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Final Version


Demographic and health survey (EDSB-V-2017)
Woman’s Questionnaire

Republic of Benin
Ministry of Planning and Development
National institute of statistics and economic analysis (INSAE)

Identification

Department
Commune

Urban/rural (urban=1, rural=2)

Urban 1
Rural 2

Name of head of household
Cluster number
Household number
Name and line number of woman

Household selected for men’s survey? (1=Yes, 2=No)

Yes 1
No 2

Household selected for domestic violence module? (1=Yes, 2=No)

Yes 1
No 2

Interviewer visits
1 2 3
Date

Interviewer’s name
Result*

Final visit
Day
Month
Year 201
Int. number
Result

Next visit
Date
Time

Total no. of visits

* Result codes

1Completed
2 Not at home
3 Postponed
4 Refused
5 Partly completed
6 Incapacitated
7 Other (specify)

Language of questionnaire 01

Language of interview

Native language of respondent

Translator used (yes=1, no=2)

Yes 1
No 2

Language of questionnaire: French

Language codes:

01 French
02 Adja
03 Bariba
04 Fon
05 Dendi
06 Ditamari
07 Yorub
08 Other

Supervisor
Name
Date

Editor
Name
Number

Introduction and consent

Hello. My name is ___. I am working with the National Institute of Statistics and Economic Analysis (INSAE). We are conducting a survey about health all over Benin. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 60 to 90 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don’t have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don’t want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?

Signature of interviewer Date

Respondent agrees to be interviewed 1
Respondent does not agree to be interviewed 2-End

Section 1. Respondent’s background

No.
Questions and filters
Coding categories
Skip

101) Record the time

Hour
Minutes

102) How long have you been living continuously in (Name of current city, town or village of residence)?
If less than one year, record 00 years

Years
Always 95-skip to 105
Visitor 96-skip to 105

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

City (Regional capital) 1
Town 2
Rural area 3
Outside of Benin 4

104) Before you moved here, which (province/region/state) did you live in?

Alibori 01
Atacora 02
Atlantique 03
Borgou 04
Collines 05
Couffo 06
Donga 07
Littoral 08
Mono 09
Oueme 10
Plateau 11
Zou 12
Outside of Benin 96

105) In what month and year were you born?

Month
Don’t know month 98
Year
Don’t know year 9998

106) How old were you at your last birthday?
Compare and correct 105 and/or 106 if inconsistent

Age in completed years

106a) Check cover of questionnaire

Household selected for men’s survey
Household not selected for men’s survey-skip to 107

106b) Check 106:

15-29 years 1-skip to 107
30-49 years 2

106c) During this interview I would like to measure your blood pressure. I will do this three times during the interview. There is no danger to the procedure. We do it to know if a person has high blood pressure. If it isn’t treated, high blood pressure can seriously hurt the heart.

I will give you the results of the blood pressure measurement after the interview and explain to you the meaning of the results. If you have high blood pressure, we recommend that you consult a health care facility or see a doctor because we cannot offer any treatment as part of the survey.

Do you have any questions to ask me about blood pressure measurement?

You can say yes or no, and you can also decide at any point in the interview to not participate in taking blood pressure measurements.

Respondent signature
Date

Yes, respondent accepts 1
No, respondent doesn’t accept 2-skip to 107

106d) Before measuring your blood pressure, I would like to ask you some questions on things that could affect the measurements. Did you do any of the following things in the last 30 minutes:

a) Eat something?
Yes 1
No 2
b) Drink coffee, tea, cola, or drank any other caffeinated beverage?
Yes 1
No 2
c) Smoked tobacco in any form?
Yes 1
No 2
d) Engaged in physical activity or intense physical exercises?
Yes 1
No 2

106e) Look at the respondent’s arm and take the appropriate armband to take [##translator note: text is cut off here]

106f) Take the blood pressure
Record the systolic and diastolic pressure

If you can’t measure the respondent’s blood pressure, record the reason.

Systolic
Diastolic
Refused 994
Technical problems 995
Other 996

107) Have you ever attended school?

Yes 1
No 2- skip to 111

108) What is the highest level of school you attended: primary, secondary 1st cycle, secondary 2nd cycle, or higher?

Primary 1
Secondary 1st cycle 2
Secondary 2nd cycle 3
Higher 4

109) What is the highest (grade/form/year) you completed at this level?
If completed less than one year at that level, record 00

Grade/form/year

110) Check 108

Primary or secondary (1st or 2nd cycle)
Higher- skip to 113

111) Now I would like you to read this sentence to me.

Show card to respondent

If respondent cannot read whole sentence, probe:
Can you read any part of the sentence to me?

Cannot read at all 1
Able to read only part of sentence 2
Able to read whole sentence 3
No card with required language (specify language) 4
Blind/visually impaired 5

112) Check 111:

Code 2, 3, or 4 circled
Code 1 or 5 circled-skip to 114

113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

At least once a week 1
Less than once a week 2
Not at all 3

114) Do you listen to the radio at least once a week, less than once a week or not at all?

At least once a week 1
Less than once a week 2
Not at all 3

115) Do you watch television at least once a week, less than once a week, or not at all?

At least once a week 1
Less than once a week 2
Not at all 3

116) Do you own a mobile telephone?

Yes 1
No 2-skip to 118

117) Do you use your mobile phone for any financial transactions?

Yes 1
No 2

118) Do you have an account in a bank or other financial institution that you yourself use?

Yes 1
No 2

119) Have you ever used the internet?

Yes 1
No 2-skip to 122

120) In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.

Yes 1
No 2-skip to 122

121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

Almost every day 1
At least once a week 2
Less than once a week 3
Not at all 4

122) What is your religion?

Muslim 1
Christian 2
Animist 3
No religion 4
Other (specify) 6

123) What is your ethnicity?

Adja and similar 1
Bariba and similar 2
Dendi and similar 3
Fon and similar 4
Yoa and Lokpa and similar 5
Betamaribe and similar 6
Peulh and similar 7
Yoruba and similar 8
Other Beninese (specify) 96
Other nationality (specify) 97

123a) Check cover of questionnaire

Household selected for men’s survey
Household not selected for men’s survey –skip to 201

123b) Check 106:

15-29 years 1-skip to 201
30-49 years 2

123c) Can I measure your blood pressure now?
Respondent signature
Date

Yes, respondent accepted 1
No, respondent did not accept 2-skip to 201

123d) Take blood pressure
Record systolic and diastolic pressure
If you cannot measure the respondent’s blood pressure, record the reason

Systolic
Diastolic
Refused 994
Technical problems 995
Other 996

124) How many kilometers away is the nearest health care facility?

Kilometers____
Don’t know 998

125) How much time does it take to reach the nearest health care facility?

Minutes
Don’t know 998

Codes for Q 108 and 109: Education
Level attainted
Class successfully achieved

1=Primary
Less than one year in C1=0
C1=1
CP=2
CE1=3
CE2=4
CM1=5
CM2=6
Don’t know=8
2=Secondary 1st cycle
Less than 1 year in 6th =0
6th=1
5th=2
4th=3
3rd=4
Don’t know =8
3=Secondary 2nd cycle
Less than one year in 2nd=0
2nd=1
1st=2
Final=3
Don’t know =8
4=Higher
Less than one year in 1st =0
1st year=1
2nd year=2
3rd year=3
4th year=4
Don’t know 8

Section 2. Reproduction

No.
Questions and filters
Coding categories
Skip

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

Yes 1
No 2- skip to 206

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

Yes 1
No 2- skip to 204

203) How many sons live with you?
And how many daughters live with you?
If none, record ‘00’

Sons at home
Daughters at home

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

Yes 1
No 2- skip to 206

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
If none, recode ‘00’

Sons elsewhere
Daughters elsewhere

206) Have you ever given birth to a boy or girl who was born alive but later died?
If no, probe: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even for a very short time?

Yes 1
No 2- 208

207) How many boys have died?
And how many girls have died?
If none, record ‘00’

Boys dead
Girls dead

208) Sum answers to 203, 205, and 207 and enter total.
If none, record 00

Total births

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

Yes
No-probe and correct 201-208 as necessary

210) Check 208:

One or more births
No births- skip to 226

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. Record names of all the births in 212. Record twins and triplets on separate rows.
If there are more than 10 births, use an additional questionnaire, starting with the second row.

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

Record name
Birth history number

01, 02, 03, etc.…

213) Is (name) a boy or a girl?

Boy 1
Girl 2

214) Were any of these births twins?

Single 1
Multiple 2

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

Day
Month
Year

216) Is (name) still alive?

Yes 1
No 2- skip to 220

217) If alive:
How old was (name) at his/her last birthday? Record age in completed years.

Age in years

218) If alive:
Is (name) living with you?

Yes 1
No 2

219) If alive:
Record household line number of child (record ‘00’ if child not listed in household)

Household line number
01, Next birth; 02, 03, 04, etc., Go to 221

220) If dead:
How old was (name) when he/she died?

If 12 months or 1 year, ask: Did (name) have his/her first birthday?
Then ask: Exactly how many months old was (name) when he/she died?
Record days if less than 1 month, months if less than two years, or years.

Days 1
Months 2
Years 3

221) Were there any other live births between (name of previous birth) and (name), including any children who died after birth?

Yes 1-add birth
No 2-next birth

[##translator note: 212-221 were repeated for births 6-10]

222) Have you had any live births since the birth of (name of last birth)?

Yes 1-(record birth(s) in table)
No 2

223) Compare 208 with number of births in history above and mark.

Numbers are the same
Numbers are different-(Probe and reconcile)

224) Check 215:
Enter the number of births in 2012-2017.

Number of births
None 0-skip to 226

225) C
For each birth since in 2012-2017, enter B in the month of birth in the calendar. Write the name of the child to the left of the code B 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 Ps must be one less than the number of months that the pregnancy lasted.)

226) Are you pregnant now?

Yes 1
No 2-skip to 230
Unsure 8-skip to 230

227) How many months pregnant are you?
Record number of completed months.
Enter Ps in the calendar, beginning with the month of interview and for the total number of completed months.

Months____

228) When you got pregnant, did you want to get pregnant at that time?

Yes 1-skip to 230
No 2

229) Check 208: Total number of births
One or more-
a) Did you want to have a baby later on or did you not want any more children?
None-
b) Did you want to have a baby later on or did you not want any children?

Later 1
No more/none 2

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

Yes 1
No 2-skip to 239

231) When did the last such pregnancy end?

Month
Year

232) Check 231:

Last pregnancy ended in 2012- -skip to 234

Last pregnancy ended before January 2012 or earlier-skip to 239

233) In what month and year did the preceding such pregnancy end?

Line number
01, 02, 03, etc.…
Month
Year

234) How many months pregnant were you when that pregnancy ended?

Number of months

235) Since January 2012, have you had any other pregnancies that did not result in a live birth?

Yes 1-next line
No2-skip to 236

236) For each pregnancy that did not end in a live birth in 2012-2017 or later, enter T in the calendar in the month that the pregnancy terminated and P for the remaining number of completed months of pregnancy.
If there are more than four pregnancies that did not end in a live birth, use an additional questionnaire starting on the second line.

237) Did you have any miscarriages, abortions or stillbirths that ended before 2012?

Yes 1
No 2-skip to 239

238) When did the last such pregnancy that terminated before 2012 end?

Month
Year

239) When did you last menstrual period start?

(Date, if given)
Days ago 1
Weeks ago 3
Months ago 2
Years ago 4
In menopause/has had hysterectomy 994
Before last birth 995
Never menstruated 996

240) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

Yes 1
No 2 –skip to 242
Don’t know 8- skip to 242

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

Just before her period begins 1
During her period 2
Right after her period had ended 3
Halfway between two periods 4
Other (specify) 6
Don’t know 8

242) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

Yes 1
No 2
Don’t know 8

Section 3. Contraception

301) Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you ever heard of (method)?

01) Female Sterilization
Probe: Women can have an operation to avoid having any more children
Yes 1
No 2
02) Male Sterilization
Probe: Men can have an operation to avoid having any more children
Yes 1
No 2
03) IUD
Probe: Women can have a loop or coil placed inside them by a doctor or a nurse/midwife which can prevent pregnancy for one or more months.
Yes 1
No 2
04) Injectables
Probe: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
Yes 1
No 2
05) Implants
Probe: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
Yes 1
No 2
06) Pill
Probe: Women can take a pill every day to avoid becoming pregnant.
Yes 1
No 2
07) Condom
Probe: Men can put a rubber sheath on their penis before sexual intercourse.
Yes 1
No 2
08) Female condom
Probe: Women can place a sheath in their vagina before sexual intercourse.
Yes 1
No 2
09) Emergency contraception
Probe: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
Yes 1
No 2
10) Standard Days Method
Probe: A women uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
Yes 1
No 2
11) Locational amenorrhea method (LAM)
Up to six months after giving birth, before the menstrual period has returned, women use a method which requires her to breastfeed frequently day and night.
Yes 1
No 2
12) Rhythm Method
Probe: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
Yes 1
No 2
13) Withdrawal
Probe: Men can be careful and pull out before climax.
Yes 1
No 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
Yes, modern method A
(specify)
Yes, traditional method B
(specify)
No Y

302) Check 226:

Not pregnant or unsure
Pregnant-skip to 312

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

Yes 1
No 2-skip to 312

304) Which method are you using?
Circle all mentioned.
If more than one method mentioned, follow skip instruction for highest method in list.

Female sterilization A-skip to 307
Male sterilization B-307
IUD C –skip to 309
Injectables D–skip to 309
Implants E–skip to 309
Pill F
Condom G-skip to 306
Female condom H
Emergency contraception I
Standard Days method J
Lactational Amen. Method K
Rhythm method L
Withdrawal M
Other modern method X
Other traditional method Y
H-Y skip to 309

305) What is the brand name of the pills you are using?
If don’t know brand, ask to see the package.

Harmonie 01
Duofem 02
Microgynon 03
Eugynon 04
Lo-Femenal 05
Confiance 06
Minidril 07
Stediril 08
Other (specify) 96
Don’t know 98
All skip to 309

306) What is the brand name of the condoms you are using?
If don’t know the brand, ask to see the package.

Prudence 01
Cool 02
No Logo 03
Other (specify) 96
Don’t know 98
All skip to 309

307) In what facility did the sterilization take place?
Probe to identify the type of source.
If unable to determine if public or private sector, write the name of the place
(Name of place)

Public sector
Govt. Hospital 11
Govt. Health Center 12

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Private doctor’s office 22
Religious hospital 23
Other private medical (specify) 26

Other (specify) 96
DK 98

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

Month-skip to 310
Year –skip to 320

309) Since what month and year did you start using (Current method) without stopping?
Probe: For how long have you been using (Current method first mentioned) now without stopping?

Month____
Year____

310) Check 308 and 309, 215, and 231:
Any birth or pregnancy termination after month and year of start of use of contraception in 308 or 309.

No
Yes-Go back to 308 and 309, probe and record month and year at start of continuous use of current method (must be after last birth or pregnancy termination).

311) Check 308 and 309: Year is 2012-2017- C Enter code for method used in month of interview in the calendar and in each month back to the date started using.
Then continue.

Year is 2011 or earlier- C Enter code for method used in month of interview in the calendar and each month back to January 2012
Then skip to 324.

312) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
Use calendar to probe for earlier periods of use and nonuse, starting with most recent use, back to January 2012. Use names of children, dates of birth, and periods of pregnancy as reference points.

Column 1
Column 2
Column 3

312a) Month and year of start of the interval of use or non-use.

Month___
Year___

312b) Between (event) in (Month/year) and (event) in (month/year), did you or your partner use any method of contraception?

Yes 1
No 2-skip to 312i

312c) Which method was that?

Method code____

312d) How many months after (event) in (month/year) did you start to use (method)?
Record 95 if respondent gives the date of starting to use the method. [##translator note: end of sentence cut off, I used what matched the standard English version]

Immediately 00-skip to 312f
Months-skip to 312f
Date given 95

312e) Record the month and year respondent started using method

Month___
Year___

312f) For how many months did you use (method)?
Record 95 if respondent gives the date of termination of use

Months –skip to 312h
Date given 95

312g) Record month and year respondent stopped using method

Month___
Year___

312h) Why did you stop using (method)?

Reason stopped___

312i) Go back to 312a in next column; or, if no more gaps, go to 313.

313) Check the calendar for use of any contraceptive method in any month.

No method used
Any method used-skip to 315

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

Yes 1-skip to 326
No 2-skip to 326

315) Check 304:
Circle method code.
If more than one method code circled in 304, circle code for highest method in list.

No code circled 00-skip to 326
Female sterilization 01-skip to 319
Male sterilization 02-skip to 327
IUD 03
Injectables 04
Implants 05
Pill 06
Condom 07
Female condom 08
Emergency contraception 09
Standard Day Method 10
Lactational Amen. Method 11-skip to 323
Rhythm method 12-skip to 323
Withdrawal 13-skip to 323
Other modern method 95
Other traditional method 96

316) You first started using (current method) in (date from 309). Where did you get it at that time?
Probe to identity the type of source.
If unable to determine if public or private sector, write the name of the place.
(Name of place)

Public sector
Govt. Hospital 11
Govt. Health Center 12
Mobile clinic 14
Fieldworker 15

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Pharmacy 22
Private doctor 23
Mobile clinic 24
Religious hospital 25
Other private medical (specify) 26
NGO
Family planning clinic 31
Other source
Shop 41
Church 42
Friend/relative 43

Other (specify) 96

317) Check 304:
Circle method code:
If more than one method code circled in 304, circle code for highest method in list.

IUD 03
Injectables 04
Implants 05
Pill 06
Condom 07 –skip to 323
Female condom 08-skip to 322
Emergency contraception 09-skip to 322
Standard day method 10-skip to 322
Other modern method 95-skip to 322
Other traditional method 96-skip to 323

318) At that time, where you told about side effects or problems you might have with the method?

Yes 1-skip to 321
No 2-skip to 320

319) When you got sterilized, were you told about side effects or problems you might have with the method?

Yes 1-skip to 321
No 2

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

Yes 1
No 2-skip to 322

321) Were you told what to do if you experienced side effects or problems?

Yes 1
No 2

322) Check 318 and 319:

Any yes- At that time, were you told about other methods of family planning that you could use?

Other-When you obtained (Current method from 315) from (Source of method from 307 or 316), were you told about other methods of family planning that you could use?
Yes 1-skip to 324
No 2

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

Yes 1
No 2

324) Check 304:
Circle method code.
If more than one method code circled in 304, circle code for highest method in list.

Female sterilization 01-skip to 327
Male sterilization 02-skip to 327
IUD 03
Injectables 04
Implants 05
Pill 06
Condom 07
Female condom 08
Emergency contraception 09
Standard days method 10
Lactational Amen. Method 11-skip to 327
Rhythm method 12-skip to 327
Withdrawal 13-skip to 327
Other modern method 95
Other traditional method 96-skip to 327

325) Where did you obtain (current method) the last time?
Probe to identity the type of source.
If unable to determine if public or private sector, write the name of the place.
(Name of place)

Public sector
Govt. Hospital 11
Govt. Health Center 12
Mobile clinic 14
Fieldworker 15

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Pharmacy 22
Private doctor 23
Mobile clinic 24
Religious hospital 25
Other private medical (specify) 26
NGO
Family planning clinic 31
Other source
Shop 41
Church 42
Friend/relative 43

Other (specify) 96
All skip to 327

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

Yes 1
No 2

327) In the last 12 months, were you visited by a fieldworker?

Yes 1
No 2-skip to 329

328) Did the fieldworker talk to you about family planning?

Yes 1
No 2

329) Check 202: Living children

Yes a) In the last 12 months, have you visited a health facility for care for yourself or your children?
No b) In the last 12 months, have you visited a health facility for yourself?
Yes 1
No 2-skip to 401

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

Yes 1
No 2

Section 4. Pregnancy and postnatal care

401) Check 224:

One or more births in 2012-2017
No births in 2012-2017-skip to 648

402) Check 215: Record the birth history number in 403 and the name and the survival state from 404 for each birth in 2012-2017. Ask the questions about all these births. Begin with the last birth. (If there are more than 2 births, use last column of additional questionnaire(s)).

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

403) Birth history number from 212 in birth history

Last birth
Birth history number
Next-to-last birth
Birth history number

404) From 212 and 216

Name
Living
Dead

405) When you got pregnant with (Name), did you want to become pregnant at that time?

Yes 1-skip to 408
No 2

406) Check 208:
Only one birth- a) Did you want to have a baby later on, or did you not want any children?
More than one birth- b) Did you want to have a baby later on, or did you not want any more children?

Later 1
No more 2-skip to 408

407) How much longer did you want to wait?

Months 1
Years 2
Don’t know 998

408) Did you see anyone for antenatal care for this pregnancy?

Yes 1
No 2-skip to 414

409) Whom did you see?
Anyone else?
Probe to identify each type of person and record all mentioned.

Heath professional
Doctor A
Nurse B
Midwife C

Other person
Aide D
Matron E
Traditional birth attendant F
Community/village health worker G

Other (specify) X

410) Where did you receive this antenatal care for this pregnancy?
Anywhere else?
Probe to identity the type of source.
If unable to determine if public or private sector, write the name of the place.
(Name of place(s))

Home
Her home A
Other home B
Public sector
Govt. Hospital C
Govt. Health Center D
Maternity E
Village unit F

Other public sector (specify) G
Private medical sector
Private hospital/clinic H
Religious hospital I
Other private medical (specify) J

Other (specify) X

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

Months
Don’t know 98

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

Number of times
Don’t know 98

413) As part of your antenatal care during this pregnancy, were any of the following done at least once?

a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?
d) Did they weigh you?
e) Did they measure you?
f) Did they feel your abdomen?
g) Did they do an ultrasound?
h) Did they give you nutritional advice?

BLOOD PRESSURE
Yes 1
No 2
URINE
Yes 1
No 2
BLOOD
Yes 1
No 2
WEIGHT
Yes 1
No 2
HEIGHT
Yes 1
No 2
ABDOMEN
Yes 1
No 2
ULTRASOUND
Yes 1
No 2
NUTRITIONAL ADVICE
Yes 1
No 2

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

Yes 1
No 2- skip to 417
Don’t know 8-skip to 417

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

Times
Don’t know 8

416) Check 416: Tetanus injections

2 or more times-skip to 420
Don’t know

416) Check 416: Tetanus injections

2 or more times-skip to 420
Don’t know

417) At any time before this pregnancy, did you receive any tetanus injections?

Yes 1
No 2-skip to 420
Don’t know 8-skip to 420

418) Before this pregnancy, how many times did you receive a tetanus injection?
If 7 or more times, record 7

Times
Don’t know 8

419) Check 418;
Only once:
a) How many years ago did you receive the last tetanus injection?
More than once:
b) How many years ago did you receive the last tetanus injection before this pregnancy?

Years ago

420) During this pregnancy, were you given or did you buy iron tablets or iron syrup?
Show tables/syrup

Yes 1
No 2-skip to 422
Don’t know 8- skip to 422

421) During the whole pregnancy, for how many days did you take the tables or syrup?
If answer not numeric, probe for approximate number of days.

Days
Don’t know 998

422) During this pregnancy, did you take any drug for intestinal worms?

Yes 1
No 2
Don’t know 8

423) During this pregnancy, did you take any drugs to keep you from getting malaria?

Yes 1
No 2-skip to 426
Don’t know 8-skip to 426

423a) What drugs did you take?
Record all mentioned. If the type of drug isn’t determined, show current malaria drugs to the respondent.

SP/Fansidar A
Chloroquine B
Other (specify) X
Don’t know Z

423b) Check 324a:
SP/Fansidar take as a preventative against malaria.

Code A circled
Code A not circled-skip to 426

424) How many times did you take SP/Fansidar during this pregnancy

Times____

424b) How many times did you take SP/Fansidar while under observation from a health care worker?

Number of times_____
None 0

425) Did you get the SP/Fansidar during any antenatal visit, during another visit to a health facility or from another source?
If more than one source, record the highest source on the list.

Antenatal visit 1
Another facility visit 2
Other source 6

425a) Check 425:
Antenatal visit

Code 1 circled
Code 1 not circled-skip to 426

425b) Did you have an antenatal card during the time you were pregnant with (name)?

Yes, seen 1
Yes, not seen 2-skip to 426
No card 8-skip to 426

425c) Check the antenatal card and record the number of times SP/Fansidar was given

Number of times
None 0

426) When (Name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

Very large 1
Larger than average 2
Average 3
Smaller than average 4
Very small 5
Don’t know 8

427) Was (Name) weighed at birth?

Yes 1
No 2-skip to 429
Don’t know 8-skip to 429

428) How much did (Name) weigh?
Record weight in kilograms from health card, if available

Grams from card 1
Grams from recall 2
Don’t know 99998

429) Who assisted with the delivery of (Name)?
Anyone else?
Probe for the type of person and record all persons assisting.
If respondent says no one assisted, probe to determine whether any adults were present at the delivery

Heath professional
Doctor A
Nurse B
Midwife C
Other person
Aide D
Matron E
Traditional birth attendant F
Relative/friend G

Other (specify) X
No one Y

430) Where did you give birth to (name)?
Probe to identity the type of source.
If unable to determine if public or private sector, write the name of the place.
(Name of place(s))

Home
Her home 11-skip to 434
Other home 12-skip to 434
Public sector
Govt. Hospital 21
Govt. Health Center 22
Maternity 23
Village unit 24

Other public sector (specify) 26
Private medical sector
Private hospital/clinic 31
Religious hospital 32
Other private medical (specify) 36

Other (specify) 96-skip to 434

431) How long after (Name) was delivered did you stay there?
If less than one day, record hours. If less than one week, record days. If a week or more, record weeks.

Hours 1
Days 2
Weeks 3
Don’t know 998

432) Was (name) delivered by caesarean, that is, did they cut your belly open to take the baby out?

Yes 1
No 2-skip to 434

433) When was the decision made to have the caesarean section? Was it before or after your labor pains started?

Before 1
After 2

433a) Did you pay to delivery by caesarean?

Yes 1
No 2
Don’t know 8

434) Immediately after the birth, was (name) put directly on the bare skin of your chest?

Yes 1
No 2-skip to 434 b
Don’t know 8-skipt to 434b

434a) Did (name)’s skin have contact with your skin?

Yes 1
No 2
Don’t know 8

434b) Check 430: Place of delivery

Code 11, 12, or 96 circled-skip to 449
Other

435) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

Yes 1
No 2-skip to 438

436) How long after delivery did the first check take place?
If less than one day, record in hours. If less than one week, record days.
If one week or more, record in weeks.

Hours 1
Days 2
Weeks 3
Don’t know 998

437) Who checked on your health at that time?
Probe for most qualified person.

Heath professional
Doctor 11
Nurse 12
Midwife 13
Other person
Aide 21
Matron 22
Traditional birth attendant 23
Community/village health worker 24

Other (specify) 96

437a) Does a woman pay to have a caesarean in Benin?

Yes, pays 1
No, does not pay 2
Don’t know 8

438) Now I would like to talk to you about checks on (name)’s health after delivery—for example, someone examining (name), checking the cord, or seeing if (name) is OK. Did anyone check on (name)’s health while you were still in the facility?

Yes 1
No 2-skip to 441
Don’t know 8-skip to 441

439) How long after delivery was (name)’s health first checked?
If less than one day, record hours. If less than one week, record days. If one week or more, record in weeks.

Hours 1
Days 2
Weeks 3
Don’t know 998

440) Who checked on (name)’s health at that time?
Probe for the most qualified person.

Heath professional
Doctor 11
Nurse 12
Midwife 13
Other person
Aide 21
Matron 22
Traditional birth attendant 23

Other (specify) 96

441) Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

Yes 1
No 2-skip to 445

442) How long after delivery did that check take place?
If less than one day, record hours; if less than one week, record days. If one week or more, record in weeks.

Hours 1
Days 2
Weeks 3
Don’t know 998

443) Who checked on (name)’s health at that time?
Probe for the most qualified person.

Heath professional
Doctor 11
Nurse 12
Midwife 13
Other person
Aide 21
Matron 22
Traditional birth attendant 23
Community/village health worker 24

Other (specify) 96

444) Where did this first check of (name) take place?
Probe to identity the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place.
(Name of place(s))

Home
Her home 11
Other home 12
Public sector
Govt. Hospital 21
Govt. Health Center 22
Maternity 23
Village unit 24

Other public sector (specify) 26
Private medical sector
Private hospital/clinic 31
Religious hospital 32
Other private medical (specify) 36

Other (specify) 96

445) I would like to talk to you about checks on (name)’s health after you left (facility in 430). Did any health care provider or a traditional birth attendant check on (name)’s health in the two months after you left (facility in 430)?

Yes 1
No 2-skip to 457
Don’t know 8-skip to 457

446) How many hours, days or weeks after the birth of (name) did that check take place?
If less than one day, record hours; if less than one week, record days. If one week or more, record in weeks.

Hours 1
Days 2
Weeks 3
Don’t know 998

447) Who check on (name)’s health at that time?
Probe for most qualified person.

Heath professional
Doctor 11
Nurse 12
Midwife 13
Other person
Aide 21
Matron 22
Traditional birth attendant 23
Community/village health worker 24

Other (specify) 96

448) Where did this check of (name) take place.
Probe to identity the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place.
(Name of place(s))

Home
Her home 11
Other home 12
Public sector
Govt. Hospital 21
Govt. Health Center 22
Maternity 23
Village unit 24

Other public sector (specify) 26
Private medical sector
Private hospital/clinic 31
Religious hospital 32
Other private medical (specify) 36
Other (specify) 96
All skip to 457

449) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (name)?

Yes 1
No 2-skip to 453

450) How long after delivery did the first check take place?
If less than one day, record in hours. If less than one week, record days. If one week or more, record in weeks.

Hours 1
Days 2
Weeks 3
Don’t know 998

451) Who checked on your health at that time?
Probe for most qualified person.

Heath professional
Doctor 11
Nurse 12
Midwife 13
Other person
Aide 21
Matron 22
Traditional birth attendant 23
Community/village health worker 24

Other (specify) 96

452) Where did this first check take place?
Probe to identity the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place.
(Name of place(s))

Home
Her home 11
Other home 12
Public sector
Govt. Hospital 21
Govt. Health Center 22
Maternity 23
Village unit 24

Other public sector (specify) 26
Private medical sector
Private hospital/clinic 31
Religious hospital 32
Other private medical (specify) 36

Other (specify) 96

453) I would like to talk to you about checks on (name)’s health after delivery—for example, someone examining (name), checking the cord, or seeing if (name) is OK. In the two months after (name) was born, did any health care provider or a traditional birth attendant check on (name)’s health?

Yes 1
No 2-skip to 457
Don’t know 9-skip to 457

454) How many hours, days, or weeks after the birth of (name) did the first check take place?
If less than one day, record in hours. If less than one week, record days. If one week or more, record in weeks.

Hours 1
Days 2
Weeks 3
Don’t know 998

455) Who checked on (name)’s health at that time?
Probe for the most qualified person.

Heath professional
Doctor 11
Nurse 12
Midwife 13
Other person
Aide 21
Matron 22
Traditional birth attendant 23
Community/village health worker 24

Other (specify) 96

456) Where did this first check of (name) take place?
Probe to identity the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place.
(Name of place(s))

Home
Her home 11
Other home 12
Public sector
Govt. Hospital 21
Govt. Health Center 22
Maternity 23
Village unit 24

Other public sector (specify) 26
Private medical sector
Private hospital/clinic 31
Religious hospital 32
Other private medical (specify) 36

Other (specify) 96

457) In the first two days after (name)’s birth, did any health care provider do the following:
a) Examine the cord?
b) Measure (name)’s temperature?
c) Counsel you on danger signs for newborns?
d) Counsel you on breastfeeding?
e) Observe (name) breastfeeding?

a) Cord
Yes 1
No 2
Don't know 8
b) Temp.
Yes 1
No 2
Don't know 8
c) Signs
Yes 1
No 2
Don't know 8
d) Counsel breastfeed
Yes 1
No 2
Don't know 8
e) Observe breastfeed
Yes 1
No 2
Don't know 8

458) Has your menstrual period returned since the birth of (name)?

Yes 1-skip to 460
No 2- skip to 461

459) Did your period return between the birth of (name) and your next pregnancy?

Yes 1
No 2-skip to 463

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

Months___
Don’t know 98

461) Check 226:
Is respondent pregnant?

Not pregnant
Pregnant or not sure-skip to 463

462) Have you had sexual intercourse since the birth of (name)?

Yes 1
No 2-skip to 464

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

Months____
Don’t know 98

464) Did you ever breastfeed (Name)?

Yes 1-skip to 466
No 2

465) Check 404: Child is living?

Living-skip to 470
Dead-skip to 471

466) 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

Immediately 000
Hours 1
Days 2

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

Yes 1
No 2

468) Check 404: Is child living?

Living
Dead-Go to 471

469) Are you still breastfeeding (Name)?

Yes 1
No 2

470) Did (name) drink anything from a bottle with a nipple yesterday or last night?

Yes 1
No 2
Don't know 8

471) (Go back to 405 in next column, or, if no more births, go to 501a)

Section 5a. Child immunization (last birth)
No.
Questions and filters
Coding category
Skip

501a) Check 215 in the birth history: Any births in 2014-2017?

One or more births in 2014-2017
No births in 2014-2017-skip to 601

502a) Record the name and birth history number from 212 of the last child born in 2014-2017.

Name of last birth
Birth history number

503a) Check 216 for child:

Living
Dead-skip to 501b

504a) Do you have a card or other document where (name)’s vaccinations are written down?

Yes, only card seen 1-skip to 507a
Yes, only other document seen 2
Yes, both seen 3-skip to 507a
No, neither seen 4

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

Yes 1
No 2

506a) Check 504a

Code 2 circled
Code 4 circled-skip to 511a

507a) May I see the card or other document where (name)’s vaccinations are written down?

Yes, only card seen 1
Yes, only other document seen 2
Yes, both seen 3
No, neither seen 4-skip to 511a

508a) Copy dates from the card.
Write 44 in day column if card shows that a dose was given, but no date is recorded.

BCG
Oral polio vaccine (OPV) 0 (Polio given at birth)
Oral polio vaccine (OPV) 1
Oral polio vaccine (OPV) 2
Oral polio vaccine (OPV) 3
DPT-HEP.B-HIB (Pentavalent) 1
DPT-HEP.B-HIB (Pentavalent) 2
DPT-HEP.B-HIB (Pentavalent) 3
Pneumococcal 1
Pneumococcal 2
Pneumococcal 3
Anti-measles vaccine
Yellow fever
Vitamin A (most recent)

509a) Check 508a:
BCG to Yellow fever all recorded

No
Yes-skip to 525a

510a) In addition to what is recorded on (this document/these documents), did (name) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?
Record Yes only if the respondent mentions at least one of the vaccinations in 508a that are not recorded as having been given.

Yes 1-(Probe for vaccinations and write 66 in the corresponding day column in 508a)—(Then skip to 525a)
No 2-(Record 00 in the corresponding day column for all vaccines not given) – (Then skip to 525a
Don’t know 8- (Record 00 in the corresponding day column for all vaccines not given) – (Then skip to 525a

511a) Did (name) ever receive any vaccinations to prevent (name) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

Yes 1
No 2-skip to 525a
Don’t know 8-skip to 525a

512a) Did (name) ever receive a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

Yes 1
No 2
Don’t know 8

514a) Has (name) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

Yes 1
No 2-skip to 517a
Don’t know 8-skip to 517a

515a) Did (name) receive the first oral polio vaccine in the first two weeks after birth or later?

First two weeks 1
Later 2

516a) How many times did (name) receive the oral polio vaccine?

Number of times_____

517a) Has (name) ever received a pentavalent vaccination, that is, an injection given in the right arm sometimes at the same time as polio drops?

Yes 1
No 2skip to 519a
Don’t know 8-skip to 519a

518a) How many times did (name) receive the pentavalent vaccine?

Number of times_____

519a) Has (name) ever received a pneumococcal vaccination, that is, an injection in the left thigh to prevent pneumonia?

Yes 1
No 2-skip to 521a
Don’t know 8-skip to 521a

520a) How many times did (name) receive the pneumococcal vaccine?

Number of times____

523a) Has (name) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

Yes 1
No 2-skip to 525a
Don’t know 8-skip to 525a

524a) Has (name) ever received a vaccine against yellow fever, that is, an injection in the right thigh to prevent yellow fever?

Yes 1
No 2
Don’t know 8

524Aa) Did (name) receive certain vaccines over the past 12 months during a national vaccination campaign (day)?

Yes 1
No 2-skip to 525a
Don’t know 8-skip to 525a

524Ab) During which national vaccination campaign did (name) receive the vaccines?

April 2017 1
October 2017 2
Other (specify) 6

525a) In the last 7 days was (name) given:
a) a micronutrient powder mix (MNP)?
b) Ready-made dietary supplements like Plumpy Buts?
c) Ready-made dietary supplements like Plumpy Doz?

a) Powder
Yes 1
No 2
Don’t know 8
b) Plumpy Nuts
Yes 1
No 2
Don’t know 8
c) Plumpy Doz
Yes 1
No 2
Don’t know 8

526a) Continue with 501b

Section 5B: Child immunization (next-to-last birth)

No.
Questions and filters
Coding categories
Skip

501b) Check 215 in the birth history: Any more births in 2014-2017?

More births in 2014-2017
No more births in 2014-2017-skip to 601

502b) Record the name and birth history number from 212 of the next-to-last child born in 2014-2017.

Name of next-to-last birth
Birth history number

503b) Check 216 for child

Living
Dead-skip to 526b

504b) Do you have a card or other document where (name)’s vaccinations are written down?

Yes, only card seen 1-skip to 507b
Yes, only other document seen 2
Yes, both seen 3-skip to 507b
No, neither seen 4

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

Yes 1
No 2

506b) Check 504b

Code 2 circled
Code 4 circled-skip to 511b

507b) May I see the card or other document where (name)’s vaccinations are written down?

Yes, only card seen 1
Yes, only other document seen 2
Yes, both seen 3
No, neither seen 4-skip to 511b

508b) Copy dates from the card.
Write 44 in day column if card shows that a dose was given, but no date is recorded.

BCG
Oral polio vaccine (OPV) 0 (Polio given at birth)
Oral polio vaccine (OPV) 1
Oral polio vaccine (OPV) 2
Oral polio vaccine (OPV) 3
DPT-HEP.B-HIB (Pentavalent) 1
DPT-HEP.B-HIB (Pentavalent) 2
DPT-HEP.B-HIB (Pentavalent) 3
Pneumococcal 1
Pneumococcal 2
Pneumococcal 3
Anti-measles vaccine
Yellow fever
Vitamin A (most recent)

509a) Check 508a:
BCG to Yellow fever all recorded

No
Yes-skip to 525a

510a) In addition to what is recorded on (this document/these documents), did (name) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

Record Yes only if the respondent mentions at least one of the vaccinations in 508a that are not recorded as having been given.
Yes 1-(Probe for vaccinations and write 66 in the corresponding day column in 508a)—(Then skip to 525a)
No 2-(Record 00 in the corresponding day column for all vaccines not given) – (Then skip to 525a
Don’t know 8- (Record 00 in the corresponding day column for all vaccines not given) – (Then skip to 525a

511b) Did (name) ever receive any vaccinations to prevent (name) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

Yes 1
No 2-skip to 525b
Don’t know 8-skip to 525b

512b) Did (name) ever receive a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

Yes 1
No 2
Don’t know 8

514b) Has (name) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

Yes 1
No 2-skip to 517b
Don’t know 8-skip to 517b

515b) Did (name) receive the first oral polio vaccine in the first two weeks after birth or later?

First two weeks 1
Later 2

516b) How many times did (name) receive the oral polio vaccine?

Number of times____

517b) Has (name) ever received a pentavalent vaccination, that is, an injection given in the right arm sometimes at the same time as polio drops?

Yes 1
No 2skip to 519b
Don’t know 8-skip to 519b

518b) How many times did (name) receive the pentavalent vaccine?

Number of times_____

519b) Has (name) ever received a pneumococcal vaccination, that is, an injection in the left thigh to prevent pneumonia?

Yes 1
No 2-skip to 523b
Don’t know 8-skip to 523b

520b) How many times did (name) receive the pneumococcal vaccine?

Number of times_____

523b) Has (name) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

Yes 1
No 2
Don’t know 8

524b) Has (name) ever received a vaccine against yellow fever, that is, an injection in the right thigh to prevent yellow fever?

Yes 1
No 2
Don’t know 8

524Ba) Did (name) receive certain vaccines over the past 12 months during a national vaccination campaign (day)?

Yes 1
No 2-skip to 525b
Don’t know 8-skip to 525b

524Bb) During which national vaccination campaign did (name) receive the vaccines?

April 2017 1
October 2017 2
Other (specify) 6

525b) In the last 7 days was (name) given:
a) a micronutrient powder mix (MNP)?
b) Ready-made dietary supplements like Plumpy Buts?
c) Ready-made dietary supplements like Plumpy Doz?

a) Powder
Yes 1
No 2
Don’t know 8
b) Plumpy Nuts
Yes 1
No 2
Don’t know 8
c) Plumpy Doz
Yes 1
No 2
Don’t know 8

526b) Check 215 in birth history: any more births in 2014-2017?

More births in 2014-2017-(Go to 502b in an additional questionnaire)
No more births in 2014-2017-skip to 601

Section 6. Child health and nutrition

601) Check 224:

One or more births in 2012-2017
No births in 2012-2017-skip to 648

602) Check 215: Enter in the table the birth history number in 603 and the name and survival state in 604 for each birth between 2012-2017. Ask the questions about all of these births. Begin with the last birth. If there are more births, use last column of additional questionnaires.

Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)
603) Birth history number from 212 in birth history

Last birth
Birth history number
Next-to-last birth
Birth history number

604) From 212 and 216

Name
Living
Dead-(Go to 646)

605) In the last six months, was (name) given a vitamin A dose like (this/any of these)?
Show common types of ampoules/capsules/syrups.

Yes 1
No 2
Don't know 8

606) In the last seven days, was (name) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
Show common types of pills/sprinkles/syrups.

Yes 1
No 2
Don't know 8

607) Was (name) given any drug for intestinal worms in the last six months? [#translator note: Text cuts off, and I filled in based on the standard English. However, there is a reference to a type of worm—“albendazole,” that was part of what was cut off]

Yes 1
No 2
Don't know 8

608) Has (name) had diarrhea in the last 2 weeks?

Yes 1
No 2-skip to 618
Don't know -skip to 618

609) Check 464: Currently breastfeeding

Yes a) Now I would like to know how much (Name) was given to drink during the diarrhea including breastmilk. Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
If less, probe: Was he/she given much less than usual to drink or somewhat less?

No/Not asked b) 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?
Much less 1
Somewhat less 2
About the same 3
More 4
Nothing to drink 5
Don’t know 8

610) When (Name) had diarrhea, was (name) given less than usual to eat, about the same amount, more than usual, or nothing to eat?
If less, probe: Was (name) given much less than usual to eat or somewhat less?

Much less 1
Somewhat less 2
About the same 3
More 4
Stopped food 5
Never gave food 6
Don’t know 8

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

Yes 1
No 2-skip to 615

612) Where did you seek advice or treatment?

Anywhere else?
Probe to identify the type of source.
If unable to determine if public or private sector, write the name of the place(s).

(Name of place(s))

Public sector
Govt. Hospital A
Govt. Health Center B
Clinic C
Fieldworker D
Social center E
Health care worker F
Health care worker/community G

Other public sector (specify) H
Private medical sector
Private hospital/clinic I
Religious hospital J
Private doctor K
Pharmacy L
ABPF (Beninese Association for Families) M
Health care worker (NGO) N
Other private medical (specify) O
Other source
Shop P
Traditional practitioner Q
Market R
Peddler S

Other (specify) X

613) Check 612:

Two or more codes circled
Only one code circled-skip to 615

614) Where did you first seek advice or treatment?
Use letter code from 612

First place

615) Was (name) given any of the following to drink at any time since (name) started having the diarrhea?
a) A fluid made from a special packet called ORASEL?
b) A government-recommended homemade fluid?
c) Zinc tablets or syrup?

a) Fluid form ORS pkt
Yes 1
No 2
DK 8
b) Homemade fluid
Yes 1
No 2
DK 8
c) Zinc
Yes 1
No 2
DK 8

616) check 615:
Any “Yes”
a) Was anything else given to treat the diarrhea?
All “No” or “DK”
b) Was anything given to treat the diarrhea?

Yes 1
No 2-skip to 618
Don't know 8-skip to 618

617) Check 615:
Any “Yes” a) What else was given to treat the diarrhea?
Anything else?

All “No” or “DK” b) What was given to treat the diarrhea?
Anything else?
Record all treatments given.

Pill or syrup
Antibiotic A
Antimotility B
Other (not antibiotic or antimotility) C
Unknown pill or syrup D
Injection
Antibiotic E
Non-antibiotic F
Unknown injection G

(IV) Intravenous H

Home remedy/Herbal medicine I

Other (specify) X

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

Yes 1
No 2-skip to 620
Don't know 8-skip to 620

619) At any time during the illness, did (name) have blood taken from (name)’s finger or heel for testing?

Yes 1
No 2
Don’t know 8

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

Yes 1
No 2
Don’t know 8

621) Has (name) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

Yes 1
No 2-skip to 623
Don’t know 8-skip to 623

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

Chest only 1
Nose only 2
Both 3
Other (specify) 6
Don't know 8
All skip to 624

623) Check 618: Had fever?

Yes
No or DK –skip to 646

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

Yes 1
No 2-skip to 629

625) Where did you seek advice or treatment?
Anywhere else?
Probe to identify each type of source.
If unable to determine if public or private sector, write the name of the place.

(Name of place(s))

Public sector
Govt. Hospital A
Govt. Health Center B
Govt. Clinic C
Mobile clinic D
Health care worker/community E

Other public sector (specify) F
Private medical sector
Private hospital/clinic G
Pharmacy H
Private doctor I
Mobile clinic J
Health care worker/community K
Other private medical (specify) L
Other source
Shop M
Traditional practitioner N
Market O
Peddler P

Other (specify) X

626) Check 625:

Two or more codes circled
Only one code circled-skip to 628

627) Where did you first seek advice or treatment?
Use letter code from 625

First place____

628) How many days after the illness began did you first seek advice or treatment for (name)?
If the same day record 00

Days____

629) At any time during the illness, did (name) take any drugs for the illness?

Yes 1
No 2-skip to 646
Don’t know 8-skip to 646

630) What drugs did (name) take?
Any other drugs?
Record all mentioned

Antimalarial drugs
Artemisinin Combination Therapy (ACT) A
SP/Fansidar B
Chloroquine C
Amodiaquine D
Quinine

Pills E
Injection/IV F
Artesunate

Rectal G
Injection/IV H
Other antimalarial (specify) I
Antibiotic
Pill/syrup J
Injection/IV K
Other drugs
Aspirin L
Acetaminophen M
Ibuprofen N
Paracetemol O

Other (specify) X
Don’t know Z

631) Check 630:
Any code A-J circled?

Yes
No –skip to 646

631a) How much did you pay for the drugs and the consultation to treat (name)’s fever?
Record the price is CFA Francs. If more than 99,000 CFA Francs, record 99,000 CFA Francs

Price____
Free 99995
Don’t know 99998

632) Check 630:
Artemisinin Combination Therapy (A) given

Code A circled
Code A not circled-skip to 634

633) How long after the fever started did (name) first take an artemisinin combination therapy?

Same day 0
Next day 1
Two days after fever 2
Three days or more after fever 3
Don’t know 8

634) Check 630:
SP/Fansidar (B) given

Code B circled
Code B not circled-skip to 636

635) How long after the fever started did (name) first take SP/Fansidar?

Same day 0
Next day 1
Two days after fever 2
Three days or more after fever 3
Don’t know 8

636) Check 630:
Chloroquine (C) given

Code C circled
Code C not circled-skip to 638

637) How long after the fever started did (name) first take Chloroquine?

Same day 0
Next day 1
Two days after fever 2
Three days or more after fever 3
Don’t know 8

638) Check 630:
Amodiaquine (D) given

Code D circled
Code D not circled-skip to 640

639) How long after the fever started did (name) first take Amodiaquine?

Same day 0
Next day 1
Two days after fever 2
Three days or more after fever 3
Don’t know 8

640) Check 630:
Quinine (E or F) given

Code E or F circled
Code E or F not circled-skip to 642

641) How long after the fever started did (name) first take Quinine?

Same day 0
Next day 1
Two days after fever 2
Three days or more after fever 3
Don’t know 8

642) Check 630:
Artesunate (G or H) given

Code G or H circled
Code G or H not circled-skip to 644

643) How long after the fever started did (name) first take Artesunate?

Same day 0
Next day 1
Two days after fever 2
Three days or more after fever 3
Don’t know 8

644) Check 630:
Other antimalarial (J) given

Code I circled
Code I not circled-skip to 646

645) How long after the fever started did (name) first take (other antimalarial)?

Same day 0
Next day 1
Two days after fever 2
Three days or more after fever 3
Don’t know 8

645a) Is there are charge for the caring of children with malaria in Benin?

Yes, must be paid 1
No, does not need to be paid 2
Don’t know 8

646) Go back to 604 in the next column; or if no more births, go to 647.

647) Check 615(a) and 615(b), all columns:

No child received fluid from ORS packet (Orasel)
Any child received fluid from ORS packet (Orasel)-skip to 649

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

Yes 1
No 2

649) Check 215 and 218, all rows:
Number of children born in 2015-2017 living with respondent

One or more-(Name of youngest child living with her)
None-skip to 701

650) Now I would like to ask you about liquids or foods that (name from 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

a) plain water?
Yes 1
No 2
DK 8
b) juice or juice drinks?
Yes 1
No 2
DK 8
c) clear broth?
Yes 1
No 2
DK 8
d) milk such as tinned, powdered, or fresh animal milk?
Yes 1
No 2
DK 8
If yes, how many times did (name) drink milk?
If 7 of more times, record 7
Number of times drank milk
e) Infant formula?
Yes 1
No 2
DK 8
If yes, how many times did (name) drink infant formula?
If 7 or more times, record 7
Number of times drank formula
f) Any other liquids?
Yes 1
No 2
DK 8
g) Yogurt?
Yes 1
No 2
DK 8
If yes, how many times did (name) eat yogurt?
If 7 or more times, record 7
Number of times ate yogurt
h) Any prepared, enriched infant meals, like cerelac, “pepite d’or,” or “cereso”?
Yes 1
No 2
DK 8
i) bread, rice, noodles, porridge, millet, pearl millet, sorghum, corn, or any other foods made from grains?
Yes 1
No 2
DK 8
j) pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
Yes 1
No 2
DK 8
k) white potatoes, white yams, manioc, or any other foods made from roots?
Yes 1
No 2
DK 8
l) any dark green, leafy vegetables, like spinach?
Yes 1
No 2
DK 8
m) ripe mangoes, papayas, or other vitamin-A rich fruits?
Yes 1
No 2
DK 8
n) any other fruits or vegetables like bananas, apples, applesauce, green beans, avocado, tomatoes?
Yes 1
No 2
DK 8
o) liver, kidney, heart or any other organ meats?
Yes 1
No 2
DK 8
p) any meat, such as beef, pork, lamb, goat, chicken or duck?
Yes 1
No 2
DK 8
q) eggs?
Yes 1
No 2
DK 8
r) fresh or dried fish or shellfish?
Yes 1
No 2
DK 8
s) Other foods based in beans, peas, lentils, or nuts?
Yes 1
No 2
DK 8
t) cheese or other food made from milk?
Yes 1
No 2
DK 8
u) any other solid, semi-solid, or soft food?
Yes 1
No 2
DK 8
v) Food based in red palm oil, palm nut oil, or palm nut oil sauce?
Yes 1
No 2
DK 8
w) sweet potatoes that are yellow inside?
Yes 1
No 2
DK 8

651) Check 650 (categories g through w)

Not a single yes
At least one yes-skip to 653

652) Did (name from 649) eat any solid, semi-solid or soft foods yesterday during the day or at night?
If yes, probe: What kind of solid, semi-solid, or soft foods did (name) eat?

Yes 1-(go back to 650 to record food eaten yesterday)-(then continue to 653)
No-2-skip to 654

653) How many times did (name from 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?
If 7 or more times, record 7

Number of times
Don’t know 8

654) The last time (name from 649) passed stools, what was done to dispose of the stools?

Child used toilet or latrine 01
Put/rinsed into toilet or latrine 02
Put/rinsed into drain or ditch 03
Thrown into garbage 04
Buried 05
Left in the open 06
Other (specify) 96

Section 7. Marriage and sexual activity

No.
Questions and filters
Coding categories
Skip

701) Are you currently married or living together with a man as if married?

Yes, currently married 1-skip to 704
Yes, living with a man 2-skip to 704
No, not in union 3

702) Have you ever been married or lived together with a man as if married?

Yes, formerly married 1
Yes, lived with a man 2
No 3-skip to 712

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

Widow 1 – skip to 709
Divorced 2-skip to 709
Separated 3- skip to 709

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

Lives with her 1
Staying elsewhere 2

705) Record the husband’s/partner’s name and line number from the household questionnaire. If he is not a listed in the household, record ‘00’.

Name_____
Line no._____

706) Does your (husband/partner) have other wives or does he live with other women as if married?

Yes 1
No 2-skip to 709
Don’t know 8-skip to 709

707) Including yourself, in total how many wives or live-in partners does he have?

Total number of wives and live-in partners
Don’t know 98

708) Are you the first, second…wife?

Rank _____

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

Once 1
More than once 2

710) Check 709:
Married/lived with man only once –a) in what month and year did you start living with your (husband/partner)?

Married/lived with man more than once –b) Now I would like to talk about your first (husband/partner) In what month and year did you start living with him?

Month _____
Don’t know month 98
Year ____ - skip to 712
Don’t know year 9998

711) How old were you when you first started living with him?

Age _____

712) Check for the presence of others. Before continuing, make every effort to ensure privacy.

713) I would like to ask you about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don’t want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?

Never had sexual intercourse 00-skip to 731
Age in years____

714) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
If less than 12 months, answer must be recorded in days, weeks, or months.
If 12 months (one year) or more, answer must be recorded in years.

Days ago 1-skip to 716
Weeks ago 2-skip to 716
Months ago 3-skip to 716
Years ago 4-skip to 727

715) When was the last time you had sexual intercourse with this person?

Days ago 1
Weeks ago 2
Months ago 3

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

Yes 1
No 2-skip to 718

717) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

Yes 1
No 2

718) 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 2
If no, circle 3

Husband 1
Live-in partner 2
Boyfriend not living with respondent 3
Casual acquaintance 4
Client/Sex worker 5
Other (specify) 6

719) How long ago did you first have sexual intercourse with this person?

Days ago 1
Weeks ago 2
Months ago 3
Years ago 4

720) How many times during the last 12 months did you have sexual intercourse with this person?

Number of times_____

If non-numeric answer, probe to get an estimate. If number of times if 95 or more, record 95.

721) How old is this person?

Age of partner____
Don’t know 98

722) Apart from this person, have you had sexual intercourse with any other persons in the last 12 months?

Yes 1-(go back to 715 in next column)
No 2 –(skip to 724)

723) 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

Number of partners last 12 months
Don’t know 98

724) Check 106:

Age 15-24
Age 25-49-skip to 727

725) Check 701:

Not in a union
Currently married/living with a man-skip to 727

726) In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

Yes 1
No 2

727) In total, how many different people have you had sexual intercourse with in your lifetime?
If non-numeric answer, probe to get an estimate.
If number of partners is greater than 95, write 95

Number of partners in lifetime_____
Don’t know 98

728) Check 716, most recent partner (first column):

Yes, condom used
No, condom not used-skip to 731
Not asked-skip to 731

729) You told me that a condom was used the last time you had sex. What is the brand name of condom you used at that time?
If brand not known, ask to see the package.

Prudence 01
Cool 02
No Logo 03

Other (specify) 96
Don’t know 98

730) From where did you obtain the condom the last time?
Probe to identify the type of source.
If unable to determine if public or private sector, write the name of the place
(Name of place)

Public sector
Govt. Hospital 11
Govt. Health Center 12
Mobile clinic 14
Fieldworker 15

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Pharmacy 22
Private doctor 23
Mobile clinic 24
Religious hospital 25
Other private medical (specify) 26
NGO
Family planning clinic 31
Other source
Shop 41
Church 42
Friend/relative 43

Other (specify) 96

731) Presence of others during this section.

Children under 10
Yes 1
No 2
Adult men
Yes 1
No 2
Adult women
Yes 1
No 2

Section 8. Fertility preferences

No.
Questions and filters
Coding categories
Skip

801) Check 304:

Neither sterilized
He or she sterilized –skip to 813

802) Check 226:

Pregnant
Not pregnant or unsure –skip to 804

803) Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

Have another child 1-skip to 805
No more 2-skip to 812
Undecided/don’t know 8-skip to 812

804) 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?

Have (a/another) child 1
No more/none 2-skip to 807
Says she can’t get pregnant 3-skip to 813
Undecided/don’t know –skip to 811

805) Check 226:
Not pregnant or not sure- a) How long would you like to wait from now before the birth of (a/another) child?

Pregnant- b) After the birth of this child you are expecting now, how long would you like to wait before the birth of another child?

Months 1
Years 2
Soon/now 993-skip to 811
Says she can’t get pregnant 994-skip to 813
After marriage 995
Other (specify) 996
Don’t know 998
995-998-skip to 811

806) Check 226:

Not pregnant or unsure
Pregnant-skip to 812

807) Check 303:
Using a contraceptive method?

Not currently using
Currently using-skip to 813

808) Check 805:

24 or more months or 02 or more years
Not asked
00-23 months or 00-01 year-skip to 812

809) Check 714:
Days, weeks or months ago

Years ago—skip to 811
Not asked-skip to 811

810) Check 804:
Wants to have a/another child—a) You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?

Wants no more/none—b) You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?

Record all reasons mentioned.

Not married A
Fertility-related reasons
Not having sex B
Infrequent sex C
Menopausal/hysterectomy D
Can’t get pregnant E
Not menstruated since last birth F
Breastfeeding G
Up to God/Fatalistic H
Opposition to use
Respondent opposed I
Husband/partner opposed J
Others opposed K
Religious prohibition L
Lack of knowledge
Knows no method M
Knows no source N
Method-related reasons
Side effects/Health concerns O
Lack of access/too far P
Costs too much Q
Preferred method not available R
No method available S
Inconvenient to use T
Interferes with body’s normal processes U

Other (specify) X
Don’t know Z

811) Check 303: Using a contraceptive method?

Not asked
No, not currently using
Yes, currently using-skip to 813

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

Yes 1
No 2
Don’t know 8

813) Check 216:
Has living children- a) 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- b) 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.

None 00-skip to 815
Number
Other (specify) 96-skip to 815

814) 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 if it’s a boy or a girl?

Boys
Girls
Either
Other (specify) 96

815) In the last few months have you:

a) Heard about family planning on the radio?
Yes 1
No 2
b) Seen anything about family planning on the television?
Yes 1
No 2
c) Read about family planning in a newspaper or magazine?
Yes 1
No 2
d) Received a voice or text message about family planning on a mobile phone?
Yes 1
No 2
e) Seen or read something about family planning on a poster or a sign?
Yes 1
No 2
f) Read something about family planning in a brochure or pamphlet?
Yes 1
No 2
g) Seen something about family planning in a cultural/education lesson?
Yes 1
No 2
h) Heard about family planning in a religious setting (church/mosque)?
Yes 1
No 2
i) Heard about family planning at school?
Yes 1
No 2

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

a) on the radio?
Acceptable 1
Not acceptable 2
b) On television?
Acceptable 1
Not acceptable 2
c) In a newspaper or magazine?
Acceptable 1
Not acceptable 2
d) On your cell phone?
Acceptable 1
Not acceptable 2
e) On a poster?
Acceptable 1
Not acceptable 2
f) In a brochure?
Acceptable 1
Not acceptable 2
g) In a cultural/education lesson?
Acceptable 1
Not acceptable 2
h) In a religious setting?
Acceptable 1
Not acceptable 2
i) At school?
Acceptable 1
Not acceptable 2

817) Check 701:

Yes, currently married
Yes, currently living with a man
No, not in union-skip to 901

818) Check 303: Using a contraceptive method?

Currently using
Not currently using or not asked-skip to 820
Not asked –skip to 822

819) Would you say that using contraception is mainly your decision, mainly your (husband’s/partner’s) decision, or did you both decide together?

Mainly respondent 1
Mainly husband/partner 2
Joint decision 3
Other (specify) 6
All skip to 821

820) Would you say that not using contraception is mainly your decision, mainly your (husband’s/partner’s) decision, or did you both decide together?

Mainly respondent 1
Mainly husband/partner 2
Joint decision 3
Other (specify) 6

821) Check 304:

Neither sterilized
He or she sterilized –skip to 901

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

Same number 1
More children 2
Fewer children 3
Don’t know 8

Section 9. Husband’s background and woman’s work

No.
Questions and filters
Coding categories
Skip

901) Check 701:

Currently married/living with a man
No in union-skip to 909

902) How old was your (husband/partner) on his last birthday?

Age in completed years____

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

Yes 1
No 2-skip to 906

904) What is the highest level of school you attended: primary, secondary 1st cycle, secondary 2nd cycle, or higher?

Primary 1
Secondary 1st cycle 2
Secondary 2nd cycle 3
Higher 4


905) What is the highest (grade/year) you completed at this level?
If completed less than one year at that level, record 00

Grade/year_____
Don’t know 98

906) Has your (husband/partner) done any work in the last 7 days?

Yes 1-skip to 908
No 2
Don’t know 8

907) Has your (husband/partner) done any work in the last 12 months?

Yes 1
No 2-skip to 909
Don’t know 8-skip to 909

908) at is your (husband’s/partner’s) occupation? That is, what kind of work does he mainly do?

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

Yes 1-skip to 913
No 2

910) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

Yes 1-skip to 913
No 2

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

Yes 1-skip to 913
No 2

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

Yes 1
No-2 Skip to 917

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

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

For family member 1
For someone else 2
Self-employed 3

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

Throughout the year 1
Seasonally/Part of the year 2
Once in a while 3

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

Cash only 1
Cash and kind 2
In kind only 3
Not paid 4

917) Check 701:

Currently married/living with a man
Not in union-skip to 925

918) Check 916:

Code 1 or 2 circled
Other-skip to 921

919) Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Other (specify) 6

920) Would you say that the money that you earn is more than what your (husband/partner) earns, less than what he earns, or about the same?

More than him 1
Less than him 2
About the same 3
Husband/partner has no earnings 4-skip to 922
Don’t know 8

921) Who usually decides how the money your (husband/partner) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Husband has no earnings 4
Other (specify) 6

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

Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Other (specify) 6

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

Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Other (specify) 6

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

Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Other (specify) 6

925) Do you own this or any other house either alone or jointly with someone else?

Alone only 1
Jointly only 2
Both alone and jointly 3
Does not own 4-skip to 928

926) Do you have a title deed for any house you own?

Yes 1
No 2-skip to 928
Don’t know –skip to 928

927) Is your name on the title deed?

Yes 1
No 2
Don’t know 8

928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

Alone only 1
Jointly only 2
Both alone and jointly 3
Does not own 4-skip to 931

929) Do you have a title deed for any land you own?

Yes 1
No 2-skip to 931
Don’t know 8-skip to 931

930) Is your name on the title deed?

Yes 1
No 2
Don’t know 8

931) Presence of others at this point (present and listening, present but not listening, or not present)

Children under 10
Pres/listen 1
Pres./Not listen 2
Not pres. 3
Husband
Pres/listen 1
Pres./Not listen 2
Not pres. 3
Other males
Pres/listen 1
Pres./Not listen 2
Not pres. 3
Other females
Pres/listen 1
Pres./Not listen 2
Not pres. 3

932) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

Goes out
Yes 1
No 2
DK 8
Negl. children
Yes 1
No 2
DK 8
Argues
Yes 1
No 2
DK 8
Refuses sex
Yes 1
No 2
DK 8
Burns food
Yes 1
No 2
DK 8

Section 10. HIV/AIDS

No.
Questions and filters
Coding categories
Skip

1000) Check the cover page: Household selected for men’s questionnaire?

Household selected for men’s questionnaire
Household not selected for men’s questionnaire-skip to 1500

1001) Now I would like to talk about something else.
Have you ever heard of HIV or AIDS?

Yes 1
No 2-skip to 1042

1002) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

Yes 1
No 2
Don’t know 8

1003) Can people get HIV from mosquito bites?

Yes 1
No 2
Don’t know 8

1004) Can people reduce their chance of getting HIV by using a condom every time they have sex?

Yes 1
No 2
Don’t know 8

1005) Can people get HIV by sharing food with a person who has HIV?

Yes 1
No 2
Don’t know 8

1006) Can people get HIV because of witchcraft or other supernatural means?

Yes
No 2
Don’t know 8

1007) Is it possible for a healthy-looking person to have HIV?

Yes 1
No 2
Don’t know 8

1008) Can HIV be transmitted from a mother to a baby?

During pregnancy?

Yes 1
No 2
DK 8
During delivery?
Yes 1
No 2
DK 8
By breastfeeding?
Yes 1
No 2
DK 8

1009) Check 1008:

At least one yes
Other-skip to 1011

1010) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

Yes 1
No 2
DK 8

1011) Check 208 and 215:

Last birth in 2015-2017
No births –skip to 1027
Last birth in 2014 or later-skip to 1027

1012) Check 408 for last birth

Had antenatal care
No antenatal care-skip to 1020

1013) Check for presence of others, before continuing, make every effort to ensure privacy.

1014) During any of the antenatal visits for your last birth were you given any information about:

Babies getting HIV from their mother?
Yes 1
No 2
DK 8
Things that you can do to prevent getting HIV?
Yes 1
No 2
DK 8
Getting tested for the HIV?
Yes 1
No 2
DK 8

1015) Were you offered a test for HIV as part of your antenatal care?

Yes 1
No 2

1016) I don’t want to know the results, but were you tested for HIV as part of your antenatal care?

Yes 1
No 2-skip to 1020

1017) Where was the test done?

Probe to identify the type of source and circle the appropriate code.

If unable to determine if public or private sector, write the name of the place
(Name of place)

Public sector
Govt. Hospital 11
Govt. Health Center 12
Stand-Alone HTC Center 13
Family planning clinic 14
Mobile HTC Services 15

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Stand-Alone HTC Center 22
Pharmacy 23
Mobile HTC Services 24

Other private medical (specify) 26
Other source
Home 31
Workplace 32
Correctional facility 33

Other (specify) 96

1018) I don’t want to know the results, but did you get the results of the test?

Yes 1
No 2-skip to 1020

1019) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

Yes 1
No 2
Don’t know 8

1020) Check 430 for last birth

Any code 21-36 circled
Other-skip to 1026

1021) Between the time you went for delivery but before the baby was born, were you offered a test for HIV?

Yes 1
No 2

1022) I don’t want to know the results, but were you tested for HIV at that time?

Yes 1
No 2-skip to 1024

1023) I don’t want to know the results, but did you get the results of the test?

Yes 1-skip to 1025
No 2-skip to 1025

1024) Check 1016:

Yes
No or not asked-skip to 1027

1025) Have you been tested for HIV since that time you were tested during your pregnancy?

Yes 1-skip to 1028
No 2

1026) How many months ago was your most recent HIV test?

Months ago
Two or more year ago 95
All skip to 1033

1027) I don’t want to know the results, but have you ever been tested for HIV?

Yes 1
No 2-skip to 1031

1028) How many months ago was your most recent HIV test?

Months ago
Two or more years ago 95

1029) I don’t want to know the results, but did you get the results of the test?

Yes 1
No 2

1030) Where was the test done?
Probe to identify the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place
(Name of place)

Public sector
Govt. Hospital 11
Govt. Health Center 12
Stand-Alone HTC Center 13
Family planning clinic 14
Mobile HTC Services 15

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Stand-Alone HTC Center 22
Pharmacy 23
Mobile HTC Services 24

Other private medical (specify) 26
Other source
Home 31
Workplace 32
Correctional facility 33

Other (specify) 96

[##translator note: The language was a bit confused in the French version for option 14-16 and 26, so I used what was in the standard English version and in the previous question with a similar response set.]

1031) Do you know of a place where people can go to get an HIV test?

Yes 1
No 2-skip to 1033

1032) Where is that?
Any other place?
Probe to identify the type of source and circle the appropriate code.
If unable to determine if public or private sector, write the name of the place
(Name of place)

Public sector
Govt. Hospital A
Govt. Health Center B
Stand-Alone HTC Center C
Family planning clinic D
Mobile HTC Services E

Other public sector (specify) F
Private medical sector
Private hospital/clinic G
Stand-Alone HTC Center H
Pharmacy I
Mobile HTC Services J

Other private medical (specify) K

Other (specify) X

1033) Have you heard of test kits people can use to test themselves for HIV?

Yes 1
No 2-skip to 1035


1034) Have you ever tested yourself for HIV using a self-test kit?

Yes 1
No 2

1035) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

Yes 1
No 2
Don’t know/Not sure/Depends 8

1036) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

Yes 1
No 2
Don’t know/Not sure/Depends 8

1037) Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test results is positive for HIV?

Yes 1
No 2
Don’t know/Not sure/Depends 8

1038) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

Yes 1
No 2
Don’t know/Not sure/Depends 8

1039) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

Yes 1
No 2
Don’t know/Not sure/Depends 8

1040) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

Agree 1
Disagree 2
Don’t know/Not sure/Depends 8

1041) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

Yes 1
No 2
Says she has HIV 3
Don’t know/not sure/depends 8

1042) Check 1001:
Heard about HIV or AIDS- a) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

Not heard about HIV or AIDS- b) Have you heard about infections that can be transmitted through sexual contact?

Yes 1
No 2

1043) Check 713:

Has had sexual intercourse
Never had sexual intercourse-skip to 1051

1044) Check 1042: Heard about other sexually transmitted infections?

Yes
No –skip to 1046

1045) 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?

Yes 1
No 2
Don’t know 8

1046) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

Yes 1
No 2
Don’t know 8

1047) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

Yes 1
No 2
Don’t know 8

1048) Check 1045, 1046, and 1047:

Has had an infection (Any ‘yes’)
Has not had an infection or does not know-skip to 1051

1049) The last time you had (problem from 1045/1046/1047), did you seek any kind of advice or treatment?

Yes 1
No 2-skip to 1051

1050) Where did you go?
Any other place?
Probe to identify the type of source.
If unable to determine if public or private sector, write the name of the place
(Name of place)

Public sector
Govt. Hospital A
Govt. Health Center B
Stand-Alone HTC Center C
Family planning clinic D
Mobile HTC Services E

Other public sector (specify) F
Private medical sector
Private hospital/clinic G
Stand-Alone HTC Center H
Pharmacy I
Mobile HTC Services J

Other private medical (specify) K
Other source
Shop L

Other (specify) X

1051) 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?

Yes 1
No 2
Don’t know 8

1052) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

Yes 1
No 2
Don’t know 8

1053) Check 701:

Currently married/living with a husband
Not in union-skip to 1401

1054) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

Yes 1
No 2
Depends/not sure 8

1055) Can you ask your (husband/partner) to use a condom if you wanted him to?

Yes 1
No 2
Depends/not sure 8

Section 11. Other health issues

No.
Questions and filters
Coding categories
Skip

1101) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
If yes: How many injections have you had?
If number of injections is 90 or more, or daily for 3 months or more, record 90.
If non-numeric answer, probe to get an estimate.

Number of injections
None 00-skip to 1104

1102) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?
If the number of injections is over 90 or if there were daily injections in the last 3 months or longer, record 90.
If the response is not numeric, probe to obtain an estimate.

Number of injections
None-00-skip to 1104

1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

Yes 1
No 2
Don’t know 8

1104) Do you currently smoke cigarettes every day, some days, or not at all?

Every day 1
Some days 2-skip to 1106
Not at all 3-skip to 1106

1105) On average, how many cigarettes do you currently smoke each day?

Number of cigarettes_____

1106) Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

Every day 1
Some days 2-skip to 1108
Not at all 3-skip to 1108

1107) What (other) type of tobacco do you currently smoke or use?
Record all mentioned.

Pipes full of tobacco
Cigars C
Water Pipe D
Snuff by mouth E
Snuff by nose F
Chewing Tobacco G
Betel Quid with Tobacco H

Other (specify) X

1108) 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 or not?

a) Getting permission to go to the doctor?
Big problem 1
Not a big problem 2
b) Getting money needed for advice or treatment
Big problem 1
Not a big problem 2
c) The distance to the health facility
Big problem 1
Not a big problem 2
d) Not wanting to go alone?
Big problem 1
Not a big problem 2

1109) Are you covered by health insurance?

Yes 1
No 2-skip to 1112

1110) What type of health insurance are you covered by? Record all mentioned.

Mutual health organization/community-based health insurance A
Health insurance through employer B
Social security C
Other privately purchased commercial health insurance D
Other (specify) X

1112) Check cover of questionnaire

Household selected for men’s questionnaire
Household not selected for men’s questionnaire-skip to 1201

1113) Check 106:

15-29 years 1-skip to 1201
30-49 years 2

1114) Can I measure your blood pressure?
Respondent signature
Date

Yes, respondent accepts 1
No, respondent doesn’t accept 2-skip to 1201

1115) Read the blood pressure measurement.
Record the systolic and diastolic measurements.
If you cannot measure the respondent’s blood pressure, record the reason.

Systolic
Diastolic
Refused 994
Technical problems 995
Other 996


Section 12. Development of young child

No.
Questions and filters
Coding categories
Skip

1201) Check 217 and 218: All children age 0-4 living with his or her mother?

Yes
No –skip to 1301

1202) Check 217 and 218: Select the youngest child age 0-4 living with his or her mother and record his or her name and line number.

Name of the youngest child from Q 212
Line number of the youngest child from Q 219

1203) Read to the respondent:
Now, I would like to ask you some questions about (name of child in 1202), your youngest child from 0-4 living with you.

1204) How many children’s books and picture books do you have for (name)?

None 00
Number of children’s books 0_
Ten or more book 10

1205) I would like to ask you what objects (name) uses to play with while at home.

Does he/she play with:

a) homemade toys (like dolls, cars, or other homemade toys)?
Yes 1
No 2
Don't know 8
b) Toys from a store or a manufacture?
Yes 1
No 2
Don't know 8
c) Household objects (like bowls or pots), or objects found outside (like sticks, stones, animals, shells, or leaves)?
Yes 1
No 2
Don't know 8

If the respondent says “yes” to one of the above categories, probe to determine precisely what the child plays with to be certain of the response.

1206) Sometimes the adults who take care of the children have to leave the house to go shopping, do the laundry, or for other reasons and have to leave the young children.

During the last week, how many days was (name):

a) Left alone for more than one hour?
Number of days alone for more than one hour
b) Left in the care of another child (meaning someone under 10 years old) for more than one hour?
Number of days left with child for more than one hour
If never, record 0. If I don’t know, record 8

1207) Check 217: Age of the child

0, 1, or 2 year old child
3 or 4 year old child-skip to 1301

1208) Check 217 and 218: If other children age 3-4 living with their mother?

Yes
No-skip to 1301

1208a) Check 217 and 218: Select the youngest child of 3 or 4 years living with his or her month and write the child’s name and line number.

Name of youngest 3-4 year old child from Q 212
Line number of youngest 3-4 year old child from Q 219

1209) Is (name) in a preschool education program or an early learning class, in a public or private establishment, including nursery school or a community child-care center?

Yes 1
No 2
Don’t know 8

1210) During the last three days did you or a member of your family age 15 or older participate with (name) in one of the following activities:
If yes, ask: Who participated in this activity with (name)?

Circle all mentioned.

a) Read books or looked at illustrated books with (name)?
Mother A
Father B
Other person X
No one Y
b) Told stories to (name)?
Mother A
Father B
Other person X
No one Y
c) Sang songs to (name), or with (name), including lullabies?
Mother A
Father B
Other person X
No one Y
d) Took (name) for a walk outside of the house, the residence, the courtyard or the enclosure wall?
Mother A
Father B
Other person X
No one Y
e) Played with (name)?
Mother A
Father B
Other person X
No one Y
f) Spent time with (name), naming, counting, and/or drawing?
Mother A
Father B
Other person X
No one Y

1211) Now I would like to ask you some questions about the health and development of your child. Children do not all develop in the same manner and at the same speed. Some, for example, walk earlier than others. These questions relate to several aspects of your child’s development.

Does (name) know or can he/she recite at least ten letters from the alphabet?

Yes 1
No 2
DK 8

1212) Can (name) read at least four simple, common words?

Yes 1
No 2
DK 8

1213) Can (name) list and recognize all digits from 1 to 10?

Yes 1
No 2
DK 8

1214) Can (name) grasp with two fingers a small object from the ground, like a stick or a pebble?

Yes 1
No 2
DK 8

1215) Is (name) ever too sick to play?

Yes 1
No 2
DK 8

1216) Is (name) able to follow simple instructions to do something correctly?

Yes 1
No 2
DK 8

1217) When you give (name) something to do, is he/she able to do it independently?

Yes 1
No 2
DK 8

1218) Does (name) get along well with other children?

Yes 1
No 2
DK 8

1219) Does (name) kick, bit, or hit other children or adults?

Yes 1
No 2
DK 8

1220) Is (name) easily distracted?

Yes 1
No 2
DK 8

Section 13. Adult and maternal mortality

No.
Questions and filters
Coding categories
Skip

1301) 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 live with you, those who live elsewhere, and those who are dead. We have learned in previous surveys that it can be hard to create a complete list of all children born to your natural mother. We will work together to create a complete list and to help you remember all your brothers and sisters. Can you now give me the names of all your brothers and sisters born to your natural mother?

Name
Order number
a-t

1302) Check 1301:

At least one brother or sister listed
Not a single brother or sister listed-skip to 1304

1303) Read their names to the respondent, and after the last one, ask: Are there any other brothers or sisters from the same mother that you didn’t list?

No
Yes-Record the other brothers and sisters in 1301

1304) Sometimes people forget to list children of their natural mother because they do not live with them or because they don’t see each other very often. Are there brothers or sisters that do not live with you that you didn’t list?

No
Yes-Record the other brothers and sisters in 1301

1305) Sometimes people forget to list children of their biological mother because they are dead. Do you have any brothers and sisters who are dead who you did not list?

No
Yes-Record the other brothers and sisters in 1301

1306) Sometimes people have brothers or sisters from the same mother but from a different father. Are there any brothers or sisters born of your natural mother but who have a different natural father who you did not list?

No
Yes-Record the other brothers and sisters in 1301

1307) Count the number of brothers or sisters recorded in 1301

Total number of brothers and sisters

1308) Check 1307:
Just to make sure that I’ve understood, not including yourself, your mother gave birth to _____ children total. Is that correct?

Yes
No-Probe and correct 1301 and or 1307

1309) Check 1307:

At least one brother or sister listed
Not a single brother or sister list-skip to 1401

1410) Please tell me which brother or sister was born first? At who was the next?
Record 01 for the order number in 1301 for the first brother or sister, 02 for the second, and so on until you have recorded order numbers for all brothers and sisters.

1311) How many births did your mother have before your own birth?

Number of previous births____

1312) Record the brother and sisters according to the order number from 1301. Ask 1313 through 1324 for one brother or sister before moving to the next brother or sister. If there are more than 12 brothers and sisters, use a supplementary questionnaire.

1313) Name of brother or sister

01, 02, 03, 04, 05, 06

1314) Is (NAME) male or female?

Male 1
Female 2

1315) Is (NAME) still alive?

Yes 1
No 2-go to 1317
DK 8-go to [2,3,4, etc]

1316) How old is (NAME)?

Go to [2,3,4,etc]
age____

1317) How many years ago did (NAME) die?

Years____

1318) How old was (NAME) when he/she died?
If don’t know, probe and ask questions to obtain an estimate.
If man, or if woman died before age 12, go to 1323.

Age____

1319) Was (NAME) pregnant when she died?

Yes 1-Go to 1323
No 2

1320) Did (NAME) die during childbirth?

Yes 1 –Go to [2,3,4,etc]
No 2

1321) Did (Name) die within two months after the end of a pregnancy or childbirth?

Yes 1
No 2-skip to 1323

1322) How many days after the end of (name)’s pregnancy did she die?

days___

1323) Was (name)’s death the result of a violent act?

Yes 1- Go to [2,3,4,etc]
No 2

1324) Was (name)’s death the result of an accident?

Yes 1
No 2
Go to [2,3,4,etc]

If no other brothers of sister, go to next section.
[##translator note: questions repeated for child 7-12 to accommodate larger families]

Section 14. Non-communicable diseases for women’s questionnaire

No.
Questions and filters
Coding categories
Skip to

1401) Has a doctor or other health care professional taken your blood pressure?

Yes 1
No 2
Don’t know 8

1402) Has a doctor or other health care professional told you that you have elevated or high blood pressures?

Yes 1
No 2-skip to 1408

1403) In the last 12 months, has a doctor or other health care professional that you have elevated or high blood pressure?

Yes 1
No 2

1404) Has a doctor or other health care professional prescribed drugs to control your blood pressure?

Yes 1
No 2

1405) Are you currently taking drugs to control your blood pressure?

Yes 1
No 2

1406) Has a doctor or other health care professional measured the level of sugar in your blood?

Yes 1
No 2
Don’t know 8

1407) Has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?

Yes 1
No 2-skip to 1411

1408) In the last 12 months, has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?

Yes 1
No 2

1409) Has a doctor or other health care professional prescribed drugs to control the levels of sugar in your blood or to control diabetes?

Yes 1
No 2

1410) Are you currently taking drugs to control the level of sugar in your blood or to control diabetes?

Yes 1
No 2

1411) Has a doctor or other health care professional told you that you have heart disease or a chronic heart problem?

Yes 1
No 2

1412) Are you currently in treatment for heart disease or a chronic heart problem?

Yes 1
No 2

1413) Has a doctor or other health care professional told you that you have a pulmonary illness or a chronic pulmonary problem like asthma?

Yes 1
No 2

1414) Are you currently undergoing treatment for a pulmonary illness or a chronic pulmonary problem?

Yes 1
No 2

1415) Has a doctor or other health care professional told you that you have cancer or a tumor?

Yes 1
No 2 –skip to 1417

1416) Are you currently undergoing treatment for cancer or a tumor?

Yes 1
No 2

1417) Has a doctor or other health care professional told you have depression?

Yes 1
No 2 –skip to 1419

1418) Are you currently undergoing treatment for depression?

Yes 1
No 2

1419) Has a doctor or other health care professional told you that have arthritis?

Yes 1
No 2 –skip to 1421

1420) Are you currently undergoing treatment for arthritis?

Yes 1
No 2

1421) Has a doctor or other health care professional told you that you have another chronic illness, meaning an illness that lasts a long time?

Yes 1
(Specify chronic illness)
No 2 –skip to 1423

1422) Are you currently undergoing treatment for (chronic illness from 1421)?

Yes 1
No 2

1423) Have you ever heard of cervical cancer?

Yes 1
No 2 –skip to 1425

1424) Have you heard of tests to detect cervical cancer?

Yes 1
No 2

1425) Now I will ask you questions about the tests that a health care professional can do to detect cervical cancer. The cervix is what connects the uterus to the vagina. To test for cervical cancer, we ask that a woman lie down on her back while spreading her legs apart. Next, using a small brush or a cotton swab, the health care professional takes a sample from the inside of the uterus. The sample is sent to a lab for testing. This test is called a Pap smear or an HPV test. There is another method called VIA or Visual Inspection with ascetic acid. During this test, the health care professional applies diluted vinegar to the cervix to see if a reaction occurs.

1426) Has a doctor or other health care professional ever tested you for cervical cancer?

Yes 1
No 2 –skip to 1430
Don’t know 8-skip to 1430

1427) When was your last cervical cancer test?
If less than a year, record 00.

Years____
Don’t know 98

1428) What was the result of your last cervical cancer test?

Normal/negative 1-skip to 1430

Abnormal/positive 2
Inconclusive 3-skip to 1430
Didn’t receive results 4-skip to 1430
Don’t know –skip to 1430

1429) Did you undergo treatment for the cervix or did you have follow-up visits as a result of the test results?

Yes 1
No 2
Don’t know 8

1430) Check Q123D and Q1115:

Systolic and diastolic blood pressure recorded in Q 123d and q1115
Systolic and diastolic blood pressure not recorded in q 123d and q 1115-skip to 1436

1431) Record and calculate the average systolic and diastolic blood pressure from q123d and q1115.

1432) Blood pressure measurement from Q123d

Systolic____
Diastolic____

1433) Blood pressure measurement form Q1115

Systolic
Diastolic

1434) Total of Q1432 + Q1433

Systolic total
Diastolic total

1435) Divide 1434 by 2

Average systolic
Average diastolic
Skip to 1440

1436) Check 123d

Systolic and diastolic blood pressure not recorded in Q 123d
Systolic and diastolic blood pressure recorded in Q 123d –skip to 1439

1437) Check 1115

Systolic and diastolic blood pressure not recorded in Q 1115
Systolic and diastolic blood pressure recorded in Q 1115-skip to 1439

1438) Check 106f

Systolic and diastolic blood pressure recorded in Q 106f
Systolic and diastolic blood pressure not recorded in Q 106f –skip to 1500

1439) Record the systolic and diastolic blood pressure

Systolic____
Diastolic____

1440) Use the table below to determine the correct code to record the report on blood pressure and the reference form.
Circle the line where you find the value of the systolic pressure from Q1435 or Q1439.
Next, circle the column with the value of the diastolic pressure from Q1435 or Q1439.
The value found at the intersection of the line and the column circled in the table should be used to compete Q1441.

Average systolic pressure
≤129
130-139
140-159
160-179
180-209
≥210
Average diastolic pressure
≤84
85-89
90-99
100-109
110-119
≥120

1441) In the table below, record the number that you circled in Q1440. Next use the instructions to the right of this number to complete the report on blood pressure and the reference form for the respondent. Give the respondent the formula and answer any questions.

Category of blood pressure for respondent/Consult a health care professional to check blood pressure in:

1/normal/24 month
2/slightly higher than normal/12 months
3/higher than normal/2 months
4/moderately high/1 month
5/very high/7 days
6/extremely high/today

Section 15. Domestic violence

No.
Questions and filters
Coding categories
Skip

1500) Check cover page: household and woman selected for domestic violence?

Household and woman selected for this section
Household and woman not selected-skip to 1533

1501) Check for presence of others:
Do not continue until privacy is ensured.

Privacy obtained 1
Privacy not possible 2-skip to 1532

1501a) Read to the respondent:
Now I would like to ask you questions about some other important aspects of a woman’s life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Benin. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you a question you do not want to answer, let me know and I will skip to the next question.

1502) Check 701 and 702:

Currently married/living with a man
Formerly married/lived with a man (Read in past tense and use ‘last’ with husband/partner)
Never married/never lived with a man-skip to 1516

1503) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner).

a) He (is/was) jealous or angry if you (talk/talked) to other men?
Yes 1
No 2
Don't know 8
b) He frequently (accuses/accused) you of being unfaithful?
Yes 1
No 2
Don't know 8
c) He (does/did) not permit you to meet your female friends?
Yes 1
No 2
Don't know 8
d) He (tries/tried) to limit your contact with your family?
Yes 1
No 2
Don't know 8
e) He (insists/insisted) on knowing where you (are/where) at all times?
Yes 1
No 2
Don't know 8

1504) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.
a) (Does/did) your (last) (husband/partner) ever:
b) How often did this happen during the last 12 months: often, only sometimes, or not in the last 12 months?

a) Ever say or do something to humiliate you in front of others?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
b) Ever threaten to hurt or harm you or someone you care about?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
c) Ever insult you or make you feel bad about yourself?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3

1505) a) Did your (last) (husband/partner) ever do any of the following things to you:
b) How often did this happen during the last 12 months: often, only sometimes, or not in the last 12 months?

a) Ever push you, shake you, or throw something at you?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
b) Ever slap you?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
c) Ever twist your arm or pull your hair?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3

d) Ever punch you with his fist or with something that could hurt you?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
e) Ever kick you, drag you, or beat you up?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
f) Ever intentionally try to chock you or burn you?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
g) Ever threaten you with a knife, gun, or other type of weapon?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
h) Ever physically force you to have sexual intercourse with him even when you did not want to?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
i) Ever physically force you to perform other sexual acts you did not want to?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3
j) Ever force you with threats or in any other way to perform sexual acts you did not want to?
Yes 1
No 2
Often 1
Sometimes 2
Not in the last 12 months 3

1506) Check 1505A (a-j):

At least one yes
Not a single yes-skip to 1509

1507) How long after you (first got married to/started living with) your (last) (husband/partner) did this or any of these things first happen?
If less than one year, record 00.

Number of years
Before marriage/before living together 95

1508) Did the following ever happen as a result of what your (last) (husband/partner), did to you:

a) You had cuts, bruises, or aches?
Yes 1
No 2
b) you had eye injuries, sprains, dislocations, or burns?
Yes 1
No 2
c) you had deep wounds, broken bones, broken teeth, or any other serious injury?
Yes 1
No 2

1509) Have you ever hit, slapped, kicked or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

Yes 1
No 2-skip to 1511

1510) In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

Often 1
Sometimes 2
Not at all 3

1511) Does (did) your (husband/partner) drink alcohol?

Yes 1
No 2 -skip to 1513

1512) How often does (did) he get drunk: often, only sometimes, or never?

Often 1
Sometimes 2
Never 3

1513) Are (were) you afraid of your (last) (husband/partner): many times, sometimes, or never?

Many times afraid 1
Sometimes afraid 2
Never afraid 3

1514) Check 709:

Married more than once
Married only once-skip to 1516

1515) a) So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

b) How long ago did this last happen?

a) Did any previous (husband/partner) ever hit, slap, kick or do anything else to hurt you physically?

Ever
Yes 1
No 2
0-11 months ago
Yes 1
No 2
12 or more months ago
Yes 1
No 2
Don’t remember
Yes 1
No 2

b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?

Ever
Yes 1
No 2
0-11 months ago
Yes 1
No 2
12 or more months ago
Yes 1
No 2
Don’t remember
Yes 1
No 2

c) Did any previous (husband/partner) humiliate you in front of others, threaten to hurt or harm you or someone you care about, insult you or make you feel bad about yourself?

Ever
Yes 1
No 2
0-11 months ago
Yes 1
No 2
12 or more months ago
Yes 1
No 2
Don’t remember
Yes 1
No 2

1516) Check 701 and 702:
Ever married/ever lived with a man:
From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?

Never married/never lived with a man:
From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

Yes 1
No 2-skip to 1519
Refused to answer/no answer 6-skip to 1519

1517) Who has physically hurt you in this way?
Anyone else?
Record all mentioned

Mother/father’s wife A
Father/Mother’s husband B
Sister/Brother C
Daughter/Son D
Other relative E
Current boyfriend F
Ex-boyfriend G
Mother-in-law H
Father-in-law I
Other in-laws J
Teacher K
Employer/someone at work L
Police/soldier M

Other (specify) X

1518) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

Often 1
Sometimes 2
Not at all 3

1519) Check 201, 226, and 230:

Ever been pregnant (yes to 201 or 226 or 230)
Never been pregnant-skip to 1522

1520) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

Yes 1
No 2 -skip to 1522

1521) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
Record all mentioned

Current husband/partner A
Mother/Step-mother B
Father/Step-father C
Sister/Brother D
Daughter/Son E
Other relative F
Former husband/partner G
Current boyfriend H
Ex-boyfriend I
Mother-in-law J
Father-in-law K
Other in-laws L
Teacher M
Employer/someone at work N
Police/soldier O

Other (specify) X

1522) Check 701 and 702:

Ever married/ever lived with a man
Never married/never lived with a man-skip to 1522b

1522a) Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner).

At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

Yes 1-skip to 1523
No 2-skip to 1524a
Refused to answer/no answer 3-skip to 1524a

1522b) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

Yes 1
No 2-skip to 1526
Refused to answer/no answer 3-skip to 1526

1523) Who was the person who was forcing you the first time?

Current husband/partner 01
Former husband/ partner 02
Current/former boyfriend 03
Father/Step-Father 04
Brother/step-brother 05
Other relative 06
In-law 07
Own friend/acquaintance 08
Family friend 09
Teacher 10
Employer/someone at work 11
Police/soldier 12
Priest/religious leader 13
Stranger 14

Other (specify) 96

1524) Check 701 and 702:
Ever married/ever lived with a man: In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?

Never married/never lived with a man: In the last 12 months, has anyone physically forced you to have sexual intercourse when you did not want to?

Yes 1-skip to 1525
No 2-skip to 1525

1524a) Check 1505a (h-j) and 1515a(b):

At least one yes
Not a single yes-skip to 1526

1525) Check 701 and 702:
Ever married/ever lived with a man: How old were you the first time someone including (your/any) (husband/partner) forced you to have sexual intercourse or perform any other sexual?

Never married/never lived with a man: How old were you the first time someone forced you to have sexual intercourse or perform any other sexual acts?

Age in completed years
Don’t know 98

1526) Check 1505 (a-j), 1515 (a,b), 1516, 1520, 1522a, and 1522b:

At least one yes
Not a single yes-skip to 1530

1527) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

Yes 1
No 2-skip to 1529

1528) From whom have you sought help?
Anyone else?
Record all mentioned.

Own family A
Husband’s/partner’s family B
Current/former husband/partner C
Current/former boyfriend D
Friend E
Neighbor F
Religious leader G
Doctor/medical personnel H
Police I
Lawyer J
Social service organization K
NGO L

Other (specify) X
All skip to 1530

1529) Have you ever told anyone about this?

Yes 1
No 2

1530) As far as you know, did your father ever beat your mother?

Yes 1
No 2
Don’t know 8

Thank the respondent for her cooperation and reassure her about the confidentiality of her answers. Fill out the questions below with reference to the domestic violence module only.

1531) Did you have to interrupt the interview because some adult was trying to listen, or came into the room, or interfered in any other way?

Husband
Yes once 1
Yes, more than once 2
No 3
Other male adult
Yes once 1
Yes, more than once 2
No 3
Female adult
Yes once 1
Yes, more than once 2
No 3

1532) Interviewer’s comments/explanation for not completing the domestic violence module

1533) Record the time

Hours____
Minutes____

Interviewer’s observations
To be filled in after completing interview

Comments about respondent:

Comments on specific questions:

Any other comments:

Supervisor’s observations

Editor’s observations

Instructions:
Only one code should appear in any box
Column 1 requires a code in every month.

Information to be coded for each column.

Column 1: Births, Pregnancies, Contraceptive Use
B Birth
P Pregnancies
T Terminations

0 No method
1 Female sterilization
2 Male sterilization
3 IUD
4 Injectables
5 Implants
6 Pill
7 Condom
8 Female condom
9 Emergency contraception
J Standard Days Method
K Lactational Amenorrhea Method
L Rhythm method

M Withdrawal
X Other modern method
Y Other traditional method

Column 2: Discontinuation of contraceptive use
0 Infrequent sex/husband away
1 Became pregnant while using
2 Wanted to become pregnant
3 Husband/partner disapproved
4 Wanted more effective method
5 Side effects/health concerns

6 Lack of access/too far
7 Costs too much
8 Inconvenient to use
F Up to God/Fatalist
A Difficult to get pregnant/menopausal
D Marital dissolution/separation
X Other (specify)
Z Don’t know

Column 1 Column 2

2017 (1)
12 Dec 01
11 Nov 02
10 Oct 03
09 Sept 04
08 Aug 05
07 Jul 06
06 Jun 07
05 May 08
04 Apr 09
03 Mar 10
02 Feb 11
01 Jan 12

2016
12 Dec 13
11 Nov 14
10 Oct 15
09 Sept 16
08 Aug 17
07 Jul 18
06 Jun 19
05 May 20
04 Apr 21
03 Mar 22
02 Feb 23
01 Jan 24

2015
12 Dec 25
11 Nov 26
10 Oct 27
09 Sept 28
08 Aug 29
07 Jul 30
06 Jun 31
05 May 32
04 Apr 33
03 Mar 34
02 Feb 35
01 Jan 36

2014
12 Dec 37
11 Nov 38
10 Oct 39
09 Sept 40
08 Aug 41
07 Jul 42
06 Jun 43
05 May 44
04 Apr 45
03 Mar 46
02 Feb 47
01 Jan 48

2013
12 Dec 49
11 Nov 50
10 Oct 51
09 Sept 52
08 Aug 53
07 Jul 54
06 Jun 55
05 May 56
04 Apr 57
03 Mar 58
02 Feb 59
01 Jan 60

2012
12 Dec 61
11 Nov 62
10 Oct 63
09 Sept 64
08 Aug 65
07 Jul 66
06 Jun 67
05 May 68
04 Apr 69
03 Mar 70
02 Feb 71
01 Jan 72