Questionnaire Text

Questionnaire form view entire document:  text  image
Was this part of district rural or urban at the time of birth?

[] Rural
[] Urban
[] N/A Outside Zambia
Questionnaire instructions view entire document:  text  image
P11: Where was [the respondent] staying in August last Year?

In this question you are to ask the respondent his/her place (district) of residence 12 months ago and whether that place was an urban or a rural area. This is not over the duration of the last 12 months; rather it is about this time 12 months back, i.e in August last year.
Write the name of the district in which this person was residing 12 months ago and then shade the appropriate code in the boxes provided. This can either be the district where he/she is now residing or another district. In case the person lived outside Zambia 12 months ago, write the name of the country where he/she was residing at that time and then enter the appropriate country code. For infants born less than 12 months ago, shade 888 in the boxes. If a person is not sure of the district, then ask him/her the name of the Chief in whose area he/she was living. From this information you can find out the name of the district (see Appendix 5).
Find out if the place where the person was living 12 months ago was a rural or an urban area. Shade the appropriate space for rural and urban areas. The list of urban areas and townships is given in Appendix 4. For infants born less than 12 months ago and for those who were living outside Zambia at that time, shade the space for Not Applicable (N/A).