Sample Page - Midline Household Survey - Ethiopia

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SAMPLE PAGE - MIDLINE HOUSEHOLD SURVEY - ETHIOPIA

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(Excerpted from a forthcoming publication by Crocker, J.) Column to indicate errors, missing answers or data Bush, field, river, or pondgo to questioncoding. 73 Grey squares Dig and burygo to question 73 indicate text answers.

Section 4: Sanitation

46a

Where do members of your family usually go to defecate?  (circle only one response)

46b 47

May I see the latrine you use please?

1. ⃝ 2. ⃝ 3. ⃝ Latrine at their own householdgo to question 47 4. ⃝ Neighbor’s householdgo to question 58 5. ⃝ Communal or public latrinego to question 58 6. ⃝ Other (specify):go to question 58

1. ⃝ Allowedgo Self-reported to question 48questions 2. ⃝ Not allowedgo question 49 by are to complemented

 If allowed to see the latrine, walk to the latrine with the respondent

48

49

Observe: Has the path to the latrine been walked on recently?

observations to verify the answers.

1. ⃝ Yes(grass is trampled, wet footprints are visible, or the path has recently been cleared) 2. ⃝ No

How much money did you spend to build this latrine?

| ___ | ___ |___ |___ | Birr

50a

Cement

50b

Pre-made slab/squat plate

50c

What did you buy to construct your latrine?

Wood

50d

 Circle all responses.

Sheet metal (for walls or roof, etc)

50e

Labor/help for digging or construction

50f

Other (specify):

51

How many total hours did it take your family to build this latrine?

52

Did anyone besides of your family help you to build this latrine?

Edited by: ___________________________

Avoid leading questions: “Did you buy cement to construct your latrine?”

| ___ |___ | hours 1. ⃝ Yesgo to question53 2. ⃝ Nogo to question 55 Peer or supervisory review to reduce potential for error.