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)
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.