BANGLADESH

IDENTIFICATION

DIVISION:
DISTRICT:
THANA:
UNION OR WARD:
VILLAGE OR MOHALLA OR BLOCK:
CLUSTER NUMBER:
HOUSEHOLD NUMBER:

DHAKA/CHITTAGONG OR SMALL CITY OR TOWN OR VILLAGE?

NAME OF HOUSEHOLD HEAD:
NAME AND LINE NUMBER OF ELIGIBLE WOMAN:

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME

FINAL VISIT
DATE
MONTH

YEAR
CODE
RESULT

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 ___. We came from the Mitra and Associates, a private research organization, is located at Dhaka. To assist in the implementation of socio-development programs in the country, we conduct different types of surveys. We are now conducting a national survey about the health of women and children under the authority of NIPORT of ministry of Health and Family Welfare. 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?

Signature of interviewer:

Date:

101. RECORD THE TIME STARTED.

102. First I would like to ask 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)?

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

105. In what month and year were you born?

106. How old are you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

106A. Are you now married, widowed, or divorced?

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 class you completed?

110. CHECK 108:

111. Can you read and write a letter in any language easily, with difficulty, or not at all?

112. Do you usually read a newspaper or magazine?

112. How often do you read newspaper or magazine: every day, at least once a week, or less than once a week?

113. Do you listen to the radio?

113A. How often do you listen to the radio: every day, at least once a week, or less than once a week?

114. Do you watch television?

114A. How often do you watch television: every day, at least once a week, or less than once a week?

115. What is your religion?

118. Do you belong to any of the following organizations?

119. CHECK QUESTION 5 IN THE HOUSEHOLD SECTION:

120. Now I would like to ask about the place in which you usually live. Do you usually live in a city, in a town, or in a village?

IF CITY: In which city do you live?

121. In which division is that located?

122. Now I would like to ask you some questions about your household where you usually live. What is the main source of water your household uses for dishwashing?

123. What is the main source of drinking water for members of your household?

123A. Do you boil drinking water?

124. What kind of toilet facility does your household have?

125. Do you share this facility with other households?

126. Does your household (or any member of your household) have:

127. What is the material of the roof of your house?

128. What is the material of the walls of your house?

129. What is the material of the floor of your house?

130. Does your household own any homestead?

IF 'NO', PROBE: Does your household own homestead any other places?

130A. Does your household own any land (other than the homestead land)?

131. How much land does your household own (other than the homestead land)?

132. In terms of household food consumption, how do you classify your household: deficit in whole year; sometimes deficit; neither deficit nor surplus; surplus.

133. Does your family have vulnerable group feeding (VGF) card?

134. Do you have any male or female member in this household who are receiving old age pension or widow or destitute benefit?

SECTION 2. REPRODUCTION

201. Now I would like to ask 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?

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 survived only a few hours or days?

207. In all, 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 THE BIRTHS IN 212. IF NO NAME WAS GIVEN, RECORD 'NO NAME' 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?

216. Is (NAME) still alive?

217. IF ALIVE: How old was (NAME) at his or 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 or she died?

IF '1 YEAR', 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)?

(IF MORE THAN ONE BIRTH)

222. Have you had any pregnancy outcome since the birth of (NAME OF LAST BIRTH)?

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

NUMBERS ARE THE SAME CHECK:

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE APRIL 1994 (BAISHAK 1401).

IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE APRIL 1994 OR BAISHAK 1401, 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 '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 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 or had a menstrual regulation?

230. When did the last such pregnancy end?

231. CHECK 230:

231A. Was that a stillbirth, a miscarriage, a menstrual regulation, or an abortion?

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

RECORD 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 which 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 APRIL 1994 (BAISHAK 1401).

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

235. IN THE BOXES AT THE BOTTOM OF THE CALENDAR, FILL IN THE MONTH AND YEAR OF TERMINATION OF THE LAST NON-LIVE BIRTH PREGNANCY PRIOR TO APRIL 1994 (BAISHAK 1401).

236. When did your last menstrual period start?

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 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED IN 302. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?
302. Have you ever heard of (METHOD)?

303. Have you ever used (METHOD)?

303A. CHECK 303:

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

305. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (GO TO 328)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY)

306A. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. What was the first method that you ever used?

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

IF NONE, RECORD '00'.

308. CHECK 303 (01):

308A. CHECK 106A:

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 '01' FOR FEMALE STERILIZATION.

312A. May I see the package of pills that you are using now?
RECORD NAME OF BRAND IF PACKAGE IS SEEN

312B. SHOW BRAND CHART FOR PILLS: Please tell me which of these is the brand of pills that you are using.

312C. May I see the package of condoms that you are using now?
RECORD NAME OF BRAND IF PACKAGE IS SEEN.

312D. SHOW BRAND CHART FOR CONDOMS: Please tell me which of these ist he brand of condoms that you are using.

313. Where did the sterilization take place?

314. CHECK 311:

CODE '1' CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

CODE '2' CIRCLED: Before the sterilization operation, was your husband told that he would not be able to have any (more) children because of the operation?

315A. Do you regret that (you or your husband) had the operation not to have any more children?

315B. Why do you regret it?

316. In what month and year was the sterilization operation performed?

317. CHECK 316:

318. CHECK 311: IN CURRENT MONTH IN COLUMN 1 OF CALENDAR, ENTER CALENDAR METHOD CODE SHOWN TO THE LEFT OF THE CALENDAR FOR THE HIGHEST METHOD CIRCLED IN 311. THEN DETERMINE WHEN SHE STARTED USING METHOD THIS TIME. ENTER METHOD CODE IN EACH MONTH OF USE. IF CURRENT METHOD STARTED IN APRIL 1994 (BAISHAK 1401) OR LATER, ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN THE SAME MONTH THAT USE OF CURRENT METHOD BEGAN.

ILLUSTRATIVE QUESTIONS:

319. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIOD OF USE AND NONUSE, STARTING WITH MORE RECENT USE, BACK TO APRIL 1994 (BAISHAK 1401). USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD OF USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS FOR COLUMN 1:

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS FOR COLUMN 2:

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE THE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTION FOR COLUMN 3:

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

320. CHECK 311 OR 311A:

CIRCLE METHOD CODE:

321. CHECK COLUMN 1 OF CALENDAR FOR MONTH STARTED USING CURRENT METHOD:

322. You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about side effects or problems you might have with the method?

323. Were you told what to do if you experienced side effects or problems?

324. CHECK COLUMN 1 OF CALENDAR FOR MONTH STARTED USING CURRENT METHOD:

325. CHECK 320:

ANY CODE '01'-'06' CIRCLED: At that time, were you told about other methods of family planning which you could use?

CODE '11' CIRCLED: You first obtained advice for (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about other methods of family planning which you could use?

325A. You had told me that you are currently using family planning. Would you say that using family planning is mainly your decision, mainly your husband's decision or did you both decide together?

326. CHECK 311 AND 311A:

CIRCLE METHOD CODE:

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

327A. CHECK 311 AND 311A:

327B. Who obtained the (pills or condoms) the last time you got them?

327C. Are you having any problems in using (CURRENT METHOD)?

327D. What problems are you having with using (CURRENT METHOD)?

328. Do you know of a place where you can obtain a method of family planning?

329. Where is that?
IF WOMAN SAYS MORE THAN ONE PLACE, ASK FOR THE PLACE SHE WOULD MOST LIKELY USE.

330. CHECK 327 AND 329:

331. In some places, there is a clinic set up for a day or part of a day in someone's house of in a school. During the past 3 months, was there any such clinic in this village or mohalla?

332. Did you visit such a temporary health clinic in the last 3 months?

333. What services did you receive?
CIRCLE ALL MENTIONED.

334A. During the last six months has anyone visited you in your house to talk to you about family planning or to give you any family planning method?
IF YES: Who came? Anyone else?
WRITE THE NAME AND WORKER IDENTIFICATION NUMBER OF THE FIELD WORKER.

334B. How many times did a worker or workers visit you for the family planning in the last six months?

334C. When was the last visit?

IF MORE THAN ONE WORKER VISITED: When did the last worker visit you?
IF LESS THAN ONE MONTH AGO, WRITE '0'.

335A. During the last six months has anyone visited you in your house to talk to you about your health or your child health or to give you any medicine such as vitamin A or ORS?
IF YES: Who came? Anyone else?
WRITE THE NAME AND WORKER IDENTIFICATION NUMBER OF THE FIELD WORKER.

335B. How many times did a worker visit you for the health services in the last six months?

335C. When was the last visit?

IF MORE THAN ONE WORKER VISITED: When did the last worker visit you?
IF LESS THAN ONE MONTH AGO, WRITE '0'.

336. CHECK 334A AND 335A:

337. Is he or she the same person who talked to you about family planning or gave you family planning method and talked to you about health or provided health services?

338. Did you discuss about family planning or health with a fieldworker in the last 6 months?

338A. What did you discuss?

339. When was the last time in the last 6 months you had contact with the fieldworker?
IF LESS THAN ONE MONTH AGO, WRITE '0'.

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. Now we will talk about possible problems that women might face when she is going to have a child. Please tell me what are the complications during pregnancy, childbirth and after delivery that needs medical treatment.
401A. Have you ever heard or (PROBLEMS)

401B. CHECK 401 AND 401A:

401C. Where can someone go to seek medical services for this (these) problem(s)? Any other place?
RECORD ALL MENTIONED.

402A. CHECK 215:

402B. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE APRIL 1994 OR BAISHAK 1401. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE 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 one child at a time.)

403. LINE NUMBER FROM QUESTION 212

404. FROM QUESTION 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, did you not want to have any (more) children at all?

FOR MOST RECENT BIRTH IN THE LAST FIVE YEARS:

FOR PREVIOUS BIRTHS IN THE LAST FIVE YEARS:

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

406A. During the time you were pregnant with (NAME) did you receive any TT injection?

406B. How many TT injection did you receive during the pregnancy with (NAME OF LAST CHILD)?

406C. Before the pregnancy wit (NAME OF LAST CHILD) did you receive any TT injection?

406D. How many TT injections did you have before this pregnancy?

406E. CHECK 406A AND 406C:
(MOST RECENT BIRTH WITHIN THE LAST FIVE YEARS)

406F. Did you have an immunization card where TT injections are recorded?
IF YES: May I see it, please?

406G. COPY TT INJECTIONS DATE FOR EACH INJECTION FROM THE CARD.

SUM ANSWER TO 406 B AND 406 D AND COMPARE WITH NUMBER OF TT INJECTION IN CARD. IF NUMBER ARE DIFFERENT, PROBE AND RECONCILE. (GO TO 407)

406H. You have mentioned that you received (NUMBER OF TT INJECTION IN QUESTION 406 B) TT injection during pregnancy with (NAME OF LAST CHILD). In what month(s) of pregnancy did you receive this (these) injections?
CODE 1 TO 9 FOR EACH INJECTION GIVEN, '0' FOR MONTH NOT KNOWN.

407. When you were pregnant with (NAME), did you see anyone for a medical checkup, for example, antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?

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

407A. Why did you not see anyone? Any other reason?
RECORD ALL MENTIONED.

408. How many months pregnant were you when you first received medical checkup, for example, antenatal care for this pregnancy?

409. How many times did you receive medical checkup during this pregnancy?

410. CHECK 409:
NUMBER OF TIMES RECEIVED MEDICAL CHECKUP (i.e. ANTENATAL CARE).

411. How many months pregnant were you the last time your received medical checkup, for example, antenatal care?

412A. During this pregnancy, were you weighed at least once?

412B. During this pregnancy, was your height measured?

412C. During this pregnancy, did anyone take your blood pressure (put a cuff on your arm and pump air into it)?

412D. When you were pregnant with (NAME), did anyone take your urine for testing?

412E. When you were pregnant with (NAME), did anyone take your blood for testing?

412F. When you were pregnant with (NAME), did anyone check or exam your eye for anemia?

413. When you were pregnant with (NAME) were you told about the signs of pregnancy complications?

414. Were you told where to go if you had these complications?

416. Did you take any iron tablet or iron syrup during this pregnancy?
SHOW TABLET OR SYRUP.

420. Around the time of the birth (NAME), did you have any of the following problems:

420A. CHECK 420:

421. Did you seek any assistance for this complication?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

421A. When you had this complication did your husband become concerned?

421B. When you had this complication, did your mother-in-law become concerned?

422. When (NAME) was born, was he or she: very large, larger than average, average, smaller than average, or very small?

423. When (NAME) was born, was your husband around?

425. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

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

427. Was (NAME) delivered by caesarian section?

428. After (NAME) was born, did any medical persons check on your health?

429. How many days or weeks after the delivery did the first check takes place?
RECORD '00' DAYS IF SAME DAY

430. Who check on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

431. Where did this first check take place?

432. In the first two months after delivery, did you take a Vitamin A capsule like this?
SHOW CAPSULE.

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

434. Did your period return between the birth of (NAME) and our next pregnancy?
(REPEAT QUESTIONS FOR ALL CHILDREN BORN IN THE LAST FIVE YEARS, EXCLUDING THE MOST RECENT BIRTH)

435. For how many months after the birth of (NAME) did you not have your period?

436. CHECK 226:
RESPONDENT PREGNANT?

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

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

439. Did you ever breastfeed (NAME)?

440. 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.

441. CHECK 404:

CHILD ALIVE?

442. Are you still breastfeeding (NAME)?

443. For how many months did you breastfeed (NAME)?

444. CHECK 404:

445. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

446. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

448. At any time yesterday or last night was (NAME) given any of the following:

450. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 451.

SECTION 4B, IMMUNIZATION AND HEALTH

451. ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE APRIL 1994 (BAISHAK 1401) IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN TWO BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

452. LINE NUMBER FROM QUESTION 212:

453. FROM QUESTIONS 212 AND 216:

454. Did (NAME) receive a Vitamin A dose like this during the last 6 months?
SHOW CAPSULE

455. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?

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

457. COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

WRITE "44" IN "DAY" COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

457A. Did you child (NAME) receive any polio vaccine from National Immunization Day (NID)?

IF YES: How many times did you receive from NID campaign?

RECORD '0' IF NOT RECEIVED

458. Has (NAME) received any vaccinations that were not recorded on this card?

RECORD "YES" ONLY IF RESPONDENT MENTIONS BCG, POLIO1-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

459. Did (NAME) receive any vaccinations to prevent him or her from getting diseases?

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

460A. A bcg vaccination against tuberculosis, that is, and injection in the left shoulder that caused a scar?

460B. Polio vaccine, that is, drops in the mouth?

460C. How many times did (NAME) receive polio vaccine:

460D. When was the first polio vaccine received, just after birth or later?

460E. DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

460F. How many times?

460G. An injection to prevent measles?

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

464. Has (NAME) been ill with a cough at any time in the last 2 weeks?

465. In the last 2 weeks, did (NAME) had:

466. CHECK 463 AND 464:

FEVER OR COUGH?

467. Did you seek advice or treatment for (NAME) for the illness?

468. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED

472. Has (NAME) had diarrhea is the last 2 weeks?

473. When (NAME) had diarrhea, was he or she offered the same amount to drink, more than usual to drink, or less than usual to drink?

474. Was he or she offered the same amount to eat, more than usual to eat or less than usual to eat?

475. When (NAME) had diarrhea, was he or she given any of the following to drink:

476. Was anything (else) given to treat the diarrhea?

477. What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED.

478. Did you seek advice or treatment for the diarrhea?

479. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED

480. GO BACK TO 453 IN NEXT COLUMN; OR IF NOW MORE BIRTHS, GO TO 480A.

480A. CHECK 208 AND 226:

480B. Many different factors can prevent women getting medical attention during the pregnancy and child birth. Sometimes women might have life threatening or serious situation during the pregnancy and childbirth. When you need medical advice or treatment for such situation, is each of the following a problem or no problem for you?

SECTION 5. MARRIAGE

501. PRESENCE OF OTHERS AT THIS POINT.

501A. CHECK 106A:

505. Is your husband staying with you now or is he staying elsewhere?

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

507. Have you been married or lived with a man only once, or more than once?

508. CHECK 507:

MARRIED ONLY ONCE: In what month and year did you start living with your husband?

MARRIED MORE THAN ONCE: Now we will talk about your first husband. In what month and year did you start living with him?

509. How old were you when you started living with him?

510. DETERMINE MONTHS MARRIED SINCE APRIL 1994 OR BAISHAK 1401. ENTER "X" IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER "0" FOR EACH MONTH NOT MARRIED, SINCE APRIL 1994 (BAISHAK 1401).

FOR WOMEN WITH MORE THAN ONE MARRIAGE: PROBE FOR STARTING AND TERMINATION DATES OF ANY PERVIOUS UNIONS.

FOR WOMEN NOT CURRENTLY MARRIED: PROBE FOR DATE WHEN LAST MARRIAGE STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATIONS DATES OF ANY PREVIOUS MARRIAGES.

SECTION 6. FERTILITY PREFERENCES

601A. CHECK 106A:

601B. CHECK 311 AND 311A:

602. CHECK 226:

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

PREGNANT: 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: How long would you like to wait from now before the birth of (a or another) child?

PREGNANT: 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 METHOD?

606. CHECK 603:

607. CHECK 602:

WANTS A OR ANOTHER CHILD(REN): You said that you do not want (a or another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why?

WANTS NO MORE CHILDREN: 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?
RECORD ALL MENTIONED.

609. CHECK 310:
USING A METHOD?

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

611. Which method would you prefer to use?

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

614. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time 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: 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 it not matter?

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

617. Have you ever seen or heard of the Green Umbrella logo?

618. What does the Green Umbrella logo mean to you?
CIRCLE ALL MENTIONED.

619. In the last month have you heard about family planning:

619A. CHECK 106A:

620. Now I want to ask you about your husband's views on family planning. Do you think that your husband approves or disapproves of couples using a method to avoid pregnancy?

621. How often have you talked to your husband about family planning in the past year?

622. Do you think your husband wants the same number of children that you want, or does he want more or fewer than you want?

SECTION 7. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

701A. From which sources of information have you learned most about AIDS? Any other sources? RECORD ALL MENTIONED.

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

703. What can a person do? Anything else?
RECORD ALL MENTIONED.

704. CHECK 703:

705. In your opinion, is there any chance of getting AIDS for a person with multiple sexual partners?

706. If a person has sex with only one partner, does this person have a greater or a lesser chance of getting AIDS than a person who has sex with many partners?

707. CHECK 703:

709. If a person uses a condom every time he or she has sexual intercourse, does this person have a greater or a lesser chance of getting AIDS than someone who does not use a condom?

710. Is it possible for a health-looking person to have the AIDS virus?

714. CHECK 106A:

715. Have you ever talked about ways to prevent getting the virus that causes AIDS with your husband?

718. (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?

719. In a man, what signs and symptoms would lead you to think that he has such an infection? Any others?
RECORD ALL MENTIONED.

720. In a woman, what signs and symptoms would lead you to think that she has such an infection? Any others?
RECORD ALL MENTIONED.

721. Now I would like to ask you about some health symptoms you yourself may have. During the past 6 months, have you had any of the following problems:

FOR CURRENTLY MARRIED:

726. CHECK 721:

727. Have you seen anyone for advice or treatment to help you with (this or these) problem(s)?
IF YES, ASK: Whom did you see? Anyone else?
RECORD ALL MENTIONED.

SECTION 8. HUSBAND'S BACKGROUND, WOMAN'S WORK

801. CHECK 106A:

802. How old was your husband or partner on his last birthday?

803. Did your (last) husband ever attend school?

804. What was the highest level of school he attended: primary, secondary, or higher?

805. What was the highest (grade or form or year) he completed at that level?

806. What kind of work does (did) your (last) husband mainly do?

807. Now I would like to ask you some questions about your work. Aside from your own housework, are you currently working?

808. As you know, some women take up jobs for which they are paid in cash or kind. Others sell thing, 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?

809. What is your occupation, that is, what kind of work do (did) you mainly do?

810. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

811. Are you paid in cash or kind for this work or are you not paid?

812. Who in your family usually has the final say on the following decisions:

812A. Do you think, if a woman faces complication during pregnancy, does her husband become concerned?

813. How frequently do you go shopping or marketing?

814. Do you usually go by yourself or do you go with children or your husband or other relatives?

815. Do you go outside the village or town or city alone (or with your young children)?

816. Can you go outside the village or town or city along (or with your young children)?

817. How frequently do you go outside this village or town or city?

818. Do you go to a health center or hospital alone (or with you young children)?

819. Can you go to a health center or hospital alone (or with your young children)?

820. RECORD THE TIME.

SECTION 9. HEIGHT AND WEIGHT

901. CHECK 215:

IN 902 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE APRIL 1994 OR BAISHAK 1401 AND STILL ALIVE. IN 903 AND 904 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE APRIL 1994 (BAISHAK 1401). IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.

(NOT: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE APRIL 1994 OR BAISHAK 1401 SHOULD BE WEIGHED AND MEASURED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE APRIL 1994 OR BAISHAK 1401, USE ADDITIONAL QUESTIONNAIRES).

902. LINE NUMBER FROM QUESTION 212
(FOR LIVING CHILD(REN) BORN SINCE APRIL 1994)

903. NAME (FROM QUESTION 212 FOR CHILDREN)

904. DATE OF BIRTH FROM QUESTION 215, AND ASK FOR DAY OF BIRTH.
(FOR LIVING CHILD(REN) BORN SINCE APRIL 1994)

905. BCG SCAR ON TOP LEFT SHOULDER
(FOR LIVING CHILD(REN) BORN SINCE APRIL 1994)

906. HEIGHT (IN CENTIMETERS)

907. WAS LENGTH OR HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP? (FOR LIVING CHILD(REN) BORN SINCE APRIL 1994)

908. WEIGHT (IN KILOGRAMS)

909. DATE WEIGHED AND MEASURED

910. RESULT

911.

NAME OF MEASURER: ______
NAME OF ASSISTANT: ______

CALENDAR

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1, 3, AND 4, ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

COLUMN 2: SOURCE OF CONTRACEPTION

COLUMN 3 DISCONTINUATION OF CONTRACEPTIVE USE

COLUMN 4 MARRIAGE OR UNION

TERMINATION OF LAST PREGNANCY PRIOR TO APRIL 1994
IF NO PREVIOUS PREGNANCY, RECORD '00' FOR MONTH AND '0000' FOR YEAR

1407

1406

1405

1404

1403

1402

1401

2000

1999

1998

1997

1996

1995

1994

INTERVIEWER'S OBSERVATIONS

(TO BE FILLED IN AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS:
NAME OF SUPERVISOR:
DATE:

EDITOR'S OBSERVATIONS
NAME OF EDITOR:
DATE: