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[page 1]

Republic of Cote d'Ivoire
Interministerial Census Oversight Committee
National Statistics Institute
National Census Committee


General Population and Housing Census 1998

Household questionnaire

1. Region _ _
2. Department _ _
3. Sub-prefecture (S/P) _ _
4. Commune (municipality) _ _
5. Census district number _ _ _ _
6. Village _ _ _
7. Neighborhood / camp _ _ _ _
8. Lot number _ _ _ _

____ Building number
____ Dwelling number

9. Household number _ _ _ _
10. Type of establishment (collective household) _
11. Record type _
12. Number of residents in household _ _ _
13. Number of persons surveyed in household _ _ _

____ Questionnaire number
____ Total number of questionnaires

Summary table

Residents

Present
_ _ _ Male
_ _ _ Female
_ _ _ Total

Absent
_ _ _ Male
_ _ _ Female
_ _ _ Total

Total
_ _ _ Male
_ _ _ Female
_ _ _ Total

Visitors

_ _ _ Male
_ _ _ Female
_ _ _ Total

Total population surveyed

_ _ _ Male
_ _ _ Female
_ _ _ Total

Census taker

____ Surname and first name
____ Date
____ Signature

Coding agent

____ Surname and first name
____ Date
____ Signature

Data entry agent

____ Surname and first name
____ Date
____ Signature

Reminder: The information contained in this questionnaire is confidential. It is covered by statistical secrecy and may not be published except in anonymous form, pursuant to the law of 7 June 1951 on statistical secrecy and the duty to respond.

[page 2]

All persons surveyed ? present residents (RP), absent residents (RA), and visitors (VI)
[Question 14 through 20 were asked of all persons.]

14. Serial number

(Assign a number to each member of the household, beginning with the head of household, who must be given number 001) _ _ _

Surname and first names (Writing very legibly and using capital letters, record on the dotted lines the surname and first names of all household members, beginning with the head of household and following the order indicated in the instructions manual) ____

15. Resident status

[] 1 Present resident (rp)
[] 2 Absent resident (ra)
[] 3 Visitor (vi)

16. Relationship to head of household

[] 1 Head of household (cm)
[] 2 Spouse of head of household (ep)
[] 3 Son / daughter (fi)
[] 4 Father / mother (pm)
[] 5 Brother / sister (fs)
[] 6 Nephew / niece (nn)
[] 7 Other relative (ap)
[] 8 No family relationship (sp)

17. Sex

[] 1 Male
[] 2 Female

18. Date of birth

What is the date of your birth? If the birthdate information is complete, record it in the 8-space box: day, month, and year. If the information is not complete, it will still be recorded in the 8-space box: (month, year) or (year).

_ _ Day
_ _ Month
_ _ Year

Or

_ _ Age

19. Place of birth

Ask the following question: Where were you born?

For persons born in the Cote d'Ivoire, record as pertinent: the name of the village with, in parentheses ( ), the name of the sub-prefecture or commune to which the village belongs; the name of the S/P or commune _ _ _ _ _ _

For persons born outside Cote d'Ivoire, the name of the country.) ____

20. Nationality or ethnic group

Record as pertinent:

For Ivorians, their ethnic group: (e.g. CI/Baoule, CI/Naturalized.) _ _ _

For non-Ivorians, the name of the country, (e.g. Togo) ____

[page 3]

All residents
[Question 21 through 25 were asked of all resident persons.]

21. Place of residence in November 1997

For the question: Where were you living in November 1997? Record for persons who were living in Cote d'Ivoire, as pertinent: the name of the village with, in parentheses ( ), the name of the sub-prefecture or commune to which the village belongs; the name of the sub-prefecture or commune_ _ _ _ _ _

For persons born outside Cote d'Ivoire, the name of the country. ____

22. Religion

[] 1 Catholic (ca)
[] 2 Protestant (pr)
[] 3 Harrist (ha)
[] 4 Other Christian (ac)
[] 5 Muslim (mu)
[] 6 Animist (an)
[] 7 Other religions (ar)
[] 8 No religion (sr)

23. Physical handicaps

[] 1 Blind (nv)
[] 2 Deaf (so)
[] 4 Mute (mu)
[] 8 Handicapped in the lower limbs (hi)
[] 16 Handicapped in the upper limbs (hs)
[] 32 Other handicaps (ah)
[] 0 No handicap (sh)

24. Is mother living?

[] 1 Mother living (mv)
[] 2 Mother deceased (md)
[] 3 Don't know (nsp)

25. Is father living?

[] 1 Father living (pv)
[] 2 Father deceased (pd)
[] 3 Don't know (nsp)

Residents of age six years and over
[Question 26 through 33 asked of resident persons aged 6 and older.]

26. Literacy

Can you read a letter from or write a letter to a friend or relative?

[] 1 Yes
[] 2 No

27. Level of education

Ask the questions as indicated in the manual. ____

28. Working status

[] 1 Working (occ)
[] 2 Unemployed (cho)
[] 3 Looking for first job (que)
[] 4 Homemaker (men)
[] 5 Student or pupil (etu)
[] 6 Retired (ret)
[] 7 Independent income (ren)
[] 8 Inactive, other (aut)

29. Vocational training

Ask the question: Have you received any vocational training? If yes, ask: What is the highest diploma you have obtained? Record the diploma on the dotted line. If no, enter "/") ____

30. Current occupation

Ask the question: What kind of work are you doing now? Record the answer on the dotted lines. E.g.: mason, taxi driver. For unemployed persons, record the last occupation. ____

31. Type of occupation

[] 1 Employer (em)
[] 2 Public sector employee (spb)
[] 3 Private sector employee (spv)
[] 4 Casual work - "by the job" (ta)
[] 5 Cooperative (cop)
[] 6 Independent (ind)
[] 7 Family helper (af)
[] 8 Apprentice (ap)

32. Economic sector

Ask the following question: What is the business of the establishment for which you work? Record the answer on the dotted lines. ____

33. Secondary occupation

Ask questions as indicated in the manual ____

[page 4]

Residents of age 12 years and over
[Question 34 and 35 are asked of resident persons age 12+.]

34. Marital status

[] 1 Single (c)
[] 2 Cohabiting/common-law marriage (ul)
[] 3 Married to a woman without a co-wife, with 1 co-wife, 2 co-wives, etc. (follow the instructions in the manual) (m1, m2, m3, m4)
[] 7 Separated or divorced (sd)
[] 8 Widowed (v)

35. Type of marriage

[] 1 Legal marriage (ml)
[] 2 Customary marriage (mc)
[] 3 Religious marriage (mr)
[] 4 Legal and customary marriage (mlc)
[] 5 Legal and religious marriage (mlr)
[] 6 Religious and customary marriage (mrc)
[] 7 Legal, customary, and religious marriage (mlrc)
[] 8 None (nean)

Female residents of age 12 years and over
[Question 36 to 38 were asked of female residents age 12+.]

36. Total number of live-born children

Ask the question: How many live births have you had in your life? Ask the number of boys and girls. Record the number of boys in the "male" box and the number of girls in the "female" box.

_ _ Male
_ _ Female

37. Total number of children still living

Ask the question: How many of your children are still living? Ask the number of boys and girls. Record the number of boys in the "male" box and the number of girls in the "female" box.

_ _ Male
_ _ Female

38. Live births within the last 12 months

Ask the question: Have you had one or more live births during the last 12 months? Ask the number of boys and girls. Record the number of boys in the "male" box and the number of girls in the "female" box.

_ _ Male
_ _ Female

[page 5]

Housing features and amenities

39. Type of construction

[] 1 Modern villa
[] 2 Simple house
[] 3 Row house
[] 4 Apartment in a building
[] 5 Plot
[] 6 Traditional hut
[] 7 Shack
[] 8 Other, specify ____

40. Total number of rooms in household

_ _ 40A. Total number of available rooms
_ _ 40B. Total number of occupied rooms

41. Nature of the walls

[] 1 Wood
[] 2 Sheet metal
[] 3 Concrete
[] 4 Tile / Everite
[] 5 Plastic tarp
[] 6 Other, specify ____

42. Nature of the roof

[] 1 Plant fiber
[] 2 Sheet metal
[] 3 Concrete
[] 4 Tile / Everite
[] 5 Plastic tarp
[] 6 Other, specify ____

43. Nature of the floors

[] 1 Earth or sand
[] 2 Cement
[] 3 Tile / marble
[] 4 Carpet / rug
[] 5 Wood
[] 6 Other, specify ____

44. Characteristics of the toilet facilities

[] 1 Indoor toilet
[] 2 Outdoor toilet
[] 3 Latrines in the courtyard
[] 4 Latrines outside the courtyard
[] 5 In nature
[] 6 Other, specify ____

45. Water

[] 1 Running water
[] 2 Running water in the yard
[] 3 Running water outdoors
[] 4 Well in the yard
[] 5 Public well
[] 6 Village water pump
[] 7 Surface water (backwater, river, etc.)
[] 8 Other, specify ____

46. Mode of lighting

[] 1 Electricity
[] 2 Lamp
[] 3 Gas
[] 4 Electricity and lamp
[] 5 Other, specify ____

47. Mode of cooking

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

48. Mode of household waste disposal

[] 1 Pick-up by truck
[] 2 In nature
[] 3 Burned garbage
[] 4 Buried garbage
[] 5 Other, specify ____

49. Mode of wastewater disposal

[] 1 Septic tank
[] 2 Sewage system
[] 3 On the street
[] 4 Gutter
[] 5 In nature

50. Household appliances

[] 1 Radio
[] 2 Television
[] 4 Telephone
[] 8 Refrigerator
[] 16 None

51. Residence occupation status

[] 1 Owner
[] 2 Lease-purchase
[] 3 Operating lease
[] 4 Staff accommodation
[] 5 Free accommodation
[] 6 End-of-term owner
[] 7 Other, specify ____

52. Amount of monthly rent (tenant or lease purchase)

_ _ _ _ _ _ CFA francs

53. Mortality

Have there been any deaths in your household in the last 12 months? If so, complete the table below.

[] 1 Yes
[] 2 No

A. Family name and given names ____

A1. Sex
[] 1 Male
[] 2 Female

A2. Age at death _ _

[The space designated for census administrator comments and the table for census administrator signatures on page 5 have been omitted.]