IDENTIFICATION

PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD _____
HOUSEHOLD NUMBER _____
COMPOUND NUMBER _____
CLUSTER NUMBER _____
REGION _____

URBAN/RURAL:

DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL:

NAME AND LINE NUMBER OF WOMAN:

CHECK THE HOUSEHOLD SURVEY: ADDITIONAL QUESTIONS ABOUT SEXUAL ACTIVITY (542, 543) SHOULD BE ASKED OF MEN (1) OF WOMEN (2) IN THE INDIVIDUAL SURVEY.

ADDITIONAL QUESTIONS 2

INTERVIEWER VISITS

INTERVIEW 1 (REPEAT FOR SECOND AND THIRD INTERVIEWS)
DATE_____
INTERVIEWER NAME_____
RESULT*___

RESULTS*_____

NEXT VISIT
DATE_____
TIME_____

FINAL VISIT
DAY_____
MONTH_____
YEAR 2005
INTERVIEWER_____
RESULT*_____

TOTAL NUMBER OF VISITS_____

LANGUAGE OF QUESTIONNAIRE: FRENCH 1

LANGUAGE OF INTERVIEW:

INTERPRETER:

SUPERVISOR
NAME_____
DATE_____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____
KEYED BY_____

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

INTRODUCTION AND CONSENT STATEMENT:

CONSENT STATEMENT AFTER INFORMATION:

Hello. My name is_____ and I work for the Minister of Health. We are conducting a national survey that asks about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you questions about your health (and that of your children). This information will be useful to the government for planning health services. The interview usually takes 20-45 minutes. The information that you give us will be strictly confidential and will be shared with no one.

Do you have questions about the survey?
Can I begin the interview now?

SIGNATURE OF INTERVIEWER_____
DATE_____

101. RECORD THE TIME:

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 a big city, in a city or in a rural area?

103. How long have you been living continuously in (NAME OF CURRENT CITY/VILLAGE OF RESIDENCE)? IF LESS THAN A YEAR, WRITE '00' YEARS.

104. Just before you moved here, did you live in a big city, a city, or village?

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

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107. Did you go to school?

108. What is the highest level of school you attended: primary, secondary (first cycle), secondary (second cycle), superior or other?

109. What is the last (year/grade) that you achieved at this level?

110. CHECK 108:

111. Now I would like you to read this sentence out loud: read as much as you can.

SHOW THE CARD TO THE RESPONDENT.

IF THE RESPONDENT CANNOT READ THE WHOLE PHRASE, PROBE: Can you read certain parts of the phrase to me?

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

112B. In which languages were the literacy programs in which you participated?
PROBE: Any other?
RECORD ALL MENTIONED.

113. CHECK 111:

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

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

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

117. During the past 12 months, how many times have you traveled outside of your locality and slept somewhere besides your home?

118. During the past 12 months have you been outside of your locality during more than a month at a time?

119. What is your religion?

120. Are you Senegalese?

121. What is your ethnicity?

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?

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

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?

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 life at birth but did not survive?

207. How many sons have died?
And how many daughters have died?

208. SUM ANSWERS TO Q.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?

210. CHECK 208:

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.

[ASK QUESTIONS 212-221 FOR ALL BIRTHS]

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

213. Was (NAME) a single or multiple birth?

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 THE CHILD IS NOT LISTED IN THE HOUSEHOLD.

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.

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?
[DO NOT ASK FOR MOST RECENT BIRTH]

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

223. COMPARE 208 WITH THE NUMBER OF BIRTH RECORDED IN THE ABOVE TABLE AND MARK:

224. CHECK 215 AND RECORD THE NUMBER OF BIRTHS IN 2000 OR LATER.
IF NONE, RECORD '0'

225. FOR EACH BIRTH SINCE JANUARY 2000, WRITE 'N' IN MONTH OF BIRTH IN THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED AND WRITE 'G' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'G'S MUST BE 1 LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED). RECORD THE NAME OF THE CHILD LEFT OF THE CODE 'N'. (SEE THE INSTRUCTIONS AT THE END OF THE QUESTIONNAIRE.

226. Are you currently pregnant?

227. How many months pregnant are you?
RECORD THE NUMBER OF COMPLETED MONTHS. RECORD 'G' IN THE CALENDAR, BEGINNING WITH THE MONTH OF THE SURVEY AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

228. 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 have any (more) children?

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

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 THE NUMBER OF COMPLETED YEARS. RECORD 'F' IN THE CALENDAR IN THE MONTH THE PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS.

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

234. ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2000. RECORD 'F' IN THE CALENDAR IN THE MONTH EACH PREGNANCY ENDED AND 'G' FOR THE REMAINING COMPLETED MONTHS,

235. Have you had a pregnancy that ended before January 2000 that did not end in a live birth?

236. When did the last such birth end before 2000?

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

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

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.

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

301. Which methods have you heard about?
FOR THE METHODS SPONTANEOUSLY MENTIONED, ASK: Have ever heard about (METHOD)?

302. Have you ever used (METHOD)?

303. CHECK 302:

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

306. What did you do or use?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

307. How many living children did you have, 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. What method are you using?
311A. CIRCLE "A" FOR FEMALE STERILIZATION.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW THE SKIP INSTRUCTIONS FOR THE HIGHEST METHOD ON THE LIST.

312. Why do you use the pill rather than another method?

312A. Can I see the pill box that you are currently using?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING CODE.

312B. What is the name of the brand of pill that you currently use?

312C. How much does a box (cycle) of pills cost you?

313. Where did the sterilization take place?
IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

314. CHECK 311:

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

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

316. In which month and in which year did the sterilization occur?
316A. Since when did you begin to use (METHOD CITED FIRST IN 311) continuously?
PROBE: In which month and in which year did you begin to use (METHOD CITED FIRST IN 311) continuously?

316B. CHECK 316/316A, 215 AND 230:
WAS THERE IN 215 A BIRTH OR IN 230 A PREGNANCY THAT ENDED BY A MISCARRIAGE, ABORTION OR STILL BIRTH AFTER THE MONTH AND YEAR OF THE BEGINNING OF USING CONTRACEPTION IN 316/316A?

317. CHECK 316/316A:

319. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD:
IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

320. Where did you get (CURRENT METHOD) when you started using it?
320A. Where did you learn how to use the lactational amenorrhea method?

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

321. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD:
IF MORE THAN ONE METHOD MENTIONED, CIRCLE THE HIGHEST METHOD CIRCLED ON THE LIST IN 311/311A.

322. You obtained (CURRENT METHOD) from (SOURCE IN 313 OR 320). At that time, were you told about the side effects or problems you might have with the method?

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

324. Did someone tell you what you should do if you experienced secondary effects or if you had problems?

325. CHECK 322:

CODE '1' CIRCLED: At that time were you told other methods or family planning you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM Q. 313 OR 320), did anyone talk to you about other methods of family planning that you could use?

326. Were you informed by a health or family planning worker about other methods of contraception that you could use?

327. CHECK 311/311A:
CIRCLE THE CODE OF THE METHOD:

328. Where did you get (THE CURRENT METHOD) the last time?
IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

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

330. Where is this place?
Anywhere else?
RECORD ALL MENTIONED.

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

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

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

333. Did a staff member at the health facility ever talk to you about family planning methods?

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

402. WRITE THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS OF ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403. LINE NUMBER FROM 212:

404. FROM LINE 212 AND 216:

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

406. How much time would you have liked to wait?

407. For the last pregnancy, did you receive prenatal care?
IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[ASK ONLY FOR MOST RECENT BIRTH]

408. How many months pregnant were you when you had your first prenatal consultation?
[ASK ONLY FOR MOST RECENT BIRTH]

409. How many times did you get consultation during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

410. CHECK 409:
NUMBER OF PRENATAL CONSULTATIONS RECEIVED
[ASK ONLY FOR MOST RECENT BIRTH]

411. How many months were you pregnant the last time you received prenatal care?
[ASK ONLY FOR MOST RECENT BIRTH]

412. During your pregnancy did you have the following tests at least once?

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

[ASK ONLY FOR MOST RECENT BIRTH]

413. Did they talk to you about signs of complications to the pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

414. Did they tell you where to go if you had these complications?
[ASK ONLY FOR MOST RECENT BIRTH]

415. During the course of this pregnancy, did they give you an injection in the arm to keep the baby from getting tetanus, that is to say, convulsions after birth?
[ASK ONLY FOR MOST RECENT BIRTH]

416. How many times during this pregnancy did you have this injection?
[ASK ONLY FOR MOST RECENT BIRTH]

417. During this pregnancy, were you given or did you buy iron tablets or small vials of syrup with iron in it? SHOW TABLETS/VIALS.
[ASK ONLY FOR MOST RECENT BIRTH]

418. During the whole pregnancy, for how many days did you take the tablets/syrup?
IF THE ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK ONLY FOR MOST RECENT BIRTH]

419. During this pregnancy, did you have difficulty with your vision during daylight?
[ASK ONLY FOR MOST RECENT BIRTH]

420. During this pregnancy did you suffer from night blindness [USE LOCAL NAME]?
[ASK ONLY FOR MOST RECENT BIRTH]

421. During this pregnancy did you take any drugs to keep from getting malaria?
[ASK ONLY FOR MOST RECENT BIRTH]

422. What medicines did you take?

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO THE RESPONDENT.
[ASK ONLY FOR MOST RECENT BIRTH]

422A. CHECK 422:
TYPE OF MEDICINE TAKEN FOR MALARIA PREVENTION.
[ASK ONLY FOR MOST RECENT BIRTH]

422B. How many times did you take Fansidar during this pregnancy?
[ASK ONLY FOR MOST RECENT BIRTH]

422C. CHECK 407:
PRENATAL CARE DURING THIS PREGNANCY
[ASK ONLY FOR MOST RECENT BIRTH]

422D. When you were pregnant with (NAME), did you get the medicine FANSIDAR during a prenatal visit, during another visit in a health facility, or from another source?
[ASK ONLY FOR MOST RECENT BIRTH]

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

424. Was (NAME) weighed at birth?

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

425A. Was (NAME)'s birth declared?

426. Who assisted with the delivery of (NAME)? Anyone else?

PROBE TO DETERMINE 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.

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

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

428. Was (NAME) delivered by caesarean section?

429. After (NAME)'s birth, were you examined by a health professional or a village birth attendant?

430. How many days after delivery did you have your first health check-up?
RECORD "00" IF THE SAME DAY.
[ASK ONLY FOR MOST RECENT BIRTH]

431. Who examined you at this time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK ONLY FOR MOST RECENT BIRTH]

432. Where did this first health exam take place?
[ASK ONLY FOR MOST RECENT BIRTH]

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

433. In the two months that followed the birth, did you receive a dose of vitamin A like this one?
SHOW THE PILL/VIAL.
[ASK ONLY FOR MOST RECENT BIRTH]

434. Has your period returned since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

435. Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

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

437. CHECK 226:
IS RESPONDENT PREGNANT?
[ASK ONLY FOR MOST RECENT BIRTH]

438. Have you begun to have sexual intercourse since the birth of (NAME)?
[ASK ONLY FOR MOST RECENT BIRTH]

439. For how many months after (NAME)'s birth did you not have sexual intercourse?

440. Did you breastfeed (NAME)?

441. 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

442. In the 3 days following birth and before your breasts began to produce milk regularly, did (NAME) drink something besides breast milk?

443. What was (NAME) given to drink before your breasts began to produce milk regularly?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

444. CHECK 404:
CHILD IS LIVING?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 404:
CHILD IS LIVING?

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

449. Yesterday, how many times did you breastfeed during the day?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

450. Did (NAME) drink something from a bottle yesterday or last night?

451. Was sugar added to any food or liquid given to (NAME) yesterday?

452. Yesterday, during the day or night, how many times was (NAME) fed purees or solid food or semi-solid food?
IF 7 TIMES OR MORE, MARK '7'.

453. RETURN TO 405 IN THE NEXT COLUMN OR THE NEXT TO LAST COLUMN ON A NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. VACCINATION, HEALTH AND NUTRITION

454. RECORD THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST 2 LINES OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212:

456. FROM 212 AND 216:

457. Did (NAME) get a dose of vitamin A, like this one, during the past 6 months?
SHOW THE PILL/VIAL.

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

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

460. (1) COPY THE DATES FOR EACH VACCINATION FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF THE CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE IS RECORDED.

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

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

463. Tell me, please, if (NAME) received one of the following vaccinations:

463A A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

463B. Polio vaccine, that is, drops in the mouth?

463C. Was the first vaccine for polio received right after birth or not?

463D. How many times was the polio vaccine given?

463E. A DPT vaccination, that is, an injection given in the thigh or buttocks, generally at the same time as the polio drops?

463F. How many times?

463G. An injection against the measles?

463H. An injection against yellow fever?

464. Were any of the vaccinations (NAME) received during the past two years given as part of a national immunization campaign?

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

466. Has (NAME) suffered from a fever, at any moment, during the past two weeks?

467. Has (NAME) suffered from a cough, at any moment, during the past two weeks?

468. When (NAME) had a cough, did he/she breathe faster than usual with short, rapid breaths?

469. CHECK 466 AND 467:
FEVER OR COUGH?

470. Did you seek advice or treatment for the fever/cough?

471. Where did you seek advice or treatment?
Where else?
RECORD EVERYTHING MENTIONED.

472. CHECK 466:
HAD A FEVER?

472A. Does (NAME) have a fever currently?

472B. Did (NAME) have convulsions at any time during the past two weeks?

472C. CHECK 466 AND 472B:
FEVER OR CONVULSIONS?

473. Did (NAME) take medicine for the fever?

474. Which medicine did (NAME) take?
RECORD EVERYTHING THAT IS MENTIONED.

ASK TO SEE THE MEDICINE IF THE TYPE OF MEDICINE IS NOT KNOWN. IF THE TYPE OF MEDICINE CANNOT BE DETERMINED, SHOW SOME COMMON ANTI-MALARIA MEDICINES TO THE RESPONDENT.

474A. Did (NAME) have an injection or suppository to treat the fever/convulsions?

474B. CHECK 474:
TYPE OF MEDICINE?

474C. How long after the beginning of the fever/convulsions did (NAME) begin to take Fansidar?

474D. For how many consecutive days did (NAME) take Fansidar?
IF MORE THAN 7 DAYS, RECORD '7'.

474E. Did you have the Fansidar at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Fansidar the first time?

474F. CHECK 474:
TYPE OF MEDICINE?

474G. How long after the beginning of the fever/convulsions did (NAME) begin to take Chloroquine?

474H. For how many consecutive days did (NAME) take Chloroquine?
IF MORE THAN 7 DAYS, RECORD '7'.

474I. Did you have the Chloroquine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Chloroquine the first time?

474J. CHECK 474:
TYPE OF MEDICINE?

474K. How long after the beginning of (the fever/convulsions) did (NAME) begin to take Amodiaquine?

474L. For how many consecutive days did (NAME) take Amodiaquine?
IF MORE THAN 7 DAYS, RECORD '7'.

474M. Did you have the Amodiaquine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Amodiaquine the first time?

474N. CHECK 474:
TYPE OF MEDICINE?

474O. How long after the beginning of (the fever/convulsions) did (NAME) begin to take
Quinine?

474P. For how many consecutive days did (NAME) take Quinine?
IF MORE THAN 7 DAYS, RECORD '7'.

474Q. Did you have the Quinine at home, or did you get it from another source?
IF MORE THAN ONE SOURCE IS MENTIONED, ASK: Where did you get the Quinine the first time?

474R. Was something else done to treat (NAME)'s (fever/convulsions)?

474S. What was done to treat (NAME)'s fever/convulsions?

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

476. Now I would like to know how much liquid was given to (NAME) during his/her diarrhea. Did you give him/her less, about the same amount or more to drink than usual?
IF LESS, PROBE: Did you give him a lot or a little less than usual to drink?

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

478. Did you give him/her any of the following things to drink?

a) A liquid prepared from a (LOCAL NAME FOR ORS PACKET)?
b) A homemade liquid recommended by the government?

479. Was something (else) given to treat diarrhea?

480. What else was given to treat diarrhea? Something else?
RECORD EVERYTHING MENTIONED.

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

482. Where did you seek advice or treatment for the diarrhea?
Anywhere else?
RECORD EVERYTHING MENTIONED.

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE(S).

483. RETURN TO 456 IN THE FOLLOWING COLUMN/SECOND COLUMN IN A NEW QUESTIONNAIRE. IF NO MORE BIRTHS, GO TO 484.

484. CHECK 215 AND 218, ALL LINES:
NUMBER OF CHILDREN BORN IN 2001 OR LATER AND LIVING WITH THE RESPONDENT.

485. What do you usually do with the excrements of your (youngest) child when he/she does not use the toilet facility?

486. CHECK 478a, ALL OF THE COLUMNS/BIRTHS:

487. Have you ever heard of a special product called (LOCAL NAME OF ORS PACKET), that you can get to treat diarrhea?

488. CHECK 218:

489. When (your child/one of your children) is seriously ill, can you, yourself, decide if he/she should be brought somewhere for medical treatment?

IF THE RESPONDENT RESPONDS THAT NO CHILD HAS EVER BEEN SERIOUSLY ILL, ASK: If (your child/one of your children) becomes seriously ill, can you, yourself, decide if he/she should be brought somewhere for medical treatment?

Now I would like to ask you questions about your own medical care.

490. Different reasons can prevent women from getting advice or medical treatment for themselves. When you are sick and want advice or medical treatment, do the following things pose a problem for you or not?

Knowing where to go.
Getting permission to go.
Getting the necessary money for the treatment.
Not having a medical establishment nearby.
Needing to take a mode of transport.
Not wanting to go alone.
Concern that there are no female personnel.

491. CHECK 215 AND 218:

492. Now I would like to ask you what liquid (NAME IN 491) drank during the past 7 days including yesterday. How many days, during the past 7 days, did (NAME IN 491) drink one or more of the following liquids?

FOR EACH LIQUID CONSUMED, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK:
Yesterday during the day or night how many times did (NAME IN 491) drink:

a) Water?
b) Baby formula?
c) Any other type of milk, like milk from a box, in powder, or fresh milk from an animal?
d) Fruit juice?
e) Other liquids such as sugar water, tea, coffee, carbonated drinks, or broths?

IF 7 OR MORE TIMES, RECORD '7'. IF DOESN'T KNOW, RECORD '8'.

493. Now I would like to ask you what food(s) (NAME IN 491) was given during the past 7 days, including yesterday. How many days, during the past 7 days, did (NAME IN 491) get the following foods?

FOR EACH FOOD GIVEN, AT LEAST ONE TIME, IN THE PAST 7 DAYS, ASK: Yesterday during the day and night how many times did (NAME IN 491) get:

a) Rice, corn, millet, sorghum or other grains?
b) Pumpkin, yam or yellow or red squash, carrots, or red sweet potatoes?
c) Other foods from roots (for ex: potatoes, white yam, manioc, white sweet potatoes, other local foods from roots)?
d) Any green leafy vegetables?
e) Mango, papaya?
f) Any other fruit or vegetable? (for ex: banana, apple, apple sauce, green beans, avocado, tomato)?
g) Meat, poultry, fish, shellfish, eggs?
h) Other vegetable foods (for ex: lentils, beans, soy, or nuts)?
i) Cheese or yogurt?
j) Any food prepared with oil, fat or butter?

IF 7 TIMES OR MORE, RECORD '7'. IF DOESN'T KNOW, RECORD '8'.

494. Last night did you sleep under a mosquito net?

495. The last time you prepared a meal for your family did you wash your hands before beginning?

496. Do you currently smoke cigarettes or chew tobacco?
IF YES: What do you usually smoke/chew?
RECORD EVERYTHING MENTIONED.

497. CHECK 496:

498. In the past 24 hours, how many cigarettes did you smoke?

I would now like to ask you ask you a few questions about your health during the past 6 months.

499B. During the past 6 months, have you had an injection for any reason?
IF YES: How many injections did you have?

IF THE NUMBER OF INJECTIONS IS MORE THAN 94 OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

499C. Among these injections, how many were given by a doctor, nurse, pharmacist, dentist or other health worker?

IF THE NUMBER OF INJECTIONS IS MORE THAN 94, OR IF THE INJECTIONS WERE DAILY DURING 3 MONTHS OR MORE, RECORD '95'. IF THE RESPONSE IS NOT NUMERIC, PROBE TO GET AN ESTIMATE.

499D. The last time you had an injection, where did you go to get it?

499E. The last time you had an injection, did the person who administered the shot take the syringe or needle from a new unopened package?

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501. Are you currently married or do you live with a man as if you were married?

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

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

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

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

507. Besides yourself, does your husband/partner have other wives or does he live with other women as if he were married?

508. Counting yourself, how many wives or partners does your husband currently have?

509. Are you the first, second...wife?

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

511. CHECK 510:

MARRIED/HAS LIVED WITH 1 MAN ONLY ONCE: In which month and in which year did you begin to live with your husband/partner?

MARRIED/HAS LIVED WITH 1 MAN MORE THAN ONCE: I would like to ask about when you started living with your first husband/partner. In what month and year did you get married or did you begin to live with your husband/partner as if married?

512. How old were you when you began living with him?

513. CHECK 503:
IS THE RESPONDENT CURRENTLY A WIDOW?

514. CHECK 510:

515. How did your last union/marriage end?

516. Who got the largest part of the belongings your husband possessed?

517. Did you receive goods or valuables from your last husband?

518. CHECK THE PRESENCE OF OTHER PEOPLE. BEFORE CONTINUING, DO YOUR BEST TO GO TO A PRIVATE PLACE.

Now I need to ask you some questions about sexual activity in order to gain a better understanding of important life issues.

519. How old were you when you had sexual intercourse for the first time?

520. Do you intend to wait until marriage to begin sexual intercourse?

521. CHECK 106:

522. The first time you had sexual intercourse, was a condom used?

523. How old was the person with whom you had sexual intercourse for the first time?

524. Was this person older than you, younger or about the same age?

525. Would you say that this person was 10 more years older than you or less than 10 years older than you?

526. When did you last have sexual intercourse?
IF IT WAS 12 MONTHS AGO OR MORE, THE ANSWER MUST BE CONVERTED AND RECORDED IN YEARS.

[ASK QUESTIONS 527-537 FOR RESPONDENT'S LAST (THREE) SEXUAL PARTNER(S)]

527. Was a condom used the last time you had sexual intercourse with this (second, third) person?

528. Did you use a condom each time you had sexual intercourse during the past 12 months?

529. The last time you had sexual intercourse with this (second, third) person, had you consumed alcohol?

530. Was this person or were you yourself drunk at that time?
IF YES: who was drunk?

531. What was your relationship with this person with whom you had sexual intercourse?
IF BOYFRIEND: Did you live together as if you were married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'.

532. For how long have you had/did you have sexual intercourse with this person?
IF THE RESPONDENT ONLY HAD SEX ONCE WITH THIS PERSON, RECORD '01' DAY.

533. CHECK 106:

534. How old is this person?

535. Was this person older than you, younger or about the same age?

536. Would you say that this person was 10 or more years older than you or less than 10 years older than you?

537. Apart from this/these two person(s) did you have sexual intercourse with anyone else during the past 12 months?
[DO NOT ASK FOR THIRD-LAST PARTNER]

538. In all, how many different people did you have sexual intercourse with in your life?
IN THE CASE OF A NON-NUMERIC RESPONSE, PROBE TO GET AN ESTIMATE.
IF THE NUMBER IS MORE THAN '95', WRITE '95.'

540. CHECK THE COVER PAGE: ADDITIONAL QUESTIONS ABOUT SEXUAL ACTIVITY FOR MEN (1) OR WOMEN (2) 2 (GO TO 541)

541. CHECK THE PRESENCE OF OTHER PEOPLE. DO NOT CONTINUE IF YOU ARE NOT IN PRIVATE WITH THE RESPONDENT.

542. The first time that you had sexual intercourse, would you say that you wanted to have sexual intercourse or were you forced against your will?

543. During the past 12 months, did someone force you to have sexual intercourse against your will?

544. Do you know a place where one could procure condoms?

545. Where is this?
Any other place?
RECORD EVERYTHING MENTIONED.

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

546. If you wanted to, could you procure a condom?

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

602. CHECK 226:

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?

603. CHECK 226:

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?

604. CHECK 226:

605. CHECK 310:
USES A METHOD?

606. CHECK 603:

607. CHECK 602:

WANTS A/ANOTHER CHILD: You said that, right now, you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why? Another reason?

DOES NOT WANT A/ANOTHER CHILD: You said that you do not want to have a/another child, but you do not use a method of avoiding pregnancy. Could you tell me why? Another reason?

RECORD ALL THE REASONS MENTIONED.

608. In the coming weeks, if you discover that you are pregnant, would this be a major problem, a minor problem or not a problem at all?

609. CHECK 310:
USES A METHOD?

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

611. Which method would you prefer to use?

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

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

614. 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?

PROBE FOR A NUMERIC RESPONSE.

615. 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?

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

617. During the last few months, have you heard about family planning:

On the radio?
On the television?
In newspapers or magazines?

619. During the past few months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

620. With whom did you discuss this?
Anyone else?
RECORD EVERYTHING MENTIONED.

621. CHECK 501:

622. CHECK 311/311A:

623. You said that you are currently using a method of contraception. Could you tell me if the use of this method is mainly your own decision, or that of your partner/husband, or a joint decision?

Now I would like to ask you about your partner/husband's opinions about family planning.

624. Do you think that your partner/husband approves or disapproves of using methods to avoid pregnancy?

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

626. CHECK 311/311A:

627. Does your husband want the same number of children that you want, or does he want more or fewer than you want?

628. Husbands and wives do not always agree on everything. Please, tell me if you think it is legitimate for a wife to refuse to have sexual intercourse with her husband when:

She knows that her husband has a sexually transmitted infection?
She knows that her husband has sexual intercourse with other women besides his wives?
She recently gave birth?
She is tired and not in the mood for it?

629. When a wife knows that her husband has an infection transmittable by sexual contact, is she justified in asking that they use a condom during intercourse?

630. CHECK 501:

631. Can you refuse sexual intercourse with your husband when you don't want to have it?

632. Can you ask that your husband use a condom if you want him to use one?

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

701. CHECK 501 AND 502:

702. How old was your husband/partner on his last birthday?

703. Did your (last) husband attend school?

704. What was the highest level of school that he achieved: primary, secondary (first cycle), secondary (second cycle), superior or other?

705. What was the last (year/grade) that he achieved at this level?

706. CHECK 701:

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

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

707. Aside from your housework, do you currently work?

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

709. Did you do any type of work during the past 12 months?

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

711. CHECK 710

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

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

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

715. Do you usually work throughout the year, seasonally or only once in a while?

716. Are you paid in cash or in kind for this work or are you not paid at all?

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

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

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

Your own healthcare?
The purchase of major things for the household?
Purchase of things for daily household needs?
Visits to family or parents?
What food will be prepared each day?

720. PRESENCE OF OTHER PEOPLE AT THIS TIME (PERSONS PRESENT AND ARE LISTENING, PRESENT BUT ARE NOT LISTENING, OR NOT PRESENT)

721. Sometimes, a husband gets upset or angry because a certain things his wife does. In your opinion, is a husband justified in beating or hitting his wife in the following situations:

If she goes out without telling him?
If she neglects her children?
If she argues with him?
If she refuses to have sexual intercourse with him?
If she burns the food?

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

Now I would like to talk to you about something else.

801. Have you ever heard of a disease called AIDS?

802. Can people reduce their chance of getting AIDS by having just one uninfected sex partner who has no other sex partners?

803. Can people get AIDS from mosquito bites?

804. Can people reduce their risk of getting aids by using a condom every time they have sex?

805. Can people get AIDS by sharing food with someone who has AIDS?

806. Can people reduce their chance of getting AIDS by not having sexual intercourse at all?

807. Can people get AIDS by witchcraft or other supernatural means?

808. Is there something (else) that a person can do to avoid or reduce their risk of contracting the virus that causes AIDS?

809. What can a person do?
Anything else?
RECORD EVERYTHING CITED.

810. Is it possible that a person who appears to be healthy, in fact, has the AIDS virus?

811. Can the virus that causes AIDS be transmitted from mother to her baby?

During the pregnancy?
During birth?
During breastfeeding?

812. CHECK 811:

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

814. Are there any special drugs that a doctor or nurse can give people infected with the AIDS virus?

815. CHECK 215:

Now I would like to ask you some questions about your last birth.

816. Did you see someone for prenatal care during this pregnancy?

817. During one of these prenatal visits for this pregnancy, did anyone talk to you about the following subjects?

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

818. Were you offered a test for the AIDS virus as part of your prenatal care?

819. I do not want to know the results, but were you tested for the AIDS virus as part of your prenatal care?

820. I do not want to know the results, but did you get the results of the test?

821. Where was the test done?

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

822. Have you been tested for the AIDS virus since you were tested during your pregnancy?

823. When was the last time you were tested for the AIDS virus?

824. I don't want to know the results, but have you ever been tested for the AIDS virus?

825. When did you last get tested for the AIDS virus?

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

827. I don't want to know the results, but have you ever been tested for the AIDS virus?

828. Where was the test done?
IF THE PLACE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

829. Do you know of a place where people can get tested for the AIDS virus?

830. Where is this?
Is there another place?
RECORD ALL PLACES MENTIONED.

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

831. Would you buy fresh vegetables from a shopkeeper or vendor if you knew the person had the AIDS virus?

832. If a member of your family had the AIDS virus would you like it to remain a secret or not?

833. If a member of your family become sick with the AIDS virus, would you be willing to take care of him/her in your own household?

834. In your opinion, if a teacher has the AIDS virus but is not sick, should he/she be able to continue teaching in the school?

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

836. 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 is suspected to have the AIDS virus?

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

838. CHECK 835, 836 AND 837:

839. Do you know someone who is suspected to have or has the AIDS virus?

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

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

842. Should children age 12-14 be taught about using a condom to avoid getting the AIDS virus?

843. Should children age 12-14 be taught to wait until they get married to have sex to avoid getting AIDS?

844. Do you think that young men should wait until marriage to have sexual intercourse?

845. Do you think that young women should wait until marriage to have sexual intercourse?

846. Do you think that married men should only have sexual intercourse with their wives?

847. Do you think that most of the men you know only have sexual intercourse with their wives?

848. Do you think that married women should only have sexual intercourse with their husband?

849. Do you think that most of the women that you know only have sexual intercourse with their husband?

850. CHECK 801:

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

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

851. When a man has a sexually transmitted infection, which symptom(s) could he have?
Are there other symptoms?
RECORD ALL MENTIONED.

852. When a woman has a sexually transmitted infection, which symptom (s) could she have?
Are there other symptoms?
RECORD ALL MENTIONED.

853. CHECK 519:

854. CHECK 850:

Now I would like to ask you about your health in the last 12 months.

855. During the last 12 months have you had a disease which you got from sexual contact?

856. Sometimes a woman has a bad smelling abnormal genital discharge. During the last 12 months have you had a bad smelling genital discharge?

857. Sometimes women have a genital sore or ulcer. During the past 12 months have you had a genital sore or ulcer?

858. CHECK 855, 856 AND 857:

859. The last time you had (PROBLEM MENTIONED IN 855/856/857), did you seek any kind of advice or treatment?

860. Where did you go?
Was there another place?
RECORD ALL MENTIONED.

SECTION 9. FEMALE CIRCUMCISION

901. Have you ever heard of female circumcision?

902. In certain countries, there is a practice that involves cutting a part of the external genitals of girls. Have you heard of this practice?

903. Were your external genitals cut?

I would now like to ask you some questions about what was done at that time.

904. Did someone cut something in the genital area?

905. Did they just make a laceration in your genitals without cutting anything off?

906. Did they stitch and close the area of your vagina?

907. How old were you when you underwent this practice?
IF THE RESPONDENT DOESN'T KNOW THE EXACT AGE, TRY TO GET AN ESTIMATE.

908. Who performed your circumcision?

909. CHECK 214 AND 216:

910. Have some of your daughters undergone this kind of practice?
IF YES: How many?

911. Which one of your daughters was most recently circumcised?
CHECK 212 AND RECORD THE LINE NUMBER OF THE DAUGHTER

I would now like to ask you some questions about what was done to (NAME OF THE DAUGHTER FROM 911) at that time.

912. Did someone remove part of her genitals?

913. Did someone just slash her genitals without removing anything?

914. Was her vagina stitched closed?

915. How old was (NAME OF THE DAUGHTER FROM 911) at the time of the circumcision?
IF THE RESPONDENT DOESN'T KNOW THE AGE, PROBE TO GET AN ESTIMATE.

916. Who performed the circumcision?

917. Did you notice at the time someone cut (NAME OF THE DAUGHTER FROM 911)'s genitals one of the following problems:

Excessive bleeding?
Difficulty urinating or retaining urine?
Swelling in the genital area?
Infection in the genital area/the wound not correctly scarred?

918. In the future, do you intend to have your daughters circumcised?

919. What are the advantages to circumcising a girl?
PROBE: Other advantages?
RECORD ALL MENTIONED.

920. What the advantages of girls not being circumcised?
PROBE: Anything else?
RECORD ALL MENTIONED.

921. Do you think this practice is a way for preventing girls from having sexual intercourse before marriage or do you think, on the contrary, that this has no effect?

922. Do you think that this practice is required by your religion?

922A. Do you think this practice is required by your tradition or customs?

923. Do you think that this practice should be maintained or that it should disappear?

924. Do you think that men want this practice to be preserved or do you think they favor abandoning it?

SECTION 10. MATERNAL MORTALITY

Now I would like to ask you some questions about your brothers and sisters, that is to say, about all of the children born to your biological mother.

1001. To how many children did your mother give birth, including yourself?

1002. CHECK 1001:

1003. How many of these births did your mother have before your own birth?

1004. What name was given to your oldest brother or sister (or the next)?

1005. Is (NAME) male or female?

1006. Is (NAME) still alive?

1007. How old is (NAME)?

1008. How many years has (NAME) been deceased?

1009. How old was (NAME) when he/she died?

1010. Was (NAME) pregnant when she died?

1011. Did (NAME) die during childbirth?

1012. Did (NAME) die in the two months following a pregnancy or birth?

1013. To how many children did (NAME) give birth during her life?

[IF NO MORE BROTHERS OR SISTERS, GO TO 1014]

1014. RECORD THE TIME:

INTERVIEWER'S OBSERVATIONS

FILL OUT AFTER ENDING THE INTERVIEW.

COMMENTS ABOUT THE RESPONDENT _____

COMMENTS ON PARTICULAR QUESTIONS _____

OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
NAME _____
DATE _____

FIELD EDITOR'S OBSERVATIONS _____
NAME _____
DATE _____

CALENDAR

INSTRUCTIONS: ONLY ONE CODE PER BOX.

BIRTHS AND PREGNANCIES:

2005:

2004:

2003:

2002:

2001:

2000: