Questionnaire Text

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]


6. How old was [Name] when he/she died?

If less than 12 months, record "000"

_ _ _
[In completed years]

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 6: How old was (name) when he/she died?
Only ask Question 6 when the birth year in Question 5 cannot be verified. The investigator must ask to verify and record the complete age (excluding the additional months) of the deceased person. The investigator may not leave the line for this question blank, or write "no verification" on it. If all measures have been used, and the subject still cannot verify accurately the age of the deceased person, then estimate the age of the deceased person at the time of death and record the answer for this question (see instruction in Question 4).