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PMA2020 Nigeria Household Questionnaire - Round 3

IDENTIFICATION
Please record the following identifying information prior to beginning the interview.
A. Your name: Is this your name?
[ODK will display the name associated with the phone's serial number.]
Check the button next to the name if that is your name and select 'yes' here. Do not check the button if that is not your name and select 'no' here (long press to remove response next to the name if needed).
[] Yes 1
[] No 0
Enter your name below.
Please record your name
Interviewer's Name

B. Current date and time.
[ODK will display on screen]
Is this date and time correct?

[] Yes 1
[] No 0

C. Record the correct date and time

Date: Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM____

D1. State

[] Kaduna 1
[] Lagos 2
[] Taraba 3
[] Kano 4
[] Rivers 5
[] Nasarawa 6
[] Anambra 7

D2. LGA

ODK will generate a list of LGA within the selected State.

D5. Enumeration area

ODK will generate a list of enumeration areas within the selected LGA.

E. Structure number
Please record the structure number from the household listing form.

Number ____

F. Household number
Please record the household number from the household listing form.

Number____
Check: Have you already sent a form for this structure and household?
Do not duplicate any form unless you are correcting a mistake in an earlier form.
[] Yes 1
[] No 0
WARNING: Contact your supervisor before sending this form again.
CHECK: Why are you resending this form?
Choose all that apply.

[] There are new household members on this form 1
[] I am correcting a mistake made on a previous form 2
[] The previous form disappeared from my phone without being sent 3
[] I submitted the previous form and my supervisor told me that is was not received 4
[] Other reason(s) 5

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

[] Yes 1
[] No 0

G2 Did this household participate in a previous PMA2020 survey?

[] Yes 1
[] No 0
[] Do not know -88
[] No response -99

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

Hello. My name is ________________________________ and I am working for the Center for Research, Evaluation Resources, and Development in collaboration with Bayero University Kano. We are conducting a local survey about various health issues. We would very much appreciate your participation in this survey. This information will help us inform the government to better plan health services. Whatever information you provide will be kept strictly confidential and will not be shown to anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important. I am going to ask you questions about your family and other household members. We would then like to ask a different set of questions to female members of this household who are between the ages of 15 and 49. years.
At this time, do you want to ask me anything about the survey?
H. May I begin the interview now?

[] Yes 1
[] No 0

I. Interviewer's name
Please record your name as a witness to the consent process. You previously entered "[NAME FROM HQ B]."
J. Respondent's first name.
Please record the first name of the respondent.
SECTION 1 - Household Roster
I am now going to ask you a series of questions about each usual member of the household or anyone who slept in the house last night.
1. First name

NAME________

2. Sex

[] Male 1
[] Female 2

3. Age (years)

AGE____

4. Marital Status

[] Married 1
[] Living with a partner 2
[] Divorced / separated 3
[] Widow / widower 4
[] Single 5

5. Relationship to head of household

[] Head 1
[] Wife/Husband 2
[] Son/Daughter 3
[] Son/Daughter-in-law 4
[] Grandchild 5
[] Parent 6
[] Parent in law 7
[] Brother/Sister 8
[] Other 9
[] Don't know -88

6. Family ID

ID____

7. Is this person a usual member of the household or has he/she slept in the house last night?

[] Usual member of the household who slept here last night 1
[] Usual member of the household who did not sleep in the house last night 2
[] Visitor who slept in the house last night 3

8. Eligible female respondent

[] Yes 1
[] No 0
ODK will determine and display eligibility based on age and sex.
After recording information for one household member, the following prompt is asked to activate a looping script to record information for another member
9. Are there any other usual members of your household or persons who slept in the house last night?

[] Yes 1
[] No 0
READ THIS CHECK OUT LOUD: There are [NUMBER OF HOUSEHOLD MEMBERS ENTERED] household members who are named [NAMES OF ENTERED HOUSEHOLD MEMBERS]. Is this a complete list of the household members?
Remember to include all children in the household.
[] Yes 1
[] No 0

Section 2 - Household Characteristics
Now I would like to ask you a few questions about the characteristics of your household.
10. Please tell me about the items you're 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.
Electricity?
[] Yes 1
[] No 0

A wall clock?
[] Yes 1
[] No 0

A radio?
[] Yes 1
[] No 0

A black/white television?
[] Yes 1
[] No 0

A color television?
[] Yes 1
[] No 0

A mobile telephone?
[] Yes 1
[] No 0

A non-mobile telephone?
[] Yes 1
[] No 0

A refrigerator?
[] Yes 1
[] No 0

A cable TV?
[] Yes 1
[] No 0

A generating set?
[] Yes 1
[] No 0

Air conditioner?
[] Yes 1
[] No 0

A computer?
[] Yes 1
[] No 0

Electric iron?
[] Yes 1
[] No 0

A fan?
[] Yes 1
[] No 0

A watch?
[] Yes 1
[] No 0

A bicycle?
[] Yes 1
[] No 0

A motorcycle or motor scooter?
[] Yes 1
[] No 0

An animal-drawn cart?
[] Yes 1
[] No 0

A car or truck?
[] Yes 1
[] No 0

A boat without a motor?
[] Yes 1
[] No 0

A canoe?
[] Yes 1
[] No 0

[] None of the above -77
[] No response -99

11a. Does this household own any livestock, herds, other farm animals, or poultry?
These livestock can be kept anywhere, not necessarily on the homestead.
[] Yes 1
[] No 0
[] No response -99

11b. How many of the following animals does this household own?
Zero is a possible answer. Enter -88 for do not know. Enter -99 for no response.
The household can keep the livestock anywhere but must own the livestock recorded here.
Milk cows or bulls? ____
Horses, donkeys, or mules? ____
Goats? ____
Sheep? ____
Chickens/Ducks? ____
Pigs? ____

12a. Does this household keep any livestock, herds, other farm animals, or poultry ON THE HOMESTEAD, regardless of who owns these livestock?
Homestead includes the structure and yard that is close to the structure.
[] Yes 1
[] No 0
[] No response -99

12b. How many of the following animals does this household keep ON THE HOMESTEAD?
Zero is a possible answer. Enter -88 for do not know. Enter -99 for no response.
The household does not need to own the livestock recorded here.

Milk cows or bulls? ____
Horses, donkeys, or mules? ____
Goats? ____
Sheep? ____
Chickens/Ducks? ____
Pigs? ____

Section 3 - Household Observation
Please observe the floors, roof and exterior walls.
13. Main material of the floor
Observe.

NATURAL FLOOR
[] EARTH/SAND 11
[] DUNG 12

RUDIMENTARY FLOOR
[] WOOD PLANKS 21
[] PALM/BAMBOO 22

FINISHED FLOOR
[] PARQUET OR POLISHED WOOD 31
[] VINYL OR ASPHALT STRIPS 32
[] CERAMIC TILES 33
[] CEMENT 34
[] CARPET/RUG 35

[] OTHER 96
[] NO RESPONSE -99

14. Main material of the roof
Observe.
NATURAL ROOFING
[] NO ROOF 11
[] THATCH/PALM LEAF 12

RUDIMENTARY ROOFING
[] RUSTIC MAT 21
[] PALM/BAMBOO 22
[] WOOD PLANKS 23
[] CARDBOARD 24

FINISHED ROOFING
[] METAL/ZINC 31
[] WOOD 32
[] CERAMIC TILES 33
[] CEMENT 34
[] ROOFING SHINGLES 35

[] OTHER 96
[] NO RESPONSE -99

15. Main material of the exterior walls
Observe.
NATURAL WALLS
[] NO WALLS 11
[] CANE/PALM TRUNKS 12
[] DIRT (MUD) 13

RUDIMENTARY WALLS
[] BAMBOO WITH MUD 21
[] STONE WITH MUD 22
[] PLYWOOD 23
[] CARDBOARD 24
[] REUSED WOOD 25

FINISHED WALLS
[] CEMENT 31
[] STONE WITH LIME/CEMENT 32
[] BRICKS 33
[] CEMENT BLOCKS . 34
[] WOOD PLANKS/SHINGLES 35

[] OTHER 96
[] NO RESPONSE -99

Section 4 - Water, Sanitation and Hygiene
Now I would like to ask you a few questions about water, sanitation and hygiene.
16. Do you have a place to wash your hands, or do you have a movable container that is not kept in a fixed location, such as a bowl or kettle, that is commonly used for hand washing?
If the container is always in the same location, then count it as a fixed place
[] Yes, fixed place 1
[] Yes, movable container 2
[] No 0
[] Don't know -88
[] No response -99

17a. Can you show it to me?

[] Yes 1
[] No 0

17b. Can you show me any soap, water, and movable container available in the household used for hand washing?

[] Yes 1
[] No 0

18a. AT THE PLACE WHERE THE HOUSEHOLD WASHES THEIR HANDS, OBSERVE IF:

Soap is present
[] Yes 1
[] No 0

Water source is present: stored water
[] Yes 1
[] No 0

Water source is present: running water
[] Yes 1
[] No 0

Hand washing area is near a sanitation facility
[] Yes 1
[] No 0

[] None of the above -77

18b. ANYWHERE WITHIN THE HOUSEHOLD,

[] Soap is present
[] Water source is present: stored water
[] Water source is present: running water
[] Hand washing container Is observed
[] None of the above -77

19. Which of the following water sources does your household use on a regular basis for any part of the year for any purpose?
Read out all types and check all that are used. Scroll to the bottom to see all choices.
Piped Water
Piped into dwelling/indoor 11
[] Yes 1
[] No 0

Pipe to yard/plot 12
[] Yes 1
[] No 0

Public tap/standpipe 13
[] Yes 1
[] No 0

Tube well or borehole 21
[] Yes 1
[] No 0

Dug Well
Protected Well 31
[] Yes 1
[] No 0

Unprotected Well 32
[] Yes 1
[] No 0

Water from Spring
Protected Spring 41
[] Yes 1
[] No 0

Unprotected Spring 42
[] Yes 1
[] No 0

Rainwater 51
[] Yes 1
[] No 0

Tanker Truck 61
[] Yes 1
[] No 0

Cart with Small Tank 71
[] Yes 1
[] No 0

Surface water (River / Dam / Lake / Pond / Stream /Canal / Irrigation Channel) 81
[] Yes 1
[] No 0

Bottled Water 91
[] Yes 1
[] No 0

Sachet Water 92
[] Yes 1
[] No 0

[] No Response -99

20. What is the main source of drinking water for members of your household?
Selections from HQ19: [ODK will list water sources selected for HQ19]
Read out HQ19 selections only.
Piped Water
[] Piped into dwelling/indoor 1
[] Pipe to yard/plot 2
[] Public tap/standpipe 3

[] Tube well or borehole 4
Dug Well
[] Protected Well 5
[] Unprotected Well 6

Water from Spring
[] Protected Spring 7
[] Unprotected Spring 8

[] Rainwater 9
[] Tanker Truck 10
[] Cart with Small Tank 11
[] Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel) 12
[] Bottled Water 13
[] Sachet Water 14
[] No Response -99

21. What is the main source of water used by your household for other purposes such as cooking and hand washing? Selections from HQ19: [ODK will list water sources selected for HQ19]
Read out HQ19 selections only.

Piped Water
[] Piped into dwelling/indoor 1
[] Pipe to yard/plot 2
[] Public tap/standpipe 3

[] Tube well or borehole 4
Dug Well
[] Protected Well 5
[] Unprotected Well 6

Water from Spring
[] Protected Spring 7
[] Unprotected Spring 8

[] Rainwater 9
[] Tanker Truck 10
[] Cart with Small Tank 11
[] Surface water (River / Dam / Lake / Pond / Stream / Canal / Irrigation Channel) 12
[] Bottled Water 13
[] Sachet Water 14
[] No Response -99

Questions HQ 22 to HQ 25 will repeat x times, once for each water source selected in HQ19. These sources include:
[ODK will display HQ19 selections.]

22. You mentioned that you used [WATER SOURCE]. At any time of the year, does your household use water from this source for:

Drinking
[] Yes 1
[] No 0

Cooking
[] Yes 1
[] No 0

Livestock
[] Yes 1
[] No 0

Gardening / agriculture
[] Yes 1
[] No 0

Business venture
[] Yes 1
[] No 0

Washing
[] Yes 1
[] No 0

[] No response -99

23. Is [WATER SOURCE] typically available:
Read all choices out loud.
[] All of the year 1
[] Some of the year 2
[] Small part of the year 3
[] No response -99

24. At a time of year when you expect to have water from [WATER SOURCE], is it usually available?

[] Yes, always 1
[] No, intermittent and predictable 2
[] No, intermittent and unpredictable 3
[] No response -99

25. How long does it take to go to [WATER SOURCE], get water, and come back?
Zero is a possible answer
Enter -88 for do not know
Enter -99 for no response
Convert time into minutes.
Answer includes waiting time in line.
Minutes____

26. Does your household have a garden?
A garden is a place to grow vegetables.
[] Yes 1
[] No 0
[] No response -99

27. Do members of your household use any of the following toilet facilities?
Read out all types and check all that are used. Scroll to the bottom to see all choices.
Flush/pour flush toilets connected to:
Piped sewer system
[] Yes 1
[] No 0

Septic tank
[] Yes 1
[] No 0

Pit Latrine
[] Yes 1
[] No 0

Elsewhere
[] Yes 1
[] No 0

Unknown / Not sure
[] Yes 1
[] No 0

Ventilated improved pit latrine
[] Yes 1
[] No 0

Pit latrine with slab
[] Yes 1
[] No 0

Pit latrine without slab/open pit
[] Yes 1
[] No 0

Bucket toilet
[] Yes 1
[] No 0

Composting toilet
[] Yes 1
[] No 0

Hanging toilet /Hanging latrine
[] Yes 1
[] No 0

No facility / bush / field
[] Yes 1
[] No 0

Other:
[] Yes 1
[] No 0

[] No Response -99

28. What is the main toilet facility used by members of your household?
HQ27: [ODK will display HQ2 selections]
The main facility must be selected in HQ 27. N1N4
Flush/pour flush toilets connected to:
[] Piped sewer system 1
[] Septic tank 2
[] Pit Latrine 13
[] Elsewhere 3
[] Unknown / Not sure / Don't know 4

[] Ventilated improved pit latrine 5
[] Pit latrine with slab 6
[] Pit latrine without slab/open pit 7
[] Composting toilet 8
[] Bucket toilet 9
[] Hanging toilet /Hanging latrine 10
[] Other: 11
[] No facility / bush / field 12
[] No Response -99

Question HQ 29 will repeat x times, once for each sanitation facility selected in HQ27. These facilities include:
HQ27: [ODK will display HQ2 selections]

29. How often does your household typically use: [TOILET FACILITY TYPE]?
Regular practices at the household only.
[] Always 1
[] Most of the time 2
[] Occasionally 3
[] Rarely 4
[] No response -99

29b. Do you share this toilet facility with other households or the public?

[] Not shared 1
[] Shared with less than ten households 2
[] Shared with ten or more households 3
[] Shared with the public. 4
[] No response -99

29c. Enter the number of households that share this facility (including your own).
[TOILET FACILITY TYPE]
Must be between 2 and 9.
If 10 or greater, swipe back to HQ29b and choose "shared with ten or more households."
Enter -99 for no response.
Number of Households____

30. How many people within your household regularly use the bush / field at home or at work?
There are x people in this household. Enter -88 for do not know, -99 for no response.

Number of People____

31. Ask permission to take a photo of the entrance of the house.
Did you get consent to take the photo?

[] Yes 1
[] No 0
Thank the respondent for her/his time.
The respondent is finished, but there is still more for you to complete outside the home.
LOCATION AND QUESTIONNAIRE RESULT
K. Location
Take a GPS point near the entrance to the household. Record location when the accuracy is smaller than 6m.

RECORD LOCATION
CHECK 32: Permission to take photo?
L. Ensure that no people are in the photo

TAKE PICTURE
CHOOSE IMAGE

M. How many times have you visited this household?

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

N. Questionnaire result
Record the result of the Household Questionnaire
[] Completed 1
[] No household member at home or no competent respondent at home at time of visit 2
[] Postponed 3
[] Refused 4
[] Partly completed 5
[] Dwelling vacant or address not a dwelling 6
[] Dwelling destroyed 7
[] Dwelling not found 8
[] Entire household absent for extended period of time 9