DEMOGRAPHIC AND HEALTH SURVEYS - HOUSEHOLD QUESTIONNAIRE (EDSG-II) - 1999 REPUBLIC OF GUINEA
PLACE NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION CODE _____
RURAL 2
CONAKRY/CAPITAL NATURAL REGION/OTHER CITY/RURAL:
CAPITAL REGION 2
OTHER CITY 3
RURAL 4
HOUSEHOLD SELECTED FOR MEN'S SURVEY?
NO 2
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
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 1999
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
TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE _____
SUPERVISOR
NAME _____
DATE _____
FIELD EDITOR
NAME _____
DATE _____
OFFICE EDITOR _____
KEYED BY _____
Now we would like some information about the people who usually live in your household or who are staying with you now.
01. LINE NUMBER:
02. 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.
03. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the 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 CO-SPOUSE
10 OTHER RELATIVE
11 ADOPTED/FOSTER CHILD/STEPCHILD
12 NOT RELATED
98 DOESN'T KNOW
04. RESIDENCE: Does (NAME) usually live here?
NO 2
05. RESIDENCE: Did (NAME) stay here last night?
NO 2
06. SEX: Is (NAME) male or female?
FEMALE 2
EDUCATION, IF AGE 5 YEARS OR OLDER:
08. Has (NAME) ever attended school?
NO 2 (GO TO 15)
09. What is the highest level of school (NAME) has attended?
What is the highest grade (NAME) completed at that level?
2 SECONDARY (1ST CYCLE) 0-4, 8
3 SECONDARY (2ND CYCLE) 0-3, 8
4 PROFESSIONAL A 0-3, 8
5 PROFESSIONAL B 0-3, 8
6 SUPERIOR 0-7, 8
8 DOESN'T KNOW 8
EDUCATION, IF AGE 5 TO 25 YEARS:
10. Is (NAME) currently attending school?
NO 2
11. During the current school year, did (NAME) attend school at any time?
NO 2 (GO TO 13)
12. During the current school year, what level and grade (is/was) (NAME) attending?
2 SECONDARY (1ST CYCLE) 0-4, 8
3 SECONDARY (2ND CYCLE) 0-3, 8
4 PROFESSIONAL A 0-3, 8
5 PROFESSIONAL B 0-3, 8
6 SUPERIOR 0-7, 8
8 DOESN'T KNOW 8
13. During the previous school year (1997-98), did (NAME) attend any school at any time?
NO 2 (GO TO 15)
14. During that school year (1997-98), what level and grade did (NAME) attend?
2 SECONDARY (1ST CYCLE) 0-4, 8
3 SECONDARY (2ND CYCLE) 0-3, 8
4 PROFESSIONAL A 0-3, 8
5 PROFESSIONAL B 0-3, 8
6 SUPERIOR 0-7, 8
8 DOESN'T KNOW 8
PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 16 YEARS OLD:
15. Is (NAME)'s natural mother alive?
NO 2
DOESN'T KNOW 8
16. IF ALIVE: Does (NAME)'s natural mother live in this household?
IF YES: what is her name?
RECORD MOTHER'S LINE NUMBER. RECORD '00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE.
17. Is (NAME)'s natural father alive?
NO 2
DOESN'T KNOW 8
18. IF ALIVE: Does (NAME)'s natural father live in this household?
IF YES: What is his name?
RECORD FATHER'S LINE NUMBER. RECORD '00' IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE.
WOMEN'S ELIGIBILITY:
19. CIRCLE LINE NUMBER OF ALL WOMEN 15-49.
MEN'S ELIGIBILITY:
20. CIRCLE LINE NUMBER OF ALL MEN 15-59 (IF MEN'S SURVEY IS PLANNED)
NO _____
TICK HERE IF CONTINUATION SHEET USED _____
Just to make sure that I have a complete listing:
1) Are there any other persons such as small children or infants that we have not listed?
NO
2) In addition, are there any other people who many not be members of your family, such as domestic servants, lodgers or friends who usually live here?
NO
3) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
NO
21. What is the main source of drinking water for members of your household?
PIPED INTO YARD/PLOT 12 (GO TO 23)
PUBLIC TAP 13
PUBLIC WELL 22
NON-CONVERTED SOURCE 32
RIVER/STREAM 33
MARSH WATER/LAKE 34
DAM 35
TANKER TRUCK 51 (GO TO 23)
OTHER (SPECIFY) _____ 96
22. How long does it take you to go there, get water, and come back?
ON PREMISES 996
23. What kind of toilet facilities does your household have?
LATRINES 21
BASIC PIT TOILET 31
NO TOILET/OUTDOORS 41
OTHER (SPECIFY) _____ 96
Electricity?
A radio?
A television?
A telephone?
A refrigerator?
A portable stove/gas or electric stove?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
25. In your household, how many rooms do you use to sleep?
26. MAIN MATERIAL OF THE FLOOR:
RECORD OBSERVATION.
TILE 32
OTHER FINISHED 33
27. Does any member of your household own:
A bicycle?
A motorcycle or motor scooter?
A car?
NO 2
NO 2
NO 2
28. Can you show me the salt you used to cook the main meal yesterday or last night?
SALT IN PACKET 1
LOOSE SALT 2
COARSE SALT IN PACKET 3
COARSE LOOSE SALT 4
SALT NOT AVAILABLE 5 (END HOUSEHOLD SURVEY)
OTHER (SPECIFY) _____ 6
REFUSED TO SHOW 7 (END HOUSEHOLD SURVEY)
NON-IODINE SALT (WHITE) 2
SALT NOT TESTED 3