(For Women Aged 15-49 Who Slept There Last Night)

NATIONAL COUNCIL OF POPULATION AND DEVELOPMENT
MINISTRY OF HOME AFFAIRS AND NATIONAL HERITAGE

IDENTIFICATION

PROVINCE __________
DISTRICT __________
LOCATION/TOWN __________
SUBLOCATION/WARD __________
CLUSTER NUMBER
HOUSEHOLD NUMBER
STRUCTURE NUMBER

URBAN/RURAL

NAME OF HOUSEHOLD HEAD

LINE NUMBER OF WOMAN

INTERVIEWER VISITS 1
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME

INTERVIEWER VISITS 2
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME

INTERVIEWER VISITS 3
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
MONTH
YEAR
INTERVIEWER NO.
FINAL RESULT

TOTAL NO.OF VISITS

RESULT___
*RESULT CODES:

LANGUAGE OF QUESTIONNAIRE** ENGLISH

LANGUAGE USED IN INTERVIEW**

RESPONDENT'S LOCAL LANGUAGE**

TRANSLATOR USED

**LANGUAGE CODES:

FIELD EDITOR
NAME
DATE

OFFICE EDITOR
NAME
DATE

KEYED BY
NAME
DATE

SECTION 1. RESPONDENT'S BACKGROUND

103. RECORD THE TIME:

104. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in the countryside, in Nairobi or Mombasa, or in another town?

105. How long have you been living continuously in (NAME OF SUBLOCATION, TOWN OR CITY)?

106. Just before you moved here, did you live in the countryside, in Nairobi or Mombasa, or in another town?

107. It is important to know your exact age. In what month and year were you born?

108. How old were you at your last birthday?
INTERVIEWER: COMPARE AND CORRECT 107 AND/OR 108 IF INCONSISTENT.

109. Have you ever attended school?

110. What was the highest level of school you attended: primary, secondary, secondary, higher or university?

111. What is the highest (standard/form/year) you completed at that level?

112. INTERVIEWER: CHECK 110:

112A. Have you ever attended an adult literacy class?

113. Can you read a letter or newspaper in any language easily, with difficulty, or not at all?

114. Do you usually listen to a radio at least once a week?

115. Where does your household get most of its water for drinking, hand washing, and cooking most of the year?

115A. How long does it usually take you to go to that place, get water, and return?

117. What kind of toilet facility does your household have?

118. At what age do children in this household start using the same toilet facility as adults?

119. Do you have, right now, bathing soap or washing soap on the premises?

120. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

121. Does any member of your household own:

A bicycle?
A motorcycle?
A car?
A tractor?
Land?
Cattle, goats or sheep?
Cash crops?
A permanent house?

122. INTERVIEWER: INQUIRE OR OBSERVE MAIN MATERIAL OF THE FLOOR.

130. What is your religion?

140. What is your ethnic group/tribe?

150. To which women's organization or association do you belong?
CIRCLE CODES FOR ALL ORGANIZATIONS MENTIONED.

SECTION 2. REPRODUCTION

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

201. Have you ever given birth?

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

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

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

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

206. Have you ever given birth to a son or daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

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

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

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

210. CHECK 208:

211. Now I would like to talk to you about all of your births, whether still alive or not, starting with the first one you had. (RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS ON SEPARATE LINES. CODE TYPE OF BIRTH.)

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

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

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

215. Is (NAME) still alive?

216. IF DEAD: How old was (NAME) when he/she died?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

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

218. IF ALIVE: Is she/he living with you?

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

Now I would like to ask you about some current events in your life.

220. Are you pregnant now?

221. For how many months have you been pregnant?

222. Since you have been pregnant, have you been given any injection to prevent the baby from getting tetanus?

222A. how many injections did you receive?

222B. Where did you go to get the (last) injection?

223. Did you see anyone for advice on this pregnancy?

224. Whom did you see?
PROBE FOR TYPE OF PERSON AND RECORD MOST QUALIFIED.

225. How long ago did your last menstrual period start?

226. From the time a woman gets her period until the time she gets her next period, when do you think she has the greatest chance of becoming pregnant?

PROBE: What are the days during the month when a woman has to be careful to avoid becoming pregnant?

227. PRESENCE OF OTHERS AT THIS POINT.

SECTION3. CONTRACEPTION

301. Now I would like to talk about a different topic. There are various ways or methods that a couple can use to delay or avoid a pregnancy. Which of these ways or methods have you heard about?

CIRCLE CODE '1' IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF METHOD IS RECOGNIZED AND CODE '3' IF NOT RECOGNIZED. THEN FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 302, ASK 302A-305 BEFORE PROCEEDING TO THE NEXT METHOD.

302. Have you ever heard of (METHOD)? READ DESCRIPTION.

302A. Do you know how to use (METHOD)?

303. Have you ever used (METHOD) with any partner?

304. Where would you go to obtain (METHOD) if you wanted to use it? (CODES BELOW)

CODES FOR 304:

305. In your opinion, what is the main problem, if any, with using (METHOD)? (CODES BELOW)

CODES FOR 305:

306. CHECK 303:

307. Just to make sure, have you ever used anything or tried in any way to delay or avoid getting pregnant? MARK APPROPRIATE BOX WITH AN 'X'.

308. What have you used or done? CORRECT 302-303 AND OBTAIN INFORMATION FOR 304 TO 306 AS NECESSARY.

309. CHECK303:

310. The last time you used periodic abstinence, how did you determine on which days you had to abstain?

311. How many living children, if any, did you already have when you first did something or used a method to avoid getting pregnant? IF NONE, ENTER '00'.

312. CHECK 220:

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

314. Which method are you using?

315. Where did you obtain (METHOD) the last time?
315A. Where did the sterilization take place?
315B. Where did you obtain instructions for this method?

315C. What agency or organization operates the service?

315D. How much time does it take to get from your home to this place?
IF TIME EXACTLY 1, 2, 3 ETC. HOURS, ENTER '00' MINUTES.

315F. For how long have you been using (CURRENT METHOD) continuously?

315G. CHECK 302:
HEARD OF AT LEAST ONE METHOD (TO 315H)
NEVER HEARD OF ANY METHOD (TO 316)

315H. How much time would it take to get from your home to a place where you could obtain family planning services?

IF TIME EXACTLY I, 2, 3 ETC. HOURS, ENTER '00' MINUTES. IF 'DOESN'T KNOW', WRITE '98' HOURS.

315I. Would you walk or use some means of transportation to get there?

316. Do you intend to use a method to avoid pregnancy at any time in the future?

317. Which method would you prefer to use?

317A. In the last six months, have you heard or read about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From friends or relatives?

319. Is it acceptable or not acceptable to you that family planning information is provided on radio or television?

SECTION 4. HEALTH AND BREASTFEEDING

401. CHECK 214:

402. ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JAN. 1983 IN THE TABLE. BEGIN WITH THE LAST BIRTH. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS.

LINE NUMBER FROM 212:

403. When you were pregnant with (NAME) were you given any injection to prevent the baby from getting tetanus?

404. When you were pregnant with (NAME), did you see anyone for advice on this pregnancy?
IF YES: Whom did you see? PROBE FOR THE TYPE OF PERSON AND RECORD THE MOST QUALIFIED.

405. Who assisted with the delivery of (NAME)?
PROBE FOR THE TYPE OF PERSON AND RECORD THE MOST QUALIFIED.

405A. Where did you deliver (NAME)?

406. Did you ever feed (NAME) at the breast?

406A. Why did you never feed (NAME) at the breast?

407. Are you still breastfeeding (NAME)?
IF DEAD, CIRCLE '2'.

408. How many months old was (NAME) when you stopped breastfeeding?

408A. Why did you stop breastfeeding (NAME)?

408B. Do you ever give (NAME) anything to drink or eat other than breast milk?

408C. How many months old was (NAME) when you first gave him/her anything to drink or eat other than breast milk?

409. How many months after the birth of (NAME) did your period return?

410. Have you resumed sexual relations since the birth of (NAME)?

411. How many months after the birth of (NAME) did you resume sexual relations?

412. CHECK 407 FOR LAST BIRTH:

413. How many times did you breastfeed last night between sunset and sunrise?

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

415. At any time yesterday or last night, was (NAME OF LAST CHILD) given any of the following:

Plain water?
Juice?
Powdered milk?
Cow's or goat's milk?
Porridge or uji?
Any other liquids?
Any solid or mushy food?

416. CHECK 415:

417. Were any of these given in a bottle with a rubber nipple?

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

419. ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JAN. 1983 BELOW.

BEGIN WITH THE LAST BIRTH. THE HEADINGS IN THE TABLE SHOULD BE EXACTLY THE SAME AS THOSE AFTER Q. 402. ASK THE QUESTIONS ONLY FOR LIVING CHILDREN.

LINE NUMBER FROM Q212

420. Do you have a child health card for (NAME)?
IF YES: May I see it please?

421. RECORD IMMUNIZATION DATES FROM CHILD HEALTH CARD.

422. Has (NAME) ever had a vaccination to prevent him/her from getting diseases?

423. Has (NAME) had diarrhea in the last 24 hours?

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

424A. Now I have some questions about (NAME)'s last episode of diarrhea. How many days ago did the diarrhea start?

424B. CHECK407:
LAST CHILD STILL BREASTFED?

424C. Did you breastfeed (NAME) when he/she had diarrhea then?

424D. When (NAME) had diarrhea then, was he/she given more, less, or the same amount to drink as before the diarrhea, or did you stop giving anything to drink?

424E. Was (NAME) given more, less, or the same amount of solid food as was given before he/she had diarrhea or did you stop giving solid food altogether?

424G. Was (NAME) given either a home solution of sugar, salt, and water to drink, or a solution made from a special packet? IF YES: Which?

424H. The last time (NAME) was given (home solution/special packet), did he/she get better within a day, worse, or was there no change?

424I. How much of the (home solution/special packet) was (NAME) given every 24 hours?

424J. For how many days was (NAME) given (home solution/ special packet)?

425. Was (NAME) taken to a private doctor, a hospital or clinic, a traditional healer, or any other place during the last episode of diarrhea? IF YES: Where was he/she taken (the last time)?

426. What treatments did (NAME) receive there (the last time)?
CIRCLE ALL TREATMENTS MENTIONED.

426A. Why was (NAME) not taken somewhere for treatment during the last episode of diarrhea?

427. CHECK 424G:

427A. Where did you learn how to prepare the sugar, salt and water solution given to (NAME)?

428. CHECK 424G:

428A. Where did you get the packet of ORS (the last time)?

428B. How much did the packet cost?

428C. Do you have one of these packets in your house now?

428D. Can I see the packet?
CODE TYPE OF PACKET.

428E. Do you think the contents of the packet are used to cure the diarrhea, or that they are used to prevent the child from drying out?

428F. Did you use boiled water, bottled water, or other water to mix the contents of the packet (the last time)?

428G. Did you mix the contents of the packet with the water before you boiled the water or after you boiled the water (the last time)?

428H. What kind of container did you use to measure the correct amount of water (the last time)?

428I. In what kind of container did you mix the contents of the packet and the water?

428J. Did you prepare a new mixture every day or did you use the same mixture for more than one day?

428K. Which places can you go if you want to get a vaccination for a child?
CIRCLE ALL PLACES MENTIONED.

429. ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JAN. 1983 BELOW. BEGIN WITH THE LAST BIRTH.

THE HEADINGS IN THE TABLE SHOULD BE EXACTLY THE SAME AS THOSE AFTER 419.

ASK THE QUESTIONS ONLY FOR LIVING CHILDREN. IF NO CHILDREN SINCE JAN. 1983, SKIP TO 501.

LINE NUMBER FROM 212:

430. Has (NAME) had fever in the last four weeks?

430A. Was the fever due to malaria, measles, or some other cause?

431. Was (NAME) taken to a private doctor, a hospital or clinic, a traditional healer, or any other place to treat the fever? IF YES: Where was he/she taken?

433. Has (NAME) suffered from a fever, cough, or difficult or rapid breathing in the last four weeks?

434. Was (NAME) taken to a private doctor, a hospital or clinic, a traditional healer, or any other place to treat the problem? IF YES: Where was he/she taken?

435. Was there anything (else) you or somebody did to treat the problem?
IF YES: What was done? CIRCLE CODE '1' FOR ALL MENTIONED.

SECTION 5. MARRIAGE

Now we come to matters of marriage.

501. Have you ever been married or lived with a man?

502. Are you now married or living with a man, or are you now widowed, divorced, or not living together?

503. Does your husband/partner usually live with you or does he stay somewhere else?

504. Does your husband/partner have any other wives besides yourself?

505. How many other wives does he have?

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

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

508. In what month and year did start living with your (first) husband/partner?

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

509A. At the time that you married him, did your (first) husband/partner have any other living wives besides yourself?

509B. How many other living wives did he have at the time that you married him?

518. In how many towns and districts have you lived for six months or more since you were first married (started living together) including this place?

Now we need some details about your sexual activity in order to get a better understanding of contraception and fertility.

519. Have you ever had sexual intercourse?

520. Now we need some details about your sexual activity in order to get a better understanding of contraception and fertility.

520A. How old were you when you first had sexual intercourse?

522. How many days in the last four weeks have you had sexual intercourse?

523. When was the last time you had sexual intercourse?

524. CHECK 220:

525. CHECK 313:

526. If you become pregnant in the next few weeks, would you feel happy, unhappy, or would it not matter very much?

527. What is the main reason that you are not using a method to avoid pregnancy?

528. PRESENCE OF OTHERS AT THIS POINT:

SECTION 6. FERTILITY PREFERENCES

601. CHECK 502:

602. CHECK 220 AND MARK BOX:
Now I have some questions about the future.

NOT PREGNANT OR UNSURE: Would you like to have a (another) child or would you prefer not to have any (more) children?

PREGNANT: After the child you are expecting, would you like to have another child or would you prefer not to have any (more) children?

603. How long would you like to wait from now before the birth of a (another) child?

604. CHECK 215:
How old would your youngest child be then?
IF NO LIVING CHILDREN, CIRCLE '96'.

605. For how long should a couple wait before starting sexual intercourse after the birth of a baby?

606. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

607. Do you think that your husband/partner approves or disapproves of couples using a method to prevent or delay pregnancy?

608. How often have you talked to your husband/partner about family planning in the past year?

609. In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

610. CHECK 202 AND 204:

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

HAS LIVING CHILD(REN): 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?

RECORD SINGLE NUMBER OR OTHER ANSWER.

611. How many boys?
How many girls?

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

701. CHECK 501:

Now I have some questions about your (most recent) husband/partner.

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

703. What was the highest level of school he attended: primary, secondary, higher, or university?

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

705. CHECK 703:

706. Can (could) he read a letter or newspaper in any language?

707. What kind of work does (did) your (last) husband/partner mainly do?

708. CHECK 707:

708A. Does he work for someone else or for himself?

709. Does (did) he earn a regular wage or salary?

710. (Does/Did) your husband/partner work mainly on his or family land, or on someone else's land?

711. Does (did) he lease the land or does (did) he work for wages?

712. Before you married your (first) husband, did you yourself ever work regularly to earn money, other than on a farm or in a business run by your family?

714. Since you were first married, have you worked regularly to earn money, other than on a farm or in a business run by your family?

715. Have you ever worked regularly to earn money, other than on a farm or in a business run by your family?

717. Are you now working to earn money other than on a farm or in a business run by your family?

718. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

PERSON INTERVIEWED _____

SPECIFIC QUESTIONS _____

OTHER ASPECTS______

NAME OF INTERVIEWER _____
DATE _____

SUPERVISOR'S OBSERVATIONS _____
NAME _____
DATE ______

EDITOR'S OBSERVATIONS _____

NAME OF FIELD EDITOR _____
DATE _____

NAME OF KEYER_____
DATE _____