Questionnaire Text

Benin 1992 Cameroon 2005 Lesotho 2006 South Africa 2011
Benin 2002 Colombia 2005 Liberia 2008 South Africa 2016
Benin 2013 El Salvador 1992 Malawi 1998 South Sudan 2008
Bolivia 1992 El Salvador 2007 Malawi 2008 Sudan 2008
Bolivia 2012 Ethiopia 1984 Mali 1987 Tanzania 1988
Botswana 1981 Ethiopia 2007 Mali 1998 Tanzania 2012
Botswana 2001 Guatemala 1994 Mali 2009 Togo 2010
Botswana 2011 Guinea 2014 Mozambique 2007 Uganda 2002
Brazil 2010 Haiti 1982 Nepal 2001 Vietnam 1989
Burkina Faso 1985 Haiti 2003 Nepal 2011 Vietnam 1999
Burkina Faso 1996 Honduras 2001 Nicaragua 2005 Zambia 1990
Cambodia 2004 Indonesia 1985 Panama 2000 Zambia 2010
Cambodia 2008 Indonesia 2010 Rwanda 2002 Zimbabwe 2012
Cambodia 2013 Jamaica 2001 Senegal 2002
Cameroon 1976 Kenya 2009 Sierra Leone 2004
Cameroon 1987 Lesotho 1996 South Africa 2007
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Benin 1992 — source variable BJ1992A_NMORT — Deaths in the past 12 months
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Events occurred in the household in the last 12 months

Deaths: has there been any deaths in the household since _ _ _ _ [date to fill out]

(Circle the applicable number)
[] 1 Yes
[] 2 No
_ _ If yes, how many?
Questionnaire instructions view entire document:  text  image
Events that occurred in the household during the last 12 months

Deaths:
This applies to the death of residing members of the household. The census agent shall ask the question "Has there been any deaths in the household since January 1st, 1991?" The census agent shall treat this question carefully because it can sometimes invoke painful memories for the respondent.
If there were no deaths during the period, the census agent shall report "0" (zero) in the grid situated above the table "Deaths."
If the answer is Yes, the census agent shall ask for how many deaths occurred in the household during the last 12 months. He shall report the number in the corresponding grid.

Column (1): this is the column for the number of deaths in the household.


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Benin 2002 — source variable BJ2002A_MORTN — Number of death records
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Deaths occurred since January 1st 2001
[Questions in columns 28 - 39 pertain to deaths in the household since January 1st, 2001]

(28) Has there been any deaths in the household since January 1st 2001?

[] 1 Yes
[] 2 No, go to column 40
Questionnaire instructions view entire document:  text  image
4-2-3- Page on deaths
This page only concerns deaths occurred in the household since January 1st, 2001.

Question [column] (28): Has there been any deaths in the household since January 1st, 2001?
If the answer to this question is no, go to column 40 (construction type) in the "household characteristics" section. If the answer is yes, go to column 29 i.e. the deaths order number.


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Bolivia 1992 — source variable BO1992A_DEADM — Number of males deceased
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17. During the last year (Jan. - Dec. 1991), did anyone who lived in this household die (including children and newborn infants)?
[Question 17 was asked of persons in occupied private dwellings, per Questions 1 and 2.]

[] 1 Yes
[] 2 No


17.1 How many were males and what was their age at death?

____ Number of males
_ _ Age or ages
_ _
_ _
_ _
Note: If the person deceased before reaching one year of age, write 00. If the person deceased at age 98 or older, write 98.

17.2 How many were female and what was their age at death?

____ Number of females
_ _ Age or ages
_ _
_ _
_ _
Note: If the person deceased before reaching one year of age, write 00. If the person deceased at age 98 or older, write 98.

Questionnaire instructions view entire document:  text  image

Question 17. Last year (January - December 1991), did anyone who was living in this household die, including children and newborns?

You should emphasize that only the passing of people, relatives or otherwise, who were usually living in the dwelling should be taken into account. The passing can have occurred in the home or outside of it, for example in a hospital or other assistance establishment, etc.

If they report No, continue on to question 18, without asking the next two questions.


17.1 How many were men, and at what age did they pass away?

You should record the number of men in the household who died, recording their age when they passed away, clarifying that [p. 33] this concerns deaths that may have occurred from January to December of 1991.


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Bolivia 1992 — source variable BO1992A_DEADF — Number of females deceased
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17. During the last year (Jan. - Dec. 1991), did anyone who lived in this household die (including children and newborn infants)?
[Question 17 was asked of persons in occupied private dwellings, per Questions 1 and 2.]

[] 1 Yes
[] 2 No


17.1 How many were males and what was their age at death?

____ Number of males
_ _ Age or ages
_ _
_ _
_ _
Note: If the person deceased before reaching one year of age, write 00. If the person deceased at age 98 or older, write 98.

17.2 How many were female and what was their age at death?

____ Number of females
_ _ Age or ages
_ _
_ _
_ _
Note: If the person deceased before reaching one year of age, write 00. If the person deceased at age 98 or older, write 98.

Questionnaire instructions view entire document:  text  image

Question 17. Last year (January - December 1991), did anyone who was living in this household die, including children and newborns?

You should emphasize that only the passing of people, relatives or otherwise, who were usually living in the dwelling should be taken into account. The passing can have occurred in the home or outside of it, for example in a hospital or other assistance establishment, etc.

If they report No, continue on to question 18, without asking the next two questions.


17.2 How many were women and at what age did they pass away?

You should record the number of women in the household who died, recording their age upon passing away, clarifying that this concerns deaths that may have occurred from January to December of 1991.


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Bolivia 2012 — source variable BO2012A_NDEATHS — Number of deaths
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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.

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Botswana 1981 — source variable BW1981A_DEATHS — Number of deaths (last year)

No questionnaire text is available for this sample.


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Botswana 2001 — source variable BW2001A_MORTN — Number of deaths (last year)
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Since Independence Day 2000, has any member (stayed for at least 14 days) of the household died?

(If "yes", ask for sex, age, and usual place of residence.)

D1. Serial number _ _

Questionnaire instructions view entire document:  text  image
132. Columns D1, D2, D3 and D4: Deaths in the household

Q: Since Independence Day 2000, has any member of this household died?

In general people are not happy to talk about deaths, especially recent ones, so be careful when asking this question. We are interested in recording information about any deaths since last Independence Day, September 30th, 2000, of anyone who had, up until their death, been a member of this household. The relevant portion of the sample questionnaire is shown below:

If there was any such death, enter the details under columns D1 to D3. Start with the serial number in D1. The first death should be given the serial number 01, the second death 02, etc. Record also the relationship in D2 of the deceased to the head of the current household, the SEX of the deceased in column D3 and his AGE at death in column D4. If the person was under 1 year at death enter 00. Lastly, in D5 you will have to collect information on where the deceased was living most of the times or usually before dying, which might help you establish if the deceased was really a member of the household. The deceased should be regarded a usual member if he/she has stayed with the household for period longer than 14 days before death. Still deaths should not be considered to be deaths.

If there were more than three deaths in the household, write "continued" in the comments box and enter the particulars of these other deaths in Part D of the next questionnaire form, starting with serial number 04.

If there were no deaths, enter dashes in the spaces provided for answer codes in the first line only. Ensure that one death is not repeated in more than one household. The repetition of one death is common among relatives of the deceased who are not of the same household, and another confusion from those people who were staying in the same dwelling with the deceased but not being of the same household with the deceased. These situations could be avoided by finding out the usual residence of the deceased and whether the deceased had common provision for food with the household interviewed.

Example: The household has had one death since independence day last year, this death is assigned serial number 1, coded 06 in D2 to show that the deceased was Maungo's grandparent and coded 1 in D3 to show that the person was male. This person was aged 96 years and was living in Francsitown most of the time, at the time of death the deceased had moved to Tsootsha until his death two months later.

[Table in P.52 of the original document is not presented here]


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Botswana 2011 — source variable BW2011A_HHMORT — Number of deaths (last year)
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D. Deaths

Since Independence Day 2010, has any member of the household died? (stayed for at least 14 days)
[If "yes", complete questions 1 to 5, if "no" put dashes in the first row only].

Questionnaire instructions view entire document:  text  image
Part D of the Questionnaire

178. Columns D1, D2, D3, D4, and D5: Deaths in the household
Q. Since Independence Day 2010, has any member of this household died (staying within the household for at least 14 days)?
Generally people are not happy to talk about deaths, especially recent ones, so be careful when asking this question. We are interested in recording information about any deaths since last Independence Day, September 30th, 2010, of anyone who had, up until their death, been a member of this household. The relevant portion of the sample questionnaire is shown below.
If there was any such death, enter the details in columns D1 to D5. Start with the serial number in D1. The first death should be given the serial number 01, the second death 02, etc. Record also the relationship in D2 of the deceased to the head of the current household, the SEX of the deceased in column D3 and his/her age in completed years at death in column D4. If the person was under 1 year at death enter 00. Lastly, in D5 you will have to collect information on where the deceased was living most of the times or usually before dying, which might help you establish if the deceased was really a member of the household. The deceased should be regarded as a member if he/she has stayed with the household for period of at least 14 days before death. Still births should not be considered to be deaths.

If there were no deaths, enter dashes in the spaces provided for answer codes in the first line only. Try by all means to eliminate the chances whereby one death is repeated in more than one household. The repetition of a death is common among relatives of the deceased who are not of the same household and confusion from those people who were staying in the same dwelling with the deceased but not being of the same household with the deceased. These situations could be avoided by finding out or probing for the usual residence of the deceased and whether the deceased had common provision for food with the household interviewed
[Table omitted]


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Brazil 2010 — source variable BR2010A_DEATHHH — Deaths in the household from August, 2009 to July, 2010

No questionnaire text is available for this sample.


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Burkina Faso 1985 — source variable BF1985A_DTHYRHH — Number of deaths in the past 12 months
Questionnaire form view entire document:  text  image

Deaths in the last 12 months
[] No
[] Yes

If yes, how many? _

First and last name of deceased ____
Sex of deceased ____
Age at death ____
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Deaths during the last 12 months

This question, located at the top of the household form, concerns the number of deaths that happened in the household during the last 12 months (since December 1984). Put a cross in the box marked Yes or No according to whether or not a death happened in the household.

If Yes, specify the full name, sex and age (in years, months or days) of the deceased at the time of their death.

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Burkina Faso 1996 — source variable BF1996A_MORTN — Number of mortality records, dwelling-wide
Questionnaire form view entire document:  text  image
IV. Deaths in the last 12 months


Has anyone in your household died within the last 12 months?

[] 1. Yes
[] 2. No


If yes, how many? _ _

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Cambodia 2004 — source variable KH2004A_DEATHS — Number of deaths
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Form B: Household questionnaire Part 5
Part 5: Deaths in households

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

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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.

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Cambodia 2008 — source variable KH2008A_DEATHS — Deaths in last year in household
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Form B: household questionnaire - part 5: death in the household


Deaths in the household in the last 12 months

Total number of deaths _ _

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133. Filling in of Form B Household Questionnaire Part 5: Death in Household

This is the last part of the household questionnaire (Form B). This section is considered as part of household questionnaire with very sensitive questions. You should be polite and patient when asking these questions. You should explain to the respondents about this information which is very necessary for studying the mortality rate (per 1000 population), maternal mortality rate and for the calculation of the population growth rate. You should take special care to see that correct information is ascertained; you may have to ask probing questions patiently to achieve this.


133.1 Deaths in household in the last 12 months: Total Number of Deaths

Columns (1) to (6) are for recording death of any member of the household in the last 12 months

This relates to the death of any member of the 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. For example, if a woman who was formerly a member of the household during the census had died as a member of another household (which she joined after marriage), her death should not be recorded in the census household.

133.2 If a member of the census household died at hospital irrespective of the period of stay in the hospital, such death should be recorded as in the census household. If a member of the census household was traveling to some place for getting health care and died in that place, it should be recorded as in the census household. For example, Nara who is a 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). To determine to which household a member belongs in such cases, six months or more may be treated as the period the person should have stayed in the household to treat him/her as belonging to that household.

133.3 For recording death in the household in the last 12 months, nine columns are provided. One line should be used for recording one death. The first
[p.54]
column is for the serial number. In Column 2 you should write the 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 the sex of the deceased. In Column 4 the relationship to the 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 give the appropriate code for the cause of death of the person. The list of causes of death given on the questionnaire contains one group of codes for illness and another for accidents. The codes from 01 to 11 relate to illness and codes from 12 to 15 for accidents. If there are two or more causes, give the code for one cause only after probing which was the most important cause. If with all efforts (i.e. discussing with other members, etc.) you are not able to ascertain the actual cause of death of any person, enter Code 16 (Not Known).


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Cambodia 2013 — source variable KH2013A_DEATHS — Deaths in the household
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Part 4: Death in household

Deaths in household in the last 12 months _ _

Total number of deaths
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94. Filling-in of Form B household questionnaire part - 4: death in household

This section is considered as part of household questionnaire with very sensitive questions. You should be polite and patient when asking these questions. You should explain to the respondents about this information which is very necessary for studying the death rate (per 1000 population), maternal death rate and for the calculation of the population growth rate. You should take special care to see that correct information is ascertained; you may have to put probing questions patiently to achieve this.

94.1 Deaths in household in the last 12 months: total Number of deaths

Columns (1) to (6) for recording death of any member of household in the last 12 months

This relates to death of any member 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. For example a woman who was formerly a member of household during the census had died as member of another household (which she joined after marriage) her death should not be recorded in the census household.

94.2 If a member of the census household died at hospital irrespective of the period of stay in the hospital such death should be recorded as in the census household. If a member of census household was traveling to some place for getting health care and died in that place, it should be recorded as in the census household. For example Nara 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). To determine to which household a member belongs in such cases, six months or more may be treated as the period the person should have stayed in the household to treat him/her as belonging to that household.

94.3 For recording death in household in the last 12 months ten 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 the deceased. In column 4. The relationship to head of household should be filled-in. For filling in col.4, the code list for relationship given below the column may be referred to and suitable code given. In column 5. The age at death in completed years of the deceased at the time of death should be recorded. In column 6 give appropriate code for the cause of death of the person. The list of causes of death given on the questionnaire contains one group of codes for illness and another for accidents. The codes from 01 to 11 relate to illness and codes from 12 to 15 for accidents. If there are two or more causes, give the code for one cause only after probing which was the most important cause.

If with all efforts (i.e. discussing with other members etc) you are not able to ascertain the actual cause of death of any person, enter code 16 (Not Known).

Column 7: has the death been registered with the civil authority in commune/Sangkat? yes: 1; No: 2

Death registration means that the death in the household was reported by any of the household members or any relative to the commune/Sangkat. If the respondent says that the death was registered with the civil authority in the commune/Sangkat concerned you should give code1, otherwise give code 2.


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Cameroon 1976 — source variable CM1976A_DTH1SEX — Sex (first death)
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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.

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Cameroon 1987 — source variable CM1987A_DNBRE — Number of deaths in the household

No questionnaire text is available for this sample.


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Colombia 2005 — source variable CO2005A_DIEDN — Number of persons who died
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24. How many persons who were members of this household have died in the past twelve months? (Write this in the table) (basic) _ _
If the answer is 00, continue with Control 7.


[Details on the first person who died]

Sex
[] 1 Man
[] 2 Woman


Age at time of death _ _ _

Is there a death certificate?
[] 1 Yes
[] 2 No


[There is space for 5 people.]

(If you encounter a household where there are more than five persons who have died in the past twelve months, use as many additional forms as necessary.)

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El Salvador 1992 — source variable SV1992A_MORTNUM — Number of mortality records
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IV. Mortality and migration
[Section IV was asked of occupied private households, per question 3 and Section 1.]


1. Mortality
1. Did any member of this household die during the last year or this year?
(Do not forget to ask about children and elderly persons)

[] 1 Yes - give details in table below
[] 2 No - skip to migration
[] 3 Unknown - skip to migration

Person number ____
Name and surnames ____
Date of death:
Day ____
Month____
Year ____

Sex
[] 1 Male
[] 2 Female

____ Age at death (put "00" for those younger than 1 and "98" for those 98 or older)

Questionnaire instructions view entire document:  text  image

14. Garbage disposal
How is the garbage disposed of?
Municipal service:
This option will be marked when the occupants of the household place the garbage in front of their house or in a municipal drop off point so that garbage collectors managed by the city or township of the area can move it to an incinerator or other destination for its elimination.

Private service:
When the residents of the community pay a person or business to remove garbage from their houses and transport it to places outside of the community.

Incineration:
The occupants of the household burn the garbage.

Buried:
The occupants of the household bury the garbage.

Thrown anywhere:
The occupants of the household, either personally or via other people, throw the garbage in waste land, the street, rivers, streams, their own property, etc. This category includes those who throw garbage in unauthorized places, even though later municipal sanitation trucks will pick it up.

If one household uses more than one method of those mentioned to dispose of their trash, the informant will be asked which method they use the most.


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El Salvador 2007 — source variable SV2007A_DEATHTOT — Number of deaths in the last 12 months
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1. Did anyone in this household die in the past 12 months?
[] 1 Yes
How many persons? /_/_/
Write the information related to each person who died in the following box.

[] 2 No (go to question 2)
Questionnaire instructions view entire document:  text  image

Question 1: Has anyone in the household died within the last 12 months?
Take into account people of all ages in this question.

If the person being interviewed answers in the affirmative, ask and then write down how many persons died and how old they were when they died. Remember to write "00" (zero) for children younger than 1 year and "98" for those who died at age 98 or older. Also, indicate if it was a male or a female by circling one ("1") or two ("2") as appropriate.

If the person was a female between the ages of 12 and 49, circle the number corresponding to the cause of death: pregnancy; birth; within 40 days of giving birth; or other.

If the person who died was a male go to question 2 in this section.


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Ethiopia 1984 — source variable ET1984A_DTHSX1 — Sex of first household death (in the past 12 months)
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41. Particulars of deaths in the households in the last 12 months.

1. Name of deceased
Sex _
Age _ _
2. Name of deceased
Sex _
Age _ _
3. Name of deceased
Sex _
Age _ _
4. Name of deceased
Sex _
Age _ _
5. Name of deceased
Sex _
Age _ _
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Column 41: Household Members Dead in the Last 12 Months

The household will be asked if there has been a regular member of the household who has died in the last 12 months. If there is any, then full name of the deceased by age and gender will be recorded in card columns 67 to 90. With regard to gender, "1" will be entered for male and "2" for female deceased members of the household. Also age of the deceased at the time of death will be entered in full years in the appropriate card columns.

This column is designed to accommodate data for up to five deceased household members. If the number of deceased household members exceeds five, then the additional data on death must be recorded in the blank space at the bottom.


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Ethiopia 1984 — source variable ET1984A_DTHSX2 — Sex of second household death (in the past 12 months)
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41. Particulars of deaths in the households in the last 12 months.

1. Name of deceased
Sex _
Age _ _
2. Name of deceased
Sex _
Age _ _
3. Name of deceased
Sex _
Age _ _
4. Name of deceased
Sex _
Age _ _
5. Name of deceased
Sex _
Age _ _
Questionnaire instructions view entire document:  text  image
Column 41: Household Members Dead in the Last 12 Months

The household will be asked if there has been a regular member of the household who has died in the last 12 months. If there is any, then full name of the deceased by age and gender will be recorded in card columns 67 to 90. With regard to gender, "1" will be entered for male and "2" for female deceased members of the household. Also age of the deceased at the time of death will be entered in full years in the appropriate card columns.

This column is designed to accommodate data for up to five deceased household members. If the number of deceased household members exceeds five, then the additional data on death must be recorded in the blank space at the bottom.


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Ethiopia 1984 — source variable ET1984A_DTHSX3 — Sex of third household death (in the past 12 months)
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41. Particulars of deaths in the households in the last 12 months.

1. Name of deceased
Sex _
Age _ _
2. Name of deceased
Sex _
Age _ _
3. Name of deceased
Sex _
Age _ _
4. Name of deceased
Sex _
Age _ _
5. Name of deceased
Sex _
Age _ _
Questionnaire instructions view entire document:  text  image
Column 41: Household Members Dead in the Last 12 Months

The household will be asked if there has been a regular member of the household who has died in the last 12 months. If there is any, then full name of the deceased by age and gender will be recorded in card columns 67 to 90. With regard to gender, "1" will be entered for male and "2" for female deceased members of the household. Also age of the deceased at the time of death will be entered in full years in the appropriate card columns.

This column is designed to accommodate data for up to five deceased household members. If the number of deceased household members exceeds five, then the additional data on death must be recorded in the blank space at the bottom.


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Ethiopia 1984 — source variable ET1984A_DTHSX4 — Sex of fourth household death (in the past 12 months)
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41. Particulars of deaths in the households in the last 12 months.

1. Name of deceased
Sex _
Age _ _
2. Name of deceased
Sex _
Age _ _
3. Name of deceased
Sex _
Age _ _
4. Name of deceased
Sex _
Age _ _
5. Name of deceased
Sex _
Age _ _
Questionnaire instructions view entire document:  text  image
Column 41: Household Members Dead in the Last 12 Months

The household will be asked if there has been a regular member of the household who has died in the last 12 months. If there is any, then full name of the deceased by age and gender will be recorded in card columns 67 to 90. With regard to gender, "1" will be entered for male and "2" for female deceased members of the household. Also age of the deceased at the time of death will be entered in full years in the appropriate card columns.

This column is designed to accommodate data for up to five deceased household members. If the number of deceased household members exceeds five, then the additional data on death must be recorded in the blank space at the bottom.


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Ethiopia 1984 — source variable ET1984A_DTHSX5 — Sex of fifth household death (in the past 12 months)
Questionnaire form view entire document:  text  image
41. Particulars of deaths in the households in the last 12 months.

1. Name of deceased
Sex _
Age _ _
2. Name of deceased
Sex _
Age _ _
3. Name of deceased
Sex _
Age _ _
4. Name of deceased
Sex _
Age _ _
5. Name of deceased
Sex _
Age _ _
Questionnaire instructions view entire document:  text  image
Column 41: Household Members Dead in the Last 12 Months

The household will be asked if there has been a regular member of the household who has died in the last 12 months. If there is any, then full name of the deceased by age and gender will be recorded in card columns 67 to 90. With regard to gender, "1" will be entered for male and "2" for female deceased members of the household. Also age of the deceased at the time of death will be entered in full years in the appropriate card columns.

This column is designed to accommodate data for up to five deceased household members. If the number of deceased household members exceeds five, then the additional data on death must be recorded in the blank space at the bottom.


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Ethiopia 2007 — source variable ET2007A_MORTHH — Deceased in the household (last 12 months)
Questionnaire form view entire document:  text  image
Section 4: Deaths in the household during the last 12 months

1. Did a death occur in the household since 29 May 2006?

If yes, record number of deaths in the box on the right and further details below.
If no, record "0" and go to Section 5 (Housing).
_
Questionnaire instructions view entire document:  text  image
Section 4:- About a death occur in the household during the last 12 months.

The information to be collected under this section is about the mortality experience of a given household during the last 12 months, prior to date of enumeration. Hence the question to be asked should refer to the mortality condition at the household rather than individual level. Therefore, enumerators should bear in mind while collecting the required information. The question to be asked must be phrased as, is there any member who died during the last 12 months in your household?

The question is designed to get raw data about number of death occurrences in the household age wise for the countries like Ethiopia which don't have a vital statistics (birth, death, marriage and divorce etc...).

Question 1:- Did a death occur in the household during the last 12 months (i.e. from May 29, 2006 to May 28, 2007)

If there were deaths occurred in the household during the last 12 month, fill the number of death occurrences on the space provided but if there is no death the enumerator should assign and shade code "0" on the give space provided in the questionnaire.


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Guinea 2014 — source variable GN2014A_DEATHS — Number of household member death in the last 12 months
Questionnaire form view entire document:  text  image
IV- Deaths occurring within the household during the last 12 months

D00: has one or more members of your household died during the last 12 months?

If yes, ask how many and enter the number of persons deceased in the space to the right and fill out the table below.

If no, enter 0 and go to section V (departures since January 2007).

If you have more than five deaths to record, use an additional household questionnaire.
[] Yes [Go to D01]
[The number of persons deceased] _
[] 0 No

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Haiti 1982 — source variable HT1982A_MORTNUM — Number of mortality records for the household

No questionnaire text is available for this sample.


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Haiti 2003 — source variable HT2003A_NHHDEATH — Number of deaths in the household during the past 12 months
Questionnaire form view entire document:  text  image
23. Were there any deaths in the household between __________, 2001 and ______________, 2002?

[] 1 Yes (if yes, how many?____)
[] 2 No (go to module 1)

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Honduras 2001 — source variable HN2001A_DTHN — Total of deceased last year
Questionnaire form view entire document:  text  image
Section E. International migration and mortality

Mortality

4. For the persons who died between January 1 and December 31, 2000, give the following information:

Order number ____
Name ____
2. Sex
[] 1 Male
[] 2 Female
3. Date of death
Day _ _
Month _ _
4. Age at death _ _ _
Questionnaire instructions view entire document:  text  image
Mortality

Question 3: Include newborns and the elderly. Has any person who belonged this household died between January 1 and December 31, 2000?
Ask the question making emphasis that the period in question covers from January 1 to December 31, 2000. You should include the persons who having their habitual residence in this dwelling died in another place (hospital, health centers, etc.).

Mark the corresponding box. If the answer is 'no', continue with section F.


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Indonesia 1985 — source variable ID1985A_DEATHS — Total number of deaths last year
Questionnaire form view entire document:  text  image
II. Recapitulation
Q.1. Number of household members ____
Q.2. Number of household members age 5 or older ____
Q.3. Number of household members age 10 or older ____
Q.4. Number of births (Code 1 at Q.9 and Q.20 Block X) _____
Q.5. Number of infant mortalities (Code 2 at Q.11 and Q.22 Block X) ____
Q.6. Total number of mortalities (from block XII B) _____
Questionnaire instructions view entire document:  text  image

Point 10: Serial number of the selected household

b. Block II: Summary
These items should be filled in after the interview using Form S is complete.

Point 1: Total number of household members
This should be the same as the last serial number used to record a member of the household in column (1), block IV of form S.

Point 2: Total number of household members age 5 or older
Count the number of household members in column (5), block IV of form S age 5 or older]

[pg. 39]

[Point 3:] Count the number of household members in column (5) Block IV age 10 or older

Point 4: Total number of births
Sum all the births to members of the household who were recorded as code "1" for Q.9 and Q.20 in block X.

Point 5: Record the number of dead babies who were born after 30 June, 1984. Fill in the sum of all baby deaths experienced in the household, that is, by summing the number of 2s in Q.11 and Q.22 Block X, for which Q.9 and Q.20 have code 1.

Point 6: Total number of deaths
Fill in the total number of deaths from 30 June, 1984 up to the date of the enumeration; this is the total number of members of the household who died as recorded in Q.1 block XII.B.


C. Block XII. B: Deaths after 30 June 1984
All deaths that occurred after 30 June, 1984 (Idul Fitri) up to the day of the enumeration are recorded in this block. Note that deaths are not limited to just deaths of babies and children, but include deaths of adults as well.


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Indonesia 2010 — source variable ID2010A_DEATHTOT — Total deaths in household
Questionnaire form view entire document:  text  image

301. Have there been any deaths in this household since 1 January 2009?
[] 1 Yes, how many?

[] 1 person
[] 2 persons
[] More than 3 persons (use additional SP2010-C1 questionnaire)

[] 2 No

Questionnaire instructions view entire document:  text  image

Question 301: Deaths since 1 January 2009
Interview procedure regarding deaths:
1. Before beginning to ask the questions, begin with a brief statement, for example: "Now I will ask you about deaths that have occurred in this household during the last year and a half. Please call to mind whether or not there were any deaths among any members of this household during the last year and a half, that is, since 1 January 2009 until now.
2. If someone has died since 1 January 2009, ask: "How many have died and what are their names?" Then put a mark in Q301 for the answer "Yes", and write the number of deaths. Record the name of each person who died in Q302, with one name per Column, following the order given by the respondent. After the respondent mentions one name, ask: "Are there more?"
Continue in this manner so that the names of those who died during this period will be complete before going on to another question regarding each of these deaths. Calculate the number of names recorded and make sure that number agrees with the number recorded for the answer to Q301 about the number of deaths.
For example, the respondent mentions 2 names, that is, Amir and Badu, then record Amir in the first column of Q302 and Badu in the second column. In Q301 mark the answer 2 people.
3. Continue to ask about every death; begin with the name recorded in the first column and ask

Q303 Q305. Example:

Q303: "Now I will ask several questions about each person who died or about the late [Amir, for example). What was the sex of (Amir)?"
Q304": "What month and year did (Amir) die?"
Q305: "How old was (Amir) when he died?"

[p. 146]
4. Put a mark in the oval for Q306 according to the answers given for Q303 and Q305. If any of those who died were "female" and "10 years of age or older", mark code 1; for any other answer mark code 2.
5. If Q306 has a code 1 ask Q307. Then if Q307 has a code 1, directly fill in Q308.
6. Continue to the next death if there is one; if there aren't any more, then continue to Block IV.

When asking Q303 Q308 the enumerator may not move to the right to record answers or ask one question about the first person who died, then the second person who died, and so on, but must ask all questions about the first person who died and then ask all of the questions about the second person who died and so on.
Deaths recorded do not include babies who were stillborn (those who died in the uterus before being born, that is died without any sign of life such as crying, having a pulse, reflexes, movement and pale skin tone, at 22 weeks or more).
If the total number of deaths since 1 January 2009 is more than 3 persons, enter this in the box provided and to enter the information about the deaths of persons 4 and so on, use a new set of form C1. For example, if the total number of deaths is 5 persons, the method of recording this is:
1. Put a mark in Q301 for the answer "Yes" and enter the number "5"in the box on the main set of Form C1 and enter 2 on the additional set of form C1.
2. Write 3 names on the main set of Form C1 and 2 names on the additional set of Form C1.
3. Follow the instructions for entering the total number of sets on the cover page.
4. On the second set (the additional set) fill in the complete identification information.


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Jamaica 2001 — source variable JM2001A_DEATHS — Number of persons who died
Questionnaire form view entire document:  text  image

5.4 Please give me the number of persons who died during the last 12 months and the sex and age of each.

If not stated, record 99.


Number of persons _ _

Questionnaire instructions view entire document:  text  image

5.38 Questions: Number of deaths
If the individual's response is "Yes" at Q5.3, write the number of deaths at Q5.4, check the sex, and record the age of each person who died at Q5.5. For babies younger than one year, record "00", and for persons 98 years and over check "98". Score "99" for all cases where a response for number of persons and age is not reported.


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Kenya 2009 — source variable KE2009A_DTHYRHH — Number of deaths last 12 months
Questionnaire form view entire document:  text  image

H-11. How many deaths occurred in this household between 24/08/2008 and 24/08/2009 (last 12 months)? _ _
If '0' skip to H-17.

Questionnaire instructions view entire document:  text  image

- Section H: Recent deaths in the household. This section covers columns H11 to H16. The questions in this section should be posed to the head of the household or any other responsible member of the household.

37. Section H: Recent deaths in the household

37.1 Introduction

- Purpose of the section: This section seeks to capture information on recent deaths in the household. The duration being considered is the last 12 months prior to the census reference night or the period between 24/8/2008 and 24/8/2009. The information collected will be crucial in the direct determination of current mortality levels in the country. Much of the section is devoted to questions relating to maternal deaths at household level. This is a key indicator in a nation's development status and has been emphasized by the UN, as one of the Millennium Development Goals (MDGs) i.e. on improvement of maternal health.
- Respondent: The questions in this section (H11?H16) should be answered by the household head or any other responsible household member. If the answer to question H11 is 00, then move to the next section (i.e. information regarding livestock). Deaths will only be captured in the households where they occurred i.e. if a death occurred to somebody visiting a different household that death should be captured in the household that was being visited. If death occurred to somebody who was transferred directly from another district to a health facility in another district, that death should be captured in the household in the district of residence.
Note: Some respondents may avoid mentioning children who died at very young ages or during birth. Cases of still births should not be captured. In this case, a child who shows any of the following signs, soon after birth, is considered a "live" birth:? cries, moves spontaneously or shows any sign of life. However, a birth that shows none of the above signs is called a 'still birth' and should be excluded in this section. A live birth that dies soon after birth or within 12 months prior to the census interview should be included.

37.2 Column H11: Death of HH member

Ask the respondent: "How many deaths occurred in this household between 24/8/2008 and 24/8/2009?" If there are deaths record the number, if none record "0"and skip to Section I.


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Lesotho 1996 — source variable LS1996A_NMORT — Number of mortality records
Questionnaire form view entire document:  text  image
Section G. Deaths of household members during past 12 months (Since April 1995)

49. Did death occur in the household in the last 12 months?

[] 1 Yes
[] 2 No
Questionnaire instructions view entire document:  text  image
7. Part G of the questionnaire

152. Column 49: Deaths to household members during the last 12 months.
Make sure that the deceased was a member of the household at the time of his/her death, and make sure that the deceased died in April 1995 or after. List the name(s) of the deceased, sex and age at death. If the deceased is a woman aged 12-49 years, ask if she died while pregnant, giving birth or one month after giving birth.


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Lesotho 2006 — source variable LS2006A_NMORT — Number of deaths (last 12 months)
Questionnaire form view entire document:  text  image
Section I. Deaths of household members during past 12 months (Since April 2005)

67. Did death occur in the household since April 2005?

[] 1 Yes
[] 2 No [If no, go to next household.]
Questionnaire instructions view entire document:  text  image
Part I of the questionnaire
Deaths of the Household Members during the Past 12 Months, Since April 2005

136. State the name, sex, age, and cause of death of all the members of the household that died in the past 12 months, that is since April 2005


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Liberia 2008 — source variable LR2008A_DEATHN — Number of deaths in the household in the past 12 months
Questionnaire form view entire document:  text  image
Section 5: Deaths in the household

D1. How many deaths occurred in this household in the last 12 months (1 April 2007 -- March 2008)

_

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Malawi 1998 — source variable MW1998A_DEATHS — Total deaths in last year
Questionnaire form view entire document:  text  image

Part C: Household information


C3. Total deaths (if no deaths, enter "00") _ _

Questionnaire instructions view entire document:  text  image

Part C: Household Information


All deaths occurred in the household from September, 1997 to date:
a.) You should obtain information of all deaths that occurred in the household from September, 1997 to date. Make sure you include deaths of persons of all ages that occurred in the household during the period from September, 1997 to the date of your visit.
For example, if your interview is on 15 September, 1998 you should ask for the total number of deaths that occurred in the household during the period 16 September, 1997 and the date of your interview; that is, 15 September, 1998.
In the case of a need for probing, you should proceed month by month in the backward direction, and enquire whether there was any death of a person related or unrelated who lived in any dwelling unit belonging to the household during the period specified above.
For recording, you should include the following categories of deaths:

i.) Death of household members occurring in dwelling units belonging to the household.
ii.) Deaths of household members occurring in the hospital/clinic, or on the way to hospital/clinic, or as a result of an accident. Make sure that the deceased lived in a dwelling unit belonging to the household immediately prior to his death.

Note:
i.) Death of prisoners, student residents in institutions, etc., should be taken as if such deaths occurred in the household where the deceased would have otherwise been members.
ii.) Death of members of other households that were brought to this household for burial should be excluded from the present household. These deaths should be included in the households where the deceased lived.
iii.) This part of the questionnaire should not be completed for institutions.


C3. Total deaths: Enter the total number of deaths in the household from September, 1977 to date. If no deaths occurred in the household, enter "00" in the two boxes in column C3. Do not leave these boxes blank.


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Malawi 2008 — source variable MW2008A_NMORT — Number of deaths in last year
Questionnaire form view entire document:  text  image

M2. Specify the sex and age of the deceased
Death no. ____

Questionnaire instructions view entire document:  text  image

Deaths in the household in the last 12 months
Regarding the number of people who died in the household in the last 12 months. Do not forget children (younger than one year old, July 2007 to June 2008).

You should be very careful on how to phrase the question. Example: "Is there any usual member of the household who died during the last 12 months, i.e. since July 2007?"

M1. Deaths that occurred in the household
If there are deaths that occurred within the last 12 months (since July 2007), shade 1 for "Yes" and proceed to ask question M2. If there are no deaths, skip to section MM.

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Mali 1987 — source variable ML1987A_MORTN — Number of mortality records
Questionnaire form view entire document:  text  image

Deaths in past 12 months
Sequential number
_ _

First name and last name ____

Sex
____

Age at death
_ _ _

Questionnaire instructions view entire document:  text  image

1-3 PART C OF THE HOUSING FORM: Births and Deaths

This section is devoted to events of the previous 12 months. It is related to births and all deaths in the household over the course of the 12 months preceding the date of the census.

These events should be recorded very faithfully and exactly to avoid omissions which could negatively affect the quality of the data. In addition, the accuracy of the results obtained is dependent upon rigorously respecting the period of the 12 months which are used as a period of reference. The date of the enumerator's visit to the household will be a point of reference in determining this period.

Thus, since the date of the enumerator's visit to the household is April 6, 1987, only those events having taken place between April 6, 1986 and that date will be recorded.

A birth or a death which took place before April 6, 1986 will not be recorded. To help in this, a seasonal calendar has been created to help illiterate people better situate the period of the 12 months preceding the census. This seasonal calendar establishes the correspondence between the dates on the French calendar and those of the Muslim calendar with those of the names of the month in Bambara. The National Council, which took place the 29, 30 and 31 of March, 1986, can be a useful reference point to help situate those events in time.

General Principal in Recording Births and Deaths
When you are ready to record these events, proceed as follows: write the date of your visit to the household on a piece of scratch paper. Let's imagine that the date is April 6, 1987. In that case, only record events which took place between April 6 1986 and that date.

For illiterate heads of household, look for the date corresponding to April 6, 1986 on the seasonal calendar in the annex to determine the reference period.


1.3.2 Table 2: Deaths during the past 12 months
This table relates to all deaths occurring in the household in the past 12 months: children, adults and old people.

The deaths will also be recorded according to the general principal indicated above. Proceed as follows: write the date of your visit to the household on a piece of scratch paper.

For example: April 6, 1987. Then ask the head of household the following question: "Have there been any deaths in the household since April 6, 1986?" For illiterate heads of household this will be the lunar month corresponding to the month of April 1986 on the Muslim calendar (annex).

- If the answer to the question is NO, cross out table 2.
- If the answer to the question is YES, fill out table 2. But before you fill out the table, first make sure that the deaths did indeed occur during the 12-month period preceding your visit to the household. Then fill out table 2 according to the order of the columns.


1. Rank
Give a rank of 1, 2, etc. to each death and write it in this column.

2. First name and last name
Write the first and last names of the deceased.

3. Sex
Write M for masculine and F for feminine.

4. Age at death
Ask the head of household the age of the person when he/she died. For persons aged more than one year, write the age in completed years. For children aged less than one year, write the age in completed months.

Comments: Record the death of those children who died before the age of one very carefully. These children should be included on the table of births. Don't forget to ask the question about deaths in all households, even if no [deaths] were reported in the last several households questioned.

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Mali 1998 — source variable ML1998A_MORTN — Number of mortality records
Questionnaire form view entire document:  text  image

Deaths in past 12 months
Sequential number
_ _


First name and last name ____

Sex
[] 1 Male
[] 2 Female


Age at death
_ _

Questionnaire instructions view entire document:  text  image
1.3. Event of the past 12 months -- Births and Deaths

This section is devoted to the [demographic] events that occurred in the past 12 months. That is, the births and the deaths that occurred in this household during the 12 months prior to the visit of the census enumerator.

These events must be registered faithfully, and with great accuracy, in order to avoid omissions that could affect the quality of the data. In addition, the accuracy of the results that will be obtained will be a function of the rigorous consideration of the recall period of 12 months, taken as the reference period. The census enumerator date of visit in the household is the milestone for determining this period.

For instance, if the date of visit of the census enumerator in the household is April 6, 1998, only the events between April 6, 1997 and this date shall be registered. A birth or a death that occurred prior to April 6, 1997 will not be registered.

One could use as a landmark the month of the previous Muslim festival [Tabaski], which occurred on April 18, 1997, or the date of the first round of parliament elections of April 13, 1997, which has been cancelled, to specify the previous 12 months period.

A seasonal calendar was elaborated (see Annex), to help the illiterate persons to better define this 12 months period prior to the census date. This seasonal calendar provides correspondences between the dates on the Gregorian calendar and the Muslim calendar with the lunar months translated into Bambara.


1.3.2. Deaths during the past 12 months

This summary table deals with all deaths that occurred in the household during the past 12 months (children, adults, elderly persons).

The deaths will be also registered according to the general principle mentioned above.

The census enumerator will proceed as follows:

- Write down on a spare sheet your date of visit in the household. Example: April 6, 1998.

Then ask to the household head: "Has there been any death in this household over the past 12 months, that is, since April 6, 1997?"

For an illiterate household head, this will be the lunar month in the Muslim calendar corresponding to April 1997 (see Annex).

Circle the number corresponding to the answer given, in the following way:

[] 1 Yes
[] 2 No


a. If the answer to the question asked is "no", circle number 2, and cross-out the summary table of the deaths in the last 12 months.

b. If the answer to the question is "yes", circle number 1, and fill in the summary table on deaths that occurred during the past 12 months.

However, before filling in this table, check one more time that the death well occurred during the reference period, that is during the 12 months prior to your visit in the household.

Filling in the summary table is done Column by Column.

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Mali 2009 — source variable ML2009A_NDEATHS — Number of persons deceased

No questionnaire text is available for this sample.


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Mozambique 2007 — source variable MZ2007A_MORTNUM — Number of mortality records
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)

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Nepal 2001 — source variable NP2001A_MORTN — Number of people who died
Questionnaire form view entire document:  text  image

6. During the last 12 months was there any deaths occurred in this HH?
[] 1 Yes
[] 2 No (go to Individual Information)


7. If yes, give the description of deceased persons.
[Question 7 was asked of households that had deaths in the household during the last 12 months, per question 6.]

Sex

[] 1 Male
[] 2 Female


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Nepal 2011 — source variable NP2011A_DEATHS — Number of deaths in the household in the last 12 months
Questionnaire form view entire document:  text  image
Household Information

[11] Were there any deaths occurred during the last 12 months in your household?

[] 1 Yes
Number: ____
[] 2 No [If no, go to number 13]
Questionnaire instructions view entire document:  text  image
Household information

Question 11: Was there any death of members in the family in last 12 months?

[] 1 Yes
[] 2 No [go to question 13]

As the family that whether there was death (by any reason) of any family members in the past 365 days from the date of enumeration. If "Yes", then circle the reference 1 "Yes" and specify the total number of death. Then go the question number 12, and ask the details of the dead persons. If there was not death of family members, circle the reference 2 "No" and jump to the question number 13, without asking question number 12.

- Such death of family members could be in home or hospital or in other places and due to disease, illness, accident, disaster or other reason.

- If any newborn dies after a short or very short period of their birth, such case should be considered as a death of family members and necessary information should be taken of that child.

- Similarly, women of fertility age, pregnant, or new mothers could die due to different reason - such as unable to deliver, without proper care during the new mother period, or tetanus after the birth of a child, or other pregnancy reason while the child is inside the womb. But, if there is a stillbirth, then in such situation no information should be taken about the death of such child.

If there is death of family members of any age in the last one year, circle the reference 1 "yes" and go to the question 12. Ask the number of deaths in the family and write the information separately of all the dead persons.


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Nicaragua 2005 — source variable NI2005A_DEATH — Death of household member (since January 1st 2004)
Questionnaire form view entire document:  text  image

1. From January 1, 2004 until now, did any member of this household die? Do not forget to note the deaths of any newborns or elderly persons.
[] 1 Yes

How many? _ _

56[] 2 No (continue to section VI-A)

Questionnaire instructions view entire document:  text  image

Question 1. From January 1, 2004 until now, did any member of this household die?

Remember to write the deaths of newborns and the elderly.

Mark an "X" next to the option stated by the informant.

If the answer is "Yes", ask "How many?" Write the number and continue the interview.

If the answer is "No", go to section VI-A, "List of persons who make up the household".

You must respect the reference period defined in the question;

It doesn't matter if the death occurred in the dwelling, in a hospital or any other place, including another municipality or country.

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Nicaragua 2005 — source variable NI2005A_NDEATH — Number of deaths (since January 1st 2004)
Questionnaire form view entire document:  text  image

1. From January 1, 2004 until now, did any member of this household die? Do not forget to note the deaths of any newborns or elderly persons.
[] 1 Yes

How many? _ _

56[] 2 No (continue to section VI-A)

Questionnaire instructions view entire document:  text  image

Question 1. From January 1, 2004 until now, did any member of this household die?

Remember to write the deaths of newborns and the elderly.

Mark an "X" next to the option stated by the informant.

If the answer is "Yes", ask "How many?" Write the number and continue the interview.

If the answer is "No", go to section VI-A, "List of persons who make up the household".

You must respect the reference period defined in the question;

It doesn't matter if the death occurred in the dwelling, in a hospital or any other place, including another municipality or country.

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Panama 2000 — source variable PA2000A_DH — Death of any member
Questionnaire form view entire document:  text  image

21. Between May 15, 1999 and today, has any member of this household died?
[] 1 Yes

[Under "yes" an arrow points to a table with spaces to fill in the following information for up to four individuals]
____ 1. Name of the person
_ _ 2. Age at death
3. Sex (male or female)
[] 1 Male
[] 2 Female

[] 2 No (Go on to the List of Occupants, Section IV)

Questionnaire instructions view entire document:  text  image

Question No. 21: Between May 15, 1999 and today, has any member of this household died?

This question has the purpose of knowing the general current mortality of the whole population, from the period of May 15, 1999 to the census date, that is to say, the mortality in the last twelve months.

[To the right of the text is a picture of three crosses.]

If the marked response is yes, write down the name, age and sex of the deceased person. Write down the age in completed years of the person on the last birthday.
Remember that this question is concerning the members of this home and not of the family.
If a person declares that the deceased person was 98 or older write down 98. Only completed years are considered; the minors of one year are registered as 00 years.
If the answer is " no" continue to Section IV. List of Occupants.

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Panama 2000 — source variable PA2000A_DHAGE2 — Age of the second deceased member at death
Questionnaire form view entire document:  text  image

21. Between May 15, 1999 and today, has any member of this household died?
[] 1 Yes

[Under "yes" an arrow points to a table with spaces to fill in the following information for up to four individuals]
____ 1. Name of the person
_ _ 2. Age at death
3. Sex (male or female)
[] 1 Male
[] 2 Female

[] 2 No (Go on to the List of Occupants, Section IV)

Questionnaire instructions view entire document:  text  image

Question No. 21: Between May 15, 1999 and today, has any member of this household died?

This question has the purpose of knowing the general current mortality of the whole population, from the period of May 15, 1999 to the census date, that is to say, the mortality in the last twelve months.

[To the right of the text is a picture of three crosses.]

If the marked response is yes, write down the name, age and sex of the deceased person. Write down the age in completed years of the person on the last birthday.
Remember that this question is concerning the members of this home and not of the family.
If a person declares that the deceased person was 98 or older write down 98. Only completed years are considered; the minors of one year are registered as 00 years.
If the answer is " no" continue to Section IV. List of Occupants.

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Rwanda 2002 — source variable RW2002A_DEAD12N — Total number of deaths in past 12 months
Questionnaire form view entire document:  text  image
IV. Deaths in past 12 months
[Questions D1-D4.]

These questions are to be asked to the head of household, or to his/her representative.


[Questions D1-D4 were asked only if there was a death in the household in the last 12 months]


D1. ____ Names

Write down the last names and the first names of all deceased persons during the past 12 months.


D2. Sex
Circle the number corresponding to the sex of the deceased person.

[] 1. Male
[] 2. Female


D3. _ _/ 200_ Date of death (month and year)
Specify in the first two boxes the month of the death, and in the last box the year of the death.


D4. _ _ _ Age at death
Write down in the empty boxes the age of the deceased person at time of his/her death.

Questionnaire instructions view entire document:  text  image

7.3.1.5: How to fill-in section 5: deaths over the past 12 months (D0-D5)

In this section, the census enumerator will be careful and discrete for obvious reasons. He will ask the head of household or his representative, in full privacy, whether there were deaths which occurred in the household over the past 12 months.
If there was no death, the interview for this topic stops here.
If there were deaths, the census enumerator will write them down in order, and will ask their sex, day, month of death, or their age at death. For each person who died, he/she will ask: the name, the sex, the date of death (month and year) and the age at death.

Remark:
The census enumerator must comply with the instructions written on the census questionnaire.

[p.52]

The issue concerning the 12-months time period, where it begins and where it ends, will require a lot of attention.

The census enumerator will do his/her best so that months included in the 12 months period are well understood by the interviewed person.
Sometimes, it will be necessary to count them one by one. He will do with the same expertise as that used for filling questions P27 to P30.

The space made to write down the month has two boxes that the census enumerator has to fill in.

The space made to write down the year has four boxes, of which three are already filled in, and are in grey ; the census enumerator is asked to fill in only the remaining box with numbers 1 or 2 (2001 or 2002).

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Senegal 2002 — source variable SN2002A_MORTN — Number of mortality records
Questionnaire instructions view entire document:  text  image

4.3 Section C: Deaths that Occurred in the Household in the past 12 Months

This section has for reference the letter "C", followed by an index (2-digits). You have to record the deaths that occurred in the household in the past 12 months.

Ask whether "During the last twelve months, did any death occur in the household?"

If the answer is "No", write an oblique hyphen, and go to the questions on out-migration (Section D).

If the answer is "Yes", record the death or the deaths that occurred in the household, in the following way:


C01. Sequential number

In the questionnaire, a maximum of 6 deaths were anticipated, numbered from 1 to 6. If there were more than 6 deaths in the household, use a second household questionnaire to register the other deaths.

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Sierra Leone 2004 — source variable SL2004A_NMORT — Number of deaths in last 12 months
Questionnaire form view entire document:  text  image
D1. Did a death occur in this household in the last 12 months?

[] 1 Yes (answer questions D2, D3, D4 and D5)
[] 2 No
[] 3 Don't know
Questionnaire instructions view entire document:  text  image
Section 5 -- Deaths in the household

189. Questions D1 to D5 are asking about deaths of a usual member of the household, which took place in the 12 months prior to the Census night, i.e. those that occurred after 4th December, 2003. This is irrespective of whether the person died in that household, in another household or in a health institution. Include children who died when they were very young but exclude stillbirths.

D1 - Occurrence of death in the last 12 months
190. Ask: "Did a usual household member die in the last 12 months?" Record the appropriate code in the box provided. If a death occurred in the household, record "1" in the box, and then ask [questions] D2, D3, D4 and D5.

[p.25]

191. If nobody died in the household, record "2", end the interview and check your work properly, particularly to ensure that all questions have been asked and answers recorded.

192. If the answer is "Don't know", record "3", end the interview and check your work properly, particularly to ensure that all questions have been asked and answers recorded.

193. It is important that you know that the question you are asking the person is very sensitive. You should know how to handle the person who has lost somebody by sympathizing with him or her and at the same time informing him or her that the information you are collecting is necessary for the census.

D2 -- Name of deceased
194. Ask for and record the names of the deceased persons in the space provided.

195. In cases where babies die before they are given a name, record as "Baby boy" or "Baby girl".


Section 5: Deaths in the household

D1 Did a death occur in this household in the last 12 months?

[] 1 Yes answer questions D2, D3, D4, and D5)
[] 2 No
[] 3 Don't know


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South Africa 2007 — source variable ZA2007A_DEADN — Number of deaths
Questionnaire form view entire document:  text  image

Section I: Mortality in the last 12 months - (between February 2006 and March 2007)


M-00 Has any member of this household passed away in the last 12 months between February 2006 and March 2007?

Mark appropriate box with an X
If no, the questionnaire is completed. Thank the respondent(s).
[] Yes
[] No


M-01 How many members passed away?

_ _

Questionnaire instructions view entire document:  text  image

(M-00) Has any member of this household passed away in the last 12 months?
If "No", the questionnaire is complete. Thank the respondent(s).


(M-01): How many members passed away?
If "Yes" on M-00, write the number in the box.


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South Africa 2011 — source variable ZA2011A_NUMDEATHS — Number of deaths
Questionnaire form view entire document:  text  image
M-00 Death occurred
Has any member of this household passed away in the last 12 months (between 9 October 2010 and 9 October 2011)?
Mark the appropriate circle with an X.

1. Yes
2. No
3. Do not know
If 2 or 3, Questionnaire completed

M-00a Number of deaths
How many members of the household passed away in the last 12 months (between 9
October 2010 and 9 October 2011)?
_ _

Questionnaire instructions view entire document:  text  image
11. Section I: Mortality (remember to follow instructions)
Purpose: Provides an estimation of mortality in the country which helps in population projections.

This section must be completed for every household.

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South Africa 2016 — source variable ZA2016A_DTHNUM — Number of deaths in the past 12 months
Questionnaire form view entire document:  text  image
5. Emigration and mortality

Mortality

[5.10] How many members of this household have passed away in the last 12 months [between 07 March 2015 and 06 March 2016]? ____


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South Sudan 2008 — source variable SS2008A_NDEATHS — Number of death records

No questionnaire text is available for this sample.


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Sudan 2008 — source variable SD2008A_NDEATHS — Number of death records

No questionnaire text is available for this sample.


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Tanzania 1988 — source variable TZ1988A_DEATHS — Any deaths in household last year
Questionnaire form view entire document:  text  image

Deceased in the household during the last 12 months


21. Did any death occur in this household during the last 12 months?
If none, proceed to question number 28.

[] 1 Yes
[] 2 No


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Tanzania 1988 — source variable TZ1988A_DSEX1 — Sex of first deceased last year
Questionnaire form view entire document:  text  image

Deceased in the household during the last 12 months


21. Did any death occur in this household during the last 12 months?
If none, proceed to question number 28.

[] 1 Yes
[] 2 No


Person 1


22. Sex

[] 1 Male
[] 2 Female


23. Age of death in complete years ____
If below 1 year, enter "00".


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Tanzania 1988 — source variable TZ1988A_DSEX2 — Sex of second deceased last year
Questionnaire form view entire document:  text  image

Deceased in the household during the last 12 months


Person 2


24. Sex

[] 1 Male
[] 2 Female


25. Age of death in complete years ____
If below 1 year, enter "00".


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Tanzania 1988 — source variable TZ1988A_DSEX3 — Sex of third deceased last year
Questionnaire form view entire document:  text  image

Deceased in the household during the last 12 months


Person 3


26. Sex

[] 1 Male
[] 2 Female


27. Age of death in complete years ____
If below 1 year, enter "00".


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Tanzania 2012 — source variable TZ2012A_NDEATHS — Number of deaths in the last 12 months
Questionnaire form view entire document:  text  image
F. General and maternal deaths in the household

Please record information on deaths that occurred in the household in the last 12 months. Do not forget childhood mortality.

33. Was there any death which occurred in this household in the last 12 months?

[] 1 Yes
[] 2 No

If the answer is no, skip to section G.

Record the number of deaths _ _
Questionnaire instructions view entire document:  text  image
Questions 33 to 40 ask about death and death that resulted from child bearing in the past 12 months. These questions are asked and answered by the head of the household or another person who will respond to these questions on behalf of the household head.

Explanation/clarification of the question: All these questions aim to get death rate, causes of death, including those related to child bearing. The questions will further enable the nation understand the average age of death [life expectancy].
The answers to these questions will enable the nation understand whether there was any death within a household during the period specified.

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Togo 2010 — source variable TG2010A_DEATHS — Number of deaths in household (last 12 months)
Questionnaire form view entire document:  text  image
Deaths occurred during the last 12 months
[Columns D02 - D09 were asked of households that answered "Yes" in D01A.]

(D01B) Number of deaths

If yes, how many? _

If not, put a dash in the box above, delete the rest of the page and go to H01 (Habitation)
Questionnaire instructions view entire document:  text  image
E- Deaths occurring in last 12 months

Question D01B: Number of deaths

Pose the question: "How many deaths have there been in the household in the last 12 months?"

Record the number of deaths in the corresponding box. In this case columns D02 to
D08 are to be completed.


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Uganda 2002 — source variable UG2002A_DEADN — Number of mortality records in original data

No questionnaire text is available for this sample.


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Vietnam 1989 — source variable VN1989A_DEADPER — Dead persons in household last year
Questionnaire form view entire document:  text  image

Ask the head of household if there was any death in the household between Tet holiday and 3-31-1989?
[] Yes
[] No

Questionnaire instructions view entire document:  text  image

Question 15
In order to get correct information for question 15, interviewers should ask the head of the household this question:

"Since the Vietnamese traditional new year (Tet) of 1988 (year of dragon) and until March 31, 1989, was there any death in the household?"
[] Yes
[] No


If the household's head replies "yes", interviewers continue to ask the other sections in question 15.

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Vietnam 1989 — source variable VN1989A_SEXDEAD1 — Sex of first dead person
Questionnaire form view entire document:  text  image

15. a. Full name of dead person
____


b. Sex
[] 1 Male
[] 2 Female

Questionnaire instructions view entire document:  text  image

a) First name and last name of the dead person:
In case a newborn died before being given a name, interviewers fill out the father's (or mother's) surname followed by three dots (. . .)

b) Sex

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Vietnam 1989 — source variable VN1989A_SEXDEAD2 — Sex of second dead person
Questionnaire form view entire document:  text  image

15. a. Full name of dead person
____


b. Sex
[] 1 Male
[] 2 Female

Questionnaire instructions view entire document:  text  image

a) First name and last name of the dead person:
In case a newborn died before being given a name, interviewers fill out the father's (or mother's) surname followed by three dots (. . .)

b) Sex

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Vietnam 1989 — source variable VN1989A_SEXDEAD3 — Sex of third dead person
Questionnaire form view entire document:  text  image

15. a. Full name of dead person
____


b. Sex
[] 1 Male
[] 2 Female

Questionnaire instructions view entire document:  text  image

a) First name and last name of the dead person:
In case a newborn died before being given a name, interviewers fill out the father's (or mother's) surname followed by three dots (. . .)

b) Sex

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Vietnam 1989 — source variable VN1989A_SEXDEAD4 — Sex of third dead person
Questionnaire form view entire document:  text  image

15. a. Full name of dead person
____


b. Sex
[] 1 Male
[] 2 Female

Questionnaire instructions view entire document:  text  image

a) First name and last name of the dead person:
In case a newborn died before being given a name, interviewers fill out the father's (or mother's) surname followed by three dots (. . .)

b) Sex

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Vietnam 1999 — source variable VN1999A_DEDLINE1 — Death in household in 1998
Questionnaire instructions view entire document:  text  image

The number of people who died in the household since the 30th of Chinese new year last year (1/27/1998) until now (question 1 to 6)

This item is asked generally for the whole household. The form was designed to record up to a maximum of eight deceased members per household. In cases where a household has nine deceased members or more, the investigator has to use a second form to continue to record. If the whole household died, write "The whole household is deceased" on the cover of the form, under "Investigation Form".

In order to accurately collect the information concerning the number of household members who have died, the investigator needs to directly ask the question to the head of the household or the representative of the household: "Since the 30th of the Chinese New Year last year (on 1/27/1998 of the Gregorian calendar) until now, did anyone or any child die in the household?"

Death information of the population is usually hard to collect, especially information about deceased or stillborn children. Therefore, in order to collect this information fully and accurately, the investigator needs to ask the questions skillfully to obtain the necessary information.


Question 1: From the 30th of Chinese New Year last year until now (on 1/27/1998 of the Gregorian calendar), did anyone or any children in the household die?
If the answer is "yes" then the investigator circles "1", and asks Question 2. If the answer is "no", then the investigator needs to ask additional questions to verify the number of infants who died before circling "2". If no one in the household died in the above period, the investigator circles "2", and goes to the questions in Section II to obtain information about the house.


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Vietnam 1999 — source variable VN1999A_DEDSEX1 — Sex of deceased 1
Questionnaire form view entire document:  text  image

No. of deceased in household from Mau Dan year 30th tet day (27/1/1998) to now


About deceased in household [There are columns for up to 3 deceased persons]


3. Is (Name) male or female?

[] 1 Male
[] 2 Female

Questionnaire instructions view entire document:  text  image

The number of people who died in the household since the 30th of Chinese new year last year (1/27/1998) until now (question 1 to 6)

This item is asked generally for the whole household. The form was designed to record up to a maximum of eight deceased members per household. In cases where a household has nine deceased members or more, the investigator has to use a second form to continue to record. If the whole household died, write "The whole household is deceased" on the cover of the form, under "Investigation Form".

In order to accurately collect the information concerning the number of household members who have died, the investigator needs to directly ask the question to the head of the household or the representative of the household: "Since the 30th of the Chinese New Year last year (on 1/27/1998 of the Gregorian calendar) until now, did anyone or any child die in the household?"

Death information of the population is usually hard to collect, especially information about deceased or stillborn children. Therefore, in order to collect this information fully and accurately, the investigator needs to ask the questions skillfully to obtain the necessary information.


Question 3: Is (name) male or female?
The investigator circles "1" if the person who died is "male", and "2" if that person is "female".


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Vietnam 1999 — source variable VN1999A_DEDSEX2 — Sex of deceased 2
Questionnaire form view entire document:  text  image

No. of deceased in household from Mau Dan year 30th tet day (27/1/1998) to now


About deceased in household [There are columns for up to 3 deceased persons]


3. Is (Name) male or female?

[] 1 Male
[] 2 Female

Questionnaire instructions view entire document:  text  image

The number of people who died in the household since the 30th of Chinese new year last year (1/27/1998) until now (question 1 to 6)

This item is asked generally for the whole household. The form was designed to record up to a maximum of eight deceased members per household. In cases where a household has nine deceased members or more, the investigator has to use a second form to continue to record. If the whole household died, write "The whole household is deceased" on the cover of the form, under "Investigation Form".

In order to accurately collect the information concerning the number of household members who have died, the investigator needs to directly ask the question to the head of the household or the representative of the household: "Since the 30th of the Chinese New Year last year (on 1/27/1998 of the Gregorian calendar) until now, did anyone or any child die in the household?"

Death information of the population is usually hard to collect, especially information about deceased or stillborn children. Therefore, in order to collect this information fully and accurately, the investigator needs to ask the questions skillfully to obtain the necessary information.


Question 3: Is (name) male or female?
The investigator circles "1" if the person who died is "male", and "2" if that person is "female".


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Vietnam 1999 — source variable VN1999A_DEDSEX3 — Sex of deceased 3
Questionnaire form view entire document:  text  image

No. of deceased in household from Mau Dan year 30th tet day (27/1/1998) to now


About deceased in household [There are columns for up to 3 deceased persons]


3. Is (Name) male or female?

[] 1 Male
[] 2 Female

Questionnaire instructions view entire document:  text  image

The number of people who died in the household since the 30th of Chinese new year last year (1/27/1998) until now (question 1 to 6)

This item is asked generally for the whole household. The form was designed to record up to a maximum of eight deceased members per household. In cases where a household has nine deceased members or more, the investigator has to use a second form to continue to record. If the whole household died, write "The whole household is deceased" on the cover of the form, under "Investigation Form".

In order to accurately collect the information concerning the number of household members who have died, the investigator needs to directly ask the question to the head of the household or the representative of the household: "Since the 30th of the Chinese New Year last year (on 1/27/1998 of the Gregorian calendar) until now, did anyone or any child die in the household?"

Death information of the population is usually hard to collect, especially information about deceased or stillborn children. Therefore, in order to collect this information fully and accurately, the investigator needs to ask the questions skillfully to obtain the necessary information.


Question 3: Is (name) male or female?
The investigator circles "1" if the person who died is "male", and "2" if that person is "female".


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Zambia 1990 — source variable ZM1990A_DEATHANY — Any deaths in the last 12 months
Questionnaire form view entire document:  text  image
Mortality

M-1 Has there been any death in this household since 1989?

[] 1-Yes
[] 2-No (Go to HH-1)
Questionnaire instructions view entire document:  text  image
Chapter VII-Mortality and household characteristics mortality

1. This is a topic about deaths that occurred in the household over the last 12 months_ It is a sensitive topic to most people, so you have to prepare the respondent and take on an air of concern before you pose the question.

M - 1: Has there been any death in this household since August, 1989?
2. This is a household question and it should be posed to the main respondent. It should not be asked of institutions. We are only concerned about deaths which occurred since August, 1989 and only those that involved members of the household. Deaths of visitors or relatives who were not usually living with the household should be excluded. If the response is "Yes", enter code 1 in box 24 and ask M - 2, if "No" go to HH-1.


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Zambia 1990 — source variable ZM1990A_DEATHM — Number of male deaths in the household
Questionnaire form view entire document:  text  image
Mortality

M-1 Has there been any death in this household since 1989?

[] 1-Yes
[] 2-No (Go to HH-1)

M-2 How many died? How many of these are male and how many are male and female?

Male ____
Female ____
Questionnaire instructions view entire document:  text  image
Chapter VII-Mortality and household characteristics mortality

1. This is a topic about deaths that occurred in the household over the last 12 months_ It is a sensitive topic to most people, so you have to prepare the respondent and take on an air of concern before you pose the question.

M - 1: Has there been any death in this household since August, 1989?
2. This is a household question and it should be posed to the main respondent. It should not be asked of institutions. We are only concerned about deaths which occurred since August, 1989 and only those that involved members of the household. Deaths of visitors or relatives who were not usually living with the household should be excluded. If the response is "Yes", enter code 1 in box 24 and ask M - 2, if "No" go to HH-1.

M - 2: How many died?
3. Enter the number of the dead by sex in boxes 25 and/or 26. Enter 0 for no death of either male or female in the appropriate box.


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Zambia 1990 — source variable ZM1990A_DEATHF — Number of female deaths in the household
Questionnaire form view entire document:  text  image
Mortality

M-1 Has there been any death in this household since 1989?

[] 1-Yes
[] 2-No (Go to HH-1)

M-2 How many died? How many of these are male and how many are male and female?

Male ____
Female ____
Questionnaire instructions view entire document:  text  image
Chapter VII-Mortality and household characteristics mortality

1. This is a topic about deaths that occurred in the household over the last 12 months_ It is a sensitive topic to most people, so you have to prepare the respondent and take on an air of concern before you pose the question.

M - 1: Has there been any death in this household since August, 1989?
2. This is a household question and it should be posed to the main respondent. It should not be asked of institutions. We are only concerned about deaths which occurred since August, 1989 and only those that involved members of the household. Deaths of visitors or relatives who were not usually living with the household should be excluded. If the response is "Yes", enter code 1 in box 24 and ask M - 2, if "No" go to HH-1.

M - 2: How many died?
3. Enter the number of the dead by sex in boxes 25 and/or 26. Enter 0 for no death of either male or female in the appropriate box.


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Zambia 2010 — source variable ZM2010A_NUMMORT — Number of mortality records

No questionnaire text is available for this sample.


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Zimbabwe 2012 — source variable ZW2012A_NMORT — Number of deaths (last 12 months)
Questionnaire form view entire document:  text  image
G - Deaths in the household

34. Did any deaths occur in the household in the last twelve months?

[] 1 Yes (If yes, go to question 35)
[] 2 No
Questionnaire instructions view entire document:  text  image
Section G: Deaths in the Household
Introduce section by saying, "In this section I would like to obtain information on all deaths that have occurred in this household in the last twelve months. The deceased persons must have been usual members of this household."

[pg.40]

The data on deaths required here refers to deaths in the last twelve months of individuals who were living with the household. There is a slight shift from the de facto method to the de jure on this particular question on deaths. Members who usually lived with the household are to be captured. The deaths should not be confused with deaths in the family. Deaths that occur after the census night are not to be recorded.

NB: The 'last twelve months' refer to the period between September 2011 and August 2012.
The order of asking this question is as follows:

Q34-37 Deaths in the household in the last twelve months
First establish if there were any deaths in the household by asking "Did any deaths occur in the household in the last twelve months?" Shade the appropriate answer. If the answer is "yes" establish the number of deaths and obtain, for each death, the following details: