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DEMOGRAPHIC AND HEALTH SURVEYS - TANZANIA 1999 - HOUSEHOLD QUESTIONNAIRE

IDENTIFICATION

REGION ___________________ ___

DISTRICT __________________ ___

WARD __________________ ___

E.A. NUMBER ___

TRCHS CLUSTER NUMBER ___

HOUSEHOLD NUMBER___

DAR ES SALAAM, SMALL CITY, TOWN, RURAL/VILLAGE

DAR ES SALAAM = 1
SMALL CITY* = 2
TOWN = 3
RURAL/VILLAGE = 4 ___

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

NAME OF HOUSEHOLD HEAD _____________________

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 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 ____
INTER. ID NO. ____
RESULT ____

TOTAL NUMBER OF VISITS __

TOTAL PERSONS IN HOUSEHOLD __

TOTAL ELIGIBLE WOMEN __

TOTAL ELIGIBLE MEN __

LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE ___

SUPERVISOR:
NAME ________
DATE ________

FIELD EDITOR:
NAME ________
DATE ________

OFFICE EDITOR: ____
KEYED BY____

HOUSEHOLD SCHEDULE

1. Now we would like some information about the people who usually live in your household or who are staying with you now.

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-IN-LAW 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/STEPCHILD
12 = NOT RELATED
98 = DON'T KNOW

4. SEX: Is (NAME) male or female?

MALE 1
FEMALE 2

5. RESIDENCE: Does (NAME) usually live here?

YES 1
NO 2

6. RESIDENCE: Did (NAME) stay here last night?

YES 1
NO 2

7. AGE: How old is (NAME)?

IN YEARS ___

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 5.

PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD

10. Is (NAME)'s natural mother alive?

YES 1
NO 2
DON'T KNOW 8

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.

LINE NUMBER___

12. Is (NAME)'s natural father alive?

YES 1
NO 2
DON'T KNOW 8

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.

LINE NUMBER____

EDUCATION IF AGE 3 YEARS OR OLDER:

14. Has (NAME) ever attended school?

YES 1
NO 2

15. What is the highest standard or form (NAME) has completed?

00 = NURSERY SCHOOL, KINDERGARTEN
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 = DOES NOT KNOW

EDUCATION IF AGE LESS 3-24 YEARS:

16. Is (NAME) currently attending school (including pre-school)?

YES 1 (GO TO 18)
NO 2

17. During the current school year, did (NAME) attend school at any time?

YES 1
NO 2 (GO TO 19)

18. During the current school year, what standard or form is (NAME) attending?

00 = NURSERY SCHOOL, KINDERGARTEN
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 = DOES NOT KNOW

19. During the previous school year, did (NAME) attend school at any time?

YES 1
NO 2

20. During that school year, what standard or form did (NAME) attend?

00 = NURSERY SCHOOL, KINDERGARTEN
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 = DOES NOT 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?

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) Are there any guests or temporary visitors staying here, or anyone else who slept here last night, who have not been listed?

YES (ENTER EACH IN TABLE)
NO

21. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 23)
PIPED INTO YARD/PLOT 12 (GO TO 23)
PUBLIC TAP 13
WATER FROM OPEN OR UNPROTECTED WELL 21
WATER FROM COVERED WELL OR BOREHOLE
PROTECTED DUG WELL 31
BOREHOLE OR TUBEWELL 32
SURFACE WATER
PROTECTED SPRING 41
UNPROTECTED SPRING 42
POND, RIVER, STREAM 43
RAINWATER 51 (GO TO 23)
TANKER TRUCK 61
BOTTLED WATER 71
OTHER (SPECIFY) _______ 96

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

MINUTES ___
ON PREMISES 996

23. What kind of toilet facility do most members of your household use?

FLUSH TOILET 11
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD 31 (GO TO 25)
OTHER (SPECIFY) ________ 96

24. Do you share this facility with other households?

YES 1
NO 2

25. 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

27. 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, CARPET 33
CEMENT 34
OTHER (SPECIFY) _____________ 96

28. Does any member of your household own:

A bicycle?
A motorcycle or motor scooter?
A car or truck?

BICYCLE
YES 1
NO 2
MOTORCYCLE/SCOOTER
YES 1
NO 2
CAR/TRUCK
YES 1
NO 2

29. Does your household have any bednets that can be used while sleeping?

YES 1
NO 2 (GO TO 34)

30. CHECK COLUMNS (6) AND (7):
NUMBER OF CHILDREN UNDER AGE 5 WHO SLEPT IN THE HOUSEHOLD LAST NIGHT

ONE OR MORE (GO TO 31)
NONE (GO TO 34)

31. Did any of the children under age 5 who slept in the household last night sleep under a bednet?
IF YES: Did all or only some sleep under a bednet?

ALL CHILDREN 1
SOME CHILDREN 2
NONE 3 (GO TO 34)

32. Were any of these bednets ever treated with a chemical (dawa) to avoid mosquito bites?

YES 1
NO 2 (GO TO 34)
DOES NOT KNOW 8 (GO TO 34)

33. How long ago was the bednet last treated?

MONTHS AGO ___
DOES NOT KNOW 98

34. ASK RESPONDENT FOR A TEASPOONFUL OF SALT.
TEST SALT FOR IODINE.
RECORD PPM (PARTS PER MILLION).

0 PPM (NO IODINE) 1
25 PPM 2
50 PPM 3
75 PPM 4
100 PPM 5
NOT TESTED 8

35. HEIGHT AND WEIGHT MEASUREMENT OF CHILDREN

1. LINE NO. FROM COL. (1)

LINE NUMBER___

2. NAME FROM COL. (2)

NAME___

3. AGE FROM COL. (7)

AGE___

4. What is (NAME)'s date of birth?

DAY___
MONTH___
YEAR___

5. WEIGHT (KILOGRAMS)

WEIGHT___

6. HEIGHT (CENTIMETERS)

HEIGHT___

7. MEASURED LYING DOWN OR STANDING?

LYING 1
STANDING 2

8. BCG SCAR (ON RIGHT SHOULDER)

YES 1
NO 2

9. RESULT

MEASURED 1
NOT HOME 2
REFUSED 3
OTHER 6

36. CHILD LABOUR MODULE FOR CHILDREN AGES 5-14

1. LINE NO. FROM COL. (1)

LINE NUMBER___

2. NAME FROM COL. (2)

NAME___

3. AGE FROM COL. (7)

AGE___

4. Has (NAME) ever done any kind of work for pay?

YES 1
NO 2

5. Is (NAME) currently doing any kind of work for pay?

YES 1
NO 2 (GO TO 7)

6. For how many hours a week does (NAME) work for pay?

HOURS___

7. Does (NAME) regularly do unpaid family work on the farm or in a family business?

YES 1
NO 2 (GO TO 9)

8. For how many hours a week does (NAME) do unpaid work?

HOURS___

9. Does (NAME) regularly help with household chores at home, like cleaning, caring for animals, cooking?

YES 1
NO 2 (GO TO NEXT LINE)

10. How many hours per day does (NAME) help with household chores?

HOURS___