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
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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
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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
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NAME AND LINE NUMBER OF WOMAN ___

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Bangladesh 1997
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NAME AND LINE NUMBER OF WOMAN ___

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Bangladesh 2000
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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
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NAME OF HOUSEHOLD HEAD ___

NAME AND LINE NUMBER OF ELIGIBLE WOMAN ___


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Bangladesh 2007
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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
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IDENTIFICATION

CLUSTER NUMBER __________

HOUSEHOLD NUMBER __________

NAME OF THE HOUSEHOLD HEAD __________

NAME AND LINE NUMBER OF WOMAN __________


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Bangladesh 2014
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IDENTIFICATION

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


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Benin 1996
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NAME OF HEAD OF HOUSEHOLD ___________________

NAME AND LINE NUMBER OF WOMAN _____________________


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Benin 2001
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NAME AND LINE NUMBER OF WOMAN

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Benin 2006
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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

LINE NUMBER___

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Benin 2011
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1. LINE NUMBER

LINE NO. ____

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Benin 2017
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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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HOUSEHOLD SCHEDULE

We would like some information about people who usually live in your household or are staying with you now.

1. LINE NUMBER:

LINE NO. _____

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Burkina Faso 1998
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Burkina Faso 2003
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Burkina Faso 2010
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1. LINE NUMBER

LINE NO. ____

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Burundi 1987
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Now I would like some information about the people who usually live in your household or who are staying with you now.

001) HOUSEHOLD NUMBER

_________

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Burundi 2010
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1. LINE NUMBER

LINE NO. ____

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Burundi 2016
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<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
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Now we would like information about the people who usually live in your household or who are staying with you now.

2) FIRST AND LAST NAME:
Please give me the name of the people who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.

______

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Cameroon 1998
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Cameroon 2004
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Cameroon 2011
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1. LINE NUMBER

LINE NO. ____

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Chad 1996
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Chad 2004
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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 no.

________

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Chad 2014
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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
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HOUSEHOLD SCHEDULE

1) LINE NO.


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Congo (Democratic Republic) 2013
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1. LINE NUMBER

LINE NO. ____

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Cote d'Ivoire 1994
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Cote d'Ivoire 1998
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Cote d'Ivoire 2011
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1. LINE NUMBER

LINE NO. ____

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Egypt 1988
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Now we would like some information about the people who usually live in your household or who are staying with you now.

001. LINE NO.

002. USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household or are staying with you now, starting with the head of the household.

AFTER LISTING NAMES, ASK QUESTIONS 003-005 TO BE SURE THAT YOU HAVE A COMPLETE LISTING. THEN GO ON TO 006-024.


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Egypt 1992
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We would like some information about people who usually live in your household or who are staying with you now.

001. LINE NO.


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Egypt 1995
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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: (the number of persons listed by the respondent)

___

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Egypt 2000
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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

LINE NO.___

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Egypt 2003
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HOUSEHOLD SCHEDULE

001. LINE NO

______________________

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Egypt 2005
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Now we would like some information about the people who usually live in your household or who are staying with you now.

001) LINE NO.

__

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Egypt 2008
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Now we would like some information about the people who usually live in your household or who are staying with you now.

001. LINE NO. (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)


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Egypt 2014
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1. LINE NUMBER

LINE NO. ____

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Ethiopia 2000
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Ethiopia 2005
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO.

LINE NUMBER____

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Ethiopia 2011
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1. LINE NUMBER

LINE NO. ____

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Ethiopia 2016
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2. USUAL RESIDENTS AND VISITORS: 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.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.

THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.

___

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Ghana 1988
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO.

______

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Ghana 1993
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO. (1)


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Ghana 1998
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Ghana 2003
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO.


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Ghana 2008
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HOUSEHOLD SCHEDULE

1) LINE NO.


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Ghana 2014
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2) USUAL RESIDENTS AND VISITORS: 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.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON

NAME _____

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Guinea 1999
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Guinea 2005
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HOUSEHOLD SCHEDULE

1) LINE NO.


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Guinea 2012
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1. LINE NUMBER

LINE NO. ____

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Guinea 2018
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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
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2. LINE NUMBER

LINE NO. _____

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India 1998
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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India 2005
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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

LINE NO. ______

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India 2015
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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 NO.

LINE NUMBER___

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Jordan 1990
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NAME AND LINE NUMBER OF WOMAN

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Jordan 1997
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2. USUAL RESIDENTS AND VISITORS: 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?

______________

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Jordan 2002
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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
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NAME AND LINE NUMBER OF WOMAN: ____________

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Jordan 2009
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2) USUAL RESIDENTS AND VISITORS: 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.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.

THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-18 FOR EACH PERSON.

________

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Jordan 2012
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2. USUAL RESIDENT AND VISITORS: Please give me the names of the persons who usually live in your household who stayed here last night, starting with the head of the household.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.

NAME __________

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Jordan 2017
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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
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO.

______

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Kenya 1993
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Kenya 1998
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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: (the number of persons listed by the respondent)

___

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Kenya 2003
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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

LINE NO.___

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Kenya 2008
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO. (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)

_________

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Kenya 2014
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LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE___

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Lesotho 2004
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Lesotho 2009
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NAME AND LINE NUMBER OF WOMAN_________________________________ ___ ___

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Lesotho 2014
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2) USUAL RESIDENTS AND VISITORS:

Please give me the names of the persons who live in your household and guests of the household who stayed here last night, starting with the head of the household.

NAME ____

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Liberia 1986
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO.

______

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Liberia 2007
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HOUSEHOLD SCHEDULE

1) LINE NO.


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Liberia 2013
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1. LINE NUMBER

LINE NO. ____

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Madagascar 1992
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1) LINE NO.

_____

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Madagascar 1997
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Madagascar 2003
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Madagascar 2008
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HOUSEHOLD SCHEDULE

1) LINE NO.


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Malawi 1992
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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

LINE NUMBER___

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Malawi 2000
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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

LINE NO.___

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Malawi 2004
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1) LINE NO.

LINE NUMBER___

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Malawi 2010
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1) LINE NO.

LINE NUMBER____

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Malawi 2016
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IDENTIFICATION (1)
PLACE NAME________________________
NAME OF HOUSEHOLD HEAD ____________________
CLUSTER NUMBER __ __ __ __
HOUSEHOLD NUMBER __ __ __ __
NAME AND LINE NUMBER OF WOMAN______________________ __ __

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Mali 1987
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HOUSEHOLD SCHEDULE:

We would now like information on the persons who usually live in your household and who are currently living with you.

LINE NO. (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)

____

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Mali 1995
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Mali 2001
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Mali 2006
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We would now like information on the persons who usually live in your household and who are currently living with you.

1. LINE NO. (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)

_____

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Mali 2012
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1. LINE NUMBER

LINE NO. ____

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Mali 2018
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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
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INDIVIDUAL QUESTIONNAIRE

WOMAN'S NAME: ____

IDENTIFICATION:

PROVINCE OR PREFECTURE: ____

CIRCLE: ____

MUNICIPALITY: Autonomous Center/Rural Commune: ____

CENTER: ____

PRIMARY UNIT NUMBER: ____

SECONDARY UNIT NUMBER: ____

LEVEL: ____

HOUSEHOLD NUMBER: ____

WOMAN'S LINE NUMBER: ____

HOUSEHOLD ADDRESS: ____


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Morocco 1992
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Now we would like information about the people who usually live in your household or who are staying with you now.

1) LINE NUMBER _____

2) FIRST AND LAST NAME ____


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Morocco 2003
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2. USUAL RESIDENTS AND VISITORS: 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.

NAME_____________________

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Mozambique 1997
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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 (the number of persons listed by the respondent)

LINE NO. ___

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Mozambique 2003
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Mozambique 2011
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1. LINE NUMBER

LINE NO. ____

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Myanmar 2015
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HOUSEHOLD SCHEDULE

1. LINE NO.

______

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Namibia 1992
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1) LINE NO.

_____

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Namibia 2000
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Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Namibia 2006
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HOUSEHOLD SCHEDULE

1) LINE NO.


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Namibia 2013
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1. LINE NUMBER

LINE NO. ____

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Nepal 1996
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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
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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
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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
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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 
2. USUAL RESIDENTS AND VISITORS: 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.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP
AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C
TO BE SURE THAT THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.

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Niger 1992
Survey form view entire document:  text 
1) LINE NO.

_____

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Niger 1998
Survey form view entire document:  text 
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 (the number of persons listed by the respondent)

LINE NO. ___

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Niger 2006
Survey form view entire document:  text 
We would now like information on the persons who usually live in your household and who are currently living with you.

1. LINE NUMBER (THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)

LINE NO. ___

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Niger 2012
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Nigeria 1990
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

(1) LINE NO. (1) (01-26) (*THE NUMBER OF PERSONS LISTED BY THE RESPONDENT)


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Nigeria 1999
Survey form view entire document:  text 
Now we would like to have some information about the people who usually live in this household or who are staying with you now.

(1) LINE NO. (1) (01-14)

LINE NUMBER____

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Nigeria 2003
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

(1) LINE NO. (1) (01-23)

LINE NUMBER___

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Nigeria 2008
Survey form view entire document:  text 
(1) LINE NO. (01-20)

LINE NUMBER____

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Nigeria 2013
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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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 
NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME


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Pakistan 2012
Survey form view entire document:  text 
2) USUAL RESIDENTS AND VISITORS
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.
AFTER LISTING NAMES, RELATIONSHIP AND SEX FOR EACH PERSON, ASK Qs 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN AS QUESTIONS IN COLUMNS 5-25 FOR EACH PERSON.

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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
Survey form view entire document:  text 
1) LINE NO.

_____

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Rwanda 2000
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Rwanda 2005
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1) LINE NO.


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Rwanda 2008
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1) LINE NO.


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Rwanda 2010
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Rwanda 2014
Survey form view entire document:  text 
2) USUAL RESIDENTS AND VISITORS:

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.

NAME ____

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.

THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-23 FOR EACH PERSON.


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Senegal 1986
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO.

______

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Senegal 1992
Survey form view entire document:  text 
1) LINE NO.

_____

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Senegal 1997
Survey form view entire document:  text 
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 (the number of persons listed by the respondent)

LINE NO. ___

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Senegal 2005
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Senegal 2010
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Senegal 2012
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Senegal 2014
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1. LINE NO.

______

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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 
2) USUAL RESIDENTS AND VISITORS

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.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.


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Senegal 2017
Survey form view entire document:  text 
2) USUAL RESIDENTS AND VISITORS

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.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.


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South Africa 1998
Survey form view entire document:  text 
**** Q.15 THROUGH Q.18:
These questions refer to the biological parents of the child. Record 00 if parent not member of household.

Now we would like some information about the people who usually live in your household or who are staying with you now.

(1) LINE NO.


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South Africa 2016
Survey form view entire document:  text 
2) USUAL RESIDENTS AND VISITORS:

Please give me the names of the persons who live in your household and guests of the household who stayed here last night, starting with the head of the household.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-28 FOR EACH PERSON.

NAME ____

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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 
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 NO.

(2) USUAL RESIDENTS AND VISITORS
Please give me the names of the persons who usually live in your household or are staying with you now, starting with the head of the household.

_______________

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Tanzania 1991
Survey form view entire document:  text 
1) LINE NO.

_____

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Tanzania 1996
Survey form view entire document:  text 
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 (the number of persons listed by the respondent)

LINE NO. ___

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Tanzania 1999
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Tanzania 2004
Survey form view entire document:  text 
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

LINE NO.___

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Tanzania 2010
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Tanzania 2015
Survey form view entire document:  text 
2. USUAL RESIDENTS AND VISITORS
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.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMN 5-25 FOR EACH PERSON.

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Tunisia 1988
Survey form view entire document:  text 
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____


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Uganda 1988
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO.

______

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Uganda 1995
Survey form view entire document:  text 
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 (the number of persons listed by the respondent)

LINE NO. ___

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Uganda 2001
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Uganda 2006
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1) LINE NO.


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Uganda 2011
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Uganda 2016
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1)LINE NO.


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Yemen 1991
Survey form view entire document:  text 
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

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Yemen 2013
Survey form view entire document:  text 
2) USUAL RESIDENTS AND VISITORS

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.

AFTER LISTING NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK QUESTIONS IN COLUMNS 5-35 FOR EACH PERSON.


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Zambia 1992
Survey form view entire document:  text 
1) LINE NO.

_____

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Zambia 1996
Survey form view entire document:  text 
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 (the number of persons listed by the respondent)

LINE NO. ___

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Zambia 2001
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Zambia 2007
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1) LINE NO.


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Zambia 2013
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Zambia 2018

No questionnaire text is available for this sample.


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Zimbabwe 1988
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1. LINE NO.

______

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Zimbabwe 1994
Survey form view entire document:  text 
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: (the number of persons listed by the respondent)

___

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Zimbabwe 1999
Survey form view entire document:  text 
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

LINE NO.___

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Zimbabwe 2005
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1) LINE NO.


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Zimbabwe 2010
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Zimbabwe 2015
Survey form view entire document:  text 
2. USUAL RESIDENTS AND VISITORS: 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.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON. ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.

THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.

___