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GHANA DEMOGRPAHIC AND HEALTH SURVEY 1998
HOUSEHOLD SCHEDULE

IDENTIFICATION

PLACE NAME ______
REGION ______
EA NUMBER _____
STRUCTURE NUMBER _____
HOUSEHOLD NUMBER _____
NAME OF HOUSEHOLD HEAD _____

HOUSEHOLD SELECTED FOR MEN'S QUESTIONNAIRE

Yes1
No 2

(For Office Use)

CITY/TOWN/VILLAGE __

large city 1
medium city 2
small city 3
town 4
village 5

INTERVIEW 1
DATE ___
INTERVIEWER'S NAME ____
RESULT* _____

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 2
DATE ___
INTERVIEWER'S NAME ___
RESULT* ____

NEXT VISIT:
DATE ___
TIME ___

INTERVIEW 3
DATE ___
INTERVIEWER'S NAME____
RESULT* ____

FINAL VISIT
MONTH ___
YEAR ___
INTERVIEWER'S NAME ___
RESULT* ___

TOTAL NUMBER OF VISITS ____

Result___
**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 IN HOUSEHOLD ___

TOTAL ELIGIBLE WOMEN ___

TOTAL ELIGIBLE MEN ___

LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE ___

SUPERVISOR
NAME ____
DATE ____

FIELD EDITOR
NAME ____
DATE _____

OFFICE EDITOR ___

KEYED BY___

HOUSEHOLD SCHEDULE

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

(1) LINE NUMBER

USUAL RESIDENTS AND VISITORS

(2) Please give me the names of the persons who usually live in your household who stayed here last night, starting with the head of the household.

RELATIONSHIP TO HEAD OF HOUSEHOLD*

(3) What is the relationship of (NAME) to the head of the household?

*CODES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD

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

(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)?

IN YEARS ___


CODES FOR Q. 7

AGE AS REPORTED 0 to 96
AGE 97 OR ABOVE 97
DON'T KNOW 98

DISABILITY

(8) Does (NAME) suffer from partial/total loss of limbs OR is paralysed?

YES 1
NO 2

(9) Is (NAME) partially/totally blind?

YES 1
NO 2

(10) Is (NAME) partially/totally deaf?

YES 1
NO 2

(11) Is (NAME) mentally retarded?

YES 1
NO 2

(12) Does (NAME) have leprosy?

YES 1
NO 2

(13) Does (NAME) have fits/epilepsy?

YES 1
NO 2

(14) Does (NAME) have mental problems?

YES 1
NO 2

MARITAL STATUS*

(IF AGE 12 YEARS OR OLDER)

(15) What is (NAME'S) current marital status?

*CODES FOR Q.15

MARITAL STATUS
CURRENTLY MARRIED 1
LIVING WITH A MAN/WOMAN 2
WIDOWED 3
DIVORCED 4
SEPARATED 5
NEVER MARRIED 6

EDUCATION

(IF AGE 6 YEARS OR OLDER)

(16) Has (NAME) ever been to school?

YES 1
NO 2

(IF AGE 6 YEARS OR OLDER)
(IF ATTENDED SCHOOL)

(17) What is the highest level of school (NAME) attended? What is the highest grade (NAME) completed at that level?**

LEVEL ___
GRADE ___

**CODES FOR Q. 17
EDUCATIONAL LEVEL:

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4
DON'T KNOW 8

EDUCATION GRADE

LESS THAN 1 YEAR COMPLETED 00
DON'T KNOW 98

(IF AGE 6 YEARS OR OLDER)
(IF ATTENDED SCHOOL)
(IF AGE LESS THAN 25 YEARS)

(18) Is (NAME) still in school?

YES 1
NO 2

(IF AGE 6 YEARS OR OLDER)
(IF ATTENDED SCHOOL)
(IF AGE LESS THAN 25 YEARS )
(IF NOT STILL IN SCHOOL)

(19) Why is (NAME) not in school?***

***CODES FOR Q. 19
REASONS FOR NOT ATTENDING SCHOOL:

FINANCIAL CONSTRAINT 1
SCHOOL TOO FAR 2
LACK OF INTEREST 3
DISABILITY 4
NEEDED TO HELP IN FAMILY BUSINESS 5
GRADUATED 6
OTHER 7

PARENTAL SURVIVORSHIP AND RESIDENCE OF PERSONS LESS THAN 15 YEARS OLD

(20) Is (NAME)'s biological mother alive?

YES 1
NO 2
DK 8

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

RECORD MOTHER'S LINE NUMBER. IF NOT LIVING IN HOUSEHOLD WRITE '00'.

____

(22) Is (NAME)'s biological father alive?

YES 1
NO 2
DK 8

(23) IF FATHER ALIVE: Does (NAME)'s biological father live in this household? IF YES: What is his name?
RECORD FATHER'S LINE NUMBER. IF NOT LIVING IN HOUSEHOLD WRITE '00'.

____

(24) ELIGIBILITY WOMAN: CIRCLE LINE NUMBER OF WOMEN ELIGIBLE FOR WOMEN'S QUESTIONNAIRE (Women age 15-49).

(25) ELIGIBILITY MAN: CIRCLE LINE NUMBER OF MEN ELIGIBLE FOR MEN'S QUESTIONNAIRE (Men age 15-59).

TICK HERE IF CONTINUATION SHEET USED __

Just to make sure that I have a complete listing:

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

YES ___ ENTER EACH IN TABLE
NO ___

2) 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 ___

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

YES ___ ENTER EACH IN TABLE
NO ___

26. What is the main source of water your household uses for laundry and dishwashing?

PIPED WATER
PIPED INTO RESIDENCE/YARD/COMPOUND 11 (SKIP TO 28)
PUBLIC TAP/NEIGHBOUR'S HSE 12
WELL WATER
WELL IN RESIDENCE/YARD/COMP 21 (SKIP TO 28)
PUBLIC WELL 22
BOREHOLE 23
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/DAM 33
DAM 34
DUGOUT 35
RAINWATER 41 (GO TO 28)
TANKER TRUCK 51
BOTTLED WATER 61 (SKIP TO 28)
OTHER (SPECIFY) ____ 96

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

MINUTES ___
ON PREMISES 996

28. Does your household get drinking water from this same source?

YES 1 (SKIP TO 31)
NO 2

29. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/COMPOUND 11 (SKIP TO 31)
PUBLIC TAP/NEIGHBOUR'S HSE 12
WELL WATER
WELL IN RESIDENCE/YARD/COMP 21 (SKIP TO 31)
PUBLIC WELL 22
BOREHOLE 23
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/DAM 33
DAM 34
DUGOUT 35
RAINWATER 41 (GO TO 31)
TANKER TRUCK 51
BOTTLED WATER 61 (SKIP TO 31)
OTHER (SPECIFY) ____ 96

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

MINUTES ___
ON PREMISES 996

31. Who usually fetches water (for both laundry/dishwashing and drinking) for the household?

RESPONDENT 1
SPOUSE/PARTNER 2
SON 3
DAUGHTER 4
BOTH SON AND DAUGHTER 5
OTHER MALE MEMBER 6
OTHER FEMALE MEMBER 7
OTHER (SPECIFY) _____ 8

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

FLUSH TOILET
OWN TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
BUCKET/PAN 23
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) _____ 96

33. Does your household have:

Electricity?
A radio?
A television?
A video deck?
A telephone?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
VIDEO DECK
YES 1
NO 2
TELEPHONE
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

34. How many rooms in your household are used for sleeping?

ROOMS ____

35. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.

NATURAL FLOOR
EARTH/SAND/MUD 11
MUD MIXED WTIH DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
LINOLEUM 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
TERRAZZO 36
OTHER (SPECIFY) ____ 96

36. Does any member of your household own:

A bicycle?
A motorcycle?
A car?
A tractor?
A horse/cart?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2
TRACTOR
YES 1
NO 2
HORSE/CART
YES 1
NO 2

37. What type of salt is usually used for cooking in your household?

MARKET PACKAGED IODATED SALT 01
MARKET PACKAGED NON-IODATED SALT 02
FACTORY PACKAGED IODATED SALT 03
FACTORY PACKAGED NON-IODATED SALT 04
OTHER (SPECIFY) ____ 96

38. TEST THE SALT AND WRITE THE RESULT.

IODINE READING (PPM) ____