Please record your ID
Must start with "N11" followed by 3 numbers
002a. Is this date and time correct?
{today_formatted}
[] No
002b. Record the correct date and time.
The date must be between 2021-07-01 and 2021-12-31.
Please record the structure number from the household listing form.
Please record the structure number from the household listing form.
Invalid response.
Please record the household number from the household listing form.
Invalid response.
007a. Are you at the same dwelling unit location from Phase 1?
[] No
007b. Do people live in this dwelling unit?
[] No
007c. Is at least one of the original P1 members still living in the dwelling unit?
[] No
007d. Why are people not living in this dwelling unit?
GO TO 099, ENTER THE RESULT CODE AND SUBMIT THE FORM
[] P1 dwelling unit destroyed
[] P1 dwelling unit not found
007e. What is the status of the original P1 household?
Confirm with the neighbors to know the status
[] Household moved within the study area
[] Household split with some members in the study area and some out of the study area
[] No information
008. Which woman from Phase 1 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.
[] I am correcting a mistake made on a previous form
[] The previous form disappeared from my phone without being sent
[] I submitted the previous form and my supervisor told me that it was not received
[] Other reason(s)
011. Is a member of the household and competent respondent present and available to be interviewed today?
[] No
Find a competent member of the household. Read the greeting on the following screen.
Bonjour, je me nomme ........................... et je travaille pour l?Ecole Nationale Supérieure de Statistique et d?Economie Appliquée (ENSEA) d?Abidjan. Nous menons une étude dans le domaine de la santé, plus spécifiquement sur la planification familiale en Côte d?Ivoire. A cet effet, je vais vous lire ce formulaire afin de vous exposer l?objectif principal de l?étude et vous donner des informations supplémentaires dans le but solliciter votre participation à cette étude.
Présentation et objet de l?étude
En collaboration avec le Ministère de la Santé, de l?Hygiène Publique et de la Couverture Maladie Universelle de la Côte d?Ivoire et l?école de santé publique et de la santé reproductive de l?université de Johns Hopkins aux Etats-Unis, l?Ecole Nationale Supérieur de la Statistique et d?Economie Appliquée (ENSEA) réalise une étude dénommée PMA (Performance Monitoring for Action).
L?objectif principal de cette étude est de mettre en ?uvre un système de suivi des performances accomplies dans le domaine de la planification familiale et de la santé reproductive des femmes au sein de la population et des structures de santé en Côte d?Ivoire. En outre, les informations que nous collecterons serviront à éclairer les programmes de développement social en Côte d?Ivoire.
Pourquoi est-ce qu?on vous demande de participer ?
Votre ménage a été sélectionné pour cette étude. Votre participation est importante car les informations recueillies serviront à informer le gouvernement en vue d?améliorer l?offre de services de santé et plus particulièrement celle des mères et des enfants dans cette région. Par ailleurs, les informations que vous partagerez avec nous seront confidentielles et ne seront divulguées à personne d?autre que les membres de notre équipe.
Nous tenons à préciser que la participation à cette enquête est volontaire et il n'y a aucun avantage personnel direct pour votre participation dans cette étude. Néanmoins nous comptons vivement sur votre participation car votre point de vue est très important. Si vous ne souhaitez pas répondre à une question en particulier, faîtes-le moi savoir et je passerai à la question suivante. L?enquête prendra environ 1 heure et vous pourriez trouver cela lassant. Si c'est le cas, vous êtes libre d?arrêter l?entretien à n?importe quel moment.
Nous aimerions ensuite poser une série de questions aux femmes du ménage, âgées entre 15 et 49 ans.
Vous ne recevrez pas de motivation financière pour votre participation, mais en guise de remerciement on vous offrira un kit d?hygiène (composé de morceaux de savon et poudre à laver) comme compensation pour le temps que les membres de votre ménage ont consacré pour répondre à nos différents questionnaires.
Protection de la confidentialité des données
Les données seront collectées sur des smartphones. Toutes les données seront envoyées par voie électronique sur le serveur « cloud » de l?étude PMA. L'utilisation et le partage des informations seront rigoureusement soumis à des principes de précautions pour garantir leur sécurité et confidentialité. Une fois la collecte terminée, les informations d'identification seront supprimées de la base de données.
Avant de continuer, avez-vous des questions sur cette enquête ?
Que veut dire votre signature sur ce formulaire de consentement ?
Votre signature sur ce formulaire veut dire que :
? Vous avez été informé sur l?objectif, les procédures, les avantages et les risques de cette étude.
? Vous avez eu l?occasion de poser des questions avant de signer.
? Vous avez donné votre accord pour votre participation de votre propre volonté.
Est?ce que j'ai votre consentement pour commencer ?
011a. Read the verbal consent text.
Then, ask:
May I begin the interview now?
[] No
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.
ODK will display the summary of all household members listed in Phase 1. You will then update their information to indicate any changes including births and deaths
Below are the Phase 1 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.
PL103. What is the status of this member in the household?
[] Moved elsewhere in the study area
[] Moved out of the study area
[] Moved out of the study area to attend school
[] Deceased
[] Unknown
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?
[] No
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?
[] Wife/Husband
[] Son/Daughter
[] Son/Daughter-in-law
[] Grandchild
[] Parent
[] Parent in law
[] Brother/Sister
[] House help
[] Other
[] Do not know
[] No response
103. Is {firstname} male or female?
[] 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.
[] Living with a partner
[] Divorced / separated
[] Widow / widower
[] Never married
[] No response
106. Does {firstname} usually live here?
[] No
[] No response
107. Did {firstname} stay here last night?
[] No
[] No response
LCL_101. What is the religion of {firstname}?
Only recorded for the head of the household.
[] Catholic
[] Methodist
[] Evangelica
[] Other Christian Religion
[] Animast
[] Other religion
[] No religion
[] No response
LCL_102. What is the ethnicity of {firstname}?
Only recorded for the head of the household.
[] Mandé du sud
[] Mandé du nord
[] Gur
[] Krou
[] Other Ivorian
[] Non Ivorian
[] No response
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?
[] No
[] No response
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.
[] A radio?
[] A television?
[] A mobile phone?
[] A landline telephone?
[] A refrigerator?
[] A TV Antenna?
[] A cabel subscription?
[] A washing machine?
[] A gas or electric stove?
[] An improved stove?
[] A DVD/CD?
[] An air conditioner?
[] A computer?
[] Home internet?
[] A wall clock?
[] Charruees?
[] A bicycle/tricycle?
[] A motorcycle or motor scooter?
[] Animal-drawn cart?
[] A canoe or fishing nets?
[] A tractor?
[] A car or truck?
[] A boat with a motor?
[] None of the above
[] No response
203. Does this household own any livestock, herds, other farm animals, or poultry?
These livestock can be kept anywhere, not necessarily on the homestead.
[] No
[] No response
203. 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 ___
Porks ___
Fowl ___
Other ___
Section 3 - Household Observation
Please observe the floors, roof and exterior walls.
301. Main material of the floor
Observe.
[] Cow dung
[] Wooden boards
[] Palm / bamboo
[] Parquet or polished wood
[] Tapes vinyl / asphalt
[] Tiles
[] Cement
[] Carpet
[] Other
[] No answer
302. Main material of the roof
Observe.
[] Thatch / palm
[] Earth mottes
[] Mats
[] Palm / bamboo
[] Wooden boards
[] Cardboard
[] Sheet metal
[] Wood
[] Zinc / fiber cement
[] Tile
[] Cement
[] Shingles
[] Other
[] No answer
303. Main material of the exterior walls
Observe.
[] Bamboo / cane / palm / trunk
[] Earth
[] Bamboo with mud
[] Stones with mud
[] Adobe not covered
[] Plywood
[] Cardboard
[] Recovered wood
[] Cement
[] Stones with lime / cement
[] Bricks
[] Cement blocks
[] Covered adobe
[] Wood board / shingles
[] Other
[] No answer
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?
[] Fixed facility observed (sink/tap) in yard/plot
[] Mobile object (bucket/jug/kettle) observed..
[] Not observed, facility in dwelling/yard/plot but no permission to see
[] Not observed, not in dwelling/yard/plot
[] Not observed, other reason
[] No Response
402. At the place where the household washes their hands, observe availability of water
[] Water is not available
[] No Response
403. At the place where the household washes their hands, observe availability of soap or detergent:
[] Soap is not available
[] No Response
404. What is the main source of drinking water for members of your household?
[] Piped Water: Pipe to yard/plot
[] Piped Water: Public tap/standpipe
[] Tube well or borehole
[] Dug Well: Protected Well
[] Dug Well: Unprotected Well
[] Water from Spring: Protected Spring
[] Water from Spring: Unprotected Spring
[] Rainwater
[] Tanker Truck
[] Cart with Small Tank
[] Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel)
[] Bottled Water
[] Sachet Water
[] No response
405. What is the main toilet facility used by members of your household?
[] Flush/pour flush toilets connected to: Septic tank
[] Flush/pour flush toilets connected to: Pit Latrine
[] Flush/pour flush toilets connected to: Elsewhere
[] Flush/pour flush toilets connected to: Unknown / Not sure / Do not know
[] Ventilated improved pit latrine
[] Pit latrine with slab
[] Pit latrine without slab / open pit
[] Composting toilet
[] Bucket
[] Hanging toilet /Hanging latrine
[] Other
[] No facility / bush / field
[] No response
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?
[] No
[] No response
502. What is the phone number?
Enter a 9 or 10-digit number without the country code. Do not include spaces or dashes.
Invalid number of digits.
503. Can you repeat the number again?
Enter a 9 or 10-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
Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6 m.
097. How many times have you visited this household?
[] 2nd time
[] 3rd time
098. In what language was this interview conducted?
[] French
[] Abbey
[] Abron
[] Adjoukrou
[] Agni
[] Arabic
[] Attie
[] Avikam
[] Bakoué
[] Baoule
[] Bete
[] Dida
[] Dioula
[] Djimini
[] Ebrié
[] Eholié
[] Elomoin
[] Fantin
[] Gnaboua
[] Godié
[] Gouro
[] Guere
[] Koulango
[] Kouzié
[] Kôyaka
[] Kroumen
[] Lobi
[] Mahou
[] Moré
[] N'zima
[] Senoufo
[] Suamlin
[] Wobe
[] Yacouba
[] Other
Record the result of the questionnaire.
Check answer to 009 and the consent.
[] No household member at home or no competent respondent at home at time of visit
[] Postponed
[] Refused
[] Partly completed
[] Dwelling vacant
[] Address not a dwelling
[] Dwelling destroyed
[] Dwelling not found
[] Entire household absent for extended period