PLANNING AND STATISTICAL UNIT/M-HEALTH
NATIONAL DEPARTMENT OF STATISTICS AND INFORMATION
REPUBLIC OF MALI

IDENTIFICATION:

PLACE NAME__
FULL NAME OF HEAD OF THE HOUSEHOLD ____
COMMUNE__
CLUSTER NUMBER___
HOUSEHOLD NUMBER______
ADMINISTRATIVE REGION ____

URBAN/RURAL ____

ARRONDISSEMENT__

LAST/FIRST NAME AND LINE NUMBER OF WOMAN__

WOMAN SELECTED FOR HOUSEHOLD RELATIONSHIPS?

HOUSEHOLD SELECTED FOR MEN'S SURVEY?

CHECK THE KISH TABLE IN THE HOUSEHOLD QUESTIONNAIRE.
CHECK THE COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE (FOR Q542 AND Q543)

INTERVIEWER VISITS:

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

RESULT____

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]
DATE__
TIME__

FINAL VISIT
DAY__
MONTH__
YEAR 2006
INTERVIEWER__
RESULT__

Total Number of Visits____

LANGUAGE OF QUESTIONNAIRE

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:

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 30-45 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 the country.

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 like the majority of the time in Bamako, in another capital, in a city or in a rural area?
IF IT'S A CITY OR CAPITAL, ASK FOR THE NAME OF THE CITY.

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

104. Just before you moved here, did you live in Bamako, another capital, a city, or village?
IF A CITY, ASK THE NAME OF THE CITY

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/grade) that you achieved at this level?

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. (3)

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)?

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. During the past 12 months, how many times have you traveled outside of your locality and slept somewhere besides your home?

118. During the past 12 months have you been outside of your locality during more than a month at a time?

119. What is your religion?

121. What is your ethnicity (for Malians)/your nationality (for foreigners)?

122. What language do you mostly speak at home?

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'

207A. Do you have other children who were born alive but died after a few minutes, a few hours, or a few days?

207B. CORRECT 207 THEN CONTINUE TO 208.

208. SUM ANSWERS TO Q.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:

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

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

[REPEAT 212-221 FOR EACH BIRTH, USE SEPARATE SHEET FOR MORE THAN 12 BIRTHS]

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?
[SKIP FIRST BIRTH]

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 2001 OR LATER. IF NONE, RECORD '0'

225. FOR EACH BIRTH SINCE JANUARY 2001, 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". (SEE THE INSTRUCTIONS AT THE END OF THE QUESTIONNAIRE)

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 2001.

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 2001 that did not end in a live birth?

236. When did the last such birth end before 2001?

237. When did your last menstrual period start?
RECORD 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?

240. Are there children who mainly depend on you?

241. Among the children who mainly depend on you, are there some who are less than 18 years?

I would now like to talk to you about the children under 18 years who mainly depend on you.

242. Are there or have you made arrangements for someone to take care of these children if you get sick or in the case that you could no longer take care of them?

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 ON LINE 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 methods have you heard about? FOR THE METHODS SPONTANEOUSLY MENTIONED, ASK: Have ever heard about (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?

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

311A. CIRCLE "A" FOR FEMALE STERILIZATION.

312. Why do you use the pill rather than another method?

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

312B. What is the name of the brand of pill that you currently use?

312C. How much does a 3 cycle box of pills cost you?

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 (METHOD CITED FIRST IN Q.311) continuously?
PROBE: In which month and which year did you begin to use (METHOD CITED FIRST IN Q.311) continuously?

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

WAS THERE IN 215 A BIRTH OR IN 230 A PREGNANCY ENDED BY A MISCARRIAGE, AND ABORTION OR A STILL BIRTH AFTER THE MONTH AND YEAR OF THE BEGINNING OF USING CONTRACEPTION IN 316/316A?

IF YES: RETURN TO 316/316A TO CORRECT, PROBE TO RECORD THE MONTH AND YEAR OF THE BEGINNING OF CONTINUOUS USE OF THE CURRENT METHOD (THE DATE MUST BE AFTER THAT OF THE LAST BIRTH OR PREGNANCY)

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 ON THE LIST IN 311/311A.

320. Where did you get (CURRENT METHOD) when you started using it?

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.

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 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 ON THE LIST IN 311/311A.

322. You obtained (CURRENT METHOD) from (SOURCE IN Q.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 Q. 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:
IF MORE THAN ONE METHOD CIRCLED IN 311/311A, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

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? Any other place?

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.

RECORD ALL PLACES MENTIONED.

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 BREAST FEEDING

401. CHECK 224:

402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES)

[REPEAT QUESTIONS 403-453 FOR ALL ELIGIBLE BIRTHS]

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 LINE Q212

404. CHECK 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?
[ONLY FOR MOST RECENT BIRTH]

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED. IF NONE, CIRCLE CODE 'Y'

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

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

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

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

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

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

416. How many times during this pregnancy did you have this injection?
[ONLY FOR MOST RECENT BIRTH]

416A. CHECK 416:
[ONLY FOR MOST RECENT BIRTH]

416B. Have you had at any time before this pregnancy an injection to protect against tetanus?
[ONLY FOR MOST RECENT BIRTH]

416C. Before this pregnancy, how many times did you receive an injection against tetanus?
[ONLY FOR MOST RECENT BIRTH]

IF 7 TIMES OR MORE RECORD '7'.

416D. In which month and in which year before this pregnancy did you receive your last injection?
[ONLY FOR MOST RECENT BIRTH]

416E. How many years ago did you receive this injection against tetanus?
[ONLY FOR MOST RECENT BIRTH]

417. During this pregnancy, were you given or did you buy iron tablets?
[ONLY FOR MOST RECENT BIRTH]

SHOW TABLETS.

418. During the whole pregnancy, for how many days did you take the tablets?
[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?
[ONLY FOR MOST RECENT BIRTH]

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

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

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

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

422A CHECK 422:
TYPE OF MEDICINE TAKEN FOR MALARIA PREVENTION?
[ONLY FOR MOST RECENT BIRTH]

422B. How many times did you take this medicine during this pregnancy?
[ONLY FOR MOST RECENT BIRTH]

422C. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY?
[ONLY FOR MOST RECENT BIRTH]

422D. When you were pregnant with (NAME), did you get the medicine SULFADOXINE-PYRIM during a prenatal visit, during another visit in a health facility, or from another source?
[ONLY FOR MOST RECENT BIRTH]

422E. CHECK 422:
TYPE OF MEDICINE TAKEN DURING PREGNANCY FOR MALARIA PREVENTION?
[ONLY FOR MOST RECENT BIRTH]

422F. How many times did you take the medicine CHLOROQUINE during this pregnancy?
[ONLY FOR MOST RECENT BIRTH]

422G. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY?
[ONLY FOR MOST RECENT BIRTH]

422H. When you were pregnant with (NAME), did you get the medicine CHLOROQUINE during a prenatal visit, during another visit in a health facility, or from another source?
[ONLY FOR MOST RECENT BIRTH]

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.

425A. Does (NAME) have a birth certificate?
IF NO PROBE: Was the birth of (NAME) registered with the state?

425B. Why wasn't the birth of (NAME) registered?

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 AND SECTOR AND CIRCLE THE APPROPRIATE CODE.

427A. At the time of (NAME)'s birth did you have any of the following problems:

A long labor, in other words regular contractions lasting more than 12 hours?
Enough bleeding that you thought that your life was in danger?
A high fever accompanied with bad smelling vaginal discharge?
Convulsions not caused by fever?

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?
[ONLY FOR MOST RECENT BIRTH]

RECORD "00" IF THE SAME DAY.

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

PROBE FOR MOST QUALIFIED PERSON.

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

SHOW THE PILL.

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

435. Did your period return between the birth of (NAME) and your next pregnancy?

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

437. CHECK 226:
IS RESPONDENT PREGNANT?

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

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

440. Did you 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 three 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 MARK '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 2001 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 LINES OF ADDITIONAL QUESTIONNAIRES).

[REPEAT QUESTIONS 455-483 FOR ALL ELIGIBLE BIRTHS]

455. CHECK LINE NUMBER FROM 212:

456. CHECK 212 AND 216:

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

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 buttocks, generally at the same time as the polio drops?

463F. How many times?

463G. An injection against the measles?

463H. An injection against yellow fever?

463I. The Hepatitis B vaccination?

463I. How many times?

464. Were any of the vaccinations that (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.

NAME OF CAMPAIGN:

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.

472. CHECK 466:
HAD A FEVER?

472A. Does (NAME) have a fever currently?

472B. Did (NAME) have convulsions at any time during the past two weeks?

472C. CHECK 466 AND 472B:
FEVER OR CONVULSIONS?

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

474. Which medicine did (NAME) take?

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.
RECORD EVERYTHING THAT IS MENTIONED.

474A. Did (NAME) have an injection or suppository to treat the fever/convulsions?

474B. CHECK 474:
TYPE OF MEDICINE?

474C. How long after the beginning of the fever/convulsions did (NAME) begin to take Fansidar/Maloxine?

474D. For how many consecutive days did (NAME) take Fansidar/Maloxine?
IF MORE THAN 7 DAYS, RECORD '7'.

474E. Did you have the Fansidar/Maloxine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Fansidar/Maloxine the first time?

474F. CHECK 474: TYPE OF MEDICINE?

474G. How long after the beginning of (the fever/convulsions) did (NAME) begin to take Chloroquine?

474H. For how many consecutive days did (NAME) take Chloroquine?
IF MORE THAN 7 DAYS, RECORD '7'.

474I. Did you have the Chloroquine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Chloroquine the first time?

474J. CHECK 474:
TYPE OF MEDICINE?

474K. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
Amodiaquin/CAMOQUIN?

474L. For how many consecutive days did (NAME) take Amodiaquin/CAMOQUIN?
IF MORE THAN 7 DAYS, RECORD '7'.

474M. Did you have the Amodiaquin/CAMOQUIN at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Amodiaquin/CAMOQUIN the first time?

474N. CHECK 474:
TYPE OF MEDICINE?

474O. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
Quinine?

474P. For how many consecutive days did (NAME) take Quinine?
IF MORE THAN 7 DAYS, RECORD '7'.

474Q. Did you have the Quinine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Quinine the first time?

474R. Was something else done to treat (NAME)'s (fever/convulsions)?

474S. What was done to treat (NAME)'s (fever/convulsions)
Something else?
RECORD EVERYTHING MENTIONED.

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

Now I would like to know how much liquid was given to (NAME) during his/her diarrhea.

476. Did you give him/her less or more to drink than usual?
IF LESS: 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: 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?

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). RECORD EVERYTHING MENTIONED.

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

484. CHECK 215 AND 218, ALL LINES:
NUMBER OF CHILDREN BORN IN 2001 OR LATER AND LIVING WITH THE RESPONDENT.

485. What do you usually do with the excrements of your (youngest) child when he/she does not use the toilet facility?

486. CHECK 478A ALL OF THE COLUMNS:

487. Have you ever heard of a special product called ORS, for example Orasel/kenèyaji, that you can get to treat diarrhea?
SHOW THE PACKET OF ORS.

487A. Do you have an ORS packet at home?

487B. Can I see the ORS packet that you have?
LOOK FOR THE BRAND OF THE ORS PACKET.

487C. Do you know the brand name of ORS that you currently have?

487D. How much did the ORS packet that you currently have cost you?

488. CHECK 318:

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?

Now I would like to ask you questions about your own medical care.

490. 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.
Not having a medical establishment nearby.
Need to take a mode of transport.
Not wanting to go alone.
Concern that there are no female personnel.

491. CHECK 215 AND 218:

Now I would like to ask you what liquid [NAME IN Q.491] drank during the past 7 days including yesterday.

492. How many days, during the past 7 days, did [NAME IN Q.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 Q.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'

Now I would like to ask you what food(s) [NAME IN Q.491] was given during the past 7 days, including yesterday.

493. How many days, during the past 7 days, [NAME IN Q.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 Q.491] get:

A) Rice, corn, millet, sorghum or other grains?
B) Pumpkin, yam or yellow or red squash, carrots, or red sweet potatoes?
C) Other foods from roots (ex: potatoes, white yam, manioc, white sweet potatoes, other local foods from roots)?
D) Any green leafy vegetables?
E) Mango, papaya?
F) Any other fruit or vegetable? (ex: banana, apple, apple sauce, green beans, avocado, tomato)?
G) Meat, poultry, fish, shellfish, eggs?
H) Other vegetable 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'.

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

496. Do you currently smoke cigarettes or chew tobacco?
IF YES: What do you usually smoke/chew?
RECORD EVERYTHING MENTIONED.

498. In the past 24 hours, how many cigarettes did you smoke?

498A. In the past 24 hours, how many pinches did you take?

I would now like to ask you a few questions about your health during the past 6 months.

499B. During the past 6 months, have you had an injection for any reason?
IF YES: How many injections did you have?

IF THE NUMBER OF INJECTIONS IS MORE THAN 94 OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

499C. Among these injections, how many were given by a doctor, nurse, pharmacist, dentist or other health worker?

IF THE NUMBER OF INJECTIONS IS MORE THAN '94', OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

499D. The last time you had an injection, where did you go to get it?

499E. The last time you had an injection, did the person who administered the shot take the syringe or needle from a new unopened package?

499F. From when you woke up yesterday morning until sunset (24h), did you consume any foods prepared with industrial oil?

499G. Which industrial oil did you consume?

499H. Is this consummation or non-consummation of foods with industrial oil usual?

499I. CHECK 499F:

499J. What is the main reason why you did not consume foods prepared with industrial oil since yesterday?

499K. In the past 7 days, how many days did you consume foods prepared with industrial oil?
IF DOESN'T KNOW (DK) OR DOES NOT RESPOND (NR), RECORD '8'.

499L. Do you consume industrial oil all the time, during the rainy season, after harvests, during the dry season, only during parties or at a different time (specify)?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

506. How old was your husband/partner at his last birthday?

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

508. Counting yourself, how many 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 1 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?

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

512A. Who mainly chose your husband/partner?

513. CHECK 503: IS THE RESPONDENT CURRENTLY A WIDOW?

514. CHECK 510:

515. How did your last union/marriage end?

516. Who got the largest part of the belongings your husband possessed?

517. Did you receive goods or valuables from your last husband?

518. CHECK THE PRESENCE OF OTHER PEOPLE
BEFORE CONTINUING, DO YOUR BEST TO GO TO A PRIVATE PLACE.

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

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

520. Do you intend to wait until marriage to start having sex?

521. CHECK 106:

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

523. How old was the person with whom you had sexual intercourse for the first time?

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

525. Would you say that this person was more than 10 years older than you or less than 10 years older than you?

526. When did you last have sexual intercourse?
IF IT WAS 12 MONTHS AGO OR MORE, THE ANSWER MUST BE CONVERTED AND RECORDED IN YEARS.

[ASK QUESTIONS 527-536 FOR THE PAST THREE PARTNERS]

527. Was a condom used the last time you had sexual intercourse with this (second, third) person?

528. Did you use a condom each time you had sexual intercourse during the past 12 months?

529. The last time you had sexual intercourse with this (second, third) person, had you consumed alcohol?

530. Was this person or were you yourself drunk at that time?
IF YES: who was drunk?

531. What was your relationship with this person with whom you had sexual intercourse?
IF BOYFRIEND: Did you live together as if you were married?

IF YES, CIRCLE '02'
IF NO, CIRCLE '03'

532. For how long have you had/did you have sexual intercourse with this person?
IF THE RESPONDENT ONLY HAD SEX ONCE WITH THIS PERSON, RECORD '01' DAY.

533. CHECK 106:

534. How old is this person?

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

536. Would you say that this person was more than 10 years older than you or less than 10 years older than you?

537. Apart from this/these two person(s) did you have sexual intercourse with anyone else during the past 12 months?
[REPEAT QUESTION FOR PAST TWO PARTNERS]

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

IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95.'

539. In all, how many different people did you have sexual intercourse with in your life?

IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95.'

540. CHECK THE COVER PAGE: HOUSEHOLD SELECTED FOR MAN'S SURVEY?

541. CHECK THE PRESENCE OF OTHER PEOPLE
DO NOT CONTINUE IF YOU ARE NOT IN PRIVATE WITH THE RESPONDENT.

542. The first time that you had sexual intercourse, would you say that you wanted to have sexual intercourse or were you forced against your will?

543. During the past 12 months, did someone force you to have sexual intercourse against your will?

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

545. Where is this?
Any other place?

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

RECORD ALL PLACES MENTIONED.

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

547. CHECK 527 ALL THE COLUMNS:

548. Where did you get the condoms last time?

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

549. Do you know the brand name of the condoms that you used last time?

550. The last time you bought condoms, how many did you buy?

551. How much did you pay?

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

Now I have a few questions about the future.

602. CHECK 226:

NOT PREGNANT OR NOT SURE
Would you like to have (a/another) child, or would you prefer not to have (other) children at all?

PREGNANT
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 (a/another) child?

604. CHECK 226:

605. CHECK 310:
USES A 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 major problem, a minor problem or not a problem at all?

609. CHECK 310:
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.

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 of couples that use 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?

619. During the past few 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 the use of this method is mainly your own decision, or that of your partner/husband, or a joint decision?

624. Now I would like to ask you about your partner/husband's opinions about family planning.
Do you think that your partner/husband approves or disapproves of using methods to avoid pregnancy?

625. How many times during the past year 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 and not in the mood for it?

629. When a wife knows that her husband has an infection transmittable by sexual contact, is she justified in asking that they use a condom during intercourse?

630. CHECK 501:

631. Can you refuse sexual intercourse with your husband when you don't want to have it?

632. Can you ask that your husband use a condom if you want him to use one?

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

701. CHECK 501 AND 502:

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/grade) 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 the husband is 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 HIV/AIDS

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

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

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

803. Can people get AIDS from mosquito bites?

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

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

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

807. Can people get AIDS by witchcraft or other supernatural means?

808. Is there something (else) that a person can do to avoid or reduce their risks of contracting the virus that causes AIDS?

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

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

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

During the pregnancy?
During birth?
During breastfeeding?

812. CHECK 811:

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

814. Are there any special drugs that a doctor or nurse can give people infected with the AIDS virus?

815. CHECK 215:

816. CHECK 407:

Now I would like to ask you some questions about your last birth. You told me that you saw someone for prenatal care during this pregnancy.

817. During one of these prenatal visits for this pregnancy, did anyone talk to you about the following subjects?

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

818. Were you offered a test for the AIDS virus as part of your prenatal care?

819. I do not want to know the results, but were you tested for the AIDS virus as part of your prenatal care?

820. I do not want to know the results, but did you get the results of the test?

821. Where was the test done?

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

822. Have you been tested for the AIDS virus since you were tested during your pregnancy?

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

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

825. When did you last get tested for the AIDS virus?

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

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

828. Where was the test done?

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

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

830. Where is this?
Is there another place?

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

RECORD ALL PLACES MENTIONED.

831. Would you buy fresh vegetables from a shopkeeper or vendor if you knew the person had the AIDS virus?

832. If a member of your family had the AIDS virus would you like it to remain a secret or not?

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

834A. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be able to continue teaching in the school?

834B. In your opinion, if a male teacher has the AIDS virus but is not sick, should he be able to continue teaching in the school?

835. Do you personally know someone who has been denied health service in the last 12 months because he or she is suspected to have the AIDS virus?

836. Do you personally know someone who has been denied involvement in social events, religious services or community events in the last 12 months because he or she is suspected to have the AIDS virus?

837. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus?

838. CHECK 835, 836 AND 837:

839. Do you know someone who is suspected to have or has the AIDS virus?

840. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

841. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

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

843. Should children age 12-14 be taught to wait until they get married to have sex to avoid getting AIDS?

844. Do you think that young men should wait until marriage to have sexual intercourse?

845. Do you think that young women should wait until marriage to have sexual intercourse?

846. Do you think that married men should only have sexual intercourse with their wives?

847. Do you think that most of the men you know only have sexual intercourse with their wives?

848. Do you think that married women should only have sexual intercourse with their husband?

849. Do you think that most of the women that you know only have sexual intercourse with their husband?

850. CHECK 801:

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

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

851. When a man has a sexually transmitted infection, which symptom could he have?
Are there other symptoms?

RECORD ALL MENTIONED

852. When a woman has a sexually transmitted infection, which symptom could she have?
Are there other symptoms?

RECORD ALL MENTIONED

853. CHECK 519:

854. CHECK 850:

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

855. During the last 12 months have you had a disease which you got from sexual contact?

856. Sometimes a woman has a bad smelling abnormal genital discharge. During the last 12 months have you had a bad smelling genital discharge?

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

858. CHECK 855, 856 AND 857

859. The last time you had (PROBLEM MENTIONED IN 855/856/857) did you seek any kind of advice or treatment?

860. Where did you go?
Was there another place?
RECORD ALL MENTIONED.

861. The last time you had (PROBLEM MENTIONED IN 855/856/857) did your partner seek any kind of advice or treatment?

862. Where did he go?
Was there another place?
RECORD ALL MENTIONED.

SECTION 9A. FEMALE CIRCUMCISION

901A. I would now like that we speak of another thing.

901B. Have you ever heard of female circumcision?

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

903. Were your external genitals cut?

I would now 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?
IF YES, RETURN TO 904 CHECK AND CHANGE IF NECESSARY.

906. Did they somehow close your vaginal area?

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?

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 somehow closed?

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 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 are favorable to abandoning it?

SECTION 9B. FISTULA

925. Do you know about an illness called "fistula," that is to say the "urine illness?"

926A. What, in your opinion, are the causes of this illness?

926B. What are the main manifestations of this illness?

927. Is it possible to treat this illness and to heal it?

928. Have you ever contracted this illness?

929. If yes, how, in your opinion, did you contract it?

930. Where are you going/did you go for treatment?

930A. CHECK 930:

931. IF you are undergoing or have undergone treatment for your fistula in a modern health center, how many surgical operations did you undergo?

932A. In your opinion was this or the last surgical operation a success?

932B. Why do you think that this operation succeeded?

932C. For how long were you/have you been undergoing treatments?

933A. Why do you think this operation did not succeed?

933B. For how long have you been undergoing treatments?

934A. CHECK 930 AND 931:

934B. What are the results of these treatments today?

934C. For how long were you/have you been undergoing treatments?

935. In your opinion, can fistulas be prevented by adopting the following behaviors?

936. In your opinion can fistulas be avoided by adopting the following behaviors in the case of pregnancy?

937A. CHECK QUESTION 930:

937B. Why did you not get care?

938. Do you know (other) women who suffer or have suffered from fistulas?

939. If yes, how many women?

940. Could you tell me where they currently live (locality, commune and region)?

SECTION 10. RELATIONSHIPS IN THE HOUSEHOLD

1001A. CHECK THE COVER PAGE:

THE WOMEN THAT YOU ARE SURVEYING WAS SELECTED FOR THE RELATIONSHIPS IN THE HOUSEHOLD?

1001B. CHECK THE PRESENCE OF OTHER PEOPLE
DO NOT CONTINUE UNTIL YOU ARE COMPLETELY IN PRIVATE.

CIRCLE THE CODE CORRESPONDING TO THE SITUATION AND FOLLOW THE SKIP INSTRUCTIONS:

READ TO ALL OF THE RESPONDENTS:

Now I would like to ask you some questions about certain aspects of the relationship within the couple. I know that some of the questions are very personal. However, your answers are very important to help us understand the situation of women in Mali. I guarantee that your answers will be completely confidential and will not be repeated to anyone. I also would like to inform you that you are the only one in your household to whom these questions will be asked and that no one will know that we asked you these questions. If someone comes in while we are talking, we will change subjects.

1002. CHECK 501, 502, AND 504:

1003. When two people are married or live together, they share good and bad times. In your relationship with your (last) husband/partner (did/do) the following things happen often, sometimes or never?

A) He usually (spends/spent) his free time with you?
B) He (consults/consulted) you about different household issues?
C) He (is/was) affectionate with you?
D) He (respects/respected) and (takes/took) your wishes into consideration.

Now I would like to ask you some questions about the situations women could come across.

1004. Please tell me if the following things are applicable to your relationship with your (last) husband/partner?

A) He (is/was) jealous when you (talk/talked) to other men?
B) He often (accuses/accused) you of being unfaithful?
C) He (does/did) not let you see your female friends?
D) He (tries/tried) to limit your contact with your family of origin?
E) He (insists/insisted) knowing where you (are/were) all the time?
F) He (does/did) not trust you with money?
G) He (keeps/kept) you from having a job or he does not think you should work?

1005. Now, if you allow it, I would like to ask you some questions about your relationship with your (last) husband.

5A. Has you (last) husband/partner ever:

5B. How many times did this happen during the last 12 months?

1006. Now, if you allow it, I would like to ask you some other questions about your relationship with your (last) husband.

6A. Has your (last) husband or partner ever:

6B. How many times did this happen during the last 12 months?

1007. CHECK 1006:

1008. How long after your (marriage/union/beginning of cohabitation) with your (last) husband/partner did this/these behaviors begin?

1009.

9A. After any deliberate such behavior on the part of your husband/partner did you have any of the following problems?

9B. How many times during the last 12 months did this happen?

1009A. Have you ever done anything to humiliate or threaten your last husband/partner in front of other people?

1009B. How long after your (marriage/union/beginning of cohabitation) with your (last) husband/partner did this/these behaviors begin?

1010. Have you ever fought, hit, kicked or done something else to physically attack your (last) husband/partner when he neither beat nor physically attacked you?

1011. During the last 12 months, how many times have you beaten, slapped, kicked, or did something else to physically attack your (last) husband/partner when he neither beat nor physically attacked you?

1012. Did/does your (last) husband drink alcohol?

1013. Is/was he drunk very often, only sometimes, or never?

1014. CHECK 1002:

MARRIED/LIVES WITH A MAN/SEPARATED/DIVORCED
Since the age of 15 years, has someone besides your (current/last) husband/partner beaten, slapped, kicked you or did something to physically attack you?

NEVER MARRIED/NEVER BEEN IN UNION
Since the age of 15 years, has someone beaten, slapped, kicked you or did something to physically attack you?

1015. Who physically attacked you?
Someone else?
CIRCLE ALL MENTIONED.

1016: CHECK 1015:

1017. Who is the person who has most often beaten, slapped, kicked or did something to physically attack you?

1018. During the last 12 months, how many times did this person beat, slap, kick or done something to physically attack you?

1019. CHECK 201, 226 AND 229:
LIVE BIRTHS, STATE OF PREGNANCY AND STILL BIRTHS

1020. Has anyone ever beaten, slapped, kicked or did something to physically attack you during (a/this) pregnancy?

1021. Who physically attacked you during a pregnancy?
Someone else?
CIRCLE ALL MENTIONED.

1022. CHECK 1006, 1009, 1014 AND 1020:

1023. Did you try to get help?

1024. From whom did you seek help?
Someone else?
CIRCLE ALL MENTIONED.

1025. What is the main reason why you never sought help?

1026. To your knowledge, did your father ever beat your mother?

1026A. Did you know of a service that educates and supports women in difficulty?

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER THAT HER RESPONSES ARE CONFIDENTIAL. RESPOND TO THE QUESTIONS BELOW ONLY WITH REGARDS TO THE PART OF THE INTERVIEW CONCERNING HOUSEHOLD RELATIONSHIPS.

1027. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE ONE OF THE PEOPLE LISTED TRIED TO LISTEN TO INTERVENE IN ANY WAY?

1028. INTERVIEWER'S COMMENTARY:

IF SECTION 10 COULD NOT BE DONE, EXPLAIN THE REASONS ____

SECTION 11. 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.

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

1101B. How many boys did your mother have that are still alive?

1101C. Besides you, how many girls did your mother have that are still alive?

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

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

1101F. Did your mother give birth to other children whom you don't know to be living or deceased?

1101G. How many other children did your mother give birth whom you don't know to be living or deceased?

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

1101I. Just to be sure that I understand, including yourself, your mother gave birth to __ children in all. Is this correct?

1102. CHECK 1101I:

1103. How many of these births did your mother have before your own birth?

Now I would like to make a list of all your brothers and sisters, whether or not they are still alive, beginning with the oldest.

RECORD THE NAME OF ALL OF THE BROTHERS AND SISTERS. REPEAT QUESTIONS 1104-1113 FOR ALL BIRTHS

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

1105. Is (NAME) male or female?

1106. Is (NAME) still alive?

1107. How old is (NAME)?

1108. How many years has (NAME) been deceased?

1109. How old was (NAME) when he/she died?

IF DOESN'T KNOW, PROBE: Did (NAME) die before the age of 12 years?
IF YES, RECORD '95.'
IF NO, ASK OTHER QUESTIONS TO GET AN ESTIMATE. FOR EXAMPLE: Did (NAME) die before getting married?

IF MAN, OR IF WOMAN DECEASED BEFORE THE AGE OF 12 YEARS GO TO NEXT
BIRTH.

1110. Was (NAME) pregnant when she died?

1111. Did (NAME) die during childbirth?

1112. Did (NAME) die in the two months following a pregnancy or birth?

1113. To how many children did (NAME) give birth during her life?

1114. RECORD THE TIME:

INTERVIEWER'S OBSERVATIONS:

FILL OUT AFTER HAVING ENDED THE INTERVIEW

COMMENTS ABOUT THE RESPONDENT ____

COMMENTS ON PARTICULAR QUESTIONS ____

OTHER COMMENTS ____

SUPERVISOR'S OBSERVATIONS ____
SUPERVISOR'S NAME____
DATE____

FIELD EDITOR'S OBSERVTIONS ____
FIELD EDITOR'S NAME____
DATE____

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX.
BIRTHS AND PREGNANCIES: