IDENTIFICATION

PLACE NAME____
CLUSTER NUMBER_____
CONCESSION NUMBER _____

NAME OF HEAD OF HOUSEHOLD AND HOUSEHOLD NUMBER______

REGION_____
VILLAGE_____

URBAN/RURAL?

BAMAKO, OTHER CITIES, OTHER VILLAGES, RURAL?

NAME AND LINE NUMBER OF THE WOMAN__

INTERVIEWER VISITS

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE____
INTERVIEWER NAME____
RESULT ____

RESULT___

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY____
MONTH____
YEAR 2001
INTERVIEWER____
RESULT____

TOTAL NUMBER OF VISITS ____

LANGUAGE OF QUESTIONNAIRE: FRENCH 01

LANGUAGE OF INTERVIEW:

INTERPRETER?

SUPERVISOR
NAME ____
DATE ____

FIELD EDITOR
NAME ____
DATE ____

OFFICE EDITOR____
KEYED BY____

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

INTRODUCTION AND CONSENT STATEMENT:

CONSENT STATEMENT AFTER INFORMATION

Hello. My name is_____ and I work for the Minister of Health and the Minister of Planning. We are conducting a national survey that asks about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and that of your children). This information will be useful to the government for planning health services. The interview usually takes 20-45 minutes. The information that you give us will be strictly confidential.

Participation in this survey is voluntary and you can refuse to respond to particular questions or to all of the questions. We hope, however, that you will accept to participate in this survey because your opinion is important to us.

Do you have questions about the survey?
Can I begin the interview now?

SIGNATURE OF INTERVIEWER _____
DATE _____

101. RECORD THE TIME.

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

102. Until the age of 12 years, did you live the majority of your time in Bamako, in another city, in a village or in a rural area?
IF 'FOREIGNER', SPECIFY THE PLACE OF RESIDENCE.

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

104. Just before you moved here, did you live in a large city, a city or in a rural area?

105. In which month and in which year were you born?

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

107. Did you go to school?

108. What is the highest level of school you attended: primary (first cycle), primary (second cycle), secondary (high school or technical) or superior?

109. What is the last (year/class) that you achieved at this level?
CODE '00' FOR LESS THAN ONE YEAR COMPLETED AND '98' FOR DOESN'T KNOW.

109A. CHECK 106:

109B. Do you currently go to school?

109C. What is the main reason why you stopped going to school?

110. CHECK 108:

111. Now I would like you to read this sentence out loud: read as much as you can.
SHOW THE CARD TO THE RESPONDENT.
IF THE RESPONDENT CAN NOT READ THE WHOLE PHRASE INSIST: Can you read certain parts of the phrase to me?

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

112A. What kind of literacy program did you participate in?
PROBE: Any other?
RECORD ALL MENTIONED.

113. CHECK 111:

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

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

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

117. What is your religion?

117A. Are you Malian?

118. What is your ethnicity?

SECTION 2. REPRODUCTION

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

201. Have you ever given birth?

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

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

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

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

206. Have you given birth to a son or daughter who was born alive but later died?
IF NO, PROBE: Any who cried and showed signs of live at birth but did not survive?

207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'

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

209. CHECK 208:
Just to be sure that I have this right: You have had in TOTAL ___ births during your life. Is that correct?

210. CHECK 208:

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

RECORD THE NAMES OF ALL THE BIRTHS IN QUESTION 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

213. Were any of these births twins?

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

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

216. Is (NAME) still alive?

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

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

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

220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR' PROBE: How old was (NAME) in months?
RECORD IN DAYS IF LESS THAN 1 MONTH; IN MONTHS IF LESS THAN 2 YEARS; OR IN YEARS

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

[Repeat lines 212-221 for each birth AND use a separate sheet for more than 12 births]

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

223. COMPARE 208 WITH THE NUMBER OF BIRTH RECORDED IN THE ABOVE TABLE AND MARK:

224. CHECK 215 AND RECORD THE NUMBER OF BIRTHS IN 1996 OR LATER.
IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE JANUARY 1996, WRITE 'N' IN MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED AND WRITE 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'G'S MUST BE 1 LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED). RECORD THE NAME OF THE CHILD LEFT OF THE CODE 'N'.

226. Are you currently pregnant?

227. How many months pregnant are you?

RECORD THE NUMBER OF COMPLETED MONTHS. RECORD 'G' IN THE CALENDAR, BEGINNING WITH THE MONTH OF THE SURVEY AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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

229. Have you ever had a pregnancy that ended in a miscarriage, abortion or still birth?

230. When did the last such pregnancy end?

231. CHECK 230:

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

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

234. ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1996. RECORD 'F' IN THE CALENDAR IN THE MONTH EACH PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS,

235. Have you had a pregnancy that ended before January 1996 that did not end in a live birth?

236. INDICATE THE MONTH AND YEAR THAT THE LAST NON-LIVE PREGNANCY ENDED BEFORE JANUARY 1996.

237. When did your last menstrual period start?
WRITE THE DATE, IF GIVEN.

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 intercourse?

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

SECTION 3. CONTRACEPTION

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

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

301. Which ways or methods have you heard about?
FOR THE METHODS SPONTANEOUSLY MENTIONED, ASK: Have you ever heard of (METHOD)?

302. Have you ever used (METHOD)?

303. CHECK 302:

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

306. What did you do or use?
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, if any?
IF NONE RECORD '00'

308. CHECK 302 (01):

309. CHECK 226:

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

311. What method(s) are you using?
311A. CIRCLE "A" FOR FEMALE STERILIZATION.

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

312. When you began using the pill for the first time did you consult a doctor, a midwife or a nurse?

312A. When you got the pill for the last time did you consult a doctor, a midwife or a nurse?

312B. Can I see the pill box that currently you use?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING CODE AND WRITE THE NAME.

312C. What is the name of the brand of pill that you currently use?
RECORD THE NAME OF THE BRAND AND CIRCLE THE CORRESPONDING CODE

312D. How much does a 3 cycle box of pills cost you?
RECORD THE AMOUNT IN FRANCS (CFA).

[IF CODES 'A' AND 'B' ARE CIRCLED IN 311, ASK 313-316/316A ONLY ABOUT FEMALE STERILIZATION.]

313. Where did the sterilization take place?

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

314. CHECK 311:

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

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

316. In which month and in which year did the sterilization occur?
316A. Since when did you begin to use (CURRENT METHOD) continuously?
PROBE: In which month and in which year did you begin to use (CURRENT METHOD) continuously?

317. CHECK 316/316A:

319. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD: IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED IN THE LIST.

320. Where did you get (CURRENT METHOD) when you started using it?
320A. Where did you learn how to use the lactational amenorrhea method?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

321. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD: IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED IN THE LIST.

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

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

324. Did someone tell you what you should do if you experienced secondary effects or if you had problems?

325. CHECK 322:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320), did anyone talk to you about other methods of family planning that you could use?

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

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

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

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

330. Where is this place?
Anywhere else?
RECORD ALL MENTIONED.

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

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

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

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE 1996. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM QUESTION 212:

404. FROM QUESTIONS 212 AND 216:

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?

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

407. For the last pregnancy, did you receive prenatal care?
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.

408. How many months pregnant were you when you had your first prenatal consultation?
[ASK ONLY FOR MOST RECENT BIRTH]

409. How many times did you get consultation during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

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

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

412. During your pregnancy did you have the following tests at least once?
[ASK ONLY FOR MOST RECENT BIRTH]

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

413. Did they talk to you about signs of complications to the pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

414. Did they tell you where to go if you had these complications?
[ASK ONLY FOR MOST RECENT BIRTH]

415. During the course of this pregnancy, did they give you an injection in the arm to keep the baby from getting tetanus, that is to say convulsions after birth?
[ASK ONLY FOR MOST RECENT BIRTH]

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

417. During this pregnancy, were you given or did you buy iron tablets or syrup containing iron?
[ASK ONLY FOR MOST RECENT BIRTH]
SHOW TABLETS/SYRUPS

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

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

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

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

422. What drugs did you take?
[ASK ONLY FOR MOST RECENT BIRTH]

RECORD ALL MENTIONED. IF TYPE OF DRUG IS UNKNOWN, SHOW TYPICAL ANTIMALARIAL DRUGS TO THE RESPONDENT.

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

424. Was (NAME) weighed at birth?

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

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

PROBE TO 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.

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

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

428. Was (NAME) delivered by caesarean section?

429. After (NAME)'s birth, were you examined by a health professional or a village birth attendant?

430. How many days after delivery did you have your first health check-up?
[ASK ONLY FOR MOST RECENT BIRTH]
RECORD '00' IF THE SAME DAY.

431. Who examined you at this time?
[ASK ONLY FOR MOST RECENT BIRTH]
PROBE FOR MOST QUALIFIED PERSON

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

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

433. In the two months that followed the birth, did you receive a dose of vitamin A like this one?
[ASK ONLY FOR MOST RECENT BIRTH]
SHOW THE VIAL/PILL/SYRUP.

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

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

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

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

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

439. For how many months after [NAME]'s birth did you not have sexual intercourse?

440. Did you ever breastfeed [NAME]?

441. How long after birth did you first put [NAME] to the breast?
IF LESS THAN ONE HOUR RECORD '00' HOURS. IF LESS THAN 24 HOURS RECORD HOURS. OTHERWISE RECORD IN DAYS.

442. In the 3 days following birth and before your breasts began to produce milk regularly, did (NAME) drink something besides breast milk?

443. What was (NAME) given to drink before your breasts began to produce milk regularly?
Anything else?
RECORD ALL LIQUIDS MENTIONED

444. CHECK 404:
LIVING CHILD?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 202:
LIVING CHILD?

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

449. Yesterday, how many times did you breastfeed during the day?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

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

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

453. RETURN TO 405 IN THE NEXT COLUMN OR THE NEXT TO LAST COLUMN ON A NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. VACCINATION, HEALTH AND NUTRITION

454. RECORD THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 1996 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE THE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212:

456. FROM 212 AND 216:

457. Did (NAME) get a dose of vitamin A, like this one, during the past 6 months?
SHOW THE VIAL/PILL/SYRUP.

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

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

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

461. Has (NAME) received any immunizations 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, MEASLES, AND/OR YELLOW FEVER VACCINES.

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

463. Tell me, please, if (NAME) received one of the following vaccinations:

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

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

463C. Was the first vaccine for polio received right after birth or not?

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

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

463F. How many times?

463G. An injection against the measles?

463H. A dose of vitamin A?

463I. An injection against yellow fever?

463J. The Hepatitis B vaccination?

464. Were any of the vaccinations (NAME) received during the past two years given as part of a national immunization campaign?

465. At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL MENTIONED CAMPAIGNS.

466. Has (NAME) suffered from a fever, at any moment, during the past two weeks?

467. Has (NAME) suffered from a cough, at any moment, during the past two weeks?

468. When (NAME) had a cough, did he/she breathe faster than usual with short, rapid breaths?

469. CHECK 466 AND 467
FEVER OR COUGH?

470. Did you seek advice or treatment for the fever/cough?

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

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

472. CHECK 466:
HAD A FEVER?

473. Did (NAME) take medicine for the fever?

474. Which medicine did (NAME) take?
RECORD EVERYTHING THAT IS MENTIONED.

ASK TO SEE THE MEDICINE IF THE TYPE OF MEDICINE IS NOT KNOWN. IF THE TYPE OF MEDICINE CAN NOT BE DETERMINED, SHOW SOME COMMON ANTI-MALARIA MEDICINES TO THE RESPONDENT.

475. Has (NAME) had diarrhea during the past two weeks?

476. Now I would like to know how much liquid was given to (NAME) during his/her diarrhea. Did you give him/her less, about the same, or more to drink than usual?
IF LESS, PROBE: Did you give him a lot or a little less than usual to drink?

477. When (NAME) had diarrhea did you give him/her less to eat than usual, about the same amount, more than usual or nothing to eat?
IF LESS, PROBE: Did you give him/her a lot less to eat or a little less than usual?

478. Did you give him/her any of the following things to drink?

a. A liquid prepared from an ORS packet?
b. A homemade liquid recommended by the government?

479. Was something (else) given to treat diarrhea?

480. What else was given to treat diarrhea?
Something else?
RECORD EVERYTHING MENTIONED.

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

482. Where did you seek advice or treatment for the diarrhea?
Anywhere else?
RECORD EVERYTHING MENTIONED.

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE(S).

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

484. CHECK 456, ALL COLUMNS:
NUMBER OF LIVING CHILDREN BORN IN 1996 OR LATER?

486. CHECK 478A ALL OF THE COLUMNS:

487. Have you ever heard of a special product called [LOCAL NAME FOR ORS] that you can get to treat diarrhea?

488. CHECK 218:

489. When (your child/one of your children) is seriously ill, can you, yourself, decide if he should be brought somewhere for medical treatment?
IF THE RESPONDENT RESPONDS THAT NO CHILD HAS EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) becomes seriously ill, can you, yourself, decide if he should be brought somewhere for medical treatment?

490. Now I would like to ask you questions about your own medical care. Different reasons can prevent women from getting advice or medical treatment for themselves. When you are sick and want advice or medical treatment, do the following things pose a problem for you or not?

Know where to go.
Get permission to go.
Get the necessary money for the treatment.
Distance to a medical establishment
Need to take a mode of transport.
Not wanting to go alone.
Concern that there are no female personnel.

491. CHECK 215 AND 218:

492. Now I would like to ask you what liquid [NAME IN 491] drank during the past 7 days including yesterday. How many days, during the past 7 days, did [NAME IN 491] drink one or more of the following liquids?

FOR EACH LIQUID CONSUMED, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK:
In all, during the day or night how many times did [NAME IN 491] did he/she drink:

a. Water?
b. Baby formula?
c. Any other type of milk, like milk from a container, in powder, or fresh milk from an animal?
d. Fruit juice?
e. Other liquids such as sugar water, tea, coffee, carbonated drinks, or broths?

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

493. Now I would like to ask you what food(s) [NAME IN 491] was given during the past 7 days, including yesterday. How many days, during the past 7 days, [NAME IN 491] did he/she get the following foods?

FOR EACH FOOD GIVEN, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK: In total, during the day and night yesterday how many times did [NAME IN 491] get:

a. Any food prepared with grains (for example: rice, corn, millet, sorghum, oatmeal or other grains)?
b. Pumpkin, yam or yellow or red squash, carrots, or red sweet potatoes?
c. Other foods from roots (for ex: potatoes, white yams, manioc, white sweet potatoes, or other local foods from roots)?
d. Any green leafy vegetables?
e. Mango, papaya (or other fruits rich in vitamin A)?
f. Any other fruit or vegetable? (ex: banana, apple, apple sauce, green beans, avocado, tomato)?
g. Meat, poultry, fish, shellfish, eggs?
h. Other legume foods (ex: lentils, beans, soy, or nuts)?
i. Cheese or yogurt?
j. Any food prepared with oil, fat or butter?

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

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

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

499F. During the past 3 months, have you had an injection for any reason?

499G. During the past 3 months how many injections did you have?

499H. The last time you had an injection, who gave it to you?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or do you live with a man?

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

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

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

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

507. Besides yourself, does your husband/partner have other wives or does he live with other women as if he were married?

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

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

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

511. CHECK 510:

MARRIED/HAS LIVED WITH ONE MAN ONLY ONCE: In which month and in which year did you begin to live with your husband/partner?

MARRIED/HAS LIVED WITH 1 MAN MORE THAN ONCE: I would like to ask about when you started living with your first husband/partner. In what month and year was that?

IF FIRST UNION WAS NOT CONSUMMATED, RETURN TO 501. CIRCLE CODE '3' AND GO TO 514.

512. How old were you when you began living with him?

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

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

515. How long ago did you last have sex?
RECORD YEARS ONLY IF RECENT SEXUAL RELATIONS WAS A YEAR AGO OR LONGER. IF 12 MONTHS OR LONGER, THE ANSWER SHOULD BE RECORDED IN YEARS.

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

516A. What was the main reason why you used a condom at this time?

517. What is your relationship with this man with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANCÉ ASK: Did your boyfriend/fiancé live with you the last time you had sex with him? IF 'YES', RECORD '1'. IF 'NO', RECORD '2'.

518. How long have you been having sexual intercourse with this man?

519. During the last 12 months, did you have sexual intercourse with another man?

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

520A. What was the main reason why you used a condom at this time?

521. What is your relationship with this man with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANCÉ ASK: Did your boyfriend/fiancé live with you the last time you had sex with him? IF 'YES', RECORD '1'. IF 'NO', RECORD '2'.

522. How long have you been having sexual intercourse with this man?

522A. Apart from this/these two person(s) did you have sexual intercourse with anyone else during the past 12 months?

522B. The last time you had sexual intercourse with this other man, was a condom used?

522C. What was the main reason why you used a condom at this time?

522D. What is your relationship with this man with whom you last had sexual intercourse?
IF BOYFRIEND OR FIANCÉ ASK: Did your boyfriend/fiancé live with you the last time you had sex with him? IF 'YES', RECORD '1'. IF 'NO', RECORD '2'.

522E. How long have you been having sexual intercourse with this man?

523. In all, how many different people did you have sexual intercourse with during the past 12 months?

524. Do you know a place where one could procure condoms?

525. Where is this?
Anywhere else?
RECORD ALL MENTIONED.

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

526. If you wanted to, could you procure a condom?

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

602. CHECK 226:

NOT PREGNANT OR NOT SURE. Now I have a few questions about the future. Would you like to have (a/another) child, or would you prefer not to have (other) children at all?

PREGNANT. Now I have a few questions about the future. After the child that you are expecting, would you like to have (a/another) child, or would you prefer not to have (other) children at all?

603. CHECK 226:

NOT PREGNANT OR NOT SURE. 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, how long would you like to wait from now before the birth of another child?

604. CHECK 226:

605. CHECK 310:
USES A CONTRACEPTIVE METHOD?

606. CHECK 603:

607. CHECK 602:

WANTS A/ANOTHER CHILD. You said that, right now, you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why?
Another reason?

DOES NOT WANT A/ANOTHER CHILD. You said that you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why?
Another reason?

RECORD ALL THE REASONS MENTIONED.

608. In the coming weeks, if you discover that you are pregnant would this be a big problem, a small problem or not a problem at all?

609. CHECK 310:
CURRENTLY USES A METHOD?

610. Do you think that, in the near or distant future you will use a method to delay or avoid a pregnancy?

611. Which method would you prefer to use?

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

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

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.
IF NONE, CIRCLE '00' AND GO TO 616.

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

616. Would you say that you approve or disapprove if couples using a method to avoid getting pregnant?

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

On the radio?
On the television?
In newspapers or magazines?
On a poster?
On a flier or brochure?
Cultural organization?
School?

618. In your opinion, is it okay or not okay to talk about family planning:

On the radio?
On the television?
In newspapers or magazines?
On a poster?
On a flier or brochure?
Cultural/educational organization?
School?

619. During the past 12 months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

620. With whom did you discuss this?
Anyone else?
RECORD EVERYTHING MENTIONED.

621. CHECK 501:

622. CHECK 311/311A:

623. You said that you are currently using a method of contraception. Could you tell me if using of this method is mainly your own decision, or that of your partner/husband, or a joint decision?

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

624. Do you think that your partner/husband approves or disapproves of couples using methods to avoid pregnancy?

625. How many times during the past 12 months did you speak with your partner/husband about family planning?

626. CHECK 311/311A:

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

628. Husbands and wives do not always agree on everything. Please, tell me if you think it is legitimate for a wife to refuse to have sexual intercourse with her husband when:

She knows that her husband has a sexually transmitted infection?
She knows that her husband has sexual intercourse with other women besides his wives?
She recently gave birth?
She is tired or not in the mood for it?

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

701. CHECK 501 AND 502:

702. How old was your husband at his last birthday?

703. Did your (last) husband attend school?

704. What was the highest level of school that he achieved: primary 1 (first cycle), primary 2 (second cycle), secondary (high school or technical) or superior?

705. What was the last (year/class) that he achieved at this level?

706. CHECK 701:

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

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

707. Aside from your housework, do you currently work?

708. As you know, some women take up jobs for which they are paid in cash or in kind. Others sell things, have a small business or work on the family farm or in a family business.
Do you currently do something like this or any other work?

709. Did you do any type of work during the past 12 months?

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

711. CHECK 710:

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

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

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

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

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

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

718. On average, how much of your household's expenses are paid by what you earn: almost nothing, less than half, about half, more than half or all?

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

Your own healthcare?
The purchase of major things for the household?
Purchase of things for daily household needs?
Visits to family or parents?
What food will be prepared each day?

720. PRESENCE OF OTHER PEOPLE AT THIS TIME (PERSONS PRESENT AND ARE LISTENING, PRESENT BUT ARE NOT LISTENING, OR NOT PRESENT)

721. Sometimes a husband can get upset or angry because a certain things his wife does. In your opinion, is it legitimate that a husband beat or hit his wife in the following situations:

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

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

Now I would like to talk to you about something else.

801. Have you ever heard of a disease called AIDS?

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

803. What can a person do?
Anything else?
RECORD EVERYTHING CITED.

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

805. Can people get AIDS from mosquito bites?

806. Can people reduce their risk of getting aids by using a condom every time they have sex?

807. Can people get AIDS by sharing food with someone who has AIDS?

808. Can people protect themselves from AIDS by completely abstaining from sexual intercourse?

809. Is it possible that a person who appears to be healthy, in fact, has AIDS virus?

810. Do you know anyone who has the AIDS virus or who died of AIDS?

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

812. The virus that causes AIDS can be transmitted from mother to her baby:

During the pregnancy?
During birth?
During breastfeeding?

813. CHECK 501:

814. Have you ever spoken about ways to avoid getting the AIDS virus with (your husband/ the man with whom you live)?

815A. In your opinion, is it okay or not okay to talk about AIDS:

On the radio?
On the television?
In newspapers or magazines?
On a poster?
On a flier or brochure?
Cultural/educational organization?
School?

815B. If a person learns that he/she was infected with the AIDS virus, should this person be allowed to keep his/her state secret or should this information be communicated to the community?

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

817A. In your opinion, if a teacher has the AIDS virus but is not sick, should she/he be able to continue teaching in the school?

817B. Should children age 12-14 be taught about using a condom to avoid getting the AIDS virus?

817C. Have you ever been tested for the AIDS virus?

817D. Would you like to have a test for the AIDS virus?

817E. Do you know of a place where you can get tested for the AIDS virus?

817F. Where can you go for a test for the AIDS virus?
817X Where did you go for this test?

RECORD EVERYTHING MENTIONED.

IF THE PLACE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

818. When a man has a sexually transmitted infection, which symptom could he have?
Are there other symptoms?
RECORD ALL MENTIONED

819. When a woman has a sexually transmitted infection, which symptom could she have?
Are there other symptoms?
RECORD ALL MENTIONED

820A. CHECK 514:

820AA. CHECK 817:

820B. Now I would like to ask you about your health in the last 12 months. During the last 12 months have you had a disease which you got from sexual contact?

820C. Sometimes a woman has a (bad smelling) abnormal genital discharge. During the last 12 months have you had a (bad smelling) genital discharge?

820D. Sometimes women have a genital sore or ulcer. During the past 12 months have you had a genital sore or ulcer?

820E. CHECK 820B, 820C AND 820D:

820F. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you seek any kind of advice or treatment?

820G. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you do one of the following things? Did you...

Visit a clinic, hospital or private doctor?
Consult a traditional healer?
Seek advice or buy medicine in a shop or pharmacy?
Seek advice from friends or relatives?

820H. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you tell the man/men with whom you had sexual intercourse?

820I. The last time you had (INFECTION MENTIONED IN 820B/820C/820D), did you do something to avoid infecting your sexual partner(s)?

820J. What did you do to avoid infecting you partner(s)? Did you?

a. Stop having sexual intercourse?
b. Use a condom during sexual intercourse?
c. Take medicine?

SECTION 9. FEMALE CIRCUMCISION

Now, I would like to ask you about a subject relating to women's health.

901. Have you ever heard of female circumcision?

902. In certain countries including Mali, there is a practice that involves cutting a part of the external genitals of girls. Have you heard of this practice?

903. Were you circumcised?

Now, I would like to ask you some questions about what was done at that time.

904. Did someone cut something in the genital area?

905. Did they just make a laceration in your genitals without cutting anything off?

906. Did they close the area of your vagina with stitches?

907. How old were you when you underwent this practice?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO GET AN ESTIMATE.

908. Who performed your circumcision?

909. CHECK 214 AND 216:

910. Have some of your daughters undergone this kind of practice?
IF YES: How many?

911. Which one of your daughters was most recently circumcised?
CHECK 212 AND RECORD THE LINE NUMBER OF THE DAUGHTER

I would now like to ask you some questions about what was done to (NAME OF THE DAUGHTER from 911) at that time.

912. Did someone remove part of her genitals?

913. Did someone just slash her genitals without removing anything?

914. Was her vagina closed by a stitch?

915. How old was (NAME OF THE DAUGHTER from 911) at the time of the circumcision?
IF THE RESPONDENT DOESN'T KNOW THE AGE, PROBE TO GET AN ESTIMATE.

916. Who performed the circumcision?

917. Did you notice at the time someone cut (NAME OF THE DAUGHTER FROM 911)'s genitals one of the following problems?

Excessive bleeding?
Difficulty urinating or retaining urine?
Swelling in the genital area?
Infection in the genital area/the wound not correctly scarred?

918. In the future, do you intend to have your daughters circumcised?

919. What are the advantages to circumcising a girl?
PROBE: other advantages?
RECORD ALL MENTIONED.

920. What are the advantages of girls not being circumcised?
PROBE: anything else?
RECORD ALL MENTIONED

921. Do you think this practice is a way for preventing girls from having sexual intercourse before marriage or do you think, on the contrary, that this has no effect?

922. Do you think that this practice is required by your religion?

923. Do you think that this practice should be maintained or that it should disappear?

924. Do you think that men want this practice to be preserved or do you think they favor abandoning it?

SECTION 10. MATERNAL MORTALITY

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

1001. To how many children, including yourself, did your mother give birth?

1002. CHECK 1001:

1003. How many births did your mother have before your birth?

[ASK QUESTIONS 1004-1013 FOR ALL BIRTHS OF RESPONDENT'S MOTHER]

1004. What name was given to your oldest brother or sister (or the next)?

1005. Is (NAME) male or female?

1006. Is (NAME) still alive?

1007. How old is (NAME)?

1008. How many years has (NAME) been deceased?

1009. How old was (NAME) when he/she died?
IF MAN, OR IF WOMAN DECEASED BEFORE THE AGE OF 12 YEARS GO TO NEXT BIRTH.

1010. Was (NAME) pregnant when she died?

1011. Did (NAME) die during childbirth?

1012. Did (NAME) die in the two months following a pregnancy or birth?

1013. To how many children did (NAME) give birth to during her life (before this pregnancy)?

1014. RECORD THE TIME:

INTERVIEWER'S OBSERVATIONS

FILL OUT AFTER ENDING THE INTERVIEW.

COMMENTS ABOUT THE RESPONDENT ______
COMMENTS ON PARTICULAR QUESTIONS ______
OTHER COMMENTS ______

SUPERVISOR'S OBSERVATIONS ______
NAME______
DATE______

FIELD EDITOR'S OBSERVATIONS ______
NAME______
DATE______

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX.

BIRTHS AND PREGNANCIES:

2001:

2000:

1999:

1998:

1997:

1996: