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GHANA DEMOGRAPHIC AND HEALTH SURVEYS WOMAN'S QUESTIONNAIRE, 2003

GHANA STATISTICAL SERVICE

IDENTIFICATION

LOCALITY NAME _________
NAME OF HOUSEHOLD HEAD ________
EA NUMBER _______
HOUSEHOLD NUMBER _________
REGION __________
DISTRICT _____________

URBAN/RURAL

URBAN 1
RURAL 2

CITY/LARGE TOWN/SMALL TOWN/VILLAGE

CITY 1
LARGE TOWN 2
SMALL TOWN 3
VILLAGE 4

NAME AND LINE NUMBER OF WOMAN ____

INTERVIEWER VISITS

VISIT 1
DATE _________
NTERVIEWER'S NAME __________
RESULT* __________

NEXT VISIT:
DATE _______
TIME ________

VISIT 2
DATE _________
INTERVIEWER'S NAME __________
RESULT* __________

NEXT VISIT:
DATE _______
TIME ________

INTERVIEWER VISIT 3
DATE _________
INTERVIEWER'S NAME __________
RESULT* __________

FINAL VISIT
DAY __
MONTH __
YEAR 2003
NAME ___
RESULT __

TOTAL NO.OF VISITS __

RESULT __
*RESULT CODES:

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

LANGUAGE

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEW *** ________

NATIVE LANGUAGE OF RESPONDENT*** __________

WAS A TRANSLATOR USED? ___

YES 1
NO 2


*** LANGUAGE CODES:

1 ENGLISH
2 AKAN
3 GA
4 EWE
5 NZEMA
6 DAGBANI
7 OTHER______________________
(SPECIFY)

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 Ghana Statistical Service. We are conducting a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

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

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer: ___________
Date: ____________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOESNOT AGREE TO BEINTERVIEWED 2 (END)

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 the 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 ONE YEAR, RECORD '00' YEARS.

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 the village?

CITY 1
TOWN 2
VILLAGE 3

105. In what month and year were you born?

MONTH___
DON'T KNOW MONTH 98
YEAR___
DONT KNOW YEAR 9998

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

AGE IN COMPLETED YEARS___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4

109. What is the highest grade you completed at that level?

GRADE___

110. CHECK 108:

PRIMARY OR MIDDLE/JSS (GO TO 111)
SECONDARY/SSS OR HIGHER (GO TO 114)

111. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.

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

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)___ 4
BLIND/VISUALLY IMPAIRED 5

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

YES 1
NO 2

113. CHECK 111:

CODE '1', '3' OR '4' CIRCLED (GO TO 114)
CODE '1' OR '5' CIRCLED (GO TO 115)

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

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

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

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

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

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

117. What is your religion?

CATHOLIC 01
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
OTHER CHRISTIAN 05
MOSLEM 06
TRADITIONAL/SPIRITUALIST 07
NO RELIGION 08
OTHER (SPECIFY) ____ 96

118. To which ethnic group do you belong?

AKAN 01
GA/DANGME 02
EWE 03
GUAN 04
MOLE-DAGBANI 05
GRUSSI 06
GRUMA 07
HAUSA 08
OTHER (SPECIFY) ____ 96

SECTION 2: REPRODUCTION

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

YES 1
NO 2 (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?

BOYS DEAD ____
GIRLS DEAD ____

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 LINES.

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

NAME___

213. Were any of these births twins?

SING 1
MULT 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?

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___ (NEXT BIRTH, IF NO MORE BIRTHS GO TO 221)

220. IF DEAD:

How old was (NAME) 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. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

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

YES 1
NO 2

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

NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
NUMBERS ARE THE 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 OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS___

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1998 OR LATER.
IF NONE, RECORD '0'.

______

225. FOR EACH BIRTH SINCE JANUARY 1998, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR.

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.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

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.

MONTHS____

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

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH___
YEAR___

231. CHECK 230:

LAST PREGNANCY ENDED IN JAN. 1998 OR LATER ___ (GO TO 232)
LAST PREGNANCY ENDED BEFORE JAN. 1998___ (GO TO 237)

232. 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.

MONTHS___

233. Have you ever had any other pregnancies which did not result in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1998.

ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any pregnancies that terminated before 1998 that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before 1998 end?

MONTH___
YEAR____

237. 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

238. 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)
DON'T KNOW 8 (GO TO 301)

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

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

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.

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

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

301. Which ways or methods have you heard about?

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

01) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
05) INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2 (GO TO NEXT METHOD)
06) IMPLANTS Women can have several 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 (GO TO NEXT METHOD)
07) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09) DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
10) FOAM OR JELLY Women can place a suppository/tablet, jelly, or cream in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
11) LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2 (GO TO NEXT METHOD)
12) RHYTHM OR PERIODIC ABSTINENCE 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 (GO TO NEXT METHOD)
13) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14) EMERGENCY CONTRACEPTION Women can take pills up to five days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
(SPECIFY)_____
(SPECIFY)_____
NO 2

302. Have you ever used (METHOD)?

01) 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
02) MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03) PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS Women can have several 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
07) 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) DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10) FOAM OR JELLY Women can place a suppository/tablet, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12) RHYTHM OR PERIODIC ABSTINENCE 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
13) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14) EMERGENCY CONTRACEPTION Women can take pills up to five days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
METHOD 1 __________
YES 1
NO 2
METHOD 2 __________
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 304)
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 329)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

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

NUMBER OF CHILDREN____

308. CHECK 302 (01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 329)

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

YES 1
NO 2 (GO TO 329)

311. Which method are you using?

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

311A. CIRCLE 'A' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
MALE CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATIONAL AMEN. METHOD K (GO TO 316A)
PERIODIC ABSTINENCE L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY)___X (GO TO 316A)

312A. At the time you first started using the pill, did you consult a doctor, nurse, midwife, or a pharmacist?

YES 1
NO 2

312B. At the time you last got the pill, did you consult a doctor, nurse, midwife, or pharmacist?

YES 1
NO 2

312C. May I see the package of pill you are using now?
RECORD NAME OF BRAND.

PACKAGE SEEN 1
BRAND NAME___ (GO TO 312E)
PACKAGE NOT SEEN 2

312D. Do you know the brand name of the pill you are using now?
RECORD NAME OF BRAND.

BRAND NAME___
DON'T KNOW 98

312E. How much did you pay for the pill the last time you got them?

CEDIS___
FREE 99996
DON'T KNOW 99998

312F. How many cycles of pill did you get the last time?

NUMBER OF CYCLES___
DON'T KNOW 8

312G. Have you experienced any side effects from the use of the pill?

YES 1
NO 2 (GO TO 316A)

312H. What side effects have you experienced?
CIRCLE ALL MENTIONED.

DIZZINESS A (GO TO 316A)
WEIGHT GAIN B (GO TO 316A)
HEADACHES C (GO TO 316A)
EXCESSIVE BLEEDING D (GO TO 316A)
IRREGULAR CYCLE E (GO TO 316A)
PAINFUL PERIOD/CRAMPS F (GO TO 316A)
PALPITATION/IRREGULAR HEARTBEAT G (GO TO 316A)
OTHER (SPECIFY)____ H (GO TO 316A)

313. In what facility did the sterilization take place?

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

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
MOBILE CLINIC 24
FP/PPAG CLINIC 26
OTHER PRIVATE MEDICAL (SPECIFY)____ 28
OTHER (SPECIFY)____ 96
DON'T KNOW 98

314. CHECK 311:

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

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

YES 1
NO 2
DON'T KNOW 8

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

MONTH ___
YEAR _____

316A. For how long have you been using (CURRENT METHOD) now without stopping?

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

MONTH___
YEAR_____

316B. CHECK 316/316A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A

YES (GO BACK TO 316/316A, 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 317)

317. CHECK 316/316A:

YEAR IS 1998 OR LATER (GO TO 319)
YEAR IS 1997 OR EARLIER (GO TO 327)

319. CHECK 311/311A: CIRCLE METHOD CODE.

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

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 320A)
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

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

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

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

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY/CHEMIST/DRUG STORE 23
MOBILE CLINIC 24
FIELDWORKER 25
FP/PPAG CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE MEDICAL (SPECIFY) _____ 28
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY)___ 96

321. CHECK 311/311A: CIRCLE METHOD CODE:

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

PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07 (GO TO 328)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATIONAL AMEN. METHOD 11 (GO TO 325)

322. You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320. At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 324)
NO 2

323. 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 325)

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

YES 1
NO 2

325. CHECK 322:

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

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

YES 1 (GO TO 327)
NO 2

326. 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

327. CHECK 311/311A: CIRCLE METHOD CODE:

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 331)
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

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

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

(NAME OF PLACE) _________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY/CHEMIST/DRUGSTORE 23
MOBILE CLINIC 24
FIELDWORKER 25
FP/PPAG CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE MEDICAL (SPECIFY)____ 28
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY)___ 96
(ALL GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is that? Any other place?

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

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY/CHEMIST/DRUGSTORE I
MOBILE CLINIC J
FIELDWORKER K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY)____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIEND/RELATIVE Q
OTHER (SPECIFY)___ X

331. In the last 12 months, were you visited by a fieldworker/CBD who talked to you about family planning?

YES 1
NO 2

332. 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)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 1998 OR LATER ___ (GO TO 402)
NO BIRTHS IN 1998 OR LATER __ (SKIP TO 487)

402. 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 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212

LINE NUMBER____

404. FROM 212 AND 216

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

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

THEN 1 (SKIP TO 407)
LATER 2
NOT AT ALL 3 (SKIP TO 407)

406. How much longer would you like to have waited?

MONTHS 1___
YEARS 2___
DON'T KNOW 998

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else? [Most recent birth within the last five years]

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[Most recent birth within the last five years]

HEALTH PROFESSIONAL
DOCTOR S
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ____X
NO ONE Y (SKIP TO 415)

407A. Where did you receive antenatal care for this pregnancy? Anywhere else?
[Most recent birth within the last five years]

HOME
YOUR HOME A
TBA'S HOME B
OTHER HOME C
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC D
GOVT. HEALTH CENTER E
GOVT. HEALTH POST F
MOBILE CLINIC G
OTHER PUBLIC (SPECIFY) ____H
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC I
MOBILE CLINIC J
MATERNITY HOME K
OTHER PVT. MEDICAL (SPECIFY)____ L
OTHER (SPECIFY)____ X

408. How many months pregnant were you when you first received antenatal care for this
pregnancy?
[Most recent birth within the last five years]

MONTHS___
DON'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?
[Most recent birth within the last five years]

NO. OF TIMES___
DON'TKNOW 98

410. CHECK 409: NUMBER OF TIMES RECEIVED ANTENATAL CARE
[Most recent birth within the last five years]

ONCE (SKIP TO 412)
MORE THAN ONCE OR DK (SKIP TO 411)

411. How many months pregnant were you the last time you received antenatal care?
[Most recent birth within the last five years]

MONTHS___
DON'T KNOW 98

412. During this pregnancy, were any of the following done at least once?
[Most recent birth within the last five years]

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

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

413. Were you told about the signs of pregnancy complications?
[Most recent birth within the last five years]

YES 1
NO 2 (SKIP TO 415)
DON'T KNOW 8 (SKIP TO 415)

414. Were you told where to go if you had these complications?
[Most recent birth within the last five years]

YES 1
NO 2
DON'T KNOW 8

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[Most recent birth within the last five years]

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

416. During this pregnancy, how many times did you get this injection? [Most recent birth within the last five years]

TIMES ___
DON'T KNOW 8

417. During this pregnancy, were you given or did you buy any iron tablets? SHOW TABLET. [Most recent birth within the last five years]

YES 1
NO 2 (SKIP TO 419)
DON'T KNOW 8 (SKIP TO 419)

418. During the whole pregnancy, for how many days did you take the tablets?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS. [Most recent birth within the last five years]

NUMBER OF DAYS ____
DON'T KNOW 998

419. During this pregnancy, did you have difficulty with your vision during the daylight?
[Most recent birth within the last five years]

YES 1
NO 2
DON'T KNOW 8

420. During this pregnancy, did you suffer from night blindness?
[Most recent birth within the last five years]

YES 1
NO 2
DON'T KNOW 8

421. During this pregnancy, did you take any drugs to prevent you from getting malaria?
[Most recent birth within the last five years]

YES 1
NO 2 (SKIP TO 423)
DON'T KNOW 8 (SKIP TO 423)

422. What drugs did you take?

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW
TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT. [Most recent birth within the last five years]

FANSIDAR A
CHLOROQUINE B
UNKNOWN DRUG C
OTHER (SPECIFY)___ X

422A. CHECK 422: DRUGS TAKEN FOR MALARIA PREVENTION
[Most recent birth within the last five years]

CODE 'A' CIRCLED (GO TO 422B)
CODE 'A' NOT CIRCLED (SKIP TO 423)

422B. How many times did you take Fansidar during this pregnancy?
[Most recent birth within the last five years]

TIMES___

422C. CHECK 407: ANTENATAL CARE RECEIVED DURING THIS PREGNANCY?
[Most recent birth within the last five years]

CODE 'A', 'B' OR 'C' CIRCED (GO TO 422D)
OTHER (SKIP TO 423)

422D. Did you get the Fansidar during an antenatal visit, during another visit to a health facility or from some other source?
[Most recent birth within the last five years]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY)____ 6

423. 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

424. Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 425A)
DON'T KNOW 8 (SKIP TO 425A)

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

KILOGRAM FROM CARD 1 __.__
KILOGRAM FROM RECALL 2 __.__
DON'T KNOW 998

425A. Was the birth of (NAME) registered with the government or local authority?

YES 1
NO 2
DON'T KNOW 8

426. Who assisted with the delivery of (NAME)? Anyone else?

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

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

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

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

(NAME OF PLACE) ________
HOME
YOUR HOME 11 (SKIP TO 429)
TBA'S HOME 12 (SKIP TO 429)
OTHER HOME 13 (SKIP TO 429)
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY)___ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
MATERNITY HOME 32
OTHER PVT. MEDICAL (SPECIFY) ____ 36
OTHER (SPECIFY) ____ 96 (SKIP TO 433)

428. Was (NAME) delivered by caesarian section?

YES 1 (SKIP TO 433)
NO 2 (SKIP TO 433)

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

YES 1
NO 2 (SKIP TO 433)

430. How many days or weeks after the delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
[Most recent birth within the last five years]

DAYS AFTER DEL 1___
WEEKS AFTER DEL 2___
DON'T KNOW 998

431. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[Most recent birth within the last five years]

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) ____ 96

432. Where did this first check take place?

IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF
THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[Most recent birth within the last five years]

(NAME OF PLACE) ____________
LAST BIRTH
HOME
YOUR HOME 1
TBA'S HOME 2
OTHER HOME 13
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
MOBILE CLINIC 24
OTHER PUBLIC (SPECIFY) ____ 26
PRIVATE MEDICAL SECTOR

PVT. HOSPITAL/CLINIC 31
MOBILE CLINIC 32
MATERNITY HOME 33
OTHER PVT. MEDICAL (SPECIFY)___ 36
OTHER (SPECIFY)___ 96

433. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW CAPSULE.
[Most recent birth within the last five years]

YES 1
NO 2

434. Has your period returned since the birth of (NAME)?
[Most recent birth within the last five years]

YES 1 (SKIP TO 436)
NO 2 (SKIP TO 437)

435. Did your period return between the birth of (NAME) and your next pregnancy?
[Repeat questions for all children born in the last 5 years, excluding the most recent birth]

YES 1
NO 2 (SKIP TO 439)

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

MONTHS ____
DON'T KNOW 98

437. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 438)
PREGNANT OR UNSURE (SKIP TO 439)

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

YES 1
NO 2 (SKIP TO 440)

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

MONTHS___
DON'T KNOW 98

440. Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 447)

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

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

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

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

YES 1
NO 2 (SKIP TO 444)

443. What was (NAME) given to drink before your milk began flowing regularly? Anything else? RECORD ALL LIQUIDS MENTIONED

MILK (OTHER THAN BREASTMILK) 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
OTHER (SPECIFY) ___ X

444. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 445)
DEAD (SKIP TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (SKIP TO 448)
NO 2

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

MONTHS___
DON'T KNOW 98

447. CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454)

448. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ___

449. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

453. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.)

SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1998 OR LATER.

(IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212

LINE NUMBER ___

456. FROM 212 AND 216

NAME____
LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 484)

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

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN 1 (SKIP TO 460)
YES, NOT SEEN (SKIP TO 462)
NO CARD 3

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

YES 1 (SKIP TO 462)
NO 2 (SKIP TO 462)

460. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION 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__
MEASLES
DAY__
MONTH__
YEAR__
VITAMIN A (MOST RECENT)
DAY__
MONTH__
YEAR__
YELLOW FEVER
DAY__
MONTH__
YEAR__

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

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (SKIP TO 464)
NO 2 (SKIP TO 464)
DON'T KNOW 8 (SKIP TO 464)

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

YES 1 (SKIP TO 466)
NO 2 (SKIP TO 466)

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

463A. A BCG vaccination against tuberculosis, that is, an injection in the right shoulder that usually causes a scar?

YES 1
NO 2
DONT' KNOW 8

463B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (SKIP TO 463E)
DON'T KNOW 8 (SKIP TO 463E)

463C. When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

463D. How many times was the polio vaccine received?

NUMBER OF TIMES ___

463E. A DPT vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?

YES 1
NO 2 (SKIP TO 463G)
DON'T KNOW 8 (SKIP TO 463G)

463F. How many times?

NUMBER OF TIMES ___

463G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

463H. An injection to prevent yellow fever?

YES 1
NO 2
DON'T KNOW 8

464. Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

YES 1
NO 2 (SKIP TO 466)
NO VACCINATION IN THE LAST 2 YEARS 3 (SKIP TO 466)
DON'T KNOW 8 (SKIP TO 466)

465. At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.

OCT/NOV 2002 A
OCT/NOV 2001 B

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 469)
DON'T KNOW 8 (SKIP TO 469)

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

YES 1
NO 2
DON'T KNOW 8

469. CHECK 466 AND 467: FEVER OR COUGH?

"YES" IN 466 OR 467 (GO TO 470)
OTHER (SKIP TO 475)

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

YES 1
NO 2 (SKIP TO 472)

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

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY/CHEMIST/DRUG STORE I
MOBLIE CLINIC J
FIELDWORKER K
MATERNITY HOME L
OTEHR PRIVATE MEDICAL (SPECIFY) ____ M
OTHER SOURCE
SHOP N
TRAD. PRACTITIONER O
DRUG PEDDLER P
OTHER (SPECIFY) ____ X

472. CHECK 466: HAD FEVER?

"YES" IN 466 (GO TO 472A)
"NO"/"DK" IN 466 (SKIP TO 475)

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

YES 1
NO 2
DON'T KNOW 8

472B. CHECK 466 AND 472A HAD FEVER?

"YES" IN 466 OR 472A (GO TO 473)
OTHER (SKIP TO 475)

473. Did (NAME) take any drugs for the fever?

YES 1
NO 2 (SKIP TO 474I)
DON'T KNOW 8 (SKIP TO 474I)

474. What drugs did (NAME) take? RECORD ALL MENTIONED.

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

ANTI-MALARIAL
FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTESUNATE E
OTHER DRUGS
ASPIRIN F
IBUPROFEN/ACETAMINOPHEN/PANADOL/PARACETAMOL G
OTHER (SPECIFY) ____ X
DON'T KNOW Z

474A. CHECK 474: WHICH MEDICINES?

CODE "B" CIRCLED (GO TO 474B)
CODE "B" NOT CIRCLED (SKIP TO 474E)

474B. How long after the (fever) started did (NAME) first take chloroquine?

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

474B1. How was the chloroquine taken?

TABLETS 1
INJECTION 2 (SKIP TO 474C)
SYRUP 3 (SKIP TO 474C)
MIX 4 (SKIP TO 474C)
DON'T KNOW 8 (SKIP TO 474C)

474B2. How many tablets did (NAME) take each day?

NUMBER OF TABLETS ___
DON'T KNOW 8

474C. For how many days did (NAME) take chloroquine?
IF 7 OR MORE DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

474D. Did you have the chloroquine at home or did you get it from somewhere else?

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

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474E. CHECK 474: WHICH MEDICINES?

CODE "C" CIRCLED (GO TO 474F)
CODE "C" NOT CIRCLED (SKIP TO 474I)

474F. How long after the (fever) started did (NAME) first take Amodiaquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER THE FEVER 2
DON'T KNOW 8

474G. For how many days did (NAME) take Amodiaquine?
IF 7 OR MORE DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

474H. Did you have the Amodiaquine at home or did you get it from somewhere else?

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

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474I. Was anything else done about (NAME)'s (fever)?

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

474J. What was done about (NAME)'s (fever)?

CONSULTED TRADITIONAL HEALER A
GAVE TEPID SPONGING B
GAVE HERBS C
OTHER (SPECIFY) ____ X

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

YES 1
NO 2 (SKIP TO 483)
DON'T KNOW 8 (SKIP TO 483)

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

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

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

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

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

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

478. Was he/she given any of the following to drink:
a A fluid made from a special packet called ORS?
b A government-recommended homemade fluid?

FLUID FROM ORS PKT
YES 1
NO 2
DK 8
HOMEMADE FLUID
YES 1
NO 2
DK 8

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

YES 1
NO 2 (SKIP TO 481)
DON'T KNOW 8 (SKIP TO 481)

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

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ____ X

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

YES 1
NO 2 (SKIP TO 483)

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

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

(NAME OF PLACE) __________
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY/CHEMIST/DRUG STORE I
MOBILE CLINIC J
FIELDWORKER K
MATERNITY HOME L
OTHER PRIVATE MEDICAL (SPECIFY) ____ M
OTHER SOURCE
SHOP N
TRAD. PRACTITIONER O
DRUG PEDDLER P
OTHER (SPECIFY) ____ X

483. GO BACK TO 456 IN NEXT COLUMN; OR, IF NOMORE BIRTHS, GO TO 484.

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

ONE OR MORE (GO TO 485)
NONE (GO TO 487)

485. What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?

CHILD ALWAYS USE TOILET/LATRINE 01
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSE AWAY 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
NOT DISPOSED OF 09
OTHER (SPECIFY) ___ 96

486. CHECK 478a, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 487)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 488)

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

YES 1
NO 2

488. CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER (GO TO 489)
HAS NO CHILDREN LIVING WITH HER (GO TO 490)

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

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

YES 1
NO 2
DEPENDS 3

490. Now I would like to ask you some questions about medical care for you yourself.
Many different factors can prevent women from getting medical advice or treatment for themselves.

When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

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

KNOWING WHERE TO GO.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING PERMISSION TO GO.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
THE DISTANCE TO A HEALTH FACILITY.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
HAVING TO TAKE TRANSPORT.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NOT WANTING TO GO ALONE.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
CONCERN THAT THERE MAY NOT BE A FEMALE HEALTH PROVIDER.
BIG PROBLEM 1
NOT A BIG PROBLEM 2

491. CHECK 215 AND 218:

DOES NOT HAVE ANY CHILDREN BORN IN 2000 OR LATER AND LIVING WITH HER (GO TO 496)
HAS AT LEAST ONE CHILD BORN IN 2000 OR LATER AND LIVING WITH HER: RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE TO 492) NAME ______

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

How many days during last seven days did (NAME FROM Q.491) drink each of the
following?

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

In total, how many times yesterday during the day or at night did (NAME FROM Q.491) drink (ITEM)?
a Plain water?
b Commercially produced infant formula?
c Any other milk such as tinned, powdered, or fresh animal milk?
d Fruit juice?
e Any other liquids?

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

1) PLAIN WATER
LAST 7 DAYS
NUMBER OF DAYS __
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
b) COMMERCIALLY PRODUCED INFANT FORMULA
LAST 7 DAYS
NUMBER OF DAYS __
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
c) ANY OTHER MILK SUCH AS TINNED, POWDERED, OR FRESH ANIMAL MILK
LAST 7 DAYS
NUMBER OF DAYS __
YESTERDAY/LAST NIGHT
NUMBER OF TIMES___
d) FRUIT JUICE?
LAST 7 DAYS
NUMBER OF DAYS __
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
e) ANY OTHER LIQUIDS?
LAST 7 DAYS
NUMBER OF DAYS __
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___

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

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

FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK:
In total, how many times yesterday during the day or at night did (NAME FROM Q.491) eat (ITEM)?

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

a) Any food made from grains [e.g. kenkey, banku, koko, tuo zaafi, akple, rice, bread, weanimix]?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
b) Pumpkin, red or yellow yams or squash, carrots, or red sweet potatoes?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
c) Any other food made from roots or tubers [e.g., white potatoes, white yams, cocoyam, cassava, fufu, or other local roots/tubers]?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
d) Any green leafy vegetables (e.g., kontamire)?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
e) Mango, paw paw [or other local Vitamin A rich fruits]?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
f) Any other fruits and vegetables [e.g., bananas, plantain, apples/sauce, green beans, avocados, tomatoes]?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
g) Meat, poultry, fish, shellfish (e.g., prawn, lobster), or eggs?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
h) Any food made from legumes [e.g., lentils, beans, soybeans, pulses, or peanuts]?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
i) Cheese or yoghurt?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___
j) Any food made with oil, fat, or butter?
LAST 7 DAYS
NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT
NUMBER OF TIMES ___

496. Do you currently smoke cigarettes or tobacco? IF YES: what type of tobacco do you smoke?
RECORD ALL TYPES MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

497. CHECK 496:

CODE 'A' CIRCLED (GO TO 498)
CODE 'A' NOT CIRCLED (GO TO 501)

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

CIGARETTES ___

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN A UNION 3

502. Have you ever been married or lived with a man?

YES, FORMERLY MARRIED 1
YES, LIVED WTIH A MAN 2 (GO TO 510)
NO 3 (GO TO 514)

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

WIDOWED 1 (GO TO 510)
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

506. 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. ___

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

YES 1
NO 2 (GO TO 510)

508. How many other wives does he have?

NUMBER ___
DONT' KNOW 98 (GO TO 510)

509. Are you the first, second, wife?

RANK ___

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

ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

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

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

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

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

AGE___

514. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.

How old were you when you first had sexual intercourse (if ever)?

NEVER 00 (GO TO 524)
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

514A. CHECK 106:

15-24 YEARS OLD ___
25-49 YEARS OLD ___

514B. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2

515. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (GO TO 524)

515B. The last time you had sexual intercourse, had you or your partner been drinking alcohol?
IF YES: Who was drinking?

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

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

YES 1
NO 2 (GO TO 517)

516A. What was the main reason a condom was used on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) ___ 96
DON'T KNOW 98

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

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

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

SPOUSE/COHABITING PARTNER 01 (GO TO 519)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY)____ 96

517A. CHECK 106:

15-19 YEARS OLD ___ (GO TO 517B)
20-49 YEARS OLD ___ (GO TO 518)

517B. Was this man younger, about the same age or older than you?

IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS ODER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW 8

518. For how long have you had sexual relations with this man?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___

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

YES 1
NO 2 (GO TO 524)

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

YES 1
NO 2 (GO TO 521)

520A. What was the main reason a condom was used on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

521. What is your relationship to this man?

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

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

SPOUSE/COHABITING PARTNER 01 (GO TO 522A)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) ___ 96

521A. CHECK 106:

15-19 YEARS OLD ___
20-49 YEARS OLD ___ (GO TO 522)

521B. Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT THE SAME 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW 8

522. For how long have you had sexual relations with this man?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___

522A. Other than these two men, have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

522B. The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 522D)

522C. What was the main reason a condom was used on that occasion?

RESPONDENT WANTED TO PREVENT STD/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03
DID NOT TRUST PARTNERS/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) 96
DON'T KNOW 98

522D. What is your relationship to this man?

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

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

SPOUSE/COHABITING PARTNER 01 (SKIP TO 523)
MAN IS BOYFRIEND/FIANCE 002
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) ____ 96

522D1. CHECK 106:

15-19 YEARS OLD ___
20-49 YEARS OLD ___ (GO TO 522E)

522D2. Was this man younger, about the same age or older than you?

IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW 8

522E. For how long have you had sexual relations with this man?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___

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

NUMBER OF PARTNERS ___

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

YES 1
NO 2 (GO TO 527)

525. Where is that? Any other place? RECORD ALL SOURCES MENTIONED?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY/CHEMIST/DRUG STORE I
MOBILE CLINIC J
FIELDWORKER K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
OTHER (SPECIFY) ____ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 601)

528. Where is that? Any other place? RECORD ALL SOURCES MENTIONED.

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY/CHEMIST/DRUG STORE I
MOBILE CLINIC J
FIELDWORKER K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
OTHER (SPECIFY) ____ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602. CHECK 226:

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 to have any (more) children?

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON'T KNOW:
AND PREGNANT 4 (GO TO 610)
AND NOT PREGNANT OR UNSURE 5 (GO TO 608)

603. CHECK 226:

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

PREGNANT __
After the birth of 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 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) ____ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

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

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

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
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
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NATURAL PROCESSES T
OTHER (SPECIFY) _____ X
DON'T KNOW Z

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

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

609. CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMEN. METHOD 11 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY) ___ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND OPPOSED 32 (GO TO 614)
OTEHRS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NATURAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) _____ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

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

YES 1
NO 2
DON'T KNOW 8

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 616)
NUMBER ___
OTHER (SPECIFY) ____ 96 (GO TO 616)

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

BOYS ___
GIRLS ___
EITHER ___
OTHER (SPECIFY) ___ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 8

617. In the last few months have you heard or seen messages about family planning:

On the radio?
On the television?
In a newspaper or magazine?
In a poster?
In leaflets or brochures?
From a health worker?
At a community or social club meeting?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2
HEALTH WORKER
YES 1
NO 2
MEETING
YES 1
NO 2

618. Have you heard the following messages about family planning:

Life Choices: It's your life. It's your choice?
Make the choice that is best for you?
Contraceptives are safe and effective?
Obra ni wora bo?

LIFE CHOICES: IT'S YOUR LIFE. IT'S YOUR CHOICE
YES 1
NO 2
MAKE THE CHOICE THAT IS BEST FOR YOU
YES 1
NO 2
CONTRACEPTIVES ARE SAFE AND EFFECTIVE
YES 1
NO 2
OBRA NI WORA BO
YES 1
NO 2

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

YES 1
NO 2 (GO TO 621)

620. With whom? Anyone else? RECORD ALL PERSONS MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
MOTHER-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) ____ X

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION ( GO TO 628)

622. CHECK 311/311A:

ANY CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

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

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

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

625. 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

626. CHECK 311/311A:

NEITHER STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627. 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

628. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted disease?
She knows her husband has sex with women other than his wives?
She has recently given birth?
She is tired or not in the mood?

HAS STD
YES 1
NO 2
DK 8
OTHER WOMEN
YES 1
NO 2
DK 8
RECENT BIRTH
YES 1
NO 2
DK 8
TIRED/MOOD
YES 1
NO 2
DK 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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

AGE IN COMPLETED YEARS ___

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

YES 1
NO 2 (GO TO 706)

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

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4
DON'T KNOW 8 (GO TO 706)

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

GRADE ___
DON'T KNOW 98

706. CHECK 701:

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

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

______

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

YES 1 (GO TO 710)
NO 2

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

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 719)

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

__________

711. CHECK 710:

WORKS IN AGRICULTURE ___
DOES NOT WORK IN AGRICULTURE ____ (GO TO 713)

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

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

713. 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

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

HOME 1
AWAY 2

715. 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

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

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

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6

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

YOUR OWN HEALTH CARE:
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
MAKING LARGE HOUSEHOLD PURCHASES:
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
MAKING HOUSEHOLD PURCHASES FOR DAILY NEEDS:
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
VISITS TO FAMILY OR RELATIVES:
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
WHAT FOOD SHOULD BE COOKED EACH DAY:
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

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

CHILDREN UNDER AGE 10:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 3
HUSBAND:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 3
OTHER MALES:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 3
OTHER FEMALES:
PRES/LISTEN. 1
PRES/NOT LISTEN. 2
NOT PRES 3

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

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

GOES OUT:
YES 1
NO 2
DK 8
NEGL. CHILDREN:
YES 1
NO 2
DK 8
ARGUES:
YES 1
NO 2
DK 8
REFUSES SEX:
YES 1
NO 2
DK 8
BURNS FOOD:
YES 1
NO 2
DK 8

SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

YES 1
NO 2 (GO TO 817)

802. Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?

YES 1
NO 2
DON'T KNOW 8

803. Can a person get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

806. Can people reduce their chance of getting the AIDS virus by not having sex at all?

YES 1
NO 2
DON'T KNOW 8

807. Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

808. Is there anything (else) a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 810)
DON'T KNOW 8 (GO TO 810)

809. What can a person do? Anything else? RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ___ W
OTHER (SPECIFY) ___ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

811. Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?

YES 1
NO 2

812. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO 813)
DON'T KNOW 8 (GO TO 813)

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

During pregnancy?
During delivery?
By breastfeeding?

DURING PREG:
YES 1
NO 2
DK 8
DURING DELIVERY:
YES 1
NO 2
DK 8
BY BREASTFEEDING:
YES 1
NO 2
DK 8

812B. Are there any special drugs that a pregnant woman infected with the AIDS virus can take to reduce the risk of transmission to the baby during pregnancy?

YES 1
NO 2
DON'T KNOW 8

813. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 814)
NO, NOT IN A UNION (GO TO 814A)

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

YES 1
NO 2

814A. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

on the radio?
on the TV?
in newspapers?

ON THE RADIO:
ACCETABLE 1
NOT ACCEPTABLE 2
ON THE TV:
ACCEPTABLE 1
NOT ACCEPTABLE 2
IN NEWSPAPERS:
ACCEPTABLE 1
NOT ACCEPTABLE 2

814A1. Have you heard or seen any messages about HIV/AIDS?

YES 1
NO 2
DON'T KNOW 8

814A2. Have you heard or seen the slogan 'Reach Out, Show Compassion?'

YES 1
NO 2
DON'T KNOW 8

814A3. Have you heard or seen the slogan 'Stop AIDS, Love Life?'

YES 1
NO 2
DON'T KNOW 8

814A4. CHECK 814A2 AND 814A3:

YES, CIRCLED FOR EITHER OR BOTH (GO TO 814A5)
NO, DON'T KNOW CIRCLED (GO TO 814B)

814A5. Did you hear or see this slogan:

On the TV?
In a music video?
On the radio?
In a newspaper or magazine?
In a poster?
On a car sticker?
In leaflets or brochures?
On a tee-shirt or a cap?
From a mobile 'ISD' van?
During a community event?
At a road show?

TV
YES 1
NO 2
MUSIC VIDEO
YES 1
NO 2
RADIO
YES 1
NO 2
NEWSPAPER/MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
CAR STICKER
YES 1
NO 2
LEAFLETS/BROCHURES
YES 1
NO 2
T-SHIRT/CAP
YES 1
NO 2
ISD VAN
YES 1
NO 2
COMMUNITY EVENT
YES 1
NO 2
ROAD SHOW
YES 1
NO 2

814A6. Have you seen a television show called 'Things we do for love' that features the characters Pusher, B.B. and Marcia?

YES 1
NO 2
DON'T KNOW 8

814B. Would you buy fresh vegetables from a vendor who has the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DK/NOT SURE 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

816A. If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

816B1. CHECK 407A:

ANY CODE D-L CIRCLED (GO TO 816B2)
ANY CODE A-C OR X CIRCLED OR Q. 407A NOT ASKED (GO TO 816CX)

816B2. Now I would like to ask some questions about your last birth. During any of the antenatal visits for this pregnancy, were you given any information or counseled about AIDS or the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

816B3. I don't want to know the results, but were you tested for the AIDS virus during any of your antenatal care visits?

YES 1
NO 2 (GO TO 816CX)
DON'T KNOW 8 (GO TO 816CX)

816B4. Did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

816B5. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

816B6. Where did you go for the test?

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

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY/CHEMIST/DRUG STORE 23
MOBILE CLINIC 24
FIELDWORKER 25
FP/PPAG CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE MEDICAL (SPECIFY) ____ 28
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) _____ 96

816C. I don't want to know the results, but have you been tested for the AIDS virus since that time you were tested during your pregnancy?

816CX. I don't want to know the results, but have you ever been tested for the AIDS virus?

YES 1
NO 2 (GO TO 816D)
DON'T KNOW 8 (GO TO 816D)

816C1. When was the last time you were tested?

LESS THAN 12 MONTHS 1
12-23 MONTHS 2
2 YEARS OR MORE 3

816C2. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

816C3. I don't want to know the results, but did you get the results of the test?

YES 1 (GO TO 816FX)
NO 2 (GO TO 816FX)

816D. Would you want to be tested for the AIDS virus?

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

816E. Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 817)

816F. Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.

816FX Where did you go for the test?

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

(NAME OF PLACE) ____________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY/CHEMIST/DRUG STORE 23
MOBILE CLINIC 24
FIELDWORKER 25
FP/PPAG CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE MEDICAL (SPECIFY) ____ 28
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) _____ 96

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

YES 1
NO 2 (GO TO 819A)

818. If a man has a sexually transmitted disease, what symptoms might he have?
Any others? RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URNINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON'T KNOW Z

819. If a woman has a sexually transmitted disease, what symptoms might she have?
Any others? RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URNINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE CHILD L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DON'T KNOW Z

819A. CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 819A1)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 820)

819A1. CHECK 817:

KNOWS STI (GO TO 819B)
DOES NOT KNOW STI (GO TO 819C)

819B. Now I would like to ask you some questions about your health in the last 12 months.
During the last 12 months, have you had a sexually-transmitted disease?

YES 1
NO 2
DON'T KNOW 8

819C. Sometimes, women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

819E. CHECK 819B, 819C, 819D:

HAS HAD AN INFECTION (GO TO 819F)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 820)

819F. The last time you had (PROBLEM FROM 819B/819C//819D), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 819H)

819G. The last time you had (PROBLEM FROM 819B/819C/819D), did you do any of the following?

Did you:

Go to a clinic, hospital or private doctor?
Consult a traditional healer?
Seek advice or buy medicines in a shop or pharmacy?
Ask for advice from friends or relatives?

CLINIC/HOSPITAL
YES 1
NO 2
TRADITIONAL HEALER
YES 1
NO 2
SHOP/PHARMACY
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

819H. When you had (PROBLEM FROM 819B/819C/819D), did you inform the person with whom you were having sex?

YES 1
NO 2
SOME/NOT ALL 3
DID NOT HAVE PARTNER 4 (GO TO 820)

819I. When you had (PROBLEM FROM 819B/819C/819D), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 820)
PARTNER ALREADY INFECTED 3 (GO TO 820)

819J. What did you do to avoid infecting your partner(s)?

Did you:

Use medicine?
Stop having sex?
Use a condom when having sex?

USE MEDICINE
YES 1
NO 2
STOP SEX
YES 1
NO 2
USE CONDOM
YES 1
NO 2

820. In many communities, girls are also circumcised.
In your community, is female circumcision practiced?

YES 1
NO 2

821. Are you circumcised?

YES 1
NO 2

822. RECORD THE TIME.

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 OF THE SUPERVISOR:_____________
DATE: ____________

EDITOR'S OBSERVATIONS:

NAME OF EDITOR:_________________
DATE: ___________________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

BIRTHS AND PREGNANCIES

B BIRTHS
P PREGNANCIES
T TERMINATIONS

2003

12 DEC 01
11 NOV 02
10 OCT 03
09 SEP 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2002

12 DEC 13
11 NOV 14
10 OCT 12
09 SEP 16
08 AUG 17
07 JUL 18
06 JUN 19
05 MAY 20
04 APR 21
03 MAR 22
02 FEB 23
01 JAN 24

2001

12 DEC 25
11 NOV 26
10 OCT 27
09 SEP 28
08 AUG 29
07 JUL 30
06 JUN 31
05 MAY 32
04 APR 33
03 MAR 34
02 FEB 35
01 JAN 36

2000

12 DEC 37
11 NOV 38
10 OCT 39
09 SEP 40
08 AUG 41
07 JUL 42
06 JUN 43
05 MAY 44
04 APR 45
03 MAR 46
02 FEB 47
01 JAN 48

1999

12 DEC 49
11 NOV 50
10 OCT 51
09 SEP 52
08 AUG 53
07 JUL 54
06 JUN 55
05 MAY 56
04 APR 57
03 MAR 58
02 FEB 59
01 JAN 60

1998

12 DEC 61
11 NOV 62
10 OCT 63
09 SEP 64
08 AUG 65
07 JUL 66
06 JUN 67
05 MAY 68
04 APR 69
03 MAR 70
02 FEB 71
01 JAN 72