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SIXTH DEMOGRAPHIC AND HEALTH SURVEY IN MALI (EDSM-VI 2018)

WOMAN'S QUESTIONNAIRE

IDENTIFICATION
PLACE NAME
NAME OF HEAD OF HOUSEHOLD
PLOT NUMBER
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN

HOUSEHOLD SELECTED FOR MAN'S QUESTIONNAIRE

YES 1
NO 2

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2

INTERVIEWER VISITS
1 2 3
DATE

INTERVIEWER'S NAME
RESULT

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

FINAL VISIT
DAY
MONTH
YEAR 2018
RESULT

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

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS

LANGUAGE OF QUESTIONNAIRE: FRENCH 01
LANGUAGE OF INTERVIEW

FRENCH 01
BAMBARA/MALINKE 02
SONRAI/DJERMA 03
PEUHL/FOULFOULDE 04
SENOUFO 05
MARKA/SONINKE 06
DOGON 07
MINIANKA 08
TAMACHECK 09
BOBO/DAFING 10
BOZO/SOMONO 11
OTHER (SPECIFY) 96

NATIVE LANGUAGE OF RESPONDENT

FRENCH 01
BAMBARA/MALINKE 02
SONRAI/DJERMA 03
PEUHL/FOULFOULDE 04
SENOUFO 05
MARKA/SONINKE 06
DOGON 07
MINIANKA 08
TAMACHECK 09
BOBO/DAFING 10
BOZO/SOMONO 11
OTHER (SPECIFY) 96

TRANSLATOR USED

YES 1
NO 2

LANGUAGE OF QUESTIONNAIRE: FRENCH 01

SUPERVISOR
NAME
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is ___. I am working with the National institute of statistics (INSTAT) and the Unit of planning statistics (CPS). We are conducting a survey about health all over Mali. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

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

Signature of interviewer Date

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

SECTION 1. RESPONDENT'S BACKGROUND

101) Record the time

HOUR
MINUTES

102) How long have you been living continuously in (Name of current city, town or village of residence)?
IF LESS THAN ONE YEAR, RECORD 00 YEARS

YEARS __
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)

103) Just before you moved here, did you live in a Bamako, in a town, or in a rural area?

BAMAKO 1
TOWN 2
RURAL 3

104) Before you moved here, which (province/region/state) did you live in?

KAYES 01
KOULIKORO 02
SIKASSO 03
SEGOU 04
MOPTI 05
TOMBOUCTOU 06
GAO 07
KIDAL 08
BAMAKO 09
MENAKA 10
TAOUDENIT 11
OUTSIDE OF MALI/ABROAD 96

105) In what month and year were you born?

MONTH
DON'T KNOW MONTH 98
YEAR
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS

107) Have you ever attended school?

YES 1
NO 2 (SKIP TO 111)

108) What is the highest level of school you attended: Primary 1 (1ST cycle), primary 2 (2nd cycle), secondary (high school, technical, professional), or higher?

PRIMARY 1ST CYCLE 1
PRIMARY 2ND CYCLE 2
SECONDARY (HIGH SCHOOL/TECHNICAL/PROFESSIONAL) 3
HIGHER 4

109) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00

PRIMARY 1ST CYCLE
LESS THAN 1 YEAR 0
1ST YEAR 1
2ND YEAR 2
3RD YEAR 3
4TH YEAR 4
5TH YEAR 5
6TH YEAR 6
PRIMARY 2ND CYCLE
LESS THAN 1 YEAR 0
7TH YEAR 1
8TH YEAR 2
9TH YEAR 3
SECONDARY (HIGH SCHOOL, TECHNICAL/PROFESSIONAL TRAINING)
LESS THAN 1 YEAR 0
1ST/10TH YEAR 1
2ND/11TH YEAR 2
3RD/12TH YEAR 3
4TH YEAR 4
HIGHER
LESS THAN 1 YEAR 0
1ST YEAR 1
2ND YEAR 2
3RD YEAR 3
4TH YEAR 4
5TH YEAR OR MORE 5

110) CHECK 108

PRIMARY, SECONDARY
HIGHER (SKIP TO 113)

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

SHOW CARD TO RESPONDENT

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANOT READ AT ALL 1
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) 4
BLIND/VISUALLY IMPARIED 5

112) CHECK 111:

CODE 2, 3, OR 4 CIRCLED
CODE 1 OR 5 CIRCLED (SKIP TO 114)

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

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

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

116) Do you own a mobile telephone?

YES 1
NO 2 (SKIP TO 118)

117) Do you use your mobile phone for any financial transactions?

YES 1
NO 2

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

YES 1
NO 2

119) Have you ever used the internet?

YES 1
NO 2 (SKIP TO 122)

120) In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (SKIP TO 122)

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

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

122) What is your religion?

MUSLIM 1
CATHOLIC 2
PROTESTANT 3
EVANGELICAL 4
OTHER CHRISTIAN RELIGION 5
ANIMIST 6
OTHER RELIGION 7
NO RELIGION 8

123) What is your ethnicity?

ETHNICITY CODE (FOR MALIANS)
BAMBARA 01
MALINKE 02
PEULH 03
SARAKOLE/SONINK/MARKA 04
SONARI 05
DOGON 06
TOUAREG/BELLA 07
SENOUFO/MINIANKA 08
BOBO 09
OTHER MALIAN (SPECIFY) 16
NATIONAL CODES (FOR FOREIGNERS)
ECWAS COUNTRY 21
OTHER AFRICAN COUNTRY 22
OTHER NATIONALITY 23

124) In the last 12 months, how many times have you been away from home for one or more nights?

NUMBER OF TIMES
NONE 00 (SKIP TO 201)

125) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

126) In the last 6 months, have you heard or seen any message about malaria?

YES 1
NO 2 (SKIP TO 128)

127) Where did you see or hear the message about malaria?
PROBE: Any other sources?
RECORD ALL MENTIONED

RADIO A
TELEVISION B
POSTER C
COMMUNITY FIELD AGENT D
COMMUNITY EVENT E
NGO WORKER F
HEATH PROFESSIONAL G
TOWN CRIER H
HOSPITAL/HEALTH CARE FACILITY I
SCHOOL/TEACHERS J
FRIEND/NEIGHBOR/RELATIVE/MOSQUE K
INTERNET/PHONE MESSAGE L
OTHER (SPECIFY) X

128) In your opinion, what is the main cause of malaria?
RECORD ALL MENTIONED

MOSQUITO BITE A
EXCESSIVE CONSUMPTION OF OIL/EGGS B
FATIGUE FROM WORK C
LACK OF SLEEP/FATIGUE D
DIRECT EXPOSURE TO THE SUN E
CONSUMPTION OF MANGOS/SWEET FRUIT F
CONSUMPTION OF MILK G
DIRTY WATER/DIRTY ENVIRONMENT/DIRTINESS H
DIRTY/POORLY PRESERVED FOOD/FLIES I
COLD FOOD/FROZEN FOOD J
COOLNESS/HUMIDITY/RAIN K
OTHER (SPECIFY) X
DON'T KNOW Z

129) According to you, what are the symptoms of malaria?
PROBE: Other symptoms?
RECORD ALL MENTIONED

FEVER A
LACK OF APPETITE/VOMITING B
ELEVATED TEMPERATURE WITH CONVULSIONS C
HIGH TEMPERATURE WITH FAINTING D
PERSISTENT TEMPERATURE E
CONVULSIONS F
JAUNDICE G
YELLOW URINE/DARK COLORED URINE H
HEADACHE/MIGRAINE I
SORE MUSCLES/JOINT PAIN J
DIARRHEA K
PALENESS/ITCHING L
OTHER (SPECIFY) X
DON'T KNOW Z

130) What are effective methods to prevent malaria?
PROBE: Any other method?
RECORD ALL MENTIONED.

SLEEPING UNDER A MOSQUITO NET A
TAKING PREVENTATIVE MEDICATIONS B
USING INSECTICIDE/DIFFUSERS/CREAMS/LOTIONS/PESTICIDES C
USING AN ANTI-MOSQUITO SPIRAL COIL D
PREVENTATIVE DECOCTION/PLANT JUICE/ROOT FOR DRINKING E
CLEANING THE SURROUNDING ENVIRONMENT F
SPRAYING INSIDE THE HOME G
WINDOW SCREEN H
USE A FUMIGATED COIL I
USE AN ELECTRIC VAPORIZING MAT J
AIR CONDITIONER/FAN K
POWDER (SPREADING)/SPRAYING IN THE DWELLING L
COVERING ONE'S BODY M
AVOID EATING FOODS WITH OIL/EGGS/FAT N
OTHER (SPECIFY) X
DON'T KNOW Z

131) What methods do you use to prevent malaria?
PROBE: Any other method?
RECORD ALL MENTIONED.

SLEEPING UNDER A MOSQUITO NET A
TAKING PREVENTATIVE MEDICATIONS B
USING INSECTICIDE/DIFFUSERS/CREAMS/LOTIONS/PESTICIDES C
USING AN ANTI-MOSQUITO SPIRAL COIL D
PREVENTATIVE DECOCTION/PLANT JUICE/ROOT FOR DRINKING E
CLEANING THE SURROUNDING ENVIRONMENT F
SPRAYING INSIDE THE HOME G
WINDOW SCREEN H
USE A FUMIGATED COIL I
USE AN ELECTRIC VAPORIZING MAT J
AIR CONDITIONER/FAN K
POWDER (SPREADING)/SPRAYING IN THE DWELLING L
COVERING ONE'S BODY M
AVOID EATING FOODS WITH OIL/EGGS/FAT N
OTHER (SPECIFY) X
DON'T KNOW Z

SECTION 2. REPRODUCTION

201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (SKIP TO 206)

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

YES 1
NO 2 (SKIP TO 204)

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

SONGS AT HOME
DAUGHTERS AT HOME

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

YES 1
NO 2 (SKIP TO 206)

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

SONS ELSEWHERE
DAUGHTERS ELSEWHERE

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even for a very short time?

YES 1
NO 2 (SKIP TO 208)

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

BOYS DEAD
GIRLS DEAD

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

TOTAL BIRTHS

209) CHECK 208: Just to makes sure that I have this right: you have had in total ____births during your life. Is that correct?

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

210) CHECK 208:

ONE OR MORE BIRTHS
NO BIRTHS (SKIP TO 226)

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. Record names of all the births in 212. Record twins and triplets on separate rows.
IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

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

RECORD NAME
BIRTH HISTORY NUMBER

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

BOY 1
GIRL 2

214) Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

DAY
MONTH
YEAR

215a) IF BORN IN 2013-2018: How many months pregnant were you when (NAME) was born?

Record B in the birth month in the calendar. Record the name of the child to the left of code B. Record P in each of the preceding months according to the duration of the pregnancy. (Note: the number of P must be 1 less than the number of months the pregnancy lasted)

DURATION OF PREGNANCY

216) Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 220)

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

AGE IN YEARS

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

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER (SKIP TO 221)

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

IF 12 MONTHS OR 1 YEAR, ASK: Did (NAME) have his/her first birthday?
THEN ASK: Exactly how many months old was (NAME) when he/she died?
RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

DAYS 1
MONTHS 2
YEARS 3

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

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

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

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

NUMBERS ARE THE SAME
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215:
Enter the number of births in 2013-2018.

NUMBER OF BIRTHS
NONE 0 (SKIP TO 226)

226) Are you pregnant now?

YES 1
NO 2 (SKIP TO 230)
UNSURE 8 (SKIP TO 230)

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

MONTHS

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

YES 1 (SKIP TO 230)
NO 2

229) CHECK 208: Total number of births

ONE OR MORE

Did you want to have a baby later on or did you not want any more children?

LATER 1
NO MORE/NONE 2

NONE

b) Did you want to have a baby later on or did you not want any children?

LATER 1
NO MORE/NONE 2

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

YES 1
NO 2 (SKIP TO 239)

231) When did the last such pregnancy end?

MONTH
YEAR

232) CHECK 231:

LAST PREGNANCY ENDED IN 2013-2018 (SKIP TO 234)
LAST PREGNANCY ENDED BEFORE 2012 OR EARLIER (SKIP TO 239)

236) In what month and year did the preceding such pregnancy end?

LINE NUMBER
MONTH
YEAR

234) How many months pregnant were you when that pregnancy ended?

NUMBER OF MONTHS

235) Since January 2013, have you had any other pregnancies that did not result in a live birth?

YES 1 (NEXT LINE)
NO 2 (SKIP TO 236)

236) For each pregnancy that did not end in a live birth in 2013-2018 or later, enter T in the calendar in the month that the pregnancy terminated and P for the remaining number of completed months of pregnancy.

If there are more than four pregnancies that did not end in a live birth, use an additional questionnaire starting on the second line.

237) Did you have any miscarriages, abortions or stillbirths that ended before 2013?

YES 1
NO 2 (SKIP TO 239)

238) When did the last such pregnancy that terminated before 2013 end?

MONTH
YEAR

239) When did you last menstrual period start? (Date, if given)

DAYS AGO 1
MONTHS AGO 2
WEEKS AGO 3
YEARS AGO 4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

YES 1
NO 2 (SKIP TO 242)
DON'T KNOW 8 (SKIP TO 242)

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

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

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

YES 1
NO 2
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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

01) FEMALE STERILIZATION
PROBE: Women can have an operation to avoid having any more children
YES 1
NO 2
02) MALE STERILIZATION
PROBE: Men can have an operation to avoid having any more children
YES 1
NO 2
03) IUD
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more months.
YES 1
NO 2
04) INJECTABLES
PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05) IMPLANTS
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06) PILL
PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) CONDOM
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM
PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) EMERGENCY CONTRACEPTION
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
10) STANDARD DAYS METHOD
PROBE: A women uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
11) LOCATIONAL AMENORRHEA METHOD (LAM)
Up to six months after giving birth, before the menstrual period has returned, women use a method which requires her to breastfeed frequently day and night.
YES 1
NO 2
12) RHYTHM METHOD
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
13) WITHDRAWAL
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD A (SPECIFY)
YES, TRADITIONAL METHOD B (SPECIFY)
NO Y

302) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (SKIP TO 312)

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

YES 1
NO 2 (SKIP TO 312)

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

FEMALE STERILIZATION A (SKIP TO 307
MALE STERILIZATION B-307
IUD C - (SKIP TO 309
INJECTABLES D- (SKIP TO 309
IMPLANTS E- (SKIP TO 309
PILL F
CONDOM G (SKIP TO 306
FEMALE CONDOM H
EMERGENCY CONTRACEPTION I
STANDARD DAYS METHOD J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
H-Y SKIP TO 309

305) What is the brand name of the pills you are using?
IF DON'T KNOW BRAND, ASK TO SEE THE PACKAGE.

PILPLAN 01
OVRETTE 02
LO FEMENAL 03
MINIDRIL 04
STEBDIRIL 05
ADEPAL 06
MICROGYNON 07
OTHER (SPECIFY) 96
DON'T KNOW 98
ALL SKIP TO 309

306) What is the brand name of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PRUDENCE 01
PROTECTOR 02
KAMASUTRA 03
IPPF 04
OTHER (SPECIFY) 96
DON'T KNOW 98
ALL SKIP TO 309

307) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR'S OFFICE 22
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER (SPECIFY) 96
DK 98

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

MONTH (SKIP TO 310)
YEAR (SKIP TO 320)

309) Since what month and year did you start using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD FIRST MENTIONED) now without stopping?

MONTH
YEAR

310) CHECK 308 AND 309, 215, AND 231:
Any birth or pregnancy termination after month and year of start of use of contraception in 308 or 309.

NO
YES (GO BACK TO 308 AND 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION)

311) CHECK 308 AND 309:

Year is 2013-2018- C Enter code for method used in month of interview in the calendar and in each month back to the date started using.
Then continue.

Year is 2012 or earlier- C Enter code for method used in month of interview in the calendar and each month back to January 2013
Then skip to 324.

312) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
Use calendar to probe for earlier periods of use and nonuse, starting with most recent use, back to January 2013. Use names of children, dates of birth, and periods of pregnancy as reference points.

COLUMN 1
COLUMN 2
COLUMN 3

312a) Month and year of start of the interval of use or non-use.

MONTH
YEAR

312b) Between (event) in (Month/year) and (event) in (month/year), did you or your partner use any method of contraception?

YES 1
NO 2 (SKIP TO 312i)

312c) Which method was that?

METHOD CODE

312d) How many months after (event) in (month/year) did you start to use (method)?
RECORD 95 IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

IMMEDIATELY 00 (SKIP TO 312f)
MONTHS (SKIP TO 312f)
DATE GIVEN 95

312E) RECORD THE MONTH AND YEAR RESPONDENT STARTED USING METHOD

MONTH
YEAR

312f) For how many months did you use (method)?
RECORD 95 IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE

MONTHS (SKIP TO 312h)
DATE GIVEN 95

312g) Record month and year respondent stopped using method

MONTH
YEAR

312h) Why did you stop using (method)?

REASON STOPPED

312i) Go back to 312a in next column; or, if no more gaps, go to 313.

313) Check the calendar for use of any contraceptive method in any month.

NO METHOD USED
ANY METHOD USED (SKIP 315)

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

YES 1 (SKIP TO 326)
NO 2 (SKIP TO 326)

315) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (SKIP TO 326)
FEMALE STERILIZATION 01 (SKIP TO 319)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAY METHOD 10
LACTATIONAL AMEN. METHOD 11 (SKIP TO 323)
RHYTHM METHOD 12 (SKIP TO 323)
WITHDRAWAL 13 (SKIP TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

316) You first started using (current method) in (date from 309). Where did you get it at that time?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)

PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERENCE HEALTH CENTER 13
COMMUNITY HEALTH CENTER 14
DISPENSARY/MATERNITY 15
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 22
PRIVATE HEALTH CLINIC 23
PHARMACY 24
HEALTH POSTS 25
FAMILY PLANNING CLINIC 26
OTHER PRIVATE MEDICAL (SPECIFY) 28
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
BOOTH 36
TRAVELING PEDDLER 34
FRIENDS/RELATIVES 35
OTHER (SPECIFY) 96

317) CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (SKIP TO 323)
FEMALE CONDOM 08 (SKIP TO 322)
EMERGENCY CONTRACEPTION 09 (SKIP TO 322)
STANDARD DAY METHOD 10 (SKIP TO 322)
OTHER MODERN METHOD 95 (SKIP TO 322)
OTHER TRADITIONAL METHOD 96 (SKIP TO 323)

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

YES (SKIP 321)
NO 2 (SKIP 320)

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

YES (SKIP 321)
NO 2

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

YES
NO 2 (SKIP 322)

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

YES
NO 2

322) CHECK 318 AND 319:

ANY YES

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

YES (SKIP TO 324)
NO 2

OTHER

When you obtained (Current method from 315) from (Source of method from 307 or 316), were you told about other methods of family planning that you could use?

YES (SKIP TO 324)
NO 2

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

YES
NO 2

324) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (SKIP TO 327)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMEN. METHOD 11 (SKIP TO 327)
RHYTHM METHOD 12 (SKIP TO 327)
WITHDRAWAL 13 (SKIP TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (SKIP TO 327)

325) Where did you obtain (current method) the last time?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE)

PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERENCE HEALTH CENTER 13
COMMUNITY HEALTH CENTER 14
DISPENSARY/MATERNITY 15
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 22
PRIVATE HEALTH CLINIC 23
PHARMACY 24
HEALTH POSTS 25
FAMILY PLANNING CLINIC 26
OTHER PRIVATE MEDICAL (SPECIFY) 28
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
BOOTH 36
TRAVELING PEDDLER 34
FRIENDS/RELATIVES 35
OTHER (SPECIFY) 96

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

YES
NO 2

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

YES
NO 2 (SKIP TO 329)

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

YES
NO 2

329) CHECK 202: Living children
Yes a) In the last 12 months, have you visited a health facility for care for yourself or your children?
No b) In the last 12 months, have you visited a health facility for yourself?

YES
NO 2 (SKIP TO 401)

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

YES
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2013-2018
NO BIRTHS IN 2013-2018 (SKIP TO 648)

402) CHECK 215: Record the birth history number in 403 and the name and the survival state from 404 for each birth in 2013-2018. Ask the questions about all these births. Begin with the last birth. (If there are more than 2 births, use last column of additional questionnaire(s)).

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

403) Birth history number from 212 in birth history

LAST BIRTH
BIRTH HISTORY NUMBER

NEXT-TO-LAST BIRTH
BIRTH HISTORY NUMBER

404) From 212 and 216

NAME
LIVING
DEAD

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

YES 1 (SKIP TO 408)
NO 2

406) CHECK 208:
ONLY ONE BIRTH

Did you want to have a baby later on, or did you not want any children?

LATER 1
NO MORE 2 (SKIP TO 408)

MORE THAN ONE BIRTH

b) Did you want to have a baby later on, or did you not want any more children?

LATER 1
NO MORE 2 (SKIP TO 408)

407) How much longer did you want to wait?

MONTHS 1
YEARS 2
DON'T KNOW 998

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

YES 1
NO 2 (SKIP TO 414)

409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT D
TRADITIONAL BIRTH ATTENDANT E
COMMUNITY/VILLAGE HEALTH WORKER F
OTHER (SPECIFY) X

410) Where did you receive this antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
NATIONAL HOSPITAL C
REGIONAL HOSPITAL D
REFERENCE HEALTH CENTER E
COMMUNITY HEALTH CENTER F
DISPENSARY/MATERNITY G
OTHER PUBLIC SECTOR (SPECIFY) H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
DOCTOR'S OFFICE J
PRIVATE HEALTH CLINIC K
HEALTH POSTS L
OTHER PRIVATE MEDICAL (SPECIFY) M
OTHER (SPECIFY) X

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

MONTHS
DON'T KNOW 98

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

NUMBER OF TIMES
DON'T KNOW 98

413) As part of your antenatal care during this pregnancy, were any of the following done at least once?
a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?
d) Did they weigh you?
e) Did they measure you?
f) Did they give you a pelvic exam?

BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2
WEIGHT
YES 1
NO 2
HEIGHT
YES 1
NO 2
PELVIC EXAM
YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 417)
DON'T KNOW 8 (SKIP TO 417)

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

TIMES
DON'T KNOW 8

416) CHECK 416: Tetanus injections

2 OR MORE TIMES (SKIP TO 420)
DON'T KNOW

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

YES 1
NO 2 (SKIP TO 420)
DON'T KNOW 8 (SKIP TO 420)

418) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD 7

TIMES
DON'T KNOW 8

419) CHECK 418:

ONLY ONCE:

How many years ago did you receive the last tetanus injection?

YEARS AGO

MORE THAN ONCE:

b) How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO

420) During this pregnancy, were you given or did you buy iron tablets or iron syrup?
SHOW TABLES/SYRUP

YES 1
NO 2 (SKIP TO 422)
DON'T KNOW 8 (SKIP TO 422)

421) During the whole pregnancy, for how many days did you take the tables or syrup?
IF ANSWER NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

423) During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
NO 2 (SKIP TO 426)
DON'T KNOW 8 (SKIP TO 426)

424) How many times did you take SP/Fansidar during this pregnancy

TIMES

425) Did you get the SP/Fansidar during any antenatal visit, during another visit to a health facility or from another source?
IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

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

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

427) Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP TO 429)
DON'T KNOW 8 (SKIP TO 429)

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

GRAMS FROM CARD 1
GRAMS FROM RECALL 2
DON'T KNOW 99998

429) Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY

HEATH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
TRAINED TRADITIONAL BIRTH ATTENDANT D
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
COMMUNITY/VILLAGE HEALTH WORKER F
FRIENDS/RELATIVES G
OTHER (SPECIFY) X
NO ONE Y

430) Where did you give birth to (NAME)?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

HOME
HER HOME 11 (SKIP TO 434)
OTHER HOME 12 (SKIP TO 434)
PUBLIC SECTOR
NATIONAL HOSPITAL 21
REGIONAL HOSPITAL 22
REFERENCE HEALTH CENTER 23
COMMUNITY HEALTH CENTER 24
DISPENSARY/MATERNITY 25
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
DOCTOR'S OFFICE 32
PRIVATE HEALTH CLINIC 36
HEALTH POSTS 34
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96 (SKIP TO 434

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

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

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

YES 1
NO 2 (SKIP TO 434)

436) When was the decision made to have the caesarean section? Was it before or after your labor pains started?

BEFORE 1
AFTER 2

434) Immediately after the birth, was (NAME) put directly on the bare skin of your chest?

YES 1
NO 2 (SKIP TO 434B)
DON'T KNOW 8 (SKIP TO 434B)

434a) Did (NAME)'s skin have contact with your skin?

YES 1
NO 2
DON'T KNOW 8

434b) CHECK 430: Place of delivery

CODE 11, 12, OR 96 CIRCLED (SKIP TO 449)
OTHER

435) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

YES 1
NO 2 (SKIP TO 438)

436) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
IF ONE WEEK OR MORE, RECORD IN WEEKS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

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

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
TRAINED TRADITIONAL BIRTH ATTENDANT 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
FRIENDS/RELATIVES 23
OTHER (SPECIFY) 96

438) Now I would like to talk to you about checks on (NAME)'s health after delivery--for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

YES 1
NO 2 (SKIP TO 441)
DON'T KNOW 8 (SKIP TO 441)

439) How long after delivery was (NAME)'s health first checked?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD IN WEEKS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

440) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
TRAINED TRADITIONAL BIRTH ATTENDANT 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
FRIENDS/RELATIVES 23
OTHER (SPECIFY) 96

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

YES 1
NO 2 (SKIP TO 445)

442) How long after delivery did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD IN WEEKS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

443) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
TRAINED TRADITIONAL BIRTH ATTENDANT 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
FRIENDS/RELATIVES 23
OTHER (SPECIFY) 96

444) Where did this first check of (NAME) take place?
PROBE TO IDENTITY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
NATIONAL HOSPITAL 21
REGIONAL HOSPITAL 22
REFERENCE HEALTH CENTER 23
COMMUNITY HEALTH CENTER 24
DISPENSARY/MATERNITY 25
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
DOCTOR'S OFFICE 32
PRIVATE HEALTH CLINIC 36
HEALTH POSTS 34
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96

445) I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

446) How many hours, days or weeks after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD IN WEEKS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

447) Who check on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
TRAINED TRADITIONAL BIRTH ATTENDANT 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
FRIENDS/RELATIVES 23
OTHER (SPECIFY) 96

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

PROBE TO IDENTITY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
NATIONAL HOSPITAL 21
REGIONAL HOSPITAL 22
REFERENCE HEALTH CENTER 23
COMMUNITY HEALTH CENTER 24
DISPENSARY/MATERNITY 25
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
DOCTOR'S OFFICE 32
PRIVATE HEALTH CLINIC 36
HEALTH POSTS 34
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96

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

YES 1
NO 2 (SKIP TO 453)

450) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD IN WEEKS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

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

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
TRAINED TRADITIONAL BIRTH ATTENDANT 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
FRIENDS/RELATIVES 23
OTHER (SPECIFY) 96

452) Where did this first check take place?
PROBE TO IDENTITY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
NATIONAL HOSPITAL 21
REGIONAL HOSPITAL 22
REFERENCE HEALTH CENTER 23
COMMUNITY HEALTH CENTER 24
DISPENSARY/MATERNITY 25
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
DOCTOR'S OFFICE 32
PRIVATE HEALTH CLINIC 36
HEALTH POSTS 34
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96

453) I would like to talk to you about checks on (NAME)'s health after delivery--for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 9 (SKIP TO 457)

454) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD IN WEEKS.

HOURS 1
DAYS 2
WEEKS 3
DON'T KNOW 998

455) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
TRAINED TRADITIONAL BIRTH ATTENDANT 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
FRIENDS/RELATIVES 23
OTHER (SPECIFY) 96

456) Where did this first check of (NAME) take place?
PROBE TO IDENTITY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
NATIONAL HOSPITAL 21
REGIONAL HOSPITAL 22
REFERENCE HEALTH CENTER 23
COMMUNITY HEALTH CENTER 24
DISPENSARY/MATERNITY 25
OTHER PUBLIC SECTOR (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
DOCTOR'S OFFICE 32
PRIVATE HEALTH CLINIC 36
HEALTH POSTS 34
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96

457) In the first two days after (NAME)'s birth, did any health care provider do the following:
a) Examine the cord?
b) Measure (NAME)'s temperature?
c) Counsel you on danger signs for newborns?
d) Counsel you on breastfeeding?
e) Observe (NAME) breastfeeding?

A) CORD
YES 1
NO 2
DK 8
B) TEMP
YES 1
NO 2
DK 8
C) SIGNS
YES 1
NO 2
DK 8
D) COUNSEL BREASTFEED
YES 1
NO 2
DK 8
E) OBSERVE BREASTFEED
YES 1
NO 2
DK 8

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

YES 1 (SKIP TO 460)
NO 2 (SKIP TO 461)

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

YES 1
NO 2 (SKIP TO 463)

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

MONTHS
DON'T KNOW 98

461) CHECK 226:
Is respondent pregnant?

NOT PREGNANT
PREGNANT OR NOT SURE (SKIP TO 463

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

YES 1
NO 2 (SKIP TO 464)

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

MONTHS
DON'T KNOW 98

464) Did you ever breastfeed (NAME)?

YES 1 (SKIP TO 466)
NO 2

465) CHECK 404: Child is living?

LIVING (SKIP TO 470)
DEAD (SKIP TO 471)

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

IMMEDIATELY 000
HOURS 1
DAYS 2

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

YES 1
NO 2

468) CHECK 404: Is child living?

LIVING
DEAD (GO TO 471)

469) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A) CHECK 215 IN THE BIRTH HISTORY: Any births in 2015-2018?

ONE OR MORE BIRTHS IN 2015-2018
NO BIRTHS IN 2015-2018 (SKIP TO 601)

502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2015-2018.

NAME OF LAST BIRTH
BIRTH HISTORY NUMBER

503a) CHECK 216 FOR CHILD:

LIVING
DEAD (SKIP TO 501B)

504a) Do you have a card or other document where (NAME)'s vaccinations are written down?

YES, ONLY CARD 1 (SKIP TO 507A
YES, ONLY OTHER DOCUMENT 2
YES, BOTH 3 (SKIP TO 507A
NO, NEITHER CARD NOR OTHER DOCUMENT 4

505a) Did you ever have a vaccination card for (NAME)?

YES 1
NO 2

506a) CHECK 504a

CODE 2 CIRCLED
CODE 4 CIRCLED (SKIP TO 511A

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

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, BOTH SEEN 3
NO, NEITHER SEEN 4 (SKIP TO 511A

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

BCG
ORAL POLIO VACCINE (OPV) 0 (POLIO GIVEN AT BIRTH)
ORAL POLIO VACCINE (OPV) 1
ORAL POLIO VACCINE (OPV) 2
ORAL POLIO VACCINE (OPV) 3
DPT-HEP.B-HIB (PENTAVALENT) 1
DPT-HEP.B-HIB (PENTAVALENT) 2
DPT-HEP.B-HIB (PENTAVALENT) 3
PNEUMOCOCCAL 1
PNEUMOCOCCAL 2
PNEUMOCOCCAL 3
ROTAVIRUS 1
ROTAVIRUS 2
ROTAVIRUS 3
ANTI-MEASLES VACCINE
VACCINE AGAINST MENINGITIS (MENAFRIVAC)
YELLOW FEVER (VAA)
VITAMIN A (MOST RECENT)

509a) CHECK 508A: BCG to Yellow fever (VAA) all recorded

NO
YES (SKIP TO 525A)

510a) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?
RECORD YES ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1-(PROBE FOR VACCINATIONS AND WRITE 66 IN THE CORRESPONDING DAY COLUMN IN 508A. RECORD 00 IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINES NOT GIVEN)--(THEN SKIP TO 525A)

NO 2-(RECORD 00 IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINES NOT GIVEN) -- (THEN SKIP TO 525A)
DON'T KNOW 8- (RECORD 00 IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINES NOT GIVEN) -- (THEN SKIP TO 525A)

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

YES 1
NO 2 (SKIP TO 525A)
DON'T KNOW 8 (SKIP TO 525A)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 517A)
DON'T KNOW 8 (SKIP TO 517A)

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

FIRST TWO WEEKS 1
LATER 2

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

NUMBER OF TIMES

516a1) Did (NAME) receive a polio vaccine in the form of an injection in the thigh?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 519A)
DON'T KNOW 8 (SKIP TO 519A)

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

NUMBER OF TIMES

519a) Has (NAME) ever received the pneumococcal vaccination, PCV 13 vaccine, that is, an injection in the left thigh to prevent pneumonia?

YES 1
NO 2 (SKIP TO 521A)
DON'T KNOW 8 (SKIP TO 521A)

520a) How many times did (NAME) receive the PCV 13 vaccine against pneumonia?

NUMBER OF TIMES

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

YES 1
NO 2 (SKIP TO 523A)
DON'T KNOW 8 (SKIP TO 523A)

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

NUMBER OF TIMES

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

YES 1
NO 2
DON'T KNOW 8

524a) Has (NAME) ever received a meningitis vaccine, the MenAfriVac vaccine, that is, an injection in the thigh to prevent meningitis?

YES 1
NO 2
DON'T KNOW 8

524aa) Has (NAME) ever received a vaccine against yellow fever, that is, an injection in the right thigh to prevent yellow fever?

YES 1
NO 2
DON'T KNOW 8

525a) In the last 7 days was (NAME) given:
a) a micronutrient powder mix like Mougoudlanin?
b) Ready-made dietary supplements like Plumpy Buts?
c) Ready-made dietary supplements like Plumpy Doz?

A) POWDER (MOUGOUDLANIN)
YES 1
NO 2
DON'T KNOW 8
B) PLUMPY NUTS
YES 1
NO 2
DON'T KNOW 8
C) PLUMPY DOZ
YES 1
NO 2
DON'T KNOW 8

526a) Continue with 501b [NOTE: Repeat questions of Section 5 A]

601) CHECK 224:

ONE OR MORE BIRTHS IN 2013-2018
NO BIRTHS IN 2013-2018 (SKIP TO 648

602) CHECK 215: Enter in the table the birth history number in 603 and the name and survival state in 604 for each birth between 2013-2018. Ask the questions about all of these births. Begin with the last birth. If there are more births, use last column of additional questionnaires.

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

603) Birth history number from 212 in birth history

LAST BIRTH
BIRTH HISTORY NUMBER

NEXT-TO-LAST BIRTH
BIRTH HISTORY NUMBER

604) From 212 and 216

NAME
LIVING
DEAD (SKIP TO 646)

605) In the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
Show common types of ampoules/capsules/syrups.

YES 1
NO 2
DON'T KNOW 8

606) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW (SKIP TO 618)

609) CHECK 464: Currently breastfeeding
YES a) Now I would like to know how much (NAME) was given to drink during the diarrhea including breastmilk. Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

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

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

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

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

611) DID YOU SEEK ADVICE OR TREATMENT FOR THE DIARRHEA FROM ANY SOURCE?


YES 1
NO 2 (SKIP TO 615)

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).
(NAME OF PLACE(S))

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERENCE HEALTH CENTER C
COMMUNITY HEALTH CENTER D
DISPENSARY/MATERNITY E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
PRIVATE HEALTH CLINIC I
PHARMACY J
CHW/HEALTH POST K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
TRAVELING PEDDLER N
TRADITIONAL PRACTITIONER/HEALER O
MARKET P
OTHER (SPECIFY) X

613) CHECK 612:

TWO OR MORE CODES CIRCLED
ONLY ONE CODE CIRCLED (SKIP TO 615

614) Where did you first seek advice or treatment?

FIRST PLACE
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERENCE HEALTH CENTER C
COMMUNITY HEALTH CENTER D
DISPENSARY/MATERNITY E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
PRIVATE HEALTH CLINIC I
PHARMACY J
HEALTH POSTS K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
TRAVELING PEDDLER N
TRADITIONAL PRACTITIONER/HEALER O
MARKET P
OTHER (SPECIFY) X

615) Was (NAME) given any of the following to drink at any time since (NAME) started having the diarrhea?
a) A fluid made from a special packet called KENEYADJI (ORS packet)?
b) ORS liquid (KENEYADJI)?
c) Homemade KENEYADJI liquid made with water, sugar, and salt
d) Zinc tablets or syrup?

A) FLUID FROM ORS PACKET
YES 1
NO 2
DK 8
B) ORS FLUID
YES 1
NO 2
DK 8
C) HOMEMADE FLUID
YES 1
NO 2
DK 8
D) ZINC
YES 1
NO 2
DK 8

616) CHECK 615:

Any "Yes"

Was anything else given to treat the diarrhea?

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

All "No" or "DK"

b) Was anything given to treat the diarrhea?

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

617) CHECK 615:

Any "Yes"
a) What else was given to treat the diarrhea? Anything else?

All "No" or "DK"
What was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

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

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

YES 1
NO 2 (SKIP TO 620)
DON'T KNOW 8 (SKIP TO 620)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 623)
DON'T KNOW 8 (SKIP TO 623)

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

CHEST ONLY 1
NOSE ONLY 2
BOTH 3
OTHER (SPECIFY) 6
DON'T KNOW 8
ALL SKIP TO 624

623) CHECK 618: Had fever?

YES
NO OR DK (SKIP TO 646)

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

YES 1
NO 2 (SKIP TO 629)

625) Where did you seek advice or treatment?

Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S))

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERENCE HEALTH CENTER C
COMMUNITY HEALTH CENTER D
DISPENSARY/MATERNITY E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
PRIVATE HEALTH CLINIC I
PHARMACY J
HEALTH POST/CHW K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
TRAVELING PEDDLER N
TRADITIONAL PRACTITIONER/HEALER O
MARKET P
OTHER (SPECIFY) X

626) CHECK 625:

TWO OR MORE CODES CIRCLED
ONLY ONE CODE CIRCLED (SKIP TO 628

627) Where did you first seek advice or treatment?
Use letter code from 625

FIRST PLACE
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERENCE HEALTH CENTER C
COMMUNITY HEALTH CENTER D
DISPENSARY/MATERNITY E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
PRIVATE HEALTH CLINIC I
PHARMACY J
HEALTH POSTS K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
TRAVELING PEDDLER N
TRADITIONAL PRACTITIONER/HEALER O
MARKET P
OTHER (SPECIFY) X

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

DAYS

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

YES 1
NO 2 (SKIP TO 646A)
DON'T KNOW 8 (SKIP TO 646A)

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

RECORD ALL MENTIONED

ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE
PILLS E
INJECTION/IV F
ARTESUNATE
RECTAL G
INJECTION/IV H
OTHER ANTIMALARIAL (SPECIFY) I
ANTIBIOTIC
PILL/SYRUP J
INJECTION/IV K
OTHER DRUGS
ASPIRIN L
ACETAMINOPHEN M
IBUPROFEN N
OTHER (SPECIFY) X
DON'T KNOW Z

631) CHECK 630: Any code A-I circled?

YES
NO (SKIP TO 646)

632) CHECK 630: Artemisinin Combination Therapy (A) given

CODE A CIRCLED
CODE A NOT CIRCLED (SKIP TO 634)

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

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

634) CHECK 630: SP/Fansidar (B) given

CODE B CIRCLED
CODE B NOT CIRCLED (SKIP TO 636)

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

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

636) CHECK 630: Chloroquine (C) given

CODE C CIRCLED
CODE C NOT CIRCLED (SKIP TO 638)

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

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

638) CHECK 630: Amodiaquine (D) given

CODE D CIRCLED
CODE D NOT CIRCLED (SKIP TO 640)

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

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

640) CHECK 630: Quinine (E or F) given

CODE E OR F CIRCLED
CODE E OR F NOT CIRCLED (SKIP TO 642)

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

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

642) CHECK 630: Artesunate (G or H) given

CODE G OR H CIRCLED
CODE G OR H NOT CIRCLED (SKIP TO 644)

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

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

644) CHECK 630: Other antimalarial (J) given

CODE I CIRCLED
CODE I NOT CIRCLED (SKIP TO 645A)

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

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

645a) CHECK 215: Child born in July 2017 or later

BEFORE JULY 2017
IN JULY 2017 OR LATER (SKIP TO 645 L)

645b) I'd like to ask you some questions about the rainy season from last year 2017:

Was (NAME) given drugs to prevent malaria at any time in the rainy season of last year 2017, or in the months that followed?

YES 1
NO 2 (SKIP TO 645E)
DON'T KNOW (SKIP TO 645E)

645c) What drugs did (NAME) take to prevent malaria during the rainy season of last year 2017, or in the months that followed?

Ask to see the box, or if the box isn't available show pictures of drugs.
Any other drugs?
RECORD ALL MENTIONED

ANTIMALARIAL DRUGS
SP/FANSIDAR AND AMODIAQUINE (COMBINED PACKET) A
SP/FANSIDAR AND AMODIAQUINE (COMBINED IN BAG) B
SP/FANSIDAR (ALONE) C
AMODIAQUINE (ALONE) D
ARTEMISININ COMBINATION THERAPY (ACT) E
CHLOROQUINE F
QUININE G
OTHER ANTIMALARIAL (SPECIFY) I
TRADITIONAL DRUGS
PLANT JUICE/ROOT I
OTHER TRADITIONAL DRUGS (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z

645d) CHECK 645C: SP/Fansidar and Amodiaquine (combined packet or combined in packet) not given

CODE A OR B NOT CIRCLED
CODE A OR B CIRCLED (SKIP TO 645F)

645E) Was (NAME) given SP/Fansidar and Amodiaquine to prevent malaria at any time during the rainy season of last year 2017 or in the months that followed?
Show the box of combined SP/Fansidar and Amodiaquine

YES 1
NO 2 (SKIP TO 645L)

645F) Where did you get the first dose of this drug to prevent malaria for (NAME)?

HEALTH CARE ESTABLISHMENT 1
HOME VISIT BY HEALTHCARE PROFESSIONAL/COMMUNITY FIELDWORKER 2
PUBLIC PLACE/FIXED PLACE 3
ANOTHER PLACE 4
DON'T KNOW 8

645g) Do you have a card or booklet where the drug doses and the months they were given to (NAME) to prevent malaria were recorded?

YES 1
NO 2 (SKIP TO 64J)

645h) May I see the card?

YES 1
NO 2 (SKIP TO 64J)

645i) Record the number of months the drug was given

NUMBER OF MONTHS

645j) For how many months was the drug to prevent malaria given to (NAME)?

NUMBER OF MONTHS

645k) In total, how many tablets of these drugs were given to (NAME) in last year 2017 to prevent malaria?

NUMBER

645l) I would like to ask you some questions about the rainy season from this year 2018.

Was (NAME) given drugs to prevent malaria at any time in the rainy season of this year 2018, or in the months that followed?

YES 1
NO 2 (SKIP TO 645O)
DON'T KNOW (SKIP TO 645O)

645m) What drugs did (NAME) take to prevent malaria during the rainy season of this year 2018, or in the months that followed?
ASK TO SEE THE BOX, OR IF THE BOX ISN'T AVAILABLE SHOW PICTURES OF DRUGS.
Any other drugs?
RECORD ALL MENTIONED

ANTIMALARIAL DRUGS
SP/FANSIDAR AND AMODIAQUINE (COMBINED PACKET) A
SP/FANSIDAR AND AMODIAQUINE (COMBINED IN PACKET) B
SP/FANSIDAR (ALONE) C
AMODIAQUINE (ALONE) D
ARTEMISININ COMBINATION THERAPY (ACT) E
CHLOROQUINE F
QUININE G
OTHER ANTIMALARIAL (SPECIFY) I
TRADITIONAL DRUGS
PLANT JUICE/ROOT I
OTHER TRADITIONAL DRUGS (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z

645n) CHECK 645M: SP/Fansidar and Amodiaquine (combined packet or combined in packet) not given

CODE A OR B NOT CIRCLED
CODE A OR B CIRCLED (SKIP TO 646)

645o) Was (NAME) given SP/Fansidar and Amodiaquine to prevent malaria at any time during the rainy season of this year 2018 or in the months that followed?
SHOW THE BOX OF COMBINED SP/FANSIDAR AND AMODIAQUINE

YES 1
NO 2

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

647) CHECK 615(A) AND 615(B), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (SKIP TO 649)

648) Have you ever heard of a special product called KENEYADJi (ORS) you can get for the treatment of diarrhea?

YES 1
NO 2

649) CHECK 215 AND 218, ALL ROWS: Number of children born in 2016-2018 living with respondent

ONE OR MORE (NAME OF YOUNGEST CHILD LIVING WITH HER)
NONE (SKIP TO 701)

650) Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

PLAIN WATER?

YES 1
NO 2
DK 8

JUICE OR JUICE DRINKS?

YES 1
NO 2
DK 8

CLEAR BROTH (DJI SOUP)?

YES 1
NO 2
DK 8

MILK SUCH AS TINNED, POWDERED, OR FRESH ANIMAL MILK?

YES 1
NO 2
DK 8
IF YES, HOW MANY TIMES DID (NAME) DRINK MILK?
IF 7 OF MORE TIMES, RECORD 7
NUMBER OF TIMES DRANK MILK

INFANT FORMULA?

YES 1
NO 2
DK 8
IF YES, HOW MANY TIMES DID (NAME) DRINK INFANT FORMULA?
IF 7 OR MORE TIMES, RECORD 7
NUMBER OF TIMES DRANK FORMULA

ANY OTHER LIQUIDS?

YES 1
NO 2
DK 8

YOGURT?

YES 1
NO 2
DK 8
IF YES, HOW MANY TIMES DID (NAME) EAT YOGURT?
IF 7 OR MORE TIMES, RECORD 7
NUMBER OF TIMES ATE YOGURT

ANY PREPARED MEALS FORTIFIED WITH "ROUILLEMUGU" OR "VITABLE" MADE FOR BABIES, LIKE CERELAC, BLENDINA (NURSIE, BLENDINE, BLEDILAIT)?

YES 1
NO 2
DK 8

BREAD, RICE, CORN, MILLET, SORGHUM, NOODLES, COUSCOUS, MISOLA, OATS, OR ANY OTHER FOODS MADE FROM GRAINS?

YES 1
NO 2
DK 8

PUMPKIN, CARROTS, SQUASH POTATOES OR SWEET POTATOES THAT ARE YELLOW OR ORANGE INSIDE?

YES 1
NO 2
DK 8

WHITE POTATOES, WHITE YAMS, MANIOC, OR ANY OTHER FOODS MADE FROM ROOTS?

YES 1
NO 2
DK 8

ANY DARK GREEN, LEAFY VEGETABLES, LIKE SPINACH?

YES 1
NO 2
DK 8

RIPE MANGOES, PAPAYAS, OR MELONS?

YES 1
NO 2
DK 8

ANY OTHER FRUITS OR VEGETABLES?

YES 1
NO 2
DK 8

LIVER, KIDNEY, HEART OR ANY OTHER ORGAN MEATS?

YES 1
NO 2
DK 8

ANY MEAT, SUCH AS BEEF, PORK, LAMB, GOAT, CHICKEN OR DUCK?

YES 1
NO 2
DK 8

EGGS?

YES 1
NO 2
DK 8

FRESH OR DRIED FISH OR SHELLFISH?

YES 1
NO 2
DK 8

OTHER FOODS BASED IN BEANS, PEAS, LENTILS, OR NUTS?

YES 1
NO 2
DK 8

CHEESE OR OTHER FOOD MADE FROM MILK?

YES 1
NO 2
DK 8

CHENILES, FIRIFIRINI OR OTHER TYPES OF FOOD WITH PROTEINS

YES 1
NO 2
DK 8

FOOD BASED IN RED PALM OIL, PALM NUT OIL, OR PALM NUT OIL SAUCE?

YES 1
NO 2
DK 8

ANY OTHER SOLID, SEMI-SOLID, OR SOFT FOOD?

YES 1
NO 2
DK 8

651) CHECK 650 (CATEGORIES G THROUGH W)

NOT A SINGLE YES
AT LEAST ONE YES (SKIP TO 653)

652) Did (NAME FROM 649) eat any solid, semi-solid or soft foods yesterday during the day or at night?
IF YES, PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat?

YES 1 (SKIP TO 650 TO RECORD FOOD EATEN YESTERDAY THEN CONTINUE TO 653)
NO 2 (SKIP TO 654)

653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD 7

NUMBER OF TIMES
DON'T KNOW 8

654) The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (SKIP TO 704)
YES, LIVING WITH A MAN 2 (SKIP TO 704)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (SKIP TO 712)

703) What is your current marital status: are you a widow, divorced, or separated?

WIDOW 1 (SKIP TO 709)
DIVORCED 2 (SKIP TO 709)
SEPARATED 3 (SKIP TO 709)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

705) Record the husband's/partner's name and line number from the household questionnaire.
IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME
LINE NO.

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

YES 1
NO 2 (SKIP TO 709)
DON'T KNOW 8 (SKIP TO 709)

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

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS
DON'T KNOW 98

708) Are you the first, second…wife?

RANK _____

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

ONCE 1
MORE THAN ONCE 2

710) CHECK 709:

MARRIED/LIVED WITH MAN ONLY ONCE

In what month and year did you start living with your (HUSBAND/PARTNER)?

MONTH _____
DON'T KNOW MONTH 98
YEAR ____ (SKIP TO 712)
DON'T KNOW YEAR 9998

MARRIED/LIVED WITH MAN MORE THAN ONCE

b) Now I would like to talk about your first (HUSBAND/PARTNER) In what month and year did you start living with him?

MONTH _____
DON'T KNOW MONTH 98
YEAR ____ (SKIP TO 712)
DON'T KNOW YEAR 9998

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

AGE _____

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

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

NEVER HAD SEXUAL INTERCOURSE 00 (SKIP TO 731)
AGE IN YEARS

714) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 (SKIP TO 716)
WEEKS AGO 2 (SKIP TO 716)
MONTHS AGO 3 (SKIP TO 716)
YEARS AGO 4 (SKIP TO 727)

715) When was the last time you had sexual intercourse with this person?

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3

716) The last time you had sexual intercourse (WITH THIS SECOND/THIRD) person, was a condom used?

YES 1
NO 2 (SKIP TO 718)

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

YES 1
NO 2

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

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/SEX WORKER 5
OTHER (SPECIFY) 6

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

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

720) How many times during the last 12 months did you have sexual intercourse with this person?

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

NUMBER OF TIMES

721) How old is this person?

AGE OF PARTNER
DON'T KNOW 98

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

YES 1 (SKIP TO 715 IN NEXT COLUMN)
NO 2 (SKIP TO 724)

723) In total, how many different people have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE 95

NUMBER OF PARTNERS LAST 12 MONTHS
DON'T KNOW 98

724) CHECK 106:

AGE 15-24
AGE 25-49 (SKIP TO 727

725) CHECK 701: Not in a union

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 727

726) In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

YES 1
NO 2

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

NUMBER OF PARTNERS IN LIFETIME
DON'T KNOW 98

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

YES, CONDOM USED
NO, CONDOM NOT USED (SKIP TO 731)
NOT ASKED (SKIP TO 731)

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERENCE HEALTH CENTER 13
COMMUNITY HEALTH CENTER 14
DISPENSARY/MATERNITY 15
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 22
PRIVATE HEALTH CLINIC 23
PHARMACY 24
HEALTH POSTS 25
FAMILY PLANNING CLINIC 26
OTHER PRIVATE MEDICAL (SPECIFY) 28
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
BOOTH 36
TRAVELING PEDDLER 34
FRIENDS/RELATIVES 35
OTHER (SPECIFY) 96
DON'T KNOW 98

731) Presence of others during this section.

CHILDREN 10
YES 1
NO 2
ADULT MEN
YES 1
NO 2
ADULT WOMEN
YES 1
NO 2

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304: Neither sterilized

HE OR SHE STERILIZED (SKIP TO 813)

802) CHECK 226:

PREGNANT
NOT PREGNANT OR UNSURE (SKIP TO 804)

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

HAVE ANOTHER CHILD 1 (SKIP TO 805)
NO MORE 2 (SKIP TO 812)
UNDECIDED/DON'T KNOW 8 (SKIP TO 812)

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 813)
UNDECIDED/DON'T KNOW (SKIP TO 811)

805) CHECK 226:

NOT PREGNANT OR NOT SURE

How long would you like to wait from now before the birth of (a/another) child?

MONTHS 1
YEARS 2
SOON/NOW 993 (SKIP TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 813)
AFTER MARRIAGE 995
OTHER (SPECIFY) 996
DON'T KNOW 998
995-998 (SKIP TO 811)

PREGNANT

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

MONTHS 1
YEARS 2
SOON/NOW 993 (SKIP TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 813)
AFTER MARRIAGE 995
OTHER (SPECIFY) 996
DON'T KNOW 998
995-998 (SKIP TO 811)

806) CHECK 226:

NO PREGNANT OR UNSURE
PREGNANT (SKIP TO 812)

807) CHECK 303: Using a contraceptive method?

NOT CURRENTLY USING
CURRENTLY USING (SKIP TO 813)

808) CHECK 805:

24 OR MORE MONTHS OR 02 OR MORE YEARS
NOT ASKED
00-23 MONTHS OR 00-01 YEAR (SKIP TO 812)

809) CHECK 714:

DAYS, WEEKS OR MONTHS AGO
YEARS AGO (SKIP TO 811)
NOT ASKED (SKIP TO 811)

810) CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD

a) You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) X
DON'T KNOW Z

WANTS NO MORE/NONE

b) You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?
RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) X
DON'T KNOW Z

811) CHECK 303: Using a contraceptive method?

NOT ASKED
NO, NOT CURRENTLY USING
YES, CURRENTLY USING (SKIP TO 813)

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

YES 1
NO 2
DON'T KNOW 8

813) 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?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (SKIP TO 815)
NUMBER
OTHER (SPECIFY) 96 (SKIP TO 815)

NO LIVING CHILDREN

b) If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (SKIP TO 815)
NUMBER
OTHER (SPECIFY) 96 (SKIP TO 815)

814) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter if it's a boy or a girl?

NUMBER BOYS GIRLS EITHER
OTHER (SPECIFY) 96

815) In the last few months have you:

A) HEARD ABOUT FAMILY PLANNING ON THE RADIO?
YES 1
NO 2
B) SEEN ANYTHING ABOUT FAMILY PLANNING ON THE TELEVISION?
YES 1
NO 2
C) READ ABOUT FAMILY PLANNING IN A NEWSPAPER OR MAGAZINE?
YES 1
NO 2
D) RECEIVED A VOICE TO TEXT MESSAGE ABOUT FAMILY PLANNING ON A MOBILE PHONE?
YES 1
NO 2
E) SEEN OR READ SOMETHING ABOUT FAMILY PLANNING ON A POSTER OR A PROMOTIONAL SIGN?
YES 1
NO 2
F) HEAR SOMETHING ABOUT FAMILY PLANNING FROM A TOWN CRIER, GRIOT, OR CHURCH LEADER?
YES 1
NO 2

817) CHECK 701:

YES, CURRENTLY MARRIED
YES, CURRENTLY LIVING WITH A MAN
NO, NOT IN UNION (SKIP TO 901)

818) CHECK 303: Using a contraceptive method?

CURRENTLY USING
NOT CURRENTLY USING OR NOT ASKED (SKIP TO 820)
NOT ASKED (SKIP TO 822)

819) Would you say that using contraception is mainly your decision, mainly your (HUSBAND'S/PARTNER'S) decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) 6
ALL (SKIP TO 821)

820) Would you say that not using contraception is mainly your decision, mainly your (HUSBAND'S/PARTNER'S) decision, or did you both decide together?

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

821) CHECK 304:

NEITHER STERILIZED
HE OR SHE STERILIZED (SKIP TO 901)

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

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

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

901) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN
NO IN UNION (SKIP TO 909)

902) How old was your (HUSBAND/PARTNER) on his last birthday?

AGE IN COMPLETED YEARS

903) Did your (last) (HUSBAND/PARTNER) ever attend school?

YES 1
NO 2 (SKIP TO 906)

904) What is the highest level of school you attended: Primary 1 (1ST cycle), primary 2 (2nd cycle), secondary (high school, technical, professional), or higher?

PRIMARY 1ST CYCLE 1
PRIMARY 2ND CYCLE 2
SECONDARY (HIGH SCHOOL/TECHNICAL/PROFESSIONAL) 3
HIGHER 4

905) WHAT IS THE HIGHEST (GRADE/YEAR) HE COMPLETED AT THIS LEVEL?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD 00

GRADE/YEAR
DON'T KNOW 98

906) Has your (HUSBAND/PARTNER) done any work in the last 7 days?

YES 1 (SKIP TO 908)
NO 2
DON'T KNOW 8

907) Has your (HUSBAND/PARTNER) done any work in the last 12 months?

YES 1
NO 2 (SKIP TO 909)
DON'T KNOW 8 (SKIP TO 909)

908) What is your (HUSBAND'S/PARTNER'S) occupation? That is, what kind of work does he mainly do?

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

YES 1 (SKIP TO 913)
NO 2

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

YES 1 (SKIP TO 913)
NO 2

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

YES 1 (SKIP TO 913)
NO 2

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

YES 1
NO 2 (SKIP TO 917)

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

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

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

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

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

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

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

917) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN
NOT IN UNION (SKIP TO 925)

918) CHECK 916:

CODE 1 OR 2 CIRCLED
OTHER (SKIP TO 921)

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

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

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (SKIP TO 922
DON'T KNOW 8

921) Who usually decides how the money your (HUSBAND/PARTNER) earnings will be used: you, your (HUSBAND/PARTNER), or you and your (HUSBAND/PARTNER) jointly?

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

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

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

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

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

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

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

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 928)

926) Do you have a title deed for any house you own?

YES 1
NO 2 (SKIP TO 928)
DON'T KNOW (SKIP TO 928)

927) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 931)

929) Do you have a title deed for any land you own?

YES 1
NO 2 (SKIP TO 931)
DON'T KNOW 8 (SKIP TO 931)

930) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

931) Presence of others at this point (present and listening, present but not listening, or not present)

CHILDREN LESS THAN 10
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
HUSBAND
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
OTHER MALES
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
OTHER FEMALES
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3

932) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DK 8
NEGL. CHILDREN
YES 1
NO 2
DK 8
ARGUES
YES 1
NO 2
DK 8
REFUSES SEX
YES 1
NO 2
DK 8
BURNS FOOD
YES 1
NO 2
DK 8

SECTION 10. HIV/AIDS

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

YES 1
NO 2 (SKIP TO 1042)

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

YES 1
NO 2
DON'T KNOW 8

1003) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1006) Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1008) Can HIV be transmitted from a mother to a baby?

DURING PREGNANCY?
YES 1
NO 2
DK 8
DURING DELIVERY?
YES 1
NO 2
DK 8
BY BREASTFEEDING?
YES 1
NO 2
DK 8

1009) CHECK 1008:

AT LEAST ONE YES
OTHER (SKIP TO 1011)

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

YES 1
NO 2
DON'T KNOW 8

1011) CHECK 208 AND 215:

LAST BIRTH IN 2016-2018
NO BIRTHS (SKIP TO 1027)
LAST BIRTH IN 2015 OR LATER (SKIP TO 1027)

1012) CHECK 408 FOR LAST BIRTH

HAD ANTENATAL CARE
NO ANTENATAL CARE (SKIP TO 1020)

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

1014) During any of the antenatal visits for your last birth were you given any information about:

A) BABIES GETTING HIV FROM THEIR MOTHER?
YES 1
NO 2
DK 8
B) THINGS THAT YOU CAN DO TO PREVENT GETTING HIV?
YES 1
NO 2
DK 8
C) GETTING TESTED FOR THE HIV?
YES 1
NO 2
DK 8

1015) Were you offered a test for HIV as part of your antenatal care?

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1020)

1017) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
STAND-ALONE HTC CENTER 13
MOBILE HTC SERVICES 14
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 21
STAND-ALONE HTC CENTER 22
MOBILE HTC SERVICES 23
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER (SPECIFY) 96

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

YES 1
NO 2 (SKIP TO 1020)

1019) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1
NO 2
DON'T KNOW 8

1020) CHECK 430 FOR LAST BIRTH

ANY CODE 21-36 CIRCLED
OTHER (SKIP TO 1024)

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1024)

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

YES 1 (SKIP TO 1025)
NO 2 (SKIP TO 1025)

1024) CHECK 1016:

YES
NO OR NOT ASKED (SKIP TO 1027)

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

YES 1 (SKIP TO 1028)
NO 2

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

MONTHS AGO
TWO OR MORE YEAR AGO 95
ALL (SKIP TO 1036)

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

YES 1
NO 2 (SKIP TO 1031)

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

MONTHS AGO
TWO OR MORE YEARS AGO 95

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

YES 1
NO 2

1030) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
STAND-ALONE HTC CENTER 13
MOBILE HTC SERVICES 14
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 21
STAND-ALONE HTC CENTER 22
MOBILE HTC SERVICES 23
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER (SPECIFY) 96

1031) Do you know of a place where people can go to get an HIV test?

YES 1
NO 2 (SKIP TO 1036)

1032) Where is that?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
STAND-ALONE HTC CENTER 13
MOBILE HTC SERVICES 14
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 21
STAND-ALONE HTC CENTER 22
MOBILE HTC SERVICES 23
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER (SPECIFY) 96

1036) Have you heard of test kits people can use to test themselves for HIV?

YES 1
NO 2 (SKIP TO 1035)

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

YES 1
NO 2

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

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

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

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

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

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

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

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

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

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

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

AGREE 1
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8

1042) CHECK 1001:

HEARD ABOUT HIV OR AIDS

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

YES 1
NO 2

NOT HEARD ABOUT HIV OR AIDS

b) Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

1043) CHECK 713:

HAS HAD SEXUAL INTERCOURSE
NEVER HAD SEXUAL INTERCOURSE (SKIP TO 1051)

1044) CHECK 1042: Heard about other sexually transmitted infections?

YES
NO (SKIP TO 1046)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1048) CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES')
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 1051)

1049) The last time you had (problem from 1045/1046/1047), did you seek any kind of advice or treatment?

YES 1
NO 2 (SKIP TO 1051)

1050) Where did you go?

Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERENCE HEALTH CENTER C
COMMUNITY HEALTH CENTER D
DISPENSARY/MATERNITY E
STAND-ALONE HTC CENTER F
MOBILE HTC SERVICES G
OTHER PUBLIC SECTOR (SPECIFY) H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
STAND-ALONE HTC CENTER J
PHARMACY K
MOBILE HTC SERVICES L
OTHER PRIVATE MEDICAL (SPECIFY) M
OTHER SOURCE
SHOP N
OTHER (SPECIFY) X

1051) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1053) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A HUSBAND
NOT IN UNION (SKIP TO 1101)

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

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

1055) Can you ask your (HUSBAND/PARTNER) to use a condom if you wanted him to?

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

SECTION 11. OTHER HEALTH ISSUES

1101) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD 90.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS
NONE 00 (SKIP TO 1104)

1102) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?

IF THE NUMBER OF INJECTIONS IS OVER 90 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD 90.
IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN AN ESTIMATE.

NUMBER OF INJECTIONS
NONE 00 (SKIP TO 1104)

1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

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

EVERY DAY 1
SOME DAYS 2 (SKIP TO 1106)
NOT AT ALL 3 (SKIP TO 1106)

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

NUMBER OF CIGARETTES

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

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 1108)

1107) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPES FULL OF TOBACCO
KRETEKS A
PIPES FULL OF TOBACCO B
CIGARS, CHEROOTS, OR CIGARILLOS C
WATER PIPE D
SNUFF BY MOUTH E
SNUFF BY NOSE F
CHEWING TOBACCO G
BETEL QUID WITH TOBACCO H
OTHER (SPECIFY) X

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

A) GETTING PERMISSION TO GO TO THE DOCTOR?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
B) GETTING MONEY NEEDED FOR ADVICE OR TREATMENT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
C) THE DISTANCE TO THE HEALTH FACILITY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
D) NOT WANTING TO GO ALONE?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1109) Are you covered by health insurance?

YES 1
NO 2 (SKIP TO 1111)

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

RECORD ALL MENTIONED.

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

1111) Has a doctor or health care professional ever checked your blood pressure.

YES 1
NO 2
DON'T KNOW 8

1112) Has a doctor or other healthcare professional ever told you that you have high blood pressure or hypertension?

YES 1
NO 2 (SKIP TO 116)

1113) In the last 12 months, as a doctor or healthcare professional told you that you have high blood pressure or hypertension?

YES 1
NO 2

1114) Has a doctor or healthcare professional ever prescribed you drugs to control your blood pressure?

YES 1
NO 2

1115) Are you currently taking drugs to control your hypertension?

YES 1
NO 2

1116) Has a doctor or other health care professional measured the level of sugar in your blood?

YES 1
NO 2
DON'T KNOW 8

1117) Has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?

YES 1
NO 2 (SKIP TO 1200)

1118) In the last 12 months, has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?

YES 1
NO 2

1119) Has a doctor or other health care professional prescribed drugs to control the levels of sugar in your blood or to control diabetes?

YES 1
NO 2

1120) Are you currently taking drugs to control the level of sugar in your blood or to control diabetes?

YES 1
NO 2

SECTION 12. FEMALE GENITAL CUTTING

1200) Check cover page of household questionnaire for men's survey?

HOUSEHOLD WASN'T SELECTED FOR MEN'S SURVEY
HOUSEHOLD WAS SELECTED FOR MEN'S SURVEY (SKIP TO 1301)

1201) I'd like to talk to you about a practice called female circumcision. Have you ever heard of female circumcision?

YES 1 (SKIP TO 1203)
NO 2

1202) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (SKIP TO 1301)

1203) Have you yourself ever been circumcised?

YES 1
NO 2 (SKIP TO 1209)

1204) Now I would like to ask you what was done to you at that time.
Was any flesh removed from the genital area?

YES 1 (SKIP TO 1206)
NO 2
DON'T KNOW 8

1205) Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1206) Was your genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1207) How old were you when you were circumcised?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS
AS A BABY/DURING INFANCY 95
DON'T KNOW 98

1208) Who performed the circumcision?

TRAD. CIRCUMCISER 11
MATRON/TRAD. BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) 16
HEALTH CARE PROFESSIONAL
DOCTOR 21
NURSE/MID-WIFE 22
OTHER HEALTH CARE PROFESSIONAL 26
DON'T KNOW 98

1209) CHECK 213, 215, 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 2003 OR LATER
HAS NO LIVING DAUGHTERS BORN IN 2003 OR LATER (SKIP TO 1216

1209a) CHECK 213, 215, and 216: Enter in the table the birth history number and name of each living daughter born in 2003 or later. Ask the questions about all of these daughters. Begin with the youngest daughter. (If there are more than 6 daughters, use additional questionnaires).
Now I would like to ask you some questions about your (daughter/daughters).

1210) Birth history number and name of each living daughter born in 2003 or later

LIVING DAUGHTER
BIRTH HISTORY NUMBER
NAME

1211) Is (NAME OF DAUGHTER) circumcised?

YES 1
NO 2 (SKIP TO 1211 IN NEXT COLUMN OR IF NO MORE DAUGHTERS, GO TO 1216)

1212) How old was (NAME OF DAUGHTER) when she was circumcised?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS
DON'T KNOW 98

1213) Was her genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1214) Who performed the circumcision?

TRAD. CIRCUMCISER 11
MATRON/TRAD. BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) 16
HEALTH CARE PROFESSIONAL
DOCTOR 21
NURSE/MID-WIFE 22
OTHER HEALTH CARE PROFESSIONAL 26
DON'T KNOW 98

1215) GO BACK TO 1211 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 1216.

1216) Do you believe that female circumcision is required by your religion?

YES 1
NO 2
NO RELIGION 3
DON'T KNOW 8

1217) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

SECTION 13. FISTULA

1301) Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery. Have you ever experienced a constant leakage of urine or stool from your vagina?

YES 1 (SKIP TO 1303)
NO 2

1302) Have you ever heard of this problem?

YES 1 (SKIP TO 1401)
NO 2 (SKIP TO 1401)

1303) Did this problem start after you delivered a baby or after a miscarriage?

AFTER A DELIVERY 1
AFTER A MISCARRIAGE 2
NEITHER 3 (SKIP TO 1305)

1304) Did this problem start after a normal labor and delivery or after a difficult labor and delivery?

NORMAL LABOR/DELIVERY 1 (SKIP TO 1306)
DIFFICULT LABOR/DELIVERY 2 (SKIP TO 1306)

1305) In your opinion, what caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER (SPECIFY) 6
DON'T KNOW 8 (SKIP TO 1307)

1306) How many days after (cause of the problem from 1303 or 1305) did the leakage start?
RECORD 90 IF 90 DAYS OR MORE

NUMBER OF DAYS AFTER DELIVERY/OTHER EVENT
DON'T KNOW 98

1307) Have you sought treatment for this condition?

YES 1 (SKIP TO 1309)
NO 2

1308) Why have you not sought treatment?
PROBE AND RECORD ALL MENTIONED

DO NOT KNOW CAN BE FIXED A
DO NOT KNOW WHERE TO GO B
TOO EXPENSIVE C
TOO FAR D
POOR QUALITY OF CARE E
COULD NOT GET PERMISSION F
EMBARRASSMENT G
PROBLEM WENT AWAY H
OTHER (SPECIFY) X
ALL (SKIP TO 1401)

1309) From whom did you last seek treatment?

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2
MATRON 3
OTHER PERSON
COMMUNITY/VILLAGE FIELDWORKER 4
OTHER (SPECIFY) 6

1310) Did you have an operation to fix the problem?

YES 1
NO 2

1311) Did the treatment stop the leakage completely?
IF NO, did the treatment reduce the leakage?

YES, STOPPED COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3
DID NOT RECEIVE ANY TREATMENT 4

SECTION 14: ADULT AND MATERNAL MORTALITY

1401) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who live with you, those who live elsewhere, and those who are dead. We have learned in previous surveys that it can be hard to create a complete list of all children born to your natural mother. We will work together to create a complete list and to help you remember all your brothers and sisters. Can you now give me the names of all your brothers and sisters born to your natural mother?

NAME
ORDER NUMBER

1402) CHECK 1401:

AT LEAST ONE BROTHER OR SISTER LISTED
NOT A SINGLE BROTHER OR SISTER LISTED (SKIP TO 1404)

1403) READ THEIR NAMES TO THE RESPONDENT, AND AFTER THE LAST ONE, ASK: Are there any other brothers or sisters from the same mother that you didn't list?

NO
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1401)

1404) Sometimes people forget to list children of their natural mother because they do not live with them or because they don't see each other very often. Are there brothers or sisters that do not live with you that you didn't list?

NO
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1401)

1405) Sometimes people forget to list children of their biological mother because they are dead. Do you have any brothers and sisters who are dead who you did not list?

NO
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1401)

1406) Sometimes people have brothers or sisters from the same mother but from a different father. Are there any brothers or sisters born of your natural mother but who have a different natural father who you did not list?

NO
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1401)

1407) COUNT THE NUMBER OF BROTHERS OR SISTERS RECORDED IN 1401

TOTAL NUMBER OF BROTHERS AND SISTERS

1408) CHECK 1407:
Just to make sure that I've understood, not including yourself, your mother gave birth to _____ children total. Is that correct?

YES
NO (PROBE AND CORRECT 1401 AND OR 1407)

1409) CHECK 1407: At least one brother or sister listed

NOT A SINGLE BROTHER OR SISTER LIST (SKIP TO 1500)

1410) Please tell me which brother or sister was born first? At who was the next?
RECORD 01 FOR THE ORDER NUMBER IN 1401 FOR THE FIRST BROTHER OR SISTER, 02 FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED ORDER NUMBERS FOR ALL BROTHERS AND SISTERS.

1411) How many births did your mother have before your own birth?

NUMBER OF PREVIOUS BIRTHS

1412) Record the brother and sisters according to the order number from 1401. Ask 1413 through 1424 for one brother or sister before moving to the next brother or sister. If there are more than 12 brothers and sisters, use a supplementary questionnaire.

1413) Name of brother or sister

NAME

1414) Is (NAME) male or female?

MALE 1
FEMALE 2

1415) Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 1417)
DK 8 (SKIP TO [2,3,4, ETC])

1416) How old is (NAME)?

AGE

1417) How many years ago did (NAME) die?

YEARS

1418) How old was (NAME) when he/she died?
IF DON'T KNOW, INSIST AND ASK OTHER QUESTION TO GET AN ESTIMATE.
IF MAN, OR IF WOMAN DIED BEFORE AGE 12, GO TO 1423.

1419) Was (NAME) pregnant when she died?

YES 1 (SKIP TO 1423)
NO 2

1420) Did (NAME) die during childbirth?

YES 1 (SKIP TO [2,3,4,ETC])
NO 2

1421) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (SKIP TO 1423)

1422) How many days after the end of (NAME)'s pregnancy did she die?

1423) Was (NAME)'s death the result of a violent act?

YES 1 (SKIP TO [2,3,4,ETC])
NO 2

1424) Was (NAME)'s death the result of an accident?

YES 1
NO 2
SKIP TO [2,3,4,ETC]

IF NO OTHER BROTHERS OF SISTER, GO TO SECTION 15. DOMESTIC VIOLENCE

SECTION 15. DOMESTIC VIOLENCE

1500a) Check cover page: household selected for men's questionnaire?

HOUSEHOLD IS SELECTED FOR MEN'S QUESTIONNAIRE
HOUSEHOLD IS NOT SELECTED FOR MEN'S QUESTIONNAIRE (SKIP TO 1536)

1500) CHECK COVER PAGE: woman selected for domestic violence module?

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE
WOMAN NOT SELECTED FOR DOMESTIC VIOLENCE MODULE (SKIP TO 1536)

1501) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (SKIP TO 1532)

1501a) READ TO THE RESPONDENT: Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Mali. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you a question you do not want to answer, let me know and I will skip to the next question.

1502) CHECK 701 AND 702:

CURRENTLY MARRIED/LIVING WITH A MAN
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH HUSBAND/PARTNER)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1516)

1503) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (HUSBAND/PARTNER).

A) HE (IS/WAS) JEALOUS OR ANGRY IF YOU (TALK/TALKED) TO OTHER MEN?
YES 1
NO 2
DK 8
B) HE FREQUENTLY (ACCUSES/ACCUSED) YOU OF BEING UNFAITHFUL?
YES 1
NO 2
DK 8
C) HE (DOES/DID) NOT PERMIT YOU TO MEET YOUR FEMALE FRIENDS?
YES 1
NO 2
DK 8
D) HE (TRIES/TRIED) TO LIMIT YOUR CONTACT WITH YOUR FAMILY?
YES 1
NO 2
DK 8
E) HE (INSISTS/INSISTED) ON KNOWING WHERE YOU (ARE/WHERE) AT ALL TIMES?
YES 1
NO 2
DK 8

1504) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.
a) (Does/did) your (last) (HUSBAND/PARTNER) ever:
b) How often did this happen during the last 12 months: often, only sometimes, or not in the last 12 months?

A) SAY OR DO SOMETHING TO HUMILIATE YOU IN FRONT OF OTHERS?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
B) THREATEN TO HURT OR HARM YOU OR SOMEONE YOU CARE ABOUT?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
C) INSULT YOU OR MAKE YOU FEEL BAD ABOUT YOURSELF?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

1505) a) Did your (last) (HUSBAND/PARTNER) ever do any of the following things to you:
b) How often did this happen during the last 12 months: often, only sometimes, or not in the last 12 months?

A) PUSH YOU, SHAKE YOU, OR THROW SOMETHING AT YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
B) SLAP YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
C) TWIST YOUR ARM OR PULL YOUR HAIR?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
D) PUNCH YOU WITH HIS FIST OR WITH SOMETHING THAT COULD HURT YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
E) KICK YOU, DRAG YOU, OR BEAT YOU UP?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
F) INTENTIONALLY TRY TO CHOCK YOU OR BURN YOU?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
G) THREATEN YOU WITH A KNIFE, GUN, OR OTHER TYPE OF WEAPON?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
H) PHYSICALLY FORCE YOU TO HAVE SEXUAL INTERCOURSE WITH HIM EVEN WHEN YOU DID NOT WANT TO?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
I) PHYSICALLY FORCE YOU TO PERFORM OTHER SEXUAL ACTS YOU DID NOT WANT TO?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3
J) FORCE YOU WITH THREATS OR IN ANY OTHER WAY TO PERFORM SEXUAL ACTS YOU DID NOT WANT TO?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT IN THE LAST 12 MONTHS 3

1506) CHECK 1505A (a-j):

AT LEAST ONE YES
NOT A SINGLE YES (SKIP TO 1509)

1507) How long after you (first got married to/started living with) your (last) (HUSBAND/PARTNER) did this or any of these things first happen?
IF LESS THAN ONE YEAR, RECORD 00.

NUMBER OF YEARS
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1508) Did the following ever happen as a result of what your (last) (HUSBAND/PARTNER), did to you:

A) YOU HAD CUTS, BRUISES, OR ACHES?
YES 1
NO 2
B) YOU HAD EYE INJURIES, SPRAINS, DISLOCATIONS, OR BURNS?
YES 1
NO 2
C) YOU HAD DEEP WOUNDS, BROKEN BONES, BROKEN TEETH, OR ANY OTHER SERIOUS INJURY?
YES 1
NO 2

1509) Have you ever hit, slapped, kicked or done anything else to physically hurt your (last) (HUSBAND/PARTNER) at times when he was not already beating or physically hurting you?

YES 1
NO 2 (SKIP TO 1511)

1510) In the last 12 months, how often have you done this to your (last) (HUSBAND/PARTNER): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1511) Does (did) your (HUSBAND/PARTNER) drink alcohol?

YES 1
NO 2 (SKIP TO 1513)

1512) How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1513) Are (were) you afraid of your (last) (HUSBAND/PARTNER): many times, sometimes, or never?

MANY TIMES AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1514) CHECK 709:

MARRIED MORE THAN ONCE
MARRIED ONLY ONCE (SKIP TO 1516)

1515)
a) So far we have been talking about the behavior of your (current/last) (HUSBAND/PARTNER). Now I want to ask you about the behavior of any previous (HUSBAND/PARTNER).
b) How long ago did this last happen?

A) DID ANY PREVIOUS (HUSBAND/PARTNER) EVER HIT, SLAP, KICK OR DO ANYTHING ELSE TO HURT YOU PHYSICALLY?

EVER?
YES 1
NO 2
0-11 MONTHS AGO
YES 1
NO 2
12 OR MORE MONTHS AGO
YES 1
NO 2
DON'T REMEMBER
YES 1
NO 2

B) DID ANY PREVIOUS (HUSBAND/PARTNER) PHYSICALLY FORCE YOU TO HAVE INTERCOURSE OR PERFORM ANY OTHER SEXUAL ACTS AGAINST YOUR WILL?

EVER?
YES 1
NO 2
0-11 MONTHS AGO
YES 1
NO 2
12 OR MORE MONTHS AGO
YES 1
NO 2
DON'T REMEMBER
YES 1
NO 2

C) DID ANY PREVIOUS (HUSBAND/PARTNER) HUMILIATE YOU IN FRONT OF OTHERS, THREATEN TO HURT OR HARM YOU OR SOMEONE YOU CARE ABOUT, INSULT YOU OR MAKE YOU FEEL BAD ABOUT YOURSELF?

EVER?
YES 1
NO 2
0-11 MONTHS AGO
YES 1
NO 2
12 OR MORE MONTHS AGO
YES 1
NO 2
DON'T REMEMBER
YES 1
NO 2

1516) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN: From the time you were 15 years old has anyone other than (your/any) (HUSBAND/PARTNER) hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (SKIP TO 1519)
REFUSED TO ANSWER/NO ANSWER 6 (SKIP TO 1519)

NEVER MARRIED/NEVER LIVED WITH A MAN: From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (SKIP TO 1519)
REFUSED TO ANSWER/NO ANSWER 6 (SKIP TO 1519)

1517) Who has physically hurt you in this way? Anyone else?
RECORD ALL MENTIONED

MOTHER/FATHER'S WIFE A
FATHER/MOTHER'S HUSBAND B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
EX-BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAWS J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) X

1518) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1519) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT (YES TO 201 OR 226 OR 230)
NEVER BEEN PREGNANT (SKIP TO 1522)

1520) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (SKIP TO 1522)

1521) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
EX-BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAWS L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) X

1522) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1522B)

1522a) Now I want to ask you about things that may have been done to you by someone other than (your/any) (HUSBAND/PARTNER).

At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1 (SKIP TO 1523)
NO 2 (SKIP TO 1524A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1524A)

1522b) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1
NO 2 (SKIP TO 1526)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1526)

1523) Who was the person who was forcing you the first time?

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/ PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) 96

1524) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN

In the last 12 months, has anyone other than (your/any) (HUSBAND/PARTNER) physically forced you to have sexual intercourse when you did not want to?

YES 1 (SKIP TO 1525)
NO 2 (SKIP TO 1525)

NEVER MARRIED/NEVER LIVED WITH A MAN

In the last 12 months, has anyone physically forced you to have sexual intercourse when you did not want to?

YES 1 (SKIP TO 1525)
NO 2 (SKIP TO 1525)

1524a) CHECK 1505a (h-j), 1515a(b), 1522a, and 1522b:

AT LEAST ONE YES
NOT A SINGLE YES (SKIP TO 1526)

1525) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN

How old were you the first time someone including (your/any) (HUSBAND/PARTNER) forced you to have sexual intercourse or perform any other sexual?

AGE IN COMPLETED YEARS
DON'T KNOW 98

NEVER MARRIED/NEVER LIVED WITH A MAN

How old were you the first time someone forced you to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS
DON'T KNOW 98

1526) CHECK 1505 (a-j), 1515 (a,b), 1516, 1520, 1522a, and 1522b:

AT LEAST ONE YES
NOT A SINGLE YES (SKIP TO 1530)

1527) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (SKIP TO 1529)

1528) From whom have you sought help?
Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A
HUSBAND'S/PARTNER'S FAMILY B
CURRENT/FORMER HUSBAND/PARTNER C
CURRENT/FORMER BOYFRIEND D
FRIEND E
NEIGHBOR F
RELIGIOUS LEADER G
DOCTOR/MEDICAL PERSONNEL H
POLICE I
LAWYER J
SOCIAL SERVICE ORGANIZATION K
OTHER (SPECIFY) X

ALL SKIP TO 1530

1529) Have you ever told anyone about this?

YES 1
NO 2

1530) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

Thank the respondent for her cooperation and reassure her about the confidentiality of her answers. Fill out the questions below with reference to the domestic violence module only.

1531) Did you have to interrupt the interview because some adult was trying to listen, or came into the room, or interfered in any other way?

HUSBAND
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES ONCE 1
YES, MORE THAN ONCE 2
NO 3

1532) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

1536) RECORD THE TIME

HOURS
MINUTES

INTERVIEWER'S OBSERVATIONS

To be filled in after completing interview

COMMENTS ABOUT RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS