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DEMOGRAPHIC AND HEALTH SURVEY - MALAWI 2016-15 - WOMAN'S QUESTIONNAIRE (ENGLISH)

MALAWI

IDENTIFICATION

PLACE NAME:

NAME OF HOUSEHOLD HEAD:

CLUSTER NUMBER:

HOUSEHOLD NUMBER:

NAME AND LINE NUMBER OF WOMAN:

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE?

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

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

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S NUMBER
RESULT*

TOTAL NUMBER OF VISITS:

LANGUAGE OF QUESTIONNAIRE:

01 ENGLISH
02 CHICHEWA
03 TUMBUKA
09 OTHER (SPECIFY)

LANGUAGE OF QUESTIONNAIRE ___

LANGUAGE OF INTERVIEW:

01 ENGLISH
02 CHICHEWA
03 TUMBUKA
09 OTHER (SPECIFY)

NATIVE LANGUAGE OF RESPONDENT:

01 ENGLISH
02 CHICHEWA
03 TUMBUKA
09 OTHER (SPECIFY)

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR
NAME
NUMBER

OFFICE EDITOR
NUMBER

KEYED BY
NUMBER

INTRODUCTION AND CONSENT

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

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

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

SIGNATURE OF INTERVIEWER ___
DATE ___

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

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME

HOURS ___
MINUTES ___

102. How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

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

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

CITY 1
TOWN 2
RURAL AREA 3

104. Before you moved here, which (REGION) did you live in?

NORTHERN 01
CENTRAL 02
SOUTHERN 03
OUTSIDE OF MALAWI 96

105. In what month and year were you born?

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

106. How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (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 (FORM/YEAR) you completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/FORM/YEAR ___

110. CHECK 108:

PRIMARY OR SECONDARY (GO TO 111)
HIGHER (GO TO 113)

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

SHOW CARD TO RESPONDENT.

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

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

112. CHECK 111:

CODE '2', '3', OR '4' CIRCLED (GO TO 113)
CODE '1' OR '5' CIRCLED (GO TO 114)

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

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

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

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

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

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

116. Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

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

YES 1
NO 2

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

YES 1
NO 2

119. Have you ever used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (GO TO 122)

120. In last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (GO TO 122)

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

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

122. 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

123. What is your tribe or ethnic group?

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

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

NUMBER OF TIME ___
NONE 00 (GO TO 201)

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

YES 1
NO 2

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 AT HOME ___

206. Have you ever given birth to a boy or girl who was born alive but later died?

IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

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 BIRTHS ___

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 BIRTH (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 ROWS. IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

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

RECORD NAME ___
BIRTH HISTORY NUMBER ___

213. Is (NAME) a boy or girl?

BOY 1
GIRL 2

214. Were any of these births twins?

SINGLE 1
MULTIPLE 2

215. On what day, month, and year was (NAME) born?

DAY ___
MONTH ___
YEAR ___

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217. IF ALIVE: How old was (NAME) and (NAME)'s last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS ___

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

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER ___ (GO TO NEXT BIRTH)

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

IF '12 MONTHS' OR '1 YEAR', ASK: Did (NAME) have (his or her) firth birthday?

THEN ASK: Exactly how many months old was (NAME) when (he or she) died?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

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

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

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

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

223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY:

NUMBERS ARE THE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215: ENTER THE NUMBER OF BIRTH IN 2010-2015.

NUMBER OF BIRTHS ___
NONE 0 (GO TO 226)

225. C:
FOR EACH BIRTH IN 2010-2015, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NATE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226. Are you pregnant now?

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

227. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

C: ENTER 'P'S IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ___

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

YES 1 (GO TO 230)
NO 2

229. CHECK 208: TOTAL NUMBER OF BIRTHS

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

NONE: Did you want to have a baby later on or did you not want any children?

LATER 1
NO MORE OR NONE 2

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

YES 1
NO 2 (GO TO 239)

230A. I will now ask you about each of them separately.

IF NONE, RECORD '00'.

01. In total, how many miscarriages have you had?
TOTAL MISCARRIAGES ___
02. In total, how many abortions have you had? Please, also include abortions induced by cytotec or other medicines/herbs with abortive effect conducted at home or elsewhere by yourself or with a help of a health professional.
TOTAL INDUCED ABORTIONS ___
03. In total, how many stillbirths have you had?
TOTAL STILLBIRTHS ___

231. When did the last such pregnancy end?

MONTH ___
YEAR ___

232. CHECK 231:

LAST PREGNANCY ENDED IN 2010-2015 (GO TO 234)
LAST PREGNANCY ENDED IN 2009 OR EARLIER (GO TO 239)

233. In what month and year did the preceding such pregnancy end?

MONTH ___
YEAR ___

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

NUMBER OF MONTHS ___

235. Since January 2010, have you had any other pregnancy that did not result in a live birth?

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

236. C:
FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2010-2015 OR LATER, ENTER 'T'' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY. IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237. Did you have any miscarriages, abortions or stillbirths that ended before 2010?

YES 1
NO 2 (GO TO 239)

238. When did the last such pregnancy that terminated before 2010 end?

MONTHS ___
YEAR ___

239. When did your last menstrual period start?

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

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

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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

01. Female Sterilization: Women can have 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.
YES 1
NO 2
03. IUD: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
04. 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
05. Implants: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06. Pill: Women can take a pill every day to avoid becoming pregnant.
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
09. Emergency Contraception: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
10. Standard Days Method: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
11. Lactational Amenorrhea Method (LAM): Up to six months after child birth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
YES 1
NO 2
12. Rhythm Method: To avoid pregnancy, women do not have sexual intercourse on days of the month they think they can get pregnant.
YES 1
NO 2
13. Withdrawal: Men can be careful and pull out before climax.
YES 1
NO 2
14. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD (SPECIFY) 1
YES, TRADITIONAL METHOD (SPECIFY) 2
NO 3

302. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 312)

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

YES 1
NO 2 (GO TO 312)

304. Which method are you using?

RECORD ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTIONS FOR HIGHEST METHOD IS LIST.

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

305. What is the brand or pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

LOFEMINOL 01 (GO TO 309)
MICROGYNON 02 (GO TO 309)
OVRETTE 03 (GO TO 309)
OTHER (SPECIFY) 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

306. What is the band name of the condoms you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

CHISHANGO 01 (GO TO 309)
MANYUCHI 02 (GO TO 309)
SILVERTOUCH 03 (GO TO 309)
CARE (FEMALE CONDOMS) 04 (GO TO 309)
PUBLIC SECTOR CONDOMS 05 (GO TO 309)
OTHER (SPECIFY) 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

307. In what facility did the sterilization take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC SECTOR (SPECIFY) 16
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
PRIVATE DOCTOR'S OFFICE 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
BLM 41
OTHER (SPECIFY) 96
DON'T KNOW 98

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

MONTH ___ (GO TO 310)
YEAR ___ (GO TO 310)

309. Since what month and year have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH ___
YEAR ___

310. CHECK 308 AND 309, 215, AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

NO (GO TO 311)
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION)).

311. CHECK 308 AND 309:

YEAR IS 2010-2015
C: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING (GO TO 312)
YEAR IS 2009 OR EARLIER
C: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2010, (GO TO 324)

312. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

C: USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE BACK TO JANUARY 2010. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

312A. MONTH AND YEAR OS START OF INTERVAL OF USE OR NON-USE.

MONTH ___
YEAR ___

312B. Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

YES 1
NO 2 (GO TO 312I)

312C. Which method was that?

METHOD CODE ___

312D. How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?

CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

IMMEDIATELY 00 (GO TO 312F)
MONTHS ___ (GO TO 312F)
DATE GIVEN 95

312E. RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

MONTH ___
YEAR ___

312F. For how many months did you use (METHOD)?

CIRCLE '95 IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

MONTHS ___ (GOT 312H)
DATE GIVEN 95

312G. RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

MONTH ___
YEAR ___

312H. Why did you stop using (METHOD)?

REASON STOPPED ___

312I. GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.

313. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

NO METHOD USED (GO TO 314)
ANY METHOD USED (GO TO 315)

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

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

315. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONCE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

316. You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST/OUTREACH 13
MOBILE CLINIC 14
HSA 15
CBDA/DOOR TO DOOR 16
OTHER PUBLIC SECTOR (SPECIFY) 17
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
CBDA/DOOR TO DOOR 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
CBDA/DOOR TO DOOR 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
BLM 41
MACRO 51
YOUTH DROP IN CENTRE 61
OTHER SOURCE
SHOP 71
CHURCH 72
FRIEND OR RELATIVE 73
OTHER (SPECIFY) 96

317. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

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

YES 1 (GO TO 321)
NO 2 (GO TO 320)

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

YES 1 (GO TO 321)
NO 2

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

YES 1
NO 2 (GO TO 322)

321. Were you told what to do if you experience side effects or problems?

YES 1
NO 2

322. CHECK 318 AND 319:

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

OTHER: When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2

324. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONCE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 327)
GOVERNMENT HEALTH CENTER 12 (GO TO 327)
GOVERNMENT HEALTH POST/OUTREACH 13 (GO TO 327)
MOBILE CLINIC 14 (GO TO 327)
HSA 15 (GO TO 327)
CBDA/DOOR TO DOOR 16 (GO TO 327)
OTHER PUBLIC SECTOR (SPECIFY) 17 (GO TO 327)
CHAM/MISSION
HOSPITAL 21 (GO TO 327)
HEALTH CENTER 22 (GO TO 327)
MOBILE CLINIC 23 (GO TO 327)
CBDA/DOOR TO DOOR 24 (GO TO 327)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31 (GO TO 327)
PHARMACY 32 (GO TO 327)
PRIVATE DOCTOR 33 (GO TO 327)
MOBILE CLINIC 34 (GO TO 327)
CBDA/DOOR TO DOOR 34 (GO TO 327)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (GO TO 327)
BLM 41 (GO TO 327)
MACRO 51 (GO TO 327)
YOUTH DROP IN CENTRE 61 (GO TO 327)
OTHER SOURCE
SHOP 71 (GO TO 327)
CHURCH 72 (GO TO 327)
FRIEND OR RELATIVE 73 (GO TO 327)
OTHER (SPECIFY) 96 (GO TO 327)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 329)

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

YES 1
NO 2

329. CHECK 202: LIVING CHILDREN

YES: In the last 12 months, have you visited a health facility for care for yourself or your children?

NO: In the last 12 months have you visited a health facility for care for yourself?

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2010-2015 (GO TO 402)
NO BIRTHS IN 2010-2015 (GO TO 648)

402. CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2010-2015. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER ___

404. FROM 212 AND 216:

NAME ___
LIVING ___
DEAD ___

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

YES 1(GO TO 408)
NO 2

406. CHECK 208:

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

MORE THAN ONCE BIRTH: Did you want to have a baby later on, or did you not want any more children?

LATER 1
NO MORE OR NONE 2 (GO TO 408)

407. How much longer did you want wait?

MONTH 1 ___
YEAR 2 ___
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 414)

409. Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL

DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT A
NURSE OR MIDWIFE B
PATIENT ATTENDANT C
HSA D

OTHER PERSON

TRADITIONAL BIRTH ATTENDANT E

OTHER (SPECIFY) X

410. Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
MOBILE CLINIC F
OTHER PUBLIC SECTOR (SPECIFY) G
CHAM/MISSION
HOSPITAL H
HEALTH CENTER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC J
MOBILE CLINIC K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) L
BLM M
OTHER (SPECIFY) X

411. How many months pregnant were you when you first received antenatal care for thsi pregnancy?

MONTHS ___
DON'T KNOW 98

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

NUMBER OF TIMES ___
DON'T KNOW 98

413. As part of your antenatal care during this pregnancy, were any of the following done at least once:

a. Was your blood pressure measured?
YES 1
NO 2
b. Did you give a urine sample?
YES 1
NO 2
c. Did you give a blood sample?
YES 1
NO 2
d. Was your height measured?
YES 1
NO 2
e. Were you weighed?
YES 1
NO 2
f. Was the fetal heartbeat checked?
YES 1
NO 2
g. Did you receive information on what foods to eat?
YES 1
NO 2

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

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

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

TIMES ___
DON'T KNOW 8

416. CHECK 415:

2 OR MORE TIME (GO TO 420)
OTHER (GO TO 417)

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

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

418. Before this pregnancy, how many times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

TIMES ___
DON'T KNOW 8

419. CHECK 418:

ONLY ONE: How many years ago did you receive that tetanus injection?

MORE THAN ONE: How many years ago did you receive the last tetanus injection prior to this pregnancy?

YEARS AGO ___

420. During this pregnancy, were you given or did you buy any iron tablets?

SHOW TABLETS.

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

421. During the whole pregnancy, for how many days did you take the tablets?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS ___
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

TIMES ___

425. Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONCE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

426. When (NAME) was born, was (NAME) very large, larger than average, average, small than average, or very small?

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

427. Was (NAME) weighed at birth?

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

428. How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KILOGRAM FROM CARD 1 ___
KILOGRAM FROM RECALL 2 ___
DON'T KNOW 99998

429. Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT A
NURSE OR MIDWIFE B
PATIENT ATTENDANT C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE OR FRIEND E
OTHER (SPECIFY) X
NO ONE ASSISTED Y

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
HOME
HER HOME 11 (GO TO 434)
OTHER HOME 12 (GO TO 434)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST/OUTREACH 23
OTHER PUBLIC SECTOR (SPECIFY) 26
CHAM/MISSION
HOSPITAL 31
HEALTH CENTER 32
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 41
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 46
BLM 51
OTHER (SPECIFY) 96 (GO TO 434)

431. How long after (NAME) was delivered did you stay there?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 434)

433. When was the decision made to have the caesarean section? Was it before or after yourlabor pains started?

BEFORE 1
AFTER 2

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

YES 1
NO 2
DON'T KNOW 8

434A. CHECK 430: PLACE OF DELIVERY

CODE 11, 12, OR 96 CIRCLED (GO TO 449)
OTHER (GO TO 435)

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

YES 1
NO 2 (GO TO 438)

436. How long after delivery did the first check place?

IF LESS THAN ONCE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

437. Who check on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT 11
NURSE OR MIDWIFE 12
PATIENT ATTENDANT 13
HSA 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

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

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

438. How long after delivery was (NAME)'s health first checked?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

440. Who check on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT 11
NURSE OR MIDWIFE 12
PATIENT ATTENDANT 13
HSA 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

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

YES 1
NO 2 (GO TO 445)

442. How long after delivery did that check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

443. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT 11
NURSE OR MIDWIFE 12
PATIENT ATTENDANT 13
HSA 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

444. Where did the check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST/OUTREACH 23
OTHER PUBLIC SECTOR (SPECIFY) 26
CHAM/MISSION
HOSPITAL 31
HEALTH CENTER 32
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 41
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 46
BLM 51
OTHER (SPECIFY) 96

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

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

446. How many hours, days or weeks after the birth of (NAME) did that check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

447. Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT 11
NURSE OR MIDWIFE 12
PATIENT ATTENDANT 13
HSA 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
HOME
HER HOME 11 (GO TO 457)
OTHER HOME 12 (GO TO 457)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21 (GO TO 457)
GOVERNMENT HEALTH CENTER 22 (GO TO 457)
GOVERNMENT HEALTH POST/OUTREACH 23 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) 26 (GO TO 457)
CHAM/MISSION
HOSPITAL 31 (GO TO 457)
HEALTH CENTER 32 (GO TO 457)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 41 (GO TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 46 (GO TO 457)
BLM 51 (GO TO 457)
OTHER (SPECIFY) 96 (GO TO 457)

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

YES 1
NO 2 (GO TO 453)

450. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

451. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT 11
NURSE OR MIDWIFE 12
PATIENT ATTENDANT 13
HSA 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

452. Where did this first check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST/OUTREACH 23
OTHER PUBLIC SECTOR (SPECIFY) 26
CHAM/MISSION
HOSPITAL 31
HEALTH CENTER 32
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 41
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 46
BLM 51
OTHER (SPECIFY) 96

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

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

454. How many hours, days or weeks after the birth of (NAME) did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998

455. Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR OR CLINICAL OFFICER OR MEDICAL ASSISTANT 11
NURSE OR MIDWIFE 12
PATIENT ATTENDANT 13
HSA 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

456. Where did this first check of (NAME) take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST/OUTREACH 23
OTHER PUBLIC SECTOR (SPECIFY) 26
CHAM/MISSION
HOSPITAL 31
HEALTH CENTER 32
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 41
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 46
BLM 51
OTHER (SPECIFY) 96

457. During the first two days after (NAME)'s birth, did any health care provider do the following:

a. Examine the cord?
YES 1
NO2
DON'T KNOW 8
b. Measure (NAME)'s temperature?
YES 1
NO2
DON'T KNOW 8
c. Counsel you on danger signs for newborns?
YES 1
NO2
DON'T KNOW 8
d. Counsel you on breastfeeding?
YES 1
NO2
DON'T KNOW 8
e. Observe (NAME) breastfeeding?
YES 1
NO2
DON'T KNOW 8

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

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

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

YES 1
NO 2 (GO TO 463)

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

MONTHS ___
DON'T KNOW 98

461. CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 462)
PREGNANT OR UNSURE (GO TO 463)

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

YES 1
NO 2 (GO TO 464)

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

MONTHS ___
DON'T KNOW 98

464. Did you ever breastfeed (NAME)?

YES 1 (GO TO 466)
NO 2

465. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 470)
DEAD (GO TO 471)

466. How long after birth did you first put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

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

YES 1
NO 2

468. CHECK 404: IS CHILD LIVING?

LIVING (GO TO 469)
DEAD (GO TO 471)

469. Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTH IN 2012-2015?

ONE OR MORE BIRTHS IN 2012-2015 (GO TO 502A)
NO BIRTHS IN 2012-2015 (GO TO 601)

502A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2012-2015.

NAME OF LAST BIRTH ___
BIRTH HISTORY NUMBER ___

503A. CHECK 216 FOR CHILD:

LIVING (GO TO 504A)
DEAD (GO TO 501B)

504A. Do you have a Health Passport or other document where (NAME)'s vaccinations are written down?

YES, HAS ONLY A HEALTH PASSPORT 1 (GO TO 507A)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS HEALTH PASSPORT AND OTHER DOCUMENT 3 (GO TO 507A)
NO, NO HEALTH PASSPORT AND NO OTHER DOCUMENT 4

505A. Did you ever have a Health Passport for (NAME)?

YES 1
NO 2

506A. CHECK 504A:

CODE '2' CIRCLED (GO TO 507A)
CODE '4' CIRCLED (GO TO 511A)

507A. May I see the Health Passport or other document where (NAME)'s vaccinations are written down?

YES, ONLY HEALTH PASSPORT SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, HEALTH PASSPORT AND OTHER DOCUMENT SEEN 3
NO HEALTH PASSPORT AND NO OTHER DOCUMENT SEEN 4 (GO TO 511A)

508A. COPY DATES FROM THE HEALTH PASSPORT OR FROM OTHER DOCUMENT. WRITE '44' IN 'DAY' COLUMN IF HEALTH PASSPORT OR OTHER DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE 1
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE 2
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE 3
DAY ___
MONTH ___
YEAR ___
DPT-HEPB-HIB (PENTAVALENT) 1
DAY ___
MONTH ___
YEAR ___
DPT-HEPB-HIB (PENTAVALENT) 2
DAY ___
MONTH ___
YEAR ___
DPT-HEPB-HIB (PENTAVALENT) 3
DAY ___
MONTH ___
YEAR ___
PCV/PNEUMOCOCCAL 1
DAY ___
MONTH ___
YEAR ___
PCV/PNEUMOCOCCAL 2
DAY ___
MONTH ___
YEAR ___
PCV/PNEUMOCOCCAL 3
DAY ___
MONTH ___
YEAR ___
ROTAVIRUS 1
DAY ___
MONTH ___
YEAR ___
ROTAVIRUS 2
DAY ___
MONTH ___
YEAR ___
MEASLES VACCINE 1
DAY ___
MONTH ___
YEAR ___
MEASLES VACCINE 2
DAY ___
MONTH ___
YEAR ___
VITAMIN A (MOST RECENT)
DAY ___
MONTH ___
YEAR ___

509A. CHECK 508A: 'BCG' TO 'MEASLES VACCINE 2' ALL RECORDED?

NO (GO TO 510A)
YES (GO TO 525A)

510A. In addition to what is recorded on (this document or these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A) (GO TO 525A)
NO 2 (GO TO 525A)
DON'T KNOW 8 (GO TO 525A)

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

FIRST TWO WEEKS 1
LATER 2

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

NUMBER OF TIMES ___

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

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

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

NUMBER OF TIMES ___

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

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

520A. How many times did (NAME) receive the pneumococcal vaccine (PCV)?

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 523A)
DON'T NOW 8 (GO TO 523A)

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

NUMBER OF TIMES ___

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

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

524A. How many times did (NAME) receive the measles vaccine?

NUMBER OF TIMES ___

525A. In the last 7 days was (NAME) given:

a. Multiple micronutrient powder?
YES 1
NO 2
DON'T KNOW 8
b. Ready to use therapeutic food such as chiponde?
YES 1
NO 2
DON'T KNOW 8
c. Supplementary food such as likuni phala?
YES 1
NO 2
DON'T KNOW 8

526A. CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B. CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2012-2015?

MORE BIRTHS IN 2012-2015 (GO TO 502B)
NO MORE BIRTHS IN 2012-2015 (GO TO 601)

502B. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2012-2015.

NAME OF NEXT-TO-LAST BIRTH ___
BIRTH HISTORY NUMBER ___

503B. CHECK 216 FOR CHILD:

LIVING (GO TO 504B)
DEAD (GO TO 526B)

504B. Do you have a Health Passport or other document where (NAME)'s vaccinations are written down?

YES, HAS ONLY A HEALTH PASSPORT 1 (GO TO 507B)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS HEALTH PASSPORT AND OTHER DOCUMENT 3 (GO TO 507B)
NO, NO HEALTH PASSPORT AND NO OTHER DOCUMENT 4

505B. Did you ever have a Health Passport for (NAME)?

YES 1
NO 2

506B. CHECK 504B:

CODE '2' CIRCLED (GO TO 507B)
CODE '4' CIRCLED (GO TO 511B)

507B. May I see the Health Passport or other document where (NAME)'s vaccinations are written down?

YES, ONLY HEALTH PASSPORT SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, HEALTH PASSPORT AND OTHER DOCUMENT SEEN 3
NO HEALTH PASSPORT AND NO OTHER DOCUMENT SEEN 4 (GO TO 511B)

508B. COPY DATES FROM THE HEALTH PASSPORT OR FROM OTHER DOCUMENT. WRITE '44' IN 'DAY' COLUMN IF HEALTH PASSPORT OR OTHER DOCUMENT SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE 1
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE 2
DAY ___
MONTH ___
YEAR ___
ORAL POLIO VACCINE 3
DAY ___
MONTH ___
YEAR ___
DPT-HEPB-HIB (PENTAVALENT) 1
DAY ___
MONTH ___
YEAR ___
DPT-HEPB-HIB (PENTAVALENT) 2
DAY ___
MONTH ___
YEAR ___
DPT-HEPB-HIB (PENTAVALENT) 3
DAY ___
MONTH ___
YEAR ___
PCV/PNEUMOCOCCAL 1
DAY ___
MONTH ___
YEAR ___
PCV/PNEUMOCOCCAL 2
DAY ___
MONTH ___
YEAR ___
PCV/PNEUMOCOCCAL 3
DAY ___
MONTH ___
YEAR ___
ROTAVIRUS 1
DAY ___
MONTH ___
YEAR ___
ROTAVIRUS 2
DAY ___
MONTH ___
YEAR ___
MEASLES VACCINE 1
DAY ___
MONTH ___
YEAR ___
MEASLES VACCINE 2
DAY ___
MONTH ___
YEAR ___
VITAMIN A (MOST RECENT)
DAY ___
MONTH ___
YEAR ___

509B. CHECK 508B: 'BCG' TO 'MEASLES VACCINE 2' ALL RECORDED?

NO (GO TO 510B)
YES (GO TO 525B)

510B. In addition to what is recorded on (this document or these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508B) (GO TO 525B)
NO 2 (GO TO 525B)
DON'T KNOW 8 (GO TO 525B)

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

YES 1
NO 2 (GO TO 525B)
DON'T KNOW 8 (GO TO 525B)

512B. Has (NAME) ever received 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

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

YES 1
NO 2 (GO TO 517B)
DON'T KNOW 8 (GO TO 517B)

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

FIRST TWO WEEKS 1
LATER 2

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

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 519B)
DON'T KNOW 8 (GO TO 519B)

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

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 521B)
DON'T KNOW 8 (GO TO 521B)

520B. How many times did (NAME) receive the pneumococcal vaccine (PCV)?

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 523B)
DON'T NOW 8 (GO TO 523B)

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

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 525B)
DON'T KNOW 8 (GO TO 525B)

524B. How many times did (NAME) receive the measles vaccine?

NUMBER OF TIMES ___

525B. In the last 7 days was (NAME) given:

a. Multiple micronutrient powder?
YES 1
NO 2
DON'T KNOW 8
b. Ready to use therapeutic food such as chiponde?
YES 1
NO 2
DON'T KNOW 8
c. Supplementary food such as likuni phala?
YES 1
NO 2
DON'T KNOW 8

526B. CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2012-2015?

MORE BIRTHS IN 2012-2015 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2012-2015 (GO TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601. CHECK 224:

ONE OR MORE BIRTHS IN 2010-2015 (GO TO 602)
NO BIRTHS IN 2010-2015 (GO TO 648)

602. CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2010-2015. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER ___

604. FROM 212 AND 216:

NAME ___
LIVING (GO TO 605)
DEAD (GO TO 646)

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

SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

606. In the last seven days, was (NAME) given iron pills, sprinkles with iron, or irons syrup like (this/any of these)?

SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

609. CHECK 464: EVER BREASTFED?

YES: Now I would like to know how much (NAME) was given to drink during the diarrhea including breast milk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

NO: Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?

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

610. When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same about, more than usual, or nothing to eat?

IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

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

611. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 615)

611A. How many days after the illness began did you first seek advice or treatment for (NAME)?

IF THE SAME DAY RECORD '00'.

DAYS ___

612. Where did you seek treatment? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HSA E
OTHER PUBLIC SECTOR (SPECIFY) F
CHAM/MISSION
HOSPITAL G
HEALTH CENTER H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC I
PHARMACY J
PRIVATE DOCTOR K
MOBILE CLINIC L
HSA M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
BLM O
MACRO P
YOUTH DROP CENTER Q
OTHER SOURCE
SHOP R
TRADITIONAL PRACTITIONER S
MARKET T
OTHER (SPECIFY) X

613. CHECK 612:

TWO OR MORE CODES CIRCLED (GO TO 614)
ONLY ONE CODE CIRCLED (GO TO 615)

614. Where did you first seek advice or treatment?

USE LETTER CODE FROM 612.

FIRST PLACE ____

615. Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:

a. A fluid made from a special packet called THANZI-ORS?
YES 1
NO 2
DON'T KNOW 8
b. A homemade fluid such as THOBWA?
YES 1
NO 2
DON'T KNOW 8
c. Zinc tablets or syrup?
YES 1
NO 2
DON'T KNOW 8

616. CHECK 615:

ANY 'YES': Was anything else given to treat the diarrhea?

ALL 'NO' OR 'DK': Was anything given to treat the diarrhea?

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

617. CHECK 615:

ANY 'YES': What else was given to treat the diarrhea? Anything else?

ALL 'NO' OR 'DK': What was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

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

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

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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

623. CHECK 618: HAD FEVER?

YES (GO TO 624)
NO OR DON'T KNOW (GO TO 646)

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

YES 1
NO 2 (GO TO 629)

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE(S) ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HSA E
OTHER PUBLIC SECTOR (SPECIFY) F
CHAM/MISSION
HOSPITAL G
HEALTH CENTER H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC I
PHARMACY J
PRIVATE DOCTOR K
MOBILE CLINIC L
HSA M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
BLM O
MACRO P
YOUTH DROP CENTER Q
OTHER SOURCE
SHOP R
TRADITIONAL PRACTITIONER S
MARKET T
ITINERANT DRUG SELLER U
OTHER (SPECIFY) X

626. CHECK 625:

TWO OR MORE CODES CIRCLED (GO TO 627)
ONLY ON CODE CIRCLED (GO TO 628)

627. Where did you first seek advice or treatment?

USE LETTER CODE FROM 625.

FIRST PLACE ___

628. How many days after the illness began did you first seek advice or treatment for (NAME)?

IF THE SAME DAY RECORD '00'.

DAYS ___

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

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

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

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
LA A
ASAQ (COMBINED AMODIAQUINE AND ARTESUNATE) B
SP/FANSIDAR/NOVIDAR SP C
QUININE TABLETS D
INJECTION/IV E
ARTESUNATE RECTAL F
INJECTION/IV G
OTHER ANTIMALARIAL (SPECIFY) H
ANTIBIOTIC DRUGS
PILL OR SYRUP I
INJECTION/IV J
OTHER DRUGS
ASPIRIN/CAFENOL K
ACETAMINOPHEN/PANADOL/PARACETAMOL L
IBUPROFEN M
OTHER (SPECIFY) X
DON'T KNOW Z

631. CHECK 630:

ANY CODE A-H CIRCLED?

YES (GO TO 632)
NO (GO TO 626)

632. CHECK 630: LA ('A') GIVEN

CODE 'A' CIRCLED (GO TO 633)
CODE 'A' NOT CIRCLED (GO TO 634)

633. How long after the fever started did (NAME) first take LA?

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

634. CHECK 630:

ASQA (COMBINED AMODIAQUINE AND ARTESUATE) ('B') GIVEN

CODE 'B' CIRCLED (GO TO 635)
CODE 'B' NOT CIRCLED (GO TO 636)

635. How long after the fever started did (NAME) first take ASAQ?

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

636. CHECK 630:

SP/FANSIDAR/NOVIDAR SP ('C') GIVEN

CODE 'C' CIRCLED (GO TO 637)
CODE 'C' NOT CIRCLED (GO TO 640)

637. How long after the fever started did (NAME) first take SP/fansidar/novidar SP?

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

640. CHECK 630:

QUININE ('D' OR 'E') GIVEN

CODE 'D' OR 'E' CIRCLED (GO TO 641)
CODE 'D' OR 'E' NOT CIRCLED (GO TO 642)

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

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

642. CHECK 630:

ARTESUNATE ('F' OR 'G') GIVEN

CODE 'F' OR 'G' CIRCLED (GO TO 643)
CODE 'F' OR 'G' NOT CIRCLED (GO TO 644)

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

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

644. CHECK 630:

OTHER ANTIMALARIAL ('H') GIVEN

CODE 'H' CIRCLED (GO TO 645)
CODE 'H' NOT CIRCLED (GO TO 646)

645. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

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

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

647. CHECK 615(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 648)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 649)

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

YES 1
NO 2

649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2013-2015 LIVING WITH THE RESPONDENT

ONE OR MORE: NAME OF YOUNGEST CHILD LIVING WITH HER ___ (GO TO 650)
NONE (GO TO 701)

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

a. Plain water?
YES 1
NO 2
DON'T KNOW 8
b. Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c. Soft drinks?
YES 1
NO 2
DON'T KNOW 8
d. Clear broth?
YES 1
NO 2
DON'T KNOW 8
e. Milk such as tinned, powdered, or fresh animal milk?

IF YES: How many times did (NAME) drink milk?

IF 7 OR MORE TIMES, RECORD '7'.

YES 1
NO 2
DON'T KNOW 8

NUMBER OF TIMES DRANK ___
f. Infant formula (S26, Naan, Lactogene, Infantcare)?

IF YES: How many times did (NAME) drink infant formula?

IF 7 OR MORE TIME, RECORD '7'.

YES 1
NO 2
DON'T KNOW 8

NUMBER OF TIMES DRANK ___
g. Any other liquids?
YES 1
NO 2
DON'T KNOW 8
h. Yogurt?

IF YES: How many times did (NAME) eat yogurt?

IF 7 OR MORE TIMES, RECORD '7'.

YES 1
NO 2
DON'T KNOW 8

NUMBER OF TIMES ATE ___
i. Any fortified cereals (Cerelac, Likuni Phala, Nestum, Purity, Sibusiso, Gluco Phala)?
YES 1
NO 2
DON'T KNOW 8
j. Bread, rice, noodles, porridge, maize meal (ngaiwa), maize flour (ufawayera), millet, sorghum, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
k. Pumpkin, carrots, squash, or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
l. Cocoyam, Irish potatoes, white sweet potatoes, white yams, cassava, or any other foods made from roots or tubers?
YES 1
NO 2
DON'T KNOW 8
m. Any dark green, leafy vegetables such as amaranth, pumpkin leaves, Chinese cabbage, greens, kale, cassava leaves, beans, cow peas or sweet potato leaves that are fresh?
YES 1
NO 2
DON'T KNOW 8
n. Ripe mangoes, papayas, or guava?
YES 1
NO 2
DON'T KNOW 8
o. Any other fruits or vegetables (bananas, apples, green beans, avocados, tomatoes, okra)?
YES 1
NO 2
DON'T KNOW 8
p. Liver, kidney, heart, or other organ meats?
YES 1
NO 2
DON'T KNOW 8
r. Grubs, snails or insects?
YES 1
NO 2
DON'T KNOW 8
s. Eggs?
YES 1
NO 2
DON'T KNOW 8
t. Fresh or dried fish or shellfish, crabs or seafood?
YES 1
NO 2
DON'T KNOW 8
u. Any foods made from beans, pigeon peas, cow peas, lentils, nuts, soybeans or ground nut powder (nsinjiro)?
YES 1
NO 2
DON'T KNOW 8
v. Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
w. Any oil, fats, or butter, or foods made with any of these?
YES 1
NO 2
DON'T KNOW 8
x. Any sugary foods such as chocolates, sweets, cadies, sugar cane, honey, patries, cakes or biscuits?
YES 1
NO 2
DON'T KNOW 8
y. Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

651. CHECK 650 (CATEGORIES 'H' THROUGH 'Y'):

NOT A SINGLE 'YES' (GO TO 652)
AT LEAST ONE 'YES' (GO TO 653)

652. Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night?

IF 'YES' PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat?

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY) (GO TO 653)
NO 2 (GO TO 654)

653. How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

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

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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

WIDOWED 1 (GO TO 709)
DIVORCED 2 (GO TO 709)
SEPARATED 3 (GO TO 709)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME ___
LINE NUMBER ___

706. Does your (husband/partner) have other wives or does he live with other women as if married?

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

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

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

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

RANK ___

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

ONLY ONCE 1
MORE THAN ONCE 2

710. CHECK 709:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask 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 712)
DON'T KNOW YEAR 9998

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

AGE ___

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

713. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?

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

714. I would like to ask you about recent sexual activity. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

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

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

DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___

716. The last time you had sexual intercourse with this person, was a male or female used?

YES 1
NO 2 (GO TO 718)

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

YES 1
NO 2

718. What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married?

IF YES, RECORD '2'.

IF NO, RECORD '3'.

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

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

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

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

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

NUMBER OF TIMES ___

721. How old is this person?

AGE OF PARTNER ___
DON'T KNOW 98

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

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

723. In total, with how many different people have you had sexual intercourse in the last 12 months?

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

NUMBER OF PARTNERS LAST 12 MONTHS ___
DON'T KNOW 98

724. CHECK 106:

AGE 15-24 (GO TO 725)
AGE 25-49 (GO TO 727)

725. CHECK 701:

NOT IN A UNION (GO TO 726)
CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 727)

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

YES 1
NO 2

727. In total, with how many different people have you had sexual intercourse in your lifetime?

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

NUMBER OF PARTNERS IN LIFETIME ___
DON'T KNOW 98

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

YES, CONDOM USED (GO TO 729)
NO CONDOM NOT USED (GO TO 731)
NOT ASKED (GO TO 731)

729. You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?

IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

CHISHANGO 01
MANYUCHI 02
SILVERTOUCH 03
CARE (FEMALE CONDOMS) 04
PUBLIC SECTOR CONDOMS 05
OTHER (SPECIFY) 96
DON'T KNOW 98

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

PROBE TO IDENTIFY TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST/OUTREACH 13
MOBILE CLINIC 14
HSA 15
CBDA/DOOR TO DOOR 16
OTHER PUBLIC SECTOR (SPECIFY) 17
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
CBDA/DOOR TO DOOR 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL OR CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
CBDA/DOOR TO DOOR 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
BLM 41
MACRO 51
YOUTH DROP IN CENTRE 61
OTHER SOURCE
SHOP 71
CHURCH 72
FRIEND OR RELATIVE 73
CONDOMISED CAMPAIGNS 74
OTHER (SPECIFY) 96
DON'T KNOW 98

731. PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN UNDER 10?
YES 1
NO 2
MALE ADULTS?
YES 1
NO 2
FEMALE ADULTS?
YES 1
NO 2

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

NEITHER STERILIZED (GO TO 802)
HE OR SHE STERILIZED (GO TO 813)

802. CHECK 226:

PREGNANT (GO TO 803)
NOT PREGNANT OR UNSURE (GO TO 804)

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

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

804. 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 813)
UNDECIDED/DON'T KNOW 8 (GO TO 811)

805. 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 OR NOW 993 (GO TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
AFTER MARRIAGE 995 (GO TO 811)
OTHER (SPECIFY) 996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)

806. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 807)
PREGNANT (GO TO 812)

807. CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 808)
CURRENTLY USING (GO TO 813)

808. CHECK 805:

'24' OR MORE MONTHS OR '02' YEARS (GO TO 809)
NOT ASKED (GO TO 809)
'00-23' MONTHS OR '00-01' YEAR (GO TO 812)

809. CHECK 714:

DAYS, WEEKS OR MONTHS AGO (GO TO 810)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)

CHECK 804:

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

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

RECORD ALL REASONS MENTIONED.

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

811. CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 812)
NO, NOT CURRENTLY USING (GO TO 812)
YES, CURRENTLY USING (GO TO 813)

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

YES 1
NO 2
DON'T KNOW 8

813. CHECK 216:

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

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

NONE 00 (GO TO 815)
NUMBER ___
OTHER (SPECIFY) 96 (GO TO 815)

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

NUMBER OF BOYS ___
NUMBER OF GIRLS ___
NUMBER OF EITHER ___
OTHER (SPECIFY) 96

815. In the last few months have you:

a. Heard about family planning on the radio?
YES 1
NO 2
b. Seen anything about family planning on the television?
YES 1
NO 2
c. Read about family planning in a newspaper or magazine?
YES 1
NO 2
d. Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2
e. Read about family planning on the internet/website?
YES 1
NO 2
f. Read about family planning on a poster?
YES 1
NO 2
g. Read about family planning on clothing (i.e. cap. chitenji, t-shirt)?
YES 1
NO 2
h. Heard about family planning in a drama?
YES 1
NO 2

817. CHECK 701:

YES, CURRENTLY MARRIED (GO TO 818)
YES, LIVING WITH A MAN (GO TO 818)
NO, NOT IN UNION (GO TO 901)

818. CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 819)
NOT CURRENTLY USING (GO TO 820)
NOT ASKED (GO TO 822)

819. Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

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

820. Would you say that not using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

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

821. CHECK 304:

NEITHER OR STERILIZED (GO TO 822)
HE OR SHE ARE STERILIZED (GO TO 901)

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

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

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

901. CHECK 701:

CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 902)
NOT IN UNION (GO TO 909)

902. How old was your (husband/partner) on his last birthday?

AGE IN COMPLETED YEARS ___

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

YES 1
NO 2 (GO TO 906)

904. 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 906)

905. What was the highest (FORM/YEAR) he completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/FORM/YEAR ___
DON'T KNOW 98

906. Has your (husband/partner) done any work in the last 7 days?

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

907. Has your (husband/partner) done any work in the last 12 months?

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

908. What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

___

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

YES 1 (GO TO 913)
NO 2

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

YES 1 (GO TO 913)
NO 2

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

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2 (GO TO 917)

913. What is your occupation? That is, what kind of work do you mainly do?

___

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

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

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

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

916. Are you paid 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
NOT PAID 4

917. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 918)
NOT IN UNION (GO TO 925)

918. CHECK 916:

CODE '1' OR '2' CIRCLED (GO TO 919)
OTHER (GO TO 921)

919. Who usually decides how the money you earn will be used: you, your (husband/partner), or do you and your (husband/partner) jointly?

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

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

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

921. Who usually decides how your (husband's/partner's) earnings will be used: you, your (husband/partner), or do you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) 6

923. Who usually makes decisions about making major household purchases: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) 6

924. Who usually makes decisions about visits to your family or relatives: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) 6

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

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

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

YES 1
NO 2 (GO TO 928)
DON'T KNOW 8 (GO TO 928)

927. Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

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

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

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

930. Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN UNDER 10
PRESENT LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

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

a. If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
b. If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c. If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d. If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e. If she does not properly cook the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 10. HIV/AIDS

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

YES 1
NO 2 (GO TO 1042)

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

YES 1
NO 2
DON'T KNOW 8

1003. Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1004A. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1008. Can HIV be transmitted from a mother to her baby:

a. During pregnancy?
YES 1
NO 2
DON'T KNOW 8
b. During delivery?
YES 1
NO 2
DON'T KNOW 8
c. By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

1009. CHECK 1008:

AT LEAST ONE 'YES' (GO TO 1010)
OTHER (GO TO 1011)

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

YES 1
NO 2
DON'T KNOW 8

1011. CHECK 208 AND 215:

LAST BIRTH IN 2013-2015 (GO TO 1012)
LAST BIRTH IN 2012 OR EARLIER (GO TO 1027)
NO BIRTHS (GO TO 1027)

1012. CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 1013)
NO ANTENATAL CARE (GO TO 1020)

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

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

a. Babies getting HIV from their mother?
YES 1
NO 2
DON'T KNOW 8
b. Things that you can do to prevent getting HIV?
YES 1
NO 2
DON'T KNOW 8
c. Getting tested for HIV?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 1019A)

1017. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST/OUTREACH 13
HSA 14
CBDA/DOOR TO DOOR 15
OTHER PUBLIC SECTOR (SPECIFY) 16
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
CBDA/DOOR TO DOOR 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
LIGHT HOUSE 32
DREAM CENTRE 33
PHARMACY 34
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36
BLM 41
MACRO 51
OTHER SOURCE
HOME 61
WORKPLACE 62
CORRECTIONAL FACILITY 63
OTHER (SPECIFY) 96

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

YES 1
NO 2 (GO TO 1019A)

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

YES 1
NO 2
DON'T KNOW 8

1019A. During any of the antenatal visits for you last birth, was the baby's father offered a test for HIV by your health provider?

YES 1
NO 2 (GO TO 1020)

1019B. I don't want to know the results, but was he tested for HIV at that time?

YES 1
NO 2
DON'T KNOW 8

1020. CHECK 430 FOR LAST BIRTH:

ANY CODE '21-51' CIRCLED (GO TO 1021)
OTHER (GO TO 1024)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 1024)

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

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

1024. CHECK 1016:

YES (GO TO 1025)
NO OR NOT ASKED (GO TO 1027)

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

YES 1 (GO TO 1028)
NO 2

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

MONTHS AGO ___ (GO TO 1033)
TWO OR MORE YEARS 95 (GO TO 1033)

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

YES 1
NO 2 (GO TO 1031)

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

MONTHS AGO ___
TWO OR MORE YEARS 95

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

YES 1
NO 2

1029A. 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 by the health provider?

TEST REQUESTED BY THE RESPONDENT 1
TEST OFFERED BY THE HEALTH PROVIDER 2
TEST REQUIRED BY THE HEALTH PROVIDER 3

1030. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 1033)
GOVERNMENT HEALTH CENTER 12 (GO TO 1033)
GOVERNMENT HEALTH POST/OUTREACH 13 (GO TO 1033)
HSA 14 (GO TO 1033)
CBDA/DOOR TO DOOR 15 (GO TO 1033)
OTHER PUBLIC SECTOR (SPECIFY) 16 (GO TO 1033)
CHAM/MISSION
HOSPITAL 21 (GO TO 1033)
HEALTH CENTER 22 (GO TO 1033)
MOBILE CLINIC 23 (GO TO 1033)
CBDA/DOOR TO DOOR 24 (GO TO 1033)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31 (GO TO 1033)
PHARMACY 32 (GO TO 1033)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 36 (GO TO 1033)
BLM 41 (GO TO 1033)
MACRO 51 (GO TO 1033)
OTHER SOURCE
HOME 61 (GO TO 1033)
WORKPLACE 62 (GO TO 1033)
CORRECTIONAL FACILITY 63 (GO TO 1033)
OTHER (SPECIFY) 96 (GO TO 1033)

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

YES 1
NO 2 (GO TO 1033)

1032. Where is that? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
HSA D
DOOR TO DOOR E
OTHER PUBLIC SECTOR (SPECIFY) F
CHAM/MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
DOOR TO DOOR J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
PHARMACY L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
BLM N
MACRO O
OTHER SOURCE
HOME P
WORKPLACE Q
CORRECTIONAL FACILITY R
OTHER (SPECIFY) X

1033. Have you heard of test kits people can use to test themselves for HIV?

YES 1
NO 2 (GO TO 1035)

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

YES 1
NO 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1042. CHECK 1001:

HEARD ABOUT HIV OR AIDS: Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?

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

YES 1
NO 2

1043. CHECK 713:

HAS HAD SEXUAL INTERCOURSE (GO TO 1044)
NEVER HAD SEXUAL INTERCOURSE (GO TO 1051)

1044. CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 1045)
NO (GO TO 1046)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1048. CHECK 1045, 1046, AND 1047:

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

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

YES 1
NO 2 (GO TO 1051)

1050. Where did you go? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
HSA D
DOOR TO DOOR E
OTHER PUBLIC SECTOR (SPECIFY) F
CHAM/MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
DOOR TO DOOR J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
PHARMACY L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
BLM N
MACRO O
OTHER SOURCE
HOME P
WORKPLACE Q
CORRECTIONAL FACILITY R
OTHER (SPECIFY) X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1053. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1054)
NOT IN UNION (GO TO 1101)

1054. Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/NOT SURE 8

1055. Could you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 11. OTHER HEALTH ISSUES

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

IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 1104)

1102. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 1104)

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

YES 1
NO 2
DON'T KNOW 8

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

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

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

NUMBER OF CIGARETTES ___

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

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

1107. What other type of tobaccos do you currently smoke or use?

RECORD ALL MENTIONED.

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

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

a. Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b. Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c. The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d. Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
e. Concern that there may not be a female health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
f. Concern that there may not be any health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
g. Concern that there may be no drugs available?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1109. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1111)

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

RECORD ALL MENTIONED.

HEALTH INSURANCE THROUGH EMPLOYER A
PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE B
OTHER (SPECIFY) X

1111. Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery. Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

YES 1 (GO TO 1114)
NO 2

1112. Have you ever heard of this problem?

YES 1
NO 2

1113. Do you know any woman who currently has or who has ever experienced this problem?

YES 1 (GO TO 1123)
NO 2 (GO TO 1123)

1114. Did this problem start after you delivered a baby or had a stillbirth?

AFTER DELIVERED BABY 1
AFTER HAD STILLBIRTH 2
NEITHER 3 (GO TO 1116)

1115. Did this problem start after a normal labor and delivery, or after a very difficult labor and delivery, or after a very difficult labor and pelvic surgery?

NORMAL LABOR/DELIVERY 1 (GO TO 1117)
VERY DIFFICULT LABOR/DELIVERY 2 (GO TO 1117)
PELVIC SURGERY 3 (GO TO 1117)

1116. What do you think caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER (SPECIFY) 6
DON'T KNOW 8 (GO TO 1118)

1117. How many days after (CAUSE OF PROBLEM FROM 1114 OR 1116) did the leakage start?

ENTER '90' IF 90 DAYS OR MORE.

NUMBER OF DAYS AFTER DELIVERY OR OTHER EVENT ___

1118. Have you sought treatment for this condition?

YES 1 (GO TO 1120)
NO 2

1119. Why have you not sought treatment?

PROBE AND RECORD ALL MENTIONED.

DO NOT KNOW CAN BE FIXED A (GO TO 1123)
DO NOT KNOW WHERE TO GO B (GO TO 1123)
TOO EXPENSIVE C (GO TO 1123)
TOO FAR D (GO TO 1123)
POOR QUALITY OF CARE E (GO TO 1123)
COULD NOT GET PERMISSION F (GO TO 1123)
EMBARRASSMENT OR STIGMA G (GO TO 1123)
PROBLEM DISAPPEARED H (GO TO 1123)
OTHER (SPECIFY) X (GO TO 1123)

1120. From whom did you last seek treatment?

HEALTH PROFESSIONAL
DOCTOR OR CLINICAL OFFICER 1
NURSE OR MIDWIFE 2
PATIENT ATTENDANT 4
OTHER PERSON
TRADITIONAL PRACTITIONER 5
OTHER (SPECIFY) 6

1121. Did you have an operation to fix the problem?

YES 1
NO 2

1122. Did the treatment stop the leakage completely?

IF NO: Did the treatment reduce the leakage?

YES, STOPPED COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3

1123. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1201)

1124. How does tuberculosis spread from one person to another?

PROBE: Any other ways?

RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) X
DON'T KNOW Z

1125. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1126. If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

SECTION 12. MATERNAL MORTALITY MODULE

1201. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to you natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did you mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER ___

1202. CHECK 1201:

TWO OR MORE BIRTH (GO TO 1203)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1300)

1203. How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ___

1204. What was the name given to your (oldest/next oldest) brother or sister?

____

1205. Is (NAME) male or female?

MALE 1
FEMALE 2

1206. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1208)
DON'T KNOW 8 (GO TO NEXT BIRTH)

1207. How old is (NAME)?

___ (GO TO NEXT BIRTH)

1208. How many years ago did (NAME) die?

___

1209. How old was (NAME) when (he or she) died?

IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

____ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO 1214)

1210. Was (NAME) pregnant when she died?

YES 1 (GO TO 1214)
NO 2

1211. Did (NAME) die during childbirth?

YES 1 (GO TO 1214)
NO 2

1212. Did (NAME) died within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO 1214)

1213. How many days after the end of the pregnancy did (NAME) die?

___

1214. Was (NAME)'s death due to an act of violence?

YES 1 (GO TO NEXT BIRTH)
NO 2

1215. Was (NAME)'s death due to an accident?

YES 1
NO 2

IF NO MORE BROTHERS OR SISTERS, GO TO 1300.

SECTION 13. DOMESTIC VIOLENCE MODULE

1300. CHECK FRONT COVER

WOMAN SELECTED FOR THIS SECTION (GO TO 1301)
WOMAN NOT SELECTED (GO TO 1333)

1301. CHECK FOR PRESENCE OF OTHER:

DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO 1301A)
PRIVACY NOT POSSIBLE 2 (GO TO 1332)

1301A. READ TO THE RESPONDENT:

Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Malawi. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go onto the next question.

1302. CHECK 701 AND 702:

CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 1303)
FORMERLY MARRIED OR LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND/PARTNER') (GO TO 1303)
NEVER MARRIED OR NEVER LIVED WITH A MAN (GO TO 1316)

1303. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner)?

a. He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
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/tied) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e. He (insist/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

1304A. Now I need to ask some more questions about your relationship with your (last) (husband/partner):

Did your (last) (husband/partner) ever:

a. Say or do something to humiliate you in front of others?
YES 1 (GO TO1304 B)
NO 2 (GO TO b)
b. Threaten to hurt or harm you or someone you care about?
YES 1 (GO TO 1304B)
NO 2 (GO TO c)
c. Insult you or make you feel bad about yourself?
YES 1 (GO TO 1304B)
NO 2 (GO TO 1305)

1304B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a. Say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b. Threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c. Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1305A. Did your (last) (husband/partner) ever do any of the following things to you:

a. Push you, shake you, or throw something at you?
YES 1 (GO TO 1305B)
NO 2 (GO TO b)
b. Slap you?
YES 1 (GO TO 1305B)
NO 2 (GO TO c)
c. Twist your arm or pull your hair?
YES 1(GO TO 1305B)
NO 2 (GO TO d)
d. Punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1305B)
NO 2 (GO TO e)
e. Kick you, drag you, or beat you up?
YES 1 (GO TO 1305B)
NO 2 (GO TO f)
f. Try to choke you or burn you on purpose?
YES 1 (GO TO 1305B)
NO 2 (GO TO g)
g. Threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO 1305B)
NO 2 (GO TO h)
h. Physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO i)
i. Physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO j)
j. Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO 1305B)
NO 2 (GO TO 1306)

1305B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a. Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
b. Slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
c. Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
d. Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
e. Kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
f. Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
g. Threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
h. Physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
i. Physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS
j. Force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS

1306. CHECK 1305A (a-j):

AT LEAST ONE 'YES' (GO TO 1307)
NOT A SINGLE 'YES' (GO TO 1309)

1307. How long after you first (got married/started living together) 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

1308. Did the following ever happen as a result of what your (last) (husband/partner) did to you:

a. You had cuts, bruises, or aches?
YES 1
NO 2
b. You had eye injuries, sprains, dislocations or burns?
YES 1
NO 2
c. You had deep wounds, broken bones, broken teeth or any other serious injury?
YES 1
NO 2

1309. 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 1311)

1310. In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1311. Does (did) your (last) (husband/partner) drink alcohol?

YES 1
NO 2 (GO TO 1313)

1312. How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1313. Are (were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1314. CHECK 709:

MARRIED MORE THAN ONCE (GO TO 1315)
MARRIED ONLY ONCE (GO TO 1316)

1315A. So far we have been talking the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner)>

a. Did any previous (husband/partner) ever hit, slap, kick, or di anything else to hurt you physically?
YES 1 (GO TO 1315B)
NO 2 (GO TO b)
b. Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (GO TO 1315B)
NO 2 (GO TO 1316)

1315B. How long ago did this last happen?

a. Did any previous (husband/partner) ever hit, slap, kick, or di anything else to hurt you physically?
0-11 MONTHS AGO
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3
b. Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
0-11 MONTHS AGO
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 3

1316. CHECK 701 AND 702:

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

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

YES 1
NO 2 (GO TO 1319)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1319)

1317. Who has hurt you in this way? Anyone else?

RECORD ALL MENTIONED.

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

1318. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1319. CHECK 201, 226, AND 230):

EVER BEEN PREGNANT ('YES' ON 201 OR 226 OR 230) (GO TO 1320)
NEVER BEEN PREGNANT (GO TO 1322)

1320. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1322)

1321. 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
STEP-MOTHER C
FATHER D
STEP-FATHER E
SISTER/BROTHER F
DAUGHTER/SON G
OTHER RELATIVE H
FORMER HUSBAND/PARTNER I
CURRENT BOYFRIEND J
FORMER BOYFRIEND K
MOTHER-IN-LAW L
FATHER-IN-LAW M
OTHER IN-LAW N
TEACHER O
EMPLOYER/SOMEONE AT WORK P
POLICE/SOLDIER Q
OTHER (SPECIFY) X

1322. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (GO TO 1322A)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1322B)

1322A. Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1 (GO TO 1323)
NO 2 (GO TO 1324A)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1324A)

1322B. At any time in your life, as a child or as an adult, has anyone ever forced you in anyway to have sexual intercourse or perform any other sexual acts when you did not want to?

YES 1
NO 2 (GOT O 1326)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1326)

1323. Who was the person who was forcing you the very first time this happened?

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP-FATHER 05
BROTHER 06
STEP-BROTHER 07
OTHER RELATIVE 08
IN-LAW 09
OWN FRIEND/ACQUAINTANCE 10
FAMILY FRIEND 11
TEACHER 12
EMPLOYER/SOMEONE AT WORK 13
POLICE/SOLDIER 14
PRIEST/RELIGIOUS LEADER 15
STRANGER 16
OTHER (SPECIFY) 96

1324. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN: In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?

NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

YES 1 (GO TO 1325)
NO 2 (GO TO 1325)

1324A. CHECK 1305 (h-j) AND 1315A (b):

AT LEAST ONE 'YES' (GO TO 1325)
NOT A SINGLE 'YES' (GO TO 1326)

1325. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?

NEVER MARRIED/NEVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS ___
DON'T KNOW 98

1326. CHECK 1305A (a-j), 1315A (a, b), 1316, 1320, 1322A, AND 1322B:

AT LEAST ONE 'YES' (GO TO 1327)
NOT A SINGLE 'YES' (GO TO 1330)

1327. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1329)

1328. From whom have you sought help? Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1330)
HUSBAND'S/PARTNER'S FAMILY B (GO TO 1330)
CURRENT/FORMER HUSBAND/PARTNER C (GO TO 1330)
CURRENT/FORMER BOYFRIEND D (GO TO 1330)
FRIEND E (GO TO 1330)
NEIGHBOR F (GO TO 1330)
RELIGIOUS LEADER G (GO TO 1330)
DOCTOR OR MEDICAL PERSONNEL H (GO TO 1330)
POLICE I (GO TO 1330)
LAWYER J (GO TO 1330)
SOCIAL SERVICE ORGANIZATION K (GO TO 1330)
DISTRICT SOCIAL WELFARE OFFICER L (GO TO 1330)
TRADITIONAL AUTHORITY/CHIEF M (GO TO 1330)
EMPLOYER/SOMEONE AT WORK N (GO TO 1330)
OTHER (SPECIFY) X (GO TO 1330)

1329. Have you ever told anyone about this?

YES 1
NO 2

1330. 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.

1331. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAM 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

1332. INTERVIEWERS COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

___

1333. RECORD THE TIME.

HOURS ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS:

EDITOR'S OBSERVATIONS:

CALENDAR

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTHS.

CODES FOR EACH COLUMN:

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE
B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD

1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
J STANDARD DAYS METHOD
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD
COLUMN 2: 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 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY)
Z DON'T KNOW
2016
04 APR 01 _ _
03 MAR 02 _ _
02 FEB 03 _ _
01 JAN 04 _ _
2015
12 DEC 05 _ _
11 NOV 06 _ _
10 OCT 07 _ _
09 SEP 08 _ _
08 AUG 09 _ _
07 JUL 10 _ _
06 JUN 11 _ _
05 MAY 12 _ _
04 APR 13 _ _
03 MAR 14 _ _
02 FEB 15 _ _
01 JAN 16 _ _
2014
12 DEC 17 _ _
11 NOV 18 _ _
10 OCT 19 _ _
09 SEP 20 _ _
08 AUG 21 _ _
07 JUL 22 _ _
06 JUN 23 _ _
05 MAY 24 _ _
04 APR 25 _ _
03 MAR 26 _ _
02 FEB 27 _ _
01 JAN 28 _ _
2013
12 DEC 29 _ _
11 NOV 30 _ _
10 OCT 31 _ _
09 SEP 32 _ _
08 AUG 33 _ _
07 JUL 34 _ _
06 JUN 35 _ _
05 MAY 36 _ _
04 APR 37 _ _
03 MAR 38 _ _
02 FEB 39 _ _
01 JAN 40 _ _
2012
12 DEC 41 _ _
11 NOV 42 _ _
10 OCT 43 _ _
09 SEP 44 _ _
08 AUG 45 _ _
07 JUL 46 _ _
06 JUN 47 _ _
05 MAY 48 _ _
04 APR 49 _ _
03 MAR 50 _ _
02 FEB 51 _ _
01 JAN 52 _ _
2011
12 DEC 53 _ _
11 NOV 54 _ _
10 OCT 55 _ _
09 SEP 56 _ _
08 AUG 57 _ _
07 JUL 58 _ _
06 JUN 59 _ _
05 MAY 60 _ _
04 APR 61 _ _
03 MAR 62 _ _
02 FEB 63 _ _
01 JAN 64 _ _
2010
12 DEC 65 _ _
11 NOV 66 _ _
10 OCT 67 _ _
09 SEP 68 _ _
08 AUG 69 _ _
07 JUL 70 _ _
06 JUN 71 _ _
05 MAY 72 _ _
04 APR 73 _ _
03 MAR 74 _ _
02 FEB 75 _ _
01 JAN 76 _ _