Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
1/16
1. To be completed by Enumerator before the interview
2. To be completed by Supervisor and Coordinator
0.12 - Questionnaire Number:
|__|__| |__|__|__|
Team + Questionnaire
code numbering
0.13 – Date of supervisor checking
|__|__| / |__|__| / 2010
Day Month
0.14 – Supervisor name ______________________
Supervisor Code |__|__|
Remarks:
Signature of Supervisor:
_______________________________________
0.15 - Date of coordinator checking
|__|__| / |__|__| / 2010
Day Month
Coordinator name ____________________
0.16 - Coordinator Code |__|__|
Remarks:
Signature of Coordinator:
3. To be completed by data entry clerk
0.17 – First data entry
Date: |__|__| / |__|__| / 2010
Day Month
Name of data entry clerk ____________________
Remarks:
Signature of first data entry clerk(to be put after
the questionnaire is entered):
____________________________
0.18 – Second data entry
Date: |__|__| / |__|__| / 2010
Day Month
Name of data entry clerk ____________________
Remarks:
Signature of second data entry clerk(to be put after the questionnaire is entered):
____________________________
0.1 -
Enumerator name: __________________________________
Enumerator ID |__|__|
0.2 -
Date: |__|__| / |__|__| / 2010
Day Month
0.3 - Province name:
________________________
Province code:
|__|
0.4 - District name:
________________________
District code:
|__|__|
0.5 - Chiefdom name:
________________________
Chiefdom code:
|__|__|__|__|
0.6- Section name:
________________________
Section code:
|__|__|__|__|__|__|
0.7- Enumeration Area (EA) name:
_______________________
Enumeration Area (EA) code:
|__|__|__|__|__|__|__|__|
0.8-
Village/Town name:
_______________________
Village/Town code: |__|__|
0.9- Area: 1 = Rural 2 = Urban
0.10– Livelihood zone name:
_______________________
Livelihood zone code: |__|__|
0.11– Household head name:
___________________________
Household code |__|__|
Replacement of Household:
1 = Fulfilled 2 = Stopped 3 = Replacement of HH
Reason for replacement of Household: _______________________________
Please read the following consent form:
“My name is…. The Government of Sierra Leone and the World Food Programme are
collecting information here in ….(name of the place, village, area) on household food
security. Only few households are chosen randomly for the survey. I would like to
ask you some questions regarding your household. Please answer all the questions
truthfully. There is no judgment on your answers to the questions that will be asked.
The researchers will keep your responses confidential. There is no direct benefit to
you or your community in participating to this study. However, we hope that the
research will benefit Sierra Leone by helping us understand what people need in order to help the country move forward. Your participation is voluntary. You may
refuse to answer any question and you may choose to stop the discussion at any
time. Refusing to participate will not affect you or your family in any way. Do you
have any questions for us? You may ask questions about this study at any time. May
I begin the interview now?”
1. Yes 2. No
If no, why? ____________________
0.17 - Native language of
interviewee:
1. Arabic
2. Bullom 3. English
4. Fula
5. Kissi
6. Kono
7. Krim
8. Krio
9. Kuranko
10. Limba
11. Loko 12. Madingo
13. Mende
14. Sherbro
15. Susu
16. Temne
17. Vai
18. Yalunka
19. Other. Specify.
_________
0.18 - Language of the
interview:
1. Arabic
2. Bullom 3. English
4. Fula
5. Kissi
6. Kono
7. Krim
8. Krio
9. Kuranko
10. Limba
11. Loko 12. Madingo
13. Mende
14. Sherbro
15. Susu
16. Temne
17. Vai
18. Yalunka
19. Other. Specify.
_________
0.19 - Did an
interpreter
participate?
1 = Yes
2 = No
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
2/16
A household is defined as a person or a group of persons related or unrelated, living together or not, making common cooking arrangements and under the authority of the same household head For questions 1.3; 1.7; 1.8; 1.12; 1.13; 1.16; 1.19 and 1.21 use codes below
MEMBERS OF THE
HOUSEHOLD (HH)
RELATIO
N WITH THE
HOUSEH
OLD
HEAD
SEX AGE RELIGI
ON
ETHNIC GROUP/
NATIONA
LITY
MARITAL
STATUS
POLYGA
MY
ACTIVE
MEMBER
S
CHRONIC ILLNESS
ALL
HOUSEHOLD
MEMBERS
EDUCATION
ONLY
HH
MEMBE
RS
ABOVE 15
YEAR
OLD
ONLY CHILDREN FROM 6 TO 15 YEAR-OLD EDUCATION
All
children 6-15
All
children 6-15
who
ever
went
to school
If 1.14
and/or
1.15 is
NO
If 1.15
is yes
If
1.15
is
yes
If 1.18
is yes
If 1.14
is yes
or 1.15 is
no
If 1.20
is yes
ID List the persons
living in this
household, starting by the
household head
(including children
who are in school,
visitors present in
the HH since at least 6 months or
planning to stay
for at least 6 months)
Do not record full name, but only an
identifying first
name to refer to
the HH member
What is
(name)’s
relation to the
household
head?
Please
remember that the
household
head can
be a woman
1
Male
2 Femal
e
What was
(name)’s
age at his/her last
birthday?
If they do
not know
their exact birth date
ask for an
ID card, a voter ID
card or
use the event
calendar
If child less
than 1 year,
write 00.
What is
the
religion of the
househol
d head?
1 Muslim
2
Christian 3 Other
What is the
ethnic group
(for Sierra Leoneans)
or the
nationality (for non-
Sierra
Leoneans)
of the household
head?
What is the
marital
status of the head of
the
household?
How many
spouses
does the household
head
have?
To fill only if the
household
head is a
man, married or
cohabitatin
g
Is this HH
member
currently earning
an income
(in cash or in-
kind) for
the
household?
1 Yes 2 No
To fill for
all
household’s
members
Has any
member
been unable to function
fully/sick or
handicapped for at
least 3
months
over the past 12
months?
1 Chronic Illness
2 Mental
disability 3 Physical
disability
4 Not
disabled/chronically sick 1.13
If
(name)
has been unable
to
function fully,
sick or
disable
has s/he been
able to
work during
the past
12 months?
What is
the
highest level of
educatio
n attained
?
Has
(name)
ever been to
school?
1. Yes
2. No
If yes
1.17
Has
(name)
gone to school
during
the 2009-
2010
school
year?
1. Yes 2. No
If yes
1.17
What is
the main
reason for not
enrolling
(name) to
school?
If No at 1.15
Go to
1.20
Or
If No at 1.14
Go to
next person
Has
(name)
received a school
meal
during the
2009-
2010
school year in
the
school he/she
was
attending?
1. Yes
2. No
3. Only part of
the
school year
Did
(nam
e) miss
schoo
l for at
least
1
week in the
last
month of
schoo
l? 1.
Yes
2. No
If no
Go to
next perso
n
What
was
the main reason
for
missing
school?
If Yes at 1.15
Go to next
person
Has
(name)
abandoned
school
before completi
ng
primary
school/grade 6?
1. Yes
2. No
If no
Go to
next
person
What
was the
main reason
for
abandoning
school
before
completing
primary
school/grade 6?
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21
01. |___| |___| |___|___| |___|
|__|__|
_________ |___| |___| |___| |___| |__| |___| |___| |___| |__|__|
______ |__| |__| |__|__|
______ |__| |__|__|
______
02. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__|
______ |__| |__| |__|__| ______ |__|
|__|__| ______
03. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__|
______ |__| |__| |__|__|
______ |__| |__|__|
______
04. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__|
______ |__| |__| |__|__|
______ |__| |__|__|
______
05. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__| ______ |__| |__|
|__|__|
______ |__| |__|__|
______
06. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__| ______ |__| |__|
|__|__|
______ |__| |__|__|
______
SECTION 1 – SOCIO-DEMOGRAPHIC, CULTURAL AND EDUCATION CHARACTERISTICS OF THE HOUSEHOLD
1.3 - Relation with Household head
1 = Household (HH) head 2 = Spouse/partner
3 = Son/daughter 4 = Mother/father
5 = Brother/sister 6 = Other relatives by blood 7 = Other relatives by marriage 8 = Other non-relatives
1.7 – Ethnic group/Nationality
01 = Bullom 02 = Fula
03 = Kissi 04 = Kono
05 = Krim 06 = Krio 07 = Kuranko 08 = Limba
09 = Loko 10 = Madingo
11 = Mende 12 = Sherbro
13 = Susu 14 = Temne 15 = Vai 16 = Yalunka
17 = Non Sierra Leonans 18 = Other (specify below the box)
1.8 – Marital Status 1 = Single 2 = Married
3 = Cohabitating (living with partner, not married)
4 = Divorced or separated 5 = Widow or widower
1.12 – Chronic illness
1 = Yes, the same number of hours /days
2 = No, working for fewer hours/days
3 = She/He is completely unable to work 4 = Never worked
1.13 – Highest level of education attained by HH members
1 = No School 2 = Some Primary 3 = Completed Primary
4 = Some secondary 5 = Completed Secondary
6 = Vocational /Technical Institute 7 = Koranic 8 = College/University
1.16, 1.19 and 1.21 – Main reason for not enrolling to school, abandoning school before completing primary
school/grade 6 or missing school at least one week in the last month of school
01 = No functioning school in this village/ 02 = No money for school fee / costs
area they can attend/school too far 03 = Have to work in the family (gardening, fetching water, 04 = Have to work for an income taking care of siblings)
05 = Parents not interested in school 06 = Children not interested in school 07 = Sickness
08 = Initiation ceremonies 09 = Pregnancy 10 = Marriage 11 = School is located in insecure area
12 = No school feeding in the nearest school 13 = Other (specify below the box)
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
3/16
MEMBERS OF THE HOUSEHOLD (HH)
RELATIO
N WITH
THE HOUSEH
OLD
HEAD
SEX AGE RELIGI
ON
ETHNIC
GROUP/ NATIONA
LITY
MARITAL STATUS
POLYGAMY
ACTIVE
MEMBER
S
CHRONIC ILLNESS
ALL
HOUSEHOLD
MEMBERS
EDUCATION
ONLY HH
MEMBE
RS
ABOVE 15
YEAR
OLD
ONLY CHILDREN FROM 6 TO 15 YEAR-OLD EDUCATION
All
childre
n 6-15
All
childre
n 6-15 who
ever
went
to school
If 1.14 and/or
1.15 is
NO
If 1.15
is yes
If 1.15
is
yes
If 1.18
is yes
If 1.14
is yes
or
1.15 is no
If 1.20
is yes
ID List the persons
living in this
household, starting by the
household head
(including children who are in school,
visitors present in
the HH since at least 6 months or
planning to stay
for at least 6 months)
Do not record full
name, but only an identifying first
name to refer to
the HH member
What is
(name)’s
relation to the
household
head?
Please
remember
that the household
head can
be a woman
1
Male
2 Femal
e
What was
(name)’s
age at his/her last
birthday?
If they do
not know
their exact birth date
ask for an
ID card, a voter ID
card or
use the
event calendar
If child less than 1 year,
write 00.
What is
the
religion of the
househol
d head?
1 Muslim
2
Christian 3 Other
What is the
ethnic group
(for Sierra Leoneans)
or the
nationality
(for non-Sierra
Leoneans)
of the household
head?
What is the
marital
status of the head of
the
household?
How many
spouses
does the household
head
have?
To fill only
if the household
head is a
man, married or
cohabitatin
g
Is this HH
member
currently earning
an income
(in cash
or in-kind) for
the
household?
1 Yes 2 No
To fill for
all
household’s
members
Has any
member
been unable to function
fully/sick or
handicappe
d for at least 3
months
over the past 12
months?
1 Chronic Illness
2 Mental
disability
3 Physical disability
4 Not
disabled/chronically sick 1.13
If
(name)
has been unable
to
function
fully, sick or
disable
has s/he been
able to
work during
the past
12
months?
What is
the
highest level of
educatio
n
attained?
Has
(name)
ever been to
school?
1. Yes
2. No
If yes
1.17
Has
(name)
gone to school
during
the
2009-2010
school
year?
1. Yes 2. No
If yes
1.17
What is
the main
reason for not
enrolling
(name)
to school?
If No at 1.15
Go to
1.20
Or
If No at 1.14
Go to
next
person
Has
(name)
received a school
meal
during
the 2009-
2010
school year in
the
school he/she
was
attendin
g? 1. Yes
2. No
3. Only part of
the
school
year
Did
(nam
e) miss
schoo
l for
at least
1
week in the
last
month of
schoo
l?
1. Yes
2. No
If no
Go to
next
person
What
was
the main reason
for
miss
ing school?
If Yes at 1.15
Go to next
person
Has
(name)
abandoned
school
before
completing
primary
school/grade 6?
1. Yes
2. No
If no
Go to
next
person
What
was the
main reason
for
abandon
ing school
before
completing
primary
school/grade 6?
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21
07. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__|
______ |__| |__| |__|__|
______ |__| |__|__|
______
08. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__| ______ |__| |__|
|__|__| ______ |__|
|__|__| ______
09. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__|
______ |__| |__| |__|__|
______ |__| |__|__|
______
10. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__|
______ |__| |__| |__|__|
______ |__| |__|__|
______
11. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__| ______ |__| |__|
|__|__| ______ |__|
|__|__| ______
12. |___| |___| |___|___| |___| |___| |__| |___| |___| |___|
|__|__|
______ |__| |__| |__|__|
______ |__| |__|__|
______
1.3 - Relation with Household head 1 = Household (HH) head 2 = Spouse/partner
3 = Son/daughter 4 = Mother/father
5 = Brother/sister 6 = Other relatives by blood
7 = Other relatives by marriage
8 = Other non-relatives
1.7 – Ethnic group/Nationality
01 = Bullom 02 = Fula
03 = Kissi 04 = Kono
05 = Krim 06 = Krio
07 = Kuranko 08 = Limba
09 = Loko 10 = Madingo
11 = Mende 12 = Sherbro
13 = Susu 14 = Temne 15 = Vai 16 = Yalunka
17 = Non Sierra Leonans
18 = Other (specify below the box)
1.8 – Marital Status
1 = Single 2 = Married
3 = Cohabitating (living with partner, not married)
4 = Divorced or separated 5 = Widow or widower
1.12 – Chronic illness
1 = Yes, the same number of hours /days
2 = No, working for fewer hours/days
3 = She/He is completely unable to work
4 = Never worked
1.13 – Highest level of education attained by HH members
1 = No School 2 = Some Primary 3 = Completed Primary
4 = Some secondary 5 = Completed Secondary
6 = Vocational /Technical Institute
7 = Koranic 8 = College/University
1.16, 1.19 and 1.21 – Main reason for not enrolling to school, abandoning school before completing
primary school/grade 6 or missing school at least one week in the last month of school 01 = No functioning school in this village/ 02 = No money for school fee / costs
area they can attend/school too far 03 = Have to work in the family (gardening, fetching water,
04 = Have to work for an income taking care of siblings)
05 = Parents not interested in school 06 = Children not interested in school 07 = Sickness
08 = Initiation ceremonies 09 = Pregnancy 10 = Marriage 11 = School is located in insecure area
12 = No school feeding in the nearest school 13 = Other (specify below the box)
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
4/16
2.1 Did any household member leave the community for at least 2 consecutive months in the past 12 months? Circle one
1 Yes
2 No go to question 2.3
2.2
If yes to question 2.1, please complete table on the right for each migrated member
ID Number to report from question 1.1
Main reason for leaving (use codes below)
|__|__| |__| ________________________________________
|__|__| |__| ________________________________________
|__|__| |__| ________________________________________
Codes for reason to leave: 1 = To do agricultural work 2 = To do non-agricultural work 3 = Divorce/Separation 4 = Education / studies 5 = To relieve strain on household 6 = Conflict 7 = Health treatment 8 = Family reunion/marriage 9 = Other (specify above)
2.3 Was the head of the household born in this village/town? Circle one
1 Yes go to Section 3
2 No
2.4 For how long has the head of the household lived in this village/town?
Years |___|___| Months |___|___|
2.5
Where did the household head move from?
Circle one
1 From another town outside the chiefdom
2 From the same chiefdom
3 From another chiefdom in the same district
4 From another district
5 From abroad/foreign country
2.6 Was the head of the Household living in a rural or urban area previously? Circle one
1 Rural
2 Urban
2.7 What was the main reason for moving? Circle one
1 Better access to agricultural land
2 Better access to roads
3 Better access to health centres and/or schools
4 Less exposure to natural hazards/disasters
5 Marriage
6 Better access to river or water sources
7 Better job opportunities
8 Better access to electricity
9 To join the family
10 Better access to market
11 To earn more money
12 Less exposure to insecurity go to question 2.8
13 Other. Specify: _____________________________
2.8
If the main reason for moving (in 2.7) is “Less exposure to insecurity”, what were the types of insecurity that the head of the household or other
members of the household were facing? Circle all that apply
1 Discrimination
2 Physical harm, danger, killing, wounding
3 Other form of violence
4 Theft or destruction of assets
5 Dispossession of land or land rights
6 Restrictions on movement, prevention of access to field, markets, jobs, social services
7 Other. Specify: _____________________________
2.9 Were you relocated or did you migrate? Circle one 1 Migrated go to Section 3
2 Relocated
2.10 If you relocated, did you receive any support in your relocation process? Circle one
1 Yes
2 No go to Section 3
2.11
What kind of support did you receive and who provided it? Circle all that apply
Type of support Support provider
1 Building material 1 Government
2 Money 2 International organizations
3 Land titles 3 Local NGOs
4 Agricultural inputs 4 Religious based organization
5 Skills training 5 Relatives/friends
6 Credit
6 Other (specify): ______________________
7 Household items (cooking pots, etc)
8 Food aid
9 Other (specify): ________________
SECTION 2 – MIGRATION AND RELOCATION
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
5/16
SECTION 3 – HOUSING AND FACILITIES
3.1
Do you or your household own or rent this house/dwelling?
Circle one
1 Own the house
2 Don’t own but live for free
3 Pay Rent
3.2
How many rooms, bed rooms + living room (kitchen and store are not included) does your household occupy?
|__|__| Rooms
3.3
What is the major material of the roof of your house? Observe and record. Ask the question if you have doubts
Circle one
1 Thatch (grass/straw)
2 Corrugated iron/zinc
3 Cement/concrete
4 Other, specify ____________________
3.4
What is the major material of the outside walls? Observe and record. Ask the question if you have doubts.
Circle one
1 Mud/mud bricks
2 Wood
3 Thatch (grass/straw) /bamboo
4 Corrugated iron/zinc
5 Stone/burnt bricks
6 Cement/concrete
7 Other, specify ____________________
3.5
What is the major material of the floor? Observe and record. Ask the question if you have doubts.
Circle one
1 Earth/mud
2 Wood
3 Stone/ bricks
4 Cement/concrete
5 Other. Specify: ____________________
3.6
What is the main source of lighting for this house?
Circle one
1 Pan lamp
2 Kerosene lantern
3 Candle
4 Electricity/NPA/BKPS
5 Generator
6 Firewood
7 Oil lamp
8 Torch light
9 Other. Specify: ____________________
3.7 What is your main source of energy for cooking?
Do not read answers. Circle one
1 Wood
2 Charcoal
3 Gas
4 Kerosene
5 Electricity/NPA
6 Other. Specify: ____________________
3.8
How long does it take to go and get (the source of energy for cooking) and come back? Write ZERO (000) if source is in the premise/dwelling or if vendor come to the house, and go to question 3.10.
|__|__|__| Minutes
3.9
How often does your household have to go and get the source of energy? Report the number of time and circle the frequency that apply
Number of time Frequency
|__| 1 Daily 3 Monthly
2 Weekly 4 Yearly
3.10 Have any members of your family experienced incidents or
problems while getting (the source of energy)? Circle one.
1 Yes
2 No
3.11
What type of toilet facilities does your household use?
Do not read answers. Circle one.
1 Flush latrine/toilet with water
2 Improved (VIP) pit latrine
3 Traditional pit latrine (no water)
4 (Partly) open pit (no roof or no wall)
5 Communal Latrine
6 None, bush, pond, river, stream
7 Bucket
8 Other. Specify :________________
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
6/16
SECTION 4 – PRODUCTIVE AND HOUSEHOLD ASSETS, INCOME FROM MIGRATION AND ACCESS TO CREDIT
4.1
Does your household own any of the following assets? Circle all that apply, but only the ones which are in working conditions (which could be used today)
Productive/transport assets
1 Shovel/spade 12 Hand tractor/power tiller
2 Sickle 13 Rice mill (fuel)
3 Hoe 14 Rice mill (Electricity)
4 Axe 15 Weaving tool
5 Plough 16 Fish net
6 Cutlass/ Machete 17 Boat/canoe
7 Pounding mill (wood), foot or hand
18 Sewing machine
8 Thresher 19 Bicycle
9 Cassava Grater/Gari processor 20 Push cart
10 Grainer 21 Motorcycle
11 Groundnut hauler 22 Car/truck
Household assets
23 Chair 33 Radio/radio-cassette
24 Table 34 Standing fan
25 Sleeping mats 35 TV
26 Bed 36 Refrigerator
27 Lantern 37 Generator (run by fuel)
28 Torchlight 38 Mobile phone
29 Umbrella 39 DVD player
30 Mosquito net 40 Air-conditioning
31 Watch/clock 41 Computer/laptop
32 Stove (gas/fuel)
4.2 Has your household received any money or support in kind from relatives living outside your household in the past 12 months?
1 Yes
2 No go to question 4.6
3.12
What is the main source of drinking water for your household?
Do not read answers. Circle one.
1 Piped water (into dwelling, yard or plot)
2 Public tap
3 Tubewell/Borehole with pump
4 Protected dug well
5 Protected spring
6 Rain water
7 Unprotected well
8 River, stream or pond
9 Other, specify _________________
3.13
Usually, how long does it take to go to the main source of water, get water and come back?
Write ZERO (000) if water is on premise. |__|__|__| Minutes
3.14 Have any members of your family experienced incidents or problems while going to get water? Circle one.
1 Yes
2 No
3.15 Are there intermittent cuts in the water source? Circle one. 1 Yes
2 No go to question 3.17
3.16
If yes, how long was the last cut? |__|__|__| days
3.17
If there are entire months in which the main water source is not available, please indicate which months.
Circle each month where water is not available
1 January 7 July
2 February 8 August
3 March 9 September
4 April 10 October
5 May 11 November
6 June 12 December
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
7/16
4.3 How often did your household receive such support in the past year? Circle one.
1 12 times a year or more (at least every month)
2 Between 6 and 11 times a year (min. every 2 months)
3 Between 3 to 5 times a year
4 Less than 3 times a year (occasionally)
4.4
Do you expect to continue to receive such support in the coming year? Circle one.
1 Yes
2 No
3 Do not know
4.5 How much money (in cash or kind) did your household receive in the past 12 months?
|__|__|__|__|__|__|__|__|__| Leones
4.6
Did the household borrow money in the last 12 months? Circle one.
1 Yes
2 No go to Section 5
4.7 What is the total amount of money the household has borrowed in the past 12 months?
|__|__|__|__|__|__|__|__|__| Leones
4.8
Who did you borrow money from?
Circle all the options which apply
1 Relatives / friends
2 Charities / NGOs
3 Local lender
4 Bank
5 Co-operatives / Osusu
6 Village head
7 Company/middle men
8 Farmer organization
9 Other. Specify: ___________________
4.9
How much of the loan do you expect to be able to repay during the next 12 months? Circle one.
1 No repayment possible
2 Less than ½ possible
3 More than ½ possible
4 Full repayment possible
5 Already repaid
4.10
What was the main use of the largest loan taken in the last 12 months?
Circle only the main one
1. To buy agricultural inputs 2. Food purchases
3. Labour 4. Funerals
5. Business investment 6. Wedding
7. Land purchase 8. Medical expenses
9. House purchase or construction, Home improvement
10. Education
11. Traditional ceremonies (initiation, festivals, societies, etc)
12. Other. Specify: _______________________
4.11
In the last 3 months, how often did you use credit or borrow money to purchase food?
Circle one
1 Never
2 On one occasion
3 On two occasions
4 On three occasions
5 On more than three occasions
Section 5 – AGRICULTURE AND LIVESTOCK
5.1
Does your household have access to agricultural land? Circle one
1 Yes
2 No go to question 5.28
5.2
How much area have your household cultivated during the last agricultural season (February 2009 to February 2010)?
|__|__|__|.|__| Acres
5.3
If the household was living here before the civil war and was already cultivating land, which proportion of your land is currently cultivated compared to before the civil war? Circle one
1 More than before (> 100%)
2 Whole/most of the land (> 90%)
3 More than half of the land (50% - 90%)
4 Less than half of the land (10% - 50%)
5 A very little part of the land (<10%)
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
8/16
5.4
What are the terms of the land tenure of the head of the household? Circle all the options which apply
1. Permission from Chief (communal)
2. Long-term lease (more than one cropping season)
3. Short term rental (one cropping season or less)
4. Inheritance
5. Family/clan owned 6. Outright ownership/purchase
7. Other. Specify: __________________________________
5.5 Does any woman in your HH own her own plot of land?
Circle one
1 Yes
2 No go to question 5.7
5.6 If the husband has several wives, does each of the wives have her own plot of land?
Circle one
1 Yes
2 No
5.7 Do youth (18 to 35 year-old) in your household do separate farming?
Circle one
1 Yes
2 No go to question 5.9
5.8
If youth do separate farming in your household, how do they access land? Circle all that apply
1. Permission from Chief (communal)
2. Long-term lease (more than one cropping season)
3. Short term rental (one cropping season or less)
4. Inheritance
5. Family/clan owned 6. Outright ownership/purchase
7. Other. Specify: ____________________________________
5.9 How many members of your HH participated in farm work during the last agricultural season (February 2009 to February 2010)?
Male |__|__| (above 18 year-old)
Female |__|__| (above 18 year-old)
Children |__|__| (under 18 year-old)
5.10 During the last agricultural season (February 2009 to February 2010), did you pay people (cash or in-kind) to help you with agricultural activities? Circle one
1 Yes
2 No
5.11 At any time during the last agricultural season (February 2009 to February 2010), did you have difficulty finding enough people to hire for your agricultural activities?
Circle one
1 Yes
2 No
3 Not applicable
5.12 During the last agricultural season (February 2009 to February 2010), did you keep any of your land uncultivated?
Circle one
1 Yes
2 No go to question 5.16
5.13
If you kept any of your land uncultivated, what were the 3 main reasons in order of importance? Put maximum 3 |__| |__| |__| First Second Third
1 To replenish soil fertility/fallow 5 Lack or not enough inputs (seeds, fertilizer, pesticides, etc)
2 Lack or not enough labour in the community
6 Lack of marketing opportunity for agricultural products
3 Access to more land than required for annual farming
7
87
Other. Specify:
_________________________ 4
Lack or not enough tools and equipment
5.14 What were the 3 main reasons which prevented you from obtaining a higher production during the last agricultural season (February 2009 to February 2010)? List maximum 3 in order of importance. Do not mention response options
1. |__||__| 2. |__||__| 3.|__||__|
___________ __________ _________
Codes for reasons:
01 = Lack of seeds 02 = Lack of tools 03 = Lack of fertilizer/pesticide 04 = Lack of household labour 05 = Lack of training/technical advice
06 = Low soil fertility
07 = Pests and diseases
08 = Heavy rains
09 = No marketing opportunities
10 = Lack of cash/money
11 = Lack of land
12 = Late/insufficient rain
13 = Household is engaged in other activity
14 = Theft of crops
15 = Lack of access to credit
16 = Ill health/ sickness
17 = Don’t need/want to
18 = Lack of storage facilities 19 = Other (specify below the box)
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
9/16
5.15
Which of the functioning services
and/or installations listed exist in your area and you have used during the last agricultural season (February
2009 to February 2010)?
Circle all that apply
5.15 a. Does this (service/installation) exist in your village/town?
If no go to next service/installation
5.15 b. If yes in 5.15.b,
have you used this (service/installation) during the last agricultural season (February 2009 to February
2010)?
Drying floor 1= yes 2 = No 1 = Yes 2 = No
Store (Cereals/ grains) 1= yes 2 = No 1 = Yes 2 = No
Rice mill 1= yes 2 = No 1 = Yes 2 = No
Cassava grater 1= yes 2 = No 1 = Yes 2 = No
Thresher 1= yes 2 = No 1 = Yes 2 = No
Power tiller/hand tractor 1= yes 2 = No 1 = Yes 2 = No
5.16 Do you use irrigation for your cultivated land in the dry season? 1= yes 2 = No
5.17 During the last agricultural season (February 2009 to February 2010) how was the timing of rain compared to a normal year? Circle one
1 Early
2 Late
3 Normal
5.18 During the last agricultural season (February 2009 to February 2010) how was the amount of the rains compared to a normal year? Circle one
1 Too much
2 Too little
3 Normal
5.19
What inputs did you use during the last agricultural season (February 2009 to February 2010)? What was the main source? Was it free (gift), paid, on loan or coming from the household own production? Circle all the types of inputs that apply- Enter the main source code
5.19 a. Type of inputs 5.19 b. Main source 5.19 c. Was it free, paid, on loan or produced by the household? Circle one per row
1 Chemical Fertilizers |__| 1=Free 2=Paid 3=Loan 4=Own production
2 Natural/organic fertilizers/compost |__| 1=Free 2=Paid 3=Loan 4=Own production
3 Pesticides/herbicides |__| 1=Free 2=Paid 3=Loan 4=Own production
4 Improved seed varieties |__| 1=Free 2=Paid 3=Loan 4=Own production
5 None
Codes for main source: 1. Government 2. NGO 3. Market/shops/traders
4. Relatives/friends/family members 5. Local creditors coming to the farm 6. Agrobusiness Centers (ABC)/Farmer Based Organization (FBO)/Cooperatives 7. Other
5.20 What do you use to work your
land?
Circle all that apply
1 Hand tools
2 Animal traction
3 Hand tractor/Power tiller
4 Big tractor
5.21
Where did you store your harvest of the last agricultural season (February 2009 to February 2010)?
Circle all that apply
1 Indoors – In basket / bags
2 Indoors – Open storage
3 In outside storage hut in boxes
4 Communal storage
5 Lockable house/Mini-store
6 Stack storage
7 Seed bank
8 Other (specify) ________________________
5.22 Do you or any member of your household belong to an agricultural
related organization? Circle one
1 Yes
2 No go to question 5.24
5.23
Which type of organization?
Circle all that apply
1 Farmer Based Organization (FBO)
2 Cooperatives societies
3 Farmer field school
4 Traders associations
5 Others. Specify: _________________________
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
10/16
5.24 What were the various crops/products cultivated by your household during the last agricultural season (February 2009 to February 2010)? Circle all that apply
Crop codes 01. Up- land Rice 02. Low-land/swamp Rice 03. Maize/Corn 04. Sorghum 05. Millet/ Fundi 06. Beans 07. Cotton 08. Plantain 09. Sugar cane 10. Okra 11. Groundnuts 12. Coffee
13. Cassava 14. Leafy vegetables (cassava leaves,
potato leaves, crain crain) 15. Kola nuts 16. Banana 17. Pineapple 18. Fignut 19. Other fruits (ex : citrus, mango,
etc) 20. Sweet potatoes 21. Vegetables (e.g. Tomato, cabbage,
onions) 22. Water yam
23. Chinese yam 24. Tobacco 25. Oil Palm 26. Cocoyam 27. Cocoa 28. Irish potatoes 29. Cashew nuts 30. Ginger 31. Other 1. Specify: ___________________ 32. Other 2. Specify: ___________________
5.25 Commodity
5.26 a. During the past 12 months, did your household cultivate (commodity)? 1 = Yes 2 = No if No go
to next line
5.26 b. During the last 12 months, how many months did your household largely depend on market purchases to consume (commodity)?
5.26 c. During the last 12 months for how many months did your household largely depend on your own production to consume (commodity)?
5.26 d. During the last 12 months for how many months did your household largely depend on gifts to consume (commodity)?
5.26 e. During the last 12 months for how many months did your household not consume (commodity)?
5.26 f. In the last 12 months, did your household sell some or all of your harvest of (commodity)? 1 = Yes 2 = No If No
got to next line
5.26 g. If yes, were these sales part of your usual income-generating activities to meet HH needs? 1 =Yes 2 = No if yes
5.28 2 = No
5.26 h. If no, what were the main reasons for unusual sales? List max. 2 reasons in order of importance 01 = Ran out of money/stocks to buy other food and/or other basic commodities 02 = Had to re-pay debts 03 = Contribute to ceremonies/festivals 04= Migration of family member/travel 05 = Cover medical expenses 06 = Pay for school -fees 07 = Good harvest (selling unexpected surplus) 08 = Other (specify below the box)
Please note: 1b+1c+1d+1e = 12 months
1 Rice |__| |__||__| months
|__||__| months
|__||__| months
|__||__| months |__| |__|
1. |__||__| 2.|__||__| ______ ______
2 Cassava |__| |__||__| months
|__||__| months
|__||__| months
|__||__| months |__| |__|
1. |__||__| 2.|__||__| ______ ______
5.27 If you have cultivated rice during the last agricultural season (February 2009 to February 2010), what was the main source of seeds?
Circle one
1 Purchase
2 Own stock
3 Government
4 NGOs/INGOs/CBOs
5 Borrow/exchange
6 Shared from neighbors/relatives (free)
7 Other. Specify: _____________________
5.28 Did you have a vegetable/backyard garden during the last agricultural season (February 2009 to February 2010)? Circle one
1 Yes
2 No
5.29 Did you grow vegetables in the uplands during the last agricultural season (February 2009 to February 2010)? Circle one
1 Yes
2 No
5.30 Does your household own any farm-animals? 1 Yes 2 No 5.32
5.31
If you own farm-animals, how many of each of the following animals do you own? (Circle all the owned animals AND report the number. If a specific animal is not owned, write ZERO)
1 Sheep/Goats |__||__||__|
2 Pigs |__||__||__|
3 Cattle |__||__||__|
4 Chickens/Ducks/Gooses/Turkey/Guinea fowl |__||__||__|
5 Rabbits |__||__||__|
6 Other. Specify. __________________________ |__||__||__|
5.32 Does the household practice fishing/fish farming? 1 Yes 2 No Section 6
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
11/16
5.33 What type of fishing/ fish farming does your household practice? Circle all that apply
1 = Ocean 2 = River 3 = Creek/stream 4 = Natural freshwater pond/lake
5 = Artificial fishpond 6 = Swamps 7 = Lagoon (salt water) 8 = Other. Specify: ____________
SECTION 6 – LIVELIHOODS
A – What are the 3 main activities (report maximum 3) that sustained your household during the past YEAR (12 months), using the activity codes below. Do not prompt.
B – Estimate the cash value (in Leones) of the yearly output from each activity
C - Using proportional piling method, estimate contribution to total income of each activity. (total100%)
D – Report who participates in each activity, using the participants codes below.
Activities
A. What are your household’s main activities throughout the last 12 months? Rank maximum 3 income activities Use livelihood activity codes
B. Estimated cash value of yearly output from this activity. Include estimates of outputs directly consumed by the household
C. Using proportional piling method, estimate the relative contribution to total income of each activity (%)
D. Who is involved in terms of gender? 1. Male(s) 2. Female(s) 3. Both
E. Who is involved in terms of age? 1. Children (below 18) 2. Adults (over 18) 3. Both
6.1
Main |__|__|___________ |__|__|__|__|__|__|__|__|__| Le |__|__|__| % |__| |__|
6.2 Second |__|__|___________ |__|__|__|__|__|__|__|__|__| Le |__|__| % |__| |__|
6.3
Third |__|__|___________ |__|__|__|__|__|__|__|__|__| Le |__|__| % |__| |__|
TOTAL 100 %
6.A. Income activity codes 1 = Production and sale of food crops
2 = Production and sale of cash crops
3 = Livestock rearing and/or selling
4 = Salt extraction
5 = Fishing
6 = Mining of minerals (gold, diamond, iron, bauxite)
7 = Unskilled wage labour – agriculture
8 = Unskilled wage labour – non-agriculture
9 = Skilled wage labour (including taxi, poda poda, okada driver/bike riding)
10 = Handicrafts /Artisan (tailoring, weaving, carving, pottery, painter, etc)
11 = Palm oil extraction
12 = Wood cutting/coal burning
13 = Petty trading
14 = Trading, Seller, Commercial activity
15 = Remittances/ Migrating labour
16 = Salaries, Wages (employees, longer-term)
17 = Mining of sand and stone
18 = Aid (Government, local NGO, international NGO)
19 = Gift (family, friends)
20 = Hunting and selling bush meat (i.e. cutting grass)
21 = Gathering and selling of wild food (bushyams, plums, blactombla, etc)
22 = Extraction of palm wine (poyo)
23 = Palm wine selling
24 = Production and sale of vegetables and/or fruits
25 = Begging
26 = Cart puller/push cart
27 = Others (specify next to the box)
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
12/16
SECTION 7 – EXPENDITURES
In the last 30 days, how much money have you spent on each of the following items or service for the household?
Estimated Expenditure during the last month, both cash and
credit (Le)
7.1 - Rice |__||__||__||__||__||__||__||__||__|Le
7.2 - Cassava (including cassava products, gari, foofoo, tho) |__||__||__||__||__||__||__||__||__|Le
7.3 - Bread |__||__||__||__||__||__||__||__||__|Le
7.4 - Sweet potatoes/tubers (yams) |__||__||__||__||__||__||__||__||__|Le
7.5 - Bulgur |__||__||__||__||__||__||__||__||__|Le
7.6 - Corn and CSB |__||__||__||__||__||__||__||__||__|Le
7.7 - Pumpkin, plantain, banana |__||__||__||__||__||__||__||__||__|Le
7.8 - Beans, peas, lentils |__||__||__||__||__||__||__||__||__|Le
7.9 - Fresh vegetables (including green leaves) and fresh fruits |__||__||__||__||__||__||__||__||__|Le
7.10 - Nuts, groundnuts, benniseeds |__||__||__||__||__||__||__||__||__|Le
7.11 - Eggs |__||__||__||__||__||__||__||__||__|Le
7.12 - Milk/diary products |__||__||__||__||__||__||__||__||__|Le
7.13 - Fish |__||__||__||__||__||__||__||__||__|Le
7.14 - Meat (beef, pork, mutton, chicken/poultry, goat) |__||__||__||__||__||__||__||__||__|Le
7.15 - Palm oil/ Oil / Butter |__||__||__||__||__||__||__||__||__|Le
7.16 - Sugar / Salt / Maggi / Manpo |__||__||__||__||__||__||__||__||__|Le
7.17 - Tea/coffee |__||__||__||__||__||__||__||__||__|Le
7.18 - Other food expenditures |__||__||__||__||__||__||__||__||__|Le
7.19 - Beverages (soda, mineral water) |__||__||__||__||__||__||__||__||__|Le
7.20 - Alcohol (including palm wine, poyo) and tobacco |__||__||__||__||__||__||__||__||__|Le
7.21 - Soap /soap powder / detergents |__||__||__||__||__||__||__||__||__|Le
7.22 Transport (fuel, taxi, okada, bus) |__||__||__||__||__||__||__||__||__|Le
7.23 Firewood/char-coal |__||__||__||__||__||__||__||__||__|Le
7.24 Kerosene |__||__||__||__||__||__||__||__||__|Le
7.25 Phone credit/ phone charge |__||__||__||__||__||__||__||__||__|Le
7.26 Internet browsing |__||__||__||__||__||__||__||__||__|Le
7.27 Religious/charity donations |__||__||__||__||__||__||__||__||__|Le
7.28 Recreation (cinema, gambling, etc) |__||__||__||__||__||__||__||__||__|Le
7.29 Hair cut/hairdressing/barber |__||__||__||__||__||__||__||__||__|Le
Since Christmas (last 6 months), how much money have you spent to acquire each of the following items or service?
Estimated Expenditure during the last month, both cash and
credit (Le)
7.30 Agricultural/farming equipment, tools, seeds |__||__||__||__||__||__||__||__||__|Le
7.31 Veterinary expenses for farm animals |__||__||__||__||__||__||__||__||__|Le
7.32 Fishing tools |__||__||__||__||__||__||__||__||__|Le
7.33 Cash for hiring labour (group and individual) |__||__||__||__||__||__||__||__||__|Le
7.34 Food for hiring labour (group and individual) |__||__||__||__||__||__||__||__||__|Le
7.35 Medical expenses, health care |__||__||__||__||__||__||__||__||__|Le
7.36 Education: fees, uniform, material |__||__||__||__||__||__||__||__||__|Le
7.37 Other clothing, shoes |__||__||__||__||__||__||__||__||__|Le
7.35 Celebrations, social events, funerals, weddings, ceremonies |__||__||__||__||__||__||__||__||__|Le
7.36 Utilities (electricity, gas, water, fuel) |__||__||__||__||__||__||__||__||__|Le
7.37 Payment of interest rates |__||__||__||__||__||__||__||__||__|Le
7.38 Housing (repairs, construction, maintenance) |__||__||__||__||__||__||__||__||__|Le
7.39 Housing rent |__||__||__||__||__||__||__||__||__|Le
7.40 Other long term expenditures:_____________________ |__||__||__||__||__||__||__||__||__|Le
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
13/16
SECTION 8 – FOOD SOURCES AND CONSUMPTION
Food Item
8.1
Number of days
eaten during the last 7 days
(From 0 to 7)
8.2
Main Food Source over the
last 7 days
Use food source codes
QU. 8.2: Food Source codes
01 = Own production (crops, animals)
02 = hunting, fishing
03 = gathering
04 = borrowed
05 = purchase
06 = exchange labor for food
07 = exchange items for food
08 = gift (food) from family/ relatives
09 = food aid (NGOs etc.)
10 = begging
11 = bought on credit
12 = other
0 = Not
consumed
1 = One day
2 = Two days
3 = Three days
4 = Four days
5 = Five days
6 = Six days
7 = Seven days
1. Rice |__| |__|__|
2. Cassava products (foufou, gari, tho)
|__| |__|__|
3. Tubers products (potato, yam)
|__| |__|__|
4. Maize/corn |__| |__|__|
5. Bulgur |__| |__|__|
6. Millet/fundi |__| |__|__|
7. Other cereals |__| |__|__|
8. CSB (Corn Soya Beans) mix
|__| |__|__|
9. Bread |__| |__|__|
10. Fish |__| |__|__|
11. Fish as condiments |__| |__|__|
12. Meat (Chicken, etc) |__| |__|__|
13. Meat as condiments |__| |__|__|
14. Eggs |__| |__|__|
15. Milk/dairy products |__| |__|__|
16. Beans/ peas/lentils |__| |__|__|
17. Vegetables |__| |__|__|
18. Green leaves (cassava, potato, crincrin, okra…)
|__| |__|__|
19. Fresh fruits |__| |__|__|
20. Nuts (groundnuts, benniseeds)
|__| |__|__|
21. Oil / Palm oil/ Butter |__| |__|__|
22. Sugar |__| |__|__|
23. Condiments (Salt, Maggi, pepper, etc)
|__| |__|__|
24. Nuts as condiments |__| |__|__|
25. Tea/coffee/cocoa |__| |__|__|
26. Bushyams and other wild fruits and wild vegetables
|__| |__|__|
8.3 How many meals did the household eat yesterday?
Adults |__|
Children (from 1 to 5 years old)
|__|
8.4 During the past 12 months, during which months your household had difficulties getting enough food to eat? Circle all that apply
June 2009
July 2009
August 2009
Sept. 2009
Oct. 2009
Nov. 2009 Dec. 2009
Jan. 2010
Feb. 2010
March 2010
April 2010
May 2010
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
14/16
Section 9 SHOCKS AND COPING STRATEGIES
Has your household experienced any shocks/difficulties in the last 12 months?
1 yes 2 no 9.4
If yes, please rank the shocks and report the three most serious.
9.1 Rank 3 main shocks by order of importance
9.2 Did (shock) decrease your household’s ability to produce or purchase food? 1 = Yes 2 = No 3 = Don’t know
9.3 What did the household do to compensate for this loss of income and/or assets? Report the three most important coping strategies. Choose from the strategy codes below
1= main 2 = second 3= third
1st |__|__|
_______________
2nd |__|__|
_______________
3rd |__|__|
_______________
a Drought/irregular rains |__| |__|
b Floods |__| |__|
c Crops damaged by insects, disease, animals |__| |__|
d Lack of HH labour |__| |__|
e Lack of agric. inputs (seeds, fertilizer, etc) |__| |__|
f HH member temporarily ill or injured |__| |__|
g HH member chronically ill |__| |__|
h Unusually high level of human disease |__| |__|
i Lack or loss of employment |__| |__|
j High costs of agric. inputs (seed, fertilizer, etc.) |__| |__|
k Political problems |__| |__|
l Price fluctuations |__| |__|
m Insecurity |__| |__|
n Death of a working household member |__| |__|
o Death of other household member |__| |__|
p Theft of Money/valuables |__| |__|
q Theft of crops or livestock |__| |__|
r Severely high level of livestock diseases |__| |__|
s Prison/detainment |__| |__|
t Fire |__| |__|
u Other, specify_____________________ |__| |__|
Coping strategies codes:
01 Rely on less preferred, less expensive food 02 Borrowed food, helped by relatives 03 Purchased food on credit 04 Consumed seed stock held for next season 05 Reduced the proportions of the meals 06 Reduced number of meals per day 07 Skipped days without eating 08 Some HH members migrated 09 Sold durable household goods 10 Sent children to live with relatives 11 Reduced expenditures on health & education
12 Spent savings 13 Gathering (wild food product) 14 Sold or consumed livestock 15 Sold agricultural tools, seeds or other inputs 16 Worked for food only 17 Sold crop before harvest 18 Rented out land 19 Sold land 20 Borrowed money 21 Other (specify below the box)
9.4 In the past 7 days, how many days your household had to:
Frequency (0-7)
0= 0 day 1= 1 day 2= 2 days 3= 3 days
4 = 4 days 5 = 5 days 6 = 6 days 7 = 7 days
a - Rely on less preferred and less expensive foods? |__|
b - Borrow food, or rely on help from a friend or relative? |__|
c - Limit portion size at mealtimes? |__|
d - Restrict consumption by adults in order for small children to eat? |__|
e - Reduce number of meals eaten in a day? |__|
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
15/16
SECTION 10 – CHILD HEALTH AND NUTRITION
ASK TO THE SELECTED RESPONDENT ONLY IF THERE ARE CHILDREN 0 - 59 MONTHS (under 5 years) IN THE HOUSEHOLD, otherwise terminate the interview Enter the children’s first names and ask the following question for one child at a time
10.1 10.2
10.3
10.4
10.5 10.6 10.7 10.8 10.
9
10.
10
10.11 10.
12
10.13 10.
14 10.15 10.16
Identification Relation
Pregnancy
Mother MUAC
Date of birth of the child
Age of the child
Size of child
Sex Sickness Antenatal care
Hygiene practice
First name
Use codes from
qu. 1.1 on
section 1
Mother’s/Car
e taker’s ID
no.
Use code from qu.
1.1
88=missing/
absent at
the
interview
What is
your
relation
to
(child)?
Are
you
1 the
mother
2 the
care
taker
3 someb
ody
else
Are
you
pregna
nt?
1 yes
2 no
Mother Mid
upper Arm
Circumferenc
e
(in
millimeters)
888 =
mother or care taker
absent
999 = MUAC
exceeded
34.2
If available Date of Birth
from the Medical Card or
other certificate where
date of birth is reported
(Use format
dd/mm/yy)
Child’s age
in months
If no certificate,
report age
of child in
months
using the
event calendar
for
children
When
the child
was
born
was he/she?
1 Very
large
2
Normal 3 Very
small
4 Do
not
know
Wha
t is
the
sex
of the
child
?
1=Male
2=F
emal
e
Has
the
child
been
sick in the
last 2
week
s?
1=
yes
2=
no
10.14
What was
the child’s
main
sickness?
1= Fever
2=
Repeated
coughs/
breathing
difficulties 3=
Diarrhea
(3 or
more
stool per
day for 3 days or
one large
watery
stool or
blood in
stool) 4=
Measles
5=Other
Was
the
child
take
n to a
heal
th
servi
ce?
1
yes
2
no 10.
13
If child
was not
taken,
why?
1= Illness not
serious
2= Far
away/lack
transport
3= Lack money
4= Does
not like/
distrust
doctor/he
alth profession
al/nurse
5= Other
source of
treatment
was used 6= Other
(specify
below the
box)
If
the
child
had
diarrhea
as
main
sick
ness
in the
last
2
wee
ks,
did you
give
him/
her
Oral
Rehydra
tion
Solu
tion
(OR
S)? 1=
yes
2=
no
If you
are the
mother,
at the
time you were
pregnant
, who did
you see
more
often for antenatal
care/advi
ces?
1 Doctor
2 Nurse
3 Midwife 4
Relative/f
riend
5 TBA
6
Traditional
herbalist
7
Communi
ty Health
officer 8 No one
When do you, the
mother/care taker, wash your
hands?
1= yes 2= no
Child
ID
Child
name
After
usin
g
the toile
t
Befor
e
eatin
g or feedi
ng an
infant
After
doin
g a
dirty job
like
chan
ging
an
infant's
diap
er
Befo
re
hand
ling food
s or
after
hand
ling
raw food
s e.g
mea
t
|__|__| _____ |__|__| |__| |__| |__||__||__|
mm |__|__|/|__|__|/|__|__| |__|__| |__| |__| |__| |__| |__|
|__|
_____ |__| |__| |__| |__| |__| |__|
|__|__| _____ |__|__| |__| |__|
|__||__||__|
mm |__|__|/|__|__|/|__|__| |__|__| |__| |__| |__| |__| |__|
|__|
_____ |__| |__| |__| |__| |__| |__|
|__|__| _____ |__|__| |__| |__|
|__||__||__|
mm |__|__|/|__|__|/|__|__| |__|__| |__| |__| |__| |__| |__|
|__|
_____ |__| |__| |__| |__| |__| |__|
|__|__| _____ |__|__| |__| |__|
|__||__||__|
mm |__|__|/|__|__|/|__|__| |__|__| |__| |__| |__| |__| |__|
|__|
_____ |__| |__| |__| |__| |__| |__|
|__|__| _____ |__|__| |__| |__|
|__||__||__| mm
|__|__|/|__|__|/|__|__| |__|__| |__| |__| |__| |__| |__|
|__|
_____ |__| |__| |__| |__| |__| |__|
|__|__| _____ |__|__| |__| |__|
|__||__||__|
mm |__|__|/|__|__|/|__|__| |__|__| |__| |__| |__| |__| |__|
|__|
_____ |__| |__| |__| |__| |__| |__|
|__|__| _____ |__|__| |__| |__|
|__||__||__|
mm |__|__|/|__|__|/|__|__| |__|__| |__| |__| |__| |__| |__|
|__|
_____ |__| |__| |__| |__| |__| |__|
Sierra Leone Comprehensive Food Security and Vulnerability Analysis (CFSVA) 2010
HOUSEHOLD QUESTIONNAIRE Questionnaire number: |___|___| |___|___|___|
16/16
10.1 10.2
10.17 10.18 10.19
10.20 10.
21
10.22
Identification Child MUAC Breastfeeding Products received by the child since this time yesterday
First name
Use codes from qu. 1.1
on section 1
Report same codes as
previous page
Mother’s/C
are taker’s
ID no.
Use code
from qu.
1.1
88=missing/absent at
the
interview
Child Mid
upper Arm
Circumference
MUAC
(in
centimeters)
Only for children from
6 to 59
months
Was the
child ever
breastfed
?
1= yes
2= no
3 = do
not know
Did the
child
receive
breast milk
yesterday
?
1= yes
2= no
Since this time yesterday, did he/she receive any of the following:
1 yes 2 no
Read each item aloud and record response before proceeding to the next
item
Yest
erda
y,
has the
child
recei
ved
1 solid
2
semi
-
solid
3
soft
food
Did the child eat food from any of the following food groups
yesterday?
1 yes 2 no
Read each item aloud and record response before
proceeding to the next item
a.
vitam
in,
min
era
l supple
ments
?
b.
medic
ine ?
c.
pla
in w
ate
r?
d.
sw
eete
ned,
flavoure
d w
ate
r,
fruit juic
e,
tea o
r in
fusio
n?
e.
ora
l re
hydra
tion s
olu
tion (
ORS)?
f. infa
nt
form
ula
?
g.
tinned,
pow
dere
d o
r fr
esh m
ilk?
h.
any o
ther
liquid
s?
i. s
olid o
r sem
i-solid (
mushy)
food?
a.
Gra
ins,
roots
and t
ubers
b.
Vegeta
ble
s a
nd n
uts
c.
Dairy p
roducts
(m
ilk,
yogurt
,
cheese)
d.
Fle
sh foods (
meat,
fis
h,
poultry
and liv
er/
org
an m
eats
)
e.
Eggs
f. V
itam
in-A
ric
h f
ruits a
nd
vegeta
ble
s
g.
Oth
er
fruits a
nd v
eg.
h.
CSB p
rem
ix
Child ID Child name
|__|__| __________ |__|__| |__|__|.|__|
cm |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |_| |_| |_| |_| |_| |_| |_| |_|
|__|__| __________ |__|__| |__|__|.|__|
cm |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |_| |_| |_| |_| |_| |_| |_| |_|
|__|__| __________ |__|__| |__|__|.|__|
cm |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |_| |_| |_| |_| |_| |_| |_| |_|
|__|__| __________ |__|__| |__|__|.|__|
cm |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |_| |_| |_| |_| |_| |_| |_| |_|
|__|__| __________ |__|__| |__|__|.|__|
cm |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |_| |_| |_| |_| |_| |_| |_| |_|
|__|__| __________ |__|__| |__|__|.|__|
cm |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |_| |_| |_| |_| |_| |_| |_| |_|
|__|__| __________ |__|__| |__|__|.|__|
cm |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |__| |_| |_| |_| |_| |_| |_| |_| |_|