CONFIDENTIAL

IDENTIFICATION

PROVINCE* _________________

DISTRICT _____________________
SUBLOCATION/WARD _________________
NASSEP CLUSTER NUMBER _______________
KDHS CLUSTER NUMBER __________________
HOUSEHOLD NUMBER _______________________

LOCATION/TOWN ____________

NAME OF HOUSEHOLD HEAD _______________

NAME AND LINE NUMBER OF WOMAN _____________

INTERVIEWER VISITS

INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________

NEXT VISIT:
DATE ______
TIME _____

INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________

NEXT VISIT:
DATE ______
TIME _____

INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________

FINAL VISIT
DAY ____
MONTH ____
YEAR 200__
INT. CODE ___
FINAL RESULT ____

TOTAL NO. OF VISITS ___

RESULT__
**RESULT CODES:

LANGUAGE

LANGUAGE OF QUESTIONNAIRE: ENGLISH __

LANGUAGE OF INTERVIEW *** ______________ __

HOME LANGUAGE OF RESPONDENT*** ____________ __

WAS A TRANSLATOR USED?

*** LANGUAGE CODES:

SUPERVISOR

NAME __________ ___
DATE __________

FIELD EDITOR

NAME __________ ___
DATE __________

OFFICE EDITOR ____

KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is ________ and I am working with the Kenya National Bureau of Statistics. We are conducting a national survey that asks women about various health issues. We would very much appreciate your participation in this survey.

This information will help the government to plan health services. The survey usually takes between 30 to 60 minutes to complete.

Whatever information you provide will be kept confidential and will not be shown to anyone other than members of our survey team.

Participation in this survey is voluntary, and if we should come to 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. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?

May I begin the interview now?

Signature of interviewer: _________
Date: ___________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

102. 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 Nairobi, Mombasa, in another city or town, or in the country-side?

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

104. Just before you moved here, did you live in a city, in a town, or in the countryside?

106. In what month and year were you born?

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108. Have you ever attended school?

109. What is the highest level of school you attended:
primary, vocational, secondary, or higher?

110. What is the highest (standard/form/year) you completed at that level?
IF NONE, WRITE '00'.

111. CHECK 109:

112. Now I would like you to read this sentence to me.
SHOW SENTENCES BELOW TO RESPONDENT.

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

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

114. CHECK 112:

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

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

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

118. What is your religion?

119. What is your ethnic group/tribe?

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the live 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'.

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'.

Sometimes it happens that children die. It may be painful to talk about and I am sorry to ask you about painful memories, but it is important to get correct information.

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 did not survive?

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

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

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

210. CHECK 208:

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

213. Were any of these births twins?.

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

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

216. Is (NAME) still alive?

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

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

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

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.

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)? IF YES, RECORD BIRTH(S) IN TABLE.

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2003 OR LATER.
IF NONE, RECORD '0' AND GO TO 226.

225. FOR EACH BIRTH SINCE JANUARY 2003, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR.

WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.

(NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226. Are you pregnant now?

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

ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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

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

230. When did the last such pregnancy end?

231. CHECK 230:

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

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233. Since January 2003, have you had any other pregnancies that did not result in a live birth?

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2003.

ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any miscarriages, abortions or stillbirths that ended before 2003?

236. When did the last such pregnancy that terminated before 2003 end?

237. When did your last menstrual period start?

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

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

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.

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

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

302. Have you ever used (METHOD)?

303. CHECK 302:

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

305. ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH. (GO TO 333)

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

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

308. CHECK 302 (01):

309. CHECK 226:

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

311. Which method are you using?
CIRCLE ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD IN LIST.

311A. CIRCLE 'A' FOR FEMALE STERILIZATION.

312. RECORD IF CODE 'C' FOR PILL IS CIRCLED IN 311.

31. Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

314. How many (pill cycles/condoms) did you get the last time?

315. The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

316. In what facility did the sterilization take place?

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

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

317. CHECK 311/311A:

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

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

318. How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?

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

319A. Since what month and year have you been using (CURRENT METHOD) without stopping?

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

320. CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A.

321. CHECK 319/319A:

YEAR IS 2003 OR LATER __
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.

YEAR IS 2002 OR EARLIER __
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2003. THEN GO TO 331.

322. 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 2003.

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

ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
* When was the last time you used a method? Which method was that?
* When did you start using that method? How long after the birth of (NAME)?
* How long did you use the method then?

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

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

324. Where did you obtain (CURRENT METHOD) when you started using it?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

324A. Where did you learn how to use the rhythm/lactational amenorrhea method?

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

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

326. You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?

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

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

329. CHECK 326:

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

CODE '1' NOT CIRCLED __
When you obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) were you told about other methods of family planning that you could use?

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

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

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

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

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

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

334. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

337. 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: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER.

ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212

404. FROM 212 AND 216

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

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

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[Most recent birth within the last five years]

408. Where did you receive antenatal care for this pregnancy? Anywhere else?

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

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
[Most recent birth within the last five years]

409. How many months pregnant were you when you first received antenatal care for this pregnancy?
[Most recent birth within the last five years]

410. How many times did you receive antenatal care during this pregnancy?
[Most recent birth within the last five years]

411. As part of your antenatal care during this pregnancy, were any of the following done at least once?

Were you weighed?
Was your height measured?
Was your blood pressure taken?
Did you give a urine sample?
Did you give a blood sample?
[Most recent birth within the last five years]

412. Were you given any information or counselled about breastfeeding?
[Most recent birth within the last five years]

412A. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?
[Most recent birth within the last five years]

413. Were you told where to go if you had any of these complications?
[Most recent birth within the last five years]

414. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[Most recent birth within the last five years]

415. During this pregnancy, how many times did you get this tetanus injection?
[Most recent birth within the last five years]

416. CHECK 415:
[Most recent birth within the last five years]

417. At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?
[Most recent birth within the last five years]

418. Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, WRITE '7'.
[Most recent birth within the last five years]

419. In what month and year did you receive the last tetanus injection before this pregnancy?
[Most recent birth within the last five years]

420. How many years ago did you receive that tetanus injection?
[Most recent birth within the last five years]

421. During this pregnancy, were you given or did you buy any iron tablets or iron syrup? SHOW TABLETS/SYRUP.
[Most recent birth within the last five years]

422. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS
[Most recent birth within the last five years]

423. During this pregnancy, did you take any drug for intestinal worms?
[Most recent birth within the last five years]

424. During this pregnancy, did you have difficulty with your vision during daylight?
[Most recent birth within the last five years]

425. During this pregnancy, did you suffer from night blindness?
[Most recent birth within the last five years]

426. During this pregnancy, did you take any drugs to keep you from getting malaria?
[Most recent birth within the last five years]

427. What drugs did you take? RECORD ALL MENTIONED.

IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[Most recent birth within the last five years]

428. CHECK 427: DRUGS TAKEN FOR MALARIA PREVENTION.

429. How many times did you take (SP/Fansidar) during this pregnancy?
[Most recent birth within the last five years]

430. CHECK 407: ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

431. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?
[Most recent birth within the last five years]

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

433. Was (NAME) weighed at birth?

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

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

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

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

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

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

437. How long after (NAME) was delivered did you stay there?

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.

438. Was (NAME) delivered by caesarean section?

439. Before you were discharged after (NAME) was born, did any health care provider check on your health?

440. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[Most recent birth within the last five years]

441. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[Most recent birth within the last five years]

442. After you were discharged, did any health care provider or a traditional birth attendant check on your health?

443. Why didn't you deliver in a health facility? PROBE: Any other reason?
RECORD ALL MENTIONED.
[Most recent birth within the last five years]

444. After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?

445. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[Most recent birth within the last five years]

446. Who checked on your health at that time?
[Most recent birth within the last five years]

447. Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
[Most recent birth within the last five years]

448. CHECK 442:

449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?
[Most recent birth within the last five years]

450. How many hours, days or weeks after the birth of (NAME) did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
[Most recent birth within the last five years]

451. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[Most recent birth within the last five years]

452. Where did this first check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
[Most recent birth within the last five years]

453. In the first two months after delivery, did you receive a vitamin A dose (like this)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
[Most recent birth within the last five years]

454. Has your menstrual period returned since the birth of (NAME)?
[Most recent birth within the last five years]

455. Did your period return between the birth of (NAME) and your next pregnancy?
[Repeat questions for all children born in the last 5 years, excluding the most recent birth]

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

457. CHECK 226: IS RESPONDENT PREGNANT?

458. Have you begun to have sexual intercourse again since the birth of (NAME)? (LAST BIRTH)
[Most recent birth within the last five years]

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

460. Did you ever breastfeed (NAME)?
[Most recent birth within the last five years]

461. 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.
[Most recent birth within the last five years]

462. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[Most recent birth within the last five years]

463. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[Most recent birth within the last five years]

464. CHECK 404: IS CHILD LIVING? (LAST BIRTH)

465. Are you still breastfeeding (NAME)? (LAST BIRTH)
[Most recent birth within the last five years]

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

467. CHECK 404: IS CHILD LIVING?

468. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[Most recent birth within the last five years]

469. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[Most recent birth within the last five years]

470. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
[Most recent birth within the last five years]

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

SECTION 5. IMMUNIZATION, HEALTH AND NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 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. LINE NUMBER FROM 212

503. FROM 212 AND 216

504. Do you have a child welfare card with (NAME)'s vaccinations?
IF YES: May I see it please?

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

506. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

BCG
DPT, HEPATITIS, HIB, 1ST DOSE
DPT, HEPATITIS, HIB, 2nd DOSE
DPT, HEPATITIS, HIB, 3rd DOSE
POLIO 0 (POLIO GIVEN AT BIRTH)
OPV 1
OPV 2
OPV 3
MEASLES
VITAMIN A (MOST RECENT)
VITAMIN A (2nd MOST RECENT)
YELLOW FEVER

506A. CHECK 506:

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

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

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

509. Please tell me if (NAME) received any of the following vaccinations:
509A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

509B. Polio vaccine, that is, drops in the mouth?

509C. Was the first polio vaccine received in the first two weeks after birth or later?

509D. How many times was the polio vaccine received?

509E. A Pentavalent vaccination, that is an injection given in the thigh, sometimes at the same time as polio drops?

509F. How many times was a Pentavalent vaccination received?

509G. A measles injection - that is, a shot in the right upper arm at the age of 9 months or older - to prevent him/her from getting measles?

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

512. CHECK 506: DATE SHOWN FOR VITAMIN A DOSE

513. According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD).

Has (NAME) received another vitamin A dose since then?

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

514. HAS (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

515. Did (NAME) receive a vitamin A dose within the last six months?

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

517. Has (NAME) taken any drug for intestinal worms in the last six months?

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

519. Was there any blood in the stools?

520. 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?

521. 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?

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

523. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

524. CHECK 523:

525. Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

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

527. Does (NAME) still have diarrhea?

528. 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 Oralite or ORS?
b) A home-made sugar-salt solution?
c) Another home-made liquid such as porridge, soup, yoghurt, coconut water, fresh fruit juice, tea, milk, or rice water?

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

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

531. CHECK 530: GIVEN ZINC?

532. How many times was (NAME) given zinc?

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

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

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

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

537. CHECK 533: HAD FEVER?

538. 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?

539. 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?

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

541. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

542. CHECK 541:

543. Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

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

545. Is (NAME) still sick with a (fever/cough)?

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

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

548. CHECK 547: ANY CODE A-G CIRCLED?

549. Did you already have (NAME OF DRUG FROM 547) at home when the child became ill?

ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'G' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 547.

IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG.
IF NO FOR ALL DRUGS, CIRCLE 'Y'

550. CHECK 547: ANY CODE A-F CIRCLED?

551. CHECK 547: SP/FANSIDAR ('A') GIVEN

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

553. For how many days did (NAME) take the SP/Fansidar?
IF 7 DAYS OR MORE, WRITE 7.

554. CHECK 547: CHLOROQUINE ('B') GIVEN

555. How long after the fever started did (NAME) first take chloroquine?

556. For how many days did (NAME) take the chloroquine?
IF 7 DAYS OR MORE, WRITE 7.

557. CHECK 547: AMODIAQUINE ('C') GIVEN

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

559. For how many days did (NAME) take the Amodiaquine?
IF 7 DAYS OR MORE, WRITE 7.

560. CHECK 547: QUININE ('D') GIVEN

561. How long after the fever started did (NAME) first take quinine?

562. For how many days did (NAME) take the quinine?
IF 7 DAYS OR MORE, WRITE 7

563. CHECK 547: ARTEMETER+LUMEFANTRINE (AL/COARTEM) ('E') GIVEN

564. How long after the fever started did (NAME) first take AL?

565. For how many days did (NAME) take AL?
IF 7 DAYS OR MORE, WRITE 7.

569. CHECK 547: OTHER ANTIMALARIAL ('F') GIVEN

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

571. For how many days did (NAME) take the (OTHER ANTIMALARIAL)?
IF 7 DAYS OR MORE, WRITE 7.

571A .Was anything else done about (NAME)'s fever?

571B. What was done about (NAME)'s fever?

572. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573.

573. CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2003 OR LATER AND LIVING WITH THE RESPONDENT

574. The last time (NAME FROM 573) passed stools, what was done to dispose of the stools?

575. CHECK 528(a) AND 528(b), ALL COLUMNS:

576. Have you ever heard of a special product called Oralite or ORS that you can get for the treatment of diarrhea?

576A. CHECK 224:

576B. CHECK 218, ALL ROWS: ANY CHILD LIVING WITH RESPONDENT?

576C. When a child is ill, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
CIRCLE ALL MENTIONED.

577. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2005 OR LATER AND LIVING WITH THE RESPONDENT

578. Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night.
Did (NAME FROM 577) (drink/eat):
Plain water?
Commercially produced infant formula?
Milk, such as tinned, powdered, or fresh animal milk?
Tea or coffee?
Any other liquids?
Any fortified baby food like Cerelac?
Any (other) porridge or gruel?

579. Now I would like to ask you about other foods (NAME FROM 577) ate over the last 24 hours. I am interested in whether (NAME) had the item even if it was combined with other foods.

Yesterday, did (NAME) eat:

a) Any foods made from grains, like maize, rice, wheat, porridge, sorghum or other local grains?
b) Pumpkin, yellow yams, butternut, carrots or yellow sweet potatoes?
c) Any other food made from roots or tubers, like white potatoes, arrowroot, cassava, or other roots or tubers?
d) Any green leafy vegetables?
e) Mango, pawpaw, guava?
f) Any other fruits and vegetables like bananas, apples, green beans, avocados, tomatoes, oranges, pineapples, passion fruit?
g) Meat, chicken, fish, liver, kidney, blood, termites, sea food or eggs?
h) Any food made from legumes, e.g. lentils, beans, soybeans, pulses or pea nuts?
i) Sour milk, cheese, or yoghurt?
j) Any other solid or semi-solid food?

580. CHECK 578 (LAST 2 CATEGORIES: BABY CEREAL OR OTHER PORRIDGE/GRUEL) AND 579:

581. How many times did (NAME FROM 577) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

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

607. Including yourself, in total, how many wives or partners does your husband live with now as if married?

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

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

615. CHECK 609:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE _
Now I would like to ask about when you started living with your first husband/partner. In what month and year was that?

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

616A. When you got married or lived with a man, was it your choice or it was arranged?

616B. When you first got married or lived with a man, was the man older than you, younger than you or the same age as you?

616C. Would you say this person was ten or more years older than you or less than ten years older than you?

617. CHECK FOR THE PRESENCE OF OTHER PEOPLE BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

618. 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?

619. CHECK 107:

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

621. CHECK 107:

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

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

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

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

626. 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.

626A. 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. (GO TO 628)

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

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

629A. What is the main reason you used a condom on that occasion?

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

630. 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'.

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

632. CHECK 107:

633. How old is this person?

634. Is this person older than you, younger than you, or about the same age?

635. Would you say this person is ten or more years older than you or less than ten years older than you?

636. The last time you had sexual intercourse with this person, did you or this person drink alcohol?

637. Were you or your partner drunk at that time? IF YES: Who was drunk?

638. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

639. In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95 WRITE '95. '

640. In total, with how many different people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95 WRITE '95 '

640A. In the last 12 months, have you ever given or received money, gifts or favours in return for sex?

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

642. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

645. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

647. In the last few months have you heard or read about condoms:
On the radio?
On the television?
In a newspaper or magazine?
On billboards?

648. In your opinion, is it acceptable or unacceptable for condoms to be advertised:
On the radio?
On the TV?
In newspapers?
On billboards?

SECTION 7. FERTILITY PREFERENCES

701. CHECK 311/311A:

702. CHECK 226:

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

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

703. CHECK 226:

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

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

704. CHECK 226:

705. CHECK 310: USING A CONTRACEPTIVE METHOD?

706. CHECK 703:

707. CHECK 702:

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

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

RECORD ALL REASONS MENTIONED.

707A. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

708. CHECK 310: USING A CONTRACEPTIVE METHOD?

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

710. Which contraceptive method would you prefer to use?

711. What is the main reason that you think you will not use a contraceptive method at any time in the future?

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

713. 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.

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

715. In the last few months have you:
Heard about family planning on the radio?
Seen about family planning on the television?
Read about family planning in a newspaper or magazine?

717. CHECK 601:

718. CHECK 311/311A:

719. Does your husband/partner know that you are using a method of family planning?

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

720A. Now I want to ask you about your husband's/partner's views on family planning. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

720B. How often have you talked to your husband/partner about family planning in the past year?

721. CHECK 311/311A:

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

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

801. CHECK 601 AND 602:

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

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

804. What is the highest level of school he attended:
primary, vocational, secondary, or higher?

805. What is the highest (standard/form/year) he completed at that level?
IF NONE, WRITE '00'.

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?

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?

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?

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

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

812. CHECK 811:

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

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

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

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

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

818. CHECK 601:

819. CHECK 817:

820. Who usually decides how the money you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?

821. 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?

822. Who usually decides how your husband's/partner's earnings will be used: you, your husband/partner, or you and your husband/partner jointly?

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

824. Who usually makes decisions about making major household purchases?

825. Who usually makes decisions about making purchases for daily household needs?

826. Who usually makes decisions about visits to your family or relatives?

826A. Who usually makes decisions about what food should be cooked each day?

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

828. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

SECTION 9. HIV/AIDS

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

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

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

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

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

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

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

908A. Is there anything else a person can do to avoid getting AIDS or the virus?

908B. What can a person do? Anything else?
CIRCLE ALL MENTIONED.

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

910. Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

911. Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?

912. CHECK 911:

912A. 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?

913. CHECK 801:

914. Have you ever talked with (your husband/the man you are with) about ways to prevent getting the virus that causes AIDS?

914A. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

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

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

916A. 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?

916B. Should children age 12-14 years be taught about using condoms to avoid getting AIDS?

916B1. Do you think your chances of getting AIDS are small, moderate, great or no risk at all?

916B2. Why do you think that you have (no risk/small chance) of getting AIDS? Any reasons?
CIRCLE ALL MENTIONED

916B3. Why do you think that you have (moderate/great) chance of getting AIDS? Any reasons?
CIRCLE ALL MENTIONED

916B4. Have you ever heard of VCT?

916B5. CHECK 208 AND 215:

916B6. CHECK 407 FOR LAST BIRTH:

916B7. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

916B8. During any of the antenatal visits for your last birth, did anyone talk to you about:
Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

916B9. Were you offered a test for the AIDS virus as part of your antenatal care?

916B10. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

916B11. I don't want to know the results, but did you get the results of the test?

916B12. Where was the test done?

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

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE '21'.

916B13. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

916B14. When was the last time you were tested for the AIDS virus?

916C . I do not want to know the results, but have you ever been tested to see if you have the AIDS virus?

916C1. When was the last time you were tested?

916C2. The last time you were tested, did you ask for the test, was it offered to you and you accepted, or was it required?

916C3. I do not want to know the results, but did you get the results of the test?

916C4. Where was the test done?

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

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE '21'.

916D. Would you want to be tested for the AIDS virus?

916E. Do you know of a place where people can go to get tested for the AIDS virus?

916F. Where is that? Any other place?

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

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE 'E'.

917. 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?

918. If a man has a sexually transmitted disease, what symptoms might he have?
Any others?
RECORD ALL MENTIONED

919. If a woman has a sexually transmitted disease, what symptoms might she have?
Any others?
RECORD ALL MENTIONED

919A. CHECK 618:

919A1. CHECK 917: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

919B. Now I would like to ask you some questions about your health in the last twelve months. During the last twelve months have you had a sexually transmitted disease?

919C. Sometimes women experience an abnormal vaginal discharge. During the last twelve months, have you had a bad smelling unusual discharge from your vagina?

919D. Sometimes women have a genital sore or ulcer. During the last twelve months have you had a genital sore or ulcer?

919E. CHECK 919B, 919C AND 919D

919F. Last time you had (PROBLEM(S) FROM 919B/919C/919D), did you seek any kind of advice or treatment?

919G. Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

919H. When you had (PROBLEM(S) FROM 919B/919C/919D), did you inform the person(s) with whom you were having sex?

919I. When you had (PROBLEM(S) FROM 919B/919C/919D), did you do anything to avoid infecting your sexual partners(s)?

919J. What did you do to avoid infecting your partner(s)? Did you:
Use medicine?
Stop having sex?
Use a condom when having sex?

SECTION 10. OTHER HEALTH ISSUES

1001. Have you ever heard of an illness called tuberculosis or TB?

1002. How does tuberculosis spread from one person to another? PROBE: Any other ways?
RECORD ALL MENTIONED.

1003. Can tuberculosis be cured?

1004. If a member of your family got tuberculosis, would you want it to remain a secret or not?

1009. Do you currently smoke cigarettes?

1010. In the last 24 hours, how many cigarettes did you smoke?

1011. Do you currently smoke or use any other type of tobacco?

1012. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

1014. Are you covered by any health insurance?

1015. What type of health insurance?
RECORD ALL MENTIONED.

1016. Sometimes a woman can have a problem such that she experiences a constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after a pelvic surgery.

Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

1017. Did this problem occur after a delivery?

1018. Did this problem occur after a sexual assault?

1019. Did this problem occur after you had pelvic surgery?

1020. Did this problem occur after some other event happened to you? IF YES: What happened?

1021. Did this problem occur after an uncomplicated delivery, after a difficult delivery where the child was born alive, or after a difficult delivery where the child was born still?

1022. After which delivery did this occur?

1023. How many days after did the leakage start?
IF MORE THAN 99 DAYS, WRITE '99'.

1024. Have you sought treatment for this condition?

SECTION 11. MATERNAL MORTALITY

Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your biological mother, including those who are living with you, those living elsewhere and those who have died.

1101. How many children did your mother give birth to, including you?

1102. CHECK 1101:

1103. How many of these births did your mother have before you were born?

1104. What was the name given to your oldest (next oldest) brother or sister?
(*USE ADDITIONAL COLUMNS IF THERE ARE OTHER SIBLINGS)

1105. Is (NAME) male or female?

1106. Is (NAME) still alive?

1107. How old is (NAME)?

1108. How many years ago did (NAME) die?

1109. How old was (NAME) when he/she died?

1110. Was (NAME) pregnant when she died?

1111. Did (NAME) die during childbirth?

1112. Did (NAME) die within two months after the end of a pregnancy or childbirth?

1113. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

SECTION 12. DOMESTIC VIOLENCE

1200. CHECK HOUSEHOLD QUESTIONNAIRE, COLUMN 9.

1201. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

1202. CHECK 601 AND 602:

1203. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?
a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?
f) He (does/did) not trust you with any money?

1204. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.

A - (Does/did) your (last) husband/partner ever:

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

1205. A - (Does/did) your (last) husband/partner ever do any of the following things to you:

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

1206. CHECK 1205 (a-i):

1207. How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

1208. Did the following ever happen as a result of what your (last) husband/partner did to you:

1209. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?

1210. CHECK 603:

1211. In the last 12 months, how often have you done this to your husband/partner: often, only sometimes, or not at all?

1212. Does (did) your husband/partner drink alcohol?

1213. How often does (did) he get drunk: often, only sometimes, or never?

1214. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN __
From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?

NEVER MARRIED/ NEVER LIVED WITH A MAN __
From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?

1215. Who has hurt you in this way?Anyone else?
RECORD ALL MENTIONED.

1216. In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

1220. CHECK 618: EVER HAD SEX?

1221. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

1222. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN __
In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?

NEVER MARRIED/ NEVER LIVED WITH A MAN __
In the last 12 months has anyone forced you to have sexual intercourse against your will?

1223. CHECK 1221 AND 1222:

1224. CHECK 1205A(h) and 1205A(i):

1225. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

1226. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1227. Who was the person who was forcing you at that time?

1228. CHECK 1205A (a-i), 1214, 1222 AND 1225:

1229. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

1230. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1231. Have you ever told anyone else about this?

1232. As far as you know, did your father ever beat your mother?

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

1233. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1234. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

SECTION 13. FEMALE GENITAL CUTTING

1301. Have you ever heard of female circumcision?

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

1303. Have you yourself ever been circumcised?

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

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

1306. Was your genital area sewn closed?

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

1308. Who performed the circumcision?

1309A. CHECK 214 AND 216:

1309B. CHECK 1309A:

1310. CHECK 1309B:

ONE LIVING DAUGHTER __
Has your daughter been circumcised?
IF YES: RECORD '01'

MORE THAN ONE LIVING DAUGHTER __
Have any of your daughters been circumcised?
IF YES: How many?

1311. CHECK 1310:

ONE LIVING DAUGHTER __
What is your daughter's name?

MORE THAN ONE LIVING DAUGHTER __
Which of your daughters was circumcised most recently?

1312. Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM Q. 1311) at that time. Was any flesh removed from her genital area?

1313. Was her genital area just nicked without removing any flesh?

1314. Was her genital area sewn closed?

1315. How old was (NAME OF THE DAUGHTER FROM Q. 1311) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

1316. Who performed the circumcision?

1317. CHECK 1309A AND 1310:

1318. Do you intend to have [your (other) daughter/any of your (other) daughters] circumcised?

1319. What benefits do girls themselves get if they are circumcised?
PROBE: Any other benefits?
RECORD ALL MENTIONED.

1320. Do you believe that this practice is required by your religion?

1321. Do you think that this practice should be continued, or should it be stopped?

1322. 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

____________________________________________

NAME OF SUPERVISOR: ____________________
DATE: _____________________

EDITOR'S OBSERVATIONS

_____________________________________________

NAME OF EDITOR: ______________________ DATE: _______________________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

2009
04 APR 01 _____
03 MAR 02 _____
02 FEB 03 _____
01 JAN 04 _____

2008
12 DEC 05 _____
11 NOV 06 _____
10 OCT 07 _____
09 SEP 08 _____
08 AUG 09 _____
07 JUL 10 _____
06 JUN 11 _____
05 MAY 12 _____
04 APR 13 _____
03 MAR 14 _____
02 FEB 15 _____
01 JAN 16 _____

2007
12 DEC 17 _____
11 NOV 18 _____
10 OCT 19 _____
09 SEP 20 _____
08 AUG 21 _____
07 JUL 22 _____
06 JUN 23 _____
05 MAY 24 _____
04 APR 25 _____
03 MAR 26 _____
02 FEB 27 _____
01 JAN 28 _____

2006
12 DEC 29 _____
11 NOV 30 _____
10 OCT 31 _____
09 SEP 32 _____
08 AUG 33 _____
07 JUL 34 _____
06 JUN 35 _____
05 MAY 36 _____
04 APR 37 _____
03 MAR 38 _____
02 FEB 39 _____
01 JAN 40 _____

2005
12 DEC 41 _____
11 NOV 42 _____
10 OCT 43 _____
09 SEP 44 _____
08 AUG 45 _____
07 JUL 46 _____
06 JUN 47 _____
05 MAY 48 _____
04 APR 49 _____
03 MAR 50 _____
02 FEB 51 _____
01 JAN 52 _____

2004
12 DEC 53 _____
11 NOV 54 _____
10 OCT 55 _____
09 SEP 56 _____
08 AUG 57 _____
07 JUL 58 _____
06 JUN 59 _____
05 MAY 60 _____
04 APR 61 _____
03 MAR 62 _____
02 FEB 63 _____
01 JAN 64 _____

2003
12 DEC 65 _____
11 NOV 66 _____
10 OCT 67 _____
09 SEP 68 _____
08 AUG 69 _____
07 JUL 70 _____
06 JUN 71 _____
05 MAY 72 _____
04 APR 73 _____
03 MAR 74 _____
02 FEB 75 _____
01 JAN 76 _____