IDENTIFICATION

DEPARTMENT

MUNICIPALITY

DISTRICT

TOWN/NEIGHBORHOOD

CLUSTER NUMBER

STRUCTURE NUMBER

HOUSEHOLD NUMBER

URBAN/RURAL

NAME OF HEAD OF HOUSEHOLD

NAME AND LINE NUMBER OF WOMAN

CHECK HOUSEHOLD QUESTIONNAIRE:
ADDITIONAL QUESTIONS ON SEXUAL ACTIVITY (Q. 542, Q. 543) MUST BE ASKED TO THE MEN (1) OR TO THE WOMEN (2).

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER NAME____
RESULT _____

RESULT _____

NEXT VISIT:
DATE____
TIME____

FINAL VISIT
DAY____
MONTH____
YEAR: 2006
INTERVIEWER NUMBER____
RESULT__

TOTAL NUMBER OF VISITS_____

LANGUAGE OF QUESTIONNAIRE:

LANGUAGE OF INTERVIEW:

INTERPRETER:

SUPERVISOR
NAME___
DATE___

FIELD EDITOR
NAME___
DATE___

OFFICE EDITOR___

KEYED BY___

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ____ and I work for the INSAE. We are conducting a national survey on women's and children's health. 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 shared with anyone other than members of our survey team.

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____

SECTION 1. RESPONDENT'S BACKGROUND

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 first cycle, secondary 2nd cycle, higher, or other?

109) What is the highest (grade/form/year) you completed at this level?
CODE '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:
RESPONDENT'S LEVEL OF EDUCATION

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 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)?

112A) In what language was the literacy program in which you participated?
PROBE: Any other?
RECORD ALL MENTIONED

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) In the last 12 months, how many times have you traveled outside of your community and slept somewhere other than your home?

118) In the last 12 months, have you been away from home for more than one month at a time?

119) What is your religion?

120) What is your nationality?

121) 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 did not survive?

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

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

209) CHECK 208:
Just to 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 was 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 2 YEARS, OR YEARS.

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

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 2001 OR LATER.
IF NONE, ENTER '0'.

225) FOR EACH BIRTH SINCE JANUARY 2001, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.
NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. WRITE THE NAME OF THE CHILD TO THE LEFT OF CODE 'B'.

226) Are you pregnant now?

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P' IN THE CALENDAR, BEGINNING WITH THE MONTH OF THE 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 THE NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

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

233A) Altogether, how many pregnancies have you had 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 2001.
RECORD 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any miscarriages, abortions, or stillbirths that ended before January 2001?

236) When did the last such pregnancy that terminated before 2001 end?

237) When did your last menstrual period start?

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?

240) Are there any children who depend primarily on you?

241) Among these children who depend primarily on you, are there any that are younger than 18 years old?

242) Now I would like to talk about the children younger than 18 who depend primarily on you. Have you made any arrangements for someone to take care of these children if you were to get sick or if you were no longer able to take care of them?

SECTION 3. CONTRACEPTION

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

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 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: Have you ever heard of (METHOD)?

302) Have you ever used this 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 children did you have at that time, if any?
IF NONE, RECORD '00'.

308) CHECK 302:

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) Why do you use the pill over another method?

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

312B) Do you know the brand name of the pills you are using now?

312C) How much does one packet (cycle) of pills cost you?
ASK THE RESPONDENT IF THE COST PER PACKET REFERS TO ONE CYCLE OR THREE CYCLES AND RECORD THE CORRESPONDING PRICE.

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 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 '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 (FIRST METHOD FROM Q. 311) without stopping?
PROBE: For how long have you been using (FIRST METHOD FROM Q. 311) now without stopping?

316B) CHECK 316/316A, 215, AND 230:
THERE WAS A BIRTH IN 215 OR A PREGNANCY IN 230 THAT ENDED IN A MISCARRIAGE , ABORTION, OR STILLBIRTH AFTER THE MONTH AND YEAR OF THE START OF THE USE OF CONTRACEPTION BASED ON 316/316A.

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 CIRCLED IN 311/311A.

320) Where did you obtain (CURRENT METHOD) when you first 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 CIRCLED IN 311/311A.

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

323) Were you ever told by a health worker 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: You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320). At that time, 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) 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 that?
330A) 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.
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 you children)?

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

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN 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 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]

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 tetanus injection?
[FOR LAST BIRTH ONLY]

416A) At any time before this pregnancy, did you receive a tetanus injection?
[FOR LAST BIRTH ONLY]

416B) How many times did you get the tetanus injection before this pregnancy?
PROBE TO OBTAIN A RESPONSE.
[FOR LAST BIRTH ONLY]

416C) When was the last injection?
IF LESS THAN ONE YEAR, RECORD '00'.
[FOR LAST BIRTH ONLY]

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

418) During the whole pregnancy, for how many days did you take the iron, either as tablets or from vials?
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 [USE LOCAL TERM]?
[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 TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.
[FOR LAST BIRTH ONLY]

422A) CHECK 422:
TYPE OF DRUG TAKEN DURING PREGNANCY TO PREVENT MALARIA.
[FOR LAST BIRTH ONLY]

422B) How many times did you take the FANSIDAR during this pregnancy?
[FOR LAST BIRTH ONLY]

422C) CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY.
[FOR LAST BIRTH ONLY]

422D) When you were pregnant with (NAME), did you get FANSIDAR during an antenatal visit, during a different visit in a heath care facility, or from another source?
[FOR LAST BIRTH ONLY]

422E) Did you take three FANSIDAR pills two times in one month intervals during this pregnancy?
INSIST ON TWO TIMES AND ONE MONTH INTERVAL. IMPORTANT TO SHOW RESPONDENT FANSIDAR.
[FOR LAST BIRTH ONLY]

422F) CHECK 422:
TYPE OF DRUG TAKEN DURING PREGNANCY TO PREVENT MALARIA (CHLOROQUINE/NIVAQUINE)
[FOR LAST BIRTH ONLY]

422G) Did you start by taking fifteen chloroquine/nivaquine pills in three days?
[FOR LAST BIRTH ONLY]

422H) Did you then take three chloroquine/nivaquine pills a week until delivery?
[FOR LAST BIRTH ONLY]

422I) During this pregnancy, did you sleep under a mosquito net every night, most nights, rarely, or never?
[FOR LAST BIRTH ONLY]

422J) During this pregnancy, did you sleep under a mosquito net soaked in insecticide?
[FOR LAST BIRTH ONLY]

422K) What other means of protection against malaria do you know of?
[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 PERSONS MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE: Was an adult present for the delivery?
IF YES, ASK: Who was present?

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

427A) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD IN HOURS; IF LESS THAN ONE WEEK, RECORD IN DAYS.

428) Was (NAME) delivered by cesarean section?

428A) Before you were discharged after (NAME) was born, did any health care provider check on your health?
[FOR LAST BIRTH ONLY]

428B) After you were discharged, after the birth of (NAME), did any heath care provider, traditional birth attendant, or auxiliary midwife check on your health?
[FOR LAST BIRTH ONLY]

429) After (NAME) was born, did any health care provider, traditional birth attendant, or auxiliary midwife check on your health?
[FOR LAST BIRTH ONLY]

430) How long after delivery did the first check take place?
RECORD '00' DAYS IF THE SAME DAY.

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

432) Where did this first check 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.
[FOR LAST BIRTH ONLY]

433) In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW BLUE/RED CAPSULE
[FOR LAST BIRTH ONLY]

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

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

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

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

438) Have you resumed sexual intercourse since the birth of (NAME)?
[FOR 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 LIQUIDS 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 NON-NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[FOR LAST BIRTH ONLY]

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

449A) Did you know that a mother may not have enough breast milk to feed her baby?
[FOR LAST BIRTH ONLY]

449B) Do you know how to avoid this problem?
[FOR LAST BIRTH ONLY]

449C) Have you had/did you have this problem with (NAME)?
[FOR LAST BIRTH ONLY]

449D) If yes, did you use a wet nurse, artificial milk, or did you use a method to get enough breast milk to feed (NAME)?
[FOR LAST BIRTH ONLY]

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 during the day or night?

452) How many times did (NAME) eat solid or semi-solid food yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

453) GO BACK TO 404 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION

454) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN THREE BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

455) LINE NUMBER FROM QUESTION 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 BLUE OR RED CAPSULE.

458) Do you have a card where (NAME)'s vaccinations 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, HepB 1-3 OR (DTCHB1-3), MEASLES, AND/OR YELLOW FEVER.

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 left forearm done at birth 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 upper left arm usually at the same time as polio drops?

462F) How many times?

463G) An injection to prevent measles done on the upper right arm?

463H) An injection to prevent yellow fever done on the backside of the right thigh?

463I) A vaccination against Hepatitis B, that is, an injection given in the upper right arm often at the same time as the DPT injection?

463J) How many times?

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? Which other campaigns?
RECORD ALL CAMPAIGNS 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:
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?

465J) Was the saturation done by you yourself, in a health center, or by an NGO (Non-governmental organization)?

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 any difficulty breathing?

469) CHECK 466 AND 467:
FEVER OR COUGH?

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

471) 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(S).
RECORD ALL MENTIONED.

472) CHECK 466:
HAD A FEVER?

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

472B) Did (NAME) have convulsions at any time in the last 2 weeks?

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

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

474) What drugs did (NAME) take?
RECORD ALL MENTIONED.
ASK TO SEE THE DRUGS IF THE TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG CANNOT BE DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO THE RESPONDENT.

474A) Did (NAME) get an injection or a suppository to treat (the fever/the convulsions)?

474B) CHECK 474:
TYPE OF DRUG?

474C) How long after the (fever/convulsions) started did (NAME) first take Fansidar?

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

474E) Did you have the Fansidar in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the Fansidar the first time?

474F) CHECK 474:
TYPE OF DRUG?

474G) How long after the (fever/convulsions/attacks) started did (NAME) first take chloroquine?

474H) For how many days did (NAME) take chloroquine?
IF 7 DAYS OR MORE, RECORD '7'.

474I) Did you have the chloroquine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the chloroquine the first time?

474J) CHECK 474:
TYPE OF DRUG?

474K) How long after the (fever/convulsions) started did (NAME) first take Amodiaquine/Flavoquine?

474L) For how many days did (NAME) take Amodiaquine?
IF SEVEN DAYS OR MORE, RECORD '7'.

474M) Did you have the Amodiaquine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the Amodiaquine the first time?

474N) CHECK 474:
TYPE OF DRUG?

474O) How long after the (fever/convulsions/attacks) started did (NAME) first take quinine?

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

474Q) Did you have the quinine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the quinine the first time?

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

474S) What was done for (NAME)'s (fever/convulsions/attacks)? Anything else?
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 breast milk than usual, about the same amount, or more than usual?
IF LESS, PROBE: Was he/she given much less breast milk 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 IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
RECORD ALL MENTIONED

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 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2001 OR LATER LIVING WITH THE RESPONDENT.

485) What do you usually do with your (youngest) child's stools when he/she doesn't use the toilet? At other times?

485A) When do you wash your hands? Any other times?

486) CHECK 478A ALL COLUMNS:

487) Have you ever heard of a special product called [LOCAL NAME OF ORS PACKET] 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 that he/she needs to be taken somewhere for medical treatment?

IF RESPONDENT ANSWERS THAT NONE OF HER CHILDREN HAVE EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) were seriously ill, could you yourself decide that he/she needs to be taken somewhere for medical treatment?

490) Now I would like to ask you questions about health care for yourself. There are different reasons that prevent women from getting advice or medical treatment for themselves. When you are ill and want advice or medical treatment, are the following things a serious problem or not?

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? Any other symptom?

490B) When a child has a cough, where would you go to seek advice or treatment? 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.

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 the following liquids?

FOR EACH LIQUID DRANK AT LEAST ONCE IN THE LAST 7 DAYS, ASK: How many times total did (NAME FROM Q. 491) drink (LIQUID) yesterday during the day or night?
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 in the last 7 did (NAME FROM Q. 491) eat one of the following foods?

FOR EACH FOOD EATEN AT LEAST ONCE IN THE LAST 7 DAYS, ASK: How many times total did (NAME FROM Q. 491) eat (FOOD) yesterday during the day or night?
IF 7 TIMES OR MORE, RECORD '7'. IF DON'T KNOW, RECORD '8'

493A) Do you usually sleep under a mosquito net?

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

494A) Was the mosquito net that you slept under last night soaked in insecticide?

495) Did you wash your hands before the last time you prepared a meal for your family?

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

497) CHECK 496:

498) How many cigarettes have you smoked in the last 24 hours?

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

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

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

499C) I would like to ask you some questions about your health over the last 6 months. Over the last 6 months, have you received an injection for any reason?
IF YES: How many injections did you receive?

IF NUMBER OF INJECTIONS IS OVER 94 OR IF DAILY FOR 3 MONTHS OR MORE, RECORD '95'. IF RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

499D) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?

IF NUMBER OF INJECTIONS IS OVER 94 OR IF DAILY FOR 3 MONTHS OR MORE, RECORD '95'. IF RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

499E) Where did you go to get the last injection?

499F) Did the person who administered the injection the last time take the syringe and needle from a new package that wasn't already opened?

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?

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

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

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

507) Other than yourself, does your husband/partner have other wives or does he live with other women as if married?

508) Including yourself, in total, how many other wives or partners does your husband live with now as if married?

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: I would like to talk about the first time you were married or started living with a man as if married. In what month and year were you married or did you start living with a man as if married for the first time?

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

513) CHECK 503:
IS RESPONDENT CURRENTLY WIDOWED?

514) CHECK 510:

515) How did your previous marriage or union end?

516) To whom did most of your late husband's property go to?

517) Did you receive any of your late husband's assets or valuables?

518) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

520) Do you intend to wait until you get married to have sexual intercourse for the first time?

521) CHECK 106:

522) The first time you had sexual intercourse, was a condom used?

523) How old was the person you first had sexual intercourse with?

524) Was this person older than you, younger than you, or about the same age as you?

525) Would you say this person was ten or more years older than you or less than ten years older than you?

526) When was the last time you had sexual intercourse?
IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS

527) The last time you had sexual intercourse (with this second/third) person, was a condom used?

528) Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

529) The last time you had sexual intercourse (with this second/third) person, did you or this person drink alcohol?

530) Were you or your partner drunk at that time?
IF YES: Who was drunk?

531) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

532) For how long (have you had/did you have) sexual relations with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

533) CHECK 106:

534) How old is this person?

535) Was this person older than you, younger than you, or about the same age as you?

536) Would you say this person was ten or more years older than you or less than ten years older than you?

537) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

538) In total, how many different people have you had sexual intercourse with in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

541) CHECK FOR PRESENCE OF OTHER PEOPLE. DO NOT CONTINUE UNTIL YOU ARE COMPLETELY ALONE WITH RESPONDENT.

542) The first time you had sexual intercourse, did you want to have sexual intercourse, or were you forced against your will?

543) Did anyone make you have sexual intercourse against your will in the last 12 months?

544) Do you know of a place where a person can get condoms?

545) Where is that? 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

546) If you wanted to, could you yourself get a 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 this 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 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?

609) CHECK 310:
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?
IF MORE THAN ONE METHOD MENTIONED, ASK: Which one interests you the most?

CIRCLE THE CORRESPONDING CODE. IF SHE HAS NO INTEREST IN ANY METHOD, CIRCLE THE CODE CORRESPONDING TO THE HIGHEST METHOD AMONG THOSE MENTIONED.

612) What is the main reason that you think you will never 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 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, neighbors, or relatives?

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

621) CHECK 501:

622) CHECK 311/311A:

623) You say that you are currently using a contraceptive method. 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 many times in the last year have you talked to your husband/partner about family planning?

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:

629) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

630) CHECK 501:

631) Can you refuse sexual intercourse with your husband when you do not wish to have intercourse?

632) Can you ask your husband to use a condom if you want him to use one?

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 first cycle, secondary second cycle, higher, or other?

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 at home or away from home?

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

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

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

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

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?

801A) How can a person get AIDS? Any other way?
RECORD ALL MENTIONED.

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

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

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

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

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

807) Can people get the AIDS virus because of witchcraft or other supernatural means?

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

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

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

811) Can the virus that causes AIDS be transmitted from a mother to a child:

812) CHECK 811:

813) Are there any special drugs that a doctor, nurse, or midwife can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

814) Are there any special drugs that people infected with the AIDS virus can get from a doctor, nurse, or midwife?

815) CHECK 215:

816) Now I would like to ask you some questions about your last birth. Did you see someone for antenatal care during this pregnancy?

817) During any of the antenatal visits for this pregnancy, did anyone talk to you about:

818) Were you offered a test for the AIDS virus as part of your antenatal care?

819) I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

820) I don't want to know the results, but did you get the results of the test?

821) Where was the test done?
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.

822) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

823) When was the last time you were tested for the AIDS virus?

824) I don't want to know the result, but have you ever been tested to see if you have the AIDS virus?

825) When was the last time you were tested?

826) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

827) I don't want to know the results, but did you get the results of the test?

828) Where was the test done?
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.

829) Do you know of a place where people can go to get tested for the AIDS virus?

830) Where is that? 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.

831) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

832) If you learned that you had the AIDS virus, would you like this to remain a secret?

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

834) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

834A) If a health agent has the AIDS virus but is not sick, should he/she be allowed to continue healing the sick?

835) Do you personally know someone who has been denied health services in the last 12 months because he/she has or is suspected to have the AIDS virus?

836) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he/she has or is suspected to have the AIDS virus?

837) Do you personally know someone who has been verbally abused or teased in the last 12 months because he/she has or is suspected to have the AIDS virus?

838) CHECK 835, 836, AND 837:

839) Do you personally know someone who has or is suspected to have the AIDS virus?

840) Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

841) Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

841A) Do you agree or disagree with the following statement: People should have a pre-nuptial medical exam to know the serological status (affected by AIDS or not) of their partner before marriage.

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

843) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

843A) In the last 6 months, how many times have you heard an ad on the radio about AIDS and how to avoid it?
IF NONE, CIRCLE '00'. RECORD '95' FOR 95 TIMES OR MORE.

843B) In the last 6 months, how many times have you seen an ad on TV about AIDS and how to avoid it?
IF NONE, CIRCLE '00'. RECORD '95' FOR 95 TIMES OR MORE.

843C) In the last 6 months, how many times have you seen an ad poster about AIDS and how to avoid it?
IF NONE, CIRCLE '00'.

843D) In the last 6 months, how many times have you participated in a discussion about AIDS and how to avoid it?
IF NONE, CIRCLE '00'.

844) Do you think that young men should wait until marriage to have sexual intercourse?

845) Do you think that young women should wait until marriage to have sexual intercourse?

846) Do you think that married men should not have sexual intercourse with people other than their spouses?

847) Do you think that most of the men you know only have sexual intercourse with their spouses?

848) Do you think that married women should not have sexual intercourse with people other than their spouses?

849) Do you think that most of the women you know only have sexual intercourse with their spouses?

850) CHECK 801:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

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

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

853) CHECK 519:

854) CHECK 850:

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

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

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

858) CHECK 855, 856, AND 857:

859) The last time you had (INFECTION FROM 855/856/857), did you seek any kind of advice or treatment?

860) Where did you go? Any other place?
CIRCLE ALL MENTIONED

860A) The last time you had (INFECTION FROM 855/856/857), did you do any of the following? Did you?

860B) When you had (INFECTION FROM 855/856/857), did you inform the people you were having sexual intercourse with?

860C) When you had (INFECTION FROM 855/856/857), did you do something to avoid infecting your sexual partner(s)?

860D) What did you do to avoid infecting your partner(s)? Did you?

860E) The last time you had (INFECTION FROM 855/856/857), did your partner seek any kind of advice or treatment?

860F) Where did he go? Any other place?
CIRCLE ALL MENTIONED

860G) Do you know of any organizations that are fighting AIDS in your town?

860H) Which ones? Any other organizations?

860I) Have you ever solicited at least once for one of the organizations that are fighting against AIDS?

860J) The last time you went, which organization did you go to?

860K) What was your main reason?

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 this 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 in any way?

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

908) Who performed the circumcision?

909) CHECK 214 AND 216:

910) Have any of your daughters been circumcised?
IF YES: How many?

911) Which of your daughters was circumcised most recently?
CHECK 212 AND RECORD THE LINE NUMBER OF 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 was done?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

916) Who performed the circumcision?

917) At the time that the genitals were cut or afterwards, did (NAME OF DAUGHTER FROM Q. 911) have any of the following problems:

918) Do you intend to have any of your daughters circumcised in the future?

919) What benefits do girls get if they are circumcised?
PROBE: Any other benefits?
RECORD ALL MENTIONED

920) What benefits do girls get if they do not undergo this genital cutting?
PROBE: Nothing 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?

922A) Do you think that this practice is required by your traditions or your customs?

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

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

924A) Did you know that there is a law in Benin prohibiting female genital cutting?

924B) How were you informed?

SECTION 10. MATERNAL MORTALITY

1001) 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 who are living with you, those living elsewhere, and those who have died. How many children did your mother give birth to, including you?

1002) CHECK 1001:

1003) How many of these births did your mother have before you were born?

1004) What was the name given to your (next) oldest brother or sister?

1005) Is (NAME) male or female?

1006) Is (NAME) still alive?

1007) How old is (NAME)?

1008) How many years ago did (NAME) die?

1009) How old was (NAME) when he/she died?

1010) Was (NAME) pregnant when she died?

1011) Did (NAME) die during childbirth?

1012) Did (NAME) die within two months after the end of a pregnancy or childbirth?

1013) How many live born children did (NAME) give birth to during her lifetime?

IF NO OTHER BROTHERS OR SISTERS, GO TO 1014.

1014) RECORD TIME

INSTRUCTIONS: ONE CODE FOR EACH SPACE

BIRTHS AND PREGNANCIES

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING THE INTERVIEW

COMMENTS ABOUT THE RESPONDENT:__________________________

COMMENTS ON SPECIFIC QUESTIONS:___________________________

ANY OTHER COMMENTS:__________________________

SUPERVISOR'S OBSERVATIONS:______________________
NAME OF SUPERVISOR________________
DATE_____________________

EDITOR'S OBSERVATIONS:________________________
NAME OF EDITOR__________________________
DATE________________________