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DEMOGRAPHIC AND HEALTH SURVEY
WOMAN'S QUESTIONNAIRE
MAY 2012
REPUBLIC OF GUINEA
NATIONAL OFFICE OF STATISTICS


IDENTIFICATION

NAME OF PLACE__________

NAME OF HEAD OF HOUSEHOLD____________

CLUSTER NUMBER___________

HOUSEHOLD NUMBER____________

ADMINISTRATIVE REGION_____________

URBAN/RURAL

URBAN 1
RURAL 2

CONAKRY/NATURAL CAPITAL REGION/OTHER CITY/RURAL

CONAKRY 1
CAPITAL REGION 2
OTHER CITY 3
RURAL 4

NAME AND LINE NUMBER OF WOMAN___________

INTERVIEWER VISITS

DATE______________
INTERVIEWER'S NAME___________
RESULT*_____________

FINAL VISIT_____________
DAY___________
MONTH___________
YEAR 2012
INT. NUMBER_____________
RESULT___________

NEXT VISIT____________
DATE___________
TIME__________

TOTAL NO. OF VISITS

RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE____________
LANGUAGE OF INTERVIEW___________

INTERPRETER

YES 1
NO 2

LANGUAGE CODES:

1 FRENCH
2 SOUSSOU
3 PEUHL
4 MALINKE
5 KISSI
6 LOMA
7 KPELE
8 OTHERS

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT
INFORMED CONSENT

Hello. My name is ___. I am working with the National Statistical Institute (INS). We are conducting a survey about health all over Guinea. The information we collect will help the government to improve 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?

SIGNATURE OF INTERVIEWER___________ DATE_________

RESPONDENT AGREES TO BE INTERVIEWED__________ 1

RESPONDENT DOES NOT AGREE TO BE INTERVIEWED_________ 2 END

101) RECORD THE TIME

HOUR_______
MINUTES________

102) In what month and year were you born?

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

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

AGE IN COMPLETED YEARS______

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

105) What is the highest level of school you attended: Primary, Secondary, or Higher?

PRIMARY 1
SECONDARY 1 2
SECONDARY 2 3
PROFESSIONAL A 4
PROFESSIONAL B 5
HIGHER 6

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

GRADE/FORM/YEAR__________

107) CHECK 105:

PRIMARY
SECONDARY OR HIGHER (GO TO 110)

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

SHOW CARD TO RESPONDENT

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

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

109) Check 108:

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

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

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

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

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


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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
113) What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY)_____ 6

114) What is your ethnicity?

SOUSSOU 1
PEUHL 2
MALINKE 3
KISSI 4
TOMA 5
GUERE 6
OTHER (SPECIFY) 96

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

NUMBER OF TIMES
NONE 00 (GO TO 201)

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

YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME__________
DAUGHTERS AT HOME_________

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

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECODE '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 or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD
GIRLS DEAD

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

TOTAL BIRTHS______

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

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

210) CHECK 208:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 226)

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.)

212) What name was given to you (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?

SING 1
MULT 2
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH_________
YEAR_________

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS___________

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

YES 1
NO 2

219) IF ALIVE:
Record household line number of child (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

HOUSEHOLD LINE NUMBER____________
(NEXT BIRTH)

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

IF '1 YR', PROBE: How many months old was (NAME)? Record days if less than 1 month; months if less than two years, or years if two year or more.

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)

[##translator note: same questions repeated on next page, with 08-12 for larger families]

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

YES 1
NO 2

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

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

224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2007 OR LATER.

NUMBER OF BIRTHS________
NONE 0 (GO TO 226)

226) Are you pregnant now?

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

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS_________

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

YES 1 (GO TO 230)
NO 2

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?

MONTH
YEAR

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN 2007 OR LATER
LAST PREGNANCY ENDED BEFORE JAN. 2007 (GO TO 238)

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

MONTHS

234) Since January 2007, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 236)

236) Did you have any miscarriages, abortions or stillbirths that ended before 2007?

YES 1
NO 2 (GO TO 238)

237) When did the last such pregnancy that terminated before 2007 end?

MONTH_________
YEAR_______

238) When did you last menstrual period start?
(DATE, IF GIVEN)________

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

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

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

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

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

SECTION 3. CONTRACEPTION

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

Have you ever heard of (METHOD)?

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.
YES 1
NO 2
04) INJECTABLES
PROBE: Women can have an injection by a heath 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) 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) LACTATIONAL AMENORRHEA METHOD (LAM)
Up to 6 months after childbirth, and when her menstrual period has not returned, a woman can use a method that requires that she breastfeeds whenever the child asks, day and night, without giving him any other food.
YES 1
NO 2
10) DIAPHRAGM
Women can place a latex disk on their cervix before intercourse.
YES 1
NO 2
11) TABLET/FOAM/JELLY
Women can place a tablet, foam or jelly in their vagina before intercourse.
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 they can get pregnant.
YES 1
NO 2
13) WITHDRAWAL
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14) 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
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
(SPECIFY)__________
(SPECIFY)__________
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 313)

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

YES 1
NO 2 (GO TO 313)

304) Which method are you using?

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

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

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

PLANYL 01
MINIDRIL 02
ADEPAL 03
TRIELLA 04
STEDRIL 05
MICROVAL 06
ORVETTE 07
NORLEVO 08
MICROLITTLE 09
MICROGINON 10
LOFEMEL 11

OTHER (SPECIFY) 96
DON'T KNOW 98
(ALL GO TO 308A)

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

PRUDENCE PLUS 01
CONDOM IPPF 02
DUREX 03
SULTAN 04
SUPERMAX 05
INOTEX 06
FEMIDON 07
MANIX EXTRA 08
MANIX NOUVEAU 09
MANIX CONTACT 10
MANIX PLEASUR 11
KAMASUTURA 12
FAGARU 13
TTK 14
ANYTIME 15
PROTECTOR 16

OTHER (SPECIFY) 96
DON'T KNOW 98
(ALL GO TO 308A)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR'S OFFICE 22
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER (SPECIFY) 96
DON'T KNOW 98

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

308a) Since what month and year did you start using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD FIRST MENTIONED) now without stopping?

MONTH_________
YEAR_________

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

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

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

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

315) You first started using (CURRENT METHOD) in (date from 308/308a). Where did you get it at that time?

315a) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
FIELDWORKER 14
OTHER (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
FIELDWORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB/HOTEL 32
FRIEND/RELATIVES 33
OTHER (SPECIFY) 96

316) CHECK 304:
CIRCLE METHOD CODE:

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

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)

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

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

YES 1 (GO TO 319)
NO 2

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

YES 1
NO 2 (GO TO 320)

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

YES 1
NO 2

320) CHECK 317:

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

CODE '2' CIRCLED When you obtained (Current method from 314) from (Source of method from 307 or 315), were you told about other methods of family planning that you could use?

YES 1 322
NO 2

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

YES 1
NO 2

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

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

323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC/AGBEF [##TRANSLATOR NOTE: GUINEAN ASSOCIATION FOR FAMILIAL WELL-BEING] 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB/HOTEL 32
FRIEND/RELATIVES 33
OTHER (SPECIFY) 96
(All GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

PUBLIC SECTOR
A GOVERNMENT HOSPITAL
B GOVERNMENT HEALTH CENTER
C FAMILY PLANNING CLINIC/AGBEF [##TRANSLATOR NOTE: GUINEAN ASSOCIATION FOR FAMILIAL WELL-BEING]
D FIELDWORKER
E OTHER (SPECIFY)
PRIVATE MEDICAL SECTOR
F PRIVATE HOSPITAL/CLINIC
G PHARMACY
H PRIVATE DOCTOR
I FIELDWORKER
J OTHER PRIVATE MEDICAL (SPECIFY)
OTHER SOURCE
K SHOP
L BAR/NIGHTCLUB/HOTEL
M FRIEND/RELATIVES
X OTHER (SPECIFY)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2007 OR LATER
NO BIRTHS IN 2007 OR LATER (GO TO 462)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2007 OR LATER. ASK THE QUESTIONS ABOUT ALL 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 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_________
DEAD_______

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

YES 1 (GO TO 408)
NO 2

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

LATER 1
NO MORE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS 1_________
YEARS 2_______
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 415)

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

HEATH PROFESSIONAL
A DOCTOR
B MIDWIFE
C HEALTH AID
D NURSE
E TRIAGE
OTHER PERSON
F TRADITIONAL BIRTH ATTENDANT
G COMMUNITY/VILLAGE FIELDWORKER
X OTHER (SPECIFY)

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

HOME
A YOUR HOME
B OTHER HOME
PUBLIC SECTOR
C GOVERNMENT HOSPITAL
D GOVERNMENT HEALTH CENTER
E GOVERNMENT HEALTH POST
F OTHER PUBLIC SECTOR(SPECIFY)
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC
H OTHER PRIVATE MEDICAL (SPECIFY)
X OTHER (SPECIFY)

411) How many months pregnant were you the last time you received antenatal care?

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?

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

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

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

YES 1
NO 2
DON'T KNOW 8

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

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

416) During this pregnancy, how many times did you get this injection?

TIMES______
DON'T KNOW 8

417) CHECK 416:

2 OR MORE TIMES (GO TO 421)
OTHER

418) At any time before this pregnancy, did you receive any tetanus injections?

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

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

TIMES_____
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO__________

421) During this pregnancy, were you given or did you buy iron tablets or iron syrup?
SHOW TABLES/SYRUP

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

422) During the whole pregnancy, for how many days did you take the tables or syrup?
IF ANSWER NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS________
DON'T KNOW 998

423) During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

424) During this pregnancy, did you take any drugs to keep you from getting malaria?

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

425) What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

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

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

CODE A CIRCLED
CODE A NOT CIRCLED (GO TO 430)

427) How many times did you take (SP/Fansidar) during this pregnancy?

TIMES______

428) CHECK 409:
Antenatal care from health personnel during this pregnancy

CODE A, B, OR C CIRCLED
OTHER (GO TO 430)

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility, or from another source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

429a) Did you take the (SP/Fansidar) obtained in q 429 in front of the doctor/nurse, at home, or elsewhere?

IN FRONT OF NURSE/DOCTOR 1
AT HOME 2
ELSEWHERE 3

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

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

431) Was (NAME) weighed at birth?

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

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

GRAMS FROM CARD 1
GRAMS FROM RECALL 2
DON'T KNOW 99998

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

PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS ASSISTING.

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

HEATH PROFESSIONAL
A DOCTOR
B MIDWIFE
C HEALTH AID
D NURSE
E TRIAGE
F MATRON
OTHER PERSON
G TRADITIONAL BIRTH ATTENDANT
H FRIENDS/RELATIVES
X OTHER (SPECIFY)
Y NO ONE ASSISTED

434) Where did you give birth to (NAME)?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
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
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96 (GO TO 438)

434a) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

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

YES 1
NO 2

435a) Where there any complications during (NAME)'s delivery?

YES 1
NO 2 (GO TO 436)

435b) What type of complications did you have?

HEMORRHAGE 1
LABOR TOO LONG 2
OTHER (SPECIFY) 6

435c) Did you receive care?

YES 1
NO 2 (GO TO 436)

435d) Who provided that care?

HEATH PROFESSIONAL
A DOCTOR
B MIDWIFE
C HEALTH AID
D NURSE
E TRIAGE
OTHER PERSON
F TRADITIONAL BIRTH ATTENDANT
G COMMUNITY/VILLAGE FIELDWORKER
X OTHER (SPECIFY)

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

YES 1
NO 2 (GO TO 439)

437) Did anyone check on your health after you left the facility?

YES 1 (GO TO 439)
NO 2 (GO TO 442)
438) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO 2 (GO TO 442)

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

HEATH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
HEALTH AID 13
NURSE 14
TRIAGE 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE FIELDWORKER 22
OTHER (SPECIFY) 96

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

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

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

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

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

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

HEATH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
HEALTH AID 13
NURSE 14
TRIAGE 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE FIELDWORKER 22
OTHER (SPECIFY) 96

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

HOME
YOUR HOME 11
OTHER HOME 12
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
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS

YES 1
NO 2
DON'T KNOW 8

447) Has your menstrual period returned since the birth of (name)?

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

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

YES 1
NO 2 (GO TO 452)

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

MONTHS
DON'T KNOW 98

450) CHECK 226:

IS RESPONDENT PREGNANT?

NOT PREGNANT
PREGNANT OR NOT SURE (GO TO 452)

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

YES 1
NO 2 (GO TO 453)

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

MONTHS
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

455) 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.

IMMEDIATELY 000
HOURS 1
DAYS 2

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

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

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

458) CHECK 404:
IS CHILD LIVING?

LIVING
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 462)

459) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

461) (GO BACK TO 405 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 462)

SECTION 4.B OBSTETRIC FISTULA

462) Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina. This problem usually occurs 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?

YES 1 (GO TO 464)
NO 2

463) Have you ever heard of this problem, meaning of a woman with constant leakage of urine or stool from her vagina?

YES 1 (GO TO 470)
NO 2 (GO TO 470)

464) Did this problem start after you delivered a baby, after a sexual assault, after a pelvic surgery, or after another event?

DELIVERY 1
ASSAULT 2 (GO TO 466)
PELVIC SURGERY 3 (GO TO 466)
OTHER (SPECIFY) 6 (GO TO 466)

465) Was this baby born alive?

YES 1
NO 2

466) Have you sought treatment for this condition?

YES 1 (GO TO 468)
NO 2

467) Why have you not sought treatment?
PROBE AND RECORD ALL MENTIONED
PROBE: WHAT ELSE?

A DO NOT KNOW CAN BE FIXED
B DO NOT KNOW WHERE TO GO
C TOO EXPENSIVE
D TOO FAR
E POOR QUALITY OF CARE
F COULD NOT GET PERMISSION
G EMBARRASSMENT
X OTHER (SPECIFY)
(ALL GO TO 470)

468) From whom did you last seek treatment?

HEATH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
HEALTH AID 13
NURSE 14
TRIAGE 15
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE FIELDWORKER 22
TRADITIONAL PRACTITIONER 23
OTHER (SPECIFY) 96

469) Did the treatment stop the leakage completely?
IF NO, DID THE TREATMENT REDUCE THE LEAKAGE?

YES, STOPPED COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3

470) CHECK 224:

ONE OR MORE BIRTHS IN 2007 OR LATER
NO BIRTHS IN 2007 OR LATER (GO TO 556)

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2007 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)

502) Birth history number from 212 in birth history

BIRTH HISTORY NUMBER________

503) From 212 and 216

NAME_______
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

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

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

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

YES 1 (GO TO 509)
NO 2

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

BCG
DAY
MONTH
YEAR
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY
MONTH
YEAR
POLIO 1
DAY
MONTH
YEAR
POLIO 2
DAY
MONTH
YEAR
POLIO 3
DAY
MONTH
YEAR
DTCOQ 1/PENTA 1
DAY
MONTH
YEAR
DTCOQ 2/PENTA 2
DAY
MONTH
YEAR
DTCOQ 3/PENTA 3
DAY
MONTH
YEAR
MEASLES
DAY
MONTH
YEAR
VITAMIN A
DAY
MONTH
YEAR
YELLOW FEVER (MOST RECENT)
DAY
MONTH
YEAR

507) CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER

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

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

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

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

FIRST 2 WEEKS 1
LATER 2

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

NUMBER OF TIMES

510e) A Pentavalan vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 510G)
DON'T KNOW 3 (GO TO 510G)

510f) How many times was the Pentavalan vaccination given?

NUMBER OF TIMES

510g) A measles injection or an MMR injection- that is, a shot in the arm at the age of 9 months or older,- to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

510h) The yellow fever vaccination, that is, an injection in the arm at the age of 9 months or older?

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

510i) How many times was the yellow fever vaccination given?

NUMBER OF TIMES

511) Within the last six months, was (name) given a vitamin A dose like (this/any of these)?
Show common types of ampoules/capsules/syrups.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

515) Was there any blood in the stools?


YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

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

YES 1
NO 2 (GO TO 522)

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

(NAME OF PLACE(S))

PUBLIC SECTOR
A GOVERNMENT HOSPITAL
B GOVERNMENT HEALTH CENTER
C GOVERNMENT HEALTH POST
D FIELDWORKER
E OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
F PRIVATE HOSPITAL/CLINIC
G PHARMACY
H PRIVATE DOCTOR
I MOBILE CLINIC
J FIELDWORKER
K OTHER PRIVATE MEDICAL (SPECIFY)
OTHER SOURCE
L SHOP
M TRADITIONAL PRACTITIONER
N MARKET
X OTHER (SPECIFY)

520) CHECK 519:

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

521) Where did you first seek advice or treatment?
Use letter code from 519

FIRST PLACE_____

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea?
a) A fluid made from a special packet called [Orasel]?
c) A government-recommended homemade fluid (water + salt + sugar)?

FLUID FORM ORS PKT
YES 1
NO 2
DK 8
HOMEMADE FLUID
YES 1
NO 2
DK 8

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

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

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

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

530) CHECK 525:
Had fever?

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

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

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

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

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

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

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

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

YES 1
NO 2 (GO TO 537)

534) Where did you seek advice or treatment?

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

(NAME OF PLACE(S))

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

535) CHECK 534:

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

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

FIRST PLACE____

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

YES 1

NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

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

538) What drugs did (NAME) take?
Any other drugs?
Record all mentioned

ANTIMALARIAL DRUGS
A SP/FANSIDAR
B CHLOROQUINE
C AMODIAQUINE
D QUININE
E COMBINATION WITH ARTEMISININ
F OTHER ANTIMALARIAL (SPECIFY)
ANTIBIOTIC
G PILL/SYRUP
H INJECTION
OTHER DRUGS
I ASPIRIN
J ACETAMINOPHEN
K IBUPROFEN
X OTHER (SPECIFY)
Z DON'T KNOW

539) CHECK 538:
ANY CODE A-F CIRCLED?

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

540) CHECK 538:

SP/FANSIDAR (A) GIVEN

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

541) How long after the fever started did (name) first take (SP/Fansidar)?

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

542) CHECK 538:
CHLOROQUINE (B) GIVEN

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

543) How long after the fever started did (name) first take (Chloroquine)?

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

544) Check 538:
AMODIAQUINE (C) GIVEN

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

545) How long after the fever started did (NAME) first take (Amodiaquine)?

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

546) CHECK 538:
QUININE (D) GIVEN

CODE D CIRCLED
CODE D NOT CIRCLED (GO TO 548)

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

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

548) CHECK 538:
COMBINATION WITH ARTEMISININ (E) GIVEN

CODE E CIRCLED
CODE E NOT CIRCLED (GO TO 550)

549) How long after the fever started did (NAME) first take (COMBINATION WITH ARTEMISININ)?

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

550) CHECK 538:
OTHER ANTIMALARIAL (F) GIVEN

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

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

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

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

553) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2007 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 554)

NONE (GO TO 556)

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

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) 07

555) CHECK 522A AND 522B, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID

ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 557)

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

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 558)

NONE (GO TO 601)

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

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

a) plain water?

YES 1
NO 2
DK 8

b) juice or juice drinks?

YES 1
NO 2
DK 8

c) clear broth?

YES 1
NO 2
DK 8

d) milk such as tinned, powdered, or fresh animal milk?

YES 1
NO 2
DK 8

IF YES, how many times did (NAME) drink milk?
IF 7 OF MORE TIMES, RECORD 7

NUMBER OF TIMES DRANK MILK

e) Infant formula?

YES 1
NO 2
DK 8

IF YES, how many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD 7

NUMBER OF TIMES DRANK FORMULA

f) Any other liquids?

YES 1
NO 2
DK 8

g) Yogurt?

YES 1
NO 2
DK 8

IF YES, how many times did (Name) eat yogurt?
IF 7 OR MORE TIMES, RECORD 7

NUMBER OF TIMES ATE YOGURT

h) Any [Brand name of commercially fortified baby food, e.g. Cerelac]?

YES 1
NO 2
DK 8

i) bread, rice, noodles, porridge, or any other foods made from grains (corn, sorghum, millet,
fonio)? [##translator note: fonio is a type of grain native to West Africa]

YES 1
NO 2
DK 8

j) pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?

YES 1
NO 2
DK 8

k) white potatoes, white yams, manioc, cassava, or any other foods made from roots?

YES 1
NO 2
DK 8

l) any dark green, leafy vegetables?

YES 1
NO 2
DK 8

m) mangoes, papayas or ripe mangoes?

YES 1
NO 2
DK 8

n) any other fruits or vegetables?

YES 1
NO 2
DK 8

o) liver, kidney, heart or any other organ meats?

YES 1
NO 2
DK 8

p) any meat, such as beef, pork, lamb, goat, chicken or duck?

YES 1
NO 2
DK 8

q) eggs?

YES 1
NO 2
DK 8

r) fresh or dried fish or shellfish?

YES 1
NO 2
DK 8

s) any foods made from beans, peas, lentils, or nuts?

YES 1
NO 2
DK 8

t) cheese or other food made from milk?

YES 1
NO 2
DK 8

u) any other solid, semi-solid, or soft food?

YES 1
NO 2
DK 8

559) CHECK 558 (CATEGORIES G THROUGH U)

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

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

YES 1(GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

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

NUMBER OF TIMES
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

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

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

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

NAME________
LINE NO.__________

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

YES 1
NO 2 (GO TO 609)
DK 8 (GO TO 609)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS______
DON'T KNOW

608) Are you the first, secondÂ…wife?

RANK _____

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

ONCE 1
MORE THAN ONCE 2

610) CHECK 609:
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 your first (husband/partner). In what month and year were you married or did you start living with him?

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

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

AGE _____

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

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

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

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

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

615) When was the last time you had sexual intercourse.

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

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4 (GO TO 627)

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

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3

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

YES 1
NO 2 (GO TO 619)

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

YES 1
NO 2

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

IF YES, CIRCLE 2
IF NO, CIRCLE 3

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

620) CHECK 609:

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

621) CHECK 613

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

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

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

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

NUMBER OF TIMES______

624) How old is this person?

AGE OF PARTNER
DON'T KNOW 98

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

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

626) 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, WRITE 95

NUMBER OF PARTNERS LAST 12 MONTHS
DON'T KNOW 98

627) 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, WRITE 95

NUMBER OF PARTNERS IN LIFETIME
DON'T KNOW 98

628) Presence of others during this section

CHILDREN UNDER 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 632)

630) Where is that?
Any other place?
Probe to identity the type of source.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

PUBLIC SECTOR
A GOVERNMENT HOSPITAL A
B GOVERNMENT HEALTH CENTER B
C FAMILY PLANNING CLINIC/AGBEF [##TRANSLATOR NOTE: GUINEAN ASSOCIATION FOR FAMILIAL WELL-BEING]

D FIELDWORKER
E OTHER (SPECIFY)
PRIVATE MEDICAL SECTOR
F PRIVATE HOSPITAL/CLINIC F
G PHARMACY G
H PRIVATE DOCTOR H
I FIELDWORKER I
J OTHER PRIVATE MEDICAL (SPECIFY) J
OTHER SOURCE
K SHOP K
L BAR/NIGHTCLUB/HOTEL L
M FRIEND/RELATIVES M
X OTHER (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

633) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

PUBLIC SECTOR
A GOVERNMENT HOSPITAL
B GOVERNMENT HEALTH CENTER
C FAMILY PLANNING CLINIC/AGBEF [##TRANSLATOR NOTE: GUINEAN ASSOCIATION FOR FAMILIAL WELL-BEING]

D FIELDWORKER
E OTHER (SPECIFY)
PRIVATE MEDICAL SECTOR
F PRIVATE HOSPITAL/CLINIC
G PHARMACY
H PRIVATE DOCTOR
I FIELDWORKER
J OTHER PRIVATE MEDICAL (SPECIFY)
OTHER SOURCE
K SHOP
L BAR/NIGHTCLUB/HOTEL
M FRIEND/RELATIVES
X OTHER (SPECIFY)

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED
HE OR SHE STERILIZED (GO TO 712)

702) CHECK 226:

PREGNANT
NOT PREGNANT OR UNSURE (GO TO 704)

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

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

704) Now I have some question 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 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (GO TO 710)

705) CHECK 226:

NOT PREGNANT OR NOT SURE 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?

MONTHS_________ 1
YEARS__________ 2
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

NO PREGNANT OR UNSURE
PREGNANT (GO TO 711)

707) CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING
CURRENTLY USING (GO TO 712)

708) CHECK 705:

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

709) CHECK 704:
WANTS TO HAVE A/ANOTHER CHILD--You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?

Any other reason?

WANTS NO MORE/NONE--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.

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

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

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

YES 1
NO 2
DON'T KNOW 8

712) CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

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

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

BOYS
NUMBER________
GIRLS
NUMBER________
EITHER
NUMBER________
OTHER (SPECIFY) 96

714) In the last three months have you
Heard about family planning on the radio?
Heard about family planning on the television?
Read something on family planning in a newspaper or magazine?

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

716) CHECK 601:

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

717) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

)

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

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

719) CHECK 304:

NEITHER STERILIZED
HE OR SHE STERILIZED (GO TO 801)

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

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

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

801) CHECK 601 AND 602:

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

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

__________

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

YES 1
NO 2 (GO TO 806)

804) What was the highest level of school he attended: Primary, Secondary, or Higher?

PRIMARY 1
SECONDARY 1 2
SECONDARY 2 3
PROFESSIONAL A 4
PROFESSIONAL B 5
HIGHER 6
DON'T KNOW 8 (GO TO 806)

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

GRADE___________
DON'T KNOW 98

806) CHECK 801:

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

FORMERLY married/lived with a man
What was your (last) (husband's/partner's) occupation? That is, what kind of work did he mainly do?

_______________

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1(GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

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

_________

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

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

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

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

814) Are you paid or do you ear in cash or in 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

815) CHECK 601:

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

816) CHECK 814:

CODE 1 OR 2 CIRCLED
OTHER (GO TO 819)

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

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

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

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

819) Who usually decides how the money your (husband/partner) 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 HAS NO EARNINGS 4
OTHER (SPECIFY) 6

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

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

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

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

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

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

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

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

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

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

825) Presence of others at this point (present and listening, present but not listening, or not present)

CHILDREN UNDER 10
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
HUSBAND
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
OTHER MALES
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
OTHER FEMALES
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3

826) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DK 8
NEGL. CHILDREN
YES 1
NO 2
DK 8
ARGUES
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8
BURNS FOOD
YES 1
NO 2
DK 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

906) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

908) Can the virus that causes AIDS be transmitted from a mother to a baby?
During pregnancy? During preg. Ys 1 No 2 DK 8
During delivery? During delivery
By breastfeeding? Breastfeeding

PREGNANCY
YES 1
NO 2
DK 8
DELIVERY
YES 1
NO 2
DK 8
BREASTFEEDING
YES 1
NO 2
DK 8

909) CHECK 908:

AT LEAST ONE YES
OTHER (GO TO 911)

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

YES 1
NO 2
DK 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2010
NO BIRTHS (GO TO 926)
LAST BIRTH BEFORE JANUARY 2010 (GO TO 926)

912) Check 408 for last birth

HAD ANTENATAL CARE
NO ANTENATAL CARE (GO TO 920)

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

914) During any of the antenatal visits for your last birth were you given any information about:
Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

AIDS FROM MOTHER
YES 1
NO 2
DK 8
THINGS TO DO
YES 1
NO 2
DK 8
TESTED FOR AIDS
YES 1
NO 2
DK 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 920)

917) Where was the test done?

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

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
FIELDWORKER 15
SCHOOL BASED CLINIC 16
OTHER PUBLIC (SPECIFY) 17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
STAND-ALONE VCT CENTER 22
PHARMACY 23
FIELDWORKER 24
SCHOOL BASED CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER SOURCE 31
CORRECTIONAL FACILITY 32
OTHER (SPECIFY) 96

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

YES 1
NO 2 (GO TO 924)

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

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

920) CHECK 434 FOR LAST BIRTH

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

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

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

YES 1 (GO TO 927)
NO 2

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

MONTHS AGO (GO TO 932)
TWO OR MORE YEAR AGO 95(GO TO 932)

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

YES 1
NO 2 (GO TO 930)

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

MONTHS AGO___________
TWO OR MORE YEARS AGO 95

928) I do not want to know the results, but have you results of this test?

YES 1
NO 2

929) Where was the test done?

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

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
FIELDWORKER 15
SCHOOL BASED CLINIC 16
OTHER PUBLIC (SPECIFY) 17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
STAND-ALONE VCT CENTER 22
PHARMACY 23
FIELDWORKER 24
SCHOOL BASED CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 26
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 32
OTHER (SPECIFY) 96

(ALL SKIP 932)

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

YES 1
NO 2 (GO TO 932)

931) Where is that?
Any other place?

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

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE(S))

PUBLIC SECTOR
A GOVERNMENT HOSPITAL
B GOVERNMENT HEALTH CENTER
C STAND-ALONE VCT CENTER
D FAMILY PLANNING CLINIC
E FIELDWORKER
F OTHER PUBLIC (SPECIFY)
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR
H STAND-ALONE VCT CENTER
I PHARMACY
J FIELDWORKER
K OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
X OTHER (SPECIFY)

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

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

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

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

937) CHECK 901:

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

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

YES 1
NO 2

938) CHECK 613:

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

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

YES
NO (GO TO 941)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

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

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

YES 1
NO 2 (GO TO 946)

945) Where did you go?

Any other place?

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

PUBLIC SECTOR
A GOVERNMENT HOSPITAL
B GOVERNMENT HEALTH CENTER
C STAND-ALONE VCT CENTER
D FAMILY PLANNING CLINIC
E FIELDWORKER
F OTHER PUBLIC (SPECIFY)
PRIVATE MEDICAL SECTOR
G PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR
H STAND-ALONE VCT CENTER
I PHARMACY
J FIELDWORKER
K OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
L SHOP
X OTHER (SPECIFY)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

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

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. MATERNAL MORTALITY

1001a) 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.
Did your mother give birth to any children other than yourself?

YES 1
NO 2 (GO TO 1001H)

1001b) How many boys did your mother have who are still living?

BOYS LIVING__________

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

GIRLS LIVING__________

1001d) How many boys did your mother have who died?

BOYS DIED_________

1001e) How many girls did your mother have who died?

GIRLS DIED________

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

YES 1
NO 2 (GO TO 1001H)

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

OTHER CHILDREN

1001h) ADD THE ANSWERS FORM 1001B, C, D, E, AND G,
ADD 1 (THE RESPONDENT) AND RECORD THE TOTAL

TOTAL___________

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

YES____________________
NO (PROBE AND CORRECT 1001A-1001H AS NECESSARY)

1002) CHECK 1001H:

TWO OR MORE BIRTHS
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1101)

1003) HOW MANY OF THESE BIRTHS DID YOUR MOTHER HAVE BEFORE YOU WERE BORN?

NUMBER OF PRECEDING BIRTHS_______

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 NAME OF ALL BROTHERS AND SISTERS.

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

_______

1005) Is (NAME) male or female?

MALE 1
FEMALE 2

1006) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1008)
DK 8 (GO TO [2,3,4, ETC])

1007) How old is (NAME)?

___________
Go to [2,3,4,etc]

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

_________

1009) How old was (NAME) when he/she died?

____________
IF MAN, OR WOMAN DECEASED BEFORE AGED 12, GO TO 2, 3, 4,ETC

1010) Was (NAME) pregnant when she died?

YES 1 (GO TO 1013)
NO 2

1011) Did (NAME) die during childbirth?

YES 1 ( GO TO 1013)
NO 2

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

YES 1
NO 2

1
013) How many live born children did (name) give birth to during her lifetime?

________
GO TO 2, 3, 4, ETC

.

IF NO OTHER BROTHERS OR SISTERS, GO TO SECTION 11 (FEMALE GENITAL CUTTING)

SECTION 11. FEMALE GENITAL CUTTING

1101) Have you ever heard of female circumcision?

YES 1 (GO TO 1103)
NO 2

1102) 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 (GO TO 1118)

1103) Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 1109)

1104) 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 (GO TO 1106)
NO 2
DON'T KNOW 8

1105) Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1106) Was your genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1107) 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

1108) Who performed the circumcision?

TRADITIONAL
TRAD. CIRCUMCISER 11
TRAD. BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MID-WIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) 26
DON'T KNOW 98

1109) CHECK 213, 215, 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 1997 OR LATER
HAS NO LIVING DAUGHTERS BORN IN 1997 OR LATER (GO TO 1116)

1109A) CHECK 213, 215, AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 1997 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. IF NO DAUGHTERS BORN IN 1997 OR LATER, GO TO 1116.

Now I would like to ask you some questions about your (daughter/daughters).

1110) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 1997 OR LATER

BIRTH HISTORY NUMBER_______
NAME___________

1111) Is (NAME OF DAUGHTER) circumcised?

YES 1
NO 2 (GO TO 1111 IN NEXT COLUMN OR IF NO MORE DAUGHTERS, GO TO 1116)

1112) 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

1113) Was her genital area sewn closed?
PROBE: WAS THE GENITAL AREA CLOSED?

YES 1
NO 2
DON'T KNOW 8

1114) Who performed the circumcision?

TRADITIONAL
TRAD. CIRCUMCISER 11
TRAD. BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MID-WIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) 26
DON'T KNOW 98

1115) GO BACK TO 1111 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 1116

1116) Do you believe that female circumcision is required by your religion?

YES 1
NO 2
DON'T KNOW 8

1117) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

1117a) Is female circumcision legal?

YES 1
NO 2
DON'T KNOW 8

1118) Record the time

HOUR_______
MINUTE_______

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

NAME OF SUPERVISOR
DATE

EDITOR'S OBSERVATIONS
NAME OF EDITOR
DATE