NIGERIA DEMOGRAPHIC AND HEALTH SURVEY
HOUSEHOLD SCHEDULE--ENGLISH
IDENTIFICATION
PLACE NAME _________________________
NAME OF RESPONDENT __________________________
CLUSTER NUMBER __
HOUSEHOLD NUMBER __
STATE __
rural=2
town=2
rural(village)=3
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER?S NAME ___________
RESULT* _____________
2 HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME
3 HOUSEHOLD ABSENT
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) ___________
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE __________
TIME ___________
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
INTERVIEWER?S NAME ____
RESULT* _____
FIELD EDITED BY
NAME ________
DATE ________
OFFICE EDITED BY
NAME ________
DATE ________
KEYED BY
NAME ________ __
DATE ________
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. (1) (01-26) (*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 or are staying with you now, 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?
SEE CODES BELOW.
02 = WIFE OR HUSBAND
03 = SON OR DAUGHTER
04 = SON 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 = DON?T KNOW
(4) RESIDENCE: Does (NAME) usually live here?
NO 2
(5) RESIDENCE: Did (NAME) sleep here last night?
NO 2
(6) SEX: Is (NAME) male or female?
FEMALE 2
(8) EDUCATION: Has (NAME) ever been to school?
NO 2
(9) EDUCATION: What is the highest level and grade of schooling** he/she completed?
2 = SECONDARY
3 = HIGHER
8 = DON'T KNOW
98 = DON'T KNOW
(10) EDUCATION FOR ALL AGED LESS THAN 25 YEARS: Is he/she still in school?
NO 2
FOSTERING FOR EVERYONE AGED LESS THAN 15 YEARS:
(11) Does his/her natural mother live here?
IF YES: What is her name?
RECORD MOTHER?S LINE NUMBER.
RECORD ?00? IF PARENT NOT MEMBER OF HOUSEHOLD.
(12) Does his/her natural father live here?
IF YES: What is his name?
RECORD FATHER?S LINE NUMBER.
RECORD ?00? IF PARENT NOT MEMBER OF HOUSEHOLD.
(13) ELIGIBILITY: CIRCLE LINE NUMBER OF WOMEN ELIGIBLE FOR INDIVIDUAL INTERVIEW.
TICK HERE IF CONTINUATION SHEET USED. __
TOTAL NUMBER OF ELIGIBLE WOMEN ___
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?
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?
NO
3) Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?
NO