IDENTIFICATION

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

URBAN/RURAL:

LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE:

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 _____________

NEXT VISIT:
DATE __________
TIME ___________

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

TOTAL NUMBER 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)

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?

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

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

105. In what month and year were you born?

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

107. Have you ever attended school?

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

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

110. CHECK 106:

111. Are you currently attending school?

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

113. CHECK 108:

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

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

116. Do you usually listen to radio every day?

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

118. What is your religion?

119. What is your ethnic group?

120. CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE:

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?

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

122. In which [STATE] is that located?

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

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

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

126. Does your household have:

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

128. Does any member of your household own:

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?

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

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

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

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'.

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?

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

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

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

210. CHECK 208:

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

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

213. Were any of these births twins?

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

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

216. Is (NAME) still alive?

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

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

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

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

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

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

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

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

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

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?

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

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

227. Are you pregnant now?

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

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

236. When did your last menstrual period start?

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?

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

SECTION 3. CONTRACEPTION

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

302. Have you ever heard of (METHOD)?

303. Have you ever used (METHOD)?

304. CHECK 303:

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

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

309. 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'.

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

311. CHECK 303:

312. CHECK 227:

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

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

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

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

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

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.

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

320. Why do you regret the operation?

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

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

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

327. CHECK 314:
CIRCLE METHOD CODE:

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

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

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

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

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

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

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

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

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

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

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

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

339. CHECK 210:

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

341. CHECK 227 AND 311:

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

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 225:

402. ENTER THE 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

404. FROM Q212 AND Q216

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?

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

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

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

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

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?

401. CHECK 225:

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

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

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

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

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?

415. Was (NAME) delivered by caesarian section?

416. When (NAME) was born, was he/she:

Very large,
Larger than average,
Average,
Smaller than average,
Or very small?

401. CHECK 225:

417. Was (NAME) weighed at birth?

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

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

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

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

422. CHECK 227:
RESPONDENT PREGNANT?

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

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

425. Did you ever breastfeed (NAME)?

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

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

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.

427. CHECK 404:
CHILD ALIVE?

428. Are you still breastfeeding (NAME)?

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

430. Why did you stop breastfeeding (NAME)?

431. CHECK 404:
CHILD ALIVE?

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

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

431C. Have you ever heard about exclusive breastfeeding?

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

431E. CHECK 404:
CHILD ALIVE?

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

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

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

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

Plain water?
Sugar water?
Juice?
Herbal Tea?
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?

436. FOOD OR LIQUID GIVEN YESTERDAY?

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

438. On how many days during 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.

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

442. FROM Q212 AND Q216

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

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

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

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).

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

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

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

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

448C. How many times?

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

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

448F. How many times?

448G. An injection to prevent measles?

448H. CHECK 216:
CHILD ALIVE

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

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

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

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

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

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

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

455. Was there any blood in the stools?

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

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

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

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?

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

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

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

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

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

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

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

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

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

469. CHECK 459, ALL COLUMNS:

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

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

FROM Q.212 AND Q.216

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.

477. Where did (NAME) die?

478. CHECK Q.219:
AGE AT DEATH

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

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

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

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

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

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

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

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

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

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?

490. Was the episode of diarrhea mild or severe?

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

492. Was there any blood in the stool?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

512. CHECK 511:

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

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

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

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

514B. What type of relationship was it?

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)?

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?

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

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

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

SECTION 5B. CIRCUMCISION

520. Are you circumcised?

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

522. How old were you when you were circumcised?

523. Who performed the circumcision?

524. CHECK 214, AND 217:

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

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

527. How old was she when she was circumcised?

528. Who performed the circumcision?

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

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

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

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

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

534. CHECK 502:

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

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

SECTION 6. FERTILITY PREFERENCES

601. CHECK 314:

602. CHECK 227:

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

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

603. CHECK 227:

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

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

604. CHECK 227:

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

606. CHECK 313:
USING A METHOD?

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

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

609. Which method would you prefer to use?

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

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

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.

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?

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

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

On the radio?
On the television?

616. In the last 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) ____________

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

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

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

620. CHECK 502:

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?

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

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

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

701. CHECK 502 AND 504:

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

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

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

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

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

707. CHECK 706:

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

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

710. As you know, some women take up jobs for which they are paid in cash or kind. Others sell 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?

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

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

713. CHECK 712:

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

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

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

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

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

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

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

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

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?

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

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

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

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

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

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

801C. CHECK 515:

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

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

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

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

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

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

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

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

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

801M. CHECK 801B:

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

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

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

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

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

805. CHECK 804:

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

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

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

808A. Can AIDS be cured?

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

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

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

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

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

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

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

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.

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

811D. CHECK 515:

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?

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

811G. If yes, was a condom used?

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?

902. CHECK 901:

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

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

905. Is (NAME) male or female?

906. Is (NAME) still alive?

907. How old is (NAME)?

908. In what year did (NAME) die?

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

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

911. Was (NAME) pregnant when she died?

912. Did (NAME) die during childbirth?

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

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

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

IF NO MORE BROTHERS OR SISTERS, GO TO 916

916. RECORD THE TIME (END OF INTERVIEW)

SECTION 10. HEIGHT AND WEIGHT

1001. CHECK 215:

1002. LINE NO. FROM Q212

1003. NAME FROM Q212 FOR CHILDREN

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

1005. BCG SCAR ON TOP OF LEFT SHOULDER

1006. HEIGHT (In centimeters)

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

1008. WEIGHT (In kilograms)

1009. DATE WEIGHED AND MEASURED

1010. RESULT

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: _________________