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FEDERAL REPUBLIC OF NIGERIA NDHS03
NATIONAL POPULATION COMMISSION
1999 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY
INDIVIDUAL QUESTIONNAIRE FOR WOMEN

IDENTIFICATION

STATE NAME ___
LOCAL GOVT. AREA ___
LOCALITY NAME ___
ENUMERATION AREA ___

URBAN/RURAL:

Urban = 1
Rural = 2

LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE:

Large Town = 1
Medium Town = 2
Small Town = 3
Village = 4

BUILDING NUMBER ___
HOUSEHOLD NAME/NUMBER ___

NAME AND LINE NUMBER OF WOMAN IN HOUSEHOLD SCHEDULE __

INTERVIEWER'S VISITS

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

RESULT ____

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

NEXT VISIT:
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ____
RESULT _____

TOTAL NO. OF VISITS __

SUPERVISOR
NAME ________ ___
DATE ________

FIELD EDITOR
NAME ________ ___
DATE ________

OFFICE EDITOR___

KEYED BY___

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME. (START OF INTERVIEW)

HOUR ____
MINUTES _____

102. First I would like to ask some questions about you and your household. For most of the time until you were 10 years old, did you live in a large town, medium town, small town, or in the village?

LARGE TOWN 1
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4

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

YEARS ____

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

104. Just before you moved here, did you live in a large town, medium town, small town, or in the village?

LARGE TOWN 1
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4

105. In what month and year were you born?

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

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

AGE IN COMPLETED YEARS ____

107. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

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

GRADE (YEAR) __________

110. CHECK 106:

AGE 24 OR BELOW (GO TO 111)
AGE 25 OR ABOVE (GO TO 113)

111. Are you currently attending school?

YES 1 (GO TO 113)
NO 2

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

GOT PREGNANT 01
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
GRADUATED/HAD ENOUGH SCHOOLING 07
DID NOT PASS ENTRANCE EXAMS 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) _____________ 96
DON'T KNOW 98

113. CHECK 108:

PRIMARY (GO TO 114)
SECONDARY OR HIGHER (GO TO 115)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)

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

YES 1
NO 2

116. Do you usually listen to radio every day?

YES 1
NO 2

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

YES 1
NO 2

118. What is your religion?

CATHOLIC 1
PROTESTANT 2
OTHER CHRISTIAN 3
ISLAM 4
TRADITIONALIST 5
OTHER (SPECIFY)________ 6

119. What is your ethnic group?

ETHNIC GROUP________________

120. CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE:

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (GO TO 121)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

121. Now I would like to ask about the place in which you usually live. What is the name of the place in which you usually live?

(NAME OF PLACE) _________________

Is that a large, medium, small town, or village?

LARGE TOWN 1
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4

122. In which [STATE] is that located?

STATE ___

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

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 125)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 125)
PUBLIC WELL 22
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 125)
WATER TANKER (TRUCK) 51 (GO TO 125)
WATER VENDOR 52
BOTTLED WATER 61 (GO TO 125)
BOREHOLE 71
OTHER (SPECIFY) __________ 96

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

MINUTES _____
ON PREMISES 996

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

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET/BUCKET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD/RIVERSIDE 31
OTHER (SPECIFY) ___________ 96

126. Does your household have:

Electricity?
A Radio?
A Television?
A Telephone?
A Refrigerator?
A Gas Cooker?
An Electric Fan?
An Electric Iron?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
TELEPHONE
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2
GAS COOKER
YES 1
NO 2
ELECTRIC FAN
YES 1
NO 2
ELECTRIC IRON
YES 1
NO 2

127. Could you describe the main material of the floor of your home?

NATURAL FLOOR
EARTH/SAND 11
DUNG 12
RUDIMENTARY FLOOR
WOOD PLANKS 21
PALM/BAMBOO 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY) ___________ 96

128. Does any member of your household own:

A bicycle?
A motorcycle?
A car?
A Donkey/Horse/Camel?
A Canoe/Boat/Ship ?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2
DONKEY/HORSE/CAMEL
YES 1
NO 2
CANOE/BOAT/SHIP
YES 1
NO 2

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

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

TOTAL ___

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

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

210. CHECK 208:

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

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

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

(NAME) ___________

213. Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

MONTH ______
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

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

AGE IN YEARS __

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

YES 1 (GO TO NEXT BIRTH IF MORE CHILDREN; OTHERWISE GO TO 220 IF NO MORE BIRTHS)
NO 2 (GO TO NEXT BIRTH IF MORE CHILDREN; OTHERWISE GO TO 220 IF NO MORE BIRTHS)

219. IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

220. FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH.
IS THE DIFFERENCE 2 OR MORE?

YES 1
NO 2 (GO TO NEXT BIRTH)

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

YES 1
NO 2

222. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH.
IS THE DIFFERENCE 2 YEARS OR MORE?

YES 1 (GO TO 223)
NO 2 (GO TO 224)

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

YES 1
NO 2

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

NUMBERS ARE SAME:
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS OR 1 YR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1996. IF NONE, RECORD '0'.

225A. CHECK 219 AND ENTER THE NUMBER OF DEATHS SINCE JANUARY 1996; IF NONE, RECORD '0'.

226A. (In addition to pregnancies which ended in live births) have you had any (other) pregnancy which ended in a stillbirth, miscarriage or an abortion?

YES 1
NO 2 (GO TO 227)

226B. How many pregnancies ended in stillbirths?
IF NONE, RECORD '00'.

STILLBIRTHS ___

226C. How many pregnancies ended in miscarriages or abortions?
IF NONE, RECORD '00'.

MISCARRIAGE OR ABORTIONS ___

227. Are you pregnant now?

YES 1
NO 2 (GO TO 236)
UNSURE 8 (GO TO 236)

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

MONTHS ____

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

THEN 1
LATER 2
NOT WANT MORE CHILDREN 3

236. When did your last menstrual period start?

(DATE, IF GIVEN) ____________
DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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

YES 1
NO 2 (GO TO 301)
DOES NOT KNOW 8 (GO TO 301)

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

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER ___________ (SPECIFY) 96
DON'T KNOW 98

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?

METHOD 01 PILL Women can take a pill every day.
SPONTANEOUS YES 1
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
SPONTANEOUS YES 1
METHOD 06 CONDOM Men can put a rubber sheath on their penis for sexual intercourse.
SPONTANEOUS YES 1
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
METHOD 09 RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
SPONTANEOUS YES 1
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
SPONTANEOUS YES 1
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES 1 (SPECIFY) ______________

302. Have you ever heard of (METHOD)?

METHOD 01 PILL Women can take a pill every day.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 06 CONDOM Men can put a rubber sheath on their penis for sexual intercourse.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 09 RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
NO 3

303. Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
METHOD 06 CONDOM Men can put a rubber sheath on their penis for sexual intercourse.
YES 1
NO 2
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had a partner who had an operation to avoid having children?
YES 1
NO 2
METHOD 09 RHYTHM, PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 305)
AT LEAST ONE 'YES' (EVER USED) (GO TO 309)

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

YES 1
NO 2 (GO TO 331)

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

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

NUMBER OF CHILDREN _____

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

WANTED CHILD LATER 1
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY) __________ 96

311. CHECK 303:

WOMAN NOT STERILIZED (GO TO 312)
WOMAN STERILIZED (GO TO 314A)

312. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 313)
PREGNANT (GO TO 332)

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

YES 1
NO 2 (GO TO 331)

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

PILL 01
IUD 02 (GO TO 326)
INJECTABLES 03 (GO TO 326)
IMPLANTS 04 (GO TO 326)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 326)
CONDOM 06 (GO TO 326)
FEMALE STERILIZATION 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
PERIODIC ABSTINENCE 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 326)
OTHER (SPECIFY) _________ 96 (GO TO 326)

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

PACKAGE SEEN 1
BRAND NAME ____________ ___ (GO TO 317)
PACKAGE NOT SEEN 2

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

BRAND NAME ________ __
DOES NOT KNOW 98

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

COST __.__

FREE 9996 (GO TO 326)
DOES NOT KNOW 9998 (GO TO 326)

318. Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

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

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 23
MOBILE CLINIC 24
NON-GOVERNMENT ORGANISATION 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER (SPECIFY) _______________ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 321)

320. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 01
HUSBAND WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
HEALTH REASONS ASSOCIATED WITH THE OPERATION 04
MARITAL STATUS HAS CHANGED 05
OPERATION FAILED 06
CHILD DIED 07
OTHER (SPECIFY) ________________ 96

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

MONTH __ (GO TO 327)
YEAR __ (GO TO 327)

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

BASED ON CALENDAR 01
BASED ON BODY TEMPERATURE 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY) ________________ 96

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

MONTH __
8 YEARS OR LONGER 96

327. CHECK 314:
CIRCLE METHOD CODE:

NOT ASKED 00 (GO TO 331)
PILL 01
IUD 02
INJECTABLES 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM/FEMIDOM 06
FEMALE STERILIZATION 07 (GO TO 329A)
MALE STERILIZATION 08 (GO TO 329A)
PERIODIC ABSTINENCE 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER METHOD 96 (GO TO 332)

328. Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PATENT MEDICINE STORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
NON-GOVERNMENT ORGANISATION 34
OTHER (SPECIFY) __________________ 36

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

YES 1 (GO TO 330)
NO 2 (GO TO 334)

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

YES 1
NO 2 (GO TO 334)

330. People select the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF PLACE IN Q.328 or Q.318) instead of some other place you know about?

RECORD RESPONSE AND CIRCLE CODE. _____________________________
ACCESS-RELATED REASONS
CLOSER TO HOME 11 (GO TO 334)
CLOSER TO MARKET/WORK 12 (GO TO 334)
AVAILABILITY OF TRANSPORT 13 (GO TO 334)

SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLY 21 (GO TO 334)
CLEANER FACILITY 22 (GO TO 334)
OFFERS MORE PRIVACY 23 (GO TO 334)
SHORTER WAITING TIME 24 (GO TO 334)
LONGER HRS. OF SERVICE 25 (GO TO 334)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 334)
LOWER COST/CHEAPER 31 (GO TO 334)
WANTED ANONYMITY 41 (GO TO 334)
OTHER (SPECIFY) _____________ 96 (GO TO 334)
DON'T KNOW 98 (GO TO 334)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 334)
KNOWS NO SOURCE 42 (GO TO 334)
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 334)

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

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PMS 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
NGO 34
OTHER (SPECIFY) __________________ 36

334. Were you visited by a family planning service provider in the last 12 months?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 337)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)
DON'T KNOW 8

338. Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

INCREASED 1 (GO TO 401)
DECREASED 2
DEPENDS 3
DON'T KNOW 8

339. CHECK 210:

ONE OR MORE BIRTHS (GO TO 340)
NO BIRTH (GO TO 401)

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

YES 1
NO 2 (GO TO 401)

341. CHECK 227 AND 311:

NOT PREGNANT OR UNSURE AND NOT STERILIZED (GO TO 342)
EITHER PREGNANT OR STERILIZED (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 225:

ONE OR MORE BIRTHS SINCE JANUARY 1996 (GO TO 402)
NO BIRTH SINCE JANUARY 1996 (GO TO 465)

402. ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

Now I would like to ask you some questions about the health of all your children born in the last three years. (We will talk about one child at a time.)

403. LINE NUMBER FROM Q212

LINE NUMBER _____

404. FROM Q212 AND Q216

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

405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

THEN 1 (GO TO 407)
LATER 2
NO MORE 3 (GO TO 407)

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

MONTHS 1 __
YEARS 2 __

DON'T KNOW 998

407. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 410)

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

MONTHS ___
DON'T KNOW 98

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

NO. OF TIMES ___
DON'T KNOW 98

410. When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 412)
DON'T KNOW 8 (GO TO 412)

401. CHECK 225:

ONE OR MORE BIRTHS SINCE JANUARY 1996 (GO TO 411)
NO BIRTH SINCE JANUARY 1996 (GO TO 465)

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

TIMES ___
DON'T KNOW 8

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

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
OTHER PRIVATE MED. (SPECIFY) _____________ 36
OTHER (SPECIFY) _____________ 96

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

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 410)

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

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

LABOR MORE THAN 12 HOURS
YES 1
NO 2
EXCESSIVE BLEEDING
YES 1
NO 2
FEVER/BAD SMELLING VAG. DISCHARGE
YES 1
NO 2
CONVULSIONS
YES 1
NO 2

415. Was (NAME) delivered by caesarian section?

YES 1
NO 2

416. 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

401. CHECK 225:

ONE OR MORE BIRTHS SINCE JANUARY 1996 (GO TO 417)
NO BIRTH SINCE JANUARY 1996 (GO TO 465)

417. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 419)

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

GRAMS FROM CARD 1 ___
GRAMS FROM RECALL 2 ___

DON'T KNOW 99998

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

YES 1 (GO TO 421)
NO 2 (GO TO 422)

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

YES 1
NO 2 (GO TO 424)

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

MONTHS __
DON'T KNOW 98

422. CHECK 227:
RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 423)
PREGNANT OR UNSURE (GO TO 424)

423. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 425)

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

MONTHS ___________
DON'T KNOW 98

425. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 427)

425A. Did you feed (NAME) colostrum from the breast or wait until colostrum had passed?

FED COLOSTRUM 1 (GO TO 426)
WAITED 2
DON'T KNOW 8 (GO TO 426)

425B. While you waited for colostrum to pass, what did you feed (NAME)?

PLAIN WATER 1
SUGAR/GLUCOSE WATER 2
BABY FORMULA 3
FRESH MILK 4
SOYA MILK 5
OTHER (SPECIFY) ____________ 6

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

IMMEDIATELY 000

HOURS 1 ______
DAYS 2 ______

427. CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 428)
DEAD (GO TO 429)

428. Are you still breastfeeding (NAME)?

YES 1 (GO TO 431B)
NO 2

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

MONTHS _____

UNTIL DIED 95 (GO TO 431B)
DON'T KNOW 98

430. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) ____________ 96

431. CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 431B)
DEAD (GO TO 431A)

431A. Was (Name) ever given any water, or something else to drink or eat (other than breastmilk)?

YES 1
NO 2 (GO TO 431C)

43lB. How many months old was (NAME) when you started giving the following on a regular basis?

Formula or milk other than breastmilk, such as soya milk?
AGE IN MONTHS __
NOT GIVEN 96
Water or other liquids?
AGE IN MONTHS __
NOT GIVEN 96
Any solid or mushy food, such as mashed banana of mashed grain?
AGE IN MONTHS __
NOT GIVEN 96

431C. Have you ever heard about exclusive breastfeeding?

YES 1
NO 2 (GO TO 432)

431D. From which source of information have you ever heard about exclusive breastfeeding?

RADIO A
TELEVISION B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY) _______________ X

431E. CHECK 404:
CHILD ALIVE?

ALIVE (STILL BREASTFEEDING, ELSE GO TO 440)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440)

432. How many times did you breastfeed (NAME) last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHT TIME FEEDINGS ______

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

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON'T KNOW 8

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

Plain water?
Sugar water?
Juice?
Herbal Tea?
Baby formula?
Tinned of powdered milk?
Fresh milk?
Any other liquid?
Any food made from [WHEAT, MAIZE, RICE, SORGHUM or LOCAL GRAIN] such as [PORRIDGE, BREAD, or NOODLES]?
Any food made from [CASSAVA, PLANTAIN, YAMS, or LOCAL TUBER]?
Eggs, fish or poultry?
Meat?
Any other solid or semi-solid foods?

PLAIN WATER
YES 1
NO 2
DON'T KNOW 8
SUGAR WATER
YES 1
NO 2
DON'T KNOW 8
JUICE
YES 1
NO 2
DON'T KNOW 8
HERBAL TEA
YES 1
NO 2
DON'T KNOW 8
BABY FORMULA
YES 1
NO 2
DON'T KNOW 8
TINNED/POWDERED MILK
YES 1
NO 2
DON'T KNOW 8
FRESH MILK
YES 1
NO 2
DON'T KNOW 8
OTHER LIQUIDS
YES 1
NO 2
DON'T KNOW 8
FOOD MADE FROM [GRAIN]
YES 1
NO 2
DON'T KNOW 8
FOOD MADE FROM [TUBER]
YES 1
NO 2
DON'T KNOW 8
EGGS/FISH/POULTRY
YES 1
NO 2
DK 8
MEAT
YES 1
NO 2
DON'T KNOW 8
OTHER SOLID/SEMI-SOLID FOODS
YES 1
NO 2
DON'T KNOW 8

436. FOOD OR LIQUID GIVEN YESTERDAY?

'YES' TO ONE OR MORE (GO TO 437)
'NO/DON'T KNOW' TO ALL (GO TO 438)

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

NUMBER OF TIMES ___
DON'T KNOW 8

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

Plain water?
Any kind of milk (other than breastmilk)?
Liquids other than plain water or milk?
Food made from [WHEAT, MAIZE, RICE, SORGHUM or LOCAL GRAIN]?
Food made from [CASSAVA, PLANTAIN, YAMS, or LOCAL TUBER]?
Eggs, fish or poultry?
Meat?
Any other solid or semi-solid foods?
IF DON'T KNOW, RECORD '8'.
RECORD THE NUMBER OF DAYS.

PLAIN WATER ___
MILK ___
OTHER LIQUIDS ___
FOOD MADE FROM [GRAIN] ___
FOOD MADE FROM [TUBER] ___
EGGS/FISH/POULTRY ___
MEAT ___
OTHER SOLID/SEMI-SOLID FOODS __

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

SECTION 4B. IMMUNIZATION AND HEALTH

440. ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1996 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

441. LINE NUMBER FROM Q212

LINE NUMBER _____

442. FROM Q212 AND Q216

NAME _______
ALIVE (GO TO 443)
DEAD (GO TO 443)

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

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3

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

YES 1 (GO TO 447)
NO 2 (GO TO 447)

164?

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

BCG
POLIO 0
POLIO 1
POLIO 2
POLIO 3
DPT 1
DPT 2
DPT 3
MEASLES

BCG
DAY __
MONTH __
YEAR __
P0
DAY __
MONTH __
YEAR __
P1
DAY __
MONTH __
YEAR __
P2
DAY __
MONTH __
YEAR __
P3
DAY __
MONTH __
YEAR __
D1
DAY __
MONTH __
YEAR __
D2
DAY __
MONTH __
YEAR __
D3
DAY __
MONTH __
YEAR __
MEA
DAY __
MONTH __
YEAR __

446. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR
MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445) (GO TO 449)
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

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

YES 1
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

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

448A. A BCG vaccination against tuberculosis, that is, an injection in the left arm or shoulder that caused a scar?

YES 1
NO 2
DON'T KNOW 8

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

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

448C. How many times?

NUMBER OF TIMES ___

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

JUST AFTER BIRTH 1
LATER 2

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

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

448F. How many times?

NUMBER OF TIMES ___

448G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

448H. CHECK 216:
CHILD ALIVE

ALIVE (GO TO 449)
DEAD (GO BACK TO Q.443 FOR NEXT BIRTH; OR IF NO BIRTHS) (GO TO 465))

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

YES 1
NO 2
DON'T KNOW 8

449A. Did you seek for medical advice or treatment for the fever?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

451. When (NAME) was ill with a cough, did he/she breathe more rapidly than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 454)

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

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC G
PHARMACY/PMS H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) _____________ L
OTHER SOURCE
SHOP M
TRAD. PRACTITIONER N
SPIRITUAL HEALER P
OTHER (SPECIFY) _____________ X

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

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

455. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

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

NUMBER OF BOWEL MOVEMENTS (STOOLING) __
DON'T KNOW 98

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

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

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

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

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

A fluid made from a special packet called "ORT"?
Thin watery gruel made from [RICE OR OTHER LOCAL GRAIN, TUBER, PLANTAIN]?
Soup?
Home-made sugar-salt-water solution?
Milk or infant formula?
Yoghurt-based drink?
Water?
Any other liquid?

FLUID FROM ORS PKT
YES 1
NO 2
DON'T KNOW 8
THIN WATERY GRUEL
YES 1
NO 2
DON'T KNOW 8
SOUP
YES 1
NO 2
DON'T KNOW 8
SUG.-SALT-WAT. SOL.
YES 1
NO 2
DON'T KNOW 8
MILK/INFANT FORM.
YES 1
NO 2
DON'T KNOW 8
YOGHURT-BASED DR.
YES 1
NO 2
DON'T KNOW 8
WATER
YES 1
NO 2
DON'T KNOW 8
OTHER LIQUID
YES 1
NO 2
DON'T KNOW 8

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

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

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

RECOMMENDED HOME FLUID A
TABLET OR SYRUP B
INJECTION C
(I.V.) INTRAVENOUS D
HOME REMEDIES/HERBAL MEDICINES E
OTHER (SPECIFY) _____________ X

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

YES 1
NO 2 (GO TO 464)

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

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC G
PHARMACY/PMS H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) _____________ L
OTHER SOURCE
SHOP M
TRAD. PRACTITIONER N
SPIRITUAL HEALER P
OTHER (SPECIFY) _____________ X

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

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

LESS TO DRINK 1
ABOUT SAME AMOUNT TO DRINK 2
MORE TO DRINK 3
DON'T KNOW 8

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

LESS TO EAT 1
ABOUT SAME AMOUNT TO EAT 2
MORE TO EAT 3
DON'T KNOW 8

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

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

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

FAST BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

469. CHECK 459, ALL COLUMNS:

NO CHILD RECEIVED ORS (GO TO 470)
ANY CHILD RECEIVED ORS (GO TO 501)

470. Have you ever heard of a special product called "ORT" you can get for the treatment of diarrhea?

YES 1
NO 2

SECTION 4C. CAUSE OF DEATH OF CHILDREN BORN AND DYING IN THE PAST 3 YEARS

473. ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH SINCE JANUARY 1996 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS WHO HAVE DIED. IF 2 OR MORE, BEGIN WITH THE LAST.

LINE NUMBER FROM Q.212

LINE NUMBER _____

FROM Q.212 AND Q.216

NAME _______
DEAD (GO TO 474)
ALIVE (GO TO NEXT COLUMN; IF NO MORE BIRTHS, GO TO 501)

474. I know it may be difficult to talk about the child(ren) you had who died, but this information is very important in helping to plan health programs to prevent other children from dying.
I would like to ask you some questions about the events and symptoms your child(ren) had during the time before he/she/they died. (We will talk about one child at a time).

475. What do you think was the cause of (NAME)'s death?

_____

476. During the illness that led to (NAME'S) death, did you seek advice or treatment anywhere or from anyone?
IF YES: Whom did you see? Where did you go?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC G
PHARMACY/PMS H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) _____________ L
OTHER SOURCE
SHOP M
TRAD. PRACTITIONER N
SPIRITUAL HEALER P
OTHER (SPECIFY) _____________ X
NONE Z

477. Where did (NAME) die?

AT HOME 1
IN A HEALTH FACILITY 2
ON THE WAY TO FACILITY 3
OTHER (SPECIFY) ____________ 4

478. CHECK Q.219:
AGE AT DEATH

LESS THAN 1 MONTH (GO TO 479)
1 MONTH OR OLDER (GO TO 489)

479. Was (NAME) born after a difficult labor/delivery?

YES 1
NO 2
DOES NOT KNOW 8

480. Was (NAME) malformed in any way?
IF YES, SPECIFY.

YES 1 (SPECIFY) _______________
NO 2
DOES NOT KNOW 8

481. Did (NAME) suckle or drink normally during the first two days of life?

YES 1
NO 2
DOES NOT KNOW 8

482. Did (NAME) have a decrease in suckling or difficulty suckling during the days before death?

YES 1
NO 2
DOES NOT KNOW 8

483. Did (NAME) have convulsions or spasms during the illness that led to death?

YES 1
NO 2
DOES NOT KNOW 8

484. During the illness that led to death, did (NAME) have a cough?

YES 1
NO 2 (GO TO 488)
DOES NOT KNOW 8 (GO TO 488)

485. For how many days did the cough last?
IF LESS THAN 1 DAY, WRITE '00'

DAYS ______________

486. When (NAME) had the illness with the cough, did he/she have difficulty or rapid breathing?

YES 1
NO 2 (GO TO 488)
DOES NOT KNOW 8 (GO TO 488)

487. For how many days did the difficult/rapid breathing last?
IF LESS THAN 1 DAY, WRITE '00'

DAYS ______________

488. GO BACK TO 475 FOR NEXT DECEASED CHILD; IF NO MORE DEATHS, GO TO 501.

489. During the illness that led to death, did (NAME) have loose or liquid stools, that is, diarrhea?

YES 1
NO 2 (GO TO 493)
DOES NOT KNOW 8 (GO TO 493)

490. Was the episode of diarrhea mild or severe?

MILD 1
SEVERE 2
DOES NOT KNOW 8

491. For how long did the diarrhea last?
IF LESS THAN 1 DAY, WRITE '00'

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

DOES NOT KNOW 998

492. Was there any blood in the stool?

YES 1
NO 2
DOES NOT KNOW 8

493. During the illness that led to death, did (NAME) have a cough?

YES 1
NO 2 (GO TO 497)
DOES NOT KNOW 8 (GO TO 497)

494. For how long did the cough last?
IF LESS THAN 1 DAY, WRITE '00'

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

DOES NOT KNOW 998

495. When (NAME) had the illness with the cough, did he/she have difficult or rapid breathing?

YES 1
NO 2 (GO TO 497)
DOES NOT KNOW 8 (GO TO 497)

496. For how long did the difficult/rapid breathing last?
IF LESS THAN 1 DAY, WRITE '00'

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

DOES NOT KNOW 998

497. During the illness that led to death, did (NAME) have a fever?

YES 1
NO 2 (GO TO 498)
DOES NOT KNOW 8 (GO TO 498)

497A. Was the fever of (NAME) mild or severe?

MILD 1
SEVERE 2
DOES NOT KNOW 8

497B. How long did the fever last?
IF LESS THAN 1 DAY, WRITE '00'

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

DOES NOT KNOW 998

498. During the illness that led to death, was (NAME) unconscious?

YES 1
NO 2
DOES NOT KNOW 8

498A. During the illness that led to death, did (NAME) have convulsions?

YES 1
NO 2
DOES NOT KNOW 8

498B. During the illness that led to death, did (NAME) have a skin rash all over his/her body and face?

YES 1
NO 2 (GO TO 498E)
DOES NOT KNOW 8 (GO TO 498E)

498C. How long did the rash last?
IF LESS THAN 1 DAY, WRITE '00'

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

DOES NOT KNOW 998

498D. During the illness that led to death, was there any discharge from the eyes?

YES 1
NO 2
DOES NOT KNOW 8

498E. During the illness that led to death, was (NAME) very thin?

YES 1
NO 2 (GO TO 498G)
DOES NOT KNOW 8 (GO TO 498G)

498F. How long was (NAME) very thin?

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

DOES NOT KNOW 998

498G. During the illness that led to death, did (NAME) have swelling of the feet or legs?

YES 1
NO 2 (GO TO 499)
DOES NOT KNOW 8 (GO TO 499)

498H. How long was the swelling present?
IF LESS THAN 1 DAY, WRITE '00'

DAYS 1 ___
WEEKS 2 ___
MONTHS 3 ___

DOES NOT KNOW 998

499. GO BACK TO 475 FOR NEXT DECEASED CHILD; IF NO MORE DEATHS, GO TO 501.

SECTION 5A. MARRIAGE

501. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND/PARTNER
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

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

YES, CURRENTLY MARRIED 1 (GO TO 507)
YES, LIVING WITH A MAN 2 (GO TO 507)
NO, NOT IN UNION 3

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

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
MULTIPLE SEXUAL PARTNER 4

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515)

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

WIDOWED 1 (GO TO 511)
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

YES 1
NO 2 (GO TO 511)

509. How many other wives/partners does he have?

NUMBER ____
DON'T KNOW 98 (GO TO 511)

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

RANK ____

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

ONLY ONCE 1
MORE THAN ONCE 2

512. CHECK 511:

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

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

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 616A)
DON'T KNOW YEAR 9998

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

AGE ____

514A. Before you got married, was your (first) husband related to you in any way?

YES 1
NO 2 (GO TO 515)

514B. What type of relationship was it?

FIRST COUSIN ON FATHER'S SIDE 1
FIRST COUSIN ON MOTHER'S SIDE 2
SECOND COUSIN 3
UNCLE 4
OTHER BLOOD RELATIVE 5
BROTHER-IN-LAW 6
OTHER NON-BLOOD RELATIVE 7

515. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
When was the last time you had sexual intercourse (if ever)?

NEVER 000 (GO TO 520)

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

BEFORE LAST BIRTH 996

516. CHECK 301 AND 302:

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

DOES NOT KNOW CONDOM: Some men use a condom, which means that they put a rubber sheath on their penis for sexual intercourse. The last time you had sex, was a condom used?

YES 1
NO 2
DON'T KNOW 8

517. Do you know of a place where you can get condoms7

YES 1
NO 2 (GO TO 519)

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

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PMS 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
NGO 34
OTHER (SPECIFY) _______________ 36

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

AGE ___
FIRST TIME WHEN MARRIED 96

SECTION 5B. CIRCUMCISION

520. Are you circumcised?

YES 1
NO 2 (GO TO 524)

521. What type of circumcision did you have?
Did you have clitoridectomy, excision, or infibulation?

CLITORIDECTOMY 01
EXCISION 02
INFIBULATION 03
OTHER (SPECIFY) _________ 96

522. How old were you when you were circumcised?

AGE IN COMPLETED YEARS ____
DOES NOT KNOW 98

523. Who performed the circumcision?

DOCTOR 01
TRAINED NURSE/MIDWIFE 02
TRADITIONAL BIRTH ATTENDANT 03
CIRCUMCISION PRACTITIONER 04
OTHER (SPECIFY) ___________ 96
DOES NOT KNOW 98

524. CHECK 214, AND 217:

HAS AT LEAST ONE LIVING DAUGHTER (GO TO 525)
HAS NO LIVING DAUGHTER (GO TO 530)

525. Has (NAME OF ELDEST DAUGHTER) been circumcised?

YES 1 (GO TO 527)
NO 2

526. Do you plan to have (NAME OF ELDEST DAUGHTER) circumcised?

YES 1 (GO TO 530)
NO 2 (GO TO 530)

527. How old was she when she was circumcised?

AGE IN COMPLETED YEARS ____
DOES NOT KNOW 98

528. Who performed the circumcision?

DOCTOR 01
TRAINED NURSE/MIDWIFE 02
TRADITIONAL BIRTH ATTENDANT 03
CIRCUMCISION PRACTITIONER 04
OTHER (SPECIFY) ___________ 96
DOES NOT KNOW 98

529. Did anyone object to your eldest daughter being circumcised? Anyone else?
RECORD ALL PERSONS MENTIONED.

NO ONE OBJECTED A
RESPONDENT B
RESPONDENT'S HUSBAND C
RESPONDENT'S MOTHER D
RESPONDENT'S MOTHER-IN-LAW E
OTHER RELATIVE OF RESPONDENT F
OTHER RELATIVE OF HUSBAND G
RESPONDENT'S FATHER-IN-LAW H
OTHER (SPECIFY) _____________ X
DOES NOT KNOW Y

530. Do you think female circumcision should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2 (GO TO 533)
DOES NOT KNOW 8 (GO TO 534)

531. What type of female circumcision do you think should be continued:
clitoridectomy, excision, or infibulation?

CLITORIDECTOMY 01
EXCISION 02
INFIBULATION 03
OTHER (SPECIFY) _________ 96

532. Why do you think female circumcision should be continued? Any other reasons?
RECORD ALL REASONS MENTIONED

GOOD TRADITION A (GO TO 534)
CUSTOM AND TRADITION B (GO TO 534)
RELIGIOUS DEMAND C (GO TO 534)
CLEANLINESS D (GO TO 534)
BETTER MARRIAGE PROSPECTS E (GO TO 534)
GREATER PLEASURE OF HUSBAND F (GO TO 534)
PRESERVATION OF VIRGINITY/PREVENTION OF IMMORALITY G (GO TO 534)
OTHER (SPECIFY) ________________ X (GO TO 534)
DOES NOT KNOW Y (GO TO 534)

533. Why do you think female circumcision should be discontinued? Any other reasons?
RECORD ALL REASONS MENTIONED.

BAD TRADITION A
AGAINST RELIGION B
MEDICAL COMPLICATIONS C
PAINFUL PERSONAL EXPERIENCE D
AGAINST DIGNITY OF WOMEN E
PREVENTS SEXUAL SATISFACTION F
OTHER (SPECIFY) ________________ X
DOES NOT KNOW Y

534. CHECK 502:

IN UNION (GO TO 535)
NOT IN UNION (GO TO 536)

535. Does your husband/partner think female circumcision should be continued or discontinued?

CONTINUED 1
DISCONTINUED 2
DOES NOT KNOW 8

536. Has there been any activities against female circumcision in this community?

YES 1
NO 2
DON'T KNOW 8

SECTION 6. FERTILITY PREFERENCES

601. CHECK 314:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 612)

602. CHECK 227:

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

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DON'T KNOW 8 (GO TO 604)

603. CHECK 227:

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

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

MONTHS 1 ___
YEARS 2 ___

SOON/NOW 993 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) _____ 996
DON'T KNOW 998

604. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 607)

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

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606. CHECK 313:
USING A METHOD?

NOT ASKED (GO TO 607)
NOT CURRENTLY USING (GO TO 607)
CURRENTLY USING (GO TO 612)

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

YES 1 (GO TO 609)
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)

609. Which method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTABLES 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 612)
CONDOM/FEMIDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
PERIODIC ABSTINENCE 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
OTHER (SPECIFY) __________ 96 (GO TO 612)
UNSURE 98 (GO TO 612)

610. What is the main reason that you think you will never use a method?

NOT CURRENTLY MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (GO TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUBFECUND/INFECUND 24 (GO TO 612)
WANTS (MORE) CHILDREN 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COST TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
OTHER (SPECIFY) _____ 96 (GO TO 612)
DON'T KNOW 98 (GO TO 612)

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

YES 1
NO 2
DON'T KNOW 8

612. CHECK216:

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.

NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 614)

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

NUMBER OF BOYS___
OTHER (SPECIFY) ______ 96
NUMBER OF GIRLS ___
OTHER (SPECIFY) ______ 96
NUMBER OF EITHER SEX___
OTHER (SPECIFY) ______ 96

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

APPROVE 1
DISAPPROVE 2
NO OPINION 3

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

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

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

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?
From town crier?
Any Other (SPECIFY) ____________

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2
TOWN CRIER
YES 1
NO 2
OTHER ____________________ X

617. In the last few months, have you heard about any message on Radio/T.V. on condom use?
617B. If Yes, (Specify) _______________

YES 1
NO 2

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

YES 1
NO 2 (GO TO 620)

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

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

620. CHECK 502:

YES, CURRENTLY MARRIED (GO TO 621)
YES, LIVING WITH A MAN (GO TO 621)
NO, NOT IN UNION (GO TO 701)

621. Spouse/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

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

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

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

701. CHECK 502 AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER IN UNION (GO TO 709)

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

AGE _______

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

YES 1
NO 2 (GO TO 706)

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

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

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

GRADE ____
DON'T KNOW 98

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

_____________ ___

707. CHECK 706:

WORKS IN (WORKED) AGRICULTURE (GO TO 708)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 709)

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

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

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

YES 1 (GO TO 712)
NO 2

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

YES 1 (GO TO 712)
NO 2

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

YES 1
NO 2 (GO TO 801A)

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

_______________ ____

713. CHECK 712:

WORKS IN AGRICULTURE (GO TO 714)
DOES NOT WORK IN AGRICULTURE (GO TO 715)

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

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

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

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

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

THROUGHOUT THE YEAR 1 (GO TO 718)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 719)

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

NUMBER OF MONTHS ___

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

NUMBER OF DAYS ___ (GO TO 720)

719. During the last 12 months, approximately how many days did you work?

NUMBER OF DAYS ___

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

YES 1
NO 2 (GO TO 723)

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

PER HOUR 1 ___
PER DAY 2 ___
PER WEEK 3 ___
PER MONTH 4 ___
PER YEAR 5 ___
OTHER (SPECIFY) ______________ 999996

722. CHECK 502:

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

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

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

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

HOME 1
AWAY 2

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

YES (GO TO 725)
NO (GO TO 801A)

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

RESPONDENT 01
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBOURS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILD CARE 10
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) __________________ 96

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

801A. Have you heard about diseases that can be transmitted through sexual intercourse?

YES 1
NO 2 (GO TO 801M)

801B. Which diseases do you know?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DOES NOT KNOW Z

801C. CHECK 515:

HAS HAD SEXUAL INTERCOURSE (GO TO 801D)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 801M)

801D. During the last twelve months, did you have any of these diseases?

YES 1
NO 2 (GO TO 801M)
DON'T KNOW 8 (GO TO 801M)

801E. Which of the diseases did you have?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DOES NOT KNOW Z

801F. The last time you had (DISEASE(S) FROM 801E) did you seek advice or treatment?

YES 1
NO 2 (GO TO 801J)

801G. In the last 12 months, did you have a discharge from your vagina?

YES 1
NO 2
DON'T KNOW 8

801H. In the last 12 months, did you have a sore or ulcer in your private part?

YES 1
NO 2
DON'T KNOW 8

801I. Where did you seek advice or treatment?
ANY OTHER PLACE OR PERSON.
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
HEALTH CENTER B
FP CLINIC C
MOBILE CLINIC D
DISPENSARY E
OTHER PUBLIC SECTOR F
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PMS H
PRIVATE DOCTOR I
MOBILE CLINIC J
OTHER MED. PRIVATE SECTOR K
OTHER SHOP L
RELATIVES/FRIENDS M
TRADITIONAL HEALER N
OTHER (SPECIFY) _______________ X
DOES NOT KNOW Z

801J. When you had (DISEASE(S) from 801E) did you inform your partner(s)?

YES 1
NO 2

801K. When you had (DISEASE(S) from 801E) did you do something not to infect your partner(s)?

YES 1
NO 2 (GO TO 801M)
PARTNER ALREADY INFECTED 3 (GO TO 801M)

801L. What did you do?
RECORD ALL MENTIONED.

NO SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICINES C
REFERRED PARTNER TO HEALTH WORKER D
OTHER (SPECIFY) ________________ X

801M. CHECK 801B:

DID NOT MENTION 'AIDS' (GO TO 801N)
MENTIONED 'AIDS' (GO TO 802)

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

YES 1
NO 2 (GO TO 811C)

802. From which sources of information have you learned most about AIDS?
ANY OTHER SOURCES?
RECORD ALL MENTIONED.

RADIO A
T.V. B
NEWSPAPER/MAGAZINE C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORKPLACE J
OTHER (SPECIFY) ________________ X

802B. How can a person get AIDS?
ANY OTHER WAYS?
RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS B
SEX WITH PROSTITUTES C
NOT USING CONDOM D
HOMOSEXUAL CONTACT E
BLOOD TRANSFUSION F
INJECTIONS G
KISSING H
MOSQUITO BITES I
CIRCUMCISION J
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 807)
DON'T KNOW 8 (GO TO 807)

804. What can a person do?
ANY OTHER WAYS?
RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
ENSURE SAFE BLOOD TRANSFUSIONS G
ENSURE INJECTIONS WITH STERILIZED NEEDLES H
ENSURE CIRCUMCISION WITH CLEAN BLADES/KNIVES I
AVOID KISSING J
AVOID MOSQUITO BITES K
SEEK PROTECTION FROM TRADITIONAL HEALER L
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DON'T KNOW Z

805. CHECK 804:

MENTION 'SAFE SEX' (GO TO 806)
DID NOT MENTION 'SAFE SEX' (GO TO 807)

806. What does 'safe sex' mean to you?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

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

YES 1
NO 2
DOES NOT KNOW 8

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

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DOES NOT KNOW 8

808A. Can AIDS be cured?

YES 1
NO 2
DOES NOT KNOW 8

808B. Can AIDS be transmitted from mother to child?

YES 1
NO 2 (GO TO 808D)
DOES NOT KNOW 8 (GO TO 808D)

808C. What can an infected pregnant mother do to avoid infecting her child with HIV?

TAKE MEDICATION LIKE AZT 1
DO NOT BREASTFEED 2
OTHER (SPECIFY) _____________ 8

808D. Do you personally know someone who has AIDS or has died of AIDS?

YES 1
NO 2
DOES NOT KNOW 8

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

SMALL 1
MODERATE 2 (GO TO 809C)
GREAT 3 (GO TO 809C)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 811A)

809B. Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS?
ANY OTHER REASONS?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
ENSURE SAFE BLOOD TRANSFUSION G
ENSURE INJECTION WITH STERILIZED NEEDLE H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DOES NOT KNOW Z

809C. Why do you think that you have a (MODERATE/GREAT CHANCE) of getting AIDS?
ANY OTHER REASONS?
RECORD ALL MENTIONED.

DO NOT USE CONDOMS C
MORE THAN ONE SEXUAL PARTNER D
SEX WITH PROSTITUTES E
SPOUSE HAS OTHER PARTNER(S) F
HOMOSEXUAL CONTACT G
HAD BLOOD TRANSFUSION H
HAD INJECTIONS WITH UNSTERILISED NEEDLES I
SEEK PROTECTION FROM TRADITIONAL HEALER K
OTHERS (SPECIFY) ________ W
OTHERS (SPECIFY) ________ X

811A. Since you heard of AIDS, have you changed your behaviour to prevent getting AIDS?
IF YES, WHAT DID YOU DO?
RECORD ALL MENTIONED

DIDN'T START SEX A (GO TO 811C)
STOPPED ALL SEX B (GO TO 811C)
STARTED USING CONDOMS C (GO TO 811C)
RESTRICTED SEX TO ONE PARTNER D (GO TO 811C)
REDUCED NUMBER OF PARTNERS E (GO TO 811C)
ADVICE SPOUSE/PARTNER TO BE FAITHFUL F (GO TO 811C)
NO MORE HOMOSEXUAL CONTACTS G (GO TO 811C)
ENSURE INJECTION WITH STERILIZED NEEDLES H (GO TO 811C)
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO BEHAVIOUR CHANGE Y

811B. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
IF YES, IN WHAT WAY?
RECORD ALL MENTIONED.

DIDN'T START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
NO MORE HOMOSEXUAL CONTACTS F
ADVISED PARTNER TO BE FAITHFUL G
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ Y
NO BEHAVIOUR CHANGE Z

811C. Some people use a condom for sexual intercourse to avoid getting AIDS or other sexually transmitted diseases?
Have you ever heard of this?

YES 1
NO 2 (GO TO 811F)

811D. CHECK 515:

HAS HAD SEXUAL INTERCOURSE (GO TO 811E)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 901)

811E. We may already have talked about this. Have you ever used a condom for sex to avoid getting or transmitting diseases such as AIDS?

YES 1
NO 2

811F. Have you given or received money, gifts or favours in return for sex at any time in the last 12 months?

YES 1
NO 2

811G. If yes, was a condom used?

YES 1
NO 2

SECTION 9. MATERNAL MORTALITY

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

NUMBER OF BIRTHS TO NATURAL MOTHER __

902. CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 916)

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

NUMBER OF PRECEDING BIRTHS __

904. What was the name given to your oldest (next oldest) brother or sister?
(*USE ADDITIONAL COLUMNS IF THERE ARE OTHER SIBLINGS)

(1) ________________

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

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

907. How old is (NAME)?

AGE_____________ (IF THERE ARE OTHER SIBLINGS, GO TO NEXT BIRTH)

908. In what year did (NAME) die?

YEAR___ (GO TO 910)
DON'T KNOW 98

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

___

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

AGE___ (IF MALE OR DIED BEFORE 10 YEARS OF AGE, GO TO NEXT BIRTH; OTHERWISE, GO TO 916)

911. Was (NAME) pregnant when she died?

YES 1 (GO TO 914)
NO 2

912. Did (NAME) die during childbirth?

YES 1 (GO TO 915)
NO 2

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

YES 1
NO 2 (GO TO 915)

914. Was her death due to complications of pregnancy or childbirth?

YES 1
NO 2

915. How many children did (NAME) give birth to during her lifetime?

NUMBER___ (GO TO NEXT SLIBING)

IF NO MORE BROTHERS OR SISTERS, GO TO 916

916. RECORD THE TIME (END OF INTERVIEW)

HOUR ___
MINUTES ___

SECTION 10. HEIGHT AND WEIGHT

1001. CHECK 215:

NO BIRTHS SINCE JAN. 1996 (END)
ONE OR MORE BIRTHS SINCE JAN. 1996
IN 1002 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1996 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1996. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1996 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1996, GO TO NEXT PAGE).

1002. LINE NO. FROM Q212

___

1003. NAME FROM Q212 FOR CHILDREN

(NAME) ___________

1004. DATE OF BIRTH
FROM Q215, AND ASK FOR DAY OF BIRTH

DAY ___
MONTH ___
YEAR ___

1005. BCG SCAR ON TOP OF LEFT SHOULDER

SCAR SEEN 1
NO SCAR 2

1006. HEIGHT (In centimeters)

HEIGHT____.__

1007. WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

LYING 1
STANDING 2

1008. WEIGHT (In kilograms)

WEIGHT____.__

1009. DATE WEIGHED AND MEASURED

DAY ___
MONTH ___
YEAR __

1010. RESULT

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) _________ 6

1011. NAME OF MEASURER: __________ __
NAME OF ASSISTANT: _________ __

INTERVIEWER'S OBSERVATIONS

(To be filled in after completing interview)

Comments about Respondent:
________________________________

Comments on Specific Questions:
_________________________________

Any other Comments:
_________________________________

SUPERVISOR'S OBSERVATIONS
_________________________________

Name of Supervisor: ________________
Date: _________________

EDITOR'S OBSERVATIONS
_________________________________

Name of Editor: ________________
Date: _________________