IDENTIFICATION

PLACE NAME _________________________

NAME OF HOUSEHOLD HEAD __________________

DISTRICT _____________________ ___

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

URBAN/RURAL __

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE ___

NAME AND LINE NUMBER OF WOMAN _________________ ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS
DATE __________
INTERVIEWER'S NAME ___________
RESULT* _____________

NEXT VISIT:
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
INTERVIEWER CODE ____
RESULT _____

TOTAL NUMBER OF VISITS ___

LANGUAGE OF QUESTIONNAIRE***:

LANGUAGE OF INTERVIEW***:

NATIVE LANGUAGE OF RESPONDENT***:

WAS A TRANSLATOR USED?

SUPERVISOR
NAME ________ ___
DATE ________

FIELD EDITOR
NAME ________ ___
DATE ________

OFFICE EDITOR____

KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

INFORMED CONSENT: INTRODUCTORY

Hello. My name is ____________ and I am working with the National Statistical Office.
The National Statistical Office, together with the Ministry of Health, is conducting a national survey about the health of women and children.
Your household is one of the households that have been randomly selected out of all households in Malawi to be asked the questions in this survey.
We would very much appreciate your participation in this survey.
I would like to ask you about your health (and the health of your children).
This information will help the government to plan health services.
The survey usually takes about 45 minutes to complete.
Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions.
However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer: ________________
Date: __________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

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 the countryside?

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 the countryside?

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. What is the highest (class/form/year) you completed at that level?

110. CHECK 108:

111. Now I would like you to read this sentence to me.
SHOW SENTENCES ON THE NEXT PAGE TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?

SENTENCES FOR LITERACY TEST (Q. 111)

CHICHEWA
Makolo amakonda ana awo.
Ulimi ndi khama.
Mwana akuwerenga bukhu.
Ana amalimbikila kusukulu.

TUMBUKA
Bapapi wakutemwa wana wawo.
Kulima ndi ntchito yinonono.
Mwana wakuwerenga bukhu.
Wana wakulimbikira kusukulu.

YAO
Anangolo akusyanonyela wanachewawo.
Kulima kukusoseka kulimbichila.
Mwanache akuwalanga buku.
Wanache akusyalimbichila sukulu.

ENGLISH
Parents love their children.
Farming is hard work.
The child is reading a book.
Children work hard at school.

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

113. CHECK 111:

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

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

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

117. What is your religion?

118. What is your tribe or ethnic group?

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 did not survive?

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 1999 OR LATER.
IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE JANUARY 1999, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF 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 COLUMN 1 OF 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 COLUMN 1 OF 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 that 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 1999.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any pregnancies that terminated before 1999 that did not result in a live birth?

236. When did the last such pregnancy that terminated before 1999 end?

237. When did your last menstrual period start?

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

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

SECTION 3. CONTRACEPTION

Now I would like to talk 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?

305. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (GO TO 329)

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 GO INSTRUCTION FOR HIGHEST METHOD ON LIST.

313. In what facility 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 'A' NOT CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?

316. In what month and year was the sterilization performed?
316A. In what month and year did you start using (CURRENT METHOD) continuously?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

316B. CHECK 316/316A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A

317. CHECK 316/316A:

318. 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 1999. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

IF SHE DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

321. 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 CALENDAR) in (DATE).
At that time, were you told about side effects or problems you might have with the method?

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

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

324A. Were you ever advised that this contraceptive method does not protect against AIDS or other sexually-transmitted diseases?

325. CHECK 322:

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

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

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

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

328. 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.

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

330. 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 PLACES MENTIONED.

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

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

333. 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 1999 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. 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]

407A. Where did you receive antenatal care for this pregnancy? Anywhere else?
[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]

412A. During any of the antenatal visits for the pregnancy, were you given any information or
counseled about AIDS or the AIDS virus?
[FOR LAST BIRTH ONLY]

412B. Were you tested for the AIDS virus as part of your antenatal care?
[FOR LAST BIRTH ONLY]

412C. I don't want to know the results, but did you get the results of the test?
[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]

414A. During this pregnancy, did you experience:
[FOR LAST BIRTH ONLY]

414B CHECK 414A:
COMPLICATIONS IN PREGNANCY
[FOR LAST BIRTH ONLY]

414C. Did you seek advice or treatment for these problems?
[FOR LAST BIRTH ONLY]

414D. Where did you seek advice or treatment? Anywhere else?

IF SOURCE IS A 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 PLACES MENTIONED.
[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]

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

416A. Before this pregnancy, were you given an injection in the arm to prevent you from getting tetanus?
[FOR LAST BIRTH ONLY]

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

418. 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]

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

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

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

422. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[FOR LAST BIRTH ONLY]

422A. CHECK 422:
DRUGS TAKEN FOR MALARIA PREVENTION
[FOR LAST BIRTH ONLY]

422B. How many times did you take SP/Fansidar during this pregnancy?
[FOR LAST BIRTH ONLY]

422C. CHECK 407:
ANTENATAL CARE RECEIVED DURING THIS PREGNANCY?
[FOR LAST BIRTH ONLY]

422D. Did you get the SP/Fansidar during an antenatal visit, during another visit to a health facility or from some other source?
[FOR LAST BIRTH ONLY]

422E. Did you take the SP/Fansidar under direct observation by the health worker each time, or did you take it at home?
[FOR LAST BIRTH ONLY]

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

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

426. 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.

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

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.

428. Was (NAME) delivered by caesarean section?

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

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

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

432. Where did this first check 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.
[FOR LAST BIRTH ONLY]

432A. After this birth, did you experience a problem such as:
[FOR LAST BIRTH ONLY]

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

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

435. Did your period return between the birth of (NAME) and your next pregnancy?
[FOR ALL BIRTHS IN THE LAST FIVE YEARS, EXCEPT FOR THE LAST BIRTH]

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

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

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

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

440. Did you ever breastfeed (NAME)?

441. 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.

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

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

444. CHECK 404:
IS CHILD LIVING?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 404:
IS CHILD LIVING?

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

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

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

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

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

453. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1999 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212

456. FROM 212 AND 216

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

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

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

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

461. 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).

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

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

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

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

463C. When was the first polio vaccine received, just after birth or later?

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

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

463F. How many times?

463G. An injection to prevent measles?

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

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

466A. 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 THE FIRST FOUR ACTIONS.
EACH COLUMN SHOULD HAVE ONLY ONE CODE CIRCLED.
ALL COLUMNS SHOULD CONTAIN AN ACTION.

466B. CHECK 466A:

466C. Which medicines were given to (NAME)?
RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.

466D. IF CHILD WITH FEVER TOOK AN ANTI-MALARIAL MEDICINE:
How long after the fever started did (NAME) start taking the medicine?

466E. CHECK 466A:

466F. How long after you noticed the fever was (NAME) taken to a government-run health center?

466G. Were any drugs or prescriptions for drugs given at the government-run health center for (NAME)?

466H. Which medicines were given to (NAME)?
RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.

466I. IF CHILD WITH FEVER TOOK AN ANTI-MALARIAL MEDICINE:
How long after the fever started did (NAME) start taking the medicine?

466J. CHECK 466A:

466K. How long after you noticed the fever was (NAME) taken to a mission health center?

466L. Were any drugs or prescriptions for drugs given at the mission health center for (NAME)?

466M. Which medicines were given to (NAME)?
RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.

466N. IF CHILD WITH FEVER TOOK AN ANTI-MALARIAL MEDICINE:
How long after the fever started did (NAME) start taking the medicine?

466O. CHECK 466A:

466P. How long after you noticed the fever was (NAME) taken to a private health center?

466Q. Were any drugs or prescriptions for drugs given at the private health center for (NAME)?

466R. Which medicines were given to (NAME)?
RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.

466S. IF CHILD WITH FEVER TOOK AN ANTI-MALARIAL MEDICINE:
How long after the fever started did (NAME) start taking the medicine?

466T. CHECK 466A:

466U. How long after you noticed the fever did (NAME) see the community health worker?

466V. What did the community health worker do?

466W. Which medicines were given to (NAME)?
RECORD ALL MENTIONED.
ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.

466X. IF CHILD WITH FEVER TOOK AN ANTI-MALARIAL MEDICINE:
How long after the fever started did (NAME) start taking the medicine?

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

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

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

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

472. Has (NAME) been ill with convulsions at any time during the last 2 weeks?

472A. Did you seek advice or treatment for the convulsions?

472B. Where did you seek advice or treatment? Anywhere else?
RECORD ALL SOURCES MENTIONED.

472C. How long after the convulsions started was (NAME) taken for treatment?

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

476. 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?

477. 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?

478. Was he/she given fluid to drink made from a special packet called THANZI-ORS?

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

480. What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.

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

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

IF SOURCE IS A 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 PLACES MENTIONED.

483. GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 486.

486. CHECK 478, ALL COLUMNS:

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

491. CHECK 215 AND 218:

492. Now I would like to ask you about liquids (NAME FROM Q. 491) drank yesterday.
In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

493. Now I would like to ask you about the types of foods (NAME FROM Q. 491) ate yesterday.
In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) eat (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

494. 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?

494A. CHECK 432A:

494B. Sometimes a woman can have a problem, usually after a difficult childbirth, such that she experiences a leakage of urine or stool from her vagina.
Have you ever experienced this problem?

495. In the past 12 months, did you receive any injections?

495A. In the past 12 months, how many injections did you receive?

495B. Who gave you the injection the last time you got it?

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

497. Do you drink alcohol?

498. How often do you get drunk: very often, only sometimes, or never?

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?

503. ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 1999 (GO TO 514)

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

504A. Who did most of your late husband's property go to?

504B. Did you receive any of your late husband's assets or valuables?

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?

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

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

511. CHECK 510:

MARRIED/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?

513. DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE JANUARY 1999. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER 'O' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 1999.

FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

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)?

514A. CHECK 106:

514B. The first time you had sexual intercourse, was a condom used?

514C. How old was the person you first had sexual intercourse with?

514D. Was this person older than you, younger than you, or about the same age as you?

514E. Would you say this person was ten or more years older than you, or less than ten years older than you?

515. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

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 MAN IS 'BOYFRIEND' OR 'FIANCE', ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

517A. CHECK 106:

517B. Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

518. For how long (have you had/did you have) sexual relations with this man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS MAN ONCE, RECORD '01' DAYS.

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

520. The last time you had sexual intercourse with another 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 MAN IS 'BOYFRIEND' OR 'FIANCE', ASK: Was your boyfriend/fiancé living with you when you last had sex with him?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

521A. CHECK 106:

521B. Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

522. For how long (have you had/did you have) sexual relations with this man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS MAN ONCE, RECORD '01' DAYS.

522A. Other than these two men, have you had sex with any other man 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 MAN IS 'BOYFRIEND' OR 'FIANCE', ASK: Was your boyfriend/fiancé living with you when you last had sex with him?
IF YES, CIRCLE '01'. IF NO, CIRCLE '02'.

522D1. CHECK 106:

522D2. Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

522E. For how long (have you had/did you have) sexual relations with this man?
IF ONLY HAD SEXUAL RELATIONS WITH THIS MAN ONCE, RECORD '01' DAYS.

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

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

525. Where is that? Any other place?
RECORD ALL SOURCES MENTIONED.

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. 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 CONTRACEPTIVE 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 REASONS 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 CONTRACEPTIVE METHOD?

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

611. Which contraceptive method would you prefer to use?

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

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

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

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

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

617. In the last few months have you 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 PERSONS MENTIONED.

621. CHECK 501:

622. CHECK 311/311A:

623. 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?

624. 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 contraceptive method to avoid pregnancy?

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

626. CHECK 311/311A:

627. 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?

628. 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:

628A. When a wife knows her husband has a sexually transmitted disease, is she justified in asking that they use a condom?

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. What was the highest (class/form/year) he completed 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?

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

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

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

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

718. 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 that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

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

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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 WAYS MENTIONED.

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

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

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

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

808. Can people reduce their chance of getting the AIDS virus by not having sex at all?

808A. Can people get the AIDS virus because of witchcraft or other supernatural means?

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

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

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

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

812A. CHECK 812:

812B. Are there any special medications that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

812C. Is there any special medication that people infected with the AIDS virus can get from a doctor or a nurse?

813. CHECK 501:

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

814A. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

814B. Would you buy fresh vegetables from a vendor who has the AIDS virus?

814C. If a member of your family got infected with the virus that causes AIDS, would you fear disclosing their status?

814D. If a member of your extended family such as a cousin died of AIDS and left orphaned children behind, would you be willing to take those children as part of your family?

814E. If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?

816. 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?

816A. Are people who have AIDS immoral?

816B. Should children age 12-14 be taught about using a condom to avoid AIDS?

816C. Do you think that condoms are safe to use?

816D. Do you think that men and women who intend to marry should be tested for the AIDS virus before marriage?

816E. Have you heard any radio spots or messages with regard to HIV/AIDS in the last 30 days?

816F. Have you seen any TV spots or programs with regard to HIV/AIDS in the last 30 days?

816G. Have you read articles, messages or advertisements about HIV/AIDS in a magazine or newspaper in the last 30 days?

816H. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

816I. When was the last time you were tested?

816J. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

816K. I don't want to know the results, but did you get the results of the test?

816L. Do you know a place where you could go to get an AIDS test?

816M. Where can you go for the test?

RECORD ONLY FIRST RESPONSE GIVEN.

816MX. 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.

816P. CHECK 515:

817. Do you know the HIV status of any partner with whom you have had sex in the past year?

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

818. If a man has a sexually transmitted disease, what symptoms might he have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

819. If a woman has a sexually transmitted disease, what symptoms might she have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

819A. CHECK 514:

819A1. CHECK 817A:

819B. 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?

819C. Sometimes, women experience a bad smelling abnormal genital discharge.
During the last 12 months, have you had a bad smelling abnormal genital discharge?

819D. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

819E. CHECK 819B, 819C, 819D:

819F. The last time you had (PROBLEM FROM 819B/819C/819D), did you seek any kind of advice or treatment?

819G. The last time you had (PROBLEM FROM 819B/819C/819D), did you do any of the following? Did you?

819H. When you had (PROBLEM FROM 819B/819C/819D), did you inform the person with whom you were having sex?

819I. When you had (PROBLEM FROM 819B/819C/819D), did you do something to avoid infecting your sexual partner(s)?

819J. 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. What was the name given to your oldest (next oldest) brother or sister?

905. Is (NAME) male or female?

906. Is (NAME) still alive?

907. How old is (NAME)?

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

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

910. Was (NAME) pregnant when she died?

911. Did (NAME) die during childbirth?

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

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

IF NO MORE BROTHERS OR SISTERS, GO TO 914.

914. CHECK Q910, 911 AND 912 FOR ALL SISTERS

SECTION 10. DOMESTIC VIOLENCE

DV00. CHECK HOUSEHOLD QUESTIONNAIRE, COLUMN (8A):

DV01. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

DV02. CHECK 501, 502, AND 504:

DV03. When two people marry or live together, they share both good and bad moments. In your relationship with your (last) husband/partner do (did) the following happen frequently, only sometimes, or never?

DV04. Now 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?

DV05. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/ partner.

5A. (Does/did) your (last) husband/partner ever:

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

DV06. 6A. (Does/did) your (last) husband/partner ever:

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

DV07. CHECK DV06:

DV08. How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

DV09. 9A. Did the following ever happen because of something your (last) husband/partner did to you:

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

DV10. 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?

DV11. In the last 12 months, how many times have you hit, slapped, kicked or done something to physically hurt your (last) husband/partner at a time when he was not already beating or physically hurting you?

DV12. Does (did) your husband/partner drink alcohol?

DV12A. How often does (did) he get drunk: very often, only sometimes, or never?

DV14. CHECK 501, 502 AND 504:

MARRIED/LIVING WITH A MAN/SEPARATED/DIVORCED/WIDOWED: From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?

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

DV15. Who has physically hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

DV16. CHECK DV15:

DV17. Who has hit, slapped, kicked, or done something to physically hurt you most often?

DV18. In the last 12 months, how many times has this person hit, slapped, kicked, or done anything else to physically hurt you?

DV19. CHECK 201 AND 226:

DV20. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

DV21. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

DV21A. CHECK Q514: EVER HAD SEX?

DV21B. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

DV21C. In the last 12 months, has anyone forced you to have sexual intercourse against your will?

DV22. CHECK DV06, DV09, DV14, AND DV20:

DV23. Have you ever tried to get help to prevent or stop (this person/these persons) from physically hurting you?

DV24. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

DV25. What is the main reason you have never sought help?

DV26. As far as you know, did your father ever beat your mother?

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.

DV27. 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?

DV28. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE: ____________________________

DV29. RECORD THE TIME.

SECTION 11. ANTHROPOMETRY, ANEMIA AND HIV TESTING

1101. WEIGHT (KILOGRAMS)

1101A. HEIGHT (CENTIMETERS)

1101B. RESULT:

1102. CHECK 106:

1103. LINE NUMBER OF PARENT/RESPONSIBLE ADULT:
(FROM COLUMN 1 IN HOUSEHOLD SCHEDULE)
(IF PARENT OR RESPONSIBLE ADULT IS NOT IN HOUSEHOLD, WRITE '00')

1104. READ THE ANEMIA CONSENT STATEMENT TO THE PARENT OR RESPONSIBLE ADULT.
CIRCLE CODE AND SIGN.

1105. READ THE ANEMIA CONSENT STATEMENT TO THE WOMAN OR ADOLESCENT.
CIRCLE CODE AND SIGN.

REQUEST FOR CONSENT FOR ANEMIA TEST

As part of this survey, we are studying anemia among women and children. Anemia is a serious health problem. You do not have to participate; however, if you do, it will help the government to develop programs to prevent and treat anemia.

We request that you participate in the anemia testing part of this survey and give a few drops of blood from a finger or from the heel of the child.
The test uses disposable sterile instruments that are clean and completely safe.
The blood will be analyzed with new equipment and the results of the test will be given to you right after the blood is taken.
If your results show that you are mildly or moderately anemic you will be briefed on how to decrease your anemia.
If your results show you are severely anemic you need to see your doctor or health center immediately.
We will give you a paper with the results that you can take with you and show to the health worker for proper medical attention.
We will keep the results confidential.

Do you have any questions? Do you agree to have the test done?
IF YES: CONTINUE WITH HIV CONSENT FORM

1106. RESULTS:

1107. HEMOGLOBIN LEVEL (G/DL):

1108. CURRENTLY PREGNANT:

1109. CHECK 1107:
THE CUTOFF POINT IS 9 G/DL FOR PREGNANT WOMEN AND 7 G/DL FOR WOMEN WHO ARE NOT PREGNANT (OR WHO DON'T KNOW IF THEY ARE PREGNANT).

1110. We detected a low level of hemoglobin in your blood. This indicates that you have developed severe anemia, which is a serious health problem. We would like to inform the doctor at _____________ about your condition. This will assist you in obtaining appropriate treatment for the condition. Do you agree that the information about the level of hemoglobin in your blood may be given to the doctor?

AGREES TO REFERRAL?

1111. CHECK 1102:

1112. LINE NUMBER OF PARENT/ RESPONSIBLE ADULT:
(FROM 1103; IF PARENT OR RESPONSIBLE ADULT IS NOT IN HOUSEHOLD, WRITE '00')

1113. READ THE CONSENT TO THE PARENT OR RESPONSIBLE ADULT.
CIRCLE CODE AND SIGN.

1114. READ THE CONSENT TO THE WOMAN OR ADOLESCENT.
CIRCLE CODE AND SIGN.

1115. RESULTS:

PASTE FIRST LABEL HERE
PASTE SECOND LABEL ON FILTER PAPER AND THE THIRD LABEL ON BLOOD SAMPLE TRANSMITTAL FORM

REQUEST FOR CONSENT FOR HIV TEST

We would also like to ask you to participate in the HIV test at the same time, by allowing us to collect a few more drops of blood from your finger. As part of the survey, we are asking people all over the country to help find out how big the AIDS problem is in Malawi.

This blood will be tested later in the laboratory. To ensure the confidentiality of this test result, no individual names will be attached to the blood sample; therefore, we will not be able to give you the result of your test and no one will be able to trace the test back to you.

However, if you want to know whether you have HIV, I can tell you where you can go to get tested. You can go to a Voluntary Counseling and Testing (VCT) Centre where you will receive free counseling and confirmed HIV test results that same day.
We will provide you with a voucher for yourself, and a voucher for your partner, which either of you can use at the VCT Centre in the next 30 days.
With the voucher, there will be no charge for the service, and you will be reimbursed for your travel costs upon receiving the VCT services, and you will meet trained staff available to discuss with you all issues and matters regarding HIV/AIDS.
They will provide you with an HIV test and appropriate counseling.

Do you have any questions?

I hope you will agree to participate in the HIV testing. You can say yes or you can say no; it is up to you. However, if you agree, it will help the government to develop programs to fight the problem of HIV/AIDS in Malawi.

Will you agree to participate in the HIV test?

GO TO 1114, CIRCLE THE APPROPRIATE CODE (AND SIGN).

IF RESPONDENT IS AGE 15-17:
ASK PARENT/GUARDIAN: Will you tell me if you will allow (NAME OF YOUTH) to participate in the HIV test? (GO TO COLUMN 1113, CIRCLE THE APPROPRIATE CODE (AND SIGN)).

IF PARENT/GUARDIAN AGREES, READ THE PRECEDING PARAGRAPHS TO YOUTH FOR HIS/HER CONSENT. (GO TO COLUMN 1114, CIRCLE THE APPROPRIATE CODE (AND SIGN)).

*DON'T FORGET TO GIVE EACH ELIGIBLE PERSON TWO REFERRAL VOUCHERS FOR FREE HIV TESTS/TRAVEL EXPENSES TO VCT SITE.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:_____________________________

COMMENTS ON SPECIFIC QUESTIONS:_____________________________

ANY OTHER COMMENTS:_____________________________

SUPERVISOR'S OBSERVATIONS:__________________________

NAME OF THE SUPERVISOR:_________________
DATE: _________

EDITOR'S OBSERVATIONS:__________________________

NAME OF EDITOR:________________
DATE: _________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COL. 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

COL 2: SOURCE OF CONTRACEPTION

COL 3: DISCONTINUATION OF CONTRACEPTIVE USE

COL 4: MARRIAGE/UNION