FEDERAL ISLAMIC REPUBLIC OF COMOROS

NATIONAL CENTER OF DOCUMENTATION AND SCIENTIFIC RESEARCH

IDENTIFICATION

ISLAND NAME AND CODE

PREFECTURE NAME AND CODE

LOCALITY NAME AND CODE

COUNTING ZONE CODE

NAME OF HEAD OF HOUSEHOLD

CLUSTER NUMBER

HOUSEHOLD NUMBER

URBAN/RURAL

MORONI 1
OTHER CITY 2
COUNTRYSIDE 3

NAME AND LINE NUMBER OF THE WOMAN ON THE HOUSEHOLD SCHEDULE_______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME____
RESULT*

NEXT VISIT
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
NAME
RESULT

TOTAL NUMBER OF VISITS______

LANGUAGE OF INTERVIEW:

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

101) Record the time

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Moroni, in another city, or in another locality?

103) How long have you been continuously live in (NAME OF CURRENT PLACE OF RESIDENCE)?

104) Just before you moved here, did you live in Moroni, in another city, or in another locality?

105) In what month and what year were you born?

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCORRECT.

107) Have you ever attended school?

108) What is the highest level of school you attended: primary, secondary 1st cycle, secondary 2nd cycle, or higher?

109) What is the highest (grade/form/year) you completed at this level?*

CODES FOR Q. 109

110) CHECK 106:

111) Are you currently attending school?

112) What is the main reason you stopped attending school?

113) CHECK 108:

114) Can you read and understand a letter or a newspaper easily, with difficulty, or not at all?

115) Do you usually read a newspaper or magazine at least once a week?

116) Do you usually listen to the radio every day?

117) Do you usually watch television at least once a week?

120) CHECK QUESTION 4 ON HOUSEHOLD QUESTIONNAIRE

121) Now I would like to ask about the place in which you usually live.
What is the name of the place where you usually live?

Is it in Moroni, in another city, or in the countryside?

122) What island is it on?

123) Now I would like to ask you about the household in which you usually live.
What is the main source of drinking water for your household?

124) How long does it take to go there, get water, and come back?

125) What kind of toilet facility does your household have?

126) Does your household have:

127) Could you describe the main material of the floor in your home?

128) Does any member of your household own:

SECTION 2. REPRODUCTION

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

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

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

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

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

206) Have you ever given birth to a boy or a girl who was born alive but later died?
If no, probe: any child cried or showed signs of life but survived only a few hours or days?

207) How many boys have died? And how many girls have died?
If none, record 00.

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

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

210) CHECK 208:

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. Record names of all the births in 212. Record twins and triplets on separate lines.

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

213) Were any of these births twins?

214) Is (name) a boy or a girl?

215) In what month and year was (name) born?
Probe: What is his/her birthday?
Or:
In what season was he/she born?

216) Is (name) still alive?

217) If alive: how old was (NAME) at his/her last birthday?
RECORD THE AGE IN COMPLETED YEARS.

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

219) IF DEAD: How old was (NAME) when he/she died?
IF "1 year," PROBE: How many months old was (NAME)?

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

220) From year of birth of (name) subtract year of previous birth.
Is the difference 4 or more years?
[FOR ALL BIRTHS EXCEPT MOST RECENT]

221) Were there any other lives births between (name of previous birth) and (name)?
[FOR ALL BIRTHS EXCEPT MOST RECENT]

QUESTIONS 212-221 ARE REPEATED ON THE NEXT PAGE TO ACCOUNT FOR LARGER FAMILIES

222) FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH
IS THE DIFFERENCE 4 YEARS OR MORE?

223) Have you had any live births since the birth of (name of last birth)?

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

225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1993
IF NONE, NOTE '0'.

227) Are you pregnant now?

228) How many months pregnant are you?

229) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?

236) When did you last menstrual cycle start?

237) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

238) During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

SECTION 3: CONTRACEPTION

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.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301) Which ways or methods have you heard about?

302) Have you ever heard of (METHOD)?

303) Have you ever used (METHOD)?

304) CHECK 303:

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

307) What have you used or done?
CORRECT 303 AND 305 (AND 302 IF NECESSARY)

309) Now I would like to ask about the first time that you did something or used a method to avoid getting pregnant.

How many living children did you have at that time, if any?
If none, record 00.

310) When you first started using family planning, did you want to have another child but at a later time, or did you not want to have another child at all?

311) CHECK 303:

312) CHECK 227:

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

314) Which method are you using?
314A) CIRCLE 07 FOR FEMALE STERILIZATION

317) How much does one packet of pills cost you?

318) Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

319) Do you regret that (you/your husband) had the operation to not have any (more) children?

320) Why do you regret it?

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

323) How do you determine which days of your monthly cycle not to have sexual relations?

326) How many months have you used (METHOD) continuously?
If less than 1 month, record 00

327) CHECK 314:
Circle the code of the method

328) Where did you obtain (METHOD) the last time?

If source is hospital, health center, or clinic, write the name of the place. Probe to identify the type of source and circle the appropriate code.

331) What is the main reason you did not use a contraceptive method to avoid pregnancy?

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

333) Where is this?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

334) Were you visited by a family planning program worker in the last 12 months?

335) Have you visited a health facility for any reason in the last 12 months?

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

337) Do you think that breastfeeding can affect a woman's chance of becoming pregnant?

338) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

339) CHECK 210:

340) Have you ever relied on breastfeeding as a method of avoiding pregnancy?

341) CHECK 227 AND 311:

342) Are you currently relying on breastfeeding to avoid getting pregnant?

SECTION 4A. PREGNANCY AND BREASTFEEDING

401) CHECK 225:

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1993 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last three years. We will talk about one child at time.

403) LINE NUMBER FROM 212

404) FROM 212 AND 216

405) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

406) How much longer would you have liked to have waited?

407) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

408) How many months pregnant were you when you first received antenatal care?

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

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

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

412) Where did you give birth to (Name)?

413) Who assisted with the delivery of (Name)?
Anyone else?

Probe for the type of person and record all persons assisting.

414) Around the time of the birth of (name), did you have any of the following problems:

415) Was (NAME) delivered by caesarean section?

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

417) Was (NAME) weighed at birth?

418) How much did (NAME) weigh?
Record weight from health card, if available

419) Has your period returned since the birth of (NAME)?
[MOST RECENT BIRTH ONLY]

420) Did your period return between the birth of (NAME) and your next pregnancy?
[SECOND-TO-LAST BIRTH ONLY]

421) How many months after the birth of (NAME) did you not have a period?

422) CHECK 227:
Respondent pregnant?
[MOST RECENT BIRTH ONLY]

423) Have you resumed sexual intercourse since the birth of (NAME)?
[MOST RECENT BIRTH ONLY]

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

425) Did you ever breastfeed (NAME)?

426) 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.

427) CHECK 404:
CHILD ALIVE?

428) Are you still breastfeeding (NAME)?

429) For how many months did you breastfeed (NAME)?

430) Why did you stop breastfeeding (NAME)?

431) CHECK 404:
IS CHILD LIVING?

432) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

434) Did (NAME) drink anything form a bottle with a nipple yesterday or last night?

435) At any time yesterday or last night, was (NAME) given any of the following:

436) CHECK 435:
Food or liquid given yesterday?

437) (Aside from breastmilk,) how many times did (NAME) eat yesterday, including both meals and snacks?
If 7 or more times, record 7

438) On how many days during the last seven days was (NAME) given any of the following:
IF DON'T KNOW, RECORD 8

439) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 1993 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN TWO BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

441) LINE NUMBER FROM Q. 212

442) FROM Q. 212 AND Q. 216

443) Do you have a card where (NAME'S) vaccination are written down?
IF YES: May I please see it?

444) Have you ever had a vaccination care for (NAME)?

445) 1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD
2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED

446) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

447) Did (NAME) receive any vaccinations to prevent him/her from getting diseases?

448) Please tell me if (NAME) received any of the following vaccinations:

448A) A BCG vaccination against tuberculosis, that is, an injection in the left arm or shoulder done at birth that caused a scar?

448B) Polio vaccine, that is, drops in the mouth?

448C) How many times?

448D) When was the first polio vaccine received, just after birth or later?

448E) A DPT vaccination, that is, an injection usually given at the same time as polio drops?

448F) How many times?

448G) An injection to prevent measles?

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

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

451) When (NAME) was ill with a cough, did he/.she breathe more rapidly than usual with a short, rapid breath?

452) Did you seek advice or treatment for the cough?

453) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED

453A) How many months passed between the time that (NAME) started to have the cough and the time you sought advice or treatment?

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

455) Was there any blood in the stools?

456) On the worst day of the diarrhea, how many bowel movements did (NAME) have?

457) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

458) Was he/she given the same amount of food as before the diarrhea, or more, or less?

459) Was (NAME) given a liquid prepared from a special packet called rehydration salts?

460) Was anything (else) given to treat the diarrhea?

461) What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED

462) Did you seek advice or treatment for the diarrhea?

463) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED

463A) How many months passed between the time that (NAME) got diarrhea and the time you sought advice or treatment?

464) GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465) When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

466) When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

467) When a child is sick diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED

468) When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED

469) CHECK 459, ALL COLUMNS:

470) Have you heard of a special product called ORS you can get for the treatment of diarrhea?

SECTION 5. MARRIAGE

501) Presence of others at this point

502) Are you currently married or living with a man?

503) Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

504) Have you ever been married or lived with a man?

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

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

507A) Record line number of her husband from the household questionnaire.
If he is not in the household, record 00

508) Does your husband/partner have any other wives besides yourself?

509) How many other wives does he have?

510) Are you the first, second?wife?

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

512) CHECK 511:

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

MARRIED/LIVED WITH MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?

513) How old were you when you started living with him?

515) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.

When was the last time you had sexual intercourse (if ever)?

516) CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex, was a condom used?

DOES NOT KNOW CONDOM: Some men used a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?

517) Do you know of a place where you can get condoms?

518) Where is that?
RECORD ALL MENTIONED

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

519) How old were you when you first had sexual intercourse?

SECTION 6. FERTILITY PREFERENCES

601) Check 314:

602) CHECK 227:

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

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

603) CHECK 227:

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

604) CHECK 227:

605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

606) CHECK 313:
USING A METHOD?

607) Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

608) Do you think you will use a method any time in the future?

609) Which method would you prefer to use?

610) What is the main reason that you think you will never use a method?

611) Would you use a method if you were married?

612) CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

614) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

615) Is it acceptable or not acceptable to you for information on family planning to be provided:

616) In the last few months have you heard about family planning:

618) In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

619) With whom?
Anyone else?
RECORD ALL PERSONS MENTIONED

620) CHECK 502:

621) Spouses/partner do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.

Do you think your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

622) How often have you talked to your husband/partner about family planning in the last twelve months?

623) Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

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

701) Check 502 and 504:

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

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

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

705) What was the highest (grade/form/year) he completed at that level?

706) What is/was your (last) husband's occupation? That is, what kind of work does/did he mainly do?

707) CHECK 706:

708) Does/did your husband/partner work mainly on his own land or on family land, or does/did he work on land that he rent from someone else, or does/did he work on someone else's land?

709) Aside from your own housework, are you currently working?

710) 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. Are you currently doing any of these things or any other work?

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

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

713) CHECK 712:

714) 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?

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

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

717) During the last 12 months, how many months did you work?

718) During the last 12 months, how many days a week did you usually work (in the months that you worked)?

719) During the last 12 months, approximately how many days did you work?

720) Do you earn cash for your work?
PROBE: Do you make money for working?

721) How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?

722) CHECK 502:

Yes, currently married/Yes, currently living with a man: Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

No, not in union: Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

723) Do you usually work at home or away from home?

724) CHECK 217 AND 218: IS A CHILD LIVING AT HOME WHO IS AGE 3 OR LESS?

725) Who usually takes care of (Name of youngest child at home) while you are working?

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801) Have you ever heard of an illness called AIDS?

802) From which sources of information have you learned the most about AIDS?
Any other sources?
Record all mentioned

803) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

804) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.

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

808) Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

809) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

810) Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
If yes: probe: In what way?
Record all mentioned

811) Record the time

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 215:

IN 902 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1993 AND STILL ALIVE. IN 903 AND 904, RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1993. IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1993 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1993, USE ADDITIONAL QUESTIONNAIRES.)

902) LINE NUMBER FROM Q. 212
[LAST AND SECOND-TO -LAST BIRTH]

903) NAME FROM Q. 212 FOR CHILDREN

904) Date of birth
From q. 215, and ask for day of birth
[LAST AND SECOND-TO -LAST BIRTH]

905) BCG scar on top of left shoulder
[LAST AND SECOND-TO -LAST BIRTH]

906) Height (in centimeters)

907) Was length/height of child measured lying down or standing up?
[LAST AND SECOND-TO -LAST BIRTH]

908) Weight (in kilograms)

909) Date weighed and measured

910) RESULT

[FOR THE INTERVIEWEE]

[FOR THE LAST AND SECOND-TO-LAST BIRTH]

911) NAME OF MEASURER AND NAME OF ASSISTANT

**Adapt question locally after determining the most common injection site (usually the left arm or shoulder)

INTERVIEWER'S OBSERVATIONS
To be filled out after completing interview

Comments about respondent_______________

Comments on specific questions________________

Any other comments________________

Supervisor's observations________
Name of supervisor_______
Date_____

Editor's observations______
Name of editor_____
Date______