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2012 Population and Housing Census
The United Republic of Tanzania
Long Questionnaire

Form number _ _ of _ _

A. Identification data:

____ Region
____ District
____ Ward / Shehia
____ Village / street
____ Enumeration area
____ Household number

B. All persons
[Questions 1-19 were asked of all persons.]

1. Person number _

2. Household members

Please state the names of all persons who spent the census night, that is Sunday 26th August 2012 in your household, starting with the name of the head of the household
____

3. Relationship to the head of household

What is the relationship of the individual to the head of the household?

[] 1 Head
[] 2 Spouse
[] 3 Son / daughter
[] 4 Parent
[] 5 Grandchild
[] 6 Other relative
[] 7 Not related

4. Sex

Is [the respondent] a male or a female?

[] 1 Male
[] 2 Female

5. Age

How old is [the respondent]? _ _

Write and shade age in complete years. If under 1 year write 0. For 97 years and above write 97

Disability

6. Albinism

Is [the respondent] an albino?

[] Yes
[] No

7. Seeing

Does [the respondent] have difficulty seeing, even if wearing glasses?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Unable to see
[] 5 Not applicable

8. Hearing

Does [the respondent] have difficulty hearing, even if using a hearing aid?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Unable to hear
[] 5 Not applicable

9. Walking

Does [the respondent] have difficulty walking or climbing steps?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Unable to walk
[] 5 Not applicable

10. Remembering

Does [the respondent] have difficulty remembering or concentrating?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Unable to remember
[] 5 Not applicable

11. Self-care

Does [the respondent] have difficulty in self-care, such as washing all over or dressing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Unable to care
[] 5 Not applicable

11A. Other disabilities

Does [the respondent] have any other disability among the following? Read all types of disabilities / difficulties to respondent.

If answer is no, go to question 12
[]Yes
[]No
Multiple response is allowed
[] 1 Cleft palete
[] 2 Spinal befida
[] 3 Spinal cord injuries
[] 4 Mental health
[] 5 Psoriasis

12. Marital status

What is the current marital status of [the respondent]? Read all responses to respondent.

[] 1 Never married
[] 2 Married
[] 3 Living together
[] 4 Divorced
[] 5 Separated
[] 6 Widowed
[] 7 Not stated

13. Citizenship

[The respondent] is a citizen of which country? If Tanzania, write 1 in the box in the left. Write code of the country in the two boxes on the right. For dual citizenship, write code "98". Codes are on a separate sheet.

[] 1 Tanzania
[] Other _ _
[] 98 Dual citizenship


14. Place of residence

Which region/country does [the respondent] usually live in? _ _ _ _

Write and shade code for the region and district if living in Tanzania, or the country code followed by "44" if living outside Tanzania. Codes are in a separate handbook.

15. [Place] where respondent spends most of [the day]

Where do you spend most of his time during the day? _ _ _ _ _
Codes for the 5th box

[] 1 Rural
[] 2 Regional / district headquarter
[] 3 Other urban
Write and shade region and district codes if spends most of the day time in Tanzania or the country code followed by "444" if outside Tanzania. Codes are in a separate handbook.

16. Place of birth

In which region/country was [the respondent] born? _ _ _ _

Write code for the region and district if born in the country or the country code followed by "44" if born outside Tanzania. Codes are in a separate handbook

17. Place of residence in 2011

Where was [the respondent] living in 2011? _ _ _ _

Write and shade code of the region and district if living in the country or the country code followed by "44" if living outside Tanzania. For children aged '00" in question 5, write code '9798'.


18. Birth certificate

Does [the respondent] have birth certificate / notification?

[] 1 Yes, birth certificate
[] 2 Yes, birth notification
[] 3 No
[] 4 Don't know

19. Survival of parents

Is [the respondent's] father alive?
[] 1 Yes
[] 2 No
[] 3 Don't know
Is [the respondent's] mother alive?
[] 1 Yes
[] 2 No
[] 3 Don't know

C. Education: All persons aged 4 years and above
[Questions 20-22 were asked of persons aged 4+]

20. Literacy

Can [the respondent] read and write a short sentence in Kiswahili, English, Kiswahili and English or any other language?

[] 1 Kiswahili
[] 2 English
[] 3 Kiswahili and English
[] 4 Other language
[] 5 Illiterate

21. Education attainment

Is [the respondent] currently attending, partially attended, completed or never attended school?

[] 1 Now attending
[] 2 Partially attended
[] 3 Completed
[] 4 Never attended

If the answer is never attended, skip to section D.

22. Level of education

What level of education has [the respondent] completed or is currently attending? _ _

Write and shade the appropriate code. Codes are in a separate handbook.

D. Economic activity: All persons aged 5 years and above
[Questions 23-27 were asked of persons aged 5+]

Economic activity

23. In the last 12 months, did [the respondent] mainly...

Write and shade the appropriate code. Codes are in a separate handbook.

[] Worked for payment
[] Worked without payment
[] Worked for own benefit
[] Not worked but actively seeking for work
[] Available for work but not actively seeking for work
[] Household chores (e.g. cooking)
[] Full time student
[] Unable to work / sick / too old / disable

24. In the week preceding census' night did [the respondent] mainly...

Write and shade the appropriate code. If code greater than '3', skip to section E. Codes are in a separate handbook.

[] Worked for payment
[] Worked without payment
[] Worked for own benefit
[] Not worked but actively seeking for work
[] Available for work but not actively seeking for work
[] Household chores (e.g. cooking)
[] Full time student
[] Unable to work / sick / too old / disable

25. Employment status

In the week preceding the census' night was [the respondent] an...

[] Employer
[] Employee
[] Own account worker non agriculture
[] Own account worker agriculture
[] Contributing family worker
[] An apprentice

Write and shade the appropriate code. Codes are in a separate handbook.

26. Occupation

What type of work did [the respondent] do in the week preceding the census' night? _ _

Write and shade the appropriate code. Codes are in a separate handbook.

27. Industry

What is the main activity at [the respondent's] place of work for the week preceding the census' night? _ _

Write and shade the appropriate code. Codes are in a separate handbook.

E. Females aged 12 years and above
[Questions 28-32 were asked of females aged 12+]

Children ever born

28. How many male/female children were born alive to [the respondent] and are now living with you/her in this household?

_ _ Male
_ _ Female

If she is not living with any of her children, write and shade '00'.

29. How many male/female children were born alive to [the respondent] and are now living elsewhere?

_ _ Male
_ _ Female

If she has no children living elsewhere, write and shade '00'.

30. How many male/female children were born alive to [the respondent] and are now unfortunately dead?

_ _ Male
_ _ Female

If none of her children has died, write and shade '00'.

Fertility in the last 12 months for women aged 12 to 49 years

31 How many male/female children were born alive to [the respondent] in the last 12 months [i.e. 26 August 2011-25 August 2012]?

_ Male
_ Female

If there is no child born alive in the last 12 months write and shade '0'. Don't ask women of age 50 years and above.

32. How many of the male/female children born alive in the last 12 months are still alive?

_ Male
_ Female

If there is no child surviving, write and shade '0'.

F. General and maternal deaths in the household

Please record information on deaths that occurred in the household in the last 12 months. Do not forget childhood mortality.

33. Was there any death which occurred in this household in the last 12 months?

[] 1 Yes
[] 2 No

If the answer is no, skip to section G.

Record the number of deaths _ _

34. Death serial number _

35. Was the deceased a male or a female?

[] 1 Male
[] 2 Female

36. How old was the deceased at the time of death? _ _

Write age in completed years. If under one year write '00', if 97 years or above write '97'.

37. What was the cause of death?

[] 1 Road accident
[] 2 Other injuries
[] 3 Suicide
[] 4 Domestic violence
[] 5 Sickness / disease
[] 6 Maternal death
[] 7 Other

If the death is of a woman aged 12 to 49 years

38. Did the death occur during pregnancy?

[] 1 Yes
[] 2 No

If the answer is yes, skip to section G.


39. Did the death occur during childbirth?

[] 1 Yes
[] 2 No

If the answer is yes, skip to section G.

40. Did the death occur during the 6 weeks period following the end of pregnancy, irrespective of the way the pregnancy ended?

[] 1 Yes
[] 2 No

G. Housing conditions and ownership of assets

41. What is the ownership status of the main dwelling used by the household?

[] 1 Owned by household
[] 2 Lived in without paying any rent
[] 3 Rented privately
[] 4 Rented by employer
[] 5 Rented by government at a subsidized rent
[] 6 Owned by employer - Free of charge
[] 7 Owned by employer -With rent

If the answer is code 2 or above, skip to question 43.

42. What legal right do you have over the ownership of this land where your house is built?

[] 1 Title deed
[] 2 Residential license
[] 3 Offer
[] 4 Customary ownership
[] 5 Contract
[] 6 Registration [Zanzibar]
[] 7 No legal right

43. What are the main roofing materials used for the main building of this household?

[] 1 Iron sheets
[] 2 Tiles
[] 3 Concrete
[] 4 Asbestos
[] 5 Grass / leaves
[] 6 Mud and leaves
[] 7 Plastics / box
[] 8 Tent

44. What are the main flooring materials used for the main building of this household?

[] 1 Cement
[] 2 Ceramic tiles
[] 3 Parquet or polished wood
[] 4 Terazzo
[] 5 Vinyl or asphalt strips
[] 6 Wood planks
[] 7 Palm / bamboo
[] 8 Earth / sand
[] 9 Dung

[] 1 Modern floor
[] 0 Non modern floor

45. What are the main wall materials used for the main building of this household?

[] 1 Stones
[] 2 Cement bricks
[] 3 Sundried bricks
[] 4 Baked bricks
[] 5 Timber
[] 6 Timber and sheets
[] 7 Poles and mud
[] 8 Grass
[] 9 Tent

46. How many rooms are available for sleeping in this household?

Record number of rooms for sleeping _ _

47. What is the main source of drinking water for this household?

[] 1 Piped water into dwelling
[] 2 Piped water in the yard / plot
[] 3 Public tap / standpipe
[] 4 Tubewell / borehole
[] 5 Protected dug well
[] 6 Unprotected dug well
[] 7 Protected spring
[] 8 Unprotected spring
[] 9 Rainwater collection
[] 10 Bottled water
[] 11 Cart with small tank/drum
[] 12 Tanker truck
[] 13 Surface water [river, dam, lake, pond, stream, charco, canal, irrigation channels]

48. What is the main source of energy used by this household for cooking?

[] 1 Electricity [Tanesco / Zeco]
[] 2 Solar
[] 3 Generator / private sources
[] 4 Cooking gas
[] 5 Gas [biogas]
[] 6 Electricity [wind]
[] 7 Paraffin
[] 8 Coal
[] 9 Charcoal
[] 10 Firewood
[] 11 Wood / residuals
[] 12 Animal residuals
[] 13 Not applicable

[] Improved cooking fuel
[] Non improved cooking fuel

49. What is the main source of energy used by this household for lighting?

[] 1 Electricity [Tanesco / Zeco]
[] 2 Solar
[] 3 Generator [private source]
[] 4 Gas [industrial]
[] 5 Gas [biogas]
[] 6 Electricity [wind]
[] 7 Acetylene lamp
[] 8 Kerosene [lantern/chimney]
[] 9 Kerosene [wick lamps]
[] 10 Candles
[] 11 Firewood
[] 12 Torch / rechargeable lamps

[] Have electricity
[] Have no electricity

50. What is the main type of toilet facility used by this household?

[] 1 Flush/pour flush to piped water system
[] 2 Flush/pour flush to septic tank
[] 3 Flush/pour flush to covered pit
[] 4 Flush/pour flush to somewhere else
[] 5 Ventilated improved pit [VIP] latrine
[] 6 Pit latrine with washable slab and with lid
[] 7 Pit latrine with washable slab without lid
[] 8 Pit latrine with not-washable /soil slab
[] 9 Pit latrine without slab /open pit
[] 10 Composting /ecosan latrine
[] 11 Bucket
[] 12 No facility / bush / field / beach

[] 1 Improved
[] 0 Non improved

51. How is the household refuse disposed of?

[] 1 Regularly collected
[] 2 Irregularly collected
[] 3 Burnt
[] 4 Roadside dumping
[] 5 Burying / pit
[] 6 Other dumping

52. Does your household have/own the following assets?
For yes answer, these assets should be in working condition. Shade the appropriate answer for each item.

Radio
[] 1 Yes
[] 2 No

Telephone [land line]
[] 1 Yes
[] 2 No

Mobile phone
[] 1 Yes
[] 2 No

Bicycle
[] 1 Yes
[] 2 No

Motor vehicle

[] 1 Yes
[] 2 No

Motorcycle / vespa
[] 1 Yes
[] 2 No

Tricycle [Guta]
[] 1 Yes
[] 2 No

Tri motorcycle [Bajai]
[] 1 Yes
[] 2 No

Television
[] 1 Yes
[] 2 No

Electric iron
[] 1 Yes
[] 2 No

Charcoal iron
[] 1 Yes
[] 2 No

Cooker [electric or gas]
[] 1 Yes
[] 2 No

Refrigerator / freezer
[] 1 Yes
[] 2 No

Computer / laptop
[] 1 Yes
[] 2 No

Internet facility
[] 1 Yes
[] 2 No

Plough
[] 1 Yes
[] 2 No

Power tiller
[] 1 Yes
[] 2 No

Hand hoe
[] 1 Yes
[] 2 No

Wheelbarrow
[] 1 Yes
[] 2 No

Oxen
[] 1 Yes
[] 2 No

Donkey / camel
[] 1 Yes
[] 2 No

House
[] 1 Yes
[] 2 No

Land / farm
[] 1 Yes
[] 2 No
[] 1 At least two items out of the listed assets
[] 0 Less than two items out of the listed assets
52. Does your household have/own the following assets?

For yes answer, these assets should be in working condition. Shade the appropriate answer for each item.

Radio
[] 1 Yes
[] 2 No
Telephone [land line]
[] 1 Yes
[] 2 No
Mobile phone
[] 1 Yes
[] 2 No
Bicycle
[] 1 Yes
[] 2 No
Motor vehicle

[] 1 Yes
[] 2 No
Motorcycle / vespa
[] 1 Yes
[] 2 No
Tricycle [Guta]
[] 1 Yes
[] 2 No
Tri motorcycle [Bajai]
[] 1 Yes
[] 2 No
Television
[] 1 Yes
[] 2 No
Electric iron
[] 1 Yes
[] 2 No
Charcoal iron
[] 1 Yes
[] 2 No
Cooker [electric or gas]
[] 1 Yes
[] 2 No
Refrigerator / freezer
[] 1 Yes
[] 2 No
Computer / laptop
[] 1 Yes
[] 2 No
Internet facility
[] 1 Yes
[] 2 No
Plough
[] 1 Yes
[] 2 No
Power tiller
[] 1 Yes
[] 2 No
Hand hoe
[] 1 Yes
[] 2 No
Wheelbarrow
[] 1 Yes
[] 2 No
Oxen
[] 1 Yes
[] 2 No
Donkey / camel
[] 1 Yes
[] 2 No
House
[] 1 Yes
[] 2 No
Land / farm
[] 1 Yes
[] 2 No
[] 1 At least two items out of the listed assets
[] 0 Less than two items out of the listed assets

H. Agriculture and livestock

Agriculture

53. Has/is any member of this household operated/operating any land for agricultural purposes during 2011/12 agricultural year?

[] 1 Yes
[] 2 No

If the answer is no, skip to question 55.

54. Which of the following crops did the household grow?

Maize
[] 1 Yes
[] 2 No
Paddy
[] 1 Yes
[] 2 No
Cassava
[] 1 Yes
[] 2 No
Banana
[] 1 Yes
[] 2 No
Other crops
[] 1 Yes
[] 2 No

Livestock

55. Was any member of this household engaged in raising cattle, goats, sheep or poultry up to the census night?

[] 1 Yes
[] 2 No

If the answer is no, skip to question 57.

56. How many cattle, goats or sheep were available during the census night?

If no write and shade code "00000"

____ Cattle
____ Goats
____ Sheep
____ Poultry

Fish farming

57. Is there any member of this household who is currently engaged in fish farming?

[] 1 Yes
[] 2 No

I. Citizens in diaspora

58. Is there any person who was a member of this household currently living outside Tanzania?

[] 1 Yes
[] 2 No

If the answer is no, skip to section J.

59. Write the number of males and females living outside Tanzania?

_ _ Males
_ _ Females

60. In which country are they living?

Codes are in separate handbook

_ _ 1st HH member
_ _ 2nd HH member
_ _ 3rd HH member
_ _ 4th HH member
_ _ 5th HH member
_ _ 6th HH member
_ _ 7th HH member
_ _ 8th HH member
_ _ 9th HH member
_ _ 10th HH member

If the number of diaspora is more than 10, use extra questionnaire.

61. Have you or anyone in this household received remittance in the form of cash or in kind from them during the last 12 months?

1st HH member
[] 1 Yes
[] 2 No
2nd HH member
[] 1 Yes
[] 2 No
3rd HH member
[] 1 Yes
[] 2 No
4th HH member
[] 1 Yes
[] 2 No
5th HH member
[] 1 Yes
[] 2 No
6th HH member
[] 1 Yes
[] 2 No
7th HH member
[] 1 Yes
[] 2 No
8th HH member
[] 1 Yes
[] 2 No
9th HH member
[] 1 Yes
[] 2 No
10th HH member
[] 1 Yes
[] 2 No

J. Social security funds

62. Is there a person in this household who is a member of the following social security funds?

[] 1 Yes
[] 2 No

If the answer is no, go to section H. Multiple response is allowed.
[] 1 National Social Security Fund [NSSF]
[] 2 Zanzbar Social Security Fund [ZSSF]
[] 3 Parastatal Pension Fund [PPF]
[] 4 Public Service Pension Fund [PSPF]
[] 5 Government Employee Provident Fund [GEPF]
[] 6 Local Authority Pension Fund [LAPF]
[] 7 National Health Insurance Fund / Community Health Fund [NHIF/CHF]
[] 8 Other Fund

K. Total number of persons in the household

_ _ _ Males
_ _ _ Females
_ _ _ Total

Date household enumerated
Day_ _ Month_ _
Name of supervisor____

Date of editing questionnaire
Day_ _ Month_ _