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2019-20 GAMBIA DEMOGRAPHIC AND HEALTH SURVEY
WOMAN'S QUESTIONNAIRE

THE GAMBIA
THE GAMBIA BUREAU OF STATISTICS

IDENTIFICATION

NAME OF SETTLEMENT
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
HOUSEHOLD SELECTED FOR MAN'S SURVEY AND BIOMARKERS?

YES 1
NO 2

CHECK HOUSEHOLD QUESTIONNAIRE Q.22: WOMAN SELECTED FOR DV MODULE?

YES 1
NO 2

INTERVIEWER VISITS

DATE
INTERVIEWER'S NAME
RESULT

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

NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT

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

TOTAL NUMBER OF VISITS
LANGUAGE OF QUESTIONNAIRE
LANGUAGE OF INTERVIEW
NATIVE LANGUAGE OF RESPONDENT
TRANSLATOR USED

YES 1
NO 2

LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE CODES

ENGLISH 01
MANDINKA 02
WOLLOF 03
FULA 04
JOLA 05
SARAHULE 06
SERERE 07
MANJANGO 08
CREOLE/AKU MARABOUT 09
BAMBARA 10
OTHER LANGUAGE (SPECIFY) 11

SUPERVISOR
NAME
CODE

INTRODUCTION AND CONSENT

Hello. My name is__. I am working with Gambia Bureau of Statistics. We are conducting a survey about health and other topics all over The Gambia. 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 to 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 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

HOURS__
MINUTES__

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

YEARS__
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)

103. Just before you moved here, did you live in an urban area or in a rural area?

URBAN AREA 1
RURAL AREA 2

104. Before you moved here, which LGA did you live in?

BANJUL 01
KANIFING 02
BRIKAMA 03
MANSAKONKO 04
KEREWAN 05
KUNTAUR 06
JANJANBUREH 07
BASSE 08
OUTSIDE OF THE GAMBIA 96

105. In what month and year were you born?

MONTH__
DON'T KNOW MONTH 98
YEAR__
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS__

107. Have you ever attended school?

YES 1
NO 2

108. What is the highest level of school you attended: ECE, primary, lower secondary, upper secondary, vocational, diploma, or higher?

EARLY CHILDHOOD EDUCATION 0 (SKIP TO 111)
PRIMARY 1
LOWER SECONDARY 2
UPPER SECONDARY 3
VOCATIONAL 4
DIPLOMA 5
HIGHER 6

109. What is the highest (grade/form/year) you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/FORM/YEAR__

110. CHECK 108:

PRIMARY, LOWER/UPPER SECONDARY, OR VOCATIONAL (CONTINUE)
DIPLOMA OR HIGHER (SKIP TO 113)

111. Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CAN NOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

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

112. CHECK 111:

CODE '2', '3', OR '4' CIRCLED (CONTINUE)
CODE '1' OR '5' CIRCLED (SKIP TO 114)

113. 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

114. 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

115. 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

116. Do you own a mobile telephone?

YES 1
NO 2 (SKIP TO 118)

117. Do you use your mobile phone for any financial transactions?

YES 1
NO 2

118. Do you have an account in a bank or other financial institution that you yourself use?

YES 1
NO 2

119. Have you ever used the internet?

YES 1
NO 2 (SKIP TO 122)

120. In the last 12 months, have you used the internet? IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (SKIP TO 122)

121. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

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

122. What is your religion?

ISLAM 1
CHRISTIANITY 2
OTHER RELIGION 3
NO RELIGION 4

122A. What is your nationality?

GAMBIAN 1
NON-GAMBIAN 2

123. What is your ethnicity?

MANJINKA/JAHANKA 01
WOLLOF 02
JOLA/KARONINKA 03
FULA/TUKULUR/LOROBO 04
SERERE 05
SARAHULE 06
CREOLE/AKU MARABOUT 07
MANJANGO 08
BAMBARA 09
OTHER ETHNIC GROUP (SPECIFY) 96

SECTION 2. REPORDUCTION

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 (SKIP 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 (SKIP TO 204)

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

YES 1
NO 2 (SKIP TO 206)

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 (SKIP TO 206)

205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE, RECORD '00'.

SONS ELSEWHERE__
DAUGHTERS ELSEWHERE__

206. Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

YES 1
NO 2 (SKIP 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 (CONTINUE)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
NO BIRTHS (SKIP 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 10 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. On what day, month, and year was (NAME) born?

DAY
MONTH
YEAR

216. Is (NAME) still alive?

YES 1
NO 2 (SKIP TO NEXT BIRTH)

217. IF ALIVE: How old was (NAME) at (NAME)'s 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__ (SKIP TO NEXT BIRTH)

220. IF DEAD: How old was (NAME) when (he/she) died? IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday? THEN ASK: Exactly how many months old was (NAME) when (he/she) died? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1
MONTHS 2
YEARS 3

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

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

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

NUMBERS ARE SAME (CONTINUE)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2014 OR LATER

NUMBER OF BIRTHS__
NONE 0 (SKIP TO 226)

225. FOR EACH BIRTH IN 2014 OR LATER, 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 COMPLETED 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 (SKIP TO 230)
UNSURE 8 (SKIP 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 1 (SKIP TO 230)
NO 2

229. CHECK 208: TOTAL NUMBER OF BIRTHS
ONE OR MORE a) Did you want to have a baby later on or did you not want any more children?
NONE b) Did you want to have a baby later on or did you not want any children?

LATER 1
NO MORE/NONE 2

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

YES 1
NO 2 (SKIP TO 239)

231. When did the last such pregnancy end?

MONTH__
YEAR__

232. CHECK 231:

LAST PREGNANCY ENDED IN 2014 OR LATER (SKIP TO 234)
LAST PREGNANCY ENDED IN 2013 OR EARLIER (SKIP TO 239)

233. In what month and year did the preceding such pregnancy end?

MONTH__
YEAR__

234. How many months pregnant were you when that pregnancy ended?

NUMBER OF MONTHS__

235. Since January 2014, have you had any other pregnancies that did not result in a live birth?

YES 1 (NEXT LINE)
NO 2 (SKIP TO 236)

236. FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2014 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY. IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237. Did you have any miscarriages, abortions or stillbirths that ended before 2014?

YES 1
NO 2 (SKIP TO 239)

238. When did the last such pregnancy that terminated before 2014 end?

MONTH__
YEAR__

239. When did your last menstrual period start?

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

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

YES 1
NO 2 (SKIP TO 242)
DON'T KNOW 8 (SKIP TO 242)

241. 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

242. After the birth of a child, can a woman become pregnant before her menstrual period has returned?

YES 1
NO 2
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)

01) Female Sterilization. PROBE: Women can have an operation to avoid having any more children.

YES 1
NO 2

02) Male Sterilization. PROBE: Men can have an operation to avoid having any more children.

YES 1
NO 2

03) IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.

YES 1
NO 2

04) Injectables (Depo) 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

05) 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

06) Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

07) Male condom PROBE: Men can put a rubber sheath on their penis before sexual intercourse.

YES 1
NO 2

08) Female Condom PROBE: Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

09) 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

10) Standard Days Method. (Cyclebeads) PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.

YES 1
NO 2

11) Lactational Amenorrhea Method (LAM) PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.

YES 1
NO 2

12) Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think can get pregnant

YES 1
NO 2

13) Withdrawal. PROBE: Men can be careful and pull out before the climax.

YES 1
NO 2

14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES, MODERN METHOD (SPECIFY) A
YES, TRADITIONAL METHOD (SPECIFY) B
NO Y

302. CHECK 226:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (SKIP TO 312)

303. Are you or your partner currently doing something or using any method to delay or avoid getting

YES 1
NO 2 (SKIP TO 312)

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

FEMALE STERILIZATION A (SKIP TO 307)
MALE STERILIZATION B (SKIP TO 307)
IUD C (SKIP TO 309)
INJECTIBLES D (SKIP TO 309)
IMPLANTS E (SKIP TO 309)
PILL F
MALE CONDOM G (SKIP TO 309)
FEMALE CONDOM H (SKIP TO 309)
EMERGENCY CONTRACEPTION I (SKIP TO 309)
STANDARD DAYS METHOD J (SKIP TO 309)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 309)
RHYTHM METHOD L (SKIP TO 309)
WITHDRAWAL M (SKIP TO 309)
OTHER MODERN METHOD X (SKIP TO 309)
OTHER TRADITIONAL METHOD Y (SKIP TO 309)

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

MICROGYNON 01 (SKIP TO 309)
MICROLUT 02 (SKIP TO 309)
OTHER (SPECIFY) 96 (SKIP TO 309)
DON'T KNOW 98 (SKIP TO 309)

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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
NGO HOSPITAL/CLINIC 22
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER (SPECIFY) 96
DON'T KNOW 98

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

MONTH__ (SKIP TO 310)
YEAR__ (SKIP TO 310)

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

MONTH__
YEAR__

310. CHECK 308 AND 309, 215 AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

NO (CONTINUE)
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY)

311. CHECK 308 AND 309:

YEAR IS 2014 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.) (THEN CONTINUE)
YEAR IS 2013 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2014) (THEN SKIP TO 324)

312. 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 2014. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

312A. MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE

MONTH__
YEAR__

312B. Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

YES 1
NO 2 (SKIP TO 312I)

312C. Which method was that?

METHOD CODE__

312D. How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)? CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

IMMEDIATELY 00 (SKIP TO 312F)
MONTHS__ (SKIP TO 312F)
DATE GIVEN 95

312E. RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

MONTH__
YEAR__

312F. For how many months did you use (METHOD)? CIRCLE '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE

MONTHS__ (SKIP TO 312H)
DATE GIVEN 95

312G. RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

MONTH__
YEAR__

312H. Why did you stop using (METHOD)?

REASON STOPPED__

312I. GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.

313. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

NO METHOD USED (CONTINUE)
ANY METHOD USED (SKIP TO 315)

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

YES 1 (SKIP TO 326)
NO 2 (SKIP TO 326)

315. CHECK 304: CIRCLE METHOD CODE. IF MORE THAN ONCE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (SKIP TO 326)
FEMALE STERILIZATION 01 (SKIP TO 319)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 323)
RHYTHM METHOD 12 (SKIP TO 323)
WITHDRAWAL 13 (SKIP TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
RCH OUTREACH CENTER 14
FIELDWORKER/VHS 15
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
NGO HOSPITAL/CLINIC 26
NGO FAMILY PLANNING CLINIC 27
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 28
OTHER SOURCE
SHOP 31
FRIEND/RELATIVE 32
OTHER (SPECIFY) 96

317. 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
MALE CONDOM 07 (SKIP TO 323)
FEMALE CONDOM 08 (SKIP TO 322)
EMERGENCY CONTRACEPTION 09 (SKIP TO 322)
STANDARD DAYS METHOD 10 (SKIP TO 322)
OTHER MODERN METHOD 95 (SKIP TO 322)
OTHER TRADITIONAL METHOD 96 (SKIP TO 323)

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

YES 1 (SKIP TO 321)
NO 2 (SKIP TO 320)

319. When you got sterilized, were you told about the side effects or problems you might have with the method?

YES 1 (SKIP TO 321)
NO 2

320. 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 (SKIP TO 322)

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

YES 1
NO 2

322. CHECK 318 AND 319:
ANY 'YES' a) At that time, were you told about other methods of family planning that you could use?
OTHER b) When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

YES 1 (SKIP TO 324)
NO 2

323. 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

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

FEMALE STERILIZATION 01 (SKIP TO 327)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 327)
RHYTHM METHOD 12 (SKIP TO 327)
WITHDRAWAL 13 (SKIP TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (SKIP TO 327)

325. 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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (SKIP TO 327)
GOVERNMENT HEALTH CENTER 12 (SKIP TO 327)
GOVERNMENT HEALTH POST 13 (SKIP TO 327)
RCH OUTREACH CLINIC 14 (SKIP TO 327)
FIELDWORKER/VHS 15 (SKIP TO 327)
OTHER PUBLIC SECTOR (SPECIFY) 16 (SKIP TO 327)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (SKIP TO 327)
PHARMACY 22 (SKIP TO 327)
PRIVATE DOCTOR 23 (SKIP TO 327)
MOBILE CLINIC 24 (SKIP TO 327)
FIELDWORKER 25 (SKIP TO 327)
NGO HOSPITAL/CLINIC 26 (SKIP TO 327)
NGO FAMILY PLANNING CLINIC 27 (SKIP TO 327)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 28 (SKIP TO 327)
OTHER SOURCE
SHOP 31 (SKIP TO 327)
FRIEND/RELATIVE 33 (SKIP TO 327)
OTHER (SPECIFY) 96 (SKIP TO 327)

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

YES 1
NO 2

327. In the last 12 months, were you visited by a health fieldworker?

YES 1
NO 2 (SKIP TO 329)

328. Did the health fieldworker talk to you about family planning?

YES 1
NO 2

329. CHECK 202: CHILDREN LIVING WITH
YES a) In the last 12 months, have you visited a health facility for care for yourself or your children?
NO b) In the last 12 months, have you visited a health facility for care for yourself?

YES 1
NO 2 (SKIP TO 401)

330. 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 2014 OR LATER (CONTINUE)
NO BIRTHS IN 2014 OR LATER (SKIP TO 648)

402. CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2014 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. 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 FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER__

404. FROM 212 AND 216: NAME__

LIVING (CONTINUE)
DEAD (CONTINUE)

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

YES 1 (SKIP TO 408)
NO 2

406. CHECK 208:
ONLY ONE BIRTH a) Did you want to have a baby later on, or did you not want any children?
MORE THAN ONE BIRTH b) Did you want to have a baby later on, or did you not want any more children?

LATER 1
NO MORE/NONE 2 (SKIP 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?

YES 1
NO 2 (SKIP TO 414)

409. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY NURSE/ COMM. NURSE ATTENDAI C
OTHER PERSON
COMMUNITY BIRTH COMPANION D
VILLAGE HEALTH WORKER E
OTHER (SPECIFY) X

410. Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
RCH OUTREACH CLINIC F
OTHER PUBLIC SECTOR (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
NGO HOSPITAL/CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) J
OTHER (SPECIFY) X

411. How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS__
DON'T KNOW 98

412. How many times did you receive antenatal care during this pregnancy?

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:
a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?
d) Were you weighed?

YES 1
NO 2

414. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

415. During this pregnancy, how many times did you get a tetanus injection?

TIMES__
DON'T KNOW 8

416. CHECK 415:

2 OR MORE TIMES (SKIP TO 420)
OTHER (CONTINUE)

417. At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (SKIP TO 420)
DON'T KNOW 8 (SKIP TO 420)

418. Before this pregnancy, how many times did you receive a tetanus injection? IF 7 OR MORE TIMES, RECORD '7'.

TIMES__
DON'T KNOW 8

419. CHECK 418:

ONLY ONE a) How many years ago did you receive that tetanus injection?
MORE THAN ONE b) How many years ago did you receive the last tetanus injection prior to this pregnancy?

420. During this pregnancy, were you given or did you buy any iron tablets or iron syrup? SHOW TABLETS/SYRUP

YES 1
NO 2 (SKIP TO 422)
DON'T KNOW 8 (SKIP TO 422)

421. During the whole pregnancy, for how many days did you take the tablets or syrup? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE DAYS.

DAYS__
DON'T KNOW 998

422. During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

423. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
NO 2 (SKIP TO 426)
DON'T KNOW 8 (SKIP TO 426)

424. How many times did you take SP/Fansidar during this pregnancy?

TIMES__

425. Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source. IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL CARE VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

426. When (NAME) was born, was (NAME) 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

427. Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 429)
DON'T KNOW 8 (SKIP TO 429)

428. 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

429. 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
AUXILLERY NURSE/COMM. NURSE ATTENDANT. C
OTHER PERSON
COMMUNITY BIRTH COMPANION D
RELATIVE/FRIEND E
OTHER (SPECIFY) X
NO ONE ASSISTED Y

430. 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.

HOME
HER HOME 11 (SKIP TO 434)
OTHER HOME 12 (SKIP TO 434)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NGO HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER (SPECIFY) 96 (SKIP TO 434)

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

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

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

YES 1
NO 2 (SKIP TO 434)

433. When was the decision made to have the caesarean section? Was it before or after your labor pains started?

BEFORE 1
AFTER 2

434. Immediately after birth, was (NAME) put on your chest?

YES 1
NO 2 (SKIP TO 434B)
DON'T KNOW 8 (SKIP TO 434B)

434A. Was (NAME)'s bare skin touching your bare skin?

YES 1
NO 2
DON'T KNOW 8

434B. CHECK 430: PLACE OF DELIVERY

CODE 11, 12, OR 96 CIRCLED (SKIP TO 449)
OTHER (CONTINUE)

435. 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?

YES 1
NO 2 (SKIP TO 438)

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

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

437. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILLARY NURSE/COMM. NURSE ATTENDANT 13
OTHER PERSON
COMMUNITY BIRTH COMPANION 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

438. Now I would like to talk to you about checks on (NAME)'s health after delivery - for example, someone examining (NAME), checking on the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

YES 1
NO 2 (SKIP TO 441)
DON'T KNOW 8 (SKIP TO 441)

439. How long after delivery was (NAME)'s health first checked? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 4

440. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILLARY NURSE/COMM. NURSE ATTENDANT 13
OTHER PERSON
COMMUNITY BIRTH COMPANION 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

441. Now I want to talk to you about what happened after you left the health facility. Did anyone check on your health after you left the facility?

YES 1
NO 2 (SKIP TO 445)

442. How long after delivery did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

443. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILLARY NURSE/COMM. NURSE ATTENDANT 13
OTHER PERSON
COMMUNITY BIRTH COMPANION 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

444. Where did this check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
RCH OUTREACH CLINIC 24
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NGO HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER (SPECIFY) 96

445. I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a community birth companion check on (NAME)'s health n the two months after you left (FACILITY IN 430)

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

446. How many hours, days, or weeks after the birth of (NAME) did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

447. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILLARY NURSE/COMM. NURSE ATTENDANT 13
OTHER PERSON
COMMUNITY BIRTH COMPANION 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

448. Where did this check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

HOME
HER HOME 11 (SKIP TO 457)
OTHER HOME 12 (SKIP TO 457)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21 (SKIP TO 457)
GOVERNMENT HEALTH CENTER 22 (SKIP TO 457)
GOVERNMENT HEALTH POST 23 (SKIP TO 457)
RCH OUTREACH CLINIC 24 (SKIP TO 457)
OTHER PUBLIC SECTOR (SPECIFY) 26 (SKIP TO 457)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (SKIP TO 457)
NGO HOSPITAL/CLINIC 32 (SKIP TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (SKIP TO 457)
OTHER (SPECIFY) 96 (SKIP TO 457)

449. 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)?

YES 1
NO 2 (SKIP TO 453)

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

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

451. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILLARY NURSE/COMM. NURSE ATTENDANT 13
OTHER PERSON
COMMUNITY BIRTH COMPANION 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

452. Where did this first check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
RCH OUTREACH CLINIC 24
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NGO HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER (SPECIFY) 96

453. I would like to talk to you about checks on (NAME)'s health after delivery - for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a community birth companion check on (NAME)'s health?

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

454. How many hours, days, or weeks after the birth of (NAME) did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

455. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILLARY NURSE/COMM. NURSE ATTENDANT 13
OTHER PERSON
COMMUNITY BIRTH COMPANION 21
VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) 96

456. Where did the first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
RCH OUTREACH CLINIC 24
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NGO HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
OTHER (SPECIFY) 96

457. During the first two days after (NAME)'s birth, did any health care provider do the following:
a) Examine the cord?
b) Measure (NAME)'s temperature?
c) Counsel you on the danger signs for newborns?
d) Counsel you on breastfeeding?
e) Observe (NAME) breastfeeding?

YES 1
NO 2
DON'T KNOW 8

458. Has your menstrual period returned since the birth of (NAME)?

YES 1 (SKIP TO 460)
NO 2 (SKIP TO 461)

459. Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (SKIP TO 463)

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

MONTHS__
DON'T KNOW 98

461. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (CONTINUE)
PREGNANT OR UNSURE (SKIP TO 463)

462. Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (SKIP TO 464)

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

MONTHS__
DON'T KNOW 98

464. Did you ever breastfeed (NAME)?

YES 1 (SKIP TO 466)
NO 2

465. CHECK 404: IS CHILD LIVING?

LIVING 1 (SKIP TO 470)
DEAD 2 (SKIP TO 471)

466. How long after birth did you first put (NAME) to the breast? IF LESS THAN ONE HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1
DAYS 2

467. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2

468. CHECK 404: IS CHILD LIVING?

LIVING (CONTINUE)
DEAD (SKIP TO 471)

469. Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2016 OR LATER?

ONE OR MORE BIRTHS IN 2016 OR LATER (CONTINUE)
NO BIRTHS IN 2016 OR LATER (SKIP TO 601)

502A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2016 OR LATER.

NAME OF LAST BIRTH__
BIRTH HISTORY NUMBER__

503A. CHECK 216 FOR CHILD:

LIVING (CONTINUE)
DEAD (SKIP TO 501B)

504A. Do you have a card or other document where (NAME)'s vaccinations are written down?

YES, HAS ONLY IWC 1 (SKIP TO 507A)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS IWC AND OTHER DOCUMENT 3 (SKIP TO 507A)
NO, NO IWC AND NO OTHER DOCUMENT 4

505A. Did you ever have an infant welfare card for (NAME)?

YES 1
NO 2

506A. CHECK 504A:

CODE '2' CIRCLED (CONTINUE)
CODE '4' CIRCLED (SKIP TO 511A)

507A. May I see the card or other document where (NAME)'s vaccinations are written down?

YES, ONLY IWC SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, IWC AND OTHER DOCUMENT SEEN 3
NO IWC AND NO OTHER DOCUMENT SEEN 4 (SKIP TO 511A)

508A. COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY__
MONTH__
YEAR__
HEPATITIS B AT BIRTH
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 1
DAY__
MONTH__
YEAR__
PENTAVALENT (DPT-HEP .B-HIB) 1
DAY__
MONTH__
YEAR__
PNEUMOCOCCAL 1
DAY__
MONTH__
YEAR__
ROTAVIRUS 1
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 2
DAY__
MONTH__
YEAR__
PENTAVALENT (DPT-HEP .B-HIB) 2
DAY__
MONTH__
YEAR__
PNEUMOCOCCAL 2
DAY__
MONTH__
YEAR__
ROTAVIRUS 2
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 3
DAY__
MONTH__
YEAR__
PENTAVALENT (DPT-HEP .B-HIB) 3
DAY__
MONTH__
YEAR__
PNEUMOCOCCAL 3
DAY__
MONTH__
YEAR__
ROTAVIRUS 3
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 4
DAY__
MONTH__
YEAR__
MEASLES/MR 1
DAY__
MONTH__
YEAR__
YELLOW FEVER
DAY__
MONTH__
YEAR__
MENINGITIS A VACCINE
DAY__
MONTH__
YEAR__
DPT BOOSTER
DAY__
MONTH__
YEAR__
ORAL POLIO BOOSTER
DAY__
MONTH__
YEAR__
MEASLES/MR 2
DAY__
MONTH__
YEAR__
VITAMIN A (MOST RECENT)
DAY__
MONTH__
YEAR__
MEBENDAZOLE/DEWORMING (MOST RECENT)
DAY__
MONTH__
YEAR__

509A. CHECK 508A: 'BCG' TO 'MEASLES/MR 2' ALL RECORDED?

NO (CONTINUE)
YES (SKIP TO 525A)

510A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A THEN WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 525A)
NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 525A)
DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 525A)

511A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

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

512A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

513A. At or soon after birth, did (NAME) receive a Hepatitis B vaccination, that is, an injection in the arm to prevent Hepatitis B?

YES 1
NO 2 (SKIP TO 514A)
DON'T KNOW 8 (SKIP TO 514A)

513A1. Did (NAME) receive it within 24 hours of birth?

YES 1
NO 2
DON'T KNOW 8

514A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2 (SKIP TO 517A)
DON'T KNOW 8 (SKIP TO 517A)

515A. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

516A. How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES__

516A1. Did (NAME) also receive an IPV injection, that is, an injection given in the right thigh to prevent polio, usually given at age 4 months at the same time as a dose of polio drops?

YES 1
NO 2
DON'T KNOW 8

517A. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the left thigh sometimes at the same time as the polio drops?

YES 1
NO 2 (SKIP TO 519A)
DON'T KNOW 8 (SKIP TO 519A)

518A. How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES__

519A. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the right thigh to prevent pneumonia?

YES 1
NO 2 (SKIP TO 521A)
DON'T KNOW 8 (SKIP TO 521A)

520A. How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES__

521A. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (SKIP TO 523A)
DON'T KNOW 8 (SKIP TO 523A)

522A. How many times did (NAME) receive the rotavirus vaccine?

NUMBER OF TIMES__

523A. Has (NAME) ever received measles or MR vaccination, that is, an injection in the arm to prevent measles or measles and rubella?

YES 1
NO 2 (SKIP TO 524AA)
DON'T KNOW 8 (SKIP TO 524AA)

524A. How many times did (NAME) receive the measles or MR vaccine?

NUMBER OF TIMES__

524AA. Has (NAME) ever received a yellow fever vaccination, that is, an injection in the arm to prevent yellow fever usually given at the age of 9 months or older?

YES 1
NO 2
DON'T KNOW 8

524AB. Has (NAME) ever received a meningitis vaccination, that is, an injection to the arm to prevent meningitis?

YES 1
NO 2
DON'T KNOW 8

525A. In the last 7 days was (NAME) given:
a) Sprinkles?
b) PlumpyNut?
c) PLUMPY DOZ?

YES 1
NO 2
DON'T KNOW 8

526A. CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B. CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2016 OR LATER?

ONE OR MORE BIRTHS IN 2016 OR LATER (CONTINUE)
NO BIRTHS IN 2016 OR LATER (SKIP TO 601)

502B. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2016 OR LATER.

NAME OF NEXT-TO-LAST BIRTH__
BIRTH HISTORY NUMBER__

503B. CHECK 216 FOR CHILD:

LIVING (CONTINUE)
DEAD (SKIP TO 526B)

504B. Do you have a card or other document where (NAME)'s vaccinations are written down?

YES, HAS ONLY IWC 1 (SKIP TO 507B)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS IWC AND OTHER DOCUMENT 3 (SKIP TO 507B)
NO, NO IWC AND NO OTHER DOCUMENT 4

505B. Did you ever have an infant welfare card for (NAME)?

YES 1
NO 2

506B. CHECK 504B:

CODE '2' CIRCLED (CONTINUE)
CODE '4' CIRCLED (SKIP TO 511B)

507B. May I see the card or other document where (NAME)'s vaccinations are written down?

YES, ONLY IWC SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, IWC AND OTHER DOCUMENT SEEN 3
NO IWC AND NO OTHER DOCUMENT SEEN 4 (SKIP TO 511B)

508B. COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY__
MONTH__
YEAR__
HEPATITIS B AT BIRTH
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 1
DAY__
MONTH__
YEAR__
PENTAVALENT (DPT-HEP .B-HIB) 1
DAY__
MONTH__
YEAR__
PNEUMOCOCCAL 1
DAY__
MONTH__
YEAR__
ROTAVIRUS 1
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 2
DAY__
MONTH__
YEAR__
PENTAVALENT (DPT-HEP .B-HIB) 2
DAY__
MONTH__
YEAR__
PNEUMOCOCCAL 2
DAY__
MONTH__
YEAR__
ROTAVIRUS 2
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 3
DAY__
MONTH__
YEAR__
PENTAVALENT (DPT-HEP .B-HIB) 3
DAY__
MONTH__
YEAR__
PNEUMOCOCCAL 3
DAY__
MONTH__
YEAR__
ROTAVIRUS 3
DAY__
MONTH__
YEAR__
ORAL POLIO VACCINE (OPV) 4
DAY__
MONTH__
YEAR__
MEASLES/MR 1
DAY__
MONTH__
YEAR__
YELLOW FEVER
DAY__
MONTH__
YEAR__
MENINGITIS A VACCINE
DAY__
MONTH__
YEAR__
DPT BOOSTER
DAY__
MONTH__
YEAR__
ORAL POLIO BOOSTER
DAY__
MONTH__
YEAR__
MEASLES/MR 2
DAY__
MONTH__
YEAR__
VITAMIN A (MOST RECENT)
DAY__
MONTH__
YEAR__
MEBENDAZOLE/DEWORMING (MOST RECENT)
DAY__
MONTH__
YEAR__

509B. CHECK 508B: 'BCG' TO 'MEASLES/MR 2' ALL RECORDED?

NO (CONTINUE)
YES (SKIP TO 525B)

510B. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508B THEN WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 525B)
NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 525B)
DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN) (THEN SKIP TO 525B)

511B. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

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

512B. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

513B. At or soon after birth, did (NAME) receive a Hepatitis B vaccination, that is, an injection in the arm to prevent Hepatitis B?

YES 1
NO 2 (SKIP TO 514B)
DON'T KNOW 8 (SKIP TO 514B)

513B1. Did (NAME) receive it within 24 hours of birth?

YES 1
NO 2
DON'T KNOW 8

514B. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2 (SKIP TO 517B)
DON'T KNOW 8 (SKIP TO 517B)

515B. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

516B. How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES__

516B1. Did (NAME) also receive an IPV injection, that is, an injection given in the right thigh to prevent polio, usually given at age 4 months at the same time as a dose of polio drops?

YES 1
NO 2
DON'T KNOW 8

517B. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the left thigh sometimes at the same time as the polio drops?

YES 1
NO 2 (SKIP TO 519B)
DON'T KNOW 8 (SKIP TO 519B)

518B. How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES__

519B. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the right thigh to prevent pneumonia?

YES 1
NO 2 (SKIP TO 521B)
DON'T KNOW 8 (SKIP TO 521B)

520B. How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES__

521B. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (SKIP TO 523B)
DON'T KNOW 8 (SKIP TO 523B)

522B. How many times did (NAME) receive the rotavirus vaccine?

NUMBER OF TIMES__

523B. Has (NAME) ever received measles or MR vaccination, that is, an injection in the arm to prevent measles or measles and rubella?

YES 1
NO 2 (SKIP TO 524BA)
DON'T KNOW 8 (SKIP TO 524BA)

524B. How many times did (NAME) receive the measles or MR vaccine?

NUMBER OF TIMES__

524BA. Has (NAME) ever received a yellow fever vaccination, that is, an injection in the arm to prevent yellow fever usually given at the age of 9 months or older?

YES 1
NO 2
DON'T KNOW 8

524BB. Has (NAME) ever received a meningitis vaccination, that is, an injection to the arm to prevent meningitis?

YES 1
NO 2
DON'T KNOW 8

525B. In the last 7 days was (NAME) given:
a) Sprinkles?
b) PlumpyNut?
c) PLUMPY DOZ?

YES 1
NO 2
DON'T KNOW 8

526B. CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2016 OR LATER?

MORE BIRTHS IN 2016 OR LATER (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2016 OR LATER (SKIP TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601. CHECK 224:

ONE OR MORE BIRTHS IN 2014 OR (CONTINUE)
NO BIRTHS IN 2014 OR LATER (SKIP TO 648)

602. CHECK 215 FOR DATE OF BIRTH: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2014 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S). Now I would like to ask some questions about your children born in the last 5 years. (We will talk about each separately.)

603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER__

604. FROM 212 AND 216:

NAME__
LIVING (CONTINUE)
DEAD (SKIP TO 646)

605. In the last six months, was (NAME) given a vitamin A dose like any of these? SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2 (SKIP TO 606)
DON'T KNOW 8 (SKIP TO 606)

605A. The last time, did (NAME) receive the vitamin A dose during routine immunization services or during a campaign?

ROUTINE IMMUNIZATION 1
CAMPAIGN 2

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

YES 1
NO 2
DON'T KNOW 8

607. Was (NAME) given any drug for deworming in the last six months? SHOW COMMON TYPES OF DEWORMING TABLETS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

609. CHECK 469: CURRENTLY BREASTFEEDING?

YES a) Now I would like to know how much (NAME) was given to drink during the diarrhea including breast milk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
NO/NOT b) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) 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

610. When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was (NAME) 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

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

YES 1
NO 2 (SKIP TO 615)

612. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S)

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
RCH OUTREACH CLINIC D
FIELDWORKER/VHW E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
NGO HOSPITAL/CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
ITINERANT DRUG SELLER Q
OTHER (SPECIFY) X

613. CHECK 612:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 615)

614. Where did you first seek advice or treatment? USE LETTER CODE FROM 612.

FIRST PLACE__

615. Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:
a) A fluid made from a special packed called ORS?
c) A government-recommended homemade sugar/salt solution?
d) Zinc tablets or syrup?

YES 1
NO 2
DON'T KNOW 8

616. CHECK 615:
ANY 'YES' a) Was anything given to treat the diarrhea?
ALL 'NO' OR 'DK' b) Was anything given to treat the diarrhea?

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

617. CHECK 615:
ANY 'YES' a) What else was given to treat diarrhea? Anything else? RECORD ALL TREATMENTS GIVEN.
ALL 'NO' OR 'DK' b) What was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G

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

YES 1
NO 2 (SKIP TO 620)
DON'T KNOW 8 (SKIP TO 620)

619. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

621. Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

YES 1
NO 2 (SKIP TO 623)
DON'T KNOW 8 (SKIP TO 623)

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

CHEST ONLY 1 (SKIP TO 624)
NOSE ONLY 2 (SKIP TO 624)
BOTH 3 (SKIP TO 624)
OTHER (SPECIFY) (SKIP TO 624)
DON'T KNOW 8 (SKIP TO 624)

623. CHECK 618: HAD FEVER?

YES (CONTINUE)
NO OR DON'T KNOW (SKIP TO 646)

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

YES 1
NO 2 (SKIP TO 629)

625. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
RCH OUTREACH CLINIC D
FIELDWORKER/VHW E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
NGO HOSPITAL/CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
ITINERANT DRUG SELLER Q
OTHER (SPECIFY) X

626. CHECK 625:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 628)

627. Where did you first seek advice or treatment? USE LETTER CODE FROM 625.

FIRST PLACE__

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

DAYS__

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

YES 1
NO 2 (SKIP TO 646)
DON'T KNOW 8 (SKIP TO 646)

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

ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT)/COARTEM A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE PILLS E
INJECTION/IV F
ARTESUNATE RECTAL G
INJECTION/IV H
DIHYDROARTEMISININ I
OTHER ANTIMALARIAL (SPECIFY) J
ANTIBIOTIC DRUGS
PILL/SYRUP K
INJECTION/IV L
OTHER DRUGS
ASPIRIN M
PARACETAMOL/PANADOL/ACETAMINOPHEN N
IBUPROFEN O
OTHER (SPECIFY) X
DON'T KNOW Z

631. CHECK 630: ANY CODE A-J CIRCLED?

YES (CONTINUE)
NO (SKIP TO 646)

632. CHECK 630: ARTEMISININ COMBINATION THERAPY ('A') GIVEN

CODE 'A' CIRLED (CONTINUE)
CODE 'A' NOT CIRCLED (SKIP TO 634)

633. How long after the fever started did (NAME) first take artemisinin combination therapy?

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

634. CHECK 630: SP/FANSIDAR ('B') GIVEN

CODE 'B' CIRCLED (CONTINUE)
CODE 'B' NOT CIRCLED (SKIP TO 636)

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

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

636. CHECK 630: CHLOROQUINE ('C') GIVEN

CODE 'C' CIRCLED (CONTINUE)
CODE 'C' NOT CIRCLED (SKIP TO 638)

637. 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

638. CHECK 630: AMODIAQUINE ('D') GIVEN

CODE 'D' CIRCLED (CONTINUE)
CODE 'D' NOT CIRCLED (SKIP TO 640)

639. How long after the fever started did (NAME) first take amodiaquine?

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

640. CHECK 630: QUININE ('E' OR 'F' GIVEN)

CODE 'E' OR 'F' CIRCLED (CONTINUE)
CODE 'E' OR 'F' NOT CIRCLED (SKIP TO 642)

641. 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

642. CHECK 630: ARTESUNATE ('G' OR 'H') GIVEN

CODE 'G' OR 'H' CIRCLED (CONTINUE)
CODE 'G' OR 'H' NOT CIRCLED (SKIP TO 643A)

643. How long after the fever started did (NAME) first take artesunate?

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

643A. CHECK 630: DIHYDROARTEMISININ ('I') GIVEN

CODE 'I' CIRCLED (CONTINUE)
CODE 'I' NOT CIRCLED (SKIP TO 644)

643B. How long after the fever started did (NAME) first take dihydroartemisinin?

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

644. CHECK 630: OTHER ANTIMALARIAL ('J') GIVEN

CODE 'J' CIRCLED (CONTINUE)
CODE 'J' NOT CIRCLED (SKIP TO 646)

645. 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

646. GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.

647. CHECK 615(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (CONTINUE)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (SKIP TO 649)

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

YES 1
NO 2

649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDEN BORN IN 2017 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (NAME OF THE YOUNGEST CHILD LIVING WITH HER) (THEN CONTINUE)
NONE (SKIP TO 701)

650. Now I would like to ask you about liquids or foods that (NAME FROM 649) 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.

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__

e) Infant formula, such as SMA or Lactogen? 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__

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__

h) Any fortified baby food, such as Cerelac, Nutrilac, or Dundal Njoboot?

YES 1
NO 2
DON'T KNOW 8

i) Bread, rice, noodles, porridge, ogi, or other foods made from grains?

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, manioc, cassava, or any other foods made from roots?

YES 1
NO 2
DON'T KNOW 8

l) Cassava leaves, moringa leaves, potato leaves, or any other dark green, leafy vegetables?

YES 1
NO 2
DON'T KNOW 8

m) Ripe mangoes or ripe papayas?

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, duck, or sausages made from these meats?

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, 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) Foods made with red palm oil, palm nut, or palm nut pulp sauce?

YES 1
NO 2
DON'T KNOW 8

v) Any other solid, semi-solid, or soft food?

YES 1
NO 2
DON'T KNOW 8

651. CHECK 650 (CATEGORIES 'g' THROUGH 'v'):

NOT A SINGLE 'YES' (CONTINUE)
AT LEAST ONE 'YES' (SKIP TO 653)

652. Did (NAME FROM 649) 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 650 TO RECORD FOOD EATEN YESTERDAY) (THEN CONTINUE TO 653)
NO 2 (SKIP TO 654)

653. How many times did (NAME FROM 649) 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

654. The last time (NAME FROM 649) passed stools, what was done to dispose of those stools?

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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY.

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

YES, CURRENTLY MARRIED 1 (SKIP TO 704)
YES, LIVING WITH A MAN 2 (SKIP TO 704)
NO, NOT IN UNION 3

702. 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 (SKIP TO 712)

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

WIDOWED 1 (SKIP TO 709)
DIVORCED 2 (SKIP TO 709)
SEPARATED 3 (SKIP TO 709)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

705. 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__

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

YES 1
NO 2 (SKIP TO 709)
DON'T KNOW 8 (SKIP TO 709)

707. 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

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

RANK__

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

ONLY ONCE 1
MORE THAN ONCE 2

710. CHECK 709:
MARRIED/LIVED WITH A MAN ONLY ONCE a) In what month and year did you start living with your (husband/partner)?
MARRIED/LIVED WITH A MAN MORE THAN ONCE b) 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__ (SKIP TO 712)
NEVER LIVED WITH HUSBAND 9995 (SKIP TO 712)
DON'T KNOW YEAR 9998

711. How old were you when you first started living with him?

AGE__

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

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

NEVER HAD SEXUAL INTERCOURSE 00 (SKIP TO 730A)
AGE IN YEARS__

714. I would like to ask you about your recent sexual activity. 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 (SKIP TO 716)
WEEKS AGO 2 (SKIP TO 716)
MONTHS AGO 3 (SKIP TO 716)
YEARS AGO 4 (SKIP TO 727)

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

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3

716. The last time you had sexual intercourse with this person, was a male condom or female condom used?

YES 1
NO 2 (SKIP TO 718)

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

YES 1
NO 2

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

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/COMMERCIAL SEX WORKER 5
OTHER (SPECIFY) 6

719. How long ago did you first have sexual intercourse with this person?

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

720. 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, RECORD '95'.

NUMBER OF TIMES__

721. How old is this person?

AGE OF PARTNER__
DON'T KNOW 98

722. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 715 IN NEXT)
NO 2 (SKIP TO 724)

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

NUMBER OF PARTNERS LAST 12 MONTHS__
DON'T KNOW 98

724. CHECK 106:

AGE 15-24 (CONTINUE)
AGE 25-49 (SKIP TO 727)

725. CHECK 701:

NOT IN A UNION (CONTINUE)
CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 727)

726. In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

YES 1
NO 2

727. 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, RECORD '95'.

NUMBER OF PARTNERS IN LIFETIME__
DON'T KNOW 98

728. CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):

YES, CONDOM USED (CONTINUE)
NO, CONDOM NOT USED (SKIP TO 730A)
NOT ASKED (SKIP TO 730A)

730. You told me that a condom was used the last time you had sex. From where did you obtain the condom last time? PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
RCH OUTREACH CLINIC 14
FIELDWORKER/VHW 15
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
NGO HOSPITAL/CLINIC 26
NGO MOBILE CLINIC 27
COMMUNITY BASED DISTRIBUTOR 28
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 29
OTHER SOURCE
SHOP 31
FRIEND/RELATIVE/PARTNER 32
OTHER (SPECIFY) 96
DON'T KNOW 98

730A. Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs during the after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery. Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

YES 1 (SKIP TO 730C)
NO 2

730B. Have you ever heard of this problem?

YES 1
NO 2 (SKIP TO 731)

730C. How are women with this problem treated by the community? Anything else? RECORD ALL MENTIONED.

DIVORCE/SEPARATION FROM HUSBAND/PARTNER A
ABANDONED BY FAMILY/FRIENDS B
EXCLUDED FROM COMMUNITY EVENTS C
WON'T SHARE MEALS D
WON'T BUY FROM HER SHOP/BUSINESS E
LOSE RESPECT FOR HER F
TALK BADLY ABOUT HER G
OTHER (SPECIFY) X
DON'T KNOW Z

730D. CHECK 730A: EVER EXPERIENED FISTULA

YES, HAS EXPERIENCED (CONTINUE)
NO, NEVER EXPERIENCED (SKIP TO 731)

730E. Did this problem start after you delivered a baby or had a stillbirth?

AFTER DELIVERED BABY 1
AFTER HAD A STILLBIRTH 2
NEITHER 3 (SKIP TO 730G)

730F. Did this problem start after a normal labor and delivery, or after a very difficult labor and delivery?

NORMAL LABOR/DELIVERY 1 (SKIP TO 730H)
VERY DIFFICULT LABOR/DELIVERY 2 (SKIP TO 730H)

730G. What do you think caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER (SPECIFY) 6
DON'T KNOW 8 (SKIP TO 730I)

730H. How many days after (CAUSE OF PROBLEM FROM 730E OR 730G) did the leakage start? ENTER '90' IF 90 DAYS OR MORE.

NUMBER OF DAYS AFTER DELIVERY/OTHER EVENT__

730I. Have you sought treatment for this condition?

YES 1 (SKIP TO 730K)
NO 2

730J. Why have you not sought treatment? PROBE AND RECORD ALL METIONED.

DO NOT KNOW CAN BE FIXED A (SKIP TO 731)
DO NOT KNOW WHERE TO GO B (SKIP TO 731)
TOO EXPENIVE C (SKIP TO 731)
TOO FAR D (SKIP TO 731)
POOR QUALITY OF CARE E (SKIP TO 731)
COULD NOT GET PERMISSION F (SKIP TO 731)
EMBARRASSMENT G (SKIP TO 731)
PROBLEM DISAPPEARED H (SKIP TO 731)
OTHER (SPECIFY) X (SKIP TO 731)

730K. Where did you seek treatment? Anywhere else? RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL (RVH/EDWARD FRANCES SMALL HOSPITAL) A
GOVERNMENT HEALTH CENTER B
OTHER (SPECIFY) C
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC D
PHARMACY E
NGO CLINIC/HOSPITAL (BAFROW) F
OTHER (SPECIFY) G
OTHER
HER HOME H
OTHER HOME I
OTHER (SPECIFY) X

730L. CHECK 730K:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 730N)

730M. Where did you last seek treatment? USE LETTER CODE FROM 730K.

LAST PLACE__

730N. From whom did you seek treatment? Anyone else? RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
VILLAGE HEALTH WORKER C
TRADITIONAL HEALER/MARABOUT D
OTHER (SPECIFY) X

730N1. CHECK 730N:

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 730O)

730N2. From whom did you last seek treatment? USE LETTER CODE FROM 730N

LAST PERSON__

730O. Did you have an operation to fix the problem?

YES 1
NO 2

730P. Did the treatment stop the leakage completely? IF NO: Did the treatment reduce the leakage?

YES, STOPPED COMPLETELY 1
NO STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3
DID NOT RECEIVE TREATMENT 4

731. 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

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

NEITHER STERILIZED (CONTINUE)
HE OR SHE STERILIZED (SKIP TO 813)

802. CHECK 226:

PREGNANT (CONTINUE)
NOT PREGNANT OR UNSURE (SKIP TO 804)

803. 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 (SKIP TO 805)
NO MORE 2 (SKIP TO 812)
UNDECIDED/DON'T KNOW 8 (SKIP TO 812)

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 813)
UNDECIDED/DON'T KNOW 8 (SKIP TO 811)

805. CHECK 226:
NOT PREGNANT OR UNSURE a) How long would you like to wait from now before the birth of (a/another) child?
PREGNANT b) 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 (SKIP TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 813)
AFTER MARRIAGE 995 (SKIP TO 811)
OTHER (SPECIFY) 996 (SKIP TO 811)
DON'T KNOW 998 (SKIP TO 811)

806. CHECK 226:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (SKIP TO 812)

807. CHECK 303: USING A CONTRACEPTIVE

NOT CURRENTLY USING (CONTINUE)
CURRENTLY USING (SKIP TO 813)

808. CHECK 805:

'24' OR MORE MONTHS OR '02' OR MORE YEARS (CONTINUE)
NOT ASKED (CONTINUE)
'00-23' MONTHS OR '00-01' YEAR (SKIP TO 812)

809. CHECK 714:

DAYS, WEEKS OR MONTHS AGO (CONTINUE)
YEARS AGO (SKIP TO 811)
NOT ASKED (SKIP TO 811)

810. CHECK 804:
WANTS TO HAVE A/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? RECORD ALL REASONS MENTIONED
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
PREFFERED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVIENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) X
DON'T KNOW Z

811. CHECK 303: USING A CONTRACEPTIVE

NOT ASKED (CONTINUE)
NO, NOT CURRENTLY USING (CONTINUE)
YES, CURRENTLY USING (SKIP TO 813)

812. 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

813. 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? PROBE FOR A NUMERIC RESPONSE.
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 (SKIP TO 815)
NUMBER__
OTHER (SPECIFY) 96 (SKIP TO 815)

814. 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?

BOYS__
GIRLS__
EITHER__
OTHER (SPECIFY) 96

815. 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?
d) Received a voice or text message about family planning on a mobile phone?
e) Heard about family planning through peer health education?
f) Heard about family planning from friends or relatives?
g) Heard about family planning from traditional communicators?
h) Heard about family planning from a health worker or health personnel?
i) Seen or heard anything about family planning from the internet or on social media platforms such as Facebook, WhatsApp, Twitter, or others?

YES 1
NO 2

817. CHECK 701:

YES, CURRENTLY MARRIED (CONTINUE)
YES, LIVING WITH A MAN (CONTINUE)
NO, NOT IN A UNION (SKIP TO 901)

818. CHECK 303: USING A CONTRACEPTIVE

CURRENTLY USING (CONTINUE)
NOT CURRENTLY USING (SKIP TO 820)
NOT ASKED (SKIP TO 822)

819. 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 (SKIP TO 821)
MAINLY HUSBAND/PARTNER 2 (SKIP TO 821)
JOINT DECISION 3 (SKIP TO 821)
OTHER (SPECIFY) 6 (SKIP TO 821)

820. Would you say that not 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

821. CHECK 304:

NEITHER ARE STERILIZED (CONTINUE)
HE OR SHE ARE STERILIZED (SKIP TO 901)

822. 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 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (SKIP TO 909)

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

AGE IN COMPLETED YEARS__

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

YES 1
NO 2 (SKIP TO 906)

904. What was the highest level of school he attended: ECE, primary, lower secondary, upper secondary, vocational, diploma, or higher?

EARLY CHILDHOOD EDUCATION 0 (SKIP TO 906)
PRIMARY 1
LOWER SECONDARY 2
UPPER SECONDARY 3
VOCATIONAL 4
DIPLOMA 5
HIGHER 6
DON'T KNOW 8 (SKIP TO 906)

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

GRADE/FORM/YEAR__
DON'T KNOW 98

906. Has your (husband/partner) done any work in the last 1ast 7 days?

YES 1 (SKIP TO 908)
NO 2
DON'T KNOW 8

907. Has your (husband/partner) done any work in the last 12 months?

YES 1
NO 2 (SKIP TO 909)
DON'T KNOW 8 (SKIP TO 909)

908. What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

OCCUPATION__

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

YES 1 (SKIP TO 913)
NO 2

910. 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 (SKIP TO 913)
NO 2

911. 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 (SKIP TO 913)
NO 2

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

YES 1
NO 2 (SKIP TO 917)

913. What is your occupation? That is, what kind of work do you mainly do?

OCCUPATION__

914. 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

915. 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

916. 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

917. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (SKIP TO 925)

918. CHECK 916:

CODE '1' OR '2' CIRCLED (CONTINUE)
OTHER (SKIP TO 921)

919. 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/PARTER JOINTLY 3
OTHER (SPECIFY) 6

920. 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 (SKIP TO 922)
DON'T KNOW 8

921. Who usually decides how your (husband's/partner's) cash 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

922. 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

923. 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

924. 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

925. 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

928. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 931)

929. Do you have a title deed for any land you own?

YES 1
NO 2 (SKIP TO 931)
DON'T KNOW 8 (SKIP TO 931)

930. Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN YOUNGER THAN 10
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8

932. 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?
f) If she uses contraceptives without his consent?
g) if she argues with his relatives?

YES 1
NO 2
DON'T KNOW 8

SECTION 10. HIV/AIDS

1001. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

YES 1
NO 2 (SKIP TO 1042)

1002. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

1003. Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

1004. Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

1005. Can people get HIV by sharing food with a person who has HIV?

YES 1
NO 2
DON'T KNOW 8

1006. Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

1007. Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

1008. Can HIV be transmitted from a mother to her baby:
a) During pregnancy?
b) During delivery?
c) By breastfeeding?

YES 1
NO 2
DON'T KNOW 8

1009. CHECK 1008:

AT LEAST ONE 'YES' (CONTINUE)
OTHER (SKIP TO 1011)

1010. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

1011. CHECK 208 AND 215:

LAST BIRTH IN 2017 OR LATER (CONTINUE)
LAST BITRH IN 2016 OR EARLIER (SKIP TO 1027)
NO BIRTHS (SKIP TO 1027)

1012. CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (CONTINUE)
NO ANTENATAL CARE (SKIP TO 1020)

1013. CHECK PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1014. During any of the antenatal visits for your last birth were you given any information about:
a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?

YES 1
NO 2
DON'T KNOW 8

1015. Were you offered a test for HIV as part of your antenatal care?

YES 1
NO 2

1016. I don't want to know the results, but were you tested for HIV as part of your antenatal care?

YES 1
NO 2 (SKIP TO 1020)

1017. 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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
RCH OUTREACH CLINIC 13
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MOBILE HTC SERVICES 22
NGO HOSPITAL/CLINIC 23
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER (SPECIFY) 96

1018. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2 (SKIP TO 1020)

1019. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1
NO 2
DON'T KNOW 8

1020. CHECK 430 FOR LAST BIRTH:

ANY CODE '21-36' CIRCLED (CONTINUE)
OTHER (SKIP TO 1024)

1021. Between the time you went for delivery but before the baby was born, were you offered an HIV test?

YES 1
NO 2

1022. I don't want to know the results, but were you tested for HIV at that time?

YES 1
NO 2 (SKIP TO 1024)

1023. I don't want to know the results, but did you get the results of the test?

YES 1 (SKIP TO 1025)
NO 2 (SKIP TO 1025)

1024. CHECK 1016:

YES (CONTINUE)
NO OR NOT ASKED (SKIP TO 1027)

1025. Have you been tested for HIV since that time you were tested during your pregnancy?

YES 1 (SKIP TO 1028)
NO 2

1026. How many months ago was your most recent HIV test?

MONTHS AGO__ (SKIP TO 1033)
TWO OR MORE YEARS 95 (SKIP TO 1033)

1027. I don't want to know the results, but have you ever been tested for HIV?

YES 1
NO 2 (SKIP TO 1031)

1028. How many months ago was your most recent HIV test?

MONTHS AGO__
TWO OR MORE YEARS 95

1029. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

1030. 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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (SKIP TO 1033)
GOVERNMENT HEALTH CENTER 12 (SKIP TO 1033)
RCH OUTREACH CLINIC 13 (SKIP TO 1033)
OTHER PUBLIC SECTOR (SPECIFY) 16 (SKIP TO 1033)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (SKIP TO 1033)
MOBILE HTC SERVICES 22 (SKIP TO 1033)
NGO HOSPITAL/CLINIC 23 (SKIP TO 1033)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26 (SKIP TO 1033)
OTHER SOURCE
HOME 31 (SKIP TO 1033)
WORKPLACE 32 (SKIP TO 1033)
OTHER (SPECIFY) 96 (SKIP TO 1033)

1031. Do you know of a place where people can go get an HIV test?

YES 1
NO 2 (SKIP TO 1033)

1032. Where is that? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
RCH OUTREACH CLINIC C
OTHER PUBLIC SECTOR (SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
MOBILE HTC SERVICES F
NGO HOSPITAL/CLINIC G
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) H
OTHER (SPECIFY) X

1033. Have you heard of test kits people can use to test themselves for HIV?

YES 1
NO 2

1035. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

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

1036. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

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

1037. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

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

1038. Do people talk badly about people living with HIV, or who are thought to be living with HIV?

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

1039. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

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

1040. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

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

1041. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8

1042. CHECK 1001:
HEARD ABOUT HIV OR AIDS a) Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT HIV OR AIDS b) Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

1043. CHECK 713:

HAS HAD SEXUAL INTERCOURSE (CONTINUE)
NEVER HAD SEXUAL INTERCOURSE (SKIP TO 1051)

1044. CHECK 1042.: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (CONTINUE)
NO (SKIP TO 1046)

1045. 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

1046. 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

1047. 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

1048. CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES') (CONTINUE)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 1051)

1049. The last time you had (PROBLEM FROM 1045/1046/1047), did you seek any kind of advice or treatment?

YES 1
NO 2 (SKIP TO 1051)

1050. Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
RCH OUTREACH CLINIC C
OTHER PUBLIC SECTOR (SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
MOBILE HTC SERVICES G
NGO HOSPITAL/CLINIC H
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) I
OTHER SOURCE
SHOP J
TRADITIONAL HEALER K
OTHER (SPECIFY) X

1051. 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

1052. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women other than his wives?

YES 1
NO 2
DON'T KNOW 8

1053. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (SKIP TO 1101)

1054. 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

1055. Could you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 11. OTHER HEALTH ISSUES.

1101. 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 INJECTION__
NONE 00 (SKIP TO 1104)

1102. Among these injections, how many were administered by a doctor, a nurse, a public health officer, 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 INJECTION__
NONE (SKIP TO 1104)

1103. 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

1104. Do you currently smoke manufactured or hand rolled cigarettes every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2 (SKIP TO 1106)
NOT AT ALL 3 (SKIP TO 1106)

1105. On average, how many cigarettes do you currently smoke each day?

NUMBER OF CIGARETTES__

1106. Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 1108)

1107. What other type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

PIPES FULL OF TOBACCO A
CIGARS, CHEROOTS, OR CIGARILLOS B
SHISHA/WATER PIPE C
SNUFF BY MOUTH D
SNUFF BY NOSE E
CHEWING TOBACCO F
E-CIGARETTES G
OTHER (SPECIFY) X

1108. 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 big problem:
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?

BIG PROBLEM 1
NOT A BIG PROBLEM 2

1109. Are you covered by any health insurance?

YES 1
NO 2 (SKIP TO 1200)

1110. What type of health insurance are you covered by? RECORD ALL MENTIONED.

HEALTH INSURANCE THROUGH EMPLOYER A
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE B
OTHER (SPECIFY) X

SECTION 12. NON-COMMUNICABLE DISEASES

1200. CHECK COVER PAGE: HOUSEHOLD SELECTED FOR MAN'S SURVEY/BIOMARKERS?

HOUSEHOLD SELECTED (CONTINUE)
HOUSEHOLD NOT SELECTED (SKIP TO 1401)

1201. Have you ever had your blood pressure measured by a doctor or other health worker?

YES 1
NO 2
DON'T KNOW 8

1202. Have you ever been told by a doctor or health worker that you have high blood pressure or hypertension?

YES 1
NO 2 (SKIP TO 1205A)

1203. In the past 12 months, have you been told by a doctor or other health worker that you have high blood pressure or hypertension?

YES 1
NO 2

1204. Has a doctor or other healthcare worker prescribed medication to control your blood pressure?

YES 1
NO 2

1205. Are you taking medication to control your blood pressure?

YES 1
NO 2

1205A. In your opinion, what can increase the risk of having high blood pressure or hypertension? Anything else? RECORD ALL MENTIONED.

OVERWEIGHT/OBESE A
TOBACCO USE B
TOO MUCH SALT C
UNHEALTHY DIET D
LACK OF EXERCISE E
DRINKING ALCOHOL F
FAMILY HISTORY/GENETICS G
AGE H
SEX/GENDER I
STRESS J
WITCHCRAFT K
GERMS L
DIRTY ENVIRONMENT M
OTHER (SPECIFY) X
DON'T KNOW Z

1205B. What are the signs and symptoms of high blood pressure or hypertension? Anything else? RECORD ALL MENTIONED.

DIZZINESS A
HEADACHE B
FATIGUE/TIREDNESS C
BLURRY VISION D
CHEST PAIN/POUNDING IN CHEST E
DIFFICULTY BREATHING F
IRREGULAR HEARTBEAT G
BLOOD IN URINE H
CONFUSION I
LOSS OF CONSCIOUSNESS J
JOINT PAIN K
BACKACHE/BACK PAIN L
OTHER (SPECIFY) X
DON'T KNOW Z

1206. Have you ever had your blood sugar measured by a doctor or other health worker?

YES 1
NO 2
DON'T KNOW 8

1207. Have you ever been told by a doctor or other health worker that you have high blood sugar or diabetes?

YES 1
NO 2 (SKIP TO 1210A)

1208. In the past 12 months, have you been told by a doctor or other health worker that you have high blood sugar or diabetes?

YES 1
NO 2

1209. Has a doctor or other healthcare worker prescribed medication to control your high blood sugar or diabetes?

YES 1
NO 2

1210. Are you taking medication to control your high blood sugar or diabetes?

YES 1
NO 2

1210A. In your opinion, what can increase the risk of having high blood sugar or diabetes? Anything else? RECORD ALL MENTIONED.

OVERWEIGHT/OBESE A
TOBACCO USE B
TOO MUCH SUGAR C
UNHEALTHY DIET D
LACK OF EXERCISE E
DRINKING ALCOHOL F
FAMILY HISTORY/GENETICS G
AGE H
SEX/GENDER I
STRESS J
WITCHCRAFT K
GERMS L
DIRTY ENVIRONMENT M
OTHER (SPECIFY) X
DON'T KNOW Z

1210B. What are the signs and symptoms of high blood sugar or diabetes? Anything else? RECORD ALL MENTIONED.

DIZZINESS A
HEADACHE B
FATIGUE/TIREDNESS C
BLURRY VISION D
CHEST PAIN/POUNDING IN CHEST E
DIFFICULTY BREATHING F
IRREGULAR HEARTBEAT G
BLOOD IN URINE H
INCREASED URINATION I
INCREASED THIRST J
INCREASED HUNGER K
NUMBNESS/TINGLING/BURNING IN HANDS/FEET L
WEIGHT LOSS M
CONFUSION N
LOSS OF CONSCIOUSNESS O
JOINT PAIN P
BACKACHE/BACK PAIN Q
OTHER (SPECIFY) X
DON'T KNOW Z

SECTION 13. FEMALE GENITAL CUTTING/MUTILATION

1301. Now I would like to ask some questions about a process known as female circumcision. Have you ever heard of female circumcision?

YES 1 (SKIP TO 1303)
NO 2

1302. In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (SKIP TO 1401)

1303. Have you yourself ever been circumcised?

YES 1
NO 2 (SKIP TO 1309)

1304. Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

YES 1 (SKIP TO 1306)
NO 2
DON'T KNOW 8

1305. Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1306. Was your genital area sealed?

YES 1
NO 2
DON'T KNOW 8

1307. How old were you when you were circumcised? IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS__
AS A BABY/DURING INFANCY 95
DON'T KNOW 98

1308. Who performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
COMMUNITY BIRTH COMPANION 12
OTHER TRAD. (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) 26
DON'T KNOW 98

1309. CHECK 213, 214, AND 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 2004 OR LATER (CONTINUE)
HAS NO DAUGHTERS BORN IN 2004 OR LATER (SKIP TO 1316)

1309A. CHECK 213, 215, AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2004 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 3 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES). Now I would like to ask you some questions about your (daughter/daughters)

1310. BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2004 OR LATER.

BIRTH HISTORY NUMBER__
NAME__

1311. Is (NAME OF DAUGHTER) circumcised?

YES 1
NO 2 (GO TO 1311 IN NEXT COLUMN; OR IF NO MORE DAUGHTERS, GO TO 1316)

1312. How old was (NAME OF DAUGHTER) when she was circumcised? IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS__
DON'T KNOW 98

1313. Was her genital area sealed?

YES 1
NO 2
DON'T KNOW 8

1314. Who performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
COMMUNITY BIRTH COMPANION 12
OTHER TRAD. (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) 26
DON'T KNOW 98

1315. GO BACK TO 1311 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 1316.

1316. Do you believe that female circumcision is required by your religion?

YES 1
NO 2
NO RELIGION 3
DON'T KNOW 8

1317. Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2 (SKIP TO 1319)
DEPENDS 3 (SKIP TO 1320)
DON'T KNOW 8 (SKIP TO 1320)

1318. Why do you think female circumcision should be continued? Anything else? RECORD ALL MENTIONED.

RELIGIOUS OBLIGATION A (SKIP TO 1320)
PREVENTS PREGNANCY B (SKIP TO 1320)
HYGENE/CLEANLINESS C (SKIP TO 1320)
EASIER DELIVERY D (SKIP TO 1320)
REDUCED PROMISCUITY E (SKIP TO 1320)
TRADITION/CULTURE F (SKIP TO 1320)
PART OF WOMANHOOD G (SKIP TO 1320)
OTHER (SPECIFY) X (SKIP TO 1320)

1319. Why do you think female circumcision should be stopped? Anything else? RECORD ALL MENTIONED.

NEGATIVE HEALTH EFFECTS A
HARMFUL PRACTICE B
NOT RELIGIOUS OBLIGATION C
ILLEGAL D
COMPLICATES DELIVERY E
PAINFUL/UNSATISFYING SEX F
OTHER (SPECIFY) X

1320. Are you aware of any law that prohibits the practice of female circumcision in The Gambia?

YES 1
NO 2

SECTION 14. ADULT AND MATERNAL MORTALITY

1401. Now I would like to ask you some questions about your brothers and sisters born to your biological mother, including those who are living with you, those living elsewhere and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your biological mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all of your brothers and sisters born to your biological mother.

NAME__
ORDER NUMBER__

1402. CHECK 1401:

ONE OR MORE BROTHERS OR SISTERS LISTED (CONTINUE)
NO BROTHERS OR SISTERS LISTED (SKIP TO 1404)

1403. READ THE NAMES OF THE BROTHERS AND SISTERS TO THE RESPONDENT AND AFTER THE LAST ONE ASK: Are there any older brothers and sisters from the same mother that you have not mentioned?

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1401)

1404. Sometimes people forget to mention children born to their biological mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have not mentioned.

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHER AND SISTERS IN 1401)

1405. Sometimes people forget to mention children born to their biological mother because they have died. Are there any brothers or sisters who died that you have not mentioned?

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1401)

1406. Some people have brothers or sisters from the same mother but a different father. Are there any brothers or sisters born to your biological mother, but who have a different biological father, that you have not mentioned?

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1401)

1407. COUNT THE NUMBER OF BROTHERS AND SISTERS RECORDED IN 1401.

TOTAL BROTHERS AND SISTERS__

1408. CHECK 1407: Just to make sure that I have this right: your mother had in TOTAL__ births, excluding you, during her lifetime. Is that correct?

YES (CONTINUE)
NO (PROBE AND CORRECT 1401 AND/OR 1407)

1409. CHECK 1407:

ONE OR MORE BROTHERS/SISTERS (CONTINUE)
NO BROTHER OR SISTER (SKIP TO 1500)

1410. Please tell me, which brother or sister was born first? And which was born next? RECORD '01' FOR THE ORDER NUMBER IN 1401 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED THE ORDER NUMBER FOR ALL BROTHERS AND SISTERS.

1411. How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS__

1412. LIST THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER IN 1401. ASK 1413 TO 1424 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS OR SISTERS, USE AN ADDITIONAL QUESTIONNAIRE.

1413. NAME OF BROTHER OR SISTER.

NAME__

1414. Is (NAME) male or female?

MALE 1
FEMALE 2

1415. Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 1417)
DON'T KNOW 8 (SKIP TO (02))

1416. How old is (NAME)?

AGE__ (GO TO (02))

1417. How many years ago did (NAME) die?

YEARS AGO__

1418. How old was (NAME) when (he/she) died? IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

AGE__ (IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO 1423)

1419. Was (NAME) pregnant when she died?

YES 1 (SKIP TO 1423)
NO 2

1420. Did (NAME) die during childbirth?

YES 1 (SKIP TO (02))
NO 2

1421. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (SKIP TO 1423)

1422. How many days after the end of the pregnancy or childbirth did (NAME) die?

DAYS__

1423. Was (NAME)'s death due to an act of violence?

YES 1 (GO TO (02))
NO 2

1424. Was (NAME)'s death due to an accident?

YES 1 (GO TO (02))
NO 2 (GO TO (02))

IF NO MORE BROTHERS OR SISTERS, GO TO 1500.

SECTION 15. DOMESTIC VIOLENCE

1500. CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?

WOMAN SELECTED FOR THIS SECTION (CONTINUE)
WOMAN NOT SELECTED (SKIP TO 1532A)

1501. CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (CONTINUE)
PRIVACY NOT POSSIBLE 2 (SKIP TO 1532)

1501A. READ TO THE RESPONDENT: Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in The Gambia. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go to the next question.

1502. CHECK 701 AND 702:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
FORMERLY MARRIED/LIVING WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND/PARTNER' (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1516)

1503. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner)?
a) He (is/was) jealous or angry if you (talk/talked) to other
b) He frequently (accuses/accused you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?

YES 1
NO 2
DON'T KNOW 8

1504. Now I need to ask some more questions about your relationship with your (last) (husband/partner).

A. Did your (last) (husband/partner) ever:

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

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

OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1505. A. Did your (last) (husband/partner) ever do any of the following things to you:

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

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

OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1506. CHECK 1505 (a-j):

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (SKIP TO 1509)

1507. How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen? IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS__
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1508. Did the following ever happen as a result of what you (last) (husband/partner) did you:

a) You had cuts, bruises, or aches?

YES 1
NO 2

b) You had eye injuries, sprains, dislocations, or burns?

YES 1
NO 2

c) You had deep wounds, broken bones, broken teeth, or any other serious injury?

YES 1
NO 2

1509. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

YES 1
NO 2 (SKIP TO 1511)

1510. In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1511. Does (did) your (last) (husband/partner) drink alcohol?

YES 1
NO 2 (SKIP TO 1513)

1512. How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1513. Are (were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFTAID 2
NEVER AFRAID 3

1514. CHECK 709:

MARRIED MORE THAN ONCE (CONTINUE)
MARRIED ONLY ONCE (SKIP TO 1516)

1515. A. So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?

YES 1 (SKIP TO B)
NO 2 (CONTINUE TO b)

b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?

YES 1 (SKIP TO B)
NO 2 (CONTINUE TO c)

c) Did any previous (husband/partner) humiliate you in front of others, threaten to hurt you or someone you care about, or insult you or make you feel bad about yourself?

YES 1 (SKIP TO B)
NO 2

B. How long ago did this last happen?

0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

1516. CHECK 701 AND 702:
EVER MARRIED/EVER LIVED WITH A MAN a) From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER MARRIED/NEVER LIVED WITH A MAN b) From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (SKIP TO 1519)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1519)

1517. Who has hurt you in this way? Anyone else? RECORD ALL MENTIONED.

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

1518. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1519. CHECK 201, 226, AND 230:

EVER BEEN PREGNANT ('YES' ON 201 OR 226 OR 230) (CONTINUE)
NEVER BEEN PREGNANT (SKIP TO 1522)

1520. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (SKIP TO 1522)

1521. Who has done any of these things to physically hurt you while you were pregnant? Anyone else? RECORD ALL MENTIONED.

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

1522. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1522B)

1522A. Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1 (SKIP TO 1523)
NO 2 (SKIP TO 1524A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1524A)

1522B. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1
NO 2 (SKIP TO 1526)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1526)

1523. Who was the person who was forcing you the very first time this happened?

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

1524. CHECK 701 AND 702:
EVER MARRIED/EVER LIVED WITH A MAN a) In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A MAN b) In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

YES 1 (SKIP TO 1525)
NO 2 (SKIP TO 1525)

1524A. CHECK 1505A (h-j) and 1515A(b)

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (SKIP TO 1526)

1525. CHECK 701 AND 702:
EVER MARRIED/EVER LIVED WITH A MAN a) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?
NEVER MARRIED/NEVER LIVED WITH A MAN b) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS__
DON'T KNOW 98

1526. CHECK 1505A (a-j), 1515A (a,b), 1516, 1520, 1522A, and 1522B:

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES (SKIP TO 1530)

1527. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (SKIP TO 1529)

1527. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (SKIP TO 1529)

1528. From whom have you sought help? Anyone else? RECORD ALL MENTIONED.

OWN FAMILY A (SKIP TO 1530)
HUSBAND'S/PARTNER'S FAMILY B (SKIP TO 1530)
CURRENT/FORMER HUSBAND/PARTNER C (SKIP TO 1530)
CURRENT/FORMER BOYFRIEND D (SKIP TO 1530)
FRIEND E (SKIP TO 1530)
NEIGHBOR F (SKIP TO 1530)
RELIGIOUS LEADER G (SKIP TO 1530)
DOCTOR/MEDICAL PERSONNEL H (SKIP TO 1530)
POLICE I (SKIP TO 1530)
LAWYER J (SKIP TO 1530)
SOCIAL SERVICE ORGANIZATION K (SKIP TO 1530)
OTHER (SPECIFY) X (SKIP TO 1530)

1529. Have you ever told any one about this?

YES 1
NO 2

1530. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

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

1531. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

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

1532. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE

1532A. RECORD THE TIME.

HOURS__
MINUTES__

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW
COMMENTS ON SPECIFC QUESTIONS
ANY OTHER COMMENTS
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS

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

CODES 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 MALE CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
J STANDARD DAYS METHOD
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
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

COLUMN 1
COLUMN 2

2020

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

2019

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

2018

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

2017

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

2016

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

2015

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

2014

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