Household Questionnaire
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PMA2020 1 Uganda Round 6 - Household Questionnaire select_one yes_no_list your_name_check 001a. Your name: Yes yes Is this your name? No no name_typed text 001b. Enter your name below. Please record your name date_group dateTime Jour: system_date Mois: 002a. Current date and time. Année: select_one yes_no_list system_date_check Yes yes Is this date and time correct? No no dateTime manual_date 002b. Record the correct date and time. Jour: The date must be between 2018-03-01 and 2019-03-01. Mois: Année: select_one_external level1_list KaramoJa karamoja North north West-Nile west_nile level1 Eastern eastern 003a. Region East-Central east_central Central2 central2 Central1 central1 Western western South-West south_west Kampala kampala select_one_external level2 level2_list Uganda – Round 6 PMA2020 2 003b. District Abim abim Kaabong kaabong Kotido kotido Nakapiripirit nakapiripirit Napak napak Agago agago Alebtong alebtong Amuru amuru Apac apac Gulu gulu Kitgum kitgum Lamwo lamwo Lira lira Otuke otuke Oyam oyam Pader pader Arua arua Koboko koboko Nebbi nebbi Yumbe yumbe Zombo zombo Budaka budaka Bududa bududa Bukedea bukedea Kibuku kibuku Kumi kumi Manafwa manafwa Mbale mbale Serere serere Sironko sironko Soroti soroti Tororo tororo Bugiri bugiri Busia busia Buyende buyende Iganga iganga Jinja jinja Kaliro kaliro Kamuli kamuli Luuka luuka Mayuge mayuge Namayingo namayingo Buikwe buikwe Kakumiro kakumiro Kyankwanzi kyankwanzi Luwero luwero Mityana mityana Mubende mubende Mukono mukono Uganda – Round 6 PMA2020 3 Nakaseke nakaseke Nakasongola nakasongola Bukomansimbi bukomansimbi Lwengo lwengo Lyantonde lyantonde Mpigi mpigi Ssembabule ssembabule Wakiso wakiso Hoima hoima Kabarole kabarole Kamwenge kamwenge Kasese kasese Kiryandongo kiryandongo Masindi masindi Ntoroko ntoroko Ibanda ibanda Isingiro isingiro Kabale kabale Kiruhura kiruhura Kisoro kisoro Mbarara mbarara Mitooma mitooma Ntungamo ntungamo Rukungiri rukungiri Sheema sheema Kampala kampala select_one_external level3_list Alerek alerek Kapedo kapedo Sidok sidok Kaabong Tc kaabong_tc Panyangara panyangara Loregae loregae Matany matany Paimol paimol level3 Omoro omoro Amuru Tc amuru_tc 003c. Sub-county Lamogi lamogi Akokoro akokoro Unyama unyama Mucwini mucwini Agoro agoro Barr barr Alango alango Aber aber Minakulu minakulu Pader pader Manibe manibe Uganda – Round 6 PMA2020 4 Omugo omugo Lobule lobule Koboko Tc koboko_tc Pakwach pakwach Kei kei Kango kango Kaderuna kaderuna Bududa Town Council. bududa_town_council Malera malera Bulangira bulangira Kanyum kanyum Bumwoni bumwoni Lwasso lwasso Pingire pingire Bukyambi bukyambi Asuret asuret Nabuyoga nabuyoga Kapyanga kapyanga Dabani dabani Bugaya bugaya Namalemba namalemba Namungalwe namungalwe Busedde busedde Buyengo buyengo Nawaikoke nawaikoke Kaliro Tc kaliro_tc Namwendwa namwendwa Bukooma bukooma Bukatube bukatube Malongo malongo Mutumba mutumba Njeru Town Council njeru_town_council Kasambya kasambya Kyankwanzi kyankwanzi Zirobwe zirobwe Banda banda Kibalinga kibalinga Mpatta mpatta Central Division mukono_central_division Wakyato wakyato Kalungi kalungi Butenga butenga Kyazanga kyazanga Lyantonde Tc lyantonde_tc Kituntu kituntu Lwemiyaga lwemiyaga Nsangi nsangi Makidye -ssabagabo Uganda – Round 6 PMA2020 5 makidye_ssabagabo Division A division_a Buhimba buhimba Karambi karambi Western Division western_division Nyabbani nyabbani Bugoye bugoye Kigumba kigumba Bweyale Tc bweyale_tc BwiJanga bwijanga Karugutu karugutu Kicuzi kicuzi Kabingo kabingo Ikumba ikumba Buhara buhara Kanyaryeru kanyaryeru Sanga Tc sanga_tc Muramba muramba Kamukuzi kamukuzi Rubindi rubindi Katenga katenga Rubaare rubaare Kibatsi kibatsi Nyakagyeme nyakagyeme Kitagata kitagata Central Division kampala_central_division Kawempe Division kawempe_division Lubaga Division lubaga_division Makindye Division makindye_division Nakawa Division nakawa_division select_one_external EA_list EA ['A list of EAs.'] 004. Enumeration area structure integer 005. Structure number Please record the structure number from the household listing form. household integer 006. Household number Please record the household number from the household listing form. select_one yes_no_list hh_duplicate_check 007. CHECK: Have you already sent a form for this structure and Yes yes household? No no Uganda – Round 6 PMA2020 6 DO NOT DUPLICATE ANY FORM UNLESS YOU ARE CORRECTING A MISTAKE IN AN EARLIER FORM. duplicate_warning note WARNING: Contact your supervisor before sending this form again. select_multiple resubmit_reasons_list There are new household members on this form new_members I am correcting a mistake made on a resubmit_reasons previous form correction 008. CHECK: Why are you resending this form? The previous form disappeared from Choose all that apply. my phone without being sent dissappeared I submitted the previous form and my supervisor told me that it was not received not_received Other reason(s) other duplicate_warning_hhmember note 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. select_one yes_no_list available 009a. Is a member of the household and competent respondent Yes yes present and available to be interviewed today? No no select_one yes_no_dnk_nr_list previous_survey Yes yes 009b. Did this household participate in a previous PMA2020 No no survey? Do not know -88 No response -99 consent_start note INFORMED CONSENT Find a competent member of the household. Read the greeting on the following screen. note consent Hello. My name is ________________________________ and I ['Biraha ibaara lyange ninyowe am working for the Makerere University, School of Public in ________________________ninkorra collaboration with Ministry of Health, and Uganda Bureau of Statistics. We are conducting a local survey about various health Makerere University, School of Public issues. We would very much appreciate your participation in this hamu n’ekitongole Uganda – Round 6 PMA2020 7 survey. This information will help us inform the government to ky’ebyobwomezi,hamu n’ekitongole better plan health services. Whatever information you provide ky’ebyomutindo. Tuli hamusomo gwo will be kept strictly confidential and will not be shown to anyone ebyokuhabuza ebirukukwata other than members of our survey team. Participation in this habw’ebyomwezi. Twakugondeze survey is voluntary, and if we should come to any question you kwenyigira mukuseruliliza kunu. 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 Ebyoratugamba nibija kuyamba hope that you will participate in this survey since your views are ihanga mu kutegekera kurungi important. empereza y’ebyobwomezi.Byona I am going to ask you questions about your family and other ebyoratugambira nibija kuba household members. We would then like to ask a different set of by’ensita, kandi tibirikwija kwolekwa questions to female members of this household who are omuntu wena kwihaho abo bonka between the ages of 15 and 49 years. abali hamusomo gunu At this time, do you want to ask me anything about the survey? 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?'] select_one yes_no_list begin_interview ['010a. Provide a paper copy of the 010a. Provide a paper copy of the Consent Form to the Consent Form to the respondent and respondent and explain it. Then, ask: May I begin the interview now? explain it. Then, ask: May I begin the interview now?'] select_one blank_list witness_auto 010c. Interviewer's name: 1 Mark your name as a witness to the consent process. witness_manual 010c. Interviewer's name text 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. respondent_firstname_raw text 011. Respondent's first name Uganda – Round 6 PMA2020 8 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. hh_rpt Household member nm_grp firstname_raw text 101. Name of household member / visitor Start with the head of the household. select_multiple respondent_match blank_list 101a. Is this person the respondent? 1 mb_grp select_one relationship_list Head head Wife/Husband spouse Son/Daughter child Son/Daughter-in-law relationship child_in_law 102. What is [Name]'s relationship to the head of Grandchild grandchild household? Parent parent Parent in law parent_in_law Brother/Sister sibling House help help Other other Do not know -88 No response -99 select_one gender_list gender Male male 103. Is [Name] male or female? Female female age integer 104. How old was [Name] at their last birthday? Uganda – Round 6 PMA2020 9 If less than one year old, record 0 Age must be less than 130 and greater than zero. ms_grp select_one marital_status_list marital_status Married currently_married 105. What is [Name]'s current marital status? Living with a partner If not married,