IDENTIFICATION

COUNTRY ____________

DISTRICT ____________

LOCATION/TOWN ____________

SUBLOCATION ____________

NASSEP CLUSTER NUMBER ____________

KDHS CLUSTER NUMBER ____________

HOUSEHOLD NUMBER ____________

NAME OF HOUSEHOLD HEAD ____________

NAME AND LINE NUMBER OF WOMAN ____________

CHECK IN 101A IN HOUSEHOLD QUESTIONNAIRE: IS WOMAN SELECTED FOR SECTION 14?

INTERVIEWER VISITS

FIRST VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________

SECOND VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________

THIRD VISIT
DATE ______
INTERVIEWER'S NAME __________
RESULT* _________

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY ____
MONTH _____
YEAR _____
INTERVIEW NUMBER _____
RESULT* ____

RESULT CODES:

LINE NUMBER OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___

TOTAL PERSONS IN HOUSEHOLD ___

TOTAL ELIGIBLE WOMEN ___

TOTAL ELIGIBLE MEN ____

LANGUAGE OF QUESTIONNAIRE: 17 ENGLISH

LANGUAGE OF INTERVIEW _____

NATIVE LANGUAGE OF RESPONDENT _____

TRANSLATOR USED

SUPERVISOR NAME ________

FIELD EDITOR NAME _________

OFFICE EDITOR _________

KEYED BY _________

SECTION 1: RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ________________________. I am working with the Kenya National Bureau of Statistics. We are conducting a survey about health all over Kenya. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household. Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER: ____________________

DATE: _______________

101) RECORD THE TIME

101A) 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, Kisumu, in a town, in the countryside, or outside of Kenya?

101B) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD '00' YEARS

101C) Just before you moved here, did you live in Nairobi, Mombasa, Kisumu, in a town, in the countryside, or outside of Kenya?

101D) What is your nationality?

101E) What was the main reason for moving to Kenya?

102) In what month and year were you born?

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

104) Have you ever attended school?

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

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

107) CHECK 105:

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

SHOW CARD TO RESPONDENT.

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

109) CHECK 108:

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

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

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

113) What is your religion?

114) What is your ethnic group/tribe?

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

116) 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 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'.

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

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

206) Have you ever given birth to a boy or girl who was born alive but later died?

IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

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

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

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

210) CHECK 208:

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (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?
RECORD NAME

213) Is (NAME) a boy or 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 '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? [DO NOT ASK FOR FIRST BIRTH]

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

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

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER

225) C:
FOR EACH BIRTH SINCE JANUARY 2009, 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?

C: RECORD THE 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) When you got pregnant, did you want to get pregnant at the time?

229) Did you want to have a baby later on or did you not want any (more) 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) How many months pregnant were you when the last such pregnancy ended?

C: 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.

234) Since January 2009, have you had any other pregnancies that did not result in a live birth?

235) C:
ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2009. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2009?

237) When did the last such pregnancy that terminated before 2009 end?

238) When did your last menstrual period start?

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

240) 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. Have you ever heard of (METHOD)?

302) CHECK 226:

303) Are you 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 GO INSTRUCTION FOR HIGHEST METHOD IN LIST.

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.

307A) The last time you obtained (HIGHEST METHOD ON LIST IN 304), how much did you pay in total, including the cost of the method and any consultation you may have had.

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

308A) 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?

309) CHECK 308/308A, 215 AND 231:

310) C:

CHECK 308/308A:

311) I would 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 THE MOST RECENT USE, BACK TO JANUARY 2009.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:

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

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:

d) Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
e) IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

312) CHECK THE CALENDAR FOR THE USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

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

314) CHECK 304:

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

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?

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

316) CHECK 304:

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

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

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

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

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

320) CHECK 317:

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 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

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

322) CHECK 304:

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

323) Where did you obtain (CURRENT METHOD) 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.

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

325) Where is that?
Any other place?

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

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

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

328) 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 BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 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 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 get pregnant at that time?

406) 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?

[MOST RECENT BIRTH ONLY]

408A) What are the reasons for not receiving antenatal care for this pregnancy? RECORD ALL MENTIONED.

[MOST RECENT BIRTH ONLY]

409) Whom did you see?

Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

[MOST RECENT BIRTH ONLY]

410) Where did you receive antenatal care for this pregnancy?

Anywhere else?

[MOST RECENT BIRTH ONLY]

PROBE TO IDENTIFY EACH 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?
[MOST RECENT BIRTH ONLY]

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

[MOST RECENT BIRTH ONLY]

413) As part of your antenatal care during this pregnancy, were any of the following done at least once:

a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?
d) Were you weighted?
e) Was your height measured?

[MOST RECENT BIRTH ONLY]

413A) Were you given any information or counseled about breastfeeding?

[MOST RECENT BIRTH ONLY]

413B) Were you given any information or counseled about iron tablets, iron syrup, or iron and folic acid supplementation?
[MOST RECENT BIRTH ONLY]

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

414A) During any of your antenatal care visits, were you asked about your family
planning needs after delivery?
[MOST RECENT BIRTH ONLY]

415) 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 ONLY]

416) During this pregnancy, how many times did you get a tetanus injections?
[MOST RECENT BIRTH ONLY]

417) CHECK 416:
[MOST RECENT BIRTH ONLY]

418) At any time before this pregnancy, did you receive any tetanus injections?
[MOST RECENT BIRTH ONLY]

419) Before this pregnancy, how many times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.
[MOST RECENT BIRTH ONLY]

420) How many years ago did you receive the last tetanus injection before this pregnancy?
[MOST RECENT BIRTH ONLY]

421) During this pregnancy, were you given or did you buy any iron tablets, iron syrup, or iron and folic acid supplements?

SHOW TABLET/SYRUP
[MOST RECENT BIRTH ONLY]

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

423) During this pregnancy, did you take any drug for intestinal worms?
[MOST RECENT BIRTH ONLY]

424) During this pregnancy, did you take any drugs to keep you from getting malaria?
[MOST RECENT BIRTH ONLY]

425) What drugs did you take?

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

[MOST RECENT BIRTH ONLY]

426) CHECK 425: SP/FANSIDAR TAKEN FOR MALARIA PREVENTION.
[MOST RECENT BIRTH ONLY]

427) How many times did you take (SP/Fansidar) during this pregnancy?
[MOST RECENT BIRTH ONLY]

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY
[MOST RECENT BIRTH ONLY]

429) 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 ONLY]

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

431) Was (NAME) weighted at birth?

432) How much did (NAME) weigh? RECORD WEIGHT IN KILOGRAMS FROM MOTHER AND CHILD HEALTH BOOKLET, OR FROM CHILD HEALTH CARD, IF AVAILABLE.

432A) Was (NAME) weighted within two weeks after birth?

433) 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 DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

433A) What are the reasons you preferred a (Traditional Birth Attendant/relative) in the birth of (NAME)? RECORD ALL MENTIONED.
[MOST RECENT BIRTH ONLY]

434) Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

[MOST RECENT BIRTH ONLY]

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

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

437) Did anyone check on your health after you left the facility?
[MOST RECENT BIRTH ONLY]

438) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?
[MOST RECENT BIRTH ONLY]

439) Who checked on your health at that time? PROBE FOR MOST QUALIFIED.
[MOST RECENT BIRTH ONLY]

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 ONLY]

440A) Did the person who checked your health after you gave birth discuss with you about family planning?

[MOST RECENT BIRTH ONLY]

442) 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 ONLY]

443) 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 ONLY]

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

[MOST RECENT BIRTH ONLY]

445) Where did this first check of (NAME) take 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.

[MOST RECENT BIRTH ONLY]

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS
[MOST RECENT BIRTH ONLY]

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

[MOST RECENT BIRTH ONLY]

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

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

450) CHECK 226: IS RESPONDENT PREGNANT?

[MOST RECENT BIRTH ONLY]

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

[MOST RECENT BIRTH ONLY]

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

453) Did you ever breastfeed (NAME)?

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

IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.
[MOST RECENT BIRTH ONLY]

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

[MOST RECENT BIRTH ONLY]

457) What was (NAME) given to drink?

Anything else?
RECORD ALL LIQUIDS MENTIONED.
[MOST RECENT BIRTH ONLY]

457A) What are the reasons (NAME) was given drinks other than breast milk?

Anything else?

RECORD ALL MENTIONED.
[MOST RECENT BIRTH ONLY]

458) CHECK 404: IS CHILD LIVING?

[MOST RECENT BIRTH ONLY]

459) Are you still breastfeeding (NAME)?
[MOST RECENT BIRTH ONLY]

459A) For how many months did you breastfeed (NAME)?

459B) CHECK 404: IS CHILD LIVING?

459C) Was (NAME) breastfed yesterday during the day or at night?
[MOST RECENT BIRTH ONLY]

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

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

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

503) FROM 212 AND 216:

504) Do you have a card/child health book where (NAME)'s vaccinations are written down?

IF YES: May I see it please?

505) Did you ever have a vaccination card or child health book for (NAME)?

506) (1) COPY DATES FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED. (3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES, FOR MOST RECENT AND SECOND MORE RECENT DOSES.

507) CHECK 506:

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

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

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

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

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

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

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

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

510E) A Pentavalent vaccination, that is, an injection given in the left outer thigh, sometimes at the same time as polio drops?

510F) How many times was the Pentavalent vaccination given?

510F1) A Pneumococcal vaccination, that is, an injection given in the right outer thigh, sometimes at the same time as polio drops or the Pentavalent vaccination?

510F2) How many times was the Pneumococcal vaccination given?

510F3) A Rota virus vaccination given orally?

510F4) How many times was the Rota virus vaccination given?

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

510H) A yellow fever injection- that is, a shot in the arm or shoulder at the age of 9 months or older- prevent him/her from getting yellow fever?

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

511A) How many times was Vitamin A given in the last six months?

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

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

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

515) Was there any blood in the stools?

516) Now I would like to know how much (NAME) was given to drink during the diarrhoea (including breast milk). 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?

517) When (NAME) had diarrhoea, 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?

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

519) Where did you seek advice or treatment?
Anywhere else?

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

520) CHECK 519:

521) Where did you first seek advice or treatment?
USE LETTER CODE FROM 519.

521A) How many days after the diarrhoea began did you first seek advice or treatment for (NAME)?

IF SAME DAY, RECORD '00'

521B) Why did you not seek advice or treatment?

RECORD ALL MENTIONED.

521C) Does (NAME) still have diarrhoea?

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhoea:

A) A fluid made from a special packet called ORS?
B) A home-made sugar-salt solution?
C) Other home-made liquid such as porridge, soup, yoghurt, coconut water, fresh fruit juice, tea, milk, or rice water?

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

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

524A) CHECK 524.
GIVEN ZINC TABLETS?

524B) How many days was (NAME) given zinc tablets?

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

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

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

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

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

530) CHECK 525: HAD FEVER?

531) Now I would like to know how much (NAME) was given to drink (including breast milk) 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?

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

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

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

534) Where did you seek advice or treatment?

Anywhere else?

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

535) CHECK 534:

536) Where did you first seek advice or treatment?

USE LETTER CODE FROM 534.

536A) How many days after the illness did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'

536B) Is (NAME) still sick with a (fever/cough)?

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

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

539) CHECK 538:

ANY CODE A-G CIRCLED?

539A) Did you already have (NAME OF DRUG FROM 538) 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 538.

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

540) CHECK 538:

SP/FANSIDAR ('A') GIVEN

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

541A) For how many days did (NAME) take the (SP/Fansidar)? IF 7 DAYS OR MORE, WRITE 7.

542) CHECK 538:

CHLOROQUINE ('B') GIVEN

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

543A) For how many days did (NAME) take the chloroquine?
IF 7 DAYS OR MORE, WRITE '7'.

544) CHECK 538:

AMODIAQUINE ('C') GIVEN

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

545A) For how many days did (NAME) take the amodiaquine? IF 7 DAYS OR MORE, WRITE 7.

546) CHECK 538:

QUININE ('D') GIVEN

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

547A) For how many days did (NAME) take the quinine? IF 7 DAYS OR MORE, WRITE 7.

548) CHECK 538:

ARTEMISININ+LUMEFANTRINE (AL/COARTEM)('E') GIVEN

549) How long after the fever started did (NAME) first take AL/Coartem?

549A) For how many days did (NAME) take AL/Coartem? IF 7 DAYS OR MORE, WRITE 7

550) CHECK 538:

OTHER ANTIMALARIAL ('F') GIVEN

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

551A) CHECK 525:

HAD FEVER?

551B) Was anything else done about (NAME'S) fever?

551C) What was done about (NAME'S) fever?

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

553) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH THE RESPONDENT

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

554A) 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? RECORD ALL MENTIONED.

555) CHECK 522(a), ALL COLUMNS:

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

556A) Where did you get this information? RECORD ALL MENTIONED

556B) CHECK 524 ALL COLUMNS:

556C) Have you ever heard of zinc tablets which you can get for the treatment of diarrhoea?

556D) Where did you get information? RECORD ALL MENTIONED.

557) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2012 OR LATER LIVING WITH THE RESPONDENT

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

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

559) CHECK 558 (CATEGORIES "g" THROUGH "u"):

560) Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?

IF 'YES' PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat?

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

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 any other wives or does he live with other women as if married?

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

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

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

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

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

611A) When you got married or lived with a man, was it your choice or was it arranged?

611B) 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?

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

613) Now I would like to ask 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?

613A) CHECK 103:

613B) The first time you had sexual intercourse, was a condom used?

613C) How old was the person you first had sexual intercourse with?

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

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

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

616) When was the last time you had sexual intercourse with this person?
[DO NOT ASK FOR MOST RECENT SEXUAL PARTNER]

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

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

619) What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

620) CHECK 609:

621) CHECK 613: FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (CODE 95)

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

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

624) How old is this person?

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

626) 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 95 OR MORE, WRITE '95'.

626A) In the last 12 months, have you ever given or received money, gifts, or favors in return for sex?

627) 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 95 OR MORE, WRITE '95'.

628) PRESENCE OF OTHERS DURING THIS SECTION

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

630) Where is that?

Any other place?

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

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

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

633) Where is that?

Any other place?

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

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

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

702) CHECK 226:

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

704) 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?

705) 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?

706) CHECK 226:

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

709) CHECK 704:

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

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

Any other reason?

RECORD ALL REASONS MENTIONED.

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

711A) What contraceptive method would you prefer to use?

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

712) CHECK 216:

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

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.

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

714) 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?

715A) In the last 12 months have you:

a) Heard family planning at public forums, such as Barazas or public gatherings?
b) Seen family planning information material, such as posters, brochures, or stickers?
c) Been visited by a health worker or health professional to discuss family planning issues?
d) Received family planning messages through social media platforms, such as Facebook or Twitter?
e) Received family planning messages through a mobile phone via text or email?
f) Heard political/religious/community leaders talk favorably about family planning?

716) CHECK 601:

716A) 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?

716B) How often have you talked to your husband/partner about family planning in the past?

717A) CHECK 304: CURRENT CONTRACEPTIVE METHOD USED

717B) Does your husband/partner know you are using a method of family planning?

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

719) CHECK 304:

720) 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 was the highest level of school he attended: primary, vocational, secondary, or higher?

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

806) CHECK 801:

806A) What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

806B) What was your (last)(husband's/partner's) occupation? That is, what kind of work does 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 form 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?

811A) CHECK 811:

811B) 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?

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

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

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

815) CHECK 601:

816) CHECK 814:

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

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

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

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

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

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

822A) Who usually makes decisions about what food should be cooked each day?

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

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

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

826) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?

SECTION 9. HIV/AIDS

901) Now I would like to talk about something else. Have you ever heard of the 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 reduce their chance of getting the AIDS virus by not have sexual intercourse at all?

904A) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

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

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

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

907A) Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

908) Can the virus that causes AIDS be transmitted from a mother to her baby:

a) During pregnancy?
b) During delivery?
c) By breastfeeding?

909) CHECK 908:

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

911) CHECK 208 AND 215:

912) CHECK 408 FOR LAST BIRTH:

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

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

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

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

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

917) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

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

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

920) CHECK 434 FOR LAST BIRTH:

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

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

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

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

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

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

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

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

929) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

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

931) Where is that?

Any other place?

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

931A) CHECK 601:

931B) Have you ever talked with your (husband/partner) about ways to prevent getting the virus that causes AIDS?

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

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

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

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

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

937) CHECK 901:

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

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

937A) If a man has a sexually transmitted disease, what symptoms might he have?

Any others?

RECORD ALL MENTIONED.

937B) If a woman has a sexually transmitted disease, what symptoms might she have?

Any others?

RECORD ALL MENTIONED.

938) CHECK 613:

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

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

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

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

943) CHECK 940, 941, AND 942:

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

945) Where did you go?

Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

945A) When you had (PROBLEM(S) FROM 940/941/942), did you inform the persons with whom you were having sex?

945B) When you had (PROBLEM(S) FROM 940/941/942), did you do anything to avoid infecting your sexual partner(s)?

945C) What did you do to avoid infecting your partner(s)? Did you:

a) Use medicine?
b) Stop sex?
c) Use a condom when having sex?

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

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

948) CHECK 601:

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

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

SECTION 10. OTHER HEALTH ISSUES

1001) 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.

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

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.

1003) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1003A) Have you ever been told by a doctor or health worker that you have high blood pressure or hypertension?

1003B) Have you ever been told by a doctor or health worker that you have high blood sugar or diabetes?

1003C) In the past 12 months, have you been involved in a road traffic accident as a driver, passenger, pedestrian, or cyclist?

1003D) In the past 12 months, were you injured accidentally, not related to a traffic accident?

1003E) How did the injury happen? RECORD ALL MENTIONED.

1003F) Have you even heard of an illness called tuberculosis or TB?

1003G) How does tuberculosis spread from one person to another?

PROBE: Any other ways? RECORD ALL MENTIONED.

1004) Do you currently smoke cigarettes?

1005) In the last 24 hours, how many cigarettes did you smoke?

1006) Do you currently smoke or use any (other) type of tobacco?

1007) What (other) type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

1007A) Do you drink alcohol?

1007B) During the last two weeks, on how many days did you have at least one alcoholic drink?

1007C) Are you involved in exercise that causes an increase in your heart rate for at least 10 minutes continuously...

a) At work?
b) During other physical activities?

1008) 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 health facility?
d) Not wanting to go alone?

1008A) Now I would like to ask you about women's health. Have any ever heard of cervical cancer?

1008B) Have you ever had a test or exam to see if you had cervical cancer?

1008C) What type of exam did you have to see if you had cervical cancer?

1008D) Have you ever examined your breasts to detect or check for breast cancer?

1008E) Has a doctor or other health professional examined your breasts to detect or check for breast cancer?

1009) Are you covered by any health insurance?

1010) What type of health insurance are you covered by?

RECORD ALL MENTIONED.

SECTION 11. MATERNAL MORTALITY

1101) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

1102) CHECK 1101:

1103) How many births did your mother have before you were born?

1104) What was the name given to your oldest (next oldest) brother or sister?

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?

SECTION 12: FISTULA

1201) Sometimes a woman can have a problem of 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 pelvic surgery. Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

1202) Have you ever heard of this problem?

1203) Did this problem start after you delivered a baby or had a stillbirth?

1204) Did this problem start after a normal labor and delivery, or after a very difficult labor and delivery?

1205) What do you think caused this problem?

1206) How many days after (CAUSE OF PROBLEM FROM 1203 OR 1205) did the leakage start?

1207) Have you sought treatment for this condition?

1208) Why have you not sought treatment?

PROBE AND RECORD ALL MENTIONED.

1209) From whom did you last seek treatment?

1210) Did you have an operation to fix the problem?

1211) Did the treatment stop the leakage completely? IF NO: Did the treatment reduce the leakage?

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?

1309) CHECK 213, 215, AND 216:

CHECK 213, 215 AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 1999 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).

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

1310) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 1999 OR LATER.

1311) Is (NAME OF DAUGHTER) circumcised?

1312) How old was (NAME OF DAUGHTER) when she was circumcised?

IF RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

1313) Was her genital area sewn closed?

1314) Who performed the circumcision?

1315) GO BACK TO 1311 IN NEXT COLUMN, OR IF NO MORE DAUGHTERS, GO TO 1315A.

1315A) Do you believe that this practice is required by your community?

1316) Do you believe that this practice is required by your religion?

1317) Do you think that female circumcision should be continued, or should it be stopped?

SELECTION 14: DOMESTIC VIOLENCE

1401) CHECK COVER PAGE: IS WOMAN SELECTED FOR SECTION 14?

1401A) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

READ TO THE RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Kenya. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

1402) CHECK 601 AND 602:

1403) 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 (tires/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?

1404A) Now I need to ask some more questions about your relationship with your (last) (husband/partner). Did you (last) (husband/partner) ever:

a) say or do something to humiliate you in front of others?
b) threaten to hurt or harm you or someone you care about?
c) insult you or make you feel bad about yourself?

1404B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of others?
b) threaten to hurt or harm you or someone you care about?
c) insult you or make you feel bad about yourself?

1405A) Did your (last) (husband/partner) ever do any of the following things to you:

a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?

1405B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
b) slap you?
c) twist your arm or pull your hair?

1406) CHECK 1405A (a-j):

1407) How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen?

1408) Did the following ever happen as a result of what your (last) (husband/partner) did to you:

a) You had cuts, bruises, or aches?
b) You had eye injuries, sprains, dislocations, or burns?
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?

1409) 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?

1410) In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

1411) Does (did) your (last) (husband/partner) drink alcohol?

1412) How often does (did) he get drunk: often, only sometimes, or never?

1413) Are (were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

1414) CHECK 609:

1415A) So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

1415B) How long ago did this last happen?

1416) CHECK 601 AND 602:

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

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

1419) CHECK 201, 226, AND 230:

1420) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1421) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?

1422) CHECK 601 AND 602:

Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner).

1422A) 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 when you did not want to?

1422B) 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 when you did not want to?

1423) Who was the person who was forcing you the very first time this happened?

1424) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN: In the last 12 months, has anyone other than you ( your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?

NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

1424A) CHECK 1405A(h-j) and 1415A(b):

1425) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?

NEVER MARRIED/NEVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1426) CHECK 1405(a-j), 1415(a, b), 1416, 1420, 1422A, AND 1422B:

1427) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1428) From whom have you sought help? Anyone else? RECORD ALL MENTIONED.

1429) Have you ever told anyone about this?

1430) 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.

1431) 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?

1432) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE. ______________________

1433) RECORD THE TIME.