IDENTIFICATION:

PLACE NAME ____

NAME OF HOUSEHOLD HEAD ____

EA NUMBER ____

HOUSEHOLD NUMBER ____

LESOTHO ECOLOGICAL ZONE

DISTRICT CODE ____

URBAN/RURAL

HOUSEHOLD SELECTED FOR MALE SURVEY AND BIOMARKER COLLECTION?

INTERVIEWER VISITS:

FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT CODE**

NEXT VISIT:
DATE ____
TIME ____

SECOND VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT CODE**

NEXT VISIT:
DATE ____
TIME ____

THIRD VISIT
DATE ____
INTERVIEWER'S NAME____
RESULT CODE**

FINAL VISIT
DAY ____
MONTH ____
YEAR 2014
INT. NUMBER ____
RESULT CODE**

TOTAL NUMBER OF VISITS ____

**RESULT CODES:

TOTAL PERSONS IN HOUSEHOLD____

TOTAL ELIGIBLE WOMEN____

TOTAL ELIGIBLE MEN____

LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE OF INTERVIEW

TRANSLATOR USED

SUPERVISOR
NAME ____
DATE ____

SECTION 1. RESPONDENT'S BACKGROUND:

INFORMED CONSENT

Hello. My name is _______________. I am with the Ministry of Health. We are conducting a survey about health all over the country. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER: ____
DATE: ____

101) RECORD THE TIME

101A) CHECK COVER PAGE OF WOMAN'S QUESTIONNAIRE: IS HOUSEHOLD SELECTED FOR MALE SURVEY AND BIOMARKERS?

101B) 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 any time 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: ____

101C) Before taking your blood pressure, I would like to ask a few questions about things that may affect these measurements. Have you done any of the following within the past 30 minutes:

a) Eaten anything?
b) Had coffee, tea, cola or other drink that has caffeine?
c) Smoked any tobacco product?

101D) 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 CENTIMETERS.

101E) USE THE ARM CIRCUMFERENCE MEASUREMENT TO SELECT THE APPROPRIATE CUFF SIZE. RECORD THE CODE FOR CUFF SIZE

101F) TAKE THE FIRST BLOOD PRESSURE READING. RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE.

102) In what month and year were you born?

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

104) Have you ever attended school?

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

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

107) CHECK 105:

108) Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

109) CHECK 108:

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

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

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

113) What religion do you belong to?

IF CHRISTIAN: What church do you belong to?

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

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

117) The last time you were away for more than a month, how many months were you away?

IF 12 MONTHS OR MORE, RECORD '95.'

118) Where did you go?

120) Why did you go there? PROBE: What was the main purpose of your trip?

121) CHECK 117

122) In the last 5 years, how many times have you been away from home for three or more months at a time?

123) The most recent time you were away from home for three or more months, where did you go?

124) Why did you go there? PROBE: What was the main purpose of your trip?

125) Including the time you already mentioned, in the last 5 years, how many times have you been away from home for three or more months at a time?

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?

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

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

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

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

206) Have you ever given birth to a son or a daughter who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

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

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

209) CHECK 208:

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

210) CHECK 208:

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (IF THERE ARE MORE THAN 6 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

213) Were any of these births twins?

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

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

215A) IF BIRTH SINCE JANUARY 2009: ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD BELOW. IN THE CALENDAR, PLACE A 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT [Transcriber note: survey text cuts off at this point]

216) Is (NAME) still alive?

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

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

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

220) IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?

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

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

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

IF YES, RECORD BIRTH(S) IN TABLE.

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

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

226) Are you pregnant now?

227) How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS.

C: ENTER 'P'S IN CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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

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

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

231) When did the last such pregnancy end?

232) CHECK 231:

232A) C:
In what month and year did that pregnancy end?

233) C:
How many months pregnant were you when that pregnancy ended?

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

235) C:
FOR EACH PREGNANCY THAT DID NOT RESULT IN A LIVE BIRTH IN JANUARY 2009 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2009?

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

238) When did your last menstrual period start?

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

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

SECTION 3. CONTRACEPTION:

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

Have you ever heard of (METHOD)?

302) CHECK 226:

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

304) Which method are you using? RECORD ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

307) In what facility did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

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

308A) Since what month and year have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

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

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A

310) CHECK 308/308A:

311) 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.

C: PROBE FOR EARLIER INTERVALS OF USE AND NONUSE, STARTING WITH MOST RECENT GAP BACK TO JANUARY 2009. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. ENTER METHOD AND DISCONTINUATION CODES FROM THE CALENDAR.

311A) INTERVAL OF USE OR NON-USE

311B) MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.

311C) Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your (husband/partner) use any method of contraception?

311D) Which method was that? SEE CALENDAR FOR CODES.

311E) How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?

RECORD '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

311F) RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

311G) For how many months did you use (METHOD)?

RECORD '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

311H) RECORD THE MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

311J) Why did you stop using (METHOD)?

SEE CALENDAR FOR CODES.

311K) GO BACK TO 311B IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 312.

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

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

314) CHECK 304:

RECORD METHOD CODE:

IF MORE THAN ONE METHOD CODE RECORDED IN 304, RECORD CODE FOR HIGHEST METHOD IN LIST.

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

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

316) CHECK 304:

RECORD METHOD CODE:

IF MORE THAN ONE METHOD CODE RECORDED IN 304, RECORD FOR HIGHEST METHOD IN LIST.

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

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

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

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

320) CHECK 317:

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

CODE '1' NOT RECORDED: When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

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

322) CHECK 304:

RECORD METHOD CODE:

IF MORE THAN ONE METHOD CODE RECORDED IN 304, RECORD CODE FOR HIGHEST METHOD IN LIST.

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

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

325) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

326) In the last 12 months, were you visited by a fieldworker or a community-based distributor (CBD) who talked to you about family planning?

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

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

SECTION 4. PREGNANCY AND POSTNATAL CARE:

401) CHECK 224:

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRE(S)).

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

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

404) FROM 212 AND 216

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

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

407) How much longer did you want to wait?

408) Did you see anyone for antenatal care for this pregnancy?
[FOR MOST RECENT BIRTH ONLY]

409) Whom did you see? Anyone else?
[FOR MOST RECENT BIRTH ONLY]

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

410) Where did you receive antenatal care for this pregnancy? Anywhere else?
[FOR MOST RECENT BIRTH ONLY]

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

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

412) How many times did you receive antenatal care during this pregnancy?
[FOR MOST RECENT BIRTH ONLY]

412A) How many months pregnant were you the last time you received antenatal care for this pregnancy? [FOR MOST RECENT BIRTH ONLY]

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

a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?

[FOR MOST RECENT BIRTH ONLY]

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy? [FOR MOST RECENT BIRTH ONLY]

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

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

417) CHECK 416:
[FOR MOST RECENT BIRTH ONLY]

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

419) Before this pregnancy, how many times did you receive a tetanus injection?
[FOR MOST RECENT BIRTH ONLY]

IF 7 OR MORE TIMES, RECORD '7'.

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

421) During this pregnancy, were you given or did you buy any iron tablets?
[FOR MOST RECENT BIRTH ONLY]

SHOW TABLETS.

422) During the whole pregnancy, for how many days did you take the tablets?
[FOR MOST RECENT BIRTH ONLY]

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

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

431) Was (NAME) weighed at birth?

432) How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH BOOKLET, IF AVAILABLE.

433) Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

434) Where did you give birth to (NAME)?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

434A) How long after (NAME) was delivered did you stay there?
[FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

436) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility? [FOR MOST RECENT BIRTH ONLY]

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

437A) Why didn't you deliver in a health facility? PROBE: Any other reason?
[FOR MOST RECENT BIRTH ONLY]

RECORD ALL MENTIONED.

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

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

PROBE FOR MOST QUALIFIED PERSON.

440) How long after delivery did the first check take place?
[FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

442) In the two months after (NAME) was born, did any health care provider check on his/her health? [FOR MOST RECENT BIRTH ONLY]

443) How many hours, days, or weeks after birth of (NAME) did the first check take place?
[FOR MOST RECENT BIRTH ONLY]

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

444) Who checked on (NAME)'s health at that time?
[FOR MOST RECENT BIRTH ONLY]

PROBE FOR MOST QUALIFIED PERSON.

445) Where did this first check of (NAME) take place?
[FOR MOST RECENT BIRTH ONLY]

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

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

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)? [FOR MOST RECENT BIRTH ONLY]

SHOW COMMON TYPES OF CAPSULES.

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

448) Did your period return between the birth of (NAME) and your next pregnancy?
[FOR ALL BIRTHS EXCEPT MOST RECENT BIRTH]

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

450) CHECK 226:
IS RESPONDENT PREGNANT?
[FOR MOST RECENT BIRTH ONLY]

451) Have you had sexual intercourse since the birth of (NAME)?
[FOR MOST RECENT BIRTH ONLY]

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

453) Did you ever breastfeed (NAME)?

454) CHECK 404:
IS CHILD STILL LIVING?
[FOR MOST RECENT BIRTH ONLY]

455) How long after birth did you first put (NAME) to breast?
[FOR MOST RECENT BIRTH ONLY]

IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk? [FOR MOST RECENT BIRTH ONLY]

457) What was (NAME) given to drink? Anything else?
[FOR MOST RECENT BIRTH ONLY]

RECORD ALL LIQUIDS MENTIONED.

458) CHECK 404:

IS CHILD LIVING?

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

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

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

SECTION 5. CHILD IMMUNIZATION, HEALTH, AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRE(S)).

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

503) FROM 212 AND 216

LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

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

IF YES: May I see it please?

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

505A) RECORD WHETHER CARD IS FROM LESOTHO, SOUTH AFRICA, OR ANOTHER COUNTRY.

506) (1) COPY DATES FROM THE CARD. (2) RECORD '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

507) CHECK 506:

507A) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

507B) (1) COPY DATES FROM THE CARD. (2) RECORD '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

507C) CHECK 507B:

508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

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

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

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

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

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

510E) A DTP-Hep B-Hib vaccination, also known as a penta vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?

510F) How many times was the DTP-Hep B-Hib vaccination given?

510G) A measles injection - that is, a shot in the right arm at the age of 9 months old or older - to prevent him/her from getting measles?

510H) Were any of the vaccinations that (NAME) received given outside of Lesotho?

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?

SHOW COMMON TYPES OF CAPSULES.

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

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

515) Was there any blood in the stools?

516) 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?

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

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

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

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

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

520) CHECK 519:

521) Where did you first seek advice or treatment?

USE LETTER CODE FROM 519.

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

a) A fluid made from a special packet called Motsoako or ORS?
b) A health clinic-recommended homemade fluid?

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

524) What (else) was given to treat the diarrhoea? Anything else?

RECORD ALL TREATMENTS GIVEN.

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

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

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

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

530) CHECK 525:

HAD FEVER?

531) 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?

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

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

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

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

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

535) CHECK 534:

536) Where did you first seek advice or treatment?

USE LETTER CODE FROM 534.

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

538) What drugs did (NAME) take? Any other drugs?

RECORD ALL MENTIONED.

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH THE RESPONDENT

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

555) CHECK 522(a) ALL COLUMNS:

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

557) CHECK 215 AND 218, ALL ROWS:

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

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 557) (drink/eat):

a) Plain water?
b) Juice or juice drinks?
c) Clear broth?
d) Milk such as powdered, evaporated, condensed or fresh animal milk? IF YES: How many times did (NAME) drink milk?
e) Infant formula? IF YES: How many times did (NAME) drink infant formula?
f) Any other liquids?
g) Yogurt? IF YES: How many times did (NAME) eat yogurt?
h) Any Nestum, Cerelac, Purity or other commercially fortified baby food?
i) Bread, rice, noodles, soft or hard porridge, or other foods made from grains?
j) Pumpkin, carrots, red pepper, squash or sweet potatoes that are yellow or orange inside?
k) White potatoes, white yams, or any other foods made from roots?
l) Dark green leafy vegetables such as beet greens, mustard leaves, pumpkin leaves, turnip leaves, wild moroho, spinach, swiss chard or broccoli?
m) Ripe mangoes, apricots, dried peaches or papayas?
n) Any other fruits or vegetables such as bananas, apples, apple sauce, oranges, grapefruit, lemon, pears, fresh peaches, plums, grapes, watermelon, figs, gooseberry, cauliflower, cabbage, beet root, mushrooms, green bean, avocados, tomatoes and eggplant?
o) Liver, kidney, heart or other organ meats?
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
q) Eggs?
r) Fresh, dried or tinned fish or shellfish?
s) Any foods made from beans, peas, lentils, or nuts?
t) Cheese or other food made from milk?
u) Any other solid, semi-solid, or soft food?

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

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

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

561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

600A) CHECK 101B:

600B) May I measure your blood pressure at this time?

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

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

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

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

PROBE: Elsewhere in Lesotho or outside of Lesotho?

604A) Does he stay there for work or another reason?

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'.

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

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

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

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

610) CHECK 609:

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

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

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

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

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

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

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

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

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

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

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

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

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

620) CHECK 609:

621) CHECK 613:

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

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

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.

624) How old is this person?

625) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months? [DO NOT ASK FOR THIRD MOST RECENT SEXUAL PARTNER]

626) In total, with how many different people have you had sexual intercourse in the last 12 months? [FOR THIRD MOST RECENT SEXUAL PARTNER ONLY]

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

627) In total, how many different people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

628) PRESENCE OF OTHERS DURING THIS SECTION

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

630) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

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

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

633) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

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

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

702) CHECK 226:

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

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

705) CHECK 226:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?

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

706) CHECK 226:

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

708) CHECK 705:

709) CHECK 704:

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

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

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

712) CHECK 216:

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

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.

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

714) In the last three months have you:

a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?
d) Read about family planning on billboards, posters, or pamphlets?

716) CHECK 601:

717) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

719) CHECK 304:

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

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

801) CHECK 601 AND 602:

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

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

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

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

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

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?

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

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?

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?

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

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

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

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

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

814A) Where do you usually work? In your home community, elsewhere in Lesotho, or outside Lesotho?

814B) The last time you worked away from your home community, how long were you away from home?

815) CHECK 601:

816) CHECK 814:

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

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

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

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

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

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

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

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

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

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

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?

SECTION 9. HIV/AIDS

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

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

903) Can people get HIV from mosquito bites?

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

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

906) Can people get HIV because of witchcraft or other supernatural means?

907) Is it possible for a healthy-looking person to have HIV?

907A) Can AIDS be cured?

907B) What can cure AIDS? PROBE: Anything else?

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

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

909) CHECK 908:

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

911) CHECK 208 AND 215:

912) CHECK 408 FOR LAST BIRTH:

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

914) During any of the antenatal visits for your last birth were you given any information about:

a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?

915) Were you offered a test for HIV as part of your antenatal care?

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

916A) CHECK 915 AND 916:

916B) You told me you were offered a test for HIV as part of your antenatal care, but that you were not tested. Why were you not tested?

917) Where was the test done?

PROBE TO IDENTIFY TYPE OF SOURCE.

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

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

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

920) CHECK 434 FOR LAST BIRTH:

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

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

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

924) Have you been tested for HIV since that time you were tested during your pregnancy?

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

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

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

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

929) Where was the test done?

PROBE TO IDENTIFY TYPE OF SOURCE.

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

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

931) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

931A) Some individuals choose not to go for HIV testing and counseling. In your opinion, why is this so? PROBE: Any other reason?

931B) CHECK 916, 922 AND 926:

931C) What is the main reason you have not been tested for HIV?

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

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

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

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

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

937) CHECK 901:

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

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

938) CHECK 613:

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

940) Now I would like to ask 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?

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

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

943) CHECK 940, 941, AND 942:

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

945) Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

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

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

948) CHECK 601:

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

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

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:

a) Cough for two weeks or more?
b) Fever for two weeks or more?
c) Sweating at night?
d) Weight loss?

1001B) CHECK 1001A:

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

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

1001E) The last time you had such symptoms, where did you first go for advice or treatment?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

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

1001G) Were you told by a doctor or a nurse that you had tuberculosis?

1001H) Were you given any medicine to treat TB?

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

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

1001K) Where did you go?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

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

1002) How does tuberculosis spread from one person to another? PROBE: Any other ways?

RECORD ALL MENTIONED.

1003) Can tuberculosis be cured?

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

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

1004B) What signs or symptoms would lead you to think that a person has tuberculosis? PROBE: Any other signs or symptoms?

RECORD ALL MENTIONED.

1004C) What do you think is the cause of tuberculosis? PROBE: Any other causes?

RECORD ALL MENTIONED.

1005) Now I would like to ask you some other questions relating to health matters. Have you had any injections for any reason in the last 12 months?

IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1007) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1009) Do you currently smoke cigarettes, either manufactured or hand-rolled?

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

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

1012) What (other) type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

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

1012AA) What are symptoms of diabetes? PROBE: Any other symptoms?

RECORD ALL MENTIONED.

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

1012C) Are you taking medications for diabetes?

1012D) How do you take the medicine?

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

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

1012G) Who took your blood pressure?

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

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

a) Taking prescribed medicine?
b) Controlling you weight or losing weight?
c) Cutting down on salt in your diet?
d) Exercising?
e) Cutting down on alcohol consumption?
f) Stopping smoking?
g) Taking traditional medicine/herbs?

1012J) Have you ever heard of a disease called breast cancer?

1012K) Who can get breast cancer: women only, men only, or both men and women?

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

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

1012N) 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?

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

1012P) How long ago was the last exam performed?

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?

a) Getting permission to go?
b) Getting money needed for treatment?
c) The distance to the health facility?
d) Not wanting to go alone?

1014) Are you covered by any health insurance?

1015) What type of health insurance are you covered by?

RECORD ALL MENTIONED.

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?

1102) CHECK 1101:

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

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

1105) Is (NAME) male or female?

1106) Is (NAME) still alive?

1107) How old is (NAME)?

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

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

1110) Was (NAME) pregnant when she died?

1111) Did (NAME) die during childbirth?

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

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

IF NO MORE BROTHERS OR SISTERS, GO TO 1114.

1114) CHECK Qs. 1110, 1111 AND 1112 FOR ALL SISTERS

1115) CHECK 101B:

1116) May I measure your blood pressure at this time?

1117) RECORD THE TIME.

SECTION 12. AVERAGE BLOOD PRESSURE MEASURES

1201) CHECK Q600B AND Q1116:

1202) RECORD AND CALCULATE THE AVERAGE OF THE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE FROM Q600B AND Q1116.

1203) BLOOD PRESSURE MEASUREMENTS FROM Q600B:

1204) BLOOD PRESSURE MEASUREMENTS FROM Q1116:

1205) RECORD THE SUM OF THE SYSTOLIC AND DIASTOLIC MEASURES.

1206) CALCULATE THE AVERAGE SYSTOLIC AND DIASTOLIC BY DIVIDING THE SUM IN Q1205 BY 2

1207) CHECK Q1116:

1208) CHECK Q600B:

1209) CHECK Q102F:

1210) RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE.

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. 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.

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

1213) 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.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT: ____

COMMENTS ON SPECIFIC QUESTIONS: ____

ANY OTHER COMMENTS: ____

SUPERVISOR'S OBSERVATIONS: ____
NAME OF SUPERVISOR: ____
DATE: ____

CALENDAR

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

INFORMATION TO BE CODED FOR EACH COLUMN.

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

2014

2013

2012

2011

2010

2009