MINISTRY OF ECONOMIC AFFAIRS, PROGRAMMING, AND TERRITORIAL DEVELOPMENT
NATIONAL STATISTICS INSTITUTE
REPUBLIC OF CAMEROON
PEACE-WORK-COUNTRY

IDENTIFICATION

PROVINCE ___
DEPARTMENT ___
LAYER ___
DISTRICT ___

CITY/TOWNSHIP/GROUP ___

VILLAGE CLUSTER ___
NEIGHBORHOOD/PLACE STRUCTURE ___

NAME OF HEAD OF HOUSEHOLD ___
HOUSEHOLD ___

WOMAN'S NAME ___
WOMAN'S LINE NUMBER ___

CHECK COVER OF HOUSEHOLD QUESTIONNAIRE: WAS THE HOUSEHOLD SELECTED FOR THE QUESTIONS ON FEMALE GENITAL CUTTING/HIV TEST AND ANEMIA/ANTHROPOMETRY?

CHECK COVER OF HOUSEHOLD QUESTIONNAIRE: WAS THE HOUSEHOLD SELECTED FOR QUESTIONS ON "HOUSEHOLD RELATIONSHIPS"?

IF YES, CHECK SCHEDULE 35A FOR THE SELECTION OF ELIGIBLE WOMEN FOR THE SECTION OF "HOUSEHOLD RELATIONSHIPS." WAS THE WOMAN WHO YOU ARE SURVEYING SELECTED?

INTERVIEWER VISITS

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

RESULTS:

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

TOTAL NUMBER OF VISITS____

FRENCH QUESTIONNAIRE 1

LANGUAGE OF THE INTERVIEW

INTERPRETER:

SUPERVISOR
NAME: ___
DATE: ___

FIELD EDITOR
NAME: ___
DATE: ___

OFFICE EDITOR ___
KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

INFORMED CONSENT

Hello. My name is ____ and I work with the National Institute of Statistics. In collaboration with the Ministry of Public Health, we are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey.

I would like to ask you about your health and the health of your children. This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything?

May I begin the interview now?

SIGNATURE OF INTERVIEWER ____
DATE ____

101) RECORD THE TIME.

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

IF ABROAD, SPECIFY THE PLACE OF RESIDENCE.

103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

104) Just before you moved here, did you live in Yaounde/Douala, in Garoua/Maroua/Bafoussam/Bamenda, in another city, in a rural location, or abroad?

IF "ABROAD", SPECIFY THE PLACE OF RESIDENCE.

105) In what month and year were you born?

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

IF LESS THAN 15 OR GREATER THAN 49, END INTERVIEW.

107) Have you ever attended school?

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

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

110) CHECK 109:

111) Now I would like you to read aloud this sentence to me; read as much as you can.

SHOW CARD TO RESPONDENT.

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

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

113) CHECK 111:

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

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

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

117) What is your religion?

118) What is your ethnicity?

WRITE DOWN THE NAME OF THE ETHNICITY. LEAVE THE CODE SPACE EMPTY. FOR FOREIGNERS, MARK 'FOREIGNER'.

SECTION 2. REPRODUCTION

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

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

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

IF NONE, RECORD '00'.

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

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

IF NONE, RECORD '00'.

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

IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

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

IF NONE, RECORD '00'.

207A) Have you ever had any children who were born alive but who died after a few minutes, a few hours, or a few days?

207B) CORRECT QUESTION 207 AND CONTINUE TO QUESTION 208.

208) SUM ANSWERS TO 203, 205, AND 207 AND ENTER TOTAL.

IF NONE, RECORD '00'.

209) CHECK 208:

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

210) CHECK 208:

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

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

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

213) Were any of these births twins?

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

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

PROBE: What is his/her birthday?

216) Is (NAME) still alive?

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

RECORD AGE IN COMPLETED YEARS.

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

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

220) IF DECEASED: How old was (NAME) when he/she died?

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

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS, OR YEARS.

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

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

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

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 1999 OR LATER. IF NONE, RECORD '0'.

226) Are you pregnant now?

227) How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

228) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?

228A) Have you had a pregnancy that did not end in a live birth?

228B) How many pregnancies have you had that did not end in a live birth?

228C) Among these pregnancies, how many ended in:

An abortion?
A miscarriage?
A stillbirth?

230) When did the last such pregnancy end?

237) When did your last menstrual cycle start?

MARK THE RESPONSE IN THE UNITS OF TIME GIVEN BY THE WOMAN BEING INTERVIEWED.

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

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

SECTION 3. FAMILY PLANNING

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

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301) Which ways or methods have you heard about?

FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you heard of (METHOD)?

302) Have you ever used (METHOD)?

303) CHECK 302:

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

306) What have you used or done?

CORRECT 302, 303 AND 301 IF NECESSARY.

307) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

308) CHECK 302 (01):

309) CHECK 226:

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

311) Which method are you using?

311A) CIRCLE 'A' FOR FEMALE STERILIZATION. IF MORE THAN ONE METHOD MENTIONED, FOLLOW (GO TO) INSTRUCTION FOR HIGHEST METHOD ON LIST.

313) In what facility did the sterilization take place?

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

314) CHECK 311:

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

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

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

316A) For how long have you been using, (CURRENT METHOD FIRST MENTIONED IN 311) now without stopping?

PROBE: In what month and year did you start using (CURRENT METHOD FIRST MENTIONED IN 311) continuously?

316B) CHECK 315A, 316, 215, AND 230:

WAS THERE WAS A BIRTH IN 215 OR A PREGNANCY IN 230 THAT ENDED IN A MISCARRIAGE, AN ABORTION, OR A STILLBIRTH BEFORE THE MONTH AND THE YEAR OF THE START OF THE USE OF CONTRACEPTION BASED ON 316/316A?

317) CHECK 316/316A:

319) CHECK 311/311A:

CIRCLE THE METHOD CODE:

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

320) Where did you obtain (CURRENT METHOD) when you started using it?

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

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

321) CHECK 311/311A:

CIRCLE METHOD CODE:

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

322) You obtained (CURRENT METHOD FROM 319) from (SOURCE OF METHOD FROM 313 OR 320).

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

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

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

325) CHECK 322:

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

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

326) Did a health worker or family planning worker ever tell you about other methods of family planning that you could use?

327) CHECK 311/311A:

CIRCLE METHOD CODE.

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

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

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

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

330) Where is this? Another place?

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

331) In the last 12 months, were you visited by a field worker who talked to you about family planning?

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

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

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

402) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1999 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

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

403) LINE NUMBER FROM 212:

404) FROM 212 AND 216:

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

406) How much longer would you have waited?

407) Did you see anyone for prenatal care for this pregnancy?

IF YES: Whom did you see? Anyone else?

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

IF NO ONE, CIRCLE CODE 'Y'.

408) How many months pregnant were you when you first received prenatal care for this pregnancy?

409) How many times did you receive prenatal care during this pregnancy?

410) CHECK 409: NUMBER OF TIMES RECEIVED PRENATAL CARE?

411) How many months pregnant were you the last time you received prenatal care?

412) During this pregnancy, were any of the following done at least once?

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

413) Were you told about the signs of pregnancy complications?

414) Were you told where to go if you had these complications?

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

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

417) During this pregnancy, were you given or did you buy iron tablets or capsules?

SHOW TABLES OR CAPSULES.

418) During the whole pregnancy, for how many days did you take the tablets or capsules?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

419) During this pregnancy, did you have difficulty with your vision during the daylight?

420) During this pregnancy, did you have difficulty with your vision at nightfall, sunrise, or in poorly light spaces?

421) During this pregnancy, did you take any medication in order to prevent you from getting malaria?

422) What medication did you take?

Other medication?

RECORD ALL MENTIONED. IF TYPE OF MEDICATION IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

(RESPONSE SET FOR MOST RECENT BIRTH)

(RESPONSE SET FOR OTHER BIRTHS)

422A) CHECK 422: TYPE OF MEDICATION TAKEN DURING PREGNANCY TO PREVENT MALARIA

422B) How many times did you take the Amodiaquine/Flavoquine/Camoquin during this pregnancy?

422C) CHECK 407: TYPE OF PERSON THAT GAVE PRENATAL CARE DURING THIS PREGNANCY

422D) When you were pregnant with (NAME), did you get Amodiaquine/Flavoquine/Camoquin during a prenatal visit, during a different visit in a health care facility, or from another source?

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

424) Was (NAME) weighed at birth?

425) How much did (NAME) weigh?

RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

425A) Was the birth of (NAME) declared to the civil state?

426) 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 IF ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

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

428) Was (NAME) delivered by cesarean section?

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

430) How many days or weeks after delivery did the first check take place?

RECORD '00' DAYS IF SAME DAY.

431) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

432) Where did this first check take place?

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

433) In the first two months after delivery, did you receive a vitamin A dose like this?

SHOW CAPSULE.

434) Has your period returned since the birth of (NAME)?

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

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

437) CHECK 226: IS RESPONDENT PREGNANT?

438) Have you resumed sexual relations since the birth of (NAME)?

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

440) Did you ever breastfeed (NAME)?

441) How long after birth did you first put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

442) In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

443) What was (NAME) given to drink before your milk began flowing regularly?

Anything else?

RECORD ALL LIQUIDS MENTIONED.

444) CHECK 404: IS CHILD LIVING?

445) Are you still breastfeeding (NAME)?

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

447) CHECK 404: IS CHILD LIVING?

448) How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

449) How many times did you breastfeed yesterday during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

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

452) How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

453) GO BACK TO 405 IN NEXT COLUMN. IF NO MORE BIRTHS: GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION

454) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1999 OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455) LINE NUMBER FROM 212:

456) FROM 212 AND 216:

457) Did (NAME) receive a vitamin A dose like this during the last 6 months?

SHOW CAPSULE.

458) Do you have a card where (NAME'S) vaccinations are written down?

IF YES: May I see it please?

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

460)

(1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARE AND THE DATE OF THE MOST RECENT VITAMIN A, ACCORDING TO THE CARD.

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

461) Has (NAME) received any vaccines that are not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, MEASLES, AND/OR YELLOW FEVER VACCINE(S).

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

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

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

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

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

469) CHECK 466 AND 467: FEVER OR COUGH?

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

471) Where did you seek advice or treatment?

Anywhere else?

RECORD ALL SOURCES MENTIONED.

472) CHECK 466: HAD FEVER?

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

472B) Has (NAME) had convulsions at any time during the last two weeks?

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

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

474) What medications did (NAME) take?

RECORD ALL MENTIONED. ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

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

474B) CHECK 474: AMODIAQUINE/FLAVOQUINE/CAMOQUIN?

474C) How long after the fever/convulsions started did (NAME) start taking the Amodiaquine/Flavoquine/Camoquin?

IF MORE THAN 7 DAYS, RECORD '7'.

474D) How many days in a row did (NAME) take the Amodiaquine/Flavoquine/Camoquin?

IF MORE THAN 7 DAYS, RECORD '7'.

474E) Do you have Amodiaquine/Flavoquine/Camoquin at home or did you get it from somewhere else?

IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Amodiaquine/Flavoquine/Camoquin first?

474F) CHECK 474: FANSIDAR/MALOXINE?

474G) How long after the fever/convulsions started did (NAME) start to take the Fansidar/Maloxine?

474H) How many days did (NAME) take the Amodiaquine Fansidar/Maloxine?

IF MORE THAN 7 DAYS, RECORD '7'.

474I) Do you have Fansidar/Maloxine at home or did you get it from somewhere else?

IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Fansidar/Maloxine first?

474J) CHECK 474: CHLOROQUINE/NIVAQUINE?

474K) How long after the fever/convulsions started did (NAME) start to take the Chloroquine/Nivaquine?

474L) How many days in a row did (NAME) take the Chloroquine/Nivaquine?

IF MORE THAN 7 DAYS, RECORD '7'.

474M) Do you have Chloroquine/Nivaquine at home or did you get it from somewhere else?

IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Chloroquine/Nivaquine first ?

474N) CHECK 474: QUININE/QUINIMAX?

474O) How long after the fever/convulsions started did (NAME) start to take the Quinine/Quinimax?

474P) How many days in a row did (NAME) take the Quinine/Quinimax?

IF MORE THAN 7 DAYS, RECORD '7'.

474Q) Do you have Quinine/Quinimax at home or did you get it from somewhere else?

IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Quinine/Quinimax first?

474R) Was something else done to treat (NAME'S) fever/convulsions?

474S) What was done for (NAME'S) fever/convulsions?

474T) Now I would like to know how much (NAME) was offered to drink during the fever/convulsions. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?

474U) When (NAME) had fever/convulsion, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?

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

476) Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?

477) When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?

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

a. Fluid made from a special packet called ORS (Oral Rehydration Salt)
b. A light gruel made of rice or corn, millet, yams, cassava root, plantains?
c. Soup, for example carrot soup?
d. Tea, herbal tea, guava leaves?
e. Homemade sugar-salt-water solution (SSS)?
f. Milk or baby formula?
g. Yogurt based drink?
h. Water?
i. Any other liquid?

479) Was anything else given to treat the diarrhea?

480) What (else) was given to treat the diarrhea?

Anything else?

RECORD ALL TREATMENTS MENTIONED.

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

482) Where did you seek advice or treatment?

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

Anywhere else?

RECORD ALL PLACES MENTIONED.

483) GO BACK TO 465 IN NEXT COLUMN. IF NO MORE BIRTHS, GO TO 486.

486) CHECK 478A, ALL COLUMNS:

487) Have you ever heard of a special product called ORS, for example, Orasel, that you can get for the treatment of diarrhea?

488) CHECK 218:

489) When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?

IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

490) Now I would like to ask you some questions about medical care for you yourself.

Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

Not knowing where to go?
Getting permission to go?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Not wanting to go alone?
Concern that there may not be a female health care provider?

491) CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BEFORE IN 2001 OR LATER AND LIVING WITH HER: ___ RECORD NAME OF YOUNGEST CHILD LIVING WITH HER:

DOES NOT HAVING ANY CHILDREN BORN IN 2001 OR LATER AND LIVING WITH HER: ___ (GO TO 494)

492) Now I would like to ask you about liquids (NAME IN QUESTION 491) drank over the last seven days, including yesterday.

How many days during the last seven days did (NAME IN QUESTION 491) drink each of the following?

FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK:

In total, how many times yesterday during the day or at night did (NAME IN QUESTION 491) drink (ITEM)?

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

493) Now I would like to ask you about the types of foods (NAME IN QUESTION 491) ate over the last seven days, including yesterday.

How many days during the last seven days did (NAME IN QUESTION 491) eat each of the following foods either separately or combined with other food?

FOR EACH ITEM GIVEN AT LEAST ONCE IN THE LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK:

In total, how many times yesterday during the day or at night did (NAME IN QUESTION 491) eat (ITEM)?

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

494) Did you sleep under a bednet last night?

494A) When did you last wash your hands with soap/ash?

Any other time?

CIRCLE ALL RESPONSES MENTIONED SPONTANEOUSLY. DO NOT SUGGEST ANY RESPONSES TO THE RESPONDENT.

496) Do you currently smoke cigarettes or use tobacco?

IF YES: What type of tobacco do you smoke or use? Anything else?

RECORD ALL TYPES MENTIONED.

497) CHECK 496:

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

498A) Did you receive any type of injection over the last three months?

498B) How many times did you receive an injection over the last three months?

498C) Did you have a blood transfusion at any time in your life?

498D) How many times did you get a blood transfusion in the last five years?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501) Are you currently married or living with a man as husband and wife?

502) Have you ever been married or lived with a man as husband and wife?

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

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

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

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

508) How many other wives does he have?

509) Are you the first, second?wife?

510) Have you been married or lived with a man as husband and wife only once, or more than once?

511) CHECK 510:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?

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

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

514A) CHECK 106:

514B) Was a condom used the first time you had sexual intercourse?

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

RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

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

517) What is your relationship to the man with whom you last had sex?

IF MAN IS 'BOYFRIEND' OR 'FIANCÉ', ASK: Was your boyfriend/fiancé living with you when you last had sex?

IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

518) For how long have you been having sexual intercourse with this man?

IF SHE HAD SEXUAL INTERCOURSE WITH THIS MAN ONLY ONCE, RECORD '01' DAYS. IF 12 MONTHS OR MORE, THE ANSWER SHOULD BE RECORDED IN YEARS.

518A) CHECK 106:

518B) How old is this man?

518C) Do you think he's more than 10 years older than you?

518D) Did either you or your partner drink alcohol the last time you had sexual intercourse?

IF YES: Who drank?

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

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

521) What is your relationship to this man?

IF MAN IS 'BOYFRIEND' OR 'FIANCÉ', ASK: Was your boyfriend/fiancé living with you when you last had sex?

IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'

522) How long have you or did you have sexual intercourse with this man?

IF SHE HAD SEXUAL INTERCOURSE WITH THIS MAN ONLY ONCE, RECORD '01' DAYS.
IF 12 MONTHS OR MORE, THE ANSWER SHOULD BE RECORDED IN YEARS.

522A) CHECK 106:

522B) How old is this man?

522C) Do you think he's more than 10 years older than you?

522D) Did either you or your partner drink alcohol the last time you had sexual intercourse?

IF YES: Who drank?

522E) Other than these two partners, have you had sex with any other man in the last 12 months?

522F) The last time you had sexual intercourse with another man, was a condom used?

522G) What is your relationship to this man?

IF MAN IS 'BOYFRIEND' OR 'FIANCÉ', ASK: Was your boyfriend/fiancé living with you when you last had sex?

IF YES, CIRCLE '01'.
IF NO, CIRCLE '02'.

522H) For how long had you been having sexual intercourse with this man?

IF SHE HAD SEXUAL INTERCOURSE WITH THIS MAN ONLY ONCE, RECORD '01' DAYS.
IF 12 MONTHS OR MORE, THE ANSWER SHOULD BE RECORDED IN YEARS.

522I) CHECK 106:

522J) How old is this man?

522K) Do you think he's more than 10 years older than you?

522L) Did either you or your partner drink alcohol the last time you had sexual intercourse?

IF YES: Who drank?

523) In total, with how many different men have you had sex in the last 12 months?

523A) In total, with how many different men have you had sex in your life?

PROBE TO GET AN EXACT NUMBER.
IF THE NUMBER IF MORE THAN 95, RECORD '95'.

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

525) Where is that?

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

Any other place?

RECORD ALL PLACES MENTIONED.

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

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311/311A:

602) CHECK 226:

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

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

603) CHECK 226:

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

PREGNANT: After the birth of this child you are expecting now, how long would you like to wait before the birth of another child?

604) CHECK 226:

605) CHECK 310: USING A CONTRACEPTIVE METHOD?

606) CHECK 603:

607) CHECK 602:

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

Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why?

Any other reason?

RECORD ALL REASONS MENTIONED

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

609) CHECK 310: USING A CONTRACEPTIVE METHOD?

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

611) Which contraceptive method would you prefer to use?

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

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

614) CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

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

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

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

On the radio?
On the television?
In a newspaper or magazine?
On a poster/pamphlet?

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

620) With whom did you speak? Anyone else?

RECORD ALL PERSONS MENTIONED.

621) CHECK 501:

622) CHECK 311/311A:

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

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

625) How often have you talked to your husband/partner about family planning in the last twelve months?

626) CHECK 311/311A:

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

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

701) CHECK 501 AND 502:

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

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

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

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

706) CHECK 701:

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

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

707) Aside from your own housework, are you currently working?

708) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.

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

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

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

711) CHECK 710:

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

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

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

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

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

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

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

718A) On average, how much of your income to you reserve for your household's expenditures: almost none, less than half, about half, more than half, or all?

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

Your own health care?
Making large household purchases?
Making household purchases for daily needs?
Visits to family or relatives?
What food should be cooked every day?

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

721) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

801A) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

801B) Can people get the AIDS virus from mosquito bites?

801C) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

801D) Can people get the AIDS virus by sharing food with a person who has AIDS?

801E) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

801F) Can people get the AIDS virus because of witchcraft or other supernatural means?

801G) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

801H) What can a person do?

Anything else?

RECORD ALL WAYS MENTIONED.

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

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

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

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

During pregnancy?
During delivery?
During breastfeeding?

813) CHECK 501:

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

814A) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

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

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

816A) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

816B) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

816C) CHECK 407:

816D) During the prenatal visits for (NAME OF LAST BIRTH ON QUESTION 404), did anyone:

Tell you that children can contract the virus that causes AIDS from their mother?
Speak to you about being tested for the virus that causes AIDS?

816E) I don't want to know the results, but were you tested to see if you have the AIDS virus during any of these prenatal visits?

816F) Did you yourself ask for the test, was it offered to you and you accepted, or was it required?

816G) I don't want to know the results, but did you get the results of the test?

816H) Have you had an AIDS test since you were tested during your pregnancy?

816I) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

816J) When was the last time you were tested?

816K) Where was the test done?

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

816L) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

816M) I don't want to know the results, but did you get the results of the test?

816N) Have you ever heard of the CPDV (Prevention and Voluntary Screening Center)?

816O) Have you ever gone to the CPDV?

816P) CHECK 816E AND 816I:

816Q) Have you ever had an AIDS test in a CPDV?

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

818) If a man has a sexually transmitted disease, what symptoms might he have?

Any other sign or symptom?

RECORD ALL SYMPTOMS MENTIONED.

819) If a woman has a sexually transmitted disease, what symptoms might she have?

Any other sign or symptom?

RECORD ALL SYMPTOMS MENTIONED.

819A) CHECK 514:

819B) CHECK 817:

819C) 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?

819D) Sometimes women experience a bad-smelling abnormal genital discharge. Have you had a bad-smelling abnormal genital discharge in the last 12 months?

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

819F) CHECK 819C, 819D, 819E:

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

819H) Where did you go for treatment?

Any other place?

CIRCLE ALL MENTIONED.

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

819I) When you had (INFECTION FROM 819C, 819D, AND/OR 819E), did you inform the people were you having sexual intercourse with?

819J) When you had (INFECTION FROM 419C, 419D, AND/OR 419E), did you do something to avoid infecting your sexual partners?

819K) What did you do to prevent infection in your partner(s)? Did you...

Stop sexual intercourse?
Use a condom during sexual intercourse?
Taken medication?

819L) Husband and wives do not always agree on everything. Please tell me if you think a woman is justified refusing to have sex with her husband when:

She knows her husband has a disease that she can get during sexual intercourse?
She knows her husband has sex with other women?
She recently gave birth?
She is tired or not in the mood?

819M) 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?

SECTION 9. MATERNAL MORTALITY

901A) Now I would like to ask you some questions about your brothers and sisters, that is all of the children born to your biological mother. Did your mother give birth to any children other than yourself?

901B) How many boys did your mother have who are still living?

901C) Other than yourself, how many girls did your mother have who are still living?

901D) How many boys did your mother have who died?

901E) How many girls did your mother have who died?

901F) Did your mother give birth to any other children, who you don't know if they are living or dead?

901G) How many other children did your mother give birth do, who you don't know if they are living or dead?

901H) ADD THE ANSWERS FORM 901B, C, D, E, AND G THEN ADD 1 (THE RESPONDENT) AND RECORD THE TOTAL.

901I) CHECK 901H:

Just to make sure that I've understood, including yourself, your mother gave birth to ___ children total. Is that correct?

902) CHECK 901H:

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

Now I would like to make a list of all your sisters and brothers, whether they are still alive or not, starting with the oldest.

RECORD THE NAME OF ALL THE SISTERS AND BROTHERS.

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

905) Is (NAME) male or female?

906) Is (NAME) still alive?

907) How old is (NAME)?

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

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

IF 'DON'T KNOW' PROBE:

Did (NAME) die before the age of twelve?

IF YES, RECORD '95 '.
IF NO, ASK OTHER QUESTIONS FOR AN ESTIMATE. FOR EXAMPLE:
Did (NAME) die before marriage?

910) Was (NAME) pregnant when she died?

911) Did (NAME) die during childbirth?

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

913) How many live born children did (NAME) give birth to during her lifetime, before this pregnancy?

SECTION 10. FEMALE GENITAL CUTTING

1000A) CHECK THE FRONT PAGE: HOUSEHOLD SELECTED FOR FEMALE GENITAL CUTTING MODULE?

1001) Have you ever heard of female circumcision?

1002) In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard of this practice?

1003) Have you yourself ever had your genitals cut, meaning did someone cut a part of your external genital organs?

1004) Now I would like to ask you what was done to you at this time.
Was any flesh removed from the genital area?

1005) Was the genital area just nicked without removing any flesh?

1006) Was your genital area sewn closed?

1007) How old were you when this occurred?

IF LESS THAN ONE YEAR, RECORD '00'.
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

1008) Who cut (or nicked) your genitals?

1009) CHECK 214 AND 216:

1010) CHECK 214 AND 216:

HAS ONE LIVING DAUGHTER: Did your daughter have her genitals cut? IF YES, RECORD 01. IF NO, CIRCLE 95.

HAS TWO OR MORE LIVING DAUGHTERS: Have any of your daughters had her genitals cut?
IF YES: How many?
RECORD THE NUMBER; IF NONE, CIRCLE 95.

1011) CHECK 1010:

HAD ONLY ONE DAUGHTER CIRCUMCISED: What is the name of your daughter who was circumcised?
CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.

HAD TWO OR MORE DAUGHTERS CIRCUMCISED: To which of your daughters did this happen most recently?
CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.

1012) Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM QUESTION 1011) at this time. Was any flesh removed from her genital area?

1013) Was her genital area just nicked without removing any flesh?

1014) Was her genital area sewn closed?

1015) How old was (NAME OF THE DAUGHTER FROM QUESTION 1011) when this occurred?

IF LESS THAN ONE YEAR RECORD '00'.

IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

1016) Who cut (or nicked) her genitals?

1017) At the time that the genitals were cut or afterwards, did (NAME OF THE DAUGHTER FROM QUESTION 1011) have any of the following problems:

Excessive bleeding?
Difficulty in passing urine or urine retention?
Swelling in the genital area?
Infection in the genital area?
Wound that did not heal properly?

1018) CHECK 214 AND 216:

HAS ONE LIVING DAUGHTER: Do you intend to have this genital cutting done on your daughter in the future?

HAS TWO OR MORE LIVING DAUGHTERS: Do you intend to have this genital cutting done to any of your daughters in the future?

1019) What benefits do girls get if they undergo this genital cutting?

PROBE: Other benefits?

RECORD ALL MENTIONED.

1020) What benefits do girls get if they do not undergo this genital cutting?

PROBE: Anything else?

RECORD ALL MENTIONED.

1020A) CHECK 1019:

1021) Would you say that this practice is a way to prevent a girl from having sex before marriage or does it have no effect on premarital sex?

1021A) CHECK 1019 AND 1020:

1022) Do you believe that this practice is required by your religion?

1023) Do you think that this practice should be continued, or should it be discontinued?

1024) Do you think that men want this practice to be continued, or discontinued?

SECTION 11. HOUSEHOLD RELATIONSHIPS

1100A) CHECK THE FRONT COVER PAGE: WAS THE WOMAN YOU ARE SURVEYING SELECTED FOR THE QUESTIONS ON "HOUSEHOLD RELATIONSHIPS"?

1101) CHECK FOR THE PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

READ TO ALL RESPONDENTS:

Now I would like to ask you some questions about other important aspects of a woman's life.

I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Cameroon. Let me assure you that your answer are completely confidential and will not be told to anyone.

Additionally, you are the only person in your household that is being asked these questions and no one will know that you were asked these questions. If someone arrives while we are talking, we will talk about something else.

1102) CHECK 501, 502, AND 504:

1103) When two people marry or live together, they share both good and bad moments. In your relationship with your (last) husband/partner does/did the following happened frequently, only sometimes, or never?

a) He usually (spends/spent) his free time with you?
b) He (consults/consulted) you on different household matters?
c) He (is/was) affectionate with you?
d) He (respects/respected) you and your wishes?

1104) Now 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?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your girlfriends?
d) He (tries/tried) to limit your contact with your family?
e) He (insist/insisted) on knowing where you (are/were) at all time?
f) He (does/did) not trust you with any money?
g) He prevents you from working or he isn't alright with you working?

1105) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

5A. (Does/did) your (last) husband/partner ever:

5B. How many times did this happen during the last 12 months?

1106)

6A. (Does/did) your (last) husband/partner ever:

6B. How often did this occur in the past 12 months?

1107) CHECK 1106:

1108) How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD '00'.

1109)
9A. Did the following ever happen because of something your (last) husband/partner did to you:

9B. How many times did this happened during the last 12 months?

1109C) Did you ever do or say something to humiliate or threaten your (last) husband/partner in front of others?

1109D) How many times in the last 12 months did you say or do something to threaten or humiliate him in front of other people?

1110) 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?

1111) In the last 12 months, how many times have you hit, slapped, kicked or done something to physically hurt your (last) husband/partner at a time when he was not already beating or physically hurting you?

1112) Does (did) your husband/partner drink (alcohol)?

1113) How often does (did) he get drunk: very often, only sometimes, or never?

1114) CHECK 1102:

MARRIED/LIVING WITH A MAN/SEPARATED/DIVORCE:
From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?

WIDOWED/NEVER MARRIED/NEVER LIVED WITH A MAN:
From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?

1115) Who has physically hurt you in this way?

Anyone else?

RECORD ALL MENTIONED.

1116) CHECK 1115:

1117) Who has hit, slapped, kicked or done something to physically hurt you most often?

1118) In the last 12 months, how many times has this person hit, slapped, kicked, or done anything else to physically hurt you?

1119) CHECK QUESTION 201, QUESTION 226 AND QUESTION 228A: LIVE BIRTHS, PREGNANCIES, STILLBIRTHS

1120) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

1121) How has done any of these things to physically hurt you while you were pregnant?

Anyone else?

RECORD ALL MENTIONED.

1122) CHECK 1106, 1109, 1114, AND 1120:

1123) Have you ever tried to get help to prevent or stop (this person/these persons) from physically hurting you?

1124) From whom have you sought help?

Anyone else?

RECORD ALL MENTIONED.

1125) What is the main reason you have never sought help?

1126) As far as you know, did your father ever beat your mother?

1126A) Do you know of any services or support for women in trouble?

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.

1127) 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?

1128) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

1129) RECORD THE TIME

INTERVIEWER'S OBSERVATIONS___

COMMENTS ABOUT RESPONDENT ___

COMMENTS ON SPECIFIC QUESTIONS ___

ANY OTHER COMMENTS ___

SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR ___
DATE ___

EDITOR'S OBSERVATIONS
NAME OF EDITOR ___
DATE ___