[YEAR] [COUNTRY] MIS INTERVIEWER’S ASSIGNMENT SHEET PAGE _______ OF _______ PAGES CLUSTER NUMBER INTERVIEWER NAME ----------------------------------------------------------------------- INTERVIEWER NUMBER COUNT OF BLOOD SLIDES HOUSEHOLD CHILDREN WOMEN NOTES LMIS NUMBER NUMBER OR ADDRESS NAME OF HOUSEHOLD HEAD FINAL RESULT TOTAL ELIGIBLE CHILDREN 6-59 MOS LINE NUMBER OF ELIGIBLE CHILD TESTED FOR MALARIA AND ANEMIA TOTAL ELIGIBLE WOMEN LINE NUMBER OF ELIG. FINAL RESULT (1) (2) (3) (4)* (5) (6) (7) (8) (9) (10)* (11) Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N CODES FOR COLUMN (4)* CODES FOR COLUMN (10)* 1 COMPLETED 2 NO HH MEMBER AT HOME 3 ENTIRE HH ABSENT FOR EXTENDED PERIOD 4 POSTPONED 5 REFUSED 6 DWELLING VACANT/ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 DWELLING NOT FOUND 9 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 INCAPACITATED 7 TOTAL NUMBER OF HOUSEHOLD TOTAL NUMBER OF WOMAN’S QUESTIONNAIRES NUMBER OF CHILDREN ELIGIBLE FOR ANEMIA AND MALARIA TESTING NUMBER OF CHILDREN TESTED FOR ANEMIA AND MALARIA QUESTIONNAIRE
It is very important not to ask a respondent any questions that are not relevant to his or her situation. For example, a who is not pregnant should not be asked for how many months she has been pregnant. In cases where a particular response makes subsequent questions irrelevant, an instruction is written in the questionnaire directing you to skip to the next appropriate question. It is important that you carefully follow skip instructions. Example: In Q. 225, notice that if you circled Code ‘2’ or Code ‘8’ you would skip to Q. 227. Q. 226 is about the number of months the woman has been pregnant and is only asked to women who respond ‘YES’ to Q. 225. 2. Filters To ensure the proper flow of the questionnaire, you will sometimes be directed to a respondent’s answer to an earlier question, indicate what the response was by marking a box, and then follow various skip instructions. Questions of this type are called “filters”; they are used to prevent a respondent from being asked irrelevant, and perhaps embarrassing or upsetting, questions. For filter questions, it is important that you follow the instructions that ask you to check back to an earlier question. Do not rely on your memory. Remember that you do not need to ask the respondent the same question a second time. Check back and mark an ‘X’ in the appropriate box in the filter, then follow the skip instructions. Example: Question 227 in the Woman’s Questionnaire V. HOUSEHOLD QUESTIONNAIRE The purpose of the Household Questionnaire is to provide information on general characteristics of the population and their households. You will use it to identify women who are eligible to be interviewed with the Woman’s Questionnaire. A. Identification of Household on the Cover Page Before you go to a selected household, fill in the identification information in the box at the top of the cover page. The identification information is obtained from the sample household listing and will be given to you by your supervisor. The following are key points in completing the identification section: Write the name of the place or locality in which you are working. Write the name of the head of the household that you are to interview. Record the Cluster number and Household number in the boxes to the right of those lines. You will fill in the rest of the cover page after you have conducted the interview. See the instructions in Section C (RETURN TO COVER PAGE) below.