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Republic of Cote d'Ivoire
Interministerial Census Oversight Committee
National Statistics Institute
National Census Committee
General Population and Housing Census 1998
1. Region _ _
2. Department _ _
3. Sub-prefecture (S/P) _ _
4. Commune (municipality) _ _
5. Census district number _ _ _ _
6. Village _ _ _
7. Neighborhood / camp _ _ _ _
8. Lot 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 _ _ _
____ Total number of questionnaires
_ _ _ Female
_ _ _ Total
Absent
_ _ _ Female
_ _ _ Total
Total
_ _ _ Female
_ _ _ Total
Visitors
_ _ _ Female
_ _ _ Total
Total population surveyed
_ _ _ Female
_ _ _ Total
____ Date
____ Signature
Coding agent
____ Date
____ Signature
Data entry agent
____ 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 It is covered by statistical secrecy and may not be published except in anonymous form, pursuant to the law of 7 June 1951 on statistical secrecy and the duty to respond.
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All persons surveyed ? present residents (RP), absent residents (RA), and visitors (VI)
[Question 14 through 20 were asked of all persons.]
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) ____
[] 2 Absent resident (ra)
[] 3 Visitor (vi)
16. Relationship to head of household
[] 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)
[] 2 Female
_ _ Day
_ _ Month
_ _ Year
Or
_ _ Age
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
For Ivorians, their ethnic group: (e.g. CI/Baoule, CI/Naturalized.) _ _ _
For non-Ivorians, the name of the country, (e.g. Togo) ____
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All residents
[Question 21 through 25 were asked of all resident persons.]
21. Place of residence in November 1997
For persons born outside Cote d'Ivoire, the name of the country. ____
[] 2 Protestant (pr)
[] 3 Harrist (ha)
[] 4 Other Christian (ac)
[] 5 Muslim (mu)
[] 6 Animist (an)
[] 7 Other religions (ar)
[] 8 No religion (sr)
[] 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)
[] 2 Mother deceased (md)
[] 3 Don't know (nsp)
[] 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.]
[] 1 Yes
[] 2 No
[] 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)
[] 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)
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Residents of age 12 years and over
[Question 34 and 35 are asked of resident persons age 12+.]
[] 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)
[] 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
_ _ Male
_ _ Female
37. Total number of children still living
_ _ Male
_ _ Female
38. Live births within the last 12 months
_ _ Male
_ _ Female
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Housing features and amenities
[] 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
_ _ 40B. Total number of occupied rooms
[] 2 Sheet metal
[] 3 Concrete
[] 4 Tile / Everite
[] 5 Plastic tarp
[] 6 Other, specify ____
[] 2 Sheet metal
[] 3 Concrete
[] 4 Tile / Everite
[] 5 Plastic tarp
[] 6 Other, specify ____
[] 2 Cement
[] 3 Tile / marble
[] 4 Carpet / rug
[] 5 Wood
[] 6 Other, specify ____
44. Characteristics of the toilet facilities
[] 2 Outdoor toilet
[] 3 Latrines in the courtyard
[] 4 Latrines outside the courtyard
[] 5 In nature
[] 6 Other, specify ____
[] 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 ____
[] 2 Lamp
[] 3 Gas
[] 4 Electricity and lamp
[] 5 Other, specify ____
[] 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
[] 2 In nature
[] 3 Burned garbage
[] 4 Buried garbage
[] 5 Other, specify ____
49. Mode of wastewater disposal
[] 2 Sewage system
[] 3 On the street
[] 4 Gutter
[] 5 In nature
[] 2 Television
[] 4 Telephone
[] 8 Refrigerator
[] 16 None
51. Residence occupation status
[] 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)
53. Mortality
Have there been any deaths in your household in the last 12 months? If so, complete the table below.
[] 2 No
A. Family name and given names ____
[] 2 Female
[The space designated for census administrator comments and the table for census administrator signatures on page 5 have been omitted.]