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Ministry of the Economy, Industry, and Commerce
National Office of Statistics and Data
Central Survey Bureau


Republic of Mali
One People-One Goal-One Faith
Fourth General Population and Housing Survey
Law No. 98-020 from March 1998
Household and Housing questionnaire

April 1-14, 2009

Confidential: The information in this document are confidential and cannot be used in judicial proceedings, tax audits, and economic suppression.

Questionnaire No.: _____

Number of questionnaires used for this household: ____

I. Identification:

Region: _____
Circle: ______
District: ______
Commune: _______
Village or location: ______
Hamlet or regrouping location: ______
Neighborhood for urban communes: ______
SE: ______
Plot: ______
Household in the SE: _______

Type of household

[] 1 Settled
[] 2 Nomad
[] 3 Collective

If collective (Type=3)

Type of collective household:

[] 1 Barracks
[] 2 Convent/monastery
[] 3 Hotel
[] 4 Prison
[] 5 Boarding school/orphanage
[] 6 Center for handicapped people
[] 7 Hospital
[] 8 Muslim religious school
[] 9 Other (specify)

First and last name of head of household:___________

II. Summary table
[Give the number of males, females, and total members in the household]
0) Residence status
1) Residents present (RP)

____Male
____Female
____Total

2) Residents absent (RA):

____Male
____Female
____Total

3) Subtotal 1 (RP +RA):

____Male
____Female
____Total

4) Visitors (V):

____Male
____Female
____Total

5) Subtotal 2 (RP + V):

____Male
____Female
____Total

6) Total list (RP + RA + V):

____Male
____Female
____Total

7) Emigrants:

____Male
____Female
____Total

Administrative usage
Survey agent: _______
Name: _______
Date Signature: _______
Supervisor [##translator note: in other surveys, this term was translated as supervisor, a word repeated later in this section]
Name: _______
Date Signature: _______
Editor
Name: _______
Date Signature: _______
Supervisor
Name: _______
Date Signature: _______
Checked by
Name: _______
Date Signature: _______
Coded by Name
Date Signature: _______
Keyed by
Name: _______
Date Signature: _______
Keyed editor
Name: _______
Date Signature: _______
Observations: _______________________________________________

III. Information on individuals
P0) Type of registration: _______

P1) Order number: _______

P2) First and last name: _______

Record the member of the household in the following order:

Head of household
Unmarried children of head of household whose mother does not live in the household
Spouse(s) of head of household followed by her unmarried child(ren) from youngest to oldest
Other relatives of head of household or of his spouse(s)
Persons not related to the head of household

P3) Sex
What is [Name]’s sex?

Record the corresponding code

[] 1 Male
[] 2 Female

P4) Relationship to head of household
What is the relationship of [Name] to the head of the household?

Record the number in front of the suitable response after the instructions on the bottom of the page.

[] 01 Head of household
[] 02 Spouse of head of household
[] 03 Son or daughter of head of household
[] 04 Brother or sister of head of household
[] 05 Father or mother of head of household
[] 06 Grandchild
[] 07 Nephew/niece
[] 08 Uncle/Aunt
[] 09 Daughter-in-law/Son-in-law
[] 10 Other relative of head of household
[] 11 Servant
[] 12 Not related to head of household

P5) Residence

Record the corresponding code

[] 1 Resident present
[] 2 Resident absent
[] 3 Visitor

P6) Religion
What is [Name]’s religion?

Record the code in front of the corresponding answer

[] 01 Muslim
[] 02 Christian
[] 03 Animist
[] 04 Other religion
[] 05 No religion

P7) Birth registration
Does [Name] have a birth certificate or a suppletory judgment?

Record the corresponding code

[] 1 Yes
[] 2 No
[] 3 Don't know

P8) Date of birth

Record the month and year of birth. If the month of birth is not known, record 99. Similarly, record 9999 for the year of birth if it is not known.

Month: _ _
Year: _ _ _ _

P9) Age

Circle the code of the unit used to tell the age. Record the age in the two spaces provided.

[] 1 Day
[] 2 Month
[] 3 Year

_ _

P10) Location of birth
Where was [Name] born?

If in Mali, record the name of the circle if it is known of the name of region if not. Record the name of the country if it’s abroad.
____

P11) Nationality
What is [Name]’s nationality?

Record Mali for Malians and the name of the country for foreigners.
____

P12) Handicap
Does [Name] have any kind of handicap?

Record the corresponding code.

[] 00 None
[] 01 Physical handicap
[] 02 Hearing handicap
[] 03 Visual handicap
[] 04 Mental handicap
[] 05 Multiple handicaps

P13) Previous residence
Did [Name] ever live elsewhere for more than 6 months?

If no, record No. If yes: Where did [Name] live just before moving to where he/she currently lives? Record the circle if it’s known, or the region if not. Record the name of the country if abroad.
____

P14) Length of residence/stay
For how many years has [Name] continuously lived here?

_ _

P15) Usual residence
Ask only visitors: Where does [Name] usually live?

Record the circle if it’s known or the region if not, the country if abroad.
____

Survival of parents

P16) Father
Is [Name]’s natural father alive?

Record the corresponding code

[] 1 Yes
[] 2 No
[] 3 Don't know

P17) Mother
Is [Name]’s natural mother alive?

Record the corresponding code

[] 1 Yes
[] 2 No
[] 3 Don't know

Population age three or older
[Questions P18-P23 were asked for persons age 3+.]

Education

P18) School attendance
Has [Name] ever attended school or is he/she currently attending school?

Record the corresponding code

[] 0 No, never attended
[] 1 Yes, attended in past
[] 2 Yes, attending currently

P19) Level
What is [Name]’s education level?

Record the code corresponding to the response (compare from bottom of the page)

[] 00 Not applicable (less than 3 years)
[] 01 None
[] 02 Instruction in the Koran (not trained)
[] 03 Literate (not trained)
[] 04 Preschool
[] 05 Fundamental 1st cycle
[] 06 Fundamental 2nd cycle
[] 07 Madras 1st cycle
[] 08 Madras 2nd cycle
[] 09 Secondary
[] 10 Technical and Professional
[] 11 Teaching school
[] 12 University
[] 13 Post University

P20) Class
What is the highest class in this level of school [Name] has attended?

____

P21) Diploma
What is the highest diploma [Name] earned?

Record code corresponding to the answer based on the instructions at the bottom of the page.

[] 00 Nothing, Koran instruction, literate, person not applicable
[] 01 Certificate of primary studies
[] 02 Fundamental studies diploma (DEF) [##translator note: entrance exam for secondary school admission
[] 03 CAP [##translator note: Level V diploma, stands for Certificate of Professional Aptitude]
[] 04 Preschool and special educator teacher training
[] 05 Technician’s certificate (BT)
[] 06 Superior Technician’s certificate (BTS)/University Technology Diploma (DUT) (BAC + 2, 3)
[] 07 Teaching training (IFM)
[] 08 High school diploma
[] 09 2-year college degree (DEUG)
[] 10 Bachelor’s degree
[] 11 Master’s degree
[] 12 Post university diploma (Master, DEA, DESS, PHD, etc)

Language
P22) What is [Name]’s native language?

Record code corresponding to the answer based on the instructions at the bottom of the page.

[] 00 Person not applicable
[] 01 Bambara
[] 02 Malinke
[] 03 Peul/Foulfoulbe
[] 04 Sonrai/Djerma
[] 05 Maraka/Soninke
[] 06 Kassonke
[] 07 Senoufo
[] 08 Dogon
[] 09 Maure
[] 10 Tamacheq
[] 11 Bobo
[] 12 Dafing
[] 13 Minianka
[] 14 Haoussa
[] 15 Samogo
[] 16 Bozo
[] 17 Arab
[] 18 Other Malian languages
[] 19 Other African languages
[] 20 Other foreign languages

P23) Spoken
What language does [Name] speak fluently?

Record code corresponding to the answer based on the instructions at the bottom of the page.

[] 00 Person not applicable
[] 01 Bambara
[] 02 Malinke
[] 03 Peul/Foulfoulbe
[] 04 Sonrai/Djerma
[] 05 Maraka/Soninke
[] 06 Kassonke
[] 07 Senoufo
[] 08 Dogon
[] 09 Maure
[] 10 Tamacheq
[] 11 Bobo
[] 12 Dafing
[] 13 Minianka
[] 14 Haoussa
[] 15 Samogo
[] 16 Bozo
[] 17 Arab
[] 18 Other Malian languages
[] 19 Other African languages
[] 20 Other foreign languages

Population age six or older
[Questions P24-P28 were asked for persons age 6+.]

P24) Occupation situation
What did [Name] do for work most of the time in the last 4 weeks?

Record code corresponding to the answer based on the instructions at the bottom of the page. If Yes, use codes 1 or 2, if no, use codes 3 to 9.

[] 0 Person not applicable
[] 1 Occupied
[] 2 Unemployed
[] 3 Looking for first job
[] 4 Seasonal inactivity
[] 5 Occupied at home
[] 6 Student
[] 7 Person of independent means
[] 8 Retired, elderly
[] 9 Hasn’t worked

P25) Main economic activity
For those who worked during the reference month: What type of work did [Name] mainly do? For those who did not work but who have worked: What was the last main job that [Name] had?

Record the response.
____

P26) Position in main occupation
What is (or what was) the position that [Name] had in this occupation?

Record the code corresponding to the response

[] 00 Person not applicable
[] 01 Independent worker
[] 02 Employer/Boss
[] 03 Salaried/Permanent employee
[] 04 Salaried/Temporary employee
[] 05 Apprentice
[] 06 Family helper
[] 07 Others

Agricultural sector
[] 08 Independent
[] 09 Primary associated [partnered] household
[] 10 Secondary associated [partnered] household

P27) Branch of economic activity
What does the business or establishment that [Name] works or worked for mainly do?

____

P28) Agriculture
For workers in the agricultural sector: What is the main type of agricultural work that [Name] does?

[] 00 Person not applicable
[] 01 Growing of dry grains
[] 02 Rice farming
[] 03 Industrial farming
[] 04 Vegetable farming
[] 05 Fruit tree farming
[] 06 Livestock farming
[] 07 Fishing
[] 08 Silviculture/forestry
[] 09 Harvesting
[] 10 Hunting
[] 11 Other agricultural activities

Population age twelve or older
[Questions P29-P30 were asked for persons age 12+.]

P29) Martial status

Determine the marital status of the surveyed individual and record the code corresponding to the response

[] 0 Person not applicable
[] 1 Single
[] 2 Married monogamous
[] 3 Married polygamous
[] 4 Widowed
[] 5 Divorced/separated
[] 6 De facto union/Civil partnership

P30) Literacy
Does (name know how to read and write?

Record the code corresponding to the response

[] 0 Person not applicable
[] 1 Can read and write French only
[] 2 Can read and write a national language only
[] 3 Can read and write only other language
[] 4 Can read and write French and a national language
[] 5 Cannot read or write

Women age 12-49 years
[Questions P31-P33 were asked for women age 12-49.]

P31) Total live births
This question should be asked only to women age 12-49: How many live births has [Name] had?

M _ _
F _ _

P32) Surviving children
This question should be asked only to women age 12-49. Among the live births mentioned in P31 how many are still alive?

M _ _
F _ _

P33) Births in the last 12 months
How many of [Name]’s children were born alive in the last 12 months?

M _ _
F _ _

IV. Deaths in last 12 months (not including collective households)

D1. Were there any deaths in this household in the last 12 months (circle the number corresponding to the response).

[] 1 Yes
[] 2 No

If yes, get the name of each of the deceased in the household in D3, circle their sex in D4, record their date of birth in D5, their date of death in D6, and their age at death in D7. For the women deceased between ages 12 and 49, ask questions D8 to D10.

All deceased persons
Type of registration

D2) 01, 02, 03, etc.

D3) First and last name _____

D4) Sex

[] 1 Male
[] 2 Female

D5) Date of birth

Month: _ _
Year: _ _ _ _

D6) Date of death

Month: _ _
Year: _ _ _ _

D7) Age at death

_ _

If the deceased person is a woman age 12 to 49, the death was related to:

D8) Pregnancy

[] 1 Yes
[] 2 No
D9) Delivery
[] 1 Yes
[] 2 No
D10) In the two months after a pregnancy or a delivery (If yes, record the exact number of days)
[] 1 Yes _ _
[] 2 No

V. Questions about emigration (not including communal households)

E1. In the last 5 years, have there been any members of your household who moved abroad and currently live there (emigrated)?

[] 1 Yes
[] 2 No

If yes, get the number of emigrants in the household in E2, record each person’s name in E4, record their age in E5, Circle the code corresponding to the emigrant’s sex in E6, record the month and year of departure in E7, record all the letters of the destination country in E8.

E2. If yes, How many?

_ _

E3) Number in list
01, 02, 03, etc.

E4) Names: _____

E5) Age at departure

_ _

E6) Sex

[] 1 Male
[] 2 Female

E7) Date of departure

Month _ _
Year _ _ _ _

E8) Destination

____

E9) Reason for leaving: _____

[] 01 Economic reasons
[] 02 Social reasons
[] 03 Professional reasons
[] 04 Political reasons
[] 05 Scholarly reasons
[] 06 Health reasons

VI. Questions about the dwelling (including ordinary and collective households)

Circle the code that applies or record the appropriate code in the space provided. If there is a plot occupied by a single household, use the characteristics of the main building (without including the number of rooms)

H1) Type

[] 1 Fixed
[] 2 Mobile

H2) Type of dwelling

[] 1 Apartment building
[] 2 Villa
[] 3 Simple individual house
[] 4 Concession with several dwellings
[] 5 Hut
[] 6 Tent
[] 7 Precarious dwelling/shack
[] 8 Others

H3) Main material of walls

[] 1 Hard
[] 2 Semi Hard
[] 3 Mudbrick
[] 4 Wood/straw
[] 5 Other, specify

H4) Main material of roof

[] 1 Sheet metal
[] 2 Sheet metal with ceiling
[] 3 Tile
[] 4 Concrete
[] 5 Mudbrick
[] 6 Thatch
[] 7 Other, specify

H5) Main material of floor

[] 1 Cement
[] 2 Tile
[] 3 Beaten earth
[] 4 Other, specify

H6) Main method of lighting

[] 1 Electricity (EDM) [##translator note: EDM is the company, Electricity of Mali]
[] 2 Rural electrification/multifunction platform
[] 3 Generator
[] 4 Gas
[] 6 Petroleum lamp
[] 7 Gas lamp
[] 8 Flashlight (batteries)
[] 9 Other, specify

H7) Supply of drinking water

[] 1 Tap
[] 2 Bore hole
[] 3 Improved well
[] 4 Traditional well
[] 5 Public tap
[] 6 Surface water
[] 7 Other, specify

H8) Main source of energy for cooking

[] 1 Electricity
[] 2 Gas
[] 3 Petroleum
[] 4 Wood
[] 5 Wood charcoal
[] 6 Animal dung
[] 7 Solar oven
[] 8 Other, specify

H9) Type of toilet

[] 1 Indoor private with flush
[] 2 Outdoor private with flush
[] 3 Communal to several household with flush
[] 4 Private latrine
[] 5 Communal latrine
[] 6 Nature/field
[] 7 Other, specify

H10) Occupancy status

[] 1 Owner with property title
[] 2 Owner without property title
[] 3 Co-owner
[] 4 Renter
[] 5 Hire purchase
[] 6 Lodged for free
[] 7 Others, specify

H11) Number of occupied rooms: _____

H12) Existence of improved stove

[] 1 Yes
[] 2 No

H13) Trash evacuation method

[] 1 Private pickup
[] 2 Truck/collection
[] 3 Communal trash can
[] 4 GIE [Groupement d’Intérêt Economique: NGO initiative facilitating lower cost collaborative waste removal activity]
[] 5 Trash pile
[] 6 Ditch
[] 7 Street
[] 8 Nature/field
[] 9 Others

H14) Used water evacuation method

[] 1 Courtyard
[] 2 Street
[] 3 Soak pit
[] 4 Truck/collection
[] 5 Septic tank
[] 6 Sewer system
[] 7 Nature/field
[] 8 Others, specify