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Final Version


Demographic and health survey (EDSB-V-2017)
Household Questionnaire

Republic of Benin
Ministry of Planning and Development
National institute of statistics and economic analysis (INSAE)

Identification

Department
Commune

Urban/rural (urban=1, rural=2)

urban 1
rural 2

Name of head of household
Cluster number
Household number

Household selected for men’s survey? (1=Yes, 2=No)

yes 1
no 2

Interviewer visits
1 2 3
Date

Interviewer’s name
Result*

Final visit
Day
Month
Year 201
Int. number
Result

Next visit
Date
Time

Total no. of visits

*Result codes:

1 Completed
2 No household member at home or no competent respondent at home at time of visit
3 Entire household absent for extended period of time
4 Postponed
5 Refused
6 Dwelling vacant or address not a dwelling
7 Dwelling destroyed
8 Dwelling not found
9 Other (Specify)

Total persons in household
Total eligible women
Total eligible men
Line no. of respondent to household questionnaire

Language of questionnaire 01
Language of interview
Native language of respondent

Translator used (Yes=1, No=2)

yes 1
no 2

Language codes:

01 French
02 Adja
03 Bariba
04 Fon
05 Dendi
06 Yoruba
07 Other

Supervisor
Name
Date

Editor
Name
Number

Introduction and consent
Hello. My name is ___. I am working with the National Institute of Statistics and Economic Analysis (INSAE). We are conducting a survey about health and other topics all over Benin. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 30 to 45 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don’t have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don’t want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on this card.

Give card with contact information
Do you have any questions?
May I begin the interview now?

Signature of interviewer Date

Respondent agrees to be interviewed 1
Respondent does not agree to be interviewed 2-End

100) Record the time

Hours
Minutes

Household schedule
1) 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.

After listing the names and recording the relationship and sex for each person, ask questions 2a-2c to be sure that the listing is complete.

Then ask appropriate questions in columns 5-20 for each person.

3) Relationship to head of household
What is the relationship of (name) to the head of the household?
See codes below.

4) Sex
Is (name) male or female?

Male 1
Female 2

5) Residence
Does (name) usually live here?

Yes 1
No 2

6) Did (name) stay here last night?

Yes 1
No 2

7) Age
How old is (name)?
If 95 or more, record 95.

In years


If age 10 or older:
8) Marital status
What is (name)’s current marital status?

1=married or living together
2=divorced/separated
3=widowed
4=never married and never lived together

Eligibility
9) Circle line number of all women age 15-49

10) If household selected for man’s survey
Circle line number of all men age 15-59

11) Circle line number of all children age 0-5
If household selected for men’s survey

11a) Circle line number of all women age 30-49

11B) Circle line number of all men age 30-64

Just to make sure that I have a complete listing:

2A) Are there any other persons such as small children or infants that we have not listed?
Yes add to table
No
2B) In addition, are there any other people who many not be members of your family, such as domestic servants, lodgers or friends who usually live here?
Yes add to table
No
2C) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
Yes add to table
No

Codes for q. 3: Relationship to head of household

01= Head
02= Wife or husband
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=Other relative
10= Adopted/Foster/stepchild
11= Other wife of head of household (if head of household =male)
12= Co-spouse (if head of household = female)
13= Not related
98= Don’t know

Life migration for residents

11c) Birth place:
In what commune was (name) born?
Record dept/comm or country for abroad

11d) Former residence
In what commune did (name) live before moving here?
Record dept/comm or country for abroad

11e) How long was (name)’s stay in this commune?
Note: 1 and the number of months for less than 1 year
OR
2 and number of years for more than 1 year
AND 998 if since birth—skip to 11g

Return migration
11f) Has (name) returned from this commune after having lived there for at least 6 months?
Yes 1
No 2

Migratory status
11g) Guess the migratory status
Record
1=non-migrant If Q 11e= 9 and 98
2=return migrant if Q11e=9 and 98 and Q11f-1
3=Other return migrant if q11e=9 and 98 and [##translator note: text is cut off here]

If 0-17 years

Survivorship and residence of biological parents
12) Is (NAME)’s natural mother alive?

Yes 1
No 2-skip to 14
Don't know 8-skip to 14

13) Does (NAME)’s natural mother usually live in this household or was she a guest last night?

If yes: What is her name?
Record mother’s line number.
If no, record 00.

14) Is (NAME)’s natural father alive?

Yes 1
No 2-skip to 16
Don't know 8-skip to 16

15) Does (NAME)’s natural father live in this household or was he a guest last night?

If yes, what is his name?
Record father’s line number.
If no, record 00.

Codes for q 17 and 19: Education

Level

1=Primary
2=Secondary 1
3=Secondary 2
4=Higher
5=Pre-primary/nursery
8=Don’t know

Class

00=less than 1 year completed (Use code 00 for Q17 only. This code is not authorized for q 19)
98=Don’t know

If age 5 years or older

Ever attended school
16) Has (NAME) ever attended school?

Yes 1
No 2-skip to 20a

17) What is the highest level of school (NAME) has attended?
See codes below.
What is the highest grade (NAME) completed at that level?

Level____
Grade____

If age 5-24 years
Current/recent school attendance
18) Did (name) attend school at any time during the (2016-2017) school year?

Yes 1
No 2-skip to 20a

19) During this/that school year, what level and grade (is/was) (name) attending?
See codes below.

Level____
Grade____

If age 0-4 years
Birth registration
20) Does (name) have a birth certificate?

If no, probe: Has (name)’s birth ever been registered with the civil authority?

1=Has certificate
2=Registered
3=Neither
8=Don’t know

If age 6 or older
Literacy
20a) If level in column 17=2, 3, or 4: Ask: Can (name) read, write, and understand at least one national language?
Other: Ask: Can (name) read, write, and understand at least one language?

If yes, which ones?

1=AF
2=ALN
3=AFLN
4=NLE
8=Don’t know

Codes for Qs 17 and 19: Education
Level attainted
Class successfully achieved

1=Primary
Less than one year in C1=0
C1=1
CP=2
CE1=3
CE2=4
CM1=5
CM2=6
Don’t know=8
2=Secondary 1st cycle
Less than 1 year in 6th =0
6th=1
5th=2
4th=3
3rd=4
Don’t know =8
3=Secondary 2nd cycle
Less than one year in 2nd=0
2nd=1
1st=2
Final=3
Don’t know =8
4=Higher
Less than one year in 1st =0
1st year=1
2nd year=2
3rd year=3
4th year=4
Don’t know 8

Codes for Q20a: Literacy

AF=Literate in French
ALN=Literate in a national language
AFLN=Literate in French and a national language
NLE=Illiterate
NSP=Don’t know

[##translator note: questions 1-20 repeated for line numbers 11-20 to accommodate larger households]

Tick here if continuation sheet used

Codes for Q3: for relationship with head of household

01= Head
02= Wife or husband
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=Other relative
10= Adopted/Foster/stepchild
11= Other wife of head of household (if head of household =male)
12= Co-spouse (if head of household = female)
13= Not related
98= Don’t know

Household characteristics

No.
Questions and filters
Coding categories
Skip

101) What is the main source of drinking water for members of your household?

Piped water
Piped into dwelling 11 –skip to 106
Piped into yard/plot 12- skip to 106
Piped from neighbor 13- skip to 106
Public tap/standpipe 14

Tube well or borehold 21
Dug well
Protected well 31
Unprotected well 32
Water from spring
Protected spring 41
Unprotected spring 42

Rainwater 51

Tanker truck 61

Cart with small tank/canister or inner tube/barrel 71

Surface water (river/dam/lake/pond/stream/canal/irrigation channel) 81

Bottled water 91
Sachet water 92

14-81-skip to 103
Other (specify) 96-skip to 103

102) What is the main source of water used by your household for other purposes such as cooking and handwashing?

Piped water
Piped into dwelling 11 –skip to 106
Piped into yard/plot 12- skip to 106
Piped from neighbor 13- skip to 106
Public tap/standpipe 14

Tube well or borehold 21
Dug well
Protected well 31
Unprotected well 32
Water from spring
Protected spring 41
Unprotected spring 42

Rainwater 51

Tanker truck 61

Cart with small tank/canister or inner tube/barrel 71

Surface water (river/dam/lake/pond/stream/canal/irrigation channel) 81

Other (specify) 96

103) Where is the water source located?

In own Dwelling 1-skip to 105
In own yard/plot 2-skip to 105
Elsewhere 3

104) How long does it take you to go there, get water, and come back?

Minutes_____
Don’t know 998

105) Check 101 and 102: Code 14 or 21 circled

Yes
No-skip to 107

106) In the past two weeks, was the water from this source not available for at least one full day?

Yes 1
No 2
Don’t know 8

107) Do you do anything to the water to make it safer to drink?

Yes 1
No 2-skip to 109
DK 8-skip to 109

108) What do you usually do to make the water safer to drink?
Anything else?
Record all mentioned

Boil a
Add bleach/chlorine b
Add Aquatabs c
Strain through a cloth d
Use water filter (ceramic/sand/composite/etc.) e
Solar disinfection f
Let it stand and settle g

Other (specify) x
Don’t know z

109) What kind of toilet facility do members of your household usually use?
If not possible to determine, ask permission to observe the facility.

Flush or pour flush toilet
Flush to piped sewer system 11
Flush to septic tank 12
Flush to pit latrine 13
Flush to somewhere else 14
Flush, don’t know where 15
Pit latrine
Ventilated improved pit latrine 21
Pit latrine with slab 22
Pit latrine without slab/open pit 23

Composting toilet 31

Bucket toilet 41

Hanging toilet/hanging latrine 51

No facility/bush/field 61-skip to 113

Other (specify) 96

110) Do you share this toilet facility with other households?

Yes 1
No 2-skip to 112

111) Including your own household, how many households use this toilet facility?

No. of households if less than 10
10 or more households 95
Don’t know 98

112) Where is this toilet facility located?

In own dwelling 1
In own yard/plot 2
Elsewhere 3

113) What type of fuel does your household mainly use for cooking?

Electricity 01
LPG 02
Natural gas 03
Biogas 04
Karosene 05
Coal, lignite 06
Charcoal 07
Wood 08
Straw/shrubs/grass 09
Agricultural crop 10
Animal dung 11

No food cooked in household 95-skip to 116

Other (specify) 96

114) Is the cooking usually done in the house, in a separate building, or outdoors?

In the house 1
In a separate building 2
Outdoors 3
Other (specify) 6
2-6-skip to 116

115) Do you have a separate room which is used as a kitchen?

Yes 1
No 2

116) How many rooms in this household are used for sleeping?

Rooms____

117) Does this household own any livestock, herds, other farm animals, or poultry?

Yes 1
No 2-skip to 119

118) How many of the following animals does this household own?
If none, enter 00
If 95 or more, enter 95
If unknown, enter 98

Milk cows or bulls?
Other cattle?
Horses, donkeys, or mules?
Goats?
Sheep?
Chicken or other poultry?
Hogs/pigs?
Rabbits?

119) Does any member of this household own any agricultural land?

Yes 1
No 2-skip to 121

120) How many hectares of agricultural land do members of this household own?
If 95 or more, circle 950

Hectares
95 of more Hectares 950
Don’t know 998

121) Does your household have:

a) Electricity?
Yes 1
No 2
b) A radio?
Yes 1
No 2
c) A television?
Yes 1
No 2
d) A non-mobile telephone?
Yes 1
No 2
e) A computer?
Yes 1
No 2
f) A refrigerator?
Yes 1
No 2
g) A generator?
Yes 1
No 2
h) A stereo system?
Yes 1
No 2
i) A stove?
Yes 1
No 2
j) A DVD player?
Yes 1
No 2
k) A VCR?
Yes 1
No 2
l) An internet connection?
Yes 1
No 2
m) A washing machine?
Yes 1
No 2

122) Does any member of your household own:

a) A watch?
Yes 1
No 2
b) A cell phone?
Yes 1
No 2
c) A bicycle?
Yes 1
No 2
d) A motorcycle or motor scooter?
Yes 1
No 2
e) A cart pulled by an animal?
Yes 1
No 2
f) A commercial car or truck?
Yes 1
No 2
g) A motor boat?
Yes 1
No 2
h) A canoe?
Yes 1
No 2

123) Does any member of this household have a bank account?

Yes 1
No 2

123a) Does any member of this household have an account in another micro-finance organization?

Yes 1
No 2

124) Does anyone in your household smoke? Would you say daily, weekly, monthly, less than monthly, or never?

Daily 1
Weekly 2
Monthly 3
Less than monthly 4
Never 5

125) At any time in the past 12 months, has anyone come into your dwelling to spay the interior walls against mosquitos?

Yes 1
No 2-skip to 127
Don’t know 8-skip to 127

126) Who sprayed the dwelling?

Government worker/program A
Private company B
Nongovernmental organization (NGO) C
Other (specify) X
Don’t know Z

127) Does your household have any mosquito nets?

Yes 1
No 2-skip to 139

128) How many mosquito nets does your household have?
If 7 or more nets, record 7.

Number of nets____

Mosquito nets

Net #1
Net #2
Net #3

129) Ask the respondent to show you the nets in the household.
If more than 3 nets, use additional questionnaire(s).

Observed 1
Not observed 2

130) How many months ago did your household get the mosquito net?
If less than one month ago, record 00.

Months ago_____
More than 37 months ago 95
Not sure 98

131) Observe or ask the brand/type of mosquito net.
If brand is unknown and you cannot observe the net, show pictures of typical net types/brands to respondent.

Long-lasting insecticide-treated net (LLIN)

Permanet 11
Olyset 12
Duranet 13
Netprotect 14
Interceptor 15
Other/Don’t know brand 16
All skip to 134

Other type 96
Don’t know 98

132) Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?

Yes 1
No 2-skip to 134
Not sure 8-skip to 134

133) How many months ago was the net last soaked or dipped
If less than one month ago, record 00.

Months ago
More than 24 months ago 95
Not sure 98

134) Did you get the net through a mass distribution campaign, during an antenatal care visit, during an immunization visit, or at a primary school?

Yes, mass distribution campaign 1
Yes, ANC 2
Yes, immunization visit 3
Yes, primary school 4
1-4 skip to 136
No 5

135) Where did you get the net?

Govt. Health Facility 01
Private Health Facility 02
Pharmacy 03
Shop/market 04
Community field agent 05
Religious institution 06
School 07
Other 96
Don’t know 98

135a) How did you acquire the mosquito net?

Bought without voucher 01
Bought with voucher 02
Free 03
Other (specify) 06
Don’t know 98

136) Did anyone sleep under this mosquito net last night?

Yes 1
No 2-skip to 138
DK 8-skip to 138

137) Who slept under the mosquito net last night?
Record the person’s name and line number from household schedule

Name____
Line number____

138) Go back to 129 for next net; or, if no more nets, go to 139.

Additional household characteristics
139) We would like to learn about the places that households use to watch their hands. Can you please show me where members of your household most often wash their hands?

Observed, fixed place 1
Observed, mobile 2
Not observed, not in dwelling/yard/plot 3-skip to 142
Not observed, no permission to see 4-skip to 142
Not observed, other reason 5-skip to 142

140) Observe presence of water at the place for handwashing.
Record observation

Water is available 1
Water is not available 2

141) Observe presence of soap, detergent, or other cleansing agent at the place for handwashing.

Record observation.
Soap or detergent (bar, liquid, powder, paste) A
Ash, mud, sand B
None Y

142) Observe main materials of the floor in the dwelling.
Record observation.

Natural floor
Earth/sand 11
Dung 12
Rudimentary floor
Wood planks 21
Palm/bamboo 22
Finished floor
Parquet or polished wood 31
Vinyl or asphalt strips 32
Ceramic tiles 33
Cement 34
Carpet 35

Other (specify) 96

143) Observe main material of the roof of the dwelling.
Record observation.

Natural roofing
No roof 11
Thatch/palm leaf 12
Sod 13
Rudimentary roofing
Rustic mat 21
Palms/bamboo 22
Wood planks 23
Cardboard 24
Finished flooring
Metal 31
Wood 32
Calamine/cement fiber 33
Ceramic tiles 34
Cement 35
Roofing shingles 36

Other (specify) 96

144) Observe main materials of the exterior walls of the dwelling.
Record observation.

Natural walls
No walls 11
Bamboo/cane/palm/trunks 12
Dirt 13
Rudimentary walls
Bamboo with mud 21
Stone with mud 22
Uncovered adobe 23
Plywood 24
Cardboard 25
Reused wood 26
Finished walls
Cement 31
Stone with lime/cement 32
Bricks 33
Cement blocks 34
Covered adobe 35
Wood planks/shingles 36

Other (specify) 96

144a) Where do you usually through away your household garbage?

Public garbage collection 01
Private garbage collection/NGO 02
Buried 03
Burned 04
In the yard 05
Outside 06
Other (specify) 96

144b) Where do you usually through away dirty water?

Closed gutter 01
Open air gutter 02
Septic 03
Ruined well 04
Sewer 05
In the yard 06
Outside 07
Other (specify) 96

145) I would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals in your household?

Test salt for iodine

Iodine present 1
No iodine 2
No salt in household 3

Salt not tested (specify reason) 6

Selection of a child for children’s work and discipline

No.
Questions and filters
Coding categories

151) Check column 7 in the list of household members and record the total number of children age 1-17.

Total number_____

152) Check the number of children age 1-17 from Q. 151:

None-go to 185
One-go to 159 and record the rank number as 1, enter the line number, child’s name, and his/her age.
Two or more-

152) List each child age 1-17 below in the order in which they appear on the list of household members. Do not include other household members outside of the group aged 1-17. Record the line number, name, sex and age of each child.

153) Rank number

Rank___
1, 2, 3, etc.

154) Line number from column 1

Line_____

155) Name from column 2

Name_____

156) Sex from column 4

Male 1
Female 2

157) Age from column 7

Age____

158) Check the digit of the household number of the cover page. Go to this line number of the table below. Verify the total number of children Q 151 on the previous page. Go to this column number in the table below.

Find the space where the line and the column cross and circle the number that is in the space. This is the rank number of the child selected for the children’s work/discipline among the eligible children in Q 153.

Record the rank number, line number, age, and name of the child selected in the space below.
Example: The household number is 716 and Q 151 shows that there are three eligible children age 1-17 in the household. Since the last digit of the household number is 6, go to line six, and since there are three eligible children, go to column 3. Find the space where the line and column intersect (2) and circle the number. Now, go to Q 153 and find the second child. Write the name, age, line number, and rank of the child in the space below.

Last digit the household number

Total number of eligible children age 1-17 in the household from 716

159)

Name of child selected
Age of child selected
Line number of child selected
Rank of child selected

Children’s work

No.
Questions and filters
Coding categories
Skip

161) Check age of child selected from Q 159

5-17 years
1-4 years-skip to 181

162) Now I would like to ask you some questions on the type of work that children in your household can do.

Since last (day of week), did (name) do any of the following activities, even if only for one hour?

a) Did (name) work on his/her own land/farm/garden or help on one of a household member, or take care of animals. For example: help grow farm produce, harvest, feed animal, take them to pasture or bring them back?
Yes 1
No 2
b) Did (name) help in a relative’s family business, with or without payment or worked in his or her own business?
Yes 1
No 2
c) Did (name) produce or sell items, artisanal products, clothes, food, or agricultural products?
Yes 1
No 2
d) Since last (day of week), did (name) do any kind of activity in exchange for payment in cash or in kind, even for only one hour?
Yes 1
No 2
If no, probe:
Please include any type of activity that (name) might have done like regular or temporary employment, for his own business or for an employer, or as an unpaid family worker in the household or farm.
All other activity
Yes 1
No 2

163) Check 162, a to d

At least one Yes
Not a single yes-skip to 168

164) Since last (day of week), approximately how many hours total did (name) work on this activity/these activities?

If less than 1 hour, record 00.
Number of hours_____

165) Does this activity/do these activities require carrying heavy loads?

Yes 1-skip to 168
No 2

166) Does this activity/do these activities require working with dangerous tools (knives, etc.) or big machines?

Yes 1 –skip to 168
No 2

167) Now I would like to ask some questions about how you would describe (name)’s work environment.

a) Is (name) exposed to dust/smoke or gas?
Yes 1
No 2
b) Is (name) exposed to cold, heat, or excessive humidity?
Yes 1
No 2
c) Is (name) exposed to loud noises or vibrations?
Yes 1
No 2
d) Is (name) exposed to working at high heights?
Yes 1
No 2
e) Is (name) exposed to chemical products (pesticides, glues, etc.) or to explosives?
Yes 1
No 2
f) Is (name) exposed to other things, behaviors, or conditions that are bad for his/her behavior or security?
Yes 1
No 2

168) Since last (day of week), did name fetch water for the household?

Yes 1
No 2-skip to 170


169) In total, since last (day of week), how many hours did (name) spend fetching water for the household?
If less than one hour, record 00

Number of hours____

170) Since last (day of week), did (name) fetch firewood for the household?

Yes 1
No 2-skip to 172

171) In total, since last (day of week), how many hours did (name) spend fetching firewood for the household?
If less than one hour, record 00

hours___

172) Since last (day of week), did (name) do any of the following tasks for the household?

a) make purchases for the household?
Yes 1
No 2
b) cook?
Yes 1
No 2
c) cook or clean utensils for the household?
Yes 1
No 2
d) wash clothing?
Yes 1
No 2
e) take care of children?
Yes 1
No 2
f) take care of elderly or sick people?
Yes 1
No 2
g) other tasks for the household?
Yes 1
No 2

173) Check 172 a to g:

At least one Yes
Not a single yes-skip to 181

174) Since last (day of week of interview), about how many hours in total did (name) spend doing these activities?

Number of hours____

Discipline of children

No.
Questions and filters
Coding categories
Skip

181) Check age of selected child in Q 159:

Age 1-14
Age 15-17 –skip to 185

182) Record the child’s line number and name from 159

Line number_____
Name_____

183) Now I would like to talk about something else.
Adults use certain methods to teach child how to behave well or to correct behavioral problems. I will read you a list of methods that are used. Please tell me if you or someone else in your household has

a) revoked privileges, not allowed (name) to do something that he/she likes or now allowed him/her to leave the house
Yes 1
No 2
b) explained to (name) why his/her behavior is not acceptable
Yes 1
No 2
c) shaken him/her
Yes 1
No 2
d) yelled or screamed
Yes 1
No 2
e) given him/her something else to do
Yes 1
No 2
f) hit or spanked him/her on his/her buttocks with bare hands
Yes 1
No 2
g) hit him/her on his/her buttocks or elsewhere on his/her body with something like a belt, a hairbrush, a stick, or another hard object
Yes 1
No 2
h) called him/her an idiot, lazy, or a similar word
Yes 1
No 2
i) slapped or hit him/her on the face, head, or ears
Yes 1
No 2
j) slapped or hit him/her on the hands, arms or legs
Yes 1
No 2
k) beat him/her, that is, hitting as hard as possible without stopping
Yes 1
No 2

184) Do you think that to properly raise and educate (name), you must punish him/her physically?

Yes 1
No 2
Don’t know/no opinion 8

185) Record the time

Hours_____
Minutes_____

Interviewer’s observations
To be filled in after completing interview

Comments about the interview:

Comments on specific questions:

Any other comments:

Supervisor’s observations

Editor’s observations