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NIGERIA DEMOGRAPHIC AND HEALTH SURVEY 2003
INDIVIDUAL WOMAN’S QUESTIONNAIRE

IDENTIFICATION

STATE NAME ___________________ ___
LOCAL GOVERNMENT AREA ________________ ___
LOCALITY NAME ___________________ ___
ENUMERATION AREA _______________ ___

URBAN/RURAL ___

URBAN l
RURAL 2

CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD NAME/NUMBER __

LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE __

LARGE TOWN 1
MEDIUM TOWN 2
SMALL TOWN 3
VILLAGE 4

NAME AND LINE NUMBER OF WOMAN _____________ ___

INTERVIEWER 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 OTHER (SPECIFY) _________________

NEXT VISIT:
DATE __________
TIME ___________

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

TOTAL NO. OF VISITS __

LANGUAGE OF INTERVIEW

HAUSA 1
YORUBA 2
IGBO 3
ENGLISH 4
OTHER 6

NATIVE LANGUAGE OF RESPONDENT

HAUSA 1
YORUBA 2
IGBO 3
ENGLISH 4
OTHER 6

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR
NAME ________ ___
DATE ________

FIELD EDITOR
NAME ________ ___
DATE ________

OFFICE EDITOR___

KEYED BY____

SECTION 1. RESPONDENT’S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT
GREETINGS. My name is ________ and I am working with the National Population Commission. We are conducting a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. We won’t take too much of your time. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

We hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer: ______________
Date: __________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

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 12 years old, did you live in a city, in a town, or in a village?

CITY 1
TOWN 2
VILLAGE 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD ‘00’ YEARS.

YEARS ___

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

104. Just before you moved here, did you live in a city, in a town, or in a village?

CITY 1
TOWN 2
VILLAGE 3

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 as at 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 111)

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 (class/form/year) you completed at that level?

CLASS __

110. CHECK 108:

PRIMARY (GO TO 111)
SECONDARY OR HIGHER (GO TO 114)

111. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _______ 4

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

YES 1
NO 2

113. CHECK 111:

CODE ‘2’, ‘3’ OR ‘4’ CIRCLED (GO TO 114)
CODE ‘1’ CIRCLED (GO TO 115)

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

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

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

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

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

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

117. What is your religion?

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

118. What is your ethnic group?

ETHNIC GROUP________________ ___

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 did not survive?

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 226)

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?

MONTH ______
YEAR ____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS __

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

YES 1
NO 2

219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD ‘00’ IF CHILD NOT LISTED IN HOUSEHOLD)

LINE NUMBER __ (GO TO NEXT BIRTH OR TO 221)

220. 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 ____

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

YES 1
NO 2

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

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED IN Q.215. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED IN Q.217. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN Q.220. __
FOR AGE AT DEATH 12 MONTHS OR 1 YR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS (Q.220). __
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1998 OR LATER.
IF NONE, RECORD ‘0’.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

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

MONTHS ____

228. 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 AT ALL 3

229. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?

YES 1
NO 2 (GO TO 237)

230. When did the last such pregnancy end?

MONTH _______
YEAR _______

231. CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 1998 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 1998 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS ______

233. Have you ever had any other pregnancies that did not result in live births?

YES 1
NO 2 (GO TO 237)

236. When did the last such previous pregnancy end?

MONTH ____
YEAR ____

237. When did your last menstrual period start?

(DATE, IF GIVEN) ____________
DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

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

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

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

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _____ 6
DON’T KNOW 8

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

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

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) ____
NO 2

302. Have you ever used (METHOD)?

01 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
02 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 any more children?
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE ‘YES’ (NEVER USED) (GO TO 304)
AT LEAST ONE ‘YES’ (EVER USED) (GO TO 307)

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

YES 1
NO 2 (GO TO 329)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

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

NUMBER OF CHILDREN _______

308. CHECK 302 (01):

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

309. CHECK 226:

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

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

YES 1
NO 2 (GO TO 329)

311. Which method are you using?
IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD ON LIST.
311A. CIRCLE ‘A’ FOR FEMALE STERILIZATION.

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

313. In what facility 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’S OFFICE 23
MOBILE CLINIC 24
NON-GOVERNMENT ORGANIZATION 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER (SPECIFY) _______________ 96
DON’T KNOW 98

314. CHECK 311:

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

CODE ‘A’ NOT CIRCLED: Before his sterilization operation, was your (husband/partner) told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON’T KNOW 8

316. In what month and year was the sterilization performed?
316A. For how long have you been using (CURRENT METHOD) now without stopping?
PROBE: In what month and year did you start using (CURRENT METHOD) continuously?

MONTH __
YEAR __

316B. CHECK 316/316A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A

YES (GO BACK TO 316/316A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION))
NO (GO TO 317)

317. CHECK 316/316A:

YEAR IS 1998 OR LATER (GO TO 319)
YEAR IS 1997 OR EARLIER (GO TO 327)

319. CHECK 311/311A:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

320. Where did you obtain (CURRENT METHOD) when you started using it?
320A. Where did you learn to use the lactational amenorrhea method?
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’S OFFICE 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
NGO 34
OTHER (SPECIFY) _______________ 96

321. CHECK 311/311A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09 (GO TO 325)
FOAM/JELLY 10 (GO TO 325)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 325)

322. You first obtained (CURRENT METHOD FROM 319) from (SOURCE OF METHOD FROM 313 OR 320). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2 (GO TO 325)

324. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

325. CHECK 322:

CODE ‘1’ CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE ‘1’ NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 313 OR 320), were you told about other methods of family planning that you could use?

YES 1 (GO TO 327)
NO 2

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

YES 1
NO 2

327. CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

328. Where did you obtain (CURRENT 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 (GO TO 331)
GOVERNMENT HEALTH CENTER 12 (GO TO 331)
FAMILY PLANNING CLINIC 13 (GO TO 331)
MOBILE CLINIC 14 (GO TO 331)
COMMUNITY HEALTH WORKER 15 (GO TO 331)
OTHER PUBLIC (SPECIFY) ______ 16 (GO TO 331)

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 331)
PHARMACY/PATENT MEDICINE STORE 22 (GO TO 331)
PRIVATE DOCTOR 23 (GO TO 331)
MOBILE CLINIC 24 (GO TO 331)
COMMUNITY HEALTH WORKER 25 (GO TO 331)
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26 (GO TO 331)
OTHER SOURCE
SHOP 31 (GO TO 331)
CHURCH 32 (GO TO 331)
FRIEND/RELATIVE 33 (GO TO 331)
NGO 34 (GO TO 331)
OTHER (SPECIFY) _______________ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is that? Any other 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.
RECORD ALL PLACES MENTIONED

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ______ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PATENT MEDICINE STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
NGO P
OTHER (SPECIFY) _______________ X

331. In the last 12 months, were you visited by a community health extension worker or family planning provider who talked to you about family planning?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 1998 OR LATER (GO TO 402)
NO BIRTHS IN 1998 OR LATER (GO TO 487)

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1998 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212

LINE NUMBER _____

404. FROM 212 AND 216

NAME _______
LIVING (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 not want to have any (more) children at all?

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

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

MONTHS 1 __
YEARS 2 __

DON’T KNOW 998

407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
COMMUNITY HEALTH EXTENSION WORKER D
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 415)

407A. Where did you receive antenatal care for this pregnancy? Anywhere else?

HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTRE D
GOVERNMENT HEALTH POST E
MOBILE CLINIC F
OTHER PUBLIC (SPECIFY) ____________ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
MOBILE CLINIC I
OTHER PRIVATE MEDICAL (SPECIFY) _____________ J
OTHER X

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

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. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 412)

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

MONTHS ___
DON’T KNOW 98

412. During this pregnancy, were any of the following done at least once?

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

412A. During any of the antenatal visits for this pregnancy, were you given any information or counseled about AIDS or the AIDS virus?

YES 1
NO 2
DON’T KNOW 8

413. Were you told about the signs of pregnancy complications?

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

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

YES 1
NO 2
DON’T KNOW 8

415. During this pregnancy, 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 417)
DON’T KNOW 8 (GO TO 417)

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

TIMES ____
DON’T KNOW 8

417. During this pregnancy, were you given or did you buy any iron tablets or iron syrups?
SHOW TABLET/SYRUPS

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

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

NUMBER OF DAYS _____
DON’T KNOW 998

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

YES 1
NO 2
DON’T KNOW 8

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

YES 1
NO 2
DON’T KNOW 8

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

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

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

FANSIDAR A
CHLOROQUINE B
HALFAN C
DARAPRIM/METAPRIM D
AMODIAQUINE E
NIVAQUINE F
MALOZINE G
UNKNOWN DRUG H
OTHER (SPECIFY) _________ X

422A. CHECK 422:
DRUGS TAKEN FOR MALARIA PREVENTION.

CODE ‘A’ CIRCLED (GO TO 422B)
CODE ‘A’ NOT CIRCLED (GO TO 423)

422B. How many times did you take Fansidar during this pregnancy?

NUMBER OF TIMES _____

422C. CHECK 407:
ANTENATAL CARE RECEIVED DURING THE PREGNANCY?

CODE ‘A’ OR ‘B’ OR ‘C’ OR ‘D’ CIRCLED (GO TO 422D)
OTHER (GO TO 423)

422D. Did you get the Fansidar during an antenatal visit, during another visit to a health facility or from some other source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY) ___________ 8

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

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

424. Was (NAME) weighed at birth?

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

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

GRAMS FROM CARDS 1 ______
GRAMS FROM RECALL 2 ________

DON’T KNOW 99998

426. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
COMMUNITY HEALTH EXTENSION WORKER D
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
RELATIVE/FRIEND F
OTHER (SPECIFY) ________ X
NO ONE Y

426A. 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?
YES 1
NO 2
Excessive bleeding that was so much that you feared it was life threatening?
YES 1
NO 2
A high fever with bad smelling vaginal discharge?
YES 1
NO 2
Convulsions not caused by a fever?
YES 1
NO 2

427. Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTRE OR CLINIC, WRITE THE NAME OF THE PLACE, PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _______________________
HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTRE 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) _____________ 36
OTHER (SPECIFY) _____________ 96 (GO TO 429)

428. Was (NAME) delivered by caesarian section?

YES 1 (GO TO 433)
NO 2 (GO TO 433)

429. After (NAME) was born did a health professional or a traditional birth attendant check on your health?

YES 1
NO 2 (GO TO 433)

430. How many days or weeks after the delivery did the first check take place?
RECORD ‘00’ DAYS IF SAME DAY.

DAYS AFTER DELIVERY 1 ______
WEEKS AFTER DELIVERY 2 _____

DON’T KNOW 998

431. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH EXTENSION WORKER 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) ________ 96

432. Where did this first check take place?
IF SOURCE IS HOSPITAL, HEALTH CENTRE OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ____________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTRE 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) _____________ 36
OTHER (SPECIFY) _____________ 96

433. In the first two months after delivery, did you receive a vitamin A dose like this?
(SHOW AMPULE/CAPSULE/SYRUP)

YES 1
NO 2
DON’T KNOW 8

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

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

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

YES 1
NO 2 (GO TO 439)

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

MONTHS __
DON’T KNOW 98

437. CHECK 226:
IS RESPONDENT PREGNANT?

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

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

YES 1
NO 2 (GO TO 440)

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

MONTHS ___________
DON’T KNOW 98

440. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

441. 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 ______

442. In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 444)
DON’T KNOW 8 (GO TO 444)

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

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/HERBAL DRINKS H
HONEY I
OTHER (SPECIFY) _____ X

444. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 445)
DEAD (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS _____
DON’T KNOW 98

447. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 454)

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

NUMBER OF NIGHT TIME FEEDINGS ______

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

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON’T KNOW 8

451. Was sugar added to any of the foods or liquids (NAME) ate yesterday?

YES 1
NO 2
DON’T KNOW 8

452. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD ‘7’

NUMBER OF TIMES ________
DON’T KNOW 8

453. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1998 OR LATER. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES)

455. LINE NUMBER FROM 212

LINE NUMBER _____

456. FROM 212 AND 216

NAME _______
LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 484)

457. Did (NAME) receive a vitamin A dose like this during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2
DON’T KNOW 8

458. Do you have a card where (NAME’S) vaccinations are written down?
IF YES: May l see it please?

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

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

YES 1 (GO TO 462)
NO 2 (GO TO 462)

460. (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
DAY __
MONTH __
YEAR __
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY __
MONTH __
YEAR __
POLIO 1
DAY __
MONTH __
YEAR __
POLIO 2
DAY __
MONTH __
YEAR __
POLIO 3
DAY __
MONTH __
YEAR __
DPT 1
DAY __
MONTH __
YEAR __
DPT 2
DAY __
MONTH __
YEAR __
DPT 3
DAY __
MONTH __
YEAR __
MEASLES
DAY __
MONTH __
YEAR __
VITAMIN A (MOST RECENT)
DAY __
MONTH __
YEAR __

461. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD ‘YES’ ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

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

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

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

463. Please tell me if (NAME) received any of the following vaccinations:
463A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON’T KNOW 8

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

YES 1
NO 2 (GO TO 463E)
DON’T KNOW 8 (GO TO 463E)

463C. When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

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

NUMBER OF TIMES ___

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

YES 1
NO 2 (GO TO 463G)
DON’T KNOW 8 (GO TO 463G)

463F. How many times?

NUMBER OF TIMES ___

463G. An injection to prevent measles?

YES 1
NO 2
DON’T KNOW 8

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

YES 1
NO 2
NO VACCINATION IN THE LAST 2 YEARS 3
DON’T KNOW 8

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

YES 1
NO 2 (GO TO 467)
DOES NOT KNOW 8 (GO TO 467)

466A. Does (NAME) have a fever now?

YES 1
NO 2
DON’T KNOW 8

467. Has (NAME) had an illness with a cough at any time in the last 2 weeks?

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

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

YES 1
NO 2
DON’T KNOW 8

469. CHECK 466 AND 467:
FEVER OR COUGH?

‘YES’ IN 466 OR 467 (GO TO 470)
OTHER (GO TO 471A)

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

YES 1
NO 2 (GO TO 471A)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ______ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PATENT MEDICINE STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER SOURCE
SHOP M
TRADITIONAL PR ACTIONER N
SPIRITUAL HEALER O
OTHER (SPECIFY) _______________ X

471A. Has (NAME) been ill with convulsions at any time during the last 2 weeks?

YES 1
NO 2
DON’T KNOW 8

472A. CHECK 466 AND 471A:
HAD FEVER OR CONVULSIONS?

‘YES’ IN 466 OR 471A (GO TO 473)
OTHER (GO TO 475)

473A. Was (NAME) given any drugs for the (fever/convulsions)?

YES 1
NO 2 (GO TO 474R)
DON’T KNOW 8 (GO TO 474R)

474. What drugs did (NAME) take?
RECORD ALL MENTIONED. ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTI-MALARIAL DRUGS TO RESPONDENT.

ANTI-MALARIAL
CHLOROQUINE A
FANSIDAR B
AMODIAQUINE (CAMOQUINE) C
QUININE D
OTHER DRUGS
ASPIRIN E
PARACETAMOL (PANADOL) F
OTHER (SPECIFY) ______ X
DON’T KNOW Z

474A. Did (NAME) get any injection or suppository for the (fever/convulsions)?

INJECTION A
SUPPOSITORY B
NONE C
DON’T KNOW Z

474B. CHECK 474:
WHICH MEDICINES?

CODE ‘A’ CIRCLED (GO TO 474C)
CODE ‘A’ NOT CIRCLED (GO TO 474F)

474C. How long after the (fever/convulsions) started did (NAME) first take chloroquine?

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

474D. For how many days did (NAME) take the chloroquine?
IF 7 OR MORE DAYS, RECORD ‘7’.

DAYS ________
DON’T KNOW 8

474E. Did you have the chloroquine at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the chloroquine first?

AT HOME 1
OTHER SOURCE 2
DON’T KNOW 8

474F. CHECK 474:
WHICH MEDICINES?

CODE ‘B’ CIRCLED (GO TO 474G)
CODE ‘B’ NOT CIRCLED (GO TO 474J)

474G. How long after the (fever/convulsions) started did (NAME) first take Fansidar?

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

474H. For how many days did (NAME) take Fansidar?
IF 7 OR MORE DAYS, RECORD ‘7’.

DAYS ________
DON’T KNOW 8

474I. Did you have Fansidar at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Fansidar first?

AT HOME 1
OTHER SOURCE 2
DON’T KNOW 8

474J. CHECK 474:
WHICH MEDICINES?

CODE ‘C’ CIRCLED (GO TO 474K)
CODE ‘C’ NOT CIRCLED (GO TO 474N)

474K. How long after the (fever/convulsions) started did (NAME) first take (Amodiaquine/Camoquine)?

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

474L. For how many days did (NAME) take (Amodiaquine/Camoquine)?
IF 7 OR MORE DAYS, RECORD ‘7’.

DAYS ________
DON’T KNOW 8

474M. Did you have the (Amodiaquine/Camoquine) at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the (Amodiaquine/Camoquine) first?

AT HOME 1
OTHER SOURCE 2
DON’T KNOW 8

474N. CHECK 474:
WHICH MEDICINES?

CODE ‘D’ CIRCLED (GO TO 474O)
CODE ‘D’ NOT CIRCLED (GO TO 474R)

474O. How long after the (fever/convulsions) started did (NAME) first take Quinine?

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

474P. For how many days did (NAME) take Quinine?
IF 7 OR MORE DAYS, RECORD ‘7’.

DAYS ________
DON’T KNOW 8

474Q. Did you have the Quinine at home or did you get if from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Quinine first?

AT HOME 1
OTHER SOURCE 2
DON’T KNOW 8

474R. Was anything else done about (NAME)’s (fever/convulsions)?

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

474S. What was done about (NAME)’s (fever/convulsions)?

CONSULTED TRADITIONAL HEALER A
GAVE TEPID SPONGING B
GAVE HERBS C
PRAYED/TOOK CHILD TO CHURCH D
OTHER (SPECIFY) ____________ X

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

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

476. Now I would like to know how much fluid (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON’T KNOW 8

477. When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON’T KNOW 8

478. Was he/she given any of the following to drink:

a. A fluid made from a special packet called ORS?
YES 1
NO 2
DON'T KNOW 8
b. Salt-Sugar-Solution (ORT)?
YES 1
NO 2
DON'T KNOW 8

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

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

480. What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS MENTIONED.

PILL OR SYRUP A
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ____ X

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

YES 1
NO 2 (GO TO 483)

482. Where did you seek advice or treatment? Anywhere else?
IF SOURCE IS HOSPITAL, HEALTH CENTRE OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.

(NAME OF PLACE) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PATENT MEDICINE STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
SPIRITUAL HEALER O
OTHER (SPECIFY) _______________ X

483. GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484.

484. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1998 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (GO TO 485)
NONE (GO TO 487)

485. What is usually done to dispose of your (youngest) child’s stools when he/she does not use any toilet facility?

CHILD ALWAYS USE TOILET/LATRINE 01
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSE AWAY 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
NOT DISPOSED OF 09
OTHER (SPECIFY) _________ 96

486. CHECK 478a, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 487)
AT LEAST ONE RECEIVED FLUID FROM ORS PACKET (GO TO 488)

487. Have you ever heard of a special product called an ORS packet you can get for the treatment of diarrhea?

YES 1
NO 2

488. CHECK 218:

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

489. When (your child/one of your children) is seriously ill, can you by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK:
If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

490. Now I would like to ask you some questions about medical care for you yourself. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem or no problem?

Knowing where to go.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Getting permission to go.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Getting money needed for treatment.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
The distance to a health facility.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Having to take transport.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Not wanting to go alone.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
Concern that there may not be a female health provider.
BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3

491. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2000 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE TO 492))
(NAME) __________
DOES NOT HAVE ANY CHILDREN BORN IN 2000 OR LATER AND LIVING WITH HER (GO TO 494)

492. Now I would like to ask you about liquids (NAME FROM Q. 491) drank over the last seven days, including yesterday. How many days during last seven days did (NAME FROM Q. 491) drink each of the following?
FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE PROCEEDING TO THE NEXT ITEM, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?
IF 7 OR MORE TIMES, RECORD ‘7’. IF DON’T KNOW, RECORD ‘8’.

a. Plain water?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
b. Commercially produced infant formula?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
c. Any other milk such as tinned, powdered, or fresh animal milk?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
d. Fruit juice?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
e. Herbal drink?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
f. Any other liquids such as sugar water, tea, coffee, carbonated drinks, or soup broth?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __

493. Now I would like to ask you about the types of foods (NAME FROM Q.491) ate over the last seven days, including yesterday. How many days during last seven days did (NAME FROM Q. 491) eat each of the following foods either separately or combined with other food?
FOR EACH ITEM GIVEN AT LEAST ONCE IN LAST SEVEN DAYS, BEFORE
PROCEEDING TO THE NEXT ITEM, ASK: In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) eat (ITEM)?
IF 7 OR MORE TIMES, RECORD ‘7’. IF DON’T KNOW, RECORD ‘8’.

a. Any food made from grains [e.g. millet, sorghum, maize, rice, wheat, porridge, or other local grains]?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
b. Pumpkin, red or yellow yams, carrots, or sweet potatoes?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
c. Food made from roots or tubers [e.g. Irish potatoes, white yams, cocoyam, cassava, or other local roots/tubers]?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
d. Any green leafy vegetables?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
e. Mango, pawpaw, and palm-nuts?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
f. Any other fruits and vegetables [e.g. bananas, plantains, water-melon, apples/sauce, green beans, avocados, tomatoes]?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
g. Meat, poultry, fish, shellfish, or eggs?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
h. Any food made from legumes [e.g. lentils, beans, soybeans, pulses, or peanuts]?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
i. Cheese or yoghurt (local cheese)?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __
j. Any food made with oil, fat, or butter?
(LAST 7 DAYS) NUMBER OF DAYS __
(YESTERDAY/LAST NIGHT) NUMBER OF TIMES __

494. Did you sleep under a bednet last night?

YES 1
NO 2

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

YES 1
NO 2
NEVER PREPARED MEALS 3

496. Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco/cigarette do you smoke?
RECORD ALL TYPES MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

497. CHECK 496:

CODE ‘A’ CIRCLED (GO TO 498)
CODE ‘A’ NOT CIRCLED (GO TO 499A)

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

CIGARETTES ______

499A. Have you ever drunk an alcohol-containing beverage?

YES 1
NO 2 (GO TO 501)

499B. In the last 3 months, on how many days did you drink an alcohol-containing beverage?
IF EVERY DAY: RECORD ‘90’.

NUMBER OF DAYS _____
NONE 95

499C. Have you ever gotten ‘drunk’ from drinking an alcohol-containing beverage?

YES 1
NO 2 (GO TO 501)

499D. CHECK 499B:

DRANK ALCOHOL ON AT LEAST ONE DAY (GO TO 499E)
NONE (GO TO 501)
499E. In the last 3 months, on how many occasions did you get ‘drunk’?

NUMBER OF TIMES ___
NONE/NEVER 95

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 510)
NO 3 (GO TO 514)

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

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

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

506. RECORD THE HUSBAND’S/PARTNER’S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD ‘00’.

NAME _______
LINE NUMBER____

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

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

508. How many other wives does he have?

NUMBER __
DON’T KNOW 8 (GO TO 510)

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

RANK __

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

ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

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 514)
DON’T KNOW YEAR 9998

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

AGE ____

514. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?

NEVER 00 (GO TO 524)
AGE IN YEARS ________
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

514A. CHECK 106:

15-24 YEARS OLD (GO TO 514B)
25-49 YEARS OLD (GO TO 515)

514B. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2

515. When was the last time you had sexual intercourse?
RECORD ‘YEARS AGO’ ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. RECORD MONTHS ONLY IF 11 MONTHS OR LESS.

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __ (GO TO 524)

516. The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 517)

516A. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STI/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STI/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) ________ 96
DON’T KNOW 98

517. What is your relationship to the man with whom you last had sex?
IF MAN IS ‘BOYFRIEND’ OR ‘FIANCɒ, ASK: Was your boyfriend/fiancé living with you when you last had sex?
IF YES, CIRCLE ‘01’. IF NO, CIRCLE ‘02’.

SPOUSE/COHABITING PARTNER 01 (GO TO 519)
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ________ 96

517A. CHECK 106:

15-19 YEARS OLD (GO TO 517B)
20-49 YEARS OLD (GO TO 518)

517B. Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON’T KNOW DIFFERENCE 5
DON’T KNOW 8

518. For how long have you had sexual relations with this man?

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

519. Have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

520. The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 521)

520A. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STI/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STI/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) ________ 96
DON’T KNOW 98

521. What is your relationship to this other man?
IF MAN IS ‘BOYFRIEND’ OR ‘FIANCɒ, ASK: Was your boyfriend/fiancé living with you when you last had sex with him?
IF YES, CIRCLE ‘01’. IF NO, CIRCLE ‘02’.

SPOUSE/COHABITING PARTNER 01 (GO TO 522A)
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ________ 96

521A. CHECK 106:

15-19 YEARS OLD (GO TO 521B)
20-49 YEARS OLD (GO TO 522)

521B. Was this man younger, about the same age or older than you?
IF OLDER: Do you think that he was less than 10 years older than you or 10 or more years older than you?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON’T KNOW DIFFERENCE 5
DON’T KNOW 8

522. For how long have you had sexual relations with this man?

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

522A. Other than these two men, have you had sex with any other man in the last 12 months?

YES 1
NO 2 (GO TO 524)

522B. The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 522D)

522C. What was the main reason you used a condom on that occasion?

RESPONDENT WANTED TO PREVENT STI/HIV 01
RESPONDENT WANTED TO PREVENT PREGNANCY 02
RESPONDENT WANTED TO PREVENT BOTH STI/HIV AND PREGNANCY 03
DID NOT TRUST PARTNER/FELT PARTNER HAD OTHER PARTNERS 04
PARTNER REQUESTED/INSISTED 05
OTHER (SPECIFY) ________ 96
DON’T KNOW 98

522D. What is your relationship to this man?
IF MAN IS ‘BOYFRIEND’ OR ‘FIANCɒ, ASK: Was your boyfriend/fiancé living with you when you last had sex with him?
IF YES, CIRCLE ‘01’. IF NO, CIRCLE ‘02’.

SPOUSE/COHABITING PARTNER 01 (GO TO 523)
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ________ 96

522D1. CHECK 106:

15-19 YEARS OLD (GO TO 522D2)
20-49 YEARS OLD (GO TO 522E)

522D2. Was this man younger, about the same age or older than you?

YOUNGER 1
ABOUT THE SAME AGE 2
LESS THAN 10 YEARS OLDER 3
10 OR MORE YEARS OLDER 4
OLDER, DON’T KNOW DIFFERENCE 5
DON’T KNOW 8

522E. For how long have you had sexual relations with this man?

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

523. In total, with how many different men have you had sex in the last 12 months?

NUMBER OF PARTNERS ___

524. Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 527)

525. Where is that? Any other 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.
RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ______ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PATENT MEDICINE STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
NGO P
OTHER (SPECIFY) _______________ X

526. If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

527. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 530)

528. Where is that? Any other 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.
RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE) _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ______ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PATENT MEDICINE STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
NGO P
OTHER (SPECIFY) _______________ X

529. If you wanted to, could you yourself get a female condom?

YES 1
NO 2
DON’T KNOW/UNSURE 8

530. Is it acceptable or not acceptable to you for information on condoms to be provided:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
In newspaper or magazine?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

531. In the last few months, have you heard/read about condoms:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
From a poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2
From town crier?
YES 1
NO 2
Mobile public announcement?
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

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

602. CHECK 226:

NOT PREGNANT OR 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 604)
SAYS SHE CAN’T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON’T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 608)

603. CHECK 226:

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

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

MONTHS 1 ___
YEARS 2 ___

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

604. CHECK 226:

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

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why? Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
GOD WILL DECIDE/FATE H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY’S NORMAL PROCESSES T
OTHER _______ X
DON’T KNOW Z

608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN’T GET PREGNANT/NOT HAVING SEX 4

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON’T KNOW 8 (GO TO 612)

611. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY) ______ 96 (GO TO 614)
UNSURE 98 (GO TO 614)

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

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

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

YES 1
NO 2
DON’T KNOW 8

614. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 616)

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

NUMBER OF BOYS____
OTHER (SPECIFY) ______ 96
NUMBER OF GIRLS____
OTHER (SPECIFY) ______ 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY) ______ 96

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

APPROVE 1
DISAPPROVE 2
DON’T KNOW/UNSURE 3

617. In the last 3 months have you heard/read about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
From a poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2
From town crier?
YES 1
NO 2
Mobile public announcement?
YES 1
NO 2

619. In the last 3 months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 621)

620. With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

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

621. CHECK 501:

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

622. CHECK 311/311A:

AT LEAST ONE CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband’s/partner’s decision or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _______ 6

624. 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 contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON’T KNOW 8

625. 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

627. 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

628. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted infection?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with women other than his wives?
YES 1
NO 2
DON'T KNOW 8
She has recently given birth?
YES 1
NO 2
DON'T KNOW 8
She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

628A. When a wife knows her husband has a sexually transmitted infection, is she justified in asking that he use a condom?

YES 1
NO 2
DON’T KNOW 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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

AGE IN COMPLETED YEARS _______

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 (GO TO 706)
DON’T KNOW 8

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

CLASS____
DON’T KNOW 98

706. CHECK 701:

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

FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband’s/ partner’s occupation? That it, what kind of work did he mainly do?

OCCUPATION______________

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

YES 1 (GO TO 710)
NO 2

708. 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 710)
NO 2

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

YES 1
NO 2 (GO TO 719)

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

OCCUPATION_____________

711. CHECK 710:

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

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

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

713. 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

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

HOME 1
AWAY 2

714A. CHECK 217 AND 218:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

YES (GO TO 714B)
NO (GO TO 715)

714B. 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

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

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

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 719)
NOT PAID 4 (GO TO 719)

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

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

718. On average, how much of your household’s expenditures do your earnings pay for: none, almost none, less than half, about half, more than half, or all?

NONE 1
ALMOST NONE 2
LESS THAN HALF 3
ABOUT HALF 4
MORE THAN HALF 5
ALL 6

719. Who in your family usually has the final say on the following decisions:

Your own health care?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making large household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Making household purchases for daily needs?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Visits to family or relatives?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
What food should be cooked each day?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Children’s health care?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6
Children’s education?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
DECISION NOT MADE/NOT APPLICABLE 6

720. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING OR NOT PRESENT)

CHILDREN UNDER 10 YEARS
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8
If food is not cooked on time?
YES 1
NO 2
DON'T KNOW 8

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 817)

801A. How can a person get AIDS? Any other ways?
RECORD ALL MENTIONED.

SEX WITH PROSTITUTES 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
RAZOR BLADES/BARBER/CLIPPER K
SHARP OBJECTS L
OTHER (SPECIFY) _______ W
OTHER (SPECIFY) _______ X
DON’T KNOW Z

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

YES 1
NO 2 (GO TO 809)
DON’T KNOW 8 (GO TO 809)

803. What can a person do? Anything else?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PR ACTIONER N
AVOID USING SHARP OBJECTS O
OTHER (SPECIFY) _______ W
OTHER (SPECIFY) _______ X
DON’T KNOW Z

804. Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?

YES 1
NO 2
DON’T KNOW 8

805. Can a person get the AIDS virus from mosquito bites?

YES 1
NO 2
DON’T KNOW 8

806. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON’T KNOW 8

807. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON’T KNOW 8

808. Can a person reduce their chance of getting the AIDS virus by not having sex at all?

YES 1
NO 2
DON’T KNOW 8

808A. Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON’T KNOW 8

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

YES 1
NO 2
DON’T KNOW 8

810. Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

YES 1
NO 2

811. Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2 (GO TO 813)
DON’T KNOW 8 (GO TO 813)

812. Can the virus that causes AIDS be transmitted from a mother to a child:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

812A. Have you heard of any drugs that a woman infected with the AIDS virus can take to reduce the risk of transmission to the baby during pregnancy?

YES 1
NO 2
DON’T KNOW 8

813. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 814)
NO, NOT IN UNION (GO TO 814A)

814. Have you ever talked with (your husband/the man you are living with) about ways to prevent getting the virus that causes AIDS?

YES 1
NO 2

814A. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
On the TV?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In newspapers/magazines?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In Church/Mosque?
ACCEPTABLE 1
NOT ACCEPTABLE 2
At home?
ACCEPTABLE 1
NOT ACCEPTABLE 2
In School?
ACCEPTABLE 1
NOT ACCEPTABLE 2

814B. Would you buy fresh vegetables from a seller who has the AIDS virus?

YES 1
NO 2
DON’T KNOW 8

815. If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

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

816. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

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

816A. If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?

CAN CONTINUE 1
NO, SHOULD NOT CONTINUE 2
DON'T KNOW/NOT SURE/DEPENDS 8

816B. Should children age 12-14 be taught about using a condom to avoid AIDS?

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

816C. I don’t want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 816D)

816C1. When was the last time you were tested?

LESS THAN 12 MONTHS 1
12-23 MONTHS 2
2 YEARS OR MORE 3

816C2. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

816C3. I don’t want to know the results, but did you get the results of the test?

YES 1 (GO TO 816FX)
NO 2 (GO TO 816FX)

816D. Would you want to be tested for the AIDS virus?

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

816E. Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 816G)

816F. Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.
816FX. Where did you go for the test?
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
DISPENSARY 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PATENT MEDICINE STORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) _______________ 96

816G. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 816I)
GREAT 3 (GO TO 816I)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 816K)
DON’T KNOW/UNSURE 8 (GO TO 816J)

816H. 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 (GO TO 816J)
USE CONDOMS C (GO TO 816J)
AVOID MULTIPLE SEX PARTNERS D (GO TO 816J)
AVOID SEX WITH PROSTITUTES E (GO TO 816J)
AVOID SEX WITH HOMOSEXUALS F (GO TO 816J)
ENSURE SAFE BLOOD TRANSFUSION G (GO TO 816J)
ENSURE INJECTION WITH STERILIZED NEEDLE H (GO TO 816J)
AVOID KISSING I (GO TO 816J)
AVOID MOSQUITO BITES J (GO TO 816J)
SEEK PROTECTION FROM TRADITIONAL HEALER K (GO TO 816J)
OTHER (SPECIFY) _______ W (GO TO 816J)
OTHER (SPECIFY) _______ X (GO TO 816J)
DON’T KNOW Z (GO TO 816J)

816I. Why do you think that you have a (MODERATE/GREAT CHANCE) of getting AIDS? Any other reasons?
RECORD ALL MENTIONED.

DO NOT USE CONDOMS A
MORE THAN ONE SEXUAL PARTNER B
SEX WITH PROSTITUTES C
SPOUSE HAS OTHER PARTNER(S) D
HOMOSEXUAL CONTACT E
HAD BLOOD TRANSFUSION F
HAD INJECTIONS WITH UNSTERILIZED NEEDLES G
SEEK PROTECTION FROM TRADITIONAL HEALER H
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
DON’T KNOW Z

816J. 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
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
ADVICE SPOUSE/PARTNER TO BE FAITHFUL F
NO MORE HOMOSEXUAL CONTACTS G
ENSURE INJECTION WITH STERILIZED NEEDLES H
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
NO BEHAVIOUR CHANGE Y

816K. From which sources of information have you learned most about AIDS? Any other source?
RECORD ALL MENTIONED.

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

817. (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 819A)

818. If a man has a sexually transmitted infection, what symptoms might he have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DON’T KNOW Z

819. If a woman has a sexually transmitted infection, what symptoms might she have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE CHILD L
OTHER (SPECIFY) ________ W
OTHER (SPECIFY) ________ X
NO SYMPTOMS Y
DON’T KNOW Z

819A. CHECK 514:

HAS HAD SEXUAL INTERCOURSE (GO TO 819A1)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

819A1. CHECK 817:

KNOWS STIs (GO TO 819B)
DOES NOT KNOW STIs (GO TO 819C)

819B. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a sexually-transmitted infection?

YES 1
NO 2
DON’T KNOW 8

819C. Sometimes, women experience a bad-smelling, abnormal genital discharge. During the last 12 months, have you had a bad-smelling, abnormal genital discharge?

YES 1
NO 2
DON’T KNOW 8

819D. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON’T KNOW 8

819E. CHECK 819B, 819C, 819D:

AT LEAST ONE ‘YES’ (GO TO 819F)
OTHER (GO TO 901)

819F. The last time you had (PROBLEM FROM 819B/819C/819D), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 819H)

819G. The last time you had (PROBLEM FROM 819B/819C/819D), did you do any of the following? Did you....

Go to a clinic, hospital or private doctor?
YES 1
NO 2
Consult a traditional healer?
YES 1
NO 2
Seek advice or buy medicines in a shop or pharmacy?
YES 1
NO 2
Ask for advice from friends or relatives?
YES 1
NO 2

819H. When you had (PROBLEM FROM 819B/819C/819D), did you inform the person with whom you were having sex?

YES 1
NO 2
SOME/NOT ALL 3
DID NOT HAVE A PARTNER 4 (GO TO 901)

819I. When you had (PROBLEM FROM 819B/819C/819D), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 901)
PARTNER ALREADY INFECTED 3 (GO TO 901)

819J. What did you do to avoid infecting your partner(s)? Did you....

Use medicine?
YES 1
NO 2
Stop having sex?
YES 1
NO 2
Use a condom when having sex?
YES 1
NO 2

SECTION 9. FEMALE GENITAL CUTTING (CIRCUMCISION)

901. Have you ever heard of female circumcision?

YES 1 (GO TO 903)
NO 2

902. In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (GO TO 925)

903. Have you ever been circumcised?

YES 1
NO 2 (GO TO 909)
DON’T KNOW 8 (GO TO 909)

904. Now I would like to ask you what was done to you at this time. Was any flesh removed from the genital area?

YES 1 (GO TO 906)
NO 2
DON’T KNOW 8

905. Was the genital area cut on the surface without removing any flesh?

YES 1
NO 2
DON’T KNOW 8

906. Was your genital area sewn closed?

YES 1
NO 2
DON’T KNOW 8

907. How old were you when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS ___

DURING INFANCY 95
DON’T KNOW 98

908. Who did the circumcision?

TRADITIONAL
TRADITIONAL ‘CIRCUMCISER’ 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) __________ 16
HEALTH PROFESSIONAL
DOCTOR 21
TRAINED NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _________ 26
DON’T KNOW 98

909. CHECK 214 AND 216:

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

910. Have any of your daughters been circumcised?
IF YES: How many?

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

911. To which of your daughters did this happen most recently?
INTERVIEWER: CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER

(DAUGHTER’S NAME) _____________
DAUGHTER’S LINE NUMBER FROM Q212 __

912. Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM Q.911) at this time? Was any flesh removed from her genital area?

YES 1 (GO TO 914)
NO 2
DON’T KNOW 8

913. Was her genital area cut on the surface without removing any flesh?

YES 1
NO 2
DON’T KNOW 8

914. Was her genital area sewn closed?

YES 1
NO 2
DON’T KNOW 8

915. How old was (NAME OF THE DAUGHTER FROM Q.911) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS ___

DURING INFANCY 95
DON’T KNOW 98

916. Who did the circumcision?

TRADITIONAL
TRADITIONAL ‘CIRCUMCISER’ 11
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) __________ 16
HEALTH PROFESSIONAL
DOCTOR 21
TRAINED NURSE/MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY) _________ 26
DON’T KNOW 98

917. At the time of circumcision or afterwards, did (NAME OF THE DAUGHTER FROM Q.911) have any of the following:

Excessive bleeding?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Difficulty in passing urine or urine retention?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Swelling in the genital area?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)
Infection in the genital area? Wound that did not heal properly?
YES 1 (GO TO 919)
NO 2 (GO TO 919)
DON'T KNOW 8 (GO TO 919)

918. Do you intend to have any of your daughters circumcised in the future?

YES 1
NO 2
DON’T KNOW 8

919. What benefits do girls themselves get if they undergo this circumcision?
PROBE: Any other benefits?
RECORD ALL MENTIONED.

CLEANLINESS/HYGIENE A
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
PRESERVE VIRGINITY/PREVENT PREMARITAL SEX D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS APPROVAL F
OTHER (SPECIFY) ___________ X
NO BENEFITS Y
DON’T KNOW Z

920. What benefits do girls themselves get if they do not undergo this circumcision?
PROBE: Anything else?
RECORD ALL MENTIONED.

FEWER MEDICAL PROBLEMS A
AVOIDING PAIN B
MORE SEXUAL PLEASURE FOR HER C
MORE SEXUAL PLEASURE FOR THE MAN D
FOLLOWS RELIGION E
OTHER (SPECIFY) ___________ X
NO BENEFITS Y
DON’T KNOW Z

921. Would you say that this practice is a way to prevent a girl from having sex before marriage or does it have no effect?

PREVENT SEX 1
NO EFFECT 2
DON’T KNOW 8

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

YES 1
NO 2
DON’T KNOW 8

923. Do you think that this practice should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON’T KNOW 8

924. Do you think that men want this practice to be continued, or discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON’T KNOW 8

925. RECORD THE TIME.

HOUR ___
MINUTES ___

NOTE: GO BACK TO THE HOUSEHOLD QUESTIONNAIRE AND ADMINISTER THE HEIGHT AND WEIGHT SECTION.

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 THE SUPERVISOR:__________
DATE:____________________

EDITOR’S OBSERVATIONS:_______________________________

NAME OF EDITOR:________________________
DATE:_____________________