Enquête sur les Conditions de Vie en Haïti (ECVH) WOMAN AND

Enquête sur les Conditions de Vie en Haïti (ECVH) WOMAN AND

Enquête sur les Conditions de Vie en Haïti (ECVH)
IHSI/Fafo/PNUD
WOMAN AND CHILD QUESTIONNAIRE
Questionnaire Identification
AI1
Department
AI2
Commune
AI3
Ville
AI4
Quartier / section communale
AI5
Geographic code
AI6
Primary unit (UP)
AI7
Section d’Enumeration (SDE)
AI8
Serial number of the questionnaire
AI9
Selected household
Respondent Information
AC1
Respondent
AC2
Number of births
AC3
Children 5-18
AC4
Number of children <5
Interview status
AR1
Interview status
AR2
………………………
………………………
………………………
………………………
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R. number: |__|__|
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Interview completed
Refusal converted
Partly completed
No usable information
No contact
Refusal
1
2
3
4
5
6
Eligible
Caretaker only
1
2
Is respondent eligible for Woman
questionnaire or only responding
as caretaker for children?
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Ł BH
Ł CA
Page 1/1
BH: Birth History (All women aged 14 and more who gave birth at least once)
BH1
Have you ever given birth?
Yes
1
Ł AN
No
2
Now I would like to talk to you about your children. I hope you will give me a list of all the children that you have ever born, omitting no one, whether still
alive or not, even if the child died right after birth.
BH2 # of child
What was the
name given to
your
child(ren)?
Please start
with the child
that was born
first
BH3
BH4
BH5
Do not Enter date, month,
and year
ask if
obvious
DK 97 97 97
NA 98 98 98
1=Boy
If the child had
not had received 2=Girl
any name, mark
dd mm y y
“bebe”.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
BH12
BH13
BH14
BH7
BH6
Is..... a What was the date Is ... still
boy or a of birth of ... ?
alive?
girl?
1=Yes
2=No Ł
BH11
7=DK Ł
Next child
8=NA Ł
Next child
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
1
2
|__|__| |__|__| |__|__|
1 2
7 8
Where is …
currently
residing?
1 In household Ł
BH10
2 Within the
metropolitan area
3 In another city in
Haiti
4 Within a section
communale
5 Abroad
7 DK Ł BH10
8 NAŁ BH10
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BH8
At what age Who is …
did … leave living with?
the household?
Mark age in
whole years
|__|__|
|__|__|
|__|__|
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|__|__|
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1 Relatives
2 Non –
relatives
3 Alone
7 DK
8 NA
Are you still breast-feeding your youngest child?
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
BH10
Enter roster
number of ...
00 = Not in
household
1 Adopted
2 Education
3 Housework in Ł Next child
receiving
household
4 Other reason
7 DK
8 NA
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
1 2 3 7 8
1 2 3 4 7 8
Interviewer check: If more than 1 live birth, are all birth dates listed in BH4 at least 7 months
apart?
Interviewer check BH4: Is youngest child less than 3 years of age?
BH9
What is the
purpose of
the stay?
Yes
No
Yes
No
Yes
No
Page 2/2
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BH11
How old was (s)he when
(s)he died?
Enter mode of recording and
answer
1 = Date
2 = Days (Use first two boxes)
3 = Months (Use first two boxes)
4 = Years (Use first two boxes)
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1 2 3 4 |__|__| |__|__| |__|__|
1
2
1
2
1
2
Ł BH4
Ł AN
End of subsection
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 3/3
Antenatal and postnatal care (All women between 14 (inclusive) and 55)
Yes
No
Yes
No
1
2
1
2
Yes
No
Yes
No
DK
NA
1
2
1
2
7
8
Once
More than once
Not been pregnant
1
2
3
Ł CP
Yes, equal or less
No, higher
1
2
Ł AN4
Interviewer check: Is the woman aged less than 55?
AN1
Are you pregnant now?
Do not ask if obvious.
AN2
AN3
AN4
Interviewer check BH1: Has ... ever given birth?
You have told me that you have not given birth and that you are not pregnant now.
But now we are interested in care for pregnant women even if the pregnancy did not
result in a live birth. Therefore, I would like to ask you if you have ever been
pregnant before?
I would like to ask you some questions about what care you have received during
pregnancy. We are interested in pregnancies you have had during the last 5 years.
Have you been pregnant on e, more than once, or not at all during the last 5 years?
Interviewer Check: Count the number of births in questions BH2 and BH4 during the last 5 years
(from 01. 02.1996). Is this number less than or equal to the number of pregnancies reported in
AN4?
Ł CP
Ł AN4
Ł AN4
Ł CP
Ł CP
Ł CP
If currently pregnant, ask about this pregnancy as the latest.
Latest
pregnancy
2nd latest
pregnancy
3rd latest
pregnancy
4th latest
pregnancy
5th latest
pregnancy
Enter 00 if not a live birth
Enter 95 if the woman is pregnant now
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
Yes, doctor
Yes, nurse
Yes, midwife
Yes, matron (certified modern midwife)
Yes, other
No
DK
NA
1
2
3
4
5
5 Ł AN8
7 Ł AN10
8 Ł AN10
1
2
3
4
5
5 Ł AN8
7 Ł AN10
8 Ł AN10
1
2
3
4
5
5 Ł AN8
7 Ł AN10
8 Ł AN10
1
2
3
4
5
5 Ł AN8
7 Ł AN10
8 Ł AN10
If pregnant once, ask about this pregnancy as the latest.
If pregnant more than once ask about all pregnancies during the 5-year
period irrespective of their result.
AN5
AN6
Birth history
number of child
When you were
pregnant, (last time,
second to last time, third
to last time, etc.) who
did you go to for a
consultation?
Circle all that apply
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 4/4
1
2
3
4
5
5 Ł AN8
7 Ł AN10
8 Ł AN10
AN7
Where did you go to have
health care?
Circle all that apply
All Ł AN9
AN8
Why was the reason or
the reasons for not seeing
someone for pregnancy
health care for this
pregnancy?
Do not read answer categories.
Circle two most important reasons
AN9
AN10
How did the pregnancy
end ?
During the 40 days
following the birth of …
did you see anyone for a
check on your health?
Circle all appropriate answers
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Health center
Community clinic
Public hospital
Private hospital
Private doctor’s office (clinic)
Specialized pregnancy clinic
Home
Other
DK
NA
Too expensive / no money
Too far to travel
Husband disapproves
Lack confidence in service
Prefer not to have such care
Don’t have time
No need
Other
DK
NA
Livebirth
Stillbirth
Miascarriage/abortion
Still pregnant
Yes, doctor
Yes, nurse
Yes, midwife
Yes, matron
Yes, other
No
DK
NA
Print date:5/8/02
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
1
2Ł
3Ł
4Ł
1Ł
2Ł
3Ł
4Ł
5Ł
6
7Ł
8Ł
CP
CP
CP
CP
CP
CP
CP
CP
CP
CP
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
1
2Ł
3Ł
4Ł
1Ł
2Ł
3Ł
4Ł
5Ł
6
7Ł
8Ł
CP
CP
CP
CP
CP
CP
CP
CP
CP
CP
Page 5/5
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
1
2Ł
3Ł
4Ł
1Ł
2Ł
3Ł
4Ł
5Ł
6
7Ł
8Ł
CP
CP
CP
CP
CP
CP
CP
CP
CP
CP
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
1
2Ł
3Ł
4Ł
1Ł
2Ł
3Ł
4Ł
5Ł
6
7Ł
8Ł
CP
CP
CP
CP
CP
CP
CP
CP
CP
CP
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
1
2Ł
3Ł
4Ł
1Ł
2Ł
3Ł
4Ł
5Ł
6
7Ł
8Ł
CP
CP
CP
CP
CP
CP
CP
CP
CP
CP
AN11
What was the main
reason for not seeing
someone to check your
health after the birth
of …?
Too expensive / I was broke
Too far to travel
Husband disapproves
Lack confidence in service
Prefer not to have care
Don’t have time
No need
Other
DK
NA
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
End of subsection
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 6/6
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
6
7
8
97
98
CP: Contraception
CP1
Have you ever used any method or tried
in any way to delay or avoid getting
pregnant?
CP2
What is the first method you ever used
to delay or avoid getting pregnant?
Mark all that apply
CP3
CP4
Where were you or who introduced to
this method the first time?
How many children did you have when
you began using this method?
Yes
No
DK
NA
Pill
IUD
Injections
Implants
Foam / jelly/ Sponge/ Diaphragm etc.
Condom
Female sterilization
Male sterilization
Periodic abstinence
Withdrawal
Prolonged breastfeed
Natural medicine
Other
DK
NA
Health center
Community clinic
Public hospital
Private hospital
Private doctor’s office (clinic)
Specialized pregnancy clinic
Midwife
Matron (certified modern midwife)
Houngan / mambo
Tradional healer
The press / medias
Spouse
Other household member
Other
DK
NA
97 = DK, 98 = NA
Number of children
|__|__|
Pregnant
Not pregnant
1
2
Check about pregnancy (AN1)
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 7/7
1
2
3
8
1
2
3
4
5
6
7
8
9
10
11
12
13
97
98
1
2
3
4
5
6
7
8
9
10
11
12
13
14
97
98
Ł CA
Ł CA
Ł CA
Ł CA
CP5
Which method are you and your spouse
currently using?
Circle max two methods
Pill
IUD
Injections
Implants
Foam / jelly / Sponge / Diaphragm
Condom
Female sterilization
Male sterilization
Periodic abstinence
Withdrawal
Prolonged breastfeed
Natural medicine
Other
None
DK
NA
End of subsection
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 8/8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
97
98
CA: Care of children (Mother (or other caretaker) about her child(ren) <5 years)
Yes
No
Interviewer: Check HR6 for children and their age. Has ... (or is ... caretaker for)
any children less than 5 years old?
CA1
CA2
Interviewer: Take number and
name of the children from roster
(HR1). Mark if respondent is
mother or not (HR32).
I will now ask you some
questions about your
children. I am interested in
the children of less than 5
years of age.
Who takes care of . . .
during the day?
Circle up to three categories
Kinship terms relate to the child
CA3
Interviewer: Check the age of
the child (HR6). Is the child
younger than 2 years of age?
Where does … usually
play?
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Roster number
Roster name
Resp. is mother
Resp. is not mother
Mother
Father
Sister
Brother
Grandmother
Grandfather
Aunt
Uncle
Servant
Neighbour
Day care center
Kindergarten / preschool
Other
No one
DK
NA
Yes
No
Inside the house
In the courtyard
In the street / road
On the roof
Does not usually play
Other
Not applicable
DK
NA
Print date:5/8/02
1
2
Ł CV
|__|__|
_____________
1
2
|__|__|
_____________
1
2
|__|__|
_____________
1
2
|__|__|
_____________
1
2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
97
98
1 Ł DR
2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
97
98
1 Ł DR
2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
97
98
1 Ł DR
2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
97
98
1 Ł DR
2
1
2
3
4
5 Ł DR
6
7 Ł DR
97 Ł DR
98 Ł DR
1
2
3
4
5 Ł DR
6
7 Ł DR
97 Ł DR
98 Ł DR
1
2
3
4
5 Ł DR
6
7 Ł DR
97 Ł DR
98 Ł DR
1
2
3
4
5 Ł DR
6
7 Ł DR
97 Ł DR
98 Ł DR
Page 9/9
CA4
When . . . is playing outside
of the house, will there
always or sometimes be
adult supervision?
CA5 How much time does ...
normally play outside?
Yes, always
Yes, sometimes
No
DK
NA
Most of the day
Around half of the day
2-4 hours
1-2 hours
Less than 1 hour
DK
NA
1
2
3
7
8
1
2
3
4
5
7
8
1
2
3
7
8
1
2
3
4
5
7
8
End of subsection
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 10/10
1
2
3
7
8
1
2
3
4
5
7
8
1
2
3
7
8
1
2
3
4
5
7
8
DR : CHILDREN MORBIDITY ( children less than 5 years old)
Now I would like to ask you about illnesses that the children in this household may have had in the recent past.
DR1
Interviewer: Transfer the name and roster
number from CA1
During the last two weeks, did ...
have ....
Ask for each illness/accident and circle the
appropriate answer.
If no yes (1) for all Ł DR11
DR2
Roster number |__|__|
|__|__|
|__|__|
|__|__|
Roster name _____________ _____________ _____________ _____________
Yes=1, No=2, DK=7,
NA=8
1 2
7 8
1 2
7 8
1 2
7 8
7 8
1 Fever 1 2
1 2
7 8
1 2
7 8
1 2
7 8
7 8
2 A cough or cold 1 2
1 2
7 8
1 2
7 8
1 2
7 8
7 8
3 Diarrhoea 1 2
1 2
7 8
1 2
7 8
1 2
7 8
7 8
4 Accident 1 2
1 2
7 8
1 2
7 8
1 2
7 8
7 8
5 Other illness 1 2
Fever 1
A cough or cold 2
Diarrhoea 3
Accident 4
Other illness 5
DK 7
NA 8
I am now interested in the treatment
the child was given while ill or after
the accident.
If more than one illness/ accident in DR1 ask:
Which of these illnesses did ... have
last?
1
2
3
4
5
7
8
1
2
3
4
5
7
8
1
2
3
4
5
7
8
If only one illness/ accident, Skip to DR3.
Circle the type of illness/ accident
DR3
During the illness/accident, who was
1 General practitionner
consulted?
If several persons were consulted,
please indicate who was consulted
first, so next, etc.
If no consultation, enter 1 outside of ‘No
consultation’
DR4
2 Specialist
3 Nurse
4 Pharmacist
5 Healer
6 Houngan /mambo
7 Relative /neighbour
8 Other
9 No consultation
Did you or anybody in your
household give medicines to the
child?
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
(Mark order)
|__|
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Yes 1
No 2 Ł DR6
DK 7 Ł DR6
NA 8 Ł DR6
(Mark order)
|__|
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|__|
|__|
|__|
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1
2 Ł DR6
7 Ł DR6
8 Ł DR6
Page 11/11
(Mark order)
|__|
|__|
|__|
|__|
|__|
|__|
|__|
|__|
|__|
1
2 Ł DR6
7 Ł DR6
8 Ł DR6
(Mark order)
|__|
|__|
|__|
|__|
|__|
|__|
|__|
|__|
|__|
1
2 Ł DR6
7 Ł DR6
8 Ł DR6
DR5
DR6
DR7
DR8
Was the medicine prescribed
for the child for this illness by
any modern or traditional
health worker ?
Yes, modern health worker 1
Interviewer check: Was the illness
diarrhoea?
During the diarrhoea, was
… given any of the
following?
Yes 1
No 2 Ł DR11
Antibiotics 1
ORS 2
Tea 3
Sugar water 4
Read items one by one, circle all that apply
Rice water 5
Yoghurt 6
Other 7
Gave nothing of the above 8
DK 97
NA 98
Yes, increased 1
During . . . ‘s diarrhoea, did you change
Yes, reduced 2
the frequency of breast-feeding?
No 3
If yes, ask:
Stopped 4
Did you increase the number of feeds or
Not applicable 5
DK 7
reduce them, or did you stop completely?
NA 8
Yes, increased 1
During . . . ‘s diarrhoea, was the
Yes, reduced 2
frequency of bottle-feeding changed?
No 3
If yes, ask:
Stopped 4
Was the number of feeds increased or
Not applicable 5
DK 7
reduced, or did you stop completely?
NA 8
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
1
1
1
1
2 Ł DR11
1
2 Ł DR11
1
2 Ł DR11
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
7
8
1
2
3
4
5
7
8
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
7
8
1
2
3
4
5
7
8
1
2
3
4
5
6
7
8
97
98
1
2
3
4
5
7
8
1
2
3
4
5
7
8
Page 12/12
DR9
DR10
DR11
During . . .’s diarrhoea, did he/she drink Much less or none 1
Somewhat less 2
much less or nothing, somewhat less,
About the same 3
about the same, somewhat more or
Somewhat more 4
much more than usual?
Much more 5
During …‘s diarrhoea, did he/she eat
much less or nothing, somewhat less,
about the same or more than usual?
Compared to other children inside or
outside the family, would you say that
… is more often sick than them, sick
about as often as them or less sick than
them?
DK 7
NA 8
Much less or none 1
Somewhat less 2
About the same 3
More 4
Not applicable 5
DK 7
NA 8
More often sick 1
About the same 2
Less sick 3
DK 7
NA 8
1
2
3
4
5
7
8
1
2
3
4
5
7
8
1
2
3
7
8
End of subsection
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 13/13
1
2
3
4
5
7
8
1
2
3
4
5
7
8
1
2
3
7
8
1
2
3
4
5
7
8
1
2
3
4
5
7
8
1
2
3
7
8
CV: Anthropometry (About children 6 months-5 years) and adult women (>14 years of age)
CV1
CV2
Now I would like to take a simple measurement of your children who are between 6 months and 5 years of age. I will need
to see the children. Please remove shoes, undress the child and remove diapers from the child. And please take of your
shoes, jackets and if you have anything in the pockets, please put it aside.
cm |__|__|__|.|__|
Height mother/adult
kg |__|__|__|.|__|
Weight mother/adult
Interviewer check HR5: If child(ren) < 6 months or she doesn’t have any children < 5 years of age Ł YU
CV3
CV4
CV5
Interviewer: Transfer the name
and roster number from CA1
Weight mother/adult and
child together
Note interview status for weight
measurements
Roster number
Roster name
kg
Measured
Not present
Caretaker refused
Child refused
|__|__|
_____________
|__|__|
_____________
|__|__|
_____________
|__|__|
_____________
|__|__|__|.|__|
|__|__|__|.|__|
|__|__|__|.|__|
|__|__|__|.|__|
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
|__|__|__|.|__|
|__|__|__|.|__|
|__|__|__|.|__|
|__|__|__|.|__|
1
2
8
1
2
3
4
1
2
8
1
2
3
4
1
2
8
1
2
3
4
1
2
8
1
2
3
4
|__|__|__|
|__|__|__|
|__|__|__|
|__|__|__|
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Height/length of the child
cm
If child < 2 year of age measure length
If child ≥ 2 years of age measure height
CV6
CV7
CV8
CV9
Note if it was the length or the
height that were measured
Note interview status for
height/length measurements
Length
Height
Not Measured
Measured
Not present
Caretaker refused
Child refused
Mid-Upper-ArmCircumference
Note interview status for MUAC
measurements
mm
Measured
Not present
Caretaker refused
Child refused
End of subsection
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 14/14
YU: Youth (Mothers (or other caretaker) about persons they take care of in the age group 5-17 years (17 included))
Yes
No
Interviewer: Check HR6 to make sure of presence of individuals in the age group (5-17)
years. Has ... (or is ... caretaker for) any children of age between 5 and 17 years in the
household?
I will now ask you some questions about your children. I am interested in the children between 5 and 17 years of age.
YU1
Roster number |___|___| |___|___|
|___|___| |___|___|
Interviewer: Take number and
name of the children aged 517 from roster (HR1).
YU2
YU3
YU4
YU5
YU6
YU7
YU8
Interviewer: Does the
biological parents of … live in
the household? Check HR2 in
HHQ
Have … always lived in
this household?
|___|___|
|___|___|
|___|___|
_______
_______
_______
_______
_______
_______
Both mother and father
Only mother
Only father
Neither mother nor
father
1 Ł YU11
2 Ł YU11
3 Ł YU11
4
1 Ł YU11
2 Ł YU11
3 Ł YU11
4
1 Ł YU11
2 Ł YU11
3 Ł YU11
4
1 Ł YU11
2 Ł YU11
3 Ł YU11
4
1 Ł YU11
2 Ł YU11
3 Ł YU11
4
1 Ł YU11
2 Ł YU11
3 Ł YU11
4
1 Ł YU11
2 Ł YU11
3 Ł YU11
4
Yes
No
DK
NA
1 Ł YU11
2
7 Ł YU11
8 Ł YU11
1 Ł YU11
2
7 Ł YU11
8 Ł YU11
1 Ł YU11
2
7 Ł YU11
8 Ł YU11
1 Ł YU11
2
7 Ł YU11
8 Ł YU11
1 Ł YU11
2
7 Ł YU11
8 Ł YU11
1 Ł YU11
2
7 Ł YU11
8 Ł YU11
1 Ł YU11
2
7 Ł YU11
8 Ł YU11
|___|___|
|___|___|
|___|___|
|___|___|
Are the mother and/or the father
of … still alive?
Where do ….’s father and mother
live now ?
Has … received news from one or
both of his/her biological parents
during the last 12 months?
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Ł Ask this subsection
Ł End
Name
Enter whole years
How old was … when
(less
than 1 year, enter |___|___| |___|___|
arriving to the
00)
household?
Yes 1
1
Did … come to this household
No
2
2
from his/her biological parents?
Print date:5/8/02
DK
NA
Yes
No
DK
NA
Yes
No
DK
NA
Yes
No
DK
NA
7
8
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
7
8
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
_______
1
2
|___|___|
1
2
7
8
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
Page 15/15
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
1
2
7
8
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
1
2
7
8
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
1
2
7
8
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
1
2
7
8
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
1
2Ł
7Ł
8Ł
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU11
YU9
Has … visited or received a visit from
one or both of his /her biological
parents during the last 12 months?
YU10
Do you consider it likely that … may
return to live with his/her biological
parents for a prolonged period?
YU11
YU12
Did … [name]
… [activity]
last year
(past 12
months)?
At what age did
…[name] start to
… [activity]?
Ask only for the
activities the child did
last year
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Yes
1
1
1
1
1
1
1
Yes
No
DK
NA
Yes =1 No=2 DK=7 NA=8
1
2
7
8
1
2
7
8
1
2
7
8
1
2
7
8
1
2
7
8
1
2
7
8
1
2
7
8
1 Collect/transport water
2 Prepare food
3 Wash own clothes
4 Wash clothes for others
5 Take care of children
6 Sweeping/washing floors
7 Running errands
8 Agricultural activities
9 Assisting other adults in their work
10 Tending animals
11 Other work in the household
12 Focus on his/her education
Age in year, DK=97 NA=98
1
1
1
1
1
1
1
1
1
1
1
1
1 Collect/transport water
2 Prepare food
3 Wash own clothes
4 Wash clothes for others
5 Take care of children
6 Sweeping/washing floors
7 Running errands
8 Agricultural activities
9 Assisting other adults in their work
10 Tending animals
11 Other work in the household
12 Focus on his/her education
Print date:5/8/02
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
Page 16/16
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
YU13
Did … [name]
… [activity]
last week (past
7 days)
If 2 (No) on all, skip to
YU16
YU14
In total how
many hours did
… [name] use to
… [activity] last
week (past 7
days)?
Ask only for the
activities carried out
last week
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Yes =1 No=2 DK=7 NA=8
1 Collect/transport water
2 Prepare food
3 Wash own clothes
4 Wash clothes for others
5 Take care of children
6 Sweeping/washing floors
7 Running errands
8 Agricultural activities
9 Assisting other adults in their work
10 Tending animals
11 Other work in the household
12 Focus on his/her education
Hours last week,
Not carried out=00 DK=97 NA=98
1 Collect/transport water
2 Prepare food
3 Wash own clothes
4 Wash clothes for others
5 Take care of children
6 Sweeping/washing floors
7 Running errands
8 Agricultural activities
9 Assisting other adults in their work
10 Tending animals
11 Other work in the household
12 Focus on his/her education
Print date:5/8/02
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
Page 17/17
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
7
7
7
7
7
7
7
7
7
7
7
7
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
8
8
8
8
8
8
8
8
8
8
8
8
YU15
YU16
Yes =1 No=2 DK=7 NA=8
Did …
carry out
any of the
following
activities/
works last
year
outside
his/her
household?
1 Family business in own household
2 Domestic work in other household
3 Agricultural work
4 Fisheries
5 Construction work
6 Textile factory/tailor/leather industry
7 Other industry
8 Transport sector
9 Street vending
10 Begging
11 Shoeshine
12 Assisting on marked
13 Trade, shop, restaurant, other services
14 Other
Yes
Interviewer check: Is … currently enrolled
No
in school? ED10 in HHQ
YU17 Was … often, sometimes or never
absent from school because of
housework/domestic duties last year
(past 12 months)?
YU18 Did … often, sometimes or never
have to skip school homework or
studying due to housework/domestic
duties last year (past 12 months)?
YU19
Did … have any accident or illness
related to housework last year (past
12 months)?
YU20
YU21
When does … usually rise
in the morning?
When does … usually go
to sleep in the evening?
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Often
Sometimes
Never
DK
NA
Often
Sometimes
Never
DK
NA
Yes
No
DK
NA
DK=97:97 NA=98:98
Enter time as precise as
possible
DK=97:97 NA=98:98
Enter time as precise as
possible
Print date:5/8/02
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1
2 Ł YU19
1
2
3
7
8
1
2
3
7
8
1
2
7
8
1
2 Ł YU19
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1
2 Ł YU19
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1
2 Ł YU19
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1
2 Ł YU19
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1
2 Ł YU19
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1 2 7 8
1
2 Ł YU19
1
2
3
7
8
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2
3
7
8
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2
7
8
1
2
3
7
8
1
2
3
7
8
1
2
7
8
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2
3
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8
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2
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8
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2
7
8
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2
3
7
8
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2
3
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8
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2
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8
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2
3
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8
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2
3
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8
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2
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8
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3
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8
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2
3
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8
1
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7
8
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
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Page 18/18
YU22
What does … usually
do the two last hours
before going to bed?
Do not read alternatives
Mark all the apply
YU23
Where does … sleep?
YU24
On what does …
usually sleep?
YU25
How many prepared
meals did … eat
yesterday?
Have … received any
new clothes last 3
months?
YU26
YU27
How
did …
receive
the
clothes?
Playing
Watching TV
Listening to radio
Eating
Household work
Meeting with friends/others
Collecting water
Schoolwork
Continue working
Other
DK
NA
Inside the house (room)
On the gallerie
Outside the house
DK
NA
In own bed
In shared bed
On a “army frame” bed
On a mattress without bed
On a mat
"Lit de fortune"
On the floor
DK
NA
Number of meals
DK=7 NA=8
Yes
No
DK
NA
Gift from someone in the household
Given from relatives outside the household
Given from non-relatives outside the
household
Bought it him/herself
DK
NA
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
|__|
1
2 Ł YU29
7 Ł YU29
8 Ł YU29
1
2
3
4
7
8
|__|
1
2 Ł YU29
7 Ł YU29
8 Ł YU29
1
2
3
4
7
8
1
2
3
4
5
6
7
8
9
10
97
98
1
2
3
7
8
1
2
3
4
5
6
7
97
98
1
2
3
4
5
6
7
8
9
10
97
98
1
2
3
7
8
1
2
3
4
5
6
7
97
98
1
2
3
4
5
6
7
8
9
10
97
98
1
2
3
7
8
1
2
3
4
5
6
7
97
98
1
2
3
4
5
6
7
8
9
10
97
98
1
2
3
7
8
1
2
3
4
5
6
7
97
98
1
2
3
4
5
6
7
8
9
10
97
98
1
2
3
7
8
1
2
3
4
5
6
7
97
98
1
2
3
4
5
6
7
8
9
10
97
98
1
2
3
7
8
1
2
3
4
5
6
7
97
98
1
2
3
4
5
6
7
8
9
10
97
98
1
2
3
7
8
1
2
3
4
5
6
7
97
98
|__|
|__|
|__|
|__|
|__|
1
2 Ł YU29
7 Ł YU29
8 Ł YU29
1
2
3
4
7
8
1
2 Ł YU29
7 Ł YU29
8 Ł YU29
1
2
3
4
7
8
1
2 Ł YU29
7 Ł YU29
8 Ł YU29
1
2
3
4
7
8
1
2 Ł YU29
7 Ł YU29
8 Ł YU29
1
2
3
4
7
8
1
2 Ł YU29
7 Ł YU29
8 Ł YU29
1
2
3
4
7
8
Page 19/19
YU28
YU29
Was these clothes
brand-new or second
hand?
Have … been through
the first communion?
YU30
How old was … at the
first communion?
YU31 Did … receive new
clothes for the
occasion?
YU32
From who did …
receive those
clothes?
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Brand-new
Second hand
Both new and second hand
DK
NA
Yes
No
Not Catholic
DK
NA
Enter age in whole years
Yes
No
DK
NA
Someone in the household
Relatives outside the household
Non-relatives outside the household
Bought it him/herself
DK
NA
Print date:5/8/02
1
2
3
7
8
1
2Ł
3Ł
7Ł
8Ł
YU33
YU33
YU33
YU33
|__|__|
1
2 Ł YU33
7 Ł YU33
8 Ł YU33
1
2
3
4
7
8
1
2
3
7
8
1
2Ł
3Ł
7Ł
8Ł
YU33
YU33
YU33
YU33
|__|__|
1
2 Ł YU33
7 Ł YU33
8 Ł YU33
1
2
3
4
7
8
1
2
3
7
8
1
2Ł
3Ł
7Ł
8Ł
YU33
YU33
YU33
YU33
1
2
3
7
8
1
2Ł
3Ł
7Ł
8Ł
YU33
YU33
YU33
YU33
1
2
3
7
8
1
2Ł
3Ł
7Ł
8Ł
YU33
YU33
YU33
YU33
1
2
3
7
8
1
2Ł
3Ł
7Ł
8Ł
YU33
YU33
YU33
YU33
1
2
3
7
8
1
2Ł
3Ł
7Ł
8Ł
YU33
YU33
YU33
YU33
|__|__|
|__|__|
|__|__|
|__|__|
|__|__|
1
2 Ł YU33
7 Ł YU33
8 Ł YU33
1
2
3
4
7
8
1
2 Ł YU33
7 Ł YU33
8 Ł YU33
1
2
3
4
7
8
1
2 Ł YU33
7 Ł YU33
8 Ł YU33
1
2
3
4
7
8
1
2 Ł YU33
7 Ł YU33
8 Ł YU33
1
2
3
4
7
8
1
2 Ł YU33
7 Ł YU33
8 Ł YU33
1
2
3
4
7
8
Page 20/20
YU33
How is …
usually
punished?
YU34
Have … [name]
been …[form of
punishment] during
the last week
(past 7 days)?
Ask only for forms
mentioned in YU33.
If the person was not
present last week, mark
8 (NA)
YU35
By whom is …
generally
punished?
Mark all that apply
Verbally reprimanded
Imposed restriction on activities
Asked to stand on the knees
Slapped
Pushed, grabbed or shoved
Boxed on the ear
Spanked
Hit with fists
Hit with some object
Other
Usually he’s not punished
DK
NA
Yes=1 No=2 DK=7 NA=8
1 Verbally reprimanded
2 Imposed restriction on activities
3 Asked to stand on the knees
4 Slapped
5 Pushed, grabbed or shoved
6 Boxed on the ear
7 Spanked
8 Hit with fists
9 Hit with some object
10 Other
Mother
Father
Sister
Brother
Other persons in the household
Relatives outside the household
Other non-household members
DK
NA
1
2
3
4
5
6
7
8
9
10
11 Ł End
97
98
1
2
3
4
5
6
7
8
9
10
11 Ł End
97
98
1
2
3
4
5
6
7
8
9
10
11 Ł End
97
98
1
2
3
4
5
6
7
8
9
10
11 Ł End
97
98
1
2
3
4
5
6
7
8
9
10
11 Ł End
97
98
1
2
3
4
5
6
7
8
9
10
11 Ł End
97
98
1
2
3
4
5
6
7
8
9
10
11 Ł End
97
98
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1
2
3
4
5
6
7
97
98
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1
2
3
4
5
6
7
97
98
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1
2
3
4
5
6
7
97
98
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1
2
3
4
5
6
7
97
98
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1
2
3
4
5
6
7
97
98
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1
2
3
4
5
6
7
97
98
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1 2
1
2
3
4
5
6
7
97
98
7
7
7
7
7
7
7
7
7
7
8
8
8
8
8
8
8
8
8
8
7
7
7
7
7
7
7
7
7
7
8
8
8
8
8
8
8
8
8
8
End of subsection
Haiti IHSI/Fafo/PNUD HLCS_WCQ
Print date:5/8/02
Page 21/21
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