Data Cart

Your data extract

0 variables
0 samples
View Cart

DEMOGRAPHIC AND HEALTH SURVEY-MALAWI 2004-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME _________________________

NAME OF HOUSEHOLD HEAD __________________

DISTRICT _____________________ ___

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

URBAN/RURAL __

URBAN l
RURAL 2

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE ___

LARGE CITY 1
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4

NAME AND LINE NUMBER OF WOMAN _________________ ___

INTERVIEWER VISITS

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

RESULT ____

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

NEXT VISIT:
DATE __________
TIME ___________

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

TOTAL NUMBER OF VISITS ___

LANGUAGE OF QUESTIONNAIRE***:

ENGLISH 3

LANGUAGE OF INTERVIEW***:

CHICHEWA 1
TUMBUKA 2
ENGLISH 3
OTHER (SPECIFY) __________________ 4

NATIVE LANGUAGE OF RESPONDENT***:

CHICHEWA 1
TUMBUKA 2
ENGLISH 3
OTHER (SPECIFY) __________________ 4

WAS A TRANSLATOR USED?

YES 1
NO 2

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.

HOUR ___
MINUTES ___

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?

CITY 1
TOWN 2
COUNTRYSIDE 3

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

YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

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

CITY 1
TOWN 2
COUNTRYSIDE 3

105. In what month and year were you born?

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

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

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

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

CLASS ___

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 114)

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?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ______ 4
BLIND/VISUALLY IMPAIRED 5

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)?

YES 1
NO 2

113. CHECK 111:

CODE '2', '3' OR '4' CIRCLED (GO TO 114)
CODE '1' OR '5' CIRCLED (GO TO 115)

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?

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

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

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

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

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

117. What is your religion?

CATHOLIC 01
CCAP 02
ANGLICAN 03
SEVENTH DAY ADVENT./BAPTIST 04
OTHER CHRISTIAN 05
MUSLIM 06
NO RELIGION 07
OTHER (SPECIFY) _____________ 96

118. What is your tribe or ethnic group?

CHEWA 01
TUMBUKA 02
LOMWE 03
TONGA 04
YAO 05
SENA 06
NKONDE 07
NGONI 08
OTHER (SPECIFY) _____________ 96

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?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL ___

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME___________

213. Were any of these births twins?

SINGULAR 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

MONTH ______
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS __

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

YES 1
NO 2

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

LINE NUMBER __ (GO TO NEXT BIRTH, OR GO TO 221 FOR ALL BIRTHS AFTER FIRST BIRTH)

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.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

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

YES 1
NO 2

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

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. __
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

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?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

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.

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?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH _______
YEAR _______

231. CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 1999 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 1999 (GO TO 237)

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.

MONTHS ______

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

YES 1
NO 2 (GO TO 237)

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?

YES 1
NO 2 (GO TO 237)

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

MONTH ____
YEAR ____

237. When did your last menstrual period start?

DATE, IF GIVEN____________
DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

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

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

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)?

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03) PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
05) INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2 (GO TO NEXT METHOD)
06) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2 (GO TO NEXT METHOD)
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
12) RHYTHM OR PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
13 WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14) EMERGENCY CONTRACEPTION: Women can take pills up to 72 hours after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO DIFFERENT METHODS
SPECIFY____
YES 1
NO 2

302. Have you ever used (METHOD)?

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03) PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
12) RHYTHM OR PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION: Women can take pills up to 72 hours after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

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

YES 1 (GO TO 306)
NO 2

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'.

NUMBER OF CHILDREN _______

308. CHECK 302 (01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 318)

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

YES 1
NO 2 (GO TO 318)

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.

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C (GO TO 316A)
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
PERIODIC ABSTINENCE L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) _____ X (GO TO 316A)

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.

NAME OF PLACE___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC (SPECIFY) ______ 16

MISSION
HOSPITAL 21
HEALTH CENTER 22
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE DOCTOR'S OFFICE 32
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 36
BLM 41
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

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?

YES 1
NO 2
DON'T KNOW 8

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?

MONTH __
YEAR __

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

YES (GO BACK TO 316/316A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION)).
NO (GO TO 317)

317. CHECK 316/316A:

YEAR IS 1999 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH STARTED USING. THEN CONTINUE WITH 318).
YEAR IS 1998 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1999. THEN GO TO 327).

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.

ILLUSTRATIVE QUESTIONS:
COLUMN 1:
*When was the last time you used a method? Which method was that?
*When did you start using that method? How long after the birth of (NAME)?
*How long did you use the method then?

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

ILLUSTRATIVE QUESTIONS:
COLUMN 2:
*Where did you obtain the method when you started using it?
*Where did you get advice on how to use the method [for LAM, rhythm, or withdrawal]?

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.

ILLUSTRATIVE QUESTIONS:
COLUMN 3:
*Why did you stop using (METHOD)?
*Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF SHE DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

*How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

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

NO CODE CIRCLED 00 (GO TO 329)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
FEMALE CONDOM 08 (GO TO 325)
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

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?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2 (GO TO 324A)

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

YES 1
NO 2

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

YES 1
NO 2

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?

YES 1 (GO TO 327)
NO 2

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

YES 1
NO 2

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

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

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.

NAME OF PLACE________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 331)
GOVERNMENT HEALTH CENTER 12 (GO TO 331)
FAMILY PLANNING CLINIC 13 (GO TO 331)
MOBILE CLINIC 14 (GO TO 331)
CBDA/FIELDWORKER 15 (GO TO 331)
OTHER PUBLIC (SPECIFY) ______ 16 (GO TO 331)

MISSION
HOSPITAL 21 (GO TO 331)
HEALTH CENTER 22 (GO TO 331)
MOBILE CLINIC 23 (GO TO 331)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 331)
PHARMACY 32 (GO TO 331)
PRIVATE DOCTOR 33 (GO TO 331)
MOBILE CLINIC 34 (GO TO 331)
CBDA/FIELDWORKER 35 (GO TO 331)
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36 (GO TO 331)
BLM 41 (GO TO 331)
OTHER SOURCE
SHOP 51 (GO TO 331)
FRIEND/RELATIVE 53 (GO TO 331)
OTHER (SPECIFY) _____ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

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.

NAME OF PLACE(S) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
CBDA/FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F

MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
CBDA/FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) __________ O
BLM P
OTHER SOURCE
SHOP Q
CHURCH R
FRIEND/RELATIVE S
OTHER (SPECIFY) _____ X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 1999 OR LATER (GO TO 402)
NO BIRTHS IN 1999 OR LATER (GO TO 487)

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

LINE NUMBER _____

404. FROM 212 AND 216

NAME _______
LIVING (GO TO 405)
DEAD (GO TO 405)

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?

THEN 1 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

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

MONTHS 1 __
YEARS 2 __
DON'T KNOW 998

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]

HEALTH PROFESSIONAL
DOCTOR/CLINICAL OFFICER A
NURSE/MIDWIFE B
PATIENT ATTENDANT C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ____________ X
NO ONE Y (GO TO 415)

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

HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
MOBILE CLINIC F
OTHER PUBLIC (SPECIFY) _____ G
MISSION
HOSPITAL H
HEALTH CENTER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
TRADITIONAL BIRTH ATTENDANT M
OTHER (SPECIFY) ________ X

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

MONTHS ___
DON'T KNOW 98

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

NUMBER OF TIMES ___
DON'T KNOW 98

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

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

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

MONTHS ___
DON'T KNOW 98

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

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2
Was the fetal heartbeat checked?
YES 1
NO 2
Did someone examine your eyes?
YES 1
NO 2

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]

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 413)
DON'T KNOW 8 (GO TO 413)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 414A)
DON'T KNOW 8 (GO TO 414A)

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

YES 1
NO 2
DON'T KNOW 8

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

High blood pressure?
YES 1
NO 2
Swelling of your feet?
YES 1
NO 2
Anemia?
YES 1
NO 2
Bleeding?
YES 1
NO 2

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

IF ANY YES RESPONSE (GO TO 414C)
ALL NO RESPONSE (GO TO 415)

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

YES 1
NO 2 (GO TO 415)

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]

NAME OF PLACE________________
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
MOBILE CLINIC F
OTHER PUBLIC (SPECIFY) _____ G
MISSION
HOSPITAL H
HEALTH CENTER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
TRADITIONAL BIRTH ATTENDANT M
OTHER (SPECIFY) ________ X

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]

YES 1
NO 2 (GO TO 416A)
DON'T KNOW 8 (GO TO 416A)

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

TIMES ____
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 419)
DON'T KNOW 8 (GO TO 419)

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]

NUMBER OF DAYS _____
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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]

YES 1
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)

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]

SP/FANSIDAR 1
DON'T KNOW 8
OTHER (SPECIFY) ______ 6

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

CODE '1' CIRCLED (GO TO 422B)
CODE '1' NOT CIRCLED (GO TO 423)

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

TIMES _____

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

CODE 'A', 'B', OR 'C' CIRCLED (GO TO 422D)
OTHER (GO TO 423)

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]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY) ____________ 6 (GO TO 423)

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]

DIRECT OBSERVATION 1
AT HOME 2

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

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

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

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

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.

HEALTH PROFESSIONAL
DOCTOR/CLINICAL OFFICER A
NURSE/MIDWIFE B
PATIENT ATTENDANT C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER (SPECIFY) _______ X
NO ONE Y

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.

NAME OF PLACE_____________________
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) _____ 26
MISSION
HOSPITAL 31
HEALTH CENTER 32
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL (SPECIFY) __________ 46
TRADITIONAL BIRTH ATTENDANT 51
OTHER (SPECIFY) ________ 96 (GO TO 429)

428. Was (NAME) delivered by caesarean section?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 432A)

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

DAYS AFTER DELIVERY 1 ______
WEEKS AFTER DELIVERY 2 ______
DON'T KNOW 998

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

HEALTH PROFESSIONAL
DOCTOR/CLINICAL OFFICER 11
NURSE/MIDWIFE 12
PATIENT ATTENDANT 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) _______ 96

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]

NAME OF PLACE_________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) _____ 26
MISSION
HOSPITAL 31
HEALTH CENTER 32
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL (SPECIFY) __________ 46
TRADITIONAL BIRTH ATTENDANT 51
OTHER (SPECIFY) ________ 96

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

Heavy bleeding?
YES 1
NO 2
DON'T KNOW 8
High blood pressure?
YES 1
NO 2
DON'T KNOW 8
Stroke/convulsions?
YES 1
NO 2
DON'T KNOW 8
Infection/fever?
YES 1
NO 2
DON'T KNOW 8
Leakage of urine or stool from your vagina?
YES 1
NO 2
DON'T KNOW 8
Post-partum depression/blues?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1 (GO TO 436)
NO 2 (GO TO 437)

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]

YES 1
NO 2 (GO TO 439)

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

MONTHS __
DON'T KNOW 98

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

NOT PREGNANT (GO TO 438)
PREGNANT OR UNSURE (GO TO 439)

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

YES 1
NO 2 (GO TO 440)

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

MONTHS __
DON'T KNOW 98

440. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

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.

IMMEDIATELY 000
HOURS 1 ______
DAYS 2 ______

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

YES 1
NO 2 (GO TO 444)

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

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) _____ X

444. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 445)
DEAD (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS __
DON'T KNOW 98

447. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454)

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

NUMBER OF NIGHTTIME FEEDINGS ______

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

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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'.

NUMBER OF TIMES ________
DON'T KNOW 8

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

LINE NUMBER ____

456. FROM 212 AND 216

NAME ______
LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 486)

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

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN 1 (GO TO 460)
YES, NOT SEEN 2 (GO TO 462)
NO CARD 3

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

YES 1 (GO TO 462)
NO 2 (GO TO 462)

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.

BCG
DAY __
MONTH __
YEAR __
POLIO 0 (BEFORE 14 DAYS OLD)
DAY __
MONTH __
YEAR __
POLIO 1 (AT 6 WEEKS OLD OR LATER)
DAY __
MONTH __
YEAR __
POLIO 2 (1 MONTH AFTER 1ST DOSE)
DAY __
MONTH __
YEAR __
POLIO 3 (1 MONTH AFTER 2ND DOSE)
DAY __
MONTH __
YEAR __
DPT 1 (AT 6 WEEKS OLD OR LATER)
DAY __
MONTH __
YEAR __
DPT 2
DAY __
MONTH __
YEAR __
DPT 3
DAY __
MONTH __
YEAR __
MEASLES
DAY __
MONTH __
YEAR __
VITAMIN A (MOST RECENT)
DAY __
MONTH __
YEAR __

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).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (GO TO 464)
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

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

YES 1
NO 2 (GO TO 466)
DON'T KNOW 8 (GO TO 466)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 463E)
DON'T KNOW 8 (GO TO 463E)

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

JUST AFTER BIRTH 1
LATER 2

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

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 463G)
DON'T KNOW 8 (GO TO 463G)

463F. How many times?

NUMBER OF TIMES ______

463G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
NO VACCINATION IN THE LAST 2 YEARS 3
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 467)
DON'T KNOW 8 (GO TO 467)

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.

FIRST ACTION DONE
GAVE MEDICINE FROM HOME 01
GAVE MEDICINE FROM A PHARMACIST/SHOPKEEPER (WITHOUT A PRESCRIPTION) 02
TAKEN TO A GOVERNMENT-RUN HEALTH CENTER 03
TAKEN TO A MISSION HEALTH CENTER 04
TAKEN TO A PRIVATE HEALTH CENTER 05
CONSULTED TRADITIONAL HEALER 06
CONSULTED COMMUNITY HEALTH WORKER 07
GAVE TEPID SPONGING 08
GAVE HERBS AT HOME 09
OTHER 10
DID NOTHING (ELSE) 11
DON'T KNOW 12
SECOND ACTION DONE
GAVE MEDICINE FROM HOME 01
GAVE MEDICINE FROM A PHARMACIST/SHOPKEEPER (WITHOUT A PRESCRIPTION) 02
TAKEN TO A GOVERNMENT-RUN HEALTH CENTER 03
TAKEN TO A MISSION HEALTH CENTER 04
TAKEN TO A PRIVATE HEALTH CENTER 05
CONSULTED TRADITIONAL HEALER 06
CONSULTED COMMUNITY HEALTH WORKER 07
GAVE TEPID SPONGING 08
GAVE HERBS AT HOME 09
OTHER 10
DID NOTHING (ELSE) 11
DON'T KNOW 12
THIRD ACTION DONE
GAVE MEDICINE FROM HOME 01
GAVE MEDICINE FROM A PHARMACIST/SHOPKEEPER (WITHOUT A PRESCRIPTION) 02
TAKEN TO A GOVERNMENT-RUN HEALTH CENTER 03
TAKEN TO A MISSION HEALTH CENTER 04
TAKEN TO A PRIVATE HEALTH CENTER 05
CONSULTED TRADITIONAL HEALER 06
CONSULTED COMMUNITY HEALTH WORKER 07
GAVE TEPID SPONGING 08
GAVE HERBS AT HOME 09
OTHER 10
DID NOTHING (ELSE) 11
DON'T KNOW 12
FOURTH ACTION DONE
GAVE MEDICINE FROM HOME 01
GAVE MEDICINE FROM A PHARMACIST/SHOPKEEPER (WITHOUT A PRESCRIPTION) 02
TAKEN TO A GOVERNMENT-RUN HEALTH CENTER 03
TAKEN TO A MISSION HEALTH CENTER 04
TAKEN TO A PRIVATE HEALTH CENTER 05
CONSULTED TRADITIONAL HEALER 06
CONSULTED COMMUNITY HEALTH WORKER 07
GAVE TEPID SPONGING 08
GAVE HERBS AT HOME 09
OTHER 10
DID NOTHING (ELSE) 11
DON'T KNOW 12

466B. CHECK 466A:

CODE "01" OR CODE "02" CIRCLED IN ANY COLUMN (GO TO 466C)
CODE "01" OR "02" NOT CIRCLED (GO TO 466E)

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.

ANTI-MALARIAL
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTESUNATE E
OTHER DRUGS
ASPIRIN F (IF NO ANTI-MALARIAL CIRCLED, GO TO 466E)
IBUPROFEN/ACETAMINOPHEN/ PANADOL/ PARACETAMOL G (IF NO ANTI-MALARIAL CIRCLED, GO TO 466E)
OTHER (SPECIFY) ___________ X (IF NO ANTI-MALARIAL CIRCLED, GO TO 466E)
DON'T KNOW Z (IF NO ANTI-MALARIAL CIRCLED, GO TO 466E)

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

SAME DAY 0
NEXT DAY AFTER THE FEVER 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

466E. CHECK 466A:

CODE '03' CIRCLED IN ANY COLUMN (GO TO 466F)
CODE '03' NOT CIRCLED (GO TO 466J)

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

SAME DAY 0
NEXT DAY 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

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

YES 1
NO 2 (GO TO 466J)
DON'T KNOW 8 (GO TO 466J)

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.

ANTI-MALARIAL
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTESUNATE E
OTHER DRUGS
ASPIRIN F (IF NO ANTI-MALARIAL CIRCLED, GO TO 466J)
IBUPROFEN/ACETAMINOPHEN/ PANADOL/ PARACETAMOL G (IF NO ANTI-MALARIAL CIRCLED, GO TO 466J)
OTHER (SPECIFY) ___________ X (IF NO ANTI-MALARIAL CIRCLED, GO TO 466J)
DON'T KNOW Z (IF NO ANTI-MALARIAL CIRCLED, GO TO 466J)

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

SAME DAY 0
NEXT DAY AFTER THE FEVER 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

466J. CHECK 466A:

CODE '04' CIRCLED IN ANY COLUMN (GO TO 466K)
CODE '04' NOT CIRCLED (GO TO 466O)

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

SAME DAY 0
NEXT DAY 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

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

YES 1
NO 2 (GO TO 466O)
DON'T KNOW 8 (GO TO 466O)

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.

ANTI-MALARIAL
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTESUNATE E
OTHER DRUGS
ASPIRIN F (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)
IBUPROFEN/ACETAMINOPHEN/ PANADOL/ PARACETAMOL G (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)
OTHER (SPECIFY) ___________ X (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)
DON'T KNOW Z (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)

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

SAME DAY 0
NEXT DAY AFTER THE FEVER 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

466O. CHECK 466A:

CODE "05" CIRCLED IN ANY COLUMN (GO TO 466P)
CODE "05" NOT CIRCLED (GO TO 466T)

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

SAME DAY 0
NEXT DAY 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

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

YES 1
NO 2 (GO TO 466T)
DON'T KNOW 8 (GO TO 466T)

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.

ANTI-MALARIAL
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTESUNATE E
OTHER DRUGS
ASPIRIN F (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)
IBUPROFEN/ACETAMINOPHEN/ PANADOL/ PARACETAMOL G (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)
OTHER (SPECIFY) ___________ X (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)
DON'T KNOW Z (IF NO ANTI-MALARIAL CIRCLED, GO TO 466O)

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

SAME DAY 0
NEXT DAY AFTER THE FEVER 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

466T. CHECK 466A:

CODE '07' CIRCLED IN ANY COLUMN (GO TO 466U)
CODE '07' NOT CIRCLED (GO TO 467)

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

SAME DAY 0
NEXT DAY 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

466V. What did the community health worker do?

GAVE MEDICINE 1
RECOMMENDED PURCHASE OF MEDICINE 2 (GO TO 467)
REFERRED TO HEALTH CENTER/DOCTOR 3 (GO TO 467)
OTHER (SPECIFY) _________ 4 (GO TO 467)

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.

ANTI-MALARIAL
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTESUNATE E
OTHER DRUGS
ASPIRIN F (IF NO ANTI-MALARIAL CIRCLED, GO TO 467)
IBUPROFEN/ACETAMINOPHEN/ PANADOL/ PARACETAMOL G (IF NO ANTI-MALARIAL CIRCLED, GO TO 467)
OTHER (SPECIFY) ___________ X (IF NO ANTI-MALARIAL CIRCLED, GO TO 467)
DON'T KNOW Z (IF NO ANTI-MALARIAL CIRCLED, GO TO 467)

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

SAME DAY 0
NEXT DAY AFTER THE FEVER 1
2 DAYS AFTER THE FEVER 2
3 OR MORE DAYS AFTER THE FEVER 3

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

YES 1
NO 2 (GO TO 472)
DON'T KNOW 8 (GO TO 472)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 472)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F

MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) __________ O
OTHER SOURCE
SHOP P
TRADITIONAL PRACTITIONER Q
OTHER (SPECIFY) _____ X

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

YES 1
NO 2 (GO TO 475)
DON'T KNOW 8 (GO TO 475)

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

YES 1
NO 2 (GO TO 475)
DON'T KNOW 8 (GO TO 475)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F

MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) __________ O
OTHER SOURCE
SHOP P
TRADITIONAL PRACTITIONER Q
OTHER (SPECIFY) _____ X

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

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

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

YES 1
NO 2 (GO TO 483)
DON'T KNOW 8 (GO TO 483)

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?

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

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?

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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 481)
DON'T KNOW 8 (GO TO 481)

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

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ____ X

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

YES 1
NO 2 (GO TO 483)

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.

NAME OF PLACE___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F

MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) __________ O
OTHER SOURCE
SHOP P
TRADITIONAL PRACTITIONER Q
OTHER (SPECIFY) _____ X

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

486. CHECK 478, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (THANZI) (GO TO 487)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (THANZI) (GO TO 491)

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

YES 1
NO 2

491. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2001 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE TO 492))
NAME__________
DOES NOT HAVE ANY CHILDREN BORN IN 2001 OR LATER AND LIVING WITH HER (GO TO 494)

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'.

a. Plain water?
NUMBER OF TIMES_____
b. Commercially produced infant formula?
NUMBER OF TIMES_____
c. Any other milk such as tinned, powdered, or fresh animal milk?
NUMBER OF TIMES_____
d. Fruit juice?
NUMBER OF TIMES_____
e. Any other liquids?
NUMBER OF TIMES_____

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'.

a. Bread, scone, maize meal (ngaiwa), maize flour (ufawoyera), millet, rice, sorghum, or any other food made from grains?
NUMBER OF TIMES_____
b. Pumpkin, red or yellow yams or squash, carrots, or yellow/orange sweet potatoes?
NUMBER OF TIMES_____
c. Any other food made from roots or tubers, for example cocoyams, irish potatoes, white sweet potatoes, white yams, cassava, or other local roots or tubers?
NUMBER OF TIMES_____
d. Any dark green leafy vegetables such as amaranth, cassava, pumpkin, or sweet potato leaves, chinese cabbage, greens, kale, or other dark green leafy vegetables?
NUMBER OF TIMES_____
e. Mango or papaya?
NUMBER OF TIMES_____
f. Any other fruits and vegetables [for example, bananas, apples, green beans, avocados, tomatoes]?
NUMBER OF TIMES_____
g. Meat, poultry, fish, shellfish, insects, rodents, or eggs?
NUMBER OF TIMES_____
h. Any food made from legumes [for example, beans, soybeans, groundnuts, lentils, pigeon peas, or cowpeas]?
NUMBER OF TIMES_____
i. Cheese, milk or yoghurt?
NUMBER OF TIMES_____
j. Any food made with oil, fat, margarine or butter?
NUMBER OF TIMES_____
k. Any other foods?
NUMBER OF TIMES_____

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?

Knowing where to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting permission to go.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for treatment.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The time required to cover the distance to the health facility.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The availability of means of transport.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The cost of transport.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone.
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be a female health provider.
BIG PROBLEM 1
NOT A BIG PROBLEM 2

494A. CHECK 432A:

DID NOT REPORT LEAKAGE OF URINE OR STOOL AFTER THIS PREGNANCY, OR WAS NOT ASKED QUESTION (GO TO 494B)
REPORTED EXPERIENCING LEAKAGE OF URINE OR STOOL AFTER THIS PREGNANCY (GO TO 495)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 496)

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

NUMBER _____

495B. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

Number _____
None 00

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

DOCTOR 1
NURSE 2
PHARMACIST 3
DRUG VENDOR 4
SELF-ADMINISTERED 5
FRIEND OR FAMILY 6
LOCAL INJECTION DOCTOR 7
OTHER (SPECIFY) ____________ 9

495D. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

Yes 1
No 2
Don't know 8

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

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
YES, CHEWING TOBACCO D
YES, SNUFF E
NO Y

497. Do you drink alcohol?

YES 1
NO 2 (GO TO 501)

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

VERY OFTEN 1
SOMETIMES 2
NEVER 3

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1 (GO TO 504)
YES, LIVED WITH A MAN 2 (GO TO 510)
NO 3

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?

WIDOWED 1
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)

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

RESPONDENT 1 (GO TO 510)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
OTHER (SPECIFY) _________ 5
NO PROPERTY 6

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

YES 1 (GO TO 510)
NO 2 (GO TO 510)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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'.

NAME _______
LINE NO. ____

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

YES 1
NO 2 (GO TO 510)

508. How many other wives does he have?

NUMBER __
DON'T KNOW 98 (GO TO 510)

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

RANK ___

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

ONLY ONCE 1
MORE THAN ONCE 2

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?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 513)
DON'T KNOW YEAR 9998

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

AGE ____

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)?

NEVER 00 (GO TO 524)
AGE IN YEARS ________
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

514A. CHECK 106:

15-24 YEARS OLD (GO TO 514B)
25-49 YEARS OLD (GO TO 515)

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

YES 1
NO 2

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

AGE OF PARTNER ___ (GO TO 515)
DON'T KNOW 98

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

OLDER 1
YOUNGER 2 (GO TO 515)
SAME AGE 3 (GO TO 515)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 515)

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

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

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.

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __ (GO TO 524)

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

YES 1
NO 2 (GO TO 517)

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

RESPONDENT WANTED TO PREVENT STD/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) _______________ 96
DON'T KNOW 98

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'.

SPOUSE/COHABITING PARTNER 01 (GO TO 519)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) _______________ 96

517A. CHECK 106:

15-24 YEARS OLD (GO TO 517B)
25-49 YEARS OLD (GO TO 518)

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?

YOUNGER 1
ABOUT SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW 8

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.

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

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

YES 1
NO 2 (GO TO 524)

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

YES 1
NO 2 (GO TO 521)

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

RESPONDENT WANTED TO PREVENT STD/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) _______________ 96
DON'T KNOW 98

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'.

SPOUSE/COHABITING PARTNER 01 (GO TO 522A)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) _______________ 96

521A. CHECK 106:

15-24 YEARS OLD (GO TO 521B)
25-49 YEARS OLD (GO TO 522)

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?

YOUNGER 1
ABOUT SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW 8

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.

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

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

YES 1
NO 2 (GO TO 524)

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

YES 1
NO 2 (GO TO 522D)

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

RESPONDENT WANTED TO PREVENT STD/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) _______________ 96
DON'T KNOW 98

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'.

SPOUSE/COHABITING PARTNER 01 (GO TO 523)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
PROSTITUTE 06
OTHER (SPECIFY) _______________ 96

522D1. CHECK 106:

15-24 YEARS OLD (GO TO 522D2)
25-49 YEARS OLD (GO TO 522E)

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?

YOUNGER 1
ABOUT SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON'T KNOW DIFFERENCE 5
DON'T KNOW 8

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.

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

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

NUMBER OF PARTNERS ___

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

YES 1
NO 2 (GO TO 527)

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.

NAME OF PLACE______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F

MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) __________ O
BLM P
OTHER SOURCE
SHOP Q
CHURCH R
FRIENDS/RELATIVES S
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

527. Have you heard of a condom called 'Chishango'?

YES 1
NO 2
DON'T KNOW 8

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON'T KNOW: PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW: NOT PREGNANT/UNSURE 5 (GO TO 608)

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?

MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993 (GO TO 609)
SAYS SHE CANNOT GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) _____ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

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.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER _______ X
DON'T KNOW Z

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?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY) _____________ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) _____ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

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

YES 1
NO 2
DON'T KNOW 8

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.

NONE 00 (GO TO 616)
NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 616)

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

NUMBER OF BOYS___
OTHER (SPECIFY)____ 96
NUMBER OF GIRLS___
OTHER (SPECIFY)___ 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY)____ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 8

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

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
On a poster?
YES 1
NO 2
On clothing (i.e., cap, chitenji, t-shirt)?
YES 1
NO 2
In a drama?
YES 1
NO 2
Somewhere else? (SPECIFY)
YES 1
NO 2

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

Uchembere Wabwino?
YES 1
NO 2
Phukusi la Moyo?
YES 1
NO 2
Pa Mtondo?
YES 1
NO 2
Women's Talking Point?
YES 1
NO 2
Window Through Health?
YES 1
NO 2
Umoyo M'Malawi?
YES 1
NO 2
Tikuferanji?
YES 1
NO 2
Radio Doctor?
YES 1
NO 2
Chitukuku M'Malawi?
YES 1
NO 2
Women's Forum?
YES 1
NO 2
Tichitenji?
YES 1
NO 2
Kulera?
YES 1
NO 2
Other? (SPECIFY)
YES 1
NO 2

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

YES 1
NO 2 (GO TO 621)

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

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
MOTHER(S)-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) ________________ X

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 628)

622. CHECK 311/311A:

ANY CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

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?

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

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?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

626. CHECK 311/311A:

NEITHER STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

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?

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

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:

She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with women other than his wife or wives?
YES 1
NO 2
DON'T KNOW 8
She has recently given birth?
YES 1
NO 2
DON'T KNOW 8
She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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

AGE IN COMPLETED YEARS _______

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

YES 1
NO 2 (GO TO 706)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 706)

705. What was the highest (class/form/year) he completed at that level?

CLASS ____
DON'T KNOW 98

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?

OCCUPATION_____________

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

YES 1 (GO TO 710)
NO 2

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?

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 719)

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

OCCUPATION_____________

711. CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

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?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

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

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

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

HOME 1
AWAY 2

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

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

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

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?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6

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

Your own health care?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making large household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making household purchases for daily needs?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Visits to family or relatives?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
What food should be cooked each day?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

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

CHILDREN UNDER AGE 10
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 8

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:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8
If she has an extramarital affair?
YES 1
NO 2
DON'T KNOW 8

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:

If he neglects to support the family financially?
YES 1
NO 2
DON'T KNOW 8
If he gets drunk frequently?
YES 1
NO 2
DON'T KNOW 8
If he argues with her?
YES 1
NO 2
DON'T KNOW 8
If he refuses to have sex with her?
YES 1
NO 2
DON'T KNOW 8
If he has sex with a woman who is not his wife?
YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2 (GO TO 817A)

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

YES 1
NO 2 (GO TO 809)
DON'T KNOW 8 (GO TO 809)

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

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) _______ W
OTHER (SPECIFY) _______ X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 813)
DON'T KNOW 8 (GO TO 813)

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

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

812A. CHECK 812:

AT LEAST ONE 'YES' (GO TO 812B)
OTHER (GO TO 812C)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

813. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 814)
NO, NOT IN UNION (GO TO 814A)

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

YES 1
NO 2

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

on the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
on the TV?
ACCEPTABLE 1
NOT ACCEPTABLE 2
in newspapers?
ACCEPTABLE 1
NOT ACCEPTABLE 2

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

YES 1
NO 2
DON'T KNOW 8

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

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

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?

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

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

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DON'T KNOW/NOT SURE/DEPENDS 8

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?

CAN CONTINUE 1
SHOULD NOT CONTINUE 2
DON'T KNOW/NOT SURE/DEPENDS 8

816A. Are people who have AIDS immoral?

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

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

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

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

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

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

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

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 816L)

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

LESS THAN 12 MONTHS 1
12-23 MONTHS 2
2 YEARS OR MORE 8

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?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1 (GO TO 816MX)
NO 2 (GO TO 816MX)

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

YES 1
NO 2 (GO TO 816P)

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.

NAME OF PLACE___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 36
BLM 41
MACRO 51
OTHER (SPECIFY) _____ 96

816P. CHECK 515:

RESPONDENT HAD SEX IN THE 12 MONTHS PRIOR TO THE SURVEY (GO TO 817)
RESPONDENT HAS NOT HAD SEX IN THE PAST 12 MONTHS, OR WAS NOT ASKED Q. 515. (GO TO 817A)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 819A)

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

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DON'T KNOW Z

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

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DON'T KNOW Z

819A. CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 819A1)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

819A1. CHECK 817A:

KNOWS STI (GO TO 819B)
DOES NOT KNOW STI (GO TO 819C)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

HAS HAD AN INFECTION (GO TO 819F)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 901)

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

YES 1
NO 2 (GO TO 819H)

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

Go to a clinic, hospital or private doctor?
YES 1
NO 2
Consult a traditional healer?
YES 1
NO 2
Seek advice or buy medicines in a shop or pharmacy?
YES 1
NO 2
Ask for advice from friends or relatives?
YES 1
NO 2

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

YES 1
NO 2
SOME/NOT ALL 3
DID NOT HAVE PARTNER 4 (GO TO 901)

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

YES 1
NO 2 (GO TO 901)
PARTNER ALREADY INFECTED 3 (GO TO 901)

819J. What did you do to avoid infecting your partner(s)? Did you…

Use medicine?
YES 1
NO 2
Stop having sex?
YES 1
NO 2
Use a condom when having sex?
YES 1
NO 2

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?

NUMBER OF BIRTHS TO NATURAL MOTHER ______

902. CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 914)

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

NUMBER OF PRECEDING BIRTHS ____

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

NAME__________

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DON'T KNOW 8 (GO TO NEXT BROTHER OR SISTER)

907. How old is (NAME)?

AGE_________ (GO TO NEXT BROTHER OR SISTER)

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

YEARS__________

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

AGE__________(IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT BROTHER OR SISTER)

910. Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911. Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2

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

NUMBER OF CHILDREN__________

IF NO MORE BROTHERS OR SISTERS, GO TO 914.

914. CHECK Q910, 911 AND 912 FOR ALL SISTERS

ANY YES:
Just to make sure I have this right, you told me that your sister(s) _______________ (NAME) died when she was (pregnant/delivering/just delivered). Is that correct?
IF CORRECT, CONTINUE TO DV00. IF NOT, CORRECT QUESTIONNAIRE AND CONTINUE TO 914.
ALL NO OR BLANK (GO TO DV00)

SECTION 10. DOMESTIC VIOLENCE

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

WOMAN SELECTED FOR THIS SECTION (GO TO DV01)
WOMAN NOT SELECTED (GO TO DV29)

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

PRIVACY OBTAINED 1
READ TO ALL RESPONDENTS:
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Malawi. Let me assure you that your answers are completely confidential and will not be told to anyone.
PRIVACY NOT POSSIBLE 2 (GO TO DV28)

DV02. CHECK 501, 502, AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO DV03)
WIDOWED/SEPARATED/DIVORCED (READ IN PAST TENSE) (GO TO DV03)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO DV14)

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?

a) He usually (spends/spent) his free time with you?
FREQUENTLY 1
SOMETIMES 2
NEVER 3
b) He (consults/consulted) you on different household matters?
FREQUENTLY 1
SOMETIMES 2
NEVER 3
c) He (is/was) affectionate with you?
FREQUENTLY 1
SOMETIMES 2
NEVER 3
d) He (respects/respected) you and your wishes?
FREQUENTLY 1
SOMETIMES 2
NEVER 3

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?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8
f) He (does/did) not trust you with any money?
YES 1
NO 2
DON'T KNOW 8

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:

a) Say or do something to humiliate you in front of others?
YES 1
NO 2
b) Threaten you or someone close to you with harm?
YES 1
NO 2

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

a) Say or do something to humiliate you in front of others?
TIMES IN LAST 12 MONTHS _____
b) Threaten you or someone close to you with harm?
TIMES IN THE LAST 12 MONTHS _____

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

a) push you, shake you, or throw something at you?
YES 1
NO 2
b) slap you or twist your arm?
YES 1
NO 2
c) punch you with his fist or with something that could hurt you?
YES 1
NO 2
d) kick you or drag you?
YES 1
NO 2
e) try to strangle you or burn you?
YES 1
NO 2
f) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2
g) attack you with a knife, gun, or other type of weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2
i) force you to perform other sexual acts you did not want to?
YES 1
NO 2

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

a) push you, shake you, or throw something at you?
TIMES IN LAST 12 MONTHS ___
b) slap you or twist your arm?
TIMES IN LAST 12 MONTHS ___
c) punch you with his fist or with something that could hurt you?
TIMES IN LAST 12 MONTHS ___
d) kick you or drag you?
TIMES IN LAST 12 MONTHS ___
e) try to strangle you or burn you?
TIMES IN LAST 12 MONTHS ___
f) threaten you with a knife, gun, or other type of weapon?
TIMES IN LAST 12 MONTHS ___
g) attack you with a knife, gun, or other type of weapon?
TIMES IN LAST 12 MONTHS ___
h) physically force you to have sexual intercourse with him even when you did not want to?
TIMES IN LAST 12 MONTHS ___
i) force you to perform other sexual acts you did not want to?
TIMES IN LAST 12 MONTHS ___

DV07. CHECK DV06:

AT LEAST ONE 'YES' (GO TO DV08)
NOT A SINGLE 'YES' (GO TO DV09)

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'.

NUMBER OF YEARS _____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
AFTER SEPARATION/DIVORCE 96

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

a) You had bruises and aches?
YES 1
NO 2
b) You had an injury or a broken bone?
YES 1
NO 2
c) You went to the doctor or health center as a result of something your husband/partner did to you?
YES 1
NO 2

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

a) You had bruises and aches?
TIMES IN LAST 12 MONTHS _______
b) You had an injury or a broken bone?
TIMES IN LAST 12 MONTHS _______
c) You went to the doctor or health center as a result of something your husband/partner did to you?
TIMES IN 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?

YES 1
NO 2 (GO TO DV12)

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?

NUMBER OF TIMES _______

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

YES 1
NO 2 (GO TO DV14)

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

VERY OFTEN 1
SOMETIMES 2
NEVER 3

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?

YES 1
NO 2 (GO TO DV19)
NO ANSWER 6 (GO TO DV19)

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

MOTHER A
FATHER B
STEP-MOTHER C
STEP-FATHER D
SISTER E
BROTHER F
DAUGHTER G
SON H
LATE/EX-HUSBAND/EX-PARTNER I
CURRENT BOYFRIEND J
FORMER BOYFRIEND K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER FEMALE RELATIVE/IN-LAW N
OTHER MALE RELATIVE/ IN-LAW O
FEMALE FRIEND/ACQUAINTANCE P
MALE FRIEND/ACQUAINTANCE Q
TEACHER R
EMPLOYER S
STRANGER T
OTHER (SPECIFY) ________ X

DV16. CHECK DV15:

MORE THAN ONE PERSON MENTIONED (GO TO DV17)
ONLY ONE PERSON MENTIONED (GO TO DV18)

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

MOTHER 01
FATHER 02
STEP-MOTHER 03
STEP-FATHER 04
SISTER 05
BROTHER 06
DAUGHTER 07
SON 08
LATE/EX-HUSBAND/EX-PARTNER 09
CURRENT BOYFRIEND 10
FORMER BOYFRIEND 11
MOTHER-IN-LAW 12
FATHER-IN-LAW 13
OTHER FEMALE RELATIVE/IN-LAW 14
OTHER MALE RELATIVE/ IN-LAW 15
FEMALE FRIEND/ACQUAINTANCE 16
MALE FRIEND/ACQUAINTANCE 17
TEACHER 18
EMPLOYER 19
STRANGER 20
OTHER (SPECIFY) ________ 96

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

NUMBER OF TIMES _______

DV19. CHECK 201 AND 226:

HAS ONE OR MORE LIVE OR NON-LIVE BIRTHS OR IS CURRENTLY PREGNANT (GO TO DV20)
NO LIVE BIRTHS, NO NON-LIVE BIRTHS, AND IS NOT CURRENTLY PREGNANT (GO TO DV21A)

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

YES 1
NO 2 (GO TO DV21A)

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

CURRENT HUSBAND/PARTNER A
MOTHER B
FATHER C
STEP-MOTHER D
STEP-FATHER E
SISTER F
BROTHER G
DAUGHTER H
SON I
LATE/EX-HUSBAND/EX-PARTNER J
CURRENT BOYFRIEND K
FORMER BOYFRIEND L
MOTHER-IN-LAW M
FATHER-IN-LAW N
OTHER FEMALE RELATIVE/IN-LAW O
OTHER MALE RELATIVE/ IN-LAW P
FEMALE FRIEND/ACQUAINTANCE Q
MALE FRIEND/ACQUAINTANCE R
TEACHER S
EMPLOYER T
STRANGER U
OTHER (SPECIFY) ________ X

DV21A. CHECK Q514: EVER HAD SEX?

HAS EVER HAD SEX (GO TO DV21B)
NEVER HAD SEX (GO TO DV22)

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?

WANTED TO 1
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3

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

YES 1
NO 2
REFUSED TO ANSWER/NO RESPONSE 3

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

AT LEAST ONE 'YES' (GO TO DV23)
NOT A SINGLE 'YES' (GO TO DV26)

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

YES 1
NO 2 (GO TO DV25)

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

MOTHER A (GO TO DV26)
FATHER B (GO TO DV26)
SISTER C (GO TO DV26)
BROTHER D (GO TO DV26)
CURRENT/LAST/LATE HUSBAND/PARTNER E (GO TO DV26)
CURRENT/FORMER BOYFRIEND F (GO TO DV26)
MOTHER-IN-LAW G (GO TO DV26)
FATHER-IN-LAW H (GO TO DV26)
OTHER FEMALE RELATIVE/IN-LAW I (GO TO DV26)
OTHER MALE RELATIVE/IN-LAW J (GO TO DV26)
FRIEND K (GO TO DV26)
NEIGHBOR L (GO TO DV26)
TEACHER M (GO TO DV26)
EMPLOYER N (GO TO DV26)
RELIGIOUS LEADER O (GO TO DV26)
DOCTOR/MEDICAL PERSONNEL P (GO TO DV26)
POLICE Q (GO TO DV26)
LAWYER R (GO TO DV26)
OTHER (SPECIFY) ________ X (GO TO DV26)

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

DON'T KNOW WHO TO GO TO 01
NO USE 02
PART OF LIFE 03
AFRAID OF DIVORCE/DESERTION 04
AFRAID OF FURTHER BEATINGS 05
AFRAID OF GETTING PERSON BEATING HER INTO TROUBLE 06
EMBARRASSED 07
DON'T WANT TO DISGRACE FAMILY 08
OTHER (SPECIFY) _______________ 96

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

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

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?

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

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

DV29. RECORD THE TIME.

HOUR _____
MINUTES _______


SECTION 11. ANTHROPOMETRY, ANEMIA AND HIV TESTING

1101. WEIGHT (KILOGRAMS)

WEIGHT___.___

1101A. HEIGHT (CENTIMETERS)

HEIGHT ___.___

1101B. RESULT:

MEASURED 1
REFUSED 2
ABSENT 3
OTHER (SPECIFY) __________ 6

1102. CHECK 106:

AGE IS 15-17 (GO TO 1103)
AGE IS 18-54 (GO TO 1105)

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

LINE NUMBER___

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

CONSENT 1
SIGN___
REFUSED 2 (GO TO 1106)
NOT READ 8 (GO TO 1106)

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

CONSENT 1
SIGN____
REFUSED 2 (GO TO 1106)
NOT READ 8 (GO TO 1106)

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:

BLOOD TAKEN 1
REFUSED 2 (GO TO 1111)
ABSENT 3 (GO TO 1111)
TECHNICAL PROBLEM 4 (GO TO 1111)
OTHER (SPECIFY) ______________ 6 (GO TO 1111)

1107. HEMOGLOBIN LEVEL (G/DL):

LEVEL___.___

1108. CURRENTLY PREGNANT:

YES 1
NO/DON'T KNOW 2

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).

HEMOGLOBIN LEVEL BELOW THE CUTOFF POINT: GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND CONTINUE WITH 1110.
HEMOGLOBIN LEVEL NORMAL: GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT

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?

YES 1
NO 2

1111. CHECK 1102:

AGE IS 15-17 (GO TO 1112)
AGE IS 18-54 (GO TO 1114)

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

LINE NUMBER____

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

CONSENT 1
SIGN____
REFUSED 2 (GO TO 1115)
NOT READ 8 (GO TO 1115)

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

CONSENT 1
SIGN____
REFUSED 2 (GO TO 1115)
NOT READ 8 (GO TO 1115)

1115. RESULTS:

BLOOD TAKEN 1
REFUSED 2
ABSENT 3
TECHNICAL PROBLEM 4
OTHER (SPECIFY) ______________ 6

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

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 FEMALE CONDOM
L PERIODIC ABSTINENCE
M WITHDRAWAL
X OTHER (SPECIFY) _______

COL 2: SOURCE OF CONTRACEPTION

1 GOVERNMENT HOSPITAL
2 GOVERNMENT HEALTH CENTER
3 FAMILY PLANNING CLINIC
4 GOVERNMENT MOBILE CLINIC
5 GOVERNMENT FIELDWORKER
6 OTHER PUBLIC
7 MISSION HOSPITAL
8 MISSION HEALTH CENTER
9 MISSION MOBILE CLINIC
A PRIVATE HOSPITAL/CLINIC
B PHARMACY
C PRIVATE DOCTOR
D PRIVATE MOBILE CLINIC
E PRIVATE FIELDWORKER
F OTHER PRIVATE MEDICAL
G BLM
H SHOP
I FRIENDS/RELATIVES
X OTHER (SPECIFY) _______

COL 3: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) _______
Z DON'T KNOW

COL 4: MARRIAGE/UNION

X IN UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION
2004
12 DEC 01 _____ _____ _____ ______ 01 DEC
11 NOV 02 _____ _____ _____ ______ 02 NOV
10 OCT 03 _____ _____ _____ ______ 03 OCT
09 SEP 04 _____ _____ _____ ______ 04 SEP
08 AUG 05 _____ _____ _____ ______ 05 AUG
07 JUL 06 _____ _____ _____ ______ 06 JUL
06 JUN 07 _____ _____ _____ ______ 07 JUN
05 MAY 08 _____ _____ _____ ______ 08 MAY
04 APR 09 _____ _____ _____ ______ 09 APR
03 MAR 10 _____ _____ _____ ______ 10 MAR
02 FEB 11 _____ _____ _____ ______ 11 FEB
01 JAN 12 _____ _____ _____ ______ 12 JAN
2003
12 DEC 13 _____ _____ _____ ______ 13 DEC
11 NOV 14 _____ _____ _____ ______ 14 NOV
10 OCT 15 _____ _____ _____ ______ 15 OCT
09 SEP 16 _____ _____ _____ ______ 16 SEP
08 AUG 17 _____ _____ _____ ______ 17 AUG
07 JUL 18 _____ _____ _____ ______ 18 JUL
06 JUN 19 _____ _____ _____ ______ 19 JUN
05 MAY 20 _____ _____ _____ ______ 20 MAY
04 APR 21 _____ _____ _____ ______ 21 APR
03 MAR 22 _____ _____ _____ ______ 22 MAR
02 FEB 23 _____ _____ _____ ______ 23 FEB
01 JAN 24 _____ _____ _____ ______ 24 JAN
2002
12 DEC 25 _____ _____ _____ ______ 25 DEC
11 NOV 26 _____ _____ _____ ______ 26 NOV
10 OCT 27 _____ _____ _____ ______ 27 OCT
09 SEP 28 _____ _____ _____ ______ 28 SEP
08 AUG 29 _____ _____ _____ ______ 29 AUG
07 JUL 30 _____ _____ _____ ______ 30 JUL
06 JUN 31 _____ _____ _____ ______ 31 JUN
05 MAY 32 _____ _____ _____ ______ 32 MAY
04 APR 33 _____ _____ _____ ______ 33 APR
03 MAR 34 _____ _____ _____ ______ 34 MAR
02 FEB 35 _____ _____ _____ ______ 35 FEB
01 JAN 36 _____ _____ _____ ______ 36 JAN
2001
12 DEC 37 _____ _____ _____ ______ 37 DEC
11 NOV 38 _____ _____ _____ ______ 38 NOV
10 OCT 39 _____ _____ _____ ______ 39 OCT
09 SEP 40 _____ _____ _____ ______ 40 SEP
08 AUG 41 _____ _____ _____ ______ 41 AUG
07 JUL 42 _____ _____ _____ ______ 42 JUL
06 JUN 43 _____ _____ _____ ______ 43 JUN
05 MAY 44 _____ _____ _____ ______ 44 MAY
04 APR 45 _____ _____ _____ ______ 45 APR
03 MAR 46 _____ _____ _____ ______ 46 MAR
02 FEB 47 _____ _____ _____ ______ 47 FEB
01 JAN 48 _____ _____ _____ ______ 48 JAN
2000
12 DEC 49 _____ _____ _____ ______ 48 DEC
11 NOV 50 _____ _____ _____ ______ 50 NOV
10 OCT 51 _____ _____ _____ ______ 51 OCT
09 SEP 52 _____ _____ _____ ______ 52 SEP
08 AUG 53 _____ _____ _____ ______ 53 AUG
07 JUL 54 _____ _____ _____ ______ 54 JUL
06 JUN 55 _____ _____ _____ ______ 55 JUN
05 MAY 56 _____ _____ _____ ______ 56 MAY
04 APR 57 _____ _____ _____ ______ 57 APR
03 MAR 58 _____ _____ _____ ______ 58 MAR
02 FEB 59 _____ _____ _____ ______ 59 FEB
01 JAN 60 _____ _____ _____ ______ 60 JAN
1999
12 DEC 61 _____ _____ _____ ______ 61 DEC
11 NOV 62 _____ _____ _____ ______ 62 NOV
10 OCT 63 _____ _____ _____ ______ 63 OCT
09 SEP 64 _____ _____ _____ ______ 64 SEP
08 AUG 65 _____ _____ _____ ______ 65 AUG
07 JUL 66 _____ _____ _____ ______ 66 JUL
06 JUN 67 _____ _____ _____ ______ 67 JUN
05 MAY 68 _____ _____ _____ ______ 68 MAY
04 APR 69 _____ _____ _____ ______ 69 APR
03 MAR 70 _____ _____ _____ ______ 70 MAR
02 FEB 71 _____ _____ _____ ______ 71 FEB
01 JAN 72 _____ _____ _____ ______ 72 JAN