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DEMOGRAPHIC AND HEALTH SURVEY
HOUSEHOLD QUESTIONNAIRE 1998

ECONOMY AND FINANCE MINISTRY
CENTRAL BUREAU OF THE CENSUS AND POPULATION STUDIES

REPUBLIC OF CAMEROON
PEACE - WORK - FATHERLAND

IDENTIFICATION

PROVINCE ___
DEPARTMENT ___
URBAN DISTRICT/DISTRICT ___
CITY/COUNTY/GROUP ___
NEIGHBORHOOD/TOWN ___
NAME OF HEAD OF HOUSEHOLD ___

PROVINCE ___
CLUSTER ___
URBAN DISTRICT/DISTRICT ___

YAOUNDE/DOUALA 1
GAROUA/MAROUA/BAFOUSSAM/BAMENDA 2
OTHER CITIES 3
RURAL 4

CLUSTER NUMBER ___
STRUCTURE NUMBER ___
HOUSEHOLD NUMBER ___

HOUSEHOLD SELECTED FOR MALE SURVEY?

YES 1
NO 2

INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___

RESULTS___

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): ___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

TOTAL NUMBER OF VISITS____
TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
TOTAL ELIGIBLE MEN ___
LINE NUMBER OF SURVEYED HOUSEHOLD ___

SUPERVISOR
NAME: ___
DATE: ___

FIELD EDITOR
NAME: ___
DATE: ___

OFFICE EDITOR ___
KEYED BY ___

HOUSEHOLD SCHEDULE

Now we would like information about the people who usually live in your household or who are staying with you now.

1) LINE NUMBER

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

_____

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

HEAD 01
WIFE OR HUSBAND 02
SON OR DAUGHTER 03
SON-IN-LAW OR DAUGHTER-IN-LAW 04
GRANDCHILD 05
MOTHER OR FATHER 06
MOTHER-IN-LAW OR FATHER-IN-LAW 07
BROTHER OR SISTER 08
CO-WIFE 09
OTHER RELATIVE 10
ADOPTED/FOSTER/STEP-CHILD 11
NOT RELATED 12
DK 98

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?

M 1
F 2

7) AGE
How old is (NAME)?

IF 95 OR MORE, RECORD '95'.

IN YEARS: ___

8) EDUCATION: IF AGE 6 OR OLDER
Has (NAME) ever been to school?

YES 1
NO 2 (GO TO 11)

9) EDUCATION: IF ATTENDED SCHOOL
What is the highest level of education that (NAME) attended?
What was the highest grade that he or she completed at this level?

LEVEL:

NURSERY SCHOOL 0
PRIMARY 1
SECONDARY 2
HIGHER 3
DK 8

GRADE:

NURSERY SCHOOL
IN ALL CASES 1
PRIMARY
LESS THAN ONE YEAR 0
INFANT/CLASS ONE/SIL 1
STANDARD ONE/CLASS TWO/CP 2
STANDARD TWO/CLASS THREE/CE1 3
STANDARD THREE/CLASS FOUR/CE2 4
STANDARD FOUR/CLASS FIVE/CM1 5
STANDARD FIVE/CLASS SIX/CM2 6
STANDARD SIX/CLASS SEVEN 7
DK 8
SECONDARY
LESS THAN ONE YEAR 0
FORM 1/SIXTH/1ST YEAR 1
FORM 2/FIFTH/2ND YEAR 2
FORM 3/FOURTH/3RD YEAR 3
FORM 4/THIRD/4TH YEAR 4
FORM 5/SECOND 5
LOWER SIXTH FORM/FIRST 6
UPPER SIXTH FORM/FINAL 7
DK 8
HIGHER

LESS THAN ONE YEAR 0
1ST YEAR 1
2ND YEAR 2
3RD YEAR 3
4TH+ YEAR 4
DK 8

10) EDUCATION: IF LESS THAN 25 YEARS OLD
Is (NAME) still in school?

YES 1
NO 2

PARENTAL SURVIVORSHIP AND RESIDENCE
(QUESTIONS 11-14 REFER TO THE BIOLOGICAL PARENTS OF THE CHILD. RECORD '00' IF THE PARENTS ARE NOT MEMBERS OF THE HOUSEHOLD).

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

YES 1
NO 2
DK 8

12) IF ALIVE: Does (NAME)'s natural mother live in this household?
IF YES: What is her name?

RECORD THE MOTHER'S LINE NUMBER.

___

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

YES 1
NO 2
DK 8

14) IF ALIVE: Does (NAME)'s natural father live in this household?
IF YES: What is his name?

RECORD THE FATHER'S LINE NUMBER.

___

15) WOMEN'S ELIGIBILITY
CIRCLE THE LINE NUMBER OF WOMEN AGE 15-49.

15A) MEN'S ELIGIBILITY
CIRCLE THE LINE NUMBER OF MEN AGE 15-49
(IF MALE SURVEY IS ANTICIPATED IN THIS HOUSEHOLD)

Just to make sure that I have a complete listing:

1. Are there any other people such as small children or infants who we have not listed?

YES: ___ (ENTER EACH IN TABLE)
NO: ___

2. In addition, are there any other people who may not be family members, such as domestic servants, lodgers or friends who normally live here?

YES: ___ (ENTER EACH IN TABLE)
NO: ___

3. Are there any guests or temporary visitors staying here, or anyone else who slept here last night that have not been listed?

YES: ___ (ENTER EACH IN TABLE)
NO: ___

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

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 18)
PIPED INTO YARD 12 (GO TO 18)
PIPED INTO NEIGHBOR'S YARD 13
PUBLIC TAP 14
WELL WATER
MANUAL PUMP WELL 21
WELL WITHOUT PUMP 22
SURFACE WATER
RIVER/SPRING/BACKWATER 31
RAINWATER 41 (GO TO 18)
OTHER (SPECIFY): ___ 96

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

MINUTES: ___
ON THE PREMISES 996

18) What kind of toilet facility does your household have?

FLUSH TOILET 11
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) TOILET 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY): ___ 96

19) In your household, do you have?
Electricity?
A radio?
A television?
A telephone?
A refrigerator?
A hotplate/ gas/electric stove?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
TELEPHONE
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
HOTPLATE/STOVE
YES 1
NO 2

20) In your household, how many rooms are used for sleeping?

ROOMS: ___

21) MAIN MATERIAL OF THE FLOOR.
RECORD THE OBSERVATION

NATURAL FLOOR
EARTH/SAND 11
RUDIMENTARY FLOOR
WOOD PLANKS 21
FINISHED FLOOR
CEMENT 31
TILE 32
OTHER FINISHED 33
OTHER (SPECIFY): ___ 96

22) Does any member of your household own:
A bicycle?
A motorcycle?
A car?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

23) What type of salt is usually used for cooking in your household?

(ASK TO SEE SALT PACKAGE)

LOCAL SALT 01
PACKAGED SALT (IODIZED) 02
PACKAGED SALT (NON IODIZED) 03
PACKAGED SALT (IODIZED OR NOT?) 04
SALT FOR ANIMALS 05
LOOSE SALT 06
OTHER (SPECIFY): ___ 96

24) TEST THE SALT AND RECORD THE RESULT.

POSITIVE TEST (IODIZED) 1
NEGATIVE TEST (NON IODIZED) 2
UNDETERMINED 3
TEST NOT DONE/SALT NOT AVAILABLE 8