PLACE NAME (COMMUNE/VILLAGE) _____
NAME OF HEAD OF HOUSEHOLD_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER_____
REGION_____
RURAL 2
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL?
REGIONAL CAPITAL (THIES, KAOLACK, ZIGUINCHOR, ST. LOUIS, DIOURBEL) 2
OTHER CITY 3
RURAL 4
NAME/LINE NUMBER OF THE WOMAN:
NAME/LINE NUMBER OF THE HUSBAND (IF INTERVIEWED):
FIRST INTERVIEW (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE______
INTERVIEWER NAME______
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ______ 7
NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____
TIME_____
FINAL VISIT
DAY_____
MONTH_____
YEAR _____
INTERVIEWER_____
RESULT_____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTIALLY FILLED OUT 5
ILL/INCAPACITATED 6
OTHER (SPECIFY) ______ 7
NO 2
P 2
SR 3
M 4
D 5
SM 6
ALN 7
F 8
AL 9
SUPERVISOR
NAME_____
DATE_____
FIELD EDITOR
NAME_____
DATE_____
KEYED BY_____
CODE _____
SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT
To begin, I would like to ask you questions about yourself and your household.
102. Until the age of 12 years, did you like the majority of the time in big city, in a city or in a rural area?
LARGE CITY 2
CITY 3
COUNTRYSIDE 4
FOREIGN COUNTRY 5
103. How long have you been living continuously in (NAME OF CURRENT LOCALITY OF RESIDENCE)?
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in Dakar, another capital, a city, or village?
IF A CITY, ASK THE NAME OF THE CITY.
LARGE CITY 2
CITY 3
COUNTRYSIDE 4
FOREIGN COUNTRY 5
105. In which month and in which year were you born?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 98
106. How old are you currently?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT
NO 2 (GO TO 111)
108. What is the highest level of school you attended: primary, secondary or superior?
SECONDARY 2
SUPERIOR 3
109. What is the last (year/grade) that you achieved at this level?
SECONDARY OR MORE (GO TO 113)
111. Can you read and understand a letter or a newspaper easily, with difficulty or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3
NO 2 (GO TO 114A)
POULAR 02
SERER 03
MANDINGUE/SOCE/MALINKE 04
DIOLA 05
SOLINKE/SARAKOLE 06
BAMBARA 07
MANJAAK 08
MANCAGNE 09
BALANT 10
OTHERS (SPECIFY) ______11
114A. What is your occupation?
That is, what kind of work do you mainly do?
Now I would like to ask about all of the births you have had during your life.
201. Have you ever given birth?
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?
NO 2 (GO TO 204)
203. How many sons live with you?
How many daughters live with you?
IF NONE, RECORD '00'.
204. Do you have any sons or daughters to whom you have given birth and who are alive but do not live with you?
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'.
206. Have you given birth to a son or daughter who was born alive but later died?
IF NO, PROBE: Any who cried and showed signs of live at birth but only survived a few hours or days?
NO 2 (GO TO 208)
207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'.
208. SUM ANSWERS TO 203, 205, AND 207 AND RECORD THE TOTAL.
IF NONE, RECORD '00'.
209. CHECK 208:
Just to be sure that I have this right: You have had in TOTAL _____births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NONE (GO TO 223)
Now I would like to make a list of all your births, whether still alive or not, starting with the first one you had.
211. RECORD THE NAMES OF ALL THE BIRTHS IN 212.
RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
212. What name was given to your first/next baby?
213. RECORD THE TYPE OF BIRTH:
SINGLE OR MULTIPLE?
MULT 2
214. Is (NAME) a boy or a girl?
GIRL 2
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season was he/she born?
NO 2 (GO TO 220)
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?
NO 2
219. IF THE CHILD IS LESS THAN 15 YEARS OLD: With whom does s/he live?
IF 15 OR OLDER, GO TO THE NEXT BIRTH.
OTHER RELATIVE 2
SOMEONE ELSE 3 (GO TO THE NEXT BIRTH)
220. IF DEAD: How old was (NAME) when he/she died?
IF '1 YEAR' PROBE: How old was (NAME) in months?
RECORD IN DAYS IF LESS THAN 1 MONTH; IN MONTHS IF LESS THAN 2 YEARS; OR IN YEARS
MONTHS 2_____
YEARS 3_____
221. COMPARE 208 WITH THE NUMBER OF BIRTHS RECORDED IN THE ABOVE TABLE AND MARK:
CHECK: FOR EVERY LIVING CHILD: THE CURRENT AGE IS RECORDED (217)
CHECK: FOR EACH DECEASED CHILD: THE AGE AT DEATH IS RECORDED (220)
CHECK: FOR AGE OF DEATH LESS THAN 24 MONTHS: PROBE TO DETERMINE THE EXACT NUMBER OF MONTHS (220)
222. CHECK 215 AND RECORD THE NUMBER OF BIRTHS SINCE JANUARY 1992.
IF NONE, RECORD '0'.
223. Are you currently pregnant?
NO 2 (GO TO 225A)
NOT SURE 8 (GO TO 225A)
224. How many months pregnant are you?
225. At the moment you became pregnant, did you want to become pregnant at that time, did you want to wait until later, or did you not want to become pregnant?
LATER 2
NOT AT ALL 3
NO OPINION 8
225A. Do you know of places where you can have consultations for a pregnancy?
NO 2 (GO TO 227)
225B. What places do you know of?
CIRCLE THE CODES CORRESPONDING TO THE RESPONSES.
HEALTH CENTER/PMI (Protection Maternelle et Infantile) B
HEALTH POST/FREE CLINIC C
PHARMACY E
PRIVATE DOCTOR F
PRIVATE NURSE/CONFES G
TRADITIONAL HEALER I
CHURCH J
FRIEND/RELATIVE K
OTHER (SPECIFY) _____M
227. Between the first day of a menstrual period and the next menstrual period, are there times when a woman is more likely to get pregnant?
NO 2 (GO TO 301)
DOESN'T KNOW 8 (GO TO 301)
228. At what time during the menstrual cycle does a woman have the best chance to get pregnant?
JUST AFTER HER PERIOD 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) _____5
DOESN'T KNOW 8
301. 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. Which ways or methods have you heard of?
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 303-303A BEFORE GOING ON TO THE NEXT QUESTION.
302. Have you ever heard of (METHOD)?
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
YES DESCRIPTION 2
NO 3 (GO TO NEXT METHOD)
NO 3 (GO TO 305)
303. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
303A. What are the advantages of (METHOD)?
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
EASY TO USE B
EASY ACCESS C
WITHOUT SECONDARY EFFECTS D
INEXPENSIVE/FREE E
EFFICIENT F
CONTROLE/APPROVS. INFREQUENT G
FORGETTING IS NOT A PROBLEM H
DOESN'T KNOW I
OTHER (SPECIFY) _____ J
AT LEAST ONE "YES" (EVER USED) (GO TO 308)
306. Have you ever used anything or tried in any way to delay or avoid pregnancy?
NO 2 (GO TO 324)
307. What did you do or use?
CORRECT 303-303A (AND 302 IF NECESSARY). (GO TO 308)
Now I would like to talk about the time when, for the first time you did or used something to avoid getting pregnant.
308. How many living children did you have at that time?
IF NONE, RECORD '00'.
PREGNANT (GO TO 324)
WOMAN STERILIZED (GO TO 312A)
311. Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 324)
312. What method are you using?
312A. CIRCLE '07' FOR FEMALE STERILIZATION.
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
RHYTHM METHOD 09 (GO TO 324)
WITHDRAWAL 10 (GO TO 324)
OTHER (SPECIFY) _____11 (GO TO 324)
DOESN'T KNOW 98
SHE/HE STERILIZED: Where did the sterilization take place?
USES ANOTHER METHOD: Where did you get (METHOD) the last time?
HEALTH CENTER/PMI (Protection Maternelle et Infantile) 12
HEALTH POST/FREE CLINIC 13
PHARMACY 22
PRIVATE DOCTOR 23
PRIVATE NURSE/CONFES 24
TRADITIONAL HEALER 32 (GO TO 321)
CHURCH 33 (GO TO 321)
FRIEND/RELATIVE 34 (GO TO 321)
OTHER (SPECIFY) _____51 (GO TO 321)
DOESN'T KNOW 98 (GO TO 321)
320. Is it easy or difficult to get there?
DIFFICULT 2
DOESN'T KNOW 3
USES ANOTHER METHOD (GO TO 329)
322. In which month and in which year did the sterilization take place?
324. Do you intend to use, in the future, a family planning method to delay or avoid becoming pregnant?
NO 2
DOESN'T KNOW 8 (GO TO 330)
325. What is the main reason you do not intend to use a method to delay or avoid pregnancy?
RECORD ALL THE REASONS MENTIONED.
LACK OF INFORMATION 02 (GO TO 330)
PARTNER DISAPPROVES 03 (GO TO 330
TOO EXPENSIVE 04 (GO TO 330)
SECONDARY EFFECTS 05 (GO TO 330)
HEALTH PROBLEMS 06 (GO TO 330)
HARD TO GET 07 (GO TO 330)
RELIGION 08 (GO TO 330)
OPPOSED TO FAMILY PLANNING 09 (GO TO 330)
FATALISTIC 10 (GO TO 330)
OTHER PEOPLE DISAPPROVE 11 (GO TO 330)
INFREQUENT SEX 12 (GO TO 330)
DIFFICULTY GETTING PREGNANT 13 (GO TO 330)
MENOPAUSE/HYSTERECTOMY 14 (GO TO 330)
INCONVENIENT TO USE 15 (GO TO 330)
NOT MARRIED 16 (GO TO 330)
OTHER (SPECIFY) _____17 (GO TO 330)
DOESN'T KNOW 98 (GO TO 330)
326. Do you intend to use, in the next 12 months, a family planning method?
NO 2
DOESN'T KNOW 8
327. When you would use a method, what method would you prefer to use?
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
RHYTHM METHOD 09 (GO TO 330)
WITHDRAWAL 10 (GO TO 330)
OTHER (SPECIFY) _____11 (GO TO 330)
DOESN'T KNOW 98 (GO TO 330)
328. Where can you procure (METHOD CITED IN 327)?
HEALTH CENTER/PMI (Protection Maternelle et Infantile) 12 (GO TO 332)
HEALTH POST/FREE CLINIC 13 (GO TO 332)
PHARMACY 22 (GO TO 332)
PRIVATE DOCTOR 23 (GO TO 332)
PRIVATE NURSE/CONFES 24 (GO TO 332)
TRADITIONAL HEALER 32 (GO TO 334)
CHURCH 33 (GO TO 334)
FRIEND/RELATIVE 34 (GO TO 334)
OTHER (SPECIFY) _____51 (GO TO 334)
DOESN'T KNOW 61 (GO TO 330)
USES A MODERN METHOD (GO TO 334)
330. Do you know of a place where you could get a family planning method?
NO 2 (GO TO 334)
331. What place do you know of?
HEALTH CENTER/PMI (Protection Maternelle et Infantile) 12
HEALTH POST/FREE CLINIC 13
PHARMACY 22
PRIVATE DOCTOR 23
PRIVATE NURSE/CONFES 24
TRADITIONAL HEALER 32
CHURCH 33 (GO TO 334)
FRIEND/RELATIVE 34 (GO TO 334)
OTHER (SPECIFY) _____51 (GO TO 334)
332. How long does it take you to get to this place?
IF LESS THAN 2 HOURS, RECORD IN MINUTES.
OTHERWISE RECORD IN HOURS.
HOURS 2_____
DOESN'T KNOW 9998
333. Is it easy or difficult to get to the place where you feel most at ease?
DIFFICULT 2
DOESN'T KNOW 8
334. In the last month, did you hear a message about family planning on:
The radio?
The television?
NO 2
NO 2
335. Do you find it acceptable or not acceptable that family planning be discussed on the radio or television?
NOT ACCEPTABLE 2
NO OPINION 8
336. Do you listen to the radio at least once a week?
NO 2
342. Do you approve or disapprove of family planning being discussed on the radio or television?
DISAPPROVE 2
WITHOUT OPINION 8
NO 'YES' (NEVER USED) (GO TO 401)
344. When you began to use your last method (or current method), who decided? You alone? Your husband alone? Both? Or another person?
HUSBAND ALONE 2
COUPLE 3
OTHER (SPECIFY) _____ 4
NOT PREGNANT AND DOES NOT CURRENTLY USE (GO TO 346)
USES A METHOD OR IS STERILIZED (GO TO 401)
346. What are the reasons why you stopped using your last method?
CIRCLE THE CODES CORRESPONDING TO THE RESPONSES.
SECONDARY EFFECTS B
GOT PREGNANT/CONTRACEPTION FAILED C
DIFFICULT TO GET D
EXPENSIVE E
LACK OF MEANS F
HUSBAND/PARTNER DISAPPROVES G
RELATIVES DISAPPROVE H
RELIGION I
NOT HAVING SEXUAL INTERCOURSE J
NOT CONVENIENT K
OTHER (SPECIFY) _____L
SECTION 4A PREGNANCY AND BREAST FEEDING
401. CHECK 222:
NO BIRTHS SINCE JAN. 1992 (GO TO 501)
402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH SINCE JAN. 1992 RECORDED IN THE REPRODUCTION TABLE. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE ADDITIONAL QUESTIONNAIRES).
Now I would like to some questions about the health of all of your children born in the last three years. (We will talk about each separately).
LINE NUMBER FROM 212:
FROM LINE 212 AND 216:
DEAD_____
403. When you got pregnant with (NAME), did you want to get pregnant at that moment, wait until later or did you not want to have any more children?
LATER 2
DIDN'T WANT MORE CHILDREN 3 (GO TO 405)
WITHOUT OPINION 8 (GO TO 405)
404. How long would you have liked to wait?
YEARS 2_____
DOESN'T KNOW 998
405. When you were pregnant with (NAME) did you consult someone for prenatal care?
IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
HEALTH CARE WORKER/MIDWIFE/ NURSE B
TRADITIONAL BIRTH ATTENDANT D
NO ONE F (GO TO 409)
406. Did they give you a health card for this pregnancy?
NO 2
DOESN'T KNOW 8
407. How many months pregnant were you when you had your first prenatal consultation?
DOESN'T KNOW 98
408. How many times did you get consultation during this pregnancy?
DOESN'T KNOW 98
409. When you were pregnant with (NAME), did you get an injection in the arm to avoid getting tetanus, that is to say, to avoid having convulsions after the birth?
NO 2 (GO TO 411)
DOESN'T KNOW 8 (GO TO 411)
410. During this pregnancy, how many times did you have this injection?
DOESN'T KNOW 8
411. Where did you give birth to (NAME)?
OTHER HOME 12
HEALTH CENTER 22
HEALTH POST 23
412. Who assisted you during the delivery of (NAME)? Anyone else?
CIRCLE THE CODES CORRESPONDING TO THE GIVEN RESPONSES.
HEALTH WORKER/ NURSE /MIDEWIFE B
TRADITIONAL BIRTH ATTENDENT D
OTHER (SPECIFY) _____E
413. Was (NAME) born prematurely or at term?
PREMATURELY 2
DOESN'T KNOW 8
416. Was (NAME) weighed at birth?
NO 2 (GO TO 418)
DOESN'T KNOW 8 (GO TO 418)
417. How much did (NAME) weigh?
DOESN'T KNOW 98
418. Has your period returned since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]
NO 2 (GO TO 421)
419. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]
NO 2 (GO TO 423)
420. For how long after the birth of (NAME) did you not have your period?
MONTHS 2_____
DOESN'T KNOW 998
421. CHECK 223:
[ASK ONLY FOR MOST RECENT BIRTH]
PREGNANT OR NOT SURE (GO TO 423)
422. Have you begun having sexual intercourse again since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]
NO 2 (GO TO 424)
423. How long after the birth of (NAME) did you begin to have sexual intercourse again?
MONTH 2_____
DOESN'T KNOW 998
424. Did you breastfeed (NAME)?
NO 2 (GO TO 435)
426. How long after birth did you first put (NAME) to the breast?
IF LESS THAN ONE HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS RECORD HOURS. OTHERWISE, RECORD IN DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]
HOURS 1_____
DAYS 2_____
427. CHECK 216:
[ASK ONLY FOR MOST RECENT BIRTH]
DECEASED (GO TO 433)
428. Are you still breast feeding (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]
NO 2 (GO TO 433)
429. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[ASK ONLY FOR MOST RECENT BIRTH]
430. Yesterday, how many times did you breastfeed during the day?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[ASK ONLY FOR MOST RECENT BIRTH]
431. Did you give (NAME) any of the following foods yesterday or last night?
[ASK ONLY FOR MOST RECENT BIRTH]
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
432. CHECK 431:
FOOD OR LIQUID GIVEN YESTERDAY:
[ASK ONLY FOR MOST RECENT BIRTH]
NOTHING AT ALL (GO TO 436)
433. For how many months did you breastfeed (NAME)?
UNTIL S/HE DIED 96 (GO TO 436)
434. Why did you stop breast feeding (NAME)?
CHILD ILL/WEAK 02
CHILD DIED 03
BREAST/NIPPLE PROBLEM 04
INSUFFICIENT MILK 05
WORK 06
CHILD REFUSED 07
WEANING AGE 08
GOT PREGNANT 09
BEGAN TO USE CONTRACEPTION 10
OTHER (SPECIFY) _____11
DEAD (GO TO 436)
436. Did you ever give (NAME) water or something else to eat (besides mother's milk)?
NO 2 (GO TO 440)
437. How many months old was (NAME) when you began to give him one of these foods or drinks regularly?
Fresh milk/boxed milk (other than mother's)?
Water?
Quinquéliba?
Fruit juice?
Other liquids?
Other solid or broth foods?
IF LESS THAN A MONTH, RECORD '00.'
NEVER GIVEN REGULARLY 96
NEVER GIVEN REGULARLY 96
NEVER GIVEN REGULARLY 96
NEVER GIVEN REGULARLY 96
NEVER GIVEN REGULARLY 96
NEVER GIVEN REGULARLY 96 (FOR SECOND-TO-LAST BIRTH AND LATER BIRTHS, GO TO 440)
438. CHECK 216:
[ASK ONLY FOR MOST RECENT BIRTH]
DEAD (GO TO 440)
439. Did (NAME) drink something from a bottle yesterday or last night?
[ASK ONLY FOR MOST RECENT BIRTH]
NO 2
DOESN'T KNOW 8
440. RETURN TO 403 IN THE FOLLOWING COLUMN OR, IF NO MORE BIRTHS, GO TO 460.
441. RECORD THE NAME AND LINE NUMBER OF EACH BIRTH SINCE THE FIRST OF JANUARY 1992 IN THE TABLE. ASK QUESTIONS ABOUT ALL THE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).
LINE NUMBER FROM 212:
FROM 212 AND 216:
DEAD (GO TO 480)
460. Has (NAME) had diarrhea during the past two weeks?
NO 2
DOESN'T KNOW 8
461. RETURN TO 460 FOR THE NEXT BIRTH: OR IF THERE ARE NO MORE BIRTHS, GO TO 480.
462. Has (NAME) had diarrhea in the last 24 hours?
NO 2
DOESN'T KNOW 8
463. How many days did the diarrhea last?
IF LESS THAN 1 DAY, RECORD '00'.
464. Was there blood in the stools?
NO 2
DOESN'T KNOW 8
465. CHECK 424/428:
LAST CHILD STILL BREAST FEEDING?
[ASK ONLY FOR MOST RECENT BIRTH]
NO (GO TO 468)
466. When (NAME) had diarrhea, did you change the number of breast feedings/feedings?
[ASK ONLY FOR MOST RECENT BIRTH]
NO 2 (GO TO 468)
467. Did you increase or reduce the number, or did you completely stop?
[ASK ONLY FOR MOST RECENT BIRTH]
REDUCED 2
COMPLETELY STOPPED 3
468. Did you give him/her less or more to drink (besides breast milk) than before the diarrhea?
MORE 2
LESS 3
DOESN'T KNOW 8
469. Was something given to (NAME) to treat the diarrhea?
NO 2 (GO TO 471)
DOESN'T KNOW 8 (GO TO 471)
470. What was given to treat the diarrhea?
Anything else?
RECORD EVERYTHING MENTIONED.
LIQUID MADE AT HOME B
ANTIBIOTIC C
OTHER PILL OR SYRUP D
INJECTION E
(IV) INTRAVENOUS/SERUM F
HOMEMADE REMEDIES/MEDICINAL PLANTS G
OTHER (SPECIFY) _____H
471. Did you seek advice or treatment for the diarrhea?
NO 2 (GO TO 473)
472. Where did you ask for advice or treatment?
To anyone else?
CIRCLE THE CORRESPONDING CODES FOR ALL THE RESPONSES.
HEALTH CENTER/PMI (Protection Maternelle et Infantile) B
HEALTH POST/FREE CLINIC C
COMMUNITY HEALTH PERSONNEL D
PHARMACY F
PRIVATE DOCTOR G
PRIVATE NURSE/CONFES H
TRADITIONAL HEALER J
YES, ORS PACKET CITED (GO TO 475)
474. Did (NAME) receive a liquid prepared from a special powder to fight diarrhea?
NO 2 (GO TO 476)
DOESN'T KNOW 8 (GO TO 476)
475. During how many days did (NAME) receive (LOCAL NAME)?
IF LESS THAN ONE DAY, RECORD '00'.
DOESN'T KNOW 98
YES, HOMEMADE LIQUID CITED (GO TO 478)
477. Did (NAME) get a liquid recommended by health care personnel and prepared at home with (RECOMMENDED INGREDIENTS) when s/he had diarrhea?
NO 2 (GO TO 479)
DOESN'T KNOW 8 (GO TO 479)
478. During how many days did s/he receive prepared (RECOMMENDED INGREDIENTS) when s/he had diarrhea?
IF LESS THAN ONE DAY, RECORD '00'.
DOESN'T KNOW 8
479. RETURN TO 460 FOR THE NEXT CHILD, OR IF THERE ARE NO MORE CHILDREN, GO TO 480.
480. CHECK 470 AND 474 (ALL COLUMNS):
ORS SOLUTION GIVEN TO A CHILD (GO TO 487)
481. Have you ever heard of a special product called (LOCAL NAME) that you can get to treat diarrhea?
NO 2
482. Have you ever seen a packet like this before?
SHOW THE PACKET.
NO 2 (GO TO 487)
483. Have you ever prepared a solution with one of these packets to treat diarrhea for yourself or someone else?
SHOW THE PACKET.
NO 2
483A. Do you know of a place where you could get these packets?
NO 2 (GO TO 487)
483B. What place do you know of?
HEALTH CENTER/PMI (Protection Maternelle et Infantile) 12
HEALTH POST/FREE CLINIC 13
PHARMACY 22
PRIVATE DOCTOR 23
PRIVATE NURSE/CONFES 24
TRADITIONAL HEALER 32
CHURCH 33
FRIEND/RELATIVE 34
OTHER (SPECIFY) _____51
483C. How long does it take to go from your place to this place?
IF LESS THAN 2 HOURS, RECORD THE RESPONSE IN MINUTES.
OTHERWISE, RECORD IN HOURS.
HOURS 2_____
DOESN'T KNOW 9998
483D. How far is this place from your house?
IF ON SITE OR LESS THAN 1 KM, RECORD '00'.
98 KM OR MORE 98
487. CHECK 470 AND 477 (ALL COLUMNS):
RECOMMENDED LIQUID PREPARED AT HOME AND NOT GIVEN TO CHILD OR 470 AND 477 NOT ASKED (GO TO 488A)
488. Where did you learn to prepare the recommended liquid made at home with (RECOMMENDED INGREDIENTS) that you gave to (NAME) when s/he had diarrhea?
CIRCLE THE CODES CORRESPONDING TO THE RESPONSES.
HEALTH CENTER/PMI (Protection Maternelle et Infantile) B
HEALTH POST/FREE CLINIC C
COMMUNITY HEALTH PERSONNEL D
PHARMACY F
PRIVATE DOCTOR G
PRIVATE NURSE/CONFES H
TRADITIONAL HEALER J
488A. In general, when a child has diarrhea, should you give him/her less liquid, the same amount of liquid, or more liquid?
SAME AMOUNT OF LIQUID 2
MORE LIQUID 3
DOESN'T KNOW 4
488B. In general, when a child has diarrhea, should you give him/her less food, the same amount of food, or more food?
SAME AMOUNT OF FOOD 2
MORE FOOD 3
DOESN'T KNOW 4
488C. In your opinion, what signs indicate that you must bring a child who has diarrhea to a health establishment?
CIRCLE THE CORRESPONDING CODES TO THE RESPONDENT'S RESPONSES.
REPEATED VOMITING B
INTENSE THIRST C
DOES NOT EAT/DRINK WELL D
FEVER E
BLOOD IN STOOL F
DOES NOT GET BETTER G
OTHER (SPECIFY) _____ H
IF 'J' IS CIRCLED IN ANY COLUMN (GO TO 501)
488E. What did the healer give you to treat diarrhea?
CIRCLE THE CORRESPONDING CODES TO THE RESPONDENT'S RESPONSES.
INFUSION B
MONKEY BREAD C
RICE BROTH D
GUAVA LEAVES E
AMULET F
OTHER (SPECIFY) _____G
488F. Is this treatment for diarrhea efficient, not very efficient, not at all efficient?
EFFICIENT 2
NOT VERY EFFICIENT 3
NOT AT ALL EFFICIENT 4
501. Are you currently married?
NO 2
502. Are you celibate, widowed, divorced, separated or do you live in a union with someone?
WIDOWED 2 (GO TO 509)
DIVORCED 3 (GO TO 509)
SEPARATED 4 (GO TO 509)
CELIBATE 5
503. Have you ever been in a union with someone?
NO 2 (GO TO 513)
504. Does your husband/partner live with you or elsewhere?
LIVES ELSEWHERE 2
505. Does your husband/partner have other wives besides yourself?
NO 2
DOESN'T KNOW 8
509. In which month and in which year did you consummate your union for the first time with your (first) husband/partner?
DOESN'T KNOW MONTH 98
DOESN'T KNOW YEAR 98
510. How old were you when you consummated your union with your first husband/partner?
DOESN'T KNOW AGE 98 (GO TO 514)
IF NEVER BEEN IN UNION OR FIRST UNION NOT CONSUMMATED:
513. Have you ever had sexual intercourse?
NO 2 (GO TO 518)
Now I would like to ask you some questions about sexual activity in order to gain a better understanding of family planning and fertility.
514. How many times did you have sexual intercourse in the last four weeks?
515. How many times a month do you usually have sexual intercourse?
516. How long has it been since you last had sexual intercourse?
WEEKS 2_____
MONTHS 3_____
YEARS 4 _____
BEFORE THE LAST BIRTH 996
517. How old were you when you had sexual intercourse for the first time?
FIRST TIME IN MARRIAGE 96
NEVER MARRIED OR IN UNION (GO TO 518)
517B. Did your husband/partner go to school?
NO 2 (GO TO 517D)
517C. What is the highest level of school you attended: primary, secondary or superior?
SECONDARY 2
SUPERIOR 3
DOESN'T KNOW 4
517D. What is (was) your (last) husband/partner's main kind of work?
518. OTHER PEOPLE PRESENT AT THIS MOMENT:
NO 2
NO 2
NO 2
NO 2
519. RECORD THE REACTION OF THE RESPONDENT:
BOTHERED A BIT 2
HOSTILE 3
SECTION 6. FERTILITY PREFERENCES
601. CHECK 312:
HE OR SHE STERILIZED (GO TO 610)
NOT MARRIED/NOT IN UNION (GO TO 615)
NOT PREGNANT OR NOT SURE: Now I have a few questions about the future. Would you like to have (a/another) child, or would you prefer not to have (other) children at all?
PREGNANT: Now I have a few questions about the future. After the child that you are expecting, would you like to have (a/another) child, or would you prefer not to have (other) children at all?
NO MORE/NONE 2 (GO TO 610)
SAYS SHE CANNOT GET PREGNANT 3 (GO TO 610)
NOT DECIDED/DOESN'T KNOW 8 (GO TO 610)
NOT PREGNANT OR NOT SURE: 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, how long would you like to wait from now before the birth of (a/another) child?
YEARS 2_____
SOON/NOW 994
SAYS SHE CANNOT GET PREGNANT 995
OTHER (SPECIFY) _____996
DOESN'T KNOW 998
610. Do you think that your husband/partner approves or disapproves of couples who use a method to avoid getting pregnant?
DISAPPROVES 2
DOESN'T KNOW 8
612. Have you ever discussed with your partner how many children you would like to have?
NO 2
615. Should a mother wait until she has completely stopped breast feeding before beginning to have sexual intercourse again, or is this not important?
NOT IMPORTANT 2
DOESN'T KNOW 8
616. Do you approve or disapprove of couples who use a method to avoid getting pregnant?
DISAPPROVES 2
NO OPINION 8
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
OTHER RESPONSE (SPECIFY) _____96
618. In your opinion, what is the best interval in months or in years between the birth of a child and the birth of the next child?
YEARS 2_____
OTHER (SPECIFY) _____996
IF "NO" TO 513: NEVER HAD SEXUAL INTERCOURSE (GO TO 624)
619. Have you ever had an undesired pregnancy?
NO 2 (GO TO 624)
DOESN'T KNOW/NO RESPONSE 8 (GO TO 624)
620. What did you do about this pregnancy?
FAILURE INTERRUPTION 2
INTERRUPTION 3
OTHER (SPECIFY) _____4
DOESN'T KNOW/NO RESPONSE 8
621. What is the main reason why you did not want this pregnancy?
NOT MARRIED 2
DID NOT WANT CHILDREN 3
ABANDONED BY PARTNER 4
HEALTH REASONS 5
WANTED TO REST 6
NO RESPONSE 7
OTHER (SPECIFY) _____8
NEVER USED A METHOD (GO TO 624)
623. Have you ever gotten pregnant while using a contraceptive method?
NO 2
DOESN'T KNOW 8
624. In your opinion, do women have abortions never, sometimes, often, very often?
SOMETIMES 2
OFTEN 3
VERY OFTEN 4
DOESN'T KNOW/NO RESPONSE 8 (GO TO 701)
625. In your opinion, what are the reasons why women have abortions?
CIRCLE THE CORRESPONDING CODES TO RESPONSES MENTIONED
NOT USING CONTRACEPTION B
IGNORANCE OF CONTRACEPTION C
OPPOSITION OF HUSBAND/FAMILY TO FAMILY PLANNING D
CARELESS SEXUAL BEHAVIORS E
OTHERS (SPECIFY) _____F
DOESN'T KNOW/NO RESPONSE G
701. Have you ever heard of an illness that can be transmitted sexually?
NO 2 (GO TO 707B)
702. Which sexually transmitted diseases do you know of?
CIRCLE THE CODES CORRESPONDING TO ALL MENTIONED.
GONORRHEA B
AIDS C
CONDYLOMA/HOT URINE D
OTHER (SPECIFY) _____E
DOESN'T KNOW F
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 707A)
704. During the last twelve months, have you had any of these illnesses?
NO 2 (GO TO 707A)
DOESN'T KNOW 8 (GO TO 707A)
705. Among these illnesses, which have you had?
CIRCLE THE CODES CORRESPONDING TO ALL MENTIONED.
GONORRHEA B
AIDS C
CONDYLOMA/HOT URINE D
OTHER (SPECIFY) _____E
DOESN'T KNOW F
706. The last time you had one of these illnesses (NAME OF ILLNESSES), did you seek advice or treatment?
NO 2 (GO TO 707A)
707. Where did you seek advice or treatment?
CIRCLE THE CODES CORRESPONDING TO RESPONSES GIVEN.
HEALTH CENTER B
HEALTH POST/ PMI (Protection Maternelle et Infantile) C
PHARMACY E
PRIVATE DOCTOR F
PRIVATE NURSE/CONFES G
CHURCH I
FRIEND/RELATIVE J
OTHER (SPECIFY) _____L
MENTIONED 'AIDS' (GO TO 708)
707B. Do you know or have you ever heard of a disease called AIDS?
NO 2 (GO TO 715)
708. How can a person get AIDS?
CIRCLE THE CORRESPONDING CODES TO THE RESPONSES GIVEN.
SEXUAL INTERCOURSE WITH AN UNKNOWN PERSON B
SEXUAL INTERCOURSE WITH PROSTITUTES C
NOT USING A CONDOM D
SEXUAL INTERCOURSE WITH HOMOSEXUALS E
BLOOD TRANSFUSION F
INJECTION G
BY KISSES H
BLADE/RAZOR I
BY MOSQUITOS J
OTHER (SPECIFY) _____K
DOESN'T KNOW L
709. In your opinion, is there something a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 711)
DOESN'T KNOW 8 (GO TO 711)
710. In your opinion, what can a person do to protect himself/herself from AIDS?
CIRCLE THE CORRESPONDING CODES TO THE RESPONSES GIVEN.
LOYALTY TO PARTNERS B
USE A CONDOM C
ABSTINENCE D
NO SEXUAL INTERCOURSE WITH PROSTITUTES E
NO SEXUAL INTERCOURSE WITH HOMOSEXUALS F
NO SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS G
NO BLOOD TRANSFUSION H
NO INJECTIONS I
NO KISSES J
NO MOSQUITO BITES K
SEEK PROTECTION FROM A HEALER/TRADITIONAL WITCH DOCTOR L
OTHER (SPECIFY) _____M
OTHER (SPECIFY) _____N
DOESN'T KNOW O
711. Is it possible that someone who appears to be in good health has AIDS?
NO 2
DOESN'T KNOW 8
712. Some people use condoms during sexual intercourse to avoid getting AIDS or other sexually transmitted illnesses. Have you ever heard of this?
NO 2
DOESN'T KNOW 8
713. Do you know of a place where you can get condoms?
NO 2 (GO TO 715)
714. Which place(s) do you know of?
CIRCLE THE CODES CORRESPONDING TO RESPONSES GIVEN
HEALTH CENTER B
HEALTH POST/ PMI (Protection Maternelle et Infantile) C
PHARMACY E
PRIVATE DOCTOR F
PRIVATE NURSE/CONFES G
CHURCH I
FRIEND/RELATIVE J
OTHER (SPECIFY) _____L
TO BE FILLED OUT AFTER HAVING ENDED THE INTERVIEW.
COMMENTS ABOUT THE RESPONDENT _____
COMMENTS ON PARTICULAR QUESTIONS _____
OTHER COMMENTS _____
SUPERVISOR'S OBSERVATIONS _____
NAME_____
DATE_____
OTHER OBSERVATIONS _____