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MADAGASCAR DEMOGRAPHIC AND HEALTH SURVEY - WOMEN'S QUESTIONNAIRE 2008-2009

IDENTIFICATION

PLACE NAME ______
NAME OF HOUSEHOLD HEAD _______
CLUSTER NUMBER _______
SEQUENTIAL NUMBER OF THE HOUSEHOLD WITHIN THE CLUSTER _______
BUILDING NUMBER _______
HOUSEHOLD UNIT NUMBER _______
REGION ______
VILLAGE ______

ANTANANARIVO/OTHER CITY/RURAL AREA?

ANTANANARIVO 1
OTHER CITY 2
RURAL 3

NAME AND LINE NUMBER OF RESPONDENT:

NAME ______
LINE NUMBER ______

INTERVIEWER 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 ______
INTERVIEW NUMBER ______
RESULT ______

TOTAL NUMBER OF VISITS _____

SUPERVISOR
NAME ______
DATE ______

FIELD EDITOR
NAME ______
DATE ______

OFFICE EDITOR ______
KEYED BY ______

SECTION 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

INTRODUCTION AND CONSENT

CONSENT AFTER INFORMATION:
Hello. My name is _____ and I am working with (NAME OF ORGANIZATION). We are in the process of conducting a national survey during which we ask women (and men) questions about health-related problems. We would very much appreciate your participation in this survey. This information will be very useful to the government in order to put health services in place. The survey usually takes between 30 and 60 minutes to complete. The information you will give us is strictly confidential and will not be shared with anyone other than the survey team.

Participation in this survey is completely voluntary. If we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope 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 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME:

HOUR _____
MINUTES _____

102. 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 106)
VISITOR 96 (GO TO 106)

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

CITY 1
TOWN 2
COUNTRYSIDE 3

106. In what month and year were you born?

MONTH ______
DOESN'T KNOW MONTH 98
YEAR _____
DOESN'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS ____

108. Have you ever attended school?

YES 1
NO 2 (GO TO 112)

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

PRIMARY 1
MIDDLE SCHOOL 2
HIGH SCHOOL 3
HIGHER 4

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

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
1 ONE YEAR
2 TWO YEARS
3 THREE YEARS
4 FOUR YEARS
5 FIVE OR MORE YEARS
8 DOESN'T KNOW

111. CHECK 109:

PRIMARY (GO TO 112)
SECONDARY OR HIGHER (GO TO 115)

112. 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 4
BLIND/VISUALLY IMPAIRED 5

113. Have you ever participated in a literacy program or any other program that involves learning to read or write (NOT INCLUDING PRIMARY SCHOOL)?

YES 1
NO 2

114. CHECK 112:

CODE '2', '3', OR '4' CIRCLED (GO TO 115)
CODE '1' OR '5' CIRCLED (GO TO 116)

115. 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

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

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

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

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

118. 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

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 or daughters to whom you have given birth and 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 and 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 NEXT BIRTH)

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

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

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

YES 1 (ADD BIRTH)
NO 2 (GO TO NEXT BIRTH)

[GO BACK AND REPEAT 212-221 FOR ALL OTHER BIRTHS]

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 THE SAME:
CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED ___
CHECK: FOR EACH BIRTH SINCE JANUARY 2003: MONTH AND YEAR OF BIRTH ARE RECORDED ___
CHECK: FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED ___
CHECK: FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED ___
CHECK: 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 2003 OR LATER.
IF NONE, RECORD '0' AND GO TO 226.

NUMBER OF BIRTHS ___

224A. CHECK 215:
DATE OF BIRTH?

AT LEAST ONE CHILD BORN IN 1997 OR LATER (GO TO 224B)
NO CHILDREN BORN IN 1997 OR LATER (GO TO 225)

224B. CHECK 220 FOR EACH CHILD BORN IN 1997 OR LATER:

AT LEAST ONE CHILD WHO DIED BEFORE THE AGE OF SIX (GO TO 224C)
NO CHILDREN WHO DIED BEFORE THE AGE OF SIX (GO TO 225)

224C. We would like to obtain more information on the circumstances of the child(ren) who died before the age of six so that the government can provide health services to reduce these deaths. It is possible that another member of our team will come at a later time to interview you or other members of your household concerning the deaths you've already told me about during this interview.

May a member of our survey team come back to talk to you?

SIGNATURE OF THE INTERVIEWER __________
DATE _____

RESPONDENT ACCEPTS 1
RESPONDENT DECLINES 2

225. FOR EACH BIRTH SINCE JANUARY 2003, WRITE 'N' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'N' CODE. 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.)

226. Are you pregnant now?

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

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 2003 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 2003 (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. Since January 2003, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 235)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2003. ENTER 'F' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'G' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any miscarriages, abortions or stillbirths that ended before 2003?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before January 2003 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.

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

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 '1' IF METHOD IS RECOGNIZED, AND CODE '2' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' CIRCLED IN 301, ASK 302.

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
05. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for up to three months.
YES 1
NO 2 (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 1
NO 2 (GO TO NEXT METHOD)
07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08. FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09. LACTATIONAL AMENORRHEA METHOD (LAM): For up to six months after giving birth, a woman can use this method which requires breastfeeding often, day and night, so that her menstrual cycle does not return.
YES 1
NO 2 (GO TO NEXT METHOD)
10. 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 (GO TO NEXT METHOD)
11. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
12. EMERGENCY CONTRACEPTION: As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2 (GO TO NEXT METHOD)
13. NECKLACE METHOD: A method involving moving a ring on a necklace each day from one pearl to the next, counting from the first day of her period. Using this necklace, the woman can know the days of the month where she is more likely to become pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
14. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY) _______
YES 1
NO 2

302. Have you ever used (METHOD)?
THIS QUESTION IS ASKED ABOUT EACH METHOD IN 301 WITH THE '1' 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 spouse/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.
YES 1
NO 2
05. INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for up to three 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 sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. LACTATIONAL AMENORRHEA METHOD (LAM): For up to six months after giving birth, a woman can use this method which requires breastfeeding often, day and night, so that her menstrual cycle does not return.
YES 1
NO 2
10. 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
11. WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
12. EMERGENCY CONTRACEPTION: As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2
13. NECKLACE METHOD: A method involving moving a ring on a necklace each day from one pearl to the next, counting from the first day of her period. Using this necklace, the woman can know the days of the month where she is more likely to become pregnant.
YES 1
NO 2
14. OTHER METHOD (SPECIFY) _____
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 304)
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 (GO TO 306)
NO 2

305. ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH (GO TO 333)

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 any?
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 322)

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

YES 1
NO 2 (GO TO 322)

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

FEMALE STERILIZATION A (GO TO 316)
MALE STERILIZATION B (GO TO 316)
PILL C
IUD D (GO TO 315)
INJECTABLES E (GO TO 315)
IMPLANTS F (GO TO 315)
CONDOM G
FEMALE CONDOM H (GO TO 315)
DIAPHRAGM I (GO TO 315)
FOAM/JELLY J (GO TO 315)
LACTATIONAL AMENORRHEA METHOD K (GO TO 319A)
RHYTHM METHOD L (GO TO 319A)
WITHDRAWAL M (GO TO 319A)
OTHER (SPECIFY) ______ X (GO TO 319A)

311A. CIRCLE 'A' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION A (GO TO 316)
MALE STERILIZATION B (GO TO 316)
PILL C
IUD D (GO TO 315)
INJECTABLES E (GO TO 315)
IMPLANTS F (GO TO 315)
CONDOM G
FEMALE CONDOM H (GO TO 315)
DIAPHRAGM I (GO TO 315)
FOAM/JELLY J (GO TO 315)
LACTATIONAL AMENORRHEA METHOD K (GO TO 319A)
RHYTHM METHOD L (GO TO 319A)
WITHDRAWAL M (GO TO 319A)
OTHER (SPECIFY) ______ X (GO TO 319A)

312. RECORD IF CODE 'C' FOR PILL IS CIRCLED IN 311.

YES (USING PILL): May I see the package of pills you are using?

NO (USING CONDOM BUT NOT PILL): May I see the package of condoms you are using?

RECORD NAME OF BRAND IF PACKAGE SEEN.

PACKAGE SEEN 1
BRAND NAME (SPECIFY) ___ (GO TO 314)
PACKAGE NOT SEEN 2

313. Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

BRAND NAME (SPECIFY) ______
DOESN'T KNOW 98

314. How many (pill cycles/condoms) did you get last time?

NUMBER OF PILL CYCLES/CONDOMS ___
DOESN'T KNOW 998

315. The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST _____ (GO TO 319A)

FREE 9995 (GO TO 319A)
DOESN'T KNOW 9998 (GO TO 319A)

316. In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

NAME OF THE PLACE ______
PUBLIC SECTOR
DISTRICT HOSPITAL II (facility equipped for surgeries) 11
DISTRICT HOSPITAL I (non-surgical medical capabilities) 12
UNIVERSITY/REGIONAL HOSPITAL 13
BASIC HEALTH CENTER II (basic health care, physician-run) 14
BASIC HEALTH CENTER I (basic health care, run by para-medical officer) 15
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

317. CHECK 311/313A:

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 'A' NOT 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

318. How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?

COST _____

FREE 9995
DOESN'T KNOW 9998

319. In what month and year was the sterilization performed?
319A. Since what month and year have you been using (CURRENT METHOD) without stopping?

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

MONTH _____
YEAR _____

320. CHECK 319/319A, 215, AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A:

YES (GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION))

NO (GO TO 321)

321. CHECK 319/319A:

YEAR IS 2003 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OR INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.

YEAR IS 2002 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2003. (GO TO 331)

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2003. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. ENTER THE CODE FOR THE METHOD USED OR '0' FOR NONUSE IN EACH BLANK MONTH.

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

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

NO CODE CIRCLED 00 (GO TO 333)
FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
NECKLACE METHOD 11
LACTATIONAL AMENORRHEA METHOD 12 (GO TO 324A)
RHYTHM METHOD 13 (GO TO 324A)
WITHDRAWAL 14 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

324. Where did you obtain (CURRENT METHOD) when you started using it?
324A. Where did you learn how to use the necklace/lactational amenorrhea/rhythm method?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _______
PUBLIC SECTOR
DISTRICT HOSPITAL II (facility equipped for surgeries) 11
DISTRICT HOSPITAL I (non-surgical medical capabilities) 12
UNIVERSITY/REGIONAL HOSPITAL 13
BASIC HEALTH CENTER II (basic health care, physician-run) 14
BASIC HEALTH CENTER I (basic health care, run by para-medical officer) 15
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE MOBILE CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
FAMILY PLANNING CENTER 25
OTHER SOURCE
FIELDWORKER 31
MEDIA SPOTS 32
STORE 33
KIOSK 34
CHURCH 35
FRIEND/RELATIVE 36
OTHER (SPECIFY) _____ 96

325. CHECK 311/313A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 332)
FEMALE CONDOM 08 (GO TO 329)
DIAPHRAGM 09 (GO TO 329)
FOAM/JELLY 10 (GO TO 329)
NECKLACE METHOD 11 (GO TO 329)
LACTATIONAL AMENORRHEA METHOD 12 (GO TO 335)
RHYTHM METHOD 13 (GO TO 335)

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

YES 1 (GO TO 328)
NO 2

327. 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 329)

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

YES 1
NO 2

329. CHECK 326:

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

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

YES 1 (GO TO 331)
NO 2

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

YES 1
NO 2

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

FEMALE STERILIZATION 01 (GO TO 335)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
NECKLACE METHOD 11
LACTATIONAL AMENORRHEA METHOD 12 (GO TO 335)
RHYTHM METHOD 13 (GO TO 335)
WITHDRAWAL 14 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

332. Where did you obtain (current method) the last time?

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

NAME OF PLACE ______
PUBLIC SECTOR
DISTRICT HOSPITAL II (facility equipped for surgeries) 11 (GO TO 335)
DISTRICT HOSPITAL I (non-surgical medical capabilities) 12 (GO TO 335)
BASIC HEALTH CENTER II (basic health care, physician-run) 13 (GO TO 335)
BASIC HEALTH CENTER I (basic health care, run by para-medical officer) 14 (GO TO 335)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 335)
PRIVATE MOBILE CLINIC 22 (GO TO 335)
PHARMACY 23 (GO TO 335)
PRIVATE DOCTOR 24 (GO TO 335)
FAMILY PLANNING CENTER 25 (GO TO 335)
OTHER SOURCE
FIELDWORKER 31 (GO TO 335)
STORE 32 (GO TO 335)
KIOSK 33 (GO TO 335)
CHURCH 34 (GO TO 335)
FRIEND/RELATIVE 35 (GO TO 335)
OTHER (SPECIFY) _____ 96 (GO TO 335)

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

YES 1
NO 2 (GO TO 335)

334. Where is that?
Any other place?

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

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 MOBILE CLINIC F
PHARMACY G
PRIVATE DOCTOR H
FAMILY PLANNING CENTER I
OTHER SOURCE
FIELDWORKER J
STORE K
KIOSK L
CHURCH M
FRIEND/RELATIVE N
OTHER (SPECIFY) ______ X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

337. During any of these occasions, did any staff member at the health facility speak to you about family planning methods?

YES 1
NO 2

SECTION 4: PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2003 OR LATER (GO TO 402)
NO BIRTHS IN 2003 OR LATER (GO TO 576)

402. CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OR EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL 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.)

[403-471 ARE REPEATED FOR EACH BIRTH, BEGINNING WITH THE MOST RECENT BIRTH. IF MORE THAN 3 BIRTHS, USE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES.]

403. LINE NUMBER FROM 212:

LINE NUMBER ___

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 (MOST RECENT BIRTH, GO TO 407; OTHERS, GO TO 432)
LATER 2
NOT AT ALL 3 (MOST RECENT BIRTH, GO TO 407; OTHERS, GO TO 432)

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 ONLY FOR MOST RECENT BIRTH]

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 414)

408. Where did you receive antenatal care for this pregnancy?
Anywhere else?
[ASK ONLY FOR MOST RECENT BIRTH]

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

NAME OF PLACE(S) _______
HOME
RESPONDENT'S HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
OTHER PUBLIC (SPECIFY) _______ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
OTHER PRIVATE MEDICAL (SPECIFY) _______ G
OTHER (SPECIFY) _______ X

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

MONTHS_____
DOESN'T KNOW 98

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

NUMBER OF TIMES_____
DOESN'T KNOW 98

411. As part of your antenatal care during this pregnancy, were any of the following done at least once?
[ASK ONLY FOR MOST RECENT BIRTH]

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

WEIGHED?
YES 1
NO 2
BLOOD PRESSURE MEASURED?
YES 1
NO 2
URINE SAMPLE?
YES 1
NO 2
BLOOD SAMPLE?
YES 1
NO 2

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

YES 1
NO 2 (GO TO 414)
DOESN'T KNOW 8 (GO TO 414)

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

YES 1
NO 2
DOESN'T KNOW 8

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

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

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

TIMES ___
DOESN'T KNOW 8

416. CHECK 415:
[ASK ONLY FOR MOST RECENT BIRTH]

TWO OR MORE TIMES (GO TO 421)
OTHER (GO TO 417)

417. At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 421)
DOESN'T KNOW 8 (GO TO 421)

418. Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF INJECTIONS ____
DOESN'T KNOW 8

419. In what month and year did you receive the last tetanus injection before this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

MONTH _____
DOESN'T KNOW MONTH 98
YEAR _____ (GO TO 421)
DOESN'T KNOW YEAR 9998

420. How many years ago did you receive that tetanus injection?
[ASK ONLY FOR MOST RECENT BIRTH]

YEARS AGO ___

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

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

422. During the whole pregnancy, for how many days did you take the tablets?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]

DAYS_____
DOESN'T KNOW 998

423. During this pregnancy, did you take any drug for intestinal worms?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 432)
DOESN'T KNOW 8 (GO TO 432)

427. What drugs did you take?

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

[ASK ONLY FOR MOST RECENT BIRTH]

SP/FANSIDAR A
CHLOROQUINE B
QUININE C
OTHER (SPECIFY) ______ X
DOESN'T KNOW Z

428. CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION?
[ASK ONLY FOR MOST RECENT BIRTH]

CODE 'A' CIRCLED (GO TO 429)
CODE 'A' NOT CIRCLED (GO TO 432)

429. How many times did you take SP/Fansidar during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF TIMES ___

430. CHECK 407:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY?
[ASK ONLY FOR MOST RECENT BIRTH]

CODE 'A', OR 'B' CIRCLED (GO TO 431)
OTHER (GO TO 432)

431. Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source?
[ASK ONLY FOR MOST RECENT BIRTH]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

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

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

433. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 435)
DOESN'T KNOW 8 (GO TO 435)

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

KILOGRAMS FROM CARD 1 ___
KILOGRAMS FROM RECALL 2 ___

DOESN'T KNOW 99.998

435. 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

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

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

NAME OF PLACE _____
HOME
RESPONDENT'S HOME 11 (MOST RECENT BIRTH: GO TO 443, OTHERS, GO TO 444)
OTHER HOME 12 (MOST RECENT BIRTH: GO TO 443, OTHERS, GO TO 444)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) ______ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) ______ 36
OTHER (SPECIFY) _____ 96 (MOST RECENT BIRTH: GO TO 443, OTHERS, GO TO 444)

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

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DOESN'T KNOW 998

438. Was (NAME) delivered by caesarean section?

YES 1
NO 2

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

YES 1 (FOR OTHERS, GO TO 455)
NO 2 (FOR MOST RECENT BIRTH, GO TO 442)

440. How long after delivery did the first check take place?

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

[ASK ONLY FOR MOST RECENT BIRTH]

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DOESN'T KNOW 998

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

[ASK ONLY FOR MOST RECENT BIRTH]

HEALTH PERSONNEL
DOCTOR 11 (GO TO 453)
NURSE/MIDWIFE/MEDICAL ASSISTANT 12 (GO TO 453)
OTHER PERSON
TRAINED TRADITIONAL BIRTH ASSISTANT 21 (GO TO 453)
UNTRAINED TRADITIONAL BIRTH ASSISTANT 22 (GO TO 453)
OTHER (SPECIFY) ______ 96 (GO TO 453)

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

YES 1 (GO TO 445)
NO 2 (FOR MOST RECENT BIRTH, GO TO 453)

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

[ASK ONLY FOR MOST RECENT BIRTH]

COSTS TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DOESN'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) ______ X

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

YES 1
NO 2 (FOR MOST RECENT BIRTH, GO TO 449)

445. How long after delivery did the first check take place?

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

[ASK ONLY FOR MOST RECENT BIRTH]

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DOESN'T KNOW 998

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

[ASK ONLY FOR MOST RECENT BIRTH]

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

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

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

NAME OF PLACE ______
HOME
RESPONDENT'S HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT 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

448. CHECK 442:
[ASK ONLY FOR MOST RECENT BIRTH]

YES (GO TO 453)
NOT ASKED (GO TO 449)

449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 453)
DOESN'T KNOW 8 (GO TO 453)

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

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

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DOESN'T KNOW 998

451. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK ONLY FOR MOST RECENT BIRTH]

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

452. Where did the first check of (NAME) take place?
[ASK ONLY FOR MOST RECENT BIRTH]

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

NAME OF PLACE _______
HOME
RESPONDENT'S HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT 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

453. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1
NO 2
DOESN'T KNOW 8

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

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

455. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 459)

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

MONTHS_____
DOESN'T KNOW 98

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

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

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

YES 1
NO 2 (GO TO 460)

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

MONTHS_____
DOESN'T KNOW 98

460. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 467)

461. How long after birth did you first put (NAME) to the breast?

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

[ASK ONLY FOR MOST RECENT BIRTH]

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

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

YES 1
NO 2 (GO TO 464)

463. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

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

464. CHECK 404:
IS CHILD STILL LIVING?
[ASK ONLY FOR MOST RECENT BIRTH]

LIVING (GO TO 465)
DEAD (GO TO 466)

465. Are you still breastfeeding (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

YES 1 (GO TO 468)
NO 2

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

MOST RECENT BIRTH:

MONTHS___
DOESN'T KNOW 98

OTHER BIRTHS:

MONTHS____
STILL BREAST FEEDING 95
DOESN'T KNOW 98

467. Check 404:
IS CHILD STILL LIVING?

LIVING (GO TO 470)

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

468. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF NIGHTTIME FEEDINGS ____

469. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[ASK ONLY FOR MOST RECENT BIRTH]

NUMBER OF DAYTIME FEEDINGS ____

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

YES 1
NO 2
DOESN'T KNOW 8

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

SECTION 5: CHILD IMMUNIZATION AND CHILD'S AND WOMAN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)

502. LINE NUMBER FROM 212:

LINE NUMBER _____

503. FROM 212 AND 216:

NAME ______
LIVING (GO TO 504)
DEAD (SKIP TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, SKIP TO 573)

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

YES, SEEN (PAHASALAMANA) 1 (GO TO 506)
YES, SEEN (OTHER CARD) 2 (GO TO 506)
YES, NOT SEEN 3 (GO TO 508)
NO CARD 4

505. Did you ever have a vaccination card for (NAME)?
IF YES: Was it a Karinem Pahasalamana card?

YES, PAHASALAMANA 1 (GO TO 508)
YES, NOT PAHASALAMANA 2 (GO TO 508)
NO CARD 3 (GO TO 508)

506. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. (3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

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 _____
VITAMIN A (MOST RECENT)
DAY _____
MONTH _____
YEAR _____
VITAMIN A (2ND MOST RECENT)
DAY _____
MONTH _____
YEAR _____

506A. CHECK 506:

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

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 512)
NO 2 (GO TO 512)
DOESN'T KNOW 8) (GO TO 512)

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

YES 1
NO 2 (GO TO 512)
DOESN'T KNOW 8 (GO TO 512)

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

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

YES1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 509E)
DOESN'T KNOW 8 (GO TO 509E)

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

FIRST TWO WEEKS 1
LATER 2

509D. How many times was the polio vaccine received?

NUMBER OF TIMES_____

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

YES 1
NO 2 (GO TO 509G)
DOESN'T KNOW 8 (GO TO 509G)

509F. How many times was a DPT vaccination received?

NUMBER OF TIMES ___

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

YES 1
NO 2
DOESN'T KNOW 8

512. CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE:

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

513. According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (month and year of most recent dose from card). Has (NAME) received another Vitamin A dose since then?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1 (GO TO 515)
NO 2 (GO TO 516)
DOESN'T KNOW 8 (GO TO 516)

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

YES 1
NO 2 (GO TO 516)
DOESN'T KNOW 8 (GO TO 516)

515. Did (NAME) receive a vitamin A dose within the last six months?

YES 1
NO 2
DOESN'T KNOW 8

516. In the last seven days, did (name) take iron pills, sprinkles with iron, or iron syrup (like this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DOESN'T KNOW 8

517. Has (NAME) taken any drug for intestinal worms in the last six months?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 533)
DOESN'T KNOW 8 (GO TO 533)

519. Was there any blood in the stools?

YES 1
NO 2
DOESN'T KNOW 8

520. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breast milk). 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

521. 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

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

YES 1
NO 2 (GO TO 527)

523. Where did you seek advice or treatment? Anywhere else?

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

NAME OF PLACES ______
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
TOP NETWORK K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER LOCATION
VBC AGENT M
STORE N
KIOSK O
TRADITIONAL HEALER P
OTHER (SPECIFY) ______ X

524. CHECK 523:

TWO OR MORE CODES CIRCLED (GO TO 525)
ONLY ONE CODE CIRCLED (GO TO 526)

525. Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

FIRST PLACE ___

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

NUMBER OF DAYS ___

527. Does (NAME) still have diarrhea?

YES 1
NO 2
DOESN'T KNOW 8

528. 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 pre-packaged ORS liquid?
C) A government-recommended homemade fluid?

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

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

YES 1
NO 2 (GO TO 533)
DOESN'T KNOW 8 (GO TO 533)

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

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/HERBAL MEDICINE J
OTHER (SPECIFY) ______ X

531. CHECK 530:
GIVEN ZINC?

CODE 'C' CIRCLED (GO TO 532)
CODE 'C' NOT CIRCLED (GO TO 533)

532. How many times was (NAME) given zinc?

NUMBER OF TIMES _____
DOESN'T KNOW 98

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2 (GO TO 537)
DOESN'T KNOW 8 (GO TO 537)

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

YES 1
NO 2 (GO TO 538)
DOESN'T KNOW 8 (GO TO 538)

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

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

537. CHECK 533:
HAD FEVER?

YES (GO TO 538)

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

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

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

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

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

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

YES 1
NO 2 (GO TO 545)

541. Where did you seek advice or treatment?
Anywhere else?

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

NAME OF PLACE(S) ______
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
TOP NETWORK K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER LOCATION
VBC AGENT M
STORE N
KIOSK O
TRADITIONAL HEALER P
OTHER (SPECIFY) _______ X

542. CHECK 541:

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

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

FIRST PLACE _____

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

NUMBER OF DAYS_____

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

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

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

YES 1

NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

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

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

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COMBINATION WITH ARTEMISININ E
OTHER ANTI-MALARIAL (SPECIFY) ______ F
ANTIBIOTICS
PILL/SYRUP G
INJECTION H
OTHER DRUGS
ASPIRIN I
ACETAMINOPHEN J
IBUPROFEN K
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

548. CHECK 547:
ANY CODE A-G CIRCLED?

YES (GO TO 549)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

549. Did you already have (NAME OF DRUG FROM 547) at home when the child became ill? ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'G' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 547. IF 'YES' FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG. IF NO FOR ALL DRUGS, CIRCLE 'Y'.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COMBINATION WITH ARTEMISININ E
OTHER ANTI-MALARIAL F
ANTIBIOTICS
PILL/SYRUP G
NO DRUG AT HOME Y

550. CHECK 547:
ANY CODE A-F CIRCLED?

YES (GO TO 551)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

551. CHECK 547: SP/FANSIDAR (CODE 'A') GIVEN?

CODE 'A' CIRCLED (GO TO 552)
CODE 'A' NOT CIRCLED (GO TO 554)

552. How long after the fever started did (NAME) first take SP/Fansidar?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DOESN'T KNOW 8

553. For how many days did (NAME) take the SP/Fansidar?
IF 7 DAYS OR MORE, RECORD 7.

NUMBER OF DAYS_____
DOESN'T KNOW 8

554. CHECK 547:
CHLOROQUINE (CODE 'B') GIVEN?

CODE 'B' CIRCLED (GO TO 555)
CODE 'B' NOT CIRCLED (GO TO 557)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DOESN'T KNOW 8

556. For how many days did (NAME) take the Chloroquine?
IF 7 DAYS OR MORE, RECORD 7.

NUMBER OF DAYS____
DOESN'T KNOW 8

557. CHECK 547:
AMODIAQUINE (CODE 'C') GIVEN?

CODE 'C' CIRCLED (GO TO 558)
CODE 'C' NOT CIRCLED (GO TO 560)

558. How long after the fever started did (NAME) first take Amodiaquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DOESN'T KNOW 8

559. For how many days did (NAME) take the Amodiaquine?
IF 7 DAYS OR MORE, RECORD 7.

NUMBER OF DAYS____
DOESN'T KNOW 8

560. CHECK 547:
QUININE (CODE 'D') GIVEN?

CODE 'D' CIRCLED (GO TO 561)
CODE 'D' NOT CIRCLED (GO TO 563)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DOESN'T KNOW 8

562. For how many days did (NAME) take the quinine?
IF 7 DAYS OR MORE, RECORD 7.

NUMBER OF DAYS____
DOESN'T KNOW 8

563. CHECK 547:
COMBINATION WITH ARTEMISININ (CODE 'E') GIVEN?

CODE 'E' CIRCLED (GO TO 564)
CODE 'E' NOT CIRCLED (GO TO 569)

564. How long after the fever started did (NAME) first take Artemisinin?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DOESN'T KNOW 8

565. For how many days did (NAME) take the Artemisinin?
IF 7 DAYS OR MORE, RECORD 7.

NUMBER OF DAYS____
DOESN'T KNOW 8

569. CHECK 547:
OTHER ANTIMALARIAL (CODE 'F') GIVEN?

CODE 'F' CIRCLED (GO TO 570)
CODE 'F' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

570. How long after the fever started did (NAME) first take the other antimalarial?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DOESN'T KNOW 8

571. For how many days did (NAME) take the other antimalarial?
IF 7 DAYS OR MORE, RECORD 7.

NUMBER OF DAYS ___
DOESN'T KNOW 8

572. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573.

573. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2003 OR LATER LIVING WITH THE RESPONDENT:

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

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

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

575. CHECK 528(A) AND 528(B), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 576)

ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKED ORS LIQUID (GO TO 577)

576. Have you ever heard of a special product called ORS or a pre-packaged ORS liquid you can get for the treatment of diarrhea?

YES 1
NO 2

577. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT.

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

578. Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night. Did (NAME FROM 577) drink/eat:

Plain water?
Formula?
Baby cereal?
Other porridge/gruel?

PLAIN WATER
YES 1
NO 2
DOESN'T KNOW 8
FORMULA
YES 1
NO 2
DOESN'T KNOW 8
BABY CEREAL
YES 1
NO 2
DOESN'T KNOW 8
OTHER PORRIDGE/GRUEL
YES 1
NO 2
DOESN'T KNOW 8

579. Now I would like to ask you about (other) liquids/foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods. Did (NAME FROM 577)/you drink (eat):

A) Milk such as tinned, powdered or fresh animal milk?
B) Tea or coffee?
C) Any other liquids?
D) Bread, rice, noodles, or other foods made from grains?
E) Pumpkin, carrots, squash, or sweet potatoes that are yellow or orange inside?
F) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
G) Any dark green, leafy vegetables?
H) Mangoes or papayas?
I) Any other fruits or vegetables?
J) Liver, kidney, heart or other organ meats?
K) Any meat, such as beef, pork, lamb, goat, chicken or duck?
L) Eggs?
M) Fresh or dried fish or shellfish?
N) Any foods made from beans, peas, lentils or nuts?
O) Cheese, yogurt or other milk products?
P) Any oil, fats or butter, or foods made with any of these?
Q) Any sugary foods such as chocolates, sweets, candies, pastries, cakes or biscuits?
R) Any other solid or semi-solid food?

CHILD:

MILK
YES 1
NO 2
DOESN'T KNOW 8
TEA/COFFEE
YES 1
NO 2
DOESN'T KNOW 8
OTHER LIQUIDS
YES 1
NO 2
DOESN'T KNOW 8
BREAD, RICE, NOODLES, OR FOOD FROM GRAINS
YES 1
NO 2
DOESN'T KNOW 8
PUMPKIN, CARROTS, SQUASH, SWEET POTATOES
YES 1
NO 2
DOESN'T KNOW 8
WHITE POTATOES/YAMS, MANIOC, CASSAVA, OR FOODS FROM ROOTS
YES 1
NO 2
DOESN'T KNOW 8
DARK GREEN LEAFY VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
MANGOES OR PAPAYAS
YES 1
NO 2
DOESN'T KNOW 8
OTHER FRUITS OR VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
LIVER, KIDNEY, HEART, OR ORGAN MEATS
YES 1
NO 2
DOESN'T KNOW 8
ANY OTHER MEATS (BEEF, PORK, LAMB, GOAT, CHICKEN, DUCK)
YES 1
NO 2
DOESN'T KNOW 8
EGGS
YES 1
NO 2
DOESN'T KNOW 8
FRESH/DRIED FISH OR SHELLFISH
YES 1
NO 2
DOESN'T KNOW 8
FOOD FROM BEANS, PEAS, LENTILS, OR NUTS
YES 1
NO 2
DOESN'T KNOW 8
CHEESE, YOGURTS, OR OTHER MILK PRODUCTS
YES 1
NO 2
DOESN'T KNOW 8
OIL, FATS, OR BUTTER
YES 1
NO 2
DOESN'T KNOW 8
SUGARY FOODS
YES 1
NO 2
DOESN'T KNOW 8
OTHER SOLID OR SEMI-SOLID FOODS
YES 1
NO 2
DOESN'T KNOW 8

MOTHER (RESPONDENT):

MILK
YES 1
NO 2
DOESN'T KNOW 8
TEA/COFFEE
YES 1
NO 2
DOESN'T KNOW 8
OTHER LIQUIDS
YES 1
NO 2
DOESN'T KNOW 8
BREAD, RICE, NOODLES, OR FOOD FROM GRAINS
YES 1
NO 2
DOESN'T KNOW 8
PUMPKIN, CARROTS, SQUASH, SWEET POTATOES
YES 1
NO 2
DOESN'T KNOW 8
WHITE POTATOES/YAMS, MANIOC, CASSAVA, OR FOODS FROM ROOTS
YES 1
NO 2
DOESN'T KNOW 8
DARK GREEN LEAFY VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
MANGOES OR PAPAYAS
YES 1
NO 2
DOESN'T KNOW 8
OTHER FRUITS OR VEGETABLES
YES 1
NO 2
DOESN'T KNOW 8
LIVER, KIDNEY, HEART, OR ORGAN MEATS
YES 1
NO 2
DOESN'T KNOW 8
ANY OTHER MEATS (BEEF, PORK, LAMB, GOAT, CHICKEN, DUCK)
YES 1
NO 2
DOESN'T KNOW 8
EGGS
YES 1
NO 2
DOESN'T KNOW 8
FRESH/DRIED FISH OR SHELLFISH
YES 1
NO 2
DOESN'T KNOW 8
FOOD FROM BEANS, PEAS, LENTILS, OR NUTS
YES 1
NO 2
DOESN'T KNOW 8
CHEESE, YOGURTS, OR OTHER MILK PRODUCTS
YES 1
NO 2
DOESN'T KNOW 8
OIL, FATS, OR BUTTER
YES 1
NO 2
DOESN'T KNOW 8
SUGARY FOODS
YES 1
NO 2
DOESN'T KNOW 8
OTHER SOLID OR SEMI-SOLID FOODS
YES 1
NO 2
DOESN'T KNOW 8

580. CHECK 578
LAST 2 CATEGORIES: BABY CEREAL OR OTHER PORRIDGE/GRUEL:

AT LEAST ONE 'YES' (GO TO 581)
NOT A SINGLE 'YES' (GO TO 601)

581. How many times did (NAME FROM 577) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DOESN'T KNOW 8

SECTION 6: MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME _____
LINE NUMBER _____

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

YES 1
NO 2 (GO TO 609)
DOESN'T KNOW 8 (GO TO 609)

607. Including yourself, in total, how many wives or partners does your husband live with now as if married?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS_____
DOESN'T KNOW 98

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

RANK ___

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

ONLY ONCE 1
MORE THAN ONCE 2

615. CHECK 609:

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

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

MONTH _____
DOESN'T KNOW MONTH 98
YEAR _____ (GO TO 617)
DOESN'T KNOW YEAR 9998

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

AGE ___

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

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

618. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00

AGE IN YEARS ___ (GO TO 621)

FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 621)

619. CHECK 107:

AGE 15-24 YEARS (GO TO 620)
AGE 25-49 YEARS (GO TO 641)

620. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 641)
NO 2 (GO TO 641)
DOESN'T KNOW/UNSURE 8 (GO TO 641)

621. CHECK 107:

AGE 15-24 YEARS (GO TO 622)
AGE 25-49 YEARS (GO TO 626)

622. The first time you had sexual intercourse, was a condom used?

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

623. How old was the person you first had sexual intercourse with?

AGE OF PARTNER ___ (GO TO 626)
DOESN'T KNOW 98

624. Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (GO TO 626)
ABOUT THE SAME AGE 3 (GO TO 626)
DOESN'T KNOW/DOESN'T REMEMBER 8 (GO TO 626)

625. Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

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

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

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

627. When was the last time you had sexual intercourse with this person?
[ASK ONLY FOR PAST SEXUAL PARTNERS]

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

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

YES 1
NO 2 (GO TO 630)

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

YES 1
NO 2

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

HUSBAND 1 (GO TO 636)
LIVE-IN PARTNER 2 (GO TO 636)
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
PROSTITUTE 5
OTHER (SPECIFY) ______ 6

631. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

632. CHECK 107:

AGE 15-24 YEARS (GO TO 633)
AGE 25-49 YEARS (GO TO 636)

633. How old is this person?

AGE OF PARTNER ___ (GO TO 636)
DOESN'T KNOW 98

634. Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 636)
ABOUT THE SAME AGE 3 (GO TO 636)
DOESN'T KNOW/DOESN'T REMEMBER 8 (GO TO 636)

635. Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

636. The last time you had sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 638; FOR THIRD PARTNER, GO TO 639)

637. Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

638. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?
[DO NOT ASK FOR THIRD-LAST PARTNER]

YES 1 (GO BACK TO 627 IN NEXT COLUMN)
NO 2 (GO TO 640 FOR LAST PARTNER, GO TO 639A FOR SECOND-LAST PARTNER)

639. In total, with how many people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.
[DO NOT ASK FOR LAST OR SECOND-LAST PARTNERS]

NUMBER OF PARTNERS IN LAST 12 MONTHS ___
DOESN'T KNOW 98

639A. In total, with how many people have you had sexual intercourse in the last month?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.
[DO NOT ASK FOR MOST RECENT PARTNER]

NUMBER OF PARTNERS IN LAST MONTH ___
DOESN'T KNOW 98

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

NUMBER OF PARTNERS IN LIFETIME ___
DOESN'T KNOW 98

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

YES 1
NO 2 (GO TO 644)

642. Where is that?
Any other place?

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

NAME OF PLACE(S) ______
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 DISPERSAL CENTER G
PRIVATE DOCTOR H
PF/FISA CENTER I
OTHER LOCATION
VBC AGENT J
STORE K
KIOSK L
CHURCH M
FRIENDS/RELATIVES N
MOTEL/HOTEL O
PEER EDUCATOR P
FIMAILO Q (NOTE: linked to a campaign to increase condom use in Madagascar)
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

645. Where is that?
Any other place?

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

NAME OF PLACE(S) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
PF CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC PLACE (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) _______ L
OTHER LOCATION
STORE M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _______ X

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

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

SECTION 7: FERTILITY PREFERENCES

701. CHECK 311/311A:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 713)

702. 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 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DOESN'T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DOESN'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)

703. CHECK 226:

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

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

MONTHS 1 ___
YEARS 2 ___

SOON/NOW 993 (GO TO 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) ___ 996 (GO TO 708)
DOESN'T KNOW 998 (GO TO 708)

704. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 705)
PREGNANT (GO TO 709)

705. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

706. CHECK 703:

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

707. CHECK 702:

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
BREASTMEEDING 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

708. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 709)
NO, NOT CURRENTLY USING (GO TO 709)
YES, CURRENTLY USING (GO TO 713)

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

YES 1
NO 2 (GO TO 711)
DOESN'T KNOW 8 (GO TO 713)

710. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 713)
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
FEMALE CONDOM 08 (GO TO 713)
DIAPHRAGM 09 (GO TO 713)
FOAM/JELLY 10 (GO TO 713)
NECKLACE METHOD 11 (GO TO 713)
LACTATIONAL AMENORRHEA METHOD 12 (GO TO 713)
RHYTHM METHOD 13 (GO TO 713)
WITHDRAWAL 14 (GO TO 713)
OTHER METHOD (SPECIFY) _____ 96 (GO TO 713)
NOT SURE 98 (GO TO 713)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 713)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 713)
SUBFECUND/INFECUND 24 (GO TO 713)
WANT AS MANY CHILDREN AS POSSIBLE 26 (GO TO 713)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 713)
HUSBAND/PARTNER OPPOSED 32 (GO TO 713)
OTHERS OPPOSED 33 (GO TO 713)
RELIGIOUS PROHIBITION 34 (GO TO 713)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 713)
KNOWS NO SOURCE 42 (GO TO 713)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 713)
FEAR OF SIDE EFFECTS 52 (GO TO 713)
LACK OF ACCESS/TOO FAR 53 (GO TO 713)
COSTS TOO MUCH 54 (GO TO 713)
INCONVENIENT TO USE 55 (GO TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 713)
OTHER (SPECIFY) _______ 96 (GO TO 713)
DOESN'T KNOW 98 (GO TO 713)

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

YES 1
NO 2
DOESN'T KNOW 8

713. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 715)

NUMBER _____

OTHER (SPECIFY) _______ 96 (GO TO 715)

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

BOYS____
GIRLS____
EITHER____
OTHER (SPECIFY) ______ 96

715. In the last few months have you:

Heard about family planning on the radio?
Heard about family planning on the television?
Read about family planning in a newspaper or magazine?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2

717. CHECK 601:

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

718 .CHECK 311/311A:

CODE B, G OR M CIRCLED (GO TO 720)
NO CODE CIRCLED (GO TO 722)
OTHER (GO TO 719)

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

YES 1
NO 2
DOESN'T KNOW 8

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

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _______ 6

721. CHECK 311/311A:

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

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

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

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

801. CHECK 601 AND 602:

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

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

AGE IN COMPLETED YEARS____

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

YES 1
NO 2 (GO TO 806)

804. What was the highest level of school he attended: primary, secondary 1, secondary 2 or higher?

PRIMARY 1
SECONDARY ONE 2
SECONDARY TWO 3
HIGHER 4
DOESN'T KNOW 8 (GO TO 806)

805. What was the highest grade he completed at that level?

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
1 ONE YEAR
2 TWO YEARS
3 THREE YEARS
4 FOUR YEARS
5 FIVE OR MORE YEARS
8 DOESN'T KNOW

806. CHECK 801:

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

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

OCCUPATION _____

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 818)

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

OCCUPATION _____

812. CHECK 811:

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

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

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

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

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

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

HOME 1
AWAY 2

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

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

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

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

818. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 819)
NOT IN UNION (GO TO 827)

819. CHECK 817:

CODE '1' OR '2' CIRCLED (GO TO 820)
OTHER (GO TO 822)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) ______ 6

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

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

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) _____ 6

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

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

824. Who usually makes decisions about making major household purchases?

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

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

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

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

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

827. 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 8
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8

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

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DOESN'T KNOW 8
NEGLECTS THE CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
ARGUES WITH HIM
YES 1
NO 2
DOESN'T KNOW 8
REFUSES SEX
YES 1
NO 2
DOESN'T KNOW 8
BURNS FOOD
YES 1
NO 2
DOESN'T KNOW 8

829. Do you currently participate in a micro-financing program?

YES 1
NO 2 (GO TO 831)

830. Have you encountered reimbursement problems?

YES 1
NO 2

831. Are you a member of any organization?

YES 1
NO 2 (GO TO 900)

832. What is your role in this association?

MEMBER 1
PRESIDENT/VICE-PRESIDENT 2
SECRETARY 3
OTHER 4

SECTION 9: HIV/AIDS

900. CHECK THE COVER PAGE:
IS THE HOUSEHOLD SELECTED FOR THE HOUSEHOLD SELECTED FOR THE MEN'S QUESTIONNAIRE, THE BIOMARKERS QUESTIONNAIRE, AND THE LONG VERSION OF THE WOMEN'S QUESTIONNAIRE?

YES 1
NO 2 (GO TO 1101A)

Now I would like to talk about something else.

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

YES 1
NO 2 (GO TO 942)

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

During pregnancy?
During delivery?
By breastfeeding?

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

910. CHECK 909:

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

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

913. CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2005 (GO TO 914)
NO BIRTHS (GO TO 922)
LAST BIRTH BEFORE JANUARY 2005 (GO TO 922)

914. CHECK 407 FOR LAST BIRTH:

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

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

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

Babies getting the AIDS virus from their mother?
Things you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

AIDS FROM MOTHER
YES 1
NO 2
DOESN'T KNOW 8
PREVENTING AIDS VIRUS
YES 1
NO 2
DOESN'T KNOW 8
GETTING TESTED FOR AIDS
YES 1
NO 2
DOESN'T KNOW 8

916. During the antenatal care, were you offered to get tested for the AIDS virus?

YES 1
NO 2

917. I don't want to know the results, but did you get tested for AIDS as a part of your antenatal care?

YES 1
NO 2 (GO TO 922)

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

YES 1
NO 2

919. Where was the test done?

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

NAME OF PLACE(S) ______
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 PLACE (SPECIFY) ____ 15
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DISPERSAL CENTER 23
PRIVATE DOCTOR 24
PF/FISA CENTER 25
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER (SPECIFY) ______ 96

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

YES 1 (GO TO 923)
NO 2

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

LESS THAN 12 MONTHS AGO 1 (GO TO 929)
12-23 MONTHS AGO 2 (GO TO 929)
2 OR MORE YEARS AGO 3 (GO TO 929)

922. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 927)

923. When was the last time you were tested?

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

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

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1
NO 2

926. Where was the test done?

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

NAME OF PLACE(S) ________
PUBLIC SECTOR
DISTRICT HOSPITAL II (facility equipped for surgeries) 11 (GO TO 929)
DISTRICT HOSPITAL I (non-surgical medical capabilities) 12 (GO TO 929)
BASIC HEALTH CENTER II (basic health care, physician-run) 13 (GO TO 929)
BASIC HEALTH CENTER I (basic health care, run by para-medical officer) 14 (GO TO 929)
OTHER PUBLIC PLACE (SPECIFY) _____ 15 (GO TO 929)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 929)
PRIVATE HEALTH CENTER 22 (GO TO 929)
PHARMACY/MEDICINE DISPERSAL CENTER 23 (GO TO 929)
PRIVATE DOCTOR 24 (GO TO 929)
PF/FISA CENTER 25 (GO TO 929)
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26 (GO TO 929)
OTHER (SPECIFY) ______ 96 (GO TO 929)

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

YES 1
NO 2 (GO TO 929)

928. Where is that?
Any other place?

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

NAME OF PLACE(S) _____
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 PLACE (SPECIFY) ______ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PF/FISA CENTER J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
OTHER (SPECIFY) ______ X

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

YES 1
NO 2
DOESN'T KNOW 8

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

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

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

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

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

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

940. 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

941. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

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

942. CHECK 901:

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

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

YES 1
NO 2 (GO TO 942C)

942A. What are the signs or symptoms in a man that make you think he may have a sexually transmitted infection?
PROBE: 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

942B. What are the signs or symptoms in a woman that make you think she may have a sexually transmitted infection?
PROBE: 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

942C. Have you obtained any free condoms within the last 12 months?

YES 1
NO 2
DOESN'T KNOW OF CONDOMS 3

943. CHECK 618:

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

944. CHECK 942:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 945)
NO (GO TO 946)

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

945. During the last 12 months, have you had a disease that you got through sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

948. CHECK 945, 946 AND 947:

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

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

YES 1
NO 2 (GO TO 951)

950. Where did you go?
Any other place?

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

NAME OF PLACE(S) ______
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 PLACE (SPECIFY) ______ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PF/FISA CENTER J
TOP NETWORK K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
VBC AGENT M
STORE N
KIOSK O
CHURCH P
TRADITIONAL HEALER Q
RELATIVES/FRIENDS R
OTHER (SPECIFY) ______ X

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

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

YES 1
NO 2
DOESN'T KNOW 8

954. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women that are not his partners/wives?

YES 1
NO 2
DOESN'T KNOW 8

955. CHECK 601:

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

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10: OTHER HEALTH ISSUES

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

YES 1
NO 2 (GO TO 1005)

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

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

1003. Can tuberculosis be cured?

YES 1
NO 2
DOESN'T KNOW 8

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

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

Now I would like to ask you some other questions relating to health matters.

1005. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR THREE MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _____
NONE 00 (GO TO 1009)

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

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR THREE MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 1009)

1007. The last time you had an injection given to you by a health worker, where did you go to get the injection?

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

NAME OF PLACE(S) ______
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 PLACE (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE HEALTH CENTER 22
PHARMACY/MEDICINE DISPERSAL CENTER 23
PRIVATE DOCTOR 24
DENTAL OFFICE 25
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER SOURCE
AT HOME 31
OTHER (SPECIFY) ______ 96

1008. Did the person who gave you that injection take the needle and syringe from a new, unopened package?

YES 1
NO 2
DOESN'T KNOW 8

1009. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1011)

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

CIGARETTES ___

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

YES 1
NO 2 (GO TO 1013)

1012. What (other) type of tobacco do you currently smoke or use? Record all mentioned.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) _____ X

1013. Many different factors can prevent women from getting advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

Getting permission to go?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Not wanting to go alone?
Concern that there may not be a female health provider?
Concern that there may not be any health provider?
Concern that there may be no drugs available?

PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
MONEY FOR TREATMENT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE TO FACILITY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
HAVING TO TAKE TRANSPORT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NOT GOING ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
CONCERN OF NO FEMALE HEALTH PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
CONCERN OF NO HEALTH PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
CONCERN OF DRUG AVAILABILITY
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1014. Are you covered by health insurance?

YES 1
NO 2 (GO TO 1101A)

1015. What type of health insurance?
RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) _______ X

SECTION 11: 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.

1101A. Did your mother give birth to any children other than yourself?

YES 1
NO 2 (GO TO 1101H)

1101B. How many sons did your mother have who are still alive?

LIVING SONS_____

1101C. Besides you, how many daughters did you mother have who are still alive?

LIVING DAUGHTERS_____

1101D. How many sons did your mother have who are now deceased?

DECEASED SONS_____

1101E. How many daughters did your mother have who are now deceased?

DECEASED DAUGHTERS_____

1101F. Did your mother give birth to any children whose status are either living or deceased is unknown to you?

YES 1
NO 2 (GO TO 1101H)

1101G. How many other children did your mother have whose status as either living or deceased is unknown to you?

OTHER CHILDREN____

1101H. ADD UP THE RESPONSES TO 1101B, C, D, E AND G, ADD 1 (THE RESPONDENT), AND RECORD THE TOTAL:

TOTAL _____

1101I. CHECK 1101H:
Just to be sure that I've understood correctly, including yourself, your mother has given birth to ___ children in total. Is that correct?

YES (GO TO 1102)
NO (INSIST AND CORRECT 1101A-H AS NECESSARY)

1102. CHECK 1101H:

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

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

NUMBER OF PRECEDING BIRTHS ___

Now I would like to make a list of all of your brothers and sisters, whether living or not, starting with the oldest. RECORD THE NAMES OF ALL BROTHERS AND SISTERS.

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

NAME ______

1105. Is (NAME) male or female?

MALE 1
FEMALE 2

1106. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DOESN'T KNOW 8 (GO TO NEXT BIRTH/COLUMN)

1107. How old is (NAME)?

AGE ___ (GO TO NEXT COLUMN/BIRTH)

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

YEARS AGO _____

1109. How old was (NAME) when he/she died?
IF SHE DOESN'T KNOW, PROBE: Did (NAME) die before the age of 12?
IF YES, RECORD '95'. IF NO, ASK ADDITIONAL QUESTIONS TO TRY AND RECEIVE AN APPROXIMATION. FOR EXAMPLE: Did (NAME) die before getting married?

AGE_____ (IF MALE, OR IF FEMALE AND DIED BEFORE 12 YEARS OF AGE, GO TO NEXT BIRTH/COLUMN)

1110. Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111. Did (NAME) die during childbirth?

YES 1 (GO TO 1113)
NO 2

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

YES 1
NO 2

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

NUMBER OF LIVE BORN CHILDREN ____ (GO TO NEXT BIRTH/COLUMN)

[IF NO MORE BROTHERS OR SISTERS, GO TO 1114].

1114. RECORD THE TIME:

HOURS ___
MINUTES ___

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE CODES:

N BIRTHS
G PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
10 FOAM OR JELLY
11 NECKLACE METHOD
12 LACTATIONAL AMENORRHEA METHOD
13 RHYTHM METHOD
14 WITHDRAWAL
15 OTHER (SPECIFY) _______

2009:
05 AUG ____
06 JUL ____
07 JUN ____
08 MAY ____
09 APR ____
10 MAR ____
11 FEB ____
12 JAN ____

2008:
13 DEC ____
14 NOV ____
15 OCT ____
16 SEP ____
05 AUG ____
06 JUL ____
07 JUN ____
08 MAY ____
09 APR ____
10 MAR ____
11 FEB ____
12 JAN ____

2007:
13 DEC ____
14 NOV ____
15 OCT ____
16 SEP ____
17 AUG ____
18 JUL ____
19 JUN ____
20 MAY ____
21 APR ____
22 MAR ____
23 FEB ____
24 JAN ____

2006:
25 DEC ____
26 NOV ____
27 OCT ____
28 SEP ____
29 AUG ____
30 JUL ____
31 JUN ____
32 MAY ____
33 APR ____
34 MAR ____
35 FEB ____
36 JAN ____

2005:
37 DEC ____
38 NOV ____
39 OCT ____
40 SEP ____
41 AUG ____
42 JUL ____
43 JUN ____
44 MAY ____
45 APR ____
46 MAR ____
47 FEB ____
48 JAN ____

2004:
49 DEC ____
50 NOV ____
51 OCT ____
52 SEP ____
53 AUG ____
54 JUL ____
55 JUN ____
56 MAY ____
57 APR ____
58 MAR ____
59 FEB ____
60 JAN ____

2003:
61 DEC ____
62 NOV ____
63 OCT ____
64 SEP ____
65 AUG ____
66 JUL ____
67 JUN ____
68 MAY ____
69 APR ____
70 MAR ____
71 FEB ____
72 JAN ____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT______

COMMENTS ON SPECIFIC QUESTIONS______

ANY OTHER COMMENTS______

SUPERVISOR'S OBSERVATIONS ______
NAME ______
DATE ______

EDITOR'S OBSERVATIONS ______
NAME ______
DATE ______