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REPUBLIC OF NIGER DEMOGRAPHIC AND HEALTH SURVEY
WOMEN'S QUESTIONNAIRE 1992

IDENTIFICATION

DEPARTMENT ___
DISTRICT ___
MUNICIPALITY/ADMINISTRATIVE DISTRICT/CITY CENTER ___

VILLAGE/QUARTER ___

NIAMEY 1
AGADEZ, MARADI, TAHOUA, ZINDER 2
OTHER CITY 3
RURAL 4

NAME OF RESPONDENT ___
LINE NUMBER OF RESPONDENT ___

STRATA NUMBER ___
CLUSTER NUMBER ___
STRUCTURE NUMBER ___
RESIDENCE NUMBER ___
CENSUS ZONE NUMBER ___

INTERVIEWER VISITS:

INTERVIEWER:
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___
RESULTS___

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__

FINAL VISIT:
DAY__
MONTH__
YEAR 19__
INTERVIEWER__
RESULT__

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
OTHER (SPECIFY): ___ 6

TOTAL NUMBER OF VISITS ___

FRENCH QUESTIONNAIRE: 1

INTERVIEW LANGUAGE:

FRENCH 1
HAOUSSA 2
DJERMA 3
OTHERS 4

INTERPRETER :

YES 1
NO 2

FIELD EDITED BY:
NAME ___
DATE ___

OFFICE EDITED BY:
NAME ___
DATE ___

KEYED BY:
NAME ___
DATE ___

SECTION 1. RESPONDENT BACKGROUND

101) RECORD TIME

HOUR: ___
MINUTES: ___

102) To begin, I'd like to ask you some questions about yourself and your household.
During the majority of the first 12 years of your life, did you live in the city of Niamey, in another capital in Agadez, Maradi, Tahous, Zinder or other large foreign city, in a town or the country?

NIAMEY/OTHER CAPITAL 1
AGADEZ/MARADI/TAOUA/ZINDER/OTHER LARGE FOREIGN CITY 2
TOWN 3
COUNTRY 4

103) For how long have you been a long-term resident of (NAME OF CURRENT RESIDENCE)?

NUMBER OF YEARS: ___
ALWAYS 95 (GO TO 105)
JUST VISITING 96 (GO TO 105)

104) Just before moving here, did you live in the city of Niamey, in another capital in Agadez, Maradi, Tahous, Zinder or other large foreign city, in a town or the country?

NIAMEY/OTHER CAPITAL 1
AGADEZ/MARADI/TAOUA/ZINDER/OTHER LARGE FOREIGN CITY 2
TOWN 3
COUNTRY 4

105) In what month and year were you born?

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

106) How old were you at your last birthday?

COMPARE AND CORRECT IF 105 AND 106 ARE INCOMPATIBLE.

AGE IN COMPLETED YEARS: ___

107) Did you go to school?

YES 1
NO 2 (GO TO 111)

108) What is the highest level of education that you have attained: primary, first cycle of secondary, second cycle of secondary, or higher?

PRIMARY 1
FIRST CYCLE OF SECONDARY 2
SECOND CYCLE OF SECONDARY 3
HIGHER 4

109) What was the last grade you completed at this level?

GRADES FOR PRIMARY
INTRODUCTORY COURSE 1
PREPARATORY COURSE 2
ELEMENTARY COURSE 1 3
ELEMENTARY COURSE 2 4
MID-LEVEL COURSE 1 5
MID-LEVEL COURSE 2 6
GRADES FOR SECONDARY, FIRST CYCLE
6TH 1
5TH 2
4TH 3
3RD 4
DON'T KNOW 8
GRADES FOR SECONDARY, SECOND
2ND 1
1ST 2
FINAL YEAR 3
DON'T KNOW 8
GRADES FOR HIGHER LEVEL
FIRST YEAR 1
SECOND YEAR 2
THIRD YEAR 3
FOURTH YEAR AND HIGHER 4
DON'T KNOW 8

110) CHECK 108:

PRIMARY: ___
SECONDARY OR HIGHER: ___ (GO TO 112)

111) Do you know how to read and understand a letter or a newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

112) Do you read a journal or magazine practically at least once a week?

YES 1
NO 2

113) Do you listen to the radio at least once a week?

YES 1
NO 2

114) Do you watch television at least once a week?

YES 1
NO 2

115) What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
OTHER (SPECIFY): ___ 4

116) What is your nationality?

NIGERIAN 01
TOGOLESE 02 (GO TO 118)
BENINESE 03(GO TO 118)
MALIAN 04 (GO TO 118)
BURKINABE 05 (GO TO 118)
OTHER AFRICAN 06 (GO TO 118)
OTHER (SPECIFY): ___ 07 (GO TO 118)

117) What is your ethnicity?

ARABE 01
DJERMA 02
GOURMANTH 03
HAUSSA 04
KAMOURI 05
MOSSI 06
PEULH 07
TOUAREG BELLA 08
TOUBOU 09
OTHER (SPECIFY): ___ 10

118) CHECK QUESTION 4 IN THE HOUSEHOLD QUESTIONNAIRE:

RESPONDENT IS NOT RESIDENT: ___
RESPONDENT IS A RESIDENT: ___ (GO TO 201)

119) Now I would like to ask you some questions about the place you usually live.

Do you usually live in Niamey, in another capital, in Agadez, Maradi, Tahous, Zinder or other large foreign city, in a town or the country?

NIAMEY 1 (GO TO 121)
OTHER CAPITAL 2 (GO TO 121)
AGADEZ/MARADI/TAOUA/ZINDER/OTHER LARGE FOREIGN CITY 3
TOWN 4
COUNTRY 5

120) In what department is it located?

AGADEZ 01
DIFFA 02
DOSSO 03
MARADI 04
TILLABERI 05
TAHOUA 06
ZINDER 07
FOREIGN 08

121) Now I would like to ask you some questions about the household in which you normally live.

Where does the water your household uses for hand and dishwashing come from?

PIPED WATER
PIPED INTO THE RESIDENCE/YARD/PLOT 11 (GO TO 123)
PUBLIC TAP 12
WELL WATER
WELL IN THE RESIDENCE/YARD/PLOT 21 (GO TO 123)
PUBLIC WELL OR BOREHOLE 22
SURFACE WATER
SPRING 31
RIVER OR STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 123)
WATER VENDOR 51
BOTTLED WATER 61 (GO TO 123)
OTHER (SPECIFY): ___ 71

122) How much time is needed to go there, get water, and come back?

MINUTES: ___
ON LOCATION 996

123) Does your household use water from the same source for drinking?

YES 1 (GO TO 125)
NO 2

124) Where does the water your household uses for drinking come from?

PIPED WATER
PIPED INTO THE RESIDENCE/YARD/PLOT 11
PUBLIC TAP 12
WELL WATER
WELL IN THE RESIDENCE/YARD/PLOT 21
PUBLIC WELL OR BOREHOLE 22
SURFACE WATER
SPRING 31
RIVER OR STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41
WATER VENDOR 51
BOTTLED WATER 61
OTHER (SPECIFY): ___ 71

125) What kind of toilets do you use in your household?

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PUBLIC FLUSH TOILET 13
PIT TOILET OR LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) OR LATRINES 22
NO FACILITY/BRUSH/FIELD 31
OTHER (SPECIFY): ___ 41

126) In your household do you have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

127) In your household, how many rooms do you use for sleeping?

ROOMS: ___

128) Can you describe your residence's floor?

NATURAL FLOOR
EARTH/SAND 11
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL STRIPS 32
TILE 33
CEMENT 34
RUG 35
OTHER (SPECIFY): ___ 41

129) Can you describe your residence's roof?

CONCRETE 01
SHEET METAL 02
BANCO 03
STRAW 04
CANVAS 05
OTHER (SPECIFY): ___ 06

130) Is there someone in your household who owns:

A bicycle?
A scooter or motorcycle?
A car?
A cart?

BICYCLE
YES 1
NO 2
SCOOTER/MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2
CART
YES 1
NO 2

SECTION 2. REPRODUCTION

201) Now I'd like to ask you some questions about all the children you've given birth to in your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

202) Did you give birth to sons or daughters currently living with you?

YES 1
NO 2 (GO TO 204)

203) How many sons live with you?
And how many daughters?

IF NONE, ENTER '00'.

SONS AT HOME: ___
DAUGHTERS AT HOME: ___

204) Have you given birth to sons or daughters who are still living but do not currently live with you?

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but not living with you?
And how many daughters?

IF NONE, ENTER '00'.

SONS ELSEWHERE: ___
DAUGHTERS ELSEWHERE: ___

206) Have you given birth to a son or daughter who then died?

IF NO, PROBE:
Was there any other son or daughter you did not mention in the previous question who cried at birth or gave another sign of life but who only lived a few hours or days?

YES 1
NO 2 (GO TO 208)

207) In all, how many of your sons have died?
And how many of your daughters?

IF NONE, ENTER '00'.

SONS DECEASED: ___
DAUGHTERS DECEASED: ___

208) ADD THE RESPONSES FROM 203, 205, AND 207 AND RECORD THE TOTAL.

IF NONE, RECORD '00'.

TOTAL: ___

209) CHECK 208:

I want to make sure I understand: You have had (TOTAL) ___ births in your life. Is that correct?

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

210) CHECK 208:

ONE OR MORE BIRTHS: ___
NO BIRTHS: ___ (GO TO 223)

211) Now I would like to talk to you about your children, whether they are still alive or not, beginning with the first birth that you had.

(IN 212 WRITE THE NAME OF EACH CHILD, WRITING THE NAMES OF TWINS OR TRIPLETS ON SEPARATE LINES)

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

NAME: ___

213) When (NAME) was born, was he/she alone or did he/she have a twin?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

PROBE: What is his or her birthday?
OR: In what season was he/she born?

IF MONTH/SEASON UNKNOWN, ENTER '98'.

MONTH: ___
YEAR: ___

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217) IF ALIVE: How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS: ___

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

YES 1 (GO TO NEXT BIRTH)
NO 2

219) IF CHILD IS UNDER 15: With whom does he/she live?

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3 (GO TO NEXT BIRTH)

220) IF DECEASED: How old was he/she when he/she died?

IF '1 YR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN ONE MONTH, MONTHS IF LESS THAN TWO YEARS, OR IN YEARS.

DAYS: ___ 1
MONTHS: ___ 2
YEARS: ___ 3

221) COMPARE 208 WITH THE NUMBER OF BIRTHS RECORDED IN THE ABOVE TABLE AND MARK:

THE NUMBERS ARE THE SAME: __
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS:
CHECK TO DETERMINE THE EXACT NUMBER OF MONTHS.
THE NUMBERS ARE DIFFERENT: __
VERIFY AND CORRECT

222) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987.

IF NONE, RECORD '0'.

____

223) Are you pregnant now?

YES 1
NO 2 (GO TO 226)
UNSURE 8 (GO TO 226)

224) How many months pregnant are you?

MONTHS: ___

225) 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 become pregnant?

THEN 1
LATER 2
NOT AT ALL 3
GOD WILLED IT 4
DON'T KNOW 5

226) When did your last period start?

DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
YEARS: ___ 4
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

227) 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 at other times?

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

228) During which times of the month does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY): ___ 5
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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

Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.

THEN PROCEED DOWN THE COLUMN, 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 302, ASK QUESTIONS 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302) Have you ever heard of (METHOD)?

READ DESCRIPTION OF EACH METHOD.

01. PILL Women can take a pill every day.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
02. IUD Some women have a "sterilet" that a doctor or nurse places in their uterus .
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
03. INJECTIONS Women can receive an injection by a doctor or nurse to avoid becoming pregnant for several months.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
04. DIAPHRAGM/FOAM/GEL Women can put a sponge, suppository, diaphragm, jelly, or cream inside them before intercourse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
05. CONDOM Men can wear a condom during sexual intercourse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
06. FEMALE STERILIZATION Women can undergo an operation in order to avoid having any more children.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
07. MALE STERILIZATION Men can undergo an operation in order to avoid having any more children.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
08. RHYTHM, PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
09. WITHDRAWAL Men can be careful and pull out before ejaculation.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
10. GRIS-GRIS Women can use an amulet to avoid becoming pregnant.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
11. OTHER METHODS Have you heard of other ways or methods that women or men can use to avoid pregnancy?
YES/SPONTANEOUS (SPECIFY): ___ 1
NO 3 (GO QUESTION 305)

303) Have you ever used (METHOD)?

01. PILL
YES 1
NO 2
02. IUD
YES 1
NO 2
03. INJECTIONS
YES 1
NO 2
04. DIAPHRAGM/FOAM/GEL
YES 1
NO 2
05. CONDOM Have you ever had a partner who used a condom?
YES 1
NO 2
06. FEMALE STERILIZATION Have you had an operation to avoid having any more children?
YES 1
NO 2
07. MALE STERILIZATION Have you ever had a partner who had an operation to avoid having more children?
YES 1
NO 2
08. RHYTHM, PERIODIC ABSTINENCE
YES 1
NO 2
09. WITHDRAWAL
YES 1
NO 2
10. GRIS-GRIS
YES 1
NO 2
11. OTHER METHODS
YES 1
NO 2
YES 1
NO 2

304) Do you know where a person could go to get (METHOD)?

01. PILL
YES 1
NO 2
02. IUD
YES 1
NO 2
03. INJECTIONS
YES 1
NO 2
04. DIAPHRAGM/FOAM/GEL
YES 1
NO 2
05. CONDOM
YES 1
NO 2
06. FEMALE STERILIZATION Do you know where a person can go to undergo sterilization?
YES 1
NO 2
07. MALE STERILIZATION Do you know where a person can go to undergo sterilization?
YES 1
NO 2
08. RHYTHM, PERIODIC ABSTINENCE Do you know where a person can obtain advice on how to use periodic abstinence?
YES 1
NO 2

305) CHECK 303:

NOT A SINGLE "YES" (NEVER USED): ___
AT LEAST ONE "YES" (EVER USED): ___ (GO TO 308)

306) Have you ever used any method or tried any way to delay or avoid getting pregnant?

YES
NO (GO TO 326)

307) What have you done or used?

CORRECT 303-305 (AND 302 IF NECESSARY)

308) Now I would like to speak to you about the time when you first did something or used a method to avoid getting pregnant. How many children did you have at that time?

IF NONE, RECORD '00'.

NUMBER OF CHILDREN: ___

309) CHECK 223:

NOT PREGNANT OR UNSURE: ___
PREGNANT: ___ (GO TO 326)

310) CHECK 303:

WOMAN NOT STERILIZED: ___
WOMAN STERILIZED: ___ (GO TO 312A)

311) Are you currently doing something or using a method to avoid pregnancy?

YES 1
NO 2 (GO TO 326)

312) What method are you using?

312A) CIRCLE '06' FOR FEMALE STERILIZATION

PILL 01
IUD 02 (GO TO 318)
INJECTIONS 03 (GO TO 318)
DIAPHRAGM/FOAM/GEL 04 (GO TO 318)
CONDOM 05 (GO TO 318)
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07(GO TO 318)
PERIODIC ABSTINENCE 08 (GO TO 323)
WITHDRAWAL 09 (GO TO 323)
GRIS-GRIS 10 (GO TO 323)
OTHER (SPECIFY): ___ 11 (GO TO 323)

313 At the time you first started using the pill, did you consult a doctor or a midwife?

YES 1
NO 2
DON'T KNOW 8

314) At the time you last got pills, did you consult a doctor or midwife?

YES 1
NO 2

315) May I see the package of pills you are using now?

STEDIRIL 01 (GO TO 317)
MINIDRIL 02 (GO TO 317)
MILLI ANOVLAR 03 (GO TO 317)
EUGYNON 04 (GO TO 317)
ADEPAL 05 (GO TO 317)
MINIPHASE 06 (GO TO 317)
LO-FEMENAL 07 (GO TO 317)
EUGYNON 08 (GO TO 317)
OTHER (SPECIFY): ___ 09 (GO TO 317)
BOX NOT SHOWN 10

316) Do you know the brand name of the pills that you are now using?

STEDIRIL 01
MINIDRIL 02
MILLI ANOVLAR 03
EUGYNON 04
ADEPAL 05
MINIPHASE 06
LO-FEMENAL 07
EUGYNON 08
OTHER (SPECIFY): ___ 09
DON'T KNOW 98

317) How much does one packet of pills cost you?

RECORD PRICE.

317A) For how many cycles have you used this packet of pills?

RECORD NUMBER OF CYCLES.

COST: ___
FREE 9996
DON'T KNOW 9998

NUMBER OF CYCLES: ___

318) CHECK 312:

HE/SHE IS STERILIZED: Where did the sterilization take place?

USES ANOTHER METHOD: Where did you obtain (METHOD) the last time?

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL 11
MEDICAL CENTER 12
FAMILY HEALTH CENTER 13
MOTHER AND CHILD CARE CENTER 14
DISPENSARY 15
MATERNITY WARD 16
PEOPLE'S PHARMACY 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
CLINIC/HOSPITAL 22
PHARMACY 23
OTHER PRIVATE SECTOR
RELATIVE 31 (GO TO 321)
NEIGHBOR 32 (GO TO 321)
OTHER (SPECIFY): ___ 41(GO TO 321)
DON'T KNOW 98 (GO TO 321)

319) How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES: ___ 1
HOURS: ___ 2
DON'T KNOW 9998

320) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

321) CHECK 312:

SHE/HE STERILIZED: ___
USING ANOTHER METHOD: ___ (GO TO 323)

322) In what month and year was the sterilization operation performed?

MONTH: ___ (GO TO 336)
YEAR: ___ (GO TO 336)

323) For how many months have you been using (CURRENT METHOD) continuously?

IF LESS THAN A MONTH, RECORD '00'.

MONTHS: ___
8 YEARS OR MORE 96

324) Have you had any problems with the method you are currently using?

YES 1
NO 2 (GO TO 331)

325) From whom did you ask advice for these problems?

HEALTH PERSONNEL 1 (GO TO 331)
ACQUAINTANCE/RELATIVE 2 (GO TO 331)
PARTNER 03 (GO TO 331)
NO ONE 04 (GO TO 331)

326) Do you intend to use a method to avoid getting pregnant in the future?

YES 1 (GO TO 328)
NO 2
DON'T KNOW 8 (GO TO 332)

327) What is the main reason you do not intend to use a method?

WANTS CHILDREN 01 (GO TO 332)
LACK OF INFORMATION 02(GO TO 332)
PARTNER DISAPPROVES 03(GO TO 332)
COST TOO MUCH 04 (GO TO 332)
SIDE EFFECTS 05 (GO TO 332)
HEALTH PROBLEMS 06 (GO TO 332)
HARD TO GET METHODS 07(GO TO 332)
RELIGION 08(GO TO 332)
OPPOSED TO FAMILY PLANNING 09(GO TO 332)
FATALIST 10(GO TO 332)
OTHER PEOPLE OPPOSED 11(GO TO 332)
INFREQUENT SEX 12(GO TO 332)
DIFFICULT TO GET PREGNANT 13 (GO TO 332)
MENOPAUSAL/HAD HYSTERECTOMY 14 (GO TO 332)
INCONVENIENT 15 (GO TO 332)
UNMARRIED 16 (GO TO 332)
OTHER (SPECIFY): ___ 17 (GO TO 332)
DON'T KNOW 98 (GO TO 332)

328) Do you intend to use a method within the next 12 months?

YES 1
NO 2
DON'T KNOW 8

329) When you eventually do use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/GEL 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08 (GO TO 332)
WITHDRAWAL 09 (GO TO 332)
GRIS-GRIS 10 (GO TO 332)
OTHER (SPECIFY): ___ 11 (GO TO 332)
UNSURE 98 (GO TO 332)

330) Where can you get (METHOD MENTIONED IN 329)?

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL 11 (GO TO 334)
MEDICAL CENTER 12(GO TO 334)
FAMILY HEALTH CENTER 13(GO TO 334)
MOTHER AND CHILD CARE CENTER 14 (GO TO 334)
DISPENSARY 15 (GO TO 334)
MATERNITY WARD 16 (GO TO 334)
PEOPLE'S PHARMACY 17 (GO TO 334)
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21 (GO TO 334)
CLINIC/HOSPITAL 22 (GO TO 334)
PHARMACY 23 (GO TO 334)
OTHER PRIVATE SECTOR
RELATIVE 31 (GO TO 336)
NEIGHBOR 32 (GO TO 336)
OTHER (SPECIFY): ___ 41(GO TO 336)
DON'T KNOW 98 (GO TO 332)

331) CHECK 312:

USING PERIODIC ABSTINENCE, WITHDRAWAL, OR OTHER TRADITIONAL METHOD: ___
USING MODERN METHOD: ___ (GO TO 336)

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

YES 1
NO 2 (GO TO 336)

333) Where is that?

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL 11
MEDICAL CENTER 12
FAMILY HEALTH CENTER 13
MOTHER AND CHILD CARE CENTER 14
DISPENSARY 15
MATERNITY WARD 16
PEOPLE'S PHARMACY 17
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE 21
CLINIC/HOSPITAL 22
PHARMACY 23
OTHER PRIVATE SECTOR
RELATIVE 31 (GO TO 336)
NEIGHBOR 32 (GO TO 336)
OTHER (SPECIFY): ___ 41(GO TO 336)
DON'T KNOW 98 (GO TO 336)

334) How long does it take to travel to your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES: ___ 1
HOURS: ___ 2
DON'T KNOW 9998

335) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

336) In the past month, have you heard a message about family planning on:

The radio?
The television?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2

337) Do you find it acceptable or not that information about family planning is provided on the radio and in newspapers?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

338) In the last 12 months, have you attended any awareness sessions or talks about family planning?

YES 1
NO 2 (GO TO 401)

339) Where did you attend these sessions or talks?

HEALTH FACILITY 1
NEIGHBORHOOD 2
OTHER (SPECIFY): ___ 3
DON'T KNOW 8

SECTION 4. PREGNANCY AND BREASTFEEDING

401) CHECK 222:

ONE OR MORE BIRTHS SINCE JANUARY 1987: ___
NO BIRTHS SINCE JAN 1987: ___ (GO TO 491)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE.

ASK THE QUESTIONS OF ALL THESE BIRTHS, BEGINNING WITH THE LAST BIRTH.

Now I would like to ask you some more questions about the health of all of the children you have had in the past 5 years. We will talk about one child at a time.

LINE NUMBER FROM QUESTION 212: ___

FROM QUESTION 212 AND QUESTION 216:

NAME: ___
LIVING: ___ (GO TO 403)
DECEASED: ___ (GO TO 403)

403) 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 want no more children at all?

THEN 1 (GO TO 405)
LATER 2
NO MORE 3 (GO TO 405)

404) How much longer would you have liked to have waited?

MONTHS: ___ 1
YEARS: ___ 2
DON'T KNOW 998

405) When you were pregnant with (NAME), did you see anyone for a consultation about this pregnancy?

IF YES: Whom did you see?

Anyone else?

RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
OTHER PERSON
MIDWIFE C
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY): ___ E
NO ONE F (GO TO 409)

406) Were you given an antenatal card or booklet for this pregnancy?

YES 1
NO 2
DON'T KNOW 8

407) How many months pregnant were you when you first saw someone for a consultation concerning this pregnancy?

MONTHS: ___
DON'T KNOW 98

408) How many antenatal visits did you have during this pregnancy?

NUMBER: ___
DON'T KNOW 98

409) When you were pregnant with (NAME) were you given an injection to prevent tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 411)
DON'T KNOW 8 (GO TO 411)

410) How many times did you get this injection?

NUMBER: ___
DON'T KNOW 8

411) Where did you give birth to (NAME)?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
MATERNITY WARD 22
DISPENSARY 23
PRIVATE SECTOR
PRIVATE HOSPITAL OR CLINIC 31
OTHER (SPECIFY): ___ 41

412) Who assisted you in the delivery of (NAME)?

Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS MENTIONED

HEALTH PROFESSIONAL
DOCTOR A
NURSE/ MIDWIFE B
OTHER PERSON
MIDWIFE C
TRADITIONAL BIRTH ATTENDANT D
RELATIVE E
OTHER (SPECIFY): ___ F
NO ONE G

413) Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DON'T KNOW 8

414) Was (NAME) delivered by caesarian section?

YES 1
NO 2

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

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

416) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418)

417) How much did he/she weigh?

KILOGRAMS: ___
DON'T KNOW 9998

418) FOR MOST RECENT BIRTH ONLY: Has your period returned after the birth of (NAME)?

YES 1(GO TO 420)
NO 2 (GO TO 421)

419) FOR ALL OTHER BIRTHS: Did your period return between the birth of (NAME) and the next pregnancy?

YES 1
NO 2 (GO TO 423)

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

MONTHS: ___
DON'T KNOW 98

421) CHECK 223: WOMAN PREGNANT?

NOT PREGNANT: ___
PREGNANT OR UNSURE: ___ (GO TO 423)

422) FOR MOST RECENT BIRTH: Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 424)

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

MONTHS: ___
DON'T KNOW 98

424) Did you breastfeed (NAME)?

YES 1 (GO TO 426)
NO 2

425) Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01 (GO TO 435)
CHILD ILL/WEAK 02 (GO TO 435)
CHILD DIED 03 (GO TO 435)
BREAST/NIPPLE PROBLEM 04 (GO TO 435)
INSUFFICIENT MILK 05 (GO TO 435)
MOTHER WORKING 06 (GO TO 435)
CHILD REFUSED 07 (GO TO 435)
OTHER (SPECIFY): ___ 08 (GO TO 435)

426) FOR MOST RECENT BIRTH: 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

427) FOR MOST RECENT BIRTH: CHECK 216: CHILD ALIVE?

LIVING: ___
DECEASED: ___ (GO TO 433)

428) FOR MOST RECENT BIRTH: Do you still breastfeed (NAME)?

YES 1
NO 2 (GO TO 433)

429) FOR MOST RECENT BIRTH: How many times did you breastfeed last night between sunset and sunrise?

(IF ANSWER IS NOT NUMERIC, PROBE TO EVALUATE NUMBER)

NUMBER OF NIGHT TIME FEEDINGS: ___

430) FOR MOST RECENT BIRTH: How many times did you breastfeed yesterday, during the daylight hours?

(IF ANSWER IS NOT NUMERIC, PROBE TO EVALUATE NUMBER)

NUMBER OF DAY LIGHT FEEDINGS: ___

431) FOR MOST RECENT BIRTH: At any time yesterday or last night did you give (NAME) one of the following things:

Plain water?
Sugar water?
Juice?
Herbal tea?
Tinned baby formula?
Other tinned or powdered milk?
Fresh (animal) milk?
Other liquids?
Porridge?
Other food specially made for the child?
Family meal?

WATER
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
HERBAL TEA
YES 1
NO 2
TINNED BABY FORMULA
YES 1
NO 2
POWDERED/TINNED MILK
YES 1
NO 2
FRESH MILK
YES 1
NO 2
OTHER LIQUIDS
YES 1
NO 2
PORRIDGE
YES 1
NO 2
OTHER FOOD MADE FOR THE CHILD
YES 1
NO 2
FAMILY MEAL
YES 1
NO 2

432) FOR MOST RECENT BIRTH: CHECK 431: FOOD OR LIQUID GIVEN YESTERDAY

YES TO ONE OR MORE: ___ (GO TO 437)
NO TO ALL: ___ (GO TO 436)

433) For how many months did you breastfeed (NAME)?

MONTHS: ___
UNTIL DIED 95 (GO TO 436)

434) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
BREAST/NIPPLE PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY):___ 11

435) CHECK 216: CHILD ALIVE?

LIVING: ___
DECEASED: ___ (GO TO 440)

436) Was (NAME) ever given water or anything else to drink or eat other than breast milk?

YES 1
NO 2 (GO TO 440)

437) How many months old was (NAME) when you started giving the following foods or drinks on a regular basis?

IF LESS THAN 1 MONTH, RECORD '00'.

Tinned milk or milk other than breast milk?
AGE IN MONTHS: ___
NOT GIVEN 96
Water or other liquids?
AGE IN MONTHS: ___
NOT GIVEN 96
Herbal tea?
AGE IN MONTHS: ___
NOT GIVEN 96
Other liquids?
AGE IN MONTHS: ___
NOT GIVEN 96
Mushy or solid food?
AGE IN MONTHS: ___
NOT GIVEN 96

438) FOR MOST RECENT BIRTH: CHECK 216: CHILD ALIVE?

LIVING: ___
DECEASED: ___ (GO TO 440)

439) Did (NAME) drink anything from a baby bottle yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

440) RETURN TO 403 FOR NEXT BIRTH, OR, IF THERE ARE NO MORE BIRTHS, GO TO THE FIRST COLUMN OF 441.

SECTION 4B. IMMUNIZATION AND HEALTH

441) ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM QUESTION 212: ___

FROM QUESTION 212 AND QUESTION 216:

NAME: ___
LIVING: ___
DECEASED: ___

442) Do you have a booklet or card where (NAME)'s vaccinations are written down?

IF YES: May I see it, please?

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

443) Did you ever have a vaccination booklet or card for (NAME)?

YES 1 (GO TO 446)
NO 2 (GO TO 446)

444) COPY THE VACCINATION DATES FOR EACH VACCINE FROM THE CARD.

WRITE '44' IN THE 'DAY' COLUMN IF THE CARD SHOWS THAT A VACCINATION WAS GIVEN BUT THE DATE WAS NOT RECORDED.

BCG
DAY: ___
MONTH: ___
YEAR: ___
POLIO 0
DAY: ___
MONTH: ___
YEAR: ___
POLIO 1
DAY: ___
MONTH: ___
YEAR: ___
POLIO 2
DAY: ___
MONTH: ___
YEAR: ___
POLIO 3
DAY: ___
MONTH: ___
YEAR: ___
DPT 1
DAY: ___
MONTH: ___
YEAR: ___
DPT 2
DAY: ___
MONTH: ___
YEAR: ___
DPT 3
DAY: ___
MONTH: ___
YEAR: ___
IMOVAX 1
DAY: ___
MONTH: ___
YEAR: ___
IMOVAX 2
DAY: ___
MONTH: ___
YEAR: ___
MEASLES
DAY: ___
MONTH: ___
YEAR: ___
YELLOW FEVER
DAY: ___
MONTH: ___
YEAR: ___

445) Has (NAME) received a vaccination that is not recorded on this card?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, IMOVAX 1-2, MEASLES, AND/OR YELLOW FEVER, THEN GO TO 448.

YES 1 (PROBE VACCINATIONS AND WRITE 66 IN THE CORRESPONDING DAY IN THE COLUMN IN 444)
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)

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

YES 1
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)

447) Please tell me is (NAME) has received one of the following vaccinations:

A BCG vaccination against tuberculosis, that is an injection in the left forearm that left a scar?
YES 1
NO 2
DON'T KNOW 8
Polio vaccine, that is, drops in the mouth?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times?
NUMBER OF TIMES: ___
An injection against measles?
YES 1
NO 2
DON'T KNOW 8
An injection with a jet injector?
YES 1
NO 2
DON'T KNOW 8
IF YES: How many times?
NUMBER OF TIMES: ___

448) CHECK 216: CHILD ALIVE?

LIVING: ___ (GO TO 450)
DECEASED: ___

449) GO BACK TO 442 FOR THE FOLLOWING BIRTH, OR, IF NO MORE BIRTHS, GO TO 482.

450) Has (NAME) had a fever any time during the last two weeks?

YES 1
NO 2
DON'T KNOW 8

451) Has (NAME) been ill with a cough any time during the last two weeks?

YES 1
NO 2 (GO TO 455)
DON'T KNOW 8 (GO TO 455)

452) Has (NAME) been ill with a cough any time during the last 24 hours?

YES 1
NO 2
DON'T KNOW 8

453) For how many days (has the cough lasted/did the cough last)?

IF LESS THAN ONE DAY, RECORD '00'.

DAYS: ___

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

YES 1
NO 2
DON'T KNOW 8

455) CHECK 446 AND 447: FEVER OR COUGH?

'YES' IN 450 OR 451: ___
'OTHER': ___ (GO TO 460)

456) Was anything given to (NAME) to treat the fever/cough?

YES 1
NO 2 (GO TO 458)
DON'T KNOW 8 (GO TO 458)

457) What was given to him/her?

Anything else?

RECORD ALL MENTIONED.

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY): ___ H

458) Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 460)

459) Where did you seek advice or treatment?

Anyone else?

RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
MOTHER AND CHILD CARE CENTER C
DISPENSARY D
MATERNITY WARD E
PEOPLE'S PHARMACY F
MOBILE CLINIC G
FIRST-AID WORKER H
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE I
CLINIC/HOSPITAL J
PHARMACY K
OTHER PRIVATE SECTOR
PHARMACEUTICAL WAREHOUSE M
SHOP/MARKET N
TRADITIONAL HEALER O
NEIGHBOR/RELATIVE P
OTHER (SPECIFY): ___ Q

460) Has (NAME) had diarrhea in the last two weeks?

YES 1 (GO TO 462)
NO 2
DON'T KNOW 8

461) GO BACK TO 438 FOR THE NEXT BIRTH, OR, IF THERE ARE NO MORE BIRTHS, GO TO 482.

462) Has (NAME) had diarrhea in the past 24 hours?

YES 1
NO 2
DON'T KNOW 8

463) For how many days (did the diarrhea last/has the diarrhea lasted)?

IF LESS THAN A DAY, RECORD '00'.

DAYS: ___

464) Was there any blood in the stool?

YES 1
NO 2
DON'T KNOW 8

465) CHECK 425/428: LAST CHILD STILL BREASTFED?

YES: ___
NO: ___ (GO TO 468)

466) When (NAME) had diarrhea, did you change the number of breast feedings?

YES 1
NO 2 (GO TO 468)

467) Did you increase the number of breast feedings or reduce them, or did you stop completely?

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

468) (Aside from breast milk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

469) Did you give him/her the same amount to eat as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

470) Was anything given to treat the diarrhea?

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

471) What was given or made to treat the diarrhea?

Anything else?

RECORD ALL MENTIONED.

FLUID FROM ORS PACKET A
RECOMMENDED HOME FLUID B
ANTIBIOTIC PILL OR SYRUP C
OTHER PILL OR SYRUP D
INJECTION E
(I.V.) INTRAVENOUS F
HOME REMEDY/HERBAL MEDICINE G
GUITTI/BAOURI H
OTHER (SPECIFY): ___ I

472) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 474)

473) Where did you seek advice or treatment?

Anyone else?

RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
MOTHER AND CHILD CARE CENTER C
DISPENSARY D
MATERNITY WARD E
PEOPLE'S PHARMACY F
MOBILE CLINIC G
FIRST-AID WORKER H
PRIVATE MEDICAL SECTOR
CLINIC/HOSPITAL I
PHARMACY J
PRIVATE DOCTOR'S OFFICE K
PRIVATE CLINIC L
OTHER PRIVATE SECTOR
PHARMACEUTICAL WAREHOUSE M
SHOP/MARKET N
TRADITIONAL HEALER O
NEIGHBOR/RELATIVE P
OTHER (SPECIFY): ___ Q

474) CHECK 471: FLUID FROM ORS PACKET

NO, ORS LIQUID NOT MENTIONED: ___
YES, ORS LIQUID MENTIONED: ___ (GO TO 476)

475) During the diarrhea, did (NAME) receive a fluid made from a special packet against diarrhea and vomiting when he/she had diarrhea?

YES 1
NO 2 (GO TO 478)
DON'T KNOW 8 (GO TO 478)

476) How long after the beginning of the diarrhea did (NAME) receive the liquid prepared from a special packet?

IF LESS THAN ONE DAY, RECORD '00'.

DAYS: ___
DON'T KNOW 98

477) For how many days did (NAME) receive the liquid prepared from a special packet?

IF LESS THAN ONE DAY, RECORD '00'.

DAYS: ___
DON'T KNOW 98

478) CHECK 471: RECOMMENDED HOME FLUID MENTIONED?

NO, HOME FLUID NOT MENTIONED: ___
YES, HOME FLUID MENTIONED: ___ (GO TO 480)

479) Was (NAME) given a fluid recommended by a health worker and made at home with sugar, salt, and water when he/she had diarrhea?

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

480) For how many days did (NAME) receive liquid prepared with sugar, salt, and water when he/she had diarrhea?

DAYS: ___
DON'T KNOW 98

481) RETURN TO 442 FOR THE NEXT BIRTH, OR, IF THERE ARE NO MORE CHILDREN, GO TO 482.

482) CHECK 471 AND 475 (ALL COLUMNS): FLUID FROM AN ORS PACKET MENTIONED?

YES, RECEIVED A LIQUID FROM ORS PACKET: ___ (GO TO 486)
LIQUID FROM ORS PACKET GIVEN TO NO CHILD, OR 471 AND 475 NOT ASKED: ___

483) Have you heard of a special product in a packet that you can get for the treatment of diarrhea and vomiting?

YES 1 (GO TO 485)
NO 2

484) Have you seen a packet like these before?

(SHOW THE TWO PACKETS)

YES 1
NO 2 (GO TO 489)

485) Have you ever prepared a solution with one of these packets to treat diarrhea for yourself or someone else?

(SHOW THE PACKET)

YES 1
NO 2 (GO TO 488)

486) The last time you prepared the special packet of powder, did you prepare the whole packet or only part of the packet?

WHOLE PACKET AT ONCE 1
PART OF PACKET 2 (GO TO 488)

487) How much water did you use to prepare the liquid from the special packet for diarrhea?

1/2 LITER / 1/2 CUP 01
1 LITER / 1 CUP 02
1 1/2 LITERS / 1 1/2 CUPS 03
2 LITERS / 2 CUPS 04
ACCORDING TO PACKET INSTRUCTIONS 05
OTHER (SPECIFY): ___ 06
DON'T KNOW 98

488) Where can you get this packet?

PROBE: Anywhere else?

RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
HOSPITAL A
MEDICAL CENTER B
MOTHER AND CHILD CARE CENTER C
DISPENSARY D
PEOPLE'S PHARMACY E
MOBILE CLINIC F
FIRST AID WORKER G
PRIVATE MEDICAL SECTOR
CLINIC/HOSPITAL H
PRIVATE PHARMACY I
PRIVATE DOCTOR'S OFFICE J
PRIVATE DISPENSARY K
OTHER PRIVATE SECTOR
PHARMACEUTICAL WAREHOUSE L
NEIGHBOR/RELATIVE M
OTHER (SPECIFY): ___ N

489) CHECK 471 AND 479, ALL COLUMNS:

HOME FLUID GIVEN TO ANY CHILD: ___
HOME FLUID GIVEN NOT GIVEN TO ANY CHILD, OR 471 AND 479 NOT ASKED: ___ (GO TO 491)

490) Who taught you how to prepare the home solution made with sugar, salt, and water, and which you gave to (NAME) when he/she had diarrhea?

PUBLIC SECTOR
HOSPITAL 11
MEDICAL CENTER 12
MOTHER AND CHILD CARE CENTER 13
DISPENSARY 14
MOBILE CLINIC 15
FIRST AID WORKER/MIDWIFE 16
PRIVATE MEDICAL SECTOR
CLINIC/HOSPITAL 21
PRIVATE PHARMACY 22
PRIVATE DOCTOR'S OFFICE 23
PRIVATE DISPENSARY 24
OTHER PRIVATE SECTOR
PHARMACEUTICAL WAREHOUSE 31
NEIGHBOR/RELATIVE 32
OTHER (SPECIFY): ___ 41

491) How many meals did you and your family eat yesterday?

NUMBER OF MEALS: ___

492) Where did the food you ate yesterday come from?

FAMILY-PRODUCED A
PURCHASED B
GIFT C
OTHER (SPECIFY): ___ D

SECTION 5. MARRIAGE

501) Are you now married or in a union with a man?

YES 1(GO TO 504)
NO 2

502) Have you ever been married or lived in a union with a man?

YES 1
NO 2 (GO TO 513)

503) Are you currently widowed, divorced, or separated?

WIDOWED 1 (GO TO 508)
DIVORCED 2 (GO TO 508)
SEPARATED 3 (GO TO 508)

504) Does your husband/partner live with you, or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

505) Does your husband/partner have other wives besides you?

YES 1
NO 2 (GO TO 508)

506) How many other wives does he have?

NUMBER: ___
DON'T KNOW 98 (GO TO 508)

507) Are you the first, second, third…spouse?

RANK: ___

508) Have you been married or lived with a man only once, or more than one?

ONCE 1
MORE THAN ONCE 2

509) In what month and year did you start living with him?

MONTH: ___
DON'T KNOW MONTHS 98
YEAR: ___
DON'T KNOW YEARS 98

510) How old were you when you started living with him?

AGE: ___
DON'T KNOW AGE 98

511) CHECK 509 AND 510: YEAR AND AGE GIVEN?

YES: ___
NO: ___ (GO TO 514)

512) CHECK CONSISTENCY OF 509 AND 510:
YEAR OF BIRTH (105) PLUS AGE AT MARRIAGE (510) EQUALS CALCULATED YEAR OF MARRIAGE

________ + _______ = _________

IF NECESSARY, CALCULATE YEAR OF BIRTH:
CURRENT YEAR MINUS CURRENT AGE (106) EQUALS CALCULATED YEAR OF BIRTH

________ + _______ = _________

IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (508)?

YES: ___
NO: ___ (PROBE AND CORRECT 509 AND 510)

513) IF NEVER IN A UNION: Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 518)

514) Now we need some details about your sexual activity in order to get a better understanding of contraception and fertility.

How many times did you have sexual intercourse in the last four weeks?

NUMBER OF TIMES: ___

515) How many times in a month do you usually have sexual intercourse?

NUMBER OF TIMES: ___

516) When was the last time you had sexual intercourse?

DAYS: ___ 1
WEEKS: ___ 2
MONTHS: ___ 3
YEARS: ___ 4
BEFORE LAST BIRTH 996

517) How old were you when you first had sexual intercourse?

AGE: ___
FIRST TIME WHEN MARRIED 96

515) PRESENCE OF OTHERS AT THIS POINT

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MEN
YES 1
NO 2
OTHER WOMEN
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601) CHECK 312:

NEITHER STERILIZED: ___
HIM OR HER STERILIZED: ___ (GO TO 607)

602) CHECK 501:

CURRENTLY MARRIED OR LIVING TOGETHER: ___
NOT MARRIED/LIVING TOGETHER: ___ (GO TO 614)

603) CHECK 223:

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

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

HAVE (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 610)
SHE SAYS SHE CAN'T GET PREGNANT 3 (GO TO 610)
UNDECIDED OR DON'T KNOW 8 (GO TO 610)

604) CHECK 223:

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

PREGNANT: How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS: ___ 1 (GO TO 610)
YEARS: ___ 2 (GO TO 610)
SOON/NOW 994 (GO TO 610)
SHE SAYS SHE CAN'T GET PREGNANT 995 (GO TO 610)
OTHER (SPECIFY): ___ 996
DON'T KNOW 998

605) CHECK 216 AND 223: HAS LIVING CHILD(REN) OR PREGNANT?

YES: ___
NO: ___ (GO TO 610)

606) CHECK 223:

NOT PREGNANT OR UNSURE: How old would you like your youngest child to be when your next child is born?

PREGNANT: How old would you like the child you are expecting to be when your next child is born?

AGE OF YOUNGEST CHILD IN YEARS: ___ (GO TO 610)
DON'T KNOW 98 (GO TO 610)

607) Given your present circumstances, if you could do it all over again, do you think you/your husband would make the same decision to not have any more children?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 614)

609) Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 614)
PARTNER WANTS ANOTHER CHILD 2 1 (GO TO 614)
SIDE EFFECTS 3 (GO TO 614)
OTHER REASON (SPECIFY): ___ 4 (GO TO 614)

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

611) How often have you talked to your husband/partner about this subject in the last 12 months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

612) Have you talked to your husband about the number of children you'd like to have?

YES 1
NO 2

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

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

614) After childbirth, how much time should couples wait before starting to have sexual relations again?

MONTHS: ___ 1
YEARS: ___ 2
OTHER (SPECIFY): ___ 996

615) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

WAIT 1
DOESN'T MATTER 2

616) In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2

617) 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?

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER: ___
OTHER ANSWER (SPECIFY): ___ 96

618) What do you think is the best number of months or years between the birth of one child and the birth of the next child?

MONTHS: ___ 1
YEARS: ___ 2
OTHER (SPECIFY): ___ 996

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

701) CHECK 501 AND 502:

EVER MARRIED OR LIVED TOGETHER: ___ (ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER)
NEVER MARRIED/NEVER LIVED TOGETHER: ___ (GO TO 708)

702) Did your husband/partner go to school?

YES 1
NO 2 (GO TO 705)

703) What is the highest level of school that he reached: primary, post-primary, secondary, or higher?

PRIMARY 1
SECONDARY, FIRST CYCLE 2
SECONDARY, SECOND CYCLE 3
HIGHER 4
DON'T KNOW 8 (GO TO 705)

704) What was the last (grade, year) that he completed at that level?

GRADE: ___
DON'T KNOW 8
CLASSES FOR PRIMARY LEVEL
INTRODUCTORY COURSE 1
PREPARATORY COURSE 2
ELEMENTARY COURSE 1 3
ELEMENTARY COURSE 2 4
MID-LEVEL COURSE 1 5
MID-LEVEL COURSE 2 6
CLASSES FOR SECONDARY, FIRST CYCLE LEVEL
6TH 1
5TH 2
4TH 3
3RD 4
DON'T KNOW 8
CLASSES FOR SECONDARY, SECOND CYCLE LEVEL
2ND 1
1ST 2
FINAL YEAR 3
DON'T KNOW 8
CLASSES FOR HIGHER LEVEL
FIRST YEAR 1
SECOND YEAR 2
THIRD YEAR 3
FOURTH YEAR AND HIGHER 4
DON'T KNOW 8

705) What kind of work does (did) your (last) husband mainly do?

____

706) CHECK 705:

WORKS (WORKED) IN AGRICULTURE: ___
DOES (DID) NOT WORK IN AGRICULTURE: ___ (GO TO 708)

707) (Does/did) your husband/partner work mainly on his own land or family land or someone else's land?

HIS/FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE'S LAND 3

708) Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

709) As you know, some women take up jobs for which there are paid in cash or in kind. Others sell things, have a small business or work on the family farm or in the family business.

Are you currently doing any of these things, or any other work aside from your own housework?

YES 1
NO 2 (GO TO 801)

710) What is your main occupation, that is, what kind of work do you do?

____

711) In your work, do you work for a family member, for someone else, or are you self-employed?

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

712) Do you earn money for this work?
PROBE: Do you make money for working?

YES 1
NO 2

713) Do you do this work at home or away from home?

HOME 1
AWAY 2

714) CHECK 215/216/218: HAS CHILD BORN SINCE JANUARY 1987 AND LIVING AT HOME?

YES: ___
NO: ___ (GO TO 801)

715) While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes with you, or never with you?

USUALLY 1 (GO TO 801)
SOMETIMES 2
NEVER 3

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

HUSBAND/PARTNER 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANT/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY): ___ 09

SECTION 8. MATERNAL MORTALITY

801) Now, I want to ask you questions about your brothers and sisters, that is to say, all children born to your natural mother. Please give me the names of all the brothers and sisters who live with you, those who live elsewhere and those who died.

RECORD THE NAMES OF ALL BROTHERS AND SISTERS.

IF NO BROTHERS OR SISTERS, GO TO 819.

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

NAME: ___

803) Is (NAME) male or female?

MALE 1
FEMALE 2

804) Is (NAME) still alive?

YES 1
NO 2 (GO TO 806)
DON'T KNOW 8 (GO TO NEXT SIBLING)

805) How old is (NAME)?

AGE: ___ (GO TO NEXT SIBLING)

806) How long ago did (NAME) die?

____

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

AGE: ___ (IF MALE OR DIED BEFORE THE AGE OF 15, GO TO NEXT COLUMN)

808) Was (NAME) pregnant when she died?

YES 1 (GO TO 811)
NO 2

809) Did (NAME) die in childbirth?

YES 1 (GO TO 814)
NO 2

810) Did (NAME) die in the two months following the end of pregnancy or of a birth?

YES 1
NO 2 (GO TO 812)

811) Was the death of (NAME) related to pregnancy or delivery complications?

YES 1 (GO TO 814)
NO 2
DON'T KNOW 8

812) CHECK 806-807: DEATH BETWEEN AGES 15 AND 50, AND IN THE PAST 20 YEARS?

YES: ___
NO: ___ (GO TO 814)

813) What did (NAME) die of?

____

814) How many live children did (NAME) give birth to in her lifetime (before this pregnancy)?

NUMBER OF CHILDREN: ___ (GO TO NEXT SIBLING)

815) I want to be sure I understand. In all, your mother gave birth to ___ children, including yourself?

YES: ___
NO: ___ (CHECK AND CORRECT)

816) Of your brothers, ___ have died?

YES: ___
NO: ___ (CHECK AND CORRECT)

817) Of your sisters, ___ have died?

YES: ___
NO: ___ (CHECK AND CORRECT)

818) Are there one or more of your sisters (from your natural mother) over 14 living in this household?

YES: ___ (ASK RESPONDENT WHICH ELIGIBLE WOMEN FROM THE HOUSEHOLD QUESTIONNAIRE ARE HER SISTERS, AND RECORD THEIR LINE NUMBERS BELOW)
LINE NUMBER: ___
NO: ___ (GO TO 819)

819) RECORD TIME

HOUR: ___
MINUTES: ___

SECTION 9. WEIGHT AND HEIGHT

901) CHECK 215, 216:

ONE OR MORE LIVE BIRTHS SINCE JANUARY 1987: ___
NO LIVE BIRTHS SINCE JANUARY 1987: ___ (END INTERVIEW)

INTERVIEWER:

IN 902 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1987 AND STILL ALIVE.

IN 903 AND 904, RECORD THE NAME AND BIRTH DATE OF RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1987.

IN 907 AND 909, RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.

(NOTE: ALL OF THE RESPONDENTS WITH ONE OR MORE BIRTH SINCE JANUARY 1987 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL THEIR CHILDREN HAVE DIED)

(IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1987, USE AN ADDITIONAL FORM)

902) LINE NUMBER FROM QUESTION 212:

LINE NUMBER: ___

903) NAME FROM QUESTION 212 FOR CHILDREN:

NAME: ___

904) BIRTH DATE FROM QUESTION 105 FOR RESPONDENT AND 215 FOR CHILDREN, AND ASK THE DATE OF BIRTH:

MONTH: ___
YEAR: ___

905) Do you/does (NAME) suffer from dundumi?

PROBE: Do you/does (NAME) have trouble seeing in the evening, at night or in a poorly-lit room?

YES 1
NO 2
BLIND 3
DON'T KNOW 8

906) FOR CHILDREN ONLY: BCG SCAR ON LEFT FOREARM?

SCAR SEEN 1
NO SCAR 2

907) HEIGHT (IN CENTIMETERS):

HEIGHT: ___

908) WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP?

LYING DOWN 1
STANDING UP 2

909) WEIGHT (IN KILOGRAMS):

WEIGHT: ___

910) ARM CIRCUMFERENCE (IN CENTIMETERS):

CIRCUMFERENCE: ___

911) DATE WEIGHED AND MEASURED:

DAY: ___
MONTH: ___
YEAR: ___

912) RESULT (WEIGHT AND HEIGHT):

MEASURED 1
CHILD SICK 2
ABSENT 3
REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY): ___ 6

913)

NAME OF MEASURER: ___
NAME OF ASSISTANT: ___
MOTHER 90
OTHER MEMBERS OF HOUSEHOLD 91
OTHER PERSONS 92

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT: ___
COMMENTS ON SPECIFIC QUESTIONS: ____
ANY OTHER COMMENTS: ___

SUPERVISOR'S OBSERVATIONS___
NAME OF SUPERVISOR: ___
DATE: ____

EDITOR'S OBSERVATIONS___

NAME OF EDITOR: ____
DATE: ____