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DEMOGRAPHIC AND HEALTH SURVEYS - TANZANIA 1996 - HOUSEHOLD SCHEDULE

IDENTIFICATION

NAME OF HOUSEHOLD HEAD ______________________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

REGION ___________________ ___

DISTRICT __________________ ___

WARD __________________ ___

ENUMERATION AREA _______________ ___

LARGE CITY 1
SMALL CITY* 2
TOWN 3
COUNTRYSIDE 4

HOUSEHOLD SELECTED FOR MALE SURVEY?

YES 1
NO 2

*SMALL CITIES ARE: MWANZA, ARUSHA, MOROGORO, DODOMA, MOSHI, TANGA, IRINGA, MBEYA, AND TABORA. ALL OTHER URBAN AREAS ARE TOWN.

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER’S NAME _______________
RESULT* ______________

*RESULT

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _________

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR 96
ID NO. ___
RESULT ____

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

HOUSEHOLD SCHEDULE

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.

LINE NUMBER___

(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.

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 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

RESIDENCE

(4) Does (NAME) usually live here?

YES 1
NO 2

(5) Did (NAME) sleep here last night?

YES 1
NO 2

(6) SEX
Is (NAME) male or female?

M 1
F 2

(7) AGE
How old is (NAME)?

IN YEARS __

EDUCATION

IF AGE 5 YEARS OR OLDER

(8) Has (NAME) ever been to school?

YES 1
NO 2

IF ATTENDED

(9) What is the highest formal school (NAME) completed?

00 LESS THAN 1 YEAR 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?

YES 1
NO 2

PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD***

(11) Is (NAME)’s natural mother alive?

YES 1
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.

LINE NUMBER___

(13) Is (NAME)’s natural father alive?

YES 1
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.

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?

YES ___ (ENTER EACH IN TABLE)
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?

YES ___ (ENTER EACH IN TABLE)
NO __

3) Do you have any guests or temporary visitors staying here, or anyone else who slept here last night?

YES ___ (ENTER EACH IN TABLE)
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?

PIPED WATER
PIPED INTO HOUSE/YARD/PLOT 11 (GO TO 20)
PUBLIC/PRIVATE TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 20)
PUBLIC/PRIVATE WELL 22
SURFACE WATER:
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 20)
OTHER (SPECIFY) _______ 96

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

MINUTES ___
ON PREMISES 996

20. What kind of toilet facility does your household have?
IF FLUSH TOILET, ASK IF IT IS SHARED WITH ANOTHER HOUSEHOLD.

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) ________ 96

21. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

22. How many rooms in your household are used for sleeping?

ROOMS ___

23. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.

NATURAL FLOOR
EARTH/SAND 11
RUDIMENTARY FLOOR
WOOD PLANKS 21
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
CERAMIC TILES 32
CEMENT 33
OTHER (SPECIFY) _____________ 96

24. Does any member of your household own:

A bicycle?
A motorcycle?
A car?

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

ALWAYS ENOUGH 1
SOMETIMES NOT ENOUGH 2
FREQUENTLY NOT ENOUGH 3
ALWAYS NOT ENOUGH 4
DOES NOT KNOW 8