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Socio-Demographic Questionnaire Template

This document contains the beginning of a questionnaire to collect socio-demographic data and information on sanitation practices from respondents. The questionnaire includes questions about the respondent's sex, age, residence, education level, water source, toilet facilities, handwashing practices of parents and children, and a child's nutritional status. Respondents are given multiple choice or short answer options to complete for each question.

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andualem
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77 views2 pages

Socio-Demographic Questionnaire Template

This document contains the beginning of a questionnaire to collect socio-demographic data and information on sanitation practices from respondents. The questionnaire includes questions about the respondent's sex, age, residence, education level, water source, toilet facilities, handwashing practices of parents and children, and a child's nutritional status. Respondents are given multiple choice or short answer options to complete for each question.

Uploaded by

andualem
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Part one: questionnaire on socio-demographic characteristics

Identification code ----------------------------------


Questionnaire on identification of the Alternative choice for Responses Skip Code
No. respondents
1 Sex 1. Male

2. Female

2 Age _______years

3 Residence 1. urban

2. rural

4 What is your educational status of the 1.Illitrate


child or parent?
2. Only read & write

3. Primary completed

4.Secondary completed

5. College and university

6._________________
6 What is the sources of water for 1. Unprotected
drinking for your child? 2. surface water
3.Piped tap water

7 How and where your child and family 1. open defecation


use toilet?
2. simple pit latrine

3.water carriage (flush)

4.______________
9 When did you wash your hand (for 1.before preparing food
parents)?
2. after defecating child

3. after toilet use

4.___________

10 When did your/you (if a child is able to 1. before meal


respond) child wash his/her hand? 2.after toilet
3._________
11 Nutritional status of the child as 1.normal (MUAC greater than 11
measured by the clinicians cm)
2.undernutritioned (MUAC less
than 11cm)

3. Weight _________kg

4. lateral edema

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