EGYPT DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE 1992

IDENTIFICATION
GOVERNORATE __________
KISM/MARKAZ __________
SHIAKHA/VILLAGE __________
HOUSEHOLD NO. ___________

PSU/SEGMENT NO. ________
BUILDING NO._________
HOUSE NO. ______________

URBAN 1
RURAL 2

LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4

SUBSAMPLE:
YES 1
NO 2

NAME OF HOUSEHOLD HEAD _______
ADDRESS IN DETAIL _____

GOVERNORATE __
PSU/SEGMENT NO. ___
HOUSEHOLD NO. ____
URBAN/RURAL ____
LOCALITY ___
SUBSAMPLE ___

INTERVIEWER VISITS 1
DATE _____
TEAM _____
INTERVIWER'S NAME _____
SUPERVISOR'S NAME _____
RESULT ______
NEXT VISIT: DATE _____ TIME ________

INTERVIEWER VISITS 2
DATE _____
TEAM _____
INTERVIEWER'S NAME _____
SUPERVISOR'S NAME _____
RESULT ______
NEXT VISIT: DATE _____ TIME ________

INTERVIEWER VISITS 3
DATE _____
TEAM _____
INTERVIWER'S NAME_____
SUPERVISOR'S NAME _____
RESULT ______

FINAL VISIT
DAY ____ MONTH ____ YEAR ____
TEAM ____
INTERVIEWER _____
SUPERVISOR _____
RESULT _____
TOTAL VISITS ____

RESULT CODES:

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT PERSON AT HOME AT THE 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) _______

TOTAL IN HOUSEHOLD __
TOTAL ELIGIBLE WOMEN __
TOTAL ELIGIBLE MEN__
LINE NO. OF RESPONDENT FOR HOUSEHOLD SCHEDULE __

ADDRESS CHECKED (by NAME): ________

YES 1
NO 2

REINTERVIEW: _________

YES 1
NO 2

FIELD EDITOR
NAME _______
DATE _______
SIGNATURE _______

OFFICE EDITOR
NAME _______
DATE _______
SIGNATURE _______

CODER
NAME _______
DATE _______
SIGNATURE _______

KEYER
NAME _______
DATE _______
SIGNATURE _______

HOUSEHOLD SCHEDULE

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

001. LINE NO.

002. 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 NAMES, ASK QUESTIONS 003-005 TO BE SURE THAT THE LISTING IS COMPLETE. THEN GO ON TO QUESTION 006.

Just to make sure that I have a complete listing.

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

YES ENTER EACH IN TABLE
NO

004. In addition, 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 ENTER EACH IN TABLE
NO

005. Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?

YES ENTER EACH IN TABLE
NO

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

________________________

007. RELATIONSHIP TO THE HOUSEHOLD HEAD: GENERATION NUMBER

FOR CODER __

008. RELATIONSHIP TO THE HOUSEHOLD HEAD: COUPLE NUMBER

FOR CODER __

009. RELATIONSHIP TO THE HOUSEHOLD HEAD: RELATIONSHIP TO HEAD OF HOUSEHOLD

FOR CODER __

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

YES 1
NO 2

011. RESIDENCE: Did (NAME) sleep here last night?

YES 1
NO 2

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

M 1
F 2

013. AGE: How old was (NAME) at his/her last birthday?

IN YEARS __

014. MARITAL STATUS, IF AGE 15 YEARS OR OLDER: What is (NAME'S) current marital status?

1 MARRIED
2 WIDOWED
3 DIVORCED
4 NEVER MARRIED/ SIGNED CONTRACT

015. ELIGIBLITY: CIRCLE LINE NUMBER OF WOMEN ELIGIBLE FOR INDIVIDUAL INTERVIEW (i.e., EVER-MARRIED WOMEN AGE 15-49 YEARS WHO ARE USUAL RESIDENTS OR STAYED THERE ON THE NIGHT BEFORE INTERVIEW).

016. ELIGIBLITY: HUSBAND SUBSAMPLE: FOR HOUSEHOLDS IN HUSBAND SURVEY SUBSAMPLE: CIRCLE LINE NUMBER OF MEN ELIGIBLE FOR INDIVIDUAL INTERVIEW (I.E., MEN WHOSE WIVES ARE ELIGIBLE)

017. EDUCATION: IF AGE 3 YEARS OR OLDER: Has (NAME) ever been to school? IF YES, ASK QUESTIONS 018-020. IF NO, SKIP TO QUESTION 021.

YES 1
NO 2

018. EDUCATION: IF AGE 3 YEARS OR OLDER: IF ATTENDED SCHOOL: What is the highest level of school (NAME) attended?

NURSERY 0
PRIMARY 1
PREPARATORY 2
SECONDARY 3
UPPER INTERMEDIATE 4
UNIVERSITY 5
MORE THAN UNIVERSITY 6

019. EDUCATION: IF AGE 3 YEARS OR OLDER: IF ATTENDED SCHOOL: What is the highest grade he/she successfully completed at that level?

GRADE _______

020. EDUCATION: IF AGE 3 YEARS OR OLDER: IF ATTENDED SCHOOL: FOR PERSONS UNDER AGE 25: Is (NAME) still in school?

YES 1
NO 2

021. OCCUPATION: IF AGE 6 YEARS OR OLDER: What is main work that (NAME) does?

_______________

022. OCCUPATION: IF AGE 6 YEARS OR OLDER: OCCUPATIONAL GROUP

FOR CODER __

023. WORK STATUS: IF AGE 6 YEARS OR OLDER: Did (NAME) work during the last month?

YES 1
NO 2

024. WORK STATUS: IF AGE 6 YEARS OR OLDER: Is (NAME) usually paid in cash or kind for the work he/she does?

CASH 1
KIND 2
BOTH 3
NOT PAID 4

025. ENTER THE TOTAL NUMBER OF ELIGIBLE:

WOMEN___
MEN___

026. TICK HERE IF CONTINUATION SHEET USED: ___

027. What type of dwelling does your household live in?

APARTMENT 1
FREE STANDING HOUSE 2
OTHER (SPECIFY) ____ 3

028. Is your dwelling owned by your household or not? IF OWNED: Is it owned solely by your household or jointly with someone else?

OWNED 1
OWNED JOINTLY 2
RENTED 3
OTHER (SPECIFY) ______ 4

029. MAIN MATERIAL OF THE FLOOR. RECORD YOUR OBSERVATIONS.

NATURAL FLOOR

EARTH/SAND 11

FINISHED FLOOR

PARQUET OR POLISHED WOOD 31
CERAMIC/MARBLE TILES 32
CEMENT TILES 33
CEMENT 34
WALL-TO-WALL CARPET 35

OTHER (SPECIFY)___ 41

030. How many rooms are there in your dwelling (excluding the bathrooms, kitchens and stairway areas)?

ROOMS ___

031. How many of the rooms are used for sleeping?

ROOMS __

032. Is there a special room used only for cooking inside or outside the dwelling?

YES 1
NO 2

033. What is the source of water your household uses for drinking?

PIPED WATER

PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 35)
PUBLIC TAP 12

WELL WATER

WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 35)
PUBLIC WELL 22

SURFACE WATER

NILE/CANALS 31

OTHER (SPECIFY) ____ 71

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

MINUTES ___

035. Does your household get water for other uses (e.g., for handwashing and dishwashing) from the same source?

YES 1 (GO TO 37)
NO 2

036. What is the source of water your household uses for handwashing or dishwashing or other uses?

PIPED WATER

PIPED INTO RESIDENCE/YARD/PLOT 11
PUBLIC TAP 12

WELL WATER

WELL IN RESIDENCE/YARD/PLOT 21
PUBLIC WELL 22

SURFACE WATER

NILE/CANALS 31

OTHER (SPECIFY) 71

037. What kind of toilet facility does your household have?

MODERN FLUSH TOILET 11
TRADITIONAL WITH TANK FLUSH 12
TRADITIONAL WITH BUCKET FLUSH 13
PIT TOILET/LATRINE 21
NO FACILITY 31
OTHER (SPECIFY) ______ 41

038. Are there electrical connections in all or only part of the dwelling unit?

YES, IN ALL 1
YES, IN PART 2
HAS NO ELECTRICAL CONNECTIONS 3

039. Does your household have:

A radio with cassette recorder?

YES 1
NO 2

A black and white television?

YES 1
NO 2

A color television?

YES 1
NO 2

A video?

YES 1
NO 2

040. Does your household have:

An electric fan?

YES 1
NO 2

A gas/electric cooking stove?

YES 1
NO 2

A water heater?

YES 1
NO 2

A refrigerator?

YES 1
NO 2

A washing machine?

YES 1
NO 2

A sewing machine?

YES 1
NO 2

041. Do you or any member of your household own:

A bicycle?

YES 1
NO 2

A private car/motorcycle?

YES 1
NO 2

Transport equipment (truck, taxi, van, bus, etc.)?

YES 1
NO 2

Residential or commercial buildings other than the dwelling unit?

YES 1
NO 2

Farm or other land?

YES 1
NO 2

Livestock (donkeys, horses, cows, sheep, etc.)/ poultry?

YES 1
NO 2

Mechanical farm equipment (tractor, etc.)?

YES 1
NO 2

OBSERVATIONS

THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 042-043 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNAIRE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD.

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