Att_23_Ghana_ZOI_PBS_Instrument.pdf

INSTITUTE OF STATISTICAL, SOCIAL AND ECONOMIC RESEARCH (ISSER),

UNIVERSITY OF GHANA, LEGON

MONITORING, EVALUATION AND TECHNICAL SUPPORT SERVICES (METSS),

GHANA

FEED THE FUTURE (FTF) POPULATION BASED BASELINE

SURVEY IN NORTHERN GHANA

QUESTIONNAIRE

ISSER – METSS PBS SURVEY IN NORTHERN GHANA 2012

NOTE TO ENUMERATOR: Within each Enumeration Area, your team will interview 20 households. Locate and interview the list of households assigned to you by your supervisor. If after two attempts you are unsuccessful in obtaining audience, report the case to your supervisor for the next line of action. Do not complete questions 1.08 and 1.09 until after completing Module

II. All applicable questionnaire sections should be asked of all appropriate household members. Pay attention to the skip patterns and follow Fill out the consent form on the next page. If the household agrees to continue with the survey, continue to complete the questionnaire until any respondent refuses to continue, then stop or move to another respondent/modules as appropriate.

Household Identification Code

Enumerator Code

1.02. Region:

1.13 GPS Coordinates of household

Household latitude Household longitude

1.03.District:

1.04 Community/Village

Name:

1.05. EA Number

1.06. Household Number

Visit Date

DD / MM

Interview start and end time (24HR)

1.08. Name of primary respondent (code from

roster in Module 2):

Surname, First Name:

Visit I __ ___ / ___ ___

START: HH ___MM___

END: HH ___MM___

1.09. Name of secondary respondent (code from

roster in Module 2):

Surname, First Name:

Visit II __ ___ / ___ ___

START: HH ___MM___

END: HH ___MM___

Visit III __ ___ / ___ ___

START: HH ___MM___

END: HH ___MM___

1.10. Type of household:

1.18. Name/code of supervisor:

1.11.Main religion of household (See codes below ):

1.19. Final outcome of interview (enter

code)

1.12. Main ethnic group of the household (enter

code):

Codes for questions in table above

1.02 Region Codes

1.03: Districts Codes for Northern Region 1.03: Districts Codes for Upper East Region

1.03: Districts Codes for Upper West Region

07 – Brong Ahafo 08 - Northern Region 09 - Upper East Region 10 - Upper West Region

Bole/Bamboi - 01 Bunkpurugu/Yunyoo - 02 Central Gonja - 03 Chereponi - 04 East Gonja - 05 East Mamprusi - 06 Gusheigu - 07 Karaga - 08 Kpandai - 09 Nanumba North - 10

Nanumba South - 11 Saboba - 12 Savelugu/Nanton - 13 Sawla/Tuna/Kalba - 14 Tamale Metro - 15 Tolon/Kumbungu - 16 West Gonja - 17 West Mamprusi - 18 Yendi Muni - 19 Zabzugu/Tatali - 20

Bawku Municipal - 21 Bawku West - 22 Bolgatanga Municipal - 23 Bongo - 24 Builsa - 25 Garu/Tempane - 26 Kassena Nankana - 27 Kassena Nankana West - 28 Talensi Nabdam - 29

Jirapa - 30 Lambussie Karni - 31 Lawra - 32 Nadowli - 33 Sissala East - 34 Sissala West -35 Wa East - 36 Wa Municipal - 37 Wa West - 38

1.03: Districts Codes for Brong Ahafo Region

1.10: Household Type Code

1.11: Main Religion A12: Main ethnic Group

Jaman North - 39 Kintampo North Municipal -40 Kintampo South -41 Pru -42 Sene -43 Tain -44 Wenchi Municipal -45

1 - Male and Female adult (M&F) 2 - Female adult only

(FNM)

3 - Male adult only (MNF) 4 - Child only household

(CNA)

1 - No Religion 2 - Catholic 3 - Protestant (Anglican, Lutheran, Presbyterian, Methodist etc) 4 - Pentecostal/Charismatic 5 - Other Christian 6 - Islam 7 - Traditionalist 8 - Other (specify)

Akan -01 Ga-Dangme -02 Ewe -03 Guan -04 Mole-Dagbani -05 Grusi -06 Mande -07 Gurma -08 Other -09

1.19. Final outcome of interview (enter code)

1 - Completed 2 - No household member or no competent respondent at home during all visits 3 - Entire household absent for extended period of time 4 - Refused 5 - Dwelling destroyed 6 - Dwelling not found 7 – Other (specify)________________________________

Visit 1- Module 1 Continued: Informed Consent (FTF Module B)

TO THE ENUMERATOR:

Administer the consent form to each eligible respondent.

1.24. Do you [NAME] agree to participate in the study?

Note to Enumerator: The primary respondent is ideally the person with the most decision making authority in the household.

The secondary respondent is the person of opposite sex to the primary respondent with the most decision making authority in the household. Refer to manual on details of who the secondary and primary respondent could be.

I ____________________________, the enumerator responsible for the interview taking place on __________________, 2012 certify that I have read the above statement to the participant(s) and they have consented to the interview. I pledge to conduct this interview as indicated on instructions and inform my supervisor of any problems encountered during the interview process.

1.

Respondent

Number (from HH

Listing)

2. Type of Respondent 3. Name of Respondent

4. Status of Participation

5. Signature Mark 6. Cell Phone Number 1 - Yes (Participate) 2 - No>>End Survey

Primary Respondent

Secondary Respondent

Other Respondent 1

Other Respondent 2

Other Respondent 3

Visit 1- Module 2: Household Demographics (FTF Module C)

Instruction to Enumerators: Ask these questions about all household members. Ask the primary or secondary respondent, whoever is most knowledgeable about the age, completed education, and other characteristics of household members.

Enumerator Reads: First, we would like to ask you about each member of your household. Please list the names of everyone considered to be a member of this household, starting with you (the primary respondent), followed by the secondary respondent and all other person:

ID

C o d e

Name of household member?

[start with primary respondent, continue with the secondary respondent, if applicable, and other members]

What is *NAME’s ] sex?

1 = M 2 = F

What is *NAME’s+ relationship to the primary respondent?

What is *NAME’s+ age?

If < 2 yrs enter # of months If <3 yrs , skip 2.06-2.10

What is [NAME’s] civil or marital status?

Can

[NAME]

read and write in English

What other language can you read and write

Has [NAME] ever attended school?

1= Yes 2= No>>next member

Is

[NAME]

currently attending school?

1 = Yes 2 = No

What is the highest qualification completed by [NAME]?

Number Unit

2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.07a 2.08 2.09 2.10

Visit 1- Module 2: Household Demographics (FTF Module C) Continued

ID

C o d e

Name of household member?

[start with primary respondent, continue with the secondary respondent, if applicable, and other members]

What is *NAME’s+ sex?

1 = M 2 = F

What is *NAME’s+ relationship to the primary respondent

What is *NAME’s+ age?

If < 2 yrs enter # of months If <3 yrs , skip 2.06-2.10

What is [NAME’s] civil or marital status?

Can

[NAME]

read and write in English

What other languag e can you read and write

Has

[NAME]

ever attended school?

1= Yes 2= No>>next member

Is

[NAME]

currently attending school?

1 = Yes 2 = No

What is the highest qualification completed by [NAME]?

Number Unit

2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.07a 2.08 2.09 2.10

Codes for Questions in Phase 1- Module 2: Household Demographics

2.03: Relationship to primary respondent

2.05: Unit 2.06: Marital/Civil Status

2.07: Literacy 2.07a 2.10: Education level

1 - Primary respondent 2 - Spouse (Wife/Husband) 3 - Child (Son/daughter) 4 - Parent/Parent in-law 5 - Son/Daughter in-law 6 - Grandchild 7 - Brother/Sister 8 - Step child 9 - Foster child 10 - Other relative 11 - Non-relative

1 - Months 2 - Year

1 - Never married/Single 2 - Informal/consensual union/living together

3 - Married 4 - Separated 5 - Divorced 6 – Widowed

1 - Cannot read and write 2 - Can write only 3 - Can read only 4 - Can read and write

1- None 2- Can read and write local language 3- Can read local language only 4- Can write local language only 5- Can read and write

Arabic 6- Can read Arabic only 7- Can write Arabic only

1 - None

2 - MLSC

3 - BECE

4 - Voc/Comm 5 - Teacher Tra. A 6 - Teacher Post Sec 7 - GCE O Level

8 - SSCE /WASSCE

9 - GCE A Level 10 - Tech/Prof Cert 11 - Tech/Prof Dip

12 - HND

13 - Bachelors 14 - Masters 15 - Doctorate 16 - Other (specify)

Visit 1- Module 3A: Household Hunger Scale (FTF Module H.)

Enumerator: Ask of the person responsible for Household Food Preparation.

No. Question Response Code

3.01 In the last 4 weeks, was there ever no food to eat of any kind in your dwelling because of lack of resources to get food?

1 = Yes 2 = No >>3.03

3.02 How often did this happen in the last 4 weeks?

1 = Rarely (1-2 times) 2 = Sometimes (3-10 times) 3 = Often (more than 10 times

3.03 In the last 4 weeks, did you or any household member go to sleep at night hungry because there was not enough food?

1 = Yes 2 = No>>3.05

3.04

3 = Often (more than10 times

3.05 In the last 4 weeks, did you or any household member go a whole day and night without eating anything at all because there was not enough food?

1 = Yes 2 = No >>end of module

3.06

3 = Often (more than 10 times)

Visit 1- Module 3B: Cultivation of Key Crops

Crop 3b.1 Did household cultivate any of these crops during the immediate past cropping season?

Yes – 1

No - 2 >> Next crop

3b.2 What was the approximate size of land cultivated?

3b.3 What was the quantity of crop produced?

3b.4 Income from crop sales

NB: Quantity should be in same unit as 3b.3

Quantity Unit . 1-Poles

2-Acres 3-Plots

4-Hect. 5-Mtr sqr

Quantity Unit 1-Mxbag, 2-Mnbag

3-Tonnes

Quantity (If no sales >>Next crop)

Income (GH¢)

Maize

Rice

Soya

Visit 1- Module 4: Women’s Dietary Diversity (FTF Module J.)

Enumerator Instructions: Ask these questions of each woman of reproductive age (15-49 years) in the household. Check to see if consent to be interviewed has already been given on the cover sheet, if it has not, you must obtain permission from EACH eligible woman.

Enumerator reads to respondent: We would like to ask you permission to ask questions about your diet. Your participation is voluntary and you may stop at any time. Your responses will be kept confidential.

Respondent ID (from HH Roster)

4.00A

Respondent Name

4.00B

Enumerator Instruction: Ask this question only if consent has not already been obtained in Module 1

Do you agree to participate in the survey?

1 = Yes Continue with questions 2 = No STOP survey for this woman, move to next women, if none END MODULE

4.00C

Signature/Thumbprint

4.00D

Respondent (Female 15-49 years) ID Code

In what month and year were you born?

What was your age at your last birthday?

RECORD AGE IN COMPLETED YEARS

IS THE RESPONDENT BETWEEN THE AGES

OF 15 AND 49 YEARS?

IF THE INFORMATION IN 4.02 / 4.03

AND 4.04 CONFLICTS, DETERMINE

WHICH IS MOST ACCURATE

Yes = 1 No = 2 (>> next woman or end module)

Month (mm)

Year

(YYYY)

4.01 4.02 4.03 4.04 4.05

Codes for Months

Jan = 01 Feb = 02 Mar = 03

April = 04 May = 05 June = 06

July = 07 Aug = 08 Sep = 09

Oct = 10 Nov = 11 Dec = 12

Enumerator Instruction: Ask these questions of each woman of reproductive age (15-49 years). Accurate responses to this question may require probing. Use the probes below to elicit a more thorough listing of what the respondent ate yesterday.

Enumerator Ask: Now I will like to ask you about (other) liquids or foods that you ate yesterday, during the day or night. I

[Enumerator] am interested in whether you ate the item even if it was combined with other foods. Please describe everything that you ate yesterday during the day or night, whether at home or outside the home.

1. Think about when you first woke up yesterday. Did you eat anything at that time? If YES: Please tell me everything you ate at that time. PROBE: Anything else? Until respondent says nothing else. If NO, continue to next question

2. What did you do after that? Did you eat anything at that time? If YES: Please tell me everything you ate at that time. PROBE:

Anything else? Until respondent says nothing else. Repeat question b) above until respondent says she went to sleep until the next day. If respondent mentions mixed dishes like a porridge sauce or stew, probe:

3. What ingredients were in that (MIXED DISH)? PROBE: Anything else? Until respondent says nothing else

Enumerator Instruction: As the respondent recalls foods, tick the corresponding food and enter ‘1’ in the column next to the food group for the particular woman interviewed. If the food is not listed in any of the food groups below, write the food in 4.27 labeled

‘other foods’. If foods are used in small amounts for seasoning or as a condiment, they should be included in 4.24 Condiments.

Once the respondent finishes recalling foods eaten, read each food group where ‘1’ was not circled, ask the following question and enter ‘1’ if respondent says yes, ‘2’ if no and ‘98’ if don’t know: Yesterday during the day or night, did you drink/eat any (FOOD

GROUP ITEMS)?

No. Questions Codes Woman I Woman II Woman III Woman

IV

Woman V

Yes = 1 No = 2

DK/NR = 98

HH ID

from Roster

4.6 Milk such as tinned, powdered, or fresh animal milk,

4.7 Tea or coffee

4.8 Any other liquids (juice, cocoa)

4.10 Bread, rice, noodles, or other foods made from

grains (kenkey, banku, koko, tuo zaafi, akple, weanimix)

4.11 Pumpkin, red or yellow yams, carrots, sweet

potatoes that are yellow or orange inside

4.12 White potatoes, white yams, manioc, cassava, cocoyam, fufu or any other foods made from roots, tubers or plantain

4.13 Any dark green, leafy vegetables (kontomire, aleefu, ayoyo, kale, cassava leaves)

4.14 Ripe mangoes, pawpaw

4.15 Any other fruits or vegetables [ e.g. bananas, avocados, tomatoes, oranges, apples]

4.16 Liver, kidney, heart or other organ meats

4.17 Any meat, such as beef, pork, lamb, goat, chicken, or

duck

4.18 Eggs

4.19 Fresh or dried fish or shellfish [e.g. prawn, lobster]

4.20 Any foods made from beans, peas, lentils, nuts, or

seeds

4.21 Yogurt, cheese, or other milk products

4.22 Any oil, fats, or butter, or foods made with any of

these

4.23 Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits

4.24 Condiments for flavor, such as chilies, spices, herbs

or fish powder

4.25 Grubs, snails or insects

4.26 Foods made with red palm oil, red palm nut, or red

palm nut pulp sauce

4.27 OTHER FOODS: PLEASE WRITE DOWN OTHER

FOODS IN THIS BOX THAT RESPONDENT

MENTIONED BUT ARE NOT INCLUDED IN ANY OF THE

FOOD GROUPS ABOVE:

Visit 1- Module 5: Children’s Minimum Acceptable Diet (FTF Module L)

Enumerator Instructions: Ask of Caregivers of each Child aged 6-23 Months in Household. Check to see if consent to be interviewed has already been given on the cover sheet, if it has not, you must obtain permission from EACH woman/caregiver of the child.

Ensure that the consent covers for children 0-5 months to enable for data collection for module 6 below.

Enumerator read to respondent: We would like to ask you permission to ask questions about your children and their diet. Your participation is voluntary and you may stop at any time. Your responses will be kept confidential.

1. Mother or Primary Caregiver's ID (from HH Roster)

2. Respondent (CAREGIVER'S) Name

3. Do you agree to participate in the survey?

1 = Yes Continue with questions 2 = No STOP survey for this woman, move to next women, if none END MODULE

4. Signature/Thumbprint

No Question Response Code Response

Child I Child II Child III Child IV Child V

5.01 MOTHER/CAREGIVER’S ID CODE FROM THE HH

ROSTER

5.02 CHILD’S ID CODE FROM THE HH ROSTER

5.03 CHILD’S SEX FROM THE HH ROSTER 1 - Male

2 - Female

5.04 What is (CHILD’S NAME) full date of birth

(dd/mm/yyyy)?

If the respondent does not know the exact birth date, ask for (Child's Name) health/vaccination card and record the correct birth date.

DD

MM

YYYY

5.05 How old was (CHILD’S NAME) at his/her last

birthday?

RECORD AGE IN COMPLETED YEARS.

0 - less than 1 year 1 - 1 year 2 - 2 or more years

5.06 How many months old is (CHILD’S NAME)?

RECORD AGE IN COMPLETED MONTHS.

Months

5.07 CHECK QUESTIONS 5.04, 5.05 AND 5.06 TO VERIFY

CONSISTENCY.

If the answer is ‘NO’, resolve any inconsistencies.

If the birth date was recorded on a health card, this may be used as the correct data source.

5.07A Is the year recorded in 5.04 consistent with age in years recorded in 5.05?

1 - Yes 2 - No

5.07B Are year and month of birth recorded in 5.04 consistent with age in months recorded in 5.06?

5.08 Check question 5.06. is the child equal to or older

than 6 months and less than 24 months?

1 - Yes >> continue with module 2 - No >>next child/ end module

98 - DK/ NA >>

next child/end module

No Question Response Code Response Child I Child II Child III Child IV Child V

5.09 Has (CHILD’S NAME) ever been breastfed?

2 - No >> skip to 5.11

98 - DK/NA >>

skip to 5.11

5.10 Was (CHILD’S NAME) breastfed yesterday during

the day or at night?

1 - Yes >> skip to 5.12

98 - DK/NA

5.11 Sometimes babies are fed breast milk in different

ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby.

Did (CHILD’S NAME) consume breast milk in any of these ways yesterday during the day or at night?

1 - Yes

98 - DK/NR

5.12 Now I would like to ask you about some medicines

and vitamins that are sometimes given to infants.

Was (CHILD’S NAME) given any vitamin drops or other medicines as drops yesterday during the day or at night?

1 - Yes

5.13 Was (CHILD’S NAME) given ORS yesterday during

the day or at night?

1 - Yes

No Question Response Code Response

Child I Child II Child III Child IV Child V

Enumerator Ask: Now I would like to ask you about (other) liquids or foods that your child ate yesterday during the day or at night. I am interested in whether they ate the item even if it was combined with other foods. Please describe everything he or she ate yesterday during the day or night, whether at home or outside the home. Next I would like to ask you about some liquids that (CHILD’S NAME) may have had yesterday during the day or at night.

5.14 Plain water? 1 – Yes

5.15 Infant formula such as winning mix or

commercially produced infant formula?

1 – Yes 2 - No >> skip to 5.17 98 - DK/NR >> skip to 5.17

5.16 How many times (number) yesterday during

the day or at night did (CHILD’S NAME) consume any formula?

98 - Don’t know

5.17 Milk such as tinned, powdered, or fresh

animal milk?

1 – Yes 2 - No >> skip to 5.19 98 - DK/NR >> skip to 5.19

5.18 How many times (number) yesterday during

consume any milk?

98-= Don’t know

5.19 Juice or juice drinks? 1 – Yes

5.20 Clear broth?

5.21 Yogurt? 1 – Yes

2 - No >> skip to 5.23 98 - DK/NR >> skip to 5.23

5.22 How many times (number) yesterday during

consume any yogurt?

98-= Don’t know

5.23 Thin porridge? 1 - Yes

5.24 Any other liquids. Specify

No Question Response Code Response Child I Child II Child III Child IV Child V

Now I would like to ask you about (other) liquids or foods that your child ate yesterday during the day or at night. I am interested in whether they ate the item even if it was combined with other foods. Please describe everything he or she ate yesterday during the day of night, whether at home or outside the home.

Enumerators should probe until respondent says child went to sleep at night.

Consumption Questions:

Ask these questions of each caregiver for the children 6 – 23 months old under his or her care. Accurate responses to this question may require probing. Use the probes to elicit a more thorough listing of what the respondent ate yesterday.

1. Think about when you first woke up yesterday. Did your child eat anything at that time? If YES: Please tell me everything your child ate at that time.

PROBE: Anything else? Until respondent says nothing else. If NO, continue to part 2)

2. What did your child do after that? Did your child eat anything at that time? If YES: Please tell me everything your child ate at that time. PROBE:

Anything else? Until respondent says nothing else. Repeat question PART 2 above until respondent says the child went to sleep until the next day.

If respondent mentions mixed dishes like a PORRIDGE, sauce or stew, probe:

3. What ingredients were in that (MIXED DISH)? PROBE: Anything else? Until respondent says nothing else.

As the respondent recalls foods, tick the corresponding food and enter ‘1’ in the column next to the food group for the child being interviewed. If the food is not listed in any of the food groups below, write the food in 5.42 the box labeled ‘other foods’. If foods are used in small amounts for seasoning or as a condiment, count them under 5.39 Condiments.

Once the respondent finishes recalling foods eaten, read each food group where ‘1’ was not indicated, ask the following question and enter ‘1’ if respondent says yes, ‘2’ if no and ‘98’ if don’t know: Yesterday during the day or night, did your child drink/eat any (FOOD GROUP ITEMS)?

5.25 Bread, rice, noodles, porridge or other foods made

from grains (kenkey, banku, koko, tuo zaafi, akple)

Response Code

5.26 Pumpkin, red or yellow yams, carrots, sweet

potatoes that are yellow or orange inside

5.27 White potatoes, white yams, manioc, cassava, cocoyam, fufu or any other foods made from roots, tubers or plantain

5.28 Any dark green, leafy vegetables (kontomire, aleefu, ayoyo, kale, cassava leaves)

5.29 Ripe mangoes, pawpaw

5.30 Any other fruits or vegetables [ e.g. bananas,

5.32 Any meat, such as beef, pork, lamb, goat, chicken, or duck

No Question Response Code Response Child I Child II Child III Child IV Child V

5.33 Eggs

1 - Yes

5.34 Fresh or dried fish or shellfish [e.g. prawn, lobster]

5.35 Any foods made from beans, peas, lentils, nuts, or

seeds

5.36 yogurt, cheese, or other milk products

5.37 Any oil, fats, or butter, or foods made with any of

5.38 Any sugary foods such as chocolates, sweets,

5.39 Condiments for flavor, such as peppers, spices, herbs or fish powder

5.40 Grubs, snails or insects

5.41 Foods made with red palm oil, red palm nut, or

red palm nut pulp sauce

5.42 OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS IN

THIS BOX THAT RESPONDENT MENTIONED BUT ARE

NOT INCLUDED IN THE FOOD GROUPS LISTED ABOVE:

CHECK CATEGORIES 5.25-5.41

If at least one ‘YES’ or all

‘DK/NR’>>5.44

If all ‘NO’>>5.43

5.43 Did (CHILD’S NAME) eat any solid, semi-solid, or

soft foods yesterday during the day or at night?

IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did (CHILD’S NAME) eat?

Yes = 1 >> go back to 5.25-5.41 and record foods eaten.

Then continue with 5.44 No = 2 >> next child/end module DK/NR = 98 >> next child/end module

5.44 How many times (number) did (CHILD’S NAME)

eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night?

98 - Don’t know

Visit 1- Module 6: Exclusive Breastfeeding (FTF Module K)

Enumerator: Ask of Caregivers of each child aged 0-5 months (up to end of five months old, less than six months) in Household.

No Question Response Code Response

Child I Child II Child III Child IV Child V

6.01 MOTHER/CAREGIVER ID CODE FROM THE HH

ROSTER

6.02 CHILD’S ID CODE FROM THE HH ROSTER

6.03 CHILD’S SEX FROM THE HH ROSTER 1 - Male

6.04

What is (CHILD’S NAME) full date of birth (dd/mm/yyyy)?

If the respondent does not know the exact birth date, ask for (Child's Name) health/vaccination card and record the correct birth date. If day is not known, record "98" for Day

DD

MM

YYY

6.05 How many months old is (NAME)?

RECORD AGE IN COMPLETED MONTHS

Months

6.06 CHECK QUESTIONS 6.04 AND 6.05 TO VERIFY CONSISTENCY

If the answer to 6.06A or 6.06B is ‘NO’, resolve any inconsistencies. If the birth date was recorded on a health card, this may be used as the correct data source.

6.07 Are year and month of birth recorded in 6.04

consistent with age in months recorded in 6.05?

6.08 check question 6.06 and 6.07: Is the child less than 6 months (i.e. 0-5 months?

1 - Yes >> continue 2 - No >> next child/ end module 98 - DK >> next child/end module

No Question Response Code Response

Child I Child II Child III Child IV Child V

6.09 Has (CHILD’S NAME) ever been breastfed? 1 - Yes

2 - No >> 6.11

98 - DK/NR >> 6.11

6.10 Was (CHILD’S NAME) breastfed yesterday

during the day or at night?

1 - Yes >> 6.12

6.11 Sometimes babies are fed breast milk in different

ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way.

This can happen if a mother cannot breastfeed her own baby.

Did (CHILD’S NAME) consume breast milk in any of these ways yesterday during the day or at night?

1 - Yes

6.12 Now I would like to ask you about some

medicines and vitamins that are sometimes given to infants.

Was (CHILD’S NAME) given any vitamin drops or other medicines as drops yesterday during the day or at night?

1 - Yes

6.13 Was (CHILD’S NAME) given ORS yesterday

during the day or at night?

Consumption Questions: NOTE TO ENUMERATOR: READ THE QUESTIONS BELOW. READ THE LIST OF LIQUIDS ONE BY ONE AND MARK YES OR NO, ACCORDINGLY.

Next I would like to ask you about some liquids that (CHILD’S NAME) may have had yesterday during the day or at night. Did (CHILD’S NAME) have any (ITEM FROM LIST)?: READ THE LIST OF LIQUIDS STARTING WITH ‘PLAIN WATER’

6.14 Plain water? 1 - Yes

6.15 Infant formula such as winning mix or

commercially produced infant formula?

6.16 Milk such as tinned, powdered, or fresh animal

milk?

6.17 Juice or juice drinks?

6.18 Clear broth?

No Question Response Code Response

Child I Child II Child III Child IV Child V

6.19 Yogurt? 1 - Yes

6.20 Thin porridge?

6.21 Any other liquids? Specify:

ENUMERATOR:

Please describe everything that (CHILD’S NAME) ate yesterday during the day or night, whether at home or outside the home.

1. Think about when (CHILD’S NAME) first woke up yesterday. Did (CHILD’S NAME)eat anything at that time? IF YES: Please tell me everything(CHILD’S NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYSNOTHING ELSE.IF NO, CONTINUE TO PART b)

2. What did (CHILD’S NAME) do after that? Did (CHILD’S NAME) eat anything at that time? IF YES: Please tell me everything (CHILD’S NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYSNOTHING ELSE.

REPEAT QUESTION 2) ABOVE UNTIL RESPONDENT SAYS THE CHILD WENT TO SLEEP UNTIL THE NEXT DAY.IF RESPONDENT MENTIONS MIXED DISHES LIKE A

PORRIDGE, SAUCE OR STEW,PROBE:

3. What ingredients were in that (MIXED DISH)? PROBE: Anything else? UNTIL RESPONDENT SAYSNOTHING ELSE.

AS THE RESPONDENT RECALLS FOODS, UNDERLINE THE CORRESPONDING FOOD AND ENTER 1 IN THE RESPONSE BOX IN THE COLUMN NEXT TO THE FOOD GROUP. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOW, WRITE THE FOOD IN THE BOX LABELED ‘OTHER FOODS’. IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP.

ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT ENTERED IN THE RESPONSE BOX, ASK THE FOLLOWING QUESTION AND ENTER ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘9’ IF DON’T KNOW:

Enumerator Ask: Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)?

No Question Response Code Response

Child I Child II Child III Child IV Child V

6.22 Bread, rice, noodles, porridge or other foods

made from grains (kenkey, banku, koko, tuo zaafi, akple)

1 - Yes

6.23 Pumpkin, red or yellow yams, carrots, sweet

potatoes that are yellow or orange inside?

6.24 White potatoes, white yams, manioc, cassava, cocoyam, fufu or any other foods made from roots, tubers or plantain

6.25 Any dark green, leafy vegetables (kontomire, aleefu, ayoyo, kale, cassava leaves)

6.26 Ripe mangoes, pawpaw

6.27 Any other fruits or vegetables [ e.g. bananas,

6.28 Liver, kidney, heart or other organ meats

6.29 Any meat, such as beef, pork, lamb, goat, chicken, or duck

1 - Yes

6.30 Eggs

6.31 Fresh or dried fish or shellfish [e.g. prawn, lobster]

6.32 Any foods made from beans, peas, lentils, nuts, or seeds

6.33 Cheese or other milk products

6.34 Any oil, fats, or butter, or foods made with any of

6.35 Any sugary foods such as chocolates, sweets,

6.36 Condiments for flavor, such as chilies, spices, herbs or fish powder

6.37 Grubs, snails or insects

6.38 Foods made with red palm oil, red palm nut, or

red palm nut pulp sauce

6.39 OTHER FOODS: PLEASE WRITE DOWN OTHER

FOODS IN THIS BOX THAT RESPONDENT

MENTIONED BUT ARE NOT IN THE LIST BELOW:

6.40 Check Questions 6.22–6.38. If all ‘NO’ GO TO 6.41 If at least one ‘YES’ or all ‘DK’ GO TO 6.42

6.41 Did (CHILD’S NAME) eat any solid, semi-solid, or

soft foods yesterday during the day or at night?

IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did (CHILD’S NAME) eat?

1 - Yes >>go back to 6.22-6.38 and record foods eaten then continue with 6.41 2 - No >> end module 98 - DK/NR >> end module

6.42 How many times did (CHILD’S NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night?

End of Module

Visit 1- Module 7: Anthropometry for women (FTF Module M.)

Enumerator: Apply this module to each women of reproductive age (15-49 years) in the Household.

Woman's ID from HH Roster

Name of Woman

Do you agree to be measured?

1 - Yes >> Continue 2 - No >>Next woman, if none end module

WEIGHT

IN KILOGRAMS

HEIGHT

IN CENTIMETERS

Are you pregnant?

2 - No

98 - DK

7.1 7.2 7.3 7.4 7.5 7.6

Visit 1- Module 8: Anthropometry for children (FTF Module N.)

Enumerator: Apply to each child aged 0 – 59 months in the Household.

Child's ID # (from roster)

Parent Agree to weigh and Measure child?

Yes = 1 No = 2 >> End Module

Child Sex

1 - Male

In what day, month and year was <CHILD’S NAME> born?

Child's Age (in Months)

Child less than 60 months?

1 - Yes 2 - No>> End Module 98 - DK/NR >> End Module

Child’s Weight (in Kilograms )

Child Height (in Cm) Children < 24 mons measure lying down;

children >= 24 mons measure standing up

Child Edema

Yes = 1 No = 2

Day

(DD)

Month

(MM)

Year

(YYYY)

Visit 1- Module 9: Dwelling Characteristics (FTF Module D)

Enumerator: Ask these questions about all household members. Ask the primary or secondary respondent, whoever is most knowledgeable about the household dwelling characteristics.

No Question Response Response Codes

9.01.

ENUMERATOR: OBSERVE (DO NOT ASK)

Roof top material (outer covering):

1. Palm leaves/raffia/thatch

2. Wood

3. Corrugated metal sheets

4. Asbestos/slate

5. Roofing tiles

6. Mud bricks/earth

7. Bamboo

8. Other

9.02.

Floor material:

1. Earth/mud/mud bricks

2. Wood

3. Stone

4. Cement/concrete

5. Burnt bricks

6. Vinyl tiles

7. Ceramic/marble tiles

8. Terrazzo

9. Other

9.03.

Exterior Walls:

1. Mud/mud bricks

2. Wood/bamboo

3. Metal sheets/slate/asbestos

4. Stones

5. Burnt bricks

6. Cement/sandcrete blocks

7. Thatch

8. Cardboard

9. Other

9.04.

ENUMERATOR: OBSERVE (DO NOT ASK) State of the dwelling:

1. In excellent repair, no sign of wear

2. In good shape, some minor wear-and-tear or damage

3. In moderate condition, some damage and moderate wear-and-tear

4. In poor shape, much damage

5. In very bad shape

9.05.

IF THE HOUSEHOLD SHARES THE SPACE WITH OTHER

HOUSEHOLDS: How many other households live in this same house or apartment? (Enter 0 if not shared)

9.06. This dwelling is [READ OPTIONS]:

1. Rented

2. Owned

3. Borrowed (no payment)

4. Other

9.07.

How many rooms are there in this dwelling? (Do not count bathrooms, hallways, garage, toilet, cellar, kitchen)

No Question Response Response Codes

9.08. How many rooms are used exclusively for sleeping?

9.09. What is the main type of toilets your household uses?

1. Flush toilet (WC)

2. Pit Latrine

3. KVIP

4. Pan/bucket

5. Public toilet (flush/bucket/KVIP)

6. Toilet in another house

7. No toilet facility (bush, beach)

8. Other

9.10. Is there a water source inside the dwelling?

1. Yes

2. No

9.11.

What is the main source of water for general use for your household

1. Piped into dwelling

2. Piped into plot/yard

3. Public tap (someone else’s private tap)

4. Tube well/borehole

5. Protected dug well

6. Protected spring

7. Rain water collection

8. Unprotected dug well/springs

9. River/ponds/streams/Dam

10. Tankers-truck/vendor

11. Sachet water >> 9.15

12. Bottled water >>9.15

13. Other (specify)

9.12.

What is the main source of drinking water for your household?

9.13.

Do you use a process to prepare the water used for drinking?

1. Yes

2. No >> 9.15

9.14.

What is the process through which you prepare the water used for drinking? (If more than one option is applicable, chose the most effective option)

1. Filtered

2. Boiled

3. Filtered and boiled

4. Iodine or other mineral/ natural treatments

5. UV treated

6. Other

9.15. Does this dwelling have access to electricity?

1. Yes

2. No

9.16. What is the main lighting source for your household?

1. Electricity via national grid

2. Solar panel

3. Piped or liquid propane gas

(biogas)

4. Private generator

5. Public or shared generator

6. Lanterns/candles/paraffin

7. Fire lit sticks, grass or pit

8. Other

9.17.

What is the main source of cooking fuel for your household?

1. Electricity

2. Piped or liquid propane gas

(biogas)

3. Kerosene

4. Charcoal

5. Firewood

6. Animal dung

7. Agricultural crop residue

8. Other

No Question Response Response Codes

9.18 Do you cook in an external kitchen or internal kitchen?

1. External

2. Internal

9.19.

What is the main destination of household waste for this household?

1. Collected by local authority

2. Collected by private firm

3. Own garbage pit or heap

4. Own burned or buried

5. Public garbage

6. Dumped in vacant land/property

7. Dumped in river, lake or sea

8. Other

Visit I - Module 10: Women's Empowerment in Agriculture Index (FtF Module H)

Enumerator Note: This questionnaire should be administered separately to the primary and secondary respondents. Complete the consent form if consent has not been taken earlier in Module 1 above. Ask to conduct the interview for this module in private or where other members of the household cannot overhear or contribute answers. Do not attempt to make responses between the primary and secondary respondent the same—it is ok for them to be different. Ensure that you code the outcome of the interview at the end of interview for each target respondent under this module.

Visit I - Module 10.1: Household Identification

Household Identification Response/Code

Household Identification Response/Code

10.1.01. Household Identification:

10.04. Type of household (If possible, auto fill this

field after name has been selected from 11.1.02)

Male and female adult ……………...1 Female adult only……………………2

10.1.02. Name of respondent currently being

interviewed (Select from drop down list):

Surname, First name:

10.1.05. Ability to be interviewed alone:

10.1.03. Sex of respondent (Auto fill as soon as

name is selected from 11.1.02):

Male …………… Female ………………………2

Codes for 10.1.05 Alone ............................................... ………….1 With adult females present ............ ………….2 With adult males present ................ ………….3 With adults mixed sex present…… .. ………….4 With children present ........................ … With adults mixed sex and children present…..6

Visit I - Module 10.2: Role in Household Decision-making around production and income generation (FtF Module H2).

Activity

Did you (singular) participate in [ACTIVITY] in the past 12 months (that is during the last [one/two] cropping seasons)?

Yes No ......... 2 >> next activity

How much input did you have in making decisions about

[ACTIVITY]?

How much input did you have in decisions on the use of income generated from

[ACTIVITY]

Activity Code

Activity Description

10.2.01 10.2.02 10.2.03

A Food crop farming: crops that are grown primarily for household food consumption

B Cash crop farming: crops that are grown primary for sale in the market

C Livestock raising

D Non-farm economic activities: Small business, self-employment, buy-and-sell

E Wage and salary employment: in-kind or monetary work both agriculture and other wage work

F Fishing or fishpond culture

Codes for 10.2.02 and 10.2.03: Input into decision making

No input

Input into very few decisions

Input into some decisions

Input into most decisions

Input into all decisions

No decision made

Visit I - Module 10.3: Access to Productive Capital (FtF Module H3)

Productive Capital Does anyone in your household currently have any [ITEM]?

Yes No ....... 2 >> next item

How many of [ITEM] does your household currently have?

Who would you say owns most of the

[ITEM]?

Who would you say can decide whether to sell [ITEM] most of the time?

say can decide whether to give away [ITEM] most of the time?

say can decide to mortgage or rent out [ITEM] most of the time?

Who contributes most to decisions regarding a new purchase of

[ITEM]?

Productive Capital 10.3.01a 10.3.01b 10.3.02 10.3.03 10.3.04 10.3.05 10.3.06

A Agricultural land (pieces/plots)

B Large livestock (oxen, cattle)

C Small livestock (goats, pigs, sheep)

D Chickens, Ducks, Turkeys, Pigeons

E Fish pond or fishing equipment

F Farm equipment (non-mechanized)

G Farm equipment (mechanized)

H Nonfarm business equipment

I House (and other structures)

J Large consumer durables (fridge, TV, sofa)

K Small consumer durables (radio, cookware)

L Cell phone

M Other land not used for agricultural purposes

(pieces, residential or commercial land)

N Means of transportation (bicycle, motorcycle, car)

Codes for 10.3.02 to 10.3.06: Decision-making and control over productive capital

Self ................................................ …1

Partner/Spouse ............................. …2

Self and partner/spouse jointly .... …3

Other household member ……………..4

Self and other household member(s)………

Partner/Spouse and other household member(s)…

Someone (or group of people) outside the household…7

Self and other outside people………………

Partner/Spouse and other outside people…………………….9

Self, partner/spouse and other outside people

Visit I - Module 10.3 Continued: Access to Credit (FtF Module H3)

Lending sources

Has anyone in your household taken any loans or borrowed cash/in-kind from [SOURCE] in the last 12 months?

Who made the decision to borrow from [SOURCE]?

Who makes the decision about what to do with the money/ item borrowed from

[SOURCE]?

If more credit had been available from this source, would you have used it?

1 = Yes >> Next lending source

2 = No

Why would you not have borrowed more from

[SOURCE]?

Select code then >> Next source

Did you want to borrow or get a loan from [SOURCE] in the last 12 months but did not?

1 = Yes

2 = No >> Next source

Why were you not able to borrow from

[SOURCE]?

(Main reason only)

Lending source names 10.3.07 10.3.08 10.3.09 10.3.10A 10.3.10B 10.3.11A 10.3.11B

A Non-governmental organization (NGO)

B Informal lender

C Formal lender (bank/financial institution)

D Friends or relatives

Group based micro-finance or lending including Village Savings and Loans Associations (VSLAs)/susu etc.

Codes for 10.3.07 Taken loans

Yes, cash Yes, in-kind Yes, cash and in-kind No .................................. 4 >> 10.3.11a Don’t know…………………5 >> 10.3.11a

Codes for 10.3.08 & 10.3.09:

Self……………………………

Partner/Spouse ............................. …………………………………2

Self and partner/spouse jointly…… …………………………………3

Other household member ............. …………………………………4

Self and other household member(s)……………………………..5

Partner/Spouse and other household member(s)…

Someone (or group of people) outside the household……7

Self and other outside people...……………….…

Partner/Spouse and other outside people………………………9

Self, partner/spouse and other outside people

Codes for 10.3.10B/10.311B: Borrowing Have enough money……………………………………..…………...…………………………………1

Afraid of losing collateral……………………………………………………………………………...2

Do not have enough collateral/did not qualify for the loan….……………….………3

Afraid cannot pay back the money…………………………………………….………………….4

Interest rate/other costs too high..………………………………………..….………………….5

Not allowed to borrow/family dispute in borrowing decision…………….….….…6

Place of lender is too far………....…………………………………………….…………………….7

Short time frame for repayment…………………………………………….…………………….8

Other, specify………………………………………………………………….……………………………9

Visit I - Module 10.4: Individual leadership and influence in the community (FtF Module H4)

Q.No. Question Response Response options/Instructions

10.4.01 Do you feel comfortable speaking up in public to help decide on infrastructure

(like small wells, roads, water supplies) to be built in your community?

No, not at all comfortable

Yes, but with a great deal of difficulty ... 2

Yes, but with a little difficulty

Yes, fairly comfortable

Yes, very comfortable

10.4.02 Do you feel comfortable speaking up in public to ensure proper payment of wages for public works or other similar programs?

10.4.03 Do you feel comfortable speaking up in public to protest the misbehavior of authorities or elected officials?

Visit I - Module 10.4 continued: Group membership and influence in the group (FtF Module H4)

Group membership

Is there a [GROUP] in your community?

1 = Yes 2 = No >> next group 3 = DK >> next group

Are you an active member of this [GROUP]?

1 = Yes 2 = No >> 10.4.07

How much input do you have in making decisions in this [GROUP]?

(>> next group)

Why are you not a member of this

[GROUP]?

Group Categories 10.4.04 10.4.05 10.4.06 10.4.07

A Agricultural / livestock/ fisheries producer’s group (including marketing groups)

B Water users’ group

C Forest users’ group

D Credit or microfinance group (including Susu/ Village Savings and Loans Associations (VSLAs)

Mutual help or insurance group (including burial societies)

F Trade and business association

G Civic groups (improving community) or charitable group (helping others)

H Local government

I Religious group

J Other women’s group (only if it does not fit into one of the other categories)

K Other (specify)

10.4.06: Input into decisions

No input

Input into very few decisions

Input into some decisions

Input into most decisions

Input into all decisions………………….5

10.4.07: Why not member of group

Not interested……………………………..1

No time ......................................... …2

Unable to raise entrance fees ....... …3

Unable to raise reoccurring fees ... …4

Group meeting location not convenient. 5

Family dispute/unable to join ....... …6

Not allowed because of sex .......... …7

Not allowed because of other reason …8

Other, specify……………………………..9

Visit I - Module 10.5: Decision Making (FtF Module H5)

ENUMERATOR: Ask 10.5.01 for all categories of activities before asking 10.5.02. Do not ask 10.5.02 if 10.5.01 response is 1 and respondent is male OR 10.5.01 response is 2 and respondent is female.

If household does not engage in that particular activity, enter 98 and proceed to next activity.

When decisions are made regarding the following aspects of household life, who is it that normally takes the decision?

To what extent do you feel you can make your own personal decisions regarding these aspects of household life if you want(ed) to?

Enumerator: Ask only if 10.5.01 is 1 and respondent is female, 10.5.01 is 2 and respondent is male, or 10.5.01 is 3-7.

10.5.01 10.5.02

A Agricultural production?

B What inputs to buy for agricultural production?

C What types of crops to grow for agricultural production?

D When or who would take crop produce to the market?

E Livestock raising?

F Non-farm business activity?

G Your own (singular) wage or salary employment?

H Major household expenditures? (such as a large appliance for the house like refrigerator)

I Minor household expenditures? (such as food for daily consumption or other household needs)

Codes for 10.5.01: Who makes decision

Main male or husband…………… .................... …………………..1 Main female or wife ...................................... ……………… Husband and wife jointly .............................. ……………………3 Someone else in the household .................... ……………………4 Jointly with someone else inside the household ……………5 Jointly with someone else outside the household ……………6 Someone outside the household/other ........ ……………………7 Household does not engage in activity/Decision not made98

Codes for 10.5.02: Extent of participation in decision making

Not at all …………………………1 Small extent……………………..2 Medium extent…………………..3 To a high extent…………………4

Visit I - Module 10.5 continued: Motivation for Decision Making (FtF Module H5)

ENUMERATOR: This set of questions is very important. I am going to give you some reasons why you act as you do in the aspects of household life I just mentioned. You might have several reasons for doing what you do and there is no right or wrong answer. Please tell me how true it would be to say:

If household does not engage in that particular activity, enter 98 and proceed to next activity.

My actions in [ASPECT] are determined by the situation. I don’t really have an option.

[READ OPTIONS]

My actions in [ASPECT] are partly because I will get in trouble with someone if I act differently.

Regarding [ASPECT] I do what I do so others don’t think poorly of me.

Regarding [ASPECT] I do what I do because I personally think it is the right thing to do.

10.5.03 10.5.04 10.5.05 10.5.06

A Agricultural production

B Getting inputs for agricultural production

C The types of crops to grow for agricultural production

D Taking crop produce to the market (or not)

E Livestock raising

F Nonfarm business activity

G Your own (singular) wage or salary employment

H Major household expenditures (such as a large appliance for the house like refrigerator)

Minor household expenditures (such as food for daily consumption or other household needs)

Codes for 10.5.03/10.5.04/10.5.05/10.5.06: Motivation for activity

Never true ..................................... …………………………………..1

Not very true ................................. …………………………………..2

Somewhat true .............................. …………………………………..3

Always true .................................... …………………………………..4

Household does not engage in activity /Decision not made……………98

Visit I - Module 10.6: Time Allocation (FTF Module H6)

Enumerator: Please record a log of the activities for the individual in the last complete 24 hours (starting yesterday morning at 4 am, finishing 3 am of the current day). One to two activities can be marked for each time period by selecting the corresponding time period from the drop down menu. If two activities are marked, select from the activity status drop down list which of the two activities is primary and or secondary. Please administer using the protocol in the enumeration manual. In the paper based version, enumerators should provide the activity code and indicate the start time and end time before indicating whether it was a primary or a secondary activity.

NO Activity Code

(Use codes on next page)

Start Time

End Time

Status of Activity

1 - Primary 2 - Secondary

Activity codes

Sleeping and resting -01 Shoping/getting service (including health services) -08 Exercising - 15

Eating and drinking -02 Weaving, sewing, textile care - 09 Social activities and hobbies - 16

Personal Care -03 Cooking - 10 Religious activities - 17

School (also homework) -04 Domestic Work (including fetching wood and water) - 11 Other (specify) ___________________________

Work as employed -05 Care for children/adults/elderly - 12

Own business - 06 Traveling and commuting - 13

Farming/livestock/fishing -07 Watching TV/Listening to radio/reading - 14

Visit I - Module 10.6 Continued: Satisfaction with Time Allocation (FtF Module H6)

Q. No. Question Response Response options/Instructions

10.6.02 How satisfied are you with your available time for leisure activities like visiting neighbors, watching TV, listening to the radio, seeing movies or doing sports?

READ: Please give your opinion on a scale of 1 to 10.

1 means you are not satisfied and 10 means you are very satisfied. If you are neither satisfied nor dissatisfied this would be in the middle or 5 on the scale.

Enumerator:

Complete this table after you have finished interviewing the individual for Module 10. Go back to Module 10.1 if this individual is the first (primary or secondary) respondent to Module 10.

Response Codes

10.1.06. Outcome of interview (module 10 for respondent)

Completed Incomplete Absent Refused Could not locate……………………………………5

Visit II - Module 11: Household Consumption Expenditure (FTF Module G.)

Enumerator: Ask these questions about all household members. Ask the primary or secondary respondent, whoever is most knowledgeable about the food the household members have eaten in the last week, as well as any non-food items that household members have bought. As much as possible, look for the household member who has adequate information on household food consumption and purchases over the past week. The same respondent(s) should be asked questions in 11.1-11.6.

Visit II - Module 11.1: Food Consumption Over Past 7 Days (FTF Module G1.)

Over the past one week (7 days), did you or others in your household eaten any of the following food items?

INCLUDE FOOD BOTH EATEN

COMMUNALLY IN THE

HOUSEHOLD AND THAT EATEN

SEPARATELY BY INDIVIDUAL

HOUSEHOLD MEMBERS, BOTH

INSIDE AND OUTSIDE THE

HOME

Yes=1, No=2 >>Next item

Item Code How much in total did your household eat in the past week?

How much came from purchases?

(in same unit as 11.1.03b)

How much did you spend on what was eaten last week?

(if family ate part but not all of something they purchased, estimate only cost of what was consumed )

How much came from own-production?

(in same unit as 11.1.03b)

How much came from gifts and other sources?

(in same unit as 11.1.03b)

11.1.01

11.1.02

11.1.03a Quantity

11.1.03b Unit

11.1.04 Quantity

11.1.05

GHS

11.1.06 Quantity

11.1.07 Quantity

Cereals, Grains and Cereal Products

1-15

Maize normal flour 01

Maize dough 02

Green maize (fresh maize cob) 03

Rice (paddy, grain) 04

Sorghum/Guinea corn 05

Millet grain 06

Millet flour 07

Other grains 08

Other flours 09

Bread 10

Biscuits 11

Over the past one week (7 days), did you or others in your household eaten any of the following food items?

INCLUDE FOOD BOTH EATEN

COMMUNALLY IN THE

HOUSEHOLD AND THAT EATEN

SEPARATELY BY INDIVIDUAL

HOUSEHOLD MEMBERS, BOTH

INSIDE AND OUTSIDE THE

HOME

Yes=1, your household eat in the past week?

How much came from purchases?

(in same unit as 11.1.03b)

How much did you spend on what was eaten last week?

(if family ate part but not all of something they purchased, estimate only cost of what was consumed )

How much came from own-production?

(in same unit as 11.1.03b)

How much came from gifts and other sources?

Quantity

11.1.03b Unit

11.1.04 Quantity

11.1.05

GHS

11.1.06 Quantity

11.1.07 Quantity

Spaghetti, macaroni, pasta 12

Breakfast cereal 13

Infant feeding cereals 14

Other (specify) 15

Roots, Tubers, and Plantains 16-29

Cassava tubers 21

Cassava-gari 22

Cassava flour 23

Cassava (other forms) 24

Yam 25

Cocoyam 26

Plantain 27

Potatoes (Sweet & other potato)

Other (specify) 29

Nuts and Pulses 30-38

Bambara beans 30

Cowpea 31

Pigeon pea 32

Over the past one week (7 days), did you or others in your household eaten any of the following food items?

INCLUDE FOOD BOTH EATEN

COMMUNALLY IN THE

HOUSEHOLD AND THAT EATEN

SEPARATELY BY INDIVIDUAL

HOUSEHOLD MEMBERS, BOTH

INSIDE AND OUTSIDE…