Demographic and Health Survey (EDST-1988)
Community questionnaire
PREFECTURE __
LEVEL/STRATA __
COUNTING ZONE OR NEIGHBORHOOD CODE ______
PLOT NUMBER ______
NAME OF HEAD OF PLOT ____________
HOUSEHOLD NUMBER ______
DATE__________
INTERVIEWER'S NAME______
HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME 2
POSTPONED 3
REFUSED 4
DWELLING VACANT 5
NO DWELLING AT THIS ADDRESS 6
ADDRESS NOT FOUND OR INCORRECT 7
OTHER (SPECIFY) __________ 8
NEXT VISIT
DATE__________
TIME__________
FINAL VISIT
MONTH________
YEAR 88
INT. NUMBER_____
RESULT CODE_______
FIELD EDITED BY
NAME ____________
DATE____________
OFFICE EDITED BY
NAME ___________
DATE____________
KEYED BY
NAME ___________
DATE___________
1) FIRST NAMES AND LAST NAMES OF USUAL RESIDENTS AND VISITORS
FEMALE 2
RESIDENT (ABSENT) 2
VISITOR 3
TOTAL NUMBER OF ELIGIBLE WOMEN
1) Are there any other persons (children) that we have not listed?
NO
2) Are there any other people who many not be members of your family (domestic servants or friends) who usually live here?
NO
3) Do you currently have any visitors here?
NO