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Household No.

1 2 3 4 5 6 7 8 9 10

HOUSEHOLD
SIZE
EDUCATION

No one has
completed 6
years of
schooling
At least one
school-age
child is not
going to school
HEALTH

At least one
member is
malnourished
One or more
children have
died
Living
conditions
No electricity

No access to
clean drinking
water
No access to
adequate
sanitation
House has dirty
floor
House uses
dirty cooking
fuel
House has no
access to
information or
mobility asset
or assets
related to
livelihood

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