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2014 GHANA DEMOGRAPHIC AND HEALTH SURVEY - GHANA 2014 -
WOMAN'S QUESTIONNAIRE

MINISTRY OF HEALTH, GHANA

GHANA STATISTICAL SERVICE

IDENTIFICATION

LOCALITY NAME _____

NAME OF HOUSEHOLD HEAD ____

CLUSTER NUMBER _____

STRUCTURE NUMBER _____

HOUSEHOLD NUMBER _____

REGION _____

DISTRICT _____

URBAN/RURAL

URBAN 1
RURAL 2

NAME AND LINE NUMBER OF WOMAN:

NAME ___________
LINE NO. ___________

INTERVIEW VISITS

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

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE ____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 2014
INT. NUMBER _____
RESULT ____

RESULT CODES:

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

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE:

ENGLISH 1

LANGUAGE OF INTERVIEW:

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

LANGUAGE OF RESPONDENT:

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 _______________________. I am working with Ghana Statistical Service and the Ministry of Health. We are conducting a survey about health all over Ghana. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30-60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

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

SIGNATURE OF INTERVIEWER: ___________________________
DATE: _____________________

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

101) RECORD THE TIME.

HOUR _____
MINUTES ____

101A) During the interview I would like to measure your blood pressure. This will be done three times during the interview. This is a harmless procedure. It is used to find out if a person has high blood pressure. If it is not treated, high blood pressure may eventually cause serious damage to the heart.

The results of this blood pressure measurement will be given to you after the interview together with an explanation of the meaning of your blood pressure numbers. If your blood pressure is high, we will suggest that you consult a health facility or doctor since we cannot provide any further testing or treatment during the survey.

Do you have any questions about the blood pressure measurement so far? If you have any questions about the procedure at any time, please ask me.

You can say yes or no to having the blood pressure measurement now.
You can also decide at any time not to participate in the blood pressure measures.

Would you allow me to proceed to take your blood pressure measurement at this time?

Signature of interviewer: ___________________________
Date: ____________

RESPONDENT AGREES 1 (GO TO 101B)
RESPONDENT DOES NOT AGREE 2 (GO TO 102)

101B) Before taking your blood pressure, I would like to ask a few questions about things that may affect these measurements.

Have you done any of the following within the past 30 minutes:

a) Eaten anything?
b) Had coffee, tea, cola or other drink that has caffeine?
c) Smoked any tobacco product?
d) Conducted any vigorous physical activity or exercises?

EATEN
YES 1
NO 2
HAD CAFFEINATED DRINK
YES 1
NO 2
SMOKED
YES 1
NO 2
EXERCISES
YES 1
NO 2

101C) May I begin the process of measuring your blood pressure?

BEFORE TAKING THE FIRST BLOOD PRESSURE READING, MEASURE THE CIRCUMFERENCE OF THE RESPONDENT'S ARM MIDWAY BETWEEN THE ELBOW AND THE SHOULDER.

RECORD THE MEASUREMENT IN CENTIMETERS.

ARM CIRCUMFERENCE (IN CENTIMETERS) __

101D) USE THE ARM CIRCUMFERENCE MEASUREMENT TO SELECT THE APPROPRIATE BLOOD PRESSURE MONITOR MODEL AND CUFF SIZE. CIRCLE THE CODE FOR THE MODEL AND CUFF SIZE.

MODEL 767

SMALL: 16 CM - 23 CM 1
MEDIUM: 24 CM - 35 CM 2
LARGE: 36 CM - 41 CM 3

MODEL 789

EXTRA LARGE: 42 CM - 60 CM 4

101E) TAKE THE FIRST BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q102.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.

SYSTOLIC ___
DIASTOLIC ___

REFUSED 994
TECHNICAL PROBLEMS 995
OTHER 996

102) In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR _____
DON'T KNOW YEAR 9998

103) How old were you at your last birthday?

COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS __

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105) What is the highest level of school you attended: primary, middle, JSS/JHS, secondary, SSS/SHS, or higher?

PRIMARY 1
MIDDLE 2
JSS/JHS 3
SECONDARY 4
SS/SHS 5
HIGHER 6

106) What is the highest (grade) you completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE __

106A) CHECK 103:

AGE 24 OR YOUNGER (GO TO 106B)
AGE 25 OR OLDER (GO TO 107)

106D) Why did you stop attending school?

HAD TO WORK 01
MOVED 02
NO MONEY TO COVER COSTS 03
HAD BAD GRADES 04
HEALTH REASONS 05
FAMILY REASONS/ GOT MARRIED 06
COMPLETED DESIRED LEVEL 07
NO DESIRE TO CONTINUE 08
OTHER (SPECIFY) _____ 96

107) CHECK 105:

PRIMARY/MIDDLE/JSS/JHS (GO TO 108)
SECONDARY/SSS/SHS OR HIGHER (GO TO 110)

108) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:

Can you read any part of the sentence to me?

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

109) CHECK 108:

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

110) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

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

111) Do you listen to the radio at least once a week, less than once a week or not at all?

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

112) Do you watch television at least once a week, less than once a week or not at all?

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

113) What is your religion?

CATHOLIC 01
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
PENTECOSTAL/CHARISMATIC 05
OTHER CHRISTIAN 06
ISLAM 07
TRADITIONAL/SPIRITUALIST 08
NO RELIGION 09
OTHER (SPECIFY) _____ 10

114) To which ethnic group do you belong?

AKAN 01
GA/DANGME 02
EWE 03
GUAN 04
MOLE-DAGBANI 05
GRUSI 06
GURMA 07
MANDE 08
OTHER (SPECIFY) ____ 96

115) In the last 12 months, how many times have you been away from home for one or more nights?

NUMBER OF TIMES ____
NONE 00 (GO TO 201)

116) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203) How many sons live with you?
And how many daughters live with you?

IF NONE, RECORD '00'.

SONS AT HOME ____
DAUGHTERS AT HOME ____

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

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?

IN NONE, RECORD '00' AND GO TO '206'.

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE _____

205A) How many sons living elsewhere are younger than age 18?
And how many daughters living elsewhere are younger than age 18?

IF NONE, RECORD '00' AND GO TO '206'.

SONS younger than 18 ELSEWHERE _____
DAUGHTERS younger 18 ELSEWHERE _____

205B) These children under 18 who do not live with you: where do they live at the moment? How many girls and how many boys live with:

a) Relatives
b) Family friends?
c) Institution: care home?
d) Institution: disability?
e) Institution: boarding school?
f) Institution: criminal justice?
g) On the streets / runaway?
h) Formally adopted?
x) Other? (specify) ______
z) Don't know

RELATIVES
GIRLS _____
BOYS _____
FAMILY FRIENDS
GIRLS _____
BOYS _____
INSTITUTION: CARE HOME
GIRLS _____
BOYS _____
INSTITUTION: DISABILITY
GIRLS _____
BOYS _____
INSTITUTION: BOARDING SCHOOL
GIRLS _____
BOYS _____
INSTITUTION: CRIMINAL JUSTICE
GIRLS _____
BOYS _____
ON THE STREETS/RUNAWAY
GIRLS _____
BOYS _____
FORMALLY ADOPTED
GIRLS _____
BOYS _____
OTHER (SPECIFY) ______
GIRLS _____
BOYS _____
DON'T KNOW
GIRLS _____
BOYS _____

205C) SUM ANSWERS TO 205B a-z, AND ENTER TOTAL. IF NONE, RECORD '00'.

GIRLS _____
BOYS _____

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

YES 1
NO 2 (GO TO 208)

207) How many boys have died?
And how many girls have died?

IF NONE, RECORD '00'

BOYS DEAD ____
GIRLS DEAD ____

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

TOTAL BIRTHS ____

209) CHECK 208:

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

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

210) CHECK 208:

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

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

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

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

RECORD NAME.
BIRTH HISTORY NUMBER

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

BOY 1
GIRL 2

214) Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

MONTH ___
YEAR _____

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217) IF ALIVE:
How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ____

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

YES 1
NO 2

219) IF ALIVE:

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

HOUSEHOLD LINE NUMBER ___ (GO TO NEXT BIRTH)

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

IF '1 YEAR', PROBE: How many months was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 _____
MONTHS 2 _____
YEARS 3 _____

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

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

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

YES 1
NO 2

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

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

224) CHECK 215:

ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

225) FOR EACH BIRTH SINCE JANUARY 2009, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

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

227) How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ____

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

YES (GO TO 230)
NO 2

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?

MONTH ___
YEAR _____

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN. 2009 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 2009 (GO TO 238)

233) How many months pregnant were you when the last such pregnancy ended?

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

MONTHS ___

234) Since January 2009, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2009.

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

236) Did you have any miscarriages, abortions or stillbirths that ended before 2009?

YES 1
NO 2 (GO TO 238)

237) When did the last such pregnancy that terminated before 2009 end?

MONTH _____
YEAR _____

238) When did your last menstrual period start?

DATE, IF GIVEN ______________
DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

239) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

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

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

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

SECTION 3. CONTRACEPTION

301) 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.

Have you ever heard of (METHOD)?

1) FEMALE STERILIZATION. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
2) MALE STERILIZATION. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
3) IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
4) INJECTABLES. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
5) IMPLANTS. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
6) PILL. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
7) CONDOM. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
8) FEMALE CONDOM. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
9) LACTATIONAL AMENORRHEA METHOD (LAM).
YES 1
NO 2
10) RHYTHM/CALENDAR METHOD. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11) WITHDRAWAL. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12) EMERGENCY CONTRACEPTION. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
13) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) _________
NO 2

302) CHECK 226:

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

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

YES 1
NO 2 (GO TO 311)

304) Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 308A)
DIAPHRAGM I (GO TO 308A)
FOAM/JELLY J (GO TO 308A)
LACTATIONAL AMEN. METHOD K (308A)
RHYTHM METHOD L (GO TO 308A)
WITHDRAWAL M (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

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

SECURE 01 (GO TO 308A)
MICROGYNON 02 (GO TO 308A)
DUOFEM 03 (GO TO 308A)
N/M TABLETS 04 (GO TO 308A)
MICROLUT 05 (GO TO 308A)
OTHER (SPECIFY) _____ 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

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

CHAMPION 01 (GO TO 308A)
GOLD CYCLE 02 (GO TO 308A)
PANTHER 03 (GO TO 308A)
BAZOOKA 04 (GO TO 308A)
BE SAFE NO LOGO 05 (GO TO 308A)
OTHER (SPECIFY) _____ 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

307) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________________
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER/CLINIC 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR'S OFFICE 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 26
OTHER (SPECIFY) ____ 96

DON'T KNOW 98

308) In what month and year was the sterilization performed?

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

MONTH _____
YEAR _____

309) CHECK 308/308A, 215 AND 231:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A

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

NO (GO TO 310)

310) CHECK 308/308A:

YEAR IS 2009 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.

YEAR IS 2008 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2009. (GO TO 322)

311) 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 TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2009.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

ILLUSTRATIVE QUESTIONS:

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

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:

d) Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
e) IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MOTH IN COLUMN 1.

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

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

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

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

314) CHECK 304:

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

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

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

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

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

(NAME OF PLACE) ___________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER/CLINIC 12
GOVT. HEALTH POST/CHPS 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER/OUTREACH/PEER EDUCATOR 16
OTHER PUBLIC (SPECIFY) _____ 17
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

316) CHECK 304:

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

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD (GO TO 326)

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

317A) When you got sterilized were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

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

YES 1
NO 2 (320)

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

YES 1
NO 2

320) CHECK 317:

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

CODE '1' NOT CIRCLED: b) When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

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

YES 1
NO 2

322) CHECK 304:

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

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

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

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

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11 (GO TO 326)
GOVT. HEALTH CENTER/CLINIC 12 (GO TO 326)
GOVT. HEALTH POST/CHPS 13 (GO TO 326)
FAMILY PLANNING CLINIC 14 (GO TO 326)
MOBILE CLINIC 15 (GO TO 326)
FIELDWORKER/OUTREACH/PEER EDUCATOR 16 (GO TO 326)
OTHER PUBLIC (SPECIFY) _____ 17 (GO TO 326)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 326)
PRIVATE DOCTOR 22 (GO TO 326)
PHARMACY 23 (GO TO 326)
CHEMICAL/DRUG STORE 24 (GO TO 326)
FP/PPAG CLINIC 25 (GO TO 326)
MATERNITY HOME 26 (GO TO 326)
OTHER PRIVATE MEDICAL (SPECIFY) _____ 27 (GO TO 326)
OTHER SOURCE
SHOP/MARKET 31 (GO TO 326)
CHURCH 32 (GO TO 326)
COMMUNITY VOLUNTEER 33 (GO TO 326)
FRIEND/RELATIVE 34 (GO TO 326)
OTHER (SPECIFY) _____ 96 (GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325) Where is that?
Any other place?

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

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

328) Did any staff member 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 2009 OR LATER (GO TO 402)
CHECK 215:
ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME. AND SURVIVAL STATUS OF EACH BIRTH IN 2009 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).
NO BIRTHS IN 2009 OR LATER (GO TO 556)

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

403) BIRTH HISTORY NUMBER 212 IN BIRTH HISTORY:

BIRTH HISTORY NUMBER _____

404) FROM 212 AND 216:

NAME _______
LIVING ___
DEAD ___

405) When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (GO TO 408)
NO 2

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

LATER 1
NO MORE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS 1 _____
YEARS 2 _____

DON'T KNOW 998

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

YES 1
NO 2 (GO TO 415)

409) Whom did you see?
Anyone else?

[ASK FOR MOST RECENT BIRTH ONLY]

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
COM. HEALTH OFFICER/NURSE C
OTHER PERSON
TRAD. BIRTH ATTENDANT/TBA D
VILLAGE HEALTH VOLUNTEER E
TRAD. HEALTH PRACTITIONER F
OTHER (SPECIFY) _____ X

410) Where did you receive antenatal care for this pregnancy?
Anywhere else?

[ASK FOR MOST RECENT BIRTH ONLY]

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

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

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

MONTHS ___
DON'T KNOW 98

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

NUMBER OF TIMES __
DON'T KNOW 98

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

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

[ASK FOR MOST RECENT BIRTH ONLY]

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

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

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

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

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

TIMES ___
DON'T KNOW 8

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

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

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

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

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

TIMES __
DON'T KNOW 8

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

YEARS AGO ____

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

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.
[ASK FOR MOST RECENT BIRTH ONLY]

DAYS _____
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

424) During this pregnancy, did you take any drugs to keep you from getting malaria?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 429A)
DON'T KNOW (GO TO 429A)

425) What drugs did you take?
[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

SP/FANSIDAR A
CHLOROQUINE B
OTHER (SPECIFY) _____ X
DON'T KNOW Z

426) CHECK 425:
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION.

[ASK FOR MOST RECENT BIRTH ONLY]

CODE 'A' CIRCLED (GO TO 427)
CODE 'A' NOT CIRCLED (GO TO 429A)

427) How many times did you take (SP/Fansidar) during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

TIMES ___

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY:

[ASK FOR MOST RECENT BIRTH ONLY]

CODE 'A', 'B' OR 'C' CIRCLED (GO TO 429)
OTHER (GO TO 429A)

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source? [ASK FOR MOST RECENT BIRTH ONLY]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

429A) CHECK 408:
ANC RECEIVED

[ASK FOR MOST RECENT BIRTH ONLY]

ANC RECEIVED (GO TO 429B)
NO ANC (GO TO 430)

429B) Do you have an ANC card for the time you were pregnant with (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 430)
NO CARD 3 (GO TO 430)

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

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

431) Was (NAME) weighed at birth?

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

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

KG FROM CARD 1 _.______
KG FROM RECALL 2 _._____

DON'T KNOW 99998

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

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
COM. HEALTH OFFICER/NURSE C
OTHER PERSON
TRAD. BIRTH ATTENDANT/TBA D
VILLAGE HEALTH VOLUNTEER E
TRAD. HEALTH PRACTITIONER F
OTHER (SPECIFY) ______ X

NO ONE ASSISTED Y

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

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

(NAME OF PLACE) __________
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER/CLINIC 22
GOVT. HEALTH POST/CHPS 23
MOBILE CLINIC 24
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC 31
FP/PPAG CLINIC 32
MOBILE CLINIC 33
MATERNITY HOME 34
OTHER PRIVATE MED. SECTOR (SPECIFY) ______ 36
OTHER (SPECIFY) _____ 96 (GO TO 438)

434A) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. [ASK FOR MOST RECENT BIRTH ONLY]

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DON'T KNOW 998

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

YES 1
NO 2

436) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 439)
NO 2

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

YES 1 (GO TO 439)
NO 2 (GO TO 441)

438) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 441)

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
COM. HEALTH OFFICER/NURSE 13
OTHER PERSON
TRAD. BIRTH ATTENDANT/TBA 21
VILLAGE HEALTH VOLUNTEER 22
TRADITIONAL HEALTH PRACTITIONER 23
OTHER (SPECIFY) _____ 96

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

HOURS 1 ____
DAYS 2 ____
WEEKS 3 ____

DON'T KNOW 998

441) How long after birth was (NAME) bathed for the first time?
[ASK FOR MOST RECENT BIRTH ONLY]

LESS THAN 1 HOUR 1
1-5 HOURS 2
6-12 HOURS 3
MORE THAN 12 HOURS 4
NEVER BATHED 5
DON'T KNOW 8

441A) How long after birth was (NAME) wrapped?
[ASK FOR MOST RECENT BIRTH ONLY]

LESS THAN 30 MINUTES 1
30 MINUTES TO 1 HOUR 2
MORE THAN 1 HOUR 3
NEVER WRAPPED 4
DON'T KNOW 8

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

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

443) How many hours, days or weeks after the birth of (NAME) did the first check take place?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HRS AFTER BIRTH 1 ____
DAYS AFTER BIRTH 2 ____
WKS AFTER BIRTH 3 ____

DON'T KNOW 998

444) Who checked on (NAME)'s health at that time?
[ASK FOR MOST RECENT BIRTH ONLY]

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
COM. HEALTH OFFICER/NURSE 13
OTHER PERSON
TRAD. BIRTH ATTENDANT/TBA 21
VILLAGE HEALTH VOLUNTEER 22
TRADITIONAL HEALTH PRACTITIONER 23
OTHER (SPECIFY) _____ 96

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

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

(NAME OF PLACE) _____
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER/CLINIC 22
GOVT. HEALTH POST/CHPS 23
MOBILE CLINIC 24
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
FP/PPAG CLINIC 32
MOBILE CLINIC 33
MATERNITY HOME 34
OTHER PRIVATE MED. SECTOR (SPECIFY) _____ 36
OTHER (SPECIFY) _____ 96

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

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

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

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

YES 1
NO 2 (GO TO 452)

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

MONTHS ___
DON'T KNOW 98

450) CHECK 226:
IS RESPONDENT PREGNANT?

[ASK FOR MOST RECENT BIRTH ONLY]

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

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

YES 1
NO 2 (GO TO 453)

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

MONTHS ___
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454) CHECK 404:
IS CHILD LIVING?

[ASK FOR MOST RECENT BIRTH ONLY]

LIVING (GO TO 460)
DEAD (GO TO 470)

455) How long after birth did you first put (NAME) to the breast?
[ASK FOR MOST RECENT BIRTH ONLY]

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

IMMEDIATELY 000

HOURS 1 ___
DAYS 2 ____

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

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink?
Anything else?

[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL LIQUIDS MENTIONED.

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
COFFEE I
HONEY J
OTHER (SPECIFY) _____ X

458) CHECK 404:

IS CHILD LIVING?

LIVING (GO TO 459)
DEAD (GO TO 470)

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

YES 1
NO 2

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

YES 1 (GO TO 470)
NO 2 (GO TO 470)
DON'T KNOW (GO TO 470)

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

470) Now I would like to ask some questions about taking time off work around the time (NAME) was born.

Aside from your own house chores, were you doing any work paid in cash or kind around the time (NAME) was born (for instance selling things, have a small business or work on the family farm or in the family business)?

[ASK FOR MOST RECENT BIRTH ONLY]

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

471) What was your occupation, that is, what kind of work were you mainly doing around the time (NAME) was born? [ASK FOR MOST RECENT BIRTH ONLY]

OCCUPATION ________________________________

472) Did you do this work for a member of your family, for someone else, or were you self-employed? [ASK FOR MOST RECENT BIRTH ONLY]

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

473) Were you paid in cash or kind for this work or were you not paid at all?
[ASK FOR MOST RECENT BIRTH ONLY]

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

474) Did you take paid or unpaid maternity leave around the time of (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

YES, PAID LEAVE 1
YES, UNPAID LEAVE 2 (GO TO 476)
NO 3 (GO TO 479)
DON'T REMEMBER 8 (GO TO 479)

475) Who paid for maternity leave?
[ASK FOR MOST RECENT BIRTH ONLY]

EMPLOYER 1
MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSUR. 2
OTHER PRIVATELY PURCHASED HEALTH INSUR. 3
OTHER (SPECIFY) ______ 6

476) When did you stop working before (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

IF ON THE DAY (NAME) WAS BORN, RECORD '00' DAYS. IF LESS THAN 7 DAYS BEFORE BIRTH, RECORD DAYS. IF LESS THAN 4 WEEKS, RECORD WEEKS. IF MORE THAN 4 WEEKS, RECORD MONTHS.

DAYS BEFORE 1 ____
WEEKS BEFORE 2 ____
MONTHS BEFORE 3 ____

NEVER STOPPED 994

477) When did you start working after (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

IF ON THE DAY (NAME) WAS BORN, RECORD '00' DAYS. IF LESS THAN 7 DAYS BEFORE BIRTH, RECORD DAYS. IF LESS THAN 4 WEEKS, RECORD WEEKS. IF MORE THAN 4 WEEKS, RECORD MONTHS.

DAYS BEFORE 1 ____
WEEKS BEFORE 2 ____
MONTHS BEFORE 3 ____

NEVER STOPPED 994

478) Why did you stop working after (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

LOST JOB 1
WAITING ANSWER FOR NEW JOB 2
CAN'T FIND JOB/LACK OF BUSINESS 3
NO SUITABLE JOB RELEVANT TO MY SKILLS 4
NO ONE TO CARE FOR MY CHILDREN/TOO EXPENSIVE 5
OTHER (SPECIFY) _____ 6

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

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY:

BIRTH HISTORY 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 553)

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

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

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

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

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

BCG _____
DAY _____
MONTH _____
YEAR ____
POLIO 0 (POLIO GIVEN AT BIRTH) _____
DAY _____
MONTH _____
YEAR ____
POLIO 1 _____
DAY _____
MONTH _____
YEAR ____
POLIO 2 _____
DAY _____
MONTH _____
YEAR ____
POLIO 3 _____
DAY _____
MONTH _____
YEAR ____
DPT/Hep B/Hib 1 _____
DAY _____
MONTH _____
YEAR ____
DPT/Hep B/Hib 2 _____
DAY _____
MONTH _____
YEAR ____
DPT/Hep B/Hib 3 _____
DAY _____
MONTH _____
YEAR ____
PNEUMOCOCCAL 1 _____
DAY _____
MONTH _____
YEAR ____
PNEUMOCOCCAL 2 _____
DAY _____
MONTH _____
YEAR ____
PNEUMOCOCCAL 3 _____
DAY _____
MONTH _____
YEAR ____
ROTAVIRUS 1 _____
DAY _____
MONTH _____
YEAR ____
ROTAVIRUS 2 _____
DAY _____
MONTH _____
YEAR ____
MEASLES 1 _____
DAY _____
MONTH _____
YEAR ____
MEASLES 2 _____
DAY _____
MONTH _____
YEAR ____
YELLOW FEVER _____
DAY _____
MONTH _____
YEAR ____
VITAMIN A (MOST RECENT) _____
DAY _____
MONTH _____
YEAR ____

507) CHECK 506:

BCG TO YELLOW FEVER ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

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

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

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

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

FIRST TWO WEEKS 1
LATER 2

510D) How many times was the polio vaccine given?

NUMBER OF TIMES ___

510E) A PENTA vaccination, that is, an injection given in the LEFT thigh, sometimes at the same time as polio drops?

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

510F) How many times was the PENTA vaccination given?

NUMBER OF TIMES ___

510G) A measles injection - that is, a shot in the left upper arm at the age of 9 months and 18 months - to prevent him/her from getting measles?

YES 1
NO 2 (GO TO 510I)
DON'T KNOW (GO TO 510I)

510H) How many times was the measles vaccination given?

NUMBER OF TIMES ____

510I) A PNEUMOCOCCAL vaccination, that is a new vaccine against childhood pneumonia, ear infection and meningitis, an injection given in the RIGHT thigh?

YES 1
NO 2 (GO TO 510K)
DON'T KNOW 8 (GO TO 510K)

510J) How many times was the PNEUMOCOCCAL vaccination given?

NUMBER OF TIMES ____

510K) ROTAVIRUS vaccination, a new vaccine against childhood diarrhea, that is, a liquid suspension administered from the vial in the mouth to swallow?

YES 1
NO 2 (GO TO 510M)
DON'T KNOW 8 (GO TO 510M)

510L) How many times was the ROTAVIRUS vaccination given?

NUMBER OF TIMES ____

510M) An 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

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF PILLS/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

512) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (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

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

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

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

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

YES 1
NO 2 (GO TO 522)

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

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

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

520) CHECK 519:

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

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

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

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

a) A fluid made from a special ORS packet?
b) A homemade fluid?

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

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

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

524) What (else) was given to treat the diarrhea?
Anything else?

RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I

HOME REMEDY/HERBAL MEDICINE J

OTHER (SPECIFY) _____ X

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

YES 1
NO 2 (GO TO 527)
DON'T KNOW 8 (GO TO 527)

526) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

530) CHECK 525:

HAD FEVER?

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

531) Now I would like to know how much (NAME) was given to drink (including 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

532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

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

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

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

YES 1
NO 2 (GO TO 537)

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

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

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

535) CHECK 534:

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

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

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

537) 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 553)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

538) What drugs did (NAME) take?
Any other drugs?

RECORD ALL MENTIONED. PLEASE NOTE BRAND NAMES:

SP/SULPHADOXINE-PYRIMETHAMINE:
FANSIDAR
MALAFAN
PALIDAR
SULDOX

DP/DIHYDROARTEMISININ-PIPPERAQUINE:
P-ALAXIN
DUO-COTEXCIN

AA/ARTESUNATE AMODIAQUINE:
ARTESUNATE AMODIAQUINE WINTRHOP
ARSUAMOON
CAMOQUINE PLUS
G SUNATE
CO-ARSUCAM

AL/ARTEMETHER LUMAFANTRINE:
COARTEM
LUMARTERM
ARTEFAN
LONART
GEN-M
ARTEMOS PLUS

ANTIMALARIAL DRUGS
SP/SULFADOXINE PYRIMETH. A
CHLOROQUINE B
DIHIDROARTEMIS.-PIPERAQUINE C
QUININE D
ARTESUNATE-AMODIAQUINE E
ARTEMISININ F
ARTEMETHER-LUMEFANTRINE G
OTHER ANTI-MALARIAL (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

539) CHECK 538:

ANY CODE A-H CIRCLED?

YES (GO TO 540)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

540) CHECK 538:

SP/SULFADOXINE-PYRIMETHAMINE, ('A') GIVEN

CODE 'A' CIRCLED (GO TO 541)
CODE 'A' NOT CIRCLED (GO TO 542)

541) How long after the fever started did (NAME) first take (SP/Sulfadoxine-Pyrimethamine)?

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

542) CHECK 538:

CHLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED (GO TO 543)
CODE 'B' NOT CIRCLED (GO TO 544)

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

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

544) CHECK 538:

DIHYDROARTEMISININ-PIPERAQUINE ('C') GIVEN

CODE 'C' CIRCLED (GO TO 545)
CODE 'C' NOT CIRCLED (GO TO 546)

545) How long after the fever started did (NAME) first take Dihydroartemisinin-Piperaquine?

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

546) CHECK 538:

QUININE ('D') GIVEN

CODE 'D' CIRCLED (GO TO 547)
CODE 'D' NOT CIRCLED (GO TO 547A)

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

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

547A) CHECK 538:

ARTESUNUATE/AMODIAQUINE ('E') GIVEN

CODE 'E' CIRCLED (GO TO 547B)
CODE 'E' NOT CIRCLED (GO TO 548)

547B) How long after the fever started did (NAME) first take artesunate with amodiaquine?

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

548) CHECK 538:

ARTEMISININ ('F') GIVEN

CODE 'F' CIRCLED (GO TO 549)
CODE 'F' NOT CIRCLED (GO TO 549A)

549) How long after the fever started did (NAME) first take Artemisinin?

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

549A) CHECK 538:

ARTEMETHER/LUMEFANTRINE ('G') GIVEN

CODE 'G' CIRCLED (GO TO 549B)
CODE 'G' NOT CIRCLED (GO TO 550)

549B) How long after the fever started did (NAME) first take Artemether Lumefantrine?

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

550) CHECK 538:

OTHER ANTIMALARIAL ('H') GIVEN

CODE 'H' CIRCLED (GO TO 551)
CODE 'H' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

551) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

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

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH THE RESPONDENT

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

554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?

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

555) CHECK 522(a) ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 557)

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

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2012 OR LATER LIVING WITH THE RESPONDENT:

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 558)
(NAME) __________
NONE (GO TO 562)

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

Did (NAME FROM 557) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK ____
e) Infant formula?
IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA ___
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT __
h) Any Cerelac, Weanimix, Beechnut, Motherluc, Friscolac, Gerber Baby Foods or other fortified baby foods?
YES 1
NO 2
DON'T KNOW 8
i) Bread, rice, noodles, porridge, or other foods made from grains, such as kenkey, banku, koko, tuo zaafi, akple?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, cassava, or any other foods made from roots, tubers or plantain?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables, such as kontomire, aleefu, ayoyo, kale, cassave leaves?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes or pawpaw?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

559) CHECK 558 (CATEGORIES "g" THROUGH "u"):

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

560) Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 562)

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

NUMBER OF TIMES ___
DON'T KNOW 8

562) Now I would like to ask you about foods that you had yesterday during the day or at night. I am interested in whether you or anyone else who cooked for the household added any of the following ingredients or items to food cooked for the household in the last 24 hours:
Did you or anybody else add any of the following ingredients or items to food cooked for the household in the last 24 hours:

a) Bouillon cube (such as Maggie, Jumbo, Onga or others)?
YES 1
NO 2
DON'T KNOW 8
b) Processed canned meat/fish/legume?
YES 1
NO 2
DON'T KNOW 8
c) Salted dried fish/koobi/kako?
YES 1
NO 2
DON'T KNOW 8
d) Any other ingredient of processed food that the household consumed within the period that contained salt?
YES 1
NO 2
DON'T KNOW 8

563) Have you ever heard about iodized salt?

YES 1
NO 2 (GO TO 600)

564) Can you mention benefits for consuming iodized salt?
PROBE: Any other benefits?
RECORD ALL MENTIONED.

IMPROVE INTELLIGENCE A
PROVIDES ENERGY B
PREVENTS STILL BIRTH C
PREVENTS MENTAL RETARDATION D
PREVENTS MISCARRIAGES E
PREVENTS GOITER F
OTHER (SPECIFY) ____ X
DON'T KNOW Z

565) How can you tell iodized salt from non-iodized salt?
RECORD ALL MENTIONED.

TESTING SALT A
IODIZED SALT LOGO B
FINE POWDERED SALT C
OTHER (SPECIFY) _____ X
DON'T KNOW Z

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

600) CHECK 101A:

AGREED TO MEASUREMENT (GO TO 600A)
DID NOT AGREE TO MEASUREMENT (GO TO 601)

600A) RECORD THE TIME.

HOUR ____
MINUTES ____

600B) May I measure your blood pressure at this time?

INTERVIEWER SIGNATURE ____________
DATE _____
YES, RESPONDENT AGREES 1
NO, RESPONDENT DOES NOT AGREE 2 (GO TO 601)

600C) TAKE THE BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q.601.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.

SYSTOLIC ___
DIASTOLIC ___

REFUSED 994
TECHNICAL PROBLEMS 995
OTHER 996

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

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3 (GO TO 602)

601A) Was bridewealth negotiated in your current union?

YES 1 (GO TO 601C)
NO 2

601B) Why was the bridewealth not negotiated?

FAMILY DID NOT AGREE A (GO TO 604)
BRIDEWEALTH NOT NEGOTIABLE B (GO TO 604)
HUSBAND NOT GIVEN OPPORTUNITY TO NEGOTIATE C (GO TO 604)
FAMILY TIES D (GO TO 604)
I DID NOT AGREE E (GO TO 604)
NO NEED F (GO TO 604)
PRESTIGE G (GO TO 604)
DETECTED I WAS PREGNANT H (GO TO 604)
OTHER (SPECIFY) _____ X (GO TO 604)

601C) What is the status of the bridewealth in your current union?

PAID IN FULL 1 (GO TO 604)
PARTLY PAID 2
NOT PAID AT ALL 3
OTHER (SPECIFY) _____ 6

601D) Why was the bridewealth not completely paid?

IT WAS EXPENSIVE A (GO TO 604)
AGREED TO PAY IN INSTALMENTS B (GO TO 604)
INTENTIONALLY C (GO TO 604)
DETECTED I WAS PREGNANT D (GO TO 604)
FINANCIAL CONSTRAINT E (GO TO 604)
PART OF BRIDEWEALTH USED FOR OTHER PURPOSES F (GO TO 604)
FAMILY TIES G (GO TO 604)
CUSTOMARY DEMANDS H (GO TO 604)
OTHER (SPECIFY) _____ X (GO TO 604)

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 612)

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

WIDOWED 1
DIVORCED 2
SEPARATED 3

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 (GO TO 609)

607) Including yourself, in total, how many wives or live-in partners does he have?

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

610) CHECK 609:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?

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

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

AGE ___

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

613) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.
How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

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

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

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

616) When was the last time you had sexual intercourse with this person?

DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____

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

YES 1
NO 2 (GO TO 619)

618) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

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

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
CLIENT/PROSTITUTE 5 (GO TO 622)
OTHER (SPECIFY) _____ 6 (GO TO 622)

620) CHECK 609:

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

621) CHECK 613:

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

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

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

623) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.

NUMBER OF TIMES ___

624) How old is this person?

AGE OF PARTNER _____
DON'T KNOW 98

625) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

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

626) In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS IN LAST 12 MONTHS ____
DON'T KNOW 98

627) In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.

NUMBER OF PARTNERS IN LIFETIME ___
DON'T KNOW 98

628) PRESENCE OF OTHERS DURING THIS SECTION:

CHILDREN YOUNGER THAN 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 632)

630) Where is that?
Any other place?

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

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER/CLINIC 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

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

633) Where is that?
Any other place?

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

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER/CLINIC 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

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

701) CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702) CHECK 226:

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

703) 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 ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

704) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not have any (more) children?

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

705) CHECK 226:

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

PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 ____
YEARS 2 ____

SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) _____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

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

707) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

708) CHECK 705:

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

709) CHECK 704:

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

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

NOT MARRIED A

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

DON'T KNOW Z

710) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

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

YES 1
NO 2
DON'T KNOW 8

712) CHECK 216:

HAS LIVING CHILDREN: a) 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: b) If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 714)
NUMBER ____
OTHER (SPECIFY) _____ 96 (GO TO 714)

713) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

NUMBER OF BOYS ___
NUMBER OF GIRLS ___
NUMBER OF EITHER ___
OTHER (SPECIFY) ______ 96

714) In the last few months have you:

a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) 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

716) CHECK 601:

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

717) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

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

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

719) CHECK 304:

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

720) Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

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

801) CHECK 601 AND 602:

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

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

AGE IN COMPLETED YEARS ___

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

YES 1
NO 2 (GO TO 806)

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

PRIMARY 1
MIDDLE 2
JSS/JHS 3
SECONDARY 4
SSS/SHS 5
HIGHER 6
DON'T KNOW 8 (GO TO 806)

805) What was the highest (grade) he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

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?

OCCUPATION____________________________

807) Aside from your own house chores, 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 THE 815)

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

OCCUPATION_____________

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

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

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

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

814) Are you paid in cash or 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

814A) In case of birth of a child, would you be entitled to paid or unpaid maternity leave on this job?

YES, PAID LEAVE 1
YES, UNPAID LEAVE 2
NO 3
DON'T KNOW 8

815) CHECK 601:

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

816) CHECK 814:

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

817) Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

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

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 820)
DON'T KNOW 8

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

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

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

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

821) Who usually makes decisions about making major household purchases?

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

822) Who usually makes decisions about visits to your family or relatives?

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

823) Do you own this or any other house either alone or jointly with someone else?

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

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

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

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

CHILDREN YOUNGER THAN 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3

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

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?

GOES OUT
YES 1
NO 2
DON'T KNOW 8
NEGLECTS CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
BURNS FOOD
YES 1
NO 2
DON'T KNOW 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 937)

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 get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

a) During pregnancy?
b) During delivery?
c) By breastfeeding?

DURING PREGNANCY
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

909) CHECK 908:

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

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

YES 1
NO 2
DON'T KNOW 8

910A) Have you heard about special antiretroviral drugs (e.g. ARV, nevirapine, zidovudine, lamivudine) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

YES 1
NO 2
DON'T KNOW 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2012 (GO TO 912)
NO BIRTHS (GO TO 926)
LAST BIRTH BEFORE JANUARY 2012 (GO TO 926)

912) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 913)
NO ANTENATAL CARE (GO TO 920)

913) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

914) During any of the antenatal visits for your last birth were you given any information about:

a) Babies getting the AIDS virus from their mother?
b) Things you can do to prevent getting the AIDS virus?
c) 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

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 920)

917) Where was the test done?

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

(NAME OF PLACE) ___________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER/CLINIC 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 SECTOR (SPECIFY) _____ 27
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 32
OTHER (SPECIFY) _____ 96

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

YES 1
NO 2 (GO TO 924)

919) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1 (GO TO 924)
NO 2 (GO TO 924)
DON'T KNOW 8 (GO TO 924)

920) CHECK 434 FOR LAST BIRTH:

ANY CODE 21-36 CIRCLED (GO TO 921)
OTHER (GO TO 926)

921) Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?

YES 1
NO 2

922) I don't want to know the results, but were you tested for the AIDS virus at that time?

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

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

YES 1 (GO TO 927)
NO 2

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

MONTHS AGO ____ (GO TO 932)
TWO OR MORE YEARS 95 (GO TO 932)

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

YES 1
NO 2 (GO TO 930)

927) How many months ago was you most recent HIV test?

MONTHS AGO _____
TWO OR MORE YEARS 95

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

YES 1
NO 2

929) Where was the test done?

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

(NAME OF PLACE) __________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC 11 (GO TO 932)
GOVT. HEALTH CENTER/CLINIC 12 (GO TO 932)
GOVT. HEALTH POST/CHPS 13 (GO TO 932)
STAND-ALONE VCT CENTER 14 (GO TO 932)
FAMILY PLANNING CLINIC 15 (GO TO 932)
MOBILE CLINIC 16 (GO TO 932)
FIELDWORKER/OUTREACH/PEER EDUCATOR 17 (GO TO 932)
OTHER PUBLIC (SPECIFY) _____ 18 (GO TO 932)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21 (GO TO 932)
STAND-ALONE VCT CENTER 22 (GO TO 932)
PHARMACY 23 (GO TO 932)
CHEMICAL/DRUG STORE 24 (GO TO 932)
FP/PPAG CLINIC 25 (GO TO 932)
MATERNITY HOME 26 (GO TO 932)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 27 (GO TO 932)
OTHER SOURCE
HOME 31 (GO TO 932)
CORRECTIONAL FACILITY 32 (GO TO 932)
OTHER (SPECIFY) _____ 96 (GO TO 932)

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

YES 1
NO 2 (GO TO 932)

931) Where is that?
Any other place?

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

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER/CLINIC 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) _____ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ O
OTHER SOURCE
HOME P
CORRECTIONAL FACILITY Q
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

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

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

937) 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

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
NEVER HAD SEXUAL INTERCOURSE (GO TO 946)

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

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

940) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

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

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

YES 1
NO 2 (GO TO 946)

945) Where did you go?
Any other place?

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

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER/CLINIC 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) _____ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ O
OTHER SOURCE
HOME P
CORRECTIONAL FACILITY Q
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DON'T KNOW 8

947) Is a wife justified in refusing to have sex with her husband when she knows he has sex with women other than his wives?

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 949)
NOT IN UNION (GO TO 1001)

949) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

1001) 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ____
NONE 00 (GO TO 1004)

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 1004)

1003) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1004) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

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

NUMBER OF CIGARETTES ___

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

YES 1
NO 2 (GO TO 1008)

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

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) _____ X

1008) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

a) Getting permission to go to the doctor?
b) Getting money needed for advice or treatment?
c) The distance to the health facility?
d) Not wanting to go alone?

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
GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1009) Are you covered by any health insurance?

YES 1 (GO TO 1010)
NO 2

1009A) Are you registered with the National Health Insurance Scheme (NHIS)?

YES 1 (GO TO 1016)
NO 2 (GO TO 1013)

1010) What type of health insurance are you (covered/registered) by?
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

1011) Does your insurance cover any of the following maternity benefits:

a) Antenatal health care?
b) Childbirth health care in health facility?
c) Postnatal health care for the mother?
d) Postnatal health care for the child?
e) Cash benefits during maternity leave?
f) Other?

ANTENATAL
YES 1
NO 2
DON'T KNOW 8
CHILDBIRTH
YES 1
NO 2
DON'T KNOW 8
PNC MOTHER
YES 1
NO 2
DON'T KNOW 8
PNC CHILD
YES 1
NO 2
DON'T KNOW 8
CASH BENEFITS
YES 1
NO 2
DON'T KNOW 8
OTHER (SPECIFY) _____
YES 1
NO 2
DON'T KNOW 8

1012) CHECK 1010:

CODE 'A' FOR NHIS NOT CIRCLED (GO TO 1013)
CODE 'A' FOR NHIS CIRCLED (GO TO 1014)

1013) Why have you not registered with the National Health Insurance Scheme (NHIS)?
RECORD ALL MENTIONED.

NOT HEARD OF NHIS A (GO TO 1025)
CANNOT AFFORD PREMIUM B (GO TO 1025)
DO NOT TRUST C (GO TO 1025)
DON'T NEED HEALTH INSURANCE D (GO TO 1025)
NHIS DOES NOT COVER HEALTH SERVICE I NEED E (GO TO 1025)
DON'T UNDERSTAND SCHEME F (GO TO 1025)
DON'T KNOW WHERE TO REGISTER G (GO TO 1025)
NO EASY ACCESS TO A HEALTH FACILITY H (GO TO 1025)
DO NOT LIKE THE ATTITUDE OF STAFF IN A HEALTH FACILITY I (GO TO 1025)
THOSE WITH INSURANCE ARE GIVEN SUBSTANDARD SERVICES AND MEDICINE J (GO TO 1025)
OTHER (SPECIFY) _____ X

1014) Who paid for your NHIS membership?

PAID MYSELF 1
PAID BY A RELATIVE/FRIEND 2
PAID BY EMPLOYER/SSNIT 3
EXEMPT AS ELDERLY 4
EXEMPT AS PENSIONER 5
EXEMPT AS INDIGENT 7
OTHER (SPECIFY) _____ 6

1015) Do you hold a valid National Health Insurance Scheme (NHIS) card?

YES, CARD SEEN 1 (GO TO 1017)
YES, CARD NOT SEEN 2 (GO TO 1017)
NO 3

1016) Why do you not have a valid NHIS card?

REGISTERED, NOT PAID FULLY 1 (GO TO 1020)
REGISTERED, CARD NOT RECEIVED 2 (GO TO 1020)
REGISTERED, WAITING PERIOD 3 (GO TO 1020)
NOT RENEWED REGISTRATION 4 (GO TO 1018)
LOST NHIS CARD 5 (GO TO 1020)
OTHER (SPECIFY) _____ 6 (GO TO 1020)

1017) How many weeks did it take you to obtain your NHIS card?

NUMBER OF WEEKS ___ (GO TO 1020)
DON'T KNOW 98 (GO TO 1020)

1018) Do you plan to renew the NHIS card?

YES 1 (GO TO 1020)
NO 2
DON'T KNOW/NOT SURE (GO TO 1020)

1019) 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
POOR 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

1020) Do you have to pay out of pocket for drugs and services?

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

1021) Are there any services that you need from a health provide that are not covered by NHIS?

YES 1
NO 2 (GO TO 1023)
DON'T KNOW/NOT SURE 8 (GO TO 1023)

1022) 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

1023) In your opinion, do NHIS card holders get better, the same, or worse service than others?

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

1024) In your opinion, did you receive good service last time you were treated at a clinic or hospital?
IF NO, PROBE: "What was the main problem?"

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

1025) Are you aware of any programs that help pregnant women accessing health services?

YES 1
NO 2 (GO TO 1027)

1026) Which ones?
RECORD ALL MENTIONED.

FREE NHIS PREMIUM FOR PREGNANT WOMEN A
OTHER (SPECIFY) _____ X

1027) Are you aware of any programs that help children under age 18 accessing health services?

YES 1
NO 2 (GO TO 1029)

1028) Which ones?
RECORD ALL MENTIONED.

FREE NHIS PREMIUM FOR CHILDREN UNDER THE AGE OF 18 A
OTHER (SPECIFY) _____ X

1029) These next questions are about common health problems in Ghana.
Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1033)

1030) 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

1031) Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1032) 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

1033) These next questions are about blood pressure.
Have you ever been told by a doctor or other health professional that you had hypertension or high blood pressure?

YES 1
NO 2 (GO TO 1036)
DON'T KNOW 8 (GO TO 1036)

1034) Were you told on two or more different occasions by a doctor or other health professional that you had hypertension or blood pressure?

YES 1
NO 2
DON'T KNOW 8

1035) To lower your hypertension or high blood pressure, are you now:

a) Taking prescribed medicine?
YES 1
NO 2
NOT APPLICABLE 8
b) Controlling your weight or losing weight?
YES 1
NO 2
NOT APPLICABLE 8
c) Cutting down on salt in your diet?
YES 1
NO 2
NOT APPLICABLE 8
d) Exercising?
YES 1
NO 2
NOT APPLICABLE 8
e) Cutting down on alcohol?
YES 1
NO 2
NOT APPLICABLE 8
f) Stopping smoking?
YES 1
NO 2
NOT APPLICABLE 8

1036) During the last 7 days, on how many days did you eat fruits, for example mangoes, pawpaw, banana, orange, avocados, tomatoes, passion fruit, etc?

NUMBER OF DAYS _____
NONE 0
DON'T KNOW/NOT SURE 8

1038) During the last 7 days, on how many days did you eat vegetables, for example carrots, cabbage, dark green, leafy vegetables (e.g. kontomire), pumpkin, squash, etc?

NUMBER OF DAYS _____
NONE 0
DON'T KNOW/NOT SURE 8

1040) In the last 6 months, did you visit a health facility?

YES 1
NO 2 (GO TO 1053)

1041) What type of facility did you visit during your most recent visit?

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

(NAME OF PLACE) __________
PUBLIC/GOVERNMENT 1
PRIVATE 2
OTHER (SPECIFY) _____ 6
DON'T KNOW 8

1042) What type of service did you receive during this most recent visit?

OUTPATIENT
FAMILY PLANNING 01
ANC/DELIVERY/PNC 02
NEWBORN CARE 03
MALARIA 04
FEVER 05
DIARRHEA 06
HIV/AIDS/STI 07
HIGH BLOOD PRESSURE 08
EAR/NOSE/THROAT INFECTION 09
DIABETES 10
EYE INFECTION 11
CHECKUP/PREVENTIVE CARE 12
ACCIDENT/INJURY 13
OTHER OUTPT. (SPECIFY) _____ 14
INPATIENT
PREGNANCY/DELIVERY 15
CHILD ILLNESS 16
HER OWN ILLNESS 17
ACCIDENT/INJURY 18
OTHER INPT. (SPECIFY) _____ 19
OTHER (SPECIFY) _____ 96

1043) How did you pay for the service during this most recent visit?

CASH 1
NATIONAL HEALTH INSURANCE 2
OTHER INSURANCE 3
COMBINATION OF ANY OF THE ABOVE 4
OTHER (SPECIFY) _____ 6

1044) Now I want to ask you about the ease of getting care. In your opinion, was it very easy, easy, fairly easy, difficult, or very difficult to see the health provider?

VERY EASY 1
EASY 2
FAIRLY EASY 3
DIFFICULT 4
VERY DIFFICULT 5

1045) Is the location of the health facility very convenient, convenient, fairly convenient, not convenient, or very inconvenient for you?

VERY CONVENIENT 1
CONVENIENT 2
FAIRLY CONVENIENT 3
NOT CONVENIENT 4
VERY INCONVENIENT 5

1046) Are the hours the health facility open during the day very good, good, fair, poor, or very poor for you?

VERY GOOD 1
GOOD 2
FAIR 3
POOR 4
VERY POOR 5

1047) Now I want to talk about waiting time at the health facility.
Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied about:

a) Time to wait for your turn?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
b) Time spent in consulting/examination room?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
c) Time to wait for tests to be performed?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
d) Time to wait for test results?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
e) Time at pharmacy/dispensary?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6

1048) Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied with the staff at the health facility when they:

a) Listened to you?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
b) Explained what you wanted to you?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
c) Gave advice and information on options for treatment?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6

1049) In your opinion, did the health provider spend enough time with you?

YES 1
NO 2

1050) Did the health provider seek your consent before providing treatment?

YES 1
NO 2

1051) Was the health provider friendly to you?

YES 1
NO 2

1052) Now I want to ask you about the condition of the health facility:
Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied with:

a) The cleanliness of the facility?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
b) Ease of finding where to go?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
c) Comfort and safety while waiting?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
d) Privacy during examination?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
e) Confidentiality and protection of personal information?
VERY SATISFIED 1
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6

1053) CHECK 101A:

AGREED TO MEASUREMENT (GO TO 1054)
DID NOT AGREE TO MEASUREMENT (GO TO 1101)

1054) RECORD THE TIME.

HOUR ____
MINUTES ____

1055) May I measure your blood pressure at this time?

(INTERVIEWER SIGNATURE) __________
(DATE) _____
YES, RESPONDENT AGREES 1
NO, RESPONDENT DOES NOT AGREE 2 (GO TO 1101)

1056) TAKE THE BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q1101.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.

SYSTOLIC _____
DIASTOLIC _____

REFUSED 994
TECHNICAL PROBLEMS 995
OTHER 996

SECTION 11. AVERAGING BLOOD PRESSURE MEASURES

1101) CHECK Q600C AND Q1056:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN BOTH Q600C AND Q1056 (GO TO 1102)
SYSTOLIC AND DIASTOLIC BLOOD PRESSURE MEASURES NOT RECORDED IN BOTH Q600C AND Q1056 (GO TO 1107)

1102) RECORD AND CALCULATE THE AVERAGE OF THE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE FROM Q600C AND Q1056.

1103) BLOOD PRESSURE MEASUREMENTS FROM Q600C:

SYSTOLIC ____
DIASTOLIC ____

1104) BLOOD PRESSURE MEASUREMENTS FROM Q1056:

SYSTOLIC ____
DIASTOLIC ____

1105) RECORD THE SUM OF THE SYSTOLIC AND DIASTOLIC MEASURES.

SUM SYSTOLIC ____
SUM DIASTOLIC ____

1106) CALCULATE THE AVERAGE SYSTOLIC AND DIASTOLIC PRESSURES BY DIVIDING THE SUM IN Q1105 BY 2.

AVERAGE SYSTOLIC ____ (GO TO 1111)
AVERAGE DIASTOLIC ____ (GO TO 1111)

1107) CHECK Q1056:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q1056 (GO TO 1108)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q1056 (GO TO 1110)

1108) CHECK Q600C:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q600C (GO TO 1109)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q600C (GO TO 1110)

1109) CHECK Q101E:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q101E (GO TO 1110)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q101E (GO TO 1113)

1110) RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE.

SYSTOLIC _____
DIASTOLIC _____

1111) USE THE TABLE BELOW TO DETERMINE THE CORRECT CODE TO RECORD ON THE BLOOD PRESSURE REPORT AND REFERRAL FORM.
CIRCLE THE ROW IN WHICH THE VALUE FOR THE SYSTOLIC BLOOD PRESSURE FROM Q1106 OR Q1110 IS FOUND.
THEN CIRCLE THE COLUMN IN WHICH THE VALUE FOR THE DIASTOLIC BLOOD FROM Q1106 OR Q1110 IS FOUND.
THE VALUE WHERE THE ROW AND COLUMN YOU HAVE CIRCLED INTERSECT IN THE TABLE WILL BE USED IN COMPLETING Q1112.

AVG. SYSTOLIC PRESSURE LESS THAN 130:
1 AVERAGE DIASTOLIC PRESSURE LESS THAN 84
2 AVERAGE DIASTOLIC PRESSURE 85 - 89
3 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
AVG. SYSTOLIC PRESSURE 130 - 139:
2 AVERAGE DIASTOLIC PRESSURE LESS THAN 84
2 AVERAGE DIASTOLIC PRESSURE 85 - 89
3 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
AVG. SYSTOLIC PRESSURE 140 - 159:
3 AVERAGE DIASTOLIC PRESSURE LESS THAN 84
3 AVERAGE DIASTOLIC PRESSURE 85 - 89
3 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
AVG. SYSTOLIC PRESSURE 160 - 179:
4 AVERAGE DIASTOLIC PRESSURE LESS THAN 84
4 AVERAGE DIASTOLIC PRESSURE 85 - 89
4 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
AVG. SYSTOLIC PRESSURE 180 - 209:
5 AVERAGE DIASTOLIC PRESSURE LESS THAN 84
5 AVERAGE DIASTOLIC PRESSURE 85 - 89
5 AVERAGE DIASTOLIC PRESSURE 90 - 99
5 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
AVG. SYSTOLIC PRESSURE 210 OR MORE:
6 AVERAGE DIASTOLIC PRESSURE LESS THAN 84
6 AVERAGE DIASTOLIC PRESSURE 85 - 89
6 AVERAGE DIASTOLIC PRESSURE 90 - 99
6 AVERAGE DIASTOLIC PRESSURE 100 - 109
6 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE

1112) RECORD THE NUMBER YOU CIRCLED IN Q1111 IN THE CHART BELOW. THEN USE THE INSTRUCTIONS TO THE RIGHT OF THAT NUMBER TO COMPLETE A BLOOD PRESSURE REPORT AND REFERRAL FORM FOR THE RESPONDENT. GIVE THE FORM TO THE RESPONDENT AND ANSWER ANY QUESTIONS SHE MAY HAVE.

1 RESPONDENT'S BLOOD PRESSURE CATEGORY: NORMAL
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN: 24 MONTHS
2 RESPONDENT'S BLOOD PRESSURE CATEGORY: AT THE HIGH END OF THE NORMAL RANGE
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN: 12 MONTHS
3 RESPONDENT'S BLOOD PRESSURE CATEGORY: ABOVE NORMAL RANGE
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN: 2 MONTHS
4 RESPONDENT'S BLOOD PRESSURE CATEGORY: MODERATELY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN: 1 MONTH
5 RESPONDENT'S BLOOD PRESSURE CATEGORY: VERY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN: 7 DAYS
6 RESPONDENT'S BLOOD PRESSURE CATEGORY: EXTREMELY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN: TODAY

1113) Thank you for taking the time to answer these questions. I would like to inform you that additional information on childbearing and contraception will be collected in the near future in order to find better ways to help couples in Ghana achieve their family goals. Another member of our team may return in a few days or weeks to ask you a few additional questions about these topics. Do you agree to allow another member of our team to contact you about participating in a short interview? Your responses will remain confidential.

YES 1
NO 2

1114) RECORD THE TIME.

HOUR ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT: ______________________________
COMMENTS ON SPECIFIC QUESTIONS: ______________________________
ANY OTHER COMMENTS ______________________________

SUPERVISOR'S OBSERVATIONS: _________________________________
NAME OF SUPERVISOR: __________
DATE: __________

EDITOR'S OBSERVATIONS: ______________________________
NAME OF EDITOR: __________
DATE: _________
CALENDAR INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE
B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD
COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE
0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) _____
Z DON'T KNOW

2014:
12 DEC 01 ____ ____
11 NOV 02 ____ ____
10 OCT 03 ____ ____
09 SEP 04 ____ ____
08 AUG 05 ____ ____
07 JUL 06 ____ ____
06 JUN 07 ____ ____
05 MAY 08 ____ ____
04 APR 09 ____ ____
03 MAR 10 ____ ____
02 FEB 11 ____ ____
01 JAN 12 ____ ____

2013:
12 DEC 13 ____ ____
11 NOV 14 ____ ____
10 OCT 15 ____ ____
09 SEP 16 ____ ____
08 AUG 17 ____ ____
07 JUL 18 ____ ____
06 JUN 19 ____ ____
05 MAY 20 ____ ____
04 APR 21 ____ ____
03 MAR 22 ____ ____
02 FEB 23 ____ ____
01 JAN 24 ____ ____

2012:
12 DEC 25 ____ ____
11 NOV 26 ____ ____
10 OCT 27 ____ ____
09 SEP 28 ____ ____
08 AUG 29 ____ ____
07 JUL 30 ____ ____
06 JUN 31 ____ ____
05 MAY 32 ____ ____
04 APR 33 ____ ____
03 MAR 34 ____ ____
02 FEB 35 ____ ____
01 JAN 36 ____ ____

2011:
12 DEC 37 ____ ____
11 NOV 38 ____ ____
10 OCT 39 ____ ____
09 SEP 40 ____ ____
08 AUG 41 ____ ____
07 JUL 42 ____ ____
06 JUN 43 ____ ____
05 MAY 44 ____ ____
04 APR 45 ____ ____
03 MAR 46 ____ ____
02 FEB 47 ____ ____
01 JAN 48 ____ ____

2010:
12 DEC 49 ____ ____
11 NOV 50 ____ ____
10 OCT 51 ____ ____
09 SEP 52 ____ ____
08 AUG 53 ____ ____
07 JUL 54 ____ ____
06 JUN 55 ____ ____
05 MAY 56 ____ ____
04 APR 57 ____ ____
03 MAR 58 ____ ____
02 FEB 59 ____ ____
01 JAN 60 ____ ____

2009:
12 DEC 61 ____ ____
11 NOV 62____ ____
10 OCT 63 ____ ____
09 SEP 64 ____ ____
08 AUG 65 ____ ____
07 JUL 66 ____ ____
06 JUN 67 ____ ____
05 MAY 68 ____ ____
04 APR 69 ____ ____
03 MAR 70 ____ ____
02 FEB 71 ____ ____
01 JAN 72 ____ ____