Unique Number
Person Number
Province
1=Male 2=Female
Age
Race
Q1.1 What is ... ‘s relationship to the head of the household?
Q1.2.a What is ...’s present marital status?
Q1.2.b Does ...’s spouse/partner live in this household?
Q1.2.c Which person is the spouse/partner of ...?
Q1.3.a Is ...’s fathered still alive?
Q1.3.b Is ...’s father part of the household?
Q1.3.c Which person is ...’s father?
Q1.4.a Is ... ‘s mother still alive?
Q1.4.b Is ...’s mother part of the household?
Q1.4.c Which person ...’s mother?
Q1.5.a Can ... read in at least one language?
Q1.5.b Can ... write in at least one language?
Q1.6.a In the last seven days, did ... spend at least one hour fetching water fo
Q1.6.b How many hours did ... spend on fetching water in the last seven days?
Q1.7.a In the last seven days, did ... spend at least one hour fetching wood/dun
Q1.7.b How many hours did ... spend on fetching wood/dung in the last seven days
Q1.10 What is the highest level of education that ... has completed?
Q1.11 Is ... currently attending school or any other educational institution?
Q1.12 What is the main reason why ... is currently not attending school or any o
Q1.13 Which of the following educational institutions does ... attend?
Q1.14 Is it correspondence/distance educational institution?
Q1.15 How long does it take ... to get to the school/educational institution whe
Q1.16 What is the total amount of tuition fees paid for ... in a year?
Q1.17 This academic year, has ...benefited from any exemptions and/or bursaries?
Q1.18 Lack of books
Q1.18 Poor teaching
Q1.18 Lack of teachers
Q1.18 Facilities in bad condition
Q1.18 Fees too high
Q1.18 Classes too large
Q1.18 Other, specify in column
Q1.19 Is ... covered by a medical aid or medical benefit scheme or other private
Q1.20 During the past month, did ... suffer from any illness or injuries?
Q1.21 Flu or acute respiratory tract infection
Q1.21 Diarrhoea
Q1.21 Severe trauma
Q1.21 TB or severe cough with blood
Q1.21 Abuse of alcohol or drugs
Q1.21 Depression or mental illness
Q1.21 Diabetes
Q1.21 High or low blood pressure
Q1.21 HIV/AIDS
Q1.21 Other sexually transmitted disease
Q1.21 Other illness or injury
Q1.22 Consult a health worker
Q1.23 What kind of health worker was it?
Q1.24 Where did the consultation take place?
Q1.25 Facilities not clean
Q1.25 Long waiting time
Q1.25 Opening times not convenient
Q1.25 Too expensive
Q1.25 Drugs that were needed, not available
Q1.25 Staff rude or uncaring or turned patient away
Q1.25 Incorrect diagnosis
Q1.25 Other, specify in column
Q1.26 How satisfied was ... with the service he/she received?
Q1.27 Did... have to pay for this service?
Q.128 Why did ... not consult any health worker during the past month?
Q1.29 Is ... limited in his/her daily activities, at home, at work or at school,
Q1.30 Sight
Q1.30 Hearing
Q1.30 Communicating
Q1.30 Physical
Q1.30 Intellectual
Q1.30 Emotional
Q1.30 Other
Q1.31 During the past 12 months, did ... make use of a welfare office or service
Q1.32 Social worker
Q1.32 Social grant
Q1.32 Poverty
Q1.33 How satisfied was ... with the service/assistance rendered at the welfare
Primary Sampling Unit
Person Weight