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GHANA DEMOGRAPHIC AND HEALTH SURVEY, 2008
WOMAN'S QUESTIONNAIRE

MINISTRY OF HEALTH, GHANA GHANA STATISTICAL SERVICE

SEPTEMBER 2008

IDENTIFICATION

LOCALITY NAME _______________
NAME OF HOUSEHOLD HEAD ______________
EA NUMBER _______
STRUCTURE 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 OF LINE NUMBER OF WOMAN ____

WOMAN SELECTED FOR DV INTERVIEW ____

YES 1
NO 2

CHECK COLUMIN 9 IN HOUSEHOLD QUESTIONNAIRE. IF BOX IS MARKED 'DV' RECORD 1.

MAKE SURE LINE NUMBER CORRESPONDS TO THE WOMAN'S LINE NUMBER SELECTED FOR DV.

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

NEXT VISIT:
DATE ___
TIME____

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

NEXT VISIT:
DATE ___
TIME____

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

FINAL VISIT
DAY___
MONTH ___
YEAR 2008
INT. NUMBER ____
RESULT____

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) _________

LANGUAGE OF QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW: ___

LANGUAGE OF RESPONDENT: ___

LANGUAGE CODES:

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

TRANSLATOR USED: ___

YES 1
NO 2

SUPERVISOR
NAME _____
DATE _____

FIELD EDITOR
NAME _____
DATE _____

OFFICE EDITOR _______

KEYED BY ______

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT
Hello. My name is ____________________________________ and I am working for Ghana Statistical Service and Ministry of Health.

We are conducting a national survey that asks women and men about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services.

The survey usually takes between 45 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to anyone other than members of our survey team.

Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. 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
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR ___
MINUTES ___

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

YEAR ___
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

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

CITY 1
TOWN 2
COUNTRYSIDE 3

104. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

NUMBER OF TRIPS __
NONE 00 (GO TO 106)

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

YES 1
NO 2

106. In what month and year were you born?

MONTH ____
DON'T KNOW MONTH 98
YEAR ____
DON'T KNOW YEAR 9998

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

AGE IN COMPLETED YEARS ____

108. Have you ever attended school?

YES 1
NO 2 (GO TO 112)

109. 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

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

GRADE ____

111. CHECK 109:

PRIMARY OR MIDDLE/JSS ___ (GO TO 112)
SECONDAR/SSS OR HIGHER ___ (GO TO 115)

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

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

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

113. 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

114. CHECK 112:

CODE '2', '3' OR '4' CIRCLED ___ (GO TO 115)
CODE '1' OR '5' CIRCLED ___ (GO TO 116)

115. 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

116. Do you listen to the radio 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. Do you watch television almost every day, at least once a week, less than once a week or not 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

118. What is your religion?

CATHOLIC 01
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
PENTECOSTAL/CHARISMATIC 05
OTHER CHRISTIAN 06
MOSLEM 07

119. To which ethnic group do you belong?

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

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the live 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 son or daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL ___

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

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

210 CHECK 208:

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

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

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

(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

_____

213. 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?
In what season was (NAME) born?

MONTH ____
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ___

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

YES 1
NO 2

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

LINE NUMBER ____ (GO TO 221)

220. IF DEAD: How old was (NAME) when he/she died?

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

DAYS 1 ____
MONTHS 2 ___
YEARS 3 ___

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

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

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

YES 1
NO 2

223. 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 BIRTH SINCE JANUARY 2003: MONTH AND YEAR OF BIRTH ARE 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 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. ___

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2003 OR LATER. IF NONE, RECORD '0' AND GO TO 226. ___

225. FOR EACH BIRTH SINCE JANUARY 2003, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR (PAGE W-63).

WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN
EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.

(NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226. Are you pregnant now?

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

227. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN THE CALENDAR (PAGE W-63), 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. 2003 OR LATER ___ (GO TO 232)
LAST PREGNANCY ENDED BEFORE JAN. 2003 ___ (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 (PAGE W-63) IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ___

233. Since January 2003, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 235)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2003.

ENTER 'T' IN THE CALENDAR (PAGE W-63) IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any miscarriages, abortions or stillbirths that ended before 2003?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before 2003 end?

MONTH ___
YEAR _____

237. When did your last menstrual period start?

DAYS AGO 1 ___
WEEKS AGE 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.

301. Which ways or methods have you heard about?

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

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

01) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03) 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 that 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) MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) DIAPHRAGM Women can place a thin flexible disk in their vagina before sexual intercourse.
YES 1
NO 2
10) FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before sexual intercourse.
YES 1
NO 2
11 RHYTHM (CALENDAR) METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
12) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
14) EMERGENCY CONTRACEPTION As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY) METHOD 1 ___
YES 1
NO 2
(SPECIFY) METHOD 2 __
YES 1
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 that 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) MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) DIAPHRAGM Women can place a thin flexible disk in their vagina before sexual intercourse.
YES 1
NO 2
10) FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before sexual intercourse.
YES 1
NO 2
11) RHYTHM (CALENDAR) METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
12) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
13) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
14) EMERGENCY CONTRACEPTION As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
15) Other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 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 (GO TO 306)
NO 2

305. ENTER '0' IN THE CALENDAR (PAGE W-63) IN EACH BLANK MONTH. (GO TO 333)

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 322)

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

YES 1
NO 2 (GO TO 322)

311. Which method are you using?
311A CIRCLE 'A' FOR FEMALE STERILIZATION.

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

FEMALE STERILIZATION A (GO TO 319)
MALE STERILIZATION B (GO TO 319)
PILL C
IUD D (GO TO 315)
INJECTABLES E (GO TO 315)
IMPLANTS F (GO TO 315)
MALE CONDOM G
FEMALE CONDOM H (GO TO 315)
DIAPHRAGM I (GO TO 315)
FOAM/JELLY J (GO TO 315)
LACTATIONAL AMEN. METHOD K (GO TO 319A)
RHYTHM METHOD L (GO TO 319A)
WITHDRAWAL M (GO TO 319A)
OTHER (SPECIFY) _____ X (GO TO 319A)

311A CIRCLE 'A' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION A (GO TO 319)
MALE STERILIZATION A (GO TO 319)
PILL C
IUD D (GO TO 315)
INJECTABLES E (GO TO 315)
IMPLANTS F (GO TO 315)
MALE CONDOM G
FEMALE CONDOM H (GO TO 315)
DIAPHRAGM I (GO TO 315)
FOAM/JELLY J (GO TO 315)
LACTATIONAL AMEN. METHOD K (GO TO 319A)
RHYTHM METHOD L (GO TO 319A)
WITHDRAWAL M (GO TO 319A)
OTHER (SPECIFY) _____ X (GO TO 319A)

312. RECORD IF CODE 'C' FOR PILL IS CIRCLED IN 311.

YES (USING PILL) ___ May I see the package of pills you are using?

NO (USING CONDOM BUT NOT PILL) ___ May I see the package of condoms you are using?

RECORD NAME OF BRAND IF PACKAGE SEEN.

PACKAGE SEEN 1 ___ (GO TO 314)
BRAND NAME (SPECIFY) ____
PACKAGE NOT SEEN 2

313. Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

BRAND NAME (SPECIFY) ____
DON'T KNOW 98

314. How many (pill cycles/condoms) did you get the last time?

NUMBER OF PILL CYCLES/CONDOMS ___
DON'T KNOW 998

315. The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST __.__ (GO TO 319A)
FREE 99.95 (GO TO 319A)
DON'T KNOW 99.98 (GO TO 319A)

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

MONTH ____
YEAR _____

319A. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH __
YEAR _____

320. CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A.

YES: GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
NO (TO 321)

321. CHECK 319/319A:
YEAR IS 2003 OR LATER:
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR (PAGE W-63) AND IN EACH MONTH BACK TO THFE DATE STARTED USING.

YEAR IS 2002 OR EARLIER:
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2003. THEN GO TO 331.

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

USE CALENDAR (PAGE W-63) TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2003.

USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

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

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

NO CODE CIRCLED 00 (GO TO 333)
FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 335)
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 324A)
RHYTHM METHOD 12 (GO TO 324A)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

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

324A. Where did you learn how to use the rhythm/lactational amenorrhoea method?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH POST/CHIPS 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER/OUTREACH/PEER EDUCATOR ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
CHEMICAL/DRUG STORE 24
FP/PPAG CLINIC 25
MATERNITY HOME 26
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27
OTHER SOURCE
SHOP/MARKET 31
CHURCH 32
COMMUNITY VOLUNTEER 33
FRIEND/RELATIVE 34
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

325. 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 332)
FEMALE CONDOM 08 (GO TO 329)
DIAPHRAGM 09 (GO TO 329)
FOAM/JELLY 10 (GO TO 329)
LACTATIONAL AMEN. METHOD 11 (GO TO 335)
RHYTHM METHOD 12 (GO TO 335)

326. You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 328)
NO 2

327. 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 329)

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

YES 1
NO 2

329. CHECK 326:

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 323) from (SOURCE OF METHOD FROM 324) were you told about other methods of family planning that you could use?

YES 1 (GO TO 331)
NO 2

330. 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

331. 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 335)
MALE STERILIZATION 02 (GO TO 335)
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 335)
RHYTHM METHOD 12 (GO TO 335)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

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

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

(NAME OF PLACE) ___________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11 (GO TO 335)
GOVT. HEALTH CENTER 12 (GO TO 335)
GOVT. HEALTH POST/CHPS 13 (GO TO 335)
FAMILY PLANNING CLINIC 14 (GO TO 335)
MOBILE CLINIC 15 (GO TO 335)
FIELDWORKER/OUTREACH/PEER EDUCATOR ______ 16 (GO TO 335)
OTHER PUBLIC (SPECIFY) _____ 17 (GO TO 335)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 335)
PRIVATE DOCTOR 22 (GO TO 335)
PHARMACY 23 (GO TO 335)
CHEMICAL/DRUG STORE 24 (GO TO 335)
FP/PPAG CLINIC 25 (GO TO 335)
MATERNITY HOME 26 (GO TO 335)
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27 (GO TO 335)
OTHER SOURCE
SHOP/MARKET 31 (GO TO 335)
CHURCH 32 (GO TO 335)
COMMUNITY VOLUNTEER 33 (GO TO 335)
FRIEND/RELATIVE 34 (GO TO 335)
OTHER (SPECIFY) ____ 96 (GO TO 335)
DON'T KNOW 98 (GO TO 335)

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

YES 1
NO 2 (GO TO 335)

334. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHIPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR ______ F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____ N
OTHER SOURCE
SHOP/MARKET O
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE R
OTHER (SPECIFY) ____ X

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

YES 1
NO 2

336. 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)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2003 OR LATER ___ (GO TO 402)
NO BIRTHS IN 2003 OR LATER ___ (GO TO 576)

402. CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask 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 NO. ___

404. FROM 212 AND 216

NAME ___
LIVING __
DEAD __

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 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

406. How much longer would you have liked to wait?
[Most recent birth within the last five years]

MONTHS 1 __
YEARS 2 __
DON'T KNOW 98

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 TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
COMMUNITY HEALTH OFFICER/NURSE D
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT F
UNTRAINED TRADITIONAL BIRTH ATTENDANT G
COMMUNITY/VILLAGE HEALTH VOLUNTEER H
TRADITIONAL PRACTITIONER I
OTHER (SPECIFY) ____ X
NO ONE Y (GO TO 414)

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

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

(NAME OF PLACE) ___________
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL POLYCLINIC C
GOVT. HEALTH CENTER D
GOVT. HEALTH POST/CHPS E
MOBILE CLINIC F
OTHER PUBLIC (SPECIFY) ____ G
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC H
FF/PPAG CLINIC I
MOBILE CLINIC J
MATERNITY HOME K
OTHER PRIVATE MED. (SPECIFY) _____ L
OTHER (SPECIFY) _____ X

409. 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

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

NUMBER OF TIMES ___
DON'T KNOW 98

411. As part of your antenatal care 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 taken?
Did you give a urine sample?
Did you give a blood sample?

WEIGHT
YES 1
NO 2
BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

412. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?
[Most recent birth within the last five years]

YES 1
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)

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

YES 1
NO 2
DON'T KNOW 8

414. 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 (GO TO 417)
DON'T KNOW 8 (GO TO 417)

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

TIMES ___
DON'T KNOW 8

416. CHECK 415:

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

417. At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?
[Most recent birth within the last five years]

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

418. Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, WRITE '7'.
[Most recent birth within the last five years]

TIMES ___
DON'T KNOW 8

419. In what month and year did you receive the last tetanus injection before this pregnancy?
[Most recent birth within the last five years]

MONTH ___
DK MONTH 98
YEAR ___ (GO TO 421)
DK YEAR 9998

420. How many years ago did you receive that tetanus injection?
[Most recent birth within the last five years]

YEARS AGO ___

421. During this pregnancy, were you given or did you buy any iron tablets or iron syrup? SHOW TABLETS/SYRUP
[Most recent birth within the last five years].

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

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

DAYS ___
DON'T KNOW 998

423. During this pregnancy, did you take any drug for intestinal worms?
[Most recent birth within the last five years]

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

425. 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

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

YES 1
NO 2 (GO TO 432)
DON'T KNOW 8 (GO TO 432)

427. 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]

SP/FANSIDAR/MALAFAN A
CHLOROQUINE B
PROGUANIL C
DARAPRIM D
OTHER (SPECIFY) _____ X
DON'T KNOW Z

428. CHECK 427: DRUGS TAKEN FOR MALARIA PREVENTION.

CODE 'A' CIRCLED ___ (GO TO 429)
CODE 'A' NOT CIRCLED ___ (GO TO 432)

429. How many times did you take (SP/Fansidar/Malafan) during this pregnancy?
[Most recent birth within the last five years]

TIMES _____

430. CHECK 407: ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE 'A', 'B', 'C' OR 'D' CIRCLED ___ (GO TO 431)
OTHER ___ (GO TO 432)

431. Did you get the (SP/Fansidar/Malafan) during any antenatal care visit, during another visit to a health facility or from another source?
[Most recent birth within the last five years]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

432. 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

433. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)

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

KG FROM CARD
1 ___._____
KG FROM RECALL
2 ___._____
DON'T KNOW 99.998

435. Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

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

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
COMMUNITY HEALTH OFFICER/NURSE D
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT E
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
COMMUNITY/VILLAGE HEALTH VOLUNTEER G
TRADITIONAL PRACTITIONER H
OTHER (SPECIFY) _____ X
NO ONE Y

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

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
HOME
YOUR HOME 11 (GO TO 443)
OTHER HOME 12 (GO TO 443)
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 21
GOVT. HEALTH CENTER 22
HOVT. HEALTH POST/CHPS 23
OTHER PUBLIC (SPECIFY) _____ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
FP/PPAG CLINIC 32
MATERNITY HOME 33
OTHER PRIVATED MED. (SPECIFY) ____ 36)
OTHER (SPECIFY) ____ 96 (GO TO 443)

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

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

438. Was (NAME) delivered by caesarean section?

YES 1
NO 2

439. Before you were discharged after (NAME) was born, did any health care provider check on your health?

YES 1
NO 2 (GO TO 442)

440. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[Most recent birth within the last five years]

HOUR 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11 (GO TO 453)
NURSE/MIDWIFE 12 (GO TO 453)
AUXILIARY MIDWIFE 13 (GO TO 453)
COMMUNITY HEALTH OFFICER/NURSE 14 (GO TO 453)
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 21 (GO TO 453)
UNTRAINED TRADITIONAL BIRTH ATTENDANT 22 (GO TO 453)
COMMUNITY/VILLAGE HEALTH VOLUNTEER 23 (GO TO 453)
TRADITIONAL PRACTITIONER 24 (GO TO 453)
RELATIVE/FRIEND 25 (GO TO 453)
OTHER (SPECIFY) ____ 96 (GO TO 453)

442. After you were discharged, did any health care provider or a traditional birth attendant check on your health?
[Most recent birth within the last five years]

YES 1 (GO TO 445)
NO 2 (GO TO 453)

443. Why didn't you deliver in a health facility? PROBE: Any other reason?
RECORD ALL MENTIONED.

COSTS TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
NOT THE FIRST CHILD F
NOT NECESSARY G
FATHER DIDN'T THINK IT WAS NECESSARY H
FAMILY DIDN'T THINK IT WAS NECESSARY I
HUSBAND/FAMILY DID NOT ALLOW J
NOT CUSTOMARY K
DID NOT KNOW WHERE TO GO L
NOT CUSTOMARY K
DID NOT KNOW WHERE TO GO L
NO ONE TO ACCOMPANY M
INCONVENIENT SERVICE HOUR N
AFRAID TO GO O
LONG WAITING TIME P
OTHER (SPECIFY) _____ X

444. After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?
[Most recent birth within the last five years]

YES 1
NO 2 (GO TO 449)

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

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

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH OFFICER/NURSE 14
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 21
UNTRAINED TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH VOLUNTEER 23
TRADITIONAL PRACTITIONER 24
RELATIVE/FRIEND 25
OTHER (SPECIFY) _____ 96

447. Where did this first check take place?

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

(NAME OF PLACE) __________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOPSITAL/POLYCLINIC 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST/CHPS 23
OTHER PUBLIC (SPECIFY) ____ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
MOBILE CLINIC 32
FP/PPAG CLINIC 33
MATERNITY HOME 34
OTHER PRIVATED MED. (SPECIFY) _____ 36
OTHER (SPECIFY) ______ 96

448. CHECK 442:

YES ___ (GO TO 453)
NOT ASKED ___ (GO TO 449)

449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?
[Most recent birth within the last five years]

YES 1
NO 2 (GO TO 453)
DON'T KNOW 8 (GO TO 453)

450. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[Most recent birth within the last five years]

HRS AFTER BIRTH 1 ___
DAYS AFTER BIRTH 2 __
WKS AFTER BIRTH 3 __
DON'T KNOW 998

451. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[Most recent birth within the last five years]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH OFFICER/NURSE 14
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 21
UNTRAINED TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH VOLUNTEER 23
TRADITIONAL PRACTITIONER 24
RELATIVE/FRIEND 25
OTHER (SPECIFY) _____ 96

452. Where did this first check of (NAME) take place?

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

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
[Most recent birth within the last five years]

(NAME OF PLACE) __________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOPSITAL/POLYCLINIC 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST/CHPS 23
OTHER PUBLIC (SPECIFY) ____ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
MOBILE CLINIC 32
FP/PPAG CLINIC 33
MATERNITY HOME 34
OTHER PRIVATED MED. (SPECIFY) _____ 36
OTHER (SPECIFY) ______ 96

453. In the first two months after delivery, did you receive a vitamin A dose (like this)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
[Most recent birth within the last five years]

YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 456)
NO 2 (GO TO 457)

455. 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 (GO TO 459)

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

MONTHS ___
DON'T KNOW 98

457. CHECK 226: IS RESPONDENT PREGNANT? [Most recent birth within the last five years]

NOT PREGNANT __ (GO TO 458)
PREGNANT OR UNSURE __ (GO TO 459)

458. Have you begun to have sexual intercourse again since the birth of (NAME)? [Most recent birth within the last five years]
[Most recent birth within the last five years]

YES 1
NO 2 (GO TO 460)

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

MONTHS __
DON'T KNOW 98

460. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 467)

461. 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.
[Most recent birth within the last five years]

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

462. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[Most recent birth within the last five years]

YES 1
NO 2 (GO TO 464)

463. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[Most recent birth within the last five years]

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

464. CHECK 404: IS CHILD LIVING?

LIVING __ (GO TO 465)
DEAD __ (GO TO 466)

465. Are you still breastfeeding (NAME)?
[Most recent birth within the last five years]

YES 1 (GO TO 468)
NO 2

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

MONTHS ___
DON'T KNOW 98

467. CHECK 404: IS CHILD LIVING?

LIVING __ (GO TO 470)
DEAD __ (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

468. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[Most recent birth within the last five years]

NUMBER OF NIGHTTIME FEEDINGS ___

469. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[Most recent birth within the last five years]

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON'T KNOW 8

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


SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. LINE NUMBER FROM 212

LINE NUMBER ___

503. FROM 212 AND 216

NAME _______
LIVING __ (GO TO 504)
DEAD __ (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 573)

504. Do you have a child welfare card with (NAME)'s vaccinations? IF YES: May I see it please?

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 508)
NO CARD 3

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

YES 1 (GO TO 508)
NO 2 (GO TO 508)

506. (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.

(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

BCG
DAY ___
MONTH ___
YEAR ___
POLIO 0 (POLIA GIVEN AT BIRTH)
DAY ___
MONTH ___
YEAR ___
POLIO 1
DAY ___
MONTH ___
YEAR ___
POLIO 2
DAY ___
MONTH ___
YEAR ___
POLIO 3
DAY ___
MONTH ___
YEAR ___
DPT/HEP.B/INFL 1
DAY ___
MONTH ___
YEAR ___
DPT/HEP.B/INFL 2
DAY ___
MONTH ___
YEAR ___
DPT/HEP.B/INFL 3
DAY ___
MONTH ___
YEAR ___
MEASLES
DAY ___
MONTH ___
YEAR ___
YELLOW FEVER
DAY ___
MONTH ___
YEAR ___
VITAMIN A (MOST RECENT)
DAY ___
MONTH ___
YEAR ___
VITAMIN A (2nd MOST RECENT)
DAY ___
MONTH ___
YEAR ___

506A. CHECK 506:

BCG TO YELLOW FEVER ALL RECORDED __ (GO TO 510)
OTHER __ (GO TO 507)

507. 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/Hep/infl.B, YELLOW FEVER AND/OR MEASLES VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESONDIN DAY COLUMN IN 506) (GO TO 510)
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)

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

YES 1
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)

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

509A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

509B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 509E)
DON'T KNOW 8 (GO TO 509E)

509C. Was the first polio vaccine received in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

509D. How many times was the polio vaccine received?

NUMBER OF TIMES ___

509E. A DPT/Hep B/influenza vaccination, that is an injection given in the thigh,to prevent him/her from getting tetanus, whooping cough, diphtheria, sometimes given at the same time as polio?

YES 1
NO 2 (GO TO 509G)
DON'T KNOW 8 (GO TO 509G)

509F. How many times was a DPT/Hep B/influenza vaccination received?

NUMBER OF TIMES ___

509G. A measles injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

509H. A measles injection to prevent yellow fever - a shot in the arm at the age of 9 months or older (sometimes given at the same time as measles)?

YES 1
NO 2
DON'T KNOW 8

510. 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 (GO TO 512)
NO VACCINATION IN THE LAST 2 YRS 3 (GO TO 512)
DON'T KNOW 8 (GO TO 512)

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

INTEGRATED MEASLES/POLIO (NOVEMBER 2006) A
IMCI/CHILD HEALTH CAMPAIGN (NOV. 2007 B

512. CHECK 506: DATE SHOWN FOR VITAMIN A DOSE

DATE FOR MOST RECENT VITAMIN A DOSE __ (GO TO 513)
OTHER __ (GO TO 514)

513. According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD).
Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1 (GO TO 515)
NO 2 (GO TO 516)
DON'T KNOW 8

514. HAS (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)

515. Did (NAME) receive a vitamin A dose within the last six months?

YES 1
NO 2
DON'T KNOW 8

516. In the last seven days, did (NAME) take iron pills, sprinkles with iron, or iron syrup (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

517. Has (NAME) taken any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

518. Has (NAME) had diarrhoea in the last 2 weeks?

YES 1
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)

519. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

520. Now I would like to know how much (NAME) was given to drink during the diarrhoea (including breastmilk).

Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

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

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

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

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

YES 1
NO 2 (GO TO 527)

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

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

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) __________________
PUBLIC SECTOR
GOVT HOSPITAL/POLYCLINIC A
GOVT HEALTH CENTER B
GOVT HEALTH POST/CHPS C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC G
PHARMACY H
PVT DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
FPG/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MED. (SPECIFY) ______N
OTHER SOURCE
SHOP/MARKET O
TRADITIONAL PRACTITIONER P
DRUG PEDDLER Q
OTHER (SPECIFY) ____ X

524. CHECK 523:

TWO OR MORE CODES CIRCLED ___ (GO TO 525)
ONLY ONE CODE CIRCLED ___ (GO TO 526)

525. Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

FIRST PLACE ____

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

DAYS ___

527. Does (NAME) still have diarrhoea?

YES 1
NO 2
DON'T KNOW 8

528. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
a) A fluid made from a special ORS sachet?
b) A government-recommended homemade fluid?

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

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

YES 1
NO 2 (GO TO 533)
DK 8 (GO TO 533)

530. What (else) was given to treat the diarrhoea? Anything else?
RECORD ALL TREATMENT GIVEN.

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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

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

YES 1
NO 2 (GO TO 538)
DON'T KNOW 8 (GO TO 538)

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

CHEST ONLY 1 (GO TO 538)
NOSE ONLY 2 (GO TO 538)
BOTH 3 (GO TO 538)
OTHER (SPECIFY) _____ 6 (GO TO 538)
DON'T KNOW 8 (GO TO 538)

537. CHECK 533: HAD FEVER?

YES ___ (GO TO 538)
NO OR DK ___ (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

538. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?

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

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

539. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

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

YES 1
NO 2 (GO TO 545)

541. Where did you seek advice or treatment?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVT HOSPITAL/POLYCLINIC A
GOVT HEALTH CENTER B
GOVT HEALTH POST/CHPS C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC G
PVT. DOCTOR H
PHARMACY I
MOBILE CLINIC J
FIELDWORKER K
FPG/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MED. (SPECIFY)_____ N
OTHER SOURCE
SHOP/MARKET O
TRADITIONAL PRACTITIONER P
DRUG PEDDLER Q
OTHER (SPECIFY) ____ X

542. CHECK 541:

TWO OR MORE CODES CIRCLED __ (GO TO 543)
ONLY ONE CODE CIRCLED __ (GO TO 544)

543. Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

FIRST PLACE ____

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

DAYS ____

545. Is (NAME) still sick with a (fever/cough)?

FEVER ONLY 1
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON'T KNOW 8

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

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

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

ANTIMALARIAL DRUGS
SP/FANSIDAR/MALAFAN A
CHLOROQUINE B
CAMOQUINE C
QUININE D
ARTESUNATE WITH AMODIAQUINE E
ARTEMISININ F
ARTEMETHER/LUMEFANTRINE G
OTHER ANTIMALARIAL (SPECIFY) _____ H
ANTIBIOTIC DRUGS
PILL/SYRUP I
INJECTION J
OTHER DRUGS
ASPIRIN K
PARACETAMOL/PANADOL L
IBUPROFEN M
HERBAL MEDICINE N
OTHER (SPECIFY) ______ X
DON'T KNOW Z

548. CHECK 547: ANY CODE A-I CIRCLED?

YES ___ (GO TO 549)
NO ___ (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

549. Did you already have (NAME OF DRUG FROM 547) at home when the child became ill?

ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'H' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 547.

IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG.
IF NO FOR ALL DRUGS, CIRCLE 'Y'

ANTIMALARIAL DRUGS
SP/FANSIDAR/MALAFAN A
CHLOROQUINE B
CAMOQUINE C
QUININE D
ARTESUNATE WITH AMODIAQUINE E
ARTEMISININ F
ARTEMETHER/LUMEFANTRINE G
OTHER ANTIMALARIAL (SPECIFY) _____ H
ANTIBIOTIC PILL/SYRUP I
NO DRUG AT HOME Y

550. CHECK 547: ANY CODE A-H CIRCLED?

YES __ (GO TO 551)
NO __ (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

551. CHECK 547:
SP/FANSIDAR/MALAFAN ('A') GIVEN

CODE 'A' CIRCLED __ (GO TO 552)
CODE 'A' NOT CIRCLED __ (GO TO 554)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

553. For how many days did (NAME) take the SP/Fansidar/Malafan?
IF 7 DAYS OR MORE, WRITE 7.

DAYS ___
DON'T KNOW 8

554. CHECK 547: CHLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED __ (GO TO 555)
CODE 'B' NOT CIRCLED __ (GO TO 557)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

556. For how many days did (NAME) take the chloroquine?
IF 7 DAYS OR MORE, WRITE 7.

DAYS ___
DON'T KNOW 8

557. CHECK 547: AMODIAQUINE ('C') GIVEN

CODE 'C' CIRCLED __ (GO TO 558)
CODE 'C' NOT CIRCLED __ (GO TO 560)

558. How long after the fever started did (NAME) first take Camoquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

559. For how many days did (NAME) take the Camoquine?
IF 7 DAYS OR MORE, WRITE 7.

DAYS __
DON'T KNOW 8

560. CHECK 547: QUININE ('D') GIVEN

CODE 'D' CIRCLED __ (GO TO 561)
CODE 'D' NOT CIRCLED __ (GO TO 563)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

562. For how many days did (NAME) take the quinine?
IF 7 DAYS OR MORE, WRITE 7.

DAYS ___
DON'T KNOW 8

563. CHECK 547: ARTEMETER WITH AMODIAQUINE ('E') GIVEN

CODE 'E' CIRCLED ___ (GO TO 564)
CODE 'E' NOT CIRCLED __ (GO TO 566)

564. How long after the fever started did (NAME) first take Artesunate with Amodiaquine combination?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

565. For how many days did (NAME) take Artesunate with Amodiaquine combination?
IF 7 DAYS OR MORE, WRITE 7.

DAYS ___
DON'T KNOW 8

566. CHECK 547: ARTEMISININ ('F') GIVEN

CODE 'F' CIRCLED ___ (GO TO 567)
CODE 'F' NOT CIRCLED __ (GO TO 569)

567. How long after the fever started did (NAME) first take Artemisnin?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

568. For how many days did (NAME) take the Artemisnin?
IF 7 DAYS OR MORE, WRITE 7.

DAYS ___
DON'T KNOW 8

569. CHECK 547:
ARTWMETHER/LUMEFANTRINE ('G') GIVEN

CODE 'G' CIRCLED __ (GO TO 570)
CODE 'G' NOT CIRCLED __ (GO TO 571A)

570. How long after the fever started did (NAME) first take Artemether/Lumefantrine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

571. For how many days did (NAME) take the Artemether/Lumefantrine?
IF 7 DAYS OR MORE, WRITE 7.

DAYS ___
DON'T KNOW 8

571A. CHECK 547: OTHER ANTIMALARIAL ('H') GIVEN

CODE 'H' CIRCLED __ (GO TO 571B)
CODE 'H' NOT CIRCLED __ (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

571B. How long after the fever started did (NAME) first take OTHER ANTIMALARIAL?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

571C. For how many days did (NAME) take the (OTHER ANTIMALARIAL)? IF 7 DAYS OR MORE, WRITE 7.

DAYS ___
DON'T KNOW 8

572.GO BACK TO 503 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 573.

573. CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2003 OR LATER AND LIVING WITH THE RESPONDENT ___

ONE OR MORE: ___
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 574) (NAME) _____________

NONE ___ (GO TO 576)

574. The last time (NAME FROM 573) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) _____ 96

575. CHECK 528(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET __ (GO TO 576)
ANY CHILD RECEIVED FLUID FROM ORS PACKET __ (GO TO 577)

576. Have you ever heard of a special product called Oralite or ORS that you can get for the treatment of diarrhoea?

YES 1
NO 2

577. CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT ___

ONE OR MORE: ___
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 578) (NAME) _____________

NONE ___ (GO TO 601)

578. Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night. Did (NAME FROM 577) (drink/eat):

Plain water?
Commercially produced infant formula?
Any commercially produced baby cereal such as Nestle Cerelac, Fresocrem?
Any (other) porridge or gruel?

ASK TO SEE THE BOX TO ENSURE THAT IT IS COMMERCIALLY PRODUCED AND FORTIFIED

PLAIN WATER
YES 1
NO 2
DK 8
FORMULA
YES 1
NO 2
DK 8
BABY CEREAL
YES 1
NO 2
DK 8
OTHER PORRIDGE/GRUEL
YES 1
NO 2
DK 8

579. Now I would like to ask you about (other) liquids or foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods.

Did (NAME FROM 577)/you drink (eat):

a) Milk such as tinned, powdered, or fresh animal milk
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
b) Tea or coffee
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
c) Any other liquids (juice, cocoa)
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
d) Bread, rice, noodles, or other foods made from grain (kenkey,banku, koko,tuo zaafi,akple,weanimix)?
CHILD

YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
e) Pumpkin, red or yellow yams, carrots, sweet potatoes that are yellow or orange inside?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
f) White potatoes, white yams, manioc, cassava, cocoyam, fufu or any other foods made from roots, tubers or plantain?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
g) Any dark green, leafy vegetables (kontomire, aleefu, ayoyo, kale,cassava leaves)?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
h) Ripe mangoes, paw paw?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
i) Any other fruits or vegetable [e.g. bananas, avocados, tomatoes, oranges, apples]?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
j) Liver, kidney, heart or other organ meats?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
k) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
l) Eggs
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
m) Fresh or dried fish or shellfish [e.g. prawn, lobster]?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
n) Any foods made from beans, peas, lentils, or nuts?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
o) Cheese, yogurt or other milk products?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
p) Any oil, fats, or butter, or foods made with any of these?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
q) Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8
r) Any other solid or semi-solid food?
CHILD
YES 1
NO 2
DK 8
MOTHER
YES 1
NO 2
DK 8

580. CHECK 578 (LASCATEGORIES: BABY CEREAL OR OTHER PORRIDGE/GRUEL) AND 579 (CATEGORIES d THROUGH r FOR CHILD):

AT LEAST ONE "YES" ___ (GO TO 581)
NOT A SINGLE "YES" ___ (GO TO 601)

581. How many times did (NAME FROM 577) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES __
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 617)

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

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME ___
LINE NO. ___

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

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

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

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

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

RANK ___

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

ONLY ONCE 1
MORE THAN ONCE 2

615. CHECK 609:
MARRIED/LIVED WITH A MAN ONLY ONCE (In what month and year did you start living with your husband/partner?)

MARRIED/LIVED WITH A MAN MORE THAN ONCE (Now 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 ___ (GO TO 617)
DON'T KNOW YEAR 998

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

AGE ____

617 CHECK FOR THE PRESENCE OF OTHER PEOPLE BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

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

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS __ (GO TO 621)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 621)

619. CHECK 107:

AGE 15-24 ___ (GO TO 620)
AGE 25-49 ___ (GO TO 641)

620. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 641)
NO 2 (GO TO 641)
DON'T KNOW/UNSURE 8 (GO TO 641)

621. CHECK 107:

AGE 15-24 __ (GO TO 622)
AGE 25-49 __ (GO TO 626)

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

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

623. How old was the person you first had sexual intercourse with?

AGE OF PARTNER __ (GO TO 626)
DON'T KNOW 98

624. Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (GO TO 626)
ABOUT THE SAME AGE 3 (GO TO 626)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 626)

625. Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

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

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (GO TO 640)

626A. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. (GO TO 628) (FOLLOWING QUESTIONS ASKED FOR LAST SEXUAL PARTNER, SECOND-TO-LAST, and THIRD-TO-LAST PARTNER)

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

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

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

YES 1
NO 2 (GO TO 630)

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

YES 1
NO 2

630. What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

HUSBAND 1 (GO TO 636)
LIVE-IN PARTNER 2 (GO TO 636)
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
PROSTITUTE 5
OTHER (SPECIFY) _____ 6

631. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

632. CHECK 107:

AGE 15-24 ___ (GO TO 633)
AGE 25-49 ___ (GO TO 636)

633. How old is this person?

AGE OF PARTNER __ (GO TO 636)
DON'T KNOW 98

634. Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 636)
SAME AGE 3 (GO TO 636)
DON'T KNOW 8 (GO TO 636)

635. Would you say this person is ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN THEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

636. The last time you had sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 638)

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

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

638. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 627 IN NEXT COLUMN)
NO 2 (GO TO 639A)

639. In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95 WRITE '95'

NUMBER OF PARTNERS LAST 12 MONTHS ___
DON'T KNOW 98

639A. In total, with how many different people have you had sexual intercourse in the last month?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95 WRITE '95 '

NUMBER OF PARTNERS IN MONTH ___
DON'T KNOW 98

640. In total, with how many different people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95 WRITE '95 '

NUMBER OF PARTNERS IN LIFETIME ___
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 701)

642. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ______ N
OTHER SOURCE
SHOP/MARKET O
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE R
OTHER (SPECIFY)______ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 311/311A:

NEITHER STERILIZED __ (GO TO 702)
HE OR SHE STERILIZED __ (GO TO 713)

702. 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 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)

703. 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 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) ____ 996 (GO TO 708)
DON'T KNOW 998 (GO TO 708)

704. CHECK 226:

NOT PREGNANT OR UNSURE __ (GO TO 705)
PREGNANT __ (GO TO 709)

705. CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED __ (GO TO 706)
NO CURRENTLY USING __ (GO TO 706)
CURRENTLY USING __ (GO TO 713)

706. CHECK 703:

NOT ASKED __ (GO TO 707)
24 OR MORE MONTHS OR 02 OR MORE YEARS __ (GO TO 707)
00-23 MONTHS OR 00-01 YEARS __ (GO TO 709)

707. CHECK 702:

WANTS 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?

WANTS NO (MORE) CHILDREN:
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?

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
OTHER OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE
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 NORMAL PROCESSES T
OTHER (SPECIFY) ____ X
DON'T KNOW Z

708. CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED __ (GO TO 709)
NO, NOT CURRENTLY USING __ (GO TO 709)
YES, CURRENTLY USING __ (GO TO 713)

709. 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 711)
DON'T KNOW 8 (GO TO 713)

710. Which contraception method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 713)
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
MALE CONDOM 07 (GO TO 713)
FEMALE CONDOM 08 (GO TO 713)
DIAPHRAGM 09 (GO TO 713)
FOAM/JELLY 10 (GO TO 713)
LACTATIONAL AMEN. METHOD 11 (GO TO 713)
RHYTHM METHOD 12 (GO TO 713)
WITHDRAWAL 13 (GO TO 713)
OTHER (SPECIFY) ______ 96 (GO TO 713)
UNSURE 98 (GO TO 713)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 713)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 713)
SUBFECUND/INFECUND 24 (GO TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 713)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 713)
HUSBAND/PARTNER OPPOSED 32 (GO TO 713)
OTHERS OPPOSED 33 (GO TO 713)
RELIGIOUS PROHIBITION 34 (GO TO 713)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 713)
KNOWS NO SOURCE 42 (GO TO 713)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 713)
FEAR OF SIDE EFFECTS 52 (GO TO 713)
LACK OF ACCESS/TOO FAR 53 (GO TO 713)
COSTS TOO MUCH 54 (GO TO 713)
INCONVENIENT TO USE 55 (GO TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 713)
OTHER (SPECIFY) ______ 96 (GO TO 713)
DON'T KNOW 98 (GO TO 713)

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

YES 1
NO 2
DON'T KNOW 8

713. 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 715)
NUMBER __
OTHER (SPECIFY) _____ 96 (GO TO 715)

714. 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 NUMBER __
GIRLS NUMBER ___
EITHER NUMBER ___
OTHER (SPECIFY) ____ 96

715. In the last few months have you:

Heard about family planning on the radio?
Seen about family planning on the television?
Read about family planning in a newspaper or magazine?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2

717. CHECK 601:

YES, CURRENTLY MARRIED __ (GO TO 718)
YES, LIVING WITH A MAN __ (GO TO 718)
NO, NOT IN UNION __ (GO TO 801)

718. CHECK 311/311A:

CODE B, G, OR M CIRCLED __ (GO TO 720)
NO CODE CIRCLED __ (GO TO 722)
OTHER __(GO TO 719)

719. Does your husband/partner know that you are using a method of family planning?

YES 1
NO 2
DON'T KNOW 8

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

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


721. CHECK 311/311A:

NEITHER STERILIZED __ (GO TO 722)
HE OR SHE STERILIZED __ (GO TO 722A)

722. 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

722A. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is women's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
c) Having too many children may be dangerous for a woman
d) It is better not to have more children than we can afford
e) Children in smaller families are more likely to succeed

CONTRACEPTION WOMEN'S BUSINESS
AGREE 1
DISAGREE 2
DK 8
WOMAN MAY BECOME PROMISCUOUS
AGREE 1
DISAGREE 2
DK 8
DANGEROUS F/WOMAN
AGREE 1
DISAGREE 2
DK 8
CHILDREN NOT AFFORD
AGREE 1
DISAGREE 2
DK 8
CHILDREN SUCCEED
AGREE 1
DISAGREE 2
DK 8

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

801. CHECK 601 AND 602:

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

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

AGE IN COMPLETED YEARS ___

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

YES 1
NO 2 (GO TO 806)

804. What was the highest level of school he attended: primary, middle/JSS, secondary/SSS, or higher?

PRIMARY 1
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4
DON'T KNOW 8 (GO TO 806)

805. What was the highest grade he completed at that level?

GRADE ___
DON'T KNOW 98

806. CHECK 801:

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

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

________________________

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 818)

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

___________

812. CHECK 811:

WORKS IN AGRICULTURE __ (GO TO 813)
DOES NOT WORK IN AGRICULTURE __ (GO TO 814)

813. 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

814. 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

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

HOME 1
AWAY 2

816. 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

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

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

818. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN __ (GO TO 819)
NOT IN UNION __ (GO TO 827)

819. CHECK 817:

CODE 1 OR 2 CIRCLED ___ (GO TO 820)
OTHER ___ (GO TO 822)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 823)
DON'T KNOW 8

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) _____ 6

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

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

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

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

825. Who usually makes decisions about making purchases for daily household needs?

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

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

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

826A. Who makes decisions about how many children to have?

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

827. 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

828. 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 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 942)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

906. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

During pregnancy?
During delivery?
By breastfeeding?

DURING PREG
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

910. CHECK 909:

AT LEAST ONE 'YES' ___ (GO TO 911)
OTHER __ (GO TO 912)

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

YES 1
NO 2
DON'T KNOW 8

912. Have you heard about special antiretroviral drugs (Nevirapine) that people infected with the AIDS virus can get from a doctor or nurse to help them live longer?

YES 1
NO 2
DON'T KNOW 8

913. CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2005 __ (GO TO 914)
LAST BIRTH BEFORE JANUARY 2005 __ (GO TO 922)
NO BIRTHS __ (GO TO 922)

914. CHECK 407 FOR LAST BIRTH:

HAD ANTENATAL CARE __ (GO TO 914A)
NO ANTENATAL CARE __ (GO TO 922)

914A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

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

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

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 922)

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

YES 1
NO 2

919. Where was the test done?

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

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH POST/CHPS 13
STAND-ALONE VCT CENTER 14
FAMILY PLANNING CLINIC 15
MOBILE CLINIC 16
FIELDWORKER/OUTREACH/PEER EDUCATOR 17
OTHER PUBLIC (SPECIFY) _____ 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
STAND-ALONE VCT CENTER 22
PHARMACY 23
CHEMICAL/DRUG STORE 24
FP/PPAG CLINIC 25
MATERNITY HOME 26
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27
OTHER (SPECIFY) ______ 96

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

YES 1 (GO TO 923)
NO 2

921. When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1 (GO TO 929)
12-23 MONTHS AGO 2 (GO TO 929)
2 OR MORE YEARS AGO 3 (GO TO 929)

922. I do not want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 927)

923. When was the last time you were tested?

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

924. The last time you were tested, did you 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

925. I do not want to know the results, but did you get the results of the test?

YES 1
NO 2

926. Where was the test done?

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

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11 (GO TO 929)
GOVT. HEALTH CENTER 12 (GO TO 929)
GOVT. HEALTH POST/CHPS 13 (GO TO 929)
STAND-ALONE VCT CENTER 14 (GO TO 929)
FAMILY PLANNING CLINIC 15 (GO TO 929)
MOBILE CLINIC 16 (GO TO 929)
FIELDWORKER/OUTREACH/PEER EDUCATOR 17 (GO TO 929)
OTHER PUBLIC (SPECIFY) _____ 18 (GO TO 929)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21 (GO TO 929)
STAND-ALONE VCT CENTER 22 (GO TO 929)
PHARMACY 23 (GO TO 929)
CHEMICAL/DRUG STORE 24 (GO TO 929)
FP/PPAG CLINIC 25 (GO TO 929)
MATERNITY HOME 26 (GO TO 929)
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27 (GO TO 929)
OTHER (SPECIFY) ______ 96 (GO TO 929)

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

YES 1
NO 2 (GO TO 929)

928. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER/OUTREACH/PEER EDUCATOR G
OTHER PUBLIC (SPECIFY) _____
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL (SPECIFY) ____ O
OTHER SOURCE
SHOP/MARKET P
CHURCH Q
FRIEND/RELATIVE R
OTHER (SPECIFY) ______ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DK/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

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

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

940. Should children age 12-14 years be taught about using condoms to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

941. Should children age 12-14 years be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

942. CHECK 901:

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

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

YES 1
NO 2

943. CHECK 618:

HAS HAD SEXUAL INTERCOURSE __ (GO TO 944)
HAS NOT HAD SEXUAL INTERCOURSE __ (GO TO 951)

944. CHECK 942: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES __ (GO TO 945)
NO __ (GO TO 946)

945. Now I would like to ask you some questions about your health in the last twelve months. During the last twelve months have you had a sexually transmitted disease?

YES 1
NO 2
DON'T KNOW 8

946. Sometimes women experience an abnormal vaginal discharge. During the last twelve months, have you had a bad smelling unusual discharge from your vagina?

YES 1
NO 2
DON'T KNOW 8

947. Sometimes women have a genital sore or ulcer. During the last twelve months have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

948. CHECK 945, 946 AND 947:

HAS HAD AN INFECTION (ANY 'YES') ___ (GO TO 949)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW ___ (GO TO 951)

949. Last time you had (PROBLEM(S) FROM 945/946/947), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 951)

950. Where was the test done?

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

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____ N
OTHER SOURCE
SHOP/MARKET O
FRIEND/RELATIVE P
TRADITIONAL PRACTITIONER Q
OTHER (SPECIFY) _____ X

951. Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

953. If a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

954. If a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

955. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN __ (GO TO 956)
NOT IN UNION __ (GO TO 1001)

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

1001. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1005)

1002. How does tuberculosis spread from one person to another?

PROBE: Any other ways?
RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ___ X
DON'T KNOW Z

1003. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1004. If a member of your family got tuberculosis, would you want it to remain a secret or not?

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

1005. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months? IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 1009)

1006. Among these injections, how many were administered by a doctor, a nurse, a pharmacist or any other health worker?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 1009)

1007. The last time you had an injection given to you by a health worker, where did you go to get the injection?

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

NAME ______
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
GOVT. HEALTH POST/CHPS 13
STAND-ALONE VCT CENTER 14
FAMILY PLANNING CLINIC 15
MOBILE CLINIC 16
FIELDWORKER/OUTREACH/PEER EDUCATOR 17
OTHER PUBLIC (SPECIFY) _____ 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
STAND-ALONE VCT CENTER 22
PHARMACY 23
CHEMICAL/DRUG STORE 24
FP/PPAG CLINIC 25
MATERNITY HOME 26
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27
OTHER SOURCE
AT HOME 31
OTHER (SPECIFY) ____ 96

1008. Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1009. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1011)

1010. In the last 24 hours, how many sticks of cigarettes did you smoke?

CIGARETTES ___

1011. Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 1012A)

1012. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
CIGARS D
OTHER (SPECIFY) ____ X

1012A. Do you consume alcoholic beverages?

YES 1
NO 2 (GO TO 1013)

1012B. In the last 7 days (a week) did you drink an alcoholic beverage?
IF 'YES', PROBE: How many times?

ONCE 01
2-3 TIMES 02
4 TIMES OR MORE 03
NONE 04

1013. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

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

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

1014. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1016)

1015. What type of health insurance?
RECORD ALL MENTIONED.

NATIONAL DISTRICT HEALTH INSURANCE (NHIS) A
HEALTH INSURANCE THROUGH EMPLOYER B
MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) ______ X

1015A. CHECK 1015:

CODE 'A' NOR NHIS NOT CIRCLED __ (GO TO 1015B)
CODE 'A' FOR NHIS CIRCLED __ (GO TO 1015C)

1015B. Why have you not registered with the National Health Insurance Scheme (NHIS) card? RECORD ALL MENTIONED.

NOT HEARD OF NHIS A (GO TO 1015I)
CANNOT AFFORD PREMIUM B (GO TO 1015I)
DO NOT TRUST C (GO TO 1015I)
DON'T NEED HEALTH INSURANCE D (GO TO 1015I)
NHIS DOES NOT COVER HEALTH SERVICES I NEED E (GO TO 1015I)
OTHER (SPECIFY) ____ X (GO TO 1015I)

1015C. Did you pay your NHIS membership yourself?

YES, PAID MYSELF 01
YES, PAID BY RELATIVE/FRIEND 02
YES, PAID BY EMPLOYER/SSNIT 03
NO, EXEMPT AS ELDERLY (70+ YEARS) 04
NO, EXEMPT AS PENSIONER 05
NO, EXMPT AS INDIGENT (POOR) 06
NO, OTHER (SPECIFY) _____ 96

1015D. Do you hold a valid National Health Insurance Scheme (NHIS) card? IF ANSWER IS 'YES', REQUEST TO SEE THE CARD.

YES, CARD SEEN 1 (GO TO 1015F)
YES, CARD NOT SEEN/LOST 2 (GO TO 1015F)
NO 3

1015E. Why do you not have a valid NHIS card?

REGISTERED, NOT PAID FULLY 1 (GO TO 1015I)
REGISTERED, CARD NOT RECEIVED 2 (GO TO 1015I)
REGISTERED, WAITING PERIODICALLY 3 (GO TO 1015I)
NOT RENEWED REGISTRATION 4 (GO TO 1015G)
LOST NHIS CARD 5 (GO TO 1015I)
OTHER (SPECIFY) ____ 6 (GO TO 1015I)

1015F. How many weeks did it take you to obtain your NHIS card?

NUMBER OF WEEKS ____ (GO TO 1015I)
DON'T KNOW 98 (GO TO 1015I)

1015G. Do you plan to renew the NHIS card?

YES 1 (GO TO 1015I)
NO 2
DON'T KNOW/NOT SURE 8 (GO TO 1015I)

1015H. Why do you not want to renew the NHIS card? Anything else?
RECORD ALL MENTIONED.

HAVE NOT BEEN SICK A
PREMIUM EXPENSIVE B
STILL PAY OUT OF POCKET C
WORSE QUALITY CARE WITH CARD D
WAITING TIME FOR CARD LONG E
USED SERVICES NOT COVERED F
DID NOT USE ANY HEALTH SERVICES G
USE CLINICS OR TRADITIONAL PRACTITIONERS WHO ARE NOT COVERED H
OTHER (SPECIFY) _____ X

1015I. Do you have to pay out of pocket for drugs and services?

YES 1
NO 2
SOMETIMES 3

1015J. Are there any services that you need from health provider that are not covered by NHIS?

YES 1
NO 2 (GO TO 1015L)

1015K. What are these services? Anything else?
RECORD ALL MENTIONED.

FAMILY PLANNING A
LABORATORY INVESTIGATIONS B
ANTENATAL CARE C
POSTNATAL CARE D
CARE FOR NEWBORN FOR UP TO 3 MONTHS E
OTHER (SPECIFY) _____ X

1015L. In your opinion, do NHIS card holders get better/same/worse service than others?

BETTER 1
SAME 2
WORSE 3
DON'T KNOW/NOT SURE 8

1015M .In your opinion, did you receive good service last time you were treated at a clinic or hospital? IF NO, PROBE

YES 1
NO, WAITING TIMES WERE TOO LONG 2
NO, STAFF NOT POLITE 3
NO, DID NOT RECEIVE ENOUGH INFORMATION ABOUT ILLNESS AND TREATMENT 4
OTHER (SPECIFY) _____ 6

1016. I am going to ask you about the time you spent being physically active in the last 7 days. This is about the activities you do at work, as part of your house and yard work, to get from place to place in your spare time, exercise or sport.

Now, think about all the vigorous activities which take hard physcial effort that you did in the past 7 days: activties that make you breathe much harder than normal and may include heavy lifting, digging, jogging, or fast bicycling. Think about only those physical activities that you did at least 15 minutes at a time.

In the last 7 days, on how many days did you do vigorous physical activities that lasted for at least 15 mins each time?

IF 'NONE' RECORD '0'.

NUMBER OF DAYS ____
DON'T KNOW 8

1017. How many hours do you rest per day, including naps and sleep both during the day and night?

1-3 HOURS 1
4-6 HOURS 2
7-9 HOURS 3
10 AND MORE HOURS 4
DON'T KNOW 8

1018. Now I would like to ask you about liquids and foods that you consume.

How many glasses of water do you drink in one day on average?
IF MORE THAN 9, RECORD '9', IF 'NONE' RECORD '0'

NUMBER OF GLASSES ___

1019. In a typical week, on how many days do you eat fruits, for example, mangoes, paw paw, banana, orange, avocados, tomatoes, passion fruit, etc?
IF 'NONE' RECORD '0'.

NUMBER OF DAYS ___
DON'T KNOW/NOT SURE 8 (GO TO 1021)

1020. On a day when you eat fruits, how many servings do you eat on average?
IF 'NONE' RECORD '0'.

NUMBER OF DAYS ___
DON'T KNOW/NOT SURE 8

1021. In a typical week, on how many days do you eat vegetables, for example carrots, cabbage, dark green leafy vegetables (e.g. kontomire), pumpkin, squash, etc?
IF 'NONE' RECORD '0'.

NUMBER OF DAYS ___
DON'T KNOW/NOT SURE 8 (GO TO 1100)

1022. On a day when you eat vegetables, how many servings do you eat on average?
IF 'NONE' RECORD '0'.

NUMBER OF DAYS ___
DON'T KNOW/NOT SURE 8

SECTION 11. DOMESTIC VIOLENCE

1100. CHECK HH Q.138 AND COVER PAGE OF WOMAN'S QUESTIONNAIRE:

WOMAN SELECTED FOR THIS SECTION __ (GO TO 1101)
WOMAN NOT SELECTED __ (GO TO 1135)

1101. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (READ TO RESPONDENT)
PRIVACY NOT POSSIBLE 2 (GO TO 1135)

READ TO THE RESPONDENT

Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Ghana. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.

1102. CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1103)
FORMERLY MARRIED/ LIVED WITH A MAN (READ IN PAST TENSE) (GO TO 1103)
NEVER MARRIED/ NEVER LIVED WITH A MAN (GO TO 1114)

1103. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?
f) He (does/did) not trust you with any money?
g) He (refuses/refused) or (denies/denied) to have sexual intercourse with you?

JEALOUS
YES 1
NO 2
DK 8
ACCUSES
YES 1
NO 2
DK 8
NOT MEET FRIENDS
YES 1
NO 2
DK 8
NO FAMILY
YES 1
NO 2
DK 8
WHERE YOU ARE
YES 1
NO 2
DK 8
MONEY
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8

1103A. CHECK 204 AND 205:

HAS CHILDREN LIVING ELSEWHERE (GO TO 1103B)
NO CHILDREN LIVING ELSEWHERE (GO TO 1104)

1103B. Does/did he prevent you from seeing your children?

YES 1
NO 2
DK 8

1103C. CHECK 215 AND 217:

IF CHILD 3 YEARS OR OLDER OR BORN BEFORE JAN 2005 (GO TO 1103D)
IF CHILD LESS THAN 3 YEARS (GO TO 1104)

1103D. Does/did he refuse to pay children's school fees?

YES 1
NO 2
DK 8

1104. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner. If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.

1104A (Does/did) your (last) husband/partner ever:

a) say or do something to humiliate you in front of others?
YES 1 (TO B)
NO 2
b) threaten to hurt or harm you or someone close to you?
YES 1 (TO B)
NO 2
c) insult you or make you feel bad about yourself?
YES 1 (TO B)
NO 2

1104B How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1105. A (Does/did) your (last) husband/partner ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1 (TO B)
NO 2
b) slap you?
YES 1 (TO B)
NO 2
c) twist your arm or pull your hair?
YES 1 (TO B)
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1 (TO B)
NO 2
e) kick you, drag you or beat you up?
YES 1 (TO B)
NO 2
f) try to choke you or burn you on purpose?
YES 1 (TO B)
NO 2
g) threaten or attack you with a knife, gun, or any other weapon?
YES 1 (TO B)
NO 2
h) physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (TO B)
NO 2
i) force you to perform any sexual acts you did not want to?
YES 1 (TO B)
NO 2

B How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g) threaten or attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h) physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
i) force you to perform any sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1106. CHECK 1105 (a-i):

AT LEAST ONE 'YES' (GO TO 1107)
NOT A SINGLE 'YES' (GO TO 1109)

1107. How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS ___
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1108. Did the following ever happen as a result of what your (last) husband/partner did to you:

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

1109. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1112)

1111. In the last 12 months, how often have you done this to your husband/partner: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1112. Does (did) your husband/partner drink alcohol?

YES 1
NO 2 (GO TO 1114)

1113. How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1114. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN:
From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?

NEVER MARRIED/ NEVER LIVED WITH A MAN
From the time you were 15 years old has anyone ever hit, kicked, slapped, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1117)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1117)

1115. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

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

1116. In the last 12 months how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1117. CHECK 201, 226, AND 229:

EVER BEEN PREGNANT (YES OR 201 OR 226 OR 229) ___ (GO TO 1118)
NEVER BEEN PREGNANT __ (GO TO 1120)

1118. Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1120)

1119. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

CURRENT HUSBAND/LIVE-IN PARTNER A
MOTHER/STEP-MOTHER B (GO TO 1120)
FATHER/STEP-FATHER C (GO TO 1120)
SISTER/BROTHER D (GO TO 1120)
DAUGHTER/SON E (GO TO 1120)
OTHER RELATIVE F (GO TO 1120)
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H (GO TO 1120)
FORMER BOYFRIEND I (GO TO 1120)
MOTHER-IN-LAW J (GO TO 1120)
FATHER-IN-LAW K (GO TO 1120)
OTHER-IN-LAW L (GO TO 1120)
TEACHER M (GO TO 1120)
EMPLOYER/SOMEONE AT WORK N (GO TO 1120)
POLICE/SOLDIER O (GO TO 1120)
OTHER (SPECIFY) ______ X (GO TO 1120)

1119A. Have you ever lost your pregnancy as a result of what your (last) husband/partner did to you?

YES 1
NO 2

1120. CHECK 618: EVER HAD SEX?

HAS EVER HAD SEX __ (GO TO 1121)
NEVER HAD SEX __ (GO TO 1125)

1121. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

WANTED TO 1
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3

1122. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN:
In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?

NEVER MARRIED/ NEVER LIVED WITH A MAN:
In the last 12 months has anyone forced you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

1123. CHECK 1121 AND 1122:

1121='1' or '3' and 1122= '2' or '3' __ (GO TO 1124)
OTHER __ (GO TO 1126)

1124 CHECK 1105A(h) and 1105A(i):

1105A(h) IS NOT '1' AND 1105A(i) IS NOT (1) __ (GO TO 1124)
OTHER __ (GO TO 1126)

1125. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2 (GO TO 1128)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1128)

1126. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS __
DON'T KNOW 98

1127. Who was the person who was forcing you at that time?

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUANTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) _____ 96

1128. CHECK 1105A (a-i), 1114, 1122 AND 1125:

AT LEAST ONE 'YES' __ (GO TO 1129)
NOT A SINGLE 'YES' __ (GO TO 1132)

1129. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

YES 1
NO 2 (GO TO 1131)

1130. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1132)
HUSBAND/PARTNER'S FAMILY B (GO TO 1132)
CURRENT/LAST/LATE HUSBAND/PARTNER C (GO TO 1132)
CURRENT/FORMER BOYFRIEND D (GO TO 1132)
MALE FRIEND E (GO TO 1132)
FEMALE FRIEND F (GO TO 1132)
NEIGHBOR G (GO TO 1132)
RELIGIOUS LEADER H (GO TO 1132)
DOCTOR/MEDICAL PERSONNEL I (GO TO 1132)
POLICE J (GO TO 1132)
LAWYER K (GO TO 1132)
SOCIAL SERVICE ORGANIZATION L (GO TO 1132)
COMMUNITY LEARDER/LOCAL ADMIN M (GO TO 1132)
OTHER (SPECIFY) ____ X (GO TO 1132)

1131. Have you ever told any one else about this?

YES 1
NO 2

1132. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

1132A. As far as you know, did your mother ever beat your father?

YES 1
NO 2
DON'T KNOW 8

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

1133. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

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

1134. INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

____________________________

1135. RECORD THE TIME

HOURS ___
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 SUPERVISOR: ____________________
DATE: _____________________

EDITOR'S OBSERVATIONS
_____________________________________________

NAME OF EDITOR: ______________________

DATE: ______________________