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REPUBLIC OF GHANA
GHANA DEMOGRAPHIC AND HEALTH SURVEY
WOMEN'S QUESTIONNAIRE (ENGLISH)
(FOR WOMEN OF AGES 15-49)

IDENTIFICATION

PLACE NAME______
NAME OF HOUSEHOLD HEAD ______
E A NUMBER ________
STRUCTURE NUMBER ______
HOUSEHOLD NUMBER ______
REGION _______

URBAN/RURAL __________

Urban 1
Rural 2

NAME AND LINE NUMBER OF WOMAN ___________

NAME AND LINE NUMBER OF HUSBAND __________

ENTER '98', IF NOT MARRIED AND '99' IF PARTNER IS NOT A MEMBER OF HOUSEHOLD

FOR OFFICE USE

LARGE CITY/MEDIUM CITY/SMALL CITY/TOWN/VILLAGE ____

large city 1
medium city 2
small city 3
town 4
village 5

large city 1,000,000,000 and over
medium city 500,000 -- 999,999
small city 50,000 -- 499,999
town 5,000 -- 49,999
village less than 5,000

INTERVIEWER VISITS

INTERVIEW 1
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____

NEXT VISIT:
DATE ____
TIME ____

INTERVIEW 2
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____

NEXT VISIT:
DATE ____
TIME ____

INTERVIEW 3
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ___

TOTAL NUMBER OF VISITS ___

RESULT ____
***RESULT CODES:

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

FIELD EDITED BY
NAME ____
DATE ____

OFFICE EDITED BY
NAME ____
DATE ____

KEYED BY
NAME ____
DATE ____

KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOUR __
MINUTES ____

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village?

CITY 1
TOWN 2
VILLAGE 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN A YEAR, CODE "00"

YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in a city, in a town, or in a village?

CITY 1
TOWN 2
VILLAGE 3

105. In what month and year were you born?

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

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 (GO TO 111)

108. What is the highest level of school you attended: primary, middle/jss, secondary or higher?

PRIMARY 1
MIDDLE/JSS 2
SSS/COMM./VOC/TECH 3
POST SEC./NURSING/POLYTECH 4
HIGHER 5

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

GRADE ___

110. CHECK 108:

PRIMARY OR MIDDLE/JSS (GO TO 111)
SECONDARY/SSS OR HIGHER (GO TO 112)

111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all in any language?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

112. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

113. Do you usually listen to a radio at least once a week?

YES 1
NO 2

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

YES 1
NO 2

115. What is your religious denomination?

CATHOLIC 01
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
PENTECOSTAL 05
SPIRITUALIST 06
OTHER CHRISTIAN 07
MOSLEM 08
TRADITIONAL 09
NO RELIGION 10
OTHER 96

116. To which ethnic group do you belong?

ASANTE 01
AKWAPIM 02
FANTI 03
OTHER AKAN 04
GA/ADANGBE 05
EWE 06
GUAN 07
MOLE-DAGBANI 08
GRUSSI 09
GURMA 10
HAUSA 11
OTHER 96

117. CHECK Q. 4 IN THE HOUSEHOLD QUESTIONNAIRE

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (GO TO 118)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

118. Now I would like to ask about the place where you usually live. Do you usually live in a city, in a town, or in a village?

CITY 1
TOWN 2
VILLAGE 3

119. In which region is that located?
IF USUAL RESIDENCE IS OUTSIDE GHANA, RECORD COUNTRY OF RESIDENCE

(COUNTRY) ______
WESTERN 01
CENTRAL 02
GREATER ACCRA 03
VOLTA 04
EASTERN 05
ASHANTI 06
BRONG-AHAFO 07
NORTHERN 08
UPPER WEST 09
UPPER EAST 10
OUTSIDE GHANA 11

120. Now I would like to ask about the household in which you usually live. What is the source of water your household uses for laundry and dishwashing?

PIPED WATER
PIPED INTO RESIDENCE/YARD/COMPOUND 11 (GO TO 122)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/COMP 21 (GO TO 122)
PUBLIC WELL 22
BOREHOLE 23
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/DAM 33
DAM 34
DUGOUT 35
RAINWATER 41 (GO TO 122)
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 122)
OTHER (SPECIFY) ____ 96

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

HOURS ___
MINUTES ___
ON PREMISES 996

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

YES 1 (GO TO 125)
NO 2

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

PIPED WATER
PIPED INTO RESIDENCE/YARD/COMPOUND 11 (GO TO 125)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/COMP 21 (GO TO 125)
PUBLIC WELL 22
BOREHOLE 23
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
DUGOUT 35
RAINWATER 41 (GO TO 125)
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 125)
OTHER (SPECIFY) ____ 96

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

HOURS ____
MINUTES ___
ON PREMISES 996

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

FLUSH TOILET
OWN WC 11
SHARED WC 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
BUCKET/PAN 31
NO FACILITY (BUSH/FIELD) 41
OTHER (SPECIFY) ____ 96

126. Does your household have:

Electricity?
A functioning radio?
A functioning television?
A functioning refrigerator?
A functioning video?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
VIDEO
YES 1
NO 2

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

ROOMS ____

128. Could you describe the main material of the floor of your home?

NATURAL FLOOR
EARTH/SAND 11
MUD MIXED WITH DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
LINOLEUM 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
TERRAZO 36
OTHER (SPECIFY) _____ 96

129. Does any member of your household own:

A bicycle?
A motorcycle?
A motor vehicle?
A tractor?
A horse/cart?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
MOTOR VEHICLE
YES 1
NO 2
TRACTOR
YES 1
NO 2
HORSE/CART
YES 1
NO 2

SECTION 2. REPRODUCTION

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

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? IF NONE RECORD '00'. How many daughters?

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

206. Have you ever given birth to a boy or a girl who was born alive but later died? IF NO, PROBE: Have you ever had a baby who cried or shoed any sign of life but only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

207. In all, 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 1 (GO TO 210)
NO 2 (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 223)

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

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

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

NAME ______________

213. Was (NAME) born single or as a twin, triplet, etc. REOCRD SINGLE OR MULTIPLE BIRTH STATUS.

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

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 (GO TO NEXT BIRTH)
NO 2

219. IF LESS THAN 15 YRS. OF AGE: With whom does he/she live? IF 15+: GO TO NEXT BIRTH.

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3

220. IF DEAD: How old was he/she when he/she died?
IF "1 YR.", 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. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)
NUMBERS ARE SAME ____
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. ___
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. ___
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. ___
FOR AGE AT DEATH 12 MONTHS: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. ___

222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1990. IF NONE, RECORD 0.

____

223. Are you pregnant now?

YES 1
NO 2 (GO TO 226)
UNSURE 8 (GO TO 226)

224. How many months pregnant are you?

MONTHS ___
DON'T KNOW 98

225. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

226.When did your last menstrual period start?

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

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

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

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) _____ 6
DON'T K 8

SECTION 3. CONTRACEPTION

301. Now I would like to talk about the various ways or methods that a couple can use to delay or avoid pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.

THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.

THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302 Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD.

01) PILL Women can take a pill every day.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
02) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
05) CONDOM Men can use a rubber sheath during sexual intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
07) IMPLANT Women can have a NORPLANT implant inserted under the skin of their upper arm.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
08) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
09) RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
10) WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
1 (SPECIFY) _____
YES/SPONT 1
NO 3
2 (SPECIFY) _____
YES/SPONT 1
NO 3
3 (SPECIFY) ____
YES/SPONT 1
NO 3 (GO TO 305)

303. Have you and your partner ever used (METHOD)?

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES 1
NO 2
05) CONDOM Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07) IMPLANT Women can have a NORPLANT implant inserted under the skin of their upper arm.
YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES 1
NO 2
10) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11) Any other ways or methods that women or men can use to avoid pregnancy?
1 (SPECIFY) _____
YES 1
NO 2
2 (SPECIFY) _____
YES 1
NO 2
3 (SPECIFY) ____
YES 1
NO 2

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

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside them before intercourse.
YES 1
NO 2
05) CONDOM Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
07) IMPLANT Women can have a NORPLANT implant inserted under the skin of their upper arm.
YES 1
NO 2
08) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
09) RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant. Do you know where a person can obtain advice on how to use periodic abstinence?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE "YES" (NEVER USED) (GO TO 306)
AT LEAST ONE "YES" (EVER USED) (GO TO 308)

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

YES 1
NO 2 (GO TO 324)

307. What have you used or done? CORRECT 303-305 (AND 302 IF NECESSARY).

(ENTER WHAT WAS DONE)
_________

308. Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

309. CHECK 223:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 324)

310. CHECK 303:

WOMAN NOT STERILIZED (GO TO 311)
WOMAN STERILIZED (GO TO 312A)

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

YES 1 (GO TO 312)
NO 2

311A. What was the last method used?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
IMPLANT 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
OTHER (SPECIFY) _____ 96

311B. For how many months did you use the method continuously?

______

311C. Why did you stop using method?

WANT CHILDREN 01 (GO TO 324)
LACK OF KNOWLEDGE 02 (GO TO 324)
PARTNER OPPOSED 03 (GO TO 324)
COST TOO MUCH 04 (GO TO 324)
SIDE EFFECTS 05 (GO TO 324)
HEALTH CONCERNS 06 (GO TO 324)
HARD TO GET METHODS 07 (GO TO 324)
RELIGION 08 (GO TO 324)
OPPOSED TO FAMILY PLANNING 09 (GO TO 324)
FATALISTIC 10 (GO TO 324)
OTHER PEOPLE OPPOSED 11 (GO TO 324)
INFREQUENT SEX 12 (GO TO 324)
DIFFICULT TO GET PREGNANT 13 (GO TO 324)
MENOPAUSAL/HAD WOMB REMOVED 14 (GO TO 324)
INCONVENIENT 15 (GO TO 324)
NOT MARRIED 16 (GO TO 324)
BECAME PREGNANT 17 (GO TO 324)
OTHER (SPECIFY) _____ 96 (GO TO 324)
DON'T KNOW 98 (GO TO 324)

312. Which method are you using?
312A. CIRCLE '06' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 318)
INJECTIONS 03 (GO TO 318)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 318)
CONDOM 05 (GO TO 318)
FEMALE STERILIZATION 06 (GO TO 318)
IMPLANT 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
PERIODIC ABSTINENCE 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 323)
OTHER (SPECIFY) ____ 96 (GO TO 323)

313. At the time you first started using the pill, did you consult a doctor, a nurse or a midwife for advice?

YES 1
NO 2
DON'T KNOW 8

314. At the time you last got pills, did you consult a doctor or a nurse?

YES 1
NO 2

315. May I see the package of pills you are using now?
RECORD NAME OF BRAND.

PACKAGE SEEN 1 (GO TO 317)
BRAND NAME ______
PACKAGE NOT SEEN 2

316. Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND.

BRAND NAME ____
DON'T KNOW 98

317. How much does one (packet/cycle) of pills cost you?

COST ____
FREE 9996
DON'T KNOW 9998

317A. Have you experience any side effects from the use of the pill?

YES 1
NO 2 (GO TO 318)

317B. What side effects have you experienced?
CIRCLE ALL MENTIONED

DIZZINESS A
WEIGHT GAIN B
HEADACHES C
EXCESSIVE BLEEDING D
IRREGULAR CYCLE E
PAINFUL PERIOD/CRAMPS F
PALPITATION/IRREGULAR HEART BEAT G
OTHER (SPECIFY) _____ H
NONE I

318. CHECK 312:
SHE/HE STERILIZED ___ Where did the sterilization take place?
USING ANOTHER METHOD ___ Where did you obtain (METHOD) the last time?

(NAME OF SOURCE) _____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/POLYCLINIC 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14 (GO TO 321)
FIELD WORKER 15 (GO TO 321)
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL 21
PHARMACY/CHEMIST/DRUG STORE 22
PRIVATE DOCTOR/CLINIC 23
MOBILE CLINIC 24 (GO TO 321)
FIELD WORKER 25 (GO TO 321)
PRIVATE FP/PPAG CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33 (GO TO 321)
OTHER (SPECIFY) _____ 96 (GO TO 321)
DON'T KNOW 98 (GO TO 321)

319. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1 ___
HOURS 2 __
DON'T KNOW 9998

320. Is it convenient or inconvenient to get there?

CONVENIENT 1
INCONVENIENT 2

321. CHECK 312:

SHE/HE STERILIZED (GO TO 322)
USING ANOTHER METHOD (GO TO 323)

322. In what month and year was sterilization operation performed?

MONTH ___ (GO TO 334)
YEAR ___ (GO TO 334)

323. For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS ___ (GO TO 329)
8 YEARS OR LONGER 96 (GO TO 329)

324. Do you intend to use a method to delay or avoid pregnancy at any time in the future?

YES 1 (GO TO 326)
NO 2
DON'T KNOW 8 (GO TO 330)

325. What is the main reason why you do not intend to use a method?

WANT CHILDREN 01 (GO TO 330)
LACK OF KNOWLEDGE 02 (GO TO 330)
PARTNER OPPOSED 03 (GO TO 330)
COST TOO MUCH 04 (GO TO 330)
SIDE EFFECTS 05 (GO TO 330)
HEALTH CONCERNS 06 (GO TO 330)
HARD TO GET METHODS 07 (GO TO 330)
RELIGION 08 (GO TO 330)
OPPOSED TO FAMILY PLANNING 09 (GO TO 330)
FATALISTIC 10 (GO TO 330)
OTHER PEOPLE OPPOSED 11 (GO TO 330)
INFREQUENT SEX 12 (GO TO 330)
DIFFICULT TO GET PREGNANT 13 (GO TO 330)
MENOPAUSAL/HAD WOMB REMOVED 14 (GO TO 330)
INCONVENIENT 15 (GO TO 330)
NOT MARRIED 16 (GO TO 330)
BECAME PREGNANT WHILE USING 17 (GO TO 330)
OTHER (SPECIFY) _____ 96 (GO TO 330)
DON'T KNOW 98 (GO TO 330)

326. Do you intend to use a method within the next 12 months?

YES 1
NO 2
DON'T KNOW 8

327. When you (or your partner) use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
IMPLANT 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09 (GO TO 330)
WITHDRAWAL 10 (GO TO 330)
OTHER (SPECIFY) _____ 96 (GO TO 330)
UNSURE 98 (GO TO 330)

328. Where can you get (METHOD MENTIONED IN 327)?
(IF MORE THAN ONE, ASK FOR THE NEAREST)

NAME OF SOURCE ____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/POLYCLINIC 11 (GO TO 332)
GOVERNMENT HEALTH CENTER 12 (GO TO 332)
FAMILY PLANNING CLINIC 13 (GO TO 332)
MOBILE CLINIC 14 (GO TO 334)
FIELD WORKER 15 (GO TO 324)
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL 21 (GO TO 332)
PHARMACY/CHEMIST/DRUG STORE 22 (GO TO 332)
PRIVATE DOCTOR/CLINIC 23 (GO TO 332)
MOBILE CLINIC 24 (GO TO 334)
FIELD WORKER 25 (GO TO 334)
PRIVATE FP/PPAG CLINIC 26 (GO TO 332)
MATERNITY HOME 27 (GO TO 332)
OTHER PRIVATE SECTOR
SHOP 31 (GO TO 332)
CHURCH 32 (GO TO 332)
FRIENDS/RELATIVES 33 (GO TO 321)
OTHER (SPECIFY) _____ 96 (GO TO 334)
DON'T KNOW 98 (GO TO 330)

329. CHECK 312:

USING PERIODIC ABSTINENCE, WITHDRAWAL, OTHER TRADITIONAL METHOD (GO TO 330)
USING A MODERN METHOD (GO TO 334)

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

YES 1
NO 2 (GO TO 334)

331. Where is that?
(IF MORE THAN ONE ASK FOR THE NEAREST)

NAME OF SOURCE _______________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/POLYCLINIC 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14 (GO TO 334)
FIELD WORKER 15 (GO TO 324)
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL 21
PHARMACY/CHEMIST/DRUG STORE 22
PRIVATE DOCTOR/CLINIC 23
MOBILE CLINIC 24 (GO TO 334)
FIELD WORKER 25 (GO TO 334)
PRIVATE FP/PPAG CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33 (GO TO 334)
OTHER (SPECIFY) _____ 96 (GO TO 334)

332. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1 ___
HOURS 2 __
DON'T KNOW 9998

333. Is it convenient or inconvenient to get there?

CONVENIENT 1
INCONVENIENT 2

334. In the last month, have you heard or seen a message about family planning:

on the radio?
on television?
in a newspaper?
on poster/billboard?
from community health nurse?
from family planning worker?
from friends/relatives?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER
YES 1
NO 2
POSTER/BILLBOARD
YES 1
NO 2
COMMUNITY HEALTH NURSE
YES 1
NO 2
FAMILY PLANNING WORKER
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

335. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 222:

ONE OR MORE BIRTHS SINCE JAN. 1990 (GO TO 402)
NO BIRTHS SINCE JAN. 1990 (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1990 IN THE TABLE.

ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all of your children born in the past three years. (We will talk about one child at a time).

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

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

404. How much longer would you like to have waited?
RECORD IN MONTHS IF LESS THAN 2 YEARS.

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

405. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES, Whom did you see? Anyone else?
RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED (TRADITIONAL) BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) _____ F
NO ONE G (GO TO 409)

406.Were you given an antenatal ID card for this pregnancy?

YES 1
NO 2
DON'T KNOW 8

407. How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

MONTHS ___
DON'T KNOW 98

408. How many antenatal visits did you have during this pregnancy?

NO. OF VISITS ___
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 411)
DON'T KNOW 8 (GO TO 411)

410. During the pregnancy how many times did you get this injection?

TIMES ___
DON'T KNOW 8

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

HOME
YOUR HOME 11
TBA'S HOME 12
OTHER HOME 13
PUBLIC SECTOR
GVT. HOSPITAL/CLINIC 21
GVT. HEALTH CENTER 22
GVT. HEALTH POST 23
PRIVATE SECTOR
PVT. HOSPITAL/CLINIC 31
MATERNITY HOME 32
OTHER (SPECIFY) ____ 96

412. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED (TRADITIONAL) BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
RELATIVE F
OTHER (SPECIFY) _____ G
NO ONE H

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

ON TIME 1
PREMATURELY 2
DON'T KNOW 8

414.Was (NAME) delivered by caesarian section?

YES 1
NO 2

415. 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
DON'T KNOW 8

416. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 417B)

417A. How much did (NAME) weigh?

KILOGRAMS ___.__
DON'T KNOW 98

417B. Did you receive postnatal care within six weeks after delivery of (NAME)?
[Most recent birth within the last three years]

YES 1
NO 2 (GO TO 418)

417C. Who provided the postnatal care? Anyone else?
PROBE FOR ALL PERSONS CONSULTED.
[Repeat questions for all children born in the last 3 years, excluding the most recent birth]

HEALTH PROFESSIONAL
DOCTOR A
NURSE B
MIDWIFE C
OTHER PERSON
TRAINED (TRADITIONAL) BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
RELATIVE F
OTHER (SPECIFY) _____ G
NO ONE H

418. Have you had your menstrual period since birth of (NAME)?
ASK FOR LAST BIRTH ONLY

YES 1 (GO TO 420)
NO 2 (GO TO 421)

419. Did you have your menstrual period between the birth of (NAME) and your next pregnancy? (DO NOT ASK FOR LAST BIRTH)

YES 1
NO 2 (GO TO 423)

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

MONTHS ___
DON'T KNOW 98

421. CHECK 223: RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 422)
PREGNANT OR UNSURE (GO TO 423)

422. Have you resumed sexual relations since the birth of (NAME)?
[Most recent birth within the last three years]

YES 1
NO 2 (GO TO 424)

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

MONTHS ___
DON'T KNOW 98

424. Did you ever breastfeed (NAME)?

YES 1 (GO TO 426)
NO 2

425. Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01 (GO TO 435)
CHILD ILL/WEAK 02 (GO TO 435)
CHILD DIED 03 (GO TO 435)
NIPPLE/BREAST PROBLEM 04 (GO TO 435)
INSUFFICIENT MILK 05 (GO TO 435)
MOTHER WORKING 06 (GO TO 435)
CHILD REFUSED 07 (GO TO 435)
OTHER (SPECIFY) _____ 96 (GO TO 435)

426. 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 FOR LAST BIRTH ONLY.
[Most recent birth within the last three years]

IMMEDIATELY 000
HOUR 1
DAYS 2

427. CHECK 216: CHILD ALIVE? (LAST BIRTH)
[Most recent birth within the last three years]

ALIVE (GO TO 428)
DEAD (GO TO 433)

428. Are you still breastfeeding (NAME)? (LAST BIRTH)
[Most recent birth within the last three years]

YES 1
NO 2 (GO TO 433)

429. How many times did you breastfeed last night between sunset and sunrise? (LAST BIRTH)
IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER.
[Most recent birth within the last three years]

NUMBER OF NIGHTTIME FEEDINGS ___

430. How many times did you breastfeed yesterday during the daylight hours? (LAST BIRTH)
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[Most recent birth within the last three years]

NUMBER OF DAYLIGHT FEEDINGS ___

431. At any time yesterday or last night was (NAME) given any of the following?:

Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Fresh milk?
Tinned or powdered milk?
Other liquids?
Any solid or mushy food?
[Most recent birth within the last three years]

PLAIN WATER
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
HERBAL TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
FRESH MILK
YES 1
NO 2
TINNED/POWDERED MILK
YES 1
NO 2
OTHER LIQUIDS
YES 1
NO 2
SOLID/MUSHY FOOD
YES 1
NO 2

432. CHECK 431: FOOD OR LIQUID GIVEN YESTERDAY? (LAST BIRTH)
[Most recent birth within the last three years]

"YES" TO ONE OR MORE (GO TO 437)
"NO" TO ALL (GO TO 436)

433. For how many months did you breastfeed (NAME)?

MONTHS ___
UNTIL DIED 96 (GO TO 436)

434. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) _____ 96

435. CHECK 216: CHILD ALIVE?

ALIVE (GO TO 437)
DEAD (GO TO 436)

436. Was (NAME) ever given water or anything else to drink or eat (other than breastmilk)?

YES 1
NO 2 (GO TO 440)

437. How many months old was (NAME) when you started giving the following on a regular basis?

Formula or milk other than breastmilk?
Plain water? (Water without any additive)
Other liquids? (Koko, rice water, etc)
Any solid or mushy food? (Weanimix, mashed yam, ampotomtoto, etc.)
IF LESS THAN 1 MONTH, RECORD '00'.

Formula or milk other than breastmilk?
AGE IN MONTHS ___
NOT GIVEN 96
Plain water? (Water without any additive)
AGE IN MONTHS ___
NOT GIVEN 96
Other liquids? (Koko, rice water, etc)
AGE IN MONTHS ___
NOT GIVEN 96
Any solid or mushy food? (Weanimix, mashed yam, ampotomtoto, etc.)
AGE IN MONTHS ___
NOT GIVEN 96

438. CHECK 216: CHILD ALIVE? (LAST BIRTH)
[Most recent birth within the last three years]

ALIVE (GO TO 439)
DEAD (GO TO 440)

439. Did (NAME) drink anything from a bottle with a nipple yesterday or last night? (LAST BIRTH)
[Most recent birth within the last three years]

YES 1
NO 2
DON'T KNOW 8

440. GO BACK TO 403 FOR NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO FIRST COLUMN OF 441.

SECTION 4B. IMMUNIZATION AND HEALTH

441. ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1990 IN THE TABLE.

ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

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

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

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

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

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

BCG
DAY__
MO __
YR __
POLIO 1
DAY__
MO __
YR __
POLIO 2
DAY__
MO __
YR __
POLIO 3
DAY__
MO __
YR __
DPT 1
DAY__
MO __
YR __
DPT 2
DAY__
MO __
YR __
DPT 3
DAY__
MO __
YR __
MEASLES
DAY__
MO __
YR __

445. Has (NAME) received any vaccinations that are not recorded on this card? RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT 1-3, POLIO 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 444) (GO TO 448)
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)

446. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)

447. Please tell me if (NAME) (has) received any of the following vaccinations:

A BCG vaccination against tuberculosis, that is, an injection in the right shoulder that caused a scar?
YES 1
NO 2
DON'T KNOW 8
Polio vaccine, that is, drops in the mouth?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times?
NUMBER OF TIMES____
An injection against measles?
YES 1
NO 2
DON'T KNOW 8

448. CHECK 216: CHILD ALIVE?

ALIVE (GO TO 450)
DEAD (GO TO 449)

449. GO BACK TO 442 FOR NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 480.

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

YES 1
NO 2 (GO TO 455)
DON'T KNOW 3 (GO TO 455)

451. Was anything given to treat the fever?

YES 1
NO 2 (GO TO 453)
DON'T KNOW 3 (GO TO 453)

452. What was given to treat the fever? Anything else?
RECORD ALL MENTIONED.

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY) ____ H

453. Did you seek advice or treatment for the fever?

YES 1
NO 2 (GO TO 455)

454. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTER B
GVT. HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH CENTER E
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL F
PHARMACY/DRGST./CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
OTHER (SPECIFY) _____ M

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

YES 1
NO 2 (GO TO 460)
DON'T KNOW 8 (GO TO 460)

456. Has (NAME) been ill with a cough in the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

457. For how many days (has the cough lasted/did the cough last)? IF LESS THAN 1 DAY, RECORD '00'.

DAYS ___

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

YES 1
NO 2
DON'T KNOW 8

459A. Was anything given to treat the cough?

YES 1
NO 2 (GO TO 459C)
DON'T KNOW 8 (GO TO 459C)

459B. What was given to treat the cough? Anything else?
RECORD ALL MENTIONED.

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY) _____ H

459C. Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 460)

459D. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTER B
GVT. HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH CENTER E
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL F
PHARMACY/DRGST./CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
OTHER (SPECIFY) _____ M

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

YES 1 (GO TO 462)
NO 2
DON'T KNOW 8

461. GO BACK TO 442 FOR NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 480.

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

YES 1
NO 2
DON'T KNOW 8

463. For how many days (has the diarrhea lasted/did the diarrhea last)? If LESS THAN 1 DAY, RECORD '00'.

DAYS ___

464. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

465. CHECK 426/429: LAST CHILD STILL BREASTFED?

YES (GO TO 466)
NO (GO TO 468)

466. During (NAME)'s diarrhea, did you change the frequency of breastfeeding?
[Most recent birth within the last three years]

YES 1
NO 2 (GO TO 468)

467. Did you increase the number of breastfeeds or reduce them, or did you stop completely?
[Most recent birth within the last three years]

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

468. (Aside from breastmilk) was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

469. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 471)
DON'T KNOW 8 (GO TO 471)

470. Was anything given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED.

FLUID FROM ORS PACKET A
RECOMMENDED HOME FLUID B
ANTIBIOTIC (PILL OR SYRUP) C
OTHER PILL OR SYRUP D
INJECTION E
(I.V.) INTRAVENOUS F
HOME REMEDIES/HERBAL MEDICINES G
OTHER (SPECIFY) _____ H

471. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 473)

472. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL/CLINIC A
GVT. HEALTH CENTER B
GVT. HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH CENTER E
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL F
PHARMACY/DRGST./CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
OTHER (SPECIFY) _____ M

473. CHECK 470: ORS FLUID FROM PACKET MENTIONED?

NO, ORS FLUID NOT MENTIONED (GO TO 474)
YES, ORS FLUID MENTIONED (GO TO 475B)

474. Was (NAME) given PHERMEROL when he/she had the diarrhea?

YES 1 (GO TO 475B)
NO 2
DON'T KNOW 8

475A. Was (NAME) given ORS when he/she had the diarrhea?

YES 1
NO 2 (GO TO 476)
DON'T KNOW 8 (GO TO 476)

475B. For how many days was (NAME) given (PHERMEROL) (ORS)?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ___
DON'T KNOW 98

476. CHECK 470: RECOMMENDED HOME FLUID MENTIONED?

NO, HOME FLUID NOT MENTIONED (GO TO 477)
YES, HOME FLUID MENTIONED (GO TO 478)

477. Was (NAME) given a recommended home fluid made from eg. rice water, kenkey water when he/she had the diarrhea?

YES 1
NO 2 (GO TO 479)
DON'T KNOW 8 (GO TO 479)

478. For how many days was (NAME) given the fluid made from eg. rice water, kenkey water?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS ___
DON'T KNOW 98

479. GO BACK TO 442 FOR NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 480.

480. CHECK 470, 474 AND 475A (ALL COLUMNS):

ORS FLUID FROM PACKET GIVEN TO ANY CHILD (GO TO 484)
ORS FLUID FROM PACKET NOT GIVEN TO ANY CHILD OR 470, 474 AND 475A NOT ASKED (GO TO 481)

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

YES 1 (GO TO 483)
NO 2

482. Have you ever seen a packet like this before? SHOW PACKET.

YES 1
NO 2 (GO TO 487)

483. Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else? SHOW PACKET.

YES 1
NO 2 (GO TO 486)

484. The last time you prepared the ORS, did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
PART OF PACKET 2 (GO TO 486)

485. How much water did you use to prepare ORS the last time you made it?

1/2 LITER 01
1 LITER 02
1 1/2 LITER 03
1 BEER BOTTLE 04
FOLLOWED PACKAGE INSTRUCTIONS 05
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

486. Where can you get the ORS or PHERMEROL packet? PROBE: Anywhere else?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH CENTER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRGST./CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
OTHER (SPECIFY) _____ M

487. CHECK 470 AND 477 (ALL COLUMNS):

HOME-MADE FLUID GIVEN TO ANY CHILD (GO TO 488)
HOME-MADE FLUID NOT GIVEN TO ANY CHILD OR 470 AND 477 NOT ASKED (GO TO 501)

488. Where did you learn to prepare the recommended home fluid made from sugar, salt and water give to (NAME) when he/she had diarrhea?

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
MOBILE PUBLIC SECTOR 14
COMMUNITY HEALTH WORKER 15
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL 21
PHARMACY/DRUG STORE/CHEMIST 22
PRIVATE DOCTOR/CLINIC 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER 31
SHOP 32
OTHER (SPECIFY) _____ 96

SECTION 5. MARRIAGE

501. Are you currently married or living with a man?

YES 1
NO 2 (GO TO 512)

502. Are you now married or living with a man, or are you now widowed, divorced, or no longer living together?

MARRIED 1
CONSENSUAL UNION 2
WIDOWED 3 (GO TO 507)
DIVORCED 4 (GO TO 507)
SEPARATED 5 (GO TO 507)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

YES 1
NO 2 (GO TO 507)

505. How many other wives does he have?

NUMBER ___
DON'T KNOW 98 (GO TO 507)

506. Are you first, second,...wife?

RANK ___

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

ONCE 1
MORE THAN ONCE 2

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

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

509. How old were you when you started living with him?

AGE __
DON'T KNOW AGE 98

510. CHECK 508 AND 509: YEAR AND AGE GIVEN?

YES (GO TO 511)
NO (GO TO 513)

511. CHECK CONSISTENCY OF 508 AND 509:
YEAR OF BIRTH (105) ____
PLUS
AGE AT MARRIAGE (509)
CALCULATED:
YEAR OF MARRIAGE ___

IF NECESSARY, CALCULATE YEAR OF BIRTH:
CURRENT YEAR 93
MINUS
CURRENT AGE (106) __
CALCULATED
YEAR OF BIRTH ___

IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (508)?

YES (GO TO 513)
NO (PROBE AND CORRECT 508 AND 509)

512. IF NEVER IN UNION:
Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 517)

513. Now I would like to talk to you about some aspects of your sexual life in order to get a better understanding of family planning and fertility.
How many times did you have sexual intercourse in the last four weeks?

TIMES ___

514. How many times in a month do you usually have sexual intercourse?

TIMES ___

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

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

516. How old were you when you first had sexual intercourse?

AGE __
FIRST TIME WHEN MARRIED 96

517. PRESENCE OF OTHERS AT THIS POINT.

CHILD UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 6A. FERTILITY PREFERENCES

601. CHECK 312:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 607)

602. CHECK 502:

CURRENTLY MARRIED OR LIVING TOGETHER (GO TO 603)
NOT MARRIED/NOT LIVING TOGETHER (GO TO 614)

603. CHECK 223:

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

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

HAVE A (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 610)
CANNOT GET PREGNANT 3 (GO TO 610)
UNDECIDED OR DON'T KNOW 8 (GO TO 610)

604. CHECK 223:

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

PREGNANT ___ (How long would you like to wait after the birth of the child you are expecting before the birth of another child?)

(RECORD IN MONTHS IF LESS THAN 2 YEARS)

MONTHS 1 ___ (GO TO 610)
YEARS 2 ___ (GO TO 610)
NOW 994 (GO TO 610)
CANNOT GET PREGNANT 995 (GO TO 610)
OTHER (SPECIFY) ____ 996
DON'T KNOW 998

605. CHECK 216 AND 223:

HAS LIVING CHILD(REN) OR PREGNANT
YES (GO TO 606)
NO (GO TO 610)

606. CHECK 223:

NOT PREGNANT OR UNSURE __ (How old would like your youngest child to be when your next child is born?)

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

AGE OF CHILD
YEARS ___ (GO TO 610)
DON'T KNOW 98 (GO TO 910)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 614)

609. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 614)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 614)
BOTH PARTNERS WANT ANOTHER CHILD 3 (GO TO 614)
SIDE EFFECTS 4 (GO TO 614)
OTHER REASON (SPECIFY) ____ 6 (GO TO 614)

610. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

611. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

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

YES 1
NO 2

613. Do you think your husband/partner wants 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

614. How long should a couple wait before starting sexual intercourse after the birth of a baby?
(RECORD IN MONTHS IF LESS THAN 2 YEARS)

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

615. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

WAIT 1
DOESN'T MATTER 2

616. In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2 (GO TO 617)

616B. Who do you think should decide on which method to use?

SELF 01
SPOUSE 02
BOTH OF US 03
HEALTH PROFESSIONAL 04
RELATIVE 05
FRIEND 06
OTHER (SPECIFY) ____ 96

617. CHECK 216:

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

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

RECORD ONE NUMBER OR OTHER ANSWER.
IF "NONE" CIRCLE 96 AND RECORD RESPONSE.

NUMBER ___
OTHER ANSWER (SPECIFY) ____ 96 (GO TO 619)

618. How many of those children would be sons? And how many would be daughters?

NUMBER OF BOYS___
NUMBER OF GIRLS___
NUMBER OF EITHER___
UP TO GOD 999995
OTHER ANSWER 999996

619. What do you think is the best number of months or years between the birth of one child and the birth of the next child?
RECORD MONTHS IF LESS THAN 2 YEARS.

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

NUMBER OF PARTNERS ____.

SECTION 6B. MATERNAL MORTALITY

Now I would like to ask you some questions about all female children born to your mother.

620. How many daughters did your mother ever give birth to including yourself and those who are now dead?

DAUGHTERS ___ (IF 01, GO TO 701)

621. How many of these daughters born to your mother ever reached age 15?
CHECK THAT FEMALE RESPONDENT INCLUDES HERSELF AS ONE OF THE DAUGHTERS.

REACHED AGE 15 ___ (IF 01, GO TO 701)

622. How many of these daughters who reached age 15 are alive now?

ALIVE ___

623. How many of these daughters who reached age 15 are dead?
CHECK THAT SUM OF Q622 AND Q623 IS EQUAL TO Q621.

DEAD ___ (IF 00, GO TO 701)

624. How many of these dead daughters died during pregnancy?

DURING PREGNANCY___

625. How many of these dead daughters died during childbirth?

DURING CHILDBIRTH ___

626. How many of these dead daughters died during the six weeks after the end of a pregnancy?

AFTER PREGNANCY___

627. SUM ANSWERS TO Q624, Q625, Q626.

SUM MATERNAL DEATHS ___

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

701. CHECK 501:

EVER MARRIED OR LIVED TOGETHER (ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER.)
NEVER MARRIED/NEVER LIVED TOGETHER (GO TO 708)

702. Did you (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 705)

703. What was the highest level of school he attended: primary, middle/jss, secondary or higher?

PRIMARY 1
MIDDLE/JSS 2
SSS/COMM/VOC/TECH 3
POST SEC./NURSING/POLYTECH 4
HIGHER 5
DON'T KNOW 8 (GO TO 705)

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

GRADE ___
DON'T KNOW 98

705. What kind of work does (did) your (last) husband/partner mainly do?
IF DON'T KNOW, RECORD RESPONSE AND GO TO 708.

__________ __ (TO BE CODED BY EDITOR)
__________
__________

706. CHECK 705:

MAINLY WORKS (WORKED) IN FARMING (GO TO 707)
DOES (DID) NOT WORK MAINLY IN FARMING (GO TO 708)

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

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

708. Apart from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

709. As you know, some women take up jobs for which they are paid in cash or in kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or say other work?

YES 1
NO 2 (GO TO 721)

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

__________ __ (TO BE CODED BY EDITOR)
__________
__________

711. In your current work, do you work for a member of your family, for someone else, or are you self-employed?
PROBE: FOR GOVERNMENT WORKER

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
FOR GOVERNMENT 4

712. Do you earn cash for this work?
PROBE: Do you make money for working?

YES 1
NO 2

713. Do you do this work at home or away from home?

HOME 1
AWAY 2

714. CHECK 215/216/218:
HAS A CHILD BORN SINCE JAN. 1988 AND LIVING AT HOME?

YES (GO TO 715)
NO (GO TO 721)

715. While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him, her with you, or never have him/her with you?

USUALLY 1 (GO TO 721)
SOMETIMES 2
NEVER 3

716. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

HUSBAND/PARTNER 01
OTHER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
CRECHE/NURSERY 08
OTHER (SPECIFY) ____ 96

SECTION 7B. AIDS KNOWLEDGE AND OTHER SEXUALLY TRANSMITTED DISEASES

721. Now I have a few questions about a very important topic. Have you heard of an illness called AIDS?

YES 1
NO 2 (GO TO 729)

722. From which sources of information or persons have you heard about AIDS in the last month?
CIRCLE ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS C
HEALTH WORKERS D
MOSQUES/CHURCHES E
FRIENDS/RELATIVES F
SCHOOLS G
SLOGANS/MUSIC H
PAMPHLETS/POSTERS I
COMMUNITY MEETINGS J
OTHER (SPECIFY) ____ K
NONE L

723. How is AIDS transmitted?
CIRCLE ALL MENTIONED.

NEEDLES/BLADES/SKIN WOUND A
MOTHER TO CHILD B
SEXUAL INTERCOURSE C
TRANSFUSION OF INJECTED BLOOD D
OTHER (SPECIFY) ____ E
DON'T KNOW F

724. Do you think that you can get AIDS from:

shaking hands with someone who has AIDS?
hugging someone who has AIDS?
kissing someone who has AIDS?
sexual intercourse with someone with AIDS?
wearing the clothes of someone who has AIDS?
sharing eating utensils with someone who has AIDS?
stepping on the saliva, urine or stool of someone who has AIDS?
mosquito, flea or bedbug bites?
not using a condom?

HANDSHAKING
YES 1
NO 2
HUGGING
YES 1
NO 2
KISSING
YES 1
NO 2
SEXUAL INTERCOURSE
YES 1
NO 2
SHARING CLOTHES
YES 1
NO 2
SHARING EATING UTENSILS
YES 1
NO 2
STEPPING ON URINE/STOOL
YES 1
NO 2
MOSQUITO/FLEA/BEDBUG BITES
YES 1
NO 2
NOT USING A CONDOM
YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

726. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

727. What do you suggest is the most important thing the government should do for people who have AIDS?

PROVIDE FREE MEDICAL TREATMENT 1
HELP RELATIVES PROVIDE CARE 2
ISOLATE QUARANTINE 3
SHOULD NOT BE INVOLVED 4
OTHER (SPECIFY) ____ 6

728. If you relative is suffering from AIDS, who would you prefer to care for him/her?

RELATIVES 1
FRIENDS 2
GOVERNMENT ORGANISATION 3
RELIGIOUS ORG/MISSION 4
NOBODY/ABANDON 5
OTHER (SPECIFY) ____ 6

729. Have you heard of other diseases apart from AIDS which could be transmitted through sexual intercourse?

YES 1
NO 2 (GO TO 737)

730. Name the diseases. Any other?
CIRCLE AS MANY AS MENTIONED.

GONORRHEA A
SYPHILIS B
HERPES C
HEPATITIS D
OTHER (SPECIFY) ____ E

731. CHECK 730 FOR DISEASES MENTIONED AND ASK Q 732 -- Q 736 WHERE APPROPRIATE.

732. Where can one go to treat gonorrhea?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

733. Where can one go to treat syphilis?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

734. Where can one go to treat herpes?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

735. Where can one go to treat hepatitis?
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

736. Where can one go to treat..... ? (NAME OF DISEASE RECORDED ON THE "OTHER SPECIFY" LINE OF Q 730).
CIRCLE ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL F
PHARMACY/DRUGGIST/CHEMIST G
PRIVATE DOCTOR/CLINIC H
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE SECTOR
SHOP K
TRADITIONAL PRACTITIONER L
SPIRITUALIST M
OTHER (SPECIFY) ____ N

737. RECORD THE TIME.

HOUR __
MINUTES ___

SECTION 8: LANGUAGE INFORMATION

801. WHAT IS THE RESPONDENT'S OWN LANGUAGE?

TWI 01
FANTI 02
GA-ADANGBE 03
EWE 04
NZEMA 05
DAGBANI 06
HAUSA 07
ENGLISH 08
OTHER (SPECIFY) ___ 96

802. IN WHAT LANGUAGE DID YOU CONDUCT THE INTERVIEW?

TWI 01
FANTI 02
GA-ADANGBE 03
EWE 04
NZEMA 05
DAGBANI 06
HAUSA 07
ENGLISH 08
OTHER (SPECIFY) ___ 96

803. FOR HOW MUCH OF THE INTERVIEW DID YOU DEPEND ON A THIRD PERSON TO INTERPRET FOR YOU?

NONE OF THE INTERVIEW 1 (GO TO 901)
A SMALL PORTION 2
MOST OF THE INTERVIEW 3
ALL OF THE INTERVIEW 4

804. IF AN INTERPRETER WAS USED, INDICATE THE SEX AND APPROXIMATE AGE OF THE INTERPRETER.

ADULT FEMALE 1
TEENAGE FEMALE 2
ADULT MALE 3
TEENAGE MALE 4
CHILD 5

SECTION 9. HEIGHT, WEIGHT AND ARM CIRCUMFERENCE

901. CHECK 222:

NO BIRTHS SINCE JAN. 1990 (END)

ONE OR MORE BIRTHS SINCE JAN. 1990 (IN 902 (COLUMNS 2-4)
RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1990 AND STILL ALIVE.

IN 903 AND 904 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1990.

IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.

(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1990 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED.

IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1990, USE ADDITIONAL FORMS).

902. LINE NO. FROM Q. 212

___

903. NAME FROM Q. 212 FOR CHILDREN

RESPONDENT
NAME ____
CHILD
NAME ____

904. DATE OF BIRTH
FROM Q. 105 FOR RESPONDENT.
FROM Q. 215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH.

RESPONDENT
MONTH ___
YEAR ___
CHILD
DAY ____
MONTH ___
YEAR ___

905. BCG SCAR ON TOP OF [CHILD'S] SHOULDER.

SCAR SEEN 1
NO SCAR 2

906. HEIGHT (in centimeters)

RESPONDENT
____.__
CHILD
____.__

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

LYING 1
STANDING 2

908. WEIGHT (in kilograms)

RESPONDENT
____.__
CHILD
___.__

909. LEFT UPPER ARM CIRCUMFERENCE (in MM)

RESPONDENT
____
CHILD
____

910. DATE WEIGHED AND MEASURED

RESPONDENT
DAY ___
MONTH ___
YEAR ___
CHILD
DAY ___
MONTH ___
YEAR ___

911. RESULT

RESPONDENT
MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) _____ 6
CHILD
CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ____ 6

912. NAME OF MEASURER: ____ __
NAME OF ASSISTANT: _____ __

INTERVIEWER'S OBSERVATIONS
(To be filled in after completing interview)

COMMENTS ABOUT RESPONDENT:
________________________________
________________________________
________________________________

COMMENTS ON SPECIFIC QUESTIONS:
________________________________
________________________________
________________________________

ANY OTHER COMMENTS:
________________________________
__________________________
__________________________

SUPERVISOR'S OBSERVATIONS
__________________________
__________________________
__________________________

NAME OF THE SUPERVISOR:_________________________
DATE: __________

EDITOR'S OBSERVATIONS
__________________________
__________________________
__________________________

NAME OF EDITOR:___________________________________
DATE: _________