NMICS 2010 Report - Central Bureau of Statistics

NEPAL MULTIPLE INDICATOR CLUSTER SURVEY, 2010QUESTIONNAIRE FOR CHILDREN UNDER FIVEUNDER-FIVE CHILD INFORMATION PANELThis questionnaire is to be administered to all mothers or caretakers (see Household Listing Form, columnHL9) who care for a child that lives with them and is under the age of 5 years (see Household Listing Form,column HL6).A separate questionnaire should be used for each eligible child.UFUF1. Cluster number:UF3. Child’s name:Name___ ___ ___UF2. Household serial number:UF4. Child’s line number:___ ______ ___UF5. Mother’s / Caretaker’s name:NameUF7. Interviewer name and code number:UF6. Mother’s / Caretaker’s line number:UF8. Day / Month / Year of interview in BS:___ ___Name code number ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___Repeat greeting if not already read to thisrespondent:WE ARE FROM CENTRAL BUREAU OF STATISTICS (A BUREAU OFNEPAL GOVERNMENT UNDER THE NATIONAL PLANNINGCOMMISSION), IN KATHMANDU. WE ARE WORKING ON ASURVEY CONCERNED WITH FAMILY HEALTH AND EDUCATIONIN MID AND FAR WESTERN REGION OF THE COUNTRY(NMICS). I WOULD LIKE TO TALK TO YOU ABOUT THESESUBJECTS. THE INTERVIEW WILL TAKE ABOUT 25 MINUTES.ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLYCONFIDENTIAL ACCORDING TO THE STATISTICS ACT 2015BS AND YOUR ANSWERS WILL NEVER BE SHARED WITHANYONE OTHER THAN OUR PROJECT TEAM.SHALL WE START NOW?If greeting at the beginning of the householdquestionnaire has already been read to this woman,then read the following:NOW I WOULD LIKE TO TALK TO YOU MORE ABOUT(child’s name from UF3)’S HEALTH AND OTHERTOPICS. THIS INTERVIEW WILL TAKE ABOUT 25MINUTES. AGAIN, ALL THE INFORMATION WE OBTAINWILL REMAIN STRICTLY CONFIDENTIAL AND YOURANSWERS WILL NEVER BE SHARED WITH ANYONEOTHER THAN OUR PROJECT TEAM.Yes, permission is given Go to UF12 to record the time and then begin the interview.NO, permission is not given Complete UF9. Discuss this result with your supervisor.UF9. Result of interview for children under 5Codes refer to mother/caretaker.UF10. Field edited by (Name and code number):Completed ............................................................. 01Not at home ........................................................... 02Refused ................................................................. 03Partly completed .................................................... 04Incapacitated ......................................................... 05Other (specify) ____________________ 96UF11. Data entry clerk (Name and code number):Name _______________ Code Number ___ ___Name _______________ Code Number ___ ___287