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CONTINUOUS DEMOGRAPHIC AND HEALTH SURVEY (EDS - CONTINUOUS 2017)
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 ____

DEPARTMENT ____

SANITATION DISTRICT ____

URBAN/RURAL

URBAN 1
RURAL 2

MILIEU ____

DAKAR/REGIONAL CAPITAL/OTHER CITY/RURAL

DAKAR 1
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)?

YES 1
NO 2

IF HOUSEHOLD SELECTED FOR DV, CHECK WOMEN'S SELECTION TABLE (Q157A OF HOUSEHOLD QUESTIONNAIRE)

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE (DV)?

YES 1
NO 2

INTERVIEWER VISITS:

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE: _______
INTERVIEWER'S NAME _________
RESULT*

*RESULT CODES

1 COMPLETED
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 _____

TOTAL NUMBER OF VISITS ______

LANGUAGE OF QUESTIONNAIRE: 01

LANGUAGE OF INTERVIEW

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

NATIVE LANGUAGE OF RESPONDENT

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

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR
NAME ____
NUMBER____
DATE ____

INTRODUCTION AND 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)

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOUR ____
MINUTES ____

105) In what month and year were you born?

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

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

AGE IN COMPLETED YEARS ____

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PRIMARY 1
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'.

GRADE/FORM/YEAR _____

110) CHECK 108:

PRIMARY OR SECONDARY (GO TO 111)
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?

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

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)?

YES 1
NO 2 (GO TO 112)

111B) In what languages were these literacy programs?
PROBE: Any other?
RECORD ALL MENTIONED.

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

112) CHECK 111:

CODE 2, 3, OR 4 CIRCLED (GO TO 113)
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?

AT LEAST ONCE A WEEK 1
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?

AT LEAST ONCE A WEEK 1
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?

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

116) Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

117) Do you use your mobile phone for any financial transactions?

YES 1
NO 2

118) Do you have an account in a bank or other financial institution that you yourself use?

YES 1
NO 2

119) Have you ever used the internet?

YES 1
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.

YES 1
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?

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

122) What is your religion?

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

122A) Are you Senegalese?

YES 1
NO 2 (GO TO 201)

123) What is your ethnicity?

WOLOF 01
POULAR 02
SERER 03
MANDINGUE/SOCE 04
DIOLA 05
SONINKE 06
OTHER (SPECIFY) _____ 96

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 made a movement, who emitted a sound or tried to breath, or who showed other signs of life for a very short time?

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. 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.

BIRTH HISTORY NUMBER ______

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

BOY 1
GIRL 2

214) Were any of these births twins?

SING 1
MULT 2

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

DAY ____
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).

HOUSEHOLD LINE NUMBER _____ (GO TO 221)

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.

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)? .

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK.

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

224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2012-2017.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

225) C:

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.)

226) Are you pregnant now?

YES 1
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.

MONTHS ____

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

YES 1 (GO TO 230)
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?

LATER 1
NO MORE/NONE 2

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

YES 1
NO 2 (GO TO 239)

231) When did the last such pregnancy end?

MONTH ___
YEAR ____

232) CHECK 231:

LAST PREGNANCY ENDED IN 2012-2017 OR LATER (GO TO 234)
LAST PREGNANCY ENDED IN 2011 OR EARLIER (GO TO 239)

233) In what month and year did the preceding such pregnancy end?

MONTH ____
YEAR ____

234) How many months pregnant were you when that pregnancy ended?

NUMBER OF MONTHS ____

235) Since January 2012, have you had any other pregnancies that did not result in a live birth?

YES 1 (NEXT LINE)
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?

YES 1
NO 2 (GO TO 239)

238) When did the last such pregnancy that terminated before 2012 end?

MONTH ____
YEAR ____

239) When did your 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

239A) CHECK 239:

LESS THAN ONE YEAR/LESS THAN 12 MONTHS (GO TO 239B)
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?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

239D) Have you used products such as menstrual pads, tampons or pieces of fabric?

YES 1
NO 2 (GO TO 240)
DON'T KNOW 8 (GO TO 240)

239E) Were these products reusable?

YES 1
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?

YES 1
NO 2 (GO TO 242)
NOT SURE 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?

JUST BEFORE HER PERIOD BEGINS 1
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?

YES 1
NO 2
DON'T KNOW 8

SECTION 3. CONTRACEPTION

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)?

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 or a nurse which can prevent pregnancy for one or more months.
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) 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
10) Standard Days Method
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.
YES 1
NO 2
11) Lactational amenorrhea method (LAM)
PROBE: 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.
YES 1
NO 2
12) 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
13) Withdrawal
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MODERN METHOD (SPECIFY) ______ A
YES, TRADITIONAL METHOD (SPECIFY) _____ B
NO Y

302) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 312)

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

YES 1 (GO TO 304)
NO 2

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

INFREQUENT SEX/HUSBAND ABSENT 01 (GO TO 311)
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.

FEMALE STERILIZATION A (GO TO 307)
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.

PLANYL 01
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.

PROTEC 01 (GO TO 309)
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.

(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
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

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

MONTH ____ (GO TO 310)
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?

MONTH ____
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.

NO (GO TO 311)
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.

MONTH ____
YEAR ____

312B Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

YES 1
NO 2 (GO TO 312I)

312C) Which method was that?

METHOD CODE _____

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.

IMMEDIATELY 00 (GO TO 312F)
MONTHS _____ (GO TO 312F)
DATE GIVEN 95

312E) RECORD THE MONTH AND YEAR RESPONDENT STARTED USING METHOD.

MONTH ____
YEAR ____

312F) For how many months did you use (METHOD)?
RECORD '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

MONTHS _____ (GO TO 312H)
DATE GIVEN 95

312G) RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

MONTH ____
YEAR ____

312H) Why did you stop using (METHOD)?

REASON STOPPED _____

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.

NO METHOD USED (GO TO 314)
ANY METHOD USED (GO TO 315)

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

YES 1 (GO TO 326)
NO 2 (GO TO 326)

315) 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 326)
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.

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
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 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

317) 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 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?

YES 1 (GO TO 321)
NO 2 (GO TO 320)

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

YES 1 (GO TO 321)
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?

YES 1
NO 2 (GO TO 322)

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

YES 1
NO 2

322) CHECK 318 AND 319:

ANY 'YES': At that time, were you told about other methods of family planning that you could use?

OTHER: 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?

YES 1 (GO TO 324)
NO 2

323) 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

324) 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 327)
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.

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 327)
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)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22 (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)
OTHER SOURCE
SHOP 31 (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?

YES 1
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.

(NAME OF PLACE(S)) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
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
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

327) In the last 12 months, were you visited by a fieldworker?

YES 1
NO 2

328) Did the fieldworker talk to you about family planning?

YES 1
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?

YES 1
NO 2 (GO TO 401)

330) 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 2012-2017 (GO TO 402)
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.

BIRTH HISTORY NUMBER ______

404) From 212 and 216

NAME _____
LIVING ___
DEAD __

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

YES 1 (GO TO 408)
NO 2

406) CHECK 208:

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?

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 414)

409) Whom did you see?
Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
OTHER PERSON
MATRON D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) ____ X
NOBODY Y

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.

(NAME OF PLACE(S)) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
HEALTH HUT D
MOBILE CLINIC E
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 taken?
Did you give a urine sample?
Did you give a blood sample?

BP
YES 1
NO 2
Urine
YES 1
NO 2
Blood
YES 1
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?

YES 1
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?

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)

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

NUMBER OF TIMES ___
DON'T KNOW 8

416) CHECK 416: TETANUS INJECTIONS

2 OR MORE TIMES (GO TO 420)
DON'T KNOW (GO TO 417)

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

YES 1
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'.

TIMES _____
DON'T KNOW 8

419) CHECK 418:

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?

YEARS AGO ____

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

YES 1
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.

(NAME OF PLACE(S)) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
HEALTH HUT D
MOBILE CLINIC E
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

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

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).

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 422)

421B) Where did you get this information?

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

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

YES 1
NO 2
DON'T KNOW 8

423) During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
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?

YES 1
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.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

425A) During this pregnancy, did you receive a free mosquito net?

YES 1
NO 2 (GO TO 426)

425B) How many months pregnant were you when you received the free mosquito net?

MONTHS _____
DON'T KNOW 98

426) 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

427) Was (NAME) weighed at birth?

YES 1
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 CARD ____ 1
GRAMS FROM RECALL _____2
DON'T KNOW 99998

428A) Was (NAME)'s birth ever declared?
IF YES: may I see it?

YES, SEEN 1 (GO TO 429)
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)?

YES 1 (GO TO 429)
NO 2
DON'T KNOW 8

428C) Do you know how to register (NAME)'s birth?

YES 1
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.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
OTHER PERSON
MATRON D
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.

(NAME OF PLACE(S)) _____
HOME
HER HOME 11 (GO TO 434)
OTHER HOME 12 (GO TO 434)
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/MATERNITY B
GOVERNMENT HEALTH POST C
HEALTH HUT D
MOBILE CLINIC E
HEALTH CARE WORKER F
OTHER PUBLIC SECTOR (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
HEALTH CARE WORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ M
OTHER PLACE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
COMMUNITY AGENT Q
OTHER (SPECIFY) ____ X (GO TO 434)

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.

HOURS ____ 1
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?

YES 1
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?

BEFORE 1
AFTER 2

434) Immediately after the birth, was (NAME) put directly on the bare skin of your chest?

YES 1
NO 2
DON'T KNOW 8

434A) Was (NAME)'s skin in contact with your skin?

YES 1
NO 2
DON'T KNOW 8

434B) CHECK 430: DELIVERY LOCATION

CODE 11, 12, OR 96 CIRCLED (GO TO 449)
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?

YES 1
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.

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

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

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
OTHER PERSON
MATRON D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) _____ X
NOBODY Y

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?

YES 1
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.

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

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

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE CERTIFIED IN NEWBORN CARE C
OTHER PERSON
MATRON D
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) _____ X
NOBODY Y

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?

YES 1
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.

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

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

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

NOBODY Y

444) Where did the exam 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(S)) _____
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER/MATERNITY 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36
OTHER (SPECIFY) ____ 96

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)?

YES 1
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.

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

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

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

NOBODY Y

448) Where did this check of (NAME) 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(S)) _____
HOME
HER HOME 11 (GO TO 457)
OTHER HOME 12 (GO TO 457)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21 (GO TO 457)
GOVERNMENT HEALTH CENTER/MATERNITY 22 (GO TO 457)
GOVERNMENT HEALTH POST 23 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) _____ 26 (GO TO 457)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (GO TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36 (GO TO 457)
OTHER (SPECIFY) ____ 96 (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)?

YES 1
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.

HOURS AFTER BIRTH____ 1
DAYS AFTER BIRTH_____ 2
WEEKS AFTER BIRTH____ 3
DON'T KNOW 998

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

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

NOBODY Y

452) Where did this first check 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(S)) _____
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER/MATERNITY 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36
OTHER (SPECIFY) ____ 96

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?

YES 1
NO 2 (GO TO 457)
DON'T KNOW 8 (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.

HOURS AFTER BIRTH____ 1
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.

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

NOBODY Y

456) Where did this first check of (NAME) 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(S)) _____
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER/MATERNITY 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 36
OTHER (SPECIFY) ____ 96

457) In the first two days after (NAME)'s birth, did any health care provider do the following:

a) Examine the cord?
YES 1
NO 2
DON'T KNOW 8
b) Measure (NAME)'s temperature?
YES 1
NO 2
DON'T KNOW 8
c) Counsel you on danger signs for newborns?
YES 1
NO 2
DON'T KNOW 8
d) Counsel you on breastfeeding?
YES 1
NO 2
DON'T KNOW 8
e) Observe (NAME) breastfeeding?
YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 460)
NO 2 (GO TO 461)

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

YES 1
NO 2 (GO TO 463)

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

MONTHS ____
DON'T KNOW 98

461) CHECK 226:
IS THE RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 462)
PREGNANT OR NOT SURE (GO TO 463)

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

YES 1
NO 2 (GO TO 464)

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

MONTHS ____
DON'T KNOW 98

464) Did you ever breastfeed (NAME)?

YES 1 (GO TO 466)
NO 2

465) CHECK 404: CHILD IS LIVING?

LIVING (GO TO 470)
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.

IMMEDIATELY 000
HOURS ____ 1
DAYS ____ 2

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

YES 1
NO 2

468) CHECK 404: CHILD IS LIVING?

LIVING (GO TO 469)
DEAD (GO TO 471)

469) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
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?

ONE OR MORE BIRTHS IN 2014-2107 (GO TO 502A)
NO BIRTHS IN 2014-2017 (GO TO 601)

502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2014-2017.

NAME OF LAST BIRTH _____
BIRTH HISTORY NUMBER _____

503A) CHECK 216 FOR CHILD:

LIVING (GO TO 504A)
DEAD (GO TO 501B)

504A) Do you have a card or other document where (NAME)'s vaccinations are written down?

YES, ONLY HAS CARD 1 (GO TO 507A)
YES, ONLY HAS OTHER DOCUMENT 2
YES, HAS BOTH 3 (GO TO 507A)
NO, NEITHER 4

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

YES 1
NO 2

506A) CHECK 504A:

CODE '2' CIRCLED (GO TO 507A)
CODE '4' CIRCLED (GO TO 511A)

507A) May I see the card or other document where (NAME)'s vaccinations are written down?

YES, ONLY CARD SEEN 1
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.

BCG
DAY ____
MONTH ____
YEAR ___
HEPATITIS B AT BIRTH
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 ___
INJECTABLE POLIO VACCINE
DAY ____
MONTH ____
YEAR ___
[MEASLES CONTAINING VACCINE] 1
DAY ____
MONTH ____
YEAR ___
YELLOW FEVER
DAY ____
MONTH ____
YEAR ___
[MEASLES CONTAINING VACCINE] 2
DAY ____
MONTH ____
YEAR ___
VITAMIN A (MOST RECENT)
DAY ____
MONTH ____
YEAR ___

509A) CHECK 508A:
BCG TO [MEASLES CONTAINING VACCINE 2 ALL RECORDED?

NO (GO TO 510A)
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 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A. RECORD ‘00’ IN THE CORRESPONDING DAY COLUMN, THEN GO TO 525A)
NO 2 (GO TO 525A)
DON'T KNOW 8 (RECORD '00' IN THE CORRESPONDING DAY COLUMN IN 508A, 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?

YES 1
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?

YES 1
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?

YES 1
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?

YES 1
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?

FIRST TWO WEEKS 1
LATER 2

516A) How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES ____

517A) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the though sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 519A)
DON'T KNOW 8 (GO TO 519A)

518A) How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES ___

519A) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

YES 1
NO 2 (GO TO 521A)
DON'T KNOW 8 (GO TO 521A)

520A) How many tines did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES ____

521A) Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (GO TO 523A)
DON'T KNOW 8 (GO TO 523A)

522A) How many times did (NAME) receive the rotavirus vaccine?

NUMBER OF TIMES _____

523A) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

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

524A) How many times did (NAME) receive the measles vaccine?

NUMBER OF TIMES ____

524A) Has (NAME) ever received a yellow fever vaccine?

YES 1
NO 2
DON'T KNOW 8

525A) In the last 7 days was (NAME) given:

A) A micronutrient powder mix?
YES 1
NO 2
DON'T KNOW 8
B) Plumpy Nuts?
YES 1
NO 2
DON'T KNOW 8
C) Plumpy Duz?
YES 1
NO 2
DON'T KNOW 8

526A) CONTINUE WITH 501B.

526B) CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2014-2017?

MORE BIRTHS IN 2014-2017 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2014-2017 (GO TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

ONE OR MORE BIRTHS IN 2012-2017 (GO TO 602)
NO BIRTHS IN 2012-2017 (GO TO 648)

602) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER FROM 603, AND THE NAME, AND SURVIVAL STATUS FROM 604 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.

BIRTH HISTORY NUMBER ___

604) FROM 212 AND 216:

NAME _____
LIVING (GO TO 605)
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.

YES 1
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.

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)

609) CHECK 469: 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?

MUCH LESS 1
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?

MUCH LESS 1
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?

YES 1
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).

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR'S OFFICE I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
MARKER O
PEDDLER P
OTHER (SPECIFY) ____ X

613) CHECK 612:

TWO OR MORE CODES CIRCLED (GO TO 614)
ONLY ONE CODE CIRCLED (GO TO 615)

614) Where did you first seek advice or treatment?
USE LETTER CODE FROM 612.

FIRST PLACE ___

615) Was (NAME) given any of the following to drink at any time since (NAME) 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
d) Zinc tablets or syrup?
YES 1
NO 2
DON'T KNOW 8

616) CHECK 615:

ANY 'YES': A) Was anything else given to treat the diarrhea?
ALL 'NO' OR 'DON'T KNOW': B) Was anything given to treat the diarrhea?

YES 1
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.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NO ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HOME REMEDY/HERBAL MEDICINE I
OTHER (SPECIFY) _____ X

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

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
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?

YES 1
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?

CHEST ONLY 1 (GO TO 624)
NOSE ONLY 2 (GO TO 624)
BOTH 3 (GO TO 624)
OTHER (SPECIFY) ____ 6 (GO TO 624)
DON'T KNOW 8 (GO TO 624)

623) CHECK 618: HAD FEVER?

YES (GO TO 624)
NO OR DON'T KNOW (GO TO 646)

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

YES 1
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).

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR'S OFFICE I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
MARKET O
PEDDLER P
OTHER (SPECIFY) ____ X

626) CHECK 625:

TWO OR MORE CODES CIRCLED (GO TO 627)
ONLY ONE CODE CIRCLED (GO TO 628)

627) Where did you first seek advice or treatment?
USE LETTER CODE FROM 625.

FIRST PLACE ____

628) How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

DAYS ___

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

YES 1
NO 2 (GO TO 646)
DON'T KNOW 8 (GO TO 646)

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

ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE PILLS E
QUININE INJECTION/IV F
ARTESUNATE RECTAL G
INJECTION/IV H
OTHER ANTIMALARIAL (SPECIFY) _____ I
ANTIBIOTIC
PILL/SYRUP I
INJECTION/IV K
OTHER DRUGS
ASPIRIN L
ACETAMINOPHEN M
IBUPROFEN N
OTHER (SPECIFY) _____ X
DON'T KNOW Z

631) CHECK 630:
ANY CODE A-I CIRCLED?

YES (GO TO 632)
NO (GO TO 646)

632) CHECK 630:
Artemisinin Combination Therapy (A) given

CODE 'A' CIRCLED (GO TO 633)
CODE 'A' NOT CIRCLED (GO TO 634)

633) How long after the fever started did (NAME) first take an artemisinin combination therapy?

SAME DAY 0
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' CIRCLED (GO TO 635)
CODE 'B' NOT CIRCLED (GO TO 636)

635) How long after the fever started did (NAME) first take SP/Fansidar?

SAME DAY 0
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' CIRCLED (GO TO 637)
CODE 'C' NOT CIRCLED (GO TO 638)

637) How long after the fever started did (NAME) first take Chloroquine?

SAME DAY 0
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' CIRCLED (GO TO 639)
CODE 'D' NOT CIRCLED (GO TO 640)

639) 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

640) CHECK 630:
Quinine (E or F) given

CODE 'E' OR 'F' CIRCLED (GO TO 641)
CODE 'E' OR 'F' NOT CIRCLED (GO TO 642)

641) 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

642) CHECK 630:
Artesunate (G or H) given

CODE 'G' OR 'H' CIRCLED (GO TO 643)
CODE 'G' OR 'H' NOT CIRCLED (GO TO 644)

643) How long after the fever started did (NAME) first take Artesunate?

SAME DAY 0
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' CIRCLED (GO TO 645)
CODE 'I' NOT CIRCLED (GO TO 646)

645) 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

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:

NO CHILD RECEIVED FLUID FROM ORS PACKED OR PRE-PACKAGED ORS LIQUID (GO TO 648)
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?

YES 1
NO 2

649) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2015-2017 LIVING WITH RESPONDENT

ONE OR MORE (NAME OF YOUNGEST CHILD LIVING WITH HER) ___________
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.

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?
YES 1
NO 2
DON'T KNOW 8
IF YES, how many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES DRANK MILK ____
e) Infant formula?
YES 1
NO 2
DON'T KNOW 8
IF YES, how many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES DRANK FORMULA ____
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
YES 1
NO 2
DON'T KNOW 8
IF YES, how many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
NUMBER OF TIMES ATE YOGURT ____
h) Any commercially fortified baby food, e.g. Cerelac, Farigalia, Babylac, Nutrilac, Bledine, etc?
YES 1
NO 2
DON'T KNOW 8
i) bread, rice, noodles, porridge (tiakry, lax, fonde, forzA), 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 (like spinach, bissap leaves, sweet potato leaves, manioc leaves, nebeday leaves)?
YES 1
NO 2
DON'T KNOW 8
m) ripe mangoes, papayas, jujube, soumpou?
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 (shrimp, dry oysters, pagan, toufa, yeett)?
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

651) CHECK 650 (CATEGORIES 'G' THROUGH 'U'):

NOT A SINGLE 'YES' (GO TO 652)
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?

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY, THEN CONTINUE TO 653)
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'.

NUMBER OF TIMES _____
DON'T KNOW 8

654) The last time (NAME FROM 649) 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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 704)
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, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 712)

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

WIDOWED 1 (GO TO 709)
DIVORCED 2 (GO TO 709)
SEPARATED 3 (GO TO 709)

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

LIVES WITH HER 1
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'.

NAME ______
LINE NUMBER ______

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

YES 1
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?

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

708) Are you the first, second…wife?

RANK _____

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

ONCE 1
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?

MONTH _____
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?

AGE_____

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?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 731)
AGE IN YEARS _____

713A) How old was your partner?

AGE IN YEARS ____
DON'T KNOW 98

713B) Did you use a condom (male or female)?

YES 1
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.

DAYS AGO ____ 1 (GO TO 716)
WEEKS AGO ____ 2 (GO TO 716)
MONTHS AGO _____ 3 (GO TO 716)
YEARS AGO ____ 4 (GO TO 727)

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

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

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

YES 1
NO 2 (GO TO 718)

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

YES 1
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'.

HUSBAND 1
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?

DAYS AGO ____ 1
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 IS 95 OR MORE, RECORD '95'.

NUMBER OF TIMES _____

721) How old is this person?

AGE OF PARTNER ____
DON'T KNOW 98

722) Apart from this person, have you had sexual intercourse with any other persons in the last 12 months?

YES 1 (GO BACK TO 715 IN NEXT COLUMN)
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'.

NUMBER OF PARTNERS IN LAST 12 MONTHS ______
DON'T KNOW 98

724) CHECK 106:

AGE 15-24 (GO TO 725)
AGE 25-49 (GO TO 727)

725) CHECK 701:

NOT IN A UNION (GO TO 726)
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?

YES 1
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'.

NUMBER OF PARTNERS IN LIFETIME _____
DON'T KNOW 98

728) CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):

YES, CONDOM USED (GO TO 729)
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.

PROTEC 01
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

730) 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.

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
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 MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE 21
PRIVATE 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

730A) In the last 12 months, were you given a condom (EX: during an information campaign, or at a health care establishment)?

YES 1
NO 2

731) PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN UNDER 10
YES 1
NO 2
ADULT MALES
YES 1
NO 2
ADULT FEMALES
YES 1
NO 2

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

NEITHER STERILIZED (GO TO 802)
HE OR SHE STERILIZED (GO TO 813)

802) CHECK 226:

PREGNANT (GO TO 803)
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?

HAVE ANOTHER CHILD 1 (GO TO 805)
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?

HAVE (A/ANOTHER CHILD) 1
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?

MONTHS ____ 1
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)

806) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 807)
PREGNANT (GO TO 812)

807) CHECK 303:
Using a contraceptive method?

NOT CURRENTLY USING (GO TO 808)
CURRENTLY USING (GO TO 813)

808) CHECK 805:

24 OR MORE MONTHS OR 2 OR MORE YEARS (GO TO 809)
NOT ASKED (GO TO 808)
00-23 MONTHS OR 00-01 YEAR (GO TO 812)

809) CHECK 714:

DAYS, WEEKS, OR MONTHS AGO (GO TO 810)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)

810) CHECK 804:

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.

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

811) CHECK 303: Using a contraceptive method?

NOT ASKED (GO TO 812)
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?

YES 1
NO 2
DON'T KNOW 8

813) CHECK 216:

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.

NONE 00 (GO TO 815)
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 BOYS _____
NUMBER OF GIRLS _____
NUMBER OF EITHER _____
OTHER (SPECIFY) ______ 96

815) In the last few months have you:

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2
d) Received a voice to text message about family planning on a mobile phone?
YES 1
NO 2

816) In the last few months, have you heard about family planning during the Moytou Neff campaign?

YES 1
NO 2
DON'T KNOW 8

817) CHECK 701:

YES, CURRENTLY MARRIED (GO TO 818)
YES, CURRENTLY LIVING WITH A MAN (GO TO 818)
NO, NOT IN UNION (GO TO 901)

818) CHECK 303: Using a contraceptive method?

CURRENTLY USING (GO TO 819)
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 RESPONDENT 1 (GO TO 821)
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 RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _____ 6

821) CHECK 304:

NEITHER STERILIZED (GO TO 821)
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?

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

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 902)
NOT IN UNION (GO TO 909)

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

AGE IN COMPLETED YEARS _____

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

YES 1
NO 2 (GO TO 906)

904) What is the highest level of school you attended: Primary, Middle, Secondary, or higher?

PRIMARY 1
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'.

GRADE/FORM/YEAR _____
DON'T KNOW 98

906) Has your (husband/partner) done any work in the last 7 days?

YES 1 (GO TO 908)
NO 2
DON'T KNOW 8

907) Has your (husband/partner) done any work in the last 12 months?

YES 1
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?

OCCUPATION _____

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

YES 1 (GO TO 913)
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?

YES 1 (GO TO 913)
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?

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2 (GO TO 917)

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

OCCUPATION _____

914) 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

915) 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

916) 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

917) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 918)
NOT IN UNION (GO TO 925)

918) CHECK 916:

CODE '1' OR '2' CIRCLED (GO TO 919)
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?

RESPONDENT 1
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?

MORE THAN HIM 1
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) earns 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

922) 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

923) 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

924) 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

925) 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 (GO TO 928)

926) Do you have a title deed for any house you own?

YES 1
NO 2 (GO TO 928)
DON'T KNOW 8 (GO TO 928)

927) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

ALONE ONLY 1
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?

YES 1
NO 2 (GO TO 931)
DON'T KNOW 8 (GO TO 931)

930) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN UNDER 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

932) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 10. HIV/AIDS

1001) Now I would like to talk about something else.
Have you ever heard of an illness called HIV or AIDS?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

1003) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

1004) Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

1005) Can people get HIV by sharing food with a person who has HIV?

YES 1
NO 2
DON'T KNOW 8

1006) Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

1007) Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

1008) Can HIV 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

1009) CHECK 1008:

AT LEAST ONE 'YES' (GO TO 1010)
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?

YES 1
NO 2
DON'T KNOW 8

1011) CHECK 208 AND 215:

LAST BIRTH IN 2015-2017 (GO TO 1012)
NO BIRTHS (GO TO 1027)
LAST BIRTH IN 2014 OR LATER (GO TO 1027)

1012) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 1013)
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:

Babies getting HIV from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting HIV?
YES 1
NO 2
DON'T KNOW 8
Getting tested for the HIV?
YES 1
NO 2
DON'T KNOW 8

1015) Were you offered a test for HIV as part of your antenatal care?

YES 1
NO 2

1016) I don't want to know the results, but were you tested for HIV as part of your antenatal care?

YES 1
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.

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
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
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

1018) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2 (GO TO 1020)

1019) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1
NO 2
DON'T KNOW 8

1020) CHECK 430 FOR BIRTH:

ANY CODE 21-36 CIRCLED (GO TO 1021)
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?

YES 1
NO 2

1022) I don't want to know the results, but were you tested for HIV at that time?

YES 1
NO 2 (GO TO 1024)

1023) I don't want to know the results, but did you get the results of the test?

YES 1 (GO TO 1025)
NO 2 (GO TO 1025)

1024) CHECK 1016:

YES (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?

YES 1 (GO TO 1028)
NO 2

1026) How many months ago was your most recent HIV test?

MONTHS AGO _____ (GO TO 1033)
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?

YES 1
NO 2 (GO TO 1031)

1028) How many months ago was your most recent HIV test?

MONTHS AGO _____
TWO OR MORE YEARS AGO 95

1029) I don't want to know the results, but did you get the results of the test?

YES 1
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.

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 1033)
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)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21 (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)
OTHER SOURCE
SHOP 31 (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?

YES 1
NO 2 (GO TO 1033)

1032) 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.

(NAME OF PLACE) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
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
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE K
PHARMACY L
PRIVATE DOCTOR M
PRIVATE LABORATORY N
RELIGIOUS FREE CLINIC O
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ P
OTHER SOURCE
SHOP Q
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?

YES 1
NO 2 (GO TO 1035)

1034) Have you ever tested yourself for HIV using a self-test kits?

YES 1
NO 2

1035) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

YES 1
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?

YES 1
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?

YES 1
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?

YES 1
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?

YES 1
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.

AGREE 1
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?

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

1042) CHECK 1001:

HEARD ABOUT HIV OR AIDS: a) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

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

YES 1
NO 2

1043) CHECK 713:

HAS HAD SEXUAL INTERCOURSE (GO TO 1044)
NEVER HAD SEXUAL INTERCOURSE (GO TO 1051)

1044) CHECK 1042: Heard about other sexually transmitted infections?

YES (GO TO 1045)
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?

YES 1
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?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

1048) CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 1049)
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?

YES 1
NO 2 (GO TO 1051)

1050) 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
GOVERNMENT HOSPITAL A
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
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE K
PHARMACY L
PRIVATE DOCTOR M
PRIVATE LABORATORY N
RELIGIOUS FREE CLINIC O
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ P
OTHER SOURCE
SHOP Q
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?

YES 1
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?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

1053) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1054)
NOT IN UNION (GO TO 1101)

1054) 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

1055) Can you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
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.

NUMBER OF INJECTIONS _____
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.

NUMBER OF INJECTIONS _____
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?

YES 1
NO 2
DON'T KNOW 8

1104) Do you currently smoke cigarettes every day, some days, or not at all?

EVERY DAY 1 (GO TO 1106)
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?

NUMBER OF CIGARETTES ____

1106) Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

EVERY DAY 1 (GO TO 1108)
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.

KRETEKS A
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?

a) Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c) The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d) Not wanting to go alone?
BIG PROBLEM 1
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?

YES 1 (GO TO 1108C)
NO 2

1108B) How old were you when this problem started?

AGE IN COMPLETED YEARS _____ (GO TO 1201)

1108C) Have you ever heard of this problem?

YES 1
NO 2

SECTION 12. FEMALE GENITAL CUTTING

1201) Have you ever heard of female circumcision?

YES 1 (GO TO 1203)
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?

YES 1
NO 2 (GO TO 1301)

1203) Have you yourself ever been circumcised?

YES 1
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?

YES 1 (GO TO 1206)
NO 2
DON'T KNOW 8

1205) Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1206) Was your genital area sewn closed?

YES 1
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.

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

1208) Who performed the circumcision?

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

1209) CHECK 213, 215, 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 2001 OR LATER (GO TO 1210)
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.

BIRTH HISTORY NUMBER _____
NAME _____

1211) Is (NAME OF DAUGHTER) circumcised?

YES 1
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.

AGE IN COMPLETED YEARS ____
DON'T KNOW 98

1213) Was her genital area sewn closed?
PROBE: Was the genital area closed?

YES 1
NO 2
DON'T KNOW 8

1214) Who performed the circumcision?

TRADITIONAL CIRCUMCISER 11
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?

YES 1
NO 2
DON'T KNOW 8

1217) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
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?

NAME _____
ORDER NUMBER _____

1302) CHECK 1301:

AT LEAST ONE BROTHER OR SISTER LISTED (GO TO 1303)
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?

NO (GO TO 1304)
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?

NO (GO TO 1305)
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?

NO (GO TO 1306)
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?

NO (GO TO 1307)
YES (RECORD THE OTHER BROTHERS AND SISTERS IN 1301)

1307) COUNT THE NUMBER OF BROTHERS OR SISTERS RECORDED IN 1301.

TOTAL NUMBER OF BROTHERS AND SISTERS _____

1308) CHECK 1307:
Just to make sure that I've understood, not including yourself, your mother gave birth to _____ children total. Is that correct?

YES (GO TO 1309)
NO (PROBE AND CORRECT 1301 AND/OR 1307)

1309) Check 1307:

AT LEAST ONE BROTHER OR SISTER LISTED (GO TO 1310)
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?

NUMBER OF PREVIOUS BIRTHS _____

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

NAME _____

1314) Is (NAME) male or female?

MALE 1
FEMALE 2

1315) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1317)
DON'T KNOW 8 (GO TO NEXT SIBLING)

1316) How old is (NAME)?

AGE _______ (GO TO NEXT SIBLING)

1317) How many years ago did (NAME) die?

YEARS AGO ______

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.

AGE _____

1319) Was (NAME) pregnant when she died?

YES 1 (GO TO 1323)
NO 2

1320) Did (NAME) die during childbirth?

YES 1 (GO TO NEXT SIBLING)
NO 2

1321) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO 1323)

1322) How many days after the end of (NAME)'s pregnancy did she die?

DAYS ____

1323) Was (NAME)'s death the result of a violent act?

YES 1 (GO TO NEXT SIBLING)
NO 2

1324) Was (NAME)'s death the result of an accident?

YES 1 (GO TO NEXT SIBLING)
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?

YES (GO TO 1402)
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.

NAME OF THE YOUNGEST CHILD FROM Q212 ______
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)?

NONE 00
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:

a) homemade toys (like dolls, cars, or other homemade toys)?
YES 1
NO 2
DON'T KNOW 8
b) Toys from a store or a manufacturer?
YES 1
NO 2
DON'T KNOW 8
c) Household objects (like bowls or pots), or objects found outside (like sticks, stones, animals, shells, or leaves)?
YES 1
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):

a) Left alone for more than one hour?
NUMBER OF DAYS ALONE FOR MORE THAN ONE HOUR _____
b) Left in the care of another child (meaning someone under 10 years old) for more than one hour?
NUMBER OF DAYS LEFT WITH CHILD FOR MORE THAN ONE HOUR ____

IF NEVER, RECORD '0'. IF DON'T KNOW, RECORD '8'.

1407) CHECK 217: AGE OF CHILD

3 OR 4 YEARS OLD (GO TO 1408)
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?

YES (GO TO 1408A)
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.

NAME OF THE YOUNGEST CHILD FROM Q212 ______
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?

YES 1
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.

a) Read books or looked at illustrated books with (NAME)?
MOTHER A
FATHER B
OTHER PERSON X
NO ONE Y
b) Told stories to (NAME)?
MOTHER A
FATHER B
OTHER PERSON X
NO ONE Y
c) Sang songs to (NAME), or with (NAME), including lullabies?
MOTHER A
FATHER B
OTHER PERSON X
NO ONE Y
d) Took (NAME) for a walk outside of the house, the residence, the courtyard or the enclosure wall?
MOTHER A
FATHER B
OTHER PERSON X
NO ONE Y
e) Played with (NAME)?
MOTHER A
FATHER B
OTHER PERSON X
NO ONE Y
f) Spent time with (NAME), naming, counting, and/or drawing?
MOTHER A
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?

YES 1
NO 2
DON'T KNOW 8

1412) Can (NAME) read at least four simple, common words?

YES 1
NO 2
DON'T KNOW 8

1413) Can (NAME) list and recognize all digits from 1 to 10?

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

1415) Is (NAME) ever too sick to play?

YES 1
NO 2
DON'T KNOW 8

1416) Is (NAME) able to follow simple instructions to do something correctly?

YES 1
NO 2
DON'T KNOW 8

1417) When you give (NAME) something to do, is he/she able to do it independently?

YES 1
NO 2
DON'T KNOW 8

1418) Does (NAME) get along well with other children?

YES 1
NO 2
DON'T KNOW 8

1419) Does (NAME) kick, bit, or hit other children or adults?

YES 1
NO 2
DON'T KNOW 8

1420) Is (NAME) easily distracted?

YES 1
NO 2
DON'T KNOW 8

SECTION 15. DOMESTIC VIOLENCE

1500) CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE?

WOMAN SELECTED FOR THIS SECTION (GO TO 1501)
WOMAN NOT SELECTED (GO TO 1534)

1501) CHECK THE COVER PAGE: WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE?

WOMAN SELECTED FOR THIS SECTION (GO TO 1502)
WOMAN NOT SELECTED (GO TO 1534)

1502) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
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.

1504) CHECK 701 AND 702:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1505)
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).

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/where) at all times?
YES 1
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?

a) say or do something to humiliate you in front of others?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) Threaten to hurt or harm you or someone you care about?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?
YES 1
NO 2
OFTEN 1
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?

a) push you, shake you, or throw something at you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) slap you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) twist your arm or pull your hair?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you, or beat you up?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g) threaten you with a knife, gun, or other type of weapon?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h) physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
i) physically force you to perform other sexual acts you did not want to?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
j) Force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1507) CHECK 1506A (a-j):

AT LEAST ONE 'YES' (GO TO 1508)
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'.

NUMBER OF YEARS _____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1509) Did the following ever happen as a result of what your (last) (husband/partner) did to you:

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) you had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) you had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
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?

YES 1
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?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1512) Does (did) your (husband/partner) drink alcohol?

YES 1
NO 2 (GO TO 1514)

1513) How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1514) Are (were) you afraid of your (last) (husband/partner): many times, sometimes, or never?

MANY TIMES AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1515) CHECK 709:

MARRIED MORE THAN ONCE (GO TO 1516)
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?

a) Did any previous (husband/partner) ever hit, slap, kick or do anything else to hurt you physically?
YES 1
NO 2
0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 8
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1
NO 2
0-11 MONTHS AGO 1
12 OR MORE MONTHS AGO 2
DON'T REMEMBER 8

1517) CHECK 701 AND 702:

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?

YES 1
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.

MOTHER/FATHER'S WIFE A
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?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1520) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT ('YES' TO 201 OR 226 OR 230) (GO TO 1521)
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?

YES 1
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.

CURRENT HUSBAND/PARTNER A
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

1523) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (GO TO 1523A)
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?

YES 1 (GO TO 1524)
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?

YES 1
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?

CURRENT HUSBAND/PARTNER 01
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

1525) CHECK 701 AND 702:

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?

YES 1 (GO TO 1526)
NO 2 (GO TO 1526)

1525A) CHECK 1505A (h-j) AND 1516A (b):

AT LEAST ONE 'YES (GO TO 1526)
NOT A SINGLE 'YES' (GO TO 1527)

1526) CHECK 701 AND 702:

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?

AGE IN COMPLETED YEARS _____
DON'T KNOW 98

1527) CHECK 1505 (a-j), 1516 (a,b), 1517, 1521, 1523A, AND 1523B:

AT LEAST ONE 'YES' (GO TO 1527)
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?

YES 1
NO 2 (GO TO 1530)

1529) From whom have you sought help?
Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A (GO TO 1531)
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?

YES 1
NO 2

1531) As far as you know, did your father ever beat your mother?

YES 1
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?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

1533) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

___________________

1534) RECORD THE TIME

HOUR ____
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 ______

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.

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.