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 ______

CITY/LARGE TOWN/SMALL TOWN/VILLAGE ______

NAME OF LINE NUMBER OF WOMAN ____

WOMAN SELECTED FOR DV INTERVIEW ____

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:

LANGUAGE OF QUESTIONNAIRE: 1

LANGUAGE OF INTERVIEW: ___

LANGUAGE OF RESPONDENT: ___

LANGUAGE CODES:

TRANSLATOR USED: ___

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.

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

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

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

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

106. In what month and year were you born?

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

108. Have you ever attended school?

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

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

111. CHECK 109:

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?

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

114. CHECK 112:

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?

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

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?

118. What is your religion?

119. To which ethnic group do you belong?

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?

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

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

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

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'.

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?

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

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

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

210 CHECK 208:

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?

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

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

216. Is (NAME) still alive?

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

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

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

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.

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

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

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

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?

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.

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?

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

230. When did the last such pregnancy end?

231. CHECK 230:

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.

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

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?

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

237. When did your last menstrual period start?

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?

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

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.

302. Have you ever used (METHOD)?

303. CHECK 302:

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

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'.

308. CHECK 302 (01):

309. CHECK 226:

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

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.

311A CIRCLE 'A' FOR FEMALE STERILIZATION.

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.

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

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

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?

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

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?

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.

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.

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.

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

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?

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

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

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?

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

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

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.

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

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.

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

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

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

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

404. FROM 212 AND 216

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?

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

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.

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.

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

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

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?

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]

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

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]

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

416. CHECK 415:

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]

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]

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

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

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].

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]

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

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

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

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

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]

428. CHECK 427: DRUGS TAKEN FOR MALARIA PREVENTION.

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

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

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]

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

433. Was (NAME) weighed at birth?

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

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.

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.

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.

438. Was (NAME) delivered by caesarean section?

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

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]

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

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]

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

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]

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.

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

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]

448. CHECK 442:

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]

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]

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

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]

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]

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]

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]

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

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

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]

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

460. Did you ever breastfeed (NAME)?

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]

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]

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

464. CHECK 404: IS CHILD LIVING?

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

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

467. CHECK 404: IS CHILD LIVING?

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]

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]

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

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

503. FROM 212 AND 216

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

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

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.

506A. CHECK 506:

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.

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

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?

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

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

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

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?

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

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?

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)?

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

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

512. CHECK 506: DATE SHOWN FOR VITAMIN A DOSE

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.

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

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

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.

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

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

519. Was there any blood in the stools?

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?

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?

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

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.

524. CHECK 523:

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

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

527. Does (NAME) still have diarrhoea?

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?

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

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

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

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

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

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

537. CHECK 533: HAD FEVER?

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?

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?

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

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.

542. CHECK 541:

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

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

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

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

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

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

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'

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

573. CHECK 215 AND 218, ALL ROWS:

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

575. CHECK 528(a), ALL COLUMNS:

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

577. CHECK 215 AND 218, ALL ROWS:

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

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):

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

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'.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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'.

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

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

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

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

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?)

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

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?

619. CHECK 107:

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

621. CHECK 107:

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

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

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

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

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.

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?

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

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

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'.

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.

632. CHECK 107:

633. How old is this person?

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

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

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

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

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

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'

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 '

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 '

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

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.

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

SECTION 7. FERTILITY PREFERENCES

701. CHECK 311/311A:

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?)

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?

704. CHECK 226:

705. CHECK 310: USING A CONTRACEPTIVE METHOD?

706. CHECK 703:

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.

708. CHECK 310: USING A CONTRACEPTIVE METHOD?

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

710. Which contraception method would you prefer to use?

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

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

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.

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?

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?

717. CHECK 601:

718. CHECK 311/311A:

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

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

721. CHECK 311/311A:

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?

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

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

801. CHECK 601 AND 602:

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

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

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

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

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?

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?

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?

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

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

812. CHECK 811:

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?

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

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

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

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

818. CHECK 601:

819. CHECK 817:

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?

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?

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?

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

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

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

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

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

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

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?

SECTION 9. HIV/AIDS

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

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

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

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

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

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

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

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

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

During pregnancy?
During delivery?
By breastfeeding?

910. CHECK 909:

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?

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?

913. CHECK 208 AND 215:

914. CHECK 407 FOR LAST BIRTH:

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?

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

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

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

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.

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

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

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

923. When was the last time you were tested?

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?

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

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.

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

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.

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

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

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?

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?

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

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?

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?

943. CHECK 618:

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

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?

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

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

948. CHECK 945, 946 AND 947:

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

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.

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?

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?

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

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

955. CHECK 601:

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

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

SECTION 10. OTHER HEALTH ISSUES

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

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

PROBE: Any other ways?
RECORD ALL MENTIONED.

1003. Can tuberculosis be cured?

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

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.

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.

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.

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

1009. Do you currently smoke cigarettes?

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

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

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

1012A. Do you consume alcoholic beverages?

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

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?

1014. Are you covered by any health insurance?

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

1015A. CHECK 1015:

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

1015C. Did you pay your NHIS membership yourself?

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

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

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

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

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

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

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

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

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

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

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'.

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

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'

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'.

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

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'.

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

SECTION 11. DOMESTIC VIOLENCE

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

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

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?

1103A. CHECK 204 AND 205:

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

1103C. CHECK 215 AND 217:

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

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:

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

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

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

1106. CHECK 1105 (a-i):

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'.

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

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?

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

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

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

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?

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

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?

1117. CHECK 201, 226, AND 229:

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

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

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

1120. CHECK 618: EVER HAD SEX?

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?

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?

1123. CHECK 1121 AND 1122:

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

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?

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

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

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

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?

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

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

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

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

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?

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

1135. RECORD THE TIME

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: ______________________