Questionnaire Text

Questionnaire form view entire document:  text  image
Chapter D. Mortality

21. From January to December of last year, did anyone who lived with you in this home die?

[] 1 Yes
How many people? _ _
[] 2 No [Go to question 22]

In the table below, record the information for each of the people who died. Don't forget children, newborns, and old people.
Number _
Age at death (Write 0 if under 1 year old) _ _ _
The person was:

[] 1 Female
[] 2 Male

If it was a woman at least 15 years old, did she die of causes related to...

[] 1 Pregnancy
[] 2 Childbirth
[] 3 Postpartum (up to 2 months after childbirth)
[] 4 Other cause
Questionnaire instructions view entire document:  text  image
Chapter D. Mortality
This chapter aims to gather information about mortality in general as well as maternal mortality in women aged 15 and above during the period from January to December of 2011. The first part of the question acts as a ''filter'' to find out if one or more people living in the household died during calendar year 2011. If the answer is yes, ask, ''How many people?'' and note the stated number in the appropriate boxes. Then, fill in the table, writing the name of each of the deceased, their age at their final birthday (writing 0 for those under one year old), and the deceased's sex.
If the deceased was a woman at least 15 years old, also ask the cause of death. If the answer is no, go to question 22, chapter E, of the census form.