| 6. Geographical characteristics | Where do you live? Adapt to the local geographical characteristics: district, city, village, section, tribe, etc. | District___________________ City___________________ Village___________________ Section___________________ Other___________________ |
| 7. Educational level | Have you ever attended school? If yes, continue asking: What is the highest level of school you attended? | None Primary school Secondary school Higher |
| What is the highest grade/form/year you completed at that level? | Grade_ _ _ _ | |
| Infant/young children | ||
| 1. Child’s name | What is your child’s name? | |
| 2. Child’s sex | Is (the name of the child) male or female? | Male Female |
| 3. Child’s age | When is your child’s birthday? Probe if necessary: On what day and in which month and year was (name of the child) born? Does he/she have a health/vaccination card with the birth date recorded? If yes, record the date of birth as documented in the card | _ _ _ _/_ _/_ _ year month day |
| How old was (name of the child) at his/her last birthday? Record age in completed years and/or months | Age in completed years_ _ _ _ Age in completed months_ _ _ |