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ETHIOPIA DEMOGRAPHIC AND HEALTH SURVEY - 2010
WOMAN'S QUESTIONNAIRE

IDENTIFICATION

LOCALITY NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION _____

NAME AND LINE NUMBER OF WOMAN:

NAME ______
LINE NO. ______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT _____

RESULT ____

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

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER ______
RESULT _____

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE: 6

LANGUAGE OF INTERVIEW:

AMARIGNA 1
OROMIGNA 2
TIGRIGNA 3
OTHER 6

LANGUAGE OF RESPONDENT:

AMARIGNA 1
OROMIGNA 2
TIGRIGNA 3
OTHER 6

TRANSLATOR USED:

YES 1
NO 2

SUPERVISOR
NAME _____
DATE _____

FIELD EDITOR
NAME _____
DATE _____

OFFICE EDITOR _____
KEYED BY _____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT:
Hello. My name is ______ and I am working with the Central Statistical Agency (CSA). We are conducting a survey about health all over Ethiopia. The information we collect will help the government to plan health services. Your household was selected for the survey. The survey usually takes 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.

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER ______
DATE _____

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

101. RECORD THE TIME.

MORNING/EVENING ____
MORNING 1
EVENING 2
HOUR ____
MINUTES____

101A. COLLECT ANY RELEVANT DOCUMENTS THAT MAY HAVE INFORMATION ON THE RESPONDENT AND HER CHILDREN'S AGE AND IMMUNIZATIONS.

102. In what month and year were you born?

MONTH _____
DOESN'T KNOW MONTH 98
YEAR _____
DOESN'T KNOW YEAR 9998

103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS ____

104. Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105. What is the highest level of school you attended: primary, secondary, technical/vocational or higher?

PRIMARY 1
SECONDARY 2
TECHNICAL/VOCATIONAL 3
HIGHER 4

106. What is the highest grade/number of years you completed at that level?
IF COMPLETED PRIMARY OR SECONDARY, RECORD COMPLETED GRADE.
IF TECHNICAL/VOCATIONAL OR HIGHER, RECORD YEARS COMPLETED.
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/NUMBER OF YEARS ___

107. CHECK 105:

PRIMARY (GO TO 107A)
SECONDARY AND ABOVE (GO TO 110)

107A. Have you ever attended a Bible school or Koranic school or any other informal school that involves learning to read and/or write (not including primary school)?

YES 1
NO 2

108. 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 PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____ 4
BLIND/VISUALLY IMPAIRED 5

109. CHECK 108:

CODE '2', '3' OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

110. 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

111. 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

112. 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

113. What is your religion?

ORTHODOX 1
CATHOLIC 2
PROTESTANT 3
MOSLEM 4
TRADITIONAL 5
OTHER (SPECIFY) _____ 6

114. What is your ethnicity?
RECORD THE MAJOR ETHNIC GROUP.
CODE FOR ETHNIC GROUP WILL BE FILLED IN BY OFFICE EDITOR.

NAME OF MAJOR ETHNIC GROUP _____
CODE OF ETHNIC GROUP _____

SECTION 2. REPRODUCTION

Now I would like to ask about all the births you have had during your life.

201. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

207. How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD ____
GIRLS DEAD ____

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

TOTAL ____

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

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

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

NAME ______

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

BOY 1
GIRL 2

214. Were any of these births twins?

SING 1
MULT 2

215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH_____
YEAR _____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS _____

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

YES 1
NO 2

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

LINE NUMBER _____ (GO TO NEXT BIRTH)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

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?
[DO NOT ASK FOR FIRST BIRTH]

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

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN THE TABLE.

YES 1
NO 2

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1999 E.C. OR LATER.
IF NONE, RECORD '0' AND GO TO 226.

NUMBER OF BIRTHS IN 1998 E.C. OR LATER ____
NONE 0 (GO TO 226)

225. FOR EACH BIRTH SINCE MESKEREM 1998, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226. Are you pregnant now?

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

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

NUMBER OF MONTHS _____

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

YES 1 (GO TO 230)
NO 2

229. Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231. When did the last such pregnancy end?

MONTH __
YEAR ____

231A. Did you seek medical advice or treatment when this pregnancy ended?
IF YES: Where did you seek medical advice or treatment?

HEALTH FACILITY 1
TRADITIONAL HEALER 2
NO ADVICE/TREATMENT 3
OTHER (SPECIFY) _____ 6

232. CHECK 231:

LAST PREGNANCY ENDED IN MESKEREM 1998 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE MESKEREM 1998 (GO TO 238)

233. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

NUMBER OF MONTHS _____

234. Since Meskerem 1998, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO MESKEREM 1998. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236. Did you have any miscarriages, abortions or stillbirths that ended before 1998 E.C.?

YES 1
NO 2 (GO TO 238)

237. When did the last such pregnancy that terminated before 1998 E.C. end?

MONTH ___
YEAR ___

238. 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

239. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

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

240. 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
DOESN'T KNOW 8

SECTION 3. CONTRACEPTION

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.

301. Have you ever heard of (METHOD)?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04. INJECTABLES: 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 (IMPLANON/JADELLE/ NORPLANTS): 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: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07. MALE CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. STANDARD DAYS METHOD: Women can use a cycle of beads to count the days they are most likely to get pregnant and avoid sexual intercourse during those days.
YES 1
NO 2
09A. LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
10. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
11. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
12. EMERGENCY CONTRACEPTION: 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
13. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO OTHER METHODS.
(SPECIFY) _____
YES 1
NO 2

302. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

304. Which method are you using?
CIRCLE ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 308A)
MALE STERILIZATION B (GO TO 308A)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
MALE CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 308A)
DIAPHRAGM/FOAM/JELLY I (GO TO 308A)
STANDARD DAYS METHOD J (GO TO 308A)
LACTATIONAL AMEN. METHOD K (GO TO 308A)
RHYTHM METHOD L (GO TO 308A)
WITHDRAWAL M (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

305. What is the brand name of the pills you are using?
IF DOESN'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

CHOICE/ROSELLE 01 (GO TO 308A)
TRIGESTREL 02 (GO TO 308A)
HYAN 03 (GO TO 308A)
NORDETTE 04 (GO TO 308A)
DUOFEM 05 (GO TO 308A)
NEOGYNON 06 (GO TO 308A)
EXLUTON 07 (GO TO 308A)
OTHER (SPECIFY) _____ 96 (GO TO 308A)
DOESN'T KNOW 98 (GO TO 308A)

306. What is the brand name of the condoms you are using?
IF DOESN'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

HIWOT TRUST 01
SENSATION RIBBED 02
SENSATION COFFEE 03
SENSATION HONEY 04
FRENCH FEELING 05
JEANS 06
UNIDUS/SOUTH KOREA 07
OTHER (SPECIFY) _____ 96
DOESN'T KNOW 98

308A. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH ___
YEAR ___

309. CHECK 308A, 215 AND 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308A?

YES (GO BACK TO 308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD. MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION.)

NO (GO TO 310)

310. CHECK 308A:

YEAR IS 1998 E.C. OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.)

YEAR IS 1997 E.C. OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO MESKEREM 1998.) (GO TO 322)

I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

311. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO MESKEREM 1998. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

312. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH:

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314. CHECK 304:
CIRCLE METHOD CODE:

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

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM/FOAM/JELLY 09
STANDARD DAYS METHOD 10 (GO TO 315A)
LACTATIONAL AMEN. METHOD 11 (GO TO 315A)
RHYTHM METHOD 12 (GO TO 315A)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

315. You first started using (CURRENT METHOD FROM 314) in (DATE FROM 308A). 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.

NAME OF PLACE _____
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH STATION/CLINIC 13
GOVT. HEALTH POST/HEW 14
OTHER PUBLIC (SPECIFY) _____ 15
NGO
NGO HEALTH FACILITY 21
VOLUNTARY COMMUNITY HEALTH WORKERS 22
OTHER NGO (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE CLINIC 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) _____ 34
OTHER SOURCE
DRUG VENDOR/STORE 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) _____ 96

315A. Where did you learn how to use the standard days method/rhythm/lactational amenorrhea method?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _____
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH STATION/CLINIC 13
GOVT. HEALTH POST/HEW 14
OTHER PUBLIC (SPECIFY) _____ 15
NGO
NGO HEALTH FACILITY 21
VOLUNTARY COMMUNITY HEALTH WORKERS 22
OTHER NGO (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE CLINIC 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) _____ 34
OTHER SOURCE
DRUG VENDOR/STORE 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) _____ 96

316. 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 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM/FOAM/JELLY 09 (GO TO 320)
STANDARD DAYS METHOD 10 (GO TO 326)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)

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

YES 1 (GO TO 319)
NO 2

318. 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 (GO TO 320)

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

YES 1
NO 2

320. CHECK 317:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 315) were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

321. 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

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

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03 (GO TO 326)
INJECTABLES 04
IMPLANTS 05 (GO TO 326)
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM/FOAM/JELLY 09
STANDARD DAYS METHOD 10 (GO TO 326)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)
WITHDRAWAL 13 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323. 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.

NAME OF PLACE ______
PUBLIC SECTOR
GOVT. HOSPITAL 11 (GO TO 326)
GOVT. HEALTH CENTER 12 (GO TO 326)
GOVT. HEALTH STATION/CLINIC 13 (GO TO 326)
GOVT. HEALTH POST/HEW 14 (GO TO 326)
OTHER PUBLIC (SPECIFY) _____ 15 (GO TO 326)
NGO
NGO HEALTH FACILITY 21 (GO TO 326)
VOLUNTARY COMMUNITY HEALTH WORKERS 22 (GO TO 326)
OTHER NGO (SPECIFY) _____ 26 (GO TO 326)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31 (GO TO 326)
PRIVATE CLINIC 32 (GO TO 326)
PHARMACY 33 (GO TO 326)
OTHER PRIVATE MEDICAL (SPECIFY) _____ 36 (GO TO 326)
OTHER SOURCE
DRUG VENDOR/STORE 41 (GO TO 326)
SHOP 42 (GO TO 326)
FRIEND/RELATIVE 43 (GO TO 326)
OTHER (SPECIFY) _____ 96 (GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325. Where is that?
Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) _____ E
NGO
NGO HEALTH FACILITY F
VOLUNTARY COMMUNITY HEALTH WORKERS G
OTHER NGO (SPECIFY) _____ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
PRIVATE CLINIC J
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
DRUG VENDOR/STORE M
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) ______ X

326. In the last 12 months, were you visited by a HEW/VCHW or others who talked to you about family planning?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. MATERNITY CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN MESKERM 1998 E.C. OR LATER (GO TO 402)
NO BIRTHS 556 IN MESKERM 1998 E.C. OR LATER (GO TO 556)

402. CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1998 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

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?

YES 1 (FOR MOST RECENT BIRTH, GO TO 408; FOR OTHERS, GO TO 430)
NO 2

406. Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
NO MORE 2 (FOR MOST RECENT BIRTH, GO TO 408; FOR OTHERS, GO TO 430)

407. How much longer did you want to wait?

MONTHS 1 ____
YEARS 2 ____
DOESN'T KNOW 998

408. Did you see anyone for antenatal care for this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 415)

409. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
HEW C
OTHER HEALTH PERSONNEL (SPECIFY) _____ D
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT E
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
VCHW G
OTHER (SPECIFY) _____ X

410. Where did you receive antenatal care for this pregnancy? Anywhere else?
[ASK ONLY FOR MOST RECENT BIRTH]

PROBE TO IDENTIFY TYPE(S) OF SOURCE(S). IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ______
HOME
RESPONDENT'S HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL C
GOVT. HEALTH CENTER D
GOVT. HEALTH STATION/CLINIC E
GOVT. HEALTH POST F
OTHER PUBLIC (SPECIFY) ______ G
NGO
HEALTH FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
PRIVATE CLINIC J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER (SPECIFY) _____ X

411. How many months pregnant were you when you first received antenatal care for this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF MONTHS ____
DOESN'T KNOW 98

412. How many times did you receive antenatal care during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES _____
DOESN'T KNOW 98

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

Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

[ASK ONLY FOR MOST RECENT BIRTH]

BLOOD PRESSURE
YES 1
NO 2
URINE SAMPLE
YES 1
NO 2
BLOOD SAMPLE
YES 1
NO 2

414. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 415)
DOESN'T KNOW 8 (GO TO 415)

414A. Which signs of pregnancy complications were you told about?
[ASK ONLY FOR MOST RECENT BIRTH]

VAGINAL BLEEDING A
VAGINAL GUSH OF FLUID B
SEVERE HEADACHE C
BLURRED VISION D
FEVER E
ABDOMINAL PAIN F
OTHER (SPECIFY) _____ X

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 418)
DOESN'T KNOW 8 (GO TO 418)

416. During this pregnancy, how many times did you get this tetanus injection?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES ____
DOESN'T KNOW 8

417. CHECK 416:
[ASK ONLY FOR MOST RECENT BIRTH]

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

418. At any time before this pregnancy, did you receive any tetanus injections?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 421)
DOESN'T KNOW 8 (GO TO 421)

419. Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES ____
DOESN'T KNOW 8

420. How many years ago did you receive the last tetanus injection before this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

YEARS AGO ____

421. During this pregnancy, were you given or did you buy any iron tablets?
SHOW TABLETS.
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 423)
DOESN'T KNOW 8 (GO TO 423)

422. During the whole pregnancy, for how many days did you take the tablets?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF DAYS ____
DOESN'T KNOW 998

423. During this pregnancy, did you take any drug for intestinal worms?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

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

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

431. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 433)
DOESN'T KNOW 8 (GO TO 433)

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

KG FROM CARD 1 ____
KG FROM RECALL 2 ____
DOESN'T KNOW 99.998

433. 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
HEW C
OTHER HEALTH PERSONNEL (SPECIFY) ____ D
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT E
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
VCHW G
RELATIVE/FRIEND H
OTHER (SPECIFY) ______ X
NO ONE Y

434. Where did you give birth to (NAME)?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE______
HOME
RESPONDENT'S HOME 11 (MOST RECENT BIRTH, GO TO 437A; OTHERS, GO TO 448)

OTHER HOME 12 (MOST RECENT BIRTH, GO TO 437A; OTHERS, GO TO 448)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH STAT/CLINIC 23
GOVT. HEALTH POST 24
OTHER PUBLIC (SPECIFY) ______ 26
NGO
HEALTH FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 41
PRIVATE CLINIC 42
OTHER PRIVATE MEDICAL (SPECIFY) _____ 43
OTHER (SPECIFY) _____ 96 (MOST RECENT BIRTH, GO TO 437A; OTHERS, GO TO 448)

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

YES 1
NO 2

436. After you gave birth to (NAME), did anyone check on your health while you were still in the facility?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1 (GO TO 439)
NO 2

437. Did anyone check on your health after you left the facility?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1 (GO TO 439)
NO 2 (GO TO 446)

437A. Why didn't you deliver in a health facility?
PROBE: Any other reason? RECORD ALL MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

COSTS TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/ NO TRANSPORTATION C
DOESN'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) ______ X

438. After you gave birth to (NAME), did anyone check on your health?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 442)

439. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK ONLY FOR MOST RECENT BIRTH]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEW 13
OTHER HEALTH PERSONNEL (SPECIFY) _____ 14
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 21
UNTRAINED TRADITIONAL BIRTH ATTENDANT 22
VCHW 23
OTHER (SPECIFY) ______ 96

440. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DOESN'T KNOW 998

441. CHECK 434:
[ASK ONLY FOR MOST RECENT BIRTH]

'11', '12' OR '96' CIRCLED (GO TO 442)
OTHER (GO TO 446)

442. In the two months after (NAME) was born, did any Doctor/Nurse/HEW or other health personnel or a traditional birth attendant check on his/her health?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 446)
DOESN'T KNOW 8 (GO TO 446)

443. 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.
[ASK ONLY FOR MOST RECENT BIRTH]

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____
DOESN'T KNOW 998

444. Who checked on (NAME'S) health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK ONLY FOR MOST RECENT BIRTH]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
HEW 13
OTHER HEALTH PERSONNEL (SPECIFY) ______ 14
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 21
UNTRAINED TRADITIONAL BIRTH ATTENDANT 22
VCHW 23
OTHER (SPECIFY) _____96

445. Where did this first check of (NAME) take place?
[ASK ONLY FOR MOST RECENT BIRTH]

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH STAT/CLINIC 23
GOVT. HEALTH POST 24
OTHER PUBLIC (SPECIFY) ______ 26
NGO
HEALTH FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 41
PRIVATE CLINIC 42
OTHER PRIVATE MEDICAL (SPECIFY) _____ 43
OTHER (SPECIFY) _____ 96

446. In the first two months after delivery, did you receive a vitamin A dose (like this)?
SHOW CAPSULES.
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1 (GO TO 449)
NO 2 (GO TO 450)

448. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 452)

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

NUMBER OF MONTHS _____
DOESN'T KNOW 98

450. CHECK 226:
IS RESPONDENT PREGNANT?
[ASK ONLY FOR MOST RECENT BIRTH]

NOT PREGNANT (GO TO 451)
PREGNANT OR UNSURE (GO TO 452)

451. Have you had sexual intercourse since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 453)

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

NUMBER OF MONTHS _____
DOESN'T KNOW 98

453. Did you ever breastfeed (NAME)?

YES 1(GO TO 455)
NO 2

454. CHECK 404:
IS CHILD LIVING?

LIVING (GO T0 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

455. 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.
[ASK ONLY FOR MOST RECENT BIRTH]

IMMEDIATELY 000
HOURS 1 ____
DAYS 2 ____

456. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 458)

457. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
FRESH BUTTER J
FENUGREEK K
OTHER (SPECIFY) _____X

458. CHECK 404:
IS CHILD LIVING?
[ASK ONLY FOR MOST RECENT BIRTH]

LIVING (GO TO 459)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

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

YES 1
NO 2

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

YES 1
NO 2
DOESN'T KNOW 8

461. GO BACK TO 405 IN NEXT COLUMN/IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRES; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1998 E.C. OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. BIRTH HISTORY NUMBER FROM 212:

BIRTH HISTORY NUMBER ___

503. FROM 212 AND 216:

NAME _____
LIVING (GO T0 504)
DEAD (GO BACK TO 503 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 553)

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

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 509)
NO CARD 3

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

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

506. (1) COPY DATE FROM THE CARD FOR EACH VACCINE. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ____
MONTH ____
YEAR ____
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY ____
MONTH ____
YEAR ____
POLIO 1
DAY ____
MONTH ____
YEAR ____
POLIO 2
DAY ____
MONTH ____
YEAR ____
POLIO 3
DAY ____
MONTH ____
YEAR ____
DPT 1
DAY ____
MONTH ____
YEAR ____
DPT 2
DAY ____
MONTH ____
YEAR ____
DPT 3
DAY ____
MONTH ____
YEAR ____
DPT-HEPB-HIB1
DAY ____
MONTH ____
YEAR ____
DPT-HEPB-HIB 2
DAY ____
MONTH ____
YEAR ____
DPT-HEPB-HIB 3
DAY ____
MONTH ____
YEAR ____
MEASLES
DAY ____
MONTH ____
YEAR ____
VITAMIN A (MOST RECENT)
DAY ____
MONTH ____
YEAR ____

507. CHECK 506:

BCG THROUGH VITAMIN A ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

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

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS SHOWN IN 506 AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 511)
NO 2 (GO TO 511)
DOESN'T KNOW 8 (GO TO 511)

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

YES 1
NO 2 (GO TO 511)
DOESN'T KNOW 8 (GO TO 511)

510. Please tell me if (NAME) had any of the following vaccinations:

510A. A BCG vaccination against tuberculosis, that is, an injection in the right arm or shoulder that usually causes a scar?

YES 1
NO 2
DOESN'T KNOW 8

510B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 510E)
DOESN'T KNOW 8 (GO TO 510E)

510C. Was the first polio vaccine given in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

510D. How many times was the polio vaccine received?

NUMBER OF TIMES ____

510E. A DPT or DPT-HepB-Hib vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 510G)
DOESN'T KNOW 8 (GO TO 510G)

510F. How many times was a DPT or DPT-HepB-Hib vaccination given?

NUMBER OF TIMES ____

510G. A measles injection or an MMR injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

YES 1
NO 2
DOESN'T KNOW 8

510H. Did (NAME) receive a vaccination certificate for completing the schedule for all vaccinations?

YES 1
NO 2
DOESN'T KNOW 8

511. Within the last six months, has (NAME) received a vitamin A dose like this?
SHOW CAPSULES.

YES 1
NO 2
DOESN'T KNOW 8

512. In the last seven days, was (NAME) given iron pills like this?
SHOW COMMON TYPES OF IRON PILLS.

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 525)
DOESN'T KNOW 8 (GO TO 525)

515. Was there any blood in the stools?

YES 1
NO 2
DOESN'T KNOW 8

516. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breast milk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DOESN'T KNOW 8

517. When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she 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
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 522)

519. Where did you seek advice or treatment?
Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) _____ E
NGO
HEALTH FACILITY F
VCHW G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
PRIVATE CLINIC I
PHARMACY J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
OTHER SOURCE
DRUG VENDOR/STORE L
SHOP M
TRADITIONAL HEALER N
OTHER (SPECIFY) _____ X

520. CHECK 519:

TWO OR MORE CODES CIRCLED (GO TO 521)
ONLY ONE CODE CIRCLED (GO TO 522)

521. Where did you first seek advice or treatment?
USE LETTER CODE FROM 519.

FIRST PLACE _____

522. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid made from a special ORS packet like LEMLEM?
b) A government-recommended homemade fluid?

FLUID FROM ORS PACKET
YES 1
NO 2
DOESN'T KNOW 8
HOMEMADE FLUID
YES 1
NO 2
DOESN'T KNOW 8

523. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 525)
DOESN'T KNOW 8 (GO TO 525)

524. What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/HERBAL MEDICINE J
OTHER (SPECIFY) ______ X

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DOESN'T KNOW 8 (GO TO 530)

528. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (GO TO 531)
DOESN'T KNOW 8 (GO TO 531)

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

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) _____ 6 (GO TO 531)
DOESN'T KNOW 8 (GO TO 531)

530. CHECK 525:
HAD FEVER?

YES (GO TO 531)
NO OR DOESN'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

531. Now I would like to know how much (NAME) was given to drink (including breast milk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DOESN'T KNOW 8

532. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she 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
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 537)

534. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) _______ E
NGO
HEALTH FACILITY F
VCHW G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
PRIVATE CLINIC I
PHARMACY J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
OTHER SOURCE
DRUG VENDOR/STORE L
SHOP M
TRADITIONAL HEALER N
OTHER (SPECIFY) _____ X

535. CHECK 534:

TWO OR MORE CODES CIRCLED (GO TO 536)
ONLY ONE CODE CIRCLED (GO TO 537)

536. Where did you first seek advice or treatment?
USE LETTER CODE FROM 534.

FIRST PLACE _____

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

YES 1
NO 2 (GO TO 503 IN IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DOESN'T KNOW 8 (GO TO 503 IN IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

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

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
ARTEMETHER-LUMEFANTRINE (COARTEM/ARTEFAN) C
QUININE D
OTHER ANTI-MALARIAL (SPECIFY) _____ E
ANTIBIOTIC DRUGS
INJECTION F
BACTRIM (COTRIM) G
AMPICILIN H
AMOXYCILIN I
CHLORIAM-PHENICOL J
TETRACYCLINE K
OTHER ANTIBIOTIC L
OTHER DRUGS
PARACETAMOL M
ASPIRIN (PARAMOL) N
ACETAMINOPHEN O
IBUPROFEN P
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

552. GO BACK TO 503 IN NEXT COLUMN/ IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 553

553. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1998 E.C. OR LATER LIVING WITH THE RESPONDENT?

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER) (GO TO 554)
(NAME) ______
NONE (GO TO 556)

554. The last time (NAME FROM 553) 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

555. CHECK 522(a), ALL COLUMNS:

NOT ASKED (GO TO 556)
NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 557)

556. Have you ever heard of a special fluid made from an ORS packet, like LEMLEM, that you can get for the treatment of diarrhea?

YES 1
NO 2

557. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2001 E.C. OR LATER LIVING WITH THE RESPONDENT?

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER) (GO TO 558)
(NAME) _____
NONE (GO TO 601)

558. Now I would like to ask you about (other) liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item even if it was combined with other foods. Did (NAME FROM 557) (drink/eat):

a) Plain water?
b) Juice or juice drinks?
c) Soup?
d) Milk such as tinned, powdered, or fresh animal milk?
e) Infant formula such as Plan, S-26?
f) Any other liquids?
g) Yogurt?
h) Any commercially fortified baby food, like Fafa, Hilina, Cerilak, Cerifam, or Mother Choice?
i) Injera, bread, rice, noodles, or other foods made from grains, such as, tef, oats, maize, barley, wheat, sorghum, millet or other grains?
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
k) White potatoes, white yams, bulla, kocho, manioc, cassava, or any other foods made from roots?
l) Any dark green, leafy vegetables like kale, spinach, or amaranth leaves?
m) Ripe mangoes or papayas?
n) Any other fruits or vegetables?
o) Liver, kidney, heart or other organ meats?
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
q) Eggs?
r) Fresh or dried fish or shellfish?
s) Any foods made from beans, peas, lentils, or nuts?
t) Cheese or other food made from milk?
u) Any other solid, semi-solid, or soft food?

PLAIN WATER
YES 1
NO 2
DOESN'T KNOW 8
JUICE
YES 1
NO 2
DOESN'T KNOW 8
SOUP
YES 1
NO 2
DOESN'T KNOW 8
TINNED/POWDERED/ANIMAL MILK
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES DRANK MILK _____
INFANT FORMULA
IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES DRANK FORMULA _____
ANY OTHER LIQUIDS
YES 1
NO 2
DOESN'T KNOW 8
YOGURT
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'
YES 1
NO 2
DOESN'T KNOW 8
NUMBER OF TIMES ATE YOGURT ____
COMMERCIALLY FORTIFIED BABY FOOD
YES 1
NO 2
DOESN'T KNOW 8
FOODS MADE FROM GRAINS
YES 1
NO 2
DOESN'T KNOW 8
PUMPKINS, CARROTS, SQUASH, SWEET POTATOES
YES 1
NO 2
DOESN'T KNOW 8
FOODS MADE FROM ROOTS
YES 1
NO 2
DOESN'T KNOW 8
DARK GREEN, LEAFY VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
MANGOES OR PAPAYAS
YES 1
NO 2
DOESN'T KNOW 8
OTHER FRUITS OR VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
ORGAN MEATS
YES 1
NO 2
DOESN'T KNOW 8
ANY MEAT (I.E. BEEF, PORK, LAMB, GOAT. ETC.)
YES 1
NO 2
DOESN'T KNOW 8
EGGS
YES 1
NO 2
DOESN'T KNOW 8
FRIED OR DRIED FISH OR SHELLFISH
YES 1
NO 2
DOESN'T KNOW 8
FOODS MADE FROM BEANS, PEAS, LENTILS, OR NUTS
YES 1
NO 2
DOESN'T KNOW 8
CHEESE OR OTHER FOOD MADE FROM MILK
YES 1
NO 2
DOESN'T KNOW 8
OTHER SOLID, SEMI-SOLID, OR SOFT FOOD
YES 1
NO 2
DOESN'T KNOW 8

559. CHECK 558 (CATEGORIES "h" THROUGH "u"):

NOT A SINGLE 'YES' (GO TO 560)
AT LEAST ONE 'YES' (GO TO 561)

560. Did (NAME) 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 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

561. How many times did (NAME FROM 557) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES _____
DOESN'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

602. 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 (GO TO 612)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

605. 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. ______

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

YES 1
NO 2 (GO TO 609)
DOESN'T KNOW 8 (GO TO 609)

607. Including yourself, in total, how many wives or partners does your husband live with now as if married?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ______
DOESN'T KNOW 98

608. Are you the first, second, … wife?

RANK ___

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

ONLY ONCE 1
MORE THAN ONCE 2

610. CHECK 609:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about when you started living with your first husband/partner. In what month and year was that?

MONTH _____
DOESN'T KNOW MONTH 98
YEAR _____ (GO TO 612)
DOESN'T KNOW YEAR 9998

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

AGE ___

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

Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.

613. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)

AGE IN YEARS ____

FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

614. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

615. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____ (GO TO 627)

616. When was the last time you had sexual intercourse with this person?
[DO NOT ASK FOR MOST RECENT PARTNER]

DAYS 1 ____
WEEKS 2 ____
MONTHS 3 ____

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

YES 1
NO 2 (GO TO 619)

618. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

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

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
COMMERCIAL SEX WORKER 5 (GO TO 622)
OTHER (SPECIFY) ______ 6 (GO TO 622)

620. CHECK 609:

MARRIED ONLY ONCE (GO TO 621)
MARRIED MORE THAN ONCE (GO TO 622)

621. CHECK 613:

FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (GO TO 623)
OTHER (GO TO 622)

622. How long ago did you first have sexual intercourse with this (second/third) person?

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

623. How many times during the last 12 months did you have sexual intercourse with this person? IF 95 OR MORE, WRITE '95'.

NUMBER OF TIMES ____

623A. The last time you had sexual intercourse (with this other person), did you or this person drink alcohol?

YES 1
NO 2 (GO TO 623C)

623B. Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

623C. The last time you had sexual intercourse (with this other person), did you or this person chew chat any time during that day?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

623D. Are you still having sex with this person?

YES 1
NO 2

624. How old is this person?

AGE OF PARTNER _____
DOESN'T KNOW 98

625. Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?
[DO NOT ASK FOR THIRD-TO-LAST SEXUAL PARTNER]

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 (GO TO 627)

626. 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, WRITE '95'.
[ASK ONLY FOR THIRD-TO-LAST SEXUAL PARTNER]

NUMBER OF PARTNERS LAST 12 MONTHS _____
DOESN'T KNOW 98

627. 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 GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS IN LIFETIME _____
DOESN'T KNOW 98

628. PRESENCE OF OTHERS DURING THIS SECTION:

MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2
MALE YOUTHS
YES 1
NO 2
FEMALE YOUTHS
YES 1
NO 2
CHILDREN
YES 1
NO 2

629. Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 632)

630. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) ______ E
NGO
NGO HEALTH FACILITY F
VOLUNTARY COMMUNITY HEALTH WORKERS G
OTHER NGO (SPECIFY) ______ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
PRIVATE CLINIC J
PHARMACY K
ANTI-AIDS CLUB/ASSOCIATION L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
DRUG VENDOR/STORE N
SHOP/BAR/HOTEL/GROCERY O
FRIEND/RELATIVE P
OTHER (SPECIFY) ______ X

631. If you wanted to, could you yourself get a male condom?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

631A. CHECK 301 (08):
KNOWS FEMALE CONDOM?

YES (GO TO 632)
NO (GO TO 701)

632. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

633. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) _____ E
NGO
NGO HEALTH FACILITY F
VOLUNTARY COMMUNITY HEALTH WORKERS G
OTHER NGO (SPECIFY) _____ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
PRIVATE CLINIC J
PHARMACY K
ANTI-AIDS CLUB/ASSOCIATION L
OTHER PRIVATE MEDICAL (SPECIFY) _____ M
OTHER SOURCE
DRUG VENDOR/STORE N
SHOP/BAR/HOTEL/GROCERY O
FRIEND/RELATIVE P
OTHER (SPECIFY) ______ X

634. If you wanted to, could you yourself get a female condom?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 304:

NEITHER STERILIZED (GO TO 702)
NOT ASKED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702. CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

Now I have some questions about the future.

703. 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 (GO TO 705)
NO MORE/NONE 2 (GO TO 711)
UNDECIDED/DOESN'T KNOW 8 (GO TO 711)

704. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DOESN'T KNOW 8 (GO TO 710)

705. CHECK 226:

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

PREGNANT: After the birth of 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 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) _____ 996 (GO TO 710)
DOESN'T KNOW 998 (GO TO 710)

706. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707. CHECK 303:
USING CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708. CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEAR (GO TO 711)

709. CHECK 703 AND 704:

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

WANTS NO MORE/NONE: You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

710. CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NO, NOT CURRENTLY USING (GO TO 711)
YES, CURRENTLY USING (GO TO 712)

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

YES 1
NO 2
DOESN'T KNOW 8

712. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 714)

NUMBER _____

OTHER (SPECIFY) _____ 96 (GO TO 714)

713. 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 was a boy or girl?

NUMBER OF BOYS_____
NUMBER OF GIRLS_____
NUMBER OF EITHER_____
OTHER (SPECIFY) _____ 96

714. In the last few months have you:

Heard about family planning on the radio?
Seen anything about family planning on the television?
Read about family planning in a newspaper or magazine?
Read about family planning in (a) pamphlet/Posters/Leaflets?
Heard about family planning at community event/conversation?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
PAMPHLET/POSTER/LEAFLETS
YES 1
NO 2
COMMUNITY EVENT/CONVERSATION
YES 1
NO 2

715. In the last few months have you heard or seen the following media messages on family planning?

It's wise to have a balanced family life.
Your family happiness is in your hands.
Spacing of birth will be a source for a loving, caring and healthy family.
Children by choice not by chance.

BALANCED FAMILY LIFE
YES 1
NO 2
FAMILY HAPPINESS IS IN YOUR HANDS
YES 1
NO 2
SPACING OF BIRTH IS A SOURCE FOR A HEALTHY FAMILY
YES 1
NO 2
CHILDREN BY CHOICE
YES 1
NO 2

716. CHECK 601:

YES, CURRENTLY MARRIED (GO TO 717)
YES, LIVING WITH A MAN (GO TO 717)
NO, NOT IN UNION (GO TO 801)

717. CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 718)
CURRENTLY USING (GO TO 720)

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

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _____ 6

719. CHECK 304:

NEITHER STERILIZED (GO TO 720)
HE OR SHE STERILIZED (GO TO 801)

720. 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
DOESN'T KNOW 8

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

801. CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

802. How old was your husband/partner on his last birthday?

AGE IN COMPLETED YEARS _____

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

YES 1
NO 2 (GO TO 806)

804. What is the highest level of school your husband attended: primary, secondary, technical/vocational or higher?

PRIMARY 1
SECONDARY 2
TECHNICAL/VOCATIONAL 3
HIGHER 4
DOESN'T KNOW 8 (GO TO 806)

805. What is the highest grade/number of years he completed at that level?

IF COMPLETED PRIMARY OR SECONDARY, RECORD COMPLETED GRADE. IF TECHNICAL/VOCATIONAL OR HIGHER, RECORD YEARS COMPLETED.
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL RECORD '00'.

GRADE/NUMBER OF YEARS _____

806. CHECK 801:

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

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

HUSBAND/PARTNER'S OCCUPATION ______

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

YES 1 (GO TO 811)
NO 2

808. 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 (GO TO 811)
NO 2

809. 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 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

811. What is your occupation, that is, what kind of work do you mainly do?

RESPONDENT'S OCCUPATION _____

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF EMPLOYED 3

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

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

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

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

815. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 816)
NOT IN UNION (GO TO 823)

816. CHECK 814:

CODE '1' OR '2' CIRCLED (GO TO 817)
OTHER (GO TO 819)

817. Who usually decides how the money that 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

818. 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 DOESN'T EARN ANY MONEY 4 (GO TO 820)
DOESN'T KNOW 8

819. 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

820. 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

821. Who usually make decisions about making major household purchases: 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

822. Who usually makes decisions about visits to your family or relatives: 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

822A. Does your husband help you with household chores like looking after the children, cooking, cleaning the house, and doing other work around the house?

YES 1
NO 2 (GO TO 823)

822B. Does he help almost every day, at least once a week, or rarely?

EVERY DAY 1
AT LEAST ONCE A WEEK 2
RARELY 3

823. 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

824. Do you own any land either alone or jointly with someone else?

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

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

CHILDREN YOUNGER THAN 10 YEARS OLD
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALE
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALE
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

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

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

GOES OUT
YES 1
NO 2
DOESN'T KNOW 8
NEGLECTS CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
ARGUES
YES 1
NO 2
DOESN'T KNOW 8
REFUSES SEX
YES 1
NO 2
DOESN'T KNOW 8
BURNS FOOD
YES 1
NO 2
DOESN'T KNOW 8

826A. Is there a law in Ethiopia that prevents a husband from beating his wife?

YES 1
NO 2
DOESN'T KNOW 8

SECTION 9. HIV/AIDS

Now I would like to talk about something else.

901. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 937)

902. Can people reduce their chance of getting AIDS virus by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DOESN'T KNOW 8

903. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

905. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

905A. Can people reduce their chance of getting the AIDS virus by abstaining from sexual intercourse?

YES 1
NO 2
DOESN'T KNOW 8

906. Can people get the AIDS virus because of witchcraft, God's curse, or other supernatural means?

YES 1
NO 2
DOESN'T KNOW 8

907. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

907A. Can people get the AIDS virus by sharing sharp materials such as razors/blades or through injection with non-sterilized needles?

YES 1
NO 2
DOESN'T KNOW 8

908. Can the virus that causes AIDS be transmitted from a mother to her baby:

During pregnancy?
During delivery?
By breastfeeding?

PREGNANCY
YES 1
NO 2
DOESN'T KNOW 8
DELIVERY
YES 1
NO 2
DOESN'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DOESN'T KNOW 8

909. CHECK 908:

AT LEAST ONE 'YES' (GO TO 910)
OTHER (GO TO 911)

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

YES 1
NO 2
DOESN'T KNOW 8

910A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

911. CHECK 208 AND 215:

LAST BIRTH SINCE MESKEREM 2001 (GO TO 912)
LAST BIRTH BEFORE MESKEREM 2001 (GO TO 926)
NO BIRTHS (GO TO 926)

912. CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 914)
NO ANTENATAL CARE (GO TO 926)

914. During any of the antenatal visits for your last birth, did anyone talk to you about:

Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

AIDS FROM MOTHER
YES 1
NO 2
DOESN'T KNOW 8
THINGS TO DO
YES 1
NO 2
DOESN'T KNOW 8
TESTED FOR AIDS
YES 1
NO 2
DOESN'T KNOW 8

915. Were you offered a test for the AIDS virus as part of your antenatal care?

YES 1
NO 2

916. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 926)

917. 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.

NAME OF THE PLACE(S) _______
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH STATION/CLINIC 13
STAND-ALONE VCT CENTER 14
OTHER PUBLIC (SPECIFY) ______16
NGO
NGO HEALTH FACILITY 21
STAND-ALONE VCT CENTER 22
MOBILE 23
OTHER NGO (SPECIFY) ______ 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE CLINIC 32
OTHER PRIVATE MEDICAL (SPECIFY) ______ 36
OTHER (SPECIFY) ______ 96

918. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

924. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1 (GO TO 927)
NO 2

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

MONTHS AGO _____ (GO TO 929B)
TWO OR MORE YEARS 96 (GO TO 929B)

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

YES 1
NO 2 (GO TO 930)

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

MONTHS AGO _____
TWO OR MORE YEARS 96

928. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

929. 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.

NAME OF THE PLACE(S) _______
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH STATION/CLINIC 13
STAND-ALONE VCT CENTER 14
OTHER PUBLIC (SPECIFY) _______16
NGO
NGO HEALTH FACILITY 21
STAND-ALONE VCT CENTER 22
MOBILE 23
OTHER NGO (SPECIFY) ______ 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 31
PRIVATE CLINIC 32
OTHER PRIVATE MEDICAL (SPECIFY) ______ 36
OTHER (SPECIFY) ______ 96

929B. CHECK 918 OR 928:

EVER RECEIVED HIV TEST RESULTS (GO TO 929C)
DID NOT RECEIVE HIV TEST RESULTS (GO TO 932)

929C. CHECK 601 AND 602:

EVER MARRIED OR LIVED WITH A PARTNER (GO TO 929D)
NEVER MARRIED NOR LIVED WITH A PARTNER (GO TO 932)

929D. The last time you were tested, did you share the results with your husband/partner?

YES 1 (GO TO 932)
NO, DID NOT SHARE RESULT 2 (GO TO 932)
NO HUSBAND/PARTNER AT THAT TIME 3 (GO TO 932)

930. Do you know a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 932)

931. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR WRITE THE NAME OF THE PLACE.

NAME OF THE PLACE(S) _______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
STAND-ALONE VCT CENTER D
OTHER PUBLIC (SPECIFY) ______ E
NGO
NGO HEALTH FACILITY F
STAND-ALONE VCT CENTER G
MOBILE H
OTHER NGO (SPECIFY) ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL J
PRIVATE CLINIC K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER (SPECIFY) ______ X

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

934. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

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

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

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

936. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

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

937. CHECK 910:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

938. CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 946)

939. CHECK 937:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 940)
NO (GO TO 941)

Now I would like to ask you some questions about your health in the last 12 months.

940. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

941. 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
DOESN'T KNOW 8

942. 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
DOESN'T KNOW 8

943. CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)

944. The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 946)

945. Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR WRITE THE NAME OF THE PLACE.

NAME OF THE PLACE(S) ________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) _______E
NGO HEALTH FACILITY F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
OTHER SOURCE
DRUG VENDOR/STORE K
SHOP L
TRADITIONAL HEALER M
OTHER (SPECIFY) ______ X

946. 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
DOESN'T KNOW 8

947. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other woman?

YES 1
NO 2
DOESN'T KNOW 8

948. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 949)
NOT IN UNION (GO TO 1000A)

949. 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

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

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

1000A. Have you ever heard of the Community Conversation program?

YES 1
NO 2 (GO TO 1000C)

1000B. Have you ever attended any Community Conversation meeting?
IF YES: When was the last time you attended?

WITHIN LAST THREE MONTHS 1
4-11 MONTHS AGO 2
ONE YEAR OR MORE AGO 3
NEVER ATTENDED 4

1000C. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1001)

1000D. How can a person get tuberculosis or TB?
PROBE: Any other ways?
RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
THROUGH DRINKING UN-BOILED MILK G
EXPOSURE TO COLD H
OTHER (SPECIFY) _______X
DOESN'T KNOW Z

1000E. What symptoms will a person with tuberculosis or TB have? Anything else?
RECORD ALL MENTIONED.

PERSISTENT COUGH (GREATER THAN TWO WEEKS) A
WEIGHT LOSS B
POOR APPETITE C
NIGHT SWEATING D
CHEST PAIN E
FEVER F
OTHER (SPECIFY) ______X
DOESN'T KNOW Z

1000F. Can tuberculosis or TB be cured?

YES 1
NO 2
DOESN'T KNOW 8

1000G. If a member of your family got tuberculosis or TB, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

Now I would like to ask you some other questions relating to health matters.

1001. 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 (GO TO 1004)

1002. Among these injections, how many were administered by a:

a) Doctor, a nurse, a pharmacist, a dentist, or any other health worker?
b) Traditional practitioner/injector?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NONE, RECORD '00'. IF NONE-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS HEALTH WORKER ______
NUMBER OF INJECTIONS TRADITIONAL PRACTITIONER ______

1002A. The last time you got an injection, who administered the injection?

HEALTH WORKER 1
TRADITIONAL PRACTITIONER 2

1003. The last time you got an injection, did the person who gave you the injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DOESN'T KNOW 8

1004. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

1005. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ______

1006. Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 1007A)

1007. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF/SURET C
SHISHA D
GAYA E
OTHER (SPECIFY) _______X

1007A. Have you ever chewed chat?

YES 1
NO 2 (GO TO 1007C)

1007B. During the last 30 days how many days did you chew chat?

NUMBER OF DAYS _____

1007C. Have you ever taken a drink that contains alcohol (Tella/Tegi/Areke/Beer/Wine, etc...)?

YES 1
NO 2 (GO TO 1008)

1007D. During the last 30 days, how many days did you take a drink that contains alcohol?

NUMBER OF DAYS _____

1008. 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?

Getting permission to go to the doctor?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Workload inside/outside home?
Not wanting to go alone?
Concern that there may not be a female health provider?
Concern that there may not be any health provider?
Concern that there may be no drugs available?

PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
TAKING TRANSPORT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
WORK LOAD
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO FEMALE PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO DRUGS
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1001)

1010. What type of health insurance are you covered by?
RECORD ALL MENTIONED.

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

SECTION 11. MATERNAL MORTALITY

Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died.

1101. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER _____

1102. CHECK 1101:

TWO OR MORE BIRTHS (GO TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1114)

1103. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ______

[ASK QUESTIONS 1104-1113 FOR ALL OF RESPONDENT'S MOTHER'S BIRTHS/SIBLINGS]

1104. What was the name given to your oldest (next oldest) brother or sister?

NAME ______

1105. Is (NAME) male or female?

MALE 1
FEMALE 2

1106. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DOESN'T KNOW 8 (GO TO NEXT CHILD)

1107. How old is (NAME)?

AGE ______ (GO TO NEXT CHILD)

1108. How many years ago did (NAME) die?

YEARS AGO ______

1109. How old was (NAME) when he/she died?

AGE ______ (IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO NEXT CHILD)

1110. Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111. Did (NAME) die during child birth?

YES 1 (GO TO 1113)
NO 2

1112. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1113. How many live born children did (NAME) give birth to during her lifetime?

NUMBER OF CHILDREN_____

[IF NO MORE BROTHERS OR SISTERS, GO TO 1114]

1114. RECORD THE TIME.

MORNING/EVENING ____
MORNING 1
EVENING 2
HOUR _____
MINUTES_____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT ______

COMMENTS ON SPECIFIC QUESTIONS ______

ANY OTHER COMMENTS ______

SUPERVISOR'S OBSERVATIONS ______
NAME ______
DATE______

EDITOR'S OBSERVATIONS ______
NAME ______
DATE______

INSTRUCTIONS

ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE:

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 MALE CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM/FOAM/JELLY
J STANDARD DAYS METHOD
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN (SPECIFY) ______
OTHER TRADITIONAL (SPECIFY) ______

2003 E.C.:
13 PAG 01 ______
12 NEH 02 ______
11 HAM 03 ______
10 SENE 04 ______
09 GEN 05 ______
08 MEI 06 ______
07 MEG 07 ______
06 YEK 08 ______
05 TIRR 09 ______
04 TAH 10 ______
03 HID 11 ______
02 TIK 12 ______
01 MES 13 ______

2002 E.C.:
13 PAG 14 ______
12 NEH 15 ______
11 HAM 16 ______
10 SENE 17 ______
09 GEN 18 ______
08 MEI 19 ______
07 MEG 20 ______
06 YEK 21______
05 TIRR 22 ______
04 TAH 23 ______
03 HID 24 ______
02 TIK 25 ______
01 MES 26 ______

2001 E.C.
13 PAG 27 ______
12 NEH 28 ______
11 HAM 29 ______
10 SENE 30 ______
09 GEN 31 ______
08 MEI 32 ______
07 MEG 33 ______
06 YEK 34 ______
05 TIRR 35 ______
04 TAH 36 ______
03 HID 37 ______
02 TIK 38 ______
01 MES 39 ______

2000 E.C.
13 PAG 40 ______
12 NEH 41 ______
11 HAM 42 ______
10 SENE 43 ______
09 GEN 44 ______
08 MEI 45 ______
07 MEG 46 ______
06 YEK 47 ______
05 TIRR 48 ______
04 TAH 49 ______
03 HID 50 ______
02 TIK 51 ______
01 MES 52 ______

1999 E.C.
13 PAG 53 ______
12 NEH 54 ______
11 HAM 55 ______
10 SENE 56 ______
09 GEN 57 ______
08 MEI 58 ______
07 MEG 59 ______
06 YEK 60 ______
05 TIRR 61 ______
04 TAH 62 ______
03 HID 63 ______
02 TIK 64 ______
01 MES 65 ______

1998 E.C.
13 PAG 66 ______
12 NEH 67 ______
11 HAM 68 ______
10 SENE 69 ______
09 GEN 70 ______
08 MEI 71 ______
07 MEG 72 ______
06 YEK 73 ______
05 TIRR 74 ______
04 TAH 75 ______
03 HID 76 ______
02 TIK 77 ______
01 MES 78 ______