Get documents about "EGC Ghana HH THP 050207.xls
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Document Sample
3/29/07:
1. I've added another mental health module based on the CES-D Depression Scale. Should we delete the old one?
2. In Section 6B - Land info 3, we need codes for traditional positions.
3. Can you adjust section 11 part C for the MCC version?
4. We've added modules including social participation, digist span assessment, and pattern recognition at the end of the survey, which should be completed separately for each child / member of the household.
Can you determine where to put them in the survey and adjust the contents accordingly?
5. On the social partipication questionnaire (at the end of the survey), is it okay to ask people who they voted for?
6. Should section 10 part 3 (misc income and expenditures) be included in the GLSS5+ survey?
4/10/2007
7. We need codes for section 11 part c (Savings) relating to the savings institutions (including a code for the epicenter)
8. We need codes for The Hunger Project - 1 for potential epicenter committees
9. Should we ask in The Hunger Project - 2 for how many times people have used the epicenter resources or how many times per some unit of time (currently at times / month)?
4/11/2007
10. We need codes for the community participation section, question 9.
11. We need codes for Section 13, part b #4 (in which activities can't you participate), #10 (things you want to change)
4/16/2007
12. On section 8, part e (revenue for enterprises in wholesale/retail trade): Can the GLSS people comment on whether or not "last purchased" is comparable to sales in the last two weeks?
13. Section 12 Part b (Ownership of Durables) is very similar to section 11, part b (household assets). We need to determine which one to keep.
Portions of the MCC Survey that Melissa and Treb think can be gotten rid of for the THP version: To do:
DONE - 4/16/07
get rid of these = potentiall drop (just mark in red)
1 Section 2, Part 1 (General Education): Questions 5 and 7 are very similar to questions 24 and 26. don't change
Section 2, Part 1 (General Education): Questions 28-30 may not be necessary (especially if we
2 do not have a village census). get rid of these
3 Section 2, part b (Education Career): Questions 11-15 could probably be dropped get rid of these
Section 2, part c: Questions 1-4 are very similar to Section 2, part b Questions 15 and 16 (both
4 about language capabilities). Get rid of question 15-16, add question 15 to section part c *for all surveys*
Section 3, Part 1 – Health in the last two weeks: Questions 22-24 could probably be dropped
5 (only capture overnight stays at health centers, already have visits to health centers) get rid of these
Section 3, part c (Child Health / Development): Questions 5 and 6 optional (already have
6 extensive intelligence tests, this only captures 0-5 children) (fix the multiple part c *for all surveys*, get rid of these questions *for all surveys*)
Section 3, part d (Fertility / Women’s Health): Questions 27-28 and 32-35 look optional (not sure
7 what we’re trying to capture) get rid of these
Section 3, part f (Insurance – individual specific questions): whole section optional (couldn’t we
8 just ask one question about whether they have insurance?) keep question 1, get rid of rest of section
Section 3, part g (Mental health): whole section optional (do we really need this mental health
9 section? If so, do we need three pages of it?) get rid of entire section
10 Section 3, part h (Activities of Daily Living): Is this section necessary? do not get rid of
Section 3, part h (Miscellaneous Health): Is this section necessary? (perhaps just keep question
11 #1?) do not get rid of
Section 4, part a & b: Activity Status and characteristics of main/secondary occupation in last 7
12 days/1 year: Do we need questions on both the past week and the past year? think about it
Section 4, part d (Unemployment): Do we need questions on both unemployment in the past 7
13 days and unemployment in the last year? think about it
Section 4, part e (Time Use): Can we combine question 7 with question 10 (do we need to
14 disaggregate between shopping and running errands?) put them together
Section 4, part e (Time Use): Can we combine questions 1 and 4 (do we need to disaggregate
15 between taking care of the sick and the elderly?) keep them apart
Section 4, part e (Time Use): Should we add an additional category for sleeping? Time for
16 yourself? (to attempt to make the hours sum to 24) add sleeping
Section 5, part b (Temporary migration concluded): Do we need questions 16 – 23 (do we care
17 about secondary location?) (fix ordering of part c and b)
18 Section 5, part c (Migration History): Is this section necessary? get rid of these
Section 6, part e (Transactions): Questions 2-4 are very similar to questions 13-15 (do we need
19 to know both about the original and current contracts?) get if 2-4
Section 7 (Information): Can part a and part b be combined and just act what type of information
20 was provided? do this *for all surveys*
Section 8, part c (Expenditures in household enterprise): Are questions 3, 4 and 7 (for both first
21 and second enterprise) necessary? get rid fo 3-4
Section 8, part d (Inventories and recent sales / purchases): Do we need this section (we already
22 have expenditures and revenue, do we care about inventories?) keep this
Section 8, part e (Revenue for enterprises in wholesale/retail trade): What does “Last purchased”
23 mean? Is it necessary? talk with GLSS guys about this
Section 9: Do we need information on non-household members? (It’s a very long module and
24 we’re not sure the benefits) keep
Section 12, Part B (Ownership of Durables): This seems very similar to Section 11, part b
25 (Household assets). Which should we keep? keep 1, compare later
Section 12, Part B (Food items consumed): Do we really need last 30 days, and all three
26 seasons? What about a gifts section? get rid of seasons
Sections to add to THP version:
1 Participation in THP Epicenter (courses, meetings, volunteered time, etc) (DONE)
2 Perception of control over life, women empowerment, decision making in household
Village / Community Survey
There are no differences between the three sampling frames in the village / community survey.
Household Survey
For the time being, there is no difference between the MCC version and the Hunger Project (THP) version of the survey. The THP / MCC version
of the survey differs from the GLSS5+ version because the THP / MCC version will not necessarily be administered to households that have
already responded to the GLSS5 survey. Hence, some sections are expanded and additional sections are included to capture the information
gathered in the GLSS5 survey. Additionally, several questions asking about updates to GLSS5 responses have been removed.
The THP / MCC survey includes the following different (expanded) sections that ARE NOT included in the GLSS5+ version:
Activity Status and Main Occupation
Activity Status and Secondary Occupation
Livestock and Assets
Output and Stored Crops
Misc. Income
Savings
The THP / MCC survey includes the following sections that ARE NOT included in the GLSS5+ version:
Housing Characteristics
Consumption
The specific pages of the THP / MCC survey which are new or modified have a purple background and the CONTENTS tab also includes purple
highlights of the sections that differ from the GLSS 5+ survey.
Sections that will be in the MCC version but not THP version (to be reviewed)
Sections that are in the MCC and THP versions, but not the GLSS5+ version
Sections that are in the THP version but not the MCC version
SECTIONS INCLUDED: 6 Agriculture 12 MCC & THP Specific Modules
1 Roster A Livestock and Assets A Housing Characteristics
B Land Information B Consumption
2 Education C Output and Stored Crops
A General Education D Inputs 13 THP Specific Modules
B Educational Career E Land Transactions A Epicenter Participation
C Literary and Apprenticeship B Empowerment
7 Information
3 Health A Agricultural Information 14
A Health in last two weeks
B Preventative (Immunizations) 8 Household Enterprise
C Postnatal Care/ Child Health and Development A HH Enterprise Information
D Fertility / Other Women's Health B Labor
E Contraception and AIDS C Expenditures
F Insurance D Inventory, Sales, Purchases
G Mental Health E Other Revenue
H Activities of Daily Living and Misc. Health
I Anthropometry 9 Relatives
A Parents, Children, and Siblings
4 Labor / Time use B Absent Spouses
A Activity Status and Main Occupation
B Activity Status and Secondary Occupation 10 Misc. Income and Expenses
C Underemployment A Transfers out
D Unemployment B Transfers in
E Time Use C Misc. Income
5 Migration 11 Credit, Assets, and Savings
A Migration A Borrowing
B Migration History B Assets
C Saving
D Lending
Section 1 -- MEMBERS OF THE HOUSEHOLD
Fill out for all household members
If 12 years or older, In what region/country was
What is [name's] How old is [name] born?
What is [name's]
(if more than one spouse, the first one)
relationship with head of 1=Western
What is [name's] [name]?
Sex (Male = 1; Female = 2)
What is [name's] religious
household? 2=Central
If spouse is in HH, spouse's ID
date of birth? (years and current marital status? At what denomination?
1= Head Does 3=Gt. Accra
months if 1=married, age did 1=Catholic
2=Spouse (wife/husband) [name's] 4=Volta
2=Anglican
Member ID
2=consensual union, [name]
3=Child (son/daughter) (if not available under 5, spouse 5=Eastern
3=separated 3=Presbyterian
4=Grandchild code otherwise only live in first get 6=Ashanti
(>> 9) 4=Methodist
5=Parent/parent-in-law house- married 7=Brong Ahafo
6=Son/daughter-in-law
DD = 99 years) 4=divorced 5=Pentecostalist
8=Northern
hold? or start
MM = 99 (>> 9) 6=Spiritualist
7=Other relative Yes = 1 9=Upper East
8=Adopted/foster/ Year = 9999) (if less than 12 5=widowed living 7=Other Christian
10=Upper West
No = 2
(>> 9) with a 8=Muslim
stepchild years >> 10) (>> 9) 96=Other ECOWAS
6=never married 9=Traditional
9=Househelp partner? 10=No religion
97=Africa other than
(>> 10)
10=Non-relative ECOWAS
DD MM Year Years Months 98=Outside Africa
1 2 3 4 5 6 7 8 9 10 11
1
2
3
4
5
6
7
8
9
10
11
12
13
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15
16
17
18
Section 1, PAGE 2 -- MEMBERS OF THE HOUSEHOLD (continued)
Fill out for all household members
Ethnic group codes
What kind of work has
1=Asante
What was [name's] [name's] father done for What was [name's] 2=Akwapim
What is [name's]
father's highest education most of his life? mother's highest 3=Fanti
nationality?
level completed? 1=Professional/technical education level 4=Ga
1= Ghanaian (birth) completed?
1=None 2=Administrative/manageri 5=Dangme
2=Ghanaian 1=None
2=Primary al 6=Krobo
(naturalized) To what ethnic group Does [name's] Does [name's] 2=Primary 7=Ewe
3=Middle/JSS 3=Clerical
ID of Mother
ID of Father
3=Burkinabe does [name] belong? father live in mother live in house- 3=Middle/JSS
Member ID
4=Voc/Comm 4=Sales 8=Guan
(>> 18)
(>> 22)
4=Malian house-hold? hold? 4=Voc/Comm 9=Nzema
5='O' level 5=Service
5=Nigerian Yes = 1 Yes = 1 5='O' level 10=Hausa
6=SSS 6=Agric./Ani- 6=SSS
6=Ivorian No = 2 No = 2 11=Dagomba
7='A' level Husb./Forest/Fishing/Hunti 7='A' level
7=Togolese (>> 16) (>> 20) 12=Mamprusi
8=Training college ng 8=Training college 13=Gonja
8=Liberian
9=Tech/prof 7=Production & 9=Tech/prof 14=Grussi/ Frafra
9=Other ECOWAS
10=Tertiary related works 10=Tertiary 15=Dagati
10=Other African 11=Koranic
11=Koranic 8=Workers NEC 16=Kusasi
11=Other (specify) 12=Don't know
Ethnicity Code 12=Don't know 9=Homemaker 17=Kassena-Nankani
10=Other (specify) 18=Kankoma
19=Nanumba
12 13 14 15 16 17 18 19 20 20=Builsa
1 21=Other (specify)
2
3
4
5
6
7
8
9
10
11
12
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15
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18
Section 1, PAGE 3 -- MEMBERS OF THE HOUSEHOLD (concluded)
Fill out for all household members
What kind of work has [name's] While
For how
mother done for most of her life? absent,
many
1=Professional/technical is/was
months
2=Administrative/managerial [name] a
has [name]
3=Clerical member of
been away
4=Sales another
Member ID
from this
5=Service household?
household
6=Agric./Ani- (including
?
Husb./Forest/Fishing/Hunting single-
7=Production & person
(if 6
related works household?)
months or
8=Workers NEC
less,
9=Homemaker 1=Yes
>> 24)
10=Other (specify) 2=No
21 22 23
1
2
3
4
5
6
7
8
9
10
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12
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15
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18
Section 2 (Education), Part a -- GENERAL EDUCATION
Fill out for all household members GRADE LEVEL
1 2 3 4 5 6 7 8 QUALIFI- CODES
Has What was the What was the Did (NAME) Is Is the school CATION
What is How much time does None = 0
(NAME) highest grade highest attend school / (NAME) (NAME) the CODES
(NAME) spend going Pre-school = 01
ID of person interviewed
college at any attending None = 01 P1 = 11
ever successfully educational still in current to and from school
time during the Public or MSLC = 02 P2 = 12
attended completed? qualification school? grade? daily?
Member ID
past 12 Private? BECE = 03 P3 = 13
school? attained? P4 = 14
months? Voc/Comm =
(see grade Yes = 1 (see IF IN A BOARDING 04 P5 = 15
Public = 1 P6 = 16
Yes = 1 codes) (see Yes = 1 No = 2 Private grade SCHOOL Teacher Tra. JSS1 = 17
No = 2 (>> qualification No = 2 (>> (>>12) religious = 2 codes) CODE A = 05 JSS2 = 18
Part 2C) codes) Part 2B) Private non- HRS … 00 Teacher Post JSS3 = 19
religious = 3 MINS … 00 Sec = 06 M1 = 20
GCE O Level M2 = 21
HRS MINS = 07 M3 = 22
SSCE = 08 M4 = 23
1 SSS1 = 24
GCE A Level SSS2 = 25
2
= 09 SSS3 = 26
3 Tech/Prof. S1 = 27
4 Cert = 10 S2 = 28
Tech/Prof Dip S3 = 29
5 = 11 S4 = 30
6 HND = 12 S5 = 31
Bachelor = 13 L6 = 32
7 U6 = 33
Masters = 14
8 Voc/Technical/C
Doctorate = 15 omputer/Comm/
9 Other = 16 Agric = 41
(specify) Teacher Train =
10
42
11 Nursing = 43
Polytechnic = 51
12 University = 52
13 Other tertiary =
53
14 Other = 61
15 (specify)
16
17
18
Section 2, Part a -- GENERAL EDUCATION (continued)
Fill out for all household members
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
How How How many Who paid for Did What was
I want to ask you about the educational expenses for (NAME) during the past 12 months.
ID OF PERSON INTERVIEWED
many many hours and most of the (NAME) the amount
hours ofhours of minutes of How much was spent on…. educational have a of the
class did
class did homework did (AMOUNT IN CEDIS) expenses? scholarship / scholarship
(NAME) (NAME) (NAME) do bursary / bursary
School Contri- Uniforms Books Trans- Food, Expenses In-kind (IF
Member ID
miss last
attend last last week? Father = 1 during the received for
fees and butions and sports and portation board, on extra expenses? CANNOT
week? week? Mother = 2 past 12 the past 12
regis- to parent/ clothes? school to and and/or classes? BREAK
(exclude(exclude Both parents = 3 months? months?
tration teacher supplies? from lodging DOWN)
extra extra Other HH
fees? assoc- school? at
classes)classes) member = 4 Yes = 1
iation school?
Other relative = 5 No = 2 (next
(PTA)?
vacation vacation Non-relative = 6 person)
code 99 code 99 Self = 7
Other = 8
hours hours HRS MINS AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
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Section 2, Part a -- GENERAL EDUCATION (continued) GRADE LEVEL
NEW -- fill out this sheet for all household members currently enrolled in school CODES
None = 0
24 25 26 27 28 29 Pre-school = 01
Is Name of school and code (if What is Does NAME What is the name of NAME's What is the name of NAME's P1 = 11
have one
(NAME) on village roster, otherwise the teacher? (if NAME has the same ENGLISH LANGUAGE P2 = 12
ID OF PERSON INTERVIEWED
teacher for
currently code NV if not on roster) current most or all of teacher all day) teacher? P3 = 13
P4 = 14
in school? grade? the school
P5 = 15
day? (or code NV if the teacher is not P6 = 16
Member ID
Yes = 1 (see on the village roster) JSS1 = 17
1 = Yes JSS2 = 18
No = 2 grade 2 = No,
(>> part codes) JSS3 = 19
NAME has M1 = 20
B) different M2 = 21
teachers for M3 = 22
math, science, M4 = 23
language, etc. SSS1 = 24
SSS2 = 25
SSS3 = 26
S1 = 27
name ID name ID name ID S2 = 28
1 S3 = 29
2 S4 = 30
S5 = 31
3 L6 = 32
4 U6 = 33
5 Voc/Technical/Co
mputer/Comm/Ag
6 ric = 41
7 Teacher Train =
42
8
Nursing = 43
9 Polytechnic = 51
10 University = 52
Other tertiary =
11
53
12 Other = 61
13 (specify)
14
15
16
17
18
2 part a _ general educ 4 NEW
Section 2, part a -- GENERAL EDUCATION (concluded)
NEW -- fill out this sheet for students currently in school
30 31 32 33 34 35 36
What is the name of NAME's Does How does (NAME) obtain the Does What kinds of How many What mode of
MATHEMATICS teacher? (NAME) textbooks? (NAME) meals or snacks times a transportation does
have all the participate does (NAME) week does (NAME) use to go to
textbooks 1 = provided by school, can take home school?
(or code NV if the teacher is in a receive at school? (NAME)
needed for 2 = provided by school, cannot take (if boarding, how does
not on the village roster) feeding receive
school? home (NAME) get there?)
Member ID
3 = newly purchased from the school
program at 1 = breakfast this food? 1 = walk
1 = yes, has 4 = newly purchased from private school? 2 = snack 2 = bicycle
all market 3 = lunch 3 = car
2 = has 5 = gift 1 =yes 4 = other (specify) 4 = bus
some, but 6 = passed down from older sibling 2 = no 5 = train
not all 7 = purchased used (separate multiple 6 = boat
3 =has none 8 = other (specify) responses with 7 = animal
commas) 8 = other (specify)
name ID
1
2
3
4
5
6
7
8
9
10
11
12
13
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16
17
Page 12
2 part a _ general educ 4 NEW
18
Page 13
Section 2, part b – Educational Career
Fill out for all household members
1 2 3 4 5 6 7 8 9
ID Has How many course- What was the highest Was the technical / Has (NAME) How What was the What was the highest Was the
(NAME) years did (NAME) certificate (NAME) computer / ever attended many last institution qualification tertiary
ever complete? obtained? vocational school a tertiary years did attended? (NAME) achieved? institution
attended (NAME) attended educational (NAME) Advanced/ Public or
None = 1
technical None = 1 public or private? institution attend? Specialist None = 1 Private?
NACVET = 2
and/or 3 months = 2 IMIS = 3
(e. g.. teacher training Certificate = 2
vocational 6 months = 3 NVTI = 4 Public = 1 University, =1 Diploma = 3 Public = 1
school? 1 Year = 4 City & Guild = 5 Private religious = polytechnic, Polytechnic = 2 HND = 4 Private
2 Years = 5 Certificate = 6 2 etc)? University = 3 Bachelor = 5 religious = 2
Yes = 1 3 Years = 6 Diploma = 7 Private non- Yes = 1 Other = 4 Masters = 6 Private non-
No = 2 4 Years and above = Other = 8 (specify) religious = 3 No = 2 (>> (specify) Doctorate = 7 religious = 3
(>>5) 7 part 2c) Other = 8 (specify)
YEARS
1
2
3
4
5
6
7
8
9
10
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12
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16
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Section 2, part b -- EDUCATION CAREER (concluded)
NEW -- fill out whole sheet for all current household members ages twelve and older
11 12 13 14 15 15 16 Language codes
ID Has (NAME) How many Has How If (NAME) ever attended a secondary What languages What languages
ever repeated times has (NAME) many institution, what was (NAME)'s major does (NAME) does (NAME) English = 1
/ did (NAME) ever / did times has field(s) of study? (list one or more codes) speak read and write Twi/Fanti = 2
(NAME) ever repeated / (NAME) (NAME) 1 = science comfortably? (list comfortably? (list Ewe = 3
2 = humanities all) all) Ga-Dangme = 4
repeat a did ever skip skipped /
3 = social science Dagbani = 5
grade? (NAME) a grade? did 4 = engineering Frafra/Grusi = 6
see codes see codes
repeat a (NAME) 5 = medicine Nzema = 7
1 = yes grade? 1 = yes skip a 6 = law Wali/Dagari = 8
2 = no 2 = no grade? 7 = education
8 = other (specify) French = 10
German = 11
1 Spanish = 12
2 Portuguese = 13
Chinese = 14
3
Japanese = 15
4
5 Other = 78(specify)
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 2, part c -- LITERARY AND APPRENTICESHIP
Fill out for all household members 5 years and older
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Can In what Ghanaian Can In what What Can Has If not attending/ For how Is (NAME) How long What is the main Did How much Has (NAME) What was
(NAME) language can (NAME) Ghanaian languages does (NAME) (NAME) attended, why? many or has (NAME) did ever attended the main
(is) the trade (NAME) is
read a (NAME) read a write a language can (NAME) do written ever Low quality = 1 months has (NAME) pay a fee (NAME) other short subject of
phrase/ phrase/ sentence? sentence (NAME) write speak calc- attended a Not available = 2 (NAME) ever been an apprentice- learning? for this pay for the training the most
sentence (SHOW FLASH in a phrase/ comfortably? ulations? literacy Do not need = 3 been apprentice? ship? training? training? courses recent
Household ID
in CARD) English? sentence? (list all - see course? Too costly = 4 attending / (REFER TO lasting not training?
English? State the one in State the one language (USE Takes much time = attended a Yes, SECTOR Yes, in more than 6
which (NAME) Yes = 1 in which codes below ) FLASH Yes = 5 literacy currently = 1 kind = 1 months? (see codes
TRADE/SKILLS
(SHOW is most proficient No = 2 (NAME) is CARDS) 1(>>9) Not useful = 6 course? Yes, in past Yes, in below)
FLASH (see language most proficient No = 2 Too far = 7 =2 GLSS CODE cash = 2 Yes = 1
CARD) codes below) (see language Yes = 1 Spouse does not No = 3 (if no BOOK) Both = 3 No = 2
codes below) No = 2 want = 8 >> 15) No = 4 (>>Next
1 = Yes Other = 9 (specify) (>>14) member)
2 = No
>>10
MONTHS MAIN
YRS MTHS TRADE CODE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
LANGUAGE CODES: Ghanaian codes : None = 1; Twi/Fanti = 2; Ewe = 3; Ga-Dangme = 4; Dagbani = 5; Frafra/Grusi = 6; Nzema = 7; Wali/Dagari = 8; Other = 9 (specify)
Other language codes : French = 10; German = 11; Spanish = 12; Portuguese = 13; Chinese = 14; Japanese = 15
TRAINING CODES: Clerical = 1; Prof/Managerial = 2; Computer = 3; Marketing = 4; Teaching = 5; Leadership = 6; Medicine = 7; Accountancy = 8; Trade/Skill = 9; Other = 10 (specify)
Section 3 (Health), part a -- HEALTH IN LAST TWO WEEKS
Fill out for all household members
1 2 3 4 5 6 7 8 9 10 11 12 13 WHO
ID During the What was the Was Was (NAME) given any For how During the For how During the Was the health facility What time of On the most recent visit What was the main reason for the Where did the tropical
last 2 weeks illness that (NAME) of the following to many last 2 many last 2 weeks open? day did whom did (NAME) most recent visit? consultation take diseases:
has (NAME) (NAME) suffered? given the drink: days weeks, did days? has (NAME) [NAME] arrive consult? Illness … 1 place? Trypanosomi
suffered from same during (NAME) consulted 1 = yes at the facility? Doctor … 01 Injury … 2 asis (tsetse
Dentist … 02 Follow-up … 3
either illness Fever…1 (>>5) amount to 1 = Oral Rehydration the last 2 have to stop any health 2 = no Hospital … 1 fly)
Nurse … 03 Check-up… 4
or injury? Diarrhea with drink as salt (ORS) weeks the usual (1 - 14) facility? Medical Asst … 04 Prenatal care … 5
Clinic … 2 Dengue
blood…2 (>>5) before the 2 = Rice water has activities DAYS Midwife … 05 Postnatal care … 6 MCH Clinic … 3 fever
Neither ...1 Watery watery 3 = Soup (NAME) because of Yes ...1 Pharmacist … 06 Vaccination … 7 Maternity Home … 4 Malaria
(>>6) Diarrhea…3 diarrhea, or 4 = Home-made sugar/ suffered this No … 2 Drug/Chemical Seller … Other … 8 (specify) Pharmacy … 5 Bilharzia
Illness …. 2 Cold / Cough…4 more, or saltwater solution from this condition? (>>22) 07 Chemical store … 6 Tuberculosis
Injury …. 3 (>>5) less? 5 = Milk or infant condition Trad. Healer … 08 Consultant's Home … River Symptoms:
(>>3) Guinea Worm…5 formula ? Yes … 1 Trained TBA … 09 7 blindness Fever
Both …. 4 (>>5) 1 = same 6 = Coconut water No … 2 Untrained TBA … 10 Patient's Home … 8 Guinea Diarrhea
Spiritualist … 11
Bilharzia…6 (>>5) 2 = more 7 = Water (1 - 14) (>> 8) Community epicenter worm Cough
Other … 12 Polio Vomiting
Other…7 (>>5) 3 = less 8 = herbs DAYS …9
9 = Other (specify) Other (specify) … 10
Others:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
3 part a_health in past 2 weeks
Section 3, Part a -- HEALTH IN LAST TWO WEEKS continued
Fill out for all household members
14 15 16 17 18 19 20 21
What was the name of the facility? Is this a public How much did What mode of How much did How much time How long did you How much TOTAL
or private (NAME) pay transport did (NAME) (NAME) pay did it take to travel have to wait at the time (waiting and
(enter name and code if in village facility? for this use to travel to the to travel there to and from the health facility receiving
health facility?
or code NV if not in village) consultation? and to return? facility? before being treatment) did
1 = walking
Public … 1 attended to by a (NAME) spend at
2 = bicycle
Private … 2 CEDIS 3 = motorcycle
CEDIS TRAVEL TIME health officer? the health facility?
Private non- 4 = car
religious … 3 5 = bus/public WAITING TIME CONSULTATION
transport TIME
6 = other (specify)
NAME CODE HRS MINS HRS MINS HRS MINS
Page 18
Section 3, part a -- HEALTH IN LAST TWO WEEKS concluded
Fill out for all household members
22 23 24 25 26 27 28 29 30
ID During the last two How many nights How much did During the How much Total medical Were the For the past Who pays for the greatest portion of
weeks was (NAME) did (NAME) stay (NAME) or will last 2 weeks did (NAME) expenses over medicine/ 12 months the health expenses incl.
admitted to a hospital in hospital/health (NAME) pay for did (NAME) pay the past two 2 medical was (NAME) consultations and hospital stays (if
or health center on any)?
center during the staying in a buy any altogether for weeks supplies hospitalized
account of
last two weeks? hospital / health medicine or these available/ for any
illness/injury? Household member … ID
(INCLUDE
center during the medical medicine and (IF CANNOT obtainable injury? Other relative … 80
TRADITIONAL ( 1- 14) last two weeks? supplies? medical GIVE in the same Government … 81
HEALING supplies? BREAKDOWN) place? Yes … 1 Employer … 82
CENTERS) NIGHTS AMOUNT Yes … 1 (AMOUNT) No … 2 Household member's employer … 83
Yes… 1 No … 2 Health insurance … 84
No … 2 (>>25) Other … 85 (specify)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3, part b – PREVENTATIVE HEALTH – IMMUNIZATIONS
Fill out for all household members
1 2 3 4 5
ID Has Has (NAME) ever received the following vaccines? Did you have to How Why was
(NAME) 1 = yes; 2 = no; 3 = don't know; 4 = not applicable pay any fee for much (NAME) not
ever been COPY FROM IMMUNIZATION BOOK / (WEIGH -IN) CARD IF AVAILABLE these was immunized?
immunizations? Too young .. 1
immunized? paid?
Don't know
IF ALL ANSWERS EQUAL 3 AND/OR 4>>> PART 3C
Yes .. 1 (NAME) had to
Yes … 1 No … 2 (Next
(CEDIS) …2
No … 2 Type of immunization person) Health center too
(if no >> 5) >> far … 3
NEXT Shortage of
PERSO supply … 4
FIVE IN VITAMIN YELLOW Other … 5
BCG POLIO DPT ONE MEASLES 'A' FEVER (specify)
0 1 2 3 Booster 1 2 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3 part c – Child Health / Postnatal care
Fill out for all household members
1 2 3 4 5 6 7 8 9 10 11
ID Did you or How many Did you have to How much Does (or At what age At what age At what At what age Does Who usually looks
someone else times did pay for do you did) the was did (NAME) age was did (NAME) (NAME) after (NAME)
take [name] to [name] go consultations? usually pay mother (NAME) receive any (NAME) receive any participate during the
ID of person interviewed
1 = yes liquid (except food other daytime?
a health center there for for one breastfeed? weaned? first in a
2 = no (>> 5) water) other than 1 = mother
for a post- consultations consulation? (NAME) given community
than breastmilk for 2 = adult male
natal care in in the past 12 REPORT breastmilk for water? the first time? feeding 3 = adult female
the past 12 months? (CEDIS) 1 = yes IN the first time? REPORT IN program? 4 = male child
months 2 = no MONTHS REPORT IN 87 = not MONTHS 5 = female child
1 = yes (>> 9) 87 = still MONTHS yet 87 = not yet 1 = yes 6 = creche
2 = no (>> 5) breast- 87 = not yet 2 = no 7 = other (specify)
feeding
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3, part c – Child Health / Development
NEW -- complete for all children in household ages 9 and younger
1 2 3 4 5 6
ID Does (NAME) attend In the How many children's/ picture How many other In the past In the past
any organized learning last 7 books are there in the house. books (adult week, how week, how
or early childhood days, (answer once for entire house) books, many times many times
ID of Person Interviewed
education programme, how schoolbooks, etc.) was (NAME) was (NAME)
such as a private or many are there in the left in care of left alone?
government facility, hours did house? (answer another child
including kindergarten (NAME) once for entire (that is,
or community child attend? house) someone
care? under 10
years old)?
Yes … 1
No … 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3, part c – Fertility and Prenatal care
Fill out for all women ages 12-49
1 2 3 4 5 6 7 8 9 10 11 12
ID Have you Have you How How I would like How How I would like to Did you How many Are you During the
ever been ever given many many to make sure many many make sure you have any of those pregnant past 12
pregnant? birth to a
girls have boys have you have girls boys are have total number pregnancy pregnancies now? months
child?
you given you given given birth to are still still of …. Children which did did not end have you
in a live
Yes … 1 birth to? birth to? … alive? alive? alive? not end in a Yes … 1 been
IF NO, birth?
No … 2 PROBE:
live birth? (>>16) pregnant?
(>> Part Even one BOYS TOTAL GIRLS BOYS TOTAL NON-LIVE No … 2
3E) who lived GIRLS NUMBER NUMBER OF Yes … 1 BIRTHS Yes … 1
only a few OF CHILDREN No … 2 No … 2
hours or less? CHILDREN ALIVE (>>11) (>>Part
(Q.3 + Q.4) (Q.6 + Q.7) 3E)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
S ection 3, part d – Fertility and Prenatal Care
Complete entire sheet for women ages 12-49
15 16 17 18 19 20 21 22 23 24
ID How did this Is that Are y ou now During this How old From where did From whom did you How How much Why didn't y ou
pregnancy end? child breastfeeding? pregnancy was y our y ou receive that receive that care? many did y ou pay go for prenatal
care? Doctor … 01 care?
still did y ou pregnanc times for the first
Nurse … 02
Live birth … 1 alive? Yes … 1 receive y when Medical Asst … 03 did y ou prenatal
Prenatal clinic Can't afford … 1
Still birth … 2 No … 2 any pre- y ou first Midwife … 04 go consultation
(private ) … 1 No health care
( 7+ months) Yes … natal care? received Pharmacist … 05 there? ?
Prenatal clinic Chemical Seller … 06 available … 2
(>>18) 1 prenatal (public) … 2 Health care too
Trad Healer … 07
Mis-carriage … No … 2 Yes ... 1 care? Hospital … 3 Trained TBA … 08 >> Part 3E far … 3
3 (>>18) (>>18) No … 2 Maternity Home … Untrained TBA … 09 Not necessary …
Other … 4 (>>24) WEEKS 4 Spiritualist … 10 AMOUNT 4
(specify ) Home of Other … 11 (specify) Other … 5
(>>18) practitioner … 5 (specify )
Community
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
S ection 3, part d – Fertility / Women's Health
NEW -- complete for all women in household ages 12 to 49
25 27 28 29 30 31 32 33
ID How many After y our How For how How old Do y ou still How old were If still
y ears/ months last child, many many were y ou at have y ou when menstruating,
have passed how many months months did y our first menstruation y ou stopped have y ou gone
since second to months passed y ou menstruatio ? menstruating? more than three
last child? passed before breastfeed? n? months without
before y ou y our Yes … 1 menstruating one
resumed period Not y et No … 2 or more times in
sexual came …87 the past y ear?
relationships? back? 1 = y es
y ears months
2 = no
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3, part e -- Contraceptive use and HIV/AIDS awareness
Complete entire sheet for household members ages 12 and older
1 2 3 4 5 6 7 CODES FOR QUESTION 5
ID Are you or What main method are you using? IF Q.2 = 01 If Q.2 = 01 TO 09, ASK: Why are you Do you think you Which main Not married … 11
Pill … 01 will use a Fertility-related reasons
your partner TO 09, ASK: not using any contraceptive
Male condom … 02 Where did you get the contraceptive Infrequent sex / no sex … 22
using any Female condom … 03 contraceptive would you Menopausal/Hysterectomy … 23
method? method to delay or
method to IUD … 04 How much method? prefer to use? Wants as many children as
avoid pregnancy in
prevent or Injection … 05 did you pay possible … 26
Female sterl … 06 Prenatal clinic (private) … the future? Opposition to use
delay for that 1 See codes at See codes at
Male sterl … 07 Respondent opposed … 31
pregnancy? Implants … 08
during the Prenatal clinic (public) … 2 right Yes, Delay/Avoid right
Husband opposed … 32
Foam/Jelly … 09 last month? Hospital … 3 Pregnancy … 1 Religious prohibition ... 34
Yes … 1 LAM … 10 Maternity home … 4 Yes Other reason Lack of knowledge
No … 2 Abstinence … 11 AMOUNT Home of practitioner … 5 …2 Knows no method ... 41
Rhythm … 12 Pharmacy/Chemist/Drug No … 3 Knows no source ... 42
(>>5)
Withdrawal … 13 store .. 6 Don't know … 4 Method-related reasons
Other … 14 (specify) Health concerns ... 51
Community epicenter … 7 (>>8)
IF Q=10 - 14 >> 8) Fear of side effects ... 52
Other … 8 (specify)
Lack of access / too far ... 53
Costs too much ... 54
Inconvenient to use ... 55
Interferes with body's normal
1 processes ... 56
2 Other (specify) ... 96
Don't know ... 98
3
4
5
6 CODES FOR QUESTION 7
Pill … 01
7
Male condom … 02
8 Female condom … 03
9 IUD … 04
Injectibles … 05
10
Female sterilization … 06
11 Male sterilization … 07
12 Implants … 08
Foam/Jelly … 09
13
Lactational Amen. Method …
14 10
15 Periodic abstinence … 11
Withdrawal … 12
16
Diaphragm ... 13
17 Other (specifiy) ... 96
18 UNSURE ... 98
Section 3, part e -- Contraceptive use and HIV/AIDS awareness (concluded)
Complete entire sheet for household members ages 12 and older
8 9 10 11 12 13 13 14
ID Now I would What can people do to prevent Is it possible Can the virus If yes, by what What would you do to Do you If yes, how CODES FOR QUESTION
like to talk to HIV/AIDS for a healthy- that causes means? prevent yourself from know many 9
you about looking AIDS be being infected with the anyone that people? Abstain from sex … 01
something else. (UP TO 3 MAIN WAYS) person to transmitted During virus that causes AIDS? currently Use condom … 02
Have you ever have the from a mother pregnancy … 1 has died of Limit sex to one
heard of an see codes at right AIDS virus? to child? During delivery Abstain from sex … 1 AIDS in the partner/stay faithful to one
illness called …2 Be faithful to partner … past year? partner … 03
HIV/AIDS? Yes … 1 Yes … 1 During 2 1 = yes Limit number of sexual
No … 2 No … 2 breastfeeding Have safe sex … 3 2 = no partners … 04
Yes … 1 Don't know (>>13) …3 Use a condom … 4 Avoid sex with prostitutes
No … 2 (>> …8 Don't Know Other … 5 (specify) … 05
Next Person) 1st 2nd 3rd … 3 (>>13) Avoid sex with persons
who have many partners …
1
06
2 Avoid sex with
3 homosexuals ... 07
Avoid sex with persons
4
who inject drugs
5 intravenously ... 08
6 Avoid blood transfusions
... 09
7 Avoid injections ... 10
8 Avoid sharing razors/blads
9 ... 11
Avoid kissing ... 12
10 Avoid mosquito bites ... 13
11 Seek protection from
traditional practioner ... 14
12
Other (specify) ... 96
13 Don't know ... 98
14
15
16
17
18
Section 3, part f -- Insurance -- individual specific questions
Fill out for all household members
1 2 3 4 5 6 7 8 9 10 11
ID Has (NAME) If (NAME) has never Is (NAME) If (NAME) is no If (NAME) is What are the Does Has (NAME) paid premium or Has Is Does
ever been been registered, why? still longer a member, registered or covered, expected (NAME) expected to pay for the current (NAME) (NAME) (NAME)
registered or Premium is too high registered why? what type of scheme benefits of pay all/part insurance year? benefitted covered have
covered with a …1 or covered? Premium is too high … is he/she registered this scheme? of the from the under the informal
health Does not have 1 with? premium? scheme? national health
insurance confidence in Yes, Do not have (CHECK Only OPD health insurance
scheme? operators of the registered confidence in MEMBERSHIP services … 1 All … 1 Yes …1 insurance coverage
scheme … 2 … 1 (>>5) purveyors of scheme CARD) Only in- Part … 2 No … 2 scheme? (e. g.
Yes registered Covered by other Yes, …2 District mutual … 1 patient Exempted 1 = Yes through a
… 1 (>>3) avenues … 3 covered … Covered by other Private mutual … 2 services … 2 …3 2 = No susu)?
Yes covered No knowledge of any (>>5) alternatives … 3 Private company … 3 Both … 3 (>>9) 1 = Yes
… 2 (>>3) scheme … 4 No … 3 Was not getting Other … 4 (specify) N/A … 4 a PAID b EXPECTED 2 = No
No … 3 Other … 5 (specify) benefits … 4 (>>9) (AMOUNT) TO PAY
NEXT PERSON Other … 5 (specify) (AMOUNT)
(NEXT PERSON)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3, part g -- MENTAL HEALTH (ALTERNATIVE MODULE)
NEW -- fill out for all household members ages 10 and older
In the past week, how many days have you:
Been Had Felt Felt that Fel hopeful Felt Had
bothered trouble depressed? everything about the fearful? restless
by things keeping you did future sleep?
that usually your mind was an
ID don't on what effort?
bother you were
you? doing?
1 2 3 4 5 6 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3, part h --ACTIVITIES OF DAILY LIVING
NEW -- fill out for all household members ages 10 and older
ID 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
ID of Person Being Interviewed
If (NAME) How long If (NAME) How long If (NAME) How long If (NAME) How long If (NAME) How long If (NAME) had How long If (NAME) How long If (NAME) How long
had to carry a has had to sweep has had to walk has had to draw has had to bend, has to stand up from has had to bathe has had to feed has
heavy load for (NAME) the floor or (NAME) for 5 km (NAME) water from a (NAME) kneel, or (NAME) a seated position (NAME) his/herself (NAME) his/herself (NAME)
20 meters yard without without any well without stoop without on the floor without any without any
had had had had had had had had
without any any help, help, could any help, any help, without any help, could help, could
difficulty / difficulty / difficulty / difficulty / difficulty / difficulty / difficulty / difficulty/
help , could could he/she he/she do it? could he/she could he/she help, could he/she do it? he/she do it?
he/she do it?
been do it? been 1 = easily been do it? been do it? been he/she do it? been been been
1 = easily unable to 1 = easily unable to 2 = with unable to 1 = easily unable to unable to unable to 1 = easily unable to 1 = easily unable to
2 = with do this? 2 = with do this? difficulty do this? 2 = with do this? 1 = easily do this? 1 = easily do this? 2 = with do this? 2 = with do this?
difficulty difficulty 3 = not at all difficulty 2 = with 2 = with difficulty difficulty
3 = not at all 3 = not at all 3 = not at all difficulty difficulty 3 = not at all 3 = not at all
3 = not at all 3 = not at all
YRS MOS YRS MOS YRS MOS YRS MOS YRS MOS YRS MOS YRS MOS YRS MOS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Section 3, part h – Miscellaneous Health
NEW -- fill out for all household members ages 10 and older
ID In general, how Have you In the past 3 Have you ever At what Do you still How long In one day In the past Would you If so, when? Will you Are you so How many
would you rate ever had any months, have you had the habit of age did smoke, or have ago did you how many 12 months, like to quit actually quit addicted to days in one
your health? sores or had numbness or chewing you begin you completely quit? cigars/ have you smoking DO NOT smoking in the smoking that week do you
irritations tingling in the hands tobacco, this habit? quit? cigarettes tried to stop sometime in PROMPT: next 6 months? you will need consume
or feet, other than smoking a pipe,
1="Very healthy" on the feet YEARS did you smoking? your life? 1 = In the next some sort of alcoholic
numbness /tingling smoking self-
2="Somewhat that took AGE IN 1= still smokes consume 30 days 1 = yes help to quit? beverages?
from hands or feet rolled cigarettes,
healthy" more than falling asleep, foot or smoking
YEARS (>>8) now/before 1 = yes 1 = yes 2 = In the next 2 = no
3="Somewhat four weeks aches or long walks? cigarettes/ 2 = has quit totally 2 = no 2 = no year 1 = yes
unhealthy" to heal? cigars? quitting? (>>13) 3 = In the next 5 2 = no
4="Unhealthy" 1 = yes years
1 = yes 2 = no 1 = yes (>>14) 4 = Later
2 = no 2 = no (>>14) 5 = When I get
sick
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 3, part i – ANTHROPOMETRY
NEW -- fill out for all household members
ID Name of Household Was If not, why not? Was height measured Height Weight Hip Size Waist Size Arm
Member (NAME) standing of lying circumference
measured? 1 = not home during down? (mid-upper arm)
survey period
1 = yes 2 = too ill 1 = standing
2 = no 3 - handicapped or 2 = lying down
deformed
4 = not willing
5 = other (specify)
MTRS CM KGS CM CM CM
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days
Complete entire sheet for new household members ages 7 and older
Did [name] do any During In total, During Has Are taxes
What is the amount
work for pay, the last 7 how the last [name] already
profit, family gain days, how many
(including any
7 days, received or deducted
ID of Person Interviewed
or did [name] During the last 7 days, what How long has bonuses,
many hours were the main tasks and What kind of trade, [name] been how will commissions, from
produce anything
jobs did did duties in the job [name] services, or industry is this doing this long did [name] allowances or tips) [name's]
Member ID
for barter or home
use during the last
[name] do [name] spent most of his/her time work connected with? work all [name] receive received? pay?
7 days? all work in on? together? actually money for
Yes = 1 together? all these work on this work? (see time unit codes 1 = Yes
No = 2 (number) jobs this job? Yes = 1 below) 2 = No
(if no >> page 47) over the (hours) No=2
last 7 main ISCO ISIC (if no >> time
industry years months amount
days? occupation code code 11) unit
1 2 3 4 5 6 7 8 9 10
1
2
dwa6:
3 Do we want a module for both the past 7 days and the past 12 months for employment?
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (cont.)
Complete entire sheet for new household members ages 7 and older
What was For Does [name] When Is there a In this job, Is [name] Will Codes for question 11:
the status whom receive any [name] trade is [name] entitled to paid [name] Paid employee = 1
entitled to sick leave and/or receive a AGRICULTURE
ID of Person Interviewed
of [name] did payment for started union in
What is the value of maternity leave Self employed
in this [name] this work in doing this the place paid retirement
goods or services on this job? 2 = with employees
job? work? the form of work, did where holidays? pension?
Member ID
provided? 1 = yes, sick 3 = without employees
goods and he/she sign [name] leave 4 = Contributing family
See code, See code services? a written works? 1 = Yes 2 = yes, 1 = yes worker
If code is 1 = Yes contract? 2 = No maternity leave 2 = no NON-AGRICULTURE
02 - 07 2 = No 1 = Yes 1 = Yes 3 = yes, both Self employed
(>>22) (>> 15) time 2 = No 2 = No 4 = no 5 = with employees
value
unit 6 = without employees
7 = Contributing family
11 12 13 14 15 16 17 18 19 worker
1 Domestic employee = 8
2 (househelp)
Apprentice = 9
3 Other (specify) = 10
4
5
6
7
Codes for question 12
8
GOVERNMENT SECTOR
9 1 = Civil Service
10 2 = Other public service
11 3 = Parastatals
NGO's = 4
12
Cooperatives = 5
13 International Org.
14 / Diplomatic Mission = 6
15 Private Sector formal = 7
(including paid apprentice)
16 Private Sector informal = 8
17 Agricultural business = 9
18 Other (specify) = 10
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (cont.)
Complete entire sheet for new household members ages 7 and older
Is [name] Is Where does How many Codes for question
entitled to [name's] [name] How far During the last 6
people 23:
months, has
ID of Person Interviewed
free or place of usually do his away is How often does altogether Office = 1
subsidized work in or her work? [name's] [name] go [name] received
work in the Home = 2
any training How long was the
medical this (>> 26)
Member ID
place of between his or place where
related to his/her training? Factory = 3
care in this village / (see codes) work from her house and [name]
job? town? his or her place of work? work, including Workshop = 4
works?
home? on-the-job Own land/farm = 5
1 = Yes 1 = Yes training? Other land/farm = 6
Code "DK" River/ocean = 7
2 = No 2 = No 1 = yes
no. of time for don't Hotel/restaurant/
km. 2 = no months weeks
trips unit know chop bar = 8
20 21 22 23 24 25 26 27 Store/shop/
1 tabletop = 9
Street at a fixed
2 location = 10
3 Street not at a fixed
4 location = 11
5 Lorry park = 12
Somebody's home
6 or veranda = 13
7 School = 14
8 Hospital/clinic = 15
Other (specify) =
9
16
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (concluded)
Complete for household members ages 7 and older
What type of training By how much was
Who paid for the Did [name] it?
did [name] receive?
training? lose an
ID of Person Interviewed
Clerical = 1
1 = [name] entirely entitlement
Prof / managerial = 2 Write difference
2 = Employer or benefit
Computer = 3 between normal
Member ID
entirely during the
Marketing = 4 entitlement /
3 = Both (shared period of
Teaching = 5 benefit while
cost) his/her
Leadership = 6
4 = Free training? training and
Medicine = 7
5 = International before training
Accountancy = 8
agency 1 = Yes
Skills / trade = 9
6 = Other (specify) 2 = No amount time
Other (specify) = 10
(cedis) unit
28 29 30 31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 12 months
Complete entire sheet for household members ages 7 and older
Did [name] do any During In total, Has Are taxes
work for pay, the past how [name] already
profit, family gain What is the amount
12 many received or deducted
or did [name] (including any
months, weeks will from
ID of Person Interviewed
produce anything During the past 12 months, How long has bonuses,
how many did [name] [name's]
for barter or home what were the main tasks What kind of trade, [name] been commissions,
use during the past jobs did [name] and duties in the job [name] services, or industry is this doing this
receive
allowances or tips)
pay?
Member ID
12 months? [name] do work in money for
spent most of his/her time work connected with? work all received?
Yes = 1 all all these this work? 1 = Yes
on? together?
No = 2 together? jobs Yes = 1 2 = No
(see time unit codes
(if no >> page 47) (number) over the No=2
below)
last 12 (if no >>
months? 10)
main ISCO ISIC time
industry years months amount
occupation code code unit
1 2 3 4 5 6 7 8 9
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 12 months (cont.)
Complete entire sheet for household members ages 7 and older
What was For Does [name] During the During these During the last 5 Codes for question 10:
the status whom receive any past 12 weeks, how years has [name] Paid employee = 1
ID of Person Interviewed
of [name] did payment for months, for many hours received any AGRICULTURE
in this [name] this work in What is the value of how many per week did training lasting at Self employed
How long was the 2 = with employees
Member ID
job? work? the form of goods or services weeks did [name] least one month
last training? 3 = without employees
goods and provided? [name] do usually relating to his/her
4 = Contributing family
See code, See code services? this work? work? work? worker
If code is 1 = Yes NON-AGRICULTURE
02 - 07 2 = No 1 = Yes Self employed
(>>14) (>> 14) time 2 = No (>> Next 5 = with employees
value weeks hours months weeks 6 = without employees
unit Person)
10 11 12 13 14 15 16 17 7 = Contributing family
worker
1
Domestic employee = 8
2 (househelp)
3 Apprentice = 9
4 Other (specify) = 10
5
6
7
Codes for question 11
8
GOVERNMENT SECTOR
9 1 = Civil Service
10 2 = Other public service
11 3 = Parastatals
NGO's = 4
12
Cooperatives = 5
13 International Org.
14 / Diplomatic Mission = 6
15 Private Sector formal = 7
(including paid apprentice)
16 Private Sector informal = 8
17 Agricultural business = 9
18 Other (specify) = 10
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 12 months (cont.)
Complete entire sheet for household members ages 7 and older
Did [name] Codes for question 19:
How
lose any By how much was Myself entirely = 1
many
ID of Person Interviewed
entitlement it? Employer entirely = 2
hours a Who paid Both (cost was shared) = 3
or benefit
week did for the Free = 4
Member ID
during the Write difference
[name] training? International Agency = 5
period of between normal
receive Other = 6 (specify)
his/her entitlement/benefit
this (see
training? while training
training? codes)
1 = yes time
hours amount
2 = no unit
18 19 20 21
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Characteristics of secondary occupation in last 7 days
Complete entire sheet for household members ages 7 and older
Has What For Codes for question 8:
Did [name] [name] What is the
was the whom Paid employee = 1
received amount AGRICULTURE
During work on this job status of did
Describe the main tasks or will Self employed
How long has the last at same time as (including any[name] [name]
ID of Person Interviewed
and duties in the other What kind of trade, [name] 2 = with employees
[name] been 7 days, his/her main job bonuses, in this work? 3 = without employees
kind of work that [name] services, or industry is how over the last 7 receive
doing this commissions, job? 4 = Contributing family
Member ID
spent most time on, apart this work connected long did days? money worker
work all for this allowances or See
from his/her main with? [name] If yes, how long NON-AGRICULTURE
together? work? tips) received See codes Self employed
occupation? actually did [name] do
work on both 1 = Yes in the past 7code, 5 = with employees
this job? altogether? 2 = No days? If code 6 = without employees
(if no, is 02 - 7 = Contributing family
Less than 1 day
>> 8) worker
(hours) =0 07 Domestic employee = 8
secondary ISCO ISIC amount time
industry years months . . . No = 9 (>>22) (househelp)
occupation code code (cedis) unit
Apprentice = 9
1 2 3 4 5 6 7 8 9 Other (specify) = 10
1
2
3
4
5
Codes for question 9:
6 GOVERNMENT SECTOR
7 1 = Civil Service
8 2 = Other public service
3 = Parastatals
9 NGO's = 4
10 Cooperatives = 5
11 International Org.
/ Diplomatic Mission = 6
12 Private Sector formal = 7
13 (including paid apprentice)
14 Private Sector informal = 8
Agricultural business = 9
15 Other (specify) = 10
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Characteristics of secondary occupation in last 7 days (continued)
Complete entire sheet for new household members ages 7 and older
When Is there a In this job, Is [name] entitled Will Are taxes Is [name] Is [name] Where How many Codes for question
Does [name]
[name] trade is [name] to paid sick leave [name] already entitled to entitled to does people 19:
receive any
and/or maternity receive a deducted Office = 1
ID of Person Interviewed
payment for started union in entitled to free or any other [name] altogether
leave on this job? retirement Home = 2
this work in What is the value of doing this the place paid from subsidized social usually work in
(>> 26)
work, did where holidays? pension? [name's] medical security do this place
Member ID
the form of goods or services 1 = yes, sick Factory = 3
goods and provided? he/she sign [name] leave
pay? care in this benefits his/her where
Workshop = 4
services? a written works? 1 = Yes 2 = yes, maternity 1 = yes job? on this work? [name] Own land/farm = 5
contract? 2 = No leave 2 = no 1 = Yes 1 = Yes job? works? Other land/farm = 6
1 = Yes 1 = Yes 3 = yes, both 2 = No 2 = No See River/ocean = 7
2 = No 1 = Yes 2 = No 4 = no 1 = Yes codes Code DK Hotel/ restaurant/
(>> 12) value time unit 2 = No 2 = No for "don’t chop bar = 8
know" Store/shop /table top
10 11 12 13 14 15 16 17 18 19 20 21 =9
1 Street at a fixed
2 location = 10
Street not at a fixed
3
location = 11
4 Lorry park = 12
5 Somebody's home or
6 veranda = 13
School = 14
7 Hospital/clinic = 15
8 Other (specify) = 16
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Activity Status and characteristics of secondary occupation in last 12 months
Complete entire sheet for household members ages 7 and older
During the past 12 Has Are taxes
months, did [name] [name] already
do any other work What is the amount
received or deducted
beside the MAIN (including any
will from
ID of Person Interviewed
OCCUPATION? Describe the main tasks and How long has bonuses,
[name] [name's]
duties in the other kind of What kind of trade, [name] been commissions,
1 = yes receive pay?
work that [name] spent most services, or industry is this doing this allowances or tips)
Member ID
2 = no money for
time on apart from his/her work connected with? work all received?
this work? 1 = Yes
main occupation? together?
Yes = 1 2 = No
(see time unit codes
No=2
below)
(if no >>
7)
secondary ISCO ISIC time
industry years months amount
occupation code code unit
1 2 3 4 5 6 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Activity Status and characteristics of secondary occupation in last 12 months (cont.)
Complete entire sheet for household members ages 7 and older
What was For Does [name] During the During these Did [name] work on this Codes for question 8:
the status whom receive any past 12 weeks, how job at the same time as Paid employee = 1
ID of Person Interviewed
of [name] did payment for months, for many hours his/her main job? AGRICULTURE
in this [name] this work in What is the value of how many per week did Self employed
2 = with employees
Member ID
job? work? the form of goods or services weeks did [name] If YES, how long did
provided? 3 = without employees
goods and [name] do usually [name] do both together?
4 = Contributing family
See code, See code services? this work? work? worker
If code is 1 = Yes Less than 1 week = 00 NON-AGRICULTURE
02 - 07 2 = No No = 99 Self employed
(>>12) (>> 12) time 5 = with employees
value weeks hours weeks 6 = without employees
unit
8 9 10 11 12 13 14 7 = Contributing family
worker
1
Domestic employee = 8
2 (househelp)
3 Apprentice = 9
4 Other (specify) = 10
5
6
7
Codes for question 9:
8
GOVERNMENT SECTOR
9 1 = Civil Service
10 2 = Other public service
11 3 = Parastatals
NGO's = 4
12
Cooperatives = 5
13 International Org.
14 / Diplomatic Mission = 6
15 Private Sector formal = 7
(including paid apprentice)
16 Private Sector informal = 8
17 Agricultural business = 9
18 Other (specify) = 10
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part d - Unemployment in last 7 days
Complete entire sheet for all household members ages 7 and older
Why has What did During this How long Codes for question 3:
Has [name] made any 1 = thought no work available
Was [name] [name] not [name] do period what has
effort during the last 2 = awaiting reply to earlier enquiries
ID of Person Interviewed
available for work made any in this type of [name]
7 days or past 30 3 = waiting to start arranged job, business or agri.
during the last 7 effort to find period to employment been
days to find work? 4 = off season in agri.
days or within the was [name]
Member ID
work? find work? seeking 5 = occupied with home duties
next 30 days? mainly 6 = illness / injury
1 = Yes, last 7 days and/or
seeking 7 = full-time student
(>> 4) (most (most available
1 = Yes, last 7 days (available, if 8 = on vacation
2 = Yes, but only important important to find
2 = Yes, but only not seeking 9 = other
within next 30 days only) only) work?
within next 30 days for)?
(>> 4)
3 = No (>> 10)
3 = No
see codes see codes see codes see codes Code for question 4:
1 = applied to prospective employer
1 2 3 4 5 6
2 = checked at farms / factories / worksites
1 3 = asked friends and relatives
dwa6:
2 4 = took action to start business (capital, land, equipment, etc.)
Do we want a module on unemployment for both the past 7
5 = took action to start agricultural activity
3 days and the past 12 months? 6 = upgrading skills
4 7 = searched newspaper adverts
8 = searched employment services
5 9 = other
6
7
Codes for question 5:
8 Wage employment in:
9 1 = government or state enterprise
2 = large private firm
10 3 = small / medium scale enterprise
11 4 = Self employment
5 = any job
12
13 Codes for question 6:
14 1 = Less than one month
2 = 1 month but less than 3 months
15 3 = 3 months but less than 6 months
16 4 = 6 months but less than 1 year
5 = 1 year but less than 2 years
17 6 = 2 years
18 7 = more than 2 years
Section 4, part d - Unemployment in last 7 days continued
Complete for all HH members not currently working outside of the home (i. e. answered NO to page 42 question 37)
What kind of work did [name] do in Why was [name] not Codes for question 11:
available for work during Under what 1 = high income potential
his/her last job?
ID of Person Interviewed
What is the lowest wage the last 7 days or within conditions, 2 = availability of training
(i. e. what was [name's] main task or possibilities
for which [name] is willing the next 30 days? if any,
duties 3 = well-defined earnings
Member ID
to work for someone? 1 = in school would (secured)
-- describe activity fully)
2 = household duties [name] 4 = within easy reach of residence
>> part 4E 3 = too old become 5 = join spouse
if never worked, write none and code 00 4 = sick 6 = other (specify)
available for
for ISCO 5 = disabled work?
ISCO 6 = pensioner
See codes
OCCUPATION amount time unit 7 = other
CODE
7 8 9 10
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part d -- Unemployment in last 12 months
Complete entire sheet for household members ages 7 and older
What did [name] do in the past 12 months
What type of work did [name] want
to find work?
when he/she was available or looking
During the past Why did [name] not look for work What was [name] doing
During the for work?
12 months, for Write most important only throughout the period he/she was when not working and not
past 12 During the past available for work? avilable to work?
ID of Person Interviewed
how many Wage employment in:
months, how 12 months, how 1 = Applied to prospective employers
weeks 1 = Government/State Enterprise
many weeks many weeks did 2 = Checked at farms/factories/work sites Write most important only 1 = Student
altogether was
Member ID
was [name] [name] actively 2 - Large private firm
[name] without 3 = Asked friends and relatives 2 = Housework
available for look for work? 3 = Small/medium scale enterprise
work? 4 = Took action to start business 1 = Thought no work available 3 = Disabled
work Self-employment:
5 = Took action to start agricultural activity 2 = Awaiting reply to earlier enquiries 4 = Sick
If 0 >> 5 4 = Non-agriculture
(0 >> next 6 = Upgrading skills 3 = Waiting to start arranged job, 5 = Retired / Aged
If 0 >> 7 5 = Agriculture
person) 7 = Searched newspaper adverts business or agriculture 6 = Income receipient
6 = Any job
8 = Searched employment services 4 = Off season in agriculture 7 = Too young
7 = Other (specify)
9 = Other (specify) 5 = Other (specify) 8 = Other (specify)
>> Next person
weeks weeks weeks >>6
1 2 3 4 5 6 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part e - Time use
Fill in for all household members ages 7 and older
How much time on a typical working day do you spend on any of the following activities for the household?
Collecting Fetching Shopping or Running
firewood? without water? without running without errands (other without
1 = yes while caring 1 = yes while caring errands? while caring than shopping? while caring
children children children children
2 = no for children 2 = no for children 1 = yes for children 1 = yes for children
present present present present
(if no, next (if no, next 2 = no 2 = no
activity) activity) (if no, next (if no, next
hours minutes hours minutes hours minutes hours minutes activity) hours minutes hours minutes activity) hours minutes hours minutes
1 2 3 4 5 6 7 8 9 10 11 12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 4, part e - Time use continued
Fill in for all household members ages 7 and older
How much time on a typical working day do you spend on any of the following activities for the household?
Caring for clothes: Washing Cleaning and Cooking and
washing, mending, without dishes/ without upkeep of without preparing without
ironing, sewing new while caring pots? while caring dwelling? while caring food? while caring
children children children children
clothes for children 1 = yes for children 1 = yes for children 1 = yes for children
present present present present
1 = yes 2 = no 2 = no 2 = no
2 = no (if no, next (if no, next (if no, next
(if no, next activity) hours minutes hours minutes activity) hours minutes hours minutes activity) hours minutes hours minutes activity) hours minutes hours minutes
1 2 3 4 5 6 7 8 9 10 11 12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 4, part e - Time use concluded
Fill in for all household members ages 7 and older
How much time on a typical working day do you spend on any of the following activities for the household?
Taking Taking care Caring for Reading
care of of sick? children – newspapers,
elderly? 1 = yes while not books, or In an
1 = yes 2 = no doing any Helping with Other activities magazines? average
without without without
2 = no while caring (if no, next while caring other homework, (e. g. playing 1=yes while caring week, how
(if no, next children activity) children activity? 2=no children Sleeping?
for children for children teaching, outside, giving for children many days
activity) present present 1=yes present
reading, etc. a bath) do you
2=no
work?
(if no, next
activity)
hours minutes hours minutes hours minutes hours minutes hours minutes hours minutes hours minutes hours minutes hours minutes days
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 5, part a - Migration
Complete entire sheet for new household members
Where was [name] born?
In Ghana Outside of Ghana
What was What was
Was [name] What was [name's] [name's]
Does [name] 1 = Kumasi
ID of person interviewed
born in this intend to stay the main REGION: daily daily wage
2 = Sunyani
Household Member
village or How long ago for a year or reason for 2=Western wage in in the job
3 = Cape Coast
3=Central
town? did [name] last more in this moving to 4 = Koforidua the job that [name]
4=Gt. Accra
move/return to village / this village 5 = Accra
5=Volta
that had just
this place? town? 6 = Tamale [name] before
1 = Yes / town? give name of city 6=Eastern give name of country
7 = Bolgatanga
(>> next (see codes 8 = Koforidua
7=Ashanti first had leaving the
person) 1 = Yes below) 8=Brong Ahafo in this previous
9 = Wa
2 = No 9=Northern
2 = No 10 = Sekondi- village? place?
10=Upper East
Takordi
11=Upper West
11 = Ho
Years Months (cedis) (cedis)
1 2 3 4 5 6 7 8 9 10
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
REASONS FOR MOVING: 1 = job transfer; 2 = seeking employment; 3 = own business; 4 = spouse's employment; 5 = accompanying parent; 6 = marriage;
7 = other family reasons; 8 = political / religious reasons; 9 = education; 10 = war; 11 = fire; 12 = flood/famine/drought; 13 = other (specify)
5 part a _ migration2
Section 5, part a -- Migration continued
Continued from previous sheet
When [name] first moved to this village,
If anyone (HH member or other village resident) If [name] worked for a specific person just after If [name] knew anyone other than a
Household Member
other than him/herself helped [name] get his or her arriving in this village, who was this person? household member who was an
first job in this village, who was this person? important reason for moving here,
List HH ID or name and village ID; or code NV who was this person?
List HH ID or name and village ID; or code NV if if this person does not appear on the village
this person does not appear on the village roster roster Code NV if this person does not
appear on village roster
village village village
name HH ID name HH ID name
ID ID ID
11 12 13
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Page 53
Section 5, part b - Migration History
Fill in a page for each HH member who answers '1' to the following question.
0. Has [name] ever lived away from this town for a year or more?
1 = Yes (>> 1) 2 = No (>> next person) ______________
Member ID _____________________ ID of person answering ___________________
Migration Number
To current
second most third most fourth most fifth most
residence
recent recent recent recent
(most recent)
1 = Kumasi; 2 = Sunyani; 3 = Cape Coast; 4 = Koforidua; 5 = Accra; 6 = Tamale; 7
= Bolgatanga; 8 = Koforidua; 9 = Wa; 10 = Sekondi-Takordi; 11 = Ho
What is the
name of the name of city in Ghana
1
[…] 2=Western; 3=Central; 4=Gt. Accra; 5=Volta; 6=Eastern; 7=Ashanti; 8=Brong
destination? Ahafo; 9=Northern; 10=Upper East; 11=Upper West
name of country
2 How old were you when you moved to destination?
Why did you move (most important reason)?
1 = job transfer; 2 = seeking employment; 3 = own business; 4 = spouse's employment; 5 =
3 accompanying parent; 6 = marriage; 7 = other family reasons; 8 = political / religious reasons; 9 =
education; 10 = war; 11 = fire; 12 = flood/famine/drought; 13 = inability to access land; 14 = loss of
land; 15 = other (specify)
Whom did you know at destination? (1=parents, 2=children, 3=spouse/fiance, 4=Other
4
relative, 5=acquaintance) -- for multiple entries, enter with commas
5 Did you ever work for wages at DESTINATION? (1=yes; 2=no, if no >> 13)
How did you find a job at DESTINATION? (1=own search before moving, 2=arranged by family,
6 3=arranged by friends, 4=own search after moving)
During the time between arriving at DESTINATION and finding a job, what was your main
7 means of support? (1=own savings, 2=family at DESTINATION, 3=family at PREVIOUS
PLACE, 4=friends, 5=menial work/begging, 6=no means of support)
8 How long after coming to DESTINATION did you find a job for wages? (months)
9 Did you work for a family member at DESTINATION? (1=yes; 2=no)
10 What type of industry was your first job in DESTINATION? (see industry codes)
11 What were the main duties of your first job in DESTINATION? (see ISCO codes)
Were you working for a wage just before you left PREVIOUS PLACE?
12
(1=yes; 2=no, if no >> next migration)
What type of industry was the job in PREVIOUS PLACE just before you moved?
13
(see industry codes)
What were the main duties of the job in PREVIOUS PLACE just before you moved? (see
14
ISCO codes)
Section 6 (Agriculture), part a -- update on stocks and last year's spending by animal
Complete entire sheet
Current In the past twelve months, how much did you spend on . . . for this animal
number Veterinary Enclosure, Hired labor Access to Other
owned Fodder/feed -- expenses shelter, (cedis) water expenses
expenses (cedis) restraint and
Type Home related
Purchase produced expenses
(cedis) (cedis) (cedis)
1 2 3 4 5 6 7 8
Draught animal (donkey, horse, bullock)
Cattle
Sheep
Goats
Pigs
Rabbits
Chicken
Fish
Snail
Other
Section 6 (Agriculture), part a -- update and new tools
Does any member Did you sell any
Was any […]
of the household What would be […] in the past 12
rented out in the What was the What was the
own any […] the value of […] months?
How many? past 12 months? value of the total value of
now? if it were sold
Tools rental? the sales?
now? 1 = Yes
1 = Yes
1 = Yes 2 = No (>> next
2 = No (>>6)
2 = No (>>6) item)
Number Value Value Value
1 2 3 4 5 6 7
Tractor
Plough
Trailer/cart
Spraying machine
Other animal drawn equipment
Other tractor drawn equipment
Outboard motor
Canoe
Fishing net
Protective clothing / safety equipment
2 Wheel Tractor
4 Wheel Tractor
Cane crusher
Hoe
Axe
Rake
Shovel
Pick
Sickle/ reaping hook
Harrow
Tiller
Water pump
Irrigation pipe
Cutlass
Other (specify:____________)
Section 6 (agriculture), part b – LAND INFORMATION
Complete entire sheet for any farms owned or used.
Size of farm Is the farm Does the If the farm How What Was the
owned by household were to be How did you obtain much did proportion farm
the have the right the land?
sold now, it cost to of crops go cultivated If you obtained the land from
household? to sell the Bought = 1 to during the a specific person, please give
how much rent it
Person interviewed
farm or use it Rented for cash or in landlord? past 12
would it over the his or her name if he or she
Farm Number
Yes, with as collateral kind =2 (see codes) months?
UNIT OF AREA be worth? Sharecropped by past 12 lives in this village
Holder
deed = 1 for security?
Acres 1 household = 3 months?
Yes, 1=yes
Poles 2 without Sell = 1 (>>11) 2=no
Ropes 3 deed = 2 Security = 2 Use free of charge = 4 (>> next
Plot 4 No = 3 Both = 3 (>>12) farm) (or write NV if not currently a
(>> 9) No right = 4 Distributed by village resident of this village)
(>> 9) or family = 5
No. of unit value (>>12) (cedis) name ID
units code (cedis)
1 3 2 6 7 4 5 9 10 8 11 12 13
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
PROPORTION CODES: 1 = 2/3 (67%); 2 = 1/2 (50%); 3 = 1/3 (33%); 4 = 1/4 (25%); 5 = 1/5 (20%)
6 part b _ land info 2
Section 6, part b – Land Information, continued
Answer about all plots of land currently owned or used.
Year Year Year Soil How long Is the land If so, what Is this farm How How Does this If yes, did you or
If pond or well, If pump,
when when when Is this land Depth does it watered method? bigger or many of many of land have someone else do
land last last more or less 1 = Up take for from a (primary smaller the these clear something to
began to fallow fallow wet than the to 1 foot this land source method if than the measured farms boundaries create these
Month filled (see code)
Hours/day in operation
Days/year in operation
Month Dry (see code)
be period period other lands 2 = 1 to Soil Soil Type to drain other than more than measured farms would fit ? boundaries? (e.
Farm number
farmed began ended in your 3 feet Colour after a rainwater? one) farm? would fit into the 1= yes g. plant trees,
(see
(enter (enter 888 (enter 000 community 3= (see
codes heavy 1=pump 1 = bigger in this measured 2 = no make a fence)?
888 for for "don't if ? more codes below) rainfall? 1=Yes 2=weir 2 = smaller farm? farm? 1 = yes
know") currently 1 = more
"don't than 3 below) 3=well (>> 18) 2 = no, naturally
fallowed 2 = less
know) feet (hours) 2=No, 4=borewell 3 = about occuring (for
or 888 for 3 = about
"don't (if no >> the same instance, a river)
the same 16)
know")
15 16 17 18 19 20 21 23 24 25 26 27 28 29 30 31 32 33 34
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Soil colour codes (column 6): Red =1; Black = 2; Grey = 3; Yellow = 4; Brown = 5; White = 6
Soil characteristic codes (column 7): Sand =1; Loam = 2; Light Clay = 3; Heavy Clay = 4; Gravely = 5; Mixed = 6
Code for columns 12 and 13: 1=January; 2=February; 3=March; 4=April; 5=May; 6=June; 7=July; 8=August; 9=Sept.; 10=Oct.; 11=Nov.; 12=December
Page 58
Section 6, part b – Land Information, continued
Answer about all plots of land currently owned or used.
What From whom did you Did this person occupy a special Was this Is this If acquired from a specific person give What was the What was the How many Could you If yes, how If no, why
year did obtain the land when political or traditional position? person a person name of person payment when you formality of the days after leave the long do you would you lose
you you began to own or use 0 = None resident currently a first began to own or contract at that reaching land empty think you the land?
begin to it? 1 = Member of Parliament of your resident of (or write NV if not currently a resident use the land? time? agreement for a period could leave 1 = lose title
1 = bought (cash, in 1 = formal about of several the land alone 2 = the land
own or 1 = family head 2 = District Chief Executive village at your of your village)
kind, or both) written contract owning or months without would be given
Farm Number
use this 2 = chief 3 = Assembly Man/Woman that time? village? 2 = used free of 2 = registered using the without losing it? to someone
land? 3 = government (>> 42) 4 = Unit Committee Member 1 = Yes 1 = Yes charge tenant land did you being (answer in else
4 = other male relative 5 = National Political Office 2 = No 2 = No (if 3 = sharecropping 3 = oral contract begin to use worried years, or code 3 = someone
5 = other female relative [Minister, Deputy Minister, etc.] no >> 7) 4 = renting/leasing 4 = other the land? about losing 888 for else might start
6 = nonrelative 5 = other (specify) (specify) it? indefinitely) using it
7 = no one AND NEED TRADITIONAL 1 = yes 4 = other
8 = other (specify) POSITIONS! 2 = no (specify)
name ID
35 36 37 38 39 40 41 42 43 44 45 46 47
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 6, part b – Land information (continued)
Answer about all plots of land currently owned (questions 47 through 53) or used (questions 54 through 58).
Continue to use the same farm numbers from the previous pages.
for land currently owned (see question 6 of this section) For land not currently owned (Q6 in land ID section)
How much, What is the [if money If so, [if land Have you If yes, what was the Contract type Nature of Duration of Is your For how long
if any, cash total value of paid for how was not ever had type of dispute? when the land the contract contract at first: current have you been
did you pay in kind land], did many? originally a dispute 1 = boundaries of land was first used when the No fixed landlord renting from the
you buy the 2 = multiple claims to rented = 1 land was duration = 1 the current landlord?
in total for contribution owned], in with
Farm number
land on land sharecropped = first used Seasonal = 2 original
the land you gave for what year anyone
install- 3 = breach of contract 2 1 = written Yearly = 3 landlord?
when you the land ments?
did you over this by former owner no payment = 3 2 = oral Multiple year = 1 = yes
began to when you 1 = Yes begin to land? 4 = breach of contract mortgaged = 4 3 = other 4 (>> 59)
own it? began to 2 = No own the 1=yes by buyer other (specify) (specify) Other (specify) 2 = no
own it? land? 2=no 5 = other (specify) =5 =5
(cedis) (cedis)
Years Months
48 49 50 51 52 53 54 55 56 57 58 59
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 6, part b – Land information (continued)
Answer about all plots of land currently used but not owned. Continue to use the same farm numbers from the previous pages (some lines may be blank).
For land not currently owned (from Q6) of land ID -- CONT. FROM PREVIOUS PAGE
Is the If this person is a resident of your Payment for land Does the From whom did the landlord How did the Do you engage
current village, give his or her name landlord obtain the land (owned)? landlord obtain the in other
landlord a Other business
Sharecrop own the 1 = chief land? (not
arrangements
resident of 2 = family head owned) transactions
(or write NV for not currently a land?
your 1 = rent from with the
resident of this village) 3 = government
How much 1 = Yes
Farm Number
village? landlord?
4 = other male relative another
1 = Yes What is the What do you pay 2 = No (e. g. other
value of inputs percent (if 5 = other female relative household
2 = No (if in cash or in (>> 66) agricultural,
no >> 61) provided by any) of 5 = another landlord 2 = allocated by household
kind to use
the landlord? output is 6 = another person family head enterprise)
(zero value given to the this land? 77 = unknown 3 = allocated by 1 = Yes
possible) landlord? (zero value 88 = other (specify) village head 2 = No
possible)
>> 67 4 = other
(specify)
Name ID cedis (%) cedis
60 61 62 63 64 65 66 67 68
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 6, part b – Land information (continued)
Answer about all plots of land currently used but not owned. Continue to use the same farm numbers from the previous pages (some lines may be blank).
For land not currently owned (from Q6) of land ID -- CONT. FROM PREVIOUS PAGE
Do you engage in Type of Duration of Do you have Can you rent Have you and If so, was this Have you and If so, was this
other business contract contract complete control the land out? the landlord disagreement related to anyone other disagreement
transactions with the 1 = written over the farming 1 = yes ever had a ... than the related to
landlord? 2 = oral
Farm Number
No fixed duration decisions you 2 = yes, but disagreement 1 = breach of contract by landlord ever ...
(e. g. other contract
=1 make regarding must be over this land? landlord? had a 1 = boundaries
agricultural, 3 = other
household (specify)
Seasonal = 2 this land? approved by 1=Yes 2=breach of contract by disagreement 2 = multiple
enterprise) Yearly = 3 1=yes; landlord 2=No tenant over this claims
1 = Yes Multiple year = 4 2=no, landlord 3 = no 3 = management of land? 3 = other
2 = No Other (specify) = must approve land? 1=Yes (specify)?
5 4 = other (specify)? 2=No
69 70 71 72 73 74 75 76 77
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 6, part b – Land information (conclunded) LAND IMPROVEMENTS
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
In the past three years, have you made any land-related investment (e.g., bunding, leveling the terrain, fencing) on land you currently own or use? (Yes=1; No=2) _________
Irrigation related investments Permanent and semi-permanent structures Soil and water conservation improvements Other improvements
Any soil and water conservation
If yes, list up What was the total If yes, list up What was the total If yes, list up What was the total
improvements made? [1 = Yes;
made (list)
Any permanent and/or semi-
Number of trees planted
permanent structures made?
to two most cash/days spending on all to two most cash/days spending on to two most cash/days spending on
Any irrigation related
in last three years
important the related investments/ important all the related important such all the related
investment made?
[1 = Yes; 2 = No]
[1 = Yes; 2 = No]
Farm Number
such improvements during the such investments/ investments improvements during
2 = No]
investments last 3 years? invesments improvements during the (see code the last 3 years?
(See code (see code last 3 years? below)
below) below)
Cash Family Cash Family Cash Family
labour labour labour
a b (cedis) (hours) a b (cedis) (hours) a b (cedis) (hours)
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Code for columns 3-4: Bore well = 1 ; Deepening Well = 2; Dig a pond = 3; Installing dug well = 4; Other (list in column 18) = 5
Code for columns 8-9: Farm bunding = 1; Animal Shed = 2 ; Fence = 3; Other (list in column 18) = 4
Code for column 13-14: Leveling the terrain = 1; Land leveling/terracing = 2; Bunding for soil and water conservation = 3; Mulching = 4; Fencing = 5; Reclamation = 6; Other (list in column 18) = 7
Section 6, part c -- Output details, Season 1 Unit codes:
Note that each crop planted on a particular farm should have its own line American tin = 02
Balls = 27
transportation to selling location
After being Bar = 28
While in While in Barrel = 03
how far did harvested but
the field, If yes, the field,
you transport did you What before being What Basket = 04
was any what was any Beer bottle = 05
the crops to transport Total was the sold or was the
quantity total
Farm number
Second- of the percent of the Bowl = 06
crop code
primary the primary other revenue crop consumed at crop
harvested ary outlet transpor- crop lost of the crop lost Box = 07
outlet location? crops at tation costs from this lost to? home, was any lost to?
(if any), to rotting/ crop to rotting/ Bucket = 29
see codes (enter 000 if the same crop (see of the crop (see Bunch = 08
see codes pests, planted insects/
below crops picked time? (cedis) codes lost to rotting, codes Bundle = 09
below etc.? was rodents?
up by buyer) (if so, list below) pests, ec.? below) Crate = 30
1=Yes lost? 1=Yes
unit 1 = yes Dozen = 31
codes) 2=No 2=No
Amt. (km.) (cedis) 2 = no Fanta /
code coke bottle = 10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Fingers = 11
Fruits = 12
Gallon = 14
Kilogram = 14
Litre = 15
Loaf = 32
Log = 16
Margarine tin = 17
Maxi bag = 18
Mini bag = 19
Nut = 20
Pair = 33
Pieces = 34
Pots = 35
Pounds = 21
Set = 36
Sheet = 22
Singles = 37
Stick = 23
Tonne = 24
Tree = 25
Tubers = 26
Yards/metres = 38
Other (specify) = 99
OUTLET CODES: 1 = pre-harvest contractor; 2 = farm gate buyer; 3 = market trader; 4 = consumer; 5 = state trading org.; 6 = coop; 7 = exporter; 8= other (specify)
CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease;
77=other known (specify); 88 = unknown
Section 6, part c -- Output details, Season 2 (if applicable) Unit codes:
Note that each crop planted on a particular farm should have its own line American tin = 02
transportation to selling location Balls = 27
After being Bar = 28
While in While in
how far did harvested but Barrel = 03
Non-labor the field, If yes, the field,
you transport did you What before being What Basket = 04
trans- was any what was any
the crops to transport Total was the sold or was the Beer bottle = 05
quantity poration
Farm number
Second- of the percent of the
crop code
primary the primary other revenue crop consumed at crop Bowl = 06
harvested ary outlet costs crop lost of the crop lost
outlet location? crops at from this lost to? home, was any lost to? Box = 07
(if any), (labor to rotting/ crop to rotting/ Bucket = 29
see codes (enter 000 if the same crop (see of the crop (see
see codes discussed pests, planted insects/ Bunch = 08
below crops picked time? (cedis) codes lost to rotting, codes Bundle = 09
below in part d) etc.? was rodents?
up by buyer) (if so, list below) pests, ec.? below) Crate = 30
1=Yes lost? 1=Yes
unit 1 = yes Dozen = 31
codes) 2=No 2=No
Amt. (km.) (cedis) 2 = no Fanta /
code
coke bottle = 10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Fingers = 11
Fruits = 12
Gallon = 14
Kilogram = 14
Litre = 15
Loaf = 32
Log = 16
Margarine tin = 17
Maxi bag = 18
Mini bag = 19
Nut = 20
Pair = 33
Pieces = 34
Pots = 35
Pounds = 21
Set = 36
Sheet = 22
Singles = 37
Stick = 23
Tonne = 24
Tree = 25
Tubers = 26
Yards/metres = 38
Other (specify) = 99
OUTLET CODES: 1 = pre-harvest contractor; 2 = farm gate buyer; 3 = market trader; 4 = consumer; 5 = state trading org.; 6 = coop; 7 = exporter; 8= other (specify)
CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease;
77=other known (specify); 88 = unknown
Section 6, part c -- Agricultural Seasonality and Other Income
Indicate with a '1' the months in which harvest, sales and purchases mainly take place:
Harvest Sales Consumption Stocks Unit Code:
Was this 00 = None
crop grown 01 = All
during the In which months was this crop What was the quantity 02 = American tin
past 12 In which months was this crop In which month(s) was this crop What is the quantity in 03 = Barrel
mainly bought for home in store 12 months
months? mainly harvested? mainly sold? store now? 04 = Basket
Crop consumption? ago?
1 = Yes 05 = Beer bottle
2 = No 06 = Bowl
(>>4) 07 = Box
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D No. of Units Unit Code No. of Units Unit Code 08 = Bunch
1 2 3 4 5 6 09 = Bundle
Maize 10 = Fanta bottle
Rice 11 = Fingers
Cassava 12 = Fruit
Yam 13 = Gallon
Plantain 14 = Kilogram
Sorghum 15 = Litre
16 = Log
Millet
17 = Margarine Tin
Cocoyam
18 = Maxi bag
19 = Mini bag
Now I would like to ask you about other household sales of produce during the past 12 months. How much were your sales of / from […]? 20 = Nut
Hunting Fruit, Berries, Milk from Other dairy Snail / crab 21 = Pounds
Honey? Eggs? Mushroom? 22 = Sheet
(game)? etc? cows? products? collection?
23 = Stick
Value Value Value Value Value Value Value Value 24 = Tonne
7 8 9 10 11 12 13 14 25 = Tree
26 = Tubers
Section 6, part c -- Agricultural Processing
I would now like to ask about processing of crops and smoking of fish/meat. This means any crops/fish processed by the household, whether grown or caught by your household or
anyone else.
What were
your labour
How Where did the
What type of coasts both
Person responsible
Person Interviewed
many Did you raw materials
food processing in cash and
months in make any mainly come
or transformation What quantity in kind in the What other Did you sell any
the past […] in the from? What was For how much
have you carried did you process last 2 cost did you […] in the last 2 What quantity
12 last two the value of could you sell
out in the past 12 in the last 2 weeks? incur in the last weeks? did you sell?
months weeks? 1 = Own the sale? one unit?
months? weeks? 2 weeks?
did you produce
Be sure to 1 = Yes
do this 1 = Yes 2 = Purchased (>> next line)
see codes below include 2 = No (>>13)
activity? 2 = No respondent
3 = Gift
(>>10) 4 = Other
time (labour
(specify)
No. of Unit cost) No. of Unit Unit
ID ID Item Code Months Value Value Value
Units Code Units Code Code
1 2 3 4 5 6 7 8 9 10 11 12 13
Codes for Processed / Transformed Goods: Unit Code:
01 = Cassava flour 02 = Cooking oils 03 = Flour from other grains 01 = All 02 = American tin 03 = Barrel 04 = Basket 05 = Beer bottle 06 = Bowl
04 = Gari 05 = Groundnut paste 06 = Home-brewed drink 07 = Box 08 = Bunch 09 = Bundle 10 = Fanta bottle 11 = Fingers 12 = Fruit
07 = Husked / Polished rice 08 = Maize flour 09 = Processed fish 10 = Processed meat 13 = Gallon 14 = Kilogram 15 = Litre 16 = Log 17 = Margarine Tin 18 = Maxi bag
11 = Sheabutter 12 = Cassava dough 13 = Corn dough 16 = Other (specify) 19 = Mini bag 20 = Nut 21 = Pounds 22 = Sheet 23 = Stick 24 = Tonne 25 = Tree
26 = Tubers
Section 6, part c – Output – Crop Stores Unit codes:
Does your household typically keep any dried/preserved crops?_________ (1 = Yes; 2 = No, if no >> next page) American tin = 02
Balls = 27
Where is the stock Bar = 28
During the
stored? previous
Barrel = 03
How much [ ] Basket = 04
How much [ ] 1 = underground Is the stock year, was
was left prior to the What Beer bottle = 05
is stored How much [ ] 2 = above ground, in treated with any of the
most recent
household was Bowl = 06
currently? was stored after the any stored crop If so,
harvest? the Box = 07
Crop code
most recent 3 = in special storage chemicals? lost to how much? Bucket = 29
If so, what chemical(s)? source
Bunch = 08
(zero response harvest? facility (specific to rotting,
(zero response (see Bundle = 09
possible) household) 1 = Yes insects,
possible) codes Crate = 30
4 = in the bush 2 = No rodents,
below) Dozen = 31
5 = in a community (>> 6) etc.?
Fanta /
1 = Yes coke bottle = 10
Unit Unit Unit storage facility Unit
2 = No Fingers = 11
Quantity Code Quantity Code Quantity Code 6 = other (specify) Quantity Code Fruits = 12
1 2 3 4 5 6 7 8 Gallon = 14
Kilogram = 14
Litre = 15
Loaf = 32
Log = 16
Margarine
tin = 17
Maxi bag = 18
Mini bag = 19
Nut = 20
Pair = 33
Pieces = 34
Pots = 35
Pounds = 21
Set = 36
Sheet = 22
Singles = 37
Stick = 23
Tonne = 24
Tree = 25
Tubers = 26
Yards/metres = 38
CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease; 77=other known (specify); 88 = unknown
Section 6, part d -- Input details -- chemical inputs for previous harvest (fertilizer, weedicide, pesticide, etc.)
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
Chemical 1 Chemical 2 Unit codes:
American tin = 02
Balls = 27
amount used amount used Bar = 28
To which To which Barrel = 03
Farm Number
type of crops was type of crops was Basket = 04
Beer bottle = 05
chemical name of this chemical name of this Bowl = 06
(see code chemical chemical (see code chemical chemical Box = 07
below) number unit value applied (list below) number unit value applied (list Bucket = 29
of units code (cedis) of units code (cedis) Bunch = 08
all) all) Bundle = 09
Crate = 30
Dozen = 31
1 2 3 4 5 6 7 8 9 10 Fanta /
coke bottle = 10
1 Fingers = 11
Fruits = 12
2 Gallon = 14
Kilogram = 14
3 Litre = 15
Loaf = 32
4 Log = 16
Margarine tin = 17
5 Maxi bag = 18
Mini bag = 19
6 Nut = 20
Pair = 33
7 Pieces = 34
Pots = 35
8 Pounds = 21
Set = 36
9 Sheet = 22
Singles = 37
10 Stick = 23
Tonne = 24
11 Tree = 25
Tubers = 26
12 Yards/metres = 38
13 Other (specify) = 99
14
15
16
17
18
TYPE CODES: 1 = Fertilizer (organic); 2= Fertilizer (inorganic) 3 = Herbicide; 4 = Insecticide; 5 = Fungicide; 6 = Other chemical input (specify purpose)
Page 66 -- Input details -- seeds used for previous harvest
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
Seed 1 Seed 2 Seed 3 Seed 4
How was the seed How was the seed How was the seed How was the seed
obatined? obatined? obatined? obatined?
Farm Number
crop code
crop code
crop code
crop code
1 = seed from own spending 1 = seed from own spending 1 = seed from own spending 1 = seed from own spending
name of name of name of name of
harvest on seed harvest on seed harvest on seed harvest on seed
seed used seed used seed used seed used
2 = purchased (cedis) 2 = purchased (cedis) 2 = purchased (cedis) 2 = purchased (cedis)
3 = exchanged 3 = exchanged 3 = exchanged 3 = exchanged
4 = gift 4 = gift 4 = gift 4 = gift
5 = other (specify) 5 = other (specify) 5 = other (specify) 5 = other (specify)
1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 6, part d – Inputs - Detailed labor (family and hired) use on crop production by plot and season
Labor use on land preparations (e. g. clearing or weeding before planting), Labor use on field management (weeding after planting, fertilizer and pesticide
seedling/nursery, planting and transplanting applications, irrigation management, etc.)
Farm number
Casual Labour (hours) Permanent Labour (hours) Family (incl’d exch’ge Casual Labour (hours) Permanent Labour (hours) Family (incl’d exch’ge
labor) (hours) labor) (hours)
Male Female Child M F C M F C M F C M F C M F C
(M) (F) (C)
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Season 1 (_________________to ___________________) Season 1
Season 2 (___________________to __________________) Season 2
Section 6, part d – Inputs - Detailed labor (family and hired) use on crop production by plot and season
Note that each crop planted on a particular farm should have its own line
Labor use on harvesting Post harvest labor use
Farm number
Crop code
Casual Labour (hours) Permanent Labour (hours) Family (incl’d exch’ge Casual Labour (hours) Permanent Labour (hours) Family (incl’d exch’ge
labor) (hours) labor) (hours)
M F C M F C M F C M F C M F C M F C
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
Season 1 Season 1
Season 2 Season 2
Section 6, part e – Transactions -- Characteristics of land leased/sharecropped/rented/allocated out
Fill out for all plots of land controlled but leased/sharecropped/rented/allocated out (i. e. farmed by someone not a member of this HH).
Continue to use the same farm numbers from the previous pages (some lines will likely be blank).
Nature of the Duration of Contract type at If not renting to original tenant, Relationship
contract when contract at first: of current
regarding the previous tenant
it was first first: rented out = 1 How long has it tenant to you
How long has the sharecropped = 2
rented/ No fixed been rented/ (see code)
land been rented no payment = 3 Who
Farm Number
sharecropped/ duration = 1 sharecropped/ If
/ sharecropped / mortgaged = 4 terminated If
mortgaged/ Seasonal = 2 other (specify) = 5 mortgaged terminated
mortgaged / lent the terminated
lent out Yearly = 3 out to the by your
out? contract? by tenant,
1 = written Multiple current tenant? household,
1 = tenant why? (see
2 = oral year = 4 why? (see
2 = your code)
3 = other Other code)
household
years months (specify) (specify) = 5 years months
1 2 3 4 5 6 7 8 9
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Code for column 4 (TENANT TERMINATED) 1 = Find better land; 2=Better off-farm opportunity; 3=Reduction in labor; 4 = Other reason
Code for column 5 (HOUSEHOLD TERMINATED) 1 = Rent to other tenant; 2 = Fail to pay rent; 3 = Cultivate yourself; 4 = Other reason
Code for column 6: Relative/friend in this village = 1, Relative/friend outside village=2, Landlord within this village = 3, Landlord outside this village = 4, Landless inside
this village = 5, Landless outside this village = 6, Other household in this village = 7, other household outside this village=8., government=9.
Code for column 8: Needed money = 1, plot undesireable = 2, wanted to leave farming = 3, already had enough land = 4, help recipient = 5, other (specify) = 6
Section 6, part e – Transactions -- Characteristics of land leased/sharecropped/rented/allocated out (concluded)
Fill out for all plots of land controlled but leased/sharecropped/rented/allocated out (i. e. farmed by someone not a member of this HH). Continue to use the same farm
numbers from the previous pages (some lines will likely be blank).
Give name of current tenant What is Do you allow Nature of Duration of contract Contract type
the main the tenant to the contract No fixed duration = 1 rented out = 1 If sharecropped out,
reason make all 1 = written Seasonal = 2 sharecropped = 2 If rented
code NV if not included in the
why you farming 2 = oral Yearly = 3 no payment = 3 out, rental
village roster
Farm Number
decided to decisions about 3 = other Multiple year = 4 mortgaged = 4 payment value of percent of
rent out the land? (specify) Other (specify) = 5 other (specify) = 5 you inputs your output
this land? 1=yes received household given to
name ID (see 2=no, I must this year provided your
codes) approve some (cedis) this year household
or all decisions (cedis) (%)
10 11 12 13 14 15 16 17 18
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 6, part e – Transactions -- Characteristics of sold
NEW -- fill out for all plots of land sold in the past three years
When Area Was the If yes, with whom Were any If yes, how How long was How long was Main Total For what Amount Amount Current
did you (Acres) transaction was the transaction taxes or much? it from the it from the reason amount you purpose paid prior paid during amount
Sold on installments? [Yes = 1,
If yes, number of installments
No = 2, if no >> next sale]
sell it? recorded in recorded? other fees (cedis) beginning of beginning of for received is the to the past 12 outstanding?
writing? such as the time that the time that selling it land Give name of buyer, if he or she is the past 12 months (cedis)
Who purchased it?
(see code below)
(year)
1. village head registration you tried to you tried to (see code (cedis) used by currently a resident of your village months (cedis)
Sale number
Yes=1 2. family head fees paid on start selling the start selling below) the (cedis)
No=2 3. administer of the sale? land to the the land to the buyer? (or write NV if not currently a
stool lands time you time you (see resident of village)
4. registry Yes=1 actually received code)
5. other [specify] No=2 received the money for the
title? land?
(weeks) (weeks) name ID
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1
2
3
4
5
6
7
8
Code for column 7: 8 = health, Code for column Code for column 11:
1= consumption, 9 = to buy ornaments 8: 1=Relative/friends within this village
2 = education , 10=poor land quality, 1=Using it for farm 2=Relative/friend outside this village
3 = startup or expand non-farm enterprises 11=poor accessibility of that subdivision, purposes 3=Landlord within this village
4 = migration, 12=poor irrigation & drainage facility, 2=Using it for 4=Landlord outside this village
5= house construction / repair, 13=litigation Non-farm 5=Other households in this village
6 = marriage, purposes. 6=Other households outside this village
7 = funeral / religious function / birth, 3=Not using it. 7=Other (specify)
6 part e _ transactions _ bough
Section 6, part e – Land transactions -- Characteristics of land purchased
NEW -- fill out for all plots of land purchased in the past three years
When Area Was the If yes, with Were any If yes, how How long was How long was Total Amount Amount paid Current
Bought on installments? [Yes = 1,
did you (Acres) transaction whom was the taxes or much? it from the it from the amount you paid prior during the amount
If yes, number of installments
No = 2, if no >> next sale]
buy it? recorded in transaction other fees (cedis) beginning of beginning of paid From to past 12 outstanding?
Give name of seller, if he or she is
writing? recorded? such as the time that the time that the past 12 months (cedis)
(year) whom did currently a resident of your village
registration you tried to you tried to include the you months (cedis)
Sale number
Yes=1 1. village head fees paid on start buying the start buying value of in- purchase (cedis)
(or write NV if not currently a
No=2 2. family head the sale? land to the the land to the kind the land? resident of village)
3. administer of time you time you payments
stool lands Yes=1 received the started using See codes
4. registry No=2 title? the land ? (cedis) below
5. other [specify] (weeks) (weeks)
name ID
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1
2
3
4
5
6
7
8
Code for column 9:
1=Relative/friends within this village
2=Relative/friend outside this village
3=Landlord within this village
4=Landlord outside this village
5=Other households in this village
6=Other households outside this village
Page 76
Section 7 (Information Seeking), part a – Information
What type of
What livestock did you
information was What were your crop
request assistance What were your Asked advice
requested? concern(s) regarding
about? (list all that livestock concern(s) regarding:
(list all that apply)
apply) regarding (list all
1 = agriculture
1 = draught animal that apply) 1 = activities
2 = non- 1 = use of fertilizer
Did you have to (donkey, horse, bullock) for household
Number of agricultural What crops did you 2 = irrigation
pay? 2 = cattle 1 = vaccination only
contacts made in production request assistance 3 = new seed varieties
Type of organization 3 = sheep 2 = disease 2 = activities
the past 12 3 = resource about? (list all crop 4 = pest infestation
1 = yes 4 = goats 3 = feed/nutrition related to a
months management codes that apply) 5 = weather
2 = no 5 = pigs 4 = insemination business/enterp
4 = business 6 = marketing
6 = rabbits 5 = other (specify) rise
5 = other 7 = blight/crop disease
7 = chicken 3 = both
(specify) 8 = access to credit
8 = fish >> next 4 = other
9 = general information
9 = snail organization (explain)
if answered 2-5, 10 = other (specify)
10 = other (specify)
>> 9
1 2 3 4 5 6 7 8 9
Government Extension
Office
Input Supplier
Farmer Based Organization
(registered)
Farmer Based Organization
(unregistered)
Nonprofit Organization /
NGO (specify)
Nonprofit Organization /
NGO (specify)
Nonprofit Organization /
NGO (specify)
Other agricultural
organization (specify)
Did you receive any home visits from agriculture extension agents? Yes No
How many? __________________ Were these visits solicited? Yes No
Did you receive an extension service in any of the following media?
Service
Gov't radio television newspaper pamplet other _________________________
NGO radio television newspaper pamplet other _________________________
Input Supp radio television newspaper pamplet other _________________________
Other radio television newspaper pamplet other _________________________
Did you receive agricultural advice from relatives/friends/neighbors in the past year? Yes No
if so, how frequently? several times a week or more about once a week
about once a month occasionally
Did you give agricultural advice to relatives/friends/neighbors in the past year? Yes No
if so, how frequently? several times a week or more about once a week
about once a month occasionally
Did you receive business/production/management advice from relatives/friends/neighbors in the past year? Yes No
if so, how frequently? several times a week or more about once a week
about once a month occasionally
Did you give business/production/management advice to relatives/friends/neighbors in the past year? Yes No
if so, how frequently? several times a week or more about once a week
about once a month occasionally
Section 8, part a -- Household enterprises
Fill out all items for any enterprises
Does the What
ID of person interviewed
How
income of percentage
many
How long has this the of the
Enterprise number
Person What is the principal activity What is the main secondary months
enterprise actively enterprise income of
Name of responsible of this enterprise? activity of the enterprise? during the
been operating? belong this
enterprise past 12
entirely to enterprise
months
you? belongs to
did the
1 = yes (>> you?
enterprise
ISIC ISIC 11) (see codes
Name ID Name of activity Name of activity years months operate?
Code Code 2 = no below)
1 2 3 4 5 6 7 8 9
1
2
Codes for column 13:
1 = household savings
During the past 12 months, has this
2 = bank
enterprise tried to get credit from banks 3 = remittances from
Is this enterprise During the
What was the most What is During the past 12 and other financial agencies? During the abroad
registered with any past 12
serious difficulty in What was the months, has this 1 = no credit used (>> 19) past 12 4 = proceeds from
government agency? months,
establishing this the main enterprise tried to 2 = bank months,
Enterprise number
nature of family farms
YES how much
enterprise? source of get credit from 3 = other financial agencies how much 5 = proceeds from
1 = Registrar general's this altogether
1 = no difficulty capital in banks and other 4 = cooperative of the total family nonfarm
Dept. capital? has the enterprise
2 = Capital / credit setting up financial agencies? 5 = money lender loans has
2 = Dept. of 1 = loan 1 = Yes, succesfully enterprise 6 = income from family
3 = Technical know- this 6 = family/friend this
Cooperatives 2 = gift borrowed? propert(ies)
how enterprise? 2 = Yes, 7 = procedes from other enterprise enterprise
3 = District Assembly 3 = self- (new loans 7 = NGO support
4 = Govt. regulation (see codes) unsuccesfully 8 = govt. agency repaid? 8 = District assembly /
4 = Other (specify) only)
5 = Other (specify) financed 3 = No 9 = NGO CEDIS town Dev. Assoc.
NO = 5 CEDIS
10 = community epicenter support
11 = other (specify) 9 = church assistance
11 12 13 14 15 16 17 18 10 = moneylenders
11 = relatives/friends
12 = other partners
1 96 = other (specify)
2
SHARE CODES: 1 = 75% (3/4); 2 = 50% (1/2); 3 = 33% (1/3); 4 = 25% (1/4); 5 = 20% (1/5); 6 = 10% (1/10); 7 = 5% (1/20)
Section 8, part a -- Additional characteristics of HH enterprise
fill out for all current (i. e. currently operating or planning to resume operation within the year) HH enterprises
ID of HH member responding now
Does your household still
business now? (give HH ID)
Who is responsible for the
participate in this enterprise? In a typical year, are your sales high, average, low, or none
1 = Yes, and [person named in (i. e., business is not in operation) in the month of [MONTH]?
Enterprise number
Q2] is still responsible (>> 8)
2 = Yes, but another household
1 = High
member is now responsible
3 = No (>> next enterprise)
2 = Average
(answer yes if business is not 3 = Low
currently in operation but you 4 = None: not in operation
plan to resume operation in the
future)
Jan Feb March April May June July Aug. Sept. Oct. Nov. Dec.
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33
1
2
What is your What is your What is your
Enterprise number
average level of average level of average level
sales in a "low" sales in an of sales in a
month? "average" month? "high" month?
(cedis) (cedis) (cedis)
(24) Has this business operated in the last 3 months?
34 35 36
(25) In this last 1 month? (1 = Yes; 2 = No)
1 (26) In the last 2 weeks?
2 (27) In the last 1 week?
Section 8, part b -- Detailed labor allocation of employees in household enterprise
NEW -- list all people who worked in one or both of the household enterprises you managed in the last year
Status How is [name] Enterprise 1 Enterprise 2
Is worker a household member?
1 = yes; 2 = no (if no, >> 3)
1 = skilled paid? What is the salary On
Employee's name On
(1 = Male; 2 = Female)
If household member,
regular 1 = fixed paid to [name], or What average, About
and village ID About how average,
employee salary the value of in kind percentage many days how many how many
list ID (>> 10)
2 = unskilled 2 = percent of days did how many
Worker no.
goods given to of profits did [name] hours per
Gender
code NV if employee regular profits are given to work in [name] hours per
[name]? day does
does not appear on employee (>> 8) [name]? work in day does
this [name]
village roster 3 = apprentice 3 = in kind this [name]
(>> 10) enterprise work in
4 = casual 4 = not paid enterprise work in
during the this
worker (>> 10) during the this
past year?
5 = working 5 = other value time enterprise past year?
name ID (%) enterprise?
proprietor (specify) (cedis) code ?
1 2 3 4 5 6 7 8 9 10 11 12 13
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 8, part c -- Expenditures in household enterprise (enterprise 1)
Fill out for enterprise #1
How During the past 12 months,
During the past Do you pay How much
many How much did was [ ] available when you
12 months, has for How much did did you needed / wished to purchase
times was you spend on you spend on spend on
the enterprise [ ] at least it?
[ ] paid [ ] during the [ ] during the [ ] during
Item
spent anything once a past 12 1 = always
for during past 3 months? the past 2 2 = often
on [ ]? week? months?
the past weeks? 3 = not often
1 = Yes 1 = Yes
12 4 = not needed
2 = No (>> 8) 2 = No
months? (cedis) (cedis) (cedis) 5 = no
2 3 4 5 6 7 8
1 Taxes on product
2 Articles for resale
3 Rents on assets/land and buildings
4 Raw materials
5 Travelling and Transport (T & T)
6 Fuel & lubricants
7 Electricity
8 Water
9 Telephones
10 Printing / stationary / postage / packing
11 Spare parts
12 Repairs / maintenance of fixed assets
13 Lease of machinery or transport equipment
14 Advertising / computer service
15 Bank charges (excluding int.)
16 Training
17 Treatment / disposal of waste products
18 Uniform and clothing
19 Accident claims
20 Other (specify)
Section 8, part c -- Expenditures in household enterprise (enterprise 2)
Fill out for enterprise #2
How During the past 12 months,
During the past Do you pay How much
many How much did was [ ] available when you
12 months, has for How much did did you needed / wished to purchase
times was you spend on you spend on spend on
the enterprise [ ] at least it?
[ ] paid [ ] during the [ ] during the [ ] during
Item
spent anything once a past 12 1 = always
for during past 3 months? the past 2 2 = often
on [ ]? week? months?
the past weeks? 3 = not often
1 = Yes 1 = Yes
12 4 = not needed
2 = No (>> 8) 2 = No
months? (cedis) (cedis) (cedis) 5 = no
2 3 4 5 6 7 8
1 Taxes on product
2 Articles for resale
3 Rents on assets/land and buildings
4 Raw materials
5 Travelling and Transport (T & T)
6 Fuel & lubricants
7 Electricity
8 Water
9 Telephones
10 Printing / stationary / postage / packing
11 Spare parts
12 Repairs / maintenance of fixed assets
13 Lease of machinery or transport equipment
14 Advertising / computer service
15 Bank charges (excluding int.)
16 Training
17 Treatment / disposal of waste products
18 Uniform and clothing
19 Accident claims
20 Other (specify)
Section 8, part d -- Inventories and recent sales / purchases - FIRST ENTERPRISE
Fill out for first enterprise Unit codes:
How much of the following items does the How much / what How much / what was American tin = 02
Balls = 27
enterprise currently possess? was the value of the the value of the items Bar = 28
items sold or bought or imported in Barrel = 03
(respondent can choose to give exported in the past 3 the past 3 months? Basket = 04
Beer bottle = 05
Item answer in units, or the value of months? Bowl = 06
the inventory as a whole) Box = 07
Bucket = 29
Product Unit Unit price Value Value Value Bunch = 08
Quantity Quantity Quantity
code code (cedis) (cedis) (cedis) (cedis) Bundle = 09
Crate = 30
2 3 4 5 6 7 8 9 10
Dozen = 31
10 Principal finished product Fanta /
coke bottle = 10
20 Principal raw material Fingers = 11
Fruits = 12
30 Principal product work in progress Gallon = 14
40 Principal goods for resale Kilogram = 14
Litre = 15
Secondary Finished Products Loaf = 32
Log = 16
51 Margarine
tin = 17
52 Maxi bag = 18
53 Mini bag = 19
Nut = 20
Secondary Raw Materials Pair = 33
Pieces = 34
61 Pots = 35
Pounds = 21
62 Set = 36
63 Sheet = 22
Singles = 37
Secondary Works in Progress Stick = 23
Tonne = 24
71 Tree = 25
Tubers = 26
72
Yards/metres = 38
73
Secondary goods purchased for resale
81
82
83
Section 8, part d -- Inventories and recent sales / purchases - SECOND ENTERPRISE
Fill out for second enterprise
How much of the following items does the How much / what How much / what Unit codes:
American tin = 02
enterprise currently possess? was the value of the was the value of the Balls = 27
items sold or items bought or Bar = 28
(respondent can choose to give exported in the past imported in the past Barrel = 03
Basket = 04
Item answer in units, or the value of 3 months? 3 months? Beer bottle = 05
the inventory as a whole) Bowl = 06
Box = 07
Product Unit Unit price Value Value Value Bucket = 29
Quantity Quantity Quantity
code code (cedis) (cedis) (cedis) (cedis) Bunch = 08
Bundle = 09
2 3 4 5 6 5 6 5 6
Crate = 30
10 Principal finished product Dozen = 31
Fanta /
20 Principal raw material coke bottle = 10
Fingers = 11
30 Principal product work in progress
Fruits = 12
40 Principal goods for resale Gallon = 14
Kilogram = 14
Secondary Finished Products Litre = 15
51 Loaf = 32
Log = 16
52 Margarine
tin = 17
53 Maxi bag = 18
Secondary Raw Materials Mini bag = 19
Nut = 20
61 Pair = 33
Pieces = 34
62 Pots = 35
63 Pounds = 21
Set = 36
Secondary Works in Progress Sheet = 22
Singles = 37
71 Stick = 23
72 Tonne = 24
Tree = 25
73 Tubers = 26
Yards/metres = 38
Secondary goods purchased for resale
81
82
83
Section 8, part e – Revenue for enterprises in wholesale/retail trade Unit codes:
American tin = 02
Balls = 27
Last purchased Sales during last two weeks Bar = 28
Barrel = 03
(answer about a typical two weeks if enterprise Basket = 04
(respondent can choose to give answer in units, Beer bottle = 05
or the value of units purchased as a whole) has not operated in past two weeks) Bowl = 06
Main Items sold Value of total Box = 07
Product Unit Unit price Quantity Unit No. units Unit price Value of total Bucket = 29
purchases Bunch = 08
code code (cedis) purchased code sold (cedis) sales (cedis) Bundle = 09
(cedis)
Crate = 30
1 2 3 4 5 6 7 8 9
Dozen = 31
FIRST ENTERPRISE Fanta /
coke bottle = 10
1 Fingers = 11
dwa6: Fruits = 12
2 Talk to GLSS: Gallon = 14
3 What does "last purchased" mean? Is it Kilogram = 14
comparable to "Sales during last two weeks?" Litre = 15
4 Loaf = 32
5 Log = 16
Margarine
6 tin = 17
Maxi bag = 18
7 Mini bag = 19
8 Nut = 20
Pair = 33
9 Pieces = 34
Pots = 35
10 Pounds = 21
SECOND ENTERPRISE Set = 36
Sheet = 22
1 Singles = 37
Stick = 23
2 Tonne = 24
3 Tree = 25
Tubers = 26
4 Yards/metres = 38
5
6
7
8
9
10
Section 8, part e -- Revenue for nonretail enterprises
Fill out for any nonretail enterprises
Amount received during last two weeks
(cedis)
Service rendered (or typical two weeks if business has not
operated in last two weeks)
First enterprise Second enterprise
3 4 8
a Sales of passenger transport (e. g. taxi, trotro, passenger buses, etc.)
b Sales of freight transport (e.g. haulage trucks, vehicles for conveying sand, refuse, etc.).
c Agency fees, commissions receivable (e.g. estate agents, lotto receivers, insurance agents, sales agents, etc.)
d Professional fes receivable (e.g. mechanics, hairdressers, barbers, lawyers, masons, painters, etc.)
e Gross profit on foreign exchange business
f Rents receivable (e.g. renting of machinery, equipment, etc.)
g Other receipts for services rendered (e.g. porters, kayayo, etc.)
h Other services not elsewhere classified
TOTAL
Section 8, part e -- Revenue for food enterprises Unit codes:
American tin = 02
Fill out for any food enterprises Balls = 27
In the past week, how much on How many days during Bar = 28
Barrel = 03
average did you earn from the sale of the past 7 days did you
Basket = 04
meals in a day? prepare meals for sale? Beer bottle = 05
(amount in cedis) Bowl = 06
Box = 07
Bucket = 29
Bunch = 08
Bundle = 09
What is the cost of the following inputs Crate = 30
What is the total cost of ingredients purchased in a day? Dozen = 31
used in 7 days? Fanta / coke bottle = 10
Ingredient Fingers = 11
Item Amount Amount Fruits = 12
code (see Unit Code Input Gallon = 14
(from GLSS5) (cedis) (cedis)
part 9B) Kilogram = 14
1 2 3 4 5 6 Litre = 15
Loaf = 32
1. Firewood / charcoal Log = 16
Margarine tin = 17
2. Gas Maxi bag = 18
Mini bag = 19
3. Water Nut = 20
Pair = 33
4. Soap Pieces = 34
Pots = 35
Pounds = 21
Set = 36
Sheet = 22
All others Singles = 37
Stick = 23
Tonne = 24
Tree = 25
Tubers = 26
Yards/metres = 38
Section 8, part e -- Revenue for service enterprise and other enterprise
Fill out for service industries if enterprise has been operational in the past 1 or 3 months
ENTERPRISE 1 ENTERPRISE 2
How much was earned through the How much was earned
provision of service during the last through the provision of
SERVICE . . .? service during the last . . .?
(amount in cedis) (amount in cedis)
1 month 3 months 1 month 3 months
1 2 3 4
1 Delivery of goods sold
2 Provision of other services
3 Rental of buildings
4 Rental of machinery and transport equipment
5 Commissions
6 Royalties, copyrights, etc. belonging to the enterprise
7 Storage and handling fees
8 Inspection and valuation fees
9 Sale of scrap
10 Profit of sales and fixed assets
11 Other (specify)
Revenue for other enterprise -- from GLSS5 but repeat to get data on most current revenue if enterprise has been operational in the past 1 or 3 months
Operating in the last 2 weeks Not operating in the last 2 weeks
During the last 2 During the last 2 What was During the last 2 What was the How much revenue Does the What is the usual Are some of What is the value
ENTERPRISE NUMBER
weeks, has this weeks, have any of is usually received enterprise value of the good of the products
weeks, how much the value of the
enterprise the goods and from the sale of usually receive payments in the usually usually consumed
revenue has been received estimated services been products
goods and services payments in the form of goods consumed by by the household
received from the payments in the value? consumed by the consumed by the the household
by this enterprise in form of goods and services in a instead of being
sale of goods and form of goods household household in the instead of
and services? a 2 week period? and services? two week period? being sold? sold over a 2 week
services by this (cedis) members instead of last 2 weeks? 1 = Yes period?
1 = Yes being sold? 1 = Yes
enterprise? 2 = No (>> 8) 1 = Yes
(cedis) (amount in cedis) 2 = No (>> 13) (cedis) 2 = No (>> (cedis)
2 = No (>> next next page)
(amount in cedis) page) >> next page
5 6 7 8 9 10 11 12 13 14
1
2
Section 9 -- INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS
Part a: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
Name In what At what age Highest Age at first Highest level To what Ethnic group
Sex (1 = Male; 2 = Female)
Relationship:
codes
1 = parent of HH head year was did [name] level of marriage of education ethnic group
2 = parent of HH head's stop living education 1=Asante
[name] completed of does [name's] 2=Akwapim
Relative number
spouse
3 = sibling of HH head
born? with his / her completed (if never or current / most current / most 3=Fanti
parents?
4 = sibling of HH head's not yet recent spouse recent spouse 4=Ga
spouse (see married belong? 5=Dangme
(code 888 if 6=Krobo
5 = child of HH head with codes code 888 (see codes
current spouse
still living 7=Ewe
with parents) below) and then below) (see codes) 8=Guan
6 = child of HH head with
another person >> 10) 9=Nzema
10=Hausa
1 2 3 4 5 6 7 8 9 11=Dagomba
12=Mamprusi
R1 13=Gonja
14=Grussi/ Frafra
R2
15=Dagati
R3 16=Kusasi
17=Kassena-
R4 Nankani
R5 18=Kankoma
19=Nanumba
R6 20=Builsa
21=Other
R7 (specify)
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Codes for col. 7 and 8: 1=None; 2=Primary; 3=Middle/JSS; 4=Voc/Comm; 5='O' level; 6=SSS; 7='A' level; 8=Training college; 9=Tech/prof; 10=Tertiary; 11=Koranic; 12=Don't know
Section 9 – INFO ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 2)
Part 1: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
Has [name] ever held a Is Year of Number of Year of last How many Current Total landholding of Does [name] Do you
[name] death visits visit phone calls, number of current household live in your farm
political office?
still [name] letters, or other people Unit codes: village? together?
0 = None contacts (other
1 = Member of Parliament alive? >> next made to code 888 if living in 1 = acre
Relative number
Number of live than visits in
2 = District Chief Executive relative your [name] has [name]'s 2 = pole 1 = Yes; 1 = Yes
children person) has
3 = Assembly Man/Woman 1=yes household never [name] made to household 3 = rope 2 = No 2 = No
4 = Unit Committee (>> 15) last year visited this the household 4 = plot (if no >> 22)
Member 2=no household in the past 12 >> 26
5 = National Political Office (if more months?
[Minister, Deputy Minister, than zero,
unit
sons daughters etc.] >> 17) amount
code
10 11 12 13 14 15 16 17 18 19 20 21
R1
R2
R3
R4
R5
R6
R7
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Section 9 – INFO ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 3)
Part 1: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
For columns 22-25, either fill out column 22 (if the respondent lives in a city in Ghana listed in column 22) OR columns 23 and 24 (if the respondent
lives in a city in Ghana not listed in column 22) OR column 25 (if the respondent left Ghana)
What is FOSTER STATUS FOR CHILDREN UNDER 18
Where does [name] live? Codes for
[name's] (who are not living with biological parents) column 21:
primary With whom does [name] 1=Professional
In Ghana Outside of Ghana
occupation? live? Why did you / technical
1 = Kumasi
REGION: [give relative number if send [name] to 2=Administra-
(give primary tive /
Relative number
2 = Sunyani
2=Western one of the relatives Does live away? managerial
3 = Cape Coast occupation
3=Central named in this section or [name] 1 = availability 3=Clerical
4 = Koforidua while
4=Gt. Accra
5 = Accra working if code attend of better school 4=Sales
5=Volta
6 = Tamale give name of retired) 777 = another relative school? 2 = to live in a 5=Service
7 = Bolgatanga
give name of city 6=Eastern
6=Agric./Ani-
7=Ashanti country (specify relationship) 1 = Yes family with better
8 = Koforidua Husb./Forest/
8=Brong Ahafo (see codes) 888 = not with a 2 = No economic status Fishing/
9 = Wa
9=Northern relative 3 = other
10 = Sekondi- Hunting
10=Upper East 7=Production
Takordi
11=Upper West
999 = don't know/can't (specify)
11 = Ho say] &
related works
22 23 24 25 26 27 28 29 8=Workers
R1 NEC
R2 9=Homemaker
10=In school
R3 full time
R4 11 = other
(specify)
R5 12=Don't know
R6
R7
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Section 9 - INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 4)
Part b: Applied to all absent spouses of any household member
When At what age did Age of To what What is the When did What is the Number Year of Ethnic group
was [absent [absent ethnic highest [absent profession of visits last visit codes
1=Asante
Present spouse's ID no.
[absent spouse's name] spouse] at group level of spouse] last of to
Absent Spouse Number
2=Akwapim
from HH roster
spouse's stop living with marriage does schooling live with [absent [present 3=Fanti
name] his / her to [absent completed [present spouse]? spouse] 4=Ga
Absent spouse's name born? parents? [present spouse's by [absent spouse]? (see codes in past 5=Dangme
6=Krobo
spouse] name] spouse's below) year
7=Ewe
(code 888 if belong? name]? (code 888 if 8=Guan
still living with (see codes they have if more 9=Nzema
parents) (see below) never lived than zero 10=Hausa
codes) together) >> 12 11=Dagomba
12=Mamprusi
1 2 3 4 5 6 7 8 9 10 11 13=Gonja
S1 14=Grussi/
Frafra
S2 15=Dagati
16=Kusasi
S3 17=Kassena-
Nankani
S4 18=Kankoma
S5 19=Nanumba
20=Builsa
S6 21=Other
(specify)
S7
S8
S9
S10
Codes for column 5: 1=None; 2=Primary; 3=Middle/JSS; 4=Voc/Comm; 5='O' level; 6=SSS; 7='A' level; 8=Training college;
9=Tech/prof; 10=Tertiary; 11=Koranic; 12=Don't know
Codes for column 12: 1=Professional/technical; 2 = Administrative/managerial; 3 = Clerical; 4 = Sales; 5=Service;
6=Agric./Ani-Husb./Forest/ Fishing/Hunting; 7=Production & related works; 8=Workers NEC; 9 = Homemaker;
10=full time student; 11=other (specify) 12=Don't know
Section 9 - INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 5)
Part b: Applied to all absent spouses of each household members (concluded)
How many Has [absent spouse's name] Where does [name] live primarily?
phone calls, ever held political office?
letters, or other In Ghana Outside of Ghana
contacts (other 0 = None
Absent Spouse Number
1 = Kumasi
than visits in 1 = Member of Parliament REGION:
2 = Sunyani
2=Western
person) has 2 = District Chief Executive 3 = Cape Coast
3=Central
[absent spouse] 3 = Assembly Man/Woman 4 = Koforidua
4=Gt. Accra
5 = Accra
made to 4 = Unit Committee 5=Volta
6 = Tamale
[present Member 7 = Bolgatanga
give name of city 6=Eastern give name of country
7=Ashanti
spouse] in the 5 = National Political Office 8 = Koforidua
8=Brong Ahafo
past 12 [Minister, Deputy Minister, 9 = Wa
9=Northern
months? etc.] 10 = Sekondi-
10=Upper East
Takordi
11=Upper West
11 = Ho
12 13 14 15 16 17
S1
S2
S3
S4
S5
S6
S7
S8
S9
S10
Section 10 (Transfers), Part 1-- TRANSFERS OUT OF THE HOUSEHOLD
Is there anyone (including household members) not living in the household at the time to whom the household has sent money or goods in the past year?
Fill out entire page for all transfers
Were these Will these What was What were the three What was What was Where does this If not a If this Through what
remittances remittances the total main uses of the cash the total the total recipient live? household person means did
made on a be repaid at amount of sent / given? value of value of 1=this town/village member, is was one of you receive
regular basis? 1 = daily consumption 2=Sekondi / Takordi the
some future the cash sent food sent other this person the
Yes, 2 = housing 3=Cape Coast remittance?
time? to or given to or goods a blood relatives
1 = weekly 3 = business 4=Accra
2 = monthly
to this 4 = education
given to sent to or 5=Ho
relative or mentioned 1 = Bank
If household member, ID
3 = quarterly 1 = Yes individual 5 = health this given to 6=Koforidua spouse of a in account
4 = annually 2 = No during the 6 = funeral individual this 7=Kumasi household previous 2 = Money
Transfer number
Name of person No = 5 past 12 7 = other ceremony in the past individual 8=Suyani member? section, transfer
to whom money Other months? 8 = savings 12 in the past 9=Tamale 1 = Yes; give agency
is sent (specify) = 6 9 = agriculture months? 12 10=Bolgatanga 2 = No relative 3 = Sender
10 = other months? 11=Wa number or him or herself
12=other urban (if no >> code 999 4 = Cash
13=rural carried by
13) if a
96=Other ECOWAS someone else
relative
97=Africa other than 5 = Other
ECOWAS not (specify)
98=Outside Africa mentioned
cedis a b c cedis cedis
1 2 3 4 5 6 7 8 9 10 11 12
1
2
3
4
5
6
7
8
9
10
Section 10, Part 2 -- TRANSFERS INTO THE HOUSEHOLD
Is there anyone (including household members) not living in the household from whom the household has received money / goods in the past year?
Fill out entire page for all transfers
Were these Will these What was What were the three What was What was Where does this If not a If this
remittances main uses of the cash the total the total recipient live? household person
remittances the total Through what
made on a sent / given? 1=this town/village
regular basis?
be repaid at amount of means did 1 = daily consumption value of value of 2=Sekondi / Takordi member, is was one of
you receive food sent other this person the
Yes, some future the cash 2 = housing 3=Cape Coast
the to or goods a blood relatives
1 = weekly time? sent to or remittance? 3 = business 4=Accra
given to sent to or relative or mentioned
If household member, ID
2 = monthly given to 4 = education 5=Ho
3 = quarterly 5 = health this given to 6=Koforidua spouse of a in the
1 = Yes this 1 = Bank individual this household previous
4 = annually 6 = funeral 7=Kumasi
Transfer number
Name of person 2 = No individual account
No = 5 7 = other ceremony in the past individual 8=Suyani member? section,
from whom Other during the 2 = Money 8 = savings 12 in the past 9=Tamale 1 = Yes; give
transfer
money is (specify) = 6 past 12 agency
9 = other months? 12 10=Bolgatanga 2 = No relative
received months? months? 11=Wa number or
3 = Sender
12=other urban (if no >> 999 =
him or herself
13=rural
4 = Cash next another
96=Other ECOWAS
carried by transfer) relative
97=Africa other than
someone else
ECOWAS
5 = Other
98=Outside Africa
(specify)
cedis a b c cedis cedis
1 2 3 4 5 6 7 8 9 10 11 12
1
2
3
4
5
6
7
8
9
10
Section 10, part 3 -- Miscellaneous Income & Expenditures
During the past 12 months, how much income in cash or kind, did any member of the household receive
from the following sources? During the past 12 months, how much did the household spend (in cash and in kind) on:
From Central Government From Other Sources
Gifts and presents
Other (specify)
exclusing those
Weddings,
Taxes (TV mentioned as transfers
INCL. DONATIONS Contribution to dowry,
Member ID
license,
Social State Retirement Dowry or FROM CHURCHES, self-help funerals
Other (specify) property tax, (INCLUDE
Security Pension Benefits inheritance INSTITUTIONS, projects and other
etc) CONTRIBUTIONS/DON
DIVIDENDS, INTEREST. cermonies
ATIONS TO CHURCES
INSTITUTIONS, ETC)
(EXCLUDE SUSU)
Amount Amount Amount Amount Value Amount Amount Amount Amount Amount
1 2 3 4 5 6 1 2 3 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 11 (savings, credit, assets) part a – Borrowing
Fill out entire sheet for any loans
What is the source of What was For what purpose was What kind of How Do you Do you If so, How frequently How If land is
this loan? the loan contracted? guarantee was still owe have to what is do you make being used
the total much of much
Which household member obtained the loan? (give ID)
1 = State bank 1 = Agricultural land / required by the this pay the payments on as collateral
2 = Private bank amount of equipment lender? the loan this loan? money is
money? interest interest (see
3 = Cooperative the original 2 = Agricultural inputs 1 = None has been 1 = Daily currently
on this rate? question 5),
4 = Govt. agency loan? 3 = Business 2 = Land repaid in 2 = Weekly owed? To whom is this money
5 = NGO 4 = Housing 3 = Cattle
1 = Yes loan? 3 = Forthnightly
then who is
the past owed?
6 = Business firm 5 = Education / training 4 = House / (%) 4 = Quarterly using the
(cedis) twelve 2 = No 1 = Yes (cedis) land?
7 = Employer 6 = Health building 5 = Semester
months? (>> next 2 = No (give name of person or 1 = person
Loan Number
8 = Moneylender 7 = Ceremonies 5 = Employer 6 = Annual
9 = Trader (weddings, funerals, 6 = Relatives loan) 7 = Only one organization / bank) to whom
10 = Farmer etc.) 7 = Non- (cedis) final payment money is
11 = Relative / 8 = Vehicle relatives 8 = No fixed owed
neighbor / friend 9 = Other consumer 8 = Other schedule 2=
12 = Community goods (specify) someone
epicenter 10 = Other (specify)
else
13 = other (specify)
8 = don't
ID (if know
name village
resident)
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1
2
3
4
5
6
7
8
Section 11, part b -- Household assets
Fill out entire sheet for any household assets
What was the
purchase price?
How many […] does your household own?
(if gift put zero)
CODE
Item
see currency codes
below
1 2
currency
working not working amount
code
1 2
301 Furniture
302 Sewing machine
dwa6:
303 Stove (kerosene)
Very similar to section 12, part B
304 Stove (electric)
305 Stove (gas)
306 Refrigerator
307 Freezer
308 Air conditioner
309 Fan
310 Radio
311 Radio cassette
312 Record player
313 3-in-one radio system
314 Video player
315 Desktop computer
316 Laptop computer
317 Printer
318 Computer accessories
319 Camcoder/video camera
320 Satellite dish
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
Section 11, part b -- Household assets concluded
Fill out entire sheet for any household assets
What was the
How many […] does your household own? purchase price?
(if gift put zero)
CODE
Item see currency codes
below
1 2
currency
working current status value
code
1 2
321 Washing machine
322 TV
323 Camera
324 Iron (electric)
325 Bicycle
326 Motorcycle
327 Car
328 House
329 Land / plot
330 Shares
331 Boat
332 Canoes
333 Outboard motor
334 Microwave
335 Food processor
336 Box iron
337 Mobile phone
338 Generator
339 Jewellery
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
Section 11, part c -- Saving
1. Does any member of the household have a savings account or participate in Susu? 1 = yes, 2 = no (>> 7) ______________
In what
ID of member's name
Where is this How much has How much
account currency is been added to has been
on account
Item Number
the account? What is the current the savings in the withdrawn
(NEED CODES, balance of these past 12 months? from the
one needs to be SEE savings? savings in
community CURRENC (EXCLUDE the past 12
epicenter) Y CODES INTEREST) months?
BELOW
2 3 4 5 6
1
2
3
4
5
6
7
8
9
10
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
? 1 = yes, 2 = no (>> 7) ______________
(7) Does
the _______ (1 = Yes; 2 = No)
househol
(8) If so, how much? amount
currency
code
(see below)
o; 7 = yen; 8 = other (specify)
Section 11, part d -- Lending
NEW -- Is any member of the household owed money? ______ (1 = Yes; 2 = No, if no >> next page)
How frequently are
What kind of
payments made on
To whom was When the guarantee was
this loan?
this loan loan was required of the
Give receiver's name, if a resident What was the 1 = Daily
given? started, how receiver? How much
of your village total amount How long ago 2 = Weekly
1 = Employee much in total 1 = None does the
Loan Number
of the original was the loan 3 = Forthnightly
2 = Tenant did the 2 = Land recipient
(or write NV if not a resident of loan given to started? 4 = Quarterly
3 = Relative recipient have 3 = Cattle currently owe?
village) the recipient? 5 = Semester
4 = Neighbor to pay you 4 = House / building
6 = Annual
/ friend back? 5 = Employer (cedis)
(cedis) 7 = Only one final
5 = other 6 = Relatives
payment
(specify) (cedis) 7 = Non-relatives
8 = No fixed
name ID Years Months 8 = Other (specify)
schedule
1 2 3 4 5 5 6 7
1
2
3
4
5
6
7
8
Section 12, Part A -- Housing Characteristics: Rent
Amount Time Unit Time Units:
1. How much does the household pay in cash towards the rent? 1 = Daily
2 = Weekly
2. Does your household also supply goods or services in exchange for 3 = Monthly
this dwelling? Code 4 = Quarterly
1 = Yes 5 = Half yearly
6 = Yearly
2 = No
0 = N/A
3. What is the appropriate value of these goods and services provided Amount Time Unit
by your household?
4. Is part or all of the rent paid by someone who is not a member of
your household?
1 = Yes All Code
2 = Yes Part
3 = No
5. Who pays?
1 = Relative
2 = Private employer
3 = Givernment Code
4 = Private individual / agency
5 = Other
Amount Time Unit
6. How much is paid?
Amount
7. How much did your household spend for construction or repair costs
and painting in the last 12 months on this dwelling?
Section 12, Part A -- Housing Characteristics: Utilities
Drinking General Use Amount
16. Did your household sell any water to someone else?
8. What is the main source of water supply for this household?
1 = Yes
See codes
2 = No (>>18)
Drinking distance Drinking distance code 17. How much did your household receive for the water sold in Amount
9. How far is this source of water from your dwelling?
the last 2 weeks?
18. What is the main source of lighting for your dwelling?
1 = Electricity (mains)
General use distance General use distance code 2 = Kerosene (>>20) code
3 = Gas lamp (>>20)
4 = Candles / Torches (flashlights) (>>20)
5 = Solar energy (>>20)
6 = Generator (>>20)
7 = No light (>>20)
8 = Other (specify) (>>20)
Number Time Unit Amount Time Unit
19. How much was your last bill (Only your part if you have a joint
10. How regular is your source of water supply?
meter or a shared bill)?
20. What is the main fuel used by the household for cooking?
1 = None, no cooking
2 = Wood
11. How much water does your household use in a day? 3 = Charcoal
Units: 4 = Gas
Quantity Unit Code
1 = Litres 5 = Electricity
2 = Gallons 6 = Kerosense
3 = Bucket (No. 34) 7 = Crop residue/sawdust
8 = Animal waste
9 = Other (specify)
12. How is the water supply system operated and managed?
21. How does your hosehold dispose of refuse?
1 = Self
1 = Collected
2 = Community operated and managed
Code 2 = Public dump (>>23) Code
3 = Community Water Sanitation Agency
3 = Dumped elsewhere (>>23)
4 = Ghana Water Company Limited
4 = Burned by household (>>23)
5 = NGO
5 = Buried by household (>>23)
6 = Other (specify)
6 = Other (>>23)
7 = Not Applicable
Code Amount Time Unit
13. Does the household pay a regular bill for this water supply system?
1 = Yes 22. How much does this household pay for refuse disposal?
2 = No (>>15)
23. What type of toilet is used by your household?
1 = Flush toilet (W.C) (>>25)
2 = Pit latrine (>>25)
Amount Time Unit 3 = KVIP (>>25) Code
14. How much was your last bill? (only your part if joint meter or shared bill) 4 = Pan/bucket (>>25)
5 = Public toilet (flush/bucket/KVIP)
6 = Toilet in another house
7 = No toilet facility (bush, beach) (>>25)
8 = Other (specify) (>>25)
Amount Amount Time Unit
15. How much did your household pay to a private water vendor, neighbour or 24. How much does the household pay for the use of the toliet
standpipe or any other source in the last 2 weeks? facility?
Question 8 codes: Distance codes:
1 = Indoor plumbing 2 = Inside standpipe 3 = Water truck/tanker service 4 = Water vendor 5 = Pipe in neighbouring household 6 = Private outside standpipe/tap 0 = In house 1 = Yard 2 = Metre 3 = Kilometre 4 = Mile
7 = Public standpipe 8 = Sachet/bottled water 9 = Borehole 10 = Protected well 11 = Unprotected well 12 = River / Stream 13 = Rain water / spring
14 = Dugout/pond/lake/dam 15 = Other (specify)
Section 12, Part A -- Housing Characteristics: Structure and Amenities
Does the Does the 29. Draw a detailed sketch of the dwelling:
household household use
have access […]?
to […]? 1 = Yes
1= Yes 2 = No
2 = No
25.a. Fixed Line Telephone
25.b. Mobile phone network
25.c. Personal Computers
25.d. Internet (other use)
25.e. E-commerce
25.f. Paid cable network (e.g. M-
NET CABLEGOLD)
26. What is the main construction material used for the outer wall? Code
1 = Mud/Mud bricks
2 = Wood/Bamboo
3 = Metal sheet/Slate/Asbestos
4 = Stone
5 = Burned bricks
6 = Cement/Sandcrete blocks
7 = Landcrete
8 = Thatch
9 = Cardboard
10 = Other (specify)
27. What is the main construction material used for the floor? Code
1 = Earth/Mud/Mud bricks
2 = Wood
3 = Stone
4 = Cement/Concrete
5 = Burnt bricks
6 = Vinyl tiles
7 = Ceramic/Marble/Tiles
8 = Terrazzo
9 = Other
28. What is the main material used for the roof? Code
1 = Palm leaves/Raffia/Thatch
2 = Wood
3 = Corrugated iron sheets
4 = Cement/Concrete
5 = Asbestos/Slate
6 = Roofing tiles
7 = Mud bricks/Earth
8 = Bamboo
9 = Other (specify)
Section 12, Part B -- Ownership of Durables
Owned until a
Owned Now year ago Accquired between (specific date ) and now
Item (specific date )
Received as
Purchased Sold Given as gift
No. Value No. Value gift
No. Value No. Value No. Value No. Value
1 2 3 4 5 6 7 8 9 10 11 12 13
1 Radio, Cassette/CD player
2 Telephone (mobile)
3 Telephone (fixed) dwa6:
Very similar to section 11, part b
4 TV
5 Parabolic/satellite receivers
6 VCR / DVD Player
7 Camera
8 Video camera
9 Refrigerator & freezers
10 Air conditioners & air coolers
11 Washing machines and driers
12 Gas cookers, stoves, and coalpots
13 Electric irons
14 Electric fans
15 Blenders
16 Lanterns, gas lights
17 Cups and plates
18 Dining pots
19 Utensils / cutlery
20 Buckets
21 Cutlasses
Shovels, rakes, wheelbarrows,
22
etc.
23 Motor driven lawn mower
24 Generators (houshold use)
Section 12, Part B -- Ownership of Durables (ctd.)
Owned until a
Owned Now year ago Accquired between (specific date ) and now
Item (specific date )
Received as
Purchased Sold Given as gift
No. Value No. Value gift
No. Value No. Value No. Value No. Value
1 2 3 4 5 6 7 8 9 10 11 12 13
25 Water cans / water pumps
26 Brooms
27 Light bulbs
28 Torches
29 Car / truck
30 Motorcycle
31 Bicycle
32 Car tyres and other spare parts
33 Computers and accessories
34 Musical instruments
35 Game cards (chess, ludo, etc)
36 Toys
37 Football, volleyball, etc
38 Video game equipment and
software
39 Bedsteads
40 Mattresses
41 Room furniture
42 Bedsheets & blankets
43 Towels and linen
44 Floor mats, tiles, linoleum, and
wollen carpets
45 Travelling bags, umbrellas
46 Office supplies (paper, pens,
pencils, staplers, etc)
47 Iron rods and roofing sheets
48 Bricks and Cement blocks
49 Paints including quicklime
S ection 12, Part B -- House Property
To be asked to the Househould head/part can be filled by surveyor as well
In what ty pe of dwelling does the household live?
1= Separate house (bungalow)
2= Semi-detached house
3= Flat/Apartment
1 4= Room(s) (Compound House)
5= Rooms(s) (Other ty pe)
6= Several Huts/Buildings (same Cpds)
7=Several Huts/Buildings (diff. Cpds)
8= Tents/Improvised home
9= Other (specify )
2 How many rooms does this household occupy ? (count living rooms, dining rooms, bed rooms but
not bathrooms, toilet & kitchen)
3
Do other households share this dwelling with y ou (1= y es, 2= no)
4 What is y our present occupancy status? (1=Owning, 2=Renting, 3=Rent-free, 4=Perching) If
owning >> 6
5 Who owns this dwelling? (1=Relative not household member, 2=Other private individual,
3=Private employ er, 4=Other private agency , 5=Public/Gov't. ownership, 6=Other (specify ))
6 What is the condition of the house in which the household is living? (1=good, 2=livable, 3=badly
damaged)
7 How are the surroundings of the house? (1=clean, 2=average, 3=dirty )
8 How many living rooms does the house have?
9 Is there a room used exclusively for cooking? (1=y es, 2=no)
10 Is there a window in the room where cooking is done? (1=y es, 2=no)
11 Is there a chimney /smoke outlet in the cooking place? (1=y es, 2=no)
12 Is cooking done outside in any season? (1=y es, 2=no)
13 If y es, which season?
14 Does y our house have electricity ? (1=y es, 2=no)
15 If y es, how regular is y our power supply after sunset? (1=regular, 2=cut once or twice a week,
3=cut more than twice a week)
16 Distance to nearest public toilet (kms)
17 Average time spent traveling to and waiting at public toilet (minutes)
18 Number of other buildings owned
19 Number of vacant plots owned
20 Where are animals tied at night? (1=inside the house, 2=outside the house, 3=animal shed)
21 Where are animals tied during the day ? (1=inside the house, 2=outside the house, 3=animal shed)
22 Where is hay (grass) kept? (1=inside the house, 2=outside the house, 3=animal shed)
23 Open sewer/drain in/around the house? (1=y es, 2=no)
24 Trash in/around the house? (1=y es, 2=no)
Section 12, Part B -- Food Items Consumed (Part 1 of 3)
Last 30 days Season 1 _________ to ___________ Season 2 _________ to ___________ Season 3 _________ to __________
Gifts Gifts Gifts
Home Produced
Home Produced
Home Produced
Home Produced
Unit
Items Purchase Purchase received Gifts Given Purchase received Gifts Given Purchase received Gifts Given
From PDS
From PDS
From PDS
From PDS
Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value
Qnty
Qnty
Qnty
Qnty
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1.1 Cereals
1 1.1.1 Guinea corn/sorghum
2 1.1.2 Maize
3 1.1.3 Millet
4 1.1.4 Rice - Local
5 1.1.5 Rice - Imported
6 1.1.6 Other cereals
1.2 Pulses and Nuts
7 1.2.1 Beans
8 1.2.2 Groundnuts
9 1.2.3 Palm nuts
10 1.2.4 Cola nuts
11 1.2.5 Other pulses and nuts
1.3 Bread
12 1.3.1 Bread - sugar bread
13 1.3.2 Other bread
14 1.3.3 Biscuits
15 1.3.4 Flour (wheat)
16 1.3.5 Maize ground/corn dough
1.3.6 Kenkey/banku (without
17
sauce)
18 1.3.7 Baby food (cerelac, etc)
2.3 Cooking oil
19 2.3.1 Coconut Oil
20 2.3.2 Groundnut oil
21 2.3.3 Palm kernel oil
22 2.3.4 Palm oil
23 2.3.5 Shea butter
24 2.3.6 Margarine/Butter
2.3.7 Other vegetable oils
25
including animal fats
Section 12, Part B -- Food Items Consumed (Part 2 of 3)
Last 30 days Season 1 _________ to ___________ Season 2 _________ to ___________ Season 3 _________ to __________
Gifts Gifts Gifts
Home Produced
Home Produced
Home Produced
Home Produced
Unit
Items Purchase Purchase received Gifts Given Purchase received Gifts Given Purchase received Gifts Given
From PDS
From PDS
From PDS
From PDS
Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value
Qnty
Qnty
Qnty
Qnty
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
2.4 Spices and Condiments
26 2.4.1 Black pepper
27 2.4.2 Salt
28 2.4.3 Ginger
2.4.4 Other condiments (Royco,
29
Maggie, etc)
2.5 Milk and milk products
30 2.5.1 Milk (fresh)
31 2.5.2 Milk (powder)
32 2.5.3 Baby milk
33 2.5.4 Tinned milk
2.5.5 Other milk products
34
including cheese
2.6 Eggs and Poultry
35 2.6.1 Eggs
36 2.6.2 Chicken
37 2.6.3 Game birds
2.7 Meat
38 2.7.1 Corned beef
39 2.7.2 Pork
40 2.7.3 Beef
41 2.7.4 Goat meet
42 2.7.5 Mutton
43 2.7.6 Bushmeat/wild game
44 2.7.7 Fish
2.8 Fruits
45 2.8.1 Coconut
46 2.8.2 Banana
47 2.8.3 Orange/tangerine
48 2.8.4 Pineapple
49 2.8.5 Mango
50 2.8.6 Avocado pear
51 2.8.7 Water melon
Section 12, Part B -- Food Items Consumed (Part 3 of 3)
Last 30 days Season 1 _________ to ___________ Season 2 _________ to ___________ Season 3 _________ to __________
Gifts Gifts Gifts
Produced Qnty
Produced Qnty
Produced Qnty
Produced Qnty
Unit
Items Purchase Purchase received Gifts Given Purchase received Gifts Given Purchase received Gifts Given
From PDS
From PDS
From PDS
From PDS
Home
Home
Home
Home
Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value Qty Value
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
2.9 Vegetables
52 2.9.1 Cocoyam leaves (kontomire)
53 2.9.2 Garden eggs
54 2.9.3 Okro
55 2.9.4 Carrots
56 2.9.5 Pepper (fresh or dried)
57 2.9.6 Onions (large/small)
58 2.9.7 Tomatoes (fresh)
59 2.9.8 Tomato puree (canned)
60 2.9.9 Other vegetables
2.10 Starchy Staples
61 2.10.1 Cassava
62 2.10.2 Cocoyam
63 2.10.3 Plantain
64 2.10.4 Yam
65 2.10.5 Cassava dough
66 2.10.6 Gari
67 2.10.5 Other starchy staples
2.11 Confectionery
68 2.11.1 Sugar (cube, granulated)
69 2.11.2 Honey
70 2.11.3 Ice cream, ice lollies, etc.
71 2.11.4 Chocolate
72 2.11.5 Other confectionaries
2.12 Beverages
73 2.12.1 Coffee, Tea, and Cocoa
2.12.2 Bottled Water, Soft drinks,
74
and Juices
75 2.12.3 Alcoholic Beverages
2.13 Other
76 2.13.1 Tobacco
77 2.13.2 Cooked meals (as wages)
2.13.3 Restaurants, Cafes, Canteens,
78
Hotels, etc
Section 12, Part B -- Clothing and Footwear - Annual Purchases During (year)
Expenditure during For children under For elderly over For adult males 16- For adult females
Item 2005-06 (cedis) 16 yrs. (Rs.) 60 yrs. (cedis) 60 yrs (cedis) 16-60 yrs. (cedis)
1 2 3 4 5 6
1
Readymade garments
2
Cloth for garments
3
Suits
4
Smocks
5
Trousers
6
Shirts
7
Jeans
8
Underwear
9
Other garments and clothing
10
Footwear
11
Tailoring, laundry / cleaning,
clothing repair charges
Section 12, Part B -- Expenditure on Other Items
Monthly average Expenditure during
Sl. no Items
(cedis) 2005-06 (cedis)
1 2 3 4
Gifts and donations
1 Regular remittances/gifts
2 Gifts/support to help at the time of difficulty
3 Cultural festivals (donations) (Homowo, Odwira, etc)
4 Funerals
Housing expenses
5 Payment for rent
6 Owner occupy housing rent (estimate)
7 Plumbing, electrical, and carpentry services
8 Sewerage removal, refuse desposal, expenditure on public toilets
9 Water (pipe-borne, metered)
10 Water (tanker services)
Repairs
11 Cement (for minor repairs of the dwelling)
12 Hired labour for dwelling repairs
13 Repairs to furniture and floor coverings
14 Repairs to household appliances
15 Car and truck repairs, maitenance, and other fees
Services
16 Lawn boys/gardeners
17 Security guards
18 House boys/house maids
19 House keepers/caretakers
20 Baby sitters, day care attendants, nannies, etc.
21 Barbers and beauty shops
Non-food non-durables
22 Soaps, bleaches, disinfectants, cleaners, and toilet papers
23 Matches and candles
24 Insecticides - coils and sprays
Medicine (pain killers, antibiotics, anti malaria medicines, condoms, tablets, syrups,
25
etc)
26 Newspapers, magazines, and books
Goods for personal care (toothpaste, razor blades, combs, scent sprays, cosmetics,
27
etc)
Other expenses
28 Postal, telephone, telegram, fax, internet/email, etc services and charges
29 Pets, pet food, vetrinary services
30 Gardening expenses (plants, pots, fertilisers, compost, etc)
31 Entertainment
32 Travel, transport and lodging
Section 12, Part B -- Fuels Used in the Past Year
Avg. value per
Value (cedis)
months
No. of
Sl. No. Fuel type months Home
used (cedis)
produced/ Purchased
collected
1 2 3 4 5 6
1 Electricity *********
2 Gas for household use *********
3 Kerosene *********
4 Charcoal
5 Firewood and other solid fuels
6 Petrol *********
7 Diesel *********
8 Dung Cake
9 Crop byproducts/waste
10 Rubbish/plastic ********* *********
S ection 13, Part A - Epicenter Participation
NEW - Ask for all household members
Have y ou
Have y ou attended
How long Did y ou Have y ou Have y ou
Do y ou donated any
Have y ou does it help donated If y es, donated
How often do y ou go serve on any of If y es, If y es, fundraiser
heard of take y ou If y es, construct any of how any of
to the epicenter? an y our how how s or
the to get to which the y our time much y our land
Member ID
epicenter money to much much meetings
Hunger the one? epicenter to the hours to the If so, how
(See Time Unit Codes committe the money land have related to
Project? nearest building? epicenter? have y ou epicenter? many ?
Below) e? epicenter? have y ou y ou the
communit NEED donated?
donated? donated? epicenter?
1 = Yes y CODES 1 = Yes 1 = Yes 1 = Yes
1 = Yes 1 = Yes
2 = No epicenter? 2 = No 2 = No 2 = No
2 = No 2 = No ( 1 = Yes
(>> 10) (14)
>>12) 2 = No
(>>16)
Number
Minutes Units Hours Cedis Acres
of visits 4
1 2 3 5 6 7 8 9 10 11 12 13 14 15
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily ; 2 = weekly ; 3 = fortnightly ; 4 = monthly ; 5 = quarterly ; 6 = y early
S ection 13, part a - Epicenter Participation (ctd.)
NEW - Ask for all household members
Have y ou Have y ou Have y ou Have y ou
ever Have y ou ever ever Have y ou Have y ou
If y es, which ever used
ever attended used the How ever used
attended attended attended services? the day care
any women's communit many the Food If y es, If y es,
any If y es, If y es, any Vision, If y es, any HIV If y es, / nursery /
empowerme y times Bank at how how
literacy how how Commitme how and how 1 = Prenatal care preschool
Member ID
nt programs epicenter' have y ou the many many
courses at many many nt and many Gender many 2 = Postnatal care services at
the at the Action Inequality have y ou s health used the communit times times
have y ou have y ou have y ou 3 = immunizations the
community resources epicenter' y have y ou have y ou
communit attended attended workshops attended workshops attended 4= community
epicenter? ? s health epicenter? used it in used them
y in the past in the past at the in the past at the in the past pharmaceuticals epicenter?
resources the past in the past
epicenter? month? month? community month? communit month?
1 = Yes 1 = Yes in the past 1 = Yes month? month?
epicenter? y (include all that 1 = Yes
1 = Yes 2 = No epicenter? 2 = No month? 2 = No
apply ) 2 = No (>>
(>>20) (>>27) (>>29)
2 = No 1 = Yes next person)
(>>18) 2 = No 1 = Yes
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 13, part b - Empowerment (1/3)
NEW - Ask for all household members
Why do you think you are not Why do you feel you cannot
Are there any
allowed to participate? How often have you socialize with these people?
community activities,
In the last three met with and talked Are there any
such as those
years, do you [Do not prompt, list up to 2] to people from other people from [Do not prompt, list up to 2]
In the past organized by the local In which
feel the roads social groups different social
year, how government, religious activities
leading to your 1 = Poverty outside your home groups that you 1 = Poverty
Member ID
many times organizations, the are you not
community 2 = Occupation in the last week? feel you cannot, 2 = Occupation
have you school, etc, in which allowed to
have: 3 = Lack of education or would have 3 = Lack of education
traveled to a you are not allowed to participate?
4 = Gender 1 = Not at all difficulty in 4 = Gender
neighboring participate?
1 = Improved 5 = Age 2 = Once socializing with? 5 = Age
village or NEED
2 = Worsened 6 = Religion 3 = Several times 6 = Religion
town? 1 = Yes CODES
3 = Remained 7 = Political Affiliation 4 = Daily 1 = Yes 7 = Political Affiliation
2 = No, I can
the same 8 = Ethnicity or language 5 = Several times a 2 = No (>>9) 8 = Ethnicity or language
participate in all
spoken/race/caste/tribe day spoken/race/caste/tribe
activities (>>6)
9 = Other (specify) 9 = Other (specify)
1 2 3 4 5 6 7 8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 13, part b - Empowerment (2/3)
NEW - Ask for all household members
Who do you think will Do you feel that How involved in the
contribute most to any How involved in the
people like yourself political process at
change? political process at
can generally change the
Is there the national level do
What thing(s) When do you things in your Were you community/regional Were you
anything in Do you Did you Did you you feel you are at
would you most think they will [Do not prompt, list up to community if they entitled to level do you feel you entitled to
your life think these two] vote in the vote in the the moment?
like to change? change? want to? vote in the are at the moment? vote in the
Member ID
that you will ever last District last
last District last
would like change? 1 = Myself Assembly national 1 = Very involved
[Do not prompt, 1 = Very soon 1 = Yes, very easily Assembly 1 = Very involved national
to change? 2 = My family elections? elections? 2 = Fairly involved
list up to three 2 = Fairly soon 2 = Yes, fairly easily elections? 2 = Fairly involved elections?
1 = Yes 3 = Our group 3 = Slightly
things] 3 = A long 3 = Yes, but with a 3 = Slightly
1 = Yes 2 = No (>> 4 = Our community 1 = Yes 1 = Yes involved
time in the little difficulty 1 = Yes involved 1 = yes
2 = No (>> 14) 5 = The local government 4 = Yes, but with a 2 = No 2 = No 4 = Not involved at
NEED CODES future 2 = No 4 = Not involved at 2 = no
14) 6 = The national all
great deal of all
government 5 = Don't know /
difficulty 5 = Don't know /
7 = Other (specify) can't say
5 = No, not at all can't say
9 10 11 12 13 14 15 16 17 18 19 20
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section 13, part b - Empowerment (3/3)
NEW - Ask for all household members
To what degree do
When decisions are made regarding aspects of household life, who is you feel you have
it that normally makes the decision? control over
How much
To what degree do you feel you can make your own personal decisions regarding Where do you go
choice do you How easy would it
1 = Male head of household decisions regarding these issues if you want to? your own personal on your own?
feel you have in be to change your
2 = Adult male household members welfare, health and
deciding your occupation if you
Member ID
3 = Female head of household 1 = To a very high degree body? 1 = Everywhere I
occupation? wanted to?
4 = Adult female household members 2 = To a fairly high degree want to
5 = Male and female heads of households 3 = To a small degree 1 = To a very high 2 = Most places I
1 = Complete 1 = Very easy
6 = All adult members of household 4 = Not at all degree want to
choice 2 = Fairly easy
7 = All members of household, including children 2 = To a fairly high 3 = Some places
2 = Some 3 = Not very easy
8 = Other (specify) degree I want to
choice 4 = Impossible
3 = To a small 4 = Nowhere
3 = No choice
degree
Household Education Political Marriage Religious / Household Education Political Marriage Religious / 4 = Not at all
expenditure and Health Decisions Choices Beliefs expenditure and Health Decisions Choices Beliefs
21 22 23 24 25 26 27 28 29 30 31 32 33 34
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Section XXX, Part XXX – Community Participation Give household polling site (from village survey)
Ask of each household member
Did you
How much does
attend the CODE FOR
being a member
previous How well do COLUMN 4:
If yes, did of these groups What is the most
village Did you vote you think your 1 = road or
you speak benefit you important
Organization Number
assembly in the ASK ISSER/GSS IF current transport
about any individually? benefit that you
List the social, political, and religious meeting on previous THIS QUESTION IS representative is 2 = health
issue at the feel you gain
organizations that you belong / participate in [date]? What was/were this election on TOO SENSITIVE TO doing? 3 = education
meeting? 1 = Greatly from being a
issue(s)? [date]? ASK: which 1 = excellent 4 = irrigation
2 = Fairly member of these
(codes from village roster) 1 = yes candidate did you 2 = very good or water
1 = yes 3 = A little groups?
2 = no 1 = yes vote for? 3 = average 5 = other
2 = no 4 = Not at all
2 = no 4 = bad agriculture
(if no >> 5) (If 4, >> next NEED CODES related
(give date 5 = very bad
household 6 = ceremonies
from village
member) 7=disputes
survey)
8 = sanitation
1 2 3 4 5 6 7 8 9 9=
1 construction
other than
2 roads or
irrigation
3 10 = access to
4 and use of
lands of the
5 assembly
11 =
6 unemployment
7 schemes
12 = other
8 (specify)
digits1
Section XXX, Part XXX: Digit Span Cognitive Assessment
Complete for each child under ages 5 - 12 in the household. Complete Part 1 first.
Child name:____________________________________ Child Household ID:_____________________
Instructions:
(1) Read each digit span only once at an even rate of one digit per second.
(2) Read Part A of a question; pause for response, then score.
(3) Read Part B of a question; pause for response; then score.
(4) If child does not respond after reading the question, do not encourage further.
(5) Stop when child misses Part A and Part B of any one question.
(6) To be scored as "correct", no digits may be omitted or be in reversed order.
Part 1: Digits Forward
Read outloud to child: "I can only read these instructions to you one time. I cannot
repeat them. I am going to say some numbers. Listen carefully, and when I am through,
say them right after me"
0. Exact Time Now ______________________
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q1(a) "2-9"
Q1(b) "4-6"
If the child got both questions wrong >> Part 2
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q2(a) "3-8-6"
Q2(b) "6-1-2"
If the child got both questions wrong >> Part 2
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q3(a) "3-4-1-7"
Q3(b) "6-1-5-8"
If the child got both questions wrong >> Part 2
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q4(a) "8-4-2-3-9"
Q4(b) "5-2-1-8-6"
If the child got both questions wrong >> Part 2
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q5(a) "3-8-9-1-7-4"
Q5(b) "7-9-6-4-8-3"
If the child got both questions wrong >> Part 2
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q6(a) "5-1-7-4-2-3-8"
Q6(b) "9-8-5-2-1-6-3"
If the child got both questions wrong >> Part 2
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q7(a) "1-6-4-5-9-7-6-3"
Q7(b) "2-9-7-6-3-1-5-4"
If the child got both questions wrong >> Part 2
Correct response:
1 = Child repeated the numbers exactly
0 = Child did not repeat the numbers
Say "Ready", then say: exactly
Q8(a) "5-3-8-7-1-2-4-6-9"
Q8(b) "4-2-6-9-1-7-8-3-5"
>> Part 2
Page 124
digits2
Section XXX, Part XXX: Digit Span Cognitive Assessment (concluded)
Complete for each child under ages 5 - 12 in the household. Complete Part 1 first.
Part 2: Digits Backward
Read outloud to child: "Now, I am going to say some more numbers, but this time
when I stop, I want you to say them backward. For example, If I say 9-2-7, what
would you say?"
If child says "7-2-9", say: "That's right. Let's go on with the rest of the numbers"
If child does not say "7-2-9", say: "No, you would say 7-2-9. I said 9-2-7, so to say
it backwards you would say 7-2-9. Now try these numbers. Remember to say them
backward."
Correct response:
1 = Child repeated the
Answer: DO answer exactly
Say "Ready", then NOT READ 0 = Child did not repeat the
say: answer exactly
Q9(a) "2-5" "5-2"
Q9(b) "6-3" "3-6"
If the child got both questions wrong >> Question 16
Correct response:
1 = Child repeated the
Answer: DO answer exactly
Say "Ready", then NOT READ 0 = Child did not repeat the
say: answer exactly
Q10(a) "5-7-4" "4-7-5"
Q10(b) "2-5-9" "9-5-2"
If the child got both questions wrong >> Question 16
Correct response:
1 = Child repeated the
Answer: DO
answer exactly
NOT READ
Say "Ready", then 0 = Child did not repeat the
say: answer exactly
Q11(a) "7-2-9-6" "6-9-2-7"
Q11(b) "8-4-9-3" "3-9-4-8"
If the child got both questions wrong >> Question 16
Correct response:
Answer: DO 1 = Child repeated the
NOT READ answer exactly
Say "Ready", then 0 = Child did not repeat the
say: answer exactly
Q12(a) "4-1-3-5-7" "7-5-3-1-4"
Q12(b) "9-7-8-5-2" "2-5-8-7-9"
If the child got both questions wrong >> Question 16
Correct response:
1 = Child repeated the
Answer: DO
answer exactly
NOT READ
Say "Ready", then 0 = Child did not repeat the
say: answer exactly
Q13(a) "1-6-5-2-9-8" "8-9-2-5-6-1"
Q13(b) "3-6-7-1-9-4" "4-9-1-7-6-3"
If the child got both questions wrong >> Question 16
Correct response:
1 = Child repeated the
Answer: DO answer exactly
Say "Ready", then NOT READ 0 = Child did not repeat the
say: answer exactly
Q14(a) "8-5-9-2-3-4-2" "2-4-3-2-9-5-8"
Q14(b) "4-5-7-9-2-8-1" "1-8-2-9-7-5-4"
If the child got both questions wrong >> Question 16
Correct response:
Answer: DO 1 = Child repeated the
NOT READ answer exactly
Say "Ready", then 0 = Child did not repeat the
say: answer exactly
Q15(a) "6-9-1-6-3-2-5-8" "8-5-2-3-6-1-9-6"
Q15(b) "3-1-7-9-5-4-8-2" "2-8-4-5-9-7-1-3"
16: Exact Time Now ______________________
Page 125
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 1 / 7)
Complete for each child under ages 5 - 12 in the household.
Child Household ID:_____________________
Child name:____________________________________
Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
Record below the pictures which shape the child pointed to.
Example
Show the child the picture and then point to shape d
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 2 / 7)
Complete for each child under ages 5 - 12 in the household.
Child Household ID:_____________________
Child name:____________________________________
Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
EK1. Shape pointed to ______________________ EK2. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 3 / 7)
Complete for each child under ages 5 - 12 in the household.
Child Household ID:_____________________
Child name:____________________________________
Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
EK3. Shape pointed to ______________________ EK4. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 4 / 7)
Complete for each child under ages 5 - 12 in the household.
Child Household ID:_____________________
Child name:____________________________________
Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
EK5. Shape pointed to ______________________ EK6. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 5 / 7)
Complete for each child under ages 5 - 12 in the household.
Child Household ID:_____________________
Child name:____________________________________
Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
EK7. Shape pointed to ______________________ EK8. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 6 / 7)
Complete for each child under ages 5 - 12 in the household.
Child Household ID:_____________________
Child name:____________________________________
Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
EK9. Shape pointed to ______________________ EK10. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 7 / 7)
Complete for each child under ages 5 - 12 in the household.
Child Household ID:_____________________
Child name:____________________________________
Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
EK11. Shape pointed to ______________________ EK12. Shape pointed to ____________________________
