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DEMOGRAPHIC AND HEALTH SURVEY MADAGASCAR 2003 - INDIVIDUAL WOMEN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME _______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER _______
HOUSEHOLD UNIT NUMBER _______
REGION (FARITANY) ______
VILLAGE ______

URBAN/RURAL ______

URBAN 1
RURAL 2

ANTANANARIVO/OTHER CITY/RURAL? ______

ANTANANARIVO 1
OTHER CITY 2
RURAL 3

NAME AND LINE NUMBER OF WOMAN ______

CHECK HOUSEHOLD QUESTIONNAIRE COVER:
ARE THE ANEMIA AND SYPHILIS TESTS INTENDED FOR THIS HOUSEHOLD?
IF 'YES', WRITE '1' IN THE BOX TO THE RIGHT, IF 'NO', WRITE '2'.

YES 1
NO 2

CHECK HOUSEHOLD QUESTIONNAIRE COVER:
ARE THE TETANUS AND MEASLES TESTS INTENDED FOR THIS HOUSEHOLD?
IF 'YES', WRITE '1' IN THE BOX TO THE RIGHT, IF 'NO', WRITE '2'.

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______
INTERVIEWER'S NAME ______
RESULT _____

1 COMPLETED
2 NOT AT HOME
3 DEFERRED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

NEXT VISIT
DATE ______
TIME ______

FINAL VISIT
DAY _____
MONTH _____
YEAR 2003
INT. NUMBER _______
RESULT ______

TOTAL NUMBER OF VISITS _____

SUPERVISOR
NAME ________
DATE ________

FIELD EDITOR
NAME ________
DATE ________

OFFICE EDITOR ________
KEYED BY ________

SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

INTRODUCTION AND CONSENT:

CONSENT AFTER INFORMATION

Hello. My name is _______ and I am working with The Department of Demographics and Social Statistics (DDSS). We are in the process of conducting a national survey on the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and the health of your children). This information will be useful to the government in order to put health services in place. The survey usually takes between 20 and 45 minutes. The information you will give us is strictly confidential and will not be shared with anyone.

Participation in this survey is completely voluntary and you may refuse to answer any or all of the questions. However, we hope you will participate in the survey since your views are important to us.

Do you have any questions to ask me about the survey?
May I begin the interview now?

SIGNATURE OF INTERVIEWER ________
DATE _______

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

101. RECORD THE TIME.

HOUR _____
MINUTES_____

To begin, I would like to ask you questions about yourself and your household.

102. Until the age of 12, did you mostly live in the capital ANTANANARIVO, in another city, or in a rural setting?

CAPITAL 1
OTHER CITY 2
RURAL 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS______

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in the capital ANTANANARIVO, in another city, or in a rural setting?

CITY 1
TOWN 2
RURAL 3

105. In what month and year were you born?

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____
DOESN'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS _____

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary, middle school, high school, or higher?

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 4

109. What is the highest grade you completed at that level?

EDUCATION LEVEL _____
PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
POST-SECONDARY 4
GRADE _____
0 LESS THAN ONE YEAR COMPLETED (FOR ALL LEVELS)
PRIMARY
1 1ST GRADE
2 2ND GRADE
3 3RD GRADE
4 4TH GRADE
5 5TH GRADE
8 DOESN'T KNOW
MIDDLE SCHOOL
1 6TH GRADE
2 7TH GRADE
3 8TH GRADE
4 9TH GRADE
8 DOESN'T KNOW
HIGH SCHOOL
1 10TH GRADE
2 11TH GRADE
3 12TH GRADE
8 DOESN'T KNOW
POST-SECONDARY
ONE YEAR 1
TWO YEARS 2
THREE YEARS 3
FOUR YEARS 4
FIVE OR MORE YEARS 5
DOESN'T KNOW 8

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 114)

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

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ______ 4

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

YES 1
NO 2

113. CHECK 111:

CODE '2', '3', OR '4' CIRCLED (GO TO 114)
CODE '1' CIRCLED (GO TO 115)

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

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

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

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

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

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

117. What is your religion?

CATHOLIC 1
PROTESTANT/MALAGASY LUTHERAN CHURCH (FLM) 2
MUSLIM 3
TRADITIONAL/ANIMIST 4
NOT RELIGIOUS/NONE 5
SECT 6
OTHER (SPECIFY) ____ 96

119. Have you ever consumed alcoholic beverages?

YES 1
NO 2 (GO TO 124)

120. Have you ever been intoxicated after consuming alcoholic beverages?

YES 1
NO 2

121. Over the past three months, how many days have you consumed alcoholic beverages?

NUMBER OF DAYS ___
NONE/NEVER 95 (GO TO 124)

122. CHECK 120:

YES, HAS BEEN INTOXICATED (GO TO 123)
NO, HAS NEVER BEEN INTOXICATED (GO TO 124)

123. Over the past three months, how many days have you been intoxicated?

NUMBER OF DAYS ___
NONE/NEVER 95

124. Over the past three months, have you received an injection?

YES 1
NO 2 (GO TO 201)

125. Over the past three months, how many times have you received an injection?

NUMBER OF DAYS ___
EVERY DAY 95

126. The last time you had an injection, who gave you the shot?

HEALTH PROFESSIONAL 1
PHARMACIST 2
TRADITIONAL HEALER 3
FRIEND/RELATIVE 4
YOURSELF 5
OTHER (SPECIFY) ____ 6

SECTION 2: REPRODUCTION

Now I would like to ask about all the births you have had during your life.

201. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ___

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL ____

209. CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct?

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

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

211. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.)

[REPEAT 212-221 FOR EACH SEPARATE BIRTH]

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

NAME _______

213. Was (NAME) a single birth or part of a multiple birth?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

MONTH ___
YEAR _____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ___

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

YES 1
NO 2

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

LINE NUMBER ____ (GO TO 221)

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months was (NAME)?
RECORD DAYS IF LESS THAN ONE MONTH; MONTHS IF LESS THAN TWO YEARS; OR IN YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2

[GO BACK AND REPEAT 212-221 FOR EACH ADDITIONAL BIRTH]

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

YES 1
NO 2

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1998 OR LATER.
IF NONE, RECORD '0'.

_______

225. FOR EACH BIRTH SINCE JANUARY 1998, WRITE 'N' IN THE MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'G's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF CODE 'N'.

226. Are you pregnant now?

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

226A. Since becoming pregnant, do you eat more than usual, the same amount as usual, or less than usual?

MORE THAN USUAL 1
SAME AMOUNT AS USUAL 2
LESS THAN USUAL 3
DOESN'T KNOW 8

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'G's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ____

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

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH __
YEAR ____

231. CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 1998 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 1998 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'F' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'G' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ____

233. Have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1998. ENTER 'F' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'G' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Have you ever been pregnant before 1998 that did not terminate in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before January 1998 end?

MONTH ___
YEAR ___

237. When did your last menstrual period start?

DATE, IF GIVEN _____
DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 ______
YEARS AGO 4 _____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

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

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

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

SECTION 3: CONTRACEPTION

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

CIRCLE CODE '1' IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 301, ASK 302.

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

01. FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
02. MALE STERILIZATION Men can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
03. PILL Women can take a pill every day to avoid becoming pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse to avoid pregnancy for a year or longer.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
05. INJECTIONS Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
06. IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
07. CONDOM Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
08. FEMALE CONDOM Women can place a latex sheath in their vagina before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
09. DIAPHRAGM Women can place a diaphragm in their vagina before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
10. MOUSSE OR GEL Women can insert a suppository, or put gel or cream inside their vagina before sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
11. LACTATIONAL AMENORRHEA METHOD (LAM) Up until 6 months after giving birth, a woman can use a method that consists of nursing frequently, day and night, and that prevents her from getting her period again.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
12. RHYTHM METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
13. WITHDRAWAL Men can be careful and pull out before climax.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
14. EMERGENCY CONTRACEPTION After sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
15. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
SPECIFY ____
YES 1
NO 2

302. Have you ever used (METHOD)?
THIS QUESTION IS ASKED ABOUT EACH METHOD IN 301 WITH '1' or '2' CIRCLED.

01. FEMALE STERILIZATION Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02. MALE STERILIZATION Men can have an operation to avoid having any more children. Has your partner ever had an operation to avoid having any more children?
YES 1
NO 2
03. PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04. IUD Women can have a loop or coil placed inside them by a doctor or a nurse to avoid pregnancy for a year or longer.
YES 1
NO 2
05. INJECTIONS Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06. IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07. CONDOM Men can put a rubber or latex sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM Women can place a latex sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. DIAPHRAGM Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. MOUSSE OR GEL Women can insert a suppository, or put gel or cream inside their vagina before sexual intercourse.
YES 1
NO 2
11. LACTATIONAL AMENORRHEA METHOD (LAM) Up until 6 months after giving birth, a woman can use a method that consists of nursing frequently, day and night, and that prevents her from getting her period again.
YES 1
NO 2
12. RHYTHM METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14. EMERGENCY CONTRACEPTION After sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2
15. OTHER METHODS (SPECIFY) ______
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE "YES" (NEVER USED)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 329)

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

Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

307. How many living children did you have at that time?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN _____

308. CHECK 302 (01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 329)

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

YES 1
NO 2 (GO TO 329)

311. Which method are you currently using?
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
CIRCLE 'B' FOR MALE STERILIZATION.

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

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D
INJECTIONS E (GO TO 316A)
IMPLANTS F (GO TO 312D)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATIONAL AMEN. METHOD K (GO TO 316A)
RHYTHM METHOD L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) _____ X (GO TO 316A)

312A. May I see the package of pills you are using?
IF THE PACKAGE IS SHOWN, CIRCLE THE CODE THAT CORRESPONDS TO THE BRAND.

PILPLAN 1 (GO TO 312C)
LOFEMENAL 2 (GO TO 312C)
MICROGYNON 3 (GO TO 312C)
OVRETTE 4 (GO TO 312C)
OTHER (SPECIFY) _____ 6 (GO TO 312C)
PACKAGE NOT SHOWN 8

312B. Do you know the brand name of the pills you are using?
IF YES: What is the name?

PILPLAN 1
LOFEMENAL 2
MICROGYNON 3
OVRETTE 4
OTHER (SPECIFY) _____ 6
DOESN'T KNOW NAME 8

312C. How much does a package of pills cost you?
NOTE THE PRICE FOR ONE MONTH/CYCLE IN MADAGASCAR FRANCS.

PRICE IN MG FRANCS ___ (GO TO 316A)
FREE 9996 (GO TO 316A)
DOESN'T KNOW 9998 (GO TO 316A)

312D. Do you know the commercial name of the injection you received the last time?
IF YES: What is the name?

CONFIANCE 1 (GO TO 316A)
DEPOPROVERA 2 (GO TO 316A)
OTHER (SPECIFY) ____ 6 (GO TO 316A)
DOESN'T KNOW NAME 8 (GO TO 316A)

313. Where did the sterilization take place?
IF CODES 'A' AND 'B' ARE CIRCLED IN 311, ASK 313-317 ON FEMALE STERILIZATION ONLY.

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] 11
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] 12
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 13
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 14
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) ______ 96
DOESN'T KNOW 98

314. CHECK 311:

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

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

YES 1
NO 2
DOESN'T KNOW 8

316. In what month and year was the sterilization performed?
316A. Since what month and year have you been using (FIRST METHOD FROM 311) without stopping?
PROBE: Since what month and year have you been using (FIRST METHOD FROM 311) without stopping?

MONTH ___
YEAR ____

316B. CHECK 316/316A, 215 AND 230:

IF THERE WAS AT '215' A BIRTH OR AT '230' A PREGNANCY TERMINATED BY MISCARRIAGE, ABORTION OR STILLBIRTH AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A:

YES (GO BACK TO 316/316A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION)).

NO

317. CHECK 316/316A:

YEAR IS 1998 OR LATER (GO TO 319)
YEAR IS 1997 OR EARLIER (GO TO 327)

319. CHECK 311/311A: CIRCLE METHOD CODE.
IF MORE THAN ONE CODE IS CIRCLED IN 311/311A, CIRCLE THE CODE OF THE FIRST METHOD CIRCLED IN 311/311A.

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 320A)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER (SPECIFY) _____ 96 (GO TO 331)

320. Where did you obtain (METHOD FROM 317A) when you first began using it?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ______
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] 11
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] 12
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 13
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DISPENSARY 23
PRIVATE DOCTOR 24
PF/FISA CENTER 25
OTHER SOURCE
VBC AGENT 31
STORE 32
KIOSK 33
CHURCH 34
RELATIVES/FRIENDS 35
OTHER (SPECIFY) ______ 96

320AA. Did you obtain (METHOD) through a prescription the last time you received it?

YES 1 (GO TO 320B)
NO 2 (GO TO 320B)

320A. Where did you learn to use the lactational amenorrhea method?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ________
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] 11
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] 12
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 13
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PRIVATE DOCTOR 24
PF/FISA CENTER 25
OTHER SOURCE
VBC AGENT 31
MEDIA 32
STORE 33
KIOSK 34
CHURCH 35
RELATIVES/FRIENDS 36
OTHER (SPECIFY) ______ 96

320B. For what reasons did you choose the method you are currently using?

AVAILABLE A
AFFORDABLE B
HIGH QUALITY C
ADVERTISING D
APPEALING E
FRIENDS' ADVICE F
DOCTOR'S ADVICE G
EASY TO USE H
LESS SIDE EFFECTS I
CONFIDENTIALITY J
EFFECTIVENESS K
OTHER (SPECIFY) _____ X

321. CHECK 311/311A:
CIRCLE METHOD CODE. IF MORE THAN ONE CODE IS CIRCLED IN 311/311A, CIRCLE THE CODE OF THE FIRST METHOD CIRCLED IN 311/311A.

PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATIONAL AMEN. METHOD 11 (GO TO 325)

322. You obtained your (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320). At that time, were you told about side effects or problems you might have from using the method?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2 (GO TO 325)

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

YES 1
NO 2

325. CHECK 322:

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

CODE '1' NOT CIRCLED When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320) were you told about other methods of family planning that you could use?

YES 1 (GO TO 327)
NO 2

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

YES 1
NO 2

327. CHECK 311/311A:
CIRCLE METHOD CODE:

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 331)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER (SPECIFY) _____ 96 (GO TO 331)

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

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ________
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] 11 (GO TO 331)
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] 12 (GO TO 331)
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 13 (GO TO 331)
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 14 (GO TO 331)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 331)
PRIVATE HEALTH CENTER 22 (GO TO 331)
PHARMACY/MEDICINE DISPENSARY 23 (GO TO 331)
PRIVATE DOCTOR 24 (GO TO 331)
PF/FISA CENTER 25 (GO TO 331)
OTHER SOURCE
VBC AGENT 31 (GO TO 331)
STORE 32 (GO TO 331)
KIOSK 33 (GO TO 331)
CHURCH 34 (GO TO 331)
RELATIVES/FRIENDS 35 (GO TO 331)
OTHER (SPECIFY) ______ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is that?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_______
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] A
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] B
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] C
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PRIVATE HEALTH CENTER F
PHARMACY/MEDICINE DISPENSARY G
PRIVATE DOCTOR H
PF/FISA CENTER I
OTHER SOURCE
VBC AGENT J
STORE K
KIOSK L
CHURCH M
RELATIVES/FRIENDS N
OTHER (SPECIFY) ______ X

331. In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

YES 1
NO 2

331A. For you, what are the goals of family planning?

SPACE OUT BIRTHS A
LIMIT BIRTHS B
PRESERVE MOTHER'S HEALTH C
PRESERVE CHILD'S HEALTH D
SOCIO-ECONOMIC REASON E
OTHER (SPECIFY) ______ X

331A1. Do you know the names of condom brands?
IF YES: What are the brands you know?
What other brand name do you know?

PROTECTOR/PROTECTOR PLUS A
MANIX B (GO TO 331B)
INNOTEX C (GO TO 331B)
PROFILTEX D (GO TO 331B)
SIMPLEX E (GO TO 331B)
HANSAPLAST E (GO TO 331B)
PLEASURE F (GO TO 331B)
WITHOUT BRAND G (GO TO 331B)
OTHER (SPECIFY) _____ X (GO TO 331B)
DOESN'T KNOW Z (GO TO 331B)

331A2. You have said that you know the condom brand Protector/Protector Plus. Where have you heard or learned of this?

RECORD ALL MENTIONED. IF THE PERSON SAYS "RADIO", ASK IF IT WAS ON THE SHOW "TOKY SY ANTOKA" OR ON THE SHOW "PROTECTOR TIMES" AND CIRCLE THE CORRESPONDING CODE.

RADIO A
SHOW "TOKY SY ANTOKA" B
SHOW "PROTECTOR TIMES" C
TELEVISION D
POSTERS E
PACKAGES FOR SALE F
RELATIVES G
FRIENDS H
DOCTORS I
TRAVELING CINEMA J
FILM "BAKAPILESY" K
T-SHIRT/HATS L
COMMUNITY VENDOR M
PSI VENDOR N
RETAIL VENDOR O
OTHER (SPECIFY) ____ X

331B. Are you a member of a community health awareness group?

YES 1
NO 2

331B1. Do you participate in the SEECALINE program?
[NOTE: THIS IS A COMMUNITY NUTRITION PROGRAM IN MADAGASCAR.]

YES 1
NO 2 (GO TO 331C)

331B2. For how long have you participated in the SEECALINE program?
IF LESS THAN A MONTH, RECORD '00'.

NUMBER OF MONTHS ___
MORE THAN A YEAR 96
DOESN'T KNOW 98

331B3. The host of this SEECALINE program, was he/she ACN SEECALINE, NAC HOST, JSI HOST, or OTHER?

ACN SEECALINE 1
NAC HOST 2
JSI HOST 3
OTHER (SPECIFY) ____ 6

331C. Do you know someone who is a member of a community health awareness group?

YES 1
NO 2

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

YES 1
NO 2

332B. In the last 6 months, have you visited a health facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

333A. The last time you or your children went to the CSB, did you find your prescribed medications?

ENTIRELY 1
PARTIALLY 2
NONE 3

333B. The last time you or your children went to the CSB, did you find the prices of medication to be expensive, average, or cheap?

EXPENSIVE 1
AVERAGE 2
AFFORDABLE/CHEAP 3
DOESN'T KNOW 8

333C. The last time you or your children went to the CSB, how much did you pay for medication (PRICE IN MGF)?

MG FRANCS ____

MGF OR MORE 99995
FREE 99996
DOESN'T KNOW 99998

333D. The last time you or your children went to the CSB, were you able to pay for medication yourself without borrowing from family, friends or neighbors?

YES 1
NO 2

SECTION 4: PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 1998 OR LATER
NO BIRTHS IN 1998 OR LATER (GO TO 486)

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS FOR EACH BIRTH AFTER 1998. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.)

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

403. LINE NUMBER FROM 212:

LINE NO. ____

[404-471 ARE REPEATED FOR EACH BIRTH, BEGINNING WITH THE MOST RECENT BIRTH. IF MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.]

404. FROM 212 AND 216:

NAME ___
LIVING ___
DEAD ___

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

THEN 1 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

406. How much longer would you have liked to wait?

MONTHS 1 ___
YEARS 2 ___
DOESN'T KNOW 998

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
[ASK FOR MOST RECENT BIRTH ONLY]

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

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE/MEDICAL ASSISTANT B
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT C
UNTRAINED TRADITIONAL BIRTH ASSISTANT D
OTHER (SPECIFY) ____ X
NO ONE Y (GO TO 415)

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

MONTHS ____
DOESN'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF TIMES ___
DOESN'T KNOW 98

410. CHECK 409:
NUMBER OF PRENATAL CONSULTATIONS RECEIVED
[ASK FOR MOST RECENT BIRTH ONLY]

ONE TIME (GO TO 412)
MORE THAN ONCE OR DOESN'T KNOW (GO TO 411)

411. How many months pregnant were you the last time you had a prenatal visit?
[ASK FOR MOST RECENT BIRTH ONLY]

MONTHS __
DOESN'T KNOW 98

412. During this pregnancy, were any of the following done at least once?
[ASK FOR MOST RECENT BIRTH ONLY]

Were you weighed?
Was your height measured?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

WEIGHT
YES 1
NO 2
HEIGHT
YES 1
NO 2
BLOOD PRESSURE
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

413. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?
[ASK FOR MOST RECENT BIRTH ONLY]

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

414. Were you told where to go if you had any of these complications?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 416A)
DOESN'T KNOW 8 (GO TO 416A)

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

TIMES ___
DOESN'T KNOW 8

416A. CHECK 416:
NUMBER OF INJECTIONS RECEIVED AGAINST TETANUS OR QUESTION 416 NOT ASKED? [ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN 2 TIMES OR QUESTION 416 NOT ASKED (GO TO 416B)
IF 2 OR MORE TIMES (GO TO 417)

Now, I would like for you to think back to any tetanus injections you might have received before you became pregnant with your last child.

416B. Did you receive any tetanus injections (vaccinations) at any time before your last pregnancy? You could have received this injection during a previous pregnancy, between pregnancies, or even before your first pregnancy.
[ASK FOR MOST RECENT BIRTH ONLY]

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

416C. IF YES: How many other times did you receive a tetanus injection before your last pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF TIMES ___
DOESN'T KNOW 8

416D. Now, I would like you to think of the tetanus injections you received before your last pregnancy. In particular, I would like you to think of when you last received a tetanus injection before your last pregnancy.

416D1. When did you receive the last tetanus injection before this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

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

416D2. OR, IF DATE UNKNOWN: How many years ago did you receive that tetanus injection?
[ASK FOR MOST RECENT BIRTH ONLY]

YEARS AGO ___
DOESN'T KNOW YEAR 98

417. During this pregnancy, were you given or did you buy any iron tablets or syrup with iron in it? SHOW TABLETS/SYRUP.
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 419)
DOESN'T KNOW 8 (GO TO 419)

418. 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.
[ASK FOR MOST RECENT BIRTH ONLY]

DAYS ___
DOESN'T KNOW 998

419. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

420. During this pregnancy, did you suffer from night blindness [USE LOCAL NAME]?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

421. During this pregnancy, did you take any drugs to keep you from getting malaria?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 423)
DOESN'T KNOW 8 (GO TO 423)

422. What was this medication?
[ASK FOR MOST RECENT BIRTH ONLY]
RECORD ALL MENTIONED.

CHLOROQUINE A
SP/FANSIDAR B
QUININE C
UNKNOWN MEDICATION D
OTHER (SPECIFY) ____ X

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DOESN'T KNOW 8

424. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 425AA)
DOESN'T KNOW 8 (GO TO 425AA)

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

GRAMS FROM CARD 1 ___
GRAMS FROM MEMORY 2 ___
DOESN'T KNOW 9998

425AA. Does (NAME) have a birth certificate?
IF YES: Can I see it, please?

YES, SEEN 1 (GO TO 426)
YES, NOT SEEN 2
NO BIRTH CERTIFICATE 3

425A. Was (NAME'S) birth reported to the Registrar General?

YES 1
NO 2
DOESN'T KNOW 8

426. 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.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE/MEDICAL ASSISTANT B
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT C
UNTRAINED TRADITIONAL BIRTH ASSISTANT D
RELATIVE/FRIEND E
OTHER (SPECIFY) ____ X
NO ONE Y

426A. During the birth of your last child (NAME), were you given a tetanus shot?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DOESN'T KNOW 8

426B. Since the birth of your last child (NAME), have you been given any shots for tetanus?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 427)
DOESN'T KNOW 8 (GO TO 427)

426C. IF YES: How many times since the birth of (NAME) have you received a tetanus shot?
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF TIMES ___
DOESN'T KNOW 8

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

IF HOSPITAL, HEALTH CENTER OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) ____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) _____ 36
OTHER (SPECIFY) ____ 96 (GO TO 429)

428. Was (NAME) delivered by caesarean section?

YES 1 (GO TO 433)
NO 2 (GO TO 433)

429. After the birth of (NAME), did a health care provider or traditional midwife examine you?

YES 1
NO 2 (GO TO 433)

430. How long after delivery did the first check take place?
[ONLY ASK FOR MOST RECENT BIRTH.]
RECORD '00' IF THE SAME DAY.

DAYS AFTER 1 ___
WEEKS AFTER 2 ___
DOESN'T KNOW 998

431. Who checked on your health at that time?
[ONLY ASK FOR MOST RECENT BIRTH.]
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE/MEDICAL ASSISTANT 12
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT 21
UNTRAINED TRADITIONAL BIRTH ASSISTANT 22
OTHER (SPECIFY) ____ 96

432. Where did this first check take place?
[ONLY ASK FOR MOST RECENT BIRTH.]

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 22
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 23
OTHER PUBLIC (SPECIFY) ____26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) _____ 36
OTHER (SPECIFY) ____ 96

433. In the two months after the birth, did you receive a dose of vitamin A such as this?
SHOW PILL/GEL CAP/SYRUP.
[ONLY ASK FOR MOST RECENT BIRTH.]

YES 1
NO 2

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

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

435. Did your period return between the birth of (NAME) and your next pregnancy?
[ASK FOR ALL BUT MOST RECENT BIRTH.]

YES 1
NO 2 (GO TO 439)

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

MONTHS ___
DOESN'T KNOW 98

437. CHECK 226:
IS RESPONDENT PREGNANT?
[ONLY ASK FOR MOST RECENT BIRTH.]

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

438. Have you begun to have sexual intercourse again since the birth of (NAME)?
[ONLY ASK FOR MOST RECENT BIRTH.]

YES 1
NO 2 (GO TO 440)

439. For how long after the birth of (NAME) did you not have sexual intercourse?

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

440. Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

441. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ____

442. In the first three days after delivery and before the mother's breasts began to produce milk regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 444)

443. What was (NAME) given to drink before the mother's breasts began to produce milk regularly?

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

444. CHECK 404:
IS CHILD STILL LIVING?

LIVING (GO TO 445)
DEAD (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS ___
DOESN'T KNOW 98

447. CHECK 404:
IS CHILD STILL LIVING?

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

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

NUMBER OF NIGHTTIME FEEDINGS___

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

NUMBER OF DAYTIME FEEDINGS ___

449A. Now I would like to know how much food you are eating since starting to breastfeed (NAME). Do you eat more than normal, as much as normal, or less than normal?

MORE THAN NORMAL 1
ABOUT NORMAL 2
LESS THAN NORMAL 3
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

451. Was sugar added to any food or liquid (NAME) was fed yesterday?

YES 1
NO 2
DOESN'T KNOW 8

452. Yesterday, day or night, how many times was (NAME) fed pureed, solid or semi-solid food?
IF 7 TIMES OR MORE, RECORD '7'.

NUMBER OF TIMES ___
DOESN'T KNOW 8

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

SECTION 4B: VACCINATION AND HEALTH

454. WRITE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998. (IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES.)

455. LINE NUMBER FROM 212.

LINE NUMBER ___

456. FROM 212 AND 216

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

457. Did (NAME) receive a vitamin A dose, like this one, within the last six months?
SHOW PILL/CAPSULE/SYRUP.

YES 1
NO 2
DOESN'T KNOW 8

458. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
IF THE CARD IS SEEN, NOTE IF IT IS A ZAZASAMALA CARD OR ANOTHER TYPE OF CARD AND CIRCLE THE CORRESPONDING CODE.

YES, SEEN/ZAZASAMALA 1 (GO TO 460)
YES, SEEN (OTHER CARD) 2 (GO TO 460)
YES, NOT SEEN 3 (GO TO 462A)
NO CARD 4
DOESN'T KNOW 8

459. Did you ever have a vaccination card for (NAME)?
IF YES: Was it a ZAZASAMALA card?
SHOW A ZAZASAMALA CARD.

YES, ZAZASAMALA 1 (GO TO 462)
YES, NOT ZAZASAMALA 2 (GO TO 462)
NO CARD 3 (GO TO 462)

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

BCG
DAY ____
MONTH ____
YEAR ____
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY ____
MONTH ____
YEAR ____
POLIO 1
DAY ____
MONTH ____
YEAR ____
POLIO 2
DAY ____
MONTH ____
YEAR ____
POLIO 3
DAY ____
MONTH ____
YEAR ____
DPT 1
DAY ____
MONTH ____
YEAR ____
DPT 2
DAY ____
MONTH ____
YEAR ____
DPT 3
DAY ____
MONTH ____
YEAR ____
MEASLES
DAY ____
MONTH ____
YEAR ____
HEPATITIS - B1
DAY ____
MONTH ____
YEAR ____
VITAMIN A (MOST RECENT)
DAY ____
MONTH ____
YEAR ____

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

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

462A. Is (NAME'S) vaccination card a ZAZASAMALA card?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 466)
DOESN'T KNOW 8 (GO TO 466)

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

463A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 463E)
DOESN'T KNOW 8 (GO TO 463E)

463C. Was the first polio vaccine received just after birth or later?

JUST AFTER BIRTH 1
LATER 2

463D. How many times was the polio vaccine received?

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 463G)
DOESN'T KNOW 8 (GO TO 463G)

463F. How many times was a DPT vaccination received?

NUMBER OF TIMES ____

463G. A measles injection?

YES 1
NO 2
DOESN'T KNOW 8

464. Did (NAME) receive any of these injections during a national vaccination day within the last two years?

YES 1
NO 2 (GO TO 466)
NO VACCINATION IN LAST 2 YEARS 3 (GO TO 466)
DOESN'T KNOW 8 (GO TO 466)

465. During which national vaccination day did (NAME) receive these vaccinations?
RECORD ALL MENTIONED.

CAMPAIGN NAME (TYPE/DATE)
1. _____ A
2. _____ B
3. _____ C
4. _____ D

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 469)
DOESN'T KNOW 8 (GO TO 469)

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

YES 1
NO 2
DOESN'T KNOW 8

469. CHECK 466 AND 467:
FEVER OR COUGH?

"YES" TO 466 OR 467 (GO TO 470)
OTHER (GO TO 475)

470. Did you seek advice or treatment when (NAME) had a (fever/cough)?

YES 1
NO 2 (GO TO 472)

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

PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] A
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] B
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] C
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] D
OTHER PUBLIC (SPECIFY) _____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PIF/FISA CENTER J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER LOCATION
VBC AGENT L
STORE M
KIOSK N
TRADITIONAL HEALER O
OTHER (SPECIFY) _____ X

472. CHECK 466:
HAD FEVER?

"YES" TO 466 (GO TO 473)
"NO" OR "DOESN'T KNOW" TO 466 (GO TO 475)

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

YES 1
NO 2 (GO TO 475)
DOESN'T KNOW 8 (GO TO 475)

474. What drugs did (NAME) take?

RECORD ALL MENTIONED. ASK TO SEE THE MEDICATION IF THE TYPE OF MEDICATION IS UNKNOWN. IF THE TYPE OF MEDICATION CANNOT BE DETERMINED, SHOW THE RESPONDENT A COMMON ANTIMALARIAL DRUG.

SP/FANSIDAR A
CHLOROQUINE B
ASPIRIN C
IBUPROFEN/ACETAMINOPHEN D
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

475. Has (NAME) had diarrhea in the last 2 weeks?

YES 1
NO 2 (GO TO 483)
DOESN'T KNOW 8 (GO TO 483)

475A. CHECK 445:
LAST CHILD STILL BEING BREASTFED?
[ONLY ASK FOR MOST RECENT BIRTH]

YES TO 445(GO TO 475B)
NO TO 455 (GO TO 476)

475B. When (NAME) had diarrhea during the last two weeks, did you change the number of feedings?

YES 1
NO 2 (GO TO 476)

475C. When (NAME) had diarrhea during the last two weeks, did you increase/decrease the number of feedings, or did you completely stop breastfeeding?

INCREASED 1
REDUCED 2
COMPLETELY STOPPED 3

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

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

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

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

478. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) a fluid made from a special packet?
b) a government-recommended homemade fluid?

FLUID FROM ORS PACKET
YES 1
NO 2
DOESN'T KNOW 8
HOMEMADE FLUID
YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 481)
DOESN'T KNOW 8 (GO TO 481)

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

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

481. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 483)

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

PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] A
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] B
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] C
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] D
OTHER PUBLIC (SPECIFY) _____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PIF/FISA CENTER J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER LOCATION
VBC AGENT L
STORE M
KIOSK N
TRADITIONAL HEALER O
OTHER (SPECIFY) _____ X

483. RETURN TO 456 IN THE NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 484.

484. CHECK 215 AND 218, ALL COLUMNS: NUMBER OF LIVING CHILDREN BORN IN 1998 OR LATER.

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

485. When (YOUNGEST CHILD) does not use the toilet, what do you typically do to dispose of the stools?

CHILD ALWAYS USES TOILET OR LATRINE 01
THROWN INTO TOILET OR LATRINE 02
THROWN OUTSIDE OF THE DWELLING 03
THROWN OUTSIDE OF THE YARD 04
BURIED IN THE YARD 05
GET RID OF IT BY RINSING WITH WATER 06
DOESN'T GET RID OF IT 07
OTHER (SPECIFY) _____ 96

486. CHECK 478(a), ALL COLUMNS:

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

487. Have you ever heard of a special product called [LOCAL NAME] that you can get for the treatment of diarrhea?

YES 1
NO 2

488. CHECK 218:

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

489. When (your child/one of your children) is seriously ill, can you yourself decide to take the child to get medical treatment?
IF RESPONDENT SAYS THAT NONE OF HER CHILDREN HAVE EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) were to fall seriously ill, could you yourself decide to take the child to get medical treatment?

YES 1
NO 2
DEPENDS 3

Now, I would like to ask you questions having to do with your own health care.

490. 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, does each of the following constitute a big problem, a small problem, or no problem?

Knowing where to go.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Getting permission to go.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Getting money needed for treatment.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
No health facility nearby.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Having to take transport.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Not wanting to go alone.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Concern that there may not be a female health provider.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3

491. CHECK 215 AND 218:

HAS AT LEAST ONE OR MORE CHILDREN BORN IN 2000 OR LATER LIVING WITH HER [RECORD NAME OF YOUNGEST CHILD LIVING WITH HER] (GO TO 492)
NAME _____
NO CHILDREN BORN IN 2000 OR LATER LIVING WITH HER (GO TO 494)

492. Now I would like to ask you what liquids (NAME FROM 491) has had over the last 7 days, including yesterday. How many days out of the last seven days did (NAME FROM 491) drink one of the following liquids? FOR EACH OF THE LIQUIDS DRANK AT LEAST ONCE OVER THE LAST SEVEN DAYS, ASK: In total, during the day or night yesterday, how many times did (NAME FROM 491) drink:

IF 7 TIMES OR MORE, RECORD '7'.
IF DOESN'T KNOW, RECORD '8'.

a. Plain water?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
b. Rice water?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
c. Formula?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
d. All other types of milk, such as boxed, powdered, or fresh animal milk?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
e. Fruit juice?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
f. Other liquids?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___

493. Now I would like to ask you what foods (NAME FROM 491) has had over the last 7 days, including yesterday. How many days out of the last seven days did (NAME FROM 491) eat one of the following foods? FOR EACH OF THE FOODS EATEN AT LEAST ONCE OVER THE LAST SEVEN DAYS, ASK: In total, during the day or night yesterday, how many times did (NAME FROM 491) eat:

IF 7 TIMES OR MORE, RECORD '7'.
IF DOESN'T KNOW, RECORD '8'.

a. Food made from grains [ex: Mogofasy, millet, sorghum, corn, rice, wheat, porridge, or other local grains]?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
b. Red or yellow yams or squash, carrots, or sweet potatoes?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
c. Other foods made from roots [ex: potatoes, cassava root, or other local roots]?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
d. Dark green, leafy vegetables?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
e. Mangoes, papayas [or other local fruits rich in vitamin A]?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
f. Any other fruits [ex: banana, apple, green beans, avocado, tomato]?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
g. Meat, poultry, fish, shellfish or eggs?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
h. Any other foods made from plants [ex: lentils, beans, soy, legumes, nuts]?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
i. Cheese or yogurt?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___
j. Any foods made with oil, fats or butter?
LAST SEVEN DAYS: NUMBER OF DAYS ___
YESTERDAY/LAST NIGHT: NUMBER OF TIMES ___

494. Did you sleep under a mosquito net last night?

YES 1
NO 2 (GO TO 494F)

494A. For what reasons did you use a mosquito net?

AVOID MOSQUITO BITES A
AVOID MALARIA B
AVOID INSECTS C
PREGNANT D
DOESN'T KNOW E
OTHER (SPECIFY) ____ F

494B. Was the mosquito net under which you slept last night bought at the market or received for free?

BOUGHT AT MARKET 1
RECEIVED FROM ONG OR OTHER ORGANIZATION 2
OTHER (SPECIFY) ______ 6
DOESN'T KNOW 8

494C. How long has it been since you bought or were given this mosquito net?
IF MORE THAN 84 MONTHS, CODE 95.

NUMBER OF MONTHS ___
DOESN'T KNOW 98

494D. Has the mosquito net been treated with insecticide since you have had it, or not?

YES 1
NO 2 (GO TO 494F)
DOESN'T KNOW 8 (GO TO 494F)

494E. How long has it been since the last time the mosquito net was treated with insecticide?
IF MORE THAN 84 MONTHS, CODE 95.

NUMBER OF MONTHS ___
DOESN'T KNOW 98

494F. Have you ever heard of a brand of mosquito net called SUPERMOUSTIQUAIRE?

YES 1
NO 2 (GO TO 494I)

494G. Where have you heard of the brand SUPERMOUSTIQUAIRE?

ON THE RADIO A
ON THE TELEVISION B
ON POSTERS C
ON PACKAGES FOR SALE D
RELATIVES E
FRIENDS F
DOCTORS G
MOBILE CINEMA H
T-SHIRTS/HATS I
OTHER (SPECIFY) _____ X

494H. Is the mosquito net under which you normally sleep a net by the brand SUPERMOUSTIQUAIRE?

YES 1
NO 2

494I. CHECK 226:

CURRENTLY PREGNANT
NOT PREGNANT OR NOT SURE (GO TO 495)

494J. Have you had a fever at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 495)

494K. Did you take any medication for the fever?

YES 1
NO 2 (GO TO 495)

494L. What medications did you take?
FOR EACH ANTI-MALARIAL, ASK: How long after the start of the fever did you begin to take (MEDICATION)?

ASK TO SEE THE MEDICATIONS. IF NOT SEEN, SHOW THE RESPONDENT MEDICATIONS. RECORD ALL MENTIONED.

ANTIMALARIALS

CHLOROQUINE A
NUMBER OF DAYS ___

NUMBER OF TIMES PER DAY ___
SAME DAY 0
1 DAY AFTER FEVER 1
2 DAYS AFTER FEVER 2
3 DAYS OR MORE 3
FANSIDAR B
NUMBER OF DAYS ___

NUMBER OF TIMES PER DAY ___
SAME DAY 0
1 DAY AFTER FEVER 1
2 DAYS AFTER FEVER 2
3 DAYS OR MORE 3
QUININE C
NUMBER OF DAYS ___

NUMBER OF TIMES PER DAY ___
SAME DAY 0
1 DAY AFTER FEVER 1
2 DAYS AFTER FEVER 2
3 DAYS OR MORE 3

OTHER MEDICATIONS

ASPIRIN C
PARACETAMOL D
OTHER X
DOESN'T KNOW Z

495. The last time you prepared a meal for your family did you wash your hands before beginning?

YES 1
NO 2
NEVER PREPARED MEALS 3

496. Do you currently smoke cigarettes or tobacco?
IF YES: What do you smoke?
RECORD ALL MENTIONED.

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

497. CHECK 496:

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

498. In the last 24 hours, how many cigarettes (number of stems) have you smoked?

CIGARETTES ___

498A. Have you ever heard any songs about breastfeeding?

YES 1
NO 2 (GO TO 498C)

498B. Have you heard breastfeeding sung about in the music of POOPY, in your community's popular music or elsewhere?

POOPY 1
COMMUNITY 2
OTHER MUSIC 3

Now, I would like to ask you questions about your own health.

498C. Do you have a health card or other document with your own vaccinations written down on it?
IF YES: Can I see it?

YES (CARD SEEN) 1
YES (BUT CARD NOT SEEN) 2
NO 3
DOESN'T KNOW 8

498D. CHECK 215:

HAS GIVEN BIRTH AT LEAST ONCE (GO TO 498E)
HAS NEVER GIVEN BIRTH (GO TO 498F)

[REPEAT 498E(1)-(8) FOR ALL CHILDREN LISTED IN THE TABLE IN 212.]

Now I would like to ask you questions about all of the children you've birthed, whether they are alive or not, starting with the first child you have birthed. These questions concern tetanus vaccinations, which we have already talked about in this interview, and measles.

498E. REPORT HERE IN THIS TABLE THE LIST OF ALL THE RESPONDENT'S BIRTHS ACCORDING TO THE REPRODUCTION TABLE IN 212. RECORD TWINS/TRIPLETS ON SEPARATE LINES.

(1) Name of your first/next child?

NAME _______

TETANUS:

(2) While you were pregnant with (NAME), did you receive an injection in your arm to prevent the baby from having tetanus, that is, an injection that prevents convulsions after birth?

YES 1
NO 2 (GO TO (4))
DOESN'T KNOW 8 (GO TO (4))

(3) IF YES: How many times did you receive injections to prevent tetanus while you were pregnant with (NAME)?

NUMBER OF TIMES ____
DOESN'T KNOW 8

MEASLES:

Now, I would like to ask you some questions about injections to prevent measles (LOCAL NAME OF MEASLES), called the measles vaccine. The measles vaccine prevents children from an illness accompanied by high fever and an eruption of bumps on the body, especially the face and neck. Children receive the measles vaccine in the arm or shoulder around one year of age.

(4) Did (NAME) receive a measles vaccine on the arm or shoulder around the age of one year to prevent him/her from these cutaneous eruptions?

YES 1 (GO TO (6))
NO 2
DOESN'T KNOW 8

(5) Did (NAME) receive a measles vaccine on the arm or shoulder at any age to prevent him/her from these cutaneous eruptions?

YES 1
NO 2
DOESN'T KNOW 8

(6) When (NAME) was born did he/she receive a measles vaccine on his/her arm or shoulder as part of a national vaccination day or during another public or scholarly campaign, to prevent him/her from these cutaneous eruptions?

YES 1 (CAMPAIGN) ____
NO 2
DOESN'T KNOW 8

(7) Has (NAME) ever fallen ill from the measles (LOCAL NAME OF MEASLES), which manifests as a high fever and cutaneous eruptions?

YES 1
NO 2
DOESN'T KNOW 8

(8) Have you yourself ever taken (NAME) to have at least one vaccination?

YES 1
NO 2
DOESN'T KNOW 8

498F. Is there a health center in your city/urban area close to you where you can go for prenatal care in case you need it?

YES 1
NO 2
DOESN'T KNOW 8

SECTION 5: MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or living with a man as if married?

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

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

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

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

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME ____
LINE NO. ____

507. Does your husband/partner have any wives or partners other than you?

YES 1
NO 2 (GO TO 510)

508. How many other wives or partners does your husband have?

NUMBER ____
DOESN'T KNOW 98 (GO TO 510)

509. Are you the first, second, ... wife?

RANK ___

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

ONLY ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE Now I would like to ask you about when you started living with your first husband/partner. In what month and year was that?

MONTH ___
DOESN'T KNOW MONTH 98
YEAR ___ (GO TO 514)
DOESN'T KNOW YEAR 9998

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

AGE ___

Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.

514. How old were you when you had sexual intercourse for the very first time (if you have had it)?

NEVER 00 (GO TO 524)

AGE IN YEARS ___

FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

515. How long has it been since the last time you had sexual intercourse?
RECORD IN 'NUMBER OF YEARS' ONLY IF THE LAST TIME WAS MORE THAN A YEAR AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (GO TO 524)

516. The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 516D)

516A. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STI/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STI/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
OTHER (SPECIFY) ___6
DOESN'T KNOW 8

516B. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 517)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 517)

516C. How much did you pay for the condoms?
RECORD THE PRICE OF 3 CONDOMS IN MGF.

PRICE OF 3 CONDOMS/MGF ___ (GO TO 517)
GIFT/FREE 9996 (GO TO 517)

516D. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN MY PARTNER H
FAITHFUL TO MY PARTNER I
AFRAID MY PARTNER SUSPECTS ME J
WE HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STI'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANTS TO CONCEIVE S
OTHER (SPECIFY) _____ X
DOESN'T KNOW OF CONDOMS Z

517. What is your relationship to the person with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANC?, ASK: Was your boyfriend/fianc? living with you at the time you last had sexual intercourse with him?
IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

HUSBAND/LIVE-IN PARTNER 01 (GO TO 519)
BOYFRIEND/FIANC? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) ______ 96

518. For how long have you had sexual relations with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

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

519. Have you had sexual intercourse with another man in the last 12 months?

YES 1
NO 2 (GO TO 524)

520. The last time you had sexual intercourse with this other person, was a condom used?

YES 1
NO 2 (GO TO 520F)

520A. What is the main reason that you used a condom on this occasion?

RESPONDENT WANTED TO AVOID STI/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID STI/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTED PARTNER OF HAVING OTHER PARTNERS 4
PARTNER ASKED/INSISTED 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8

520D. Did you procure these condoms or did you partner provide them?

RESPONDENT PROCURED THEM 1
PARTNER PROVIDED THEM 2 (GO TO 521)
SOMEONE ELSE PROVIDED THEM 3 (GO TO 521)

520E. How much did you pay for the condoms?
RECORD THE PRICE OF 3 CONDOMS IN MGF.

PRICE OF 3 CONDOMS/MGF ____ (GO TO 521)
GIFT/FREE 96 (GO TO 521)

520F. What were the reasons a condom was not used during your last sexual encounter?

NOT IN THE HABIT A
PARTNER REFUSED B
DOESN'T LIKE CONDOMS C
IT REDUCES PLEASURE D
CONDOM TEARS E
CONDOM GIVES OFF A CERTAIN SMELL F
CONDOM IS NOT WELL LUBRICATED G
TRUST IN MY PARTNER H
FAITHFUL TO MY PARTNER I
AFRAID MY PARTNER SUSPECTS ME J
WE HAVE ANOTHER METHOD OF CONTRACEPTION K
CONDOMS ARE TOO EXPENSIVE L
CONDOM NOT ON HAND M
COULDN'T FIND/GET A CONDOM N
CONDOMS ARE ASSOCIATED WITH STI'S O
CONDOMS ARE ASSOCIATED WITH CONTACT WITH PROSTITUTES Q
WANT TO CONCEIVE S
OTHER (SPECIFY) _____ X
DOESN'T KNOW OF CONDOMS Z

521. What is your relationship to this other man?
IF BOYFRIEND OR FIANC?, ASK: Was your boyfriend/fianc? living with you at the time you last had sexual intercourse with him?
IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

HUSBAND/LIVE-IN PARTNER 01 (GO TO 523)
BOYFRIEND/FIANC? 02
ANOTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
CLIENT (PROSTITUTION) 06
OTHER (SPECIFY) ____ 96

522. For how long have you had sexual relations with this other man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

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

523. In total, with how many people have you had sexual intercourse in the last 12 months?

NUMBER OF PARTNERS _____

523A. Have you ever received money, gifts or favors in exchange for sexual intercourse?

YES 1
NO 2 (GO TO 524)

523B. How long has it been since you have had sexual intercourse in exchange for money, gifts or favors?

DAYS 1 ____
WEEKS 2 ____
MONTHS 3 ___
YEARS 4 ___
DOESN'T REMEMBER 998

523C. The last time you had sexual intercourse in exchange for money, gifts or favors, was a condom used?

YES 1
NO 2

524. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 527)

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

IF IT IS A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

NAME OF PLACE _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
GROUND AGENT E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
GROUND AGENT K
OTHER PRIVATE (SPECIFY) ____L
OTHER LOCATION
STORE M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _____ X

526. If you wanted to, could you get yourself a condom?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 601)

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

IF IT IS A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

NAME OF PLACE _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
GROUND AGENT E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
GROUND AGENT K
OTHER PRIVATE (SPECIFY) ____L
OTHER LOCATION
STORE/KIOSK M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

SECTION 6: FERTILITY PREFERENCES

601. CHECK 311/311A:

NEITHER HE NOR SHE STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602. CHECK 226:

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

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DOESN'T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DOESN'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 608)

603. CHECK 226:

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

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

MONTHS 1 ___
YEARS 2 ___

SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) ______ 996 (GOT O 609)
DOESN'T KNOW 998 (GO TO 609)

604. CHECK 226:

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

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEARS (GO TO 610)

607. CHECK 602:

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

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

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

608. In the weeks to come, if you were to discover that you were pregnant, would it be an important problem, a small problem, or would it not be a problem at all?

IMPORTANT PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/CAN'T HAVE SEX 4

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

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

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

611. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTIONS 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMEN. METHOD 11 (GO TO 614)
RHYTHM METHOD 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER METHOD (SPECIFY) _____ 96 (GO TO 614)
NOT SURE 98 (GO TO 614)

612. What is the main reason that you think you will not use a contraceptive method at any time in the near or distant future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) ______ 96 (GO TO 614)
DOESN'T KNOW 98 (GO TO 614)

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

YES 1
NO 2
DOESN'T KNOW 8

614. CHECK 216:

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

NO LIVING CHILDREN If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NUMBER_____
OTHER (SPECIFY) _____ 96 (GO TO 616)

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

BOYS ____

GIRLS ____

EITHER ____

OTHER (SPECIFY) ____ 96

616. Would you say that you approve or disapprove of couples that use a method to avoid becoming pregnant?

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW/NOT SURE 3

616A. Do you know couples that use a method to avoid becoming pregnant?

YES 1
NO 2

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

a) On the radio?
YES 1
NO 2
b) On the radio show "TOKY SY ANTOKA"?
YES 1
NO 2
c) On television?
YES 1
NO 2
d) In newspapers or magazines?
YES 1
NO 2
e) On posters?
YES 1
NO 2
f) From peer educators?
YES 1
NO 2
g) At performances?
YES 1
NO 2
h) At the mobile cinema?
YES 1
NO 2
i) In the movie "BAKAPILESY"?
YES 1
NO 2

618. In your opinion, is it appropriate or inappropriate to speak of family planning:

On the radio?
APPROPRIATE 1
INAPPROPRIATE 2
On television?
APPROPRIATE 1
INAPPROPRIATE 2
In newspapers or magazines?
APPROPRIATE 1
INAPPROPRIATE 2
On posters?
APPROPRIATE 1
INAPPROPRIATE 2
In brochures?
APPROPRIATE 1
INAPPROPRIATE 2
At educational or cultural performances?
APPROPRIATE 1
INAPPROPRIATE 2
At school?
APPROPRIATE 1
INAPPROPRIATE 2

619. Over the last several months, have you discussed family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

620. With whom did you discuss it?
Anyone else?
RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
MOTHER-IN-LAW H
FRIEND(S)/NEIGHBOR(S) I
HEALTH WORKERS J
PEER EDUCATORS K
OTHER (SPECIFY) ______ X

621. CHECK 501:

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

622. CHECK 311/311A:

CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623. You have said that you are currently using a method of contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?

DECISION OF RESPONDENT 1
DECISION OF HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _____ 6

Now I would like to ask you some questions about your husband's/partner's opinions on family planning.

624. Do you think that your husband/partner approves or disapproves of couples that use a method to avoid a pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

625. How many times over the last 12 months have you discussed family planning with your husband/partner?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 3

626. CHECK 311/311A:

NEITHER HE OR NOR SHE STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627. Do you think that your husband/partner want the same number of children that you want, or does he want more or fewer than you want?

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

628. Husbands and wives don't always agree on everything. Please, tell me if you think a woman is justified in refusing to have sexual intercourse with her husband when:

She knows that her husband has a sexually transmitted infection?
YES 1
NO 2
DOESN'T KNOW 8
She knows that her husband has sexual intercourse with other women?
YES 1
NO 2
DOESN'T KNOW 8
She has recently given birth?
YES 1
NO 2
DOESN'T KNOW 8
She is tired or doesn't feel like it?
YES 1
NO 2
DOESN'T KNOW 8

SECTION 7: HUSBAND'S BACKGROUND AND WOMAN'S WORK

701. CHECK 501 AND 502:

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

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

AGE IN COMPLETED YEARS ____

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

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended: primary, middle school, high school, or higher?

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 4
DOESN'T KNOW 8 (GO TO 706)

705. What was the highest grade he completed at that level?
WRITE '0' FOR LESS THAN ONE YEAR COMPLETED.

GRADE ____
DOESN'T KNOW 98
0 LESS THAN ONE YEAR COMPLETED (FOR ALL LEVELS)
PRIMARY
1 1ST GRADE
2 2ND GRADE
3 3RD GRADE
4 4TH GRADE
5 5TH GRADE
8 DOESN'T KNOW
MIDDLE SCHOOL
1 6TH GRADE
2 7TH GRADE
3 8TH GRADE
4 9TH GRADE
8 DOESN'T KNOW
HIGH SCHOOL
1 10TH GRADE
2 11TH GRADE
3 12TH GRADE
8 DOESN'T KNOW
POST-SECONDARY
ONE YEAR 1
TWO YEARS 2
THREE YEARS 3
FOUR YEARS 4
FIVE OR MORE YEARS 5
DOESN'T KNOW 8

706. CHECK 701:

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

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

OCCUPATION _____

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

YES 1 (GO TO 710)
NO 2

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

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 719)

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

OCCUPATION ______

711. CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

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

HOME 1
AWAY 2

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

716. Are you paid in cash or kind for this work, or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

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

718. On average, what percentage of the household expenses are paid for using the money you earn?

ALMOST NOTHING 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL OF THEM 5
NONE, ALL HER EARNINGS ARE KEPT 6

719. In your family, who usually has the last word in the following decisions:

Your own health care?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
SOMEONE ELSE AND RESPONDENT JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
The purchase of important household items?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
SOMEONE ELSE AND RESPONDENT JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
The purchase of daily household items?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
SOMEONE ELSE AND RESPONDENT JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Visiting family or relatives?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
SOMEONE ELSE AND RESPONDENT JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
What food will be prepared each day?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
SOMEONE ELSE AND RESPONDENT JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

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

CHILDREN UNDER 10 YEARS
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DOESN'T KNOW 8
If she neglects the children?
YES 1
NO 2
DOESN'T KNOW 8
If she argues with him?
YES 1
NO 2
DOESN'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DOESN'T KNOW 8
If she burns the food?
YES 1
NO 2
DOESN'T KNOW 8

SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

Now I would like to talk about something else.

801. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 817)

802. Is there something people can do to avoid contracting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 809)
DOESN'T KNOW 8 (GO TO 809)

803. What can one do? Anything else?
RECORD ALL MENTIONED.

ABSTAIN FROM HAVING SEX A
USE CONDOMS B
ONLY HAVE SEX WITH ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PEOPLE WITH LOTS OF PARTNERS F
AVOID SAME-PARTNER SEX G
AVOID SEX WITH PEOPLE WHO USE IV DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL HEALERS N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

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

YES 1
NO 2
DOESN'T KNOW 8

805. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

808. Can people protect themselves from getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

810. Do you personally know anyone who has the AIDS virus or is sick from AIDS, or someone who has died of AIDS?

YES 1
NO 2

811. Can the virus that causes AIDS be transmitted from a mother to her baby?

YES 1
NO 2 (GO TO 813B)
DOESN'T KNOW 8 (GO TO 813B)

812. When can the AIDS virus be transmitted from the mother to the child? Can it be transmitted:

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

813B. According to you, do you run a significant risk, moderate risk, small risk or no risk at all in contracting the virus that causes AIDS?

SIGNIFICANT 1 (GO TO 813D)
MODERATE 2 (GO TO 813D)
SMALL 3
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 817)
DOESN'T KNOW 8 (GO TO 813)

813C. CHECK 813B:

SMALL RISK Why do you think that you run a small risk of contracting the virus that causes AIDS? Are there other reasons?

NO RISK Why do you think that you run no risk of contracting the virus that causes AIDS?
Are there other reasons?

RECORD ALL MENTIONED.

ABSTAINS FROM SEX A (GO TO 813)
USES CONDOMS B (GO TO 813)
ONLY HAS SEX WITH ONE PARTNER C (GO TO 813)
LIMITS NUMBER OF SEXUAL PARTNERS D (GO TO 813)
PARTNER IS FAITHFUL E (GO TO 813)
AVOIDS SEX WITH PEOPLE WITH LOTS OF PARTNERS G (GO TO 813)
AVOIDS SAME-PARTNER SEX H (GO TO 813)
AVOIDS SEX WITH PEOPLE WHO USE IV DRUGS I (GO TO 813)
AVOIDS BLOOD TRANSFUSIONS J (GO TO 813)
AVOIDS INJECTIONS K (GO TO 813)
AVOIDS KISSING L (GO TO 813)
AVOIDS MOSQUITO BITES M (GO TO 813)
AVOIDS SHARING RAZORS/BLADES N (GO TO 813)
OTHER (SPECIFY) _____ W (GO TO 813)
OTHER (SPECIFY) ______X (GO TO 813)
DOESN'T KNOW Z (GO TO 813)

813D. CHECK 813B:

MODERATE RISK Why do you think that you run a moderate risk of contracting the virus that causes AIDS? Are there other reasons?

SIGNIFICANT RISK Why do you think that you run a significant risk of contracting the virus that causes AIDS? Are there other reasons?

RECORD ALL MENTIONED.

DOESN'T USE CONDOMS B
DOESN'T LIMIT SEX TO ONE PARTNER/UNFAITHFUL TO PARTNER C
HAS A NUMBER OF SEXUAL PARTNERS D
PARTNER IS UNFAITHFUL E
PROSTITUTES HERSELF F
HAS SEX WITH PEOPLE WITH LOTS OF PARTNERS G
HAS SAME-PARTNER SEX H
HAS SEX WITH PEOPLE WHO USE IV DRUGS I
HAS BLOOD TRANSFUSIONS J
GETS INJECTIONS K
KISSING L
BITTEN BY MOSQUITOS M
SHARES RAZORS/BLADES N
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

813. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 814)
NO, NOT CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 815A)

814. Have you already spoken with your husband/partner about ways to avoid the AIDS virus?

YES 1
NO 2

815A. In your opinion, is it appropriate or inappropriate to speak of AIDS:

a) On the radio?
APPROPRIATE 1
INAPPROPRIATE 2
b) On the radio show "Protector Times"?
APPROPRIATE 1
INAPPROPRIATE 2
c) On television?
APPROPRIATE 1
INAPPROPRIATE 2
d) In newspapers or magazines?
APPROPRIATE 1
INAPPROPRIATE 2
e) On posters?
APPROPRIATE 1
INAPPROPRIATE 2
f) By peer educators?
APPROPRIATE 1
INAPPROPRIATE 2
g) At educational or cultural performances?
APPROPRIATE 1
INAPPROPRIATE 2
h) At the mobile cinema?
APPROPRIATE 1
INAPPROPRIATE 2
i) In the movie "BAKAPILESY"?
APPROPRIATE 1
INAPPROPRIATE 2

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

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

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

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

816A. Should people infected with the AIDS virus who work with other people in shops, offices and on farms be authorized to continue their work or not?

CAN CONTINUE TO WORK 1
CANNOT CONTINUE TO WORK 2
DOESN'T KNOW/NOT SURE/DEPENDS 8

816B. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

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

816C. Have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 816D)

816C1.When was the last time you were tested for the AIDS virus?

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

816C2. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

816C3. I don't want to know the results, but did you get the results of the test?

YES 1 (GO TO 816FX)
NO 2 (GO TO 816FX)

816D. Would you like to get tested for AIDS?

YES 1
NO 2
DOESN'T KNOW/NOT SURE 8

816E. Do you know of a place where you can get tested for the AIDS virus?

YES 1
NO 2 (GO TO 817)

816F. Where can you go for this test?
816FX. Where did you go for this test?
RECORD ALL MENTIONED.

IF IT'S A HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_________
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] A
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] B
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] C
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] D
OTHER PUBLIC (SPECIFY) _____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PIF/FISA CENTER J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER LOCATION
VBC AGENT L
STORE M
KIOSK N
TRADITIONAL HEALER O
OTHER (SPECIFY) _____ X

817. Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 901)

818. What are the signs or symptoms in a man that make you think he may have a sexually transmitted infection? INSIST: Anything else?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING DURING URINATION D
RASH/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
IMPOTENCE L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y
DOESN'T KNOW Z

819. What are the signs or symptoms in a woman that make you think she may have a sexually transmitted infection? Anything else?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING DURING URINATION D
RASH/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
DIFFICULTY GETTING PREGNANT/HAVING CHILDREN L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) ______ X
NO SYMPTOMS Y (GO TO 819B)
DOESN'T KNOW Z (GO TO 819B)

819A. If you had any of these symptoms, where would you go for advice or care?

PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] 11
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] 12
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] 13
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DISPERSAL CENTER 23
PRIVATE DOCTOR 24
PIF/FISA CENTER 25
OTHER LOCATION
VBC AGENT 31
STORE 32
KIOSK 33
CHURCH 34
TRADITIONAL HEALER 35
RELATIVES/FRIENDS 36
OTHER (SPECIFY) _____ 96

819B. CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 819C)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

Now I would like to ask you some questions about your health in the last 12 months.

819C. During the last 12 months, have you had a sexually transmitted infection?

YES 1
NO 2
DOESN'T KNOW 8

819D. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DOESN'T KNOW 8

819E. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DOESN'T KNOW 8

819F. CHECK 819C, 819D, AND 819E:

HAD HAD AN INFECTION
HAS NOT HAD AN INFECTION (GO TO 901)

819G. The last time you had (INFECTION FROM 819C/819D/819E), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 819I)

819H. The last time you had (INFECTION FROM 819C/819D/819E), did you do any of the following things? Did you...

Seek advice from a health care worker in a hospital or clinic?
YES 1
NO 2
Seek advice or treatment from a traditional healer?
YES 1
NO 2
Seek advice or buy medication from a pharmacy or store?
YES 1
NO 2
Seek advice from family or friends?
YES 1
NO 2

819I. When you had (INFECTION FROM 819C/819D/819E), did you inform your sexual partner(s)?

YES 1
NO 2
CERTAIN ONES/NOT AT ALL 3

819J. When you had (INFECTION FROM 819C/819D/819E), did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 901)
PARTNER ALREADY INFECTED 3 (GO TO 901)

819K. What did you do to avoid infecting your partner(s)? Did you...

Stop having sexual intercourse?
YES 1
NO 2
Use a condom during sexual intercourse?
YES 1
NO 2
Take medication?
YES 1
NO 2

SECTION 9: MATERNAL MORTALITY

Now, I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother including those that live with you, those that live elsewhere, and those that are deceased.

901. To how many children did your mother give birth in total, including yourself?

NATURAL MOTHER'S NUMBER OF BIRTHS ____

902. CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT) (GO TO 914)

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

NUMBER OF PRECEDING BIRTHS ______

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

NAME _______

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DOESN'T KNOW 8 (GO TO NEXT BIRTH)

907. How old is (NAME)?

AGE _____ (GO TO NEXT COLUMN)

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

_____

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

AGE _____

910. Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911. Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2

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

_______ (GO TO NEXT BIRTH. IF NO MORE BROTHERS OR SISTERS, GO TO 914)

914. RECORD THE TIME.

HOURS ___
MINUTES ____

INSTRUCTIONS

ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

BIRTHS AND PREGNANCIES?
[ASK THIS QUESTION FOR ALL MONTHS FROM 1998 THROUGH 2004]

[MONTH] _______
[YEAR] _______
N BIRTH
G PREGNANCY
F END OF PREGNANCY

END OF THE LAST PREGNANCY THAT DID NOT TERMINATE IN A LIVE BIRTH BEFORE JANUARY 1998. IF THERE ARE NO PREGNANCIES OF THIS KIND, RECORD '00' FOR THE MONTH AND '0000' FOR THE YEAR.

MONTH ___
YEAR ____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT ______

COMMENTS ON SPECIFIC QUESTIONS ______

ANY OTHER COMMENTS ______

SUPERVISOR'S OBSERVATIONS ______
NAME OF SUPERVISOR ______
DATE______

EDITOR'S OBSERVATIONS ______
NAME OF EDITOR ______
DATE_____