STATISTICAL CONFIDENTIALITY: BY THE TERMS GIVEN IN ARTICLE 11 OF THE LAW NO. 3/11, FROM THE 14TH OF JANUARY, LAW OF THE NATIONAL STATISTICS SYSTEM, ALL INDIVIDUAL DATA COLLECTED BY OFFICIAL STATISTICS ORGANIZATIONS, IN THIS CASE THE INE, ARE STRICTLY CONFIDENTIAL. COLLECTED DATA IS PROTECTED FROM ANY NON-STATISTICAL PURPOSES OR FROM ANY UNAUTHORIZED DISSEMINATION, ONLY TO BE USED FOR THE PRODUCTION OF OFFICIAL STATISTICS.

IDENTIFICATION

PLACE NAME ________
NAME OF HOUSEHOLD HEAD_______
PROVINCE_______
MUNICIPALITY_____
COMMUNITY_______
NEIGHBORHOOD/VILLAGE______
CENSUS SECTION______
AREAS OF RESIDENCE

CLUSTER NUMBER (ID. IIMS)______
HOUSEHOLD NUMBER_______
NAME AND LINE NUMBER OF WOMAN_______
THE WOMAN WAS SELECTED FOR THE DOMESTIC VIOLENCE MODULE

INTERVIEWER VISITS

FIRST VISIT
DATE_________
DAY___
MONTH___
INTERVIEWER'S NAME_________
RESULT

NEXT VISIT:
DATE_________
TIME_________

SECOND VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT

NEXT VISIT:
DATE____
TIME____

THIRD VISIT
DATE____
DAY____
MONTH____
INTERVIEWER'S NAME____
RESULT

FINAL VISIT
DAY_________
MONTH_________
YEAR_____
INT. NO._________
RESULT

TOTAL NUMBER OF VISITS_________

LANGUAGE OF QUESTIONNAIRE______

TRANSLATOR USED

SUPERVISOR
NAME_________
NUMBER_________

INTRODUCTION AND CONSENT
Good morning/afternoon. My name is _________. I am working with the Institute of National Statistics and here is my identification (SHOW YOUR ID BADGE). We are conducting a survey about health all over the country. The information we collect will help the government to plan health services. Your household was selected for the survey. All of the answers you give will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Your participation in the survey is voluntary if I ask you a question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time. We hope that you will participate in this survey since your views are important. In case that you need more information about the survey, you may contact INE [INS] or the province delegate of Statistics.

Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER:____________ DATE:________________

SECTION 1: WOMAN'S BASIC CHARACTERISTICS

101) RECORD THE TIME

102) In what month and year were you born?

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND 103 IF INCONSISTENT

104) Have you ever attended school?

105) What is the highest level of school you attended?

106) Have you completed that year successfully?

106A) What level is the year you completed?

107) CHECK 106A:

108) Can you read?

109) Can you write?

110) 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?

111) CHECK 110:

112) Do you read the newspaper or magazine at least once a week, less than once a week or not at all?

113) Do you listen to the radio at least once a week, less than once a week or not at all?

114) Do you watch television at least once a week, less than once a week or not at all?

115) Do you own a mobile telephone?

116) Have you ever used the internet?

117) In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY EVIDENCE

118) During the last 30 days, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

119) What is your religion?

120) How often do you go to the church?

121) Usually what language do you speak in the household?
IF MORE THAN ONE LANGUAGE IS MENTIONED, PROBE TO IDENTIFY THE MAIN LANGUAGE

122) In the last 12 months, how many times have you been away from home for one or more nights?

123) In the last 12 months, have you been away from home for one month or more at a time?

124) How long have you lived in this province?
IF LESS THAN A YEAR, RECORD '00' YEARS

125) In which province or country did you live before moving here?

SECTION 2. REPRODUCTION

201) Now I would like to ask about all the children [sons and daughters] that you have had in your whole life. Have you ever given birth?

202) Do you have any sons or daughters that live 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 who don't live with you?

205) How many sons are alive and living away from home?
And how many daughters are alive and living away from home?
IF NONE, RECORD '00'

206) Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, tried to breath, moved in some way or showed signs of life, even if only for a short time?

207) How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'

208) ADD UP RESPONSES TO 203, 205 AND 207. RECORD THE TOTAL
IF NONE, RECORD '00'

209) CHECK 208:
Just to make sure that I understood correctly: In your entire life, you have had a TOTAL of _____ children. Is that right?

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 IN 212, THE NAMES OF ALL CHILDREN BORN ALIVE. (Even if the child is no longer alive or is not a child of the current partner.) RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW)

212) What is the name of your (first/next) baby?
RECORD THE NAME.

213) Is (NAME) a male or female?

214) Is (NAME) a twin?

215) In what day, month and year was (NAME) born?

216) Is (NAME) alive?

217) IF ALIVE: How old was (NAME) on his/her last birthday?
RECORD AGE IN YEARS COMPLETED

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

219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD FROM HOUSEHOLD SURVEY.

RECORD '00' IF CHILD WAS NOT LISTED.

220) IF DEAD: How old was (NAME) when he/she died?
IF '12 MONTHS' OR '1 YEAR', ASK: Did (NAME) have his/her first birthday?
AND THEN ASK: How many months old was (NAME) when he/she died?

RECORD DAYS IF LESS THAN A MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

221) Were there any other births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

222) Have you given birth to another child since the birth of (NAME OF LAST BIRTH)?

223) COMPARE 208 WITH NUMBER OF BIRTHS IN THE BIRTH RECORD.

224) CHECK 215: ENTER THE NUMBER OF BIRTHS OCCURRING SINCE JANUARY 2010.

225) C FOR EACH BIRTH SINCE JANUARY 2010, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR AND RECORD THE CHILD'S NAME TO THE LEFT OF THE CODE 'B'. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETE MONTHS THAT THE WOMAN WAS PREGNANT, AND RECORD 'P' IN EACH OF THE MONTHS PRIOR TO THE BIRTH. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
C ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228) When you got pregnant, did you want/hope to get pregnant at that time?

229) CHECK 208: TOTAL NUMBER OF BIRTHS

230) Did you ever have a pregnancy where you lost the baby (miscarriage or stillbirth)?

231) In what month and year did the last such pregnancy end?

232) CHECK 231:

233) In what month and year did that pregnancy end?

234) How many months pregnant were you when the miscarriage occurred?

235) Since January 2010, did you have any pregnancy that ended in miscarriage?

236) C FOR EACH PREGNANCY THAT ENDED IN MISCARRIAGE SINCE JANUARY 2010, RECORD 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

IF THERE WERE MORE THAN FOUR PREGNANCIES THAT ENDED IN MISCARRIAGE, USE AN ADDITIONAL SURVEY, BEGINNING ON THE SECOND LINE.

237) Before 2010, did you have any pregnancy that terminated, in miscarriage or stillbirth?

238) In what year and month did the last such pregnancy that terminated before 2010 end?

239. When did your last menstrual period start?

240) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

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

242) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy. Which ways or methods have you heard about?
For methods not mentioned spontaneously, ask: Have you heard of (read: METHOD)?

302) CHECK 226:

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

304) Which method are you using?
RECORD ALL ANSWERS. IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD IN LIST.

305) What is the brand name of the pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE

306) In what facility did the sterilization take place?

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

307) In what month and year was the sterilization performed?

308) Since what month and year have you have been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

309) CHECK 307 AND 308, 215 AND 231:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 307 OR 308

310) CHECK 307/308:

311) I will like to ask you some questions about the times you or your partner they have used a method to avoid getting pregnant during the last few years.

C USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2010. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE
POINTS.

312A) MONTH AND YEAR OF START CONTRACEPTIVE METHOD

312B) Between (EVENT) in (MONTH/YEAR) and (EVENT), did you or your partner use any method of contraception?

312C) Which method was that?

312D) How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?

CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE METHOD.

312E) RECORD THE MONTH AND YEAR RESPONDENT STARTED USING METHOD.

312F) For how many months did you use (METHOD)?

CIRCLE '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE

312G) RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

312H) Why did you stop using (METHOD)?

312I) GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.

313) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

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

315) CHECK 304:

CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

316) You first started using (CURRENT METHOD) in (DATE FROM 307 OR 308). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

317) CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FRO HIGHEST METHOD IN LIST.

318) At that time, were you told about side effects of problems you might have with the method?

319) When you got sterilized, were you told about side effects or problems you might have with the method?

320) Were you ever told by a health or family planning worker about side effects or problems you my half with the method?

321) Were you told what to do if you experience side effects or problems?

322) CHECK 318 AND 319:

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

324) CHECK 304:

CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

325) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

326) Do you know if the place where you can obtain a method of family planning?

327) CHECK 202: LIVING CHILDREN

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404, FOR EACH BIRTH SINCE JANUARY 2010.
ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE.

Now I would like to ask you some more questions about the health of all your children born in the past five years. (We will talk about one child at a time.)

403) LINE NUMBER FROM QUESTION 212 IN BIRTH HISTORY.

404) FROM 212 AND 216:

405) At the time you became pregnant with (NAME), did you want to get pregnant at that time?

406) CHECK 208:

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

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

409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

410) Where did you received antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

411) How many months pregnant were you when you first received antenatal care?

412) How many antenatal appointments did you have during this pregnancy?

413) As part of your antenatal care during this pregnancy, were any of the following done at least once?
A) Was your blood pressure measured?
B) Did you give a urine sample?
C) Did you give a blood sample?

414) During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

415) When you were pregnant were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

416) During this pregnancy, how many times did you get this injection?

417) CHECK 416:

418) At any times before this pregnancy, did you receive any tetanus injections?

419) Before this pregnancy, how many other times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

420) CHECK 419:

421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLET/SYRUP

422) 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

423) During this pregnancy, did you take any drug for intestinal worms?

424) During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

425) How many times did you take SP/Fansidar during this pregnancy?

426) Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source?
IF MORE THAN ONE SOURCE, RECORD THE HIGHEST ON THE LIST.

427) When (NAME) was born, was (NAME), very large, larger than average, average, smaller than average, or very small?

428) Was (NAME) weighed at birth?

429) How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

430) Who assisted with the delivery of (NAME)?
Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

431. Where did you give birth to (NAME)?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

432) How long after (NAME) was delivered did you stayed there?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS

433) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

434) When was the decision made to have the caesarean section? Was it before or after your labor pains started?

435) Immediately after birth, was (NAME) put directly on the bare skin of your chest?

436) CHECK 431: PLACE OF DELIVERY

437) I would like to talk to you about checks on your health after delivery. Before you were discharged after (NAME) was born, did anyone check on your health while you were still in the facility?

438) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

439) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

440) Now I would like to talk to you about check on (NAME)'s health after delivery. Did anyone check on (NAME)'s health while you were still in the facility?

441) How long after delivery was (NAME)'s health first check?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN A WEEK, RECORD DAYS.

442) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON

443) Now I would like to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

444) How long after delivery did that check take place?

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN A WEEK, RECORD DAYS.

445) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON

446) Where did the check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

447) Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 431)?

448) How long after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN A WEEK, RECORD DAYS.

449) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON

450) Where did this check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

451) I would like to talk to you about checks on your health after delivery. Did anyone check on your health after you gave birth to (NAME)?

452) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN A WEEK, RECORD DAYS.

453) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON

454) Where did the first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

455) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

456) How long after the birth of (NAME) did the first check take place?

457) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON

458) Where did this check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

459) During the first two days after (NAME)'s birth, did any health care provider do the following:

A) Examine the cord?
B) Measure (NAME)'s temperature?
C) Counsel you on danger signs for newborns?
D) Counsel you on breastfeeding?
E) Observe (NAME) breastfeeding?

460) Has your period returned since the birth of (NAME)?

461) Did your period return between the birth of (NAME) and your next pregnancy?

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

463) CHECK 226: IS RESPONDENT PREGNANT?

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

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

466) Did you ever breastfeed (NAME)?

467) CHECK 404: IS CHILD LIVING?

468) 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.

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

470) What was (NAME) given to drink before your milk began flowing regularly?
PROBE: Anything else?
RECORD ALL LIQUIDS MENTIONED.

471) CHECK 404:
IS CHILD LIVING?

472) Are you still breastfeeding (NAME)?

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

474) GO BACK TO 405 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 501A.

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A) CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS SINCE JANUARY 2012?

502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN SINCE JANUARY 2012.

503A) CHECK 216 FOR CHILD:

504A) Do you have a card or other document where (NAME)'s vaccination are written down?

505A) Did you ever have a vaccination card for (NAME)?

506A) CHECK 504A:

507A) May I see the card or other document where (NAME)'s vaccination are written down?

508A) COPY THE DATES FROM THE CARD
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED

AT BIRTH

AT TWO MONTHS

AT FOUR MONTHS

AT SIX MONTHS

AT NINE MONTHS (15 MONTHS FOR MEASLES)

509A) CHECK 508A: ALL VACCINES FROM 'POLIO' TO 'MEASLES' 2 RECORDED?

510A) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511A) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

512A) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

513A) Within 24 hours after birth, did (NAME) receive a Hepatitis B vaccination, that is, an injection in the thigh to prevent Hepatitis B?

514A) Has (NAME) received oral polio vaccines, that is, about two drops in the mouth to prevent polio?

515A) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516A) How many times did (NAME) receive the oral polio vaccine?

517A) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518A) How many times did (NAME) receive the pentavalent vaccine?

519A) Has (NAME) ever received a pneumococcal vaccination, that is an injection in the thigh to prevent pneumonia?

520A) How many times did (NAME) receive the pneumococcal vaccine?

521A) Has (NAME) ever received a rotavirus vaccination, that is liquid in the mouth to prevent diarrhea?

522A) How many times did (NAME) receive the rotavirus vaccine?

523A) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

524A) How many times did (NAME) receive the measles vaccine?

525A) Has (NAME) ever received a yellow fever vaccination?

526A) In the last seven days, was (NAME) given:

Ferrous sulfate like this (SHOW IMAGES OF PILLS OR VIAL)?
Pill for intestinal worms (SHOW IMAGES OF PILLS)?
Any nutritional supplement with whole food formula?

527A) CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B) CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS SINCE JANUARY 2012?

502B) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN SINCE JANUARY 2012.

503B) CHECK 216 FOR CHILD:

504B) Do you have a card or other document where (NAME)'s vaccination are written down?

505B) Did you ever have a vaccination card for (NAME)?

506B) CHECK 504B:

507B) May I see the card or other document where (NAME)'s vaccination are written down?

508B) COPY THE DATES FROM THE CARD
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED

AT BIRTH

AT TWO MONTHS

AT FOUR MONTHS

AT SIX MONTHS

AT NINE MONTHS (15 MONTHS FOR MEASLES)

509B) CHECK 508B: ALL VACCINES FROM 'POLIO' TO 'MEASLES' 2 RECORDED?

510B) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511B) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

512B) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

513B) Within 24 hours after birth, did (NAME) receive a Hepatitis B vaccination, that is, an injection in the thigh to prevent Hepatitis B?

514B) Has (NAME) received oral polio vaccines, that is, about two drops in the mouth to prevent polio?

515B) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516B) How many times did (NAME) receive the oral polio vaccine?

517B) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518B) How many times did (NAME) receive the pentavalent vaccine?

519B) Has (NAME) ever received a pneumococcal vaccination, that is an injection in the thigh to prevent pneumonia?

520B) How many times did (NAME) receive the pneumococcal vaccine?

521B) Has (NAME) ever received a rotavirus vaccination, that is liquid in the mouth to prevent diarrhea?

522B) How many times did (NAME) receive the rotavirus vaccine?

523B) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

524B) How many times did (NAME) receive the measles vaccine?

525B) Has (NAME) ever received a yellow fever vaccination?

526B) In the last seven days, was (NAME) given:

Ferrous sulfate like this (SHOW IMAGES OF PILLS OR VIAL)?
Pill for intestinal worms (SHOW IMAGES OF PILLS)?
Any nutritional supplement with whole food formula?

527B) CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS SINCE JANUARY 2012?

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

602) CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH SINCE JANUARY 2010. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
IF THERE ARE MORE THAN 2 BIRTHS USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE
Now I would like to ask some questions about your children born in the last five years. (we will talk about each separately).

603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

604) FROM 212 AND 216:

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

606) CHECK 466: WAS (NAME) EVER BREASTFEED?

607) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount more than usual, or nothing to eat? IF LESS PROBE: Was she/he given much less than usual to eat or somewhat less?

608) Did you seek advice or treatment for the diarrhea from any source?

SECTION 6. CHILD HEALTH AND NUTRITION

609) Where did you seek advice or treatment?
Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

610) CHECK 609:

611) Where did you first seek advice or treatment?
USE LETTER CODE FROM 609.

612) Was (NAME) given any of the following to drink at any time since (NAME) started having the diarrhea:

a) A fluid made from a special packet called Oral Rehydration Salts (ORS)?
b) A pre-packaged ORS liquid?
c) A homemade sugar-salt-water solution?
d) Iron tablets or syrup?
e) Rice water?

613) CHECK 612:

614. CHECK 612:

615) Has (NAME) been ill with a fever at any time in the last 2 weeks?

616) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

617) Did you seek advice or treatment at that time?

618) Where did you seek advice or treatment?
Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

619) CHECK 618:

620) Where did you first seek advice or treatment?
USE LETTER CODE FROM 618.

621) How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY RECORD '00'

622) At any time during the fever, did (NAME) take any drugs for the illness?

623) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED

624) CHECK 623: ANY CODE A-H CIRCLED?

625) CHECK 623: ARTEMISININ COMBINATION THERAPY ('A') GIVEN

626) How long after the fever started did (NAME) first take combination with artemisinin (ACT)?

627) CHECK 623: SP/FANSIDAR ('B') GIVEN

628) How long after the fever started did (NAME) first take (SP/Fansidar)?

629) CHECK 623:
CHLOROQUINE ('C') GIVEN

630) How long after the fever started did (NAME) first take chloroquine?

631) CHECK 623:
AMODIAQUINE ('D') GIVEN

632) How long after the fever started did (NAME) first take amodiaquine?

633) CHECK 623:
QUININE ('E' OR 'F') GIVEN

634) How long after the fever started did (NAME) first take quinine?

635) CHECK 623:
COARTEM ('G') GIVEN

636) How long after the fever started did (NAME) first take coartem?

637) CHECK 623:
OTHER ANTIMALARIAL ('H') GIVEN

638) How long after the fever started did (NAME) first take other antimalarial?

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

640) In the last 2 weeks did (NAME) breathe faster than usual with short, rapid breaths or have difficulty breathing?

641) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

642) CHECK 639:
HAD A COUGH?

643) Did you seek advice or treatment at that time when (NAME) had a cough?

644) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

645) At any time during the illness with the cough, did (NAME) take any drugs for the illness?

646) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED

647)
GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 648.

648. CHECK 612(a) AND 612(b), ALL COLUMNS:

649) Have you ever heard of a special product called (Oral Rehydration Salts) or a pre-packaged ORS liquid you can get for the treatment of diarrhea?

650) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN SINCE JANUARY 2013 LIVING WITH THE RESPONDENT

651) Now I would like to ask you about liquids or foods (NAME FROM Q. 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 649) (drink/eat):

652) CHECK 651 (CATEGORIES "g" THROUGH "v")

653) Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES', PROBE: What kind of solid, semi-solid or soft foods did (NAME FROM 649) eat?

654) How many times did (NAME FROM 649) eat solid, semisolid or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

655) The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

701) Are you currently married or living together with a man as if married?

702) Have you ever been married or lived together with a man as if married?

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

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

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

706) Does your husband/partner have any other wives or does he live with other women as if married?

707) Including yourself, in total, how many other wives or partners does your husband live with now as if married?

708) Are you the first, second? wife?

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

710) CHECK 709:

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

712) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

713) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
How old were you when you had sexual intercourse for the very first time?

714) Now I would like to ask some questions about your recent sexual activity.
When was the last time you had sexual intercourse?

IF ANSWER IS IN LESS THAN 12 MONTHS, RECORD IN DAYS, WEEKS OR MONTHS. IF IS 12 OR MORE MONTHS RECORD IN YEARS.

715) When was the last time you had sexual intercourse with this person?

716) The last time you had sexual intercourse (with this second/third person), was a condom used?

717) Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

718) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'
IF NO, CIRCLE '3'

719) How long ago did your first have sexual intercourse with this person?

720) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'

721) How old is this person?

722) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

723) In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'

724) CHECK 106:

725) CHECK 701:

726) In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

727) In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

728) CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):

729) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOR KNOWN, ASK TO SEE THE PACKAGE

730) From where did you obtain the condom last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

731) PRESENCE OF OTHERS DURING THIS SECTION

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

802) CHECK 226:

803) 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?

804. 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?

805) CHECK 226:

806) CHECK 226:

807) CHECK 303: USING A CONTRACEPTIVE METHOD?

808) CHECK 805:

809) CHECK 714:

810) CHECK 804:

811) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

813) CHECK 216:

814) 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?

815) In the last 6 months have you:

a) Heard about family planning on the radio?
b) Seen about family planning on the television?
c) Read about family planning in a newspaper or magazine?
d) Received a voice or text message about family planning on a mobile phone?
e) Read about family planning from a poster?
f) Read about family planning from leaflets or brochures?

816) CHECK 701:

817) CHECK 304:

818) CHECK 303: USING A CONTRACEPTIVE METHOD?

819) Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?

820) Would you say that not using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?

821) Does your husband/partner want the same number of children that you want, or does he want more or fewer than you want?

SECTION 9. HUSBAND'S BACKGROUND AND GENDER

901) CHECK 701:

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

903) Did your husband/partner ever attend school?

904) What was the highest level of school he attended?

905) Did your spouse/partner completed that level successfully?

905A) What was the highest grade/year he completed at that level?

906) CHECK P.59 OR P.72 FOR THE CORRESPONDING LINE NUMBER OF THE HOUSEHOLD QUESTIONNAIRE:

907) Who usually decides how the money you earn will be used: mainly you, mainly your husband/partner, you and your husband/partner jointly?

908) Would you say that the money you earn is more than what your husband/partner earns, less than what he earns or about the same?

909) Who usually decides how your husband/partner's earnings will be used: you, your husband/partner, you and your husband/partner jointly?

910) Who usually makes decisions about health care for yourself: you, your husband/partner, you and your husband/partner jointly, or someone else?

911) Who usually makes decisions about making major household purchases?

912) Who usually makes decisions about visits to your family or relatives?

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

914) In your opinion, is a husband justified in hitting or beating his wife/partner in the following situations:

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burn the food?

915) Do you know whether or not laws exist to protect people from abuse and violence in Angola?

SECTION 10. HIV/AIDS

1001) Now I would like to talk about something else.
Have you ever heard of an illness called HIV or AIDS?

1002) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

1003) Can people get the AIDS virus from mosquito bites?

1004) Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

1005) Can people get the AIDS virus by sharing food with a person who has AIDS?

1006) Is it possible for a healthy-looking person to have the AIDS virus?

1007) Can the virus that causes AIDS be transmitted from mother to a child:
a) During pregnancy?
b) During delivery?
c) By breastfeeding?

1008) CHECK 1007:

1009) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

1010) CHECK 208 AND 215:

1011) CHECK 408 FOR LAST BIRTH:

1012) CHECK FOR PRESENCE OF OTHERS, BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1013) During any of the antenatal visits for your last birth, did anyone talk to you about:
a) Babies getting the AIDS virus from their mother?
b) Things that you can do to prevent getting the AIDS virus?
c) Getting tested for the AIDs virus?

1014) Were you offered a test for the AIDS virus as part of your antenatal care?

1015) Were you tested for HIV as part of your antenatal care?

1016) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

1017) Did you get the results?

1018) Did you get another HIV test after the test during antenatal care?

1019) How long ago did you get your last HIV test?

1020) Did you ever have an HIV test?

1021) How long ago did you get your last HIV test?

1022) Where was the test done?
PROBE TO IDENTIFY THE PLACE.
IF IT IS NOT POSSIBLE TO DETERMINE IF THE PLACE IS PUBLIC OR PRIVATE, RECORD THE NAME OF THE PLACE.

1023) Did you get the results?

1024) CHECK 1017 OR 1023:

1025) You said that you have had an HIV test done. What was the result of your last HIV test?

1026) AFTER RECEIVING YOUR POSITIVE RESULTS, WERE YOU DIRECTED TO MAKE AN APPOINTMENT WITH AN HIV SPECIALIST?

1027) Did you go to this medical appointment?

1028) At any time were you directed to take antiretroviral medications on a daily basis?

1029) Did you, in fact, take antiretroviral medications to protect you from the effects of HIV?

1030) At any time in the last 30 days, did you miss at least one day of taking your antiretroviral medication?

1031) Do you know of any place where people can go to get an HIV test done?

1032) Where?
Any other place?
MULTIPLE CHOICES
PROBE TO IDENTIFY THE PLACE.
IF IT IS NOT POSSIBLE TO DETERMINE IF THE PLACE IS PUBLIC OR PRIVATE, RECORD THE NAME OF THE PLACE.

1033) Would you buy fresh vegetables from a vendor, if you knew that he or she was carrying HIV?

1034) In your opinion, should it be permitted for a professor to continue teaching in a school, if he/she has HIV, but is not sick?

1035) Do you think that children infected with HIV should attend school with children who are not infected with the virus?

1036) Are you scared of getting HIV through contact with the saliva of someone infected with HIV?

1037) CHECK 1001:

1038) CHECK 713:

1039) CHECK 1037: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

1040) Now I would like to ask you about your health in the last 12 months:
During the last 12 months, have you had a disease which you got through sexual contact?

1041) Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

1042) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1043) CHECK 1040, 1041 AND 1042:

1044. The last time you had those problems (PROBLEMS MENTIONED IN 1040/1041/1042), did you seek advice or treatment?

1045) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

1046) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

1047) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

1048) CHECK 701:

1049) Can you say no to your husband/partner if you do not want to have sexual intercourse?

1050) Can you ask your husband/partner to use a condom if you wanted him to?

SECTION 11. OTHER HEALTH ISSUES

1101) Now I would like to ask you some questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1102) Among these injections, how many were administered by a health worker (a doctor, a nurse, a pharmacy clerk, dentist, or other health worker)?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1104) Do you currently smoke cigarettes everyday, occasionally, or not at all?

1105) How many cigarettes did you smoke, daily?

1106) Do you currently smoke or use any other type of tobacco everyday, occasionally, or not at all?

1107) What (other) type of tobacco do you currently smoke or use?
RECORD ALL ANSWERS MENTIONED.

1108) Currently, do you drink beer, wine or other alcoholic beverage everyday, occasionally, or not at all?

1109) 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?

a) Getting permission to go?
b) Getting money needed for treatment?
c) The distance to the health facility?
d) Not wanting to go alone?

1110) Are you covered by any medical assistance or health insurance?

1111) In the last 30 days, have you sought medical treatment for an illness or accident?

1112) During the last 30 days, have you sought medical treatment only one time, or more than one time?

1113) Where did you obtain medical treatment (the last time)?

1114) The last time you went to the (HEALTH CARE UNIT SPECIFIED IN 1113), how long did it take to be seen by a health care professional?

1115) While you were waiting to be seen, were you standing or were you seated?

1116) At the time of your last medical appointment, could you understand the health care personnel easily, with difficulty, or not at all?

1117) Did the last person who saw you speak the same language as you normally use or did they speak a different language?

1118) In general, were you very satisfied, reasonably satisfied, unsatisfied or very unsatisfied with the treatment you received at this last appointment?

SECTION 12: MATERNAL MORTALITY

1201) Now I would like to talk about your brothers and sisters, in other words, all the children born by your mother, including those that live with you, those that live elsewhere, and those who have died.

How many children did your mother have, including yourself?

1202) CHECK 1201:

1203) How many of these births did your mother have before you were born?

1204) Please tell me the name of each of your brothers and sisters, either living or dead, beginning with the oldest?

1205) Is (NAME) male or female?

1206) Is (NAME) alive?

1207) How old is (NAME)?

1208) How many years ago did (NAME) die?

1209) How old was (NAME) when s/he died?

1210) Was (NAME) pregnant when she died?

1211) Did (NAME) die during labor?

1212) Did (NAME) die within two months after labor or after losing the child?

1213) Did she die due to pregnancy complications, abortion or labor?

1214) Did (NAME) die at home, on the way to the hospital, in the hospital or in another place?

1215) How many born live children did (NAME) give birth to during her lifetime?

IF THERE ARE NO OTHER BROTHERS OR SISTERS, GO TO THE NEXT SECTION.

SECTION 13. DOMESTIC VIOLENCE MODULE

1300) CHECK HOUSEHOLD QUESTIONNAIRE COVER PAGE,

1301) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

1302) READ TO THE RESPONDENT
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the conditions of women's lives in Angola. Let me assure you that your answers are completely confidential, that is, they will not be told to anyone and no one else in your household will know that you answered these questions.

1303) CHECK 701 AND 702:

1304) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?

A) He is(was) jealous or angry if you talk(talked) to other men?
B) He frequently accuses(accused) you of being unfaithful?
C) He does(did) not allow you to meet with your female friends?
D) He tries(tried) to limit your contact with your family?
E) He insists(insisted) on knowing where you are(were) at all times?
F) He does(did) not trust you to manage money?

1305) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

A. Does (did) your (last) husband/partner ever:

A) Say or do something to humiliate you in front of others?
B) Threaten to hurt or harm you or someone close to you?
C) Insult you or make you feel bad about yourself?

B) How often did this happen during the last 12 months: often, only sometimes, or never?

1306. A. (Does/did) your (last) husband/partner ever:

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1307. CHECK 1306 (a-j):

1308. How long after you (first got married to/started living together) did that thing(s) you just mentioned first happen?
IF LESS THAN 1 YEAR, RECORD '00'.

1309) Did the following ever happen as a result of the actions of your (last) husband/partner:
Did you have cuts, bruises or pain?
Did you have eye injuries, sprains, dislocations, or burns?
Did you have deep wounds, broken bones, broken teeth or any other serious injury?

1310) Have you ever hit, slapped, kicked or done anything else to physically hurt your husband/partner at times when he was not already beating or physically hurting you?

1311) How often did you do this to your (last) husband/partner during the last 12 months: often, only sometimes, rarely or not at all?

1312) Does (did) your husband/partner drink alcohol?

1313) How often does (did) he get drunk: often, only sometimes, or never?

1314) Some men can become violent when they drink alcohol and get drunk. Has your husband/partner become violent after drinking alcoholic beverages?

1315) In the last 12 months, how many times did your husband/partner became violent after drinking alcoholic beverages: often, only sometimes, or never?

1316) Do/did you fear your husband/partner most of the time, sometimes, or never?

1317) CHECK 709:

1318) Until now, we have spoke about the behavior of your (last/current) husband/partner. Now I would like to ask you some questions about your previous husband(s)/partner(s).
Did any previous (husband/partner) hit, slap, kick, or hurt you in any other way?
AT ANY TIME

B) How long ago did this occur?

b) Did any previous (husband/partner) physically force you to have sexual intercourse or any other sexual act against your will?
AT ANY TIME

B) How long ago did this occur?

1319) CHECK 701 AND 702:

1320) Who hurt you?
Anyone else?
RECORD ALL ANSWERS MENTIONED

1321) In the past 12 months, how often were you hurt by this(these) person(people): often, only sometimes or never?

1322) CHECK 201, 226 AND 230:

1323) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

1324) When you were pregnant, who hurt you in this way?
Anyone else?
MULTIPLE RESPONSES

1325) CHECK 701 AND 702:

1326) Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

1327) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

1328) Who was the person who was forcing you the very first time this happened?

1329) CHECK 701 AND 702:

1330) CHECK 1306 (h-j) AND 1318A(b)

1331) CHECK 701 AND 702:

1332) CHECK 1306 (a-j), 1318 (a, b), 1319, 1326 AND 1327:

1333) Thinking about what you yourself have experienced among different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

1334) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.

1335. What was the reason you did not seek any help?

RECORD ALL MENTIONED.

1336) Have you ever told anyone else about this?

1337) As far as you know, did your father ever beat your mother?

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1338) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1339) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE ________________________________________________________________________________________________________________________________________________________

1340) RECORD TIME

INTERVIEWER'S OBSERVATIONS
To be filled in after completing interview

COMMENT ABOUT THE INTERVIEW: __________
COMMENTS ON SPECIFIC QUESTIONS __________
ANY OTHER COMMENTS________

SUPERVISOR'S OBSERVATIONS ________________

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS AND PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
J STANDARD DAYS METHOD
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM, PERIODIC ABSTINENCE
M WITHDRAWAL
X OTHER MODERN METHODS.
Y OTHER TRADITIONAL METHODS.

COLUMN 2: NOT USING CONTRACEPTIVE METHODS
0 IRREGULAR SEXUAL RELATIONS/ABSENT PARTNER
1 GOT PREGNANT WHILE USING A METHOD
2 STOPPED METHOD TO GET PREGNANT
3 HUSBAND/PARTNER REFUSED TO USE A METHOD
4 WANTED A MORE EFFICIENT METHOD
5 SECONDARY EFFECTS
6 NOT ACCESSIBLE/LONG DISTANCE
7 HIGH PRICE
8 INCONVENIENT METHOD
F GOD'S WILL/FATALISTIC
A DIFFICULT TO GET PREGNANT IN MENOPAUSE
D DIVORCED/SEPARATED/WIDOW
X OTHER (SPECIFY) ______

Z DON'T KNOW
COL 1. COL. 2
2016
12 DEC ___ 01
11 NOV ___02
10 OCT ___03
09 SEP ___04
08 AGO__05
07 JUL ___06
06 JUN ___07
05 MAY ___08
04 APR ___09
03 MAR ___10
02 FEB ___11
01 JAN ___12

2015
12 DEC ___ 13
11 NOV ___14
10 OCT ___15
09 SEP ___16
08 AGO__17
07 JUL ___18
06 JUN ___19
05 MAY ___20
04 APR ___21
03 MAR ___22
02 FEB ___23
01 JAN ___24

2014
12 DEC ___ 25
11 NOV ___26
10 OCT ___27
09 SEP ___28
08 AGO__29
07 JUL ___30
06 JUN ___31
05 MAY ___32
04 APR ___33
03 MAR ___34
02 FEB ___35
01 JAN ___36

2013
12 DEC ___ 37
11 NOV ___38
10 OCT ___39
09 SEP ___40
08 AGO__41
07 JUL ___42
06 JUN ___43
05 MAY ___44
04 APR ___45
03 MAR ___46
02 FEB ___47
01 JAN ___48

2012
12 DEC ___ 49
11 NOV ___50
10 OCT ___51
09 SEP ___52
08 AGO__53
07 JUL ___54
06 JUN ___55
05 MAY ___56
04 APR ___57
03 MAR ___58
02 FEB ___59
01 JAN ___60

2011
12 DEC ___ 61
11 NOV ___62
10 OCT ___63
09 SEP ___64
08 AGO__65
07 JUL ___66
06 JUN ___67
05 MAY ___68
04 APR ___69
03 MAR ___70
02 FEB ___71
01 JAN ___72

2010
12 DEC ___ 73
11 NOV ___74
10 OCT ___75
09 SEP ___76
08 AGO__77
07 JUL ___78
06 JUN ___79
05 MAY ___80
04 APR ___81
03 MAR ___82
02 FEB ___83
01 JAN ___84