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NATIONAL COUNCIL FOR POPULATION AND DEVELOPMENT
CENTRAL BUREAU OF STATISTICS
KENYA DEMOGRAPHIC AND HEALTH SURVEY 3
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 15-54 __

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.

1, LINE NO.

____

2. 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)

____________

3. 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 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-WIFE
10 = OTHER RELATIVE
11 = ADOPTED/FOSTER/STEP CHILD
12 = NOT RELATED
98 = DON'T KNOW

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

YES 1
NO 2

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

YES 1
NO 2

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

M 1
F 2

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

IN YEARS __

EDUCATION

IF AGE 6 YEARS OR OLDER

8. Has (NAME) ever been to school?

YES 1
NO 2

IF ATTENDED SCHOOL

9.What is the highest level of school (NAME) attended?

What is the highest grade (NAME) completed at that level?*** (9)

LEVEL ____
GRADE ____

** CODES FOR Q.9
EDUCATION LEVEL:
1 = PRIMARY
2 = SECONDARY
3 = HIGHER
8 = DON'T KNOW

EDUCATION GRADE:
00 = LESS THAN 1 YEAR COMPLETED
98 = DON'T KNOW

IF AGE LESS THAN 25 YEARS

10. Is (NAME) STILL IN SCHOOL?(10)

YES 1
NO 2

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

*** Q.11 THROUGH Q.14
THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD.
RECORD '00' IF PARENT NOT MEMBER OF HOUSEHOLD.

11. Is (NAME)'s natural mother alive? (11)

YES 1
NO 2
DK 8

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

___

13. Is (NAME)'s natural father alive? (13)

YES 1
NO 2
DK 8

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

__


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

ELIGIBILITY MEN
16. CIRCLE LINE NUMBER OF ALL MEN AGE 15-54 (15A)

TICK HERE IF CONTINUATION SHEET USED __

NO. OF ELIGIBLE WOMEN __

NO. 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) Are there any guests or temporary visitors staying here, or anyone else who slept here last night that have not been listed?

YES ___ (ENTER EACH IN TABLE)
NO __

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

PIPED WATER
PIPED INTO RESIDENCE/COMPOUND/PLOT 11 (GO TO 18)
PUBLIC TAP 12
WELL WATER
WELL ON RESIDENCE/PLOT 21 (GO TO 18)
PUBLIC WELL 22
SURFACE WATER
RIVER/STREAM 31
POND/LAKE 32
RAINWATER 41 (GO TO 18)
OTHER _______ 96

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

MINUTES ___
ON PREMISES 996

18. 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 (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) ____ 96

19. Does your household have:

Electricity?
A radio?
A television?
A telephone?
A refrigerator?

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

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

ROOMS ___

21. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.

NATURAL FLOOR
MUD/DUNG/SAND 11
RUDIMENTARY FLOOR
WOOD PLANKS 21
FINISHED FLOOR
POLISHED WOOD/VINYL/TILES 31
CEMENT 34
OTHER (SPECIFY) ______ 96

22. MAIN MATERIAL OF THE ROOF.
RECORD OBSERVATION.

GRASS/THATCH 11
CORRUGATED IRON (MABATI) 21
TILES 31
OTHER SPECIFY _________ 96

23. Does any member of your household own:

A bicycle?
A motorcycle?
A car?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2