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PMA2020


1. Uganda Round 6 - Household Questionnaire

001a. Your name: _______
Is this your name?

[] Yes
[] No

001b. Enter your name below.
Please record your name

002a. Current date and time.

Jour: __
Mois: __
Année: ____

Is this date and time correct?

[] Yes
[] No

002b. Record the correct date and time.
The date must be between 2018-03-01 and 2019-03-01.

Jour: ___
Mois: ___
Année: ____

003a. Region

[] Karamoja
[] North
[] West-Nile
[] Eastern
[] East-Central
[] Central 2
[] Central 1
[] Western
[] South-West
[] Kampala

2. 003b. District Abim

[] Kaabong
[] Kotido
[] Nakapiripirit
[] Napak
[] Agago
[] Alebtong
[] Amuru
[] Apac
[] Gulu
[] Kitgum
[] Lamwo
[] Lira
[] Otuke
[] Oyam
[] Pader
[] Arua
[] Koboko
[] Nebbi
[] Yumbe
[] Zombo
[] Budaka
[] Bududa
[] Bukedea
[] Kibuku
[] Kumi
[] Manafwa
[] Mbale
[] Serere
[] Sironko
[] Soroti
[] Tororo
[] Bugiri
[] Busia
[] Buyende
[] Iganga
[] Jinja
[] Kaliro
[] Kamuli
[] Luuka
[] Mayuge
[] Namayingo
[] Buikwe
[] Kakumiro
[] Kyankwanzi
[] Luwero
[] Mityana
[] Mubende
[] Mukono
[] Nakaseke
[] Nakasongola
[] Bukomansimbi
[] Lwengo
[] Lyantonde
[] Mpigi
[] Ssembabule
[] Wakiso
[] Hoima
[] Kabarole
[] Kamwenge
[] Kasese
[] Kiryandongo
[] Masindi
[] Ntoroko
[] Ibanda
[] Isingiro
[] Kabale
[] Kiruhura
[] Kisoro
[] Mbarara
[] Mitooma
[] Ntungamo
[] Rukungiri
[] Sheema
[] Kampala

003c. Sub-county

[] Alerek
[] Kapedo
[] Sidok
[] Kaabong Tc
[] Panyangara
[] Loregae
[] Matany
[] Paimol
[] Omoro
[] Amuru Tc
[] Lamogi
[] Akokoro
[] Unyama
[] Mucwini
[] Agoro
[] Barr
[] Alango
[] Aber
[] Minakulu
[] Pader
[] Manibe
[] Omugo
[] Lobule
[] Koboko Tc
[] Pakwach
[] Kei
[] Kango
[] Kaderuna
[] Bududa Town Council
[] Malera
[] Bulangira
[] Kanyum
[] Bumwoni
[] Lwasso
[] Pingire
[] Bukyambi
[] Asuret
[] Nabuyoga
[] Kapyanga
[] Dabani
[] Bugaya
[] Namalemba
[] Namungalwe
[] Busedde
[] Buyengo
[] Nawaikoke
[] Kaliro Tc
[] Namwendwa
[] Bukooma
[] Bukatube
[] Malongo
[] Mutumba
[] Njeru Town Council
[]Kasambya
[] Kyankwanzi
[] Zirobwe
[] Banda
[] Kibalinga
[] Mpatta
[] Central Division
[] Wakyato
[] Kalungi
[] Butenga
[] Kyazanga
[] Lyantonde Tc
[] Kituntu
[] Lwemiyaga
[] Nsangi
[] Makidye -ssabagabo
[] Division A
[] Buhimba
[] Karambi
[] Western Division
[] Nyabbani
[] Bugoye
[] Kigumba
[] Bweyale Tc
[] Bwijanga
[] Karugutu
[] Kicuzi
[] Kabingo
[] Ikumba
[] Buhara
[] Kanyaryeru
[] Sanga Tc
[] Muramba
[] Kamukuzi
[] Rubindi
[] Katenga
[] Rubaare
[] Kibatsi
[] Nyakagyeme
[] Kitagata
[] Central Division
[] Kawempe Division
[] Lubaga Division
[] Makindye Division
[] Nakawa Division

004. Enumeration area
['A list of EAs.']

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.

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

[] Yes
[] No

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

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

009b. Did this household participate in a previous PMA2020 survey?

[] Yes
[] No
[] Do not know -88
[] No response -99

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

Hello. My name is ________________________________ and I am working for the Makerere University, School of Public in collaboration with Ministry of Health, and Uganda Bureau of Statistics. We are conducting a local survey about various health issues. We would very much appreciate your participation in this survey. This information will help us inform the government to better plan health services. Whatever information you provide will be kept strictly confidential and will not be shown to anyone other than members of our survey team. 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 other household members. 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 years. At this time, do you want to ask me anything about the survey?
['Biraha ibaara lyange ninyowe ________________________ninkorra Makerere University, School of Public hamu n'ekitongole ky'ebyobwomezi,hamu n'ekitongole ky'ebyomutindo. Tuli hamusomo gwo ebyokuhabuza ebirukukwata habw'ebyomwezi. Twakugondeze kwenyigira mukuseruliliza kunu. Ebyoratugamba nibija kuyamba ihanga mu kutegekera kurungi empereza y'ebyobwomezi.Byona ebyoratugambira nibija kuba by'ensita, kandi tibirikwija kwolekwa omuntu wena kwihaho abo bonka abali hamusomo gunu ogwokuseruliliza. Kwetaba mumusomo gunu kwokwegondeza,obworahika hakihabuzo kyona otarugonza kukigarukamu, mmanyisa ngende hakikaguzo ekindi, rundi tusobora kukangira aho, obwire bwoona.Baitu ntunihira, okwija kwenyigira mukuseruliliza kunu , habwokuba ebitekerezo byawe by'omugaso .Nkugenda kukuhabuza ebirukukwata ha maka gawe, n'abantu b'omumaka gawe. Hanyuma nitwija kukuhabuza ebikaguzo ebyembaganiza, habakazi b'omumaka ganu abali hagati y'emyaka15 na 49. Ha saaha enu noyenda kunkaguza ekintu kyona hakuseruliliza kunu?']

010a. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask: May I begin the interview now?
['010a. Provide a paper copy of the Consent Form to the respondent and explain it. Then, ask: May I begin the interview now?']

010c. Interviewer's name: __________________
Mark your name as a witness to the consent process.

010c. Interviewer's name
Please record your name as a witness to the consent process.
You previously entered [Name]
That is not what you entered for your name earlier in this survey.

011. Respondent's first name
Please record the first name of the respondent.

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?

102. What is [Name]'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 -88
[] No response -99

103. Is [Name] male or female?

[] Male
[] Female

104. How old was [Name] at their last birthday?
If less than one year old, record 0
Age must be less than 130 and greater than zero.

105. What is [Name]'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 -99

106. Does [Name] usually live here?

[] Yes
[] No
[] No response -99

107. Did [Name] stay here last night?

[] Yes
[] No
[] No response -99

ERROR: Members on household roster must usually live here or must have stayed here last night. Go back and remove this household member.

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 [greater than 1] household heads selected:
Go back, select only one head.
For each member, check that the relationship to the household head is accurate.

The respondent must be in the roster. Only one person in the roster can be marked as the respondent. Go back and make sure that only one person is selected as the respondent. You entered the following household members:

109. READ THIS CHECK OUT LOUD: There are [number] household members who are named [name]. 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 cassette player?
[] A television?
[] A mobile phone?
[] A fixed telephone?
[] A refrigerator?
[] A table?
[] A chair?
[] A sofa set?
[] A bed?
[] A cupboard?
[] A clock?
[] A watch?
[] A bicycle?
[] A motorcycle or motor scooter?
[] An animal drawn cart?
[] A car or truck?
[] A boat with a motor?
[] A boat without a motor?
[] None of the above -77
[] No response -99

Check here to acknowledge you considered all options.

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 -99

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.
Local Cattle: ___
Enter -88 for do not know. Enter -99 for no response.
Exotic/Cross cattle: ___
Enter -88 for do not know. Enter -99 for no response.
Horses, donkeys, or mules: ___
Enter -88 for do not know. Enter -99 for no response.
Goats: ___
Enter -88 for do not know. Enter -99 for no response.
Sheep: ___
Enter -88 for do not know. Enter -99 for no response.
Pigs: ___
Enter -88 for do not know. Enter -99 for no response.
Chickens: ___
Enter -88 for do not know. Enter -99 for no response.

Section 3 - Household Observation
Please observe the floors, roof and exterior walls.

301. Main material of the floor
Observe.
[] Earth/Sand
[] Earth and Dung
[] Parquet or polished wood
[] Mosaic or Tiles
[] Bricks
[] Cement
[] Stones
[] Other
[] No response -99

302. Main material of the roof
Observe.
[] Thatched
[] Mud
[] Wood/Planks
[] Iron sheets
[] Asbestos
[] Tiles
[] Tin
[] Cement
[] Other
[] No response -99

303. Main material of the exterior walls
Observe.
[] Thatched/Straw
[] Mud and Poles
[] Un-burnt Bricks
[] Un-burnt Bricks with Plaster
[] Burnt bricks with mud
[] Cement blocks
[] Stone
[] Timber
[] Burnt Bricks with Cement
[] Other
[] No response -99

Section 4 - Water Sanitation and Hygiene
Now I would like to ask you a few questions about water, sanitation and hygiene.

401a. 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, fixed place
[] Observed, mobile
[] Not observed, not in dwelling/yard/plot
[] Not observed, no permission to see
[] Not observed, other reason
[] No response -99

401b. At the place where the household washes their hands, observe if:
Check all that apply.
Cannot select 'none of the above' with other options.
[] Soap is present
[] Stored water is present
[] Running water is present
[] Handwashing area is near a sanitation facility
[] None of the above -77

402. Which of the following water sources does your household use on a regular basis for any part of the year for any purpose?
Read out all types and check all that are used. Scroll to bottom to see all choices.
[] 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 -99

Check here to acknowledge you considered all options.

403. What is the main source of drinking water for members of your household?
Selections from 402:
Read out 402 selections only.

[] 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 -99

404. What is the main source of water used by your household for other purposes such as cooking and hand washing?
Selections from 402:
Read out 402 selections only.
[] 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 -99

405. You mentioned that you used [main water source]. At any time of the year, does your household use water from this source for:

[] Drinking
[] Cooking
[] Livestock
[] Gardening / agriculture
[] Business venture
[] Washing
[] No response -99

406. How many months out of the year is [main water source] usually available:
Zero is a possible answer. Please record the number of completed months. Enter -88 for Do Not Know, -99 for No Response

407. At a time of year when you expect to have [main water source], is it usually available?

[] Yes, always
[] No, intermittent and predictable
[] No, intermittent and unpredictable
[] No response -99

408. How long does it take to go to the [main water source], and come back?
0 is a possible answer. Convert answer to minutes. Includes waiting time in line. Enter -88 for do not know, -99 for no response.

409. Do members of your household use any of the following toilet facilities?
Read out all types. Check all that are used. Scroll to bottom to see all choices.
Cannot select 'no response' with other options.

[] 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 -99

Check here to acknowledge you considered all options.

410. What is the main toilet facility used by members of your household?
Selections from 409:
The main facility must be selected in 409.

[] 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 -99

SN_411.ii. When was the last time your [toilet facility] was emptied?
Probe: How many months or years ago?
If less than one month, select months.
[] X months ago
[] X years ago
[] Never emptied -77
[] Do not know -88
[] No response -99

Enter [number]: __
If less than one month, enter 0 months.

SN_411.iii. The last time your [toilet facility] was emptied, who emptied it?
Probe: Was it emptied by household members or by neighbors or by a service provider?

[] By household members or neighbors
[] By a service provider
[] Other
[] Do not know -88
[] No response -99

SN_411.iv. The last time your [toilet facility] was emptied, where were the contents emptied to?

[] To a covered and sealed hole (buried)
[] To an open drain or to a water body
[] To an open hole (not buried), open ground, bush, beach or to agricultural land
[] Taken away by the service provider to a treatment facility
[] Taken away by the service provider to do not know where
[] Other
[] Do not know -88
[] No response -99

411.v. Where is your toilet facility located?

[] In own dwelling
[] In own yard / plot yard
[] Elsewhere -77
[] No response -99

411. How often does your household typically use:
Regular practices at the household only.
[] Always
[] Most of the time
[] Occasionally
[] No response -99

412a. Do you share this toilet facility with other households or the public?

[] Not shared
[] Shared with less than ten households
[] Shared with ten or more households
[] Shared with the public
[] No response -99

412b. Enter the number of households that share this facility (including your own).
Must be between 2 and 9.
If 10 or greater, move back to 412a and choose "Shared with ten or more households."
Enter -99 for no response.

413. How many people within your household regularly use the bush / field at home or at work?
There are ${num_HH_members} people in this household.
Enter -88 for do not know, -99 for no response.
Must be between zero and the number of household members.

WARNING: The respondent entered zero for the previous question, 413, but listed open defecation as a household sanitation facility in 409.

414. 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.
[] Children use a latrine / toilet
[] Leave waste where it is
[] Bury 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
[] Do not know -88
[] No response -99

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

098. In what language was this interview conducted?

[] English
[] Ateso
[] Luganda
[] Lugbara
[] Lusoga
[] Luo
[] Runyankole-Rukiga
[] Runyoro-Rutoro
[] Ngakaramojong
[] Other

099. Questionnaire Result
Record the result of the questionnaire.
[] 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