REPUBLIC OF CAMEROON
Peace -- Work -- Fatherland
NATIONAL INSTITUTE OF STATISTICS

IDENTIFICATION
REGION
DIVISION
SUB-DIVISION
LOCALITY
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
STRUCTURE NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN

HOUSEHOLD SELECTED FOR MAN'S SURVEY?

WOMAN SELECTED FOR HOUSEHOLD RELATIONS MODULE?

INTERVIEWER VISITS
DATE______
INTERVIEWER'S NAME_______
RESULT*________

NEXT VISIT
DATE_______
TIME_______

FINAL VISIT
DAY_______
MONTH_______
YEAR __2018__
INT. NO. _______
RESULT*_______

TOTAL NUMBER OF VISITS________

*RESULT CODES:

LANGUAGE OF QUESTIONNAIRE** 01 ENGLISH
LANGUAGE OF INTERVIEW**
NATIVE LANGUAGE OF RESPONDENT**

INTERPRETER USED

**LANGUAGE CODES:

TEAM LEADER
NAME______
NUMBER______

CONTROLLER
NAME______
NUMBER______

100A. CHECK COVER PAGE: HOUSEHOLD SELECTED FOR MAN'S SURVEY?

100B. CHECK HOUSEHOLD QUESTIONNAIRE: AGE FROM COLUMN 7

INTRODUCTION AND CONSENT
Hello. My name is___________. I am working with the NATIONAL INSTITUTE OF STATISTICS. In collaboration with the MINISTRY OF PUBLIC HEALTH, we are conducting a survey about health and other topics all over CAMEROON. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions?
May I begin the interview now?

SECTION 1: RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

102. How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD '00'.

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

104. Before you move here, which REGION did you live in?

105. In what month and year were you born?

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND / OR 106 IF INCONSISTENT.

107. Have you ever attended school?

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

109. What is the highest (GRADE / FORM / YEAR) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

Codes for Q. 109
##note: should this table be transcribed?

110. CHECK 108:

111. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

112. CHECK 111:

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

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

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

116. Do you own a mobile telephone?

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

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

119. Have you ever used the internet?

120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

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

122. What is your religion?

123. What is your ethnicity?

124. During the last 12 months, how many times did you travel out of your community / locality, and slept elsewhere other than your residence?

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

126. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you worried about not having enough food to eat?

127. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you could not eat nutritious and healthy foods?

128. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you almost always ate the same thing?

129. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you had to skip a meal?

130. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you did not eat as much as you should have?

131. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, there was nothing left to eat at home?

132. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you were hungry but you did not eat?

133. At any moment in the last 12 months, did you find yourself in a situation where, due to lack of money or other means, you have not eaten anything all day?

SECTION 2: REPRODUCTION

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

202. Do you have any son or daughter to whom you have given birth who are now living with you?

203.

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

205.

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

207.

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

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

209A. CHECK 106: AGE OF RESPONDENT

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 BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

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

213. Is (NAME) a boy or a girl?

214. Were any of these births twins?

215. On what day, month, and year was (NAME) born?

216. Is (NAME) still alive?

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

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

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

220. IF DEAD: How old was (NAME) when (he / she) died?
IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his / her) first birthday?
THEN ASK: Exactly how many months old was (NAME) when (he/she) died?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

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

223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY:

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2013-2018.

226. Are you pregnant now?

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

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

229. CHECK 208: TOTAL NUMBER OF BIRTHS.

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

230A. How many such pregnancies have you had?

230B. Was the last such pregnancy a miscarriage, an abortion or a stillbirth?

231. When did that last such pregnancy end?

232. CHECK 231:

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

233A. Was that preceding such pregnancy a miscarriage, an abortion or a stillbirth?

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

235. Since January 2013, have you had any other pregnancies that did not result in a live birth?

237. Did you have any miscarriages, abortions or stillbirths that ended before 2013?

238. When did the last such pregnancy that terminated before 2013 end?

238A. Was that last such pregnancy a miscarriage, an abortion or a stillbirth?

239. When did your last menstrual period start? (DATE, IF GIVEN)

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

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

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

SECTION 3: CONTRACEPTION

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

302. CHECK 226:

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

304. Which method are you using?
RECORD ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

307. In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

309. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRRENT METHOD) now without stopping?

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

315. CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

317. CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

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

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

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

322. CHECK 318 AND 319:

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

324. CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

325. Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

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

329. CHECK 202: CHILDREN LIVING WITH RESPONDENT?

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

SECTION 4: PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

402. CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2013-2018. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
Now I would like to ask some questions about your children born in the last five years. (We talk about each separately.)

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

404. FROM 212 AND 216:

405. When you got pregnant with (NAME), did you want to get pregnant at that time?

406. CHECK 208:

407. How much longer did you want to wait?

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

409. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

410. Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

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

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

415. During this pregnancy, how many times did you get a tetanus injection?

416. CHECK 415:

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

418. Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.

419. CHECK 418:

420. During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS / SYRUP.

421. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

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

423. During this pregnancy, did you take SP / Fansidar / Maloxine to keep you from getting malaria?

424. How many times did you take SP / Fansidar / Maloxine during this pregnancy?

425. Did you get the SP / Fansidar / Maloxine during any antenatal care visit, during another visit to a health facility or from another source?
IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

426. When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

427. Was (NAME) weighed at birth?

428. How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

429. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

430. Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

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

434. Immediately after the birth, was (NAME) put on your chest?

434A. Was (NAME)'s bare skin touching your bare skin?

434B. CHECK 430: PLACE OF DELIVERY

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

436. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

437. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

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

439. How long after delivery was (NAME)'s health first checked?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

440. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

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

442. How long after delivery did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

443. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

444. Where did the check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

446. How many hours, days or weeks after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

447. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

448. Where did this check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

450. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

451. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

452. Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

454. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

455. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

456. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

457. During the first two days after (NAME)'s birth, did any health care provider do the following:

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

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

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

461. CHECK 226: IS RESPONDENT PREGNANT?

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

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

464. Did you ever breastfeed (NAME)?

465. CHECK 404: IS CHILD LIVING?

466. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.

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

468. CHECK 404: IS CHILD LIVING?

469. Are you still breastfeeding (NAME)?

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

471. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501A.

SECTION 5A: CHILD IMMUNIZATION (LAST BIRTH)

501A. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2015-2018?

502A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2015-2018.

503A. CHECK 216 FOR CHILD:

504A. Do you have a card or other document where (NAME)'s vaccinations are written down?

505A. Did you ever have a vaccination card for (NAME)?

506A. CHECK 504A:

507A. May I see the card or other document where (NAME)'s vaccinations are written down?

508A. COPY DATES FROM THE CARD / OTHER DOCUMENT.
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509A. CHECK 508A: 'BCG' TO 'YELLOW FEVER 1' ALL RECORDED?

510A. In addition to what is recorded on (this document / these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

512A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

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

515A. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516A. How many times did (NAME) receive the oral polio vaccine?

517A. Has (NAME) ever received a DPT-HepB-Hib/penta vaccination, that is, an injection given in the thigh or buttocks sometimes at the same time as polio drops?

518A. How many times did (NAME) receive the DPT-HepB-Hib/penta vaccine?

519A. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh or buttocks to prevent pneumonia?

520A. How many times did (NAME) receive the pneumococcal vaccine?

521A. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

522A. How many times did (NAME) receive the rotavirus vaccine?

523A. Has (NAME) ever received a measles or MMR vaccination, that is an injection in the arm to prevent measles?

524A. Has (NAME) ever received a yellow fever vaccination, that is an injection in the arm to prevent yellow fever?

526A. CONTINUE WITH 501B.

SECTION 5B: CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)
##NOTE: 501-526 FROM SECTION 5A ARE REPEATED IN 5B

SECTION 6: CHILD HEALTH AND NUTRITION

601. CHECK 224:

602. CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2013-2018. 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 QUESTIONNAIRE(S).
Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

604. FROM 212 AND 216:

605. In the last six months, was (NAME) given a vitamin A dose like (this / any of these)?
SHOW COMMON TYPES OF AMPULES / CAPSULES / SYRUPS.

606. In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this / any of these)?
SHOW COMMON TYPES OF PILLS / SPRINKLES / SYRUPS.

607. Was (NAME) given any drug for intestinal worms in the last six months?

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

609. CHECK 469: CURRENTLY BREASTFEEDING?

610. When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

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

612. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

613. CHECK 612:

614. Where did you first seek advice or treatment?
USE LETTER CODE FROM 612.

615. Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:

616. CHECK 615:

617. CHECK 615:
RECORD ALL TREATMENTS.

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

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

619A. Has (NAME) had convulsions, at any time, in the last two weeks?

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

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

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

623. CHECK 618: HAD FEVER?

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

625. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

626. CHECK 625:

627. Where did you first seek advice or treatment?
USE LETTER CODE FROM 625.

628. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY RECORD '00'.

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

630. What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.

631. CHECK 630: ANY CODE A-I CIRCLED?

632. CHECK 630: ARTMISININ COMBINATION THERAPY ('A') GIVEN

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

634. CHECK 630: SP / FANSIDAR ('B') GIVEN

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

638. CHECK 630: AMODIAQUINE ('C') GIVEN

639. How long after the fever started did (NAME) first take amodiaquine?

640. CHECK 630: QUININE ('D' OR 'E') GIVEN

641. How long after the fever started did (NAME) first take quinine?

642. CHECK 630: ARTESUNATE ('F' OR 'G') GIVEN

643. How long after the fever started did (NAME) first take artesunate?

644. CHECK 630: OTHER ANTIMALARIAL ('H') GIVEN

645. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

646. GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.

647. CHECK 615(a) ALL COLUMNS:

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

649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2016-2018 LIVING WITH THE RESPONDENT

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

651. CHECK 650 (CATEGORIES 'g' THROUGH 'u'):

652. Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

653. How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

654. The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

SECTION 7: MARRIAGE AND SEXUAL ACTIVITY

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

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

703. What is your marital status now: are you widowed, divorced, or separated?

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

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

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

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

708. Are you the first, second, ? wife?

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

710. CHECK 709:

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

712. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

713. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?

714. I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.

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

716. The last time you had sexual intercourse with this person, was a condom used?

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

718. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, RECORD '2'.
IF NO, RECORD '3'.

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

720. How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.

721. How old is this person?

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

723. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

724. CHECK 106:

725. CHECK 701:

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

727. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

728. CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):

730. From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

731. PRESENCE OF OTHERS DURING THIS SECTION.

732. CHECK 106: AGE OF RESPONDENT

SECTION 8: FERTILITY PREFERENCES

801. CHECK 304:

802. CHECK 226:

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

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

805. CHECK 226:

806. CHECK 226:

807. CHECK 303: USING A CONTRACEPTIVE

808. CHECK 805:

809. CHECK 714:

810. CHECK 804:

811. CHECK 303: USING A CONTRACEPTIVE

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

813. CHECK 216:

814. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

815. In the last few months have you:

817. CHECK 701:

818. CHECK 303: USING A CONTRACEPTIVE

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

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

821. CHECK 304:

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

SECTION 9: HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 701:

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

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

904. What was the highest level of school he attended: primary, 1st secondary cycle, 2nd secondary cycle or higher?

905. What was the highest (GRADE / FORM / YEAR) he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

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

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

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

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

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

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

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

Codes for Q. 905
##note: should the table be transcribed?

913. What is your occupation? This is, what kind of work do you mainly do?

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

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

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

917. CHECK 701:

918. CHECK 916:

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

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

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

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

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

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

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

925A. How likely are you to lose your property rights on this house or on any other of your houses in the next 5 years?

925B. What is the source of a potential loss of your property rights on this house on any other of your houses?

925C. Do you have the right to exclusively or jointly bequeath this house or any other of your houses?

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

926A. What is the type of title deed over this house?

926B. What type of title deed do you have?

927. Is your name on the title deed?

927A. Can I see the title deed?

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

928A. Do you have tenure rights on agricultural land or on non-agricultural land?

928B. What type of rights?

928C. How likely are you to lose your property rights or your rights of using your land(s) in the next 5 years?

928D. What is the source of the potential loss of your property right or right of using this (these) land(s)?

928E. Do you have the right to exclusively or jointly bequeath your land?

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

929A. What type of title deed over the land do you have?

930. Is your name on the title deed?

930A. Can I see the title deed?

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

932. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

SECTION 10: HIV / AIDS

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

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

1003. Can people get HIV from mosquito bites?

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

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

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

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

1008. Can HIV be transmitted from a mother to her baby:

1009. CHECK 1008:

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

1011. CHECK 208 AND 215:

1012. CHECK 408 FOR LAST BIRTH:

1013. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

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

1016. Were you tested for HIV as part of your antenatal care?

1017. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1018. Did you get the results of the test?

1018A. What was the result of the test?

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

1020. CHECK 430 FOR LAST BIRTH:

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

1022. Were you tested for HIV at that time?

1023. Did you get the results of the test?

1023A. What was the result of the test?

1024. CHECK 1016:

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

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

1027. Have you ever been tested for HIV?

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

1029. Did you get the results of the test?

1029A. What was the result of the test?

1030. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

1032. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

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

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

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

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

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

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

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

1042. CHECK 1001:

1043. CHECK 713:

1044. CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

1045. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

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

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

1048. CHECK 1045, 1046, AND 1047:

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

1050. Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1051. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

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

1053. CHECK 701:

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

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

1056. CHECK 106: AGE OF RESPONDENT

SECTION 11: OTHER HEALTH ISSUES

1101. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1102. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

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

1108. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not a big problem:

1109. Are you covered by any health insurance?

1110. What type of health insurance are you covered by?
RECORD ALL MENTIONED.

1111. Do you currently smoke tobacco every day, some days, or not at all?

1112. In the past, have you smoked tobacco every day?

1113. In the past, have you ever smoked tobacco every day, some days, or not at all?

1114. On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

1115. On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

1116. Do you currently use smokeless tobacco every day, some days, or not at all?

1117. On average, how many times a day do you use the following products? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

1118. On average, how many times a week do you use the following products? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

1119. In the past, have you ever used smokeless tobacco every day?

1120. In the past, have you ever used smokeless tobacco every day, some days, or not at all?

1121. CHECK 1111, 1113, 1116, AND 1120:

1122. How old were you the first time you smoked tobacco or used smokeless tobacco?

1123. How often does anyone smoke inside your house? Would you say daily, weekly, monthly, less often than once a month, or never?

1124. Do you work outside your home?

1125. Do you usually work indoors or outdoors?

1126. In the last 30 days, has any one smoked inside the room where you work?

1127. CHECK 1111:

1128. In the last 12 months, have you tried to stop smoking?

1129. Have you consulted a doctor or any other health professional in the last 12 months?

1130. During a consultation with a doctor or another health professional in the last 12 months, have been advised to stop smoking?

1131. In the last 30 days, have you seen any information on the harmful effects of cigarettes or smoking cessation incitements in newspapers or magazines?

1132. In the last 30 days, have you seen or heard any information on the harmful effects of cigarettes or smoking cessation incitements on television?

1133. In the last 30 days, have you seen health warnings on cigarette packs?

1134. CHECK 1111:

1135. In the last 30 days, have health warnings on cigarette packs made you want to quit smoking?

1136. In the past 30 days, have you seen advertisements on cigarettes or promotional signs for cigarettes in marketplace?

1137. In the last 30 days, have you seen or heard any of the following types of promotion for cigarettes?

1138. CHECK 1114a) AND 1115a):

1139. The last time you bought cigarettes / packs of cigarettes or cigarette cartridges for your personal use, how many did you buy?
CHECK THE UNIT WITH THE RESPONDANT BEFORE RECORDING THE NUMBER.

1140. In total, how much did you spend for the purchase?

SECTION 12: NON-COMMUNICABLE DISEASES

1201. Have you ever had your blood pressure measured by a doctor or other health worker?

1202. Have you ever been told by a doctor or other health worker that you have high BP, that is, high blood pressure or hypertension?

1203. In the past 12 months, have you been told by a doctor or other health worker that you have high BP, that is, high blood pressure or hypertension?

1204. Has a doctor or other healthcare worker prescribed medication to control your blood pressure?

1205. Are you taking medication to control your blood pressure?

1206. Have you ever had your blood sugar measured by a doctor or other health worker?

1207. Have you ever been told by a doctor or other health worker that you have high blood sugar or diabetes?

1208. In the past 12 months, have you been told by a doctor or other health worker that you have high blood sugar or diabetes?

1209. Has a doctor or other healthcare worker prescribed medication to control your high blood sugar or diabetes?

1210. Are you taking medication to control your high blood sugar or diabetes?

1211. Have you ever been told by a doctor or other health worker that you have heart disease?

1212. Are you receiving any treatment for heart disease?

1213. Have you ever been told by a doctor or other health worker that you have lung disease?

1214. Are you receiving any treatment for lung disease?

1215. Have you ever been told by a doctor or other health worker that you have cancer or a tumor?

1216. Are you receiving any treatment for cancer or a tumor?

1217. Have you ever been told by a doctor or other health worker that you have depression?

1218. Are you receiving any treatment for depression?

1219. Have you ever been told by a doctor or other health worker that you have arthritis?

1220. Are you receiving any treatment for arthritis?

1221. Have you ever been told by a doctor or other health worker that you have any other chronic disease, that is, any other disease that is long lasting?

1222. Are you receiving any treatment for (CHRONIC DISEASE FROM 1221)?

1223. Have you heard of cervical cancer?

1224. Have you ever heard of any test for cervical cancer?

1225. Now I'm going to ask you about tests a health care worker can do to check for cervical cancer, which is cancer in the cervix. The cervix connects the womb to the vagina. To be checked for cervical cancer, a woman is asked to lie on her back with her legs apart. Then the health care worker will use a brush or swab to collect a sample from inside her. The sample sent to a laboratory for testing. This test is called a Pap smear or HPV test. Another method is called a VIA or Visual Inspection with Acetic Acid. In this test, the health care worker puts vinegar on the cervix to see if there is a reaction.

1226. Has a doctor or other healthcare worker ever tested you for cervical cancer?

1227. How many years ago was your last test for cervical cancer?
IF LESS THAN 1 YEAR, RECORD '00'.

1228. What was the result of your last test for cervical cancer?

1229. Did you receive any treatment to your cervix or have any follow up visits because of your test results?

SECTION 13: FISTULA MODULE

1301. Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery.
Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

1302. Have you ever heard of this problem?

1303. Did this problem start after you delivered a baby or had a stillbirth?

1304. Did this problem start after a normal labor and delivery, or after a very difficult labor and delivery?

1305. What do you think caused this problem?

1306. How many days after (CAUSE OF PROBLEM FROM 1303 OR 1305) did the leakage start?
ENTER '90' IF 90 DAYS OR MORE.

1307. Have you sought treatment for this condition?

1308. Why have you not sought treatment?
PROBE AND RECORD ALL MENTIONED.

1309. From whom did you last seek treatment?

1310. Did you have an operation to fix the problem?

1311. Did the treatment stop the leakage completely?
IF NO: Did the treatment reduce the leakage?

SECTION 14: ADULT AND MATERNAL MORTALITY MODULE

1401. Now I would like to ask you some questions about your brothers and sisters born to your natural mother, including those who are living with you, those living elsewhere and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your natural mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all of your brothers and sisters born to your natural mother.

##note: a) repeated for b-t

1402. CHECK MM01:

1403. READ THE NAMES OF THE BROTHERS AND SISTERS TO THE RESPONDENT AND AFTER THE LAST ONE ASK: Are there any other brothers and sisters from the same mother that you have not mentioned?

1404. Sometimes people forget to mention children born to their natural mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have not mentioned?

1405. Sometimes people forget to mention children born to their natural mother because they have died. Are there any brothers or sisters who died that you have not mentioned?

1406. Some people have brothers or sisters from the same mother but a different father. Are there any brothers or sisters born to your natural mother, but who have a different natural father, that you have not mentioned?

1407. COUNT THE NUMBER OF BROTHERS AND SISTERS RECORDED IN 1401.

1408. CHECK 1407:
Just to make sure that I have this right: Your mother had in TOTAL________ births, excluding you, during her lifetime. Is that correct?

1409. CHECK 1407:

1410. Please tell me, which brother or sister was born first? And which was born next?
RECORD '01' FOR THE ORDER NUMBER IN 1401 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED THE ORDER NUMBER FOR ALL BROTHERS AND SISTERS.

1411. How many births did your mother have before you were born?

1412. LIST THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER IN MM01. ASK MM13 TO MM24 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE AN ADDITIONAL QUESTIONNAIRE.

1413. NAME OF BROTHER OR SISTER.

1414. Is (NAME) male or female?

1415. Is (NAME) still alive?

1416. How old is (NAME)?

1417. How many years ago did (NAME) die?

1418. How old was (NAME) when (he / she) died?
IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

1419. Was (NAME) pregnant when she died?

1420. Did (NAME) die during childbirth?

1421. Did (NAME) die within two months after the end of a pregnancy or childbirth?

1422. How many days after the end of the pregnancy did (NAME) die?

1423. Was (NAME)'s death due to an act of violence?

1424. Was (NAME)'s death due to an accident?

SECTION 15: HOUSEHOLD RELATIONS

1500. CHECK COVER PAGE: WOMAN SELECTED FOR HOUSEHOLD RELATIONS MODULE?

1501. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

1501A. READ TO THE RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Cameroon. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.

1502. CHECK 701 AND 702:

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

1504. Now I need to ask some more questions about your relationship with your (last) (husband / partner).

1505.

1506. CHECK 1505A (a-j):

1507. How long after you first (got married / started living together) with your (last) (husband / partner) did (this / any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

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

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

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

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

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

1513. Are (Were) you afraid of your (last) (husband / partner): most of the time, sometimes, or never?

1514. CHECK 709:

1515.

1516. CHECK 701 AND 702:

1517. Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.

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

1519. CHECK 201, 226, AND 230:

1520. Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1521. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

1522. CHECK 701 AND 702:

1522A. Now I want to ask you about things that may have been done to you by someone other than (your / any) (husband / partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

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

1523. Who was the person who was forcing you the very first time this happened?

1524. CHECK 701 AND 702:

1524A. CHECK 1505A (h-j) and 1515A(b):

1525. CHECK 701 AND 702:

1526. CHECK 1505A (a-j), 1515A (a,b), 1516, 1520, 1522A, AND 1522B:

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

1528. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1529. Have you ever told any one about this?

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

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE HOUSEHOLD RELATIONS MODULE ONLY.

1531. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1532. INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE HOUSEHOLD RELATION'S MODULE.

1533. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS