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Afghanistan Mortality Survey 2010 - Measure DHS

Afghanistan Mortality Survey 2010 - Measure DHS

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THE MINISTRY OF PUBLIC HEALTHAFGHANISTAN MORTALITY SURVEYHOUSEHOLD QUESTIONNAIRE14 April <strong>2010</strong>IDENTIFICATIONVILLAGE / NEIGHBORHOOD [MUQTAA/MAHALA]NAME OF HOUSEHOLD HEADCLUSTER NUMBER [SAHA SHOMOR] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .STRUCTURE NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .INTERVIEWER VISITS1 2 3FINAL VISITDATEDAYMONTHINTERVIEWER'SNAMERESULT*NEXT VISIT DATE:TIME:YEARINT. NUMB.RESULTTOTAL NUMBEROF VISITS*RESULT CODES:1 COMPLETED2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME4 POSTPONED5 REFUSED7 DWELLING VACANT OR ADDRESS NOT A DWELLING8 DWELLING DESTROYED9 DWELLING NOT FOUND6 OTHER(SPECIFY)TOTAL PERSONSIN HOUSEHOLDTOTAL ELIGIBLEWOMEN 12-49NUMBER OFDEATHS SINCE 1HAMMAL 1384LINE NO. OFRESPONDENTTO HOUSEHOLDQUESTIONNAIRESUPERVISORFIELD EDITOROFFICEEDITORDATA ENTRYOPERATORNAMENAMEAppendix F |203

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