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NATIONAL COUNCIL FOR POPULATION AND DEVELOPMENT
CENTRAL BUREAU OF STATISTICS
KENYA DEMOGRAPHIC AND HEALTH SURVEY 2
HOUSEHOLD SCHEDULE

IDENTIFICATION

PROVINCE __________
DISTRICT __________
LOCATION/TOWN __________
SUBLOCATION/WARD __________
NASSEP CLUSTER NUMBER
KDHS CLUSTER NUMBER
HOUSEHOLD NUMBER

NAIROBI/MOMBASA 1, SMALL CITY 2, TOWN 3, RURAL 4

NAIROBI/MOMBASA 1
SMALL CITY 2
TOWN 3
RURAL 4

NAME OF HOUSEHOLD HEAD _______________

HOUSEHOLD SELECTED FOR MALE SURVEY?

YES 1
NO 2

INTERVIEWER VISIT 1
DATE _________
INTERVIEWER’S NAME __________
RESULT* __________
NEXT VISIT:
DATE _______
TIME ________

INTERVIEWER VISIT 2
DATE _________
INTERVIEWER’S NAME __________
RESULT* __________
NEXT VISIT:
DATE _______
TIME ________

INTERVIEWER VISIT 3
DATE _________
INTERVIEWER’S NAME __________
RESULT* __________
FINAL VISIT
DAY __
MONTH __
YEAR __
NAME ___
RESULT __

TOTAL NO.OF VISITS __

TOTAL IN HOUSEHOLD__

TOTAL WOMEN 15-49__

MEN 20-54__


LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE __

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
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 10


FIELD EDITED BY
NAME __________
DATE __________

OFFICE EDITED BY
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.

LINE NO.

__

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. (2)

____________

RELATIONSHIP TO HEAD OF HOUSEHOLD*
What is the relationship of (NAME) to the head of the household? (3)

___

*CODES FOR Q.3
RELATIONSHIP TO HEAD OF HOUSEHOLD:
01 = HEAD
02 = WIFE/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 = OTHER RELATIVE
10 = ADOPTED/FOSTER CHILD
11 = NOT RELATED
98 = DOES NOT KNOW

RESIDENCE: Does (NAME) usually live here? (4)

YES 1
NO 2

RESIDENCE: Did (NAME) stay here last night? (5)

YES 1
NO 2

SEX : Is (NAME) male or female? (6)

M 1
F 2

AGE : How old is (NAME)? (7)

IN YEARS __

EDUCATION:

IF AGED 6 YEARS OR OLDER

Has (NAME) ever attended school? (8)

YES 1
NO 2

IF ATTENDED SCHOOL
What is the highest level of school (NAME) attended? What is the highest standard or form (NAME) completed at that level?** (9)

LEVEL ____
FORM ____

**CODES FOR LEVEL OF EDUCATION:
0 = NURSERY
1 = PRIMARY
2 = SECONDARY
3 = UNIVERSITY
8 = DK

CODES FOR STANDARD/FORM/YEAR:
00 = LESS THAN 1 YEAR COMPLETED
98 = DON’T KNOW

IF AGED LESS THAN 25 YEARS

Is (NAME) still in school?(10)

YES 1
NO 2

PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD***

***THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD. RECORD ‘00’ IF PARENT NOT MEMBER OF HOUSEHOLD.

Is (NAME)’s natural mother alive? (11)

YES 1
NO 2
DK 8

IF ALIVE
Does (NAME)’s natural mother live in this household?
IF YES: What is her name?
RECORD MOTHER’S LINE NUMBER. (12)

___

Is (NAME)’s natural father alive? (13)

YES 1
NO 2
DK 8

IF ALIVE
Does (NAME)’s natural father live in this household?
IF YES: What is his name?
RECORD FATHER’S LINE NUMBER. (14)

__

ELIGIBILITY WOMEN
CIRCLE LINE NUMBER OF ALL WOMEN AGED 15-49. (15)

HUSBAND LINE NUMBER
WRITE LINE NUMBER OF THE HUSBAND OF EACH ELIGIBLE WOMAN.
WRITE 00 IF NOT MARRIED OR IF HUSBAND NOT IN HOUSEHOLD. (16)

__

ELIGIBILITY MEN
CIRCLE LINE NUMBER OF ALL MEN AGED 20-54
(IF HOUSEHOLD FALLS IN MALE SAMPLE) (17)

TICK HERE IF CONTINUATION SHEET USED __

TOTAL NUMBER OF ELIGIBLE WOMEN __

TOTAL NUMBER OF ELIGIBLE MEN__

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 __

18. What is the source of water your household uses for handwashing and dishwashing for most of the year?

PIPED WATER
PIPED INTO HOUSE/COMPOUND/PLOT 11 (GO TO 20)
PUBLIC TAP 12
WELL WATER
WELL WITH PUMP 21
WELL WITHOUT PUMP 22
SURFACE WATER
LAKE, POND 31
RIVER/STREAM 32
RAINWATER 41 (GO TO 20)
OTHER _______ 51

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

MINUTES ___
ON PREMISES 996

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

YES 1 (GO TO 22)
NO 2

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

PIPED WATER
PIPED INTO HOUSE/COMPOUND/PLOT 11
PUBLIC TAP 12
WELL WATER
WELL WITH PUMP 21
WELL WITHOUT PUMP 22
SURFACE WATER
LAKE, POND 31
RIVER/STREAM 32
RAINWATER 41
OTHER _______ 51

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

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT TOILET 22
NO FACILITY/BUSH/FIELD 31
OTHER ____ 41

23. Does your household have:
Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

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

ROOMS ___

25. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.

EARTH/DUNG 11
RUDIMENTARY FLOOR
WOOD PLANKS 21
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL/LINOLEUM/ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
OTHER ______ 41

26. MAIN MATERIAL OF THE WALL.
RECORD OBSERVATION.

MUD/DUNG 11
RUDIMENTARY WALLS
WOOD/TIMBER 2l
FINISHED WALLS
BRICKS 31
CEMENT/STONE BLOCKS 32
OTHER ___________ 41

27. MAIN MATERIAL OF THE ROOF.
RECORD OBSERVATION.

GRASS/THATCH 11
RUDIMENTARY ROOF
CORRUGATED IRON (MABATI) 21
FINISHED ROOF
TILES 31
OTHER ______ 41

28. Does any member of your household own:
A bicycle?
Land?
Cattle, goats or sheep?
Cash crops such as tea, coffee, cotton?

BICYCLE
YES 1
NO 2
LAND
YES 1
NO 2
CATTLE, GOATS, OR SHEEP
YES 1
NO 2
CASH CROPS
YES 1
NO 2