Literal question
IDENTIFICATION
PROVINCE _____
DEPARTMENT _____
COMMUNE/URBAN CENTER _____
VILLAGE/SECTOR _____
CLUSTER NUMBER _____
NAME OF HEAD OF CONCESSION _____
CONCESSION NUMBER _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD UNIT NUMBER _____
URBAN/RURAL:
URBAN 1
RURAL 2
OUAGA/BOBO/OTHER CITIES/RURAL:
OUAGA 1
BOBO 2
OTHER CITIES 3
RURAL 4
INTERVENTION ZONE:
YES 1
NO 2
NAME OF MALE RESPONDENT _____
LINE NUMBER OF MALE RESPONDENT _____