Table 3 Example of a questionnaire to assess absolute rights (Bold indicates that absolute right has not been met)
Name | |
Address (or GPS coordinates) | |
DOB or year of birth | M/F (circle) |
WATER | (circle) |
Where do you get your water? | piped drinking water supply on premises |
public tap/stand post | |
tube well/borehole | |
protected dug well | |
protected spring; rainwater | |
bottled water | |
Surface water | |
How long does it take you to collect your water, including queuing? | >30 min/< 30 min; (circle) |
SANITATION | (circle) |
Does your house share the toilet with another household? | No/Yes |
What sort of toilet do you use (circle)? | a pit latrine with a structure, and a platform or squatting slab |
a toilet connected to a septic tank or a sewer network | |
no toilet/open defaecation | |
FOOD | |
Child's age in months | |
Child's height | |
Child's weight | |
Height/age or weight/height >2SD below median or MUAC <12.5 cm (6-59 months)? | Yes/No (circle) |
SHELTER | |
Is the house durable in terms of structure? | No/Yes (circle) |
Is the house durable in terms of tenure? | No/Yes (circle) |
How many people live in your house? | |
How many rooms are there? | |
Number of people/room? | Less than 2, 2, more than 2 (circle) |
EDUCATION | |
How many years did mother/guardian attend school? | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 (circle) |
If child has left school, did she/he complete primary school? | No/Yes (circle) |
HEALTH | |
Vaccine schedule complete at 12 months (National Guidelines)? | No/Yes (circle) |