IDENTIFICATION

PLACE NAME________

NAME OF HOUSEHOLD HEAD______

DHS CLUSTER NUMBER_____

PSU CODE____

HOUSEHOLD NUMBER_____

REGION

URBAN/RURAL

LARGE CITY/SMALL CITY/TOWN/RURAL

NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISIT 1 (REPEAT FOR VISITS 2 AND 3)
DATE____
INTERVIEWER'S NAME____
RESULT____

NEXT VISIT:
DATE____
TIME_____

FINAL VISIT
DAY____
MONTH____
YEAR 2006
INT. NUMBER____
RESULT____

TOTAL NUMBER OF VISITS____

RESULT CODES:

LANGUAGE OF QUESTIONNAIRE 2

LANGUAGE OF INTERVIEW:_____

LANGUAGE:

RESPONDENT'S LANGUAGE____

TRANSLATOR USED

SUPERVISOR
NAME____
DATE____

FIELD EDITOR
NAME_____
DATE______

OFFICE EDITOR_____
KEYED BY____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is _________________and I am working with the Central Statistical Office. We are conducting a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health and the health of your children. This information will help the government to plan health services. The survey usually takes an hour to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey? May I begin the interview now?

Signature of interviewer:_________
DATE:_________

101) RECORD THE TIME.

102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

103) Just before you moved here, did you live in a city, in a town, or in the countryside?

104) In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

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

106) In what month and year were you born?

107) How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108) Have you ever attended school?

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

110) What is the highest (grade/form/year) you completed at that level?

111) CHECK 109:

112) 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?

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

114) CHECK 112:

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

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

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

118) What is your religion?

SECTION 2. REPRODUCTION

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

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

203) How many sons live with you? And how many daughters live with you? IF NONE, RECORD '00'.

204) Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

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'.

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

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

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

209) CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct?

210) CHECK 208:

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 LINES. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).

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

213) Were any of these births twins or multiple?

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

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

216) Is (NAME) still alive?

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

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

219) IF ALIVE:
RECORD HOUSE- HOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).

220) IF DEAD:
How old was (NAME) when he/she died?
IF '1 YEAR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS

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

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

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

CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED____
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED____
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED____
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS____

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 OR LATER. IF NONE, RECORD '0'.

225) FOR EACH BIRTH SINCE JANUARY 2001, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. 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 PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

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

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

229) Have you ever had a pregnancy that miscarried or was aborted?

230) When did the last miscarriage or abortion happen?

230A) Have you ever had a pregnancy that ended in a stillbirth?

230B) When did your last stillbirth happen?

230C) Was this last stillbirth macerated or fresh? By macerated I mean the body may have started to decompose.

231) CHECK 230 AND 230B:

232) How many months pregnant were you when the last miscarriage/ abortion/stillbirth happened?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233) Since January 2001, have you had any other pregnancies that did not result in a live birth?

234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2001. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any pregnancies that terminated before 2001 that did not result in a live birth?

236) When did the last such pregnancy that terminated before 2001 end?

237) When did your last menstrual period start?

238) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

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

SECTION 2: 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. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)? CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

01) FEMALE STERILIZATION Women can have an operation to avoid having any more children.

02) MALE STERILIZATION Men can have an operation to avoid having any more children.

03) PILL Women can take a pill every day to avoid becoming pregnant.

04) IUD Women can have a loop or coil placed inside them by a doctor or a nurse.

05) INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.

06) IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

07) CONDOM Men can put a rubber sheath on their penis before sexual intercourse.

08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.

09) DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.

10) FOAM/JELLY Women can place a supersitory jelly or cream in their vagina before intercourse.

11) LACTATIONAL AMENORRHEA METHOD (LAM) Up to six months after childbirth, a woman can use a method that requires that she breastfeeds frequently day, and night and that her menstrual period has not returned.

12) RHYTHM/BILLINGS/MUCUS METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to be pregnant or the woman observes her discharge and temperature of the vagina. If the temperature is high and the discharge stretches then she can avoid sexual intercourse

13) WITHDRAWAL Men can be careful and pull out before climax.

14) EMERGENCY CONTRACEPTION Women can take pills up to five days after sexual intercourse to avoid becoming pregnant.

15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

302) Have you ever used (METHOD)?

Have you ever had an operation to avoid having any more children?

Have you ever had a partner who had an operation to avoid having any more children?

303) CHECK 302:

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

306) What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

307) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

308) CHECK 302 (1):

309) CHECK 226:

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

311) Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD ON LIST.
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.

312) RECORD IF PILL OR CONDOM IS HIGHEST METHOD ON LIST IN 311.
PILL___: May I see the package of pills you are using?
MALE/FEMALE CONDOM____: May I see the package of condoms you are using?
RECORD NAME OF BRAND IF PACKAGE SEEN.

313) Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

314) How many (pill cycles/condoms) did you get the last time?

314A) CHECK 311/311A:

314B) How do you usually dispose of used condoms?

315) The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

316) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
WRITE THE NAME OF THE PLACE.

317) CHECK 311/311A:
CODE 'A' CIRCLED___:
Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

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

318) How much did you pay in total for the sterilization, including any consultation you may have had?

319) In what month and year was the sterilization performed?
319A) In what month and year did you start using (CURRENT METHOD) continuously?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

320) CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A

GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

321) CHECK 319/319A:

323) CHECK 311/311A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST,

324) At the time you started using the (CURRENT METHOD), were you told about side effects or problems you might have with the method?

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

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

327) CHECK 324:
CODE '1' CIRCLED___: At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED___: When you obtained (CURRENT METHOD) were you told about other methods of family planning that you could use?

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

329) CHECK 311/311A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

330) Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
WRITE THE NAME OF THE PLACE.

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

332) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

333) In the last 12 months, were you visited by a RHM/CBD who talked to you about family planning?

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

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

SECTION 4. PREGNANCY CARE AND CHILDREN'S NUTRITION

401) CHECK 224:

402) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)

403) LINE NUMBER FROM 212

404) FROM 212 AND 216

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

406) How much longer would you have liked to wait?

407) Did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

408) Where did you receive antenatal care for this pregnancy?
CIRCLE ALL MENTIONED.
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

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

410) Including this first visit, how many times did you receive antenatal care during this pregnancy?

411) As part of your antenatal care during this pregnancy, were any of the following done at least once?
Were you weighed?
Was your blood pressure
measured?
Did you give a urine sample?
Did you give a blood sample?
Were you physically examined?

412) During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

413) Were you told where to go if you had any of these complications?

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

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

416) CHECK 415:

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

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

419) In what month and year did you receive the last tetanus injection before this pregnancy?

420) How many years ago did you receive that tetanus injection?

421) During this pregnancy, were you given or did you buy any iron tablets?
SHOW TABLETS

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

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

423) During this pregnancy, did you have difficulty with your vision during daylight?

424) During this pregnancy, did you suffer from night blindness?

425) During this pregnancy, did you take any drugs to prevent you from getting malaria?

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

427) CHECK 426:
DRUGS TAKEN FOR MALARIA PREVENTION.

428) How many times did you take Chloroquine during this pregnancy?

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

430) Was (NAME) weighed at birth?

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

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

433) Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

434) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

435) Was (NAME) delivered by caesarean section?

436) Before you were discharged after (NAME) was born, did a health professional conduct a physical examination on you?

437) How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

439) After you were discharged, did a health professional, a traditional birth attendant or a RHM conduct a physical examination on you?

440) Why didn't you deliver in a health facility?
PROBE: Any other reason? RECORD ALL MENTIONED.

441) After (NAME) was born, did a health professional, a traditional birth attendant, a RHM, or a traditional healer conduct a physical examination on you?

442) How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

444) Where did this first check take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

444A) CHECK 439:

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

446) 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.

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

448) Where did this first check of (NAME) take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

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

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

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

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

453) CHECK 226: IS RESPONDENT PREGNANT?

454) Have you resumed sexual relations since the birth of (NAME)?

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

456) Did you ever breastfeed (NAME)?

456A) What was the main reason you did not breastfeed (NAME)?

457) 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.

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

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

460) CHECK 404: IS CHILD LIVING?

461) Are you still breastfeeding (NAME)?

462) For how many months did you breastfeed (NAME)?

463) CHECK 404: IS CHILD LIVING?

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

465) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

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

SECTION 5. IMMUNIZATION HEALTH, AND WOMEN'S NUTRITION

501) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN THREE BIRTHS, USE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) LINE NUMBER FROM 212

503) FROM 212 AND 216

504) Has (NAME) ever received a vitamin A dose like (this/any of these)?
SHOW CAPSULES.

505) How many months ago did (NAME) take the last dose?

506) Is (NAME) currently taking iron pills like this (any of these)?

506A) Has (NAME) taken any tablet or syrup for intestinal worms in the past six months?

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

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

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

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

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

512) Please tell me if (NAME) received any of the following vaccinations:
512A) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually leaves a scar?

512B) Polio vaccine, that is, drops in the mouth?

512C) Was the first polio vaccine received in the first two weeks after birth or later?

512D) How many times was the polio vaccine received?

512E) A DPT vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

512F) How many times was a DPT vaccination received?

512G) An HBV injection given on the thigh sometimes with polio drops?

512H) How many times was an HBV vaccination received? This is an injection that is usually given in the thigh.

512I) An injection to prevent measles? This injection is usually given in the left upper arm.

513) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

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

515) Has (NAME) had diarrhea in the last two weeks?

516) Was there any blood in the stools?

517) 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?

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

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

520) Where did you seek advice or treatment?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

Anywhere else?
RECORD ALL PLACES MENTIONED.

521) CHECK 520:

522) Where did you first seek advice or treatment?
USE LETTER CODE FROM 520.

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

524) Does (NAME) still have diarrhea?

525) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
a) A fluid made from a special packet called ORS
b) Sugar-Salt-Solution (SSS)

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

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

528) CHECK 527: GIVEN VITAMIN A?

529) How many times was (NAME) given vitamin A?

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

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

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

533) When (NAME) had this illness, did he/she have a problem in the chest or a blocked or runny nose?

534) CHECK 530: HAD FEVER?

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

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

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

538) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL SOURCES MENTIONED.

539) CHECK 538:

540) Where did you first seek advice or treatment?
USE LETTER CODE FROM 538.

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

542) Is (NAME) still sick with a (fever/ cough)?

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

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

544A) CHECK 544: ANY CODE A-H CIRCLED?

545) Did you already have (NAME OF DRUG FROM 544) at home when the child became ill?
IF YES, CIRCLE CODE FOR THAT DRUG. ASK SEPARATELY FOR EACH ANTIMALARIAL OR ANTIBIOTIC DRUG GIVEN IN 544.

546) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 547.

547) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2001 OR LATER LIVING WITH THE RESPONDENT

548) The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?

549) CHECK 525(a) AND 525(b), ALL COLUMNS:

550) Have you ever heard of a special product called ORS that you can get for the treatment of diarrhea?

552) CHECK 215 AND 218 IN ALL ROWS:

553) Now I would like to ask you about liquids or foods (NAME FROM 552) had yesterday during the day or at night.
Did (NAME FROM 552) (drink/eat):

Plain water?
Commercially produced infant formula?
Any baby food, e.g., Cerelac, ligugu?
Any (other) porridge or gruel?

554) Now I would like to ask you about (other) liquids or foods that (NAME FROM 552) or you may have had yesterday during the day or at night. I am interested in whether your child or you had the item even if it was combined with other foods.

Did (NAME FROM 552)/you drink (eat):

a. Milk such as tinned, powdered, or fresh animal milk?
b. Tea or coffee?
c. Sugary drinks such as sodas or fruit juices?
d. Any other liquids?
e. Bread, rice, noodles, maize meal, or other foods made from grains?
f. Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
g. White potatoes, white yams, taro (emathapha), cassava, or any other foods made from roots?
h. Any dark green, leafy vegetables? (such as cassava leaves, spinach, ocra, blackjack and pumpkin leaves)
i. Ripe mangoes, paw paw, oranges or guavas?
j. Any other fruits or vegetables?
k. Liver, kidney, heart or other organ meats (such as tripe, offals and tongue)?
l. Beef, pork, lamb, goat, rabbit or impala?
m. Chicken, duck, turkey or other birds?
n. Eggs?
o. Fresh or dried fish or shellfish?
p. Any foods made from beans, peas, or lentils?
q. Any nuts?
r. Cheese, sour milk, yogurt or other milk products?
s. Any oil, fats, or butter, or foods made with any of these?
t. Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits?
u. Any other solid or semi-solid food?

A) MILK

B) TEA, COFFEE

C) SUGARY DRINKS SUCH AS SODAS OR FRUIT JUICES?

D) OTHER LIQUIDS

E) GRAINS

F) PUMPKINS, CARROTS, SQUASH, SWEET POTATOES

G) ROOTS

H) DARK GREEN, LEAFY VEGETABLES

I) MANGOES, PAW PAW, ORANGES, GUAVAS

J) OTHER FRUITS OR VEGETABLES

K) ORGAN MEATS

L) BEEF, PORK, LAMB, GOAT, RABBIT, OR IMPALA

M) BIRDS

N) EGGS

O) FISH

P) BEANS, PEAS, LENTILS

Q) NUTS

R) MILK PRODUCTS

S) OILS, FATS, BUTTERS

T) SUGARY FOODS

U) SOLID OR SEMI-SOLID FOOD

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601) Are you in a civil or traditional marriage or both civil and traditional marriage?

601A) Was dowry/labola paid?

601B) Are you living with a man as if married?

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

604) What is your marital status now: are you widowed, divorced, or separated?

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

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

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

608) Including yourself, in total, how many wives or partners does your husband live with now as if married?

609) Are you the first, second, ... wife?

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

611) CHECK 610:
MARRIED/LIVED WITH A MAN ONLY ONCE____:
In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE____:
Now I would like to ask about when you started living with your first husband/partner. In what month and year was that?

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

614) CHECK 604: IS RESPONDENT CURRENTLY WIDOWED?

615) CHECK 610:

616) How did your previous marriage or union end?

617) Who did most of your late husband's property go to?

618) Did you receive any of your late husband's assets or valuables?

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

620) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you had sexual intercourse for the very first time?

621) Do you intend to wait until you get married to have sexual intercourse for the first time?

622) CHECK 107:

623) The first time you had sexual intercourse, was a male condom or female condom used?

623A) What was the main reason you did not use a condom the first time you had sexual intercourse?

624) How old was the person you first had sexual intercourse with?

625) Was this person older than you, younger than you, or about the same age as you?

626) Would you say this person was ten or more years older than you or less than ten years older than you?

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

627A) 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.

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

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

629A) What was the main reason you did not use a condom the last time you had sexual intercourse with this (second/third) person?

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

631) What was your relationship to this person with whom you had sexual intercourse?
IF PARTNER: Were you living together as if married? I
F YES, CIRCLE '02' IF NO, CIRCLE '03'

632) For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

633) CHECK 107:

634) How old is this person?

635) Is this person older than you, younger than you, or about the same age?

636) Would you say this person is ten or more years older than you or less than ten years older than you?

637) The last time you had sexual intercourse with this person, did you or this person take alcohol or other intoxicating substances?

637A) CHECK 637:

638) Were you or your partner drunk at that time?
IF YES: Who was drunk?

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

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

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

641A) CHECK 301 (07):

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

643) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). WRITE THE NAME OF THE PLACE.

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

645) CHECK 301 (08):

645A) Do you know of a place where a person can get female condoms?

646) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

SECTION 7. FERTILITY PREFERENCES

701) CHECK 311/311A:

702) CHECK 226:

NOT PREGNANT OR UNSURE___:
Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

PREGNANT___:
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?

703) CHECK 226:
NOT PREGNANT OR UNSURE___:
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT___:
After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

704) CHECK 226:

705) CHECK 310: USING A CONTRACEPTIVE METHOD?

706) CHECK 703:

707) CHECK 702:
WANTS TO HAVE A/ANOTHER CHILD____:
You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method?
Any other reason?

WANTS NO MORE/NONE ____:
You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method?
Any other reason?

RECORD ALL REASONS

708) CHECK 310: USING A CONTRACEPTIVE METHOD?

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

710) Which contraceptive method would you prefer to use?

711) What is the main reason that you think you will not use a contraceptive method at any time in the future?
CIRCLE ONLY ONE CODE.

712) Would you ever use a contraceptive method if you were married?

713) CHECK 216:

HAS LIVING CHILDREN___:
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN____:
If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR NUMERIC RESPONSE

714) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

715) In the last six months have you heard or seen about family planning:
On the radio? On the television? In a newspaper or magazine?

716A) In the last six months, have you discussed the practice of family planning with your friends, neighbors, or relatives?

716B) With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

717) CHECK 601, 601B, 604:

718) CHECK 311/311A:

719) Does your husband/partner know that you are using a method of family planning?

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

721) CHECK 311/311A:

722) Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

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

801) CHECK 601 AND 602:

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

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

804) What was the highest level of school he attended: primary, secondary, or higher?

805) What was the highest (grade/form/year) he completed at that level?

806) CHECK 801:

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

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

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

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

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

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

810A) What have you been doing for most of the time over the last 12 months?

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

812) CHECK 811:

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

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

815) Do you usually work at home or away from home?

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

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

818) CHECK 601:

819) CHECK 817:

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

821) 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?

822) Who decides how your husband's/partner's earnings will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?

823) Who usually makes decisions about health care for yourself: mainly you, mainly your husband/partner, you and your husband/partner jointly, or someone else?
Who usually makes decisions about making major household purchases?
Who usually makes decisions about making purchases for daily household needs?
Who usually makes decisions about visits to your family or relatives?

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

825) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him? If she neglects the children? If she argues with him? If she refuses to have sex with him? If she burns the food?
If she has sex with other men?

SECTION 9. HIV/AIDS

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

902) Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?

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

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

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

906) Can people reduce their chance of getting the AIDS virus by abstaining from sexual intercourse?

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

907A) Can people get the AIDS virus from having anal sex?

907B) Can people get the AIDS virus from having oral sex?

907C) Can people get the AIDS virus from open wounds or sores of an infected person?

908) Is there anything else a person can do to avoid or reduce the chances of getting the AIDS virus?

909) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.

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

911) Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?

912) CHECK 911:

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

914) Have you heard about special antiretroviral drugs (ARV) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

914A) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915) CHECK 208 AND 215:

916) CHECK 404 AND 407 FOR LAST BIRTH:

917) During any of the antenatal visits for (NAME OF LAST BIRTH), did anyone talk to you about:
Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

918) Were you advised to have a test for the AIDS virus as part of your antenatal care?

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

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

921) Where did you go to take the test?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

923) When was the last time you were tested for the AIDS virus?

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

925) When was the last time you were tested?

926) The last time you had the test, did you yourself ask for the test or were you advised to have the test, or was it required?

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

927A) How long after the test did you get the result?

928) Where did you go to take the test?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
WRITE THE NAME OF THE PLACE.

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

930) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

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

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

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

935A) Do you personally know someone who has been fired or sacked from work because he or she is suspected to have the AIDS virus or has the AIDS virus?

936) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?

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

938) CHECK 935, 936, AND 937:

939) Do you personally know someone who is suspected to have the AIDS virus or who has the AIDS virus?

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

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

942) Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when she knows he has a disease that can be transmitted through sexual contact?

943) When a wife knows her husband has a disease that can be transmitted through sexual contact, is she justified in asking that they use a condom when they have sex?

944) Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

945) Is a wife justified in refusing to have sex with her husband when she is feeling unwell?

946) Is a wife justified in refusing to have sex with her husband when she has recently given birth?

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

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

949) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid AIDS?

950) Should condoms be available in secondary school?

951) CHECK 601:

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

953) Could you ask your husband/partner to use a condom if you wanted him to?

954) Do you believe that young men should wait until they are married to have sexual intercourse?

955) Do you think that most young men you know wait until they are married to have sexual intercourse?

956) Do you believe that men who are not married and are having sex should only have sex with one partner?

957) Do you think that most men you know who are not married and are having sex, have sex with only one partner?

958) Do you believe that married men should only have sex with their wives?

959) Do you think that most married men you know have sex only with their wives?

960) Do you believe that young women should wait until they are married to have sexual intercourse?

961) Do you think that most young women you know wait until they are married to have sexual intercourse?

962) Do you believe that women who are not married and are having sex should only have sex with one partner?

963) Do you think that most women you know who are not married and are having sex, have sex with only one partner?

964) Do you believe that married women should only have sex with their husbands?

965) Do you think that most married women you know have sex only with their husbands?

SECTION 10. OTHER SEXUALLY TRANSMITTED INFECTIONS

1001) CHECK 901:

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

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

1002) If a man has a sexually transmitted disease, what signs or symptoms might he have? Any others?

RECORD ALL SYMPTOMS MENTIONED.

1003) If a woman has a sexually transmitted disease, what signs or symptoms might she have? Any others?

RECORD ALL SYMPTOMS MENTIONED.

1004) CHECK 620:

1005) CHECK 1001:

1005A) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1006) 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?

1007) Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

1008) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1009) CHECK 1006, 1007, AND 1008:

1010) The last time you had (PROBLEM(S) FROM 1006/1007/1008), did you seek any kind of advice or treatment?

1011) Where did you go?
Any other place?
RECORD ALL SOURCES MENTIONED.
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
WRITE THE NAME OF THE PLACE.

1012) What was the main reason for not seeking advice or treatment?

1013) When you had (PROBLEM(S) FROM 1006/1007/1008), did you inform the person(s) with whom you were having sex?

1014) When you had (PROBLEM(S) FROM 1006/1007/1008), did you do anything to avoid infecting your sexual partner(s)?

1015) What did you do to avoid infecting your partner(s)? Did you....
Use medicine?
Stop having sex?
Use a condom when having sex?

SECTION 11. OTHER HEALTH AND WELFARE ISSUES

1101) Now I would like to ask you some other questions relating to health matters. Some women are circumcised, that is, they may have part of their genital cut. Are you circumcised?

1102) 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1103) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1104) The last time you had an injection given to you by a health worker where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
WRITE THE NAME OF THE PLACE.

1105) Did the person who gave you that injection take the syringe and needle from a new, unopened package?

1106) Do you currently smoke cigarettes?

1107) In the last 24 hours, how many cigarettes did you smoke?

1108) Do you currently smoke or use any other type of tobacco?

1109) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

1110) Do you drink alcohol?

1111) How often do you drink alcohol?

1112) Have you ever heard of an illness called tuberculosis or TB?

1113) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

1114) Can tuberculosis be cured?

1115) If a member of your family got tuberculosis, would you want it to remain a secret or not?

1116) Now I would like to ask you some questions about medical care for you yourself.
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?
Getting permission to go?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Not wanting to go alone?
Concern that there may not be a female health provider?
Concern that there may not be any health provider?
Concern that there may be no drugs available?

1117) Did you use any soap for any purpose yesterday or today?

1118) For what purpose did you use the soap? Any other purpose?
RECORD ALL MENTIONED.

1119) Are you covered by any medical aid?

1120) What type of medical aid?
RECORD ALL MENTIONED.

1121) Are you the primary care giver for any children?

1122) Are any of these children for whom you are the primary caregiver under the age of 18?

1123) Now I would like to ask you about the child(ren) who (is/are) under the age of 18 and for whom you are the primary caregiver.
Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

1124) Are you comfortable talking to the children in your care about sex and HIV/AIDS?

SECTION 12. MATERNAL MORTALITY

1201) 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 are living with you, those living elsewhere and those who have died.
How many children did your mother give birth to, including you?

1202) CHECK 1201:

1203) How many of these births did your mother have before you were born? DRAW AN ARROW AFTER THE RESPONDENT'S NEXT OLDER SIBLING.
EXCLUDE THE RESPONDENT FROM 1204.

1204) What was the name given to your oldest (next oldest) brother or sister?

1205) Is (NAME) male or female?

1206) Is (NAME) still alive?

1207) How old is (NAME)?

1208) How many years ago did (NAME) die?

1209) How old was (NAME) when he/she died?

1210) Was (NAME) pregnant when she died?

1211) Did (NAME) die during childbirth?

1212) Did (NAME) die within two months after the end of a pregnancy or childbirth?

1213) How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

IF NOT MORE BROTHERS OR SISTERS, GO TO 1214.

1214) CHECK QS. 1210. 1211 AND 1212 FOR ALL SISTERS

1215) RECORD THE TIME