001a. Enter your ID below.

Please record your ID

Must start with "N5" followed by 3 numbers

001b. Enter your ID again.

Double data entry

Second entry does not match first entry

002a. Is this date and time correct?

{today_formatted}

002b. Record the correct date and time.

The date must be between 2021-11-01 and 2022-12-31.

003a. Province

003b. District

003b. Zone de Santé

003c. Aire de Santé

003c. Quartier

003d. Village

003d. Localité / rue

004. Enumeration Area

004a. Previous Annual Survey Household list

005. Structure number

Please record the structure number from the household listing form.

Please record the structure number from the household listing form.

Invalid response.

006. Household number

Please record the household number from the household listing form.

Invalid response.

007a. Are you at the same dwelling unit location from the previous annual survey?

007b. Do people live in this dwelling unit?

007c. Is at least one of the members from the previous annual survey still living in the dwelling unit?

007d. Why are people not living in this dwelling unit?

GO TO 099, ENTER THE RESULT CODE AND SUBMIT THE FORM

007e. What is the status of the original household from the previous annual survey?

Confirm with the neighbors to know the status

008. Which woman from the previous annual survey are you following up?

If you do not see any women in this list, double-check your answers to 004a and 007a

010. CHECK: Why are you resending this form?

Choose all that apply.

011. Is a member of the household and competent respondent present and available to be interviewed today?

INFORMED CONSENT

Find a competent member of the household. Read the greeting on the following screen.

Bonjour. Je m?appelle ................................. Je suis ici en représentation du Ministère de la Santé et de l?École de Santé Publique de Kinshasa pour en savoir plus sur les services de santé à Kinshasa. Je vais maintenant vous lire une déclaration qui explique cette enquête.
Notre équipe recueille de l?information sur la planification familiale en République Démocratique du Congo. Nous aimerions vous poser des questions à propos des caractéristiques de votre ménage, ainsi que des activités liées à la planification familiale. Les informations vous concernant pourront être utilisées pour des activités et services de planification familiale en République Démocratique du Congo. Les données collectées seront également analysées par des chercheurs, mais votre nom sera retiré de toutes les analyses, pour que vos informations restent anonymes. Le questionnaire prend généralement entre 15 et 20 minutes. Toutes les informations que vous nous donnerez seront strictement confidentielles et ne seront partagées avec personne d?autre que les membres de notre équipe.

Je vais vous poser des questions concernant votre famille et les autres membres de votre ménage. Nous aimerions ensuite poser une série de questions aux femmes du ménage âgées entre 15 et 49 ans.

Vous pouvez refuser de répondre aux questions qui vous seront posées autant de fois que vous le souhaitez, et décider d?arrêter l?enquête à tout moment. Avez-vous des questions sur cette enquête ?
B. Informations de contact des chercheurs

Prenez tout le temps dont vous aurez besoin pour prendre votre décision de participer ou non à cette étude. Nous serons heureux de répondre à toute question que vous pourrez vous poser à propos de cette étude. Si vous avez des questions additionnelles, si vous souhaitez exprimer une préoccupation à propos de cette recherche, ou si vous avez un problème lié à la recherche, vous pouvez contacter le coordinateur national de cette étude. Je vous remettrai également une copie de ce formulaire contenant les informations de contact du Coordinateur de l?étude, que vous pourrez contacter directement pour toutes questions concernant cette enquête.

011a. Read the verbal consent text.

Then, ask:
May I begin the interview now?

011b. Respondent's signature

Please ask the respondent to sign or check the box in agreement of their participation.

012. Interviewer's ID: {your_name}

Mark your ID as a witness to the consent process.

Section 1 ? Household Roster

PL_102. Previous Annual Survey Household Member

Below are the previous annual survey's details for member {P_pos}:

First name: {hq_firstname_auto}
Relationship to HH head: {hq_relationship_lab}
Gender: {hq_gender_lab}
Age: {hq_age_auto}
Marital Status: {hq_marital_status_lab}

Is this person the respondent?

If yes, check this box.

PL_103. What is the status of this member in the household?

PL_104. Household Member

First name: {hq_firstname_auto}
Relationship to HH head: {hq_relationship_lab}
Gender: {hq_gender_lab}
Age: {hq_age_auto}
Marital Status: {hq_marital_status_lab}

Do you wish to update any of this information?

Section 1 ? Household Roster

I am now going to ask a series of questions about each usual member of the household or anyone who slept in the house last night.

101. Name of household member / visitor

Start with the head of the household.

101a. Is this person the respondent?

If yes, check this box.

102. What is {firstname}'s relationship to the head of household?

103. Is {firstname} male or female?

104. How old was {firstname} at their last birthday?

If less than one year old, record 0

Age must be less than 130 and greater than 0.

105. What is {firstname}'s current marital status?

If not married, probe to determine if they have ever been married and, if so, if they are divorced/separated, or widowed.

106. Does {firstname} usually live here?

107. Did {firstname} stay here last night?

LCL_101. What is the religion of {firstname}?

Only recorded for the head of the household.

LCL_102. What is the ethnicity of {firstname}?

Only recorded for the head of the household.

109. READ THIS CHECK OUT LOUD: There are {num_HH_members} household members who are named {names}. Is this a complete list of the household members?

Remember to include all children in the household.

Go back and update the roster.

Section 2 ? Household Characteristics

Now I would like to ask you a few questions about the characteristics of your household.

201. Is this structure/house newly built in the last 12 months?

SLM_1. How many rooms in this dwelling unit are used for sleeping?

1-10, or -99

202. Please tell me about items that your household owns. Does your household have:

Read out all types and select all that apply. Scroll to bottom to see all choices.

If an item is reported broken but said to be out of use only temporarily, select the item. Otherwise, do not select the item.

Cannot select 'no response' or 'none of the above' with other options.

203. Does this household own any livestock, herds, other farm animals, or poultry?

These livestock can be kept anywhere, not necessarily on the homestead.

204. How many of the following animals does this household own?

The household can keep the livestock anywhere, but must own the livestock recorded here.

Zero is a possible answer. Enter -88 for do not know. Enter -99 for no response.

Cows or bulls ___
Horses, donkeys or mules ___
Goats ___
Sheep ___
Hogs/pigs ___
Ducks/canes ___
Hens/cocks/other poultry ___
Other ___

Enter -88 for do not know.
Enter -99 for no response.

Section 3 ? Household Observation

Please observe the floors, roof and exterior walls.

301. Main material of the floor

Observe.

302. Main material of the roof

Observe.

303. Main material of the exterior walls

Observe.

SLM_2. Observe the condition of the home: Do not ask.

Observe.

Cannot select 'no response' or 'none of the above' with other options.

SLM_3. Right of occupancy: Possession of a lease document or agreement

Section 4 ? Water Sanitation and Hygiene

Now I would like to ask you a few questions about water, sanitation and hygiene.

401. We would like to learn about the places that households use to wash their hands. Can you please show me where members of your household most often wash their hands?

402. At the place where the household washes their hands, observe availability of water

403. At the place where the household washes their hands, observe availability of soap or detergent:

404. What is the main source of drinking water for members of your household?

405. What is the main toilet facility used by members of your household?

SLM_4a. Do you share this toilet facility with other households or with the public ?

SLM_4b. How many households share the toilet facility? (including your own)

2-9, or -99

501. Thank you for the time you have kindly granted us.

Are you willing to provide a phone number for this household where we may reach you in the future to follow up for future research?

502. What is the phone number?

Enter an 9-digit number without the country code. Do not include spaces or dashes.

Invalid number of digits.

503. Can you repeat the number again?

Enter an 9-digit number without the country code. Do not include spaces or dashes.

Number entered must match previously entered number.

504. What is the name of the person who normally answers this phone?

Thank the respondent for his/her time.

The respondent is finished, but there is still more for you to complete outside the home.

Location and Questionnaire result

096. Location

Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6 m.

096a. Where were you when you recorded the GPS coordinates?

097. How many times have you visited this household?

098. In what language was this interview conducted?

099. Questionnaire Result

Record the result of the questionnaire.

Check answer to 009 and the consent.