FEDERAL REPUBLIC OF NIGERIA
NATIONAL POPULATION COMMISSION
1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY
HOUSEHOLD SCHEDULE
STATE NAME ___
LOCAL GOVT. AREA ___
LOCALITY NAME ___
ENUMERATION AREA ___
RURAL 2
BUILDING NUMBER ___
HOUSEHOLD NAME/NUMBER ___
LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE:
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
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 6
DWELLING DESTROYED 7
OTHER (SPECIFY) ___________ 8
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE __________
TIME ___________
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
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 6
DWELLING DESTROYED 7
OTHER (SPECIFY) ___________ 8
LINE NO. OF RESPONDENTS TO HOUSEHOLD SCHEDULE __
SUPERVISOR
NAME ________ ___
DATE ________
FIELD EDITOR
NAME ________ ___
DATE ________
OFFICE EDITOR____
KEYED BY____
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)
(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.
(3) RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?
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
BROTHER OR SISTER-IN-LAW 09
OTHER RELATIVE 10
ADOPTED/FOSTER/STEPCHILD 11
NOT RELATED 12
DON'T KNOW 98
(4) RESIDENCE: Does (NAME) usually live here?
NO 2
(5) RESIDENCE: Did (NAME) stay here last night?
NO 2
(6) SEX: Is (NAME) male or female?
FEMALE 2
(7) AGE: How old is (NAME) as of last birthday?
EDUCATION IF AGE 6 YEARS OR OLDER:
(8) Can (NAME) read and write in any language with understanding?
NO 2
(9) Has (NAME) ever been to school?
NO 2
(10) IF ATTENDED SCHOOL: Which is the highest level of school (NAME) attended? What is the highest grade (NAME) completed at that level?**
SECONDARY 2
HIGHER 3
DON'T KNOW 8
1 YEAR COMPLETED 01
2 YEARS COMPLETED 02
3 YEARS COMPLETED 03
4 YEARS COMPLETED 04
5 YEARS COMPLETED 05
6 YEARS COMPLETED 06
DON'T KNOW 98
(11) Is (NAME) still in school? (For Age less than 25 Years)
NO 2
PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 15 YEARS OLD: Q.12 THROUGH Q.15: THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD. RECORD 00 IF PARENT NOT MEMBER OF HOUSEHOLD.
(12) Is (NAME)'s natural mother alive?
NO 2
DON'T KNOW 8
(13) (IF ALIVE) Does (NAME)'s natural mother live in this household?
IF YES: What is her name?
RECORD MOTHER'S LINE NUMBER
(14) Is (NAME)'s natural father alive?
NO 2
DON'T KNOW 8
(15) (IF ALIVE) Does (NAME)'s natural father live in this household?
IF YES: What is his name?
RECORD FATHER'S LINE NUMBER
(16) ELIGIBILITY: CIRCLE LINE NUMBER OF ALL WOMEN AGED 10-49.
(17) ELIGIBILITY: CIRCLE LINE NUMBER OF ALL MEN AGED 15-64.
TICK HERE IF CONTINUATION SHEET USED __
Tick here if Household has more than 14 persons __
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 may 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 slept here last night that have not been listed?
NO
18. What is the main source of drinking water for members of your household?
PUBLIC TAP 12
PUBLIC WELL 22
RIVER/STREAM 32
POND/LAKE 33
DAM 34
TANKER (TRUCK) 51 (GO TO 20)
TANKER VENDOR 52 (GO TO 20)
BOTTLED WATER 61
BOREHOLE 71
OTHER (SPECIFY) __________ 96 (GO TO 20)
19. How long does it take you to go there, get water, and come back?
ON PREMISES 996
20. What kind of toilet facility does your household have?
SHARED FLUSH TOILET (W.C) 12
VENTILATED IMPROVED PIT (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD/RIVER 31
OTHER (SPECIFY) ___________ 96
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
22. How many rooms are in your household?
22B. How many rooms are used for sleeping in your household?
23. MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.
DUNG 12
PALM/BAMBOO 22
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
TERRAZZO/MARBLE 35
CARPET 36
24. Does any member of your household own:
NO 2
NO 2
NO 2
NO 2
NO 2
25. What type of salt is usually used for cooking in your household?
(ASK TO SEE SALT PACKAGE).
PACKAGED SALT (IODIZED) 02
PACKAGED SALT (NOT IODIZED) 03
SALT FOR ANIMALS 04
LOOSE SALT 05
OTHER (SPECIFY) __________ 06
26. How do you hold this accommodation?
OWNER OCCUPIER 02
NOT OWNER, BUT RENT FREE 03
HOUSED BY EMPLOYER 04
OTHER (SPECIFY) ______________ 96
27. If you rent it or if it is rent-free, who owns the accommodation?
PUBLIC OWNERSHIP 02
EMPLOYER 03
PRIVATE MORTGAGE COMPANY 04
OTHER (SPECIFY) _____________ 96
28. MAIN MATERIAL USED FOR OUTER WALLS.
RECORD OBSERVATION
CONCRETE 02
BAKED BRICKS 03
UNBAKED BRICK, MUD OR EARTH 04
TERRAZZO/MARBLE/HEWN STONE 05
PLANK/WOOD/BAMBOO MATERIAL 06
THATCH/MAT/LEAVES/STRAW 07
CORRUGATED IRON SHEETS/ZINC 08
OTHER (SPECIFY) ____________ 96
29. MAIN MATERIAL USED FOR ROOF.
RECORD OBSERVATION
CORRUGATED METAL SHEET/ASBESTOS TILES 02
WOODEN TILES/PLANKS 03
EARTH/MUD 04
THATCH/MAT/LEAVES 05
OTHER (SPECIFY) ____________ 96
PRESSURE LAMP 02
KEROSINE LAMPS WITH GLASS SHADES 03
KEROSINE/OIL LAMPS WITHOUT GLASS SHADES 04
OTHER (SPECIFY) ____________ 96
SEPARATE ROOM IN THE BUILDING FOR USE OF THIS AND OTHER HOUSEHOLDS 02
ENCLOSURE WITHOUT ROOF 03
OPEN SPACE WITHIN/AROUND BUILDING 04
OTHER (SPECIFY) ____________ 96
SEPARATE ROOM IN THE BUILDING FOR ALL OCCUPANTS 02
ENCLOSURE IN THE BUILDING BUT WITHOUT ROOF 03
PUBLIC BATHROOM/STREAM/RIVER 04
OTHER (SPECIFY) ____________ 96