IDENTIFICATION

PROVINCE OR PREFECTURE

CIRCLE

MUNICIPALITY:

CENTER

PRIMARY UNIT NUMBER

SECONDARY UNIT NUMBER

LEVEL:

HOUSEHOLD NUMBER

HOUSEHOLD ADDRESS

INTERVIEWER VISITS:

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT

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

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD___
TOTAL ELIGIBLE WOMEN___
TOTAL ELIGIBLE MEN___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE

SUPERVISOR
NAME

FIELD EDITOR
NAME

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME:

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

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

104) How old were you at your last birthday?

COMPARE AND CORRECT 103 AND/OR 104 IF INCORRECT

105) Have you ever attended school?

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

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

108) CHECK 106:

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

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

111) Do you usually listen to the radio at least once a week?

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

113) CHECK QUESTION 4 ON HOUSEHOLD QUESTIONNAIRE

114) Now I would like to ask about the place in which you usually live.
Do you usually live in Rabat, in Casa, in a large city, in a city, or in the countryside?
IF CITY: What city do you live in?

115) Which province is it in?

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

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

118) Does your household get drinking water from this same source?

19) What is the main source of drinking water for your household?

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

121) Does your household have:

122) How many rooms in your household are used for sleeping?

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

124) What is the roof of your dwelling made of?

125) What is the occupation status of the dwelling?

126) Does any member of your household own:

SECTION 2. MARRIAGE

201) Are you currently a single, married, widowed, or divorced?

202) Does your husband have any other wives besides yourself?

203) How many other wives does he have?

204) Are you the first, second?wife?

205) CHECK 204:

206) How did your first marriage end?

207) In what month and year were you married for the first time?

208) How old were you when you were married for the first time?

209) CHECK 207 AND 208:
YEAR AND MONTH GIVEN:

210) CHECK CONSISTENCY OF 207 AND 208:
YEAR OF BIRTH (103) PLUS AGE OF MARRIAGE (208) EQUALS YEAR OF MARRIAGE CALCULATED
IF NECESSARY, CALCULATE YEAR OF BIRTH CURRENT YEAR MINUS CURRENT AGE (104) EQUALS YEAR OF BIRTH CALCULATED
IS THE YEAR OF MARRIAGE CALCULATED WITHIN ONE YEAR, THE SAME AS THE RECORDED YEAR OF MARRIAGE (207)

211) DETERMINE THE MONTHS OF MARRIAGE SINCE JANUARY 1986 RECORD "X" IN COLUMN 6 OF CALENDAR FOR EACH MONTH OF MARRIAGE AND RECORD "O" FOR EACH MONTH OF NON-MARRIAGE SINCE JANUARY 1986.
FOR THE WIDOWED, DIVORCED, OR MARRIED MORE THAN ONCE WOMEN:
PROBE FOR THE DATE OF DIVORCE OR WIDOWHOOD, AND THE START OF ALL OTHER MARRIAGES.

212) Is there a family relationship between yourself and your (first) husband?

213) CHECK 201:

214) Now we need some information on your sexual activity to better understand family planning and fertility.
How many times have you had sexual intercourse in the last four months?

215) How many times a month do you usually have sexual intercourse?

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

217) PRESENCE OF OTHERS AT THIS POINT:

SECTION 3. REPRODUCTION

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

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

303) How many sons live with you?
And how many daughters live with you?

IF NONE, RECORD '00'

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

305) 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, RECODE '00'

306) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: did you give birth to a boy or girl who only lived a few hours of a few days?

307) How many boys have died?
And how many girls have died?

IF NONE, RECORD '00'

308) INTERVIEWER: SUM ANSWERS TO 303, 305, AND 307 AND ENTER TOTAL.
IF NONE, RECORD 00

309) CHECK 308:
Just to makes sure that I counted all your children, did you have in total ____ children during your life?
IF NO, PROBE AND CORRECT 301 TO 308

310) INTERVIEWER: CHECK 308:

311) 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 312. RECORD TWINS AND TRIPLES ON SEPARATE LINES

312) What is the name of your (first, second?) child?

313) RECORD THE TYPE OF BIRTH: SINGLE OR MULTIPLE

314) Was (NAME OF CHILD) a boy or a girl?

315) Please give me the family booklet or the birth certificate.

316) In what month and year was (NAME)'s birth?
PROBE: What is he/her birthday?
In what season was he/she born?

317) Is (NAME) still alive?

318) IF ALIVE: How old was (NAME) at his/her last birthday?

RECORD AGE IN YEARS COMPLETED

319) IF ALIVE: Is he/she living with you?

320) IF CHILD IS AGE 15 YEARS OR LESS: With whom does he/she live?

IF 15 OR MORE: SKIP TO NEXT BIRTH

321) IF DEAD: What was his/her age when he/she died?
IF 1 YEAR, PROBE: What was (NAME)'s age in months?

RECORD THE AGE DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS, OR YEARS COMPLETED.

322) COMPARE 308 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

323) CHECK 316 AND RECORD THE NUMBER OF LIVE BIRTHS SINCE JANUARY 1986. IF THERE ARE NONE, RECORD 0 AND SKIP TO 325.

324) FOR EACH BIRTH AFTER JANUARY 1986, RECORD "N" FOR EACH MONTH OF BIRTH IN COLUMN 1 OF CALENDAR AND "G" FOR EACH OF THE 8 MONTHS BEFORE. RECORD THE NAME OF THE CHILD TO THE LEFT OF CODE "N".

325) BELOW THE CALENDAR, RECORD THE NAME AND DATE OF BIRTH OF LAST CHILD BORN BEFORE JANUARY 1986, IF THERE WAS ONE.

326) Are you currently pregnant?

327) How many months pregnant are you?

RECORD "G" IN COLUMN 1 OF CALENDAR FOR THE MONTH OF THE INTERVIEW AND FOR EACH MONTH OF PREGNANCY.

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

329) Did you ever have a pregnancy end from an abortion, a miscarriage, or stillbirth?

330) In what month and what year did the last such pregnancy end?

331) CHECK 330:

332) How many months pregnant were you when the pregnancy ended?

RECORD "F" IN COLUMN 1 OF CALENDAR FOR THE MONTH WHEN THE PREGNANCY ENDED, AND "G" FOR THE MONTHS OF PREGNANCY.

333) Have you had any other pregnancies of this type?

334) ASK THE DATES AND DURATION OF THE OTHER PREGNANCIES OF THIS TYPE UP TO JANUARY 1986. RECORD "F" IN COLUMN 1 OF CALENDAR FOR THE MONTH WHEN THE PREGNANCY ENDED, AND "G" FOR THE MONTHS OF PREGNANCY.

335) When did you last menstrual cycle start?

336) 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?

337) At what point during a woman's menstrual cycle is she more likely to get pregnant?

SECTION 4. CONTRACEPTION

400) CHECK 201:

400A) 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. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 400B FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.

400B) Have you ever heard of (METHOD)?

400C) In the last month have you heard about family planning:

400D) It is acceptable or not to you for family planning information to be provided on the radio or television?

400E) In general, do you approve or disapprove of couples using a method to avoid pregnancy?

400F) If you could choose exactly the number of children to have in your whole life, how many would that be?

401) 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. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 402 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 402, ASK 403-404 BEFORE GOING TO NEXT METHOD.

402) Have you ever heard of (method)?

READ THE DESCRIPTION OF EACH METHOD.

403) Have you ever used (method)?

404) Do you know where you can get (method)?

405) CHECK 403:

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

406b) Why have you never used any method to delay or avoid getting pregnant?

407) RECORD 0 FOR ALL THE MONTHS LEFT BLANK IN COLUMN 1 OF CALENDAR (GO TO 439)

408) What have you used or done?

CORRECT 403-405 (AND 402 IF NECESSARY)

409) Which is the first thing you did or the first method you used to avoid getting pregnant?

410) Where did you obtain this method the first time?

411) How many living children did you have at that time?

IF NONE, RECORD 00

412) CHECK 326:

413) CHECK 403:

414) Are you currently doing something or using any method to delay or avoid pregnancy?

415) Which method are you using?

415A) CIRCLE 'A' FOR FEMALE STERILIZATION

416) At the time you first started using the pill, did you consult a doctor or a nurse?

417) At the time you last got pills, did you consult a doctor or a nurse?

418) May I see the package of pills you are using now?

RECORD NAME OF BRAND

419) Do you know the brand name of the pills you are now using?

RECORD NAME OF BRAND

420) How much does one (packet/cycle) of pills cost you?

421) In what month and year was the sterilization operation performed?

422) RECORD THE STERILIZATION CODE IN THE SPACE OF THE MONTH OF THE INTERVIEW IN COLUMN 1 OF CALENDAR AND EACH MONTH UNTIL THE DATE OF THE OPERATION OR UNTIL JANUARY 1986 IF THE OPERATION TOOK PLACE BEFORE 1986.

423) CHECK 415:
WAS STERILIZED: In what facility did the sterilization take place?
CURRENTLY USING ANOTHER METHOD: Where did you obtain (METHOD) last time?

424) How long does it take to travel from your home to this place?

IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE RECORD HOURS.

425) Is it easy or difficult to get there?

426) What is the main reason you decided to use (METHOD FORM 415) rather than another family planning method?

427) Have you had any problems using (CURRENT METHOD)?

428) What is the main problem?

429) CHECK 415 AND 421:

430) RECORD THE METHOD CODE FROM 415 IN THE SPACE OF THE CURRENT MONTH IN COLUMN 1 OF THE CALENDAR. THEN DETERMINE WHEN SHE STARTED USING EACH METHOD THIS TIME. RECORD THE CODE OF THE METHOD IN THE SPACE OF ALL THE MONTHS OF USE.

EXAMPLES OF QUESTIONS:
WHEN DID YOU START USING THIS METHOD CONTINUOUSLY?
FOR HOW LONG HAVE YOU USED THIS METHOD CONTINUOUSLY?

431) I would like to ask you some questions about all the (other) times in the last few years during which you or your husband used a method to avoid pregnancy?

Use the calendar to determine periods before usage and periods of non-usage, starting with the most recent usage and going up to January 1986.

Use the name of the children, dates of birth, and periods of pregnancy as points of reference.

For each month in column 1, record the method code or 0 for non-usage. In column 2, record the discontinuation code next to the last month of usage.

The number of codes recorded in column 2 should be the same as the number of interruptions of usage in the contraception in column 1.

Ask why she stopped using that method. If a pregnancy followed, ask if she got pregnant without wanting to while using the method, or if she deliberately stopped to get pregnant.

Examples of questions:
Column 1:
When was the last time you used a method? What method was it?
When did you start using this method? How long after the birth of (NAME)?
For how long did you use the method?

Column 2:
Why did you stop using (method)?
Did you become pregnant while using (method), or did you stop using it to become pregnant, or for another reason?
If she deliberately stopped to become pregnant, ask:
"How many months after you stopped using (method) did you get pregnant?"
And record 0 for each of these months in column 1.

432) CHECK THE CALENDAR:

433) I see you used (METHOD) in January 1986. When did you start using (METHOD) this time?

THIS DATE SHOULD NOT BE BEFORE THE BIRTH DATE OF A CHILD BORN BEFORE JANUARY 1986.

434) I see that you did not use a contraceptive method in January 1986. Did you use a method before this date?

435) CHECK 315:

436) Did you use a method between the birth of (NAME OF LAST CHILD BEFORE JANUARY 1986) and January 1985?

437) When did you stop using a method the last time, before January 1986?

438) CHECK 415:

439) Do you intend to use a method to delay or avoid pregnancy at any time in the future?

440) What is the main reason you do not intend to use a method?

441) Do you intend to use a method within the next 12 months?

442) When you use a method, which method would you prefer to use?

443) Where can you get (METHOD IN 442)?

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

445) Where is that?

446) How long does it take to travel from your home to this place?

IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

447) Is it easy or difficult to get there?

448) In the last month, have you heard about family planning on:

449) It is acceptable or not to you for family planning information to be provided on the radio or television?

SECTION 5A. PREGNANCY AND BREASTFEEDING

501) CHECK 323:

502) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. START WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all your children born in the past five years. (We will talk about one child at a time).

LINE NUMBER FROM 312.

FROM 312 AND 317

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

504) How much longer would you have liked to wait?

505) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see?
Anyone else?

RECORD ALL PERSONS SEEN.

506) Were you given an antenatal card for this pregnancy?

507) How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

508) How many antenatal visits did you have during this pregnancy?

509) When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

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

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

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

513) Was (NAME) born on time or prematurely?

514) Was (NAME) delivered by cesarean section?

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

516) Was (NAME) weighed at birth?

517) How much did (NAME) weigh?

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

519) RECORD 'X' IN COLUMN 3 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH AND FOR EACH MONTH UNTIL THE CURRENT MONTH (OR UNTIL THE CURRENT PREGNANCY). GO TO 521.

520) How many months after the birth of (NAME) did you not have a period?
RECORD X IN COLUMN 3 OF THE CALENDAR FOR THE NUMBER OF MONTHS WHERE HER PERIOD WAS ABSENT STARTING WITH THE MONTH AFTER THE MONTH OF BIRTH.
IF LESS THAN A MONTH WITHOUT PERIOD, RECORD 0 IN COLUMN 3 FOR THE MONTHS FOLLOWING THE MONTH OF BIRTH.

521) CHECK 326: WOMAN PREGNANT?

522) Have you resumed sexual intercourse since the birth of (NAME)?

523) RECORD X IN COLUMN 4 OF THE CALENDAR FOR THE MONTH AFTER THE MONTH OF BIRTH AND FOR EACH MONTH AND FOR EACH MONTH UNTIL THE CURRENT MONTH. (GO TO 525)

524) For how many months after the birth of (NAME) did you not have sexual intercourse?
RECORD X IN COLUMN 4 OF THE CALENDAR FOR THE MONTH WITHOUT SEXUAL INTERCOURSE STARTING WITH THE MONTH AFTER THE MONTH OF BIRTH.
IF LESS THAN ONE MONTH WITHOUT SEXUAL INTERCOURSE, RECORD 0 IN COLUMN 4 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH.

525) Did you ever breastfeed (NAME)?

526) RECORD J IN COLUMN 5 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH.

527) Why did you not breastfeed (NAME)?

528) 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.

529) CHECK 317:
CHILD ALIVE?

530) Are you still breastfeeding (NAME)?

531) RECORD X IN COLUMN 5 OF THE CALENDAR FOR THE MONTH FOLLOWING THE MONTH OF BIRTH, AND FOR EACH MONTH UP TO THE CURRENT MONTH.

532) How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

533) How many times did you breastfeed yesterday during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER

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

535) CHECK 534:

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

RECORD X IN COLUMN 5 OF THE CALENDAR FOR THE NUMBER OF MONTHS OF BREASTFEEDING, STARTING WITH THE MONTH AFTER THE MONTH OF BIRTH.

IF LESS THAN ONE MONTH OF BREASTFEEDING, RECORD 0 IN COLUMN 5 FOR THE MONTH AFTER THE MONTH OF BIRTH.

537) Why did you stop breastfeeding (NAME)?

538) CHECK 317: IS CHILD LIVING?

539) Was (NAME) ever given water or anything else to drink or eat (other than breastmilk)?

540) How many months old was (NAME) when you started giving the following on a regular basis?

IF LESS THAN 1 MONTH, RECORD 00

541) CHECK 317: IS CHILD LIVING?

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

543) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 544

544) CHECK 316: BIRTHS IN 1983, 84, OR 85?

545) Did you ever breastfeed (NAME)?

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

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

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

549) CHECK 501:

SECTION 5B. IMMUNIZATION AND HEALTH

551) ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM 312

FROM 312 AND 317

LAST BIRTH
NAME
LIVING
DEAD

NEXT-TO-LAST BIRTH
NAME
LIVING
DEAD

SECOND-FROM-LAST BIRTH
NAME
LIVING
DEAD

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

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

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

555) Has (NAME) received any vaccinations that are not recorded on this card?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, , DPT 1-3, POLIO 1-3, AND/OR MEASLES VACCINE(S).

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

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

558) CHECK 317: IS CHILD LIVING?

559) GO BACK TO 552 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, SKIP TO 590.

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

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

562) Has (NAME) been ill with a cough in the last 24 hours?

563) For how many days (has the cough lasted/did the cough last)?

IF LESS THAN 1 DAY, RECORD 00

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

565) CHECK 560 AND 560: FEVER OR COUGH?

566) Was anything given to treat the fever/cough?

567) What was given to treat the fever/cough?
Anything else?

RECORD ALL MENTIONED.

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

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

RECORD ALL MENTIONED

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

571) GO BACK TO 552 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, SKIP TO 590.

572) Has (NAME) had diarrhea in the last 24 hours?

573) For how many days (has the diarrhea lasted/did the diarrhea last)?

IF LESS THAN 1 DAY, RECORD 00

574) Was there any blood in the stools?

575) CHECK 525/530:
LAST CHILD STILL BREASTFEED?

576) During (NAME)'s diarrhea, did you change the frequency of breastfeeding?

577) Did you increase the number of breastfeeds or reduce them, or did you stop completely?

578) (Aside from breastmilk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

579) Was anything given to treat the diarrhea?

580) What was given to treat the diarrhea?
Anything else?

RECORD ALL MENTIONED.

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

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

RECORD ALL MENTIONED

583) CHECK 580: ORS FLUID FROM PACKET MENTIONED?

584) Was (NAME) given oralyte packet when he/she had the diarrhea?

585) For how many days was (NAME) given the oralyte packet?

IF LESS THAN 1 DAY, RECORD 00

586) CHECK 580: RECOMMENDED HOME FLUID MENTIONED?

587) Was (NAME) given a recommended home fluid made from a salted or sugared water solution when he/she had diarrhea?

588) For how many days was (NAME) given the fluid made from a salted or sugared water solution?

589) GO BACK TO 554 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 590.

590) CHECK 580 AND 584 (ALL COLUMNS):

591) Have you ever heard of a special product called SRO you can get for the treatment of diarrhea?

592) Have you ever seen a packet like this before?

SHOW PACKET

593) Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?

SHOW PACKET

594) The last time you prepared the oralyte packet, did you prepare the whole packet at once or only part of the packet.

595) How much water did you use to prepare the oralyte packet the last time you made it?

596) Where can you get the (local name) packet?
PROBE: Anywhere else?

RECORD ALL PLACES MENTIONED.

597) CHECK 580 AND 587 (ALL COLUMNS):

598) Where did you learn to prepare the recommended home fluid made from (recommended ingredients) given to (NAME) when he/she had diarrhea?

SECTION 6. MATERNAL MORTALITY

601) 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. Please give me the names of all your brothers and sisters who are living with you, those living elsewhere and those who have died.
RECORD NAME OF ALL BROTHERS AND SISTERS. IF NO BROTHERS OR SISTERS (GO TO 701)

602) What was the name given to your first born brother or sister (born after (NAME)?
1, 2, 3, 4, etc.

603) Is (NAME) male or female?

604) Is (NAME) still alive?

605) How old is (NAME)?

IF LESS THAN 15, GO TO NEXT COLUMN

606) Is/was he/she married?

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

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

IF MALE OR DIED BEFORE 12 YEARS OF AGE TO GO NEXT COLUMN.

609) Was (NAME) married?

610) Was (NAME) pregnant when she died?

611) Did (NAME) die during childbirth?

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

613) Was (NAME)'s death related to the pregnancy/delivery?

614) CHECK QUESTIONS 607-608: DEATH OCCURRED BETWEEN 15 AND 50 YEARS AND IN THE LAST 20 YEARS

615) What did (NAME) die of?

616) How many pregnancies did (NAME) have (including the pregnancy she died during/after)?

[##translator note: the following questions 614-617 are numbered correctly according to the form]

614) I would like to make sure I've understood. Your mother gave birth to a total of ____ children, including yourself?

615) Among your brothers, ____ are dead?

616) Among your sisters, ____ are dead?

617) Do any of your sisters (from your own mother) aged 14 years or more live in this household?

SECTION 7. FERTILITY PREFERENCES

701) CHECK 415:

702) CHECK 201:

703) CHECK 326:

704) CHECK 326:

705) CHECK 317 AND 326: Has living child(ren) or pregnant?

706) CHECK 326:

707) Given your present circumstances, if you had to do it over again, do you think (you/your husband) would make the same decision to have an operation not to have any more children?

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

709) Why do you regret it?

710) Have you and your husband ever discussed the number of children you would like to have?

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

712) CHECK 317:

713) What do you think is the best number of months or years between the birth of one child and the birth of the next child?

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

801) CHECK 201:

802) Did your (last) husband ever attend school?

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

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

805) What kind of work does (did) your (last) husband mainly do?

806) CHECK 805:

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

808) Since January 1986, have you lived in one location or more than one?

809) Record (in column 7 of the calendar) the code corresponding to current location (1 RABAT-CASA, 2 LARGE CITY, 3 CITY, 4 COUNTRYSIDE).
START WITH THE MONTH OF THE INTERVIEW AND CONTINUE WITH ALL MONTHS BEFORE UP TO JANUARY 1986.

810) In what month and what year did you move to (NAME OF LOCATION OF INTERVIEW)?

Record (in column 7 of calendar) X for the month and year of the move, and for the months before, record the code corresponding to the type of location (1 RABAT-CASA, 2 LARGE CITY, 3 CITY, 4 COUNTRYSIDE).

CONTINUE DETERMINING THE PREVIOUS LOCATIONS AND RECORDING THE MOVES AND THE RESULTING TYPES OF LOCATIONS.

EXAMPLES OF QUESTIONS:
WHERE DID YOU LIVE BEFORE??
IN WHAT MONTH AND WHAT YEAR DID YOU ARRIVE THERE?
IS THIS LOCATION A LARGE CITY, A CITY, OR A VILLAGE?

811) REFER TO THE LOCATION OF RESIDENCE IN JANUARY 1986:
When did you move to (LOCATION OF RESIDENCE IN JANUARY 1986)?

812) Is the location you came from a large city, a city, or was it in the countryside?

813) I would like to ask you some questions about work. Aside from your own housework, are you currently working?

814) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. Are you currently doing any of these things or any other work?

815) Have you worked since January 1986?

816) RECORD 0 IN COLUMN 8 OF THE CALENDAR FOR EACH MONTH FROM JANUARY 1986 TO THE CURRENT MONTH (GO TO 821)

817) What is (was) your occupation, that is, what kind of work do (did) you mainly do?

818) USE THE CALENDAR TO DETERMINE ALL OF THE PERIOD OF WORK, STARTING WITH THE CURRENT OR MOST RECENT ONE, TO JANUARY 1986. RECORD THE CODE FOR "NOT WORKING" OR FOR THE TYPE OF WORK IN COLUMN 8.

EXAMPLES OF QUESTIONS:
WHEN DID YOU START THIS WORK (AND WHEN DID YOU STOP)?
WHAT DID YOU DO BEFORE?
HOW MUCH TIME DID YOU WORK AT THAT TIME?
WERE YOU SELF-EMPLOYED OR AN EMPLOYEE?
WERE YOU PAID FOR THIS WORK?
DID YOU WORK AT HOME OR OUTSIDE OF THE HOME?

819) CHECK COLUMN 8 ON CALENDAR:

820) I see that you were working in January 1986.
When did you start this job?

821) I see that you did not work in January 1986. Did you work before January 1986?

822) When did you stop your last job before January 1986?

823) CHECK 316/317/319: Has child born since January 1986 and living at home?

824) CHECK 813/814: CURRENTLY WORKING?

825) While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

826) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

827) RECORD THE TIME:

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 316, 317:

INTERVIEWER:
IN 902 (COLUMNS 2-4) RECORD THE LINE NUMBER OF EACH CHILD SINCE JANUARY 1986 AND STILL ALIVE.
IN 903 AND 904 RECORD THE NAME AND BIRTH DATE OF THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1986. IN 906 AND 908 RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS BEFORE JANUARY 1986 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED.)
(IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1986, USE ADDITIONAL FORMS)

902) LINE NUMBER FROM QUESTION 312:

903) NAME FROM QUESTION 312 FOR CHILDREN:

904) DATE OF BIRTH:

FROM QUESTION 105 FOR RESPONDENT
FROM QUESTION 316 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

905) BCG scar on top of left shoulder

906) HEIGHT (IN CENTIMETERS):

907) Was length/height of child measured lying down or standing up?

908) WEIGHT (IN KILOGRAMS):

909) DATE WEIGHED AND MEASURED:

910) RESULT:

911) NAME OF MEASURER:

INTERVIEWER'S OBSERVATIONS (TO BE FILLED OUT AFTER COMPLETING INTERVIEW)

INSTRUCTIONS: ONLY ONE CODE PER SPACE. FOR COLUMNS 1, 6, 7, AND 8 ALL THE MONTHS SHOULD BE FILLED OUT.

INFORMATION ON THE CODES FOR EACH COLUMN

[Translator note: I've left the original Code letter from the French, so that it corresponds with the codes indicated throughout the text. I left those codes as related to the French words here, because some of them don't actually correspond with the first letter of the word in French, and are arbitrary]

LAST CHILD BORN BEFORE JANUARY 1986