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NIGERIA DEMOGRAPHIC AND HEALTH SURVEY 2008
MODEL WOMAN'S QUESTIONNAIRE
WITH HIV/AIDS AND MALARIA MODULES

IDENTIFICATION

STATE ___________________ ___
LOCAL GOVT. AREA ________________ ___
LOCALITY ___________________ ___
ENUMERATION AREA _______________ ___

URBAN/RURAL:

URBAN l
RURAL 2

CLUSTER NUMBER __
BUILDING NUMBER __
HOUSEHOLD HEAD NAME/NUMBER ______________ ___

NAME AND LINE NUMBER OF WOMAN ______________ ___

IS WOMAN SELECTED FOR QUESTIONS ON DOMESTIC VIOLENCE (SECTION 13)?

YES 1
NO 2

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 (FOR INTERVIEWERS 1 AND 2)
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR 2008
INT. NUMBER ____
RESULT _____

TOTAL NUMBER OF VISITS __

LANGUAGE OF INTERVIEW

HAUSA 1
YORUBA 2
IGBO 3
ENGLISH 4
OTHER (SPECIFY) ___________ 6

NATIVE LANGUAGE OF RESPONDENT

HAUSA 1
YORUBA 2
IGBO 3
ENGLISH 4
OTHER (SPECIFY) ___________ 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 National Population Commission. We are conducting a national survey that asks women and men about various health issues.
This study has been reviewed and granted approval by the National Health Research Ethics Committee, assigned number NHREC/01/01/2007, for the study period of February 22, 2008 to February 23, 2009. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 30 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. Should you have any queries, feel free to call any of the following contact person(s):

2008 NDHS Contact Person:
Project Director; Email: saligar58@yahoo.com; Phone: 08033708114

NHREC Contact Person(s):
Secretary, NHREC; Email: secretary@nhrec.net; Phone: 08033143791
Desk Officer, NHREC; Email: deskofficer@nhrec.net; Phone: 08065479926

Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time.
However, 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.

HOUR ___
MINUTES ___

102. 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 104)
VISITOR 96 (GO TO 104)

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

CITY 1
TOWN 2
VILLAGE 3

104. In the last 12 months, on how many separate occasions have you travelled away from your home community and slept away?

NUMBER OF TRIPS AWAY ____
NONE 00 (GO TO 106)

105. In the last 12 months, have you been away from your home community for more than one month at a time?

YES 1
NO 2

106. In what month and year were you born?

MONTH _____
DON'T KNOW MONTH 98
YEAR ______
DON'T KNOW YEAR 9998

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

AGE IN COMPLETED YEARS _______

108. Have you ever attended school?

YES 1
NO 2 (GO TO 112)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

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

CLASS/FORM/YEAR _______

111. CHECK 109:

PRIMARY (GO TO 112)
SECONDARY OR HIGHER (GO TO 115)

112. 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
BLIND/VISUALLY IMPAIRED 5

113. 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

114. CHECK 112:

CODE '2', '3' OR '4' CIRCLED (GO TO 115)
CODE '1' OR '5' CIRCLED (GO TO 116)

115. 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

116. 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

117. 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

118. What is your religion?

CATHOLIC 1
OTHER CHRISTIAN 2
ISLAM 3
TRADITIONALIST 4
OTHER (SPECIFY) _________ 6

119. 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 NUMBER 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. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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), including any children who died after birth?

YES 1 (ADD BIRTH)
NO 2 (GO TO NEXT BIRTH)

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.

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. __
FOR EACH BIRTH SINCE JANUARY 2003: MONTH AND YEAR OF BIRTH ARE RECORDED. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. __
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224 CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2003 OR LATER. IF NONE, RECORD '0' AND GO TO 226.

225. FOR EACH BIRTH SINCE JANUARY 2003, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.
FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.
(NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

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. ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL 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 2003 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 2003 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ______

233. Since January 2003, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 235)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2003. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any miscarriages, abortions or stillbirths that ended before 2003?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before 2003 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

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

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO NEXT METHOD)
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO NEXT METHOD)
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO NEXT METHOD)
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 (GO TO NEXT METHOD)
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2 (GO TO NEXT METHOD)
07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse.
YES 1
NO 2 (GO TO NEXT METHOD)
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 (GO TO NEXT METHOD)
12 RHYTHM METHOD 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 (GO TO NEXT METHOD)
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO NEXT METHOD)
14 EMERGENCY CONTRACEPTION As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2 (GO TO NEXT METHOD)
15 Have you heard of any other ways or traditional methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
SPECIFY___
YES 1
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 MALE 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 METHOD 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 As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
15 Have you heard of any other ways or traditional 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 (GO TO 306)
NO 2

305. ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH. (GO TO 333)

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 322)

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

YES 1
NO 2 (GO TO 322)

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

FEMALE STERILIZATION A (GO TO 316)
MALE STERILIZATION B (GO TO 316)
PILL C (GO TO 312)
IUD D (GO TO 315)
INJECTABLES E (GO TO 311B)
IMPLANTS F (GO TO 315)
MALE CONDOM G (GO TO 313)
FEMALE CONDOM H (GO TO 313)
DIAPHRAGM I (GO TO 315)
FOAM/JELLY J (GO TO 315)
LACTATIONAL AMENORRHEA METHOD K (GO TO 319A)
RHYTHM METHOD L (GO TO 319A)
WITHDRAWAL M (GO TO 319A)
OTHER (SPECIFY) _____ X (GO TO 319A)

311B. What name/type of injectables are you using?

NORISTERAT (2 MONTHS) 1 (GO TO 315)
NORIGYNON (2MONTHS) 2 (GO TO 315)
DEPO PROVERA (3 MONTHS) 3 (GO TO 315)
OTHER (SPECIFY) ____________ 6 (GO TO 315)

312. What brand of pills are you using?
ASK TO SEE THE PACKAGE IF RESPONDENT DOES NOT REMEMBER NAME OF BRAND.

DUOFEM 01 (GO TO 314)
MICROBYNON 02 (GO TO 314)
LOFEMENAL 03 (GO TO 314)
NEOGYNON 04 (GO TO 314)
CONFIDENCE 05 (GO TO 314)
OTHER (SPECIFY) ___________ 96 (GO TO 314)
DON'T KNOW 98 (GO TO 314)

313. What brand name of the condoms did you use?
ASK TO SEE THE PACKAGE IF RESPONDENT DOES NOT REMEMBER NAME OF BRAND.

MALE CONDOMS
GOLD CIRCLE 01
DUREX 02
RUGH RIDER 03
TWIN LOTUS 04
FEMALE CONDOM
FEMIDOM 05
OTHER (SPECIFY) ____________ 96
DON'T KNOW 98

314. How many (pill cycles/condoms) did you get the last time?

NUMBER OF PILL CYCLES/CONDOMS ____
DON'T KNOW 998

315. The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST ___ (GO TO 319A)

FREE 99995 (GO TO 319A)
DON'T KNOW 99998 (GO TO 319A)

316. In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(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

317. CHECK 311/311A:

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 'B' CIRCLED: Before the 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

318. How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?

COST ___

FREE 995
DON'T KNOW 998

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

MONTH __ (GO TO 320)
YEAR __ (GO TO 320)

319A. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH __
YEAR __

320. CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A

YES (GO BACK TO 319/319A, 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 321)

321. CHECK 319/319A:

YEAR IS 2003 OR LATER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. (GO TO 322)

YEAR IS 2002 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2003. (GO TO 331)

322. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2003.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:
* When was the last time you used a method? Which method was that?
* When did you start using that method? How long after the birth of (NAME)?
* How long did you use the method then?

323. CHECK 311/311A:

CIRCLE METHOD CODE:

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

NO CODE CIRCLED 00 (GO TO 333)
FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 324A)
RHYTHM METHOD 12 (GO TO 324A)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

324. Where did you obtain (CURRENT METHOD) when you started using it?
324A. Where did you learn how to use the rhythm/lactational amenorrhea method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
CHEMIST/PMS STORE 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ______ 27
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
NGO 34
OTHER (SPECIFY) _______________ 96

325. 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
MALE CONDOM 07 (GO TO 332)
FEMALE CONDOM 08 (GO TO 329)
DIAPHRAGM 09 (GO TO 329)
FOAM/JELLY 10 (GO TO 329)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 335)
RHYTHM METHOD 12 (GO TO 335)

326. You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 328)
NO 2

327. 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 329)

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

YES 1
NO 2

329. CHECK 326:

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 323) from (SOURCE OF METHOD FROM 316 OR 324), were you told about other methods of family planning that you could use?

YES 1 (GO TO 331)
NO 2

330. 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

331. 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 335)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 335)
RHYTHM METHOD 12 (GO TO 335)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

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

(NAME OF PLACE) _________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 335)
GOVERNMENT HEALTH CENTER 12 (GO TO 335)
FAMILY PLANNING CLINIC 13 (GO TO 335)
MOBILE CLINIC 14 (GO TO 335)
FIELDWORKER 15 (GO TO 335)
OTHER PUBLIC (SPECIFY) ______ 16 (GO TO 335)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 335)
PHARMACY 22 (GO TO 335)
CHEMIST/PMS 23 (GO TO 335)
PRIVATE DOCTOR 24 (GO TO 335)
MOBILE CLINIC 25 (GO TO 335)
FIELDWORKER 26 (GO TO 335)
OTHER PRIVATE MEDICAL (SPECIFY) ______ 27 (GO TO 335)
OTHER SOURCE
SHOP 31 (GO TO 335)
CHURCH 32 (GO TO 335)
FRIEND/RELATIVE 33 (GO TO 335)
NGO 34 (GO TO 335)
OTHER (SPECIFY) _______________ 96 (GO TO 335)

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

YES 1
NO 2 (GO TO 335)

334. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
SHOP N
CHURCH O
FRIEND/RELATIVE P
NGO Q
OTHER (SPECIFY) _______________ X

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

YES 1
NO 2

336. 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)

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

YES 1
NO 2

SECTION 4A. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2003 OR LATER (GO TO 402)
NO BIRTHS IN 2003 OR LATER (GO TO 573)

402. CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 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 NO. _____

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 have liked to wait?

MONTHS 1 __
YEARS 2 __

DON'T KNOW 998

407. Did you see anyone for antenatal care for this pregnancy? Anyone else?
IF YES: Whom did you see?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY/VILLAGE HEALTH WORKER E
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 414)

408. Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST/DISPENSARY E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
OTHER PRIVATE MED. (SPECIFY) _____________ H
OTHER (SPECIFY) _____________ X

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

MONTHS ___
DON'T KNOW 98

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

NUMBER OF TIMES ___
DON'T KNOW 98

411. As part of your antenatal care during this pregnancy, were any of the following done at least once?

Were you weighed?
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

412. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)

413. Were you told where to go if you had any of these complications?

YES 1
NO 2
DON'T KNOW 8

414. 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)

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

TIMES ___
DON'T KNOW 8

416. CHECK 415:

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 417)

417. At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

YES 1
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)

418. Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.

TIMES ___
DON'T KNOW 8

419. In what month and year did you receive the last tetanus injection before this pregnancy?

MONTH ___
DON'T KNOW MONTH 98
YEAR ____ (GO TO 421)
DON'T KNOW YEAR 9998

420. How many years ago did you receive that tetanus injection?

YEARS AGO ___

421. During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP.

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

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

DAYS ___
DON'T KNOW 998

423. During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 432)
DON'T KNOW 8 (GO TO 432)

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

SP/FANSIDAR/AMALAR/ MALOXINE A
CHLOROQUINE B
OTHER (SPECIFY) ____________ X
DON'T KNOW Z

428. CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION.

CODE 'A' CIRCLED (GO TO 429)
CODE 'A' NOT CIRCLED (GO TO 432)

429. How many times did you take (SP/Fansidar/Amalar/Maloxine) during this pregnancy?

TIMES _____

429A. How many months pregnant were you when you took your first dose of (SP/Fansidar/Amalar/Maxoline)?

MONTH ___
DON'T KNOW 98

429B. CHECK 429:

2 OR MORE TIMES (GO TO 429C)
1 TIME (GO TO 430)

429C. How many months pregnant were you when you took your second dose of (SP/Fansidar/ Amalar/Maxoline)?

MONTH ___
DON'T KNOW 98

430. CHECK 407:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE 'A', 'B' OR 'C' CIRCLED (GO TO 431)
OTHER (GO TO 432)

431. Did you get the (SP/Fansidar/Amalar/Maloxine) during any antenatal care visit, during another visit to a health facility or from another source?

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

432. When (NAME) was born, was he/she very big, bigger than average, average, smaller than average, or very small?

VERY BIG 1
BIGGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

433. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)

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

KG. FROM CARD 1 ___.___
KG. FROM RECALL 2 ___.___

DON'T KNOW 99.998

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

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

436. Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
HOME
YOUR HOME 11 (GO TO 443)
OTHER HOME 12 (GO TO 443)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MED. SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MED. (SPECIFY) _____________ 36
OTHER (SPECIFY) _____________ 96 (GO TO 443)

437. How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DON'T KNOW 998

438. Was (NAME) delivered by caesarean section (operation)?

YES 1
NO 2

439. Before you were discharged after (NAME) was born, did any health care provider check on your health?

YES 1
NO 2 (GO TO 442)

440. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11 (GO TO 453)
NURSE/MIDWIFE 12 (GO TO 453)
AUXILIARY MIDWIFE 13 (GO TO 453)
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21 (GO TO 453)
COMMUNITY/VILLAGE HEALTH WORKER 22 (GO TO 453)
OTHER (SPECIFY) ________ 96 (GO TO 453)

442. After you were discharged, did any health care provider or a traditional birth attendant check on your health?

YES 1 (GO TO 445)
NO 2 (GO TO 453)

443. Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.

COST TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) __________ X

444. After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?

YES 1
NO 2 (GO TO 449)

445. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ________ 96

447. Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

448. CHECK 442:

YES (GO TO 453)
NOT ASKED (GO TO 449)

449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

YES 1
NO 2 (GO TO 453)
DON'T KNOW 8 (GO TO 453)

450. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 ___
DAYS 2 ___
WEEKS 3 ___

DON'T KNOW 998

451. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ________ 96

452. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

453. In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 456)
NO 2 (GO TO 457)

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

YES 1
NO 2 (GO TO 459)

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

MONTHS __
DON'T KNOW 98

457. CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 458)
PREGNANT OR UNSURE (GO TO 459)

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

YES 1
NO 2 (GO TO 460)

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

MONTHS ___________
DON'T KNOW 98

460. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 467)

461. 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 ______

462. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 464)

463. What was (NAME) given to drink? 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/INFUSIONS H
HONEY I
OTHER (SPECIFY) _____ X

464. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 465)
DEAD (GO TO 466)

465. Are you still breastfeeding (NAME)?

YES 1 (GO TO 468)
NO 2

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

LAST BIRTH

MONTHS _____
DON'T KNOW 98

ALL OTHER BIRTHS

MONTHS _____
STIFF BREASTFEEDING 95
DON'T KNOW 98

467. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 470)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

468. 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 ______

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

NUMBER OF DAYLIGHT FEEDINGS ___

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

YES 1
NO 2
DON'T KNOW 8

471. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. LINE NUMBER FROM 212

LINE NUMBER _____

503. FROM 212 AND 216

NAME _______
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 570)

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

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 508)
NO CARD 3

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

YES 1 (GO TO 508)
NO 2 (GO TO 508)

506. (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. (3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

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 __
VITAMIN A (2nd MOST RECENT)
DAY __
MONTH __
YEAR __

506A. CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 510)
OTHER (GO TO 507)

507. 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 VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 510)
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)

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

YES 1
NO 2 (GO TO 511A)
DON'T KNOW 8 (GO TO 511A)

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

509A. 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

509B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 509E)
DON'T KNOW 8 (GO TO 509E)

509C. Was the first polio vaccine received in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

509D. How many times was the polio vaccine received?

NUMBER OF TIMES ___

509E. 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 509G)
DON'T KNOW 8 (GO TO 509G)

509F. How many times was a DPT vaccination received?

NUMBER OF TIMES ___

509G. A measles injection or an MMR injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 511B)
NO VACCINATION IN THE LAST 2 YRS. 3 (GO TO 511B)
DON'T KNOW 8 (GO TO 511B)

511. At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.
NOTE: ALL RECOMMENDED VACCINES INCLUDE POLIO, MEASLES, YELLOW FEVER, CSM, BCG, ETC.

POLIO 2006 (NIDS/FEB, MAR) A (GO TO 511B)
MEASLES 2006 (SNIDS/OCT) B (GO TO 511B)
ALL 2006 (IPDS/MAY-JULY) C (GO TO 511B)
ALL 2007 (IPDS/JAN) (SIPDS/MAR-SEPT) D (GO TO 511B)
ALL 2008 (IPDS/JAN, FEB 2008) (SIPDS/APR 2008) E (GO TO 511B)

511A. What are the main reasons (NAME) has not received any vaccinations?
PROBE: Any other reasons?
CIRCLE ALL MENTIONED

LACK OF INFO A
FEAR OF SIDE EFFECTS B
FEAR CHILD MAY GET DISEASE C
VACCINES DO NOT WORK D
RELIGIOUS REASONS E
POST TOO FAR F
CHILD WAS ABSENT G
OTHER (SPECIFY) __________ X

511B. CHECK 506 AND 509B:
DATE FOR POLIO VACCINE RECORDED IN 506 OR CODE '1' RECORDED IN 509B

NO POLIO VACCINE RECEIVED (GO TO 511C)
POLIO VACCINE RECEIVED (GO TO 512)

511C. Now I want to ask you specifically about vaccinating your child against polio. What are the main reasons (NAME) has not received any polio vaccinations?
PROBE: Any other reasons?
CIRCLE ALL MENTIONED

LACK OF INFO A
FEAR OF SIDE EFFECTS B
FEAR CHILD MAY GET DISEASE C
VACCINES DO NOT WORK D
RELIGIOUS REASONS E
POST TOO FAR F
CHILD WAS ABSENT G
OTHER (SPECIFY) __________ X

512. CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE

DATE FOR MOST RECENT VITAMIN A DOSE (GO TO 513)
OTHER (GO TO 514)

513. According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD). Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1 (GO TO 515)
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)

514. HAS (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)

515. Did (NAME) receive a vitamin A dose within the last six months?

YES 1
NO 2
DON'T KNOW 8

516. In the last seven days, did (NAME) take iron pills, sprinkles with iron, or iron syrup (like this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/ SYRUPS.

YES 1
NO 2
DON'T KNOW 8

517. Has (NAME) taken any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)

519. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

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

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

522. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 527)

523. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE
CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MED. (SPECIFY) ______ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) _______________ X

524. CHECK 523:

TWO OR MORE CODES CIRCLED (GO TO 525)
ONLY ONE CODE CIRCLED (GO TO 526)

525. Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

FIRST PLACE __

526. How many days after the diarrhea began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

DAYS __

527. Does (NAME) still have diarrhea?

YES 1
NO 2
DON'T KNOW 8

528. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid made from a special sugar-salt solution (ORS/ORT)?
YES 1
NO 2
DON'T KNOW 8
b) A pre-packaged ORS/ORT liquid?
YES 1
NO 2
DON'T KNOW 8
c) A government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)

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

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/ HERBAL MEDICINE J
OTHER (SPECIFY) __________ X

531. CHECK 530:
GIVEN ZINC?

CODE 'C' CIRCLED (GO TO 532)
CODE 'C' NOT CIRCLED (GO TO 533)

532. How many times was (NAME) given zinc?

TIMES ___
DON'T KNOW 98

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

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

YES 1
NO 2 (GO TO 538)
DON'T KNOW 8 (GO TO 538)

536. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

CHEST ONLY 1 (GO TO 538)
NOSE ONLY 2 (GO TO 538)
BOTH 3 (GO TO 538)
OTHER (SPECIFY) ___________ 6 (GO TO 538)
DON'T KNOW 8 (GO TO 538)

537. CHECK 533:
HAD FEVER?

YES (GO TO 538)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 570)

538. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given 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

539. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given 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

540. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 545)

541. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) _______________ X

542. CHECK 541:

TWO OR MORE CODES CIRCLED (GO TO 543)
ONLY ONE CODE CIRCLED (GO TO 544)

543. Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

FIRST PLACE __

544. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

DAYS __

545. Is (NAME) still sick with a (fever/cough)?

FEVER ONLY 1
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON'T KNOW 8

546. At any time during the illness, did (NAME) take any drugs for the illness?

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 570)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 570)

547. What drugs did (NAME) take? Any other drugs?
CIRCLE ALL MENTIONED.

ANTIMALARIAL DRUGS
SP/FANSIDAR/AMALAR/MALOXINE A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTEMISININ COMBINATION THERAPY (ACT) E
OTHER ANTIMALARIAL (SPECIFY) ____________ F
ANTIBIOTIC DRUGS
PILL/SYRUP G
INJECTION H
OTHER DRUGS
ASPIRIN I
ACETAMINOPHEN J
IBUPROFEN K
OTHER (SPECIFY) ____________ X
DON'T KNOW Z

548. CHECK 547:
ANY CODE A-G CIRCLED?

YES (GO TO 549)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 570)

549. Did you already have (NAME OF DRUG FROM 547) at home when the child became ill?
ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'G' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 547. IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG. IF NO FOR ALL DRUGS, CIRCLE 'Y'.

ANTIMALARIAL DRUGS
SP/FANSIDAR/AMALAR/MALOXINE A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTEMISININ COMBINATION THERAPY (ACT) E
OTHER ANTIMALARIAL F
ANTIBIOTIC PILL/SYRUP G
NO DRUG AT HOME Y

550. CHECK 547:
ANY CODE A-F CIRCLED?

YES (GO TO 551)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 570)

551. CHECK 547:
SP/FANSIDAR/AMALAR/ MALOXINE ('A') GIVEN

CODE 'A' CIRCLED (GO TO 552)
CODE 'A' NOT CIRCLED (GO TO 554)

552. How long after the fever started did (NAME) first take SP/Fansidar/Amalar/Maloxine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

553. For how many days did (NAME) take the SP/Fansidar/Amalar/ Maloxine?
IF 3 DAYS OR MORE, RECORD 3.

DAYS ___
DON'T KNOW 8

554. CHECK 547:
CHLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED (GO TO 555)
CODE 'B' NOT CIRCLED (GO TO 557)

555. How long after the fever started did (NAME) first take chloroquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ___
DON'T KNOW 8

557. CHECK 547:
AMODIAQUINE ('C') GIVEN

CODE 'C' CIRCLED (GO TO 558)
CODE 'C' NOT CIRCLED (GO TO 560)

558. How long after the fever started did (NAME) first take Amodiaquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

559. For how many days did (NAME) take the Amodiaquine?
IF 7 DAYS OR MORE, RECORD 7.

DAYS ___
DON'T KNOW 8

560. CHECK 547:
QUININE ('D') GIVEN

CODE 'D' CIRCLED (GO TO 561)
CODE 'D' NOT CIRCLED (GO TO 563)

561. How long after the fever started did (NAME) first take quinine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

562. For how many days did (NAME) take the quinine?
IF 7 DAYS OR MORE, RECORD 7.

DAYS ___
DON'T KNOW 8

563. CHECK 547:
ARTEMISININ COMBINATION THERAPY - ACT ('E') GIVEN

CODE 'E' CIRCLED (GO TO 564)
CODE 'E' NOT CIRCLED (GO TO 566)

564. How long after the fever started did (NAME) first take (ARTEMISININ COMBINATION
THERAPY (ACT))?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

565. For how many days did (NAME) take the (ARTEMISININ COMBINATION THERAPY (ACT))?
IF 7 DAYS OR MORE, RECORD 7.

DAYS ___
DON'T KNOW 8

566. CHECK 547:
OTHER ANTIMALARIAL ('F') GIVEN

CODE 'F' CIRCLED (GO TO 567)
CODE 'F' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 570)

567. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

568. For how many days did (NAME) take the (OTHER ANTIMALARIAL)?
IF 7 DAYS OR MORE, RECORD

DAYS ___
DON'T KNOW 8

569. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 570

570. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2003 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING
WITH HER (AND CONTINUE WITH 571))
(NAME) ____________
NONE (GO TO 573)

571. The last time (NAME FROM 570) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) __________ 96

572. CHECK 528(a) AND 528(b), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 573)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 574)

573. Have you ever heard of a special product called ORS or other pre-packaged ORS liquids you can get for the treatment of diarrhea?

YES 1
NO 2

574. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING
WITH HER (AND CONTINUE WITH 575))
(NAME) ____________
NONE (GO TO 601)

575. Now I would like to ask you about liquids or foods (NAME FROM 574) had yesterday during the day or at night.
Did (NAME FROM 574) (drink/eat):

Plain water?
YES 1
NO 2
DON'T KNOW 8
Commercially produced infant formula?
YES 1
NO 2
DON'T KNOW 8
Any commercially-fortified baby food like Cerelac?
YES 1
NO 2
DON'T KNOW 8
Any (other) porridge or gruel?
YES 1
NO 2
DON'T KNOW 8

576. Now I would like to ask you about (other) liquids or foods that (NAME FROM 574)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods.
Did (NAME FROM 574)/you drink (eat):

a) Milk such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
b) Tea or coffee?
YES 1
NO 2
DON'T KNOW 8
c) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
d) Bread, rice, noodles, or other foods made from grains [e.g. millet, sorghum, maize, wheat, porridge, or other local grains]?
YES 1
NO 2
DON'T KNOW 8
e) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
f) Irish/white potatoes, white yams, manioc, cassava, cocoyams, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
g) Any dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
h) Ripe mangoes, pawpaw, palm-nuts, etc.
YES 1
NO 2
DON'T KNOW 8
i) Any other fruits or vegetables [e.g. bananas, plantains, watermelon, apples/sauce, green beans, avocados, tomatoes]?
YES 1
NO 2
DON'T KNOW 8
j) Liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
k) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
l) Eggs?
YES 1
NO 2
DON'T KNOW 8
m) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
n) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
o) Cheese, yogurt or other milk products?
YES 1
NO 2
DON'T KNOW 8
p) Any oil, fats, or butter, or foods made with any of these?
YES 1
NO 2
DON'T KNOW 8
q) Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits?
YES 1
NO 2
DON'T KNOW 8
r) Any other solid or semi-solid food?
YES 1
NO 2
DON'T KNOW 8

577. CHECK 575 (LAST 2 CATEGORIES: BABY CEREAL OR OTHER PORRIDGE/GRUEL) AND 576 (CATEGORIES d THROUGH r FOR CHILD):

AT LEAST ONE 'YES' (GO TO 578)
NOT A SINGLE 'YES' (GO TO 601)

578. How many times did (NAME FROM 574) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES __
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601. Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 617)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

605. 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 ____

606. Does your husband/partner have other wives or does he live with other women as if married?

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

607. Including yourself, in total, how many wives or partners does your husband live with now as if married?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS __
DON'T KNOW 98

608. Are you the first, second, … wife/partner?

RANK __

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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 611)

610. CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

CURRENTLY WIDOWED (GO TO 613)
NOT ASKED OR CURRENTLY DIVORCED/SEPARATED (GO TO 615)

611. CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED (GO TO 612)
CURRENTLY WIDOWED (GO TO 613)
CURRENTLY DIVORCED/SEPARATED (GO TO 615)

612. How did your previous marriage or union end?

DEATH 1
DIVORCE 2 (GO TO 615)
SEPARATION 3 (GO TO 615)

613. To whom did most of your late husband's property go?

RESPONDENT 1 (GO TO 615)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
NO PROPERTY 5
OTHER (SPECIFY) ___________ 6

614. Did you receive any of your late husband's assets or valuables?

YES 1
NO 2

615. CHECK 609:

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 I would like to ask about when you started living with your first husband/partner.
In what month and year was that?

MONTH __
DON'T KNOW MONTH 98
YEAR __ (GO TO 617)
DON'T KNOW YEAR 9998

616. How old were you when you first started living with him?

AGE ____

617. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

618. 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 had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS ___ (GO TO 621)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 621)

619. CHECK 107:

AGE 15-24 (GO TO 620)
AGE 25-49 (GO TO 641)

620. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 641)
NO 2 (GO TO 641)
DON'T KNOW/NOT SURE 8 (GO TO 641)

621. CHECK 107:

AGE 15-24 (GO TO 622)
AGE 25-49 (GO TO 625A)

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

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

623. How old was the person you first had sexual intercourse with?

AGE OF PARTNER ___ (GO TO 625A)
DON'T KNOW 98

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

OLDER 1
YOUNGER 2 (GO TO 625A)
ABOUT THE SAME AGE 3 (GO TO 625A)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 625A)

625. Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

625A. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

626. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS. WHEN IS LESS THAN A DAY RECORD '00'

DAYS AGO 1 __ (GO TO 628)
WEEKS AGO 2 __ (GO TO 628)
MONTHS AGO 3 __ (GO TO 628)
YEARS AGO 4 __ (GO TO 640)

627. When was the last time you had sexual intercourse with this person?

DAYS 1 __
WEEKS 2 __
MONTHS 3 __

628. The last time you had sexual intercourse with this (second/third) person, was a condom used?

YES 1
NO 2 (GO TO 630)

629. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

630. What was your relationship to this (second/third) person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

HUSBAND 1 (GO TO 636)
LIVE-IN PARTNER 2 (GO TO 636)
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
SEX WORKER 5
OTHER (SPECIFY) ___________ 6

631. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 __
MONTHS 2 __
YEARS 3 __

632. CHECK 107:

AGE 15-24 (GO TO 633)
AGE 25-49 (GO TO 636)

633. How old is this person?

AGE OF PARTNER ____ (GO TO 636)
DON'T KNOW 98

634. Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 636)
SAME AGE 3 (GO TO 636)
DON'T KNOW 8 (GO TO 636)

635. Would you say this person is ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

636. The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 638)

637. Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

638. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 627 IN NEXT COLUMN)
NO 2 (GO TO 640)

639. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS LAST 12 MONTHS __
DON'T KNOW 98

640. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS IN LIFETIME __
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 644)

642. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
NGO Q
OTHER (SPECIFY) _______________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

645. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
NGO Q
OTHER (SPECIFY) _______________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701. CHECK 311/311A:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 713)

702. 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 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)

703. 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 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) _____ 996 (GO TO 708)
DON'T KNOW 998 (GO TO 708)

704. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 705)
PREGNANT (GO TO 709)

705. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 706)
NOT CURRENTLY USING (GO TO 706)
CURRENTLY USING (GO TO 713)

706. CHECK 703:

NOT ASKED (GO TO 707)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 707)
00-23 MONTHS OR 00-01 YEAR (GO TO 709)

707. CHECK 702:

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 you are not using a method? 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 you are not using a method? 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
FATALISTIC 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 (SPECIFY) _______ X
DON'T KNOW Z

708. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 709)
NO, NOT CURRENTLY USING (GO TO 709)
YES, CURRENTLY USING (GO TO 713)

709. 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 711)
DON'T KNOW 8 (GO TO 713)

710. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 713)
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
FEMALE CONDOM 08 (GO TO 713)
DIAPHRAGM 09 (GO TO 713)
FOAM/JELLY 10 (GO TO 713)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 713)
RHYTHM METHOD 12 (GO TO 713)
WITHDRAWAL 13 (GO TO 713)
OTHER (SPECIFY) ______ 96 (GO TO 713)
UNSURE 98 (GO TO 713)

711. 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 713)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 713)
SUBFECUND/INFECUND 24 (GO TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 713)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 713)
HUSBAND/PARTNER OPPOSED 32 (GO TO 713)
OTHERS OPPOSED 33 (GO TO 713)
RELIGIOUS PROHIBITION 34 (GO TO 713)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 713)
KNOWS NO SOURCE 42 (GO TO 713)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 713)
FEAR OF SIDE EFFECTS 52 (GO TO 713)
LACK OF ACCESS/TOO FAR 53 (GO TO 713)
COSTS TOO MUCH 54 (GO TO 713)
INCONVENIENT TO USE 55 (GO TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 713)
OTHER (SPECIFY) _____ 96 (GO TO 713)
DON'T KNOW 98 (GO TO 713)

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

YES 1
NO 2
DON'T KNOW 8

713. CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 715)
NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 715)

714. 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

715. In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Read about family planning in a poster?
YES 1
NO 2
Read about family planning in leaflets and brochures?
YES 1
NO 2
Heard about family planning from town crier?
YES 1
NO 2
Heard about family planning from mobile public announcement?
YES 1
NO 2

715A. CHECK 715:

AT LEAST ONE 'YES' (HAS HEARD OR READ MESSAGE) (GO TO 715B)
NOT A SINGLE 'YES' (HAS NOT HEARD OR READ MESSAGE) (GO TO 716)

715B. Please tell me which family planning messages you have heard or seen in the past few months?
PROBE: Any others?
PROBE UNTIL YOU HAVE EXHAUSTED ALL ANSWERS.

AS FOR ME AND MY PARTNER WE 'DEY KAMPE' WITH FEMALE CONDOM A
UNSPACED CHILDREN MAKES THE GOING TOUGH. FOR THE LOVE OF YOUR FAMILY, GO FOR CHILD SPACING TODAY B
WELL-SPACED CHILDREN ARE EVERY PARENT'S JOY C
IT'S NOT TOO LATE TO PREVENT UNWANTED PREGNANCY D
WHY IS YOUR WIFE LOOKING SO GOOD? E
OTHER (SPECIFY) _____________ X

716. In the last few months have you:

Heard about family planning through a peer group discussion?
YES 1
NO 2
Heard about family planning in school?
YES 1
NO 2
Heard about family planning through community leaders?
YES 1
NO 2

717. CHECK 601 AND 602:

YES, CURRENTLY MARRIED (GO TO 718)
YES, LIVING WITH A MAN (GO TO 718)
NO, NOT IN UNION (GO TO 801)

718. CHECK 311/311A:

CODE B, G, OR M CIRCLED (GO TO 720)
NO CODE CIRCLED (GO TO 722)
OTHER CODES (GO TO 719)

719. Does your husband/partner know that you are using a method of family planning?

YES 1
NO 2
DON'T KNOW 8

720. 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

721. CHECK 311/311A:

NEITHER STERILIZED (GO TO 722)
HE OR SHE STERILIZED (GO TO 801)

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

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

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801. CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

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

AGE IN COMPLETED YEARS _______

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

YES 1
NO 2 (GO TO 806)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 806)

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

GRADE ____
DON'T KNOW 98

806. CHECK 801:

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 is, what kind of work did he mainly do?

OCCUPATION_____________

807. Aside from your own housework, have you done any work in the last seven days?

YES 1 (GO TO 811)
NO 2

808. 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.
In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 818)

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

OCCUPATION______________

812. CHECK 811:

WORKS IN AGRICULTURE (GO TO 813)
DOES NOT WORK IN AGRICULTURE (GO TO 814)

813. 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

814. 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

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

HOME 1
AWAY 2

816. 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

817. Are you paid 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
NOT PAID 4

818. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 819)
NOT IN UNION (GO TO 827)

819. CHECK 817:

CODE 1 OR 2 CIRCLED (GO TO 820)
OTHER (GO TO 822)

820. Who usually decides how the money you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) ___________ 6

821. Would you say that the money that you earn is more than what your husband/partner earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 823)
DON'T KNOW 8

822. Who usually decides how your husband's/partner's earnings will be used: you, your husband/partner, or you and your husband/partner jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) ___________ 6

823. Who usually makes decisions about health care for yourself: you, your husband/partner, you and your husband/partner jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

824. Who usually makes decisions about making major household purchases: you, your husband/partner, you and your husband/partner jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

825. Who usually makes decisions about making purchases for daily household needs: you, your husband/partner, you and your husband/partner jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

826. Who usually makes decisions about visits to your family or relatives: you, your husband/partner, you and your husband/partner jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

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

CHILDREN UNDER AGE 10
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/ NOT LISTENING 2
NOT PRESENT 3

828. 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 she fails to prepare food on time?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have another child?
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 942)

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

YES 1
NO 2
DON'T KNOW 8

903. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

906. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

908A. Can HIV and AIDS be cured?

YES 1
NO 2
DON'T KNOW 8

909. Can the virus that causes AIDS be transmitted from a mother to her baby:

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

910. CHECK 909:

AT LEAST ONE 'YES' (GO TO 911)
OTHER (GO TO 912)

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

YES 1
NO 2
DON'T KNOW 8

912. Have you heard about special antiretroviral drugs that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

YES 1
NO 2
DON'T KNOW 8

913. CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2005 (GO TO 914)
NO BIRTHS (GO TO 922)
LAST BIRTH BEFORE JANUARY 2005 (GO TO 922)

914. CHECK 407 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 914A)
NO ANTENATAL CARE (GO TO 922)

914A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915. During any of the antenatal visits for your last birth, did anyone talk to you about:

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

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

YES 1
NO 2

917. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 922)

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

YES 1
NO 2

919. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER 16
OTHER PUBLIC (SPECIFY) ______ 17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
STAND-ALONE VCT CENTER 22
PHARMACY 23
CHEMIST/PMS 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ______ 27
OTHER (SPECIFY) _______________ 96

920. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1 (GO TO 923)
NO 2

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

LESS THAN 12 MONTHS AGO 1 (GO TO 929)
12 - 23 MONTHS AGO 2 (GO TO 929)
2 OR MORE YEARS AGO 3 (GO TO 929)

922. 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 927)

923. When was the last time you were tested?

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

924. 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 TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1
NO 2

926. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 929)
GOVERNMENT HEALTH CENTER 12 (GO TO 929)
STAND-ALONE VCT CENTER 13 (GO TO 929)
FAMILY PLANNING CLINIC 14 (GO TO 929)
MOBILE CLINIC 15 (GO TO 929)
FIELDWORKER 16 (GO TO 929)
OTHER PUBLIC (SPECIFY) ______ 17 (GO TO 929)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21 (GO TO 929)
STAND-ALONE VCT CENTER 22 (GO TO 929)
PHARMACY 23 (GO TO 929)
CHEMIST/PMS 24 (GO TO 929)
MOBILE CLINIC 25 (GO TO 929)
FIELDWORKER 26 (GO TO 929)
OTHER PRIVATE MEDICAL (SPECIFY) ______ 27 (GO TO 929)
OTHER (SPECIFY) _______________ 96 (GO TO 929)

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

YES 1
NO 2 (GO TO 929)

928. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC (SPECIFY) ______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
CHEMIST/PMS K
MOBILE CLINIC L
FIELDWORKER M
OTHER PRIVATE MEDICAL (SPECIFY) ______ N
OTHER (SPECIFY) _______________ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

931. If a member of your family became sick with 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

932. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

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

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

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (GO TO 938)

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

YES 1
NO 2

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

YES 1
NO 2

936. CHECK 933, 934, AND 935:

NOT A SINGLE 'YES' (GO TO 937)
AT LEAST ONE 'YES' (GO TO 938)

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

YES 1
NO 2

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

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

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

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

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

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

941. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

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

942. CHECK 901:

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

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

YES 1
NO 2

943. CHECK 618:

HAS HAD SEXUAL INTERCOURSE (GO TO 944)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 951)

944. CHECK 942:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 945)
NO (GO TO 946)

945. 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 disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

946. 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

947. 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

948. CHECK 945, 946, AND 947:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 949)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 951)

949. The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 951)

950. Where did you go? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC (SPECIFY) ______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
CHEMIST/PMS K
MOBILE CLINIC L
FIELDWORKER M
OTHER PRIVATE MEDICAL (SPECIFY) ______ N
OTHER SOURCE
SHOP O
OTHER (SPECIFY) __________ X

951. Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

952. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

953. Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

954. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

955. CHECK 601:

CURRENTLY MARRIED/LIVING WITH A PARTNER (GO TO 956)
NOT IN UNION (GO TO 958)

956. Can you say no to your husband/partner if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/NOT SURE 8

957. Could you ask your husband/partner to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

958. Do you believe that young men should wait until they are married to have sexual intercourse?

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

959. Do you think that most young men you know wait until they are married to have sexual intercourse?

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

960. Do you believe that men who are not married and are having sex should only have sex with one partner?

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

961. Do you think that most men you know who are not married and are having sex, have sex with only one partner?

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

962. Do you believe that married men should only have sex with their wives?

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

963. Do you think that most married men you know have sex only with their wives?

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

964. Do you believe that young women should wait until they are married to have sexual intercourse?

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

965. Do you think that most young women you know wait until they are married to have sexual intercourse?

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

966. Do you believe that women who are not married and are having sex should only have sex with one partner?

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

967. Do you think that most women you know who are not married and are having sex, have sex with only one partner?

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

968. Do you believe that married women should only have sex with their husbands?

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

969. Do you think that most married women you know have sex only with their husbands?

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

SECTION 10. OTHER HEALTH ISSUES

1001. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1005)

1002. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

1002A. What are the signs or symptoms that would lead you to think a person has tuberculosis or TB? Any others?
RECORD ALL MENTIONED.

COUGHING A
COUGHING WITH SPUTUM B
COUGHING SEVERAL WEEKS C
FEVER D
BLOOD IN SPUTUM E
LOSS OF APPETITE F
NIGHTSWEATING G
PAIN IN CHEST H
TIREDNESS/FATIGUE I
WEIGHT LOSS J
PALENESS K
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

1002B. Do you know of other illnesses that are associated with tuberculosis or TB?

COLD A
PNEUMONIA B
FEVER C
HIV/AIDS D
BRONCHITIS/UPPER RESPIRATORY E
LUNG CANCER F
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

1002C. Do you know of where someone can go to receive treatment for tuberculosis?
PROBE: Any other place?

(NAME OF PLACE) ___________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
OTHER PUBLIC (SPECIFY) ______ C
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR D
PHARMACY E
CHEMIST/PMS F
OFFICE OR HOME OF NURSE/HEALTH WORKER G
OTHER PRIVATE MEDICAL (SPECIFY) ______ H
OTHER PLACE
AT HOME I
OTHER (SPECIFY) __________ X
DON'T KNOW Z

1003. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1004. If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

1004A. If a tuberculosis patient is within the house, how likely is it that tuberculosis can spread to other members of the household, highly likely, somewhat likely, or not likely at all?

HIGHLY LIKELY 1
SOMEWHAT LIKELY 2
NOT LIKELY AT ALL 3
DON'T KNOW/UNSURE 8

1004B. If a member of your household has tuberculosis, should other people in the household be screened for tuberculosis?

YES 1
NO 2
DON'T KNOW/UNSURE 8

1005. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 1009)

1006. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 1009)

1007. The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
DENTAL CLINIC/OFFICE 22
PHARMACY 23
CHEMIST/PMS 24
OFFICE OR HOME OF NURSE/HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER PLACE
AT HOME 31
OTHER (SPECIFY) ______ 96

1008. Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1009. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1011)

1010. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES _____________

1011. Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 1013)

1012. What (other) type of tobacco do you currently smoke or use, apart from cigarettes?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) ___________ X

1013. 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 or not?

Getting permission to go?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having to take transport?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be a female health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be a male health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be any health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may be no drugs available?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1014. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1016)

1015. What type of health insurance?
RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE C
OTHER (SPECIFY) ___________ X

1016. CHECK 217:

(YOUNGEST) CHILD IS AGE 0-17 (GO TO 1017)
OTHER (GO TO 1018)

1017. Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

1018. (Besides your own child/children), are you the primary caregiver for any children age 0-17?

YES 1
NO 2 (GO TO FGC01)

1019. Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

FEMALE GENITAL CUTTING

FGC01. Have you ever heard of female circumcision?

YES 1 (GO TO FGC03)
NO 2

FGC02. In some 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 1101)

FGC03. Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO FGC09)

FGC04. Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

YES 1 (GO TO FGC06)
NO 2
DON'T KNOW 8

FGC05. Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

FGC06. Was your genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

FGC07. How old were you when you were circumcised?
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

FGC08. Who performed 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

FGC09. CHECK 214 AND 216:

HAS ONE LIVING DAUGHTER (GO TO FGC10)
HAS MORE THAN ONE LIVING DAUGHTER (GO TO FGC10)
HAS NO LIVING DAUGHTER (GO TO FGC19)

FGC10. CHECK FGC09:

ONE LIVING DAUGHTER: Has your daughter been circumcised?
IF YES: RECORD '01'

MORE THAN ONE LIVING DAUGHTER: Have any of your daughters been circumcised?
IF YES: How many?
RECORD NUMBER

NUMBER CIRCUMCISED __
NO DAUGHTER CIRCUMCISED 95 (GO TO FGC18)

FGC11. CHECK FGC10:

ONE LIVING DAUGHTER: What is your daughter's name?

MORE THAN ONE LIVING DAUGHTER: Which of your daughters was circumcised most recently?

(DAUGHTER'S NAME) ______________
DAUGHTER'S LINE NUMBER FROM Q. 212 __

FGC12. Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM Q. FGC11) at that time. Was any flesh removed from her genital area?

YES 1 (GO TO FGC14)
NO 2
DON'T KNOW 8

FGC13. Was her genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

FGC14. Was her genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

FGC15. How old was (NAME OF THE DAUGHTER FROM Q. FGC11) 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

FGC16. Who performed 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

FGC17. Do you have any daughter who is not circumcised?

YES 1
NO 2 (GO TO FGC19)
DON'T KNOW 8

FGC18. Do you intend to have any of your daughters circumcised in the future?

YES 1
NO 2
DON'T KNOW 8

FGC19. What benefits do girls themselves get if they are circumcised?
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

FGC20. Do you believe that this practice is required by your religion?

YES 1
NO 2
DON'T KNOW 8

FGC21. Do you think that this practice should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

SECTION 11 : OBSTETRIC FISTULA (VVF) MODULE - LONG

1101. Sometimes a woman can have a problem such that she experiences a constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after a pelvic surgery. This is called vesicovaginal fistula (VVF). Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

YES 1 (GO TO 1103)
NO 2

1102. Have you ever heard of this kind of problem, such that a woman experiences a constant leakage of urine or stool from her vagina during the day and night?

YES 1 (GO TO 1110)
NO 2 (GO TO 1201)

1103. Did this problem occur:

After a delivery?
YES (GO TO 1103A)
NO (GO TO NEXT PROBLEM)
After a sexual assault?
YES (GO TO 1105)
NO (GO TO NEXT PROBLEM)
After pelvic surgery?
YES (GO TO 1105)
NO (GO TO NEXT PROBLEM)
After some other event?
OTHER (SPECIFY) _____________ 6

1103A. Did this problem occur after a normal labor and delivery, or after a very difficult labor and delivery?

NORMAL LABOR/DELIVERY 1
VERY DIFFICULT DELIVERY 2

1103B. Was this baby born alive?

YES, BABY BORN ALIVE 1
NO, BABY NOT BORN ALIVE 2

1104. After which delivery did this occur?

DELIVERY NUMBER: __

1105. How many days after (ANSWER TO Q1103) did the leakage start?
(ENTER 99 IF MORE THAN 99 DAYS)

NUMBER OF DAYS AFTER PRECIPITATING EVENT __

1106. Have you sought treatment for this condition?

YES 1 (GO TO 1108)
NO 2

1107. Why have you not sought treatment?

1. Did not know problem could be fixed
2. Do not know where to go
3. Too expensive
4. Too far to reach treatment facility
5. Poor quality of care at facility
6. Could not get permission to go
7. Embarrassment
8. Other (specify)

DID NOT KNOW COULD BE FIXED 1 (GO TO 1201)
DO NOT KNOW WHERE TO GO 2 (GO TO 1201)
TOO EXPENSIVE 3 (GO TO 1201)
TOO FAR 4 (GO TO 1201)
POOR QUALITY OF CARE 5 (GO TO 1201)
COULD NOT GET PERMISSION 6 (GO TO 1201)
EMBARRASSMENT 7 (GO TO 1201)
OTHER (SPECIFY) __________ 8 (GO TO 1201)

1108. From whom did you last seek treatment?

HEALTH PROFESSIONAL
DOCTOR/CLINICAL OFFICER 1
NURSE/MIDWIFE 2
PATIENT ATTENDANT 3
OTHER PERSON
UNTRAINED VILLAGE DOCTOR 4
OTHER (SPECIFY) ____________ 5

1109. Did the treatment stop the problem?

YES, NO MORE LEAKAGE AT ALL 1
YES, BUT STILL SOME LEAKAGE 2
NO, STILL HAVE PROBLEM 3

1110. Are there any (other) women in your household who suffer from obstetric fistula?

YES 1
NO 2

1111. How many (other) women in your household suffer from vesicovaginal fistula (VVF)?

NUMBER __
DON'T KNOW 98

SECTION 12. MATERNAL AND ADULT MORTALITY

1201. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER __

1202. CHECK 1201:

TWO OR MORE BIRTHS (GO TO 1203)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1301)

1203. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS __

1204. What was the name given to your oldest (next oldest) brother or sister?
(*USE ADDITIONAL COLUMNS IF THERE ARE OTHER SIBLINGS)

NAME________________

1205. Is (NAME) male or female?

MALE 1
FEMALE 2

1206. Is (NAME) still alive?

YES 1
NO 2 (GO TO 1208)
DON'T KNOW 8 (IF THERE ARE OTHER SIBLINGS, GO TO NEXT BIRTH)

1207. How old is (NAME)?

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

1208. How many years ago did (NAME) die?

YEARS___

1209. How old was (NAME) when he/she died?

AGE___ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT BIRTH)

1210. Was (NAME) pregnant when she died?

YES 1 (GO TO 1213)
NO 2
DON'T KNOW 8

1211. Did (NAME) die during childbirth?

YES 1 (GO TO 1213)
NO 2

1212. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1213. Was (NAME)'S death due to an accident or violence?

YES 1
NO 2

IF NO MORE BIRTHS/OR IF NO MORE BROTHERS OR SISTERS, GO TO 1301

TICK HERE IF CONTINUATION SHEET USED __

SECTION 13. DOMESTIC VIOLENCE

1301. CHECK HOUSEHOLD Q.9A AND FRONT COVER: WOMAN SELECTED FOR THIS SECTION?

YES (GO TO 1302)
NO (GO TO 1332)

1302. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
READ TO THE RESPONDENT: Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Nigeria. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.
PRIVACY NOT POSSIBLE 2 (GO TO 1331)

1303. CHECK 601 AND 602:

CURRENTLY MARRIED (GO TO 1304)
FORMERLY MARRIED (READ IN PAST TENSE) (GO TO 1304)
NEVER MARRIED (GO TO 1315)

1304. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8
f) He (does/did) not trust you with any money?
YES 1
NO 2
DON'T KNOW 8

1305A. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband.

A (Does/did) your (last) husband/partner ever:

a) say or do something to humiliate you in front of others?
YES 1 (GO TO 1305B a)
NO 2
b) threaten to hurt or harm you or someone close to you?
YES 1 (GO TO 1305B b)
NO 2
c) insult you or make you feel bad about yourself?
YES 1 (GO TO 1305B c)
NO 2

1305B. CHECK 603:
ASK ONLY IF RESPONDENT IS NOT A WIDOW.

How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1306A. (Does/did) your (last) husband ever do any of the following things to you:

a) slap you?
YES 1 (GO TO 1306B a)
NO 2
b) twist your arm or pull your hair?
YES 1 (GO TO 1306B b)
NO 2
c) push you, shake you, or throw something at you?
YES 1 (GO TO 1306B c)
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1 (GO TO 1306B d)
NO 2
e) kick you, drag you or beat you up?
YES 1 (GO TO 1306B e)
NO 2
f) try to choke you or burn you on purpose?
YES 1 (GO TO 1306B f)
NO 2
g) threaten or attack you with a knife, gun, or any other weapon?
YES 1 (GO TO 1306B g)
NO 2
h) physically force you to have sexual intercourse with him even when you did not want to?
YES 1 (GO TO 1306B h)
NO 2
i) force you to perform any sexual acts you did not want to?
YES 1 (GO TO 1306B i)
NO 2

1306B. CHECK 603: ASK ONLY IF RESPONDENT IS NOT A WIDOW
How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) slap you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you or beat you up?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g) threaten or attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h) physically force you to have sexual intercourse with him even when you did not want to?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
i) force you to perform any sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1307. CHECK 1306A (a-i):

AT LEAST ONE 'YES' (GO TO 1308)
NOT A SINGLE 'YES' (GO TO 1310)

1308. How long after you first got married to your (last) husband did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS __________
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1309. Did the following ever happen as a result of what your (last) husband did to you:

a) You had cuts, bruises or aches?
YES 1
NO 2
b) You had severe burns?
YES 1
NO 2
c) You had eye injuries, sprains, dislocations, or minor burns?
YES 1
NO 2
d) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

1310. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1313)

1311. CHECK 603:

RESPONDENT IS NOT A WIDOW (GO TO 1312)
RESPONDENT IS A WIDOW (GO TO 1313)

1312. In the last 12 months, how often have you done this to your husband: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1313. Does (did) your husband drink alcohol?

YES 1
NO 2 (GO TO 1315)

1314. How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1315. CHECK 201, 226, AND 229:

EVER BEEN PREGNANT (GO TO 1316)
NEVER BEEN PREGNANT (GO TO 1318)

1316. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1318)

1317. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER B
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) ___________ X

1318. CHECK 601 AND 602:

EVER MARRIED: From the time you were 15 years old has anyone other than your (current/last) husband hit, slapped, kicked, or done anything else to hurt you physically?

NEVER MARRIED: From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1321)
REFUSED TO ANSWER/ NO ANSWER 3 (GO TO 1321)

1319. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) ___________ X

1320. In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1321. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2 (GO TO 1324)
REFUSED TO ANSWER/ NO ANSWER 3 (GO TO 1324)

1322. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS __
DON'T KNOW 98

1323. Who was the person who was forcing you at that time?

CURRENT HUSBAND 01
FORMER HUSBAND 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP-FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) ______________ 96

1324. CHECK 601 AND 602:

EVER MARRIED: In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?

NEVER MARRIED: In the last 12 months has anyone forced you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

1325. CHECK 1306A (a-i), 1318, 1321, AND 1324:

AT LEAST ONE 'YES' (GO TO 1326)
NOT A SINGLE 'YES' (GO TO 1329)

1326. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop the person(s) from doing this to you again?

YES 1
NO 2 (GO TO 1328)

1327. From whom have you sought help to stop this? Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1329)
HUSBAND'S FAMILY B (GO TO 1329)
CURRENT/LAST HUSBAND C (GO TO 1329)
CURRENT/FORMER BOYFRIEND D (GO TO 1329)
FRIEND E (GO TO 1329)
NEIGHBOUR F (GO TO 1329)
RELIGIOUS LEADER G (GO TO 1329)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1329)
POLICE (e.g. Victim Support Unit) I (GO TO 1329)
LAWYER J (GO TO 1329)
SOCIAL SERVICE ORGANIZATION (e.g. YWCA) K (GO TO 1329)
OTHER (SPECIFY) ___________ X (GO TO 1329)

1328. Have you ever told anyone else about this?

YES 1
NO 2

1329. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1330. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS
TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER
WAY?

HUSBAND
YES ONCE 1
YES MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES ONCE 1
YES MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES ONCE 1
YES MORE THAN ONCE 2
NO 3

1331. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
______________________________________
______________________________________

1332. RECORD THE TIME.

HOUR ___
MINUTES ___

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:
____________________________________________

COMMENTS ON SPECIFIC QUESTIONS:
_____________________________________________

ANY OTHER COMMENTS:
____________________________________________

SUPERVISOR'S OBSERVATIONS
____________________________________________

NAME OF SUPERVISOR: ____________________
DATE: _____________________

EDITOR'S OBSERVATIONS
_____________________________________________

NAME OF EDITOR: ______________________
DATE: _______________________

CALENDAR

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 MALE CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER (SPECIFY) _____________

2008

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2007

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2006

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2003

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