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DEMOGRAPHIC AND HEALTH SURVEY IN MALI HOUSEHOLD QUESTIONNAIRE 1995-96

IDENTIFICATION:

PLACE NAME__
NAME OF HEAD OF HOUSEHOLD__
CLUSTER NUMBER___
COMPOUND__
HOUSEHOLD NUMBER______
REGION__
CIRCLE__

ARRONDISSEMENT__

BAMAKO 1
OTHER COMMUNE 2
OTHER CITIES 3
RURAL 4

HOUSEHOLD SELECTED FOR MEN'S SURVEY?

YES 1
NO 2

INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR 1996
INTERVIEWER NAME____

RESULTS___

1 COMPLETED
2 NO MEMBER OF THE HOUSEHOLD AT HOME OR NO COMPETENT RESPONDENT AT THE TIME OF THE VISIT.
3 HOUSEHOLD TOTALLY ABSENT FOR A LONG TIME
4 POSTPONED
5 REFUSED
6 EMPTY DWELLING OR NO DWELLING AT THE ADDRESS
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)__

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 1996
INTERVIEWER__
RESULTS ___

Total Number of Visits____

TOTAL IN THE HOUSEHOLD__
TOTAL ELIGIBLE WOMEN__
TOTAL ELIGIBLE MEN__

RESPONDENT'S LINE NUMBER__

SUPERVISOR
NAME___
DATE___

FIELD EDITOR
NAME__
DATE__

OFFICE EDITOR__
KEYED BY___

HOUSEHOLD SCHEDULE

We would now like information on the persons who usually live in your household and who are currently living with you.

1. LINE NO. (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)

____

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 slept here last night, starting with the head of the household.

____

3. 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 GRANDSON OR GRANDDAUGHTER
06 FATHER OR MOTHER
07 FATHER-IN-LAW OR MOTHER --IN-LAW
08 BROTHER OR SISTER
09 CO-WIFE
10 OTHER RELATIVE
11 ADOPTED/FOSTER/STEPCHILD
12 NOT RELATED
98 DOESN'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?

MALE 1
FEMALE 2

7. AGE: How old is (NAME)?

__YEARS

EDUCATION. IF 6 YEARS OR MORE:

8. Has (NAME) attended school?

YES 1
NO 2

9. What is the highest level of education attained by (NAME)? What is the last grade completed by (NAME) at this level?

LEVEL OF INSTRUCTION
1 ELEMENTARY 1(FIRST CYCLE)
2 ELEMENTARY 2(SECOND CYCLE)
3 SECONDARY (HIGH SCHOOL, TECHNICAL SCHOOL)
4 SUPERIOR
8 DOESN'T KNOW
GRADE
0 LESS THAN 1 YEAR COMPLETED
98 DOESN'T KNOW

EDUCATION. IF LESS THAN 25 YEARS OLD:

10. Does (NAME) currently attend school?

YES 1
NO 2

SURVIVORSHIP AND RESIDENCE OF PARENTS OF PERSONS UNDER 15 YEARS:

11. Is (NAME'S) biological mother still alive?

YES 1
NO 2
DOESN'T KNOW 8

12. IF ALIVE: Does the (NAME'S) biological mother live in the household?
IF YES: What is her name?

RECORD MOTHER'S LINE NUMBER. RECORD 00 IF THE BIOLOGICAL PARENTS ARE NOT LISTED IN THE HOUSEHOLD TABLE.

LINE NO. ____
YES 1
NO 2

13. Is (NAME'S) biological father still alive?

YES 1
NO 2
DOESN'T KNOW 8

14. IF ALIVE: Does the (NAME'S) biological father live in the household?
IF YES: What is his name?

RECORD FATHER'S LINE NUMBER. RECORD 00 IF THE BIOLOGICAL PARENTS ARE NOT LISTED IN THE HOUSEHOLD TABLE.

LINE NO. ____
YES 1
NO 2

ELIGIBILE WOMEN:
15A. CIRCLE THE LINE NUMBER OF ALL MEN RESIDENTS OR VISITORS BETWEEN 15-49 YEARS.

ELIGIBILE MEN:
15B. CIRCLE THE LINE NUMBER OF ALL WOMEN RESIDENTS OR VISITORS BETWEEN 15-49 YEARS.

MARK HERE IF ANOTHER SHEET WAS USED___

Just to be sure that I have a complete list:

1) Are there other persons such as small children or infants that we have not recorded on the list?

YES__(WRITE EACH ONE IN THE TABLE)
NO__

2) Are there other persons who maybe are not members of your family such as domestic workers, renters or friends who usually live here?

YES__(WRITE EACH ONE IN THE TABLE)
NO__

3) Are there guests or temporary visitors who are at your household, or other persons who spent the last night here who were not listed?

YES__(WRITE EACH ONE IN THE TABLE)
NO__

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

Piped water
Piped into the dwelling/courtyard/plot 11 (GO TO 18)
Piped into public tap 12
Well water
Open well in the dwelling/courtyard/plot 21 (GO TO 18)
In the yard/plot 22
Open public well 23
Covered or borehole wells 23
Surface water
Spring 31
River/stream 32
Swamp/lake 33
Dam 34
Rainwater 41 (GO TO 18)
Tanker 51
Bottled water 61 (GO TO 18)
Other________________(specify) 96

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

Minutes ___
On site 996

18. What kind of toilet facility do the majority of the members of your household use?

Flush
Private flush11
Communal flush 12
Pit/latrine
Rudimentary 21
Improved 22
No facility/bush/field 31
Other_____(Specify) 96

19. Does your household have:

Electricity? (EDM or solar panel)
Radio?
Television?
Telephone?
Refrigerator or freezer?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
TELEPHONE
YES 1
NO 2
REFRIGERATOR/FREEZER
YES 1
NO 2

20. How many rooms in your household do you use to sleep in?

ROOMS __

21. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION

NATURAL MATERIAL
EARTH/SAND 11
DUNG 12
RUDIMENTARY MATERIAL
WOOD/PLANKS 21
PALMS/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYLE OR LINO/ASPHALT 32
TILE 33
CEMENT 34
CARPET 35
OTHER______(SPECIFY) 96

22. Is there anyone in your household who owns:

A Bicycle?
A scooter or motorcycle?
A car?
A cart?

BICYCLE?
YES 1
NO 2
SCOOTER OR MOTORCYCLE?
YES 1
NO 2
CAR?
YES 1
NO 2
CART?
YES 1
NO 2

23. What kind of salt do you usually use for cooking in your household?

COOKING SALT (SEA SALT) 01
PACKAGING SALT (IODINE) 02
SALT FROM ROCK DEPOSITS 03
SALT IN BULK 04
OTHER (SPECIFY) ____ 96