SPKIA2000.PL
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS, DEPARTMENT OF HEALTH, DEPARTMENT OF
EDUCATION AND CULTURE, BKKBN, AND UNICEF
2000 MOTHER AND CHILD HEALTH AND EDUCATION MULTI-INDICATOR
SURVEY
Confidential
I. IDENTIFICATION
1
Province
2
Regency/Municipality *)
3
Subregency
4
Village/ Kelurahan *)
5
Village/Kelurahan classification
6
Enumeration area number
7
Segments group number
8
Sample code number
9
Household sample serial number
1
2
3
1. Urban
2. Rural
II. SURVEYING CHARACTERISTICS
Name and employment identity number of
4 Name and employment identity number of
enumerator
surveyor
Enumerator’s occupation:
5 Surveyor’s occupation:
1. BPS Provincial staff
3.Subregency staff
1. BPS Provincial staff
3.Subregency staff
2. BPS Regency staff
4. Hired worker
2. BPS Regency staff
4. Hired worker
Date of enumerating
6 Date of surveying
*) Cross out inapplicable category
Household
serial
number
(1)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
1)
Name of
head of
household
(2)
2)
Number of
household
member
3)
Number of
household
member aged
0-59 months
4)
Number of
household
member
aged 5-17
years old
Surv
eyor
Enum
erator
Surv
eyor
Enum
erator
(3)
(4)
(5)
(6)
Sur
vey
or
(7)
Enu
mera
tor
(8)
III. FIELD SUPERVISING
6)
5)
7)
Number of
Number of
Number of household member
household
women
aged 0-59 months
aged 15-49 member
b)
a)
who is
years old
using
has birth
orphans
sleeping net
certificate
aged 0-14
years old
Sur
vey
or
(9)
Enu
mera
tor
(10)
Surv
eyor
(11)
Enu
mera
tor
(12)
Surv
eyor
Enum
erator
Surv
eyor
Enum
erator
(13)
(14)
(15)
(16)
8)
Number of
household
member aged
5-17 years
old who had
not attended
school during
this school
year
Surv Enum
eyor erator
9)
Number of
women aged
15-49 years
old
Who had
heard/ read
about HIV/
AIDS
10)
Number of
women aged
15-49 years
old who has
married and
is pregnant
Surv
eyor
Enum
erator
Surv
eyor
Enum
erator
(17)
(19)
(20)
(21)
(22)
(18)