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REPUBLIC OF SENEGAL DEMOGRAPHIC AND HEALTH SURVEY 1986 INDIVIDUAL QUESTIONNAIRE

FIRST AND LAST NAME OF THE WOMAN ____
QUESTIONNAIRE NUMBER ____

REGION____

VILLAGE____

DEPARTMENT____

NEIGHBORHOOD/REGION____

ARRONDISSEMENT/COMMUNE____

SUB-DISTRICT____

PARCELLE NUMBER____

CONCESSION NUMBER (a group of houses on a plot, usually centered around the huts of a man and his wives) ____

HOUSEHOLD NUMBER _____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE____
INTERVIEWER NAME____
RESULT___

RESULTS___

1 COMPLETED
2 NO MEMBER OF THE HOUSEHOLD AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY FILLED OUT
6 OTHER (SPECIFY) ____

NEXT VISIT
DATE____
TIME____

FINAL VISIT
MONTH ____
YEAR 1986
RESPONDENT CODE ____
INTERVIEWER CODE ____

TOTAL NUMBER OF VISITS ____

SUPERVISOR
NAME____
DATE____

FIELD EDITOR
NAME____
DATE____

OFFICE EDITOR____
KEYED BY____

SECTION 1. RESPONDENTS' SOCIO-DEMOGRAPHIC CHARACTERISTICS

100. RECORD THE NUMBER OF PEOPLE SURVEYED IN THE HOUSEHOLD

NUMBER OF PEOPLE____

101. RECORD THE TIME.

HOURS __
MINUTES __

To begin, I would like to ask you questions about yourself and your family.

102. How long have you been living continuously in (NAME OF LOCALITY)?

YEARS___

ALWAYS 96 (GO TO 105)
VISITOR 97
DOESN'T KNOW 98

103. For the most part during your first 12 years, did you like the majority of the time Dakar, in another city or in the countryside?

NAME OF LOCALITY ______
DAKAR, PIKINE 1
OTHER REGIONAL CAPITAL 2
OTHER COMMUNE 3
COUNTRYSIDE 4
FOREIGN COUNTRY 5

104. Just before moving here, did you live in Dakar, in another city or in the countryside?

NAME OF LOCALITY ______
DAKAR, PIKINE 1
OTHER REGIONAL CAPITAL 2
OTHER COMMUNE 3
COUNTRYSIDE 4
FOREIGN COUNTRY 5

105. In which month and in which year were you born?

MONTH ___
DOESN'T KNOW MONTH 98
YEAR ___
DOESN'T KNOW YEAR 98

106. How old are you currently?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS __

107. What is you religion?

MUSLIM 1
CHRISTIAN 2
OTHER 3

108. Are you Senegalese?

YES 1
NO 2 (GO TO 110)

109. What is your ethnicity?

WOLOF 1
POULAR 2
SERER 3
MANDINGUE 4
OTHERS (SPECIFY) ___ 5

110. Did you ever go to school?

YES 1
NO 2 (GO TO 114)

111. What is the highest level of school you attended: primary, secondary or superior?

PRIMARY 1
SECONDARY 2
SUPERIOR 3

112. What is the last grade that you achieved?

GRADE ___

113. CHECK 111:

PRIMARY (GO TO 114)
SECONDARY OR MORE (GO TO 115)

114. Can you read and understand a letter or a newspaper easily, with difficulty or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3

115. Do you listen to the radio at least once a week?

YES 1
NO 2 (GO TO 117)

116. Do you often listen to the following programs?

DIFFO
YES 1
NO 2
DEAMOYPEY
YES 1
NO 2
OTHER NATIONAL CHANNELS
YES 1
NO 2
REGIONAL CHANNELS
YES 1
NO 2

117. What is the main source of potable water for the members of your household?

IN THE CONCESSION
RUNNING WATER 01
WELL 02
OTHER 03
OUTSIDE OF THE CONCESSION
PUBLIC TAP STANDPIPE 04
WELL 05
PROTECTED WELL 06
RIVER/STREAM 07
LAKE/POND 08
OTHER 09

118. What kind of toilet facility is there in your household?

CONNECTED TO THE SEWER 1
PIT 2
LATRINES 3
OTHER (SPECIFY) ____ 4
NO TOILET FACILITY 5

119. What kind of lighting do you use in this household?

ELECTRICITY 1
GAS 2
PETROL OR CANDLE 3
WOOD 4
OTHER 5

120. What method do you use to cook your meals?

GAS 1
WOOD, CHARCOAL 2
OTHER 3

121. Does your household have:

A stove/range?
Radio?
Television?
Refrigerator or freezer?

STOVE/RANGE
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR/FREEZER
YES 1
NO 2

122. Is there anyone in your household who owns:

A bicycle?
A motorcycle or scooter?
A car?

BICYCLE
YES 1
NO 2
SCOOTER OR MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

123. What is your flooring made of?

TILE 1
CEMENT 2
CLAY/MUD 3
SAND 4
OTHER (SPECIFY) _____ 5

124. What are you walls made of?

CEMENT BRICKS 1
MUD/ADOBE BRICKS 2
CLAY ADOBE 3
STRAW OR STEMS 4
OTHER (SPECIFY) ____ 5

125. What is your roof made of?

CEMENT 1
TIN, TILE, SLATE 2
THATCH (STRAW) 3
OTHER (SPECIFY) _____ 4

126. How many rooms are there for living in in your household ?

ROOMS _____

SECTION 2. REPRODUCTION

Now I would like to ask about all of the births you have had during your life.

201. Have you ever given birth to a living child?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?
How many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME ___
DAUGHTERS AT HOME ___

204. Do you have any sons or daughters to whom you have given birth and who do not live with you?

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE __
DAUGHTERS ELSEWHERE __

206. Have you given birth to a son or daughter who was born alive but later died?
IF NO, PROBE: Have you given birth to a boy or girl who only lived a few hours or days?

YES 1
NO 2 (GO TO 208)

207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'

SONS DEAD __
DAUGHTERS DEAD __

208. Have you ever had a still born baby?

YES 1
NO 2 (GO TO 211)

209. Among these babies are there any who breathed or showed some signs of life after birth?

YES 1
NO 2 (GO TO 211)

210. How many boys showed signs of life?
How many girls showed signs of life?

BOYS BORN ALIVE __
GIRLS BORN ALIVE __

211. SUM ANSWERS TO Q.203, 205, 207 AND 210 AND RECORD THE TOTAL.
IF NONE, RECORD '00'.

TOTAL ___

212. CHECK 211:

ONE OR MORE BIRTH. Now I would like to make a list of all your births, whether still alive or not, starting with the first one you had. RECORD THE NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

IF NO BIRTHS, GO TO 220.

213. What name was given to your first/next baby?

NAME ___

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

BOY 1
GIRL 2

215. Is (NAME) still alive?

YES 1
NO 2

216. IF DECEASED: How old was (NAME) when he/she died?
RECORD IN DAYS IF LESS THAN 1 MONTH; IN MONTHS IF LESS THAN 2 YEARS; OR IN YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

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

MONTH ___
YEAR ___

218. IF STILL ALIVE: How old is (NAME)?
RECORD AGE IN COMPLETED YEARS

AGE IN YEARS ____

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

YES 1
NO 2

220. How old were you when you had your first period?

YEARS ____

NOT YET MENSTRUATED 96 (GO TO 230)
REFUSED TO RESPOND 97
DOESN'T KNOW 98

221. Have you had your period during the last 4 weeks?

YES 1
NO 2 (GO TO 223)

222. How many days has it been since your last period?

DAYS ___ (GO TO 230)

223. Are you pregnant?

YES 1
NO 2 (GO TO 229)
NOT SURE 8 (GO TO 229)

224. How many months pregnant are you?

MONTHS ____

225. Since you got pregnant, have you ever received an injection to prevent your baby from having convulsions after birth?

YES 1
NO 2
DOESN'T KNOW 8

226. Have you had a prenatal visit for your current pregnancy?

YES 1
NO 2 (GO TO 230)

227. Who did you consult the first time?
PROBE AND RECORD THE CODE OF THE MOST QUALIFIED PERSON.

DOCTOR 1
MIDWIFE, NURSE 2
DOULA 3
HEALER 4
HOSPITAL, PMI, FREE CLINICS 5
OTHER (SPECIFY) ___ 6

228. At how many months did you have your first prenatal visit?

MONTHS ____ (GO TO 230)
DOESN'T KNOW 98 (GO TO 230)

229. When did you have your last period?

MONTH ____

BEFORE THE LAST PREGNANCY 96
NEVER HAD IT 97
DOESN'T KNOW 98

230. At what time during the menstrual cycle do you think a woman have the best chance to get pregnant?

DURING HER PERIOD 1
JUST AFTER HER PERIOD 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
AT ANY TIME 5
OTHER (SPECIFY) ____ 6
DOESN'T KNOW 8

231. PEOPLE PRESENT (DURING THIS FIRST PART OF THE INTERVIEW).

CHILDREN OLDER THAN 10 YEARS
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MEN
YES 1
NO 2
OTHER WOMEN
YES 1
NO 2

SECTION 3. CONTRACEPTION

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

301. Are you familiar with some of these methods?

CIRCLE CODE '1' ON LINE 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CONTINUE DOWN THE COLUMN READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF THE METHOD IS RECOGNIZED AND CODE '3' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 302, ASK 303 BEFORE GOING ON TO THE NEXT QUESTION.

302. Have you ever heard of (METHOD)?

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3(GO TO NEXT METHOD)
02. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
03. INJECTIONS: Women can have an injection by a doctor, mid-wife or nurse to avoid becoming pregnant during many months.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
04. OTHER SCIENTIFIC METHODS FOR THE WOMAN: Some women insert a diaphragm, a sponge, effervescent pills, jelly or cream before having sexual intercourse.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
05. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse so that their wife does not get pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
07. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
08. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
09. WITHDRAWAL: Men can be careful to pull out before climax.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
10. ABSTINENCE: Some couples, outside of postnatal abstinence, avoid having sexual intercourse for months to avoid getting the woman pregnant.
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
11. MEDICINAL PLANTS (bark, roots, leaves)
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
12. GRIS-GRIS (amulet cord, node, fass, galane)
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
13. Have you heard of other ways or methods that women or men can use to avoid pregnancy?
(SPECIFY) _____
YES, SPONTANEOUSLY 1
YES, DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)

303. Have you ever used (METHOD)?

01. PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
02. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
YES 1
NO 2
03. INJECTIONS: Women can have an injection by a doctor, mid-wife or nurse to avoid becoming pregnant during many months.
YES 1
NO 2
04. OTHER SCIENTIFIC METHODS FOR THE WOMAN: Some women insert a diaphragm, a sponge, effervescent pills, jelly or cream before having sexual intercourse.
YES 1
NO 2
05. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse so that their wife does not get pregnant.
YES 1
NO 2
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
07. MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
08. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
09. WITHDRAWAL: Men can be careful to pull out before climax.
YES 1
NO 2
10. ABSTINENCE: Some couples, outside of postnatal abstinence, avoid having sexual intercourse for months to avoid getting the woman pregnant.
YES 1
NO 2
11. MEDICINAL PLANTS (bark, roots, leaves)
YES 1
NO 2
12. GRIS-GRIS (amulet cord, node, fass, galane)
YES 1
NO 2
13. OTHER METHOD (SPECIFY) _____
YES 1
NO 2

304. Where would you go to get (METHOD)?

01. PILL: Women can take a pill every day to avoid becoming pregnant.
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
02. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
03. INJECTIONS: Women can have an injection by a doctor, mid-wife or nurse to avoid becoming pregnant during many months.
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
04. OTHER SCIENTIFIC METHODS FOR THE WOMAN: Some women insert a diaphragm, a sponge, effervescent pills, jelly or cream before having sexual intercourse.
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
05. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse so that their wife does not get pregnant.
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
07. MALE STERILIZATION: Men can have an operation to avoid having any more children.
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
08. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant. Where would you go to obtain advice about the using the rhythm method?
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
11. MEDICINAL PLANTS (bark, roots, leaves)
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
12. GRIS-GRIS (amulet cord, node, fass, galane)
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8
13. OTHER METHOD (SPECIFY) _____
HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 4
PHARMACY 5
OTHER (SPECIFY) _____ 6
DOESN'T KNOW 8

305. What is the main problem, if there is one, with using (METHOD)?

01. PILL: Women can take a pill every day to avoid becoming pregnant.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
02. IUD: Women can have a loop or a coil placed inside them by a doctor or a nurse to avoid becoming pregnant.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
03. INJECTIONS: Women can have an injection by a doctor, mid-wife or nurse to avoid becoming pregnant during many months.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
04. OTHER SCIENTIFIC METHODS FOR THE WOMAN: Some women insert a diaphragm, a sponge, effervescent pills, jelly or cream before having sexual intercourse.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
05. CONDOM: Men can put a rubber sheath on their penis before sexual intercourse so that their wife does not get pregnant.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
06. FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
07. MALE STERILIZATION: Men can have an operation to avoid having any more children.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
08. RHYTHM METHOD: Every month that a woman is sexually active she can avoid pregnancy by not having intercourse on the days of the month she is most likely to get pregnant.
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
11. MEDICINAL PLANTS (bark, roots, leaves)
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
12. GRIS-GRIS (amulet cord, node, fass, galane)
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8
13. OTHER METHOD (SPECIFY) _____
NONE 1
ACCESS/AVAILABILITY 2
COST 3
SECONDARY EFFECTS 4
METHOD DOESN'T WORK 5
HUSBAND OPPOSED 6
OTHER (SPECIFY) _____ 7
DOESN'T KNOW 8

306. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 307)
AT LEAST ONE 'YES' (EVER USED) (GO TO 309)

307. Have you ever used anything or tried in any way to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 316)

308. What did you do or use?
CORRECT 302-303 AND GET INFORMATION FOR 304-305 IF NECESSARY.

(SPECIFY) _____

309. CHECK 303:

USED THE RHYTHM METHOD (GO TO 310)
NEVER USED THE RHYTHM METHOD (GO TO 311)

310. When you used the rhythm method, how did you determine which days to abstain?

BASED ON THE CALENDAR 1
BASED ON BODY TEMPERATURE 2
BASED ON THE CERVICAL MUCUS METHOD 3
BASED ON BODY TEMPERATURE AND ON MUCUS 4
OTHER (SPECIFY) ___ 5

311. How many living children did you have the first time you did or used something to avoid getting pregnant?

NUMBER OF CHILDREN ___

312. CHECK 223 AND 303:

PREGNANT (GO TO 317)
OTHER CASE (GO TO 313)
STERILIZED (GO TO 401)

313. Are you/your husband currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 316)

314. What method are you using?

PILL 01
IUD 02
INJECTIONS 03
VAGINAL METHODS 04
CONDOM 05
RHYTHM METHOD 08
WITHDRAWAL 09 (GO TO 321)
PROLONGED ABSTINENCE 10 (GO TO 321)
MEDICINAL PLANTS 11
GRIS-GRIS (AMULET) 12
OTHER (SPECIFY) ____ 13 (GO TO 321)

315. Where did you (or your partner) get (advice for) (CURRENT METHOD) the last time?

HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1 (GO TO 321)
PUBLIC HOSPITAL 2 (GO TO 321)
HEALTH CENTER 3 (GO TO 321)
PMI 4 (GO TO 321)
PHARMACY 4 (GO TO 321)
OTHER (SPECIFY) ____ 6 (GO TO 321)
DOESN'T KNOW 8 (GO TO 321)

316. Why don't you use a contraceptive method?

BREASTFEEDING 01
STERILE OR MENOPAUSAL 02
WANTS A CHILD 03
LACK OF INFORMATION 04
DOESN'T KNOW ANY CONTRACEPTIVE METHODS 05
DIFFICULT TO ACCESS 06
HUSBAND OPPOSED 07
RELIGION 08
SIDE EFFECTS 09
POLYGAMOUS HUSBAND 10
NOT MARRIED/YOUNG GIRL 11
HUSBAND ABSENT 12
DIVORCED, WIDOWED, SEPARATED 13
UNDECIDED 14
OTHER (SPECIFY) _____ 15

317. Do you intend to use, in the future, a method to delay or avoid becoming pregnant?

YES 1
NO 2 (GO TO 321)
DOESN'T KNOW 8 (GO TO 321)

318. What method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
VAGINAL METHODS 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
RHYTHM METHOD 08
WITHDRAWAL 09 (GO TO 320)
PROLONGED ABSTINENCE 10 (GO TO 320)
MEDICINAL PLANTS 11
GRIS-GRIS (AMULET) 12
OTHER (SPECIFY) ____ 13 (GO TO 320)
UNSURE OR DOESN'T KNOW 98 (GO TO 321)

319. Where do you plan to go to ask advice or to get (PREFERRED METHOD)?

HOSPITAL, CLINIC, PRIVATE DOCTOR'S OFFICE 1 (GO TO 321)
PUBLIC HOSPITAL 2
HEALTH CENTER 3
PMI 3
PHARMACY 5
OTHER (SPECIFY) ___ 6

320. Do you intend to use (PREFERRED METHOD) in the next 12 months?

YES 1
NO 2
DOESN'T KNOW 8

321. From whom/where did you learn about contraception for the first time?

PMI 01
MATERNITY OR HOSPITAL 02
PRIVATE CLINIC 03
PRIVATE DOCTOR 04
HEALTH CARE WORKER 05
RURAL INSTRUCTORS, FAMILY ECONOMY INSTRUCTORS, RURAL ORGANIZERS 06
WOMEN'S GROUPS 07
PHARMACY 08
HUSBAND 09
OTHER PEOPLE 10
RADIO/TELEVISION 11
NEWSPAPER 12
OTHER (SPECIFY) ____ 13
DOESN'T KNOW ANYTHING 97
DOESN'T KNOW 98

SECTION 4. HEALTH AND BREAST FEEDING

401. CHECK 217:

ONE OR MORE LIVE BIRTHS SINCE APRIL 1981: WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE APRIL 1981 IN TABLE 3 BEGINNING WITH THE LAST BIRTH.

NO BIRTHS SINCE APRIL 1981 (GO TO 501)

NAME ____
LIVING ____
DEAD ____

[ASK QUESTIONS 402-411 FOR EACH BIRTH SINCE APRIL 1981]

402. When you were pregnant with (NAME) did you consult someone for prenatal care?
IF YES: Whom did you see the first time?
CIRCLE THE CODE CORRESPONDING TO THE PERSON MOST QUALIFIED.

DOCTOR 1
MIDWIFE/NURSE/AUX 2
HOSPITAL, PMI, FREE CLINIC 3
DOULA 4
OTHER (SPECIFY) ____ 5
NO CONSULTATION 6

403. When you were pregnant with (NAME), did you get an injection in the arm to avoid getting tetanus?

YES 1
NO 2
DOESN'T KNOW 8

404. Who assisted you during the delivery of (NAME)?
PROBE AND CIRCLE THE CODE OF THE MOST QUALIFIED PERSON.

DOCTOR 1
MIDWIFE/NURSE/AUX 2
HOSPITAL, PMI, FREE CLINIC 3
DOULA 4
TRADITIONAL BIRTH ATTENDANT 5
OTHER (SPECIFY) ___ 6
NO ASSISTANCE 7

405. Did you breastfeed (NAME)?

YES 1
NO 2 (GO TO 408)

406. Are you still breast feeding (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 409)
NO 2

407. How many months did you breast feed (NAME)?

MONTHS____
UNTIL DEATH 97 FOR LAST BIRTH; 96 FOR OTHER BIRTHS

408. Has your period returned?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 409)
NO 2 (GO TO 410)

409. How many months after the birth of (NAME) until your period returned?

LAST BIRTH:
MONTHS ____
OTHER BIRTHS:
MONTHS ____ (GO TO 411)
NOT INCLUDED 97

410. Have you begun having sexual intercourse again since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO THE NEXT BIRTH)

411. How many months after the birth of (NAME) did you begin to have sexual intercourse again?

MONTHS ___ (GO TO NEXT BIRTH; IF NO MORE BIRTHS, GO TO 412)

412. CHECK 406 FOR THE LAST BIRTH:

STILL BREASTFEEDING LAST CHILD (GO TO 413)
OTHER CASE (GO TO 417)

413. How many times did you breastfeed last night between sunset and sunrise?

NUMBER OF NIGHTTIME FEEDINGS ___

CHILD SLEEPS WHILE BREASTFEEDING 97
DOESN'T KNOW 98

414. Yesterday, how many times did you breastfeed during the day?

NUMBER OF DAYTIME FEEDINGS ___

WHEN DEMANDED, WHEN THE CHILD CRIES 97
DOESN'T KNOW 98

415. Did you give (NAME OF LAST CHILD) any of the following liquids or foods yesterday or last night?
READ THE LIST OF CATEGORIES.

WATER
YES 1
NO 2
JUICE
YES 1
NO 2
POWDERED MILK
YES 1
NO 2
COW/GOAT MILK
YES 1
NO 2
QUINQUELIBA
YES 1
NO 2
OTHER LIQUID (SPECIFY) _____
YES 1
NO 2
GRAIN BROTH
YES 1
NO 2
SOLID FOODS
YES 1
NO 2

416. CHECK 431:

NO FOOD OR LIQUID GIVEN (NO 'YES' IN 415) (GO TO 418)

OTHER FOOD OR LIQUID GIVEN ('YES' FOR ONE OR MORE in 415): ASK: Did you give these foods in a bottle?

YES 1 (GO TO 418)
NO 2 (GO TO 418)

417. Why did you stop breast feeding (NAME)?

WEANING 01
CHILD ILL 02
CHILD DIED 03
REFUSED TO DRINK 04
MOTHER ILL 05
NO MILK 06
PREGNANCY 07
ARTIFICIAL MILK 08
OTHER (SPECIFY) ____ 09

[ASK QUESTIONS 418-430 FOR BIRTHS SINCE APRIL 1981]

418. CHECK 401:

RECORD THE NAME AND SURVIVAL OF EACH BIRTH SINCE THE FIRST OF APRIL 1981 IN TABLE 4 BEGINNING WITH THE LAST BIRTH. THE HEADING OF TABLE 4 MUST BE EXACTLY THE SAME AS THAT OF TABLE 3. ASK QUESTIONS OF THE LIVING CHILDREN ONLY.

NAME ___
LIVING (GO TO 419)
DEAD (GO TO 428)

419. Do you have a health card for (NAME)?
IF YES: May I see it please?

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 422)
NO CARD 3 (GO TO 422)

420. COPY THE DATES FOR EACH VACCINATION FROM THE CARD.

BCG
NO 1
DAY __
MONTH __
YEAR __
DPT 1
NO 1
DAY __
MONTH __
YEAR __
POLIO 1
NO 1
DAY __
MONTH __
YEAR __
DPT 2
NO 1
DAY __
MONTH __
YEAR __
POLIO 2
NO 1
DAY __
MONTH __
YEAR __
DPT 3
NO 1
DAY __
MONTH __
YEAR __
POLIO 3
NO 1
DAY __
MONTH __
YEAR __
MEASLES
NO 1
DAY __
MONTH __
YEAR __
YELLOW FEVER
NO 1
DAY __
MONTH __
YEAR __

421. Has (NAME) received any vaccinations against disease?

YES 1
NO 2
LESS THAN THREE MONTHS 3
DOESN'T KNOW 8

422. Has (NAME) had diarrhea during the past two weeks?

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

423. Did you or someone else do something to treat the diarrhea?

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

424. What was done to treat the diarrhea?
RECORD '1' FOR ALL THE TREATMENTS MENTIONED.

ORS 1
SUGAR, SALT AND WATER SOLUTION 1
RICE BROTH 1
BAOBAB FRUIT 1
MEDICINAL PLANTS 1
GANIDAN, SYRUP AND OTHER PHARMACEUTICAL PRODUCTS 1
HOSPITAL, PMI, FREE CLINIC 1

425. Did (NAME) have malaria last winter?

YES 1
NO 2 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)
NOT YET BORN 3 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)
DOESN'T KNOW 8 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

426. Did you or someone else do something to treat the malaria?

YES 1
NO 2 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)
DOESN'T KNOW 8 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

427. What was done to treat the malaria?

NIVAQUINE, CANOQUINE, CHLOROQUINE 1 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

ASPIRINE 1 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

OTHER PILLS 1 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

INJECTION 1 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

HOSPITAL, PMI, FREE CLINIC 1 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

MEDICINAL PLANTS 1 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

OTHER (SPECIFY) ____ 1 (GO TO 419 FOR NEXT BIRTH; FOR FIRST BIRTH, GO TO 431)

428. During the illness that led to death, did the child present one or more of the following symptoms?

INCAPABLE OF SUCKLING 1
INCAPABLE OF CRYING 1
HIGH FEVER 1
RASH 1
COUGH I
RED EYES 1
COUGH AND VOMITING 1
COUGHING FITS 1
LOOSE STOOLS 1
RED HAIR 1
SWOLLEN FEET 1
ACCIDENT 1
DOESN'T KNOW 1

429. Just before death, did the child have one or more of the following symptoms?

MUSCLE SPASMS 1
CONVULSIONS 1
LOOSE STOOLS 1
RIGID BODY 1
PARALYSIS 1

430. What was the main cause of death?

TETANUS 1 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)
PERTUSSIS 2 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)
DIARRHEA 3 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)
MEASLES 4 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)
MALARIA 5 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)
FLU 6 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)
OTHER (SPECIFY) ____ 7 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)
DOESN'T KNOW 8 (GO TO THE NEXT BIRTH IN 419, FOR FIRST BIRTH GO TO 431)

431. If one or your children had a case of acute diarrhea, how would you treat it?

ORS 1
SUGAR, SALT, WATER SOLUTION 1
RICE BROTH 1
POTATO PUREE 1
HOSPITAL, PMI, FREE CLINIC 1
BAOBAB FRUIT 1
MEDICINAL PLANTS 1
GANIDAN, SYRUP AND OTHER PHARMACEUTICAL PRODUCTS 1
OTHER 1
DOESN'T KNOW 1

432. What does a vaccine do?

PREVENTS 01
HEALS 02
IMMUNIZES 03
PREVENTS AND HEALS 04
PREVENTS AND IMMUNIZES 05
HEALS AND IMMUNIZES 06
PREVENTS, HEALS AND IMMUNIZES 07
OTHER (SPECIFY) ____ 08
DOESN'T KNOW 98

SECTION 5. MARRIAGE

501. Are you currently married?

YES 1 (GO TO 505)
NO 2

502. Are you celibate, widowed, divorced or separated?

CELIBATE 1
WIDOWED 2
DIVORCED 3
SEPARATED 4

503. Do you live in union with someone?

YES 1 (GO TO 505)
NO, WIDOWED, DIVORCED OR SEPARATED 2 (GO TO 509)
NO, CELIBATE 3

504. Have you ever been in union with someone?

YES 1 (GO TO 509)
NO 2 (GO TO 522)

505. Is your husband/partner living with you now or is he staying elsewhere?

LIVES TOGETHER 1
LIVES ELSEWHERE 2

506. Besides yourself, does your husband/partner have other wives?

YES 1
NO 2 (GO TO 509)

507. How many wives does he have besides you?

NUMBER __
DOESN'T KNOW 8

508. What is your rank: Are you the first, second...wife?

RANK ___
CONCUBINE 7
DOESN'T KNOW 8

509. How many times have you been married or lived with a man?

NUMBER ____
7 OR MORE TIMES 7
DOESN'T KNOW 8

510. In which month and in which year did you consummate your union with your (first) husband/partner?

MONTH _____
DOESN'T KNOW MONTH 98
YEAR _____ (GO TO 512)
DOESN'T KNOW YEAR 98
MARRIAGE NOT CONSUMMATED 97 (GO TO 512)

511. How old were you when you began to live with him?

AGE ____

512. Are your father and mother still alive?

FATHER ALIVE
YES 1
NO 2
MOTHER ALIVE
YES 1
NO 2

513. Are the father and mother of your (first) husband still alive?

FATHER OF FIRST HUSBAND
YES 1
NO 2
DOESN'T KNOW 8
MOTHER OF FIRST HUSBAND
YES 1
NO 2
DOESN'T KNOW 8

514. CHECK 510, 512 AND 513:

ALL ALIVE (GO TO 517)
NOT ALL ALIVE/DOESN'T KNOW (GO TO 515)
MARRIAGE NOT CONSUMMATED (GO TO 521)

515. Were (CITE THE DECEASED PARENTS) alive when you began to live with your (first) husband?

FATHER OF THE WOMAN
YES 1
NO 2
DOESN'T KNOW 8
MOTHER OF THE WOMAN
YES 1
NO 2
DOESN'T KNOW 8
FATHER OF (FIRST) HUSBAND
YES 1
NO 2
DOESN'T KNOW 8
MOTHER OF (FIRST) HUSBAND
YES 1
NO 2
DOESN'T KNOW 8

516. CHECK 515:

SOME PARENTS ALIVE AT WEDDING (GO TO 517)
NO PARENTS ALIVE AT WEDDING (GO TO 520)

517. From the day you began living with your (first) husband/partner, have you lived, you and your husband, with one of these parents in the same household for 6 months, continuously?

YES 1
NO 2 (GO TO 519)

518. For how many years did you live with a relative?

YEARS_____

UNTIL NOW 97 (GO TO 520)
DOESN'T KNOW 98

519. Do you currently live with one of these relatives?

YES 1
NO 2
FIRST UNION BROKEN 3

520. Since the day you were married/began to live together, in how many different localities did you and your first husband live for 6 months or more?

NUMBER OF LOCALITIES ___
DOESN'T KNOW 98

521. Are you related to your (first) husband/partner?

PATERNAL COUSIN 1
MATERNAL COUSIN 2
OTHER RELATIVES 3
NO RELATION 4

522. PRESENCE OF OTHER PEOPLE:

CHILDREN LESS THAN 10 YEARS OLD
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MEN
YES 1
NO 2
OTHER WOMEN
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601. CHECK 501 TO 503:

CURRENTLY IN UNION (GO TO 602)
OTHER CASE (GO TO 612)

Now I would like to ask some questions about the future.

602. CHECK 223:

NOT PREGNANT OR NOT SURE. Would you like to have (other) children?

PREGNANT. After the child you are expecting, would you like to have other children?

YES 1
NO 2 (GO TO 606)
OTHER 6 (GO TO 606)
DOESN'T KNOW OR NOT DECIDED 8 (GO TO 606)

603. How many (other) boys and girls would you like to have in the future (outside of the current pregnancy)?

NUMBER OF BOYS ____
NUMBER OF GIRLS ____
DEPENDS ON GOD 95
DEPENDS ON HUSBAND 96
OTHERS (SPECIFY) ___ 97
DOESN'T KNOW 98

604. If you could decide, how long would you like to wait from now before the birth of (a/another) child (besides the one you are expecting)?

NUMBER OF MONTHS___

RIGHT AWAY/SOON AS POSSIBLE 95
WHEN GOD WOULD LIKE 96
OTHER (SPECIFY) ____ 97
DOESN'T KNOW, UNDECIDED 98

605. What sex would you like your child to be?

BOY 1
GIRL 2
NO PREFERENCE 3
DEPENDS ON GOD 4
OTHER (SPECIFY) ____ 5

606. In your opinion, what is the best interval between births?

NUMBER OF MONTHS ____
OTHER (SPECIFY) __ 97 (GO TO 608)
DOESN'T KNOW 98 (GO TO 608)

607. Why is this interval the best?

REST, MOTHER'S HEALTH 01
CHILD'S HEALTH 02
MOTHER'S AND CHILD'S HEALTH 03
CHILD'S EDUCATION 04
MOTHER'S HEALTH, CHILD'S EDUCATION 05
CHILD'S HEALTH AND EDUCATION 06
CUSTOMS, RELIGION 07
OTHER (SPECIFY) ____ 97
DOESN'T KNOW 98

608. After the birth of a child, how long should a couple wait before having sexual intercourse again?

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

OTHER (SPECIFY) ___ 497
DOESN'T KNOW 998

609. Should a mother wait until she has completely stopped breast feeding before having sexual intercourse, or is this not important?

YES 1
NO 2
DOESN'T KNOW 8

610. Would you say that your husband approves or disapproves of couples that use a method to avoid getting pregnant?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

611. How many times during the past year did you speak with your partner/husband about family planning?

NEVER 1
ONCE OR TWICE 2
THREE TIMES OR MORE 3

612. In general do you approve or disapprove of couples that use a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW 8 (GO TO 614)

613. Why?

MOTHER'S HEALTH, REST 01
CHILD'S HEALTH 02
MOTHER'S AND CHILD'S HEALTH 03
CHILD'S EDUCATION 04
MOTHER'S HEALTH AND CHILD'S EDUCATION 05
ECONOMIC DIFFICULTIES 06
RELIGION, CUSTOMS 07
SECONDARY EFFECTS 08
MORTALITY 09
ECONOMIC ADVANTAGES 10
OTHER (SPECIFY) ____ 97
DOESN'T KNOW 98

614. CHECK 212:

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

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?

NUMBER ___

DEPENDS ON GOD 96
OTHER (SPECIFY) ___ 97
DOESN'T KNOW 98

615. How many boys and girls would you like to have?

NUMBER OF BOYS ___
NUMBER OF GIRLS ___
DEPENDS ON GOD 96
OTHER (SPECIFY) ___ 97
DOESN'T KNOW 98

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

701. CHECK 502, 503 AND 504:

HAS BEEN MARRIED/HAS LIVED WITH A MAN: ASK QUESTIONS ABOUT THE CURRENT OR MOST RECENT HUSBAND/PARTNER. (GO TO 702)

NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 715)

702. Did your current husband attend school?

YES 1
NO 2 (GO TO 706)
DOESN'T KNOW 8 (GO TO 706)

703. What was the highest level of school that he achieved: primary, secondary or superior?

PRIMARY 1
SECONDARY 2
SUPERIOR 3
DOESN'T KNOW 8 (GO TO 706)

704. What was the last class that he achieved?

CLASS ____
DOESN'T KNOW 98

705. CHECK 704:

PRIMARY (GO TO 706)
SECONDARY OR MORE (GO TO 707)

706. Can (could) he read a letter or newspaper?

YES 1
NO 2
DOESN'T KNOW 8

707. What is/was your husband/partner's main occupation?

OCCUPATION ______

708. CHECK 707:

DOES NOT WORK IN AGRICULTURE (GO TO 709)
WORKS/WORKED IN AGRICULTURE (GO TO 711)
HAS NEVER WORKED (GO TO 712)

709. Does (did) he receive a regular weekly or monthly salary?

YES 1 (GO TO 712)
NO 2 (GO TO 712)
DOESN'T KNOW 8 (GO TO 712)

710. Does/did he work mainly on his own land or on family land, or did/does he work on land that he rents from someone else, on someone else's land?

PERSONAL/FAMILIAL LAND 1
OTHER LAND 2

711. Does (did) he work to be paid primarily in money or in kind?

IN MONEY 1
IN KIND 2
DOESN'T KNOW 8

712. Before getting married (before living regularly with a partner), did you work regularly to make money aside from working in a field or in a family business?

YES 1
NO 2 (GO TO 714)
DOESN'T KNOW 8 (GO TO 714)

713. Did the money you made go mostly to your family or did you keep most of it for yourself?

FAMILY 1
HERSELF 2
EQUAL PARTS 3

714. Since getting married (before living regularly with a partner), have you worked regularly to make money aside from working in a field or in a family business?

YES 1 (GO TO 717)
NO 2 (GO TO 718)

715. Have you ever worked regularly to make money aside from working in a field or in a family business?

YES 1
NO 2 (GO TO 718)

716. Does the money you earn this way go mostly to your family or did you keep most of it for yourself?

FAMILY 1
HERSELF 2
EQUAL PARTS 3

717. Do you currently work regularly to make money aside from working in a field or in a family business?

YES 1
NO 2

718. RECORD THE TIME

HOUR ___
MINUTES ___

SECTION 8. WEIGHT AND HEIGHT

801. CHECK TABLE 1:
FOR EACH LIVING CHILD BORN BETWEEN APRIL '83 AND OCTOBER '85, (6 TO 36 MONTHS) RECORD THE LINE NUMBER, WEIGHT, HEIGHT AND BIRTH DATE.

FIRST AND LAST NAME__
LINE NUMBER__
BIRTH MONTH__
BIRTH YEAR 19__
WEIGHT IN KG __
HEIGHT IN CM__
NOT MEASURED(SPECIFY)__

INTERVIEWER'S OBSERVATIONS

FILL OUT AFTER HAVING ENDED THE INTERVIEW.

INTERVIEWER'S OBSERVATIONS_____
NAME _____
DATE _____

SUPERVISOR'S OBSERVATIONS _____
NAME ___
DATE ___

FIELD EDITOR'S OBSERVATIONS _____
NAME ___
DATE ___