IDENTIFICATION
PLACE NAME
NAME OF HEAD OF HOUSEHOLD
CLUSTER NUMBER
HOUSEHOLD NUMBER
ADMINISTRATIVE REGION
NATURAL REGION
SANITATION DISTRICT NUMBER
LOCATION OF HOUSEHOLD

NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS
FIRST VISIT
DATE

INTERVIEWER'S NAME
RESULT___

FINAL VISIT
DAY
MONTH
YEAR 2018
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS

LANGUAGE OF QUESTIONNAIRE: FRENCH 01

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED

LANGUAGE OF QUESTIONNAIRE: FRENCH 01

SUPERVISOR
NAME
NUMBER

OFFICE EDITOR
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is ___. I am working with the National Institute for Statistics. We are conducting a survey about health all over Guinea. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 15 to 20 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.

In case you need more information about the survey, you may contact the person listed on this card.

Give card with contact information

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

Signature of interviewer
Date

SECTION 1: RESPONDENT'S BACKGROUND

101) RECORD THE TIME

102) How long have you been living continuously in (Name of current city, town or village of residence)?

IF LESS THAN ONE YEAR, RECORD 00 YEARS

103) Just before you moved here, did you live in a city, in a town, or in a rural area?

104) Before you moved here, which (province/region/state) did you live in?

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, higher, or professional B?

109) What is the highest (grade/form/year) you completed at this level?
If completed less than one year at that level, record 00

110) CHECK 108

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

SHOW CARD TO RESPONDENT

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

112) CHECK 111:

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

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

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

116) Do you own a mobile telephone?

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

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

119) Have you ever used the internet?

120) In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

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

122) What is your religion?

123) What is your ethnicity?

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

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

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?

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'

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?

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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

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 makes 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 rows.
If there are more than 10 births, use an additional questionnaire, starting with the second row.

212) What name was given to you (first/next) baby?
RECORD NAME.

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

214) Were any of these births twins?

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 NOT LISTED IN HOUSEHOLD)

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

IF 12 MONTHS OR ONE YEAR, ASK: Did (name) have his/her first birthday?
THEN ASK: Exactly how many months old was (name) when he/she died?
RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

221) Were there any other live births between (name of previous birth) and (name), including any children who died after birth?

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

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

224) CHECK 215: Enter the number of births in 2013-2018.

225) C
For each birth since in 2013-2018, enter B in the month of birth in the calendar. Write the name of the child to the left of the code B for each birth. Ask the number of months the pregnancy lasted and record P in each of the preceding months according to the duration of the pregnancy. (Note: The number of Ps must be one less than the number of months that the pregnancy lasted.)

226) Are you pregnant now?

227) How many months pregnant are you?
C
Record number of completed months.
Enter Ps in the calendar, beginning with the month of interview and for the total number of completed months.

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

229) CHECK 208: Total number of births

ONE OR MORE

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

NONE

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

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

231) When did the last such pregnancy end?

232) CHECK 231:

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

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

235) Since January 2013, have you had any other pregnancies that did not result in a live birth?

236) For each pregnancy that did not end in a live birth in 2013-2018 or later, enter T in the calendar in the month that the pregnancy terminated and P for the remaining number of completed months of pregnancy.

If there are more than four pregnancies that did not end in a live birth, use an additional questionnaire starting on the second line.

237) Did you have any miscarriages, abortions or stillbirths that ended before 2013?

238) When did the last such pregnancy that terminated before 2013 end?

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

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

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

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

SECTION 3. CONTRACPTION

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

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

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

04) Injectables
PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.

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.

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

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

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

09) Emergency contraception
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.

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

11) Locational amenorrhea method (LAM)
PROBE: Up to six months after giving birth, before the menstrual period has returned, women use a method which requires her to breastfeed frequently day and night.

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.

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

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

302) CHECK 226:

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

304) Which method are you using?

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

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

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

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 ___)

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

309) 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?

310) CHECK 308 and 309, 215, and 231:
Any birth or pregnancy termination after month and year of start of use of contraception in 308 or 309?

311) CHECK 308 AND 309:

YEAR IS 2013-2018
Enter code for method used in month of interview in the calendar and in each month back to the date started using.
Then continue.

YEAR IS 2011 OR EARLIER
Enter code for method used in month of interview in the calendar and each month back to January 2013
Then (GO TO 324)

312) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

Use calendar to probe for earlier periods of use and nonuse, starting with most recent use, back to January 2013. Use names of children, dates of birth, and periods of pregnancy as reference points.

312a) Month and year of start of internal of use or non-use.

312b) Between (event) in (Month/year) and (event) in (month/year), did you or your partner use any method of contraception?

312c) Which method was that?

312d) How many months after (event) in (month/year) did you start to use (method)?
Record 95 if respondent gives the date of starting to use the method.

312e) Record the month and year respondent started using method

MONTH__
YEAR__

312f) For how many months did you use (method)?
RECORD 95 IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE

MONTHS (GO TO 312h)
DATE GIVEN 95

312g) Record month and year respondent stopped using method

MONTH__
YEAR__

312h) Why did you stop using (method)?

312i) Go back to 312a in next column; or, if no more gaps, go to 313.

313) Check the calendar for use of any contraceptive method in any month.

NO METHOD USED
ANY METHOD USED (GO TO 315)

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

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

316) You first started using (current method) in (date from 309). Where did you get it at that time?

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

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

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

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

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

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

322) CHECK 318 AND 319:

ANY YES
At that time, were you told about other methods of family planning that you could use?

OTHER
When you obtained (Current method from 315) from (Source of method from 307 or 316), were you told about other methods of family planning that you could use?

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

324) CHECK 304:
Circle method code.
If more than one method code circled in 304, circle code for highest method in list.

325) 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.

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

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

328) Did the fieldworker talk to you about family planning?

329) CHECK 202: Living children

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

NO
b) In the last 12 months, have you visited a health facility for yourself?

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) CHECK 215: Record the birth history number in 403 and the survival state from 404 for each birth in 2013-2018. Ask the questions about all these births. Begin with the last birth. (If there are more than 2 births, use last column of additional questionnaire(s)).

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

403) Birth history number from 212 in birth history

404) From 212 and 216

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

406) CHECK 208:

ONLY ONE BIRTH
a) Did you want to have a baby later on, or did you not want any children?

MORE THAN ONE BIRTH
b) Did you want to have a baby later on, or did you not want any more children?

407) How much longer did you want to wait?

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

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

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.

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

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

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?

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

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

416) CHECK 415: Tetanus injections

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

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

419) CHECK 418:

ONLY ONCE
a) How many years ago did you receive this tetanus injection?

MORE THAN ONCE
b) How many years ago did you last receive this tetanus injection?

420) During this pregnancy, were you given or did you buy iron tablets or iron syrup?
Show tables/syrup

421) 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.

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

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

423a) I would like to ask you if you took any drugs during this pregnancy to prevent malaria. During this pregnancy, did you take any drugs to prevent malaria?

423b) What medications did you take to prevent malaria?
RECORD ALL MENTIONED. IF THE NAMES OF THE DRUGS ARE UNKNOWN, SHOW SAMPLE BOXES ORE PHOTOS OF THE DRUGS.

423c) CHECK 423 AND 423b

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

PROBE BY SHOWING THE SAMPLE BOTTLES OF SP/FANSIDAR OR PHOTOS.

b) How many times did you take the SP/Fansidar that you showed during this pregnancy?

PROBE BY SHOWING THE SAMPLE BOTTLES OF SP/FANSIDAR OR PHOTOS.

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

PROBE BY SHOWING THE SAMPLE BOTTLES OF SP/FANSIDAR OR PHOTOS.

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

b) Did you get the SP/Fansidar that you showed me during any antenatal care visit, during another visit to a health facility or from another source?

PROBE BY SHOWING THE SAMPLE BOTTLES OF SP/FANSIDAR OR PHOTOS.

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

425a1) CHECK 408:

425a2) Do you have a health/antenatal visit card or booklet from the time you were pregnant with (name from pregnancy from 408)?
ASK TO SEE THE CARD OR BOOKLET

425a3) CHECK THE CARD OR BOOKLET AND RECORD THE NUMBER OF SP/FANSIDAR DOSES:

425b) CHECK 424:

425b1) How many tablets did they give you the first time you received SP/Fansidar?

425b2) Did you get the SP/Fansidar tablets during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST

425b3) Did you take the SP/Fansidar tablets in front of the health care agent during the antenatal visits?

425b4) Where did you take them, at home, elsewhere, or not at all?

425b5) The first time you took SP/Fansidar that you received, how many months pregnant were you?

425c) CHECK 424:

425c1) The second time you took the SP/Fansidar you received, how many tablets were you given?

425c2) Did you get the SP/Fansidar tablets during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST

425c3) Did you take the SP/Fansidar tablets in front of the health care agent during the antenatal visits?

425c4) Where did you take them, at home, elsewhere, or not at all?

425c5) The second time you took SP/Fansidar that you received, how many months pregnant were you?

425d) CHECK 424:

425d1) The third time you took the SP/Fansidar you received, how many tablets were you given?

425d2) Did you get the SP/Fansidar tablets during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST

425d3) Did you take the SP/Fansidar tablets in front of the health care agent during the antenatal visits?

425d4) Where did you take them, at home, elsewhere, or not at all?

425d5) The third time you took SP/Fansidar that you received, how many months pregnant were you?

425e) CHECK 424:

425e1) The fourth time you took the SP/Fansidar you received, how many tablets were you given?

425e2) Did you get the SP/Fansidar tablets during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST

425e3) Did you take the SP/Fansidar tablets in front of the health care agent during the antenatal visits?

425e4) Where did you take them, at home, elsewhere, or not at all?

425e5) The fourth time you took SP/Fansidar that you received, how many months pregnant were you?

425f) CHECK 424:

425f1) The fifth time you took the SP/Fansidar you received, how many tablets were you given?

425f2) Did you get the SP/Fansidar tablets during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST

425f3) Did you take the SP/Fansidar tablets in front of the health care agent during the antenatal visits?

425f4) Where did you take them, at home, elsewhere, or not at all?

425f5) The fifth time you took SP/Fansidar that you received, how many months pregnant were you?

425g) CHECK 424:

425g1) The sixth time you took the SP/Fansidar you received, how many tablets were you given?

425g2) Did you get the SP/Fansidar tablets during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST

425g3) Did you take the SP/Fansidar tablets in front of the health care agent during the antenatal visits?

425g4) Where did you take them, at home, elsewhere, or not at all?

425g5) The sixth time you took SP/Fansidar that you received, how many months pregnant were you?

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

427) Was (NAME) weighed at birth?

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

429) 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 whether any adults were present at the delivery.

430) 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.

431) How long after (NAME) was delivered did you stay here
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF A WEEK OR MORE, RECORD WEEKS.

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

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

434) Immediately after the birth, was (NAME) put directly on the bare skin of your chest?

434a) Was (NAME)'s skin in contact with your skin?

434b) CHECK 430: DELIVER LOCATION

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

436) 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.
IF ONE WEEK OR MORE, RECORD IN WEEKS.

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

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

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

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

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

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

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

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

445) I would like to talk to you about checks on (NAME)'s health after you left (facility in 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (facility in 430)?

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

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

448) Where did this check of (NAME) take place.

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

449) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

450) 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. IF ONE WEEK OR MORE, RECORD IN WEEKS.

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

452) Where did this first CHECK take place?
PROBE TO IDENTITY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

454) 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. IF ONE WEEK OR MORE, RECORD IN WEEKS.

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

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

457) In the first two days after (NAME)'s birth, did any health care provider do the following:

a) Examine the cord?

b) Measure (name)'s temperature?

c) Counsel you on danger signs for newborns?

d) Counsel you on breastfeeding?

e) Observe (name) breastfeeding?

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

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

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

461) CHECK 226: Is respondent pregnant?

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

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

464) Did you ever breastfeed (NAME)?

465) CHECK 404: Child is living?

466) 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

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

468) CHECK 404: Is child living?

469) Are you still breastfeeding (NAME)?

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

471) (Go back to 405 in next column, or, if no more births, go to 501a)

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501a) CHECK 215 IN THE BIRTH HISTORY: Any births in 2015-2018?

502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2015-2018.

503a) CHECK 216 FOR CHILD:

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

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

506a) CHECK 504A

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

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

509a) CHECK 508A:

510a) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD YES ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

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

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

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

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

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

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

519aa) Did (NAME) receive a vaccine against polio, meaning an injection in the thigh to avoid polio?

519ab) How many times did (NAME) receive the vaccine against polio?

519ac) Did (NAME) receive the vaccine against yellow fever, meaning an injection in the arm to avoid yellow fever?

519ad) How many times did (NAME) receive the vaccine against yellow fever?

523a) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

524a) How many times did (NAME) receive the measles vaccine?

525a) In the last 7 days was (NAME) given:

a) a micronutrient powder mix?

b) A ready to eat dietary supplements like Plumpy'Nuts?

c) A ready to eat dietary supplements like Plumpy'Doz?

526a) CONTINUE WITH 501B (NEXT-TO-LAST BIRTH)

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

(501B TO 525B SAME QUESTIONS AS SECTION 5A.)

526b) CHECK 215 IN BIRTH HISTORY: any more births in 2015-2018?

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

602) CHECK 215: Enter in the table the birth history number in 603 and the name and survival state in 604 for each birth between 2013-2018. Ask the questions about all of these births. Begin with the last birth. If there are more births, use last column 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.)

603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

604) FROM 212 AND 216

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

606) 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.

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

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

609) CHECK 464: Currently breastfeeding

YES
a) 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?

NO/NOT ASKED
b) 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?

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

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

612) Where did you seek advice or treatment?

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

613) CHECK 612:

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

615) Was (NAME) given any of the following to drink at any time since (NAME) started having the diarrhea?

a) A fluid made from a special packet called ORS packet?

b) A pre-packaged ORS liquid?

c) A government-recommended homemade fluid?

d) Zinc tablets or syrup?

616) CHECK 615:

ANY YES
a) Was anything given to treat the diarrhea?

ALL "NO" OR "DON'T KNOW"
b) Was anything given to treat the diarrhea?

617) CHECK 615: What else was given to treat the diarrhea?
Anything else?

RECORD ALL TREATMENTS GIVEN.

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

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

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

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

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

623) CHECK 618: Had fever?

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

625) 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.

626) CHECK 625:

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

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

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

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

RECORD ALL MENTIONED

631) CHECK 630: Any code A-J circled?

632) CHECK 630: Artemisinin Combination Therapy (A) given

633) How long after the fever started did (NAME) first take an artemisinin combination therapy?
SAME DAY 0.

634) CHECK 630: SP/Fansidar (B) given

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

636) CHECK 630: Chloroquine (C) given

637) How long after the fever started did (NAME) first take Chloroquine?

638) CHECK 630: Amodiaquine (D) given

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

640) CHECK 630: Quinine (E or F) given

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

642) CHECK 630: Artesunate (G or H) given

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

644) CHECK 630: Other antimalarial (J) given

645) How long after the fever started did (NAME) first take (other antimalarial)?

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

647) CHECK 615(a) and 615(b), all columns:

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

649) CHECK 215 and 218, all rows:
Number of children born in 2016-2018 living with respondent

650) Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (name from 649) drink or eat:

a) plain water?

b) juice or juice drinks?

c) clear broth?

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

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

e) Infant formula?

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

f) Any other liquids?

g) Yogurt?

If yes, how many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD 7

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

i) bread, rice, noodles, porridge, millet, pearl millet, sorghum, corn, or any other foods made from grains?

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

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

l) any dark green, leafy vegetables?

m) ripe mangoes, papayas?

n) any other fruits or vegetables?

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

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

q) eggs?

r) fresh or dried fish or shellfish?

s) Other foods based in beans, peas, lentils, or nuts?

t) cheese or other food made from milk?

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

651) CHECK 650 (categories g through u)

652) Did (NAME FROM 649) eat any solid, semi-solid or soft foods yesterday during the day or at night?
IF YES, PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat?

653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD 7

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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

704) Is your (HUSBAND/PARTNER) living with you now or is he staying elsewhere?

705) RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.

706) Does your (HUSBAND/PARTNER) have other wives or does he live with other women as if married?

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

708) Are you the first, second?wife?

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

710) CHECK 709:

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

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

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

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

713) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

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

714) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

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

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

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

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

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

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

721) How old is this person?

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

723) 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

724) CHECK 106:

725) CHECK 701:

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

727) 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

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

729) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOT KNOW, ASK TO SEE THE PACKAGE.

730) From where did you obtain the condom the last time?

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

731) PRESENCE OF OTHERS DURING THIS SECTION.

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

802) CHECK 226:

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

804) 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?

805) CHECK 226:
NOT PREGNANT OR NOT SURE
a) How long would you like to wait from now before the birth of (a/another) child?

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

806) CHECK 226:

807) CHECK 303: Using a contraceptive method?

808) CHECK 805:

809) CHECK 714:

810) CHECK 804:
WANTS TO HAVE A/ANOTHER CHILD
a) You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?

RECORD ALL REASONS MENTIONED.

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

RECORD ALL REASONS MENTIONED.

811) CHECK 303: Using a contraceptive method?

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

813) CHECK 216:

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

PROBE FOR A NUMERIC RESPONSE.

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

PROBE FOR A NUMERIC RESPONSE.

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

815) In the last few months have you:

a) Heard about family planning on the radio?

b) Seen anything about family planning on the television?

c) Read about family planning in a newspaper or magazine?

d) Received a voice to text message about family planning on a mobile phone?

817) CHECK 701:

818) CHECK 303: Using a contraceptive method?

819) Would you say that using contraception is mainly your decision, mainly your (HUSBAND'S/PARTNER)'s decision, or did you both decide together?

820) Would you say that not using contraception is mainly your decision, mainly your (HUSBAND'S/PARTNER)'s decision, or did you both decide together?

821) CHECK 304:

822) Does your (HUSBAND/PARTNER) want the same number of children that you want, or does he want more or fewer than you want?

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

901) CHECK 701:

902) How old was your (HUSBAND/PARTNER) on his last birthday?

903) Did your (last) (HUSBAND/PARTNER) ever attend school?

904) What is the highest level of school you attended: primary, secondary 1, secondary 2, professional A, higher, or professional B?

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

906) Has your (HUSBAND/PARTNER) done any work in the last 7 days?

907) Has your (HUSBAND/PARTNER) done any work in the last 12 months?

908) What is your (HUSBAND'S/PARTNER)'s occupation? That is, what kind of work does he mainly do?

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

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

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

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

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

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

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

916) Are you paid in cash or in kind for this work or are you not paid at all?

917) CHECK 701:

918) CHECK 916:

919) Who usually decides how the money you earn will be used: you, your (HUSBAND/PARTNER), or you and your (HUSBAND/PARTNER) jointly?

920) Would you say that the money that you earn is more than what your (HUSBAND/PARTNER) earns, less than what he earns, or about the same?

921) Who usually decides how the money your (HUSBAND/PARTNER) earnings will be used: you, your (HUSBAND/PARTNER), or you and your (HUSBAND/PARTNER) jointly?

922) Who usually makes decisions about health care for yourself: you, your (HUSBAND/PARTNER), you and your (HUSBAND/PARTNER) jointly, or someone else?

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

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

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

926) Do you have a title deed for any house you own?

927) Is your name on the title deed?

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

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

930) Is your name on the title deed?

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

CHILDREN UNDER 10

HUSBAND

OTHER MALES

OTHER FEMALES

932) 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 10. HIV/AIDS

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

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

1003) Can people get HIV from mosquito bites?

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

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

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

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

1008) Can HIV be transmitted from a mother to a baby?
During pregnancy?

During delivery?

By breastfeeding?

1009) CHECK 1008:

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

1011) CHECK 208 and 215:

1012) CHECK 408 FOR LAST BIRTH

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

1014) During any of the antenatal visits for your last birth were you given any information about:

a) Babies getting HIV from their mother?

b) Things that you can do to prevent getting HIV?

c) Getting tested for the HIV?

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

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

1017) 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)

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

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

1020) CHECK 430 FOR LAST BIRTH

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

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

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

1024) CHECK 1016:

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

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

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

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

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

1030) 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

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

1032) 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

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

1034) Have you ever tested yourself for HIV using a self-test kit?

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

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

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

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

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

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

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

1042) CHECK 1001:

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

NOT HEARD ABOUT HIV OR AIDS
b) Have you heard about infections that can be transmitted through sexual contact?

1043) CHECK 713:

1044) CHECK 1042: Heard about other sexually transmitted infections?

1045) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

1046) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

1047) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1048) CHECK 1045, 1046, and 1047:

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

1050) Where did you go?

Any other place?

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

1051) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

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

1053) CHECK 701:

1054) Can you say no to your (HUSBAND/PARTNER) if you do not want to have sexual intercourse?

1055) Can you ask your (HUSBAND/PARTNER) to use a condom if you wanted him to?

SECTION 11. OTHER HEALTH ISSUES

1101) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD 90.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1102) 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 90 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD 90.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1104) Do you currently smoke cigarettes every day, some days, or not at all?

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

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

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

1108) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

a) Getting permission to go to the doctor?

b) Getting money needed for advice or treatment

c) The distance to the health facility

d) Not wanting to go alone?

1109) Are you covered by health insurance?

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

SECTION 12. FEMALE GENITAL CUTTING

1201) I'd like to talk to you about a practice called female circumcision. Have you ever heard of female circumcision?

1202) 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?

1203) Have you yourself ever been circumcised?

1204) Now I would like to ask you what was done to you at that time.
Was any flesh removed from the genital area?

1205) Was the genital area just nicked without removing any flesh?

1206) Was your genital area sewn closed?

1207) How old were you when you were circumcised?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

1208) Who performed the circumcision?

1209) CHECK 213, 215, 216:

1209a) CHECK 213, 215, and 216: Enter in the table the birth history number and name of each living daughter born in 2003 or later. Ask the questions about all of these daughters. Begin with the youngest daughter. (If there are more than 3 daughters, use additional questionnaires).

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

1210) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2003 OR LATER

1211) Is (NAME OF DAUGHTER) circumcised?

1212) How old was (NAME OF DAUGHTER) when she was circumcised?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

1213) Was her genital area sewn closed?

1214) Who performed the circumcision?

1215) GO BACK TO 1211 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 1216.

1216) Do you believe that female circumcision is required by your religion?

1217) Do you think that female circumcision should be continued, or should it be stopped?

1217a) Have you ever heard of parents who do not circumcise their daughters, but say they did?

1217b) Do you think this is a good thing, or a bad thing?

1217c) Do you know of anyone in your family or your community that would have made a similar claim?

SECTION 13. FISTULA

1301) 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?

1302) Have you ever heard of this problem?

1303) Did this problem start after you delivered a baby or after a miscarriage?

1304) Did this problem start after a normal labor and delivery or after a difficult labor and delivery?

1305) In your opinion, what caused this problem?

1306) How many days after (cause of the problem from 1303 or 1305) did the leakage start?
RECORD 90 IF 90 DAYS OR MORE

1307) Have you sought treatment for this condition?

1308) Why have you not sought treatment?
PROBE AND RECORD ALL MENTIONED

1309) From whom did you last seek treatment?

1310) Did you have an operation to fix the problem?

1311) Did the treatment stop the leakage completely?
IF NO, DID THE TREATMENT REDUCE THE LEAKAGE?

1312) RECORD THE TIME

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS

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

INFORMATION TO BE CODED FOR EACH COLUMN.

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE (2)

2018 (1)

2017

2016

2015

2014

2013

(1) We assume that the collection year is 2018. For collection starting in 2019, all references to calendar year must be increased by one year: for example, 20112 must be changed to 2013, 2013 to 2014, 2014 to 2015, and so on for all years in the questionnaire.

(2) Codes can be added for other methods, like those based on knowledge of fertility.