RWANDA DEMOGRAPHIC AND HEALTH SURVEY 2019-2020
WOMANS QUESTIONNAIRE
MINISTRY OF HEALTH
NATIONAL INSTITUTE OF STATISTICS OF RWANDA
PROVINCE: __
DISTRICT: __
SECTOR: __
NAME OF HOUSEHOLD HEAD __
CLUSTER NUMBER __
STRUCTURE NUMBER __
HOUSEHOLD NUMBER __
NAME AND LINE NUMBER OF WOMAN __
HOUSEHOLD SELECTED FOR WOMAN DV MODULE?
NO 2
WOMAN SELECTED FOR DV MODULE?
NO 2
FIRST VISIT
DATE __
INTERVIEWER'SNAME __
RESULT* __
NEXT VISIT:
DATE __
TIME __
SECOND VISIT
DATE __
INTERVIEWER'S NAME __
RESULT* __
NEXT VISIT:
DATE __
TIME __
THIRD VISIT
DATE __
INTERVIEWER'S NAME __
RESULT* __
FINAL VISIT
DAY __
MONTH __
YEAR __
INT. NO. __
RESULT* __
TOTAL NUMBER OF VISITS __
*RESULT CODES:
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER 7 (SPECIFY) __
LANGUAGE OF QUESTIONNAIRE 01
LANGUAGE OF INTERVIEW __
NATIVE LANGUAGE OF RESPONDENT __
TRANSLATOR USED (YES = 1, NO = 2) __
LANGUAGE OF QUESTIONNAIRE ENGLISH
LANGUAGE CODES:
KINYARWANDA 02
TEAM LEADER
NAME __
NUMBER __
FIELD EDITOR
NAME __
NUMBER __
OFFICE EDITOR
NUMBER __
KEYED BY
NUMBER __
Hello. My name is __________________________. I am working with National Institute of Statistics of Rwanda. We are conducting a survey about health and other topics all over Rwanda. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household. Do you have any questions? May I begin the interview now?
SIGNATURE OF THE INTERVIEWER __________________________ DATE: __________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
SECTION 1. RESPONDENT'S BACKGROUND
101. RECORD THE TIME
MINUTES __
102. How long have you been living continuously in this village? IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)
103. Just before you moved here, did you live in a city, in a town, or in a rural area?
TOWN 2
RURUAL AREA 3
104. Before you moved here, which province did you live in?
SOUTH 02
WEST 03
NORTH 04
EAST 05
OUTSIDE OF COUNTRY 96
105. In what month and year were you born?
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 9998
106. How old were you at your last birthday? COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107. Have you ever attended school?
NO 2 (SKIP TO 111)
108. What is the highest level of school you attended: primary, secondary, or higher?
PRIMARY 2
POST-PRIMARY/VOCATIONAL 3
SECONDARY 4
HIGHER 5
109. What is the highest (grade/form/year) you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
POST-PRIMARY/VOCATIONAL SECONDARY HIGHER (SKIP TO 113)
111. 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?
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) __
BLIND/VISUALLY IMPARED 5
CODE '1' OR '5' CIRCLED (SKIP TO 114)
113. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
114. Do you listen to the radio at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
115. Do you watch television at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
116. Do you own a mobile telephone?
NO 2 (SKIP TO 118)
117. Do you use your mobile phone for any financial transactions?
NO 2
118. Do you have an account in a bank or other financial institution that you yourself use?
NO 2
119. Have you ever used the internet?
NO 2 (SKIP TO 122)
120. In the last 12 months, have you used the internet? IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.
NO 2 (SKIP TO 122)
121. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
ADVENTIST 3
MUSLIM 4
TRADITIONAL 5
OTHER 6 (SPECIFY) ___
NO RELIGION 7
124. In the last 12 months, how many times have you been away from home for one or more nights?
NONE 00 (SKIP TO 201)
125. In the last 12 months, have you been away from home for more than one month at a time?
NO 2
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (SKIP TO 206)
202. Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (SKIP TO 204)
203. a) How many sons live with you?
b) And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME __
204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
NO 2 (SKIP TO 206)
205. a) How many sons are alive but do not live with you?
b) And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE __
205C. Where do your sons or daughters who do not live with you live? CIRCLE ALL MENTIONED.
RELATIVE B
IN THE STREET C
WORK D (SPECIFY) __
MARRIED E
OTHER X (SPECIFY) __
DON'T KNOW Z
206. Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
NO 2 (SKIP TO 208)
207. a) How many boys have died?
b) And how many girls have died?
IF NONE, RECORD '00'
GIRLS DEAD __
208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
209. CHECK 208: Just to make sure that I have this right, you have had in TOTAL __ births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)
NO BIRTHS (SKIP TO 226)
211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITINOAL QUESTIONNAIRE STARTING WITH THE SECOND ROW.
212. What name was given to your (first/next) baby?
BIRTH HISTORY NUMBER
213. Is (NAME) a boy or a girl?
GIRL 2
214. Were any of these births twins?
MULT 2
215. On what day, month, and year, was (NAME) born?
MONTH __
YEAR __
NO 2 (SKIP TO 220)
217. IF ALIVE: How old was (NAME) at (NAME)'s last birthday? RECORD AGE IN COMPLETED YEARS.
218. IF ALIVE:
Is (NAME) living with you?
NO 2
219. IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD.
RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.
220. IF DEAD: How old was (NAME) when (he/she) died? IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday? THEN ASK: Exactly how many months old was (NAME) when (he/she) died? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS 2 __
YEARS 3 __
221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
NO 2 (NEXT BIRTH)
222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?
NO 2
223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
224. CECK 215: ENTER THE NUMBER OF BIRTHS IN 2014-2019
NONE 0 (SKIP TO 226)
225. FOR EACH BIRTH IN 2014-2019, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
NO 2 (SKIP TO 230)
UNSURE 8 (SKIP TO 230)
227. How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P'S IN THE CALENDAR, BEGINNING WITH THE TOTAL NUMBER OF COMPLETED MONTHS.
228. When you pregnant, did you want to get pregnant at that time?
NO 2
229. CHECK 208: TOTAL NUMBER OF BIRTHS
ONE OR MORE:
a) Did you want to have a baby later on or did you not want any more children?
NO MORE/NONE 2
NONE:
b) Did you want to have a baby later or did you not want any children?
NO MORE/NONE 2
230. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (SKIP TO 239)
231. When did the last such pregnancy end?
YEAR __
LAST PREGNANCY ENDED IN 2013 OR EARLIER (SKIP TO 239)
233. In what month and year did the preceding such pregnancy end?
YEAR __
234. How many months pregnant were you when that pregnancy ended?
235. Since January 2014, have you had any other pregnancies that did not result in a live birth?
NO 2 (SKIP TO 236)
236. FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2014-2019 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY. IF THER ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.
237. Did you have any miscarriages, abortions, or stillbirths that ended before 2014?
NO 2 (SKIP TO 239)
238. When did the last such pregnancy that terminated before 2014 end?
YEAR __
239. When did your last menstrual period start? DATE, IF GIVEN
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
240. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?
NO 2 (SKIP TO 242)
DON'T KNOW 8 (SKIP TO 242)
241. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER 6 (SPECIFY) __
242. After the birth of a child, can a woman become pregnant before her menstrual period has returned?
NO 2
DON'T KNOW 8
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. Have you ever heard of (METHOD)?
01 Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
NO 2
02 Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
NO 2
03 IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
NO 2
04 Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
NO 2
05 Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
NO 2
06 Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
NO 2
07 Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
NO 2
08 Female Condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
NO 2
09 Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
NO 2
10 Standard Days Method. PROBE: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
NO 2
11 Lactational Amenorrhea Method (LAM). PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
NO 2
12 Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
NO 2
13 Withdrawal. PROBE: Men can be careful and pull out before climax.
NO 2
14 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, TRADITIONAL METHOD B (SPECIFY) __
NO Y
PREGNANT (SKIP TO 312)
303. Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (SKIP TO 312)
304. Which method are you using? RECORD ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION B (SKIP TO 307)
IUD C (SKIP TO 309)
INJECTABLES D (SKIP TO 309)
IMPLANTS E (SKIP TO 309)
PILL F
CONDOM G (SKIP TO 306)
FEMALE CONDOM H (SKIP TO 309)
EMERGENCY CONTRACEPTION I (SKIP TO 309)
STANDARD DAYS METHOD J (SKIP TO 309)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 309)
RHYTHM METHOD L (SKIP TO 309)
WITHDRAWAL M (SKIP TO 309)
OTHER MODERN METHOD X (SKIP TO 309)
OTHER TRADTIONAL METHOD Y (SKIP TO 309)
305. What is the brand name of the pills you are using? IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.
MICROLYTE 02 (SKIP TO 309)
OTHER 96 (SPECIFY) __ (SKIP TO 309)
DON'T KNOW 98 (SKIP TO 309)
306. What is the brand name of the condoms you are using? IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.
PLAISIR 02 (SKIP TO 309)
LOVE 03 (SKIP TO 309)
GENERIC CONDOM 04 (SKIP TO 309)
OTHER 96 (SPECIFY) __ (SKIP TO 309)
DON'T KNOW 98 (SKIP TO 309)
307. In what facility did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
OUTREACH 15
OTHER PUBLIC SECTOR 16 (SPECIFY) __
CLINIC 22
DISPENSARY 23
OTHER PRIVATE MEDICAL SECTOR 26 (SPECIFY) __
OTHER 96 (SPECIFY) __
DON'T KNOW 98
308. In what month and year was the sterilization performed?
YEAR __ (SKIP TO 310)
309. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?
YEAR __
310. CHECK 308 AND 309, 215 AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION.))
312. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2014. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
312A. MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.
YEAR __
312B. Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?
NO 2 (SKIP TO 312I)
312D. How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?
CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.
MONTHS __ (SKIP TO 312F)
DATE GIVEN 95
312E. RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.
YEAR __
312F. For how many months did you use (METHOD)?
CIRCLE '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.
DATE GIVEN 95
312G. RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.
YEAR __
312H. Why did you stop using (METHOD)?
312I. GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.
313. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH
ANY METHOD USED (SKIP TO 315)
314. Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (SKIP TO 326)
315. CHECK 304: CIRCLE/CHOOSE METHOD CODE: IF MORE THAN ONCE METHOD CODE CIRCLED IN 304, CIRCLE/CHOOSE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01 (SKIP TO 319)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 323)
RHYTHM METHOD 12 (SKIP TO 323)
WITHDRAWAL 13 (SKIP TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96
316. You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
OUTREACH 15
OTHER PUBLIC SECTOR 16 (SPECIFY) __
CLINIC 22
DISPENSARY 23
PHARMACY 24
FAMILY PLANNING CLINIC 25
OTHER PRIVATE HEALTH 26 (SPECIFY) __
CHURCH 32
FRIEND/RELATIVE 33
YOUTH CENTER 34
317. CHECK 304: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (SKIP TO 323)
FEMALE CONDOM 08 (SKIP TO 322)
EMERGENCY CONTRACEPTION 09 (SKIP TO 322)
STANDARD DAYS METHOD 10 (SKIP TO 322)
OTHER MODERN METHOD 95 (SKIP TO 322)
OTHER TRADITIONAL METHOD 96 (SKIP TO 323)
318. At that time, were you told about side effects or problems you might have with the method?
NO 2 (SKIP TO 320)
319. When you got sterilized, were you told about side effects or problems you might have with the method?
NO 2
320. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (SKIP TO 322)
321. Were you told what to do if you experienced side effects or problems?
NO 2
ANY 'YES'
a) At that time, were you told about other methods of family planning that you could use?
OTHER
b) When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHO FROM 307 OR 316), were you told about other methods of family planning that you could use?
NO 2
323. Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
324. CHECK 304: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 327)
RHYTHM METHOD 12 (SKIP TO 327)
WITHDAWL 13 (SKIP TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (SKIP TO 327)
325. Where did you obtain (CURRENT METHOD) the last time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL 12 (SKIP TO 327)
HEALTH CENTER 13 (SKIP TO 327)
HEALTH POST 14 (SKIP TO 327)
OUTREACH 15 (SKIP TO 327)
OTHER PUBLIC SECTOR 16 (SPECIFY) __ (SKIP TO 327)
CLINIC 22 (SKIP TO 327)
DISPENSARY 23 (SKIP TO 327)
PHARMACY 24 (SKIP TO 327)
FAMILY PLANNING CLINIC 25 (SKIP TO 327)
OTHER PRIVATE HEALTH 26 (SPECIFY) __ (SKIP TO 327)
CHURCH 32 (SKIP TO 327)
FRIEND/RELATIVE 33 (SKIP TO 327)
YOUTH CENTER 34 (SKIP TO 327)
326. Do you know of a place where you can obtain a method of family planning?
NO 2
327. In the last 12 months, were you visited by a health provider?
NO 2 (SKIP TO 329)
328. Did the health provider talk to you about family planning?
NO 2
329. CHECK 202: CHILDREN LIVING WITH THE RESPONDENT
YES
a) In the last 12 months, have you visited a health facility for care for yourself or your children?
NO
b) In the last 12 months, have you visited a health facility for care for yourself?
NO 2 (SKIP TO 401)
330. Did any staff member at the health facility speak to you about family planning methods?
NO 2
SECTION 4. PREGNANCY AND POSTNATAL CARE
401. CHECK 224:
NO BIRTHS IN 2014-2019 (SKIP TO 648)
402, CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2014-2019. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S). Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately).
403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.
LAST BIRTH
NEXT-TO-LAST BIRTH
LIVING (CONTINUE)
DEAD (CONTINUE)
405. When you got pregnant with (NAME), did you want to get pregnant at that time?
NO 2
ONLY ONE BIRTH
a) Did you want to have a baby later on, or did you not want any children?
MORE THAN ONE BIRTH
b) Did you want to have a baby later on, or did you not want any more children?
NO MORE/NONE 2 (SKIP TO 408)
407. How much longer did you want to wait?
YEARS 2 __
DON' KNOW 998
408. Did you see anyone for antenatal care for this pregnancy?
NO 2 (SKIP TO 414)
409. Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
COMMUNITY/VILLAGE HEALTH WORKER E
COMMUNITY HEALTH MOTHER AND CHILD F
410. Where did you receive antenatal care for this pregnancy? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
OTHER HOME B
PROV/DIST. HOSPITAL D
HEALTH CENTER E
HEALTH POST F
OUTREACH G
OTHER PUBLIC FACILITY H (SPECIFY) __
CLINIC J
DISPENSARY K
OTHER PRIVATE MED. FACILITY L (SPECIFY) __
411. How many months pregnant were you when you first received antenatal care for this pregnancy?
DON'T KNOW 98
412. How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
LESS THAN 2 TIMES (SKIP TO 413)
412B. How many months pregnant were you when you received your second antenatal care for this pregnancy?
DON'T KNOW 98
LESS THAN 3 TIMES (SKIP TO 413)
412D. How many months pregnant were you when you received your third antenatal care for this pregnancy?
LESS THAN 4 TIMES (SKIP TO 413)
412F. How many months pregnant were you when you received your fourth antenatal care for this pregnancy?
DON'T KNOW 98
413. As part of your antenatal care during this pregnancy, were any of the following done at least once:
a) Was your blood pressure measured?
b) Did you give a urine sample?
c) Did you give a blood sample?
d) Malnutrition screening (MID UPPER ARM CIRCUMFERENCE)?
BP
NO 2
URINE
NO 2
BLOOD
NO 2
CIRCUMFERENCE
NO 2
413E. During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?
NO 2
DON'T KNOW 8
414. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (SKIP TO 417)
DON'T KNOW 8 (SKIP TO 417)
415. During this pregnancy, how many times did you get a tetanus injection?
DON'T KNOW 8
OTHER (CONTINUE)
417. At any times before this pregnancy, did you receive any tetanus injections?
NO 2 (SKIP TO 420)
DON'T KNOW 8 (SKIP TO 420)
418. Before this pregnancy, how many times did you receive a tetanus injection? IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
ONLY ONE TIME
a) How many years ago did you receive that tetanus injection?
MORE THAN ONE TIME
b) How many years ago did you receive the last tetanus injection prior to this pregnancy?
420. During this pregnancy, were you given or did you buy any iron tablets or iron syrup? SHOW TABLETS/SYRUP.
NO 2 (SKIP TO 422)
DON'T KNOW 8 (SKIP TO 422)
421. During the whole pregnancy, for how many days did you take the tablets or syrup? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
422. During this pregnancy, did you take any drug for intestinal worms?
NO 2
DON'T KNOW 8
426. When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
427. Was (NAME) weighed at birth?
NO 2 (SKIP TO 429)
DON'T KNOW 8 (SKIP TO 429)
428. How much did (NAME) weigh? RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KG FROM RECALL 2 __
DON'T KNOW 99998
429. Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
COMMUNITY HEALTH WORKER E
COMMUNITY HEALTH MOTHER AND CHILD F
RELATIVE/FRIEND G
OTHER X (SPECIFY) __
430. Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
OTHER HOME 12 (SKIP TO 434)
PROVINCIAL/DISTRICT HOSPITAL 22
HEALTH CENTER 23
HEALTH POST 24
OTHER PUBLIC SECTOR 26 (SPECIFY) __
CLINIC 32
DISPENSARY 33
OTHER PRIVATE HEALTH 36 (SPECIFY) __
OTHER 96 (SPEICFY) __ (SKIP TO 434)
431. How long after (NAME) was delivered did you stay there? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
432. Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?
NO 2 (SKIP TO 434)
433. When was the decision made to have the caesarean section? Was it before or after your labor pains started?
AFTER 2
434. Immediately after the birth, was (NAME) put on your chest?
NO 2 (SKIP TO 434B)
DON'T KNOW 8 (SKIP TO 434B)
434A. Was (NAME)'s bare skin touching your bare skin?
NO 2
DON'T KNOW 8
434B. CHECK 430: PLACE OF DELIVERY
OTHER (CONTINUE)
435. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?
NO 2 (SKIP TO 438)
436. How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
437. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
438. Now I would like to talk to you about checks on (NAME)'s health after delivery -- for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?
NO 2 (SKIP TO 441)
DON'T KNOW 8 (SKIP TO 441)
439. How long after delivery was (NAME)'s health first checked? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS,
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
440. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
441. Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?
NO 2 (SKIP TO 445)
442. How long after delivery did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
443. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
444. Where did the check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
OTHER HOME 12
PROVINCIAL/DISTRICT HOSPITAL 22
HEALTH CENTER 23
HEALTH POST 24
OTHER PUBLIC SECTOR 26 (SPECIFY) __
CLINIC 32
DISPENSARY 33
OTHER PRIVATE MEDICAL SECTOR 36 (SPECIFY) __
445. I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)
446. .How many hours, days, or weeks after the birth of (NAME) did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
447. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
448. Where did this check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
OTHER HOME 12 (SKIP TO 457)
PROVINCIAL/DISTRICT HOSPITAL 22 (SKIP TO 457)
HEALTH CENTER 23 (SKIP TO 457)
HEALTH POST 24 (SKIP TO 457)
OTHER PUBLIC SECTOR 26 (SPECIFY) __ (SKIP TO 457)
CLINIC 32 (SKIP TO 457)
DISPENSARY 33 (SKIP TO 457)
OTHER PRIVATE MEDICAL SECTOR 36 (SPECIFY) __ (SKIP TO 457)
449. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?
NO 2 (SKIPT O 453)
450. How long after delivery did the first check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
451. Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
452. Where did the first check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
OTHER HOME 12
PROVINCIAL/DISTRICT HOSPITAL 22
HEALTH CENTER 23
HEALTH POST 24
OTHER PUBLIC SECTOR 26 (SPECIFY) __
CLINIC 32
DISPENSARY 33
OTHER PRIVATE MEDICAL SECTOR 36 (SPECIFY) __
453. I would like to talk to you about checks on (NAME)'s health after delivery -- for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)
454. 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.
DAYS 2 __
WEEKS 3 __
DON'T KNOW 998
455. Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
COMMUNITY HEALTH WORKER 22
COMMUNITY HEALTH MOTHER AND CHILD 23
456. Where did this first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
OTHER HOME 12
PROVINCIAL/DISTRICT HOSPITAL 22
HEALTH CENTER 23
HEALTH POST 24
OTHER PUBLIC SECTOR 26 (SPECIFY) __
CLINIC 32
DISPENSARY 33
OTHER PRIVATE MEDICAL SECTOR 36 (SPECIFY) __
457. During the first 24 hours after (NAME)'s birth, did any health care provider do the following:
a) Examine the cord?
b) Measure (NAME)'s temperature?
c) Counsel you on danger signs for newborns?
d) Counsel you on breastfeeding?
e) Observe (NAME) breastfeeding?
a) CORD
NO 2
DK 8
b) TEMP.
NO 2
DK 8
c) SIGNS
NO 2
DK 8
d) COUNSEL BREASTFEED
NO 2
DK 8
e) OBSERVE BREASTFEED
NO 2
DK 8
457F. How many times have you altogether been checked after delivering (NAME)?
458. Has your menstrual period returned since the birth of (NAME)?
NO 2 (SKIP TO 461)
459. Did your period return between the birth of (NAME) and your next pregnancy?
NO 2 (SKIP TO 463)
460. For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
461. CHECK 226: IS RESPONDENT PREGNANT?
PREGNANT OR UNSURE (SKIP TO 463)
462. Have you had sexual intercourse since the birth of (NAME)?
NO 2 (SKIP TO 464)
463. For how many months after the birth of (NAME) did you not have sexual intercourse?
DON'T KNOW 98
464. Did you ever breastfeed (NAME)?
NO 2
465. CHECK 404: IS CHILD LIVING?
DEAD (SKIP TO 471)
466. How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.
HOURS 1 __
DAYS 2 __
467. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
NO 2 (GO TO 468)
467A. What was (NAME) given to drink? Anything else? RECORD ALL LIQUIDS MENTIONED.
PLAIN WATER B
SUGAR OR GLUCOSE C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
COFFEE I
HONEY J
OTHER X (SPECIFY) __
DEAD (SKIP TO 470A)
469. Are you still breastfeeding (NAME)?
NO 2
470. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
470A. CHECK 430: CODE 11, 12, OR 96 CIRCLED
NO (SKIP TO 471)
470B. Why did you not deliver (NAME) at a health facility?
TOO FAR/NO TRANSPORT 02
DON'T TRUST FACILITY 03
NO FEMALE PROVIDER 04
HUSBAND FAMILY DON'T ALLOW 05
NOT NECESSARY/EASY TO DELIVERY/COMFORTABLE POSITION 06
CUSTOMARY TO DELIVER AT HOME 07
OTHER 96 (SPECIFY) __
471. GO BACK TO 405, IN NEXT COLUMN; OR, IF NO MORE BIRTHS GO TO 501A.
SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)
501A. CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2016-2019?
NO BIRTHS IN 2016-2019 (SKIP TO 601)
502A. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2016-2019.
BIRTH HISTORY NUMBER __
DEAD (SKIP TO 501B)
504A. Do you have a card or other document where (NAME)'s vaccinations are written down?
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (SKIP TO 507A)
NO, NO CARD AND NO DOCUMENT 4
505A. Did you ever have a vaccination card for (NAME)?
NO 2
CODE '4' CIRCLED (SKIP TO 511A)
507A. May I see the card or other document where (NAME)'s vaccinations are written down?
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMER SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (SKIP TO 511A)
508A. COPY DATES FROM THE CARD.
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
509A. CHECK 508A: 'BCG' TO '[MEASLES CONTAINING VACCINE] 2' ALL RECORDED?
YES (SKIP TO 525A)
510A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?
RECORD 'YES' ONLY IF THE RESPONDENT MENTINOS AT LEAST ONE OF THE VACCINATINOS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.
NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN SKIP TO 525A)
DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN SKIP TO 525A)
511A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?
NO 2 (SKIP TO 525A)
DON'T KNOW 8 (SKIP TO 525A)
512A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection n the arm or shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
514A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?
NO 2 (SKIP TO 517A)
DON'T KNOW 8 (SKIP TO 517A)
515A. Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?
LATER 2
516A. How many times did (NAME) receive the oral polio vaccine?
517A. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?
NO 2 (SKIP TO 519A)
DON'T KNOW 8 (SKIP TO 519A)
518A. How many times did (NAME) receive the pentavalent vaccine?
519A. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?
NO 2 (SKIP TO 521A)
DON'T KNOW 8 (SKIP TO 521A)
520A. How many times did (NAME) receive the pneumococcal vaccine?
521A. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?
NO 2 (SKIP TO 523A)
DON'T KNOW 8 (SKIP TO 523A)
522A. How many times did (NAME) receive the rotavirus vaccine?
523A. Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?
NO 2 (SKIP TO 525A)
DON'T KNOW 8 (SKIP TO 525A)
524A. How many times did (NAME) receive the measles vaccine?
525A. In the last 7 days was (NAME) given: Ongera intungamubiri? IF YES: How many times did (NAME) took Ongera intungamubiri?
a) ONGERA INTUNGAMUBIRI
NO 2
DK 8
TIMES __
SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH_
501B. CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2016-2019?
NO MORE BIRTHS IN 2016-2019 (SKIP O 601)
502B. RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2016-2019.
BIRTH HISTORY NUMBER __
DEAD (SKIP TO 526B)
504B. Do you have a card or other document where (NAME)'s vaccinations are written down?
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (SKIP TO 507B)
NO, NO CARD AND NO OTHER DOCUMENT 4
505B. Did you ever have a vaccination card for (NAME)?
NO 2
CODE '4' CIRCLED (SKIP TO 511B)
507B. May I see the card or other document where (NAME)'s vaccinations are written down?
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO, CARD AND NO OTHER DOCUMENT SEEN 4 (SKIP TO 511B)
508B. COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
509B CHECK 508B: 'BCG' TO '[MEASLES CONTAINING VACCINE] 2' ALL RECORDED?
YES (SKIP TO 525B)
510B. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORD AS HAVING BEEN GIVEN.
NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN SKIP TO 525B)
DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN, THEN SKIP TO 525B)
511B. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?
NO 2 (SKIP TO 525B)
DON'T KNOW 8 (SKIP TO 525B)
512B. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
514B. Has (NAME) ever receive oral polio vaccine, that is, about two drops in the mouth to prevent polio?
NO 2 (SKIP TO 517B)
DON'T KNOW 8 (SKIP TO 517B)
515B. Did (NAME) receive the first oral polio vaccine the first two weeks after birth or later?
LATER 2
516B. How many times did (NAME) receive the oral polio vaccine?
516B1. The last time (NAME) received the polio drops, did (NAME) also get an IPV injection in the arm to protect against polio?
NO 2
DON'T KNOW 8
517B. Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?
NO 2 (SKIP TO 519B)
DON'T KNOW 8 (SKIP TO 519B)
518B. How many times did (NAME) receive the pentavalent vaccine?
519B. Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?
NO 2 (SKIP TO 521B)
DON'T KNOW 8 (SKIP TO 521B)
520B. How many times did (NAME) receive the pneumococcal vaccine?
521B. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?
NO 2 (SKIP TO 523B)
DON'T KNOW 8 (SKIP TO 523B)
522B. How many times did (NAME) receive the rotavirus vaccine?
523B. Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?
NO 2 (SKIP TO 525B)
DON'T KNOW 8 (SKIP TO 525B)
524B. How many times did (NAME) receive the measles vaccine?
525B. In the last 7 days was (NAME) given: Ongera intungamubiri? IF YES: How many times did (NAME) took Ongera intungamubiri?
a) ONGERA INTUNGAMUBIRI
NO 2
DK8
TIMES __
526B. CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2016-2019?
NO MORE BIRTHS IN 2016-2019 (SKIP TO 601)
SECTION 6. CHILD HEALTH AND NUTRITION
601. CHECK 224:
NO BIRTHS IN 2014-2019 (SKIP TO 648)
602. CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2014-2019. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S). Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)
603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.
LAST BIRTH
NEXT-TO-LAST BIRTH
LIVING (CONTINUE)
DEAD (SKIP TO 646)
605. In the last six months, was (NAME) given a vitamin A dose like [this/any of these]? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
NO 2
DON'T KNOW 8
607. Was (NAME) given any drug for intestinal worms in the last six months?
NO 2
DON'T KNOW 8
608. Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)
608A. Was there any blood in the stools?
NO 2
DON'T KNOW 8
609. CHECK 469: CURRENTLY BREASTFEEDING?
NO/NOT ASKED b) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
610. When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
610A. CHECK 469: CURRENTLY BREASTFEEDING?
NO/NOT ASKED (SKIP TO 611)
610B. When (NAME) had diarrhea, did you continue to breastfeed him/her?
NO 0
611. Did you seek advice or treatment for the diarrhea from any source?
NO 2 (SKIP TO 615)
612. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S). NAME OF PLACE(S)
PROVINCIAL/DISTRICT HOSPITAL B
HEATH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC SECTOR G (SPECIFY) __
CLINIC I
DISPENSARY J
PHARMACY K
OTHER PRIVATE MEDICAL SECTOR L (SPECIFY) __
TRADITIONAL HEALER N
CHURCH O
FRIEND/RELATIVE P
ONLY ONE CODE CIRCLED (SKIP TO 615)
614. Where did you first seek advice or treatment? USE LETTER CODE FROM 612.
615. Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:
a) A pre-packaged ORS liquid?
b) A government-recommended homemade fluid?
c) Zinc tablets or syrup?
a) ORS LIQUID
NO 2
DK 8
b) HOMEMADE FLUID
NO 2
DK 8
c) ZINC
NO 2
DK 8
616. CHECK 615:
ANY 'YES' a) Was anything else given to treat the diarrhea?
ALL 'NO' OR 'DK' b) Was anything given to treat the diarrhea?
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)
617. CHECK 615:
ANY 'YES' a) What else was given to treat the diarrhea?Anything else?
ALL 'NO' OR 'DK' b) What was given to treat the diarrhea?Anything else?
RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
HOME REMEDY/HERBAL MEDICINE I
OTHER X (SPECIFY) __
618. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (SKIP TO 620)
DON'T KNOW 8 (SKIP TO 620)
619. At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?
NO 2
DON'T KNOW 8
620. Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
621. Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?
NO 2 (SKIP TO 623)
DON'T KNOW 8 (SKIP TO 623)
622. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (SKIP TO 624)
BOTH 3 (SKIP TO 624)
OTHER 6 (SPECIFY) __ (SKIP TO 624)
DON'T KNOW 8 (SKIP TO 624)
NO OR DK (SKIP TO 646)
623A. Now I would like to know how much (NAME) was given to drink (including breastmilk) 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
623B. When (NAME) had a (fever/cough), 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
624. Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 629)
625. Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S). NAME OF PLACE(S)
PROVINCIAL/DISTRICT HOSPITAL B
HEATH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC SECTOR G (SPECIFY) __
CLINIC I
DISPENSARY J
PHARMACY K
OTHER PRIVATE MEDICAL SECTOR L (SPECIFY) __
TRADITIONAL HEALER N
CHURCH O
FRIEND/RELATIVE P
ONLY ONE CODE CIRCLED (SKIP TO 628)
627. Where did you first seek advice or treatment? USE LETTER CODE FROM 625.
628. How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.
629. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 646)
DON'T KNOW 8 (SKIP TO 646)
630. What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.
QUININE B
ARTESUNATE C
OTHER ANTIMALARIAL E (SPECIFY) __
INJECTION/IV G
PARACETAMOL I
IBUPROFEN J
DON'T KNOW Z
631. CHECK 630: ANY CODE A-D CIRCLED?
NO (SKIP TO 646)
632. CHECK 630: ACT (COARTEM) ('A') GIVEN
CODE 'A' NOT CIRCLED (SKIP TO 636)
633. How long after the fever started did (NAME) first take ACT (COARTEM)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
636. CHECK 630: QUININE ('B') GIVEN
CODE 'B' NOT CIRCLE (SKIP TO 638)
637. How long after the fever started did (NAME) first take QUININE?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
638. CHECK 630: ALTESUNATE ('C') GIVEN
CODE 'C' NOT CIRCLED (SKIP TO 640)
639. How long after the fever started did (NAME) first take artesunate?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
640. CHECK 630: OTHER ANTIMALARIAL ('D') GIVEN
CODE 'D'NOT CIRCLED (SKIP TO 646)
641. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
646. GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.
647. CHECK 615(a) AND 615(b), ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (SKIP TO 649)
648. Have you ever heard of a special product called ORS you can get for the treatment of diarrhea?
NO 2
649. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2017-2019 LIVING WITH THE RESPONDENT
NAME OF YOUNGEST CHILD LIVING WITH HER
NONE (SKIP TO 701)
650. Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.
a) Plain water?
NO 2
DK 8
b) Juice or juice drinks?
NO 2
DK 8
c) Clear broth?
NO 2
DK 8
d) Milk such as tinned, powdered, or fresh animal milk? IF YES: How many times did (NAME) drink? IF 7 OR MORE TIMES, RECORD '7'.
NO 2
DK 8
e) Infant formula? IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
NO 2
DK 8
f) Any other liquids?
NO 2
DK 8
g) Yogurt? IF YES: How many times did (NAME) eat yogurt? IF 7 OR MORE TIMES, RECORD '7'.
NO 2
DK 8
h) Cerelac, phosphatin?
NO 2
DK 8
i) Bread, rice, noodles, porridge, or other foods made from grains?
NO 2
DK 8
j) Pumpkin, carrots, squash, or sweet potatoes that are yellow or orange inside?
NO 2
DK 8
k) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
NO 2
DK 8
l) Any dark green, leafy vegetables?
NO 2
DK 8
m) Ripe mangoes, avocadoes, papayas, banana or other fruit with A vitamin?
NO 2
DK 8
n) Any other fruits or vegetables?
NO 2
DK 8
o) Liver, kidney, heart, or other organ matters?
NO 2
DK 8
p) Any meat such as beef, pork, lamb, goat, chicken, or duck?
NO 2
DK 8
q) Eggs?
NO 2
DK 8
r) Fresh or dried fish or shellfish?
NO 2
DK 8
s) Any foods made from beans, peas, lentils?
NO 2
DK 8
t) Cheese or other food made from milk?
NO 2
DK 8
u) Any other solid, semi-sold, or soft food?
NO 2
DK 8
651. CHECK 650 (CATEGORIES 'g' THROUGH 'u'):
AT LEAST ONE 'YES' (SKIP TO 653)
652. Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night? IF YES, PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?
NO 2 (SKIP TO 653A)
653. How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
653A. In the last month, did you participate in the monthly growth monitoring and nutrition promotion sessions conducted by the community health workers?
NO 2
653B. What is the main reason you did not participate in this growth monitoring and nutrition promotion session last month?
DO NOT HAVE TO TIME TO ATTEND 2
DO NOT FIND IT RELEVANT TO ATTEND 3
SITE IS TOO FAR FOR ME TO ATTEND 4
NO MEANS TO CONTRIBUTE TO COOKING DEMONSTRATION 5
MY CHILD WAS SICK 6
FAMILY EMERGENCY 7
OTHER 8 (SPECIFY) __
653C. Last month has (NAME) received any deworming treatment?
NO 2
654. The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER 96 (SPECIFY) __
655. CHECK 217 AND 218: ANY CHILD 0-4 YEARS OLD LIVING WITH HIS/HER MOTHER?
NO (SKIP TO 701)
656. CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGED 0-4 LIVING WITH HIS/HER MOTHER AND RECORD NAME AND LINE NUMBER
LINE NUMBER OF THE YOUNGEST CHILD (Q.219) __
657. Now I would like to ask you about (NAME); your youngest child that is 0-4 years old.
657a. In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (NAME)? IF YES, ASK: Who is engaged in this activity with (NAME)?
a) Read books to or looked at picture with (NAME)?
b) Told stories to (NAME)?
c) Sang songs to (NAME) or with (NAME), including lullabies?
d) Took (NAME) outside the home, compound, yard, or enclosure?
e) Played with (NAME)
f) Named, counted, or drew things to or with (NAME)?
a) READ BOOKS
FATHER B
OTHER X
NO ONE Y
b) TOLD STORIES
FATHER B
OTHER X
NO ONE Y
c) SANG SONGS
FATHER B
OTHER X
NO ONE Y
d) TOOK OUTSIDE
FATHER B
OTHER X
NO ONE Y
e) PLAYED WITH
FATHER B
OTHER X
NO ONE Y
f) NAMED OR COUNTED
FATHER B
OTHER X
NO ONE Y
658. How many children's books or picture books do you have for name?
NUMBER OF CHILDREN'S BOOKS __
TEN OR MORE BOOKS 10
659. I am interested in learning about the things that (NAME) plays with when he/she is at home. Does he/she play with:
a) Homemade toys (such as dolls, cars, or other toys made at home)?
b) Toys from a shop or manufactured toys?
c) Household objects (such as bowls or pots) or objects found outside (such as sticks, rocks, animal shells or leaves)?
IF RESPONDENT SAYS 'YES' TO THE CATEGORIES ABOVE, THEN PROBE TO LEARN SPECIFICALLY WHAT THE CHILD PLAYS WITH TO ASCERTAIN THE RESPONSE.
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
660. Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children. On how many days in the past week was (NAME):
a) Left alone for more than an hour?
b) Left in the care of another child, that is, someone less than 10 years old for more than an hour?
IF NONE, ENTER '0'. IF 'DON'T KNOW' ENTER '8'.
NUMBER OF DAYS LEFT WITH ANOTHER CHILD FOR MORE THAN AN HOUR __
660C. Do you attend any of the following forms of Parenting Education program in the last month?
d) Umugoroba w'ababyeyi?
e) Inshuti z'umuryango?
f) Community Parenting Session in ecd facility?
g) Parenting Programmes religious sessions?
h) Parenting programmes from women's groups?
i) Community Theatre?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
661. VERY 217: AGE OF THE CHILD
CHILD 2 OR 3 OR 4 YEARS (SKIP TO 664)
662. VERIFY 217 AND 218: ANY CHILD AGE 2-4 LIVING WITH HIS/HER MOTHER?
NO (SKIP TO 701)
663. CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGE 2 OR 3 OR 4 LIVING WITH HIS/HER MOTHER AND RECORD NAME AND LINE NUMBER
LINE NUMBER OF YOUNGEST CHILD AGE 2 OR 3 OR 4 FROM Q.212 __
664. Does (NAME) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care?
NO 2
DON'T KNOW 8
665. In the past 7 days, about how many hours did (NAME) go to that place:
667. I would like to ask you some questions about the health and development of (NAME). Children do not all develop and learn at the same rate. For example, some walk earlier than others. These questions are related to several aspects of (NAME)'s development. Can (NAME) identify or name at least ten letters of the alphabet?
NO 2
DK 8
668. Can (NAME) read at least four simple, popular words?
NO 2
DK 8
669. Does (name) know the name and recognize the symbol of all numbers from 1 to 10?
NO 2
DK 8
670. Can (NAME) pick up a small object with two fingers, like a stick or a rock from the ground?
NO 2
DK 8
671. Is (NAME) sometimes to sick to play?
NO 2
DK 8
672. Does (NAME) follow simple directions on how to do something correctly?
NO 2
DK 8
673. When given something to do, is (NAME) able to do it independently?
NO 2
DK 8
674. Does (NAME) get along well with other children?
NO 2
DK 8
675. Does (NAME) kick, bite, or hit other children or adults?
NO 2
DK 8
676. Does (NAME) get distracted easily?
NO 2
DK 8
SECTION 7. MARRIAGE AND SEXUAL ACTIVITY
701. Are you currently married or living together with a man as if married?
YES, LIVING WITH A MAN 2 (SKIP TO 704)
NO, NOT IN UNION 3
702. Have you ever been married or lived together with a man as if married?
YES, LIVED WITH A MAN 2
NO 3 (SKIP TO 712)
703. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (SKIP TO 709)
SEPARATED 3 (SKIP TO 709)
704. Is your (husband/partner) living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
705. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NO. __
706. Does your (husband/partner) have other wives or does he live with other women as if married?
NO 2 (SKIP TO 709)
DON'T KNOW 8 (SKIP TO 709)
707. Including yourself, in total, how many wives or live-in partners does he have?
DON'T KNOW 98
708. Are you the first, second, ? wife?
709. Have you been married or lived with a man only once or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A MAN ONLY ONCE a) In what month and year did you start living with your (husband/partner)?
MARRIED/LIVED WITH A MAN MORE THAN ONCE b) Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?
DON'T KNOW MONTH 98
YEAR __ (SKIP TO 712)
DON'T KNOW YEAR 9998
711. How old were you when you first started living with him?
712. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
713. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?
AGE IN YEARS __
714. I would like to ask you about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. When was the last time you had sexual intercourse? IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 2 __ (SKIP TO 716)
MONTHS AGO 3 __ (SKIP TO 716)
YEARS AGO 4 __ (SKIP TO 727)
715. When was the last time you had sexual intercourse with this person? SECOND-TO-LAST SEXUAL PARTNER
WEEKS AGO 2 __
MONTHS AGO 3 __
716. The last time you had sexual intercourse with this person, was a condom used?
NO 2 (SKIP TO 718)
717. Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
718. What was your relationship to this person with whom you had sexual intercourse? IF BOYFRIEND: Were you living together as if married? IF YES, RECORD '2'. IF NO, RECORD '3'.
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/SEX WORKER 5
OTHER 6 (SPECIFY) __
719. How long ago did you first have sexual intercourse with this person?
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
720. How many times during the last 12 months did you have sexual intercourse with this person? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.
720A. How many times during the last month did you have sexual intercourse with this person?
DON'T KNOW 98
722. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
NO 2 (SKIP TO 724)
723. In total with how many different people have you had sexual intercourse in the last 12 months? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
723A. In total, with how many different people have you had sexual intercourse in the last month? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.
DON'T KNOW #
AGE 25-49 (SKIP TO 727)
CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 727)
726. In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?
NO 2
727. In total, with how many different people have you had sexual intercourse in your lifetime? IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.
DON'T KNOW 98
728. CHECK 716, MOST RECENT PARTNERS (FIRST COLUMN):
NO, CONDOM NOT USED (SKIP TO 730A)
NOT ASKED (SKIP TO 730A)
729. You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time? IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.
PLEASURE 02
LOVE 03
GENERIC CONDOM 04
OTHER 96 (SPECIFY) __
DON'T KNOW 98
730. From where did you obtain the condom the last time? PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE FI PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC SECTOR 16 (SPECIFY) __
CLINIC 22
DISPENSARY 23
PHARMACY 24
FAMILY PLANNING CLINIC 25
OTHER PRIVATE MEDICAL SECTOR 26 (SPECIFY) __
CHURCH 32
FRIEND/RELATIVE 33
YOUTH CENTER 34
DON'T KNOW 98
730A. If you wanted to, could you get a male condom by yourself?
NO 2
DON'T KNOW MALE CONDOM 3
DON'T KNOW/UNSURE 8
731. PRESENCE OF OTHER DURING THIS SECTION.
NO 2
NO 2
NO 2
SECTION 8. FERTILITY PREFERENCES
801. CHECK 304:
HE OR SHE STERILIZED (SKIP TO 813)
NOT PREGNANT OR UNSURE (SKIP TO 804)
803. Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have anymore children?
NO MORE 2 (SKIP TO 812
UNDECIDED/DON'T KNOW 8 (SKIP TO 812)
804. Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not have any(more) children?
NO MORE/NONE 2 (SKIP TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 813)
UNDECIDED/DON'T KNOW 8 (SKIP TO 811)
NOT PREGNANT OR UNSURE a) How long would like to wait from now before the birth of (a/another) child?
PREGNANT b) After the birth of the child you are expecting now, how long would like to wait before the birth of another child?
YEARS 2 __
SOON/NOW 993 (SKIP TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 813)
AFTER MARRIAGE 995 (SKIP TO 811)
OTHER 996 (SPECIFY) __ (SKIP TO 811)
DON'T KNOW 998 (SKIP TO 811)
PREGNANT (SKIP TO 812)
807. CHECK 303: USING A CONTRACEPTIVE METHOD?
CURRENTLY USING (SKIP TO 813)
NOT ASKED (CONTINUE)
'00-23' MONTHS OR '00-01' YEAR (SKIP TO 812)
YEARS AGO (SKIP TO 811)
NOT ASKED (SKIP TO 811)
WANTS TO HAVE ANOTHER CHILD a) You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method prevent pregnancy? Any other reason?
WANTS NO MORE/NONE b) You have said that you do not want any(more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
RECORD ALL REASONS MENTIONED.
FERTILITY-RELATED REASONS
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTEREFERES WITH BODY'S NORMAL PROCESSES U
DON'T KNOW Z
811. CHECK 303: USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING (CONTINUE)
YES, CURRENTLY USING (SKIP TO 813)
812. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8
HAS LIVING CHILDREN a) 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 b) 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.
NUMBER __
OTHER 96 (SPECIFY) __ (SKIP TO 815)
814. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl
GIRLS __
EITHER __
OTHER 96 (SPECIFY) __
815. In the last few months have you:
a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?
d) Received a voice or text message about family planning on a mobile phone?
NO 2
NO 2
NO 2
NO 2
YES, LIVING WITH A MAN (CONTINUE)
NO, NOT IN A UNION (SKIP TO 901)
818. CHECK 303: USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING (SKIP TO 820)
NOT ASKED (SKIP TO 822)
819. Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2 (SKIP TO 821)
JOINT DECISION 3 (SKIP TO 821)
OTHER 6 (SPECIFY) __ (SKIP TO 821)
820. Would you say that not using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER 6 (SPECIFY) __
HE OR SHE ARE STERILIZED (SKIP TO 901)
822. Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK
901. CHECK 701:
NOT IN UNION (SKIP TO 909)
902. How old was your (husband/partner) on his last birthday?
903. Did your (husband/partner) ever attend school?
NO 2 (SKIP TO 906)
904. What was the highest level of school he attended: primary, secondary, or higher?
PRIMARY 2
POST-PRIMARY/VOCATIONAL 3
SECONDARY 4
HIGHER 5
DON'T KNOW 8 (SKIP TO 906)
905. How many years have you completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
DON'T KNOW 98
906. Has your (husband/partner) done any work in the last 7 days for at least one hour?
NO 2
DON'T KNOW 8
907. Has your (husband/partner) done any work in the last 12 months?
NO 2 (SKIP TO 909)
DON'T KNOW 8 (SKIP TO 909)
908. What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?
909. Aside from your own housework, have you done any work in the last seven days for at least one hour?
NO 2
910. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work for at least one hour?
NO 2
911. 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?
NO 2
912. Have you done any work in the last 12 months?
NO 2 (SKIP TO 917)
913. What is your occupation? That is, what kind of work do you mainly do?
914. Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
915. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
916. Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT IN UNION (SKIP TO 925)
OTHER (SKIP TO 921)
919. Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6 (SPECIFY) __
920. Would you say that the money that you earn is more than what your (husband/partner) earns, less than what he earns, or about the same?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (SKIP TO 922)
DON'T KNOW 8
921. Who usually decides how your (husband's/partner's) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER 6 (SPECIFY) __
922. Who usually makes decisions about health care for yourself: you, your (husband/partner), or you and your (husband/partner) jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6 (SPECIFY) __
923. Who usually makes decisions about making major household purchases?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
924. Who usually makes decisions about visits to your family or relatives?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
925. Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 928)
926. Do you have a title deed for any house you own?
NO 2 (SKIP TO 928)
DON'T KNOW 8 (SKIP TO 928)
927. Is your name on the title deed?
NO 2
DON'T KNOW 8
928. Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 931)
929. Do you have a title deed for any land you own?
NO 2 (SKIP TO 931)
DON'T KNOW 8 (SKIP TO 931)
930. Is your name on the title deed?
NO 2
DON'T KNOW 8
931. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRES./NOT LISTEN 2
NOT PRES. 3
PRES./NOT LISTEN 2
NOT PRES. 3
PRES./NOT LISTEN 2
NOT PRES. 3
PRES./NOT LISTEN 2
NOT PRES. 3
932. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?
f) If she has sex with someone else?
g) If she looks in his telephone?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
932H. In your opinion, is a parent justified in hitting or beating his children for the following reasons:
i) If he/she disobeys?
j) If he/she is impolite?
k) If he/she has embarrassed the family?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
1001. Now I would like to talk about something else. Have you ever heard of HIV or AIDS?
NO 2 (SKIP TO 1042)
1002. HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
1003. Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
1004. Can people reduce their change of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
1005. Can people get HIV by sharing food with a person who has HIV?
NO 2
DON'T KNOW 8
1006. Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
1007. Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
1007A. Can men reduce their chance of getting the AIDS virus by getting circumcised?
NO 2
DON'T KNOW 8
1008. Can HIV be transmitted from a mother to her baby:
a) During pregnancy?
b) During delivery?
c) By breastfeeding?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (SKIP TO 1011)
1010. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
1010A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
1010B. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus for prenuptial purposes?
NO 2
1010B. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus for prenuptial purposes?
NO 2
1010C. CHECK 701, 702, AND 703:
FORMERLY MARRIED OR LIVING WITH A MAN (CONTINUE)
NEVER MARRIED OR NEVER LIVED WITH A MAN (SKIP TO 1011)
1010D. I don't want to know the results, but have you ever been tested as a couple with your husband/partner to see if you and/or him have the AIDS virus?
NO 2 (SKIP TO 1011)
1010E. I don't want to know the results, but have you and your husband told each other the results of your tests?
NO 2
NO BIRTHS (SKIP TO 1027)
LAST BIRTH IN 2016 OR EARLIER (SKIP TO 1027)
1012. CHECK 408 FOR LAST BIRTH:
NO ANTENATAL CARE (SKIP TO 1020)
1013. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
1014. During any of the antenatal visits for your last birth were you given any information about:
a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1015. Were you offered a test for HIV as part of your antenatal care?
NO 2
1016. I don't want to know the results but were you tested for HIV as part of your antenatal care?
NO 2 (SKIP TO 1020)
1017. Where was the test done? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL 12
HEALTH CENTER 13
HEALTH POST 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC SECTOR 16 (SPECIFY) __
CLINIC 22
DISPENSARY 23
PHARMACY 24
FAMILY PLANNING CLINIC 25
OTHER PRIVATE MEDICAL SECTOR 26 (SPECIFY) __
PLACE OF WORK 32
CORRECTIONAL FACILITY 33
YOUTH CENTER 34
1018. I don't want to know the results, but did you get the results of the test?
NO 2 (SKIP TO 1020)
1019. All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?
NO 2
DON'T KNOW 8
1020. CHECK 430 FOR LAST BIRTH:
OTHER (SKIP TO 1024)
1021. Between the time you went for delivery but before the baby was born, were you offered an HIV test?
NO 2
1022. I don't want to know the results, but were you tested for HIV at that time?
NO 2 (SKIP TO 1024)
1023. I don't want to know the results, but did you get the results of the test?
NO 2 (SKIP TO 1025)
NO OR NOT ASKED (SKIP TO 1027)
1025. Have you been tested for HIV since that time you were tested during your pregnancy?
NO 2
1026. How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95 (SKIP TO 1033)
1027. I don't want to know the results, but have you ever been tested for HIV?
NO 2 (SKIP TO 1031)
1028. How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95
1029. I don't want to know the results, but did you get the results of the test?
NO 2
1030. Where was the test done? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL 12 (SKIP TO 1033)
HEALTH CENTER 13 (SKIP TO 1033)
HEALTH POST 14 (SKIP TO 1033)
COMMUNITY HEALTH WORKER 15 (SKIP TO 1033)
OTHER PUBLIC SECTOR 16 (SPECIFY) __ (SKIP TO 1033)
CLINIC 22 (SKIP TO 1033)
DISPENSARY 23 (SKIP TO 1033)
PHARMACY 24 (SKIP TO 1033)
FAMILY PLANNING CLINIC 25 (SKIP TO 1033)
OTHER PRIVATE MEDICAL SECTOR 26 (SPECIFY) __ (SKIP TO 1033)
PLACE OF WORK 32 (SKIP TO 1033)
CORRECTIONAL FACILITY 33 (SKIP TO 1033)
YOUTH CENTER 34 (SKIP TO 1033)
1031. Do you know of a place where people can go to get an HIV test?
NO 2 (SKIP TO 1033)
1032 Where is that? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
COMMUNITY HEALTH WORKER E
OTHER PUBLIC SECTOR F (SPECIFY) __
CLINIC H
DISPENSARY I
PHARMACY J
FAMILY PLANNING CLINIC K
OTHER PRIVATE MEDICAL SECTOR L (SPECIFY) __
1033. Have you heard of test kits people can use to test themselves for HIV?
NO 2 (SKIP TO 1035)
1034. Have you ever tested yourself for HIV using a self-test kit?
NO 2
1035. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1036. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1037. Do you think people hesitate to take an HIV test because they are afraid to know how other people will react if the test result is positive for HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1038. Do people talk badly about people living with HIV, or who are thought to be living with HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1039. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1040. Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8
1040A. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1040B. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1040C. Should children age 12-14 be taught about using a condom to avoid getting AIDS?
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8
1041. Do you fear that you could get HIV if you into contact with the saliva of a person living with HIV?
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8
1042. CHECK 1001
HEARD ABOUT HIV OR AIDS a) Apart from HIV, have you heard about other infection that can be transmitted through sexual contact?
NOT HEARD ABOUT HIV OR AIDS b) Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE (SKIP TO 1051)
1044. CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (SKIP TO 1046)
1045. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
1046. Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?
NO 2
DON'T KNOW 8
1047. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW 8
1048. CHECK 1045, 1046, AND 1047:
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 1051)
1049. The last time you had (PROBLEM FROM 1045/1046/1047), did you seek any kind of advice or treatment?
NO 2 (SKIP TO 1051)
1050. Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. NAME OF PLACE
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
COMMUNITY HEALTH WORKER E
OTHER PUBLIC SECTOR F (SPECIFY) __
CLINIC H
DISPENSARY I
PHARMACY J
FAMILY PLANNING CLINIC K
OTHER PRIVATE MEDICAL SECTOR L (SPECIFY) __
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
1051. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
1052. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?
NO 2
DON'T KNOW 8
NOT IN A UNION (SKIP TO 1101)
1054. Can you say no to your (husband/partner) if you do not want to have sexual intercourse?
NO 2
DEPENDS/NOT SURE 8
1055. Could you ask your (husband/partner) to use a condom if you wanted him to?
NO 2
DEPENDS/NOT SURE 8
SECTION 11. OTHER HEALTH ISSUES
1101. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months? IF YES: How many injections have you had? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (SKIP TO 1104)
1102. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90. IF NON-NUMERIC ANSWER PROBE TO GET AN ESTIMATE.
NONE 00 (SKIP TO 1104)
1103. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1104. Do you currently smoke cigarettes every day, some days, or not at all?
SOME DAYS 2 (SKIP TO 1106)
NOT AT ALL 3 (SKIP TO 1106)
1105. On average, how many cigarettes do you currently smoke each day?
1106. Do you currently smoke or use any other type of tobacco every day, some days, or not at all?
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 1108)
1107. What other type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.
PIPES FULL OF TOBACCO B
CIGARS, CHEROOTS, OR CIGARILLOS C
WATER PIPE/SHISHA D
SNUFF BY MOUTH E
SNUFF BY NOSE F
CHEWING TOBACCO G
BETEL QUID WITH TOBACCO H
OTHER X (SPECIFY) __
1108. Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not a big problem:
a) Getting permission to go to the doctor?
b) Getting money needed for advice or treatment?
c) The distance to the health facility?
d) Not wanting to go alone?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
1108E. How does tuberculosis spread from one person to another? PROBE: Any other ways? RECORD ALL MENTIONED
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH SHARING FOOD OR DRINK WITH A PERSON WITH TB D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER X (SPECIFY) __
DON'T KNOW Z
1108F. What are the main ways to avoid TB bacilli spread?
COVER THE MOUTH WHEN SNEEZING B
OPEN WINDOWS C
OTHER X (SPECIFY) __
DON'T KNOW Z
1108G. Who is at risk of Tuberculosis disease?
POOREST PEOPLE 2
HEAVY MANUAL LABOR 3
CHILDREN 4
PEOPLE LIVING WITH HIV 5
HEAVY SMOKERS 6
ELDERLY PEOPLE 7
PEOPLE LIVING WITH A TB CASE 8
OTHER 9 (SPECIFY) __
DON'T KNOW 96
1108H. What are the main symptoms of Tuberculosis diseases?
FEVER B
DRENCHING NIGHT SWEATS C
UNEXPECTED LOSS OF WEIGHT D
GENERAL FATIGUE/MALAISE E
CHEST PAIN F
DON'T KNOW X
1108I. Do you currently have the following symptoms? PROBE FOR TIME
j) Cough
YES, LESS THAN TWO WEEKS 2
NO 3
k) Fever
YES, LESS THAN TWO WEEKS 2
NO 3
l) Drenching night sweats
YES, LESS THAN TWO WEEKS 2
NO 3
m) Unexpected weight lost
YES, LESS THAN TWO WEEKS 2
NO 3
n) General fatigue or malaise
YES, LESS THAN TWO WEEKS 2
NO 3
o) Chest pain
YES, LESS THAN TWO WEEKS 2
NO 3
IF 'NO' TO ALL SYMPTOMS (SKIP TO 1109)
1108Q. Have you ever sought care or help?
NO 2 (SKIP TO 1109)
1108R (IF 'YES') Where did you seek care or help?
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC SECTOR G (SPECIFY) __
CLINIC I
DISPENSARY J
PHARMACY K
OTHER PRIVATE MEDICAL SECTOR L (SPECIFY) __
TRADITIONAL HEALER N
FRIEND/RELATIVE O
YOUTH CENTER P
1109. Are you covered by any health insurance?
NO 2 (SKIP TO 1110A)
16-49 YEARS OLD (SKIP TO MM01)
1110B. Do you have a card where HPV vaccinations against cervical cancer are written down? A Human papilloma virus (HPV) vaccine is an injection given on the thigh or upper part of arm when you are age 12 while attending school or between the ages of 9-14 years when you are not enrolled in school, as a protection against cervical cancer.
NO 2 (SKIP TO 1110D)
DON'T KNOW 8 (SKIP TO 1110D)
1110C. RECORD ALL THE DATES ON THE CARD
1ST TIME (SKIP TO 1110G)
MM __
YY __
MM __
YY __
1110D. Did you ever have a card for HPV vaccine?
NO 2
DON'T KNOW 8
1110E. Did you receive HPV vaccine in the previous 5 years?
NO 2 (SKIP TO 1110H)
DON'T KNOW 8 (SKIP TO MM01)
1110F. When was the HPV vaccine given to you for the first time and second time?
MM __
YY __
MM __
YY __
1110G. CHECK Q1110C and Q1110F
TWO VACCINE (SKIP TO 1110I)
1110H. What are the reasons for (not receiving HPV/receiving only one) vaccine? PROBE. ANY OTHER REASON? KEEP ASKING FOR MORE REASONS UNTIL CANNOT RECALL ANY OTHER REASON. DO NOT PROMPT WITH ANY SUGGESTIONS. RECORD ALL MENTIONED.
PROBLEMS OF TIME/PLACE B
PERSONAL OBSTACLES TO BE PRESENT C
NEGATIVE BELIEFS D
VACCINE/HEALTH PROVIDER NOT AVAILABLE E
OTHERS F
1110I. Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery. Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night called fistula?
NO 2
1110J. Have you sought treatment and got cured?
SOUGHT TREATMENT, NOT CURED 2
NO TREATMENT SOUGHT 3
1110K. In the last week, have you taken or consumed any of the followings?:
a) Iron supplement?
b) NOOTRIMAMA
c) Other vitamin or mineral supplements?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
SECTION MM. ADULAT AND MATERNAL MORTALITY MODULE
MM01. Now I would like to ask you some questions about your brothers and sisters born to your natural mother, including those who are living with you, those living elsewhere and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your natural mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all your brothers and sisters born to your natural mother. DO NOT FILL IN THE ORDER NUMBER YET NAME
ORDER NUMBER __
B __
ORDER NUMBER __
C __
ORDER NUMBER __
D __
ORDER NUMBER __
E __
ORDER NUMBER __
F __
ORDER NUMBER __
G __
ORDER NUMBER __
H __
ORDER NUMBER __
I __
ORDER NUMBER __
J __
ORDER NUMBER __
K __
ORDER NUMBER __
L __
ORDER NUMBER __
M __
ORDER NUMBER __
N __
ORDER NUMBER __
O __
ORDER NUMBER __
P __
ORDER NUMBER __
Q __
ORDER NUMBER __
R __
ORDER NUMBER __
S __
ORDER NUMBER __
T __
ORDER NUMBER __
NO BROTHERS OR SISTERS LISTED (SKIP TO MM04)
MM03. READ THE NAMES OF THE BROTHERS AND SISTERS TO THE RESPONDENT AND AFTER THE LAST ONE ASK: Are there any other brothers and sisters from the same mother that you have not mentioned?
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN MM01)
MM04. Sometimes people forget to mention children born to their natural mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have not mentioned?
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN MM01)
MM05. Sometimes people forget to mention children born to their natural mother because they have died. Are there any brothers or sisters who have died that you have not mentioned?
YES (LIST ADDITINOAL BROTHERS AND SISTERS IN MM01)
MM06. Some people have brothers or sisters from the mother but a different father. Are there any brothers or sister born to your natural mother, but who have a different natural father, that you have not mentioned?
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN MM01)
MM07. COUNT THE NUMBER OF BROTHERS AND SISTERS RECORDED IN MM01.
MM08. CHECK MM07: Just to make sure that I have this right: Your mother had in TOTAL __ births, excluding you, during her life time. Is that correct?
NO (PROBE AND CORECNT MM01 AND/OR MM07)
NO BROTHER OR SISTER (NEXT SECTION)
MM10. Please tell me, which brother or sister was born first? And which was born last?
RECORD '01' FOR THE ORDER NUMBER IN MM01 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SOON UNTIL YOU HAVE RECORDED THE ORDER NUMBER FOR ALL BROTHERS AND SISTERS.
MM11. How many births did your mother have before you were born?
MM12. LIST THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER IN MM01. ASK MM13 TO MM24 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE AN ADDITIONAL QUESTIONNAIRE.
MM13. NAME OF BROTHER OR SISTER
MM14. Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO MM17)
DK 8 (GO TO (02))
MM17. How many years ago did (NAME) die?
MM18. How old was (NAME) when (he/she) died? IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.
MM19. Was (NAME) pregnant when she died?
NO 2
MM20. Did (NAME) die during childbirth?
NO 2
MM21. Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2 (GO TO MM22A)
MM22. How many days after the end of the pregnancy did (NAME) die?
MM22A. How many live born children and (name) give birth to during her lifetime?
MM23. Was (NAME)'s death due to an act of violence?
NO 2
MM24. Was (NAME)'s death due to an accident?
NO 2
IF NO MORE BROTHERS OR SISTERS, GO TO NEXT SECTION.
DV00. CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?
WOMAN NOT SELECTED (CLOSE INTERVIEW)
DV01. CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (SKIP TO DV32)
DV01A. READ TO THE RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in [COUNTRY]. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND/PARTNER') (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO DV16)
DV03. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner)?
a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
DV04. Now I need to ask some more questions about your relationship with your (last) (husband/partner).
A. Did your (last) (husband/partner) ever:
a) say or do something to humiliate you in front of others?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) threaten to hurt or harm you or someone you care about?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) insult you or make you feel bad about yourself?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
DV05. A. Did your (last) (husband/partner) ever do any of the following things to you:
a) push you, shake you, or throw something at you?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
NO 2
B. How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NOT A SINGLE 'YES' (SKIP TO DV09)
DV07. How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen? IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
DV08. Did the following ever happen as a result of what your (last) (husband/partner) did to you:
a) You had cuts, bruises, or aches?
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
NO 2
DV09. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?
NO 2 (SKIP TO DV11)
DV10. In the the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
DV11. Does (did) your (last) (husband/partner) drink alcohol?
NO 2 (SKIP TO DV13)
DV12. How often does (did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
DV13. Are (Were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?
SOMETIMES AFRAID 2
NEVER AFRAID 3
MARRIED ONLY ONCE (SKIP TO DV16)
DV15. A. So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).
a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
NO 2 (CONTINUE)
B. How long ago did this happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
NO 2 (CONTINUE)
B. How long ago did this happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
c) Did any previous (husband/partner) humiliate you in front of others, threaten to hurt you or someone you care about, or insult you or make you feel bad about yourself?
NO 2 (CONTINUE)
B. How long ago did this happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
EVER MARRIED/EVER LIVED WITH A MAN a) From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER MARRIED/NEVER LIVED WITH A MAN b) From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
NO 2 (SKIP TO DV19)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO DV19)
DV17. Who has hurt you in this way? Anyone else? RECORD ALL MENTIONED.
STEP-MOTHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER X (SPECIFY) __
DV18. In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
ONLY ONE RESPONSE SELECTED (SKIP TO DV22B)
DV18B. Who is the main person that has hurt you in this way in the last 12 months?
STEP-MOTHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER X (SPECIFY) __
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO DV22B)
DV22A. Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NO 2 (SKIP TO DV24A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO DV24A)
DVV22B. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NO 2 (SKIP TO DV26)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO DV26)
DV23. Who was the person who was forcing you the very first time this happened?
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER 96 (SPECIFY) __
EVER MARRIED/EVER LIVED WITH A MAN: a) In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A MAN: b) In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?
NO 2 (SKIP TO DV25)
DV24A. CHECK DV05A(h-) and DV15A(b)
NOT A SINGLE 'YES' (SKIP TO DV26)
EVER MARRIED/EVER LIVED WITH A MAN: a) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?
NEVER MARRIED/NEVER LIVED WITH A MAN: b) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
DON'T KNOW 98
DV26. CHECK DV05A(a-j), DV15A(a,c), DV16, DV20, DV22A, AND DV22B:
NOT A SINGLE 'YES' (SKIP TO DV30)
DV27. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?
NO 2 (SKIP TO DV29)
DV28. From whom have you sought help? Anyone else? RECORD ALL MENTIONED.
HUSBAND'S/PARTNER'S FAMILY B (SKIP TO DV30)
CURRENT/FORMER HUSBAND/PARTNER C (SKIP TO DV30)
CURRENT/FORMER BOYFRIEND D (SKIP TO DV30)
FRIEND E (SKIP TO DV30)
NEIGHBOR F (SKIP TO DV30)
RELIGIOUS LEADER G (SKIP TO DV30)
DOCTOR/MEDICAL PERSONNEL H (SKIP TO DV30)
POLICE I (SKIP TO DV30)
LAWYER J (SKIP TO DV30)
SOCIAL SERVICE ORGANIZATION K (SKIP TO DV30)
OTHER X (SPECIFY) __ (SKIP TO DV30)
DV29. Have you ever told anyone about this?
NO 2
DV30. As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.
DV31. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
DV32. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.
MINUTES __
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT INTERVIEW: __
COMMENTS IN SPECIFIC QUESTIONS: __
ANY OTHER COMMENTS: __
SUPERVISOR'S OBSERVATIONS __
EDITOR'S OBSERVATIONS __