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A planned IPUMS system update is scheduled for Monday, December 9. The maintenance window is 10am to 1pm CST. Within that window, each site will have a brief outage of 10 or fewer minutes. This notice will be removed as soon as the update is complete.

BURKINA FASO DEMOGRAPHIC AND HEALTH SURVEY - WOMEN'S QUESTIONNAIRE 1993

IDENTIFICATION

PROVINCE _____
DEPARTMENT _____
COMMUNE/URBAN CENTER _____
CLUSTER NUMBER _____
HOUSEHOLD UNIT NUMBER_____
VILLAGE/SECTOR _____

OUAGA, BOBO/KOUD, OTHER CITIES, OR RURAL AREA?

OUAGA 1
BOBO/KOUD 2
OTHER CITIES 3
RURAL 4

NAME OF WOMAN INTERVIEWED ______

LINE NUMBER OF FEMALE RESPONDENT _____

INTERVIEWER VISITS

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

RESULT _____

1 COMPLETED
2 NOT AT HOME
3 DEFERRED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____

TOTAL NUMBER OF VISITS ______

FRENCH QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW:

FRENCH 1
MOORE 2
DIOULA 3
FULFULDE 4
OTHERS 5

INTERPRETER USED?

YES 1
NO 2

SUPERVISOR
NAME _____
DATE _____

FIELD EDITOR
NAME _____
DATE _____

KEYED BY (NAME) _____
KEYED BY (DATE) _____
KEYED BY (CODE) _____

SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

101. RECORD THE TIME:

HOUR ____
MINUTES ____

To begin, I would like to ask you questions about yourself and your household.

102. Until the age of 12, did you mostly live in Ouaga, or in another capital, in Bobo, Koudougou, in another city, or in a rural setting?

OUAGADOUGOU/OTHER CAPITAL 1
BOBO/KOUDOUGOU/OTHER LARGE FOREIGN CITY 2
CITY 3
RURAL 4

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

YEARS_____

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before moving here, did you live in Ouagadougou, or in another capital, in Bobo, Koudougou, in another city, or in a rural setting?

OUAGADOUGOU/OTHER CAPITAL 1
BOBO/KOUDOUGOU/OTHER LARGE FOREIGN CITY 2
CITY 3
RURAL 4

105. In what month and year were you born?

MONTH _____
DOESN'T KNOW MONTH 98
YEAR _____
DOESN'T KNOW YEAR 98

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS _______

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary, middle school, high school, or higher?

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 4

109. What is the highest grade you completed at that level?

GRADE _____
PRIMARY
0 LESS THAN ONE YEAR COMPLETED
1 CP1
2 CP2
3 CE1
4 CE2
5 CM1
6 CM2
8 DOESN'T KNOW
MIDDLE SCHOOL
0 LESS THAN ONE YEAR COMPLETED
1 6TH
2 5TH
3 4TH
4 3RD
8 DOESN'T KNOW
HIGH SCHOOL
0 LESS THAN ONE YEAR COMPLETED
1 2ND
2 1ST
3 FINAL
8 DOESN'T KNOW
POST-SECONDARY
0 LESS THAN ONE YEAR COMPLETED
1 ONE YEAR
2 TWO YEARS
3 THREE YEARS
4 FOUR YEARS
5 FIVE OR MORE YEARS
8 DOESN'T KNOW

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 112)

111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

112. Do you read a newspaper or magazine at least once a week?

YES 1
NO 2

113. Do you listen to the radio at least once a week?

YES 1
NO 2

114. Do you watch the television at least once a week?

YES 1
NO 2

115. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
OTHER (SPECIFY) _____ 4

116. What is your nationality?

BURKINABE 01
NIGERIAN 02 (GO TO 118)
TOGOLESE 03 (GO TO 118)
BENINESE 04 (GO TO 118)
MALIAN 05 (GO TO 118)
OTHER AFRICAN (SPECIFY) _____ 06 (GO TO 118)
OTHER (SPECIFY) _____ 07 (GO TO 118)

117. What is your ethnicity?

BOBO 01
DIOULA 02
FULFULDE/PEUL 03
GOURMANTCHE 04
GOUROUSSI 05
LOBI 06
MOSSI 07
SENOUFO 08
TOUARAG/BELLA 09
OTHER (SPECIFY) _____ 10
DOESN'T KNOW 98

118. CHECK (4) IN THE HOUSEHOLD QUESTIONNAIRE:

RESPONDENT IS NOT RESIDENT (GO TO 119)
RESPONDENT IS RESIDENT (GO TO 201)

Now I would like to ask you some questions about the place you usually live.

119. Do you live in Ouagadougou, or in another capital, in Bobo, Koudougou, in another city, or in a rural setting?

OUAGADOUGOU/OTHER CAPITAL 1 (GO TO 121)
BOBO/KOUDOUGOU/OTHER LARGE FOREIGN CITY 2
CITY 3
RURAL 4

120. In which province is it?

NAME OF PROVINCE _____
PROVINCE CODE _____
IN ANOTHER COUNTRY 96

Now I would like to ask some questions about the household that you usually live in.

121. What is the main source of water used by your household for hand washing and dish washing?

PIPED WATER
PIPED INTO DWELLING/YARD/PLOT 11 (GO TO 123)
PUBLIC TAP/STANDPIPE 12
OPEN TUBE WELL OR BOREHOLE
TRADITIONAL WELL IN DWELLING/YARD/PLOT 21 (GO TO 123)
PUBLIC WELL/BORE HOLE 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAIN WATER 41 (GO TO 123)
WATER VENDOR 51
BOTTLED WATER 61 (GO TO 123)
OTHER (SPECIFY) _____ 71

122. How long does it take to go there, get water, and come back?

MINUTES_____
ON SITE 996

123. Does your household use the same water for drinking purposes?

YES 1 (GO TO 125)
NO 2

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

PIPED WATER
PIPED INTO DWELLING/YARD/PLOT 11
PUBLIC TAP/STANDPIPE 12
OPEN TUBE WELL OR BOREHOLE
TRADITIONAL WELL IN DWELLING/YARD/PLOT 21
PUBLIC WELL/BORE HOLE 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAIN WATER 41
WATER VENDOR 51
BOTTLED WATER 61
OTHER (SPECIFY) _____ 71

125. What kind of toilet facility does your household use?

FLUSH TOILET
PRIVATE FLUSH TOILET 11
SHARED FLUSH TOILET 12
PUBLIC FLUSH TOILET 13
PIT LATRINE
RUDIMENTARY 21
VENTILATED IMPROVED PIT LATRINE 22
NO TOILET/OUTSIDE 31
OTHER (SPECIFY) _____ 41

126. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
A RADIO
YES 1
NO 2
A TELEVISION
YES 1
NO 2
A REFRIGERATOR
YES 1
NO 2

127. In your household, how many rooms do you use for sleeping?

NUMBER OF ROOMS_____

128. Can you describe the floor of your house?

NATURAL FLOOR
SAND 11
EARTH 12
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) _____ 41

129. Does any member of your household own:

A bicycle?
A motorcycle or motor scooter?
A car or truck?

A BICYCLE
YES 1
NO 2
A MOTORCYCLE OR MOTOR SCOOTER
YES 1
NO 2
A CAR OR TRUCK
YES 1
NO 2

SECTION 2: REPRODUCTION

Now I would like to ask about all the births you have had during your life.

201. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME ______
DAUGHTERS AT HOME ________

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

YES 1
NO 2 (GO TO 206)

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'.

SONS ELSEWHERE ______
DAUGHTERS ELSEWHERE ______

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 at birth but did not survive more than a few hours or days?

YES 1
NO 2 (GO TO 208)

207. How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD ______
GIRLS DEAD _____

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

TOTAL ______

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 222B)

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

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

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

NAME _____

213. Was (NAME) a single birth or part of a multiple birth?

SING 1
MULT 2

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

BOY 1
GIRL 2

215. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: What season was (NAME) born in?
IF MONTH/SEASON UNKNOWN, RECORD '98'.

MONTH _____
DOESN'T KNOW 98
YEAR _____
DOESN'T KNOW 98

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ______

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

YES 1 (GO TO NEXT BIRTH)
NO 2

IF CHILD IS LESS THAN 15 YEARS:

219. With whom does he/she live?
IF CHILD IS OVER 15, GO TO NEXT BIRTH.

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3 (GO TO NEXT BIRTH)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 _____
MONTHS 2 _____
YEARS 3 _____

[GO BACK AND REPEAT 212-220 FOR EACH ADDITIONAL BIRTH]

221. COMPARE 208 WITH NUMBER OF BIRTHS REGISTERED IN TABLE ABOVE AND MARK:

NUMBERS ARE SAME
CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. ____
CHECK: FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. ____
CHECK: FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. ____
CHECK: FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. ____
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987.
IF NONE, RECORD '0'.

222A. Besides live births, have you had any pregnancies that ended in a miscarriage, an abortion or a stillbirth?
222B. Have you had any pregnancies that ended in a miscarriage, an abortion or a stillbirth?

YES 1
NO 2 (GO TO 223)

222C. How many in total?

NUMBER OF BIRTHS ____

223. Are you pregnant now?

YES 1
NO 2 (GO TO 226)
UNSURE 8 (GO TO 226)

224. How many months pregnant are you?

NUMBER OF MONTHS ____

225. 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 be pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

226. When did your last menstrual period start?
RECORD THE DATE IF IT IS GIVEN.

DATE, IF GIVEN _____
NUMBER OF DAYS 1 _____
NUMBER OF WEEKS 2 _____
NUMBER OF MONTHS 3 _____
NUMBER OF YEARS 4 _____

IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER HAD PERIOD 996

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

YES 1
NO 2 (GO TO 301)
DOESN'T KNOW 8 (GO TO 301)

228. At what point in her menstrual cycle is a woman most likely to become pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
MIDDLE OF HER CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) _____ 5
DOESN'T KNOW 8

SECTION 3: CONTRACEPTION

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

301. What are the ways or methods that have you heard about?

CIRCLE CODE '1' IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF METHOD IS RECOGNIZED AND CODE '3' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 302, ASK 303-304 BEFORE CONTINUING TO THE NEXT METHOD.

302. Have you ever heard of (METHOD)?
READ THE DESCRIPTION OF EACH METHOD.

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
03. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
04. MOUSSE, FOAM OR GEL: Women can place a mousse, gel or foam inside their vagina before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
05. CONDOM: Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
07. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
08. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
09. WITHDRAWAL: Men can be careful and pull out before ejaculation.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
10. PROLONGED ABSTINENCE: Beyond the avoidance of sex traditionally observed after a birth, some couples avoid having sex for some months so the woman won't become pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
11. CHARM/TALISMAN: Some women use amulets/charms to avoid getting pregnant.

YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
12. OTHER METHODS: Have you heard of any other ways or methods that women or men can use to avoid pregnancy? IF YES, LIST UP TO TWO OTHER METHODS.
(SPECIFY) _____
YES 1
NO 3 (GO TO NEXT METHOD)

303. Have you ever used (METHOD)?
[THIS QUESTION IS ASKED ABOUT EACH METHOD IN 301 WITH '1' or '2' CIRCLED.]

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
04. MOUSSE, FOAM OR GEL: Women can place a mousse, gel or foam inside their vagina before sexual intercourse.
YES 1
NO 2
05. CONDOM: Men can put a rubber or latex sheath on their penis before sexual intercourse. Have you ever used a condom with a partner?
YES 1
NO 2
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07. MALE STERILIZATION: Men can have an operation to avoid having any more children. Has your husband/partner ever had an operation to avoid having any more children?
YES 1
NO 2
08. RHYTHM METHOD: Some couples avoid having sex during certain days of the month when the woman is most likely to get pregnant.
YES 1
NO 2
09. WITHDRAWAL: Men can be careful and pull out before ejaculation.
YES 1
NO 2
10. PROLONGED ABSTINENCE: Beyond the avoidance of sex traditionally observed after a birth, some couples avoid having sex for some months so the woman won't become pregnant.
YES 1
NO 2
11. CHARM/TALISMAN: Some women use amulets/charms to avoid getting pregnant.

YES 1
NO 2
12. OTHER METHOD(S) (SPECIFY) _____
YES 1
NO 2

304. Do you know where one can go to obtain (METHOD)?

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
04. MOUSSE, FOAM OR GEL: Women can place a mousse, gel or foam inside their vagina before sexual intercourse.
YES 1
NO 2
05. CONDOM: Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES 1
NO 2
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children. Do you know where a woman can get an operation to get sterilized?
YES 1
NO 2
07. MALE STERILIZATION: Men can have an operation to avoid having any more children. Do you know where a man can get an operation to be sterilized?
YES 1
NO 2
08. RHYTHM METHOD: Some couples avoid having sex during certain days of the month when the woman is most likely to get pregnant. Do you know where one can obtain advice on using the rhythm method?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE "YES" (NEVER USED) (GO TO 306)
AT LEAST ONE "YES" (EVER USED) (GO TO 308)

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

YES ____
NO ____ (GO TO 326)

307. What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY).

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

308. How many living children did you have at that time?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ____

309. CHECK 223:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 326)

310. CHECK 303:

WOMAN NOT STERILIZED (GO TO 311)
WOMAN STERILIZED (GO TO 312A)

311. Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 326)

312. Which method are you currently using?
312A. CIRCLE '06' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 318)
INJECTABLES 03 (GO TO 318)
MOUSSE/FOAM/JELLY 04 (GO TO 318)
CONDOM 05 (GO TO 318)
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07 (GO TO 318)
RHYTHM METHOD 08 (GO TO 323)
WITHDRAWAL 09 (GO TO 323)
PROLONGED ABSTINENCE 10 (GO TO 323)
CHARM/AMULET 11 (GO TO 323)
OTHER (SPECIFY) ______ 12 (GO TO 323)

313. When you began using the pill for the first time, did you consult a doctor or midwife?

YES 1
NO 2
DOESN'T KNOW 8

314. The last time you obtained the pill, did you consult a doctor or midwife?

YES 1
NO 2

315. May I see the package of pills you are currently using?

MICRO-NOVUM 01 (GO TO 317)
LO-FEMENAL 02 (GO TO 317)
OVRETTE 03 (GO TO 317)
EUGYNON 04 (GO TO 317)
ADEPAL 05 (GO TO 317)
MINIPHASE 06 (GO TO 317)
MINIDRIL 07 (GO TO 317)
OTHER (SPECIFY) _____ 09 (GO TO 317)
PACKAGE NOT SHOWN 96

316. Do you know the brand name of the pills you are currently using?
WRITE THE NAME OF THE BRAND, THEN THE CODE GIVEN IN 315.

MICRO-NOVUM 01
LO-FEMENAL 02
OVRETTE 03
EUGYNON 04
ADEPAL 05
MINIPHASE 06
MINIDRIL 07
OTHER (SPECIFY) _____ 09
DOESN'T KNOW 98

317. How much does one box of pills cost?
NOTE THE PRICE.

COST ______

FREE 9996
DOESN'T KNOW 9998

317A. For how many cycles do you use this box of pills?
NOTE NUMBER OF CYCLES.

NUMBER OF CYCLES ____

317B. How do you use this pill?

ONCE A DAY 1
OTHER (SPECIFY) ____ 2
DOESN'T KNOW 98

318. CHECK 312:

HE/SHE STERILIZED: Where did the sterilization take place?

USES ANOTHER METHOD: Where did you obtain (METHOD) the last time?

NAME OF PLACE_____
PUBLIC SECTOR
HOSPITAL 11
MEDICAL CENTER 12
CSPS 13
SMI 14
DISPENSARY/MATERNITY POST 15
PRIMARY HEALTH POST 16
COMMUNITY PHARMACEUTICAL DEPOT 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
FAMILY PLANNING CLINIC 22
PHARMACY 23
NURSE'S OFFICE 24
OTHER PRIVATE SECTOR
RELATIVE/NEIGHBOR/FRIEND 32 (GO TO 321)
OTHER (SPECIFY) _____ 41 (GO TO 321)
DOESN'T KNOW 98 (GO TO 321)

319. How long does it take to get from your house to this place?
IF LESS THAN 2 HOURS, WRITE THE RESPONSE IN MINUTES.
OTHERWISE, WRITE IN HOURS. IF 1 DAY OR MORE RECORD 24 HOURS.

MINUTES 1 ____
HOURS 2 ____

DOESN'T KNOW 9998

320. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

321. CHECK 312:

HE/SHE STERILIZED (GO TO 322)
USES ANOTHER METHOD (GO TO 323)

322. In what month and year was the sterilization performed?

MONTH ____
YEAR ____ (GO TO 326)

323. For how many months have you been continuously using (METHOD)?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS_____
8 YEARS OR MORE 96

324. Have you had any problems with the method you are currently using?

YES 1
NO 2 (GO TO 331)

325. From whom did you ask advice for these problems?

HEALTH WORKER 1 (GO TO 331)
ACQUAINTANCE/RELATIVE 2 (GO TO 331)
PARTNER 3 (GO TO 331)
NO ONE 4 (GO TO 331)

326. Do you intend to use a method of contraception in the future to delay or prevent a pregnancy?

YES 1 (GO TO 328)
NO 2
DOESN'T KNOW 8 (GO TO 332)

327. What is the main reason that you do not intend to use a contraceptive method?

WANTS CHILDREN 01 (GO TO 332)
LACK OF INFORMATION 02 (GO TO 332)
PARTNER DISAPPROVES 03 (GO TO 332)
COST TOO HIGH 04 (GO TO 332)
SIDE EFFECTS 05 (GO TO 332)
HEALTH PROBLEMS 06 (GO TO 332)
DIFFICULT TO OBTAIN 07 (GO TO 332)
RELIGION 08 (GO TO 332)
OPPOSES FAMILY PLANNING 09 (GO TO 332)
FATALIST 10 (GO TO 332)
OTHERS DISAPPROVE 11 (GO TO 332)
INFREQUENT SEXUAL INTERCOURSE 12 (GO TO 332)
DIFFICULTY GETTING PREGNANT 13 (GO TO 332)
MENOPAUSE/HYSTERECTOMY 14 (GO TO 332)
NOT CONVENIENT 15 (GO TO 332)
NOT MARRIED 16 (GO TO 332)
OTHER (SPECIFY) _____ 17 (GO TO 332)
DOESN'T KNOW 98 (GO TO 332)

328. Do you intend to use contraception in the next 12 months?

YES 1
NO 2
DOESN'T KNOW 8

329. When you will use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTABLES 03
MOUSSE/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
RHYTHM METHOD 08 (GO TO 332)
WITHDRAWAL 09 (GO TO 332)
PROLONGED ABSTINENCE 10 (GO TO 332)
CHARM/AMULET 11 (GO TO 332)
OTHER (SPECIFY) _____ 12 (GO TO 332)
NOT SURE 98 (GO TO 332)

330. Where can you get (METHOD IN 329)?

NAME OF PLACE _______
PUBLIC SECTOR
HOSPITAL 11 (GO TO 334)
MEDICAL CENTER 12 (GO TO 334)
CSPS 13 (GO TO 334)
SMI 14 (GO TO 334)
DISPENSARY/MATERNITY POST 15 (GO TO 334)
PRIMARY HEALTH POST 16 (GO TO 334)
COMMUNITY PHARMACEUTICAL DEPOT 17 (GO TO 334)
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21 (GO TO 334)
FAMILY PLANNING CLINIC 22 (GO TO 334)
PHARMACY 23 (GO TO 334)
NURSE'S OFFICE 24 (GO TO 334)
OTHER PRIVATE SECTOR
RELATIVE/NEIGHBOR/FRIEND 32 (GO TO 336)
OTHER (SPECIFY) _____ 41 (GO TO 336)
DOESN'T KNOW 98 (GO TO 332)

331. CHECK 312:

USES RHYTHM METHOD, WITHDRAWAL, PROLONGED ABSTINENCE OR OTHER TRADITIONAL METHOD (GO TO 332)

USES A MODERN METHOD (GO TO 336)

332. Do you know of a place where one can get a contraceptive method?

YES 1
NO 2 (GO TO 336)

333. Where is it?

NAME OF PLACE _______
PUBLIC SECTOR
HOSPITAL 11
MEDICAL CENTER 12
CSPS 13
SMI 14
DISPENSARY/MATERNITY POST 15
PRIMARY HEALTH POST 16
COMMUNITY PHARMACEUTICAL DEPOT 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
FAMILY PLANNING CLINIC 22
PHARMACY 23
NURSE'S OFFICE 24
OTHER PRIVATE SECTOR
RELATIVE/NEIGHBOR/FRIEND 32 (GO TO 336)
OTHER (SPECIFY) _____ 41 (GO TO 336)
DOESN'T KNOW 98 (GO TO 336)

334. How long does it take to get from your house to this place?

IF LESS THAN 2 HOURS, RECORD THE RESPONSE IN MINUTES. OTHERWISE, RECORD IN HOURS. IF 1 DAY OR MORE RECORD 24 HOURS.

MINUTES 1 ____
HOURS 2 ____
DOESN'T KNOW 9998

335. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

336. During the past month, have you heard a message about family planning:

On the radio?
On the television?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2

337. Do you find it acceptable or unacceptable that information about family planning is given out on the radio or television?

ACCEPTABLE 1
UNACCEPTABLE 2
DOESN'T KNOW 8

338. What is your main source of information about family planning?

SMI 01
HEALTH AGENT 02
RADIO/TELEVISION 03
NEWSPAPER 04
RELATIVES/NEIGHBORS/FRIENDS 05
DOESN'T KNOW OF FAMILY PLANNING 06
OTHER (SPECIFY) _____ 07
DOESN'T KNOW 98

SECTION 4A: PREGNANCY AND BREASTFEEDING

401. CHECK 222:

AT LEAST ONE BIRTH SINCE JANUARY 1987 (GO TO 402)
NO BIRTHS SINCE JANUARY 1987 (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH SINCE JANUARY 1987 IN THE REPRODUCTION TABLE. ASK THE QUESTIONS FOR ALL BIRTHS BEGINNING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 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 only talk about one child at a time.

LINE NUMBER FROM 212:

LINE NO. _____

FROM 212 AND 216:

NAME _____
LIVING ____
DEAD ____

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

THEN 1 (GO TO 405)
LATER 2
NOT AT ALL 3 (GO TO 405)

404. How much longer would you have liked to wait?

MONTHS 1 ____
YEARS 2 ____
DOESN'T KNOW 998

405. When you were pregnant with (NAME), did you see anyone for antenatal care?
IF YES: Whom did you see? Anyone else?

CIRCLE ALL CODES CORRESPONDING TO PERSONS SEEN.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
BIRTH ASSISTANT/MATRON C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT D
TRADITIONAL BIRTH ASSISTANT E
OTHER (SPECIFY) ______F
NO ONE G (GO TO 409)

406. Were you given a health card for this pregnancy?

YES 1
NO 2
DOESN'T KNOW 98

407. How many months pregnant were you when you first received antenatal care for this pregnancy?

NUMBER OF MONTHS____
DOESN'T KNOW 98

408. How many prenatal visits did you have during this pregnancy?

NUMBER OF VISITS _____
DOESN'T KNOW 98

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

YES 1
NO 2 (GO TO 411)
DOESN'T KNOW 8 (GO TO 411)

410. How many times did you get this injection?

NUMBER OF TIMES _____
DOESN'T KNOW 8

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

HOME
RESPONDENT'S HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
MATERNITY POST 22
DISPENSARY 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHERS (SPECIFY) _____ 41

412. Who assisted you with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
BIRTH ASSISTANT/MATRON C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT D
TRADITIONAL BIRTH ASSISTANT E
RELATIVE F
OTHER (SPECIFY) _____ G
NO ONE H

413. Was (NAME) born full-term or premature?

FULL TERM 1
PREMATURE 2
DOESN'T KNOW 8

414. Was (NAME) delivered by caesarean section?

YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DOESN'T KNOW 8

416. Was (NAME) weighed at birth?

YES 1
NO 2 (MOST RECENT BIRTH: GO TO 418; OTHERS: GO TO 419)

417. How much did (NAME) weigh?

KILOGRAMS _____
DOESN'T KNOW 98

418. Has your period come back since the birth of (NAME)?
[ONLY ASK OF MOST RECENT BIRTH]

YES 1 (GO TO 420)
NO 2 (GO TO 421)

419. Did your period come back between the birth of (NAME) and your next birth?
[ASK FOR ALL BUT MOST RECENT BIRTH.]

YES 1
NO 2 (GO TO 423)

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

NUMBER OF MONTHS____
DOESN'T KNOW 98

421. CHECK 223:
IS RESPONDENT PREGNANT?
[ONLY ASK FOR MOST RECENT BIRTH]

NOT PREGNANT (GO TO 422)
PREGNANT OR UNSURE (GO TO 423)

422. Have you begun to have sexual intercourse again since the birth of (NAME)?
[ONLY ASK FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 424)

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

NUMBER OF MONTHS____
DOESN'T KNOW 98

424. Did you breastfeed (NAME)?

YES 1 (GO TO 426)
NO 2

425. Why didn't you breastfeed (NAME)?

MOTHER SICK/WEAK 01 (GO TO 435)
CHILD SICK/WEAK 02 (GO TO 435)
CHILD DIED 03 (GO TO 435)
PROBLEMS WITH BREASTS/NIPPLES 04 (GO TO 435)
INSUFFICIENT MILK 05 (GO TO 435)
MOTHER WORKS 06 (GO TO 435)
CHILD REFUSED 07 (GO TO 435)
OTHER (SPECIFY) _____ 08 (GO TO 435)

426. How long after birth did you first put (NAME) to the breast?
[ASK ONLY FOR MOST RECENT BIRTH]

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

IMMEDIATELY 000
HOURS 1 _____
DAYS 2 _____

427. CHECK 216:
CHILD LIVING?
[ASK ONLY FOR MOST RECENT BIRTH]

LIVING (GO TO 428)
DECEASED (GO TO 433)

428. Are you still breastfeeding (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 433)

429. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF NIGHTTIME FEEDINGS _____

430. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF DAYTIME FEEDINGS _____

431. Did (NAME) receive, at any moment yesterday or last night, any of the following:

Water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Powdered or boxed milk?
Fresh (animal) milk?
Any other liquid?
Gruel?
Other food especially prepared for the infant/child?
Family dish?

[ASK ONLY FOR MOST RECENT BIRTH]

WATER
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
HERBAL TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
POWDERED OR BOXED MILK
YES 1
NO 2
FRESH (ANIMAL) MILK
YES 1
NO 2
ANY OTHER LIQUID
YES 1
NO 2
GRUEL
YES 1
NO 2
OTHER FOOD ESPECIALLY PREPARED FOR THE CHILD
YES 1
NO 2
FAMILY DISH
YES 1
NO 2

432. CHECK 431:
FOOD OR LIQUID GIVEN YESTERDAY?
[ASK ONLY FOR MOST RECENT BIRTH]

'YES' FOR ONE OR MORE (GO TO 437)
NOTHING AT ALL (GO TO 436)

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

NUMBER OF MONTHS ____
UNTIL HIS/HER DEATH 96 (GO TO 436)

434. Why did you stop breastfeeding (NAME)?

MOTHER SICK/WEAK 01
CHILD SICK/WEAK 02
CHILD DIED 03
PROBLEMS WITH BREASTS 04
INSUFFICIENT MILK 05
MOTHER WORKS 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
BEGAN USING CONTRACEPTION 10
OTHER (SPECIFY) ______ 11

435. CHECK 216:
CHILD LIVING?

LIVING (GO TO 437)
DECEASED (GO TO 436)

436. Have you ever given (NAME) water, or something else to eat or drink to the child (that wasn't breast milk)?

YES 1
NO 2 (GO TO 440)

437. How many months old was (NAME) when you began to regularly give him/her the following foods and drinks: IF LESS THAN ONE MONTH, RECORD '00'.

Boxed milk or milk other than breast milk?
Water?
Herbal tea?
Other liquids?
Gruel?
Solid foods?

BOXED MILK OR MILK OTHER THAN BREAST MILK
AGE IN MONTHS ____
NEVER BEEN GIVEN 96
WATER
AGE IN MONTHS ____
NEVER BEEN GIVEN 96
HERBAL TEA
AGE IN MONTHS ____
NEVER BEEN GIVEN 96
OTHER LIQUIDS
AGE IN MONTHS ____
NEVER BEEN GIVEN 96
GRUEL
AGE IN MONTHS ____
NEVER BEEN GIVEN 96
SOLID FOODS
AGE IN MONTHS ____
NEVER BEEN GIVEN 96

438. CHECK 216:
CHILD LIVING?
[ASK ONLY FOR MOST RECENT BIRTH]

LIVING (GO TO 439)
DECEASED (GO TO 440)

439. Did (NAME) drink anything from a bottle yesterday or last night?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

440. RETURN TO 403 FOR THE NEXT BIRTH. (IF NO MORE BIRTHS, GO TO THE FIRST COLUMN OF 441.)

SECTION 4B: VACCINATION AND HEALTH

441. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS FOR ALL BIRTHS BEGINNING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.)

LINE NUMBER FROM 212:

LINE NO. _____

FROM 212 AND 216:

NAME _____
LIVING ____
DEAD ____

442. Do you have a vaccination card for (NAME)?
IF YES: May I see it please?

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

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

YES 1 (GO TO 446)
NO 2 (GO TO 446)

444. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN DAY COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE IS RECORDED.

BCG
DAY ____
MONTH ____
YEAR ____
POLIO 0
DAY ____
MONTH ____
YEAR ____
POLIO 1
DAY ____
MONTH ____
YEAR ____
POLIO 2
DAY ____
MONTH ____
YEAR ____
POLIO 3
DAY ____
MONTH ____
YEAR ____
DPT 1
DAY ____
MONTH ____
YEAR ____
DPT 2
DAY ____
MONTH ____
YEAR ____
DPT 3
DAY ____
MONTH ____
YEAR ____
IMOVAX 1
DAY ____
MONTH ____
YEAR ____
IMOVAX 2
DAY ____
MONTH ____
YEAR ____
MEASLES
DAY ____
MONTH ____
YEAR ____
YELLOW FEVER
DAY ____
MONTH ____
YEAR ____

445. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD YES ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, IMOVAX 1-2, MEASLES AND/OR YELLOW FEVER VACCINES. PROBE FOR VACCINATIONS AND RECORD '66' IN THE CORRESPONDING DAY COLUMN IN 444.

YES 1
NO 2
DOESN'T KNOW 8 (GO TO 448)

446. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 448)
DOESN'T KNOW 8 (GO TO 448)

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

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

Polio vaccine, that is, drops in the mouth?

A measles injection?

An injection from a gun/syringe?

A BCG VACCINATION AGAINST TUBERCULOSIS
YES 1
NO 2
DOESN'T KNOW 8
POLIO VACCINE
IF YES: How many times?
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES ____
A MEASLES INJECTION
YES 1
NO 2
DOESN'T KNOW 8
AN INJECTION FROM A GUN/SYRINGE
IF YES: How many times?
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES _____

448. CHECK 216:
CHILD LIVING?

LIVING (GO TO 450)
DECEASED (GO TO 449)

449. RETURN TO 442 FOR THE NEXT BIRTH.
IF NO MORE BIRTHS, GO TO 482.

450. Has (NAME) had a fever at any time in the last 2 weeks?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 455)
DOESN'T KNOW 8 (GO TO 455)

452. Has (NAME) suffered from a cough within the last 24 hours?

YES 1
NO 2
DOESN'T KNOW 8

453. How many days did/has the cough last/lasted?
IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS____

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

YES 1
NO 2
DOESN'T KNOW 8

455. CHECK 450 AND 451:
FEVER OR COUGH?

'YES' IN 450 OR 451 (GO TO 456)
OTHER (GO TO 460)

456. Was anything given to treat the fever/cough?

YES 1
NO 2 (GO TO 458)
DOESN'T KNOW 8 (GO TO 458)

457. What was given to treat the fever/cough? Anything else?
RECORD ALL MENTIONED.

INJECTION A
ANTIBIOTIC (TABLET OR SYRUP) B
NIVAQUINE, FLAVOQUINE (TABLET OR SYRUP) C
ASPIRIN/ASPRO D
COUGH SYRUP E
UNKNOWN TABLET/SYRUP F
TRADITIONAL REMEDY/MEDICINAL PLANTS G
OTHER (SPECIFY) ____ H

457A. Where did you obtain the treatments?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL, MEDICAL CENTER, CSPS A
COMMUNITY PHARMACEUTICAL DEPOT B
PRIVATE SECTOR
PRIVATE PHARMACY C
OTHER PRIVATE SECTOR
STORE/MARKET D
HEALER E
OTHER (SPECIFY) _____ F
DOESN'T KNOW G

458. Did you seek advice for the fever/cough?

YES 1
NO 2 (GO TO 460)

459. Where did you seek advice? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
CSPS C
SMI D
DISPENSARY E
PSP F
COMMUNITY PHARMACEUTICAL DEPOT G
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE H
PHARMACY I
NURSE'S OFFICE J
RELIGIOUS DISPENSARY K
OTHER PRIVATE SECTOR
TRADITIONAL HEALER L
RELATIVE/NEIGHBOR/FRIEND M
OTHER (SPECIFY) _____ N

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

YES 1 (GO TO 462)
NO 2
DOESN'T KNOW 8

461. RETURN TO 442 FOR THE NEXT BIRTH.
IF NO MORE BIRTHS, GO TO 482.

462. Has (NAME) had diarrhea within the last 24 hours?

YES 1
NO 2
DOESN'T KNOW 8

463. How many days did/has the diarrhea last/lasted?
IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS____

464. Was there blood in the stool?

YES 1
NO 2
DOESN'T KNOW 8

465. CHECK 424 AND 428:
LAST INFANT STILL BEING BREASTFED?
[ASK FOR MOST RECENT BIRTH ONLY]

YES (GO TO 466)
NO (GO TO 468)

466. When (NAME) had diarrhea, did you change the number of feedings/nursings?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 468)

467. Did you increase or decrease the number of feedings, or did you stop them altogether? [ASK FOR MOST RECENT BIRTH ONLY]

INCREASED 1
DECREASED 2
STOPPED 3

468. (Besides breast milk), did you give the child the same amount to drink, more to drink, or less to drink as before the diarrhea?

SAME 1
MORE 2
LESS 3
DOESN'T KNOW 8

469. Did you give the child the same amount to eat, more to eat, or less to eat as before the diarrhea?

SAME 1
MORE 2
LESS 3
DOESN'T KNOW 8

470. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 472)
DOESN'T KNOW 8 (GO TO 472)

471. What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.

LIQUID FROM ORS PACKETS A
SALT/SUGAR WATER B
ERSEFLURIL/TYPHOMICINE/OTHER ANTIBIOTIC C
GANIDAN/IMMODIUM/CHARCOAL/OTHER ANTI-DIURRHETIC D
INJECTION E
DRIP/SERUM F
MEDICINAL PLANTS/TRADITIONAL REMEDY (SPECIFY) _____ G
OTHER (SPECIFY) _____ H

471A. Where did you obtain the treatments?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL, MEDICAL CENTER, CSPS A
COMMUNITY PHARMACEUTICAL DEPOT B
PRIVATE SECTOR
PRIVATE PHARMACY C
OTHER PRIVATE SECTOR
STORE/MARKET D
HEALER E
OTHER (SPECIFY) _____ F
DOESN'T KNOW G

472. Did you seek advice for the diarrhea?

YES 1
NO 2 (GO TO 474)

473. Where did you seek advice? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
CSPS C
SMI D
DISPENSARY E
PSP F
COMMUNITY PHARMACEUTICAL DEPOT G
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE H
PHARMACY I
NURSE'S OFFICE J
RELIGIOUS DISPENSARY K
OTHER PRIVATE SECTOR
TRADITIONAL HEALER L
RELATIVE/NEIGHBOR/FRIEND M
OTHER (SPECIFY) _____ N

474. CHECK 471:
LIQUID FROM ORS PACKET MENTIONED?

NO, ORS LIQUID NOT MENTIONED (GO TO 475)
YES, ORS LIQUID MENTIONED (GO TO 476)

475. Did (NAME) receive a liquid prepared from a special packet of powder to treat diarrhea and vomiting occurring during diarrhea?

YES 1
NO 2 (GO TO 478)
DOESN'T KNOW 8 (GO TO 478)

476. How long after the diarrhea started did (NAME) first receive the liquid prepared from the special packet? IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS ____
DOESN'T KNOW 98

477. For how many days did (NAME) receive this liquid from a special packet?
IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS____
DOESN'T KNOW 98

478. CHECK 471:
RECOMMENDED HOMEMADE LIQUID MENTIONED?

NO, HOMEMADE LIQUID NOT MENTIONED (GO TO 479)
YES, HOMEMADE LIQUID MENTIONED (GO TO 480)

479. Did (NAME) receive a liquid recommended by a health professional and prepared at home with a solution of salt and sugar water when (NAME) had diarrhea?

YES 1
NO 2 (GO TO 481)
DOESN'T KNOW 8 (GO TO 481)

480. For how many days did (NAME) receive the liquid prepared with a solution of salt and sugar water? IF LESS THAN ONE DAY, RECORD '00'.

NUMBER OF DAYS____
DOESN'T KNOW 98

481. RETURN TO 442 FOR THE NEXT CHILD.
IF NO MORE CHILDREN, GO TO 482.

482. CHECK 471 AND 475, ALL COLUMNS:

ANY CHILD RECEIVED ORS PACKET (GO TO 486)
NO CHILD RECEIVED ORS PACKET OR 471 AND 475 NOT ASKED (GO TO 483)

483. Have you ever heard of a product called ORS you can get for the treatment of diarrhea and vomiting?

YES 1 (GO TO 485)
NO 2

484. Have you ever seen a packet like this before?
SHOW PACKET.

YES 1
NO 2 (GO TO 489)

485. Have you ever used this product to prepare a solution to treat diarrhea for yourself or someone else? SHOW PACKET.

YES 1
NO 2 (GO TO 488)

486. The last time you prepared the special packet, did you prepare the entire packet at one time, or only a part of it?

WHOLE PACKET AT ONCE 1
PART OF THE PACKET 2 (GO TO 488)

487. The last time you prepared the special packet, how much water did you use?

1/2 LITER 01
1 LITER 02
1.5 LITERS 03
2 LITERS 04
ACCORDING TO PACKET INSTRUCTIONS 05
OTHER (SPECIFY) ______ 06
DOESN'T KNOW 98

487A. The last time you prepared the special packet, what receptacle did you use?

33 CL BOTTLE 01
66 CL BOTTLE 02
1.5 LITER BOTTLE 03
PLASTIC CUP 04
SAUCE PAN 05
OTHER (SPECIFY) ____ 06
DOESN'T KNOW 98

488. Where can you obtain the ORS packet? Anywhere else?
RECORD ALL RESPONSES.

PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
CSPS C
SMI D
DISPENSARY E
PSP F
COMMUNITY PHARMACEUTICAL DEPOT G
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE H
PHARMACY I
NURSE'S OFFICE J
RELIGIOUS DISPENSARY K
OTHER PRIVATE SECTOR
TRADITIONAL HEALER L
RELATIVE/NEIGHBOR/FRIEND M
OTHER (SPECIFY) _____ N

489. CHECK 471 AND 479, ALL COLUMNS:

RECOMMENDED HOUSE-MADE LIQUID GIVEN TO A CHILD (GO TO 490)
RECOMMENDED HOUSE-MADE LIQUID NOT GIVEN TO A CHILD OR 471/479 NOT ASKED (GO TO 501)

490. Where did you learn to make the recommended liquid made at home with salt, sugar and water that you gave to (NAME) when he/she had diarrhea?

PUBLIC SECTOR
HOSPITAL 11
MEDICAL CENTER 12
CSPS 13
SMI 14
DISPENSARY 15
PSP 16
COMMUNITY PHARMACEUTICAL DEPOT 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
PHARMACY 23
NURSE'S OFFICE 24
RELIGIOUS DISPENSARY 25
OTHER PRIVATE SECTOR
TRADITIONAL HEALER 31
RELATIVE/NEIGHBOR/FRIEND 32
OTHER (SPECIFY) _____ 41

SECTION 5: MARRIAGE

501. Are you currently married or living with a man as if married?

YES 1 (GO TO 504)
NO 2

502. Have you ever been married or lived with a man as if married?

YES 1
NO 2 (GO TO 513)

503. Are you currently widowed, divorced, or separated?

WIDOWED 1(GO TO 508)
DIVORCED 2 (GO TO 508)
SEPARATED 3 (GO TO 508)

504. Is your husband/partner living with you now or is he staying elsewhere?

LIVING WITH HER 1
LIVING ELSEWHERE 2

505. Does your husband/partner have any wives other than you?

YES 1
NO 2 (GO TO 508)

506. How many other wives does your husband have?

NUMBER OF WIVES _____
DOESN'T KNOW 98 (GO TO 508)

507. Are you the first, second, third ... wife?

RANK _____

508. Were you married or did you live with a man once or more than once?

ONCE 1
MORE THAN ONCE 2

509. In what month and year did you consummate your (first) union?

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____
DOESN'T KNOW YEAR 98
MARRIAGE NOT CONSUMMATED 96 (GO TO 518)

510. How old were you when you consummated your (first) union?

AGE ____
DOESN'T KNOW AGE 98

511. CHECK 509 AND 510:
YEAR AND AGE OF CONSUMMATION OF MARRIAGE GIVEN?

YES (GO TO 512)
NO (GO TO 514)

512. CHECK COHERENCE OF 509 AND 510:

YEAR OF BIRTH (105) + AGE AT MARRIAGE (510) = CALCULATED YEAR OF MARRIAGE

YEAR OF MARRIAGE _____

IF NECESSARY, CALCULATE YEAR OF BIRTH:
CURRENT YEAR - CURRENT AGE (106) = CALCULATED YEAR OF BIRTH

YEAR OF BIRTH ____

IS THE CALCULATED YEAR OF MARRIAGE WITHIN A YEAR OF THE RECORDED YEAR OF MARRIAGE (509)?

YES (GO TO 514)
NO (CHECK AND CORRECT 509 AND 510)

IF NEVER IN UNION:

513. Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 518)

Now we need some information about your sexual activity in order to gain a better understanding of family planning and fertility.

514. How many times have you had sexual intercourse in the last four weeks?

NUMBER OF TIMES ____

515. How many times in a month do you usually have sexual intercourse?

NUMBER OF TIMES ____

516. How long has it been since the last time you had sexual intercourse?

DAYS AGO 1 ______
WEEKS AGO 2 _______
MONTHS AGO 3 _______
YEARS AGO 4 ______
BEFORE LAST BIRTH 996

517. What age were you the first time you had sexual intercourse?

AGE ____
FIRST TIME AT MARRIAGE 96

518. PRESENCE OF OTHERS AT THIS TIME:

CHILDREN UNDER 10 YEARS
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 6: FERTILITY PREFERENCES

601. CHECK 312:

NEITHER HE NOR SHE STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 607)

602. CHECK 501:

YES, CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 603)
NOT MARRIED/NOT IN UNION (GO TO 614)

603. CHECK 223:

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

PREGNANT: 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 610)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 610)
UNDECIDED/DOESN'T KNOW 8 (GO TO 610)

604. CHECK 223:

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

MONTHS 1 ____ (GO TO 610)
YEARS 2 ____ (GO TO 610)

SOON/NOW 994 (GO TO 610)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 610)
OTHER (SPECIFY) _____ 996
DOESN'T KNOW 998

605. CHECK 216 AND 223:
LIVING CHILD(REN) OR PREGNANT?

YES (GO TO 606)
NO (GO TO 610)

606. CHECK 223:

NOT PREGNANT OR NOT SURE: What age would you like your youngest child to be when the next child is born?

PREGNANT: What age would you like the child with which you're pregnant to be when the next child is born?

AGE OF YOUNGEST IN YEARS _____ (GO TO 610)
DOESN'T KNOW 98 (GO TO 610)

607. In your current situation, if you had it to do over again, do you think that you/your husband/partner would make the same decision to get sterilized?

YES 1
NO 2

608. Do you regret that you/your husband had the operation so as to not have any (more) children?

YES 1
NO 2 (GO TO 614)

609. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 614)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 614)
SIDE EFFECTS 3 (GO TO 614)
OTHER REASON (SPECIFY) _____ 4 (GO TO 614)

610. Do you think your husband/partner approves or disapproves of couples that use a method to avoid becoming pregnant?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

611. How many times over the last year have you discussed family planning with your husband/partner?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3

612. Have you already discussed the number of children you want with your husband?

YES 1
NO 2

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

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DOESN'T KNOW 8

614. After the birth of a child, how long should a couple wait to begin having sexual intercourse?

MONTHS 1 ____
YEARS 2 ____
OTHER (SPECIFY) ______ 996

615. Should a mother wait until she is completely done breastfeeding before restarting sexual relations or does it not matter?

WAIT 1
NO IMPORTANCE 2

616. In general, do you approve or disapprove of couples that use a method to avoid becoming pregnant?

APPROVE 1
DISAPPROVE 2

617. CHECK 216:
RECORD JUST A NUMBER OR ANOTHER RESPONSE.

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?

NUMBER OF CHILDREN _____
OTHER (SPECIFY) _____ 96

618. In your opinion, what is the best interval in months or years between the birth of one child and the birth of the next child?

MONTHS 1 ____
YEARS 2 ____
OTHER (SPECIFY) _____ 996

SECTION 7: HUSBAND'S BACKGROUND AND WOMAN'S PROFESSIONAL ACTIVITY

701. CHECK 501 AND 502:
ASK THE QUESTIONS ABOUT THE CURRENT/MOST RECENT HUSBAND/PARTNER.

IS/WAS MARRIED/LIVING (LIVED) WITH A MAN (GO TO 702)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 708)

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

YES 1
NO 2 (GO TO 705)

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

PRIMARY 1
SECONDARY (1ST CYCLE) 2
SECONDARY (2ND CYCLE) 3
HIGHER 4
DOESN'T KNOW 8 (GO TO 705)

704. What was the highest grade he completed at that level?

GRADE ____
DOESN'T KNOW 8

705. What is (was) your husband's/partner's principal occupation?

OCCUPATION _____

706. CHECK 705:

WORKS/WORKED IN AGRICULTURE (GO TO 707)
DOES/DID NOT WORK IN AGRICULTURE (GO TO 708)

707. Did/Does your husband/partner work mainly on his own land or on family land, or does/did he work on land that he rents/rented from someone else, or does/did he work on someone else's land?

OWN LAND/FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

708. Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 801)

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

OCCUPATION _____

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

712. Do you earn a salary for this work?
INSIST: Do you earn money for doing this work?

YES 1
NO 2

713. Do you usually work in the home or outside the home?

IN THE HOME 1
OUTSIDE THE HOME 2

714. CHECK 215/216/218:
HAS A CHILD BORN SINCE JANUARY 1987 LIVING WITH HER?

YES (GO TO 715)
NO (GO TO 801)

715. While you work, do you usually have (NAME) with you, sometimes with you or never with you?

USUALLY 1 (GO TO 801)
SOMETIMES 2
NEVER 3

716. Who usually takes care of (NAME OF YOUNGEST CHILD IN HOUSEHOLD) while you are working?

HUSBAND/PARTNER 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
NANNY/HIRED PERSON 06
CHILD GOES TO SCHOOL 07
DAYCARE/KINDERGARTEN 08
OTHER (SPECIFY) _____ 09

SECTION 8: KNOWLEDGE AND ATTITUDES ABOUT AIDS

Now I would like to ask you some questions about a very important subject.

801. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 810)

802. Who have you heard talking about it?

HUSBAND/PARTNER 01
HEALTH AGENT 02
RADIO/TELEVISION 03
NEWSPAPERS 04
FRIEND/RELATIVE/COUSIN 05
POSTERS/ADVERTISING CAMPAIGNS 06
OTHER (SPECIFY) _____ 07
DOESN'T KNOW 98

803. Have you previously attended meetings or talks about AIDS?

YES 1
NO 2
DOESN'T KNOW 8

804. In your opinion, how can someone get AIDS?
RECORD ALL MENTIONED.

SEXUAL INTERCOURSE WITH SOMEONE WHO HAS AIDS A
SEXUAL INTERCOURSE WITH PROSTITUTES B
SEXUAL INTERCOURSE WITH DIFFERENT PARTNERS C
HOMOSEXUAL RELATIONS D
BLOOD TRANSFUSIONS E
EAT FROM THE SAME PLATE AS SOMEONE WITH AIDS F
WEAR THE CLOTHES OF SOMEONE WITH AIDS G
USE NON-STERILIZED SYRINGES OR NEEDLES H
MOTHER TO CHILD I
MOSQUITO/INSECT BITES J
OTHER (SPECIFY) _____ K
DOESN'T KNOW L

805. In your opinion, what should one do to avoid contracting AIDS?
RECORD EVERYTHING MENTIONED.

USE CONDOMS A
HAVE ONE PARTNER B
AVOID PROSTITUTES C
NOT USE NON-STERILIZED SYRINGES OR NEEDLES D
DON'T TOUCH CONTAMINATED BLOOD E
OTHER (SPECIFY) _____ F
DOESN'T KNOW G

806. How can one recognize someone who has AIDS?
RECORD ALL MENTIONED.

WEIGHT LOSS A
DIARRHEA B
VOMITING C
CHILLS AND FEVER D
BLOOD TEST E
SPOTS ON THE SKIN F
PERSISTENT COUGH G
OTHER (SPECIFY) _____ H
DOESN'T KNOW I

807. Can a woman who has AIDS give birth to a baby with AIDS?

YES 1
NO 2
DOESN'T KNOW 8

808. Is it possible for a healthy-looking person to have AIDS?

YES 1
NO 2
DOESN'T KNOW 8

809. In your opinion, what should be done with people sick with AIDS?

SEND THEM TO THE HOSPITAL 1
KEEP THEM AT HOME 2
ISOLATE THEM 3
OTHER (SPECIFY) _____ 4
DOESN'T KNOW 8

810. In the last 2 months have you received an injection for any reason whatsoever?

YES 1
NO 2 (GO TO 812)

811. Who gave you this injection?

PUBLIC SECTOR
HOSPITAL, MEDICAL CENTER, CSPS 11
PRIVATE SECTOR
DOCTOR'S OFFICE 21
NURSE'S OFFICE 22
OTHER (SPECIFY) ____ 41

812. CHECK 516:

HAS HAD SEXUAL INTERCOURSE IN THE LAST 2 MONTHS (GO TO 813)
HAS NOT HAD SEXUAL INTERCOURSE IN THE LAST 2 MONTHS (GO TO 819)

813. During the sexual intercourse you've had in the last two months, have you used condoms?

YES 1
NO 2 (GO TO 818)

814. Have you used them every time, sometimes, or rarely?

EVERY TIME 1
SOMETIMES 2
RARELY 3

815. Why did you use these condoms?
RECORD ALL MENTIONED.

AVOID PREGNANCY A
AVOID STDS B
AVOID AIDS C
OTHER (SPECIFY) _____ D
DOESN'T KNOW E

816. Where did you obtain these condoms?

PUBLIC SECTOR
SMI 11
COMMUNITY PHARMACEUTICAL DEPOT 12
PRIVATE MEDICAL SECTOR
PHARMACY 21
OTHER PRIVATE SECTOR
STORE/STAND 31
RELATIVES/FRIENDS 32
PARTNER HAD THEM 33
OTHER (SPECIFY) _____ 41
DOESN'T KNOW 98

817. What brand of condoms does your husband/partner use?

PRUDENCE 1
SULTAN 2
OTHERS (SPECIFY) ____ 3
DOESN'T KNOW 8

818. With how many partners have you had sexual intercourse in the last two months?

NUMBER OF PARTNERS _____

HUSBAND/PARTNER ONLY 95
SEVERAL 96

819. RECORD TIME OF END OF INTERVIEW:

HOUR_____
MINUTES_____

SECTION 9: HEIGHT AND WEIGHT

901. CHECK 215 AND 216:

ONE OR MORE BIRTHS SINCE JANUARY 1987 (GO TO 902)
NO BIRTHS SINCE JANUARY 1987 (END OF INTERVIEW)

902. RECORD THE LINE NUMBER OF EACH LIVING CHILD BORN AFTER JANUARY 1987 IN COLUMNS 2-4:
[DO NOT ASK FOR RESPONDENT]

LINE NO. FROM 212 _____

903. RECORD THE NAME AND DATE OF BIRTH OF RESPONDENT AND EACH LIVING CHILD BORN AFTER JANUARY 1987 IN 903 AND 904:

NAME (FROM 212 FOR CHILDREN) _____

904. BIRTH DATE (FROM 103 FOR THE RESPONDENT: ACCORDING TO 215 FOR CHILDREN AND ASK FOR DATE OF BIRTH):

[ASK FOR MONTH AND YEAR FROM RESPONDENT; ASK FOR DAY, MONTH, AND YEAR FOR RESPONDENT'S CHILDREN]

DAY ____
MONTH ____
YEAR _____

905. TB VACCINE SCAR ON THE TOP OF LEFT SHOULDER:
[DO NOT ASK FOR RESPONDENT; ONLY FOR CHILDREN]

SCAR SEEN 1
NO SCAR 2

[IN 907 AND 909, RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1987 MUST BE MEASURED AND WEIGHED, EVEN IF ALL OF THE CHILDREN ARE DECEASED. IF THERE ARE MORE THAN THREE LIVING CHILDREN BORN SINCE JANUARY 1987, USE AN ADDITIONAL QUESTIONNAIRE.)]

906. HEIGHT (IN CENTIMETERS):

CM _____

907. WERE THE CHILDREN MEASURED LYING DOWN OR STANDING UP?
[DO NOT ASK FOR RESPONDENT]

LYING DOWN 1
STANDING UP 2

908. WEIGHT (IN KILOGRAMS):

KM _____

909. CIRCUMFERENCE OF ARM (IN CENTIMETERS):
[ASK ONLY FOR RESPONDENT]

CM _____

910. DATE OF HEIGHT AND WEIGHT MEASUREMENT:

DAY ____
MONTH ____
YEAR ____

911. RESULT

FOR WOMAN/RESPONDENT _____
MEASURED 1
ABSENT 2
REFUSED 3
OTHER (SPECIFY) _____ 6
FOR CHILD(REN) _____
CHILD MEASURED 1
CHILD SICK 2
CHILD ABSENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ____ 6

912. NAME OF OPERATOR _____
OPERATOR CODE _____

NAME OF ASSISTANT _____
ASSISTANT CODE _____

MOTHER 90
OTHER HOUSEHOLD MEMBER 91
OTHER PERSONS 92

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT _____

COMMENTS ON SPECIFIC QUESTIONS _____

ANY OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
NAME _____
DATE _____

EDITOR'S OBSERVATIONS _____
NAME _____
DATE _____

[RETURN TO THE FIRST PAGE OF THE QUESTIONNAIRE TO COMPLETE THE RESULT CODE]