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ZIMBABWE DEMOGRAPHIC AND HEALTH SURVEY 1994

HOUSEHOLD SCHEDULE

IDENTIFICATION

WARD/VILLAGE __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
PROVINCE ___

URBAN/RURAL

Urban 1
Rural 2

MAIN TOWN/OTHER URBAN/RURAL

Main town=1
Other urban=2
Rural=3

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
* 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 ELIGIBLE WOMEN ___

TOTAL ELIGIBLE MEN ___

LINE NUMBER OF HOUSEHOLD RESPONDENT ___

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEW:

SHONA 1
NDEBELE 2
ENGLISH 3
OTHER (SPECIFY) __________ 6

TEAM LEADER

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.

1) LINE NUMBER ___

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.

NAMES __________

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 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 OTHER RELATIVE
10 ADOPTED/FOSTER CHILD
11 NOT RELATED
98 DON'T 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 5 YEARS 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/years (NAME) completed at that level?

CODES FOR QUESTION 9

LEVEL OF EDUCATION:
1 PRIMARY
2 SECONDARY
3 HIGHER
8 DON'T KNOW
YEARS:
00 LESS THAN 1 YEAR COMPLETED
98 DON'T KNOW

10) IF AGE LESS THAN 25 YEARS Is (NAME) still in school?

YES 1
NO 2

PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD

These questions refer to the biological parents of the child. Record 00 if parent is not a member of household.

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

LINE NUMBER ___
NAME __________

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

LINE NUMBER ___
NAME __________

ELIGIBILITY

15) CIRCLE LINE NUMBER ELIGIBLE WOMEN. "ROOF" LINE NUMBER ELIGIBLE MEN

LINE NUMBER ELIGIBLE WOMEN ___
LINE NUMBER ELIGIBLE MEN ___

TICK HERE IF CONTINUATION SHEET USED ___

TOTAL NUMBER OF ELIGIBLE MEN ___

TOTAL NUMBER OF ELIGIBLE WOMEN ___

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 ___

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

PIPED WATER
PIPED INTO OWN RESIDENCE/YARD/PLOT 11 (SKIP TO 18)
COMMUNAL TAP 12
WELL WATER
PROTECTED WELL 21
UNPROTECTED WELL 22
BOREHOLE 23
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/DAM/LAKE 33
RAINWATER 41 (SKIP TO 18)
OTHER (SPECIFY) __________ 96

17) How long does it take to go there, get water, and come back?

MINUTES ___
ON PREMISES 996

18) 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
BLAIR TOILET 22
NO FACILITY 31
OTHER (SPECIFY) __________ 96

19) Does your household have:

Electricity?
YES 1
NO 2
A radio?
YES 1
NO 2
A television?
YES 1
NO 2
A refrigerator?
YES 1
NO 2

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

ROOMS ___

21) MAIN MATERIAL OF THE FLOOR. RECORD OBSERVATION.

NATURAL FLOOR
EARTH/DUNG 11
RUDIMENTARY FLOOR
WOOD PLANKS 21
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) __________ 96

22) Does any member of your household own:

A modern oxcart?
YES 1
NO 2
A bicycle?
YES 1
NO 2
A motorcycle?
YES 1
NO 2
A car?
YES 1
NO 2