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Fourth General Census of the Population and Habitation -- 2010
Togolese Republic

Work, liberty, country

Presidency of the Republic
Minister with the President of the Republic responsible for planning, development, and improving of territory

[stamp] General Census of the Population and Habilitation

Togo 2010
General directorate of statistics and national accounting
Central census office

Decree number 2008 -- 068/Pr of July 21, 2008 concerning organization of the 4th General Census of Population and Habitation in Togo

Household questionnaire
Confidential: the date contained in this document is confidential and cannot be used for the purposes of legal proceedings, tax control or repression. Any refusal or false declarations will be punished in accordance with article number 28 of decree number 2008-068/Pr of July 21, 2008 concerning organization of the 4th general census of population and habitation in Togo.

Localization
M1. Region / lome-municipality _
M2. Prefecture / arrondissement _ _
M3. Sub-prefecture (if applicable) _
M4. Canton / neighborhood of lome _ _
M5. Number of zone of enumeration _ _
M6. Environment of residence

[] 1 Urban
[] 2 Rural

M7. Village/ town_ _
M8. Hamlet (if applicable) _ _
M9. Neighborhood (if applicable) _ _
M10. Farm (if applicable) _ _
M11. Number of the compound (if applicable) _ _ _
M12. Number of the household_ _ _

M13. Type of household (circle appropriate code and record it in the box)

[] 0. Homeless
[] 1. Ordinary
[] 2. Barracks
[] 3. Convent / monastery
[] 4. Hotel
[] 5. Boarding school / orphanage
[] 6. Prison
[] 7. Handicapped center
[] 8. Other (specify) ____

Summary table
[In table form]

Sex (1)

R1. Male

____ (2) Present residents
____ (3) Absent residents
____ (4) Present and absent residents
____ (5) Visitors
____ (6) Total counted (4 + 5)

R2. Female

____ (2) Present residents
____ (3) Absent residents
____ (4) Present and absent residents
____ (5) Visitors
____ (6) Total counted (4 + 5)

R3. Total

____ (2) Present residents
____ (3) Absent residents
____ (4) Present and absent residents
____ (5) Visitors
____ (6) Total counted (4 + 5)

Control table
Agents

Census agent
Name and first name ____
Date _ _ _ _ _ _
Signature ____
Observations ____
Head of team
Name and first name ____
Date _ _ _ _ _ _
Signature ____
Observations ____

Questionnaire number _ _
Number of questionnaires used for this household _ _

Checking agent
Name and first name ____
Date _ _ _ _ _ _
Signature ____
Observations ____
Codifying agent
Name and first name ____
Date _ _ _ _ _ _
Signature ____
Observations ____
Entry clerk
Name and first name ____
Date _ _ _ _ _ _
Signature ____
Observations ____

For all persons
[Columns P01 to P10B were asked of all persons]

(P01) Order number _ _

(P02) Last and first names ____

Register according to the following order:

Head of household
Unmarried children whose mother is no longer in the household
The first spouse and her children and so on
The married children of the head of household followed by their spouse(s) and living children
Head of household's other relatives
Other members of the household
Visitors

(P03) Family relationship with head of household

What is the family tie of [the respondent] to the head of household?

[] 1 CM Head of household
[] 2 EP Spouse
[] 3 FF Son or daughter
[] 4 FS Brother or sister
[] 5 PM Father or mother
[] 6 BP Father-in-law or mother-in-law
[] 7 PF Grandson or granddaughter
[] 8 AP Other relative
[] 0 SP No family relation to head of household

(P04) Sex

Circle the appropriate code

[] 1 Male
[] 2 Female

(P05) Situation of residence

Circle the appropriate code

[] 1 Present resident present
[] 2 Absent resident absent
[] 3 Visitor

(P06) Date of birth _ _ _ _ _ _

Record the date of birth or where appropriate the age declared in completed years. If the age declared is less than one (1) year, record 00. If the age declared is more than 98, record 98

(P07) Place of birth ____ _ _ _

Record on the dotted lines the name of the locality, the canton, and the prefecture or sub-prefecture or record the name of the country for all those born outside of Togo.

(P08) Ethnicity or nationality _ _

Record the ethnicity for Togolese and the nationality (country of origin) for foreigners

(P09) Religion

[] 00 No religion
[] 11 Catholic
[] 21 Evangelical Presbyterian
[] 22 Methodist
[] 23 Assembly of God
[] 24 Baptist
[] 25 Pentecostalism
[] 26 Jehovah's Witness
[] 27 Adventist
[] 30 Other Christian
[] 41 Muslim
[] 51 Traditional (Animist)
[] 61 Other religion ____

(P10A-P10B) Presence of handicap(s)

[] 0 No handicap
[] 1 Blind
[] 2 Deaf
[] 3 Deaf and mute
[] 4 Handicapped lower members
[] 5 Handicapped higher members
[] 6 Mental illness
[] 8 Other handicap (specify) ____

Resident persons
[Columns P11 - P15 were asked of all resident persons.]

(P11) Duration in current residence _ _

Record the length in past years and put 00 for less than one year. For those residing since birth put 98 in the boxes

(P12) Location of previous residence

Record on dotted lines the name of the locality, canton, and the prefecture or sub- prefecture or record the names of the country for all those whose previous place of residence was outside of Togo.

(P13) Possession of birth certificate

Circle the appropriate code

[] 1 Yes
[] 2 No
[] 3 Do not know

(P14) Survival of father

[] 1 Yes
[] 2 No
[] 3 Do not know

(P15) Survival of mother

[] 1 Yes
[] 2 No
[] 3 Do not know

Residents of 3 years or more of age
[Columns P16 - P18 were asked of resident persons age 3 or more.]

(P16) Educational attendance

Circle the appropriate code

[] 1 Currently attending
[] 2 Has attended
[] 3 Never attended (go to P19)

Level of instruction.
For those who are currently attending (FA) or have attended (AF), see P16

[Questions P17 and P18 were asked of persons who are currently attending or have attended school.]

(P17) Cycle

[] 0 Nursery school
[] 1 Primary
[] 2 Secondary 1st Cycle (6th, 5th, 4th, 3rd)
[] 3 Secondary 2nd Cycle (2nd, 1st, Tle)
[] 4 Short cycle professional training
[] 5 Long cycle technical teaching
[] 6 Higher education
[] 7 Professional school
[] 8 Other (specify)

(19) Last class attended _ _

Current class for those attending or last class for those who no longer attend

Residents of 6 years or more of age
[Columns P19 - P23 were asked of resident people age 6 or more.]

(P19) Literacy

[] 1 Can read, write, and understand French only
[] 2 Can read, write, and understand a national language only
[] 3 Can read, write, and understand French and a national language
[] 4 Can read, write, and understand another language
[] 5 Can read only
[] 6 Cannot read nor write

Economic activities

(P20) Occupation status

[] 1 Occupied
[] 2 Unemployed who has already worked
[] 3 Unemployed who has never worked
[] 4 Housewives
[] 5 Retired
[] 6 Student / pupil
[] 7 Rentier
[] 8 Other inactive

For those occupied and the unemployed who have already worked
[See column P20. Questions P21 through P23 were asked of persons age 6 or more who reported have worked in question P20.]

(P21) Current profession ____ _ _ _

Record current profession on the dotted lines

(P22) Status within the profession

Record the abbreviation on the dotted lines and the code in the box.

[] 1 Independent
[] 2 Employer
[] 3 Permanent salaried employee
[] 4 Temporary salaried employee
[] 5 Familial aid
[] 6 Apprentice
[] 7 Member of cooperative
[] 9 Other (specify)

(P23) Branch of activity ____ _ _ _

Record the branch of activity of the establishment in which the person works or has most worked.

Persons resident of 12 years or more of age
[Question P24 was asked of resident persons aged 12 or more.]

(P24) Marital status

Record the abbreviation on the dotted lines and the code in the box

[] 0 Never married
[] 1 Married monogamously
[] 2 Men and women in polygamous union 2 spouses
[] 3 Men and women in polygamous union 3 spouses
[] 4 Men and women in polygamous union 4 spouses or more
[] 5 Widower
[] 6 Divorced
[] 7 Separated
[] 8 Free union

Female residents of 12 or more of age
[columns P25-29]

(P25) Born alive children

How many born alive children have you had?

Record the declared number according to gender in the appropriate boxes. If none put 00 in the boxes and go to the following line (following person)
_ _ Male
_ _ Female

(P26) Living children

How many living children do you currently have?

Write down the declared number according to gender in the appropriate boxes. If none put 00 in the boxes
_ _ Male
_ _ Female

Births that occurred during the last 12 months
[Columns P27 - P29 were asked about births that occurred in the last 12 months.]

(P27) How many living births have you had during the last 12 months?

Record the number for each sex in the appropriate boxes. If none put 00 in the boxes and go to the following line (following person)
_ _ Male
_ _ Female

(P28) How many are still registered at the civil registry?

Record the number for each sex in the appropriate boxes. If none put 00 in the boxes and go to the following line (following person)
_ _ Male
_ _ Female

(P29) How many are still living?

Record the number for each sex in the appropriate boxes. If none put 00 in the boxes and go to the following line (following person)
_ _ Male
_ _ Female

Deaths occurred during the last 12 months
[Columns D02 - D09 were asked of households that answered "Yes" in D01A.]

(D01A) Has there been any deaths in the household during the last 12 months?

Circle the appropriate code and record in the right-hand box.

[] 1 Yes
[] 2 No

(D01B) Number of deaths

If yes, how many? _

If not, put a dash in the box above, delete the rest of the page and go to H01 (Habitation)

(D02) Order number _

(D03) Name of the deceased ____

(D04) Sex of the deceased

Circle the gender's code
[] 1 Male
[] 2 Female

(D05) Date of death

Record the day, month and year of death in the appropriate boxes

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

(D06) Age at death _ _

Circle the appropriate unit and code, then record the number in the boxes

[] 1 Days
[] 2 Months
[] 3 Years

Mortality for women of 12 to 49 years of age
[Columns D07 - D09 were asked if there was a death in the household was of a woman age 12 to 49.]

(D07) Did she die due to problems linked to pregnancy?

Circle the appropriate code.

[] 1 Yes
[] 2 No
[] 3 Do not know

(D08) Did she die while giving birth?

Circle the appropriate code

[] 1 Yes
[] 2 No
[] 3 Do not know

(D09) Did she die within 42 days of the birth event due to giving birth?

Circle the appropriate code

[] 1 Yes
[] 2 No
[] 3 Do not know

Dwelling unit

(H01) Construction type

Circle the appropriate code and record it in the box

[] 1 Traditional isolated house
[] 2 Traditional compartmentalized house
[] 3 Ordinary isolated house
[] 4 Ordinary compartmentalized house (common court)
[] 5 Villa
[] 6 House of one or two floors
[] 7 Apartment building
[] 8 Other (specify) ____

(H02) Material of walls

Circle the appropriate code and record it in the box

[] 1 Breeze block, fired or stabilized brick
[] 2 Stone
[] 3 Semi hard
[] 4 Earth, adobe, bricks other than red
[] 5 Board
[] 6 Brushwood, weaves, clay, leaves, bamboo
[] 8 Other (specify) ____

(H03) Material of roof

Circle the appropriate code and record it in the box

[] 1 Reinforced concrete (slab)
[] 2 Tile (fiber cement)
[] 3 Aluminum trough
[] 4 Corrugated iron (zinc)
[] 5 Straw
[] 6 Earth, adobe
[] 7 Leaves, brushwood, clay, bamboo
[] 8 Other (specify) ____

(H04) Material of the floor of rooms in dwelling

Circle the appropriate code and record it in the box

[] 1 Marble, tile, granite
[] 2 Cement
[] 3 Earth/sand
[] 4 Board/wood
[] 8 Other (specify) ____

(H05) Number of rooms in the dwelling

Record the number declared in the corresponding boxes. Put 0, if none.

A. Dwelling use _ _
B. Other use E.g.: kitchen, shop, stable _

(H06) Occupation status of the dwelling

Circle the appropriate code and record it in the box

[] 1 Family house
[] 2 Owner with ownership title
[] 3 Owner without ownership title
[] 4 Renter
[] 5 Housed by employer
[] 6 Housed free of charge
[] 8 Other (specify) ____

(H07) Principal lighting mode

Circle the appropriate code and record it in the box

[] 1 Oil lamp
[] 2 Lampion
[] 3 Electricity (CEET)
[] 4 Electricity generator
[] 5 Solar energy
[] 6 Gas lamp
[] 7 Torch
[] 8 Other (specify) ____

(H08) Principal source of energy used for cooking

Circle the appropriate code and record it in the box

[] 1 Fire wood
[] 2 Charcoal
[] 3 Vegetable waste
[] 4 Oil
[] 5 Butane gas
[] 6 Electricity
[] 8 Other (specify) ____

(H09) Principal source of drinking water

Circle the appropriate code and record it in the box

[] 0 Mineral water (bottle or sachet)
[] 1 Tap water in the compound
[] 2 Tap water from outside
[] 3 Well equipped with pump
[] 4 Well
[] 5 Rainwater
[] 6 River / marigot / source
[] 7 Water reservoir, dam
[] 8 Other (specify) ____

(H10) Principal source of water used for other purposes (bathing, washing, washing up)

Circle the appropriate code and record it in the box

[] 1 Tap water in the compound
[] 2 Tap water from outside
[] 3 Well equipped with pump
[] 4 Well
[] 5 Rainwater
[] 6 River / marigot / source
[] 7 Water reservoir / dam
[] 8 Other (specify) ____

(H11) Type of lavatory

Circle the appropriate code and record it in the box

[] 1 Private WC with water flush
[] 2 Public WC with water flush
[] 3 Private dry pit
[] 4 Public dry pit
[] 5 In nature
[] 8 Other (specify) ____

(H12) Mode of household waste evacuation

Circle the appropriate code and record it in the box

[] 1 Recognized (authorized) public dump
[] 2 Private dump
[] 3 Door to door removal
[] 4 Burning
[] 5 Burial
[] 6 In nature
[] 8 Other (specify) ____

(H13) Used water evacuation mode

Circle the appropriate code and record it in the box

[] 1 Sewage system
[] 2 Dry well / cesspool
[] 3 Ditch
[] 4 In the courtyard, compound
[] 5 In the street
[] 6 In nature
[] 8 Other (specify) ____

(H14) Goods possessed by the household

Record in the boxes (Yes = 1, No = 0)

A - Radio set
[] 0 No
[] 1 Yes

B - Television set
[] 0 No
[] 1 Yes

C- Parabolic antenna / cable
[] 0 No
[] 1 Yes

D - Computer
[] 0 No
[] 1 Yes

E - Video recorder / VCD / DVD player
[] 0 No
[] 1 Yes

F - Refrigerator / freezer
[] 0 No
[] 1 Yes

G - Stove / gas cooker
[] 0 No
[] 1 Yes

H - Bicycle
[] 0 No
[] 1 Yes

I - Motorcycle
[] 0 No
[] 1 Yes

J - Car
[] 0 No
[] 1 Yes

K - Land line telephone
[] 0 No
[] 1 Yes

L - Mobile telephone
[] 0 No
[] 1 Yes

M - Air conditioner
[] 0 No
[] 1 Yes

N - Ventilator
[] 0 No
[] 1 Yes

O - Mill
[] 0 No
[] 1 Yes

P - Agricultural plot
[] 0 No
[] 1 Yes

H15 -- Livestock possessed by household

Record in the boxes (Yes = 1 No = 0)

A - Cattle
[] 0 No
[] 1 Yes

B - Sheep / goats
[] 0 No
[] 1 Yes

C - Pigs
[] 0 No
[] 1 Yes

D - Donkeys
[] 0 No
[] 1 Yes

E - Horses
[] 0 No
[] 1 Yes

F - Poultry
[] 0 No
[] 1 Yes