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India 2020 Phase 1 Household Questionnaire

001a. Your ID: [interviewer's ID]

Is this your ID?

[] Yes
[] No

001b. Enter your ID below.

Please record your ID

002a. Current date and time.

Is this date and time correct?

[] Yes
[] No

002b. Record the correct date and time.

The date must be between 2019-09-01 and 2020-11-01.

003a. District

003b. Tehsil / Taluk

003c. City / Town / Village

004. Enumeration Area

005. Structure number

Please record the structure number from the household listing form.

006. Household number

Please record the household number from the household listing form.

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

[] Yes
[] No


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

Namaskar! My name is ____________________________________ and I am working for the IIHMR University Jaipur in collaboration with local Partners. I belong to this/nearby village. We are conducting a local survey that asks about your family and family members. Post to that we would also ask different questions from women aged between 15-49 years, which would help to identify gaps in family planning and health services that affect regular availability and quality of information, services, and products. This survey is conducted across Rajasthan. From every enumeration area 35 households have been selected and in this extension your house is randomly selected. Though we would very much appreciate your participation in the survey, your refusal to take part in this survey will have no repercussions on you. Information provided by you would help us inform the government to better plan health services. As such there is no risk however; there may be a distress among participants to share information on personal topics. If you agree to take part in this study, it will not benefit you directly. However, we believe that information gathered in this study will help us and other groups like us to develop programs that will improve the lives of men and women in communities in Rajasthan and around India so we hope that you would take part in this survey. Whatever information you provide will be kept confidential and only our research team will have access to it. We will never use your name while analyzing the data. The tracking sheet and the database with your responses will be kept on password-protected computers and on a secure server. Participation in this study is entirely voluntary, if you do not wish to answer any question feel free to inform me and I would skip to the next question. You can choose not to participate at all or to end the interview at any point. The survey usually takes between 20 to 30 minutes to complete.
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 Dr. Anoop Khanna at IIHMR University, in Jaipur, Rajasthan at +91-141-3924738.

010a. Provide a paper copy of the Consent Form to the respondent and read it.

Then, ask:
May I begin the interview now?

[] Yes
[] No

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.

Household member

101. Name of household member / visitor

Start with the head of the household.

101a. Is this person the respondent?

If yes, check this box.

[] NA

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

[] Head
[] 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?

[] Male
[] 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.

[] Married
[] Living with a partner
[] Divorced / separated
[] Widow / widower
[] Never married
[] No response

106. Does ${firstname} usually live here?

[] Yes
[] No
[] No response

107. Did ${firstname} stay here last night?

[] Yes
[] No
[] No response

LCL_101. What is the religion of ${firstname}?

[] Hindu
[] Muslim
[] Christian
[] Sikh
[] Buddhist/Neo-Buddhist
[] Jain
[] Jewish
[] Parsi/Zoroastrian
[] No religion
[] Other
[] No response

LCL_102. What is the caste of ${firstname}?

[] Scheduled Caste (SC)
[] Scheduled Tribe (ST)
[] Other Backward Caste (OBC)
[] General
[] Do not know
[] No response

108. Are there any other usual members of your household or persons who slept in the house last night?

[] Yes
[] No

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.

[] Yes
[] No

Section 2 ? Household Characteristics

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

201. 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.

[] Electricity
[] Mattress
[] Pressure cooker
[] Chair
[] Cot / bed
[] Table
[] Electric fan
[] Radio / transistor
[] Black and White television
[] Colour television
[] Sewing machine
[] Mobile telephone
[] Land line telephone
[] Internet
[] Computer
[] Refrigerator
[] Air conditioner / cooler
[] Washing machine
[] Watch / clock
[] Bicycle
[] Motorcycle / scooter
[] Animal-drawn cart
[] Car
[] Water pump
[] Thresher
[] Tractor
[] None of the above
[] No response

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

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

[] Yes
[] 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 / bulls / buffaloes ___
Camels ___
Horses / donkeys / mules ___
Goats ___
Sheep ___
Chickens / ducks ___
Other ___

Section 3 ? Household Observation

Please observe the floors, roof and exterior walls.

301. Main material of the floor


[] Mud / clay / earth
[] Sand
[] Dung
[] Raw wood planks
[] Palm / bamboo
[] Brick
[] Stone
[] Parquet / finished wood
[] Vinyl / asphalt
[] Ceramic tile
[] Cement
[] Carpet
[] Polished stone / marble / granite
[] Other
[] No response

302. Main material of the roof


[] No roof
[] Thatch / palm leaf / reed / grass
[] Mud
[] Sod / mud and grass mixture
[] Plastic / polythene sheeting
[] Rustic mat
[] Palm / bamboo
[] Raw wood planks / timber
[] Unburnt brick
[] Loosely packed stone
[] Metal / GI
[] Wood
[] Calamine / cement fiber
[] Asbestos sheets
[] RCC / RBC / Cement / Concrete
[] Roofing shingles
[] Tiles
[] Slate
[] Burnt brick
[] Other
[] No response

303. Main material of the exterior walls


[] No walls
[] Cane / palm / trunks / bamboo
[] Mud
[] Grass / reeds / thatch
[] Bamboo with mud
[] Stone with mud
[] Plywood
[] Cardboard
[] Unburnt brick
[] Raw wood / reused wood
[] Cement / concrete
[] Stone with lime / cement
[] Burnt brick
[] Cement blocks
[] Wood planks / shingles
[] GI / metal / asbestos sheets
[] Other
[] No response

Section 4 ? Water Sanitation and Hygiene

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

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

[] Piped Water: Piped into dwelling/indoor
[] 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

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

[] Flush/pour flush toilets connected to: Piped sewer system
[] 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

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.

097. How many times have you visited this household?

[] 1st time
[] 2nd time
[] 3rd time

098. In what language was this interview conducted?

[] English
[] Hindi
[] Other

099. Questionnaire Result

Record the result of the questionnaire.

Check answer to 009 and the consent.

[] Completed
[] 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