IDENTIFICATION

VILLAGE/PLACE NAME_____

NAME OF HOUSEHOLD HEAD_____

MDHS CLUSTER NUMBER _____

HOUSEHOLD NUMBER ______

URBAN/RURAL _____

NAME AND LINE NUMBER OF WOMAN_____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ___
INTERVIEWER'S NAME ___
RESULT* ____

RESULT ____

NEXT VISIT:
DATE___
TIME____

FINAL VISIT
DAY___
MONTH ___
YEAR ___
NAME ___
RESULT ___

TOTAL NUMBER OF VISITS ____

LANGUAGE OF QUESTIONNAIRE:

LANGUAGE OF INTERVIEW:

SUPERVISOR
NAME ____
DATE ____

FIELD EDITOR
NAME ____
DATE ____

OFFICE EDITOR_____

KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village?

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

104. Just before you moved here, did you live in a city, in a town, or in a village?

105. In what month and year were you born?

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

107. Have you ever attended school?

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

109. How many years of school did you complete at that level?

110. CHECK 108:

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?

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

113. CHECK 111:

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

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

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

117. What is your religion?

118. What is your tribe or ethnic group?

119. Have you heard that when a child is born in Malawi, you can register that child with the government and receive a birth certificate?

SECTION 2: REPRODUCTION

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

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

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

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

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'.

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few moments?

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

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

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

210. CHECK 208:

211. Now I would like to 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 LINES.

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

213. Were any of these births twins?

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

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

216. Is (NAME) still alive?

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

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

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

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

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1995 OR LATER.
IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE JANUARY 1995, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.
(NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

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

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

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

230. When did the last such pregnancy end?

231. CHECK 230:

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

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

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1995.
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

234A. Did you have any pregnancies that terminated before 1995 which did not result in a live birth?

235. FILL IN THE MONTH AND YEAR OF TERMINATION OF THE LAST NON-LIVE BIRTH PREGNANCY PRIOR TO JANUARY 1995.

236. When did your last menstrual period start?

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

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

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

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

302. Have you ever used (METHOD)?

303. CHECK 302:

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

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

307. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.
How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

308. CHECK 302 (01):

309. CHECK 226:

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

311. Which method are you using?
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

313. Where did the sterilization take place?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF BOTH CODE 'A' AND CODE 'B' ARE CIRCLED IN 311, ASK 313-317 ABOUT FEMALE STERILIZATION ONLY.

314. CHECK 311:

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

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

316. In what month and year was the sterilization performed?

317. CHECK 316:

319. Where did you obtain (CURRENT METHOD) when you started using it?
319A. Where did you learn to use the lactational amenorrhea method?

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

319B. For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH RECORD '00'.

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

322. You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 319).
At that time, were you told about side effects or problems you might have with the method?

322A. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

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

325. CHECK 322:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 319), were you told about other methods of family planning which you could use?

325A. Were you ever told by a health or family planning worker about other methods of family planning which you could use?

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

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

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

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

329. Where is that? Any other place?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL MENTIONED.

330. In the last 12 months, were you visited by a community-based distribution agent who talked to you about family planning?

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

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

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212.

404. FROM 212 AND 216.

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

406. How much longer would you like to have waited?

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[FOR LAST BIRTH ONLY]

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

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

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[FOR LAST BIRTH ONLY]

411. How many months pregnant were you the last time you received antenatal care?
[FOR LAST BIRTH ONLY]

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

413. Were you told about the signs of pregnancy complications?
[FOR LAST BIRTH ONLY]

414. Were you told where to go if you had these complications?
[FOR LAST BIRTH ONLY]

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

415A. During this pregnancy, how many times did you get this injection?
[FOR LAST BIRTH ONLY]

416. During this pregnancy, were you given or did you buy any iron tablets?
SHOW TABLET.
[FOR LAST BIRTH ONLY]

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

418. During this pregnancy, did you have difficulty with your vision during the daylight?
[FOR LAST BIRTH ONLY]

419. During this pregnancy, did you have difficulty with your vision at night?
[FOR LAST BIRTH ONLY]

420. During this pregnancy, did you take any drugs in order to prevent you from getting malaria? Not considered here are instances where you took the drug because you had malaria.
[FOR LAST BIRTH ONLY]

421. Which medicines did you take to prevent malaria?
RECORD ALL MENTIONED.
IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.
FOR EACH DRUG CIRCLED ASK: How many times did you take the malaria medicine(s) during the pregnancy?
[FOR LAST BIRTH ONLY]

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

423. Was (NAME) weighed at birth?

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

425. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

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

427. Was (NAME) delivered by caesarian section?

428. After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

429. How many days or weeks after the delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.
[FOR LAST BIRTH ONLY]

430. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[FOR LAST BIRTH ONLY]

431. Where did this first check take place?
[FOR LAST BIRTH ONLY]

431A. At that first check, did any health worker discuss use of family planning?
[FOR LAST BIRTH ONLY]

432. In the first two months after delivery, did you receive a vitamin A capsule like this?
SHOW CAPSULE.
[FOR LAST BIRTH ONLY]

433. Has your period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

434. Did your period return between the birth of (NAME) and your next pregnancy?
[REPEAT QUESTION FOR ALL BIRTHS SINCE 1995 EXCEPT THE LAST BIRTH]

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

436. CHECK 226:
RESPONDENT PREGNANT?
[FOR LAST BIRTH ONLY]

437. Have you resumed sexual relations since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

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

439. Did you ever breastfeed (NAME)?

440. 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.

440A. Within the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

440B. What was (NAME) given to drink before your milk began flowing regularly? Anything else?
RECORD ALL MENTIONED.

441. CHECK 404:
CHILD ALIVE?

442. Are you still breastfeeding (NAME)?

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

444. CHECK 404:
CHILD ALIVE?

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

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

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

447A. Was sugar added to any of the foods or liquids (NAME) ate yesterday?

448. How many times did (NAME) eat solid, semi-solid or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

450. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 451.

SECTION 4B. IMMUNIZATION, HEALTH, AND NUTRITION

451. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER.
(IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).

452. LINE NUMBER FROM 212.

453. FROM 212 AND 216.

454. Did (NAME) receive a Vitamin A dose like this during the last 6 months?
SHOW CAPSULE.

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

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

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

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

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

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

460A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

460B. Polio vaccine, that is, drops in the mouth?

460C. When was the first polio vaccine received, just after birth or later?

460D. How many times was the polio vaccine received?

460E. DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

460F. How many times?

460G. An injection to prevent measles?

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

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

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

463A. Does (NAME) have a fever now?

463B. I would like to know what things were done in response to (NAME'S) fever.
What was done first? What was done after that?
NOTE: CIRCLE ONE CODE IN EACH COLUMN FOR FIRST FOUR ACTIONS. EACH COLUMN SHOULD HAVE ONLY ONE CODE CIRCLED.
ALL COLUMNS SHOULD CONTAIN AN ACTION.

463C. CHECK 463B:

463D. Which medicines were given to (NAME)?
ASK TO SEE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
FOR EACH ANTI-MALARIAL MEDICINE: How long after the fever started did (NAME) start taking the medicine?
RECORD ALL MENTIONED.

TYPE OF DRUG:

WHEN ANTI-MALARIAL WAS GIVEN:

463E. CHECK 463B:

463F. How long after you noticed the fever was (NAME) taken to a government-run health center?

463G. Were any drugs or prescriptions for drugs given at the government-run health center for (NAME)?

463H. Which medicines were given to (NAME)?
ASK TO SEE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
FOR EACH ANTI-MALARIAL MEDICINE: How long after the fever started did (NAME) start taking the medicine?
RECORD ALL MENTIONED.

TYPE OF DRUG:

WHEN ANTI-MALARIAL WAS GIVEN:

463I. Did (NAME) receive any injection at the government-run health center?

463J. CHECK 463B:

.

463K. How long after you noticed the fever was (NAME) taken to a mission health center?

463L. Were any drugs or prescriptions for drugs given at the mission health center for (NAME)?

463M. Which medicines were given to (NAME)?
ASK TO SEE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
FOR EACH ANTI-MALARIAL MEDICINE: How long after the fever started did (NAME) start taking the medicine?
RECORD ALL MENTIONED.

TYPE OF DRUG:

WHEN ANTI-MALARIAL WAS GIVEN:

463N. Did (NAME) receive any injection at the mission health center?

463O. CHECK 463B:

463P. How long after you noticed the fever was (NAME) taken to a private health center?

463Q Were any medicines or prescriptions for medicines given at the private health center for (NAME)?

463R. Which medicines were given to (NAME)?
ASK TO SEE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
FOR EACH ANTI-MALARIAL MEDICINE: How long after the fever started did (NAME) start taking the medicine?
RECORD ALL MENTIONED.

TYPE OF DRUG:

WHEN ANTI-MALARIAL WAS GIVEN:

463S. Did (NAME) receive any injection during the visit to the private health center?

463T. CHECK 463B:

463U. How long after you noticed the fever did (NAME) see the community health worker?

463V. What did the community health worker do?
RECORD ALL MENTIONED.

463W. CHECK 463V:

463X. Which medicines were given to (NAME) by the community health worker?
ASK TO SEE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
FOR EACH ANTI-MALARIAL MEDICINE:
How long after the fever started did (NAME) start taking the medicine?
RECORD ALL MENTIONED.

TYPE OF DRUG:

WHEN ANTI-MALARIAL WAS GIVEN:

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

465. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths?

467. Did you seek advice or treatment for the cough?

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

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

472A. Did (NAME)'s stool contain blood?

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

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

475. Was he/she given a drink made from a special packet called ORS?

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

477. What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED.

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

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

480. Do you have any mosquito nets in your house?

480A. Does (NAME) usually sleep under a mosquito net?

480B. Did (NAME) sleep under a mosquito net last night?

480C. Where was the mosquito net (NAME) slept under bought or obtained?

480D. How long ago was the mosquito net bought or obtained?
WRITE THE ANSWER IN MONTHS (LESS THAN 1 MONTH = 00)
IF MORE THAN 7 YEARS, RECORD '95'.

480E. Since you got the mosquito net was it ever soaked or dipped in an insecticide to repel mosquitoes or bugs?

480F. How long ago was the mosquito net last soaked or dipped?
WRITE THE ANSWER IN MONTHS (LESS THAN 1 MONTH = 00)

480G. GO BACK TO 451 IN NEXT COLUMN, OR, IF NO MORE CHILDREN, GO TO 481.

481. CHECK 453, ALL COLUMNS:
NUMBER OF LIVING CHILDREN BORN IN 1995 OR LATER

482. The last time you fed your child(ren), did you wash your hands immediately before feeding (him/her/them)?

483. The last time you had to clean (your child/one of your children) after he/she defecated, did you wash your hands immediately afterwards?

484. What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?

485. CHECK 475, ALL COLUMNS:

486. Have you ever heard of a special product called ORS you can get for the treatment of diarrhea?

487. CHECK 218:

488. When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK:
If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

489. Now I would like to ask you some questions about medical care for you yourself.
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?

489A. CHECK 215 AND 218:

489B. Now I would like to ask you about liquids (NAME FROM Q. 489A) drank over the last seven days, including yesterday.
How many days during the last seven days did (NAME FROM Q. 489A) drink each of the following?
FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK:
In total, how many times yesterday during the day or at night did (NAME FROM Q. 489A) drink (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

Now I would like to ask you about the types of foods (NAME FROM Q. 489A) ate over the last seven days, including yesterday.
How many days during the last seven days did (NAME FROM Q. 489A) eat each of the following foods either separately or combined with other food?
FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK:
In total, how many times yesterday during the day or at night did (NAME FROM Q. 489A) eat (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

491. The last time you prepared a meal for your family, before starting did you wash your hands?

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

492A. CHECK 492:

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

493A. Have you ever drank an alcohol-containing beverage?

493B. Have you ever gotten "drunk" from drinking an alcohol-containing beverage?

493C. In the last 3 months, on how many days did you drink an alcohol-containing beverage?

493D. CHECK 493B:

493E. In the last 3 months, on how many occasions did you get "drunk"?

493F. Have you had any kind of injection in the last 3 months?

493G. How many times did you have an injection in the last 3 months?

493H. The last time you had an injection, who was the person who gave you the injection?

494F. CHECK 226:

494G. Did you have a fever at any time in the last two weeks?

494H. Did you take any medicine for the fever?

494I. Which medicines did you take?
ASK TO SEE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
FOR EACH ANTI-MALARIAL MEDICINE:
How long after the fever started did you start taking the medicine?
RECORD ALL MENTIONED.

494J. How many times did you take this medicine(s)?

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

494L. Where was the mosquito net you slept under bought or obtained?

494M. How long ago was the mosquito net bought or obtained?
WRITE THE ANSWER IN MONTHS (LESS THAN 1 MONTH = 00)
IF MORE THAN 84 MONTHS, WRITE 95.

494N. Since you got the mosquito net, was it ever soaked or dipped in an insecticide to repel mosquitoes or bugs?

494O. How long ago was the mosquito net last soaked or dipped?
WRITE THE ANSWER IN MONTHS (LESS THAN 1 MONTH = 00)
IF MORE THAN 84 MONTHS, WRITE 95.

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

507. Does your husband/partner have any other wives besides yourself?

508. How many other wives does he have?

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

511. CHECK 510:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?

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

514. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
How old were you when you first had sexual intercourse (if ever)?

515. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO

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

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

517. What is your relationship to the man with whom you last had sex?
IF "BOYFRIEND" OR "FIANCE", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF 'YES' RECORD '1'
IF 'NO' RECORD '2'

518. For how long have you had sexual relations with this man?

519. Have you had sex with any other man in the last 12 months?

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

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

521. What is your relationship to this man?
IF "BOYFRIEND" OR "FIANCE", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF 'YES' RECORD '1'
IF 'NO' RECORD '2'

522. For how long have you had sexual relations with this man?

522A. Other than these two men, have you had sex with anyone else in the last 12 months?

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

522C. What was the main reason you used a condom on that occasion?

522D. What is your relationship to this man?
IF "BOYFRIEND" OR "FIANCE", ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF 'YES' RECORD '1'
IF 'NO' RECORD '2'

522E. For how long have you had a sexual relationship with this man?

523. Altogether, with how many different men have you had sex in the last 12 months?

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

525. Where is that?
RECORD FIRST RESPONSE ONLY.

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

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

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

528. Where is that?
RECORD FIRST RESPONSE ONLY.

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

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

530. Have you heard of a condom called "Chishango"?

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

602. CHECK 226:

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

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

603. CHECK 226:

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

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

604. CHECK 226:

605. CHECK 310:
USING A METHOD?

606. CHECK 603:

607. CHECK 602:

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

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

RECORD ALL MENTIONED.

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

609. CHECK 310:
USING A METHOD?

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

611. Which method would you prefer to use?

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

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

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

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

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

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

618. In the last few months, have you listened to any of the following program series about family planning or health on the radio?

619. In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

620. With whom? Anyone else?
RECORD ALL MENTIONED.

621. CHECK 501:

621A. CHECK 311/311A:

621B. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision or did you both decide together?

622. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

623. How often have you talked to your husband/partner about family planning in the past year?

623A. CHECK 311/311A:

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

624A. CHECK 501 AND 502:

625. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

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

701. CHECK 501 AND 502:

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

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

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

705. How many years of school did he complete at that level?

706. CHECK 701:

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

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

707. Aside from your own housework, are you currently working?

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

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

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

711. CHECK 710:

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

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

713A. Do you usually work at home or away from home?

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

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

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

717. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

719. Who in your family usually has the final say on the following decisions:

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

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

SECTION 8: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

801. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

802. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

803. What can a person do? Anything else?
RECORD ALL MENTIONED.

804. Can people protect themselves from getting the AIDS virus by having just one uninfected sex partner who has no other partners?

805. Can a person get the AIDS virus from mosquito bites?

806. Can people protect themselves from getting the AIDS virus by using a condom every time they have sex?

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

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

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

811. Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?

812. Can the virus that causes AIDS be transmitted from a mother to a child?

813. Can the virus that causes AIDS be transmitted from a mother to a child:

814. CHECK 501:

815. Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

815A. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

816. If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community?

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

817A. Should persons with the AIDS virus who work with other persons such as in a shop, office, or farm be allowed to continue their work or not?

817B. Should children aged 12-14 be taught about using a condom to avoid AIDS?

817BX. Do you think that condoms are safe to use?

817BY. Do you think that men and women who intend to marry should be tested for the AIDS virus before marriage?

817C. Have you ever been tested to see if you have the AIDS virus?

817D. Would you want to be tested for the AIDS virus?

817E. Do you know a place where you could go to get an AIDS test?

817F. Where can you go for the test?
817FX. Where did you go for the test?

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

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

820A. CHECK 514:

820B. 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 sexually-transmitted disease?

820C. Sometimes, women experience an abnormal genital discharge. During the last 12 months, have you had an abnormal genital discharge?

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

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

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

820G. The last time you had (INFECTION FROM 820B/820C/820D) did you do any of the following? Did you....

820H. When you had (INFECTION FROM 820B/820C/820D), did you inform the persons with whom you were having sex?

820I. When you had (INFECTION FROM 820B/820C/820D) did you do something to avoid infecting your sexual partner(s)?

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

SECTION 9. MATERNAL MORTALITY

901. 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 are living with you, those living elsewhere and those who have died.
How many children did your mother give birth to, including you?

902. CHECK 901:

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

904. Please tell me the names of all your brothers and sisters starting with the oldest.

905. Is (NAME) male or female?

906. Is (NAME) still alive?

907. How old is (NAME)?

908. In what year did (NAME) die?

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

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

911. Was (NAME) pregnant when she died?

912. Did (NAME) die during childbirth?

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

915. How many children did (NAME) give birth to during her lifetime?

IF NO MORE BROTHERS OR SISTERS, GO TO 916

916. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:_____________________________

COMMENTS ON SPECIFIC QUESTIONS:_____________________________

ANY OTHER COMMENTS:_____________________________

SIGNATURE OF THE INTERVIEWER: ______________
DATE: ______________

SUPERVISOR'S OBSERVATIONS:____________________________

NAME OF THE SUPERVISOR: _____________________
DATE: ______________

EDITOR'S OBSERVATIONS:____________________________

NAME OF EDITOR: _______________________________
DATE: ______________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

BIRTHS AND PREGNANCIES