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
[] 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
Population type
[] 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
All persons
[Questions P1-P18]
Name
What are the names of all persons who spent census night here (December 3 and 4, 2004)?
P2. Surname ____
P3. First name ____
P4. Relationship
What is [the respondent's] relationship to the household 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)
_ _
P6. Sex
Is [the respondent] male or female?
[] 2 Female
P7. Religion
What is [the respondent's] religion?
[] 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?
[] 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]?
[] 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]?
[] 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?
Country ____
P12. Place of residence in December 1990
Where was [the respondent] living in December 1990?
Orphanhood
P13. Is [the respondent's] mother alive?
[] 2 No
[] 3 Don't know
P14. Is [the respondent's] father alive?
[] 2 No
[] 3 Don't know
P15. Disability
Is [the respondent] disabled?
[] 2 No (go to P19)
Disability
[Questions 16-18 were asked of persons who are disabled, per question P15]
P16. Type of disability
[] 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
[] 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?
[] 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?
[] 2 Still
[] 3 Left
P20. Highest level attained
What is the highest level that [the respondent] attained?
[] 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?
[] 2 No
[Questions P22-P25: Persons age 10 years or older]
P22. Marital status
What is the marital status of [the respondent]?
[] 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?
[] 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?
[] 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?
[] 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:
P27. Female _ _
P29. Female _ _
P31. Female _ _
P33. Female _ _
[Questions P34 - P38: Females age 10 to 54 years]
Particulars of her most recent birth (last 12 months)
P35. Month _ _
P36. Sex
[] 2 Female
[] 2 No
[] 2 No
[] 3 Partial
H01. What are the current repair needs of the dwelling unit?
[] 2 Minor repairs
[] 3 Rehabilitation
[] 4 Reconstruction
H02. How many rooms does the household occupy? _ _
H03. How many beds with mosquito nets?
[] B Regular _ _
[] C None _ _
H04. How was this dwelling acquired?
[] 02 Constructed
[] 03 Inherited
[] 05 Private
[] 06 Parastatal
[] 07 Quasi-Government
[] 09 Housing corporation
[] 10 Private
[] 11 Parastatal
[] 12 Quasi-government
[] 14 Other
Major material of construction of dwelling units
[] 2 Asbestos
[] 3 Zinc
[] 4 Thatch
[] 5 Tarpaulin
[] 6 Tiles
[] 7 Other
[] 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) ____
[] 2 Tiles
[] 3 Cement
[] 4 Wood
[] 5 Mud
[] 6 Other
H08. How do you dispose of rubbish?
[] 2 Dumped anywhere
[] 3 Burnt
[] 4 Buried
[] 5 Deposited in bin
[] 6 Other
H09. What is your principal source of fuel supply for cooking?
[] 2 Gas
[] 3 Kerosene
[] 4 Charcoal
[] 5 Wood
[] 6 Other
H10. What is your principal source for lighting?
[] 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?
[] 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:
[] 12 Flushed inside
[] 13 Flushed outside
[] 14 Pit
[] 15 Bucket
[] 16 Bush/river bed
[] 17 Other (specify) ____
[] 22 Flushed inside
[] 23 Flushed outside
[] 24 Pit
[] 25 Bucket
[] 26 Other (specify) ____
[] 2 Outside; built
[] 3 Outside makeshift
[] 4 Other (specify) ____
[] 5 None
H14. What is the main source of information for the household?
[] 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
[] 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
[] 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
[] 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
[] 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]?
A4. Sheep _ _
A5. Goat _ _
A6. Pigs _ _
A7. Chicken _ _
A8. Duck _ _
Do household members have access to agricultural facilities:
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
Does the household own any of the following (include items only if they are in working condition):
[] 2 No
[] 2 No
[] 2 No
[] 2 No
Section 5: Deaths in the household
D1. Did a death occur in this household in the last 12 months?
[] 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 ____
[] 2 Female
[] 2 Malnutrition
[] 3 CCF
[] 4 Hypertension
[] 5 Anaemia
[] 6 ARI
[] 7 Bronchopneumonia
[] 8 Maternal death
[] 9 Other (specify) ____