IDENTIFICATION

PLACE NAME__
NAME OF HOUSEHOLD HEAD__
CLUSTER NUMBER___
HOUSEHOLD NUMBER______
REGION__

NAME AND LINE NUMBER OF WOMAN ____

URBAN/RURAL___

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE___

INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULT ____

RESULTS___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR __
NAME__
RESULT__

TOTAL NUMBER OF VISITS ____

SUPERVISOR
NAME___
DATE___

FIELD EDITOR
NAME__
DATE__

OFFICE EDITOR__
KEYED BY___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT:
Hello. My name is _________ and I am working with (NAME OF ORGANIZATION). We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

101) RECORD THE TIME

102) First I would like to ask you some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in the countryside?

103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

104) Just before you moved here, did you live in a city, in a town, or in the countryside?

105) In what month and year were you born?

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107) Have you ever attended school?

108) What is the highest level of school you attended: primary, secondary or higher?

109) What is the highest (grade/form/year) you completed at that level?

110) CHECK 108:

111) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

112) Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

113) CHECK 111:

114) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

115) Do you listen to the radio almost every day, at least once a week, less than once a week, or not at all?

116) Do you watch television almost every day, at least once a week, less than once a week, or not at all?

117) COUNTRY SPECIFIC QUESTION ON RELIGION.

118) COUNTRY SPECIFIC QUESTION ON ETHNICITY.

SECTION 2. REPRODUCTION

201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?

202) Do you have any sons or daughters to whom you have given birth who are now living with you?

203) How many sons live with you?
And how many daughters live with you?

IF NONE, RECORD '00'.

204) Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

206) Have you ever given birth to a boy or girl who was born alive but later died?

IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

207) How many boys have died?
And how many girls have died?

IF NONE, RECORD '00'.

208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.

209) CHECK 208: Just to make sure that I have this right: you have had in TOTAL ___ births during your life. Is that correct?

210) CHECK 208:

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

212) What name was given to your (first/next) baby?

213) Were any of these births twins?

214) Is (NAME) a boy or a girl?

215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

216) Is (NAME) still alive?

217) IF ALIVE: How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

218) IF ALIVE: Is (NAME) living with you?

219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).

220) IF DEAD: How old was (NAME) when he/she died?

IF '1 YR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[Exclude first birth]

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?

223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

224) CHECK 214 AND ENTER THE NUMBER OF BIRTHS IN 1995 OR LATER. IF NONE, RECORD '0'.

225) FOR EACH LIVE BIRTH SINCE JANUARY 1995, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226) Are you pregnant now?

227) How many months pregnant are you?

RECORD THE NUMBER OF COMPLETED MONTHS. ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

230) When did the last such pregnancy end?

231) CHECK 230:

232) How many months pregnant were you when the last such pregnancy ended?

RECORD THE NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233) Have you ever had any other pregnancies that did not result in a live birth?

234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1995.

ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any pregnancies that terminated before 1995 that did not result in a live birth?

236) When did the last such pregnancy that terminated before 1995 end?

237) When did your last menstrual period start?

238) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

239) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301) Which ways or methods have you heard about?

FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

302) Have you ever used (METHOD)?

303) CHECK 302:

304) Have you ever used anything or tried in any way to delay or avoid getting pregnant?

(NOTE: There is no question 305 on the survey)

306) What have you done or used?

CORRECT 302 AMD 303 (AND 301 IF NECESSARY).

307) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

308) CHECK 302 (01):

309) CHECK 226:

310) Are you currently doing something or using any method to delay or avoid getting pregnant?

311) Which method are you using?
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SHIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

312) QUESTIONS ON SOCIAL MARKETING SHOULD BE ADDED IN COUNTRIES THAT HAVE AN ACTIVE SOCIAL MARKETING PROGRAM.

313) In what facility did the sterilization take place?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

314) CHECK 311:

315) IN COUNTRIES WHERE STERILIZATION IS COMMON, ADD ADDITIONAL APPROPRIATE QUESTIONS FROM STERILIZATION MODULE.

316) In what month and year was the sterilization preformed?
316A) For how long have you been using (CURRENT METHOD) now without stopping?

PROBE: In what month and year did you start using (CURRENT METHOD) continuously?

317) CHECK 316/316A:

NOTE: THERE IS NO QUESTION 318.

319) CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

320) Where did you obtain (CURRENT METHOD) when you started using it?

320A) Where did you learn to use the lactational amenorrhea method?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

321) CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

322) You obtained (CURRENT METHOD FROM 319) from (SOURCE OF METHOD FROM 313 OR 320).
At that time, were you told about side effects or problems you might have with the method?

323) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

324) Were you told what to do if you experienced side effects or problems?

325) CHECK 322:

CODE '1' CIRCLED: ___
ASK: At that time, were you told about other family planning that you could use?

CODE '1' NOT CIRCLED: ___
ASK: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?

326) Were you ever told by a health or family planning worker about other methods of family planning that you could use?

327) CHECK 311/311A:

CIRCLE METHOD CODE:

328) Where did you obtain (CURRENT METHOD) the last time?

IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE AND SOURCE AND CIRCLE THE APPROPRIATE CODE.

329) Do you know of a place where you can obtain a method of family planning?

330) Where is that?

IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

Any other place?

RECORD ALL PLACES MENTIONED.

331) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

332) In the last 12 months, have you visited a health facility for care for yourself (or your children)?

333) Did any staff member at the health facility speak to you about family planning?

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401) CHECK 224:

402) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately).

403) LINE NUMBER FROM 212:

404) FROM 212 AND 216:

405) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

406) How much longer would you like to have waited?

407) Did you see anyone for antenatal care for this pregnancy?

IF YES: Whom did you see? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[LAST BIRTH ONLY]

408) How many months pregnant were you when you first received antenatal care for this pregnancy?
[LAST BIRTH ONLY]

409) How many times did you receive antenatal care during this pregnancy?
[LAST BIRTH ONLY]

410) CHECK 409:

NUMBER OF TIMES RECEIVED ANTENATAL CARE
[LAST BIRTH ONLY]

411) How many months pregnant were you the last time you received antenatal care?
[LAST BIRTH ONLY]

412) During this pregnancy, were any of the following done at least once?
[LAST BIRTH ONLY]

Were you weighed?
Was your height measured?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

413) Were you told about the signs of pregnancy complications?

[LAST BIRTH ONLY]

414) Were you told where to go if you had these complications?
[LAST BIRTH ONLY]

415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[LAST BIRTH ONLY]

416) During this pregnancy, how many times did you get this injection?
[LAST BIRTH ONLY]

417) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

SHOW TABLET/SYRUP.
[LAST BIRTH ONLY]

418) During the whole pregnancy, for how many days did you take the tablets or syrup?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[LAST BIRTH ONLY]

419) During this pregnancy, did you have difficulty with your vision during the daylight?
[LAST BIRTH ONLY]

420) During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?
[LAST BIRTH ONLY]

421) During this pregnancy, did you take any drugs to prevent you from getting malaria?
[LAST BIRTH ONLY]

422) What drugs did you take?

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[LAST BIRTH ONLY]

423) When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?

424) Was (NAME) weighed at birth?

425) How much did (NAME) weigh?

RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

426) Who assisted with the delivery of (NAME)?

Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

427) Where did you give birth to (NAME)?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

428) Was (NAME) delivered by caesarean section?

429) After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

430) How many days or weeks after delivery did the first check take place?

RECORD '00' DAYS IF SAME DAY.
[LAST BIRTH ONLY]

431) Who checked on your health at that time?

PROBE FOR THE MOST QUALIFIED PERSON.
[LAST BIRTH ONLY]

432) Where did this first check take place?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[LAST BIRTH ONLY]

433) In the first two months after delivery, did you receive a vitamin A dose like this?

SHOW AMPULE/CAPSULE/SYRUP.
[LAST BIRTH ONLY]

434) Has your period returned since the birth of (NAME)?
[LAST BIRTH ONLY]

435) Did your period return between the birth of (NAME) and your next pregnancy?
[EXCLUDE LAST BIRTH]

436) For how many months after the birth of (NAME) did you not have a period?

437) CHECK 226: IS RESPONDENT PREGNANT?

438) Have you resumed sexual relations since the birth of (NAME)?

439) For how many months after the birth of (NAME) did you not have sexual relations?

440) Did you ever breastfeed (NAME)?

441) How long after birth did you first put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.

442) In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

443) What was (NAME) given to drink before your milk began flowing regularly?

Anything else?

RECORD ALL LIQUIDS MENTIONED.

444) CHECK 404: IS CHILD LIVING?

445) Are you still breastfeeding (NAME)?

446) For how many months did you breastfeed (NAME)?

447) CHECK 404: IS CHILD LIVING?

448) How many times did you breastfeed last night between sunset and sunrise?

IF NUMBER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

449) How many times did you breastfeed yesterday during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

450) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

451) Was sugar added to any of the foods or liquids (NAME) ate yesterday?

452) How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?

IF 7 MORE TIMES, RECORD '7'.

453) GO BACK TO 405 AND COMPLETE FOR NEXT BIRTH, OR, IF MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION

454) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

455) LINE NUMBER FROM 212

456) FROM 212 AND 216

457) Did (NAME) receive a vitamin A dose like this during the last 6 months?

SHOW AMPULE/CAPSULE/SYRUP.

458) Do you have a card where (NAME'S) vaccinations are written down?

IF YES: May I see it please?

459) Did you ever have a vaccination card for (NAME)?

460) (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

(2) WRITE '44' IN 'DAY' COLUMN IS CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

461) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

462) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

463) Please tell me if (NAME) received any of the following vaccinations.

463A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

463B) Polio vaccine, that is, drops in the mouth?

463C) When was the first polio vaccine received, just after birth or later?

463D) How many times was the polio vaccine received?

463E) A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

463F) How many times?

463G) An injection to prevent measles?

464) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

465) At which national immunization day campaigns did (NAME) receive vaccinations?

RECORD ALL CAMPAIGNS MENTIONED.

466) Has (NAME) been ill with a fever at any time in the last two weeks?

467) Has (NAME) had an illness with a cough at any time in the last 2 weeks?

468) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths?

469) CHECK 466 AND 467:

FEVER OR COUGH?

470) Did you seek advice or treatment for the fever/cough?

471) Where did you seek advice or treatment for the fever/cough?

Anywhere else?

RECORD ALL SOURCES MENTIONED.

472) CHECK 466: HAD FEVER?

473) Did (NAME) take any drugs for the fever?

474) What drugs did (NAME) take?

RECORD ALL MENTIONED.

ASK TO SEE IF DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

475) Has (NAME) had diarrhea in the last 2 weeks?

476) Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same, or more than usual to drink?

IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?

477) When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?

478) Was he/she given any of the following drink:

a. A fluid made from a special packet called [LOCAL NAME]?
b. A government-recommended homemade fluid?

479) Was anything (else) given to treat the diarrhea?

480) What (else) was given to treat the diarrhea?

Anything else?

RECORD ALL TREATMENTS MENTIONED.

481) Did you seek advice or treatment for the diarrhea?

482) Where did you seek advice or treatment?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

Anywhere else?

RECORD ALL PLACES MENTIONED.

483) GO BACK TO 456 FOR NEXT BIRTH, OR, IF NO MORE BIRTHS, GO TO 484.

484) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 1995 OR LATER LIVING WITH THE RESPONDENT.

485) What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?

486) CHECK 478a, ALL COLUMNS:

487) Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET] you can get for the treatment of diarrhea?

488) CHECK 218:

489) When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?

IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK:
If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

490) Now I would like to ask you some questions about medical care for you yourself.

Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

491) CHECK 215 AND 218:

492) Now I would like to ask you about the liquids (NAME FROM Q. 491) drank over the last seven days, including yesterday.

How many days during the last seven days did (NAME FROM Q. 491) drink each of the following?

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK:

In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?

a. Plain water?
b. Commercially produced infant formula?
c. Any other milk such as tinned, powdered, or fresh animal milk?
d. Fruit juice?
e. Any other liquids such as sugar, water, tea, coffee, carbonated drinks, or soup broth?

IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

493) Now I would like to ask you about the types of foods (NAME FROM Q. 491) ate over the last seven days, including yesterday.

How many days during the last seven days did (NAME FROM Q. 491) eat each of the following foods either separately or combined with other food.

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK:

In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) eat (ITEM)?

a. Any food made from grains [e.g., millet, sorghum, maize, rice, wheat, porridge, or other local grains]?
b. Pumpkin, red or yellow yams or squash, carrots, or red sweet potatoes?
c. Any other food made from roots or tubers [e.g., white potatoes, white yams, manioc, cassava, or other local roots/tubers]?
d. Any green leafy vegetables?
e. Mango, papaya [or other local vitamin A rich fruits]?
f. Any other fruits and vegetables [e.g., bananas, apples/sauce, green beans, avocados, tomatoes]?
g. Meat, poultry, fish, shellfish, or eggs?
h. Any food made from legumes [e.g., lentils, beans, soybeans, pulses, or peanuts]?
i. Cheese or yoghurt?
j. Any food made with oil, fat, or butter?

IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

494) Did you sleep under a bednet last night?

495) The last time you prepared a meal for your family, before starting did you wash your hands?

496) Do you currently smoke cigarettes or tobacco?

IF YES: What type of tobacco do you smoke?

RECORD ALL TYPES MENTIONED.

497) CHECK 496:

498) In the last 24 hours, how many cigarettes did you smoke?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501) Are you currently married or living with a man?

502) Have you ever been married or lived with a man?

NOTE: THERE IS NO QUESTION 503

504) What is your marital status now: are you widowed, divorced, or separated?

505) Is your husband/partner living with you now or is he staying elsewhere?

506) RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

507) Does your husband/partner have any other wives besides yourself?

508) How many wives does he have?

509) Are you the first, second, ... wife?

510) Have you been married or lived with a man only once, or more than once?

511) CHECK 510:

MARRIED/LIVED WITH A MAN ONLY ONCE: ___
ASK:
In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: ___
ASK:
Now we will talk about your first husband/partner.
In what month and year did you start living with him?

512) How old were you when you started living with him?

NOTE: THERE IS NO QUESTION 513.

514) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.

How old were you when you first had sexual intercourse (if ever)?

515) When was the last time you had sexual intercourse?

RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

516) The last time you had sexual intercourse, was a condom used?

517) What is your relationship to the man with whom you last had sex?

IF MAN IS "BOYFRIEND" OR "FIANCÉ" ASK:
Was your boyfriend/fiancé living with you when you last had sex?

IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

518) For how long have you had sexual relations with this man?

519) Have you had sex with any other man in the last 12 months?

520) The last time you had sexual intercourse with another man, was a condom used?

521) What is your relationship to this man?

IF MAN IS "BOYFRIEND" OR "FIANCÉ", ASK:
Was your boyfriend/fiancé living with you when you last had sex with him?

IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

522) For how long have you had sexual relations with this man?

523) In total, with how many different men have you had sex in the last 12 months?

524) Do you know of a place where a person can get condoms?

525) Where is that?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

Any other place?

RECORD ALL SOURCES MENTIONED.

526) If you wanted to, could you yourself get a condom?

527) Do you know of a place where a person can get female condoms?

528) Where is that?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

Any other place?

RECORD ALL SOURCES MENTIONED.

529) If you wanted to, could you yourself get a female condom?

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311/311A:

602) CHECK 226:

NOT PREGNANT OR UNSURE: ___
ASK:
Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

PREGNANT: ___
ASK:
Now I have some questions about the future.
After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

603) CHECK 226:

NOT PREGNANT OR UNSURE, ASK:
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT, ASK:
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

604) CHECK 226:

605) CHECK 310: USING A CONTRACEPTIVE METHOD?

606) CHECK 603:

607) CHECK 602:

WANTS TO HAVE A/ANOTHER CHILD: ___
ASK: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

WANTS NO MORE/NONE: ___
ASK: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

RECORD ALL REASONS MENTIONED.

608) In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

609) CHECK 310: USING A CONTRACEPTIVE METHOD?

610) Do you think that you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

611) Which contraceptive method would you prefer to use?

612) What is the main reason that you think you will not use a contraceptive method at any time in the future?

613) Would you ever use a contraceptive method if you were married?

614) CHECK 216:

PROBE FOR A NUMERIC RESPONSE.

HAS LIVING CHILDREN: ___
ASK:
If you could go back to the time when you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: ___
ASK:
If you could choose exactly the number of children to have in your whole life, how many would that be?

615) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

616) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

617) In the last few months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?

618) COUNTRY SPECIFIC QUESTIONS ON MEDIA MESSAGES ABOUT FAMILY PLANNING.

619) In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

620) With whom?
Anyone else?

RECORD ALL PERSONS MENTIONED.

621) CHECK 501:

622) CHECK 311/311A:

623) You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision or did you both decide together?

624) Now I want to ask you about your husband's/partner's views on family planning.

Do you think that your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

625) How often have you talked to your husband/partner about family planning in the past year?

626) CHECK 311/311A:

627) Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

628) Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted disease?
She knows her husband has sex with other women?
She has recently given birth?
She is tired or not in the mood?

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701) CHECK 501 AND 502:

702) How old was your husband/partner on his last birthday?

703) Did your (last) husband/partner ever attend school?

704) What was his highest level of school he ever attended: primary, secondary, or higher?

705) What was the highest (grade/form/year) he completed at that level?

706) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN: ___
ASK:
What is your husband's/partner's occupation?
That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN: ___
ASK:
What was your (last) husband's/partner's occupation?
That is, what kind of work did he mainly do?

707) Aside from your own housework, are you currently working?

708) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?

709) Have you done any work in the last 12 months?

710) What is your occupation, that is, what kind of work do you mainly do?

711) CHECK 710:

712) Do you mainly work on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

713) Do you do this work for a member of your family, for someone else, or are you self-employed?

714 ) Do you usually work at home or away from home?

715) Do you usually work throughout the year, or do you work seasonally, or only once and while?

716) Are you paid or do you earn in cash or in kind for this work or are you not paid at all?

717) Who mainly decides how the money you earn will be used?

718) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

719) Who in your family usually has the final say on the following decisions:

Your own healthcare?
Making large household purchases?
Making household purchases for daily needs?
Visits to family or relatives?
What food should be cooked each day?

720) PRESENCE OF OTHERS LISTENING AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

721) Someone times a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

SECTION 8. HIV/AIDS AND OTHER SEXUAL TRANSMITTED INFECTIONS

801) Now I would like to talk about something else:
Have you ever heard of an illness called AIDS?

802) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

803) What can a person do?
Anything else?

RECORD ALL WAYS MENTIONED?

804) Can people reduce their chances of getting the AIDS virus by having just one sex partner who has no other partners?

805) Can people get the AIDS virus from mosquito bites?

806) Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

807) Can people get the AIDS virus by sharing food with a person who has AIDS?

NOTE: THERE IS NO QUESTION 808.

809) Is it possible for a healthy-looking person to have the AIDS virus?

810) Do you know someone personally who has the virus that causes AIDS or someone who has died of AIDS?

811) Can the virus the causes AIDS be transmitted from mother to a child?

812) Can the virus that causes AIDS be transmitted from a mother to a child:

During pregnancy?
During delivery?
By breastfeeding?

813) CHECK 501:

814) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

815) If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

816) If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

817) Apart from AIDS, have you heard of other infections that can be transmitted through sexual contact?

818) If a man has a sexually transmitted disease, what symptoms might he have?
Any others?

RECORD ALL SYMPTOMS MENTIONED.

819) If a woman has a sexually transmitted disease, what symptoms might she have?
Any others?

RECORD ALL SYMPTOMS MENTIONED.

820) RECORD THE TIME.