Data Cart

Your data extract

0 variables
0 samples
View Cart
A planned IPUMS system update is scheduled for Monday, December 9. The maintenance window is 10am to 1pm CST. Within that window, each site will have a brief outage of 10 or fewer minutes. This notice will be removed as soon as the update is complete.

BURKINA FASO DEMOGRAPHIC AND HEALTH SURVEY - HOUSEHOLD QUESTIONNAIRE 1993

IDENTIFICATION

PROVINCE _____
DEPARTMENT _____
COMMUNE/URBAN CENTER ______
CLUSTER NUMBER _____
VILLAGE/SECTOR _____
HOUSEHOLD UNIT NUMBER _____

OUAGA, BOBO/KOUD, OTHER CITIES, OR RURAL?

OUAGA 1
BOBO/KOUD 2
OTHER CITIES 3
RURAL 4

NAME OF PERSON INTERVIEWED ______

LINE NUMBER OF RESPONDENT FROM HOUSEHOLD QUESTIONNAIRE _____

MEN'S QUESTIONNAIRE?

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____

RESULT _____

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT PERSON AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR AN EXTENDED PERIOD
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____

TOTAL NUMBER OF VISITS _____

TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____

FRENCH QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW:

FRENCH 1
MOORE 2
DIOULA 3
FULFULDE 4
OTHERS 5

INTERPRETER USED?

YES 1
NO 2

SUPERVISOR
NAME ______
DATE ______

FIELD EDITOR
NAME ______
DATE ______

KEYED BY (NAME) _____
KEYED BY (DATE) _____
KEYED BY (CODE) _____

HOUSEHOLD SCHEDULE

We would like some information about people who usually live in your household or are staying with you now.

1. LINE NUMBER:

LINE NO. _____

2. USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.

NAME _____

3. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?

01 HEAD
02 HUSBAND OR WIFE
03 SON OR DAUGHTER
04 SON-IN-LAW OR DAUGHTER-IN-LAW
05 GRANDCHILD
06 PARENT
07 PARENT-IN-LAW
08 BROTHER OR SISTER
09 CO-SPOUSE
10 OTHER RELATIVE
11 CHILDREN ADOPTED/BEING TAKEN CARE OF
12 NOT RELATED
98 DOESN'T KNOW

4. RESIDENCE: Does (NAME) usually live here?

YES 1
NO 2

5. RESIDENCE: Did (NAME) stay here last night?

YES 1
NO 2

6. SEX: Is (NAME) male or female?

MALE 1
FEMALE 2

7. AGE: How old is (NAME)?
IF 97 OR OLDER, RECORD '97'.

IN YEARS _______

EDUCATION, IF AGE 6 YEARS OR OLDER:

8. Has (NAME) ever attended school?

YES 1
NO 2 (GO TO 11)

9. IF ATTENDED: What is the highest level of school (NAME) has attended?
What is the highest grade (NAME) completed at that level?

LEVEL ____
PRIMARY 1
SECONDARY (FIRST CYCLE) 2
SECONDARY (SECOND CYCLE) 3
POST-SECONDARY 4
DOESN'T KNOW 8
GRADE ____
PRIMARY
0 LESS THAN ONE YEAR
1 CP 1
2 CP 2
3 CE 1
4 CE 2
5 CH 1
6 CH 2
8 DOESN'T KNOW
SECONDARY (FIRST CYCLE)
0 LESS THAN ONE YEAR
1 6TH
2 5TH
3 4TH
4 3RD
5 FPP
8 DOESN'T KNOW
SECONDARY (2ND CYCLE)
0 LESS THAN ONE YEAR
1 2ND
2 1ST
3 THIRD
4 FPS
8 DOESN'T KNOW
POST-SECONDARY
0 LESS THAN ONE YEAR
1 FIRST YEAR
2 SECOND YEAR
3 THIRD YEAR
4 FOURTH YEAR
8 DOESN'T KNOW

EDUCATION, IF LESS THAN 25 YEARS:

10. IF ATTENDED: Is (NAME) still attending school?

YES 1
NO 2

SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS FOR PERSONS YOUNGER THAN 15 YEARS:

11. Is (NAME)'s natural mother alive?

YES 1
NO 2 (GO TO 13)
DOESN'T KNOW 8 (GO TO 13)

12. IF ALIVE: Does (NAME)'s natural mother live in this household?
IF YES: What is her name?
RECORD MOTHER'S LINE NUMBER.

LINE NO. ______

13. Is (NAME)'s natural father alive?

YES 1
NO 2 (GO TO 15)
DOESN'T KNOW 8 (GO TO 15)

14. IF ALIVE: Does (NAME)'s natural father live in this household?
IF YES: What is his name?
RECORD FATHER'S LINE NUMBER.

LINE NO. ______

MARITAL STATUS, FOR PERSONS 15 YEARS AND OLDER:

15. Is (NAME) currently married/in a union, widowed, divorced/separated, or single?

MARRIED/IN UNION 1
WIDOWED 2
DIVORCED/SEPARATED 3
SINGLE 4

ELIGIBILITY OF WOMEN:
16. CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49. (SEE 6 AND 7)

17. LINE NUMBER OF HUSBANDS:
INDICATE THE LINE NUMBER OF THE HUSBAND OF EACH ELIGIBLE WOMAN.
IF NOT MARRIED OR IF HUSBAND DOES NOT RESIDE IN THE HOUSEHOLD, RECORD '00'.

HUSBAND'S LINE NO. _____

ELIGIBILITY OF MEN:
18. MEN'S QUESTIONNAIRE?
IF YES, CIRCLE LINE NUMBER OF ALL MEN AGE 18 AND OLDER. (SEE 6 AND 7).

YES ____
NO ____

CHECK HERE IF ANOTHER SHEET IS USED AND NOTE THE SHEET NUMBER ON THE FIRST PAGE. ______

NUMBER OF ELIGIBLE WOMEN:

NUMBER OF WOMEN _____

NUMBER OF ELIGIBLE MEN:

NUMBER OF MEN _____

Just to make sure that I have a complete listing:

1) Are there any other persons such as small children or infants that we have not listed?

YES (ADD TO TABLE)
NO

2) Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends, who usually live here?

YES (ADD TO TABLE)
NO

3) Are there any other guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?

YES (ADD TO TABLE)
NO

18. What is the main source of water used by your household for hand washing and dish washing?

PIPED WATER
PIPED INTO DWELLING/YARD/PLOT 11 (GO TO 20)
PUBLIC TAP/STANDPIPE 12
OPEN TUBE WELL OR BOREHOLE
TRADITIONAL WELL IN DWELLING/YARD/PLOT 21 (GO TO 20)
PUBLIC WELL/BORE HOLE 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAIN WATER 41 (GO TO 20)
WATER VENDOR 51
BOTTLED WATER 61 (GO TO 20)
OTHER (SPECIFY) _____ 71

19. How long does it take to go there, get water, and come back?

MINUTES_____
ON SITE 996

20. Does your household use the same water for drinking purposes?

YES 1 (GO TO 22)
NO 2

21. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO DWELLING/YARD/PLOT 11
PUBLIC TAP/STANDPIPE 12
OPEN TUBE WELL OR BOREHOLE
TRADITIONAL WELL IN DWELLING/YARD/PLOT 21
PUBLIC WELL/BORE HOLE 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAIN WATER 41
WATER VENDOR 51
BOTTLED WATER 61
OTHER (SPECIFY) _____ 71

22. What kind of toilet facility does your household use?

FLUSH TOILET
PRIVATE FLUSH TOILET 11
SHARED FLUSH TOILET 12
PUBLIC FLUSH TOILET 13
PIT LATRINE
RUDIMENTARY 21
VENTILATED IMPROVED PIT LATRINE 22
NO TOILET/OUTSIDE 31
OTHER (SPECIFY) ______ 41

23. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY?
YES 1
NO 2
A RADIO?
YES 1
NO 2
A TELEVISION?
YES 1
NO 2
A REFRIGERATOR?
YES 1
NO 2

24. In your household, how many rooms do you use for sleeping?

ROOMS ____

25. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.

NATURAL FLOOR
SAND 11
EARTH 12
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) _____ 41

26. Does any member of this household own:

A bicycle?
A motorcycle or motor scooter?
A car?

A BICYCLE?
YES 1
NO 2
A MOTORCYCLE OR MOTOR SCOOTER?
YES 1
NO 2
A CAR?
YES 1
NO 2