Demographic and health survey (EDSB-V-2017)
Household Questionnaire
Republic of Benin
Ministry of Planning and Development
National institute of statistics and economic analysis (INSAE)
Department
Commune
Urban/rural (urban=1, rural=2)
rural 2
Name of head of household
Cluster number
Household number
Household selected for men's survey? (1=Yes, 2=No)
no 2
Interviewer's name
Result*
Final visit
Day
Month
Year 201
Int. number
Result
Next visit
Date
Time
Total no. of visits
2 No household member at home or no competent respondent at home at time of visit
3 Entire household absent for extended period of time
4 Postponed
5 Refused
6 Dwelling vacant or address not a dwelling
7 Dwelling destroyed
8 Dwelling not found
9 Other (Specify)
Total persons in household
Total eligible women
Total eligible men
Line no. of respondent to household questionnaire
Language of questionnaire 01
Language of interview
Native language of respondent
no 2
02 Adja
03 Bariba
04 Fon
05 Dendi
06 Yoruba
07 Other
Editor
Name
Number
Introduction and consent
Hello. My name is ___. I am working with the National Institute of Statistics and Economic Analysis (INSAE). We are conducting a survey about health and other topics all over Benin. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 30 to 45 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on this card.
Give card with contact information
Do you have any questions?
May I begin the interview now?
Signature of interviewer Date
Respondent does not agree to be interviewed 2-End
Minutes
Household schedule
1) Line no.
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.
3) Relationship to head of household
What is the relationship of (name) to the head of the household?
See codes below.
4) Sex
Is (name) male or female?
Female 2
5) Residence
Does (name) usually live here?
No 2
6) Did (name) stay here last night?
No 2
7) Age
How old is (name)?
If 95 or more, record 95.
If age 10 or older:
8) Marital status
What is (name)'s current marital status?
2=divorced/separated
3=widowed
4=never married and never lived together
Eligibility
9) Circle line number of all women age 15-49
10) If household selected for man's survey
Circle line number of all men age 15-59
11) Circle line number of all children age 0-5
If household selected for men's survey
11a) Circle line number of all women age 30-49
11B) Circle line number of all men age 30-64
Just to make sure that I have a complete listing:
No
No
No
Codes for q. 3: Relationship to head of household
02= Wife or husband
03= Son or daughter
04= Son-in-law or daughter-in-law
05= Grandchild
06= Parent
07= Parent-in-law
08= Brother or sister
09=Other relative
10= Adopted/Foster/stepchild
11= Other wife of head of household (if head of household =male)
12= Co-spouse (if head of household = female)
13= Not related
98= Don't know
11c) Birth place:
In what commune was (name) born?
Record dept/comm or country for abroad
11d) Former residence
In what commune did (name) live before moving here?
Record dept/comm or country for abroad
11e) How long was (name)'s stay in this commune?
Note: 1 and the number of months for less than 1 year
OR
2 and number of years for more than 1 year
AND 998 if since birth--skip to 11g
Return migration
11f) Has (name) returned from this commune after having lived there for at least 6 months?
Yes 1
No 2
Migratory status
11g) Guess the migratory status
Record
1=non-migrant If Q 11e= 9 and 98
2=return migrant if Q11e=9 and 98 and Q11f-1
3=Other return migrant if q11e=9 and 98 and [##translator note: text is cut off here]
If 0-17 years
Survivorship and residence of biological parents
12) Is (NAME)'s natural mother alive?
No 2-skip to 14
Don't know 8-skip to 14
13) Does (NAME)'s natural mother usually live in this household or was she a guest last night?
Record mother's line number.
If no, record 00.
14) Is (NAME)'s natural father alive?
No 2-skip to 16
Don't know 8-skip to 16
15) Does (NAME)'s natural father live in this household or was he a guest last night?
Record father's line number.
If no, record 00.
Codes for q 17 and 19: Education
Level
2=Secondary 1
3=Secondary 2
4=Higher
5=Pre-primary/nursery
8=Don't know
Class
98=Don't know
Ever attended school
16) Has (NAME) ever attended school?
No 2-skip to 20a
17) What is the highest level of school (NAME) has attended?
See codes below.
What is the highest grade (NAME) completed at that level?
Grade____
If age 5-24 years
Current/recent school attendance
18) Did (name) attend school at any time during the (2016-2017) school year?
No 2-skip to 20a
19) During this/that school year, what level and grade (is/was) (name) attending?
See codes below.
Grade____
If age 0-4 years
Birth registration
20) Does (name) have a birth certificate?
If no, probe: Has (name)'s birth ever been registered with the civil authority?
2=Registered
3=Neither
8=Don't know
If age 6 or older
Literacy
20a) If level in column 17=2, 3, or 4: Ask: Can (name) read, write, and understand at least one national language?
Other: Ask: Can (name) read, write, and understand at least one language?
If yes, which ones?
2=ALN
3=AFLN
4=NLE
8=Don't know
Codes for Qs 17 and 19: Education
Level attainted
Class successfully achieved
Less than one year in C1=0
C1=1
CP=2
CE1=3
CE2=4
CM1=5
CM2=6
Don't know=8
Less than 1 year in 6th =0
6th=1
5th=2
4th=3
3rd=4
Don't know =8
Less than one year in 2nd=0
2nd=1
1st=2
Final=3
Don't know =8
Less than one year in 1st =0
1st year=1
2nd year=2
3rd year=3
4th year=4
Don't know 8
ALN=Literate in a national language
AFLN=Literate in French and a national language
NLE=Illiterate
NSP=Don't know
[##translator note: questions 1-20 repeated for line numbers 11-20 to accommodate larger households]
Tick here if continuation sheet used
Codes for Q3: for relationship with head of household
02= Wife or husband
03= Son or daughter
04= Son-in-law or daughter-in-law
05= Grandchild
06= Parent
07= Parent-in-law
08= Brother or sister
09=Other relative
10= Adopted/Foster/stepchild
11= Other wife of head of household (if head of household =male)
12= Co-spouse (if head of household = female)
13= Not related
98= Don't know
No.
Questions and filters
Coding categories
Skip
101) What is the main source of drinking water for members of your household?
Piped into yard/plot 12- skip to 106
Piped from neighbor 13- skip to 106
Public tap/standpipe 14
Tube well or borehold 21
Unprotected well 32
Unprotected spring 42
Rainwater 51
Tanker truck 61
Cart with small tank/canister or inner tube/barrel 71
Surface water (river/dam/lake/pond/stream/canal/irrigation channel) 81
Bottled water 91
Sachet water 92
14-81-skip to 103
Other (specify) 96-skip to 103
102) What is the main source of water used by your household for other purposes such as cooking and handwashing?
Piped into yard/plot 12- skip to 106
Piped from neighbor 13- skip to 106
Public tap/standpipe 14
Tube well or borehold 21
Unprotected well 32
Unprotected spring 42
Rainwater 51
Tanker truck 61
Cart with small tank/canister or inner tube/barrel 71
Surface water (river/dam/lake/pond/stream/canal/irrigation channel) 81
Other (specify) 96
103) Where is the water source located?
In own yard/plot 2-skip to 105
Elsewhere 3
104) How long does it take you to go there, get water, and come back?
Don't know 998
105) Check 101 and 102: Code 14 or 21 circled
No-skip to 107
106) In the past two weeks, was the water from this source not available for at least one full day?
No 2
Don't know 8
107) Do you do anything to the water to make it safer to drink?
No 2-skip to 109
DK 8-skip to 109
108) What do you usually do to make the water safer to drink?
Anything else?
Record all mentioned
Add bleach/chlorine b
Add Aquatabs c
Strain through a cloth d
Use water filter (ceramic/sand/composite/etc.) e
Solar disinfection f
Let it stand and settle g
Other (specify) x
Don't know z
109) What kind of toilet facility do members of your household usually use?
If not possible to determine, ask permission to observe the facility.
Flush to septic tank 12
Flush to pit latrine 13
Flush to somewhere else 14
Flush, don't know where 15
Pit latrine with slab 22
Pit latrine without slab/open pit 23
Composting toilet 31
Bucket toilet 41
Hanging toilet/hanging latrine 51
No facility/bush/field 61-skip to 113
Other (specify) 96
110) Do you share this toilet facility with other households?
No 2-skip to 112
111) Including your own household, how many households use this toilet facility?
10 or more households 95
Don't know 98
112) Where is this toilet facility located?
In own yard/plot 2
Elsewhere 3
113) What type of fuel does your household mainly use for cooking?
LPG 02
Natural gas 03
Biogas 04
Karosene 05
Coal, lignite 06
Charcoal 07
Wood 08
Straw/shrubs/grass 09
Agricultural crop 10
Animal dung 11
No food cooked in household 95-skip to 116
Other (specify) 96
114) Is the cooking usually done in the house, in a separate building, or outdoors?
In a separate building 2
Outdoors 3
Other (specify) 6
2-6-skip to 116
115) Do you have a separate room which is used as a kitchen?
No 2
116) How many rooms in this household are used for sleeping?
117) Does this household own any livestock, herds, other farm animals, or poultry?
No 2-skip to 119
118) How many of the following animals does this household own?
If none, enter 00
If 95 or more, enter 95
If unknown, enter 98
Other cattle?
Horses, donkeys, or mules?
Goats?
Sheep?
Chicken or other poultry?
Hogs/pigs?
Rabbits?
119) Does any member of this household own any agricultural land?
No 2-skip to 121
120) How many hectares of agricultural land do members of this household own?
If 95 or more, circle 950
95 of more Hectares 950
Don't know 998
121) Does your household have:
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
122) Does any member of your household own:
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
123) Does any member of this household have a bank account?
No 2
123a) Does any member of this household have an account in another micro-finance organization?
No 2
124) Does anyone in your household smoke? Would you say daily, weekly, monthly, less than monthly, or never?
Weekly 2
Monthly 3
Less than monthly 4
Never 5
125) At any time in the past 12 months, has anyone come into your dwelling to spay the interior walls against mosquitos?
No 2-skip to 127
Don't know 8-skip to 127
126) Who sprayed the dwelling?
Private company B
Nongovernmental organization (NGO) C
Other (specify) X
Don't know Z
127) Does your household have any mosquito nets?
No 2-skip to 139
128) How many mosquito nets does your household have?
If 7 or more nets, record 7.
Mosquito nets
Net #2
Net #3
129) Ask the respondent to show you the nets in the household.
If more than 3 nets, use additional questionnaire(s).
Not observed 2
130) How many months ago did your household get the mosquito net?
If less than one month ago, record 00.
More than 37 months ago 95
Not sure 98
131) Observe or ask the brand/type of mosquito net.
If brand is unknown and you cannot observe the net, show pictures of typical net types/brands to respondent.
Long-lasting insecticide-treated net (LLIN)
Olyset 12
Duranet 13
Netprotect 14
Interceptor 15
Other/Don't know brand 16
All skip to 134
Other type 96
Don't know 98
132) Since you got the net, was it ever soaked or dipped in a liquid to kill or repel mosquitoes?
No 2-skip to 134
Not sure 8-skip to 134
133) How many months ago was the net last soaked or dipped
If less than one month ago, record 00.
More than 24 months ago 95
Not sure 98
134) Did you get the net through a mass distribution campaign, during an antenatal care visit, during an immunization visit, or at a primary school?
Yes, ANC 2
Yes, immunization visit 3
Yes, primary school 4
1-4 skip to 136
No 5
135) Where did you get the net?
Private Health Facility 02
Pharmacy 03
Shop/market 04
Community field agent 05
Religious institution 06
School 07
Other 96
Don't know 98
135a) How did you acquire the mosquito net?
Bought with voucher 02
Free 03
Other (specify) 06
Don't know 98
136) Did anyone sleep under this mosquito net last night?
No 2-skip to 138
DK 8-skip to 138
137) Who slept under the mosquito net last night?
Record the person's name and line number from household schedule
Line number____
138) Go back to 129 for next net; or, if no more nets, go to 139.
Additional household characteristics
139) We would like to learn about the places that households use to watch their hands. Can you please show me where members of your household most often wash their hands?
Observed, mobile 2
Not observed, not in dwelling/yard/plot 3-skip to 142
Not observed, no permission to see 4-skip to 142
Not observed, other reason 5-skip to 142
140) Observe presence of water at the place for handwashing.
Record observation
Water is not available 2
141) Observe presence of soap, detergent, or other cleansing agent at the place for handwashing.
Soap or detergent (bar, liquid, powder, paste) A
Ash, mud, sand B
None Y
142) Observe main materials of the floor in the dwelling.
Record observation.
Dung 12
Palm/bamboo 22
Vinyl or asphalt strips 32
Ceramic tiles 33
Cement 34
Carpet 35
Other (specify) 96
143) Observe main material of the roof of the dwelling.
Record observation.
Thatch/palm leaf 12
Sod 13
Palms/bamboo 22
Wood planks 23
Cardboard 24
Wood 32
Calamine/cement fiber 33
Ceramic tiles 34
Cement 35
Roofing shingles 36
Other (specify) 96
144) Observe main materials of the exterior walls of the dwelling.
Record observation.
Bamboo/cane/palm/trunks 12
Dirt 13
Stone with mud 22
Uncovered adobe 23
Plywood 24
Cardboard 25
Reused wood 26
Stone with lime/cement 32
Bricks 33
Cement blocks 34
Covered adobe 35
Wood planks/shingles 36
Other (specify) 96
144a) Where do you usually through away your household garbage?
Private garbage collection/NGO 02
Buried 03
Burned 04
In the yard 05
Outside 06
Other (specify) 96
144b) Where do you usually through away dirty water?
Open air gutter 02
Septic 03
Ruined well 04
Sewer 05
In the yard 06
Outside 07
Other (specify) 96
145) I would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals in your household?
Test salt for iodine
No iodine 2
No salt in household 3
Salt not tested (specify reason) 6
Selection of a child for children's work and discipline
No.
Questions and filters
Coding categories
151) Check column 7 in the list of household members and record the total number of children age 1-17.
152) Check the number of children age 1-17 from Q. 151:
One-go to 159 and record the rank number as 1, enter the line number, child's name, and his/her age.
Two or more-
152) List each child age 1-17 below in the order in which they appear on the list of household members. Do not include other household members outside of the group aged 1-17. Record the line number, name, sex and age of each child.
1, 2, 3, etc.
154) Line number from column 1
Female 2
158) Check the digit of the household number of the cover page. Go to this line number of the table below. Verify the total number of children Q 151 on the previous page. Go to this column number in the table below.
Find the space where the line and the column cross and circle the number that is in the space. This is the rank number of the child selected for the children's work/discipline among the eligible children in Q 153.
Record the rank number, line number, age, and name of the child selected in the space below.
Example: The household number is 716 and Q 151 shows that there are three eligible children age 1-17 in the household. Since the last digit of the household number is 6, go to line six, and since there are three eligible children, go to column 3. Find the space where the line and column intersect (2) and circle the number. Now, go to Q 153 and find the second child. Write the name, age, line number, and rank of the child in the space below.
Last digit the household number
Age of child selected
Line number of child selected
Rank of child selected
No.
Questions and filters
Coding categories
Skip
161) Check age of child selected from Q 159
1-4 years-skip to 181
162) Now I would like to ask you some questions on the type of work that children in your household can do.
Since last (day of week), did (name) do any of the following activities, even if only for one hour?
No 2
No 2
No 2
No 2
Please include any type of activity that (name) might have done like regular or temporary employment, for his own business or for an employer, or as an unpaid family worker in the household or farm.
All other activity
No 2
Not a single yes-skip to 168
164) Since last (day of week), approximately how many hours total did (name) work on this activity/these activities?
Number of hours_____
165) Does this activity/do these activities require carrying heavy loads?
No 2
166) Does this activity/do these activities require working with dangerous tools (knives, etc.) or big machines?
No 2
167) Now I would like to ask some questions about how you would describe (name)'s work environment.
No 2
No 2
No 2
No 2
No 2
No 2
168) Since last (day of week), did name fetch water for the household?
No 2-skip to 170
169) In total, since last (day of week), how many hours did (name) spend fetching water for the household?
If less than one hour, record 00
170) Since last (day of week), did (name) fetch firewood for the household?
No 2-skip to 172
171) In total, since last (day of week), how many hours did (name) spend fetching firewood for the household?
If less than one hour, record 00
172) Since last (day of week), did (name) do any of the following tasks for the household?
No 2
No 2
No 2
No 2
No 2
No 2
No 2
Not a single yes-skip to 181
174) Since last (day of week of interview), about how many hours in total did (name) spend doing these activities?
No.
Questions and filters
Coding categories
Skip
181) Check age of selected child in Q 159:
Age 15-17 --skip to 185
182) Record the child's line number and name from 159
Name_____
183) Now I would like to talk about something else.
Adults use certain methods to teach child how to behave well or to correct behavioral problems. I will read you a list of methods that are used. Please tell me if you or someone else in your household has
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
No 2
184) Do you think that to properly raise and educate (name), you must punish him/her physically?
No 2
Don't know/no opinion 8
Minutes_____
Interviewer's observations
To be filled in after completing interview
Comments about the interview:
Comments on specific questions:
Any other comments:
Supervisor's observations
Editor's observations