Form B: Household questionnaire Part 5
Part 5: Deaths in households

Deaths in households in the last 12 months: total number of deaths ____

102. Deaths in household in the last 12 months
Columns (1) to (7) for recording death of any member of household in the last 12 months
This relates to deaths of any members of household during the last 12 months in the same household. Before recording any death you should know that the death of the person took place when he/she was living in the household. The death of the person living in other places at the time of death should not be recorded. For example a woman who was formerly a member of household during the survey had died as member of another household (which she joined after marriage) her death should not be recorded in the surveyed household.
102.1 The place of death, if hospital, is not important in some cases. For example a member of the surveyed household died at hospital. Such death should be recorded in the household. A member of surveyed household was traveling to some place for getting health care and died in that place, it should be recorded in the surveyed household. For example Kim who is member of household (A) in Kandal fell ill and went to Phnom Penh to receive treatment and stayed in the household of (B) in Phnom Penh. If he died in Phnom Penh, his death should be recorded in household (A) and not in household (B).
102.2 For recording death in household in the last 12 months nine columns are provided. One line should be used for recording one death. The first column is for the serial number. In column 2 you should write full name of the deceased. In case of infant death where the infant is not given a name, write "INFANT (Kouy Kim Deth's infant)". In column 3 you should fill-in sex of deceased. In column 4 the relationship to head of household should be filled-in. In column 5 the age at death in completed years of the deceased at the time of death should be recorded. In column 6 concerning the registration with the Civil Authority, if the answer is "Yes" give code 1 and if "No" give code 2. The causes of death contain one groups of codes for illness and another for accidents. The codes (see the bottom of the questionnaire) from 1 to 19 relate to illness and codes from 20 to 34 for accidents. In column 7 give appropriate code for the cause of death of the person. If there are two or more causes, give the code for one cause only after probing which was the most important cause.