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DEMOGRAPHIC AND HEALTH SURVEY
INDIVIDUAL WOMAN'S SURVEY

Ministry of Territory Planning and Development
Republic of Cameroon
Peace-Work-Country

Confidential

IDENTIFICATION

PROVINCE__________
DEPARTMENT __________
URBAN DISTRICT/DISTRICT __________
CITY/COUNTY/GROUP __________
VILLAGE __________
NEIGHBORHOOD/TOWN __________
NAME OF HEAD OF HOUSEHOLD __________
WOMAN'S NAME________

PROVINCE ____
NUMBER OF LAYER _______
URBAN DISTRICT/DISTRICT _________
CLUSTER __________
STRUCTURE _________
HOUSEHOLD ________
WOMAN'S LINE NUMBER _________
NUMBER OF COUNTING ZONE ________

INTERVIEWER VISITS:

INTERVIEWER 1
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___

RESULTS___

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY): ___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__

RESULT__

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY): ___

LANGUAGE OF INTERVIEW

FRENCH 1
ENGLISH 2
FULFULDE 3
EWONDO 4
PIDGIN 5
OTHER 6

INTERPRETER

YES 1
NO 2

SUPERVISOR
NAME ___
DATE ___

FIELD EDITOR
NAME ___
DATE ___

OFFICE EDITOR ___

KEYED BY ___

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

101) RECORD TIME:

HOURS: ___
MINUTES: ___

102) First I would like to ask you some questions about you and your household. For most of the time until you were 12 years old, did you live in Yaounde/Douala or another capital, in another city, or in the countryside?

YAOUNDE/DOUALA/ANOTHER CAPITAL 1
OTHER CITY 2
COUNTRYSIDE 3

103) How long has you been living in (name of current place of residence)?

SINCE BIRTH 95(GO TO 105)
VISITOR 96 (GO TO 105)
YEARS: ___

104) Just before you moved here, did you live in Yaounde/Douala or another capital, in another city, or in the countryside?

YAOUNDE/DOUALA/OTHER CAPITAL 1
OTHER CITY 2
COUNTRYSIDE 3

105) What is your date of birth?

MONTH: ___
DON'T KNOW MONTH 98
YEAR: __
DON'T KNOW YEAR 98

106) How old are you?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT

AGE IN COMPLETED YEARS: ___

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108) What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3

109) What is the highest (grade/form/year) you completed at this level?

CODES BASED OFF OF DIFFERENT EDUCATION SYSTEMS

GRADE: ___

ALL LEVELS

0 LESS THAN ONE YEAR
8 DON'T KNOW

FOR POST-SECONDARY: SEE THE INSTRUCTION MANUAL

PRIMARY
ANGLOPHONE/FRANCOPHONE

INFANT/CLASS ONE/SIL 1
STANDARD ONE/CLASS TWO/CP 2
STANDARD TWO/CLASS THREE/CE1 3
STANDARD THREE/CLASS FOUR/CE2 4
STANDARD FOUR/CLASS FIVE/CM1 5
STANDARD FIVE/CLASS SIX/CM2 6
STANDARD SIX/CLASS SEVEN 7

SECONDARY
ANGLOPHONE/FRANCOPHONE

FORM 1/SIXTH/1ST YEAR 1
FORM 2/FIFTH/2ND YEAR 2
FORM 3/FOURTH/3RD YEAR 3
FORM 4/THIRD/4TH YEAR 4
FORM 5/SECOND 5
LOWER SIXTH FORM/FIRST 6
UPPER SIXTH FORM/FINAL YEAR 7

110) CHECK 108:

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

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3

112) Do you typically listen to the radio at least once a week?

YES 1
NO 2 (GO TO 114)

113) Do you usually listen to radio shows on the advancement of women or on health?
IF YES: Which ones?

RECORD ALL RESPONSES MENTIONED.

BETWEEN US WOMEN A
CALLING THE WOMEN B
HEALTH FOR EVERYONE C
MEDICAL HOTLINE D
OTHER HEALTH/WOMEN'S SHOWS E
OTHER SHOWS F
NO HEALTH/WOMEN'S SHOWS G
DON'T KNOW H

114) Do you usually watch television at least once a week?

YES 1
NO 2 (GO TO 116)

115) On the television, do you typically watch:

Screen Pavilion?
Health Watch?
All Fire All Women?
Feminine Line?
Gestures That Save?

SCREEN PAVILION
YES 1
NO 2
HEALTH WATCH
YES 1
NO 2
ALL FIRE ALL WOMEN
YES 1
NO 2
FEMININE LINE
YES 1
NO 2
GESTURES THAT SAVE
YES 1
NO 2

116) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY): ___ 4
NONE 5

117) What is your nationality?

CAMEROONIAN 1
OTHER AFRICAN 2
OTHER 3

118) CHECK 4 IN THE HOUSEHOLD QUESTIONNAIRE:

THE WOMAN BEING INTERVIEWED IS NOT A RESIDENT ('NO' TO 4 IN THE HOUSEHOLD QUESTIONNAIRE: ___

THE WOMAN BEING INTERVIEWED IS A RESIDENT ('YES' TO 4 IN THE HOUSEHOLD QUESTIONNAIRE) (GO TO 201)

119) Do you usually live in Yaounde/Douala, in another capital, in another city, or in the country?

YAOUNDE/DOUALA/OTHER CAPITAL 1
OTHER CITY 2
COUNTRY 3

120) Now I would like to ask you about the household in which you usually live. What is the source of water your household uses to wash the dishes, to wash clothes, and to bathe?

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 122)
PIPED INTO YARD 12 (GO TO 122)
PIPED INTO NEIGHBOR'S YARD 13
PUBLIC TAP 14
WELL WATER
MANUAL PUMP WELL 21
WELL WITHOUT PUMP 22
SURFACE WATER
RIVER/BACKWATER/MARSHLAND/UNPROTECTED SPRING 31
RAINWATER 41
OTHER (SPECIFY): ___ 51

121) How long does it take to go there, get water, and come back?

IF 90 MINUTES OR LESS, RECORD THE MINUTES. IN OTHER CASES, RECORD IN HOURS.

MINUTES: ___ 1
HOURS: ___ 2
ON THE PREMISES 996

122) Does your household get drinking water from this same source?

YES 1 (GO TO 125)
NO 2

123) What is the source of drinking water for members of your household?

PIPED WATER
PIPED INTO DWELLING 11 (GO TO 125)
PIPED INTO YARD 12 (GO TO 125)
PIPED INTO NEIGHBOR'S YARD 13
PUBLIC TAP 14
WELL WATER
MANUAL PUMP WELL 21
WELL WITHOUT PUMP 22
SURFACE WATER
RIVER/BACKWATER/MARSHLAND/UNPROTECTED SPRING 31
RAINWATER 41
OTHER (SPECIFY): ___ 51

124) How long does it take to go there, get water, and come back?

IF 90 MINUTES OR LESS, RECORD IN MINUTES. IN OTHER CASES, RECORD IN HOURS.

MINUTES: ___ 1
HOURS: ___ 1
ON THE PREMISES 996

125) What kind of toilet facility does your household have?

FLUSH TOILET 11
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD
OUTSIDE 31
RIVER 32
NO TOILET 33
OTHER (SPECIFY): ___ 41

126) Does your household have:
Electricity?
A radio?
A television?
A refrigerator?
A gas or electric stove?
A gas ring or hotplate?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
GAS OR ELECTRIC STOVE
YES 1
NO 2
GAS RING OR HOTPLATE
YES 1
NO 2

127) How many rooms in your household are used for sleeping?

ROOMS: ___

128) How many people sleep in the room that sleeps the most people?

NO. OF PEOPLE: ___

129) Could you describe the main material of the floor in your home?

Is it mainly: Earth? Wood? Cement? Tile?

NATURAL FLOORING: EARTH 11
BASIC FLOORING: WOOD 21
FINISHED FLOORING
CEMENT 31
TILE 32
OTHER (SPECIFY): ___ 41

130) Does any member of your household own:
A bicycle?
A motorcycle?
A car?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO 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 (GO TO 204)

203) How many sons live with you?
How many daughters live with you?

IF NONE, RECORD '00'.

SONS AT HOME: ___
DAUGHTERS AT HOME: ___

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

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you?
How many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

SONS ELSEWHERE: ___
DAUGHTERS ELSEWHERE: ___

206) Have you ever given birth to a boy or a girl who was born alive but later died?

IF NO, PROBE: Any child cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

207) How many boys have died? And how many girls have died?

IF NONE, RECORD '00'.

BOYS DEAD: ___
GIRLS DEAD: ___

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

TOTAL: ___

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

YES: ___
NO: ___ (PROBE AND CORRECT 201-209 IF NECESSARY, THEN PROCEED TO 210)

210) In addition, have you had any pregnancies that did not lead to the birth of a live baby?

YES 1
NO 2 (GO TO 212)

211) How many pregnancies have you had that did not lead to the birth of a live baby?

NUMBER: ___

212) CHECK 208:

ONE OR MORE BIRTHS: ___
NO BIRTHS: ___ (GO TO 225)

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

RECORD IN 214 THE NAMES OF ALL THE BIRTHS. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

214) What name was given to your (first, next) child?

(214-222 IN TABLE FORMAT, SPACE FOR EACH CHILD)

NAME: ___

215) ASK THE RESPONDENT IF ONE OF HER BIRTHS WAS A MULTIPLE AND RECORD THE TYPE OF BIRTH: SINGLE OR MULTIPLE.

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

217) In what month and what year was (NAME) born?

PROBE: What is his/her birthday? OR: In what season was he/she born?

MONTH: ___
YEAR: ___

218) Is (NAME) still alive?

YES 1
NO 2 (GO TO 222)

219) IF ALIVE: How old was (NAME) at his/her last birthday?

RECORD THE AGE IN COMPLETED YEARS.

AGE IN YEARS: ___

220) IF ALIVE: Does (NAME) live with you?

YES 1 (GO TO NEXT BIRTH)
NO 2

221) IF LESS THAN 15 YEARS OF AGE: With whom does he/she live?
(IF 15 +: GO TO THE NEXT BIRTH)

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

222) IF DEAD: How old was he/she when he/she died?

IF "1 YEAR," PROBE: How many months old was (NAME)?

RECORD IN:
DAYS IF LESS THAN ONE MONTH
MONTHS IF LESS THAN 2 YEARS
YEARS IF 2 YEARS OR OLDER
IF DECEASED ON DAY OF BIRTH, RECORD '00' DAYS.

DAYS: ___ 1
MONTHS: ___ 2
YEARS: ___ 3

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

NUMBERS ARE SAME: ___
VERIFY
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED
FOR EACH DECEASED CHILD: AGE AT DEATH IS RECORDED
FOR AGE OF DEATH AT 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS
NUMBERS ARE DIFFERENT: ___ (PROBE AND RECONCILE)

224) CHECK 217 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1986.
IF NONE, RECORD '00'.

_______

225) Are you pregnant now?

YES 1
NO 2 (GO TO 228)
NOT SURE (GO TO 228)

226) How many months pregnant are you?

MONTHS: ___

227) At the time you became pregnant:
Did you want to become pregnant then?
Did you want to wait until later?
Or did you not want to become pregnant at all?

AT THAT TIME 1 (GO TO 231)
LATER 2 (GO TO 231)
DID NOT WANT 3 (GO TO 231)

228) Do you have your period at this time?

YES 1
NO 2 (GO TO 230)
NEVER HAD PERIOD 3 (GO TO 232)
MENOPAUSAL 4 (GO TO 231)

229) How many days ago did your period start?

DAYS: ___ (GO TO 231)

230) When did your last menstrual period start?

TIME IN:

DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
YEARS: ___ 4
BEFORE THE LAST BIRTH 994
NEVER MENSTRUATED 995 (GO TO 232)
IN MENOPAUSE 996

231) At what age did you have your first period?

AGE IN YEARS: ___
DON'T KNOW 98

232) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

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

233) During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF HER CYCLE 3
JUST BEFORE THE BEGINNING OF HER PERIOD 4
NOT IMPORTANT WHEN 5
OTHER (SPECIFY): ___ 6
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. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN READING THE NAME AND THE DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 2 IF THE WOMAN HAS HEARD OF IT AND CODE 3 IF SHE HAS NOT HEARD OF THE METHOD.

THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-305 BEFORE CONTINUING TO THE NEXT METHOD.

302) Which methods of contraception have you heard about?

01. Pill: Women can take a pill every day.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
03. Injectables: Women can have an injection by a health provider which stops them from becoming pregnant for several months.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
04. Diaphragm/foam/jelly: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
05. Condom (rubber): Men can put a rubber sheath on their penis during sexual intercourse.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
06. Female Sterilization: Women can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
07. Male Sterilization: Men can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
08. Rhythm method/periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant; it is called the Ogino method.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
09. Abstinence: Outside of the cessation of sexual relations traditionally observed after giving birth, some couples avoid having sexual intercourse for months so that the woman doesn't become pregnant.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
10. Withdrawal: Men can be careful and pull out before climax.
YES/SPONTANEOUS 1
YES/DESCRIPTION 2
NO 3
11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES/SPONTANEOUS (SPECIFY) 1
SPECIFY METHOD ONE: ___
SPECIFY METHOD TWO: ___
SPECIFY METHOD THREE: ___
NO 3

303) Have you ever used (METHOD)?

01. Pill: Women can take a pill every day.
YES 1
NO 2
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. Injectables: Women can have an injection by a health provider which stops them from becoming pregnant for several months.
YES 1
NO 2
04. Diaphragm/foam/jelly: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
05. Condom (rubber): Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
06. Female Sterilization: Women can have an operation to avoid having any more children.

Have you had an operation to avoid having any more children?
YES 1
NO 2
07. Male Sterilization: Men can have an operation to avoid having any more children.

Has your husband /partner had an operation to avoid having any more children?
YES 1
NO 2
08. Rhythm method/periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant; it is called the Ogino method.
YES 1
NO 2
09. Abstinence: Outside of the cessation of sexual relations traditionally observed after giving birth, some couples avoid having sexual intercourse for months so that the woman doesn't become pregnant.
YES 1
NO 2
10. Withdrawal: Men can be careful and pull out before climax.
YES 1
NO 2
11. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES (SPECIFY) 1
SPECIFY METHOD ONE: ___
SPECIFY METHOD TWO: ___
SPECIFY METHOD THREE: ___
NO 3

304) Do you know where a person could go to get (METHOD)?

01. Pill: Women can take a pill every day.
YES 1
NO 2
02. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03. Injectables: Women can have an injection by a health provider which stops them from becoming pregnant for several months.
YES 1
NO 2
04. Diaphragm/foam/jelly: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
05. Condom (rubber): Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
06. Female Sterilization: Do you know where one can go to have an operation to avoid having other children?
YES 1
NO 2
07. Male Sterilization: Do you know where a man can go to undergo an operation to avoid having other children?
YES 1
NO 2
08. Rhythm method/periodic abstinence: Do you know where one can obtain advice on how to use periodic abstinence?
YES 1
NO 2

305) CHECK 303

NOT A SINGLE "YES" (NEVER USED): ___
AT LEAST ONE "YES" (USED): ___ (GO TO 308)

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

YES 1
NO 2 (GO TO 326)

307) What have you used or done?

CORRECT 303-305 (AND 302 IF NECESSARY)

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

How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

NUMBER OF CHILDREN: ___

309) CHECK 225:

NOT PREGNANT OR NOT SURE: ___
PREGNANT: ___ (GO TO 326)

310) CHECK 303:

WOMAN NOT STERILIZED: ___
WOMAN STERILIZED: ___ (GO TO 312A)

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

YES 1
NO 2 (GO TO 326)

312) Which method are you using?

312A) CIRCLE '06' FOR FEMALE STERILIZATION.

PILL 01 (GO TO 314)
IUD 02 (GO TO 319)
INJECTIONS 03 (GO TO 319)
DIAPHRAGM/SPONGE/GEL 04 (GO TO 319)
CONDOM 05 (GO TO 319)
FEMALE STERILIZATION 06 (GO TO 319)
MALE STERILIZATION 07 (GO TO 319)
PERIODIC ABSTINENCE 08
ABSTINENCE 09 (GO TO 325)
WITHDRAWAL 10 (GO TO 325)
OTHER (SPECIFY): ___ 11 (GO TO 325)

313) The last time you used the periodic abstinence method, how did you determine the days when you had to avoid having sexual relations?

CALCULATING THE DAYS/CALENDAR 1 (GO TO 325)
BODY TEMPERATURE 2 (GO TO 325)
CERVICAL MUCUS METHOD (BILLINGS) 3 (GO TO 325)
BODY TEMPERATURE AND MUCUS 4 (GO TO 325)
OTHER (SPECIFY): ___ (GO TO 325)

314) At the time you started using the pill for the first time, did you consult a doctor, a midwife, or a nurse?

YES 1
NO 2
DK 8

315) At the time you last got pills, did you consult a doctor, a midwife, or a nurse?

YES 1
NO 2

316) May I see the package of pills that you are using now?

(RECORD NAME OF BRAND)

PACKAGE SEEN 1 (go to 318)
BRAND NAME: ___ (go to 318)
PACKAGE NOT SEEN 2

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

(RECORD NAME OF BRAND)

BRAND NAME: ___
DON'T KNOW NAME OF PILLS 98

318) How much does one packet of pills cost you?

(RECORD THE PRICE)

PRICE: ___
FREE 9996
DON'T KNOW 9998

318a) How many months do you use this box of pills?

(RECORD NUMBER OF CYCLES)

NUMBER OF CYCLES: ___

319) CHECK 312:

IF SHE/HE IS STERILIZED:
Is it easy or difficult to get sterilized?

IF USING ANOTHER METHOD:
Is it easy or difficult to obtain (method)?

EASY 1
DIFFICULT 2

320) CHECK 312:

IF SHE/HE IS STERILIZED:
Where did the sterilization take place?/Where did your husband/spouse's sterilization take place?

IF USING ANOTHER METHOD:
Where did you obtain (method) the last time?

NAME OF PLACE: ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH POST 12
PUBLIC HEALTH CENTER 13
MOBILE CLINIC 14
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL 21
PRIVATE SECULAR HOSPITAL 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
PHARMACY 24
OTHER PRIVATE SECTOR
CHURCH 31 (GO TO 323)
ACQUAINTANCES/RELATIVES 32 (GO TO 323)
OTHER (SPECIFY): ___ 41 (GO TO 323)
DK 98 (GO TO 323)

321) How long does it take you to travel from your home to (NAME OF LOCATION)?

IF 90 MINUTES OR LESS, RECORD IN MINUTES. IN OTHER CASES, RECORD IN HOURS, OR IN DAYS.

MINUTES: ___ 1
HOURS: ___ 2
DAYS: ___ 3
DK 998

322) Is it easy or difficult to get to (NAME OF LOCATION)?

EASY 1
DIFFICULT 2

323) CHECK 312:

SHE/HE IS STERILIZED: ___
USING ANOTHER METHOD: ___ (GO TO 325)

324) In what month and what year did you (did he) get sterilized?

MONTH: ___ (GO TO 337)
YEAR: ___ (GO TO 337)

325) For how many months have you used (CURRENT METHOD) continuously?

IF LESS THAN ONE MONTH, RECORD '00'.

MONTHS: ___ (GO TO 337)
8 YEARS OR MORE 96 (GO TO 337)

326) Do you intend to use a method to avoid becoming pregnant in the future?

YES 1
NO 2 (GO TO 330)
DK 8 (GO TO 333)

327) Which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/GEL 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
RHYTHM METHOD 08
ABSTINENCE 09
WITHDRAWAL 10
OTHER (SPECIFY): ___ 11
DK 98

328) When do you plan to start using (PREFERRED METHOD)?

IF 1 MONTH OR MORE, RECORD THE NUMBER OF MONTHS.
IF NOT, CIRCLE THE APPROPRIATE CODE.

MONTHS: ___
LESS THAN A MONTH 96 (GO TO 331)
DK 98 (GO TO 331)

329) Why don't you use (PREFERRED METHOD) starting right now?

PREGNANT 01 (GO TO 331)
AMENORRHEA/NURSING 02 (GO TO 331)
SPOUSE DISAPPROVES 03 (GO TO 331)
WANTS CHILDREN 04 (GO TO 331)
COSTS TOO MUCH 05 (GO TO 331)
HEALTH CONCERNS 06 (GO TO 331)
DIFFICULT TO OBTAIN METHOD 07 (GO TO 331)
FAMILY DISAPPROVES 08 (GO TO 331)
INFREQUENT SEX 09 (GO TO 331)
NOT MARRIED 10 (GO TO 331)
OTHER (SPECIFY): ___ 11 (GO TO 331)
DK 98 (GO TO 331)

330) What is that main reason you do not intend to use a method?

WANTS CHILDREN 01
LACK OF KNOWLEDGE 02
PARTNER OPPOSES 03
COSTS TOO MUCH 04
SIDE EFFECTS 05
HEALTH CONCERNS 06
DIFFICULT TO OBTAIN METHOD 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALIST/IT'S UP TO GOD 10
FAMILY DISAPPROVES 11
INFREQUENT SEX 12
DIFFICULT TO GET PREGNANT 13
MENOPAUSAL/STERILIZATION 14
INCONVENIENT 15
NOT MARRIED 16
OTHER (SPECIFY): ___ 17
DK 98

331) CHECK 327 FOR THE PREFERRED METHOD

CODES 1-7 CIRCLED: ___
327 NOT ASKED: ___ (GO TO 333)
CODES 8-11 OR 98 CIRCLED: ___ (GO TO 333)

332) Where can you obtain (METHOD LISTED ON 327) most easily?

NAME OF LOCATION: ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 335)
GOVERNMENT HEALTH CENTER 12 (GO TO 335)
GOVERNMENT HEALTH POST 13 (GO TO 335)
MOBILE CLINIC 14 (GO TO 335)
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL 21 (GO TO 335)
PRIVATE SECULAR HOSPITAL 22 (GO TO 335)
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23 (GO TO 335)
PHARMACY 24 (GO TO 335)
OTHER PRIVATE SECTOR
CHURCH 31 (GO TO 337)
ACQUAINTANCES/RELATIVES 32 (GO TO 337)
OTHER (SPECIFY): ___ 41 (GO TO 337)
DK 98 (GO TO 337)

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

YES 1
NO 2 (G TO 337)

334) Where is that?

NAME OF PLACE: ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
MOBILE CLINIC 14
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL 21
PRIVATE SECULAR HOSPITAL 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
PHARMACY 24
OTHER PRIVATE SECTOR
CHURCH 31 (GO TO 337)
ACQUAINTANCES/RELATIVES 32 (GO TO 337)
OTHER (SPECIFY): ___ 41 (GO TO 337)

335) How long does it take to travel from your home to (NAME OF LOCATION)?

IF 90 MINUTES OR LESS, RECORD MINUTES.
IN OTHER CASES, RECORD IN HOURS, OR IN DAYS.

MINUTES: ___ 1
HOURS: ___ 2
DAYS: ___ 3
DK 998

336) Is it easy or difficult to get to (NAME OF LOCATION)?

EASY 1
DIFFICULT 2

337) In the last month, have you heard or read a message about family planning:
On the radio?
On television?
In a newspaper/magazine or on a poster?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER/MAGAZINE/POSTER
YES 1
NO 2

338) Are you for or against family planning information being provided on the radio or on television?

FOR/GOOD 1
AGAINST/BAD 2
DK 8

SECTION 4.A. PREGNANCY AND BREASTFEEDING

401) CHECK 224:

ONE OR MORE BIRTHS SINCE JAN. 1986: ___
NO BIRTHS SINCE JAN. 1986: ___ (GO TO 601)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1986 ON THE TABLE.

ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN THREE BIRTHS, USE ADDITIONAL FORMS)

Now I would like to ask you some more questions about the health of all your children born in the past five years. We'll start with the last birth you had.

LINE NUMBER FROM 214: ___

CHECK 214 AND 218:

NAME: ___

LIVING: ___
DECEASED: ___

403) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait for later, or did you want no children at all?

THEN 1 (GO TO 405)
LATER 2
NO MORE 3 (GO TO 405)

404) How much longer would you like to have waited?

MONTHS: ___ 1
YEARS: ___ 2
DK 998

405) When you were pregnant with (NAME), did you see anyone for prenatal care for this pregnancy?

If yes, whom did you see? Anyone else?

INSIST ON THE TYPE OF PERSON AND RECORD ALL THE PEOPLE SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY): ___ E

NO/NO ONE F (GO TO 409)

406) Were you given a prenatal card for this pregnancy?

IF YES: Can I see it, please?

YES, SAW IT 1
YES, DID NOT SEE IT 2
NO, NO HEALTH RECORD 3
DK 8

407) How many months pregnant were you when you first saw someone for a prenatal check on this pregnancy?

CHECK THE PRENATAL CARD

MONTHS: ___
DK 98

408) How many prenatal visits did you have during your pregnancy?

CHECK THE PRENATAL CARD

NO. OF VISITS: ___
DK 98

409) When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

CHECK THE PRENATAL CARD

YES 1
NO 2 (GO TO 411)
DK 8 (GO TO 411)

410) During your pregnancy how many times did you get this injection?

CHECK THE PRENATAL CARD

NUMBER: ___
DK 8

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

AT HOME 11
PUBLIC SECTOR
MATERNITY HOSPITAL 21
PUBLIC HOSPITAL 22
PUBLIC HEALTH CENTER 23
PRIVATE SECTOR
PRIVATE RELIGIOUS HOSPITAL 21
PRIVATE SECULAR HOSPITAL 22
MISSIONARY CLINIC 23
OTHER (SPECIFY): ___ 41

412) Who assisted with the delivery of (NAME)?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE E
OTHER (SPECIFY): ___ F
NO ONE G

413) Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DK 8

414) How many months pregnant were you when you gave birth?

NUMBER OF MONTHS: ___
DK 8

415) Was (NAME) delivered by caesarian section, meaning did they opened your stomach to take the baby out?

YES 1
NO 2

416) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418)

417) How much did (NAME) weigh?

GRAMS: ___
DK 9998

418) When (NAME) was born, was he/she:
Larger than average, average, smaller than average, or very small?

LARGER THAN AVERAGE 1
AVERAGE 2
SMALLER THAN AVERAGE 3
VERY SMALL 4
DK 8

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

YES 1 (GO TO 421)
NO 2 (GO TO 422)

420) Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 424)

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

MONTHS: ___
DK 98

422) CHECK 225: WOMAN PREGNANT?
[ASK FOR MOST RECENT BIRTH ONLY]

NOT PREGNANT: ___
PREGNANT OR NOT SURE: ___ (GO TO 424)

423) Have you resumed sexual relations since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 425)

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

MONTHS: ___
DK 98

425) Did you ever breastfeed (NAME), even for a short amount of time?

YES 1 (GO TO 427 FOR THE MOST RECENT BIRTH, GO TO 434 FOR THE OTHER BIRTHS)
NO 2

426) Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 1 (GO TO 436)
CHILD ILL/WEAK 2 (GO TO 436)
CHILD DIED 3 (GO TO 436)
NIPPLE/BREAST PROBLEM 4 (GO TO 436)
NO MILK 5 (GO TO 436)
WORKING 6 (GO TO 436)
CHILD REFUSED 7 (GO TO 436)
OTHER (SPECIFY): ___ (GO TO 436)

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

IF LESS THAN 1 HOUR, RECORD '00'.
IF LESS THAN 24 HOURS, RECORD IN HOURS.
IN OTHER CASES, RECORD DAYS.

IMMEDIATELY 000
HOURS: ___ 1
DAYS: ___ 2

428) CHECK 218: CHILD ALIVE?
[ASK FOR MOST RECENT BIRTH ONLY]

ALIVE: ___
DEAD: ___ (GO TO 434)

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

YES 1
NO 2 (GO TO 434)

430) How many times did you breastfeed last night between sunset and sunrise?
[ASK FOR MOST RECENT BIRTH ONLY]

(IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER)

NUMBER OF NIGHT TIME FEEDINGS: ___

431) How many times did you breastfeed yesterday between sunrise and sunset?
[ASK FOR MOST RECENT BIRTH ONLY]

(IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER)

NUMBER OF DAYLIGHT FEEDINGS: ___

432) At any time yesterday or last night was (NAME) given any of the following:
[ASK FOR MOST RECENT BIRTH ONLY]

Mineral water?
Water from the house?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Fresh milk?
Tinned or powdered milk?
Other liquids?
Solid or bottled food?

MINERAL WATER
YES 1
NO 2
WATER FROM THE HOUSE
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
HERBAL TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
FRESH MILK
YES 1
NO 2
TINNED OR POWDERED MILK
YES 1
NO 2
OTHER LIQUIDS
YES 1
NO 2
SOLID OR BOTTLED FOOD
YES 1
NO 2

433) CHECK 432: LIQUID OR FOOD GIVEN YESTERDAY OR LAST NIGHT?
[ASK FOR MOST RECENT BIRTH ONLY]

"YES" TO ONE OR MORE: ___ (GO TO 438)
NO "YES" ANSWERS: ___ (GO TO 437)

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

IF LESS THAN 1 MONTH, MARK '00'.

MONTHS: ___
UNTIL DEATH 95 (GO TO 437)

435) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NO MILK 05
WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
OTHER (SPECIFY): ___ 10

436) CHECK 218: CHILD ALIVE?

ALIVE: ___ (GO TO 438)
DECEASED: ___

437) Was (NAME) ever given water or anything else to drink or eat other than breast milk?

YES 1
NO 2 (GO TO 441)

438) How many months old was (NAME) when you started giving one or several of the following drinks or foods regularly:

Formula or milk other than breast milk?
Water?
Other liquids?
Solid or bottled food?

IF LESS THAN ONE MONTH, MARK '00'.

FORMULA OR MILK
AGE IN MONTHS: ___
NEVER GIVEN 96
WATER
AGE IN MONTHS: ___
NEVER GIVEN 96
OTHER LIQUIDS
AGE IN MONTHS: ___
NEVER GIVEN 96
SOLID OR BOTTLED FOOD
AGE IN MONTHS: ___
NEVER GIVEN 96

439) CHECK 218: CHILD ALIVE?
[ASK FOR MOST RECENT BIRTH ONLY]

ALIVE: ___
DECEASED: ___ (GO TO 441)

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

YES 1
NO 2
DK 8

441) According to you, how long should a woman breastfeed her child?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN 1 MONTH, RECORD '00'.

NUMBER OF MONTHS: ___
NEVER 96
DK 98

442) GO BACK TO 403 FOR NEXT BIRTH; OR IF THERE ARE NO MORE BIRTHS, GO TO 443.

SECTION 4.B. IMMUNIZATION AND HEALTH

443) ENTER LINE NUMBER, NAME AND SURVIVAL STATE OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE.
ASK EACH QUESTION ABOUT ALL OF THE BIRTHS STARTING WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN THREE BIRTHS, USE ADDITIONAL FORMS)

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

YES, SEEN 1 (GO TO 446)
YES, NOT SEEN 2 (GO TO 448)
NO CARD 3

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

YES 1 (GO TO 448)
NO 2

446)
1. COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD.

2. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

3. IF VACCINE WAS NOT GIVEN, DO NOT MARK ANYTHING.

BCG?
POLIO 1?
POLIO 2?
POLIO 3?
DPT 1?
DPT 2?
DPT 3?
Measles?
Yellow Fever?

BCG
DAY: ___
MONTH: ___
YEAR: ___
POLIO 1
DAY: ___
MONTH: ___
YEAR: ___
POLIO 2
DAY: ___
MONTH: ___
YEAR: ___
POLIO 3
DAY: ___
MONTH: ___
YEAR: ___
DPT 1
DAY: ___
MONTH: ___
YEAR: ___
DPT 2
DAY: ___
MONTH: ___
YEAR: ___
DPT 3
DAY: ___
MONTH: ___
YEAR: ___
MEASLES
DAY: ___
MONTH: ___
YEAR: ___
YELLOW FEVER
DAY: ___
MONTH: ___
YEAR: ___

447) Has (NAME) received any vaccinations that are not recorded on this card?
IF YES: which vaccine?

RECORD 'YES' ONLY IN RESPONDENT MENTIONED: BCG, POLIO, DPT, MEASLES, AND/OR YELLOW FEVER.

YES 1 (PROBE FOR TYPE OF VACCINATION AND WRITE '66' IN THE CORRESPONDING DAY COLUMN FOR 446) (GO TO 450)
NO 2 (GO TO 450)
DK 8 (GO TO 450)

448) Did (NAME) ever receive any vaccination to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 450)
DK 8 (GO TO 450)

449) Please tell me if (NAME) has received one of the following vaccines:

A vaccination of BCG, that is, an injection in the arm that caused a scar?

YES 1
NO 2
DK 8

Polio vaccine, that is, drops in the mouth?

YES 1
NO 2
DK 8

IF YES: how many times?

NUMBER OF TIMES: ___
DON'T KNOW NUMBER OF TIMES 8

A vaccine of DPT (or Dtcoq-polio), meaning a shot in the shoulder?

YES 1
NO 2
DK 8

IF YES: how many times?

NUMBER OF TIMES: ___
DON'T KNOW NUMBER OF TIMES 8

An injection against measles?

YES 1
NO 2
DK 8

A vaccine against yellow fever, meaning a shot in the shoulder?

YES 1
NO 2
DK 8

450) CHECK 218: CHILD ALIVE?

ALIVE: ___ (GO TO 452)
DECEASED: ___

451) GO BACK TO 444 FOR THE NEXT BIRTH, OR IF THERE ARE NO MORE BIRTHS, GO TO 479.

452) Has (NAME) been ill with a fever in the last 2 weeks?

YES 1
NO 2
DK 8

453) Has (NAME) been ill with a cough in the last 2 weeks?

YES 1
NO 2 (GO TO 456)
DK 8 (GO TO 456)

454) For how many days (has the cough lasted/did the cough last)?

IF LESS THAN ONE DAY, RECORD '00'.

DAYS: ___

455) When (NAME) had the illness with a cough, did he/she breath faster than usual, with short, rapid breaths?

YES 1
NO 2
DK 8

456) CHECK 452 AND 453: FEVER OR COUGH?

"YES" IN 452 OR 453: ___
OTHER: ___ (GO TO 461)

457) Did you bring (NAME) to the doctor or to see someone when he/she had the fever/cough?

YES 1 (GO TO 459)
NO 2

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

YES 1 (GO TO 459A)
NO 2 (GO TO 460)

459) Where did you bring (NAME)?

459A) Where did you get advice or a treatment for (NAME)'s fever/cough?

Anywhere else?

(CIRCLE ALL THAT ARE LISTED)

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
PRIVATE MEDICAL CENTER
PRIVATE RELIGIOUS HOSPITAL E
PRIVATE SECULAR HOSPITAL F
HEALTH CENTER/RELIGIOUS CLINIC/MISSION G
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE SECTOR
ACQUAINTANCES/RELATIVES J
TRADITIONAL PRACTITIONER K
OTHER (SPECIFY): ___ L

460) Was anything given to treat the fever/cough?

IF YES: What was it? Anything else?

(CIRCLE ALL THAT ARE LISTED)

NO TREATMENT A
INJECTION B
NIVAQUINE/FLAVOQUINE/QUINIMAX/RESOCHIN/CAMOQUIN/OTHER ANTI-MALARIAL C
ASPIRIN/ASPRO/APC D
PHENSIC E
ANTIBIOTIC SYRUP/PILL F
COUGH SYRUP G
OTHER PILL/SYRUP H
TRADITIONAL REMEDY I
OTHER (SPECIFY): ___ J

461) Has (NAME) had diarrhea in the last two weeks?

YES 1 (GO TO 463)
NO 2
DK 8

462) GO BACK TO 444 FOR THE NEXT CHILD; OR IF THERE ARE NO MORE CHILDREN, GO TO 479.

463) Has (NAME) had diarrhea in the last 24 hours?

YES 1
NO 2
DK 8

464) For how many days (has the diarrhea lasted/did the diarrhea last)?

IF LESS THAN 1 DAY, RECORD '00'.

DAYS: ___

465) Was there any blood in the stools?

YES 1
NO 2
DK 8

466) CHECK 425/429: LAST CHILD STILL BREASTFEEDING?
[ASK FOR MOST RECENT BIRTH ONLY]

YES: ___
NO: ___ (GO TO 469)

467) During (NAME)'s diarrhea, did you change the frequency of breastfeeding?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 469)

468) Did you increase the number of breastfeeds or reduce them, or did you stop completely?
[ASK FOR MOST RECENT BIRTH ONLY]

INCREASED 1
DECREASED 2
STOPPED COMPLETELY 3

469) (Aside from breast milk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DK 8

470) Did (NAME) get a liquid prepared from a special anti-diarrhea packet?

YES 1
NO 2
DK 8

471) Did (NAME) receive a liquid recommended by the health personnel and prepared at home using sugar, salt, and water for the treatment of diarrhea?

YES 1
NO 2
DK 8

472) CHECK 470 AND 471: CHILD RECEIVED LIQUID FROM PACKET (470) AND/OR RECOMMENDED LIQUID MADE AT HOME (471).

YES, RECEIVED LIQUID (PACKET/HOME): ___
NO LIQUID: ___ (GO TO 474)

473) For how many days did (NAME) get this liquid?

IF LESS THAN ONE DAY, RECORD '00'.

DAYS: ___
DK 98

474) Did he/she receive something for the diarrhea (other than this liquid)?

YES 1
NO 2 (GO TO 476)
DK 8 (GO TO 476)

475) What was given (made) to treat (NAME)'s diarrhea?
Something else?

(CIRCLE EACH THING MENTIONED)

ERCEFURLY/TYPHOMICINE/OTHER ANTIBIOTIC A
GANIDAN/COAL/IMODIUM/OTHER ANTIDIARRHEAL B
OTHER PILL OR SYRUP C
INJECTION D
IV E
RICE WATER/GUAVA TEA F
OTHER TRADITIONAL REMEDY G
OTHER (SPECIFY): ___ H

476) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 478)

477) Where did you seek advice or treatment?
Anywhere else?

(CIRCLE ALL THOSE LISTED)

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL E
PRIVATE SECULAR HOSPITAL F
HEALTH CENTER/RELIGIOUS CLINIC/MISSION G
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE SECTOR
ACQUAINTANCES/RELATIVES J
TRADITIONAL PRACTITIONER K
OTHER (SPECIFY): ___ L

478) GO BACK TO 444 FOR THE NEXT CHILD; OR, IF THERE ARE NO MORE CHILDREN, GO TO 479.

479) CHECK 470:

ORT (ORAL REHYDRATION THERAPY) SOLUTION NOT RECEIVED, 'NO' OR 'DON'T KNOW' TO 470, OR 470 NOT ASKED: ___
ORT SOLUTION RECEIVED BY CHILD, 'YES' TO 470: ___ (GO TO 483)

480) Have you heard of a special product called an ORS packet/UNICEF packet/salt packet for the treatment of diarrhea?

YES 1 (GO TO 482)
NO 2

481) Have you ever seen a packet like this before?

(SHOW PACKET)

YES 1
NO 2 (GO TO 485)

482) Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or in someone else?

(SHOW PACKET)

YES 1
NO 2 (GO TO 484)

483) How much water do you use to prepare the ORS packet/UNICEF packet/salt packet for the treatment of diarrhea?

33CL 01
1/2 LITER 02
66CL 03
1 LITER 04
1 1/2 LITER 05
2 LITERS 06
ACCORDING TO INSTRUCTIONS OF THE PACKET 07
OTHER (SPECIFY): ___ 08
DK 98

484) Where can you get an ORS packet/UNICEF packet/salt packet for the treatment of diarrhea?

PROBE: Somewhere else?

(CIRCLE ALL LOCATIONS MENTIONED)

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL E
PRIVATE SECULAR HOSPITAL E
HEALTH CENTER/RELIGIOUS CLINIC/MISSION G
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE SECTOR
ACQUAINTANCES/RELATIVES J
SHOP/MARKET K
OTHER (SPECIFY): ___ L
DK M

485) CHECK 471:

RECOMMENDED SOLUTION MADE AT HOME GIVEN TO CHILD (YES TO 471): ___ (GO TO 488)
RECOMMENDED SOLUTION MADE AT HOME NOT GIVEN OR 471 NOT ASKED: ___

486) Have you heard of a liquid recommended by health personnel and made at home with salt, sugar, and water for the treatment of diarrhea?

YES 1
NO 2 (GO TO 501)

487) Have you prepared at home a liquid recommended by health personnel with salt, sugar, and water for the treatment of diarrhea?

YES 1
NO 2 (GO TO 501)

488) Where did you learn to prepare at home the liquid recommended by health personnel with salt, sugar, and water for the treatment of diarrhea?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
MOBILE CLINIC 14
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL 21
PRIVATE SECULAR HOSPITAL 22
HEALTH CENTER/RELIGIOUS CLINIC/MISSION 23
PHARMACY 24
PRIVATE DOCTOR 25
OTHER PRIVATE SECTOR
ACQUAINTANCES/RELATIVES 31
TRADITIONAL PRACTITIONER 32
OTHER (SPECIFY): ___ 41

489) How much water do you use to prepare at home the liquid recommended by health personnel with salt, sugar and water for the treatment of diarrhea?

33 CL (SIZE OF A SMALL BEER) 01
1/2 LITER 02
66 CL (SIZE OF A LARGE BEER) 03
1 LITER (SIZE OF BOTTLE OF WINE) 04
1 1/2 LITER (SIZE OF BOTTLE OF MINERAL WATER) 05
2 LITERS 06
OTHER (SPECIFY): ___ 07
DK 98

490) How many sugar cubes do you use to prepare at home the liquid recommended by health personnel for treatment of diarrhea, when you use (QUANTITY OF WATER FROM 489)?

NUMBER OF CUBES: ___
OTHER (SPECIFY): ___ 97
DK 98

491) How many teaspoons of salt do you use at home to prepare the liquid recommended by health personnel for the treatment of diarrhea, when you use (QUANTITY OF WATER FROM 489 AND NUMBER OF SUGAR CUBES FROM 490)?

NUMBER OF TEASPOONS: ___
OTHER (SPECIFY): ___ 97
DK 98

SECTION 5. CAUSES OF DEATH

501) CHECK 214, 218, AND 224

ONE OR MORE CHILDREN DECEASED AMONG BIRTHS OCCURRING SINCE JANUARY 1986: ___
NO CHILDREN DECEASED AMONG BIRTHS OCCURRING SINCE JANUARY 1986: ___ (GO TO 601)

502) RECORD LINE NUMBER, NAME, AND THE SURVIVAL STATE OF EACH BIRTH SINCE JANUARY 1986 ON THE TABLE.

ASK THE QUESTIONS ONLY REGARDING THE DEAD CHILDREN. IF MORE THAN 3 BIRTHS SINCE JANUARY 1986, USE A 2ND QUESTIONNAIRE.

ACCORDING TO 214 AND 218:

LAST BIRTH

LINE NUMBER (FROM 214): ___
NAME: ___
LIVING: ___ (GO TO NEXT BIRTH)
DECEASED: ___

NEXT TO LAST BIRTH

LINE NUMBER (FROM 214): ___
NAME: ___
LIVING: ___ (GO TO NEXT BIRTH)
DECEASED: ___

SECOND TO LAST BIRTH

LINE NUMBER (FROM 214): ___
NAME: ___
LIVING: ___ (GO TO 601)
DECEASED: ___

Now I would like to ask you a few questions about your children who have died among the births you've had over the last five years.

503) Was the death of (NAME) caused by an accident or an illness?

IF THE WOMAN REPLIES "ACCIDENT", INSIST:
Was it an accident or an accident linked to childbirth?

ACCIDENT 1
ACCIDENT AT CHILDBIRTH/PREMATURE/DEFORMITY 2 (GO TO 505)
SICKNESS/BAD LOT 3 (GO TO 505)

504) What type of accident?

FALL 1 (GO TO 502 FOR NEXT BIRTH, IF LAST BIRTH GO TO 601)
DROWNING 2 (GO TO 502 FOR NEXT BIRTH, IF LAST BIRTH GO TO 601)
TRAFFIC ACCIDENT 3 (GO TO 502 FOR NEXT BIRTH, IF LAST BIRTH GO TO 601)
BURN 4 (GO TO 502 FOR NEXT BIRTH, IF LAST BIRTH GO TO 601)
POISONING 5 (GO TO 502 FOR NEXT BIRTH, IF LAST BIRTH GO TO 601)
OTHER (SPECIFY): ___ 6 (GO TO 502 FOR NEXT BIRTH, IF LAST BIRTH GO TO 601)
DK 8 (GO TO 502 FOR NEXT BIRTH, IF LAST BIRTH GO TO 601)

505) What is the illness that caused (NAME)'s death?

RECORD THE NAME OF THE ILLNESS LISTED BY THE RESPONDENT.

ILLNESS(ES): ___

506) During the illness that caused (NAME)'s death, did you take him/her somewhere for a consultation?

IF YES: Where did you take him/her?
Anywhere else?

RECORD ALL THE RESPONSES LISTED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL E
PRIVATE SECULAR HOSPITAL F
HEALTH CENTER/RELIGIOUS CLINIC/MISSION G
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER J
OTHER (SPECIFY): ___ K
NOWHERE L

507) Where did (NAME) die?

AT HOME 1
MEDICAL ESTABLISHMENT 2
OTHER (SPECIFY): ___ 3

508) During the first days of his/her life, was (NAME) suckling or drinking well?

YES 1 (GO TO 509)
NO 2 (GO TO 509)
DK (GO TO 509)

CHECK 502, RECORD LINE NUMBER AND THE NAME OF THE LAST BIRTH (IF DECEASED), OR THE NEXT TO LAST BIRTH (IF DECEASED), THEN ASK 509 TO 513.

509) During the illness that lead to death, did (NAME) have (SYMPTOM)?

CIRCLE THE APPROPRIATE CODE FOR EACH SYMPTOM, THEN ASK 510-513, OR GO TO THE NEXT SYMPTOM.

1. DIARRHEA
YES 1
NO 2 (GO TO 03)
DK 8 (GO TO 03)
2. DIARRHEA WITH BLOOD
YES 1
NO 2 (GO TO 03)
DK 8 (GO TO 03)
3. COUGH
YES 1
NO 2 (GO TO 04)
DK 8 (GO TO 04)
4. SHORT AND RAPID BREATHING
YES 1
NO 2 (GO TO 05)
DK 8 (GO TO 05)
5. FEVER
YES 1
NO 2 (GO TO 06)
DK 8 (GO TO 06)
6. CONVULSIONS
YES 1
NO 2 (GO TO 07)
DK 8 (GO TO 07)
7. PIMPLES ON THE BODY
YES 1
NO 2 (GO TO 08)
DK 8 (GO TO 08)
8. VERY THIN
YES 1
NO 2 (GO TO 09)
DK 8 (GO TO 09)
09. SWOLLEN LEGS AND ARMS
YES 1
NO 2 (GO TO 502 FOR NEXT DECEASED CHILD, OR IF THERE ARE NO MORE, GO TO 601)
DK 8 (GO TO 502 FOR NEXT DECEASED CHILD, OR IF THERE ARE NO MORE, GO TO 601)

510) Was the (SYMPTOM) serious?

1. DIARRHEA
YES 1
NO 2
DK 8
2. DIARRHEA WITH BLOOD
YES 1
NO 2
DK 8
3. COUGH
YES 1
NO 2
DK 8
4. SHORT AND RAPID BREATHING
YES 1
NO 2
DK 8
5. FEVER
YES 1
NO 2
DK 8
6. CONVULSIONS
YES 1
NO 2
DK 8
7. PIMPLES ON THE BODY
YES 1
NO 2
DK 8
8. VERY THIN
YES 1
NO 2
DK 8
09. SWOLLEN LEGS AND ARMS
YES 1
NO 2
DK 8

511) How much time before his/her death did (SYMPTOM) start?

RECORD THE RESPONSE WITH THE UNIT OF TIME USED BY THE RESPONDENT

1. DIARRHEA
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
2. DIARRHEA WITH BLOOD
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
3. COUGH
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
4. SHORT AND RAPID BREATHING
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
5. FEVER
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
6. CONVULSIONS
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
7. PIMPLES ON THE BODY
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
8. VERY THIN
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
09. SWOLLEN LEGS AND ARMS
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998

512) Did the (SYMPTOM) last until death?

1. DIARRHEA
YES 1 (GO TO 02)
NO 2
DK 8
2. DIARRHEA WITH BLOOD
YES 1 (GO TO 03)
NO 2
DK 8
3. COUGH
YES 1 (GO TO 04)
NO 2
DK 8
4. SHORT AND RAPID BREATHING
YES 1 (GO TO 05)
NO 2
DK 8
5. FEVER
YES 1 (GO TO 06)
NO 2
DK 8
6. CONVULSIONS
YES 1 (GO TO 07)
NO 2
DK 8
7. PIMPLES ON THE BODY
YES 1 (GO TO 08)
NO 2
DK 8
8. VERY THIN
YES 1 (GO TO 09)
NO 2
DK 8
09. SWOLLEN LEGS AND ARMS
YES 1 (GO TO 502 FOR NEXT DECEASED CHILD, OR IF THERE ARE NO MORE, GO TO 601)
NO 2
DK 8

513) How much time before death did the (SYMPTOM) stop?

RECORD THE RESPONSE WITH THE UNIT OF TIME USED BY THE RESPONDENT.

1. DIARRHEA
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
2. DIARRHEA WITH BLOOD
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
3. COUGH
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
4. SHORT AND RAPID BREATHING
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
5. FEVER
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
6. CONVULSIONS
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
7. PIMPLES ON THE BODY
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
8. VERY THIN
DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
DK 998
09. SWOLLEN LEGS AND ARMS
DAYS: ___ 1 (GO TO 502 FOR NEXT DECEASED CHILD, OR IF THERE ARE NO MORE, GO TO 601)
WEEKS: ___ 2 (GO TO 502 FOR NEXT DECEASED CHILD, OR IF THERE ARE NO MORE, GO TO 601)
MONTHS: ___ 3 (GO TO 502 FOR NEXT DECEASED CHILD, OR IF THERE ARE NO MORE, GO TO 601)
DK 998 (GO TO 502 FOR NEXT DECEASED CHILD, OR IF THERE ARE NO MORE, GO TO 601)

SECTION 6. MARRIAGE

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

YES 1
NO 2 (GO TO 611)

602) Are you now married or currently living with a man, or are you a widow, divorced, or no longer living together?

MARRIED 1
LIVING TOGETHER 2
WIDOW 3 (GO TO 607)
DIVORCED 4 (GO TO 607)
NO LONGER LIVING TOGETHER 5 (GO TO 607)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

604) Does your husband/partner have other wives besides yourself?

YES 1
NO 2 (GO TO 607)

605)How many other wives does he have?

NUMBER: ___
DK 98 (GO TO 607)

606) Are you the first, second, thirdÂ…wife?

RANK: ___

607) Have you been married or lived with a man only once, or more than once?

ONCE 1 (GO TO 609)
MORE THAN ONCE 2

608) Counting your current marriage/partnership, how many times have you been married or lived with a man?

NUMBER OF MARRIAGES/PARTNERSHIPS: ___

609) How old were you when you started living with your (first) husband/partner?

AGE: ___

610) In what month and year did you start living with your (first) husband/partner?

COMPARE AND CORRECT 609 AND/OR 610 IF INCOMPATIBLE

MONTH: ___ (GO TO 612)
DK MONTH 98 (GO TO 612)
YEAR: ___ (GO TO 612)
DK YEAR 98 (GO TO 612)

611) IF NEVER IN A UNION: Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 616)

612) Now we need some details about your sexual activity in order to get a better understanding of family planning and fertility.

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

NUMBER OF TIMES: ___

613) How many times a month do you usually have sexual relations?

NUMBER OF TIMES: ___

614) When was the last time you had sexual intercourse?

DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
YEARS: ___ 4
BEFORE LAST BIRTH 996

615) How old were you the first time you had sexual intercourse?

AGE: ___
FIRST TIME WHEN MARRIED 96

616) PRESENCE OF OTHERS AT THIS TIME:

CHILDREN UNDER 10 YEARS
YES 1
NO 2
HUSBAND/PARTNER
YES 1
NO 2
OTHER MEN
YES 1
NO 2
OTHER WOMEN
YES 1
NO 2

SECTION 7. FERTILITY PREFERENCES

701) CHECK 312:

NEITHER STERILIZED: ___
HE OR SHE STERILIZED: __ (GO TO 707)

702) CHECK 602:

CURRENTLY MARRIED OR LIVING TOGETHER (CODES '1' OR '2' CIRCLED FOR 602): ___
OTHER: ___ (GO TO 715)

703) CHECK 225:

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

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

HAVE A (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 710)
SAYS THAT SHE CAN'T GET PREGNANT (ANYMORE) 3 (GO TO 710)
UNDECIDED OR DK 4 (GO TO 710)

704) CHECK 225:

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

PREGNANT:
How long would you like to wait after the birth of the child you are expecting and the birth of another child?

MONTHS: ___ 1 (GO TO 710)
YEARS: ___ 2 (GO TO 710)
SOON/NOW 994 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT (ANYMORE) 995 (GO TO 710)
OTHER (SPECIFY): ___ 996
DK 998

705) CHECK 218 AND 225:

HAS LIVING CHILD(REN) OR IS PREGNANT

YES: ___
NO: ___ (GO TO 710)

706) CHECK 225:

PREGNANT OR UNSURE:
How old would you like your youngest child to be when your next child is born?

PREGNANT:
How old would you like the child you are expecting to be when your next child is born?

AGE OF CHILD IN YEARS: ___ (GO TO 710)
DK 98 (GO TO 710)

707) Do you regret that (you/your husband) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO 709)

708) Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 718)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 718)
SIDE EFFECTS 3 (GO TO 718)
OTHER REASON (SPECIFY): ___ 4 (GO TO 718)

709) Given your present circumstances, if you had to do it over again, do you think (you/your husband) would make the same decision to have an operation not to have any more children?

YES 1 (GO TO 718)
NO 2 (GO TO 718)

710) Do you think that your husband/partner approves of couples using a method to avoid pregnancy?

YES/APPROVES 1
NO/DISAPPROVES 2
DK 8

711) Have you ever spoken to your husband/partner about the methods to avoid becoming pregnant and their usage?

YES 1
NO 2 (GO TO 713)

712) How often have you talked to your husband/partner about this subject in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

713) Have you and your husband/partner ever discussed the number of children you would like to have?

YES 1
NO 2

714) Do you think your husband/partner wants to have 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
DK 8

715) How long should a couple wait before starting sexual intercourse after the birth of a baby?

MONTHS: ___ 1
YEARS: ___ 2
OTHER (SPECIFY): ___ 996

716) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations, or does it not matter?

WAIT 1
DOESN'T MATTER 2

717) Do you think that couples should use a method to delay or avoid pregnancy?

YES, APPROVE 1
NO, DISAPPROVE 2

718) CHECK 218:

HAS LIVING CHILD(REN):
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 CHILD(REN):
If you could choose exactly the number of children to have in your whole life, how many would that be?

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER: ___
OTHER ANSWER (SPECIFY): ___ (GO TO 720)

719) How many boys and how many girls?

NUMBER OF BOYS: ___
BOYS: IT'S GOD'S WILL 95

NUMBER OF GIRLS: ___
GIRLS: IT'S GOD'S WILL 95

OTHER RESPONSE (SPECIFY): ___ 96
DK 98

720) According to you, what are the main advantages of having a lot of children?

RECORD THE CODES IN THE ORDER THAT THE RESPONSES ARE GIVEN.
IF THERE IS NO 2ND AND 3RD ADVANTAGE, MARK '00'.

1ST ADVANTAGE: ___
HELP WITH THE WORK 01
FINANCIAL ASSISTANCE/AID 02
SUPPORT IN OLD AGE 03
AFFECTION/COMPANIONSHIP 04
RELIGIOUS/SOCIAL OBLIGATIONS 05
PRIDE/AFFIRMATION OF SELF 06
SOCIAL STATUS 07
POSTERITY/FAMILY NAME 08
NO ADVANTAGES 09
OTHER (SPECIFY): ____ 10
DK 98
2ND ADVANTAGE: ___
HELP WITH THE WORK 01
FINANCIAL ASSISTANCE/AID 02
SUPPORT IN OLD AGE 03
AFFECTION/COMPANIONSHIP 04
RELIGIOUS/SOCIAL OBLIGATIONS 05
PRIDE/AFFIRMATION OF SELF 06
SOCIAL STATUS 07
POSTERITY/FAMILY NAME 08
NO ADVANTAGES 09
OTHER (SPECIFY): ____ 10
DK 98
3RD ADVANTAGE: ___
HELP WITH THE WORK 01
FINANCIAL ASSISTANCE/AID 02
SUPPORT IN OLD AGE 03
AFFECTION/COMPANIONSHIP 04
RELIGIOUS/SOCIAL OBLIGATIONS 05
PRIDE/AFFIRMATION OF SELF 06
SOCIAL STATUS 07
POSTERITY/FAMILY NAME 08
NO ADVANTAGES 09
OTHER (SPECIFY): ____ 10
DK 98

721) According to you, what are the main disadvantages to having a lot of children?

RECORD THE CODES IN THE ORDER THAT THE RESPONSES ARE GIVEN.
IF THERE IS NO 2ND AND 3RD ADVANTAGE, MARK '00'.

1ST ADVANTAGE: ___
COST/FINANCIAL EXPENSES 01
PROBLEMS WITH SUPERVISION 02
PROBLEMS WITH DISCIPLINE 03
INCREASE IN WORK 04
CONSTRAINTS FOR PARENTS 05
WORRY ABOUT FUTURE 06
PROBLEMS FOR THE COUPLE'S RELATIONSHIP 07
ILLNESS/DEATH 08
NO DISADVANTAGES 09
OTHER (SPECIFY): ___ 10
2ND ADVANTAGE: ___
COST/FINANCIAL EXPENSES 01
PROBLEMS WITH SUPERVISION 02
PROBLEMS WITH DISCIPLINE 03
INCREASE IN WORK 04
CONSTRAINTS FOR PARENTS 05
WORRY ABOUT FUTURE 06
PROBLEMS FOR THE COUPLE'S RELATIONSHIP 07
ILLNESS/DEATH 08
NO DISADVANTAGES 09
OTHER (SPECIFY): ___ 10
3RD ADVANTAGE: ___
COST/FINANCIAL EXPENSES 01
PROBLEMS WITH SUPERVISION 02
PROBLEMS WITH DISCIPLINE 03
INCREASE IN WORK 04
CONSTRAINTS FOR PARENTS 05
WORRY ABOUT FUTURE 06
PROBLEMS FOR THE COUPLE'S RELATIONSHIP 07
ILLNESS/DEATH 08
NO DISADVANTAGES 09
OTHER (SPECIFY): ___ 10

722) According to you, starting with how many children, at what point can one consider a woman to have a lot of children?

NUMBER: ___
DK 98

723) For yourself, do you prefer to have a lot of children or a few children?

A LOT OF CHILDREN 1
FEW CHILDREN 2

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601:

EVER MARRIED/LIVED TOGETHER (YES TO 601): ___ (ASK THE QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER)
NEVER MARRIED/NEVER LIVED TOGETHER (NO TO 601): ___ (GO TO 810)

802) Did your husband/partner ever attend school?

YES 1
NO 2 (GO TO 805)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DK 8 (GO TO 805)

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

LESS THAN ONE YEAR 0
DK 8
PRIMARY
INFANT/CLASS ONE/SIL 1
STANDARD ONE/CLASS TWO/CP 2
STANDARD TWO/CLASS THREE/CE1 3
STANDARD THREE/CLASS FOUR/CE2 4
STANDARD FOUR/CLASS FIVE/CM1 5
STANDARD FIVE/CLASS SIX/CM2 6
STANDARD SIX/CLASS SEVEN 7
SECONDARY
FORM 1/SIXTH/1ST YEAR 1
FORM 2/FIFTH/2ND YEAR 2
FORM 3/FOURTH/3RD YEAR 3
FORM 4/THIRD/4TH YEAR 4
FORM 5/SECOND 5
LOWER SIXTH FORM/FIRST 6
UPPER SIXTH FORM/FINAL 7

805) What kind of work does (did) your (last) husband/partner mainly do?

____________

806) CHECK 805:

WORKS (WORKED) IN AGRICULTURE: __
DOES NOT WORK (DID NOT WORK) IN AGRICULTURE: ___ (GO TO 808)

807) (Does/did) your husband/partner work mainly on his own land or family land, or (does/did) he rent land or (does/did) he work on someone else's land?

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

808) What (is/was) your (last) husband/partner's religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY): ___ 4
NONE 5
DK 8

809) What (is/was) your (last) husband/partner's nationality?

CAMEROONIAN 1
OTHER AFRICAN 2
OTHER 3

810) As you know, many women work outside of their own housework. Some take up jobs for which they are paid in cash or in kind. Others have a boutique or a small business at home or elsewhere, others farm family fields or work in the family business.

Are you currently doing any of these things or any other work?

YES 1
NO 2 (GO TO 818)

811) What kind of work do you do?

__________

812) In your current work, are you an employee, are you self-employed, are you an employer, or do you work for someone in your family?

EMPLOYEE 1
SELF-EMPLOYED 2
EMPLOYER 3
FOR FAMILY MEMBER 4

813) Do you earn cash for this work?

YES 1
NO 2

814) Do you do this work at home or away from home?

HOME 1
AWAY 2

815) CHECK 217/218/220:

HAS A CHILD BORN SINCE JANUARY 1986 AND LIVING AT HOME?

YES: ___
NO: ___ (GO TO 818)

816) While you are working, do you usually have (name of youngest child at home) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1 (GO TO 818)
SOMETIMES 2
NEVER 3

817) Who usually takes care of (name of youngest child in house) while you are working?

HUSBAND 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY): ___ 09

818) Record the time

HOUR: ___
MINUTES: ___

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 217, 218:

ONE OR MORE BIRTHS SINCE JANUARY 1986 ALIVE: ___
NO BIRTHS SINCE JANUARY 1986 ALIVE: ___ (GO TO END)

IN 902-904, RECORD THE LINE NUMBER, NAME, AND BIRTH DATE OF EACH LIVING CHILD BORN SINCE JANUARY 1986, STARTING WITH THE YOUNGEST CHILD. RECORD THE HEIGHT AND WEIGHT ON 906 AND 908. IF THERE WERE MORE THAN THREE BIRTHS SINCE JANUARY STILL ALIVE, USE ADDITIONAL FORMS.

902) LINE NUMBER FROM 214

______

903) NAME FROM 214

NAME: ___

904) DATE OF BIRTH FROM 217, AND ASK FOR DAY OF BIRTH.

DAY: ___
MONTH: ___
YEAR: ___

905) BCG SCAR ON TOP LEFT OF SHOULDER?

SCAR SEEN 1
NO SCAR 2

906) HEIGHT (IN CENTIMETERS).

______

907) WAS THE HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP?

LYING 1
STANDING 2

908) WEIGHT (IN KILOGRAMS).

_____

909) DATE WEIGHED AND MEASURED.

DAY: ___
MONTH: ___
YEAR: ___

910) RESULT (WEIGHT AND HEIGHT).

CHILD MEASURED 1
CHILD SICK 2
CHILD ABSENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY): ___ 6

911)

NAME OF MEASURER: ___
NAME OF ASSISTANT: ___

INTERVIEWER'S OBSERVATIONS:

(TO BE FILLED IN AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT _________
COMMENTS ON SPECIFIC QUESTIONS _________
ANY OTHER COMMENTS _________

SUPERVISOR'S OBSERVATIONS__________
NAME OF THE SUPERVISOR: ______
DATE: ________

EDITOR'S OBSERVATIONS: ____________

NAME OF EDITOR: ______
DATE: ________