DEMOGRAPHIC AND HEALTH SURVEYS - TANZANIA 1996 - HOUSEHOLD SCHEDULE
NAME OF HOUSEHOLD HEAD ______________________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
REGION ___________________ ___
DISTRICT __________________ ___
WARD __________________ ___
ENUMERATION AREA _______________ ___
SMALL CITY* 2
TOWN 3
COUNTRYSIDE 4
HOUSEHOLD SELECTED FOR MALE SURVEY?
NO 2
*SMALL CITIES ARE: MWANZA, ARUSHA, MOROGORO, DODOMA, MOSHI, TANGA, IRINGA, MBEYA, AND TABORA. ALL OTHER URBAN AREAS ARE TOWN.
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
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 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _________ 9
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _________ 9
NEXT VISIT:
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR 96
ID NO. ___
RESULT* ____
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) _________ 9
TOTAL NUMBER OF VISITS __
TOTAL IN HOUSEHOLD __
TOTAL ELIG. WOMEN __
TOTAL ELIG. MEN __
LINE NO. OF RESP. TO HOUSEHOLD __
SUPERVISOR
NAME ________
DATE ________
FIELD EDITOR
NAME ________
DATE ________
OFF. EDIT.
KEYED BY
Now we would like some information about the people who usually live in your household or who are staying with you now.
(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?
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 CO-WIFE
10 OTHER RELATIVE
11 ADOPTED/FOSTER CHILD
12 NOT RELATED
98 DK
(4) Does (NAME) usually live here?
NO 2
(5) Did (NAME) sleep here last night?
NO 2
(6) SEX
Is (NAME) male or female?
F 2
IF AGE 5 YEARS OR OLDER
(8) Has (NAME) ever been to school?
NO 2
(9) What is the highest formal school (NAME) completed?
01 STANDARD 1
02 STANDARD 2
03 STANDARD 3
04 STANDARD 4
05 STANDARD 5
06 STANDARD 6
07 STANDARD 7
08 STANDARD 8
09 FORM 1
10 FORM 2
11 FORM 3
12 FORM 4
13 FORM 5
14 FORM 6
15 UNIVERSITY
96 OTHER
98 DON'T KNOW
(10) (IF AGED LESS THAN 25 YEARS) Is (NAME) still in school?
NO 2
PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD***
(11) Is (NAME)'s natural mother alive?
NO 2
DK 8
(12) (IF ALIVE) Does (NAME)'s natural mother live in this household?
IF YES: What is her name?
RECORD MOTHER'S LINE NUMBER.
(13) Is (NAME)'s natural father alive?
NO 2
DK 8
(14) (IF ALIVE) Does (NAME)'s natural father live in this household?
IF YES: What is his name?
RECORD FATHER'S LINE NUMBER.
(15) ELIGIBILITY WOMEN
CIRCLE LINE NUMBER OF ALL WOMEN AGED 15-49.
(16) HUSBAND LINE NUMBER
WRITE LINE NUMBER OF THE HUSBAND OF EACH ELIGIBLE WOMAN. WRITE 00 IF NOT MARRIED OR IF HUSBAND NOT IN HOUSEHOLD.
(17) ELIGIBILITY MEN
CIRCLE LINE NUMBER OF ALL MEN AGED 15-59 (IF HOUSEHOLD FALLS IN MALE SAMPLE).
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) Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?
NO __
***QUESTIONS 12 AND14: RECORD '00' IF THE NATURAL (BIOLOGICAL) PARENT IS NOT A MEMBER OF THE HOUSEHOLD.
18. What is the main source of drinking water for members of your household?
PUBLIC/PRIVATE TAP 12
PUBLIC/PRIVATE WELL 22
RIVER/STREAM 32
POND/LAKE 33
DAM 34
OTHER (SPECIFY) _______ 96
19. How long does it take to go there, get water, and come back?
ON PREMISES 996
20. What kind of toilet facility does your household have?
IF FLUSH TOILET, ASK IF IT IS SHARED WITH ANOTHER HOUSEHOLD.
SHARED FLUSH TOILET 12
VENTILATED IMPROVED PIT LATRINE 22
OTHER (SPECIFY) ________ 96
Electricity?
A radio?
A television?
A refrigerator?
NO 2
NO 2
NO 2
NO 2
22. How many rooms in your household are used for sleeping?
23. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.
CERAMIC TILES 32
CEMENT 33
24. Does any member of your household own:
A bicycle?
A motorcycle?
A car?
NO 2
NO 2
NO 2
25. Does your household always have enough food to eat, or do you have sometimes or frequently have not enough food to eat?
SOMETIMES NOT ENOUGH 2
FREQUENTLY NOT ENOUGH 3
ALWAYS NOT ENOUGH 4
DOES NOT KNOW 8