STATISTICS SIERRA LEONE

IDENTIFICATION

LOCALITY NAME_________

NAME OF HOUSEHOLD HEAD________

CLUSTER NUMBER_______

HOUSEHOLD NUMBER _______

LOCAL COUNCIL_______

DISTRICT ______

PROVINCE_____

CHIEFDOM______

SECTION_____

ENUMERATION AREA______

URBAN-RURAL

FREETOWN, OTHER CITY, TOWN, RURAL

NAME AND LINE NUMBER OF WOMAN_______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME_____
RESULT____

RESULT

NEXT VISIT:
DATE____
TIME____

FINAL VISIT
DAY_____
MONTH______
YEAR_____
INT. NUMBER_____
RESULT______

TOTAL NUMBER OF VISITS____

INTERVIEW LANGUAGE

NATIVE LANGUAGE OF THE RESPONDENT

SUPERVISOR
NAME____
DATE _____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____
KEYED BY______

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is _______________________________________ and I am working with STATISTICS SIERRA LEONE. We are conducting a national survey that asks women (and men) about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 30 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary, and if we should come to 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. However, we hope that you will participate in this survey since your views are important.

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

Signature of interviewer:___________
Date:______

101) RECORD THE TIME.

102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

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

104) In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

105) In the last 12 months, have you been away from your home community for more than one month at a time?

106) In what month and year were you born?

107) How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108) Have you ever attended school?

109) What is the highest level of school you attended: primary, junior secondary, senior secondary, vocational, commercial, nursing, technical, teaching or higher?

110) What is the highest (grade/form/year) you completed at that level?

111) CHECK 109:

112) 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?

113) Have you ever participated in a literacy/numeracy program or any other program that involves learning to read or write (not including primary school)?

114) CHECK 112:

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

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

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

118) What is your religion?

119) What is your ethnicity?

SECTION 2: REPRODUCTION

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

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

203) How many sons do you have?
And how many daughters do you have?
IF NONE, RECORD '00'.

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

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

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

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

208) SUM ANSWERS TO 203, 205, 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?

210) CHECK 208:

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

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

213) Were any of these births twins?

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

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

216) Is (NAME) still alive?

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

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

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

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

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME) including any children who died after birth?

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

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

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2003 OR LATER.
IF NONE, RECORD '0' AND GO TO 226.

225) FOR EACH BIRTH SINCE JANUARY 2003, 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 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.)

226) Are you pregnant now?

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.ENTER 'P's IN THE CALENDAR, BEGINNING WITHTHE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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

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

230) When did the last such pregnancy end?

231) CHECK 230:

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

233) Since January 2003, have you had any other pregnancies that did not result in a live birth?

234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2003.
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P'FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any miscarriages, abortions or stillbirths that ended before 2003?

236) When did the last such pregnancy that terminated before 2003 end?

237) When did your last menstrual period start?

238) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual intercourse?

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

SECTION 3: CONTRACEPTION

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

Which ways or methods have you heard about?

FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

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

302) Have you ever used (METHOD)?

303) CHECK 302:

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

305) ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH.(GO TO 333)

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

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

308) CHECK 302 (01):

309) CHECK 226:

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

311) Which method are you using?
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.
CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD IN LIST.

312) RECORD IF CODE 'C' FOR PILL IS CIRCLED IN 311.

YES (USING PILL): May I see the package of pills you are using?

NO (USING CONDOM BUT NOT PILL): May I see the package of condoms you are using?

RECORD NAME OF BRAND IF PACKAGE SEEN

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

314) How many (pills/condoms) did you get the last time?

315) The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

316) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

317) CHECK 311/311A:

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

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

318) How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?

319) In what month and year was the sterilization performed?
319A) 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?

320) CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A

321) CHECK 319/319A:

YEAR IS 2003 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING)

YEAR IS 2002 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2003) (THEN GO TO 331)

322) 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 2003. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:

When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

323) CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR THE HIGHEST METHOD IN LIST.

324) Where did you obtain (CURRENT METHOD) when you started using it?
324A) Where did you learn how to use the rhythm/Lactational amenorrhea method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

325) CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLES IN 311/311A, CIRCLE CODE FOR THE HIGHEST METHODS IN THE LIST.

326) You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?

327) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

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

329) CHECK 326:

CODE "1" CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE "1" NOT CIRCLED: When you obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) were you told about other methods of family planning that you could use?

330) Were you ever told by a health or family planning worker about other methods of family planning that you could use?

331) CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

332) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

334) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

335) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

336) In the last 12 months, have you visited a health facility for care for yourself (or your children)?

337) Did any staff member at the health facility speak to you about family planning methods?

338) In the last 12 months have you visited a health facility family planning?

339) In the last 6 months have you discussed family planning with your spouse/partner?

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403) LINE NUMBER FROM 212

404) FROM 212 AND 216

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

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

407) Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

408) Where did you receive antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

409) How many months pregnant were you when you received antenatal care for this pregnancy?

410) How many times did you receive antenatal care during this pregnancy?

411) As part of your antenatal care during this pregnant, were any of the following done at least once?

Were you weighed?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

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

413) Were you told where to go if you had any of these complications?

414) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

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

416) CHECK 415:

417) At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

418) Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIME'S, RECORD '7'.

419) In what month and year did you receive the last tetanus injection before this pregnancy?

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

421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP

422) During the whole pregnancy, for how may days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

423) During this pregnancy, did you take any drug for intestinal worms?

424) During this pregnancy, did you have difficulty with your vision during daylight?

425) During this pregnancy, did you suffer from night blindness (USE LOCAL TERM)?

426) During this pregnancy, did you take any drugs to keep you from getting malaria?

427) What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

428) CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION.

429) How many times did you take (SP/Fansidar) during this pregnancy?

430) CHECK 407:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

431) Did you get the (SP/Fansidar) during any antenatal care visit during another visit to a health facility or from another source?

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

433) Was (NAME) weighed at birth?

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

435) 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.

436) Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

438) Was (NAME) delivered by caesarean section?

439) Before you were discharged after (NAME) was born, did any health care provider check on your health?

440) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

441) Who checked on your health at that time?

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

443) Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED

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

445) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

447) Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

448) CHECK 442:

449) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

450) How many hours, days or weeks after the birth of (NAME) did the first check take place?

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

452) Where did the first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OD SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE OF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

453) In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF CAPSULES

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

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

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

457) CHECK 226:
IS RESPONDENT PREGNANT?

458) Have you begun to have sexual intercourse again since the birth of (NAME)?

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

460) Did you ever breastfeed (NAME)?

461) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 OURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

462) In the first three days after delivery, was (NAME) given anything to drink other than breast milk.

463) What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

464) CHECK 404:
IS CHILD LIVING?

465) Are you still breastfeeding (NAME)?

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

467) CHECK 404:
IS CHILD LIVING?

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

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

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

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

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) LINE NUMBER FROM 212

503) FROM 212 AND 216

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

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

506) (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.
(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES. (REPEAT FOR NEXT-TO-LAST, AND SECOND-FROM LAST BIRTHS)

506A) CHECK 506:

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

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

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

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

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

509C) Was the first polio vaccine received in the first two weeks after birth or later?

509D) How many times was the polio vaccine received?

509E) A DPT/PENTA vaccine, that is, an injection given in the thigh sometimes at the same time as polio drops?

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

509G) A measles injection-that is, a shot in the arm at the age of 9 months or older-to prevent him/her from getting measles?

510) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

511) At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.

512) CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE

513) According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD). Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF CAPSULES.

514) Has (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF CAPSULES.

515) Did (NAME) receive a vitamin A dose within the last six months?

516) In the last seven days, did (NAME) take iron pills, sprinkles with iron, or iron syrup (like his/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

517) Has (NAME) taken any drug for intestinal worms in the last six months?

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

519) Was there any blood in the stools?

520) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk).
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?

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

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

523) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY THE SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

524) CHECK 523:

525) Where did you first seek advice or treatment?

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

527) Does (NAME) still have diarrhea?

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

a) A fluid from a special packet called ORS?
c) A government-recommended homemade fluid SSS-salt and sugar solution?

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

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

531) CHECK 530:
GIVEN ZINC?

532) How many times was (NAME) given zinc?

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

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

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

536) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

537) CHECK 533:
HAD FEVER?

538) 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?

539) 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?

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

541) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

542) CHECK 541:

543) Where did you first seek advice or treatment?

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

545) Is (NAME) still sick with a (fever/cough)?

546) At any time during the illness, did (NAME) take any drugs for the illness?

547) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.

548) CHECK 547:
ANY CODE A-H CIRCLED?

549) Did you already have (NAME OF DRUG FROM 547) at home when the child became ill?
ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'H' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 547.
IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG. IF NO FOR ALL DRUGS, CIRCLE 'Y'.

550) CHECK 547:
ANY CODE A-G CIRCLED?

551) CHECK 547:
SP/FANSIDAR ('A') GIVEN

552) How long after the fever started did (NAME) first take SP/Fansidar?

553) For how many days did (NAME) take the SP/Fansidar?
IF 7 DAYS OR MORE, RECORD 7.

554) CHECK 547:
CHLOROQUINE (B) GIVEN

555) How long after the fever started did (NAME) first take chloroquine?

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

557) CHECK 547:
AMODIAQUINE ('C') GIVEN

558) How long after the fever started did (NAME) first take the Amodiaquine?

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

560) CHECK 547:
QUININE ("D") GIVEN

561) How long after the fever started did (NAME) first take quinine?

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

563) CHECK 547:
COMBINATION WITH ARTEMISININ ('E') GIVEN

564) How long after the fever started did (NAME) first take (COMBINATION WITH ARTEMISININ)?

565) For how many days did (NAME) take the (COMBINATION WITH ARTEMISININ)?
IF 7 DAYS OR MORE, RECORD 7.

566) CHECK 547:
COUNTRY SPECIFIC GBANGBA ROOT/SHEKU TURE LEAVES ('F') GIVEN

567) How long after the fever started did (NAME) first take gbangba root/sheku ture leaves?

568) For how many days did (NAME) take the gbangba root/sheku ture leaves?
IF 7 DAYS OR MORE, RECORD 7.

569) CHECK 547:
OTHER ANTIMALARIAL ('G') GIVEN

570) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

571) For how many days did (NAME) take the (OTHER ANTIMALARIAL)?
IF 7 DAYS OR MORE, RECORD 7.

572) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573.

573) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2003 OR LATER LIVING WITH THE RESPONDENT

574) The last time (NAME FROM 573) passed stools, what was done to dispose of the stools?

575) CHECK 528(a) AND 528(b), ALL COLUMNS:

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

577) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT

578) Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night.
Did (NAME FROM 577) (drink/eat):

Plain water?
Commercially produced infant formula?
Any [BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD] Fresocrem,Cerelac?
Any (other) porridge or gruel?

579) Now I would like to ask you about (other) liquids or foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods.
Did (NAME FROM 577)/you drink (eat):

a) Milk such as tinned, powdered, or fresh animal milk?
b) Tea or coffee?
c) Any other liquids?
d) Bread, rice, noodles, or other foods made from grains?
e) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
f) White potatoes, white yams, manioc, cassava, or any other foods made from roots?
g) Any dark green, leafy vegetables?
h) Ripe mangoes, papayas or [INSERT ANY OTHER LOCALLY AVAILABLE VITAMIN A-RICH FRUITS]?
i) Any other fruits or vegetables?
j) Liver, kidney, heart or other organ meats?
k) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
l) Eggs?
m) Fresh or dried fish or shellfish?
n) Any foods made from beans, peas, lentils, or nuts?
o) Cheese, yogurt or other milk products?
p) Any oil, fats, or butter, or foods made with any of these?
q) Any sugary foods such as chocolate, sweets,, candles, pastries, cakes, or biscuits?
r) Any other solid or semi-solid food?

580) CHECK 578 (LAST 2 CATEGORIES: BABY CEREAL OR OTHER PORRIDGE/GRUEL) AND 579 (CATEGORIES d THROUGH r FOR CHILD):

581) How many times did (NAME FROM 577) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD'7'.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601) Are you currently married or living together with a man as if married?

602) Have you ever been married or lived together with a man as if married?

603) What is your marital status now: are you widowed, divorced, or separated?

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

605) RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

606) Does your husband/partner have other wives or does he live with other women as if married?

607) Including yourself, in total, how many wives or partners does your husband live with now as if married?

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

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

610) CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

611) CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

612) How did your previous marriage or union end?

613) To whom did most of your late husband's property go to?

614) Did you receive any of your late husband's assets or valuables?

615) CHECK 609:

MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about when you started living with your first husband/partner. In what month and year was that?

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

617) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

618) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. How old were you when you had sexual intercourse for the very first time?

619) CHECK 107:

620) Do you intend to wait until you get married to have sexual intercourse for the first time?

620A) When do you intend to have your first sexual intercourse?

621) CHECK 107:

622) The first time you had sexual intercourse, was a condom used?

623) How old was the person you first had sexual intercourse with?

624) Was this person older than you, younger than you, or about the same age as you?

625) Would you say this person was ten or more years older than you or less than ten years older than you?

626) 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.

626A) Now I would like to ask you some questions about your recent sexual activity. 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. (GO TO 628)

627) When was the last time you had sexual intercourse with this person?

628) The last time you had sexual intercourse (with this second/third person), was a condom used?

629) Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

630) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

631) For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

632) CHECK 107:

633) How old is this person?

634) Is this person older than you, younger than you, or about the same age?

635) Would you say this person is ten or more years older than you or less than ten years older than you?

636) The last time you had sexual intercourse with this person, did you or this person drink alcohol?

637) Were you or your partner drunk at that time?
IF YES: Who was drunk?

638) Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

639) 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 GREATER THAN 95, WRITE '95.'

640) 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 GREATER THAN 95, WRITE '95.'

641) Do you know of a place where a person can get condoms?

642) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

643) If you wanted to, could you yourself get a condom?

643A) Where would you like to buy a condom? Any other place?

644) Do you know of a place where a person can get female condoms?

645) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

646) If you wanted to, could you yourself get a female condom?

646A) Where would you like to buy a female condom?
Any other place?

SECTION 7. FERTILITY PREFERENCES

701) CHECK 311/311A:

702) CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

PREGNANT: Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

703) CHECK 226:

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

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

704) CHECK 226:

705) CHECK 310:
USING A CONTRACEPTIVE METHOD?

706) CHECK 703:

707) CHECK 702:

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

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

RECORD ALL REASONS MENTIONED.

708) CHECK 310:
USING CONTRACEPTIVE METHOD?

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

710) Which contraceptive method would you prefer to use?

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

712) Would you ever use a contraceptive method if you were married?

713) CHECK 216:

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

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

714) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

715) In the last six months have you:

Heard about family planning on the radio?
Seen about family planning on the television?
Read about family planning in a newspaper or magazine?
Heard about family planning from a health worker?
Seen about family planning on posters/billboards?

716) In the last 12 months have you seen any of the following Family Planning messages on posters/billboards:

Boku Born, Boku Losis?
Have self control, value your body, respect yourself, avoid teenage pregnancy?
Space the birth of your children ?
Children by choice, not by chance?

717) CHECK 601:

718) CHECK 311/311A:

719) Does your husband/partner know that you are using a method of family planning?

719A) Do you discuss family planning with your husband/partner?

720) Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?

721) CHECK 311/311A

722) Does your husband/partner want the same number of children that you want, or does he want more or fewer than you want?

SECTION 8: HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601 AND 602:

802) How old was your husband/partner on his last birthday?

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

804) What was the highest level of school he attended: primary, junior secondary, senior secondary, vocational, commercial, nursing, technical, teaching or higher?

805) What was the highest (grade/form/year) he completed at that level?

806) CHECK 801:

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

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

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

808) 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?

809) 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?

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

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

812) CHECK 811:

813) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

814) Do you do this work for a member of your family, for someone else, or are you self-employed?

815) Do you usually work at home or away from home?

816) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

817) Are you paid in cash or kind for this work or are you not paid at all?

818) CHECK 601:

819) CHECK 817:

820) Who usually decides how the money you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?

821) 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?

822) Who usually decides how your husband's/partner's earnings will be used: you, your husband/partner, or you and your husband/partner jointly?

823) Who usually makes decisions about health care for yourself: you, your husband/partner, you and your husband/partner jointly, or someone else?

824) Who usually makes decisions about making major household purchases?

825) Who usually makes decisions about making purchases for daily household needs?

826) Who usually makes decisions about visits to your family or relatives?

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

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

If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?
If she refuses to cook?
If he suspects her of being unfaithful?
If she refuses to clean the house?

SECTION 9. HIV/AIDS

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

902) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

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

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

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

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

907) Can people get the AIDS virus because of witchcraft/witch gun or other supernatural means?

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

909) Can the virus that causes AIDS be transmitted from a mother to her baby:

During pregnancy?
During delivery?
By breastfeeding?

910) CHECK 909:

911) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

912) Have you heard about special antiretroviral drugs (ARV) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

913) CHECK 208 AND 215:

914) CHECK 407 FOR LAST BIRTH:

914A) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915) During any of the antenatal visits for your last birth, did anyone talk to you about:

Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

916) Were you offered a test for the AIDS virus as part of your antenatal care?

917) I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

918) I don't want to know the results, but did you get the results of the test?

919) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

920) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

921) When was the last time you were tested for the AIDS virus?

922) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

923) When was the last time you were tested?

924) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

925) I don't want to know the results, but did you get the results of the test?

926) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

927) Do you know of a place where people can go to get tested for the AIDS virus?

928) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

929) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

930) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

931) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

932) In your opinion, if a teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

933) Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?

934) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?

935) Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?

936) CHECK 933, 934, AND 935:

937) Do you personally know someone who has or is suspected to have the AIDS virus?

938) Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

939) Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

940) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

941) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

942) CHECK 901:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

943) CHECK 618:

944) CHECK 942:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTION?

945) 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?

946) Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

947) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

948) CHECK 954, 946, AND 947:

949) The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?

950) Where did you go? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

951) Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

952) 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?

953) Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

954) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women other than his wives?

955) CHECK 601:

956) Can you say no to your husband/partner if you do not want to have sexual intercourse?

957) Could you ask your husband/partner to use a condom if you wanted him to?

SECTION 10. OTHER HEALTH ISSUES

1001) Have you ever heard of an illness called tuberculosis or TB?

1002) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

1003) Can tuberculosis be cured?

1004) If a member of your family got tuberculosis, would you want it to remain a secret or not?

1005) 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1006) 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1007) The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

1008) Did the person who gave you that injection take the syringe and needle from a new, unopened package?

1009) Do you currently smoke cigarettes?

1010) In the last 24 hours, how many cigarettes did you smoke?

1011) Do you currently smoke or use any other type of tobacco?

1012) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

1013) 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?

Getting permission to go?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Not wanting to go alone?
Concern that there may not be a female health provider?
Concern that there may not be any health provider?
Concern that there may be no drugs available?

1014) Are you covered by any health insurance?

1015) What type of health insurance?
RECORD ALL MENTIONED.

1016) CHECK 217:

1017) Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

1018) (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

1019) Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

SECTION 11. FEMALE GENITAL CUTTING

1101) Have you ever heard of the Bondo/Sande/other secret societies/female circumcision?

1102) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

1103) Have you yourself ever been initiated/circumcised?

1104) Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

1105) Was the genital area just nicked without removing any flesh?

1106) Was your genital area sewn closed?

1107) How old were you when you were initiated/circumcised?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

1108) Who performed the initiation/circumcision?

1109) CHECK 214 AND 216:

1110) CHECK 1109:

ONE LIVING DAUGHTER: Has your daughter been initiated/circumcised?
IF YES: RECORD '01'

MORE THAN ONE LIVING DAUGHTER: Have any of your daughters been initiated/circumcised?
IF YES: How many? RECORD NUMBER

1111) CHECK 1110:

ONE LIVING DAUGHTER: What is your daughter's name?

MORE THAN ONE LIVING DAUGHTER: Which of your daughters was circumcised most recently?

1112) Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM Q. 1111) at that time. Was any flesh removed from her genital area?

1113) Was her genital area just nicked without removing any flesh?

1114) Was her genital area sewn closed?

1115) How old was (NAME OF THE DAUGHTER FROM Q. 1111) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

1116) Who performed the initiation/circumcision?

1117) Do you have any daughter who is not initiated/circumcised?

1118) Do you intend to have any of your daughters initiated/circumcised in the future?

1119) What benefits do girls themselves get if they are initiated/circumcised?
PROBE: Any other benefits?
RECORD ALL MENTIONED.

1120) Do you believe that this practice is required by your religion?

1121) Do you think that this practice should be continued, or should it be stopped?

SECTION 12. MATERNAL MORTALITY

1201A) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother. Did your mother give birth to any children, in addition to you?

1201B) How many sons did your mother have who are still living?

1201C) How many sons did your mother have who have died?

1201D) Apart from you, how many daughters did your mother have who are still living?

1201E) How many daughters did your mother have who have died?

1201F) Did your mother have any other children which you do not know if they are alive or dead?

1201G) How many other children did your mother have which you do not know if they are alive or dead?

1201H) SUM ANSWERS TO 1201B,C,D,E, AND G, ADD 1 (THE RESPONDENT) AND ENTER TOTAL.

1201I) CHECK 1201H:
Just to make sure that I have this right: including yourself, your mother gave birth to children in total. Is that correct?

1202) CHECK 1201:

1203) How many of these births did your mother have before you were born?

1204) What was the name given to your oldest (next oldest) brother or sister?

1205) Is (NAME) male or female?

1206) Is (NAME) still alive?

1207) How old is (NAME)?

1208) How many years ago did (NAME) die?

1209) How old was (NAME) when he/she died?
IF DON'T KNOW, PROBE: Did (NAME) die before age 12? IF YES,
ENTER "95" IF NO, ASK ADDITONAL QUESTION TO GET AN ESTI- MATE, FOR EXAMPLE: Did (NAME) die before or after being married?

1210) Was (NAME) pregnant when she died?

1211) Did (NAME) die during childbirth?

1212) Did (NAME) die within two months after the end of a pregnancy or childbirth?

1213) How many live born children did (NAME) give birth to during her lifetime?

IF NO MORE BROTHERS OR SISTERS, GO TO 1214.

1214) RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS

SUPERVISOR'S OBSERVATIONS

NAME OF SUPERVISOR:___________
DATE:______

EDITOR'S OBSERVATION
___________

NAME OF EDITOR:_______
DATE________