fluids such as ORS. Try to find out what actually happened, not what the respondent thinks ought to have happened. An answer such as, "A child with diarrhoea (or 'a child who is ill') needs more fluids" is not satisfactory. You would need to ask, "BUT HOW MUCH DID YOUR CHILD ACTUALLY DRINK DURING THIS DIARRHOEA?" It may be difficult to estimate the relative amount of breastmilk taken by the child. The respondent may make an estimate based on whether the child nursed longer or more frequently. Children aged 0-4 1 Much less or none 2 About the same (or somewhat less) 3 More 8 DK 9 Missing Child ate less or more during illness Child ate less or more during illness Child ate less or more during illness Child ate less or more during illness Child ate less or more during illness During (name's) illness, did he/she eat less, about the same, or more food than usual? If "less", probe: Much less or a little less? During an episode of diarrhoea or other illness, a child may change the amount usually eaten. The focus in this question is on how much food was actually consumed by the child. Ask the question just as it is worded here. Read out the entire question and circle the code corresponding to the caretaker's response. Get the caretaker's best judgement of the relative amount of total food actually consumed by the child. Try to find out what actually happened, not what the caretaker thinks ought to have happened. An answer such as, "A child with diarrhoea (or 'a child who is ill') needs more food" is not satisfactory. You would need to ask, "BUT HOW MUCH DID YOUR CHILD ACTUALLY EAT DURING THIS DIARRHOEA?" If the caretaker replies that the child took only fluids (that is, the child did not 'eat'), circle '1' for 'None'. If the caretaker's answer is 'less than usual', probe by asking "MUCH LESS OR A LITTLE LESS?" to find out if she/he thinks the amount was 'much less' or 'somewhat less'. Then circle the appropriate code. If the mother/primary caretaker offered more food than usual, but the child ate much less, the answer is 'much less'; circle '2'. Make sure that the respondent understands that this includes breastmilk, if the child is still being breastfed. If the child is very young and the caretaker replies that he/she takes only fluids or breastmilk (that is, has not started 'eating' yet), there is no need to probe, since 'drinking' and 'eating' count as the same for this child. Circle the answer for this question (eating) that comes closest to the answer you circle for CA3 (drinking). Children aged 0-4 1 None 2 Much less 3 Somewhat less 4 About the same 5 More 8 DK 9 Missing Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks Has (name) had an illness with a cough at any time in the last two weeks, that is, since (day of the week) of the week before last? Illness with a cough means a cold or other acute respiratory illness with a cough. Circle the code corresponding to the response given. If the respondent says "He coughs all the time," or "She's been coughing for months," do not count this as an 'illness with a cough' since it is a chronic problem. If the answer is 'No' or 'DK', circle the appropriate code and go to CA12. If the symptoms started before but continued into the 2-week period, this counts as 'Yes'. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Difficulty breathing during illness with cough Difficulty breathing during illness with cough Difficulty breathing during illness with cough Difficulty breathing during illness with cough Difficulty breathing during illness with cough When (name) had an illness with a cough, did he/she breathe faster than usual with short, quick breaths or have difficulty breathing? The question aims to find out if the child has or had an illness needing assessment by a health professional (as defined by the US Centers for Disease Control/Integrated Management of Childhood Illness programme). If the respondent asks "What do you mean by 'fast breathing'?" you may say "NOTICEABLY FASTER THAN NORMAL WHEN THE CHILD IS RESTED." If the respondent asks "What do you mean by 'difficulty breathing'?" you may say "THE CHILD SOUNDED/LOOKED AS IF HE/SHE WAS HAVING TROUBLE BREATHING." You may give other explanations that were developed and tested during the adaptation and pre-testing of the questionnaire. Circle the code corresponding to the response. If the answer is 'Yes', continue to the next question. Otherwise, skip to CA12. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose Were the symptoms due to a problem in the chest or a blocked nose? This question aims to find out if the problem needs assessment by a health professional, which does not include a simple cold. Circle the code corresponding to the caretaker's response. If the symptoms were from a 'Blocked nose', skip to CA12. If the symptoms were due to 'Other' reasons, write the respondent's description in the line provided, circle '6' and skip to CA12. Otherwise, continue to the next question. Children aged 0-4 1 Problem in chest 2 Blocked nose 3 Both 6 Other 8 DK 9 Missing Sought advice or teatment for illness Sought advice or teatment for illness Sought advice or teatment for illness Sought advice or teatment for illness Sought advice or teatment for illness Did you seek advice or treatment for the illness outside the home? 'Seeking care outside the home' means going outside the family or household for advice or treatment. Seeking care could include anything from asking a neighbour for advice, to holding a religious ceremony on the child's behalf, to going to a hospital. If a physician or other provider visits the household to give care, this counts as seeking care outside the home. The child may or may not have accompanied the respondent when he/she sought care. For example, going to buy medicine without the child counts as seeking care. Circle the code corresponding to the response given. If the answer is 'Yes', continue to the next question. Otherwise, skip to CA10. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Place sought care: Govt Hospital Place sought care: Govt Hospital Place sought care: Govt Hospital Place sought care: Govt Hospital Place sought care: Govt Hospital From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing A Govt. Hospital/health centre Place sought care: Village health worker Place sought care: Village health worker Place sought care: Village health worker Place sought care: Village health worker Place sought care: Village health worker From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing D Health worker/HA/MA Place sought care: Mobile/outreach clinic Place sought care: Mobile/outreach clinic Place sought care: Mobile/outreach clinic Place sought care: Mobile/outreach clinic Place sought care: Mobile/outreach clinic From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing E Mobile/outreach clinic Place sought care: Other public medical center Place sought care: Other public medical center Place sought care: Other public medical center Place sought care: Other public medical center Place sought care: Other public medical center From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing H Other public sources Place sought care: Private hospital/clinic Place sought care: Private hospital/clinic Place sought care: Private hospital/clinic Place sought care: Private hospital/clinic Place sought care: Private hospital/clinic From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing I Private hospital/clinic Place sought care: Private physician Place sought care: Private physician Place sought care: Private physician Place sought care: Private physician Place sought care: Private physician From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing J Private phisician Place sought care: Private pharmacy Place sought care: Private pharmacy Place sought care: Private pharmacy Place sought care: Private pharmacy Place sought care: Private pharmacy From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing K Pharmacy Place sought care: Other private medical Place sought care: Other private medical Place sought care: Other private medical Place sought care: Other private medical Place sought care: Other private medical From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing O Other private Place sought care: Relative or friend Place sought care: Relative or friend Place sought care: Relative or friend Place sought care: Relative or friend Place sought care: Relative or friend From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing P Relative or friend Place sought care: Shop Place sought care: Shop Place sought care: Shop Place sought care: Shop Place sought care: Shop From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing Q Shop Place sought care: Traditional practitioner Place sought care: Traditional practitioner Place sought care: Traditional practitioner Place sought care: Traditional practitioner Place sought care: Traditional practitioner From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing R Traditional practitioner Place sought care: NGO hospital/clinic Place sought care: NGO hospital/clinic Place sought care: NGO hospital/clinic Place sought care: NGO hospital/clinic Place sought care: NGO hospital/clinic ? Missing S NGO hospital/Clinic Place sought care: Other Place sought care: Other Place sought care: Other Place sought care: Other Place sought care: Other From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) After the first reply, ask: "ANYWHERE ELSE?" until all providers are mentioned. However, do not suggest or prompt any answers. Circle the code for every provider mentioned. If the source of care is a hospital, health centre or clinic, write the name of the place in the space provided on the questionnaire. Ask whether the source is in the public (run by the government) or private sector. If the source is in the public sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other public' and circle 'H'. Similarly, if the source is in the private medical sector, but is not one of the pre-coded choices, write the description in the space provided for 'Other private medical' and circle 'O'. If the respondent answers that he/she sought care from another place not listed, write the description of the place in the space provided for 'Other' and circle 'X'. Then write the name of the place in the space provided on the questionnaire (Name of place) and tell your supervisor. Your supervisor will learn from other people in the community whether the place is public or private and then circle the code corresponding to the response. Children aged 0-4 ? Missing X Other Given medicine to treat this illness Given medicine to treat this illness Given medicine to treat this illness Given medicine to treat this illness Given medicine to treat this illness Was (name) given medicine to treat this illness? Circle the appropriate code. If the answer is 'Yes', continue to the next question. Otherwise, go to CA12. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Antibiotic Antibiotic Antibiotic Antibiotic Antibiotic What medicine was (name) given? Circle all medicines given. This question aims to determine whether the child was given an antibiotic for the illness. More than one medicine may have been administered to the child. Circle the codes corresponding to all medicines given. If the respondent does not know the name of the medicine, ask him/her to show you the medicines. If he/she cannot show the packaged medicine, follow the guidelines provided to you during training. If the respondent names a medicine that is not listed, circle 'X' for 'Other' medicine and fill in the name of the medicine in the space provided. If you cannot determine the type of medicine given to the child with a cough, circle 'Z' for 'DK'. Children aged 0-4 ? Missing A Antibiotic Paracetamal/Panadol/Acetaminophen Paracetamal/Panadol/Acetaminophen Paracetamal/Panadol/Acetaminophen Paracetamal/Panadol/Acetaminophen Paracetamal/Panadol/Acetaminophen What medicine was (name) given? Circle all medicines given. This question aims to determine whether the child was given an antibiotic for the illness. More than one medicine may have been administered to the child. Circle the codes corresponding to all medicines given. If the respondent does not know the name of the medicine, ask him/her to show you the medicines. If he/she cannot show the packaged medicine, follow the guidelines provided to you during training. If the respondent names a medicine that is not listed, circle 'X' for 'Other' medicine and fill in the name of the medicine in the space provided. If you cannot determine the type of medicine given to the child with a cough, circle 'Z' for 'DK'. Children aged 0-4 ? Missing P Paracetamol/Panadol/Acetaminophen Aspirin Aspirin Aspirin Aspirin Aspirin What medicine was (name) given? Circle all medicines given. This question aims to determine whether the child was given an antibiotic for the illness. More than one medicine may have been administered to the child. Circle the codes corresponding to all medicines given. If the respondent does not know the name of the medicine, ask him/her to show you the medicines. If he/she cannot show the packaged medicine, follow the guidelines provided to you during training. If the respondent names a medicine that is not listed, circle 'X' for 'Other' medicine and fill in the name of the medicine in the space provided. If you cannot determine the type of medicine given to the child with a cough, circle 'Z' for 'DK'. Children aged 0-4 ? Missing Q Aspirin Ibupropfen Ibupropfen Ibupropfen Ibupropfen Ibupropfen What medicine was (name) given? Circle all medicines given. This question aims to determine whether the child was given an antibiotic for the illness. More than one medicine may have been administered to the child. Circle the codes corresponding to all medicines given. If the respondent does not know the name of the medicine, ask him/her to show you the medicines. If he/she cannot show the packaged medicine, follow the guidelines provided to you during training. If the respondent names a medicine that is not listed, circle 'X' for 'Other' medicine and fill in the name of the medicine in the space provided. If you cannot determine the type of medicine given to the child with a cough, circle 'Z' for 'DK'. Children aged 0-4 ? Missing R Ibuprofen Other Other Other Other Other What medicine was (name) given? Circle all medicines given. This question aims to determine whether the child was given an antibiotic for the illness. More than one medicine may have been administered to the child. Circle the codes corresponding to all medicines given. If the respondent does not know the name of the medicine, ask him/her to show you the medicines. If he/she cannot show the packaged medicine, follow the guidelines provided to you during training. If the respondent names a medicine that is not listed, circle 'X' for 'Other' medicine and fill in the name of the medicine in the space provided. If you cannot determine the type of medicine given to the child with a cough, circle 'Z' for 'DK'. Children aged 0-4 ? Missing X Other DK DK DK DK DK What medicine was (name) given? Circle all medicines given. This question aims to determine whether the child was given an antibiotic for the illness. More than one medicine may have been administered to the child. Circle the codes corresponding to all medicines given. If the respondent does not know the name of the medicine, ask him/her to show you the medicines. If he/she cannot show the packaged medicine, follow the guidelines provided to you during training. If the respondent names a medicine that is not listed, circle 'X' for 'Other' medicine and fill in the name of the medicine in the space provided. If you cannot determine the type of medicine given to the child with a cough, circle 'Z' for 'DK'. Children aged 0-4 ? Missing Z DK What was done to dispose of the stools What was done to dispose of the stools What was done to dispose of the stools What was done to dispose of the stools What was done to dispose of the stools Check UF11: Child aged under 3? Yes. Continue with CA13 No. Go to CA14 The last time (name) passed stools, what was done to dispose of the stools? CA13 is used to filter out children aged 3, 4 and 5 years, since the next question is to be asked only of children under age three. Check UF11; if the child is under three (he/she is 0, 1 or 2 years old), mark the box corresponding to 'Yes' and continue with the next question. If the child is not under three (she/he is 3, 4 or 5 years old), mark the box corresponding to 'No' and skip to CA14. --- The purpose of this question is to know what was done with the most recent stools passed by the child in the household. The safe disposal of children's stools is of particular importance because children's stools are the most likely cause of faecal contamination to the immediate household environment. Correct disposal of stools is linked with lower risks of diarrhoea. Respondents are asked where they usually dispose of their children's stools if the child did not use the toilet facility. Circle the most appropriate code. Children aged 0-4 1 Child used toilet/latrine 2 Put/rinsed into toilet or latrine 3 Put/rinsed into drain or ditch 4 Thrown into garbage (solid waste) 5 Buried 6 Left in the open 96 Other 98 DK 99 Missing Symptoms: Child not able to drink or breastfeed Symptoms: Child not able to drink or breastfeed Symptoms: Child not able to drink or breastfeed Symptoms: Child not able to drink or breastfeed Symptoms: Child not able to drink or breastfeed Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing A Child not able to drink or breatfeed Symptoms: Child becomes sicker Symptoms: Child becomes sicker Symptoms: Child becomes sicker Symptoms: Child becomes sicker Symptoms: Child becomes sicker Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing B Child becomes sicker Symptoms: Child develops a fever Symptoms: Child develops a fever Symptoms: Child develops a fever Symptoms: Child develops a fever Symptoms: Child develops a fever Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing C Child develops a fever Symptoms: Child has faster breathing Symptoms: Child has faster breathing Symptoms: Child has faster breathing Symptoms: Child has faster breathing Symptoms: Child has faster breathing Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing D Child has fast breathing Symptoms: Child has difficult breathing Symptoms: Child has difficult breathing Symptoms: Child has difficult breathing Symptoms: Child has difficult breathing Symptoms: Child has difficult breathing Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing E Child has difficult breathing Symptoms: Child has blood in stool Symptoms: Child has blood in stool Symptoms: Child has blood in stool Symptoms: Child has blood in stool Symptoms: Child has blood in stool Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing F Child has blood in stool Symptoms: Child is drinking poorly Symptoms: Child is drinking poorly Symptoms: Child is drinking poorly Symptoms: Child is drinking poorly Symptoms: Child is drinking poorly Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing G Child is drinking poorly Symptoms: Animal bite Symptoms: Animal bite Symptoms: Animal bite Symptoms: Animal bite Symptoms: Animal bite ? Missing H Animal bite Symptoms: Snake bite Symptoms: Snake bite Symptoms: Snake bite Symptoms: Snake bite Symptoms: Snake bite ? Missing I Snake bite Symptoms: Drowing Symptoms: Drowing Symptoms: Drowing Symptoms: Drowing Symptoms: Drowing Snake bite Symptoms: Other Symptoms: Other Symptoms: Other Symptoms: Other Symptoms: Other Ask the following question (CA14) only once for each caretaker. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. This question asks for symptoms that would cause the respondent to take a child to a health facility right away. Note that this question will only be asked once per mother/primary caretaker. If you are interviewing the same mother/primary caretaker for more than one child, ask this question when you interview her/him for the first child. Copy the response to this question to the same question in the questionnaire for the second child. If you are interviewing more than one mother/primary caretaker in the same household, ask the question once of each of the mothers/primary caretakers. Circle the codes for the symptoms mentioned. If the caretaker mentions a few signs and stops, continue by asking "ANY OTHERS?" until the caretaker cannot recall any additional symptoms, but do not prompt with any suggestions. Circle the codes corresponding to all symptoms mentioned. If you are not sure whether a certain sign as reported by the respondent fits in one of the above categories, write it down in full and check with your supervisor later. Children aged 0-4 ? Missing Z Other Vaccination card for child Vaccination card for child Vaccination card for child Vaccination card for child Vaccination card for child If an immunization card is available, copy the dates in IM2-IM8 for each type of immunization or vitamin A dose recorded on the card. IM10-IM18 are for recording vaccinations that are not recorded on the card. IM10-IM18 will only be asked when a card is not available. Is there a vaccination card for (name)? If the respondent reports that there is a vaccination card for the child, ask to see it. You should have obtained vaccination cards at the beginning of the interview. If you did not already obtain the card for the child, now is the time to ask for it again. In some cases, the respondent may not be willing to take time to look for the vaccination card, thinking that you are in a hurry. Encourage the respondent to look for the vaccination card for the child. It is critical to obtain written documentation of the child's immunization history. Therefore, be patient if the respondent needs to search for the card. If the respondent does not have a vaccination card but the vaccine doses are registered in another document (for example, a booklet with records of clinic visits), ask to see it. If the card or other document is seen, circle '1' and continue to the next question. If the card or other document is not seen, circle '2' and skip to IM10 - you will be asking the respondent to recall the child's vaccinations. If the respondent does not have a vaccination card or any other document where the vaccine doses are registered for the child, circle '3' and skip to IM10. Children aged 0-4 1 Yes, seen 2 Yes, not seen 3 No 9 Missing Day of BCG immunization Day of BCG immunization Day of BCG immunization Day of BCG immunization Day of BCG immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization BCG You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of BCG immunization Month of BCG immunization Month of BCG immunization Month of BCG immunization Month of BCG immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization BCG You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of BCG immunization Year of BCG immunization Year of BCG immunization Year of BCG immunization Year of BCG immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization BCG You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of DPT1 immunization Day of DPT1 immunization Day of DPT1 immunization Day of DPT1 immunization Day of DPT1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of DPT1 immunization Month of DPT1 immunization Month of DPT1 immunization Month of DPT1 immunization Month of DPT1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of DPT1 immunization Year of DPT1 immunization Year of DPT1 immunization Year of DPT1 immunization Year of DPT1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of DPT2 immunization Day of DPT2 immunization Day of DPT2 immunization Day of DPT2 immunization Day of DPT2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of DPT2 immunization Month of DPT2 immunization Month of DPT2 immunization Month of DPT2 immunization Month of DPT2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of DPT2 immunization Year of DPT2 immunization Year of DPT2 immunization Year of DPT2 immunization Year of DPT2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of DPT3 immunization Day of DPT3 immunization Day of DPT3 immunization Day of DPT3 immunization Day of DPT3 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 3 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of DPT3 immunization Month of DPT3 immunization Month of DPT3 immunization Month of DPT3 immunization Month of DPT3 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 3 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of DPT3 immunization Year of DPT3 immunization Year of DPT3 immunization Year of DPT3 immunization Year of DPT3 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization DPT 3 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of Hepatitis B1 immunization Day of Hepatitis B1 immunization Day of Hepatitis B1 immunization Day of Hepatitis B1 immunization Day of Hepatitis B1 immunization Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of Hepatitis B1 immunization Month of Hepatitis B1 immunization Month of Hepatitis B1 immunization Month of Hepatitis B1 immunization Month of Hepatitis B1 immunization 99 Missing Year of Hepatitis B1 immunization Year of Hepatitis B1 immunization Year of Hepatitis B1 immunization Year of Hepatitis B1 immunization Year of Hepatitis B1 immunization 9999 Missing Day of Hepatitis B2 immunization Day of Hepatitis B2 immunization Day of Hepatitis B2 immunization Day of Hepatitis B2 immunization Day of Hepatitis B2 immunization Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing month of Hepatitis B2 immunization month of Hepatitis B2 immunization month of Hepatitis B2 immunization month of Hepatitis B2 immunization month of Hepatitis B2 immunization 99 Missing Year of Hepatitis B2 immunization Year of Hepatitis B2 immunization Year of Hepatitis B2 immunization Year of Hepatitis B2 immunization Year of Hepatitis B2 immunization 9999 Missing Day of Hepatitis B3 immunization Day of Hepatitis B3 immunization Day of Hepatitis B3 immunization Day of Hepatitis B3 immunization Day of Hepatitis B3 immunization Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of Hepatitis B3 immunization Month of Hepatitis B3 immunization Month of Hepatitis B3 immunization Month of Hepatitis B3 immunization Month of Hepatitis B3 immunization 99 Missing Year of Hepatitis B4 immunization Year of Hepatitis B4 immunization Year of Hepatitis B4 immunization Year of Hepatitis B4 immunization Year of Hepatitis B4 immunization 9999 Missing Day of OPV0 immunization Day of OPV0 immunization Day of OPV0 immunization Day of OPV0 immunization Day of OPV0 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio at birth You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of OPV0 immunization Month of OPV0 immunization Month of OPV0 immunization Month of OPV0 immunization Month of OPV0 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio at birth You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of OPV0 immunization Year of OPV0 immunization Year of OPV0 immunization Year of OPV0 immunization Year of OPV0 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio at birth You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of OPV1 immunization Day of OPV1 immunization Day of OPV1 immunization Day of OPV1 immunization Day of OPV1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of OPV1 immunization Month of OPV1 immunization Month of OPV1 immunization Month of OPV1 immunization Month of OPV1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of OPV1 immunization Year of OPV1 immunization Year of OPV1 immunization Year of OPV1 immunization Year of OPV1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of OPV2 immunization Day of OPV2 immunization Day of OPV2 immunization Day of OPV2 immunization Day of OPV2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of OPV2 immunization Month of OPV2 immunization Month of OPV2 immunization Month of OPV2 immunization Month of OPV2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of OPV2 immunization Year of OPV2 immunization Year of OPV2 immunization Year of OPV2 immunization Year of OPV2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of OPV3 immunization Day of OPV3 immunization Day of OPV3 immunization Day of OPV3 immunization Day of OPV3 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 3 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of OPV3 immunization Month of OPV3 immunization Month of OPV3 immunization Month of OPV3 immunization Month of OPV3 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 3 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of OPV3 immunization Year of OPV3 immunization Year of OPV3 immunization Year of OPV3 immunization Year of OPV3 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Polio 3 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of OPV4 immunization Day of OPV4 immunization Day of OPV4 immunization Day of OPV4 immunization Day of OPV4 immunization Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of OPV4 immunization Month of OPV4 immunization Month of OPV4 immunization Month of OPV4 immunization Month of OPV4 immunization 99 Missing Year of OPV4 immunization Year of OPV4 immunization Year of OPV4 immunization Year of OPV4 immunization Year of OPV4 immunization 9999 Missing Day Measles or MMR immunization Day Measles or MMR immunization Day Measles or MMR immunization Day Measles or MMR immunization Day Measles or MMR immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Measles (or MMR) You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month Measles or MMR immunization Month Measles or MMR immunization Month Measles or MMR immunization Month Measles or MMR immunization Month Measles or MMR immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Measles (or MMR) You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of Measles or MMR immunization Year of Measles or MMR immunization Year of Measles or MMR immunization Year of Measles or MMR immunization Year of Measles or MMR immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Measles (or MMR) You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of Vitamin A 1 immunization Day of Vitamin A 1 immunization Day of Vitamin A 1 immunization Day of Vitamin A 1 immunization Day of Vitamin A 1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Vitamin A 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of Vitaimn A 1 imunization Month of Vitaimn A 1 imunization Month of Vitaimn A 1 imunization Month of Vitaimn A 1 imunization Month of Vitaimn A 1 imunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Vitamin A 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 99 Missing Year of Vitamin A 1 immunization Year of Vitamin A 1 immunization Year of Vitamin A 1 immunization Year of Vitamin A 1 immunization Year of Vitamin A 1 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Vitamin A 1 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Day of Vitamin A 2 immunization Day of Vitamin A 2 immunization Day of Vitamin A 2 immunization Day of Vitamin A 2 immunization Day of Vitamin A 2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Vitamin A 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 Not given 44 Marked on card - no date given 66 Reported by mother 99 Missing Month of Vitamin A (2) Month of Vitamin A (2) Month of Vitamin A (2) Month of Vitamin A (2) Month of Vitamin A (2) 99 Missing Year of Vitamin A 2 immunization Year of Vitamin A 2 immunization Year of Vitamin A 2 immunization Year of Vitamin A 2 immunization Year of Vitamin A 2 immunization (a) Copy dates for each vaccination from the card. (b) Write '44' in day column if card shows that vaccination was given but no date recorded. Date of immunization Vitamin A 2 You will complete questions from IM2 through IM8B when respondents show you the vaccination card for the child: " Copy the dates in the spaces provided for IM2-IM8B for each type of immunization or vitamin A dose recorded on the card or document. " If the card shows only part of the date, record '98' for 'DK' in the column for which the information is not given. For example, if the date given was July 2004, you would record '98' for 'Day', '07' for 'Month', and '2004' for 'Year'. " If the card shows that a vaccination or vitamin A dose was administered but the date is not specified, write '44' in the day column, and leave the month and year columns blank. " However, if a date is given for a DPT vaccination and there is simply a check to show that a polio vaccine was also given, record the date of the DPT injection on the polio line since this probably indicates that the vaccinations were given on the same day. Remember that vaccines may be listed on the card in a different order than the one that appears on the questionnaire. Be sure to check the card carefully because sometimes the month may be listed first, sometimes the day. Be careful to record the dates correctly. Besides recording vaccination dates on the card, some health facilities may also record the dates (appointments) that children should be brought in for their next immunizations. Be very careful not to record a scheduled appointment date as a vaccination date. It is possible that an appointment date was given, but the child never received the vaccination. Only record dates that vaccinations were actually given, and not date of appointments. Be patient and read the card thoroughly. It is very important that you copy the information on administered vaccinations on the card to the questionnaire accurately. After you have completed transferring the information from the card to the questionnaire, proceed with question IM9. Children aged 0-4 9999 Missing Received additional vaccinations Received additional vaccinations Received additional vaccinations Received additional vaccinations Received additional vaccinations In addition to the vaccinations and vitamin A capsules shown on this card, did (name) receive any other vaccinations - including vaccinations received in campaigns or immunization days? Record 'Yes' only if respondent mentions BCG, OPV 0-3, DPT 1-3, Hepatitis B 1-3, Measles, Yellow Fever vaccine(s), or Vitamin A supplements. (If yes, Probe for vaccinations and write '66' in the corresponding day column on IM2 to IM8B.) It is possible that some of the vaccinations received by the child were not recorded. For example, the respondent may have forgotten to bring the card to the health facility or the respondent may have taken (name) to a National Immunization Day. If the answer is 'Yes', circle '1' only if the respondent mentions vaccines included in the questionnaire. You can refer to the information already obtained from the vaccination card to make sure that the mother/primary caretaker is referring only to these vaccines. Write '66' in the corresponding 'Day' column for IM2-IM8B, and leave the month and year columns blank. For example, if two doses of DPT were recorded on the card, and another dose was given but not recorded, the answer to IM4C should be '66' in the 'Day' column. Do not ask the respondent to supply dates from memory. Enter a date only if the card or other document is available and lists a date for the immunization dose. Once you have probed for all vaccinations, skip to IM19. 1 Yes 2 No 8 DK 9 Missing Child ever received any vaccinations Child ever received any vaccinations Child ever received any vaccinations Child ever received any vaccinations Child ever received any vaccinations Has (name) ever received any vaccinations to prevent him/her from getting diseases, including vaccinations received in a campaign or immunization day? Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Only ask IM10-18 to obtain the child's vaccination status if a vaccination card or other document is not available (that is, if the answer to IM1 was '2' for 'Yes, 'Not seen' or '3' for 'No'). Describe the vaccination techniques in detail to the caretaker and provide further explanations if needed. When mentioning the vaccines or the specific diseases, use local synonyms if needed. We are not interested in injections for treating a disease - antibiotics, antimalarials, etc. - but only in vaccines. Circle the code corresponding to the response. If the answer is 'Yes', continue to the next question, to start asking about each of the vaccines. If the answer is 'No' or 'DK', skip to IM19. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child ever given BCG vaccination Child ever given BCG vaccination Child ever given BCG vaccination Child ever given BCG vaccination Child ever given BCG vaccination Has (name) ever been given a BCG vaccination against tuberculosis - that is, an injection in the arm or shoulder that caused a scar? Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Circle the code corresponding to the response. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child ever given Polio vaccination Child ever given Polio vaccination Child ever given Polio vaccination Child ever given Polio vaccination Child ever given Polio vaccination Has (name) ever been given any "vaccination drops in the mouth" to protect him/her from getting diseases - that is, polio? Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Circle the code corresponding to the response. If the answer is 'Yes', continue to the next question. If the answer is 'No' or 'DK', skip to IM15. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Polio first given just after birth or later Polio first given just after birth or later Polio first given just after birth or later Polio first given just after birth or later Polio first given just after birth or later How old was he/she when the first dose was given - just after birth (within two weeks) or later? Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Ask how old the child was at first dose, prompting "JUST AFTER BIRTH OR LATER?" Circle the code corresponding to the response. Children aged 0-4 1 Just after birth (within 2 weeks) 2 Later 9 Missing Times child given Polio vaccination Times child given Polio vaccination Times child given Polio vaccination Times child given Polio vaccination Times child given Polio vaccination How many times has he/she been given these drops? Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Fill in the number in the space provided. Children aged 0-4 99 Missing Child ever given DPT vaccination Child ever given DPT vaccination Child ever given DPT vaccination Child ever given DPT vaccination Child ever given DPT vaccination Has (name) ever been given "DPT vaccination injections" - that is, an injection in the thigh or buttocks - to prevent him/her from getting tetanus, whooping cough, diphtheria? (sometimes given at the same time as polio) Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Circle the code corresponding to the response. If the answer is 'Yes', continue to the next question. If 'No' or 'DK', skip to IM17. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Times child given DPT vaccination Times child given DPT vaccination Times child given DPT vaccination Times child given DPT vaccination Times child given DPT vaccination How many times? Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Fill in the number in the space provided. Children aged 0-4 99 Missing Child ever given Measles or MMR vaccination Child ever given Measles or MMR vaccination Child ever given Measles or MMR vaccination Child ever given Measles or MMR vaccination Child ever given Measles or MMR vaccination Has (name) ever been given "Measles vaccination injections" or MMR - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles? Questions IM10 through IM18 are asked only to mothers/primary caretakers of children who do not have vaccination cards, or those children for whom vaccination cards were not shown. --- Circle the code corresponding to the response. If the caretaker specifically mentions measles vaccine but refers to an injection in the thigh, accept the answer as valid and circle '1' for 'Yes'. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child participated in national immunization day A Child participated in national immunization day A Child participated in national immunization day A Child participated in national immunization day A Child participated in national immunization day A Please tell me if (name) has participated in any of the following campaigns, national immunization days and/or vitamin A or child health days: Date/type of campaign A This question is asked to provide information about immunization programmes. It also provides a check on IM9 for children with a vaccination card, since doses given in National Immunization Days are usually not recorded on the card. Circle the code corresponding to the response. If the respondent answers 'Yes' here to at least one of the dates, check back to IM9. If the answer given there (to IM9) was 'No', ask again. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child participated in national immunization day B Child participated in national immunization day B Child participated in national immunization day B Child participated in national immunization day B Child participated in national immunization day B Please tell me if (name) has participated in any of the following campaigns, national immunization days and/or vitamin A or child health days: Date/type of campaign B This question is asked to provide information about immunization programmes. It also provides a check on IM9 for children with a vaccination card, since doses given in National Immunization Days are usually not recorded on the card. Circle the code corresponding to the response. If the respondent answers 'Yes' here to at least one of the dates, check back to IM9. If the answer given there (to IM9) was 'No', ask again. Children aged 0-4 1 Yes 2 No 8 DK 9 Missing Child participated in national immunization day C Child participated in national immunization day C Child participated in national immunization day C Child participated in national immunization day C Child participated in national immunization day C Please tell me if (name) has participated in any of the following campaigns, national immunization days and/or vitamin A or child health days: Date/type of campaign C This question is asked to provide information about immunization programmes. It also provides a check on IM9 for children with a vaccination card, since doses given in National Immunization Days are usually not recorded on the card. Circle the code corresponding to the response. If the respondent answers 'Yes' here to at least one of the dates, check back to IM9. If the answer given there (to IM9) was 'No', ask again. 1 Yes 2 No 8 DK 9 Missing Sex Sex Sex Sex Sex Children aged 0-4 1 Male 2 Female 9 Missing Highest level of school attended Highest level of school attended Highest level of school attended Highest level of school attended Highest level of school attended What is the highest level of school (name) attended? Children aged 0-4 Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 6 NGO/Mosque based/Adult literacy programme 8 DK 9 Missing Highest grade at level Highest grade at level Highest grade at level Highest grade at level Highest grade at level What is the highest grade (name) completed at this level? Children aged 0-4 97 Inconsistent 98 DK 99 Missing Interviewer number Interviewer number Interviewer number Interviewer number Interviewer number Interviewer name and number: Enter your own name and identification number provided to you at the time of training. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor Number Supervisor name and number: Enter your supervisor's name and identification number. You will be provided with your supervisor's identification number as soon as you know who you will be working with. Households 1 Mr. Aminul Islam Bir 2 Mr. Husain Shahid 3 Mr. Jamal Uddin 4 Mr. Hamidul Islam 5 Mr. Abdur Rahman 6 Mr. Mohd. Almas Uddin 7 Mr. Mahadi Hassan 8 Mr. Sontosh Kr. Mandal (Sumon 9 Mr. Amar Ch. Majumder 10 Ms. Sahana Parvin 11 Mr. Mominul Haque (Firoj) 12 Ms. Shirajum Munira 13 Mr. Moniruzzaman 14 Mr. Nasir Ahmed 15 Mr. Mahamud Ali Mamun 16 Ms. Ziaonnessa Begum 17 Ms. Farida Yesmin (Old) 18 Mr. Alakesh Bepary 19 Mr. Mokbul Hossain Sharif 20 Mr. Nasir Uddin (Mostafa) 21 Ms. Tahera Khatun 22 Mr. Abdur Rahim 23 Ms. Salma Sultana 24 Mr. Prodip Biswas 25 Mr. Ajoy Krishna Das 26 Mr. Rabindranath Chowdhury 27 Mr. Rafiqul Alam 28 Mr. Monjurul Haque (Monju) 29 Ms. Selina Akter 30 Mr Helal Uddin 31 Mr. Sanjoy Kumar Biswas 32 Mr. Monir Ahamed 33 Mr. Dibyendu Kumar Dutta 34 Ms. Nasima Khatun 35 Ms. Kanan Bala Mozumder 36 Ms. Zakia Sultana 37 Mr. Rezaul Islam 38 Mr. Firoz Khan 39 Ms. Suriya Parvin (Trishna) 40 Ms. Fatima Begum 42 Mr. Shahinul Islam 43 Ms. Asma Akther 44 Ms. Fatema Hasnin 45 Mr. Abdur Rahim Sikder 46 Mr. Liton Acharja 47 Ms. Afroza Jannat 48 Ms. Marzia Begum 49 Mr. Nazrul Islam 51 Ms. Salma Akter 52 Ms. Nasima Khatun (Shaila) 53 Mr. Dudha Mia 54 Ms. Nusrat Sharmin Nipa 55 Ms. Mina Khanam 56 Ms. Farzana Yasmin 57 Mr. Nurul Islam 58 Mr. Abdul Malek 59 Ms. Rina Aktar 60 Ms. Lovely Begum 61 Mr. Sanjoy Bepary 62 Ms. Shalina Khanam 63 Ms. Anima Biswas 64 Ms. Shirin Akter (K) 65 Mr. Abdul Motalab 66 Mr. Saidduz-zaman 67 Ms. Susama Halder 68 Ms. Nazmun Nahar (Popy) 69 Mr. Sabyasachi Dash 70 Mr. Shaheen Uddin 71 Ms. Shakila Sultana Moni 72 Ms. Shila Chakrabarty 74 Ms. Nazma Khanam 75 Mr. Sohel Mozumder 76 Ms. Amena Akter 77 Mr. Shafi Mohd. Ali Siddiki 78 Mr. Reaj Uddin 79 Ms. Taibatun Nehar 80 Ms. Rupali Biswas 81 Mr. Zulfikar Ali 82 Mr. ASM Kamrul Hasan 83 Ms. Aysha Begum 84 Ms. Rajia Sultana 85 Mr. Monotos Halder 86 Ms. Nasima Akter Mozumder 87 Ms. Uranus Ahamad(Lubna) 88 Ms. Jesmin Akter Banu 89 Mr. Jasim Uddin 90 Ms. Momeja Khatun 91 Ms. Sheikh Nargis Akter 92 Ms. Rebaka Sultana 93 Mr. Billal Hossain 94 Mr. Mobinur Rahman 95 Ms. Mahamuda Akter 96 Ms. Nazmun Naher (Jharna) 97 Mr. Meher Ali 98 Mr. Sayed Abdul Gaffar 99 Ms. Labonee 100 Ms. Nadira Khatun 101 Mr. Anowarul Islam Khan 102 Ms. Mahmumada Parvin 103 Ms. Ayesa Akter (Anna) 104 Ms. Anupa Biswas 105 Mr. Masudul Haque Bhuiyan 106 Ms. Majeda Begum 107 Ms. Shaheen Akhter 108 Ms. Mousumi Akter 109 Mr. Sheikh Moniruzzaman 110 Ms. Sharmin Sultana 111 Ms. Lutfunnesa 112 Ms. Salina Jahan 113 Mr. Ahmad Al-Munzir (Rana) 114 Mr. Saidur Rahman 115 Ms. Anima Rani Mistry 116 Ms. Gita Rani Biswas 117 Mr. Ahmad Al-Amin 118 Ms. Rozina Khatun 119 Ms. Nargis Sultana 120 Ms. Margia Khatun 121 Mr. Bahadur Mia 122 Mr. Swapan Kumar Halder 123 Ms. Nilufar Yeasmin 124 Ms. Motahara Begum (Rozy) 125 Mr. Habibur Rahman 126 Ms. Hosne Ara Konica 127 Ms. Sharmin Sayela 129 Mr. ATM Anowarul Hakim 130 Ms. Nazrin Akter Bithi 131 Ms. Shahanaz Pervin 132 Ms. Najiba Fairuj 133 Mr. Rukun Uddin 134 Ms. Pala Halder 135 Ms. Shayla Sharmin 136 Ms. Nurjahan Akter 137 Mr. Khairul Motin 138 Ms. Kohinoor Akter 139 Ms. Beauty Akter 140 Ms. Tahasna Azima Azam 141 Mr. Abu Sayem (Mamun) 142 Ms. Shahanaj Nasrin 143 Ms. Sabina Yasmin (Sapna) 144 Ms. Marufa Akter 145 Mr. Anamul Haque 146 Mr. KM Rezaul Karim 147 Ms. Shelina Khatun (Lipy) 148 Ms. Mahafuja Akter (Ratna) 149 Mr. Shahajahan Ali 150 Ms. Liza Sultana 151 Ms. Roushon Ara 152 Ms. Badrun Nessa 153 Mr. Mirza Md. Robiul Islam 154 Ms. Sabina Akter 155 Ms. Shilpi Adhekary 157 Mr. Ranjit Ku. Barman 158 Ms. Rabeya Jesmin Chowdhury 159 Ms. Farida Parvin 160 Ms. Lucky Akter 161 Ms. Lal Rin-Pui 162 Mr. Shahidul Islam Milon 163 Mr. Sharif Miah Day of interview Day of interview Day of interview Day of interview Day of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Month of interview Month of interview Month of interview Month of interview Month of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Year of interview Year of interview Year of interview Year of interview Year of interview Day/Month/Year of interview: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been conducted but there will be no more attempts to interview the household. Households Area Area Area Area Area Area: Circle the code for area of residence as instructed by your supervisor. This will have been pre-determined; you will not be required to assess whether the household is in an urban or rural area. Households 1 Rural 2 Urban (Municipality) 3 Urban non-slum (Metro city) 4 Urban slum 5 Tribal Region Region Region Region Region Region: Circle the code for region. Households 1 Barisal 2 Chittagong 3 Dhaka 4 Khulna 5 Rajshahi 6 Sylhet District District District District District 1 Bagerhat 3 Bandarban 4 Barguna 6 Barisal 9 Bhola 10 Bogra 12 Brahmanbaria 13 Chandpur 15 Chittagong 18 Chuadanga 19 Comilla 22 Cox's Bazar 26 Dhaka 27 Dinajpur 29 Faridpur 30 Feni 32 Gaibandha 33 Gazipur 35 Gopalganj 36 Habiganj 38 Joypurhat 39 Jamalpur 41 Jessore 42 Jhalokati 44 Jhenaidah 46 Khagrachhari 47 Khulna 48 Kishorganj 49 Kurigram 50 Kushtia 51 Lakshmipur 52 Lalmonirhat 54 Madaripur 55 Magura 56 Manikganj 57 Meherpur 58 Maulvibazar 59 Munshiganj 61 Mymensingh 64 Naogaon 65 Narail 67 Narayanganj 68 Narsingdi 69 Natore 70 Nawabganj 72 Netrakona 73 Nilphamari 75 Noakhali 76 Pabna 77 Panchagarh 78 Patuakhali 79 Pirojpur 81 Rajshahi 82 Rajbari 84 Rangamati 85 Rangpur 86 Shariatpur 87 Satkhira 88 Sirajganj 89 Sherpur 90 Sunamganj 91 Sylhet 93 Tangail 94 Thakurgaon Sub-district Sub-district Sub-district Sub-district Sub-district Result of HH interview Result of HH interview Result of HH interview Result of HH interview Result of HH interview After all questionnaires for the household have been completed, fill in the following information: Result of HH interview: If the Household Questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the household after repeated visits, circle '2' for 'Not at home'. If the household refuses to be interviewed, circle '3' for 'Refused'. If you are unable to locate the household or if the dwelling is destroyed, circle '4' for 'HH not found/destroyed'. If you have not been able to complete the Household Questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Some examples of 'Other' codes might be: the household respondent is incapacitated; the questionnaire is partly completed; adult household members were not found at home after repeated visits. Households 1 Completed 2 Not at home 3 Refused 4 HH not found/destroyed 6 Other Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent HH questionnaire Respondent to HH questionnaire: Enter the name and line number (from the Household Listing, columns HL1 and HL2) of the respondent to the Household Questionnaire. Households 99 Missing Number of household members Number of household members Number of household members Number of household members Number of household members Total number of household members: Count the number of household members recorded in column HL1 of the Household Listing and enter the total here. Households Total eligible women Total eligible women Total eligible women Total eligible women Total eligible women No.of women eligible for interview: Enter the total number of women eligible for interview for the Questionnaire for Individual Women - you will copy this from the row for totals at the bottom of the Household Listing, for HL6. Households Women interviews completed Women interviews completed Women interviews completed Women interviews completed Women interviews completed No.of women questionnaires completed: Once all of the Questionnaires for Individual Women have been completed for a particular household, enter the number completed here. Households Total children under 5 Total children under 5 Total children under 5 Total children under 5 Total children under 5 No.of children under age 5: Enter the total number of children under five eligible for inclusion in the survey from the row for totals at the bottom of the Household Listing, for HL8. You will be using the Questionnaire for Children Under Five to interview the mothers or primary caretakers of these children. Households Child interviews completed Child interviews completed Child interviews completed Child interviews completed Child interviews completed No.of under-5 questionnaires completed: Once all of the Questionnaires for Children Under Five have been completed for a particular household, enter the number completed here. Households Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk Data entry clerk: Leave this space blank. The data clerk will enter his/her number in the space provided. Households 1 Rokan Mia 3 Jharna Datta 4 Rina 5 Ripon 6 Foysal 7 Shakil 8 Anwar 9 Ratan 10 Shahinul Islam 11 Moniruzzaman 12 Nazimuddin 13 Hafiz Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water What is the main source of drinking water for members of your household? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- Circle the code for the most usual source. If several sources are mentioned, probe to determine the most usual source. If the source varies by season, record the source for the season of the interview. Note that the next question is only asked if the response to this question is 'Bottled water'. You should skip WS2 if the response to WS1 is other than 'Bottled water'. If the response is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise, skip to WS3. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 91 Bottled water 96 Other 99 Missing Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat What is the main source of water used by your household for other purposes such as cooking and handwashing? The purpose of the first two questions of this module is to assess the type of household water used for drinking as well as for other purposes, such as cooking and washing hands. Definitions of the various sources of water are as follows (codes refer to those used in WS1 and WS2): '11' - Piped into dwelling, also called a house connection, is defined as water service connected by pipe with in-house plumbing to one or more taps, for example, in the kitchen and/or bathroom. '12' - Piped water to yard/plot, also called a yard connection, is defined as a piped water connection to a tap placed in the yard or plot outside the house. '13' - A public tap or standpipe is a water point from which the public may collect their water. A standpipe may also be known as a public fountain or public tap. Public standpipes can have one or more taps and are typically made of brickwork, masonry or concrete. '21' - A tube-well or borehole is a deep hole that has been driven, bored or drilled with the purpose of reaching groundwater supplies. Boreholes/tube-wells are constructed with casing, or pipes, which prevent the small-diameter hole from caving in and provide protection from infiltration of run-off water. Water is delivered from a tube-well or borehole through a pump that may be powered by humans, animals, wind, electricity, diesel fuel or solar energy. '31' - A protected dug well is a dug well that is protected from run-off water through a well lining or casing that is raised above ground level and a platform that diverts spilled water away from the well. Additionally, a protected dug well is covered so that bird droppings and animals cannot fall down the hole. '32' - An unprotected dug well is a dug well for which one or both of the following are true: (1) the well is not protected from run-off water; (2) the well is not protected from bird droppings and animals. If at least one of these conditions is true, the well is unprotected. '41' - A protected spring is a spring that is free from run-off and from bird droppings and animals. A spring is typically protected by a 'spring box' that is constructed of brick, masonry or concrete and is built around the spring so that water flows directly out of the box into a pipe without being exposed to outside pollution. '42' - An unprotected spring is a spring that is subject to run-off or bird droppings or animals. Unprotected springs typically do not have a 'spring box' (described above). '51' - Rainwater collection refers to rain that is collected or harvested from surfaces by roof or ground catchment and stored in a container, tank or cistern until used. '61' - A tanker-truck water source transports and sells water by means of a tanker truck. '71' - Cart with small tank/drum is used by a water provider who transports water into a community and then sells the water. Types of transports may include donkey cart, motorized vehicle or other means. '81' - Surface water is water located above ground and includes rivers, dams, lakes, ponds, streams, canals and irrigation channels from which water is taken directly. '91' - Bottled water is purchased water sold in bottles. Note that the code refers only to bottled water that is commercially available. Sometimes household members may store water from other sources in bottles - this should not be coded as bottled water. --- This question should only be asked to households that use 'Bottled water' for drinking. Circle the code for the most usual source. If the source varies by season, record the source for the season of the interview. If the most usual source of non-drinking water is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise continue to the next question. Households 11 Piped into dwelling 12 Piped into yard or plot 13 Public tap/standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 81 Surface water 96 Other 99 Missing Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back Time to get water and come back How long does it take to go there, get water, and come back? This question is used to find out how convenient the source of water is to the dwelling. Note that the question is asked for water sources coded as '13-81' and '96' in WS1, or water sources coded as '13-96' in WS2. Fill in the estimated time (in minutes, converting from hours, if necessary) it takes by the usual mode of transport to get to the water source, wait to get water, and get back to the dwelling. Use zero(s) preceding the number if less than 100 minutes (for example, '060' or '005'). Then continue to the next question. If the water source is on the dwelling premises or if water is delivered to the dwelling by a vendor, circle '995' for 'Water on premises' and skip to WS5. If the respondent does not know how long it takes, circle '998' and continue on to the next question. Households 995 On premises 998 DK 999 Missing Person fetching water Person fetching water Person fetching water Person fetching water Person fetching water Who usually goes to this source to fetch the water for your household? Probe: Is this person under age 15? What sex? Circle code that best describes this person. The purpose of this question is to find out the age and gender of the person who usually performs the task of hauling water. This will provide an understanding of whether water hauling responsibilities are given to members of a particular sex or age group. Probe: "IS THIS PERSON UNDER AGE 15? WHAT SEX IS THIS PERSON?" Circle the code that corresponds with the response or '8' if the respondent does not know. Adult refers to anyone age 15 or over, regardless of whether he/she is a household member. Child refers to anyone under the age of 15, regardless of whether he/she is a household member. Households 1 Adult woman 2 Adult man 3 Female child (under 15) 4 Male child (under 15) 8 DK 9 Missing Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Do you treat your water in any way to make it safer to drink? The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle '1' if 'Yes', and continue to the next question. If 'No' or 'DK' (Doesn't know'), circle '2' or '8', respectively, and skip to WS7. Households 1 Yes 2 No 8 DK 9 Missing Boil Boil Boil Boil Boil What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing A Boil Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine Add bleach/chlorine What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing B Add bleach/chlorine Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth Strain it through a cloth What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing C Strain it through a cloth Use water filter Use water filter Use water filter Use water filter Use water filter What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing D Use water filter Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle Let it stand and settle What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing F Let it stand and settle Alum Alum Alum Alum Alum ? Missing G Alum Other Other Other Other Other What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing X Other DK DK DK DK DK What do you usually do to the water to make it safer to drink? Anything else? Record all items mentioned. The purpose of the following two questions, WS5 and WS6, is to determine whether the household drinking water is treated within the household and, if so, what type of treatment is used. This question is intended to gather information on water treatment at the household level and not water treatment at the municipal or vendor level. --- Circle the code corresponding to the response. The household may be using a method that you know does not make water safer to drink. Do not use your own judgement, just record the response. Record all items mentioned (for example, the household may be filtering the water and adding chlorine at the same time). Probe: "Anything else?" Circle 'X' for 'Other' and specify on the line provided what the household does to the water to make it safer to drink. Circle 'Z' if the respondent 'Doesn't know'. Definitions of various methods of water treatment are as follows: 'A' - Boil refers to boiling or heating water with fuel. 'B' - Add bleach/chlorine refers to using liquid chlorine bleach or bleaching powder to treat drinking water. SURVEY COORDINATORS: FREE CHLORINE MAY BE USED IN THE FORM OF LIQUID SODIUM HYPOCHLORITE, SOLID CALCIUM HYPOCHLORITE AND BLEACHING POWDER (CHLORIDE OF LIME) 'C' - Strain it through a cloth refers to pouring water through a cloth that acts as a filter for collecting particles from the water. 'D' - Use water filter involves water flowing through a filter made of ceramic, sand or a combination of materials to remove particles and at least some microbes from the water. SURVEY COORDINATORS: CERAMIC MAY INCLUDE CLAYS, DIATOMACEOUS EARTH, GLASS AND OTHER FINE PARTICLES. 'E' - Solar disinfection consists of exposing water, stored in buckets, containers or clear vessels, to sunlight. 'F' - Let it stand and settle refers to storing water undisturbed and without mixing long enough for larger particles to settle to the bottom by gravity. The settled water is carefully removed by decanting, ladling or other gentle methods that do not disturb the settled particles. Households ? Missing Z DK Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water Heard of arsenic in water 1 Yes 2 No 9 Missing Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body Black, white or red spot in body ? Missing A Black, white or red spot in body Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough Hand and feet become rough ? Missing B Hand and feet become rough Legs swells up Legs swells up Legs swells up Legs swells up Legs swells up ? Missing C Legs swells up Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs Losing the feelings of hand and legs ? Missing D Losing the feelings of hand and legs Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg Sore over hand and leg ? Missing E Sore over hand and leg Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW Using water from arsenic free TW ? Missing A Using water from arsenic free TW Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water Using boiled pond/river/canal water ? Missing B Using boiled pond/river/canal water Using rain water Using rain water Using rain water Using rain water Using rain water ? Missing C Using rain water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water Using pond/sand filter water ? Missing D Using pond/sand filter water Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter Using SIDKO filter ? Missing E Using SIDKO filter Others Others Others Others Others ? Missing X Others Nothing/DK Nothing/DK Nothing/DK Nothing/DK Nothing/DK ? Missing Z Nothing/DK TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic TW tested for arsenic 1 Not tested 2 Tested/marked red 3 Tested/marked green 9 Missing Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility Kind of toilet facility What kind of toilet facility do members of your household usually use? If "flush" or "pour flush", probe: Where does it flush to? If necessary, ask permission to observe the facility. Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of this question is to obtain a measure of the cleanliness of the sanitary facility used by the household members. It may be necessary to observe the facility. If so, ask permission to do so. If the respondent answers or it is observed that the household members have no facilities or use the bush or field, enter '95' for 'No facilities or bush or field' and skip to the next module. If any of the flush or pour flush responses (11-15) are given, probe: "WHERE DOES IT FLUSH TO?" Circle the code corresponding to the response given. Definitions of various types of toilet facilities are as follows: A flush toilet uses a cistern or holding tank for flushing water and has a water seal, which is a U-shaped pipe, below the seat or squatting pan that prevents the passage of flies and odours. A pour flush toilet uses a water seal, but unlike a flush toilet, a pour flush toilet uses water poured by hand for flushing (no cistern is used). . '11' - A piped sewer system is a system of sewer pipes, also called sewerage, that is designed to collect human excreta (faeces and urine) and wastewater and remove them from the household environment. Sewerage systems consist of facilities for collection, pumping, treating and disposing of human excreta and wastewater. . '12' - A septic tank is an excreta collection device and is a water-tight settling tank normally located underground, away from the house or toilet. . '13' - A flush/pour flush to pit latrine refers to a system that flushes excreta to a hole in the ground. . '14' - A flush/pour flush to somewhere else refers to excreta being deposited in or nearby the household environment (not into pit, septic tank or sewer); excreta may be flushed to the street, yard/plot, drainage way or other location. . '15' - Flush to unknown place/not sure/DK where should be coded in cases when the respondent knows that the toilet facility is a flush toilet, but does not know where it flushes to. '21' - A ventilated improved pit latrine or VIP is a type of pit latrine that is ventilated by a pipe extending above the latrine roof. The open end of the vent pipe is covered with gauze mesh or fly-proof netting and the inside of the superstructure is kept dark. '22' - A pit latrine with slab uses a hole in the ground for excreta collection and has a squatting slab, platform or seat that is firmly supported on all sides, easy to clean and raised above the surrounding ground level to prevent surface water from entering the pit. '23' - A pit latrine without slab uses a hole in the ground for excreta collection and does not have a squatting slab, platform or seat. An open pit is a rudimentary hole in the ground where excreta is collected. '31' - A composting toilet is a toilet into which excreta and carbon-rich material are added (vegetable wastes, straw, grass, sawdust, ash) and special conditions maintained to produce inoffensive compost. '41' - Bucket refers to the use of a bucket or other container for the retention of faeces (and sometimes urine and anal cleaning material), which is periodically removed for treatment or disposal. '51' - A hanging toilet or hanging latrine is a toilet built over the sea, a river, or other body of water into which excreta drops directly. '95' - No facilities or bush or field includes excreta wrapped and thrown with garbage, the 'cat' method of burying excreta in dirt, defecation in the bush or field or ditch, and defecation into surface water (drainage channel, beach, river, stream or sea). Households 11 Flush to piped sewer system 12 Flush to septic tank 13 Flush to pit (latrine) 14 Flush to somewhere else 15 Flush to unknown place/not sure/DK where 22 Pit latrine with slab 23 Pit latrine without slab/open pit 41 Bucket 51 Hanging toilet/hanging latrine 95 No facilities or bush or field 96 Other 99 Missing Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Toilet facility shared Do you share this facility with other households? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- Circle the code corresponding to the response given. If 'No', go to the next module. Households 1 Yes 2 No 9 Missing Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility How many households in total use this toilet facility? Questions WS7, WS8 and WS9 are about the toilet facility household members use. --- The purpose of the following two questions is to determine whether the household shares their sanitation facility with other households. The shared status of a sanitation facility is important because shared facilities can be less hygienic than facilities used by only a single household. Unhygienic conditions (faeces on the floor, seat or wall and flies) may discourage use of the facility. --- The total number of households using this facility should include the household being interviewed. If less than ten households use this toilet facility, enter the number of households on the line provided. Circle '10' if ten or more households use this toilet facility. Note that '01' is not a valid response (since it means that this is the only this household that uses the facility; if that is the case, you should go back to WS8 and correct the response there). Circle '98' for 'DK' ('Doesn't know'). Households 10 Ten or more households 98 DK 99 Missing Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication Hand washing after defication 1 Only water 2 Water and soil 3 Water and ash 4 Water and soap 6 Others 9 Missing Religion Religion Religion Religion Religion What is the religion of the head of this household? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Islam 2 Hindu 3 Christian 4 Buddist 6 Others 7 No religion 9 Missing Ethnicity Ethnicity Ethnicity Ethnicity Ethnicity To what ethnic group does the head of this household belong? Circle the code corresponding to the answer given. Make sure to get the religion, ethnicity or mother tongue/native language of the household head. Households 1 Bangali 2 Chakma 3 Saontal 4 Marma 5 Tripura 6 Others 7 Garo 9 Missing Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping How many rooms in this household are used for sleeping? This information provides a measure of how crowded the house is, and reflects the socio-economic condition of the household. A room in this case refers to a special area with a permanent partition that is used for sleeping. It is not necessarily the number of rooms in the household that are called 'bedrooms', but rather how many rooms get used for sleeping on a regular basis. Exclude rooms that are used only for sleeping by visitors to the household, but include those rooms that may not be regular 'bedrooms' but may be regularly used by one or more of the household members for sleeping. Enter the number of rooms in this household that are used for sleeping. Households 99 Missing Main material of floor Main material of floor Main material of floor Main material of floor Main material of floor Main material of the dwelling floor: Record observation. Circle the correct code for the material of the dwelling floor based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the floor, record the main flooring material (the material that covers the largest amount of floor space). Households 11 Earth/sand 21 Wood planks 22 Palm/bamboo 31 Polished wood 33 Ceramic tiles/Mojaic 34 Cement 35 Carpet 96 Other 99 Missing Main material of roof Main material of roof Main material of roof Main material of roof Main material of roof Main material of the roof. Record observation. Circle the correct code for the material of the dwelling roof, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the roof, record the main roofing material (the material that covers the largest amount of roof). Households 12 Thatch/palm leaf 21 Rustic mat/Plastic sheet/Polythine 22 Palm/bamboo 31 Metal 32 Wood 34 Ceramic tiles 35 Cement 96 Other 99 Missing Main material of wall Main material of wall Main material of wall Main material of wall Main material of wall Main material of the walls. Record observation. Circle the correct code for the material of the dwelling walls, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the walls, record the main wall material (the material that covers the largest amount of wall space). Households 12 Cane/palm/trunks/Leaf/Jute stick/Sod 13 Dirt/Mud 21 Bambo with mud 22 Stone with mud 25 Carton/Tin sheet 31 Cement 33 Bricks 96 Other 99 Missing Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking What type of fuel does your household mainly use for cooking? Information on the type of fuel used for cooking is collected as another measure of the socio-economic status of the household. The use of some cooking fuels can also have adverse health consequences. Circle the code corresponding to the answer given. Remember that this question asks about fuel for cooking, not fuel for heating or lighting. If the household uses more than one fuel for cooking, find out which type of fuel is used most often. If electricity, liquid propane gas (LPG), natural gas, or biogas is mainly used, circle '01', '02', '03', or '04', respectively, and skip to HC8. If any fuel other than the pre-coded ones is reported as being the main fuel used for cooking, circle '96' and specify the type of fuel on the line provided. Definitions of some of the types of fuel are as follows: 'Biogas' includes gases produced by fermenting manure in an enclosed pit. 'Lignite' is a derivative of coal that produces more smoke when burned but produces less heat than coal. Households 1 Electricity 2 Liquid propane gas (LPG) 3 Natural gas 4 Biogas 5 Kerosene 8 Wood 9 Straw/shrubs/grass 10 Animal dung 11 Agricultural crop residue 96 Other 99 Missing Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire In this household, is food cooked on an open fire, an open stove or a closed stove? Probe for type. Probe for type of stove and circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '96' and specify the type of stove on the line provided. For 'Closed stove', skip the next question and ask HC8. Households 1 Open fire 2 Open stove 3 Closed stove 6 Other 9 Missing Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire stove have a chimney or a hood Does the fire/stove have a chimney or a hood? Circle the appropriate response. Households 1 Yes 2 No 9 Missing Cooking location Cooking location Cooking location Cooking location Cooking location Is the cooking usually done in the house, in a separate building, or outdoors? Circle the code corresponding to the response given. If a response is given other than the pre-coded ones, circle '6' and specify on the line provided. Households 1 In the house 2 In a separate bulding 3 Outdoors 6 Other 9 Missing Electricity Electricity Electricity Electricity Electricity Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Radio Radio Radio Radio Radio Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Television Television Television Television Television Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Mobile phone Mobile phone Mobile phone Mobile phone Mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Refrigerator Refrigerator Refrigerator Refrigerator Refrigerator Does your household have: Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: ELECTRICITY, RADIO, TELEVISION, MOBILE TELEPHONE, NON-MOBILE TELEPHONE, REFRIGERATOR? Households 1 Yes 2 No 9 Missing Electric fan Electric fan Electric fan Electric fan Electric fan 1 Yes 2 No 9 Missing Computer Computer Computer Computer Computer 1 Yes 2 No 9 Missing AC AC AC AC AC 1 Yes 2 No 9 Missing Washing machine Washing machine Washing machine Washing machine Washing machine 1 Yes 2 No 9 Missing Watch Watch Watch Watch Watch Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Bicycle Bicycle Bicycle Bicycle Bicycle Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Car or truck Car or truck Car or truck Car or truck Car or truck Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Boat with a motor Boat with a motor Boat with a motor Boat with a motor Boat with a motor Does any member of your household own: This question collects information on the ownership of various items owned by any of the household members. Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that an item such as a motorcycle is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. Ask the question for the following items: WATCH, BICYCLE, MOTORCYCLE OR SCOOTER, ANIMAL-DRAWN CART, CAR OR TRUCK, BOAT WITH A MOTOR. Households 1 Yes 2 No 9 Missing Sofa Sofa Sofa Sofa Sofa 1 Yes 2 No 9 Missing Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van Rickshaw Van 1 Yes 2 No 9 Missing Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured Did any under 18 children get injured 1 Yes 2 No 9 Missing Fall_Boy Fall_Boy Fall_Boy Fall_Boy Fall_Boy 9 Missing Fall_Girl Fall_Girl Fall_Girl Fall_Girl Fall_Girl 9 Missing Burn_Boy Burn_Boy Burn_Boy Burn_Boy Burn_Boy 9 Missing Burn_Girl Burn_Girl Burn_Girl Burn_Girl Burn_Girl 9 Missing Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy Accidental poisoning_Boy 9 Missing Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl Accidental poisoning_Girl 9 Missing Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy Animal/snake/insect_Boy 9 Missing Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl Animal/snake/insect_Girl 9 Missing Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy Rd. Accident_Boy 9 Missing Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl Rd. Accident_Girl 9 Missing Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy Drowned_Boy 9 Missing Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl Drowned_Girl 9 Missing Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy Acid victim_Boy 9 Missing Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl Acid victim_Girl 9 Missing Other_Boy Other_Boy Other_Boy Other_Boy Other_Boy 9 Missing Other_Girl Other_Girl Other_Girl Other_Girl Other_Girl 9 Missing Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy Recovered_Boy 9 Missing Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl Recovered_Girl 9 Missing Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy Still suffering_Boy 9 Missing Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl Still suffering_Girl 9 Missing Died_Boy Died_Boy Died_Boy Died_Boy Died_Boy 9 Missing Died_Girl Died_Girl Died_Girl Died_Girl Died_Girl 9 Missing Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household Was there any marriage in the household 1 No Marriage 2 Registered 3 Not registered 8 DK Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year Duration of living in the slum area in year 99 Missing Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin Do you or someone in this household own or rent this dwellin 1 Own 2 Rent 3 Rentfree/squatter/other 9 Missing Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th Do you or someone in this household have a title deed for th 1 Yes 2 No 9 Missing Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) Certificate of occupation (or adjudication certificate) ? Missing A Certificate of occupation (or adjudication certificate) Property tax certification Property tax certification Property tax certification Property tax certification Property tax certification ? Missing B Property tax certification Utility bills Utility bills Utility bills Utility bills Utility bills ? Missing C Utility bills Other Other Other Other Other ? Missing X Other None/No document None/No document None/No document None/No document None/No document ? Missing Y None/No document Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling Do you have a written rental contract for this dwelling 1 Yes 2 No 9 Missing Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) Informal agreement (written) ? Missing A Informal agreement (written) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) Verbal agreement (no document) ? Missing B Verbal agreement (no document) Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner Occupied rent free with knowledge of the owner ? Missing C Occupied rent free with knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner Occupied rent free without knowledge of the owner ? Missing D Occupied rent free without knowledge of the owner Other Other Other Other Other ? Missing X Other None/No document None/No document None/No document None/No document None/No document ? Missing Y None/No document Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling Do you feel secure from eviction fromthis dwelling 1 Yes 2 No 8 DK 9 Missing Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years Have you been evicted from your home in the 5 past years 1 Yes 2 No 9 Missing Landslide area Landslide area Landslide area Landslide area Landslide area ? Missing A Landslide area Flood-prone area Flood-prone area Flood-prone area Flood-prone area Flood-prone area ? Missing B Flood-prone area River bank River bank River bank River bank River bank ? Missing C River bank Steep hill Steep hill Steep hill Steep hill Steep hill ? Missing D Steep hill Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile Garbage mountain/pile ? Missing E Garbage mountain/pile Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area Industrial pollution area ? Missing F Industrial pollution area Railroad Railroad Railroad Railroad Railroad ? Missing G Railroad None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Cracks/openings in walls Cracks/openings in walls Cracks/openings in walls Cracks/openings in walls Cracks/openings in walls ? Missing A Cracks/openings in walls No windows No windows No windows No windows No windows ? Missing B No windows Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass Windows with broken glass/no glass ? Missing C Windows with broken glass/no glass Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof Visible holes in the roof ? Missing D Visible holes in the roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof Incomplete roof ? Missing E Incomplete roof Insecure door Insecure door Insecure door Insecure door Insecure door ? Missing F Insecure door Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) Squartter (Jhupri) ? Missing G Squartter (Jhupri) None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Very narrow passage between house intead of road Very narrow passage between house intead of road Very narrow passage between house intead of road Very narrow passage between house intead of road Very narrow passage between house intead of road ? Missing A Very narrow passage between house intead of road Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's Too many power cables connecting to neighborhood's ? Missing B Too many power cables connecting to neighborhood's None of the above None of the above None of the above None of the above None of the above ? Missing Y None of the above Children's sample weight Children's sample weight Children's sample weight Children's sample weight Children's sample weight Recoded variable Children aged 0-4 Wealth index score Wealth index score Wealth index score Wealth index score Wealth index score Recoded variable Children aged 0-4 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Recoded variable Children aged 0-4 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Date of interview child (CMC) Date of interview child (CMC) Date of interview child (CMC) Date of interview child (CMC) Date of interview child (CMC) Recoded variable Children aged 0-4 Date of birth (CMC) Date of birth (CMC) Date of birth (CMC) Date of birth (CMC) Date of birth (CMC) Recoded variable Children aged 0-4 Age (months) Age (months) Age (months) Age (months) Age (months) Recoded variable Children aged 0-4 Age Age Age Age Age Recoded variable Children aged 0-4 1 < 6 months 2 6-11 months 3 12-23 months 4 24-35 months 5 36-47 months 6 48-59 months Age Age Age Age Age Recoded variable Children aged 0-4 1 0-11 months 2 12-23 months 3 24-35 months 4 36-47 months 5 48-59 months Mother's education Mother's education Mother's education Mother's education Mother's education 1 None 2 Primary 3 Secondary 4 Non-standard curriculum 9 Missing/DK Mother's education Mother's education Mother's education Mother's education Mother's education Recoded variable Children aged 0-4 1 None 2 Primary incomplete 3 Primary completed 4 Secondary incomplete 5 Secondary completed or higher 6 Non-standard curriculum 9 Missing/DK