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
[] 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)
[] 1. Ordinary
[] 2. Barracks
[] 3. Convent / monastery
[] 4. Hotel
[] 5. Boarding school / orphanage
[] 6. Prison
[] 7. Handicapped center
[] 8. Other (specify) ____
____ (3) Absent residents
____ (4) Present and absent residents
____ (5) Visitors
____ (6) Total counted (4 + 5)
____ (3) Absent residents
____ (4) Present and absent residents
____ (5) Visitors
____ (6) Total counted (4 + 5)
____ (3) Absent residents
____ (4) Present and absent residents
____ (5) Visitors
____ (6) Total counted (4 + 5)
Control table
Agents
Date _ _ _ _ _ _
Signature ____
Observations ____
Date _ _ _ _ _ _
Signature ____
Observations ____
Questionnaire number _ _
Number of questionnaires used for this household _ _
Date _ _ _ _ _ _
Signature ____
Observations ____
Date _ _ _ _ _ _
Signature ____
Observations ____
Date _ _ _ _ _ _
Signature ____
Observations ____
For all persons
[Columns P01 to P10B were asked of all persons]
(P02) Last and first names ____
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
[] 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
[] 1 Male
[] 2 Female
[] 1 Present resident present
[] 2 Absent resident absent
[] 3 Visitor
(P06) Date of birth _ _ _ _ _ _
(P07) Place of birth ____ _ _ _
(P08) Ethnicity or nationality _ _
[] 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)
[] 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 _ _
(P12) Location of previous residence
(P13) Possession of birth certificate
[] 1 Yes
[] 2 No
[] 3 Do not know
[] 2 No
[] 3 Do not know
[] 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.]
[] 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.]
[] 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)
Residents of 6 years or more of age
[Columns P19 - P23 were asked of resident people age 6 or more.]
[] 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
[] 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 ____ _ _ _
(P22) Status within the profession
[] 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 ____ _ _ _
Persons resident of 12 years or more of age
[Question P24 was asked of resident persons aged 12 or more.]
[] 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]
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)
_ _ Female
Write down the declared number according to gender in the appropriate boxes. If none put 00 in the boxes
_ _ 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?
_ _ Female
(P28) How many are still registered at the civil registry?
_ _ Female
(P29) How many are still living?
_ _ 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?
[] 1 Yes
[] 2 No
If not, put a dash in the box above, delete the rest of the page and go to H01 (Habitation)
(D03) Name of the deceased ____
[] 1 Male
[] 2 Female
[] 1 Day _ _
[] 2 Month _ _
[] 3 Year _ _ _ _
[] 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?
[] 1 Yes
[] 2 No
[] 3 Do not know
(D08) Did she die while giving birth?
[] 1 Yes
[] 2 No
[] 3 Do not know
(D09) Did she die within 42 days of the birth event due to giving birth?
[] 1 Yes
[] 2 No
[] 3 Do not know
[] 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) ____
[] 1 Breeze block, fired or stabilized brick
[] 2 Stone
[] 3 Semi hard
[] 4 Earth, adobe, bricks other than red
[] 5 Board
[] 6 Brushwood, woven mats, claies, leaves, bamboo
[] 8 Other (specify) ____
[] 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
[] 1 Marble, tile, granite
[] 2 Cement
[] 3 Earth/sand
[] 4 Board/wood
[] 8 Other (specify) ____
(H05) Number of rooms in the dwelling
A. Dwelling use _ _
B. Other use E.g.: kitchen, shop, stable _
(H06) Occupation status of the dwelling
[] 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) ____
[] 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
[] 1 Fire wood
[] 2 Charcoal
[] 3 Vegetable waste
[] 4 Oil
[] 5 Butane gas
[] 6 Electricity
[] 8 Other (specify) ____
(H09) Principal source of drinking water
[] 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)
[] 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) ____
[] 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
[] 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
[] 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
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
H15 -- Livestock possessed by household
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes
[] 1 Yes