IDENTIFICATION

DEPARTMENT

SUB-PREFECTURE/URBAN DISTRICT

RURAL/URBAN MUNICIPALITY

TOWN/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER

NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME___
RESULT ____

NEXT VISIT
DATE___
TIME___

FINAL VISIT
DAY____
MONTH___
YEAR 2001
NAME___
RESULT ____

RESULT CODES:

TOTAL NUMBER OF VISITS__

QUESTIONNAIRE USED:

LANGUAGE OF INTERVIEW:

INTERPRETER:

SUPERVISOR
NAME___
DATE____

FIELD EDITOR
NAME____
DATE_____

OFFICE EDITOR____

KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ____ and I work for the National Institute of Statistics and Economic Analysis. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you some questions about your health (and your children's health). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes. Whatever information you provide will be kept strictly confidential and will not be shown to other people.

We hope that you will participate in the survey as your opinion is important to us.

Do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer____
Date____

101) RECORD THE TIME

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Cotonou, in another city, in a rural location, or abroad?

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 Cotonou, in another city, in a rural location, or abroad?

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, secondary, or higher?

109) What is the highest (grade/form/year) you completed at this level?
RECORD "00" FOR NO CLASS/YEAR FINISHED AND "98" FOR DON'T KNOW

109A) CHECK 106:

109B) Are you currently attending school?

109C) What is the main reason why you stopped attending school?

110) CHECK 108:

111) Now I would like you to read this sentence out loud to me; read as much as you can.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ THE 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 involved learning to read or write (not including primary school)?

113) CHECK 111:

114) Do you read a newspaper or 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 nationality?

118B) What is your ethnicity?

SECTION 2. REPRODUCTION

201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?

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

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

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

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

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

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

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

209) CHECK 208:
Just to makes sure that I have this right: you have had in TOTAL ____births during your life. Is that correct?

210) CHECK 208:

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

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

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

213) Were any of these births twins?

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

215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

216) Is (NAME) still alive?

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

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

219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD
(RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

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

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[ASK FOR ALL BIRTHS EXCEPT THE FIRST 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 SINCE JANUARY 1996
IF NONE, RECORD '0'.

226) Are you pregnant now?

227) How many months pregnant are you?
RECORD 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?

232) How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED MONTHS.

233) Have you had any other pregnancies that did not result in a live birth?

233A) All together, how many pregnancies have you had that did not result in a live birth?

237) When did your last menstrual period start?
RECORD THE ANSWER BASED ON THE UNIT 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-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 AND ASK 302 FOR THIS METHOD. THEN READ THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND ASK 302 FOR THIS METHOD. IF THE METHOD IS NOT MENTIONED SPONTANEOUSLY OR RECOGNIZED AFTER DESCRIPTION, CIRCLE CODE 2 FOR THIS METHOD AND GO TO THE NEXT METHOD.

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)?

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)

307) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

308) CHECK 302(01):

309) CHECK 226:

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

311) Which method are you using?
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

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

312A) Do you know the brand name of the pills you are now using?
RECORD THE NAME OF BRAND

312B) How much does one packet (cycle) of pills cost you?

313) In what facility did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF CODES 'A' AND 'B' ARE CIRCLED IN 311, ASK 313-316 FOR 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 'A' NOT 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 (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

317) CHECK 316/316A:

319) CHECK 311/311A:
CIRCLE THE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE THE CODE FOR THE HIGHEST METHOD IN THE LIST.

320) Where did you obtain (CURRENT METHOD) when you started using it?
320A) Where did you learn to use the lactational amenorrhea method (LAM)? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

321) CHECK 311/311A:
CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE THE CODE FOR THE HIGHEST METHOD IN THE LIST.

322) You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320). At that time, where you told 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:
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 worker or family planning worker about other methods of family planning that you could use?

327) CHECK 311/311A:
CIRCLE METHOD CODE:

328) Where did you obtain (CURRENT METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

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

330) Where is this?
330A) Where did you learn to use the lactational amenorrhea method (LAM)? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL MENTIONED.

331) In the last 12 months, were you visited by a field worker 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 any staff member at the health facility speak to you about family planning methods?

SECTION 4A. PREGNANCY, POST-NATAL CARE, AND BREASTFEEDING

401) CHECK 224:

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN TWO BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately).

403) LINE NUMBER FROM 212

404) FROM 212 AND 216

405) At the time you became pregnant with (NAME), did you want to become pregnant 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 see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[FOR LAST BIRTH ONLY]

407A) Where did you see this person?
[FOR LAST BIRTH ONLY]

408) How many months pregnant were you when you first received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]

409) How many times did you receive antenatal care during this pregnancy?
[FOR LAST BIRTH ONLY]

410) CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[FOR LAST BIRTH ONLY]

411) How many months pregnant were you the last time you received antenatal care?
[FOR LAST BIRTH ONLY]

412) During this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]

413) Were you told about the signs of pregnancy complications?
[FOR LAST BIRTH ONLY]

414) Were you told where to go if you had any of these complications?
[FOR LAST BIRTH ONLY]

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

416) During this pregnancy, how many times did you get this injection?
[FOR LAST BIRTH ONLY]

416A) How many weeks before the delivery did you receive the last injection?
[FOR LAST BIRTH ONLY]

417) During this pregnancy, were you given or did you buy iron tablets or syrup with iron?
SHOW TABLETS/SYRUP.
[FOR LAST BIRTH ONLY]

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

419) During this pregnancy, did you have difficulty with your vision during the daylight?
[FOR LAST BIRTH ONLY]

420) During this pregnancy, did you suffer from night blindness?
[FOR LAST BIRTH ONLY]

421) During this pregnancy, did you take any drugs in order to keep you from getting malaria?
[FOR LAST BIRTH ONLY]

422) What drugs did you take?
RECORD ALL MENTIONED. IF RESPONDENT DOES NOT KNOW NAME OF DRUG, SHOW EXAMPLES.
[FOR LAST BIRTH ONLY]

422A) What other ways can you protect yourself against malaria?
RECORD ALL MENTIONED.
[FOR LAST BIRTH ONLY]

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.

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

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

428) Was (NAME) delivered by caesarean section?

429) After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

430) How many days or weeks after delivery did the first check take place?
RECORD '00' IF SAME DAY.
[LAST BIRTH ONLY]

431) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON
[LAST BIRTH ONLY]

432) Where did this first check take place?
[LAST BIRTH ONLY]

433) In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP
[LAST BIRTH ONLY]

434) Has your period returned since the birth of (NAME)?
[LAST BIRTH ONLY]

435) Did your period return between the birth of (NAME) and your next pregnancy?
[ASK FOR ALL BIRTHS EXCEPT LAST BIRTH]

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

437) CHECK 226:
IS RESPONDENT PREGNANT?
[LAST BIRTH ONLY]

438) Have you resumed sexual intercourse since the birth of (NAME)?
[LAST BIRTH ONLY]

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

440) Did you ever 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, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

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

444) CHECK 404:
IS CHILD LIVING?

445) Are you still breastfeeding (NAME)?

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

447) CHECK 404:
IS CHILD LIVING?

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

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

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

451) Was sugar added to any of the foods or liquids given to (NAME) yesterday?

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

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

SECTION 4B. IMMUNIZATION AND HEALTH

454) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.)

455) LINE NUMBER FROM Q. 212

456) FROM Q. 212 AND Q. 216

457) Did (NAME) get a dose of vitamin A like this one during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP.

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

459) Have you ever had a vaccination card for (NAME)?

460) (1) COPY VACCINATION DATES 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.

462) Did (NAME) 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) When 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, usually at the same time as polio drops?

463F) How many times?

463G) An injection to prevent measles?

464) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

465) At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL MENTIONED.

465A) CHECK RESPONSE TO QUESTION 29 OF HOUSEHOLD QUESTIONNAIRE

465B) Does (NAME) usually sleep under a mosquito net?

465C) Did (NAME) sleep under a mosquito net last night?

465D) CHECK ANSWERS FOR 465B AND 465C

465E) Now let's talk about the mosquito net that (NAME) sleeps under most often. How long ago was the mosquito net bought or obtained?
IF LESS THAN ONE MONTH, RECORD '00'. IF MORE THAN 95 MONTHS, RECORD '95'.

465F) Was the mosquito net soaked or dipped in insecticide when it was purchased?

465G) Since you obtained the mosquito net, have you soaked or dipped it in insecticide?

465H) How much time has passed since the last saturation of the mosquito net?

465I) What is the name of the insecticide that you used to saturate the mosquito net?

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

466A) Did (NAME) take any drugs to treat the fever?

466B) What type of drug did (NAME) take?
RECORD ALL MENTIONED.
ASK TO SEE THE DRUG IF THE TYPE OF DRUG IS NOT KNOWN. IF THE TYPE OF DRUG CANNOT BE DETERMINED, SHOW THE RESPONDENT A TYPICAL ANTI-MALARIAL.

466C) Did you seek advice or treatment for the fever?

466D) Where did you seek advice or treatment? Anywhere else?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL MENTIONED.

466E) How many days did (NAME) have the fever before you sought advice or treatment?
IF MORE THAN 95 DAYS, RECORD '95'.

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?

470) Did you seek advice or treatment for the cough?

471) Where did you seek advice or treatment? Anywhere else?
IF SOURCE IF HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL MENTIONED.

475) Has (NAME) had diarrhea in the last two 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?

477A) CHECK 445:
STILL BREASTFEEDING?

477B) When (NAME) had diarrhea, was he/she given less breastmilk than usual, about the same amount, or more than usual?
IF LESS, PROBE: Was he/she given much less breastmilk than usual or somewhat less?

478) Was he/she given any of the following to drink?

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?
IF SOURCE IF HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.

REGISTRATION OF BIRTHS:

482A) Does (NAME) have a birth certificate? May I see it?
IF BIRTH CERTIFICATE IS PRESENT, CHECK THE BIRTH DATE. IF NO BIRTH CERTIFICATE IS PRESENT, TRY TO VERIFY THE DATE USING ANOTHER DOCUMENT (HEALTH CARD, ETC.). CORRECT DECLARED AGE, IF NECESSARY.

482B) IF BIRTH CERTIFICATE NOT SHOWN, ASK:
Was the birth of (NAME) declared to the civil state?

482C) Why wasn't (NAME)'s birth declared to the state?

482D) Do you know how to declare your child's birth to the state?

483) GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484.

484) CHECK 456 ALL COLUMNS:
NUMBER OF CHILDREN BORN SINCE JANUARY 1996 AND STILL LIVING

485) What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?

486) CHECK 478A ALL COLUMNS:

487) Have you ever heard of a special product called ORASEL you can get for the treatment of diarrhea?

488) CHECK 218:

489) When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should to be taken for medical treatment?

490) Now I would like to ask you questions about health care for yourself. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem, or no problem?

490A) When a child has a cough, what are the symptoms that indicate that he/she should be taken to a health care facility or to a health care professional?

490B) When a child has a cough, where would you go to seek advice or treatment? Any other place?
RECORD ALL MENTIONED.

491) CHECK 215 AND 218:

492) Now I would like to ask you about the liquids (NAME FROM Q.491) drank over the last 7 days, including yesterday. How many days in the last 7 did (NAME FROM Q.491) drink each of the following?

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFORE PROCEEDING, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q.491) drink (item)?

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

493) Now I would like to ask you about the foods (NAME FROM Q.491) ate over the last 7 days, including yesterday. How many days during the last 7 did (NAME FROM Q.491) eat each of the following foods either separately or combined with other foods?

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFORE PROCEEDING, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q.491) eat (item)?

IF 7 TIME OR MORE, RECORD '7'. IF DON'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, before starting did you wash your hands?

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

498) In the last 24 hours, how many cigarettes did you smoke?

499) Now I would like to ask you about alcoholic beverages. Have you ever drank alcoholic beverages?

499B) In the last 3 months, how many days did you drink alcoholic beverages?

499C) Have you ever been drunk after drinking alcoholic beverages?

499D) In the last 3 months, how many days were you drunk?

499E) Now, I would like to talk to you about injections. Over the last 3 months, have you received an injection for any reason?

499F) In the last 3 months, how many injections did you receive?

499G) The last time you received an injection, who was the person who administered it?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501) Are you currently married or living with a man?

502) Have you ever been married or lived with a man?

504) What is your marital status now: are you a widow, divorced, or separated?

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

506) RECORD 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 other wives besides yourself?

508) How many other wives does he have?

509) Are you the first, second?wife?

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

511) CHECK 510:

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

MARRIED/LIVED WITH MAN MORE THAN ONCE: I would like to talk about the first time you were married or started living with a man. In what month and year were you married or did you start living with him?

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

514) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?

515) When was the last time you had sexual intercourse?
RECORD "YEARS AGO" ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.

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

516A) What is the main reason you used a condom this time?

517) What is your relationship to the man with whom you last had sex?
IF "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1'. IF NO CIRCLE '2'

518) For how long have you had sexual relations with this man? Or for how long did you have sexual relations with this man?

519) Have you had sex with any other man in the last 12 months?

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

520A) What is the main reason you used a condom that time?

521) What is your relationship to this man?
IF "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1'. IF NO CIRCLE '2'

522) For how long have you had sexual relations with this man? Or how long did you have sexual relations with this man?

522A) Apart from these two men, have you had sexual intercourse with any other person in the last 12 months?

522B) The last time you had sexual intercourse with this other man, was a condom used?

522C) What is the main reason you used a condom that time?

522D) What is your relationship to the man?
IF "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '1'. IF NO CIRCLE '2'

522E) For how long have you had sexual relations with this man? Or for how long did you have sexual relations with this man?

523) In total, with how many different men have you had sex 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?
IF SOURCE IF HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL MENTIONED.

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

526A) What are the condom brands you know?

526B) CHECK IF YES TO 516 OR 520 OR 522B AND ASK:
What are the brands of condom you have already used?

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311/311A:

602) CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some question 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?

RECORD IN MONTHS IF LESS THAN 24 MONTHS OR LESS THAN TWO YEARS AND IN COMPLETED YEARS IF 24 MONTHS OR MORE OR 2 YEARS OR MORE.

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? 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? Any other reason?

RECORD ALL MENTIONED.

608) In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem at all for you?

609) CHECK 311/311A:
USING A CONTRACEPTIVE METHOD?

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

611) Which method would you prefer to use?

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

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

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

618) In your opinion, is it acceptable or not acceptable to talk about family planning:

619) In the last few months, have you discussed the practice of family planning with your friends, your neighbors, or your relatives?

620) With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

621) CHECK 501:

622) CHECK 311/311A:

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

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

625) How often have you talked to your husband/partner about family planning in the past year?

626) CHECK 311/311A:

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

628) Husbands and wives do not always agree on everything. Please tell me if you think a woman is justified in refusing to have sex with her husband when:

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, or higher?

705) What was the highest (grade/form/year) he completed at that level?

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, are you currently working?

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. Are you currently doing 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 throughout the year, seasonally, or only once in a while?

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

716) Who mainly decides how the money you earn will be used?

717) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

718) Do you usually work at home or away from home?

719) Who in your household usually has the final say on the following decisions?

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:

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

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

803) What can a person do? Anything else?
RECORD ALL WAYS MENTIONED.

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

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

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

811) Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

812) Can the virus that causes AIDS be transmitted from a mother to a child?

813A) When can the virus that causes AIDS be transmitted from a mother to a child? Can it be transmitted:

814) CHECK 501:

815) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

815A) Do you think it's acceptable or unacceptable to talk about AIDS:

816) If a person learns that he/she is infected with the virus that causes AIDS, should this person be allowed to keep that a secret or should he/she communicate this information to the community?

817) If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

817A) Should people with the AIDS virus who work with other people in shops, offices, or on farms be allowed to keep their jobs or not?

817B) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

817C) Have you ever been tested to see if you have the AIDS virus?

817D) Would you like to have a test for the AIDS virus?

817E) Do you know a place where you can go to get tested for the AIDS virus?

817F) Where can you go for this test?
RECORD ALL MENTIONED.

817FX) Where did you go for this test?

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

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

819) If a man has a sexually transmitted disease, what symptoms might he have? Any other signs or symptoms?
RECORD ALL SYMPTOMS MENTIONED.

820) If a woman has a sexually transmitted disease, what symptoms might she have? Any other signs or symptoms?
RECORD ALL SYMPTOMS MENTIONED.

820A) CHECK 514:

820B) During the last 12 months, have you had a disease which you got through sexual contact?

820C) Now I would like to ask you some questions about your health in the last 12 months. Sometimes women experience vaginal discharge. During the last 12 months, have you had any vaginal discharge?

820D) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

820E) CHECK 820B, 820C, 820D:

820F) The last time you had (INFECTION FROM 820B, 820C, 820D), did you seek any kind of advice or treatment?

820G) The last time you had (INFECTION FROM 820B, 820C, 820D), did you do any of the following? Did you?

820H) When you had (INFECTION FROM 820B, 820C, 820D), did you inform the people were you having sexual intercourse with?

820I) When you had (INFECTION FROM 820B, 820C, 820D), did you do anything to avoid infecting your sexual partner(s)?

820J) What did you do to prevent infection in your partner(s)? Did you?

SECTION 9. FEMALE GENITAL CUTTING

901) Have you ever heard of female circumcision?

902) In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard of this practice?

903) Have you yourself ever had your outer genitals cut?

904) Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

905) Was the genital area just nicked without removing any flesh?

906) Was your genital area closed?

907) How old were you when this occurred?
IF RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

908) Who cut (or nicked) your genitals?

909) CHECK 214 AND 216:

910) Have any of your daughters had their genitals cut?
IF YES: How many?

911) To which of your daughters did this happen most recently?
INTERVIEWER: CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER

912) Now I would like to ask you what was done to (NAME OF DAUGHTER FROM Q.911) at that time. Was any flesh removed from her genital area?

913) Was her genital area just nicked without removing any flesh?

914) Was her genital area closed?

915) How old was (NAME OF DAUGHTER FROM Q. 911) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

916) Who cut (or nicked) the genitals?

917) At the time that the genitals were cut or afterwards, did (NAME OF DAUGHTER FROM Q. 912) have any of the following problems:

918) Do you intend to have this genital cutting done to any of your daughters in the future?

919) What benefits do girls themselves get if they undergo this genital cutting?
PROBE: Any other benefits?
RECORD ALL MENTIONED

920) What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED

921) Would you say that this practice is a way to prevent a girl from having sex before marriage or does it have no effect on premarital sex?

922) Do you believe that this practice is required by your religion?

923) Do you think that this practice should be continued, or should it be discontinued?

924) Do you think that men want this practice to be continued, or discontinued?

925) RECORD THE TIME AT THE END OF THE INTERVIEW AND THANK THE RESPONDENT FOR HER ANSWERS.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:________________

COMMENTS ON SPECIFIC QUESTIONS:___________________

ANY OTHER COMMENTS:________________

SUPERVISOR'S OBSERVATIONS______________________

NAME OF SUPERVISOR:__________________________

DATE:______________________

EDITOR'S OBSERVATIONS:______________________

NAME OF FIELD EDITOR:___________________

DATE:______________