IDENTIFICATION

CLUSTER NUMBER____
HOUSEHOLD NUMBER____
NAME OF THE HOUSEHOLD HEAD____
NAME AND LINE NUMBER OF WOMAN____
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

INTERVIEWER VISITS

FIRST VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:

NEXT VISIT:
DATE____
TIME____

SECOND VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:

NEXT VISIT:
DATE____
TIME____

THIRD VISIT:
DATE____
INTERVIEWER'S NAME____
RESULT:

FINAL VISIT:
DAY____
MONTH____
YEAR: 2007
INT. NUMBER____
RESULT:

TOTAL NUMBER OF VISITS____

SUPERVISOR
NAME____
DATE____

FIELD EDITOR
NAME____
DATE____

OFFICE EDITOR____
KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is ____ and I am working with Mitra and Associates, a private research organization located in 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, men 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 you children. This 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 the survey is completely voluntary. If we should come to any 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. However, we hope you will participate in the 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?
Signature of interviewer: ____
Date: ____

101) RECORD THE TIME.

102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD '00' YEARS.

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

104) In what month and year were you born?

105) How old were you at your last birthday? COMPARE AND CORRECT 104 AND/OR 105 IF INCONSISTENT.

105A) Are you now married, separated, deserted, widowed, divorced or have you never been married?

106) Have you ever attended school/madrasha?

106A) What type of school have you last attended?

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

108) What is the highest class you completed at that level?

109) CHECK 107:

110) Now I would like 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 a newspaper or magazine?

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

113) Do you listen to the radio?

113A) Do you listen to the radio almost every day, at least once a week, or less than once a week?

114) Do you watch television?

114A) Do you watch television almost every day, at least once a week, or less than once a week?

115) What is your religion?

116) Do you belong to any of the following organizations?
Grameen Bank?
BRAC?
BRDB?
ASHA?
PROSHIKA?
Mother's Club?
Any other organization (such as micro credit)?

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? IF NONE, RECORD '00'.

206) Have you ever given birth to a boy or girl who was born alive but 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 THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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 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), including any children who died after birth?

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.

223) COMPARE 2008 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2002 OR LATER. IF NONE, RECORD '0'.

225) FOR EACH BIRTH SINCE JANUARY 2002, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. 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.)

226) Are you pregnant now?

227) How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN THE 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?

228A) Have you ever heard of menstrual regulation (MR)? MR means when a woman's menstrual period does not come on time, she can go to a health centre or to the FWV or to another provider and have a tube put in her for a short while to regulate her periods.

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

229A) CHECK 228B AND 229:

230) When did the last such pregnancy/menstrual interruption occur?

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 THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233) Since January 2002, have you 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 2002. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any miscarriages, abortions, stillbirths or MR that ended before 2002?

236) When did the last such pregnancy that terminated before 2002 end?

237) When did your last menstrual period start?

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 a pregnancy.
Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
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 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.

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?

305) ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH (GO TO 322)

306) What have you used or done? CORRECT 302 AND 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):

308A) CHECK 105A:

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? CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

311A) CIRCLE 'A' FOR FEMALE STERILIZATION.

312) RECORD IF CODE 'C' FOR PILL IS CIRCLED IN 311.

313) PLEASE SHOW THE BRAND CHART FOR PILLS AND CONDOMS. Do you know the brand name of the (pills/condoms) you are using? RECORD NAME OF BRAND.

313A) Who obtained the (pills/condoms) the last time you got them?

314) Where did the sterilization take place? 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.

315) CHECK 311/311A:

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

316A) Since what month and year have you been using (CURRENT METHOD) without stopping? PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

317) CHECK 316/316A, 215 AND 230: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A

318) CHECK 316/316A:

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 PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2002. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

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

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

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

323) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE THE NAME OF THE PLACE.

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

325) Did you visit such a temporary health clinic in the last 3 months?

326) What services did you receive?

327) 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?

328) Who visited you to talk about family planning or to give you family planning methods? Anyone else? WRITE THE NAME OF THE FIELDWORKER(S)

329) During the last six months, how many times did a worker or workers visit you to talk about family planning or to give you family planning methods?

330) When was the last time you were visited by a fieldworker who talked to you about family planning? IF MORE THAN ONE WORKER VISITED: When did the last worker visit you? IF LESS THAN ONE MONTH AGO WRITE '0'

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS 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 them, 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 have liked to wait?

407) When you were pregnant with (NAME), did you see anyone for a medical checkup? IF YES: Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
IF CODE 'D' CIRCLED: WRITE NAME OF CSBA

408) Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UN ABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

409) How many months pregnant were you when you first received antenatal care for this pregnancy?

410) How many times did you receive antenatal care during this pregnancy?

411) As part of your antenatal care during this pregnancy, were any of the following done at least once?
Were you weighed?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?
Did you have an ultrasonography?

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

413) Were you told where to go if you had any of these complications?

413A) Why did you not see anyone for antenatal care?

414) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

415) During this pregnancy, how many times did you get this tetanus toxoid injection?

416) CHECK 415:

417) At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

418) Before this pregnancy, how many other times did you receive a tetanus injection? IF 7 OR MORE TIMES, RECORD '7'.

419) In what month and year did you receive the last tetanus injection before this pregnancy?

420) How many years ago did you receive that tetanus injection?

421) Did you take any iron tablet or iron syrup during this pregnancy? SHOW TABLETS/SYRUP.

422A) Around the time of the birth of (NAME), did you have any of the following problems:
a) Long labor, that is, regular contractions that lasted more than 12 hours?
b) Excessive bleeding that was so much that you feared it was life threatening?
c) A high fever with bad smelling vaginal smelling vaginal discharge?
d) Convulsions?
e) Baby's hands and feet came first during delivery?
f) Retained placenta?

422B) CHECK 422A:

422C) Did you seek assistance for this complication? IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED. IF CODE 'D' CIRCLED, WRITE NAME OF CSBA.

422D) Where did you seek assistance for this complication? Anywhere else? PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

422E) CHECK 422D:

422F) Where did you first seek assistance for this complication? USE LETTER CODE FROM 422D.

422G) Why did you not seek treatment for this complication?

423) 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. IF CODE 'D' CIRCLED, WRITE NAME OF CSBA

424) Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

425) How long after (NAME) was delivered did you stay there? IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

426) Was (NAME) delivered by caesarean section?

430A) CHECK 215:

Now I would like to ask you some specific questions about what was done with (NAME) immediately following delivery.

430B) What was used to cut the cord?

430C) Was the ____ (instrument) boiled before the cord was cut?

430D) Was anything applied to the cord immediately after cutting and tying it?

430E) What was applied to the cord after it was cut and tied? Anything else?

430G) How long after (NAME) was born was the body wiped (dried)?

430H) How long after (NAME) was born was the body wrapped?

430J) How long after delivery was (NAME) bathed for the first time?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD IN DAYS.

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

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

434) Who checked on your health at that time? IF CODE 'D' CIRCLED, WRITE NAME OF CSBA.

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

437) After (NAME) was born, did any medical persons check on your baby's health?

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 baby's health at that time? IF CODE 'D' CIRCLED, WRITE NAME OF CSBA.

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

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

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

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

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

445) CHECK 226: IS RESPONDENT PREGNANT?

446) Have you begun to have sexual intercourse again since the birth of (NAME)?

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

448) Did you ever breastfeed (NAME)?

449) 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.

449A) Was (NAME) given colostrum immediately after his/her birth?

450) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

451) What was (NAME) given to drink? Anything else? RECORD ALL LIQUIDS MENTIONED.

452) CHECK 404: CHILD ALIVE?

453) Are you still breastfeeding (NAME)?

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

455A) When you were pregnant with (NAME) did you live in a village, or in a town/city?

455B) Did you deliver (NAME) in the same village where you lived, a different village, or in a town/city?

455C) Did you deliver (NAME) in the town/city where you lived, a different town/city, or in a village?

455D) Write down the village/mohalla of the delivery place of (NAME).

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

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) LINE NUMBER FROM 212

503) FROM 212 AND 216

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

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

506/506A) 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.
COPY DATE OF BIRTH IF WRITTEN ON CARD

506B) CHECK 506:

507) Has (NAME) received any vaccinations that are not recorded on this card? RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0 THROUGH 3, DPT 1 THROUGH 3, MEASLES, AND/OR HEP B VACCINES.

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

509A) A BCG vaccination against tuberculosis, that is, an injection in the left shoulder that usually causes a scar?

509B) Polio vaccine, that is, drops in the mouth?

509C) Was the first polio vaccine received in the first two weeks after birth or later?

509D) How many times was the polio vaccine received?

509E) A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

509F) How many times was a DPT vaccination received?

509G) A measles injection or an MMR injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

509H) A HEPATITIS B vaccination, that is, an injection given in the right thigh, sometimes given at the same time as DPT?

509J) How many times was a HEPATITIS B vaccination received?

510) Did (NAME) receive any polio vaccine from the National Immunization Days (NID) on March 3, 2007?

511) Did (NAME) receive a vitamin A dose (like this/any of these) within the last six months? SHOW COMMON TYPES OF CAPSULES.

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

513) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

514) 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 he/she given much less than usual to eat or somewhat less?

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

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

517) Does (NAME) still have diarrhea?

518) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
a) A fluid made from a special saline packet
b) Homemade sugar-salt-water solution (laban gur)?
c) Zinc Syrup?
d) Zinc tablets?

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

520) What (else) was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS GIVEN.

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

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

522A) CHECK 521: HAD FEVER?

523) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

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

525) Did you seek advice or treatment for the illness from any source?

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

Is (NAME) still sick with a (fever/cough)?

531) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2004 OR LATER LIVING WITH THE RESPONDENT

532) Now I would like to as k you about liquids or food (NAME FROM 531) had yesterday during the day or at night.

A. Plain water?
B. Sugar Water/Honey/Juice
C. Commercially produced infant formula/baby formula?
D. Cow's or goat's milk or yoghurt?
E. Other liquid?
F. Papaya/mango?
G. Green leafy vegetables?
H. Other fruits and vegetables?
I. Rice, wheat, porridge, bread?
J. Meat/fish/eggs?
K. Dal?
X. Other solid or semi-solid?

532A) CHECK 532 FOR CATEGORIES 'F' THROUGH 'X':

533) How many times did (NAME FROM 531) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

SECTION 6. MARRIAGE

601) CHECK 105A:

602) Is your husband staying with you no or is he staying elsewhere?

603) How long has your husband been staying away from you?

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

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

606) CHECK 605:

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

608) How old was your husband when you started living with him?

SECTION 7. FERTILITY PREFERENCES

701) CHECK 105A:

701A) CHECK 311:

702) CHECK 226:

703) CHECK 226:

704) CHECK 226:

705) CHECK 310: USING A CONTRACEPTIVE METHOD?

706) CHECK 703:

707) CHECK 702:

708) CHECK 310: USING A CONTRACEPTIVE METHOD?

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

710) Which contraceptive method would you prefer to use?

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

713) CHECK 216:

714) 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?

715) In the last month have you:
Heard about family planning on the radio?
Seen shows about family planning on the television?
Read about family planning in a newspaper or magazine?
Read about family planning in a poster, billboard or leaflet?
Heard about family planning from a community event?

717) CHECK 105A:

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

723) How often have you talked to your husband about family planning in the last three months?

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

801) CHECK 105A:

802) How old was your husband on his last birthday?

803) Did your (last) husband ever attend school or madrasha?

803A) What type of schooling did your husband last attend?

804) What level of schooling did he last attend?

804A) What is the highest class he completed at that level?

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

806) Now I would like to ask you some questions about your work. Aside from your own housework, have you done any work in the last seven days?

807) 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. In the last seven days, have you done any of these things or any other work?

808) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

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

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

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

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

814) CHECK 105A:

818) CHECK 813:

819) Who usually decides how the money you earn will be used: mainly you, mainly your husband, you and your husband jointly, or someone else?

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

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

824) Who usually makes decisions about making purchases for daily household needs?

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

826) Who usually makes decisions about your child health care?

826A) Do you go to a health centre or hospital alone or with your young children?

826B) Can you go to a health centre or hospital alone or with your young children?

SECTION 9. HIV/AIDS

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

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

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

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

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

906) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

906A) Can people get the AIDS virus by using unsterilized needles or syringes?

906B) Can people get the AIDS virus through unsafe blood transfusion?

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

913) CHECK 901:

914) Have you heard about:
a) Syphilis?
b) Gonorrhea?

915) CHECK 913/914: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

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

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

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

919) CHECK 916, 917, 918:

920) The last time you had (PROBLEM FROM 916/917/918), did you seek any kind of advice or treatment?

921) Where did you go? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

922) Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

SECTION 10. OTHER HEALTH ISSUES

1001) Have you ever heard of an illness called tuberculosis or TB?

1002) How does tuberculosis spread from one person to another? PROBE: Any other ways? RECORD ALL MENTIONED.

1003) Can tuberculosis be cured?

SECTION 11. DOMESTIC VIOLENCE MODULE

1101A) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

1101B) Sometimes 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 does not obey elders in the family?

1101C) CHECK COVER PAGE:

1102) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

1103) 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 condition of women in Bangladesh. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.

1104) As far as you know, did your father ever hit or beat your mother?

1105) How often did your father hit or beat your mother: often, sometimes or rarely?

1106) CHECK 105A:

1107A) (Does/did) your (last) husband/partner ever do any of the following things to you:
a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?
d) punch you with his fist or with something that could hurt you?
e) kick you, drag you or beat you up?
f) try to choke you or burn you on purpose?
g) threaten or attack you with a knife, gun, or any other weapon?
h) physically force you to have sexual intercourse with him even when you did not want to?

1107B) CHECK A: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1108) CHECK 1107B:

1109) Why did your husband hurt you in the last 12 months? Any other reason? RECORD ALL MENTIONED.

1109A) CHECK 1109:

1109B) Is your husband hurting you related to demand for dowry?

1109C) CHECK 1109:

1109D) Is your husband hurting you related to your inability to bring money/other resources from your family?

1109E) CHECK 1109:

1109F) Is your husband hurting you related to his drinking alcohol or taking drugs?

1110) Did you tell anyone about your husband hurting you?

1111) Whom did you tell? RECORD ALL MENTIONED.

1112) Did anyone provide any assistance to protect you from being hurt by your husband?

1112A) What type of assistance did you receive?

1113) RECORD THE TIME.

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: ____

CALENDAR:

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

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE:

2007
08 AUG 01 ____
07 JUL 02 ____
06 JUN 03 ____
05 MAY 04 ____
04 APR 05 ____
03 MAR 06 ____
02 FEB 07 ____
01 JAN 08 ____

2006
12 DEC 09 ____
11 NOV 10 ____
10 OCT 11 ____
09 SEP 12 ____
08 AUG 13 ____
07 JUL 14 ____
06 JUN 15 ____
05 MAY 16 ____
04 APR 17 ____
03 MAR 18 ____
02 FEB 19 ____
01 JAN 20 ____

2005
12 DEC 21 ____
11 NOV 22 ____
10 OCT 23 ____
09 SEP 24 ____
08 AUG 25 ____
07 JUL 26 ____
06 JUN 27 ____
05 MAY 28 ____
04 APR 29 ____
03 MAR 30 ____
02 FEB 31 ____
01 JAN 32 ____

2004
12 DEC 33 ____
11 NOV 34 ____
10 OCT 35 ____
09 SEP 36 ____
08 AUG 37 ____
07 JUL 38 ____
06 JUN 39 ____
05 MAY 40 ____
04 APR 41 ____
03 MAR 42 ____
02 FEB 43 ____
01 JAN 44 ____

2003
12 DEC 45 ____
11 NOV 46 ____
10 OCT 47 ____
09 SEP 48 ____
08 AUG 49 ____
07 JUL 50 ____
06 JUN 51 ____
05 MAY 52 ____
04 APR 53 ____
03 MAR 54 ____
02 FEB 55 ____
01 JAN 56 ____

2002
12 DEC 57 ____
11 NOV 58 ____
10 OCT 59 ____
09 SEP 60 ____
08 AUG 61 ____
07 JUL 62 ____
06 JUN 63 ____
05 MAY 64 ____
04 APR 65 ____
03 MAR 66 ____
02 FEB 67 ____
01 JAN 68 ____

2001
12 DEC 69 ____
11 NOV 70 ____
10 OCT 71 ____
09 SEP 72 ____