IDENTIFICATION

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

URBAN/RURAL ___

CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD NAME/NUMBER __

LARGE TOWN/MEDIUM TOWN/SMALL TOWN/VILLAGE __

NAME AND LINE NUMBER OF WOMAN _____________ ___

INTERVIEWER 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 __

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED?

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: __________

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

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

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

105. In what month and year were you born?

106. How old were you as at 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 (class/form/year) you completed at that level?

110. CHECK 108:

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?

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

113. CHECK 111:

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?

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

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

117. What is your religion?

118. What is your 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?

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 did not survive?

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?

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 ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)

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.

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

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

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

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

226. Are you pregnant now?

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

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

230. When did the last such pregnancy end?

231. CHECK 230:

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

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

236. When did the last such previous pregnancy end?

237. When did your last menstrual period start?

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?

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

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)?

302. Have you ever used (METHOD)?

303. CHECK 302:

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

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'.

308. CHECK 302 (01):

309. CHECK 226:

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

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.

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.

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?

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?

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

317. CHECK 316/316A:

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

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.

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

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?

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

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

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?

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

327. CHECK 311/311A:

CIRCLE METHOD CODE:

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

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.

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

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

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?

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

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

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

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

404. FROM 212 AND 216

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?

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

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.

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

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

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

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

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

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

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

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

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

415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

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

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

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

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

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

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

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

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

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

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

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

424. Was (NAME) weighed at birth?

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

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

426A. Around the time of the birth of (NAME), did you have any of the following problems:

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.

428. Was (NAME) delivered by caesarian section?

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

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

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

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.

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

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

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

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

437. CHECK 226:
IS RESPONDENT PREGNANT?

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

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

440. Did you ever breastfeed (NAME)?

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.

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

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

444. CHECK 404:
IS CHILD LIVING?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 404:
IS CHILD LIVING?

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

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

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

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

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'

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

456. FROM 212 AND 216

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

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

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

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.

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).

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

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?

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

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

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

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

463F. How many times?

463G. An injection to prevent measles?

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

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

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

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

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

469. CHECK 466 AND 467:
FEVER OR COUGH?

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

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

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

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

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

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.

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

474B. CHECK 474:
WHICH MEDICINES?

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

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

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?

474F. CHECK 474:
WHICH MEDICINES?

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

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

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?

474J. CHECK 474:
WHICH MEDICINES?

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

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

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?

474N. CHECK 474:
WHICH MEDICINES?

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

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

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?

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

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

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

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?

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?

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

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

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

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

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.

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

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

486. CHECK 478a, ALL COLUMNS:

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

488. CHECK 218:

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?

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?

491. CHECK 215 AND 218:

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'.

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'.

494. Did you sleep under a bednet last night?

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

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

497. CHECK 496:

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

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

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

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

499D. CHECK 499B:

499E. In the last 3 months, on how many occasions did you get 'drunk'?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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'.

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

508. How many other wives does he have?

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

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

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?

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

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)?

514A. CHECK 106:

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

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.

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

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

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

517A. CHECK 106:

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?

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

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

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

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

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

521A. CHECK 106:

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?

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

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

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

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

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

522D1. CHECK 106:

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

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

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

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

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.

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

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

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.

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

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

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

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

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?

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?

604. CHECK 226:

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

606. CHECK 603:

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.

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?

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

611. Which contraceptive method would you prefer to use?

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

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

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.

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?

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

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

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

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

621. CHECK 501:

622. CHECK 311/311A:

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?

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?

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

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?

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:

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

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

701. CHECK 501 AND 502:

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

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?

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

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?

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

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

711. CHECK 710:

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?

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

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

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

714B. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

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

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

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

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?

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

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

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:

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?

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

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

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

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?

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

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

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

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

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

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

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

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

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

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?

813. CHECK 501:

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

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

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

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?

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?

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

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

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

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

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?

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

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

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

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.

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

816H. Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS? Any other reasons?
RECORD ALL MENTIONED.

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

816J. Since you heard of AIDS, have you changed your behaviour to prevent getting AIDS?
IF YES, what did you do?
RECORD ALL MENTIONED.

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

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

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

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

819A. CHECK 514:

819A1. CHECK 817:

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?

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

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

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

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

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

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

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

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

SECTION 9. FEMALE GENITAL CUTTING (CIRCUMCISION)

901. Have you ever heard of female circumcision?

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?

903. Have you ever been circumcised?

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

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

906. Was your genital area sewn closed?

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

908. Who did the circumcision?

909. CHECK 214 AND 216:

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

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

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?

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

914. Was her genital area sewn closed?

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.

916. Who did the circumcision?

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

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

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

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

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?

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

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

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

925. RECORD THE TIME.

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:_____________________