Republic of South Sudan
National Population Census Council
Long Questionnaire
Fifth Population and Housing Census
2-16 February 2008
State _ _
County / Mahaliya _ _
Payam / Administrative unit _ _
Boma / Popular Administrative unit _ _ _
Enumeration Area number _ _ _
Town / village / nomad camp _ _
Household number _ _ _
Continuation Sheet
If this is a continuation sheet for this household/institution mark here [] and enter the sheet sequence number in the box right.
Sheet sequence number _ _
Population group/type of household
[] 2 Nomads
[] 3 Internally displaced
[] 4 Institutional household
[] 5 Homeless
[] 6 Refugees
[] 7 Cattle camp
[] 8 Overnight travelers
Enumerator number _ _ _ _ _ _
Supervisor validation
Supervisor name ____
Supervisor signature ____
Date ____
Enumerator validation
Enumerator name ____
Enumerator signature ____
Date ____
Serial number of household member _ _
Details of persons in the household -- All household members
[Questions 1 to 14: All persons]
1. Name of usual members of the household and visitors ________
Write names in full (tripled: name of person, father and grandfather)
Children should always be listed after their mothers
2. What is the relationship of [the respondent] to the head of household?
[] 2 Spouse
[] 3 Son / daughter
[] 4 Wife of son / husband of daughter
[] 5 Grandchild
[] 6 Niece / nephew
[] 7 Parent / parent-in-law
[] 8 Sister / brother-in-laws
[] 9 Other relative
[] 10 Non relative
3. Is [the respondent] male or female?
[] 2 Female
4. What is [the respondent's] age in completed years?
_ _
5. What is [the respondent's] nationality?
_ _
6. To what regional group does [the respondent] belong?
[] 2 Southern Sudanese
[] 3 Non Sudanese
[] 4 No response
7. What is [the respondent's] region of origin?
[] 2 Eastern
[] 3 Khartoum
[] 4 Central
[] 5 Kordofan
[] 6 Darfur
[] 7 Upper Nile
[] 8 Bahr El Ghazal
[] 9 Equatoria
[] 10 Not Sudan
[] 11 No response
8. In what state was [the respondent] born?
_ _
9. What is [the respondent's] current usual state of usual residence? Where [the respondent] lived or intends to live for 6 months or more.
_ _
10. How many years has [the respondent] lived continuously in the state of usual residence?
_ _
11. In what state did [the respondent] usually reside this time last year?
_ _
12. Is [the respondent's] biological mother alive?
[] 2 No
[] 3 Don't know
13. Is [the respondent's] biological father alive?
[] 2 No
[] 3 Don't know
14. Does [the respondent] have any difficulty in moving, seeing, hearing, speaking or learning?
[] 1 Limited use of legs
[] 2 Loss of leg(s)
[] 3 Limited use of arms
[] 4 Loss of arm(s)
[] 5 Difficulty in hearing
[] 6 Deaf
[] 7 Difficulty in seeing
[] 8 Blind
[] 9 Difficulty in speaking
[] 10 Mute
[] 11 Mental disability
[] 12 No disability
[] 13 Don't know
Education status
[Questions 15 - 18: Persons age 6 or older]
15. Can [the respondent] read and write with understanding a simple sentence in any language?
[] 2 No
16. Has [the respondent] ever attended, or is currently attending school this year?
[] 2 Previously attended (skip to Q18)
[] 3 Never attended (skip to Q19)
17. For those currently attending: what is the grade and level that [the respondent] is attending?
[] 1 P1
[] 2 P2
[] 3 P3
[] 4 P4
[] 5 P5
[] 6 P6
[] 7 P7
[] 8 P8
[] 9 S1
[] 10 S2
[] 11 S3
[] 12 S4
[] 13 S5
[] 14 S6
[] 15 Post secondary diploma program
[] 16 College
[] 17 University
[] 18 Master degree
[] 19 Ph.D. degree
18. What is the highest level [the respondent] completed?
[] 1 No qualification (previously)
[] 2 Incomplete primary (currently)
[] 3 Primary 4
[] 4 Primary 6
[] 5 Primary 8
[] 6 Junior 3
[] 7 Junior 4
[] 8 Secondary 3
[] 9 Secondary 4
[] 10 Secondary 5
[] 11 Secondary 6
[] 12 Postsecondary diploma
[] 13 University first degree
[] 14 Postgraduate diploma
[] 15 Master's degree
[] 16 Ph.D. degree
[] 17 Khawa
Economic activity
[Questions 19 - 23: Persons age 10 or older]
19. During the week before census night, did [the respondent] work at least one hour for pay (or without pay), profit, in kind, or for family business?
[] 2 Did not work but have a job to go back to (skip to Q21)
[] 3 Did not work but worked before and seeking work and available for work (skip to Q21)
[] 4 Did not work, seeking work for the first time and available for work (skip to Q24)
[] 5 Did not work and not seeking work
20. For those who did no work and were not seeking work, why did [the respondent] not seek work?
[] 1 No hope of finding job
[] 2 Full-time student
[] 3 Income recipient
[] 4 Too old
[] 5 Disabled / too sick
[] 6 Full-time homemaker / housewife
[] 7 Pensioner / retired
21. For those who worked or have worked before (Q19, codes 1-3), state in detail, the main job that [the respondent] was engaged in during the week before census night?
Occupation ________
22. For those who worked or have worked before (Q19, codes 1-3), what was [the respondent's] place of work or main activity of [the respondent's] place of work during the week before census night?
Industry ________ _ _
23. For those who worked or have worked before, what was [the respondent's] employment status?
[] 1 Paid employee
[] 2 Employer
[] 3 Own account worker
[] 4 Unpaid family worker
[] 5 Unpaid working for others
Marital status
[Questions 24 - 25: Persons age 12 or older]
24. What is [the respondent's] marital status?
[] 2 Married
[] 3 Widowed
[] 4 Divorced
25. For all ever-married persons: what was [the respondent's] age at first marriage?
_ _
Number of children ever born alive
[Questions 26 - 32: Women aged 12 to 54 years]
If no children, write "00"
26. What is the total number of children [the respondent] has ever born alive? (even if the child was only alive for a short time and died soon after birth)
Female _ _
27. How many of these children are living with [the respondent] in this household?
Female _ _
28. How many of those children are living elsewhere (not in this household)?
Female _ _
29. How many of those children are no longer alive?
Female _ _
Births during the last 12 months
30. Did [the respondent] give birth during the last 12 months?
Male _ _
Female _ _
31. How many children has [the respondent] given birth to in the last 12 months?
Male _ _
Female _ _
32. How many of these children born in the last 12 months are still alive?
Female _ _
Housing characteristics
[Questions 33 - 42]
33. What type of dwelling does this household live in?
[] 2 Dwelling of straw mats
[] 3 Tukul / gottiya -- mud
[] 4 Tukul / gottiya -- sticks
[] 5 Flat or apartment
[] 6 Villa
[] 7 House of one floor -- mud
[] 8 House of one floor -- brick/concrete
[] 9 House constructed of wood
[] 10 Multi-storey house
[] 11 Incomplete
34. How many rooms does this household use for sleeping indoors?
35. What is the tenure status of this dwelling?
[] 2 Rented
[] 3 Housing provided as part of work
[] 4 Free
36. What is the main source of drinking water for this household?
[] 2 Mechanical boreholes with common network stand pipe (koshk)
[] 3 Deep boreholes (donkey) with network
[] 4 Deep boreholes (donkey) without network
[] 5 Hand pumps
[] 6 Sand filters with common network stand pipe (koshk)
[] 7 Shallow wells (dug wells)
[] 8 Hafeer / dam without filter (still open water)
[] 9 Hafeer /dam with filter (still open water)
[] 10 Turda / fula / river (still open water)
[] 11 Running open water source (river, pond, tura'a)
[] 12 Water vendor (tanker-cart-bearer) from deep boreholes
[] 13 Water vendor - from shallow wells pond/river/spring
37. What is the main source of lighting for this household?
[] 2 Public electricity
[] 3 Private electricity (generator)
[] 4 Gas
[] 5 Paraffin lantern
[] 6 Paraffin lamp
[] 7 Firewood
[] 8 Grass
[] 9 Candle wax
[] 10 Solar power
[] 11 Biogas
38. What is the main source of energy used for cooking in this household?
[] 2 Charcoal
[] 3 Gas
[] 4 Electricity
[] 5 Paraffin
[] 6 Cow dung
[] 7 Grass
[] 8 Biogas
[] 9 No cooking
39. What is the main type of toilet facility used by this household?
[] 2 Shared pit latrine
[] 3 Private flush toilet
[] 4 Shared flush toilet
[] 5 Bucket toilet
[] 6 No toilet facility
40. Does any member of this household own any of the following?
[] 1 Motor vehicle
[] 2 Motor cycle / motor rickshaw
[] 3 Bicycle
[] 4 Canoe / boat
[] 5 Any type of animal used for transport
[] 6 Tractor
[] 7 None
41. Does any member of this household own any of the following?
[] 1 Television
[] 2 Radio/transistor
[] 3 Mobile phone
[] 4 Fixed phone (landline)
[] 5 Computer
[] 6 Refrigerator
[] 7 Satellite dish
[] 8 Fan
[] 9 Air cooler / air-conditioner
[] 10 None
42. What is the household's main source of livelihood?
[] 2 Subsistence animal husbandry
[] 3 Wages and salaries
[] 4 Owned business enterprise
[] 5 Property income
[] 6 Remittance
[] 7 Pension
[] 8 Humanitarian aid
For households engaged in cultivation/plantation, animal husbandry, fishery
[Questions 43 - 48]
43. Does this household perform any cultivation/plantation activities?
[] 2 No (skip to Q47)
44. How large is the area being cultivated by this household? Code area in Feddans. If more than 999, mark "999".
Area _ _ _
45. What type of crops did this household cultivate during the previous year?
(Mark all that apply)
[] 1 Cereals
[] 2 Vegetables
[] 3 Fruits and nuts
[] 4 Oil seed
[] 5 Root and tuber
[] 6 Beverage/spice
[] 7 Leguminous
[] 8 Sugar
[] 9 Cotton
[] 10 Coffee
[] 11 Tea
[] 12 Other
46. What is the tenure status of land under cultivation/plantation?
[] 1 Owned
[] 2 Rented
[] 3 Partially owned
[] 4 Communal
47. Does this household perform any fishery activities?
[] 2 No
48. Does this household own any of the following animals? Code the number for all that apply, if more than 999, code "999")
Camels _ _ _
Sheep _ _ _
Goats _ _ _
Horses _ _ _
Donkeys _ _ _
Pigs _ _ _
Poultry _ _ _
Deaths in the household during the last 12 months
[Questions 49 - 54]
49. Was there any deaths among members of the household in the past 12 months?
[] 2 No (end interview)
50. Name of the deceased ________
51. Was the deceased male or female?
[] 2 Female
52. Age at death _ _
If age is unknown, estimate age using local historic calendar.
Record age in completed years
53. Was the death related to either accident or act of violence?
[] 2 No
54. Did the death occur during pregnancy, delivery or the first 2 months after delivery?
[] 1 Yes
[] 2 No