NIGERIA DEMOGRAPHIC AND HEALTH SURVEY 2003
HOUSEHOLD QUESTIONNAIRE
STATE NAME ___________________ ___
LOCAL GOVT. AREA ________________ ___
LOCALITY NAME ___________________ ___
ENUMERATION AREA _______________ ___
RURAL 2
CLUSTER NUMBER __
BUILDING NAME/NUMBER __
HOUSEHOLD NUMBER __
NO 2
LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE __
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT* _____________
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
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 ___
NAME ____
RESULT _____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __
YORUBA 2
IGBO 3
ENGLISH 4
OTHER 6
YORUBA 2
IGBO 3
ENGLISH 4
OTHER 6
NO 2
SUPERVISOR
NAME ________ ___
DATE ________
FIELD EDITOR
NAME ________ ___
DATE ________
OFFICE EDITOR____
KEYED BY___
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) (01-23)
(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.
(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-IN-LAW OR DAUGHTER-IN-LAW
05 GRANDCHILD
06 PARENT
07 PARENT-IN-LAW
08 BROTHER OR SISTER
09 BROTHER OR SISTER-IN-LAW
10 OTHER RELATIVE
11 ADOPTED/FOSTER/ STEPCHILD
12 NOT RELATED
98 DON'T KNOW
(4) SEX: Is (NAME) male or female?
FEMALE 2
(5) RESIDENCE: Does (NAME) usually live here? (5)
NO 2
(6) RESIDENCE: Did (NAME) stay here last night?
NO 2
(7) AGE: How old is (NAME) as of last birthday?
(8) ELIGIBILITY: CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49.
(8A) ELIGIBILITY: CIRCLE LINE NUMBER OF ALL MEN AGE 15-59.
(9) ELIGIBILITY: CIRCLE LINE NUMBER OF ALL CHILDREN UNDER AGE 6.
PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD**
THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD.
(10) Is (NAME)'s natural mother alive?
NO 2 (GO TO 12)
DON'T KNOW 8 (GO TO 12)
(11) (IF ALIVE) Does (NAME)'s natural mother live in this household?
IF YES: What is her name?
RECORD MOTHER'S LINE NUMBER
RECORD '00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE.
(12) Is (NAME)'s natural father alive?
NO 2 (GO TO 13A)
DON'T KNOW 8 (GO TO 13A)
(13) (IF ALIVE) Does (NAME)'s natural father live in this household?
IF YES: What is his name?
RECORD FATHER'S LINE NUMBER
RECORD '00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE.
EDUCATION IF AGE 5 YEARS OR OLDER
(13A) (IF AGE 5 YEARS OR OLDER) Can (NAME) read and write in any language with understanding?
NO 2
(14) Has (NAME) ever attended school?
NO 2 (GO TO NEXT LINE)
(15) What is the highest level of school (NAME) has attended?***
What is the highest class/year (NAME) completed at that level?***
FOR 'HIGHER', TOTAL THE NUMBER OF YEARS AT THE POST-SECONDARY LEVEL.
1 PRIMARY
2 SECONDARY
3 HIGHER
8 DON'T KNOW
98 DON'T KNOW
(16) Is (NAME) currently attending school?
NO 2
(17) During the current school year, did (NAME) attend school at any time?
NO 2 (GO TO 19)
(18) During the current school year, what level and class/year [is/was] (NAME) attending? ***
FOR 'HIGHER', TOTAL THE NUMBER OF YEARS AT THE POST-SECONDARY LEVEL.
1 PRIMARY
2 SECONDARY
3 HIGHER
8 DON'T KNOW
98 DON'T KNOW
(19) During the previous school year, did (NAME) attend school at any time?
NO 2 (GO TO NEXT LINE)
(20) During that school year, what level and class/year did (NAME) attend? ***
FOR 'HIGHER', TOTAL THE NUMBER OF YEARS AT THE POST-SECONDARY LEVEL.
1 PRIMARY
2 SECONDARY
3 HIGHER
8 DON'T KNOW
98 DON'T KNOW
TICK HERE IF CONTINUATION SHEET USED. __
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) Are there any guests or temporary visitors staying here, or anyone else who slept here last night, who have not been listed?
NO __
21. What is the main source of drinking water for members of your household?
PIPED INTO YARD/PLOT 12 (GO TO 23)
PUBLIC TAP 13
OPEN WELL IN YARD/PLOT 22 (GO TO 23)
OPEN PUBLIC WELL 23
PROTECTED WELL/BOREHOLE IN YARD/PLOT 32 (GO TO 23)
PROTECTED PUBLIC WELL/BOREHOLE 33
RIVER/STREAM 42
POND/LAKE 43
DAM 44
TANKER TRUCK 61
BOTTLED WATER 71 (GO TO 23)
OTHER (SPECIFY) _______ 96
22. How long does it take you to go there, get water, and come back?
ON PREMISES 996
23. What kind of toilet facilities does your household have?
PIT TOILET/LATRINE
VENTILATED IMPROVED PIT (VIP) LATRINE 22
RIVER 32 (GO TO 25)
24. Do you share these facilities with other households?
NO 2
Electricity?
A radio?
A television?
A telephone/Cellular phone?
A refrigerator?
A gas cooker?
An electric iron?
An electric fan?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
26. What does your household mainly use for cooking?
PROBE TO DETERMINE EXACT TYPE.
LPG/NATURAL GAS 02
BIOGAS 03
KEROSENE 04
COAL, LIGNITE 05
CHARCOAL 06
FIREWOOD, STRAW 07
DUNG 08
OTHER (SPECIFY) ______ 96
26A. How many rooms in total are in your household, including rooms for sleeping and all other rooms?
26B. How many rooms are used for sleeping in your household?
27. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
28. Does any member of your household own:
A bicycle?
A motorcycle or motor scooter?
A car or truck?
A donkey or horse or camel?
A canoe or boat or ship?
NO 2
NO 2
NO 2
NO 2
NO 2
29A. Does your household own any mosquito nets that can be used to protect against mosquitoes while sleeping? I am talking about nets people sleep under.
NO 2 (GO TO 30G)
29B. How many mosquito nets does your household own?
30A. ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. ASK OR RECORD APPROPRIATE ANSWER FOR THE FOLLOWING QUESTIONS. IF UNABLE TO OBSERVE THE NETS, CIRCLE APPROPRIATE CODE AND ASK QUESTIONS.
NOT SEEN 2
30B. How long ago did your household obtain the mosquito net?
MORE THAN 3 YRS AGO 96
30C. OBSERVE OR ASK THE BRAND OF MOSQUITO NET(S) IN THE HOUSEHOLD.
PRETREATED NET 2
NET WITH KIT 3
UNTREATED NET 4
OTHER 6
DON'T KNOW/UNSURE 8
30D. Since you got the mosquito net, was it ever soaked or dipped in a liquid to repel mosquitoes or bugs?
NO 2 (GO TO 30F)
NOT SURE 8 (GO TO 30F)
30E. How long ago was the net last soaked or dipped?
IF LESS THAN 1 MONTH, RECORD '00'.
MORE THAN 3 YRS AGO 96
30F. Who slept under this mosquito net last night?
RECORD RESPECTIVE LINE NUMBER FROM THE HOUSEHOLD SCHEDULE.
30G. Does your household do anything else to protect themselves against mosquito?
NO 2 (GO TO 33)
30H. What does your household do?
SPRAY (INSECTICIDE) B
WIRE GAUZE C
OTHER (SPECIFY) ____________ X
33. Where do you usually wash your hands?
SOMEWHERE ELSE 2 (GO TO 35)
NOWHERE 3 (GO TO 35)
34. Where you wash your hands, do you have the following:
Water/tap?
Soap, ash or other cleansing agent?
Basin?
NO 2
NO 2
NO 2
35. ASK RESPONDENT FOR A TEASPOONFUL OF SALT.
TEST SALT FOR IODINE.
RECORD PPM (PARTS PER MILLION).
7 PPM 2
15 PPM 3
30 PPM 4
NO SALT IN HH 5
SALT NOT TESTED (SPECIFY REASON) ________________ 6
There will be an education survey done at a later point in time. Your household may or may not be asked to participate in the survey. If your household is included in the survey someone will return to your house and ask additional questions about education.
HEIGHT AND WEIGHT
CHECK COLUMNS (8) AND (9): RECORD LINE NUMBER, NAME AND AGE OF WOMEN AGE 15-49 AND ALL CHILDREN UNDER AGE 6.
WOMEN 15-49/CHILDREN UNDER AGE 6
(36) LINE NO. FROM COL.(8)
(37) NAME FROM COL.(2)
(38) AGE FROM COL.(7)
(39) What is (NAME)'s date of birth?*
*FOR CHILDREN NOT INCLUDED IN ANY BIRTH HISTORY, ASK DAY, MONTH AND YEAR. FOR ALL OTHER CHILDREN, COPY MONTH AND YEAR FROM 215 IN MOTHER'S BIRTH HISTORY AND ASK DAY.
MONTH__
YEAR____
WEIGHT AND HEIGHT MEASUREMENT OF WOMEN 15-49/ CHILDREN BORN IN 1998 OR LATER
(40) WEIGHT (KILOGRAMS)
(41) HEIGHT (CENTIMETRES)
(42) MEASURED LYING DOWN OR STANDING UP
2 NOT PRESENT
3 REFUSED
6 OTHER