Please record your name
002b. Record the correct date and time.
The date must be between 2020-10-01 and 2021-10-01.
Please record the structure number from the household listing form.
Please record the structure number from the household listing form.
Please record the household number from the household listing form.
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 EA
[] Household split with some members in EA and some out of EA
[] 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
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.
010a. Provide a paper copy of the Consent Form to the respondent and read it.
Then, ask:
May I begin the interview now?
[] No
Please ask the respondent to sign or check the box in agreement of their participation.
011. Interviewer's name: ${your_name}
Mark your name 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
Move forward and select "Add Group"
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 EA
[] Moved out of the EA
[] Moved out of the EA 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.
[] Muslim
[] Protestant/Christian
[] Other
[] No religion
[] No response
Are there any other usual members of your household or persons who slept in the house last night that I have not listed here?
[] No
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 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.
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
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.
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.
[] 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.
[] Dung/Mud/Sod
[] Corrugated Iron (Mabati)
[] Tin Cans
[] Asbestos Sheet
[] Concrete
[] Tiles
[] Other
[] No response
303. Main material of the exterior walls
Observe.
[] 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.
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 an 10-digit number without the country code. Do not include spaces or dashes.
503. Can you repeat the number again?
Enter an 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?
[] Kiswahili
[] 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 or address not a dwelling
[] Dwelling destroyed
[] Dwelling not found
[] Entire household absent for extended period