Data Cart

Your data extract

0 variables
0 samples
View Cart


HOUSEHOLD QUSTIONNAIRE

REPUBLIC OF YEMEN
MINISTRY OF PLANNING AND DEVELOPMENT
CENTRAL STATISTICAL ORGANIZATION
YEMEN DEMOGRAPHIC AND CHILD HEALTH SURVEY 1991

IDENTIFICIATION

GOVERNORATE: ____

DISTRICT: ____

URBAN/RURAL: ____

CLUSTER NUMBER: ____

NAME HOUSEHOLD/ADDRESS: ____

BUILDING NUMBER: ____

NUMBER OF FAMILY IN BUILDING: ____

HOUSEHOLD NUMBER: ____

NAME OF HEAD OF THE HOUSEHOLD: ____

INTERVIEWER VISITS

FIRST VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW

HOURS____
MINUTES____

RESULT CODE*

NEXT VISIT
DATE
TIME

SECOND VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW

HOURS____
MINUTES____

RESULT CODE*

NEXT VISIT
DATE
TIME

FINAL VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW

HOURS____
MINUTES____

RESULT CODE*

*RESULT CODES:

1 COMPLETED
2 NO COMPETENT RESPONDENT AT HOME
3 REFUSED
4 POSTPONED
5 DWELLING DESTROYED
6 DWELLING VACANT
7 DWELLING NOT FOUND
8 OTHER (SPECIFY) ____

KEYED BY____

HOUSEHOLD ROSTER

101) NAME Please give me the names of the persons who usually live in your household starting with the head of the household.

NAME____

JUST TO MAKE SURE I HAVE A COMPLETE LISTING:

Are there any other persons, such as small children or infants whom we have not listed? IF ANSWER IS "YES", ENTER EACH IN TABLE.

YES
NO

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? IF ANSWER IS "YES", ENTER EACH IN TABLE.

YES
NO

102) SEX Is (NAME) male or female?

MALE 1
FEMALE 2

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

RELATIONSHIP____
MOTHER LINE NUMBER ____

104) RESIDENCE Does (NAME) usually live here?

YES 1
NO 2

105) AGE How old is (NAME) now? IF LESS THAN 6: in years and months.

MONTHS____
YEARS____

ORPHANHOOD
106) Is his/her father still alive?

YES 1
NO 2

107) Is his/her mother still alive?

YES 1
NO 2

EDUCATION
108) PERSONS 6-30 YEARS Is (NAME) currently attending school, or has he/she ever attended school?

YES: CURRENTLY 1
YES: EVER 2
NO 3

109) PERSONS AGED 10 AND OVER What is the educational status of (NAME)?

ILLITERATE 1
READ 2
READ AND WRITE 3
PRIMARY 4
PREPARATORY 5
SECONDARY 6
POSTSECONDARY 7
UNIVERSITY 8

110) MARITAL STATUS: PERSONS AGED 10 AND OVER What is the marital status of (NAME)?

SINGLE 1
MARRIED 2
DIVORCED 3
WIDOWED 4

ELIGIBILITY
112) LINE NUMBER OF EVERY ELIGIBLE WOMAN

LINE NUMBER____

113) LINE NUMBER OF EVERY ELIGIBLE CHILD

LINE NUMBER____

114) LINE NUMBER OF THE MOTHER OF EVERY ELIGIBLE CHILD

LINE NUMBER____
IF DECEASED 97
OTHER 96

ECONOMIC ACTIVITY

PERSONS AGED 10 YEARS AND OVER
201) What did (NAME) do most of the time during the past month? Was he/she:

WORKING 1
UNEMPLOYED 2
HOUSEWORK AND WORKING 3
STUDENT AND WORKING 4
SEEKING WORK FOR FIRST TIME 5
DOING HOUSEWORK 6
STUDENT 7
RETIRED 8

202) IF 201 IS 1 OR 4: What is (was) his/her status in employment?

SALARIED EMPLOYEE 1
OUR ACCOUNT WORKER 2
EMPLOYER 3
UNPAID FAMILY WORKER 4
UNPAID APPRENTICE 5

203) IF 201 IS 1 TO 4: What is (was) his/her main occupation?

OCCUPATION____

TOTAL NUMBER OF ELIGIBLE WOMEN____
TOTAL NUMBER OF ELIGIBLE CHILDREN____
TOTAL NUMBER OF ELIGIBLE CHILDREN WHOSE MOTHER LIVE IN THE HOUSEHOLD____
IF CONTINUATION SHEET USED, TICK HERE____

GENERAL MORTALITY

301) During the past 24 months, has any of the usual members of this household died?

YES 1 (CONTINUE)
NO 2 (GO TO 401)

302) NAME____

303) Relationship to the head of the household?

RELATIONSHIP____

304) SEX

MALE 1
FEMALE 2

305) Age at death?

AGE____

306) DATE OF DEATH

MONTH____
YEAR____

DISABILITY

401) Does anyone in this household, including very young children and women, have any long-term condition or health problem which prevents or limits his/her participation in activities normal for a person of his/her age?

YES 1 (CONTINUE)
NO 2 (GO TO 501)

402) NAME AND LINE NUMBER IN HOUSEHOLD ROSTER

NAME____
LINE NUMBER____

403) What is the type of his/her condition?

CONGENITAL 1
INFANT BIRTH TRAUMA 2
INJURY/ACCIDENT 3
INFECTIOUS ILLNESS 4
DISEASE 5
EVIL EYE/ENVY 6
OTHER (SPECIFY)____ 7
DON’T KNOW 8

FERTILITY AND CHILD SURVIVAL (FOR EVER MARRIED WOMEN UNDER AGE 55)

501) NAME AND LINE NUMBER IN HOUSEHOLD ROSTER

NAME____
LINE NUMBER____

CHILDREN EVER BORN
502) Does (NAME) have any children of her own living with her? IF ‘YES’: How many sons and how many daughters?

YES
NO
NUMBER OF SONS____
NUMBER OF DAUGHTERS____

503) Does she have any children of her own who do not live with her? IF ‘YES’: How many sons and how many daughters?

YES
NO
NUMBER OF SONS____
NUMBER OF DAUGHTERS____

504) Has she ever given birth to a child who later died? IF ‘YES’: How many sons and daughters have died?

YES
NO
NUMBER OF SONS____
NUMBER OF DAUGHTERS____

505) Just to make sure I have this correct, she has had (SUM) births. Is this correct? IF ‘NO’: CORRECT THE RESPONSES.

SUM____

LAST LIVE BIRTH
506) In what month and year did her last live birth occur?

MONTH____
YEAR____

507) What was the sex of this child?

BOY 1
GIRL 2

508) Is this child still living?

YES 1
NO 2

HOUSING CHARACTERISTICS QUESTIONNAIRE

10) INTERVIEWER: RECORD THE TIME

HOUR____
MINUTES____

11) What type of dwelling unit does your household occupy?

INDEPENDENT HOUSE/VILLA 1
APARTMENT IN BUILDING 2
HUT 3 (GO TO 19)
WOOD HOUSE 4 (GO TO 19)
CAVE 5 (GO TO 19)
TENT 6 (GO TO 19)
TEMPORARY SHELTER 7 (GO TO 19)
OTHER (SPECIFY)____ 8 (GO TO 19)

12) Is your dwelling owned by your household or is it rented?

OWNED 1
BENEFICIAL CONTRACT 2
RENTED 3
OTHER (SPECIFY)____ 4

13) What kind of material is the floor made from? RECORD MAIN TYPE

EARTH 1
CEMENT 2
STONE/MUD 3
GYPSUM 4
TILE 5
WOOD 6
MARBLE 7
OTHER (SPECIFY)____ 8

14) How many rooms are there in this dwelling for the exclusive use of this household?

NUMBER OF ROOMS____

15) Of this number, how many are bedrooms or used for sleeping?

NUMBER OF ROOMS____

16) INTERVIEWER: CHECK THE VENTILATION IN THE HOUSE AND MARK THE APPROPRIATE ANSWER.

GOOD 1
FAIR 2
POOR 3

17) INTERVIEWER: CHECK LIGHT CONDITION IN THE HOUSE AND MARK THE APPROPRIATE ANSWER.

GOOD 1
FAIR 2
POOR 3

18) INTERVIEWER: CHECK AMOUNT OF SUNLIGHT IN THE HOUSE AND MARK THE APPROPRIATE ANSWER.

GOOD 1
FAIR 2
NO SUN 3

19) Are any farm animals kept in any part of this dwelling?

YES 1
NO 2

21) Is there a special room used for cooking inside or outside your dwelling?

YES: INSIDE DWELLING 1
YES: OUTSIDE DWELLING 2
NO 3

22) Is the place used for cooking shared with other households?

NOT SHARED, ONLY HH USING 1
SHARED 2

23) What fuel is used for cooking?

GAS 1
ELECTRICITY 2
KEROSENE 3
COAL/CHARCOAL 4
WOOD 5
OTHER (SPECIFY)____ 6

31) What is the major source of drinking water for members of the household?

GOVERNMENT PROJECT 1
COOPERATIVE PROJECT 2
PRIVATE PROJECT 3
WELL WITH PUMP 4
REGULAR WELL 5
STREAM 6
COVERED POOL 7
UNCOVERED POOL 8
OTHER (SPECIFY)____ 9

32) Where is this source of drinking water located?

WITHIN DWELLING 1 (GO TO 35)
OUTSIDE DWELLING 2

33) How long does it take you to go to the source from the household and come back?

TIME (MINUTES) ____

34) Who usually brings the water?

CHILDREN 1
ADULT WOMEN 2
ADULT MEN 3
‘SAKKA’ USING ANIMALS 4
TRUCKS/MULES 5

35) Do you buy this water?

YES 1
NO 2
OTHER (SPECIFY)____ 3

36) What kind of container do you use to store water in your home?

CONCRETE/ZINC WATER TANK 1
PLASTIC CONTAINER 2
BOTTLES 3
EARTHEN POTS 4
TIN 5
OTHER (SPECIFY)____ 6
NO STORAGE 7

37) How do you treat drinking water to purify it in your house?

BOILING 1
DISTILLATION 2
CHLORINATION 3
FILTRATION 4
OTHER (SPECIFY)____ 5
NO TREATMENT 6

41) What kind of lighting does this unit have?

GOVERNMENT ELECTRICITY 1
COOPERATIVE ELECTRICITY 2
PRIVATE ELECTRICITY 3
PERSONAL GENERATOR 4
GAS 5 (GO TO 51)
KEROSENE/OIL LAMPS/CANDLE 6 (GO TO 51)
OTHER (SPECIFY)____ 7 (GO TO 51)
NONE 8 (GO TO 51)

42) How many hours in a whole day does your household use electricity?

LESS THAN 6 HOURS 1
6 TO 12 HOURS 2
13 TO 18 HOURS 3
19 TO 24 HOURS 4

51) What type of toilet facilities are available for this household?

FLUSH TOILET CONNECTED TO SEWER 1
FLUSH TOILET NOT CONNECTED TO SEWER 2
BUCKET 3
PIT 4
TOILET CONNECTED TO AN OPEN DRAINAGE 5 (GO TO 53)
LATRINE SHARED WITH OTHERS IN BUILDING 6 (GO TO 53)
PUBLIC (STREET) TOILET 7 (GO TO 53)
OPEN AIR 8 (GO TO 53)
OTHER (SPECIFY) 9

52) Where is the toilet that you use located?

INSIDE DWELLING 1
OUTSIDE DWELLING WITHIN SAME BUILDING/COURTYARD 2
ELSEWHERE 3

53) Do you use soap when you wash your hands?

YES 1
NO 2

61) In what do you put the garbage before it is disposed of?

CONTAINER WITH LID 1
CONTAINER WITHOUT LID 2
PLASTIC BAG 3
THROWN STRAIGHT IN STREET 4 (GO TO 71)
OTHER (SPECIFY)____ 5

62) And where is the garbage (container/bag/etc.) kept?

INSIDE KITCHEN 1
OUTSIDE KITCHEN WITHIN DWELLING 2
OUTSIDE DWELLING 3

63) How do you dispose of the garbage?

GARBAGE COLLECTOR 1
DUMPING IN SPECIAL PLACE 2
BURNING 3
THROWN IN STREET 4 (GO TO 71)
OTHER (SPECIFY) ____ 5

64) How often do you dispose of the garbage?

EVERYDAY 1
AT LEAST TWICE A WEEK 2
ONCE A WEEK 3
OTHER (SPECIFY)____ 4

71) Do you have any of the following objects at this dwelling?

RADIO/CASSETTE RECORDER
YES 1
NO 2
COLOUR TV
YES 1
NO 2
VIDEO
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
GAS/ELECTRIC COOKING STOVE
YES 1
NO 2
WATER HEATER
YES 1
NO 2
SEWING MACHINE
YES 1
NO 2
ELECTRIC FAN
YES 1
NO 2
WASHING MACHINE
YES 1
NO 2
TELEPHONE
YES 1
NO 2
AIR CONDITIONER
YES 1
NO 2
VACUUM CLEANER
YES 1
NO 2
BLENDER
YES 1
NO 2
BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
PRIVATE CAR
YES 1
NO 2
TAXI
YES 1
NO 2

81) INTERVIEWER: OBSERVE AROUND THE DWELLING AND CIRCLE APPROPRIATE RESPONSE.

CLEAN 1
DIRTY 2
STAGNANT WATER 3
SEWAGE OVERFLOW 4

82) INTERVIEWER: RECORD THE TIME.

HOUR____
MINUTES____