Republic of Cote d'Ivoire
Unity - Discipline - Work
National Census Committee

Ministry of Planning
Department of Statistics
Confidential

General Survey of the Population and Housing
R.G.P.H. 1988

[p. 1]

Questionnaire - household

1. Region ____
2. Department ____ _ _
3. Sub-prefecture ____ _ _
4. Municipality / commune ____ _ _
5. Village ____ _ _ _
6. Census district no.____ _ _ _
7. Island no. ____ or encampment no. ____
8. Building no. ____ _ _ _
9. Dwelling no. ____ _ _ _
10. Household no. ____ _ _ _ _

Record type ____
11. Type of establishment (collective households only) ____ _
12. Page no. _ _
13. Total number of pages _ _
14. Address of the household ____ _ _ _
15. Total number of residents in the household ____ _ _ _
16. Total number of individuals surveyed in the household ____ _ _ _

Summary table

Residents

Present

_ _ Male
_ _ Female
_ _ Total

Absent

_ _ Male
_ _ Female
_ _ Total

Total

_ _ Male
_ _ Female
_ _ Total

Visitors

_ _ Male
_ _ Female
_ _ Total

Observations of the census official
Name of census official ____

Date and signature ____

Name of team leader ____

Date and signature ____

Note: The information contained in this questionnaire is confidential. It is covered by statistical confidentiality and may only be published in anonymous form in accordance with the Law of June 7, 1951 on the obligation to answer and statistical confidentiality

[p. 2]

All individuals
[Question 17 through 28 were asked of all individuals]

17. Order number _ _ _

Assign a number to each member of the household, starting with the head of the household, who must be assigned the number 001

18. Last name, first name ____

Clearly print the last names and first names of the members of the household (in capital letters) on the dashed line, starting with the head of the household and following the order indicated in the instruction manual.

19. Residence status

For each member of the household entered, circle the code that corresponds to their residence status:

[] 1 Resident present (rp)
[] 2 Resident absent (ra)
[] 3 Visitor (vi)

20. Relationship

Ask the question, "What is your relationship with the head of the household?"

[] 1 Head of household (hh)
[] 2 Spouse of hh (sp)
[] 3 Child of hh or sp (ch)
[] 4 Parent of hh (pa)
[] 5 Other relative of hh (or)
[] 6 Not relation of hh (nr)

21. Sex

[] 1 Sex, male (sm)
[] 2 Sex, female (sf)

22. Date of birth or age

Ask the question, "What is your date of birth?" Write:

____ a) For the date of birth, the day, month, and year. Ex: 6 January 1955 for a person born on 6 January 1955.

____ b) For age, the number followed by the letter D (days), M (months), Y (years). Ex: 5d (for 5 days old), 20M (for 20 months old), 19Y (for 19 years old)

23. Place of birth

Ask the question, "Where were you born?" Write:

a) For people born in CI [Côte d'Ivoire], as applicable

____ The name of the village with the name of the sub-prefecture or municipality in which that village is located between ( );
____ The name of the sub-prefecture or municipality

b) For people born outside of the Côte d'Ivoire

____ The country name

24. Place of residence in March 1987

Ask the question, "Where were you residing in March 1987?" Write:

a) For people residing in Cote d'Ivoire, as applicable,

____ The name of the village with the name of the sub-prefecture or the municipality in which that village is located between ( )
____ The name of the sub-prefecture or municipality

b) For people residing outside of the CI [Côte d'Ivoire]:

____ The name of the country with urban or rural indicated between ( ), as applicable

25. Marital status

Ask the question in accordance with the instruction manual

[] 1 Single (s)
[] 2 Cohabitation (ch)
[] 3 Man married to 1 wife (m1)
[] 4 Man married to 2 wives (m2)
[] 5 Man married to 3 or more wives (m3)
[] 6 Married woman (w)
[] 7 Separated or divorced (sd)
[] 8 Widow/widower (w)

26. Nationality / ethnicity

Indicate as applicable

____ a) For Ivorians, CI/Ethnicity. Ex: CI/Baoulé. Note: For a naturalized citizen, write CI/naturalized
____ b) For foreigners, the country name. Ex: Burkina-Faso, for Burkinabe nationality

27. Religion

Ask the question, "What is your religion?"

[] 1 Catholic (ca)
[] 2 Protestant (pr)
[] 3 Muslim (mu)
[] 4 Animist (an)
[] 5 Harrist (ha)
[] 6 Other religion (or)
[] 7 No religion (nr)

28. Survival of mother

Ask the question, "Is your mother still living?"

[] 1 Yes
[] 2 No
[] 3 Does not know

[p. 3]

Individuals age 6 and older
[Question 29 through 33 were asked of persons age 6 and older]

29. Level of education

Ask the question in accordance with the instruction manual

[] 1 Illiterate (il)
[] 2 Knows how to read and write (krw)
[] 3 Koranic school (ks)
[] 4 Primary school (pri)
[] 5 General secondary, 1st cycle (gs1)
[] 6 General secondary, 2nd cycle (gs2)
[] 7 Technical or professional secondary (tps)
[] 8 Higher education (hi)

30. Employment status

Ask the question in accordance with the instruction manual

[] 1 Employed (em)
[] 2 Unemployed (ue)
[] 3 Seeking 1st job (sk)
[] 4 Homemaker (hm)
[] 5 Student (st)
[] 6 Retiree (ret)
[] 7 Not working (nw)
[] 8 Other (ot)

31. Current occupation _ _

Ask the question, "What kind of work do you do currently?" Clearly indicate the surveyed individual's answer under the coding table. Ex: mason, teacher, police officer, taxi driver. Note: For the unemployed, indicate their last occupation.

32. Job level

Ask the question in accordance with the instruction manual

[] 1 Employer (em)
[] 2 Salaried worker (sa)
[] 3 Contingent work (cw)
[] 4 Independent (in)
[] 5 Family helper (fh)
[] 6 Apprentice (ap)

33. Work sector _

Ask the question, "What kind of work does the company or establishment at which you are employed do?" Clearly indicate the surveyed individual's answer under the coding table. Ex: masonry, education, police, transportation, etc. Note: a domestic worker's job category is "individual services"

Women age 12 and older
[Question 34 through 36 were asked to women age 12 and older.]

34. Total number of live births

Ask the question, "How many live births have you had in your life?" Indicate the reported number in the coding table.

_ _ Total

Ask the surveyed woman to indicate how many male live births she has had. Indicate the reported number in the coding table.

_ _ Male

Ask the surveyed woman to indicate how many female live births she has had. Indicate the reported number in the coding table.

_ _ Female

35. Total number of children still living

Ask the question, "How many of your children are still living?" Indicate the reported number in the coding table.

_ _ Total

Ask the surveyed woman to indicate how many of her male children are still living. Indicate the reported number in the coding table.

_ _ Male

Ask the surveyed woman to indicate how many of her female children are still living. Indicate the reported number in the coding table.

_ _ Female

36. Live births in the last 12 months

Ask the question, "How many male live births have you had between the time of March 1987 and today? Indicate the reported number in the coding table.

_ Male

Ask the question, "How many female live births have you had between the time of March 1987 and today? Indicate the reported number in the coding table.

_ Female

[p. 4]

Fertility: Live births in the last 12 months where the mother has died.
(Questions to ask the head of household only)

37. Have there been any live births in your household between March 1987 and today where the mother has died?

[] Yes
[] No

38. Indicate the number of births by sex in the coding table.

_ Male
_ Female

Housing: characteristics of the home
(Questions to ask the head of household only)

39. Total number of separate dwellings in the household

Ask the question, "What is the total number of separate dwellings in your household?" Indicate the total number of dwellings in the table below.

__ __ Number of dwellings

40. Total number of rooms occupied by the household

Ask the question, "What is the total number of rooms occupied by your household?" Indicate the total number of rooms in the table below.

__ __Number of rooms

41. Type of building

Observe the building and circle the appropriate response.

[] 1 Single home
[] 2 Row house
[] 3 Building
[] 4 Concession

42. Type of walls

Ask the question, "What are the walls of your home made out of?"

[] 1 Wood
[] 2 Other plant material
[] 3 Banco or clay
[] 4 Semi-hard
[] 5 Hard
[] 6 Other, specify ____

43. Type of roof

Ask the question, "What is the roof of your home made out of?"

[] 1 Plant material
[] 2 Sheet metal
[] 3 Concrete
[] 4 Other, specify ____

44. Type of floor

Ask the question, "What is the floor of your home made out of?"

[] 1 Clay
[] 2 Hard floor
[] 3 Other, specify ____

45. Sanitation facilities

Ask the question in accordance with the instruction manual.

[] 1 Flushing toilet inside home
[] 2 Non-flushing toilet inside home
[] 3 Flushing toilet in courtyard
[] 4 Non-flushing toilet in courtyard
[] 5 Latrine in courtyard
[] 6 Latrine outside of courtyard
[] 7 Outdoor sanitation area without facilities

46. Water supply

Ask the question, "How is your household usually supplied with water?"

[] 1 Running water
[] 2 Village pump
[] 3 Well
[] 4 Source, stream, creek
[] 5 Other, specify ____

47. Lighting method

Ask the question, "What method does your household usually use for lighting?"

[] 1 Electricity
[] 2 Lamp
[] 3 Wood fire
[] 4 Electricity and lamp
[] 5 Lamp and wood fire
[] 6 Other, specify ____

48. Cooking method

Ask the question, "How do you cook your meals?"

[] 1 Firewood
[] 2 Charcoal
[] 3 Gas
[] 4 Wood and charcoal
[] 5 Gas and charcoal
[] 6 Gas and wood
[] 7 Other, specify ____

49. Household appliances

Ask the question, "Do you have a working radio, refrigerator, or television?"

[] 1 None
[] 2 Radio
[] 3 Refrigerator
[] 4 Television
[] 5 Radio and refrigerator
[] 6 Radio and TV
[] 7 Refrigerator and TV
[] 8 Radio, refrigerator, and TV

50. Occupation status of home

Ask the question in accordance with the instruction manual.

[] 1 Owner
[] 2 Renter
[] 3 Employee housing
[] 4 Other, specify ____

51. Monthly rent (renters)

Ask the question, "How much are you paying in rent per month?"

Indicate the amount in CFA francs in the table below ____

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