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CONTINUED DEMOGRAPHIC AND HEALTH SURVEY (EDS-CONTINUED 2015)
WOMAN'S QUESTIONNAIRE
REPUBLIC OF SENEGAL
MINISTRY OF THE ECONOMY, FINANCE, AND PLANNING
MINISTRY OF HEALTH AND SOCIAL ACTION

ICF INTERNATIONAL

IDENTIFICATION

PLACE NAME _______
NAME OF HEAD OF HOUSEHOLD
HOUSEHOLD NUMBER ______
PLOT NUMBER _____
CLUSTER NUMBER ______
REGION ______

URBAN/RURAL

URBAN 1
RURAL 2

LOCATION


DAKAR 1
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4

LOCATION (DETAIL) ______

WOMAN'S NAME AND LINE NUMBER _____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

INTERVIEWER'S NAME _____
DATE _____
RESULT*
FINAL VISIT

DAY ____
MONTH ____
YEAR ____
INTERVIEW NUMBER ____
RESULT* _____

NEXT VISIT

DATE _____
TIME ____
TOTAL NUMBER OF VISITS _____
* RESULT CODES

1COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

LANGUAGE OF QUESTIONNAIRE _____
LANGUAGE OF INTERVIEW _____

INTERPRETER

YES 1
NO 2

LANGUAGE CODES:

1 FRENCH
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHER

SUPERVISOR

NAME _____
DATE _____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ___. I am working with the National Agency for Statistics and Demography in collaboration with the Ministry of Health and Social Action. We are conducting a survey about health all over Senegal. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
May I begin the interview?

SIGNATURE OF INTERVIEWER _____
DATE ______
RESPONDENT AGREES TO BE INTERVIEWED 1
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101) RECORD THE TIME

HOUR _____
MINUTES _____

102) In what month and year were you born?

MONTH ____
DON'T KNOW MONTH 98
YEAR _____
DON'T KNOW YEAR 9998

103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS _____

104) Have you ever attended school?


YES 1
NO 2 (GO TO 108)

105) What is the highest level of school you attended: primary, middle, secondary, or higher?


PRIMARY 1
MIDDLE 2
SECONDARY 3
HIGHER 4
OTHER (SPECIFY) _____ 6

106) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE/FORM/YEAR _____

107) CHECK 105:

PRIMARY (GO TO 108)
MIDDLE, SECONDARY OR HIGHER (GO TO 110)

108) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?


CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____ 4
BLIND/VISUALLY IMPAIRED 5

108A) Have you ever participated in a literacy program or any other program that included learning how to read and right (not including primary school)?

YES 1
NO 2 (GO TO 109)

108B) In what languages were these literacy programs?
PROBE: Any other?
RECORD ALL MENTIONED.

ARABIC/MADRASA A
WOLOF B
POULAR C
SERER D
DIOLA E
MANDINGUE F
SONINKE G
OTHER (SPECIFY LANGUAGE) ____ X

109) CHECK 108:


CODE 2, 3, OR 4 CIRCLED (GO TO 110)
CODE 1 OR 5 CIRCLED (GO TO 111)

110) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?


AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111) Do you listen to the radio at least once a week, less than once a week or not at all?


AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112) Do you watch television at least once a week, less than once a week, or not at all?


AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113) What is your religion?


MUSLIM 1
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) _____ 6

114A) Are you Senegalese?


YES 1
NO 2 (GO TO 114B)

114) What is your ethnicity?


WOLOF 1
POULAR 2
SERER 3
MANDINGUE 4
DIOLA 5
SONINKE 6
OTHER (SPECIFY) ____ 8

114B) Do you own a mobile telephone?


YES 1
NO 2 (GO TO 114D)

114C) Do you own a mobile telephone to conduct financial transactions?


YES 1
NO 2

114D) Do you have an account in another financial institution that you can use?


YES 1
NO 2

114E) Have you ever used the internet?


YES 1
NO 2

114F) In the last 12 months, have you used the internet?


YES 1
NO 2

114G) During the last twelve months, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?


ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

115) In the last 12 months, how many times have you been away from for one or more nights?


NUMBER OF TIMES _____
NONE 00 (GO TO 201)

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


YES 1
NO 2

SECTION 2. REPRODUCTION

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


YES 1
NO 2 (GO TO 206)

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


YES 1
NO 2 (GO TO 204)

203) How many sons live with you?
And 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 who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD _____
GIRLS DEAD _____

208) SUM ANSWERS TO 203, 205, AND 207 AND ENTER TOTAL.
IF NONE, RECORD '00'.


TOTAL BIRTHS _____

209) CHECK 208:
Just to makes sure that I have this right: you have had in total ____births during your life. Is that correct?


YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210) CHECK 208:


ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

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

212) What name was given to you (first/next) baby?
RECORD NAME.


NAME _____
BIRTH HISTORY NUMBER ____

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


BOY 1
GIRL 2

214) Were any of these births twins?


SINGLE 1
MULTIPLE 2

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


MONTH ____
YEAR _____

216) Is (NAME) still alive?


YES 1
NO 2 (GO TO 220)

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


AGE IN YEARS _____

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


YES 1
NO 2

219) IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD. (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.)Record household line number of child (record '00' if child not


HOUSEHOLD LINE NUMBER _____ (GO TO 221)

220) IF DEAD:
How old was (NAME) when he/she died?

IF '1 YEAR', PROBE: How many months old was (NAME)? RECORDD DAYS IF LESS THAN ONE MONTH; MONTHS IF LESS THAN TWO YEARS, OR YEARS.


DAYS 1 _____
MONTHS 2 _____
YEARS 3 _____

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


YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

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


YES 1
NO 2

223) Compare 208 with number of births in history above and mark.

NUMBERS ARE THE SAME (GO TO 224)
NUMBER ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2010 OR LATER.

NUMBER OF BIRTHS _____
NONE 0 (GO TO 225)

224A) CHECK 217: CURRENT AGE
Current age of youngest child-From 3 to 4 completed years: Identify this child, record his/her name (from q 212) (If twins, use the one recorded last).


AGE _____
OTHER (GO TO 225)

224B) Who participates most often in (name from 224A)'s activities?

FATHER 1
MOTHER 2
OTHER HOUSEHOLD MEMBER 3
NO HOUSEHOLD MEMBER 4 (GO TO 225)
DON'T KNOW 8 (GO TO 225)

224C) What are these activities?


READING BOOKS OR LOOKING AT PICTURE BOOKS A
TELLING STORIES B
SINGING SONGS, INCLUDING NURSERY RHYMES C
GOING FOR WALKS D
PLAYING WITH HIM/HER E
SPENDING TIME COUNTING/DRAWING/NAMING OBJECTS F
OTHER (SPECIFY) _____ X

225) C: FOR EACH BIRTH SINCE JANUARY 2010, ENTER B IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE CODE B FOR EACH BIRTH. ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD P IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF PS MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?


YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

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


MONTHS _____

228) When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 230)
NO 2

229) Did you want to have a baby later on or did you not want any (more) children?

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?


MONTH ____
YEAR ____

232) CHECK 231:


LAST PREGNANCY ENDED IN JAN. 2010 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JAN. 2010 (GO TO 238)

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


MONTHS _____

234) Since January 2010, have you had any other pregnancies that did not result in a live birth?


YES 1
NO 2 (GO TO 236)

235) ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2010.

C: ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2010?


YES 1
NO 2 (GO TO 238)

237) When did the last such pregnancy that terminated before 2010 end?


MONTH ____
YEAR _____

238) When did you last menstrual period start?


(DATE, IF GIVEN) _____


DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

239) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?


YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

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


JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _____ 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning: that is, the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you ever heard of (METHOD)?

01) Female Sterilization
PROBE: Women can have an operation to avoid having any more children
YES 1
NO 2
02) Male Sterilization
PROBE: Men can have an operation to avoid having any more children
YES 1
NO 2

03) IUD
PROBE: Women can have a loop or coil placed inside them by a doctor, nurse or midwife.
YES 1
NO 2

04) Injectables
PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2

05) Implants
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2

06) Pill
PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2

07) Condom
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2

08) Female condom
PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) Lactational amenorrhea method (LAM)
PROBE: Up to six months after giving birth, a woman can use a method which requires her to breastfeed frequently, day and night, and her period does not return.
YES 1
NO 2
10) Cycle beads
PROBE: A woman uses a string of colors beads to know which days she could get pregnant.
YES 1
NO 2
11) Rhythm Method
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2

12) Withdrawal
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2

13) Emergency contraception
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2

14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES (SPECIFY) _____ 1
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

303A) Why are you not using something or a contraceptive method to delay or prevent a pregnancy?

INFREQUENT SEX/HUSBAND ABSENT 01
GOT PREGNANT WHILE USING 02
WANTS TO GET PREGNANT 03
HUSBAND/PARTNER/FAMILY DISAPPROVE 04
SIDE EFFECTS/HEALTH CONCERNS 05
LACK OF ACCESS/TOO FAR 06
COSTS TOO MUCH 07
INCONVENIENT TO USE 08
UP TO GOD/FATALISTIC 09
DIFFICULTY GETTING PREGNANT/MENOPAUSE 10
MARITAL DISSOLUTION/SEPARATION 11

304) Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 306)
DIAPHRAGM I (GO TO 308A)
FOAM/JELLY J (GO TO 308A)
LACTATIONAL AMEN. METHOD K (GO TO 308A)
CYCLE BEADS L (GO TO 308A)
RHYTHM METHOD M (GO TO 308A)
WITHDRAWAL N (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

305) What is the brand name of the pills you are using?
IF DON'T KNOW BRAND, ASK TO SEE THE PACKAGE.

PLANYL 01
PLANOR 02
OVRETTE 03
LO FEMENAL 04
MINIDRIL 05
MINIPHASE 06
STEDIRIL 07
MICORVAL 08
ADEPAL 09
MICROGYNON 10
NEOGYNON 11
DIANE 35 12
TRINORDIOL 13
SECURIL 14
LUSIAF 15
MICROLUT 16
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

306) What is the brand name of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PROTEC 01 (GO TO 308A)
FAGAROU 02 (GO TO 308A)
VISA 03 (GO TO 308A)
MANIX 04 (GO TO 308A)
PRESA 05 (GO TO 308A)
KAMA SUTRA 06 (GO TO 308A)
PROTEX 07 (GO TO 308A)
INNOTEX 08 (GO TO 308A)
CASANOVA 09 (GO TO 308A)
INTIMY 10 (GO TO 308A)
CONTEX 11 (GO TO 308A)
STAR 12 (GO TO 308A)
TROJAM 13 (GO TO 308A)
FEMIDON 14 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

307) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR'S OFFICE 22
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) ____96
DON'T KNOW 98

308) In what month and year was the sterilization performed?

308A) Since what month and year did you start using (CURRENT METHOD) without stopping?

PROBE: FOR HOW LONG HAVE YOU BEEN USING (CURRENT METHOD FIRST MENTIONED) NOW WITHOUT STOPPING?

MONTH ____
YEAR ____

309) CHECK 308/308A, 215, 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A.

YES (GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).)
NO (GO TO 310)

310) CHECK 308/308A

YEAR IS 2010 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING)
YEAR IS 2009 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2010, THEN GO TO 322)

311) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2010.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

C: IN COLUMN 1, ENTER METHOD USE CODE OR 0 FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

In column 2, enter codes for discontinuation next to the last month of use. Number of codes in column 2 must be the same as number of interruptions of method use in column 1.

Ask why she stopped using the method. If pregnancy followed, ask whether she became pregnant unintentionally while using the method or deliberately stopped to get pregnant.

ILLUSTRATIVE QUESTIONS:
Why did you stop using the (method)? Did you become pregnant while using (method), or did you stop to get pregnant, or did you stop for some other reason?
If deliberately stopped to become pregnant, ask: How many months did it take you to get pregnant after you stopped using (method)? And enter 0 in each such month in column 1.

312) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314) CHECK 304:
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 315A)
CYCLE BEADS 12 (GO TO 315A)
RHYTHM METHOD 13 (GO TO 315A)
WITHDRAWAL 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

315) You first started using (CURRENT METHOD) in (date from 308/308a). Where did you get it at that time?

315a) Where did you learn how to use the cycle beads/rhythm/lactational amenorrhea method?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
HEALTH POST 13
GOVT. FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) _____19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) _____96

316) CHECK 304:
CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
CYCLE BEADS 12 (GO TO 326)
RHYTHM METHOD 13 (GO TO 326)

317) At that time, where you told about side effects or problems you might have with the method?

317A) When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 319)
NO 2

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

YES 1
NO 2 (GO TO 320)

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

YES 1
NO 2

320) CHECK 317:
CODE '1' CIRCLED: At that time, were you told about other methods of family planning that you could use?
CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

YES 1 (GO TO 322)
NO 2

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

YES 1
NO 2

322) CHECK 304:
CIRCLE METHOD CODE. IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03 (GO TO 326)
INJECTABLES 04
IMPLANTS 05 (GO TO 326)
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
CYCLE BEADS 12 (GO TO 326)
RHYTHM METHOD 13 (GO TO 326)
WITHDRAWAL 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVT. HOSPITAL 11 (GO TO 326)
GOVT. HEALTH CENTER 12 (GO TO 326)
HEALTH POST 13 (GO TO 326)
GOVT. FAMILY PLANNING CENTER 14 (GO TO 326)
RURAL MATERNITY 15 (GO TO 326)
HEALTH HUT 16 (GO TO 326)
COMMUNITY PHARMACY 17 (GO TO 326)
MOBILE CLINIC 18 (GO TO 326)
OTHER PUBLIC SECTOR (SPECIFY) _____19 (GO TO 326)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22 (GO TO 326)
PHARMACY 23 (GO TO 326)
PRIVATE DOCTOR 24 (GO TO 326)
RELIGIOUS FREE CLINIC 25 (GO TO 326)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____26 (GO TO 326)
OTHER SOURCE
SHOP 31 (GO TO 326)
CHURCH 32 (GO TO 326)
FRIENDS/RELATIVES 33 (GO TO 326)
BAR 34 (GO TO 326)
OTHER (SPECIFY) ____ 96 (GO TO 326)

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

YES 1
NO 2 (GO TO 326)

325) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _____
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____X

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2010 OR LATER (GO TO 402)
NO BIRTHS IN 2010 OR LATER (GO TO 556)

402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2010 OR LATER. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER _____

404) FROM 212 AND 216

NAME _____
LIVING (GO TO 405)
DEAD (GO TO 405)

405) When you got pregnant with (NAME), did you want to become pregnant at that time?

YES 1 (GO TO 408)
NO 2

406) Did you want to have a baby later on, or did you not want any (more) children?

LATER 1
NO MORE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS _____ 1
YEARS _____ 2
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 415)

409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEATH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
OTHER PERSON
MATRON D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) _____ X

410) Where did you receive this antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _____
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
HEALTH HUT D
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) _____G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
COMMUNITY AGENT Q
OTHER (SPECIFY) ____ X

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

MONTHS _____
DON'T KNOW 98

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

NUMBER OF TIMES _____
DON'T KNOW 98

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

Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

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

TIMES _____
DON'T KNOW 8

417) CHECK 416:

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

418) At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)

419) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.

TIMES _____
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO ____

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

YES 1
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)

421A) Where did you purchase or receive the iron tablets or iron syrup?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
HEALTH HUT D
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
COMMUNITY AGENT Q
OTHER (SPECIFY) _____ X

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

DAYS ____
DON'T KNOW 998

422A) Can you describe the advantages of taking iron/folic acid supplements daily?
LET HER DESCRIBE AND CIRCLE THE ANSWER(S).

PREVENT ANEMIA A
PROTECTS THE BABY B
PROTECTS THE PREGNANCY C
PROTECTS THE MOTHER D
PREVENTS WEAKNESS E
WEIGHT OF THE BABY F
OTHER (SPECIFY) _____ X
DON'T KNOW 9 (GO TO 423)

422B) Where did you get this information?

FROM A PRENATAL VISIT A
THE MEDIA B
RELATIVES/NEIGHBORS C
COMMUNITY FIELDWORKER D
OTHER (SPECIFY) ____ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

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

SP/FANSIDAR A
ACT B
OTHER (SPECIFY) _____ X
DON'T KNOW Z

426) CHECK 425:
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION

CODE A CIRCLED (GO TO 427)
CODE A NOT CIRCLED (GO TO 430)

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

TIMES _____

427A) During this pregnancy, did you receive a free mosquito net during a prenatal visit?

YES 1
NO 2

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE A, B, OR C CIRCLED (GO TO 429)
OTHER (GO TO 430)

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

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

431) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 432A)
DON'T KNOW 8 (GO TO 432A)

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

GRAMS FROM CARD _____ 1
GRAMS FROM RECALL _____ 2
DON'T KNOW 99998

432A) Was (NAME)'s birth ever declared?
IF YES, may I see it?

YES, SEEN 1 (GO TO 433)
YES, NOT SEEN 2 (GO TO 433)
No 3
DON'T KNOW 8

432B) Was (NAME)'s birth registered with the civil authority (neighborhood head/village head or civil state officer)?

YES 1 (GO TO 433)
NO 2
DON'T KNOW 8

432C) Do you know how to register (NAME)'s birth?

YES 1
NO 2

433) Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEATH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
OTHER PERSON
MATRON D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) ____ X
NO ONE Y

434) Where did you give birth to (NAME)?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______
HOME
YOUR HOME 11 (GO TO 438)
OTHER HOME 12 (GO TO 438)
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER/MATERNITY 22
GOVT. HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36
OTHER (SPECIFY) _____ 96 (GO TO 438)

435) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

YES 1
NO 2

436) After you delivered (NAME), did anyone check on your health while you were still in the facility?

YES 1 (GO TO 439)
NO 2

437) Did anyone check on your health after you left the facility?

YES 1 (GO TO 439)
NO 2 (GO TO 446)

438) Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO 2 (GO TO 442)

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

HEATH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
OTHER PERSON
MATRON 21
TRADITIONAL BIRTH ATTENDANT 22
OTHER (SPECIFY) _____ 96

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

HOURS 1 _____
DAYS 2 _____
WEEKS 3 ____
DON'T KNOW 998

441) CHECK 437:

YES (GO TO 446)
NOT ASKED (GO TO 442)

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

YES 1
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)

443) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD IN HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

HRS AFTER BIRTH _____ 1
DAYS AFTER BIRTH _____ 2
WKS AFTER BIRTH _____ 3
DON'T KNOW 998

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

HEATH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
OTHER PERSON
MATRON 21
TRADITIONAL BIRTH ATTENDANT 22
OTHER (SPECIFY) ____ 96

445) Where did this first check of (NAME) take place?
PROBE TO IDENTITY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _____
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER/MATERNITY 22
GOVT. HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 36
OTHER (SPECIFY) _____ 96

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 449)
NO 2 (GO TO 450)

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

YES 1
NO 2 (GO TO 452)

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

MONTHS _____
DON'T KNOW 98

450) CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 451)
PREGNANT OR NOT SURE (GO TO 452)

451) Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 453)

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

MONTHS _____
DON'T KNOW 98

453) Did you ever breastfeed (NAME)?

YES 1 (GO TO 455)
NO 2

454) CHECK 404: CHILD IS LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)

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

IMMEDIATELY 000
HOURS _____ 1
DAYS _____ 2

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

YES 1
NO 2 (GO TO 458)

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

MILK (OTHER THAN BREAST MILK) A
HOLY WATER B
PLAIN WATER C
SUGAR OR GLUCOSE WATER D
GRIPE WATER E
SUGAR-SALT-WATER SOLUTION F
FRUIT JUICE G
INFANT FORMULA H
TEA/INFUSIONS I
HONEY J
OTHER (SPECIFY) ____X

458) CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 459)
DEAD (GO TO 459A)

459) Are you still breastfeeding (NAME)?

YES 1 (GO TO 460)
NO 2

459A) For how many months did you breastfeed (NAME)?

MONTHS _____
DON'T KNOW 98

459B) CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2010 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES.)

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

BIRTH HISTORY NUMBER _____

503) From 212 and 216

NAME _____
LIVING (GO TO 504A)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

504A) Do you have a card where (NAME)'s vaccinations are written down? If yes: May I see it please?

YES, CARD SEEN 1 (GO TO 506A)
YES, ONLY OTHER CARD SEEN 2
YES, BOTH SEEN 3 (GO TO 506A)
NO, NO CARD SEEN 4

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

YES 1 (GO TO 509)
NO 2

506A)
1) COPY DATES FROM THE CARD
2) WRITE 44 IN DAY COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ___
MONTH ____
YEAR _____
Oral polio vaccine (OPV) 0 (Polio given at birth)
DAY ___
MONTH ____
YEAR _____
Oral polio vaccine (OPV) 1
DAY ___
MONTH ____
YEAR _____
Oral polio vaccine (OPV) 2
DAY ___
MONTH ____
YEAR _____
Oral polio vaccine (OPV) 3
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (Pentavalent) 1
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (Pentavalent) 2
DAY ___
MONTH ____
YEAR _____
DPT-HEP.B-HIB (Pentavalent) 3
DAY ___
MONTH ____
YEAR _____
Pneumococcal 1
DAY ___
MONTH ____
YEAR _____
Pneumococcal 2
DAY ___
MONTH ____
YEAR _____
Pneumococcal 3
DAY ___
MONTH ____
YEAR _____
Rotavirus 1
DAY ___
MONTH ____
YEAR _____
Rotavirus 2
DAY ___
MONTH ____
YEAR _____
Rotavirus 3
DAY ___
MONTH ____
YEAR _____
Measles
DAY ___
MONTH ____
YEAR _____
Yellow fever
DAY ___
MONTH ____
YEAR _____
Vitamin A (most recent)
DAY ___
MONTH ____
YEAR _____

507) CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

508) Has (NAME) received any vaccines that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE 66 IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 511)
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

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

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

510) Please tell me if (NAME) had any of the following vaccinations:

510a) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

510b) Polio vaccine, that is, two drops in the mouth?

YES 1
NO 2 (GO TO 510e)
DON'T KNOW 8 (GO TO 510e)

510c) Was the first polio vaccine given in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2

510d) How many times was the polio vaccine given?

NUMBER OF TIMES ____

510e) A pentavalent vaccination. that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 510G)
DON'T KNOW 3 (GO TO 510G)

510f) How many times was the pentavalent vaccination given?

NUMBER OF TIMES _____

510fa) Did (NAME) receive a vaccination against pneumococcus, meaning an injection in the thigh to prevent pneumonia?

YES 1
NO 2
DON'T KNOW 8

510fb) How many times did (NAME) receive this vaccine against pneumonia?

NUMBER OF TIMES _____

510fc) Did (NAME) receive a vaccination against rotavirus, meaning liquid in the mouth to prevent diarrhea?

YES 1
NO 2
DON'T KNOW 8

510fd) How many times did (NAME) receive this vaccine against diarrhea?

NUMBER OF TIMES _____

510g) An injection or an MMR injection, that is, a shot in the arm at the age of 9 months or older, to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

510h) A yellow fever vaccination?

YES 1
NO 2
DON'T KNOW 8

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

512) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

513) Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 524A)
DON'T KNOW (GO TO 524A)

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 522)

519) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _____
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
HEALTH HUT D
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) ____G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
COMMUNITY AGENT Q
OTHER (SPECIFY) ____ X

520) CHECK 519:

TWO OR MORE CODES CIRCLED (GO TO 521)
ONLY ONE CODE CIRCLED (GO TO 522)

521) Where did you first seek advice or treatment?
USE LETTER CODE FROM 519.

FIRST PLACE _____

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

a) A fluid made from a special packet called (local name for the ORS packet)?
YES 1
NO 2
DON'T KNOW 8
b) A pre-packaged ORS liquid?
YES 1
NO 2
DON'T KNOW 8
c) A government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

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

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY OR ZINC) D
UNKNOWN PILL OR SYRUP E
INJECTION
ANTIBIOTIC F
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
(IV) INTRAVENOUS I
HOME REMEDY/HERBAL MEDICINE J
OTHER (SPECIFY) ____ X

524a) If your child had diarrhea, what would you do?
RECORD ALL MENTIONED.

SOUGHT TREATMENT FROM HEALTH CARE ESTABLISHMENT A
GIVEN ORS/ZINC B
OTHER (SPECIFY) _____ X
NOTHING Y

524b) Can you list the advantages to using ORS/Zinc to treat diarrhea?
RECORD ALL MENTIONED.

REDUCE THE SEVERITY OF THE DIARRHEA A
REDUCE THE LENGTH OF THE DIARRHEA B
REDUCE THE OCCURRENCE OF THE DIARRHEA C
OTHER (SPECIFY) ____ X
DON'T KNOW Z

524c) Can you list the advantages to using ORS/Zinc to treat diarrhea?
RECORD ALL MENTIONED.

REDUCE THE SEVERITY OF THE DIARRHEA A
REDUCE THE LENGTH OF THE DIARRHEA B
REDUCE THE OCCURRENCE OF THE DIARRHEA C
OTHER (SPECIFY) ____X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

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

YES 1
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

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

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) _____6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

530) CHECK 525:
HAD FEVER?

YES (GO TO 531)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

531) Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 537)

534) Where did you seek advice or treatment?

Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _____
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
HEALTH HUT D
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
COMMUNITY AGENT Q
OTHER (SPECIFY) _____ X

535) CHECK 534:

TWO OR MORE CODES CIRCLED (GO TO 536)
ONLY ONE CODE CIRCLED (GO TO 536A)

536) Where did you first seek advice or treatment?
USE LETTER CODE FROM 534.


FIRST PLACE _____

536a) At any time during his/her illness, did someone take blood from his/her finger or heal?

YES 1
NO 2 (GO TO 537)

536b) Did someone perform a malaria diagnostic test on (NAME)?

YES 1
NO 2 (GO TO 537)

536c) What was the result?

POSITIVE 1
NEGATIVE 2
DON'T KNOW 8

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

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

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

ANTIMALARIAL DRUGS
ACT A
QUININE B
AMODIAQUINE C
SP/FANSIDAR D
OTHER ANTIMALARIAL (SPECIFY) ____ E
ANTIBIOTIC
PILL/SYRUP F
INJECTION G
OTHER DRUGS
ASPIRIN H
ACETAMINOPHEN I
IBUPROFEN J
OTHER (SPECIFY) ____ X
DON'T KNOW Z

539) CHECK 538:
ANY CODE A-F CIRCLED?

YES (GO TO 540)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

540) CHECK 538:
ACT (A) GIVEN

CODE 'A' CIRCLED (GO TO 541)
CODE 'A' NOT CIRCLED (GO TO 542)

541) How long after the fever started did (NAME) first take ACT?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

542) CHECK 538:
QUININE (B) GIVEN

CODE 'B' CIRCLED (GO TO 543)
CODE 'B' NOT CIRCLED (GO TO 544)

543) How long after the fever started did (NAME) first take Quinine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

544) CHECK 538:
AMODIAQUINE (C) GIVEN

CODE 'C' CIRCLED (GO TO 545)
CODE 'C' NOT CIRCLED (GO TO 546)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

546) CHECK 538:
SF/FANSIDAR (D) GIVEN

CODE 'D' CIRCLED (GO TO 547)
CODE 'D' NOT CIRCLED (GO TO 550)

547) How long after the fever started did (NAME) first take SF/Fansidar?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

550) CHECK 538:
OTHER ANTIMALARIAL (E) GIVEN

CODE 'E' CIRCLED (GO TO 551)
CODE 'E' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

551) How long after the fever started did (NAME) first take (Other antimalarial)?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 554)
NONE (GO TO 556)

554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) ____ 96

555) CHECK 522A AND 522B, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 557)

556) Have you ever heard of a special product called [local name for ORS packet or pre-packaged ORS liquid] you can get for the treatment of diarrhea?

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2013 OR LATER LIVING WITH RESPONDENT

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 558)
NONE (GO TO 601)

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 557) (drink/eat):

a) plain water?
YES 1
NO 2
DON'T KNOW 8
b) juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) clear broth?
YES 1
NO 2
DON'T KNOW 8
d) milk such as tinned, powdered, or fresh animal milk?
IF YES, how many times did (NAME) drink milk?
IF 7 OF MORE TIMES, RECORD 7
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK____
e) Infant formula?
IF YES, how many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD 7
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA _____
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
IF YES, how many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD 7
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT ____
h) Any [brand name of commercially fortified baby food, e.g. Cerelac]?
YES 1
NO 2
DON'T KNOW 8
i) bread, rice, noodles, porridge, or any other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) white potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) any dark green, leafy vegetables?
YES 1
NO 2
DON'T KNOW 8
m) ripe mangoes, papayas or [insert any other locally available vitamin a-rich fruits]?
YES 1
NO 2
DON'T KNOW 8
n) any other fruits or vegetables)?
YES 1
NO 2
DON'T KNOW 8
o) liver, kidney, heart or any other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) any meat, such as beef, pork, lamb, goat, chicken or duck?
YES 1
NO 2
DON'T KNOW 8
q) eggs?
YES 1
NO 2
DON'T KNOW 8
r) fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Other foods based in beans, soy, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

559) CHECK 558 (CATEGORIES 'g' THROUGH 'u')

NOT A SINGLE 'YES' (GO TO 560)
AT LEAST ONE 'YES' (GO TO 561)

560) Did (NAME) eat any solid, semi-solid or soft foods yesterday during the day or at night?
IF YES, PROBE: What kind of solid, semi-solid, or soft foods did (NAME FROM 557) eat?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD 7

NUMBER OF TIMES _____
DON'T KNOW 8

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 612)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

605) RECORD THE LINE NUMBER OF HER HUSBAND/PARTNER ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME ______
LINE NUMBER _____

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

YES 1
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)

607) Including yourself, in total how many wives or live-in partners does he have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS _____
DON'T KNOW 98

608) Are you the first, second…wife?

RANK _____

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

ONCE 1
MORE THAN ONCE 2

610) CHECK 609:
MARRIED/LIVED WITH MAN ONLY ONCE: in what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH MAN MORE THAN ONCE: Now I would like to talk about your first (husband/partner). In what month and year did you start living with him?

MONTH _____
DON'T KNOW MONTH 98
YEAR____ (GO TO 612)
DON'T KNOW YEAR 9998

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

AGE_____

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

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

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

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 628)
AGE IN YEARS _____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

613a) How old was your partner?

AGE IN YEARS _____
DON'T KNOW 98

613b) Did you use a condom (male or female)?

YES 1
NO 2
DON'T KNOW 8

614) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

615) When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO _____ 1
WEEKS AGO _____ 2
MONTHS AGO _____ 3
YEARS AGO _____ 4 (GO TO 627)

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

DAYS AGO _____ 1
WEEKS AGO _____ 2
MONTHS AGO _____ 3

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

YES 1
NO 2 (GO TO 619)

618) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

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

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
CLIENT/PROSTITUTE 5 (GO TO 622)
OTHER (SPECIFY) _____ 6 (GO TO 622)

620) CHECK 609:

MARRIED ONLY ONCE (GO TO 621)
MARRIED MORE THAN ONCE (GO TO 622)

621) CHECK 613:

FIRST TIME WHEN STARTED LIVING WITH HUSBAND (GO TO 623)
OTHER (GO TO 622)

622) How long ago did you first have sexual intercourse with this (second/third) person?

DAYS AGO _____ 1
WEEKS AGO _____ 2
MONTHS AGO _____ 3
YEARS AGO _____ 4

623) How many times during the last 12 months did you have sexual intercourse with this person?

NUMBER OF TIMES _____

624) How old is this person?

AGE OF PARTNER _____
DON'T KNOW 98

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

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 (GO TO 627)

626) In total, how many different people have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS LAST 12 MONTHS _____
DON'T KNOW 98

627) In total, how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

NUMBER OF PARTNERS IN LIFETIME _____
DON'T KNOW 98

628) PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN OVER 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 632)

630) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

633) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) ____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702) CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

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

HAVE ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

704) Now I have some question about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW (GO TO 710)

705) 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 this child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS ____1
YEARS ____ 2
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707) CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708) CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEARS (GO TO 711)

709) CHECK 704:
WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy?

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

Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) _____ X
DON'T KNOW Z

710) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NO, NOT CURRENTLY USING (GO TO 711)
YES, CURRENTLY USING (GO TO 712)

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

YES 1
NO 2
DON'T KNOW 8

712) 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.

NONE 00 (GO TO 714)
NUMBER _____
OTHER (SPECIFY) 96 (GO TO 714)

713) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter if it's a boy or a girl?

NUMBER OF BOYS _____
NUMBER OF GIRLS _____
NUMBER OF EITHER _____
OTHER (SPECIFY) _____96

714) In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2

715) COUNTRY-SPECIFIC QUESTIONS ON MEDIA MESSAGES ABOUT FAMILY PLANNING.

716) CHECK 601:

YES, CURRENTLY MARRIED (GO TO 717)
YES, CURRENTLY LIVING WITH A MAN (GO TO 717)
NO, NOT IN UNION (GO TO 801)

717) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 718)
NOT CURRENTLY USING OR NOT ASKED (GO TO 720)

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

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) ____ 6

719) CHECK 304:

NEITHER STERILIZED (GO TO 720)
HE OR SHE STERILIZED (GO TO 801)

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

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

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

801) CHECK 601 AND 602:
CURRENTLY MARRIED/LIVING WITH A MAN

FORMERLY MARRIED/LIVING WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

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

AGE _____

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

YES 1
NO 2 (GO TO 806)

804) What is the highest level of school he attended: Primary, Secondary, or higher?

PRIMARY 1
MIDDLE 2
SECONDARY 3
HIGHER 4
DON'T KNOW 8 (GO TO 806)

805) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '0'.

GRADE/FORM/YEAR _____

806) CHECK 801:
CURRENTLY MARRIED/LIVING WITH A MAN:
What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

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

OCCUPATION _____

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

YES 1 (GO TO 811)
NO 2

808) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 815)

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

OCCUPATION _____

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

815) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 816)
NOT IN UNION (GO TO 823)

816) CHECK 814:

CODE '1' OR '2' CIRCLED (GO TO 817)
OTHER (GO TO 819)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6

818) Would you say that the money that you earn is more than what your (husband/partner) earns, less than what he earns, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 820)
DON'T KNOW 8

819) Who usually decides how the money your (husband/partner) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER (SPECIFY) _____ 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____ 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____6

823) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

824) Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

CHILDREN OVER 10
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
HUSBAND
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
OTHER MALES
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3
OTHER FEMALES
PRES/LISTEN 1
PRES./NOT LISTEN 2
NOT PRES. 3

826) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DON'T KNOW 8
NEGL. CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

906) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

908) Can the virus that causes AIDS be transmitted from a mother to a baby?

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

909) CHECK 908:

AT LEAST ONE 'YES' (GO TO 910)
OTHER (GO TO 911)

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

YES 1
NO 2
DON'T KNOW 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2012 (GO TO 912)
NO BIRTHS (GO TO 926)
LAST BIRTH BEFORE JANUARY 2012 (GO TO 926)

912) CHECK 408 FOR LAST BIRTH

HAD ANTENATAL CARE (GO TO 913)
NO ANTENATAL CARE (GO TO 920)

913) Check for presence of others, before continuing, make every effort to ensure privacy.

914) During any of the antenatal visits for your last birth were you given any information about:

Babies getting the AIDS virus from their mother?

YES 1
NO 2
DON'T KNOW 8


Things that you can do to prevent getting the AIDS virus?


YES 1
NO 2
DON'T KNOW 8


Getting tested for the AIDS virus?


YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

916) Were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 920)

917) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
HEALTH POST 13
GOVT. FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
VOLUNTARY TESTING CENTER 18
MOBILE CLINIC 19
OTHER PUBLIC SECTOR (SPECIFY) ____ 20
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
PRIVATE DOCTOR 23
RELIGIOUS FREE CLINIC 24
PRIVATE LABORATORY 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) ____ 96

918) Did you get the results of the test?

YES 1
NO 2 (GO TO 924)

919) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1 (GO TO 924)
NO 2 (GO TO 924)
DON'T KNOW 8 (GO TO 924)

920) CHECK 434 FOR LAST BIRTH

ANY CODE 21-36 CIRCLED (GO TO 921)
OTHER (GO TO 926)

921) Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?

YES 1
NO 2

922) I don't want to know the results, but were you tested for the AIDS virus at that time?

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

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

YES 1 (GO TO 927)
NO 2

925) How many months ago was your most recent HIV test?

MONTHS AGO ______ (GO TO 932)
TWO OR MORE YEAR AGO 95 (GO TO 932)

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

YES 1
NO 2 (GO TO 930)

927) How many months ago was your most recent HIV test?

MONTHS AGO ______
TWO OR MORE YEARS AGO 95

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

YES 1
NO 2

929) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVT. HOSPITAL 11 (GO TO 932)
GOVT. HEALTH CENTER 12 (GO TO 932)
HEALTH POST 13 (GO TO 932)
GOVT. FAMILY PLANNING CENTER 14 (GO TO 932)
RURAL MATERNITY 15 (GO TO 932)
HEALTH HUT 16 (GO TO 932)
COMMUNITY PHARMACY 17 (GO TO 932)
VOLUNTARY TESTING CENTER 18 (GO TO 932)
MOBILE CLINIC 19 (GO TO 932)
OTHER PUBLIC SECTOR (SPECIFY) _____20 (GO TO 932)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21 (GO TO 932)
PHARMACY 22 (GO TO 932)
PRIVATE DOCTOR 23 (GO TO 932)
RELIGIOUS FREE CLINIC 24 (GO TO 932)
PRIVATE LABORATORY 25 (GO TO 932)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____26 (GO TO 932)
OTHER SOURCE
SHOP 31 (GO TO 932)
CHURCH 32 (GO TO 932)
FRIENDS/RELATIVES 33 (GO TO 932)
BAR 34 (GO TO 932)
OTHER (SPECIFY) _____ 96 (GO TO 932)

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

YES 1
NO 2 (GO TO 932)

931) Where is that?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
VOLUNTARY TESTING CENTER H
MOBILE CLINIC I
OTHER PUBLIC SECTOR (SPECIFY) _____ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE K
PHARMACY L
PRIVATE DOCTOR M
PRIVATE LABORATORY N
RELIGIOUS FREE CLINIC P
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ O
OTHER SOURCE
SHOP P
CHURCH Q
FRIENDS/RELATIVES R
BAR S
OTHER (SPECIFY) _____ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

934) If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

SHOULD BE ALLOWED 1
SHOULD BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

937) CHECK 901:
HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

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

YES 1
NO 2

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
NEVER HAD SEXUAL INTERCOURSE (GO TO 946)

939) CHECK 937: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 940)
NO (GO TO 941)

940) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)

944) The last time you had (infection from 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 946)

945) Where did you go?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) ____X

946) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

947) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED/LIVING WITH HUSBAND/PARTNER (GO TO 949)
NOT IN UNION (GO TO 1001)

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

YES 1
NO 2
DEPENDS/NOT SURE 8

950) Can you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. FEMALE GENITAL CUTTING

1001) Have you ever heard of female circumcision?

YES 1 (GO TO 1003)
NO 2

1002) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (END INTERVIEW)

1003) Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 1009)

1004) Now I would like to ask you what was done to you at that time.
Was any flesh removed from the genital area?

YES 1
NO 2
DON'T KNOW 8 (GO TO 1006)

1005) Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1006) Was your genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1007) How old were you when you were circumcised?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS ______
AS A BABY/DURING INFANCY 95
DON'T KNOW 98

1008) Who performed the circumcision?

TRADITIONAL CIRCUMCISER 11
NON-MEDICAL MIDWIFE/TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) ____ 16

1009) CHECK 213, 215, 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 2000 OR LATER (CONTINUE)
HAS NO LIVING DAUGHTERS BORN IN 2000 OR LATER (GO TO 1016)

CHECK 213, 215, AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 6 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about your (daughter/daughters).

1010) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2000 OR LATER.

BIRTH HISTORY NUMBER _____
NAME ______

1011) Is (NAME OF DAUGHTER) circumcised?

YES 1 (GO TO 1012)
NO 2 (GO TO 1011 IN NEXT COLUMN OR IF NO MORE DAUGHTERS, GO TO 1016)

1012) How old was (NAME OF DAUGHTER) when she was circumcised?
If the respondent does not know the age, probe to get an estimate.

AGE IN COMPLETED YEARS _____
DON'T KNOW 98

1013) Was her genital area sewn closed?
PROBE: Was the genital area closed?

YES 1
NO 2
DON'T KNOW 8

1014) Who performed the circumcision?

TRADITIONAL CIRCUMCISER 11
NON-MEDICAL MIDWIFE/TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) _____ 16
DON'T KNOW 98

1015) GO BACK TO 1011 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 1016

1016) Do you believe that female circumcision is required by your religion?

YES 1
NO 2
DON'T KNOW 8

1017) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

1018) RECORD THE TIME.

HOURS _____
MINUTES _____

SECTION 11. TOBACCO USE

1100) Now, I would like to ask you a few questions about the usage of "smoked" tobacco, including cigarettes, cigars, pipes, and roll-ups.

IF AGE 50 OR MORE, START THE INTERVIEW WITH ALL THE "INDIVIDUAL CHARACTERISTICS" QUESTIONS, 601 TO 606 AND 801 TO 814, WHILE FOLLOWING THE SKIPS.

1101) Do you currently smoke tobacco daily, less than once a day, or not at all?

DAILY 1 (GO TO 1104)
LESS THAN ONCE A DAY 2
NOT AT ALL 3 (GO TO 1103)
DON'T KNOW 7 (END OF INTERVIEW)
REFUSE TO RESPOND 8 (END OF INTERVIEW)

1102) Have you ever smoked tobacco daily in the past?

YES 1 (GO TO 1108)
NO 2 (GO TO 1110)
DON'T KNOW 3 (GO TO 1110)
REFUSE TO RESPOND 8 (GO TO 1110)

1103) In the past, have you ever smoked tobacco daily, less than once a day, or not at all?
IF THE RESPONDENT SMOKED "DAILY" AND "LESS THAN ONCE A DAY" IN THE PAST, CHECK "DAILY"

DAILY 1 (END OF INTERVIEW)
LESS THAN ONCE A DAY 2
NOT AT ALL 3
DON'T KNOW 7
REFUSE TO RESPOND 8 (END OF INTERVIEW)

1104) How old were you when you first started smoking tobacco daily?
IF DON'T KNOW OR RESPONSE TO RESPOND, RECORD '99'
IF 1104=99, ASK QUESTION 1105. OTHERWISE, SKIP TO QUESTION 1106.

AGE IN COMPLETED YEARS _____

1105) How many years ago did you start smoking tobacco daily?
If refuse to respond, record '99'.

YEARS _____

1106) On average, how many of the following products do you currently smoke every day? Also, tell me if you smoke this product, but not every day.
If the respondent says that he or she smoke the product, but not every day, record '888'.
If the respondent provides the number of packets or cartons, ask how many are in each one, and calculate the total number.

a) manufactured cigarettes?
DAILY _____
a1) [If 1106a=888] On average, how many manufactured cigarettes do you currently smoke each week?
WEEKLY _____
b) roll-ups?
DAILY _____
b1) [If 1106b=888] On average, how many roll-ups do you currently smoke each week?
WEEKLY _____
c) Tobacco-filled pipes?
DAILY ____
c1) [If 1106c=888] On average, how many tobacco-filled pipes do you currently smoke each week?
WEEKLY _____
d) Cigars, cheroots, or cigarillos?
DAILY _____
d1) [If 1106d=888] On average, how many cigars, cheroots, or cigarillos do you currently smoke each week?
WEEKLY _____
e) number of daily sessions using a water pipe (nargile)?
DAILY ____
e1) [If 1106e=888] On average, how many sessions using a water pipe do you perform each week?
WEEKLY ____
f) Other forms of smoked tobacco? (Please specify the other type of tobacco you currently smoke every day: _____ )
DAILY ____
f2) [If 1106f=888] On average, how many [Indicate the product] do you currently smoke each week?
WEEKLY _____

1107) How long do you typically wait after waking up before smoking? Would you say within 5 minutes, between 6 and 30 minutes, between 31 and 60 minutes, or over 60 minutes?

WITHIN 5 MINUTES 1 (END OF INTERVIEW)
BETWEEN 6 AND 30 MINUTES 2 (END OF INTERVIEW)
BETWEEN 31 AND 60 MINUTES 3 (END OF INTERVIEW)
OVER 60 MINUTES 4 (END OF INTERVIEW)
REFUSE TO RESPOND 8 (END OF INTERVIEW)

CURRENT SMOKERS SMOKING LESS THAN ONCE A DAY

1108) What age were you when you started smoking tobacco daily?
IF DON'T KNOW OR REFUSE TO RESPOND, RECORD '99'
IF 1108=99, ASK QUESTION 1109. IF NOT, SKIP TO QUESTION 1110.

AGE IN COMPLETED YEARS ____

1109) How many years ago did you start smoking tobacco daily?
IF REFUSE TO RESPOND, RECORD '99'.

YEARS AGO _____

1110) How many of the following products do you currently smoke over the course of a normal week?
IF THE RESPONDENT INDICATES THAT SHE ENGAGES IN THE ACTIVITY "OVER THE COURSE OF THE LAST 30 DAYS," BUT LESS THAN ONCE A WEEK, RECORD '888'. IF THE RESPONDENT PROVIDES THE NUMBER OF PACKETS OR CARTONS, ASK HOW MANY ARE IN EACH ONE, AND CALCULATE THE TOTAL NUMBER.

a) manufactured cigarettes?

PER WEEK _____

b) roll-ups?

PER WEEK _____

c) tobacco-filled pipes?

PER WEEK ____

d) cigars, cheroots, or cigarillos?

PER WEEK _____

e) number of sessions using a water pipe (nargile)?

PER WEEK _____

f) other forms of smoking tobacco? (Please specify the other form of tobacco you currently smoke each day)

PER WEEK _____

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT: ______________
COMMENTS ON SPECIFIC QUESTIONS: ______________
ANY OTHER COMMENTS: ____________

SUPERVISOR'S OBSERVATIONS ________________

NAME OF SUPERVISOR: ______
DATE: ___________

EDITOR'S OBSERVATIONS: _________________

NAME OF EDITOR: __________
DATE: ______________

CALENDAR

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX
COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

INFORMATION TO BE CODED FOR EACH COLUMN.

2015
12 DEC 01
11 NOV 02
10 OCT 03
09 SEPT 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2014
12 DEC 01
11 NOV 02
10 OCT 03
09 SEPT 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2013
12 DEC 01
11 NOV 02
10 OCT 03
09 SEPT 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2012
12 DEC 01
11 NOV 02
10 OCT 03
09 SEPT 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2011
12 DEC 01
11 NOV 02
10 OCT 03
09 SEPT 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2010
12 DEC 01
11 NOV 02
10 OCT 03
09 SEPT 04
08 AUG 05
07 JUL 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE**
B BIRTH
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE
0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALIST
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY)
Z DON'T KNOW