NIGERIA DEMOGRAPHIC AND HEALTH SURVEYS 2018
HOUSEHOLD QUESTIONNAIRE
NIGERIA NATIONAL POPULATION COMMISSION
IDENTIFICATION
STATE ____
LOCAL GOVT. AREA______
LOCALITY _____
ENUMERATION AREA_____
NAME OF HOUSEHOLD HEAD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
HOUSEHOLD SELECTED FOR MAN'S SURVEY?
NO 2
DATE_____
INTERVIEWER'S NAME_____
RESULT*_____
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) 9
FINAL VISIT
DAY_____
MONTH_____
YEAR_____
INT. NO_____
RESULT*_____
TOTAL NUMBER OF VISITS_____
TOTAL PERSONS IN HOUSEHOLD____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
LANGUAGE OF QUESTIONNAIRE: 01 ENGLISH
LANGUAGE OF INTERVIEW**_____
NATIVE LANGUAGE OF RESPONDENT_____
TRANSLATOR USED
NO 2
LANGUAGE CODES
HAUSA 02
YORUBA 03
IGBO 04
NUMBER_____
FIELD EDITOR
NUMBER_____
Hello. My name is __________. I am working with National Population Commission. We are conducting a survey about health and other topics all over Nigeria. The information we collect will help the government to plan health services. Your household was selected for this survey. I would like to ask you some questions about your household. The questions usually take 20 to 30 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time. In case you need more information about the survey, you may contact the person listed on this card.
GIVE CONTACT INFORMATION
Do you have any questions?
May I begin the interview now?
DATE_________
MINUTES _____
USUAL RESIDENTS AND VISITORS
2. Please give me the name of the persons who usually live in your household who stayed here last night, starting with the head of the household.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 1A-1C TO BE SURE THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN THE COLUMNS 5-20 FOR EACH PERSON
.
2A. Just to make sure I have a clear listing: are there any other people such as children and infants that we have not listed?
NO 2
2B. Are there any people who may not be part of your family, such as domestic servants, lodgers, or friends who usually live here?
NO 2
2C. Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
NO 2
3. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?
WIFE OR HUSBAND 2
SON OR DAUGHTER 3
SON-IN-LAW or DAUGHTER-IN-LAW 4
GRANDCHILD 5
PARENT 6
PARENT-IN-LAW 7
BROTER OR SISTER 8
BROTHER-IN-LAW OR SISTER-IN-LAW 9
NIECE/NEPHEW BY BLOOD 10
NIECE/NEPHEW BY MARRIAGE 11
OTHER RELATIVE 12
ADOPTED/FOSTER/STEPCHILD 13
NOT RELATED 14
CO-WIFE 15
DON'T KNOW 98
4. Is (NAME) male or female?
FEMALE 2
5. Does (NAME) usually live here?
NO 2
6. Did (NAME) stay here last night?
NO 2
IF 15 YEARS OR OLDER
MARITAL STATUS
8. What is (NAME)'s current marital status?
DIVORCED/SEPERATED 2
WIDOWED 3
NEVER-MARRIED AND NEVER LIVED TOGETHER 4
9. CIRCLE LINE NUMBERS OF ALL WOMEN AGE 15-49
10. CIRCLE LINE NUMBERS OF ALL MEN AGE 15-59
11. CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5
IF AGE 0-17 YEARS
SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS
12. Is (NAME)'s natural mother alive?
NO 2 (GO TO 14)
DON'T KNOW 8 (GO TO 14)
13. Does (NAME)'s natural mother usually live in this household or was she a guest here last night? IF YES: What is her name?
IF NO, RECORD '00'.
14. Is (NAME)'s natural father alive?
NO 2 (GO TO 16)
DON'T KNOW 8 (GO TO 16)
15. Does (NAME)'s natural father usually live in this household or was he a guest here last night?
IF YES; What is his name?
IF NO, RECORD '00'.
IF AGE 5 YEARS OR OLDER
EVER ATTENDED SCHOOL
16. Has (NAME) ever attended school?
NO 2 (GO TO 21)
17. What is the highest level of school (NAME) has attended?
NO 2 (GO TO 21)
18. What is the highest level of school (NAME) has attended? SEE CODES BELOW. What is the highest grade (NAME) has completed at that level?
PRE-SCHOOL 0
PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8
EDUCATION YEAR _____
IF LESS THAN 1 YEAR COMPLETED 00
YEARS AT PRELIMINARY/KINDERGARTEN 01-03
YEARS 1-6 AT PRIMARY LEVEL 01-06
YEARS AT SECONDARY LEVEL 01-06
TOTAL NUMBER OF YEARS AT THE POST SECONDARY LEVEL 01
AGE 5-24 YEARS
CURRENT/RECENT SCHOOL ATTENDANCE
19. Did (NAME) attend school at any time during the 2017-2018(2018-2019) school year?
NO 2 (GO TO 21)
20. During [this/that] school year, what year/class [is/was] (NAME) attending?
PRE-SCHOOL 0
PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8
EDUCATION YEAR _____
IF LESS THAN 1 YEAR COMPLETED 00
YEARS AT PRELIMINARY/KINDERGARTEN 01-03
YEARS 1-6 AT PRIMARY LEVEL 01-06
YEARS AT SECONDARY LEVEL 01-06
TOTAL NUMBER OF YEARS AT THE POST SECONDARY LEVEL 01
IF AGED 0-4 YEARS
BIRTH REGISTRATION
20A. Was (NAME)'s birth registered?
NO 2 (GO TO 20B)
DON'T KNOW 8 (GO TO 20B)
20B. With which authority was (NAME'S) birth registered?
LGA 2
PRIVATE CLINIC/HOSPITAL 3
OTHER _____ 3
20C. May I see (NAME'S) birth certificate?
NOT SEEN 2
HOUSEHOLD NOT SELECTED FOR MAN'S SURVEY (GO TO 21)
HOUSEHOLD SELECTED FOR MAN'S SURVEY (GO TO 101)
SEEING DIFFICULTIES
21. Does (NAME) wear glasses or contact lenses to help them see?
NO 2 (GO TO 23)
DON'T KNOW 8 (GO TO 23)
22. I would like to know if (NAME) has difficulty seeing even when wearing glasses of contact lenses. Would you say that (NAME) has no difficulty seeing, some difficulty, a lot of difficulty, or cannot see at all?
SOME DIFFICULTY 2
A LOT OF DIFFICULTY 3
CANNOT SEE AT ALL 4
DON'T KNOW 8
23. I would like to know if (NAME) has difficulty seeing. Would you say that (NAME) has no difficulty seeing, some difficulty, a lot of difficulty, or cannot see at all?
SOME DIFFICULTY SEENIG 2
A LOT OF DIFFICULTY SEEING 3
CANNOT SEE 4
DON'T KNOW 8
24. Does (NAME) wear a hearing aid?
NO 2 (GO TO 26)
DON'T KNOW 8 (GO TO 26)
25. I would like to know if (NAME) has difficulty hearing. Would you say that (NAME) has no difficulty hearing even when using a hearing aid, some difficulty, a lot of difficulty, or cannot hear at all?
SOME DIFFICULTY 2
A LOT OF DIFFICULTY 3
CANNOT EAR AT ALL 4
DON'T KNOW 8
26. I would like to know if (NAME) has difficulty hearing. Would you say that (NAME) has no difficulty hearing, some difficulty hearing, a lot of difficulty hearing, or cannot hear at all?
SOME DIFFICULTY HEARING 2
A LOT OF DIFFICULTY HEARING 3
CANNOT HEAR 4
DON'T KNOW 8
27. I would like to know if (NAME) has difficulty communicating when using his/her usual language. Would you say (NAME) has no difficulty understanding or being understood, some difficulty, a lot of difficulty, or cannot communicate at all?
SOME DIFFICULTY 2
A LOT OF DIFFICULTY 3
CANNOT COMMUNICATE AT ALL 4
DON'T KNOW 8
28. I would like to know if (NAME) has difficulty remembering or concentrating. Would you say (NAME) has no difficulty remembering and concentrating, some difficulty, a lot of difficulty, or cannot remember or concentrate at all?
SOME DIFFICULTY 2
A LOT OF DIFFICULTY 3
CANNOT REMEMBER/CONCENTRATE AT ALL 4
DON'T KNOW 8
29. I would like to know if (NAME) has difficulty walking or climbing stairs. Would you say that (NAME) has no difficulty walking and climbing stairs, some difficulty, a lot of difficulty, or cannot walk or climb stairs at all?
SOME DIFFICULTY 2
A LOT OF DIFFICULTY 3
CANNOT WALK OR CLIMB STAIRS AT ALL 4
DON'T KNOW 8
30. I would like to know if (NAME) has difficulty washing all over or dressing. Would you say that (NAME) has no difficulty washing all over or dressing, some difficulty, a lot of difficulty, or cannot wash all over or dress at all?
SOME DIFFICULTY 2
A LOT OF DIFFICULTY 3
CANNOT WASH OR DRESS AT ALL 4
DON'T KNOW 8
101. What is the main source of drinking water for the members of your household?
PIPED INTO YARD/PLOT(GO TO 106) 12
PIPED TO NEIGHBOR (GO TO 106) 13
PUBLIC TAP/STANDPIPE (GO TO 103) 14
PROTECTED WELL 31 (GO TO 103)
UNPROTECTED WELL 32 (GO TO 103)
UNPROTECTED SPRING 42 (GO TO 103)
RAINWATER 51 (GO TO 103)
TANKER TRUCK 61 (GO TO 103)
CART WITH SMALL TANK 71 (GO TO 103)
SURFACE WATER(RIVER/DAM/LAKE/POND.STREAM/CANEL/IRRIGATION CHANNEL) 81 (GO TO 103)
BOTTLED WATER 91
SACHET WATER 92
OTHER _____96 (GO TO 103)
102. What is the main source of water used by your household for other purposes such as cooking and handwashing?
PIPED INTO YARD/PLOT 12 (GO TO 106)
PIPER TO NEIGHBOR 13 (GO TO 106)
PUBLIC TAP/STANDPIPE 14
TUBE WELL OR BOREHOLE 21
PROTECTED SPRING 41
UNPROTECTED SPRING 42
RAINWATER 51
TANKER TRUCK 61
CART WITH SMALL TANK 71
OTHER _____ 96
103. Where is that water source located?
IN OUR YARD/PLOT 2 (GO TO 105)
ELSEWHERE 3
104. How long does it take to go there, get water, and come back?
DON'T KNOW 998
105. CHECK 101 AND 102: CODE '14' OR '21' CIRCLED?
NO 2 (GO TO 107)
106. In the past two weeks, was the water from this source not available for at least one full day?
NO 2
DON'T KNOW 8
107. Do you do anything to the water to make it safer to drink?
NO 2 (GO TO 109)
DON'T KNOW 8 (GO TO 109)
108. What do you usually do to make the water safer to drink? (RECORD ALL MENTIONED)
ADD BLEACH/CHLORINE B
STRAIN THROUGH CLOTH C
USE WATER FILTER (CERAMIC/SAND/COMPOSITE/ECT) D
SOLAR DISINFECTION E
LET IT STAND AND SETTLE F
ALUM G
OTHER _____X
DON'T KNOW Z
109. What kind of toilet facility do members of your household use? (IF NOT POSSIBLE TO DETERMINE, ASK TO OBSERVE THE FACILITY.)
FLUSH TO SEPTIC SYSTEM 12
FLUSH TO PIT LATRINE 13
FLUSH TO SOMEWHERE ELSE 14
FLUSH, DON'T KNOW WHERE 15
PIT LATRINE WITH SLAB 22
PIT LATRINE WITHOUT SLAB/OPEN PIT 23
COMPOSTING TOILET 31
BUCKET TOILET 41
HANGING TOILET/HANGING LATRINE 51
NO FACILITY/BUSH/FIELD 61
OTHER (SPECIFY) 96
110. Do you share this toilet facility with other households?
NO 2 (GO TO 112)
111. Including your own household, how many households use this toilet facility?
DON'T KNOW 98
112. Where is the toilet facility located?
IN OWN YARD/PLOT 2
ELSEWHERE 3
113. What type of fuel does your household mainly use for cooking?
LPG 2
NATURAL GAS 3
BIOGAS 4
KEROSENE 5
GOAL, LIGNITE 6
CHARCOAL 7
WOOD 8
STRAW/SHRUBS/GRASS 9
AGRICULTURAL CROP 10
ANIMAL DUNG 11
NO FOOD COOKED IN HOUSEHOLD (GO TO 116) 95
OTHER _____ 96
114. Is the cooking usually done in the house, in a separate building, or outdoors?
IN A SEPARATE BUILDING 2 (GO TO 116)
OUTDOORS 3 (GO TO 116)
OTHER _____ 6 (GO TO 116)
115. Do you have a separate room which is used as a kitchen?
NO 2
116. How many rooms in the household are used for sleeping?
ROOMS
117. Does this household own any livestock, herds, other farm animals, or poultry?
NO (GO TO 119) 2
118. How many of the following animals does this household own?
IF NONE, RECORD '00'
IF 95 OR MORE, RECORD '95'
IF UNKNOWN, RECORD '98'
a) Milk cows or bulls?
b) Other cattle?
c) Horses, donkeys, or mules?
d) Goats?
e) Sheep?
f) Chickens or other poultry?
g) Pigs?
h) Camels?
119. Does any member of this house own any agricultural land?
NO 2 (GO TO 121)
120. How many plots/acres/hectares of agricultural land do members of this household own?
(IF 95 OR MORE, CIRCLE 9950)
PLOT 1
ACRES 2
HECTARES 3
DON'T KNOW 9998
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
122. Does any member of this household own:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
123. Does any member of this household have a bank account?
NO 2
124. How often does anyone smoke inside of your house? Would you say daily, weekly, monthly, less often than once a month, or never?
WEEKLY 2
MONTHLY 3
LESS THAN ONCE A MONTH 4
NEVER 5
125. Does your household have any mosquito nets?
NO 2 (GO TO 139)
126. How many mosquito nets does your household have?
NUMBER OF NETS _____
129. ASK RESPONDENT TO SHOW YOU ALL THE NETS IN THE HOUSEHOLD. IF MORE THAN 3 NETS, USE ADDITIONAL QUESTIONNAIRE(S).
OBSERVED NOT HANGING 2
NOT OBSERVED 3
130. How many months ago did your household get your mosquito net?
MONTHS AGO_____
MORE THAN 36 MONTHS AGO 95
NOT SURE 98
131. OBSERVE OR ASK WHAT BRAND/TYPE OF MOSQUITO NET.
IF BRAND IS UNKNOWN AND YOU CANNOT OBSERVE THE NET, SHOW PICTURES OF TYPICAL NET TYPES/BRANDS TO RESPONDENT.
PERMANET 11
OLYSET 12
ICONLIFE 13
DURANET 14
NETPROTEC 15
BASF INTERCEPTO 17
YORKOOL 18
OTHER/DON'T KNOW BRAND 16
OTHER TYPE 96
DON'T KNOW THE TYPE 98
134. Did you get the net through a net mass distribution campaign, during an antenatal care visit, or during an immunization visit?
YES, ANC 2 (GO TO 136)
YES, IMMUNIZATION VISIT 3 (GO TO 136)
NO 4
135. Where did you get the net?
PRIVATE HEALTH FACILITY 02
PHARMACY 03
SHOP/MARKET 04
COMMUNITY HEALTH WORKER 05
RELIGIOUS INSTITUTION 06
SCHOOL 07
OTHER 96
DON'T KNOW 98
136. Did anyone sleep inside the mosquito net last night?
N0 2
NOT SURE 8 (GO TO 138)
136A. Why did not anyone sleep inside this net?
NO MALARIA 02 (GO TO 138)
TOO HOT 03 (GO TO 138)
DIFFICULT TO HANG 04 (GO TO 138)
DON'T LIKE SMELL 05 (GO TO 138)
FEEL 'CLOSED IN' OR CONSTRAINED 06 (GO TO 138)
NET TO OLD/TORN 07 (GO TO 138)
NET TOO DIRTY 08 (GO TO 138)
NET WAS NOT AVAILABLE LAST NIGHT (ASHING) 09 (GO TO 138)
FEEL ITN CHEMICALS ARE UNSAFE 10 (GO TO 138)
ITN PROVOKES COUGH 11 (GO TO 138)
USERS DID NOT SLEEP HERE LAST NIGHT 12 (GO TO 138)
NET NOT NEEDED LAST NIGHT 13 (GO TO 138)
NO SPACE TO HANG 14(GO TO 138)
OTHER ____ 96 (GO TO 138)
DON'T KNOW 98 (GO TO 138)
137. Who slept in this mosquito net last night?
NAME_____
LINE NUMBER_____
138. GO BACK TO 129 FOR NEXT NET; OR, IF THERE ARE NO MORE NETS, GO TO 139.
ADDITIONAL HOUSEHOLD CHARACTERISTICS
139. We would like to learn about the places that household's use to wash their hands. Can you please show me where members of your household most often wash their hands?
OBSERVED, MOBILE 2
NOT OBSERVED, NOT IN DWELLING/YARD/PLOT (GO TO 142) 3
NOT OBSERVED, NO PERMISSION TO SEE (GO T0 142) 4
NOT OBSERVED, OTHER REASON (GO TO 142) 5
140. OBSERVE PRESENCE OF WATER AT THE PLACE FOR HANDWASHING.
RECORD OBSERVATION.
WATER IS NOT AVAILABLE 2
141. OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT AT THE PLACE FOR HANDWASHING.
RECORD OBSERVATION.
ASH, MUD, SAND B
NONE Y
142. OBSERVE MAIN MATERIAL ON THE FLOOR OF THE DWELLING.
RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CARAMIC TILES 33
CEMENT 34
CARPET/RUG 35
OTHER 96
_____
143. OBSERVE MAIN MATERIAL OF THE ROOF OF THE DWELLING.
RECORD OBSERVATION.
THATCH/PALM LEAF 12
PALM/BAMBOO 22
WOOD PLANKS 23
CARDBOARD 24
WOOD 32
CALAMINE/CEMENT FIBER 33
CERAMIC TILES 34
CEMENT 35
ROOFING SHINGLES 36
OTHER 96_____
144. OBSERVE MAIN MATERIAL OF THE EXTERIOR WALLS OF THE DWELLING.
RECORD OBSERVATION.
CANE/PLAM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
UNCOVERED ADOBE 23
PLYWOOD 24
CARDBOARD 25
REUSED WOODFINISHED WALLS 26
CEMENT 31
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BLOCKS 34
COVERED ADOBE 35
WOOD PLANKS/SHINGLES 36
OTHER_____ 96
145. I would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals?
IODINE PRESENT 1
NO IODINE 2
NO SALT IN HOUSEHOLD 3
SALT NOT TESTED_______ 6
MINUTES____
INTERVIEWER'S OBSERVATIONS
TO BE FILLED OUT AFTER COMPLETING INTERVEIW
COMMENTS ABOUT INTERVIEW:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS:
EDITOR'S OBSERVATIONS