Vietnam Population and AIDS Indicator Survey 2005 ... - Measure DHS

Department of population and labour statistics National institute of hygiene and epidemiology (NIHE)
General statistical office (GSO)
Ministry of health
Vietnam population and aids indicator survey (vpais)
Individual questionnaire
confidential
identification
province: _______________________________________________________
district: ________________________________________________________
commune:_______________________________________________________
cluster number:................................................................................................
name of household head: _____________________________________
household number: .........................................................................................
urban/rural (Urban = 1; Rural = 2):..................................................................
large city/small city/town/rural (*)...................................................
(Large city = 1; Small city = 2; Town = 3; Rural = 4):
name and line number of respondent: ________________________
sex of respondent (Male = 1; Female = 2): ....................................................
Interviewer visits
1 2 3 Final visit
date
interviewer’s
name
result (**)
date
month
year 2 0 0 5
int. number
result
Next visit
- date
- time
total number
of visits
(**) result codes:
1 = completed 4 = refused
2 = not at home 5 = partly completed
3 = postponed 6 = incapacitated
7 = other
(specify)
supervisor
Field editor
Office editor
Keyed by
name
name
name
name
date
date
date
date
(*) The following guideliness should be used to categorize urban sample points: ‘Large cities’ are national capitals and
places with over 1 million population; ‘small cities’ are places between 50,000 and 1 million population; remaining
urban sample points are ‘towns’.
Appendix D |
137