Survey Text
Afghanistan 2015
No questionnaire text is available for this sample.
Angola 2006
No questionnaire text is available for this sample.
Angola 2011
Survey form
view entire document:
text
IDENTIFICATION
NAME OF LOCALITY
REGION
PROVINCE
MUNICIPALITY
CLUSTERED NUMBER IN AMIS
URBAN / RURAL
URBAN 1
RURAL 2
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
Angola 2015
Survey form
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text
IDENTIFICATION
PLACE NAME ________
NAME OF HOUSEHOLD HEAD_______
PROVINCE_______
MUNICIPALITY_____
COMMUNITY_______
NEIGHBORHOOD/VILLAGE______
CENSUS SECTION______
AREAS OF RESIDENCE
URBAN 1
RURAL 2
CLUSTER NUMBER (ID. IIMS)______
HOUSEHOLD NUMBER_______
NAME AND LINE NUMBER OF WOMAN_______
THE WOMAN WAS SELECTED FOR THE DOMESTIC VIOLENCE MODULE
YES 1
NO 2
Bangladesh 1994
Survey form
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text
IDENTIFICATION
DIVISION:
DISTRICT:
UPAZILA OR THANA:
VILLAGE OR MOHALLA OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:
DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE:
DHAKA OR CHITTAGONG 1
SMALL CITY 2
TOWN 3
VILLAGE 4
Bangladesh 1997
No questionnaire text is available for this sample.
Bangladesh 2000
Survey form
view entire document:
text
IDENTIFICATION
DIVISION:
DISTRICT:
THANA:
UNION OR WARD:
VILLAGE OR MOHALLA OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:
DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE?
DHAKA OR CHITTAGONG 1
SMALL CITY 2
TOWN 3
VILLAGE 4
NAME OF HOUSEHOLD HEAD:
NAME AND LINE NUMBER OF ELIGIBLE WOMAN:
Bangladesh 2004
No questionnaire text is available for this sample.
Bangladesh 2007
No questionnaire text is available for this sample.
Bangladesh 2011
Survey form
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text
IDENTIFICATION
DIVISION_____
DISTRICT_____
UPAZILA_____
UNION/WARD_____
VILLAGE/MOHALLA/BLOCK_____
CLUSTER NUMBER____
HOUSEHOLD NUMBER____
RURAL, CITY CORPORATION, OR OTHER URBAN:
RURAL 1
CITY CORPORATION 2
OTHER URBAN 3
Bangladesh 2014
No questionnaire text is available for this sample.
Bangladesh 2018
Survey form
view entire document:
text
IDENTIFICATION
DIVISION_________
DISTRICT_________
UPAZILA_________
VILLAGE/MOHALLA/BLOCK________
CLUSTER NUMBER____
HOUSEHOLD NUMBER_____
RURAL 1
CITY CORPORATION 2
OTHER URBAN 3
NAME OF THE HOUSEHOLD HEAD_____
Benin 1996
No questionnaire text is available for this sample.
Benin 2001
Survey form
view entire document:
text
RURAL/URBAN MUNICIPALITY
URBAN 1
RURAL 2
Benin 2006
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Benin 2011
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Benin 2017
Survey form
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text
Urban/rural (urban=1, rural=2)
Urban 1
Rural 2
Burkina Faso 1993
No questionnaire text is available for this sample.
Burkina Faso 1998
Survey form
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text
URBAN/RURAL:
URBAN 1
RURAL 2
Burkina Faso 2003
Survey form
view entire document:
text
URBAN/RURAL:
URBAN 1
RURAL 2
Burkina Faso 2010
Survey form
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text
URBAN/RURAL:
URBAN 1
RURAL 2
Burkina Faso 2014
Survey form
view entire document:
text
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
ADMINISTRATIVE REGION ______
AREA (URBAN = 1, RURAL = 2) ______
SPECIFIC AREA (OUAGADOUGOU = 1, OTHER CITY = 2, RURAL = 3) ______
NAME AND LINE NUMBER OF WOMAN ______
Burkina Faso 2018
Survey form
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text
IDENTIFICATION (1)
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
ADMINISTRATIVE REGION ______
PROVINCE ______
HEALTH DISTRICT ______
AREA (URBAN = 1, RURAL = 2) ______
SPECIFIC AREA (OUAGADOUGOU = 1, OTHER CITY = 2, RURAL = 3) ______
NAME AND LINE NUMBER OF WOMAN ______
Burundi 1987
No questionnaire text is available for this sample.
Burundi 2010
Survey form
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text
URBAN-RURAL MILIEU:
URBAN 1
RURAL 2
Burundi 2012
Survey form
view entire document:
text
IDENTIFICATION
NAME OF LOCALITY/SUB-HILL (COLLINE) ______
NAME OF HEAD OF HOUSEHOLD ______
PROVINCE ______
COMMUNE ______
NAME AND NUMBER OF HILL (COLLINE) ______
CLUSTER NUMBER ______
HOUSEHOLD NUMBER ______
URBAN-RURAL AREA (1 = URBAN, 2 = RURAL) ______
WOMAN'S NAME AND LINE NUMBER ______
Burundi 2016
No questionnaire text is available for this sample.
Cameroon 1991
No questionnaire text is available for this sample.
Cameroon 1998
No questionnaire text is available for this sample.
Cameroon 2004
No questionnaire text is available for this sample.
Cameroon 2011
No questionnaire text is available for this sample.
Cameroon 2018
No questionnaire text is available for this sample.
Cameroon 2022
Survey form
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text
REGION
DIVISION
SUB-DIVISION
LACALITY
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
STRUCTURE NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
Central African Republic 1995
Survey form
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NAME OF PREFECTURE____
SUB-PREFECTURE____
TOWN____
URBAN OR RURAL
URBAN 1
RURAL 2
CLUSTER NUMBER____
VILLAGE/NEIGHBORHOOD____
HOUSEHOLD NUMBER____
NAME OF HEAD OF HOUSEHOLD____
Chad 1996
No questionnaire text is available for this sample.
Chad 2004
Survey form
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text
REPUBLIC OF CHAD
MINISTRY OF PLANNING, DEVELOPMENT, AND COOPERATION
NATIONAL INSTITUTE OF STATISTICS, ECONOMIC STUDY, AND DEMOGRAPHY
SECOND DEMOGRAPHIC AND HEALTH SURVEY
WOMAN'S QUESTIONNAIRE
IDENTIFICATION
NAME OF LOCALITY__________
NAME OF HEAD OF HOUSEHOLD___________
DEPARTMENT:___
SUBPREFECTURE: ___
MUNICIPALITY:___
CLUSTER NUMBER (EDST):___
STRUCTURE NUMBER:___
HOUSEHOLD NUMBER IN THE STRUCTURE: ___
SEQUENTIAL NUMBER OF SELECTED HOUSEHOLD (01-24 URBAN; 01-33 RURAL:___
Urban/rural
URBAN 1
RURAL 2
Residence
N'DJAMENA=1
ABECHE/MOUNDOU/SARH=2
OTHER DEPARTMENTAL ADMINISTRATIVE CENTER=3
OTHER SMALL CITIES=4
RURAL=5
WOMAN'S NAME AND LINE NUMBER (FROM HOUSEHOLD QUESTIONNAIRE)_______
Chad 2014
Survey form
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text
IDENTIFICATION
REGION NAME
REGION __ __
LOCALITY NAME (NEIGHBORHOOD/VILLAGE)__________
NAME OF HEAD OF HOUSEHOLD____________
CLUSTER NUMBER
CLUSTER __ __
HOUSEHOLD NUMBER (URBAN=01 TO 25; RURAL=01 TO 30)
HOUSEHOLD URBAN RURAL __ __
HOUSEHOLD NUMBER (SEQUENTIAL IN THE CLUSTER)
HOUSEHOLD CLUSTER __ __
URBAN/RURAL (URBAN=1, RURAL=2)
MILIEU __ __
N'DJAMENA-MOUNDOU/SARH/ABECHE-OTHER CITY-RURAL (N'DJAMENA=1, MOUNDOU/SARH/ABECHE=2, OTHER CITY=3, RURAL=4)
RESIDENCE __ __
WOMAN'S NAME AND LINE NUMBER_________________
Comoros 1996
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Comoros 2012
No questionnaire text is available for this sample.
Congo (Democratic Republic) 2007
No questionnaire text is available for this sample.
Congo (Democratic Republic) 2013
No questionnaire text is available for this sample.
Congo Brazzaville 2005
No questionnaire text is available for this sample.
Congo Brazzaville 2011
No questionnaire text is available for this sample.
Cote d'Ivoire 1994
Survey form
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text
URBAN OR RURAL?
URBAN 1
RURAL 2
Cote d'Ivoire 1998
No questionnaire text is available for this sample.
Cote d'Ivoire 2011
Survey form
view entire document:
text
RESIDENTIAL TYPE/ MILIEU______
URBAN 1
RURAL 2
Egypt 1988
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Egypt 1992
Survey form
view entire document:
text
URBAN 1
RURAL 2
LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4
Egypt 1995
Survey form
view entire document:
text
URBAN/RURAL ___
URBAN 1
RURAL 2
Egypt 2000
Survey form
view entire document:
text
LOCALITY
LARGE CITY 1
SMALL CITY 2
TOWN 3
VILLAGE 4
Egypt 2003
No questionnaire text is available for this sample.
Egypt 2005
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Egypt 2008
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Egypt 2014
No questionnaire text is available for this sample.
Eswatini (Swaziland) 2006
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Ethiopia 2000
Survey form
view entire document:
text
URBAN/RURAL___
URBAN 1
RURAL 2
Ethiopia 2005
Survey form
view entire document:
text
LARGE CITY/SMALL CITY/TOWN/RURAL
LARGE CITY 1
SMALL CITY 2
TOWN 3
RURAL 4
Ethiopia 2011
No questionnaire text is available for this sample.
Ethiopia 2016
No questionnaire text is available for this sample.
Ethiopia 2019
No questionnaire text is available for this sample.
Gabon 2000
Survey form
view entire document:
text
DEMOGRAPHIC AND HEALTH SURVEY
REPUBLIC OF GABON 2000 -- WOMAN'S QUESTIONNAIRE
GENERAL MANAGEMENT OF STATISTICS AND ECONOMIC STUDY
IDENTIFICATION
NAME OF LOCATION____
NAME OF HEAD OF HOUSEHOLD_____
EDSG CODE______
STRUCTURE NUMBER______
HOUSEHOLD NUMBER IN STRUCTURE_____
EDSG REGION______
PROVINCE___________
DEPARTMENT______
URBAN-RURAL MILIEU
URBAN 1
RURAL 2
RESIDENCE:
LIBREVILLE-PORT-GENTIL 1
OTHER CITIES 2
RURAL 3
Gabon 2012
Survey form
view entire document:
text
IDENTIFICATION
NAME OF PROVINCE______
NAME OF LOCATION______
NAME OF HEAD OF HOUSEHOLD_____
CLUSTER NUMBER_____
STRUCTURE NUMBER______
HOUSEHOLD NUMBER______
WOMAN'S NAME AND LINE NUMBER____
CHECK HOUSEHOLD QUESTIONNAIRE (Q 300):
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE:
Yes 1
No
Gambia 2013
No questionnaire text is available for this sample.
Gambia 2019
Survey form
view entire document:
text
103. Just before you moved here, did you live in an urban area or in a rural area?
URBAN AREA 1
RURAL AREA 2
Ghana 1988
No questionnaire text is available for this sample.
Ghana 1993
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Ghana 1998
Survey form
view entire document:
text
CITY/TOWN/VILLAGE _____
LARGE CITY 1
MEDIUM CITY 2
SMALL CITY 3
TOWN 4
VILLAGE 5
Ghana 2003
Survey form
view entire document:
text
URBAN/RURAL___
URBAN 1
RURAL 2
Ghana 2008
Survey form
view entire document:
text
URBAN/RURAL ______
URBAN 1
RURAL 2
Ghana 2014
Survey form
view entire document:
text
IDENTIFICATION
LOCALITY NAME _____
NAME OF HOUSEHOLD HEAD ____
CLUSTER NUMBER _____
STRUCTURE NUMBER _____
HOUSEHOLD NUMBER _____
REGION _____
DISTRICT _____
URBAN/RURAL
URBAN 1
RURAL 2
NAME AND LINE NUMBER OF WOMAN:
NAME ___________
LINE NO. ___________
Ghana 2016
Survey form
view entire document:
text
26 SEPT 2016
2016 GHANA MALARIA INDICATOR SURVEY FIELDWORKER QUESTIONNAIRE
GHANA STATISTICAL SERVICES
LANGUAGE OF QUESTIONNAIRE: ENGLISH
Ghana 2019
Survey form
view entire document:
text
103. Do you live in a city, town, or rural area?
CITY 1
TOWN 2
RURAL 3
Guinea 1999
Survey form
view entire document:
text
URBAN/RURAL:
URBAN 1
RURAL 2
Guinea 2005
Survey form
view entire document:
text
Guinea 2012
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Guinea 2018
Survey form
view entire document:
text
IDENTIFICATION
PLACE NAME
NAME OF HEAD OF HOUSEHOLD
CLUSTER NUMBER
HOUSEHOLD NUMBER
ADMINISTRATIVE REGION
NATURAL REGION
SANITATION DISTRICT NUMBER
LOCATION OF HOUSEHOLD
CONAKRY 1
OTHER CITY 2
RURAL 3
NAME AND LINE NUMBER OF WOMAN
Guinea 2021
Survey form
view entire document:
text
IDENTIFICATION (1)
NAME OF LOCALITY: ______
NAME OF HEAD OF HOUSEHOLD: ______
CLUSTER NUMBER ______
HOUSEHOLD NUMBER ______
NAME AND LINE NUMBER OF WOMAN ______
ADMINISTRATIVE REGION ______
NATURAL REGION ______
HEALTH DISTRICT NUMBER ______
AREA OF RESIDENCE (1 = CITY OF CONAKRY, 2 = OTHER CITY, 3 = RURAL)
______
India 1992
Survey form
view entire document:
text
URBAN/RURAL ______
URBAN 1
RURAL 2
India 1998
Survey form
view entire document:
text
URBAN/RURAL _______
URBAN 1
RURAL 2
India 2005
Survey form
view entire document:
text
MEGA CITY/LARGE CITY/SMALL CITY/LARGE TOWN/SMALL TOWN/RURAL _____
MEGA CITY 1
LARGE CITY 2
SMALL CITY 3
LARGE TOWN 4
SMALL TOWN 5
RURAL 6
India 2015
Survey form
view entire document:
text
NATIONAL FAMILY HEALTH SURVEY, INDIA 2015-2016 (NFHS-4)
WOMAN'S QUESTIONNAIRE
IDENTIFICATION
STATE___________
DISTRICT__________
TEHSIL/TALUK_________
TYPE OF PSU (URBAN EQUALS 1, RURAL EQUALS 2) ________
URBAN 1
RURAL 2
India 2019
No questionnaire text is available for this sample.
Jordan 1990
No questionnaire text is available for this sample.
Jordan 1997
No questionnaire text is available for this sample.
Jordan 2002
No questionnaire text is available for this sample.
Jordan 2007
Survey form
view entire document:
text
217) IF ALIVE:
How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS. IF LESS THAN 1 YEAR, RECORD '00'
AGE IN YEARS___
Jordan 2009
No questionnaire text is available for this sample.
Jordan 2012
No questionnaire text is available for this sample.
Jordan 2017
No questionnaire text is available for this sample.
Kenya 1989
Survey form
view entire document:
text
URBAN/RURAL
Urban 1
Rural 2
Kenya 1993
Survey form
view entire document:
text
NAIROBI/MOMBASA 1, SMALL CITY 2, TOWN 3, RURAL 4
NAIROBI/MOMBASA 1
SMALL CITY 2
TOWN 3
RURAL 4
Kenya 1998
Survey form
view entire document:
text
NAIROBI/MOMBASA 1
SMALL CITY 2
TOWN 3
RURAL 4
Kenya 2003
Survey form
view entire document:
text
LOCATION
NAIROBI/MOMBASA/KISUMU 1
NAKURU/ELDORET/THIKA/NYERI 2
SMALL TOWN 3
RURAL 4
Kenya 2008
Survey form
view entire document:
text
LOCATION/TOWN ____________
NAIROBI/MOMBASA/KISUMU 1
NAKURU/ELDORET/THIKA/NYERI 2
SMALL TOWN 3
RURAL 4
Kenya 2014
No questionnaire text is available for this sample.
Kenya 2015
No questionnaire text is available for this sample.
Kenya 2020
No questionnaire text is available for this sample.
Lesotho 2004
Survey form
view entire document:
text
IDENTIFICATION
PLACE NAME ___________________
NAME OF HOUSEHOLD HEAD ______________
EA NUMBER_____
HOUSEHOLD NUMBER____
LESOTHO ECOLOGICAL ZONE
LOWLANDS 1
FOOTHILLS 2
MOUNTAINS 3
SENQU RIVER VALLEY 4
DISTRICT
BUTHA-BUTHE 01
LERIBE 02
BEREA 03
MASERU 04
MAFETENG 05
MOHALE'S HOEK 06
QUTHING 07
QASHA'S NEK 08
MOKHOTLONG 09
THABA-TSEKA 10
URBAN/RURAL
URBAN 1
RURAL 2
NAME AND LINE NUMBER OF WOMAN ___
Lesotho 2009
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Lesotho 2014
No questionnaire text is available for this sample.
Liberia 1986
No questionnaire text is available for this sample.
Liberia 2007
Survey form
view entire document:
text
IDENTIFICATION
NAME OF COUNTY ___
NAME OF DISTRICT___
NAME OF CLAN/TOWNSHIP___
NAME OF CITY/TOWN/VILLAGE___
Liberia 2009
Survey form
view entire document:
text
IDENTIFICATION
NAME OF COUNTY
DISTRICT
CLAN/TOWNSHIP
LMIS CLUSTER NUMBER
HOUSEHOLD NUMBER
URBAN
MONROVIA 1
OTHER URBAN 2
VILLAGE 3
NAME OF HOUSEHOLD HEAD
NAME AND LINE NUMBER OF WOMAN
Liberia 2011
Survey form
view entire document:
text
IDENTIFICATION
NAME OF COUNTY
NAME OF DISTRICT
NAM OF CLAN/TOWNSHIP
NAME OF CITY/TOWN/VILLAGE
LMIS CLUSTER NUMBER
HOUSEHOLD NUMBER
URBAN
MONROVIA 1
OTHER URBAN 2
VILLAGE 3
NAME OF HOUSEHOLD HEAD
NAME AND LINE NUMBER OF WOMAN
Liberia 2013
No questionnaire text is available for this sample.
Liberia 2016
No questionnaire text is available for this sample.
Liberia 2019
Survey form
view entire document:
text
IDENTIFICATION
PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: HOUSEHOLD SELECTED FOR MAN'S SURVEY AND BIOMARKERS?
YES 1
NO 2
CHECK HOUSEHOLD QUESTIONNAIRE Q.61: WOMAN SELECTED FOR DV MODULE?
YES 1
NO 2
Madagascar 1992
No questionnaire text is available for this sample.
Madagascar 1997
No questionnaire text is available for this sample.
Madagascar 2003
No questionnaire text is available for this sample.
Madagascar 2008
No questionnaire text is available for this sample.
Madagascar 2011
Survey form
view entire document:
text
IDENTIFICATIONNAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
HOUSEHOLD NUMBER ______
REGION ______
COMMUNE ______
CITY/RURAL (CITY = 1, RURAL = 2) _______
NAME AND LINE NUMBER OF WOMAN ______
Madagascar 2013
Survey form
view entire document:
text
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
HOUSEHOLD NUMBER ______
REGION ______
COMMUNE ______
CITY/RURAL (CITY = 1, RURAL = 2) RESIDENCE ______
NAME AND LINE NUMBER OF WOMAN ______
Madagascar 2016
Survey form
view entire document:
text
IDENTIFICATION
PLACE NAME ______________________
NAME OF THE LOCALITY _______________________
NAME OF HOUSEHOLD HEAD ______________________________
CLUSTER NUMBER _____________________________
HOUSEHOLD NUMBER ______________________________
REGION ____
DISTRICT ____
COMMUNE ____
MILIEU
CITY 1
RURAL 2
Madagascar 2021
No questionnaire text is available for this sample.
Malawi 1992
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Malawi 2000
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Malawi 2004
Survey form
view entire document:
text
Malawi 2010
No questionnaire text is available for this sample.
Malawi 2012
No questionnaire text is available for this sample.
Malawi 2014
No questionnaire text is available for this sample.
Malawi 2016
Survey form
view entire document:
text
103. Just before you moved here, did you live in a city, in a town, or in a rural area?
CITY 1
TOWN 2
RURAL AREA 3
Malawi 2017
Survey form
view entire document:
text
103. Do you live in a city, town, or rural area?
CITY 1
TOWN 2
RURAL AREA 3
Mali 1987
No questionnaire text is available for this sample.
Mali 1995
Survey form
view entire document:
text
ARRONDISSEMENT__
BAMAKO 1
OTHER COMMUNE 2
OTHER CITIES 3
RURAL 4
Mali 2001
Survey form
view entire document:
text
URBAN/RURAL___
URBAN 1
RURAL 2
Mali 2006
Survey form
view entire document:
text
URBAN/RURAL ____
URBAN 1
RURAL 2
Mali 2012
Survey form
view entire document:
text
URBAN/RURAL MILIEU
URBAN 1
RURAL 2
Mali 2015
Survey form
view entire document:
text
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
ADMINISTRATIVE REGION ______
ENVIRONMENT (URBAN = 1, RURAL = 2) ______
DETAILED ENVIRONMENT (BAMAKO = 1, OTHER CITY = 2, RURAL = 3) ______
Mali 2018
No questionnaire text is available for this sample.
Mali 2021
Survey form
view entire document:
text
103. Do you live in Bamako, in another city, or in a rural area?
1 BAMAKO
2 OTHER CITY
3 RURAL AREA
Morocco 1992
Survey form
view entire document:
text
IDENTIFICATION
PROVINCE OR PREFECTURE
CIRCLE
MUNICIPALITY:
AUTONOMOUS CENTER
RURAL COMMUNE
CENTER
PRIMARY UNIT NUMBER
SECONDARY UNIT NUMBER
LEVEL:
RABAT-CASA 1
LARGE CITY 2
CITY 3
COUNTRYSIDE 4
HOUSEHOLD NUMBER
HOUSEHOLD ADDRESS
Morocco 2003
No questionnaire text is available for this sample.
Mozambique 1997
Survey form
view entire document:
text
URBAN OR RURAL?
URBAN 1
RURAL 2
Mozambique 2003
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Mozambique 2011
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Mozambique 2018
No questionnaire text is available for this sample.
Myanmar 2015
No questionnaire text is available for this sample.
Namibia 1992
No questionnaire text is available for this sample.
Namibia 2000
No questionnaire text is available for this sample.
Namibia 2006
No questionnaire text is available for this sample.
Namibia 2013
No questionnaire text is available for this sample.
Nepal 1996
Survey form
view entire document:
text
NEPAL FAMILY HEALTH SURVEY INDIVIDUAL QUESTIONNAIRE (ENGLISH)
IDENTIFICATION
DISTRICT NAME AND NUMBER
VILLAGE/MUNICIPALITY NAME AND NUMBER
WARD NUMBER
CLUSTER NUMBER
HOUSEHOLD NUMBER
CITY/TOWN/COUNTRYSIDE
City 1
Town 2
Countryside 3
NAME OF HOUSEHOLD HEAD
NAME AND LINE NUMBER OF WOMAN
Nepal 2001
No questionnaire text is available for this sample.
Nepal 2006
No questionnaire text is available for this sample.
Nepal 2011
No questionnaire text is available for this sample.
Nepal 2016
No questionnaire text is available for this sample.
Niger 1992
Survey form
view entire document:
text
VILLAGE/QUARTER ___
NIAMEY 1
AGADEZ, MARADI, TAHOUA, ZINDER 2
OTHER CITY 3
RURAL 4
Niger 1998
Survey form
view entire document:
text
URBAN/RURAL:
URBAN 1
RURAL 2
Niger 2006
Survey form
view entire document:
text
URBAN/RURAL:
URBAN 1
RURAL 2
Niger 2012
Survey form
view entire document:
text
URBAN/RURAL ___________
URBAN 1
RURAL 2
Niger 2021
Survey form
view entire document:
text
103. Do you live in a big city, a small city, or a rural area?
1 BIG CITY
2 SMALL CITY
3 RURAL AREA
Nigeria 1990
Survey form
view entire document:
text
URBAN/RURAL
URBAN 1
RURAL 2
Nigeria 1999
Survey form
view entire document:
text
URBAN/RURAL___
URBAN 1
RURAL 2
Nigeria 2003
Survey form
view entire document:
text
URBAN/RURAL ___
URBAN l
RURAL 2
Nigeria 2008
Survey form
view entire document:
text
URBAN/RURAL:
URBAN l
RURAL 2
Nigeria 2010
Survey form
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text
IDENTIFICATION
STATE __
LOCAL GOVT. AREA __
LOCALITY __
ENUMERATION AREA __
URBAN/RURAL (URBAN = 1, RURAL = 2) __
CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD HEAD NAME/NUMBER __
NAME AND LINE NUMBER OF WOMAN __
Nigeria 2013
Survey form
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URBAN/RURAL
URBAN 1
RURAL 2
Nigeria 2015
Survey form
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IDENTIFICATION
STATE __
LOCAL GOVT. AREA __
LOCALITY __
ENUMERATION AREA __
URBAN/RURAL (URBAN = 1, RURAL = 2) __
CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD HEAD NAME/HOUSEHOLD NUMBER __
NAME AND LINE NUMBER OF WOMAN __
Nigeria 2018
No questionnaire text is available for this sample.
Nigeria 2021
No questionnaire text is available for this sample.
Pakistan 1991
Survey form
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IDENTIFICATION
PLACE NAME_______________
NAME OF HOUSEHOLD____________
PROVINCE ____
URBAN/RURAL
URBAN 1
RURAL 2
MAJOR CITY/DIVISION/DISTRICT ____
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
MAJOR CITY/SMALL CITY, TOWN/VILLAGE
MAJOR CITY 1
SMALL CITY, TOWN 2
VILLAGE 3
NAME AND LINE NUMBER OF WOMEN______________
NAME AND LINE NUMBER OF HUSBAND (IF ELIGIBLE)
Pakistan 2006
No questionnaire text is available for this sample.
Pakistan 2012
No questionnaire text is available for this sample.
Pakistan 2017
No questionnaire text is available for this sample.
Rwanda 1992
Survey form
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URBAN/RURAL
URBAN 1
RURAL 2
Rwanda 2000
Survey form
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text
URBAN/RURAL___
URBAN 1
RURAL 2
Rwanda 2005
Survey form
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text
URBAN/RURAL _______
URBAN 1
RURAL 2
Rwanda 2008
Survey form
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IDENTIFICATION
VILLAGE NAME
NAME OF HOUSEHOLD HEAD
PROVINCE
DISTRICT
CLUSTER NUMBER
STRUCTURE NUMBER
HOUSEHOLD NUMBER
URBAN/RURAL
URBAN = 1
RURAL = 2
CITY OF KIGALI/OTHER CITY/RURAL
CITY OF KIGALI = 1
OTHER CITY = 2
RURAL = 3
NAME AND LINE NUMBER OF WOMAN
Rwanda 2010
No questionnaire text is available for this sample.
Rwanda 2013
No questionnaire text is available for this sample.
Rwanda 2014
No questionnaire text is available for this sample.
Rwanda 2017
No questionnaire text is available for this sample.
Rwanda 2019
Survey form
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IDENTIFICATION
PROVINCE: __
DISTRICT: __
SECTOR: __
NAME OF HOUSEHOLD HEAD __
CLUSTER NUMBER __
STRUCTURE NUMBER __
HOUSEHOLD NUMBER __
NAME AND LINE NUMBER OF WOMAN __
HOUSEHOLD SELECTED FOR WOMAN DV MODULE?
YES 1
NO 2
WOMAN SELECTED FOR DV MODULE?
YES 1
NO 2
Sao Tome 2008
No questionnaire text is available for this sample.
Senegal 1986
No questionnaire text is available for this sample.
Senegal 1992
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Senegal 1997
Survey form
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text
URBAN/RURAL ?
URBAN 1
RURAL 2
Senegal 2005
Survey form
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text
URBAN/RURAL___
URBAN 1
RURAL 2
Senegal 2006
Survey form
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IDENTIFICATION
NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
HOUSEHOLD NUMBER ______
CONCESSION NUMBER ______
CLUSTER NUMBER ______
HEALTH DISTRICT ______
URBAN/RURAL (URBAN = 1, RURAL = 2) ENVIRONMENT ______
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
(DAKAR = 1, REGIONAL CAPITAL = 2, OTHER CITY = 3, RURAL = 4) DETAILED ENVIRONMENT ______
NAME AND LINE NUMBER OF WOMAN ______
CLUSTER NUMBER IN DHS-IV 2005 ______
HOUSEHOLD SURVEYED IN DHS-IV 2005? (YES = 1, NO = 2) ______
HOUSEHOLD NUMBER IN DHS-IV 2005 ______
WOMAN SURVEYED IN DHS-IV 2005? (YES = 1, NO = 2) ______
WOMAN'S LINE NUNBER IN DHS-IV ______
Senegal 2008
Survey form
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IDENTIFICATION
REGION______
HEALTH DISTRICT ______
DISTRICT MUNICIPALITY/RURAL COMMUNITY ______
CLUSTER NUMBER ______
NAME OF HEAD OF CONCESSION ______
NAME OF HEAD OF HOUSEHOLD ______
HOUSEHOLD NUMBER IN SAMPLE ______
NAME OF LOCALITY (DISTRICT MUNICIPALITY IN DAKAR, MUNICIPALITY, RURAL COMMUNITY) ______
URBAN/RURAL (URBAN = 1, RURAL = 2) ENVIRONMENT ______
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
(DAKAR = 1, REGIONAL CAPITAL = 2, OTHER CITY = 3, RURAL = 4) DETAILED ENVIRONMENT ______
NAME AND LINE NUMBER OF WOMAN ______
HOUSEHOLD SAMPLE (OF THE 30 IN CLUSTER)? (YES = 1, NO = 2) ______
HOUSEHOLD CHOSEN FOR ANEMIA/MALARIA TEST? (YES = 1, NO = 2) ______
Senegal 2010
Survey form
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URBAN/RURAL:
URBAN 1
RURAL 2
Senegal 2012
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Senegal 2014
Survey form
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URBAN/RURAL
URBAN 1
RURAL 2
Senegal 2015
No questionnaire text is available for this sample.
Senegal 2016
Survey form
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IDENTIFICATION
PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD ______
HOUSEHOLD NUMBER ____
PLOT NUMBER ____
CLUSTER NUMBER _____
REGION ____
DEPARTMENT ____
SANITATION DISTRICT ____
URBAN/RURAL
URBAN 1
RURAL 2
MILIEU ____
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4
WOMAN'S NAME AND LINE NUMBER _____
CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE
HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?
YES 1
NO 2
IF HOUSEHOLD SELECTED FOR DV, CHECK WOMEN'S SELECTION TABLE (Q157A OF HOUSEHOLD QUESTIONNAIRE)
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?
YES 1
NO 2
Senegal 2017
Survey form
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IDENTIFICATION
PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD ______
HOUSEHOLD NUMBER ____
PLOT NUMBER ____
CLUSTER NUMBER _____
REGION ____
DEPARTMENT ____
SANITATION DISTRICT ____
URBAN/RURAL
URBAN 1
RURAL 2
MILIEU ____
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4
WOMAN'S NAME AND LINE NUMBER _____
CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE
HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?
YES 1
NO 2
IF HOUSEHOLD SELECTED FOR DV, CHECK WOMEN'S SELECTION TABLE (Q157A OF HOUSEHOLD QUESTIONNAIRE)
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?
YES 1
NO 2
Senegal 2021
Survey form
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IDENTIFICATION
NAME OF REGION ______
NAME AND NUMBER OF HEAD OF HOUSEHOLD ______
CONCESSION NUMBER ______
CLUSTER NUMBER ______
REGION ______
DEPARTMENT ______
HEALTH DISTRICT ______
URBAN/RURAL (URBAN = 1, RURAL = 2) ______
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
(DAKAR = 1, REGIONAL CAPITAL = 2, OTHER CITY = 3, RURAL = 4)______
NAME AND LINE NUMBER OF WOMAN ______
Sierra Leone 2008
Survey form
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URBAN-RURAL
RURAL 1
URBAN 2
Sierra Leone 2013
Survey form
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RURAL/URBAN
RURAL 1
URBAN 2
Sierra Leone 2016
Survey form
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IDENTIFICATION
LOCALITY NAME __
NAME OF HOUSEHOLD HEAD __
CLUSTER NUMBER __
DISTRICT __
PROVINCE __
CHIEFDOM __
SECTION __
ENUMERATION AREA __
URBAN-RURAL (RURAL = 1, URBAN = 2) __
Sierra Leone 2019
Survey form
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SIERRA LEONE DEMOGRAPHIC AND HEALTH SURVEY 2018
WOMAN'S QUESTIONNAIRE
IDENTIFICATION
LOCALITY NAME ___
LOCAL COUNCIL___
NAME OF HOUSEHOLD HEAD___
PROVINCE NAME AND CODE___
DIRECT CODE___
CHIEFDOM CODE___
SECTION CODE___
CLUSTER NUMBER___
ENUMERATION AREA CODE___
RURAL / URBAN
RURAL 1
URBAN 2
HOUSEHOLD NUMBER___
NAME AND LINE NUMBER OF WOMAN
HOUSEHOLD SELECTED FOR DV MODULE?
YES 1
NO 2
South Africa 1998
No questionnaire text is available for this sample.
South Africa 2016
No questionnaire text is available for this sample.
Sri Lanka 1987
Survey form
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104) First I would like to ask some questions about yourself and your household. For most of the time until you were 12 years old, did you live in metropolitan Colombo, another urban area, in a village, or on an estate?
COLOMBO METRO (ZONE 1) 1
OTHER URBAN 2
VILLAGE 3
ESTATE 4
Sudan 1989
No questionnaire text is available for this sample.
Tanzania 1991
Survey form
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URBAN/RURAL ___
URBAN 1
RURAL 2
Tanzania 1996
No questionnaire text is available for this sample.
Tanzania 1999
No questionnaire text is available for this sample.
Tanzania 2004
No questionnaire text is available for this sample.
Tanzania 2010
No questionnaire text is available for this sample.
Tanzania 2015
No questionnaire text is available for this sample.
Tanzania 2017
No questionnaire text is available for this sample.
Togo 1988
No questionnaire text is available for this sample.
Togo 1998
Survey form
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text
URBAN OR RURAL?
URBAN 1
RURAL 2
Togo 2013
Survey form
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text
Togo 2017
Survey form
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103. Do you live in a city, small town or in a rural area?
1 CITY
2 SMALL TOWN
3 RURAL AREA
Tunisia 1988
No questionnaire text is available for this sample.
Uganda 1988
No questionnaire text is available for this sample.
Uganda 1995
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Uganda 2001
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Uganda 2006
No questionnaire text is available for this sample.
Uganda 2009
Survey form
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SECTION 1A: IDENTIFICATION
REGION_
DISTRICT_
COUNTY_
SUBCOUNT/TOWN_
PARISH/LC2 NAME_
EA NAME_
UMIS NUMBER_
URBAN=1, PERI URBAN=2, RURAL=3_
NAME OF HEAD OF HOUSEHOLD_
HOUSEHOLD NUMBER_
HOUSEHOLD SAMPLE NUMBER_
Uganda 2011
No questionnaire text is available for this sample.
Uganda 2014
Survey form
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IDENTIFICATION (1)
REGION ___
DISTRICT ___
COUNTY ___
SUBCOUNTY/TOWN ___
PARISH/LC2 NAME ____
EA NAME ____
UMIS NUMBER ___
URBAN 1
PERI URBAN 2
RURAL 3
NAME AND LINE NUMBER OF WOMAN ___
HOUSEHOULD NUMBER ____
HOUSEHOLD SAMPLE NUMBER ___
Uganda 2016
No questionnaire text is available for this sample.
Uganda 2018
No questionnaire text is available for this sample.
Yemen 1991
No questionnaire text is available for this sample.
Yemen 2013
No questionnaire text is available for this sample.
Zambia 1992
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Zambia 1996
Survey form
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text
URBAN OR RURAL?
URBAN 1
RURAL 2
Zambia 2001
Survey form
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text
URBAN/RURAL___
URBAN 1
RURAL 2
Zambia 2007
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Zambia 2013
Survey form
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text
RURAL/URBAN
RURAL 1
URBAN 2
Zambia 2018
No questionnaire text is available for this sample.
Zimbabwe 1988
No questionnaire text is available for this sample.
Zimbabwe 1994
Survey form
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text
URBAN OR RURAL?
Urban 1
Rural 2
Zimbabwe 1999
Survey form
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text
URBAN/RURAL
URBAN 1
RURAL 2
Zimbabwe 2005
Survey form
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text
LARGE CITY/SMALL CITY/TOWN/RURAL
HARARE 1
SMALL CITY 2
TOWN 3
RURAL 4
Zimbabwe 2010
No questionnaire text is available for this sample.
Zimbabwe 2015
No questionnaire text is available for this sample.