IDENTIFICATION

PLACE NAME ______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER ______
HOUSEHOLD UNIT NUMBER _______
REGION _______
VILLAGE _______

URBAN/RURAL:

BIG CITY/OTHER CITY/RURAL:

NAME OF FEMALE RESPONDENT _____

LINE NUMBER OF FEMALE RESPONDENT _____

CHECK HOUSEHOLD QUESTIONNAIRE COVER: IS THE ANEMIA TEST/HIV TEST ANTICIPATED FROM THIS HOUSEHOLD?

INTERVIEWER VISITS

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

RESULT______

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY _____
MONTH _____
YEAR 2003
INT. NUMBER ______
RESULT __________

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE: FRENCH 01

LANGUAGE OF INTERVIEW _____

INTERPRETER USED:

SUPERVISOR
NAME ______
DATE ______

FIELD EDITOR
NAME ______
DATE ______

OFFICE EDITOR ______
KEYED BY ______

SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

INTRODUCTION AND CONSENT:

CONSENT AFTER INFORMATION:

Hello. My name is _______ and I am working with the National Institute of Demography and Statistics. We are in the process of conducting a national survey on the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and the health of your children). This information will be useful to the government in order to put health services in place. The survey usually takes between 20 and 45 minutes. The information you will give us is strictly confidential and will not be shared with anyone.

Participation in this survey is completely voluntary and you may refuse to answer any or all of the questions. However, we hope you will participate in the survey since your views are important to us.

Do you have any questions to ask me about the survey?
May I begin the interview now?

SIGNATURE OF INTERVIEWER ______
DATE ______

101. RECORD THE TIME:

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 OUAGADOUGOU, in another city, or in a rural setting?

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

104. Just before you moved here, did you live in OUAGADOUGOU, in another city, or in a rural setting?

105. In what month and year were you born?

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

107. Have you ever attended school?

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

109. What is the highest grade you completed at that level?
RECORD '00' FOR LESS THAN ONE YEAR COMPLETED AND '8' FOR DOESN'T KNOW.

109A. CHECK 106:

109B. Are you currently attending school?

109C. What is the main reason you stopped going to school?

110. CHECK 108:

111. Now I would like you to read this sentence to me; read the most of it you can.

SHOW CARD TO RESPONDENT.

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

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

113. CHECK 111:

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

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

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

117. What is your religion?

118. What is your ethnicity?

119. Have you ever consumed alcoholic beverages?

120. Have you ever been intoxicated after consuming alcoholic beverages?

121. Over the past three months, how many days have you consumed alcoholic beverages?

122. CHECK 120:

123. Over the past three months, how many times have you been intoxicated?

124. Over the past three months, have you received an injection?

125. Over the past three months, how many times have you received an injection?

126. The last time you had an injection, who gave you the shot?

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?

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

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

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

205. How many sons are alive but do not live with you?
How many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life at birth but did not survive?

207. How many boys have died?
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:

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

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 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)?
[DO NOT ASK FOR FIRST BIRTH]

[GO BACK AND REPEAT 212-221 FOR EACH ADDITIONAL BIRTH]

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1998 OR LATER.
IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE JANUARY 1998, WRITE 'N' IN THE MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.

NOTE: THE NUMBER OF G's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. WRITE THE NAME OF THE CHILD TO THE LEFT OF CODE N.

226. Are you pregnant now?

227. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'G' 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?

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

230. When did the last such pregnancy end?

231. CHECK 230:

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'F' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'G' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233. Since January 1998, 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 1998.

ENTER 'F' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'G' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any miscarriages, abortions or stillbirths that ended before 1998?

236. When did the last such pregnancy that terminated before January 1998 end?

237. When did your last menstrual period start?
RECORD THE DATE, IF GIVEN.

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

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

SECTION 3: CONTRACEPTION

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

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

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

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

303. CHECK 302:

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

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

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

308. CHECK 302 (01):

309. CHECK 226:

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

311. Which method are you currently using?
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
CIRCLE 'B' FOR MALE STERILIZATION.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW THE SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

312A. May I see the package of pills you are using?
IF THE PACKAGE IS SHOWN, CIRCLE THE CODE THAT CORRESPONDS TO THE BRAND.

312B. Do you know the brand name of the pills you are using?
IF YES: What is the name?

312C. How much does a package of pills cost you?
NOTE THE PRICE FOR ONE MONTH/CYCLE IN CFA FRANCS.

312D. Do you know the commercial name of the injection you received the last time?
IF YES: What is the name?

313. Where did the sterilization take place?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

IF CODES 'A' AND 'B' ARE CIRCLED IN 311, ASK 313-317 ON FEMALE STERILIZATION ONLY.

314. CHECK 311:

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

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

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

316A. Since what month and year have you been using (FIRST METHOD FROM 311) without stopping?

PROBE: Since what month and year have you been using (FIRST METHOD FROM 311) without stopping?

316B. CHECK 316/316A, 215 AND 230:

WAS THERE WAS AT 215 A BIRTH OR AT 230 A PREGNANCY TERMINATED BY MISCARRIAGE, ABORTION OR STILLBIRTH AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A?

317. CHECK 316/316A:

319. CHECK 311/311A: CIRCLE METHOD CODE.
IF MORE THAN ONE CODE IS CIRCLED IN 311/311A, CIRCLE THE CODE OF THE FIRST METHOD CIRCLED IN 311/311A.

320. Where did you obtain (METHOD FROM 319) when you first began using it?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

321. CHECK 311/311A: CIRCLE METHOD CODE.
IF MORE THAN ONE CODE IS CIRCLED IN 311/311A, CIRCLE THE CODE OF THE FIRST METHOD CIRCLED IN 311/311A.

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

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

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

325. CHECK 322:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320) were you told about other methods of family planning that you could use?

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

327. CHECK 311/311A: CIRCLE METHOD CODE:
IF MORE THAN ONE CODE IS CIRCLED IN 311/311A, CIRCLE THE CODE OF THE FIRST METHOD CIRCLED IN 311/311A.

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

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

330. Where is that?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

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

333. Did a staff member at the health facility speak to you about family planning methods?

333A. The last time you or your children went to the CSB, did you find your prescribed medications?

333B. The last time you or your children went to the CSB, did you find the prices of medication to be expensive, average, or cheap?

333C. The last time you or your children went to the CSB, how much did you pay for the medication (PRICE IN CFA FRANCS)?

333D. The last time you or your children went to the CSB, were you able to pay for medication yourself without borrowing from family, friends or neighbors?

SECTION 4A: PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH SINCE 1998. ASK THE QUESTIONS FOR ALL 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 each separately.

403. LINE NUMBER FROM 212:

[404-471 ARE REPEATED FOR EACH BIRTH, BEGINNING WITH THE MOST RECENT BIRTH. IF MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES]

404. FROM 212 AND 216:

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

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

407. Did you receive prenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

408. How many months pregnant were you when you first received antenatal care for this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

409. How many times did you receive antenatal care during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

410. CHECK 409:
NUMBER OF PRENATAL CONSULTATIONS RECEIVED:
[ASK ONLY FOR MOST RECENT BIRTH]

411. How many months pregnant were you the last time you had a prenatal visit?
[ASK ONLY FOR MOST RECENT BIRTH]

412. During this pregnancy, were any of the following done at least once?
[ASK ONLY FOR MOST RECENT BIRTH]

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

413. Were you told about the signs of pregnancy complications?
[ASK ONLY FOR MOST RECENT BIRTH]

414. Were you told where to go if you had any of these complications?
[ASK ONLY FOR MOST RECENT BIRTH]

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

416. During this pregnancy, how many times did you get this tetanus injection?
[ASK ONLY FOR MOST RECENT BIRTH]

417. During this pregnancy, were you given or did you buy any iron tablets or syrup with iron in it? SHOW TABLETS/SYRUP.
[ASK ONLY FOR MOST RECENT BIRTH]

418. During the whole pregnancy, for how many days did you take the iron tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]

419. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK ONLY FOR MOST RECENT BIRTH]

420. During this pregnancy, did you suffer from night blindness/(USE LOCAL NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

421. During this pregnancy, did you take any drugs to keep you from getting malaria?
[ASK ONLY FOR MOST RECENT BIRTH]

422. What was this medication?
[ASK ONLY FOR MOST RECENT BIRTH]

RECORD ALL MENTIONED. IF THE KIND OF MEDICATION IS UNKNOWN, SHOW RESPONDENT A SAMPLING OF ANTIMALARIAL MEDICATIONS.

422A. CHECK 422:
TYPE OF MEDICATION TAKEN DURING PREGNANCY TO AVOID MALARIA?
[ASK ONLY FOR MOST RECENT BIRTH]

422B. How many times did you take the medication FANSIDAR during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

IF THE RESPONDENT DOES NOT KNOW THE NUMBER OF TIMES, ASK IF THE RESPONDENT TOOK THE MEDICATION ALL THROUGHOUT THE PREGNANCY OR FROM TIME TO TIME, THEN CIRCLE THE CORRESPONDING CODE.

422C. CHECK 407:
TYPE OF PERSONNEL THAT GAVE PRENATAL CARE DURING THIS PREGNANCY?
[ASK ONLY FOR MOST RECENT BIRTH]

422D. When you were pregnant with (NAME), did you obtain Fansidar, Chloroquine/Nivaquine, Flavoquine/Amodiaquine or Quinine during a prenatal visit, or during another health-related visit, or from another source?
[ASK ONLY FOR MOST RECENT BIRTH]

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

424. Was (NAME) weighed at birth?

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

425AA. Does (NAME) have a birth certificate?
IF YES: Can I see it, please?

425A. Was (NAME'S) birth reported to the Registrar General?

426. 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.

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

IF IT IS A PUBLIC HOSPITAL/CLINIC OR A PRIVATE CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

428. Was (NAME) delivered by caesarean section?

429. After the birth of (NAME), did a health care provider or traditional midwife examine you?

430. How long after delivery did the first check take place?
[ASK ONLY FOR MOST RECENT BIRTH]
RECORD '00' IF THE SAME DAY.

431. Who checked on your health at that time?
[ASK ONLY FOR MOST RECENT BIRTH]
PROBE FOR MOST QUALIFIED PERSON.

432. Where did this first check take place?
[ASK ONLY FOR MOST RECENT BIRTH]

433. In the two months after the birth, did you receive a dose of vitamin A such as this?
[ASK ONLY FOR MOST RECENT BIRTH]
SHOW PILL/GEL CAP/SYRUP.

434. Has your menstrual period returned since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

435. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

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

437. CHECK 226:
IS RESPONDENT PREGNANT?
[ASK ONLY FOR MOST RECENT BIRTH]

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

439. For how long after the birth of (NAME) did you not have sexual intercourse?

440. Did you breastfeed (NAME)?

441. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD 00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

442. In the first three days after delivery and before the mother's breasts began to produce milk regularly, was (NAME) given anything to drink other than breast milk?

443. What was (NAME) given to drink before the mother's breasts began to produce milk regularly?

444. CHECK 404:
IS CHILD STILL LIVING?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 404:
IS CHILD STILL LIVING?

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

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

449A. Now I would like to know how much food you are eating since starting to breastfeed (NAME). Do you eat more than normal, as much as normal, or less than normal?

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

451. Was sugar added to any food or liquid that (NAME) was fed yesterday?

452. Yesterday, day or night, how many times was (NAME) fed pureed, solid or semi-solid food? IF 7 TIMES OR MORE, RECORD '7'.

453. GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 454.

SECTION 4B: VACCINATION AND HEALTH

454. WRITE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998.

ASK THE QUESTIONS FOR ALL BIRTHS. START WITH THE MOST RECENT BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.

455. LINE NUMBER FROM 212:

456. FROM 212 AND 216:

457. Did (NAME) receive a vitamin A dose, like this one, within the last six months?
SHOW PILL/CAPSULE/SYRUP.

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

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

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

461. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINES.

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

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

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

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

463C. Was the first polio vaccine received just after birth or later?

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

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

463F. How many times?

463G. A measles injection?

464. Did (NAME) receive any of these injections during a national vaccination day within the last two years?

465. During which national vaccination day did (NAME) receive these vaccinations?
RECORD ALL MENTIONED IN FOLLOWING FORMAT: NAME/CAMPAIGN
(TYPE AND DATE).

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

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

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

469. CHECK 466 AND 467:
FEVER OR COUGH?

470. Did you seek advice or treatment when (NAME) had a (fever/cough)?

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

472. CHECK 466:
HAD FEVER?

472A. Does (NAME) have a fever now?

472B. Has (NAME) had convulsions at any point in the last two weeks?

472C. CHECK 466 AND 472B:
FEVER OR CONVULSIONS?

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

474. What drugs did (NAME) take?

RECORD ALL MENTIONED. ASK TO SEE THE MEDICATION IF THE TYPE OF MEDICATION IS UNKNOWN. IF THE TYPE OF MEDICATION CANNOT BE DETERMINED, SHOW THE RESPONDENT A COMMON ANTIMALARIAL DRUG.

474A. Has (NAME) had an injection or suppository to treat the fever/convulsions?

474B. CHECK 474:
INDICATE TYPE OF MEDICATION:

474C. How long after the beginning of the fever/convulsions did (NAME) begin to take Fansidar?

474D. For how many consecutive days did (NAME) take Fansidar?
IF MORE THAN 7 DAYS, RECORD '7'.

474E. Do you have Fansidar in the house, or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you first obtain Fansidar?

474F. CHECK 474:
INDICATE TYPE OF MEDICATION.

474G. How long after the beginning of the fever/convulsions did (NAME) begin to take Chloroquine or Nivaquine?

474H. For how many consecutive days did (NAME) take Chloroquine or Nivaquine?
IF MORE THAN 7 DAYS, RECORD '7'.

474I. Do you have Chloroquine or Nivaquine in the house, or did you get it from somewhere else? IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you first obtain Chloroquine or Nivaquine?

474J. CHECK 474:
INDICATE TYPE OF MEDICATION:

474K. How long after the beginning of the fever/convulsions did (NAME) begin to take Flavoquine or Amodiaquine?

474L. For how many consecutive days did (NAME) take Flavoquine or Amodiaquine?
IF MORE THAN 7 DAYS, RECORD '7'.

474M. Do you have Flavoquine or Amodiaquine in the house, or did you get it from somewhere else? IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you first obtain Flavoquine or Amodiaquine?

474N. CHECK 474:
INDICATE TYPE OF MEDICATION:

474O. How long after the beginning of the fever/convulsions did (NAME) begin to take Quinine?

474P. For how many consecutive days did (NAME) take Quinine?
IF MORE THAN 7 DAYS, RECORD '7'.

474Q. Do you have Quinine in the house, or did you get it from somewhere else? IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you first obtain quinine?

474R. Was anything else done to treat (NAME)'s fever/convulsions?

474S. What was done to treat (NAME)'s fever/convulsions?

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

476. Now I would like to know how much (NAME) was given to drink during the diarrhea. 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?

477. 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?

478. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A liquid prepared from an ORS packet/(LOCAL NAME FOR ORS PACKET)?
b) A homemade liquid recommended by the government?

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

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

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

482. Where did you seek advice or treatment? Anywhere else?

RECORD ALL MENTIONED. IF IT IS A PUBLIC HOSPITAL/CLINIC OR A PRIVATE CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

483. RETURN TO 456 IN THE NEXT COLUMN OR (IF NO MORE BIRTHS, GO TO 484.)

484. CHECK 215 AND 218, ALL COLUMNS: NUMBER OF LIVING CHILDREN BORN IN 1998 OR LATER.

485. When (YOUNGEST CHILD) does not use the toilet, what do you typically do to dispose of the stools?

486. CHECK 478(a), ALL COLUMNS:

487. Have you ever heard of a special product called (Orasel OR OTHER LOCAL NAME FOR ORS PACKET) that you can get for the treatment of diarrhea?

488. CHECK 218:

489. When your child/one of your children is seriously ill, can you yourself decide to take the child to get medical treatment?

IF RESPONDENT SAYS THAT NONE OF HER CHILDREN HAVE EVER BEEN SERIOUSLY ILL, ASK: If your child/one of your children were to fall seriously ill, could you yourself decide to take the child to get medical treatment?

Now, I would like to ask you questions having to do with your own health care.

490. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, does each of the following constitute a big problem, a small problem, or no problem?

Knowing where to go.
Getting permission to go.
Getting money needed for treatment.
No health facility nearby.
Having to take transport.
Not wanting to go alone.
Concern that there may not be a female health provider.

491. CHECK 215 AND 218:

492. Now I would like to ask you what liquids (NAME FROM 491) has had over the last 7 days, including yesterday. How many days out of the last seven days did (NAME FROM 491) drink one of the following liquids?

FOR EACH OF THE LIQUIDS DRANK AT LEAST ONCE OVER THE LAST 7 DAYS, ASK: In total, during the day or night yesterday, how many times did (NAME FROM 491) drink:

a) Water?
b) Formula?
c) All other types of milk, such as boxed, powdered, or fresh animal milk?
d) Fruit juice?
e) Other liquids?

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

493. Now I would like to ask you what foods (NAME FROM 491) has had over the last 7 days, including yesterday. How many days out of the last seven days did (NAME FROM 491) eat one of the following foods?

FOR EACH OF THE FOODS EATEN AT LEAST ONCE OVER THE LAST SEVEN DAYS, ASK: In total, during the day or night yesterday, how many times did (NAME FROM 491) eat:

a) Food made from grains (example: millet, sorghum, corn, rice, wheat, porridge, or other local grains)?
b) Red or yellow yams or squash, carrots, or sweet potatoes?
c) Other foods made from roots (example: potatoes, cassava root, or other local roots)?
d) Dark green, leafy vegetables?
e) Mangoes, papayas or other local fruits rich in vitamin A?
f) Any other fruits (example: banana, apple, green beans, avocado, tomato)?
g) Meat, poultry, fish, shellfish or eggs?
h) Any other foods made from plants (example: lentils, beans, soy, legumes, nuts)?
i) Cheese or yogurt?
j) Any foods made with oil, fats or butter?

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

494. Did you sleep under a mosquito net last night?

495. The last time you prepared a meal for your family did you wash your hands before beginning?

496. Do you currently smoke cigarettes or tobacco?
IF YES: What do you smoke? RECORD ALL MENTIONED.

497. CHECK 496:

498. In the last 24 hours, how many cigarettes (number of stems) have you smoked?

SECTION 5: MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

507. Does your husband/partner have any wives or partners other than you?

508. How many other wives or partners does your husband have?

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

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

511. CHECK 510:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask you about when you started living with your first husband/partner. In what month and year was that?

512. How old were you when you first started living with him?

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

514. How old were you when you had sexual intercourse for the very first time, if you have had it?

515. How long has it been since the last time you had sexual intercourse?
RECORD IN NUMBER OF YEARS ONLY IF THE LAST TIME WAS MORE THAN A YEAR AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

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

516A. What is the main reason that you used a condom on this occasion?

516B. Do you know the brand name of condom that was used on this occasion?
IF YES: What is the brand?

516D. Did you procure these condoms or did you partner provide them?

516E. How much did you pay for the condoms?
RECORD THE PRICE OF 4 CONDOMS IN CFAF.

516F. What were the reasons a condom was not used during your last sexual encounter?

517. What is your relationship to the person with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANCÉ, ASK: Was your boyfriend/fiancé living with you at the time you last had sexual intercourse with him? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

518. For how long have you had sexual relations with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAY.

519. Have you had sexual intercourse with another man in the last 12 months?

520. The last time you had sexual intercourse with this other person, was a condom used?

520A. What is the main reason that you used a condom on this occasion?

520B. Do you know the brand name of condom that was used on this occasion?
IF YES: What is the brand?

520D. Did you procure these condoms or did you partner provide them?

520E. How much did you pay for the condoms?
RECORD THE PRICE OF 4 CONDOMS IN CFAF.

520F. What were the reasons a condom was not used during your last sexual encounter?

521. What is your relationship to this other man?
IF BOYFRIEND OR FIANCÉ, ASK: Was your boyfriend/fiancé living with you at the time you last had sexual intercourse with him? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

522. For how long have you had sexual relations with this other man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAY.

523. In total, with how many people have you had sexual intercourse in the last 12 months?

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

525. Where is that? Any other place?
RECORD ALL MENTIONED.

IF IT IS A HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

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

528. Where is that? Any other place?
RECORD ALL MENTIONED.

IF IT IS A HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

SECTION 6: FERTILITY PREFERENCES

601. CHECK 311/311A:

602. CHECK 226:

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?

603. CHECK 226:

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?

604. CHECK 226:

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

606. CHECK 603:

607. CHECK 602:

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

WANTS NO MORE/NONE : 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 you are not using a method? Any other reason?

RECORD ALL REASONS MENTIONED.

608. In the weeks to come, if you were to discover that you were pregnant, would it be an important problem, a small problem, or would it not be a problem at all?

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

611. Which contraceptive method would you prefer to use?

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

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

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?

PROBE FOR A NUMERIC RESPONSE.

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

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

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

On the radio?
On television?
In newspapers or magazines?
On posters?
In a prospectus/brochure?
At a cultural/educational performance?
At school?

618. In your opinion, is it appropriate or inappropriate to speak of family planning:

On the radio?
On television?
In newspapers or magazines?
On posters?
In a prospectus/brochure?
At a cultural/educational performance?
At school?

619. Over the last several months, have you discussed family planning with your friends, neighbors, or relatives?

620. With whom did you discuss it? Anyone else?
RECORD ALL MENTIONED.

621. CHECK 501:

622. CHECK 311/311A:

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

Now I would like to ask you some questions about your husband's/partner's opinions on family planning.

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

625. How many times over the last 12 months have you discussed family planning with your husband/partner?

626. CHECK 311/311A:

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

628. Husbands and wives don't always agree on everything. Please, tell me if you think a woman is justified in refusing to have sexual intercourse with her husband when:

She knows that her husband has a sexually transmitted infection?
She knows that her husband has sexual intercourse with other women?
She has recently given birth?
She is tired or doesn't feel like it?

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

701. CHECK 501 AND 502:

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

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

704. What was the highest level of school he attended: primary, secondary (1st cycle), secondary (2nd cycle) or higher?

705. What was the highest (grade/form/year) he completed at that level?
WRITE '0' FOR LESS THAN ONE YEAR COMPLETED AND '8' FOR DOESN'T KNOW.

706. CHECK 701:

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

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

707. Aside from your own housework, have you done any work in the last seven days?

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

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

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

711. CHECK 710:

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

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

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

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

716. Are you paid in cash or kind for this work, or are you not paid at all?

717. Who usually decides how the money you earn will be used?

718. On average, what percentage of the household expenses are paid for using the money you earn?

719. In your family, who usually has the last word in the following decisions:

Your own health care?
The purchase of important household items?
The purchase of daily household items?
Visiting family or relatives?
What food will be prepared each day?

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

721. 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 burns the food?

SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

Now I would like to talk about something else.

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

802. Is there something people can do to avoid contracting AIDS or the virus that causes AIDS?

803. What can one do? Anything else?
RECORD ALL MENTIONED.

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

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

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

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

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

810. Do you personally know anyone who has the AIDS virus or is sick from AIDS, or someone who has died of AIDS?

811. Can the virus that causes AIDS be transmitted from a mother to her baby?

812. When can the AIDS virus be transmitted from the mother to the child? Can it be transmitted:

During pregnancy?
During delivery?
By breastfeeding?

813. CHECK 501:

814. Have you already spoken with your husband/partner about ways to avoid the AIDS virus?

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

816. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

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

818. What are the signs or symptoms in a man that make you think he may have a sexually transmitted infection?
INSIST: Anything else?
RECORD ALL MENTIONED.

819. What are the signs or symptoms in a woman that make you think she may have a sexually transmitted infection?
INSIST: Anything else?
RECORD ALL MENTIONED.

819A. If you had any of these symptoms, where would you go for advice or care?

819B. CHECK 514:

Now I would like to ask you some questions about your health in the last 12 months.

819C. During the last 12 months, have you had a sexually transmitted infection?

819D. Sometimes women experience a bad smelling abnormal vaginal discharge. During the last 12 months, have you had a bad smelling abnormal vaginal discharge?

819E. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

819F. CHECK 819C, 819D, AND 819E:

819G. The last time you had (INFECTION FROM 819C/819D/819E), did you seek any kind of advice or treatment?

819H. The last time you had (INFECTION FROM 819C/819D/819E), did you do any of the following things? Did you...

Seek advice from a health care worker in a hospital or clinic?
Seek advice or treatment from a traditional healer?
Seek advice or buy medication from a pharmacy or store?
Seek advice from family or friends?

819I. When you had (INFECTION FROM 819C/819D/819E), did you inform your sexual partner(s)?

819J. When you had (INFECTION FROM 819C/819D/819E), did you do anything to avoid infecting your sexual partner(s)?

819K. What did you do to avoid infecting your partner(s)? Did you...

Stop having sexual intercourse?
Use a condom during sexual intercourse?
Take medication?

SECTION 9: MORTALITY

Now, I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother including those that live with you, those that live elsewhere, and those that are deceased.

901. To how many children did your mother give birth in total, including yourself?

902. CHECK 901:

903. How many of these births did your mother have before you were born?

904. What was the name given to your (oldest/next oldest) brother or sister?

905. Is (NAME) male or female?

906. Is (NAME) still alive?

907. How old is (NAME)?

908. How many years ago did (NAME) die?

909. How old was (NAME) when he/she died?

[IF NO MORE BROTHERS OR SISTERS, GO TO 1001]

SECTION 10: FEMALE CIRCUMCISION

I would now like to interview you about a subject relating to women's health.

1001. Have you ever heard of female circumcision?

1002. In certain societies or countries such as Burkina Faso, a practice exists which consists of cutting a part of the external genital organs of girls. Have you ever heard of this practice?

1003. Have you been circumcised?

I would now like to ask you questions about what happened at that time.

1004. Did they cut some of your skin in the genital region?

1005. Did they only cut into your genital area without removing any skin?

1006. During your circumcision, did they completely close the vaginal opening by sewing a seam?

1007. What age were you at the time of your circumcision?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO OBTAIN AN ESTIMATE.

1008. Who performed your circumcision?

1009. CHECK 214 AND 216:

1010. Have any of your daughters undergone circumcision?
IF YES: How many?

1011. Which of your daughters has most recently been circumcised?
INTERVIEWER: CHECK 212 AND RECORD THE DAUGHTER'S LINE NUMBER

I would now like to ask you questions about what was done to (NAME OF DAUGHTER IN 1011) at that time.

1012. Did they remove any part of her genitals?

1013. Did they only cut into her genital area without removing any skin?

1014. During her circumcision, did they completely close the vaginal opening by sewing a seam?

1015. What age was (NAME OF DAUGHTER IN 1011) at the time of her circumcision?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO OBTAIN AN ESTIMATE.

1016. Who performed your daughter's circumcision?

1017. During or after they cut (NAME OF DAUGHTER IN 1011)'s genitals, did any of the following problems present themselves:

Excessive bleeding?
Difficulty urinating or retaining urine?
Swelling in the genital region?
Infection in the genital region/wound improperly healed?

1018. In the future, do you intend to have your daughters circumcised?

1019. What are the advantages for a girl to be circumcised?
INSIST: Other advantages? RECORD ALL MENTIONED.

1020. What are the advantages for a girl not to be circumcised?
INSIST: Anything else? RECORD ALL MENTIONED.

1021. Do you think that the practice of female circumcision is a way to prevent girls from having premarital sex or do you think, on the contrary, that it has no effect?

1022. Do you think that female circumcision is demanded by your religion?

1023. Do you think that the practice of female circumcision should continue or disappear?

1024. Do you think that men believe the practice of female circumcision should be maintained, or on the contrary, do you think they favor its abandonment?

1024A. Do you think a law exists in Burkina that prohibits female circumcision?

1025. RECORD THE TIME:

CALENDAR INSTRUCTIONS

ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

BIRTHS AND PREGNANCIES CODES:

2003:
12 DEC 01 ____
11 NOV 02 ____
10 OCT 03 ____
09 SEPT 04 ____
08 AUG 05 ____
07 JUL 06 ____
06 JUN 07 ____
05 MAY 08 ____
04 APR 09 ____
03 MAR 10 ____
02 FEB 11 ____
01 JAN 12 ____

2002:
12 DEC 13 ____
11 NOV 14 ____
10 OCT 15 ____
09 SEPT 16 ____
08 AUG 17 ____
07 JUL 18 ____
06 JUN 19 ____
05 MAY 20 ____
04 APR 21 ____
03 MAR 22 ____
02 FEB 23 ____
01 JAN 24 ____

2001:
12 DEC 25 ____
11 NOV 26 ____
10 OCT 27 ____
09 SEPT 28 ____
08 AUG 29 ____
07 JUL 30 ____
06 JUN 31 ____
05 MAY 32 ____
04 APR 33 ____
03 MAR 34 ____
02 FEB 35 ____
01 JAN 36 ____

2000:
12 DEC 37 ____
11 NOV 38 ____
10 OCT 39 ____
09 SEPT 40 ____
08 AUG 41 ____
07 JUL 42 ____
06 JUN 43 ____
05 MAY 44 ____
04 APR 45 ____
03 MAR 46 ____
02 FEB 47 ____
01 JAN 48 ____

1999:
12 DEC 49 ____
11 NOV 50 ____
10 OCT 51 ____
09 SEPT 52 ____
08 AUG 53 ____
07 JUL 54 ____
06 JUN 55 ____
05 MAY 56 ____
04 APR 57 ____
03 MAR 58 ____
02 FEB 59 ____
01 JAN 60 ____

1998:
12 DEC 61 ____
11 NOV 62 ____
10 OCT 63 ____
09 SEPT 64 ____
08 AUG 65 ____
07 JUL 66 ____
06 JUN 67 ____
05 MAY 68 ____
04 APR 69 ____
03 MAR 70 ____
02 FEB 71 ____
01 JAN 72 ____

END OF THE LAST PREGNANCY THAT DID NOT TERMINATE IN A LIVE BIRTH BEFORE JANUARY 1998:

[IF THERE ARE NO PREGNANCIES OF THIS KIND, RECORD '00' FOR THE MONTH AND '0000' FOR THE YEAR.]

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 _____