IDENTIFICATION

PLACE NAME ________
NAME OF HOUSEHOLD HEAD_______
CLUSTER NUMBER_______
HOUSEHOLD NUMBER_______
PROVINCE_______

URBAN/RURAL:

LARGE CITY/SMALL CITY/VILLAGE/RURAL AREA:

NAME AND LINE NUMBER OF WOMAN______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE______
INTERVIEWER'S NAME_____

RESULT______

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR_____
NAME______
RESULT_____

TOTAL NUMBER OF VISITS______

LANGUAGE OF SURVEY: PORTUGUESE 01

LANGUAGE OF THE INTERVIEW______

WAS IT NECESSARY TO HAVE AN INTERPRETER?

SUPERVISOR
NAME_____
DATE_____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____

KEYED BY_____

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME:

102. For most of the time until you were 12 years old, did you live in a city, village or rural area?

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

104. Before you moved here, did you live in a city, village or rural area?

105. In what month and year were you born?

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

107. Have you attended school?

107A. Have you attended a literacy course?

108. What is the highest level of school you attended?

109. What is the highest grade/year you completed at that level?

110. CHECK 106:

111. Are you currently attending school?

112. What was the main reason you stopped attending school?

113. CHECK 108:

114. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

115. Do you usually read a newspaper or magazine at least once a week?

116. Do you usually listen to a radio every day?

117. Do you usually watch television at least once a week?

118. What is your religion?

119. What language did you grow up speaking?

120. CHECK QUESTION 4 IN THE HOUSEHOLD QUESTIONNAIRE:

Now I would like to ask about the place in which you usually live.

121. What is the name of the place in which you usually live?
Is that a city, village or rural area?

122. In which province is that located?

123. Now I would like to ask about the household in which you usually live.
What is the main source of drinking water for members of your household?

124. How long does it take to go there, get water, and come back?

124A. How much did you pay for that water in the last month?

125. What kind of toilet facility does your household have?

125A. Is the bathroom used by only the members of your household or other people?

126. Does your household have:

Electricity?
Radio?
Television?
A telephone?
A refrigerator?

127. What is the main material of the floor of your home?

128. Does any member of your household own:

A bicycle?
A motorcycle?
A car?

TABLE OF LEVEL OF EDUCATION OF IDSM CODES (DEMOGRAPHIC AND HEALTH SURVEYS OF MOZAMBIQUE):

SECTION 2. REPRODUCTION

Now I would like to ask about all the births you have had during your life (and if the children are still alive).

201. Have you ever given birth?

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

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

204. Do you have any sons or daughters to whom you have given birth who live in another place?

205. How many sons are living somewhere else?
And how many daughters are living somewhere else?
IF NONE RECORD '00'

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

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

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

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

210. CHECK 208:

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

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

213. Where any of these births twins?
IF YES, which ones?

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

215. In what month and year was (NAME) born?

216. Is (NAME) still alive?

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

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

219. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN A MONTH; MONTH IF LESS THAN TWO YEARS; OR YEARS.

220. FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH. IS THE DIFFERENCE 4 YEARS OR MORE?
[FOR ALL BIRTHS EXCEPT FOR FIRST BIRTH]

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[FOR ALL BIRTHS EXCEPT FOR FIRST BIRTH]

222. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH. IS THE DIFFERENCE 4 YEARS OR MORE?

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

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

225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1994. IF NONE, RECORD '0' AND GO TO 227.

227. Are you pregnant now?

228. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS

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

236. What is the day when your last menstrual period started?

237. Do you think that, between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

238. During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy.

CIRCLE CODE '1' IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF METHOD IS RECOGNIZED, AND CODE '3' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?
302. Have you ever heard of (METHOD)?

303. Have you ever used (METHOD)?

304. CHECK 303:

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

307. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY)

309. When you used a method for the first time to avoid getting pregnant, how many living children did you have at that time?
IF NONE, RECORD '00'.

310. When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?

311. CHECK 303:

312. CHECK 227:

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

314. Which method are you using?
314A. CIRCLE CODE '07' FOR FEMALE STERILIZATION

315. May I see the package of pills you are now using?
RECORD NAME OF BRAND IF PACKAGE IS SEEN

316. Do you know the brand name of the pills you are now using?
RECORD NAME BRAND

317. How much does one packet of pills cost you last time you bought it?

318. Where did the operation to stop having children/ sterilization take place?

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

319. Do you regret that (you/ your husband) had the operation to not have any (more) children?

320. Why do you regret the operation?

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

323. How do you determine which days of your monthly cycle not to have sexual relations?

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

327. CHECK 314:
CIRCLE METHOD CODE:

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

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

329. Do you know another place where you could have obtained (METHOD) the last time?

329A. At the time of the sterilization operation, did you know another place where you could have received the operation?

330. People select the place where they get family planning services for various reasons. What was the main reason you went to (NAME OF PLACE IN Q. 326 OR Q. 318) instead of some other place you know about?
RECORD RESPONSE AND CIRCLE CODE.

331. What is the main reason you are not using a method of contraception to avoid pregnancy?

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

333. Where is that?

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

335. Have you visited a health facility for any reason in the last 12 months?

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

337. Do you think that breastfeeding can affect a woman's chance of becoming pregnant?

338. Do you think that if a woman is breastfeeding, is it easier or more difficult to become pregnant?

339. CHECK 210:

340. Have you ever relied on breastfeeding as a method of avoiding pregnancy?

341. CHECK 227 AND 311:

342. Are you currently relying on breastfeeding to avoid getting pregnant?

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 225:

402. ENTER THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1994 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL THESE LIVING BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES)

Now I would like to ask you some more questions about the health of all your living children born in the past three years. (We will talk about each child separately).

403. LINE NUMBER FROM 212:

404. FROM 212 AND 216:

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

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

407. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Who examined you? Anyone else?
RECORD ALL PERSONS THAT EXAMINED RESPONDENT.

408. How many months pregnant were you when you first received antenatal care?

409. How many antenatal appointments did you have during this pregnancy?

410. When you were pregnant with (NAME), were you given an injection in the arm?

410A. What was the injection for?

411. During this pregnancy, how many times did you get this injection?

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

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

414. Around the time of the birth of (NAME) did you have any of the following problems:

Did your regular contractions last more than 12 hours?
Excessive bleeding that was so much that you feared it was life threatening?
A high fever with bad smelling vaginal discharge?
Convulsions not caused by fever?

415. Was (NAME) delivered by caesarean section?

416. When (NAME) was born was s/he: very large, large, average, small, or very small?

417. Was (NAME) weighed at birth?

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

419.Has you period returned since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

420. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT AST FOR MOST RECENT BIRTH]

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

422. CHECK 227:
RESPONDENT PREGNANT?
[ASK ONLY FOR MOST RECENT BIRTH]

423. Have you resumed sexual relations since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

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

425.Did you ever breastfeed (NAME)?

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

427. CHECK 404:
CHILD ALIVE?

428. Are you still breastfeeding (NAME)?

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

430. Why did you stop breastfeeding (NAME)?

431. CHECK 404:
CHILD ALIVE?

432. How many times did you breastfeed since 6pm yesterday until today at 6 am?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

433. Yesterday, how many times did you breastfeed since 6am until 6 pm?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

434. Did (NAME) drink water or other liquids yesterday or last night?

435. At any time yesterday or last night, was (NAME) given any of the following:

Plain water?
Sugar water?
Juice?
Herbal Tea?
Powdered Milk?
Fresh Milk?
Other Liquids?
Any foods made from cereal?
Any foods made from potatoes or yams?
Any peanuts or sesame seeds?
Beans?
Eggs, fish, or other poultry?
Meat?
Any other solid or semi-solid foods?

436. CHECK 435:
FOOD OR LIQUID GIVEN YESTERDAY?

437. (Aside from breastfeeding), how many times did (NAME) eat yesterday, including both meals and snacks?
IF 7 OR MORE TIMES, RECORD '7'.

438. On how many days during last seven days was (NAME) given any of the following:

Plain water?
Any kind of milk (other than breast milk)?
Liquids other than water or milk?
Food made from cereal?
Food made from potatoes or yams?
Peanuts or sesame seeds?
Beans?
Eggs, fish, or poultry?
Meat?
Other solid or semi-solid foods?

IF DOESN'T KNOW, RECORD '8'.

439. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440. ENTER LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1994 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE LIVING BIRTHS, BEGINNING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

441. LINE NUMBER FROM 212:

442. FROM QUESTIONS 212 AND 216:

443. Do you have the vaccination card of (NAME)?
IF YES: May I see it please?

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

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

446. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, AND/OR MEASLES VACCINE(S).

447. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

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

448A. A BCG vaccination against tuberculosis, that is, an injection in the arm that leaves a scar?

448B. POLIO vaccine, that is drops in the mouth?

448C. IF ANSWER IS 'YES': How many times?

448D. When was the first polio vaccines given just after birth or later?

448E. DPT (triplex) vaccination, that is, an injection usually given at the same time as polio drops?

448F. IF ANSWER IS 'YES': How many times?

448G. A MEASLES vaccine, that is, an injection in the arm to prevent measles?

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

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

451. When (NAME) was ill with a cough,

Did s/he breathe more rapidly than usual?
Did s/he breathe with difficulty?
Did s/he have noisy breathing?
Did s/he eat well and had enough liquids?
Was s/he very ill?

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

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

454. Has (NAME) has diarrhea in the last two weeks?

455. Was there any blood in the stools?

456. On the worst day of the diarrhea, how many bowel movements did (NAME) have?

457. Was he/she given the same amount to drink as before the diarrhea, or more, or less?

458. Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?

458A. CHECK 428:
ARE YOU STILL BREASTFEEDING (NAME)?

458B. When (NAME) had diarrhea, did you continue breastfeeding him/her?

459. When (NAME) had diarrhea, was he/she given any of the following to drink:

A fluid called 'Mixture' (salts ORS)?
Thin watery gruel made from rice?
Soup?
Homemade sugar-salt-water solution?
Traditional medicines such as herbal or root teas?
Infant formula?
Tea, juices, coconut water?
Water?
Any other liquids?

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

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

462. Did you seek advice to treat the diarrhea?

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

464. GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465. When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

466. When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

467. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

468. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

469. CHECK 459, ALL COLUMNS:

470. Have you ever heard of a special product called 'Mixture' (oral rehydration salts) you can get for the treatment of diarrhea?

SECTION 5. MARRIAGE

501. PRESENCE OF OTHERS AT THIS POINT:

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

503. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

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

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

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

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

509. How many wives does he have besides yourself?

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

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

512. CHECK 511:

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

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

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

Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.

515. When was the last time you had sexual intercourse (if ever)?

516. CHECK 301 AND 302:

KNOWS ABOUT CONDOM: The last time you had sex, was a condom used?

DOESN'T KNOW ABOUT CONDOM: Some men use a condom. The last time you had sex, was a condom used?

516A. What was the brand of condom used?

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

518. Where is that?

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

519. How old were you when you first had sexual intercourse?

SECTION 6. FERTILITY PREFERENCES

601. CHECK 314:

602. CHECK 227:

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

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

603. CHECK 227:

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

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

604. CHECK 227:

605. If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter to you very much?

606. CHECK 313:
USING A METHOD?

607. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

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

609. Which method would you prefer to use?

610. What is the main reason that you think you will not use a method?

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

612. CHECK 216:

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

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

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

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

615. Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
On the television?

616. In the last month have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?

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

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

620. CHECK 502:

Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.

621. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

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

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

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

701. CHECK 502 AND 504:

702. How old is your husband/partner?

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

704. What was the highest level of school he attended?

705. What was the highest grade he completed at that level?

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

707. CHECK 706:

708. Does/did your husband/partner work mainly on his own land, on family land, or does/did he rent land, or does/did he work on someone else's land?

709. Aside from your housework, are you currently working?

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

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

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

713. CHECK 712:

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

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

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

717. During the last 12 months, how many months did you work?

718. During the last 12 months, how many days a week did you usually work (in the months that you worked)?

719. During the last month, approximately how many days did you work?

720. Do you earn cash for your work?
PROBE: Do you make money for working?

721. How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?

(REGISTER EM 1.000 METICAIS [MOZAMBICAN CURRENCY])

722. CHECK 502:

YES, CURRENTLY MARRIED/YES, LIVING WITH A MAN: Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

NO, NOT IN UNION/SINGLE: Who mainly decides how the money you earn will be used: you, someone else or you and someone else jointly?

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

724. CHECK 217 AND 218:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

725. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

TABLE OF LEVEL OF EDUCATION:

CURRENT SYSTEM:

OLD SYSTEM:

COLONIAL SYSTEM:

SECTION 8. AIDS

801. Have you ever heard of an illness called AIDS?

802. From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED,

803. Do you know how a person can avoid getting AIDS or the virus that cause AIDS?

804. What can a person do to avoid the risk of contracting AIDS?
Any other ways?
RECORD ALL MENTIONED.

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

808. Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

809. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

810. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
IF YES, PROBE: In what way?
RECORD ALL MENTIONED.

SECTION 9. MATERNAL DEATH RATE

Now I would like to ask you questions about your brothers and sisters, that is, all of the children born from your mother, including those that live with you or those that not live with you or have died.

901. How many children did you mother have?

902. CHECK 901:

903. Of all of the children, how many were born before you?

904. What is the name of your older....next sister or brother?

905. Is (NAME) male or female?

906. Is (NAME) alive?

907. How old is (NAME)?

908. In which year did (NAME) die?

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

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

911. When (NAME) died, was she pregnant?

912. Did (NAME) die during labor?

913. Did (NAME) die two months after being pregnant or after labor?

914. Did she die because of labor or pregnancy complications?

915. During her life, how many children did (NAME) have?

[IF NO MORE SIBLINGS GO TO 916]

916. RECORD THE TIME

SECTION 10. HEIGHT AND WEIGHT

1001. CHECK 215:

IN 1002 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1994 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE OF RESPONDENT AND ALL CHILDREN BORN SINCE JANUARY 1994. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENT WITH ONE OR MORE LIVING BIRTHS SINCE JANUARY 1994, SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1994, USE ADDITIONAL QUESTIONNAIRES.)

1002. LINE NUMBER FROM QUESTION 212:
[DO NOT ASK FOR RESPONDENT]

1003. NAME FROM QUESTION 212:

1004. DATE OF BIRTH: FROM QUESTION 215 AND ASK FOR DAY OF BIRTH
[DO NOT ASK FOR RESPONDENT]

1005. BCG SCAR ON ARM?
[DO NOT ASK FOR RESPONDENT]

1006. HEIGHT (IN CENTIMETERS):

1007. WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP? [DO NOT ASK FOR RESPONDENT]

1008. WEIGHT (IN KILOGRAMS):

1009. DATE WEIGHED AND MEASURED:

1010. RESULT:

1011. NAME OF MEASURER: _____

NAME OF SUPERVISOR: _____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT ____
COMMENTS ON SPECIFIC QUESTIONS _____
ANY OTHER COMMENTS ____

SUPERVISOR'S OBSERVATIONS_____
NAME _____
DATE _____

EDITOR'S OBSERVATIONS_____
NAME _____
DATE _____