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


2018 CAMEROON DEMOGRAPHIC AND HEALTH SURVEY (2018 CDHS)
WOMAN'S QUESTIONNAIRE

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?

YES 1
NO 2

WOMAN SELECTED FOR HOUSEHOLD RELATIONS MODULE?

YES 1
NO 2

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:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)_______

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

INTERPRETER USED

YES 1
NO 2

**LANGUAGE CODES:

01 ENGLISH
02 FRENCH
03 FUFULDE
04 EWONDO
05 PIDGIN
96 OTHER (SPECIFY)__________

TEAM LEADER
NAME______
NUMBER______

CONTROLLER
NAME______
NUMBER______

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

HOUSEHOLD IS NOT SELECTED FOR MAN'S SURVEY (GO TO 100B)
HOUSEHOLD IS SELECTED FOR MAN'S SURVEY (GO TO CONSENT)

100B. CHECK HOUSEHOLD QUESTIONNAIRE: AGE FROM COLUMN 7

AGE 15-49 (GO TO INTRODUCTION AND CONSENT)
AGE 50-64 (GO TO 1533)

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?

SIGNATURE OF INTERVIEWER_______
DATE_______
RESPONDENT AGREES TO BE INTERVIEWED 1 (SKIP TO SECTION 1)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)

SECTION 1: RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOURS_______
MINUTES_______

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

YEARS______
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)

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

CITY 1
TOWN 2
RURAL AREA 3

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

ADAMAOUA 01
CENTRE (EXCLUDES YAOUNDE) 02
DOUALA 03
EAST 04
FAR NORTH 05
LITTORAL (EXCLUDES DOUALA) 06
NORTH 07
NORDWEST 08
WEST 09
SOUTH 10
SOUTHWEST 11
YAOUNDE 12
OUTSIDE OF CAMEROON 96

105. In what month and year were you born?

MONTH_______
DON'T KNOW MONTH 98
YEAR_______
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS_________

107. Have you ever attended school?

YES 1
NO 2 (SKIP TO 111)

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

PRIMARY 1
1ST SECONDARY CYCLE 2
2ND SECONDARY CYCLE 3
HIGHER 4

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

GRADE / FORM / YEAR__________

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

110. CHECK 108:

PRIMARY OR SECONDARY (GO TO 111)
HIGHER (SKIP TO 113)

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

CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)_______ 4
BLIND / VISUALLY IMPAIRED 5

112. CHECK 111:

CODE '2', '3' OR '4' CIRCLED (GO TO 113)
CODE '1' OR '5' CIRCLED (SKIP TO 114)

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

116. Do you own a mobile telephone?

YES 1
NO 2 (SKIP TO 118)

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

YES 1
NO 2

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

YES 1
NO 2

119. Have you ever used the internet?

YES 1
NO 2 (SKIP TO 122)

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

YES 1
NO 2 (SKIP TO 122)

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

122. What is your religion?

CATHOLIC 1
PROTESTANT 2
OTHER CHRISTIAN (SPECIFY)______ 3
MUSLIM 4
ANIMIST 5
OTHER (SPECIFY)______6
NONE 7

123. What is your ethnicity?

ETHNICITY____________
RECORD THE ETHNICITY AND LEAVE THE CODING BOXES EMPTY. FOR THE FOREIGNERS, RECORD " FOREIGN".

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

NUMBER OF TIMES________
NONE 00 (SKIP TO 126)

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

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2

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?

YES 1
NO 2 (SKIP TO 206)

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

YES 1
NO 2 (SKIP TO 204)

203.

a) How many sons live with you?
SONS AT HOME__________
IF NONE, RECORD '00'.
b) And how many daughters live with you?
DAUGHTERS AT HOME__________
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?

YES 1
NO 2 (SKIP TO 206)

205.

a) How many sons are alive but do not live with you?
SONS ELSEWHERE________
IF NONE, RECORD '00'.
b) And how many daughters are alive but do not live with you?
DAUGHTERS ELSEWHERE________
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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

YES 1
NO 2 (SKIP TO 208)

207.

a) How many boys have died?
BOYS DEAD_________
IF NONE, RECORD '00'.
b) And how many girls have died?
GIRLS DEAD_________
IF NONE, RECORD '00'.

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

TOTAL BIRTHS_________

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

YES (GO TO 209A)
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)

209A. CHECK 106: AGE OF RESPONDENT

AGE 15-49 (GO TO 210)
AGE 50-64 (GO TO 701)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (SKIP TO 226)

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

NAME________
RECORD NAME. BIRTH HISTORY NUMBER.

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

BOY 1
GIRL 2

214. Were any of these births twins?

SING 1
MULT 2

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

DAY______
MONTH______
YEAR______

216. Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 220)

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

AGE IN YEARS_________

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

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER__________ (SKIP TO 221)

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.

DAYS 1_________
MONTHS 2_________
YEARS 3_________

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

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

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

NUMBERS ARE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

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

NUMBER OF BIRTHS_________
NONE 0

226. Are you pregnant now?

YES 1
NO 2 (SKIP TO 230)
UNSURE 8 (SKIP TO 230)

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

MONTHS_________

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

YES 1 (SKIP TO 230)
NO 2

229. CHECK 208: TOTAL NUMBER OF BIRTHS.

ONE OR MORE:
a) Did you want to have a baby later on or did you not want any more children?
LATER 1
NO MORE / NONE 2
NONE:
b) Did you want to have a baby later on or did you not want any children?
LATER 1
NO MORE / NONE 2

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

YES 1
NO 2 (SKIP TO 239)

230A. How many such pregnancies have you had?

NUMBER OF PREGNANCIES________

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

MISCARRIAGE 1
ABORTION 2
STILLBIRTH 3

231. When did that last such pregnancy end?

MONTH______
YEAR______

232. CHECK 231:

LAST PREGNANCY ENDED IN 2013-2018 (SKIP TO 234)
LAST PREGNANCY ENDED IN 2012 OR EARLIER (SKIP TO 239)

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

MONTH_______
YEAR_______

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

MISCARRIAGE 1
ABORTION 2
STILLBIRTH 3

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

NUMBER OF MONTHS__________

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

YES 1 (NEXT LINE)
NO 2 (SKIP TO 236)

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

YES 1
NO 2 (SKIP TO 239)

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

MONTH_______
YEAR_______

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

MISCARRIAGE 1
ABORTION 2
STILLBIRTH 3

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

DAYS AGO 1__________
WEEKS AGO 2__________
MONTHS AGO 3__________
YEARS AGO 4__________
IN MENOPAUSE / HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

YES 1
NO 2 (SKIP TO 242)
DON'T KNOW 8 (SKIP TO 242)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY)_________ 6
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

SECTION 3: CONTRACEPTION

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

01 Female Sterilization.
PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02 Male Sterilization.
PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03 IUD.
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
04 Injectables.
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05 Implants.
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06 Pill.
PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07 Male Condom.
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 Female Condom.
PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 Emergency Contraception.
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
10 Standard Days Method.
PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
11 Lactational Amenorrhea Method (LAM).
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring intensive and frequent breastfeeding day and night.
YES 1
NO 2
12 Rhythm Method.
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
13 Withdrawal.
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD (SPECIFY)________ A
YES, TRADITIONAL METHOD (SPECIFY)________B
NO Y

302. CHECK 226:

NOT PREGNANT OR UNSURE (SKIP TO 303)
PREGNANT (SKIP TO 314)

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

YES 1
NO 2 (SKIP TO 314)

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

FEMALE STERILIZATION A (SKIP TO 307)
MALE STERILIZATION B (SKIP TO 307)
IUD C (SKIP TO 309)
INJECTABLES D (SKIP TO 309)
IMPLANTS E (SKIP TO 309)
PILL F (SKIP TO 309)
CONDOM G (SKIP TO 309)
FEMALE CONDOM H (SKIP TO 309)
EMERGENCY CONTRACEPTION I (SKIP TO 309)
STANDARD DAYS METHOD J (SKIP TO 309)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 309)
RHYTHM METHOD L (SKIP TO 309)
WITHDRAWAL M (SKIP TO 309)
OTHER MODERN METHOD X (SKIP TO 309)
OTHER TRADITIONAL METHOD Y (SKIP TO 309)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
INTEGRATED HEALTH CENTER / DISPENSARY 12
SUB-DIVISIONAL MEDICAL CENTER 13
OTHER PUBLIC SECTOR (SPECIFY)_________ 16
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 21
PRIVATE LAY HOSPITAL / CLINIC 22
CONFESSIONAL HEALTH CENTER / DISPENSARY 23
DOCTOR'S OFFICE 24
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________ 26
OTHER (SPECIFY)________ 96
DON'T KNOW 98

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

MONTH_________ (SKIP TO 315)
YEAR_________ (SKIP TO 315)

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?

MONTH_________ (SKIP TO 315)
YEAR__________ (SKIP TO 315)

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

YES 1 (SKIP TO 326)
NO 2 (SKIP TO 326)

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

FEMALE STERILIZATION 01 (SKIP TO 319)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 323)
RHYTHM METHOD 12 (SKIP TO 323)
WITHDRAWAL 13 (SKIP TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

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

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11
INTEGRATED HEALTH CENTER / DISPENSARY 12
SUB-DIVISIONAL MEDICAL CENTER 13
OTHER PUBLIC SECTOR (SPECIFY)________ 16
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 21
PRIVATE LAY HOSPITAL / CLINIC 22
CONFESSIONAL HEALTH CENTER / DISPENSARY 23
PHARMACY 24
DOCTOR'S OFFICE 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)__________ 26
OTHER SOURCE
SHOP / MARKET 31
CHURCH 32
FRIEND / RELATIVE 33
OTHER (SPECIFY)_________ 96

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

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07 (SKIP TO 323)
FEMALE CONDOM 08 (SKIP TO 322)
EMERGENCY CONTRACEPTION 09 (SKIP TO 322)
STANDARD DAYS METHOD 10 (SKIP TO 322)
OTHER MODERN METHOD 95 (SKIP TO 322)
OTHER TRADITIONAL METHOD 96 (SKIP TO 323)

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

YES 1 (SKIP TO 321)
NO 2 (SKIP TO 320)

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

YES 1 (SKIP TO 321)
NO 2

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

YES 1
NO 2 (SKIP TO 322)

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

YES 1
NO 2

322. CHECK 318 AND 319:

ANY 'YES':
a) At that time, were you told about other methods of family planning that you could use?
YES 1 (SKIP TO 324)
NO 2
OTHER:
b) When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?
YES 1 (SKIP TO 324)
NO 2

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

YES 1
NO 2

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

FEMALE STERILIZATION 01 (SKIP TO 327)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 327)
RHYTHM METHOD 12 (SKIP TO 327)
WITHDRAWAL 13 (SKIP TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (SKIP TO 327)

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

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 11 (SKIP TO 327)
INTEGRATED HEALTH CENTER / DISPENSARY 12 (SKIP TO 327)
SUB-DIVISIONAL MEDICAL CENTER 13 (SKIP TO 327)
OTHER PUBLIC SECTOR (SPECIFY)________16 (SKIP TO 327)
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 21 (SKIP TO 327)
PRIVATE LAY HOSPITAL / CLINIC 22 (SKIP TO 327)
CONFESSIONAL HEALTH CENTER / DISPENSARY 23 (SKIP TO 327)
PHARMACY 24 (SKIP TO 327)
DOCTOR'S OFFICE 25 (SKIP TO 327)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________26 (SKIP TO 327)
OTHER SOURCE
SHOP / MARKET 31 (SKIP TO 327)
CHURCH 32 (SKIP TO 327)
FRIEND / RELATIVE 33 (SKIP TO 327)
OTHER (SPECIFY)___________96 (SKIP TO 327)

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 329)

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

YES 1
NO 2

329. CHECK 202: CHILDREN LIVING WITH RESPONDENT?

YES:
a) In the last 12 months, have you visited a health facility for care for yourself or your children?
YES 1
NO 2 (SKIP TO 401)
NO:
b) In the last 12 months, have you visited a health facility for care for yourself?
YES 1
NO 2 (SKIP TO 401)

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

YES 1
NO 2

SECTION 4: PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2013-2018 (GO TO 402)
NO BIRTHS IN 2013-2018 (SKIP TO 648)

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.

LAST BIRTH
BIRTH HISTORY NUMBER_______
NEXT -- TO -- LAST BIRTH
BIRTH HISTORY NUMBER_______

404. FROM 212 AND 216:

NAME_______
LIVING (GO TO 405)
DEAD (GO TO 405)

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

LAST BIRTH:
YES 1 (SKIP TO 408)
NO 2
NEXT -- TO -- LAST BIRTH:
YES 1 (SKIP TO 426)
NO 2

406. CHECK 208:

ONLY ONE BIRTH:
a) Did you want to have a baby later on, or did you not want any children?
LATER 1
NO MORE / NONE 2 (SKIP TO 408)
MORE THAN ONE BIRTH:
b) Did you want to have a baby later on, or did you not want any more children?
LATER 1
NO MORE / NONE 2 (SKIP TO 408)

407. How much longer did you want to wait?

MONTHS 1_________
YEARS 2__________
DON'T KNOW 998

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

YES 1
NO 2 (SKIP TO 414)

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

HEALTH PERSONNEL
DOCTOR A
NURSE / MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY / VILLAGE HEALTH WORKER E
OTHER (SPECIFY)_________X

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.

HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
SUB-DIVISIONAL MEDICAL CENTER / INTERGRATED HEALTH CENTER / DISPENSARY D
OTHER PUBLIC SECTOR (SPECIFY)________E
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC F
PRIVATE LAY HOSPITAL / CLINIC G
CONFESSIONAL HEALTH CENTER / DISPENSARY H
DOCTOR'S OFFICE I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________J
OTHER (SPECIFY)_________X

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

MONTHS_________
DON'T KNOW 98

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

NUMBER OF TIMES_________
DON'T KNOW 98

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

a) Was your blood pressure measured?
YES 1
NO 2
b) Did you give a urine sample?
YES 1
NO 2
c) Did you give a blood sample?
YES 1
NO 2
d) Were you weighed?
YES 1
NO 2
e) Was your height measured?
YES 1
NO 2
f) Did you undergo a vaginal touch?
YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 417)
DON'T KNOW 8 (SKIP TO 417)

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

TIMES_________
DON'T KNOW 8

416. CHECK 415:

2 OR MORE TIMES (SKIP TO 420)
OTHER (GO TO 417)

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

YES 1
NO 2 (SKIP TO 420)
DON'T KNOW 8 (SKIP TO 420)

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

TIMES__________
DON'T KNOW 8

419. CHECK 418:

ONLY ONE:
a) How many years ago did you receive that tetanus injection?
YEARS AGO__________
MORE THAN ONE:
b) How many years ago did you receive the last tetanus injection prior to this pregnancy?
YEARS AGO__________

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

YES 1
NO 2 (SKIP TO 422)
DON'T KNOW 8 (SKIP TO 422)

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

DAYS_________
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 426)
DON'T KNOW 8 (SKIP TO 426)

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

TIMES__________

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.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

427. Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 429)
DON'T KNOW 8 (SKIP TO 429)

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

KG FROM CARD 1 _____._____
KG FROM RECALL 2 _____._____
DON'T KNOW 99998

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.

HEALTH PERSONNEL
DOCTOR A
NURSE / MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE / FRIEND E
OTHER (SPECIFY)______X
NO ONE ASSISTED Y

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.

HOME
HER HOME 11 (SKIP TO 434)
OTHER HOME 12 (SKIP TO 434)
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 21
INTEGRATED HEALTH CENTER / DISPENSARY 22
SUB-DIVISIONAL MEDICAL CENTER 23
OTHER PUBLIC SECTOR (SPECIFY)________26
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 31
PRIVATE LAY HOSPITAL / CLINIC 32
CONFESSIONAL HEALTH CENTER / DISPENSARY 33
DOCTOR'S OFFICE 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________36
OTHER (SPECIFY)_________96 (SKIP TO 434)

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

HOURS 1__________
DAYS 2__________
WEEKS 3__________
DON'T KNOW 998

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

YES 1
NO 2 (SKIP TO 434)

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

BEFORE 1
AFTER 2

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

YES 1
NO 2 (SKIP TO 434B)
DON'T KNOW 8 (SKIP TO 434B)

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

YES 1
NO 2
DON'T KNOW 8

434B. CHECK 430: PLACE OF DELIVERY

CODE 11,12, OR 96 CIRCLED (SKIP TO 449)
OTHER (SKIP TO 435)

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

YES 1
NO 2 (SKIP TO 438)

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

HOURS 1________
DAYS 2________
WEEKS 3________
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE / MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY / VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)________96

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?

YES 1
NO 2 (SKIP TO 441)
DON'T KNOW 8 (SKIP TO 441)

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

HOURS 1____________
DAYS 2____________
WEEKS 3____________
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE / MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY / VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)__________96

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

YES 1
NO 2 (SKIP TO 445)

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

HOURS 1_________
DAYS 2_________
WEEKS 3_________
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE / MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY / VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)________96

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.

HOME
HER HOME 11
OTHER HOME 12
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 21
INTEGRATED HEALTH CENTER / DISPENSARY 22
SUB-DIVISIONAL MEDICAL CENTER 23
OTHER PUBLIC SECTOR (SPECIFY)_________26
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 31
PRIVATE LAY HOSPITAL / CLINIC 32
CONFESSIONAL HEALTH CENTER / DISPENSARY 33
DOCTOR'S OFFICE 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________36
OTHER (SPECIFY)_________96

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

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

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

HOURS 1___________
DAYS 2___________
WEEKS 3___________
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE / MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY / VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)_________96

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.

HOME
HER HOME 11 (SKIP TO 457)
OTHER HOME 12 (SKIP TO 457)
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 21 (SKIP TO 457)
INTEGRATED HEALTH CENTER / DISPENSARY 22 (SKIP TO 457)
SUB-DIVISIONAL MEDICAL CENTER 23 (SKIP TO 457)
OTHER PUBLIC SECTOR (SPECIFY)_________26 (SKIP TO 457)
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 31 (SKIP TO 457)
PRIVATE LAY HOSPITAL / CLINIC 32 (SKIP TO 457)
CONFESSIONAL HEALTH CENTER / DISPENSARY 33 (SKIP TO 457)
DOCTOR'S OFFICE 34 (SKIP TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________36 (SKIP TO 457)
OTHER (SPECIFY)__________96 (SKIP TO 457)

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

YES 1
NO 2 (SKIP TO 453)

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

HOURS 1_________
DAYS 2__________
WEEKS 3__________
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE / MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY / VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)________96

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.

HOME
HER HOME 11
OTHER HOME 12
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 21
INTEGRATED HEALTH CENTER / DISPENSARY 22
SUB-DIVISIONAL MEDICAL CENTER 23
OTHER PUBLIC SECTOR (SPECIFY)________26
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 31
PRIVATE LAY HOSPITAL / CLINIC 32
CONFESSIONAL HEALTH CENTER / DISPENSARY 33
DOCTOR'S OFFICE 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________36
OTHER (SPECIFY)_________96

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

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

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

HOURS AFTER BIRTH 1___________
DAYS AFTER BIRTH 2___________
WEEKS AFTER BIRTH 3___________
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE / MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY / VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)__________96

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.

HOME
HER HOME 11
OTHER HOME 12
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL 21
INTEGRATED HEALTH CENTER / DISPENSARY 22
SUB-DIVISIONAL MEDICAL CENTER 23
OTHER PUBLIC SECTOR (SPECIFY)__________26
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 31
PRIVATE LAY HOSPITAL / CLINIC 32
CONFESSIONAL HEALTH CENTER / DISPENSARY 33
DOCTOR'S OFFICE 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________36
OTHER (SPECIFY)_________96

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

a) Examining the cord?
YES 1
NO 2
DON'T KNOW 8
b) Measure (NAME)'s temperature?
YES 1
NO 2
DON'T KNOW 8
c) Counsel you on danger signs for newborns?
YES 1
NO 2
DON'T KNOW 8
d) Counsel you on breastfeeding?
YES 1
NO 2
DON'T KNOW 8
e) Observe (NAME) breastfeeding?
YES 1
NO 2
DON'T KNOW 8

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

YES 1 (SKIP TO 460)
NO 2 (SKIP TO 461)

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

YES 1
NO 2 (SKIP TO 463)

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

MONTHS________
DON'T KNOW 98

461. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 462)
PREGNANT OR UNSURE (SKIP TO 463)

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

YES 1
NO 2 (SKIP TO 464)

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

MONTHS_________
DON'T KNOW 98

464. Did you ever breastfeed (NAME)?

YES 1 (SKIP TO 466)
NO 2

465. CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 470)
DEAD (SKIP TO 471)

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

IMMEDIATELY 000
HOURS 1_________
DAYS 2_________

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

YES 1
NO 2

468. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 469)
DEAD (SKIP TO 471)

469. Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5A: CHILD IMMUNIZATION (LAST BIRTH)

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

ONE OR MORE BIRTHS IN 2015-2018 (GO TO 502A)
NO BIRTHS IN 2015-2018 (SKIP TO 601)

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

NAME OF LAST BIRTH____________
BIRTH HISTORY NUMBER____________

503A. CHECK 216 FOR CHILD:

LIVING (GO TO 504A)
DEAD (SKIP TO 501B)

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

YES, HAS ONLY A CARD 1 (SKIP TO 507A)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (SKIP TO 507A)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

506A. CHECK 504A:

CODE '2' CIRCLED (GO TO 507A)
CODE '4' CIRCLED (SKIP TO 511A)

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

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT 4 (SKIP TO 511A)

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.

BCG
DAY_________
MONTH_________
YEAR_________
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY__________
MONTH__________
YEAR__________
ORAL POLIO VACCINE (OPV) 1
DAY__________
MONTH__________
YEAR__________
ORAL POLIO VACCINE (OPV) 2
DAY__________
MONTH__________
YEAR__________
ORAL POLIO VACCINE (OPV) 3
DAY__________
MONTH__________
YEAR__________
DPT-HepB-Hib (PENTAVALENT) 1
DAY__________
MONTH__________
YEAR__________
DPT-HepB-Hib (PENTAVALENT) 2
DAY__________
MONTH__________
YEAR__________
DPT-HepB-Hib (PENTAVALENT) 3
DAY__________
MONTH__________
YEAR__________
PNEUMOCOCCAL (Pneumo13) 1
DAY__________
MONTH__________
YEAR__________
PNEUMOCOCCAL (Pneumo13) 2
DAY__________
MONTH__________
YEAR__________
PNEUMOCOCCAL (Pneumo13) 3
DAY__________
MONTH__________
YEAR__________
ROTAVIRUS (Rota) 1
DAY__________
MONTH__________
YEAR__________
ROTAVIRUS (Rota) 2
DAY__________
MONTH__________
YEAR__________
MEASLES / MMR (AMV) 1
DAY__________
MONTH__________
YEAR__________
YELLOW FEVER 1
DAY__________
MONTH__________
YEAR__________
VITAMIN A (MOST RECENT)
DAY__________
MONTH__________
YEAR__________

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

NO (GO TO 510A)
YES (SKIP TO 526A)

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A THEN WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 526A)

NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 526A)

DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 526A)

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

YES 1
NO 2 (SKIP TO 526A)
DON'T KNOW 8 (SKIP TO 526A)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 517A)
DON'T KNOW 8 (SKIP TO 517A)

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

FIRST TWO WEEKS 1
LATER 2

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

NUMBER OF TIMES__________

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

YES 1
NO 2 (SKIP TO 519A)
DON'T KNOW 8 (SKIP TO 519A)

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

NUMBER OF TIMES__________

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

YES 1
NO 2 (SKIP TO 521A)
DON'T KNOW 8 (SKIP TO 521A)

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

NUMBER OF TIMES__________

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

YES 1
NO 2 (SKIP TO 523A)
DON'T KNOW 8 (SKIP TO 523A)

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

NUMBER OF TIMES__________

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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:

ONE OR MORE BIRTHS IN 2013-2018 (GO TO 602)
NO BIRTHS IN 2013-2018 (SKIP TO 648)

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.

LAST BIRTH
BIRTH HISTORY NUMBER_________
NEXT-TO-LAST BIRTH
BIRTH HISTORY NUMBER_________

604. FROM 212 AND 216:

NAME________
LIVING (GO TO 605)
DEAD (SKIP TO 646)

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.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

609. CHECK 469: CURRENTLY BREASTFEEDING?

YES:
a) Now I would like to know how much (NAME) was given to drink during the diarrhea including breastmilk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
NO / NOT:
b) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 615)

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

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL A
SUB-DIVISIONAL MEDICAL CENTER / INTEGRATED HEALTH CENTER / DISPENSARY B
HEALTH / COMMUNITY WORKER C
OTHER PUBLIC SECTOR (SPECIFY)________D
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC E
PRIVATE LAY HOSPITAL / CLINIC F
CONFESSIONAL HEALTH CENTER / DISPENSARY G
DOCTOR'S OFFICE H
PHARMACY I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________J
OTHER SOURCE
SHOP / MARKET K
TRADITIONAL PRACTITIONER L
ITINERANT / NON ITINERANT DRUG SELLER M
NGO / GIC N
COMMUNITY RELAY / HEALTHWORKER O
OTHER (SPECIFY)___________X

613. CHECK 612:

TWO OR MORE CODES CIRCLED (GO TO 614)
ONLY ONE CODE CIRCLED (SKIP TO 615)

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

FIRST PLACE___________

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

a) A fluid made from a special packet called ORS?
YES 1
NO 2
DON'T KNOW 8
c) Homemade sugar-salt-water solution (SSS)?
YES 1
NO 2
DON'T KNOW 8
d) Zinc tablets or syrup?
YES 1
NO 2
DON'T KNOW 8

616. CHECK 615:

ANY 'YES':
a) Was anything else given to treat the diarrhea?
YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)
ALL 'NO' OR 'DK':
b) Was anything given to treat the diarrhea?
YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

617. CHECK 615:
RECORD ALL TREATMENTS.

ANY 'YES':
a) What else was given to treat the diarrhea? Anything else?
PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D

INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HOME REMEDY / HERBAL MEDICINE I
OTHER (SPECIFY)_______X
ALL 'NO' OR 'DK':
b) What was given to treat the diarrhea? Anything else?
PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D

INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HOME REMEDY / HERBAL MEDICINE I
OTHER (SPECIFY)_______X

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

YES 1
NO 2 (SKIP TO 620)
DON'T KNOW 8 (SKIP TO 620)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 623)
DON'T KNOW 8 (SKIP TO 623)

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

CHEST ONLY 1 (SKIP TO 624)
NOSE ONLY 2 (SKIP TO 624)
BOTH 3 (SKIP TO 624)
OTHER (SPECIFY)_______6 (SKIP TO 624)
DON'T KNOW 8 (SKIP TO 624)

623. CHECK 618: HAD FEVER?

YES (GO TO 624)
NO OR DK (SKIP TO 646)

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

YES 1
NO 2 (SKIP TO 629)

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

PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL A
SUB-DIVISIONAL MEDICAL CENTER / INTEGRATED HEALTH CENTER / DISPENSARY B
HEALTH / COMMUNITY WORKER C
OTHER PUBLIC SECTOR (SPECIFY)________D
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC E
PRIVATE LAY HOSPITAL / CLINIC F
CONFESSIONAL HEALTH CENTER / DISPENSARY G
DOCTOR'S OFFICE H
PHARMACY I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________J
OTHER SOURCE
SHOP / MARKET K
TRADITIONAL PRACTITIONER L
ITINERANT / NON ITINERANT DRUG SELLER M
NGO / GIC N
COMMUNITY RELAY / HEALTHWORKER O
OTHER (SPECIFY)________X

626. CHECK 625:

TWO OR MORE CODES CIRCLED (GO TO 627)
ONLY ONE CODE CIRCLED (SKIP TO 628)

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

FIRST PLACE_________

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

DAYS__________

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

YES 1
NO 2 (SKIP TO 646)
DON'T KNOW 8 (SKIP TO 646)

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

ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT) A
SP / FANSIDAR B
AMODIAQUINE C
QUININE PILLS D
INJECTION / IV E
ARTESUNATE RECTAL F
INJECTION / IV G
OTHER ANTIMALARIAL (SPECIFY)________H
ANTIBIOTIC DRUGS
PILL / SYRUP I
INJECTION / IV J
OTHER DRUGS
ASPIRIN K
PARACETAMOL L
IBUPROFEN M
OTHER (SPECIFY)__________X
DON'T KNOW Z

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

YES (GO TO 632)
NO (SKIP TO 646)

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

CODE 'A' CIRCLED (GO TO 633)
CODE 'A' NOT CIRCLED (SKIP TO 634)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

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

CODE 'B' CIRCLED (GO TO 635)
CODE 'B' NOT CIRCLED (SKIP TO 636)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

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

CODE 'C' CIRCLED (GO TO 639)
CODE 'C' NOT CIRCLED (SKIP TO 640)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

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

CODE 'D' OR 'E' CIRCLED (GO TO 641)
CODE 'D' OR 'E' NOT CIRCLED (SKIP TO 642)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

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

CODE 'F' OR 'G' CIRCLED (GO TO 643)
CODE 'F' OR 'G' NOT CIRCLED (SKIP TO 644)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

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

CODE 'H' CIRCLED (GO TO 645)
CODE 'H' NOT CIRCLED (SKIP TO 646)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8

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

647. CHECK 615(a) ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 648)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (SKIP TO 649)

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

YES 1
NO 2

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

NAME OF YOUNGEST CHILD LIVING WITH HER__________
ONE OR MORE (GO TO 650)
NONE (SKIP TO 701)

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

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk?
NUMBER OF TIMES DRANK_________
IF 7 OR MORE TIMES, RECORD '7'.
e) Infant formula?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink infant formula?
NUMBER OF TIMES DRANK_________
IF 7 OR MORE TIMES, RECORD '7'.
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) eat yogurt?
NUMBER OF TIMES ATE_________
IF 7 OR MORE TIMES, RECORD '7'.
h) Any commercially fortified food (e.g. cerelac, bledine, phosphatine, bledilac)?
YES 1
NO 2
DON'T KNOW 8
i) Fufu, bread, millet, sorghum, maize, rice, wheat, noodles, porridge, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash, or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, cassava, white sweet potatoes, colocasia, cocoyam, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Cassava leaves, kale, spinach, pepper leaves, colocasia, leaves, amaranth leaves, or other fresh or dried dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, papayas, avocados, oranges, guava, pineappleĀ ?
YES 1
NO 2
DON'T KNOW 8
n) Any other fresh or dried fruits or dried fruits or vegetables (e.g. bananas, apples, applesauce, plantains, green beans, tomatoes, okra)?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart, or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, soybeans, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Foods made with red palm oil, palm nut, or palm nut pulp sauce?
YES 1
NO 2
DON'T KNOW 8
v) Grubs, snails, insects or other small protein?
YES 1
NO 2
DON'T KNOW 8
w) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

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

NOT A SINGLE 'YES' (GO TO 652)
AT LEAST ONE 'YES' (SKIP TO 653)

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

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY) (THEN CONTINUE TO 653)
NO 2 (SKIP TO 654)

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

NUMBER OF TIMES_________
DON'T KNOW 8

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

CHILD USED TOILET OR LATRINE 01
PUT / RINSED INTO TOILET OR LATRINE 02
PUT / RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY)__________96

SECTION 7: MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (SKIP TO 704)
YES, LIVING WITH A MAN 2 (SKIP TO 704)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (SKIP TO 712)

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

WIDOWED 1 (SKIP TO 709)
DIVORCED 2 (SKIP TO 709)
SEPARATED 3 (SKIP TO 709)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME__________
LINE NO.__________

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

YES 1
NO 2 (SKIP TO 709)
DON'T KNOW 8 (SKIP TO 709)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNER____________
DON'T KNOW 98

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

RANK___________

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

ONLY ONCE 1
MORE THAN ONCE 2

710. CHECK 709:

MARRIED / LIVED WITH A MAN ONLY ONCE:
a) In what month and year did you start living with your (husband / partner)?
MONTH_________
DON'T KNOW MONTH 98
YEAR_________ (SKIP TO 712)
DON'T KNOW YEAR 9998
MARRIED / LIVED WITH A MAN MORE THAN ONCE:
b) Now I would like to ask about your first (husband / partner). In what month and year did you start living with him?
MONTH__________
DON'T KNOW MONTH 98
YEAR__________ (SKIP TO 712)
DON'T KNOW YEAR 9998

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

AGE__________

712. CHECK FOR 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?

NEVER HAD SEXUAL INTERCOURSE 00 (SKIP TO 731)
AGE IN YEARS___________

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

DAYS AGO 1_______ (SKIP TO 716)
WEEKS AGO 2_______ (SKIP TO 716)
MONTHS AGO 3_______ (SKIP TO 716)
YEARS AGO 4_______ (SKIP TO 727)

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

DAYS AGO 1________
WEEKS AGO 2________
MONTHS AGO 3________

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

YES 1
NO 2 (SKIP TO 718)

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

YES 1
NO 2

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

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT / SEX WORKER 5
OTHER (SPECIFY)_______6

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

DAYS AGO 1_________
WEEKS AGO 2_________
MONTHS AGO 3_________
YEARS AGO 4_________

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

NUMBER OF TIMES__________

721. How old is this person?

AGE OF PARTNER_________
DON'T KNOW 98

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

YES 1 (GO BACK TO 715 IN NEXT COLUMN)
NO 2 (SKIP TO 724)

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'.

NUMBER OF PARTNERS LAST 12 MONTHS____________
DON'T KNOW 98

724. CHECK 106:

AGE 15-24 (GO TO 725)
AGE 25-49 (SKIP TO 727)

725. CHECK 701:

NOT IN A UNION (GO TO 726)
CURRENTLY MARRIED / LIVING WITH A MAN (SKIP TO 727)

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

YES 1
NO 2

727. In total, 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'.

NUMBER OF PARTNERS IN LIFETIME_________
DON'T KNOW 98

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

YES, CONDOM USED (GO TO 730)
NO, CONDOM NOT USED (SKIP TO 731)
NOT ASKED (SKIP TO 731)

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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
INTEGRATED HEALTH CENTER / DISPENSARY 12
SUB-DIVISIONAL MEDICAL CENTER 13
HEALTH / COMMUNITY WORKER 14
OTHER PUBLIC SECTOR (SPECIFY)________16
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 21
PRIVATE LAY HOSPITAL / CLINIC 22
CONFESSIONAL HEALTH CENTER / DISPENSARY 23
DOCTOR'S OFFICE 24
PHARMACY 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________26
OTHER SOURCE
SHOP / MARKET 31
KIOSK / BOX 32
ITINERANT SELLAR 33
BAR / NIGHT CLUB 34
PARTNER HAD A CONDOM 35
FRIEND / RELATIVE 36
HOTEL / MOTEL / HOSTEL 37
OTHER (SPECIFY)_________96
DON'T KNOW 98

731. PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN UNDER 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

732. CHECK 106: AGE OF RESPONDENT

AGE 15-49 (GO TO 801)
AGE 50-64 (SKIP TO 901)

SECTION 8: FERTILITY PREFERENCES

801. CHECK 304:

NEITHER STERILIZED (GO TO 802)
HE OR SHE STERILIZED (SKIP TO 813)

802. CHECK 226:

PREGNANT (GO TO 803)
NOT PREGNANT OR UNSURE (SKIP TO 804)

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

HAVE ANOTHER CHILD 1 (SKIP TO 805)
NO MORE 2 (SKIP TO 812)
UNDECIDED / DON'T KNOW 8 (SKIP TO 812)

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

HAVE (A / ANOTHER) CHILD 1
NO MORE / NONE (SKIP TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 813)
UNDECIDED / DON'T KNOW 8 (SKIP TO 811)

805. CHECK 226:

NOT PREGNANT OR UNSURE:
a) How long would you like to wait from now before the birth of (a / another) child?
MONTHS 1________
YEARS 2________
SOON / NOW 993 (SKIP TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 813)
AFTER MARRIAGE 995 (SKIP TO 811)
OTHER (SPECIFY)______996 (SKIP TO 811)
DON'T KNOW 998 (SKIP TO 811)
PREGNANT:
b) After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
MONTHS 1________
YEARS 2________
SOON / NOW 993 (SKIP TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 813)
AFTER MARRIAGE 995 (SKIP TO 811)
OTHER (SPECIFY)______996 (SKIP TO 811)
DON'T KNOW 998 (SKIP TO 811)

806. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 807)
PREGNANT (SKIP TO 812)

807. CHECK 303: USING A CONTRACEPTIVE

NOT CURRENTLY USING (GO TO 808)
CURRENTLY USING (SKIP TO 813)

808. CHECK 805:

'24' OR MORE MONTHS OR '02' OR MORE YEARS (GO TO 809)
'00-23' MONTHS OR '00-01' YEAR (SKIP TO 812)
NOT ASKED (GO TO 809)

809. CHECK 714:

DAYS, WEEKS OR MONTHS AGO (GO TO 810)
YEARS AGO (SKIP TO 811)
NOT ASKED (SKIP TO 811)

810. CHECK 804:

WANTS TO HAVE A / ANOTHER CHILD:
a) You have said that you do not want (a / another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
RECORD ALL REASONS MENTIONED.
NOT MARRIED A

FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL / HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD / FATALISTIC H

OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND / PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L

LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N

METHOD-RELATED REASONS
SIDE EFFECTS / HEALTH CONCERN O
LACK OF ACCESS / TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY)________X
DON'T KNOW Z
WANTS NO MORE / NONE:
b) You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
RECORD ALL REASONS MENTIONED.
NOT MARRIED A

FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL / HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD / FATALISTIC H

OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND / PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L

LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N

METHOD-RELATED REASONS
SIDE EFFECTS / HEALTH CONCERN O
LACK OF ACCESS / TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY)________X
DON'T KNOW Z

811. CHECK 303: USING A CONTRACEPTIVE

NOT ASKED (GO TO 812)
NO, NOT CURRENTLY USING (GO TO 812)
YES, CURRENTLY USING (SKIP TO 813)

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

YES 1
NO 2
DON'T KNOW 8

813. CHECK 216:

HAS LIVING CHILDREN:
a) If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NONE 00 (SKIP TO 815)
NUMBER_________
OTHER (SPECIFY)_________96 (SKIP TO 815)
NO LIVING CHILDREN:
b) If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NONE 00 (SKIP TO 815)
NUMBER_________
OTHER (SPECIFY)_________96 (SKIP TO 815)

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

NUMBER BOYS__________
NUMBER GIRLS__________
NUMBER EITHER__________
OTHER (SPECIFY)________96

815. In the last few months have you:

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2
d) Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2
e) Seen anything about family planning on banners or billboards?
YES 1
NO 2

817. CHECK 701:

YES, CURRENTLY MARRIED (GO TO 818)
YES, LIVING WITH A MAN (GO TO 818)
NO, NOT IN A UNION (SKIP TO 901)

818. CHECK 303: USING A CONTRACEPTIVE

CURRENTLY USING (GO TO 819)
NOT CURRENTLY USING (SKIP TO 820)
NOT ASKED (SKIP TO 822)

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

MAINLY RESPONDENT 1 (SKIP TO 821)
MAINLY HUSBAND / PARTNER 2 (SKIP TO 821)
JOINT DECISION 3 (SKIP TO 821)
OTHER (SPECIFY)_______6 (SKIP TO 821)

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

MAINLY RESPONDENT 1
MAINLY HUSBAND / PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY)________6

821. CHECK 304:

NEITHER ARE STERILIZED (GO TO 822)
HE OR SHE ARE STERILIZED (SKIP TO 901)

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

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

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

901. CHECK 701:

CURRENTLY MARRIED / LIVING WITH A MAN (GO TO 902)
NOT IN UNION (SKIP TO 909)

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

AGE IN COMPLETED YEARS___________

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

YES 1
NO 2 (SKIP TO 906)

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

PRIMARY 1
1ST SECONDARY CYCLE 2
2ND SECONDARY CYCLE 2
HIGHER 3
DON'T KNOW 8 (SKIP TO 906)

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

GRADE / FORM / YEAR___________
DON'T KNOW 98

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

YES 1 (SKIP TO 908)
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 909)
DON'T KNOW 8 (SKIP TO 909)

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

OCCUPATION___________

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

YES 1 (SKIP TO 913)
NO 2

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

YES 1 (SKIP TO 913)
NO 2

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

YES 1 (SKIP TO 913)
NO 2

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

YES 1
NO 2 (SKIP TO 917)

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?

OCCUPATION____________

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

FOR FAMILY MEMBERS 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

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

THROUGHOUT THE YEAR 1
SEASONALLY / PART OF THE YEAR 2
ONCE IN AWHILE 3

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

917. CHECK 701:

CURRENTLY MARRIED / LIVING WITH A MAN (GO TO 918)
NOT IN UNION (SKIP TO 925)

918. CHECK 916:

CODE '1' OR '2' CIRCLED (GO TO 919)
OTHER (SKIP TO 921)

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

RESPONDENT 1
HUSBAND / PARTNER 2
RESPONDENT AND HUSBAND / PARTNER JOINTLY 3
OTHER (SPECIFY)________6

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND / PARTNER HAS NO EARNINGS 4 (SKIP TO 922)
DON'T KNOW 8

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

RESPONDENT 1
HUSBAND / PARTNER 2
RESPONDENT AND HUSBAND / PARTNER JOINTLY 3
HUSBAND / PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY)_________6

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

RESPONDENT 1
HUSBAND / PARTNER 2
RESPONDENT AND HUSBAND / PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

RESPONDENT 1
HUSBAND / PARTNER 2
RESPONDENT AND HUSBAND / PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

RESPONDENT 1
HUSBAND / PARTNER 2
RESPONDENT AND HUSBAND / PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 928)

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?

VERY LIKELY 1
SOMEWHAT LIKELY 2
NOT LIKELY 3 (SKIP TO 925C)

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

NATIONAL GOVERNMENT 1
LOCAL AUTHORITIES 2
COMMERCIAL INTERESTS 3
FAMILY MEMBERS OR OTHER INDIVIDUALS 4

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

YES, ALONE ONLY 1
YES, JOINTLY ONLY 2
YES, BOTH ALONE AND JOINTLY 3
NO 4

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

YES 1
NO 2 (SKIP TO 928)
DON'T KNOW 8 (SKIP TO 928)

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

YES 1
NO 2
DOES NOT KNOW 8

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

CUSTOM CERTIFICATE A
SALE CERTIFICATE B
LAND CERTIFICATE C
OTHER DOCUMENT (SPECIFY)__________X

927. Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

927A. Can I see the title deed?

YES, CUSTOM CERTIFICATE SEEN A
YES, ATTESTATION / SALE CERTIFICATE SEEN B
YES, LAND CERTIFICATE SEEN C
YES, OTHER DOCUMENT SEEN D
NO, NO DOCUMENT SEEN E

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

YES, AGRICULTURAL LAND 1
YES, NON-AGRICULTURAL LAND 2
YES, FOR BOTH TYPES OF LAND 3
NO 4 (SKIP TO 931)

928B. What type of rights?

FREEHOLD 1
LEASEHOLD 2
OTHER (SPECIFY)_________6

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

VERY LIKELY 1
SOMEWHAT LIKELY 2
NOT LIKELY 3 (SKIP TO 928E)

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

NATIONAL GOVERNMENT 1
LOCAL AUTHORITIES 2
COMMERCIAL INTERESTS 3
FAMILY MEMBERS OR OTHER INDIVIDUALS 4

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

YES, ALONE ONLY 1
YES, JOINTLY ONLY 2
YES, BOTH ALONE AND JOINTLY 3
NO 4

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

YES, AGRICULTURAL LAND 1
YES, NON-AGRICULTURAL LAND 2
YES, BOTH TYPES OF LAND 3
NO 4 (SKIP TO 931)
DON'T KNOW 8 (SKIP TO 931)

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

CUSTOM CERTIFICATE A
ATTESTATION / SALE CERTIFICATE B
LAND CERTIFICATE C
OTHER DOCUMENT (SPECIFY)_________X

930. Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

930A. Can I see the title deed?

YES, CUSTOM CERTIFICATE SEEN A
YES, ATTESTATION / SALE CERTIFICATE SEEN B
YES, LAND CERTIFICATE SEEN C
YES, OTHER DOCUMENT SEEN D
NO, NO DOCUMENT SEEN E

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

CHILDREN UNDER 10:
PRESENT / LISTENING 1
PRESENT / NOT LISTENING 2
NOT PRESENT 3
HUSBAND:
PRESENT / LISTENING 1
PRESENT / NOT LISTENING 2
NOT PRESENT 3
OTHER MALES:
PRESENT / LISTENING 1
PRESENT / NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES:
PRESENT / LISTENING 1
PRESENT / NOT LISTENING 2
NOT PRESENT 3

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

a) If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
b) If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c) If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d) If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e) If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 10: HIV / AIDS

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

YES 1
NO 2 (SKIP TO 1042)

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

YES 1
NO 2
DON'T KNOW 8

1003. Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

a) During pregnancy?
YES 1
NO 2
DON'T KNOW 8
b) During delivery?
YES 1
NO 2
DON'T KNOW 8
c) By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

1009. CHECK 1008:

AT LEAST ONE 'YES' (GO TO 1010)
OTHER (SKIP TO 1011)

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

YES 1
NO 2
DON'T KNOW 8

1011. CHECK 208 AND 215:

LAST BIRTH IN 2016-2018 (GO TO 1012)
LAST BIRTH IN 2015 OR EARLIER (SKIP TO 1027)
NO BIRTHS (SKIP TO 1027)

1012. CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 1013)
NO ANTENATAL CARE (SKIP TO 1020)

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

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

a) Babies getting HIV from their mother?
YES 1
NO 2
DON'T KNOW 8
b) Things that you can do to prevent getting HIV?
YES 1
NO 2
DON'T KNOW 8
c) Getting tested for HIV?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1020)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
SUB-DIVISIONAL MEDICAL CENTER / INTEGRATED HEALTH CENTER / DISPENSARY 12
HEALTH / COMMUNITY WORKER 13
STAND-ALONE HTC CENTER 14
MOBILE HTC SERVICES / CNLS 15
OTHER PUBLIC SECTOR (SPECIFY)________16
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 21
PRIVATE LAY HOSPITAL / CLINIC 22
CONFESSIONAL HEALTH CENTER / DISPENSARY 23
DOCTOR'S OFFICE 24
PHARMACY 25
STAND-ALONE HTC CENTER 26
MOBILE HTC SERVICES 27
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________28
OTHER SOURCE
HOME 31
WORKPLACE 32
CORRECTIONAL FACILITY 33
SCHOOL / CULTURAL CENTER 34
OTHER (SPECIFY)_________96

1018. Did you get the results of the test?

YES 1
NO 2 (SKIP TO 1020)

1018A. What was the result of the test?

POSITIVE 1
NEGATIVE 2
INDETERMINATE 3
DECLINED TO ANSWER 4
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1020. CHECK 430 FOR LAST BIRTH:

ANY CODE '21-36' CIRCLED (GO TO 1021)
OTHER (SKIP TO 1024)

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

YES 1
NO 2

1022. Were you tested for HIV at that time?

YES 1
NO 2 (SKIP TO 1024)

1023. Did you get the results of the test?

YES 1
NO 2 (SKIP TO 1025)

1023A. What was the result of the test?

POSITIVE 1 (SKIP TO 1025)
NEGATIVE 2 (SKIP TO 1025)
INDETERMINATE 3 (SKIP TO 1025)
DECLINED TO ANSWER 4 (SKIP TO 1025)
DON'T KNOW 8 (SKIP TO 1025)

1024. CHECK 1016:

YES (GO TO 1025)
NO OR NOT ASKED (SKIP TO 1027)

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

YES 1 (SKIP TO 1028)
NO 2

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

MONTHS AGO___________ (SKIP TO 1033)
TWO OR MORE YEARS 95 (SKIP TO 1033)

1027. Have you ever been tested for HIV?

YES 1
NO 2 (SKIP TO 1031)

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

MONTHS AGO___________
TWO OR MORE YEARS 95

1029. Did you get the results of the test?

YES 1
NO 2 (SKIP TO 1030)

1029A. What was the result of the test?

POSITIVE 1
NEGATIVE 2
INDETERMINATE 3
DECLINED TO ANSWER 4
DON'T KNOW 8

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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (SKIP TO 1033)
SUB-DIVISIONAL MEDICAL CENTER / INTEGRATED HEALTH CENTER / DISPENSARY 12 (SKIP TO 1033)
HEALTH / COMMUNITY WORKER 13 (SKIP TO 1033)
STAND-ALONE HTC CENTER 14 (SKIP TO 1033)
MOBILE HTC SERVICES / CNLS 15 (SKIP TO 1033)
OTHER PUBLIC SECTOR (SPECIFY)_________16 (SKIP TO 1033)
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC 21 (SKIP TO 1033)
PRIVATE LAY HOSPITAL / CLINIC 22 (SKIP TO 1033)
CONFESSIONAL HEALTH CENTER / DISPENSARY 23 (SKIP TO 1033)
DOCTOR'S OFFICE 24 (SKIP TO 1033)
PHARMACY 25 (SKIP TO 1033)
STAND-ALONE HTC CENTER 26 (SKIP TO 1033)
MOBILE HTC SERVICES 27 (SKIP TO 1033)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________28 (SKIP TO 1033)
OTHER SOURCE
HOME 31 (SKIP TO 1033)
WORKPLACE 32 (SKIP TO 1033)
CORRECTIONAL FACILITY 33 (SKIP TO 1033)
SCHOOL / CULTURAL CENTER 34 (SKIP TO 1033)
OTHER (SPECIFY)_________96 (SKIP TO 1033)

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

YES 1
NO 2 (SKIP TO 1033)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
SUB-DIVISIONAL MEDICAL CENTER / INTEGRATED HEALTH CENTER / DISPENSARY B
HEALTH / COMMUNITY WORKER C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES / CNLS E
OTHER PUBLIC SECTOR (SPECIFY)_________F
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC G
PRIVATE LAY HOSPITAL / CLINIC H
CONFESSIONAL HEALTH CENTER / DISPENSARY I
DOCTOR'S OFFICE J
PHARMACY K
STAND-ALONE HTC CENTER L
MOBILE HTC SERVICES M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)________N
OTHER SOURCE
HOME O
WORKPLACE P
CORRECTIONAL FACILITY Q
SCHOOL / CULTURAL CENTER R
OTHER (SPECIFY)__________X

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

YES 1
NO 2 (SKIP TO 1035)

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

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8

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

YES 1
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8

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

YES 1
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW / NOT SURE / DEPENDS 8

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

AGREE 1
DISAGREE 2
DON'T KNOW / NOT SURE / DEPENDS 8

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

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW / NOT SURE / DEPENDS 8

1042. CHECK 1001:

HEARD ABOUT HIV OR AIDS:
a) Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
YES 1
NO 2
NOT HEARD ABOUT HIV OR AIDS:
b) Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

1043. CHECK 713:

HAS HAD SEXUAL INTERCOURSE (GO TO 1044)
NEVER HAD SEXUAL INTERCOURSE (SKIP TO 1051)

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

YES (GO TO 1045)
NO (SKIP TO 1046)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1048. CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 1049)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 1051)

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

YES 1
NO 2 (SKIP TO 1051)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
SUB-DIVISIONAL MEDICAL CENTER / INTEGRATED HEALTH CENTER / DISPENSARY B
HEALTH / COMMUNITY WORKER C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES / CNLS E
OTHER PUBLIC SECTOR (SPECIFY)_________F
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC G
PRIVATE LAY HOSPITAL / CLINIC H
CONFESSIONAL HEALTH CENTER / DISPENSARY I
DOCTOR'S OFFICE J
PHARMACY K
STAND-ALONE HTC CENTER L
MOBILE HTC SERVICES M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________N
OTHER SOURCE
HOME O
WORKPLACE P
CORRECTIONAL FACILITY Q
SCHOOL / CULTURAL CENTER R
OTHER (SPECIFY)_________X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1053. CHECK 701:

CURRENTLY MARRIED / LIVING WITH A MAN (GO TO 1054)
NOT IN UNION (SKIP TO 1056)

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

YES 1
NO 2
DEPENDS / NOT SURE 8

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

YES 1
NO 2
DEPENDS / NOT SURE 8

1056. CHECK 106: AGE OF RESPONDENT

AGE 15-49 (GO TO 1101)
AGE 50-64 (SKIP TO 1533)

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.

NUMBER OF INJECTIONS__________
NONE 00 (SKIP TO 1108)

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.

NUMBER OF INJECTIONS__________
NONE 00 (SKIP TO 1108)

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

YES 1
NO 2
DON'T KNOW 8

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:

a) Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c) The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d) Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1109. Are you covered by any health insurance?

YES 1
NO 2 (SKIP TO 1111)

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

MUTUAL HEALTH ORGANIZATION / COMMUNITY-BASED HELATH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY)__________X

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

EVERY DAY 1 (SKIP TO 1114)
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 1113)

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

YES 1 (SKIP TO 1115)
NO 2 (SKIP TO 1115)

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

EVERY DAY 1 (SKIP TO 1116)
SOME DAYS 2 (SKIP TO 1116)
NOT AT ALL 3 (SKIP TO 1116)

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'.

a) Manufactured cigarettes?
NUMBER DAILY__________ (SKIP TO 1116)
b) Hand-rolled cigarettes?
NUMBER DAILY__________ (SKIP TO 1116)
c) Kreteks?
NUMBER DAILY__________ (SKIP TO 1116)
d) Pipes full of tobacco?
NUMBER DAILY__________ (SKIP TO 1116)
e) Cigars, cheroots, or cigarillos?
NUMBER DAILY__________ (SKIP TO 1116)
f) Number of water pipe sessions?
NUMBER DAILY__________ (SKIP TO 1116)
g) Any others? (SPECIFY)_________
NUMBER DAILY__________ (SKIP TO 1116)

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'.

a) Manufactured cigarettes?
NUMBER WEEKLY_____________
b) Hand-rolled cigarettes?
NUMBER WEEKLY_____________
c) Kreteks?
NUMBER WEEKLY_____________
d) Pipes full of tobacco?
NUMBER WEEKLY_____________
e) Cigars, cheroots, or cigarillos?
NUMBER WEEKLY_____________
f) Number of water pipe sessions?
NUMBER WEEKLY_____________
g) Any others? (SPECIFY)___________
NUMBER WEEKLY_____________

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

EVERY DAY 1
SOME DAYS 2 (SKIP TO 1118)
NOT AT ALL 3 (SKIP TO 1119)

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'.

a) Snuff, by mouth?
TIMES DAILY___________ (SKIP TO 1121)
b) Snuff, by nose?
TIMES DAILY___________ (SKIP TO 1121)
c) Chewing tobacco?
TIMES DAILY___________ (SKIP TO 1121)
d) Betel quid with tobacco?
TIMES DAILY___________ (SKIP TO 1121)
e) Any others? (SPECIFY)__________
TIMES DAILY___________ (SKIP TO 1121)

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'.

a) Snuff, by mouth?
TIMES WEEKLY___________ (SKIP TO 1121)
b) Snuff, by nose?
TIMES WEEKLY___________ (SKIP TO 1121)
c) Chewing tobacco?
TIMES WEEKLY___________ (SKIP TO 1121)
d) Betel quid with tobacco?
TIMES WEEKLY___________ (SKIP TO 1121)
e) Any others? (SPECIFY)__________
TIMES WEEKLY___________ (SKIP TO 1121)

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

YES 1
NO 2 (SKIP TO 1121)

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

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3

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

CURRENTLY SMOKE TOBACCO / USE SMOKELESS TOBACCO ('EVERY DAY' OR 'SOME DAYS') (GO TO 1122)
NOT A SINGLE 'EVERY DAY' OR 'SOME DAY' (SKIP TO 1123)

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

AGE IN COMPLETED YEARS____________
DON'T KNOW YEAR 98

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

DAILY 1
WEEKLY 2
MONTHLY 3
LESS OFTEN THAN ONCE A MONTH 4
NEVER 5

1124. Do you work outside your home?

YES 1
NO / NOT WORKING 2 (SKIP TO 1127)

1125. Do you usually work indoors or outdoors?

INDOORS 1
OUTDOORS 2 (SKIP TO 1127)
INDOORS AND OUTDOORS 3

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

YES 1
NO 2
DON'T KNOW 8

1127. CHECK 1111:

CURRENTLY SMOKE TOBACCO ('EVERY DAY' OR 'SOME DAYS') (GO TO 1128)
NOT AT ALL (SKIP TO 1131)

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1131)

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

YES 1
NO 2

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?

YES 1
NO 2
NOT APPLICABLE 8

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?

YES 1
NO 2
NOT APPLICABLE 8

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

YES 1
NO 2
NOT APPLICABLE 7

1134. CHECK 1111:

CURRENTLY SMOKE TOBACCO ('EVERY DAY' OR 'SOME DAYS') (GO TO 1135)
NOT AT ALL (SKIP TO 1136)

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

YES 1
NO 2

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

YES 1
NO 2

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

a) Free samples of cigarettes?
YES 1
NO 2
b) Discounted price for cigarettes?
YES 1
NO 2
c) Coupons for price discount on cigarettes?
YES 1
NO 2
d) Gifts or discount on other products for the purchase of cigarettes?
YES 1
NO 2
e) Clothing or other items bearing the name or logo of a brand of cigarettes?
YES 1
NO 2
f) Promotion for cigarettes by mail?
YES 1
NO 2

1138. CHECK 1114a) AND 1115a):

CURRENTLY SMOKE MANUFACTURED CIGARETTES ('1114a) >0' OR 1115a)>0') (GO TO 1139)
BOTH '1114a) AND 1115a) ARE '0' OR BLANK (SKIP TO 1201)

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.

CIGARETTES 1:
QUANTITY_________
NUMBER OF CIGARETTTES PER CARTON_________
PACKS 2:
QUANTITY_________
NUMBER OF CIGARETTES PER CARTON_________
CARTRIDGES 3:
QUANTITY_________
NUMBER OF CIGARETTES PER CARTON_________
OTHER CARTONS 6:
QUANTITY_________
NUMBER OF CIGARETTES PER CARTON__________

DON'T KNOW 998

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

COST (IN FCFA)___________
DON'T KNOW 99998

SECTION 12: NON-COMMUNICABLE DISEASES

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

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2 (SKIP TO 1206)

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?

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 1211)

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?

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1213)

1212. Are you receiving any treatment for heart disease?

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1215)

1214. Are you receiving any treatment for lung disease?

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1217)

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1219)

1218. Are you receiving any treatment for depression?

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1221)

1220. Are you receiving any treatment for arthritis?

YES 1
NO 2

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?

YES 1 (SPECIFY CHRONIC DISEASE)_________
NO 2 (SKIP TO 1223)

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

YES 1
NO 2

1223. Have you heard of cervical cancer?

YES 1
NO 2 (SKIP TO 1225)

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

YES 1
NO 2

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?

YES 1
NO 2 (SKIP TO 1300)
DON'T KNOW 8 (SKIP TO 1300)

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

YEARS________
DON'T KNOW 98

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

NORMAL / NEGATIVE 1 (SKIP TO 1300)
ABNORMAL / POSITIVE 2
UNCLEAR / INCONCLUSIVE 3 (SKIP TO 1300)
DID NOT RECEIVE RESULTS 4 (SKIP TO 1300)
DON'T KNOW 8 (SKIP TO 1300)

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

YES 1
NO 2
DON'T KNOW 8

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?

YES 1 (SKIP TO 1303)
NO 2

1302. Have you ever heard of this problem?

YES 1 (SKIP TO 1401)
NO 2 (SKIP TO 1401)

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

AFTER DELIVERED BABY 1
AFTER HAD STILLBIRTH 2
NEITHER 3 (SKIP TO 1305)

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

NORMAL LABOR / DELIVERY 1 (SKIP TO 1306)
VERY DIFFICULT LABOR / DELIVERY 2 (SKIP TO 1306)

1305. What do you think caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER (SPECIFY)________6
DON'T KNOW 8 (SKIP TO 1307)

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

NUMBER OF DAYS AFTER DELIVERY / OTHER EVENT__________

1307. Have you sought treatment for this condition?

YES 1 (SKIP TO 1309)
NO 2

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

DO NOT KNOW CAN BE FIXED A (SKIP TO 1401)
DO NOT KNOW WHERE TO GO B (SKIP TO 1401)
TOO EXPENSIVE C (SKIP TO 1401)
TOO FAR D (SKIP TO 1401)
POOR QUALITY OF CARE E (SKIP TO 1401)
COULD NOT GET PERMISSION F (SKIP TO 1401)
EMBARRASSMENT G (SKIP TO 1401)
PROBLEM DISAPPEARED H (SKIP TO 1401)
OTHER (SPECIFY)_________X (SKIP TO 1401)

1309. From whom did you last seek treatment?

HEALTH PROFESSIONAL
DOCTOR 1
NURSE / MIDWIFE / AUXILIARY MIDWIFE 2
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 3
COMMUNITY / VILLAGE HEALTH WORKER 4
TRADITIONAL HEALER 5
OTHER (SPECIFY)_________6

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

YES 1
NO 2

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

YES, STOPPED COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3
DID NOT RECEIVE THE TREATMENT 4

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.

a) NAME__________
ORDER NUMBER_________

##note: a) repeated for b-t

1402. CHECK MM01:

ONE OR MORE BROTHERS OR SISTERS LISTED (GO TO 1403)
NO BROTHERS OR SISTERS LISTED (SKIP TO 1404)

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?

NO (GO TO 1404)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1401)

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?

NO (GO TO 1405)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1401)

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?

NO (GO TO 1406)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1401)

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?

NO (SKIP TO 1407)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1401)

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

TOTAL BROTHERS AND SISTERS_____________

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?

YES (GO TO 1409)
NO (PROBE AND CORRECT 1401 AND / OR 1407)

1409. CHECK 1407:

ONE OR MORE BROTHERS / SISTERS (GO TO 1410)
NO BROTHER OR SISTER (SKIP TO 1500)

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?

NUMBER OF PRECEDING BIRTHS___________

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.

NAME__________

1414. Is (NAME) male or female?

MALE 1
FEMALE 2

1415. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1417)
DON'T KNOW 8 (GO TO (02))

1416. How old is (NAME)?

AGE__________ (GO TO 02)

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

YEARS____________

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

AGE___________
IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO 1423.

1419. Was (NAME) pregnant when she died?

YES 1 (GO TO 1423)
NO 2

1420. Did (NAME) die during childbirth?

YES 1 (GO TO (02))
NO 2

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

YES 1
NO 2 (GO TO 1423)

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

DAYS____________

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

YES 1 (GO TO (02))
NO 2

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

YES 1
NO 2
GO TO (02).
IF NO MORE BROTHERS OR SISTERS, GO TO SECTION 15. DOMESTIC VIOLENCE MODULE.

SECTION 15: HOUSEHOLD RELATIONS

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

WOMAN SELECTED FOR THIS SECTION (GO TO 1501)
WOMAN NOT SELECTED (SKIP TO 1533)

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

PRIVACY OBTAINED 1 (SKIP TO 1501A)
PRIVACY NOT POSSIBLE 2 (SKIP TO 1532)

1501A. READ TO THE RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in 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:

CURRENTLY MARRIED / LIVING WITH A MAN (GO TO 1503)
FORMERLY MARRIED / LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND / PARTNER') (GO TO 1503)
NEVER MARRIED / NEVER LIVED WITH A MAN (SKIP TO 1516)

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

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

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

A. Did your (last) (husband / partner) ever:
a) say or do something to humiliate you in front of others?
YES 1
NO 2
b) threaten to hurt or harm you or someone you care about?
YES 1
NO 2
c) Insult you or make you feel bad about yourself?
YES 1
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1505.

A. Did your (last) (husband / partner) ever do any of the following things to you:
a) push you, shake you, or throw something at you?
YES 1
NO 2
b) slap you?
YES 1
NO 2
c) twist your arm or pull your hair?
YES 1
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
e) kick you, drag you, or beat you up?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1506. CHECK 1505A (a-j):

AT LEAST ONE 'YES' (GO TO 1507)
NOT A SINGLE 'YES' (SKIP TO 1509)

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'.

NUMBER OF YEARS____________
BEFORE MARRIAGE / BEFORE LIVING TOGETHER 95

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

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

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

YES 1
NO 2 (SKIP TO 1511)

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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

YES 1
NO 2 (SKIP TO 1513)

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

OFTEN 1
SOMETIMES 2
NEVER 3

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

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1514. CHECK 709:

MARRIED MORE THAN ONCE (GO TO 1515)
MARRIED ONLY ONCE (SKIP TO 1516)

1515.

A. So far we have been talking about the behavior of your (current / last) (husband / partner). Now I want to ask you about the behavior of any previous (husband / partner).
a) Did any previous (husband / partner) ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (GO TO B)
NO 2 (GO TO 1516)
b) Did any previous (husband / partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (GO TO B)
NO 2 (GO TO 1516)
c) Did any previous (husband / partner) humiliate you in front of others, threaten to hurt you or someone you care about, or insult you or make you feel bad about yourself?
YES 1 (GO TO B)
NO 2 (GO TO 1516)
B. How long ago did this last happen?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

1516. CHECK 701 AND 702:

EVER MARRIED / EVER LIVED WITH A MAN:
a) From the time you were 15 years old has anyone other than (your / any) (husband / partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
YES 1
NO 2 (SKIP TO 1519)
REFUSED TO ANSWER / NO ANSWER 3 (SKIP TO 1519)
NEVER MARRIED / NEVER LIVED WITH A MAN:
b) From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
YES 1
NO 2 (SKIP TO 1519)
REFUSED TO ANSWER / NO ANSWER 3 (SKIP TO 1519)

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

MOTHER / STEP-MOTHER A
FATHER / STEP-FATHER B
SISTER / BROTHER C
DAUGHTER / SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER / SOMEONE AT WORK L
POLICE / SOLDIER / GENDARME M
OTHER (SPECIFY)___________X

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1519. CHECK 201, 226, AND 230:

EVER BEEN PREGNANT ('YES' ON 201 OR 226 OR 230) (GO TO 1520)
NEVER BEEN PREGNANT (SKIP TO 1522)

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

YES 1
NO 2 (SKIP TO 1522)

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

CURRENT HUSBAND / PARTNER A
MOTHER / STEP-MOTHER B
FATHER / STEP-FATHER C
SISTER / BROTHER D
DAUGHTER / SON E
OTHER RELATIVE F
FORMER HUSBAND / PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER / SOMEONE AT WORK N
POLICE / SOLDIER / GENDARME O
OTHER (SPECIFY)__________X

1522. CHECK 701 AND 702:

EVER MARRIED / EVER LIVED WITH A MAN (GO TO 1522A)
NEVER MARRIED / NEVER LIVED WITH A MAN (SKIP TO 1522B)

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

YES 1 (SKIP TO 1523)
NO 2 (SKIP TO 1524A)
REFUSED TO ANSWER / NO ANSWER 3 (SKIP TO 1524A)

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

YES 1
NO 2 (SKIP TO 1526)
REFUSED TO ANSWER / NO ANSWER 3 (SKIP TO 1526)

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

CURRENT HUSBAND / PARTNER 01
FORMER HUSBAND / PARTNER 02
CURRENT / FORMER BOYFRIEND 03
FATHER / STEP-FATHER 04
BROTHER / STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND / ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER / SOMEONE AT WORK 11
POLICE / SOLDIER / GENDARME 12
PRIEST / RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY)_________96

1524. CHECK 701 AND 702:

EVER MARRIED / EVER LIVED WITH A MAN:
a) In the last 12 months, has anyone other than (your / any) (husband / partner) physically forced you to have sexual intercourse when you did not want to?
YES 1 (SKIP TO 1525)
NO 2 (SKIP TO 1525)
NEVER MARRIED / NEVER LIVED WITH A MAN:
b) In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?
YES 1 (SKIP TO 1525)
NO 2 (SKIP TO 1525)

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

AT LEAST ONE 'YES' (GO TO 1525)
NOT A SINGLE 'YES' (SKIP TO 1526)

1525. CHECK 701 AND 702:

EVER MARRIED / EVER LIVED WITH A MAN:
a) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your / any) husband / partner?
AGE IN COMPLETED YEARS_____________
DON'T KNOW 98
NEVER MARRIED / NEVER LIVED WITH A MAN:
b) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
AGE IN COMPLETED YEARS_____________
DON'T KNOW 98

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

AT LEAST ONE 'YES' (GO TO 1527)
NOT A SINGLE 'YES' (SKIP TO 1530)

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

YES 1
NO 2 (SKIP TO 1529)

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

OWN FAMILY A (SKIP TO 1530)
HUSBAND'S / PARTNER'S FAMILY B (SKIP TO 1530)
CURRENT / FORMER HUSBAND / PARTNER C (SKIP TO 1530)
CURRENT / FORMER BOYFRIEND D (SKIP TO 1530)
OWN FRIEND / ACQUAINTANCE E (SKIP TO 1530)
NEIGHBOR F (SKIP TO 1530)
RELIGIOUS LEAD G (SKIP TO 1530)
DOCTOR / MEDICAL PERSONNEL H (SKIP TO 1530)
POLICE / SOLDIER / GENDARME I (SKIP TO 1530)
LAWYER J (SKIP TO 1530)
SOCIAL SERVICE ORGANIZATION K (SKIP TO 1530)
OTHER (SPECIFY)__________X (SKIP TO 1530)

1529. Have you ever told any one about this?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

HUSBAND / PARTNER:
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT:
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT:
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

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

1533. RECORD THE TIME.

HOURS____________
MINUTES____________

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