WOMAN'S QUESTIONNAIRE
NAME AND CODE OF REGION _______
NAME OF VILLAGE/TOWN/CITY _________
DHS CLUSTER NUMBER _______
HOUSEHOLD NUMBER ________
NAME OF HOUSEHOLD HEAD __________
NAME AND LINE NUMBER OF WOMAN ________
INTERVIEWER 1(REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE ____
INTERVIEWER'S NAME ____
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7
NEXT VISIT:
DATE ___
TIME ___
FINAL VISIT
DAY ___
MONTH ___
YEAR 20___
INT. COD ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___ 7
LANGUAGE OF QUESTIONNAIRE: ENGLISH 3
LANGUAGE OF INTERVIEW ______
DAMARA/NAMA 2
ENGLISH 3
HERERO 4
KWANGALI 5
LOZI 6
OSHIWAMBO 7
OTHER 8
HOME LANGUAGE OF RESPONDENT ______
DAMARA/NAMA 2
ENGLISH 3
HERERO 4
KWANGALI 5
LOZI 6
OSHIWAMBO 7
OTHER 8
WAS A TRANSLATOR USED?
NO 2
DAMARA/NAMA 2
ENGLISH 3
HERERO 4
KWANGALI 5
LOZI 6
OSHIWAMBO 7
OTHER 8
SUPERVISOR
NAME _____
DATE _____
FIELD EDITOR
NAME ____
DATE _____
OFFICE EDITOR ____
KEYED BY _____
ERONGO 02
HARDAP 03
KARAS 04
KHOMAS 05
KUNENE 06
OHANGWENA 07
KAVANGO 08
OMAHEKE 09
OMUSATI 10
OSHANA 11
OSHIKOTO 12
OTJOZONDJUPA 13
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
Hello. My name is _______ and I am working with the Ministry of Health and Social Services. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
At this time, do you want to ask me anything about the survey? May I begin the interview now?
Signature of interviewer:_______
Date:______
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
NO.
QUESTIONS AND FILTERS
CODING CATEGORIES
GO
MINUTES ___
102) First I would like to ask some questions about you and your household.
For most of the time until you were 12 years old, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104) Just before you moved here, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
105) In what month and year were you born?
DON'T KNOW MONTH 98
YEAR ___
DON'T KNOW YEAR 9998
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107) Have you ever attended school?
NO 2 (GO TO 111)
108) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109) What is the highest grade you completed?
SECONDARY OR HIGHER___(GO TO 112)
111) Now I would like you to read out loud as much of this sentence as you can.
SHOW CARD TO RESPONDENT.
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4
112) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
113) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
114) Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
NO RELIGION 3
OTHER (SPECIFY) ____ 6
116) What is the main language spoken in your home?
DAMARA/NAMA 02
ENGLISH 03
HERERO 04
KWANGALI 05
LOZI 06
OSHIWAMBO 07
SAN 08
TSWANA 09
OTHER (SPECIFY)_____ 96
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
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?
NO 2 (GO TO 204)
203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
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?
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'.
DAUGHTERS ELSEWHERE ___
206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
207) How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD ____
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.
209) CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct?
NO___ (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS___ (GO TO 226)
211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
212) What name was given to your (first/next) baby?
213) Were any of these births twins?
MULT 2
GIRL 2
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
YEAR ___
NO 2 (GO TO 220)
217) IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.
218) IF ALIVE: Is (NAME) living with you?
NO 2
219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)
220) IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS___2
YEARS ___ 3
221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
NO 2
222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED ___
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED ___
FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS ___
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1995 OR LATER. IF NONE, RECORD '0'.
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)
227) How many months pregnant are you?
IF LESS THAN 1 MONTH, RECORD "00".
228) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (GO TO 233)
230) When did the last such pregnancy end?
YEAR ______
232) How many months pregnant were you when the last such pregnancy ended?
IF LESS THAN 1 MONTH, RECORD '00'.
233) When did your last menstrual period start?
WEEKS AGO ___ 2
MONTHS AGO___ 3
YEARS AGO ____4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
234) From one menstrual period to the next, is there a time when a woman is more likely to become pregnant if she has sexual relations?
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)
235) Is this time just before her period begins, during her period, right after her period has ended, or half way between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALF WAY BETWEEN PERIODS 4
OTHER (SPECIFY) ____ 6
DON'TK NOW 8
Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNISED, AND CODE 2 IF NOT RECOGNISED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
301) Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
(SPECIFY) ____
(SPECIFY) ____
NO 2
302) Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE 'YES' (EVER USED)____ (GO TO 306)
304) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 323)
305) What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).
306) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.
How many children did you have at that time, if any?
IF NONE, RECORD '00'.
WOMAN STERILISED___ (GO TO 310A)
PREGNANT___ (GO TO 323)
309) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 323)
310) Which method are you using?
310A) CIRCLE 'A' FOR FEMALE STERILISATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD ON LIST.
MALE STERILISATION B (GO TO 311)
PILL C (GO TO 313A)
IUD D (GO TO 313A)
INJECTIONS E (GO TO 313A)
CONDOM G (GO TO 313A)
FEMALE CONDOM H (GO TO 313A)
DIAPHRAGM/FOAM/JELLY I (GO TO 313A)
RHYTHM/PERIODIC ABSTINENCE L (GO TO 313A)
WITHDRAWAL M (GO TO 313A)
OTHER (SPECIFY) ___ X (GO TO 313A)
311) Where did the sterilisation take place?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF BOTH CODE 'A' AND CODE 'B' ARE CIRCLED IN 310, ASK 313-316 ABOUT FEMALE STERILISATION ONLY.
GOVT. HEALTH CENTRE/CLINIC 12
OTHER PUBLIC (SPECIFY)____ 16
PRIVATE DOCTOR'S OFFICE 23
OTHER PRIVATE MEDICAL (SPECIFY)____ 26
DON'T KNOW 98
312) CHECK 310:
CODE 'A' CIRCLED:
Before your sterilisation operation, were you told that you would not be able to have any (more) children because of the operation?
CODE 'B' CIRCLED:
Before the sterilisation operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?
NO 2
DON'T KNOW 8
313) In what month and year was the sterilisation performed?
313A) For how long have you been using (CURRENT METHOD) without stopping?
PROBE: In what month and year did you start using (CURRENT METHOD) continuously?
YEAR ____
YEAR IS 1994 OR EARLIER___ (GO TO 321)
315) CHECK 310/310A:
CIRCLE METHOD CODE:
IF MORE THAN ONE MONTH CODE CIRCLED IN 310/310A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILISATION 02 (GO TO 401)
PILL 03
IUD 04
INJECTIONS 05
CONDOM 06
FEMALE CONDOM 07
DIAPHRAGM/FOAM/JELLY 08
RHYTHM, PERIODIC ABSTINENCE 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER METHOD 96 (GO TO 401)
316) Where did you obtain (CURRENT METHOD) when you started using it?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVT. HEALTH CENTRE/CLINIC 12
PHC CLINIC (MOBILE) 13
COMMUNITY HEALTH WORKER 14
OTHER PUBLIC (SPECIFY)____ 16
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY)____ 26
CHURCH/SCHOOL 32
FRIEND/RELATIVE 33
TRAD. BIRTH ATTENDANT 34
TRADITIONAL HEALER 35
317) CHECK 310/310A:
CIRCLE METHOD CODE:
IF MORE THANO NE METHOD CODE CIRCLED IN 310/310A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
IUD 04
INJECTIONS 05
CONDOM 06 (GO TO 322)
FEMALE CONDOM 07 (GO TO 320)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 320)
318) You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 311 OR 316).
At that time, were you told about side effects or problems you might have with the method?
NO 2 (GO TO 320)
319) Were you told what to do if you experienced side effects or problems?
NO 2
320) CHECK 318:
CODE '1' CIRCLED___:
At that time, were you told about other methods of family planning that you could use?
CODE '1' NOT CIRCLED___:
You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 311 OR 316) At that time, were you told about other methods of family planning that you could use?
NO 2
321) CHECK 310/310A:
CIRCLE METHOD CODE:
IF MORE THAN 1 METHOD CIRCLED IN 1. 310/310A, CIRCLE THE HIGHEST METHOD ON THE LIST IN Q. 321.
MALE STERILISATION 02 (GO TO 401)
PILL 03
IUD 04
INJECTIONS 05
CONDOM 06
FEMALE CONDOM 07
DIAPHRAGM/FOAM/JELLY 08
RHYTHM, PERIODIC ABSTINENCE 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER 96 (GO TO 401)
322) Where did you obtain (CURRENT METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVT. HEALTH CENTRE/CLINIC 12
PHC CLINIC (MOBILE) 13
COMMUNITY HEALTH WORKER 14
OTHER PUBLIC (SPECIFY)____ 16
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY)____ 26
CHURCH/SCHOOL 32
FRIEND/RELATIVE 33
TRADITIONAL BIRTH ATTENDANT 34
TRADITIONAL HEALER 35
(ALL GO TO 401)
323) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 401)
324) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
Any other places?
RECORD ALL MENTIONED.
GOVT. HEALTH CENTRE/CLINIC B
PHC CLINIC (MOBILE) C
COMMUNITY HEALTH WORKER D
OTHER PUBLIC (SPECIFY)____ E
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY)____ I
CHURCH/SCHOOL K
FRIEND/RELATIVE L
TRAD. BIRTH ATTENDANT M
TRADITIONAL HEALER N
SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING
401) CHECK 224:
NO BIRTHS IN 1995 OR LATER___ (GO TO 475)
402) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER. 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 QUESTIO
NNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately)
403) LINE NUMBER FROM 212:
DEAD___
405) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3 (GO TO 407 FOR LAST BIRTH AND TO 414 FOR NEXT-TO-LAST BIRTH)
406) How much longer would you like to have waited?
YEARS _____2
DON'T KNOW 998
407) Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
[Last Birth Only]
NURSE/MIDWIFE B
NO ONE Y (GO TO 414)
407A) Were you given an antenatal card for this pregnancy?
[Last Birth Only]
NO 2
DOES NOT KNOW 8
408) How many months pregnant were you when you first received antenatal care for this pregnancy?
[Last Birth Only]
DON'T KNOW 98
409) How many times did you receive antenatal care during this pregnancy?
[Last Birth Only]
DON'T KNOW 98
410) CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
MORE THAN ONCE OR DK____
411) How many months pregnant were you the last time you received antenatal care?
[Last Birth Only]
DON'T KNOW 98
412) Were you told about the signs of pregnancy complications?
[Last Birth Only]
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)
413) Were you told where to go if you had these complications?
[Last Birth Only]
NO 2
DON'T KNOW 8
414) When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
415) Was (NAME) weighed at birth?
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
416) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.
GRAMS FROM RECALL_____2
DON'T KNOW 99998
417) Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
NURSE/MIDWIFE B
RELATIVE/FRIEND E
NO ONE Y
418) Where did you give birth to (NAME)?
OTHER HOME 12 (GO TO 421)
GOVT. HEALTH CENTER 22
GOVT. HEALTH CLINIC 23
OTHER PUBLIC (SPECIFY)______26
OTHER PVT. MEDICAL (SPECIFY)______36
419) Did you pay anything for the delivery, either in cash or in goods or gifts?
[Last Birth Only]
GOODS/SERVICES 2 (GO TO 421)
PAID NOTHING/FREE 3 (GO TO 421)
420) Altogether how much did you pay for the delivery: including examinations, laboratory tests, medicines, and staff fees?
[Last Birth Only]
421) In the 4-6 weeks after the birth, did a health professional or a traditional birth attendant check on your health?
NO 2 (GO TO 424)
422) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[Last Birth Only]
NURSE/MIDWIFE 2
TRADITIONAL BIRTH ATTENDENT 3
OTHER (SPECIFY) ____ 6
423) Where did this first check take place?
[Last Birth Only]
OTHER HOME 12
GOVT. HEALTH CNTR/CLINIC 22
PHC CLINIC (MOBILE) 23
OTHER PUBLIC (SPECIFY) ____ 26
OTHER PVT. MEDICAL (SPECIFY) ____ 36)
424) In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.
[Last Birth Only]
NO 2
DOES NOT KNOW/UNSURE 8
425) Has your period returned since the birth of (NAME)?
[Last Birth Only]
NO 2 (GO TO 428)
426) Did your period return between the birth of (NAME) and your next pregnancy?
[Exclude Last Birth]
NO 2 (GO TO 430)
427) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
428) CHECK 226: RESPONDENT PREGNANT?
PREGNANT OR UNSURE___ (GO TO 430)
429) Have you resumed sexual relations since the birth of (NAME)?
[Last Birth Only]
NO 2 (GO TO 431)
430) For how many months after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
431) Did you ever breastfeed (NAME)?
NO 2 (GO TO 436)
432) 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.
HOURS ___1
DAYS ____2
DEAD___ (GO TO 435)
434) Are you still breastfeeding (NAME)?
NO 2
435) For how many months did you breastfeed (NAME)?
DON'T KNOW 98
DEAD___
437) You said that (NAME) died. Did he/she die at home or in a hospital or clinic?
FOR ANY KIND OF HEALTH FACILITY, CIRCLE CODE '2'.
AT HOSPITAL/CLINIC 2
ON WAY TO HOSPITAL/CLINIC 3
DON'T KNOW 8
(ALL GO BACK TO 403 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 442.)
438) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
439) Now I would like to ask you about the types of foods and liquids (NAME) was given yesterday. At any time yesterday or last night, was he/she given any of the following:
Vitamins, minerals, or medicine?
Plain water?
Tinned, powdered, fresh milk or infant
formula?
Fruit juice, tea, soda?
Any other liquids?
Solid or semi-solid (mushy) food?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
440) How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
441) GO BACK TO 403 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 442.
SECTION 4B. IMMUNIZATION AND HEALTH
442) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1995 OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES).
DEAD___(GO TO 444 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 472)
445) Has (NAME) ever received a Vitamin A capsule (supplement) like this?
SHOW AMPLE/CAPSULE/SYRUP
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)
445A) How many months ago did (NAME) take the last dose?
DON'T KNOW 98
445B) Where did (NAME) get this last dose?
SICK CHILD VISIT TO CLINIC 2
NAT'L IMMUNISATION DAY 3
OTHER 6
DOES NOT KNOW 8
446) Do you have a card where (NAME'S) vaccination card for (NAME)?
YES, NOT SEEN 2 (GO TO 450)
NO CARD 3
447) Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 450)
448) (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.
POLIO 0 (POLIO GIVEN AT BIRTH)
BCG
POLIO 1
POLIO 2
POLIO 3
DPT 1
DPT 2
DPT 3
MEASLES
MONTH ___
YEAR ____
MONTH ___
YEAR ____
MONTH ___
YEAR ____
MONTH ___
YEAR ____
MONTH ___
YEAR ____
MONTH ___
YEAR ____
MONTH ___
YEAR ____
MONTH ___
YEAR ____
MONTH ___
YEAR ____
449) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).
NO 2 (GO TO 452)
DON'T KNOW 8 (GO TO 452)
450) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?
NO 2 (GO TO 453A)
DON'T KNOW 8 (GO TO 453A)
451. Please tell me if (NAME) received any of the following vaccinations:
451A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
451B) Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 451E)
DON'T KNOW 8 (GO TO 451E)
451C) When was the first polio vaccine received, just after birth or later?
LATER 2
451D) How many times was the polio vaccine received?
451E) DPT vaccination, that is, an injection given in the thigh, usually at the same time as polio drops?
NO 2 (GO TO 451G)
DON'T KNOW 8 (GO TO 451G)
451G) An injection to prevent measles?
NO 2
DON'T KNOW 8
452) Were any of the vaccinations (NAME) received during the last two years given as a part of a national immunisation day campaign?
NO 2 (GO TO 453A)
NO VACCINATION IN THE LAST 2 YEARS 3 (GO TO 453A)
DOES NOT KNOW 8 (GO TO 453A)
453) At which national immunization day JULY 2000 (SECOND ROUND) campaigns did (NAME) receive vaccinations? RECORD ALL MENTIONED.
JUNE 2000 (FIRST ROUND) B
JUNE 1999 (SECOND ROUND) C
APRIL 1999 (FIRST ROUND) D
453A) Does (NAME) have a birth certificate?
IF YES: may I see it please?
YES, NOT SEEN 2
NO 3
DON'T KNOW 8
453B) Has (NAME)'s birth been registered?
NO 2
DON'T KNOW 8 (GO TO 453D)
453C). Why is (NAME)'s birth not registered?
MUST TRAVEL TOO FAR 2
DID NOT KNOW IT SHOULD BE 3
LATE, DIDN'T WANT TO PAY FINE 4
DOES NOT KNOW WHERE TO GO TO REGISTER 5
OTHER (SPECIFY)________ 6
DON'T KNOW 8
453D) Do you know a place where you can get your child birth registered?
NO 2
454) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
455) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (GO TO 457)
DON'T KNOW 8 (GO TO 457)
456) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths?
NO 2
DON'T KNOW 8
456A) Were the symptoms due to a problem in the chest or a blocked nose?
PROBLEM IN CHEST 2
BOTH 3
OTHER 6
DON'T KNOW 8
457) CHECK 454 AND 455: FEVER OR COUGH?
'NO/DK' ___ (GO TO 463)
458) Did you seek advice or treatment for the fever/cough?
NO 2 (GO TO 460)
459) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED.
GOVT. HEALTH CNTR/CLINIC B
PHC CLINIC (MOBILE) C
COMMUN. HEALTH WORKER D
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY H
PRIVATE DOCTOR I
OTHER PVT. MEDICAL (SPECIFY) _____ L
TRAD. PRACTITIONER N
'NO'/'DK' IN 454___ (GO TO 463)
461) Did (NAME) take any medicine for the fever?
NO 2 (GO TO 463)
DON'T KNOW 8 (GO TO 463)
462) What medicine did (NAME) take?
RECORD ALL MENTIONED.
ASK TO SEE MEDICINE IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
ANTIBIOTIC B
PANADOL C
IBUPROFEN/ACETAMINOPHEN D
OTHER (SPECIFY) ____ X
DON'T KNOW Z
463) Has (NAME) had diarrhoea in the last 2 weeks?
NO 2 (GO TO 470A)
DON'T KNOW 8 (GO TO 470A)
463A) Was there any blood in the stools?
NO 2
DON'T KNOW 8
464) Now I would like to know how much (NAME) was offered to drink during the diarrhoea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
465) When (NAME) had diarrhoea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
466) Was he/she given any of the following:
a. A fluid made from a special sachet called ORS?
b. Cereal, ontaku, mageu, or soup?
c. Milk, omaere, or infant formula?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
467) Was anything (else) given to treat the diarrhoea?
NO 2 (GO TO 469)
DON'T KNOW 8 (GO TO 469)
468) What was given to treat the diarrhoea?
Anything else?
RECORD ALL MENTIONED.
INJECTION B
(I.V.) INTRAVENOUS C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ____ X
469) Did you seek advice or treatment for the diarrhoea?
NO 2 (GO TO 470A)
470) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED.
GOVT. HEALTH CNTR/CLINIC B
PHC CLINIC (MOBILE) C
COMMUN. HEALTH WORKER D
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY H
PRIVATE DOCTOR I
OTHER PVT. MEDICAL (SPECIFY) _____ L
TRAD. PRACTITIONER N
470A) Did (NAME) sleep under a bednet last night?
NO 2 (GO TO 471)
DON'T KNOW 8 (GO TO 471)
470B) Was this bednet ever treated with a product to kill mosquitos?
NO 2 (GO TO 471)
DON'T KNOW 8 (GO TO 471)
470C) When was the bednet last treated?
DON'T KNOW 98
471) GO BACK TO 444 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 472.
472) CHECK 444, ALL COLUMNS: NUMBER OF LIVING CHILDREN BORN IN 1995 OR LATER
NONE___ (GO TO 475)
473) What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSE AWAY 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
NOT DISPOSED OF 09
OTHER (SPECIFY) _____ 96
473A) Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms should cause you to take your child to a health facility right away?
Any others?
DO NOT READ CODES. DO NOT SUGGEST ANSWERS.
RECORD ALL MENTIONED.
CHILD BECOMES SICKER B
CHILD DEVELOPS FEVER C
CHILD HAS FAST BREATHING D
CHILD HAS DIFFICULT BREATHING E
CHILD HAS BLOOD IN STOOL F
CHILD IS DRINKING POORLY G
OTHER (SPECIFY) ____ Y
OTHER (SPECIFY) ____ Z
ANY CHILD RECEIVED FLUID FROM ORS PACKET____ (GO TO 475A)
475) Have you ever heard of a special product called ORS you can get for the treatment of diarrhoea?
NO 2 (GO TO 476)
475A) Do you have a sachet of ORS in your house now?
NO 2
476) Did you sleep under a bednet last night?
NO 2
477) Now I would like to ask you some questions about medical care for you
yourself.
Many things can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem, or no problem for you?
Not knowing where to go.
Getting permission to go.
Getting money needed for treatment.
Not having a health facility nearby.
Difficulty getting transport.
Concern that the clinic staff are not helpful or kind.
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
SMALL PROBLEM 2
NO PROBLEM 3
478) The last time you prepared a meal for your family, before starting, did you wash your hands?
NO 2
NEVER PREPARED MEAL 3
479) Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?
YES, PIPE 2 (GO TO 481)
YES, OTHER TOBACCO 3 (GO TO 481)
NO 4 (GO TO 482)
480) In the last 24 hours, how many cigarettes did you smoke?
481) How old were you when you first started smoking?
482) Have you ever drunk an alcohol-containing beverage?
NO 2 (GO TO 484)
483) In the last month, on how many days did you drink an alcohol-containing beverage?
NONE/NEVER 95
484) Have you ever had a "Pap" smear to test for cervical cancer?
PROBE: When a doctor or nurse takes a swab in your vagina and sends the slide to the laboratory for analysis?
NO 2
DOES NOT KNOW/NOT SURE 8
485) Has a doctor or nurse ever felt your breasts to check for lumps that might be breast cancer?
NO 2
DOES NOT KNOW/NOT SURE 8
NO BIRTHS IN 1999 OR LATER___ (GO TO 501)
487) Do you have a card or other document with your own immunizations listed?
IF YES: may I see it please?
YES, CARD NOT SEEN 2
NO 3
DOES NOT KNOW 8
487A) When you were pregnant with your last child, did you receive any injection to prevent him or her from getting convulsions after birth, that is an anti-tetanus injection in the top of your arm or shoulder?
NO 2 (GO TO 487C)
DOES NOT KNOW 8 (GO TO 487C)
487B) How many doses of tetanus toxoid did you receive during your last pregnancy?
DOES NOT KNOW 8
487C) Did you receive any tetanus toxoid injection at any time after your last pregnancy?
NO 2 (GO TO 487E)
DOES NOT KNOW 8 (GO TO 487E)
487D) How many doses of tetanus toxoid did you receive after your last pregnancy?
DOES NOT KNOW 8
487E) Did you receive any tetanus toxoid injection at any time before your last pregnancy, including during a previous pregnancy or between pregnancies?
NO 2 (GO TO 487G)
DOES NOT KNOW 8 (GO TO 487G)
487F) How many doses of tetanus toxoid did you receive before your last pregnancy?
DOES NOT KNOW 8
487G) When did you receive the most recent dose of tetanus toxoid?
THIS REFERS TO THE MOST RECENT DOSE, WHETHER IT WAS DURING, AFTER OR BEFORE HER LAST PREGNANCY.
DON'T KNOW MONTH 98
YEAR ___ (GO TO 501)
DON'T KNOW YEAR 9998
487H. How many years ago did you receive the most recent dose?
SECTION 5. MARRIAGE AND SEXUAL ACTIVITY
501. Are you currently married or living with a man?
YES, MARRIED BY CUSTOM 2 (GO TO 504)
YES, LIVING WITH A MAN 3 (GO TO 504)
NO, NOT IN UNION 4
502. Have you ever been married or lived with a man?
YES, FORMERLY MARRIED BY CUSTOM 2
YES, LIVED WITH A MAN 3 (GO TO 508)
NO 4 (GO TO 511)
503. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 508)
SEPARARTED 3 (GO TO 508)
504. Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
506. Does your husband/partner have any other wives besides yourself?
NO 2 (GO TO 508)
DOES NOT KNOW 8 (GO TO 508)
507. How many other wives does he have?
DON'T KNOW 98
508. Have you been married or lived with a man only once, or more than once?
MORE THAN ONCE 2
509. CHECK 508:
MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?
MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?
DON'T KNOW MONTH 98
YEAR ____ (GO TO 511)
DON'T KNOW YEAR 9998
510. How old were you when you started living with him?
511. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you first had sexual intercourse (if ever)?
AGE IN YEARS ____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 96
512. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___ (GO TO 521)
513. The last time you had sexual intercourse, was a condom used?
NO 2
513A. What is the main reason you did not use a condom on that occasion?
USED A FAMILY PLAN. METHOD 02 (GO TO 514)
TRUSTED PARTNER 03 (GO TO 514)
PARTNER TESTED NEGATIVE/NO RISK 04 (GO TO 514)
RESPONDENT DOESN'T LIKE 05 (GO TO 514)
PARTNER REFUSED/OBJECTED 06 (GO TO 514)
PARTNER DRUNK/ON DRUGS 07 (GO TO 514)
WANTED TO GET PREGNANT 08 (GO TO 514)
OTHER (SPECIFY) ____ 96
513B. What is the main reason you used a condom on that occasion?
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/HIV AND PREGNANCY 3
DID NOT TRUST PARTNER/HE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) ____ 6
514. What is your relationship to the man with whom you last had sex?
IF MAN IS "BOYFRIEND" OR "FIANCE", ASK:
Was your boyfriend/fiance living with you when you last had sex?
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ____ 96
515. For how long have you had a sexual relationship with this man?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
516. Have you had sex with any other man in the last 12 months?
NO 2 (GO TO 521)
517. The last time you had sexual intercourse with another man, was a condom used?
NO 2
517A. What is the main reason you did not use a condom on that occasion?
USED A FAMILY PLAN. METHOD 02 (GO TO 518)
TRUSTED PARTNER 03 (GO TO 518)
PARTNER TESTED NEGATIVE/NO RISK 04 (GO TO 518)
RESPONDENT DOESN'T LIKE 05 (GO TO 518)
PARTNER REFUSED/OBJECTED 06 (GO TO 518)
PARTNER DRUNK/ON DRUGS 07 (GO TO 518)
WANTED TO GET PREGNANT 08 (GO TO 518)
OTHER (SPECIFY) ____ 96
517B. What is the main reason you used a condom on that occasion?
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/HIVE AND PREGNANCY 3
DID NOT TRUST PARTNER/HE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) _____ 6
518. What is your relationship to this other man?
IF MAN IS "BOYFRIEND" OR "FIANCE", ASK:
Was your boyfriend/fiance living with you when you last had sex?
IF YES, RECORD '01'.
NO 2
519. For how long have you had a sexual relationship with this man?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
519A. Other than these two men, have you had sexual intercourse with anyone else in the last 12 months?
NO 2 (GO TO 521)
519B. The last time you had sexual intercourse with this other man, was a condom used?
NO 2
519C. What is the main reason you did not use a condom on that occasion?
USED A FAMILY PLAN. METHOD 02 (GO TO 519E)
TRUSTED PARTNER 03 (GO TO 519E)
PARTNER TESTED NEGATIVE/NO RISK 04
RESPONDENT DOESN'T LIKE 05
PARTNER REFUSED/OBJECTED 06
PARTNER DRUNK/ON DRUGS 07
WANTED TO GET PREGNANT 08
OTHER (SPECIFY) _____ 96
519D. What is the main reason you used a condom on that occasion?
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/HIVE AND PREGNANCY 3
DID NOT TRUST PARTNER/HE HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) _____ 6
519E. What is your relationship to this other man?
IF MAN IS "BOYFRIEND" OR "FIANCE", ASK:
Was your boyfriend/fiance living with you when you last had sex?
IF YES, RECORD '01'.
IF NO, RECORD '02'.
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) ____ 96
519F. For how long have you had a sexual relationship with this man?
WEEKS 2 ___
MONTHS 3 ___
YEARS 4 ___
520. In total, with how many different men have you had sex in the last 12 months?
521. Do you know of a place where one can get condoms?
NO 2 (GO TO 524)
522. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
(NAME OF PLACE)
Any other place?
RECORD ALL MENTIONED.
GOVT. HEALTH CENTER/CLINIC B
PHC CLINIC (MOBILE) C
COMMUN. HEALTH WORKER D
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
CHURCH N
FRIENDS/RELATIVES O
PRAD'L BIRTH ATTENDANT P
TRADITIONAL HEALER Q
523. If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW/UNSURE 8
524. In the last few months have you heard about condoms:
On the radio?
On the television?
In a newspaper or magazine?
NO 2
NO 2
NO 2
SECTION 6. FERTILITY PREFERENCES
601. CHECK 310/310A:
HE OR SHE STERILISED (GO TO 613)
602. CHECK 226:
NOT PREGNANT OR UNSURE (Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?)
PREGNANT (Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?)
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 613)
UNDECIDED/DON'T KNOW:
AND PREGNANT 4 (GO TO 610)
NOT PREGNANT OR UNSURE 5 (GO TO 608)
603. CHECK 226:
NOT PREGNANT OR UNSURE (How long would you like to wait from now before the birth of (a/another) child?)
PREGNANT (After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?)
YEARS 2 ___
SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 613)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) ____ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)
PREGNANT (GO TO 610)
605. CHECK 309: USING A METHOD?
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)
24 OR MOREMONTSH OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)
607. CHECK 602:
WANTS A/ANOTHER CHILD (You have said that you do not want (a/another) chid soon, but you are not using any method to avoid pregnancy. Can you tell me why?)
WANTS NO (MORE) CHILDREN (You have said that you do not want an (more) children, but you are not using any method to avoid pregnancy. Can you tell me why?
RECORD ALL MENTIONED.
INFREQUENT SEX B
MENOPAUSAL/HYSTERECTOMY C
INFERTILE D
POSTPARTUM AMENORRHEIC E
BREASTFEEDING F
FATALISTIC G
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
608. In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4
609. CHECK 310: USING A METHOD?
NOT CURRENTLY USING (GO TO 610)
CURRENTLY USING (GO TO 613)
610. Do you think you will use a method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)
611. Which method would you prefer to use?
MALE STERILISATION 02 (GO TO 613)
PILL 03 (GO TO 613)
IUD 04 (GO TO 613)
INJECTIONS 05 (GO TO 613)
CONDOM 06 (GO TO 613)
FEMALE CONDOM 07 (GO TO 613)
DIAPHRAGM, FOAM, JELLY 08 (GO TO 613)
RHYTHM, PERIODIC ABSTINENCE 09 (GO TO 613)
WITHDRAWAL 10 (GO TO 613)
OTHER (SPECIFY) _____ 96 (GO TO 613)
UNSURE 98 (GO TO 613)
612. What is the main reason that you think you will not use a method at any time in the future?
MENOPAUSAL/HYSTERECTOMY 23
INFERTILE 24
WANTS AS MANY CHILDREN AS POSSIBLE 26
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
HAS LIVING CHILDREN (If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?)
NO LIVING CHILDREN (If you could choose exactly the number of children to have in your whole life, how many would that be?)
PROBE FOR A NUMERIC RESPONSE
OTHER (SPECIFY) _____ 96 (GO TO 615)
614. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
BOYS ____
GIRLS ____
EITHER ____
OTHER (SPECIFY) ____ 96
615. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
DON'T KNOW/UNSURE 3
616. In the last few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 618)
617. With whom?
Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
MOTHER-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) ____ X
YES, LIVING WITH A MAN (GO TO 619)
NO, NOT IN UNION (GO TO 622)
619. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
620. How often have you talked to your husband/partner about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
621. 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?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
622. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:
She is tired or not in the mood?
She has recently given birth?
She knows her husband has sex with other women?
She knows her husband has a sexually transmitted disease?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
623. Sometimes a woman falls pregnant when she does not want to. Have you ever fallen pregnant when you didn't want to?
NO 2 (GO TO 701)
624. How long ago did this happen to you?
'IF LESS THAN 1 YEAR, RECORD '00'
625. When that happened to you, did you feel like doing something about it?
NO 2
626. Did you do something to end the pregnancy?
NO 2
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
701. CHECK 501 AND 502:
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)
702. How old was your husband/partner on his last birthday?
703. Did your (last) husband/partner ever attend school?
NO 2 (GO TO 706)
704. What was the highest level of school he attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 706)
705. What was the highest (grade/form/year) he completed at that level?
DON'T KNOW 98
706. CHECK 701:
CURRENTLY MARRIED/LIVING WITH A MAN (What is your husband's/partner's occupation? That is, what kind of work does he mainly do?)
FORMERLY MARRIED/LIVED WITH A MAN (What was your (last) husband's/partner's occupation? What kind of work does he mainly do?)
_______
_______
707. Aside from your own housework, are you currently working?
NO 2
708. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?
NO 2
709. Have you done any work in the last 12 months?
NO 2 (GO TO 801)
710. What is your occupation, that is, what kind of work do you mainly do?
______
______
DOES NOT WORK IN AGRICULTURE (GO TO 713)
712. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
713. Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOEMONE ELSE 2
SELF-EMPLOYED 3
714. Do you usually work at home or away from home?
DON'T KNOW 98
715. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
716. Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 801)
NOT PAID 4 (GO TO 801)
717. Who mainly decides how the money you earn will be used?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
718. On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HLAF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6
SECTION 8. AIDS AND OTHER SEXUALLY-TRANSMITTED DISEASES
801. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 815)
801A. Where have you heard about AIDS?
RECORD ALL MENTIONED.
TELEVISION B
NEWSPAPERS/MAGAZINES C
DOCTOR, NURSE, HEALTH STAFF D
FRIENDS/RELATIVES E
OTHER (SPECIFY) ____ X
DON'T KNOW Z
802. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 808)
DON' T KNOW 8 (GO TO 808)
803. What can a person do?
Anything else?
RECORD ALL MENTIONED.
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID KISSING K
AVOID MOSQUITO BITES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
AVOID SHARING RAZORS, BLADES N
OTHER (SPECIFY) ____ W
OTHER (SPECIFY) ____ X
DON'T KNOW Z
804. Can people reduce their chances of getting the AIDS virus by having just one sex partner who has no other partners?
NO 2
DON'T KNOW 8
805. Can a person get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
806. Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
807. Can people protect themselves from getting the AIDS virus by not sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
808. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
809. Can the virus that causes AIDS be transmitted from a mother to a child?
NO 2
DON'T KNOW 8
810. When can the virus that causes AIDS be transmitted from a mother to a child? Can it be transmitted...
During pregnancy?
During delivery?
During breastfeeding?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
810A. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?
MODERATE 2 (GO TO 810C)
GREAT 3 (GO TO 810C)
NO RISK AT ALL 4
DON'T KNOW 8 (GO TO 810D)
810B. Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.
USE CONDOMS B (GO TO 810D)
HAS ONLY 1 PARTNER C (GO TO 810D)
HAS LIMITED NUMBER OF PARTNERS D (GO TO 810D)
OTHER (SPECIFY) ____ E (GO TO 810D)
DON' TKNOW X (GO TO 810D)
810C. Why do you think that you have a (MODERATE/GREAT) chance of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.
MULTIPLE PARTNERS B
PARTNER HAS MANY PARTNERS C
HAD TRANSFUSION/INJECTIONS D
OTHER (SPECIFY) _____ E
DON'T KNOW X
810D. Since you have heard of AIDS have you changed your behavior?
NO 2 (GO TO 810F)
DON'T KNOW 8 (GO TO 810F)
810E. How have you changed your behaviour since you heard about AIDS?
Any other ways?
RECORD ALL MENTIONED.
STARTED USING CONDOMS B
STAYED WITH ONLY 1 PARTNER C
REDUCED NUMBER OF PARTNERS D
STOPPED SEX WITH PROSTITUTES E
OTHER (SPECIFY) ____ F
DON'T KNOW X
810F. If a teacher has the AIDS virus but is not sick, should he or she be allowed to continue teaching in school?
NO 2
DON'T KNOW 8
810G. If you knew that a shopkeeper or food seller had AIDS or the virus that causes it, would you buy food from him or her?
NO 2
DON'T KNOW 8
NOT CURRENTLY MARRIED/NOT LIVING WITH A MAN (GO TO 812A)
812. Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?
NO 2
812A. In your opinion, is it acceptable or unacceptable for AIDS to be discussed:
on the radio?
on the TV?
In newspapers?
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
NOT ACCEPTABLE 2
813. If a person learns that he/she is infected with the virus that causes AIDS, should the person be allowed to keep this fact private or should this information be available to the community?
AVAILABLE TO COMMUNITY 2
DK/NOT SURE 8
814. If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?
NO 2
DK/NOT SURE/DEPENDS 8
814A. Should children aged 12-14 be taught about using a condom to avoid AIDS?
NO 2
DK/NOT SURE/DEPENDS 8
814B. We are interested to know how much demand there is in your community for HIV testing and counselling. I do not want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 814E)
814C. When you went to get tested, did the staff at the health facility talk to you about the consequences of getting the results?
NO 2
814D. I do not want you to tell me the results of the test, but have you been told the results?
NO 2 (GO TO 814H)
814E. Would you want to be tested for the AIDS virus?
NO 2
DON'T KNOW/UNSURE 8
814F. Do you know a place where you could go to get an AIDS test?
NO 2 (GO TO 814I)
814G. Where can you go for the test?
814H. Where did you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THEAPPROPRIATE CODE.
(NAME OF PLACE)
GOVT. HEALTH CENTER/CLINIC 12
OTHER PUBLIC (SPECIFY) ____ 16
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
814I. Do you know someone personally who has the virus that causes AIDS or someone who died from AIDS?
NO 2 (GO TO 815)
814J. How well do (did) you know this person?
IF MORE THAN 1 PERSON, ASK ABOUT THE CLOSEST PERSON.
CLOSE FRIEND 2
DISTANT RELATIVE (COUSIN, UNCLE) 3
ACQUAINTANCE/COLLEAGUE 4
815. Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NO 2 (GO TO 901)
816. If a woman has a sexually transmitted disease, what symptoms might she have?
Any others?
RECORD ALL MENTIONED.
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
BLOOD IN URINE I
LOSS OF WEIGHT J
INABILITY TO GIVE BIRTH K
NO SYMPTOMS L
OTHER (SPECIFY) ____ X
DON'T KNOW Z
901. 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?
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 914)
903. How many of these births did your mother have before you were born?
904. What was the name given to your oldest (next oldest) brother or sister?
[2] ____
[3] ____
[4] ____
[5] ____
[6] ____
[7] ____
[8] ____
[9] ____
[10] ____
[11] ____
[12] ____
Q. 905- Q. 913 ARE ASKED OF 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 CHILD SEPARATELY.
905. Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 908)
DK 8 (GO TO NEXT CHILD)
908 How many years ago did (NAME) die?
909. How old was (NAME) when he/she died?
IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO NEXT CHILD
910. Was (NAME) pregnant when she died?
911. Did (NAME) die during childbirth?
NO 2
912. Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2
913. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?
IF NO MORE BROTHERS OR SISTERS, GO TO 914
MINUTES______
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
________________________________
________________________________
COMMENTS ON SPECIFIC QUESTIONS:
_________________________________
_________________________________
ANY OTHER COMMENTS:
_________________________________
_________________________________
SUPERVISOR'S OBSERVATIONS
_________________________________
_________________________________
NAME OF THE SUPERVISOR: ___________DATE: _______
EDITOR'S OBSERVATIONS
__________________________________
__________________________________
NAME OF EDITOR:____________________ DATE: _______
SENTENCES FOR LITERACY TEST (Q. 111)
NOTE: These should be translated into all the languages that respondents might be literate in.
1. The child is reading a book.
2. The rains came late this year.
3. Parents must care for their children.
4. Farming is hard work.