WASH KAP survey questionnaire

Enumerator Name: __________________Gender _______ Date (D/M): ____/____/2021 - MEAL Cross

Check Signature: _____

Household (HH) Demographics:

Q1 Province ‫والیت‬ Q2 Interviewee Name ‫استم مصاحبه شوند‬

Q3 District ‫ولسوالی‬ Q4 Gender ‫جنسیت مصاحبه شونده‬

Q5 Village ‫قریه‬ Q6 Household Census Number ‫شماره خانواده‬

Name of Head of HH ‫نام مسئول‬ Q

Q7 Gender of Head of HH ‫جنسیت مسئول خانواده‬
‫خانواده‬ 8

Total number of people living in this HH by # Male-

Q9
group and sex (DO NOT INCLUDE Children <5 # Female-
in 9.1 Male and 9.2 Female numbers) # Children <5 y -
1. Longtime resident ‫مهاجرین قبلی‬
Q10 Type of resident?
2. IDP ‫بیجا شده گان‬ 3. Original village ‫ساکنین اصلی‬

WATER
What is the main source of water for HH for drinking and bathing/washing (clothes
Drinking Bathing/Washing
and dishes) during the dry and rain season? ‫منابع آب برای آشامیدن و شستن‬

1- Borehole with hand pump‫چاه با بمبه دستی‬

2- Protected shallow well ‫چاه عمیق مصئون و سرپت‬

Q11 3- Open shallow well ‫چاه عمیق سر باز‬

4- Roof catchment water )‫آب وردی سقف (آب باران‬

5- Surface water source (River, stream, pond, puddles) ،‫آب سطح زمین (دریا‬
)...‫ ذخیره های سرباز‬،‫کنده‬
6- Piped network ‫شبکه‬
99 - Other-specify for each________________________________ )‫دگر (مشخص سازید‬

What is the main
influence on your decision
Q12
for which water source to
use? ‫چرا از منابع ذکر شده آب‬
‫میگیرید؟‬
1 - Distance to the water source ‫فاصله کم‬ Who usually collects 1 - Adult Women
2 - Quality of the water in the source ‫کیفیت‬ the water from the 2 - Adult Men
3 - Less waiting time than other sources ‫وقت‬ water source?
Q13 3 - Female Children
(Multiple answers
4 - That is the only source we have ‫یگانه منبع‬ possible) ‫کی مسئولیت‬ 5 - Male Children
5 - Easier to draw water from than others ‫جمع آوری آب را بدوش‬
‫دارند؟‬ 99 – Other
‫بخاطر سهولت‬

How long does it take to collect Time Frequency

How many times a
water from the main source you use
1 - <30 min day do you go to
during dry and rainy season (add 1 - Once
this source to
Q14 time going to and from plus waiting 2 - 30min to 1hr Q15 2 - twice
collect water?
time) 3 - 1hr to 2hr 3 - 3 times
4 - 2hr to 4hr ‫ هفته می‬/ ‫چند بار در روز‬ 4 - Once a week
‫چه مدت زمان را میگیرد تا از منابع آب ذکر شده آب‬
‫آورید؟‬
‫بیاورید؟‬ 5 - 4hr or more
99 - Other_________

Q16 What do you use to store

1 - Jerry can (different than transport container) ‫بوجکه‬
your HH drinking water?
 WASH KAP survey questionnaire
2 - Bucket without lid ‫سطل سر بسته‬
‫آب مورد استفاده تان در چه جمع‬ 3 - Metal pot without lid ‫سطل سر باز‬
‫میکنید؟‬ 4 - Metal pot with lid ‫ترموز های آهنی با پوش‬

5 - Container (of any type) with lid and tap ‫کانتیز یا ذخیره آب سر بسته‬
1 - Yes, Every time before
1 - Soap/powder ‫پودر‬/‫صابون‬
refilling/Daily
Do you clean the What do you
inside of water use to wash
2 - Yes, Weekly 2 - Soap + water ‫ آب‬/ ‫صابون‬
containers? If Q18 the container?
YES. How often? 3 - Yes, Monthly 3 - Ash +water ‫ آب‬/ ‫خاکستر‬
Q17 ‫با چه داخل ذخیره ها‬
DO NOT ‫را میشوید‬
4 - Yes, infrequently/ if it looks
PROMPT ‫آیا داخل‬ 4 - Rocks/sand +water ‫ریگ و آب‬
dirty
‫ذخیره را مشوئید؟‬
5 - No, Never

Do you have any 1.Yes

mechanic in your village If yes, what are the responsibilities he do?
Q19 for maintaining and
operation of the water 2.No
sources?

1.Yes Do you have 1.Yes If Yes, specify the membrane numbers:

Is there any Family Health
Q20 CHW in your Q21 Action Groups
village? 2.No (FHAG) in your 2.No
village?

Hygiene
On a normal day,
do you wash your 1 - No, I don’t regularly wash my hands ‫نمی شویم‬
hands? 2 - Yes, whenever they look/feel dirty ‫هروقت کثیف‬
‫شدند‬ 1 - water and soap ‫آب و صابون‬
DO NOT PROMPT
3 - Yes, before preparing food ‫قبل از تهیه غذا‬
4 - Yes, After defecation ‫بعد از رفع حاجب‬
MOST OFTEN, 2 - water and ash‫آب و خاکستر‬
Q28 If yes, what times 5 - Yes, Before eating food ‫قبل از غذا خوردن‬ what do you
do you wash? 6 - Yes, After eating food ‫بعد از غذا خوردن‬ use to wash
Q29
your hands? 3 - water and sand ‫آب و ریگ‬
‫آیا دست های تان را منظم‬ 7 - Yes, Before feeding a child/BF ‫قبل تغذیه طفل‬
‫مشوئید؟ اگر بلی در کدام‬ 8 - Yes, After disposing of child’s feces/cleaning ‫همرا با چه دست های‬
‫اوقات؟‬ child ‫بعد از پاک کاری طفل‬ ‫تان را میشوئید؟‬
4 - Water only ‫تنها آب‬
9 - Yes, after working with animals, crops ‫بعد از‬
(multiple ‫تماس با حیوانات‬
answers possible)
99 - Other-specific________________‫دگر‬ 5 - Wipe on cloth ‫با تکته تر‬
1 - Cost of soap

If you normally do not wash your 2 - Lack of water

hands, or do not wash as much as
Q30 you would want to/the way you 3 - I don’t think it is necessary to wash my hands
want to, why? ‫اگر دست های تان را‬
‫ علت اش چه است؟‬،‫نمیشوئید‬ 4 - Other-specific___________________
 WASH KAP survey questionnaire

1 - Remove visible dirt (hands look/feel dirty)

2 - Prevent disease/stay healthy

Why do you wash your hands? ‫چرا‬
Q31
‫دست های را باید شست؟‬
3 - I don’t normally wash my hands

4 - Other _______________

What do you use during 1 - Old clothes ‫تکه کهنه‬

menstruation period?
1 - New clothes ‫تکه جدید‬
Q32 ‫عادات ماهوار از چی استفاده‬ ‫در مدت جریان‬
)‫می کنید (مخصوص خانمها‬ 2 - Sanitary pad ‫کوتکس‬

3 - Nothing ‫هیچ کدام‬

Do you wash your hands during Do you take bath during menstruation
menstruation period? 1- Yes 1 - Yes
Q33 Period?
‫آیا دست های تان را در جریان عادت‬ Q34
)‫ماهوار میشویید (مخصوص خانمها‬ ‫آیا شما در جریان عادت ماهوار حمام میگیرد؟‬
2 -No 2 - No

How do you wash the food?

Q35
‫مواد خام غذایی (سبزیجات و میوه ها) را چطور میشویید؟‬

Did any children under 5 of the HH have diarrhea in

Q36 the last two weeks? ‫ایا یکی از اعضای فامیل تان مصاب به اسهاالت‬ 1 - Yes 2 - No How Many?
‫شده در جریان دوهفته گذشته؟‬

1 - Bloody diarrhea ‫اسهال خونی‬

Q37 Type of Diarrhea? ‫نوع اسهاالت‬
2 - Watery diarrhea ‫اسهال آبکین‬

3 - Dysentery ‫اسهال عادی‬

1 - Flies

2 - open feces /Defecating in an open

What do you or members of your household think can
cause diarrhea? 3 - Dirty water/Food

Q38 ‫چه فکر میکنید علت عمده اسهاالت کدام ها اند؟‬ 4 - Dirty hands
DO NOT PROMPT
5 - Leaving food/water uncovered
(more than one answer possible)
6 - I don’t know what can cause diarrhea

10 - Other- specify____________________________

Q39 Do you or members of your Household do anything to 1 - wash hands after defecation or cleaning baby’s bottom
 WASH KAP survey questionnaire

2 - wash hands before eating

3 - wash hands before preparing food

prevent diarrhea?
4 - Clean house/compound
‫آیا شام و یا یکی از اعضای فامیل تان کاری میکنید که اسهال نشوید؟چه‬
5 - Drink only clean water
‫میکنید؟‬

DO NOT PROMPT 6 - Keep food covered from flies

7 - Wash clothes, body and face frequently

(more than one answer possible) 8 - Local treatments

(specify)________________________________________

9 - Nothing can be done to prevent diarrhea

10 - Other-
specify________________________________________________

Sanitation

LATRINES AND GARBAGE

Do you have a latrine inside of your compound?  Yes  NO .33

..………OBSEVATION: If Yes, type of latrine.  Flush latrine  vault latrine  pit latrine  compost latrine  other

?OBSEVATION: If yes What is the condition of the latrine .34

 clean  Rather clean  dirty  Rather dirty
35. OBSEVATION: Is the latrine full or overflowing?  Yes  NO
.…………Who emptied the latrines?  Night soil collector  Your family member  Farmers  Other

36. If dispose by your family member where do you disposing the excreta which are emptying from the latrine?

 in river  in Streets  in lands  family in garden  Disposing it on the rainy time  compost for Agriculture land  in
the ditch  compost for the kitchen garden
37. Who use the latrine?  Women with Children  All member of family  guests

38. OBSEVATION: If yes Is there any washing facility next to the latrine?

 Yes water with soap  Yes just water  No hand washing facilities

39. If NO latrine. Where do you go for defecation?  Open defecation Inside the compound . Open defecation in the
..……… Bush  Open defecation near the river  Open defecation in the ditch other

OBSERVATION: Is there excreta in or near the compound?  Yes  No - 40

41. What do you do with Organic and Inorganic waste at home?

. Throwing in a corner of the yard . Throwing outside the yard . Burying those  Burning the an open hole

Bring to waste collection point somebody collect In the river  compost for Agriculture. For animal

42. What do you do with animal dung at home?  Keeping for fuel during the Winter  using for cooking of food 
 WASH KAP survey questionnaire
provided for Selling other………………………………………………………….

43. -OBSERVATION: Is there waste and animal dung in or vicinity the compound? Yes No

44. OBSERVATION: Condition of the target community?  Very dirty  Rather clean  Rather dirty Very dirty

45. The reason about Condition of the target community, Waste no waste  animal dung no animal dung OD  ODF