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Village #: Village
1. Luteete
2. Nnindye A
Name of Main Respondent: 3. Nnindye B
4. Kikoota
5. Lubanda A
6. Lubanda B
7. Lubanda C
8. Kasaalu
9. Kayunga
START TIME: 10. Kankobe-Bugaro
11. Kanknobe-Senero
END TIME:
Date of Interview:
Interviewed by:
A1. Name A6. Is he/she involved in A7. If yes, about how many hours a
A2. Sex A4. Relationship A5. Primary A8. If yes, what types of agriculture
(Do not write down A3.Age household’s agriculture? week does he/she work on the
to Respondent Occupation activities is he/she involved in?
names) household farm?
A4: Relation to Respondent A5: Primary Occupation A6: Why not involved in A8: Agriculture Activities
0=Head 1=Farmer agriculture 1= All aspects
1=Spouse 2=Student 1= School 2= Collecting water
2=Parent 3=Hired labor 2= Housework 3=Weeding
A2
3=Child 4=Paid work (Specify…) 3= Too Old 4=Preparation for planting
4=Grand child 96=Other 4= Sick 5=Harvesting
5=Nephew/Niece 5= Disabled 96=Other (Specify…)
6=Son/daughter-in-law 6= Lack of opportunity
A3
7=Brother/Sister 96= Other (specify….)
8=Wife 2
9=Wife 3
10=Wife 4
96=Other relative (Specify……….)
97=Other non-relative (Specify……..)
A9. Who is the head of your household?
A10. What religion does your household practice?
A10:
1= Christian 4=Other (Specify…)
2= Muslim 96=Don’t know
3=Local religion
A11. How long have you been farming the land that you live on now?
A13. If yes, for how long did you farm that plot?
A14. How long have you or your spouse been making decisions about what crop to grow or seed type to use?
B. HEALTH
B1.How many members, if any, in this household have been taken seriously ill, hospitalized, or bedridden during the past growing season (6 months)? _______
B2. If there was any serious illness, hospitalization, or bedridden periods, did the sick member and any household member lose any working time/school time? (Include those
members that lost time at work/school due to care of the ill person) Y / N
If yes, do you think that affected how much crop output your family produced? Y / N
B3. If yes to either question above, fill in the table for both sick members and caretaker members who lost working time/school time:
Cause of illness, Length of time lost due to illness Caretaker (if any) Length of time lost due to caretaking for
Sick Member hospitalization, (make note of unit of the corresponding sick member (make
bedridden period measurement: M=months, Name note of unit of measurement: M=months,
Name B3A. D=days) D=days)
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
B4.When someone in you family is sick, who do you see for help making them better? B4:
B3A: Causes 7 = Tuberculosis / TB 16 = Cancer
1 = Malaria 8 = Sexually transmitted disease 96 = Other (specify ………)
2 = Flu/cold/upper respiratory tract 9 = HIV/AIDS related 97 = Don’t know
infection 11= Typhoid B4: Medical Help
3 = Eye disease 12 = Diarrhea 1 = Doctor
4 = Skin problem/ rash 2 = Nurse
13 = Intestinal worms 3= Herbalist
5 = Accident 14= Meningitis/ brain infection 4=Other (Specify…)
6 = Pneumonia 15= Convulsions
C. EDUCATION and TRAINING
Name C6 C7
C11. Did your children miss school at any point during the last growing season to help you with farming? Y / N
C6: Why not in school 8 =no room in school 17=Travel to school is unsafe or 96. =Other (specify………)
9=caring for household members difficult
1=Not yet schooling age 10=pregnant 18=Feel are too old for school C7. School Names (SEE CAITY)
2=Can’t pay school fee 11 =sick or disabled 19=Aged 1.
3=Can’t pay for books and/or school 12=religious/cultural beliefs 20=work on farm 2.
uniform 13=not interested 21=work around 3.
4=Poor school quality 14=bias against girl education household/homestead (non- 4.
5=No need for further schooling 15=long distance to school caregiving) 96. =Other (specify………)
6=Early Marriage 16=inadequate learning facilities in 27. =lack of clean/private sanitary
7 =Found jobs school facilities at school
C13. Who taught you the farming techniques that you use? C13:
C13: 1=parents
2=UMU University
3=NGO
4=Government
5=Other (Specify…)
C14. Has any member of this household received agricultural training or had contact with extension agents in the past year? Y / N
Training
[over the past
year]
If yes, it may be helpful to look at those records as you answer the next few questions.
D2. How much land do you for farming? (Make note of units)
D3. Do you and your spouse share a family plot or do you farm on separate pieces of land? D3
D3 1=Yes our household only has one plot
2=No we have a household plot and husband has separate plot
3=No we have a household plot and husband and wife both have separate plots
4=Other (Specify…)
Please answer the following questions about total output and total inputs for the entire household’s production on the Household Plot. JUST ANSWER QUESTIONS ABOUT
YOUR LAST GROWING SEASON/HARVEST
Crop Estimated quantity Total Quantity Total Quantity Total Quantity sold Total Quantity Quantity of Seed Fertilizer for this
[use codes, one row of last harvest for consumed at home stored (last harvest) (last harvest) given out as gifts land used for type for crop
for each code] entire household (last harvest) *Make note of unit *Make note of unit or as payments in- this crop this crop
*Make note of unit *Make note of unit kind (last harvest) *Make note Type Quantity
*Make note of of unit
D5 D6 D7 unit D13 D14
D8 D9 D10 D11 D12
D15. Please answer the following questions about total output and total inputs for the entire household’s production for Husband’s Plot:
Agricultural Activity Estimated quantity of Total Quantity Total Quantity stored Total Quantity sold Total Quantity Quantity of Seed type Fertilizer for this crop
[use codes, one row last harvest for consumed at home (last harvest) (last harvest) given out as gifts or land used for this
for each code] husband’s plot (last harvest) *Make note of unit *Make note of unit as payments in- for this crop crop
*Make note of unit *Make note of unit kind(last harvest) *Make note
*Make note of unit of unit Type Quantity
D16. Please answer the following questions about total output and total inputs for the entire household’s production for Wife’s Plot:
Agricultural Activity Estimated quantity of Total Quantity Total Quantity stored Total Quantity sold Total Quantity Quantity of Seed type Fertilizer for this crop
[use codes, one row last harvest for wife’s consumed at home (last harvest) (last harvest) given out as gifts or land used for this
for each code] plot (last harvest) *Make note of unit *Make note of unit as payments in- for this crop crop
*Make note of unit *Make note of unit kind(last harvest) *Make note
*Make note of unit of unit Type Quantity
D20. Tools:
D2 Do you own D3 If yes, D4 How many of D5 Type of D6 On Average,
the following Number [item] did you Energy how many hours
functioning assets? Owned purchase in the last Source Used is it used per
(Tick if Yes) (functioning) 2 years? by the Asset day?
Farm Equipment
a.Hand hoe
b.Hand-pumped sprayer
c.Spade/Shovel
d.Sickle
e.Rake
f.Axe
g.Pest spray
h.Animal-drawn plow
i.Other (specify…)
*****ASK UMUCOP********
D21. Farming Techniques:
- get list of agricultural techniques and ask if farmer uses each technique on each crop (tick if yes approach)---broadcast, rows, etc.
Loan
E18. Have you received a loan in the past year? Y / N
E19 If yes to E18, who did you receive the loan from?
E19 1=Family
2=Friend
3=NGO
4=UMU
5=Local lender
6=Local lending group (ex. women’s group)
7=Other (Specify…)
96=Don’t know
Food Security
E21. At any point in the past six months, have your or anyone in your family not had two meals in a day?
E22. At any point in the past six months, have you or anyone in your family gone hungry?
E23. Has having enough food ever been a problem for your family?