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2009 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___

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 ___ ___ ___

TOTAL NUMBER OF VISITS ____

LANGUAGE OF QUESTIONNAIRE:

ENGLISH

LANGUAGE OF INTERVIEW

1 ENGLISH
2 SESOTHO
6 OTHER_______________________(SPECIFY)

HOME LANGUAGE OF RESPONDENT

1 ENGLISH
2 SESOTHO
6 OTHER_______________________(SPECIFY)

WAS A TRANSLATOR USED?

YES=1
NO=2

SUPERVISOR
NAME _____________________
DATE _____________________ ___ ___

FIELD EDITOR
NAME _____________________
DATE _____________________ ___ ___
.

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 that asks women and men about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 30 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to 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. However, we hope that you will participate in this survey since your views are important.
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 E INTERVIEWED 2 GO TO END

101 RECORD THE TIME.

HOUR ___ ___
MINUTES ___ ___

102 During the interview I would like to measure your blood pressure. This will be done three times during the interview.
This is a harmless procedure. It is used to find out if a person has high blood pressure. If it is not treated, high blood pressure may eventually cause serious damage to the heart.
The results of this blood pressure measurement will be given to you after the interview together with an explanation of the meaning of your blood pressure numbers. If your blood pressure is high, we will suggest that you consult a health facility or doctor since we cannot provide any further testing or treatment during the survey.
Do you have any questions about the blood pressure measurement so far? If you have any questions about the procedure at any time, please ask me.
You can say yes or no to having the blood pressure measurement now.
You can also decide at anytime not to participate in the blood pressure measures.
Would you allow me to proceed to take your blood pressure measurement at this time?
Signature of interviewer: ____________________
Date: ___________________

RESPONDENT AGREES 1 (GO TO 102A)
RESPONDENT DOES NOT AGREE 2 (GO TO 103)

102A Before taking your blood pressure , I would to ask a few questions about things that may affect these measurements.
Have you done any of the following within the past 30 minutes:

Eaten anything?
YES 1
NO 2
Had coffee, tea, cola or other drink that has caffeine?
YES 1
NO 2
Smoked any tobacco product?
YES 1
NO 2

102B May I begin the process of measuring your blood pressure?
BEFORE TAKING THE FIRST BLOOD PRESSURE READING, MEASURE THE CIRCUMFERENCE OF THE RESPONDENT'S ARM MIDWAY BETWEEN THE ELBOW AND THE SHOULDER.
RECORD THE MEASUREMENT IN CENTIMETRES.

ARM CIRCUMFERNCE (IN CENTIMETERS) ___ ___

102C USE THE ARM CIRCUMFERENCE MEASUREMENT TO SELECT THE APPROPRIATE BLOOD PRESSURE MONITOR MODEL AND CUFF SIZE. CIRCLE THE CODE FOR THE MODEL AND CUFF SIZE.

MODEL 789
SMALL: 17 CM ¨C 22 CM 1
MEDIUM: 22 CM ¨C 32 CM 2
LARGE: 32 CM ¨C 42 CM 3

102D TAKE THE FIRST BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q.103
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON IN Q.102E.

BLOOD PRESSURE MEASURED
SYSTOLIC ___ ___ ___
DIASTOLIC ___ ___ ___

102E RECORD REASON BLOOD PRESSURE NOT MEASURED.

REASON BLOOD PRESSURE NOT MEASURED
REFUSED 9994
TECHNICAL PROBLEMS 9995
OTHER 9996

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 104
VISITOR 96 GO TO 104

103A Just before you moved here, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

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

NUMBER OF TRIPS ____ ____
NONE 00 GO TO 106

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

YES 1
NO 2

106 In what month and year were you born?

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

107 How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___ ___

108 Have you ever attended school?

YES 1
NO 2 GO TO 112

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

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

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

STANDARD/FORM/YEAR ___ ___

111 CHECK 109:

PRIMARY VOCATION/TECH.AFTER PRIMARY GO TO NEXT
SECONDARY OR HIGHER GO TO 115

112 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 4
BLIND/VISUALLY IMPAIRED 5

113 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

114 CHECK 112:

CODE '2', '3' OR '4' CIRCLED GO TO NEXT
CODE '1' OR '5' CIRCLED GO TO 116

115 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 116

115A What kind of newspaper or magazine do you read: Lesotho newspaper/magazine, RSA newspaper/magazine or any other?
RECORD ALL MENTIONED.

LESOTHO NEWSPAPER/MAGAZINE A
RSA NEWSPAPER/MAGAZINE B
OTHER X

116 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 117

116A 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 X

117 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 118

117A What kind of TV do you watch: Lesotho TV, RSA TV, or any other?
RECORD ALL MENTIONED.

LESOTHO TV A
RSA TV B
OTHER X

118 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
ISLAM 08
HINDU 09
NONE 10
OTHER RELIGION 96

SECTION 2. REPRODUCTION

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

YES 1
NO 2 GO TO 206

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

YES 1
NO 2 GO TO 204

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

SONS AT HOME ___ ___
DAUGHTERS AT HOME ___ ___

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

YES 1
NO 2 GO TO 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 NO BIRTHS GO TO 211
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.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

NAME______________________________________

213 Is (NAME) a boy or a girl?

BOY 1
GIRL 2

214 Were any of these births twins?

SING 1
MULT 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 did?
IF 1 'YR', PROBE:
How many months of was (NAME)?
RECORD DAYS IF LESS AN 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 ADD BIRTH
NO 2 NEXT BIRTH

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 ABOVE AND MARK:

NUMBERS ARE SAME GO TO NEXT
NUMBERS ARE DIFFERENT PROBE AND RECONCILE

224 CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2004 OR LATER. IF NONE, RECORD '0' AND SKIP TO 226

225 FOR EACH BIRTH SINCE JANUARY 2004, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH,
ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226 Are you pregnant now?

YES 1
NO 2
UNSURE 8 GO TO 229

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.

MONTHS ___ ___

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

YES 1 GO TO 229
NO 2

228A Did you want to have a baby later, or did you not want any (more) children at all?

LATER 1
NO MORE 2

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

YES 1
NO 2 GO TO 237

230 When did the last such pregnancy end?

MONTH ___ ___
YEAR ___ ___ ___ ___

231 CHECK 230:

LAST PREGNANCY ENDED IN JAN. 2004 OR LATER GO TO NEXT
LAST PREGNANCY ENDED BEFORE JAN. 2004 GO TO 237

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

MONTHS ___ ___

233 Since January 2004, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 GO TO 235

234 ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2004.
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235 Did you have any miscarriages, abortions or stillbirths that ended before 2004?

YES 1
NO 2 GO TO 237

236 When did the last such pregnancy that terminated before 2004 end?

MONTH ___ ___
YEAR ___ ___ ___ ___

237 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

238 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
DON'T KNOW 8 GO TO 301

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

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

SECTION 3. CONTRACEPTION

301 Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you 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 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04 INJECTABLES Women can have an injection by a health provide that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05 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
06 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07 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 RHYTHM METHOD 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
10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
11 EMERGENCY CONTRACEPTION As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2

309 CHECK 226:

NOT PREGNANT OR UNSURE GO TO NEXT
PREGNANT GO TO 322

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

YES 1
NO 2 GO TO 322

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

FEMALE STERILIZATION A
MALE STERILIZATION B
IUCD C
INJECTABLES D
IMPLANTS E
PILL F
MALE CONDOM G
FEMALE CONDOM H
RHYTHM METHOD I
WITHDRAWAL J
OTHER MODERN METHOD X
OTHER TRAD. METHOD Y

316 In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

______________________(NAME OF PLACE)
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC SECTOR 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
OTHER 96
DON'T KNOW 98

319 In what month and year was the sterilization performed?
319A Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH 1 ___ ___
YEAR 2 ___ ___ ___ ___

320 CHECK 319/319A, 215 AND 230:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A
YES: GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
NO GO TO NEXT

321 CHECK 319/319A:

YEAR IS 2004 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.)

YEAR IS 2003 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2004.
THEN SKIP TO 331)

322 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 CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2004.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:

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

322A CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

NO METHOD USED GO TO NEXT
ANY METHOD USED GO TO 323

322B Have you ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 GO TO 333

323 CHECK 311:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 GO TO 333
FEMALE STERILIZATION 01 GO TO 326
MALE STERILIZATION 02 GO TO 335
IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
RHYTHM METHOD 09 GO TO 324A
WITHDRAWAL 10 GO TO 324A
OTHER MODERN METHOD 11 GO TO 335
OTHER TRAD. METHOD 12 GO TO 335

324 Where did you obtain (CURRENT METHOD) when you started using it?
324A Where did you learn how to use the rhythm method?
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

______________________(NAME OF PLACE)
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC SECTOR 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
CHAL HEALTH POST 33
CBD
COMMUNITY HEALTH WORKER 41
SUPPORT GROUPS 42
OTHER SOURCE
SHOP 51
CHURCH 52
PEER EDUCATORS
FRIEND/RELATIVE 54
OTHER 96

325 CHECK 311:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08 GO TO 332
RHYTHM METHOD 09 GO TO 329
WITHDRAWAL 10 GO TO 335
OTHER MODERN METHOD 11
OTHER TRAD. METHOD 12

326 You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A).
At that time, were you told about side effects or problems you might have with the method?

YES 1
NO 2

327 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 329

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

YES 1
NO 2

329 CHECK 326:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) were you told about other methods of family planning that you could use?

YES 1 GO TO 331
NO 2

330 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

331 CHECK 311:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 GO TO 335
MALE STERILIZATION 02 GO TO 335
IUCD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
RHYTHM METHOD 12 GO TO 335
WITHDRAWAL 13 GO TO 335
OTHER METHOD 96

332 Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVT. HOSPITAL 11 (GO TO 335)
GOVT. HEALTH CENTER 12 (GO TO 335)
OTHER PUBLIC SECTOR 13 (GO TO 335)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 335)
LPPA 22 (GO TO 335)
PHARMACY 23 (GO TO 335)
PRIVATE DOCTOR 24 (GO TO 335)
OTHER PRIVATE MEDICAL SECTOR 25 (GO TO 335)
CHAL
CHAL HOSPITAL 31 (GO TO 335)
CHAL HEALTH CENTER 32 (GO TO 335)
CHAL HEALTH POST 33 (GO TO 335)
CBD 41 (GO TO 335)
COMMUNITY HEALTH WORKER 42 (GO TO 335)
SUPPORT GROUPS 43 (GO TO 335)
OTHER SOURCE
SHOP 51 (GO TO 335)
CHURCH 52 (GO TO 335)
PEER EDUCATORS 53 (GO TO 335)
FRIEND/RELATIVE 54 (GO TO 335)
OTHER 96 (GO TO 335)

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

YES 1
NO 2 GO TO 335

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

(NAME OF PLACE(S)) _____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CHAL HEALTH POST K
CBD L
COMMUNITY HEALTH WORKER M
SUPPORT GROUPS N
OTHER SOURCE
SHOP O
CHURCH P
PEER EDUCATORS Q
FRIEND/RELATIVE R
OTHER X

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

YES 1
NO 2

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

YES 1
NO 2 GO TO 401

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401 CHECK 224:

ONE OR MORE BIRTHS IN 2004 OR LATER GO TO 402
NO BIRTHS IN 2004 OR LATER GO TO 576

402 CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2004 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 some questions about your children born in the last five years. (We will talk about each separately.)

403 BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NO. __________

404 FROM 212 AND 216

NAME __________
LIVING GO TO NEXT
DEAD GO TO NEXT

405 When you got pregnant with (NAME), did you want to become pregnant at that time?
IF NO: Did you want to have a baby later, or did you not want any (more) children?

THEN 1 (SKIP TO 432)
LATER 2
NOT AT ALL 3 (SKIP TO 432)

406 How much longer did you want to wait?

MONTH 1 ___ ___
YEARS 2 ___ ___

DON'T KNOW 998

407 Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (SKIP TO 417)

407A Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT C
OTHER X

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

(NAME OF PLACE(S)) ___________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC SECTOR D
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC E
PRIVATE MED. SECTOR F
CHAL
CHAL HOSPITAL G
CHAL HEALTH CENTER H
CHAL HEALTH POST I
OTHER X

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

MONTHS PREGNANT _____
DON'T KNOW 98

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

NUMBER OF TIMES _________
DON'T KNOW 98

410A How many months pregnant were you the last time you received antenatal care?

MONTHS ______
DON'T KNOW 98

411 As part of your antenatal care 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

412 During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

YES 1
NO 2 SKIP TO 414
DON'T KNOW 8 SKIP TO 414

413 Were you told where to go if you had any of these complications?

YES 1
NO 2
DON'T KNOW 8

414 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 SKIP TO 417
DON'T KNOW 8 SKIP TO 417

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

TIMES ___
DON'T KNOW 8

416 CHECK 415:

2 OR MORE TIMES SKIP TO 421
OTHER GO TO 417

417 At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

YES 1
NO 2 SKIP TO 421
DON'T KNOW 8 SKIP TO 421

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

TIMES _____
DON'T KNOW 8

419 In what month and year did you receive the last tetanus injection before this pregnancy?

MONTH ________
DON'T KNOW MONTH 98
YEAR ________ (SKIP TO 421)
DON'T KNOW YEAR 9998

420 How many years ago did you receive that tetanus injection?

YEARS AGO __________

421 During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP.

YES 1
NO 2 (SKIP TO 424)
DON'T KNOW 8 (SKIP TO 424)

422 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.

DAYS ________
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 SKIP TO 421
DON'T KNOW 8 SKIP TO 421

432 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

433 Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 435)
DON'T KNOW 8 (SKIP TO 435)

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

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

DON'T KNOW 99.998

435 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
COM. HEALH WORKER C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
TRADITIONAL HEALER F
RELATIVE/FRIEND G
OTHER X
NO ONE ASSISTED Y

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

(NAME OF PLACE) ___________
HOME
YOUR HOME 11 (SKIP TO 443)
OTHER HOME 12 (SKIP TO 443)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC SECTOR 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PVTIVATE MEDICAL SECTOR 36
CHAL
CHAL HOSPITAL 41
CHAL HEALTH CENTER 42
CHAL HEALTH POST 43
OTHER 96

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

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 98

438 Was (NAME) delivered by caesarean section?

YES 1
NO 2

439 Before you were discharged after (NAME) was born, did any health care provider check on your health?

YES 1
NO 2 (SKIP TO 442)

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

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

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

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
COM. HEALTH WORKER 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
TRADITIONAL HEALTHER 22
RELATIVE/FRIEND 23
OTHER 96

442 After you were discharged, did any health care provider or a traditional birth attendant check on your health?

YES 1 (SKIP TO 446)
NO 2 (SKIP TO 449)

443 Why didn't you deliver in a health facility?
PROBE: Any other reason? RECORD ALL MENTIONED.

COST TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/ NO TRANSPORTATION C
DON'T TRUST FACILITY/ POOR QUALITY SERVICE D
NEAREST FACILITY DOES NOT PROVIDE SERVICES E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER X

444 After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?

YES 1
NO 2 (SKIP TO 449)

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

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

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

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
COM. HEALTH WORKER 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
TRADITIONAL HEALTHER 22
RELATIVE/FRIEND 23
OTHER 96

447 Where did this first 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.

(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 SECTOR 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PVTIVATE MEDICAL SECTOR 36
CHAL
CHAL HOSPITAL 41
CHAL HEALTH CENTER 42
CHAL HEALTH POST 46
OTHER 96

448 CHECK 442:

YES (SKIP TO 453)
NOT ASKED GO TO 449

449 In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (SKIP TO 453)
DON'T KNOW 8 (SKIP TO 453)

450 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.

HRS AFTER BIRTH 1 ____
DAYS AFTER BIRTH 2 ____
WKS AFTER BIRTH 3 ____

DON'T KNOW 998

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

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
COM. HEALTH WORKER 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
TRADITIONAL HEALTHER 22
RELATIVE/FRIEND 23
OTHER 96

452 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.

(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 SECTOR 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PVTIVATE MEDICAL SECTOR 36
CHAL
CHAL HOSPITAL 41
CHAL HEALTH CENTER 42
CHAL HEALTH POST 46
OTHER 96

453 In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2
DON'T KNOW 8

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

YES 1 (SKIP TO 456)
NO 2 (SKIP TO 457)

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

YES 1
NO 2 (SKIP TO 459)

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

MONTHS ___ ___
DON'T KNOW 98

457 CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT GO TO 458
PREGNANT OR UNSURE (SKIP TO 459)

458 Have you begun to have sexual intercourse again since the birth of (NAME)?

YES 1
NO 2 (SKIP TO 460)

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

MONTHS ___ ___
DON'T KNOW 98

460 Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 461)

460A CHECK 404:
IS CHILD LIVING?

LIVING (SKIP TO 470)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

461 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 ___ ___

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

YES 1
NO 2 (SKIP TO 464)

463 What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.

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

464 CHECK 404:
IS CHILD LIVING?

LIVING GO TO 465
DEAD (SKIP TO 466)

465 Are you still breastfeeding (NAME)?

YES 1 (SKIP TO 468)
NO 2

466 For how many months did you breastfeed (NAME)? MONTHS

MONTHS ___ ___
DON'T KNOW 98

467 CHECK 404:
IS CHILD LIVING?

LIVING (SKIP TO 470)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

468 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 ___ ___

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

NUMBER OF DAYTIME FEEDINGS ___ ___

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S NUTRITION

501 ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2004 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).

502 BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER ___________

503 FROM 212 AND 216

NAME __________________
LIVING GO TO NEXT
DEAD GO TO 503 IN NEXT-TO-LAST COLUMN OR, IF NO MORE COLUMN OF NEW BIRTHS, GO TO 573

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

YES, SEEN 1 (SKIP TO 506)
YES, NOT SEEN 2 (SKIP TO 508)
NO CARD 3

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

YES 1 (SKIP TO 508)
NO 2 (SKIP TO 508)

506 (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.
(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.
LAST BIRTH

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

506A CHECK 506:

BCG TO MEASLES ALL RECORDED GO TO 512
OTHER GO TO 507

507 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 506)
NO 2 (SKIP TO 512)
DON'T KNOW 8 (SKIP TO 512)

508 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 512)
DON'T KNOW 8 (SKIP TO 512)

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

509A A BCG vaccination against tuberculosis, that is, an injection in the left forearm or upper arm that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

509B Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (SKIP TO 509E)
DON'T KNOW 8 (SKIP TO 509E)

509C Was the first polio vaccine received in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

509D How many times was the polio vaccine received?

NUMBER OF TIMES ___ ___

509E A DPT vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?

YES 1
NO 2 (SKIP TO 509G)
DON'T KNOW 8 (SKIP TO 509G)

509F How many times was a DPT vaccination received?

NUMBER OF TIMES ___ ___

509G A measles injection--that is a shot in the right arm at the age of 9 months or older - to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

509H An injection to prevent Hepatitis B given in the right thigh, usually at the same time as polio and DPT vaccinations?

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

509I How many times?

NUMBER OF TIMES ___ ___

512 CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE

DATE FOR THE MOST RECENT VITAMIN A DOSE GO TO 513
OTHER (SKIP TO 514)

513 According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD).
Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF CAPSULES.

YES 1 (SKIP TO 515)
NO 2 (SKIP TO 517)
DON'T KNOW 8 (SKIP TO 517)

514 HAS (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2 (SKIP TO 517)
DON'T KNOW 8 (SKIP TO 517)

515 Has (NAME) received a vitamin A dose like (this/any of these) within the last six months?
SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2
DON'T KNOW 8

517 Has (NAME) taken any drug for intestinal worms in the last six months?
SHOW COMMON TYPES OF CAPSULES.

YES 1
NO 2
DON'T KNOW 8

518 Has (NAME) had diarrhoea in the last 2 weeks, that is three or more loose stools per day?

YES 1
NO 2 (SKIP TO 533)
DON'T KNOW 8 (SKIP TO 533)

519 Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

520 Now I would like to know how much (NAME) was given to drink during the diarrhoea (including breastmilk).
Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

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

521 When (NAME) had diarrhoea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

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

YES 1
NO 2 (SKIP TO 528)

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

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

524 CHECK 523:

TWO OR MORE CODES CIRCLED (GO TO 525)
ONLY ONE CODE CIRCLED (SKIP TO 528)

525 Where did you first seek advice or treatment?

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC SECTOR D
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PVTIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CHAL HEALTH POST K
COMMUNITY HEALTH WORKER/ SUPPORT GROUPS L
OTHER SOURCE
SHOP M
TRADITIONAL HEALER N
OTHER X

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

a) A fluid made from a special packet called Motsoako or ORS?
YES 1
NO 2
DON'T KNOW 8
b) A health clinic-recommended homemade sugar-salt solution?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 533)
DON'T KNOW 8 (SKIP TO 533)

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

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS C
HOME REMEDY/ HERBAL MEDICINE D
OTHER X

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

YES 1
NO 2 (SKIP TO 534)
DON'T KNOW 8 (SKIP TO 534)

533A At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 537)
DON'T KNOW 8 (SKIP TO 537)

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

YES 1
NO 2 (SKIP TO 538)
DON'T KNOW 8 (SKIP TO 538)

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

CHEST ONLY 1 (GO TO 538)
NOSE ONLY 2 (GO TO 538)
BOTH 3 (GO TO 538)
OTHER 6 (GO TO 538)
DON'T KNOW 8 (GO TO 538)

537 CHECK 533:
HAD FEVER?

YES (GO TO 538)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 573)

538 Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough).
Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

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

539 When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

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

YES 1
NO 2 (SKIP TO 545)

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

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

542 CHECK 541:

TWO OR MORE CODES CIRCLED GO TO 543
ONLY ONE CODE CIRCLED (SKIP TO 544)

543Where did you first seek advice or treatment? USE LETTER CODE FROM 541.

PUBLIC SECTOR
GOVT HOSPITAL A
GOVT HEALTH CENTER B
GOVT HEALTH POST C
OTHER PUBLIC SECTOR D
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC E
PHARMACY F
PVT DOCTOR G
OTHER PRIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CHAL HEALTH POST K
COMMUNITY HLTH. WORKER/ SUPPORT GROUPS L
OTHER SOURCE
SHOP M
TRADITIONAL HEALER N
OTHER X

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

DAYS _________

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

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

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

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

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

PARACETAMOL A
IBUPROFEN B
ASPIRIN C
OTHER X
DON'T KNOW Z

572 GO TO 503 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 573.

573 CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2004 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 574)
(NAME) _____________
NONE GO TO 576

574 The last time (NAME FROM 573) passed stools, what was done to dispose of the stools?

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

575 CHECK 528(a) AND 528(b), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET GO TO 576
ANY CHILD RECEIVED FLUID FROM ORS PACKET GO TO 577

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

YES 1
NO 2

577 CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2007 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE: RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 578)
(NAME) __________
NONE GO TO 601

578A I would like to ask you about liquids or foods that (NAME FROM 577) 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 577) drink plain water yesterday, during the day or night?

YES 1
NO 2
DON'T KNOW 8

578B Did (NAME) drink infant formula yesterday?

YES 1
NO 2 GO TO 578D
DON'T KNOW 8 GO TO 578D

578C How many times did (NAME) have infant formula?

NUMBER OF TIMES __________

578D Did (NAME) drink milk, such as tinned, powdered, or fresh animal milk yesterday?

YES 1
NO 2 GO TO 578F
DON'T KNOW 8 GO TO 578F

578E How many times did (NAME) drink tinned, powdered or fresh milk?

NUMBER OF TIMES __________

578F Did (NAME) drink juice or juice drinks? YES

YES 1
NO 2
DON'T KNOW 8

578G Did (NAME) drink or eat soup?

YES 1
NO 2
DON'T KNOW 8

578H Did (NAME) drink any other liquids?

YES 1
NO 2
DON'T KNOW 8

578I Did (NAME) drink or eat yoghurt?

YES 1
NO 2 GO TO 578K
DON'T KNOW 8 GO TO 578K

578J How many times did (NAME) have yoghurt?

NUMBER OF TIMES __________

578K Did (NAME) drink or eat any (COMMERCIALLY FORTIFIED BABY FOOD), such as Nestum, Cerelac, and Purity?

YES 1
NO 2
DON'T KNOW 8

578L Did (NAME) eat bread, rice, noodles, or other foods made of grains?

YES 1
NO 2
DON'T KNOW 8

578M Did (NAME) eat pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside yesterday, during the day or night?

YES 1
NO 2
DON'T KNOW 8

578N Did (NAME) eat white potatoes, white yams, manioc, cassava, or any other foods made of roots?

YES 1
NO 2
DON'T KNOW 8

578O Did (NAME) eat any dark green vegetables, such as broccoli, beet, kale, mustard laeves, pumpkin leaves, turnip leaves, wild moroho, pepper, spinach, swiss chard, cabbage?

YES 1
NO 2
DON'T KNOW 8

578Q Did (NAME) eat ripe mangoes, papayas, apricots, peaches, gooseberries, fresh or dried?

YES 1
NO 2
DON'T KNOW 8

578R Did (NAME) eat any other fruits or vegetables such as bananas, apples/apple sauce, citrus fruit, figs, pears, plums, cauliflower, eggplant, mushrooms, green beans, avocados, and tomatoes?

YES 1
NO 2
DON'T KNOW 8

578S Did (NAME) eat liver, kidney, heart or other organ meats?

YES 1
NO 2
DON'T KNOW 8

578T Did (NAME) eat any meat, such as beef, pork, lamb, goat, chicken, or duck?

YES 1
NO 2
DON'T KNOW 8

578U Did (NAME) eat eggs?

YES 1
NO 2
DON'T KNOW 8

578V Did (NAME) eat fresh or dried fish or shellfish?

YES 1
NO 2
DON'T KNOW 8

578W Did (NAME) eat any foods made from beans, peas, lentils, or nuts?

YES 1
NO 2
DON'T KNOW 8

578X Did (NAME) eat cheese or other food made from milk?

YES 1
NO 2
DON'T KNOW 8

591A CHECK 578 (CATEGORIES "I" THROUGH "X"):

ALL "NO" GO TO 591B
AT LEAST ONE "YES" OR ALL DON'T KNOWs GO TO 592

591B Did (NAME) eat solid or semi-solid (mushy) food yesterday, during the day or night?

YES 1 (GO BACK TO 578 TO RECORD FOOD EATEN YESTERDAY)
NO 2 GO TO 601A
DON'T KNOW 8 GO TO 601A

592 How many times did (NAME) have solid or semi-solid (mushy) food?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ______
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601A CHECK 102D:

AGREED TO MEASUREMENT GO TO 601B
DID NOT AGREE TO MEASUREMENT GO TO 601

601B May I measure your blood pressure at this time?

INTERVIEWER SIGNATURE _______
DATE ______________
RESPONDENT AGREES (RECORD OUTCOME OF BLOOD PRESSURE MEASUREMENT.)
RESPONDENT DOES NOT AGREE (RECORD 9994. )

BLOOD PRESSURE MEASURED

SYSTOLIC __________
DIASTOLIC __________

REASON BLOOD PRESSURE NOT MEASURED

REFUSED 9994
TECHNICAL PROBLEMS 9995
OTHER 9996

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

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

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 GO TO 617

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

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME _________
LINE NO. __________

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

ONLY ONCE 1
MORE THAN ONCE 2 GO TO 611

610 CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

CURRENTLY WIDOWED GO TO 613
NOT ASKED OR CURRENTLY DIVORCED/SEPARATED GO TO 615

611 CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

CURRENTLY WIDOWED GO TO 613
NOT ASKED GO TO 612
CURRENTLY DIVORCED/SEPARATED GO TO 615

612 How did your previous marriage or union end?

DEATH/WIDOWHOOD 1
DIVORCE 2 GO TO 615
SEPARATION 3 GO TO 615

613 To whom did most of your late husband's property go to?

RESPONDENT 1 GO TO 615
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
OTHER 6
NO PROPERTY 7

614 Did you receive any of your late husband's assets or valuables?

YES 1
NO 2

615 CHECK 609:

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

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

MONTH _______
DON'T KNOW MONTH 98
YEAR _______ GO TO 617
DON'T KNOW YEAR 9998

616 How old were you when you first started living with him?

AGE ________

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

618 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 GO TO 631
AGE IN YEARS ______
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

621 CHECK 107:

AGE 15-24 GO TO 622
AGE 25-49 GO TO 626

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

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

626When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4 GO TO 640

626A Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. SKIP TO 628

627 When was the last time you had sexual intercourse with this person?

DAYS 1 ____
WEEKS 2 ____
MONTHS 3 ____

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

YES, MALE COND. 1
YES, FEMALE COND 2
NO 3 (SKIP TO 630)

629 Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

630 What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.
LAST/SECOND-TO-LAST/THIRD-TO-LAST SEXUAL PARTNER

SPOUSE 01
COHABITING PARTNER 02
BOYFRIEND NOT
LIVING WITH RESPONDENT 03 (SKIP TO 631)
CASUAL ACQUAINTANCE 04 (SKIP TO 631)
RELATIVE 05 (SKIP TO 631)
PROSTITUTE 06 (SKIP TO 631)
OTHER 96 (SKIP TO 631)

630A CHECK 609:

MARRIED ONLY ONCE GO TO 630B
MARRIED MORE THAN ONCE SKIP TO 631

630B CHECK 618:

FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (SKIP TO 631A)
OTHER (GO TO 631)

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

DAYS . 1 ______
MONTHS 2 ______
YEARS 3 ______

631A How many times during the last 12 months did you have sexual intercourse with this person?

NUMBER OF TIMES _______
RECORD 95 IF 95 OR MORE

633 How old is this person?

AGE OF PARTNER _______
DON'T KNOW 98

638 Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 627 IN NEXT COLUMN)
NO 2 (SKIP TO 640)

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

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

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

NUMBER OF PARTNERS IN LIFETIME
DON'T KNOW 98

640A PRESENCE OF OTHERS DURING THIS SECTION

MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2
MALE YOUTHS
YES 1
NO 2
FEMALE YOUTHS
YES 1
NO 2
CHILDREN
YES 1
NO 2

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

YES 1
NO 2 GO TO 644

642 Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

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

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 GO TO 701

645Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701 CHECK 311:

NEITHER HE OR SHE STERILIZED GO TO 701A
HE OR SHE STERILIZED GO TO 713

701A CHECK 226:

PREGNANT GO TO 702A
NOT PREGNANT OR UNSURE GO TO 702B

702A Now I have some questions about the future. After the birth of 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 GO TO 703
NO MORE/NONE 2 GO TO 709
UNDECIDED/DON'T KNOW 8 GO TO 709

702B Now I have some questions about the future. Would you like to have a (another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 GO TO 705
SAYS SHE CAN'T GET PREGNANT 3 GO TO 713
UNDECIDED/DON'T KNOW 8 GO TO 708

703 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 708
SAYS SHE CAN'T GET PREGNANT 994 GO TO 713
AFTER MARRIAGE 995 GO TO 708
OTHER 996 GO TO 708
DON'T KNOW 998 GO TO 708

704 CHECK 226:

NOT PREGNANT OR UNSURE GO TO 705
PREGNANT GO TO 709

705 CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED GO TO 706
NOT CURRENTLY USING GO TO 706
CURRENTLY USING GO TO 713

706 CHECK 703:

NOT ASKED GO TO 707
24 OR MORE MONTHS OR 02 OR MORE YEARS GO TO 707
00-23 MONTHS OR 00-01 YEAR GO TO 709

707 CHECK 702:

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

WANTS NO MORE/NONE: You have said that you do not want any (more) children. Can you tell me why you are not using a method? Any other reason?
RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SAYS SHE CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH 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/CONCERN ABOUT SIDE EFFECTS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER X
DON'T KNOW Z

708 CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED GO TO 708
NO, NOT CURRENTLY USING GO TO 709
YES, CURRENTLY USING GO TO 713

709 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

713 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.

NONE 00 GO TO 715
NUMBER _____
OTHER 96 GO TO 715

714 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 96

715 In the last three months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Read about family planning on billboards, posters, pamphlets?
YES 1
NO 2

717 CHECK 601:

YES, CURRENTLY MARRIED GO TO 718
YES, LIVING WITH A MAN GO TO 718
NO, NOT IN UNION GO TO 801

718 CHECK 310:

CURRENTLY USING GO TO 719
NOT CURRENTLY USING GO TO 722

719 Does your husband/partner know that you are using a method of family planning?

YES 1
NO 2
DON'T KNOW 8

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

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER 6

721 CHECK 311:

NEITHER STERILIZED GO TO 722
HE OR SHE STERILIZED GO TO 801

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

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

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

801 CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN GO TO 802
FORMERLY MARRIED/LIVED WITH A MAN GO TO 803
NEVER MARRIED AND NEVER LIVED WITH A MAN GO TO 807

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

AGE IN COMPLETED YEARS ________

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

YES 1
NO 2 GO TO 806

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

PRIMARY 1
VOCATIONAL/TECHNICAL TRAINING AFTER PRIMARY 2
SECONDARY/HIGH 3
VOCATIONAL/TECHNICAL TRAINING AFTER SECONDARY/HIGH 4
COLLEGE 5
GRADUATE/POST GRADUATE 6
DON'T KNOW 8 GO TO 806

805 What was the highest (standard/form/year) he completed at that level?

STANDARD/FORM/YEAR _____
DON'T KNOW 98

806 CHECK 801:

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_________________

807 Aside from your own housework, have you done any work in the last seven days?

YES 1 GO TO 811
NO 2

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

YES 1 GO TO 811
NO 2

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

YES 1 GO TO 811
NO 2

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

YES 1
NO 2 GO TO 818

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

OCCUPATION____________

812 CHECK 811:

WORKS IN AGRICULTURE GO TO 813
DOES NOT WORK IN AGRICULTURE GO TO 814

813 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

814 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

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

HOME 1
AWAY 2

816 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

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

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

818 CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN GO TO 819
NOT IN UNION GO TO 826B

819 CHECK 817:

CODE 1 OR 2 CIRCLED GO TO 820
OTHER GO TO 822

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 GO TO 823
DON'T KNOW 8

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER 6

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

RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT and HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6

824 Who usually makes decisions about making major household purchases?

RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT and HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6

825 Who usually makes decisions about making purchases for daily household needs?

RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT and HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6

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

RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT and HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6

826A Who usually makes decisions about what food should be cooked each day?

RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT and HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6

826B Do you personally own any land?

YES 1
NO 2 GO TO 826D

826C Do you own the land alone or jointly with someone else?

ALONE 1
JOINTLY WITH HUSBAND 2
JOINTLY WITH SOMEONE 3
BOTH ALONE AND JOINTLY 4

826D Do you personally own this or any other house?

YES 1
NO 2 GO TO 827

826E Do you own it alone or jointly with someone else?

ALONE 1
JOINTLY WITH HUSBAND 2
JOINTLY WITH SOMEONE 3
BOTH ALONE AND JOINTLY 4

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

CHILDREN YOUNGER THAN10
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3
HUSBAND
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3
OTHER MALES
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3
OTHER FEMALES
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3

828 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
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8
If she refuses to let her husband decide how she should use her pay?
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 GO TO 942

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

YES 1
NO 2
DON'T KNOW 8

903 Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

910 CHECK 909:

AT LEAST ONE 'YES' GO TO 911
OTHER GO TO 912

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

YES 1
NO 2
DON'T KNOW 8

912 Have you heard about special antiretroviral drugs (ART) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

YES 1
NO 2
DON'T KNOW 8

913 CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2004 GO TO 914
NO BIRTHS GO TO 922
LAST BIRTH BEFORE JANUARY 2004 GO TO 922

914 CHECK 407 FOR LAST BIRTH:

HAD ANTENATAL CARE GO TO 914A
NO ANTENATAL CARE GO TO 922

914A CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915 During any of the antenatal visits for your last birth, did anyone talk to you about:

Babies getting the AIDS virus from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting the AIDS virus?
YES 1
NO 2
DON'T KNOW 8
Getting tested for the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

Special medications that can be taken by pregnant women to reduce the risk of transmission of HIV to their baby?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 GO TO 922

917A Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21
LPPA 22
PHARMACY 23
PVT DOCTOR 24
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41
OTHER 96

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

YES 1
NO 2

918A Regardless of the result, all women who are tested are supposed to receive counseling after getting the result. Did you receive post-test counseling?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 GO TO 927

921 How many months ago was your most recent HIV test?

MONTHS AGO _____ GO TO 929
TWO OR MORE YEARS AGO 96 GO TO 929

922 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 927

923 How many months ago was your most recent HIV test?

MONTHS AGO _______
TWO OR MORE YEARS AGO 96

924 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

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

YES 1
NO 2

926 Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 929)
GOVT. HEALTH CENTER 12 (GO TO 929)
OTHER PUBLIC SECTOR 13 (GO TO 929)
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21 (GO TO 929)
LPPA 22 (GO TO 929)
PHARMACY 23 (GO TO 929)
PVT DOCTOR 24 (GO TO 929)
OTHER PRIVATE MEDICAL SECTOR 26 (GO TO 929)
CHAL
CHAL HOSPITAL 31 (GO TO 929)
CHAL HEALTH CENTER 32 (GO TO 929)
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41 (GO TO 929)
OTHER 96 (GO TO 929)

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

YES 1
NO 2 GO TO 929

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

(NAME OF PLACE(S)) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PVT DOCTOR G
OTHER PRIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
COMMUNITY HEALTH WORKER/SUPPORT GROUPS K
OTHER X

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

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

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

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

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

932A In your opinion, if a male teacher has the AIDS virus but is not sick, should he be allowed to continue teaching in the school?

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

933 Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 3 GO TO 938

934 Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

935 Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

938 Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

939 Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

940 Should children age 12-14 be taught about using a condom to avoid getting HIV?

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

941 CHECK 938, 939, AND 940:

OTHER GO TO 941A
AT LEAST ONE 'YES/AGREE' GO TO 942

941A Do you personally know someone who has or is suspected to have the AIDS virus?

YES 1
NO 2

942 CHECK 901:

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

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

YES 1
NO 2

943 CHECK 618:

HAS HAD SEXUAL INTERCOURSE GO TO 944
HAS NOT HAD SEXUAL INTERCOURSE GO TO 951

944 CHECK 942:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES GO TO 945
NO GO TO 946

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

YES 1
NO 2
DON'T KNOW 8

946 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

947 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

948 CHECK 945, 946, AND 947:

HAS HAD AN INFECTION (ANY 'YES') GO TO 949
HAS NOT HAD AN INFECTION OR DOES NOT KNOW GO TO 951

949 The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?

YES 1
NO 2 GO TO 950A

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

(NAME OF PLACE(S)) ___________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PVT DOCTOR G
OTHER PRIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
COMMUNITY HEALTH WORKER/SUPPORT GROUPS K
FRIENDS/RELATIVES L
TRADITIONAL HEALER M
OTHER X

950A When you had (PROBLEM FROM 945/946/947), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 GO TO 951
PARTNER ALREADY INFECTED 3 GO TO 951

950B When you had (PROBLEM FROM 945/946/947), did you inform your sexual partner(s) about it?

YES 1
SOME/NOT ALL 2
NO 3 GO TO 951
DID NOT HAVE A PARTNER 4 GO TO 951

950C What did you do to avoid infecting your partners? 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

951 Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

953 Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

954 Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

955 CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN GO TO 956
NOT IN UNION GO TO 1001A

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

YES 1
NO 2
DEPENDS/NOT SURE 8

957 Can you ask your husband/partner to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

1001A Now I would like to ask you about something else. Since age 15, have you ever had the following symptoms:

Cough for two weeks or more?
YES 1
NO 2
Fever for two weeks or more?
YES 1
NO 2
Chest or back pain?
YES 1
NO 2
Coughing up blood?
YES 1
NO 2
Sweating at night?
YES 1
NO 2

1001B CHECK 1001A

AT LEAST ONE YES' GO TO 1001C
NOT A SINGLE YES' GO TO 1001L

1001C Did you seek consultation or treatment for the symptoms?

YES 1 GO TO 1001E
NO 2

1001D What is the main reason you did not seek treatment for the symptoms?

SYMPTOMS HARMLESS 1 (GO TO 1001L)
COST 2 (GO TO 1001L)
DISTANCE 3 (GO TO 1001L)
EMBARASSED 4 (GO TO 1001L)
LONG QUEUE 5 (GO TO 1001L)
OTHER 6 (GO TO 1001L)

1001E The last time you had such symptoms, where did you first go for advice or treatment?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21
LPPA 22
PHARMACY 23
PVT DOCTOR 24
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53
TRADITIONAL HEALER 54
OTHER 96

1001F How soon after the symptom(s) did you first seek consultation or treatment?

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

1001G During that first visit, were you told by a doctor or a nurse that you had tuberculosis?

YES 1
NO 2 GO TO 1001L

1001H Were you given any medicine to treat TB?

YES 1
NO 2 GO TO 1002

1001I How long were you told to take the medicine?

NUMBER OF MONTHS ______
DON'T KNOW/DON'T REMEMBER 9998

1001J Did you go anywhere else for advice or treatment after you were told that you had tuberculosis?

YES 1
NO 2 GO TO 1002

1001K Where did you go?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21
LPPA 22
PHARMACY 23
PVT DOCTOR 24
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53
TRADITIONAL HEALER 54
OTHER 96

1001L Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 GO TO 1005

1002 How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

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

1003 Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1004 If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

1004A Would you be willing to work with someone who has been previously treated for tuberculosis?

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

1004B What signs or symptoms would lead you to think that a person has tuberculosis?
PROBE: Any other ways?
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 K
NO SYMPTOMS Y
DON'T KNOW Z

1004C What do you think is the cause of tuberculosis?
PROBE: Any other ways?
RECORD ALL MENTIONED.

MICROBES/GERMS/BACTERIA A
INHERITED B
LIFESTYLE C
SMOKING D
ALCOHOL DRINKING E
EXPOSURE TO COLD TEMP. F
DUST/POLLUTION G
OTHER X
DON'T KNOW Z

1005 Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 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 (GO TO 1009)

1006 Among these injections, how many were administered by a doctor, a nurse, a dentist, or any other health worker?
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 GO TO 1009

1007 The last time you had an injection given to you by a doctor or a nurse, a dentist or any other health worker, where did you go to get the injection?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
OTHER PUBLIC SECTOR 13
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC 21
LPPA 22
PHARMACY 23
PVT DOCTOR 24
OTHER PRIVATE MEDICAL SECTOR 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
COMMUNITY HEALTH WORKER/SUPPORT GROUPS 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53
TRADITIONAL HEALER 54
OTHER 96

1009 Do you currently smoke cigarettes?

YES 1
NO 2 GO TO 1011

1010 In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ________

1011 Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 GO TO 1012A

1012 What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER X

1012A Now I want to talk about diabetes. Have you ever heard of an illness called diabetes?

YES 1
NO 2 GO TO 1012E

1012B Have you ever been told by a doctor or a nurse that you have diabetes?

YES 1
NO 2 GO TO 1012E

1012C Are you taking medications for diabetes?

YES 1
NO 2 GO TO 1012E

1012D How do you take the medicine?

INJECTED 1
ORALLY 2

1012E Now I want to talk about blood pressure. Before this survey, has your blood pressure ever been checked?

YES 1
NO 2 GO TO 1012J

1012F Who took your blood pressure?

DOCTOR 1
NURSE 2
PHARMACIST 3
OTHER 6
DON'T KNOW 8

1012G When was the last time you had your blood pressure checked?

LESS THAN 6 MONTHS AGO 1
6 - 11 MONTHS AGO 2
1 - 5 YEARS AGO 3
MORE THAN 5 YEARS AGO 4
DON'T KNOW 8

1012H Have you ever been told by a doctor or a nurse that you have high blood pressure?

YES 1
NO 2 GO TO 1012J

1012I To lower your blood pressure, are you now:

a. taking prescribed medicine?
YES 1
NO 2
N/A 3
b. controlling your weight or losing weight?
YES 1
NO 2
N/A 3
c. cutting down on salt in your diet?
YES 1
NO 2
N/A 3
d. exercising?
YES 1
NO 2
N/A 3
e. cutting down on alcohol consumption?
YES 1
NO 2
N/A 3
f. stopping smoking?
YES 1
NO 2
N/A 3
g. taking traditional medicine/herbs
YES 1
NO 2
N/A 3

1012J Have you performed a breast self exam to detect lumps within the last 12 months?

YES 1
NO 2

1012K Have you had a breast cancer clinical exam to detect breast cancer in the last 12 months?

YES 1
NO 2
NOT SURE 8

1012L Have you ever heard of a pap smear, that is an exam that consists of removing cells from the cervix to detect changes that can suggest the presence of cancer in a woman's womb?

YES 1
NO 2 GO TO 1013

1012M Have you ever had such an exam in your life time?

YES 1
NO 2 GO TO 1013

1012N How long ago was the last exam performed?

LESS THAN 12 MONTHS AGO 1
1-3 YEARS 2
4 + YEARS 3
DON'T KNOW/REMEMBER 8

1013 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?

Getting permission to go?
YES 1
NO 2
N/A 3
Getting money needed for treatment?
YES 1
NO 2
N/A 3
The distance to the health facility?
YES 1
NO 2
N/A 3
Having to take transport?
YES 1
NO 2
N/A 3
Not wanting to go alone?
YES 1
NO 2
N/A 3
Concern about health professional's attitude?
YES 1
NO 2
N/A 3
Concern that there may be no drugs available?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1014 Are you covered by any health insurance?

YES 1
NO 2 GO TO 1016

1015 What type of health insurance?
RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE C
OTHER X

1016 CHECK 217:

(YOUNGEST) CHILD IS AGE 0-17 GO TO 1017
OTHER GO TO 1018

1017 Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

1018 (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

YES 1
NO 2 GO TO 1101

1019 Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2

SECTION 11. MATERNAL MORTALITY

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

NUMBER OF BIRTHS TO NATURAL MOTHER ________

1102 CHECK 1101:

TWO OR MORE BIRTHS GO TO 1103
ONLY ONE BIRTH (RESPONDENT ONLY) GO TO 1114

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

NUMBER OF PRECEDING BIRTHS _________

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

NAME____________

1105 Is (NAME) male or female?

MALE 1
FEMALE 2

1106 Is (NAME) still alive?

YES 1
NO 2 GO TO 1108
DON'T KNOW 8 GO TO NEXT PERSON

1107 How old is (NAME)?

AGE____________

1108 How many years ago did (NAME) die?

YEARS_____________

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

AGE_____________ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT PERSON.)

1110 Was (NAME) pregnant when she died?

YES 1 GO TO 1113
NO 2

1111 Did (NAME) die during childbirth?

YES 1 GO TO 1113
NO 2

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

YES 1
NO 2

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

CHILDREN___________________ (IF NO MORE BROTHERS OR SISTERS, GO TO 1114.)

1114 CHECK QS. 1110, 1111 AND 1112 FOR ALL SISTERS

ANY YES: Just to make sure I have this right, you told me that your sister(s) _______________ (NAME) died when she was (pregnant/delivering/just delivered). Is that correct?
IF CORRECT, END INTERVIEW.
IF NOT, CORRECT QUESTIONNAIRE AND CONTINUE TO 1115.

ALL NO OR BLANK GO TO 1115

1115 CHECK 102 AND 473:

AGREED TO MEASUREMENT GO TO 1116
DID NOT AGREE TO MEASUREMENT GO TO 1117

1116 May I measure your blood pressure at this time?

INTERVIEWER SIGNATURE _________
DATE _________
RESPONDENT AGREES (RECORD OUTCOME OF BLOOD PRESSURE MEASUREMENT.)
RESPONDENT DOES NOT AGREE (RECORD 9994.)
BLOOD PRESSURE
DIASTOLIC _______
SYSTOLIC ________

REASON BLOOD PRESSURE NOT MEASURED
REFUSED 9994
TECHNICAL PROBLEMS 9995
OTHER 9996

1117 RECORD THE TIME.

HOURS ________
MINUTES ________

SECTION 12. AVERAGING BLOOD PRESSURE MEASURES

1201 CHECK Q601B AND Q1116:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN BOTH Q601B AND Q1116 GO TO 1202
SYSTOLIC AND DIASTOLIC BLOOD MEASURES NOT PRESSURE RECORDED IN BOTH IN BOTH Q601B AND Q1116 GO TO 1207

1202 RECORD AND CALCULATE THE AVERAGE OF THE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE FROM Q601B AND Q1116.

1203 BLOOD PRESSURE MEASUREMENTS FROM Q601B

SYSTOLIC _______
DIASTOLIC _______

1204 BLOOD PRESSURE MEASUREMENTS FROM Q1116

SYSTOLIC _______
DIASTOLIC ________

1205 RECORD THE SUM OF THE SYSTOLIC AND DIASTOLIC MEASURES.

SUM SYSTOLIC _______
SUM DIASTOLIC _______

1206 CALCULATE THE AVERAGE SYSTOLIC AND DIASTOLIC PRESSURES BY THE SUM IN Q1205 BY 2.

AVERAGE SYSTOLIC ________(GO TO 1211)
AVERAGE DIASTOLIC ________(GO TO 1211)

1207 CHECK Q1116:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q1116 (GO TO 1208)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q1116 (GO TO 1210)

1208 CHECK Q601B:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q601B (GO TO 1209)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q601B (GO TO 1210)

1209 CHECK Q102D:

SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q102D (GO TO 1210)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q102D (GO TO 1213)

1210 RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE.

SYSTOLIC _______
DIASTOLIC _______

1211 USE THE TABLE BELOW TO DETERMINE THE CORRECT CODE TO RECORD ON THE BLOOD PRESSURE REPORT AND REFERRAL FORM.
CIRCLE THE ROW IN WHICH THE VALUE FOR THE SYSTOLIC BLOOD PRESSURE FROM Q1206 OR Q1210 IS FOUND.
THEN CIRCLE THE COLUMN IN WHICH THE VALUE FOR THE DIASTOLIC BLOOD FROM Q1206 OR Q1210 IS FOUND.
THE VALUE WHERE THE ROW AND COLUMN YOU HAVE CIRCLED INTERSECT IN THE TABLE WILL BE USED IN COMPLETING Q1212.

AVERAGE DIASTOLIC PRESSURE
Less than 84
85-89
90-99
100-109
110-119
greater than 120
AVERAGE SYSTOLIC PRESSURE
less than 130 1 2 3 4 5 6
130-139 2 2 3 4 5 6
140-159 3 3 3 4 5 6
160-179 4 4 4 4 5 6
180-209 5 5 5 5 5 6
greater than 210 6 6 6 6 6 6

1212 RECORD THE NUMBER YOU CIRCLED IN Q1211 IN THE CHART BELOW. THEN USE THE INSTRUCTIONS TO THE RIGHT OF THAT NUMBER TO COMPLETE A BLOOD PRESSURE REPORT AND REFERRAL FORM FOR THE RESPONDENT. GIVE THE FORM TO THE RESPONDENT AND ANSWER ANY QUESTIONS HE/SHE MAY HAVE.

RESPONDENT'S BLOOD PRESSURE CATEGORY
1 NORMAL
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
1 24 MONTHS

RESPONDENT'S BLOOD PRESSURE CATEGORY
2 AT THE HIGH END OF THE NORMAL RANGE
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
2 12 MONTHS

RESPONDENT'S BLOOD PRESSURE CATEGORY
3 ABOVE NORMAL RANGE
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
3 2 MONTHS

RESPONDENT'S BLOOD PRESSURE CATEGORY
4 MODERATELY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
4 1 MONTH

RESPONDENT'S BLOOD PRESSURE CATEGORY
5 VERY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
5 7 DAYS

RESPONDENT'S BLOOD PRESSURE CATEGORY
6 EXTREMELY HIGH
CONSULT HEALTH PROVIDER TO CHECK BLOOD PRESSURE WITHIN:
6 TODAY

1213 CHECK THAT THE HOUSEHOLD HAS RECEIVED A BROCHURE ON BLOOD PRESSURE.
THANK THE RESPONDENT AND ADVISE THAT THE RESPONDENT OR OTHER MEMBERS OF THE HOUSEHOLD MAY BE ASKED TO PARTICIPATE AGAIN IN INTERVIEWS OR OTHER SURVEY ACTIVITIES IN THE FUTURE.
Thank you for taking the time to answer these questions.
We may return to interview you or other members of your household again or to ask you to participate in other survey activities in the future. We hope that you will agree at that time.

CALENDAR

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE
B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER (SPECIFY) _____________

2009
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 _____

2008
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 _____

2007
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 _____

2006
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 _____

2005
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 _____

2004
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 _____