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UGANDA DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE 1995

IDENTIFICATION

REGION ___________________
DISTRICT ___________________
COUNTY ___________________
SUB-COUNTY/TOWN ___________________
PARISH/RC2 NAME ___________________
EA NAME ___________________
UDHS NUMBER
URBAN/RURAL

Urban1
Rural2

CITY/MUNICIPALITY/TOWN/COUNTRYSIDE

City1
municipality2
town3
countryside4

HOUSEHOLD NUMBER
NAME OF HOUSEHOLD HEAD ___________________
HOUSEHOLD SELECTED FOR MALE SURVEY?

YES1
NO2

INTERVIEWER VISITS

FIRST VISIT
DATE __________
INTERVIEWER'S NAME __________
RESULT __________

NEXT VISIT:
DATE __________
TIME __________

SECOND VISIT
DATE __________
INTERVIEWER'S NAME __________
RESULT __________

NEXT VISIT:
DATE __________
TIME __________

THIRD VISIT
DATE __________
INTERVIEWER'S NAME __________
RESULT __________

FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT

TOTAL NUMBER OF VISITS

*RESULT CODES:

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) _____________

TOTAL IN HOUSEHOLD

TOTAL WOMEN 15 - 49

MEN 15 - 54

LINE NUMBER OF REPONDENT OF HOUSEHOLD SCHEDULE

LANGUAGE OF QUESTIONNAIRE: ENGLISH

SUPERVISOR

NAME ___________
DATE ___________

FIELD EDITOR

NAME ___________
DATE ___________

OFFICE EDITOR

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.

LINE NUMBER

1) USUAL RESIDENTS AND VISITORS

2) 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.

_________________

RELATIONSHIP TO HEAD OF HOUSEHOLD*

3) What is the relationship of (NAME) to the head of the household?

CODES FOR QUESTION 3

RELATIONSHIP TO HEAD OF HOUSEHOLD:
01 HEAD
02 SPOUSE
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 CHILD/STEP CHILD
12 NOT RELATED
98 DOES NOT KNOW

RESIDENCE

4) Does (NAME) usually live here?

YES 1
NO 2

5) Did (NAME) sleep here last night?

YES 1
NO 2

SEX

6) Is (NAME) male or female?

MALE 1
FEMALE 2

AGE

7) How old is (NAME)?

IN YEARS

EDUCATION IF AGE 6 OR OLDER

8) Has (NAME) ever been to school?

YES 1
NO 2

9) IF ATTENDED SCHOOL: What is the highest level of school (NAME) attended? What is the highest grade (NAME) completed at the level?

LEVEL
GRADE

CODES FOR QUESTION 9

LEVEL OF EDUCATION
1 PRIMARY
2 JUNIOR
3 SECONDARY
4 UNIVERSITY
8 DOES NOT KNOW
GRADE:
1
2
3
4 [for all except junior]
5 [for all except junior]
6 [for primary and secondary only]
7 [for primary only]
8 DOES NOT KNOW

10) IF AGE IS 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
DON'T KNOW 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?

YES 1
NO 2
DON'T KNOW 8

14) IF ALIVE: Does (NAME)'s natural father live in this household? IF YES: What is his name?

RECORD FATHER'S LINE NUMBER

ELIGIBILITY WOMEN

15) CIRCLE LINE NUMBER OF ALL WOMEN AGED 15-49

HUSBAND LINE NUMBER

16) WRITE LINE NUMBER OF THE HUSBAND OF EACH ELIGIBLE WOMAN

WRITE 00 IF NOT MARRIED OR IF HUSBAND NOT IN HOUSEHOLD

ELIGIBILITY MEN

17) CIRCLE LINE NUMBER OF ALL MEN AGED 15-54 (IF HOUSEHOLD FALLS IN MAN SAMPLE)

TICK HERE IF CONTINUATION SHEET USED

TOTAL NUMBER OF ELIGIBLE WOMEN

TOTAL NUMBER OF ELIGIBLE MEN

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 that have not been listed?

YES (ENTER EACH IN TABLE)
NO

18A) What is the main source of drinking water for members of your household?

PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 20)
PUBLIC TAP 12
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 20)
PUBLIC WELL 22
BOREHOLE 23
SPRING 31
RIVER/STREAM 32
POND/LAKE/DAM 33
GRAVITY FLOW SCHEME 34
RAINWATER 41 (GO TO 20)
BOTTLED WATER 51 (GO TO 20)
OTHER ___________________ 96

18B) Where do you store the drinking water?

POT 1
JERRY CAN 2
PAN 3
KALABASH 4
OTHER __________ 6

18C) How much water is used in this household every day?

LITRES

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?

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
IMPROVED PIT LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER __________ 96

21) Does your household have:

Electricity?
YES 1
NO 2
A radio?
YES 1
NO 2
A television?
YES 1
NO 2
A telephone?
YES 1
NO 2
A refrigerator?
YES 1
NO 2
A Video
YES 1
NO 2
An Electric cooker
YES 1
NO 2

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

ROOMS

23) MAIN MATERIAL OF THE FLOOR.

RECORD OBSERVATION.

EARTH/SAND 11
COW DUNG 12
PARQUET OR POLISHED WOOD 21
VINYL OR ASPHALT STRIPS 22
CERAMIC TILES 23
CEMENT 24
OTHER (SPECIFY) _________ 96

24) Does any member of your household own:

A bicycle?
YES 1
NO 2
A motorcycle?
YES 1
NO 2
A Motor vehicle (CAR, BUS, LORRY, TRACTOR)
YES 1
NO 2

25) What type of salt is usually used for cooking in your household?

(ASK TO SEE SALT PACKAGE)

LOCAL SALT 1
PACKAGED SALT (IODIZED) 2
PACKAGED SALT (NOT IODIZED) 3
SALT FOR ANIMALS 4
OTHER SALT 6

25A) TEST THE SALT AND WRITE THE RESULT.

IODINE READING (PPM)

26) How many meals did the household have yesterday?

(MEALS: OTHER THAN TEA AND SNACKS)

NUMBER OF MEALS

27) In terms of household consumption, do you think that your household is:

Surplus household
Neither surplus nor deficit
Occasionally deficit
Always deficit

SURPLUS 1
NEITHER SURPLUS NOR DEFICIT 2
OCCASIONALLY DEFICIT 3
ALWAYS DEFICIT 4
DOES NOT KNOW 8