REPUBLIC OF YEMEN
MINISTRY OF PLANNING AND DEVELOPMENT
CENTRAL STATISTICAL ORGANIZATION
YEMEN DEMOGRAPHIC AND CHILD HEALTH SURVEY 1991
GOVERNORATE: ____
DISTRICT: ____
URBAN/RURAL: ____
CLUSTER NUMBER: ____
NAME HOUSEHOLD/ADDRESS: ____
BUILDING NUMBER: ____
NUMBER OF FAMILY IN BUILDING: ____
HOUSEHOLD NUMBER: ____
NAME OF HEAD OF THE HOUSEHOLD: ____
FIRST VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW
MINUTES____
RESULT CODE*
NO COMPETENT RESPONDENT AT HOME 2
REFUSED 3
POSTPONED 4
DWELLING DESTROYED 5
DWELLING VACANT 6
DWELLING NOT FOUND 7
OTHER (SPECIFY) ____ 8
NEXT VISIT
DATE
TIME
SECOND VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW
MINUTES____
RESULT CODE*
NO COMPETENT RESPONDENT AT HOME 2
REFUSED 3
POSTPONED 4
DWELLING DESTROYED 5
DWELLING VACANT 6
DWELLING NOT FOUND 7
OTHER (SPECIFY) ____ 8
NEXT VISIT
DATE
TIME
FINAL VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW
MINUTES____
RESULT CODE*
NO COMPETENT RESPONDENT AT HOME 2
REFUSED 3
POSTPONED 4
DWELLING DESTROYED 5
DWELLING VACANT 6
DWELLING NOT FOUND 7
OTHER (SPECIFY) ____ 8
KEYED BY____
101) NAME Please give me the names of the persons who usually live in your household starting with the head of the household.
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.
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.
NO
102) SEX: Is (NAME) male or female?
FEMALE 2
103) RELATIONSHIP: What is the relationship of (NAME) to the head of the household?
MOTHER LINE NUMBER ____
104) RESIDENCE: Does (NAME) usually live here?
NO 2
105) AGE How old is (NAME) now? IF LESS THAN 6: in years and months.
YEARS____
ORPHANHOOD
106) Is his/her father still alive?
NO 2
107) Is his/her mother still alive?
NO 2
EDUCATION
108) PERSONS 6-30 YEARS Is (NAME) currently attending school, or has he/she ever attended school?
YES: EVER 2
NO 3
109) PERSONS AGED 10 AND OVER What is the educational status of (NAME)?
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)?
MARRIED 2
DIVORCED 3
WIDOWED 4
ELIGIBILITY
112) LINE NUMBER OF EVERY ELIGIBLE WOMAN
113) LINE NUMBER OF EVERY ELIGIBLE CHILD
114) LINE NUMBER OF THE MOTHER OF EVERY ELIGIBLE CHILD
IF DECEASED 97
OTHER 96
PERSONS AGED 10 YEARS AND OVER
201) What did (NAME) do most of the time during the past month? Was he/she:
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?
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?
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____
301) During the past 24 months, has any of the usual members of this household died?
NO 2 (GO TO 401)
303) Relationship to the head of the household?
FEMALE 2
YEAR____
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?
NO 2 (GO TO 501)
402) NAME AND LINE NUMBER IN HOUSEHOLD ROSTER
LINE NUMBER____
403) What is the type of his/her condition?
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
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?
NO
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?
NO
NUMBER OF DAUGHTERS____
504) Has she ever given birth to a child who later died? IF 'YES': How many sons and daughters have died?
NO
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.
LAST LIVE BIRTH
506) In what month and year did her last live birth occur?
YEAR____
507) What was the sex of this child?
GIRL 2
508) Is this child still living?
NO 2
10) INTERVIEWER: RECORD THE TIME
MINUTES____
11) What type of dwelling unit does your household occupy?
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?
BENEFICIAL CONTRACT 2
RENTED 3
OTHER (SPECIFY)____ 4
13) What kind of material is the floor made from? RECORD MAIN TYPE
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?
15) Of this number, how many are bedrooms or used for sleeping?
16) INTERVIEWER: CHECK THE VENTILATION IN THE HOUSE AND MARK THE APPROPRIATE ANSWER.
FAIR 2
POOR 3
17) INTERVIEWER: CHECK LIGHT CONDITION IN THE HOUSE AND MARK THE APPROPRIATE ANSWER.
FAIR 2
POOR 3
18) INTERVIEWER: CHECK AMOUNT OF SUNLIGHT IN THE HOUSE AND MARK THE APPROPRIATE ANSWER.
FAIR 2
NO SUN 3
19) Are any farm animals kept in any part of this dwelling?
NO 2
21) Is there a special room used for cooking inside or outside your dwelling?
YES: OUTSIDE DWELLING 2
NO 3
22) Is the place used for cooking shared with other households?
SHARED 2
23) What fuel is used for cooking?
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?
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?
OUTSIDE DWELLING 2
33) How long does it take you to go to the source from the household and come back?
34) Who usually brings the water?
ADULT WOMEN 2
ADULT MEN 3
'SAKKA' USING ANIMALS 4
TRUCKS/MULES 5
NO 2
OTHER (SPECIFY)____ 3
36) What kind of container do you use to store water in your home?
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?
DISTILLATION 2
CHLORINATION 3
FILTRATION 4
OTHER (SPECIFY)____ 5
NO TREATMENT 6
41) What kind of lighting does this unit have?
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?
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 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?
OUTSIDE DWELLING WITHIN SAME BUILDING/COURTYARD 2
ELSEWHERE 3
53) Do you use soap when you wash your hands?
NO 2
61) In what do you put the garbage before it is disposed of?
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?
OUTSIDE KITCHEN WITHIN DWELLING 2
OUTSIDE DWELLING 3
63) How do you dispose of the garbage?
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?
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?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
81) INTERVIEWER: OBSERVE AROUND THE DWELLING AND CIRCLE APPROPRIATE RESPONSE.
DIRTY 2
STAGNANT WATER 3
SEWAGE OVERFLOW 4
82) INTERVIEWER: RECORD THE TIME.
MINUTES____