Democratic Republic of Congo Round 7 -Household Questionnaire

Home , Barumbu, Bumbu, Kimbanseke, Kintambo, Kisenso, Limete

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

Day: 002b. Record the correct date and time. Month: Year:

◯ Kongo Central 003a. Province ◯ KINSHASA

◯ BARUMBU ◯ BAS_FLEUVE ◯ BINZA_METEO ◯ BINZA_OZONE ◯ BIYELA ◯ BOMA ◯ BUMBU ◯ CATARACTES ◯ KALAMU_I ◯ KALAMU_II ◯ KIKIMI ◯ KIMBANSEKE ◯ KINGABWA ◯ KINGASANI ◯ KINSHASA 003b. District ◯ KINTAMBO ◯ KISENSO ◯ LEMBA ◯ LIMETE ◯ LINGWALA ◯ LUKAYA ◯ MASINA_I ◯ MASINA_II ◯ MATADI ◯ MATETE ◯ MONT_NGAFULA_I ◯ MONT_NGAFULA_II ◯ NGABA ◯ NGIRINGIRI ◯ SELEMBAO

◯ BARUMBU 003b. Zone de Santé ◯ BAS_FLEUVE

◯ BINZA_METEO ◯ BINZA_OZONE ◯ BIYELA ◯ BOMA ◯ BUMBU ◯ CATARACTES ◯ KALAMU_I ◯ KALAMU_II ◯ KIKIMI ◯ KIMBANSEKE ◯ KINGABWA ◯ KINGASANI ◯ KINSHASA ◯ KINTAMBO ◯ KISENSO ◯ LEMBA ◯ LIMETE ◯ LINGWALA ◯ LUKAYA ◯ MASINA_I ◯ MASINA_II ◯ MATADI ◯ MATETE ◯ MONT_NGAFULA_I ◯ MONT_NGAFULA_II ◯ NGABA ◯ NGIRINGIRI ◯ SELEMBAO

◯ 17_MAI ◯ ASSOSSA_NGIRI_NGIRI ◯ BAKI_VILLE ◯ BAMBOMA ◯ BANA ◯ BANGU ◯ BETON ◯ BINZA_PIGEON ◯ BITSHAKU_TSHAKU 003c. Aire de Santé ◯ BOBA ◯ BUMBA ◯ BUNZI ◯ CAMP_PERMANENT ◯ CNECI ◯ CONGO ◯ CONGO_1 ◯ DIANGIENDA_I ◯ DINGI_DINGI

◯ ESSANGA ◯ HYGIENE_A ◯ IMBALI ◯ INGA ◯ KAPINGA ◯ KASAI_MASINA ◯ KASAI_BUMBU ◯ KAUKA_I ◯ KEMI ◯ KHAMI ◯ KHESA ◯ KIFUMA_NGIMBI ◯ KIKIMI ◯ KIMBANGU_A ◯ KIMBANZA ◯ KIMBATA___TUDI ◯ KIMBIANGA ◯ KIMBONDO1(_KINDELE) ◯ KIMUAKA ◯ KINGABWA ◯ KINKENGE ◯ KINSUKA_PECHEUR ◯ KINZAU_MVUE ◯ KIPASA ◯ KISANTU ◯ KISENSO_GARE ◯ KITOMESA ◯ KIVALA_TADI ◯ KIVEVE ◯ KIVUNDA ◯ KUMBI ◯ LOBIKO ◯ LOVO_BOMA ◯ LOVO_CATARACTES ◯ LT_MBAKI ◯ LT_MPAKA ◯ LUBAMBA ◯ LUBUDI_KUKA ◯ LUBUSI ◯ LUKUNGA ◯ LUNGI ◯ LUNIONZO ◯ LUOZI ◯ LUYI ◯ MAMA_YEMO ◯ MAMAN_YEMO ◯ MAPELA_1

◯ MATADI ◯ MATEBA ◯ MAYULU ◯ MBANZA_NZUNGU ◯ MBATA_NLUNDU ◯ MB.KILENDA ◯ MFUMU_SUKA ◯ MITENDI ◯ MONGO ◯ MUANDA ◯ MUNGANGA ◯ MUSHIE_CPA ◯ MVULA_MATADI ◯ NDEMBO_LUKAYA ◯ NDEMBO_CATARCTES ◯ NGADI ◯ NGBAKA ◯ NGOMBA_KIKUSA ◯ NGOMBE_LUTENDELE ◯ NGOMUILA ◯ NKAMUNA ◯ NKANDU ◯ NKULU ◯ NSANGA ◯ NTAMPA ◯ PETI_PETI ◯ POSTE_24 ◯ Q_LONZO ◯ SADI ◯ SALONGO_KINGABWA ◯ SALONGO_MATADI ◯ SANS_FIL ◯ TELEVISION ◯ TROUPE ◯ TSANGA_NGOM ◯ TSHIANGU ◯ TSHUENGE ◯ TUZOLANA ◯ VIVI ◯ YANGALA ◯ YEMA_NTENE ◯ YOLO_NORD_II

◯ 17_MAI ◯ ASSOSSA_NGIRI_NGIRI 003c. Quartier ◯ BAKI_VILLE ◯ BAMBOMA

◯ BANA ◯ BANGU ◯ BETON ◯ BINZA_PIGEON ◯ BITSHAKU_TSHAKU ◯ BOBA ◯ BUMBA ◯ BUNZI ◯ CAMP_PERMANENT ◯ CNECI ◯ CONGO ◯ CONGO_1 ◯ DIANGIENDA_I ◯ DINGI_DINGI ◯ ESSANGA ◯ HYGIENE_A ◯ IMBALI ◯ INGA ◯ KAPINGA ◯ KASAI_MASINA ◯ KASAI_BUMBU ◯ KAUKA_I ◯ KEMI ◯ KHAMI ◯ KHESA ◯ KIFUMA_NGIMBI ◯ KIKIMI ◯ KIMBANGU_A ◯ KIMBANZA ◯ KIMBATA___TUDI ◯ KIMBIANGA ◯ KIMBONDO1(_KINDELE) ◯ KIMUAKA ◯ KINGABWA ◯ KINKENGE ◯ KINSUKA_PECHEUR ◯ KINZAU_MVUE ◯ KIPASA ◯ KISANTU ◯ KISENSO_GARE ◯ KITOMESA ◯ KIVALA_TADI ◯ KIVEVE ◯ KIVUNDA ◯ KUMBI ◯ LOBIKO ◯ LOVO_BOMA

◯ LOVO_CATARACTES ◯ LT_MBAKI ◯ LT_MPAKA ◯ LUBAMBA ◯ LUBUDI_KUKA ◯ LUBUSI ◯ LUKUNGA ◯ LUNGI ◯ LUNIONZO ◯ LUOZI ◯ LUYI ◯ MAMA_YEMO ◯ MAMAN_YEMO ◯ MAPELA_1 ◯ MATADI ◯ MATEBA ◯ MAYULU ◯ MBANZA_NZUNGU ◯ MBATA_NLUNDU ◯ MB.KILENDA ◯ MFUMU_SUKA ◯ MITENDI ◯ MONGO ◯ MUANDA ◯ MUNGANGA ◯ MUSHIE_CPA ◯ MVULA_MATADI ◯ NDEMBO_LUKAYA ◯ NDEMBO_CATARCTES ◯ NGADI ◯ NGBAKA ◯ NGOMBA_KIKUSA ◯ NGOMBE_LUTENDELE ◯ NGOMUILA ◯ NKAMUNA ◯ NKANDU ◯ NKULU ◯ NSANGA ◯ NTAMPA ◯ PETI_PETI ◯ POSTE_24 ◯ Q_LONZO ◯ SADI ◯ SALONGO_KINGABWA ◯ SALONGO_MATADI ◯ SANS_FIL ◯ TELEVISION

◯ TROUPE ◯ TSANGA_NGOM ◯ TSHIANGU ◯ TSHUENGE ◯ TUZOLANA ◯ VIVI ◯ YANGALA ◯ YEMA_NTENE ◯ YOLO_NORD_II

◯ 17_MAI_A ◯ ASSOSSA_NGIRI_NGIRI_A ◯ BAMBOMA_A ◯ BANDUNDU ◯ BATALLON_3_TALANGAYI ◯ BATENDE_1 ◯ BETON_1 ◯ BLOC_1 ◯ BOBA_I ◯ BOKALA ◯ BOLAFA_PETI_PETI ◯ BUNZI_1 ◯ CBCO ◯ CNECI_I ◯ CONGO_A ◯ DIANGIENDA_I ◯ FOIRE_AGRICOLE ◯ KAI_MANSITU 003d. Village ◯ KANIOKA ◯ KAPINGA_1 ◯ KASAI_MASINA ◯ KASAI_BUMBU ◯ KAUKA_A ◯ KEMI_A ◯ KHAMI_1 ◯ KHESA_1 ◯ KIBULA ◯ KIFUMA_NGIMBI_1 ◯ KIKIMI_KIKIMI ◯ KIKIMI_LOBIKO ◯ KIMBANZA_1 ◯ KIMBATA_TUDI_1 ◯ KIMBIANGA_1 ◯ KIMPESE ◯ KIMPONKO ◯ KIMUAKA ◯ KIMVULA

◯ KINDAMBA ◯ KINGABWA_A ◯ KINGABWA_SALONGO ◯ KINKENGE ◯ KINKONDO ◯ KINSIONA ◯ KINZAU_MVUE_A ◯ KINZAU_MVUE_B ◯ KINZAU_MVUE_C ◯ KIPASA__1 ◯ KISANTU_A ◯ KISENSO_GARE_A ◯ KITOMESA_1 ◯ KIVALA_TADI_1__1 ◯ KIVEVE_1 ◯ KIVUNDA_1 ◯ KUMBI_1 ◯ KUNDA_1 ◯ LAC_MOERO ◯ LIKONZI_LUTUNU ◯ LOVO_1 ◯ LUBUDI_KUKA_A ◯ LUBUSI_1 ◯ LUKI ◯ LUKUNGA ◯ LUNGI_1 ◯ LUVUEZO_1 ◯ MABANGA ◯ MADIMBA ◯ MASIKA_BASANKUSU ◯ MATEBA_A ◯ MATONGA_CONSACRE ◯ MAYULU_A ◯ MAZAL_AILE_DROITE ◯ MBAMBA_KILENDA ◯ MBANZA_KANU ◯ MBATA ◯ MBUKU_NDINGI ◯ MFUMU_SUKA_A ◯ MOLENDE ◯ MONDONGA ◯ MOTANGA ◯ MPOMPAGE ◯ MUANDA_MAMPUTU ◯ MUTEBA ◯ NDEMBO_1 ◯ NDJILI

◯ NDUNU ◯ NGOMUILA_1 ◯ NIENGA_MBOTA ◯ NKAMUNA ◯ NKANZA ◯ NKONGO_DE_LA_PAIX ◯ NKULU_I ◯ NTOLASANI ◯ POSTE_24 ◯ PROMOBAT ◯ Q1 ◯ Q_SINZA ◯ SADI_1 ◯ SAMBI ◯ SANS_FIL ◯ SHABA ◯ SONA_BATA ◯ SONABATA_ASOSA ◯ THUTA ◯ TSANGA_NGOM_1 ◯ TSHIANGU_A ◯ TUZOLANA_1 ◯ USOKE ◯ WAMBA ◯ YANGALA ◯ YOLO_NORD_II_A

◯ 17_MAI_A ◯ ASSOSSA_NGIRI_NGIRI_A ◯ BAMBOMA_A ◯ BANDUNDU ◯ BATALLON_3_TALANGAYI ◯ BATENDE_1 ◯ BETON_1 ◯ BLOC_1 ◯ BOBA_I ◯ BOKALA 003d. Localité / rue ◯ BOLAFA_PETI_PETI ◯ BUNZI_1 ◯ CBCO ◯ CNECI_I ◯ CONGO_A ◯ DIANGIENDA_I ◯ FOIRE_AGRICOLE ◯ KAI_MANSITU ◯ KANIOKA ◯ KAPINGA_1

◯ KASAI_MASINA ◯ KASAI_BUMBU ◯ KAUKA_A ◯ KEMI_A ◯ KHAMI_1 ◯ KHESA_1 ◯ KIBULA ◯ KIFUMA_NGIMBI_1 ◯ KIKIMI_KIKIMI ◯ KIKIMI_LOBIKO ◯ KIMBANZA_1 ◯ KIMBATA_TUDI_1 ◯ KIMBIANGA_1 ◯ KIMPESE ◯ KIMPONKO ◯ KIMUAKA ◯ KIMVULA ◯ KINDAMBA ◯ KINGABWA_A ◯ KINGABWA_SALONGO ◯ KINKENGE ◯ KINKONDO ◯ KINSIONA ◯ KINZAU_MVUE_A ◯ KINZAU_MVUE_B ◯ KINZAU_MVUE_C ◯ KIPASA__1 ◯ KISANTU_A ◯ KISENSO_GARE_A ◯ KITOMESA_1 ◯ KIVALA_TADI_1__1 ◯ KIVEVE_1 ◯ KIVUNDA_1 ◯ KUMBI_1 ◯ KUNDA_1 ◯ LAC_MOERO ◯ LIKONZI_LUTUNU ◯ LOVO_1 ◯ LUBUDI_KUKA_A ◯ LUBUSI_1 ◯ LUKI ◯ LUKUNGA ◯ LUNGI_1 ◯ LUVUEZO_1 ◯ MABANGA ◯ MADIMBA ◯ MASIKA_BASANKUSU

◯ MATEBA_A ◯ MATONGA_CONSACRE ◯ MAYULU_A ◯ MAZAL_AILE_DROITE ◯ MBAMBA_KILENDA ◯ MBANZA_KANU ◯ MBATA ◯ MBUKU_NDINGI ◯ MFUMU_SUKA_A ◯ MOLENDE ◯ MONDONGA ◯ MOTANGA ◯ MPOMPAGE ◯ MUANDA_MAMPUTU ◯ MUTEBA ◯ NDEMBO_1 ◯ NDJILI ◯ NDUNU ◯ NGOMUILA_1 ◯ NIENGA_MBOTA ◯ NKAMUNA ◯ NKANZA ◯ NKONGO_DE_LA_PAIX ◯ NKULU_I ◯ NTOLASANI ◯ POSTE_24 ◯ PROMOBAT ◯ Q1 ◯ Q_SINZA ◯ SADI_1 ◯ SAMBI ◯ SANS_FIL ◯ SHABA ◯ SONA_BATA ◯ SONABATA_ASOSA ◯ THUTA ◯ TSANGA_NGOM_1 ◯ TSHIANGU_A ◯ TUZOLANA_1 ◯ USOKE ◯ WAMBA ◯ YANGALA ◯ YOLO_NORD_II_A

◯ 17_MAI_A 004. EA ◯ ASSOSSA_NGIRI_NGIRI_A ◯ NDEMBO_1

◯ KIMBATA___TUDI_1 ◯ NDEMBO ◯ BUNZI ◯ KIMBANGU_A ◯ KIVEVE_1 ◯ NGOMUILA_1 ◯ LOVO ◯ MBANZA_NZUNGU ◯ MVULA_MATADI ◯ KINKENGE ◯ KIMUAKA ◯ YANGALA ◯ LOVO_1 ◯ LUBUSI_1 ◯ TSANGA_NGOM_1 ◯ KIFUMA_NGIMBI_1 ◯ KIVALA_TADI_1 ◯ NKANDU ◯ KIPASA_1 ◯ MB.KILENDA ◯ CAMP_PERMANENT ◯ BAKI_VILLE ◯ TROUPE ◯ KIVUNDA_1 ◯ YEMA_NTENE ◯ BETON ◯ POSTE_24 ◯ SADI_1 ◯ TUZOLANA ◯ KIMBIANGA ◯ MBATA_NLUNDU ◯ LUOZI ◯ BANA ◯ HYGIENE_A ◯ MONGO ◯ NGADI ◯ SALONGO ◯ KUMBI_1 ◯ MUANDA_MAMPUTU ◯ MUANDA_CBCO ◯ KIMBANZA ◯ LUNGI_1 ◯ NKAMUNA ◯ KITOMESA_1 ◯ LT_MPAKA ◯ KINZAU_MVUE_A ◯ KINZAU_MVUE_B

◯ KINZAU_MVUE_C ◯ NTAMPA ◯ KHESA_1 ◯ KHAMI_1 ◯ BAMBOMA_A ◯ BANDUNDU ◯ BATALLON_3__TALANGAYI ◯ BATENDE_1 ◯ BOBA_I ◯ BOKALA ◯ BOLAFA_PETI_PETI ◯ CNECI_I ◯ CONGO_A ◯ DIANGIENDA_I ◯ FOIRE_AGRICOLE ◯ KANIOKA ◯ KAPINGA_1 ◯ KASAI_MASINA ◯ KASAI_BUMBU ◯ KAUKA_A ◯ KEMI_A ◯ KIKIMI_KIKIMI ◯ KIKIMI_LOBIKO ◯ KIMPESE ◯ KIMPONKO ◯ KIMVULA ◯ KINGABWA_A ◯ KINGABWA_SALONGO ◯ KISANTU_A ◯ KISENSO_GARE_A ◯ KUNDA_1 ◯ LAC_MOERO ◯ LIKONZI_LUTUNU ◯ LUBUDI_KUKA_A ◯ LUKUNGA ◯ MABANGA ◯ MADIMBA ◯ MASIKA_BASANKUSU ◯ MATEBA_A ◯ MAYULU_A ◯ MAZAL_AILE_DROITE ◯ MBANZA_KANU ◯ MFUMU_SUKA_A ◯ MOLENDE ◯ MONDONGA ◯ MOTANGA ◯ MPOMPAGE

◯ MUTEBA ◯ NDUNU ◯ NKANZA ◯ NKONGO_DE_LA_PAIX ◯ NKULU_I ◯ PROMOBAT ◯ SAMBI ◯ SANS_FIL_A ◯ SONABATA_ASOSA ◯ TSHIANGU_A ◯ USOKE ◯ WAMBA ◯ YOLO_NORD_II_A

005. Please note the street or avenue number where the household is located The supervisor will give you the street or avenue name.

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 DO NOT DUPLICATE ANY FORM UNLESS YOU ARE CORRECTING ◯ No A MISTAKE IN AN EARLIER FORM. ☐ There are new household members on this form ☐ I am correcting a mistake made on a previous form 008. CHECK: Why are you resending this form? ☐ The previous form disappeared Choose all that apply. from my phone without being sent ☐ I submitted the previous form and my supervisor told me that it was not received ☐ Other reason(s)

009a. Is a member of the household and competent respondent ◯ Yes present and available to be interviewed today? ◯ No ◯ Yes 009b. Did this household participate in a previous PMA2020 ◯ No survey? ◯ Do not know ◯ No response 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 School of Public Health of Kinshasa in collaboration with the Ministry of Health. 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?

010a. Provide a paper copy of the Consent Form to the ◯ Yes respondent and explain it. Then, ask: May I begin the interview now? ◯ No

010b. Respondent's signature Please ask the respondent to sign or check the box in agreement of their participation.

010c. Interviewer’s name Please record your name as a witness to the consent process. You previously entered [NAME FROM 001]

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? ☐

◯ Head ◯ Wife/Husband ◯ Son/Daughter ◯ Son/Daughter-in-law ◯ Grandchild 102. What is [NAME] relationship to the head of ◯ Parent household? ◯ Parent in law ◯ Brother/Sister ◯ House help ◯ Other ◯ Do not know ◯ No response

◯ Male 103. Is [NAME] male or female? ◯ Female

104. How old was [NAME] at their last birthday? If less than one year old, record 0

◯ Married ◯ Living with a partner 105. What is [NAME]'s current marital status? ◯ Divorced / separated If not married, probe to determine if they have ever been married and, if so, if they are divorced/separated, or widowed. ◯ Widow / widower ◯ Never married ◯ No response ◯ Yes 106. Does [NAME] usually live here? ◯ No ◯ No response ◯ Yes 107. Did [NAME] stay here last night? ◯ 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. ◯ Catholic ◯ Protestant ◯ Armée du Salut ◯ Kimbangauiste ◯ Eglises de réveil ◯ Muslim LCL_101. What is the religion of [NAME] ? ◯ Bundu dia Kongo ◯ Vuvamu ◯ Animist ◯ Other ◯ No religion ◯ No response ◯ Bakongo from the north and south of the river ◯ Bas-Kasai and Kwilu-Kwango ◯ Cuvette Centrale ◯ Ubangi and Itimbiri-Ngiri ◯ Uele ; Lac Albert LCL_102. What is the ethnicity of [NAME]? ◯ Basele-Komo, Maniema and Kivu ◯ Kasai, Katanga, Tanganyika ◯ Lunda ◯ Pygmie ◯ Not congolese

◯ Other ◯ No response

108. Are there any other usual members of your household ◯ Yes or persons who slept in the house last night? ◯ 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 [NUMBER] household heads selected: [HOUSEHOLD HEAD NAMES ENTERED] 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 [NUMBER OF HOUSEHOLD MEMBERS ENTERED] household members who ◯ Yes are named [NAMES]. Is this a complete list of the household members? ◯ No Remember to include all children in the household.

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. ☐ Electricity? Does your household have: ☐ A wall clock? Read out all types and select all that apply. Scroll to bottom to see all ☐ choices. A radio? If an item is reported broken but said to be out of use only temporarily, ☐ A black/white television? select the item. Otherwise, do not select the item. ☐ A color television?

☐ A mobile phone? ☐ A landline telephone? ☐ A refrigerator? ☐ A freezer? ☐ An electric generator/invertor(s)? ☐ A washing machine? ☐ A computer? ☐ A digital photo camera? ☐ A non digital photo camera? ☐ A video deck? ☐ A DVD/CD? ☐ A sewing machine? ☐ A bed? ☐ A table? ☐ A cabinet/cupboard? ☐ A bicycle? ☐ A motorcycle or motor scooter? ☐ A car or truck? ☐ A boat with a motor? ☐ A boat without a motor? ☐ A gas or electric stove? ☐ A chair(s)? ☐ A lamp(s)? ☐ An oven? ☐ A hoe(s)? ☐ Animal-drawn cart? ☐ A canoe or motorized canoe? ☐ A rental house? ☐ None of the above ☐ No response Check here to acknowledge you considered all options. ◯

202a. Does this household own any livestock, herds, other farm ◯ Yes animals, or poultry? ◯ No These livestock can be kept anywhere, not necessarily on the homestead. ◯ 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.

Cows or bulls 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.

Hogs/pigs: Enter -88 for do not know. Enter -99 for no response.

Ducks/canes Enter -88 for do not know. Enter -99 for no response.

Hens/cocks/other poultry Enter -88 for do not know. Enter -99 for no response.

Other: Enter -88 for do not know. Enter -99 for no response.

Section 3 – Household Observation Please observe the floors, roof and exterior walls. ◯ Earth / sand ◯ Cow dung ◯ Wooden boards ◯ Palm / bamboo ◯ Parquet or polished wood 301. Main material of the floor ◯ Tapes vinyl / asphalt Observe. ◯ Tiles ◯ Cement ◯ Carpet ◯ Other ◯ No answer ◯ No roof ◯ Thatch / palm ◯ Earth mottes ◯ Mats ◯ Palm / bamboo ◯ Wooden boards ◯ Cardboard 302. Main material of the roof ◯ Sheet metal Observe. ◯ Wood ◯ Zinc / fiber cement ◯ Tile ◯ Cement ◯ Shingles ◯ Other ◯ No answer

◯ No wall ◯ Bamboo / cane / palm / trunk ◯ Earth ◯ Bamboo with mud ◯ Stones with mud ◯ Adobe not covered ◯ Plywood ◯ Cardboard 303. Main material of the exterior walls ◯ Recovered wood Observe. ◯ Cement ◯ Stones with lime / cement ◯ Bricks ◯ Cement blocks ◯ Covered adobe ◯ Wood board / shingles ◯ Other ◯ No answer

Section 4 – Water Sanitation and Hygiene Now I would like to ask you a few questions about water, sanitation and hygiene. ◯ Observed, fixed place ◯ Observed, mobile ◯ Not observed, not in 401a. We would like to learn about the places that households dwelling/yard/plot use to wash their hands. Can you please show me where members of your household most often wash their hands? ◯ Not observed, no permission to see ◯ Not observed, other reason ◯ No response ☐ Soap is present ☐ Stored water is present 401c. At the place where the household washes their hands, ☐ Running water is present observe if: Check all that apply. ☐ Handwashing area is near a sanitation facility ☐ None of the above

☐ Piped Water: Piped into dwelling/indoor ☐ Piped Water: Pipe to yard/plot 402. Which of the following water sources does your household ☐ Piped Water: Public tap/standpipe use on a regular basis for any part of the year for any purpose? ☐ Tube well or borehole Read out all types and check all that are used. Scroll to bottom to see all choices. ☐ 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

Check here to acknowledge you considered all options. ◯

◯ 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 403. What is the main source of drinking water for members of Spring your household? Selections from 402: [ODK will show the ◯ Water from Spring: Unprotected sources selected in 402] Spring Read out 402 selections only. ◯ Rainwater ◯ Tanker Truck ◯ Cart with Small Tank ◯ Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel) ◯ Bottled Water ◯ Sachet Water ◯ No response ◯ Piped Water: Piped into dwelling/indoor ◯ Piped Water: Pipe to yard/plot ◯ Piped Water: Public tap/standpipe ◯ Tube well or borehole 404. What is the main source of water used by your household ◯ Dug Well: Protected Well for other purposes such as cooking and hand washing? ◯ Dug Well: Unprotected Well Selections from 402: [ODK will show the sources selected in 402] ◯ Water from Spring: Protected Read out 402 selections only. 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 ☐ Drinking ☐ Cooking 405. You mentioned that you used [MAIN WATER SOURCE]. At ☐ Livestock any time of the year, does your household use water from this ☐ Gardening / agriculture source for: ☐ Business venture ☐ Washing ☐ No response 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 ◯ Yes, always 407. At a time of year when you expect to have [MAIN WATER ◯ No, intermittent and predictable SOURCE], is it usually available? ◯ No, intermittent and unpredictable ◯ No response 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.

☐ 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 409. Do members of your household use any of the following toilet facilities? to: Unknown / Not sure / Do not Read out all types. Check all that are used. Scroll to bottom to see all know choices. ☐ 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

Check here to acknowledge you considered all 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 410. What is the main toilet facility used by members of your ◯ Flush/pour flush toilets connected household? Selections from 409: [SELECTIONS] to: Unknown / Not sure / Do not know The main facility must be selected in 409. ◯ 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 ◯ X months ago SN_411.ii. When was the last time your [MAIN SANITATION ◯ X years ago FACILITY] was emptied? Probe: How many months or years ◯ ago? Never emptied If less than one month, select months. ◯ Do not know ◯ No response

Enter [Months OR Years]: If less than one month, enter 0 months. ◯ By household members or neighbors SN_411.iii. The last time your [MAIN SANITATION FACILITY] ◯ By a service provider was emptied, who emptied it? Probe: Was it emptied by ◯ household members or by neighbors or by a service provider? Other ◯ Do not know ◯ No response ◯ To a covered and sealed hole (buried) ◯ To an open drain or to a water body ◯ To an open hole (not buried), open SN_411.iv. The last time your [MAIN SANITATION FACILITY] ground, bush, beach or to agricultural was emptied, where were the contents emptied to? 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 ◯ No response ◯ In own dwelling SN_411.v. Where is your toilet facility located? [MAIN ◯ In own yard / plot SANITATION FACILITY] ◯ Elsewhere ◯ No response ◯ Always 411. How often does your household typically use: [TOILET ◯ Most of the time FACILITY] ◯ Regular practices at the household only. Occasionally ◯ No response ◯ Not shared ◯ Shared with less than ten households 412a. Do you share this toilet facility with other households or the ◯ Shared with ten or more public? [MAIN SANITATION PLACE] households ◯ Shared with the public ◯ No response 412b. Enter the number of households that share this facility (including your own). [MAIN SANITATION PLACE] 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 [X NUMBER] people in this household. Enter -88 for do not know, -99 for no response. ☐ Children use a latrine / toilet ☐ Leave waste where it is ☐ Bury waste in field / yard ☐ Dispose of waste in latrine / toilet 414. For all children under age five: what methods, if any, does ☐ Dispose of waste with rubbish / your household use to dispose of children's waste? garbage PROBE: Other methods? ☐ Dispose of waste with waste water Do not read the possible responses out loud. ☐ Use it as manure ☐ Burn it ☐ Do not know ☐ 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. ◯ 1st time 097. How many times have you visited this household? ◯ 2nd time ◯ 3rd time ◯ French ◯ Lingala ◯ Kikongo ◯ Tshiluba ◯ Swahili 098. In what language was this interview conducted? ◯ Kintandu ◯ Manianga ◯ Kiyombe ◯ Kindibu ◯ Kilemfu ◯ Other ◯ Completed ◯ No household member at home or no competent respondent at home at time of visit ◯ Postponed ◯ Refused 099. Questionnaire Result ◯ Partly completed Record the result of the questionnaire. ◯ Dwelling vacant or address not a dwelling ◯ Dwelling destroyed ◯ Dwelling not found ◯ Entire household absent for extended period