IDENTIFICATION

PLACE NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____
REGION _____

URBAN/RURAL:

CONAKRY/CAPITAL NATURAL REGION/OTHER CITY/RURAL:

NAME OF THE WOMAN _____

LINE NUMBER OF THE WOMAN _____

HOUSEHOLD SELECTED FOR MEN'S SURVEY?

INTERVIEWER VISITS

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

RESULT _____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 2005
NAME _____
RESULT _____

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE: FRENCH

LANGUAGE OF INTERVIEW:

INTERPRETER:

FIELD EDITOR
NAME _____
DATE _____

OFFICE EDITOR _____

KEYED BY _____

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT

INTRODUCTION AND CONSENT:

CONSENT AFTER INFORMATION:
Hello. My name is ____ and I work with the National statistics office. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

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

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

SIGNATURE OF INTERVIEWER _____
DATE _____

101. RECORD THE TIME:

First I would like to ask some questions about you and your household.

102. For most of the time until you were 12 years old, did you live in a big city, a city, or a rural location? IF A CITY, PLEASE STATE THE NAME OF THE CITY.

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

104. Just before you moved here, did you live in a big city, a city, or a rural location?
IF A CITY, STATE THE NAME OF THE CITY.

105. In what month and year were you born?

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

107. Have you ever attended school?

108. What is the highest level of school you attended: primary, secondary 1, secondary 2, professional A, professional B, or superior?

109. What is the highest (grade/form/year) you completed at this level?

110. CHECK 108:

111. Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.

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

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

113. CHECK 111:

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

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

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

117. In the last 12 months, how many times have you traveled out of your home location and slept somewhere other than your home?

118. Have you been outside of your home location for more than one continuous month in the last 12 months?

119. What is your religion?

120. What is your nationality?

121. What is your ethnicity?

122. What language do you mainly speak at home?

SECTION 2. REPRODUCTION

Now I would like to ask you about all the births you have had during your life.

201. Have you ever given birth?

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

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

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

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

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

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

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

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

210. CHECK 208:

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

213. Were any of these births twins?

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

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

216. Is (NAME) still alive?

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

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

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

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months old was (NAME)?

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

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[DO NOT ASK FOR FIRST BIRTH]

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 2000 OR LATER.
IF NONE, RECORD '0'

225. FOR EACH BIRTH SINCE JANUARY 2000, RECORD "N" IN THE MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "G" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF "G"s MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED). WRITE THE NAME OF THE CHILD NEXT TO THE LEFT OF CODE 'N'.

226. Are you pregnant now?

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS. (ENTER "G" IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS)

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

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

230. When did the last such pregnancy end?

231. CHECK 230:

232. How many months pregnant were you when the last such pregnancy ended?

RECORD NUMBER OF COMPLETED MONTHS. (ENTER "F" IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND "G" FOR THE REMAINING NUMBER OF COMPLETED MONTHS)

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

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2000. ENTER "F" IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND "G" FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any miscarriages, abortions or stillbirths that ended before January 2000?

236. When did the last such pregnancy that terminated before 2000 end?

237. When did your last menstrual cycle start?
RECORD THE DATE, IF GIVEN.

238. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

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

240. Are there any children who depend primarily on you?

241. Among these children who depend primarily on you, are there any that are younger than 18 years old?

Now I would like to talk about the children younger than 18 years who depend primarily on you.

242. Have you made any arrangements for someone to take care of these children if you were to get sick or if you were no longer able to take care of them?

SECTION 3. FAMILY PLANNING

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

CIRCLE CODE '1' IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '1' IF METHOD IS RECOGNIZED AND CODE '2' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

302. Have you ever used (METHOD)?

303. CHECK 302:

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

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

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

308. CHECK 302 (01):

309. CHECK 226:

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

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

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

312. Why do you use the pill over another method?

312A. May I see the package of pills you are using right now?
RECORD NAME OF BRAND IF PACKAGE IS SEEN.

312B. Do you know the brand name of the pills you are now using?

312C. How much does one packet for 3 cycles of pills cost you?

313. In what facility did the sterilization take place?

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

314. CHECK 311:

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

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

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

316A. For how long have you been using (METHOD FIRST MENTIONED IN 311) now without stopping?

PROBE: In what month and year did you start using (METHOD FIRST MENTIONED IN 311) continuously?

316B. CHECK 316/315A, 215, AND 230:

WAS THERE A BIRTH IN 215 OR A PREGNANCY IN 230 THAT ENDED IN A MISCARRIAGE, AN ABORTION, OR A STILLBIRTH AFTER THE MONTH AND THE YEAR OF THE START OF THE USE OF CONTRACEPTION BASED ON 316/316A?

317. CHECK 316/316A:

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

320. Where did you obtain (CURRENT METHOD) when you started using it?
320A. Where did you learn to use the lactational amenorrhea method?

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

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

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

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

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

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

325. CHECK 322:

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

CODE '1' NOT CIRCLED: You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320). Were you told about other methods of family planning that you could use?

326. Did a health worker or family planning worker ever tell you about other methods of family planning that you could use?

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

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

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

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

330. Where is this?
Another place?
RECORD ALL PLACES MENTIONED.

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

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

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

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

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401. CHECK 224:

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)

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

403. LINE NUMBER FROM 212:

404. FROM 212 AND 216:

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

406. How much longer would you have liked to wait?

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
[ASK ONLY FOR MOST RECENT BIRTH]

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. IF NO, CIRCLE CODE 'Y'

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

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

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE:
[ASK ONLY FOR MOST RECENT BIRTH]

411. How many months pregnant were you the last time you received antenatal care?
[ASK ONLY FOR MOST RECENT BIRTH]

412. During this pregnancy, were any of the following done at least once?
[ASK ONLY FOR MOST RECENT BIRTH]

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

413. Did anyone tell you about signs of complications from your pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

414. Were you told where to go if you had these complications?
[ASK ONLY FOR MOST RECENT BIRTH]

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

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

417. During this pregnancy, were you given or did you buy iron tablets?
[ASK ONLY FOR MOST RECENT BIRTH]
SHOW TABLETS.

418. During the whole pregnancy, for how many days did you take the tablets?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]

419. During this pregnancy, did you have difficulty with your vision during the daylight?
[ASK ONLY FOR MOST RECENT BIRTH]

420. During this pregnancy, did you suffer form night blindness?
[ASK ONLY FOR MOST RECENT BIRTH]

421. During this pregnancy, did you take any drugs in order to prevent you from getting malaria?
[ASK ONLY FOR MOST RECENT BIRTH]

422. What drugs did you take?
Any other medications?
[ASK ONLY FOR MOST RECENT BIRTH]

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

422A. CHECK 422:
TYPE OF DRUG TAKEN DURING PREGNANCY TO PREVENT MALARIA:
[ASK ONLY FOR MOST RECENT BIRTH]

422B. How many times did you take the Fansidar/Maloxine during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

422C. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY:
[ASK ONLY FOR MOST RECENT BIRTH]

422D. When you were pregnant with (NAME), did you get Fansidar/Maloxine during an antenatal visit, during a different visit in a heath care facility, or from another source?
[ASK ONLY FOR MOST RECENT BIRTH]

422E. CHECK 422:
TYPE OF DRUG TAKEN DURING PREGNANCY TO PREVENT MALARIA:
[ASK ONLY FOR MOST RECENT BIRTH]

422F. How many times did you take the Chloroquine during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

422G. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY:
[ASK ONLY FOR MOST RECENT BIRTH]

422H. When you were pregnant with (NAME), did you get Chloroquine during an antenatal visit, during a different visit in a heath care facility, or from another source?
[ASK ONLY FOR MOST RECENT BIRTH]

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

424. Was (NAME) weighed at birth?

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

425A. Does (NAME) have a birth certificate?
IF NO, PROBE: Was the birth of (NAME) declared to the civil state?

425B. Why wasn't (NAME)'s birth declared to the state?

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

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE IF ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

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

428. Was (NAME) delivered by cesarean section?

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

430. How many days or weeks after delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
[ASK ONLY FOR MOST RECENT BIRTH]

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

432. Where did this first check take place?
[ASK ONLY FOR MOST RECENT BIRTH]

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

433. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW THE CAPSULE. [ASK ONLY FOR MOST RECENT BIRTH]

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

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

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

437. CHECK 226:
IS RESPONDENT PREGNANT?
[ASK ONLY FOR MOST RECENT BIRTH]

438. Have you resumed sexual relations since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

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

440. Did you ever breastfeed (NAME)?

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

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

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

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

444. CHECK 404:
IS CHILD LIVING?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 404:
IS CHILD LIVING?

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

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

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

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

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

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

SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212:

456. FROM 212 AND 216:

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

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

459. Have you ever had a vaccination card for (NAME)?

460. (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE IS RECORDED.

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

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

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

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

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

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

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

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

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

463F. How many times?

463G. An injection to prevent measles?

463H. An injection to prevent yellow fever?

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

465. During the national immunization day campaign, did (NAME) get these vaccinations?
RECORD ALL MENTIONED.

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

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

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

469. CHECK 466 AND 467:
FEVER OR COUGH?

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

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

472. CHECK 466:
HAD A FEVER?

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

472B. Did (NAME) have convulsions at any time in the last 2 weeks?

472C. CHECK 466 AND 472B:
FEVER OR CONVULSIONS?

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

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

ASK TO SEE THE DRUGS IF THE TYPE OF DRUG IS NOT KNOWN. IF THE TYPE OF DRUG CANNOT BE DETERMINED, RECORD THE ANTIMALARIAL DRUG TYPICAL TO THE RESPONDENT.

474A. Did (NAME) get an injection or a suppository to treat (the fever/the convulsions)?

474B. CHECK 474:
WHAT TYPE OF DRUG?

474C. How long after the (fever/convulsions) started did (NAME) first take Fansidar/Maloxine?

474D. For how many days did (NAME) take Fansidar/Maloxine?
IF 7 DAYS OR MORE, RECORD '7'.

474E. Did you have the Fansidar/Maloxine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the Fansidar/Maloxine the first time?

474F. CHECK 474:
TYPE OF DRUG?

474G. How long after the (fever/convulsions) started did (NAME) first take Chloroquine?

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

474I. Did you have the Chloroquine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the Chloroquine the first time?

474J. CHECK 474:
TYPE OF DRUG?

474K. How long after the (fever/convulsions) started did (NAME) first take Amodiaquine/Camoquine?

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

474M. Did you have the Amodiaquine/Camoquine in your home, or did you get it from another source? IF MORE THAN ONE SOURCE, ASK: Where did you get the Amodiaquine/Camoquine the first time?

474N. CHECK 474:
TYPE OF DRUG?

474O. How long after the (fever/convulsions) started did (NAME) first take Quinine?

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

474Q. Did you have the Quinine in your home, or did you get it from another source?
IF MORE THAN ONE SOURCE, ASK: Where did you get the Quinine the first time?

474R. Was anything else done to treat (NAME)'s (fever/convulsions)?

474S. What was done for (NAME)'s (fever/convulsions)?
Anything else?
RECORD ALL MENTIONED.

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

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

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

478. Was he/she given any of the following to drink?

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

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

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

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

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

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

483. GO BACK TO 456 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 484.

484. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2001 OR LATER WITH THE RESPONDENT:

485. What do you usually do with your (youngest) child's stools when he/she doesn't use the toilet?

486. CHECK 478A ALL COLUMNS:

487. Have you ever heard of a special product called ORS, for example Orasel, you can get for the treatment of diarrhea?
SHOW ORS PACKET.

487A. Do you currently have an ORS packet in your home?

487B. Could I see the ORS packet you have?
RECORD THE BRAND OF THE ORS PACKET.

487C. Do you know the brand name of the ORS packet that you have now?
RECORD THE NAME OF THE BRAND.

487D. How much did the packet of ORS cost?

488. CHECK 218:

489. When (your child/one of your children) is seriously ill, can you yourself decide that he/she needs to be taken somewhere for medical treatment?

IF THE RESPONDENT ANSWERS THAT NONE OF HER CHILDREN HAS EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) was to become seriously ill, could you yourself decide that he/she needs to be taken somewhere for medical treatment?

Now I would like to ask you questions about health care for yourself.

490. There are different reasons that prevent women from getting advice or medical treatment for themselves. When you are ill and want advice or medical treatment, which of the following are a serious problem or not?

Knowing where to go.
Getting permission to go.
Getting money for treatment.
Not close to a health care establishment.
Finding a mode of transportation.
Not wanting to go alone.
Worry that there is no female health care professional.

491. CHECK 215 AND 218:

492. Now I would like to ask you about the liquids (NAME FROM 491) drank over the last 7 days, including yesterday. How many days in the last 7 days did (NAME FROM 491) drink one or several of the following liquids?

FOR EACH LIQUID DRANK AT LEAST ONCE IN THE LAST 7 DAYS, ASK: Yesterday, how many times total did (NAME FROM 491) drink (LIQUID DRANK) during the day or night?

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

a) Water?
b) Baby formula?
c) Any other type of milk, such as tinned, powdered, or fresh animal milk?
d) Fruit juice?
e) Other liquids, such as sugar water, tea, coffee, carbonated beverages, or broths?

493. Now I would like to ask you about the foods (NAME FROM 491) ate over the last 7 days, including yesterday. How many days in the last 7 days did (NAME FROM 491) eat one or several of the following foods?

FOR EACH FOOD EATEN AT LEAST ONCE IN THE LAST 7 DAYS, ASK: Yesterday, how many times total did (NAME FROM 491) eat (FOOD EATEN) during the day or night?

a) Rice, corn, sorghum, or other grains?
b) Pumpkin, yam, red or yellow squash, carrots, or red sweet potatoes?
c) Other tuber based foods (for example; potatoes, white yams, cassava root, white sweet potatoes, or other tuber/local roots?
d) Any other green-leaf vegetable?
e) Mango, papaya?
f) Any other fruit or vegetable (for example: banana, apple, applesauce, green beans, avocado, tomato)?
g) Meat, poultry, fish, shellfish, or eggs?
h) Other legume based foods (lentils, beans, soy, peanuts)?
i) Cheese or yogurt?
j) All foods prepared with oil, fat, or butter?

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

495. Did you wash your hands before the last time you prepared a meal for your family?

496. Do you currently smoke cigarettes or tobacco?
IF YES: What do you smoke?
RECORD ALL RESPONSES MENTIONED.

498. How many cigarettes have you smoked in the last 24 hours?

I would like to ask you some questions about your health over the last 6 months.

499B. Over the last 6 months, have you received an injection for any reason?
IF YES: how many injections did you receive?

IF THE NUMBER OF INJECTIONS IS OVER 94 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

499C. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?

IF THE NUMBER OF INJECTIONS IS OVER 94 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

499D. Where did you go to get the last injection?

499E. Did the person who administered the injection the last time take the syringe and needle from a new package that wasn't already opened?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

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

503. What is your current marital status: are you a widow, divorced, or separated?

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

505. RECORD THE LINE NUMBER OF HER HUSBAND/PARTNER ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

506. How old was your husband/partner at his last birthday?

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

508. How many other wives/partners does your husband currently have?

509. Are you the first, second?wife?

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

511. CHECK 510:

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

MARRIED/LIVED WITH MAN MORE THAN ONCE: I would like to talk about the first time you were married or started living with a man as if married. In what month and year were you married or did you start living with a man as if married for the first time?

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

513. CHECK 503:
IS RESPONDENT CURRENTLY A WIDOW?

514. CHECK 510:

515. How did your previous marriage or union end?

516. To whom did most of your late husband's property go to?

517. Did you receive any of your late husband's assets or valuables?

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

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

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

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

521. CHECK 106:

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

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

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

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

526. When was the last time you had sexual intercourse?
IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

[ASK QUESTIONS 527-537 FOR THE LAST (THREE) SEXUAL PARTNER(S)]

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

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

529. The last time you had sexual intercourse (with this last, second, third) person, did you or this person drink alcohol?

530. Were you or your partner drunk at that time?
IF YES: who was drunk?

531. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?

IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

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

533. CHECK 106:

534. How old is this person?

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

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

537. Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months? [DO NOT ASK FOR THIRD-TO-LAST SEXUAL PARTNER]

538. In total, how many different 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 GREATER THAN 95, RECORD '95'.

539. In total, how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, RECORD '95'.

540. CHECK COVER PAGE.
HOUSEHOLD SELECTED FOR MEN'S SURVEY?

541. CHECK FOR PRESENCE OF OTHER PEOPLE.
DO NOT CONTINUE UNTIL YOU ARE COMPLETELY ALONE WITH RESPONDENT.

542. The first time you had sexual intercourse, did you want to have sexual intercourse, or were you forced against your will?

543. Did anyone make you have sexual intercourse against your will in the last 12 months?

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

545. Where is that?
Any other place?
RECORD ALL MENTIONED.

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

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

547. CHECK 527 ALL COLUMNS:

548. Where did you get the condom last time?

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

549. Do you know the brand name of the condoms that you used last time?
RECORD NAME OF BRAND.

550. The last time you bought condoms, how many did you buy?

551. How much did you pay?

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

602. CHECK 226:

NOT PREGNANT OR UNSURE IF PREGNANT: Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children?

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

603. CHECK 226:

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

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

604. CHECK 226:

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

606. CHECK 603:

607. CHECK 602:

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

WANTS NO MORE OR ANY: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method?
Any other reason?

RECORD ALL REASONS MENTIONED.

608. In the coming weeks, if you discovered that you were pregnant, would it be a serious problem, a small problem, or would it not be a problem at all?

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

611. Which method would you prefer to use?

612. What is the main reason that you think you will never use a contraceptive method at any time in the future?

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

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

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

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

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

On the radio?
On the television?
In a newspaper or magazine?

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

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

621. CHECK 501:

622. CHECK 311/311A:

623. You say that you are currently using a contraception method. Would you say that using contraception is mainly your decision, your husband's/partner's decision, or did you both decide together?

Now I want to ask you about your husband's/partner's views on family planning.

624. Do you think your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

625. How often have you talked to your husband/partner about family planning in the last twelve months?

626. CHECK 311/311A:

627. Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

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

She knows her husband has a disease that she can get during sexual intercourse?
She knows her husband has sex with women other than his wives?
She recently gave birth?
She is tired or not in the mood?

629. 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?

630. CHECK 501:

631. Can you refuse sexual intercourse with your husband when you do not wish to have intercourse?

632. Can you ask your husband to use a condom if you want him to use one?

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

701. CHECK 501 AND 502:

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

704. What was the highest level of school he attended: primary, secondary 1, secondary 2, professional A, professional B, or superior?

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

706. CHECK 701:

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

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

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

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

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

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

711. CHECK 710:

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

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

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

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

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

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

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

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

Your own health care?
Making large household purchases?
Making household purchases for daily needs?
Visits to family or relatives?
What food should be cooked every day?

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

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

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

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

Now I would like to talk about something else.

801. Have you ever heard of an illness called AIDS?

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

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

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

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

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

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

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

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

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

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

During pregnancy?
During delivery?
By breastfeeding?

812. CHECK 811:

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

814. Are there any special drugs that people infected with the AIDS virus can get from a doctor or a nurse?

815. CHECK 215:

816. CHECK 407:

Now I would like to ask you some questions about your last birth.

817. You said that you saw someone for antenatal care during this pregnancy. During any of the antenatal visits for your last birth, did anyone talk to you about:

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

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

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

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

821. Where was the test done?

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

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

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

824. I don't want to know the result, but have you ever been tested to see if you have the AIDS virus?

825. When was the last time you were tested?

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

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

828. Where was the test done?

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

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

830. Where is that?
Any other place?
RECORD ALL PLACES MENTIONED.

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

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

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

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

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

835. Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?

836. Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?

837. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?

838. CHECK 835, 836, AND 837:

839. Do you personally know someone who has or is suspected to have the AIDS virus?

840. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

841. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

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

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

844. Do you think that young men should wait until marriage to have sexual intercourse?

845. Do you think that young women should wait until marriage to have sexual intercourse?

846. Do you think that married men should avoid having sexual intercourse with people other than their spouses?

847. Do most of the men you know only have sexual intercourse with their spouses?

848. Do you think that married women should avoid having sexual intercourse with people other than their spouses?

849. Do most of the women you know only have sexual intercourse with their spouses?

850. CHECK 801:

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

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

851. If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED.

852. If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED.

853. CHECK 519:

854. CHECK 850:

Now I would like to ask you some questions about your health in the last 12 months.

855. During the last 12 months, have you had a disease which you got through sexual contact?

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

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

858. CHECK 855, 856, AND 857:

859. The last time you had (INFECTION FROM 855/856/857), did you seek any kind of advice or treatment?

860. Where did you go?
Any other place?
RECORD ALL THAT IS MENTIONED.

861. The last time you had (INFECTION FROM 855/856/857), did your partner seek any kind of advice or treatment?

862. Where did he go?
Any other place?
RECORD ALL THAT IS MENTIONED.

SECTION 9. FEMALE CIRCUMCISION

901. Have you ever heard of female circumcision?

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

903. Have you yourself ever had your genitals cut?

Now I would like to ask you what was done to you at this time.

904. Was any flesh removed from the genital area?

905. Was the genital area just nicked without removing any flesh?
IF YES, CHECK 904 AND CHANGE IF NECESSARY.

906. Was your genital area closed in any way?

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

908. Who performed the circumcision?

909. CHECK 214 AND 216:

910. Did any of your daughters have her genitals cut?
IF YES: How many?

911. To which of your daughters did this happen most recently?
(CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER)

912. Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM 911) at this time. Was any flesh removed from her genital area?

913. Was her genital area just nicked without removing any flesh?

914. Was her genital area closed in any way?

915. How old was (NAME OF THE DAUGHTER FROM 911) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

916. Who performed the circumcision?

917. At the time that the genitals were cut or afterwards, did (NAME OF THE DAUGHTER FROM 911) have any of the following problems:

Excessive bleeding?
Difficulty in passing urine/urine retention?
Swelling in the genital region?
Infection in the genital region/has not healed properly?

918. Do you intend to have this genital cutting done to any of your daughters in the future?

919. What benefits do girls get if they undergo this genital cutting?
PROBE: Other benefits?
RECORD ALL MENTIONED.

920. What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED.

921. Would you say that this practice is a way to prevent a girl from having sex before marriage or does it have no effect on premarital sex?

922. Do you believe that this practice is required by your religion?

923. Do you think that this practice should be continued, or should it be discontinued?

924. Do you think that men want this practice to be preserved, or do you think that they are in favor of abandoning it?

SECTION 10. MATERNAL MORALITY

Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother.

1001A. Did your mother give birth to other children, in addition to you?

1001B. How many boys did your mother have who are still living?

1001C. Other than yourself, how many girls did your mother have who are still living?

1001D. How many boys did your mother have who died?

1001E. How many girls did your mother have who died?

1001F. Did your mother give birth to any other children, who you don't know if they are living or dead?

1001G. How many other children did your mother give birth to, who you don't know if they are living or dead?

1001H. ADD THE ANSWERS FROM 1001B, C, D, E, AND G. ADD '1' TO THIS NUMBER (TO INCLUDE THE RESPONDENT) AND RECORD THE TOTAL.

1001I. CHECK 1001H:
Just to make sure that I've understood, including yourself, your mother gave birth to _____ children total. Is that correct?

1002. CHECK 1001H:

1003. How many of these births did your mother have before you were born?

Now I would like to make a list of all your brothers and sisters, whether they are still alive or not, starting with the oldest. RECORD THE NAMES OF ALL BROTHERS AND SISTERS.

[ASK 1004-1013 FOR ALL OF RESPONDENT'S SIBLINGS]

1004. What was the name given to your oldest (next oldest) brother or sister?

1005. Is (NAME) male or female?

1006. Is (NAME) still alive?

1007. How old is (NAME)?

1008. How many years ago did (NAME) die?

1009. How old was (NAME) when he/she died?
IF DOESN'T KNOW, PROBE: Did (NAME) die before the age of 12? IF YES, RECORD '95'.
IF NO, ASK OTHER QUESTIONS TO GET AN ESTIMATE, FOR EXAMPLE: Did (NAME) die before getting married?

1010. Was (NAME) pregnant when she died?

1011. Did (NAME) die during childbirth?

1012. Did (NAME) die within two months after the end of a pregnancy or childbirth?

1013. How many live born children did (NAME) give birth to during her lifetime?

[IF NO OTHER BROTHERS OR SISTERS, GO TO 1014]

1014. RECORD TIME:

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT _____

COMMENTS ON SPECIFIC QUESTIONS _____

ANY OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
NAME _____
DATE _____

EDITOR'S OBSERVATIONS _____
NAME _____
DATE _____

CALENDAR INSTRUCTIONS

ONE CODE FOR EACH SPACE.

BIRTHS AND PREGNANCIES:

2005:
12 DEC 01 _____
11 NOV 02 _____
10 OCT 03 _____
09 SEPT 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 _____

2004:
12 DEC 13 _____
11 NOV 14 _____
10 OCT 15 _____
09 SEPT 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 _____

2003:
12 DEC 25 _____
11 NOV 26 _____
10 OCT 27 _____
09 SEPT 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 _____

2002:
12 DEC 37 _____
11 NOV 38 _____
10 OCT 39 _____
09 SEPT 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 _____

2001:
12 DEC 49 _____
11 NOV 50 _____
10 OCT 51 _____
09 SEPT 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 _____

2000:
12 DEC 61 _____
11 NOV 62 _____
10 OCT 63 _____
09 SEPT 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 _____