DDI_GEO_2005_MICS_v01_M
Bjelic, Ivana
Croft, Trevor
Holmberg, Emma
2009-04-24
NADA
Georgia MICS 2005 v0.1
Slightly edited version of UNICEF's DDI ref. DDI-GEO-SDS-MICS2005/1.0-v0.7
Multiple Indicator Cluster Survey 2005
MICS3 2005
Georgia Multiple Indicator Cluster Survey (MICS) 2005
GEO_2005_MICS_v01_M
State Department of Statistics of Georgia
National Center for Disease Control
Croft, Trevor
Unalan,Turgay
Sullivan, Kevin
Turner, Tony
State Department of Statistics of Georgia
National Center for Disease Control
UNICEF, Georgia Country Office
UNICEF Regional MICS coordinator
UNICEF Regional M&E officer
Strategic Information Section, Division of Policy and Planning, UNICEF NYHQ
2008, State Department of Statistics, Georgia
NADA
UNICEF
UNICEF
Organisation for economic co-operation and development
SC/2003/9901-50 SC/2003/9901-50
Paqsashvili, Temur
Hancioglu, Attila
Barberis, Giovanna
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
Child discipline
Disability
Salt iodization
Women's background
Child mortality
Maternal and newborn health
Marriage and union
Contraception
Attitudes towards domestic violence
HIV/AIDS
Cigarette smoking
Hemoglobin test
Children's background
Birth registration
Early learning
Child development
Breastfeeding
Care of illness
Immunization
Anthropometry
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 2005 Georgia Multiple Indicator Cluster Survey has as its primary objectives:
- To provide up-to-date information for assessing the situation of children and women in Georgia;
- To furnish data needed for monitoring progress toward goals established in the Millennium Declaration, 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 Georgia 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 carried out by the State Department of Statistics of Georgia and the National Centre for Disease Control of Georgia, with the support and assistance of UNICEF.
Technical assistance and training for the MICS 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.
Georgia
The survey is nationally representative and covers the whole of Georgia.
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 Georgia Multiple Indicator Cluster Survey included the following modules in the questionnaires:
HOUSEHOLD QUESTIONNAIRE : Household Listing, Education, Water and Sanitation, Household Characteristics, Child Labour, Child Discipline, Disability, and Salt Iodization.
WOMEN'S QUESTIONNAIRE: Child Mortality, Maternal and Newborn Health, Marriage and Union, Contraception, Attitudes Towards Domestic Violence, HIV knowledge, Cigarette Smoking, and Hemoglobin Test (Hemoglobin measurements were performed in every third household in all clusters on women 15-49 years of age).
CHILDREN'S QUESTIONNAIRE: Birth Registration and Early Learning, Child Development, Breastfeeding, Care of Illness, Immunization (The immunization levels were based primarily on recall and it appeared that the respondents' reporting of the immunizations received and, in particular, the number of doses was under reported. As a result, it was decided that the immunization levels are not reported because of the strong potential for biased estimates), Anthropometry.
State Department of Statistics of Georgia
The principal objective of the sample design was to provide current and reliable estimates on a set of indicators covering the four major areas of the World Fit for Children declaration, including promoting healthy lives; providing quality education; protecting against abuse, exploitation and violence; and combating HIV/AIDS. The population covered by the 2005 MICS is defined as the universe of all women aged 15-49 and all children aged under 5. A sample of households was selected and all women aged 15-49 identified as usual residents of these households were interviewed. In addition, the mother or the caretaker of all children aged under 5 who were usual residents of the household were also interviewed about the child.
The 2005 MICS collected data from a nationally representative sample of households, women and children. The primary focus of the 2005 MICS was to prodvide estimates of key population and health, education, child protection and HIV related indicators for the country as a whole, and for urban and rural areas separately. In additon, the sample was designed to provide estimates for each of the 11 regions for key indicators. Georgia is devided into 11 regions: Tbilisi, Kakheti, Mtskheta - Mtianeti, Shida Kartli, Kvemo Kartli, Samtskhe - Javakheti, Racha - Lechkhumi and Kvemo, Svaneti, Imereti, Guria, Samegrelo and Zemo Svaneti, Adjara. The sample frame for this survey was based on the list of enumeration areas developed from the 2002 population census.
The primary sampling unit (PSU), the cluster for the 2005 MICS, is defined on the basis of the enumeration areas from the census frame. The minimum PSU size in Georgia is 11 households and the maximum PSU size is 188 households. The average PSU size is 70.8 households. While constructing the sampling frame the PSUs that are smaller then 30 households is merged with the neighbouring PSUs to achieve the minimum size of PSU equalling to 30 households. Although the original sample design for the Georgia MICS 2005 called for approximately 14000 households with an equal number of clusters (42) of households in each of the 11 regions, stratified into urban and rural areas, this sample design was changed to use a more complicated stratification design, with unequal numbers of clusters in each stratum. The rationale for this was for the selection to more closely follow the population distribution of the population.
The sample was selected in four stages and in the first two stages, sample design was stratified according to 11 regions, 3 settlement types (Large town, Small town, and Village), and 4 geographic strata (Valley, Foothills, Mountain, and High mountain). This stratification was applied in all regions, except the city of Tbilisi where the region is stratified according to 10 districts. In total 49 separate strata were identified. The last two stages of the sample design were for the selection of clusters and households.
First stage of sampling: The number of clusters based on sample size calculations was 467 and these were allocated to regions based on the cube root of the number of households in the region. Because the number of clusters for the Racha-Lechkumi region was small (12 clusters), it was decided to increase the number of clusters in that region by 8 for a total of 20 clusters in that region for a total of 475 clusters nationwide.
Second stage of sampling: Within each region, another level of stratification was on a combination of the following: size of settlement (large town, small town, and village) and topography (valley, foothills, mountain, and mountain). The allocation of the number of clusters for a settlement/topography stratum was based on the square root of the number of households in each stratum. Some regions did not have each of the different size settlements or topography. Also, in Tbilisi, the Rayons (districts) were used for stratification.
Third stage of sampling: Within each stratum, clusters were selected with probability proportional to population size (PPS).
Fourth stage of sampling: Within each cluster, 30 households were systematically selected, resulting with 14,250 households.
The Georgia Multiple Indicator Cluster Survey sample is not self-weighted. The basic weighting of the data has been done using the inverse of the probability of selection of each household.
Following standard MICS data collection rules, if a household was actually more than one household when visited, then a) if the selected household contained two households, both were interviewed, or b) if the selected household contained 3 or more households, then only the household of the person named as the head was interviewd.
No replacement of households was permitted in case of non-response or non-contactable households. Adjustments were made to the sampling weights to correct for non-response, according to MICS standard procedures.
The sampling procedures are more fully described in the sampling design document and the sampling appendix of the final report.
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 for the Georgia MICS were structured questionnaires based on the MICS3 Model Questionnaire with some modifications and additions. A household questionnaire was administered in each household, which collected various information on household members including sex, age, relationship, and orphanhood status. The household questionnaire includes household listing, education, water and sanitation, household characteristics, child labour, child discipline, disability, and salt iodization.
In addition to a household questionnaire, questionnaires were administered in each household for women age 15-49 and children under age five. For children, the questionnaire was administered to the mother or caretaker of the child.
The women's questionnaire includes child mortality, maternal and newborn health, marriage and union, contraception, attitudes towards domestic violence, HIV knowledge, cigarette smoking, and hemoglobin test.
The children's questionnaire includes birth registration and early learning, child development, breastfeeding, care of illness, immunization*, and anthropometry.
The questionnaires are based on the MICS3 model questionnaire. From the MICS3 model English and Russian versions, the questionnaires were translated into Georgian and were pre-tested in Tbilisi and in Mtskheta-Mtianeti during September 2005. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires.
*The immunization levels were based primarily on recall and it appeared that the respondents' reporting of the immunizations received and, in particular, the number of doses was under reported. As a result, it was decided that the immunization levels are not reported because of the strong potential for biased estimates.
The pretest for the survey took place in September 2005 at Tbilisi and Mtskheta-Mtianeti.
The data were collected by 12 teams; each was comprised of five interviewers, two drivers, one editor/measurer and one supervisor.
Data collection took place from September 11, 2005 until December 30, 2005. Interviewing took place everyday throughout the fieldwork period, although interviewing teams were permitted to take one day off per week.
Interviews averaged 35 minutes for the household questionnaire (excluding salt testing), 23 minutes for the women's questionnaire, and 27 for the under five children's questionnaire (excluding the anthropometry). Interviews were conducted in Georgian.
Four staff members of Department of Statistics provided overall fieldwork coordination and supervision. The overall field coordinator was Nodar Kapanadze.
Interviewing was conducted by teams of interviewers. Each interviewing team comprised of five interviewers, two drivers, one editor/measurer and one supervisor. Each team used a 4 wheel drive vehicle to travel from cluster to cluster (and where necessary within cluster).
The role of the supervisor was to coordinate field data collection activities, including management of the field teams, supplies and equipment, finances, maps and listings, coordinate with local authorities concerning the survey plan and make arrangements for accomodation and travel. Additionally, the field supervisor assigned the work to the interviewers, spot checked work, maintained field control documents, and sent completed questionnaires and progress reports to the central office
The field editor was responsible for reviewing each questionnaire at the end of the day, checking for missed questions, skip errors, fields incorrectly completed, and checking for inconsistencies in the data. The field editor also observed interviews and conducted review sessions with interviewers.
Responsibilities of the supervisors and field editors are described in the Instructions for Supervisors and Field Editors, together with the different field controls that were in place to control the quality of the fieldwork.
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 14,250 households selected for the sample, 12,268 were found to be occupied. Of these, 12,010 were successfully interviewed for a household response rate of 97.9 percent. In the interviewed households, 10,908 women (age 15-49) were identified. Of these, 9,847 were successfully interviewed, yielding a response rate of 90.3 percent. In addition, 2,196 children under age five were listed in the household questionnaire. Questionnaires were completed for 2,037 of these children, which corresponds to a response rate of 92.8 percent. Overall response rates of 88.4 and 90.8 are calculated for the women's and under-5's interviews respectively.
Response rates were similar across residence while slight variations in response rates observed by regions. Although the capital city of Tbilisi had the lowest household response rate, the highest response rate for the women questionnaire was found in Tbilisi. The highest response rates for household and children under-5 questionnaires were found in Racha-Lechkhumi and Kvemo Svaneti while Guria region had the lowest response rate for children 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 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 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 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 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 11 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).
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 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.
State Department of Statistics of Georgia
Giovanna Barberis
State Department of Statistics, Georgia. Multiple Indicator Cluster Survey: Household , household listing, women and children's files, 2005 [Computer file]. Tbilisi, Georgia: State Department of Statistics [producer], 2008. Tbilisi, Georgia: State Department of Statistics and New York: Strategic Information Section, Dvision of Policy and Planning, UNICEF [distributors], 2008.
Survey datasets are distributed at no cost for legitimate research, with the condition that we receive a description of the research objectives 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: Dimitri Gugushvili, UNICEF Georgia, dgugushvili@unicef.org
Requests for access to the datasets may be made through the website www.childinfo.org.
State Department of Statistics and UNICEF provide these data to external users without any warranty or responsibility implied. State Department 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
84
hl
Data collected at the household member's level (MICS Household questionnaire: modules Household listing, Child labour,Child Disability)
0
108
wm
Data collected at the women's level (MICS Women's questionnaire: modules Women's Information Panel, Child mortality, Maternal and newborn health, Marriage/union, Contraception (and unmet need), HIV/AIDS, Sexual behaviour, Attitudes towards domestic violence Cigarette Smoking, Hemoglobin Test (Hemoglobin measurements were performed in every third household in all clusters on women 15-49 years of age)).
0
187
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, Breastfeeding, Care of Illness, Immunization, Anthropometry, Child development)
0
233
Interview and HH identification
Characteristics of dwelling
Water and sanitation
Characteristics of the head
Members characteristics
Education
Children's living arrangements
Child mortality
Maternal and newborn health
Nutrition
Child health
Contraception
Child protection
Marriage/union
HIV-AIDS
Women smoking prevalence
Hemoglobin testing
Wealth Index
Asset ownership
Weighting coefficients
Antenatal care
Care seeking behaviour
Child labor
Salt iodization
Early child development
Early learning
Child discipline
Support to orphans and vulnerable children
Child disability
Vitamin A
Assistance at delivery
Unmet need
Attitudes towards domestic violence
Newborn health
Immunizations
Birth registration
Early marriage
Anthropometry
Cooking fuels
Diarrhoea
Acute respiratory infection
Disposal of child's stools
Breastfeeding
Cluster number
Cluster number
Cluster number
Cluster number
Cluster number
We are from Department for Statistics and National Center of Illness Control. 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 30 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:
Children aged 0-4
Unique identifier for the cluster in which the household exists
Household number
Household number
Household number
Household number
Household number
Household number:
Children aged 0-4
Houshold number within the cluster
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer name and number:
Children aged 0-4
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor name and number:
Children aged 0-4
Day of interview
Day of interview
Day of interview
Day of interview
Day of interview
Day/Month/Year of interview:
Children aged 0-4
Month of interview
Month of interview
Month of interview
Month of interview
Month of interview
Day/Month/Year of interview:
Children aged 0-4
Year of interview
Year of interview
Year of interview
Year of interview
Year of interview
Day/Month/Year of interview:
Children aged 0-4
Area
Area
Area
Area
Area
Area:
Children aged 0-4
1
Urban
2
Rural
Region
Region
Region
Region
Region
Region:
Children aged 0-4
1
Tbilisi
2
Kaxeti
3
Mcxeta - Mtianeti
4
Sida Qartli
5
Qvemo Qartli
6
Samcxe - Javaxeti
7
Raja - Lechxumi
8
Imereti
9
Guria
10
Samegrelo
11
Adjara
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:
Children aged 0-4
1
Completed
2
Refused
3
Not at home
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:
Children aged 0-4
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:
Children aged 0-4
Total eligible women
Total eligible women
Total eligible women
Total eligible women
Total eligible women
No.of women eligible for interview:
Children aged 0-4
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
No.of women questionnaires completed:
Children aged 0-4
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:
Children aged 0-4
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
No.of under-5 questionnaires completed:
Children aged 0-4
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk:
Children aged 0-4
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
Missing
D
Use water filter
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
E
Solar disinfection
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?
Children aged 0-4
?
Missing
F
Let it stand and settle
Other
Other
Other
Other
Other
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
X
Other
DK
DK
DK
DK
DK
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
Z
DK
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?
Children aged 0-4
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
21
Ventilated Improved Pit latrine (VIP)
22
Pit latrine with slab
23
Pit latrine without slab/open pit
31
Composting toilet
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?
Children aged 0-4
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?
Children aged 0-4
10
Ten or more households
98
DK
99
Missing
Religion of head
Religion of head
Religion of head
Religion of head
Religion of head
What is the religion of the head of this household?
Children aged 0-4
1
Christian
2
Jewish
3
Muslim
6
Other Religion
7
No Religion
9
Missing
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
What is the mother tongue/native language of the head of this household?
Children aged 0-4
1
Georgian
2
Abkhazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Language
9
Missing
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Recoded variable
To what ethnic group does the head of this household belong?
Children aged 0-4
1
Georgian
2
Abkhazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Ethnicity
9
Missing
The variable is created from information collected on religion in the HH file. Codes 2,6 and 7 are recoded into code 6 (other).
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?
Children aged 0-4
99
Missing
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Record observation.
Children aged 0-4
11
Earth/sand
12
Dung
21
Wood planks
22
Palm/bamboo
31
Parquet or polished wood
32
Vinyl or asphalt strips
33
Ceramic tiles
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
Record observation.
Children aged 0-4
11
No roof
12
Thatch/palm leaf
13
Sod
21
Rustic mat
22
Palm/bamboo
23
Wood Planks
31
Metal
32
Wood
33
Calamine/cement fiber
34
Ceramic tiles
35
Cement
36
Roofing shingles
96
Other
99
Missing
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Record observation.
Children aged 0-4
11
No walls
12
Cane/palm/trunks
13
Dirt
21
Bambo with mud
22
Stone with mud
23
Uncovered adobe
24
Plywood
25
Carton
26
Reused wood
31
Cement
32
Stone with lime/cement
33
Bricks
34
Cement blocks
35
Covered adobe
36
Wood planks/shingles
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?
Children aged 0-4
1
Electricity
2
Liquid propane gas (LPG)
3
Natural gas
4
Biogas
5
Kerosene
6
Coal/lignite
7
Charcoal
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
1
Yes
2
No
9
Missing
Electricity
Electricity
Electricity
Electricity
Electricity
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Radio
Radio
Radio
Radio
Radio
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Television
Television
Television
Television
Television
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Does your household have:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Watch
Watch
Watch
Watch
Watch
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Bicycle
Bicycle
Bicycle
Bicycle
Bicycle
Does any member of your household own:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Total children aged 2-14 years
Total children aged 2-14 years
Total children aged 2-14 years
Total children aged 2-14 years
Total children aged 2-14 years
Review the household listing and list each of the children aged 2-14 years below in order according to their line number (HL1). Do not include other household members outside of the age range 2-14 years. Record the line number, name, sex, age, and the line number of the mother or caretaker for each child. Then record the total number of children aged 2-14 in the box provided (CD7). Total children aged 2-14 years
Households
99
Missing
Rank number of child (from response box)
Rank number of child (from response box)
Rank number of child (from response box)
Rank number of child (from response box)
Rank number of child (from response box)
Use this table to select one child between the ages of 2 and 14 years, if there is more than one child in that age range in the household. Look for the last digit of the household number from the cover page. This is the number of the row you should go to in the table below. Check the total number of eligible children (2-14) in CD7 above. This is the number of the column you should go to. Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the child about whom the questions will be asked. Record the rank number in CD9 below. Finally, record the line number and name of the selected child in CD11 on the next page. Then, find the mother or primary caretaker of that child, and ask the questions, beginning with CD12. Record the rank number of the selected child from table 2 above
Households
99
Missing
Child line number
Child line number
Child line number
Child line number
Child line number
Identify eligible child aged 2 to 14 in the household using the tables on the preceding page, according to your instructions. Ask to interview the mother or primary caretaker of the selected child (identified by the line number in CD6). Write name and line no. of the child selected for the module from CD3 and CD2, based on the rank number in CD9.
One selected child per household aged 2-14
97
Inconsistent
99
Missing
Took away privileges
Took away privileges
Took away privileges
Took away privileges
Took away privileges
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Took away privileges, forbade something (name) liked or did not allow him/her to leave house).
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Explaned why something was wrong
Explaned why something was wrong
Explaned why something was wrong
Explaned why something was wrong
Explaned why something was wrong
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Explained why something (the behavior) was wrong.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Shook him/her
Shook him/her
Shook him/her
Shook him/her
Shook him/her
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Shook him/her.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Shouted yelled at or screamed at him/her
Shouted yelled at or screamed at him/her
Shouted yelled at or screamed at him/her
Shouted yelled at or screamed at him/her
Shouted yelled at or screamed at him/her
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Shouted, yelled at or screamed at him/her.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Gave him/hersomething else to do
Gave him/hersomething else to do
Gave him/hersomething else to do
Gave him/hersomething else to do
Gave him/hersomething else to do
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Gave him/her something else to do.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Spanked, hit or slapped him/her with bare hand
Spanked, hit or slapped him/her with bare hand
Spanked, hit or slapped him/her with bare hand
Spanked, hit or slapped him/her with bare hand
Spanked, hit or slapped him/her with bare hand
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Spanked, hit or slapped him/her on the bottom with bare hand.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Hit him/her on the bottom with or elsewhere with a belt
Hit him/her on the bottom with or elsewhere with a belt
Hit him/her on the bottom with or elsewhere with a belt
Hit him/her on the bottom with or elsewhere with a belt
Hit him/her on the bottom with or elsewhere with a belt
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Called him/her dumb, lazy
Called him/her dumb, lazy
Called him/her dumb, lazy
Called him/her dumb, lazy
Called him/her dumb, lazy
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Called him/her dumb, lazy, or another name like that.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Hit or slapped him/her on the face
Hit or slapped him/her on the face
Hit or slapped him/her on the face
Hit or slapped him/her on the face
Hit or slapped him/her on the face
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Hit or slapped him/her on the face, head or ears.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Hit or slapped him/her on the hand
Hit or slapped him/her on the hand
Hit or slapped him/her on the hand
Hit or slapped him/her on the hand
Hit or slapped him/her on the hand
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Hit or slapped him/her on the hand, arm, or leg.
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Beat him/her up with an implement
Beat him/her up with an implement
Beat him/her up with an implement
Beat him/her up with an implement
Beat him/her up with an implement
All adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you or anyone else in your household has used this method with (name) in the past month.
Beat him/her up with an implement (hit over and over as hard as one could).
One selected child per household aged 2-14
1
Yes
2
No
9
Missing
Do you believe to bring up you nedd to punish him/her
Do you believe to bring up you nedd to punish him/her
Do you believe to bring up you nedd to punish him/her
Do you believe to bring up you nedd to punish him/her
Do you believe to bring up you nedd to punish him/her
Do you believe that in order to bring up (raise, educate) (name) properly, you need to physically punish him/her?
One selected child per household aged 2-14
1
Yes
2
No
8
Don't know/no opinion
9
Missing
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.
Households
1
Not iodized 0 PPM (no colour)
2
Less than 15 PPM (weak colour)
3
15 PPM or more (strong colour)
7
Salt not tested
8
No salt in home
9
Missing
Head Religion (original)
Head Religion (original)
Head Religion (original)
Head Religion (original)
Head Religion (original)
What is the religion of the head of this household?
Households
1
Christian
2
Jewish
3
Muslim
6
Other Religion
7
No Religion
9
Missing
Head Tongue (Original)
Head Tongue (Original)
Head Tongue (Original)
Head Tongue (Original)
Head Tongue (Original)
What is the tongue of the head of this household?
Households
Head nationality (original)
Head nationality (original)
Head nationality (original)
Head nationality (original)
Head nationality (original)
To what ethnic group does the head of this household belong?
Households
1
Georgian
2
Abkhazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Ethnicity
9
Missing
Household weight
Household weight
Household weight
Household weight
Household weight
Recoded variable
De jure household members (usual residents)
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
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
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
Pre Primary and Primary
2
Secondary
3
High
4
Other-standard curriculum
9
Missing/DK
The variable is created from information collected on educational level in the HL file. See makehh.sps in the data processing external documentation.
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
The variable is created from information collected in the HL file. See makehh.sps in the data processing folder under technical information.
Cluster number
Cluster number
Cluster number
Cluster number
Cluster number
We are from Department for Statistics and National Center of Illness Control. 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 30 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:
Children aged 0-4
Unique identifier for the cluster in which the household exists
Household number
Household number
Household number
Household number
Household number
Household number:
Children aged 0-4
Houshold number within the cluster
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?
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 by blood
12
Niece/nephew by marriage
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
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").
De jure household members (usual residents)
97
97+
98
DK
Status
Status
Status
Status
Status
Member's Status 1 Lives permanently 2 Lives temporarily 3 Temporarily away in the country 4 Temporarily away outside the country
De jure household members (usual residents)
1
Lives permanently
2
Lives temporarily
3
Temporarily away in the country
4
Temporarily away outside the country
9
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
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
De jure household members (usual residents)
Not eligible
Line number of mother/caretaker for under 5 Interview
Line number of mother/caretaker for under 5 Interview
Line number of mother/caretaker for under 5 Interview
Line number of mother/caretaker for under 5 Interview
Line number of mother/caretaker for under 5 Interview
For each child under 5:
Who is the mother or primary caretaker of this child?
Record Line no. of mother/caretaker
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?
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'
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?
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'
De jure household members (usual residents) aged 0-17 (under 18)
97
Inconsistent
99
Missing
Line number
Line number
Line number
Line number
Line number
For household members age 5 and above
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?
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
Other-standard curriculum
8
DK
9
Missing
Highest grade at level
Highest grade at level
Highest grade at level
Highest grade at level
Highest grade at level
For household members age 5 and above
What is the highest grade (name) completed at this level?
De jure household members (usual residents)
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?
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.
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?
De jure household members (usual residents) aged 5-24
Preschool/kindergarten
1
Primary
2
Secondary
3
Higher
6
Other-standard curriculum
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?
De jure household members (usual residents) aged 5-24
97
Inconsistent
98
DK
99
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)?
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?
De jure household members (usual residents) aged 5-24
Preschool/kindergarten
1
Primary
2
Secondary
3
Higher
6
Other-standard curriculum
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?
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.
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?
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.
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?
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?
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?
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?)
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?
Children aged 5-14
98
DK
99
Missing
Line number from household listing
Line number from household listing
Line number from household listing
Line number from household listing
Line number from household listing
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.
De jure children aged 2-14
Any serious delay sitting, standang or walking
Any serious delay sitting, standang or walking
Any serious delay sitting, standang or walking
Any serious delay sitting, standang or walking
Any serious delay sitting, standang or walking
Compared with other children, does or did (name) have any serious delay in sitting, standing, or walking?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Does he have difficulty seeing in daytime or nightime
Does he have difficulty seeing in daytime or nightime
Does he have difficulty seeing in daytime or nightime
Does he have difficulty seeing in daytime or nightime
Does he have difficulty seeing in daytime or nightime
Compared with other children, does (name) have difficulty seeing, either in the daytime or at night?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Does he apprea to have difficulty hearing
Does he apprea to have difficulty hearing
Does he apprea to have difficulty hearing
Does he apprea to have difficulty hearing
Does he apprea to have difficulty hearing
Does (name) appear to have difficulty hearing? (uses hearing aid, hears with difficulty, completely deaf?)
De jure children aged 2-14
1
Yes
2
No
9
Missing
When you ask him to do something, does he understand what y
When you ask him to do something, does he understand what y
When you ask him to do something, does he understand what y
When you ask him to do something, does he understand what y
When you ask him to do something, does he understand what y
When you tell (name) to do something, does he/she seem to understand what you are saying?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Does he have difficulty walking or moving
Does he have difficulty walking or moving
Does he have difficulty walking or moving
Does he have difficulty walking or moving
Does he have difficulty walking or moving
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?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Does he have fits, become rigid or los consciousnes
Does he have fits, become rigid or los consciousnes
Does he have fits, become rigid or los consciousnes
Does he have fits, become rigid or los consciousnes
Does he have fits, become rigid or los consciousnes
Does (name) sometimes have fits, become rigid, or lose consciousness?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Does he learn to do thing like other
Does he learn to do thing like other
Does he learn to do thing like other
Does he learn to do thing like other
Does he learn to do thing like other
Does (name) learn to do things like other children his/her age?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Can says recognizable words
Can says recognizable words
Can says recognizable words
Can says recognizable words
Can says recognizable words
Does (name) speak at all (can he/she make him or herself understood in words; can say any recognizable words)?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Speech in any way different from normal
Speech in any way different from normal
Speech in any way different from normal
Speech in any way different from normal
Speech in any way different from normal
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)?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Can he name at least one object
Can he name at least one object
Can he name at least one object
Can he name at least one object
Can he name at least one object
For 2 year olds:
Can (name) name at least one object (for example, an animal, a toy, a cup, a spoon)?
De jure children aged 2-14
1
Yes
2
No
9
Missing
Compared to other children does he appear mentally backward,
Compared to other children does he appear mentally backward,
Compared to other children does he appear mentally backward,
Compared to other children does he appear mentally backward,
Compared to other children does he appear mentally backward,
Compared with other children of the same age, does (name) appear in any way mentally backward, dull or slow?
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:
Children aged 0-4
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor name and number:
Children aged 0-4
Day of interview
Day of interview
Day of interview
Day of interview
Day of interview
Day/Month/Year of interview:
Children aged 0-4
Month of interview
Month of interview
Month of interview
Month of interview
Month of interview
Day/Month/Year of interview:
Children aged 0-4
Year of interview
Year of interview
Year of interview
Year of interview
Year of interview
Day/Month/Year of interview:
Children aged 0-4
Area
Area
Area
Area
Area
Area:
Children aged 0-4
1
Urban
2
Rural
Region
Region
Region
Region
Region
Region:
Children aged 0-4
1
Tbilisi
2
Kaxeti
3
Mcxeta - Mtianeti
4
Sida Qartli
5
Qvemo Qartli
6
Samcxe - Javaxeti
7
Raja - Lechxumi
8
Imereti
9
guria
10
samegrelo
11
adjara
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:
Children aged 0-4
1
Completed
2
Refused
3
Not at home
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:
Children aged 0-4
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:
Children aged 0-4
Total eligible women
Total eligible women
Total eligible women
Total eligible women
Total eligible women
No.of women eligible for interview:
Children aged 0-4
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
No.of women questionnaires completed:
Children aged 0-4
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:
Children aged 0-4
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
No.of under-5 questionnaires completed:
Children aged 0-4
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk:
Children aged 0-4
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
Missing
D
Use water filter
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
E
Solar disinfection
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?
Children aged 0-4
?
Missing
F
Let it stand and settle
Other
Other
Other
Other
Other
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
X
Other
DK
DK
DK
DK
DK
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
Z
DK
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?
Children aged 0-4
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
21
Ventilated Improved Pit latrine (VIP)
22
Pit latrine with slab
23
Pit latrine without slab/open pit
31
Composting toilet
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?
Children aged 0-4
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?
Children aged 0-4
10
Ten or more households
98
DK
99
Missing
Religion of head
Religion of head
Religion of head
Religion of head
Religion of head
What is the religion of the head of this household?
Children aged 0-4
1
Christian
2
Jewish
3
Muslim
6
Other Religion
7
No Religion
9
Missing
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
What is the mother tongue/native language of the head of this household?
Children aged 0-4
1
Georgian
2
Abkhazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Language
9
Missing
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Recoded variable
To what ethnic group does the head of this household belong?
Children aged 0-4
1
Georgian
2
Abkhazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Ethnicity
9
Missing
The variable is created from information collected on religion in the HH file. Codes 2,6 and 7 are recoded into code 6 (other).
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?
Children aged 0-4
99
Missing
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Record observation.
Children aged 0-4
11
Earth/sand
12
Dung
21
Wood planks
22
Palm/bamboo
31
Parquet or polished wood
32
Vinyl or asphalt strips
33
Ceramic tiles
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
Record observation.
Children aged 0-4
11
No roof
12
Thatch/palm leaf
13
Sod
21
Rustic mat
22
Palm/bamboo
23
Wood Planks
31
Metal
32
Wood
33
Calamine/cement fiber
34
Ceramic tiles
35
Cement
36
Roofing shingles
96
Other
99
Missing
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Record observation.
Children aged 0-4
11
No walls
12
Cane/palm/trunks
13
Dirt
21
Bambo with mud
22
Stone with mud
23
Uncovered adobe
24
Plywood
25
Carton
26
Reused wood
31
Cement
32
Stone with lime/cement
33
Bricks
34
Cement blocks
35
Covered adobe
36
Wood planks/shingles
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?
Children aged 0-4
1
Electricity
2
Liquid propane gas (LPG)
3
Natural gas
4
Biogas
5
Kerosene
6
Coal/lignite
7
Charcoal
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
1
In the house
2
In a separate bulding
3
Outdoors
6
Other
9
Missing
Electricity
Electricity
Electricity
Electricity
Electricity
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Radio
Radio
Radio
Radio
Radio
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Television
Television
Television
Television
Television
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Does your household have:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Watch
Watch
Watch
Watch
Watch
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Bicycle
Bicycle
Bicycle
Bicycle
Bicycle
Does any member of your household own:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Household Weight
Household Weight
Household Weight
Household Weight
Household Weight
Recoded variable
De jure household members (usual residents)
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
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
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)
The variable is created from information collected in the houshold listing in the HL file. See makehl.sps in the data processing external documentation.
Mother's education
Mother's education
Mother's education
Mother's education
Mother's education
Recoded variable
Children aged 0-4
1
Pre Primary and Primary
2
Secondary
3
High
4
Other-standard curriculum
5
Mother not in household
9
Missing/DK
The variable is created from information collected on educational level in the HL file. See makewm.sps in the data processing external documentation.
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)
The variable is created from information collected in the houshold listing in the HL file. See makehl.sps in the data processing external documentation.
Father's education
Father's education
Father's education
Father's education
Father's education
Recoded variable
De jure household members (usual residents)
1
Pre Primary and Primary
2
Secondary
3
High
4
Other-standard curriculum
5
Father not in household
9
Missing/DK
The variable is created from information collected on educational level in the HL file. See makehl.sps in the data processing external documentation.
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
Pre Primary and Primary
2
Secondary
3
High
4
Other-standard curriculum
9
Missing/DK
The variable is created from information collected on educational level in the HL file. See makehh.sps in the data processing external documentation.
Cluster number
Cluster number
Cluster number
Cluster number
Cluster number
We are from Department for Statistics and National Center of Illness Control. 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 30 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:
Children aged 0-4
Unique identifier for the cluster in which the household exists
Household number
Household number
Household number
Household number
Household number
Household number:
Children aged 0-4
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:
Women aged 15-49
Household number
Household number
Household number
Household number
Household number
Household number:
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:
Women aged 15-49
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer name and number:
Women aged 15-49
Day of interview
Day of interview
Day of interview
Day of interview
Day of interview
Day/Month/Year of interview:
Women aged 15-49
Month of interview
Month of interview
Month of interview
Month of interview
Month of interview
Day/Month/Year of interview:
Women aged 15-49
Year of interview
Year of interview
Year of interview
Year of interview
Year of interview
Day/Month/Year of interview:
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
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?
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?
Women aged 15-49
9997
Inconsistent
9998
DK
9999
Missing
Age of woman
Age of woman
Age of woman
Age of woman
Age of woman
How old were you at your last birthday?
Women aged 15-49
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?
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?
Women aged 15-49
1
Primary
2
Secondary
3
Higher
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?
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
Women aged 15-49
1
Cannot read at all
2
Able to read only parts of sentence
3
Able to read whole sentence
4
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?
Women aged 15-49
1
Yes
2
No
Day of first birth
Day of first birth
Day of first birth
Day of first birth
Day of first birth
What was the date of your first birth? I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.
Skip to CM3 only if year of first birth is given. Otherwise, continue with CM2B.
Women aged 15-49
97
Inconsistent
98
DK
99
Missing
Month of first birth
Month of first birth
Month of first birth
Month of first birth
Month of first birth
What was the date of your first birth? I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.
Skip to CM3 only if year of first birth is given. Otherwise, continue with CM2B.
Women aged 15-49
97
Inconsistent
98
DK
99
Missing
Year of first birth
Year of first birth
Year of first birth
Year of first birth
Year of first birth
What was the date of your first birth? I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.
Skip to CM3 only if year of first birth is given. Otherwise, continue with CM2B.
Women aged 15-49
9997
Inconsistent
9998
DK
9999
Missing
Years since first birth
Years since first birth
Years since first birth
Years since first birth
Years since first birth
How many years ago did you have your first birth?
Women aged 15-49
97
Inconsistent
99
Missing
Any sons or daughters living with you
Any sons or daughters living with you
Any sons or daughters living with you
Any sons or daughters living with you
Any sons or daughters living with you
Do you have any sons or daughters to whom you have given birth who are now living with you?
Women aged 15-49
1
Yes
2
No
Sons living with you
Sons living with you
Sons living with you
Sons living with you
Sons living with you
How many sons live with you?
Women aged 15-49
Daughters living with you
Daughters living with you
Daughters living with you
Daughters living with you
Daughters living with you
How many daughters live with you?
Women aged 15-49
Any sons or daughters not living with you
Any sons or daughters not living with you
Any sons or daughters not living with you
Any sons or daughters not living with you
Any sons or daughters not living with you
Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
Women aged 15-49
1
Yes
2
No
Sons living not with you
Sons living not with you
Sons living not with you
Sons living not with you
Sons living not with you
How many sons are alive but do not live with you?
Women aged 15-49
Daughters not living with you
Daughters not living with you
Daughters not living with you
Daughters not living with you
Daughters not living with you
How many daughters are alive but do not live with you?
Women aged 15-49
Ever had child who later died
Ever had child who later died
Ever had child who later died
Ever had child who later died
Ever had child who later died
Have you ever given birth to a boy or girl who was born alive but later died?
Women aged 15-49
1
Yes
2
No
Boys dead
Boys dead
Boys dead
Boys dead
Boys dead
How many boys have died?
Women aged 15-49
Girls dead
Girls dead
Girls dead
Girls dead
Girls dead
How many girls have died?
Women aged 15-49
Children ever born
Children ever born
Children ever born
Children ever born
Children ever born
Sum answers to CM4, CM6, and CM8.
Just to make sure that I have this right, you have had in total (total number) births during your life. Is this correct? Yes. Go to CM11 No. Check responses and make corrections before proceeding to CM11
Women aged 15-49
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.
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)?
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)?
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_______________________
Women aged 15-49
N
No
Y
Yes
Wanted last child
Wanted last child
Wanted last child
Wanted last child
Wanted last child
At the time you became pregnant with (name), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?
Women aged 15-49
1
Then
2
later
3
No more
9
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.
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.
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.
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.
Women aged 15-49 who gave birth to a child in the 2 years preceding the survey
?
Missing
F
Traditional birth attendance
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.
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.
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.
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?
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?
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?
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?
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?
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
Tested for HIV/AIDS
Tested for HIV/AIDS
Tested for HIV/AIDS
Tested for HIV/AIDS
Tested for HIV/AIDS
I don't want to know the results, but were you tested for HIV/AIDS as part of your antenatal care?
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
Received result of HIV test
Received result of HIV test
Received result of HIV test
Received result of HIV test
Received result of HIV test
I don't want to know the results, but did you get the results of the test?
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.
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.
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.
Women aged 15-49 who gave birth to a child in the 2 years preceding the survey
?
Missing
F
Traditional birth attendance
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.
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.
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.
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.
Women aged 15-49 who gave birth to a child in the 2 years preceding the survey
11
Resondent's home
12
Other home
21
Government hospital
22
Government clinic/health center
26
Other public
31
Private hospital
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?
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?
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.
Women aged 15-49 who gave birth to a child in the 2 years preceding the survey
1
Card
2
Recall
7
Inconsistent
9
Missing
Weight at birth (Kilograms)
Weight at birth (Kilograms)
Weight at birth (Kilograms)
Weight at birth (Kilograms)
Weight at birth (Kilograms)
How much did (name) weigh?
Record weight from health card, if available.
Women aged 15-49 who gave birth to a child in the 2 years preceding the survey
9.998
DK
9.999
Missing
Ever breastfeed
Ever breastfeed
Ever breastfeed
Ever breastfeed
Ever breastfeed
Did you ever breastfeed (name)?
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.
Women aged 15-49 who gave birth to a child in the 2 years preceding the survey
Immediately
1
Hours
2
Days
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.
Women aged 15-49 who gave birth to a child in the 2 years preceding the survey
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?
Women aged 15-49
1
Yes, currently married
2
Yes, living with a man
3
No, not in union
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?
Women aged 15-49
98
DK
99
Missing
Ever married or lived with a man
Ever married or lived with a man
Ever married or lived with a man
Ever married or lived with a man
Ever married or lived with a man
Have you ever been married or lived together with a man?
Women aged 15-49
1
Yes, formerly married
2
Yes, formerly lived with a man
3
No
Marital status
Marital status
Marital status
Marital status
Marital status
What is your marital status now: are you widowed, divorced or separated?
Women aged 15-49
1
Widowed
2
Divorced
3
Separated
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?
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?
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?
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?
Women aged 15-49
97
Inconsistent
98
DK
99
Missing
Currently pregnant
Currently pregnant
Currently pregnant
Currently pregnant
Currently pregnant
I would like to talk with you about another subject - family planning - and your reproductive health.
Are you pregnant now?
Women aged 15-49
1
Yes, currently pregnant
2
No
8
Unsure or DK
9
Missing
Currently using a method to avoid pregnancy
Currently using a method to avoid pregnancy
Currently using a method to avoid pregnancy
Currently using a method to avoid pregnancy
Currently using a method to avoid pregnancy
Some people use various ways or methods to delay or avoid a pregnancy. Are you currently doing something or using any method to delay or avoid getting pregnant?
Women aged 15-49
1
Yes
2
No
9
Missing
Current method: Female sterilization
Current method: Female sterilization
Current method: Female sterilization
Current method: Female sterilization
Current method: Female sterilization
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
A
Female sterilization
Current method: Male sterilization
Current method: Male sterilization
Current method: Male sterilization
Current method: Male sterilization
Current method: Male sterilization
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
B
Male sterilization
Current method: Pill
Current method: Pill
Current method: Pill
Current method: Pill
Current method: Pill
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
C
PILL
Current method: IUD
Current method: IUD
Current method: IUD
Current method: IUD
Current method: IUD
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
D
IUD
Current method: Injections
Current method: Injections
Current method: Injections
Current method: Injections
Current method: Injections
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
E
Injections
Current method: Implants
Current method: Implants
Current method: Implants
Current method: Implants
Current method: Implants
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
F
Implants
Current method: Condom
Current method: Condom
Current method: Condom
Current method: Condom
Current method: Condom
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
G
Condom
Current method: Female condom
Current method: Female condom
Current method: Female condom
Current method: Female condom
Current method: Female condom
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
H
Female condom
Current method: Diaphragm
Current method: Diaphragm
Current method: Diaphragm
Current method: Diaphragm
Current method: Diaphragm
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
I
Diaphragm
Current method: Foam/jelly
Current method: Foam/jelly
Current method: Foam/jelly
Current method: Foam/jelly
Current method: Foam/jelly
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
J
Foam/Jelly
Current method: Lactational amenorrhea method
Current method: Lactational amenorrhea method
Current method: Lactational amenorrhea method
Current method: Lactational amenorrhea method
Current method: Lactational amenorrhea method
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
K
Lactational amenorrhoea (LAM)
Current method: Periodic abstinence
Current method: Periodic abstinence
Current method: Periodic abstinence
Current method: Periodic abstinence
Current method: Periodic abstinence
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
L
Periodic abstinence
Current method: Withdrawal
Current method: Withdrawal
Current method: Withdrawal
Current method: Withdrawal
Current method: Withdrawal
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
M
Withdrawal
Current method: Other
Current method: Other
Current method: Other
Current method: Other
Current method: Other
Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Women aged 15-49
?
Missing
X
Other
If she goes out with out telling him
If she goes out with out telling him
If she goes out with out telling him
If she goes out with out telling him
If she goes out with out telling him
Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out with out telling him?
Women aged 15-49
1
Yes
2
No
8
DK
9
Missing
If she neclects the children
If she neclects the children
If she neclects the children
If she neclects the children
If she neclects the children
Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she neglects the children?
Women aged 15-49
1
Yes
2
No
8
DK
9
Missing
If she argues with him
If she argues with him
If she argues with him
If she argues with him
If she argues with him
Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she argues with him?
Women aged 15-49
1
Yes
2
No
8
DK
9
Missing
If she refuses sex with him
If she refuses sex with him
If she refuses sex with him
If she refuses sex with him
If she refuses sex with him
Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she refuses sex with him?
Women aged 15-49
1
Yes
2
No
8
DK
9
Missing
If she burns the food
If she burns the food
If she burns the food
If she burns the food
If she burns the food
Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she burns the food?
Women aged 15-49
1
Yes
2
No
8
DK
9
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?
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?
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?
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?
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?
Women aged 15-49
1
Yes
2
No
8
DK
9
Missing
Can avoid AIDS by not having sex at all
Can avoid AIDS by not having sex at all
Can avoid AIDS by not having sex at all
Can avoid AIDS by not having sex at all
Can avoid AIDS by not having sex at all
Can people reduce their chance of getting infected with the AIDS virus by not having sex at all?
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?
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?
Women aged 15-49
1
Yes
2
No
8
DK
9
Missing
Healthy-looking person to have AIDS
Healthy-looking person to have AIDS
Healthy-looking person to have AIDS
Healthy-looking person to have AIDS
Healthy-looking person to have AIDS
Is it possible for a healthy-looking person to have the AIDS virus?
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?
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?
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?
Women aged 15-49
1
Yes
2
No
8
DK
9
Missing
Should teacher with HIV/AIDS be allowed to teach in school
Should teacher with HIV/AIDS be allowed to teach in school
Should teacher with HIV/AIDS be allowed to teach in school
Should teacher with HIV/AIDS be allowed to teach in school
Should teacher with HIV/AIDS be allowed to teach in school
If a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?
Women aged 15-49
1
Yes
2
No
8
DK/not sure/depends
9
Missing
Would buy fresh vegetables from shopseller with HIV/AIDS
Would buy fresh vegetables from shopseller with HIV/AIDS
Would buy fresh vegetables from shopseller with HIV/AIDS
Would buy fresh vegetables from shopseller with HIV/AIDS
Would buy fresh vegetables from shopseller with HIV/AIDS
Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
Women aged 15-49
1
Yes
2
No
8
DK/not sure/depends
9
Missing
If a member became infected with the virus, would you want i
If a member became infected with the virus, would you want i
If a member became infected with the virus, would you want i
If a member became infected with the virus, would you want i
If a member became infected with the virus, would you want i
If a member of your family became infected with the AIDS virus, would you want it to remain a secret?
Women aged 15-49
1
Yes
2
No
8
DK/not sure/depends
9
Missing
Willing to care for person with AIDS in household
Willing to care for person with AIDS in household
Willing to care for person with AIDS in household
Willing to care for person with AIDS in household
Willing to care for person with AIDS in household
If a member of your family became sick with the AIDS virus, would you be willing to care for him or her in your household?
Women aged 15-49
1
Yes
2
No
8
DK/not sure/depends
9
Missing
Ever had HIV test
Ever had HIV test
Ever had HIV test
Ever had HIV test
Ever had HIV test
Check MN5: Tested for HIV during antenatal care? Yes. Go to HA18A No. Continue with HA15
I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?
Women aged 15-49
1
Yes
2
No
9
Missing
Received results of HIV test
Received results of HIV test
Received results of HIV test
Received results of HIV test
Received results of HIV test
I do not want you to tell me the results of the test, but have you been told the results?
Women aged 15-49
1
Yes
2
No
9
Missing
Asked for HIV test or was it offered to you
Asked for HIV test or was it offered to you
Asked for HIV test or was it offered to you
Asked for HIV test or was it offered to you
Asked for HIV test or was it offered to you
Did you, yourself, ask for the test, was it offered to you and you accepted, or was it required?
Women aged 15-49
1
Asked for the test
2
Offered and accepted
3
Required
9
Missing
Know a place to get HIV test
Know a place to get HIV test
Know a place to get HIV test
Know a place to get HIV test
Know a place to get HIV test
At this time, do you know of a place where you can go to get such a test to see if you have the AIDS virus?
Women aged 15-49
1
Yes
2
No
9
Missing
Place 2 to get HIV test
Place 2 to get HIV test
Place 2 to get HIV test
Place 2 to get HIV test
Place 2 to get HIV test
At this time, do you know of a place where you can go to get such a test to see if you have the AIDS virus? A. If tested for HIV during antenatal care: Other than at the antenatal clinic, do you know of a place where you can go to get a test to see if you have the AIDS virus?
Women aged 15-49
1
Yes
2
No
9
Missing
Currently smoke cigarettes
Currently smoke cigarettes
Currently smoke cigarettes
Currently smoke cigarettes
Currently smoke cigarettes
Do you currently smoke cigarettes?
Women aged 15-49
1
Yes
2
No
8
DK
Average number of cigarettes
Average number of cigarettes
Average number of cigarettes
Average number of cigarettes
Average number of cigarettes
On average, how many cigarettes do you smoke each day?
Women aged 15-49
98
DK
Finger stick blood
Finger stick blood
Finger stick blood
Finger stick blood
Finger stick blood
This module is to be administered to all women 15 through 49 years of age. We would like to perform a simple test to determine whether or not you are anemic. The test would require us to use a sterile, disposable lancet to prick your finger to produce a few drops of blood. Would you give us permission to perform this test? If permission given, perform the HemoCue test.
Was a finger stick blood sample collected from this woman?
Women aged 15-49
1
Yes
2
No
3
Stick but insufficient blood
6
Other
8
DK
Hemoglobin level
Hemoglobin level
Hemoglobin level
Hemoglobin level
Hemoglobin level
This module is to be administered to all women 15 through 49 years of age. We would like to perform a simple test to determine whether or not you are anemic. The test would require us to use a sterile, disposable lancet to prick your finger to produce a few drops of blood. Would you give us permission to perform this test? If permission given, perform the HemoCue test.
Hemoglobin level from HemoCue Hemoglobin values <4 g/dL or >18 g/dL are considered unlikely If hemoglobin <7 g/dL refer women to health center
Women aged 15-49
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer name and number:
Children aged 0-4
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor name and number:
Children aged 0-4
Day of interview
Day of interview
Day of interview
Day of interview
Day of interview
Day/Month/Year of interview:
Children aged 0-4
Month of interview
Month of interview
Month of interview
Month of interview
Month of interview
Day/Month/Year of interview:
Children aged 0-4
Year of interview
Year of interview
Year of interview
Year of interview
Year of interview
Day/Month/Year of interview:
Children aged 0-4
Area
Area
Area
Area
Area
Area:
Children aged 0-4
1
Urban
2
Rural
Region
Region
Region
Region
Region
Region:
Children aged 0-4
1
Tbilisi
2
Kaxeti
3
Mcxeta - Mtianeti
4
Sida Qartli
5
Qvemo Qartli
6
Samcxe - Javaxeti
7
Raja - Lechxumi
8
Imereti
9
guria
10
samegrelo
11
adjara
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:
Children aged 0-4
1
Completed
2
Refused
3
Not at home
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:
Children aged 0-4
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:
Children aged 0-4
Total eligible women
Total eligible women
Total eligible women
Total eligible women
Total eligible women
No.of women eligible for interview:
Children aged 0-4
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
No.of women questionnaires completed:
Children aged 0-4
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:
Children aged 0-4
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
No.of under-5 questionnaires completed:
Children aged 0-4
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk:
Children aged 0-4
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
Missing
D
Use water filter
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
E
Solar disinfection
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?
Children aged 0-4
?
Missing
F
Let it stand and settle
Other
Other
Other
Other
Other
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
X
Other
DK
DK
DK
DK
DK
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
Z
DK
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?
Children aged 0-4
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
21
Ventilated Improved Pit latrine (VIP)
22
Pit latrine with slab
23
Pit latrine without slab/open pit
31
Composting toilet
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?
Children aged 0-4
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?
Children aged 0-4
10
Ten or more households
98
DK
99
Missing
Religion of head
Religion of head
Religion of head
Religion of head
Religion of head
What is the religion of the head of this household?
Children aged 0-4
1
Christian
2
Jewish
3
Muslim
6
Other religion
7
No religion
9
Missing
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
What is the mother tongue/native language of the head of this household?
Children aged 0-4
1
Georgian
2
Abhkazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Language
9
Missing
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Recoded variable
To what ethnic group does the head of this household belong?
Children aged 0-4
1
Georgian
2
Abkhazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Ethnicity
9
Missing
The variable is created from information collected on religion in the HH file. Codes 2,6 and 7 are recoded into code 6 (other).
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?
Children aged 0-4
99
Missing
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Record observation.
Children aged 0-4
11
Earth/sand
12
Dung
21
Wood planks
22
Palm/bamboo
31
Parquet or polished wood
32
Vinyl or asphalt strips
33
Ceramic tiles
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
Record observation.
Children aged 0-4
11
No roof
12
Thatch/palm leaf
13
Sod
21
Rustic mat
22
Palm/bamboo
23
Wood Planks
31
Metal
32
Wood
33
Calamine/cement fiber
34
Ceramic tiles
35
Cement
36
Roofing shingles
96
Other
99
Missing
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Record observation.
Children aged 0-4
11
No walls
12
Cane/palm/trunks
13
Dirt
21
Bambo with mud
22
Stone with mud
23
Uncovered adobe
24
Plywood
25
Carton
26
Reused wood
31
Cement
32
Stone with lime/cement
33
Bricks
34
Cement blocks
35
Covered adobe
36
Wood planks/shingles
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?
Children aged 0-4
1
Electricity
2
Liquid propane gas (LPG)
3
Natural gas
4
Biogas
5
Kerosene
6
Coal/lignite
7
Charcoal
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
1
In the house
2
In a separate bulding
3
Outdoors
6
Other
9
Missing
Electricity
Electricity
Electricity
Electricity
Electricity
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Radio
Radio
Radio
Radio
Radio
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Television
Television
Television
Television
Television
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Does your household have:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Watch
Watch
Watch
Watch
Watch
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Bicycle
Bicycle
Bicycle
Bicycle
Bicycle
Does any member of your household own:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Woman weight
Woman weight
Woman weight
Woman weight
Woman weight
Recoded variable
Women aged 15-49
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
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 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
Recoded variable
Children aged 0-4
1
Pre Primary and Primary
2
Secondary
3
High
4
Other-standard curriculum
9
Missing/DK
The variable is created from information collected on educational level in the HL file. See makewm.sps in the data processing external documentation.
Children ever born
Children ever born
Children ever born
Children ever born
Children ever born
Recoded variable
Women aged 15-49
Obtained from infomation provided in the child mortality module of the women's questionnaire. See the makewm.sps in the data processing external documentation.
Dead children
Dead children
Dead children
Dead children
Dead children
Recoded variable
Women aged 15-49
Obtained from infomation provided in the child mortality module of the women's questionnaire. See the makewm.sps in the data processing external documentation.
Number of children surviving
Number of children surviving
Number of children surviving
Number of children surviving
Number of children surviving
Women aged 15-49
Cluster number
Cluster number
Cluster number
Cluster number
Cluster number
We are from Department for Statistics and National Center of Illness Control. 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 30 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:
Children aged 0-4
Unique identifier for the cluster in which the household exists
Household number
Household number
Household number
Household number
Household number
Household number:
Children aged 0-4
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:
Children aged 0-4
Household number
Household number
Household number
Household number
Household number
Household number:
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:
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:
Children aged 0-4
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer name and number:
Children aged 0-4
Day of interview
Day of interview
Day of interview
Day of interview
Day of interview
Day/Month/Year of interview:
Children aged 0-4
Month of interview
Month of interview
Month of interview
Month of interview
Month of interview
Day/Month/Year of interview:
Children aged 0-4
Year of interview
Year of interview
Year of interview
Year of interview
Year of interview
Day/Month/Year of interview:
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
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.
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.
Children aged 0-4
97
Inconsistent
98
DK
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.
Children aged 0-4
9997
Inconsistent
9998
DK
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.
Children aged 0-4
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?
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?
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?
Children aged 0-4
1
Costs too much
2
Must travel too far
3
Did not know it should be registered
4
Late, and did not want to pay fine
5
Does not know where to register
6
Other
8
DK
9
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?
Children aged 0-4
1
Yes
2
No
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?
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?
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)?
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)?
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)?
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)?
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)?
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)?
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)?
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)?
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)?
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)?
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)?
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)?
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?
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?
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?
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?
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)?
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)?
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)?
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)?
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?
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?
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?
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?
Children aged 0-4
?
Missing
Y
No one
How many books are there in the household
How many books are there in the household
How many books are there in the household
How many books are there in the household
How many books are there in the household
Question CE1 is to be administered only once to each caretaker
How many books are there in the household? Please include schoolbooks, but not other books meant for children, such as picture books
If 'none' enter 00
Children aged 0-4
10
Ten or more books
How many children books or picture books do you have for him
How many children books or picture books do you have for him
How many children books or picture books do you have for him
How many children books or picture books do you have for him
How many children books or picture books do you have for him
How many children's books or picture books do you have for (name)?
If 'none' enter 00
Children aged 0-4
10
Ten or more books
Bowls, plate, cups ,pots
Bowls, plate, cups ,pots
Bowls, plate, cups ,pots
Bowls, plate, cups ,pots
Bowls, plate, cups ,pots
I am interested in learning about the things that (NAME) plays with when he/she is at home. What does (NAME) play with? Does he/she play with household objects, such as bowls, plates, cups or pots?
Children aged 0-4
?
Missing
A
Household objects
Sticks , rocks, animals shells, leaves
Sticks , rocks, animals shells, leaves
Sticks , rocks, animals shells, leaves
Sticks , rocks, animals shells, leaves
Sticks , rocks, animals shells, leaves
I am interested in learning about the things that (NAME) plays with when he/she is at home. What does (NAME) play with? Does he/she play with objects and materials found outside the living quarters, such as sticks, rocks, animals, shells, or leaves?
Children aged 0-4
?
Missing
B
Outside objects
Homemae toys
Homemae toys
Homemae toys
Homemae toys
Homemae toys
I am interested in learning about the things that (NAME) plays with when he/she is at home. What does (NAME) play with? Does he/she play with homemade toys, such as dolls, cars and other toys made at home?
Children aged 0-4
?
Missing
C
Homemade toys
Toys that came from a store
Toys that came from a store
Toys that came from a store
Toys that came from a store
Toys that came from a store
I am interested in learning about the things that (NAME) plays with when he/she is at home. What does (NAME) play with? Does he/she play with toys that came from a store?
Children aged 0-4
?
Missing
D
Store bought toys
No playthings mentioned
No playthings mentioned
No playthings mentioned
No playthings mentioned
No playthings mentioned
I am interested in learning about the things that (NAME) plays with when he/she is at home. What does (NAME) play with? Does he/she play with household objects, such as bowls, plates, cups or pots?
If the respondent says "YES" to any of the prompted categories, then probe to learn specifically what the child plays with to ascertain the response Code Y if child does not play with any of the items mentioned.
Children aged 0-4
?
Missing
Y
No playthings mentioned
How many time was he/her left in the care of another child
How many time was he/her left in the care of another child
How many time was he/her left in the care of another child
How many time was he/her left in the care of another child
How many time was he/her left in the care of another child
Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children with others. since last (day of the week) how many times was (name) left in the care of another child (that is, someone less than 10 years old)?
If 'none' enter 00
Children aged 0-4
98
DK
99
Missing
How many time he was left alone
How many time he was left alone
How many time he was left alone
How many time he was left alone
How many time he was left alone
In the past week, how many times was (name) left alone?
If 'none' enter 00
Children aged 0-4
98
DK
99
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?
Children aged 0-4
1
Yes
2
No
8
DK
9
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?
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?
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?
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?
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)?
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?
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?
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?
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?
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'.
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.
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)?
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?
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?
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?
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?
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?
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?
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?
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)
Children aged 0-4
?
Missing
A
Govt. Hospital
Place sought care: Govt Health centre
Place sought care: Govt Health centre
Place sought care: Govt Health centre
Place sought care: Govt Health centre
Place sought care: Govt Health centre
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)
Children aged 0-4
?
Missing
B
Govt. Health centre
Place sought care: Govt Health post
Place sought care: Govt Health post
Place sought care: Govt Health post
Place sought care: Govt Health post
Place sought care: Govt Health post
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)
Children aged 0-4
?
Missing
C
Govt. health post
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)
Children aged 0-4
?
Missing
E
Mobile/outreach clinic
Place sought care: Other public source
Place sought care: Other public source
Place sought care: Other public source
Place sought care: Other public source
Place sought care: Other public source
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)
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)
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)
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)
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)
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)
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)
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)
Children aged 0-4
?
Missing
R
Traditional practitioner
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)
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?
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.
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.
Children aged 0-4
?
Missing
B
Paracetamol/Panadol/Acetaminophen
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
What medicine was (name) given?
Circle all medicines given.
Children aged 0-4
?
Missing
C
Aspirin
Ibupropfen
Ibupropfen
Ibupropfen
Ibupropfen
Ibupropfen
What medicine was (name) given?
Circle all medicines given.
Children aged 0-4
?
Missing
D
Ibuprofen
Other
Other
Other
Other
Other
What medicine was (name) given?
Circle all medicines given.
Children aged 0-4
?
Missing
X
Other
DK
DK
DK
DK
DK
What medicine was (name) given?
Circle all medicines given.
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?
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.
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.
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.
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.
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.
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.
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.
Children aged 0-4
?
Missing
G
Child is drinking poorly
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.
Children aged 0-4
?
Missing
X
Other
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.
Children aged 0-4
?
Missing
Y
Other
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.
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)?
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
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
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
Children aged 0-4
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Children aged 0-4
9999
Missing
Day of HepB1 immunization
Day of HepB1 immunization
Day of HepB1 immunization
Day of HepB1 immunization
Day of HepB1 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 HepB1 (or DPTHepB1)
Children aged 0-4
Not given
44
Marked on card - no date given
66
Reported by mother
99
Missing
Month of HepB1 immunization
Month of HepB1 immunization
Month of HepB1 immunization
Month of HepB1 immunization
Month of HepB1 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 HepB1 (or DPTHepB1)
Children aged 0-4
99
Missing
Year of HepB1 immunization
Year of HepB1 immunization
Year of HepB1 immunization
Year of HepB1 immunization
Year of HepB1 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 HepB1 (or DPTHepB1)
Children aged 0-4
9999
Missing
Day HepB2 immunization
Day HepB2 immunization
Day HepB2 immunization
Day HepB2 immunization
Day HepB2 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 HepB2 (or DPTHepB2)
Children aged 0-4
Not given
44
Marked on card - no date given
66
Reported by mother
99
Missing
Month of HepB2 imunization
Month of HepB2 imunization
Month of HepB2 imunization
Month of HepB2 imunization
Month of HepB2 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 HepB2 (or DPTHepB2)
Children aged 0-4
99
Missing
Year of HepB2 immunization
Year of HepB2 immunization
Year of HepB2 immunization
Year of HepB2 immunization
Year of HepB2 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 HepB2 (or DPTHepB2)
Children aged 0-4
9999
Missing
Day of DPTHepB3 immunization
Day of DPTHepB3 immunization
Day of DPTHepB3 immunization
Day of DPTHepB3 immunization
Day of DPTHepB3 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 HepB3 (or DPTHepB3)
Children aged 0-4
Not given
44
Marked on card - no date given
66
Reported by mother
99
Missing
Month of DPTHepB3 immunization
Month of DPTHepB3 immunization
Month of DPTHepB3 immunization
Month of DPTHepB3 immunization
Month of DPTHepB3 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 HepB3 (or DPTHepB3)
Children aged 0-4
99
Missing
Year of DPTHepB3 immunization
Year of DPTHepB3 immunization
Year of DPTHepB3 immunization
Year of DPTHepB3 immunization
Year of DPTHepB3 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 HepB3 (or DPTHepB3)
Children aged 0-4
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)
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)
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)
Children aged 0-4
9999
Missing
Child received any other vaccinations
Child received any other vaccinations
Child received any other vaccinations
Child received any other vaccinations
Child received any other 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.)
Children aged 0-4
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?
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?
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?
Children aged 0-4
1
Yes
2
No
8
DK
9
Missing
Polio first given age of two months or later
Polio first given age of two months or later
Polio first given age of two months or later
Polio first given age of two months or later
Polio first given age of two months or later
How old was he/she when the first dose was given - just after birth (within two weeks) or later?
Children aged 0-4
1
At the age of two months
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?
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)
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?
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?
Children aged 0-4
1
Yes
2
No
8
DK
9
Missing
Child's weight (kilograms)
Child's weight (kilograms)
Child's weight (kilograms)
Child's weight (kilograms)
Child's weight (kilograms)
After questionnaires for all children are complete, the measurer weighs and measures each child. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child's name and line number on the household listing before recording measurements. Child's weight.
Children aged 0-4
99
Missing
Child measured lying or standing
Child measured lying or standing
Child measured lying or standing
Child measured lying or standing
Child measured lying or standing
Child's length or height.
Check age of child in UF11: Child under 2 years old. Measure length (lying down). Child age 2 or more years. Measure height (standing up).
Children aged 0-4
1
Lying down
2
Standing up
9
Missing
Child's length or height
Child's length or height
Child's length or height
Child's length or height
Child's length or height
Child's length or height.
Check age of child in UF11: Child under 2 years old. Measure length (lying down). Child age 2 or more years. Measure height (standing up).
Children aged 0-4
999
Missing
Measurer's identification code
Measurer's identification code
Measurer's identification code
Measurer's identification code
Measurer's identification code
Measurer's identification code.
Children aged 0-4
Result of measurement
Result of measurement
Result of measurement
Result of measurement
Result of measurement
Result of measurement.
Children aged 0-4
1
Measured
2
Not present
3
Refused
6
Other
7
Inconsistent
9
Missing
Height for age percentile
Height for age percentile
Height for age percentile
Height for age percentile
Height for age percentile
Recoded variable
Is (name) male or female?
Children aged 0-4
Height for age z-score
Height for age z-score
Height for age z-score
Height for age z-score
Height for age z-score
Recoded variable
Is (name) male or female?
Children aged 0-4
Height for age percent of reference median
Height for age percent of reference median
Height for age percent of reference median
Height for age percent of reference median
Height for age percent of reference median
Recoded variable
Is (name) male or female?
Children aged 0-4
Weight for age percentile
Weight for age percentile
Weight for age percentile
Weight for age percentile
Weight for age percentile
Recoded variable
Is (name) male or female?
Children aged 0-4
Weight for age z-score
Weight for age z-score
Weight for age z-score
Weight for age z-score
Weight for age z-score
Recoded variable
Is (name) male or female?
Children aged 0-4
Weight for age percent of reference median
Weight for age percent of reference median
Weight for age percent of reference median
Weight for age percent of reference median
Weight for age percent of reference median
Recoded variable
Is (name) male or female?
Children aged 0-4
Weight for height percentile
Weight for height percentile
Weight for height percentile
Weight for height percentile
Weight for height percentile
Recoded variable
Is (name) male or female?
Children aged 0-4
Weight for height z-score
Weight for height z-score
Weight for height z-score
Weight for height z-score
Weight for height z-score
Recoded variable
Is (name) male or female?
Children aged 0-4
Weight for height percent of reference median
Weight for height percent of reference median
Weight for height percent of reference median
Weight for height percent of reference median
Weight for height percent of reference median
Recoded variable
Is (name) male or female?
Children aged 0-4
Flag for anthropometric indicators
Flag for anthropometric indicators
Flag for anthropometric indicators
Flag for anthropometric indicators
Flag for anthropometric indicators
Recoded variable
Is (name) male or female?
Children aged 0-4
No flag
1
Height for age
2
Weight for height
3
Weight for height, Height for age
4
Weight for age
5
Weight for age, Height for age
6
Weight for age, Weight for height
7
Weight for age, Weight for height, Height for age
Sex
Sex
Sex
Sex
Sex
Children aged 0-4
1
Male
2
Female
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
Other-standard curriculum
8
DK
9
Missing
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer number
Interviewer name and number:
Children aged 0-4
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor Number
Supervisor name and number:
Children aged 0-4
Day of interview
Day of interview
Day of interview
Day of interview
Day of interview
Day/Month/Year of interview:
Children aged 0-4
Month of interview
Month of interview
Month of interview
Month of interview
Month of interview
Day/Month/Year of interview:
Children aged 0-4
Year of interview
Year of interview
Year of interview
Year of interview
Year of interview
Day/Month/Year of interview:
Children aged 0-4
Area
Area
Area
Area
Area
Area:
Children aged 0-4
1
Urban
2
Rural
Region
Region
Region
Region
Region
Region:
Children aged 0-4
1
Tbilisi
2
Kaxeti
3
Mcxeta - Mtianeti
4
Sida Qartli
5
Qvemo Qartli
6
Samcxe - Javaxeti
7
Raja - Lechxumi
8
Imereti
9
guria
10
samegrelo
11
adjara
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:
Children aged 0-4
1
Completed
2
Refused
3
Not at home
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:
Children aged 0-4
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:
Children aged 0-4
Total eligible women
Total eligible women
Total eligible women
Total eligible women
Total eligible women
No.of women eligible for interview:
Children aged 0-4
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
Women interviews completed
No.of women questionnaires completed:
Children aged 0-4
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:
Children aged 0-4
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
Child interviews completed
No.of under-5 questionnaires completed:
Children aged 0-4
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk
Data entry clerk:
Children aged 0-4
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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
61
Tanker-truck
71
Cart with small tank/drum
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
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?
Children aged 0-4
?
Missing
D
Use water filter
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
Solar disinfection
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
E
Solar disinfection
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?
Children aged 0-4
?
Missing
F
Let it stand and settle
Other
Other
Other
Other
Other
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
X
Other
DK
DK
DK
DK
DK
What do you usually do to the water to make it safer to drink? Anything else?
Children aged 0-4
?
Missing
Z
DK
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?
Children aged 0-4
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
21
Ventilated Improved Pit latrine (VIP)
22
Pit latrine with slab
23
Pit latrine without slab/open pit
31
Composting toilet
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?
Children aged 0-4
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?
Children aged 0-4
10
Ten or more households
98
DK
99
Missing
Religion of head
Religion of head
Religion of head
Religion of head
Religion of head
What is the religion of the head of this household?
Children aged 0-4
1
Christian
2
Jewish
3
Muslim
6
Other religion
7
No religion
9
Missing
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
Mother tongue of head
What is the mother tongue/native language of the head of this household?
Children aged 0-4
1
Georgian
2
Abhkazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Language
9
Missing
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Ethnic group of head
Recoded variable
To what ethnic group does the head of this household belong?
Children aged 0-4
1
Georgian
2
Abkhazian
3
Osetian
4
Russian
5
Azerbaijani
6
Armenian
7
Other Ethnicity
9
Missing
The variable is created from information collected on religion in the HH file. Codes 2,6 and 7 are recoded into code 6 (other).
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?
Children aged 0-4
99
Missing
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Main material of floor
Record observation.
Children aged 0-4
11
Earth/sand
12
Dung
21
Wood planks
22
Palm/bamboo
31
Parquet or polished wood
32
Vinyl or asphalt strips
33
Ceramic tiles
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
Record observation.
Children aged 0-4
11
No roof
12
Thatch/palm leaf
13
Sod
21
Rustic mat
22
Palm/bamboo
23
Wood Planks
31
Metal
32
Wood
33
Calamine/cement fiber
34
Ceramic tiles
35
Cement
36
Roofing shingles
96
Other
99
Missing
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Main material of wall
Record observation.
Children aged 0-4
11
No walls
12
Cane/palm/trunks
13
Dirt
21
Bambo with mud
22
Stone with mud
23
Uncovered adobe
24
Plywood
25
Carton
26
Reused wood
31
Cement
32
Stone with lime/cement
33
Bricks
34
Cement blocks
35
Covered adobe
36
Wood planks/shingles
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?
Children aged 0-4
1
Electricity
2
Liquid propane gas (LPG)
3
Natural gas
4
Biogas
5
Kerosene
6
Coal/lignite
7
Charcoal
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?
Children aged 0-4
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?
Children aged 0-4
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?
Children aged 0-4
1
In the house
2
In a separate bulding
3
Outdoors
6
Other
9
Missing
Electricity
Electricity
Electricity
Electricity
Electricity
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Radio
Radio
Radio
Radio
Radio
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Television
Television
Television
Television
Television
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Mobile phone
Does your household have:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Does your household have:
Children aged 0-4
1
Yes
2
No
9
Missing
Watch
Watch
Watch
Watch
Watch
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Bicycle
Bicycle
Bicycle
Bicycle
Bicycle
Does any member of your household own:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
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:
Children aged 0-4
1
Yes
2
No
9
Missing
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Boat with motor
Does any member of your household own:
Children aged 0-4
1
Yes
2
No
9
Missing
Child weight
Child weight
Child weight
Child weight
Child weight
Recoded variable
Children aged 0-4
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
Sample Stratum Code
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
Recoded variable
Children aged 0-4
1
Pre Primary and Primary
2
Secondary
3
High
4
Other-standard curriculum
9
Missing/DK
The variable is created from information collected on educational level in the HL file. See makewm.sps in the data processing external documentation.