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Niger 2022 Phase 2 Household Questionnaire

001a. Your name:

001b. Enter staff name below:

Please record your name

002a. Is this date and time correct?


[] Yes
[] No

002b. Record the correct date and time.

The date must be between 2021-12-01 and 2022-12-31.

003a. Region

003b. Commune / Departement

003c. Locality / Commune

004. Enumeration area

004a. Phase 1 Household list

005. Structure number

Please record the structure number from the household listing form.

Please record the structure number from the household listing form.

Invalid response.

006. Household number

Please record the household number from the household listing form.

Invalid response.

007a. Are you at the same dwelling unit location from Phase 1?

[] Yes
[] No

007b. Do people live in this dwelling unit?

[] Yes
[] No

007c. Is at least one of the original P1 members still living in the dwelling unit?

[] Yes
[] No

007d. Why are people not living in this dwelling unit?


[] P1 dwelling unit vacant or address not a dwelling unit
[] P1 dwelling unit destroyed
[] P1 dwelling unit not found

007e. What is the status of the original P1 household?

Confirm with the neighbors to know the status

[] Household moved out of the study area
[] Household moved within the study area
[] Household split with some members in the study area and some out of the study area
[] No information

008. Which woman from Phase 1 are you following up?

If you do not see any women in this list, double-check your answers to 004a and 007a

[] FQ_ODK_display_name

010. CHECK: Why are you resending this form?

Choose all that apply.

[] There are new household members on this form
[] I am correcting a mistake made on a previous form
[] The previous form disappeared from my phone without being sent
[] I submitted the previous form and my supervisor told me that it was not received
[] Other reason(s)

011. Is a member of the household and competent respondent present and available to be interviewed today?

[] Yes
[] No


Find a competent member of the household. Read the greeting on the following screen.

My name is ........................ and I work for the National Institute of Statistics (INS) in collaboration with the Ministry of Public Health, Population and Social Affairs. We are currently conducting a national survey on several topics related to women's reproductive health. We very much appreciate your being part of this survey. The information we collect will help inform the government to better plan health services. The survey usually takes about 15-20 minutes to complete. Any information you share will be strictly confidential and will not be shared with anyone outside the research team.
Your household has been selected for this survey. Participation in this survey is voluntary, and if there is a question you do not wish to answer, please let me know and I will move on to the next question; or you may stop the interview at any time. However, we hope that you will agree to participate in this survey as your opinion is important.
Before I start, do you have any questions on this survey?

010a. Read the verbal consent text.

Then, ask:
May I begin the interview now?

[] Yes
[] No

010b. Respondent's signature

Please ask the respondent to sign or check the box in agreement of their participation.

011. Interviewer's name: {your_name}

Mark your name as a witness to the consent process.

[] NA

Household Roster Updating

ODK will display the summary of all household members listed in Phase 1. You will then update their information to indicate any changes including births and deaths

Section 1 - Household Roster

PL102. P1 Household Member

Below are the Phase 1 details for member {P_pos}:

First name: {hq_firstname_auto}
Relationship to HH head: {hq_relationship_lab}
Gender: {hq_gender_lab}
Age: {hq_age_auto}
Marital Status: {hq_marital_status_lab}

Is this person the respondent?

If yes, check this box.

[] Yes

PL103. What is the status of this member in the household?

Respondent cannot be deceased

[] Resident
[] Moved elsewhere in the study area
[] Moved out of the study area
[] Moved out of the study area to attend school
[] Deceased
[] Unknown

PL104. Household Member

First name: {hq_firstname_auto}
Relationship to HH head: {hq_relationship_lab}
Gender: {hq_gender_lab}
Age: {hq_age_auto}
Marital Status: {hq_marital_status_lab}

Do you wish to update any of this information?

[] Yes
[] No

Section 1 - Household Roster

I am now going to ask a series of questions about each usual member of the household or anyone who slept in the house last night.

101. Name of household member / visitor

Start with the head of the household.

101a. Is this person the respondent?

If yes, check this box.

[] NA

102. What is {firstname}'s relationship to the head of household?

[] Head
[] Wife/Husband
[] Son/Daughter
[] Son/Daughter-in-law
[] Grandchild
[] Parent
[] Parent in law
[] Brother/Sister
[] House help
[] Other
[] Do not know
[] No response

103. Is {firstname} male or female?

[] Male
[] Female

104. How old was {firstname} at their last birthday?

If less than one year old, record 0

Age must be less than 130 and greater than 0.

105. What is {firstname}'s current marital status?

If not married, probe to determine if they have ever been married and, if so, if they are divorced/separated, or widowed.

[] Married
[] Living with a partner
[] Divorced / separated
[] Widow / widower
[] Never married
[] No response

106. Does {firstname} usually live here?

[] Yes
[] No
[] No response

107. Did {firstname} stay here last night?

[] Yes
[] No
[] No response

LCL_101. What is the religion of {firstname}?

Only recorded for the head of the household.

[] Muslim
[] Chrétienne
[] Animiste
[] Sans religion
[] Autre
[] Pas de religion
[] Pas de réponse

LCL_102. What is the ethnicity of {firstname}?

Only recorded for the head of the household.

[] Arabe
[] Djerma/sonraï
[] Gourmanthé
[] Haoussa
[] Kanouri
[] Peulh
[] Touareg
[] Toubou
[] Autre
[] Pas de réponse

Are there any other usual members of your household or persons who slept in the house last night that I have not listed here?

[] Yes
[] No

109. READ THIS CHECK OUT LOUD: There are {num_HH_members} household members who are named {names}. Is this a complete list of the household members?

Remember to include all children in the household.

Go back and update the roster.

[] Yes
[] No

Section 2 - Household Characteristics

Now I would like to ask you a few questions about the characteristics of your household.

201. Is this structure/house newly built in the last 12 months?

[] Yes
[] No
[] No response

202. Please tell me about items that your household owns. Does your household have:

Read out all types and select all that apply. Scroll to bottom to see all choices.

If an item is reported broken but said to be out of use only temporarily, select the item. Otherwise, do not select the item.

Cannot select 'no response' or 'none of the above' with other options.

[] Electricity?
[] A radio?
[] A television?
[] A DVD/CD?
[] A mobile phone?
[] A landline telephone?
[] A refrigerator?
[] An air conditioner?
[] A stove
[] Satellite dish?
[] A computer?
[] Animal-drawn cart?
[] Charruees?
[] Motorized water pump
[] None of the above
[] No response

203. Does this household own any livestock, herds, other farm animals, or poultry?

These livestock can be kept anywhere, not necessarily on the homestead.

[] Yes
[] No
[] No response

203. How many of the following animals does this household own?

The household can keep the livestock anywhere, but must own the livestock recorded here.

Zero is a possible answer. Enter -88 for do not know. Enter -99 for no response.

Cows or bulls ___
Horses, donkeys or mules ___
Goats ___
Sheep ___
Camels ___
Chickens ___
Geese ___
Other ___

Section 3 - Household Observation

Please observe the floors, roof and exterior walls.

301. Main material of the floor


[] Earth / sand
[] Wooden boards
[] Palm / bamboo
[] Parquet or ciré wood
[] Tapes vinyl / asphalt
[] Tiles
[] Cement
[] Carpet
[] Other
[] No answer

302. Main material of the roof


[] No roof
[] Thatch / palm
[] Earth mottes
[] Mats
[] Palm / bamboo
[] Wooden boards
[] Cardboard
[] Animal hide
[] Sheet metal
[] Wood
[] Zinc / fiber cement
[] Tile
[] Cement
[] Other
[] No answer

303. Main material of the exterior walls


[] No wall
[] Bamboo / cane / palm / trunk
[] Earth
[] Straw
[] Stones with mud
[] Plywood
[] Cardboard
[] Recovered wood
[] Cement
[] Stones with lime / cement
[] Bricks
[] Cement blocks
[] Wood board / shingles
[] Sheet metal
[] Other
[] No answer

Section 4 - Water Sanitation and Hygiene

Now I would like to ask you a few questions about water, sanitation and hygiene.

401. We would like to learn about the places that households use to wash their hands. Can you please show me where members of your household most often wash their hands?

[] Fixed facility observed (sink/tap) in dwelling
[] Fixed facility observed (sink/tap) in yard/plot
[] Mobile object (bucket/jug/kettle) observed..
[] Not observed, facility in dwelling/yard/plot but no permission to see
[] Not observed, not in dwelling/yard/plot
[] Not observed, other reason
[] No Response

402. At the place where the household washes their hands, observe availability of water

[] Water is available
[] Water is not available
[] No Response

403. At the place where the household washes their hands, observe availability of soap or detergent:

[] Soap is available
[] Soap is not available
[] No Response

404. What is the main source of drinking water for members of your household?

[] Piped Water: Piped into dwelling/indoor
[] Piped Water: Pipe to yard/plot
[] Piped Water: Public tap/standpipe
[] Tube well or borehole
[] Dug Well: Protected Well
[] Dug Well: Unprotected Well
[] Water from Spring: Protected Spring
[] Water from Spring: Unprotected Spring
[] Rainwater
[] Tanker Truck
[] Cart with Small Tank
[] Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel)
[] Bottled Water
[] Sachet Water
[] No response

405. What is the main toilet facility used by members of your household?

[] Flush/pour flush toilets connected to: Piped sewer system
[] Flush/pour flush toilets connected to: Septic tank
[] Flush/pour flush toilets connected to: Pit Latrine
[] Flush/pour flush toilets connected to: Elsewhere
[] Flush/pour flush toilets connected to: Unknown / Not sure / Do not know
[] Ventilated improved pit latrine
[] Pit latrine with slab
[] Pit latrine without slab / open pit
[] Composting toilet
[] Bucket
[] Hanging toilet /Hanging latrine
[] Other
[] No facility / bush / field
[] No response

501. Thank you for the time you have kindly granted us.

Are you willing to provide a phone number for this household where we may reach you in the future to follow up for future research?

[] Yes
[] No
[] No response

502. What is the phone number?

Enter an 8-digit number without the country code. Do not include spaces or dashes.

Invalid number of digits.

503. Can you repeat the number again?

Enter an 8-digit number without the country code. Do not include spaces or dashes.

Number entered must match previously entered number.

504. What is the name of the person who normally answers this phone?

Thank the respondent for his/her time.

The respondent is finished, but there is still more for you to complete outside the home.

Location and Questionnaire result

096. Location

Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6 m.

097. How many times have you visited this household?

[] 1st time
[] 2nd time
[] 3rd time

098. In what language was this interview conducted?

[] Anglais
[] Français
[] Djerma/Sonraï
[] Haussa
[] Fulfulde
[] Kanouri
[] Gourmantchema
[] Tamacheq
[] Toubou
[] Arabe
[] Autre

099. Questionnaire Result

Record the result of the questionnaire.

Check answer to 009 and the consent.

[] Completed
[] No household member at home or no competent respondent at home at time of visit
[] Postponed
[] Refused
[] Partly completed
[] Dwelling vacant
[] Address not a dwelling
[] Dwelling destroyed
[] Dwelling not found
[] Entire household absent for extended period