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KENYA DEMOGRAPHIC AND HEALTH SURVEY 1989
HOUSEHOLD SCHEDULE

SURVEY QUESTIONNAIRES
NATIONAL COUNCIL FOR POPULATION AND DEVELOPMENT
MINISTRY OF HOME AFFAIRS AND NATIONAL HERITAGE

IDENTIFICATION

PROVINCE __________
DISTRICT __________
LOCATION/TOWN __________
SUBLOCATION/WARD __________
CLUSTER NUMBER
HOUSEHOLD NUMBER
STRUCTURE NUMBER
NAME OF HOUSEHOLD HEAD _____

URBAN/RURAL

urban l
rural 2

INTERVIEWER VISITS 1
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE ______
TIME ______

INTERVIEWER VISITS 2
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE _____
TIME _____

INTERVIEWER VISITS 3
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
MONTH
YEAR
INTERVIEWER NO.
FINAL RESULT

TOTAL NO.OF VISITS

TOTAL IN HOUSEHOLD

TOTAL ELIGIBLE WOMEN

TOTAL ELIGIBLE HUSBANDS

RESULTS__
*RESULT CODES:

1 COMPLETED
2 HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME
3 HOUSEHOLD ABSENT NIGHT BEFORE INTERVIEW
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _________

LANGUAGE OF QUESTIONNAIRE: ENGLISH

FIELD EDITOR
NAME
DATE

OFFICE EDITOR
NAME
DATE

KEYED BY
NAME
DATE

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 NO.

USUAL RESIDENTS AND VISITORS

2. 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.

3. RELATIONSHIP TO HEAD OF HOUSEHOLD

1 Head
2 Spouse
3 Son/daugh.
4 Broth/sis.
5 Grandchild
6 Parent
7 Other rel.
8 Unrelated

RESIDENCE

4. Does (NAME) usually live here?

YES 1
NO 2

5. 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 __

FOSTERING

ONLY FOR CHILDREN UNDER 15 YEARS OLD:

8. Do any of his/her parents usually live in this household?* ?

YES 1
NO 2

ELIGIBILITY

9. CIRCLE LINE NUMBER OF WOMEN AND HUSBANDS ELIGIBLE FOR INDIVIDUAL INTERVIEW.

TOTAL NUMBER OF ELIGIBLE WOMEN __

TOTAL NUMBER OF ELIGIBLE HUSBANDS __

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, who have not been listed?

YES (ENTER EACH IN TABLE)
NO