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REPUBLIC OF SENEGAL -DEMOGRAPHIC AND HEALTH SURVEY (EDSII) -1992/1993 - HOUSEHOLD QUESTIONNAIRE

IDENTIFICATION

PLACE NAME (COMMUNE/VILLAGE) _____
NAME OF HEAD OF HOUSEHOLD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
REGION_____

URBAN/RURAL:

URBAN 1
RURAL 2

REGION:

DAKAR (REGION OF DAKAR NOT RURAL) 1,
LARGE CITIES (THIES, KAOLACK, ZIGUINCHOR, SAINT-LOUIS, DJOURBEL) 2
CITY (OTHER COMMUNES) 3
COUNTRYSIDE (RURAL) 4

NAME/LINE NUMBER OF RESPONDENT ON THE HOUSEHOLD SHEET:

______

MEN'S SURVEY?

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD INTERVIEWERS):
DATE____
INTERVIEWER NAME______
RESULT___

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 _____
INTERVIEWER_____
RESULT_____

TOTAL NUMBER OF VISITS_____

TOTAL IN THE HOUSEHOLD_____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____

SUPERVISOR
NAME_____
DATE_____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____
KEYED BY______

HOUSEHOLD TABLE

Now I would like information on the people who usually live in your household or who are currently visiting your household.

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

LINE NO. ______

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.

NAME _____

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 FOSTERED CHILD
12 ADOPTED CHILD
13 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)?
RECORD '97' FOR 97 YEARS OR MORE.

YEARS _____

EDUCATION. IF 6 YEARS OR MORE:

8. Has (NAME) attended school?

YES 1
NO 2 (GO TO NEXT LINE)

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

LEVEL OF EDUCATION ____
1 ELEMENTARY
2 SECONDARY
3 SUPERIOR
8 DOESN'T KNOW
GRADE ____
00 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 (GO TO 13)
DOESN'T KNOW 8

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

LINE NO. _____

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

YES 1
NO 2 (GO TO 15)
DOESN'T KNOW 8

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

LINE NO. _____

15. ELIGIBILITY: CIRCLE THE LINE NUMBER OF ALL WOMEN RESIDENTS OR VISITORS BETWEEN 15-49 YEARS. (SEE QUESTIONS 5, 6 AND 7)

16. ELIGIBILITY: CIRCLE THE LINE NUMBER OF ALL MEN RESIDENTS OR VISITORS AGED 20 YEARS OR MORE. (SEE QUESTIONS 5, 6 AND 7)

MARK HERE IF ANOTHER SHEET WAS USED____

TOTAL NUMBER OF ELIGIBLE PEOPLE____

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

17. What is the main source of water that the members of your household use to wash their hands and to wash the dishes?

PIPED WATER
PIPED INTO THE DWELLING/YARD/LOT 11 (GO TO 19)
PUBLIC TAP/STANDPIPE 12
OPEN WELL
OPEN WELL IN DWELLING/ YARD/PLOT 21 (GO TO 19)
OPEN PUBLIC WELL 22
PROTECTED WELL 23
SURFACE WATER
RIVER/STREAM/BROOK 31
SWAMP/LAKE/POND 32
SPRING 33
DAM 34
RAINWATER 41 (GO TO 19)
TANKER 51
BOTTLED WATER 61 (GO TO 19)
OTHER (SPECIFY) ____ 71

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

MINUTES____
ON SITE 996

19. Do the members of your household get water from the same source to drink?

YES 1 (GO TO 21)
NO 2

20. From where does the drinking water for your household come?

PIPED WATER
PIPED INTO THE DWELLING/YARD/LOT 11
PUBLIC TAP/STANDPIPE 12
OPEN WELL
OPEN WELL IN DWELLING/ YARD/PLOT 21
OPEN PUBLIC WELL 22
PROTECTED WELL 23
SURFACE WATER
RIVER/STREAM/BROOK 31
SWAMP/LAKE/POND 32
SPRING 33
DAM 34
RAINWATER 41
TANKER 51
BOTTLED WATER 61
OTHER (SPECIFY) ____ 71

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

FLUSH
PERSONAL FLUSH 11
COMMUNAL FLUSH 12
PIT/LATRINE
PIT 21
LATRINES 22
NO FACILITY IN THE HOUSEHOLD 31
OTHER (SPECIFY) ____41

22. Does your household have:

Electricity?
Radio?
Television?
Refrigerator or freezer?
Video?

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

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

ROOMS____

24. MAIN MATERIAL OF THE FLOOR:
RECORD OBSERVATION.

NATURAL MATERIAL
EARTH/SAND 11
DUNG 12
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYLE OR LINO/ASPHALT 32
TILE 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) ______ 41

25. Is there anyone in your household who owns:

A bicycle?
A scooter or motorcycle?
A car?

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

26. END OF HOUSEHOLD QUESTIONNAIRE.

HOUR___
MINUTES___