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EGYPT DEMOGRAPHIC AND HEALTH SURVEY
HOUSEHOLD SCHEDULE 1995

IDENTIFICATION

GOVERNORATE __________
PSU/SEGMENT NO. _____________
KISM/MARKAZ __________
BUILDING NO. ________________
SHIAKHA/VILLAGE __________
HOUSING UNIT NO___________
HOUSEHOLD NO.__________

URBAN 1RURAL 2

LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4

WOMEN'S STATUS SUBSAMPLE

YES 1
NO 2

NAME OF HOUSEHOLD HEAD _______________
ADDRESS IN DETAIL _______________

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

INTERVIEWER VISITS
DATE _____
TEAM _____
INTERVIEWER _____
SUPERVISOR _____
ASSISTANT SUPERVISOR ___
RESULT ______

NEXT VISIT:
DATE _____
TIME ________

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
TEAM ____
INTERVIEWER _____
SUPERVISOR _____
ASSISTANT 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 PERSONS IN HOUSEHOLD __

TOTAL ELIGIBLE WOMEN __

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 who are not listed?

YES (ADD TO 002)
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 (ADD TO 002)
NO

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

YES (ADD TO 002)
NO

006. RELATIONSHIP: What is the relationship of (NAME) to the head of the household? (SEE CODES BELOW).

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
10 = OTHER RELATIVE
11 = ADOPTED/FOSTER CHILD
12 = STEPCHILD
13 = NOT RELATED
98 = DON'T KNOW

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

YES 1
NO 2

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

YES 1
NO 2

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

M 1
F 2

010. AGE: How old was (NAME) at his/her last birthday? RECORD IN COMPLETED YEARS.

IN YEARS __

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

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

012. ELIGIBILITY: 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).

EDUCATION

013. IF AGE 6 YEARS OR OLDER: Has (NAME) ever been to school? IF YES, ASK QUESTIONS 014-016. IF NO, GO TO QUESTION 017.

YES 1
NO 2

014. IF AGE 6 YEARS OR OLDER: IF ATTENDED SCHOOL: What is the highest level of school (NAME) attended?

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

015. IFIF AGE 6 YEARS OR OLDER: IF ATTENDED SCHOOL: What is the highest grade he/she successfully completed at that level?

GRADE _______

016. IF AGE 6 YEARS OR OLDER: IF ATTENDED SCHOOL: FOR PERSONS UNDER AGE 25: Is (NAME) still in school or at the university?

YES 1
NO 2

WORK STATUS

017. IF AGE 6 YEARS OR OLDER: Did (NAME) work during the last month? IF YES, ASK 018. IF NO, GO TO 006 FOR NEXT PERSON.

YES 1
NO 2

018. Is (NAME) paid in cash or kind for the work he/she does?

CASH 1
KIND 2
BOTH 3
NOT PAID 4

019. ENTER THE TOTAL NUMBER OF ELIGIBLE WOMEN:

___________

020. TICK HERE IF CONTINUATION SHEET USED:

___________

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

APARTMENT 1
FREE STANDING HOUSE 2
OTHER (SPECIFY) ____ 6

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

OWNED 1
OWNED JOINTLY 2
RENTED 3
OTHER (SPECIFY) ______ 6

023. MAIN MATERIAL OF THE FLOOR. RECORD YOUR OBSERVATION.

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) ______ 96

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

ROOMS _____

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

ROOMS _____

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

YES 1
NO 2

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

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT. 11 (GO TO 29)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 29)
PUBLIC WELL 22
SURFACE WATER
NILE/CANALS 31
BOTTLED WATER 41 (GO TO 29)
OTHER (SPECIFY) ________ 96

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

MINUTES ___

029. 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) _______ 96

030. 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

031. 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

032. 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 sewing machine?
YES 1
NO 2
An automatic washing machine?
YES 1
NO 2
Any other washing machine?
YES 1
NO 2

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

A bicycle?
YES 1
NO 2
A private car/motorcycle?
YES 1
NO 2
Farm or other land?
YES 1
NO 2
Livestock(donkeys, horses, cows, sheep, etc.)/ poultry?
YES 1
NO 2

034. What type of salt is usually used for cooking in your household? (ASK TO SEE SALT PACKAGE).

SALT IN PLASTIC BAGS 01
PACKAGED SALT (lODIZED) 02
PACKAGED SALT (NOT IODIZED) 03
SALT FOR ARIHALS 04
LOOSE SALT 05
NO SALT USED 06
OTHER (SPECIFY) ________ 96

OBSERVATIONS

THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 035-036 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNAIRE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD.

035. DEGREE OF COOPERATION.

POOR 1
FAIR 2
GOOD 3
VERY GOOD 4

036. INTERVIEWER'S COMMENTS:
_____________________________

037. FIELD EDITOR'S COMMENTS:
______________________________

038. SUPERVISOR'S/ASSISTANT SUPERVISOR'S COMMENTS:
________________________________

039. OFFICE EDITOR'S COMMENTS:
_________________________________