IDENTIFICATION

STATE _____
LOCAL GOVT. AREA_____
ENUMERATION AREA_____
NAME OF HOUSEHOLD HEAD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
NAME AND LINE NUMBER OF WOMEN_____

CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: HOUSEHOLD SELECTED FOR MAN'S SURVEY?

CHECK HOUSEHOLD QUESTIONNAIRE DVH01: WOMAN SELECTED FOR DV MODULE?

INTERVIEWER VISITS

VISIT 1

NEXT VISIT:

FINAL VISIT

TOTAL NUMBER OF VISITS_____

LANGUAGE OF QUESTIONNAIRE**

LANGUAGE CODES:

TRANSLATOR USED?

SUPERVISOR

FIELD EDITOR

INSTRUCTION AND CONSENT

Hello. My name is _____. I am working with National Population Commission. We are conducting a survey about health and other topics all over Nigeria. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 to 30 minutes. All of the answers are confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you a question you don't want to answer, just let me know and I will go on to the next question of you can stop the interview at any time.
In case you need more information about the survey, you may contact the person on the card that has already been given to your household.

Do you have any questions?

May I begin the interview?

SECTION 1: RESPONDENT'S BACKGROUND

101. RECORD THE TIME

102. How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN 1 YEAR, RECORD '00' YEARS.

103. Just before you oved here, did you live in a city, a town, or in a rural area?

104. Before you moved here, which state did you live in?

105. In what month and year were you born?

106. How old were you at your last birthday?

107. Have you ever attended school?

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

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

110. CHECK 108:

111. Now I would like you to read this card to me.

SHOW CARD TO THE RESPONDENT.

IF THE RESPONDENT CANNOT READ WHOLE SENTENCE,

PROBE: Can you read any part of the sentence to me?

112. CHECK 111:

113. Do you read a newspaper of magazine at least once a week, less than once a week or not at all?

114. Do you listen to the radio at least once a week, less than once a week or not at all?

115. Do you watch television at least once a week, less than once a week or not at all?

116. Do you own a mobile telephone?

117. Do you use your phone for any financial transactions?

118. Do you have an account in a bank or financial institution that you yourself use?

119. Have you ever used the internet?

120. In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121. During the last month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

122. What is your religion?

123. What is your ethnic group?

124. In the last 12 months, how many times have you been away from home for one or more nights?

125. In the last 12 months, have you been away from home for more than 1 month at a time?

SECTION 2. REPRODUCTION

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

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

203. a) How many sons live with you?

b) How many daughters live with you?

IF NONE, RECORD '00'.

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

205. a) How many sons are alive but do not live with you?

b) How many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

206. Have you ever given birth to a boy or girl who was born alive but later died?

IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207. a) How many boys have died?

b) How many girls have died?

IF NONE, RECORD '00'.

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

209. CHECK 208:

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

210. CHECK 208:

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD ALL NAMES OF THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 10 BIRTHS USE ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

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

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

214. Were any of these births twins?

215. On what day, month, and year was (NAME) born?

216. Is (NAME) still alive?

217. How old was (NAME) at (NAME)'s last birthday?

218. Is (NAME) living with you?

219. RECORD HOUSEHOLD LINE NUMBER OF CHILD RECORD '00' IF CHILD NO LISTED IN HOUSEHILD.

(REPEAT FOR NEXT CHILD OR GO TO 221)

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

IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday?

THEN ASK: Exactly how many months old was (NAME) when (he/she) died?

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

220B. IF DEATH AT AGE 0-5
On what day, month and year did (NAME) die?

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

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

223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY.

223A. CHECK 220B: ENTER THE NUMBERS OF DEATHS IN JANUARY 2014 OR LATER.

IF NONE, RECORD '0'.

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2013-2018

225. FOR EACH BIRTH 2013-2018, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDER. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED 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 PREGNANCT LASTED.)

226. Are you pregnant now?

227. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS

ENTER 'P's IN THE CALENDER, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228. When you got pregnant, did you want to be pregnant at that time?

229. CHECK 208: TOTAL NUMBER OF BIRTHS

ONE OR MORE

NONE

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

231. When did the last such pregnancy end?

232. CHECK 231:

233. In what month and year did the preceding such pregnancy end?

234. How many months pregnant were you when the pregnancy ended?

235. Since January 2013, have you had any other pregnancies that did not result in a live birth?

236. FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2013-2018 OR LATER, ENTER 'T' IN THE CALENDER IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237. Did you have any miscarriages, abortions or stillbirths that ended before 2013?

238. When did the last pregnancy that terminated before 2013 end?

239. When was your last menstrual period start?

240. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

241. Is this time right before her period starts, right after her period has ended, or half way between two periods?

242. After the birth of a child, can a woman become pregnant before her menstrual period has returned?

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning- the various methods that a couple can use to delay or avoid pregnancy. Have you heard of (METHOD)?

PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.

14. Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?

302. CHECK 226:

303. Are you and your partner currently doing something or using any method to avoid getting pregnant?

304. Which method are you using?

RECORD ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

305. What is the brand of pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

306. What is the brand name of the condoms you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

307. In what facility did the sterilization take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
__________

308. In what month was the sterilization preformed?

309. Since what month have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CUURENT METHOD) now without stopping?

310. CHECK 308, 215, AND 231: ANY BIRTH OR PREGNANCY TERMINATION
AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309

311. CHECK 308 AND 309:

312. 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 2013, USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

312A. MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.

312B. Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

312C. What method was it?

312D. How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?
CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

312E. RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

312F. For how many months did you use (METHOD)?
CIRLCE '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

312G. RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

312H. Why did you stop using (METHOD)?

312I. GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.

313. CHECK THE CALENDAR FOR USE OF ANY CONTACEPTIVE METHOD IN ANY MONTH.

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

315. CHECK 304:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST CODE FOR HIGHEST METHOD IN LIST.

316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
__________

317. CHECK 304:

CIRCLE METHOD CODE:
IF MORE THAN ONE CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

318. At that time, were you told about side effects or problems you might have with the method?

319. When you got sterilized, were you told about side effects or problems you might have with this method?

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

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

322. CHECK 318 AND 319:
ANY 'YES':

a) At that time, were you told about any other methods of family planning methods that you could use?

b) When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

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

324. CHECK 304:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

325. Where did you obtain (CURRENT METHOD) the last time?

PROBE TO INDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
__________

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

327. In the last 12 months, were you visited by a fieldworker?

328. Did the fieldworker talk to you about family planning?

329. CHECK 202: CHILDREN LIVING WITH RESPONDENT

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

b) In the last 12 months, have you visited a health facility for care for yourself?

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

SECTION 4: PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

402. CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2013-2018. ASK THE QUESTIONS ABOUTALL OF THESE BIRTHS BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

404. FROM 212 AND 216:

405. When you got pregnant with (NAME), did you want to get pregnant at that time?

406. CHECK 208.

ONLY ONE BIRTH
a) Did you want to have a baby later on, or did you not want any children?

MORE THAN ONE BIRTH
b) Did you want to have a baby later on, or did you not want any more children?

407. How much longer did you want to wait?

408. Did you see anyone for antenatal care for pregnancy?

Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

409. Whom did you see?

410. Where did you receive antenatal care for this pregnancy?

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

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

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

a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?

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

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

416. CHECK 415:

417. At any time before this pregnancy, did you receive any tetanus injections?

418. Before this pregnancy, how many times did you receive a tetanus injection?

IF MORE THAN 7 TIMES, RECORD 7.

419. CHECK 418:

ONLY ONE
a) How many years ago did you receive that tetanus injection?

MORE THAN ONE TIME
b) How many years ago did you receive the last tetanus injection prior to this pregnancy?

420. During this pregnancy, were you given or did you buy iron tablets or iron syrup?

SHOW TABLETS/SYRUP.

421. 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.

422. During the pregnancy, did you take any drug for intestinal worms?

423. During this pregnancy, did you take SP/Fansider to keep you from getting malaria?

424. How many times did you take SP/Fansider during this pregnancy?

425. Did you get the SP/Fansider during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

426. When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

427. Was (NAME) weighed at birth?

428. How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

429. 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.

429A. Immediately after the delivery of (NAME) did you receive an injection in the thigh or buttock?

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE _____

430A. Did you move from another health facility to come to this facility or did you go directly from home to this facility, or from somewhere else that was not a health facility?

430B. Which health facility referred or sent you to this facility where you gave birth to (NAME)?

PROBE TO IDENTIFY THE TYPE PF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE ______

430C. Why did you move from this facility to the facility where you gave birth to (NAME)?

430D. Did a health worker go with you when you moved to the facility where you gave birth to (NAME)?

430E. What means of transportation did you use to get from the facility that referred you to the facility where you gave birth to (NAME)?

430F. What means of transportation did you use to get to the health facility where you gave birth to (NAME)?

PROBE FOR THE TYPE(S) OF TRANSPORT USE AND RECORD ALL MENTIONED.

430G. How long did it take for you to decide to go and reach the health facility?

IF LESS THAN ONE HOUR, RECORD IN MINUTES.

431. How long after (NAME) was delivered did you stay there?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

432. Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

433. When was the decision made to have the caesarean section? Was it before or after your labor pains started?

433A. When was the reason for making the decision to have the caesarean section?

EXCESS BLEEDING 1
BREECH POSITION 2
MEDICAL CONDITION OF MOTHER 3
CORD PROBLEM 4
VOLUNTARY 5
OTHER _____ 6

434. Immediately after the birth, was (NAME) put on your chest?

434A. Was (NAME)'s bare skin touching your bare skin?

434B. Was (NAME) wiped dry within a few minutes after birth?

434C. How long after birth was (NAME) bathed for the first time?

IF LESS THAN ONE HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.

434D. CHECK 430: PLACE OF DELIVERY

434E. What was used to cut the cord?

434F. Was it new or had it ever been used before?

434G. Was it boiled before it was used to cut the cord?

434H. Was anything applied to the stump of the cord at any time?

434I. What was applied?

434J. CHECK 434I: SUBSTANCE APPLIED TO CHORD

434K. Was chlorhexidine applied to the stump at any time?

SHOW SAMPLE OF CHLORHEXIDINE

434L. How long after the cord was cut was chlorhexidine first applied?

IF LESS THAN 1 HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.

434M. CHECK 430: PLACE OF DELIVERY

435. I would like to talk to you about the checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

436. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

437. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

438. Now I would like to talk to you about checks on (NAME)'s health after delivery- for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

439. How long after delivery was (NAME)'s health first checked?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

440. Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

441. Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

442. How long after delivery did that check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

443. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

444. Where did the check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE _______

445. I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in two months after you left (FACILITY IN 430)?

446. How many house, days or weeks after the birth of (NAME) did that check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

447. Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

448. Where did this check of (NAME) take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE ________

449. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

450. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

451. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

452. Where did this first check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

453. I would like to talk to you about checks on (NAME)'s health after delivery- for example, someone examining (NAME), checking the chord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

IF LESS TAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

455. Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

456. Where did this first check of (NAME) take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
________

457. During the first two days after (NAME)'s birth, did any health care provider do the following:

a) Examine the cord?
b) Measure (NAME)'s temperature?
c) Counsel you on danger signs for newborns?
d) Counsel you on breastfeeding?
e) Observe (NAME) breastfeeding?

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

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

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

461. CHECK 226: IS RESPONDENT PREGNANT?

462. Have you had sexual intercourse since the birth of (NAME)?

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

464. Did you ever breastfeed (NAME)?

465. CHECK 404: IS CHILD LIVING?

466. 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.

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

468. CHECK 404: IS CHILD LIVING?

469. Are you still breastfeeding (NAME)?

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

471. GO BACK TO 405 AND COMPLETE QUESTION FOR FOLLOWING BIRTHS; OR, IF NO MORE BIRTHS, GO TO 501A.

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2015-2018?

502A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2015-2016.

503A. CHECK 216 FOR CHILD:

504A. Do you have a card or other document where (NAME)'s vaccinations are written down?

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

506A. CHECK 504A:

508A. COPY DATES FROM THE CARD.
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509A. CHECK 508A:'BCG' TO 'MEASLES/MMR 2' ALL RECORDED?

510A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

511A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

512A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

513A. Within 24 hours after birth, did (NAME) receive a Hepatitis B vaccination, that is, an injection in the thigh to prevent Hepatitis B?

514A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

515A. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

516A. How many times did (NAME) receive the oral polio vaccine?

517A. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

518A. How many times did (NAME) receive the pentavalent vaccine?

519A. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

520A. How many times did (NAME) receive the pneumococcal vaccine?

521A. Has (NAME) ever received an inactivated polio vaccine(IPV), that is, an injection in the thigh to prevent polio>

522A. Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

523A. How many times did (NAME) receive the measles vaccine?

526A. CONTINUE WITH 501B. (NEXT TO LAST BIRTH)

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

(REPEAT QUESTIONS IN SECTION 5A WITH NEXT-TO-LAST BIRTH)

526B. CHECK 215 IN BIRTH HISTORY ANY MORE BIRTHS IN 2015-2018?

SECTION 6. CHILD HEALTH AND NUTRITION

601. CHECK 224:

602. CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2013-2018. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

604. FROM 212 AND 216:

605. In the last six months, was (NAME) given a vitamin A dose like this?

SHOW COMMON TYPES OF DOSES.

606. In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like [this/any of these]?

SHOW COMMON TYPES OF SPRINKLES/PILLS/SYRUPS.

607. Was (NAME) given any medicine for deworming in the last six months?

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

609. CHECK 469: CURRENTLY BREASTFEEDING?

YES

NO/NOT ASKED

IF LESS PROBE: Was (NAME) given much less than usual to drink or somewhat less?

610. When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same, more than usual, or nothing to eat?

IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

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

612. Where did you seek advice or treatment?

Anyone else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF PLACE(S).
__________

613. CHECK 612:

614. Where did you first seek advice or treatment?

615. Was (NAME) given any of the following at any time since (NAME) started having diarrhea:

a) A fluid made from a special packet called CHI ORS, Emzor, Orasure, Olphram ORS ect.?
c) A government-recommended homemade fluid?
d) Zinc tablets or syrup?

616. CHECK 615:

ANY YES

ALL 'NO' OR 'DON'T KNOW'

617. CHECK 615:

ANY YES

a) What else was given to treat the diarrhea?

Anything else?

ALL 'NO' OR 'DON'T KNOW'

b) What was given to treat the diarrhea?

Anything else?

RECORD ALL TREATMENTS GIVEN

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

619. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

620. Has (NAME) had an illness with a cough in the last 2 weeks?

621. Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

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

623. CHECK 618: HAD FEVER?

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

625. Where did you seek advice or treatment?
Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

626. CHECK 625:

627. Where did you seek treatment first?

USE LETTER CODES FROM 626.

628. How many days after the illness began did you seek advice or treatment for (NAME)?

IF THE SAME DAY, RECORD '00'.

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

630. What drugs did (NAME) take?

Any other drugs?

RECORD ALL MENTIONED.

631. CHECK 630:
ANY CODE A-I CIRCLED?

632. CHECK 630:
ARTEMISININ COMBONATION THERAPY ('A') GIVEN

633. How long after the fever started did (NAME) first take an artemisinin combination therapy?

646. GO BACK TO 604 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 647.

647. CHECK 615(a) AND 615(b), ALL COLUMNS.

648. Have you ever heard of a special product ORS called CHI ORS, Emzorlyte, Orasure, Olpharm ORS ect. you can get for treatment of diarrhea?

649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2016-2018 LIVING WITH THE RESPONDENT

650. Now I would like to ask about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods. Did (NAME FROM 649) eat or drink:

IF YES: How many times did (NAME) drink milk?

RECORD NUMBER OF TIMES DRANK:
IF 7 OR MORE TIMES, RECORD '7'.

IF 7 OR MORE TIMES, RECORD '7'.

IF YES: How many times did (NAME) eat yogurt?

651. CHECK 650 (CATEGORIES 'g' THROUGH 'u')

652. Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or night?

IF 'YES' PROBE: What kind of solid, semi-solid, or soft food did (NAME) eat? ____

653. How many times did (NAME FROM 149) eat solid, semi-solid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

653A. Now I would like to ask you about foods and drinks that you ate or drank yesterday during the day or the night, whether you ate it at home or anywhere else.

I am interested in whether you had any food items I will mention even if they were combined with other foods. For example, if you had a soup made with carrots, potatoes and meat, you should reply "yes" for each of these ingredients when I read you the list. However, if you consumed only the broth of the soup, but not the meat or vegetables, do not reply "yes" for the meat or vegetable.

As I ask you about foods and drinks, please think of foods and drinks you have had as snacks or small meals as well as during any main meals. Please also remember foods you may have eaten while preparing meals or preparing food for others.

Please do not include any food used in small amount for seasoning or condiments (like spices, herbs, or crayfish powder). I will ask you about those foods separately.

Any foods made with grains, like:

Any vegetables or roots that are colored orange inside like:

Any white roots and tubers or plantains, like:

Any dark, leafy vegetables, like:

Any fruits that are dark yellow or orange on the inside, like:

Any other fruits, like:

Any other vegetables, like:

Any meat made from animal organ, like:

Any other types of meat of poultry, like:

Any fish or seafood, whether fresh or dried, like:

Any beans or peas, like:

Any nuts or seeds, like:

Any milk or milk products, like?

An insects and other small protein foods, like:

Any red palm oil, like:

Any other oils and fats, like:

Any savory and fried snacks, like:

Any sweets, like:

Any sugar-sweetened beverages, like:

Any condiments and seasonings, like:

Any other beverages and foods, like:

653B. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2016-2018 LIVING WITH THE RESPONDENT

654. The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

705. RECORD THE HUNBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

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

707. Including yourself, in total, how many wives or live-in partners does he have?

708. Are you the first, second, or third wife?

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

710. CHECK 709

MARRIED/LIVED WITH A MAN ONLY ONCE

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

712. CHECK FOR PRESENCE OF OTHERS, BEFORE CONTINUING; MAKE EVERY EFFORT TO ENSURE PRIVACY.

713. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. 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. How old were you when you had sexual intercourse for the very first time?

714. I would like to ask about your recent sexual activity. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSWERS MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWERS MUST BE RECORDED IN YEARS.

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

716. The last time you had sexual intercourse with this person, was a condom used?

717. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

718. What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married?

719. How long ago did you first have sexual intercourse with this person?

720. How many times during the last 12 months did you have sexual intercourse with this person?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF THE NUMBER OF TIMES IS 95 OR MORE. RECORD '95'.

721. How old is this person?

722. Apart from this person, have you has sexual intercourse with any other person in the last 12 months?

723. In total, how many different people have you had intercourse with in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF THE NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

724. CHECK 106.

725. CHECK 701.

726. In the last 12 months, have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash or anything else?

727. In total, with how many different people have you had sexual intercourse with in your life?

728. CHECK 716, MOST RECENT PARTNER

729. You told me that a condom was used the last time you had sex. What is the brand name of the condom used at the time?

IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

730. From where did you obtain the condom the last time?

731. PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN LESS THAN 10

MALE ADULTS:

FEMALE ADULTS:

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

802. CHECK 226:

803. 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?

804. 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?

805. CHECK 226:

NOT PREGNANT OR UNSURE

PREGNANT:

806. CHECK 226:

807. CHECK 303: USING A CONTRACEPTIVE METHOD?

808. CHECK 805:

809. CHECK 714:

810. CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD

Any other reason?

WANTS NO MORE/NONE

Any other reason?

811. CHECK 303: USING A CONTRACEPTIVE METHOD?

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

813. CHECK 216:

HAS LIVING CHILDREN:

PROBE FOR NUMERIC RESPONSE

NO LIVING CHILDREN

PROBE FOR NUMERIC RESPONSES

814. How many of these children would you prefer to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

815. In the last few months have you:

815A. CHECK 815:

816. Please tell me which family planning messages you have heard or seen in the past few months?

PROBE: Any others?

817. CHECK 701:

818. CHECH 303: USING A CONTACEPTIVE METHOD?

819. Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

820. Would you say that not using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

821. CHECK 304:

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

SECTION 9. HUSBAND'S BACKGROUND AND WOMEN'S WORK

901. CHECK 701:

902. How old was you (husband/partner) on his last birthday?

903. Did you (husband/partner) ever attend school?

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

905. What was the highest class/year he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

906. Has your (husband/partner) done any work in the last 7 days?

907. Has your (husband/partner) done any work in the last 12 months?

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

909. Aside from your own housework, have you done any work in the last 7 days?

910. As you know, some women take up jobs 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 7 days, have you done any of these things or any other work?

911. Although you did not work in the last 7 days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

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

913. What is your occupation? That is, what kind or work do you mainly do?

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

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

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

917. CHECK 701:

918. CHECK 916:

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

920. Would you say that the money you ear is more than what your (husband/partner) earns, less than what he earns, or about the same?

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

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

923. Who usually makes decisions about major household purchases?

924. Who usually makes decisions about visits to your family or relatives?

925. Do you own this or any other house either alone or jointly with someone else?

926. Do you have a title deed for any house you own?

927. Is your name on the title deed?

928. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

929. Do you have a title deed for any land you own?

930. Is your name on the title deed?

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

CHILDREN

HUSBAND

OTHER MALES

OTHER FEMALES

932. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?

SECTION 10. HIV/AIDS

1001. Now I would like to talk to you about something else. Have you ever heard of HIV or AIDS?

1002. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just on uninfected sex partner who has no other sex partners?

1003. Can people get HIV from mosquito bites?

1004. Can people reduce their chance of getting HIV by using a condom every time they have sex?

1005. Can people get HIV by sharing food with a person who has HIV?

1006. Can people get HIV because of witchcraft or other supernatural means?

1007. Is it possible for a healthy-looking person to have HIV?

1008. Can HIV be transmitted from a mother to her baby:

a) During pregnancy?
b) During delivery?
c) By breastfeeding?

1009. CHECK 1008:

1010. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

1011. CHECK 208 AND 215:

1012. CHECK 408 FOR LAST BIRTH:

1014. During any of the antenatal visits for your last birth were you given any information about:

a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?

1035. Would you buy fresh vegetables from a shopkeeper or vendor if you knew this person had HIV?

1036. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

1037. Do you think that people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

1038. Do people talk badly about people living with HIV, or about people who are thought to be living with HIV?

1039. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

1040. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV?

1041. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

1042.CHECK 1001:

HEARD ABOUT HIV OR AIDS

NOT HEARD ABOUT HIV OR AIDS:

1043. CHECK 713:

1044. CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

1045. 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?

1046. Sometimes women experience bad-smelling abnormal genital discharge. During the last 21 months, have you had bad-smelling abnormal genital discharge?

1047. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1048. CHECK 1045, 1046, AND 1047:

1049. The last time you had (PROBLEM from 1045/1046/1047), did you seek any kind or advice or treatment?

1050. Where did you go?

Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OF PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
__________

1051. 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?

1052. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

1053. CHECK 701:

1054. Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

1055. Could you ask your (husband/partner) to use a condom if you wanted him to?

SECTION 11. OTHER HEALTH IISSUES

1101. 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1102. 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1103. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1104. Do you currently smoke cigarettes every day, some days, or not at all?

1105. On average, how many cigarettes do you currently smoke each day?

1106. Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

1107. What type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

1108. 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 a big problem:

a) Getting permission to go to the doctor?
b) Getting money needed for advice or treatment?
c) The distance to the health facility?
d) Not wanting to go alone?

1108A. I am going to ask you your opinion on behavior/practice on reducing the risk of malaria. Please tell me whether you agree with the following statements:

b) The medicine given to pregnant women to prevent malaria works to keep the mother healthy.

c) The medicine given to pregnant women to prevent malaria works well to keep the baby healthy when it is born.

d) The malaria tests are the only way to know if someone really has malaria or not.

f) Even if malaria test show that the fever is not caused by malaria, I will seek out treatment for malaria because I don't trust the test result.

i) When the entire course of malaria medicine is taken, the disease will be fully cured.

1108B. I am going to ask you about your opinion on consequences of malaria. Please tell me whether you agree or disagree with the following statements:

a) Every case of malaria can potentially lead to death.

c) You don't worry about malaria because it can be easily treated.

d) You know people who have become dangerously sick with malaria.

f) Only weak children can die from malaria.

1109. Are you covered by health insurance?

1110. What type of health insurance are you covered by?

RECORD ALL MENTIONED.

SECTION 12. FEMALE GENITAL CUTTING/MUTILATION

1200. CHECK COVER PAGE: HOUSEHOLD SELECTED FOR MAN'S SURVEY?

1201. Now I would like to ask some questions about a practice known as female circumcision, that is, a practice in which a girl may have part of her genitals cut, for example, excision of the clitoris and the labia minora, scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts) and even use of corrosive substances or herbs into vagina to tighten or narrow or to cause bleeding.

Have you heard about any of these practices?

1202. Have you yourself ever had any of these procedures performed on you?

1203. Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

1204. Was the genital area just nicked without any removal of flesh?

1205. Was your genital area sown closed?

1205A. Which type of procedure was performed on you?

a) Removal of clitoris along with partial or total excision of the labia minora?
b) Infibulation: removal of clitoris, labia minora and adjacent medial part of labia majora and stitching?
c) Scraping of tissue surrounding the vaginal orifice (eg. Anguyura cutes ect.)?
d) Cutting of the vagina (eg. Gishiri cutes ect.)?

1205B. Have you ever used corrosive substances or herbs into the vagina with the aim of tightening or narrowing it or to cause bleeding?

1206. How old were you when this procedure (GC6A/GC6B) was performed for the first time?

IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

1207. Who performed the procedure?

1208. CHECK 213, 215 AND 216:

CHECK 213, 215 AND 216. ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2003 OR LATER. ASK THE QUESTION ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 3 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES).

1209. Now I would like to ask you some questions about your (daughter/daughters).

1210. BIRTH HISTORY NUMBER OF EACH LIVING DAUGHTER BORN IN 2003 OR LATER.

1211. Is (NAME) circumcised?

1212. How old was (NAME OF DAUGHTER) when she was circumcised?

IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

1213. Was her genital area sown closed?

1214. Who performed the circumcision?

1215. GO TO 1211 WITH NEXT DAUGHTER; OR, IF NO MORE DAUGHTERS, GO TO 1216.

1216. Do you believe that female circumcision is required by your religion?

1217. Do you think that female circumcision should be continued, or should it be stopped?

SECTION 13. FISTULA

1301. Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and the night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery.

Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

1302. Have you ever heard of this problem?

1303. Did this problem start after you delivered a baby or had a stillbirth?

1304. Did this problem start after a normal labor and delivery, or after a difficult labor and delivery?

1305. What do you think caused this problem?

1006. How many days after (CAUSE OF PROBLEM FROM 1303 OR 1305) did the leakage start?

ENTER '90' IF 90 DAYS OR MORE.

1306A. How old were you when you experienced this problem?

1307. Have you sought treatment for this condition?

1308. Why have you not sought treatment?

1309. From whom did you last seek treatment?

1310. Did you have an operation to fix the problem?

1311. Did the treatment stop the leakage completely?

IF NO: Did the treatment reduce the leakage?

1312. Are there any (other) women in your household who suffer from obstetric fistula?

)

1313. How many (other) women in your household suffer from obstetric fistula?

SECTION 14. ADULT AND MATERNAL MORTALITY MODULE

1401. Now I would like to ask you some questions about your brothers and sisters born from your natural mother, including those who are living with you, those living elsewhere and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your natural mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please give me the names of all your brothers and sisters born to your natural mother?
DO NOT FILL IN THE ORDER NUMBER YET.

1402. CHECK 1401.

1403. READ THE NAMES OF THE BROTHERS AND SISTERS TO THE RESPONDENT AND AFTER THE LAST ONE ASK: Are there any other brothers and sisters from the same mother that you have not mentioned.

1404. Sometimes people forget to mention children born to their natural mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have no mentioned?

1405. Sometimes people forget to mention children born to their natural mother because they have died. Are there any brothers or sisters who died who you have not mentioned?

1406. Some people have brothers or sisters from the dame mother but a different father. Are there any brothers or sisters born to your natural mother, but who have a different father, that you have not mentioned?

1407. COUNT THE NUMBERS OF BROTHERS AND SISTERS RECORDED IN 1401.

1408. CHECK 1407:
Just to make sure that I have this right: Your mother had in TOTAL _____ births, excluding you, during her lifetime. Is that correct?

1409. CHECK 1407:

1410. Please tell me, which brother or sister was born first? And which was born next?
RECORD '01' FOR THE ORDER NUMBER IN 1401 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED THE ORDER NUMBER FOR ALL BROTHERS AND SISTERS.

1411. How many births did your mother have before you were born?

1412. LIST THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER IN 1401. ASK 1413 TO 1424 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE AN ADDITIONAL QUESTIONNAIRE.

1413. NAME OF BROTHER OR SISTER

1414. Is (NAME) male or female?

1415. Is (NAME) still alive?

1416. How old is (NAME)?

1417. How many years ago did (NAME) die?

1418. How old was (NAME) when (he/she) died?

IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

1419. Was (NAME) pregnant when she died?

1420. Did (NAME) die during childbirth?

1421. Did (NAME) die within two months after the end of a pregnancy or childbirth?

1422. How many days after the end of the pregnancy did (NAME) die?

1422A. In which State did (NAME) die?
WRITE THE STATE CODE.

1422B. CHECK 1420:

1423. Was (NAME)'s death due to an act of violence?

1424. Was (NAME)'s death due to an accident?

IF NO MORE BROTHERS OR SISTERS, GO TO NEXT SECTION.

SECTION 15. DOMESTIC VIOLENCE MODULE

1500. CHECK COVER PAGE: WOMEN SELECTED FOR DV MODULE?

1501. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

1501A. READ TO THE RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Nigeria. Let me assure you your answers are completely confidential and will not be told to anyone and no one else in your household will know you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.

1502. CHECK 701 AND 702.:

1503. 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/partner)?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/where) at all times?

1504. Now I need to ask you some questions about your relationship with your (last) (husband/partner).

A. Did your (last) (husband/partner) ever:
B. How often did this happen in the last 12 months; often, only sometimes, or not at all?

a) say or do anything to humiliate you in front of others?

b) threaten to hurt or harm you or someone you care about?

c) insult you or make you feel bad about yourself?

1505A. Did your (last) (husband/partner) ever do any of the following things to you:

a) push you, shake you, or throw something at you?

b) slap you?

c) twist your arm or pull your hair?

d) punch you with his fist or with something that could hurt you?

e) kick you, drag you, or beat you up?

f) try to choke you or burn you on purpose?

g) threaten or attack you with a knife, gun, or other weapon?

h) physically force you to have sexual intercourse with him when you did not want to?

i) physically force you to perform any other sexual acts you did not want to do?

j) force you with threats or in any other way to preform sexual acts you did not want to?

1506. CHECK 1505(a-j)

1507. How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD '00'.

1508. Did the following ever happen as a result of what your (last) (husband/partner) did to you?

1509. Have you ever hit, kicked, or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

1510. In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

1511. Does (did) your (last) (husband/partner) drink alcohol?

1512. How often does (did) he get drunk: often, only sometimes, or never?

1513. Are (were) you ever afraid of your (last) (husband/partner): most of the time, sometimes, or never?

1514. CHECK 709:

1515. A. So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?

B. How long ago did this happen?

b) Did any previous (husband/partner) physically force you to have intercourse or preform other sexual acts against your will?

B. How long ago did this happen?

c) Did any previous (husband/partner) humiliate you in front of others, threaten to hurt you or someone you care about, or insult you or make you feel bad about yourself?

B. How long ago did this happen?

1516. CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN

NEVER MARRIED/LIVED WITH A MAN

1517. Who has hurt you in this way?

Anyone else?

RECORD ALL MENTIONED.

1518. In the last 12 months, how often has (this person, these persons) physically hurt you: often, only sometimes, or not at all?

1519. CHECK 201, 226, AND 230:

1520. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1521. Who has done any of these things to physically hurt you while you were pregnant?

Anyone else?

RECORD ALL MENTIONED.

1522. CHECK 701 AND 702:

1522A. Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1522B. At any time in your life, as a child or an adult, has anyone ever forced you in any way to have sexual intercourse or preform any sexual acts when you did not want to?

1523. Who was the person forcing you the very first time this happened?

CHECK 701 AND 702:

EVER MARRIED/LIVED WITH A MAN

NEVER BEEN MARRIED/LIVED WITH A MAN

1524A. CHECK 1505A(h-j) AND 1515A(b)

1525. CHECK 701 AND 702:

EVER MARRIED/LIVED WITH A MAN

NEVER BEEN MARRIED/LIVED WITH A MAN

1526. CHECK 1505A (a-j), 1515A (a,b), 1516, 1520, 1522A, AND 1522B:

1527. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1528. From whom have you sought help?

Anyone else?

RECORD ALL MENTIONED.

1529. 1529. Have you ever told anyone about this?

1530. As far as you know, did your father beat your mother?

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

1531. DID YOU INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

HUSBAND

OTHER MALE ADULT

FEMALE ADULT

1532. INTERVIEWER'S COMMENTS/EXPLANATIONS FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

1533. CHECK 223A.

1534. READ TO RESPONENT:

I would like to inform you that detailed information on the circumstances surrounding the deaths of children under the age of 5 will be collected in the near future so that the federal government of Nigeria can provide health services to help reduce these deaths. If you do not mind, another team will be coming at a later date to interview members of the household about the death(s) you have told me about. Is this okay?

1535. RECORD THE TIME

INTERVIEWER OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
SUPERVISOR'S OBSERVATIONS
EDITOR'S OBSERVATIONS: