POPULATION CENSUS

HOUSEHOLD QUESTIONAIRE
Relation
Name Sex Date of birth Age For children age 0-17 EDUCATION
(to HHH)
Record the names of the 0: If not M:Male When was Record in Is mother in the Is father in the Has (name) What is the highest During the During the
HH members in the related F:Female (name) born? completed HH? HH? ever attended level of school current previous school
following order: 1: If related years. If yes record line  If yes record school or (name) has school year, year, which level
1. Head  If age is less number of line number of preschool? attended? did name and grade did
2. Spouse than one mother. father 1: yes 0: Preschool attend (name) attend?
3. Unmarried children record 00. If no record 00. If no record 00 2: no 1:Primary school?
4. Married children,  If age is 95 2:secondary 1:yes
their spouses and years and 3:higher 2:no
their children above record
5. Relatives of HHH 95
6. Non relatives
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
HOUSEHOLD CHARACTERISTICS
What is the religion of What is the How many Main material of Type of dwelling Main material of What type of fuel Does your house Does this HH How many of
the HHH? mother- rooms in HH the dwelling unit. the roof. does your HH have: own any the following
tongue/Nati are used for floor. Record Record mainly use for (a). Electricity livestock? animals does
ve language sleeping? Record observation observation cooking? (b). A radio this HH have?
of the observation (c). A television (a). Cattle
HHH? (d). A phone (b). Donkeys
(e). Satellite (c). Goats
(f). DVD/VCD (d). Sheep
(g). Solar Panel (e). Chickens
(f). Pigs
 RCZ:11  ChiShona:  Write number  Earth;sand:11  Traditional: 11  No roof: 11  Electricity: 01  Yes: 1  Yes: 1 If none record 00
 Protestant: 12 1 of rooms  Dung: 12  Mixed: 12  Thatch: 12  Gas: 02  No: 2  No: 2
 Pentecostal: 13  Ndebele: 2  wood planks: 21  Detached: 13  Rustic mat: 21  Biogas: 04
 Apostolic Sect: 14  English: 3  ceramic tiles:33  Semi-detached:  Planks: 23  kerosene: 05
 Islam: 16  Other lang:  cement: 34 14  Cardboard:24  Coal: 06
 Traditional: 17 6  carpet:35  Flat/town  Metal: 31  Charcoal: 07
 No religion: 97 house: 15  Tiles: 34  Wood: 08
 Shack 16  Cement: 35  Straw/grass: 09
 Asbestos: 37  Animal waste: 10
 QUESTIONNAIRE FOR MEN AGE 15 TO 54 IN THE HH (To be administered to members as individuals. Assure respondent of confidentiality).
Man’s Background Fertility Marriage/Union Sexual Behaviour
(a). Names (a). D.O.B (a). Have you ever fathered children with any (a). Are you currently married? (a). How old were you when you first had sexual intercourse?
(b). Age woman? (b). Do you live with other women as if (b). Did you use a condom?
(c). Education (b). How old were you when you 1st child was married? (c). When was the last time you had sexual intercourse?
(d). Literacy born? (c). How many are these women? (d). Did you use a condom?
(c). How many of your children are living (d). In what year did you start living with a (e). What is your relationship with the person you had your last
with you? woman as if married? intercourse?
(d). How many of the children you fathered (e). How old were you when you started (f). In total how many women did you have sexual intercourse with in
are not living with you? living with a woman as your wife? the last 12 months?
(e). How many of the children you fathered (g). In total with how many different people have you had sexual
died? intercourse in your life time?
(f). How many women have you fathered
children with?

QUESTIONNAIRE FOR WOMEN AGE 15 TO 49 IN THE HH (To be administered to members as individuals. Assure respondent of confidentiality).
Woman’s Background Fertility Birth History Maternal health Contraception Marriage/union Sexual behaviour
(a). Name (a). D.O.B (a). Have you ever given (a). What name was given (a). Did you see anyone (a). Are you pregnant (a). Are you currently (a). How old were you
(b). Age birth? to your (first/next) for antenatal care now? married? when you had sexual
(c). Education (b). How many of sons baby? during your (b). Are you using any (b). How old is your intercourse for the
(d). Literacy and daughters to (b). Was the baby a boy or pregnancy? method to delay or husband? very first time?
whom you have given girl? (b). Whom did you see? avoid getting (c). How many other (b). Was a condom used?
birth are living with (c). When was the (baby (c). How many weeks or pregnant? wives or partners (c). When was the last
you? name) born? months were you (c). What are you doing to does he have? time you had sexual
(c). How many of your (d). How old is (baby when you first delay or avoid a (d). Have you ever been intercourse?
sons and daughters to name) now? received antenatal pregnancy? married before? (d). Was a condom used?
whom you have given (e). How old was (baby care for this (d). When you got (e). How many times? (e). What was your
birth are not living name) when he/she pregnancy? pregnant, did you (f). How old were you relationship to this
with you? died? (d). How many times did want to get pregnant when you first started person?
(d). How many of your you visit each of at that time? living with your first (f). How old was this
sons and daughters them? (e). Would like to have partner/husband? person?
you have given birth (e). When you were another child? (g). Have you had sexual
have died? pregnant with (name), (f). How long would you intercourse with
did you get the tetanus like to want before the another person in the
injection? birth of another last 12 months?
(f). Who assisted with the child? (h). In total wth how many
delivery of (name)? different people have
(g). Was (name) delivered you had sexual
by the caesarean intercourse?
section?
(b). (e). (e). (f). (h). (g). (g). (i).
(c). (f). (f). (g). (i). (h). (h). (j).
(d). (g). (g). (h). (j). (i). (i). (k).
(e). (h). (h). (i). (k). (j). (j). (l).