IDENTIFICATION

PROVINCE

DISTRICT __

TEHSIL __

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

IS HOUSEHOLD SELECTED FOR:

NAME OF HOUSEHOLD HEAD ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __
INTERVIEWERS NAME ___
RESULT* __

NEXT VISIT
DATE ______
TIME ________

FINAL VISIT
DAY __
MONTH __
YEAR ___
INT. NUMBER ___
RESULT* __

TOTAL NUMBER OF VISITS __

TOTAL PERSONS IN HOUSEHOLD __

DEATHS UNDER 5/SBs FROM Q. 38 __

FEMALE DEATHS AGE 12-49 FROM Q. 39 __

LINE NO. OF RESPONDENT __

LANGUAGE OF QUESTIONNAIRE: URDU

SUPERVISOR
NAME__
DATE__

FIELD EDITOR
NAME__
DATE__

OFFICE EDITOR__

KEYED BY __

SIGNATURE OF INTERVIEWER: ___________
DATE: ___________

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

102) In what month and year were you born?

103) How old are you?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT

104) What is your current marital status? Are you married, Godforbid widowed, divorced, or separated?

105) Is your husband usually living with you now or is he staying elsewhere?

106) Does your husband have other wives?

107) Is/was there a blood relationship between you and your husband?

108) What type of relationship (is/was) it?

109) Have you been married only once or more than once?

110) CHECK 109:

MARRIED ONLY ONCE: In what month and year did you start living with your husband?
MARRIED/MORE THAN ONCE: Now I would like to ask about when you started living with your first husband. In what month and year was that?

111) How old were you when you first started living with him?

112) Have you ever attended school?

113) What is the highest class you completed?
WRITE '00' IF LESS THAN CLASS ONE;
WRITE '16' = IF MA, MPHIL, PHD, MBBS, BSC/4YEARS

114) CHECK 113

115) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:

Can you read any part of the sentence to me?

116) What is your mother tongue?

SECTION 2. REPRODUCTION

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

202) Do you have any sons or daughters to whom you have given birth who are now living with you?

203) How many sons live with you? And how many daughters live you with?
IF NONE, RECORD '00'

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

205) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'

206) Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of live but did not survive?

207) How many boys have died? And how many girls have died?
IF NONE, RECORD '00'

208) SUM ANSWERS TO 203, 205, 207.
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 like. Is that correct?

210) CHECK 208:

211) Now I would like to record the names of all your births, whether still alive or not, starting with the last one you had. RECORD THE NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE FIRST ROW)

212) What name was given to your last (next-to-last) baby?

213) Were any of the births twins?

214) Is (NAME) a boy or girl?

215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
RECORD MONTHS 1 THROUGH 12
OR SEASONS

216) Is (NAME) still alive?

217) IF ALIVE: How old is (NAME)?
WRITE AGE IN COMPLETED YEARS. WRITE '00' IF UNDER 1.

218) IF ALIVE: Is (NAME) living with you?

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

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

221) IF DEAD: Where did (NAME) die?

222) Were there any other livebirths between (NAME) and (NAME OF PREVIOUS BIRTH), including any children who died after birth?

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

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

225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 OR LATER.
IF NONE, RECORD '0' AND GO TO 226.

226) Are you pregnant now?

227) How many months pregnant are you?

228) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

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

230) When did the last such pregnancy end?
PROBE TO ASK BETWEEN WHICH BIRTHS, ETC.

231) CHECK 230:

232) How many months pregnant were you when the last such pregnancy ended?

233) Since January 2001, how many pregnancies have you had that did not result in a live birth. How many of these pregnancies were miscarried, aborted or ended in a still birth?
IF 7 OR MORE, RECORD '7'

234) When did your last menstrual period start?
IF LESS THAN A WEEK, RECORD DAYS. IF ONE WEEK AND LESS THAN ONE MONTH, RECORD WEEKS. IF ONE MONTH AND LESS THAN A YEAR, RECORD MONTHS. IF YEAR OR MORE RECORD YEARS.

235) Do you know about any problems or complications a woman can have during pregnancy or delivery or after delivery?

236) What complications or problems do you know about?

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

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD S RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

302) Have you ever used (METHOD)?

303) CHECK 302:

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

305) What have you used or done?

306) CHECK 104:

307) CHECK 302 (01):

308) CHECK 226:

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

310) Which method are you using?
CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

311) May I see the package of pills/condoms you are now using?
RECORD NAME OF BRAND IF PACKAGE SEEN.

312) Do you know the brand name of the (pills/condoms) you are using?
RECORD THE NAME OF BRAND

313) How many (pill cycles/condoms) did you or your husband get the last time?

314) Can you tell me the name of the injection you are using?

315) Please tell me for how many weeks one injection is effective.

316) The last time you obtained (CURRENT METHOD), how much did you pay in total, including the cost of the method and any consultation you may have had?
IF STERILIZED: How much did you or your husband pay for the sterilization, including any consultation?

317) Where did you obtain (CURRENT METHOD) the last time?
IF STERILIZED: Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR FWC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

ONLY FOR MODERN METHOD

318) At the time you obtained (CURRENT METHOD) from the above source, were you told about side effects or problems you might have with the method?

319) Were you ever told what to do if you experienced side effects or problems?

320) Were you ever told about other methods of family planning that you could use?

321) Since what month or year have you been using (CURRENT METHOD) without stopping?
IF STERILIZED: In what month and year was the sterilization performed?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

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

323) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR FWC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
________(NAME OF PLACE)
RECORD ALL PLACES MENTIONED.

324) In the last 12 months, were you visited by a fieldworker of a Lady Health Worker who talked to you about family planning?

325) Did you receive any care and help from this woman?

326) What type of help did you receive?
CIRCLE ALL MENTIONED.

327) In the last month, have you heard a message about family planning on:

328) CHECK 327:

329) What messages did it convey to you?
RECORD ALL MENTIONED.

330) Do you think that the message you heard was effective or not effective in persuading couples to use family planning?

SECTION 4. PREGNANCY, LABOUR/DELIVERY AND POSTNATAL CARE

401) CHECK 225:

402) ENTER IN THE TABLE THE BIRTH NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEING WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born since January 2001. (We will talk about each separately).

403) BIRTH NUMBER FROM 212

404) FROM 212 AND 216

405) At the time you became pregnant wit (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

406) How much longer would you have liked to wait?

407) Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

408) Where did you receive antenatal care for this pregnancy? Anywhere else?
FOR ANY HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE.
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

409) The first time you went for antenatal care, did you go because you had a problem or did you go just for a checkup?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

410) How many months pregnant were when you first received antenatal care for this pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

411) How much did you pay for the first antenatal visit?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

412) How many time did you receive antenatal care during this pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

413) As part of your antenatal care during this pregnancy, were any of the following measures taken at least once?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

414) Do you know your blood group?

415) During any antenatal care visit, were you told about the signs of pregnancy complications?

416) During any antenatal care visit, were you told where to go if you had any of these complications?

417) Why didn't you see anyone for an antenatal check-up?
CIRCLE ALL CODES MENTIONED.

418) When you were pregnant with (NAME), did anyone talk to you about how to have a safe delivery? I mean things like using a safe delivery kit or a clean blade to cut the baby's cord or asking the person who helps you to wash their hands?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

419) During this pregnancy, were you given an injection in the buttocks or your arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

420) During this pregnancy, how many times did you get this tetanus injection?

421) CHECK 420:

422) At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

423) Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'
[ONLY ASKED FOR MOST RECENT PREGNANCY

424) In what month and year did you receive the last tetanus injection before this pregnancy?
ASK TO SEE THE CHILD HEALTH/IMMUNIZATION CARD. CHECK TETANUS INJECTIONS FOR MOTHER.

425) How many years ago did you receive that tetanus injection?

426) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP
[ONLY ASKED FOR MOST RECENT PREGNANCY]

427) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER NOT NUMERIC, ASK FOR APPROXIMATE NUMBER.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

428) During this pregnancy, were you given or did you take calcium tablets?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

429) During the whole pregnancy for how many days did you take the tablets?

430) During this pregnancy, did you have difficulty with your vision during daylight?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

431) During this pregnancy, did you suffer from night blindness?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

432) During this pregnancy, did you suffer from malaria?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

433) Did you receive treatment for malaria during the pregnancy?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

434) Where did you receive treatment for the malaria during this pregnancy?
IF MORE THAN ONE PLACE, ASK FOR THE MAIN ONE.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

435) When you were pregnant with (NAME), did you have any of the following problems?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

436) CHECK 435:

437) Were any of these problems so severe that you were afraid you might die?

438) Did you seek advice or treatment for the problem(s)?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

439) Where did you seek treatment for the problem(s)? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

440) How long after you first started having the (first) problem did you seek advice or treatment?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ON WEEK, RECORD DAYS. IF MORE THAN ONE WEEK, RECORD WEEKS.

441) Why didn't you see anyone for the problem(s)?
RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

442) During this pregnancy, did you and your husband discuss where you would deliver?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

443) During this pregnancy, did you set aside any money in case of an emergency?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

445) Was (NAME) weighed at birth?

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

447) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OR PERSON AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, ASK IF ANY ADULTS WERE PRESENT AT THE DELIVERY.

448) Were you given an injection to induce labour to deliver (NAME)?

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

450) Why did you deliver at the hospital/health centre?

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

452) Was (NAME) delivered by caesarean section?

453) In total, how much did you pay for the delivery, including doctors' fees, facility costs and medicines?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

454) Before you were discharged after (NAME) was born, did any health personnel check on your health?

455) How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF MORE THAN ONE WEEK, RECORD WEEKS.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

456) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

458) Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

459) In total, how much did you pay for the delivery?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

460) Was a safe delivery kit used during this delivery?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

461) What was used to TIE the umbilical cord?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

462) What was used to CUT the umbilical cord?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

463) Was the instrument boiled before using or not boiled?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

465) How many hours, day or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD WEEKS.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

467) Where did this first check take place?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE

468) In the two months after (NAME) was born, did any health care provider or dai or a LHW or hakim check on his/her health?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

469) How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. IF ONE WEEK OR MORE, RECORD WEEKS.
[ONLY ASKED FOR THE MOST RECENT PREGNANCY]

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

471) Where did the first check of (NAME) take place?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE

472) How long after birth was (NAME) first bathed?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. IF ONE DAY OR MORE, RECORD DAYS.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

473) During the delivery or in the 40-day period after the delivery of (NAME), did you experience any of the following problems?
[ONLY ASKED FOR THE MOST RECENT PREGNANCY]

473A) IF YES: When did you experience this?

474) CHECK 473:

475) Were any of these problems so severe that you were afraid you might die?

476) Did you seek advice or treatment for the problem(s)?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

477) Where did you seek treatment for the problem(s)? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

478) How long after you first started having the problem did you seek advice or treatment?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. IF LESS THAN 7 DAYS, RECORD DAYS. OTHERWISE WEEKS.

479) Why didn't you see anyone for the problem(s)?
CIRCLE ALL MENTIONED.

480) In the first two months after deliver, did you receive a vitamin A does like this?
SHOW AMPULES/CAPSULES/SYRUP
[ONLY ASKED FOR MOST RECENT PREGNANCY]

481) Has you menstrual period returned since the birth of (NAME)?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

482) Did your period return between the birth of (NAME) and your next pregnancy?
[NOT ASKED FOR MOST RECENT PREGNANCY]

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

484) CHECK 226: IS RESPONDENT PREGNANT?

485) Have you resumed sexual relations since the birth of (NAME)?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

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

487) Did you ever breastfeed (NAME)?

488) 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.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

489) Did you give the (NAME) the thick milk (colostrum) that comes first or did you discard it?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

490) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

491) What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[ONLY ASKED FOR MOST RECENT PREGNANCY]

492) CHECK 404: IS CHILD LIVING?

493) Are you still breastfeeding (NAME)?
[ONLY ASKED FOR MOST RECENT PREGNANCY]

494) For how many months did you breastfeed (NAME)?
IF LESS THAN ONE MONTH, RECORD '00'

495) CHECK 404: IS CHILD LIVING?

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

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

498) Yesterday or last night, did (NAME) eat or drink:

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

499A) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD VACCINATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH NUMBER, NAME AND SURVIVAL STATUS OF EACH LIVE BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MOE THAN 3 BIRTHS, USE LAST 2 COLUMN OF ADDITIONAL QUESTIONNAIRES).

502) BIRTH NUMBER FROM 212

503) FROM 212 AND 216

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

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

506) (1) COPY DATE OF BIRTH IF GIVEN. IF NOT ON CARD, LEAVE IT BLANK.
(2) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD
(3) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BIT NO DATE IS RECORDED.

507) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, OR MEASLES VACCINES.

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

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

509A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

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

509C) Was the first time polio drops were received in the first 2 weeks after birth or later?

509D) How many times was the polio vaccine received?
IF 7 OR MORE TIMES, RECORD 7.

509E) A DPT vaccination, that is, an injection given in the thigh or buttocks, (sometimes at the same time as the polio drops)?

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

509G) A hepatitis HBV vaccination, that is an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

509H) How many times was an HBV vaccination received?

509I) An injection to prevent measles?

510) Did (NAME) ever receive a polio vaccine (drops in the mouth) during a national immunization campaign?
IF YES, CHECK 506 OR 509D OR MORE.

511) Has (NAME) ever received a vitamin A dose like this?
SHOW VIT.A CAPSULES

512) How many months ago did (NAME) take the last dose?
PUT '00' IF LESS THAN 1 MONTH

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

514) Was there any blood in the stools?

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

516) How many times did (NAME) pass stool in the last 24 hours?

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

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

519) Did you seek advice or treatment for the diarrhea from any source?

520) Where did you seek advice or treatment? Anywhere else?
FOR ANY HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

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

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

523) Was anything (else) given to treat the diarrhea?

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

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

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

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

528) Were these breathing symptoms due to a problem in the chest or to a blocked or runny nose?

529) CHECK 525: HAD FEVER?

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

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

532) Did you seek advice or treatment for the illness from any source?

533) Where did you seek advice or treatment? Anywhere else?
FOR ANY HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND RECORD ALL MENTIONED.

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

535) At any time during the illness, did (NAME) take any medicine for the illness?

537) What medicine did (NAME) take? Any other medicine?
RECORD ALL MENTIONED.

538) Was any medicine prescribed by a doctor, nurse, pharmacist, or other health practitioner?

539) CHECK 537: ANY CODE A-D CIRCLED?

540) How long after the fever started did (NAME) first take the medicine?

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

542) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601.

SECTION 6. FERTILITY PREFERENCES

601) CHECK 104:

602) CHECK 310:

603) 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 now expecting now, would you like to have another child, or would you prefer to have any more children?

604) 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?

605) CHECK 226:

606) CHECK 309:

607) CHECK 604:

608) CHECK 603:
WANTS TO HAVE A/ANOTHER CHILD (CODE 1): You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

WANTS NO MORE/NONE (CODE 2): You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
CIRCLE ALL MENTIONED.

609) CHECK 309:

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

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

612) CHECK 216:
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.

613) 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?

614) CHECK 104:

615) CHECK 310:

616) Do you think your husband wants the same number of children that you want, or does he want more or fewer than you want?

617) PRESENCE OF OTHERS AT THIS POINT:

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

701) CHECK 104:

702) How old is you husband?

703) Did your (last) husband ever attend school?

704) What was the highest class he completed?
WRITE '00' IF LESS THAN CLASS ONE; WRITE '16' IF MA, MPHIL, PHD, MBBS, BSC(4 YEARS)

705) CHECK 701:
CURRENTLY MARRIED: What is your husband's occupation? That is, what kind of work does he mainly do?
WIDOWED, DIVORCED, OR SEPARATED: What was your (last) husband's occupation? That is, what kind of work did he mainly do?

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

707) As you know, some women take us jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

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

709) Do you receive money for the work you do?

710) If you could find a suitable job, would you like to work?

711) Have you done any work in the last 12 months?

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

713) Did you work at any time before you (first) got married?

714) Did you work after you (first) got married?

SECTION 8. HIV/AIDS

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

802) Can people reduce their chance of getting the AIDS virus by staying faithful to just one partner?

803) Can people get the AIDS virus from mosquito bites?

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

805) Can people get the AIDS virus by sharing food with a person who has AIDS?

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

807) Can people get the AIDS virus because of witchcraft or other supernatural means?

808) Is it possible for a healthy-looking person to have the AIDS virus?

809) Do you know someone personally who has the virus that causes AIDS or someone who has died from AIDS?

810) Can the virus that causes AIDS be transmitted from a mother to a child:

811) Have you ever talked about ways to prevent getting the virus that causes AIDS with your (former) husband?

812) God forbid if a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret or not?

813) God forbid 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?

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

815) Could you kindly tell me some signs of these infections that you know about?
RECORD ALL MENTIONED.

SECTION 9. OTHER HEALTH RELATED ISSUES

901) Have you ever heard of an illness called tuberculosis or TB?

902) How does TB spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

903) Can TB be cured?

904) What is the duration of treatment of TB now a days?
IF MORE THAN 7 MONTHS, RECORD 7

905) Have you ever been told by a doctor or nurse or LHV that God forbid you have/had TB?

906) CHECK 212:

907) Sometimes a women can have a problem, usually after a difficult childbirth, such that she continuously dribbles urine even during sleep that wets her clothes too and/or leaks stool from her vagina. Have you ever experienced this problem?

908) Do you still have this problem?

909) Please tell me how did this problem start:

910) What happened to baby?

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

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

913) The last time you had an injection from where did you obtain the syringe?
IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF SYRINGE WAS PURCHASED FROM A CHEMIST CODE '23'

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

915) Do you think that one can protect herself/himself from getting Hepatitis B, C and HIV AIDS if:

916) RECORD THE TIME.