LOCAL GOVERNMENT AREA
1 = IFO

AGE
1 = 20-24
2 = 25-30
3 = 31-40
4 = 41-44
5 = 45 and above

RELIGION
1 = CHRISTIANITY
2 = ISLAM
3 = TRADITIONAL
4 = OTHER (SPECIFY)

MARITAL STATUS
1 = SINGLE
2 = MARRIED
3 = DIVORCED/SEPRATED
4 = WIDOW

HUSBAND HAD ANOTHER WIFE
1 = YES
2 = NO

EDUCATION
1 = NONE
2 = PRIMARY
3 = SECONDARY
4 = POST-SECONDARY
5 = PROFESSIONAL

SPOUSE'S EDUCATION
1 = NONE
2 = PRIMATY
3 = SECONDARY
4 = POST-SECONDARY
5 = PROFESSIONAL

OCCUPATION
1 = NOT WORKING
2 = SELF EMPPLOYED
3 = CIVIL/PUBLIC SERVANT
4 = PRIVATE SECTOR EMPLOYEE
5 = FARMING
6 = TRADING
7 = ARTISAN

SPOUSE OCCUPATION
1 = NOT WORKING
2 = SELF EMPLOYED
3 = CIVIL/PUBLIC SERVANT
4 = PRIVATE SECTOR EMPLOYEE
5 = FARMING
6 = TRADING
7 = ARTISIAN

TYPE OF HOUSE LIVING IN
1 = MUD/GRASS/HUT
2 = ONE ROOM
3 = ROOM AND PALOUR
4 = TWO/THREE BEDROOM FLAT
5 = DETACHED HOUSE/MANSION

NUMBER OF PERSONS LIVING IN THE HOUSE
1 = BELOW 3
2 = 3-4
3 = 5-6
4 = 7 AND ABOVE

TOLIET FACILTY FOR HOUSEHOLD USE
1 = PIT LATRINE
2 = FLUSH TOILET
3 = BUCKET TOILET
4 = FIELD/BUSH
5 = OTHER (SPECIFY)

MAIN SOURCE OF WATER SUPPLY
1 = TAP
2 = BOREHOLE
3 = COVERED-WELL
4 = RIVER/STREAM
5 = TANKER-TRUCK

HOW FAR IS HOUSE TO HEALTH FACILITY
1 = NOT FAR/TREKABLE
2 = FAR BUT TREKABLE
3 = VERY FAR
4 = I DONT KNOW

PLACE OF DELIVERY OF LAST CHILD
1 = PHC/HOSPITAL
2 = HOME
3 = PRIVATE CLINIC
4 = TRADITIONAL BIRTH ATTENDANT'S PLACE
5 = OTHER (SPECIFY)

WHO ASSISTED IN THE DELIVERY OF YOUR LAST CHILD
1 = DOCTOR
2 = NURSES/MIDWIVES
3 = TRADITIONAL BIRTH ATTENDANT
4 = RELATIVES
5 = OTHER (SPECIFY)

WHO TAKES CARE OF LAST CHILD IN ABSENCE
1 = HOUSE HELP
2 = DAY CARECENTER (CRECHE)
3 = MOTHER /MOTHER-IN-LAW
4 = HUSBAND
5 = OTHER (SPECIFY)

SICKENESS MOST CHILDREN SUFFER IN YOUR COMMUNITY
1 = MALARIA
2 = DIARRHEA
3 = MEASLES
4 = PNEUMONIA
5 = MALNUTRITION
6 = COLD/COUGH
7 = FEVER
8 = CONVULSION
9 = OTHER (SPECIFY)

MAJOR WATER RELATED ALIMENT THAT CHILDREN SUFFER
1 = TYPHOID
2 = CHOLERA
3 = DYSENTERY
4 = DIARRHEA
5 = OTHER (SPECIFY)

COST OF TREATMENT AT HEALTH FACILTY
1 = VERY EXPENSIVE
2 = EXPENSIVE
3 = MODERATE
4 = CHEAP
5 = VERY CHEAP

TIME NEEDED TO OBTAIN TREATMENT FOR CHILD AT THE HEALTH FACILITY
1 = LESS THAN 30 MINUTES
2 = 30 MINUTES
3 = 31 MINUTES-1 HOUR
4 = 1-2 HOURS
5 = 2 HOURS AND ABOVE

BEHAVIOR OF HEALTH WORKERS AT HEALTH FACILITY
1 = VERY CORDIA;
2 = CORDIAL
3 = INDIFFERENT
4 = NOT CORDIAL
5 = NOT VERY CORDIAL

DESCRIPTION OF THE SERVICES PROVIDED AT THE HEALTH FACILITY
1 = VERY GOOD
2 = GOOD
3 = NEUTRAL
4 = BAD
5 = VERY BAD

NUMBER OF TIMES LAST CHILD FALL SICK IN A MONTH
1 = ONCE
2 = TWICE
3 = THRICE
4 = OTHER (SPECIFY)

WHO TO CONSULT FOR TREATMENT OF CHILDREN
1 = DOCTOR/NURSE
2 = TRADITONAL HEALER
3 = PASTOR/ALFA
4 = RELATIVES/FRIENDS
5 = SELF-MEDICATION
6 = OTHER (SPECIFY)

WHO DECIDES CHILD'S PLACE OF TREATMENT
1 = HUSBAND
2 = MYSELF
3 = PARENTS
4 = RELATION/FRIEND
5 = OTHER (SPECIFY)

IMMUNIZATION STATUS OF LAST CHILD
1 = COMPLETE
2 = NOT COMPLETE
3 = NO IMMUNIZATION

BIRTH SPACING BETWEEN LAST CHILD AND PRESENT PREGANCY
1 = BELOW 6 MONTHS
2 = 6-12 MONTHS
3 = 13-18 MONTHS
4 = 19-24 MONTHS
5 = 25 MONTHS AND ABOVE

TYPE OF DISEASES CHILD HAD IN LAST 3 MONTHS
1 = Body Temperature
2 = Malaria
3 = Typhoid
4 = Boil
5 = Diaheera
6 = Cholera
7 = Cold/cough/catherta
8 = Headache
9 = Rashes
10 = Convulsion
11 = Chicken Pox /Measles

TYPE OF HOUSEHOLD WASTE DISPOSAL PRACTICE
1 = GOVERNMENT COLLECTION
2 = PRIVATE AGENCY COLLECTION
3 = DISPOSAL WITHIN THE COMPOUND VIA BURYING OR BURNING
4 = USE UNAUTHORIZED DUMPSITE

NUMBER OF MONTHS USED TO BREASTFEED LAST CHILD
1 = BELOW 6 MONTHS
2 = 6-9 MONTHS
3 = 10-12 MONTHS
4 = ABOVE 12 MONTHS

WHEN BREASTFEEDING STARTED FOR FIRST TIME FOR LAST CHILD
1 = BETWEEN Ist-3RD DAY
2 = BETWEEN 4th and 7th DAY
3 = AFTER ONE WEEK
4 = OTHER (SPECIFY)

CHILD MORTALITY RATE IN COMMUNITY
1 = LOW
2 = MODERATE
3 = HIGH
4 = I DONT KNOW

IF YES, WHAT WAS THE CAUSES OF THE DEATH
1 = Convulsion
2 = Still Birth
3 = Measles
4 = Stooling
5 = Congential malformation
6 = Malaria
7 = Malnutrition
8 = Tetanus
9 = Diaheraa
10 = Kwashokor
11 = Typhoid
12 = Accident
13 = Lack of Money
14 = Menigitis
15 = Jandices

GIVE YOUR SUGGESTIONS ON HOW TO IMPROVE THE SURVIVAL CHANCES OF CHILDREN IN YOUR WARD/COMMUNITY
1 = Good service delivery
2 = Provision of Health Facilities an Awareness of Services
3 = Cheap Housing and Health Rate
4 = Employment Professionals at all Clinics
5 = Provide Mosquito Nets, Immunization and Environmental Hyginene

0 = alive
1 = dead