002a. Is this date and time correct?
{today_formatted}
[] No
002b. Record the correct date and time.
The date must be between 2022-06-01 and 2022-12-31.
Please record your name
004a. Previous Annual Survey Household list
Structure number
Please record the structure number from the household listing form.
Please record the structure number from the household listing form.
Invalid response.
Please record the household number from the household listing form.
Invalid response.
007a. Are you at the same dwelling unit location from the previous annual survey?
[] No
007b. Do people live in this dwelling unit?
[] No
007c. Is at least one of the members from the previous annual survey 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
[] Address not a dwelling unit
[] Dwelling unit destroyed
[] Dwelling unit not found
007e. What is the status of the original household from the previous annual survey?
Confirm with the neighbors to know the status
[] Household moved within the study area
[] Household split with some members in the study area and some out of the study area
[] No information
Which woman from the previous annual survey are you following up?
If you do not see any women in this list, double-check your answers to 004a and 007a
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.
011a. Provide a paper copy of the Consent Form to the respondent and read it.
Then, ask: May I begin the interview now?
[] No
Interviewer?s name: {your_name}
Mark your name as a witness to the consent process.
Interviewer?s name
Please record your name as a witness to the consent process. You previously entered "{your_name_text}."
That is not what you entered for your name earlier in this survey.
Household Roster Updating
ODK will display the summary of all household members listed in the previous annual survey. You will then update their information to indicate any changes including births and deaths.
Is this person the respondent?
If yes, check this box.
PL_103. What is the status of this member in the household?
Respondent cannot be deceased
[] Resident, temporarily not at home
[] Moved elsewhere in the study area
[] Moved out of the study area
[] Deceased
[] Unknown
PL_103a. Do you know where the panel woman {firstname} moved to so that she can be followed up at her new household?
[] No
PL_103b. Where did {firstname} move to?
PL_104. Household Member
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.
Name of household member / visitor
Start with the head of the household.
101a. Is this person the respondent?
If yes, check this box.
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
Is {firstname} male or female?
[] Female
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.
CIFF_1. Has {firstname} completed at least 6 or more years of schooling at the primary level?
[] No
[] Do not know
[] No response
CIFF_2. Is {firstname} currently attending / attended school during the most recent school year?
Note that this includes remote learning during COVID lockdowns
[] No
[] Do not know
[] No response
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.
A spouse must be married
[] Living with a partner
[] Divorced / separated
[] Widow / widower
[] Never married
[] No response
Does {firstname} usually live here?
[] No
[] No response
Did {firstname} stay here last night?
[] No
[] No response
CIFF_3. Has a child aged under 18 in your household died in the last five years?
[] No
[] No response
PL-106/PL-108. 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
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.
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.
[] No
Section 2 ? Household Characteristics
Now I would like to ask you a few questions about the characteristics of your household.
Is this structure/house newly built in the last 12 months?
[] No
[] No response
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 cassette player?
[] A television?
[] A computer?
[] 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
[] No response
Check here to acknowledge you considered all options.
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
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: ____
Exotic/Cross cattle: ____
Horses, donkeys, or mules: ____
Goats: ____
Sheep: ____
Pigs: ____
Chickens: ____
Other: ____
Section 3 ? Household Observation
Please observe the floors, roof and exterior walls.
Observe.
[] Dung
[] Wood Planks
[] Palm/bamboo
[] Parquet or polished wood
[] Mosaic or Ceramic Tiles
[] Bricks
[] Stones
[] Concrete
[] Cement screed
[] Carpet
[] Other
[] No response
Observe.
[] Thatched/Palm leaf
[] Mud
[] Rustic mat
[] Tin
[] Wood planks
[] Cardboard
[] Tarpaulin
[] Iron sheets
[] Wood
[] Asbestos
[] Tiles
[] Concrete
[] Roofing shingles
[] Other
[] No response
Main material of the exterior walls
Observe.
[] Thatched/Straw
[] Dirt
[] Mud with Poles
[] Stone with mud
[] Un-burnt Bricks with mud
[] Plywood
[] Cardboard
[] Reused wood
[] Un-burnt Bricks with Plaster
[] Burnt bricks with mud
[] Cement blocks
[] Cement
[] Stone with lime/cement
[] Wood planks/shingles
[] Burnt Bricks with Cement
[] Unburnt bricks with cement
[] Other
[] No response
Section 4 ? Water Sanitation and Hygiene
Now I would like to ask you a few questions about water, sanitation and hygiene.
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
At the place where the household washes their hands, observe availability of water
[] Water is not available
[] No Response
At the place where the household washes their hands, observe availability of soap or detergent:
[] Soap is not available
[] No Response
What is the main source of drinking water for members of your household?
[] Piped Water: Pipe to yard/plot
[] Piped Water: Pipe to neighbor
[] 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
[] Bicycle with jerrycans
[] Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel)
[] Bottled Water
[] Sachet Water
[] Other
[] No response
CIFF_7. What is the source of water for non-drinking activities, such as cooking and washing?
Cannot select ?no response? with other options.
[] Piped Water: Pipe to yard/plot
[] Piped Water: Pipe to neighbor
[] 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
[] Bicycle with jerrycans
[] Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel)
[] Bottled Water
[] Sachet Water
[] Other
[] No response
CIFF_4. How far a walk is this main source of drinking water from your house, roundtrip?
Number of minutes
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
CIFF_5. Is the toilet or latrine shared with other households?
[] No
[] No response
CIFF_6. What type of fuel does your household mainly use for cooking?
[] LPG/CYLINDER GAS
[] BIOGAS
[] KEROSENE
[] CHARCOAL
[] WOOD
[] STRAW/SHRUBS/GRASS
[] AGRICULTURAL CROP
[] ANIMAL DUNG
[] NO FOOD COOKED IN HOUSEHOLD
[] OTHER
[] No response
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
Enter an 10-digit number without the country code. Do not include spaces or dashes.
Invalid number of digits.
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.
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.
096a. Where were you when you recorded the GPS coordinates?
[] Away from the structure but within the study area
[] Outside the study area
How many times have you visited this household?
[] 2nd time
[] 3rd time
In what language was this interview conducted?
[] Ateso
[] Luganda
[] Lugbara
[] Luo
[] Lusoga
[] Ngakarimojong
[] Runyankole-Rukiga
[] Runyoro-Rutoro
[] 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
[] Address not a dwelling
[] Dwelling unit destroyed
[] Dwelling unit not found
[] Entire household absent for extended period