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NAMIBIA DEMOGRAPHIC AND HEALTH SURVEY

IDENTIFICATION

PLACE NAME_____
NAME OF HOUSEHOLD HEAD_______
P.S.U. NUMBER_____
HOUSEHOLD NUMBER______

REGION

Northwest 1
Northeast 2
Central 3
South 4

URBAN/RURAL

Urban 1
Rural 2

NAME AND LINE NUMBER OF WOMAN______

INTERVIEWER VISIT 1 (REPEAT FOR INTERVIEWER VISITS 2 AND 2)
DATE_____
INTERVIEWER'S NAME_____
RESULT_____

NEXT VISIT:
DATE____
TIME_____

FINAL VISIT
DAY____
MONTH_____
YEAR_____
NAME_____
RESULT_____

TOTAL NUMBER OF VISITS_____

RESULT CODES

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY)______6

LANGUAGE OF THE QUESTIONNAIRE

ENGLISH 1
AFRIKAANS 2
OSHIVAMBO 3
HERERO 4
KWANGALI 5
LOZI 6

TRANSLATOR USED

YES 1
NO 2

FIELD EDITED BY
NAME____
DATE_____

OFFICE EDITED BY
NAME____
DATE_____

KEYED BY
NAME_____
DATE_____

KEYED BY
______

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

HOUR_____
TIME_____

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

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

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

104) Just before you moved here, did you live in a city, in s town, or in the countryside?

CITY 1
TOWN 2
COUNTRYSIDE 3

105) In what month and year were you born?

MONTH____
DK MONTH 98
YEAR____
DK YEAR 98

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

AGE IN COMPLETED YEARS______

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

109) What is the highest grade you completed at that level?

GRADE_____

110) CHECK 108:

PRIMARY___
SECONDARY OR HIGHER____ (GO TO 112)

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

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)

112) Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

113) Do you usually listen to a radio at least once a week?

YES 1
NO 2

114) Do you usually watch television at least once a week?

YES 1
NO 2

115) What is your religion?

ROMAN CATHOLIC 1
PROTESTANT 2
NO RELIGION 3
OTHER (SPECIFY)______

116) What is the main language spoken in your home?

ENGLISH 1
AFRIKAANS 2
OSHIVAMBO 3
DAMARA/NAMA 4
HERERO 5
KWANGALI 6
LOZI 7
TSWANA 8
SAN 9
GERMAN 10
OTHER (SPECIFY)_____ 11

117) CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT____
THE WOMAN INTERVIEWED IS A USUAL RESIDENT____ (GO TO 129)

118) Now I would like to ask about the place in which you usually live.
Do you usually live in a city, in a town, or in the countryside?
IF CITY: In which city do you live?

CITY 1
OTHER TOWN 2
COUNTRYSIDE 3

119) In which region is that located?

NORTHWEST 1
NORTHEAST 2
CENTRAL 3
SOUTH 4

120) Now I would like to ask about the household in which you usually Live.
What is the source of water your household uses for hand washing and dishwashing?

PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 122)
PUBLIC TAP 12
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 122)
PUBLIC WELL 22
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 122)
TANKER TRUCK 51
OTHER (SPECIFY)_____71

121) How long does it take to go there, get water, and come back?

MINUTES_____
ON PREMISE 996

122) Does your household get drinking water from this same source?

YES 1 (GO TO 124)
NO 2

123) What is the source of drinking water for members of your household7

PIPES INTO RESIDENCE/YRD/PLOT 11
PUBLIC TAP 12
WELL IN RESIDENCE/YARD/PLOT 21
PUBLIC WELL 22
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41
TANKER TRUCK 51
OTHER (SPECIFY)______71

124) What kind of toilet Facility does your household have?

FLUSH TOILET 11
TRADITIONAL PIT LATRINE 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
BUCKET 23
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY)______41

125) Does your household have:

Electricity?
A radio?
A televisions?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

126) How many rooms in your household are used for sleeping?

ROOMS_______

127) Could you describe the main material of the floor of your home?
Is it:

Earth or sand?
Dung?
Wood planks?
Palms or bamboo?
Parquet or polished wood?
Vinyl or asphalt strips?
Ceramic tiles?

EARTH/SAND 11
DUNG 12
WOOD PLANKS 21
PALMS/BAMBOO 22
PARQUET OR POLISHED WOOD 31
VINYL OR ASPHALT STRIPS 32
CERAMIC TILES 33
CEMENT 34
CARPET 35
OTHER (SPECIFY)_____41

128) Does any member of your household own:

A donkey cart/horse?
A bicycle?
A motorcycle?
A car?

DONKEYCART/HORSE
YES 1
NO 2
BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

129) What is the name of the nearest health facility that provides health services to this (LOCALITY)?

(NAME)________

130) How far is it from here (in km)?
(RECORD '000' IF LESS THAN 1 KM. IF UNKNOWN RECORD '998')

KILOMETERS________

131) How do you get from here to (HEALTH FACILITY NAME)?

CAR/MOTORCYCLE 1 (GO TO 132)
PUBLIC TRANSPORT (BUS, TAXI) 2
ANIMAL/ANIMAL CART 3 (GO TO 132)
WALKING 4 (GO TO 132)
OTHER (SPECIFY)______5 (GO TO 132)

131A) FOR RURAL CLUSTERSONLY: How often per week is motorized transport available to you to go to the facility?
(RECORD '00' IF LESS THAN ONCE PER WEEK. IF UNKNOWN RECORD '98')

NO. OF TIMES PER WEEK_____

132) How long does it take you to get from here to (HEALTH FACILITY NAME)?
(RECORD IN MINUTES IF LESS THAN 2 HOURSAND IN HOURS IF 2 HOURS OR MORE)

MINUTES______1
HOURS______2

133) Does (HEALTH FACILITY NAME) provide:

antenatal care?
delivery care?
child immunization?
family planning services?

ANTENATAL CARE
YES 1
NO 2
DK 8
DELIVERY CARE
YES 1
NO 2
DK8
CHILD IMMUNIZATION
YES 1
NO 2
DK 8
FAMILY PLANNING
YES !
NO 2
DK 8

134) CHECK:
IS THE NEAREST FACILITY A HOSPITAL?

NO___
YES __ (GO TO 140)

135) What is the name of the nearest hospital that provides health services to this facility?

(NAME)_________

136) How far is it from here (in km)?
(RECORD '000' IF LESS THAN 1 KM.
IF UNKNOWN RECORD '998')

KILOMETERS________

137) How do you get from here to (HOSPITAL NAME)?

CAR/MOTORCYCLE 1 (GO TO 138)
PUBLIC TRANSPORTATION (BUS, TAXI) 2
ANIMAL (CART) 3 (GO TO 138)
WALKING 4 (GO TO 138)
OTHER (SPECIFY)______5 (GO TO 138)

137A) FOR RURAL CLUSTERS ONLY: How often per week is motorized transport available to go to the hospital?
(RECORDIOO' IF LESS THAN ONCE PER WEEK. IF UNKNOWN RECORD '98')

NO. OF TIMES PER WEEK____

138) How tong does it take you to get from here to (HOSPITAL NAME)?
RECORD IN MINUTES IF LESS THAN 2 HOURS AND IN HOURS IF 2 HOURS OR MORE)

MINUTES______1
HOURS______2

139) Does (HOSPITAL NAME) provide:

antenatal care?
delivery care?
child immunization?
family planning services?

ANTENATAL CARE
YES 1
NO 2
DK 8
DELIVERY CARE
YES 1
NO 2
DK8
CHILD IMMUNIZATION
YES 1
NO 2
DK 8
FAMILY PLANNING
YES 1
NO 2
DK 8

140) Is (THIS LOCALITY) served by a PHC (Mobile outreach)?
IF YES: What is the name of the outreach point?
IF NO, RECORD '000"

(NAME)___________

NO USE OF MOBILE CLINIC 000 (END)

141) How far is it from here (in km)?
(RECORD '000' IF LESS THAN 1 KM. IF UNKNOWN RECORD '998)

KILOMETERS_____

142) How do you get from here to (OUTREACH POINT)?

CAR/MOTORCYCLE 1 (GO TO 143)
PUBLIC TRANSPORTATION (BUS, TAXI) 2
ANIMAL (CART) 3 (GO TO 143)
WALKING 4 (GO TO 138)
OTHER (SPECIFY)______5 (GO TO 143)

142A) FOR RURAL CLUSTERS ONLY: How often per week is motorized transport available to go to the outreach point?
(RECORD '00' Of LESS THAN ONCE PER WEEK. IF UNKNOWN RECORD '98')

NO. OF TIMES PER WEEK_____

143) How tong does it take you to get from here to (OUTREACHPOINT)?
(RECORD IN MINUTES IF LESS THAN 2 HOURS AND IN HOURS IF 2 HOURS MORE)

MINUTES _______ 1
HOURS _______ 2

144) Does (OUTREACH POINT NAME) provide:

antenatal care?
child immunization?
family planning services?

ANTENATAL CARE
YES 1
NO 2
DK 8
CHILD IMMUNIZATION
YES 1
NO 2
DK 8
FAMILY PLANNING
YES 1
NO 2
DK 8

SECTION 2. REPRODUCTION

201) Now t 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____
DAUGHTER'S ELSEWHERE_____

206) Have you ever given birth to a boy or a girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed any sign of life but only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

207) In all, 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___
NO___ (PROBE AND CORRECT 201-209 AS NECESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS____
NO BIRTHS____ (GO TO 223)

211) Now I would like to talk about all of 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 LINE.

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

(NAME)_______

213) RECORD SINGLE OR MULTIPLE BIRTH STATUS.

SING 1
MULT 2

214) Is (NAME) a boy or girl?

BOY 1
GIRL 2

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

MONTH_____
YEAR______

216) Is (NAME) still alive?

YES 1
NO 2

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 (GO TO NEXT BIRTH)
NO 2

219) IF LESS THAN 15 YRS. OF AGE:
With whom does he/she live?
IF 15+: GO TO NEXT BIRTH.

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3
(GO TO NEXT BIRTH)

220) IF DEAD:
How old was he/she when he/she died?
IF "1 YR.", PROBE: How many months old was (NAME)?
RECORD DAYS F LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

DAYS_____1
MONTHS_____2
YEARS______3

221) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE THE SAME___ :CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED___
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED____
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED___
FOR AGE AT DEATH 12 MONTHS: PROBE TO DETERMINE EXAXT NUMBER OF MONTHS___

NUMBERS ARE DIFFERENT___(PROBE AND RECONCILE)

222) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987.
IF NONE, RECORD 0

_____

223) Are you pregnant now?

YES 1
NO 2 (GO TO 226)
UNSURE 8 (GO TO 226)

224) How many months pregnant are you?

MONTHS_____

225) 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 become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

226) When did your last menstrual period start?

DAYS AGO_____1
WEEKS AGO____2
MONTHS AGO____3
YEARS AGO____4
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

227) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

YES 1
NO 2 (GO TO 301)
DK 8 (GO TO 301)

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

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY)_____5
DK 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?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302) Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.

01) PILL Women can take a pill every day.
YES/SPONT 1
YES/PROBED 2
NO 3
02) IUD Women can have a loop or coil placed inside them by a doctor or nurse.
YES/SPONT 1
YES/PROBED 2
NO 3
03) INJECTIONS Women can have an injection by a doctor which stops them from becoming pregnant for one or more months.

YES/SPONT 1
YES/PROBED 2
NO 3
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream in their vagina before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3
05) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3
07) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3
08) PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES/SPONT 1
YES/PROBED 2
NO 3
09) WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONT 1
YES/PROBED 2
NO 3
10) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES/SPONT 1 (SPECIFY)
NO 3

303) Have you ever used (METHOD)

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by a doctor or nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor which stops them from becoming pregnant for one or more months.

YES 1
NO 2
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream in their vagina before intercourse.
YES 1
NO 2
05) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had operation to avoid having any more children?
YES 1
NO 2
07) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
08) PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES 1
NO 2
09) WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
10) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304) Do you know where a person could go to get (method)?

01) PILL Women can take a pill every day.
YES 1
NO 2
02) IUD Women can have a loop or coil placed inside them by a doctor or nurse.
YES 1
NO 2
03) INJECTIONS Women can have an injection by a doctor which stops them from becoming pregnant for one or more months.

YES 1
NO 2
04) DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream in their vagina before intercourse.
YES 1
NO 2
05) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
06) FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had operation to avoid having any more children?
YES 1
NO 2
07) MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
08) PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant: Do you know where a person can obtain advice on how to use periodic abstinence?
YES 1
NO 2

305) CHECK 303:

NOT A SINGLE "YES" (NEVER USED)_____
AT LEAST ONE "YES" (EVER USED)____ (GO TO 308)

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

YES___
NO___ (GO TO 324)

307) What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY).

308) Now I would like to ask you about the time when first 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______

309) CHECK 223:

NOT PREGNANT OR UNSURE____
PREGNANT____ (GO TO 324)

310) CHECK 303:

WOMAN NOT STERILIZED___
WOMAN STERILIZED___ (GO TO 312A)

311) Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 324)

312) Which method are you using?

312A) CIRCLE '06' FOR FEMALE STERILIZATION

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERIIZATION 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER (SPECIFY) 10
(02-07 GO TO 318)
(08-10 GO TO 323)

313) At the time you first started using the pill, did you consult a doctor or a nurse?

YES 1
NO 2
DK 8

314) At the time you last got pills, did you consult a doctor or a nurse?

YES 1
NO 2

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

TRIPHASIT 1
OVRAL 2
MICROVAL 3
NORDETTE 4
OTHER (SPECIFY)________ 5
PACKAGE NOT SEEN 6
(1-5 GO TO 317)

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

TRIPHASIT 1
OVRAL 2
MICROVAL 3
NORDETTE 4
OTHER (SPECIFY)________ 5

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

COST (RAND)_______
FREE 996
DK 998

318) CHECK 312:
SHE/HE STERILIZED__: Where did the sterilization take place?
USING ANOTHER METHOD___: Where did you obtain (method) the last time?

(NAME OF PLACE)________
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER/ GOVERNMENT CLINIC12
PHC CLINIC (MOBILE) 13 (GO TO 321)
FIELD WORKER 14 (GO TO 321)
PRIVATE DOCTOR 21
PRIVATE HOSPITAL OR CLINIC 22
PHARMACY 23
SHOP 31
FRIENDS/RELATIVES 32
OTHER (SPECIFY)______41
DK 98 (GO TO 321)

319) How long does it take to travel from your home to this place?
IF 90 MINUTES OR LESS, RECORD MINUTES.
OTHERWISE, RECORD HOURS.

MINUTES_____1
HOURS______2
DK 998

320) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

321) CHECK 312:

SHE/HE STERILIZED___
USING ANOTHER METHOD___ (GO TO 323)

322) In what month and year was the sterilization operation performed?

MONTH_____(GO TO 329)
YEAR_____ (GO TO 329)

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

MONTHS_____ (GO TO 329)
8 YEARS OR LONGET 96 (GO TO 329)

324) Do you intend to use a method to delay or avoid pregnancy at any time in the future?

YES 1 (GO TO 326)
NO 2
DK 8 (GO TO 330)

325) What is the main reason you do not intend to use a method?

WANTS CHILDREN 01
LACK OF KNOWLEDGE 02
PARTNER OPPOSED 03
COST TOO MUCH 04
SIDE EFFECTS 05
HEALTH CONCERNS 06
HARD TO GET METHODS 07
RELIGION 08
OPPOSED TO FAMILY PLANNING 09
FATALISTIC 10
OTHER PEOPLE OPPOSED 11
INFREQUENT SEX 12
DIFFICULT TO GET PREGNANT 13
MENOPAUSAL/ HAD HYSTERECTOMY 14
INCONVENIENT 15
NOT MARRIED 16
OTHER (SPECIFY)_____17
DK 98
(ALL GO TO 330)

326) Do you intend to use a method within the next 12 months?

YES 1
NO 2
DK 8

327) When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER (SPECIFY)______10
UNSURE 98
(08-98 GO TO 330)

328) Where can you get (METHOD MENTIONED IN 327)?

(NAME OF PLACE)___________
GOVERNMENT HOSPITAL 11 (GO TO 332)
GOVERNMENT HEALTH CENTER/GOVERNMENT CLINIC 12 (GO TO 332)
PHC CLINIC (MOBILE) 13 (GO TO 334)
FIELD WORKER 14 (GO TO 334)
PRIVATE DOCTOR 21 (GO TO 332)
PRIVATE HOSPITAL OR CLINIC 22 (GO TO 332)
PHARMACY 23 (GO TO 332)
SHOP 31 (GO TO 332)
FRIENDS/RELATIVES 32 (GO TO 334)
OTHER (SPECIFY)________41 (GO TO 334)
DK 8 (GO TO 330)

329) CHECK 312:

USING PERIODIC ABSTINENCE, WITHDRAWAL, OTHER TRADITIONAL METHOD____
USING A MODERN METHOD____ (GO TO 334)

330) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 334)

331) Where is that?

(NAME OF PLACE)_______
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER/GOVERNMENT CLINIC 12
PHC CLINIC (MOBILE) 13
FIELD WORKER 14 (GO TO 334)
PRIVATE DOCTOR 21
PRIVATE HOSPITAL OR CLINIC 22
PHARMACY 23
SHOP 31
FRIENDS/RELATIVES 32
OTHER (SPECIFY)________41 (GO TO 334)

332) How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS

MINUTES_____1
HOURS______2
DK 9998

333) Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

334) Is it acceptable or not acceptable to you for family planning information to be provided in the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8

SECTION 4A PREGNANCY AND BREASTFEEDING

401) CHECK 222:

ONE OR MORE BIRTHS SINCE JAN. 1987___
NO BIRTHS SINCE JAN. 1987___ (GO TO 501)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all your children born in the past five years. (We will talk about one child at a time.)

______

FROM Q. 212 AND Q. 216

NAME_____
ALIVE__
DEAD____

403) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later or did you want no more children at all?

THEN 1 (GO TO 405)
LATER 2
NO MORE 3 (GO TO 405)

404) How much longer would you like to have waited?

MONTHS_____1
YEARS_____2
DK 998

405) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
RECORD ALL PERSONS SEEN.

DOCTOR A
NURSE/MIDWIFE B
TRADITIONAL BIRTH ATTENDANT C
OTHER (SPECIFY)_____D
NO ONE E (GO TO 409)

406) Were you given an antenatal card for this pregnancy?

YES 1
NO 2
DK 8

407) How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

MONTHS____
DK 98

408) How many antenatal visits did you have during this pregnancy?

NO. OF VISITS___
DK 98

409) When you were pregnant with (NAME) were you given an injection in the upper arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 411)
DK 8 (GO TO 411)

410) During this pregnancy how many times did you get this injection?

TIMES____
DK____

411) Where did you give birth to (NAME)?

YOUR HOME 11
OTHER HOME 12
GVT. HOSPITAL 21
GVT. HEALTH CENTER 22
GVT. HEALTH CLINIC 23
PRIVATE HOSPITAL/CLINIC 31
OTHER (SPECIFY)_____41

412A) Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS ASSISTING.

DOCTOR A
NURSE/MIDWIFE B
TRADITIONAL BIRTH ATTENDANT C
RELATIVE D
OTHER (SPECIFY)____E
NO ONE F

412B) Did you experience any complications during labor and/or delivery of (NAME)?
IF YES: What kind of problem(s) did you have?
RECORD ALL PROBLEMS LISTED.

LABOR MORE THAN 24 HOURS A
EXCESSIVE BLEEDING B
CONVULSIONS C
MALPRESENTATION D
MULTIPLE PREGNANCY E
HIGH FEVER F
OTHER (SPECIFY)____G
NONE H

413) Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DK 8

414) Was (NAME) delivered by caesarian section?

YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DK 8

416) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418)

417) How much did (NAME) weigh?

GRAMS______
DK 98

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

YES 1 (GO TO 420)
NO 2 (GO TO 421)

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

YES 1
NO 2 (GO TO 423)

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

MONTHS_____
DK 98

421) CHECK 223: RESPONDENT PREGNANT?

NOT PREGNANT___
PREGNANT OR UNSIRE____ (GO TO 423)

422) Have you resumed sexual relations since the birth of (NAME)?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 424)

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

MONTHS_____
DK 98

424) Did you ever breastfeed (NAME)?

YES 1 (GO TO 426)
NO 2

425) Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL.WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
OTHER (SPECIFY)_____08
(ALL GO TO 435)

426) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR. RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE RECORD DAYS.
[LAST BIRTH ONLY]

IMMEDIATELY 000
HOURS_____1
DAYS_____2

427) CHECK 216: CHILD ALIVE?

ALIVE____
DEAD____ (GO TO 433)

428) Are you still breastfeeding (NAME)?
[LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 433)

429) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NO.
[LAST BIRTH ONLY]

NUMBER OF NIGHTIME FEEDINGS_______

430) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NO.
[LAST BIRTH ONLY]

NUMBER OF DAYLIGHT FEEDINGS_____

431) At any time yesterday or last night was (NAME) given any of the following?
[LAST BIRTH ONLY]

Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Fresh/sour milk?
Tinned or powdered milk?
Other liquids?
Any solid or mushy food?

PLAIN WATER
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
HERBAL TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
FRESH/SOUR MILK
YES 1
NO 2
TINNED/POWDERED MILK
YES 1
NO 2
OTHER LIQUIDS
YES 1
NO 2
SOLID.MUSHY FOOD
YES 1
NO 2

432) CHECK 431: FOOD OR LIQUID GIVEN YESTERDAY?

"YES" TO ONE OR MORE___ (GO TO 437)
"NO" TO ALL___ (GO TO 436)

433) For how many months did you breastfeed (NAME)?

MONTHS_____
UNTIL DIED 96 9GO TO 436)

434) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY)_____11

435) CHECK 216: CHILD ALIVE?

ALIVE___ (GO TO 437)
DEAD____

436) Was (NAME) ever given water or anything else to drink or eat (other than breast milk)?

YES 1
NO 2 (GO TO 440)

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

Formula or milk other than breast milk?
Plain water?
Other liquids?
Any solid or mushy food?
IF LESS THAN 1 MONTH, RECORD '00'.

AGE IN MONTHS____
NOT GIVEN 96
(REPEAT FOR EACH)

438) CHECK 216: CHILD ALIVE?

ALIVE___
DEAD___ (GO TO 440)

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

YES 1
NO 2
DK 8

440) GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO FIRST COLUMN OF 441

SECTION 4B. IMMUNIZATION AND HEALTH

441) ENTER THE LINE NUMBER NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM Q. 212

_____

442) Do you have a health passport or card where (NAME'S) vaccinations are written down?
IF YES: May I see it, please?

YES, SEEN 1 (GO TO 444)
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3

443) Did you ever have a health passport or vaccination card for (NAME)?

YES 1 (GO TO 446)
NO 2

444) (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN, IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE RECORDED.

POLIO 0
BCG
POLIO 1
DPT 1
POLIO 2
DPT 2
POLIO 3
DPT 3
MEASLES

P0
DAY___
MO___
YR___
BCG
DAY___
MO___
YR___
P1
DAY___
MO___
YR___
D1
DAY___
MO___
YR___
P2
DAY___
MO___
YR___
D2
DAY___
MO___
YR___
P3
DAY___
MO___
YR___
D3
DAY___
MO___
YR___
MEA
DAY___
MO___
YR___

445) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT 11-3 AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 444)
NO 2
DK 8
(ALL GO TO 447A)

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

YES 1
NO 2 (GO TO 447A)
DK 8 (GO TO 447A)

447) Please tell me if (NAME) (has) received any of the following vaccinations:
A BCG vaccination against tuberculosis, that is, an injection in the left upper arm that caused a scar?
Polio vaccine, that is, drops in the mouth?
IF YES: How many times?
An injection against measles?

YES 1
NO 2
DK 8
(REPEAT FOR EACH VACCINE)
NUMBER OF TIMES (POLIO)_____

447A) Did (NAME) ever have measles?

YES 1
NO 2
DK 8

447B) How old was (NAME) when he/she had measles?
RECORD IN MONTHS IF LES THAN 2 YEARS. OTHERWISE RECORD IN YEARS.

MONTHS_____1
YEARS_____2
DK 8

448( CHECK 216:
CHILD ALIVE?

ALIVE___ (GO TO 450)
DEAD___

449) GO BACK TO 442 FOR NEXT BIRTH; OR IF NO MORE BIRTHS, GO TO 477.

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

YES 1
NO 2
DK 8

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

YES 1
NO 2 (GO TO 455)
DK 8 (GO TO 455)

452) Has (NAME) been ill with a cough in the last 24 hours?

YES 1
NO 2
DK 8

453) For how many days (has the cough lasted/did the cough last)?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS_____

454) When (NAME) has the illness with a cough, did he/she breathe faster than usual with short, rapid breathe?

YES 1
NO 2
DK 8

455) CHECK 450 AND 451: FEVER OR COUGH?
"YES" IN EITHER 450 OR 451___
OTHER___ (GO TO 560)

456) Was anything given to treat the fever/cough?

YES 1
NO 2 (GO TO 458)
DK 8 (GO TO 458)

457) What was given to treat the fever/cough?
Anything else?
RECORD ALL MENTIONED

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY)_____H

458) Did you seek advice or consultation for the fever/cough?

YES 1
NO 2 (GO TO 460)

459) Where did you seek advice or consultation?
Anywhere else?
RECORD ALL MENTIONED

GVT. HOSPITAL A
GVT. HEALTH CENTER B
GVT. CLINIC C
PHC CLINIC (MOBILE) D
COMUNITY HEALTH WORKER E
PVT. HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
SHOP J
TRADITIONAL PRACTIONER K
OTHER (SPECIFY)____L

460) Has (NAME) had diarrhea in the last two weeks?

YES 1 (GO TO 461A)
NO 2
DK 8

461) GO BACK TO 442 FOR NEXT BIRTH; OR IF NO MORE BIRTHS, GO TO 477.

461A) How many stools did (NAME) have on the worst day of the episode?

NUMBER OF STOOLS____
DK 98

461B) Was the diarrhea episode of (NAME) mild or sever?

MILD 1
SEVER 2
DK 8

462) Has (NAME) had diarrhea in the last 24 hours?

YES 1
NO 2
DK 8

463) For how many days (has the diarrhea lasted/ did the diarrhea last)?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS_____

464) Was there any blood in the stools?

YES 1
NO 2
DK 8

465) CHECK 424/428: LAST CHILD SYILL BREASTFED?

YES___
NO___(GO TO 468)

466) During (NAME)'s diarrhea, did you change the frequency of breastfeeding?

YES 1
NO 2 (GO TO 468)

467)Did you increase the number of breastfeeds or reduce them, or did you stop completely?

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

468) (Aside from breast milk) was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DK 8

469) Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 471)
DK 8 (GO TO 471)

470) What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED

FLUID FROM ORS PACKET A
RECOMMENDED HOME FLUID B
ANTIBIOTIC PILL OR SYRUP C
OTHER PILL OR SYRUP D
UNKNOWN PILL OR SYRUP E
INJECTION F
(I.V.) INTRAVENOUS G
HOME REMEDIES/HERBAL REMEDIES/ HERBAL MEDICINES H
OTHER (SPECIFY)____I

471) Did you seek advice or consultation for the diarrhea?

YES 1
NO 2 (GO TO 473)

472) Where did you seek advice or consultation? Anywhere else?
RECORD ALL MENTIONED.

GVT. HOSPITAL A
GVT. HEALTH CENTER B
GVT. CLINIC C
PHC CLINIC (MOBILE) D
COMUNITY HEALTH WORKER E
PVT. HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
SHOP J
TRADITIONAL PRACTIONER K
OTHER (SPECIFY)____L

473) CHECK 470: ORS FLUID FROM PACKET MENTIONED?
NO, ORS FLUID NOT MENTIONED___
YES, ORS FLUID MENTIONED___(GO TO 475)

474) Was (NAME) given fluid from ORS packet when he/she had the diarrhea?

YES 1
NO 2 (GO TO 476)
DK 8 (GO TO 476)

475) For how many days was (NAME) given (LOCAL NAME)?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS___
DK 98

476) GO BACK TO 442 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 477.

477) CHECK 470 AND 474 (ALL COLUMNS):
ORS FLUID FROM PACKET MENTIONED___ (GO TO 481)
ORS FLUID NOT MENTIONED OR 470 AND 474 NOT ASKED___

478) Have you ever heard of a special product called ORS packet you can get for the treatment of diarrhea?

YES 1 (GO TO 480)
NO 2

479) Have you ever seen a packet like this before?
SHOW PACKET.

YES 1
NO 2 (GO TO 501)

480) Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?
SHOW PACKET

YES 1
NO 2 (GO TO 483)

481) The last time you prepared the ORS packet solution, did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
PART OF PACKET 2 (GO TO 483)

482) How much water did you use to prepare ORS packet the last time you made it?

LESS THAN 1/4 LITER 01
1/4 LITER 02
1/2 LITER 03
FOLLOWED PASCKAGE INSTRUCTIONS 05
OTHER (SPECIFY) 06
DK 98

483) Where can you get the ORS packet?
PROBE: Anywhere else?
RECORD ALL PLACES MENTIONED

GVT. HOSPITAL A
GVT. HEALTH CENTER B
GVT. HEALTH POST C
PHC CLINIC (MOBILE) D
COMUNITY HEALTH WORKER E
PVT. DOCTOR F
PVT. HOSPITAL/CLINIC G
PHARMACY H
SHOP I
TRADITIONAL PRACTIONER J
OTHER (SPECIFY)____K
DK L

SECTION 4C. CAUSE OF DEATH OF CHILDREN BORN AND DYING IN PAST 5 YEARS

484) CHECK 216:
ONE OE MORE DEATHS SINCE JAN. 1987___
NO DEATHS SINCE JAN. 1987___(GO TO 501)

ENTER IN THE TABLE THE LINE NUMBERS AND NAME OF EACH CHILD BORN INCE JANUARY 1987 WHO LATER DIES. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST OF THESE BIRTHS. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).
I would now like to ask you some specific questions about the events and symptoms (NAME) had during the time before he/she died. I know it may be difficult to talk about children you have had who died after they were born, but this information is very important in helping to plan health programs to prevent other children from dying.

LINE NUMBER FROM Q. 212

____

485) FROM Q. 212

NAME_____

486A) What do you think was the cause of (NAME)'s death?

_________

486B) During the illness that led to (NAME)'s death, did you seek advice or treatment from anywhere/anyone?
IF YES, SPECIFY.
CIRCLE ALL THAT APPLY.

GVT. HOSPITAL A
GVT. HEALTH CENTER B
GVT. HEALTH POST C
PHC CLINIC (MOBILE) D
COMUNITY HEALTH WORKER E
PVT. DOCTOR F
PVT. HOSPITAL/CLINIC G
PHARMACY H
SHOP I
TRADITIONAL PRACTIONER J
OTHER (SPECIFY)____K
NONE L

486C) Where did (NAME) die?

AT HOME 1
IN A HEALTH FACILITY 2
ON THE WAY TO FACILITY 3
OTHER (SPECIFY)______4

487) CHECK Q. 220: AGE AT DEATH
LESS THAN 1 MONTH____
1 MONTH OR OLDER___(GO TO 491A)

488A) Was (NAME) born after a difficult delivery?

YES 1
NO 2
DK 8

488B) Was (NAME) malformed in any way?
IF YES, SPECIFY

YES (SPECIFY)______ 1
NO 2
DK 8

488C) Did (NAME) suck or drink normally during the first two days of life?

YES 1
NO 2
DK 8

488D) Did (NAME) have a decrease in sucking or difficulty sucking during the days before death?

YES 1
NO 2
DK 8

488E) Did (NAME) have convulsions or spasms during the disease that led to death?

YES 1
NO 2
DK 8

489A) During the disease that led to death, did (NAME) have a cough?

YES 1
NO 2 (GO TO 490)
DK 8 (GO TO 490)

489B) For how many days did the cough last?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS_____

489C) When (NAME) had the illness with the cough, did he/she have difficult or rapid breathing?

YES 1
NO 2 (GO TO 490)
DK 8 (GO TO 490)

489D) For how many days did the difficult or rapid breathing last?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS_____

490) GO BACK TI 485 FOR NEXT DECEASED CHILD; IF NO MORE DECEASED CHILDREN, GO TO 501.

491A) During the disease that led to death, did (NAME) have loose or liquid stools, that is diarrhea?

YES 1
NO 2 (GO TO 492A)
DK (GO TO 492A)

491B) Was the diarrhea episode of (NAME) mild or severe?

MILD 1
SEVERE 2
DK 8

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

DAYS_____1
WEEKS____2
MONTHS____3
DK 998

491D) Was there any blood in the stool?

YES 1
NO 2
DK 8

492A) During the disease that led to death, did (NAME) have a cough?

YES 1
NO 2 (GO TO 493A)
DK 8 (GO TO 493A)

492B) For how long did the cough last?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS____1
WEEKS_____2
MONTHS____3
DK 998

492C) When (NAME) had the illness with the cough, did he/she have difficult/rapid breathing?

YES 1
NO 2 (GO TO 493A)
DK 8 (GO TO 493A)

492D) For hoe long did the difficult/rapid breathing last?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS___1
WEEKS____2
MONTHS____3
DK 998

493A) During the disease that led to death, did (NAME) have a fever?

YES 1
NO 2 (GO TO 494A)
DK 8 (GO TO 494A)

493B) Was the fever of (NAME) mild or severe?

MILD 1
SEVERE 2
DK 8

493C) How long did the fever last?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS_____1
WEEKS____3
MONTHS______4
DK 998

493D) During the disease that led to death, was (NAME) unconscious?

YES 1
NO 2
DK 8

493E) During the disease that led to death, did (NAME) have convulsions?

YES 1
NO 2
DK 8

494A) During the disease that led to death, did (NAME) have a skin rash all over his/her body and face?

YES 1
NO 2 (GO TO 495A)
DK 8 (GO TO 495A)

494B) How long did the rash last?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS______1
WEEKS_____2
MONTHS_____3
DK 998

495A) During the disease that led to death, was (NAME) very thin?

YES 1
NO 2 (GO TO 496)
DK 8 (GO TO 496)

495B) How long was (NAME) very thin?

DAYS______1
WEEKS______2
MONTHS_____3
DK 998

495C) During the disease that led to death, did (NAME) have swelling of the feet or legs?

YES 1
NO 2 (GO TO 496)
DK 8 (GO TO 496)

495D) How long was the swelling present?
IF LESS THAN 1 DAY, RECORD '00'.

DAYS____1
WEEKS____2
MONTHS_____3
DK____998

496) GO BACK TO 485 FOR NEXT DECEASED CHILD. IF NO MORE DECEASED CHILDREN, GO TO 501.

SECTION 5. MARRIAGE

501) Have you ever been married or lived with a man?

YES 1
NO 2 (GO TO 512)

502) Are you now married or living with a man, or are you now widowed, divorced, or no longer living together?

MARRIED 1
LIVING TOGETHER 2
WIDOWED 3
DIVORCED 4
NO LONGER LIVING TOGETHER 5
(3-5 GO TO 507)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

504) Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 507)
DK 8 (GO TO 507)

505) How many other wives does he have?

NUMBER_____
DK 98 (GO TO 507)

506) Are you the first, second,...wife?

RANK____

507) Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

508) In what month and year did you start living with your first husband/partner?

MONTH_____
DK MONTH 98
YEAR_____
DK YEAR 98

509) How old were you when you started living with him?

AGE_____
DK AGE 98

510) CHECK 508 AND 509: YEAR AND AGE GIVEN?

YES___
NO___ (GO TO 513)

511) CHECK CONSISTENCY OF 508 AND 509:
YEAR OF BIRTH (105) PLUS AGE AT MARRIAGE (509)___(CALCULATED YEAR OF MARRIAGE)

IF NECESSARY, CALCULATE YEAR OF BIRTH: CURRENT YEAR MINUS CURRENT AGE (106)___(CALCULATED YEAR OF BIRTH)

IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (508)?

YES___(GO TO 513)
NO__(PROBE AND CORRECT 508 AND 509)

512) IF NEVER IN UNION:
Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 517)

513) Now we need some details about your sexual activity in order to get a better understanding of family planning and fertility.
How many times did you have sexual intercourse in the last four weeks?

TIMES_____

514) How many times in a month do you usually have sexual intercourse?

TIMES_____

515) When was the last time you had sexual intercourse?

DAYS AGO___1
WEEKS AGO_____2
MONTHS AGO____3
YEARS AGO_____4
BEFORE LAST BIRTH 996

516) How old were you when you first had sexual intercourse?

AGE______
FIRST TIME WHEN MARRIED 96

517) PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601) CHECK 312:

SHE/HE NOT STERILIZED___
HE OR SHE STERILIZED (GO TO 607)

602) CHECK 501 AND 502:

CURRENTLY MARRIED OR LIVING TOGETHER____
NOT MARRIED/NOT LIVING TOGETHER___

603) CHECK 223:
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, 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
SAYS SHE CAN'T GET PREGNANT 3
UNDECIDED OR DK 8
(2-8 GO 610)

604) CHECK 223:
NOT PREGNANT OR UNSURE___: How long would you like to wait from now before the birth of (a/another) child?

PREGNANT__: How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS___1 (GO TO 610)
YEARS____2 (GO TO 610)
SOON/NOW____994 (GO TO 610)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 610)
OTHER (SPECIFY)_____996
DK 998

605) CHECK 216 AND 223: HAS LIVING CHILDREN OR PREGNANT?

YES___
NO___ (GO TO 610)

606) CHECK 223:
NOT PREGNANT OR UNSURE___: How old would you like your youngest child to be when your next child is born?

PREGNANT___: How old would you like the child you are expecting to be when your next child is born?

AGE OF CHILD YEARS____
DK 98
(GO TO 610)

607) Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have sterilization?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 614)

609) Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1
PARNTER WANTS ANOTHER CHILD 2
OTHER REASON (SPECIFY)_____4
(ALL GO TO 614)

610) Do you think that your husband/partner approves or disapproves of couples sing a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DK 8

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

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

612) Have you and your husband/partner ever discussed the number of children you would like to have?

YES 1
NO 2

613) Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want>

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DK 8

614) How long should a couple wait before starting sexual intercourse after the birth of a baby?

MONTHS______1
YEARS______2
OTHER (SPECIFY)______996

615) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't matter?

WAIT 1
DOESN'T MATTER 2

616) In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2

617) 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?

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER___
OTHER ANSWER (SPECIFY)____96

618) What do you think is the best number of months or years between the birth of one child and the birth of the next child?

MONTHS_____1
YEARS_____2
OTHER (SPECIFY)______996

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

701) CHECK 501:
EVER MARRIED OR LIVED TOGETHER___ (ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER)

NEVER MARRIED/NEVER LIVED TOGETHER___(GO TO 708)

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

YES 1
NO 2 (GO TO 705)

703) What was the highest level of school he attended; primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3
DK 8 (GO TO 705)

704) What was the highest grade he completed at that level?

GRADE____
DK 98

705) What kind of work does (did) your (last) husband/partner mainly do?

___________

706) CHECK 705:
WORKS (WORKED) IN AGRICULTURE____
DOES (DID) NOT WORK IN AGRICULTURE____ (GO TO 708)

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

HIS/FAMILY LAND 1
RENTED LAND 2
COMMUNAL LAND 3
SOMEONE ELSE'S LAND 4

708) Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

709) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?

YES 1
NO 2 (GO TO 717)

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

____________

711) In your current work do you work, do you 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

712) Do you earn cash for this work?
PROBE: Do you make money for working?

YES 1
NO 2

713) Do you do this work at home or away from home?

HOME 1
AWAY 2

714) CHECK 215/216/218: HAS CHILD BORN SINCE JAN. 1987 AND LIVING AT HOME?

YES___
NO__(GO TO 717)

715) While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1 (GO TO 717)
SOMETIMES 2
NEVER 3

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

HUSBAND/PARTNER 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY)______09

SECTION 8. MATERNAL MORTALITY

801) 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 BIRTH TO NATURAL MOTHER______

802) CHECK 801:
TWO OR MORE BIRTHS___
ONLY ONE BIRTH (RESPONDENT ONLY)____(GO TO END)

803) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS_____

804) What are the names of all your mother's children, starting with the first born?

________

805) Is (NAME) male or female?

MALE 1
FEMALE 2

806) Is (NAME) still alive?

YES 1
NO 2 (GO TO 808)
DK 8 (GO TO NEXT BIRTH)

807) How old is (NAME)?

________

808) How many years ago did (NAME) die?

______

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

______ (IF MALE OR DIED BEFORE 13 YEARS OF AGE GO TO NEXT BIRTH)

810) Was (NAME) pregnant when she died?

YES 1 (GO TO 813)
NO 2
DK 8

811) Did (NAME) die during childbirth?

YES 1 (GO TO 813)
NO 2
DK 8

812) Did (NAME) die within six weeks after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO NEXT BIRTH)
DK 8

813) How many children had (NAME) given birth to before that pregnancy?

_______

814) RECORD THE TIME WHEN INTERVIEW COMPLETED

HOURS_____
MINUTES________

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 222:
ONE OR MORE BIRTHS SINCE JAN. 1987___
NO BIRTHS SINCE JAN. 1987___(END)

INTERVIEWER: IN 902 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1987 AND STILL ALIVE. IN 903 AND 904 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1987. IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPORDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1987 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED)

1) RESPONDENT_____
2) YOUNGEST CHILD______
3) NEXT-TO-YOUNGEST CHILD_______
4) SECOND-TO-YOUNGEST CHILD______

902) LINE NUMBER FROM Q. 212

_____

903) NAME FROM Q. 212 FOR CHILDREN

NAME__________

904) DATE OF BIRTH
FROM Q. 103 FOR RESPONDENT. FROM Q.215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

MONTH_____
YEAR______

905) BCG SCAR ON TOP OF LEFT UPPER ARM

SCAR SEEN 1
NO SCAR 2

906) HEIGHT (IN CENTIMETERS)
IF AGE UNDER 24 MOS. MEASURE LYING. IF 24 MOS OR MORE, MEASURE STANDING

_______

907) WEIGHT (IN KILOGRAMS)

_______

908) MID-UPPER ARM CIRCUMFERENCE (IN MILLIMETERS)

________

909) DATE WEIGHED AND MEASURED

DAY_____
MONTH_____
YEAR_____

910) RESULT

MEASURED 1
NOT PRESENT 2
REFUSED 4
OTHER 4
OTHER (SPECIFY)_______4

911) NAME OF MEASURER:________
NAME OF ASSISTANT:__________

INTERVIEWER'S OBSERVATION
(TO BE FILLED IN AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT:
______________

COMMENTS ON SPECIFUC QUESTIONS:
______________

ANY OTHER COMMENTS:
______________

SUPERVISOR'S OBSERVATION

_______________

NAME OF SUPERVISOR:___________
DATE:___________

EDITOR'S OBSERVATION
___________