1
SUSENAS
SSN87-S1
RUPUBLIC OF ONDONESIA
CENTRAL BUREAU OF STATISTICS
1987 NATIONAL SOCIO-ECONOMIC SURVEY
DEMOGRAPHY, HEALTH, AND SOCIO-CULTURE LISTING
CONFIDENTIAL
I. LOCATION IDENTIFICATION
1
2
3
4
5
6
7
8
9
10
Province
District/Municipality *)
Sub-district
Village/village unit
Area
Enumeration Area Number
Census Block Number
SUSENAS Sample Code Number
Sample Household serial number
Selected Household serial number
1
3
1
2
3
4
5
Number of household members
Number of household member aged ≥ 5 years
Number of household member aged ≥ 10 years
Number of household member aged 0 – 4 years
Average monthly household expenditure
1
2
3
Name of enumerator
Date of enumeration
Signature of enumerator
Urban
-1
Rural
-2
5
6
9
II. 1 HOUSEHOLDS LISTING
12
14
16
18
20
II. 2. ENUMERATION PARTICULARS
4
5
6
Name of Supervisor
Date of supervision
Signature of Supervisor
2
3
III. HOUSEHOLD MEMBER’S LISTING
Serial number
(1)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Name of household member
(2)
Relation to household head
(3)
Household head
CODE FOR AVERAGE MONTHLY HOUSEHOLD EXPENDITURE
Less than 25.000
-1
100.000 – 149.999
-5
25.000 – 49.999
-2
150.000 – 199.999
-6
50.000 – 74.999
-3
200.000 – 299.999
-7
75.000 – 99.999
-4
300.000 and above
-8
4
5
IV. HOUSEHOLD MEMBER CHARACTERISTICS
Name: ……………… Number: …………..
1. Relation to the head of household:
Head of h.h
-1 Parent/in-law
Husband/wife
-2 Other relative
Children
-3 Servant
Son/daughter in
-4 Other
law
Grandchild
-5
2. Gender:
Male
-1 Female
3. Age: ……………………………. Year
4. Marital status:
Single
-1 Widowed
Married
-2 Divorced
5. Highest education completed:
No schooling
Not completed
Primary school
Primary School
Junior High School
Vocational Junior
High School
-0
-1
-2
-3
-4
V.1. HEALTH CHARACTERISTICS (for all ages)
12
14
-6
-7
-8
-9
15
16
18
-3
-4
19
-5
-6
-7
-8
-9
ONLY FOR THOSE AGED 5 YEAR AND OLDER
6. School Status:
20
No school
-1 Attending school -2
No longer in school
-3
To Q. 10
to Q. 8
21
7. Reasons you are no longer in school:
Satisfied with current education
Funding problem
Unintelligent/not capable
No school available/too far
Not accepted
Other
8. Type of education ever/ being attending:
Primary school
Junior High School
Vocational Junior
High school
Senior High
School
-1
-2
-3
-4
-1
-2
-3
-4
-5
-6
22
Vocational High
School
Diploma I/II
Academy/
Diploma III
University/
Diploma III
-5
-6
-7
-8
9. Highest grade ever or being attended:
1 2 3 4 5 6 7 8 (completed)
10.Can you speak Bahasa Indonesia?
Yes
-1 No
-2
23
11.Daily language used at home:
Indonesian
-1 Foreign
Regional Language –2
25
12.Can you read and write:
Latin
-1 Can not
Other alphabets -2
24
-3
26
-3
27
2. If “yes”, for how long were you sick?
………… day
-2
Senior High
School
Vocational High
School
Diploma I /II
Academy/
Diploma III
University/
Diploma IV
A. Situation during previous week
1. Were you ill?
Yes
-1 No
-2 →go to Q8
28
29
3. If “yes” what kind of illness?
TB/blood
Internal
-8
Cough
-1 disease
Diarrhea & -2 Measles/
-16
Vomiting
morbili
Malaria
-4 Other
-32
4. Where did you go for treatment:
31
Doctor
-1 Health worker -5
Hospital
-2 Traditional
-6
‘Puskesmas’ -3 healer
Polyclinic
-4 Self treatment -7
No treatment
-8
5. Distance to place of treatment
32
………………… km
6. Have you ever been treated?
34
Yes -1
No
-2 →go to Q8
35
7. If “yes”, where did you go for treatment?
Puskesmas/
-1 Paramedic’s -3
Polyclinic/
house
BKIA
Traditional
-4
Hospital
-2 healer
B. SITUATION DURING THE PREVIOUS
THREE MONTHS
8. Were you ill?
36
Yes -1
No
-2 →go to block V.2
9. If ‘yes’, how long were you ill?
……………….. day
10. If ‘yes’, what kind of illness?
TB/blood
Internal
cough
-1 disease
Diarrhea & -2 Measles/
Vomiting
morbili
Malaria
-4 Other
11. Where did you go for treatment:
Doctor
-1 Health worker
Hospital
-2 Traditional
‘Puskesmas’ -3 healer
Polyclinic
-4 Self treatment
Not treated -8
37
39
-8
-16
-32
41
-5
-6
-7
12. Distance to treatment place: …………km
13. Had you ever been treated?
Yes -1
No
-2 →go to block V.2
14 If “yes”, where did you go for treatment?
Puskesmas/
-1 At paramedic’s -3
Polyclinic/
house
BKIA
Traditional
-4
Hospital
-2
healer
42
44
45
6
7
V.2. HEALTH SITUATION OF CHILDREN AGED 0 – 4 YEARS OLD
1. Name:………………
Number:……………..
2. Gender:
Male
-1
Female
-2
3. a. Date of birth: …………..
b. Age: …………….. months
12 14
16
18.Duration of breastfeeding:
……months
16
4. Does the child have a birth certificate?
Yes
-1 →go to Q.6
No
-2
18
19.Children’s feeding pattern
Filling duration
(code) (month)
↓
↓
5. If ‘no’, is the date in Q.3 above correct?
Yes
-1
No
-2
19
15
20
6. Weight :
………..kg
7. Nutrition status:
Good
-1
Fine
-2
17.Has the baby/child been breast fed?
Yes -1
No -2 →go to Q.19
14
15
a. At aged 0 – 5 months:
Breast feeding
Mother’s milk substitute
Mashed food
Soft food
Adult food
-1
-2
-3
-4
-5
16
20
22
24
26
b. At aged 5 – 8 months:
Breast feeding
Mother’s milk substitute
Mashed food
Soft food
Adult food
-1
-2
-3
-4
-5
28
30
32
34
36
c. At aged 8 – 11 months;
Breast feeding
Mother’s milk substitute
Mashed food
Soft food
Adult food
-1
-2
-3
-4
-5
38
40
42
44
46
d. At aged 11 – 23 months:
Breast feeding
Mother’s milk substitute
Mashed food
Soft food
Adult food
-1
-2
-3
-4
-5
48
51
54
57
60
-1
-2
-3
-4
63
66
69
72
-5
-6
-7
75
78
81
23
Not good
Bad
-3
-4
8. Does the biological mother live here?
Yes
-1
No
-2 →go to Q.10
24
9. Serial number of biological mother
25
10.This child is number…..
27
11.That child was the ….th pregnancy?
29
12.What is the child’s condition?
Normal -1 →go to Q.14 disabled
31
-2
13.Type of disability:
Blind
-1 physical disability4
Deaf/mute
-2 mentally disabled-8
32
14.Has the child ever been immunized?
Yes -1
No
-2 →go to Q.17
34
15.Type of immunization:
BCG
-1 Polio
DPT
-2 Measles/
Chotypa
-4 morbili
35
16.If ever got DPT/Polio immunization:
DPT ……………… times
Polio ………………times
-8
-16
37
38
e. At aged 23 – 59 months:
Breast feeding
Mother’s milk substitute
Rice/substitute
Meat, chicken liver,
fish, egg
Tofu, tempe, pulses
Green vegetables/colored
Colored fruits
8
9
VI. SOCIO-CULTURE CHARACTERISTICS
(ONLY FOR AGED 10 YEARS OLD AND OLDER)
Name: ……………… Number: …………..
12
Name: ……………… Number: …………..
1. Did you listen to/follow a radio program during the
14
1. Did you listen to/follow a radio program during the
previous week?
previous week?
Yes
-1
No
-2 → go to Q. 3
Yes
-1
No
-2 → go to Q. 3
2. What interested you?:
15
2. What interested you?:
News
-1 Science program
-4
News
-1 Science program
-4
Entertainment/art
-2 Religious program -5
Entertainment/art
-2 Religious program -5
Sports
-3 Other
-6
Sports
-3 Other
-6
3. Did you watch a TV program during the previous
16
3. Did you watch a TV program during the previous
week?
week?
Yes
-1
No
-2 → go to Q. 5
Yes
-1
No
-2 → go to Q. 5
4. What program interested you?
17
4. What program interested you?
News
-1 Science program
-4
News
-1 Science program
-4
Entertainment/art
-2 Religious program -5
Entertainment/art
-2 Religious program -5
Sports
-3 Other
-6
Sports
-3 Other
-6
5. Did you watch a movie during the previous week?
18
5. Did you watch a movie during the previous week?
Yes
-1
No
-2 → go to Q. 7
Yes
-1
No
-2 → go to Q. 7
6. What type of film is most interesting?
19
6. What type of film is most interesting?
War/history
-1 Comedy
-5
War/history
-1 Comedy
-5
Detective
-2 Fantasy
-6
Detective
-2 Fantasy
-6
“Silat”
-3 Horror
-7
“Silat”
-3 Horror
-7
Drama/Romance
-4 Cartoon
-8
Drama/Romance
-4 Cartoon
-8
Other
-9
Other
-9
7. Did you read a newspaper/magazine during the
20
7. Did you read a newspaper/magazine during the
previous week?
previous week?
Yes
-1
No
-2 → go to Q. 9
Yes
-1
No
-2 → go to Q. 9
8. Which article was most interesting?
21
8. Which article was most interesting?
News
-1 Sport
-4
News
-1 Sport
-4
Science
-2 Cultural/art
-5
Science
-2 Cultural/art
-5
Editorial
-3 Fiction
-6
Editorial
-3 Fiction
-6
Other
-7
Other
-7
9. Did you do sport during previous week?
22
9. Did you do sport during previous week?
Yes
-1
No
-2 → go to Q. 11
Yes
-1
No
-2 → go to Q. 11
10.Which sports do you usually practice:
23
10.Which sports do you usually practice:
Athletic
-1 Aerobics
-5
Athletic
-1 Aerobics
-5
Football
-2 Self-defense
-6
Football
-2 Self-defense
-6
Badminton
-3 Tennis table
-7
Badminton
-3 Tennis table
-7
Volleyball
-4 Swimming
-8
Volleyball
-4 Swimming
-8
Other
-9
Other
-9
11. Did you see/participate in an art performance
24
11. Did you see/participate in an art performance
during the previous 3 months?
during the previous 3 months?
Yes
-1
No
-2 → go to Q. 13
Yes
-1
No
-2 → go to Q. 13
12. What the most type of cultural activity do you
25
12. What the most type of cultural activity do you
watch/participate?
watch/participate?
Dance
-1 Wayang/Puppet
-4
Dance
-1 Wayang/Puppet
-4
Music
-2 Other
-5
Music
-2 Other
-5
Play/Theatre
-3
Play/Theatre
-3
13. Are you a member of a social organization?
26
13. Are you a member of a social organization?
Yes
-1
No
-2 → go to Q. 15
Yes
-1
No
-2 → go to Q. 15
14. Which social organization:
27
14. Which social organization:
Youth
-1 Religious
-8
Youth
-1 Religious
-8
Sport/art
-2 PKK/”Dharma
-16
Sport/art
-2 PKK/”Dharma
-16
Burial
-4 Wanita”/women club
Burial
-4 Wanita”/women club
Other
-32
Other
-32
15. Why are you not a social organization member ?
29
15. Why are you not a social organization member ?
No social
-1 Not useful
-3
No social
-1 Not useful
-3
Organization
Do not understand -4
Organization
Do not understand -4
available
Other
-5
available
Other
-5
Reluctant/lazy
-2
Reluctant/lazy
-2
14
15
16
17
18
19
20
21
22
23
24
25
26
27
29
10