Questionnaire Text

Questionnaire form view entire document:  text  image

27) Deaths
Have there been any deaths in this household during the period from _____ to _______
Mark an x in the proper box

Yes [ ] No [ ]

If yes, specify the sex and the age of the deceased

Sex of the deceased __
Age of the deceased _ _

Questionnaire instructions view entire document:  text  image

Column 27: Deaths.

Ask if there has been a death in this household over the course of the period from April 9 1975 to April 8 1976 (take care to respect this period).

Mark a cross in the square corresponding to the correct answer.
If NO: go to the question on housing.
If YES: mark the sex of the deceased (M for male, F for female) and the age of the deceased (in years passed) in the corresponding columns.


N.B. If a child is born during the period of reference and died between the moment of his or her birth and the beginning of the survey period, he or she must count both in 'births' and 'deaths'.

If a child is born during the period of reference and he or she doesn't count among the deceased or among the household members, this means either he left the household, or he died between April 9 1976 and the time of the your visit to this household. In this case, mark him in "observations": this will show that you didn't make an error in filling out the questionnaire.