Afghanistan Mortality Survey 2010 - Measure DHS

SECTION 1. HOUSEHOLD SCHEDULESURVIVORSHIP OF MIGRATION LINE USUAL RESIDENTS AND AGE ELIGIBILITYRELATIONSHIP SEX RESIDENCE TO HOUSEHOLD INPATIENT OUTPATIENTNO.VISITORSTO HEAD OFBIOLOGICAL PARENTSHOUSEHOLDPlease give me the names What is the Is Does Did How CIRCLE Is Is Has In what In the last 12 CIRCLE In the last 30 CIRCLEof the persons who usually relationship of (NAME) (NAME) (NAME) old is LINE (NAME)'s (NAME)'s (NAME) month and months, was LINE days, did LINElive in your household and (NAME) to the male or usually stay (NAME)? NUMBER natural natural lived year did (NAME) NUMBER (NAME) NUMBERguests of the household head of the female? live here OF ALL mother father here (NAME) admitted OF receive care OFwho stayed here last night, household? here? last IF AGE 95 WOMEN alive? alive? since move in? overnight PERSON from any PERSONstarting with the head of night? OR MORE, AGE 1 Hammal to stay at a ELIGIBLE source, ELIGIBLEthe household. RECORD 12-49 1384? health facility? FOR without FORSEE CODESBELOW. 95'. IN- staying OUT-AFTER LISTING THE PATIENT overnight? PATIENTNAMES AND RECORDING IF AGE SECTION SECTIONTHE RELATIONSHIPLESS THANAND SEX FOR ALL1 YEARPERSONS, ASKRECORDQUESTIONS 102A-102C'00'TO BE SURE THAT THELISTING IS COMPLETE.THEN ASK APPROPRIATEQUESTIONS IN COLUMNS105-116 FOR EACH PERSON.(102) (103) (107) (108) (113) (114) (115) (116)(104) (105) (106) (109) (110)(101) (111) (112)N MONTH M F Y N Y N IN YEARS Y N Y N Y Y N DK Y N DK01 1 2 1 2 1 2 01 1 2 1 2 1 20 1GO TO Q.113YEAR01 011 2 8 1 2 8GO TO Q.115 GO TO (2)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK02 1 2 1 2 1 2 02 1 2 1 2 1 2GO TO Q.113YEAR02 021 2 8 1 2 8GO TO Q.115 GO TO (3)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK03 1 2 1 2 1 2 03 1 2 1 2 1 2GO TO Q.113YEAR03 031 2 8 1 2 8GO TO Q.115 GO TO (4)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK04 1 2 1 2 1 2 04 1 2 1 2 1 2GO TO Q.113YEAR04 041 2 8 1 2 8GO TO Q.115 GO TO (5)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK05 1 2 1 2 1 2 05 1 2 1 2 1 2GO TO Q.113YEAR05 051 2 8 1 2 8GO TO Q.115 GO TO (6)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK06 1 2 1 2 1 2 06 1 2 1 2 1 2GO TO Q.113YEAR06 061 2 8 1 2 8GO TO Q.115 GO TO (7)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK07 1 2 1 2 1 2 07 1 2 1 2 1 2GO TO Q.113YEAR07 071 2 8 1 2 8GO TO Q.115 GO TO (8)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK08 1 2 1 2 1 2 08 1 2 1 2 1 2GO TO Q.113YEAR08 081 2 8 1 2 8GO TO Q.115 GO TO (9)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK09 1 2 1 2 1 2 09 1 2 1 2 1 2GO TO Q.113YEAR09 091 2 8 1 2 8GO TO Q.115 GO TO (10)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK10 1 2 1 2 1 2 10 1 2 1 2 1 2GO TO Q.113YEAR10 101 2 8 1 2 8GO TO Q.115 GO TO (11)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK11 1 2 1 2 1 2 11 1 2 1 2 1 2GO TO Q.113YEAR11 111 2 8 1 2 8GO TO Q.115 GO TO (12)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK12 1 2 1 2 1 2 12 1 2 1 2 1 2GO TO Q.113YEAR12 121 2 8 1 2 8GO TO Q.115 GO TO (13)M F Y N Y N IN YEARS Y N Y N Y N MONTH Y N DK Y N DK13 1 2 1 2 1 2 13 1 2 1 2 1 2GO TO Q.113YEAR13 131 2 8 1 2 8GO TO Q.115 GO TO Q.201TICK HERE IF CONTINUATION SHEET USEDCODES FOR Q.103: RELATIONSHIP TO HEAD OF HOUSEHOLD102A) Just to make sure that I have a complete 01 = HEAD 08 = BROTHER OR SISTERlisting. Are there any other persons such as small ADD TO02 = WIFE OR HUSBAND 09 = OTHER RELATIVEchildren or infants that we have not listed? YES TABLE NO 03 = SON OR DAUGHTER 10 = ADOPTED/FOSTER/102B) Are there any other people who may not be 04 = SON-IN-LAW OR STEPCHILDmembers of your family, such as domestic servants, ADD TODAUGHTER-IN-LAW 11 = NOT RELATEDlodgers, or friends who usually live here? YES TABLE NO 05 = GRANDCHILD 98 = DON'T KNOW102C) Are there any guests or temporary visitors 06 = PARENTstaying here, or anyone else who stayed here lastADD TO07 = PARENT-IN-LAWnight, who have not been listed? YES TABLE NOAppendix F |205