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MZ2007A_DEATHS
Any deaths in household in last 12 months
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Questionnaire Text

Questionnaire form view entire document:  text  image
Section H: Mortality
Enumerator: Get information about the deceased in the household. Do not forget about the deceased children.

1. In this household, has anybody passed away in the past 12 months? (from August 1, 2006 to July 31, 2007)

[] 1 Yes- Go to H2
[] 2 No (To make sure, ask whether in that period any newborn or infant has passed away)
2. If so, please specify:
Name of deceased people: ________
Sex
[] 1 Male
[] 2 Female
Age: ____
For Women aged 12-50 only:
Did death occur during pregnancy?
[] 1 Yes
[] 2 No
Did death occur during delivery?
[] 1 Yes
[] 2 No
Did death occur within 2 months after pregnancy or delivery?
[] 1 Yes
[] 2 No
Questionnaire instructions view entire document:  text  image
H1. In this household, has anybody passed away in the past 12 months? (from August 1, 2006 to July 31, 2007)

Ask whether someone in the household passed away in the past 12 months. Always be careful not to omit information about the deceased persons, especially the newborns.
In order to be sure, ask whether within that period of time some newborn or baby passed away.

Attention:

Make sure that the respondent understood the reference period (the past 12 months), i.e., from August 1, 2006 to July 31, 2007.
The Question refers to persons who lived in the household and died.
They should not include relatives who died in their households.

Mark an X in box number 1 if the members of the household declared that someone passed away in the past 12 months, and go on to Question H2.

If no one in the household passed away in the past 12 months, write an X in box number 2 and finish the interview.