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DEMOGRAPHIC AND HEALTH SURVEY-REPUBLIC OF RWANDA 2000-WOMAN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF LOCALITY_____

NAME OF HEAD OF HOUSEHOLD_____

PREFECTURE (ADMINISTRATIVE CENTER)_______

TOWN OR MUNICIPALITY______

SECTOR_____

SUB-SECTOR_____

HOUSEHOLD NUMBER______

URBAN/RURAL

URBAN 1
RURAL 2

LARGE CITY, OTHER CITY, OR RURAL?

KIGALI 1
OTHER CITY 2
RURAL 3

NAME AND LINE NUMBER OF WOMAN______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER NAME____
RESULT____

RESULT

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)____

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE___
TIME___

FINAL VISIT
DAY____
MONTH____
YEAR____
NAME____
RESULT_____

TOTAL NUMBER OF VISITS_____

LANGUAGE OF INTERVIEW:

KINYARWANDA 1
OTHER LANGUAGE (SPECIFY)______ 2

INTERPRETER USED?

YES 1
NO 2

FIELD EDITOR
NAME___
DATE____

SUPERVISOR
NAME____
DATE____

OFFICE EDITOR_____
KEYED BY____

SECTION 1. RESPONDENT’S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ___and I am working with National Population Office (NPO). We are conducting a national survey about the health of women and children in Rwanda. 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 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

SIGNATURE OF INTERVIEWER___
DATE____

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

101. RECORD THE TIME

HOUR____
MINUTES____

102. To begin, I would like to ask you some questions about yourself and your household. Until the age of 12, did you mostly live in Kigali, in another city, or in a rural area?

KIGALI 1
OTHER CITY 2
RURAL 3

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

NUMBER OF YEARS_____

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

104. Just before moving here, did you live in the city of Kigali, another city, or in a rural area?

CITY OF KIGALI 1
ANOTHER CITY 2
RURAL 3

105. In what month and year were you born?

MONTH___
DON'T KNOW 98
YEAR____
DON'T KNOW YEAR 9998

106. How old were you on 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, post-primary, secondary, or higher?

PRIMARY 1
POST-PRIMARY 2
SECONDARY 3
HIGHER 4

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

CLASS____

110. CHECK 108:

PRIMARY (GO TO 111)
POST-PRIMARY AND HIGHER (GO TO 114)


111. Now, I would like you to read this sentence aloud to me. Read as much as you can.
SHOW CARD TO RESPONDENT

CANNOT READ AT ALL 1
CAN READ SOME PARTS 2
CAN READ THE WHOLE SENTENCE 3
NO CARD IN REQUIRED LANGUAGE (SPECIFY LANGUAGE)_____ 4

112. Have you ever participated in a literacy program or any other program that included learning to read and write (not including primary school?)

YES 1
NO 2

113. CHECK 111:

CODE '2', '3' OR ‘4' CIRCLED (GO TO 114)
CODE '1' CIRCLED (GO TO 115)

114. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week, or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

115. Do you listen to the radio almost every day, at least once a week, less than once a week, or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

116. Do you watch television almost every day, at least once a week, less than once a week, or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

119. Have you ever drunk alcoholic beverages?

YES 1
NO 2 (GO TO 124)

120. Have you ever become drunk after drinking alcoholic beverages?

YES 1
NO 2

121. During the last three months, how many times did you drink alcoholic beverages?

NUMBER OF DAYS ______
NONE/NEVER 95 (GO TO 124)

122. CHECK 120:

YES, HAS BEEN DRUNK (GO TO 123)
NO, HAS NEVER BEEN DRUNK (GO TO 124)

123. During the last three months how many times did you become drunk?

NUMBER OF TIMES____
NONE/NEVER 95

124. During the last three months, have you had an injection?

YES 1
NO 2 (GO TO 201)

125. During the last three months, how many times have you had an injection?

NUMBER OF INJECTIONS_____
EVERY DAY 95

126. The last time you had an injection, who gave you the shot?

HEALTH PROFESSIONAL 1
PHARMACIST 2
TRADITIONAL HEALER 3
FRIEND/RELATIVE 4
YOURSELF 5
OTHER (SPECIFY)______ 6

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

202. Do you have any sons or daughters that you gave birth to who are currently 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, ENTER '00'.

SONS AT HOME____

DAUGHTERS AT HOME____

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

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but not living with you? How many daughters are alive but not living with you?
IF NONE, ENTER '00'.

NUMBER OF SONS ELSEWHERE____

NUMBER OF DAUGHTERS ELSEWHERE____

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any child that cried at birth or showed signs of life but only lived a few hours or days?

YES 1
NO 2 (GO TO 208)

207 How many boys have died? How many girls have died?
IF NONE, WRITE '00'

BOYS DEAD_____
GIRLS DEAD_____

208. SUM ANSWERS FROM 203, 205, AND 207 AND RECORD THE TOTAL.
IF NONE, RECORD '00'.

TOTAL____

209. CHECK 208:
I want to make sure I have this right: you have had in TOTAL ___ births in your life. Is that correct?

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

211. Now I would like to talk to you about your children, whether they are still alive or not, beginning with the first birth that you had.
IN 212, WRITE THE NAME OF EACH CHILD. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME____

213. Among these births, were there any twins?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

215. In what month and year was (NAME) born?
PROBE: What is his or her birthday?

MONTH____
YEAR_____

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

217. IF ALIVE: How old was (NAME) on his/her last birthday?
RECORD AGE IN COMPLETED YEARS

AGE IN YEARS____

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

YES 1
NO 2

219. IF ALIVE: RECORD THE LINE NUMBER OF CHILD FROM THE HOUSEHOLD SCHEDULE.
RECORD '00' IF CHILD IS NOT LISTED IN THE HOUSEHOLD

LINE NUMBER___ (GO TO NEXT BIRTH FOR FIRST BIRTH; GO TO 221 FOR ALL OTHER BIRTHS)

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 IN YEARS

DAYS 1____
MONTHS 2___
YEARS 3___

221. Were there any other live births between (NAME OF LAST BIRTH) and (NAME)?
[FOR ALL BIRTHS EXCEPT THE FIRST BIRTH]

YES 1
NO 2

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

YES 1
NO 2

223. COMPARE 208 WITH THE NUMBER OF BIRTHS RECORDED IN THE TABLE ABOVE AND CHECK:

NUMBERS ARE THE SAME:
CHECK:
FOR EACH BIRTH: THE BIRTH YEAR 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 OR 1 YEAR: PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS___
NUMBERS ARE DIFFERENT (PROBE AND CORRECT)

224. CHECK 215 AND RECORD THE NUMBER OF LIVE BIRTHS SINCE JANUARY 1995. IF NONE, RECORD ‘0’.

225. FOR EACH BIRTH SINCE JANUARY 1995, RECORD ‘B’ IN THE BIRTH MONTH ON THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED AND RECORD ‘P’ IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.

(NOTE: THE NUMBER OF ‘G’s MUST BE 1 LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED). RECORD THE NAME OF THE CHILD ON THE LEFT OF THE CODE ‘B’.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227. How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS. ENTER ‘P’ IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS_____

228. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have a/another child at all?

THEN 1
LATER 2
NO MORE/NONE 3

229. Have you ever had a pregnancy that ended in a miscarriage, abortion, or stillbirth?

YES 1
NO 2 (GO TO 236)

230. When did the last pregnancy of this kind end?

MONTH___
YEAR___

231. CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 1995 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 1995 (GO TO 236)

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

MONTHS_____

233. Have you had any other pregnancies that did not end in a live birth?

YES 1
NO 2 (GO TO 236)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1995.

ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS

235. IN THE BOXES ON THE BOTTOM OF THE CALENDAR, RECORD THE MONTH AND YEAR OF THE END OF THE LAST PREGNANCY BEFORE JANUARY 1995 THAT DID NOT END IN A LIVE BIRTH

236. When did your last menstrual period start?
RECORD THE DATE, IF GIVEN

DATE___
DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4_____

IN MENOPAUSE / HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

237. From one menstrual period to the next, is there a time when a woman is more likely to become pregnant than others if she has sexual relations?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

238. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
IN THE MIDDLE OF TWO PERIODS 4
OTHER (SPECIFY)_____6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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
RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. 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)?

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) PILL: Women can take a pill every day.
YES 1
NO 2
04) IUD: Women can have an IUD placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES: Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10) FOAM OR JELLY: Women can place a suppository, jelly, or cream in their vagina before sexual intercourse.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12) RHYTHM/PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
14) MORNING AFTER PILL: Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
SPECIFY___
YES 1
NO 2

302. Have you ever used (METHOD)?

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03) PILL: Women can take a pill every day.
YES 1
NO 2
04) IUD: Women can have an IUD placed inside them by a doctor or a nurse.
YES 1
NO 2

05) INJECTABLES: Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) DIAPHRAGM: Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10) FOAM OR JELLY: Women can place a suppository, jelly, or cream in their vagina before sexual intercourse.
YES 1
NO 2
11) LACTATIONAL AMENORRHEA METHOD (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12) RHYTHM/PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
14) MORNING AFTER PILL: Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE “YES” (NEVER USED) (GO TO 304)
AT LEAST ONE “YES” (EVER USED) (GO TO 307)

304. Have you ever used a method or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 328)

306. What have you done or used?
CORRECT 302, 303, (AND 301 IF NECESSARY)

307. Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant. How many children did you have at that time?
IF NONE, RECORD '00'

NUMBER OF CHILDREN____

308. CHECK 301(01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 320)

310. Are you currently doing something or using a method to avoid pregnancy?

YES 1
NO 2 (GO TO 320)

311. What method are you using?
311A. CIRCLE ‘A’ FOR FEMALE STERILIZATION
CIRCLE ‘B’ FOR MALE STERILIZATION

IF MORE THAN ONE METHOD MENTIONED, FOLLOW THE CORRESPONDING SKIP INSTRUCTION FOR THE FIRST METHOD ON THE LIST

FEMALE STERILIZATION A (GO TO 313)
MALE STERILIZATION B (GO TO 313)
PILL C (GO TO 319)
IUD D (GO TO 319)
INJECTABLES E (GO TO 319)
IMPLANTS F (GO TO 319)
CONDOM G (GO TO 319)
FEMALE CONDOM H (GO TO 319)
DIAPHRAGM I (GO TO 319)
FOAM/JELLY J (GO TO 319)
LACTATIONAL AMENORRHEA METHOD (LAM) K (GO TO 319A)
PERIODIC ABSTINENCE L (GO TO 319B)
WITHDRAWAL M (GO TO 319B)
OTHER (SPECIFY)______ X (GO TO 319B)


313. Where did the sterilization take place?

IF SOURCE IS GOVERNMENTAL HOSPITAL, GOVERNMENT-APPROVED HOSPITAL, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF CODES ‘A’ AND ‘B’ WERE BOTH CIRCLED IN 311, ASK 313-317 ABOUT FEMALE STERILIZATION ONLY

NAME OF PLACE____

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT-APPROVED HOSPITAL 12
OTHER PUBLIC (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER (SPECIFY)_____ 96
DON'T KNOW 98

314. CHECK 311:

CODE ‘A’ CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

CODE ‘B’ CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

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

MONTH_____
YEAR_____

317. CHECK 316:

STERILIZED BEFORE 1995 (GO TO 326)
STERILIZED 1995 OR LATER (GO TO 320)

319. Where did you obtain (CURRENT METHOD) when you first started using it?

IF SOURCE IS GOVERNMENT HOSPITAL, GOVERNMENT-APPROVED HOSPITAL, CLINIC, OR HEALTH CENTER, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/GOVERNMENT-APPROVED HOSPITAL 11 (GO TO 319B)
GOVERNMENT HEALTH CENTER 12 (GO TO319B)
FAMILY PLANNING CLINIC 13 (GO TO 319B)
DBC AGENT 15 (GO TO 319B)
OTHER PUBLIC (SPECIFY)_____ 16 (GO TO 319B)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 319B)
PHARMACY 22 (GO TO 319B)
PRIVATE DOCTOR 23 (GO TO 319B)
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC 24 (GO TO 319B)
INFIRMARY 25 (GO TO 319B)
OTHER PRIVATE MEDICAL (SPECIFY)_____ 26 (GO TO 319B)
OTHER SOURCE
SHOP/KIOSK 31 (GO TO 319B)
CHURCH 32 (GO TO 319B)
RELATIVES/FRIEND 33 (GO TO 319B)
OTHER (SPECIFY)____ 96 (GO TO 319B)

319A. Where did you learn to use the lactational amenorrhea method (LAM)?

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___
PUBLIC SECTOR
GOVERNMENT HOSPITAL/GOVERNMENT-APPROVED HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
DBC AGENT 15
OTHER PUBLIC (SPECIFY)____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY)______ 26
OTHER SOURCE
SHOP/KIOSK 31
CHURCH 32
RELATIVES/FRIEND 33
OTHER (SPECIFY)____ 96

319B. How long have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD ‘00’

MONTHS____
8 YEARS OR MORE 96

320. CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE CODE CIRCLED FOR A METHOD IN 331/311A, CIRCLE THE CODE FOR THE FIRST METHOD ON THE LIST

NO CODE CIRCLED 00 (GO TO 328)
FEMALE STERILIZATION 01 (GO TO 322)
MALE STERILIZATION 02 (GO TO 330)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 327)
FEMALE CONDOM 08 (GO TO 324)
DIAPHRAGM 09 (GO TO 324)
FOAM/JELLY 10 (GO TO 324)
LACTATIONAL AMENORRHEA METHOD (LAM) 11 (GO TO 324)
PERIODIC ABSTINENCE 12 (GO TO 330)
WITHDRAWAL 13 (GO TO 330)
OTHER (SPECIFY)______ 96 (GO TO 330)

321. CHECK 319B:

USED FOR 59 MONTHS OR FEWER (GO TO 322)
USED FOR 60 MONTHS OR MORE (GO TO 326)

322. You first obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM Q. 313 OR 319). At that time, were you told about any side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 325)

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

YES 1 (GO TO 325)
NO 2 (GO TO 325)

324. CHECK 319B:

USED FOR 59 MONTHS OR FEWER (GO TO 325)
USED FOR 60 MONTHS OR MORE (GO TO 326)

325. CHECK 320:

ANY CODE FROM ‘1’ TO ‘6’ CIRCLED: At that time, were you told about other methods of family planning that you could use?

ANY CODE ‘8’ TO ‘11’ CIRCLED: In the beginning, you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM Q. 313 OR 319). At that time, were you told about other methods of family planning that you could use?

YES 1
NO 2

326. CHECK 311/311A:

CIRCLE METHOD CODE:

FEMALE STERILIZATION 01 (GO TO 330)
PILL 03
IUD 04 (GO TO 330)
INJECTABLES 05
IMPLANTS 06 (GO TO 330)
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENORRHEA METHOD (LAM) 11 (GO TO 330)

327. 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

NAME OF PLACE_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL/GOVERNMENT-APPROVED HOSPITAL 11 (GO TO 330)
GOVERNMENT HEALTH CENTER 12 (GO TO 330)
FAMILY PLANNING CLINIC 13 (GO TO 330)
DBC AGENT 15 (GO TO 330)
OTHER PUBLIC (SPECIFY)_____ 16 (GO TO 330)

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 330)
PHARMACY 22 (GO TO 330)
PRIVATE DOCTOR 23 (GO TO 330)
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC 24 (GO TO 330)
INFIRMARY 25 (GO TO 330)
OTHER PRIVATE MEDICAL (SPECIFY)_____ 26 (GO TO 330)
OTHER SOURCE
SHOP/KIOSK 31 (GO TO 330)
CHURCH 32 (GO TO 330)
RELATIVES/ FRIEND 33 (GO TO 330)
OTHER (SPECIFY)_____ 96 (GO TO 330)

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

YES 1
NO 2 (GO TO 330)

329. 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_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL/GOVERNMENT-APPROVED HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
DBC AGENT 15
OTHER PUBLIC (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC 24
INFIRMARY 25
OTHER PRIVATE MEDICAL (SPECIFY)_____ 26
OTHER SOURCE
SHOP/KIOSK 31
CHURCH 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY)_____ 96

330. During the past 12 months, have you had a visit from a fieldworker who spoke to you about family planning?

YES 1
NO 2

331. In the past 12 months, have you gone to a health center to receive care for yourself (or your children)?

YES 1
NO 2 (GO TO 401)

332. Did someone at the health center speak to you about family planning methods?

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS SINCE JANUARY 1995 (GO TO 402)
NO BIRTHS SINCE JANUARY 1995 (GO TO 486)

402. RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE 1995 IN THE TABLE. 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 QUESTIONNAIRES)

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

403. LINE NUMBER FROM Q. 212

LINE NO____

404. FROM Q. 212 AND Q. 216:

NAME____
ALIVE___ (GO TO 405)
DEAD___ (GO TO 405)

405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have a/another child at all?

THEN 1 (GO TO 407 FOR LAST BIRTH; GO TO 422 FOR ALL OTHER BIRTHS)
LATER 2
NOT AT ALL 3 (GO TO 407 FOR LAST BIRTH; GO TO 422 FOR ALL OTHER BIRTHS)

406. How much longer would you like to have waited?

MONTHS 1____
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
[FOR LAST BIRTH ONLY]

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MID-WIFE HEALTH ASSISTANT B
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT C
UNTRAINED TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY)____ X
NO ONE Y (GO TO 415)

408. How many months pregnant were you when you first received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]

MONTHS____
DON'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?
[FOR LAST BIRTH ONLY]

NUMBER OF TIMES____
DON'T KNOW 98

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE
[FOR LAST BIRTH ONLY]

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

411. How many months pregnant were you the last time you received antenatal care?
[FOR LAST BIRTH ONLY]

MONTHS____
DON'T KNOW 98

412. During this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

413. Were you told about the signs of pregnancy complications?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8 (GO TO 415)

414. Were you told where to go if you had these complications?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8


415. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 416)
DON'T KNOW 8 (GO TO 416)

415A. During this pregnancy, how many times did you get this injection?
[FOR LAST BIRTH ONLY]

TIMES____
DON'T KNOW 8

416. During this pregnancy, were you given or did you buy iron tablets or syrup containing iron?
SHOW TABLETS/SYRUP.
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

417. During the whole pregnancy, for how many days did you take iron in tablets or syrup?
IF ANSWER IS NON-NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS
[FOR LAST BIRTH ONLY]

NUMBER OF DAYS____
DON'T KNOW 998

418. During this pregnancy, did you have difficulty with your vision during the daylight?
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

419. During this pregnancy, did you suffer from night blindness?
(USE LOCAL TERM)
[FOR LAST BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

420. During this pregnancy, did you take any drugs to prevent you from getting malaria?
[FOR LAST BIRTH ONLY]

YES 1
NO 2 (GO TO 422)
DON'T KNOW 8 (GO TO 422)

421. What drugs did you take?
RECORD ALL MENTIONED
[FOR LAST BIRTH ONLY]

CHLOROQUINE A
FANSIDAR B
QUININE C
UNKNOWN MEDICATION D
OTHER (SPECIFY)______ X

422. 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
DON'T KNOW 8

423. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 425)
DON'T KNOW 8 (GO TO 425)

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

GRAMS FROM CARD 1_____
GRAMS FROM RECALL 2______

DON'T KNOW 99998

425. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS MENTIONED

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE/MEDICAL ASSISTANT B
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT C
UNTRAINED TRADITIONAL BIRTH ATTENDANT D
RELATIVES/FRIENDS E
OTHER (SPECIFY)____ X
NO ONE Y

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

IF SOURCE IS GOVERNMENT HOSPITAL, GOVERNMENT HEALTH CENTER, OR PRIVATE CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE____
HOME
YOUR HOME 11 (GO TO 428)
OTHER HOME 12 (GO TO 428)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
OTHER PUBLIC (SPECIFY)_____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY)_____ 36
OTHER (SPECIFY)____ 96 (GO TO 428)

427. Was (NAME) delivered by caesarian section?

YES 1 (GO TO 432 FOR LAST BIRTH; GO TO 434 FOR ALL OTHER BIRTHS)
NO 2 (GO TO 432 FOR LAST BIRTH; GO TO 434 FOR ALL OTHER BIRTHS)

428. After (NAME) was born, did a health professional or a traditional birth attendant check on your health?

YES 1 (GO TO 434 FOR ALL BIRTHS EXCEPT LAST BIRTH)
NO 2 (GO TO 432 FOR LAST BIRTH; GO TO 434 FOR ALL OTHER BIRTHS)

429. How many days or weeks after the delivery did the first postnatal check take place?
RECORD ‘00’ DAYS IF SAME DAY.
[FOR LAST BIRTH ONLY]

DAYS AFTER DELIVERY 1____
WEEKS AFTER DELIVERY 2_____

DON'T KNOW 998

430. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[FOR LAST BIRTH ONLY]

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE/MEDICAL ASSISTANT 2
OTHER PERSON
TRAINED TRADITIONAL BIRTH ATTENDANT 3
UNTRAINED TRADITIONAL BIRTH ATTENDANT 4
OTHER (SPECIFY)_____ 6

431. Where did this first visit take place?
[FOR LAST BIRTH ONLY]

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
DISPENSARY 23
OTHER PUBLIC (SPECIFY)______ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY)_____ 36
OTHER (SPECIFY)_____ 96

432. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.
[FOR LAST BIRTH ONLY]

YES 1
NO 2

433. Has your period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]

YES 1 (GO TO 435)
NO 2 (GO TO 436)

434. Did your period return between the birth of (NAME OF NEXT-TO-LAST BIRTH) and your next pregnancy? [FOR ALL BIRTHS EXCEPT LAST BIRTH]

YES 1
NO 2 (GO TO 438)

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

MONTHS____
DON'T KNOW 98

436. CHECK 226:
RESPONDENT PREGNANT?
[FOR LAST BIRTH ONLY]

NOT PREGNANT (GO TO 437)
PREGNANT OR UNSURE (GO TO 438)

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

YES 1
NO 2 (GO TO 439)

438. For how long after the birth of (NAME) did you not have sexual relations?

DAYS 1_____
WEEKS 2_____
MONTHS 3____

DON'T KNOW 998

439. Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 444)

440. How long after birth did you first put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD ‘00’ HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS

IMMEDIATELY 000

HOURS 1____
DAYS 2_____

441. CHECK 404:
CHILD LIVING?

LIVING (GO TO 442)
DEAD (GO TO 443)

442. Are you still breastfeeding (NAME)?

YES 1 (GO TO 445)
NO 2

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

MONTHS____
DON'T KNOW 98

444. CHECK 404:
CHILD LIVING?

LIVING (GO TO 447)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO
TO 451)

445. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NON-NUMERIC, PROBE FOR APPROXIMATE NUMBER

NUMBER OF NIGHTTIME FEEDINGS______

446. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NON-NUMERIC, PROBE FOR APPROXIMATE NUMBER

NUMBER OF DAYLIGHT FEEDINGS_____

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

YES 1
NO 2
DON'T KNOW 8

448. Now I would like to ask you about the food (NAME) received during the past 7 days, including yesterday. How many days during the past 7 days did (NAME) receive the following foods and/or liquids?

FOR EACH FOOD RECEIVED AT LEAST ONCE IN THE PAST 7 DAYS, ASK:
In total, yesterday, during the day or night, how many times did (NAME) receive:

IF 7 OR MORE TIMES, RECORD ‘7’. IF RESPONDENT DOESN’T KNOW, RECORD ‘8’

a. Water?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
b. Baby formula?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
c. Any other kind of milk, such as canned milk, powdered milk, or fresh animal milk?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
d. Fruit juice?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
e. Other liquids, such as tea, coffee, carbonated beverages, or broth?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
f. Grain-based foods (ex: millet, sorghum, corn, rice, wheat, gruel, or other local grains)?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
g. Pumpkin, yam or red or yellow squash, carrots, or sweet potato?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
h. Other tuber-based foods, such as potatoes, white yams, manioc, cassava, or other local tubers/roots?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
i. Any kind of leafy green vegetable?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
j. Mango, papaya (or other local fruit rich in vitamin A)?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
k. Any other fruit or vegetable (ex: banana, apple, green beans, avocado, tomato)?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
l. Meat, poultry, fish, shellfish, or eggs?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
m. Other vegetable-based foods (ex: lentils, beans, soybeans, or peanuts)?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
n. Cheese or yogurts?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____
o. Any food prepared with oil, fat, or butter?
NUMBER OF TIMES YESTERDAY/LAST NIGHT___
NUMBER OF DAYS IN LAST 7 DAYS____

450. GO BACK TO 405 IN THE NEXT COLUMN; OR, IF NO OTHER BIRTHS, GO TO 451

SECTION 4B. IMMUNIZATION AND HEALTH

451. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995 IN THE TABLE. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES)

452. LINE NUMBER FROM Q. 212

LINE NUMBER___

453. FROM Q. 212 AND Q. 216:

NAME____
ALIVE (GO TO 454)
DEAD (GO TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 481)


454. Did (NAME) receive a vitamin A dose like this during the last 6 months?
SHOW AMPULE/CAPSULE/SYRUP

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN 1 (GO TO 457)
YES, NOT SEEN 2 (GO TO 459)
NO CARD 3

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

YES 1 (GO TO 459)
NO 2 (GO TO 459)

457. (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

BCG
DAY___
MONTH___
YEAR___
POLIO 0 (GIVEN AT BIRTH)
DAY___
MONTH___
YEAR___
POLIO 1
DAY___
MONTH___
YEAR___
POLIO 2
DAY___
MONTH___
YEAR___
POLIO 3
DAY___
MONTH___
YEAR___
DPT 1
DAY___
MONTH___
YEAR___
DPT 2
DAY___
MONTH___
YEAR___
DPT 3
DAY___
MONTH___
YEAR___
MEASLES
DAY___
MONTH___
YEAR___
VITAMIN A (MOST RECENT)
DAY___
MONTH___
YEAR___

458. 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).

YES 1 (PROBE FOR VACCINATIONS AND WRITE ‘66’ IN THE CORRESPONDING DAY COLUMN IN 457) (GO TO 461)
NO 2 (GO TO 461)
DON'T KNOW 8 (GO TO 461)

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

YES 1
NO 2 (GO TO 463)
DON'T KNOW 8 (GO TO 463)

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

460A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually leaves a scar?

YES 1
NO 2
DON'T KNOW 8

460B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 460E)
DON'T KNOW 8 (GO TO 460E)

460C. When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

460D. How many times was the polio vaccine given?

NUMBER OF TIMES_____

460E. A DPT vaccination, that is, an injection given in the thigh or buttocks, generally given at the same time as polio drops?

YES 1
NO 2 (GO TO 460G)
DON'T KNOW 8 (GO TO 460G)


460F. How many times?

NUMBER OF TIMES____

460G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

461. Did (NAME) receive any of these vaccinations in the past two years during a national vaccination day campaign?

YES 1
NO 2 (GO TO 463)
NO VACCINE IN THE LAST 2 YEARS 3 (GO TO 463)
DON'T KNOW 8

462. During which national vaccination day campaigns in the past two years has (NAME) received these vaccinations?
RECORD ALL MENTIONED.

1 A
2 B
3 C
4 D

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

YES 1 (GO TO 463B)
NO 2
DON'T KNOW 8

463A. Does (NAME) have a fever right now?

YES 1
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

463B. Have you done anything for (NAME)’s fever?

YES 1
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

463C. What have you done? What was done first? What was done afterwards?
CIRCLE A CODE IN EACH COLUMN FOR EACH OF THE FIRST THREE ACTIONS

FIRST ACTION DONE
GAVE MEDICINE FROM HOME 01
GAVE MEDICINE FROM THE PHARMACY (WITHOUT A PRESCRIPTION) 02
WAS BROUGHT TO A PUBLIC HEALTH CENTER 03
WAS BROUGHT TO A MISSION OR GOVERNMENT-APPROVED HEALTH CENTER 04
CONSULTED A PRIVATE DOCTOR 05
CONSULTED A TRADITIONAL HEALER 06
CONSULTED A COMMUNITY HEALTH WORKER 07
GAVE HOME/HERBAL REMEDY 08
OTHER (SPECIFY)______ 09
NOTHING 10
DON'T KNOW 98
SECOND ACTION DONE
GAVE MEDICINE FROM HOME 01
GAVE MEDICINE FROM THE PHARMACY (WITHOUT A PRESCRIPTION) 02
WAS BROUGHT TO A PUBLIC HEALTH CENTER 03
WAS BROUGHT TO A MISSION OR GOVERNMENT-APPROVED HEALTH CENTER 04
CONSULTED A PRIVATE DOCTOR 05
CONSULTED A TRADITIONAL HEALER 06
CONSULTED A COMMUNITY HEALTH WORKER 07
GAVE HOME/HERBAL REMEDY 08
OTHER (SPECIFY)______ 09
NOTHING ELSE 10
DON'T KNOW 98
THIRD ACTION DONE
GAVE MEDICINE FROM HOME 01
GAVE MEDICINE FROM THE PHARMACY (WITHOUT A PRESCRIPTION) 02
WAS BROUGHT TO A PUBLIC HEALTH CENTER 03
WAS BROUGHT TO A MISSION OR GOVERNMENT-APPROVED HEALTH CENTER 04
CONSULTED A PRIVATE DOCTOR 05
CONSULTED A TRADITIONAL HEALER 06
CONSULTED A COMMUNITY HEALTH WORKER 07
GAVE HOME/HERBAL REMEDY 08
OTHER (SPECIFY)______ 09
NOTHING ELSE 10
DON'T KNOW 98

463D. CHECK 463C:

CODE ‘01’ OR ‘02’ CIRCLED IN ANY COLUMN (GO TO 463E)
CODE ‘01’ OR ‘02’ NOT CIRCLED IN ANY COLUMN (GO TO 463F)

463E. What medicine was given to (NAME)?
ASK TO SEE THE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO THE RESPONDENT
RECORD ALL MENTIONED

ANTI-MALARIALS
CHLOROQUINE A
FANSIDAR B
QUININE C
OTHER DRUGS

ASPIRIN D
PARACETAMOL E
OTHER (SPECIFY)_____ X
DON'T KNOW Z

FOR EACH ANTI-MALARIAL GIVEN, ASK:
How long after the fever started did (NAME) start taking (NAME OF MEDICINE)?

CHLOROQUINE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
FANSIDAR
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
QUININE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3

463EA. How much did you spend on the over-the-counter medicine that you gave to (NAME)?

FR____
DON'T KNOW 999998

463F. CHECK 463C

CODE ‘03’ OR ‘04’ CIRCLED IN ANY COLUMN (GO TO 463G)
CODE ‘03’ OR ‘04’ NOT CIRCLED IN ANY COLUMN (GO TO 463K)

463G. How long after you noticed (NAME)’s fever was he taken to a health center?

SAME DAY 0 (GO TO 463H)
1 DAY AFTER THE FEVER STARTED 1 (GO TO 463H)
2 DAYS AFTER THE FEVER STARTED 2
3 DAYS OR MORE 3

463GA. Why did you wait this long before taking (NAME) to a health center?

ILLNESS NOT SERIOUS 1
HEALTH ESTABLISHMENT TOO FAR 2
TRANSPORTATION TOO EXPENSIVE 3
NO MONEY TO PAY 4
OTHER (SPECIFY)_____ 5
DON'T KNOW 8

463H. Did (NAME) receive medicine or a prescription at the health center?

YES 1
NO 2 (GO TO 463HD)
DON'T KNOW 8 (GO TO 463HD)

463I. What medicines or prescriptions did (NAME) receive at the health center?
ASK TO SEE THE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
RECORD ALL MENTIONED.

ANTI-MALARIALS
CHLOROQUINE A
FANSIDAR B
QUININE C
OTHER MEDICINES
ASPIRIN D
PARACETAMOL E
OTHER (SPECIFY)____ X
DON'T KNOW Z

FOR EACH ANTI-MALARIAL, ASK:
How long after the fever started did (NAME) start taking (NAME OF MEDICINE)?

CHLOROQUINE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
FANSIDAR
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
QUININE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3

463HA. Did you buy all of these medicines, some of the medicines, or none of the prescription medicines to treat (NAME)'s fever?

ALL THE MEDICINES 1
SOME OF THE MEDICINES 2
NONE 3 (GO TO 463HC)

463HB. How much did you spend on the medicine you gave to (NAME)?

FR____ (GO TO 463HD)
DON'T KNOW 999998 (GO TO 463HD)

463HC. Why didn't you buy medicine or a prescription to treat (NAME)'s fever?

ILLNESS NOT SERIOUS 1
CHILD RECOVERED 2
NO MONEY TO PAY 3
OTHER (SPECIFY)____ 4
DON'T KNOW 8

463HD. How much did you pay for (NAME)'s consultation fees at the health center?

FR_____
DON'T KNOW 99998

463J. Did (NAME) receive an injection at the health center?

YES 1
NO 2
DON'T KNOW 8

463K. CHECK 463C:

CODE "05" CIRCLED IN ANY COLUMN (GO TO 463L)
CODE "05" NOT CIRCLED IN ANY COLUMN (GO TO 463P)

463L. How long after you noticed (NAME)'s fever did you consult a private doctor?

SAME DAY 0 (GO TO 463M)
1 DAY AFTER THE FEVER STARTED 1 (GO TO 463M)
2 DAYS AFTER THE FEVER STARTED 2
3 DAYS OR MORE 3

463LA. Why did you wait this long before taking (NAME) to a health center?

ILLNESS NOT SERIOUS 1
HEALTH ESTABLISHMENT TOO FAR 2
TRANSPORTATION TOO EXPENSIVE 3
NO MONEY TO PAY 4
OTHER (SPECIFY)_____ 5
DON'T KNOW 8

463M. Did (NAME) receive medicine or a prescription from the private doctor?

YES 1
NO 2 (GO TO 463MD)
DON'T KNOW 8

463N. What medicines or prescriptions did (NAME) receive from the private doctor?
ASK TO SEE THE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
RECORD ALL MENTIONED.

ANTI-MALARIALS
CHLOROQUINE A
FANSIDAR B
QUININE C
OTHER MEDICINES
ASPIRIN D
PARACETAMOL E
OTHER (SPECIFY)____ X
DON'T KNOW Z

FOR EACH ANTI-MALARIAL, ASK:
How long after the fever started did (NAME) start taking (NAME OF MEDICINE)?

CHLOROQUINE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
FANSIDAR
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
QUININE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3

463MA. Did you buy all of these medicines, some of the medicines, or none of the prescription medicines to treat (NAME)'s fever?

ALL THE MEDICINES 1
SOME OF THE MEDICINES 2
NONE 3 (GO TO 463MC)

463MB. How much did you spend on the medicine you gave to (NAME)?

FR____ (GO TO 463MD)
DON'T KNOW 999998 (GO TO 463MD)

463MC. Why didn't you buy medicine or a prescription to treat (NAME)'s fever?

ILLNESS NOT SERIOUS 1
CHILD RECOVERED 2
NO MONEY TO PAY 3
OTHER (SPECIFY)____ 4
DON'T KNOW 8

463MD. How much did you pay for (NAME)'s consultation fees from the private doctor?

FR______
DON'T KNOW 99998

463O. Did (NAME) receive an injection from the private doctor?

YES 1
NO 2
DON'T KNOW 8

463P. CHECK 463C:

CODE "07" CIRCLED IN ANY COLUMN (GO TO 463Q)
CODE "07" NOT CIRCLED IN ANY COLUMN (GO TO 464)

463Q. How long after you noticed (NAME)'s fever did you consult a community health worker?

SAME DAY 0
1 DAY AFTER THE FEVER STARTED 1
2 DAYS AFTER THE FEVER STARTED 2
3 DAYS OR MORE 3

463R. What did the community health worker do?
RECORD ALL MENTIONED

GAVE MEDICINE A
RECOMMENDED BUYING MEDICINE B
SENT TO HEALTH CENTER/DOCTOR C
OTHER (SPECIFY)____ X

463S. CHECK 463R:

CODE "A" AND/OR "B" CIRCLED (GO TO 463T)
NEITHER CODE "A" NOR CODE "B" CIRCLED (GO TO 464)

463T. What medicines or prescriptions was (NAME) given or recommended by the community health worker?
ASK TO SEE THE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT.
RECORD ALL MENTIONED.

ANTI-MALARIALS
CHLOROQUINE A
FANSIDAR B
QUININE C
OTHER MEDICINES
ASPIRIN D
PARACETAMOL E
OTHER (SPECIFY)____ X
DON'T KNOW Z

FOR EACH ANTI-MALARIAL, ASK:
How long after the fever started did (NAME) start taking (NAME OF MEDICINE)?

CHLOROQUINE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
FANSIDAR
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
QUININE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3

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

YES 1
NO 2 (GO TO 472)
DON'T KNOW 8 (GO TO 472)

465. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

467. Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 472)

468. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
CLINIC C
DBC AGENT C
COMMUNITY HEALTH WORKER E
OTHER PUBLIC (SPECIFY)____ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC J
INFIRMARY K
OTHER PRIVATE MEDICAL (SPECIFY)____ L
OTHER SOURCE
SHOP/KIOSK M
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY)_____ X

472. Has (NAME) had diarrhea in the past two weeks?

YES 1
NO 2 (GO TO 480A)
DON'T KNOW 8 (GO TO 480A)

473. Now, I want to know how much liquid (NAME) received when he/she had diarrhea. Did you give him/her less than usual, about the same amount, or more than usual?
IF LESS, PROBE: Did you give him/her much less than usual to drink or a little less than usual?

 
MUCH LESS 1
A LITTLE LESS 2
ABOUT THE SAME AMOUNT 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

474. When (NAME) had diarrhea, did you give him/her less to eat than usual, about the same amount, more than usual, or nothing to eat at all?
IF LESS, PROBE: Did you give him/her much less than usual or a little less than usual?

MUCH LESS 1
A LITTLE LESS THAN 2
ABOUT THE SAME AMOUNT 3
MORE 4
STOPPED FOOD 5
NEVER FED 6
DON'T KNOW 8

475. Did you give (NAME) one of the following things to drink?

a. Liquid prepared from a packet [LOCAL NAME]?
YES 1
NO 2
DON'T KNOW 8
b. Government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8

476. Was anything else given to treat the diarrhea?

YES 1
NO 2 (GO TO 478)
DON'T KNOW 8 (GO TO 478)

477. What was given to treat diarrhea? Anything else?
RECORD ALL MENTIONED

TABLET OR SYRUP A
INJECTION B
(IV) INTRAVENOUS C
HOME/HERBAL REMEDIES D
OTHER (SPECIFY)_____ X

 

478. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 480A)

479. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT/GOVERNMENT-APPROVED HOSPITAL A
GOVERNMENT/GOVERNMENT-APPROVED HEALTH CENTER B
CLINIC C
DBC AGENT D
COMMUNITY HEALTH WORKER E
OTHER PUBLIC (SPECIFY)_____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC J
INFIRMARY K
OTHER PRIVATE MEDICAL (SPECIFY)_____ L
OTHER SOURCE
SHOP/KIOSK M
TRADITIONAL HEALER N
OTHER (SPECIFY)_____ X

480A. Does (NAME) usually sleep under a mosquito net?

YES 1
NO 2

480B. Did (NAME) sleep under a mosquito net last night?

YES 1 
NO 2 (GO TO 480G)
DON'T KNOW 8 (GO TO 480G)

480C. Was the net (NAME) slept under last night purchased at the market or received free?

PURCHASED AT MARKET 1
RECEIVED FROM NGO OR OTHER ORGANIZATION 2
OTHER (SPECIFY)_____ 6
DON'T KNOW 8

480D. How long ago did your household obtain the mosquito net?
IF MORE THAN 84 MONTHS, RECORD '95.' IF LESS THAN A MONTH, ENTER '00'.

NUMBER OF MONTHS___
DON'T KNOW 98

 

480E. Since you got the mosquito net, was it soaked or dipped in a liquid to repel mosquitoes or bugs?

YES 1
NO 2 (GO TO 480G)
DON'T KNOW 8 (GO TO 480G)

480F. How long ago was the net last soaked or dipped?
IF MORE THAN 84 MONTHS, RECORD '95.' IF LESS THAN A MONTH, ENTER '00'

NUMBER OF MONTHS___
DON'T KNOW 98

480G. GO BACK TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 481

481. CHECK 453, ALL COLUMNS:
NUMBER OF LIVING CHILDREN BORN SINCE JANUARY 1995

ONE OR MORE (GO TO 482)
NO (GO TO 486)

482. The last time you fed your child(ren), did you wash your hands just before feeding?

YES 1
NO 2
NEVER FED CHILD(REN) 3

483. The last time you cleaned (your child/any of your children) after he or she defecated, did you wash your hands immediately afterwards?

YES 1
NO 2
NEVER CLEANED CHILD(REN) 3

484. What do you generally with the stools of your (youngest) child when he/she does not use the toilet?

ALWAYS USE TOILETS/LATRINES 01
THROW IN TOILETS/LATRINES 02
THROW OUTSIDE RESIDENCE 03
THROW OUT OF COURTYARD 04
BURY IN THE YARD 05
GET RID OF IT BY WASHING WITH WATER 06
DOES NOT GET RID OF IT 07
OTHER (SPECIFY)_____ 96

485. CHECK 475A, ALL COLUMNS:

NO CHILD RECEIVED ORS PACKET (GO TO 486)
CHILD RECEIVED ORS PACKET (GO TO 487)

486. Have you ever heard of a special product called [LOCAL NAME] that you can get to treat diarrhea?

YES 1
NO 2

487. CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER (GO TO 488)
HAS NO CHILDREN LIVING WITH HER (GO TO 489)

488. When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?

IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

489. Now I would like to ask you some questions about medical care for yourself. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem, a small problem, or not a problem?

Knowing where to go.
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Getting permission to go.
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Getting money needed for treatment.
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
The distance to the health facility.
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Having to take transport.
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Not wanting to go alone.
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3
Concern that there may not be a female health provider.
BIG PROBLEM 1
SMALL PROBLEM 2
NOT A PROBLEM 3

491. Do you currently smoke cigarettes or tobacco?
IF YES: What do you smoke?
RECORD ALL MENTIONED

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

492. CHECK 491:

CODE 'A' CIRCLED (GO TO 493)
CODE 'A' NOT CIRCLED (GO TO 494)

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

CIGARETTES___

494. The last time you prepared a meal for your family, did you wash your hands before you started?

YES 1
NO 2
NEVER PREPARED MEALS 3

494A. Do you know how people get malaria in your community?

YES 1
NO 2 (GO TO 496)

495. How can they get malaria?
RECORD ALL MENTIONED

WHEN IT IS COLD A
WHEN IT IS HOT B
SEASONAL CHANGES C
MOSQUITOES D
KISSING E
EXPOSURE TO SUNLIGHT F
WITCHCRAFT G
OTHER (SPECIFY)_____ X

496. What can a person do to avoid getting malaria?
RECORD ALL MENTIONED

REMAIN INSIDE A
REMAIN UNDER A MOSQUITO NET B
AVOID MOSQUITO BITES C
USE OF INSECTICIDES D
BURNING LEAVES/DUNG E
WEAR WARM CLOTHING F
TAKE ANTI-MALARIALS G
OTHER (SPECIFY)_____ X
DON'T KNOW Z (GO TO 498)

497. How long does one need to take chloroquine to treat malaria?

NUMBER OF DAYS_____
DON'T KNOW 98

498. CHECK 226:

CURRENTLY PREGNANT (GO TO 498A)
NOT PREGNANT OR NOT SURE (GO TO 498E)

498A. Have you suffered from a fever, at any time during the last two weeks?

YES 1
NO 2 (GO TO 498E)

498B. Did you take any drugs for the fever?

YES 1
NO 2 (GO TO 498E)

498C. What drugs did you take?
ASK TO SEE MEDICATION(S). IF NOT SEEN, SHOW MEDICATION(S) TO THE RESPONDENT.

RECORD ALL MENTIONED.

ANTI-MALARIALS
CHLOROQUINE A
FANSIDAR B
QUININE C
OTHER MEDICINES
ASPIRIN D
PARACETAMOL E
OTHER (SPECIFY)____ X
DON'T KNOW Z

FOR EACH ANTI-MALARIAL, ASK:
How long after the fever started did (NAME) start taking (NAME OF MEDICINE)?

CHLOROQUINE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
FANSIDAR
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3
QUININE
NUMBER OF DAYS____
SAME DAY 0
1 DAY AFTER FEVER STARTED 1
2 DAYS AFTER FEVER STARTED 2
3 DAYS OR MORE 3

498D. How many times did you take this medicine?

NUMBER OF TIMES_____
DON'T KNOW 98

498E. Did you sleep under a mosquito net last night?

YES 1
NO 2 (GO TO 501)

498F. Was the net you slept under last night purchased at the market or received free?

PURCHASED AT MARKET 1
RECEIVED FROM AN NGO OR OTHER ORGANIZATION 2
OTHER (SPECIFY)_____ 6
DON'T KNOW 8

498G. How long ago did you purchased or received the net?
IF MORE THAN 84 MONTHS, RECORD 95.

NUMBER OF MONTHS____
DON'T KNOW 98

498H. Has the net been dipped or soaked in insecticide since you've had it?

YES 1
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)

498I. How long ago was the screen last dipped or soaked in insecticide?
IF MORE THAN 84 MONTHS, CODE 95

NUMBER OF MONTHS____
DON'T KNOW 98

SECTION 5. MARRIAGE SEXUAL ACTIVITY

501. Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

502. Have you ever been married or lived with a man?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 507)
NO 3 (GO TO 514)

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

WIDOWED 1 (GO TO 507)
DIVORCED 2 (GO TO 507)
SEPARATED 3 (GO TO 507)

505. Does your husband/partner live with you now, or is he living elsewhere?

LIVES WITH HER 1
LIVES ELSEWHERE 2

506. RECORD THE NAME AND LINE NUMBER OF THE HUSBAND/PARTNER FROM THE HOUSEHOLD SCHEDULE. IF NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME_____
LINE NUMBER_____

506A. Does your husband /partner have other spouses/wives other than yourself?

YES 1
NO 2 (GO TO 507)

506B. How many other wives does he have?

NUMBER___
DON'T KNOW 98 (GO TO 507)

 506C. Are you the first, second,… wife?

RANK____

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

ONCE 1
MORE THAN ONCE 2

508. CHECK 507:

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, let's talk about your first husband/partner. In what month and year did you start living with him?

MONTH_____
DON'T KNOW MONTH 98
YEAR____ (GO TO 511)
DON'T KNOW YEAR 9998

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

AGE____

511. CHECK 501:

YES, CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 512)
NO, NOT IN UNION (GO TO 514)

512. CHECK 311/311A:

ANY CODE CIRCLED (GO TO 513)
NO CODE CIRCLED (GO TO 514)

513. You told me that you are currently using contraception. Would you say that the decision to use contraception is mainly yours, mainly your husband's/partner's decision, or have you decided together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY)_____ 6

514. Now, I want to ask you some questions about sexual activity to better understand some of the problems of family life. How old were you when you had your first sexual intercourse (if ever)?

NEVER 00 (GO TO 524)
AGE IN YEARS___
FIRST TIME WHEN STARTED TO LIVE WITH (FIRST) HUSBAND/PARTNER 95

515. How long ago did you last have sex?
RECORD "NUMBER OF YEARS'' ONLY IF THE LATEST RELATIONS TOOK PLACE A YEAR AGO OR MORE.

NUMBER OF DAYS 1____
NUMBER OF WEEKS 2____
NUMBER OF MONTHS 3____
NUMBER OF YEARS 4_____ (GO TO 524)

516. The last time you had sex, was a condom used?

YES 1
NO 2 (GO TO 517)

516A. What is the main reason you used a condom at that time?

RESPONDENT WANTED TO PREVENT STD/AIDS 1
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/AIDS AND PREGNANCY 3
DID NOT TRUST PARTNER/SUSPECTED PARTNER HAD OTHER PARTNERS 4
PARTNER REQUESTED/INSISTED 5
OTHER (SPECIFY)____ 6
DON'T KNOW 8

517. What is your relationship with the man with whom you last had sexual intercourse?
IF "BOYFRIEND'' OR "FIANCÉ," ASK: Was your boyfriend/fiancé living with you last had sex with him?
IF "YES", RECORD '1'
IF "NO", RECORD '2'

HUSBAND/LIVE-IN PARTNER 1
BOYFRIEND/FIANCÉ 2
ANOTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
CLIENT (PROSTITUTION) 6
OTHER (SPECIFY)_____ 7

518. When did you start having sexual relations with this man? Or for how long have you had sexual relations with this man?

DAYS 1____
WEEKS 2____
MONTHS 3____
YEARS 4_____

519. In the past 12 months, have you had sex with anyone else?

YES 1
NO 2 (GO TO 524)

520. The last time you had sex with another man, was a condom used?

YES 1
NO 2 (GO TO 521)

520A. What was the main reason you used a condom at that time?

RESPONDENT WANTED TO PREVENT STD/AIDS 1
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/AIDS AND PREGNANCY 3
DID NOT TRUST PARTNER/SUSPECTED PARTNER HAD OTHER PARTNERS 4
PARTNER REQUESTED/INSISTED 5
OTHER (SPECIFY)_____ 6
DON'T KNOW 8

521. What is your relationship with this man?
IF "BOYFRIEND'' OR "FIANCÉ", ASK: Was your boyfriend/fiancé living with you when you last had sex with him?

IF "YES", RECORD '1'
IF "NO", RECORD '2'

HUSBAND/LIVE-IN PARTNER 1 (GO TO 522A)
BOYFRIEND/FIANCÉ 2
ANOTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
CLIENT (PROSTITUTION) 6
OTHER (SPECIFY)___ 7

 

522. For how long have you been having sex with this man? Or for how long did you have sex with this man?

DAYS 1_____
WEEKS 2_____
MONTHS 3_____
YEARS 4_____

522A. Apart from these two men did you have sex with someone else in the past 12 months?

YES 1
NO 2 (GO TO 524)

522B. The last time you had sex with this other man, was a condom used?

YES 1
NO 2 (GO TO 522D)

522C. What is the main reason you used a condom at that time?

RESPONDENT WANTED TO PREVENT STD/AIDS 1
RESPONDENT WANTED TO PREVENT PREGNANCY 2
RESPONDENT WANTED TO PREVENT BOTH STD/AIDS AND PREGNANCY 3
DID NOT TRUST PARTNER/SUSPECTED PARTNER HAD OTHER PARTNERS 4
PARTNER REQUESTED/INSISTED 5
OTHER (SPECIFY)_____ 6
DON'T KNOW 8

522D. What is your relationship with this man?
IF "BOYFRIEND OR "FIANCÉ'' ASK: Was your boyfriend/fiancé living with you when you last had sexual relations with him?
IF "YES", RECORD '1'
IF "NO", RECORD '2'

HUSBAND / LIVE-IN PARTNER 1 (GO TO 523)
BOYFRIEND/FIANCÉ 2
ANOTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
CLIENT (PROSTITUTION) 6
OTHER (SPECIFY)______ 7

522E. For how long have you been having sex with this man? Or for how long did you have sex with this man?

DAYS 1_____
WEEKS 2____
MONTHS 3_____
YEARS 4_____

523. In total, with how many different men have you had sex in the past 12 months?

NUMBER OF PARTNERS_____

524. Do you know of a place where one can get condoms?

YES 1 
NO 2 (GO TO 601)

525. Where is that? Anywhere else?

IF SOURCE IS A HOSPITAL, CLINIC, OR HEALTH CENTER, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

RECORD ALL MENTIONED

NAME OF PLACE____ 
PUBLIC SECTOR

   

GOVERNMENT/GOVERNMENT-APPROVED HOSPITAL A
GOVERNMENT/GOVERNMENT-APPROVED HEALTH CENTER B
FAMILY PLANNING CLINIC C
DBC AGENT D
OTHER PUBLIC (SPECIFY)_____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC I
OTHER PRIVATE MEDICAL (SPECIFY)____ J
OTHER SOURCE
SHOP/KIOSK K
CHURCH L
RELATIVES/FRIENDS M
OTHER (SPECIFY)_____ X

 

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

530. Do you know of a place where one can go on foot and get condoms?

  
YES 1
NO 2 (GO TO 601)

531. Where is that?

PUBLIC SECTOR
GOVERNMENT/ GOVERNMENT-APPROVED HOSPITAL 11
GOVERNMENT/GOVERNMENT-APPROVED HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
DBC AGENT 15
OTHER PUBLIC (SPECIFY)_____ 16

  

PRIVATE MEDICAL SECTOR
PRIVATE CLINIC/HOSPITAL 21
PHARMACY 22
PRIVATE DOCTOR 23
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY)_____ 26

  

OTHER SOURCE

  

SHOP/KIOSK 31
CHURCH 32
RELATIVES/FRIENDS 33
OTHER (SPECIFY)____ 96

532. How long does it take to get to this place on foot?

MINUTES_____
ON PREMISES 996

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

NEITHER HE NOR SHE STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602. CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some questions about the future. Do you want to have a/another child, or would you prefer not to have a/another child?

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 another child?

HAVE A/ANOTHER CHILD 1
NO OTHER/NONE 4 (GO TO 604)
SAYS SHE CANNOT GET PREGNANT 3 (GO TO 609)
NOT PREGNANT/UNSURE AND UNDECIDED/DON'T KNOW 4 (GO TO 608)
PREGNANT AND UNDECIDED/DON'T KNOW 5 (GO TO 610)

603. CHECK 226:

NOT PREGNANT OR UNSURE: How long would you wait from now before the birth of a/another child?

PREGNANT: After the birth of the child you are expecting, how long would you wait before the birth of another child?

MONTHS 1____
YEARS 2____

SOON/NOW 993 (GO TO 609)
SAYS SHE CANNOT GET PREGNANT 994 (GO TO 609)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY)_____ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 MONTHS OR TWO YEARS OR MORE (GO TO 607)
00-23 MONTHS OR 00-01 YEARS (GO TO 610)

607. CHECK 602:

WANTS A/ANOTHER CHILD: You said that in the immediate future, you do not want to have a/another child, but you are not using a method to avoid pregnancy. Can you tell me why?
     
DOES NOT WANT A/ANOTHER CHILD: You said that you do not want to have a/another child, but you are not using a method to avoid pregnancy can you tell me why?

RECORD ALL MENTIONED

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSE / HYSTERECTOMY D
SUB-FECUND/STERILE E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND / PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH PROBLEMS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS /TOO FAR Q
COST TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY’S NATURAL PROCESSES T
OTHER (SPECIFY)______ X
DON'T KNOW Z

608. In the coming weeks, if you discover that you are pregnant, would it be a big problem, a small problem, or it would do be no problem?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CANNOT GET PREGNANT 4

609. CHECK 310:
USING A METHOD?

NOT ASKED (GO TO 610)
NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)

610. Do you think that in the future, you will use a method to delay or avoid pregnancy?

 
YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611. What method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)  
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMENORRHEA METHOD (LAM) 11 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY)_____ 96 (GO TO 614)
NOT SURE/DON'T KNOW 98 (GO TO 614)

612. What is the main reason you think that you will not use a method in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX/INFREQUENT SEX 22 (GO TO 614)
MENOPAUSE / HYSTERECTOMY 23 (GO TO 614)
SUB-FECUND/STERILE 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH PROBLEMS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COST TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY’S NATURAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY)______ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

613. Would you use a method if you were married?

YES 1
NO 2
DON'T KNOW 8

614. CHECK 216:

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

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

PROBE FOR A NUMERICAL ANSWER       

NUMBER____
OTHER (SPECIFY)_____ 96 (GO TO 616)

615. Of these children, how many would you like to be boys, how many would you like to be girls, and for how many would the sex not matter?

NUMBER OF BOYS____
OTHER (SPECIFY)____ 96
NUMBER OF GIRLS_____
OTHER (SPECIFY)____ 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY)_____ 96

616. Would you say you approve or disapprove of young couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

617. In the past month, have you heard about family planning:

On the radio?
YES 1
NO 2
On television?
YES 1
NO 2
In newspapers or magazines?
YES 1
NO 2

619. In the past month, have you discussed the practice of family planning with your friend(s), neighbor(s), or relative(s)?

YES 1
NO 2 (GO TO 621)

620. With whom did you discuss it? Anyone else?
RECORD ALL MENTIONED

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SON G
STEPMOTHER H
FRIEND(S)/NEIGHBOR(S) I
OTHER (SPECIFY)______ X

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 625)

622. Now I want to talk about your husband’s/partner‘s views on family planning. Do you think your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPPROVES 1
DISAPPROVES 2
DON'T KNOW 8

623. How many times in the past 12 months, have you discussed family planning with your husband/partner?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

624. Do you think your husband/partner wants the same number of children as you, more, or less than you?

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

625. Husbands and wives do not always agree on everything. Please tell me if you think it is normal for a woman to refuse to have sex with her husband/partner when:

She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

   

She has recently given birth?

   

YES 1
NO 2
DON'T KNOW 8
She knows that her husband/partner has sex with other women?
YES 1
NO 2
DON'T KNOW 8

   

She knows that her husband/partner has a sexually transmitted disease?
YES 1
NO 2
DON'T KNOW 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
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?

AGE IN YEARS____

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

YES 1
NO 2 (GO TO 706)

704. What is the highest level of school he attended: primary, post-primary, secondary, or higher?

PRIMARY 1
POST-PRIMARY 2
SECONDARY 3
HIGHER 4
DON'T KNOW 8 (GO TO 706)

705. What was the last (class/year) he completed at that level?

CLASS/YEAR____
DON'T KNOW 8

706. CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN: What is the occupation of your husband/partner, that is, what kind of work does he mainly do?

WAS MARRIED/LIVED WITH A MAN: What was the occupation of your (last) husband/partner? That is to say, what kind of work did he mainly do?

OCCUPATION_____

707. Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

708. As you know, some women have jobs for which they are paid in cash or kind. Others have a small business, or work on family land or in the family business. Do you do something like this or any other kind work?

YES 1 (GO TO 710)
NO 2

709. Have you done any work in the past 12 months?

YES 1
NO 2 (GO TO 719)

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

OCCUPATION______

711. CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712. Do you work mostly on your own land, or on family land, or do you work on land that you rent, or are do you work on someone else’s land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE’S LAND 4
SHARED LAND 5

 

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

FAMILY MEMBER 1
SOMEONE ELSE 2
SELF-EMPLOYED 3

714. Do you usually work throughout the year, seasonally, or only from time to time?

THROUGHOUT THE YEAR 1
SEASONALLY/ PART OF THE YEAR 2
FROM TIME TO TIME 3

715. For this work, are you paid in cash, in kind, or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
KIND ONLY 3 (GO TO 718)
NOT PAID 4 (GO TO 718)

716. Who decides mainly how the money you earn will be used?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE 5

717. On average, how much of your household expenses are paid by what you earn: almost nothing, less than half, nearly half, more than half, or all?

ALMOST NOTHING 1
LESS THAN HALF 2
NEARLY HALF 3
MORE THAN HALF 4
ALL 5
NOTHING, ALL INCOME IS SAVED 6

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

AT HOME 1
AWAY FROM HOME 2

719. In your family, who usually has the last word in the following decisions:

Your own health care?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE 5
DECISION NOT MADE/NOT APPLICABLE 6
Large household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE 5
DECISION NOT MADE/NOT APPLICABLE 6
Purchases for daily household needs?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE 5
DECISION NOT MADE/NOT APPLICABLE 6
Visits to family, friends, or relatives?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE 5
DECISION NOT MADE/NOT APPLICABLE 6
What food will be prepared each day?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE 5
DECISION NOT MADE/NOT APPLICABLE 6

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

CHILDREN LESS THAN 10 YEARS OLD
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she discusses her opinions with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 8. HIV/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?

YES 1
NO 2 (GO TO 818)

802. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 809)
DON'T KNOW 8 (GO TO 809)

803. What can be done? Anything else?
RECORD ALL MENTIONED

ABSTAIN FROM SEX A
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 SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER 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 sexual partner who has no other partners?

YES 1
NO 2
DON'T KNOW 8

805. Can a person get the AIDS virus from mosquito bites?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

807. Can a person contract the AIDS virus by sharing food with someone with AIDS?

YES 1
NO 2
DON'T KNOW 8

808. Can people protect themselves from the AIDS virus by abstaining from sex completely?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

811. Do you personally know someone who has the AIDS virus or someone who has died of AIDS?

YES 1
NO 2

812. Can the virus that causes AIDS be transmitted from mother to child?

YES 1
NO 2 (GO TO 814)
DON'T KNOW 8 (GO TO 814)

813A. When can the virus that causes AIDS can be transmitted from mother to child?
Can it be transmitted:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During childbirth?
YES 1
NO 2
DON'T KNOW 8
While breastfeeding?
YES 1
NO 2
DON'T KNOW 8

814. CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 815)
NO, NOT IN UNION/DOES NOT LIVE WITH A MAN (GO TO 815A)

815. Have you ever talked about ways to avoid contracting the AIDS virus with your (husband/live-in partner)?

YES 1
NO 2

 
815A. In your opinion, is it acceptable or unacceptable to talk about AIDS:

On the radio?
ACCEPTABLE 1
UNACCEPTABLE 2
On television?
ACCEPTABLE 1
UNACCEPTABLE 2
In the newspapers?
ACCEPTABLE 1
UNACCEPTABLE 2

816. If a person learns that he or she is infected with the virus that causes AIDS, should that person be permitted to keep his condition a secret, or should the information be shared with the community?

MAY BE KEPT SECRET 1
SHARED WITH THE COMMUNITY 2
DON'T KNOW/UNSURE 8

817. If someone in your family contracted the virus that causes AIDS, would you be willing to take care of him/her in your own household?

YES 1
NO 2
DON'T KNOW/UNSURE/DEPENDS 8

817A. Should people with AIDS who work with other people in shops, offices, or on farms be allowed to continue their work or not?

CAN CONTINUE TO WORK 1
CANNOT CONTINUE TO WORK 2
DON'T KNOW/UNSURE/DEPENDS 8

817B. Should children aged 12 to 14 be educated on the use of condoms to avoid contracting AIDS?

YES 1
NO 2
DON'T KNOW/UNSURE/DEPENDS 8

817C. Have you ever been tested to see if you have the AIDS virus?

YES 1 (GO TO 817FX)
NO 2

817D. Would you like to be tested for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 8

817E. Do you know of a place where you could be tested for AIDS?

YES 1
NO 2 (GO TO 818)

817F. Where can you go for this test?
817FX. Where did you go for this test?

IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SOURCE AND CRICLE THE APPROPRIATE CODE.

RECORD ALL MENTIONED

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)_____F
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC/HOSPITAL G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY)_____ L
OTHER SOURCE
SHOP M
CHURCH N
RELATIVES/FRIENDS O
OTHER (SPECIFY)_____ X

818. (Apart from AIDS), have you heard of any (other) infections that can be transmitted by sexual contact?

YES 1
NO 2 (GO TO 901)

819. If a man has a sexually transmitted disease, what symptoms might he have? Any others?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING 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
IMPOTENCE K
NO SYMPTOMS L
OTHER (SPECIFY)____ W
OTHER (SPECIFY)____ X
DON'T KNOW Z

820. If a woman has a sexually transmitted disease, what symptoms might she have? Any others?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE/DRIPPING 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 GET PREGNANT/HAVE A CHILD K
NO SYMPTOMS L
OTHER (SPECIFY)_____ W
OTHER (SPECIFY)_____ X
DON’T KNOW Z

820A. CHECK 514:

HAS HAD SEXUAL RELATIONS (GO TO 820B)
HAS NOT HAD SEXUAL RELATIONS (GO TO 901)

820B. Now, I would like to ask you questions about your health in the past 12 months. In the past 12 months, have you had a sexually transmitted disease?

YES 1
NO 2
DON'T KNOW 8

820C. Sometimes women can have vaginal discharge. In the past 12 months, have you had vaginal discharge?

YES 1
NO 2
DON'T KNOW 8

820D. Sometimes women can have a genital sore or ulcer. In the past 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

820E. CHECK 820B, 820C, 820D:

HAD AN INFECTION (GO TO 820F)
HAS NOT HAD AN INFECTION (GO TO 901)

820F. The last time you had (INFECTION FROM 820B, 820C, 820D), did you seek advice or treatment?

YES 1
NO 2 (GO TO 820H)

820G. The last time you had (INFECTION FROM 820B, 820C, 820D) did you do any of the following? Did you:

Seek advice from health personnel in a clinic or hospital?
YES 1
NO 2
Seek advice or treatment from a traditional healer?
YES 1
NO 2
Seek advice or purchase drugs from a store or a pharmacy?

 

YES 1
NO 2
Seek advice from friends or relatives?
YES 1
NO 2

820H. When you had (INFECTION FROM 820B, 820C, 820D), did you inform the person(s) with whom you have sex?

YES 1
NO 2
SOME/NOT ALL 3

820I. When you had (INFECTION FROM 820B, 820C, 820D) did you do anything to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 901)
PARTNER ALREADY INFECTED 3 (GO TO 901)

820J. What did you do to avoid infecting your partner(s)? Did you:

Stop having sex?
YES 1
NO 2
Use a condom during sex?
YES 1
NO 2
Take drugs?
YES 1
NO 2

SECTION 9. MATERNAL MORTALITY

901. Now, I want to ask you questions about your brothers and sisters, that is, all the children born to your natural mother, including those who live with you, those who live elsewhere, and those who died. To how many children has your own mother given birth, including yourself?

NUMBER OF BIRTHS TO NATURAL MOTHER______

902. CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE (RESPONDENT ONLY) (GO TO 914)

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

NUMBER OF PRECEDING BIRTHS______

904. What was the name given to your (next) oldest brother or sister?

NAME______

905. Is (NAME) male or female?

MALE 1
FEMALE 2
 

 
906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DON'T KNOW 8 (GO TO NEXT COLUMN)

907. How old is (NAME)?

AGE___ (GO TO NEXT COLUMN)

908. How long ago did (NAME) die?

YEARS___

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

AGE____ (IF MALE OR DIED BEFORE THE AGE OF 12, GO TO NEXT COLUMN)

910. Was (NAME) pregnant when she died?
   

YES 1 (GO TO 913)
NO 2

 

911. Did (NAME) die in childbirth?

YES 1 (GO TO 913)
NO 2

912. Did (NAME) die in the two months following the end of pregnancy or of a birth?

YES 1
NO 2 (GO TO NEXT COLUMN)

913. How many live children did (NAME) give birth to in her lifetime (before this pregnancy)?

NUMBER OF BIRTHS____ (GO TO NEXT COLUMN)

IF NO MORE BROTHERS OR SISTERS, GO TO 914

914. RECORD THE TIME

HOURS____
MINUTES_____

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX.

BIRTHS AND PREGNANCIES

B BIRTHS
P PREGNANCIES
T TERMINATIONS

END OF LAST PREGNANCY THAT DID NOT END IN A LIVE BIRTH BEFORE JANUARY 1994:
IF THERE WAS NO SUCH PREGNANCY, RECORD ‘00’ FOR THE MONTH AND ‘0000’ FOR THE YEAR

MONTH_____
YEAR

1999

12 DECEMBER 01
11 NOVEMBER 02
10 OCTOBER 03
09 SEPTEMBER 04
08 AUGUST 05
07 JULY 06
06 JUNE 07
05 MAY 08
04 APRIL 09
03 MARCH 10
02 FEBRUARY 11
01 JANUARY 12

1998

12 DECEMBER 13_ _
11 NOVEMBER 14_ _
10 OCTOBER 15_ _
09 SEPTEMBER 16_ _
08 AUGUST 17_ _
07 JULY 18_ _
06 JUNE 19_ _
05 MAY 20_ _
04 APRIL 21_ _
03 MARCH 22_ _
02 FEBRUARY 23_ _
01 JANUARY 24_ _

1997

12 DECEMBER 25_ _
11 NOVEMBER 26_ _
10 OCTOBER 27_ _
09 SEPTEMBER 28_ _
08 AUGUST 29_ _
07 JULY 30_ _
06 JUNE 31_ _
05 MAY 32_ _
04 APRIL 33_ _
03 MARCH 34_ _
02 FEBRUARY 35_ _
01 JANUARY 36_ _

1996

12 DECEMBER 37_ _
11 NOVEMBER 38_ _
10 OCTOBER 39_ _
09 SEPTEMBER 40_ _
08 AUGUST 41_ _
07 JULY 42_ _
06 JUNE 43_ _
05 MAY 44_ _
04 APRIL 45_ _
03 MARCH 46_ _
02 FEBRUARY 47_ _
01 JANUARY 48_ _

1995

12 DECEMBER 49_ _
11 NOVEMBER 50_ _
10 OCTOBER 51_ _
09 SEPTEMBER, 52_ _
08 AUGUST 53_ _
07 JULY 54_ _
06 JUNE 55_ _
05 MAY 56_ _
04 APRIL 57_ _
03 MARCH 58 _ _
02 FEBRUARY 59 _ _
01 JANUARY 60 _ _

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:___

COMMENTS ON SPECIFIC QUESTIONS:____

ANY OTHER COMMENTS:___

SUPERVISOR'S OBSERVATIONS___

NAME OF SUPERVISOR:___
DATE:____

EDITOR'S OBSERVATIONS___

NAME OF EDITOR:____
DATE:____