WOMAN'S QUESTIONNAIRE
Republic of Senegal
Ministry of the Economy, Finance, and Planning
Ministry of Health and Social Action
ICF International
PLACE NAME _____
NAME OF HEAD OF HOUSEHOLD ______
HOUSEHOLD NUMBER ____
PLOT NUMBER ____
CLUSTER NUMBER _____
REGION ____
DEPARTMENT ____
SANITATION DISTRICT ____
URBAN/RURAL
RURAL 2
MILIEU ____
DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL
REGIONAL CAPITAL 2
OTHER CITY 3
RURAL 4
WOMAN'S NAME AND LINE NUMBER _____
CHECK COVER PAGE OF THE HOUSEHOLD QUESTIONNAIRE
HOUSEHOLD SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?
NO 2
IF HOUSEHOLD SELECTED FOR DV, CHECK WOMEN'S SELECTION TABLE (Q157A OF HOUSEHOLD QUESTIONNAIRE)
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?
NO 2
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE: _______
INTERVIEWER'S NAME _________
RESULT*
*RESULT CODES
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____
FINAL VISIT
DAY ____
MONTH ____
YEAR _____
INT. NUMBER ____
RESULT* _____
NEXT VISIT
DATE _____
TIME _____
LANGUAGE OF INTERVIEW
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHER
NATIVE LANGUAGE OF RESPONDENT
2 WOLOF
3 POULAR
4 SERER
5 MANDINGUE
6 DIOLA
8 OTHER
TRANSLATOR USED
NO 2
SUPERVISOR
NAME ____
DATE ____
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 DOES NOT AGREE TO BE INTERVIEWED 2 (END)
SECTION 1. RESPONDENT'S BACKGROUND
101) RECORD THE TIME.
MINUTES ____
105) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107) Have you ever attended school?
NO 2 (GO TO 111)
108) What is the highest level of school you attended: primary, secondary 1, secondary 2, or higher?
MIDDLE 2
SECONDARY 3
HIGHER 4
OTHER (SPECIFY) _____ 6
109) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
MIDDLE, SECONDARY OR HIGHER (GO TO 113)
111) 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?
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
111A) Have you ever participated in a literacy program or any other program that included learning how to read and right (not including primary school)?
NO 2 (GO TO 112)
111B) In what languages were these literacy programs?
PROBE: Any other?
RECORD ALL MENTIONED.
WOLOF B
POULAR C
SERER D
DIOLA E
MANDINGUE F
SONINKE G
OTHER (SPECIFY LANGUAGE) _____ X
CODE 1 OR 5 CIRCLED (GO TO 114)
113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
114) Do you listen to the radio at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
115) Do you watch television at least once a week, less than once a week, or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
116) Do you own a mobile telephone?
NO 2 (GO TO 118)
117) Do you use your mobile phone for any financial transactions?
NO 2
118) Do you have an account in a bank or other financial institution that you yourself use?
NO 2
119) Have you ever used the internet?
NO 2 (GO TO 122)
120) In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.
NO 2 (GO TO 122)
121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
CHRISTIAN 2
ANIMIST 3
NO RELIGION 4
OTHER (SPECIFY) _____ 6
NO 2 (GO TO 201)
POULAR 02
SERER 03
MANDINGUE/SOCE 04
DIOLA 05
SONINKE 06
OTHER (SPECIFY) _____ 96
201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?
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?
NO 2 (GO TO 204)
203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
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?
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'.
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?
NO 2 (GO TO 208)
207) How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD ____
208) SUM ANSWERS TO 203, 205 AND 207 AND ENTER TOTAL.
IF NONE, RECORD '00'.
209) CHECK 208:
Just to makes sure that I have this right: you have had in total ____births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
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. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.)
212) What name was given to you (first/next) baby?
RECORD NAME.
213) Is (NAME) a boy or a girl?
GIRL 2
214) Were any of these births twins?
MULT 2
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
YEAR ____
NO 2 (GO TO 220)
217) IF ALIVE:
How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.
218) IF ALIVE:
Is (NAME) living with you?
NO 2
219) IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
220) IF DEAD:
How old was (NAME) when he/she died?
IF 12 MONTHS OR ONE YEAR, ASK: Did (NAME) have his/her first birthday?
THEN ASK: Exactly how many months old was (NAME) when he/she died?
RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.
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?
NO 2 (NEXT BIRTH)
222) Have you had any live births since the birth of (NAME OF LAST BIRTH)? .
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK.
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2012-2017.
NONE 0 (GO TO 226)
For each birth since in 2012-2017, 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.)
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)
227) How many months pregnant are you?
C: RECORD NUMBER OF COMPLETED MONTHS. ENTER Ps IN THE CALENDAR, BEGINNING WITH MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.
228) When you got pregnant, did you want to get pregnant at that time?
NO 2
229) CHECK 208: TOTAL NUMBER OF BIRTHS
ONE OR MORE:
A) Did you want to have a baby later on or did you not want any more children?
NONE:
b) Did you want to have a baby later on or did you not want any children?
NO MORE/NONE 2
230) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (GO TO 239)
231) When did the last such pregnancy end?
YEAR ____
LAST PREGNANCY ENDED IN 2011 OR EARLIER (GO TO 239)
233) In what month and year did the preceding such pregnancy end?
YEAR ____
234) How many months pregnant were you when that pregnancy ended?
235) Since January 2012, have you had any other pregnancies that did not result in a live birth?
NO 2 (GO TO 236)
236) FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2012 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.
IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.
237) Did you have any miscarriages, abortions or stillbirths that ended before 2012?
NO 2 (GO TO 239)
238) When did the last such pregnancy that terminated before 2010 end?
YEAR ____
239) When did you last menstrual period start?
WEEKS AGO ____ 2
MONTHS AGO ____ 3
YEARS AGO _____ 4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
ONE YEAR/12 MONTHS OR MORE (GO TO 240)
239B) Were there any social activities or working days that you could not participate in because of your last period?
NO 2
DON'T KNOW/NOT SURE/NO SUCH ACTIVITIES 8
239C) During your last period, were you able to wash and change yourself in private while you were at home?
NO 2
DON'T KNOW 8
239D) Have you used products such as menstrual pads, tampons or pieces of fabric?
NO 2 (GO TO 240)
DON'T KNOW 8 (GO TO 240)
239E) Where these products reusable?
NO 2
DON'T KNOW 8
240) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?
NO 2 (GO TO 242)
DON'T KNOW 8 (GO TO 242)
241) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAD ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _____ 6
DON'T KNOW 8
242) After the birth of a child, can a woman become pregnant before her menstrual period has returned?
NO 2
DON'T KNOW 8
301) Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you ever heard of (METHOD)?
PROBE: Women can have an operation to avoid having any more children
NO 2
PROBE: Men can have an operation to avoid having any more children
NO 2
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more months.
NO 2
PROBE: Women can have an injection by a heath provider that stops them from becoming pregnant for one or more months.
NO 2
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.
NO 2
PROBE: Women can take a pill every day to avoid becoming pregnant
NO 2
PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
NO 2
PROBE: Women can place a sheath in their vagina before sexual intercourse.
NO 2
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
NO 2
PROBE: A women uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
NO 2
Up to six months after giving birth, before the menstrual period has returned, women use a method which requires her to breastfeed frequently day and night.
NO 2
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
NO 2
PROBE: Men can be careful and pull out before climax.
NO 2
YES, TRADITIONAL METHOD (SPECIFY) _____ B
NO Y
PREGNANT (GO TO 312)
303) Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
NO 2
303A) Why are you not using something or a contraceptive method to delay or prevent a pregnancy?
GOT PREGNANT WHILE USING 02 (GO TO 311)
WANTS TO GET PREGNANT 03 (GO TO 311)
HUSBAND/PARTNER/FAMILY DISAPPROVE 04 (GO TO 311)
SIDE EFFECTS/HEALTH CONCERNS 05 (GO TO 311)
LACK OF ACCESS/TOO FAR 06 (GO TO 311)
COSTS TOO MUCH 07 (GO TO 311)
INCONVENIENT TO USE 08 (GO TO 311)
UP TO GOD/FATALISTIC 09 (GO TO 311)
DIFFICULTY GETTING PREGNANT/MENOPAUSE 10 (GO TO 311)
MARITAL DISSOLUTION/SEPARATION 11 (GO TO 311)
OTHER (SPECIFY) _____ 96 (GO TO 311)
DON'T KNOW 98 (GO TO 311)
304) Which method are you using?
CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 309)
INJECTABLES D (GO TO 309)
IMPLANTS E (GO TO 309)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 306)
EMERGENCY CONTRACEPTION I (GO TO 309)
STANDARD DAYS METHOD J (GO TO 309)
LACTATIONAL AMEN. METHOD K (GO TO 309)
RHYTHM METHOD L (GO TO 309)
WITHDRAWAL M (GO TO 309)
OTHER MODERN METHOD X (GO TO 309)
OTHER TRADITIONAL METHOD Y (GO TO 309)
305) What is the brand name of the pills you are using?
IF DON'T KNOW BRAND, ASK TO SEE THE PACKAGE.
PLANOR 02
OVRETTE 03
LO FEMENAL 04
MINIDRIL 05
MINIPHASE 06
STEDIRIL 07
MICORVAL 08
ADEPAL 09
MICROGYNC 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.
FAGAROU 02 (GO TO 309)
VISA 03 (GO TO 309)
MANIX 04 (GO TO 309)
PRESA 05 (GO TO 309)
KAMA SUTRA 06 (GO TO 309)
PROTEX 07 (GO TO 309)
INNOTEX 08 (GO TO 309)
CASANOVA 09 (GO TO 309)
INTIMY 10 (GO TO 309)
CONTEX 11 (GO TO 309)
STAR 12 (GO TO 309)
TROJAM 13 (GO TO 309)
FEMIDON 14 (GO TO 309)
DON'T KNOW 98 (GO TO 309)
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.
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER (SPECIFY) _____ 16
PRIVATE DOCTOR'S OFFICE 22
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
DON'T KNOW 98
308) In what month and year was the sterilization performed?
YEAR ____ (GO TO 320)
309) 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?
YEAR _____
310) CHECK 308 AND 309, 215, AND 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.
YES (GO BACK TO 308 AND 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION))
311) C: YEAR IS 2012-2017: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
C: YEAR IS 2011 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2012, THEN SKIP TO 324.
312) 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 2012. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
312A) MONTH AND YEAR OF START OF INTERVAL OF USE OR NONUSE.
YEAR ____
312B Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?
NO 2 (GO TO 312I)
312D) How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?
RECORD '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.
MONTHS _____ (GO TO 312F)
DATE GIVEN 95
312E) RECORD THE MONTH AND YEAR RESPONDENT STARTED USING METHOD.
YEAR ____
312F) For how many months did you use (METHOD)?
RECORD '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.
DATE GIVEN 95
312G) RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.
YEAR ____
312H) Why did you stop using (METHOD)?
312I) GO BACK TO 312A IN NEXT COLUMN; OR, IF NO MORE GAPS, GO TO 313.
313) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.
ANY METHOD USED (GO TO 315)
314) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 326)
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01 (GO TO 319)
MALE STERILIZATION 02 (GO TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAY METHOD 10
LACTATIONAL AMEN. METHOD 11 (GO TO 323)
RHYTHM METHOD 12 (GO TO 323)
WITHDRAWAL 13 (GO TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96
316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) ____ 19
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 26
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) _____ 96
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 322)
EMERGENCY CONTRACEPTION 09 (GO TO 322)
STANDARD DAYS METHOD 10 (GO TO 322)
OTHER MODERN METHOD 95 (GO TO 322)
OTHER TRADITIONAL METHOD 96 (GO TO 323)
318) At that time, where you told about side effects or problems you might have with the method?
NO 2 (GO TO 320)
319) When you got sterilized, were you told about side effects or problems you might have with the method?
NO 2
320) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (GO TO 322)
321) Were you told what to do if you experienced side effects or problems?
NO 2
ANY 'YES': 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 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?
NO 2
323) Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (GO TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMEN. METHOD 11 (GO TO 327)
RHYTHM METHOD 12 (GO TO 327)
WITHDRAWAL 13 (GO TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 327)
325) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER 12 (GO TO 327)
HEALTH POST 13 (GO TO 327)
GOVERNMENT FAMILY PLANNING CENTER 14 (GO TO 327)
RURAL MATERNITY 15 (GO TO 327)
HEALTH HUT 16 (GO TO 327)
COMMUNITY PHARMACY 17 (GO TO 327)
MOBILE CLINIC 18 (GO TO 327)
OTHER PUBLIC SECTOR (SPECIFY) ____ 19 (GO TO 327)
PHARMACY 23 (GO TO 327)
PRIVATE DOCTOR 24 (GO TO 327)
RELIGIOUS FREE CLINIC 25 (GO TO 327)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 26 (GO TO 327)
CHURCH 32 (GO TO 327)
FRIENDS/RELATIVES 33 (GO TO 327)
BAR 34 (GO TO 327)
OTHER (SPECIFY) _____ 96 (GO TO 327)
326) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 327)
327) Where is that?
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.
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ N
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X
327) In the last 12 months, were you visited by a fieldworker?
NO 2
328) Did the fieldworker talk to you about family planning?
NO 2
329) CHECK 202: LIVING CHILDREN
YES: a) In the last 12 months, have you visited a health facility for care for yourself or your children?
NO: b) In the last 12 months, have you visited a health facility for yourself?
NO 2 (GO TO 401)
330) Did any staff member at the health facility speak to you about family planning methods?
NO 2
SECTION 4. PREGNANCY AND POSTNATAL CARE
401) CHECK 224:
NO BIRTHS IN 2012-2017 (GO TO 648)
402) CHECK 215:
ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2012-2107. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S)).
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.
DEAD __
405) When you got pregnant with (NAME), did you want to become pregnant at that time?
NO 2
ONLY ONE BIRTH: A) Did you want to have a baby later on, or did you not want any (more) children?
MORE THAN ONE BIRTH: b) Did you want to have a baby later on, or did you not want any more children?
NO MORE 2 (GO TO 408)
407) How much longer did you want to wait?
YEARS ____ 2
DON'T KNOW 998
408) Did you see anyone for antenatal care for this pregnancy?
NO 2 (GO TO 414)
409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
TRADITIONAL BIRTH ATTENDANT E
COMMUNITY/VILLAGE HEALTH WORKER F
OTHER (SPECIFY) ____ X
410) Where did you receive this antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
HEALTH HUT D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) _____ G
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ M
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?
DON'T KNOW 98
412) How many times did you receive antenatal care during this pregnancy?
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 taken?
Did you give a urine sample?
Did you give a blood sample?
NO 2
NO 2
NO 2
413A) During any of your antenatal care visits, were you told about things to look out for that might suggest problems with the pregnancy?
NO 2
DON'T KNOW 8
414) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
415) During this pregnancy, how many times did you get this injection?
DON'T KNOW 8
416) CHECK 416: TETANUS INJECTIONS
DON'T KNOW (GO TO 417)
417) At any time before this pregnancy, did you receive any tetanus injections?
NO 2 (GO TO 420)
DON'T KNOW 8 (GO TO 420)
418) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
ONLY ONCE: A) How many years ago did you receive the last tetanus injection?
MORE THAN ONCE: b) How many years ago did you receive the last tetanus injection before this pregnancy?
420) During this pregnancy, were you given or did you buy iron tablets or iron syrup?
SHOW TABLETS/SYRUP
NO 2 (GO TO 422)
DON'T KNOW 8 (GO TO 422)
420A) Where did you purchase or receive the iron tablets or iron syrup?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
HEALTH HUT D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) _____ G
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ M
TRADITIONAL PRACTITIONER O
MARKET P
COMMUNITY AGENT Q
OTHER (SPECIFY) ____ X
421) During the whole pregnancy, for how many days did you take the tables or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
421A) Can you describe the advantages of taking iron/folic acid supplements daily?
LET HER DESCRIBE AND CIRCLE THE ANSWER(S).
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 422)
421B) Where did you get this information?
THE MEDIA B
RELATIVES/NEIGHBORS C
COMMUNITY FIELDWORKER D
OTHER (SPECIFY) _____ X
422) During this pregnancy, did you take any drug for intestinal worms?
NO 2
DON'T KNOW 8
423) During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?
NO 2 (GO TO 425A)
DON'T KNOW 8 (GO TO 425A)
424) How many times did you take SP/Fansidar to keep you from getting malaria?
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)
425) Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source?
IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6
425A) During this pregnancy, did you receive a free mosquito net?
NO 2 (GO TO 426)
425B) How many months pregnant were you when you received the free mosquito net?
DON'T KNOW 98
426) When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
427) Was (NAME) weighed at birth?
NO 2 (GO TO 429)
DON'T KNOW 8 (GO TO 429)
428) How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
GRAMS FROM RECALL _____2
DON'T KNOW 99998
428A) Was (NAME)'s birth ever declared?
IF YES: may I see it?
YES, NOT SEEN 2 (GO TO 429)
NO 3
DON'T KNOW 8
428B) Was (NAME)'s birth registered with the civil authority (neighborhood head/village head or civil state officer)?
NO 2
DON'T KNOW 8
428C) Do you know how to register (NAME)'s birth?
NO 2
429) 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 (NAME)'S BIRTH.
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
TRADITIONAL BIRTH ATTENDANT E
RELATIVE/FRIEND F
OTHER (SPECIFY) _____ X
NO ONE Y
430) Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME 12 (GO TO 434)
GOVERNMENT HEALTH CENTER/MATERNITY 22
GOVERNMENT HEALTH POST 23
HEALTH HUT 24
MOBILE CLINIC 25
HEALTH CARE WORKER 26
OTHER PUBLIC SECTOR (SPECIFY) _____ 28
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36
431) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS ____ 2
WEEKS ____ 3
DON'T KNOW 998
432) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?
NO 2 (GO TO 434)
433) When was the decision made to have the caesarean section? Was it before or after your labor pains started?
AFTER 2
434) Immediately after the birth, was (NAME) put directly on the bare skin of your chest?
NO 2
DON'T KNOW 8
434A) Was (NAME)'s skin in contact with your skin?
NO 2
DON'T KNOW 8
434B) CHECK 430: DELIVERY LOCATION
OTHER (GO TO 435)
435) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?
NO 2 (GO TO 438)
436) 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.
DAYS ____ 2
WEEKS ____ 3
DON'T KNOW 998
437) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH WORKER 23
OTHER (SPECIFY) _____ 96
438) Now I would like to talk to you about checks on (NAME)'s health after delivery--for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?
NO 2 (GO TO 441)
DON'T KNOW 8 (GO TO 441)
439) How long after delivery was (NAME)'s health first checked?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS _____ 2
WEEKS ____ 3
DON'T KNOW 998
440) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON,
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH WORKER 23
OTHER (SPECIFY) _____ 96
441) Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?
NO 2 (GO TO 445)
442) How long after delivery did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS _____ 2
WEEKS ____ 3
DON'T KNOW 998
443) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON,
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH WORKER 23
OTHER (SPECIFY) _____ 96
444) Where did this first check of (NAME) take 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.
OTHER HOME 12
GOVERNMENT HEALTH CENTER/MATERNITY 22
GOVERNMENT HEALTH POST 23
HEALTH HUT 24
MOBILE CLINIC 25
HEALTH CARE WORKER 26
OTHER PUBLIC SECTOR (SPECIFY) _____ 28
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36
445) I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?
NO 2 (GO TO 457)
DON'T KNOW 8 (GO TO 457)
446) How many hours, days or weeks after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS _____ 2
WEEKS ____ 3
DON'T KNOW 998
447) Who check on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON,
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH WORKER 23
OTHER (SPECIFY) _____ 96
448) Where did this check of (NAME) take 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.
OTHER HOME 12 (GO TO 457)
GOVERNMENT HEALTH CENTER/MATERNITY 22 (GO TO 457)
GOVERNMENT HEALTH POST 23 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) _____ 28 (GO TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36 (GO TO 457)
449) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?
NO 2 (GO TO 453)
450) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS AFTER BIRTH_____ 2
WEEKS AFTER BIRTH____ 3
DON'T KNOW 998
451) How checked on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON,
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH WORKER 23
OTHER (SPECIFY) _____ 96
452) Where did this first check take 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.
OTHER HOME 12 (GO TO 457)
GOVERNMENT HEALTH CENTER/MATERNITY 22 (GO TO 457)
GOVERNMENT HEALTH POST 23 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) _____ 28 (GO TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36 (GO TO 457)
453) I would like to talk to you about checks on (NAME)'s health after delivery--for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?
NO 2 (GO TO 457)
DON'T KNOW 9 (GO TO 457)
454) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS AFTER BIRTH_____ 2
WEEKS AFTER BIRTH____ 3
DON'T KNOW 998
455) Who checked on (NAME)'s health at that time?
PROBE FOR THE MOST QUALIFIED PERSON,
MIDWIFE 12
NURSE/NURSE CERTIFIED IN NEWBORN CARE 13
TRADITIONAL BIRTH ATTENDANT 22
COMMUNITY/VILLAGE HEALTH WORKER 23
OTHER (SPECIFY) _____ 96
456) Where did this first check of (NAME) take 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.
OTHER HOME 12 (GO TO 457)
GOVERNMENT HEALTH CENTER/MATERNITY 22 (GO TO 457)
GOVERNMENT HEALTH POST 23 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) _____ 28 (GO TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36 (GO TO 457)
457) In the first two days after (NAME)'s birth, did any health care provider do the following:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
458) Has your menstrual period returned since the birth of (NAME)?
NO 2 (GO TO 461)
459) Did your period return between the birth of (NAME) and your next pregnancy?
NO 2 (GO TO 463)
460) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
461) CHECK 226:
IS RESPONDENT PREGNANT?
PREGNANT OR NOT SURE (GO TO 463)
462) Have you had sexual intercourse since the birth of (NAME)?
NO 2 (GO TO 464)
463) For how many months after the birth of (NAME) did you not have sexual intercourse?
DON'T KNOW 98
464) Did you ever breastfeed (NAME)?
NO 2
465) CHECK 404: CHILD IS LIVING?
DEAD (GO TO 471)
466) 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.
HOURS ____ 1
DAYS ____ 2
467) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
NO 2
468) CHECK 404: CHILD IS LIVING?
DEAD (GO TO 471)
469) Are you still breastfeeding (NAME)?
NO 2
470) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
471) GO BACK TO 405 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 501A.
SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)
501A) CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2014-2017?
NO BIRTHS IN 2014-2017 (GO TO 601)
502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2012-2015.
BIRTH HISTORY NUMBER _____
DEAD (GO TO 501B)
504A) Do you have a card or other document where (NAME)'s vaccinations are written down?
YES, ONLY OTHER DOCUMENT SEEN 2
YES, BOTH SEEN 3 (GO TO 507A)
NO, NEITHER SEEN 4
505A) Did you ever have a vaccination card for (NAME)?
NO 2
CODE '4' CIRCLED (GO TO 511A)
507A) May I see the card or other document where (NAME)'s vaccinations are written down?
YES, ONLY OTHER DOCUMENT SEEN 2
YES, BOTH SEEN 3
NO, NEITHER SEEN 4 (GO TO 511A)
508A) COPY DATES FROM THE CARD.
WRITE '44' IN DAY COLUMN IF CARD SHOWS THAT A DOES WAS GIVEN, BUT NO DATE IS RECORDED.
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
MONTH ____
YEAR ___
509A) CHECK 508A:
BCG TO [MEASLES CONTAINING VACCINE 2 ALL RECORDED?
YES (GO TO 525A)
510A) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 507A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.
NO 2 (GO TO 525A)
DON'T KNOW 8 (RECORD '00' IN THE CORRESPONDING DAY COLUMN IN 507A, THEN GO TO 525A)
511A) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?
NO 2 (GO TO 525A)
DON'T KNOW 8 (GO TO 525A)
512A) Did (NAME) ever receive a BCG vaccination against tuberculosis, that is, an injection in the arm of shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
513A) Within 24 hours after birth, did (NAME) receive a Hepatitis B vaccination, that is, an injection in the thigh to prevent Hepatitis B?
NO 2
DON'T KNOW 8
514A) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?
NO 2 (GO TO 517A)
DON'T KNOW 8 (GO TO 517A)
515A) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?
LATER 2
516A) How many times did (NAME) receive the oral polio vaccine?
517A) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the though sometimes at the same time as polio drops?
NO 2 (GO TO 519A)
DON'T KNOW 8 (GO TO 519A)
518A) How many times did (NAME) receive the pneumococcal vaccine?
519A) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?
NO 2 (GO TO 521A)
DON'T KNOW 8 (GO TO 521A)
520A) How many tines did (NAME) receive the pneumococcal vaccine?
521A) Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?
NO 2 (GO TO 522A)
DON'T KNOW 8 (GO TO 522A)
522A) How many times did (NAME) receive the rotavirus vaccine?
523A) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?
NO 2 (GO TO 524AA)
DON'T KNOW 8 (GO TO 524AA)
524A) How many times did (NAME) receive the measles vaccine?
524AA) Has (NAME) ever received a yellow fever vaccine?
NO 2
DON'T KNOW 8
525A) In the last 7 days was (NAME) given:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
526B) CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2014-2017?
NO MORE BIRTHS IN 2014-2017 (GO TO 601)
SECTION 6. CHILD HEALTH AND NUTRITION
601) CHECK 224:
NO BIRTHS IN 2012-2017 (GO TO 648)
602) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2012-2017. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE BIRTHS, USE LAST COLUMN 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.)
603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.
DEAD (GO TO 646)
605) In the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
NO 2
DON'T KNOW 8
606) 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.
NO 2
DON'T KNOW 8
607) Was (NAME) given any drug for intestinal worms in the last six months?
NO 2
DON'T KNOW 8
608) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 618)
DON'T KNOW (GO TO 618)
609) CHECK 464: CURRENTLY BREASTFEEDING
YES: A) 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?
NO/NOT ASKED: B) Now I would like to know how much (NAME) was given to drink during the diarrhea. 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
610) When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
611) Did you seek advice or treatment for the diarrhea from any source?
NO 2 (GO TO 615)
612) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ____ F
PHARMACY H
PRIVATE DOCTOR'S OFFICE I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ L
TRADITIONAL PRACTITIONER N
MARKER O
PEDDLER P
OTHER (SPECIFY) ____ X
ONLY ONE CODE CIRCLED (GO TO 615)
614) Where did you first seek advice or treatment?
USE LETTER CODE FROM 612.
615) Was (NAME) given any of the following to drink at any time since (NAME) started having the diarrhea?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
ANY 'YES': A) Was anything given to treat the diarrhea?
ALL 'NO' OR 'DON'T KNOW': B) Was anything given to treat the diarrhea?
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)
617) CHECK 615:
ANY 'YES' A) What else was given to treat the diarrhea? Anything else?
ALL 'NO' OR 'DON'T KNOW' B) What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
OTHER (NO ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
HOME REMEDY/HERBAL MEDICINE I
OTHER (SPECIFY) _____ X
618) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (GO TO 620)
DON'T KNOW 8 (GO TO 620)
619) At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?
NO 2
DON'T KNOW 8
620) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
621) Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?
NO 2 (GO TO 623)
DON'T KNOW 8 (GO TO 623)
622) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (GO TO 624)
BOTH 3 (GO TO 624)
OTHER (SPECIFY) ____ 6 (GO TO 624)
DON'T KNOW 8 (GO TO 624)
NO OR DON'T KNOW (GO TO 646)
624) Did you seek advice or treatment for the illness from any source?
NO 2 (GO TO 629)
625) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ____ F
PHARMACY H
PRIVATE DOCTOR'S OFFICE I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ L
TRADITIONAL PRACTITIONER N
MARKER O
PEDDLER P
OTHER (SPECIFY) ____ X
ONLY ONE CODE CIRCLED (GO TO 628)
627) Where did you first seek advice or treatment?
USE LETTER CODE FROM 625.
628) How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
629) At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO TO 646)
DON'T KNOW 8 (GO TO 646)
630) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE PILLS E
QUININE INJECTION/IV F
ARTESUNATE RECTAL G
INJECTION/IV H
OTHER ANTIMALARIAL (SPECIFY) _____ I
INJECTION/IV K
ACETAMINOPHEN M
IBUPROFEN N
DON'T KNOW Z
631) CHECK 630:
ANY CODE A-I CIRCLED?
NO (GO TO 646)
632) CHECK 630:
Artemisinin Combination Therapy (A) given
CODE 'A' NOT CIRCLED (GO TO 634)
633) How long after the fever started did (NAME) first take an artemisinin combination therapy?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
634) CHECK 630:
SP/Fansidar (B) given
CODE 'B' NOT CIRCLED (GO TO 636)
635) How long after the fever started did (NAME) first take SP/Fansidar?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
636) CHECK 630:
Chloroquine (C) given
CODE 'C' NOT CIRCLED (GO TO 638)
637) How long after the fever started did (NAME) first take Chloroquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
638) CHECK 630:
Amodiaquine (D) given
CODE 'D' NOT CIRCLED (GO TO 640)
639) How long after the fever started did (NAME) first take Amodiaquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
640) CHECK 630:
Quinine (E or F) given
CODE 'E' OR 'F' NOT CIRCLED (GO TO 642)
641) How long after the fever started did (NAME) first take Quinine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
642) CHECK 630:
Artesunate (G or H) given
CODE 'G' OR 'H' NOT CIRCLED (GO TO 644)
643) How long after the fever started did (NAME) first take Artesunate?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
644) CHECK 630:
Other antimalarial (I) given
CODE 'I' NOT CIRCLED (GO TO 646)
645) How long after the fever started did (NAME) first take (other antimalarial)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS OR MORE AFTER FEVER 3
DON'T KNOW 8
646) GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 647.
647) CHECK 615(A) AND 615(B), ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 649)
648) 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?
NO 2
649) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2015-2017 LIVING WITH RESPONDENT
NONE (GO TO 701)
650) Now I would like to ask you about liquids or foods that (name from 649) 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.
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
IF 7 MORE MORE TIMES, RECORD '7'.
NO 2
DON'T KNOW 8
IF 7 MORE MORE TIMES, RECORD '7'.
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
IF 7 MORE MORE TIMES, RECORD '7'.
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
651) CHECK 650 (CATEGORIES 'G' THROUGH 'U'):
AT LEAST ONE 'YES' (GO TO 653)
652) 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) eat?
NO 2 (GO TO 654)
653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
654) The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?
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
SECTION 7. MARRIAGE AND SEXUAL ACTIVITY
701) Are you currently married or living together with a man as if married?
YES, LIVING WITH A MAN 2 (GO TO 704)
NO, NOT IN UNION 3
702) Have you ever been married or lived together with a man as if married?
YES, LIVED WITH A MAN 2
NO 3 (GO TO 712)
703) What is your current marital status: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 709)
SEPARATED 3 (GO TO 709)
704) Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
705) RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER ______
706) Does your husband/partner have other wives or does he live with other women as if married?
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)
707) Including yourself, in total how many wives or live-in partners does he have?
DON'T KNOW 98
708) Are you the first, second?wife?
709) Have you been married or have you lived with a man only once or more than once?
MORE THAN ONCE 2
710) CHECK 709:
MARRIED/LIVED WITH A MAN ONLY ONCE --A) in what month and year did you start living with your husband/partner?
MARRIED/LIVED WITH A MAN MORE THAN ONCE--B) Now I would like to talk about your first (husband/partner) In what month and year did you start living with him?
DON'T KNOW MONTH 98
YEAR ____ (GO TO 712)
DON'T KNOW YEAR 9998
711) How old were you when you first started living with him?
712) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
713) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. 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. How old were you when you had sexual intercourse for the very first time?
AGE IN YEARS _____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95
713A) How old was your partner?
DON'T KNOW 98
713B) Did you use a condom (male or female)?
NO 2
DON'T KNOW 8
714) Now I would like to ask you some questions about your recent sexual activity. 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.
WEEKS AGO ____ 2 (GO TO 716)
MONTHS AGO _____ 3 (GO TO 716)
YEARS AGO ____ 4 (GO TO 716)
715) When was the last time you had sexual intercourse with this person?
WEEKS AGO _____ 2
MONTHS AGO _____ 3
716) The last time you had sexual intercourse (with this second/third) person, was a condom used?
NO 2 (GO TO 718)
717) Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
718) 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'.
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLIENT/PROSTITUTE 5
OTHER (SPECIFY) _____ 6
719) How long ago did you first have sexual intercourse with this person?
WEEKS AGO ____ 2
MONTHS AGO ____ 3
YEARS AGO ____ 4
720) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IF 95 OR MORE, RECORD '95'.
DON'T KNOW 98
722) Apart from this person, have you had sexual intercourse with any other persons in the last 12 months?
NO 2 (GO TO 724)
723) 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'.
DON'T KNOW 98
AGE 25-49 (GO TO 727)
CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 727)
726) In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?
NO 2
727) 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'.
DON'T KNOW 98
728) CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):
NO, CONDOM NOT USED (GO TO 731)
NOT ASKED (GO TO 731)
729) You told me that a condom was used the last time you had sex. What is the brand name of condom you used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.
FAGAROU 02
VISA 03
MANIX 04
PRESA 05
KAMA SUTRA 06
PROTEX 07
INNOTEX 08
CASANOVA 09
INTIMY 10
CONTEX 11
STAR 12
TROJAM 13
FEMIDON 14
OTHER (SPECIFY) ____ 96
DON'T KNOW 98
731) From where did you obtain the condom the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE,
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) ____ 19
PRIVATE 22
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 26
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) ____ 96
730A) In the last 12 months, were you given a condom (EX: during an information campaign, or at a health care establishment)?
NO 2
731) PRESENCE OF OTHERS DURING THIS SECTION.
NO 2
NO 2
NO 2
SECTION 8. FERTILITY PREFERENCES
801) CHECK 304:
HE OR SHE STERILIZED (GO TO 813)
NOT PREGNANT OR UNSURE (GO TO 804)
803) 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?
NO MORE 2 (GO TO 812)
UNDECIDED/DON'T KNOW 8 (GO TO 812)
804) 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?
NO MORE/NONE 2 (GO TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 813)
UNDECIDED/DON'T KNOW (GO TO 811)
805) CHECK 226:
NOT PREGNANT OR NOT SURE: A) How long would you like to wait from now before the birth of (a/another) child?
PREGNANT: B) After the birth of this child you are expecting now, how long would you like to wait before the birth of another child?
YEARS ____ 2
SOON/NOW 993 (GO TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
AFTER MARRIAGE 995 (GO TO 811)
OTHER (SPECIFY) ____ 996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)
PREGNANT (GO TO 812)
807) CHECK 303:
Using a contraceptive method?
CURRENTLY USING (GO TO 813)
NOT ASKED (GO TO 808)
00-23 MONTHS OR 00-01 YEAR (GO TO 812)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)
WANTS TO HAVE A/ANOTHER CHILD: A) 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: B) 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.
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
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
DON'T KNOW Z
811) CHECK 303: Using a contraceptive method?
NO, NOT CURRENTLY USING (GO TO 812)
YES, CURRENTLY USING (GO TO 813)
812) Do you think you will use a method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8
HAS LIVING CHILDREN: a) 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: b) 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.
NUMBER ______
OTHER (SPECIFY) ______ 96 (GO TO 815)
814) 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 GIRLS _____
NUMBER OF EITHER _____
OTHER (SPECIFY) ______ 96
815) In the last few months have you:
NO 2
NO 2
NO 2
NO 2
NO 2
816) In the last few months, have you heard about family planning during the Moytou Neff campaign?
NO 2
DON'T KNOW 8
YES, CURRENTLY LIVING WITH A MAN (GO TO 818)
NO, NOT IN UNION (GO TO 901)
818) CHECK 303: Using a contraceptive method?
NOT CURRENTLY USING OR NOT ASKED (GO TO 820)
NOT ASKED (GO TO 822)
819) Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2 (GO TO 821)
JOINT DECISION 3 (GO TO 821)
OTHER (SPECIFY) _____ 6 (GO OT 821)
820) Would you say that not using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _____ 6
HE OR SHE STERILIZED (GO TO 901)
822) Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK
901) CHECK 701:
NOT IN UNION (GO TO 909)
902) How old was your (husband/partner) on his last birthday?
903) Did your (last) (husband/partner) ever attend school?
NO 2 (GO TO 906)
904) What is the highest level of school you attended: Primary, Middle, Secondary, or higher?
MIDDLE 2
SECONDARY 3
HIGHER 4
DON'T KNOW 8 (GO TO 906)
905) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
DON'T KNOW 98
906) Has your (husband/partner) done any work in the last 7 days?
NO 2
DON'T KNOW 8
907) Has your (husband/partner) done any work in the last 12 months?
NO 2 (GO TO 909)
DON'T KNOW 8 (GO TO 909)
908) What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?
909) Aside from your own housework, have you done any work in the last seven days?
NO 2
910) 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?
NO 2
911) 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?
NO 2
912) Have you done any work in the last 12 months?
NO 2 (GO TO 917)
913) What is your occupation, that is, what kind of work do you mainly do?
914) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
915) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
916) Are you paid or do you ear in cash or in kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT IN UNION (GO TO 925)
OTHER (GO TO 921)
919) Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6
920) 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?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 922)
DON'T KNOW 8
921) Who usually decides how the money your (husband/partner) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER (SPECIFY) _____ 6
922) Who usually makes decisions about health care for yourself: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6
923) Who usually makes decisions about making major household purchases?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6
924) Who usually makes decisions about visits to your family or relatives?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6
925) Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN (GO TO 928)
926) Do you have a title deed for any house you own?
NO 2 (GO TO 928)
DON'T KNOW 8 (GO TO 928)
927) Is your name on the title deed?
NO 2
DON'T KNOW 8
928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN (GO TO 931)
929) Do you have a title deed for any land you own?
NO 2 (GO TO 931)
DON'T KNOW 8 (GO TO 931)
930) Is your name on the title deed?
NO 2
DON'T KNOW 8
931) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRES/NOT LISTEN 2
NOT PRES 3
PRES/NOT LISTEN 2
NOT PRES 3
PRES/NOT LISTEN 2
NOT PRES 3
PRES/NOT LISTEN 2
NOT PRES 3
932) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1001) Now I would like to talk about something else.
Have you ever heard of an illness called HIV or AIDS?
NO 2 (GO TO 1042)
1002) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
1003) Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
1004) Can people reduce their chance of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
1005) Can people get HIV by sharing food with a person who has HIV?
NO 2
DON'T KNOW 8
1006) Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
1007) Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
1008) Can HIV be transmitted from a mother to a baby?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (GO TO 1011)
1010) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
NO BIRTHS (GO TO 1027)
LAST BIRTH IN 2014 OR LATER (GO TO 1027)
1012) CHECK 408 FOR LAST BIRTH:
NOT ANTENATAL CARE (GO TO 1020)
1013) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
1014) During any of the antenatal visits for your last birth were you given any information about:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1015) Were you offered a test for HIV as part of your antenatal care?
NO 2
1016) I don't want to know the results, but were you tested for HIV as part of your antenatal care?
NO 2 (GO TO 1020)
1017) 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.
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT 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
PHARMACY 22
PRIVATE DOCTOR 23
RELIGIOUS FREE CLINIC 24
PRIVATE LABORATORY 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 26
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) _____ 96
1018) I don't want to know the results, but did you get the results of the test?
NO 2 (GO TO 1020)
1019) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?
NO 2
DON'T KNOW 8
OTHER (GO TO 1024)
1021) Between the time you went for delivery but before the baby was born, were you offered a test for HIV?
NO 2
1022) I don't want to know the results, but were you tested for HIV at that time?
NO 2 (GO TO 1024)
1023) I don't want to know the results, but did you get the results of the test?
NO 2 (GO TO 1025)
NO OR NOT ASKED (GO TO 1027)
1025) Have you been tested for HIV since that time you were tested during your pregnancy?
NO 2
1026) How many months ago was your most recent HIV test?
TWO OR MORE YEARS AGO 95 (GO TO 1033)
1027) I don't want to know the results, but have you ever been tested for HIV?
NO 2 (GO TO 1031)
1028) How many months ago was your most recent HIV test?
TWO OR MORE YEARS AGO 95
1029) I don't want to know the results, but did you get the results of the test?
NO 2
1030) 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.
GOVERNMENT HEALTH CENTER 12 (GO TO 1033)
HEALTH POST 13 (GO TO 1033)
GOVERNMENT FAMILY PLANNING CENTER 14 (GO TO 1033)
RURAL MATERNITY 15 (GO TO 1033)
HEALTH HUT 16 (GO TO 1033)
COMMUNITY PHARMACY 17 (GO TO 1033)
VOLUNTARY TESTING CENTER 18 (GO TO 1033)
MOBILE CLINIC 19 (GO TO 1033)
OTHER PUBLIC SECTOR (SPECIFY) _____ 20 (GO TO 1033)
PHARMACY 22 (GO TO 1033)
PRIVATE DOCTOR 23 (GO TO 1033)
RELIGIOUS FREE CLINIC 24 (GO TO 1033)
PRIVATE LABORATORY 25 (GO TO 1033)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 26 (GO TO 1033)
CHURCH 32 (GO TO 1033)
FRIENDS/RELATIVES 33 (GO TO 1033)
BAR 34 (GO TO 1033)
OTHER (SPECIFY) _____ 96 (GO TO 1033)
1031) Do you know of a place where people can go to get an HIV test?
NO 2 (GO TO 1033)
1032) 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.
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT 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
PHARMACY L
PRIVATE DOCTOR M
RELIGIOUS FREE CLINIC N
PRIVATE LABORATORY O
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ P
CHURCH R
FRIENDS/RELATIVES S
BAR T
OTHER (SPECIFY) _____ X
1033) Have you heard of test kits people can use to test themselves for HIV?
NO 2 (GO TO 1035)
1034) Have you ever tested yourself for HIV using a self-test kits?
NO 2
1035) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1036) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1037) Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test results is positive for HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1038) Do people talk badly about people living with HIV, or who are thought to be living with HIV?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1039) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1040) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8
1041) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/NOT SURE/DEPENDS 8
1041A) In your opinion, if a teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
HEARD ABOUT AIDS: a) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS: b) Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE (GO TO 1051)
1044) CHECK 1042: Heard about other sexually transmitted infections?
NO (GO TO 1046)
1045) 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?
NO 2
DON'T KNOW 8
1046) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?
NO 2
DON'T KNOW 8
1047) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW 8
1048) CHECK 1045, 1046, AND 1047:
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1051)
1049) The last time you had (infection from 1045/1046/1047), did you seek any kind of advice or treatment?
NO 2 (GO TO 1051)
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.
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
VOLUNTARY TESTING CENTER H
MOBILE HTC SEVICES I
OTHER PUBLIC SECTOR (SPECIFY) _____ J
PHARMACY L
PRIVATE DOCTOR M
RELIGIOUS FREE CLINIC N
PRIVATE LABORATORY O
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ P
CHURCH R
FRIENDS/RELATIVES S
BAR T
OTHER (SPECIFY) _____ X
1050A) The last time you had (problem from 1045/1046/1047), did you use a condom with your partner the last time you had sexual intercourse?
NO 2
DON'T KNOW 8
1051) 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?
NO 2
DON'T KNOW 8
1052) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?
NO 2
DON'T KNOW 8
NOT IN UNION (GO TO 1101)
1054) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?
NO 2
DEPENDS/NOT SURE 8
1055) Can you ask your (husband/partner) to use a condom if you wanted him to?
NO 2
DEPENDS/NOT SURE 8
SECTION 11. OTHER HEALTH ISSUES
1101) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1104)
1102) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or another healthcare worker?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1104)
1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1104) Do you currently smoke cigarettes every day, some days, or not at all?
SOME DAYS 2 (GO TO 1106)
NOT AT ALL 3 (GO TO 1106)
1105) On average, how many cigarettes do you currently smoke each day?
1106) Do you currently smoke or use any other type of tobacco every day, some days, or not at all?
SOME DAYS 2 (GO TO 1108)
NOT AT ALL 3 (GO TO 1108)
1107) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
PIPES FULL OF TOBACCO B
CIGARS, CHEROOTS, OR CIGARILLOS C
WATER PIPE D
SNUFF BY MOUTH E
SNUFF BY NOSE F
CHEWING TOBACCO G
OTHER (SPECIFY) ____ X
1108) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
1108A) Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery.
Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?
NO 2
1108B) How old were you when this problem started?
1108C) Have you ever heard of this problem?
NO 2
SECTION 12. FEMALE GENITAL CUTTING
1201) Have you ever heard of female circumcision?
NO 2
1202) 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?
NO 2 (GO TO 1301)
1203) Have you yourself ever been circumcised?
NO 2 (GO TO 1209)
1204) Now I would like to ask you what was done to you at that time.
Was any flesh removed from the genital area?
NO 2
DON'T KNOW 8
1205) Was the genital area just nicked without removing any flesh?
NO 2
DON'T KNOW 8
1206) Was your genital area sewn closed?
NO 2
DON'T KNOW 8
1207) How old were you when you were circumcised?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.
AS A BABY/DURING INFANCY 95
DON'T KNOW 98
1208) Who performed the circumcision?
NON-MEDICAL MIDWIFE/TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) ______ 16
HAS NO LIVING DAUGHTERS BORN IN 2001 OR LATER (GO TO 1216)
CHECK 213, 215, AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER IN 2001 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).
1210) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2001 OR LATER.
NAME _____
1211) Is (NAME OF DAUGHTER) circumcised?
NO 2 (GO TO 1211 IN THE NEXT COLUMN, OR, IF NO MORE DAUGHTERS, GO TO 1216)
1212) How old was (NAME OF DAUGHTER) when she was circumcised?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.
DON'T KNOW 98
1213) Was her genital area sewn closed?
PROBE: Was the genital area closed?
NO 2
DON'T KNOW 8
1214) Who performed the circumcision?
NON-MEDICAL MIDWIFE/TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY) ______ 16
DON'T KNOW 98
1215) GO TO 1211 IN THE NEXT COLUMN, OR, IF NO MORE DAUGHTERS, GO TO 1216
1216) Do you believe that female circumcision is required by your religion?
NO 2
DON'T KNOW 8
1217) Do you think that female circumcision should be continued, or should it be stopped?
STOPPED 2
DEPENDS 3
DON'T KNOW 8
SECTION 13. MATERNAL MORTALITY
1301) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who live with you, those who live elsewhere, and those who are dead. We have learned in previous surveys that it can be hard to create a complete list of all children born to your natural mother. We will work together to create a complete list and to help you remember all your brothers and sisters. Can you now give me the names of all your brothers and sisters born to your natural mother?
ORDER NUMBER _____
NOT A SINGLE BROTHER OR SISTER LISTED (GO TO 1304)
1303) READ THEIR NAMES TO THE RESPONDENT, AND AFTER THE LAST ONE, ASK: Are there any other brothers or sisters from the same mother that you didn't list?
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1301)
1304) Sometimes people forget to list children of their natural mother because they do not live with them or because they don't see each other very often. Are there brothers or sisters that do not live with you that you didn't list?
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1301)
1305) Sometimes people forget to list children of their biological mother because they are dead. Do you have any brothers and sisters who are dead who you did not list?
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1301)
1306) Sometimes people have brothers or sisters from the same mother but from a different father. Are there any brothers or sisters born of your natural mother but who have a different natural father who you did not list?
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1301)
1307) COUNT THE NUMBER OF BROTHERS OR SISTERS RECORDED IN 1301.
1308) CHECK 1307:
Just to make sure that I've understood, not including yourself, your mother gave birth to _____ children total. Is that correct?
NO (PROBE AND CORRECT 1301 AND/OR 1307)
NOT A SINGLE BROTHER OR SISTER LISTED (GO TO 1401)
1310) Please tell me which brother or sister was born first? At who was the next?
RECORD '01' FOR THE ORDER NUMBER IN 1301 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED ORDER NUMBERS FOR ALL BROTHERS AND SISTERS.
1311) How many births did your mother have before your own birth?
1312) RECORD THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER FROM 1301. ASK 1313 THROUGH 13224 FOR ONE BROTHER OR SISTER BEFORE MOVING TO THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE A SUPPLEMENTARY QUESTIONNAIRE.
1313) NAME OF BROTHER OR SISTER
1314) Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 1317)
DON'T KNOW 8 (GO TO NEXT SIBLING)
1317) How many years ago did (NAME) die?
1318) How old was (NAME) when he/she died?
IF DON'T KNOW, PROBE AND ASK OTHER QUESTIONS TO GET AN ESTIMATE. IF MAN, OR WOMAN DECEASED BEFORE AGE 12, GO TO 1323.
1319) Was (NAME) pregnant when she died?
NO 2
1320) Did (NAME) die during childbirth?
NO 2
1321) Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2 (GO TO 1323)
1322) How many days after the end of (NAME)'s pregnancy did she die?
1323) Was (NAME)'s death the result of a violent act?
NO 2
1324) Was (NAME)'s death the result of an accident?
NO 2 (GO TO NEXT SIBLING)
IF NO OTHER BROTHERS OR SISTERS, GO TO NEXT SECTION.
SECTION 14. DEVELOPMENT OF YOUNG CHILD
1401) CHECK 217 AND 218: All children age 0-4 living with his or her mother?
NO (GO TO 1500)
1402) CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGE 0-4 LIVING WITH HIS OR HER MOTHER AND RECORD HIS OR HER NAME AND LINE NUMBER.
LINE NUMBER OF YOUNGEST CHILD FROM Q219 ____
1403) READ TO THE RESPONDENT:
Now, I would like to ask you some questions about (NAME OF CHILD IN 1402), your youngest child from 0-4 living with you.
1404) How many children's books and picture books do you have for (NAME)?
NUMBER OF CHILDREN'S BOOKS ___
TEN OR MORE BOOKS 10
1405) I would like to ask you what objects (NAME) uses to play with while at home.
Does he/she play with:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
IF THE RESPONDENT SAYS 'YES' TO ONE OF THE ABOVE CATEGORIES, PROBE TO DETERMINE PRECISELY WHAT THE CHILD PLAYS WITH TO BE CERTAIN OF THE RESPONSE.
1406) Sometimes the adults who take care of the children have to leave the house to go shopping, do the laundry, or for other reasons and have to leave the young children.
During the last week, how many days was (NAME):
IF NEVER, RECORD '0'. IF DON'T KNOW, RECORD '8'.
0, 1, OR 2 YEARS OLD (GO TO 1500)
1408) Check 217 AND 218: ALL CHILDREN AGE 3-4 LIVING WITH HIS OR HER MOTHER?
NO (GO TO 1500)
1408A) CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGE 0-4 LIVING WITH HIS OR HER MOTHER AND RECORD HIS OR HER NAME AND LINE NUMBER.
LINE NUMBER OF YOUNGEST CHILD FROM Q219 ____
1409) Is (NAME) in a preschool education program or an early learning class, in a public or private establishment, including nursery school or a community child-care center?
NO 2
DON'T KNOW 8
1410) During the last three days did you or a member of your family age 15 or old participate with (NAME) in one of the following activities:
IF YES, ASK: Who participated in this activity with (NAME)?
CIRCLE ALL MENTIONED.
FATHER B
OTHER PERSON X
NO ONE Y
FATHER B
OTHER PERSON X
NO ONE Y
FATHER B
OTHER PERSON X
NO ONE Y
FATHER B
OTHER PERSON X
NO ONE Y
FATHER B
OTHER PERSON X
NO ONE Y
FATHER B
OTHER PERSON X
NO ONE Y
1411) Now I would like to ask you some questions about the health and development of your child. Children do not all develop in the same manner and at the same speed. Some, for example, walk earlier than others. These questions relate to several aspects of your child's development.
Does (NAME) know or can he/she recite at least ten letters from the alphabet?
NO 2
DON'T KNOW 8
1412) Can (NAME) read at least four simple, common words?
NO 2
DON'T KNOW 8
1413) Can (NAME) list and recognize all digits from 1 to 10?
NO 2
DON'T KNOW 8
1414) Can (NAME) grasp with two fingers a small object from the ground, like a stick or a pebble?
NO 2
DON'T KNOW 8
1415) Is (NAME) ever too sick to play?
NO 2
DON'T KNOW 8
1416) Is (NAME) able to follow simple instructions to do something correctly?
NO 2
DON'T KNOW 8
1417) When you give (NAME) something to do, is he/she able to do it independently?
NO 2
DON'T KNOW 8
1418) Does (NAME) get along well with other children?
NO 2
DON'T KNOW 8
1419) Does (NAME) kick, bit, or hit other children or adults?
NO 2
DON'T KNOW 8
1420) Is (NAME) easily distracted?
NO 2
DON'T KNOW 8
1500) CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE?
WOMAN NOT SELECTED (GO TO 1534)
1501) CHECK THE COVER PAGE: WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE?
WOMAN NOT SELECTED (GO TO 1534)
1502) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (GO TO 1533)
1503) READ TO THE RESPONDENT:
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Senegal. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you a question you do not want to answer, let me know and I will skip to the next question.
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH HUSBAND/PARTNER)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1517)
1505) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/partner).
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1506) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.
a) (Does/did) your (last) (husband/partner) ever:
b) How often did this happen during the last 12 months: often, only sometimes, or not at all?
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
1506) A) Did your (last) (husband/partner) ever do any of the following things to you:
b) How often did this happen during the last 12 months: often, only sometimes, or not at all?
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NO 2
SOMETIMES 2
NOT AT ALL 3
NOT A SINGLE 'YES' (GO TO 1510)
1508) How long after you (first got married to/started living with) your (last) (husband/partner) did this or any of these things first happen?
IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
1509) Did the following ever happen as a result of what your (last) (husband/partner) did to you:
NO 2
NO 2
NO 2
1510) Have you ever hit, slapped, kicked or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?
NO 2 (GO TO 1512)
1511) In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1512) Does (did) your (husband/partner) drink alcohol?
NO 2 (GO TO 1514)
1513) How often does (did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NOT AT ALL 3
1514) Are (were) you afraid of your (last) (husband/partner): many times, sometimes, or never?
SOMETIMES AFRAID 2
NEVER AFRAID 3
MARRIED ONLY ONCE (GO TO 1517)
1516) a) So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).
b) How long ago did this last happen?
NO 2
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 8
NO 2
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 8
EVER MARRIED/EVER LIVED WITH A MAN:
From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER MARRIED/NEVER LIVED WITH A MAN:
From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
NO 2 (GO TO 1520)
REFUSED TO ANSWER/NO ANSWER 6 (GO TO 1520)
1518) Who has physically hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.
FATHER/MOTHER'S HUSBAND B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
EX-BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAWS K
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) ____ X
1519) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1520) CHECK 201, 226, AND 230:
NEVER BEEN PREGNANT (GO TO 1523)
1521) Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?
NO 2 (GO TO 1523)
1522) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
EX-BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAWS L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLIDER O
OTHER (SPECIFY) ____ X
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1523B)
1523A) Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner).
At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NO 2 (GO TO 1525A)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1525A)
1523B) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NO 2 (GO TO 1326)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1527)
1524) Who was the person who was forcing you the first time?
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) _____ 96
EVER MARRIED/EVER LIVED WITH A MAN: In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?
NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months, has anyone physically forced you to have sexual intercourse when you did not want to?
NO 2 (GO TO 1526)
1525A) CHECK 1505A (h-j) AND 1516A (b):
NOT A SINGLE 'YES' (GO TO 1527)
EVER MARRIED/EVER LIVED WITH A MAN: How old were you the first time someone including (your/any) (husband/partner) forced you to have sexual intercourse or perform any other sexual?
NEVER MARRIED/NEVER LIVED WITH A MAN: How old were you the first time someone forced you to have sexual intercourse or perform any other sexual acts?
DON'T KNOW 98
1527) CHECK 1505 (a-j), 1516 (a,b), 1517, 1521, 1523A, AND 1523B:
NOT SINGLE 'YES' (GO TO 1531)
1528) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?
NO 2 (GO TO 1530)
1529) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.
HUSBAND'S/PARTNER'S FAMILY B (GO TO 1531)
CURRENT/FORMER HUSBAND/PARTNER C (GO TO 1531)
CURRENT/FORMER BOYFRIEND D (GO TO 1531)
FRIEND E (GO TO 1531)
NEIGHBOR F (GO TO 1531)
RELIGIOUS LEADER G (GO TO 1531)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1531)
POLICE I (GO TO 1531)
LAWYER J (GO TO 1531)
SOCIAL SERVICE ORGANIZATION K (GO TO 1531)
OTHER (SPECIFY) ______ X (GO TO 1531)
1530) Have you ever told anyone about this?
NO 2
1531) As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.
1532) Did you have to interrupt the interview because some adult was trying to listen, or came into the room, or interfered in any other way?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
1533) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.
MINUTE _____
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETED 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 ______
INSTRUCTIONS:
Only one code should appear in any box
Column 1 requires a code in every month.
Information to be coded for each column.
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 Emergency contraception
J Standard Days Method
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
Column 1 Column 2
2017 (1)
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
2016
12 Dec 13
11 Nov 14
10 Oct 15
09 Sept 16
08 Aug 17
07 Jul 18
06 Jun 19
05 May 20
04 Apr 21
03 Mar 22
02 Feb 23
01 Jan 24
2015
12 Dec 25
11 Nov 26
10 Oct 27
09 Sept 28
08 Aug 29
07 Jul 30
06 Jun 31
05 May 32
04 Apr 33
03 Mar 34
02 Feb 35
01 Jan 36
2014
12 Dec 37
11 Nov 38
10 Oct 39
09 Sept 40
08 Aug 41
07 Jul 42
06 Jun 43
05 May 44
04 Apr 45
03 Mar 46
02 Feb 47
01 Jan 48
2013
12 Dec 49
11 Nov 50
10 Oct 51
09 Sept 52
08 Aug 53
07 Jul 54
06 Jun 55
05 May 56
04 Apr 57
03 Mar 58
02 Feb 59
01 Jan 60
2012
12 Dec 61
11 Nov 62
10 Oct 63
09 Sept 64
08 Aug 65
07 Jul 66
06 Jun 67
05 May 68
04 Apr 69
03 Mar 70
02 Feb 71
01 Jan 72
(1) There is an assumption that the collection year is 2017. For a collection beginning in 2018, all references to calendar years should be increased by one year; for example, 2011 must be changed in 2012, 2012 must be changed in 2013, 2013 must be changed in 2014, and so on for all years throughout the questionnaire.
(2) Codes can be added for other methods, such as those based on knowledge of fertility.