PMA Ethiopia Household Questionnaire 2021
HHQ001. Enter the three digits of your Phone?s ID
If it contains only two digits start with 0 followed by two digits, Example: 014. FOR TESTING PURPOSE ENTER 371.
Invalid ID format.
HHQ001a. Your name: {your_name}
Is this your name?
Check the button next to the name if that is your name and select ?yes? here. Do not check the button if that is not your name and select ?no? here (long press to remove response next to the name if needed).
[] No
HHQ001b. Enter your name below.
Please record your name
Is this date and time correct?
[] No
HHQ002b. Record the correct date and time.
Please record the structure number from the household listing form.
Invalid response.
Please record the household number from the household listing form.
Invalid response.
HHQ009.Is a member of the household and competent respondent present and available to be interviewed today?
[] No
HHQ009a.Is this a cross-section household?
[] No
INFORMED CONSENT Find a competent member of the household. Read the greeting on the following screen.
Hello. My name is {re_name} and I am working for the Addis Ababa University, and Federal Ministry of Health. We are conducting a local survey about various health issues using a smartphone. We would very much appreciate your participation in this survey. This information will help us inform the government to better plan health services. The survey usually takes only 15 minutes. Your data will not be linked to your identity when conducting analyses, presenting results, or sharing data.
Participation in this survey is voluntary, and if we should come to any question you don?t want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important.
I am going to ask you questions about your family and information about this household. We would then like to ask a different set of questions to female members of this household who are between the ages of 15 and 49.
If you have any questions about the study and your right as a research participant, you may ask me now or you may also contact the principal investigators of the study, Dr. Solomon Shiferaw or Dr. Assefa at Addis Ababa University in Addis Ababa, Ethiopia. For any ethical issues, please call Dr. Adamu Addissie, the IRB chairperson at the Addis Ababa University, College of Health Sciences.
At this time, do you want to ask me anything about the survey?
HHQ010a. Explain the consent form to the respondent. Then, ask: May I begin the interview now?
[] No
Please record your name as a witness to the consent process. You previously entered "{name_typed}."
SECTION 1 ? Household Roster I am now going to ask you a series of questions about each usual member of the household or anyone who slept in the house last night and pregnant or Postpartum women who are currently staying at their parental home?
HHQ101.Name of HH member/visitor
Start with the head of the household.
Please use only alphabets to enter the name of the HH member
HHQ101a. Is this person the respondent?
[] No
HHQ102. What is {firstname}?s relationship to the head of the household?
[] Wife/Husband
[] Son/Daughter
[] Son/Daughter-in-law
[] Grandchild
[] Parent
[] Parent in law
[] Brother/Sister
[] House help
[] Step child/adopted
[] Other
[] Do not know
[] No response
HHQ103. Is {firstname} male or female?
[] Female
[] No response
HHQ104. How old was {firstname} at their last birthday?
If less than one year old, enter 0
Invalid response.
HHQ105. 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, widowed, or have never been married.
[] Living with a partner
[] Divorced / separated
[] Widow / widower
[] Never married
[] No response
HHQ106. Does {firstname} usually live here?
[] No
[] No response
HHQ107. Did {firstname} stay here last night?
[] No
[] No response
If the person does not live in the house and did not spend last night in the house, please go back and remove him/her from the HH roster.
HHQ-Panel1. Is {firstname} enrolled in the panel study?
[] No
[] No response
HHQ-Panel2.Scan QR Code
Confirm that the scanned code matches the code on the card before advancing.
If you are unable to scan the QR code enter the number on the next screen.
CHECK: Are the last 4 digits the same as the two digit EA number and the two digit number on the ID card?"
If no, enter the 2-digit ID number on the next screen
If you select ?Yes? here, please make sure the QR code field IS NOT EMPTY. If you select ?No? here, please make sure the QR code field IS EMPTY.
[] No
HHQ-panel3. Record the correct number on the ID card
Please enter a two digit number.
Confirm that the QR code matches the code on the card before advancing.
QR Code - {qr_lab}
Please go back and correct this.
[] No
HHQ-panel4. Does the QR code match what is on the paper?
Please go back and correct this.
[] No
LCL101. What is the religion of {firstname}?
Only recorded for the head of the household.
[] Catholic
[] Protestant
[] Moslem
[] Traditional
[] Wakefeta
[] Other
[] No religion
[] No response
This person IS NOT eligible for the female respondent questionnaire.
This person IS eligible for the female respondent questionnaire.
Cross section HH - {cross_section_hh}
HHQ108. Are there any other usual members of your household or persons who slept in the house last night?
[] No
There are other members of the household. Move forward and select "Add Group"
There are no other members of the household. Move forward and select "Do Not Add"
There is no household head selected in the roster, please go back and select a head.
There are multiple household heads selected in the roster, please go back and select a single head.
There is no respondent selected in the household roster.
There is more than one respondent selected in the household roster.
HHQ109. 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 and pregnant or Postpartum women who are currently staying at thier parental home?
Remember to include all children in the household.
Go back and update the roster.
[] No
Section 2 ? Household Characteristics Now I would like to ask you a few questions about the characteristics of your household.
HHQ011. Please tell me about the items 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 watch/clock
[] A radio
[] A television
[] A mobile phone
[] A non-mobile telephone
[] A refrigerator
[] A table
[] A chair
[] A bed with cotton/sponge/spring mattress
[] An electric mitad
[] A kerosene lamp/pressure lamp
[] A bicycle
[] A TRICYCLE (bajaj)
[] A motorcycle/scooter
[] An animal-drawn cart
[] A car/truck
[] None of the above
[] No response
Have you considered all item options in HHQ011 (the previous question)?
Please go back and correct this.
[] No
HHQ012. What type of fuel does your household mainly use for cooking?
[] CHARCOAL
[] LIQUID PETROLEUM GAS (LPG)
[] ANIMAL DUNG
[] KEROSENE
[] WOOD
[] COAL, LIGNITE
[] BIOGAS
[] NATURAL GAS
[] STRAW/SHRUBS/GRASS
[] AGRICULTURAL CROP
[] NO FOOD COOKED IN HOUSEHOLD
[] No response
HHQ013. Where does your cooking take place?
[] In separate building
[] Outdoors
[] No response
HHQ014. Do you have an insecticide treated net in your household?
The net must be treated. The number of insecticide treated nets in the household does not matter, as long as the household owns at least one insecticide treated net.
[] No
[] No response
HHQ015a. 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
015b.How many of the following animals does this household own? Zero is a possible answer. Enter -88 for do not know. Enter -99 for no response
The household can keep the livestock anywhere, but must own the livestock recorded here.
Zero is a possible answer.
Milk Cows/Bulls/Oxen ___
Horses/Donkeys/Mules ___
Camels ___
Goats ___
Sheep ___
Chickens ___
Beehives ___
Enter -88 for do not know.Enter -99 for no response.
You have indicated the household owns livestock in HHQ015a, however you have entered zero (0) for all quantities owned on HHQ015b. Please go back and correct this.
Section 3 ? Household Observation Please observe the floors, roof and exterior walls.
HHQ016. Main material of the floor
Observe.
[] Dung
[] Wood Planks
[] Palm/Bamboo
[] Parquet or polished wood
[] Vinyl/Asphalt strips/Plastic tiles
[] Ceramic Tiles
[] Cement
[] Carpet
[] Other
[] No response
HHQ017. Main material of the roof
Observe.
[] Thatch/Leaf/Mud
[] Rustic Mat/Plastic Sheets
[] Reed/Bamboo
[] Wood Planks
[] Cardboard
[] Corrugated Iron/metal
[] Calamine/Asbestos/Cement Fiber
[] Cement/Concrete
[] Roof Shingles
[] Other
[] No response
HHQ018. Main material of the exterior walls
Observe.
[] Cane/Palm/Trunks/Bamboo/Reed
[] Dirt
[] Bamboo/Wood with Mud
[] Stone with Mud
[] Uncovered mud brick
[] Plywood
[] Cardboard
[] Reused Wood
[] Corrugated sheets
[] Cement
[] Stone with Lime/Cement
[] Bricks
[] Cement Blocks
[] Covered mud bricks
[] Wood Planks/Shingles
[] Other
[] No response
Section 4 ? Water, Sanitation and Hygiene Now I would like to ask you a few questions about water, sanitation and hygiene.
HHQ019a. 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?
[] Observed, mobile
[] Not observed, not in dwelling/yard/plot
[] Not observed, no permission to see
[] Not observed, other reason
[] No response
HHQ019b. At the place where the household most often washes their hands, observe if:
Check all that apply.
Cannot select ?none of the above? with other options.
[] Stored water is present
[] Running water is present
[] Handwashing area is near a sanitation facility
[] None of the above
HHQ020. 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 or Bicycle with Small Tank
[] Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel)
[] Bottled Water
[] Sachet Water
[] No response
HHQ021. What is the main toilet facility used by members of your household?
IF NOT POSSIBLE TO DETERMINE, ASK PERMISSION TO OBSERVE THE TOILET FACILITY.
[] 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
[] Bucket/pan
[] Composting toilet
[] Hanging toilet /Hanging latrine
[] Other
[] No facility / bush / field
[] No response
HHQ022. Where is your toilet facility located?
{sanitation_main_lab}
[] In own yard / plot
[] Elsewhere
[] No response
HHQ023. How often does your household typically use:
{sanitation_main_lab}
Regular practices at the household only.
[] Most of the time
[] Occasionally
[] No response
HHQ024. Do you share this toilet facility with other households or the public?
{sanitation_main_lab}
[] Shared with less than ten households
[] Shared with ten or more households
[] Shared with the public
[] No response
HHQ025. Enter the number of households that share this facility (including your own).
{sanitation_main_lab}
Hint: Please record the number of households not the number of people. Must be between 2 and 9. If 10 or greater, swipe back to HHQ024 and choose "shared with ten or more households OR with the Public" when applicable. Enter -99 for no response.
Invalid response.
HHQ026. For all children under age five: what methods, if any, does your household use to dispose of children?s waste?
PROBE: Other methods?
Do not read the possible responses out loud.
Check all that apply.
Invalid response.
[] Leave waste where it is
[] Dispose of waste in field / yard
[] Dispose of waste in latrine / toilet
[] Dispose of waste with rubbish / garbage
[] Dispose of waste with waste water
[] Use it as manure
[] Burn it
[] No response
Section 5 ?Occurrence and Frequency of Household Food Insecurity
Now I would like to ask you a few questions about experience and frequency of food insecurity ever occurred during the previous four weeks (30 days)
HFI033. In the past four weeks, did you worry that your household would not have enough food?
[] No
[] No response
HFI033a. How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI034. In the past four weeks, were you or any household member not able to eat the kinds of foods you preferred because of a lack of resources?
[] No
[] No response
HFI034a. How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI035. In the past four weeks, did you or any household member have to eat a limited variety of foods due to a lack of resources?
[] No
[] No response
HFI035a.How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI036.In the past four weeks, did you or any household member have to eat some foods that you really did not want to eat because of a lack of resources to obtain other types of food?
[] No
[] No response
HFI036a.How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI037.In the past four weeks, did you or any household member have to eat a smaller meal than you felt you needed because there was not enough food?
[] No
[] No response
HFI037a.How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI038.In the past four weeks, did you or any other household member have to eat fewer meals in a day because there was not enough food?
[] No
[] No response
HFI038a.How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI039.In the past four weeks, was there ever no food to eat of any kind in your household because of lack of resources to get food?
[] No
[] No response
HFI039a.How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI040.In the past four weeks, did you or any household member go to sleep at night hungry because there was not enough food?
[] No
[] No response
HFI040a.How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
HFI041.In the past four weeks, did you or any household member go a whole day and night without eating anything because there was not enough food?
[] No
[] No response
HFI041a.How often did this happen?
[] Sometimes (three to ten times in the past four weeks)
[] Often (more than ten times in the past four weeks)
[] No response
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
HHQ027. Location Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6m.
HHQ028. Did you have to move away from the household to take the GPS reading?
[] No
HHQ029. How many times have you visited this household?
[] 2nd time
[] 3rd time
HHQ030. In what language was this interview conducted?
[] Amharic
[] Afan Oromo
[] Tigringna
[] Sidamigna
[] Wolayitigna
[] Afar
[] Somali
[] Kefigna
[] Other
HHQ031. Was a translator used for this interview?
[] No
Record the result of the questionnaire.
The result must correspond to the response values.
[] No household member at home or no competent respondent at home at time of visit
[] Postponed
[] Refused
[] Partly completed
[] Dwelling vacant or address not a dwelling
[] Dwelling destroyed
[] Dwelling not found
[] Entire household absent for extended period
HHQ033. Take a photo of the QR code.
Make sure you have taken a picture of the full page and not just the QR code image and number