REPUBLIC OF CHAD
MINISTRY OF PLANNING AND COOPERATION
DIRECTORATE OF STATISTICS, ECONOMIC STUDIES, AND DEMOGRAPHICS
CENTRAL CENSUS BUREAU

IDENTIFICATION:

LOCALITY NAME ___
NAME OF HEAD OF HOUSEHOLD ___
PREFECTURE ___
SUB-PREFECTURE ___
CANTON ___
CLUSTER NUMBER (ENUMERATION DISTRICT) ___
STRUCTURE NUMBER ___
RESIDENCE NUMBER ___

CENSUS ZONE NUMBER ___

NAME AND LINE NUMBER OF WOMAN ___

INTERVIEWER VISITS:

INTERVIEWER 1:
(REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE__
DAY__
MONTH__
YEAR__
INTERVIEWER NAME___

RESULT:

NEXT VISIT [FOR INTERVIEWERS 1 AND 2]:
DATE__
TIME__

FINAL VISIT:
DAY__
MONTH__
YEAR __
NAME__

RESULT:

TOTAL NUMBER OF VISITS ___

LANGUAGE OF INTERVIEW:

INTERPRETER:

FIELD EDITED BY:
NAME ___
DATE ___

OFFICE EDITED BY:
NAME ___
DATE ___

KEYED BY:
NAME ___
DATE ___

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENT

101) RECORD TIME:

102) To begin, I'd like to ask you some questions about yourself and your household.
During the majority of the first 12 years of your life, did you live in the city of N'Djamena, in Abeche, in Moundou, in Sarh, in another city, in a village, or abroad?

103) For how long have you been a long-term resident of (NAME OF CURRENT RESIDENCE)?

104) Just before moving (NAME OF CURRENT RESIDENCE), did you live in N'Djamena, in Abeche, in Moundou, in Sarh, in another city, in a village, or abroad?

105) In what month and year were you born?

106) How old were you at your last birthday?

COMPARE AND CORRECT IF 105 AND/OR 106 ARE INCOMPATIBLE.

107) Have you ever attended school?

107A) Why have you never attended school?

108) What is the highest level of education that you have attained: primary, secondary, higher, secondary-level professional, higher-level professional, or madrassa?

109) What was the last class you completed at this level?

110) CHECK 106:

111) Are you currently attending school?

112) What is the main reason why you stopped attending school?

113) CHECK 108:

114) Do you know how to read and understand a letter or a newspaper easily, with difficulty, or not at all?

114A) In what language do you mainly know how to read?

IF MORE THAN ONE LANGUAGE IS CITED, ONLY CIRCLE THE CODE OF THE LANGUAGE FIRST ON THE LIST.

115) Do you usually read a journal or magazine at least once a week?

116) Do you usually listen to the radio every day?

117) Do you watch television at least once a week?

118) What is your religion?

119) What is your ethnicity?

119A) Sometimes children who play normally during the day have trouble seeing or moving around at nighttime, at nightfall, or after sunset. In the evening, these children sometimes sit by themselves, or hold on to their mother's clothing. They are unable to find their toys, or to see well enough to eat.

Are you familiar with this problem?

119B) What do you call this problem?

TRY TO OBTAIN THE LOCAL NAME OF ILLNESS.

120) CHECK 4 IN THE HOUSEHOLD QUESTIONNAIRE:

121) Now I would like to ask you some questions about the place that you usually live.
What is the name of the place in which you usually live?

IF DIFFERENT FROM N'DJAMENA, ABECHE, MOUDOU, SARH, OR ABROAD, ASK:
Is this a town/city or village?

122) In which prefecture is it located?

123) Now I would like to ask you about the household in which you usually live.

What is the main source of drinking water for members of your household?

124) How long does it take to go there, get water, and come back?

125) What kind of toilet facility does your household have?

126) Does your household have:

Grid power?
Personal electricity: (power generator, solar panel, batteries)?
A radio?
A television?
Telephone?
A refrigerator/freezer?

126A) In your household, what kind of lighting do you mainly use?

126B) In your household, how many rooms are used for sleeping?

127) Could you describe the floor of your home?

127A) Could you describe the roof of your home?

127B) Could you describe the walls of your home?

128) Is there someone in your household who owns:

A bicycle?
A scooter/motorcycle?
A car?
A canoe?
A cart?
A camel/horse/donkey?

SECTION 2. REPRODUCTION

201) Now I'd like to ask you some questions about all the children you've given birth to in your life. Have you ever given birth?

202) Did you give birth to sons or daughters currently living with you?

203) How many sons live with you?
And how many daughters?

IF NONE, ENTER '00'.

204) Have you given birth to sons or daughters who are still living and do not currently live with you?

205) How many sons are alive but not living with you?
How many daughters are alive but not living with you?

IF NONE, ENTER '00'.

206) Have you given birth to a son or daughter who later died?

IF NO, PROBE: Any baby who cried or showed signs of life but who only survived a few hours or days?

207) How many of your sons have died?
And how many of your daughters have died?

IF NONE, WRITE '00'.

208) SUM ANSWERS TO 203, 205, and 207 AND ENTER TOTAL:

IF NONE, RECORD '00'.

209) CHECK 208:

I want to make sure I understood: you have had in TOTAL___ births in your life. Is that correct?

210) CHECK 208:

211) Now I would like to talk to you about your children, whether they are still alive or not, beginning with the first birth that you had.

IN 212 WRITE THE NAME OF EACH CHILD, WRITING THE NAMES OF TWINS OR TRIPLETS ON SEPARATE LINES.

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

213) Were any of these births twins?

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

215) In what month and year was (NAME) born?

PROBE: What is his or her birthday?
OR: In what season was he/she born?

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 DECEASED:

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

IF "1YR", INSIST: How old was (NAME) in months?

RECORD IN DAYS IF LESS THAN ONE MONTH; IN MONTHS IF LESS THAN TWO YEARS; OR IN YEARS.

220) FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH.
IS THE DIFFERENCE 4 OR MORE?

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

222) SUBTRACT THE YEAR OF THE BIRTH OF THE LAST CHILD FROM THE YEAR OF THE INTERVIEW. IS THE DIFFERENCE 4 OR MORE YEARS?

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

224) COMPARE 208 WITH THE NUMBER OF BIRTHS RECORDED IN THE TABLE ABOVE AND NOTE:

225) CHECK 215 AND ENTER THE NUMBER OF LIVING BIRTHS SINCE JANUARY 1991. IF THERE ARE NONE, RECORD '0'.

227) Are you pregnant now?

228) How many months pregnant are you?

RECORD IN COMPLETED MONTHS.

229) 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?

236) When did your last period start?

237) Between the first day of a woman's period and the first day of her NEXT period, are there certain times when she has a greater chance of becoming pregnant than at other times?

238) During which times of the month does a woman have the greatest chance of becoming pregnant?

239) Did you have any pregnancies that did not end with a live birth?

240) How many pregnancies have you had that did not end with a live birth?

241) Among these pregnancies, how many ended with:

- a voluntary induced abortion?
- a spontaneous abortion, that is to say, a miscarriage?
- a stillbirth?

SECTION 3. CONTRACEPTION

Now I would like to talk to you about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.

CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.

THEN FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK QUESTION 303.

301) Which ways or methods have you heard about?

302) Have you ever heard of (METHOD)?

303) Have you ever used (METHOD)?

304) CHECK 303:

305) Have you ever used or tried any way to delay or avoid getting pregnant?

307) What have you done or used?

CORRECT 303-304 (AND 302 IF NECESSARY).

309) Now I would like to speak to you about the time when you first did something or used a method to avoid getting pregnant. How many living children did you have at that time?

IF NONE, RECORD '00'.

310) When you first used family planning, was it because you wanted to have another child but at a later time, or because you did not want to have another child at all?

311) CHECK 303:

312) CHECK 227:

313) Are you currently doing something or using a method to avoid pregnancy?

314) What method are you using?

314A) CIRCLE '07' FOR FEMALE STERILIZATION.

315) May I see the package of pills you are using now?

RECORD NAME OF BRAND IF PACKAGE IS SEEN.

316) Do you know the brand name of the pills that you are now using?

RECORD BRAND.

317) How much does one packet (cycle) of pills cost you?

318) Where did the sterilization take place?

319) Do you regret that (you/your husband) had the operation to not have any more children?

320) Why do you regret it?

321) In what month and year was the sterilization operation performed?

323) How do you determine which days of your monthly cycle not to have sexual relations?

326) For how many months have you been using (CURRENT METHOD) continuously?

IF LESS THAN A MONTH, RECORD '00'.

327) CHECK 314:

CIRCLE METHOD CODE.

328) Where did you obtain (METHOD) the last time?

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

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE '12' FOR N'DJAMENA AND THE CODE '13' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE', PROBE TO DETERMINE IF A REAL NURSE (CODE '25' 'WORKPLACE HEALTH CENTER'), A HOSPITAL, OR A PUBLIC HEALTH CENTER.

329) Do you know of another place where you could have obtained (METHOD) the last time?

329A) At the time of the sterilization operation, did you know of another place where you could have received the operation?

330) People select the place where they get family planning services for various reasons.

What was the main reason you went to (NAME OF PLACE IN 328 OR IN 318) instead of another place you know about?

RECORD RESPONSE AND CIRCLE CODE.

331) What is the main reason you are not using a method?

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

333) Where is that?

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.

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE '12' FOR N'DJAMENA AND THE CODE '13' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE '25' 'WORKPLACE HEALTH CENTRE), A HOSPITAL, OR A PUBLIC HEALTH CENTRE

335) Have you been in a health facility for any reason in the last 12 months?

336) Did someone at the health facility speak to you about family planning methods?

337) Do you thing that breastfeeding can affect a woman's chance of becoming pregnant?

338) Do you think that a woman's chance of becoming pregnant is increased or diminished by breastfeeding?

339) CHECK 210:

340) Have you ever relied on breastfeeding as a method to avoid pregnancy?

341) CHECK 227 AND 311:

342) Are you currently relying on breastfeeding to avoid getting pregnant?

SECTION 4A. PREGNANCY AND BREASTFEEDING

401) CHECK 225:

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS OF ALL THESE BIRTHS, BEGINNING WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE)

Now I would like to ask you some more questions about the health of all of the children you have had in the past 5 years. (We will talk about one child at a time)

403) SEE SECTION 2:

404)
FROM 212: NAME OF (LAST/NEXT-TO-LAST/-SECOND-FROM-LAST) BIRTH:

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 want no (more) children at all?

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

407) When you were pregnant with (NAME), did you see anyone for a consultation about this pregnancy?

IF YES, Whom did you see? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
IF 'TRADITIONAL BIRTH ATTENDANT' PROBE TO DETERMINE IF SHE RECEIVED TRAINING.

- SOMETIMES TRAINED BIRTH ATTENDANTS HAVE A CASE CONTAINING VARIOUS DRUGS.

- ASK IF THE BIRTH ATTENDANT HAS CONTACTS WITH REGIONAL HEAD NURSE

408) How many months pregnant were you when you first received antenatal care?

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

410) When you were pregnant with (NAME) were you given an injection in the arm or backside to prevent the baby from getting tetanus, that is, convulsions after birth?

411) During this pregnancy, how many times did you receive this injection?

412) Where did you give birth to (NAME)?

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE '22' FOR N'DJAMENA AND THE CODE '23' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE '34', OR IF A HOSPITAL ('21'), OR A PUBLIC HEALTH CENTRE ('23')

413) Who assisted you in the delivery of (NAME)?

Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

IF 'TRADITIONAL BIRTH ATTENDANT' PROBE TO DETERMINE IF SHE RECEIVED TRAINING.
- SOMETIMES TRAINED BIRTH ATTENDANTS HAVE A CASE CONTAINING VARIOUS DRUGS.
- ASK IF THE BIRTH ATTENDANT HAS CONTACTS WITH REGIONAL HEAD NURSE

414) At the time of the birth of (NAME) did you have any of the following health problems?

Long labor, that is, did your regular contractions last more than 12 hours?
Excessive bleeding that was so much that you feared it was life-threatening?
A high fever with bad-smelling vaginal discharge?
Convulsions not caused by fever?

415) Was (NAME) delivered by caesarean section?

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

417) Was (NAME) weighed at birth?

418) How much did he/she weigh?

RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

419) FOR MOST RECENT BIRTH ONLY: Has your period returned after the birth of (NAME)?

420) SKIP FOR MOST RECENT BIRTH: Did your period return between the birth of (NAME) and the next pregnancy?

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

422) CHECK 227:
WOMAN PREGNANT?

423) FOR MOST RECENT BIRTH ONLY: Have you resumed sexual relations since the birth of (NAME)?

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

425) Did you breastfeed (NAME)?

426) How long after the 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.

427) CHECK 404:
CHILD ALIVE?

428) Do you still breastfeed (NAME)?

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

430) Why did you stop breastfeeding (NAME)?

431) CHECK 404:
CHILD ALIVE?

432) How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

433) How many times did you breastfeed yesterday, during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

434A) CHECK 428:
CHILD BREASTFED?

434B) Was (NAME) given water or anything else to drink or eat other than breast milk yesterday or last night?

435) At any time yesterday or last night, was (NAME) given any of the following foods or beverages?

Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Tinned or powdered milk?
Fresh (animal) milk?
Other liquids?
Gruel, dumplings, bread, or doughnut made from wheat, sorghum, millet, corn, or rice?
Gruel, puree, or dumplings made from manioc, plantain, yam, potato, or taro?
Eggs, fish, or poultry?
Meat?
Other solid or semisolid food specially made for the child?

436) CHECK 435:
FOOD OR LIQUID GIVEN YESTERDAY?

437) (Aside from breast milk), how many times did (NAME) eat yesterday, including both meals and snacks like gruel, doughnuts, cookies?

IF 7 OR MORE TIMES, RECORD '7'.

438) On how many days during the last 7 days was (NAME) given the following?

Plain water?
Milk (other than breast milk)?
Other liquids?
Gruel, dumplings, bread, or doughnut made from wheat, sorghum, millet, corn, or rice?
Gruel, puree, or dumplings made from manioc, plantain, yam, potato, or taro?
Eggs, fish, or poultry?
Meat?
Green leafy vegetables?
Carrots?
Mango (including its juice)?
Papaya?
Melon?
Other solid or semisolid food specially made for the child?

439) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440) ENTER THE LINE NUMBER AND NAME OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

441) SEE SECTION 2: LINE NUMBER FROM QUESTION 212

442) FROM 212 AND 216:

443) Do you have a booklet or card where (NAME)'s vaccinations are written down?

IF YES: May I see it, please?

444) Did you ever have a vaccination booklet or card for (NAME)?

445)
(1) COPY THE VACCINATION DATES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN THE 'DAY' COLUMN IF THE CARD SHOWS THAT A VACCINATION WAS GIVEN BUT THE DATE WAS NOT RECORDED.

446) Has (NAME) received a vaccination that is not recorded on this card?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, DTAP 1-2, MEASLES, YELLOW FEVER, AND/OR VIT. A.

447) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

448) Please tell me if (NAME) has received one of the following vaccinations:

448A) A BCG vaccination against tuberculosis, that is an injection in the left forearm that left a scar?

448B) Polio vaccine, that is, drops in the mouth?

448C) How many times?

448D) When was the first polio vaccination given, just after birth or later?

448E) DPT vaccine, that is, an injection usually given at the same time as the polio drops?

448F) How many times?

448G) The DTAP vaccine, that is, an injection given against several illnesses, including tetanus, pertussis, and polio?

448H) How many times?

448I) An injection against measles?

448J) An injection against yellow fever?

448K)
CHECK 445:
VITAMIN A RECORDED?

448L) Did (NAME) receive a capsule like this one?

SHOW GEL CAP OF VITAMIN A.

448M) How long ago did (NAME) receive a gel cap like this the last time?

RECORD THE RESPONSE IN MONTHS OR YEARS.

449) Has (NAME) had a fever any time during the last two weeks?

450) Has (NAME) been ill with a cough any time during the last 24 hours?

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

452) Did you seek advice or treatment for the cough?

453) Where did you seek advice or treatment?

Anywhere else?

RECORD ALL MENTIONED.

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE 'B' FOR N'DJAMENA AND THE CODE 'C' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE 'J' 'A HOSPITAL ('A'), OR A PUBLIC HEALTH CENTRE ('C').

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

455) Was there any blood in the stool?

456) On the worst day of the diarrhea, how many bowel movements did (NAME) have?

457) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

458) Did you give him/her the same amount to eat as before the diarrhea, or more, or less?

458A) CHECK 428: CHILD BREASTFED?

458B) When (NAME) had diarrhea, did he/she receive the same amount of breast milk, or more or less?

459) When (NAME) had diarrhea, was he/she given any of the following to drink?

A fluid made from a ORS packet like this one here? SHOW ORS PACKET
Grain-based Soup/gruel?
Sugar-salt-water solution (Oral rehydration solution)?
Rice water?
Milk/curdled milk (kefir)/yoghurt/or infant formula?

460) Was anything else given to treat the diarrhea?

461) What was given or made to treat the diarrhea?

Anything else?

RECORD ALL MENTIONED.

462) Did you seek advice or treatment for the diarrhea?

463) Where did you seek advice or treatment?

Anywhere else?

RECORD ALL MENTIONED.

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE 'B' FOR N'DJAMENA AND THE CODE 'C' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE 'J' 'A HOSPITAL ('A'), OR A PUBLIC HEALTH CENTER ('C').

463A) CHECK 119A AND 119B:
NIGHT BLINDNESS KNOWN?

463B) Does (NAME) suffer from (NAME OF ILLNESS FROM 119B)?

464) GO BACK TO 442 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 465.

465) When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

466) When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

467) When a child is sick with diarrhea, what signs of illness would tell you that he/she should be taken to a health facility or health worker?

RECORD ALL MENTIONED.

468) When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?

469) CHECK 459, ALL COLUMNS:

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

SHOW ORS PACKET.

471) Have you heard messages about certain foods good for eyesight and for avoiding night blindness?

472) Can you name some of these foods?

Any others?

RECORD ALL MENTIONED.

SECTION 4C. CAUSES OF DEATH OF CHILDREN BORN AND WHO HAVE DIED IN LAST 5 YEARS

473) RECORD THE LINE, THE NAME AND SURVIVAL STATUS OF EACH CHILD BORN SINCE JANUARY 1991 ACCORDING TO THE REPRODUCTION TABLE.
ASK THE QUESTIONS ABOUT ALL THESE BIRTHS ENDING IN DEATH. IF 3 OR MORE, BEGIN WITH THE LAST (IF MORE THAN 3 BIRTHS, USE ANOTHER QUESTIONNAIRE).

LINE NUMBER FROM 212:

ACCORDING TO 212 AND 216:

474) I know it can be difficult to talk about children that you have had who have died, but this information is very important for health programs and to avoid the deaths of other children.

I would like to ask you some questions about what happened and what symptoms your child presented before they died. (We will talk about only one child at a time)

475) In your opinion, what was the cause of (NAME)'s death?

476) During the illness that preceded the death of (NAME), did you seek advice or treatment?

IF YES: Where did you go/who did you see?

477) Where did (NAME)'s death happen?

478) CHECK 219: AGE AT DEATH

479) Was (NAME) born in a difficult delivery?

480) Did (NAME) have any kind of malformation?

IF 'YES,' SPECIFY:

481) In the first days of life, did (NAME) breastfeed or drink normally?

482) Did (NAME) at least breastfeed or did he/she have difficulty breastfeeding in the days
preceding death?

483) In the illness preceding death, did (NAME) have convulsions or spasms?

484) In the illness preceding death, did (NAME) have a cough?

485) For how many days did the cough last?

IF LESS THAN A DAY, RECORD '00'.

486) When (NAME) had a cough, did he/she have difficulty breathing/rapid breathing?

487) For how many days did he/she have difficulty breathing/rapid breathing?

IF LESS THAN A DAY, RECORD '1'.

488) RETURN TO 475 FOR THE FOLLOWING DECEASED CHILD. IF NO MORE DECEASED CHILDREN, GO TO 501.

489) During the illness that preceded the death, did (NAME) have very soft or liquid stool, that is, did he/she have diarrhea?

490) Was the episode of diarrhea moderate or serious?

491) How long did the diarrhea last?

IF LESS THAN A DAY, RECORD 00 FOR 'DAY'.

492) Was there any blood in the stool?

493) During the illness that preceded the death, did (NAME) have a cough?

494) How long did the cough last?

IF LESS THAN A DAY, RECORD 00 FOR 'DAY'.

495) When (NAME) had a cough, did he/she have difficulty breathing or labored/rapid breaths?

496) How long did he/she have difficulty breathing or labored/rapid breaths?

IF LESS THAN A DAY, RECORD 00 FOR 'DAY'.

497) During the illness that led to his/her death, did (NAME) have a fever?

497A) Was the fever mild or high?

497B) How long did the fever last?

IF LESS THAN A DAY, RECORD 00 FOR 'DAY'.

498) In the illness that preceded death, was (NAME) unconscious?

498A) In the illness that preceded death, did (NAME) have convulsions?

498B) In the illness that preceded death, did (NAME) have a rash all over the body/face?

498C) How long did the rash last?

IF LESS THAN A DAY, RECORD 00 FOR 'DAY'.

498D) In the illness that preceded death, was (NAME) very thin?

498E) How long was he/she very thin?

IF LESS THAN A DAY, RECORD 00 FOR 'DAY'.

498F) In the illness that preceded death, did (NAME) have swollen feet or legs?

498G) How long did he/she have swollen feet or legs?

IF LESS THAN A DAY, RECORD 00 FOR 'DAY'.

499) RETURN TO 475 FOR THE NEXT DECEASED CHILD; IF NO MORE DECEASED CHILDREN, GO TO 501.

SECTION 5. MARRIAGE

501) PRESENCE OF OTHERS AT THIS POINT.

502) Are you currently married or living with a man?

503) Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

504) Have you ever been married or lived in a union with a man?

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

506A) Who initiated the divorce/separation?

506B) What was the cause of your divorce/separation?

507) Does your husband/partner live with you, or is he staying elsewhere?

507A) RECORD THE LINE NUMBER OF HER HUSBAND FROM THE HOUSEHOLD QUESTIONNAIRE. IF NOT THERE, RECORD '00'.

508) Does your husband/partner have other wives besides you?

509) How many other wives does he have?

510) Are you the first, second, third?spouse?

511) Have you been married or lived with a man only once, or more than one?

IF ONCE, RECORD '1'.
IF SEVERAL TIMES, ASK AND RECORD NUMBER.

512) CHECK 511:

MARRIED/LIVED WITH A MAN ONLY ONCE:
In what month and year did you start living with him?

MARRIED/LIVED WITH A MAN MORE THAN ONCE:
Now we will talk about your first husband/partner. In what month and year did you start living with him?

513) How old were you when you started living with your (first) husband/partner?

514) CHECK 502 AND 506:

515) Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of some family planning issues.

When did you last have sexual relations with your (husband/man you live with)?

IF RESPONSE IS 'NEVER,' RETURN TO 502, RECORD 'NON-CONSUMMATED MARRIAGE' AND FOLLOW THE NEW PATH INSTRUCTIONS.

515A) CHECK 301 AND 302:

KNOWS CONDOM:
The last time you had sex, was a condom used?

DOES NOT KNOW CONDOM:
Some men use a condom, which means that the put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?

515B) Have you had sexual relations with anyone else besides your (husband/man you live with) in the past 12 months?

515C) When did you last have sexual relations with someone besides your (husband/man you live with)?

515D) Was a condom used at this time?

515E) Over the past 12 months, with how many different people besides your (husband/man you live with) did you have sexual relations?

515F) Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of some family planning issues.

When did you last have sexual relations (if ever)?

515G) CHECK 301 AND 302:

KNOWS CONDOM:
The last time you had sex, was a condom used?

DOES NOT KNOW CONDOM:
Some men use a condom, which means that the put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?

515H) CHECK 515F:

515I) Over the past 12 months, with how many different people did you have sexual relations?

517) Do you know of a place where you can get condoms?

518) Where is that?

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.

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE '12' FOR N'DJAMENA AND THE CODE '13' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE '25' 'WORKPLACE HEALTH CENTER), A HOSPITAL, OR A PUBLIC HEALTH CENTER.

518A) How far away is (NAME OF PLACE IN 518)?

RECORD '95' FOR 95 KILOMETERS OR MORE.

518B) How long does it take to get to (NAME OF PLACE IN 518)?

RECORD '300' FOR 5 HOURS OR MORE.

518C) How much does one condom cost?

519) How old were you when you first had sexual intercourse?

SECTION 6. FERTILITY PREFERENCES

601) CHECK 314:

602) CHECK 227:

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

PREGNANT:
Now I have some questions about the future. After the child you're expecting, would you like to have another child or would you prefer to not have any more children?

603) CHECK 227:

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

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

604) CHECK 227:

605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

606) CHECK 313: USING A METHOD?

607) Do you think you will use a method to delay or avoid pregnancy in the next 12 months?

608) Do you think you will use a method in the future?

609) What method would you prefer to use?

610) What is the main reason you think you will never use a method?

611) Would you use a method if you were married?

612) CHECK 216:

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

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

PROBE FOR A NUMERIC RESPONSE.

612A) What is the main reason you would like to have (NUMBER OF CHILDREN FROM 612)?

613) Among the (NUMBER OF CHILDREN FROM 612), of children that you want, how many would you like to be boys, how many would you like to be girls, and for how many would it not matter?

ADD 'BOYS' AND 'GIRLS' AND 'EITHER'. THIS NUMBER SHOULD BE EQUAL TO NUMBER IN 612. IF 'NO', CHECK AND CORRECT.

614) In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

615) Do you find it acceptable or not acceptable that information on family planning is broadcast :
On the radio?
On television?

616) In the last few months, have you heard anything about family planning:

On the radio?
On television?
In newspapers or magazines?
From a poster?
From a leaflet or brochure?

616A) CHECK 616:

617) In the last few months, have you heard a message on the radio promoting:
Birth spacing?
Mother's health?

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

619) With whom have you discussed it?
Anyone else?

RECORD ALL MENTIONED.

620) CHECK 502:

621) Spouses/partners do not always agree on everything. Now I want to ask you some questions about your husband/partner's point of views on family planning.

Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

622) How often have you talked to your husband/partner about this subject in the last 12 months?

623) 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 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701) CHECK 502 AND 504:

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

703) Did your husband/partner go to school?

704) What is the highest level of school that he reached: primary, secondary, higher, secondary-level professional, higher-level professional, or madrassa?

705) What was the last (grade, year) that he completed at that level?

706) What is/was your husband/partner's main occupation, that is, what kind of work does (did) he mainly do?

707) CHECK 706:

708) (Does/did) your husband/partner work mainly on his own land or on family land or does/did he rent land, or does/did he work on someone else's land?

709) Aside from your own housework, are you currently working?

710) As you know, some women take up jobs for which there are paid in cash or in kind. Others sell things, have a small business or work on the family farm or in the family business.

Are you currently doing any of these things or any other work aside from your own housework?

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

712) What is your main occupation, that is, what kind of work do you do?

713) CHECK 712:

714) Do you work on your own land or on family land, or do you rent land, or do you work on someone else's land?

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

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

717) In the last 12 months, how many months did you work?

718) (In the months that you worked), how many days per month did you work?

719) During the past 12 months, approximately how many days did you work?

720) Do you earn money for this work? That is, do you earn cash or something else in kind for this work?

721) How much do you usually earn for this work?

-IF WOMAN IS PAID IN KIND, CIRCLE '0'.

-IF WOMAN EARNS CASH, PROBE:
Is this by the hour, by the day, by the week, by the month, or by the year?

RECORD THE CORRESPONDING CODE AND RECORD THE SUM, PRECEDED BY'0' IF NECESSARY.

722) CHECK 502:

YES, CURRENTLY MARRIED,
YES, LIVING WITH A MAN:
Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

NO, NOT IN UNION/ IN NON-CONSUMMATED MARRIAGE:
Who mainly decides how the money you earn will be used: you, someone else, or you and someone else together?

723) Do you do this work at home or away from home?

724) CHECK 217 AND 218: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

725) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

801A) Have you ever heard of illnesses that can be sexually transmitted?

801B) What illnesses do you know about?

RECORD ALL MENTIONED.

801C) CHECK 515 AND 515F:

801D) In the last 12 months, have you had any of these illnesses?

801E) What illnesses have you had?

RECORD ALL MENTIONED.

801F) The last time that you had (DISEASE FROM 801E) did you seek advice or treatment?

801G) Where did you seek advice or treatment?

Anywhere else? From anyone else?

RECORD ALL MENTIONED.

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

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE 'B' FOR N'DJAMENA AND THE CODE 'C' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE 'K' "WORKPLACE HEALTH CENTER") OF IF A HOSPITAL OR A PUBLIC HEALTH CENTER.

801GA) In all, how much did the treatment cost you?

IF MORE THAN 99,994 CFA, RECORD '99994'.

810H) When you had the (DISEASE(S) FROM 801E), did you tell your partner(s)?

810I) When you had the (DISEASE(S) FROM 801E), did you do something to avoid infecting your partner(s)?

801J) What did you do?

RECORD ALL MENTIONED.

801K) CHECK 801B:

801L) Have you ever heard of an illness called AIDS?

801LA) Where did you hear about AIDS for the first time?

802) From which sources of information have you learned most about AIDS?

Any other sources?

RECORD ALL MENTIONED.

802B) How can one catch AIDS?

Any other way?

RECORD ALL MENTIONED.

803) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

804) What can a person do?

Anything else?

RECORD ALL MENTIONED.

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

808) Do you think that a person with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

808A) Can one be cured of AIDS?

808B) Can AIDS be transmitted from mother to child during pregnancy or birth?

808C) Do you know someone personally who has AIDS or who died of AIDS?

809) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

809B) Why do you think that you have (NO/LITTLE) risk of getting AIDS?

Any other reason?

RECORD ALL MENTIONED.

809C) Why do you think that you have (MODERATE/GREAT) risk of getting AIDS?

Any other way?

RECORD ALL MENTIONED.

809CA) In your opinion, what should be done with people sick with AIDS?

811A) Since you have heard about AIDS, have you changed your behavior to avoid getting AIDS?

IF YES, What have you done?

RECORD ALL MENTIONED.

811B) Has your knowledge of AIDS influenced or changed your decision to have sex or your sexual behavior?

IF YES, in what way?

RECORD ALL MENTIONED.

811C) Some people use a condom during sexual relations to avoid getting AIDS or other sexually transmitted diseases. Have you ever heard about them?

811D) CHECK 515 AND 515F:

811E) It is possible that we have already talked about this. Have you ever used a condom during sex to avoid getting or transmitting illnesses, such as AIDS?

811F) CHECK 515 AND 515F:

811G) In the last 12 months, have you given or received money, presents, or favors in exchange for sex?

SECTION 9. MATERNAL MORTALITY

901) Now, I want to ask you questions about your brothers and sisters, that is to say, all children born to your natural mother. Please give me the names of all the brothers and sisters who live with you, those who live elsewhere and those who died.

How many children did your mother give birth to, including you?

902) CHECK 901:

903) How many of these births did your mother have before your birth?

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

905) Is (NAME) male or female?

906) Is (NAME) still alive?

907) How old is (NAME)?

908) In what year did (NAME) die?

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

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

911) Was (NAME) pregnant when she died?

912) Did (NAME) die in childbirth?

913) Did (NAME) die in the two months following the end of pregnancy or of a birth?

914) Was the death related to pregnancy or delivery complications?

915) To how many children has (NAME) given birth in her life?

915A) Where did this death occur?

IF NO MORE BROTHERS/SISTERS, GO TO 916.

916) RECORD TIME:

SECTION A. WEIGHT AND HEIGHT

A01) CHECK 215:

INTERVIEWER:
IN A02 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN AFTER JANUARY 1991 AND STILL ALIVE.
IN A03 AND A04, RECORD THE NAME AND BIRTH DATE OF RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991.
IN A06 AND A08, RECORD THE HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.

NOTES:
-ALL OF THE RESPONDENTS WITH ONE OR MORE BIRTH SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL THE CHILDREN HAVE DIED.
-IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1991, USE AN ADDITIONAL FORM.

A02) LINE NUMBER FROM 212 SECTION 2:

A03) NAME (FROM 212 FOR CHILDREN)

A04) BIRTH DATE:

FROM 215 FOR CHILDREN, AND ASK THE DAY OF BIRTH.

A05) BCG SCAR ON ARM:

A06) HEIGHT (IN CENTIMETERS)

A07) WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UP?

A08) WEIGHT (IN KILOGRAMS)

A09) DATE WEIGHED AND MEASURED

A10) RESULT:

A11)

INTERVIEWER'S OBSERVATIONS:
(To be filled in after completing interview)

COMMENTS ABOUT RESPONDENT: ___
COMMENTS ON SPECIFIC QUESTIONS: ___
ANY OTHER COMMENTS: ___

NAME OF INTERVIEWER: ___
TEAM LEADER OBSERVATIONS: ___
TEAM LEADER NAME: ___
DATE: ___

SUPERVISOR'S OBSERVATION: ___
NAME OF SUPERVISOR: ___
DATE: ___