Survey Text

Afghanistan 2015 Ethiopia 2011 Malawi 2016 Senegal 1986
Angola 2015 Ethiopia 2016 Mali 1987 Senegal 1992
Bangladesh 1994 Ghana 1988 Mali 1995 Senegal 1997
Bangladesh 1997 Ghana 1993 Mali 2001 Senegal 2005
Bangladesh 2000 Ghana 1998 Mali 2006 Senegal 2010
Bangladesh 2004 Ghana 2003 Mali 2012 Senegal 2012
Bangladesh 2007 Ghana 2008 Mali 2018 Senegal 2014
Bangladesh 2011 Ghana 2014 Morocco 1987 Senegal 2015
Bangladesh 2014 Guinea 1999 Morocco 1992 Senegal 2016
Benin 1996 Guinea 2005 Morocco 2003 Senegal 2017
Benin 2001 Guinea 2012 Mozambique 1997 South Africa 1998
Benin 2006 Guinea 2018 Mozambique 2003 South Africa 2016
Benin 2011 India 1992 Mozambique 2011 Sri Lanka 1987
Benin 2017 India 1998 Myanmar 2015 Sudan 1989
Burkina Faso 1993 India 2005 Namibia 1992 Tanzania 1991
Burkina Faso 1998 India 2015 Namibia 2000 Tanzania 1996
Burkina Faso 2003 Jordan 1990 Namibia 2006 Tanzania 1999
Burkina Faso 2010 Jordan 1997 Namibia 2013 Tanzania 2004
Burundi 1987 Jordan 2002 Nepal 1996 Tanzania 2010
Burundi 2010 Jordan 2007 Nepal 2001 Tanzania 2015
Burundi 2016 Jordan 2009 Nepal 2006 Tunisia 1988
Cameroon 1991 Jordan 2012 Nepal 2011 Uganda 1988
Cameroon 1998 Jordan 2017 Nepal 2016 Uganda 1995
Cameroon 2004 Kenya 1989 Niger 1992 Uganda 2001
Cameroon 2011 Kenya 1993 Niger 1998 Uganda 2006
Chad 1996 Kenya 1998 Niger 2006 Uganda 2011
Chad 2004 Kenya 2003 Niger 2012 Uganda 2016
Chad 2014 Kenya 2008 Nigeria 1990 Yemen 1991
Congo (Democratic Republic) 2007 Kenya 2014 Nigeria 1999 Yemen 2013
Congo (Democratic Republic) 2013 Lesotho 2004 Nigeria 2003 Zambia 1992
Cote d'Ivoire 1994 Lesotho 2009 Nigeria 2008 Zambia 1996
Cote d'Ivoire 1998 Lesotho 2014 Nigeria 2013 Zambia 2001
Cote d'Ivoire 2011 Liberia 1986 Nigeria 2018 Zambia 2007
Egypt 1988 Liberia 2007 Pakistan 1991 Zambia 2013
Egypt 1992 Liberia 2013 Pakistan 2006 Zambia 2018
Egypt 1995 Madagascar 1992 Pakistan 2012 Zimbabwe 1988
Egypt 2000 Madagascar 1997 Pakistan 2017 Zimbabwe 1994
Egypt 2003 Madagascar 2003 Rwanda 1992 Zimbabwe 1999
Egypt 2005 Madagascar 2008 Rwanda 2000 Zimbabwe 2005
Egypt 2008 Malawi 1992 Rwanda 2005 Zimbabwe 2010
Egypt 2014 Malawi 2000 Rwanda 2008 Zimbabwe 2015
Ethiopia 2000 Malawi 2004 Rwanda 2010
Ethiopia 2005 Malawi 2010 Rwanda 2014
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Afghanistan 2015
Survey form view entire document:  text 
IDENTIFICATION

PROVINCE

DISTRICT

VILLAGE/NAHIA

CONTROLLER AREA

CLUSTER NUMBER

TYPE OF LOCATION

URBAN 1
RURAL 2

STRUCTURE/BUILDING NUMBER/GATE NUMBER

HOUSEHOLD NUMBER

NAME OF HOUSEHOLD HEAD

NAME AND LINE NUMBER OF WOMAN

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2

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Angola 2015
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ________
NAME OF HOUSEHOLD HEAD_______
PROVINCE_______
MUNICIPALITY_____
COMMUNITY_______
NEIGHBORHOOD/VILLAGE______
CENSUS SECTION______
AREAS OF RESIDENCE

URBAN 1
RURAL 2

CLUSTER NUMBER (ID. IIMS)______
HOUSEHOLD NUMBER_______
NAME AND LINE NUMBER OF WOMAN_______
THE WOMAN WAS SELECTED FOR THE DOMESTIC VIOLENCE MODULE

YES 1
NO 2

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Bangladesh 1994
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
REGION ___


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Bangladesh 1997
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
REGION ___


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Bangladesh 2000
Survey form view entire document:  text 
IDENTIFICATION

DIVISION:
DISTRICT:
THANA:
UNION OR WARD:
VILLAGE OR MOHALLA OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:

DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE?

DHAKA OR CHITTAGONG 1
SMALL CITY 2
TOWN 3
VILLAGE 4

NAME OF HOUSEHOLD HEAD:
NAME AND LINE NUMBER OF ELIGIBLE WOMAN:


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Bangladesh 2004
Survey form view entire document:  text 
IDENTIFICATION

DIVISION:

DISTRICT:

UPAZILA:

UNION OR WARD:

VILLAGE OR MOHALLA OR BLOCK:

CLUSTER NUMBER:

HOUSEHOLD NUMBER:

RURAL OR MUNICIPALITY OR OTHER URBAN OR SMA?

RURAL 1
MUNICIPALITY 2
OTHER URBAN 3
SMA 4

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Bangladesh 2007
Survey form view entire document:  text 
IDENTIFICATION

CLUSTER NUMBER____
HOUSEHOLD NUMBER____
NAME OF THE HOUSEHOLD HEAD____
NAME AND LINE NUMBER OF WOMAN____
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2

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Bangladesh 2011
Survey form view entire document:  text 
IDENTIFICATION

CLUSTER NUMBER __________

HOUSEHOLD NUMBER __________

NAME OF THE HOUSEHOLD HEAD __________

NAME AND LINE NUMBER OF WOMAN __________


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Bangladesh 2014
Survey form view entire document:  text 
IDENTIFICATION

CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
NAME OF THE HOUSEHOLD HEAD _____
NAME AND LINE NUMBER OF ELIGIBLE WOMAN ________________


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Benin 1996
Survey form view entire document:  text 
IDENTIFICATION

DEPARTMENT

SUB-PREFECTURE/URBAN DISTRICT

RURAL/URBAN MUNICIPALITY

VILLAGE/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER


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Benin 2001
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TOWN/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER


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Benin 2006
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IDENTIFICATION

DEPARTMENT

MUNICIPALITY

DISTRICT

TOWN/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER


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Benin 2011
Survey form view entire document:  text 
VILLAGE/NEIGHBORHOOD___________
CLUSTER NUMBER __________
STRUCTURE NUMBER _________
HOUSEHOLD NUMBER________

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Benin 2017
Survey form view entire document:  text 
Name of head of household
Cluster number
Household number
Name and line number of woman

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Burkina Faso 1993
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IDENTIFICATION

PROVINCE _____
DEPARTMENT _____
COMMUNE/URBAN CENTER _____
CLUSTER NUMBER _____
HOUSEHOLD UNIT NUMBER_____
VILLAGE/SECTOR _____


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Burkina Faso 1998
Survey form view entire document:  text 
PROVINCE _____
DEPARTMENT _____
COMMUNE/URBAN CENTER _____
VILLAGE/SECTOR _____
CLUSTER NUMBER _____
NAME OF HEAD OF CONCESSION _____
CONCESSION NUMBER _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD UNIT NUMBER _____

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Burkina Faso 2003
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER ______
HOUSEHOLD UNIT NUMBER _______
REGION _______
VILLAGE _______


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Burkina Faso 2010
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ______
CLUSTER NUMBER _____
PLOT NUMBER _____
FIRST AND LAST NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD NUMBER _____
REGION _____


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Burundi 1987

No questionnaire text is available for this sample.


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Burundi 2010
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME/SUB-DISTRICT______

NAME OF HEAD OF HOUSEHOLD______

PROVINCE_______

MUNICIPALITY_______

DISTRICT NAME AND NUMBER_____

CLUSTER NUMBER______

HOUSEHOLD NUMBER______


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Burundi 2016
Survey form view entire document:  text 
<br />REPUBLIC OF BURUNDI THIRD DEMOGRAPHIC AND HEALTH SURVEY 2016 WOMAN'S QUESTIONNAIRE<br />

IDENTIFICATION

PLACE NAME

NAME OF HEAD OF HOUSEHOLD

PROVINCE

CLUSTER NUMBER

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF WOMAN

WOMAN SELECTED FOR MODULE ON VIOLENCE?

YES 1
NO 2

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Cameroon 1991
Survey form view entire document:  text 
PROVINCE ____
NUMBER OF LAYER _______
URBAN DISTRICT/DISTRICT _________
CLUSTER __________
STRUCTURE _________
HOUSEHOLD ________
WOMAN'S LINE NUMBER _________
NUMBER OF COUNTING ZONE ________

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Cameroon 1998
Survey form view entire document:  text 
VILLAGE CLUSTER ___
NEIGHBORHOOD/PLACE STRUCTURE ___

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Cameroon 2004
Survey form view entire document:  text 
VILLAGE CLUSTER ___
NEIGHBORHOOD/PLACE STRUCTURE ___

NAME OF HEAD OF HOUSEHOLD ___
HOUSEHOLD ___

WOMAN'S NAME ___
WOMAN'S LINE NUMBER ___


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Cameroon 2011
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME: ___
NAME OF HEAD OF HOUSEHOLD: ___
REGION: ___
CLUSTER NUMBER: ___
STRUCTURE NUMBER: ___
HOUSEHOLD NUMBER: ___
NAME OF HEAD OF HOUSEHOLD AND HOUSEHOLD NUMBER: ___
NAME AND LINE NUMBER OF WOMAN: ___


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Chad 1996

No questionnaire text is available for this sample.


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Chad 2004
Survey form view entire document:  text 
REPUBLIC OF CHAD
MINISTRY OF PLANNING, DEVELOPMENT, AND COOPERATION
NATIONAL INSTITUTE OF STATISTICS, ECONOMIC STUDY, AND DEMOGRAPHY

SECOND DEMOGRAPHIC AND HEALTH SURVEY

WOMAN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF LOCALITY__________
NAME OF HEAD OF HOUSEHOLD___________

DEPARTMENT:___
SUBPREFECTURE: ___
MUNICIPALITY:___
CLUSTER NUMBER (EDST):___
STRUCTURE NUMBER:___
HOUSEHOLD NUMBER IN THE STRUCTURE: ___
SEQUENTIAL NUMBER OF SELECTED HOUSEHOLD (01-24 URBAN; 01-33 RURAL:___
Urban/rural

URBAN 1
RURAL 2

Residence

N'DJAMENA=1
ABECHE/MOUNDOU/SARH=2
OTHER DEPARTMENTAL ADMINISTRATIVE CENTER=3
OTHER SMALL CITIES=4
RURAL=5

WOMAN'S NAME AND LINE NUMBER (FROM HOUSEHOLD QUESTIONNAIRE)_______


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Chad 2014
Survey form view entire document:  text 
IDENTIFICATION

REGION NAME

REGION __ __

LOCALITY NAME (NEIGHBORHOOD/VILLAGE)__________

NAME OF HEAD OF HOUSEHOLD____________

CLUSTER NUMBER

CLUSTER __ __

HOUSEHOLD NUMBER (URBAN=01 TO 25; RURAL=01 TO 30)

HOUSEHOLD URBAN RURAL __ __

HOUSEHOLD NUMBER (SEQUENTIAL IN THE CLUSTER)

HOUSEHOLD CLUSTER __ __

URBAN/RURAL (URBAN=1, RURAL=2)

MILIEU __ __

N'DJAMENA-MOUNDOU/SARH/ABECHE-OTHER CITY-RURAL (N'DJAMENA=1, MOUNDOU/SARH/ABECHE=2, OTHER CITY=3, RURAL=4)

RESIDENCE __ __

WOMAN'S NAME AND LINE NUMBER_________________


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Congo (Democratic Republic) 2007
Survey form view entire document:  text 
IDENTIFICATION

RESPONDENT POOL _________

NAME OF LOCATION (NEIGHBORHOOD/VILLAGE) _________

NAME OF HOUSEHOLD HEAD ___________

CLUSTER NUMBER _____

HOUSEHOLD NUMBER ______

PROVINCE _____


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Congo (Democratic Republic) 2013
Survey form view entire document:  text 
NAME OF LOCATION (NEIGHBORHOOD/VILLAGE) ____

NAME OF HEAD OF HOUSEHOLD ____

CLUSTER NUMBER

CLUSTER ____

HOUSEHOLD NUMBER

HOUSEHOLD ____

FORMER PROVINCE

FORMER PROVINCE ____

NEW PROVINCE

NEW PROVINCE ____

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Cote d'Ivoire 1994
Survey form view entire document:  text 
IDENTIFICATION

DEPARTMENT NAME____

SUB-PREFECTURE NAME____

CENSUS DISTRICT___

CLUSTER NUMBER___

STRUCTURE NUMBER____

HOUSEHOLD NUMBER___


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Cote d'Ivoire 1998
Survey form view entire document:  text 
IDENTIFICATION:

DEPARTMENT ___
SUB PREFECTURE ___
CENSUS DISTRICT ___
CLUSTER NUMBER ___
STRUCTURE NUMBER ___
HOUSEHOLD NUMBER ___


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Cote d'Ivoire 2011
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME_________
NAME OF HEAD OF HOUSEHOLD__________
CLUSTER NUMBER_____
STRUCTURE NUMBER________
HOUSEHOLD NUMBER________
REGION_______


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Egypt 1988

No questionnaire text is available for this sample.


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Egypt 1992

No questionnaire text is available for this sample.


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Egypt 1995

No questionnaire text is available for this sample.


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Egypt 2000

No questionnaire text is available for this sample.


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Egypt 2003

No questionnaire text is available for this sample.


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Egypt 2005

No questionnaire text is available for this sample.


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Egypt 2008

No questionnaire text is available for this sample.


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Egypt 2014

No questionnaire text is available for this sample.


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Ethiopia 2000
Survey form view entire document:  text 
IDENTIFICATION

REGION ________________

ZONE __________________

WOREDA _______________

TOWN _________________

KEBELE _______________

ENUMERATION AREA ________________

CLUSTER NUMBER __________________


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Ethiopia 2005
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME ____________________

NAME OF HOUSEHOLD HEAD __________________________

CLUSTER NUMBER ___ ___ ___

HOUSEHOLD NUMBER ___ ___

REGION ___ ___


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Ethiopia 2011
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION _____


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Ethiopia 2016
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME:

NAME OF HOUSEHOLD HEAD:

CLUSTER NUMBER:

HOUSEHOLD NUMBER:

NAME AND LINE NUMBER OF WOMAN:

HOUSEHOLD SELECTED FOR FEMALE GENITAL MUTILATION AND DV?

YES 1
NO 2

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Ghana 1988
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER ______
LINE NUMBER OF WOMAN _____

NAME OF WOMAN ______


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Ghana 1993

No questionnaire text is available for this sample.


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Ghana 1998

No questionnaire text is available for this sample.


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Ghana 2003

No questionnaire text is available for this sample.


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Ghana 2008

No questionnaire text is available for this sample.


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Ghana 2014
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME _____

NAME OF HOUSEHOLD HEAD ____

CLUSTER NUMBER _____

STRUCTURE NUMBER _____

HOUSEHOLD NUMBER _____

REGION _____

DISTRICT _____

URBAN/RURAL

URBAN 1
RURAL 2

NAME AND LINE NUMBER OF WOMAN:

NAME ___________
LINE NO. ___________

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Guinea 1999
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION CODE _____


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Guinea 2005
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION _____

URBAN/RURAL:

URBAN 1
RURAL 2

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Guinea 2012
Survey form view entire document:  text 
IDENTIFICATION

NAME OF PLACE__________

NAME OF HEAD OF HOUSEHOLD____________

CLUSTER NUMBER___________

HOUSEHOLD NUMBER____________

ADMINISTRATIVE REGION_____________


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Guinea 2018
Survey form view entire document:  text 
IDENTIFICATION
PLACE NAME
NAME OF HEAD OF HOUSEHOLD
CLUSTER NUMBER
HOUSEHOLD NUMBER
ADMINISTRATIVE REGION
NATURAL REGION
SANITATION DISTRICT NUMBER
LOCATION OF HOUSEHOLD

CONAKRY 1
OTHER CITY 2
RURAL 3

NAME AND LINE NUMBER OF WOMAN


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India 1992

No questionnaire text is available for this sample.


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India 1998

No questionnaire text is available for this sample.


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India 2005

No questionnaire text is available for this sample.


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India 2015

No questionnaire text is available for this sample.


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Jordan 1990
Survey form view entire document:  text 
IDENTIFICATION *

PLACE NAME _____

NAME OF HOUSEHOLD HEAD _____

CLUSTER NUMBER _____

HOUSEHOLD NUMBER _____

REGION _____


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Jordan 1997
Survey form view entire document:  text 
IDENTIFICATION

1. GOVERNORATE

2. DISTRICT

3. SUBDISTRICT

4. LOCALITY

5. STRATUM NUMBER

6. CENSUS BLOCK NUMBER

7. JPFHS-II CLUSTER NUMBER

8. HOUSEHOLD NUMBER

9. URBAN/RURAL

URBAN 1
RURAL 2

10. AMMAN/LARGE CITY/MEDIUM CITY/TOWN/COUNTRYSIDE

AMMAN 1
MEDIUM CITY 2
SMALL CITY 3
TOWN 4
COUNTRYSIDE 5

AMMAN ALMOST 1,000,000
MEDIUM CITY (ZARQA, RUSSAIFA, IRBID, SALT, MADABA) 50,000 - 500,000
SMALL CITY 20,000 - 49,999
TOWN 5,000 - 19,999
COUNTRYSIDE LESS THAN 5,000

11. NAME OF HOUSEHOLD HEAD

12. NAME AND LINE NUMBER OF WOMAN


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Jordan 2002
Survey form view entire document:  text 
IDENTIFICATION

GROUP NO:__

QUESTIONNAIRE NO:___

GOVERNORATE:____

DISTRICT:____

SUBDISTRICT:____

LOCALITY:____

STRATUM:____

URBAN/RURAL:

URBAN 1
RURAL 2

BLOCK NO:_____

BUILDING NO:_____

HOUSING UNIT NO:_____

CLUSTER NO:_____

HOUSEHOLD NO:____

TELEPHONE NO (IF AVAILABLE):____________

NAME AND LINE NUMBER OF WOMAN: _______________


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Jordan 2007
Survey form view entire document:  text 
IDENTIFICATION

GOVERNORATE ____

DISTRICT______

SUB-DISTRICT _____

LOCALITY ______

AREA ____

SUB-AREA ______

STRATUM ______

URBAN/ RURAL

URBAN 1
RURAL 2

QUESTIONNAIRE NUMBER______

BLOCK NUMBER ______

BUILDING NUMBER _____

HOUSING UNIT NUMBER ________

CLUSTER NUMBER ________

HOUSEHOLD NUMBER _______

TELEPHONE/ MOBILE NUMBER (if available) __________


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Jordan 2009
Survey form view entire document:  text 
INDENTIFICATION

QUESTIONNAIRE NO.: _____

GOVERNORATE: __________

DISTRICT: _________

SUB-DISTRICT: ________

LOCALITY: ________

AREA: ________

SUB-AREA: ________

STRATUM: ________

URBAN/RURAL

URBAN 1
RURAL 2

BLOCK NO.: ___

BUILDING NO.: ___________

HOUSING UNIT NO.: __________

CLUSTER NO: __________

HOUSEHOLD NO.: ____________

TELEPHONE/MOBILE NO. (if available)
____________________

NAME AND LINE NUMBER OF WOMAN: ______________________ ____


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Jordan 2012
Survey form view entire document:  text 
IDENTIFICATION:

QUESTIONNAIRE NUMBER _____
GOVERNORATE ____
DISTRICT _____
SUB-DISTRICT _____
LOCALITY ____
AREA _____
SUB-AREA _____
STRATUM _____
URBAN/RURAL

URBAN 1
RURAL 2

BLOCK NUMBER _____
BUILDING NUMBER _____
HOUSING UNIT NUMBER _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
TELEPHONE/MOBILE NUMBER (if available) _______________


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Jordan 2017
Survey form view entire document:  text 
IDENTIFICATION

CLUSTER NUMBER ___________

HOUSEHOLD NUMBER __

NAME OF HOUSEHOLD HEAD ____________________

NAME AND LINE NUMBER OF WOMAN __________________________ ___

TELEPHONE/MOBLIE NUMBER (IF AVAILABLE) _______________________


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Kenya 1989
Survey form view entire document:  text 
IDENTIFICATION

PROVINCE __________
DISTRICT __________
LOCATION/TOWN __________
SUBLOCATION/WARD __________
CLUSTER NUMBER
HOUSEHOLD NUMBER
STRUCTURE NUMBER


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Kenya 1993
Survey form view entire document:  text 
IDENTIFICATION

PROVINCE __________
DISTRICT __________
LOCATION/TOWN __________
SUBLOCATION/WARD __________
NASSEP CLUSTER NUMBER__
KDHS CLUSTER NUMBER__


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Kenya 1998
Survey form view entire document:  text 
IDENTIFICATION

PROVINCE __________
DISTRICT __________
LOCATION/TOWN __________
SUBLOCATION/WARD __________
NASSEP CLUSTER NUMBER
KDHS CLUSTER NUMBER


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Kenya 2003
Survey form view entire document:  text 
DISTRICT __________
LOCATION/TOWN __________
SUBLOCATION/WARD ___________
NASSEP CLUSTER NUMBER ____________
KDHS CLUSTER NUMBER ___________
HOUSEHOLD NUMBER _____________

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Kenya 2008
Survey form view entire document:  text 
DISTRICT _____________________
SUBLOCATION/WARD _________________
NASSEP CLUSTER NUMBER _______________
KDHS CLUSTER NUMBER __________________
HOUSEHOLD NUMBER _______________________

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Kenya 2014
Survey form view entire document:  text 
IDENTIFICATION

COUNTRY ____________

DISTRICT ____________

LOCATION/TOWN ____________

SUBLOCATION ____________

NASSEP CLUSTER NUMBER ____________

KDHS CLUSTER NUMBER ____________

HOUSEHOLD NUMBER ____________

NAME OF HOUSEHOLD HEAD ____________

NAME AND LINE NUMBER OF WOMAN ____________

CHECK IN 101A IN HOUSEHOLD QUESTIONNAIRE: IS WOMAN SELECTED FOR SECTION 14?

YES 1
NO 2

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Lesotho 2004

No questionnaire text is available for this sample.


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Lesotho 2009
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME __________________

NAME OF HOUSEHOLD HEAD ____________________

EA NUMBER ___ ___ ___

HOUSEHOLD NUMBER ___ ___ ___


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Lesotho 2014

No questionnaire text is available for this sample.


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Liberia 1986

No questionnaire text is available for this sample.


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Liberia 2007

No questionnaire text is available for this sample.


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Liberia 2013

No questionnaire text is available for this sample.


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Madagascar 1992
Survey form view entire document:  text 
IDENTIFICATION

FARITANY (REGION) NAME ______
FIVONDRONAMPOKOTANY (DISTRICT) NAME ______
CLUSTER NUMBER _____
HOUSEHOLD UNIT NUMBER _____


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Madagascar 1997
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ____
NAME OF HOUSEHOLD HEAD ____
CLUSTER NUMBER ____
HOUSEHOLD UNIT NUMBER ____
REGION (FARITANY) ____


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Madagascar 2003
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER _______
HOUSEHOLD UNIT NUMBER _______
REGION (FARITANY) ______
VILLAGE ______


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Madagascar 2008
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER _______
SEQUENTIAL NUMBER OF THE HOUSEHOLD WITHIN THE CLUSTER _______
BUILDING NUMBER _______
HOUSEHOLD UNIT NUMBER _______
REGION ______
VILLAGE ______

ANTANANARIVO/OTHER CITY/RURAL AREA?

ANTANANARIVO 1
OTHER CITY 2
RURAL 3

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Malawi 1992
Survey form view entire document:  text 
REGION/DISTRICT______

TA/STA/TOWN______

ENUMERATION AREA _______

VILLAGE OR PLACE_______

MDHS CLUSTER NUMBER _______

HOUSEHOLD NUMBER ________


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Malawi 2000
Survey form view entire document:  text 
VILLAGE/PLACE NAME_____

NAME OF HOUSEHOLD HEAD_____

MDHS CLUSTER NUMBER _____

HOUSEHOLD NUMBER ______

URBAN/RURAL _____

URBAN 1
RURAL 2

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Malawi 2004
Survey form view entire document:  text 
PLACE NAME _________________________

NAME OF HOUSEHOLD HEAD __________________

DISTRICT _____________________ ___

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

URBAN/RURAL __

URBAN l
RURAL 2

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Malawi 2010
Survey form view entire document:  text 
DEMOGRAPHIC AND HEALTH SURVEY-MALAWI 2010-WOMEN'S QUESTIONNAIRE

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Malawi 2016
Survey form view entire document:  text 
IDENTIFICATION (1)
PLACE NAME________________________
NAME OF HOUSEHOLD HEAD ____________________
CLUSTER NUMBER __ __ __ __
HOUSEHOLD NUMBER __ __ __ __
NAME AND LINE NUMBER OF WOMAN______________________ __ __

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Mali 1987
Survey form view entire document:  text 
IDENTIFICATION

NX__
OF__

NUMBER OF HOUSEHOLD QUESTIONNAIRE__
REGION__
CLUSTER__
ARRONDISSEMENT/COMMUNE__
VILLAGE CODE__
VILLAGE NEIGHBORHOOD__
NAME OF HEAD OF COMPOUND__
NAME OF HEAD OF HOUSEHOLD__


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Mali 1995
Survey form view entire document:  text 
IDENTIFICATION:

PLACE NAME__
NAME OF HEAD OF HOUSEHOLD__
CLUSTER NUMBER___
COMPOUND__
HOUSEHOLD NUMBER______
REGION__
CIRCLE__


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Mali 2001
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME____
CLUSTER NUMBER_____
CONCESSION NUMBER _____


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Mali 2006
Survey form view entire document:  text 
IDENTIFICATION:

PLACE NAME__
FULL NAME OF HEAD OF THE HOUSEHOLD ____
COMMUNE__
CLUSTER NUMBER___
HOUSEHOLD NUMBER______
ADMINISTRATIVE REGION ____


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Mali 2012
Survey form view entire document:  text 
IDENTIFICATION

NAME OF PLACE____________
CLUSTER NUMBER_______
LAST NAME AND FIRST NAME OF HEAD OF HOUSEHOLD_______________
PLOT NUMBER_______
HOUSEHOLD NUMBER__________
REGION____________


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Mali 2018
Survey form view entire document:  text 
SIXTH DEMOGRAPHIC AND HEALTH SURVEY IN MALI (EDSM-VI 2018)

WOMAN'S QUESTIONNAIRE

IDENTIFICATION
PLACE NAME
NAME OF HEAD OF HOUSEHOLD
PLOT NUMBER
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN


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Morocco 1987

No questionnaire text is available for this sample.


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Morocco 1992

No questionnaire text is available for this sample.


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Morocco 2003
Survey form view entire document:  text 
IDENTIFICATION

REGION _____

PROVINCE OR PREFECTURE ___

CIRCLE ___

MUNICIPALITY/RURAL MUNICIPALITY ____

OTHER CENTER ___

SURVEY DISTRICT _

RABAT-CASA/LARGER CITY/SMALL CITY/RURAL

RABAT CASA 1
LARGE CITY 2
SMALL CITY 3
RURAL 4

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

HOUSEHOLD ADDRESS ____

NAME OF HEAD OF HOUSEHOLD ________


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Mozambique 1997
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ________
NAME OF HOUSEHOLD HEAD_______
CLUSTER NUMBER_______
HOUSEHOLD NUMBER_______
PROVINCE_______


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Mozambique 2003
Survey form view entire document:  text 
CLUSTER NUMBER ______
HOUSEHOLD NUMBER______

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Mozambique 2011

No questionnaire text is available for this sample.


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Myanmar 2015
Survey form view entire document:  text 

IDENTIFICATION

STATE/REGION______

DISTRICT_____

TOWNSHIP_____

WARD/VILLAGE TRACT____

CLUSTER NUMBER____

HOUSEHOLD NUMBER____

LINE NUMBER OF WOMAN___

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2

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Namibia 1992

No questionnaire text is available for this sample.


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Namibia 2000
Survey form view entire document:  text 
IDENTIFICATION

NAME AND CODE OF REGION _______
NAME OF VILLAGE/TOWN/CITY _________
DHS CLUSTER NUMBER _______
HOUSEHOLD NUMBER ________
NAME OF HOUSEHOLD HEAD __________
NAME AND LINE NUMBER OF WOMAN ________


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Namibia 2006

No questionnaire text is available for this sample.


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Namibia 2013
Survey form view entire document:  text 
IDENTIFICATION

NAME AND THE CODE OR REGION __________

PLACE (LOCALITY) NAME __________

CLUSTER NAME _____

HOUSEHOLD NUMBER _____


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Nepal 1996
Survey form view entire document:  text 
NEPAL FAMILY HEALTH SURVEY INDIVIDUAL QUESTIONNAIRE (ENGLISH)

IDENTIFICATION

DISTRICT NAME AND NUMBER

VILLAGE/MUNICIPALITY NAME AND NUMBER

WARD NUMBER

CLUSTER NUMBER

HOUSEHOLD NUMBER

CITY/TOWN/COUNTRYSIDE

City 1
Town 2
Countryside 3

NAME OF HOUSEHOLD HEAD

NAME AND LINE NUMBER OF WOMAN


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Nepal 2001
Survey form view entire document:  text 
IDENTIFICATION

NAME AND CODE OF DISTRICT ________________
NAME AND CODE OF VILLAGE/MUNICIPALITY __________

WARD NUMBER ____________
CLUSTER NUMBER __________

HOUSEHOLD NUMBER ______________

CITY 1
TOWN 2
COUNTRYSIDE 3

NAME OF HOUSEHOLD HEAD_____

NAME AND LINE NUMBER OF WOMAN ____________


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Nepal 2006
Survey form view entire document:  text 
IDENTIFICATION

NAME AND CODE OF DISTRICT

NAME AND CODE OF VILLAGE/MUNICIPALITY

WARD NUMBER

CLUSTER NUMBER

HOUSEHOLD NUMBER

CITY/TOWN/RURAL

CITY 1
TOWN 2
RURAL 3

NAME AND LINE NUMBER OF WOMAN

NAME OF HOUSEHOLD HEAD


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Nepal 2011
Survey form view entire document:  text 
NAME AND CODE OF DISTRICT _____________

NAME AND CODE OF VILLAGE/MUNICIPALITY _____________

WARD NUMBER _____________

CLUSTER NUMBER _____________

NAME AND LINE NUMBER OF WOMAN _____________

NAME OF HOUSEHOLD HEAD _____________


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Nepal 2016
Survey form view entire document:  text 
IDENTIFICATION

NAME AND CODE OF DISTRICT

NAME AND CODE OF VILLAGE/MUNICIPALITY

WARD NUMBER

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF WOMAN


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Niger 1992
Survey form view entire document:  text 
STRATA NUMBER ___
CLUSTER NUMBER ___
STRUCTURE NUMBER ___
RESIDENCE NUMBER ___
CENSUS ZONE NUMBER ___

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Niger 1998
Survey form view entire document:  text 
IDENTIFICATION:

PLACE NAME ___
NAME OF HOUSEHOLD HEAD ___

CONCESSION NUMBER ___
HOUSEHOLD NUMBER ___
CLUSTER NUMBER ___

DEPARTMENT ___
DISTRICT ___
COUNTY ___


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Niger 2006
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME __________
CLUSTER NUMBER __________
COMPOUND NUMBER __________
HOUSEHOLD NUMBER ________
REGION __________

FIRST AND LAST NAME OF HEAD OF HOUSEHOLD _____


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Niger 2012
Survey form view entire document:  text 
IDENTIFICATION

NAME OF PLACE ___________

CLUSTER NUMBER ___________

CONCESSION NUMBER ____________

FIRST AND LAST NAME OF HEAD OF HOUSEHOLD ____________

REGION _____________


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Nigeria 1990
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _________________________
NAME OF RESPONDENT __________________________
CLUSTER NUMBER __
HOUSEHOLD NUMBER __
STATE __


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Nigeria 1999

No questionnaire text is available for this sample.


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Nigeria 2003
Survey form view entire document:  text 
CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD NAME/NUMBER __

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Nigeria 2008
Survey form view entire document:  text 
CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD HEAD NAME/NUMBER ______________ ___

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Nigeria 2013
Survey form view entire document:  text 
CLUSTER NUMBER
BUILDING/STRUCTURE NUMBER

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Nigeria 2018
Survey form view entire document:  text 
IDENTIFICATION

STATE _____
LOCAL GOVT. AREA_____
ENUMERATION AREA_____
NAME OF HOUSEHOLD HEAD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
NAME AND LINE NUMBER OF WOMEN_____


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Pakistan 1991
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME_______________
NAME OF HOUSEHOLD____________
PROVINCE ____

URBAN/RURAL

URBAN 1
RURAL 2

MAJOR CITY/DIVISION/DISTRICT ____
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___

MAJOR CITY/SMALL CITY, TOWN/VILLAGE

MAJOR CITY 1
SMALL CITY, TOWN 2
VILLAGE 3

NAME AND LINE NUMBER OF WOMEN______________
NAME AND LINE NUMBER OF HUSBAND (IF ELIGIBLE)


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Pakistan 2006
Survey form view entire document:  text 
IDENTIFICATION (1)

PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
REGION


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Pakistan 2012
Survey form view entire document:  text 
IDENTIFICATION (1)

PLACE NAME_____
NAME OF HOUSEHOLD HEAD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____


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Pakistan 2017
Survey form view entire document:  text 
DISTRICT ________

TEHSIL _______

NAME OF HOUSEHOLD HEAD ______

CLUSTER NUMBER ______

HOUSEHOLD NUMBER _________

NAME AND LINE NUMBER OF WOMAN _______


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Rwanda 1992

No questionnaire text is available for this sample.


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Rwanda 2000

No questionnaire text is available for this sample.


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Rwanda 2005
Survey form view entire document:  text 
IDENTIFICATION

NAME OF LOCALITY _____
NAME OF HOUSEHOLD HEAD ______
PROVINCE ______
DISTRICT _____
SECTOR _____
CLUSTER NUMBER _____
STRUCTURE NUMBER _____
HOUSEHOLD NUMBER _____


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Rwanda 2008

No questionnaire text is available for this sample.


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Rwanda 2010
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD STRUCTURE NUMBER

HOUSEHOLD NUMBER


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Rwanda 2014
Survey form view entire document:  text 
RWANDA DEMOGRAPHIC AND HEALTH SURVEYS 2014-15
WOMAN'S QUESTIONNAIRE

MINECOFIN

MINISTRY OF HEALTH

NATIONAL INSTITUTE OF STATISTICS

IDENTIFICATION

PROVINCE____

DISTRICT____

SECTOR____

NAME OF HOUSEHOLD HEAD____

CLUSTER NUMBER____

HOUSEHOLD STRUCTURE NUMBER____

HOUSEHOLD NUMBER____

NAME AND LINE NUMBER OF WOMAN:
NAME____
LINE NO.____


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Senegal 1986
Survey form view entire document:  text 
REGION____

VILLAGE____

DEPARTMENT____

NEIGHBORHOOD/REGION____

ARRONDISSEMENT/COMMUNE____

SUB-DISTRICT____

PARCELLE NUMBER____

CONCESSION NUMBER (a group of houses on a plot, usually centered around the huts of a man and his wives) ____

HOUSEHOLD NUMBER _____


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Senegal 1992
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME (COMMUNE/VILLAGE) _____
NAME OF HEAD OF HOUSEHOLD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
REGION_____


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Senegal 1997
Survey form view entire document:  text 
PLACE NAME (COMMUNE/VILLAGE) _____
NAME OF HEAD OF HOUSEHOLD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
REGION_____

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Senegal 2005
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD NUMBER _____
COMPOUND NUMBER _____
CLUSTER NUMBER _____
REGION _____


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Senegal 2010
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME_____
NAME OF HEAD OF HOUSEHOLD_____
HOUSEHOLD NUMBER_____
CONCESSION NUMBER _____
CLUSTER NUMBER _____
REGION _____
DEPARTMENT_____
SANITARY DISTRICT______


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Senegal 2012
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ________________
NAME OF HEAD OF HOUSEHOLD ______________
PLOT NUMBER ___________
CLUSTER NUMBER ____________
REGION ___________


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Senegal 2014
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ________
NAME OF HEAD OF HOUSEHOLD _________
HOUSEHOLD NUMBER __________
PLOT NUMBER ___________
CLUSTER NUMBER ____________
REGION_________
DEPARTMENT________
SANITARY DISTRICT _________


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Senegal 2015
Survey form view entire document:  text 
IDENTIFICATION (1)
PLACE NAME________________________
NAME OF HOUSEHOLD HEAD ____________________
CLUSTER NUMBER __ __ __ __
HOUSEHOLD NUMBER __ __ __ __
NAME AND LINE NUMBER OF WOMAN______________________ __ __

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Senegal 2016
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _____

NAME OF HEAD OF HOUSEHOLD ______

HOUSEHOLD NUMBER ____

PLOT NUMBER ____

CLUSTER NUMBER _____

REGION ____

DEPARTMENT ____

SANITATION DISTRICT ____

URBAN/RURAL

URBAN 1
RURAL 2

MILIEU ____

DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

WOMAN'S NAME AND LINE NUMBER _____

CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE

HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

YES 1
NO 2

IF HOUSEHOLD SELECTED FOR DV, CHECK WOMEN'S SELECTION TABLE (Q157A OF HOUSEHOLD QUESTIONNAIRE)

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

YES 1
NO 2

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Senegal 2017
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME _____

NAME OF HEAD OF HOUSEHOLD ______

HOUSEHOLD NUMBER ____

PLOT NUMBER ____

CLUSTER NUMBER _____

REGION ____

DEPARTMENT ____

SANITATION DISTRICT ____

URBAN/RURAL

URBAN 1
RURAL 2

MILIEU ____

DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL

DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

WOMAN'S NAME AND LINE NUMBER _____

CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE

HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

YES 1
NO 2

IF HOUSEHOLD SELECTED FOR DV, CHECK WOMEN'S SELECTION TABLE (Q157A OF HOUSEHOLD QUESTIONNAIRE)

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

YES 1
NO 2

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South Africa 1998
Survey form view entire document:  text 
SOUTH AFRICAN DEMOGRAPHIC AND HEALTH SURVEY
WOMEN QUESTIONNAIRE

IDENTIFICATION
PROVINCE
DISTRICT
EA NUMBER
EA TYPE
SADHS CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
NAME OF HOUSEHOLD HEAD


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South Africa 2016
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ______________

NAME OF HOUSEHOLD HEAD ______________

CLUSTER NUMBER ________

HOUSEHOLD NUMBER ____

NAME AND LINE NUMBER OF WOMAN ________________ ____


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Sri Lanka 1987

No questionnaire text is available for this sample.


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Sudan 1989
Survey form view entire document:  text 
IDENTIFICATION

REGION
PROVINCE
PLACE NAME
URBAN/RURAL

URBAN 1
RURAL 2

CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN


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Tanzania 1991
Survey form view entire document:  text 
IDENTIFICATION
NAME OF HOUSEHOLD HEAD ______________________
TDHS CLUSTER ID ___
HOUSEHOLD NO. ___
REGION ___________________ ___
DISTRICT __________________ ___
WARD __________________ ___
ENUMERATION AREA _______________ ___

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Tanzania 1996
Survey form view entire document:  text 
IDENTIFICATION

NAME OF HOUSEHOLD HEAD ______________________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

REGION ___________________ ___

DISTRICT __________________ ___

WARD __________________ ___


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Tanzania 1999
Survey form view entire document:  text 
IDENTIFICATION

REGION___

DISTRICT___

WARD___

E.A. NUMBER___

TRCHS CLUSTER NUMBER___

HOUSEHOLD NUMBER___


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Tanzania 2004
Survey form view entire document:  text 
IDENTIFICATION

REGION

DISTRICT

WARD

ENUMERATION AREA

NAME OF HOUSEHOLD HEAD

TDHS NUMBER

HOUSEHOLD NUMBER


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Tanzania 2010
Survey form view entire document:  text 
IDENTIFICATION

REGION_______

DISTRICT________

WARD_______

ENUMERATION AREA______

NAME OF HOUSEHOLD HEAD_____

TDHS NUMBER_____

HOUSEHOLD NUMBER_____


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Tanzania 2015
Survey form view entire document:  text 
UNITED REPUBLIC OF TANZANIA
NATIONAL BUREAU OF STATISTICS

QST. No. ______


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Tunisia 1988
Survey form view entire document:  text 
IDENTIFICATION

1) PROVINCE

2) NAME AND CLUSTER NUMBER____

3) HOUSEHOLD NUMBER____

4) LINE NUMBER OF WOMAN____


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Uganda 1988
Survey form view entire document:  text 
ENGLISH VERSION

IDENTIFICATION

DISTRICT _____________
SUBCOUNTY/TOWN _____________
PARISH/WARD _____________
SUBPARISH/RC2 _____________
CLUSTER NUMBER
HOUSEHOLD NUMBER
LINE NUMBER OF WOMAN


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Uganda 1995
Survey form view entire document:  text 
IDENTIFICATION

REGION ________________________
DISTRICT ________________________
COUNTY ________________________
SUB-COUNTY/TOWN ________________________
PARISH/RC2 NAME ________________________
EA NAME ________________________
UDHS NUMBER


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Uganda 2001
Survey form view entire document:  text 
IDENTIFICATION
REGION __________
DISTRICT __________
COUNTY __________
SUBCOUNTY/TOWN __________
PARISH/LC2 NAME __________
EA NAME __________
UDHS NUMBER __________

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Uganda 2006
Survey form view entire document:  text 
IDENTIFICATION

REGION

DISTRICT

COUNTY

SUBCOUNTY/TOWN

PARISH/LC2 NAME

EA NAME

UDHS NUMBER

NAME OF HOUSEHOLD HEAD

HOUSEHOLD NUMBER

NAME AND LINE NUBER OF WOMAN

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2

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Uganda 2011

No questionnaire text is available for this sample.


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Uganda 2016
Survey form view entire document:  text 
CLUSTER NUMBER

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Yemen 1991
Survey form view entire document:  text 
[NAME OF COUNTRY]

[NAME OF ORGANIZATION]


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Yemen 2013
Survey form view entire document:  text 
SECTOR NUMBER____

SECTION NUMBER____

CLUSTER NUMBER____

HOUSEHOLD NUMBER____

HOUSEHOLD CLUSTER NUMBER____

NAME OF HOUSEHOLD HEAD____


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Zambia 1992
Survey form view entire document:  text 
IDENTIFICATION

PROVINCE _________________ ___

DISTRICT _____________________ ___

CSA NUMBER ___

SEA NUMBER ___

HOUSEHOLD NUMBER ___

NAME OF HOUSEHOLD HEAD _______________ ___


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Zambia 1996
Survey form view entire document:  text 
IDENTIFICATION

CLUSTER NUMBER ___

PROVINCE _________________ ___

DISTRICT _____________________ ___

HOUSEHOLD NUMBER ___

NAME OF HOUSEHOLD HEAD _______________ ___


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Zambia 2001
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME ___________________ ___

NAME OF HOUSEHOLD HEAD ____________________ ___

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE _________________ ___


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Zambia 2007
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME ___________________ ___

NAME OF HOUSEHOLD HEAD ____________________ ___

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE _________________ ___


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Zambia 2013
Survey form view entire document:  text 
IDENTIFICATION

LOCALITY NAME__________________

CLUSTER NUMBER________________

HOUSEHOLD NUMBER_________________

PROVINCE_________________


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Zambia 2018
Survey form view entire document:  text 

2018 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY
WOMEN'S QUESTIONNAIRE
ZAMBIA
MINISTRY OF HEALTH/CENTRAL STATISTICAL OFFICE

IDENTIFICATION
PLACE NAME _________________________
NAME OF HOUSEHOLD HEAD _________________________
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____


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Zimbabwe 1988
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME __________
PROVINCE __________
STRATA ___
DHS SEGMENT NUMBER _____
HOUSEHOLD NUMBER ___
LINE NUMBER OF WOMEN ___


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Zimbabwe 1994
Survey form view entire document:  text 
IDENTIFICATION

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


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Zimbabwe 1999
Survey form view entire document:  text 
IDENTIFICATION

NAME OF HOUSEHOLD HEAD __________

WARD NAME __________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE ___


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Zimbabwe 2005
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME __________

NAME OF HOUSEHOLD HEAD __________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE ___


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Zimbabwe 2010
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NUMBER

HOUSEHOLD NUMBER


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Zimbabwe 2015
Survey form view entire document:  text 
IDENTIFICATION

PLACE NAME ___

NAME OF HOUSEHOLD HEAD ___

CLUSTER NAME ___

HOUSEHOLD NUMBER ___

NAME AND LINE NUMBER OF WOMAN ___