Questionnaire Text

Questionnaire form view entire document:  text  image

Deaths that occurred during the past twelve months in this household

H11. Have there been deaths in this household during the period from April 1986 to March 1987?
(Circle the appropriate number)

[] 1 Yes
[] 2 No


If yes, circle the number corresponding to the sex of each deceased, and record the age at death (a line per death.)
Questionnaire instructions view entire document:  text  image

2) Space for deaths during the past 12 months.
You should end your interview with these questions.
Note that reference is being made here to deaths of persons who were resident members of the household and not deaths of members of the family and visitors who were not resident members of the household.
a) If there was no death, encircle the figure 2 of question H11, close the interview by writing the date and your name at the bottom of the page.
b) If there were deaths in the household, firm encircle the figure 1 of question H11. Ask the sex and age of each deceased

There was only one death; ask the sex and age of the deceased, encircle.
1 if a man
2 if a woman

Then ask his age at the time of death and write the age in H13.
If there are many deaths, proceed in the same way for each death.

3) Visas
Date of the interview: Do not forget to mention the date of the interview.
Name of the enumerator: Write your name clearly on the first questionnaire used in each household.
Endorsement of crew leader: Write nothing there.
Endorsement of controller: Write nothing there.