Tanzania - Kagera Health and Development Survey 1991-1994 (Wave 1 to 4 Panel)

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The Kagera Health and Development Survey was conducted for the research project on “The Economic Impact of Fatal Adult Illness due to AIDS and Other Causes”, Mead Over (Principal Investigator, World Bank), Martha Ainsworth (Co-investigator, World Bank), and Godlike Koda, George Lwihula, Phare Mujinja, and Innocent Semali (Co-investigators, University of Dar es Salaam). The primary objective of the Kagera Health and Development Survey (KHDS) was to estimate the economic impact of the death of prime-age adults on surviving household members. This impact was primarily measured as the difference in well-being between households with and without the death of a prime-age adult (15-50), over time. An additional hypothesis was that households in communities with high mortality rates might be less successful in coping with a prime-age adult death. Thus, the research design called for collecting extensive socioeconomic information from households with and without adult deaths in communities with high and low adult mortality rates. Data collected by the KHDS can be used to estimate the "direct costs” of illness and mortality in terms of out-of-pocket expenditures, the "indirect costs" in terms of foregone earnings of the patient, and the "coping costs” in terms of changes in the well-being of other household members and in the allocation on of time and resources within the household as these events unfold. The KHDS was an economic survey. It did not attempt to measure knowledge, attitudes, behaviors or practices related to HIV infection or AIDS in households or communities. It also did not collect blood samples or attempt to measure HIV seroprevalence; this would have substantially affected the costs and complexity of the research and possibly the willingness of households to participate. Information on the cause of death in the KHDS household survey is based on the reports of surviving household members; the researchers maintained that household coping will respond to the perceived cause of death, irrespective of whether the deceased actually died of AIDS. Lastly, the KHDS did not attempt to measure the psycho-social impact of HIV infection or AIDS deaths. OVERVIEW OF THE RESEARCH DESIGN The research design called for a longitudinal survey of a sample of households, some of which would experience an adult death and some of which would not, some of them drawn from communities with high adult mortality rates, and some drawn from low-mortality communities. The sampling frame for the survey was based on the 1988 Tanzania Census, which also provided information on adult death rates by ward within Kagera region. While it was possible to determine which communities had relatively high and low adult death rates from the census data, two additional problems arose that led to the decision for a stratified sample of households based on multiple criteria: - First, despite the high rates of HIV infection in Kagera and the large number of deaths over time due to AIDS, the death of a prime-age adult is still a relatively rare event over a short time period. This meant that a very large sample would have had to be selected in order to ensure that the survey could interview enough families suffering our about to suffer the death of a prime-age adult. - Second, HIV prevalence and adult mortality rates in Kagera were geographically concentrated and thus strongly correlated with different climates and cropping patterns. The highest rural HIV infection rates were in the northeast (10% in Bukoba Rural and Muleba districts and 24% in the town of Bukoba), where tree crops (bananas, coffee) were predominant, while the lowest rates were in the south and west (0.4% in Ngara and Biharamulo districts), where perennial crops and livestock are more common (Killewo and others 1990). A survey design stratified only on mortality rates might confound the effects of high mortality with different agricultural, soil, and rainfall patterns. Thus, the sample of households was selected from a stratified random sample of communities from the 1988 census (stratified on agroclimatic zone and adult mortality rate). Within communities, the household sample was stratified according to the anticipated risk of each household of suffering a prime-age adult death. Households were classified as “high-risk” or “low-risk”, based on information obtained from a house-to-house enumeration of all selected communities. One additional concern was that the high mortality of households might lead to attrition from the sample that is systematically related to household coping. For example, if out-migration is an important coping behavior, then the most severely affected households might leave the sample and the analysis of the remaining households would understate the economic impact of adult deaths. For this reason, at the conclusion of the fieldwork, interviewers attempted to locate and interview all of the individuals who were members of households that dropped out of the longitudinal survey between the first and last interviews, and who were still resident in the region. Individuals were given a specially designed “follow-up questionnaire” that included much of the individual information collected in the household questionnaire, plus information on the reason for leaving the sample and the characteristics of the household were they were now residing. The final longitudinal household survey followed 816 households at 6-7 month intervals, over a 24-month period from 1991-94. The 816 households were selected from 51 “clusters” of 16 households each located in 49 villages or urban areas representing four economic zones of all districts in Kagera region and, within each zone, representing areas with both high and low adult mortality. Because household coping behavior is conditioned on local prices, services, and available programs, the KHDS also collected data from the communities from which households were drawn, local markets, the nearest source of modern medical care, and all of the primary schools in the community. This information was collected longitudinally, with the exception of a questionnaire for traditional healers, which was administered only once. While households were drawn from a stratified random sample of households, the health facilities, schools, markets and healers interviewed represent those closest to each community and thus are not random samples that are statistically representative of Kagera facilities. The panel survey was conducted in a total of five waves. - Wave 1 September 1991 - May 1992 - Wave 2 April 1992 - November 1992 - Wave 3 November 1992 - May 1993 - Wave 4 June 1993 - January 1994 - Wave 5 - 2004

Type: 
Microdata
Acronym: 
KHDS 1991-1994
Languages Supported: 
English
Topics: 
Topic not specified
Tags: 
Geographical Coverage: 
Tanzania
Economy Coverage: 
Economy Coverage not specified
Release Date: 
September 29, 2011

Last Updated

Last Updated: 
January 30, 2020

Harvest System ID

Harvest System ID: 
Microdata

Harvest Source ID

Harvest Source ID: 
83
Disclaimer: 
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Version Description: 
Version 1.1 (March 2011).
Study Type: 
Living Standards Measurement Study [hh/lsms]
Series Information: 
This dataset provides waves 1 to 4 (1991-1994) of the panel Kagera Health and Development Survey. A fifth wave was conducted in 2004.
Primary Investigator Name, Affiliation: 
World Bank and University of Dar es Salaam
Sampling Procedure: 
SAMPLE DESIGN AND SELECTION Qualitative studies of small samples of households can point to hypotheses about the ways in which fatal adult illness affects households. However, policymakers need to know which households are suffering the most, the size of the impact, the extent to which they suffer more than other households in a poor country, and the potential costs and effects of assistance programs. For this purpose, the sample of households must be representative of the population, a random sample for which the probability of selecting each household from the whole population is known. The KHDS used a random sample that was stratified geographically and according to several measures of adult mortality risk. This strategy allowed the team to ensure an adequate number of households with an adult death in the sample while retaining the ability to extrapolate the results to the entire population. The results from the household survey show that stratification of the sample on mortality risk at both the community and household level proved to be worthwhile. Among the 816 households in the original sample that began the survey in the first passage, 91 had an adult death in the course of the survey—more than three times the expected number (25) had the households been drawn at random with no stratification. The 816 households that began the survey in the first passage were observed, on average, for 1.6 years, generating a total of 1,322.7 years of observation. The average probability of an adult death per household per year, according to the 1988 Tanzania Census, is 0.0188. Thus, the expected number of deaths from a random sample of 816 households observed for 1.6 years is 25. Because households were added to the sample to compensate for attrition, a total of 918 households were eventually interviewed at least once. Between the first and last interview, 102 of these households had an adult death, compared to 27 households that would have been expected to have a death from from a non-stratified sample. A. THE TWO-STAGE STRATIFIED RANDOM SAMPLING PROCEDURE The KHDS household sample was drawn in two stages, with stratification based on geography in the first stage and mortality risk in both stages. 1. First Stage: Selection of communities and clusters In the first stage of selecting the sample, the 550 primary sampling units (PSUs) in Kagera region were classified according to eight strata defined over four agronomic zones and, within each zone, the level of adult mortality (high and low). A PSU is a geographical area delineated by the 1988 Tanzanian Census that usually corresponds to a community or, in the case of a town, to a neighborhood. Clusters of households were drawn randomly from the PSUs in each stratum, with a probability of selection proportional to the size of the PSU. a) Classification of communities by sampling stratum The four agronomic zones are: - Tree Crop Zone: Low fertility soils in areas of high rainfall, where the main crops are bananas, coffee, and tea. This zone is in the northern part of Kagera with communities in Bukoba Rural and Muleba Districts. - Riverine Zone: Alluvial and colluvial soils of considerable potential, but requiring flood control, where the cropping pattern is mixed and includes cereals, sugarcane, rice, and legumes, as well as tree crops. This zone is in the middle of the region; most of its communities are in Karagwe and Bukoba Rural Districts and a few in Muleba District. - Annual Crop Zone: Soils of low to medium fertility with moderate potential and lower rainfall, where the cropping pattern is mixed and includes groundnuts, cassava, beans, cotton as well as some cereals (maize, sorghum) and pasture, but few tree crops. This is in the southern part of Kagera in Biharamulo and Ngara Districts. - Urban Zone: The town of Bukoba, the region's capital, plus an additional 27 communities in Muleba, Karagwe, Ngara, and Biharamulo Districts that were designated as urban by the 1988 census. The zone labels were chosen for simplicity. They suggest the characteristic, though by no means exclusive, agricultural pattern. Within each agronomic zone, PSUs were classified according to the level of adult mortality. The 1988 Tanzanian Census asked a 15 percent sample of households about recent adult deaths. Those answers were aggregated at the level of the "ward", an administrative area that is smaller than a district. The adult mortality rate (15-50) was calculated for each ward and each PSU was assigned its ward’s adult mortality rate. [Note: There were 111 wards in Kagera in 1988. Because the adult mortality rates were much higher in some zones than others and the distribution was quite different within zones, "high" and "low" mortality PSUs were defined relative to other PSUs within the same zone. A PSU was classified as in the "high" mortality category if its ward adult mortality rate was at the 90th percentile or higher of the ward adult mortality rates within a given agronomic zone. b) Selection of Clusters Having classified all of the PSUs in Kagera into the eight strata, it remained to select the PSUs from which households would be drawn, and how many households would be interviewed in each of the selected PSUs. To facilitate fieldwork and reduce its costs, the KHDS interviewed households within PSUs in clusters of 16 households each. Based on experience with other LSMS surveys, this is the number of households that could reasonably be interviewed by a field team of one supervisor, two interviewers, and an anthropometrist in a week. The probability that a PSU was selected within each stratum was proportional to its size (the number of households), according to the following formula [note: in the high-mortality urban stratum, eight clusters had to be selected from only six PSUs. In that case, for some PSUs in the stratum the probability exceeded one and more than one cluster was drawn from a PSU]: Probability of Selecting this PSU = (Number of Clusters in this Stratum x Number of households in this PSU) / Number of HHs in this Stratum The research design and the budget called for surveying 50 clusters of 16 households each, for a total sample of 800 households. Divided across the eight strata, this would imply the need to enumerate roughly 6 PSUs in each of six strata and 7 PSUs in two strata. However, to guard against attrition of entire communities and the possibility that actual mortality rates would be found to be quite different from those observed in the census, more PSUs were enumerated than would be needed for the survey. A total of 62 PSUs were selected from the 549 in the region to be enumerated--8 PSUs were selected at random from each of seven strata and all 6 PSUs in the high-mortality urban stratum were selected. However, the field teams successfully enumerated only 52 PSUs, from which 54 clusters could be drawn. Ten PSUs were not enumerated, generally because they were inaccessible or the teams ran out of time. Two PSUs were on islands and one was in a game park. The rainy season substantially slowed down the enumeration and made some PSUs inaccessible. Among the 10 PSUs not enumerated, three were in the riverine zone, six were in the annual crop zone, and one was in the urban zone . The distribution of the ten PSUs not enumerated by district is: Bukoba Urban (0); Bukoba Rural (1); Muleba (1); Biharamulo (3); Ngara (3); Karagwe (2). Of the 52 PSUs that were enumerated, only 48 were needed (allowing for selection of two clusters from each of two PSUs in the urban high-mortality zone). In zone 3, where fewer PSUs were enumerated than were anticipated in the research design, all 10 enumerated PSUs were accepted into the sample. To compensate, it was decided to select a total of 14 PSUs in the tree crop zone, and 12 each in the annual crop and urban zones, for a total of 48. In deciding which PSUs to drop, the PSUs were ordered within each zone, from highest to lowest adult death rate based on the enumeration results. [The correspondence between the adult mortality rates from the 1988 Tanzanian Census and the rates found by the enumeration was not particularly good. The AMR from the enumeration were often higher for PSUs classified as “low mortality” within a zone, than they were for “high mortality”, and vice-versa.] In order to maximize the differences between PSUs in the high- and low mortality groupings within a zone (the definition of which remained based on the census), the PSUs dropped from each zone were in the "middle" of the distribution of enumeration adult mortality rates for that zone. For example, in the riverine zone, where 13 PSUs were enumerated, the PSU with the median adult mortality rate from the enumeration was dropped. Using this method, one PSU each was dropped from the riverine and urban zones and two were dropped from the tree crop zone, leaving 48 PSUs from which 50 clusters were selected. A 51st cluster from the highmortality tree crop stratum was added toward the end of the first passage of field work, to ensure that an adequate sample size would be maintained should an entire cluster drop out later during the panel. Thus, the final KHDS sample included 49 PSUs from which 51 clusters of 16 households each were drawn. 2. Second Stage : Selection of Households In the second stage, households within each of the selected PSUs were assigned to one of two strata "sick" or "well" based on the results of an enumeration of all households in each community. Sixteen households were selected at random per cluster, of which 14 were selected from the "sick" group and 2 from the "well" group. a) Enumeration of households Between March 15 and June 13, 1991, 29,602 households were enumerated in 52 primary sampling units. In addition to recording the name of the head of each household, the number of adults in the household (15 and older), and the number of children, the enumeration form asked: "Are any adults in this household ill at this moment and unable to work? If so, the age of the sick adult and the number of weeks he/she has been too sick to work. "Has any adult 15-50 in this household died in the past 12 months? If so, the age of each adult and the cause of death (illness, accident, childbirth, other). The enumeration form asked explicitly about illness and death of adults 15-50 because this is the age group disproportionately affected by the HIV/AIDS epidemic and it is the impact of these deaths that were of research interest. Since AIDS is sexually transmitted, other adults in the same household with an AIDS patient may also become infected, either through sexual contact with the HIV-infected person or because of similarities in sexual behavior. Thus, AIDS morbidity and deaths are likely to be clustered in households. Information on illness and deaths on the enumeration form could be recorded for a maximum of three people (for each question) per household. Of the more than 29,000 households enumerated, only 3.7%, or 1,101, had experienced the death of a an adult 15-50 due to illness during the twelve months before the interview and only 3.9%, or 1,145, contained a prime-age adult too sick to work at the time of the interview. Only 77 households had both an adult death due to illness and a sick adult. This underscores the point that, even with some stratification based on community mortality rates and in an area with very high adult mortality due to an AIDS epidemic, a very large sample would have had to have been selected to observe a sufficient number of households that would experience an adult death during the two-year survey. b) Selection of households To further increase the probability of capturing households with adult deaths in the sample, households were stratified according to the extent of adult illness and mortality. It was assumed that in communities suffering from an HIV epidemic, a history of prior adult death or illness in a household might predict future adult deaths in the same household. The households in each enumerated PSU were classified into two groups, based on their response to the enumeration: -"Sick" households: Those that had either an adult death 15-50 due to illness in the past 12 months, an adult too sick to work at the time of the survey, or both (n=2,169). - "Welll" households: Those that had neither an adult death 15-50 due to illness nor an adult 15-50 too sick to work (n=27,433). In selecting the 16 households to be interviewed in each PSU from which a cluster was drawn, 14 were selected at random from among the "sick" households in that PSU and 2 were selected at random from among the "well" households. In one cluster, where the number of "sick" households available was less than 14, all available sick households were included in the sample and the balance were from well households. The final sample drawn for the first passage was therefore 816 households in 51 clusters drawn from 49 PSUs . B. HOUSEHOLD ATTRITION AND REPLACEMENT PROCEDURES 1. Attrition from the household sample a) Attrition between the enumeration and the first passage Among the original 816 households selected from the enumeration, 47 (5.8%) could not be interviewed during the first passage, which occurred 7-12 months after the enumeration. The most important reason for attrition was that the household had moved (53% of the cases). In about a third of these cases, the move was related to the death of a household member. This included five cases in which the household moved following a death and two cases in which the person who died was a single-person household. In nine cases (19%) the household was not interviewed because the head was away.[This was in fact an error on the part of the interviewers early in the survey, which was subsequently corrected. The presence of the household head was not necessary to conduct the interview, unless a household was a single-person household.] Only 4 households -less than half of a percent of the entire sample of 816 households- refused to participate. b) Attrition between the first and fourth passages During the first passage, a total of 840 households were interviewed. This group included the 816 "original" households selected from the enumeration (or their replacements) and 24 "extra" households. The field teams added these households, taken from the list of replacement households, when they sensed that another continuing household in the sample was likely to drop out or was a poor source of information. [Extra households were interviewed during the first passage at the initiative of the field manager. The “extras” were selected from the list of replacement households, however the decision rule for adding extra households was not well documented. An additional 75 households began the survey in later passages, completing a wave 1 questionnaire at the first interview. Their subsequent attrition (5 households) is not studied here.] By the end of the fourth passage, more than two years later, 81 households (9.6% of the 840 interviewed in the first passage) had dropped out. In 80 percent of the cases, the reason for attrition was that the household moved; about a third of those moves were related to an adult death in the household, including one case in which a single-person household died. Only 13 households--16% of the household attrition during the panel--refused to participate. Taken over all 840 households interviewed during the first passage, only 1.5% of the households completing a questionnaire in the first passage refused to be interviewed by the end of the survey. c) Household attrition and adult deaths While there is no indication that adult deaths were the major reported cause of attrition, it was nevertheless not uncommon for a move to be associated with an adult death. Were households with an adult death more likely to drop out of the sample? In fact, households with an adult death in the 12 months before the enumeration were less likely to drop out before the first passage than were households without a death (see Table III.6). On the other hand, the 94 households that had an adult death between passages one and four were half again as likely as households without a death to drop out by the end of the fourth passage. Neither of these differences is statistically significant, however. [In a logit regression of the probability that a household would continue in the sample, controlling for geographic zone or district, neither an adult death nor an illness prior to the enumeration was a statistically significant predictor of continuation between the enumeration and the first passage. However, both the urban zone and Bukoba Urban district had a highly significant negative impact. In a logit regression of the 840 households beginning the panel, a death between waves significantly lowered the probability of continuing to the end of the panel (p=.08), as did urban location.] d) Follow-up of individuals in households that moved In the course of the household survey, between the first and fourth passages, a total of 86 households left the sample, including the 81 households that began the survey in the first passage and 5 households that replaced them and subsequently dropped out. During the fourth passage, the interviewers attempted to locate the 306 individuals who were members of these households if they were still alive and living in Kagera region to be interviewed with a follow-up questionnaire. The time that had elapsed since the last interview was from 6-28 months. The interviewers were able to locate and interview 169 individuals from 52 households that had dropped out, or 55% of the total (see Table III.7). An additional 10 individuals (3%) were known to have died in that interval, and the remaining 127 (42%) individuals were not interviewed, either because they were outside Kagera (4%) or because the whereabouts of the individual could not be determined (37%). Only 3 individuals known to be residing in Kagera could not be found for a follow-up interview. 2. Procedures for replacing households In order to guard against a dwindling sample and to eliminate any incentive for interviewers to reduce their workload by not striving to find a household, households that moved, refused, or otherwise dropped out were replaced. At the start of the first passage, the team supervisors were provided with a list of additional households chosen at random from the PSU to be used as replacements. Beginning in the second passage, the supervisors were to replace a household with another of the same type--"sick" or "well" drawn from the list of replacements. They were provided with the names of 12 additional households from each PSU--six each of "type A" (sick households) and "type B" (well households)--and a new list of sampled households in which the type was indicated. The interviewers and supervisors were not told which type of household (A or B) was a "sick" household. C. SELECTION OF HEALTH FACILITIES, SCHOOLS, MARKETS AND HEALERS The sample of health facilities, schools, and markets that were interviewed or visited was selected based on the information provided by community leaders. The facilities interviewed generally represent those closest to the cluster, and thus do not represent a random sample of facilities in Kagera region. Traditional healers were randomly selected within each community. 1. Health facilities The sample consisted of the nearest health facility (dispensary, health center, or hospital) to each cluster, as indicated on the community questionnaire. Where there was more than one health facility in the cluster (i.e., Bukoba town), all health facilities were to be interviewed. At the same time, some clusters shared the same facilities. The number of facilities interviewed over time increased from 42 in the first passage to 61 by the fourth passage. 2. Primary schools The sample consists of the nearest primary school to each cluster. In the event that there were several primary schools in a cluster, a separate questionnaire was completed for each. As a result, 62 primary schools were interviewed in the first passage. This increased by the fourth passage to 64 because of two schools inadvertently omitted in earlier passages. 3. Markets During the first passage, price data were collected from the nearest market to each cluster. There was no distinction made between whether the data were collected from an open market with several stalls or vendors or whether it was a "duka" or shop of a local merchant, although the type of establishment was noted on the form.[In theory, there should have been 51 price questionnaires for the first passage, one per cluster. However, in some clusters the interviewer completed separate questionnaires for markets and dukas, even in the first passage. Further, two PSUs and four clusters were selected from the Hamgembe neighborhood of Bukoba town. However, the interviewers failed to realize that a price questionnaire was to be completed each time a Hamgembe cluster was interviewed.] For the second through fourth passages, in principle, two price questionnaires were completed for each cluster. One was completed for the nearest marketplace and another was completed for the nearest duka(s). 4. Traditional healers During the third passage, respondents to the community questionnaire were asked to list all of the traditional healers in the community. A total of 317 healers were listed, with 2-13 recorded per cluster. Two healers were selected at random from the list in each cluster to receive the healer questionnaire. An enthusiastic interviewer in fact interviewed a third healer in one cluster, so 103 of these questionnaires were completed in the third passage -- two per cluster in 50 clusters and three in one cluster.
Questionnaires: 
The seven main questionnaires of the KHDS aimed to collect four types of variables, essential to analyzing the impact of fatal adult illness: (1) variables reflecting the well-being of individuals; (2) variables that measure individual and household coping or adjustment; (3) exogenous explanatory variables; and (4) policy instruments. A. HOUSEHOLD QUESTIONNAIRE The KHDS Household Questionnaire is the main data collection instrument used to assess the impact of fatal adult illness. To gather information across the four variable types listed above, the household questionnaire collected data on individuals and households in the following subjects: - Demographic characteristics - Health status, symptoms, health-seeking behavior and medical expenditures - Nutritional status - Mortality and related expenditures - Human capital, enrollments and education expenditures - Fertility and contraceptive use - Time use in the labor force, other productive and health-related activities - Income levels and sources - Assets and durable goods, including housing, farm and business assets - Consumption expenditure, by component - Savings, debts, transfers and receipt of assistance - Characteristics of non-resident parents and children, including their mortality Development of the household questionnaire Rather than design the household questionnaire from scratch, the project team adapted the prototype household questionnaire from the World Bank's Living Standards Measurement Survey (LSMS). The specific needs of the KHDS required important modifications, primarily to measure changes over time and to enable greater analysis of individual well-being within a household: - A new module to measure the mortality of household members and of other relatives, the cause of death, health care-seeking behavior before death and expenditures associated with health care and funerals. - Expanded sets of questions on health status, in terms of both acute and chronic conditions, and on the utilization of health care. - More detailed information about the time use of each household member across a greater number of activities, including caring for sick household members. - An expanded set of questions on remittances and the flow of resources between household members and persons or organizations outside the household. - Revision of all modules to better capture inter-personal differences in well-being. - Adaptation of the questionnaire for a longitudinal research design. The first draft of the household questionnaire was produced in Swahili in March 1991 and subjected to a two-week field test in Kagera Region from April 20 - May 4. The draft questionnaires were asked of different types of households and communities, to ensure that they were capable of collecting the necessary information efficiently and accurately. Attention was also given to making the questionnaire — which included highly sensitive topics such as income, savings, severe illness, and death — culturally acceptable and as inoffensive as possible. The household questionnaire was tested in Bilele ward of Bukoba town and in the village of Lukindo (located about 15 miles from Bukoba in the surrounding hills). The wave 1 household questionnaire was tested at two levels. First, individual sections of the questionnaire were tested independently, then the complete household questionnaire with all sections was tested on a small sample of households. While many parts of the questionnaire were tested on urban and rural households in general (education, activities, farming, consumption), it was necessary to seek out specific types of households to evaluate other parts of the questionnaire (for example, households that had experienced a recent adult death due to AIDS for the section on mortality). One of the major challenges of the field test was to design a module on consumption expenditure that would take into account the seasonality of consumption and production in Kagera, where there are two rainy seasons and two dry seasons in a twelve-month period. Respondents were not able to recall total agricultural production or the quantities of agricultural inputs; all quantity questions in the farming section, except for the total amount of a crop that was sold, were dropped. The health section of the questionnaire was also transformed into separate sets of questions about acute illness (in the past four weeks) and chronic conditions (lasting six months or more). One of the important findings of the field test was that, despite their grief, households were willing to discuss the circumstances surrounding recent deaths with project interviewers. The wave 2 household questionnaire was tested in 29 households in 4 urban and rural communities in March 1992. The main tasks were to develop ways of updating the rosters of household members (section 1), children living elsewhere (section 2), and household durable goods (section 16A), and to adapt the questionnaire to a six-month reference period. In addition, the field test suggested new, inter-wave checks for the data entry program and for the supervisors in the field. Summary of the household questionnaire and respondents a) Section 1: Household roster The objective of the Household Roster is identify household members. For the purposes of the KHDS survey, a household is defined as a person or group of persons who live in the same dwelling and eat meals together for at least three of the 12 months preceding the date of the survey. The household has been "defined” in this way purely to achieve consistency in terms of the field work and to identify those individuals who will answer the in-depth questions of the household questionnaire. Other parts of the household questionnaire collect information on a larger set of individuals to which the household is linked, including non-resident parents, children and other individuals to whom and from whom the household sends and receives transfers of cash or goods. Section 1 collects the names of household members, their relationship to the head of the household, their age, sex, marital status, and the length of time they have been resident. Household members retain the same identification code throughout all waves of the survey. b) Section 2: Children residing elsewhere Section 2 collects information on all nonresident children (both youngsters and adults) of household members, their relation to members of the household, their age, sex, educational attainment, current area of residence, and type of work. Transfers from these children are captured in Section 19 of the questionnaire on remittances. Each child living elsewhere is assigned a unique identification code that is retained for the entire survey. c) Section 3: Information on parents Every household member is linked to his or her parents in the household by their identification code. For those whose parent(s) are deceased or living elsewhere, the following information is collected: area of residence of parents who are alive; educational achievement; and primary lifetime work. For orphans and children living away from both parents, the section also obtains information on the length of time that the child has been in the current household. Information on transfers from non-resident parents to household members, as well as transfers from household members to their parents, is collected in Section 19 of the questionnaire, on remittances. d) Section 4: Summary of household activities This section guides the interviewer in the selection of respondents for the sections of the questionnaire dealing with economic activities and expenditures (Sections 7, 11, 12, 13, 14, 18). It asks about the household's main economic activities and who in the household is most knowledgeable about the household's farming, livestock, fishing, family businesses, and food expenditure. e) Section 5: Education The section on education has three objectives: (1) to measure the current levels of schooling and training of all household members; (2) to measure the current enrollment of all children in the household; and (3) to measure household expenditure on education in the past 12 months. This last objective includes measuring contributions to the schooling of household members by benefactors outside the household—both individuals and organizations. The education section collects the following information for each household member 7 and older: literacy; educational attainment; current enrollment and attendance in the seven days before the interview; distance to school; school expenditures in the past 12 months; and scholarships received, in cash and in kind, by type of sponsoring institution. In instances in which a child missed school in the past 7 days, the questionnaire establishes the reasons for absence, including illness of the child and/or illness of other household members. f) Section 6: Health This section identifies which individuals are suffering from illnesses and details on their health care seeking behavior. The three parts of this section ask about acute illness (part A), chronic illness (part B), and physical ability and general health (part C, added in the wave 2 questionnaire). The questions on acute illness record: (1) who in the household was ill in the four weeks before the interview; (2) the symptoms and diagnosis; (3) the health seeking behavior of households as a result of illness; and (4) medical expenditures and the source of finance. For each household member who was ill or injured in the four weeks prior to the interview, the following information is collected: the duration of the illness; the major symptoms; the number of days the patient was unable to perform his/her usual activities; the first three health practitioners consulted; all of the expenditures associated with them, in cash, in kind, and in time; and expenditures on all other consultations for this episode of illness. The acute illness questions also include information about hospitalizations, the costs of medicine and travel to health consultations, and debt incurred due to the illness. The final questions ascertain whether the illness was diagnosed, the actual diagnosis, and whether the patient has recovered. Chronic conditions, in Part B, are conditions that have existed for 6 months or more. The questions include the symptoms, the duration of the condition, the diagnosis (if a practitioner had been consulted), and expenditures on those conditions in the four weeks before the interview. Through the skip pattern of this section, all household members, including those who had and didn’t have an acute or chronic illness, must respond to questions concerning four symptoms often (but not always) associated with AIDS: recurring diarrhea for a month or more; weight loss; recurring fever: and skin rash. Part C, which was added in the wave 2 household questionnaire, includes questions on general health, specific disabilities, and activities of daily living, like walking, running, lifting, and performing hard labor. The consequences of ill health are taken up in many other sections of the questionnaire: economic activities (7); migration (8); fertility (9); anthropometry (10); expenditures (18); remittances (19); and mortality (20). g) Section 7: Activities of household members The objective of Section 7 is to establish the full scope of economic activities performed by members of the household. In particular, the section aims to: (1) establish the allocation of each household member's time across economic and domestic activities in the days before the interview; and (2) estimate the income of each household member in the past 2 months. It is the section of the questionnaire that will permit the analysis of the impact of adult illness and mortality on the time allocated to individual economic activities, like farming, and on individual and household income. Section 7 is the largest section of the questionnaire, with 8 parts. It collects information on the number of hours per day spent by each household member in the past 7 days on the following activities, and income from them: - work as an employee in as many as two jobs (Part B); - work on an own or family farm, work on a communal farm, processing crops, tending livestock and processing livestock products (Part C); - work on as many as three own or family businesses (Part D); - domestic activities (preparing meals, cleaning, doing laundry, shopping), collecting firewood, collecting water, seeking medical care, caring for sick household members, looking for additional work, helping neighbors and attending funerals (Part E). An elaborate slip pattern sends each respondent to the part of Section 7 that is relevant for his/her activities. Parts F and G capture information on income if the main job last year or the secondary job was different than any of the activities in the seven days before the interview. Finally, part H collects non-earned income for each household member. This information is obtained from the recall of respondents and is known to he inexact. However, it is intended to represent a rough snapshot of the allocation of each person's time in the 7 days prior to the interview.[The KHDS questionnaire seeks to account for all activities of each household member in the past 7 days because it is hypothesized that fatal adult illness and mortality would result in shifting responsibilities and allocation of time among household members. In contrast, the LSMS prototype questionnaire was concerned only with the main economic activity and the secondary activity within the past 7 days.] Other sections of the questionnaire also collect data on the self-employment activities and income at the household level, notably the sections on farming (11), livestock (12), fishing (13) and non-farm self-employment (14). These latter sections collect greater detail on the income and expenditure. h) Section 8: Migration The objective of this short section on migration is to establish the length of time each household member has been residing in his/her current place of residence and the circumstances surrounding the last move. Other aspects of migration covered in the questionnaire are on the Household Roster (section 1) and in sections on children living elsewhere (section 2) and non-resident parents of household members (section 3). i) Section 9: Fertility The objective of the section on fertility is to ascertain: (1) the number of children ever born to every female household member age 15 and older (or younger, if already married); (2) child mortality; (3) the level of schooling attained by deceased children; (4) current pregnancy status; (5) fetal wastage; and (6) contraceptive use. Children are an asset to the household that will hopefully bring future earnings as the child matures. Section 9 provides information on the potential source of support for elderly survivors in the household who may have lost adult children through fatal illness. Related sections of the questionnaire are the Household Roster (Section 1), children living elsewhere (Section 2), education (Section 5), health (Section 6), anthropometrics (Section 10) and mortality (Section 20). j) Section 10 Anthropometry In the anthropometry section, the interviewer measures and records the height and weight of all household members. Section 10 also collects information on the immunization status of children. Children under two years of age were weighed in hanging Salter scales, while those who were older were weighted on adult scales. During the first two passages, all adults were measured with spring scales. In the third and fourth passages, the spring scales were replaced with digital scales. This greatly reduced the dispersion in the weight data for the young children weighed on the adult scales. k) Section 11 : Farming The objective of the section on farming is to collect information on: (1) annual net income due to cultivation of crops; (2) the number and value of farm assets (land and equipment); and (3) the quantity of crops sold. This section is asked in all households engaged in farming, and the respondent is the person in the household who is most familiar with farm income and expenditure. The major parts of Section 11 collect information on the number and size of fields (shambas) owned and cultivated by the household, their sale value, and how they were acquired (Part A); the crops cultivated in the past 12 months, the quantity of production sold, income from sale of crops and expenditures on crop inputs (Part B); the number and age of tree crops (Part C); use of and expenditure on farm inputs (Part D); income from the sale of products from homegrown crops, and expenditures on transforming these crops for sale (Part E); and the ownership, value, purchase and sale of agricultural equipment (Parts F and G). l) Section 12: Livestock This section assesses: (1) the number and value of livestock owned by the household; and (2) household income in the past 12 months due to livestock activities. The first part of section 12 establishes the household's stock of animals at the time of the survey, the value of the stock and changes in the stock over the past year. Part B collects information on income from processing of livestock products in the past year, such as from milk and egg production. Part C measures the expenditures on livestock production in the past 12 months, for items such as herding, veterinary services, and animal feed. m) Section 13: Fishing This section seeks to measure the value of assets of fishermen and their annual income, net of expenses. A separate section on income and assets from fishing was deemed necessary because of the proximity of the project site to Lake Victoria. The three parts of this section include questions on fishing equipment (Part A), income from fishing and smoking or drying fish (Part B) and expenditures on fishing inputs (Part C). The fishermen in this area engage in three types of fishing—with hooks, trawling nets and stationary nets. n) Section 14: Non-farm self-employment The objective of Section 14 is to measure the net income and value of assets for small businesses owned or operated by household members. For each business owned by a member of the household, Section 14 collects the expenditures (Parts A and B), income (Part C) and assets (Part D). The reference period for reporting expenditures is the two weeks prior to the interview (that is, the interval between rounds one and two) if the business is functioning or, if the business is not functioning at the time of the interview a typical time unit of the respondent's choosing. o) Section 15: Housing This section has the objective of measuring: (1) the value of housing assets; (2) expenditures on housing, water, electricity and other utilities; and (3) the physical condition of the housing, which is a direct measure of well-being. Expenditures on housing and utilities, together with the results of other expenditure sections (16, 17, and 18), are an input into the estimate of total annual household consumption expenditure. p) Section 16: Durable goods, annual expenditures and income from assistance programs The objective of this section is to collect information on: (1) the value of durable consumer goods owned by the household (Part A); (2) expenditures on infrequently-purchased items in the past 12 months (Part B); and (3) receipt of cash or in-kind assistance from community organizations (Part C). For each durable good possessed by the household, information is collected on ownership, year of acquisition, purchase price, and potential sale price. Part C is of central importance to the research, since it is here that receipt of assistance by the household from outside organizations is recorded. Receipt of outside assistance by individuals is recorded in Section 19. q) Section 17: Food consumption The objective of the section is to collect information on habitual and recent food consumption, on the basis of which an annual measure of food consumption can be constructed. While some households in the Kagera region purchase all of their food, in most cases they consume both purchased food and food that they produce at home. Thus, Section 17 had to collect information on the value of home production that was consumed as well as purchased food. The second and more difficult challenge was capturing the seasonality of food consumption. Because different foods are consumed during different seasons of the year, it would be incorrect to ask about food consumption for a recent period and to infer that this pattern was representative of the past 12 months. The seasonality of food production and consumption over the entire 12 months before the survey had to be considered. This was rendered more difficult for KHDS by virtue of the fact that there are two rainy and two dry seasons in the Kagera region in a 12 month period, and the timing and duration of each season vary according to locale within the region. The solution to the seasonality problem was to ask every household at the beginning of Section 17 to name the months of the past 12 months during which each wet and dry season took place (Part A). In the remaining parts of Section 17, for each food item that is home-produced (Part B) or purchased (Part C), the respondent must indicate during which months of the year the item was consumed. [By asking for the specific months of the year that an item was consumed, it becomes possible to compute both an annual (12-month) estimate of food consumption expenditure and a 6-month estimate. The latter is very important to the KHDS, since the household questionnaire for the subsequent waves will have a 6-month reference period for food consumption expenditures.] For home-produced and purchased items that are seasonal (Part B and Part C-1). The respondent must report how often the item was consumed in the rainy season and in the dry season, and the value of the amount consumed on average each time. For non-seasonal purchased items (Part. C-2), the respondent is asked how often the item was consumed in the past 12 months and the value of the amount consumed on average each time. The information on the months of the year that an item was consumed, the seasons represented, the frequency of consumption and the average value will permit computation of an estimate of the value of annual food consumption. As an alternative to this method, the questionnaire also asks for all purchased food items (seasonal and non-seasonal, Parts C-l and C-2) the amount spent since round one (two weeks earlier). Thus, for purchased food it will be possible to estimate annual consumption expenditure by two methods: (1) frequency x average value; and (2) actual expenditures in the past 2 weeks x 26. r) Section 18: Individual expenditures While sections 16 and 17 collect expenditures made on behalf of the entire household, section 18 collects information on personal expenditures by individual household members. Section 18A collects expenditures and acquisitions or behalf of individual household members in the past 12 months, while Section 18B collects information on personal expenditures by individual household member since round one (about two weeks previously). The information is gathered for each individual because: (a) it should improve the accuracy of household consumption expenditure estimates; and (b) it will allow the researchers to analyze the distribution of expenditures and acquisitions across different household members, and thus compare levels of individual welfare within households. [Collecting expenditure and consumption information for each individual household member is another way in which the KHDS questionnaire distinguishes itself from the LSMS prototype] The results of this section will allow comparison of expenditures and acquisitions across different types of individuals -- for example, orphans vs. non-orphans, boys vs. girls, men vs. women, sick vs. healthy adults and younger vs. elderly adults. s) Section 19: Remittances and credit Section 19 measures transfers and credit flowing into and out of the household, the reasons for these arrangements, and the level of household savings. Many of the transfers captured in this section will be from nonresident family members - children and parents - whose background is captured in sections 2 and 1 . Section 19 has three parts. The first two parts collect information on receipt of remittances or borrowing (Part A) and sending of remittances or lending (Part B) in the past 12 months, for each household member. [This is another example of the effort of the KHDS questionnaire to collect information on an individual level so as to better analyze the intra-household distribution of well-being.] The total number of each type of transaction is recorded, followed by detailed questions on a maximum of three of each type of transaction: the relationship of the lender or borrower to the household member, where the latter lives, the amount received, borrowed or sent, the reason behind the transaction (if any) and the repayment terms (if any). Part C deals with the savings of individual household members: participation in traditional savings organizations in the past 12 months; savings in formal institutions on the day of the interview; and savings kept elsewhere. t) Section 20: Mortality This section measures: (l) all deaths in the past 12 months and their causes; (2) the health seeking behavior of persons who died in the past 12 months; and (3) household expenditures connected with mortality in the past 12 months. Part A collects information on mortality of relatives living elsewhere. For each death in the household, it collects: the relation of the deceased to the head; age at death; sex; relationship to other household members (including children); marital status; educational background; major work: activity; cause of death; duration of illness before death; symptoms of the fatal illness; consultations before death and expenditures on health care and funerals. A subset of this information is collected on the deaths of non-resident relatives in Part B. As this is perhaps the most sensitive topic in the household questionnaire, it appears at the very end, after the interviewer has established rapport with the household. B. COMMUNITY QUESTIONNAIRE The objective of this questionnaire is to elicit community-wide information on: - demographic characteristics - economy and infrastructure - education - health - agriculture - culture that are common to all households residing in each community. The questionnaire is directed at community leaders who were also specifically asked about the location, distance and identity of the closest market, primary school, dispensary, health center, and hospital. In addition, they were asked to name traditional healers within the community. Information from these questions was used to identify the sample of markets, schools, health facilities, and traditional healers for specific questionnaires in the study. It is important to note that these samples are not randomly selected and therefore, are not representative of the markets, health facilities, schools, and traditional healers in Kagera District. They are representative of the facilities located near the selected sample of households. Changes in the questionnaire across Passages are found in Appendix 1. The questionnaire was shortened between Passage 1 and 2 because communities were being revisited. C. HEALTH FACILITY QUESTIONNAIRE The objective of this questionnaire is to establish changes in the demand for health services and the supply of health services offered at a health facility. The Health Facility Questionnaire was administered to the health facility closest to each cluster. Data collected in this section was organized in three parts. Part A was administered to the medical person in charge and had nine sections: 1. Characteristics of the Facility 2. Personnel 3. Equipment 4. Services 5. Immunizations 6. Family Planning 7. Inpatient Services 8. Demand 9. Fee Exemption Policies Part B was administered to the pharmacist of the facility and asked about the availability of drugs at the facility. Part C, on inpatient and outpatient consultations, was not administered by an interviewer, but was completed by the medical officer in charge. D. SCHOOL QUESTIONNAIRE The objective of the school questionnaire is to assist in the analysis of demand for schooling of household members. It was completed for every primary school in a cluster. If there was no school in the cluster, a school questionnaire was completed for the nearest primary school to the cluster. There are two parts to the school questionnaire. Part A focused on the characteristics, enrollments, and fees for each school and was administered by the interviewer. Part B was left with the headmaster or head teacher of each school so they could refer to school records and inventory to provide information on: (1) the number of textbooks (Kiswahili, math, other) available for the students of each grade; and (2) the number of classes, enrolled students, enrolled female students, students who attended last week, and two-parent orphans enrolled for each grade. A third part, dealing with assistance provided to the school, was added in the second passage. E. PRICE QUESTIONNAIRE The objective of this questionnaire is to measure prices of key consumption goods throughout the survey area and over time. The price questionnaire contained a list of thirty food items, six pharmaceutical products, and thirteen non-food items. Three prices were collected for each item from three different traders at different locations in the market. Price data were collected from two types of market: the nearest community market and roadside shops or dukas for each cluster in each passage. In Passage 1 interviewers generally only visited one type of market. For Passages 2 - 4 the Price Questionnaire was fielded twice in each cluster-- once to the nearest community market and once to the roadside shop. It is important to note that each cluster does not have a market that is uniquely associated with that cluster. Different clusters may share markets and the market closest to the cluster may change from passage to passage. F. TRADITIONAL HEALER QUESTIONNAIRE This questionnaire documents the prices, types of facilities, services, and referral practices of traditional healers in the survey area. The questionnaire was administered to two healers per cluster, who were randomly selected from those listed by the community leaders. [In one cluster the field workers interviewed a third healer. Because of this, there were 103 completed healer questionnaires at the end of Wave 3 instead of the 102 that were expected.] This questionnaire was administered only in Passage 3. This survey includes questions on the number and types of patients seen, the types of health problems encountered, and the healer's knowledge of the etiology of AIDS and of other diseases. There are seven sections of this questionnaire: 1. Personal background of respondents 2. Consultations in past seven days 3. Facilities and equipment 4. Knowledge and practices 5. Prescription and referrals 6. Income and prices 7. Childbirth services Traditional birth attendants were not interviewed. In areas where more than one cluster was selected (for example, Hamgembe), two healers were interviewed for each cluster. SECTION A: Personal Background Question 4: Gastrointestinal problems included problems of the mouth, bloating, abdominal pain and swelling, vomiting, jaundice, liver problems, and rectal and anal problems. STDs (Sexually transmitted diseases) included painful urination, puss from urethra, warts, inguinal swelling, genital ulcers, and genital infections. Cardiovascular conditions included heart palpitations, high blood pressure, stroke, dyspnea on exercise, and varicose veins. The total number of patients seen in question 4 had to be at least equal to the number of patients in questions 1-3. Question 4 could have more patients listed if some had more than one condition. G. FOLLOW-UP QUESTIONNAIRES If the households most severely impacted by adult deaths disintegrate or move out of the sample, then an analysis of the households that remained might underestimate the severity of the impact. In order to deal with this possibility, during the fourth passage the survey teams obtained information from all individuals who were members of households that dropped out since the first passage, and who were still residing in Kagera region. - For all households that dropped out at any time after the first passage, the teams attempted to locate all former household members individually, under the assumption that they may now belong to different households. Those individuals who were found were administered a “Follow-up Questionnaire”, or FUQ, described below. - For households that dropped out during the fourth passage, whose members could be located in Kagera region, and who moved intact, the household-level sections of the wave 4 household questionnaire were also completed. (Households that dropped out in the fourth passage were not replaced.) An intact household is one in which no household members have left, unless they died. They include cases in which new members have joined. The survey questionnaires for individuals and for intact households are described below. Detailed instructions on interview procedures and interpretation of questions in the FUQ are provided in the Wave 4 Interviewer Manual. 1. Follow-up questionnaire for individuals The objective of the FUQ is to obtain information on the well-being of individuals who were in households that moved out of the sample. Using the last questionnaire completed by the household before it dropped out, augmented with data from section 1B concerning where and why the household moved, the field teams attempted to find each member of the households that moved between passages 1 and 4, if they were still in Kagera region. In some instances, household members were no longer living together and had joined other households. Thus, the FUQ, while organized around the household roster from previous interviews, collected information on individuals who formerly lived together but may not be currently living together. It basically consists of the individual sections of a wave 4 household questionnaire (sections 3, 5, 6, 7, 9, 18, 19) plus some additional questions for each individual concerning the characteristics of the new household in which he/she now resides (sections 00C, 00D, 1C, 1D, 1E). The sections that are unique to the FUQ are discussed briefly below. a) Section 00C: Survey information sheet This section identifies which members of the former household moved, when they moved, and where, based on information copied from the household questionnaire for the passage when the household dropped out. In addition, it records the results of the field team’s search for the individual within and outside the survey cluster. b) Section 00D: Identification of the new household In this section the interviewer records characteristics of the household where the former household member is now residing: the place name, region, district of Kagera (if still within Kagera), and cluster number (if in a survey cluster); the name of the current head of household and whether this is the same as the head at the time the household discontinued; and the current head’s sex, age, schooling, religion, tribe, and occupation. c) Section 1C: Demographic characteristics of the respondent This section is an abbreviated version of the questions in Section 1 of the KHDS household questionnaire. It asks for the respondent’s sex, relationship to the head of the current household, age, marital status, co-residence in the current household of the spouse and his/her ID code, the number of months the respondent has been living with the current household in this dwelling, and the reason why the household member moved. In addition, the interviewer must list the ID code of all people formerly in the respondent’s household who are also in the household where the respondent is currently residing. d) Section 1D: Economic characteristics of the current household This section collects summary information on the characteristics of the respondent’s current household: the number of household members by age (0-14 and 15+) and gender; and the number of members who work on a family farm (question 5), raise animals that they own (question 6), own a business or are self-employed (question 7), or who work as employees for an employer outside the household (question 8). e) Section 1E: Individual assets This section collects information on assets and durable goods currently owned by individuals and those sold by individuals since they were last interviewed. The assets and durable goods include: dwellings (questions 1-4A); durable goods (questions 5-8); shambas/fields (questions 9-12A); and cattle (questions 13-16A). 2. Following intact households that moved A total of 14 households moved intact between the third and fourth passages of fieldwork--that is, all of the household members except those who died were still living together as a unit, even though some new members may have joined the household. All of these households had joined the survey in the first passage and dropped out between the third and fourth passages. The last complete household questionnaire for all of them was a wave 3 questionnaire. In following these intact households, several different questionnaires were completed: - As was the case for all households that dropped out at any time during the survey, sections 1A, 1B, and 20a of the household questionnaire were completed and entered with the rest of the household data for wave 4. The information in sections 1A and 1B will indicate that the household members moved. - The Follow-up Questionnaire for individuals (described above) was completed for all household members who could be located from the 14 intact households. However, the FUQ was not completed for anyone who had joined the household since the third passage. - Household-level sections of the Wave 4 questionnaire were also completed for these 14 households: sections 1, 2, 4, 11, 12, 13, 14, 15, 16, 17, and 20b. Thus, except for information on those who joined the household, it is theoretically possible to assemble a complete file of wave 4 data on the 14 households that moved intact between passages 3 and 4, thereby increasing the sample size for the fourth passage. There was no logical place to put moving expenses or housing construction expenditure in the wave 4 household questionnaire, so interviewers were instructed to record moving expenses for the intact households in Section 16B, item 17, as expenditures on “home services”, and construction or purchase of new housing under item 37 of Section 16B.
Supervision: 
The KHDS field operations used a number of important supervisory checks and a customized data entry program, which minimized errors by the respondents, interviewers, and data entry operators, and guaranteed high-quality data. - Sections 1-10 of the household questionnaire, completed in round one of each passage, collected information on each household member. Each individual was interviewed separately, in private. This procedure minimized the use of proxy respondents and ensured greater confidentiality during the interview. - The supervisors observed one interview per interviewer per week to assure that the correct procedures were being followed and that the interviewer fully understood the questionnaires. - Before leaving the field site, the supervisors completed a list of twenty or more internal consistency checks on each of the questionnaires and conducted random re-interviews for a subset of questions in one quarter of all households. In the event of mistakes or incomplete answers, the interviewer returned to the household to complete or correct the questionnaire. - A customized data entry program in the Bukoba office detected internal inconsistencies, missing information, and erroneous answers after each round. The data entry program also compared the following information between waves: sex, age, activities, durable goods, livestock and housing. Discrepancies were flagged to the supervisor. It also produced a printout of all of the entered data, which was then checked by the supervisors or a group of verifiers for errors. The ability to return to the field between rounds to correct the information directly with respondents was expected to markedly improve the accuracy and timeliness of the data. - The data entry program for the wave 2, 3, and 4 household questionnaires printed a list of durable goods owned the previous passage which allowed the interviewer to confirm that every durable good previously declared could be accounted for during subsequent interviews. - The field manager and a senior supervisor checked the supervisors’ work randomly through unannounced field visits. The quality controls implemented in the KHDS are discussed in greater detail in the Supervisor Manual.
Other Processing: 
Household level information - Demographic characteristics - Health status, symptoms, health-seeking behavior and medical expenditures - Nutritional status - Mortality and related expenditures - Human capital, enrollments and education expenditures - Fertility and contraceptive use - Time use in the labor force, other productive and health-related activities - Income levels and sources - Assets and durable goods, including housing, farm and business assets - Consumption expenditure, by component - Savings, debts, transfers and receipt of assistance - Characteristics of non-resident parents and children, including their mortality Community-level information - Demographic characteristics - Economy and infrastructure - Education - Health - Agriculture - Culture Health facility information - Characteristics of the Facility - Personnel - Equipment - Services - Immunizations - Family Planning - Inpatient Services - Demand - Fee Exemption Policies School facility information - Characteristics, enrollments, and fees - Number of textbooks (Kiswahili, math, other) available for the students of each grade - Number of classes, enrolled students, enrolled female students, students who attended last week, and two-parent orphans enrolled for each grade. - Assistance provided to the school (added on second passage) Price data - Pices of key consumption goods
Time Periods: 
August, 2017

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Use of the dataset must be acknowledged by including a citation which would include: - Identification of the Primary Investigator - Title of the survey (including the country name and year of implementation) - Survey reference number - Source and date of download Example: World Bank and University of Dar es Salaam.Tanzania, Kagera Health and Development Survey 1991-1994 (Wave 1 to 4 Panel). Ref. TZA_1991_KHDS_v01_M. Dataset downloaded from the World Bank Microdata Library (www.microdata.worldbank.org) on [date]

The Kagera Health and Development Survey was conducted for the research project on “The Economic Impact of Fatal Adult Illness due to AIDS and Other Causes”, Mead Over (Principal Investigator, World Bank), Martha Ainsworth (Co-investigator, World Bank), and Godlike Koda, George Lwihula, Phare Mujinja, and Innocent Semali (Co-investigators, University of Dar es Salaam). The primary objective of the Kagera Health and Development Survey (KHDS) was to estimate the economic impact of the death of prime-age adults on surviving household members. This impact was primarily measured as the difference in well-being between households with and without the death of a prime-age adult (15-50), over time. An additional hypothesis was that households in communities with high mortality rates might be less successful in coping with a prime-age adult death. Thus, the research design called for collecting extensive socioeconomic information from households with and without adult deaths in communities with high and low adult mortality rates. Data collected by the KHDS can be used to estimate the "direct costs” of illness and mortality in terms of out-of-pocket expenditures, the "indirect costs" in terms of foregone earnings of the patient, and the "coping costs” in terms of changes in the well-being of other household members and in the allocation on of time and resources within the household as these events unfold. The KHDS was an economic survey. It did not attempt to measure knowledge, attitudes, behaviors or practices related to HIV infection or AIDS in households or communities. It also did not collect blood samples or attempt to measure HIV seroprevalence; this would have substantially affected the costs and complexity of the research and possibly the willingness of households to participate. Information on the cause of death in the KHDS household survey is based on the reports of surviving household members; the researchers maintained that household coping will respond to the perceived cause of death, irrespective of whether the deceased actually died of AIDS. Lastly, the KHDS did not attempt to measure the psycho-social impact of HIV infection or AIDS deaths. OVERVIEW OF THE RESEARCH DESIGN The research design called for a longitudinal survey of a sample of households, some of which would experience an adult death and some of which would not, some of them drawn from communities with high adult mortality rates, and some drawn from low-mortality communities. The sampling frame for the survey was based on the 1988 Tanzania Census, which also provided information on adult death rates by ward within Kagera region. While it was possible to determine which communities had relatively high and low adult death rates from the census data, two additional problems arose that led to the decision for a stratified sample of households based on multiple criteria: - First, despite the high rates of HIV infection in Kagera and the large number of deaths over time due to AIDS, the death of a prime-age adult is still a relatively rare event over a short time period. This meant that a very large sample would have had to be selected in order to ensure that the survey could interview enough families suffering our about to suffer the death of a prime-age adult. - Second, HIV prevalence and adult mortality rates in Kagera were geographically concentrated and thus strongly correlated with different climates and cropping patterns. The highest rural HIV infection rates were in the northeast (10% in Bukoba Rural and Muleba districts and 24% in the town of Bukoba), where tree crops (bananas, coffee) were predominant, while the lowest rates were in the south and west (0.4% in Ngara and Biharamulo districts), where perennial crops and livestock are more common (Killewo and others 1990). A survey design stratified only on mortality rates might confound the effects of high mortality with different agricultural, soil, and rainfall patterns. Thus, the sample of households was selected from a stratified random sample of communities from the 1988 census (stratified on agroclimatic zone and adult mortality rate). Within communities, the household sample was stratified according to the anticipated risk of each household of suffering a prime-age adult death. Households were classified as “high-risk” or “low-risk”, based on information obtained from a house-to-house enumeration of all selected communities. One additional concern was that the high mortality of households might lead to attrition from the sample that is systematically related to household coping. For example, if out-migration is an important coping behavior, then the most severely affected households might leave the sample and the analysis of the remaining households would understate the economic impact of adult deaths. For this reason, at the conclusion of the fieldwork, interviewers attempted to locate and interview all of the individuals who were members of households that dropped out of the longitudinal survey between the first and last interviews, and who were still resident in the region. Individuals were given a specially designed “follow-up questionnaire” that included much of the individual information collected in the household questionnaire, plus information on the reason for leaving the sample and the characteristics of the household were they were now residing. The final longitudinal household survey followed 816 households at 6-7 month intervals, over a 24-month period from 1991-94. The 816 households were selected from 51 “clusters” of 16 households each located in 49 villages or urban areas representing four economic zones of all districts in Kagera region and, within each zone, representing areas with both high and low adult mortality. Because household coping behavior is conditioned on local prices, services, and available programs, the KHDS also collected data from the communities from which households were drawn, local markets, the nearest source of modern medical care, and all of the primary schools in the community. This information was collected longitudinally, with the exception of a questionnaire for traditional healers, which was administered only once. While households were drawn from a stratified random sample of households, the health facilities, schools, markets and healers interviewed represent those closest to each community and thus are not random samples that are statistically representative of Kagera facilities. The panel survey was conducted in a total of five waves. - Wave 1 September 1991 - May 1992 - Wave 2 April 1992 - November 1992 - Wave 3 November 1992 - May 1993 - Wave 4 June 1993 - January 1994 - Wave 5 - 2004

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2020-02-12
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4f5d558c-955d-468c-b421-a819df54e95e
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Acronym: 
KHDS 1991-1994
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The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Time Periods: 
August, 2017
Supervision: 
The KHDS field operations used a number of important supervisory checks and a customized data entry program, which minimized errors by the respondents, interviewers, and data entry operators, and guaranteed high-quality data. - Sections 1-10 of the household questionnaire, completed in round one of each passage, collected information on each household member. Each individual was interviewed separately, in private. This procedure minimized the use of proxy respondents and ensured greater confidentiality during the interview. - The supervisors observed one interview per interviewer per week to assure that the correct procedures were being followed and that the interviewer fully understood the questionnaires. - Before leaving the field site, the supervisors completed a list of twenty or more internal consistency checks on each of the questionnaires and conducted random re-interviews for a subset of questions in one quarter of all households. In the event of mistakes or incomplete answers, the interviewer returned to the household to complete or correct the questionnaire. - A customized data entry program in the Bukoba office detected internal inconsistencies, missing information, and erroneous answers after each round. The data entry program also compared the following information between waves: sex, age, activities, durable goods, livestock and housing. Discrepancies were flagged to the supervisor. It also produced a printout of all of the entered data, which was then checked by the supervisors or a group of verifiers for errors. The ability to return to the field between rounds to correct the information directly with respondents was expected to markedly improve the accuracy and timeliness of the data. - The data entry program for the wave 2, 3, and 4 household questionnaires printed a list of durable goods owned the previous passage which allowed the interviewer to confirm that every durable good previously declared could be accounted for during subsequent interviews. - The field manager and a senior supervisor checked the supervisors’ work randomly through unannounced field visits. The quality controls implemented in the KHDS are discussed in greater detail in the Supervisor Manual.
Economy Coverage: 
Primary Investigator Name, Affiliation: 
World Bank and University of Dar es Salaam
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Version Description: 
Version 1.1 (March 2011).
Geographical Coverage: 
Data Classification of a Dataset: 
Series Information: 
This dataset provides waves 1 to 4 (1991-1994) of the panel Kagera Health and Development Survey. A fifth wave was conducted in 2004.
Sampling Procedure: 
SAMPLE DESIGN AND SELECTION Qualitative studies of small samples of households can point to hypotheses about the ways in which fatal adult illness affects households. However, policymakers need to know which households are suffering the most, the size of the impact, the extent to which they suffer more than other households in a poor country, and the potential costs and effects of assistance programs. For this purpose, the sample of households must be representative of the population, a random sample for which the probability of selecting each household from the whole population is known. The KHDS used a random sample that was stratified geographically and according to several measures of adult mortality risk. This strategy allowed the team to ensure an adequate number of households with an adult death in the sample while retaining the ability to extrapolate the results to the entire population. The results from the household survey show that stratification of the sample on mortality risk at both the community and household level proved to be worthwhile. Among the 816 households in the original sample that began the survey in the first passage, 91 had an adult death in the course of the survey—more than three times the expected number (25) had the households been drawn at random with no stratification. The 816 households that began the survey in the first passage were observed, on average, for 1.6 years, generating a total of 1,322.7 years of observation. The average probability of an adult death per household per year, according to the 1988 Tanzania Census, is 0.0188. Thus, the expected number of deaths from a random sample of 816 households observed for 1.6 years is 25. Because households were added to the sample to compensate for attrition, a total of 918 households were eventually interviewed at least once. Between the first and last interview, 102 of these households had an adult death, compared to 27 households that would have been expected to have a death from from a non-stratified sample. A. THE TWO-STAGE STRATIFIED RANDOM SAMPLING PROCEDURE The KHDS household sample was drawn in two stages, with stratification based on geography in the first stage and mortality risk in both stages. 1. First Stage: Selection of communities and clusters In the first stage of selecting the sample, the 550 primary sampling units (PSUs) in Kagera region were classified according to eight strata defined over four agronomic zones and, within each zone, the level of adult mortality (high and low). A PSU is a geographical area delineated by the 1988 Tanzanian Census that usually corresponds to a community or, in the case of a town, to a neighborhood. Clusters of households were drawn randomly from the PSUs in each stratum, with a probability of selection proportional to the size of the PSU. a) Classification of communities by sampling stratum The four agronomic zones are: - Tree Crop Zone: Low fertility soils in areas of high rainfall, where the main crops are bananas, coffee, and tea. This zone is in the northern part of Kagera with communities in Bukoba Rural and Muleba Districts. - Riverine Zone: Alluvial and colluvial soils of considerable potential, but requiring flood control, where the cropping pattern is mixed and includes cereals, sugarcane, rice, and legumes, as well as tree crops. This zone is in the middle of the region; most of its communities are in Karagwe and Bukoba Rural Districts and a few in Muleba District. - Annual Crop Zone: Soils of low to medium fertility with moderate potential and lower rainfall, where the cropping pattern is mixed and includes groundnuts, cassava, beans, cotton as well as some cereals (maize, sorghum) and pasture, but few tree crops. This is in the southern part of Kagera in Biharamulo and Ngara Districts. - Urban Zone: The town of Bukoba, the region's capital, plus an additional 27 communities in Muleba, Karagwe, Ngara, and Biharamulo Districts that were designated as urban by the 1988 census. The zone labels were chosen for simplicity. They suggest the characteristic, though by no means exclusive, agricultural pattern. Within each agronomic zone, PSUs were classified according to the level of adult mortality. The 1988 Tanzanian Census asked a 15 percent sample of households about recent adult deaths. Those answers were aggregated at the level of the "ward", an administrative area that is smaller than a district. The adult mortality rate (15-50) was calculated for each ward and each PSU was assigned its ward’s adult mortality rate. [Note: There were 111 wards in Kagera in 1988. Because the adult mortality rates were much higher in some zones than others and the distribution was quite different within zones, "high" and "low" mortality PSUs were defined relative to other PSUs within the same zone. A PSU was classified as in the "high" mortality category if its ward adult mortality rate was at the 90th percentile or higher of the ward adult mortality rates within a given agronomic zone. b) Selection of Clusters Having classified all of the PSUs in Kagera into the eight strata, it remained to select the PSUs from which households would be drawn, and how many households would be interviewed in each of the selected PSUs. To facilitate fieldwork and reduce its costs, the KHDS interviewed households within PSUs in clusters of 16 households each. Based on experience with other LSMS surveys, this is the number of households that could reasonably be interviewed by a field team of one supervisor, two interviewers, and an anthropometrist in a week. The probability that a PSU was selected within each stratum was proportional to its size (the number of households), according to the following formula [note: in the high-mortality urban stratum, eight clusters had to be selected from only six PSUs. In that case, for some PSUs in the stratum the probability exceeded one and more than one cluster was drawn from a PSU]: Probability of Selecting this PSU = (Number of Clusters in this Stratum x Number of households in this PSU) / Number of HHs in this Stratum The research design and the budget called for surveying 50 clusters of 16 households each, for a total sample of 800 households. Divided across the eight strata, this would imply the need to enumerate roughly 6 PSUs in each of six strata and 7 PSUs in two strata. However, to guard against attrition of entire communities and the possibility that actual mortality rates would be found to be quite different from those observed in the census, more PSUs were enumerated than would be needed for the survey. A total of 62 PSUs were selected from the 549 in the region to be enumerated--8 PSUs were selected at random from each of seven strata and all 6 PSUs in the high-mortality urban stratum were selected. However, the field teams successfully enumerated only 52 PSUs, from which 54 clusters could be drawn. Ten PSUs were not enumerated, generally because they were inaccessible or the teams ran out of time. Two PSUs were on islands and one was in a game park. The rainy season substantially slowed down the enumeration and made some PSUs inaccessible. Among the 10 PSUs not enumerated, three were in the riverine zone, six were in the annual crop zone, and one was in the urban zone . The distribution of the ten PSUs not enumerated by district is: Bukoba Urban (0); Bukoba Rural (1); Muleba (1); Biharamulo (3); Ngara (3); Karagwe (2). Of the 52 PSUs that were enumerated, only 48 were needed (allowing for selection of two clusters from each of two PSUs in the urban high-mortality zone). In zone 3, where fewer PSUs were enumerated than were anticipated in the research design, all 10 enumerated PSUs were accepted into the sample. To compensate, it was decided to select a total of 14 PSUs in the tree crop zone, and 12 each in the annual crop and urban zones, for a total of 48. In deciding which PSUs to drop, the PSUs were ordered within each zone, from highest to lowest adult death rate based on the enumeration results. [The correspondence between the adult mortality rates from the 1988 Tanzanian Census and the rates found by the enumeration was not particularly good. The AMR from the enumeration were often higher for PSUs classified as “low mortality” within a zone, than they were for “high mortality”, and vice-versa.] In order to maximize the differences between PSUs in the high- and low mortality groupings within a zone (the definition of which remained based on the census), the PSUs dropped from each zone were in the "middle" of the distribution of enumeration adult mortality rates for that zone. For example, in the riverine zone, where 13 PSUs were enumerated, the PSU with the median adult mortality rate from the enumeration was dropped. Using this method, one PSU each was dropped from the riverine and urban zones and two were dropped from the tree crop zone, leaving 48 PSUs from which 50 clusters were selected. A 51st cluster from the highmortality tree crop stratum was added toward the end of the first passage of field work, to ensure that an adequate sample size would be maintained should an entire cluster drop out later during the panel. Thus, the final KHDS sample included 49 PSUs from which 51 clusters of 16 households each were drawn. 2. Second Stage : Selection of Households In the second stage, households within each of the selected PSUs were assigned to one of two strata "sick" or "well" based on the results of an enumeration of all households in each community. Sixteen households were selected at random per cluster, of which 14 were selected from the "sick" group and 2 from the "well" group. a) Enumeration of households Between March 15 and June 13, 1991, 29,602 households were enumerated in 52 primary sampling units. In addition to recording the name of the head of each household, the number of adults in the household (15 and older), and the number of children, the enumeration form asked: "Are any adults in this household ill at this moment and unable to work? If so, the age of the sick adult and the number of weeks he/she has been too sick to work. "Has any adult 15-50 in this household died in the past 12 months? If so, the age of each adult and the cause of death (illness, accident, childbirth, other). The enumeration form asked explicitly about illness and death of adults 15-50 because this is the age group disproportionately affected by the HIV/AIDS epidemic and it is the impact of these deaths that were of research interest. Since AIDS is sexually transmitted, other adults in the same household with an AIDS patient may also become infected, either through sexual contact with the HIV-infected person or because of similarities in sexual behavior. Thus, AIDS morbidity and deaths are likely to be clustered in households. Information on illness and deaths on the enumeration form could be recorded for a maximum of three people (for each question) per household. Of the more than 29,000 households enumerated, only 3.7%, or 1,101, had experienced the death of a an adult 15-50 due to illness during the twelve months before the interview and only 3.9%, or 1,145, contained a prime-age adult too sick to work at the time of the interview. Only 77 households had both an adult death due to illness and a sick adult. This underscores the point that, even with some stratification based on community mortality rates and in an area with very high adult mortality due to an AIDS epidemic, a very large sample would have had to have been selected to observe a sufficient number of households that would experience an adult death during the two-year survey. b) Selection of households To further increase the probability of capturing households with adult deaths in the sample, households were stratified according to the extent of adult illness and mortality. It was assumed that in communities suffering from an HIV epidemic, a history of prior adult death or illness in a household might predict future adult deaths in the same household. The households in each enumerated PSU were classified into two groups, based on their response to the enumeration: -"Sick" households: Those that had either an adult death 15-50 due to illness in the past 12 months, an adult too sick to work at the time of the survey, or both (n=2,169). - "Welll" households: Those that had neither an adult death 15-50 due to illness nor an adult 15-50 too sick to work (n=27,433). In selecting the 16 households to be interviewed in each PSU from which a cluster was drawn, 14 were selected at random from among the "sick" households in that PSU and 2 were selected at random from among the "well" households. In one cluster, where the number of "sick" households available was less than 14, all available sick households were included in the sample and the balance were from well households. The final sample drawn for the first passage was therefore 816 households in 51 clusters drawn from 49 PSUs . B. HOUSEHOLD ATTRITION AND REPLACEMENT PROCEDURES 1. Attrition from the household sample a) Attrition between the enumeration and the first passage Among the original 816 households selected from the enumeration, 47 (5.8%) could not be interviewed during the first passage, which occurred 7-12 months after the enumeration. The most important reason for attrition was that the household had moved (53% of the cases). In about a third of these cases, the move was related to the death of a household member. This included five cases in which the household moved following a death and two cases in which the person who died was a single-person household. In nine cases (19%) the household was not interviewed because the head was away.[This was in fact an error on the part of the interviewers early in the survey, which was subsequently corrected. The presence of the household head was not necessary to conduct the interview, unless a household was a single-person household.] Only 4 households -less than half of a percent of the entire sample of 816 households- refused to participate. b) Attrition between the first and fourth passages During the first passage, a total of 840 households were interviewed. This group included the 816 "original" households selected from the enumeration (or their replacements) and 24 "extra" households. The field teams added these households, taken from the list of replacement households, when they sensed that another continuing household in the sample was likely to drop out or was a poor source of information. [Extra households were interviewed during the first passage at the initiative of the field manager. The “extras” were selected from the list of replacement households, however the decision rule for adding extra households was not well documented. An additional 75 households began the survey in later passages, completing a wave 1 questionnaire at the first interview. Their subsequent attrition (5 households) is not studied here.] By the end of the fourth passage, more than two years later, 81 households (9.6% of the 840 interviewed in the first passage) had dropped out. In 80 percent of the cases, the reason for attrition was that the household moved; about a third of those moves were related to an adult death in the household, including one case in which a single-person household died. Only 13 households--16% of the household attrition during the panel--refused to participate. Taken over all 840 households interviewed during the first passage, only 1.5% of the households completing a questionnaire in the first passage refused to be interviewed by the end of the survey. c) Household attrition and adult deaths While there is no indication that adult deaths were the major reported cause of attrition, it was nevertheless not uncommon for a move to be associated with an adult death. Were households with an adult death more likely to drop out of the sample? In fact, households with an adult death in the 12 months before the enumeration were less likely to drop out before the first passage than were households without a death (see Table III.6). On the other hand, the 94 households that had an adult death between passages one and four were half again as likely as households without a death to drop out by the end of the fourth passage. Neither of these differences is statistically significant, however. [In a logit regression of the probability that a household would continue in the sample, controlling for geographic zone or district, neither an adult death nor an illness prior to the enumeration was a statistically significant predictor of continuation between the enumeration and the first passage. However, both the urban zone and Bukoba Urban district had a highly significant negative impact. In a logit regression of the 840 households beginning the panel, a death between waves significantly lowered the probability of continuing to the end of the panel (p=.08), as did urban location.] d) Follow-up of individuals in households that moved In the course of the household survey, between the first and fourth passages, a total of 86 households left the sample, including the 81 households that began the survey in the first passage and 5 households that replaced them and subsequently dropped out. During the fourth passage, the interviewers attempted to locate the 306 individuals who were members of these households if they were still alive and living in Kagera region to be interviewed with a follow-up questionnaire. The time that had elapsed since the last interview was from 6-28 months. The interviewers were able to locate and interview 169 individuals from 52 households that had dropped out, or 55% of the total (see Table III.7). An additional 10 individuals (3%) were known to have died in that interval, and the remaining 127 (42%) individuals were not interviewed, either because they were outside Kagera (4%) or because the whereabouts of the individual could not be determined (37%). Only 3 individuals known to be residing in Kagera could not be found for a follow-up interview. 2. Procedures for replacing households In order to guard against a dwindling sample and to eliminate any incentive for interviewers to reduce their workload by not striving to find a household, households that moved, refused, or otherwise dropped out were replaced. At the start of the first passage, the team supervisors were provided with a list of additional households chosen at random from the PSU to be used as replacements. Beginning in the second passage, the supervisors were to replace a household with another of the same type--"sick" or "well" drawn from the list of replacements. They were provided with the names of 12 additional households from each PSU--six each of "type A" (sick households) and "type B" (well households)--and a new list of sampled households in which the type was indicated. The interviewers and supervisors were not told which type of household (A or B) was a "sick" household. C. SELECTION OF HEALTH FACILITIES, SCHOOLS, MARKETS AND HEALERS The sample of health facilities, schools, and markets that were interviewed or visited was selected based on the information provided by community leaders. The facilities interviewed generally represent those closest to the cluster, and thus do not represent a random sample of facilities in Kagera region. Traditional healers were randomly selected within each community. 1. Health facilities The sample consisted of the nearest health facility (dispensary, health center, or hospital) to each cluster, as indicated on the community questionnaire. Where there was more than one health facility in the cluster (i.e., Bukoba town), all health facilities were to be interviewed. At the same time, some clusters shared the same facilities. The number of facilities interviewed over time increased from 42 in the first passage to 61 by the fourth passage. 2. Primary schools The sample consists of the nearest primary school to each cluster. In the event that there were several primary schools in a cluster, a separate questionnaire was completed for each. As a result, 62 primary schools were interviewed in the first passage. This increased by the fourth passage to 64 because of two schools inadvertently omitted in earlier passages. 3. Markets During the first passage, price data were collected from the nearest market to each cluster. There was no distinction made between whether the data were collected from an open market with several stalls or vendors or whether it was a "duka" or shop of a local merchant, although the type of establishment was noted on the form.[In theory, there should have been 51 price questionnaires for the first passage, one per cluster. However, in some clusters the interviewer completed separate questionnaires for markets and dukas, even in the first passage. Further, two PSUs and four clusters were selected from the Hamgembe neighborhood of Bukoba town. However, the interviewers failed to realize that a price questionnaire was to be completed each time a Hamgembe cluster was interviewed.] For the second through fourth passages, in principle, two price questionnaires were completed for each cluster. One was completed for the nearest marketplace and another was completed for the nearest duka(s). 4. Traditional healers During the third passage, respondents to the community questionnaire were asked to list all of the traditional healers in the community. A total of 317 healers were listed, with 2-13 recorded per cluster. Two healers were selected at random from the list in each cluster to receive the healer questionnaire. An enthusiastic interviewer in fact interviewed a third healer in one cluster, so 103 of these questionnaires were completed in the third passage -- two per cluster in 50 clusters and three in one cluster.
Release Date: 
Thursday, September 29, 2011
Last Updated Date: 
Thursday, January 30, 2020
Questionnaires: 
The seven main questionnaires of the KHDS aimed to collect four types of variables, essential to analyzing the impact of fatal adult illness: (1) variables reflecting the well-being of individuals; (2) variables that measure individual and household coping or adjustment; (3) exogenous explanatory variables; and (4) policy instruments. A. HOUSEHOLD QUESTIONNAIRE The KHDS Household Questionnaire is the main data collection instrument used to assess the impact of fatal adult illness. To gather information across the four variable types listed above, the household questionnaire collected data on individuals and households in the following subjects: - Demographic characteristics - Health status, symptoms, health-seeking behavior and medical expenditures - Nutritional status - Mortality and related expenditures - Human capital, enrollments and education expenditures - Fertility and contraceptive use - Time use in the labor force, other productive and health-related activities - Income levels and sources - Assets and durable goods, including housing, farm and business assets - Consumption expenditure, by component - Savings, debts, transfers and receipt of assistance - Characteristics of non-resident parents and children, including their mortality Development of the household questionnaire Rather than design the household questionnaire from scratch, the project team adapted the prototype household questionnaire from the World Bank's Living Standards Measurement Survey (LSMS). The specific needs of the KHDS required important modifications, primarily to measure changes over time and to enable greater analysis of individual well-being within a household: - A new module to measure the mortality of household members and of other relatives, the cause of death, health care-seeking behavior before death and expenditures associated with health care and funerals. - Expanded sets of questions on health status, in terms of both acute and chronic conditions, and on the utilization of health care. - More detailed information about the time use of each household member across a greater number of activities, including caring for sick household members. - An expanded set of questions on remittances and the flow of resources between household members and persons or organizations outside the household. - Revision of all modules to better capture inter-personal differences in well-being. - Adaptation of the questionnaire for a longitudinal research design. The first draft of the household questionnaire was produced in Swahili in March 1991 and subjected to a two-week field test in Kagera Region from April 20 - May 4. The draft questionnaires were asked of different types of households and communities, to ensure that they were capable of collecting the necessary information efficiently and accurately. Attention was also given to making the questionnaire — which included highly sensitive topics such as income, savings, severe illness, and death — culturally acceptable and as inoffensive as possible. The household questionnaire was tested in Bilele ward of Bukoba town and in the village of Lukindo (located about 15 miles from Bukoba in the surrounding hills). The wave 1 household questionnaire was tested at two levels. First, individual sections of the questionnaire were tested independently, then the complete household questionnaire with all sections was tested on a small sample of households. While many parts of the questionnaire were tested on urban and rural households in general (education, activities, farming, consumption), it was necessary to seek out specific types of households to evaluate other parts of the questionnaire (for example, households that had experienced a recent adult death due to AIDS for the section on mortality). One of the major challenges of the field test was to design a module on consumption expenditure that would take into account the seasonality of consumption and production in Kagera, where there are two rainy seasons and two dry seasons in a twelve-month period. Respondents were not able to recall total agricultural production or the quantities of agricultural inputs; all quantity questions in the farming section, except for the total amount of a crop that was sold, were dropped. The health section of the questionnaire was also transformed into separate sets of questions about acute illness (in the past four weeks) and chronic conditions (lasting six months or more). One of the important findings of the field test was that, despite their grief, households were willing to discuss the circumstances surrounding recent deaths with project interviewers. The wave 2 household questionnaire was tested in 29 households in 4 urban and rural communities in March 1992. The main tasks were to develop ways of updating the rosters of household members (section 1), children living elsewhere (section 2), and household durable goods (section 16A), and to adapt the questionnaire to a six-month reference period. In addition, the field test suggested new, inter-wave checks for the data entry program and for the supervisors in the field. Summary of the household questionnaire and respondents a) Section 1: Household roster The objective of the Household Roster is identify household members. For the purposes of the KHDS survey, a household is defined as a person or group of persons who live in the same dwelling and eat meals together for at least three of the 12 months preceding the date of the survey. The household has been "defined” in this way purely to achieve consistency in terms of the field work and to identify those individuals who will answer the in-depth questions of the household questionnaire. Other parts of the household questionnaire collect information on a larger set of individuals to which the household is linked, including non-resident parents, children and other individuals to whom and from whom the household sends and receives transfers of cash or goods. Section 1 collects the names of household members, their relationship to the head of the household, their age, sex, marital status, and the length of time they have been resident. Household members retain the same identification code throughout all waves of the survey. b) Section 2: Children residing elsewhere Section 2 collects information on all nonresident children (both youngsters and adults) of household members, their relation to members of the household, their age, sex, educational attainment, current area of residence, and type of work. Transfers from these children are captured in Section 19 of the questionnaire on remittances. Each child living elsewhere is assigned a unique identification code that is retained for the entire survey. c) Section 3: Information on parents Every household member is linked to his or her parents in the household by their identification code. For those whose parent(s) are deceased or living elsewhere, the following information is collected: area of residence of parents who are alive; educational achievement; and primary lifetime work. For orphans and children living away from both parents, the section also obtains information on the length of time that the child has been in the current household. Information on transfers from non-resident parents to household members, as well as transfers from household members to their parents, is collected in Section 19 of the questionnaire, on remittances. d) Section 4: Summary of household activities This section guides the interviewer in the selection of respondents for the sections of the questionnaire dealing with economic activities and expenditures (Sections 7, 11, 12, 13, 14, 18). It asks about the household's main economic activities and who in the household is most knowledgeable about the household's farming, livestock, fishing, family businesses, and food expenditure. e) Section 5: Education The section on education has three objectives: (1) to measure the current levels of schooling and training of all household members; (2) to measure the current enrollment of all children in the household; and (3) to measure household expenditure on education in the past 12 months. This last objective includes measuring contributions to the schooling of household members by benefactors outside the household—both individuals and organizations. The education section collects the following information for each household member 7 and older: literacy; educational attainment; current enrollment and attendance in the seven days before the interview; distance to school; school expenditures in the past 12 months; and scholarships received, in cash and in kind, by type of sponsoring institution. In instances in which a child missed school in the past 7 days, the questionnaire establishes the reasons for absence, including illness of the child and/or illness of other household members. f) Section 6: Health This section identifies which individuals are suffering from illnesses and details on their health care seeking behavior. The three parts of this section ask about acute illness (part A), chronic illness (part B), and physical ability and general health (part C, added in the wave 2 questionnaire). The questions on acute illness record: (1) who in the household was ill in the four weeks before the interview; (2) the symptoms and diagnosis; (3) the health seeking behavior of households as a result of illness; and (4) medical expenditures and the source of finance. For each household member who was ill or injured in the four weeks prior to the interview, the following information is collected: the duration of the illness; the major symptoms; the number of days the patient was unable to perform his/her usual activities; the first three health practitioners consulted; all of the expenditures associated with them, in cash, in kind, and in time; and expenditures on all other consultations for this episode of illness. The acute illness questions also include information about hospitalizations, the costs of medicine and travel to health consultations, and debt incurred due to the illness. The final questions ascertain whether the illness was diagnosed, the actual diagnosis, and whether the patient has recovered. Chronic conditions, in Part B, are conditions that have existed for 6 months or more. The questions include the symptoms, the duration of the condition, the diagnosis (if a practitioner had been consulted), and expenditures on those conditions in the four weeks before the interview. Through the skip pattern of this section, all household members, including those who had and didn’t have an acute or chronic illness, must respond to questions concerning four symptoms often (but not always) associated with AIDS: recurring diarrhea for a month or more; weight loss; recurring fever: and skin rash. Part C, which was added in the wave 2 household questionnaire, includes questions on general health, specific disabilities, and activities of daily living, like walking, running, lifting, and performing hard labor. The consequences of ill health are taken up in many other sections of the questionnaire: economic activities (7); migration (8); fertility (9); anthropometry (10); expenditures (18); remittances (19); and mortality (20). g) Section 7: Activities of household members The objective of Section 7 is to establish the full scope of economic activities performed by members of the household. In particular, the section aims to: (1) establish the allocation of each household member's time across economic and domestic activities in the days before the interview; and (2) estimate the income of each household member in the past 2 months. It is the section of the questionnaire that will permit the analysis of the impact of adult illness and mortality on the time allocated to individual economic activities, like farming, and on individual and household income. Section 7 is the largest section of the questionnaire, with 8 parts. It collects information on the number of hours per day spent by each household member in the past 7 days on the following activities, and income from them: - work as an employee in as many as two jobs (Part B); - work on an own or family farm, work on a communal farm, processing crops, tending livestock and processing livestock products (Part C); - work on as many as three own or family businesses (Part D); - domestic activities (preparing meals, cleaning, doing laundry, shopping), collecting firewood, collecting water, seeking medical care, caring for sick household members, looking for additional work, helping neighbors and attending funerals (Part E). An elaborate slip pattern sends each respondent to the part of Section 7 that is relevant for his/her activities. Parts F and G capture information on income if the main job last year or the secondary job was different than any of the activities in the seven days before the interview. Finally, part H collects non-earned income for each household member. This information is obtained from the recall of respondents and is known to he inexact. However, it is intended to represent a rough snapshot of the allocation of each person's time in the 7 days prior to the interview.[The KHDS questionnaire seeks to account for all activities of each household member in the past 7 days because it is hypothesized that fatal adult illness and mortality would result in shifting responsibilities and allocation of time among household members. In contrast, the LSMS prototype questionnaire was concerned only with the main economic activity and the secondary activity within the past 7 days.] Other sections of the questionnaire also collect data on the self-employment activities and income at the household level, notably the sections on farming (11), livestock (12), fishing (13) and non-farm self-employment (14). These latter sections collect greater detail on the income and expenditure. h) Section 8: Migration The objective of this short section on migration is to establish the length of time each household member has been residing in his/her current place of residence and the circumstances surrounding the last move. Other aspects of migration covered in the questionnaire are on the Household Roster (section 1) and in sections on children living elsewhere (section 2) and non-resident parents of household members (section 3). i) Section 9: Fertility The objective of the section on fertility is to ascertain: (1) the number of children ever born to every female household member age 15 and older (or younger, if already married); (2) child mortality; (3) the level of schooling attained by deceased children; (4) current pregnancy status; (5) fetal wastage; and (6) contraceptive use. Children are an asset to the household that will hopefully bring future earnings as the child matures. Section 9 provides information on the potential source of support for elderly survivors in the household who may have lost adult children through fatal illness. Related sections of the questionnaire are the Household Roster (Section 1), children living elsewhere (Section 2), education (Section 5), health (Section 6), anthropometrics (Section 10) and mortality (Section 20). j) Section 10 Anthropometry In the anthropometry section, the interviewer measures and records the height and weight of all household members. Section 10 also collects information on the immunization status of children. Children under two years of age were weighed in hanging Salter scales, while those who were older were weighted on adult scales. During the first two passages, all adults were measured with spring scales. In the third and fourth passages, the spring scales were replaced with digital scales. This greatly reduced the dispersion in the weight data for the young children weighed on the adult scales. k) Section 11 : Farming The objective of the section on farming is to collect information on: (1) annual net income due to cultivation of crops; (2) the number and value of farm assets (land and equipment); and (3) the quantity of crops sold. This section is asked in all households engaged in farming, and the respondent is the person in the household who is most familiar with farm income and expenditure. The major parts of Section 11 collect information on the number and size of fields (shambas) owned and cultivated by the household, their sale value, and how they were acquired (Part A); the crops cultivated in the past 12 months, the quantity of production sold, income from sale of crops and expenditures on crop inputs (Part B); the number and age of tree crops (Part C); use of and expenditure on farm inputs (Part D); income from the sale of products from homegrown crops, and expenditures on transforming these crops for sale (Part E); and the ownership, value, purchase and sale of agricultural equipment (Parts F and G). l) Section 12: Livestock This section assesses: (1) the number and value of livestock owned by the household; and (2) household income in the past 12 months due to livestock activities. The first part of section 12 establishes the household's stock of animals at the time of the survey, the value of the stock and changes in the stock over the past year. Part B collects information on income from processing of livestock products in the past year, such as from milk and egg production. Part C measures the expenditures on livestock production in the past 12 months, for items such as herding, veterinary services, and animal feed. m) Section 13: Fishing This section seeks to measure the value of assets of fishermen and their annual income, net of expenses. A separate section on income and assets from fishing was deemed necessary because of the proximity of the project site to Lake Victoria. The three parts of this section include questions on fishing equipment (Part A), income from fishing and smoking or drying fish (Part B) and expenditures on fishing inputs (Part C). The fishermen in this area engage in three types of fishing—with hooks, trawling nets and stationary nets. n) Section 14: Non-farm self-employment The objective of Section 14 is to measure the net income and value of assets for small businesses owned or operated by household members. For each business owned by a member of the household, Section 14 collects the expenditures (Parts A and B), income (Part C) and assets (Part D). The reference period for reporting expenditures is the two weeks prior to the interview (that is, the interval between rounds one and two) if the business is functioning or, if the business is not functioning at the time of the interview a typical time unit of the respondent's choosing. o) Section 15: Housing This section has the objective of measuring: (1) the value of housing assets; (2) expenditures on housing, water, electricity and other utilities; and (3) the physical condition of the housing, which is a direct measure of well-being. Expenditures on housing and utilities, together with the results of other expenditure sections (16, 17, and 18), are an input into the estimate of total annual household consumption expenditure. p) Section 16: Durable goods, annual expenditures and income from assistance programs The objective of this section is to collect information on: (1) the value of durable consumer goods owned by the household (Part A); (2) expenditures on infrequently-purchased items in the past 12 months (Part B); and (3) receipt of cash or in-kind assistance from community organizations (Part C). For each durable good possessed by the household, information is collected on ownership, year of acquisition, purchase price, and potential sale price. Part C is of central importance to the research, since it is here that receipt of assistance by the household from outside organizations is recorded. Receipt of outside assistance by individuals is recorded in Section 19. q) Section 17: Food consumption The objective of the section is to collect information on habitual and recent food consumption, on the basis of which an annual measure of food consumption can be constructed. While some households in the Kagera region purchase all of their food, in most cases they consume both purchased food and food that they produce at home. Thus, Section 17 had to collect information on the value of home production that was consumed as well as purchased food. The second and more difficult challenge was capturing the seasonality of food consumption. Because different foods are consumed during different seasons of the year, it would be incorrect to ask about food consumption for a recent period and to infer that this pattern was representative of the past 12 months. The seasonality of food production and consumption over the entire 12 months before the survey had to be considered. This was rendered more difficult for KHDS by virtue of the fact that there are two rainy and two dry seasons in the Kagera region in a 12 month period, and the timing and duration of each season vary according to locale within the region. The solution to the seasonality problem was to ask every household at the beginning of Section 17 to name the months of the past 12 months during which each wet and dry season took place (Part A). In the remaining parts of Section 17, for each food item that is home-produced (Part B) or purchased (Part C), the respondent must indicate during which months of the year the item was consumed. [By asking for the specific months of the year that an item was consumed, it becomes possible to compute both an annual (12-month) estimate of food consumption expenditure and a 6-month estimate. The latter is very important to the KHDS, since the household questionnaire for the subsequent waves will have a 6-month reference period for food consumption expenditures.] For home-produced and purchased items that are seasonal (Part B and Part C-1). The respondent must report how often the item was consumed in the rainy season and in the dry season, and the value of the amount consumed on average each time. For non-seasonal purchased items (Part. C-2), the respondent is asked how often the item was consumed in the past 12 months and the value of the amount consumed on average each time. The information on the months of the year that an item was consumed, the seasons represented, the frequency of consumption and the average value will permit computation of an estimate of the value of annual food consumption. As an alternative to this method, the questionnaire also asks for all purchased food items (seasonal and non-seasonal, Parts C-l and C-2) the amount spent since round one (two weeks earlier). Thus, for purchased food it will be possible to estimate annual consumption expenditure by two methods: (1) frequency x average value; and (2) actual expenditures in the past 2 weeks x 26. r) Section 18: Individual expenditures While sections 16 and 17 collect expenditures made on behalf of the entire household, section 18 collects information on personal expenditures by individual household members. Section 18A collects expenditures and acquisitions or behalf of individual household members in the past 12 months, while Section 18B collects information on personal expenditures by individual household member since round one (about two weeks previously). The information is gathered for each individual because: (a) it should improve the accuracy of household consumption expenditure estimates; and (b) it will allow the researchers to analyze the distribution of expenditures and acquisitions across different household members, and thus compare levels of individual welfare within households. [Collecting expenditure and consumption information for each individual household member is another way in which the KHDS questionnaire distinguishes itself from the LSMS prototype] The results of this section will allow comparison of expenditures and acquisitions across different types of individuals -- for example, orphans vs. non-orphans, boys vs. girls, men vs. women, sick vs. healthy adults and younger vs. elderly adults. s) Section 19: Remittances and credit Section 19 measures transfers and credit flowing into and out of the household, the reasons for these arrangements, and the level of household savings. Many of the transfers captured in this section will be from nonresident family members - children and parents - whose background is captured in sections 2 and 1 . Section 19 has three parts. The first two parts collect information on receipt of remittances or borrowing (Part A) and sending of remittances or lending (Part B) in the past 12 months, for each household member. [This is another example of the effort of the KHDS questionnaire to collect information on an individual level so as to better analyze the intra-household distribution of well-being.] The total number of each type of transaction is recorded, followed by detailed questions on a maximum of three of each type of transaction: the relationship of the lender or borrower to the household member, where the latter lives, the amount received, borrowed or sent, the reason behind the transaction (if any) and the repayment terms (if any). Part C deals with the savings of individual household members: participation in traditional savings organizations in the past 12 months; savings in formal institutions on the day of the interview; and savings kept elsewhere. t) Section 20: Mortality This section measures: (l) all deaths in the past 12 months and their causes; (2) the health seeking behavior of persons who died in the past 12 months; and (3) household expenditures connected with mortality in the past 12 months. Part A collects information on mortality of relatives living elsewhere. For each death in the household, it collects: the relation of the deceased to the head; age at death; sex; relationship to other household members (including children); marital status; educational background; major work: activity; cause of death; duration of illness before death; symptoms of the fatal illness; consultations before death and expenditures on health care and funerals. A subset of this information is collected on the deaths of non-resident relatives in Part B. As this is perhaps the most sensitive topic in the household questionnaire, it appears at the very end, after the interviewer has established rapport with the household. B. COMMUNITY QUESTIONNAIRE The objective of this questionnaire is to elicit community-wide information on: - demographic characteristics - economy and infrastructure - education - health - agriculture - culture that are common to all households residing in each community. The questionnaire is directed at community leaders who were also specifically asked about the location, distance and identity of the closest market, primary school, dispensary, health center, and hospital. In addition, they were asked to name traditional healers within the community. Information from these questions was used to identify the sample of markets, schools, health facilities, and traditional healers for specific questionnaires in the study. It is important to note that these samples are not randomly selected and therefore, are not representative of the markets, health facilities, schools, and traditional healers in Kagera District. They are representative of the facilities located near the selected sample of households. Changes in the questionnaire across Passages are found in Appendix 1. The questionnaire was shortened between Passage 1 and 2 because communities were being revisited. C. HEALTH FACILITY QUESTIONNAIRE The objective of this questionnaire is to establish changes in the demand for health services and the supply of health services offered at a health facility. The Health Facility Questionnaire was administered to the health facility closest to each cluster. Data collected in this section was organized in three parts. Part A was administered to the medical person in charge and had nine sections: 1. Characteristics of the Facility 2. Personnel 3. Equipment 4. Services 5. Immunizations 6. Family Planning 7. Inpatient Services 8. Demand 9. Fee Exemption Policies Part B was administered to the pharmacist of the facility and asked about the availability of drugs at the facility. Part C, on inpatient and outpatient consultations, was not administered by an interviewer, but was completed by the medical officer in charge. D. SCHOOL QUESTIONNAIRE The objective of the school questionnaire is to assist in the analysis of demand for schooling of household members. It was completed for every primary school in a cluster. If there was no school in the cluster, a school questionnaire was completed for the nearest primary school to the cluster. There are two parts to the school questionnaire. Part A focused on the characteristics, enrollments, and fees for each school and was administered by the interviewer. Part B was left with the headmaster or head teacher of each school so they could refer to school records and inventory to provide information on: (1) the number of textbooks (Kiswahili, math, other) available for the students of each grade; and (2) the number of classes, enrolled students, enrolled female students, students who attended last week, and two-parent orphans enrolled for each grade. A third part, dealing with assistance provided to the school, was added in the second passage. E. PRICE QUESTIONNAIRE The objective of this questionnaire is to measure prices of key consumption goods throughout the survey area and over time. The price questionnaire contained a list of thirty food items, six pharmaceutical products, and thirteen non-food items. Three prices were collected for each item from three different traders at different locations in the market. Price data were collected from two types of market: the nearest community market and roadside shops or dukas for each cluster in each passage. In Passage 1 interviewers generally only visited one type of market. For Passages 2 - 4 the Price Questionnaire was fielded twice in each cluster-- once to the nearest community market and once to the roadside shop. It is important to note that each cluster does not have a market that is uniquely associated with that cluster. Different clusters may share markets and the market closest to the cluster may change from passage to passage. F. TRADITIONAL HEALER QUESTIONNAIRE This questionnaire documents the prices, types of facilities, services, and referral practices of traditional healers in the survey area. The questionnaire was administered to two healers per cluster, who were randomly selected from those listed by the community leaders. [In one cluster the field workers interviewed a third healer. Because of this, there were 103 completed healer questionnaires at the end of Wave 3 instead of the 102 that were expected.] This questionnaire was administered only in Passage 3. This survey includes questions on the number and types of patients seen, the types of health problems encountered, and the healer's knowledge of the etiology of AIDS and of other diseases. There are seven sections of this questionnaire: 1. Personal background of respondents 2. Consultations in past seven days 3. Facilities and equipment 4. Knowledge and practices 5. Prescription and referrals 6. Income and prices 7. Childbirth services Traditional birth attendants were not interviewed. In areas where more than one cluster was selected (for example, Hamgembe), two healers were interviewed for each cluster. SECTION A: Personal Background Question 4: Gastrointestinal problems included problems of the mouth, bloating, abdominal pain and swelling, vomiting, jaundice, liver problems, and rectal and anal problems. STDs (Sexually transmitted diseases) included painful urination, puss from urethra, warts, inguinal swelling, genital ulcers, and genital infections. Cardiovascular conditions included heart palpitations, high blood pressure, stroke, dyspnea on exercise, and varicose veins. The total number of patients seen in question 4 had to be at least equal to the number of patients in questions 1-3. Question 4 could have more patients listed if some had more than one condition. G. FOLLOW-UP QUESTIONNAIRES If the households most severely impacted by adult deaths disintegrate or move out of the sample, then an analysis of the households that remained might underestimate the severity of the impact. In order to deal with this possibility, during the fourth passage the survey teams obtained information from all individuals who were members of households that dropped out since the first passage, and who were still residing in Kagera region. - For all households that dropped out at any time after the first passage, the teams attempted to locate all former household members individually, under the assumption that they may now belong to different households. Those individuals who were found were administered a “Follow-up Questionnaire”, or FUQ, described below. - For households that dropped out during the fourth passage, whose members could be located in Kagera region, and who moved intact, the household-level sections of the wave 4 household questionnaire were also completed. (Households that dropped out in the fourth passage were not replaced.) An intact household is one in which no household members have left, unless they died. They include cases in which new members have joined. The survey questionnaires for individuals and for intact households are described below. Detailed instructions on interview procedures and interpretation of questions in the FUQ are provided in the Wave 4 Interviewer Manual. 1. Follow-up questionnaire for individuals The objective of the FUQ is to obtain information on the well-being of individuals who were in households that moved out of the sample. Using the last questionnaire completed by the household before it dropped out, augmented with data from section 1B concerning where and why the household moved, the field teams attempted to find each member of the households that moved between passages 1 and 4, if they were still in Kagera region. In some instances, household members were no longer living together and had joined other households. Thus, the FUQ, while organized around the household roster from previous interviews, collected information on individuals who formerly lived together but may not be currently living together. It basically consists of the individual sections of a wave 4 household questionnaire (sections 3, 5, 6, 7, 9, 18, 19) plus some additional questions for each individual concerning the characteristics of the new household in which he/she now resides (sections 00C, 00D, 1C, 1D, 1E). The sections that are unique to the FUQ are discussed briefly below. a) Section 00C: Survey information sheet This section identifies which members of the former household moved, when they moved, and where, based on information copied from the household questionnaire for the passage when the household dropped out. In addition, it records the results of the field team’s search for the individual within and outside the survey cluster. b) Section 00D: Identification of the new household In this section the interviewer records characteristics of the household where the former household member is now residing: the place name, region, district of Kagera (if still within Kagera), and cluster number (if in a survey cluster); the name of the current head of household and whether this is the same as the head at the time the household discontinued; and the current head’s sex, age, schooling, religion, tribe, and occupation. c) Section 1C: Demographic characteristics of the respondent This section is an abbreviated version of the questions in Section 1 of the KHDS household questionnaire. It asks for the respondent’s sex, relationship to the head of the current household, age, marital status, co-residence in the current household of the spouse and his/her ID code, the number of months the respondent has been living with the current household in this dwelling, and the reason why the household member moved. In addition, the interviewer must list the ID code of all people formerly in the respondent’s household who are also in the household where the respondent is currently residing. d) Section 1D: Economic characteristics of the current household This section collects summary information on the characteristics of the respondent’s current household: the number of household members by age (0-14 and 15+) and gender; and the number of members who work on a family farm (question 5), raise animals that they own (question 6), own a business or are self-employed (question 7), or who work as employees for an employer outside the household (question 8). e) Section 1E: Individual assets This section collects information on assets and durable goods currently owned by individuals and those sold by individuals since they were last interviewed. The assets and durable goods include: dwellings (questions 1-4A); durable goods (questions 5-8); shambas/fields (questions 9-12A); and cattle (questions 13-16A). 2. Following intact households that moved A total of 14 households moved intact between the third and fourth passages of fieldwork--that is, all of the household members except those who died were still living together as a unit, even though some new members may have joined the household. All of these households had joined the survey in the first passage and dropped out between the third and fourth passages. The last complete household questionnaire for all of them was a wave 3 questionnaire. In following these intact households, several different questionnaires were completed: - As was the case for all households that dropped out at any time during the survey, sections 1A, 1B, and 20a of the household questionnaire were completed and entered with the rest of the household data for wave 4. The information in sections 1A and 1B will indicate that the household members moved. - The Follow-up Questionnaire for individuals (described above) was completed for all household members who could be located from the 14 intact households. However, the FUQ was not completed for anyone who had joined the household since the third passage. - Household-level sections of the Wave 4 questionnaire were also completed for these 14 households: sections 1, 2, 4, 11, 12, 13, 14, 15, 16, 17, and 20b. Thus, except for information on those who joined the household, it is theoretically possible to assemble a complete file of wave 4 data on the 14 households that moved intact between passages 3 and 4, thereby increasing the sample size for the fourth passage. There was no logical place to put moving expenses or housing construction expenditure in the wave 4 household questionnaire, so interviewers were instructed to record moving expenses for the intact households in Section 16B, item 17, as expenditures on “home services”, and construction or purchase of new housing under item 37 of Section 16B.
Other Processing: 
Household level information - Demographic characteristics - Health status, symptoms, health-seeking behavior and medical expenditures - Nutritional status - Mortality and related expenditures - Human capital, enrollments and education expenditures - Fertility and contraceptive use - Time use in the labor force, other productive and health-related activities - Income levels and sources - Assets and durable goods, including housing, farm and business assets - Consumption expenditure, by component - Savings, debts, transfers and receipt of assistance - Characteristics of non-resident parents and children, including their mortality Community-level information - Demographic characteristics - Economy and infrastructure - Education - Health - Agriculture - Culture Health facility information - Characteristics of the Facility - Personnel - Equipment - Services - Immunizations - Family Planning - Inpatient Services - Demand - Fee Exemption Policies School facility information - Characteristics, enrollments, and fees - Number of textbooks (Kiswahili, math, other) available for the students of each grade - Number of classes, enrolled students, enrolled female students, students who attended last week, and two-parent orphans enrolled for each grade. - Assistance provided to the school (added on second passage) Price data - Pices of key consumption goods
Harvest Source: 
Harvest System ID: 
83
Citation Text: 
Use of the dataset must be acknowledged by including a citation which would include: - Identification of the Primary Investigator - Title of the survey (including the country name and year of implementation) - Survey reference number - Source and date of download Example: World Bank and University of Dar es Salaam.Tanzania, Kagera Health and Development Survey 1991-1994 (Wave 1 to 4 Panel). Ref. TZA_1991_KHDS_v01_M. Dataset downloaded from the World Bank Microdata Library (www.microdata.worldbank.org) on [date]
Modified date: 
18291
Study Type: 
Living Standards Measurement Study [hh/lsms]
Primary Dataset: 
Yes
Mode of Data Collection: 

Face-to-face

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