Assessment of socio-economic level. NB : Tick only the most valuable: Low; 8 - 19: Medium; 20 - 26: High

14

Does any member of your household have a stable monthly or annual income?

0 = No 1 = Yes

e1

15

Main wall materials?

0 = Earth/wood/plank/palm/bamboo

1 = Semi-hard/brick

e2

16

Main floor materials

0 = Terracotta

1 = Cement

2 = Tiles

e3

17

Main roof materials

0 = Straw/branches/leaves

1 = Sheet metal/tulle

2 = Slab

e4

18

Number of rooms (e.g. living room = 2 rooms)

0 = One piece

1 = More than one piece

e5

19

Toilet type

0 = None (no WC in the concession)

1 = Ordinary

2 = Sanitary

e6

20

What energy source do you use mainly for lighting?

0 = Kerosene lamp/candle

1 = Electric battery

2 = Electricity (SBEE)

3 = Solar energy and/or SBEE

4 = Generator and/or SBEE

e7

21

How do you travel? (mention only the added value)

0 = None

1 = Bicycle

2 = Motorcycle

3 = Vehicle

e8

22

What household appliances do you have? (mention only the added value)

0 = None

1 = Radio set

2 = Android mobile phone

3 = Television set

4 = Fridge

e9

23

What type of fuel does your household mainly use for cooking?

0 = Wood/branch

1 = Charcoal/steel

2 = Gas/heating plate

e10

24

What is the main source of water in your household?

0 = River/marigot

1 = Well water

2 = Drilling

3 = Tap water (SONEB/AEV)

e11

25

Do you own the house you live in, or do you have a house or plot of land that you pay for yourself?

0 = Yes 1 = No

e12

26

Total household points

/_____/_____/

e13

Information on sexuality

27

At what age did you start menstruating?

/____/____/ years

s1

28

Did you have your first sexual intercourse before the age of 15?

0 = No 1 = Yes

s2

29

Have you ever been pregnant?

0 = No 1 = Yes

s3