Republic of Benin
Ministry of Governmental Action Coordination, Planning, and Development
National Institute for Statistics and Economic Analysis (INSAE)
National Census Comity
Demographic Studies Authority
Benin 2002 Form
Third population and habitation census of February 2002
Prescribed by decree number 99-459 of 09/22/1999 on the organization of the third General Population and Habitation Census and the composition of the national census comity; it is obligatory for all persons present on the territory of the Republic of Benin
Household Questionnaire
Document RGPH 3 Number 1
Confidential
The individual information obtained through this questionnaire is covered by data privacy [statistical privacy is used] Results can only be anonymously published in accordance with article 25 of the law 99-014 of 01/29/1999 on the creation, organization, and functioning of the national statistics council
Township _
District_ _
Census zone number_ _ _
Village or city neighborhood _ _
Locality or hamlet_ _
Building number_ _ _
Household number _ _ _
[] 2 Collective
Name of head of household or establishment____
____ B. Absent residents
____ C. Present and absent residents
____ D. Visitors
____ Total counted (C + D)
____ B. Absent residents
____ C. Present and absent residents
____ D. Visitors
____ Total counted (C + D)
____ B. Absent residents
____ C. Present and absent residents
____ D. Visitors
____ Total counted (C + D)
Is there at least one household member who independently runs an agricultural exploitation?
[] 2 No
If Yes, specify its location
_ _ Township
_ _ District
_ _ Village/neighborhood
Date of household visit _ _ _ _ _ _
Observations and signature ____
Control date _ _ _ _ _ _
Observations and signature ____
____ Number of forms used for the household
Date____
Date____
Entry clerk [data entry agent]
Date____
For all persons
[Questions in columns 1 to 11 were asked of all persons]
Now we would like to ask for information on you and the persons habitually living in your household or currently residing in your home
Head of household
Head of household's unmarried children whose mother is not in the household, from the youngest to the oldest
Head of household's wives followed by their unmarried children
Head of household's married children followed by their spouses and living children
Head of household's other relatives with their potential spouses and children
Servants and potentially their families
Visitors
(3) Relationship to the head of household
[] 1 CM = head of household
[] 2 EP = spouse of head of household
[] 3 ENF = child of head of household
[] 4 PAR = father and mother of head of household
[] 5 BPAR = parents-in-law of head of household
[] 6 PENF = grandson, granddaughter of head of household
[] 7 EPC = placed children
[] 8 AP = other relatives
[] 0 No ties
Number of nuclear units _
[] 1 Male
[] 2 Female
Month _ _
Year _ _ _ _
[] 0 0 is age is less than a year
[] 9 8 if age is equal to or higher than 98
[] 2 CAT = Catholic
[] 3 PRM = Protestant Methodist
[] 4 APR = Other Protestants
[] 5 CEL = Celestial
[] 6 ISL = Islam
[] 7 ACH = Other Christians
[] 8 ATR = Other traditional
[] 9 ARE = Other religions
[] 0 AUC = None
[] 2 Deaf
[] 3 Mute
[] 4 Visually impaired
[] 5 Mentally disabled
[] 6 Paralyzed upper member
[] 7 Paralyzed lower member
[] 8 Other handicaps
[] 0 No handicaps
_ _ _ Write down the codes for the three main declared handicaps
[] 2 RA: absent resident
[] 3 VISIT: visitor
Residents only
[Questions in columns 12 - 15 were asked of residents only]
(12) Duration [of stay] in current residence _ _
(13) Location of previous residence
And the country for locations abroad___
[] 2 PRC = present in the township
[] 3 PRAB = present elsewhere in Benin
[] 4 PRE = present outside of Benin
[] 5 DEC = deceased
[] 6 NSP = unknown
[] 2 PRC = present in the township
[] 3 PRAB = present elsewhere in Benin
[] 4 PRE = present outside of Benin
[] 5 DEC = deceased
[] 6 NSP = unknown
Residents of 3 years or more of age
[ Questions in columns 16 - 17 were asked of residents 3+ years old]
(16) Pre-school and school attendance
[] 2 AF: has attended
[] 3 JF: never attended
(17) Last school grade level attended ____
Residents of 6 years or more of age
[Questions in columns 18 - 22 were asked of residents 6+ years old]
[] 2 SLN = can read in the national language
[] 3 ALN = can read, write, and understand the national language only
[] 4 AFLN = can read, write, and understand French and the national language
[] 5 AUT = can read, write, and understand another language only
[] 6 NLE = cannot read nor write
[] 1 OCFP = employed formal state sector
[] 2 OCFP = employed formal private sector
[] 3 CT = seeking first employment
[] 4 CHO = unemployed
[] 5 MEN = housewife
[] 6 ETU = school children and students
[] 7 RET = retired
[] 8 REN = rentier
[] 9 AINA = other unemployed
(21) Status within the profession
[] 1 IND: independent
[] 2 SAP: permanent salaried employee
[] 3 SAT: temporary salaried employee
[] 4 COOP: cooperative member
[] 5 AF: familial aid
[] 6 APP: apprentice
[] 9 AUT: other
(22) Branch of activity ____ _ _ _ _ _
Persons of 10 years or more of age
[Question 23 was asked of persons 10+ years old]
[] 1 Monogamous marriage
[] 2 Polygamous marriage with 2 wives
[] 3 Polygamous marriage with 3 wives
[] 4 Polygamous marriage with 4 or more wives
[] 5 Divorced
[] 6 Widowed
[] 7 Separated
[] 8 Free union [unmarried couple]
Female residents of 10 or more of age
[Questions in columns 24-27 were asked of female residents age 10 years old or more]
_ _ Male
_ _ Female
_ _ Male
_ _ Female
Births that occurred since January 1st 2001
[Questions in columns 26 - 27 concerns births that occurred since January 1st, 2001 and were asked of females age 10+]
(26) How many living births have you had since January 1st 2001?
_ _ Female
(27) How many are still alive?
_ _ Female
Deaths occurred since January 1st 2001
[Questions in columns 28 - 39 pertain to deaths in the household since January 1st, 2001]
(28) Has there been any deaths in the household since January 1st 2001?
[] 2 No, go to column 40
(30) Last and first names ____
[] Female
[] Year _ _ _ _
[] Year _ _ _ _
Number
[] 2 Months _ _
[] 3 Years _ _
[] 2 Cemetery
[] 3 Other
(36) Marital status of deceased persons of 10 years or more of age
[] 1 M1 [Monogamous marriage]
[] 2M2 [Polygamous marriage with 2 wives]
[] 3 M3 [Polygamous marriage with 3 wives]
[] 4 M4 [Polygamous marriage with 4 or more wives]
[] 5 D [Divorced]
[] 6 W [Widowed]
[] 7 S [Separated]
[] 8 UL [Free union; unmarried couple]
Mother mortality for women of 10 to 55 years of age
[Questions in columns 37 - 39 pertain to maternal mortality and were asked of women age 10 to 55 who died in the household since January 1st, 2001]
(37) Did she die due to problems linked to pregnancy?
[] 2 No
(38) Did she die while giving birth?
[] 2 No
(39) Did she die within 42 days of the birth event due to birth giving?
[] 2 No
[] 2 Compartmentalized house
[] 3 Villa
[] 4 Building (multiple story house)
[] 5 Isolated case (traditional dwelling)
[] 9 Other
[] 2 No
[] 2 Mixed
[] 2 Owner without ownership title
[] 3 Family property
[] 4 Housed for free by the State
[] 5 Housed for free by a private individual
[] 6 Renter
[] 9 Other
(44) Total number of occupied rooms _ _
(45) Nature of the roof (primary construction)
[] 2 Tile
[] 3 Clay
[] 4 Straw
[] 5 Slab
[] 6 Wood/Board
[] 7 Palm/Bamboo
[] 9 Other
(46) Nature of the walls (primary construction)
[] 2 Stone
[] 3 Bamboo/Palm
[] 4 Clay
[] 5 Semi-hard
[] 6 Wood/Board
[] 9 Other
(47) Nature of the floor (primary construction)
[] 2 Wood/Board
[] 3 Clay/Sand
[] 4 Tile
[] 5 Bamboo/Palm
[] 9 Other
[] 2 Electricity (SBEE)
[] 3 Solar energy
[] 4 Communal electric generator
[] 5 Private electric generator
[] 6 Gas
[] 7 Oil
[] 9 Other
[] 2 Running water (SBEE) elsewhere
[] 3 Fountain/public faucet
[] 4 Village pump or manual pump drilling
[] 5 Cistern
[] 6 Protected well [buse]
[] 7 Unprotected well
[] 8 River/lake
[] 9 Other
(50) Household's sanitation mode
[] 2 Latrine with unventilated tank
[] 3 Toilet with water flush
[] 4 Sewer system
[] 5 Suspended latrine/on stilts
[] 6 Latrine with bucket [tinette ]
[] 7 No toilet/in nature
[] 9 Other
[] 2 Open air gutter
[] 3 Sceptic tank
[] 4 Lost [unused] well
[] 5 Sewer
[] 6 In the courtyard
[] 7 In nature/outside
[] 9 Other
(52) Household waste evacuation
[] 2 Private/NGO garbage dump
[] 2 Burial
[] 3 Burning
[] 4 In nature/outside
[] 9 Other
(53) Household's most used cooking energy method
[] 2 Wood/palm
[] 3 Electricity SBEE
[] 4 Gas
[] 5 Coal
[] 9 Other