GOVERNMENT OF LIBERIA
LIBERIA INSTITUTE OF STATISTICS AND GEO-INFORMATION SERVICES

IDENTIFICATION

PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: HOUSEHOLD SELECTED FOR MAN'S SURVEY AND BIOMARKERS?

CHECK HOUSEHOLD QUESTIONNAIRE Q.61: WOMAN SELECTED FOR DV MODULE?

INTERVIEWER VISITS

DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

TOTAL NUMBER OF VISITS
SUPERVISOR
NAME
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is __. I am working with the Liberia Institute of Statistics and Geo-Information Services. We are conducting a survey about health and other topics all over Liberia. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 45 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__

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

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

103. Just before you moved here, did you live in a city, in a town, or in a rural area?

104. Before you moved here, which county did you live in?

105. In what month and year were you born?

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

107. Have you ever attended school?

108. What is the highest level of school you attended: elementary, junior high, senior high, or higher?

109. What is the highest grade you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

110. CHECK 108:

111. 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?

112. CHECK 111:

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

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

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

116. Do you own a mobile telephone?

117. Do you use your mobile phone for any financial transactions?

118. Do you have an account in a bank or other financial institution that you yourself use?

119. Have you ever used the internet?

120. In the last 12 months, have you used the internet? IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

122. What is your religion?

123. What dialect do you speak (besides English)?

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever born a child?

202. Do you have any sons or daughters you born who are now living with you? I mean your own belly born.

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

204. Do you have any sons or daughters you born who are alive but do not live with you?

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

206. Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

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

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

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

210. CHECK 208:

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 5 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

212. What was the name given to your (first/next) baby? RECORD NAME. BIRTH HISTORY NUMBER.

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

214. Were any of these births twins?

215. On what day, month, and year was (NAME) born?

216. Is (NAME) still alive?

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

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

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

220. IF DEAD: How old was (NAME) when (he/she) died? IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday? THEN ASK: Exactly how many months old was (NAME) when (he/she) died? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS

221. Did you born any other child between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

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

223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2014-2020

225. FOR EACH BIRTH IN 2014-2020, 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 COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226. Are you pregnant now?

227. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228. When you got pregnant, did you want to get pregnant at that time?

229. CHECK 208: TOTAL NUMBER OF BIRTHS.
ONE OR MORE BIRTH a) Did you want to have a baby later on or did you not want any more children?
NONE b) Did you want to have a baby later on or did you not want any children?

230. Did you ever have a pregnancy that got spoiled: was miscarried, was aborted, or the baby was born dead (stillbirth)?

231. When was the last time it happened?

232. CHECK 231:

233. In what month and year did the preceding such pregnancy end?

234. How many months pregnant were you when that pregnancy ended (spoiled)?

235. Since January 2014, have you had any other pregnancies that got spoiled or aborted?

236. FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2014-2020, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY. IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237. Did you have any miscarriages, abortions or stillbirths that ended before 2014?

238. When did the last such pregnancy that terminated before 2014 end?

239. When did your last menstrual period start? DATE IF GIVEN__

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

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

242. After the birth of a child, can a woman become pregnant before her menstrual period has returned?

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 heard of (METHOD)?

302. CHECK 226:

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

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

305. What is the brand name of the pills you are using? IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

306. What is the brand name of condoms you are using? IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

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)__.

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

309. 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?

310. CHECK 308 AND 309, 215 AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

311. CHECK 308 AND 309:

312. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years. USE CALANDER TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2014. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS A REFERENCE POINTS.

312A. MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.

312B. Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

312C. Which method was that?

312D. How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)? CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

312E. RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

312F. For how many months did you use (METHOD)? CIRCLE '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

312G. RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

312H. Why did you stop using (METHOD)?

312I. GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.

313. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

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

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

316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

319. When you got sterilized, were you told about side effects or problems you might have with the method?

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

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

322. CHECK 318 AND 319:
ANY 'YES' a) At that time, were you told about other methods of family planning that you could use?
OTHER b) When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

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

324. CHECK 304: CIRCLE METHOD CODE: IF MORE THAN ONCE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

325. 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.

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

327. In the last 12 months, were you visited by a fieldworker?

328. Did the fieldworker talk to you about family planning?

329. CHECK 202: CHILDREN LIVING WITH THE RESPONDENT.
YES a) In the last 12 months, have you visited a health facility for care for yourself or your children?
NO b) In the last 12 months, have you visited a health care facility for care for yourself?

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

402. CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2014-2020. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S). Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

404. FROM 212 AND 216:

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

406. CHECK 208:
ONLY ONE BIRTH a) Did you want to have a baby later on, or did you not want any children?
MORE THAN ONE BIRTH b) Did you want to have a baby later on, or did you not want any more children?

407. How much longer did you want to wait?

408. Did you see anyone for prenatal care for this pregnancy?

409. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

410. Where did you receive prenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

411. How many months pregnant were you when you first received prenatal care for this pregnancy?

412. How many times did you receive prenatal care during this pregnancy?

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

413AA. CHECK 412:

413AB. Why did you (not receive any prenatal care/only receive care a few times)? Any other reason? PROBE FOR REASONS AND RECORD ALL MENTIONED.

414. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, jerking after birth?

415. During this pregnancy, how many times did you get a tetanus injection?

416. CHECK 415:

417. At any time before this pregnancy, did you receive any tetanus injections?

418. Before this pregnancy, how many times did you receive a tetanus injection? IF 7 OR MORE TIMES, RECORD '7'

419. CHECK 418:
ONLY ONE a) How many years ago did you receive that tetanus injection?
MORE THAN ONE b) How many years ago did you receive the last tetanus injection prior to this pregnancy?

420. During this pregnancy were you given or did you buy any iron tablets (blood tablets)? SHOW TABLETS

421. During the whole pregnancy, for how many days did you take the tablets? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

422. During this pregnancy, did you take any worm medicine?

423. During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

424. How many times did you take SP/Fansidar during this pregnancy?

425. Did you get the SP/Fansidar during any prenatal care visit, during another visit to a health facility or from another source? IF MORE THAN ONCE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

426. When (NAME) was born, was (NAME) very big, bigger than normal, smaller than normal, or very small?

427. Was (NAME) weighed at birth?

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

429. 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.

430. Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

432. Was (NAME) delivered by C-section, that is, did they cut your belly open to take the baby out?

433. When was the decision made to have the C-section? Was it before or after your labor pains started?

434. Immediately after the birth, was (NAME) put on your chest?

434A. Was (NAME)'s bare skin touching your bare skin?

434AA. CHECK 430: PLACE OF DELIVERY

434AB. What was used to cut the cord?

434AC. Was it new or had it ever been used before?

434AD. Was it boiled before it was used to cut the cord?

434AE. Was anything applied to the stump of the cord at any time?

434AF. What was applied? Anything else?

434B. CHECK 430: PLACE OF DELIVERY

435. 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?

436. How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

437. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

438. Now I would like to talk to you about checks on (NAME)'s health after delivery-for example, someone examining (NAME), checking on the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

439. How long after delivery was (NAME)'s health first checked? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

441. Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

442. How long after delivery did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

443. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

444. Where did the check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

445. I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430).

446. How many hours, days, or weeks after the birth of (NAME) did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

448. Where did this check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

449. 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)?

450. How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

451. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.

452. Where did this check first take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

453. I would like to talk to you about checks on (NAME)'s health after delivery - for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

454. 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.

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

456. Where did this first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

457. During the first two days after (NAME)'s birth, did any health care provider do the following:

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

459. Did your period return between the birth of (NAME) and your next pregnancy?

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

461. CHECK 226: IS RESPONDENT PREGNANT?

462. Have you started man business again since the birth of (NAME)?

463. For how many months after the birth of (NAME) did you not do man business?

464. Did you ever give titi water to (NAME)?

465. CHECK 404: IS CHILD LIVING?

466. How long after birth did you first give (NAME) the titi? IF LESS THAN ONE HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.

467. In the first three days after delivery, was (NAME) given anything to drink besides the titi?

468. CHECK 404: IS CHILD LIVING?

469. Are you still giving titi water to (NAME)?

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

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

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2016-2020?

502A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2016-2020

503A. CHECK 216 FOR CHILD:

504A. Do you have a card or other document where (NAME)'s vaccinations are written down?

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

506A. CHECK 504A:

507A. May I see the card or other document where (NAME)'s vaccinations are written down?

508A. COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509A. CHECK 508A: 'POLIO-0' TO 'YELLOW FEVER' ALL RECORDED?

510A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

512A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

515A. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516A. How many times did (NAME) receive the oral polio vaccine?

516A1. The last time (NAME) received polio drops, did (NAME) also get an IPV injection in the arm to protect against polio?

517A. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the left thigh at the same time as polio drops?

518A. How many times did (NAME) receive the pentavalent vaccine?

519A. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the right thigh to prevent pneumonia?

520A. How many times did (NAME) receive the pneumococcal vaccine?

521A. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

522A. How many times did (NAME) receive the rotavirus vaccine?

523A. Has (NAME) ever received a measles vaccination, that is, an injection in the left arm to prevent measles?

524A. How many times did (NAME) receive the measles vaccine?

524AA. Has (NAME) ever received a yellow fever injection, that is, an injection in the right arm at the age of 9 months or older to prevent him/her from getting yellow fever?

525A. In the last 7 days was (NAME) given:

526A. CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2016-2020?

502B. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2016-2020

503B. CHECK 216 FOR CHILD:

504B. Do you have a card or other document where (NAME)'s vaccinations are written down?

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

506A. CHECK 504B:

507A. May I see the card or other document where (NAME)'s vaccinations are written down?

508B. COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509B. CHECK 508B: 'POLIO-0' TO 'YELLOW FEVER' ALL RECORDED?

510B. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511B. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

512B. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

514B. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

515B. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516B. How many times did (NAME) receive the oral polio vaccine?

516B1. The last time (NAME) received polio drops, did (NAME) also get an IPV injection in the arm to protect against polio?

517B. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the left thigh at the same time as polio drops?

518B. How many times did (NAME) receive the pentavalent vaccine?

519B. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the right thigh to prevent pneumonia?

520B. How many times did (NAME) receive the pneumococcal vaccine?

521B. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

522B. How many times did (NAME) receive the rotavirus vaccine?

523B. Has (NAME) ever received a measles vaccination, that is, an injection in the left arm to prevent measles?

524B. How many times did (NAME) receive the measles vaccine?

524BB. Has (NAME) ever received a yellow fever injection, that is, an injection in the right arm at the age of 9 months or older to prevent him/her from getting yellow fever?

525B. In the last 7 days was (NAME) given:

526B. CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2016-2020?

SECTION 6. CHILD HEALTH AND NUTRITION

601. CHECK 224:

602. CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS FOR EACH BIRTH IN 2014-2020. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S). Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

604. FROM 212 AND 216:

605. In the last six months, was (NAME) given a vitamin A dose like [this/any of these]? SHOW COMMON TYPES OF CAPSULES.

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

607. Was (NAME) given any worm medicine in the last six months?

608. Has (NAME) had running stomach in the last 2 weeks?

609. CHECK 469: CURRENTLY BREASTFEEDING?

YES a) Now I would like to know how much (NAME) was given to drink during the running stomach including titi water. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
NO/NOT ASKED b) Now I would like to know how much (NAME) was given to drink during the running stomach. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?

610. When (NAME) had running stomach, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

611. Did you seek advice or treatment for the running stomach from any source?

612. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IN UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

613. CHECK 612:

614. Where did you first seek advice or treatment? USE LETTER CODE FROM 612

615. Was (NAME) given any of the following at any time since (NAME) started having the running stomach:

616. CHECK 615:

ANY 'YES' a) Was anything else given to treat the running stomach?
ALL 'NO' OR 'DON'T KNOW' b) Was anything given to treat the running stomach?

617. CHECK 615:

ANY 'YES' a) What else was given to treat the running stomach? Anything else? RECORD ALL TREATMENTS GIVEN
ALL 'NO' OR 'DON'T KNOW' b) What was given to treat the running stomach? Anything else? RECORD ALL TREATMENTS GIVEN.

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

619. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

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

621. Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

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

623. CHECK 618: HAD FEVER?

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

625. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE ID PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

626. CHECK 625:

627. Where did you first seek advice or treatment? USE LETTER CODE FROM 625.

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

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

630. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED. IF AMODIAQUINE IS MENTIONED, PROBE TO CLARIFY IF IT IS AN ACT.

631. CHECK 630: ANY CODE A-I CIRCLED?

632. CHECK 630: ARTEMISININ COMBINATION THERAPY ('A') GIVEN

633. How long after the fever started did (NAME) first take artemisinin combination therapy?

634. CHECK 630: SP/FANSIDAR ('B') GIVEN

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

636. CHECK 630: CHLOROQUINE ('C') GIVEN

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

638. CHECK 630: AMODIAQUINE ('D') GIVEN

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

640. CHECK 630: QUININE ('E' OR 'F') GIVEN

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

642. CHECK 630: ARTESUNATE ('G' OR 'H' GIVEN)

643. How long after the fever started did (NAME) first take artesunate?

644. CHECK 630: ANTIMALARIAL ('I') GIVEN

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

646. GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.

647. CHECK 615(a), ALL COLUMNS:

648. Have you ever heard of a special product called ORS or oral rehydration salts you can get for the treatment of running stomach?

649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2017-2020 LIVING WITH THE RESPONDENT

650. Now I would like to ask you about liquids or foods that (NAME FROM 649) 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 649) drink or eat:

651. CHECK 650 (CATEGORIES 'g' THROUGH 'v'):

652. Did (NAME FROM 649) 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?

653. How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

654. The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

702. Have you ever been married or living together with a man as if married?

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

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

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

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

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

708. Are you his first, second, ? wife?

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

710. CHECK 709:

MARRIED/LIVED WITH A MAN ONLY ONCE: a) In what month and year did you start living with your (husband/partner)?
MARRIED/LIVED WITH A MAN MORE THAN ONCE: b) Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?

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

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

713. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. 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. How old were you when you did man business for the very first time?

714. I would like to ask you about your recent sexual activity. When was the last time you did man business? 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.

715. When was the last time you did man business?

716. The last time you did man business with this person, was a condom used?

717. Was a condom used every time you did man business with this person in the last 12 months?

718. What was your relationship to this person with whom you did the man business? IF BOYFRIEND: Were you living together as if married? IF YES, RECORD '2'. IF NO, RECORD '3'.

719. How long ago did you first do man business with this person?

720. How many times during the last 12 months did you do man business with this person? IF NON-NUMERIC ANSWER, PROBE TO GER AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.

721. How old is this person?

722. Apart from this person, have you done man business with any other person in the last 12 months?

723. In total, with how many different people have you done man business in the last 12 months? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'

724. CHECK 106:

725. CHECK 701:

726. In the past 12 months have you done man business or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

727. In total, with how many different people have you done man business in your lifetime? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

731. PRESENCE OF OTHERS DURING THIS SECTION.

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

802. CHECK 226:

803. 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?

804. 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?

805. CHECK 226:

NOT PREGNANT OR UNSURE a) How long would you like to wait from now before the birth of (a/another) child?
PREGNANT b) After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

806. CHECK 226:

807. CHECK 303: USING A CONTRACEPTIVE METHOD?

808. CHECK 805:

809. CHECK 714:

810. CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD a) 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 b) 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.

811. CHECK 303: USING A CONTRACEPTIVE METHOD?

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

813. CHECK 216:

HAS LIVING CHILDREN a) 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 b) 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.

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

815. In the last few months have you:

817. CHECK 701:

818. CHECK 303: USING A CONTRACEPTIVE METHOD?

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

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

821. CHECK 304:

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

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 701:

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

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

904. What was the highest level of school he attended: elementary, junior high, senior high, or higher?

905. What is the highest grade he completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

906. Has your (husband/partner) done any work in the last 12 months?

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

909. Aside from your own housework, have you don't any work in the last seven days?

910. 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?

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

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

913. What is your occupation? That is, what kind of work do you mainly do?

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

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

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

917. CHECK 701:

918. CHECK 916:

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

920. 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?

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

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

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

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

925. Do you own this or any other house either alone or jointly with someone else?

926. Do you have a title deed for any house you own?

927. Is your name on the title deed?

928. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

929. Do you have a title deed for any land you own?

930. Is your name on the title deed?

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

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

SECTION 10. HIV/AIDS

1001. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

1002. HIV is a virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

1003. Can people get HIV from mosquito bites?

1004. Can people reduce their chance of getting HIV by using a condom every time they have sex?

1005. Can people get HIV by sharing food with a person who has HIV?

1006. Can people get HIV because of witchcraft or other supernatural means?

1007. Is it possible for a healthy-looking person to have HIV?

1008. Can HIV be transmitted from a mother to her baby:

1009. CHECK 1008:

1010. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

1011. CHECK 208 AND 215:

1012. CHECK 408 FOR LAST BIRTH:

1013. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1014. During any of the prenatal visits for your last birth were you given any information about:

1015. Were you offered a test for HIV as part of your prenatal care?

1016. I don't want to know the results, but were you tested HIV as part of your prenatal care?

1017. 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.

1017A. All women are supposed to receive counseling before being tested. Before you were tested, did you receive counseling?

1018. I don't want to know the results, but did you get the results of the test?

1019. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

1020. CHECK 430 FOR LAST BIRTH:

1021. Between the time you went for delivery but before the baby was born, were you offered an HIV test?

1022. I don't want to know the results, but were you tested for HIV at that time?

1023. I don't want to know the results, but did you get the results of the test?

1024. CHECK 1016:

1025. Have you been tested for HIV since that time you were tested during your pregnancy?

1026. How many months ago was your most recent HIV test?

1027. I don't want to know the results, but have you ever been tested for HIV?

1028. How many months ago was your most recent HIV test?

1029. I don't want to know the results, but did you get the results of the test?

1030. Where was the test done?

1031. Do you know of a place where people can go to get an HIV test?

1032. Where is that? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1033. Have you heard of test kits people can use to test themselves for HIV?

1034. Have you ever tested yourself for HIV using a self-test kit?

1035. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

1036. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

1037. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

1038. Do people talk badly about people living with HIV, or who are thought to be living with HIV?

1039. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

1040. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

1041. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

1042. CHECK 1001:

HEARD ABOUT HIV OR AIDS a) Apart from HIV, have you heard about other infections that can be transmitted through man business?
NOT HEARD ABOUT HIV OR AIDS b) Have you heard about infections that can be transmitted through man business?

1043. CHECK 713:

1044. CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

1045. 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 man business?

1046. Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

1047. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1048. CHECK 1045, 1046, AND 1047:

1049. The last time you had (PROBLEM FROM 1045/1046/1047), did you seek any kind of advice or treatment?

1050. Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1051. If a wife knows her husband has a disease that she can get from doing man business, is she justified in asking that they se a condom when they do man business?

1052. Is a wife justified in refusing to do man business with her husband when she knows he has sex with other women?

1053. CHECK 701:

1054. Can you say no to your (husband/partner) if you do not want to do man business?

1055. Could you ask your (husband/partner) to use a condom if you wanted him to?

SECTION 11. OTHER HEALTH ISSUES

1104. Do you currently smoke cigarettes every day, some days, or not at all?

1105. On average, how many cigarettes do you currently smoke each day?

1106. Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

1107. What other type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

1107A. Have you ever heard of an illness called tuberculosis or TB?

1107B. What are the things that can happen to you when you have tuberculosis? Anything else? RECORD ALL MENTIONED.

1107C. How does tuberculosis spread from one person to another? Any other way? RECORD ALL MENTIONED.

1107D. Can tuberculosis be cured?

1107E. If a member of your family got tuberculosis, would you want it to remain a secret or not?

1108. 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 big problem:

1109. Are you covered by any health insurance?

1110. What type of health insurance are you covered by? RECORD ALL MENTIONED.

1110A. Do you currently possess a form of identity document for yourself, such as a birth certificate, voter card, or national ID?

1110B. A. Do you currently possess a:
B. Have you ever tried to obtain a [document from 1110B A]?

SECTION 12. ADULT AND MATERNAL MORTALITY MODULE

1201. Now I would like to ask you some questions about your brothers and sisters belly born to your biological mother, including those who are living with you, those living elsewhere, and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your biological mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all of your brothers and sisters born to your biological mother? DO NOT FILL IN THE ORDER NUMBER YET.

1202. CHECK 1201:

1203. READ THE NAMES OF THE BROTHERS AND SISTERS TO THE RESPONDENT AND AFTER THE LAST ONE ASK: Are there any other brothers and sisters from the same biological mother that you have not mentioned?

1204. Sometimes people forget to mention children born to their biological mother because they do not live with them or they do not se them very often. Are there any brothers or sisters who do not live with you that you have not mentioned?

1205. Sometimes people forget to mention children born to their biological mother because they have died. Are there any brothers or sisters who dies that you have not mentioned?

1206. Some people have brothers or sisters from the same mother but a different father. Are there any brothers or sisters born to your biological mother, but who have a different biological father, that you have not mentioned?

1207. COUNT THE NUMBER OF BROTHERS AND SISTERS RECORDED IN 1201.

1208. CHECK 1207: Just to make sure that I have this right: Your mother had in TOTAL__ births, excluding you, during her lifetime. Is that correct?

1209. CHECK 1207:

1210. Please tell me, which brother or sister was born first? And which was born next? RECORD '01' FOR THE ORDER NUMBER IN 1201 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED THE ORDER NUMBER FOR ALL BROTHERS AND SISTERS.

1211. How many births did your mother have before you were born?

1212. LIST THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER IN 1201. ASK 1213 TO 1224 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE AN ADDITIONAL QUESTIONNAIRE.

1213. NAME OF BROTHER OR SISTER

1214. Is (NAME) male or female?

1215. Is (NAME) still alive?

1216. How old is (NAME)?

1217. How many years ago did (NAME) die?

1218. How old was (NAME) when (he/she) died? IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

1219. Was (NAME) pregnant when she died?

1220. Did (NAME) die during childbirth?

1221. Did (NAME) die within two months after the end of a pregnancy or childbirth?

1222. How many days after the end of the pregnancy did (NAME) die?

1223. Was (NAME)'s death due to an act of violence?

1224. Was (NAME)'s death due to an accident?

IF NO MORE BROTHERS AND SISTERS, GO TO NEXT SECTION.

SECTION 13. FEMALE GENITAL CUTTING/MUTILATION

1301. Now I would like to ask about a practice known as female circumcision. Have you ever heard of female circumcision?

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

1303. Have you yourself ever been circumcised?

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

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

1317A. Now I would like to ask you about something else. As you know some women belong to bush societies, like the Sande society. Have you heard of these bush societies?

1317B. Are you a member of the Sande society or a woman's bush society?

1317C. How long have you been a member of the Sande society or a woman's bush society?

SECTION 14. EBOLA

1401. During the Ebola time in Liberia, which counties did you live in? Anywhere else? RECORD ALL MENTIONED

1401A. CHECK 1401: ONLY 'Z-OUTSIDE OF LIBERIA' CIRCLED?

1402. Did you get sick with any illness during the Ebola time in Liberia?

1403. In what month and year did you first get sick with the illness during Ebola time in Liberia?

1404. In what county were you when you first got sick with the illness?

1405. When you were sick with the illness, did you have symptoms like fever, vomiting, diarrhea, severe headache, muscle pain, stomach pain, or unexplained bleeding?

1406. Did you seek advice or treatment for those symptoms from any source?

1407. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1408. Were you admitted to an Ebola treatment unit or ETU during the Ebola time in Liberia?

1409. In what month and year were you admitted to an Ebola treatment unit or ETU?

1410. In what county was the Ebola treatment unit or ETU?

1411. Did any members of your household or other persons you were close to like relatives or friends get sick with any illness during the Ebola time in Liberia?

1412. Were you in close contact with any of these people who got sick? By close contact I mean you took care of them when they were sick or shared, for example, the same bed, cooking utensils, or toilet facilities.

1413. Were any of these people who got sick admitted to an Ebola treatment unit or ETU?

1414. Were you ever on a contact list, that is, did someone ever come to your house to take your temperature two times every day?

1415. Did members of your household, other relatives, or close friends die during the Ebola time in Liberia?

1416.

1417. Did you attend any of the burials for these deaths?

1418. Did you ever receive the Ebola vaccine by PREVAIL?

1419. In what month and year were you vaccinated for Ebola by PREVAIL?

1420. During the Ebola time in Liberia, did you work in an Ebola treatment unit or ETU?

1421. During the Ebola time in Liberia, did you work in a health facility that was not an Ebola treatment unit or ETU?

1421A. Have you ever worked in a health facility?

1422. During the Ebola time in Liberia, did you care for someone at home who had Ebola?

1423. Have you ever come into contact with animals that were hunted or caught in the bush?

1424. What kinds of bush animals were they? Any other kind of animal? RECORD ALL MENTIONED.

1425. What did you do with the bush animal(s) that you came in contact with? Anything else? RECORD ALL MENTIONED.

SECTION 15. DOMESTIC VIOLENCE MODULE

1500. CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?

1501. CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

1501A. 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 Liberia. 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. 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.

1502. CHECK 701 AND 702:

1503. 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)?

1504. Now I need to ask some more questions about your relationship with your (last) (husband/partner)

A. Did your (last) (husband/partner) ever:
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1505. A. Did your (last) (husband/partner) ever do any of the following things to you
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1506. CHECK 1505A (a-j):

1507. How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen? IF LESS THAN ONE YEAR, RECORD '00'.

1508. Did the following ever happen as a result of what your (last) (husband/partner) did to you:

1509. Have you ever hit, slapped, kicked, or done anything to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

1510. In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

1511. Does (did) your (last) (husband/partner) drink alcohol?

1512. How often does (did) he get drunk: often, only sometimes, or never?

1513. Are (were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

1514. CHECK 709:

1515. A. 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).
B. How long ago did this happen?

1516. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN a) 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 LIVED WITH A MAN b) From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

1517. Who has hurt you in this way? Anyone else? RECORD ALL MENTIONED.

1518. In the last 12 months, how often (has this person/have these persons) physically hurt you: often, only sometimes, or not at all?

1519. CHECK 201, 226, AND 230:

1520. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1521. Who has done any of these things to physically hurt you while you were pregnant? Anyone else? RECORD ALL MENTIONED.

1522. CHECK 701 AND 702:

1522A. Now I want to ask you some things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to do man business or perform any other sexual acts when you did not want to?

1522B. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to do man business or perform any other sexual acts when you did not want to?

1523. Who was the person who was forcing you the very first time this happened?

1524. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN a) In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to do man business when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A MAN b) In the last 12 months has anyone physically forced you to do man business when you did not want to?

1524A. CHECK 1505A (h-j) AND 1515A(b)

1525. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN a) How old were you the first time you were forced to do man business or perform any other sexual acts by anyone, including (your/any) husband/partner?
NEVER MARRIED/NEVER LIVED WITH A MAN b) How old were you the first time you were forced to do man business or perform any other sexual acts?

1526. CHECK 1505A (a-j), 1515A (a,b), 1516, 1520, 1522A, AND 1522B:

1527. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1528. From whom have you sought help? Anyone else? RECORD ALL MENTIONED.

1528A. Do you feel that (any of) this help was useful to solve the situation that was happening at the time or useful in the longer term, or was it not useful at all?

1528B. After seeking (any of) this help, did the physical or sexual assaults from your husband/partner or others that resulted in you being physically or sexually hurt at that time change in one way or another?

1529. Have you ever told any one about this?

1530. As far as you know, did you father ever beat your mother?

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

1531. 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?

1532. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

1533. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTRVIEW

COMMENTS ABOUT INTERVIEW__

COMMENTS ON SPECIFIC QUESTIONS__

ANY OTHER COMMENTS__

SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS

CALENDAR

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

CODES FOR EACH COLUMN:

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTIBLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
J STANDARD DAYS METHOD/CYCLEBEADS
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY
Z DON'T KNOW

COLUMN 1 COLUMN 2

2020
12 DEC 01
11 NOV 02
10 OCT 03
09 SEP 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2019
12 DEC 13
11 NOV 14
10 OCT 15
09 SEP 16
08 AUG 17
07 JUL 18
06 JUN 19
05 MAY 20
04 APR 21
03 MAR 22
02 FEB 23
01 JAN 24

2018
12 DEC 25
11 NOV 26
10 OCT 27
09 SEP 28
08 AUG 29
07 JUL 30
06 JUN 31
05 MAY 32
04 APR 33
03 MAR 34
02 FEB 35
01 JAN 36

2017
12 DEC 37
11 NOV 38
10 OCT 39
09 SEP 40
08 AUG 41
07 JUL 42
06 JUN 43
05 MAY 44
04 APR 45
03 MAR 46
02 FEB 47
01 JAN 48

2016
12 DEC 49
11 NOV 50
10 OCT 51
09 SEP 52
08 AUG 53
07 JUL 54
06 JUN 55
05 MAY 56
04 APR 57
03 MAR 58
02 FEB 59
01 JAN 60

2015
12 DEC 61
11 NOV 62
10 OCT 63
09 SEP 64
08 AUG 65
07 JUL 66
06 JUN 67
05 MAY 68
04 APR 69
03 MAR 70
02 FEB 71
01 JAN 72

2014
12 DEC 73
11 NOV 74
10 OCT 75
09 SEP 76
08 AUG 77
07 JUL 78
06 JUN 79
05 MAY 80
04 APR 81
03 MAR 82
02 FEB 83
01 JAN 84