Questionnaire Text

Burkina Faso 2015 Ethiopia 2016 Kenya 2015b Niger 2017
Burkina Faso 2016a Ethiopia 2017 Kenya 2016 Nigeria 2017
Burkina Faso 2016b Indonesia 2015 Niger 2015 Uganda 2015b
Cote d'Ivoire 2017 Indonesia 2016 Niger 2016a Uganda 2016
Ethiopia 2015 Kenya 2015a Niger 2016b Uganda 2017
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Burkina Faso 2015
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Burkina Faso 2016a
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Burkina Faso 2016b
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Cote d'Ivoire 2017

No questionnaire text is available for this sample.


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Ethiopia 2015
Questionnaire form view entire document:  text 

10. Please tell me about the items 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 watch clock?
[] Yes 1
[] No 0

A radio?
[] Yes 1
[] No 0

A television?
[] Yes 1
[] No 0

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

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

A refrigerator?
[] Yes 1
[] No 0

A table?
[] Yes 1
[] No 0

A chair?
[] Yes 1
[] No 0

A bed with cotton sponge spring mattress?
[] Yes 1
[] No 0

An electric mitad?
[] Yes 1
[] No 0

A kerosene lamp pressure lamp?
[] 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

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


READ OUT ALL TYPES AND SELECT ALL THAT APPLY.


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Ethiopia 2016
Questionnaire form view entire document:  text 

10. Please tell me about the items 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.
READ OUT ALL TYPES AND SELECT ALL THAT APPLY.

[] Electricity?
[] A watch/clock?
[] A radio?
[] A television?
[] A mobile phone?
[] A non-mobile telephone?
[] A refrigerator?
[] A table
[] A chair

[] A bed with cotton/sponge/spring mattress
[] An electric mitad
[] A kerosene lamp/pressure lamp
[] A bicycle?
[] A motorcycle or motor scooter?
[] An animal-drawn cart?
[] A car or truck?
[] None of the above -77
[] No response -99

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Ethiopia 2017
Questionnaire form view entire document:  text 

201. Please tell me about the items 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
[] A WATCH/CLOCK
[] A RADIO
[] A TELEVISION
[] A MOBILE PHONE
[] A NON-MOBILE TELEPHONE
[] A REFRIGERATOR
[] A TABLE
[] A CHAIR
[] A BED WITH COTTON/SPONGE/SPRING MATTRESS
[] AN ELECTRIC MITAD
[] A KEROSENE LAMP/PRESSURE LAMP
[] A BICYCLE
[] A MOTORCYCLE/ SCOOTER
[] AN ANIMAL-DRAWN CART
[] A CAR/TRUCK
[] None of the above -77
[] No response-99

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Indonesia 2015
Questionnaire form view entire document:  text 

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 radio?
[] Yes 1
[] No 0

Television?
[] Yes 1
[] No 0

Telephone?
[] Yes 1
[] No 0

Hand phone?
[] Yes 1
[] No 0

Refrigerator?
[] Yes 1
[] No 0

A Bicycle?
[] Yes 1
[] No 0

A motorcycle?
[] Yes 1
[] No 0

A rowboat?
[] Yes 1
[] No 0

A motorboat?
[] Yes 1
[] No 0

An animal-drawn cart (Sado, Cidomo, Dokar, Andong, Bendi)?
[] Yes 1
[] No 0

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

A ship?
[] Yes 1
[] No 0

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

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Indonesia 2016
Questionnaire form view entire document:  text 

201. Please tell me about the 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.

[] Electricity?
[] A radio?
[] Television?
[] Telephone?
[] Hand phone?
[] Refrigerator?
[] A Bicycle?
[] A motorcycle?
[] A rowboat?
[] A motorboat?
[] An animal-drawn cart (Sado, Cidomo, Dokar, Andong, Bendi)?
[] A car or truck?
[] A ship?
[] None of the above
[] No response

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Kenya 2015a
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Kenya 2015b
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Kenya 2016
Questionnaire form view entire document:  text 

Section 2 - Household Characteristics
Now I would like to ask you a few questions about the characteristics of your household.
201. Please tell me about the items 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
[] RADIO
[] TELEVISION
[] MOBILE PHONE
[] NON-MOBILE TELEPHONE
[] REFRIGERATOR
[] SOLAR PANEL
[] TABLE
[] CHAIR
[] SOFA
[] BED
[] CUPBOARD
[] CLOCK
[] MICROWAVE OVEN
[] DVD PLAYER
[] CASSETTE/CD PLAYER
[] AIR CONDITIONER
[] WATCH
[] BICYCLE
[] MOTORCYCLE/SCOOTER
[] ANIMAL-DRAWN CART
[] CAR/TRUCK
[] BOAT WITH MOTOR
[] None of the above -77
[] No response -99

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Niger 2015
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Niger 2016a
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Niger 2016b
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Niger 2017
Questionnaire form view entire document:  text 

10. Please tell me about the items you're your household owns. Does your household have:
[ODK populates a list of country-specific household assets, e.g. bed, television, electricity. The asset list may vary between countries, but is constant within each country for each round of data collection.]
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.
[ASSET 1]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 2]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

[ASSET 3]

[] Yes 1
[] No 0
[] Don't know -88
[] No response -99

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Nigeria 2017
Questionnaire form view entire document:  text 

201. Please tell me about the items 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?
[] A radio?
[] A television?
[] A mobile telephone?
[] A non-mobile telephone?
[] A refrigerator?
[] A cable TV?
[] A generating set?
[] An air conditioner?
[] A computer?
[] An electric iron?
[] A fan?
[] A watch?
[] A bicycle?
[] A motorcycle or motor scooter?
[] An animal-drawn cart?
[] A car or truck?
[] A canoe?
[] A boat with a motor?
[] None of the above -77
[] No response -99

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Uganda 2015b
Questionnaire form view entire document:  text 

Please tell me about the items 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 radio?
[] Yes 1
[] No 0

A cassette player?
[] Yes 1
[] No 0

A television?
[] Yes 1
[] No 0

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

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

A refrigerator?
[] Yes 1
[] No 0

A table?
[] Yes 1
[] No 0

A chair?
[] Yes 1
[] No 0

A sofaset?
[] Yes 1
[] No 0

A bed?
[] Yes 1
[] No 0

A cupboard?
[] Yes 1
[] No 0

A clock?
[] 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 with a motor?
[] Yes 1
[] No 0

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

[] None of the above -88
[] No response -99
READ OUT ALL TYPES AND SELECT ALL THAT APPLY


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Uganda 2016
Questionnaire form view entire document:  text 

10. Please tell me about the items 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?
[] A radio?
[] A cassette player
[] A television?
[] A mobile phone?
[] A fixed telephone?
[] A refrigerator?
[] A table?
[] A chair?
[] A sofa set?
[] A bed?
[] A cupboard?
[] A clock?
[] A watch?
[] A bicycle?
[] A motorcycle or motor scooter
[] An animal-drawn cart?
[] A car or truck?
[] A boat with a motor?
[] A boat without a motor?
[] None of the above -88
[] No response -99
READ OUT ALL TYPES AND SELECT ALL THAT APPLY.

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Uganda 2017
Questionnaire form view entire document:  text 

201. Please tell me about the items 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
[] RADIO
[] A CASSETTE PLAYER
[] TELEVISION
[] MOBILE PHONE
[] A FIXED TELEPHONE
[] REFRIGERATOR
[] TABLE
[] CHAIR
[] SOFA SET
[] BED
[] CUPBOARD
[] CLOCK
[] WATCH
[] BICYCLE
[] MOTORCYCLE/SCOOTER
[] ANIMAL-DRAWN CART
[] CAR/TRUCK
[] BOAT WITH MOTOR
[] BOAT WITHOUT A MOTOR
[] None of the above -77
[] No response -99