Questionnaire Text

Burkina Faso 2014 Congo (Democratic Republic) 2016a Ghana 2014b Nigeria 2014b
Congo (Democratic Republic) 2013 Congo (Democratic Republic) 2016b Ghana 2015 Uganda 2014
Congo (Democratic Republic) 2014 Ethiopia 2014a Ghana 2016 Uganda 2015a
Congo (Democratic Republic) 2015a Ethiopia 2014b Kenya 2014a
Congo (Democratic Republic) 2015b Ghana 2013 Kenya 2014b
Congo (Democratic Republic) 2015c Ghana 2014a Nigeria 2014a
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Burkina Faso 2014
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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Congo (Democratic Republic) 2013
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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Congo (Democratic Republic) 2014
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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Congo (Democratic Republic) 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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Congo (Democratic Republic) 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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Congo (Democratic Republic) 2015c
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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Congo (Democratic Republic) 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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Congo (Democratic Republic) 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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Ethiopia 2014a
Questionnaire form view entire document:  text 

10. Does your household have:

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 phone?
[] Yes 1
[] No 0

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

A refrigerator?
[] Yes 1
[] No 0

A freezer?
[] Yes 1
[] No 0

Electric generator/invertor(s)?
[] Yes 1
[] No 0

A washing machine?
[] Yes 1
[] No 0

A computer?
[] Yes 1
[] No 0

A digital photo camera?
[] Yes 1
[] No 0

A non digital photo camera?
[] Yes 1
[] No 0

A video deck?
[] Yes 1
[] No 0

A DVD/CD?
[] Yes 1
[] No 0

A sewing machine?
[] Yes 1
[] No 0

A bed?
[] Yes 1
[] No 0

A table?
[] Yes 1
[] No 0

A cabinet/cupboard?
[] Yes 1
[] No 0

A bicycle?
[] Yes 1
[] No 0

A motorcycle or motor scooter?
[] 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 -77
[] No response -99
READ OUT ALL TYPES AND SELECT ALL THAT APPLY.

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Ethiopia 2014b
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 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 phone?
[] Yes 1
[] No 0

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

A refrigerator?
[] Yes 1
[] No 0

A freezer?
[] Yes 1
[] No 0

Electric generator/invertor(s)?
[] Yes 1
[] No 0

A washing machine?
[] Yes 1
[] No 0

A computer?
[] Yes 1
[] No 0

A digital photo camera?
[] Yes 1
[] No 0

A non digital photo camera?
[] Yes 1
[] No 0

A video deck?
[] Yes 1
[] No 0

A DVD/CD?
[] Yes 1
[] No 0

A sewing machine?
[] Yes 1
[] No 0

A bed?
[] Yes 1
[] No 0

A table?
[] Yes 1
[] No 0

A cabinet/cupboard?
[] Yes 1
[] No 0

A bicycle?
[] Yes 1
[] No 0

A motorcycle or motor scooter?
[] 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 -77
[] No response -99
READ OUT ALL TYPES AND SELECT ALL THAT APPLY.

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Ghana 2013
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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Ghana 2014a
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

top
Ghana 2014b
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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Ghana 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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Ghana 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.

[] ASSET 1
[] ASSET 2
[] ASSET 3
[] ASSET 4
[] ASSET 5
[] ASSET 6
[] ASSET 7
[] ASSET 8
[] ASSET 9
[] ASSET 10
[] ASSET 11
[] ASSET 12
[] ASSET 13
[] ASSET 14
[] ASSET 15
[] ASSET 16
[] None of the above -77
[] No response -99

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Kenya 2014a
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 2014b
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 2014a
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 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 phone?
[] Yes 1
[] No 0

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

A refrigerator?
[] Yes 1
[] No 0

A freezer?
[] Yes 1
[] No 0

Electric generator/invertor(s)?
[] Yes 1
[] No 0

A washing machine?
[] Yes 1
[] No 0

A computer?
[] Yes 1
[] No 0

A digital photo camera?
[] Yes 1
[] No 0

A non-digital photo camera?
[] Yes 1
[] No 0

A video deck?
[] Yes 1
[] No 0

A DVD/CD?
[] Yes 1
[] No 0

A sewing machine?
[] Yes 1
[] No 0

A bed? A table?
[] Yes 1
[] No 0

A cabinet/cupboard?
[] Yes 1
[] No 0

A bicycle?
[] Yes 1
[] No 0

A motorcycle or motor scooter?
[] 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

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Nigeria 2014b
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 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 phone?
[] Yes 1
[] No 0

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

A refrigerator?
[] Yes 1
[] No 0

A freezer?
[] Yes 1
[] No 0

Electric generator/invertor(s)?
[] Yes 1
[] No 0

A washing machine?
[] Yes 1
[] No 0

A computer?
[] Yes 1
[] No 0

A digital photo camera?
[] Yes 1
[] No 0

A non-digital photo camera?
[] Yes 1
[] No 0

A video deck?
[] Yes 1
[] No 0

A DVD/CD?
[] Yes 1
[] No 0

A sewing machine?
[] Yes 1
[] No 0

A bed? A table?
[] Yes 1
[] No 0

A cabinet/cupboard?
[] Yes 1
[] No 0

A bicycle?
[] Yes 1
[] No 0

A motorcycle or motor scooter?
[] 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

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Uganda 2014
Questionnaire form view entire document:  text 

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

[] Electricity?
[] A wall clock?
[] A radio?
[] A black/white television?
[] A color television?
[] A mobile phone?
[] A landline telephone?
[] A refrigerator?
[] A freezer?
[] An electric generator/invertor(s)?
[] A washing machine?
[] A computer?
[] A digital photo camera?
[] A non digital photo camera?
[] A video deck?
[] A DVD/CD?
[] A sewing machine?
[] A bed?
[] A table?
[] A cabinet/cupboard?
[] A bicycle?
[] A motorcycle or motor scooter?
[] A car or truck?
[] A boat with a motor?
[] A boat without a motor?
[] None of the above
[] No response -99

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.


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Uganda 2015a
Questionnaire form view entire document:  text 

10. Does your household have:
Read out all types and select all that apply.

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 phone?
[] Yes 1
[] No 0

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

A refrigerator?
[] Yes 1
[] No 0

A freezer?
[] Yes 1
[] No 0

Electric generator/invertor(s)?
[] Yes 1
[] No 0

A washing machine?
[] Yes 1
[] No 0

A computer?
[] Yes 1
[] No 0

A digital photo camera?
[] Yes 1
[] No 0

A non digital photo camera?
[] Yes 1
[] No 0

A video deck?
[] Yes 1
[] No 0

A DVD/CD?
[] Yes 1
[] No 0

A sewing machine?
[] Yes 1
[] No 0

A bed?
[] Yes 1
[] No 0

A table?
[] Yes 1
[] No 0

A cabinet/cupboard?
[] Yes 1
[] No 0

A bicycle?
[] Yes 1
[] No 0

A motorcycle or motor scooter?
[] 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