household schedule - Measurement, Learning & Evaluation Project

OFFICE USE ONLY: QUESTIONNAIRE NO: [__|__|__|__|__|__|__|__|__|]
(cluster code 4 digits + HH number 3 digits + household division number 2 digits)
MLE Project - Nigeria
WOMEN’SHOUSEHOLD QUESTIONNAIRE 2012
ENGLISH / YORUBA
BASELINE STATE NAME & CODE __________________________________________________
BASELINE CITY NAME & CODE____________________________________________________
(Abuja=1, Ibadan=3, Ilorin=4, Kaduna=5)
BASELINE LGA NAME & CODE ____________________________________________________
(IF RELOCATED) MID-TERM CITY NAME & CODE ________________________________
(Abuja=1, Ibadan=3, Ilorin=4, Kaduna=5)
(IF RELOCATED) MID-TERM LGA NAME & CODE _________________________________
BASELINE CLUSTER NAME & CODE ____________________________________________
BASELINEHOUSEHOLD NUMBER ……………………………………………………………………
HOUSEHOLD DIVISION NUMBER (for women’s HH interviews only)……………………………………………..
(Same HH=0, Household divided/1 st new household =1, Household divided/2 nd new household =2, etc.)
[__|__|__]
[__]
[__|__|__]
[__]
[__|__|__]
[__|__|__|__]
[__|__|__]
[__|__]
HOUSEHOLD HEAD NAME _____________________________________________________
[surname, given name]
ADDRESS OF HOUSEHOLD ____________________________________________________
INTERVIEWER VISITS
VISIT NUMBER 1 2 3 FINAL VISIT
DATE
DAY/ MONTH/ YEAR
[____/_____/_12_]
DAY/ MONTH/ YEAR
[____/_____/__12_]
DAY/ MONTH/ YEAR
[____/_____/__12__]
DAY
[____|____]
MONTH
YEAR
[____|____]
[_2_|_0_|_1_|_2_]
INTERVIEWER’S NAME
_________________
________________
________________
_____________________
INTERVIEWER CODE
RESULT*
NEXT VISIT:
*RESULT CODES:
DATE
TIME OF VISIT
[____/_____/12_]
H H M M
1. COMPLETED
2. NO HOUSEHOLD MEMBER AT HOME OR
NO COMPETENT RESPONDENT AT
HOME AT TIME OF VISIT
3. ENTIRE HOUSEHOLD ABSENT FOR
EXTENDED PERIOD OF TIME
4. POSTPONED
MAIN LANGUAGE OF INTERVIEW
LANGUAGE
[____/_____/12_]
H H M M
TRANSLATOR USED? YES= 1 NO=2
5. REFUSED
6. DWELLING VACANT OR ADDRESS NOT
A DWELLING
7. DWELLING DESTROYED
8. DWELLING NOT FOUND
9. OTHER ____________________
(Specify)
LANGUAGE CODES: HAUSA=1 YORUBA=2 ENGLISH = 3 PIDGIN = 4 OTHERS = 6 ( specify_____________ )
TOTAL NO. OF VISITS
TOTAL PERSONS IN
HOUSEHOLD
TOTAL
ELIGIBLE
BASELINE WOMEN
LINE NO. OF
RESPONDENT TO
HH SCHEDULE
SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY
NAME…………………….……….…
NAME…………………………..
NAME…………………………..
NAME…………………………..
CODE:
CODE:
CODE:
CODE:
DATE [__ / ___/ 12_]
DATE [__ / __/ 12_]
DATE [__ / __/ 12_]
DATE [__ / __/ 12_]
DD MM
YY
DD MM
YY
DD MM
YY
DD MM
YY
1

Introduction
Household Head Consent: Household-Based Survey on Family Planning
Hello! My name is _________________________________, I am part of a research team working for the National Population Commission
under the Monitoring, Learning and Evaluation Project. We are carrying out research on childbirth spacingin urban areas of Nigeria. Your
participation in this study will help to improve child spacing/birth spacingservices in this city. We will be asking questions to women ages 15-49
in this household and in some households men ages 15-59 for this study. We would also like to ask some questions from you about household
assets, a list of the people who usually live in the household, and details about the head of the household.
Are you the head of the household? Are you interested in participating? Please let me tell you more about it.
E nlee o! Oruko mi ni_________________________________, Mo je okan ninu awon oluwadi ti o n se ise fun ile ise eleto
ikaniyan (National Population Commission). A nse iwadi lori ifeto s’omobibi ni awon ilu nla ni Nigeria. Ipa ti e o ko ninu
iwadi yi yio se iranwo lati mu ifeto s’omobibi dara si ni ilu nla yi. A o maa bere awon ibere lowo gbogbo awon obirin ti o je
omo odun medoogun si okandini – aadoota (15-49)ninu ebi yi, atipe ninu awon ebi kokan, ao ma se ibere lowo okunrin ti
ojo ori won je medoogun si okandini ogota fun eto iwadi yi. A maa fe lati se ibeere lowo yin nipa awon ohun elo ti ebi yi ni
, awon enia ti o n gbe pelu ebi yin pelu alaye lekunrere nipa olori ebi yi.
Se eyin ni olori ebi yi? Se e nifesi lati kopa? Ejowo e je ki nso fun yin nipa iwadi yi.
Explanation of Procedures
Being part of this study involves answering questions during a short interview that will take about 45 minutes. To join the study is voluntary. You
may refuse to participate, or you may stop the interview at any point. If you stop the interview, there will be no effect on the household’s access
to health services in the future.
Ki kopa ninu iwadi yi gba pe ki e se idahun si awon ibeere lakoko iforowanilenuwo kukuru tiko ni gba wa ju bi iseju marun
di laadota. Lati kopa ninu iwadi yi je ife lati okan yin. E le ko lati kopa tabi da iforowanilenuwo yi duro ni akoko ki akoko.
Ti e ba da iforowanilenuwo yi duro, eyi ko le ni ohunkohun se pelu anfani si eto ilera ebi yi ni ojo iwaju
Confidentiality
Your answers will not be shared with anyone outside the research project. All interviews will be held in private. Your name will not appear on
the survey. We will not share your answers with community members, health providers, family or anyone else. At the end of the study, we will
put all the answers together and make a report.
Your contact information will be kept in a locked cabinet, and kept apart from your answers to the questions. Once the study is finished, the list
of names with your contact information, and the completed questionnaires will be destroyed.
A ko ni je ki awon idahun yin di mimo fun elomiran ti ko kopa ninu eto iwadi yi. Gbogbo iwadi yi ni a o se ni ikoko. Oruko
yin ko ni han ninu iwadi yi. A ko si ni fi awon idahun yin han fun awon ara ilu yin, osise eleto ilera , ara ile yin tabi
enikeni miran. Ni ipari iwadi yi, ao se apapo gbogbo awon idahun iwadi yi ao si se akoole abajade re . Ni afikun eto iwadi
yi loni, ao fe lati se ipade pelu yin ati awon obirin toku lee meji si, ki a le se awon ibeere die si. A o fe lati ri yin ni odun
meji si akoko yi ki a le se iwadilowo yin fun igba keta. A o fe lati se awon ibere wonyi lee meta lati ri bi nkan se nyato si
ninu ebi. Nitorina ki ale ri ebi yin ni igba miran, a ni lati beere ibeere nipa nibo, bawo ati akoko wo ni o dara ju lati ri yin.
A o se akikitiyan lati se eto iwadi ti o mbo lai je pe enikeni mo si. Akoole nipa bi ase le ri yin yio wa ni ipamo ni ibi ti o tun
yato si ibi ti a maa pa awon idahun yin mo si. Ni kete ti aba pari ise lori iwadi yi, a o fi ina jo gbogbo awon iwe
iforowanilenuwo pelu gbogbo awon ibi ti a se akoole oruko yin ati bi ati le ri yin si.
Benefits
You may not personally benefit from being in this study, but research helps society by providing new knowledge. The answers to our survey will
help us design better programs to improve women’s and men’s reproductive health in Nigeria.
Eyin gege bi eni kan le ma ni anfani latari pe ekopa ninu iwadi yi, sugbon, iwadi a ma n ran awujo lowo lati ni imo tuntun.
Awon idahun si iwadi wa yi yio ran wa lowo lati se agbekale awon eto ti o le mu iyipada rere ba eto ilera awon obinrin ati
okunrin orile ede Nigeria.
Risks and Discomforts
There is the possibility you may feel uncomfortable about a question I ask. If you feel uncomfortable about any of the questions, you do not
have to answer them. I can skip those questions and go on to the next section. You can end the interview at any time.
There is also the possibility that someone may approach us during the interview to find out what we are discussing. We intend to do this
interview in private, if someone approaches us, we will stop the interview until we can continue in private. Some questions may not apply to you,
but the interviewer must ask the same questions of everyone.
O seese ki e lora nipa ibeere ti mo fe beere lowo yin, ti ibeere ki ibeere o ba te yin lorun, ko je dandanwipe ki e dahunwon
mo le fo awon ibeere na ki asi lo si awon toku. E le mu opin wa si iforowanilenu wo yi ni akoko ki akoko.
O se se ki enikan wole lakoko ti ansoro, ero wa ni lati se ohun gbogbo ni bonkele , nitorina ti eyi ba wa ye a o da ibeere
duro titi di igba ti aba le te si waju ni bonkele. Awon ibeere kookan le ma je mo yin, sugbon oluwadi nilati beere ibeere
wonyi lowo gbogbo eniyan.
Costs and Payment
There are no costs for being in this study. You will not receive any money for taking part in this study.
Kosi ohunkohun ti e nilati san fun ikopa ninu iwadi yi. Ako si ni san owo fun yin fun ikopa yin ninu iwadi.
2

Questions /Your rights as Participants
This study has been approved by the Nigerian Ministry of Health Ethics Review Board and the University of North Carolina (USA). If you have
any questions about this study or the results, you can contact the following: The study coordinator at the National Population Commission (Mr.
Bolaji Akinsulie at 0802-330-7806 or the Institutional Review Board at the University of North Carolina at +1 919-966-3113. You have the right
to ask, and have answered, any questions you may have about this research. If you have questions or concerns, you should contact the
researchers listed above, or ask me before or after the interview. Do you have any questions now?
Iwadi yi ti gba ase ijoba orile ede yi ti Nigerian Ministry of Health Ethics Review Board n se akoso re, ile eko nla ni ilu
okeere (the University of North Carolina (USA). Ti eba ni ibeere lori iwadi yi tabi abajade re, e le kan si awon alakoso eto
iwadi wonyi – The Project Director Mr. Bolaji Babatunde Akinsulie at the National Population Commission (0803-497-
0932) tabi Ajo awon Alayewo ni University of North Carolina +1 919-966-3113. Eni eto lati beere ohunkohun nipa iwadi
yi ki esi gba idahun . Ti e ba ni ibeere ki e kan si awon oruko ti ako siwaju tabi ki e beere lowo mi ki a to beere tabi ti aba
pari iwadi yi. Nje e ni ibeere Kankan bayi?
Consent
Now, can you tell me if you agree to participate in this research? If you say yes, it means that you have agreed to be part of the study.
Bayi, nje e le so fun mi ti e ba fara mo ki e kopa ninu iwadi yi? Ti e ba so pe beni o tumo si pe eti gba lati kopa ninu
iwadi yi.
Yes ………………………………………1
No …………………………………………2
CONTINUE
THANK RESPONENT AND END INTERVIEW
Would you like a copy of this document?
Nje e o fe lati ni okan ninu awon iwe yi?
Yes ………………………………………1
No …………………………………………2
Signature of interviewer: __________________________________________
Date: _________________________________________________________
3

RECORD START TIME: HOUR………………………………………………[__|__] MINUTES……………………………..[__|__]
HOUSEHOLD SCHEDULE
Now we would like some information about the people who usually live in your household or who are staying with you now, starting with the household head.
Bayi a nfe awon ifitonileti nipa awon ti o ngbe pelu ebi yin tabi ti o ngbe pelu yin bayi, bere lati olori ebi
(1) (2) (3) (4) (5) (6) (7) (10)
Line No.
Name
Usual residents and
visitors
Please give me the names of
the persons who usually live
in your household, or who
are staying with you now
starting with the head of the
household.
E jowo e fun mi loruko
awon eniyan ti won n gbe
ninu ebi yin ati awon alejo
ti won sun sibi lale ana,
Bere lati olori ebi?
Relationship
to head of
household
(use codes
below)
What is the
relationship of
(NAME) to the
HH head?
Bawo ni
(ORUKO) ti se je
si olori ebi
Sex
Is (NAME)
male or
female?
Se okunrin ni
(ORUKO) tabi
obinrin?
MALE=1
FEMALE=2
Q5A
Does (NAME)
usually live
here?
Se (ORUKO) n
gbe po pelu yin
ni bi?
YES=1
NO=2
IF YES SKIP
TO Q6
Residence
Q5B
Did (NAME)
stay here last
night?
Se (ORUKO)
sun nibi lale
ana?
YES=1
NO=2
How old is
(NAME)?
Age MARITAL STATUS ELIGIBILITY
Omo odun
melo ni
(ORUKO)
IF BELOW 1
YEAR OLD,
ENTER 00
IF AGED 10 YEARS AND
OLDER
What is the current marital
status of (NAME)?
Ipo wo ni (ORUKO) wa bayi
nipa loko laya?
1= MARRIED OR LIVING
TOGETHER
2= DIVORCED/SEPARATED
3= WIDOWED
4= NEVER MARRIED
INTERVIEWED AT
BASELINE
COPY THE WOMAN’S
BASELINE LINE NUMBER
HERE
WOMEN MUST HAVE A
BASELINE NUMBER TO BE
ELIGIBLE TO PARTICIPATE
01. HH Head: M F
0 1 1 2
YES NO
1 2
YES NO
1 2
02.
03.
04.
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
Just to make sure that I have a complete listing. Are there any other persons such as small children or infants that we have not listed? (If yes, add to table).
Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here? (If yes, add to table).
Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed? (If yes, add to table).
CODES FOR Q3: RELATIONSHIP TO HEAD OF HOUSEHOLD:
01 HEAD 06 PARENT 11 OTHER RELATIVE 96. OTHER
02 SPOUSE 07 PARENT IN LAW 12 ADOPTED/FOSTER/STEPCHILD 98. DON’T KNOW
03 SON OR DAUGHTER 08 BROTHER OR SISTER 13 DOMESTIC SERVANT
04 SON- OR DAUGHTER-IN LAW 09 BROTHER OR SISTER –IN- LAW 14 NOT RELATED
05 GRANDCHILD 10 NIECE/NEPHEW 15CO-WIFE
4

(1) (2) (3) (4) (5) (6) (7) (10)
Line No.
Name
Usual residents and
visitors
Please give me the names of
the persons who usually live
in your household, or who
are staying with you now
starting with the head of the
household.
E jowo e fun mi loruko
awon eniyan ti won n gbe
ninu ebi yin ati awon alejo
ti won sun sibi lale ana,
Bere lati olori ebi?
Relationship
to head of
household
(use codes
below)
What is the
relationship of
(NAME) to the
HH head?
Bawo ni
(ORUKO) ti se je
si olori ebi
Sex
Is (NAME)
male or
female?
Se okunrin ni
(ORUKO) tabi
obinrin?
MALE=1
FEMALE=2
Q5A
Does (NAME)
usually live
here?
Se (ORUKO) n
gbe po pelu yin
ni bi?
YES=1
NO=2
IF YES SKIP
TO Q6
Residence
Q5B
Did (NAME)
stay here last
night?
Se (ORUKO)
sun nibi lale
ana?
YES=1
NO=2
How old is
(NAME)?
Age MARITAL STATUS ELIGIBILITY
Omo odun
melo ni
(ORUKO)
IF BELOW 1
YEAR OLD,
ENTER 00
IF AGED 10 YEARS AND
OLDER
What is the current marital
status of (NAME)?
Ipo wo ni (ORUKO) wa bayi
nipa loko laya?
1= MARRIED OR LIVING
TOGETHER
2= DIVORCED/SEPARATED
3= WIDOWED
4= NEVER MARRIED
INTERVIEWED AT
BASELINE
COPY THE WOMAN’S
BASELINE LINE NUMBER
HERE
WOMEN MUST HAVE A
BASELINE NUMBER TO BE
ELIGIBLE TO PARTICIPATE
05. M F
1 2
YES NO
1 2
YES NO
1 2
06.
07.
08.
09.
10.
11.
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
Just to make sure that I have a complete listing. Are there any other persons such as small children or infants that we have not listed? (If yes, add to table).
Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here? (If yes, add to table).
Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed? (If yes, add to table).
CODES FOR Q3: RELATIONSHIP TO HEAD OF HOUSEHOLD:
01 HEAD 06 PARENT 11 OTHER RELATIVE 96. OTHER
02 SPOUSE 07 PARENT IN LAW 12 ADOPTED/FOSTER/STEPCHILD 98. DON’T KNOW
03 SON OR DAUGHTER 08 BROTHER OR SISTER 13 DOMESTIC SERVANT
04 SON- OR DAUGHTER-IN LAW 09 BROTHER OR SISTER –IN- LAW 14 NOT RELATED
05 GRANDCHILD 10 NIECE/NEPHEW 15CO-WIFE
5

(1) (2) (3) (4) (5) (6) (7) (10)
Line No.
Name
Usual residents and
visitors
Please give me the names of
the persons who usually live
in your household, or who
are staying with you now
starting with the head of the
household.
E jowo e fun mi loruko
awon eniyan ti won n gbe
ninu ebi yin ati awon alejo
ti won sun sibi lale ana,
Bere lati olori ebi?
Relationship
to head of
household
(use codes
below)
What is the
relationship of
(NAME) to the
HH head?
Bawo ni
(ORUKO) ti se je
si olori ebi
Sex
Is (NAME)
male or
female?
Se okunrin ni
(ORUKO) tabi
obinrin?
MALE=1
FEMALE=2
Q5A
Does (NAME)
usually live
here?
Se (ORUKO) n
gbe po pelu yin
ni bi?
YES=1
NO=2
IF YES SKIP
TO Q6
Residence
Q5B
Did (NAME)
stay here last
night?
Se (ORUKO)
sun nibi lale
ana?
YES=1
NO=2
12. M F YES NO YES NO
1 2 1 2 1 2
13.
0
1
1 2 1 2 1 2
How old is
(NAME)?
Age MARITAL STATUS ELIGIBILITY
Omo odun
melo ni
(ORUKO)
IF BELOW 1
YEAR OLD,
ENTER 00
IF AGED 10 YEARS AND
OLDER
What is the current marital
status of (NAME)?
Ipo wo ni (ORUKO) wa bayi
nipa loko laya?
1= MARRIED OR LIVING
TOGETHER
2= DIVORCED/SEPARATED
3= WIDOWED
4= NEVER MARRIED
INTERVIEWED AT
BASELINE
COPY THE WOMAN’S
BASELINE LINE NUMBER
HERE
WOMEN MUST HAVE A
BASELINE NUMBER TO BE
ELIGIBLE TO PARTICIPATE
14.
15.
16.
17.
18.
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
1 2 1 2 1 2
Just to make sure that I have a complete listing. Are there any other persons such as small children or infants that we have not listed? (If yes, add to table).
Are there any other people who may not be members of your family, such as domestic servants, lodgers, or friends who usually live here? (If yes, add to table).
Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed? (If yes, add to table)
CODES FOR Q3: RELATIONSHIP TO HEAD OF HOUSEHOLD:
01 HEAD 06 PARENT 11 OTHER RELATIVE 96. OTHER
02 SPOUSE 07 PARENT IN LAW 12 ADOPTED/FOSTER/STEPCHILD 98. DON’T KNOW
03 SON OR DAUGHTER 08 BROTHER OR SISTER 13 DOMESTIC SERVANT
04 SON- OR DAUGHTER-IN LAW 09 BROTHER OR SISTER –IN- LAW 14 NOT RELATED
05 GRANDCHILD 10 NIECE/NEPHEW 15CO-WIFE
6

BASIC CHARACTERISTICS
NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP
Q11
FAMILY BACKGROUND
How long has your family/household continuously lived in (NAME
OF CURRENT PLACE OF RESIDENCE)
MONTHS…………………… 1 [__|__]
Q12
O to igba wo ni idile/ebi yin ti ngbe ni
(NAME OF CURRENT PLACE OF RESIDENCE )
IF A FEW WEEKS TO 11 MONTHS, RECORD 00-11.
OTHERWISE, RECORD NUMBER OF YEARS.
Where is the ancestral home of the household head located?
Nibo ni ile abinibi yin wa?
LEGAL STATUS
YEARS……………………….2 [__|__]
ALWAYS………………………..995
ABUJA………..…………………………. 01
BENIN CITY………….………………… 02
IBADAN……..……….…………………. 03
ILORIN……………… …………………. 04
KADUNA…………… ………………….. 05
ZARIA……………………………………...06
OTHER CITY IN NIGERIA………………07
RURAL VILLAGE IN NIGERIA……..…..08
OUTSIDE NIGERIA..……………………..09
Q13
Q14
Does your household own this structure (house, flat, shack), do
you rent it, or do you live here without paying?
Nje eyin ni o ni ile yi tabi e yagbe ni, tabi e n gbe bi yi lai san
owo ni?
OWN ....................................................... 1
RENT/LEASE .......................................... 2
NO RENT, WITH CONSENT OF
OWNER………………………………… 3
NO RENT, SQUATTING………………… 4
OTHER__________________________ 6
(SPECIFY)
DON’T KNOW ......................................... 8
Who owns the land on which this structure (house, flat, shack) RESPONDENT/HOUSEHOLD…………..01
stands?
GOVERNMENT (NON-TENURE LAND)..02
GOVERNMENT (WORKER HOUSING)..03
Tani o ni ile ti ako ile yi le lori?
EMPLOYER (NON-GOVERNMENT)..... ..04
LANDLORD .......................................... ..05
RELATIVE ...............................................06
OTHER__________________________96
(SPECIFY)
DON'T KNOW ........................................ 98
BASIC PHYSICAL CHARACTERISTICS
Q15
How many rooms in total are in your household, including rooms
for sleeping and all other rooms (not including bathrooms and
kitchen)?
ROOMS (TOTAL)…………………
Q16
Q17
Q18
Ni apapo, yara melo ni ebi yin ni, eleyi pelu yara ibusun ati awon
yara iyoku (eleyi ko pelu ile iwe ati ile idana)?
How many rooms are used for sleeping in your household?
Yara melo ni ebi yin n lo fun sisun?
What type of fuel does your household mainly use for cooking?
Iru eto idanaa wo ni e n lo lati fi se ounje julo?
SINGLE RESPONSE
Do you have a separate room which is used as a kitchen?
Se e ni iyara oto ti e n nlo fun ile idana?
ROOMS (SLEEPING)……………
ELECTRICITY………………….………01
LPG /NATURAL (Gas)…………….......02
BIOGAS………………………………....03
KEROSENE…………….…..…….…….04
COAL /LIGNITE…………………………05
CHARCOAL……………………….…… 06
WOOD…………………………………...07
STRAW/SHRUBS/GRASS …………..08
AGRICUTURAL CROP………………..09
ANIMAL DUNG…………………….. ….10
OTHER _______________________ 96
(SPECIFY)
NO FOOD COOKED IN HH…………..97
YES......................................................... 1
NO .......................................................... 2
Q19
7

Q19
Q20
Q21
MAIN MATERIAL OF THE ROOF.
RECORD OBSERVATION.
MAIN MATERIAL OF THE FLOOR.
RECORD OBSERVATION.
MAIN MATERIAL OF THE EXTERIOR WALLS.
RECORD OBSERVATION.
NATURAL ROOFING
NO ROOF…………………………………...11
THATCH/PALM LEAF /REED/GRASS….12
DUNG/MUD ………………………………..13
RUDIMENTARY ROOFING
RUSTIC MAT……………………………….21
PALM/BAMBOO……………………………22
RAW WOOD PLANKS….…………………23
CARDBOARD………………………………24
PLASTIC BAGS…………………...……….25
TIN CANS…………………………...………26
CORRUGATED IRON SHEETS…..……..27
FINISHED ROOFING
METAL/ZINC………………………………..31
CERAMIC TILES……………………...……33
CEMENT………………………………...…..34
WOOD PLANKS/ SHINGLES……...……..35
ASBESTOS…………………………...…….36
CONCRETE……………………………..….37
OTHER __________________________96
(SPECIFY)
NATURAL FLOORING
EARTH/SAND……………………………11
DUNG…………………………………..……12
RUDIMENTARY FLOORING
WOOD PLANKS………….…..….…..…21
PALM/BAMBOO…………..…..…….….22
FINISHED FLOORING
PARQUEST OR POLISHED
WOOD………………………………..31
VINYL OR ASPHALT STRIPS...………32
CERAMIC TILES………………………..33
CEMENT………………………...……....34
CARPET/RUG..……………………...….35
OTHER _________________________ 96
(SPECIFY)
NATURAL WALLS
NO WALLS . . . . . . . . . . . . . .. . . . . . . 11
CANE/PALM/TRUNKS . . . . . .. . . . . . 12
DIRT /MUD. . . . . . . . . .. . . . .. . . . . . .13
RUDIMENTARY WALLS
BAMBOO WITH MUD . . . . . . . . . . . .21
STONE WITH MUD . . . . . . . . . . . . . .22
PLYWOOD . . . . . . . . . . . . . . . . . . . ..23
CARDBOARD………….…………..…..24
REUSED WOOD ……… . . . . . . ... …25
UNBURNT BRIKS…………………..…26
PLASTIC BAGS…………………..……27
FINISHED WALLS
CEMENT . . . . . . . . . . . . . . . . . . . . . . 31
STONE WITH LIME/CEMENT. . . . . . 32
BURNT BRICKS . . . . . . . . . . . . . . . . 33
CEMENT BLOCKS . . . . .. . . . . . . . . 34
WOOD PLANKS/SHINGLES . . . . . . .35
METAL/IRON SHEETS………………..36
OTHER___________________________96
(SPECIFY)
ELECTRICITY AND WATER
Q22
Does this household have electricity?
Se ebi yi ni ina monamona?
YES…………………………………1
NO…………………………………..2
Q24
Q23
What is the main source of electricity?
Nibo ni e ti n ri ina monamona ju?
NATIONAL GRID/PHCN………….…...1
SOLAR POWER..……………….……...2
GENERATOR…….………… ….……..3
OTHER _____________________ 6
(SPECIFY)
8

Q24
What is the main source of drinking water for your household?
Ibo ni e ti n pon omi ti ebi yin n mu lopo igba?
PIPED WATER
INTO DWELLING............................11
PIPED TO YARD/PLOT..................12
PUBLIC TAP/STANDPIPE..............13
TUBE WELL OR BOREHOLE..............21
DUG WELL
PROTECTED WELL........................31
UNPROTECTED WELL...................32
WATER FROM SPRING
PROTECTED SPRING....................41
UNPROTECTED SPRING...............42
RAINWATER
WITHIN THE YARD/PLOT……….… 51
OUTSIDE THE YARD/PLOT…….… 52
TANKER TRUCK..................................61
CART WITH SMALL TANK...................71
SURFACE WATER (RIVER/DAM/
LAKE/POND/STREAM/
CANAL)............................................81
BOTTLED WATER................................91
Q31
WATER DISPENSER ……………….… 92
Q31
SACHETS ……………………………..…93
Q31
Q25
Q26
Do other households share your household’s water source?
Se awon ebi miran n pon omi ni ibi ti ebi yin ti n pon omi yi?
How many households share your family’s main drinking water
source?
OTHER_________________________96
YES………………………………………1
NO………………………………………..2
DON’T KNOW…………………………..8
IFNINE HH OR FEWER ……..
Q27
Q27
Awon ebi melo ni e jo n pon omi ni ibi ti ebi yin ti n pon omi yi?
WRITE THE NUMBER OF HH IF LESS THAN 10.
10 OR MORE…………… 95
DON'T KNOW……….…...98
Q27
CHECK Q24
IF HOUSEHOLD SOURCE OF WATER IS OBTAINED OUTSIDE
OF THE DWELLING AND THE COMPOUND
(Q24 DOES NOT EQUAL 11, 12 OR 51)
IF HOUSEHOLD WATER IS PIPED INTO
HOUSE OR COMPOUND, REGARDLESS
OF SOURCE (Q24=11, 12 OR 51)
Q29
Q28
How long does it take to go to [HOUSEHOLD SOURCE OF
WATER], get water, and come back?
MINUTES
Q29
Akoko wo ni o n gba lati pon omi tie bi yin nlo lojojumo (eyi pelu
akoko ti o gba lati lo ati lati bo ati eyi ti e fi n duro ki e to pon omi)?
Do you do anything to your water to make it safer to drink?
Nje e ma n toju omi yin lonakona fun idaabobo fun mimu?
YES………………………………………..1
NO………………………………………….2
DON’T KNOW………………….…………8
Q31
Q31
9

Q30
Q31
What does your household usually do to your drinking water?
Anything else?
Kini e e bi yin maa n se si omi na fun idaabobo fun mimu?
Se ona miran wa?
MULTIPLE RESPONSE POSSIBLE
RECORD ALL MENTIONED.
TOILET FACILITIES
What kind of toilet facility do members of your household usually
have?
Iru ile igbonse wo ni ebi yin saba maa n lo?
BOIL . . . . . . . . . . . . . . . . . …… .. . . . ….. . A
CHLORINE TREATMENT (JIK/
/WATERGUARD)………………..……..B
COVER/STORE IN COVERED
CONTAINER………………………………....C
LET IT STAND AND SETTLE. .. . ………...D
CLOTH FILTER/DECANTER.…...……..….E
WATER FILTER (CERAMIC/
SAND/COMPOSITE/ETC.) .. . …… . ..……F
SUN PURIFICATION………………………..G
ALUM……………………………………….…H
OTHER____________________________X
(SPECIFY)
DON'T KNOW . . . . . ……. . . . . . . . . . . …Z
FLUSH OR POUR FLUSH TOILET
FLUSH TO PIPED SEWER SYSTEM .11
FLUSH TO SEPTIC TANK . . . . . . . .. 12
FLUSH TO PIT LATRINE . . . . . . . . . . 13
FLUSH TO SOMEWHERE ELSE……..14
FLUSH, DON'T KNOW WHERE . . . …15
PIT LATRINE
VENTILATED IMPROVED
PIT LATRINE . . . . . . . . . . . . . … .. . . 21
PIT LATRINE WITH SLAB . . . . .... . .. 22
PIT LATRINE WITHOUT SLAB/
OPEN PIT . . . . . . . . . . . . . . . . . ... . . ..23
COMPOSTING TOILET . . . . . . . . . . . . . ..31
BUCKET TOILET . . . . . . . . . . . . . . . . . . ..41
HANGING TOILET/HANGING LATRINE...51
NO FACILITY/BUSH/FIELD . . . . . . ... . . 61
Q35
OTHER___________________________96
(SPECIFY)
Q32
Q33
Q34
Is it inside or outside your dwelling?
Se inu ile yin tabi ita ni o wa?
Do you share this toilet with other households?
Se awon ebi miran n bayin lo ile igbonse yi?
How many households, including your own, share this toilet?
WRITE THE NUMBER OF HH IF LESS THAN 10.
Ebi melo pelu ti yin ni o n lo ile igbonse yi?
INSIDE DWELLING ................................. 1
OUTSIDE DWELLING ............................. 2
YES ......................................................... 1
NO ........................................................... 2
DON’T KNOW………………….………...….8
IFNINE HH OR FEWER …. ……
10 OR MORE HOUSEHOLDS ………95
DON’T KNOW …………………………98
Q35
Q35
10

Q35
Q36
BASIC DURABLES GOODS AND ASSETS
Does any member of this household own any agricultural land?
YES………………………...1
NO……………………….…2
Se okan lara ebi yin ni ile oko kankan?
DON’T KNOW………..… ..8
Does this household own any livestock, herds, poultry or other animals?
YES………………………...1
Se ebi yin ni ohun osin, agbo eran, abiye tabi eran miran?
NO…………………….……2
Q38
Q37
Does any member of this household own:
YES
NO
Nje okan ninu ebi yin ni :
Milk cows or bulls? Ako tabi abo maluu? ……………………………………….
Donkeys or mules? Ketekete? ………………………………………………….
Goat? Ewure? …………………………………………………………………….
Sheep? Aguntan? ………………………………………………………………..
Chicken or other poultry? Ediye? ………………………………………………
Pigs? Elede? ……………………………………………………………………..
Rabbits? Ehoro? …………………………………………………………………
COWS/BULLS
1 2
DONKEYS/MULES 1 2
GOATS 1 2
SHEEP 1 2
CHICKEN 1 2
PIGS 1 2
RABBITS 1 2
Horses?
Esin? …………………………………………………………………...
HORSES 1 2
Q38
Does any member of this household own:
YES
NO
Q39
Nje okan ninu awon ebi yin ni:
A bicycle? Keke? …………………………………………………………………..
A motorcycle or motor scooter/keke napep? Alupupu? ……………………….
A hand or animal drawn cart? Oko afi eranko wa? ……………………………
A car/truck/minibus
Oko ayokele tabi oko akeru? …………………………….
A boat with a motor? Oko oju omi igba lode?
Does any member of this household own:
Nje okan ninu ebi yin ni :
A clock? Ago agbekogiri? ………………………………………………………
A radio Ero asoro magbesi?………………………………………………..
A television? Ero amohun maworan? …………………………..…………..
A mobile phone? Ero ibanisoro alagbeka? ……………………...……………
A landline telephone? ?
Ero ibanisoro inu ile?……………...…………….
A refrigerator? Ero amomi tutu? …………………………....……………….
Kerosene stove? Stofu elepo oyinbo?……………………...……………….
Electric/Gas: Gaasi idana? ……………………………….
Electric fan Ero ifategun? ……………………………………………………..
Mosquito net Apo efon? ……………………………………………...……..
Mattres: Timu Timu?………………………………………………………..
Bed: Ibusun?……………………………………………………………………..
Bedsheets : Bulanketi ibora? ………………………………………………..
Table : Tabili?……………………………………………………….…..
Kerosene lamp with glass: Atupa elepo? ……………………….….
Torch light: Tooshi? …………………………………………………………….
BICYCLE
MOTORCYCLE/SCOOTER/KEKE
NSPEP
HAND OR ANIMAL-DRAWN
CART
1
2
1 2
1 2
ANY VEHICLE 1 2
BOAT WITH MOTOR 1 2
CLOCK
YES
RADIO 1 2
TELEVISION 1 2
MOBILE PHONE 1 2
LANDLINE PHONE 1 2
REFRIGERATOR 1 2
KEROSENE STOVE 1 2
ELECTRIC/GAS
COOKER/GAS BURNER
1
NO
2
1 2
ELECTRIC FAN 1 2
MOSQUITO NET 1 2
MATTRESS 1 2
BED 1 2
BEDSHEETS 1 2
TABLE 1 2
KEROSENE LAMP WITH
GLASS
1 2
TORCHLIGHT 1 2
11

Q40
Q41
Q42
Sewing machine: Ero iranso? ……………………………………………..........
Sofa set: Aga timu timu?…………………………………………...................
Computer : Ero computa? ………………………………………….........
Electric iron: Ayonu iloso? …………………………………................
Charcoal iron box: Ayonu eleedu? …………………………….............
VCR/DVD player: Ero DVD? ……………………………………...
Does your household employ any help (such as a house
help, driver cook, cleaner etc.)?
Nje ebi yin gba oluranlowo (gege bii agbale, awako, eni ti
o n dana onje, etc.)?
Is any usual member of this household covered by health
insurance?
Se enikeni ninu ebi yin se eto ilera ti o dangajia (health
insurance)?
Did your household save any money in the last month?
IF YES, How much?
SEWING MACHINE 1 2
SOFA SET 1 2
COMPUTER 1 2
ELECTRIC IRON 1 2
CHARCOAL IRONBOX 1 2
VCR/DVD PLAYER 1 2
YES………………………… ……...1
NO……………………………. .……2
DON’T KNOW……………… ……..8
YES ............................................. 1
NO ............................................... 2
DON’T KNOW……. . . . . ……..…8
YES, NAIRA…….[__|__|__|__|__|__|__]
Q43
Nje ebi yin fi owo kankan pamo ni osu ti o koja,
IF YES, Elo ni?
In the last three (3) months, has any member of this
household missed a meal due to lack of food?
Nje awon ojo kan wa ni bii osu meta se hin ti okan ninu
awon ebi yin ko ri onje,eekan je ni ojo kan nitori wipe onje
ko si?
YES, DON’T KNOW AMOUNT…9999991
NO………………………………….9999992
DON’T KNOW…………………….9999998
YES………………………………...1
NO…………………….……………2
DON’T KNOW………..………… ..8
COMMENTS:
END THE INTERVIEW AND THANK THE RESPONDENT FOR HIS/HER TIME AND PARTICIPATION.
RECORD END TIME
HOUR………………………………….[__|__]
MINUTES……………………………...[__|__]
12