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2014 KENYA DEMOGRAPHIC AND HEALTH SURVEY WOMEN'S QUESTIONNAIRE -- LONG VERSION (ENGLISH)

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?

YES 1
NO 2

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:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED

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 _____

01 BORANA
02 EMBU
03 KALENJIN
04 KAMBA
05 KIKUYU
06 KISII
07 LUHYA
08 MARAGOLI
09 LUO
10 MAASAI
11 MERU
12 MIJIKENDA
13 POKOT
14 SOMALI
15 SWAHILI
16 TURKANA
17 ENGLISH
18 OTHER

NATIVE LANGUAGE OF RESPONDENT _____

01 BORANA
02 EMBU
03 KALENJIN
04 KAMBA
05 KIKUYU
06 KISII
07 LUHYA
08 MARAGOLI
09 LUO
10 MAASAI
11 MERU
12 MIJIKENDA
13 POKOT
14 SOMALI
15 SWAHILI
16 TURKANA
17 ENGLISH
18 OTHER

TRANSLATOR USED

YES 1
NO 2

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: _______________

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

101) RECORD THE TIME

HOUR ___
MINUTES ____

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?

NAIROBI/MOMBASA/KISUMU 1
TOWN 2
COUNTRYSIDE 3
OUTSIDE KENYA 4

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

YEARS ___
ALWAYS 95 (GO TO 101D)
VISITOR 96 (GO TO 101D)

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

NAIROBI/MOMBASA/KISUMU 1
TOWN 2
COUNTRYSIDE 3
OUTSIDE KENYA 4

101D) What is your nationality?

KENYAN 01 (GO TO 102)
TANZANIAN 02
UGANDAN 03
SOMALI 04
ETHIOPIAN 05
SUDANESE 06
OTHER (SPECIFY) __________96

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

JOIN FAMILY LIVING IN KENYA 01
MARRIAGE 02
WORK 03
SCHOOL 04
ESCAPE INSECURITY/WAR 05
ESCAPE ENVIRONMENTAL DISASTER (E.G. FLOOD, DROUGHT, ETC.) 06
OTHER (SPECIFY) _____________ 96

102) In what month and year were you born?

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

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

AGE COMPLETED YEARS _____

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

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

PRIMARY 1
POST-PRIMARY/VOCATIONAL 2
SECONDARY 'A' LEVEL 3
COLLEGE (MIDDLE LEVEL) 4
UNIVERSITY 5

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

STANDARD/FORM/YEAR _____

107) CHECK 105:

PRIMARY, POST-PRIMARY, VOCATIONAL ____ (GO TO 108)
SECONDARY OR HIGHER _____ (GO TO 110)

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

SHOW CARD TO RESPONDENT.

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

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____4
BLIND/VISUALLY/IMPAIRED 5

109) CHECK 108:

CODE '2', '3', OR '4' CIRCLED ____ (GO TO 110)
CODE 1' OR '5' CIRCLED _____ (GO TO 111)

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

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

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

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

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

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

113) What is your religion?

ROMAN CATHOLIC 1
PROTESTANT/OTHER CHRISTIAN 2
MUSLIM 3
NO RELIGION 4
OTHER (SPECIFY) ___________6

114) What is your ethnic group/tribe?

EMBU 01
KALENJIN 02
KAMBA 03
KIKUYU 04
KISII 05
LUHYA 06
LUO 07
MAASAI 08
MERU 09
MIJIKENDA/SWAHLI 10
SOMALI 11
TAITA/TAVETA 12
OTHER (SPECIFY) ________ 96

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

NUMBER OF TIMES _____
NONE 00 (GO TO 201)

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

YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ____

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

YES 1
NO 2 (GO TO 208)

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'.

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

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

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ____
GIRLS DEAD ____

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

TOTAL BIRTHS _______

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

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

210) CHECK 208:

ONE OR MORE BIRTHS ___ (GO TO 211)
NO BIRTHS (GO TO 226)

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

BIRTH HISTORY NUMBER ______
NAME _______

213) Is (NAME) a boy or girl?

BOY 1
GIRL 2

214) Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

MONTH _____
YEAR ______

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217) IF ALIVE: How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ____

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

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER ______ (GO TO NEXT BIRTH)

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

IF '1 YR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS ___ 1
MONTHS ___ 2
YEARS ___ 3

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth? [DO NOT ASK FOR FIRST BIRTH]

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

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

YES 1 (ADD BIRTH)
NO 2

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

NUMBERS ARE SAME ____
NUMBERS ARE DIFFERENT _____ (PROBE AND RECONCILE)

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

NUMBER OF BIRTHS IN 2009 OR LATER ___ (GO TO 224)
NONE 0 (GO TO 226)

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?

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

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.

MONTHS ____

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

YES 1 (GO TO 230)
NO 2

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?

MONTH ____
YEAR ______

232) CHECK 231:

LAST PREGNANCY ENDED IN JAN. 2009 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 2009 (GO TO 238)

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.

MONTHS ______

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

YES 1
NO 2 (GO TO 236)

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?

YES 1
NO 2 (GO TO 238)

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

MONTH ___
YEAR _____

238) When did your last menstrual period start?

DATE, IF GIVEN ___________
DAYS AGO ___ 1
WEEKS AGO ____ 2
MONTHS AGO _____ 3
YEARS AGO ____ 4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

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

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

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

SECTION 3: CONTRACEPTION

301) Now I would like to talk about family planning -- the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

01) FEMALE STERILIZATION
PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION
PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) IUD
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04) INJECTABLES
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05) IMPLANTS
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06) PILL
PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) MALE CONDOM
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM
PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
10) RHYTHM METHOD
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11) WITHDRAWAL
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12) EMERGENCY CONTRACEPTION.
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
13) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2
(SPECIFY) _______
(SPECIFY) _______

302) CHECK 226:

NOT PREGNANT OR UNSURE ___ (GO TO 303)
PREGNANT ___ (GO TO 311)

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

YES 1
NO 2 (311)

304) Which method are you using? CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD IN LIST.

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

307) In what facility did the sterilization take place?

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

NAME OF PLACE ____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 308)
GOVERNMENT HEALTH CENTER 12 (GO TO 308)
GOVERNMENT DISPENSARY 13 (GO TO 308)
OTHER PUBLIC SECTOR (SPECIFY) _______ 16 (GO TO 308)
PRIVATE MEDICAL SECTOR
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC 21 (GO TO 308)
FAMILY OPTIONS/FHOK CLINIC 22 (GO TO 308)
PRIVATE HOSPITAL/CLINIC 23 (GO TO 308)
NURSING/MATERNITY HOME 24 (GO TO 308)
MOBILE CLINIC 25 (GO TO 308)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________ 26 (GO TO 308)
OTHER (SPECIFY) _______ 96 (GO TO 308)
DON'T KNOW 98 (GO TO 308)

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.

COST ____________ (GO TO 308A)
FREE 99995 (GO TO 308A)
DON'T KNOW 99998 (GO TO 308A)

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?

MONTH______
YEAR______

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

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A?
YES ____
NO _____
GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
YES ____
NO _____

310) C:

CHECK 308/308A:

YEAR IS 2009 OR LATER ____ C: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
YEAR IS 2008 OR EARLIER ____ C: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2009 (GO TO 322)

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

NO METHOD USED ____ (GO TO 313)
ANY METHOD USED ____ (GO TO 314)

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

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

314) CHECK 304:

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

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

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

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

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

NAME OF PLACE ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT DISPENSARY 13
OTHER PUBLIC SECTOR (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/CHEMIST 22
NURSING/MATERNITY HOME 23
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC 24
FAMILY OPTIONS/FHOK CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ 26
OTHER SOURCE
SHOP 31
MOBILE CLINIC 32
COMMUNITY-BASED DISTRIBUTOR 33
COMMUNITY HEALTH WORKER/CHW 34
FRIEND/RELATIVE 35
OTHER (SPECIFY) __________ 96

316) CHECK 304:

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

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD 12 (GO TO 326)

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

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

YES 1 (GO TO 319)
NO 2

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

YES 1
NO 2 (GO TO 320)

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

YES 1
NO 2

320) CHECK 317:

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

CODE '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?

YES 1 (GO TO 322)
NO 2

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

YES 1
NO 2

322) CHECK 304:

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

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

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

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

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 326)
GOVERNMENT HEALTH CENTER 12 (GO TO 326)
GOVERNMENT DISPENSARY 13 (GO TO 326)
OTHER PUBLIC SECTOR (SPECIFY) ________ 16 (GO TO 326)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 326)
PHARMACY/CHEMIST 22 (GO TO 326)
NURSING/MATERNITY HOME 23 (GO TO 326)
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC 24 (GO TO 326)
FAMILY OPTIONS/FHOK CLINIC 25 (GO TO 326)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_______ 26
OTHER SOURCE
SHOP 31 (GO TO 326)
MOBILE CLINIC 32 (GO TO 326)
COMMUNITY-BASED DISTRIBUTOR 33 (GO TO 326)
COMMUNITY HEALTH WORKER/CHW 34 (GO TO 326)
FRIEND/RELATIVE 35 (GO TO 326)
OTHER (SPECIFY) _______96 (GO TO 326)

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

YES 1
NO (GO TO 326)

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.

(NAME OF PLACE) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY/CHEMIST F
NURSING/MATERNITY HOME G
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC H
FAMILY OPTIONS/FHOK CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ J
OTHER SOURCE
SHOP K
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
COMMUNITY HEALTH WORKER/CHW N
FRIEND/RELATIVE O
OTHER (SPECIFY) _______ X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2009 OR LATER (GO TO 402)
NO BIRTHS IN 2009 OR LATER (GO TO 556)

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

BIRTH HISTORY NUMBER _____

404) FROM 212 AND 216

NAME _________
LIVING ____
DEAD ____

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

YES 1 (GO TO 408)
NO 2

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

LATER 1
NO MORE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS _____ 1
YEARS ______ 2
DON'T KNOW 998

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

[MOST RECENT BIRTH ONLY]

YES 1 (GO TO 409)
NO 2

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

[MOST RECENT BIRTH ONLY]

DISTANCE A (GO TO 415)
COST B (GO TO 415)
TOO MUCH WORK C (GO TO 415)
HUSBAND REFUSED D (GO TO 415)
RELIGIOUS REASONS E (GO TO 415)
OTHER (SPECIFY) _______ X (GO TO 415)

409) Whom did you see?

Anyone else?

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

[MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
COMMUNITY HEALTH WORKER C
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ________ X

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.

(NAME OF PLACE) _____
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
DISPENSARY E
OTHER PUBLIC SECTOR (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
FAITH-BASED, CHURCH, HOSP./CLINIC H
NURSING/MATERNITY HOME I
OTHER PRIVATE MED. SECTOR (SPECIFY) _________ J
OTHER (SPECIFY) ___________ X

411) How many months pregnant were you when you first received antenatal care for this pregnancy?
[MOST RECENT BIRTH ONLY]

MONTHS ____
DON'T KNOW 98

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

[MOST RECENT BIRTH ONLY]

NUMBER OF TIMES _____
DON'T KNOW 98

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

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]

a) BP
YES 1
NO 2
b) URINE
YES 1
NO 2
c) BLOOD
YES 1
NO 2
d) WEIGHT
YES 1
NO 2
c) HEIGHT
YES 1
NO 2

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

[MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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]

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

TIMES ____
DON'T KNOW 8

417) CHECK 416:
[MOST RECENT BIRTH ONLY]

2 OR MORE TIMES ____ (GO TO 421)
OTHER ____ (GO TO 418)

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

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

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

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

TIMES ____
DON'T KNOW 8

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

YEARS AGO _____

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]

YES 1
NO 2 (GO TO 423)
DON'T KNOW (GO TO 428)

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]

DAYS ____
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

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

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

425) What drugs did you take?

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

[MOST RECENT BIRTH ONLY]

SP/FANSIDAR A
CHLOROQUINE B
OTHER _______ X
DON'T KNOW Z

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

CODE 'A' CIRCLED _____ (GO TO 427)
CODE 'A' NOT CIRCLED _____ (GO TO 430)

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

TIMES ____

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

CODE 'A' OR 'B' CIRCLED ____ (GO TO 429)
OTHER _____ (GO TO 430)

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

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

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

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

431) Was (NAME) weighted at birth?

YES 1
NO 2 (GO TO 432A)
DON'T KNOW 8 (GO TO 432A)

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

KG. FROM CARD 1 ______ (GO TO 433)
KG. FROM RECALL 2 ______ (GO TO 433)
DON'T KNOW 99998 (GO TO 433)

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

YES 1
NO 2
DON'T KNOW 8

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.

HEALTH PERSONNEL
DOCTOR A (GO TO 434)
NURSE/MIDWIFE B (GO TO 434)
OTHER PERSON
COMMUNITY HEALTH WORKER C (GO TO 434)
TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER ________ X (GO TO 434)
NO ONE ASSISTED Y (GO TO 434)

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

DISTANCE A
BETTER CARE THAN FACILITY B
RELIGIOUS REASONS C
HUSBAND PREFERENCE D
OTHER (SPECIFY) ______ X

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

(NAME OF PLACE) ________
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT DISPENSARY 23
OTHER PUBLIC SECTOR (SPECIFY) _________26
PRIVATE MEDICAL SECTOR
MISSION HOSPITAL/CLINIC 31
PRIVATE HOSPITAL/CLINIC 32
NURSING/MATERNITY HOME 33
OTHER PRIVATE MED. SECTOR (SPECIFY) _________36
OTHER_________96 (GO TO 438)

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

[MOST RECENT BIRTH ONLY]

HOURS _____ 1
DAYS _____ 2
WEEKS _____ 3
DON'T KNOW 998

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

YES 1
NO 2

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]

YES 1 (GO TO 439)
NO 2

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

YES 1 (GO TO 439)
NO 2 (GO TO 442)

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

YES 1
NO 2 (GO TO 442)

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
OTHER PERSON
COMMUNITY HEALTH WORKER 21
TRADITIONAL BIRTH ATTENDANT 22
OTHER _______96

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]

HOURS ___ 1
DAYS ___ 2
WEEKS ___ 3
DON'T KNOW 998

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

[MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

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]

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

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

HOURS AFTER BIRTH ___ 1
DAYS AFTER BIRTH ___ 2
WEEKS AFTER BIRTH ___ 3
DON'T KNOW 998

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

[MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
OTHER PERSON
COMMUNITY HEALTH WORKER 21
TRADITIONAL BIRTH ATTENDANT 22
OTHER __________ 96

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.

_______________ (NAME OF PLACE)

[MOST RECENT BIRTH ONLY]

(NAME OF PLACE) ____
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT DISPENSARY 23
OTHER PUBLIC (SPECIFY) _____ 26
PRIVATE MED. SECTOR
MISSION HOSPITAL/CLINIC 31
PVT. HOSPITAL/CLINIC 32
NURSING/MATERNITY HOME 33
OTHER PRIVATE MED. (SPECIFY) _____ 36
OTHER (SPECIFY) ______ 96

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

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

YES 1
NO 2
DON'T KNOW 8

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

[MOST RECENT BIRTH ONLY]

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

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

YES 1
NO 2 (GO TO 452)

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

MONTHS ____
DON'T KNOW 98

450) CHECK 226: IS RESPONDENT PREGNANT?

[MOST RECENT BIRTH ONLY]

NOT PREGNANT ___ (GO TO 451)
PREGNANT OR UNSURE ____ (GO TO 452)

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

[MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 453)

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

MONTHS ____
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 459B)

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]

IMMEDIATELY 000
HOURS ___ 1
DAYS ____ 2

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

[MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink?

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

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

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

Anything else?

RECORD ALL MENTIONED.
[MOST RECENT BIRTH ONLY]

NOT ENOUGH BREAST MILK A
BABY CRIED TOO MUCH B
CULTURAL REASONS C
WORK-RELATED OBLIGATIONS D
WEATHER TOO HOT E
FIRST MILK NOT GOOD FOR BABIES F
OTHER (SPECIFY) _______ X

458) CHECK 404: IS CHILD LIVING?

[MOST RECENT BIRTH ONLY]

LIVING ____ (GO TO 459)
DEAD _____ (GO TO 459A)

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

YES 1 (GO TO 459C)
NO 2

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

MONTHS ____
DON'T KNOW 98

459B) CHECK 404: IS CHILD LIVING?

LIVING ____ (GO TO 460)

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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

BIRTH HISTORY NUMBER ____

503) FROM 212 AND 216:

NAME _________
LIVING ___
DEAD ___ (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

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

IF YES: May I see it please?

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

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

YES 1 (GO TO 509)
NO 2 (GO TO 509)

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.

BCG (AT BIRTH)
DAY ___
MONTH ____
YEAR___
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY ___
MONTH ____
YEAR___
OPV 1
DAY ___
MONTH ____
YEAR___
OPV 2
DAY ___
MONTH ____
YEAR___
OPV 3
DAY ___
MONTH ____
YEAR___
DPT, HEPATITIS, HIB 1st DOSE
DAY ___
MONTH ____
YEAR___
DPT, HEPATITIS, HIB 2nd DOSE
DAY ___
MONTH ____
YEAR___
DPT, HEPATITIS, HIB 3rd DOSE
DAY ___
MONTH ____
YEAR___
PNEUMOCOCCAL VACCINE 1
DAY ___
MONTH ____
YEAR___
PNEUMOCOCCAL VACCINE 2
DAY ___
MONTH ____
YEAR___
PNEUMOCOCCAL VACCINE 3
DAY ___
MONTH ____
YEAR___
ROTA VIRUS VACCINE 1
DAY ___
MONTH ____
YEAR___
ROTA VIRUS VACCINE 2
DAY ___
MONTH ____
YEAR___
MEASLES
DAY ___
MONTH ____
YEAR___
YELLOW FEVER
DAY ___
MONTH ____
YEAR___
VITAMIN A (MOST RECENT)
DAY ___
MONTH ____
YEAR___
VITAMIN A (2nd MOST RECENT)
DAY ___
MONTH ____
YEAR___
AL/MEBENDAZOLE
DAY ___
MONTH ____
YEAR___

507) CHECK 506:

BCG TO YELLOW FEVER ALL RECORDED ___ (GO TO 511)
OTHER ____ (GO TO 508)

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.

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

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

FIRST 2 WEEKS 1
LATER 2

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

NUMBER OF TIMES ____

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

YES 1
NO 2 (GO TO 510F1)
DON'T KNOW 8 (GO TO 510F1)

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

NUMBER OF TIMES ___

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?

YES 1
NO 2 (GO TO 510F3)
DON'T KNOW 8 (GO TO 510F3)

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

NUMBER OF TIMES ____

510F3) A Rota virus vaccination given orally?

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

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

NUMBER OF TIMES ____

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?

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2
DON'T KNOW 8

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.

YES 1
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)

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

NUMBER OF TIMES ___

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the 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?

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

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?

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

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

YES 1
NO 2 (GO TO 521B)

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

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

(NAME OF PLACE(S)) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY)_________ D
PRIVATE MEDICAL SECTOR
PRIVATE
HOSPITAL/CLINIC E
PHARMACY F
MISSION HOSP./CLINIC G
OTHER PRIVATE SECTOR _______ H
OTHER SOURCE
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
SHOP K
TRADITIONAL PRACTITIONER L
RELATIVE/FRIEND M
OTHER (SPECIFY) ________X

520) CHECK 519:

TWO OR MORE CODES CIRCLED ___ (GO TO 521)
ONLY ONE CODE CIRCLED ____ (GO TO 521A)

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

FIRST PLACE ____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC _________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
MISSION HOSP./CLINIC G
OTHER PRIVATE SECTOR _______ H
OTHER SOURCE
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
SHOP K
TRADITIONAL PRACTITIONER L
RELATIVE/FRIEND M
OTHER (SPECIFY) ________X

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

IF SAME DAY, RECORD '00'

DAYS __ (GO TO 521C)

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

RECORD ALL MENTIONED.

EPISODE WAS NOT SERIOUS A
TOO FAR/NO TRANSPORT B
TOO EXPENSIVE C
BELIEVE HOME REMEDIES ARE EFFECTIVE D
NO REASON E
OTHER (SPECIFY)________ X

521C) Does (NAME) still have diarrhoea?

YES 1
NO 2
DON'T KNOW 8

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?

A) FLUID FROM ORS PACKET
YES 1
NO 2
DON'T KNOW 8
B) SUGAR-SALT SOLUTION
YES 1
NO 2
DON'T KNOW 8
C) HOME-MADE FLUID
YES 1
NO 2
DON'T KNOW 8

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

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

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

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

524A) CHECK 524.
GIVEN ZINC TABLETS?

CODE "C" CIRCLED ___ (GO TO 524B)
CODE "C" NOT CIRCLED ____ (GO TO 525)

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

DAYS ___
DON'T KNOW 8

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

530) CHECK 525: HAD FEVER?

YES ____ (GO TO 531)

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

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

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

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

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

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

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

YES 1
NO 2 (GO TO 537)

534) Where did you seek advice or treatment?

Anywhere else?

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

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
MISSION HOSP./CLINIC G
OTHER PRIVATE SECTOR (SPECIFY) _______ H
OTHER SOURCE
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
SHOP K
TRADITIONAL PRACTITIONER L
RELATIVE/FRIEND M
OTHER (SPECIFY) ________ X

535) CHECK 534:

TWO OR MORE CODES CIRCLED _____ (GO TO 536)
ONLY ONE CODE CIRCLED _____ (GO TO 536A)

536) Where did you first seek advice or treatment?

USE LETTER CODE FROM 534.

FIRST PLACE_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
MISSION HOSPITAL/CLINIC G
OTHER PRIVATE SECTOR (SPECIFY) _______ H
OTHER SOURCE
MOBILE CLINIC I
COMMUNITY HEALTH WORKER J
SHOP K
TRADITIONAL PRACTITIONER L
RELATIVE/FRIEND M
OTHER (SPECIFY)________ X

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

DAYS_____

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

FEVER ONLY 1
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 551A)
DON'T KNOW 8 (GO TO 551A)

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

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
AL/COARTEM E
OTHER ANTIMALARIAL (SPECIFY) ________ F
ANTIBIOTIC DRUGS
PILL/SYRUP G
INJECTION H
OTHER DRUGS
ASPIRIN I
ACETAMINOPHEN/PARACETAMOL J
IBUPROFEN K
OTHER (SPECIFY) _______X
DON'T KNOW Z

539) CHECK 538:

ANY CODE A-G CIRCLED?

YES ___ (GO TO 539A)
NO ____ (GO TO 551A)

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'

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
AL/COARTEM E
OTHER ANTI-MALARIAL (SPECIFY) ______ F
ANTIBIOTIC DRUGS
PILL/SYRUP G
NO DRUG AT HOME Y

540) CHECK 538:

SP/FANSIDAR ('A') GIVEN

CODE 'A' CIRCLED ____ (GO TO 541)
CODE 'A' NOT CIRCLED _____ (GO TO 542)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ___
DON'T KNOW 8

542) CHECK 538:

CHLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED ____ (GO TO 543)
CODE 'B' NOT CIRCLED ____ (GO TO 544)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ___
DON'T KNOW 8

544) CHECK 538:

AMODIAQUINE ('C') GIVEN

CODE 'C' CIRCLED ___
CODE 'C' NOT CIRCLED _____ (GO TO 546)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ____
DON'T KNOW 8

546) CHECK 538:

QUININE ('D') GIVEN

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

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ____
DON'T KNOW 8

548) CHECK 538:

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

CODE 'E' CIRCLED ___
CODE 'E' NOT CIRCLED ____ (GO TO 550)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ____
DON'T KNOW 8

550) CHECK 538:

OTHER ANTIMALARIAL ('F') GIVEN

CODE 'F' CIRCLED ____
CODE 'F' NOT CIRCLED ____ (GO TO 551A)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

551A) CHECK 525:

HAD FEVER?

YES ____
NO OR DON'T KNOW ____ (GO TO 552)

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

YES 1
NO 2 (GO TO 552)
DON'T KNOW 8 (GO TO 552)

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

CONSULTED TRADITIONAL HEALER A
GAVE WARM SPONGING B
GAVE HERBS C
OTHER X

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

ONE OR MORE _____:
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 554 (NAME) _______________
NONE _____ (GO TO 556)

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

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) ________ 96

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.

NOT ABLE TO DRINK/BREASTFEED A
FEVER, SHIVERING, B
REPEATED VOMITING C
DIARRHOEA D
BLOOD IN STOOLS E
FAST BREATHING F
CONVULSIONS G
WEAKNESS H
GETTING SICKER I
OTHER (SPECIFY) _________ X

555) CHECK 522(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET ____
ANY CHILD RECEIVED FLUID FROM ORS PACKET _____

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

YES 1
NO 2 (GO TO 556B)

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

HEALTH WORKERS IN A PUBLIC HOSPITAL A
HEALTH WORKERS IN A PRIVATE HOSPITAL B
MINISTRY OF HEALTH THROUGH RADIO, TV, POSTERS C
COMMUNITY HEALTH WORKER/CHW D
FRIENDS OR RELATIVES E
OTHER (SPECIFY) ________ X

556B) CHECK 524 ALL COLUMNS:

524 ALL COLUMNS BLANK, OR CODE "C" NOT CIRCLED ZINC TABLETS NOT GIVEN _____

CODE "C" CIRCLED ANY CHILD RECEIVED ZINC TABLETS ____ 557

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

YES 1
NO 2 (GO TO 557)

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

HEALTH WORKERS IN A PUBLIC HOSPITAL A
HEALTH WORKERS IN A PRIVATE HOSPITAL B
MINISTRY OF HEALTH THROUGH RADIO, TV, POSTERS C
COMMUNITY HEALTH WORKER/CHW D
FRIENDS OR RELATIVES E
OTHER (SPECIFY) __________ X

557) CHECK 215 AND 218, ALL ROWS:

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

ONE OR MORE ______
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 558 (NAME) _______________
NONE _______ (GO TO 601)

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):

a) PLAIN WATER?
YES 1
NO 2
DON'T KNOW 8
b) JUICE OR JUICE DRINKS?
YES 1
NO 2
DON'T KNOW 8
c) CLEAR BROTH?
YES 1
NO 2
DON'T KNOW 8
d) MILK SUCH AS TINNED, POWDERED, OR FRESH ANIMAL MILK?
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK_____
e) INFANT FORMULA?
IF YES: How many times did (NAME) drink infant formula?
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA_____
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) YOGURT?
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT ____
h) ANY FORTIFIED BABY FOOD LIKE CERELAC?
YES 1
NO 2
DON'T KNOW 8
i) MAIZE, RICE, WHEAT, PORRIDGE, SORGHUM, BREAD, OR OTHER FOODS MADE FROM GRAINS?
YES 1
NO 2
DON'T KNOW 8
j) PUMPKIN, CARROTS, SQUASH, OR SWEET POTATOES THAT ARE YELLOW OR ORANGE INSIDE?
YES 1
NO 2
DON'T KNOW 8
k) IRISH POTATOES, YAMS, CASSAVA, WHITE SWEET POTATOES, OR ANY OTHER FOODS MADE FROM ROOTS?
YES 1
NO 2
DON'T KNOW 8
l) SUKUMU WIKI OR ANY DARK GREEN, LEAFY VEGETABLES?
YES 1
NO 2
DON'T KNOW 8
m) RIPE MANGOES, PAWPAW, GUAVA?
YES 1
NO 2
DON'T KNOW 8
n) ANY OTHER FRUITS OR VEGETABLES?
YES 1
NO 2
DON'T KNOW 8
o) LIVER, KIDNEY, HEART OR OTHER ORGAN MEATS?
YES 1
NO 2
DON'T KNOW 8
p) ANY MEAT, SUCH AS BEEF, PORK, LAMB, GOAT, CHICKEN, OR DUCK?
YES 1
NO 2
DON'T KNOW 8
q) EGGS?
YES 1
NO 2
DON'T KNOW 8
r) FRESH OR DRIED FISH OR SHELLFISH?
YES 1
NO 2
DON'T KNOW 8
s) ANY FOODS MADE FROM BEANS, PEAS, LENTILS, OR NUTS?
YES 1
NO 2
DON'T KNOW 8
t) CHEESE OR OTHER FOOD MADE FROM MILK?
YES 1
NO 2
DON'T KNOW 8
u) ANY OTHER SOLID, SEMI-SOLID, OR SOFT FOOD?
YES 1
NO 2
DON'T KNOW 8

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

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

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

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

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

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

NUMBER OF TIMES _____
DON'T KNOW 8

SECTION 6: MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

603) What is your marital status now; are you widowed, divorced, or separated?

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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'.

NAME ______________
LINE NUMBER _______

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

YES 1 (GO TO 609)
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS _____
DON'T KNOW 98

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

RANK ____

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

ONLY ONCE 1
MORE THAN ONCE 2

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?

MONTH ______
DON'T KNOW MONTH 98
YEAR _______ (GO TO 611A)
DON'T KNOW YEAR 9998

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

AGE _____

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

OWN CHOICE 1
ARRANGED 2

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?

OLDER 1
YOUNGER 2
ABOUT THE SAME AGE 3
DON'T KNOW/DON'T REMEMBER 8

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?

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

613A) CHECK 103:

AGE 15-24 ____
AGE 25-49 _____ (GO TO 614)

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

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

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

AGE OF PARTNER ______
DON'T KNOW 98

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

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

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

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

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

DAYS AGO _____ 1
WEEKS AGO _____ 2
MONTHS AGO ______ 3

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

PREVENT STD/HIV 1
AVOID PREGNANCY 2
BOTH PREVENT STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/HE MAY HAVE OTHER PARTNERS 4
PARTNERS WANTED TO USE 5
OTHER (SPECIFY) ________ 6

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

YES 1
NO 2

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

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

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

620) CHECK 609:

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

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

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

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

DAYS AGO ___ 1
WEEKS AGO ____ 2
MONTHS AGO ____ 3
YEARS AGO _____ 4

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

NUMBER OF TIMES _____

624) How old is this person?

AGE OF PARTNER _____
DON'T KNOW 98

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

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 (GO TO 626A)

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'.

NUMBER OF PARTNERS LAST 12 MONTHS _____
DON'T KNOW 98

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

YES 1
NO 2

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'.

NUMBER OF PARTNERS IN LIFETIME _____
DON'T KNOW 98

628) PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN LESS THAN 10 YEARS OLD
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 632)

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.

________________________ (NAME OF PLACE(S))
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) ________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY/CHEMIST F
NURSING/MATERNITY HOME G
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC H
FAMILY OPTIONS/FHOK CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________ J
OTHER SOURCE
SHOP K
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
COMMUNITY HEALTH WORKER/CHW N
FRIEND/RELATIVE O
DISPENSER P
OTHER (SPECIFY) ___________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

633) Where is that?

Any other place?

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

_________________ (NAME OF PLACE(S))
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY/CHEMIST F
NURSING/MATERNITY HOME G
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC H
FAMILY OPTIONS/FHOK CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ J
OTHER SOURCE
SHOP K
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
COMMUNITY HEALTH WORKER/CHW N
FRIEND/RELATIVE O
OTHER (SPECIFY) __________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED _____
HE OR SHE STERILIZED _____ (GO TO 712)

702) CHECK 226:

PREGNANT____
NOT PREGNANT OR UNSURE ____ 704

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

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

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?

HAVE ANOTHER CHILD 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (710)

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?

MONTHS 1 _____
YEARS 2 _____

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

706) CHECK 226:

NOT PREGNANT OR UNSURE ____
PREGNANT ____ (GO TO 711)

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING _____
CURRENTLY USING ______ (GO TO 712)

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.

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

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED ____
NO, NOT CURRENTLY USING ______
YES, CURRENTLY USING ______ (GOT TO 712)

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

YES 1
NO 2 (GO TO 711B)
DON'T KNOW 8 (GO TO 712)

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

FEMALE STERILIZATION 01 (GO TO 712)
MALE STERILIZATION 02 (GO TO 712)
IUD 03 (GO TO 712)
INJECTABLES 04 (GO TO 712)
IMPLANTS 05 (GO TO 712)
PILL 06 (GO TO 712)
CONDOM 07 (GO TO 712)
FEMALE CONDOM 08 (GO TO 712)
LACTATIONAL AMEN. METHOD 09 (GO TO 712)
RHYTHM METHOD 10 (GO TO 712)
WITHDRAWAL 11 (GO TO 712)
OTHER (SPECIFY) __________ 96 (GO TO 712)
UNSURE __________ 98 (GO TO 712)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 12
MENOPAUSAL/HYSTERECTOMY 13
SUBFECUND/INFECUND 14
WANTS AS MANY CHILDREN AS POSSIBLE 15
OPPOSITION TO USE
RESPONDENT OPPOSED 16
HUSBAND/PARTNER OPPOSED 17
OTHERS OPPOSED 18
RELIGIOUS PROHIBITION 19
LACK OF KNOWLEDGE
KNOWS NO METHOD 20
KNOWS NO SOURCE 21
METHOD-RELATED REASONS
HEALTH CONCERNS 22
FEAR OF SIDE EFFECTS 23
LACK OF ACCESS/TOO FAR 24
COSTS TOO MUCH 25
INCONVENIENT TO USE 26
INTERFERES WITH BODY'S NORMAL PROCESSES 27
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

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.

NONE 00 (GO TO 714)
NUMBER ____
OTHER (SPECIFY) ________ (GO TO 714)

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

NUMBER BOYS ____
NUMBER GIRLS ____
NUMBER EITHER ____
OTHER (SPECIFY) ______ 96

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?

A) RADIO
YES 1
NO 2
B) TELEVISION
YES 1
NO 2
c) NEWSPAPER OR MAGAZINE.
YES
NO

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?

a) PUBLIC FORUMS
YES 1
NO 2
b) INFORMATION MATERIAL
YES 1
NO 2
c) VISITED BY HEALTH WORKER
YES 1
NO 2
d) SOCIAL MEDIA
YES 1
NO 2
e) MOBILE PHONE
YES 1
NO 2
f) COMMUNITY LEADERS
YES 1
NO 2

716) CHECK 601:

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

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?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

717A) CHECK 304: CURRENT CONTRACEPTIVE METHOD USED

ORDER CODE ____ (GO TO 717A)
CODE B, G, OR M CIRCLED ___ (GO TO 718)

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

YES 1
NO 2
DON'T KNOW 8

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

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

719) CHECK 304:

NEITHER STERILIZED ____ (GO TO 720)
HE OR SHE STERILIZED ____ ( GO TO 801)

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

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

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

801) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN ____ (GO TO 801)
FORMERLY MARRIED/LIVED WITH A MAN ____ (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN ____ (GO TO 807)

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

AGE IN COMPLETED YEARS ____

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

YES 1
NO 2 (GO TO 806)

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

PRIMARY 1
POST-PRIMARY/VOCATIONAL 2
SECONDARY/ 'A' LEVEL 3
COLLEGE (MIDDLE LEVEL) 4
UNIVERSITY 5
DON'T KNOW 8 (GO TO 806)

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

STANDARD/FORM/YEAR ____
DON'T KNOW 98

806) CHECK 801:

CURRENTLY MARRIED/LIVING WITH A MAN ____ (GO TO 806A)
FORMERLY MARRIED/LIVED WITH A MAN ___ (GO TO 806B)

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?

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2
(GO TO 815)

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

______________________________________________

811A) CHECK 811:

WORKS IN AGRICULTURE ____ (GO TO 811B)
DOES NOT WORK IN AGRICULTURE ___ (GO TO 812)

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?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
OTHER (SPECIFY) _________ 6

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

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

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

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

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

815) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN ____ (GO TO 816)
NOT IN UNION ____ (GO TO 823)

816) CHECK 814:

CODE 1 OR 2 CIRCLED ____ (GO TO 817)
OTHER ___ (GO TO 819)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHILDREN LESS THAN 10 YEARS OLD
PRESENT AND LISTENING 1
PRESENT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT NOT LISTENING 2
NOT PRESENT 3

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?

a) GOES OUT
YES 1
NO 2
DON'T KNOW 8
b) NEGLECTED CHILDREN
YES 1
NO 2
DON'T KNOW 8
c) ARGUES
YES 1
NO 2
DON'T KNOW 8
d) REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
e) BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
DON'T KNOW

905) Can people reduce their chance of getting the AIDS virus by not have sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

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

a) DURING PREGNANCY
YES 1
NO 2
DON'T KNOW 8
b) DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
c) BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

909) CHECK 908:

AT LEAST ONE 'YES' ____ (GO TO 910)
OTHER ___ (GO TO 911)

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

YES 1
NO 2
DON'T KNOW 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2012 ____ (GO TO 912)
NO BIRTHS ___ (GO TO 926)
LAST BIRTH BEFORE JANUARY 2012 ____ (GO TO 926)

912) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE ____ (GO TO 913)
NO ANTENATAL CARE _____ (GO TO 920)

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

914) During any of the antenatal visits for 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?

a) AIDS FROM MOTHER
YES 1
NO 2
DON'T KNOW 8
b) THINGS TO DO
YES 1
NO 2
DON'T KNOW 8
c) TESTED FOR AIDS
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 920)

917) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

______________________________ (NAME OF PLACE)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER/CLINIC 12
GOVERNMENT DISPENSARY 13
OTHER PUBLIC SECTOR (SPECIFY) __________ 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSIONARY/CHURCH HOSPITAL/CLINIC 22
FAMILY OPTIONS/FHOK CLINIC 23
VCT CENTRE 24
NURSING/MATERNITY HOMES 25
BLOOD TRANSFUSION SERVICES 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________ 27
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 34
OTHER (SPECIFY) ________ 96

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

YES 1
NO 2 (GO TO 924)

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

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

920) CHECK 434 FOR LAST BIRTH:

ANY CODE 21-36 CIRCLED ____ (GO TO 921)
OTHER ____ (GO TO 926)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

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

YES 1 (GO TO 927)
NO 2

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

MONTHS AGO ____ (GO TO 931A)
TWO OR MORE YEARS 95 (GO TO 931A)

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

YES 1
NO 2 (GO TO 930)

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

MONTHS AGO ____ (GO TO 931A)
TWO OR MORE YEARS 95

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

YES 1
NO 2

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.

_______________________ (NAME OF PLACE)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 931A)
GOVERNMENT HEALTH CENTER/CLINIC 12 (GO TO 931A)
GOVERNMENT DISPENSARY 13 (GO TO 931A)
OTHER PUBLIC SECTOR (SPECIFY) __________ 18 (GO TO 931A)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 931A)
MISSIONARY/CHURCH HOSPITAL/CLINIC 22 (GO TO 931A)
FAMILY OPTIONS/FHOK CLINIC 23 (GO TO 931A)
VCT CENTRE 24 (GO TO 931A)
NURSING/MATERNITY HOMES 25 (GO TO 931A)
BLOOD TRANSFUSION SERVICES 26 (GO TO 931A)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________ 27 (GO TO 931A)
OTHER SOURCE
HOME 31 (GO TO 931A)
CORRECTIONAL FACILITY 34 (GO TO 931A)
OTHER (SPECIFY) ________ 96 (GO TO 931A)

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

YES 1
NO 2 (GO TO 931A)

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.

NAME OF THE PLACE_________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) ________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/MISSIONARY/CHURCH HOSPITAL/CLINIC E
FAMILY OPTIONS/FHOK CLINIC G
VCT CENTER H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___________ K
OTHER (SPECIFY) __________ X

931A) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN ____
NOT IN UNION ____ (GO TO 932)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

937) CHECK 901:

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

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

YES 1
NO 2 (GO TO 938)

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

Any others?

RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELL/DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE/NO ERECTION L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DOES NOT KNOW Z

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

Any others?

RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELL/DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DOES NOT KNOW Z

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE ____ (GO TO 939)
NEVER HAD SEXUAL INTERCOURSE ___ (GO TO 946)

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

YES ___ (GO TO 940)
NO ___ (GO TO 941)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES') ___ (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW ___ (GO TO 946)

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

YES 1
NO 2 (GO TO 945A)

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.

_________________ (NAME OF PLACE(S))
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR E
MISSIONARY/CHURCH HOSPITAL/CLINIC F
FAMILY OPTIONS/FHOK CLINIC G
VCT CENTER H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ K
OTHER SOURCE
SHOP/PHARMACY L
TRADITIONAL HEALER M
COMMUNITY HEALTH WORKER/CHW N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _________ X

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

YES, INFORMED ALL PARTNERS 1
INFORMED SOME, NOT ALL 2
NO, INFORMED NONE 3
DID NOT HAVE A PARTNER 4 (GO TO 946)

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

YES 1
NO 2 (GO TO 946)

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?

a) USE MEDICINE
YES 1
NO 2
b) STOP HAVING SEX
YES 1
NO 2
c) USE CONDOM
YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN ____ (GO TO 949)
NOT IN UNION ____ (GO TO 1001)

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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.

NUMBER OF INJECTIONS _______
NONE 00 (GO TO 1003A)

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.

NUMBER OF INJECTIONS _____
NONE 00 (GO TO 1003A)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 1003F)

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

FALL A
BURN B
POISONING C
CUT D
NEAR-DROWNING E
ANIMAL BITE F
SHOOTING G
OTHER (SPECIFY) ___________ X

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

YES 1
NO 2 (GO TO 1004)

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

PROBE: Any other ways? RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ____________ X
DON'T KNOW Z

1004) Do you currently smoke cigarettes?

YES 1
NO 2

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

NUMBER OF CIGARETTES _____

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

YES 1
NO 2 (GO TO 1007A)

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

PIPE A
CHEWING TOBACCO B
SNUFF C
WATER PIPE/SHISHA D
OTHER (SPECIFY) _______ X

1007A) Do you drink alcohol?

YES 1
NO 2 (GO TO 1007C)

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

NUMBER OF DAYS _____

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?

a) AT WORK?
YES 1
NO 2
b) OTHER PHYSICAL ACTIVITIES
YES 1
NO 2

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?

a) PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c) DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d) GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2

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

YES 1
NO 2 (GO TO 1008D)

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

YES 1
NO (GO TO 1008D)

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

PAP SMEAR A
VISUAL INSPECTION (WITH ACETIC ACID (VIA)/LUGOL'S IODINE (VILI) B
DON'T KNOW X

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

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

1009) Are you covered by any health insurance?

YES 1
NO 2 (1101)

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

RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
NATIONAL HEALTH INSURANCE SCHEME C
PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
PRE-PAYMENT SCHEME E
OTHER (SPECIFY) ________ X

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?

NUMBER OF BIRTHS TO NATURAL MOTHER _____

1102) CHECK 1101:

TWO OR MORE BIRTHS ___ (GO TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY) ____ (GO TO 1201)

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

NUMBER OF PRECEDING BIRTHS _____

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

___________

1105) Is (NAME) male or female?

MALE 1
FEMALE 2

1106) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DON'T KNOW 8 (GO TO (2))

1107) How old is (NAME)?

_______ (GO TO (2))

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

_____ YRS. AGO

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

AGE AT DEATH _____ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT SIBLING)

1110) Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111) Did (NAME) die during childbirth?

YES 1 (GO TO 113)
NO 2

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

YES 1
NO 2

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

NUMBER OF CHILDREN_____

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?

YES 1 (GO TO 1203)
NO 2

1202) Have you ever heard of this problem?

YES 1 (GO TO 1301)
NO 2 (GO TO 1301)

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

AFTER DELIVERED BABY 1
AFTER HAD STILLBIRTH 2
NEITHER 3 (GO TO 1205)

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

NORMAL LABOR/DELIVERY 1 (GO TO 1206)
VERY DIFFICULT LABOR/DELIVERY 2 (GO TO 1206)

1205) What do you think caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER (SPECIFY) ______ 6
DON'T KNOW 8 (GO TO 1207)

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

NUMBER OF DAYS AFTER DELIVER/OTHER EVENT ____
(ENTER 90 IF 90 DAYS OR MORE)

1207) Have you sought treatment for this condition?

YES 1 (GO TO 1209)
NO 2

1208) Why have you not sought treatment?

PROBE AND RECORD ALL MENTIONED.

DO NOT KNOW CAN BE FIXED A (GO TO 1301)
DO NOT KNOW WHERE TO GO B (GO TO 1301)
TOO EXPENSIVE C (GO TO 1301)
TOO FAR D (GO TO 1301)
POOR QUALITY OF CARE E (GO TO 1301)
COULD NOT GET PERMISSION F (GO TO 1301)
EMBARRASSMENT G (GO TO 1301)
PROBLEM DISAPPEARED H (GO TO 1301)
OTHER (SPECIFY) _________ X (GO TO 1301)

1209) From whom did you last seek treatment?

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2
OTHER PERSON
COMMUNITY/VILLAGE WORKER 3
OTHER (SPECIFY) _______ 6

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

YES 1
NO 2

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

YES, STOPPED COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3
DID NOT RECEIVE TREATMENT 4

SECTION 13: FEMALE GENITAL CUTTING

1301) Have you ever heard of female circumcision?

YES 1 (GO TO 1303)
NO 2

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?

YES 1
NO 2 (GO TO 1401)

1303) Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 1309)

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

YES 1 (GO TO 1306)
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1306) Was your genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1307) How old were you when you were circumcised?

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

AGE IN COMPLETED YEARS ____
AS A BABY/DURING INFANCY 95
DON'T KNOW 98

1308) Who performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) _______ 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) ______ 26
DON'T KNOW 98

1309) CHECK 213, 215, AND 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 1999 OR LATER____
HAS NO LIVING DAUGHTERS BORN IN 1999 OR LATER _____ (GO TO 1315A)

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.

BIRTH HISTORY NUMBER _____
NAME _________

1311) Is (NAME OF DAUGHTER) circumcised?

YES 1
NO 2 (GO TO 311 IN NEXT COLUMN, OR IF NO MORE DAUGHTERS, GO TO 1315A)

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

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

AGE IN COMPLETED YEARS ____
DON'T KNOW 98

1313) Was her genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1314) Who performed the circumcision?

TRADITIONAL
TRADITIONAL CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) _______ 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) ______ 26
DON'T KNOW 98

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
NO RELIGION 3
DON'T KNOW 8

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

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

SELECTION 14: DOMESTIC VIOLENCE

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

WOMAN SELECTED FOR THIS SECTION ___ (GO TO 1401A)
WOMAN NOT SELECTED ___ (GO TO 1433)

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

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1432)

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:

CURRENTLY MARRIED/MARRIED LIVING WITH A MAN ____ (GO TO 1403)

FORMERLY MARRIED/ LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH HUSBAND/PARTNER) (GO TO 1403)

NEVER MARRIED/MARRIED NEVER LIVED WITH A MAN (GO TO 1416)

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?

a) JEALOUS
YES 1
NO 2
DON'T KNOW 3
b) ACCUSES
YES 1
NO 2
DON'T KNOW 3
c) NOT MEET FRIENDS
YES 1
NO 2
DON'T KNOW 3
d) NO FAMILY
YES 1
NO 2
DON'T KNOW 3
e) WHERE YOU ARE
YES 1
NO 2
DON'T KNOW 3

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?

a)SAY OR DO SOMETHING TO HUMILIATE YOU IN FRONT OF OTHERS
YES 1 (GO TO 1404B-a)
NO 2 (GO TO 1404A-b)
b) THREATEN TO HURT OR HARM YOU OR SOMEONE YOU CARE ABOUT
YES 1 (GO TO 1404B-b)
NO 2 (GO TO 1404A-c)
c) INSULT YOU OR MAKE YOU FEEL BAD ABOUT YOURSELF
YES 1 (GO TO 1404B-c)
NO 2 (GO TO 1405)

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?

a) SAY OR DO SOMETHING TO HUMILIATE YOU IN FRONT OF OTHERS
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) THREATEN TO HURT OR HARM YOU OR SOMEONE YOU CARE ABOUT
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) INSULT YOU OR MAKE YOU FEEL BAD ABOUT YOURSELF
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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?

a) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU
YES 1 (GO TO 1405B-a)
NO 2 (GO TO 1405A-b)
b) SLAP YOU
YES 1 (GO TO 1405B-b)
NO 2 (GO TO 1405A-c)
c) TWIST YOUR ARM OR PULL YOUR HAIR
YES 1 (GO TO 1405B-c)
NO 2 (GO TO 1406)

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?

a) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
b) SLAP YOU
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
c) TWIST YOUR ARM OR PULL YOUR HAIR
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS

1406) CHECK 1405A (a-j):

AT LEAST ONE 'YES' ____ (GO TO 1407)
NOT A SINGLE 'YES' ____ (GO TO 1409)

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

NUMBER OF YEARS ____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

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?

a) CUTS, BRUISES, OR ACHES
YES 1
NO 2
b) EYE INJURIES, SPRAINS, DISLOCATIONS, OR BURNS
YES 1
NO 2
c) DEEP WOUNDS, BROKEN BONES, BROKEN TEETH, OR ANY OTHER SERIOUS INJURY
YES 1
NO 2

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?

YES 1
NO 2 (GO TO 1411)

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 1413)

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1414) CHECK 609:

MARRIED MORE THAN ONCE ____ (GO TO 1415)
MARRIED ONLY ONCE ____ (GO TO 1416)

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).

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
a) YES 1 (GO TO 1415B-a)
NO 2 (GO TO 1415A-b)
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
b) YES 1 (GO TO 1415B-b)
NO 2 (GO TO 1416)

1415B) How long ago did this last happen?

a) PREVIOUS (HUSBAND/PARTNER) HIT, SLAP, KICK, OR DO ANYTHING ELSE TO HURT YOU PHYSICALLY
0-11 MONTHS AGO
12 OR MORE MONTHS AGO
DON'T REMEMBER
b) PREVIOUS (HUSBAND/PARTNER) PHYSICALLY FORCE INTERCOURSE OR PERFORM ANY OTHER SEXUAL ACTS AGAINST YOUR WILL
0-11 MONTHS AGO
12 OR MORE MONTHS AGO
DON'T REMEMBER

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?

YES 1 (GO TO 1416B)
NO 2 (GO TO 1419)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1419)

1419) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT (YES ON 201 OR 226 OR 230) ___
NEVER BEEN PREGNANT ____ (GO TO 1422)

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

YES 1
NO 2 (GO TO 1422)

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

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) _________ X

1422) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN ___ (GO TO 1422A)
NEVER MARRIED/NEVER LIVED WITH A MAN ____ (GO TO 1422B)

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?

YES 1 (GO TO 1423)
NO (GO TO 1424A)
REFUSED TO ANSWER (GO TO 1424A)

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?

YES 1
NO 2 (GO TO 1426)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1426)

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

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHERS/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) ________ 96

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?

YES 1 (GO TO 1425)
NO 2 (GO TO 1425)

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

AT LEAST ONE 'YES' ____ (GO TO 1425)
NOT A SINGLE 'YES' ____ (GO TO 1426)

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?

AGE IN COMPLETED YEARS _____
DON'T KNOW 98

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

AT LEAST ONE 'YES' _____ (GO TO 1427)
NOT A SINGLE 'YES' _____ (GO TO 1430)

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

YES 1
NO 2 (GO TO 1429)

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

OWN FAMILY A (GO TO 1430)
HUSBAND'S/PARTNER'S FAMILY B (GO TO 1430)
CURRENT/FORMER HUSBAND/PARTNER C (GO TO 1430)
CURRENT/FORMER BOYFRIEND D (GO TO 1430)
FRIEND E (GO TO 1430)
NEIGHBOR F (GO TO 1430)
RELIGIOUS LEADER G (GO TO 1430)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1430)
POLICE I (GO TO 1430)
LAWYER J (GO TO 1430)
SOCIAL SERVICE ORGANIZATION K (GO TO 1430)
OTHER (SPECIFY) _____________ X (GO TO 1430)

1429) Have you ever told anyone about this?

YES 1
NO 2

1430) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

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?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

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

1433) RECORD THE TIME.

HOUR _____
MINUTES ____