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Benin 2013 form

Republic of Benin
Ministry of Development, Economic Analysis, and Planning
National Census Comity
National Institute for Statistics and Economic Analysis (INSAE)

Fourth Population and Habitation Census

Prescribed by decree number 09/PR/SGG/REL of March 17th, 2011 on the organization of the fourth General Population; it is obligatory for all persons present on the national territory

Household Questionnaire

Document RGPH 4 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 April 12th, 2000 on the creation, organization, and functioning of the national statistics council.

Localization

1. Department ____ _ _
2. Township ____ _
3. District ____ _ _
4A. Village or city neighborhood _ _
4B. New village/neighborhood_ _
5. Census zone number_ _
6. Locality or hamlet_ _
7A. Block (if un-allotted urban zone) _ _
7B. Lot number (if allotted urban zone) _ _
8. Building number_ _ _
9. Household number in the census zone_ _ _

10. Type of household - Write down the code:

[] 0 Ordinary
[] 1 Dorm
[] 2 Hospital
[] 3 Hotel
[] 4 Orphanage
[] 5 Prison
[] 6 Barracks
[] 7 Convent/Monastery
[] 8 Construction site
[] 9 Other (specify) ____

11. Name of head of household or establishment ________

Summary Table
[The following lines represent a table summarizing information of the household members]
Sex

Male

____ Present residents (A)
____ Absent residents (B)
____ Present and absent residents (C = A + B)
____ Visitors (D)
____ Total counted (C + D)

Female

____ Present residents (A)
____ Absent residents (B)
____ Present and absent residents (C = A + B)
____ Visitors (D)
____ Total counted (C + D)

Total

____ Present residents (A)
____ Absent residents (B)
____ Present and absent residents (C = A + B)
____ Visitors (D)
____ Total counted (C + D)

Census agent's seal

Last and first names ________
Date of household visit _ _ _ _ _ _
Observations and signature ________

Team leader's seal

Last and first names ________
Control date _ _ _ _ _ _
Observations and signature ________

_ Household form number
_ Number of forms used for the household

Coding agent

Name ________
Code _ _
Date ________

Verifying agent

Name ________
Code _ _
Date ________

Data entry clerk/agent

Name ________
Code _ _
Date ________

Now we would like to ask for information on you and the persons habitually living in your household or currently residing in your home

For all persons
[Questions 1-12 were asked of all persons]

1. Order number

_ _

Last and first names - Register the household members according to the following order:

- Head of household
- Head of household's unmarried children whose mother is no longer 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. Family relationship - What is the family tie of the head of household?

[] 01 Head of household
[] 02 Husband/wife of head of household
[] 03 Child of head of household
[] 04 Son-in-law or daughter-in-law of head of household
[] 05 Grandson or granddaughter of head of household
[] 06 Father or mother of head of household
[] 07 Father-in-law or mother-in-law of head of household
[] 08 Brother or sister of head of household
[] 09 Co-wife of head of household
[] 10 Other relative or child of a partner
[] 11 Adopted or guarded child by head of household
[] 12 No family relation to head of household
[] 98 Does not know

Number of nuclear units _ _

4. Sex - Is [the person] male or female?

[] 1 Male
[] 2 Female

5. Date of birth - In which month and year is [the person] born?

_ _ _ _ _ _

Write in the 2-unit grid below the month and in the 4-unit grid below the year declared

6. Age - What is the age of [the person]?

_ _ _

Write the age in years fully lived years. Write "00" if age is less than one year. Write "98" if age is equal to or higher than 98

7. Place of birth - In what town was [the person] born?

________

Write down the department, township, or country if the person was born abroad

8. Birth registration - Does [the person] have a birth certificate or a supplementary judgment?

[] 1 Yes
[] 2 No

9. Ethnicity or nationality - Which is the ethnicity or nationality of [the person]?

________

Write down FON, MINA, DENDI, etcetera for Beninese, and country for foreigners

10. Religion

[] 0 AUC: None
[] 1 CAT: Catholic
[] 2 PRM: Protestant Methodist
[] 3 APR: Other Protestants
[] 4 CEL: Celestial
[] 5 ACH: Other Christians
[] 6 ISL: Islam
[] 7 VOD: Voodoo
[] 8 ATR: Other traditional
[] 9 ARE: Other religions

11. Type of disability

[] 00 No handicap
[] 01 Cerebral motor infirmity

Motor:
[] 02 Amputated
[] 03 Paralyzed

Visual:
[] 04 Amblyopic (visually impaired)
[] 05 Blind

Auditory/Verbal:
[] 06 Hard of hearing
[] 07 Deaf
[] 08 Mute

Intellectual:
[] 09 With Down syndrome
[] 10 Autistic
[] 11 Mentally impaired or retarded

Mental
[] 12 Mentally ill

Write down the codes for the three main declared disabilities

_ _ 1st
_ _ 2nd
_ _ 3rd

12. Residency status

[] 1 RP: present resident
[] 2 RA: absent resident
[] 3 VISIT: visitor

Residents only
[Questions 13 to 16 were asked of residents]

13. Location of previous residence - In which township did [the person] live (for a least 6 continuous months) before settling down here?

Write down department/township or country for abroad

_ _ Department
_ _ Township

14. Duration of stay in current residence - What is the duration of [the person's] stay in this township?

Report the number of years: _ _
"00" if less than one year
"97" if 97 or more years
"98" if since birth

15. Status of the father - Is the father of [the person] still alive and if so, where does he live?

[] 1 PRM: present in the household
[] 2 PRC: present in the township
[] 3 PRAB: present elsewhere in Benin
[] 4 PRE: present outside of Benin
[] 5 DEC: deceased
[] 6 NSP: unknown

16. Status of the mother - Is the mother of [the person] still alive and if so, where does she live?

[] 1 PRM: present in the household
[] 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 17-19 were asked of persons aged 3 years or older]

17. Primary language spoken - What is the primary language spoken by [the person] in the household?

Write down Fon, Mina, Dendi, Ditamari, Ibo, Ashanti, etcetera.

________

(18) Pre-school and school attendance - Has [the person] ever attended school?

[] 1 FA: currently attending
[] 2 AF: has attended
[] 3 JF: never attended

19. Last school grade level attended - What is the last grade level that [the person] attended?

Current grade level for those attending or last grade level for those who no longer attend

_ _

Residents of 6 years or more of age (questions 20 to 24)
[Questions 20-24 were asked of persons aged 6 years or older]

20. Literacy

[] 1 AF: can read, write, and understand French only
[] 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

21. Occupation status - Does [the person] currently work or has [the person] worked in the last 3 months for at least one continuous week?

[] 0 OCSI: employed informal sector
[] 1 OCFP: employed formal state sector
[] 2 OCFP: employed formal private sector
[] 3 CHO: unemployed
[] 4 CT: seeking first employment
[] 5 MEN: housewife
[] 6 ETU: school children and students
[] 7 RET: retired
[] 8 REN: rentier
[] 9 AINA: other inactive

[If the person chose an option between 4 and 9, go to question 25]

22. Current profession - What type of work has [the person] had for at least 7 days, continuously or otherwise, during the last 3 months? If [the person is] unemployed: What type of work has [the person] previously had prior to the last 3 months?

________

23. Status within the profession

[] 0 EMP: Employer
[] 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

24. Economic activity - What does the establishment in which [the person] works or has most worked primarily do?

Examples:
- Shoe manufacturing company
- Bike repair
- Corn cultivation
- Domestic services
- Construction

________

For persons aged 10 years or older
[Question 25 was asked of residents aged 10 years or older]

25. Marital status

[] 0 Single
[] 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)

For women aged 10 years or older
[Question 26-29 were asked of residents aged 10 years or older]

26. Born alive children - How many born alive children have [the person] had?

Write down the declared number according to gender in the appropriate boxes

_ _ M
_ _ F

27. Alive children - How many alive children does [the person] currently have?

Write down the declared number according to gender in the appropriate boxes

_ _ M
_ _ F

Births that occurred since January 1st, 2012

28. How many living births have you had since January 1st, 2012?

_ M
_ F

29. How many [children] are still alive?

_ M
_ F

Deaths occurred since January 1st, 2012

30. Have there been any deaths in the household since January 1st, 2012?

[] 1 Yes
[] 2 No

[If the person answered "no", go to question 43]

31. Order number [of the deceased person]

_ _ _

32. Last and first names of the deceased

________

33. Sex of the deceased - Circle the gender's code

[] 1 M
[] 2 F

34. Date of birth - Write down the month and year of birth. "M" means months and "A" means year

M _ _
A _ _ _ _

35. Date of death - Write down the month and year of death. "M" means months and "A" means year

M _ _
A _ _ _ _

36. Age at death - Circle the unit code then write down the age at death

[] 1 Days
[] 2 Months
[] 3 Years

37. Place of burial - Circle the code corresponding to the location of burial

[] 1 Current domicile (residence)
[] 2 Other residence elsewhere
[] 3 Administrative cemetery
[] 4 Religious cemetery
[] 5 Family cemetery
[] 6 Other (specify) ____

38. Marital status at death (10 years or older)

[Question 38 was asked in case where the deceased person died at age 10 years or older]

[] 0 Single
[] 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 or unmarried couple

Mortality of women aged 10 to 55 years old
[Questions 39 to 42 were asked in case the deceased person was a woman aged 10 to 55 years old]

39. Did she die due to problems linked to a pregnancy?

[] 1 Yes, go to question 42
[] 2 No

[If the person answered yes, go to question 42]

40. Did she die while giving birth?

[] 1 Yes
[] 2 No

[If the person answered yes, go to question 42]

41. Did she die within 42 days of the birth event due to giving birth?

[] 1 Yes
[] 2 No

[If the person answered yes, go to question 43]

42. Location of death

[] 1 Domicile
[] 2 On the way to a health center
[] 3 Health center
[] 4 Healer
[] 5 Other (specify) ____

Dwelling Unit Characteristics
[Questions 43-56 were asked of all households]

43. Construction type

[] 1 Isolated house
[] 2 Compartmentalized house
[] 3 Villa
[] 4 Building (multiple story house)
[] 5 Isolated case (traditional dwelling)
[] 9 Other (specify) ____

44. Concession

[] 1 Yes
[] 2 No

45. Usage type

[] 1 Residency
[] 2 Mixed

46. Residency occupation status

[] 1 Owner with ownership title
[] 2 Owner without ownership title
[] 3 Family property with ownership title
[] 4 Family property without ownership title
[] 5 Housed by employer (state, private)
[] 6 Housed by a family member or friend
[] 7 Renter
Monthly rent in CFA Francs [West African Francs] _ _ _ _ _ _ _
[] 9 Other (specify) ____

47. Total number of occupied rooms - Report the total number of rooms occupied by the household in the dwelling unit in the grid

_ _

48. Nature of the roof - Primary construction material used

[] 1 Sheet metal
[] 2 Tile
[] 3 Clay
[] 4 Straw
[] 5 Slab
[] 6 Wood, board, or bamboo
[] 9 Other (specify) ____

49. Nature of the walls - Primary construction material used

[] 1 Brick
[] 2 Stone
[] 3 Wood, board, or bamboo
[] 4 Clay
[] 5 Semi-hard
[] 9 Other (specify) ____

(50) Nature of the floor - Primary construction material used

[] 1 Cement
[] 2 Wood, board, or bamboo
[] 3 Clay or sand
[] 4 Tile
[] 9 Other (specify) ____

51. Lighting mode

[] 1 Petrol
[] 2 Electricity (SBEE) [Electricity and Water Company of Benin]
[] 3 Solar energy
[] 4 Communal electric generator
[] 5 Private electric generator
[] 6 Gas
[] 7 Oil
[] 8 Other generators (corn mill, dynamo, etcetera)
[] 9 Other (specify) ____

52. Drinking water provisioning

[] 0 River/lake
[] 1 Running water (SBEE) at home
[] 2 Running water (SBEE) elsewhere
[] 3 Fountain or public faucet
[] 4 Village pump or manual pump drilling
[] 5 Cistern
[] 6 Protected public well
[] 7 Protected private well
[] 8 Unprotected well
[] 9 Other (specify) ____

53. Household's sanitation mode

[] 1 Latrine with ventilated tank
[] 2 Latrine with unventilated tank
[] 3 Toilet with water flush
[] 4 Suspended latrine or on stilts
[] 5 No toilet or in nature
[] 9 Other (specify) ____

54. Used water evacuation mode

[] 1 Closed gutter
[] 2 Open air gutter
[] 3 Sceptic tank
[] 4 Unused well
[] 5 In the courtyard
[] 6 In nature or outside
[] 9 Other (specify) ____

55. Household waste evacuation

[] 1 Public garbage dump
[] 2 Private or NGO garbage dump
[] 3 Burial
[] 4 Burning
[] 5 In nature/outside
[] 9 Other (specify) ____

56. Most used cooking energy method

[] 1 Petrol
[] 2 Wood or palm
[] 3 Electricity SBEE
[] 4 Solar energy
[] 5 Gas
[] 6 Coal
[] 7 Chips or sawdust
[] 8 Agricultural residues
[] 9 Other (specify) ____

57. Head of household's income - How much has the head of household earned last month or how much do you estimate his last month's income in (FCFA)?

_ _ _ _ _ _ _ _

Report 99999999 if no income is declared

Goods or property items owned by the household
[Questions 58.1-58.5 were asked of all households]

58.1 Do you own the following goods? Write down 1 if the answer is "yes" or 2 if the answer is "no" (for all items listed below)

A - Radio set
[] 1 Yes
[] 2 No

B - Television set
[] 1 Yes
[] 2 No

C - Wi-Fi system
[] 1 Yes
[] 2 No

D - Parabolic antenna or decoder
[] 1 Yes
[] 2 No

E - Video recorder
[] 1 Yes
[] 2 No

F - DVD or CD player
[] 1 Yes
[] 2 No

G - Fridge
[] 1 Yes
[] 2 No

H - Stove or gas cooker
[] 1 Yes
[] 2 No

I - Improved fireplace
[] 1 Yes
[] 2 No

J - Electrical iron
[] 1 Yes
[] 2 No

K - Air conditioner
[] 1 Yes
[] 2 No

L - Ventilator
[] 1 Yes
[] 2 No

M - Bed
[] 1 Yes
[] 2 No

N - Mattress (foam)
[] 1 Yes
[] 2 No

O - Modern armchair
[] 1 Yes
[] 2 No

P - Computer
[] 1 Yes
[] 2 No

Q - Internet connection
[] 1 Yes
[] 2 No

R - Generator
[] 1 Yes
[] 2 No

S - Bicycle
[] 1 Yes
[] 2 No

T - Motorcycle
[] 1 Yes
[] 2 No

U - Car
[] 1 Yes
[] 2 No

V - Small boat or canoe
[] 1 Yes
[] 2 No

58.2 How many of the following goods do you own? Write down the number of these owned goods ("00" if the answer is none)

_ _ Phone lines [landlines]
_ _ Active GSM lines (SIM cards)
_ _ Land or plots

58.3 Do you own a house that is rented?

[] 1 Yes
[] 2 No

[If the person answered no, go to question 58.5]

58.4 Total amount of monthly rent (in CFA Francs)

_ _ _ _ _ _ _

58.5 What is your primary method of access to Internet in the household? Circle the corresponding code

[] 0 None
[] 1 Cybercaf?
[] 2 Home "cellular phone"
[] 3 Home "USB stick"
[] 4 Home "landline phone"
[] 5 Home "other" (specify) ____

Agricultural exploitation
[Questions 59.1-59.5 were asked of all households]

59.1 Is there someone in the household who runs or practices an agricultural activity?

[] 1 Yes
[] 2 No

[If the answer is "no, end here the interview]
If the answer is "yes", specify the location in which the household's primary exploitation is situated.

Department _____ _
Township _____
District _____ _

59.2 What is the primary domain of activity in this exploitation?

[] 1 Plants
[] 2 Animals
[] 3 Fishery
[] 4 Other ____

59.3 What were the 2 largest productions during the 2012-2013 campaign in this domain? Write down in the 1st grid, and if applicable, in the 2nd grid, the largest production/productions in this domain
[] 01 Cotton
[] 02 Oil palm trees
[] 03 Pineapple
[] 04 Cashew
[] 05 Corn
[] 06 Rice
[] 07 Manioc [cassava]
[] 08 Yams
[] 09 Meat
[] 10 Milk
[] 11 Eggs
[] 12 Fish
[] 13 Shrimp
[Write down the first and second largest productions]
_ _ 1st
_ _ 2nd
Other [products]
____ 1st
____ 2nd

59.4 What type of equipment do you use?

[] 1 Traditional
[] 2 Coupling
[] 3 Mechanical
[] 4 Traditional and coupling
[] 5 Traditional and mechanical

59.5 What is the total surface of the agricultural lands owned by the household?

In hectares _ _ _
In acres _ _