HOUSEHOLD QUESTIONNAIRE 1992
DEPARTMENT ___
DISTRICT ___
MUNICIPALITY/ADMINISTRATIVE DISTRICT/CITY CENTER ___
AGADEZ, MARADI, TAHOUA, ZINDER 2
OTHER CITY 3
RURAL 4
NAME OF RESPONDENT ___
LINE NUMBER OF INTERVIEW FOR HOUSEHOLD QUESTIONNAIRE ___
STRATA NUMBER ___
CLUSTER NUMBER ___
STRUCTURE NUMBER ___
RESIDENCE NUMBER ___
CENSUS ZONE NUMBER ___
NO 2
INTERVIEWER:
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULTS___
2 HOUSEHOLD PRESENT BUT NO COMPETENT RESPONDENT AT HOME
3 ABSENT
4 POSTPONED
5 REFUSED
6 DWELLING EMPTY 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 19__
INTERVIEWER__
RESULT__
2 HOUSEHOLD PRESENT BUT NO COMPETENT RESPONDENT AT HOME
3 ABSENT
4 POSTPONED
5 REFUSED
6 DWELLING EMPTY OR NO DWELLING AT THE ADDRESS
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY): ___
TOTAL NUMBER OF RESIDENTS IN HOUSEHOLD ___
TOTAL NUMBER OF NON-HABITUAL RESIDENTS ___
TOTAL NUMBER OF ELIGIBLE WOMEN ___
TOTAL NUMBER OF ELIGIBLE HUSBANDS ___
QUESTIONNAIRE NUMBER ___
NUMBER OF QUESTIONNAIRES ___
INTERVIEW LANGUAGE:
HAOUSSA 2
DJERMA 3
OTHERS 4
INTERPRETER:
NO 2
FIELD EDITED BY:
NAME ___
DATE ___
OFFICE EDITED BY:
NAME ___
DATE ___
KEYED BY:
NAME ___
DATE ___
Now we would like some information on the people usually living in your household or who currently live with you.
2) USUAL OR CURRENT RESIDENTS:
Please give the name of those persons usually living in your household or currently living with you, starting with the head of household.
3) RELATIONSHIP TO HEAD OF HOUSEHOLD:
What is the familial relation between (NAME) and the head of household?
WIFE OR HUSBAND 02
SON OR DAUGHTER 03
SON OR DAUGHTER-IN-LAW 04
GRANDSON OR GRANDDAUGHTER 05
FATHER OR MOTHER 06
PARENT-IN-LAW 07
BROTHER OR SISTER 08
CO-SPOUSE 09
OTHER RELATIVE 10
ADOPTED/FOSTER/STEP CHILD 11
NO FAMILY RELATIONSHIP 12
DON'T KNOW 98
4) RESIDENCE:
Does (NAME) normally live here?
NO 2
5) RESIDENCE:
Did (NAME) sleep here last night?
NO 2
6) SEX:
Is (NAME) male or female?
FEMALE 2
NOTE '97' FOR 97 AND OLDER.
8) SCHOOLING (IF CHILD IS 6 OR OLDER):
Did (NAME) attend school?
NO 2 (GO TO 11)
9) SCHOOLING (IF CHILD 6 OR OLDER):
What is the highest level of education (NAME) attained?
What was the last class that he or she successfully completed at this level?
SECONDARY, FIRST CYCLE 2
SECONDARY, SECOND CYCLE 3
HIGHER 4
DON'T KNOW 8
CP 2
CE1 3
CE2 4
CM1 5
CM2 6
5TH 2
4TH 3
3RD 4
DON'T KNOW 8
1ST YEAR 2
FINAL YEAR 3
DON'T KNOW 8
SECOND YEAR 2
THIRD YEAR 3
FOURTH YEAR AND HIGHER 4
DON'T KNOW 8
10) IF UNDER 25 YEARS OLD: Does (NAME) still go to school?
NO 2
PARENTAL SURVIVORSHIP AND RESIDENCE FOR THOSE UNDER AGE 15 (QUESTIONS 11 - 14):
THESE QUESTIONS ARE FOR THE BIOLOGICAL PARENTS.
RECORD '00' IF PARENTS ARE NOT MEMBERS OF THE HOUSEHOLD
11) Is (NAME)'s natural mother still living?
NO 2 (GO TO 13)
DON'T KNOW 8 (GO TO 13)
12) Is (NAME)'s natural mother living in the household?
IF YES: What is her name?
WRITE THE MOTHER'S LINE NUMBER.
13) Is (NAME)'s natural father still living?
NO 2 (GO TO 15)
DON'T KNOW 8 (GO TO 15)
14) Is (NAME)'s natural father living in the household?
IF YES: What is his name?
WRITE THE FATHER'S LINE NUMBER.
15) FOR PERSONS AGED 15 AND OVER:
MARITAL STATUS: Is (NAME) currently married/ partnered, widowed/er, divorced/separated, or single?
WIDOWED/ER 2
DIVORCED/SEPARATED 3
SINGLE 4
16) ELIGIBILITY OF WOMEN:
CIRCLE THE LINE NUMBER OF WOMEN BETWEEN THE AGES OF 15 AND 49 (SEE QUESTIONS 6 AND 7).
IF HOUSEHOLD HAS MORE THAN 20 MEMBERS, RECORD 'N.A.'
17) HUSBAND ELIGIBILITY: FOR EACH ELIGIBLE PARTNERED WOMAN:
Does the husband/partner of (NAME) currently live in this household, or did he sleep here last night?
IF YES: What is his name?
RECORD THE HUSBAND'S LINE NUMBER NEXT TO HIS WIFE'S.
IF NO: RECORD '00' NEXT TO HIS WIFE'S LINE NUMBER.
CHECK HERE IF ANOTHER PAGE IS USED AND NOTE THE PAGE NUMBER ON THE FIRST PAGE: ___
TOTAL NUMBER OF ELIGIBLE WOMEN:
TOTAL NUMBER OF ELIGIBLE MEN:
Just to make sure I have a complete list:
NO: ___
NO: ___
NO: ___
18) Where does the water your household uses for hand and dishwashing come from?
PUBLIC TAP 12
PUBLIC WELL OR BOREHOLE 22
RIVER OR STREAM 32
POND/LAKE 33
DAM 34
WATER VENDOR 51
BOTTLED WATER 61 (GO TO 20)
OTHER (SPECIFY): ___ 71
19) How much time does it take to go there, get water, and come back?
ON LOCATION 996
20) Does your household use water from the same source for drinking?
NO 2
21) Where does the water your household uses for drinking come from?
PUBLIC TAP 12
PUBLIC WELL OR BOREHOLE 22
RIVER OR STREAM 32
POND/LAKE 33
DAM 34
WATER VENDOR 51
BOTTLED WATER 61
OTHER (SPECIFY): ___ 71
22) What kind of toilet is there in your household?
SHARED FLUSH TOILET 12
PUBLIC FLUSH TOILET 13
VENTILATED IMPROVED PIT (VIP) OR LATRINES 22
OTHER (SPECIFY): ___ 41
23 In your residence, do you have:
Electricity?
A radio?
A television?
A refrigerator?
NO 2
NO 2
NO 2
NO 2
24) In your household, how many rooms do you use for sleeping?
25) PRINCIPLE FLOORING MATERIAL.
RECORD OBSERVATION.
VINYL STRIPS 32
TILE 33
CEMENT 34
RUG 35
RECORD OBSERVATION.
SHEET METAL 02
BANCO [TRANSLATOR NOTE: A TYPE OF MUDBRICK OR ADOBE SPECIFIC TO WEST AFRICA] 03
STRAW 04
CANVAS 05
OTHER (SPECIFY): ___ 06
27) Is there someone in your household who owns:
A bicycle?
A scooter or motorcycle?
A car?
A cart?
NO 2
NO 2
NO 2
NO 2