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DEMOGRAPHIC AND HEALTH SURVEYS - HOUSEHOLD QUESTIONNAIRE (EDSG-II) - 1999 REPUBLIC OF GUINEA

IDENTIFICATION

PLACE NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION CODE _____

URBAN/RURAL:

URBAN 1
RURAL 2

CONAKRY/CAPITAL NATURAL REGION/OTHER CITY/RURAL:

CONAKRY 1
CAPITAL REGION 2
OTHER CITY 3
RURAL 4

HOUSEHOLD SELECTED FOR MEN'S SURVEY?

YES 1
NO 2

CODE OF MEN'S SELECTION _____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____

RESULT _____

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
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 1999
NAME _____
RESULT _____

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 NO. OF VISITS _____

TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____

LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE _____

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.

01. LINE NUMBER:

LINE NO. _____

02. 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.

NAME _____

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

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
09 CO-SPOUSE
10 OTHER RELATIVE
11 ADOPTED/FOSTER CHILD/STEPCHILD
12 NOT RELATED
98 DOESN'T KNOW

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

YES 1
NO 2

05. RESIDENCE: Did (NAME) stay here last night?

YES 1
NO 2

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

MALE 1
FEMALE 2

07. AGE: How old is (NAME)?

IN YEARS _____

EDUCATION, IF AGE 5 YEARS OR OLDER:

08. Has (NAME) ever attended school?

YES 1
NO 2 (GO TO 15)

09. What is the highest level of school (NAME) has attended?
What is the highest grade (NAME) completed at that level?

LEVEL _____
1 PRIMARY 0-6, 7
2 SECONDARY (1ST CYCLE) 0-4, 8
3 SECONDARY (2ND CYCLE) 0-3, 8
4 PROFESSIONAL A 0-3, 8
5 PROFESSIONAL B 0-3, 8
6 SUPERIOR 0-7, 8
8 DOESN'T KNOW 8
GRADE _____

EDUCATION, IF AGE 5 TO 25 YEARS:

10. Is (NAME) currently attending school?

YES 1 (GO TO 12)
NO 2

11. During the current school year, did (NAME) attend school at any time?

YES 1
NO 2 (GO TO 13)

12. During the current school year, what level and grade (is/was) (NAME) attending?

LEVEL _____
1 PRIMARY 0-6, 7
2 SECONDARY (1ST CYCLE) 0-4, 8
3 SECONDARY (2ND CYCLE) 0-3, 8
4 PROFESSIONAL A 0-3, 8
5 PROFESSIONAL B 0-3, 8
6 SUPERIOR 0-7, 8
8 DOESN'T KNOW 8
GRADE _____

13. During the previous school year (1997-98), did (NAME) attend any school at any time?

YES 1
NO 2 (GO TO 15)

14. During that school year (1997-98), what level and grade did (NAME) attend?

LEVEL _____
1 PRIMARY 0-6, 7
2 SECONDARY (1ST CYCLE) 0-4, 8
3 SECONDARY (2ND CYCLE) 0-3, 8
4 PROFESSIONAL A 0-3, 8
5 PROFESSIONAL B 0-3, 8
6 SUPERIOR 0-7, 8
8 DOESN'T KNOW 8
GRADE _____

PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 16 YEARS OLD:

15. Is (NAME)'s natural mother alive?

YES 1
NO 2
DOESN'T KNOW 8

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

RECORD MOTHER'S LINE NUMBER. RECORD '00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE.

LINE NO. ______

17. Is (NAME)'s natural father alive?

YES 1
NO 2
DOESN'T KNOW 8

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

RECORD FATHER'S LINE NUMBER. RECORD '00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE.

LINE NO. _____

WOMEN'S ELIGIBILITY:
19. CIRCLE LINE NUMBER OF ALL WOMEN 15-49.

MEN'S ELIGIBILITY:
20. CIRCLE LINE NUMBER OF ALL MEN 15-59 (IF MEN'S SURVEY IS PLANNED)

YES _____
NO _____

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 many not be members of your family, such as domestic servants, lodgers or friends who usually live here?

YES (ENTER EACH IN TABLE)
NO

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

YES (ENTER EACH IN TABLE)
NO

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

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 23)
PIPED INTO YARD/PLOT 12 (GO TO 23)
PUBLIC TAP 13
WELL WATER
WELL IN DWELLING/YARD/PLOT 21 (GO TO 23)
PUBLIC WELL 22
SURFACE WATER
CONVERTED SOURCE 31
NON-CONVERTED SOURCE 32
RIVER/STREAM 33
MARSH WATER/LAKE 34
DAM 35
RAINWATER 41 (GO TO 23)
TANKER TRUCK 51 (GO TO 23)
OTHER (SPECIFY) _____ 96

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

NUMBER OF MINUTES _____
ON PREMISES 996

23. What kind of toilet facilities does your household have?

FLUSH TOILET 11
LATRINES 21
BASIC PIT TOILET 31
NO TOILET/OUTDOORS 41
OTHER (SPECIFY) _____ 96

24. Does your household have:

Electricity?
A radio?
A television?
A telephone?
A refrigerator?
A portable stove/gas or electric stove?

ELECTRICITY
YES 1
NO 2
A RADIO
YES 1
NO 2
A TELEVISION
YES 1
NO 2
A TELEPHONE
YES 1
NO 2
A REFRIGERATOR
YES 1
NO 2
A PORTABLE STOVE/GAS OR ELECTRIC STOVE
YES 1
NO 2

25. In your household, how many rooms do you use to sleep?

NUMBER OF ROOMS _____

26. MAIN MATERIAL OF THE FLOOR:
RECORD OBSERVATION.

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

27. Does any member of your household own:

A bicycle?
A motorcycle or motor scooter?
A car?

A BICYCLE
YES 1
NO 2
A MOTORCYCLE OR MOTOR SCOOTER
YES 1
NO 2
A CAR
YES 1
NO 2

28. Can you show me the salt you used to cook the main meal yesterday or last night?

DIDN'T USE 0 (END HOUSEHOLD SURVEY)
SALT IN PACKET 1
LOOSE SALT 2
COARSE SALT IN PACKET 3
COARSE LOOSE SALT 4
SALT NOT AVAILABLE 5 (END HOUSEHOLD SURVEY)
OTHER (SPECIFY) _____ 6
REFUSED TO SHOW 7 (END HOUSEHOLD SURVEY)

29. RECORD RESULTS OF TEST:

IODINE SALT (COLOR) 1
NON-IODINE SALT (WHITE) 2
SALT NOT TESTED 3