IDENTIFICATION

NAME OF PLACE ____

NAME OF HEAD OF HOUSEHOLD ______

CLUSTER NUMBER _____

HOUSEHOLD NUMBER ____

NAME AND LINE NUMBER OF WOMAN _____

CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE

HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

(LEAVE BOX BLANK IF HOUSEHOLD NOT SELECTED FOR MAN'S SURVEY)

INTERVIEWER VISITS 1, 2, 3

DATE: ____
INTERVIEWER'S NAME ______
RESULT* ____

NEXT VISIT

FINAL VISIT

TOTAL NUMBER OF VISITS _____

*RESULT CODES:

QUESTIONNAIRE LANGUAGE** ____ (LANGUAGE CODE)

QUESTIONNAIRE LANGUAGE** ____ (LANGUAGE NAME)

LANGUAGE OF INTERVIEW** ____

NATIVE LANGUAGE OF RESPONDENT** ___

TRANSLATOR USED

**LANGUAGE CODES

TEAM SUPERVISOR

NAME ____
NUMBER ____

INTRODUCTION AND CONSENT

Hello. My name is _______________________________________. I am working with the NATIONAL INSTITUTE OF STATISTICS (INSTAT). We are conducting a survey about health all over MADAGASCAR. 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 was given to your household.

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER ____
DATE ____

SECTION 1. SOCIODEMOGRAPHIC HOUSEHOLD CHARACTERISTICS

101) RECORD THE TIME.

102) How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ____

103) Just before you moved here, did you live in a city, town, or village?

104) Just before you moved here, which region did you live in?

105) In what month and year were you born?

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107) Have you ever attended school?

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

109) What is the highest [GRADE/YEAR] you completed at that level?

ENTER THE CODE CORRESPONDING TO THE GRADE COMPLETED AT THAT LEVEL.

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

[GRADE/YEAR] ____

CLASS CODES:

110) CHECK 108:

111) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE,

PROBE: Can you read any part of the sentence to me?

112) CHECK 111:

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

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

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

116) Do you have a mobile telephone?

117) In the past 12 months, have you used a mobile phone to make financial transactions?

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

119) Have you ever used the internet?

120) In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

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

122) What is your religion?

SECTION 2: REPRODUCTION

201) Now I would like to ask you 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)

a) How many sons live with you?
b) 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 and are alive but do not live with you?

205)

a) How many sons are alive but do not live with you?
b) And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

206) Have you ever given birth to a boy or girl who was born alive but later died?

IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207)

a) How many boys have died?
b) 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 makes 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 all your pregnancies including live births, stillbirths, miscarriages, and abortions, starting with your first pregnancy.

RECORD ALL PREGNANCIES IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 10 PREGNANCIES, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

PREGNANCY HISTORY LINE NUMBER 01, 02. 03, 04, 05, 06, 07, 08, 09, 10

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

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

214) Among these births, were there any twins?

215) What day, month, and year was (NAME) born?

216) Is (NAME) still alive?

217) IF ALIVE: How old was (NAME) at (NAME)'s last birthday?

RECORD AGE IN COMPLETED YEARS

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

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

220) IF DECEASED: How old was (NAME) when (he/she) died?

IF '12 MONTHS' OR '1 YEAR', ASK: Did (NAME) have (his/her) first birthday?

THEN ASK: Exactly how many months old was (NAME) when (he/she) died?

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

221) Did you have any other livING births between (NAME OF PREVIOUS BIRTH) and (NAME), including any babies who died after birth?

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

223) COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY TABLE

224) CHECK 215: RECORD THE NUMBER OF BIRTHS IN 2016-2021

225) FOR EACH LIVE BIRTH IN 2016-2021, 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 LIVE BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

227) How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

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

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

229) CHECK 208: TOTAL NUMBER OF LIVE BIRTHS

230) Have you ever had a pregnancy that resulted in a miscarriage, abortion, or stillbirth?

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

232) CHECK 231:

LINE NO. 01, 02, 03, 04

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

234) How many months pregnant were you when the last such pregnancy ended?

235) Since January 2016, have you had other pregnancies that did not result in a live birth?

236) FOR EACH PREGNANCY THAT DID NOT RESULT IN A LIVE BIRTH IN 2016-2021 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 ADDITIONAL QUESTIONNAIRE(S), STARTING WITH THE SECOND LINE.

237) Have you had a pregnancy that ended before 2016 that did not result in a live birth?

238) In what month and year did the last such pregnancy end before 2016?

239) When did your last menstrual period start?

____ (DATE IF GIVEN)

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

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

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

SECTION 3: CONTRACEPTION

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

301-01) Female sterilization.

PROBE: Women can have an operation to avoid having any more children.

301-02) Male Sterilization.

PROBE: Men can have an operation to avoid having any more children.

301-03) IUD.

PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more months.

301-04) Injectables.

PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for three or more months.

301-05) Implants.

PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

301-06) Pill.

PROBE: Women can take a pill every day to avoid becoming pregnant.

301-07) Condom.

PROBE: Men can put a rubber sheath on their penis before sexual intercourse.

301-08) Female Condom.

PROBE: Women can place a sheath in their vagina before sexual intercourse.

301-09) Emergency Contraception.

PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.

301-10) Standard Days Method.

PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.

301-11) Lactational Amenorrhea Method (LAM).

PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.

301-12) Rhythm Method.

PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.

301-13) Withdrawal.

PROBE: Men can be careful and pull out before climax.

301-14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

302) CHECK 226:

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

304) Which method are you using?

RECORD ALL MENTIONED.

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

305) What is the brand name of the pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

306) What is the name brand of the condoms you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

307) In what facility did the sterilization take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

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

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

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

310) CHECK 308, 309 AND 231: ANY LIVE BIRTH, STILLBIRTH, MISCARRIAGE OR ABORTION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309?

SECTION 3: CONTRACEPTION (PAPER OPTION)

311) CHECK 308 AND 309:

312) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE,
STARTING WITH MOST RECENT USE, BACK TO JANUARY 2016. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER THE METHOD USE CODE OR '0' FOR NON-USE IN EACH BLANK MONTH.

EXAMPLE QUESTIONS:

a) When was the last time you used a method? What method was that?
b) When did you start using that method? How long after (NAME)'s birth?
c) How long afterwards did you use that method?

IN COLUMN 2, ENTER THE METHOD USE CODES FOR DISCONTINUATION OF USE NEXT TO THE LAST MONTH OF USE. THE CODE NUMBERS IN COLUMN 2 SHOULD BE THE SAME AS THE NUMBER OF DISCONTINUATIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING METHOD. IF A PREGNANCY FOLLOWED, ASK IF SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR IF SHE DELIBERATELY STOPPED USING THE METHOD TO GET PREGNANT.

EXAMPLE QUESTIONS:

d) Why did you stop using (METHOD)? Did you become pregnant while using (METHOD), did you stop to get pregnant, or did you stop for another reason?
e) IF SHE DELIBERATELY STOPPED TO GET PREGNANT, ASK: How many months did it take to get pregnant after you stopped using (METHOD)? ENTER '0' FOR EACH OF THESE MONTHS IN COLUMN 1.

311) YEAR IS 2016-2021: IN THE CALENDAR ENTER THE CODE FOR METHOD USED IN THE MONTH OF THE INTERVIEW AND FOR EACH MONTH UNTIL THE START OF METHOD USE. THEN CONTINUE.

YEAR IS 2015 OR EARLIER: IN THE CALENDAR ENTER THE CODE FOR THE METHOD USED IN THE MONTH OF THE INTERVIEW AND FOR EACH MONTH UNTIL JANUARY 2016. THEN GO TO 324.

312) Now I would like to ask you some questions about times over the last few years when you or your partner used a method of contracpetion to avoid getting pregnant.

USE CALENDAR TO VERIFY PRIOR PERIODS OF USE AND NON-USE, STARTING WITH THE MOST RECENT USE BEGINNING IN JANUARY 2016. USE NAMES OF CHILDREN, BIRTH DATES, AND PREGNANCIES AS POINTS OF REFERENCE.

COLUMN 1, COLUMN 2, COLUMN 3

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

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

312C) What method was that?

312D) How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?

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

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

312F) For how many months did you use (METHOD)?

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

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

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

312I) GO BACK TO 312A FOR NEXT GAP; OR, IF NO MORE GAPS, GO TO 313.

318) Have you used emergency contraception in the past 12 months? That is, have you taken special pills within three days after having unprotected sexual intercourse to prevent pregnancy?

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

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

315) CHECK 304:

CIRCLE METHOD CODE:

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

316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

317) CHECK 304: CIRCLE METHOD CODE.

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

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

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

320) Did a community health or family planning worker tell you about side effects or problems you might have with the method?

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

322) CHECK 318 AND 319:

323) Did a community or family planning health worker tell you about other family planning methods could use?

324) CHECK 304:

CIRCLE METHOD CODE:

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

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

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

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

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

329) CHECK 202: CHILDREN LIVING WITH RESPONDENT?

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

SECTION 4: PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) CHECK 215: FOR EACH BIRTH IN 2016-2021, ENTER THE PREGNANCY HISTORY NUMBER IN 403 AND THE NAME AND PREGNANCY OUTCOME IN 404. ASK QUESTIONS FOR EACH BIRTH. START WITH THE MOST RECENT BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

Now I would like to ask some questions about your pregnancies in the last five years. (We will talk about each separately, starting with the last one you had.)

LAST BIRTH

403) PREGNANCY HISTORY NUMBER FROM 212 IN PREGNANCY HISTORY.

404) FROM QUESTIONS 212 AND 216.

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

406) CHECK 208:

407) How much longer did you want to wait?

408) Did you see anyone for antenatal care for this pregnancy?

409) Whom did you see? Anyone else?

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

410) Where did you receive antenatal care for this pregnancy?

Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

_____ (NAME OF PLACE)

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

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

413) As part of your antenatal care during this pregnancy, did a healthcare provider do any of the following at least once:

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

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

416) CHECK 421:

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

418) Before this pregnancy, how many times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

419) CHECK 418:

420) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

SHOW TABLETS/SYRUP/MULTIPLE MICRONUTRIENT SUPPLEMENT.

421) During the whole pregnancy, for how many days did you take the iron tablets or syrup?

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

422) During this pregnancy, did you take any medicine for intestinal worms?

423) During this pregnancy, did you take SP (Fansidar, Maloxine, or another brand) to keep you from getting malaria?

424) How many times did you take SP (Fansidar, Maloxine, or another brand) during this pregnancy?

424A) Why did you not take the SP (Fansidar, Maloxine, or another brand) three times?

425) Did you get the SP (Fansidar, Maloxine, or another brand) during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

426) When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

427) Was (NAME) weighed at birth?

428) How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

429) Who assisted with the delivery of (NAME)?

Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

431) How long after (NAME) was delivered did you stay there?

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

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

433) When was the decision to have a caesarean made? Was it before or after labor started?

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

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

434B) CHECK 430: PLACE OF DELIVERY

435) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you.

Before you left the facility, did anyone check on your health?

436) How long after the delivery did the first check take place?

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

437) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

438) Now I would like to talk to you about checks on (NAME'S) health -- for example, someone examining (NAME), checking the cord, or talking to you about how to care for (NAME).

Before (NAME) left the facility, did anyone check on (NAME'S) health?

439) How long after delivery was (NAME)'s health first checked?

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

440) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

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

442) How long after delivery did that check take place?

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

443) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON

444) Where did the check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF THE PLACE)

445) After (NAME) left (FACILITY IN 430) did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?

446) How long after the birth of (NAME) did that check take place?

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

447) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

448) Where did this check of (NAME) take place?

PROBE TO DETERMINE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

449) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

450) How long after delivery did this check take place?

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

451) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

452) Where did this first check take place?

PROBE TO DETERMINE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

453) I would like to talk to you about checks on (NAME)'s health -- for example, someone examining (NAME), checking the cord, or talking to you about how to care for (NAME).

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

454) How long after the birth of (NAME) did that check take place?

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

455) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

456) Where did this first check of (NAME) take place?

PROBE TO DETERMINE THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

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

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

460) For how long after the birth of (NAME) did you not have your period?

461) CHECK 226: IS RESPONDENT PREGNANT?

462) Have you had sexual intercourse since the birth of (NAME)?

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

464) Did you ever breastfeed (NAME)?

465) CHECK 404: IS CHILD LIVING?

466) 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.

467) In the first three days after delivery, was (NAME) given anything to drinkother than breast milk?

468) CHECK 404: IS CHILD LIVING:

469) Are you still breastfeeding (NAME)?

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

471) GO BACK TO 405 IN THE NEXT COLUMN; OR, IF THERE ARE NO MORE BIRTHS, GO TO 472.

NEXT-TO-LAST BIRTH

403) PREGNANCY HISTORY NUMBER FROM 212 IN PREGNANCY HISTORY.

404) FROM QUESTIONS 212 AND 216.

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

406) CHECK 208:

407) How much longer did you want to wait?

426) When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

427) Was (NAME) weighed at birth?

428) How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

429) Who assisted with the delivery of (NAME)?

Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

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

433) When was the decision to have a caesarean made? Was it before or after labor started?

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

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

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

460) For how long after the birth of (NAME) did you not have your period?

468) CHECK 404: IS CHILD LIVING:

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

471) GO BACK TO 405 IN THE NEXT COLUMN; OR, IF THERE ARE NO MORE BIRTHS, GO TO 472.

472) Sometimes woman can have urinary or fecal discharge continuously throughout the day and night. This problem usually occurs after a difficult delivery, but it can also happen after a sexual assault or after a pelvic operation.

Have you ever had urinary or fecal discharge from the vagina continuously throughout the day and night?

1502) Have you heard about this condition?

473) Did the condition begin after a live or miscarriage?

475) Did this condition begin after a normal labor and delivery or after a difficult labor and delivery?

476) What do you think caused this condition?

477) How many days after (CAUSE OF CONDITION FROM 474 OR 476) did the discharge begin?

478) Did you seek treatment for the condition?

1508) Why didn't you seek treatment?

PROBE AND RECORD ALL MENTIONED.

480) From whom did you seek treatment last time?

481) Did you have an operation to treat the condition?

482) Did the treatment completely stop the discharge?

IF NOT: Did the treatment reduce the discharge?

SECTION 5: CHILD IMMUNIZATION

501A) CHECK 215 IN THE PREGNANCY HISTORY: ANY BIRTHS IN 2018-2021?

502A) RECORD THE NAME AND PREGNANCY HISTORY NUMBER FROM 212 OF THE MOST RECENT CHILD BORN IN 2018-2021.

503A) CHECK 216 FOR CHILD:

504A) Do you have a child health card, mother-child health card, or other document where (NAME)'s vaccinations are written down?

505A) Do you have a vaccination card for (NAME)?

506A) CHECK 504A:

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

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

DAY__ , MONTH__ , YEAR___

509A) CHECK 508A: 'BCG' TO 'MEASLES CONTAINING VACCINE' ALL RECORDED?

510A) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

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

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

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

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

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

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

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

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

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

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

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

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

525A) In the last seven days, was (NAME) given:

526A) Have you tracked (NAME)'s growth?

527A) Where did you go to have (NAME)'S growth tracked?

528A) Did you receive breastfeeding or feeding advice about (NAME) during your growth-monitoring check-up?

529A) CONTINUE WITH 501B.

501B) CHECK 215 IN THE PREGNANCY HISTORY: ANY OTHER BIRTHS IN 2018-2021?

502B) RECORD THE NAME AND PREGNANCY HISTORY NUMBER FROM 212 OF THE NEXT-MOST-RECENT CHILD BORN IN 2018-2021.

503B) CHECK 216 FOR CHILD:

504B) Do you have a child health card, mother-child health card, or other document where (NAME)'s vaccinations are written down?

505B) Do you have a vaccination card for (NAME)?

506B) CHECK 504B:

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

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

DAY__ , MONTH__ , YEAR___

509B) CHECK 508B: 'BCG' TO 'MEASLES CONTAINING VACCINE' ALL RECORDED?

510B) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

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

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

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

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

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

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

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

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

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

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

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

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

525B) In the last seven days, was (NAME) given:

526B) Have you tracked (NAME)'s growth?

527B) Where did you go to have (NAME)'S growth tracked?

528B) Did you receive breastfeeding or feeding advice about (NAME) during your growth-monitoring check-up?

529B) CHECK 215 IN THE PREGNANCY HISTORY: ANY OTHER BIRTHS IN 2018-2021?

SECTION 6: CHILD HEALTH AND NUTRITION

601) CHECK 224:

602) CHECK 215: FOR EACH BIRTH IN 2016-2021, ENTER BIRTH HISTORY NUMBER FROM PREGNANCY HISTORY IN 603 AND THE NAME AND SURVIVAL STATUS IN 604. ASK QUESTIONS ABOUT ALL BIRTHS. START WITH THE MOST RECENT BIRTH. IF THERE ARE MORE BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

MOST RECENT BIRTH, NEXT-MOST-RECENT BIRTH

603) BIRTH HISTORY NUMBER FROM 212 IN PREGNANCY HISTORY

604) FROM 212 AND 216:

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

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

606) In the last six days, was (NAME) given iron pills or capsules or syrup containing iron like [this/any of these]?

SHOW COMMON TYPES OF PILLS/CAPSULES/SYRUPS.

607) Was (NAME) given any medicine for intestinal worms in the last six months?

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

609) CHECK 469: CURRENTLY BREASTFEEDING?

a) YES: Now I would like to know how much (NAME) was given to drink during the diarrhea, including breast milk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?

b) NO/NOT ASKED: Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?

610) When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

611) Did you seek advice or treatment for the diarrhea from any source?

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

_____ (NAME OF PLACE)

613) CHECK 612:

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

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

616) CHECK 615:

617) CHECK 615:

a) ANY 'YES': What else was given to treat the diarrhea? Anything else?
b) ALL 'NO' OR 'DK': What was given to treat the diarrhea?

RECORD ALL TREATMENTS

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

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

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

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

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

623) CHECK 618: HAD FEVER?

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

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

_____ (NAME OF PLACE)

626) CHECK 625:

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

628) How many days after the illness began did you first seek advice or treatment for (NAME)?

IF THE SAME DAY RECORD '00'.

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

630) What medicine did (NAME) take? Any other medicine?

RECORD ALL MENTIONED.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

647) CHECK 615(a) AND 615(b), ALL COLUMNS:

648) Have you heard of a special product called OVIDA OR PRE-TREATED LIQUID SRO that you can get to treat diarrhea?

649) CHECK 225 AND 218, ALL LINES: NUMBER OF CHILDREN BORN 0-23 MONTHS BEFORE THE SURVEY LIVING WITH THE RESPONDENT

650) Now I would like to ask you about all the solid food and liquids that (NAME FROM 649) had yesterday during the day or at night. I am interested in foods your child ate whether at home or somewhere else. I will ask you about different types of foods, and I would like to know whether your child ate the food even if it was combined with other foods.

651) CHECK 650 (CATEGORIES 'g' THROUGH 'u'):

652) Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night?

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

653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

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

656) In the last six months, have you seen or heard any messages about malaria?

656) Where did you hear these messages?

Anywhere else?

657) In the last six months, have you seen or heard any of the following messages about LLINs?

658) Are there ways to avoid getting malaria?

659) What can someone do to keep from getting malaria?

RECORD ALL MENTIONED.

660) Now I am going to read some statements and I would like you to tell me if you agree or disagree. If you don't know, respond "I don't know."

In this community, people get malaria only during the rainy season, do you agree or disagree?

661) When a child has a fever, do you always worry that it's malaria?

Do you agree or disagree?

662) You don't worry about malaria because it is easy to treat.

Do you agree or disagree?

663) Only frail children can die from malaria?

Do you agree or disagree?

664) You can sleep under a mosquito net for a whole night when there are a lot of mosquitos.

Do you agree or disagree?

665) You can sleep under a mosquito net for a whole night when there are few mosquitos.

Do you agree or disagree?

666) When a child has a fever, the best thing to do is to start the child on a medication that I have at home.

Do you agree or disagree?

667) People in your community usually bring their children to a health care provider the same day or the day after a fever begins.

Do you agree or disagree?

668) People in your community who have mosquito nets usually sleep under the nets every night.

Do you agree or disagree?

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

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

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

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

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

710) CHECK 709:

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

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

713) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?

714) I would like to ask you about your recent sexual activity. 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.

LAST SEXUAL PARTNER, NEXT-TO-LAST SEXUAL PARTNER, SECOND-TO-LAST SEXUAL PARTNER

(DO NOT ASK 715 FOR LAST SEXUAL PARTNER)
715) When was the last time you had sexual intercourse with this person?

716) The last time that you had sexual intercourse, was a condom used?

717) Was a condom used each time that you had sexual intercourse with this person in the last 12 months?

718) 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'.

719) How long ago did you first have sexual intercourse with this person?

720) In the last 12 months, how many times did you have sexual intercourse with this person?

IF ANSWER IS NOT NUMERIC, PROBE FOR AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.

721) How old is this person?

722) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

723) In the last 12 months, how many different people have you had sexual intercourse with?

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

724) CHECK 106:

725) CHECK 701:

726) In the last 12 months, have you had sexual intercourse or an ongoing sexual relationship with someone because he gave you or told you he would give you gifts, money, or anything else?

727) 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 95 OR MORE, RECORD '95'.

728) CHECK 716: MOST RECENT PARTNER (FIRST COLUMN):

729) You told me that a condom was used the last time you had sexual intercourse. What was the brand name of the condom used?

IF THE BRAND IS UNKNOWN, ASK TO SEE THE PACKAGE.

730) From where did you obtain the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (PLACE NAME)

731) PRESENCE OF OTHERS DURING THIS SECTION.

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

802) CHECK 226:

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

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

805) CHECK 226:

806) CHECK 226:

807) CHECK 303: CURRENTLY USING A CONTRACEPTIVE METHOD?

808) CHECK 805:

809) CHECK 714:

810) CHECK 804:

a) 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 to prevent pregnancy?

Any other reason?

b) 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?

RECORD ALL REASONS MENTIONED

811) CHECK 303: USING A CONTRACEPTIVE METHOD

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

813) CHECK 216:

a) 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?
b) 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.

814) 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 a girl?

NUMBER

815) In the last few months have you:

816) In the last few months, have you seen any of the following messages on family planning in the media?

817) CHECK 701:

818) CHECK 303: USING A CONTRACEPTIVE METHOD?

819) Would you say that the decision to use contraception was primarily your decision, your (husband/partner)'s decision, or a decision you and your (husband/partner) made jointly?

820) Would you say that the decision not to use contraception was primarily your decision, your (husband/partner)'s decision, or a decision you and your (husband/partner) made jointly?

821) CHECK 304:

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

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

901) CHECK 701:

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

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

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

905) What was the highest [GRADE/FORM/YEAR] he completed at that level?

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

906) Has your (husband/partner) done any work in the last 7 days?

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

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

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

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

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

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

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

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

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

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

917) CHECK 701:

918) CHECK 916:

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

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

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

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

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

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

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

926) Do you have a title deed or other government recognized document for any house you own?

927) Is your name on this document?

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

929) Do you have a title deed or other government recognized document for any land you own?

930) Is your name on this document?

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

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

SECTION 10. HIV/AIDS

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

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

1003) Can people get HIV from mosquito bites?

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

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

1006) Can people get HIV by kissing a person who has HIV?

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

1008) Can HIV be transmitted from mother to child:

1009) CHECK 1008:

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

1011) CHECK 208 AND 215:

1012) CHECK FOR LAST BIRTH:

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

1014) During these antenatal visits for your most recent birth, did anyone talk to you about:

1015) During these antenatal visits, were you offered an HIV test?

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

1017) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

____ (NAME OF PLACE)

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

1019) All women are supposed to be receive counseling after getting the test. Did you receive counseling after you were tested?

1020) CHECK 430 FOR LAST BIRTH:

1021) Between the time you went for delivery but before the baby was born, were you tested for HIV?

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

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

1024) CHECK 1016:

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

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

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

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

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

1030) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE, RECORD '96' AND WRITE THE NAME OF THE PLACE.

_____ (NAME OF PLACE)

1031) Do you know of a place people can go to get tested for HIV?

1032) Where is that?

Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE RECORD '96' AND WRITE THE NAME OF THE PLACE.

_____ (NAME OF PLACE)

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

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

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

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

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

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

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

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

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

1042) CHECK 1001:

1043) CHECK 713:

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

1045) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

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

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

1048) CHECK 1045, 1046, AND 1047:

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

1050) Where did you go?

Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE RECORD '96' AND WRITE THE NAME OF THE PLACE.

_____ (NAME OF PLACE)

1051) 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?

1052) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

1048) CHECK 701:

1054) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

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

SECTION 11. OTHER HEALTH ISSUES

1101) Now I would like to ask you some questions about health issues. In the past 12 months, were you given an injection for any reason?

IF YES: How many injections were you given?

IF THE NUMBER OF INJECTIONS IS 90 OR MORE OR IF INJECTIONS WERE GIVEN DAILY FOR 3 OR MORE MONTHS, RECORD '90'. IF RESPONSE IS NON-NUMERIC, PROBE FOR AN ESTIMATE.

1102) Of these injections, how many were given by a doctor, nurse, pharmacist, dentist or other health professional?

IF THE NUMBER OF INJECTIONS IS 90 OR MORE OR IF INJECTIONS WERE GIVEN DAILY FOR 3 OR MORE MONTHS, RECORD '90'. IF RESPONSE IS NON-NUMERIC, PROBE FOR AN ESTIMATE.

1103) The last time that you were given an injection by a health professional, did he/she take the syringe and needle from a new, unopened package?

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

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

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

1107) What other type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

1108) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not a big problem:

1109) Are you covered by any health insurance?

1110) What type of health insurance are you covered by?

RECORD ALL MENTIONED.

1111) CHECK COVER PAGE:

SECTION 12: DOMESTIC VIOLENCE MODULE

1200) CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?

1201) CHECK FOR THE PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL TOTAL PRIVACY IS ENSURED.

1201A) READ TO THE RESPONDENT:

Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in MADAGASCAR. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you a question you do not want to answer, let me know and I will skip to the next question.

1202) CHECK 701 AND 702:

1203) First, I am going to ask you about some situations which happen to some women.

Please tell me if these apply to your relationship with your (last) (husband/partner).

1204) Now if you will permit me, I would like to ask some more questions about your relationship with your (last) (husband/partner).

A. (Does/did) your (last) (husband/partner) ever:

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1205)
A) Did your (last) (husband/partner) ever do any of the following things to you:

B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

1206) CHECK 1205 (a-j):

1207) How long after you (married/started living with) your (last) (husband/partner), did this/these action(s) first occur?

1208) Did the following ever happen as a result of what your (last) (husband/partner) did to you:

1209) Have you ever hit, slapped, kicked or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

1210) In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

1211) (Does/Did) your (last) (husband/partner) drink alcohol?

1212) How often (does/did) he get intoxicated: often, sometimes or not at all?

1213) (Do/did) you ever feel afraid of your (last) (husband/partner): many times, sometimes, or never?

1214) CHECK 709:

1215)

A) So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you some questions about the behavior of any previous (husband(s)/partners(s)).

B. How long ago did this happen?

1216) CHECK 701 AND 702:

1217) Who hurt you this way?

Anyone else?

RECORD ALL MENTIONED.

1218) In the last 12 months, how often did (this person/these people) hurt you physically: often, sometimes, or not at all?

1219) CHECK 201, 226, AND 230:

1220) Did anyone ever hit, slap, kick or do anything else to hurt you physically while you were pregnant?

1221) Who hurt you this way while you were pregnant?

Anyone else?

RECORD ALL MENTIONED.

1222) CHECK 701 AND 702:

1222A) Now I would like to ask you some questions about things that could have been done to you by (your/a) (husband/partner). At any time in your life, as a child or adult, did anyone force you to have sexual intercourse or perform sexual acts that you did not want to do?

1222B) At any time in your life, as a child or adult, did anyone force you to have sexual intercourse or perform sexual acts that you did not want to do?

1223) Who forced you the first time this occurred?

1224) CHECK 701 AND 702:

a) BEEN MARRIED/LIVED WITH A MAN: In the last 12 months, did anyone other than (your/a) (husband/partner) force you to have sexual intercourse when you did not want to?
b) NEVER BEEN MARRIED/LIVED WITH A MAN: In the last 12 months, did anyone force you have to sexual intercourse when you did not want to?

1224A) CHECK 1205A (h-j) and 1215A(b):

1225) CHECK 701 AND 702:

a) BEEN MARRIED/LIVED WITH A MAN: How old were you the first time that someone, including (your/one of your) husband(s) or partner(s), forced you to have sexual intercourse or perform other sexual acts when you did not want to?

b) NEVER MARRIED/LIVED WITH A MAN: How old were you the first time that someone forced you to have sexual intercourse or perform other sexual acts when you did not want to?

1226) CHECK 1205A (a-j), 1215A (a,b), 1216, 1220, 1222A AND 1222B:

1227) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1228) From whom have you sought help?

Anyone else?

RECORD ALL MENTIONED.

1229) Have you ever told anyone about this?

1230) As far as you know, did your father ever beat your mother?

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

1336) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1337) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

SECTION 13. NON-TRANSMISSIBLE DISEASES FOR WOMAN'S SURVEY

1301) Has a doctor or other health professional already checked your blood pressure?

1302) Did a doctor or other health professional ever tell you that you have high blood pressure or hypertension?

1303) In the past 12 months, did a doctor or other health professional tell you that you have high blood pressure or hypertension?

1304) Has a doctor or other health professional ever prescribed you medication to control your blood pressure?

1305) Are you currently taking medication to control your blood pressure?

1306) Has a doctor or other health professional ever measured your blood sugar?

1307) Has a doctor or other health professional ever told you that that you have high blood sugar or diabetes?

1308) In the past 12 months, did a doctor or other health professional tell you that you have high blood sugar or diabetes?

1309) In the last 12 months, did a doctor or other health professional prescribe you medication to control your blood sugar or diabetes?

1310) Do you take any medication to control your high blood sugar or diabetes?

1311) Has a doctor or other health professional ever told you that you have heart disease or a chronic heart condition?

1312) Are you currently being treated for heart disease or chronic heart condition?

1313) Has a doctor or other health professional ever told you that you have lung disease or a chronic lung condition?

1314) Are you currently being treated for lung disease or a chronic lung condition?

1315) Has a doctor or other health professional ever told you that you have cancer or a tumor?

1316) Are you currently being treated for cancer or a tumor?

1317) Has a doctor or other health professional ever told you that you have depression?

1318) Are you currently being treated for depression?

1319) Has a doctor or other health professional ever told you that you have arthritis?

1320) Are you currently being treated for arthritis?

1321) Has a doctor or other health professional ever told you that you have another chronic illness, that is, another long-term illness?

1322) Are you currently being treated for (CHRONIC ILLNESS FROM 1321)?

1323) Have you heard about cervical cancer?

1324) Have you heard about tests for cervical cancer?

1325) Now I'm going to ask you about tests a healthcare worker can do to check for cervical cancer, which is cancer in the cervix. The cervix connects the womb to the vagina. To be checked for cervical cancer, a woman is asked to lie on her back with her legs apart. Then the healthcare worker will use a brush or swab to collect a sample from inside her. The sample is sent to a laboratory for testing. This test is called a Pap smear or HPV test. Another method is called a VIA or Visual Inspection with Acetic Acid. In this test, the healthcare worker puts vinegar on the cervix to see if there is a reaction.

1326) Has a doctor or other healthcare worker ever tested you for cervical cancer?

1327) When was your last test for cervical cancer?

IF LESS THAN ONE YEAR, RECORD '00'.

1328) What was the result of your most recent test for cervical cancer?

1329) Did you receive treatment for the cervical cancer or have follow-up visits because of the results of the test?

1330) RECORD THE TIME.

INTERVIEWER OBSERVATIONS

TO BE FILLED IN AFTER COMPLETED INTERVIEW

COMMENTS ABOUT INTERVIEW ____

COMMENTS ON SPECIFIC QUESTIONS ___

ANY OTHER COMMENTS ____

SUPERVISER OBSERVATIONS ____

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

Column 1, Column 2

(1) There is an assumption that the collection year is 2021. For a collection beginning in 2022, all references to calendar years should be increased by one year; for example, 2015 must be changed in 2016, 2016 must be changed in 2017, 2017 must be changed in 2018, and so on for all years throughout the questionnaire.
(2) Codes can be added for other methods, such as those based on knowledge of fertility.