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LESOTHO DEMOGRAPHIC AND HEALTH SURVEY
WOMAN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME ___________________

NAME OF HOUSEHOLD HEAD ______________

EA NUMBER_____

HOUSEHOLD NUMBER____

LESOTHO ECOLOGICAL ZONE

LOWLANDS 1
FOOTHILLS 2
MOUNTAINS 3
SENQU RIVER VALLEY 4

DISTRICT

01=BUTHA-BUTHE
02=LERIBE
03=BEREA
04=MASERU
05=MAFETENG
06=MOHALE'S HOEK
07=QUTHING
08=QASHA'S NEK
09=MOKHOTLONG
10=THABA-TSEKA

URBAN/RURAL

URBAN 1
RURAL 2

NAME AND LINE NUMBER OF WOMAN ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME __________
RESULT* ________

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ________

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE _______
TIME _______

FINAL VISIT
DAY _____
MONTH _____
YEAR _____
INT. NUMBER ______
RESULT _____

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEW

HOME LANGUAGE OF RESPONDENT

WAS A TRANSLATOR USED? (YES=1, NO=2)

LANGUAGE CODES:

ENGLISH 01
SESOTHO 02
OTHER (SPECIFY) ______ 06

SUPERVISOR
NAME _______
DATE _______

FIELD EDITOR
NAME _______
DATE _______

OFFICE EDITOR ___ ___
KEYD BY ___ ___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT
Hello. My name is _______________and I am working with the Ministry of Health and Social Welfare. We are conducting a national survey about the health of women, men, and children. We would very much appreciate your participation in this survey. I would like to ask you about your health and the health of your children. This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: _______________ Date: __________________

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

101 RECORD THE TIME.

HOUR ___ ___
MINUTES ___ ___

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 an urban or in a rural area?

URBAN 1
RURAL 2

103 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 105
VISITOR 96 (GO TO 105

104 Just before you moved here, did you live in an urban or in a rural area?

URBAN 1
RURAL 2

105 In what month and year were you born?

MONTH ___ ___
DON'T KNOW MONTH 98
YEAR ___ ___ ___ ___
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS ___ ___

107 Have you ever attended school?

YES 1
NO 2 (GO TO 111

108 What is the highest level of school you attended?

PRIMARY 1
VOCATIONAL/TECHNICAL TRAINING AFTER PRIMARY 2
SECONDARY/HIGH 3
VOCATIONAL/TECHNICAL TRAINING AFTER SECONDARY/HIGH 4
COLLEGE 5
GRADUATE/POST GRADUATE 6

109 What is the highest (standard/form/year) you completed at that level?

STND/FORM/YEAR ___ ___

110 CHECK 108:

PRIMARY/SECONDARY AFTER PRIMARY (GO TO 111)
VOCATION/TECHN. OR HIGHER )(GO TO 114)

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?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE_______________(SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPAIRED 5

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

YES 1
NO 2

113 CHECK 111:

CODE '2', '3' OR '4' CIRCLED (GO TO NEXT
CODE '1' OR '5' CIRCLED (GO TO 115

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 (GO TO 115

114A What kind of newspapers or magazines do you read: Lesotho newspapers/magazines, RSA newspapers/magazines, or any other?
RECORD ALL MENTIONED.

LESOTHO NEWSPAPER/MAGAZINE A
RSA NEWSPAPER/MAGAZINE B
OTHER X __________________(SPECIFY)

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 (GO TO 116

115A What kind of radio do you listen to: Lesotho radio, RSA radio, or any other?
RECORD ALL MENTIONED.

LESOTHO RADIO A
RSA RADIO B
OTHER __________________(SPECIFY)X

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4 (GO TO 117

116A What kind of TV do you watch: Lesotho TV, RSA TV or any other?
ROECORD ALL MENTIONED

LESOTHO TV A
RSA TV B
OTHER X ________ (SPECIFY)

117 What religion do you belong to?
IF CHRISTIAN: What church do you belong to?

ROMAN CATHOLIC CHURCH 01
LESOTHO EVANGELICAL CHURCH 02
METHODIST .03
ANGLICAN CHURCH 04
SEVENTH DAY ADVENTIST 05
PENTECOSTAL 06
OTHER CHRISTIAN 07
NONE 08
OTHER RELIGION _____________(SPECIFY) 96

LITERACY CARD (Q.111):
1) Parents love their children.
2) Farming is hard work.
3) Birds fly in the sky.
4) Children work hard at school.

SECTION 2: REPRODUCTION

201 Now I would like to ask about all the births you have had during your life. I am interested only in the children that are biologically yours.
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 206

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 ______

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 (GO TO 210)
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 LINES.

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

NAME _________

213 Were any of these births twins?

SING 1
MULT 2

214 Is (NAME) a boy or a girl?

BOY 1
GIRL 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).

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?

YES 1
NO 2

222 Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED IN Q.215
FOR EACH LIVING CHILD :CURRENT AGE IS RECORDED IN Q.217
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN Q.220
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224 CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1999 E.C. OR LATER. IF NONE, RECORD '0'

226 Are you pregnant now?

YES 1
NO 2 (GO TO 229
UNSURE 8 (GO TO 229

227 How many months pregnant are you?

MONTHS ___ ___

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

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 236

230 When did the last such pregnancy end?

MONTH ___ ___
YEAR ___ ___ ___ ___

231 How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNACY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS

MONTHS ___ ___

232 CHECK 230:

LAST PREGNANCY ENDED IN JAN. 1999 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 1999 (GO TO 236)

233 Have you ever had any other pregnancies which did not result in a live birth?

YES 1
NO 2 (GO TO 236)

234 When did the previous such pregnancy end?

MONTH _______
YEAR _______

235 How many months pregnant were you when that pregnancy ended?

MONTHS _______

236 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

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

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

238 Is this time just before her period begins, during her period, right after her period has ended, or half way between two periods?

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

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

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

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several 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
07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse or IUCD up to five days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15 LOCAL TRADITIONAL METHODS There are various traditional methods that exist in different regions in Lesotho used to delay or avoid a pregnancy.
YES 1
NO 2
16 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS
SPECIFY___
YES 1
NO 2

302 Have you ever used (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several 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
07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse or IUCD up to five days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15 LOCAL TRADITIONAL METHODS There are various traditional methods that exist in different regions in Lesotho used to delay or avoid a pregnancy.
YES 1
NO 2
16 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS
(SPECIFY) ____________
YES 1
NO 2

303 CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 306)

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

YES 1
NO 2 (GO TO 318)

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

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

NUMBER OF CHILDREN __________

307 CHECK 302 (01):

WOMAN NOT STERILIZED (GO TO 308)
WOMAN STERILIZED (GO TO 310A)

308 CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 309)
PREGNANT (GO TO 318)

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

YES 1
NO 2 (GO TO 318)

310. Which method are you using?
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.
310A. CIRCLE 'A' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (GO TO 312A)
IUCD D (GO TO 312A)
INJECTABLES E (GO TO 312A)
IMPLANTS F (GO TO 312A)
MALE CONDOM G (GO TO 312A)
FEMALE CONDOM H (GO TO 312A)
DIAPHRAGM I (GO TO 312A
FOAM/JELLY J (GO TO 312A
LACTATIONAL AMEN. METHOD K (GO TO 312A
PERIODIC ABSTINENCE L (GO TO 312A
WITHDRAWAL M (GO TO 312A
LOCAL TRADITIONAL METHOD N (GO TO 312A
OTHER (SPECIFY)__________ X (GO TO 312A

311 CHECK 310:

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

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

YES 1
NO 2
DON'T KNOW 8

312. In what month and year was the sterilization performed?
312A. For how long have you been using (CURRENT METHOD) now without stopping?

MONTH ___ ___
YEAR ___ ___

313 CHECK 310/310A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 310/310A, CIRCLE
CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 320)
MALE STERILIZATION 02 (GO TO 320)
PILL 03
IUCD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 320)
PERIODIC ABSTINENCE 12 (GO TO 320)
WITHDRAWAL 13 (GO TO 320)
LOCAL TRADITIONAL METHOD 14 (GO TO 320)
OTHER ______________(SPECIFY) 96 (GO TO 320)

314 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 316)

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

YES 1
NO 2

316 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

317 Where did you obtain (CURRENT 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.

(NAME OF PLACE)_____________________
PUBLIC SECTOR
GOVT. HOSPITAL 11 (GO TO 320)
GOVT. HEALTH CENTER 12 (GO TO 320)
FAMILY PLANNING CLINIC 13 (GO TO 320)
OTHER PUBLIC ________(SPECIFY) 16 (GO TO 320)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 320)
PHARMACY 22 (GO TO 320)
PRIVATE DOCTOR 23 (GO TO 320)
OTHER PRIVATE MEDICAL __________(SPECIFY) 26 (GO TO 320)
CHAL
CHAL HOSPITAL 31 (GO TO 320)
CHAL HEALTH CENTER 32 (GO TO 320)
CBD 41
COMMUNITY HEALTH WORKER 42 (GO TO 320)
SUPPORT GROUPS 43 (GO TO 320)
OTHER SOURCE
SHOP 51 (GO TO 320)
CHURCH 52 (GO TO 320)
PEER EDUCATORS 53 (GO TO 320)
FRIEND/RELATIVE 54 (GO TO 320)
OTHER __________(SPECIFY) 96 (GO TO 320)

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

YES 1
NO 2 (GO TO 320)

319 Where is that? Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC ______(SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL _______ (SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
PEER EDUCATORS P
FRIENDS/RELATIVES Q
OTHER _____________(SPECIFY) X

320 In the last 12 months, were you visited by a fieldworker or CBD who talked to you about family planning?

YES 1
NO 2

321 In the last 12 months, have you visited a health facility for care for yourself or your family?

YES 1
NO 2 (GO TO 401

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

YES 1
NO 2

SECTION 4A PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401 CHECK 224:

ONE OR MORE BIRTHS IN 1999 OR LATER (GO TO NEXT
NO BIRTHS IN 1999 OR LATER (GO TO 487

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1999 OR LATER. 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 QUESTIONNAIRES).

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

403 LINE NUMBER FROM 212

LINE NUMBER ___ ___

404 FROM 212 AND 216

NAME __________
LIVING (GO TO 405)
DEAD (GO TO 405)

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

THEN 1 (GO TO 407 FOR LAST BIRTH; GO TO 423 FOR ALL OTHERS)
LATER 2
NOT AT ALL 3 (GO TO 407 FOR LAST BIRTH; GO TO 423 FOR ALL OTHERS)

406 How much longer would you like to have waited?

MONTH 1 ___ ___
YEARS 2 ___ ___

DON'T KNOW 998

407 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.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT C
OTHER _____________(SPECIFY) X
NO ONE Y (GO TO 415)

407A Where did you receive antenatal care for this pregnancy? Anywhere else?

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC _________(SPECIFY) D
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC E
OTHER PVT. MEDICAL _______(SPECIFY) F
CHAL
CHAL HOSPITAL G
CHAL HEALTH CENTER H
OTHER _________(SPECIFY) X

408 How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS ___ ___
DON'T KNOW 98

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

NO. OF TIMES ___ ___
DON'T KNOW 98

410 CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

411 How many months pregnant were you the last time you received antenatal care?
LAST BIRTH

MONTHS ___ ___
DON'T KNOW 98

412 During this pregnancy, were any of the following done at least once?

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

412A During any of the antenatal visits for this pregnancy, were you given any information or counseled about AIDS or the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

413 Were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8

414 Were you told where to go if you had these complications?

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?

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8

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

TIMES ___
DON'T KNOW 8

417 During this pregnancy were you given or did you buy any iron tablets or iron syrup? SHOW TABLET/SYRUP.

YES 1
NO 2 (SKIP TO 419)
DON'T KNOW 8

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

NUMBER OF DAYS ___ ___ ___
DON'T KNOW 998

419 During this pregnancy, did you have difficulty with your vision during the daylight?

YES 1
NO 2
DON'T KNOW 8

420 During this pregnancy, did you suffer from night blindness?

YES 1
NO 2
DON'T KNOW 8

423 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

424 Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 425A)
DON'T KNOW 8

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

KG FROM CARD 1 ___ ___.___
KG FROM RECALL 2 ___ ___.___

DON'T KNOW 9998

425A Was the birth of (NAME) registered?

YES 1
NO 2
DON'T KNOW 8

426 Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT C
RELATIVE/FRIEND D
OTHER ______(SPECIFY) X
NO ONE Y

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

(NAME OF PLACE) (LAST BIRTH)________________
HOME
YOUR HOME 11 (SKIP TO 429)
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC _______(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PVT. MEDICAL ___________(SPECIFY) 36
CHAL
CHAL HOSPITAL 41
CHAL HEALTH CENTER 42
OTHER _____________(SPECIFY) 96 (SKIP TO 435)

428 Was (NAME) delivered by caesarian section?

YES 1
NO 2

429 [After (NAME) was born/Before you were discharged], did anyone check on your health?

YES 1
NO 2 (SKIP TO 433)

430 How many hours, days or weeks after the delivery did the first check take place?

HOURS AFTER DEL 1 ___ ___
DAYS AFTER DEL… 2 ___ ___
WEEKS AFTER DEL 3 ___ ___

DON'T KNOW 998

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

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER ________(SPECIFY) 96

432 Where did this first check 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.

(NAME OF PLACE)_____________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC ___________(SPECIFY) 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PVT. MEDICAL ________(SPECIFY) 36
CHAL
CHAL HOSPITAL 41
CHAL HEALTH CENTER 42
OTHER _________(SPECIFY) 96

433 In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2

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

YES 1 (SKIP TO 436)
NO 2 (SKIP TO 437)

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

YES 1
NO 2 (SKIP TO 439)

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

MONTHS ___ ___
DON'T KNOW 98

437 CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 438)
PREGNANT OR UNSURE (SKIP TO 439)

438 Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (SKIP TO 440)

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

MONTHS ___ ___
DON'T KNOW 98

440 Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 447)

441 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.

IMMEDIATELY 000

HOURS 1 ___ ___
DAYS 2 ___ ___

442 In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (SKIP TO 444)

443 What was (NAME) given to drink before your began flowing regularly? Anything else?
RECORD ALL LIQUIDS MENTIONED

MILK (OTHER THAN MILK 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
HONEY I
OTHER ______________(SPECIFY) X

444 CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 446)
DEAD (SKIP TO 446)

445) Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS ___ ___
DON'T KNOW 98

447 CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, (GO TO 454)

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

NUMBER OF NIGHTTIME FEEDINGS ___ ___

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

NUMBER OF DAYTIME FEEDINGS ___ ___

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

YES 1
NO 2
DON'T KNOW 8

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

NUMBER OF TIMES ___ ___
DON'T KNOW 8

453. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION

454 ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1999 OR LATER.
(IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455 LINE NUMBER FROM 212

LINE NUMBER ___ ___

456 FROM 212 AND 216

NAME __________________
LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN OR, IF NO MORE BIRTHS, (GO TO 484

457 Did (NAME) receive a vitamin A dose like this during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2
DON'T KNOW 8

458 Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
LAST BIRTH

YES, SEEN 1 (SKIP TO 460)
YES, NOT SEEN 2 (SKIP TO 462)
NO CARD 3

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

YES 1 (SKIP TO 462)
NO 2 (SKIP TO 462)

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

BCG
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
POLIO 1
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
POLIO 2
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
POLIO 3
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
DPT 1
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
DPT 2
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
DPT 3
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
MEASLES
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
VITAMIN A (MOST RECENT)
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
HEP B1
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
HEP B2
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___
HEP B3
DAY ___ ___
MONTH ___ ___
YEAR ___ ___ ___ ___

461 Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, MEASLES VACCINE, VITAMIN A, HEPB 1-3.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (SKIP TO 464)
NO 2 (SKIP TO 464)
DON'T KNOW 8 (SKIP TO 464)

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

YES 1
NO 2 (SKIP TO 466)
DON'T KNOW 8 (SKIP TO 466)

463 Please tell me if (NAME) received any of the following vaccinations:
463A A BCG vaccination against tuberculosis, which is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

463B Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (SKIP TO 463E)
DON'T KNOW 8 (SKIP TO 463E)

463C When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

463D How many times was the polio vaccine received?

NUMBER OF TIMES ___ ___

463E A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (SKIP TO 463G)
DON'T KNOW 8 (SKIP TO 463G)

463F How many times?
LAST BIRTH

NUMBER OF TIMES ___ ___

NEXT-TO-LAST BIRTH

NUMBER OF TIMES ___ ___

463G An injection to prevent measles?
LAST BIRTH

YES 1
NO 2
DON'T KNOW 8

NEXT-TO-LAST BIRTH

YES 1
NO 2
DON'T KNOW 8

463H A vitamin A dose (capsules/syrup)?
LAST BIRTH

YES 1
NO 2
DON'T KNOW 8

NEXT-TO-LAST BIRTH

YES 1
NO 2
DON'T KNOW 8

463I An injection to prevent Hepatitis B?
LAST BIRTH

YES 1
NO 2 (SKIP TO 464)
DON'T KNOW 8 (SKIP TO 464)

NEXT-TO-LAST BIRTH

YES 1
NO 2 (SKIP TO 464)
DON'T KNOW 8 (SKIP TO 464)

463J How many times?
LAST BIRTH

NUMBER OF TIMES ___ ___

NEXT-TO-LAST BIRTH

NUMBER OF TIMES ___ ___

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

YES 1
NO 2 (SKIP TO 466)
NO VACCINATION IN THE LAST 2 YEARS 3 (SKIP TO 466)
DON'T KNOW 8 (SKIP TO 466)

465 At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.

MEASLES AUG-SEPT 1999 A
MEASLES SEPT 2000 B
MEASLES MAY 2003 C
POLIO AUG-SEPT 2004 D
OTHER ___________(SPECIFY) X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 469)
DON'T KNOW 8 (SKIP TO 469)

468 When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

469 CHECK 466 AND 467:
FEVER OR COUGH?

"YES" IN 466 OR 467 (GO TO 470)
NO/DON'T KNOW (SKIP TO 475)

470 Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (SKIP TO 472)

471 Where did you seek advice or treatment? Anywhere else?
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.
RECORD ALL MENTIONED.

(NAME OF PLACE) ________________________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC _________(SPECIFY) D
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PVT. MEDICAL ________(SPECIFY)H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
TRADITIONAL HEALER O
OTHER __________________(SPECIFY) X

472 CHECK 466: HAD FEVER?
LAST BIRTH

"YES" IN 466 (GO TO NEXT
"NO"/"DK" IN 466 (SKIP TO 475)

NEXT-TO-LAST BIRTH

"YES" IN 466 (GO TO NEXT
"NO"/"DK" IN 466 (SKIP TO 475)

473 Did (NAME) take any drugs for the fever?

YES 1
NO 2 (SKIP TO 475)
DON'T KNOW 8 (SKIP TO 475)

474 What drugs did (NAME) take?
RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN.

PARACETAMOL/PANADOL A
IBUPROFEN B
ASPIRIN C
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

475 Has (NAME) had diarrhea in the last 2 weeks, that is three or more watery stools per day?

YES 1
NO 2 (SKIP TO 483)
DON'T KNOW 8 (SKIP TO 483)

476 Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she offered 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

476A CHECK 445:

'YES' (BF): When (NAME) had diarrhea, was he/she offered less than usual to breastfeed, about the same amount, more than usual, or nothing to breastfeed?

'NO' (NOT BF) (GO TO 477)

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

477 When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she offered 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
DK 8

478 Was he/she given any of the following to drink:

a. A fluid made from a special packet called Motsoako or ORS?
YES 1
NO 2
DK 8
b. A health clinic-recommended sugar-salt solution?
YES 1
NO 2
DK 8

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

YES 1
NO 2 (SKIP TO 481)
DON'T KNOW 8 (SKIP TO 481)

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

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER __________(SPECIFY) X

481 Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (SKIP TO 483)

482 Where did you seek advice or treatment? Anywhere else?

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.
RECORD ALL MENTIONED.

(NAME OF PLACE) ______________________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC ___________(SPECIFY) D
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PVT. MEDICAL __________(SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
TRADITIONAL HEALER O
OTHER _____________(SPECIFY) X

483 GO BACK TO 456 IN LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 484.

484 CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1999 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (GO TO 485)
NONE (GO TO 487)

485 What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?

CHILD ALWAYS USE TOILET/LATRINE 01
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSE AWAY 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
NOT DISPOSED OF 09
OTHER ___________(SPECIFY) 96

486 CHECK 478a, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 487)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 488

487 Have you ever heard of a special product called ORS or Motsoako you can get for the treatment of diarrhea?

YES 1
NO 2

488 CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER (GO TO 489)
HAS NO CHILDREN LIVING WITH HER (GO TO 490)

489 When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

490 Now I would like to ask you some questions about medical care for you yourself.
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?

Knowing where to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting permission to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for treatment.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to a health facility.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having to take transport.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be a female health provider.
BIG PROBLEM 1
NOT A BIG PROBLEM 2

490A Do you have a Health Card/Bukana?

YES 1
NO 2 (GO TO 491

490B Have you ever used another person's Health Card/Bukana?

YES 1
NO 2

491 CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2001 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE TO 492)
(NAME)______________________________
DOES NOT HAVE ANY CHILDREN BORN IN 2001 OR LATER AND LIVING WITH HER (GO TO 496)

492 Now I would like to ask you about liquids (NAME FROM Q. 491) drank yesterday. In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

a. Plain water?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
b. Commercially produced infant formula?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
c. Any other milk such as tinned, powdered, or fresh animal milk?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
d. Fruit juice?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
e. Any other liquids?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____

493 Now I would like to ask you about the types of foods (NAME FROM Q. 491) ate yesterday. In total, how many times yesterday during the day or at night did (NAME
FROM Q. 491) eat (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

a. Barley, bread, rolls, cereal bran, flour, maize, noodles, pasta, oats, porridges, rice, sorghum, wheat?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
b. Pumpkin, red/orange/dark yellow squash, carrots, or red sweet potatoes - fresh or dried?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
c. Any other food made from roots or tubers, such as white potatoes?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
d. Any dark green leafy vegetables, such as broccoli, beet, kale, mustard, pumpkin leaves, turnip leaves, wild Moroho, pepper, spinach, swiss chard, cabbage -- fresh or
dried?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
e. Mango, papaya, apricots, peaches, goose berries -- fresh or dried?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
f. Any other fruits and vegetables, such as bananas, apples/sauce, citrus fruit, figs, pears, plums, cauliflower, eggplant, mushrooms, green beans, avocados, tomatoes?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
g. Red meat, pork, poultry, fish, or eggs?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
h. Any food made from legumes, such as lentils, beans, bean sprouts, chickpeas, almonds, cashew nuts, or peanuts?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
i. Cheese or yoghurt?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____
j. Any food made with oil, fat, or butter?
YESTERDAY/LAST NIGHT NUMBER OF TIMES____

496 Do you currently smoke cigarettes or tobacco?
IF YES: what type of tobacco do you smoke?
RECORD ALL TYPES MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, SNUFF C
YES, OTHER TOBACCO D
NO Y

497 CHECK 496:

CODE 'A' CIRCLED (GO TO 498)
CODE 'A' NOT CIRCLED (GO TO 499A)

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

CIGARETTES ___ ___

499A Have you ever drunk an alcohol-containing beverage?

YES 1
NO 2 (GO TO 499F

499B In the last 3 months, on how many days did you drink an alcohol-containing beverage?
IF EVERY DAY: RECORD '90'.

NUMBER OF DAYS ___ __
NONE 95

499C Have you ever gotten "drunk" from drinking an alcohol-containing beverage?

YES 1
NO 2 (GO TO 499F

499D CHECK 499B:

DRANK ALCOHOL ON AT LEAST ONE DAY (GO TO 499E)
NONE (GO TO 499F)

499E In the last 3 months, on how many occasions did you get "drunk"?

NUMBER OF TIMES ___ ___
NONE 95

499F Have you had an injection for any reason in the last three months?
IF YES: How many injections did you have?
IF DAILY INJECTIONS FOR 3 MONTHS, ASK: Are you diabetic?
IF YES, CIRLCE CODE '95'.
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS AND NOT DIABETIC, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___ ___

DIABETIC 95 (GO TO 499H
NONE 00 (GO TO 501

499G Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health workers?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___ ___
NONE 00

499H The last time you had an injection, did [YOU/The person who gave you the injection] take the syringe and the needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501 Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

502 Have you ever been married or lived with a man?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 514)

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

WIDOWED 1 (GO TO 510)
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

506 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 NO. ___ ___

510 Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

511 CHECK 510:

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 we will talk 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 514)
DON'T KNOW YEAR 9998

512 How old were you when you started living with him?

AGE ___ ___

514 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
How old were you when you first had sexual intercourse (if ever)?

NEVER 00 (GO TO 529
AGE IN YEARS ___ ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

514A CHECK 106:

15-24 YEARS OLD (GO TO 514B)
25-49 YEARS OLD (GO TO 515)

514B The first time you had sexual intercourse, was a male or a female condom used?

YES, MALE CONDOM 1
YES, FEMALE CONDOM 2
NO 3

515 When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO ___ ___
WEEKS AGO ___ ___
MONTHS AGO ___ ___

516 The last time you had sexual intercourse, was a male or female condom used?

YES, MALE CONDOM 1
YES, FEMALE CONDOM 2
NO 3 (GO TO 516B)

516A What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STI/HIV 01 (GO TO 516C)
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 516C)
RESPONDENT WANTED TO PREVENT BOTH STI/HIV AND PREGNANCY 03 (GO TO 516C)
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04 (GO TO 516C)
PARTNER REQUESTED/INSISTED 05 (GO TO 516C)
OTHER ____________(SPECIFY) 96 (GO TO 516C)
DON'T KNOW 98 (GO TO 516C)

516B What is the main reason you did not use a condom that time?

NOT AVAILABLE 01
COST TOO MUCH 02
USED FAMILY PLANNING METHOD 03
CONDOMS TRANSMIT HIV 04
CONDOMS HAVE WORMS 05
TRUSTED PARTNER 06
PARTNER WAS NEGATIVE/NO RISK 07
RESPONDENT DOESN'T LIKE 08
PARTNER REFUSED/OBJECTED 09
PARTNER DRUNK/ON DRUGS 10
RESPONDENT DRUNK/ON DRUGS 11
RESPONDENT WANTED TO GET PREGNANT 12
OTHER ______________(SPECIFY)96

516C The last time you had sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 517)

516D Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
BOTH RESPONDENT AND PARTNER 3
NEITHER 4

517 What is your relationship to the man with whom you last had sex?
IF MAN IS "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 519
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER _____________(SPECIFY) 96

517A. CHECK 106:

15-24 YEARS OLD (GO TO 518)
25-49 YEARS OLD (GO TO 518)

518 Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW .8

518 For how long have you had sexual relations with this man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD 'O1' DAYS.

DAYS 1 ___ ___
WEEKS 2 ___ ___
MONTHS 3 ___ ___
YEARS 4 ___ ___

519 Have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 529

520 The last time you had sexual intercourse this second man, was a male or female condom used?

YES, MALE CONDOM 1
YES, FEMALE CONDOM 2
NO 3 (GO TO 520B)

520A What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STI/HIV 01 (GO TO 520C)
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 520C)
RESPONDENT WANTED TO PREVENT BOTH STI/HIV AND PREGNANCY 03 (GO TO 520C)
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04 (GO TO 520C)
PARTNER REQUESTED/INSISTED 05 (GO TO 520C)
OTHER __________(SPECIFY) 96 (GO TO 520C)

520B What is the main reason you did not use a condom that time?

NOT AVAILABLE 01
COST TOO MUCH 02
USED FAMILY PLANNING METHOD 03
CONDOMS TRANSMIT HIV 04
CONDOMS HAVE WORMS 05
TRUSTED PARTNER 06
PARTNER WAS NEGATIVE/NO RISK 07
RESPONDENT DOESN'T LIKE 08
PARTNER REFUSED/OBJECTED 09
PARTNER DRUNK/ON DRUGS 10
RESPONDENT DRUNK/ON DRUGS 11
RESPONDENT WANTED TO GET PREGNANT 12
OTHER __________________(SPECIFY) 96

520C The last time you had sexual intercourse with this econd person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 521)

520D Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
BOTH RESPONDENT AND PARTNER 3
NEITHER 4

521 What is your relationship to this second man?
IF MAN IS "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex with him?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 523)
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER __________(SPECIFY) 96

521A CHECK 106:

15-24 YEARS OLD (GO TO 521B)
25-49 YEARS OLD (GO TO 522)

521B Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW .8

522For how long have you had sexual relations with this second man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD 'O1' DAYS.

DAYS 1 ___ ___
WEEKS 2 ___ ___
MONTHS 3 ___ ___
YEARS 4 ___ ___

523 Other than these two men, have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 527)

524 The last time you had sexual intercourse with this third man, was a male or a female condom used?

YES 1
NO 2 (GO TO 524B

524A What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STI/HIV 01 (GO TO 524C)
RESPONDENT WANTED TO PREVENT PREGNANCY 02 (GO TO 524C)
RESPONDENT WANTED TO PREVENT BOTH STI/HIV AND PREGNANCY 03 (GO TO 524C)
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04 (GO TO 524C)
PARTNER REQUESTED/INSISTED 05 (GO TO 524C)
OTHER __________(SPECIFY)96 (GO TO 524C)
DON'T KNOW 98 (GO TO 524C)

524B What is the main reason you did not use a condom that time?

NOT AVAILABLE 01
COST TOO MUCH 02
USED FAMILY PLANNING METHOD 03
CONDOMS TRANSMIT HIV 04
CONDOMS HAVE WORMS 05
TRUSTED PARTNER 06
PARTNER WAS NEGATIVE/NO RISK 07
RESPONDENT DOESN'T LIKE 08
PARTNER REFUSED/OBJECTED 09
PARTNER DRUNK/ON DRUGS 10
RESPONDENT DRUNK/ON DRUGS 11
RESPONDENT WANTED TO
GET PREGNANT 12
OTHER _________(SPECIFY) 96

524C The last time you had sexual intercourse with this third person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 525

524D Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
BOTH RESPONDENT AND PARTNER 3
NEITHER 4

525 What is your relationship to this third man?
IF MAN IS "BOYFRIEND" OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex with him?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 527
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER _________(SPECIFY) 96

525A. CHECK 106:

15-24 YEARS OLD (GO TO 525B)
25-49 YEARS OLD (GO TO 526)

525B Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW 8

526 For how long have you had sexual relations with this third man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD 'O1' DAYS.

DAYS 1 ___ ___
WEEKS 2 ___ ___
MONTHS 3 ___ ___
YEARS 4 ___ ___

527 In total, how many different men have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS ___ ___
DON'T KNOW 98

528 In total, how many different men have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS ___ ___
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 531

530 Where is that? Any other place?
RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC ___________(SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL ___________(SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
PEER EDUCATORS P
FRIENDS/RELATIVES Q
OTHER _____________(SPECIFY) X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

532 Do you know of a place where one can get female condoms?

YES 1
NO 2 (GO TO 534

533 Where is that? Any other place?
RECORD ALL SOURCES MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC ___________(SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL ___________(SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
PEER EDUCATORS P
FRIENDS/RELATIVES Q
OTHER _____________(SPECIFY) X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 6. FERTILITY PREFERENCES

601 CHECK 310/310A:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602 CHECK 226:

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

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604
SAYS SHE CAN'T GET PREGNANT 3
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 608)

603 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 609
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614
AFTER MARRIAGE 995 (GO TO 609
OTHER ______________(SPECIFY) 996 (GO TO 609
DON'T KNOW 998 (GO TO 609

604 CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605 CHECK 309:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606 CHECK 603:

NOT ASKED (GO TO NEXT
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO NEXT
00-23 MONTHS OR 00-01 YR (GO TO 610

607 CHECK 602:

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

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

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
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
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NATURAL PROCESSES T
OTHER__________ (SPECIFY)X
DON'T KNOW Z

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

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/ NOT HAVING SEX 4

609 CHECK 309:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES CURRENTLY USING (GO TO 614

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

YES 1
NO 2
DON'T KNOW 8 (GO TO 612)

611 Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
MALE CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMEN. METHOD 11 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
LOCAL TRADITIONAL METHODS 14 (GO TO 614)
OTHER ______________ (SPECIFY) 96 (GO TO 614)
UNSURE 98 (GO TO 614)

612 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 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER ____________(SPECIFY)96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

613 Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DON'T KNOW 8

614 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.

NUMBER 00 (GO TO 616)
NUMBER ___ ____
OTHER ______________(SPECIFY) 96 (GO TO 616)

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

NUMBER OF BOYS___
NUMBER OF GIRLS___
NUMBER OF EITHER___
OTHER _____________(SPECIFY) 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

617 In the last 3 months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
On billboards, posters, pamphlets?
YES 1
NO 2

619 In the last 3 months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621

620 With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FRIENDS/NEIGHBORS I
TEACHERS J
CHIEFS K
OTHER _______________(SPECIFY) X

621 CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 628)

622 CHECK 310/310A:

ANY CODE CIRCLED (GO TO NEXT
NO CODE CIRCLED (GO TO 624

623 You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's decision or did you both decide together?

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

624 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 contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

626 CHECK 310/310A:

NEITHER STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627 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?

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

628 Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DK 3
She knows her husband has sex with women other than his wives?
YES 1
NO 2
DK 3
She has recently given birth?
YES 1
NO 2
DK 3
She is tired or not in the mood?
YES 1
NO 2
DK 3

628A When a wife knows her husband has a sexually transmitted disease, is she justified in asking that they use a condom?

YES 1
NO 2
DON'T KNOW .8

SECTION 7 HUSBAND'S BACKGROUND AND WOMAN'S WORK

701 CHECK 501 AND 502:

CURRENTLY MARRIED LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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

AGE IN COMPLETE YERAS ___ ___

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

YES 1
NO 2

704 What is highest level of school he attended?

PRIMARY 1
VOCAT/TECHN.TRAINING AFTER
PRIMARY 2
SECONDARY/HIGH 3
VOCAT/TECHN. TRAINING AFTER SECONDARY/HIGH 4
COLLEGE 5
GRADUATE/POST GRADUATE 6
DON'T KNOW 8 (GO TO 706

705 What is the highest (standard/form/year) he completed at that level?

STDN/FORM/YEAR ___ ___
DON'T KNOW 98

706 CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN: What is your husband's/partner's occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?

OCCUPATION____

707 Aside from your own housework, are you currently working?

YES 1
NO 2

708 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?

YES 1 (GO TO 710
NO 2

709 Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 719

710 What is your occupation, that is, what kind of work do you mainly do?
_________________________________ ____ ____

711 CHECK 710:

WORKS IN AGRICULTURE (GO TO NEXT
DOES NOT WORK IN AGRICULTURE (GO TO 713

712 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

713 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

714 Do you usually work at home or away from home?

HOME 1
AWAY 2

715 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

716 Are you paid or do you earn 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 (GO TO 719
NOT PAID 4 (GO TO 719

717 Who mainly decides how the money you earn will be used?

MYSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND
HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

718 On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6

719 Who in your family usually has the final say on the following decisions:

RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT and HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT and SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
Your own health care?
1 2 3 4 5 6
Making large household purchases?
1 2 3 4 5 6
Making household purchases for daily needs?
1 2 3 4 5 6
Visits to family or relatives?
1 2 3 4 5 6
What food should be cooked each day?
1 2 3 4 5 6

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

CHILDREN less than 10
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

HUSBAND
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

OTHER MALES
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

OTHER FEMALES
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

721 Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?

YES 1
NO 2
DK 8

If she neglects the children?

PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

If she argues with him?

PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

If she refuses to have sex with him?

PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

If she burns the food?

PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

If she refuses to let husband decide how she should use her pay?

PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 8

SECTION 8: HIV AND AIDS, OTHER SEXUALLY TRANSMITTED DISEASES, AND TUBERCULOSIS

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

YES 1
NO 2 (GO TO 837

802 Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?

YES 1
NO 2
DON'T KNOW 8

803 Can a person get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

804 Can a person get the AIDS virus from kissing another person?

YES 1
NO 2
DON'T KNOW 8

805 Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

807 Can people get the AIDS virus by using the same eating utensils as a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

808 Can people reduce their chance of getting the AIDS virus by not having sex at all?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 812
DON'T KNOW 8 (GO TO 812

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

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL HEALER N
OTHER ___________________(SPECIFY) W
OTHER ___________________(SPECIFY) X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

813 Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?

YES 1
NO 2

814 Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?

YES 1
NO 2
DK 8

During delivery?

YES 1
NO 2
DK 8

By breastfeeding?

YES 1
NO 2
DK 8

815 Are there any special medications that a doctor or a nurse can give to a pregnant woman infected with the AIDS virus can take to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

816 Is there any special medication that people infected with the AIDS virus can get from a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

817 CHECK 215:

LAST BIRTH SINCE JANUARY 2002 (GO TO NEXT
NO BIRTHS/LAST BIRTH BEFORE JANUARY 2002 (GO TO 820

818 CHECK 407:

SOMEONE SEEN FOR ANTENATAL CARE FOR LAST PREGNANCY SINCE 2002 (GO TO NEXT
NOONE SEEN FOR ANTENATAL CARE FOR LAST PREGNANCY SINCE 2002 (GO TO 820

819 During any of the antenatal visits for that pregnancy, did anyone talk to you about:
1. Babies getting the ADIS virus from the mother?

YES 1
NO 2
DK 8

2. Things that you can do to prevent getting the AIDS virus?

YES 1
NO 2
DK 8

3. Getting tested for the AIDS virus?

YES 1
NO 2
DK 8

4. Special medications that can be taken by pregnant women to reduce risk of transmission of the AIDS virus to their baby?

YES 1
NO 2
DK 8

820 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 824

821 When was the last time you were tested?

LESS THAN 12 MONTHS 1
12-23 MONTHS 2
2 YEARS OR MORE 3

822 The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1 (GO TO 826A
NO 2 (GO TO 826A

824 Would you want to be tested for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 8

825 Do you know a place where you could (GO TO get an AIDS test?

YES 1
NO 2 (GO TO 827

826 Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.
826A Where did you go for the test?
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.
_________________________________________ (NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC __________(SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL _____________(SPECIFY) 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
OTHER SOURCE
SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53
OTHER ______________(SPECIFY) 96

827 CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO NEXT
NO, NOT IN UNION (GO TO 829

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

YES 1
NO 2

829 In your opinion, is it acceptable or unacceptable for a woman to talk with her partner about ways to prevent getting the virus that causes AIDS?

ACCPETABLE 1
UNACCEPTABLE 2

830 In your opinion, is it acceptable or unacceptable for AIDS to be discussed:
On the radio?

ACCEPTABLE 1
NOT ACCEPTABLE 2

On the TV?

ACCEPTABLE 1
NOT ACCEPTABLE 2

In newspapers?

ACCEPTABLE 1
NOT ACCEPTABLE 2

831 Would you buy fresh vegetables from a vendor who has the AIDS virus?

YES 1
NO 2
DK/NOT SURE 8

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

YES 1
NO 2
DK/NOT SURE 8

833 If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DK/NOT SURE 8

834A If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DK/NOT SURE 8

834B If a male teacher has the AIDS virus, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DK/NOT SURE 8

835 Should children age 12-14 be taught about using a condom to avoid AIDS?

YES 1
NO 2
DK/NOT SURE 8

836 Have you ever been taught how to use a condom?

YES 1
NO 2 (GO TO 837

836A Where/who taught you how to use a condom? Anywhere/anybody else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC _____________(SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL _______________(SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
MEDIA N
PEER EDUCATORS O
SHOP P
CHURCH Q
FRIENDS/RELATIVES R
OTHER ________________(SPECIFY) X

837 (Apart from AIDS), have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 840

838 If a man has a sexually transmitted infection, what symptoms might he have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING 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 L
OTHER _____________(SPECIFY) W
OTHER _______________(SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

839 If a woman has a sexually transmitted infection, what symptoms might she have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING 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/HAVE
A CHILD L
OTHER _____________ (SPECIFY) W
OTHER ________________(SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

840 CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 851
HAS NOT HAD SEXUAL NTERCOURSE (GO TO NEXT

841 CHECK 837:

KNOWS STI (GO TO NEXT
DOES NOT KNOW STIP TO 843

842 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 sexually-transmitted infection?

YES 1
NO 2
DON'T KNOW 8

843 Sometimes, women experience a 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

844 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

845 CHECK 842/843/844:

HAS HAD AN INFECTION (GO TO NEXT
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 851

846 The last time you had (PROBLEM FROM 842/843/844), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 848

847 Where did you go? Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC __________ (SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL ___________ (SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
TRADITIONAL HEALER Q
OTHER ____________(SPECIFY) X

848 When you had (PROBLEM FROM 842/843/844), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2
PARTNER ALREADY INFECTED 3 (GO TO 851

849 When you had (PROBLEM FROM 842/843/844), did you inform your sexual partner(s) about it?

YES 1
SOME/NOT ALL 2
NO 3
DID NOT HAVE PARTNER 4 (GO TO 851

850 What did you do to avoid infecting your partner(s)? Did you
Use medicine?

YES 1
NO 2

Stop having sex?

YES 1
NO 2

Use a condom when having sex?

YES 1
NO 2

851 Now I would like to ask you about something else.
Since age 15, have you ever had the following symptoms:
a. Cough for two weeks or more?

YES 1
NO 2

b. Fever for two weeks or more?

YES 1
NO 2

c. Chest or back pain?

YES 1
NO 2

d. Coughing up blood?

YES 1
NO 2

e. Sweating at night?

YES 1
NO 2

852 CHECK 851:
AT LEAST ONE 'YES' (NO SYMPTOM) (GO TO NEXT
NOT A SINGLE 'YES' (ANY SYMPTOMS) (GO TO 860

853 Did you seek consultation or treatment for the symptom(s)?

YES 1
NO 2 (GO TO 855

854 What is the main reason you did not seek consultation or treatment for the symptom(s)?

SYMPTOMS HARMLESS 1
COST 2
DISTANCE 3
EMBARRASSED 4
NOT ALLOWED 5
OTHER ______________(SPECIFY) 6

855 The last time you had such symptoms, where did you first go for advice or treatment?
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.
_________________________________________ (NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC _________(SPECIFY) 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL _____________(SPECIFY) 24
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
TRADITIONAL HEALER 51
OTHER ________________(SPECIFY) 96

856 How soon after the symptom(s) did you first seek consultation or treatment?

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

857 During that first visit, were you told by a doctor or another health professional that you had tuberculosis?

YES 1
NO 2 (GO TO 860

858 Did you go anywhere else for advice or treatment after you were told that you had tuberculosis?

YES 1
NO 2 (GO TO 861

859 Where did you go?
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.

_________________________________________ (NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC ___________(SPECIFY) 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL ____________(SPECIFY) 24
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
TRADITIONAL HEALER 51
OTHER ______________(SPECIFY) 96

ALL (GO TO 861

860 Have you ever heard of an illness called tuberculosis?

YES 1
NO 2 (GO TO 901

861 Do you think tuberculosis can be cured?

YES 1
NO 2

862 Would you be willing to work with someone who has been previously treated for tuberculosis?

YES 1
NO 2
DK/NOT SURE 8

863 What signs or symptoms would lead you to think that a person has tuberculosis?
PROBE: Any others?
RECORD ALL MENTIONED.

COUGHING A
COUGHING WITH SPUTUM B
COUGHING FOR SEVERAL
WEEKS C
FEVER D
BLOOD IN SPUTUM E
LOSS OF APPETITE F
NIGHT SWEATING G
PAIN IN CHEST OR BACK H
TIREDNESS/FATIGUE I
WEIGHT LOSS J
OTHER _________________(SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW . Z

864 What do you think is the cause of tuberculosis?
PROBE: Anything else?
RECORD ALL MENTIONED.

MICROBES/GERMS/BACTERIA A
INHERITED B
LIFESTYLE C
SMOKING D
ALCOHOL DRINKING E
EXPOSURE TO COLD TEMPERAT F
DUST/POLLUTION G
OTHER ________________(SPECIFY) X
OTHER ______________(SPECIFY) Y

SECTION 9. MATERNAL MORTALITY

901 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 ___ ___

902 CHECK 901:

TWO OR MORE BIRTHS (GO TO NEXT
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 914

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

NUMBER OF PRECEDING BIRTHS ___ ___

[1]-[18]
904 What was the name given to your oldest (next oldest) brother or sister?
____________________________

905 Is (NAME) male or female?

MALE 1
FEMALE 2

906 Is (NAME) still alive?

YES 1
NO 2 (GO TO 908
DK (GO TO NEXT PERSON

907 How old is (NAME)?
___ ___ (GO TO NEXT PERSON

908 How many years ago did (NAME) die?
___ ___

909 How old was (NAME) when he/she died?
___ ___
IF MALE OR DIED BEFORE 12 YEARS OF AGE (GO TO NEXT PERSON

910 Was (NAME) pregnant when she died?

YES 1 (GO TO 913
NO 2

911 Did (NAME) die during childbirth?

YES 1 (GO TO 913
NO 2

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

YES 1
NO 2

913 How many live born children (NAME) give birth to during her lifetime (before this pregnancy)?
___ ___
IF NOE MORE BROTHERS OR SISTERS, (GO TO 914

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
_________________________________________________________________________________________________________________

COMMENTS ON SPECIFIC QUESTIONS:
_________________________________________________________________________________________________________________

ANY OTHER COMMENTS:
_________________________________________________________________________________________________________________

SUPERVISOR'S OBSERVATIONS
_________________________________________________________________________________________________________________

NAME OF THE SUPERVISOR:______________________ DATE: __________________

EDITOR'S OBSERVATIONS
_________________________________________________________________________________________________________________

NAME OF EDITOR:______________________ DATE: _____________________

914 RECORD THE TIME.

HOURS: ____
MINUTES: ____