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REPUBLIC OF NIGER 2006
DEMOGRAPHIC AND HEALTH SURVEYS - WOMEN'S QUESTIONNAIRE

NATIONAL INSTITUTE OF STATISTICS
DEMOGRAPHIC AND HEALTH AND MULTIPLE INDICATORS SURVEY (EDSN-MICIII, 2006)

IDENTIFICATION

PLACE NAME __________
CLUSTER NUMBER __________
COMPOUND NUMBER __________
HOUSEHOLD NUMBER ________
REGION __________

FIRST AND LAST NAME OF HEAD OF HOUSEHOLD _____

URBAN/RURAL:

URBAN 1
RURAL 2

NIAMEY/OTHER REGION CAPITAL/OTHER CITY/RURAL:

NIAMEY 1
OTHER REGION CAPITAL 2
OTHER CITY 3
RURAL 4

FIRST AND LAST NAME AND LINE NUMBER OF THE WOMAN ____

HOUSEHOLD SELECTED FOR MAN'S SURVEY?

YES 1
NO 2

INTERVIEWER VISITS

INTERVIEWER 1
DATE _____
DAY _____
MONTH _____
YEAR 2006
INTERVIEWER NAME __________
RESULT * __________

INTERVIEWER 2
DATE _____
DAY _____
MONTH _____
YEAR 1998
INTERVIEWER NAME __________
RESULT * __________

INTERVIEWER 3
DATE _____
DAY _____
MONTH _____
YEAR 1998
INTERVIEWER NAME __________
RESULT * __________

*RESULT CODES:

1 COMPLETED
2 NO HOUSEHOLD MEMBER OR COMPETENT RESPONDENT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
7 OTHER (SPECIFY) __________

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE _____
TIME _____

TOTAL NUMBER OF VISITS ___

LANGUAGE OF QUESTIONNAIRE __________

LANGUAGE OF INTERVIEW:

1 FRENCH
2 HAOUSSA
3 ZARMA
4 TAMASHEQ
5 FULFULDE
6 OTHERS __________

INTERPRETER:

YES 1
NO 2

SUPERVISOR:
NAME ____
DATE ____

FIELD EDITOR
NAME ____
DATE ____

OFFICE EDITOR __________
KEYED BY __________

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS

INTRODUCTION AND CONSENT STATEMENT:

Hello. My name is__ and I work for the National Institute of Statistics. We are conducting a national survey that asks about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and that of your children). This information will be useful to the government for planning health services. The interview usually takes between 1hour and 1 hour and 30 minutes. The information that you give us will be strictly confidential.

Participation in this survey is voluntary and you can refuse to respond to particular questions or to all of the questions. We hope, however, that you will accept to participate in this survey because your opinion is important to the country.

Do you have questions about the survey?
Can I begin the interview now?

THE RESPONDENT ACCEPTS 1 (CONTINUE)
THE RESPONDENT REFUSES 2 (END)

SIGNATURE OF INTERVIEWER __________ DATE _____

101. RECORD THE TIME:

HOUR ___
MINUTES ___

To begin, I would like to ask you questions about yourself and your household.

102. Until the age of 12 years, did you live the majority of the time in Niamey, in another capital, in a city or in a rural area? IF A CITY OR CAPITAL, ASK THE NAME OF THE CITY.

NIAMEY 1

CAPITAL OTHER COUNTRY 2 __________
OTHER CITIES 3 __________
RURAL AREA 4

103. How long have you been living continuously in (NAME OF CURRENT CITY/VILLAGE OF RESIDENCE)? IF LESS THAN A YEAR, WRITE '00'.

IN YEARS ___

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

104. Just before you moved here, did you live in Niamey, another capital, a city, or village?
IF A CITY, ASK THE NAME OF THE CITY.

NIAMEY 1
CAPITAL OTHER COUNTRY 2
OTHER CITIES 3
RURAL AREA 4

105. In which month and in which year were you born?

MONTH ______
DON'T KNOW MONTH 98
YEAR 19___
DON'T KNOW YEAR

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

AGE IN COMPLETED YEARS ___

107. Did you go to school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary, secondary first cycle, secondary second cycle, or superior?

PRIMARY 1 1
SECONDARY FIRST CYCLE 2
SECONDARY SECOND CYCLE 3
SUPERIOR 4

109. What is the last (year/class) that you achieved at this level?

CLASS ___

110. CHECK 108:

PRIMARY 1 (GO TO 111)
SECONDARY OR MORE (GO TO 114)

111. Now I would like you to read this sentence out loud; read as much as you can.

SHOW THE CARD TO THE RESPONDENT (3).

IF THE RESPONDENT CANNOT READ THE WHOLE PHRASE, INSIST: Can you read certain parts of the phrase for me?

CANNOT READ AT ALL 1
CAN READ SOME PARTS 2
CAN READ THE WHOLE PHRASE 3
NO CARD IN THE RIGHT LANGUAGE (SPECIFY LANGUAGE) __________ 4
NO/LOW VISIONS 5

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

YES 1
NO 2

113. CHECK 111:

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

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

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

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

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

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

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

117. During the past 12 months, how many times have you traveled outside of the your locality and slept somewhere besides your home?

NUMBER OF TRIPS ___
NEVER 00 (GO TO 119)

118. During the past 12 months have you been outside of your locality during more than a month at a time?

YES 1
NO 2

119. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) __________ 6

121. What is your ethnicity?
ETHNICITY CODE

ARABE 01
DJERMA/SONGHAI 02
GOURMANTCHE 03
HAOUSSA 04
KANOURI 05
PEUL 06
TOUAREG 07
TOUBOU 08
OTHER (SPECIFY) __________ 96

122. What language do you mostly speak at home?

ARABIC 01
DJERMA/SONGHAI 02
GOURMANTCHE 03
HAOUSSA 04
KANOURI 05
PEUL 06
TOUAREGE 07
TOUBOU 08
OTHER (SPECIFY) __________ 96

SECTION 2. REPRODUCTION

Now I would like to ask about all of the births you have had during your life.

201. 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 and who are now living with you?

YES 1
NO 2 (GO TO 204)

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

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

206. Have you given birth to a son or daughter who was born alive but later died?
IF NO, PROBE: Any who cried and showed signs of live at birth but did not survive?

YES 1
NO 2 (GO TO 208)

207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'.

SONS DEAD ___
DAUGHTERS DEAD ___

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

TOTAL ___

209. CHECK 208: Just to be sure that I have this right: You have had in total ___ births during your life. Is this correct?

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

210 CHECK 208:

ONE OR MORE BIRTH (GO TO 211)
NONE (GO TO 226)

211. Now I would like to make a list of all your births, whether still alive or not, starting with the first one you had.

RECORD THE NAMES OF ALL THE BIRTHS IN QUESTION 212. RECORD ANY PAIRS OF TWINS AND/OR TRIPLETS ON SEPARATE LINES.

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

NAME __________

213. Were any of these births twins?

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?
What is his/her birthday?

MONTH ______
YEAR _____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS ____

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

YES 1
NO 2

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

LINE NUMBER ___ (GO TO 221)

220. (IF DEAD) How old was (NAME) when he/she died?
(IF '1 YEAR') How old was (NAME) in months? (RECORD IN DAYS IF LESS THAN 1 MONTH; IN MONTHS IF LESS THAN 2 YEARS; OR IN 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
NO 2

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

YES 1 (ADD THE BIRTH TO QUESTION 212)
NO 2

223. COMPARE 208 WITH THE NUMBER OF BIRTH RECORDED IN THE ABOVE TABLE AND MARK:

NUMBERS ARE THE SAME ___
CHECK FOR EACH BIRTH: THE YEAR OF BIRTH IS RECORDED ___
CHECK FOR EVERY LIVING CHILD: THE CURRENT AGE IS RECORDED ___
CHECK FOR EACH DECEASED CHILD: THE AGE AT DEATH IS RECORDED ___
CHECK FOR AGE OF DEATH 12 MONTHS OR 1 YEAR, PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS: NO. MONTHS_____

224. CHECK 215 AND RECORD THE NUMBER OF BIRTHS IN 2001 OR LATER. IF NONE, RECORD '0'.

225. FOR EACH BIRTH SINCE JANUARY 2001, WRITE 'N' IN MONTHS OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED AND WRITE 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.

NOTE: THE NUMBER OF 'G'S MUST BE 1 LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. RECORD THE NAME OF THE CHILD LEFT OF THE CODE 'N'. (SEE THE INSTRUCTIONS AT THE END OF THE QUESTIONNAIRE)

226. Are you currently pregnant?

YES 1
NO 2 (GO TO 229)
NOT SURE 8 (GO TO 229)

227. How many months pregnant are you?
RECORD THE NUMBER OF COMPLETED MONTHS. RECORD 'G' IN THE CALENDAR, BEGINNING WITH THE MONTH OF THE SURVEY AND THEN FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ___

228. At the moment you became pregnant, did you want to become pregnant at that time, did you want to wait until later, or did you not want to have any (more) children?

THEN 1
LATER 2
NOT AT ALL 3

229. Have you ever had a pregnancy that ended in a miscarriage, abortion or still birth?

YES 1
NO 2 (GO TO 237)

230 When did the last such pregnancy end?

MONTH _______
YEAR _____

231. CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 2001 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 2001 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED YEARS. RECORD 'F' IN THE CALENDAR IN THE MONTH THE PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS.

MONTHS ___

233. Have you had other pregnancies that did not end in a live birth?

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2001. RECORD 'F' IN THE CALENDAR IN THE MONTH EACH PREGNANCY ENDED, AND 'G' FOR THE REMAINING COMPLETED MONTHS.

235. Have you had a pregnancy that ended before January 2001 that did not end in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such birth end before 2001?

MONTH ______
YEAR _____

237. When did your last menstrual period start?
RECORD THE DATE, IF GIVEN.

DATE, IF GIVEN ____
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO ___
YEARS AGO 4 ___

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE THE LAST BIRTH 995
NEVER MENSTRUATED 996

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

YES 1
NO 2 (GO TO 240)
DON'T KNOW 8 (GO TO 240)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
JUST AFTER THE END OF HER PERIOD 3
HALFWAY BETWEEN 2 PERIODS 4
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

240. Are there children who mainly depend on you?

YES 1
NO 2 (GO TO 301)

241. Among the children who mainly depend on you, are there some who are less than 18 years?

YES 1
NO 2 (GO TO 301)

242. I would now like to talk to you about the children under 18 years who mainly depend on you. Are there or have you made arrangements for someone to take care of these children if you get sick or in the case that you could no longer take care of them?

YES 1
NO 2
NOT SURE 8

SECTION 3. CONTRACEPTION

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).

CIRCLE EACH METHOD (CODE 1) WITH WHICH THE RESPONDENT IS FAMILIAR. ONLY CIRCLE METHODS ANSWERED SPONTANEOUSLY. CONTINUE DOWN COLUMN 302 READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 FOR METHODS WITH WHICH THE RESPONDENT IS FAMILIAR. CIRCLE CODE 3 FOR METHODS WITH WHICH THE RESPONDENT IS UNFAMILIAR.

301. Which methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have ever heard about (METHOD)?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
05. INJECTIONS: Women can have an injection by a health provider to avoid becoming pregnant during one or more months.
YES 1
NO 2 (GO TO NEXT METHOD)
06. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2 (GO TO NEXT METHOD)
07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08. FEMALE CONDOM: Women can place a sheath in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
10. COMPRESS, FOAM OR JELLY: Women can insert a compress, jelly or lotion in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
11. LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after a birth and before her period returns, a woman can use a method consisting of nursing her baby each time that he/she wants, day and night, without ever giving him/her any other food.
YES 1
NO 2 (GO TO NEXT METHOD)
12. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
13. WITHDRAWAL: Men can be careful to pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14. DAY AFTER PILL: Women can take pills days following intercourse until the third day after to avoid getting pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
15. Have you heard of other ways or methods that women or men can use to avoid pregnancy?
YES (SPECIFY) __________ 1
NO 2

302. Have ever used this method?

01. FEMALE STERILIZATION: Women can have an operation to avoid having any more children. Have you ever had an operation to avoid having (other) children?
YES 1
NO 2
02. MALE STERILIZATION: Men can have an operation to avoid having any more children. Has your husband or partner ever had an operation to avoid having (other) children?
YES 1
NO 2
03. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES 1
NO 2
05. INJECTIONS: Women can have an injection by a health provider to avoid becoming pregnant during one or more months.
YES 1
NO 2
06. IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM: Women can place a sheath in their vagina before intercourse.
YES 1
NO 2
09. DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. COMPRESS, FOAM OR JELLY: Women can insert a compress, jelly or lotion in their vagina before intercourse.
YES 1
NO 2
11. LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after a birth and before her period returns, a woman can use a method consisting of nursing her baby each time that he/she wants, day and night, without ever giving him/her any other food.
YES 1
NO 2
12. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by Not having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL: Men can be careful to pull out before climax.
YES 1
NO 2
14. DAY AFTER PILL: Women can take pills days following intercourse until the third day after to avoid getting pregnant.
YES 1
NO 2
15. Have you heard of other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

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

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

YES 1
NO 2 (GO TO 329)

306. What did you do or use?
(CORRECT 302, 303, AND 301 IF NECESSARY)

307 Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

308. CHECK 302 (FEMALE STERILIZATION)

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

309. CHECK 226

NOT PREGNANT OR NOT SURE (GO TO 310)
PREGNANT (GO TO 329)

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

YES 1
NO 2 (GO TO 329)

311. What method(s) are you using?
311A. CIRCLE 'A' IF FEMALE STERILIZATION HAS BEEN USED

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION LIST FOR HIGHEST METHOD ON THE LIST.

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C
IUD D (GO TO 316A)
INJECTIONS E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATIONAL AMENORRHEA METHOD K (GO TO 316A)
RHYTHM METHOD L (GO TO 316A)
WITHDRAWAL M
OTHER (SPECIFY) ___ X

312. Why do you use the pill rather than another method?

COSTS LESS 01
EASIER TO OBTAIN 02
PRESCRIBED TO ME 03
MORE EFFECTIVE 04
NO SIDE EFFECTS 05
I LIKE IT 06
ONLY METHOD I KNOW 07
REVERSIBLE METHOD 08
OTHER (SPECIFY) __________ 96

312A. Can I see the pill box that currently you use?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING CODE.

PLANYL 01 (GO TO 312C)
OVRETTE 02 (GO TO 312C)
LO FEMENAL 03 (GO TO 312C)
MINIDRIL 04 (GO TO 312C)
STEDIDRIL 05 (GO TO 312C)
ADEPAL 06 (GO TO 312C)
MICROGYNON 07
OTHER (SPECIFY) __________ 96 (GO TO 312C)
BOX NOT SEEN 98

312B. What is the name of the brand of pill that you currently use?

PLANYL 01
OVRETTE 02
LO FEMENAL 03
MINIDRIL 04
STEDIDRIL 05
ADEPAL 06
MICROGYNON 07
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

312C. How much does a 3 cycle box of pills cost you?

COST _____ (GO TO 316A)
FREE 9996 (GO TO 316A)
DON'T KNOW 9998 (GO TO 316a)

313. Where did the sterilization take place?

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE AND SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT __________
PUBLIC SECTOR
NATIONAL HOSPITAL 11
INTEGRATED HEALTH CENTER 12
MATERNITY 13
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR 22
OTHER PRIVATE (SPECIFY) __________ 26
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

314. CHECK 311:

CODE 'A' CIRCLED: Before your sterilization, were you told that because of the operation you would Not be able to have any (more) children?

CODE 'B' CIRCLED: Before the operation, was your husband/partner told that he would Not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

316. In which month and in which year did the sterilization occur?

MONTH ______
YEAR _____

316A. Since when did you begin to use (METHOD CITED FIRST IN QUESTION 311) continuously? In which month and in which year did you begin to use (METHOD CITED FIRST IN QUESTION 311) continuously?

MONTH ______
YEAR _____

316B. CHECK 316/316A, 215 AND 230:
WAS THERE IN 215 A BIRTH OR IN 230 AN ENDED PREGNANCY BY A MISCARRIAGE, AND ABORTION OR A STILL BIRTH AFTER THE MONTH AND YEAR OF THE BEGINNING OF USING CONTRACEPTION IN 316/316A?

YES: RETURN TO 316/316A TO CORRECT. PROBE TO RECORD THE MONTH AND YEAR OF THE BEGINNING OF CONTINUOUS USE OF THE CURRENT METHOD (THE DATE MUST BE AFTER THAT OF THE LAST BIRTH OR PREGNANCY)

NO: (GO TO 317)

317. CHECK 316/316A:

THE YEAR IS 2001 OR LATER (GO TO 319)
THE YEAR IS 2000 OR BEFORE (GO TO 327)

319. CHECK 311/311A
CIRCLE THE CODE OF THE METHOD.
IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 320A)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

320. Where did you get (current method) when you started using it?
320A. Where did you learn how to use the Lactational Amenorrhea method?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT __________
PUBLIC SECTOR
NATIONAL HOSPITAL 11
INTEGRATED HEALTH CENTER 12
MATERNITY 13
HEALTH HUT 14
COMMUNITY HEALTH CARE WORKER 15
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
WALKING SALESMAN 24
STREET VENDOR 25
OTHER PRIVATE (SPECIFY) __________ 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
VENDOR 34
FRIEND/ACQUAINTANCE/RELATIVE 35
HOTEL/MOTEL 36
OTHER (SPECIFY) __________ 96

321. CHECK 311/311A: CIRCLE THE CODE OF THE METHOD.
IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07 (GO TO 327)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 325)

322. You obtained (CURRENT METHOD) from (SOURCE IN QUESTION 313 OR 320). At that time, were you told about the side effects or problems you might have with the method?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2 (GO TO 325)

324. Did someone tell you what you should do if you experienced secondary effects or if you had problems?

YES 1
NO 2

325. CHECK 322

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

CODE '1' NOT CIRCLED: When you obtained (current method) from (source of method from Question 313 or 320), did anyone talk to you about other methods of family planning that you could use?

YES 1 (GO TO 327)
NO 2

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

YES 1
NO 2

327. CHECK 311/311A
CIRCLE THE CODE OF THE METHOD: IF MORE THAN ONE METHOD CIRCLED IN 311/311A, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTIONS 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATION AMENORRHEA METHOD 11 (GO TO 331)
RHYTHM METHOD 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

328. Where did you get (the current method) the last time?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT __________
PUBLIC SECTOR
NATIONAL HOSPITAL 11 (GO TO 331)
INTEGRATED HEALTH CENTER 12 (GO TO 331)
MATERNITY 13 (GO TO 331)
HEALTH HUT 14 (GO TO 331)
COMMUNITY HEALTH CARE WORKER 15 (GO TO 331)
OTHER PUBLIC (SPECIFY) __________ 16 (GO TO 331)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/ DOCTOR 21 (GO TO 331)
PHARMACY 22 (GO TO 331)
WALKING SALESMAN 23 (GO TO 331)
STREET VENDOR 24 (GO TO 331)
OTHER PRIVATE (SPECIFY) __________ 26 (GO TO 331)
OTHER SOURCE
SHOP 31 (GO TO 331)
BAR/NIGHTCLUB 32 (GO TO 331)
KIOSK 33 (GO TO 331)
VENDOR 34 (GO TO 331)
FRIEND/ACQUAINTANCE/RELATIVE 35 (GO TO 331)
HOTEL/MOTEL 36 (GO TO 331)
OTHER (SPECIFY) __________ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is this place?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT __________
PUBLIC SECTOR
NATIONAL HOSPITAL A
INTEGRATED HEALTH CENTER B
MATERNITY C
HEALTH HUT D
COMMUNITY HEALTH CARE WORKER E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
WALKING SALESMAN I
STREET VENDOR J
OTHER PRIVATE (SPECIFY) __________ K
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
VENDOR P
FRIEND/ACQUAINTANCE/RELATIVE Q
HOTEL/MOTEL R
OTHER (SPECIFY) __________ X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREAST FEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 2001 OR LATER (GO TO 402)
NO BIRTHS IN 2001 OR LATER (GO TO 487)

402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM LINE QUESTION 212

LAST BIRTH ___

404. FROM LINE 212 AND 216:

NAME __________
LIVING __________
DEAD __________

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

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

406. How much time would you have liked to wait?

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

407. For the last pregnancy, did you receive prenatal care? IF YES, whom did you see? Anyone else?

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

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT/DOULA E
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
OTHER (SPECIFY) ___ X
NO One Y (GO TO 415)

408. How many months pregnant were you when you had your first prenatal consultation?

MONTHS ___
DON'T KNOW 98

409. How many times did you get consultation during this pregnancy?

NUMBER OF TIMES ___
DON'T KNOW 98

410. CHECK 409: NUMBER OF PRENATAL CONSULTATIONS RECEIVED

ONE TIME ___ (GO TO 412)
MORE THAN ONE TIME ___ (GO TO 411)

411. How many months were you pregnant the last time you received prenatal care?

MONTHS ___
DON'T KNOW 98

412. During your pregnancy did you have the following tests at least once?

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Did they take your blood pressure?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

413. Did they talk to you about signs of complications to the pregnancy?

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8 (GO TO 415)

414. Were you told where to go if you had these complications?

YES 1
NO 2
DON'T KNOW 8

415. During the course of this pregnancy, did they give you an injection in the arm to keep the baby from getting tetanus, that is to say convulsions after birth?

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

416. How many times during this pregnancy did you have this injection?

NUMBER OF TIMES ___
DON'T KNOW 8

417. During this pregnancy were you given or did you buy iron tablets?
(ASK TO SEE TABLETS)

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

418. During the whole pregnancy, for how many days did you take the tablets?
IF THE ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS ___
DON'T KNOW 998

419. During this pregnancy, did you have difficulty with your vision during daylight?

YES 1
NO 2
DON'T KNOW 8

420. During this pregnancy did you suffer from night blindness?

YES 1
NO 2
DON'T KNOW 8

421. During this pregnancy did you take any drugs to keep from getting malaria?

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

422. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO THE RESPONDENT.

FANSIDAR/MALOXINE/SP A
CHLOROQUINE B
AMODIAQUINE/CAMOQUINE C
QUININE D
UNKNOWN MEDICINE Z
OTHER (SPECIFY) __________ X

422A. CHECK 422
CHECK THE TYPE OF MEDICINE TAKEN FOR MALARIA PREVENTION.

CODE 'A' CIRCLED (GO TO 422B)
CODE 'A' NOT CIRCLED (GO TO 422e)

422B. How many times did you take fansidar/maloxine during this pregnancy?

NUMBER OF TIMES ___

422C. CHECK 407: CHECK THE PRENATAL CARE DURING THIS PREGNANCY.

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

422D. When you were pregnant with (name of most recent birth), did you get the medicine fansidar/maloxine during a prenatal visit, during another visit in a health facility, or from another source?

PRENATAL VISIT 1
OTHER MEDICAL VISIT 2
OTHER SOURCE (SPECIFY) __________ 6

422E. CHECK 422: CHECK THE TYPE OF MEDICINE TAKEN DURING THE PREGNANCY FOR MALARIA PREVENTION.

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

422F. How many times did you take the medicine chloroquine during this pregnancy (for the most recent birth)

NUMBER OF TIMES ___

422G. CHECK 407: CHECK PRENATAL CARE DURING THIS PREGNANCY.

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

422H. When you were pregnant with (NAME), did you get the medicine chloroquine during a prenatal visit, during another visit in a health facility, or from another source?

PRENATAL VISIT 1
OTHER MEDICAL VISIT 2
OTHER SOURCE (SPECIFY) __________ 6

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

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

424. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 425a)
DON'T KNOW 8 (GO TO 425a)

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

GRAMS FROM CARD 1 ___
GRAMS FROM MEMORY 2 ___
DON'T KNOW 99998

425A. Does (NAME) have a birth certificate?
If not, was the birth of (NAME) registered with the state?

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

425B. Why wasn't the birth of (NAME) registered?

COST 1
DISTANCE 2
LATENESS 3
NOT INFORMED 4
NOT NECESSARY 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

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

PROBE TO 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 A
MIDWIFE B
NURSE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT E
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
OTHER (SPECIFY) _____ X
NO ONE Y

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

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE AND SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT __________
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
HOSPITAL 21
MATERNITY 22
HEALTH CENTER 23
HEALTH HUT 24
OTHER PUBLIC (SPECIFY) __________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE MATERNITY 32
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER (SPECIFY) __________ 96 (GO TO 429)

427A. At the time of (NAME)'s birth did you have any of the following problems:

A long labor, in other words regular contractions lasting more than 12 hours?
YES 1
NO 2
Enough bleeding that you thought that your life was in danger?
YES 1
NO 2
A high fever accompanied with bad smelling vaginal discharge?
YES 1
NO 2
Convulsions not caused by fever?
YES 1
NO 2

428. Was (NAME) delivered by caesarean section?

YES 1 (GO TO 433 FOR MOST RECENT BIRTH, AND TO 435 FOR PREVIOUS BIRTHS)

NO 2 (GO TO 433 FOR MOST RECENT BIRTH AND TO 435 FOR PREVIOUS BIRTHS)

429. After (NAME)'s birth, were you examined by a health professional or a village birth attendant?

YES 1
NO 2 (GO TO 433 ONLY FOR THE MOST RECENT BIRTH)

430. How many days or weeks after delivery did you have your first health checkup?
RECORD '00' IF YOU HAD ONE ON THE SAME DAY.

DAYS AFTER BIRTH 1 ___
WEEKS AFTER BIRTH 2 ___
DON'T KNOW 998

431. Who examined you at this time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT/DOULA E
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
OTHER (SPECIFY) __________ X
NO ONE Y

432. Where did this first health exam take place?

IF IT WAS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE AND SECTOR, AND CIRCLE THE APPROPRIATE CODE.

NAME OF THE ESTABLISHMENT __________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL 21
HEALTH CENTER 22
HEALTH HUT 23
OTHER PUBLIC (SPECIFY) __________ 26
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE MATERNITY 32
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER (SPECIFY) __________ 96

433. In the two months that followed the birth, did you receive a dose of vitamin A like this one? SHOW THE PILL.

YES 1
NO 2
DON'T KNOW 8

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

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

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

YES 1
NO 2 (GO TO 439)
MULTIPLE BIRTH 3 (GO TO 439)

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

MONTHS ___
DON'T KNOW 98

437. CHECK 226: IS RESPONDENT PREGNANT?

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

438. Have you begun to have sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 440)

439. For how many months after (NAME)'s birth did you not have sexual intercourse?

MONTHS ___
DON'T KNOW 98

440. Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

44.1 How long after birth did you first put (NAME) to the breast?
(IF LESS THAN ONE HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD NUMBER OF HOURS; OTHERWISE RECORD IN DAYS)

IMMEDIATELY 000
HOURS 1 ___
DAYS 2 ___

442. In the 3 days following birth and before your breasts began to produce milk regularly, did (NAME) drink something besides breast milk?

YES 1
NO 2 (GO TO 444)

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

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

444. CHECK 404:
IS THIS A LIVING CHILD?

ALIVE ___ (GO TO 445)
DECEASED ___ (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS ___
DON'T KNOW 98

447. CHECK 202:
IS THIS A LIVING CHILD?

ALIVE (GO TO 450)
DECEASED (RETURN TO 405, FOLLOWING COLUMN, OR IF MORE BIRTHS SKIP TO 454)

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

NUMBER OF NIGHTTIME FEEDINGS ___

449. Yesterday, how many times did you breastfeed during the day?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYTIME FEEDINGS ___

450. Did (NAME) drink something from a bottle yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

451. Was sugar added to any food or liquid given to (NAME) yesterday?

YES 1
NO 2
DON'T KNOW 8

452. Yesterday, during the day or night, how many times was (NAME) fed purees or solid food or semi-solid food? If 7 times or more, mark '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

453. RETURN TO 405 IN THE NEXT COLUMN OR THE NEXT TO LAST COLUMN ON A NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, SKIP TO 454.

SECTION 4B. VACCINATION, HEALTH, AND NUTRITION

454. RECORD THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST 2 LINES OF ADDITIONAL QUESTIONNAIRES)

455. LINE NUMBER FROM 212:

LINE NUMBER ___

456. FROM 212 AND 216:

NAME ___
LIVING (GO TO 457)
DEAD (GO TO NEXT COLUMN OR IF NO MORE BIRTHS, SKIP TO 484)

457. Did (NAME) get a dose of vitamin A, like this one, during the past 6 months?
(SHOW THE PILL)

YES 1
NO 2
DON'T KNOW 8

458. Do you have a card where (NAME)'s vaccinations are written down?
If YES, may I see it please?

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

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

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

460. (1) COPY THE DATES FOR EACH VACCINATION FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF THE CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NOD ATE IS RECORDED.

BCG
DAY ___
MONTH ___
YEAR ___
POLIO 0 (GIVEN AT BIRTH)
DAY ___
MONTH ___
YEAR ___
POLIO 1
DAY ___
MONTH ___
YEAR ___
POLIO 2
DAY ___
MONTH ___
YEAR ___
POLIO 3
DAY ___
MONTH ___
YEAR ___
DPT
DAY ___
MONTH ___
YEAR ___
DPT 2
DAY ___
MONTH ___
YEAR ___
DPT 3
DAY ___
MONTH ___
YEAR ___
MEASLES
DAY ___
MONTH ___
YEAR ___
YELLOW FEVER
DAY ___
MONTH ___
YEAR ___
VITAMIN A (MOST RECENT)
DAY ___
MONTH ___
YEAR ___

461. Has (NAME) received any immunizations not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS: BCG, POLIO 0-3, DPT 1-3, MEASLES, AND/OR YELLOW FEVER VACCINES.

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

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

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

463. Tell me, please, if (NAME) received one of the following vaccinations.

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

YES 1
NO 2
DON'T KNOW 8

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

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

463C. Was the first vaccine for polio received right after birth or Not?

JUST AFTER BIRTH 1
LATER 2
DON'T KNOW 8

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

NUMBER OF TIMES ___

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

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

463F. How many times?

NUMBER OF TIMES ___

463G. An injection against the measles?

YES 1
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

463H. An injection against yellow fever?

YES 1
NO 2
DON'T KNOW 3

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

YES 1
NO 2 (GO TO 466)
NO VACCINATIONS IN THE PAST 2 YEARS 3 (GO TO 466)
DON'T KNOW 8 (GO TO 466)

465. At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL MENTIONED CAMPAIGNS.

NAME OF CAMPAIGN _____
POLIO/VITAMIN A, 2005 (1) A
POLIO/VITAMIN A, 2005 (2) B
MEASLES, 2004 C
MEASLES, 2005 D
POLIO, 2004 E
OTHER __________ X

466. Has (NAME) suffered from a fever, at any moment, during the past two weeks?

YES 1
NO 2
DON'T KNOW 8

467. Has (NAME) suffered from a cough, at any moment, during the past two weeks?

YES 1
NO 2 (GO TO 469)
DON'T KNOW 8 (GO TO 469)

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

YES 1
NO 2
DON'T KNOW 8

469. CHECK 466 AND 467:
FEVER OR COUGH?

'YES' TO 466 OR 467 (GO TO 470)
OTHER (GO TO 475)

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

YES 1
NO 2 (GO TO 472)

471. Where did you seek advice or treatment?
Where else?

RECORD EVERYTHING MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
MATERNITY C
FAMILY HEALTH CENTER D
HEALTH HUT E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
PHARMACY I
WALKING SALESMAN J
OTHER PRIVATE (SPECIFY) __________ K
OTHER SOURCE
SHOP L
TRADITIONAL HEALER M
OTHER (SPECIFY) __________ X

472. CHECK 466:
HAD A FEVER?

'YES' TO 466 (GO TO 472A)
'NO' OR 'DON'T KNOW' 466, (GO TO 475)

472A. Does (NAME) have a fever currently?

YES 1
NO 2
DON'T KNOW 8

472B. Did (NAME) have convulsions at any time during the past two weeks?

YES 1
NO 2
DON'T KNOW 8

472C. CHECK 466 AND 472B
FEVER OR CONVULSIONS?

'YES' TO 466 AND 472B (GO TO 473)
OTHER (GO TO 475)

473. Did (NAME) take medicine for the fever?

YES 1
NO 2 (GO TO 474r)
DON'T KNOW 8 (GO TO 474r)

474. Which medicine did (NAME) take?

RECORD EVERYTHING THAT IS MENTIONED. ASK TO SEE THE MEDICINE IF THE TYPE OF MEDICINE IS NOT KNOWN. IF THE TYPE OF MEDICINE CANNOT BE DETERMINED, SHOW SOME COMMON ANTI-MALARIA MEDICINES TO THE RESPONDENT.

ANTI-MALARIA
FANSIDAR/MALOXINE/SP A
CHLOROQUINE B
AMODIAQUINE/CAMOQUIN C
QUININE D
OTHER
ASPIRIN/PARACETAMOL E
PANADOL F
IBUPROPHEN/ACETAMINOPHEN G
OTHER (SPECIFY) __________ X
DON'T KNOW Z

474A. Did (NAME) have an injection or suppository to treat the fever/convulsions?

INJECTION A
SUPPOSITORY B
NEITHER Y
DON'T KNOW Z

474B. CHECK 474
TYPE OF MEDICINE?

CODE 'A' CIRCLED (GO TO 474C)
CODE 'A' NOT CIRCLED (GO TO 474F)

474C. How long after the beginning of the fever/convulsions did (NAME) begin to take Fansidar/Maloxine?

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

474D. For how many consecutive days did (NAME) take Fansidar/Maloxine?
IF MORE THAN 7 DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

474E Did you have the Fansidar/Maloxine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Fansidar/Malodine the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474F. CHECK 474
TYPE OF MEDICINE?

CODE 'B' CIRCLED (GO TO 474G)
CODE 'B' NOT CIRCLED (GO TO 474J)

474G. How long after the beginning of (the fever/convulsions) did (NAME) begin to take Chloroquine?

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

474H. For how many consecutive days did (NAME) take Chloroquine?
IF MORE THAN 7 DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

474I. Did you have the Chloroquine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: WHERE did you get the Chloroquine the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474F. CHECK 474:
TYPE OF MEDICINE?

CODE 'C' CIRCLED (GO TO 474K)
CODE 'C' NOT CIRCLED (GO TO 474N)

474K. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
Amodiaquin/Camoquin?

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

474L. For how many consecutive days did (NAME) take Amodiaquin/Camoquin?
IF MORE THAN 7 DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

474M. Did you have the Amodiaquin/Camoquin at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Amodiaquin/Camoquin the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474N. CHECK 474:
TYPE OF MEDICINE?

CODE 'D' CIRCLED (GO TO 474O)
CODE 'D' NOT CIRCLED (GO TO 474r)

474O. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
quinine?

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

474P. For how many consecutive days did (NAME) take quinine?
IF TAKEN MORE THAN 7 DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

474Q. Did you have the quinine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the quinine the first time?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474R. Was something else done to treat (NAME)'s (fever/convulsions)?

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

474S. What was done to treat (NAME)'s (fever/convulsions)?
Something else?

RECORD EVERYTHING MENTIONED.

CONSULTED A TRADITIONAL HEALER A
SWABBED WITH MOIST COMPRESSES B
GIVEN MEDICINAL PLANTS C
OTHER (SPECIFY) __________ X

475. Has (NAME) had diarrhea during the past two weeks?

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

476. Now I would like to know how much liquid was given to (NAME) during his/her diarrhea. Did you give him/her less or more to drink than usual?
If less, did you give him a lot or a little less than usual to drink?

A LOT LESS 1
A LITTLE LESS 2
ABOUT THE SAME AMOUNT 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

477. When (NAME) had diarrhea did you give him/her less to eat than usual, about the same amount, more than usual or nothing to eat?
If less, did you give him/her a lot less to eat or a little less than usual?

A LOT LESS 1
A LITTLE LESS 2
ABOUT THE SAME AMOUNT 3
MORE 4
STOPPED FOOD 5
NEVER FED 6
DON'T KNOW 8

478. Did you give him/her any of the following things to drink?

A liquid prepared from an ORS packet?
YES 1
NO 2
DON'T KNOW 8
A homemade liquid recommended by the government?
YES 1
NO 2
DON'T KNOW 8

479. Was something (else) given to treat diarrhea?

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

480. What else was given to treat diarrhea?
Something else?

RECORD EVERYTHING MENTIONED.

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS C
HOMEMADE REMEDIES/PLANTS D
OTHER (SPECIFY) __________ X

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

YES 1
NO 2 (GO TO 483)

482. Where did you seek advice or treatment for the diarrhea?
Anywhere else? RECORD EVERYTHING MENTIONED.

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE(S).

PLACE NAME __________
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
HEALTH HUT C
COMMUNITY HEALTH CARE WORKER D
OTHER PUBLIC (SPECIFY) __________ E
PRIVATE SECTOR
PRIVATE/HOSPITAL CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY) __________ I
OTHER SOURCE
SHOP/KIOSK J
TRADITIONAL HEALER K
WALKING SALESMAN L
OTHER (SPECIFY) __________ X

483. RETURN TO 456 IN THE FOLLOWING COLUMN. (IF NO MORE BIRTHS, GO TO 484)

484. CHECK 215 AND 218, ALL LINES:
NUMBER OF CHILDREN BORN IN 2001 OR LATER AND LIVING WITH THE RESPONDENT

ONE OR MORE (GO TO 485)
NO (GO TO 487)

485. What do you usually do with the excrements of your (youngest) child when he/she does not use the toilet facility?

ALWAYS USES THE TOILET/LATRINE 01
THROW IT IN THE TOILET/LATRINE 02
THROW IT OUTSIDE OF THE DWELLING 03
THROW IT OUTSIDE OF THE YARD 04
BURY IT IN THE YARD 05
GET RID OF IT BY WASHING IT AWAY WITH WATER 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
DO NOT GET RID OF IT 09
OTHER (SPECIFY) __________ 96

486. CHECK 478A, ALL OF THE COLUMNS:

NO CHILD RECEIVED ORS PACKET OR THE QUESTION WASN'T ASKED (GO TO 487)

A CHILD RECEIVED ORS PACKETS 487A

487. Have you ever heard of a special product called ORS, for example Orasel/kenèyaji, that you can get to treat diarrhea?

YES 1
NO 2 (GO TO 488)

487A. Do you have an ORS packet at home?

YES 1
NO 2 (GO TO 488)

487B. Can I see the ORS packet that you have?
(LOOK FOR THE BRAND OF THE ORS PACKET)

ORASEL 1 (GO TO 487D)
ORS UNICEF 2 (GO TO 487D)
ORS USAID 3 (GO TO 487D)
ORS CHINESE 4 (GO TO 487d)
OTHER (SPECIFY) __________ 6
PACKET NOT SEEN 8

487C. Do you know the brand name of ORS that you currently have?

ORASEL 1
ORS UNICEF 2
ORS USAID 3
ORS CHINESE 4
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

487D. How much did the ORS packet that you currently have cost you?

COST _____
FREE 995
DON'T KNOW 998

488. CHECK 318:

ONE OR MORE CHILDREN LIVING WITH HER (GO TO 489)
NO CHILDREN LIVING WITH HER (GO TO 490)

489. When (your child/one of your children) is seriously ill, can you, yourself, decide if he should be brought somewhere for medical treatment?

IF THE RESPONDENT RESPONDS THAT NO CHILD HAS EVER BEEN SERIOUSLY ILL, ASK: IF (your child/one of your children) becomes seriously ill, can you, yourself, decide if he should be brought somewhere for medical treatment?

YES 1
NO 2
IT DEPENDS 3

490 Now I would like to ask you questions about your own medical care.
Different reasons can prevent women from getting advice or medical treatment for themselves. When you are sick and want advice or medical treatment, do the following things pose a problem for you or not?

Knowing where to go?
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting permission to go?
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting the necessary money for the treatment?
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not having a medical establishment nearby?
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
Needing to take a mode of transport?
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
A BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having a concern that there are NO female personnel?
A BIG PROBLEM 1
NOT A BIG PROBLEM 2

491. CHECK 215 AND 218:
AT LEAST ONE CHILD WAS BORN IN 2004 OR LATER, AND IS LIVING WITH HER.
(RECORD THE NAME OF THE CHILD LIVING WITH HER AND CONTINUE TO 492)

NAME __________

NO CHILD BORN IN 2004 OR LATER, AND NO CHILD LIVING WITH HER (GO TO 495)

492. Now I would like to ask you what liquid (NAME IN QUESTION 491) drank during the past 7 days including yesterday. How many days, during the past 7 days, did (NAME IN QUESTION 491) drink one or more of the following liquids?

FOR EACH LIQUID CONSUMED AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK: In all, during the day or night how many times did (name in Question 491) did he/she drink?

IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

Water?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Baby formula?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Any other type of milk, like milk from a container, in powder, or fresh milk from an animal?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Fruit juice?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Other liquids such as sugar water, tea, coffee, carbonated drinks, or broths?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___

Now I would like to ask you what food(s) (NAME IN QUESTION 491) was given during the past 7 days, including yesterday.

493. How many days, during the past 7 days, (NAME IN QUESTION 491) did he/she get the following foods?

FOR EACH FOOD GIVEN, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK: In total, yesterday, during the day and night how many times did (NAME IN QUESTION 491) receive (KIND OF FOOD)?

IF 7 TIMES OR MORE, RECORD '7'.
IF DON'T KNOW, RECORD '8'.

Rice, corn, millet, sorghum or other grains?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Pumpkin, yam or yellow or red squash, carrots, or red sweet potatoes?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Other foods from roots (for example: potatoes, white yam, manioc, white sweet potatoes, other local foods from roots)?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Any green leafy vegetables?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Mango, papaya?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Any other fruit or vegetable? (for example: banana, apple, apple sauce, green beans, avocado, tomato)?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Meat, poultry, fish, shellfish, eggs?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Other vegetable foods (for example: lentils, beans, soy, or nuts)?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Cheese or yogurt?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___
Any food prepared with oil, fat or butter?
NUMBER OF DAYS IN THE PAST 7 DAYS ___
YESTERDAY/LAST NIGHT ___
NUMBER OF TIMES DURING THE DAY OR NIGHT ___

495. The last time you prepared a meal for your family did you wash your hands before beginning?

YES 1
NO 2
HAS NEVER PREPARED A MEAL 3

496. Do you currently smoke cigarettes or chew tobacco?
If YES, what do you usually smoke/chew?
RECORD EVERYTHING MENTIONED.

YES, CIGARETTES A
YES, PIPE B (GO TO 499B)
YES, OTHER TOBACCO C (GO TO 499B)
NO 2 (GO TO 499B)

498. In the past 24 hours, how many cigarettes did you smoke?

CIGARETTES ___

499B. I would now like to ask you ask you a few questions about your health during the past 6 months. During the past 6 months, have you had an injection for any reason?
If YES, how many injections did you have?
If the number of injections is more than 94 or if the injections were daily during 3 months or more, record '95'.
If the response is Not numeric, probe to get an estimate.

Number of injections ___
None 00 (GO TO 501)

499C. Among these injections, how many were given by a doctor, nurse, pharmacist, dentist or other health worker?

IF THE NUMBER OF INJECTIONS IS MORE THAN '94', OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 501)

499D. The last time you had an injection, where did you go to get it?

PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
HEALTH HUT 13
OTHER PUBLIC (SPECIFY) ___ 16
PRIVATE SECTOR MEDICAL
PRIVATE HOSPITAL/CLINIC/DOCTOR 21
DENTIST 22
PHARMACY 23
PRIVATE OFFICE/NURSE'S HOME/HEALTH WORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) ___ 26
OTHER PLACE
HOME 31
OTHER (SPECIFY) __________ 96

499E. The last time you had an injection, did the person who administered the shot take the syringe or needle from a new unopened package?

YES 1
NO 2
DON'T KNOW 8

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or do you live with a man as if you were married?

YES, CURRENTLY MARRIED 1 (GO TO 504)
YES, CURRENTLY LIVING WITH A MAN 2 (GO TO 504)
NO, NOT IN UNION 3

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

YES, HAS BEEN MARRIED 1
YES, HAS LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 518)

503. What is your current marital status: are you widowed, divorced or separated?

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

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

LIVE TOGETHER 1
LIVES ELSEWHERE 2

505. 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 _____

506. How old was your husband/partner at his last birthday?

AGE IN COMPLETED YEARS ___

507. Besides yourself, does your husband/partner have other wives or does he live with other women as if he were married?

YES 1
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)

508. Counting yourself, how many wives or partners does your husband currently have?

NUMBER OF WIVES OR PARTNERS ___
DON'T KNOW 98

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

RANK ___

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

ONLY ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

MARRIED OR HAS LIVED WITH ONE MAN ONLY ONCE: In which month and in which year did you begin to live with your husband or partner?

MARRIED OR HAS LIVED WITH ONE MAN MORE THAN ONCE: I would like to ask about when you started living with your first husband/partner. In what month and year was that?

MONTH ___
DON'T KNOW MONTH 98
YEAR _____ (GO TO 512A)
DON'T KNOW YEAR 9998

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

AGE ___

513. CHECK 503:
IS THE RESPONDENT CURRENTLY A WIDOW?

NOT ASKED OR NOT WIDOW (GO TO 514)
WIDOW (GO TO 516)

514. CHECK 510:

MARRIED MORE THAN ONCE (GO TO 515)
MARRIED ONCE (GO TO 518)

515. How did your last union/marriage end?

DEATH/WIDOWHOOD 1
DIVORCE 2 (GO TO 518)
SEPARATION 3 (GO TO 518)

516. Who got the largest part of the belongings your husband possessed?

RESPONDENT 1 (GO TO 518)
OTHER SPOUSE 2
CHILDREN OF THE HUSBAND 3
FAMILY OF THE HUSBAND 4
OTHER (SPECIFY) __________ 5
NO BELONGINGS 6

517. Did you receive goods or valuables from your last husband?

YES 1
NO 2

518. CHECK THE PRESENCE OF OTHER PEOPLE.
(BEFORE CONTINUING, DO YOUR BEST TO GO TO A PRIVATE PLACE)

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

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

NEVER 00
AGE IN YEARS ___ (GO TO 521)
FIRST TIME AFTER BEGINNING TO LIVE WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 521)

520. Do you intend to wait until marriage to start having sex?

YES 1 (GO TO 544)
NO 2 (GO TO 544)
DON'T KNOW/NOT SURE 8 (GO TO 544)

521. CHECK 106:

15-24 YEARS (GO TO 522)
25-49 YEARS (GO TO 526)

522. The first time you had sexual intercourse was a condom used?

YES 1
NO 2
DOESN'T REMEMBER 8

523. How old was the person with whom you had sexual intercourse for the first time?

AGE OF PARTNER ___ (GO TO 526)
DON'T KNOW 98

524. Was this person older than you, younger or about the same age?

OLDER 1
YOUNGER 2 (GO TO 526)
SAME AGE 3 (GO TO 526)
Doesn't remember 8 (GO TO 526)

525. Would you say that this person was 10 more years older than you or less than 10 years older than you?

10 YEARS OR MORE 1
LESS THAN 10 YEARS 2
OLDER, DON'T KNOW HOW MUCH 3

526. When did you last have sexual intercourse?
IF IT WAS 12 MONTHS AGO OR MORE, THE ANSWER MUST BE CONVERTED AND RECORDED IN YEARS.

DAYS AGO ____ 1
WEEKS AGO ____ 2
MONTHS AGO ____ 3
YEARS AGO 4 ____ (GO TO 539)

527. Was a condom used the last time you had sexual intercourse with this (second, third) person? (BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

YES 1
NO 2 (GO TO 529)

528. Did you use a condom each time you had sexual intercourse during the past 12 months?
(BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

YES 1
NO 2

529. The last time you had sexual intercourse with this (second, third) person, had you consumed alcohol? (BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

YES 1
NO 2 (GO TO 531)

530. Was this person or were you yourself drunk at that time?
If YES, who was drunk?

(BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

ONLY THE RESPONDENT 1
ONLY THE PARTNER 2
THE RESPONDENT AND HER PARTNER 3
NEITHER 4

531. What was your relationship with this person with whom you had sexual intercourse?
If Boyfriend, did you live together as if you were married?

(BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

IF YES, CIRCLE '02'.
IF NO, CIRCLE '03'.

HUSBAND 01 (GO TO 537)
PARTNER LIVING WITH RESPONDENT 02 (GO TO 537)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
CAUSAL ACQUAINTANCE 04
PROSTITUTE 05
OTHER (SPECIFY) __________ 96

532. For how long have you had/did you have sexual intercourse with this person?

(IF THE RESPONDENT HAD SEXUAL INTERCOURSE ONLY ONCE WITH THIS PERSON RECORD '01', AND BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

533. CHECK 106:
(BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

15-24 YEARS (GO TO 534)
25-49 YEARS (GO TO 537)

534. How old is this person?
(BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

PARTNER'S AGE ___ (GO TO 537)
DON'T KNOW 98

535. Was this person older than you, younger or about the same age?
(BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

OLDER 1
YOUNGER 2 (GO TO 537)
SAME AGE 3 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

536. Would you say that this person was 10 more years older than you or less than 10 years older than you? (BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

10 YEARS OR MORE 1
LESS THAN 10 YEARS 2
OLDER, DON'T KNOW HOW MUCH 3

537. Apart from this/these two person(s) did you have sexual intercourse with anyone else during the past 12 months? (BEGIN WITH THE MOST RECENT PARTNER AND REPEAT FOR THE SECOND-TO-LAST AND THIRD-TO-LAST PARTNER)

YES 1 (RETURN TO 527)
NO 2 (GO TO 539)

538. In all, how many different people did you have sexual intercourse with during the past 12 months?

IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95'.

NUMBER OF PARTNERS ___
DON'T KNOW 98

539. In all, how many different people did you have sexual intercourse with in your life?

IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95'.

NUMBER OF PARTNERS ___
DON'T KNOW 98

540. CHECK THE COVER PAGE:
HOUSEHOLD SELECTED FOR MAN'S SURVEY?

NO (GO TO 541)
YES (GO TO 544)

541. CHECK THE PRESENCE OF OTHER PEOPLE
DO NOT CONTINUE IF YOU ARE NOT IN PRIVATE WITH THE RESPONDENT.

PRIVACY ACHIEVED 1
PRIVACY IMPOSSIBLE 2 (GO TO 544)

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

WANTED 1
WAS FORCED 2
REFUSED TO RESPOND/NO RESPONSE 3

543. During the past 12 months, did someone force you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO RESPOND/NO RESPONSE 3

544. Do you know a place where one could procure condoms?

YES 1
NO 2 (GO TO 601)

545. Where is this?

IF THE PLACE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE __________
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
HEALTH HUT C
FAMILY PLANNING CLINIC D
COMMUNITY HEALTH AGENT E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY I
DOCTOR'S OFFICE J
WALKING SALESMAN K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
WALKING SALESMAN/CART P
FRIEND/ACQUAINTANCE/RELATIVE Q
HOTEL/MOTEL R
OTHER (SPECIFY) __________ X

546. If you wanted to, could you procure a condom?

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

547. CHECK 527 ALL OF THE COLUMNS:

AT LEAST ONE 'YES' (GO TO 548)
OTHER (GO TO 601)

548. Where did you get the condoms last time?

IF THE PLACE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE __________
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
HEALTH HUT 13
FAMILY PLANNING CLINIC 14
COMMUNITY HEALTH AGENT 15
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
DOCTOR'S OFFICE 24
WALKING SALESMAN 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
WALKING SALESMAN/CART 34
FRIEND/ACQUAINTANCE/RELATIVE 35
HOTEL/MOTEL 36
PARTNER HAD THE CONDOM 41 (GO TO 601)
OTHER (SPECIFY) __________ X
DON'T KNOW 98

549. Do you know the brand name of the condoms that you used last time?

VISA 1
ROMED 2
DUMPER 3
CAREX 4
SULTAN 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

550. The last time you bought condoms, how many did you buy?

NUMBER OF CONDOMS ___
DON'T KNOW 98
NEVER BOUGHT CONDOMS 99 (GO TO 601)

551. How much did you pay?

COST ___
DON'T KNOW 9998

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

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

602. CHECK 226:

NOT PREGNANT OR NOT SURE: Now I have a few questions about the future. Would you 819like to have (a/another) child, or would you prefer not to have (other) children at all?

PREGNANT: Now I have a few questions about the future. After the child that you are expecting, would you like to have (a/another) child, or would you prefer not to have (other) children at all?

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

603. CHECK 226:

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

MONTHS 1 ___
YEARS 2 ___

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

604. CHECK 226:

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

605. CHECK 310:
USES A METHOD?

NOT ASKED (GO TO 606)
DOES NOT CURRENTLY USE (GO TO 606)
CURRENTLY USES (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 MONTHS OR MORE OR 2 YEARS OR MORE (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

WANTS A/ANOTHER CHILD: You said that right Now, you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why? Any other reason?

DOES NOT WANT A/ANOTHER CHILD: You said that you do Not want to have a/another child, but you do Not use a method of avoiding pregnancy. Could you tell me why? Any other reason?

RECORD ALL THE REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSE/HYSTERECTOMY D
SUB FECUND/STERILE E
POSTPARTUM AMENORRHEA F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHER PERSONS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH PROBLEMS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER (SPECIFY) __________ X
DON'T KNOW Z

608. In the coming weeks, if you discover that you are pregnant, would this be a major problem, a minor problem or Not a problem at all?

MAJOR PROBLEM 1
MINOR PROBLEM 2
NO PROBLEM 3
SAYS SHE CANNOT GET PREGNANT/IS NOT HAVING SEX 4

609. CHECK 310:
USES A METHOD?

NOT ASKED (GO TO 610)
DOES NOT CURRENTLY USE (GO TO 610)
CURRENTLY USES (GO TO 614)

610. Do you think that, in the near or distant future you will use a method to delay or avoid a pregnancy?

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

611. Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTIONS 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATION AMENORRHEA METHOD 11 (GO TO 614)
RHYTHM METHOD 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER METHOD (SPECIFY) _____ 96 (GO TO 614)
NOT SURE 98 (GO TO 614)

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

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

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

YES 1
NO 2
DON'T KNOW 8

614. CHECK 216:

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

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be? (Probe for a numeric response)

NONE 00 (GO TO 616)
NUMBER ___
OTHER (SPECIFY) __________ 96 (GO TO 616)

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

NUMBER OF BOYS _____
NUMBER OF GIRLS _____
EITHER _____
OTHER (SPECIFY) __________ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/NOT SURE 8

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

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In newspapers or magazines?
YES 1
NO 2
On a poster?
YES 1
NO 2
On a flier or brochure?
YES 1
NO 2

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

YES 1
NO 2 (GO TO 621)

620. With whom did you discuss this?
Anyone else? RECORD EVERYTHING MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
STEP MOTHER(S)/MOTHER(S) IN LAW H
FRIEND(S)/NEIGHBOR(S) I
OTHER (SPECIFY) __________ X

621. CHECK 501:

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

622. CHECK 311/311A:

'A' CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623. You said that you are currently using a method of contraception. Could you tell me if the use of this method is mainly your own decision, or that of your partner/husband, or a joint decision?

RESPONDENT'S DECISION 1
PARTNER/HUSBAND'S DECISION 2
JOINT DECISION 3
OTHER (SPECIFY) __________ 6

624. Now I would like to ask you about your partner/husband's opinions about family planning.
Do you think that your partner/husband approves or disapproves of using methods to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

625. How many times during the past year did you speak with your partner/husband about family planning?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

626. CHECK 311/311A:

NEITHER HE NOR SHE STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627. Does your husband want the same number of children that you want, or does he want more of fewer than you want?

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

628. Husbands and wives do not always agree on everything. Please, tell me if you think it is legitimate for a wife to refuse to have sexual intercourse with her husband when:

She knows that her husband has a sexually transmitted infection?
YES 1
NO 2
DON'T KNOW 8
She knows that her husband has sexual intercourse with other women besides his wives?
YES 1
NO 2
DON'T KNOW 8
She recently gave birth?
YES 1
NO 2
DON'T KNOW 8
She is tired and Not in the mood for it?
YES 1
NO 2
DON'T KNOW 8

629. When a wife knows that her husband has an infection transmittable by sexual contact, is she justified in asking that they use a condom during intercourse?

YES 1
NO 2
DON'T KNOW 8

630. CHECK 501:

CURRENTLY MARRIED/IN UNION (GO TO 631)
NOT IN UNION (GO TO 701)

631. Can you refuse sexual intercourse with your husband when you don't want to have it?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

632. Can you ask that your husband use a condom if you want him to use one?

YES 1
NO 2
IT DEPENDS/NOT SURE 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVES WITH A MAN (GO TO 703)
HAS BEEN MARRIED/HAS LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

703. Did your (most recent) husband attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school that he achieved: primary 1 (first cycle), secondary 1 (first cycle), secondary 2 (second cycle) or superior?

PRIMARY 1
SECONDARY 1(FIRST CYCLE) 2
SECONDARY 2 (SECOND CYCLE) 3
SUPERIOR 4
DON'T KNOW 8 (GO TO 706)

705. What was the last (year/class) that he achieved at this level?

CLASS/YEAR ___
DON'T KNOW 98

706. CHECK 701:

CURRENTLY MARRIED/LIVES WITH A MAN: What is your husband/partner's occupation? That is, what kind of work does he mainly do?

HAS BEEN MARRIED/HAS LIVED WITH A MAN: What was your last husband/partner's occupation? That is, what kind of work did he mainly do?

__________
__________

707. Aside from your housework, do you currently work?

YES 1 (GO TO 710)
NO 2

708. As you know, some women take up jobs for which they are paid in cash or in kind. Others sell things, have a small business or work on the family farm or in a family business.
Do you currently do something like this or any other work?

YES 1 (GO TO 710)
NO 2

709. Did you do any type of work during the past 12 months?

YES 1
NO 2 (GO TO 719)

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

__________

711. CHECK 710:

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

712. Do you work mainly on your own land or on family land, or did you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
OTHER (SPECIFY) __________ 6

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

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

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

HOME 1
AWAY 2

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

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

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

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

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

THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5

718. On average, how much of your household 's expenses are paid by what you earn: almost Nothing, less than half, about half, more than half or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, ALL EARNINGS ARE KEPT 6

719. In your family who generally has the last word in the following decisions:

Your own healthcare?
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
The purchase of major things for the household?
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
Purchase of things for daily household needs?
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
Visits to family or parents?
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
What food will be prepared each day?
THE RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6

720. PRESENCE OF OTHER PEOPLE AT THIS TIME (PERSONS PRESENT AND ARE LISTENING, PRESENT BUT ARE NOT LISTENING, OR NOT PRESENT)

CHILDREN LESS THAN 10 YEARS
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8
OTHER MEN
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8
OTHER WOMEN
PRESENT AND ARE LISTENING 1
PRESENT BUT ARE NOT LISTENING 2
NOT PRESENT 8

721. Sometimes the husband is upset or angry because of certain things his wife does. In your opinion, is it legitimate that a husband beat or hit his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects her children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sexual intercourse with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 8. HIV/AIDS

Now I would like to talk to you about something else.

801. Have you ever heard of a disease called AIDS?

YES 1
NO 2 (GO TO 844)

802. Can people reduce their chance of getting AIDS by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

803. Can people get AIDS from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

804. Can people reduce their risk of getting AIDS by using a condom every time they have sex?

YES 1
NO 2
DON' T KNOW 8

805. Can people get AIDS by sharing food with someone who has AIDS?

YES 1
NO 2
DON'T KNOW 8

806. Can people reduce their chances of getting AIDS by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

807. Can people get AIDS by witchcraft of other supernatural means?

YES 1
NO 2
DON'T KNOW 8

808. Is there something (else) that a person can do to avoid or reduce their risks of contracting the virus that causes AIDS?

YES 1
NO 2 (GO TO 810)
DON'T KNOW 8 (GO TO 810)

809. What can a person do?
Anything else? RECORD EVERYTHING MENTIONED.

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

810. Is it possible that a person who appears to be healthy, in fact, has AIDS virus?

YES 1
NO 2
DON'T KNOW 8

811. Can the virus that causes AIDS be transmitted from mother to her baby?

During the pregnancy?
YES 1
NO 2
DON'T KNOW 8
During birth?
YES 1
NO 2
DON'T KNOW 8
During breastfeeding?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

814. Are there any special drugs that a doctor or nurse can give people infected with the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

815. CHECK 215:

LAST BIRTH SINCE JANUARY 2004 (GO TO 816)
NO BIRTHS (GO TO 824)
LAST BIRTH BEFORE JANUARY 2004 (GO TO 824)

816. CHECK 407:

SAW SOMEONE FOR PARENTAL CARE (GO TO 817)
DIDN'T SEE ANYONE (GO TO 824)

Now I would like to ask you some questions about your last birth.

817. You told me that you saw someone for prenatal care during this pregnancy. During one of these prenatal visits for this pregnancy, did anyone talk to you about the following subjects?

Babies getting the AIDS virus from their mothers?
YES 1
NO 2
DON'T KNOW 8
Things you can do to prevent getting the AIDS virus?
YES 1
NO 2
DON'T KNOW 8
Getting tested for the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

818. Were you offered a test for the AIDS virus as part of your prenatal care?

YES 1
NO 2

819. I do not want to know the results, but were you tested for the AIDS virus as part of your prenatal care?

YES 1
NO 2 (GO TO 824)

820 I do not want to know the results, but did you get the results of the test?

YES 1
NO 2

821. Where was the test done?

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

PLACE NAME __________
PUBLIC SECTOR
HOSPITAL 11
CEDAV (ANONYMOUS AND VOLUNTARY TESTING CENTER) 12
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC 21
PRIVATE LAB 22
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER (SPECIFY) __________ 96

822. Have you been tested for the AIDS virus since you were tested during your pregnancy?

YES 1 (GO TO 825)
NO 2

823. When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1 (GO TO 831)
BETWEEN 12 AND 23 MONTHS 2 (GO TO 831)
2 OR MORE YEARS AGO 3 (GO TO 831)

824. I don't want to know the results, but have you ever been tested for the AIDS virus?

YES 1
NO 2 (GO TO 829)

825. When did you last get tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1 (GO TO 831)
BETWEEN 12 AND 23 MONTHS 2 (GO TO 831)
2 OR MORE YEARS AGO 3 (GO TO 831)

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

ASKED FOR TEST 1
TEST OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1
NO 2

828. Where was the test done?

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

PLACE NAME __________
PUBLIC SECTOR
HOSPITAL 11 (GO TO 831)
CEDAV (ANONYMOUS AND VOLUNTARY TESTING CENTER) 12 (GO TO 831)
OTHER PUBLIC (SPECIFY) __________ 16 (GO TO 831)
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC 21 (GO TO 831)
PRIVATE LAB 22 (GO TO 831)
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26 (GO TO 831)
OTHER (SPECIFY) __________ 96 (GO TO 831)

829. Do you know of a place where people can get tested for the AIDS virus?

YES 1
NO 2 (GO TO 831)

830. Where is this? Is there another place?
RECORD ALL PLACES MENTIONED.

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

PLACE NAME __________
PUBLIC SECTOR
HOSPITAL A
CEDAV (ANONYMOUS AND VOLUNTARY TESTING CENTER) B
OTHER PUBLIC (SPECIFY) __________ 16 G
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC 21 H
PRIVATE LAB 22 I
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26 J
OTHER (SPECIFY) __________ 96 X

831. Would you buy fresh vegetables from a shopkeeper or vendor if you knew the person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

832. If a member of your family had the AIDS virus would you like it to remain a secret or Not?

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

833. If a member of your family become sick with the AIDS virus would you be willing to take care of him/her in your own household?

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

834. In your opinion, if a teacher has the AIDS virus but is not sick, should s/he be able to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/IT DEPENDS 8

835. Do you personally know someone who has been denied health service in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW ANYONE WITH THE AIDS 8 (GO TO 840)

836. Do you personally know someone who has been denied involvement in social events, religious services or community events in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2

837. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus?

YES 1
NO 2

838. CHECK 835, 836 AND 837:

NO 'YES' (GO TO 839)
AT LEAST ONE 'YES' (GO TO 840)

839. Do you know someone who is suspected to have or has the AIDS virus?

YES 1
NO 2

840. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

841. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

842. Should children ages 12-14 be taught about using a condom to avoid getting the AIDS virus?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

843. Should children ages 12-14 be taught to wait until they get married to have sex to avoid getting AIDS?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

844. Do you think that young men should wait until marriage to have sexual intercourse?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

845. Do you think that young women should wait until marriage to have sexual intercourse?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

846. Do you think that married men should only have sexual intercourse with their wives?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

847. Do you think that most of the men you know only have sexual intercourse with their wives?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

848. Do you think that married women should only have sexual intercourse with their own husbands?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

849 Do you think that most of the women that you know only have sexual intercourse with their husband?

YES 1
NO 2
DON'T KNOW/IT DEPENDS 8

850. CHECK 801:

HEARD ABOUT AIDS: Apart from AIDS have you heard about other diseases that can be transmitted through sexual contact?

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

YES 1
NO 2 (GO TO 853)

851. When a man has a sexually transmitted infection, which symptom could he have?
Are there other symptoms?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
IMPOTENCE L
OTHER (SPECIFY) __________ X
NO SYMPTOMS Y
DON'T KNOW Z

852. When a woman has a sexually transmitted infection, which symptom could she have?
Are there other symptoms?

RECORD ALL MENTIONED.

ABDOMINAL PAIN A
VAGINAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
DIFFICULTY GETTING PREGNANT L
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
NO SYMPTOMS Y
DON'T KNOW Z

853. CHECK 519:

HAS HAD SEXUAL INTERCOURSE (GO TO 854)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

854. CHECK 850:

HAS HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 855)
HAS NOT HEARD ABOUT SEXUALLY TRANSMITTED DISEASES (GO TO 855)

Now I would like to ask you about your health in the last 12 months.

855. During the last 12 months have you had a disease which you got from sexual contact?

YES 1
NO 2
DON'T KNOW 8

856. Sometimes a woman has a bad smelling abnormal genital discharge. During the last 12 months have you had a bad smelling genital discharge?

YES 1
NO 2
DON'T KNOW 8

857. Sometimes women have a genital sore or ulcer. During the past 12 months have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

858. CHECK 855, 856 AND 857:

HAS HAD AN INFECTION, OR AT LEAST ONE 'YES' (GO TO 859)
HAS NOT HAD AN INFECTION OR DON'T KNOW (GO TO 901)

859. The last time you had (PROBLEM MENTIONED IN 855/856/857) did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 861)

860. Where did you go? Was there another place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
HEALTH HUT C
CTV CENTER D
COMMUNITY HEALTH CARE WORKER E
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H, I
CTV CENTER J
PHARMACY K
HEALTH WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __________ M
OTHER SOURCE
TRADITIONAL HEALER N
SHOP O
OTHER (SPECIFY) __________ X

861. The last time you had (PROBLEM MENTIONED IN 855/856/857) did your partner seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 901)
DON' T KNOW 8 (GO TO 901)

862. Where did he go? Was there another place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
HEALTH HUT C
CTV CENTER D
COMMUNITY HEALTH CARE WORKER E
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H, I
CTV CENTER J
PHARMACY K
HEALTH WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __________ M
OTHER SOURCE
TRADITIONAL HEALER N
SHOP O
OTHER (SPECIFY) __________ X

SECTION 9A. FEMALE CIRCUMCISION

901. Have you ever heard of female circumcision?

YES 1 (GO TO 903)
NO 2

902. In certain countries there is a practice that involves cutting a part of the external genitals of girls. Have you heard of this practice?

YES 1
NO 2 (GO TO 925)

903. Were your external genitals cut?

YES 1
NO 2 (GO TO 909)

904. I would now like to ask you some questions about what was done at that time.
Did someone cut something in the genital area?

YES 1 (GO TO 906)
NO 2
DON'T KNOW 8

905. Did they just make a laceration in your genitals without cutting anything off?
IF YES, RETURN TO 904 CHECK AND CHANGE IF NECESSARY.

YES 1
NO 2
DON'T KNOW 8

906. Did they somehow close the area your vagina?

YES 1
NO 2
DON'T KNOW 8

907. How old were you when you underwent this practice?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO GET AN ESTIMATE.

AGE IN YEARS COMPLETED ___
DURING CHILDHOOD 95
DON'T KNOW 98

908. Who performed your circumcision?

TRADITIONAL
TRADITIONAL FEMALE CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) __________ 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE 22
MIDWIFE 23
OTHER HEALTH PROFESSIONAL (SPECIFY) __________ 26
DON'T KNOW 98

909. CHECK 214 AND 216:

AT LEAST ONE LIVING DAUGHTER (GO TO 910)
NO LIVING DAUGHTER (GO TO 919)

910. Have some of your daughters undergone this kind of practice?
IF YES: How many?

NUMBER CIRCUMCISED ___
NO DAUGHTER CIRCUMCISED 95 (GO TO 918)

911. Which one of your daughters was most recently circumcised?
CHECK 212 AND RECORD THE LINE NUMBER OF THE DAUGHTER.

NAME OF DAUGHTER ________
LINE NUMBER OF THE DAUGHTER FROM 212 ___

912. I would now like to ask you some questions about what was done to (NAME OF THE DAUGHTER FROM 911) at that time. Did someone remove part of her genitals?

YES 1 (GO TO 914)
NO 2
DON'T KNOW 8

913. Did someone just slash her genitals without removing anything?

YES 1
NO 2
DON'T KNOW 8

914. Was her vagina somehow closed?

YES 1
NO 2
DON'T KNOW 8

915. How old was (NAME OF THE DAUGHTER FROM 911) at the time of the circumcision?
IF THE RESPONDENT DOESN'T KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS ___

DURING CHILDHOOD 95
AGE IN COMPLETED MONTHS ___
DON'T KNOW 98

916. Who performed the circumcision?

TRADITIONAL
TRADITIONAL FEMALE CIRCUMCISER 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) __________ 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE 22
MIDWIFE 23
OTHER HEALTH PROFESSIONAL (SPECIFY) __________ 26
DON'T KNOW 98

917. Did you Notice at the time someone cut (NAME OF THE DAUGHTER FROM 911)'s genitals one of the following problems?

Excessive bleeding?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Difficulty urinating or retaining urine?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Swelling in the genital area?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Infection in the genital area/the wound Not correctly scarred?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)

918. In the future, do you intend to have your daughters circumcised?

YES 1
NO 2
DON'T KNOW 8

919. What are the advantages to circumcising a girl?
PROBE: Are there other advantages?
RECORD ALL MENTIONED.

BETTER HYGIENE A
SOCIAL RECOGNITION B
BETTER CHANCE FOR MARRIAGE C
PRESERVATION OF VIRGINITY/PREVENT SEXUAL INTERCOURSE BEFORE MARRIAGE D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS NECESSITY F
OTHER (SPECIFY) __________ X
NO ADVANTAGE Y

920. What the advantages of girls not being circumcised?
PROBE: Anything else?
RECORD ALL MENTIONED.

FEWER HEALTH PROBLEMS A
AVOIDING THE SUFFERING B
MORE SEXUAL PLEASURE FOR HER C
MORE PLEASURE FOR THE MAN D
IN ACCORDANCE WITH RELIGION E
OTHER (SPECIFY) __________ X
NO ADVANTAGE Y

921. Do you think this practice is a way for preventing girls from having sexual intercourse before marriage or do you think, on the contrary, that this has NO effect?

PREVENTS SEX 1
NO EFFECT 2
DON'T KNOW 8

922. Do you think that this practice is required by your religion?

YES 1
NO 2
DON'T KNOW 8

923. Do you think that this practice should be maintained or that it should disappear?

MAINTAINED 1
DISAPPEAR 2
IT DEPENDS 3
DON'T KNOW 8

924. Do you think that men want this practice to be preserved or do you think they are favorable to abandoning it?

PRESERVED 1
ABANDONED 2
IT DEPENDS 3
DON'T KNOW 8

SECTION 9B. FISTULA

925. Do you know about an illness called "fistula," that is to say the "urine illness"?

YES 1
NO 2 (GO TO 1001A)

926A. What, in your opinion, are the causes of this illness?
RECORD SPONTANEOUS RESPONSES OF THE RESPONDENT.

WITCHCRAFT OR MYSTICAL CHARMS A
EVIL SPELLS, FATE B
TOO YOUNG TO GIVE BIRTH C
TOO OLD TO GIVE BIRTH D
TOO THIN TO SUPPORT A PREGNANCY E
TOO MANY SUCCESSIVE BIRTHS F
FREQUENT ILLNESS DURING THE PREGNANCY G
BIRTH OF A LARGE BABY H
BIRTH AT HOME AND WITHOUT MEDICAL ASSISTANCE I
WILL OF GOD J
OTHERS (SPECIFY) __________ X
DON'T KNOW Y

926B. What are the main manifestations of this illness?

CONTINUOUS WEIGHT LOSS A
INVOLUNTARY URINATION B
INVOLUNTARY BOWL MOVEMENTS C
BOTH INVOLUNTARY URINATION AND BOWEL MOVEMENTS D
CONSTANTLY WET E
NAUSEATING ODORS F
LOCOMOTIVE DISABILITY G
OTHERS (SPECIFY) _____ X
DON'T KNOW Y

927. Is it possible to treat this illness and to heal it?

YES 1
NO 2

928. Have you ever contracted this illness?

YES 1
NO 2 (GO TO 929b)

929. If YES, how, in your opinion, did you contract it?

WITCHCRAFT OR MYSTICAL CHARMS A
EVIL SPELLS, FATE B
TOO YOUNG TO GIVE BIRTH C
TOO OLD TO GIVE BIRTH D
TOO THIN TO SUPPORT A PREGNANCY E
TOO MANY SUCCESSIVE BIRTHS F
FREQUENT ILLNESS DURING THE PREGNANCY G
BIRTH OF A LARGE BABY H
BIRTH AT HOME WITHOUT MEDICAL ASSISTANCE I
WILL OF GOD J
OTHERS (SPECIFY) __________ X
DON'T KNOW Y

929B. In your opinion how is this illness contracted?

WITCHCRAFT OR MYSTICAL CHARMS A
EVIL SPELLS, FATE B
TOO THIN TO SUPPORT A PREGNANCY C
TOO MANY SUCCESSIVE BIRTHS D
FREQUENT ILLNESS DURING THE PREGNANCY E
BIRTH OF A LARGE BABY F
BIRTH AT HOME WITHOUT MEDICAL ASSISTANCE G
WILL OF GOD H
OTHERS (SPECIFY) __________ X
DON'T KNOW Y

930. Where are you going/did you go for treatment?

HEALTH CENTER 01
MATERNITY 02
HOSPITAL 03
PRIVATE CLINIC 04
OTHER MEDICAL STRUCTURE (SPECIFY) __________ 06
TRADITIONAL TREATMENTS IN THE VILLAGE 07 (GO TO 933)
NO TREATMENT 08 (GO TO 934B)
OTHER (SPECIFY) __________ 09

931. If you are undergoing or have undergone treatment for your fistula in a modern health center, how many surgical operations did you undergo?

NUMBER ___
IF NONE 00 (GO TO 935)

932A. This surgical operation, or the last one undergone, was it successful in your opinion?

YES 1
NO 2 (GO TO 932c)

932B. Why do you think that this operation succeeded?

NO MORE LOSS OF URINE A (GO TO 935)
RETURN TO NORMAL DAILY ACTIVITIES B (GO TO 935)
FEELING BETTER, FEELING RELIEF C (GO TO 935)
RETURN TO FAMILY LIFE D (GO TO 935)
OTHERS (SPECIFY) _____ X (GO TO 935)

932C. Why do you think this operation did not succeed?

AGGRAVATION: MORE FREQUENT LOSS OF URINE A (GO TO 935)
NO IMPROVEMENT B (GO TO 935)
EXCESSIVE PAIN C (GO TO 935)
CONTINUED INTERNMENT IN MEDICAL FACILITY D (GO TO 935)
ANOTHER OPERATION PLANNED E (GO TO 935)
OTHERS (SPECIFY) __________ X (GO TO 935)

933. For how long were you/have you been undergoing traditional treatments?

NUMBER OF MONTHS 1 ___
NUMBER OF YEARS 2 ___

934A. In your opinion, what were the results of these treatments?

WORSENING 1
NOT IMPROVEMENT 2
SIGNIFICANT IMPROVEMENT 3
PARTIAL HEALING 4
COMPLETE HEALING 5
DURATION TOO SHORT TO JUDGE 6
NO OPINION 7

934B. Why have you gone without care to this point?

LACK OF INFORMATION A
INCURABLE ILLNESS B
WITCHCRAFT C
LACK OF FAMILY SUPPORT D
LACK OF MONEY E
NO OPINION F
OTHER (SPECIFY) __________ X

935. In your opinion, can fistulas be prevented by adopting the following behaviors?

Avoid early marriages of adolescents less than 18 years
YES 1
NO 2
DON'T KNOW 3
Encourage schooling for the young girl
YES 1
NO 2
DON'T KNOW 3
Avoid early pregnancies
YES 1
NO 2
DON'T KNOW 3
Avoid too many pregnancies
YES 1
NO 2
DON'T KNOW 3
Avoid having pregnancies too close together
YES 1
NO 2
DON'T KNOW 3

936. In your opinion can fistulas be avoiding by adopting the following behaviors in the case of pregnancy?

Get prenatal care in a health center
YES 1
NO 2
DON'T KNOW 3
Give birth in a hospital facility or in a maternity
YES 1
NO 2
DON'T KNOW 3
Have postnatal care
YES 1
NO 2
DON'T KNOW 3
Participate in family planning meetings
YES 1
NO 2
DON'T KNOW 3
Avoid doing the most demanding house work (getting water, wood, etc.)
YES 1
NO 2
DON'T KNOW 3
Avoid taking traditional medicinal potions
YES 1
NO 2
DON'T KNOW 3

937. Do you know (other) women who suffer or have suffered from fistulas?

YES 1
NO 2 (GO TO 1001A)

938. If YES, how many women?

NUMBER OF WOMEN ___

939. Could you tell me where they currently live (locality, commune and region)?

___________

SECTION 10. MATERNAL MORTALITY

Now I would like to ask you some questions about your brothers and sisters, that is to say about all of the children born to your biological mother.

1001A. Did your mother give birth to other children besides yourself?

YES 1
NO 2 (GO TO 1001h)

1001B. How many boys did your mother have that are still alive?

LIVING BOYS ___

1001C. Besides you, how many girls did your mother have that are still alive?

LIVING GIRLS ___

1001D. How many boys did your mother have who are deceased?

DECEASED BOYS ___

1001E. How many girls did your mother have who are deceased?

DECEASED GIRLS ___

1001F. Did your mother give birth to other children whom you don't know to be living or deceased?

YES 1
NO 2 (GO TO 1001h)

1001G. How many other children did your mother give birth whom you don't know to be living or deceased?

OTHER CHILDREN ___

1001. ADD THE ANSWERS TO 1101B, C, D, E, AND G. ADD 1 (THE RESPONDENT) TO THE TOTAL.

TOTAL ___

1001I. Just to be sure that I understand, including yourself, your mother gave birth to ____ children in all. Is this correct?

YES (GO TO 1102)
NO (PROBE AND CORRECT 1001A-1001H AS NECESSARY)

1002. CHECK 1001I:

TWO OR MORE BIRTHS (GO TO 1003)
ONLY ONE BIRTH RESPONDENT ONLY (GO TO 1014)

1003. How many of these births did your mother have before your own birth?

NUMBER OF PREVIOUS BIRTHS ___

Now I would like to make a list of all your brothers and sisters, whether or not they are still alive, beginning with the oldest. RECORD THE NAME OF ALL OF THE BROTHERS AND SISTERS.

1004. What name was given to your oldest brother or sister (or the next)?

NAME ___

1005. Is (NAME) male or female?

Male 1
Female 2

1006. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1008)
DON'T KNOW 8 (GO TO NEXT BIRTH)

1007. How old is (NAME)?

AGE ___ (GO TO NEXT BIRTH)

1008. How many years has (NAME) been deceased?

YEARS___

1009. How old was (NAME) when he/she died?
IF RESPONDENT DOESN'T KNOW, PROBE: Did (NAME) die before the age of 12 years?

IF YES, RECORD '95'. IF NO, ASK OTHER QUESTIONS TO GET AN ESTIMATE. FOR EXAMPLE: Did (NAME) die before getting married?

AGE ___ (GO TO NEXT BIRTH IF MAN OR IF WOMAN WHO DIED BEFORE THE AGE OF 12)

1010. Was (NAME) pregnant when she died?

YES (GO TO 1013)
NO 2

1011. Did (NAME) die during childbirth?

YES 1
NO 2

1012. Did (NAME) die in the two months following a pregnancy or birth?

YES 1
NO 2

1013. To how many children did (NAME) give birth during her life?

NUMBER ___ (IF NO MORE SIBLINGS, GO TO 1014)

1014. RECORD THE TIME:

HOURS ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

FILL OUT AFTER HAVING ENDED THE INTERVIEW.

COMMENTS ABOUT THE RESPONDENT _____

COMMENTS ON PARTICULAR QUESTIONS _____

OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
SUPERVISOR'S NAME __________
DATE _____

FIELD EDITOR'S OBSERVATIONS _____
FIELD EDITOR'S NAME __________
DATE _____

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX

BIRTHS AND PREGNANCIES:

N BIRTH
G PREGNANCY
F END OF PREGNANCY

2006

12 DEC 01 ___
11 NOV 02 ___
10 OCT 03 ___
09 SEPT 04 ___
08 AUG 05 ___
07 JUL 06 ___
06 JUN 07 ___
05 MAY 08 ___
04 APR 09 ___
03 MAR 10 ___
02 FEB 11 ___
01 JAN 12 ___

2005

12 DEC 13 ___
11 NOV 14 ___
10 OCT 15 ___
09 SEPT 16 ___
08 AUG 17 ___
07 JUL 18 ___
06 JUN 19 ___
05 MAY 20 ___
04 APR 21 ___
03 MAR 22 ___
02 FEB 23 ___
01 JAN 24 ___

2004

12 DEC 25 ___
11 NOV 26 ___
10 OCT 27 ___
09 SEPT 28 ___
08 AUG 29 ___
07 JUL 30 ___
06 JUN 31 ___
05 MAY 32 ___
04 APR 33 ___
03 MAR 34 ___
02 FEB 35 ___
01 JAN 36 ___

2003

12 DEC 37 ___
11 NOV 38 ___
10 OCT 39 ___
09 SEPT 40 ___
08 AUG 41 ___
07 JUL 42 ___
06 JUN 43 ___
05 MAY 44 ___
04 APR 45 ___
03 MAR 46 ___
02 FEB 47 ___
01 JAN 48 ___

2002

12 DEC 49 ___
11 NOV 50 ___
10 OCT 51 ___
09 SEPT 52 ___
08 AUG 53 ___
07 JUL 54 ___
06 JUN 55 ___
05 MAY 56 ___
04 APR 57 ___
03 MAR 58 ___
02 FEB 59 ___
01 JAN 60 ___

2001

12 DEC 61 ___
11 NOV 62 ___
10 OCT 63 ___
09 SEPT 64 ___
08 AUG 65 ___
07 JUL 66 ___
06 JUN 67 ___
05 MAY 68 ___
04 APR 69 ___
03 MAR 70 ___
02 FEB 71 ___
01 JAN 72 ___