EGYPT INTERIM DEMOGRAPHIC AND HEALTH SURVEY 2003 HOUSEHOLD QUESTIONNAIRE
GOVERNORATE
PSU/SEGMENT NO.
KISM/MARQAZ
BUILDING NO.
SHIAKHA/VILLAGE
HOUSING UNIT NO.
HOUSEHOLD NO. INSIDE SEGMENT.
RURAL 2
LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4
NOT SLUM AREA 1
SLUM AREA 2
NAME OF HOUSEHOLD HEAD
ADDRESS IN DETAIL
INTERVIEWER VISITS
DATE
TEAM
INTERVIEWER
SUPERVISOR ASSISTANT
SUPERVISOR
RESULT CODES:
2=NOT HOUSEHOLD MEMBER AT HOME/NO COMPETENT PERSON AT HOME
3=ENTIRE HOUSEHOLD ABSENT FOR AN EXTENDED PERIOD
4=POSTPONED
5=REFUSED
6=DWELLING VACANT/ADDRESS NOT A DWELLING
7=DWELLING DESTROYED
8=DWELLING NOT FOUND
9=OTHER (SPECIFY)
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
TEAM
INTERVIEWER
SUPERVISOR ASSISTANT
SUPERVISOR
RESULT
TOTAL NUMBER OF VISITS
TOTAL ELIGIBLE WOMEN
LINE NO. OF RESPONDENT FROM HH Q.
NO 2
REINTERVIEW
NO 2
NAME
DATE
SIGNATURE
OFFICE EDITOR
NAME
DATE
SIGNATURE
CODER
NAME
DATE
SIGNATURE
KEYER
NAME
DATE
SIGNATURE
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.
003. Are there any other persons such as small children or infants who are not listed?
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?
NO
005. Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?
NO
006. RELATIONSHIP: What is the relationship of (NAME) to the head of the household?
CODING:
02=WIFE/HUSBAND
03=SON/DAUGHTER
04=SON-IN=LAW/DAUGHTER-IN-LAW
05=GRANDCHILD
06=PARENT
07=PARENT-IN-LAW
08=BROTHER/SISTER
09=BROTHER-IN-LAW/SISTER-IN-LAW
10=OTHER RELATIVE
11=ADOPTED/FOSTER CHILD
12=STEP CHILD
13=NOT RELATED
98=DON'T KNOW
007. Does (NAME) usually live here?
NO 2
008. Did (NAME) sleep here last night?
NO 2
009. SEX: Is (NAME) a male or female?
FEMALE 2
010. AGE: How old was (NAME) at his/her last birthday? RECORD IN COMPLETED YEARS.
011. MARITAL STATUS: IF AGE 15 OR OLDER: What is (NAME'S) current marital status?
WIDOWED 2
DIVORCED 3
SEPARATED 4
NEVER MARRIED/SIGNED CONTRACT 5
012. WOMEN: 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)
013. CHILDREN: CIRCLE LINE NUMBER OF CHILD UNDER AGE 6.
EDUCATION: IF AGE 6 YEARS OR OLDER
014. Has (NAME) ever been to school?
IF YES: ASK QUESTIONS 015-022 AS APPROPRIATE.
IF NO: GO TO 006 FOR NEXT PERSON.
NO 2
015. What is the highest level of school (NAME) attended?
1=PRIMARY
2=PREPARATORY
3=SECONDARY
4=UPPER INTERMEDIATE
5=UNIVERSITY
6=MORE THAN UNIVERSITY
016. What is the highest grade he/she successfully completed at that level?
ATTENDENCE DURING THE 2002-2003 SCHOOL YEAR: IF AGE 3-24 YEARS
017. Has (NAME) attended school at any time during the 2002-2003 school year, that is since September 2002 current (school year)?
IF YES: ASK QUESTIONS 018-019.
IF NO: GO TO 020
NO 2
018. During this school year, what level has (NAME) been attending?
0=NURSERY/KINDERGARTEN
1=PRIMARY
2=PREPARATORY
3=SECONDARY
4=UPPER INTERMEDIATE
5=UNIVERSITY
6=MORE THAN UNIVERSITY
019. What grade is he/she attending?
ATTENDANCE DURING THE 2001-2002 SCHOOL YEAR: IF AGE 3-24 YEARS
020. Did (NAME) attend during the 2001-2002 school year, that is the school year beginning in September 2001 (the previous school year)?
IF YES: ASK QUESTIONS 021-022.
IF NO: GO TO 006.
NO 2
021. What level of school did (NAME) attend during the 2001-2001 school year?
0=NURSERY/KINDERGARTEN
1=PRIMARY
2=PREPARATORY
3=SECONDARY
4=UPPER INTERMEDIATE
5=UNIVERSITY
6=MORE THAN UNIVERSITY
022. What grade did he/she attend during the 2001-2002 school year?
GO TO 006 FOR NEXT PERSON.
023. CHECK 012 AND ENTER THE TOTAL NUMBER OF ELIGIBLE WOMEN.
024. CHECK 013 AND ENTER THE TOTAL NUMBER OF ELIGIBLE CHILDREN
025. TICK IF AN ADDITIONAL HOUSEHOLD QUESTIONNAIRE USED
026. What type of dwelling does your household live in?
FREE STANDING HOUSE 2
OTHER__________6
027. Is your dwelling owned by your household or not? IF OWNED: Is it owned solely by your household or jointly with someone else?
OWNED JOINTLY 2 (GO TO 30)
RENTED 3
OTHER__________6
028. Is there a possibility that you could be evicted from this dwelling?
NO 2 (GO TO 30)
DON'T KNOW 8 (GO TO 30)
029. How likely is it that you could be evicted from this dwelling?
SOMEWHAT LIKELY 2
VERY LITTLE LIKELY 3
DON'T KNOW 4
030. MAIN MATERIAL OF THE FLOOR. RECORD YOUR OBSERVATIONS.
CERAMIC/MARBLE TILES 32
CEMENT TILES 33
CEMENT 34
WALL-TO-WALL CARPET 35
VINYL 36
031. How many rooms does your household use for living (excluding the bathrooms, kitchens and stairway areas)?
032. What is the main source of drinking water for members of your household?
PIPED INTO YARD/PLOT 12 (GO TO 034)
PUBLIC TAP 13
OPEN WELL IN YARD/PLOT 22 (GO TO 034)
OPEN PUBLIC WELL 23
PROTECTED WELL IN YARD/PLOT 32 (GO TO 034)
PROTECTED PUBLIC WELL 33
OTHER__________96
033. How long does it take to go there, get water, and come back?
034. During the last two weeks, has there been any time when water was not available from (source in 032)?
NO 2 (GO TO 036)
DON'T KNOW 3 (GO TO 036)
035. Did this happen on a daily or almost daily basis, only a few times per week, or less frequently?
FEW TIMES PER WEEK 2
LESS FREQUENTLY 3
DON'T KNOW 8
036. Do you store water in the household?
NO 2 (GO TO 039)
DON'T KNOW 8 (GO TO 039)
037. ASK TO SEE THE CONTAINER(S) IN WHICH WATER IS STORED: Could you show me in which container(s) you store water? OBSERVE: Are the container(s) covered?
SOME COVERED 2
NONE COVERED 3
NOT ABLE TO OBSERVE 8 (GO TO 039)
038. OBSERVE: Do(es) the container(s) have a narrow or wide mouth(s)?
WIDE MOUTH(S) 2
BOTH TYPES 3
039. What kind of toilet facility do most members of your household use?
TRADITIONAL WITH TANK FLUSH 12
TRADITIONAL WITH BUCKET FLUSH 13
PIT TOILET/LATRINE 21
NO FACILITY 31 (GO TO 045)
OTHER_________96
040. Is this toilet in working condition at this time?
NO 2
DON'T KNOW 8
041. Into where does this facility drain?
VAULT (BAYARA) 02
SEPTIC SYSTEM 03
PIPE CONNECTED TO CANAL 04
PIPE CONNECTED TO GROUND WATER 05
EMPTIED (NO CONNECTION) 06 (GO TO 043)
OTHER_________96 (GO TO 043)
042. Are you or your neighbors currently experiencing any problems with this drainage system?
IF YES: What type of problems?
POOLING AROUND NEIGHBOR'S DWELLING B
COST OF EVACUATION C
OTHER__________X
NO PROBLEM(S) Y
DON'T KNOW Z
043. Do you share this facility with other households?
IF YES: How many other households sharing this facility?
NOT SURE HOW MANY SHARING 98
TOILET NOT SHARED 00
044. ASK TO SEE THE TOILET FACILITY USED BY MOST HOUSEHOLD MEMBERS. OBSERVE WHETHER THERE IS FECAL MATTER INSIDE THE FACILITY ON THE FLOOR OR WALLS.
NO, NO MATTER 2
NOT ABLE TO DETERMINE 3
NOT ABLE TO OBSERVE TOILET 8
045. Does your household have any place used for hand washing?
NO 2 (GO TO 48)
046. ASK TO SEE THE PLACE USED MOST OFTEN FOR HANDWASHING. INDICATE IF PLACE IS IN SAME ROOM/ IN ROOM ADJACENT TO THE TOILET FACILITY USED BY HOUSEHOLD MEMBERS.
NOT NEAR TOILET FACILITY 2
NOT ABLE TO DETERMINE/NO TOILET FACILITY 3
NOT ABLE TO OBSERVE HANDWASHING AREA 8 (GO TO 048)
047. OBSERVE IF THE FOLLOWING ITEMS ARE PRESENT IN THE AREA USED FOR HANDWASHING.
NO 2
NO 2
NO 2
NO 2
048. How does this household primarily dispose of kitchen waste and trash?
RECORD MAIN METHOD OF DISPOSAL ONLY. IF TWO OR MORE METHODS ARE USED EQUALLY, RECORD THE HIGHEST METHOD ON THE LIST.
FROM CONTAINER IN THE STREET 12
INTO CANAL/DRAINAGE 22
FED TO ANIMALS 32
OTHER______96
049. What type of fuel does your household use for cooking?
LPG/NATURAL GAS 02
KEROSENE 03
COAL/IGNITE 04
CHARCOAL 05
FIREWOOD/STRAW 06
DUNG 07
OTHER_____96
050. Does your household have:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
051. Does your household have?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
052. Do you or any member of your household own:
NO 2
NO 2
NO 2
NO 2
NO 2
053. How much on average does your household pay in a month for the electric bill?
NO ELECTRICITY 997
DON'T KNOW 998
054. ASK RESPONDENT FOR A TEASPOON OF SALT. TEST SALT FOR IODINE.
RECORD PPM (PARTS PER MILLION).
1-25 PPM 2
26-50 PPM 3
51-75 PPM 4
76-100 PPM 5
055. CHECK QUESTIONS 012 AND 013 AND IDENTIFY ALL ELIGIBLE EVER-MARRIED WOMEN 1549 AND CHILDREN UNDER AGE 6. RECORD THE LINE NUMBERS, NAMES AND AGES OF THE WOMEN AND CHILDREN FROM THE HOUSEHOLD SCHEDULE IN THE APPROPRIATE GRID BELOW. USE AN ADDITIONAL QUESTIONNAIRE IF THERE ARE NOT SUFFICIENT LINES TO RECORD ALL OF THE ELIGIBLE WOMEN AND CHILDREN.
059. What is (NAME'S) date of birth?
MONTH___
YEAR_____
STANDING 2
NOT PRESENT 2
REFUSED 3
OTHER 6
064. TICK IF ADDITIONAL QUESTIONNAIRE USED TO RECORD MEASUREMENTS FOR:
CHILDREN__
NAME OF ASSISTANT_______
THANK THE RESPONDENT FOR PARTICIPATING IN THE SURVEY. COMPLETE QUESTIONS 066-067 AS APPROPRIATE. BE SURE TO REVIEW THE QUESTIONNAIRE FOR COMPLETENESS BEFORE LEAVING THE HOUSEHOLD.
FAIR 2
GOOD 3
VERY GOOD 4
________________________________________________
068. FIELD EDITOR'S COMMENTS:
________________________________________________
069. SUPERIVSOR'S COMMENTS:
________________________________________________
070. OFFICE EDITOR'S COMMENTS:
________________________________________________