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Republic of Sierra Leone
Sierra Leone 2004 Population and Housing Census
(with Agricultural module)

If institution, write name: ____
Province _ _ _ _
District _ _ _ _
Chiefdom _ _
Section _ _
EA _ _ _
Locality/street ____ _ _
Locality name/street address ________

Structure type

[] 1 Single unit 1 storey
[] 2 Multiple unit 1 storey
[] 3 Single unit 2 storey
[] 4 Multiple unit 2 storey
[] 5 Single unit 3+ storey
[] 6 Multiple unit 3+ storey

Structure number: _ _ _

Household number _ _ _

Population type

[] 01 Household
[] 02 Educational
[] 03 Religious
[] 04 Medical
[] 05 Hotel
[] 06 Hostel
[] 07 Prison
[] 08 Barracks
[] 09 Orphanage/reformatory
[] 10 Refugee camp
[] 11 Other institution
[] 12 Homeless
[] 13 Floating population

Section One: Population

All persons
[Questions P1-P18]

Serial number _ _

Name
What are the names of all persons who spent census night here (December 3 and 4, 2004)?

(Record names of all young and old starting with the household head)

P2. Surname ____
P3. First name ____

P4. Relationship
What is [the respondent's] relationship to the household head?

[] 1 Head
[] 2 Spouse
[] 3 Son/daughter
[] 4 Sister/brother
[] 5 Nephew/niece
[] 6 Parent
[] 7 In-law
[] 8 Grandchild
[] 9 Other
[] 0 Not related

P5. Age (completed years)

If younger than 1, record "00". For 95 and over, record "95".
_ _

P6. Sex
Is [the respondent] male or female?

[] 1 Male
[] 2 Female

P7. Religion
What is [the respondent's] religion?

[] 01 Catholic
[] 02 Anglican
[] 03 Methodist
[] 04 SDA [Seventh-Day Adventist]
[] 05 Pentecostal
[] 06 Other Christian
[] 07 Ahmadis Muslim
[] 08 Sunni Muslim
[] 09 Shiek Muslim
[] 10 Other Muslim
[] 11 Bahai
[] 12 Traditional
[] 13 None
[] 14 Other

P8. Nationality/ethnicity
What is [the respondent's] nationality/ethnicity group?

[] 01 Krio
[] 02 Mende
[] 03 Temne
[] 04 Madingo
[] 05 Loko
[] 06 Sherbro
[] 07 Limba
[] 08 Kissi
[] 09 Kono
[] 10 Susu
[] 11 Fullah
[] 12 Krim
[] 13 Yalunka
[] 14 Koranko
[] 15 Vai
[] 16 English
[] 17 French
[] 18 Arabic
[] 19 Other
[] 20 None

P9. Language: primary
What is the primary language spoken by [the respondent]?

[] 01 Krio
[] 02 Mende
[] 03 Temne
[] 04 Madingo
[] 05 Loko
[] 06 Sherbro
[] 07 Limba
[] 08 Kissi
[] 09 Kono
[] 10 Susu
[] 11 Fullah
[] 12 Krim
[] 13 Yalunka
[] 14 Koranko
[] 15 Vai
[] 16 English
[] 17 French
[] 18 Arabic
[] 19 Other
[] 20 None

P10. Language: secondary
What is the secondary language spoken by [the respondent]?

[] 01 Krio
[] 02 Mende
[] 03 Temne
[] 04 Madingo
[] 05 Loko
[] 06 Sherbro
[] 07 Limba
[] 08 Kissi
[] 09 Kono
[] 10 Susu
[] 11 Fullah
[] 12 Krim
[] 13 Yalunka
[] 14 Koranko
[] 15 Vai
[] 16 English
[] 17 French
[] 18 Arabic
[] 19 Other
[] 20 None

P11. Place of birth
In which chiefdom/country was [the respondent] born?

Chiefdom ____
Country ____

P12. Place of residence in December 1990
Where was [the respondent] living in December 1990?

____

Orphanhood
P13. Is [the respondent's] mother alive?

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

P14. Is [the respondent's] father alive?

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

P15. Disability
Is [the respondent] disabled?

[] 1 Yes
[] 2 No (go to P19)

Disability
[Questions 16-18 were asked of persons who are disabled, per question P15]

P16. Type of disability

[] 01 Limited use of legs
[] 02 Loss of leg(s)
[] 03 Limited use of arms
[] 04 Loss of arm(s)
[] 05 Serious problem with back spine
[] 06 Hearing difficulty
[] 07 Unable to hear (deafness)
[] 08 Sight difficulty
[] 09 Blindness
[] 10 Speech impairment
[] 11 Unable to speak (mute)
[] 12 Mental retardation
[] 13 Mental illness (strange behavior)
[] 14 Epileptic
[] 15 Rheumatism
[] 16 Others (specify) ____

P17. Cause of disability

[] 1 Congenital (from birth)
[] 2 Disease/illness
[] 3 Transport accident
[] 4 Occupational injury
[] 5 Other accident
[] 6 War
[] 7 Natural aging process
[] 8 Other (specify) ____

P18. Are you receiving any assistance?

[] 1 Surgical operation
[] 2 Medication
[] 3 Assistive devices
[] 4 Special education (mentally retarded)
[] 5 Braille training/sign language training
[] 6 Skills training (vocational)
[] 7 Counseling
[] 8 Financial
[] 9 Other (specify) ____
[] 0 None

[Questions P19-P21: Persons age 6 years and older]

P19. School attended
Has [the respondent] ever attended school?

[] 1 Never (go to P21)
[] 2 Still
[] 3 Left

P20. Highest level attained
What is the highest level that [the respondent] attained?

[Question P20 was asked of persons age 6 or older who have ever attended school, per question P19]

[] 01 None
[] 11 Kindergarten
[] 21 Primary 1
[] 22 Primary 2
[] 23 Primary 3
[] 24 Primary 4
[] 25 Primary 5
[] 26 Primary 6
[] 31 JSS 1-3
[] 41 SSS 1-3
[] 51 Vocational/commercial
[] 61 Teacher training (TC/HTC)
[] 62 Technical (OND, HND)
[] 63 Nursing (up to SRN)
[] 71 Tertiary (certificate/diploma)
[] 72 Tertiary (first degree)
[] 73 Tertiary (post-graduate)
[] 81 Koranic
[] 92 Other (specify) ____

P21. Literacy
Can [the respondent] read and write in any language?

[] 1 Yes
[] 2 No

[Questions P22-P25: Persons age 10 years or older]

P22. Marital status
What is the marital status of [the respondent]?

[] 1 Never married
[] 2 Engaged
[] 3 Married monogamous
[] 4 Married polygamous
[] 5 Separated
[] 6 Divorced
[] 7 Widowed

Type of economic activity
[Questions P23-P25]

P23. What was [the respondent's] main activity status in the past one month?

[] 1 Paid employee
[] 2 Self-employed
[] 3 Unpaid family worker
[] 4 Looking for work
[] 5 Not working and not looking for work
[] 6 Household work
[] 7 Full-time student
[] 8 Retired/pensioner
[] 9 Other (specify) ____

P24. What kind of work did [the respondent] do?

[] 1 Legislators, senior officials and managers
[] 2 Professionals
[] 3 Technicians and associate professionals
[] 4 Clerks
[] 5 Service workers, shop and market sales workers
[] 6 Skilled agricultural and fishery worker
[] 7 Craft and related trade workers
[] 8 Plant and machine operators and assemblers
[] 9 Elementary occupations
[] 0 Armed Forces

P25. What is the main economic activity of the place where [the respondent] works?

[] 01 Crop farming
[] 02 Livestock
[] 03 Poultry
[] 04 Hunting
[] 05 Forestry
[] 06 Fishing
[] 07 Mining and quarrying
[] 08 Manufacturing
[] 09 Electricity, gas and water supply
[] 10 Construction
[] 11 Wholesale and retail trade, repair of motor vehicles, motorcycles and personal household goods
[] 12 Hotels and restaurants
[] 13 Transport, storage and communication
[] 14 Financial intermediation
[] 15 Real estate, renting and business activities
[] 16 Public administration and defense, compulsory social security
[] 17 Education
[] 18 Health and social work
[] 19 Other community, social and personal service activities
[] 20 Private households with employed persons
[] 21 Extra-territorial organizations and bodies

[Questions P26 - P33: Females age 10 years or older]

How many children have been born alive to [the respondent] who are:

P26. Male _ _
P27. Female _ _

Living in this household
P28. Male _ _
P29. Female _ _

Living elsewhere
P30. Male _ _
P31. Female _ _

Dead
P32. Male _ _
P33. Female _ _

[Questions P34 - P38: Females age 10 to 54 years]

Particulars of her most recent birth (last 12 months)

P34. Year _ _ _ _

P35. Month _ _

P36. Sex
[] 1 Male
[] 2 Female

P37. Is the child alive?
[] 1 Yes
[] 2 No

P38. Immunization for age status
[] 1 Yes
[] 2 No
[] 3 Partial

Section 2: Housing facilities

H01. What are the current repair needs of the dwelling unit?

[] 1 No repairs
[] 2 Minor repairs
[] 3 Rehabilitation
[] 4 Reconstruction

H02. How many rooms does the household occupy? _ _

H03. How many beds with mosquito nets?

[] A Impregnated _ _

[] B Regular _ _

[] C None _ _

H04. How was this dwelling acquired?

Owner
[] 01 Purchased
[] 02 Constructed
[] 03 Inherited
Employer provided
[] 04 Government
[] 05 Private
[] 06 Parastatal
[] 07 Quasi-Government
Renting
[] 08 Government
[] 09 Housing corporation
[] 10 Private
[] 11 Parastatal
[] 12 Quasi-government
Other
[] 13 Squatter
[] 14 Other

Major material of construction of dwelling units

H05. Roof
[] 1 Concrete
[] 2 Asbestos
[] 3 Zinc
[] 4 Thatch
[] 5 Tarpaulin
[] 6 Tiles
[] 7 Other

H06. Wall
[] 01 Stone
[] 02 Cement blocks
[] 03 Clay bricks
[] 04 Sandcrete
[] 05 Zinc
[] 06 Timber
[] 07 Mud bricks
[] 08 Poles/reed
[] 09 Tarpaulin
[] 10 Mud and wattle
[] 11 Other (specify) ____

H07. Floor
[] 1 Stone
[] 2 Tiles
[] 3 Cement
[] 4 Wood
[] 5 Mud
[] 6 Other

H08. How do you dispose of rubbish?

[] 1 Collected
[] 2 Dumped anywhere
[] 3 Burnt
[] 4 Buried
[] 5 Deposited in bin
[] 6 Other

H09. What is your principal source of fuel supply for cooking?

[] 1 Electricity
[] 2 Gas
[] 3 Kerosene
[] 4 Charcoal
[] 5 Wood
[] 6 Other

H10. What is your principal source for lighting?

[] 1 NPA/BKPS [Electricity]
[] 2 Gas
[] 3 Kerosene
[] 4 Generator
[] 5 Battery/rechargeable light
[] 6 Candle
[] 7 Wood
[] 8 Other

H11. What is your principal source of water supply for drinking?

[] 1 Piped indoors
[] 2 Piped in compound
[] 3 Public tap
[] 4 Protected ordinary well
[] 5 Unprotected ordinary well
[] 6 Mechanical well
[] 7 River/riverbed/stream
[] 8 Neighbor's tap
[] 9 Water vendor/bowser
[] 0 Other (specify) ____

What kind of facilities do you have for:

H12. Toilet
Communal
[] 11 VIP
[] 12 Flushed inside
[] 13 Flushed outside
[] 14 Pit
[] 15 Bucket
[] 16 Bush/river bed
[] 17 Other (specify) ____
Private
[] 21 VIP
[] 22 Flushed inside
[] 23 Flushed outside
[] 24 Pit
[] 25 Bucket
[] 26 Other (specify) ____

H13. Bathing
[] 1 Inside
[] 2 Outside; built
[] 3 Outside makeshift
[] 4 Other (specify) ____
[] 5 None

H14. What is the main source of information for the household?

[] 1 Radio
[] 2 Television
[] 3 Print media
[] 4 Post mail
[] 5 Hand mail
[] 6 Word of mouth
[] 7 Church/mosque
[] 8 Other (specify) ____

What is the distance from home to the nearest

H15. Health facility
[] 1 On premises
[] 2 Less than half mile
[] 3 Half mile and less than 1 mile
[] 4 One mile and less than five miles
[] 5 Five miles and above

H16. Primary school
[] 1 On premises
[] 2 Less than half mile
[] 3 Half mile and less than one mile
[] 4 One mile and less than five miles
[] 5 Five miles and above

H17. Source of water
[] 1 On premises
[] 2 Less than half mile
[] 3 Half mile and less than one mile
[] 4 One mile and less than five miles
[] 5 Five miles and above

Section 3: Agricultural module

What are the major agricultural activities undertaken [and the acreage covered] by the household?

A1 and A2: Crop acreage

[] 01 Upland rice ____
[] 02 Lowland rice ____
[] 03 Cassava ____
[] 04 Sweet potato ____
[] 05 Groundnut ____
[] 06 Maize ____
[] 07 Coffee ____
[] 08 Cacao ____
[] 09 Oil palm ____
[] 10 Citrus ____
[] 11 Vegetables ____

What is the number of livestock owned by [the household]?

A3. Cattle _ _
A4. Sheep _ _
A5. Goat _ _
A6. Pigs _ _
A7. Chicken _ _
A8. Duck _ _

Do household members have access to agricultural facilities:

A9. Tractors
[] 1 Yes
[] 2 No

A10. Power tillers
[] 1 Yes
[] 2 No

A11. Threshers
[] 1 Yes
[] 2 No

A12. Rice mills
[] 1 Yes
[] 2 No

A13. Stores
[] 1 Yes
[] 2 No

A14. Drying floors
[] 1 Yes
[] 2 No

A15. Cassava grater
[] 1 Yes
[] 2 No

A16. Oil palm pressers
[] 1 Yes
[] 2 No

Section 4: Ownership

Does the household own any of the following (include items only if they are in working condition):

01. Electric iron
[] 1 Yes
[] 2 No

02. Refrigerator
[] 1 Yes
[] 2 No

03. Television
[] 1 Yes
[] 2 No

04. Computer
[] 1 Yes
[] 2 No

05. Radio
[] 1 Yes
[] 2 No

06. Telephone
[] 1 Yes
[] 2 No

07. Cell phone
[] 1 Yes
[] 2 No

08. Modern stove
[] 1 Yes
[] 2 No

09. Bicycle
[] 1 Yes
[] 2 No

10. Motor cycle
[] 1 Yes
[] 2 No

11. Car/truck
[] 1 Yes
[] 2 No

Section 5: Deaths in the household

D1. Did a death occur in this household in the last 12 months?

[] 1 Yes (answer questions D2, D3, D4 and D5)
[] 2 No
[] 3 Don't know

[Questions D2-D5 were asked of households that had deaths in their household in the last 12 months, as per question D1]

D2. Name of the deceased ____

D3. Sex

[] 1 Male
[] 2 Female

D4. Age at death _ _

D5. Cause of death

[] 1 Malaria
[] 2 Malnutrition
[] 3 CCF
[] 4 Hypertension
[] 5 Anaemia
[] 6 ARI
[] 7 Bronchopneumonia
[] 8 Maternal death
[] 9 Other (specify) ____

Household size

_ _ Males
_ _ Females
_ _ Total