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PMA Kenya Household Questionnaire 2019 - Baseline

001a. Your name: ${your_name}

Is this your name?

[] Yes
[] No

001b. Enter your name below.

Please record your name

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 2020-09-01.

003a. County

003b. District (sub-county)

003c. Division

003d. Location

004. Enumeration area

005. Structure number

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.

007. CHECK: Have you already sent a form for this structure and household?

DO NOT DUPLICATE ANY FORM UNLESS YOU ARE CORRECTING A MISTAKE IN AN EARLIER FORM.

[] Yes
[] No

WARNING: Contact your supervisor before sending this form again.

008. CHECK: Why are you resending this form?

Choose all that apply.

[] There are new household members on this form
[] 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)

WARNING: Each household should have ONLY ONE household roster with all household members listed on the same form.

Please contact your supervisor before sending this form.

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

[] Yes
[] No

INFORMED CONSENT

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

010a. Provide a paper copy of the Consent Form to the respondent and read it. / Read the verbal consent text.

Then, ask:
May I begin the interview now?

[] Yes
[] No

010b. Respondent's signature

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

Checkbox

[] NA

WARNING: The respondent has not signed or checked the box, despite agreeing to be interviewed in the previous question. To conduct the survey, the respondent must sign or touch the checkbox.

You may go back to obtain a signature or check the box or you should go back to the previous question to indicate the respondent does not want to be interviewed.

010c. Interviewer's name: ${your_name}

Mark your name as a witness to the consent process.

[] NA

010c. Interviewer's name

Please record your name as a witness to the consent process. You previously entered "${name_typed}."

That is not what you entered for your name earlier in this survey.

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

ERROR: Members on household roster must usually live here or must have stayed here last night.

Go back and remove this household member.

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

[] Catholic
[] Muslim
[] Protestant/Christian
[] Other
[] No religion
[] No response

This person IS NOT eligible for the female respondent questionnaire.

This person IS eligible for the female respondent questionnaire.

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

[] Yes
[] 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"


ERROR: There is no household head.

Go back, select a head.

For each member, check that the relationship to the household head is accurate.

ERROR: There are ${heads} household heads selected:
${head_name_joined}

Go back, select only one head.

For each member, check that the relationship to the household head is accurate.

101a NO RESPONDENT ERROR.

The checkbox for 101a (Is this person the respondent?) was never selected for any of the household members.

You entered the following household members: ${names}.

If the respondent was entered in the roster but never selected as the respondent in 101a: Please go back and select the checkbox in 101a for the correct respondent.

If the respondent is a household member but left out of the list of household members: Add the respondent to the list.

If the respondent is not a household member: Stop the interview. Find a household member and interview that person. Be sure to ask for consent.

101a TOO MANY RESPONDENTS ERROR.

The checkbox for 101a (Is this person the respondent?) was selected more than once.

Please go back and make sure that it is only selected once.

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?
[] A radio?
[] A television?
[] A mobile phone?
[] A non-mobile telephone?
[] A refrigerator?
[] A solar panel?
[] A table?
[] A chair?
[] A sofa?
[] A bed?
[] A cupboard?
[] A clock?
[] A microwave oven?
[] A DVD player?
[] A cassette / CD player?
[] An air conditioner?
[] A watch?
[] A bicycle?
[] A motorcycle / scooter?
[] Animal-drawn cart?
[] A car / truck?
[] A boat with a motor?
[] None of the above
[] No response

Check here to acknowledge you considered all options.

[] NA

202a. 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

202b. 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.

_____Local cattle (Indigenous)
_____Exotic/grade cattle (milk cows or bulls)
_____Horses/donkeys/camels
_____Goats
_____Sheep
_____Chickens

Section 3 - Household Observation

Please observe the floors, roof and exterior walls.

301. Main material of the floor

Observe.

[] Earth / sand
[] Dung
[] Wood Planks
[] Palm / bamboo
[] Parquet or polished wood
[] Vinyl or Asphalt strips
[] Ceramic Tiles
[] Cement
[] Carpet
[] Other
[] No response

302. Main material of the roof

Observe.

[] Grass/Thatch/Makuti
[] Dung/Mud/Sod
[] Corrugated Iron (Mabati)
[] Tin Cans
[] Asbestos Sheet
[] Concrete
[] Tiles
[] Other
[] No response

303. Main material of the exterior walls

Observe.

[] No Walls
[] Cane/Palm Trunks
[] Dung/Mud/Sod
[] Bamboo with Mud
[] Stone with Mud
[] Uncovered Adobe
[] Plywood
[] Cardboard
[] Reused Wood
[] Iron sheets
[] Cement
[] Stone with Lime/Cement
[] Bricks
[] Cement Blocks
[] Covered Adobe
[] 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.

403. 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

410. 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
[] Kiswahili
[] 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