2019-20 GAMBIA DEMOGRAPHIC AND HEALTH SURVEY
HOUSEHOLD QUESTIONNAIRE
THE GAMBIA BUREAU OF STATISTICS
NAME OF SETTLEMENT
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
HOUSEHOLD SELECTED FOR MAN'S SURVEY AND BIOMARKERS?
NO 2
DATE
INTERVIEWER'S NAME
RESULT
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) 9
NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) 9
TOTAL NUMBER OF VISITS__
TOTAL PERSONS IN THE HOUSEHOLD__
TOTAL ELIGIBLE WOMEN__
TOTAL ELIGIBLE MEN__
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE__
LANGUAGE OF QUESTIONNAIRE__
LANGUAGE OF INTERVIEW__
NATIVE LANGUAGE OF RESPONDENT__
TRANSLATOR USED__
NO 2
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE CODES
MANDINKA 02
WOLLOF 03
FULA 04
JOLA 05
SARAHULE 06
SERERE 07
MANJAGO 08
CREOLE/AKU MARABOUT 09
BAMBARA 10
OTHER LANGUAGE (SPECIFY) 11
SUPERVISOR
NAME
CODE
Hello. My name is__. I am working with Gambia Bureau of Statistics. We are conducting a survey about health and other topics all over The Gambia. 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 15 to 20 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__
1. LINE NUMBER
2. Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household. 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.
2A) Just to make sure that I have a complete listing: are there any other people such as small children or infants that we have not listed?
NO
2B) Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live there?
NO
2C) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
NO
RELATIONSHIP TO HEAD OF HOUSEHOLD
3. What is the relationship of (NAME) to the head of the household? SEE CODES BELOW.
WIFE OR HUSBAND 02
SON OR DAUGHTER 03
SON-IN-LAW OR DAUGHTER-IN-LAW 04
GRANDCHILD 05
PARENT 06
PARENT-IN-LAW 07
BROTHER OR SISTER 08
OTHER RELATIVE 09
ADOPTED/FOSTER/STEPCHILD 10
NOT RELATED 11
CO-WIFE 12
DON'T KNOW 98
4. Is (NAME) male or female?
FEMALE 2
5. Does (NAME) usually live here?
NO 2
6. Did (NAME) stay here last night?
NO 2
7. How old is (NAME)? IF 95 OR MORE, RECORD '95'.
IF AGE 12 OR OLDER
MARITAL STATUS
8. What is (NAME)'s current marital status?
LIVING TOGETHER 2
DIVORCED/SEPARATED 3
WIDOWED 4
NEVER MARRIED AND NEVER LIVED TOGETHER 5
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 15-49
11. CIRCLE LINE NUMBER OF ALL CHILDREN AGE 0-5
IF AGE 0-17 YEARS
SURVIVORSHIP AND RESIDENCE OF BIOLOGICAL PARENTS
12. Is (NAME)'s natural mother alive?
NO 2 (GO TO 14)
DON'T KNOW 8 (GO TO 14)
13. Does (NAME)'s natural mother usually live in this household or was she a guest last night? IF YES: What. RECORD MOTHER'S LINE NUMBER. IF NO, RECORD '00'
14. Is (NAME)'s natural father alive?
NO 2 (GO TO 16)
DON'T KNOW 8 (GO TO 16)
15. Does (NAME)'s natural father usually live in this household or was he a guest last night? IF YES: what. RECORD FATHER'S LINE NUMBER. IF NO, RECORD '00'.
IF AGE 3 YEARS OR OLDER
EVER ATTENDED SCHOOL
16. Has (NAME) ever attended school?
NO 2 (GO TO 20)
17. What is the highest level of school (NAME) has attended? What is the highest grade (NAME) completed at that level? SEE CODES BELOW.
PRIMARY (GRADE 1-6) 1
LOWER ESCONDARY (GRADE 7-9) 2
UPPER SECONDARY (GRADDE 10-12) 3
VOCATIONAL (TECHNICAL) 4
DIPLOMA 5
HIGHER (UNIVERSITY) 6
DON'T KNOW 8
DON'T KNOW 98
IF AGE 3-24 YEARS
CURRENT/RECENT SCHOOL ATTENDANCE
18. Did (NAME) attend school at any time during the 2019-2020 school year?
NO 2 (GO TO 20)
19. During this school year, what level and grade is (NAME) attending? SEE CODES BELOW
PRIMARY (GRADE 1-6) 1
LOWER ESCONDARY (GRADE 7-9) 2
UPPER SECONDARY (GRADDE 10-12) 3
VOCATIONAL (TECHNICAL) 4
DIPLOMA 5
HIGHER (UNIVERSITY) 6
DON'T KNOW 8
DON'T KNOW 98
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?
REGISTERED 2
NEITHER 3
DON'T KNOW 8
TICK HERE IF CONTINUATION SHEET USED
SELECTION OF WOMAN FOR THE DOMESTIC VIOLENCE QUESTIONS (PAPER OPTION)
21. CHECK COVER PAGE: HOUSEHOLD SELECTED FOR MAN'S SURVEY/BIOMARKERS?
NO (SKIP TO 101)
LOOK AT THE LAST DIGIT OF THE HOUSEHOLD NUMBER ON THE COVER PAGE. THIS IS THE ROW NUMBER YOU SHOULD GO TO. CHECK THE TOTAL NUMBER OF ELIGIBLE WOMEN (COLUMN 9) IN THE HOUSEHOLD SCHEDULE. THIS IS THE COLUMN NUMBER YOU SHOULD GO TO. FOLLOW THE SELECTED ROW AND COLUMN TO THE CELL WHERE THEY MEET AND CIRCLE THE NUMBER IN THE CELL. THIS IS THE NUMBER OF THE WOMAN SELECTED FOR THE DOMESTIC VIOLENCE QUESTIONS FROM THE LIST OF ELIGIBLE WOMEN IN COLUMN 9 OF THE HOUSEHOLD SCHEDULE. WRITE THE NAME AND LINE NUMBER OF THE SELECTED WOMAN IN THE SPACE BELOW THE TABLE.
EXAMPLE: THE HOUSEHOLD NUMBER IS '716' AND THE HOUSEHOLD SCHEDULE COLUMN 9 SHOWS THAT THERE ARE THREE ELIGIBLE WOMEN AGE 15-49 IN THE HOUSEHOLD (LINE NUMBERS 02, 04, AND 05). SINCE THE LAST DIGIT OF THE HOUSEHOLD NUMBER IS '6' GO TO ROW '6' AND SINCE THERE ARE THREE ELIGIBLE WOMEN IN THE HOUSEHOLD, GO TO COLUMN '3'. FOLLOW THE ROW AND COLUMN AND FIND THE NUMBER IN THE CELL WHERE THEY MEET ('2') AND CIRCLE THE NUMBER. NOW GO TO THE HOUSEHOLD SCHEDULE AND FIND THE SECOND WOMAN WHO IS ELIGIBLE FOR THE WOMAN'S INTERVIEW (LINE NUMBER '04' IN THIS EXAMPLE). WRITE HER NAME.
[LINE 1] LAST DIGIT OF HOUSEHOLD NUMBER 123456789
[NEXT 8 LINES] TOTAL NUMBER OF ELIGIBLE WOMEN AGE 15-49 IN HOUSEHOLD SCHEDULE COLUMN 9 (NUMBERED CHART)
HH LINE NUMBER OF SELECTED WOMAN
101. What is the main source of drinking water of members of your household?
PIPED INTO YARD/PLOT 12 (SKIP TO 106)
PIPED TO NEIGHBOR 13 (SKIP TO 106)
PUBLIC TAP/STANDPIPE 14 (SKIP TO 103)
DUG WELL
UNPROTECTED WELL 32 (SKIP TO 103)
BOTTLED WATER 91
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 TO NEIGHBOR 13 (SKIP TO 106)
PUBLIC TAP/STANDPIPE 14
DUG WELL
UNPROTECTED WELL 32
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL) 81
OTHER (SPECIFY) 96
103. Where is that water source located?
IN OWN YARD/PLOT 2 (SKIP TO 105)
ELSEWHERE 3
104. How long does it take to go there, get water, and come back?
DON'T KNOW 998
105. CHECK 101 AND 102: CODE '14' OR '21'
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)
DON'T KNOW 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
STRAIN THROUGH A CLOTH C
USE WATER FILTER (CERAMIC/SAND/COMPOSITE/ETC) D
SOLAR DISINFECTION E
LET IT STAND AND SETTLE F
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
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 (GAS TANK) 02
BIOGAS 03
KEROSENE 04
CHARCOAL 05
WOOD 06
STRAW/SHRUBS/GRASS 07
SAWDUST 08
ANIMAL DUNG 09
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 (SKIP TO 116)
OUTDOORS 3 (SKIP TO 116)
OTHER (SPECIFY) 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, RECORD '00'. IF 95 OR MORE, RECORD '95'. IF UNKNOWN, RECORD '98'.
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 HECTARES, CIRCLE '950'. IF 95 OR MORE ACRES, RECORD IN HECTARES.
ACRES __.__ 2
95 OR 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
NO 2
NO 2
NO 2
NO 2
NO 2
122. Does any member of this 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
124. How often does anyone smoke inside your house? Would you say daily, weekly, monthly, less often than once a month, or never?
WEEKLY 2
MONTHLY 3
LESS OFTEN THAN ONCE A MONTH 4
NEVER 5
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'.
129. ASK THE RESPONDENT TO SHOW YOU ALL THE NETS IN THE HOUSEHOLD. IF MORE THAN 6 NETS, USE ADDITIONAL
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 36 MONTHS AGO 95
NOT SURE 98
131. OBSERVE OR ASK BRAND/TYPE OF MOSQUITO NET. IF BRAND IS UNKNOWN AND YOU CANNOT OBSERVE THE NET, SHOW PICTURES OF TYPICAL NET TYPES/BRANDS TO RESPONDENT.
PERMANET 12
NET PROTECT 13
MAGNET 14
DURANET 15
OTHER/DON'T KNOW BRAND (SPECIFY) 16
OTHER TYPE 96
DON'T KNOW TYPE 98
134. Did you get the net through a mass distribution campaign, during an antenatal care visit, or during an infant welfare visit?
YES, ANC 2 (SKIP TO 136)
YES, INFANT WELFARE VISIT 3 (SKIP TO 136)
NO 4
135. Where did you get the net?
PRIVATE HEALTH FACILITY 02
PHARMACY 03
SHOP/MARKET 04
VHW 05
RELIGIOUS INSTITUTION 06
SCHOOL 07
NGO CLINIC/FACILITY 08
OTHER 96
DON'T KNOW 98
136. Did anyone sleep under this mosquito net last night?
NO 2 (SKIP TO 138)
NOT SURE 8 (SKIP TO 138)
137. Who slept under this 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 wash 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 OBERVATION.
WATER IS NOT AVAILABLE 2
141. OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT AT THE PLACE FOR HANDWASHING. RECORD OBSERVATION.
ASH, MUD, SAND B
NONE Y
142. OBSERVE MAIN MATERIAL OF THE FLOOR OF THE DWELLING. RECORD OBSERVATION.
DUNG 12
VINYL/LINOLEUM/TAPEH 32
TILES 33
CEMENT/CONCRETE 34
CARPET 35
143. OBSERVE THE MAIN MATERIAL OF THE ROOF OF THE DWELLING. RECORD OBSERVATION.
THATCH/PALM LEAF 12
WOOD PLANKS 22
WOOD 32
CERAMIC TILES 33
CEMENT/CONCRETE 34
DECRA 34
OBSERVE THE MAIN MATERIAL OF THE EXTERIOR WALLS OF THE DWELLING. RECORD OBSERVATION.
CANE/PALM/TRUNKS 12
DIRT 13
STONE WITH MUD 22
MUD/MUD BRICKS 23
PLYWOOD 24
CARDBOARD 25
REUSED WOOD/PALLETS 26
STONE WITH LIME/CEMENT 32
BRICKS 33
CEMENT BRICKS 34
MUD BLOCKS PLASTERED WITH CEMENT 35
WOOD PLANKS/SHINGLES 36
BAMBOO WITH CEMENT 37
CERAMIC TILES WITH CEMENT 38
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
MINUTES__
INTERVEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS
ANY OTHER COMMENTS
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS