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REPUBLIC OF CHAD
MINISTRY OF PLANNING, DEVELOPMENT, AND COOPERATION
NATIONAL INSTITUTE OF STATISTICS, ECONOMIC STUDY, AND DEMOGRAPHY

SECOND DEMOGRAPHIC AND HEALTH SURVEY

WOMAN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF LOCALITY__________
NAME OF HEAD OF HOUSEHOLD___________

DEPARTMENT:___
SUBPREFECTURE: ___
MUNICIPALITY:___
CLUSTER NUMBER (EDST):___
STRUCTURE NUMBER:___
HOUSEHOLD NUMBER IN THE STRUCTURE: ___
SEQUENTIAL NUMBER OF SELECTED HOUSEHOLD (01-24 URBAN; 01-33 RURAL:___
Urban/rural

URBAN 1
RURAL 2

Residence

N'DJAMENA=1
ABECHE/MOUNDOU/SARH=2
OTHER DEPARTMENTAL ADMINISTRATIVE CENTER=3
OTHER SMALL CITIES=4
RURAL=5

WOMAN'S NAME AND LINE NUMBER (FROM HOUSEHOLD QUESTIONNAIRE)_______

INTERVIEWER VISITS

FIRST INTERVIEWER VISIT

DATE______
INTERVIEWER'S NAME__________
RESULT*

SECOND INTERVIEWER VISIT

DATE_____
INTERVIEWER'S NAME________
RESULT*

THIRD INTERVIEWER VISIT

DATE_____
INTERVIEWER'S NAME______
RESULT*

FINAL VISIT

DAY____
MONTH____
YEAR 200__
NAME_______
RESULT___

NEXT VISIT

DATE_____
TIME_____

TOTAL NO. OF VISITS
*RESULT CODES
1COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

LANGUAGE OF INTERVIEW**

INTERPRETER

YES 1
NO 2

**LANGUAGE CODES
FRENCH 01
CHADIAN ARABIC 02
SAR 03
BORNOU 04
GOR 05
GORANE 06
COULEY 07
KANEMBOU 08
LELE 09
MABA (OUADDAIEN) 10
MBAY 11
MOUDANG 12
MOUSSEYE 13
NGAMBAY 14
TOUPOURI 15
OTHER LANGUAGES 16

SUPERVISOR

NAME_______
DATE____

FIELD EDITOR

NAME_____
DATE_____

OFFICE EDITOR________

KEYED BY________

SECTION 1. RESPONDENT'S BACKGROUND

Informed consent

Hello. My name is ____ and I work with the National Institute of Statistics, Economic Study and Demographics. In collaboration with the Ministry of Public Healthy, we are conducting a national survey about the health of women 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 between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

At this time, do you have any questions?
May I begin the interview now?

101) RECORD TIME

HOURS __ __
MINUTES __ __

105) What year and what month were you born in?

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

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

AGE IN COMPLETED YEARS ___

If Respondent under age 15 or over age 49, stop the interview and make the appropriate corrections on the household questionnaire.

107) Have you ever attended school?

YES 1
NO 2 (GO TO 112A)

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

MADRASA ONLY 1-SKIP TO 112A
PRIMARY 2
SECONDARY 3
HIGHER 4
PROFESSIONAL SECONDARY LEVEL 5
PROFESSIONAL HIGHER LEVEL 6

109) What is the highest (grade/form/year) you completed at this level?*
*codes for q. 109
(Including Madrasa)
0=less than one year in corresponding level
Level/class

PRIMARY
1=cp1
2=cp2
3=ce1
4=ce2
5=cm1
6=cm2
8=don't know
SECONDARY
1=6TH
2=5TH
3=4TH
4=3RD
5=2ND
6=1ST
7=FINAL
8=DON'T KNOW
HIGHER
1=1ST YEAR
2=2ND YEAR
3=3RD YEAR
4=4TH YEAR +
8=DON'T KNOW
PROFESSIONAL SECONDARY LEVEL
1=6th or1st year
2=5th or 2nd year
3=4th or 3rd year
4=3rd or 4th year
5=2nd or 5th year
6=1st or 6th year
7=final or 7th year
8=don't know
PROFESSIONAL HIGHER LEVEL
1=1ST YEAR
2=2ND YEAR
3=3RD YEAR
4=4TH YEAR +
8=DON'T KNOW
DON'T KNOW =8

110) CHECK 106:

AGE 24 YEARS OR LESS
AGE 25 YEARS OR MORE-SKIP TO 112A

111) Are you currently attending school?

YES 1-SKIP TO 112A
NO 2

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

GOT MARRIED 01
GOT PREGNANT 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
HAD ENOUGH SCHOOLING 07
DID NOT LIKE SCHOOL 08
FAILED AT SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
HEALTH REASONS 11
LACK OF TUTOR 12
OTHER (SPECIFY) 96
DON'T KNOW 98

112a) Can you read Arabic, French, French and Arabic, or can you not read at all?

ARABIC ONLY 1-SKIP TO 115
FRENCH ONLY 2
ARABIC AND FRENCH 3
CANNOT READ AT ALL 4-SKIP TO 116

113) Check 107 and 108:

NEVER ATTENDED SCHOOL OR PRIMARY ONLY OR MADRASA ONLY
SECONDARY OR PROFESSIONAL SECONDARY, OR HIGHER OR PROFESSIONAL HIGHER-SKIP TO 115

114) Now I would like you to read this sentence in French out loud to me; read as much as you can.

SHOW CARD TO RESPONDENT

If respondent cannot read whole sentence, probe:
Can you read any part of the sentence to me?

CANNOT READ AT ALL 1-SKIP TO 116
ABLE TO READ CERTAIN PARTS 2
ABLE TO READ WHOLE SENTENCE 3

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?

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

116) Do you listen to the radio every day or almost every day?

YES 1
NO 2

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

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

118) What is your religion?

CATHOLIC 1
PROTESTANT 2
ISLAM 3
ANIMIST 4
NO RELIGION 5
OTHER 6

120) What is your ethnicity?

GORANE 01
ARAB 02
OUADDAI 03
BAGUIRMIEN 04
KANEM-BORNOU 05
FITRI-BATHA 06
HADJARAI 07
LAC IRO 08
SARA 09
TANDJILE 10
PEUL 11
MAYO KEBBI 12
OTHER CHADIAN ETHNICITIES 13
FOREIGNER 14
INDETERMINATE 98

SECTION 2. REPRODUCTION

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

YES 1
NO 2- SKIP TO 206

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

YES 1
NO 2- SKIP TO 204

203) How many sons live with you?
And how many daughters live with you?
If none, record '00'

SONS AT HOME __ __
DAUGHTERS AT HOME __ __

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

YES 1
NO 2- SKIP TO 206

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
If none, recode '00'

SONS ELSEWHERE __ __
DAUGHTERS ELSEWHERE __ __

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

YES 1
NO 2- 208

207) How many boys have died?
And how many girls have died?
If none, record '00'

BOYS DEAD __ __
GIRLS DEAD __ __

207a) Have you had any children who were born alive but then died after a few minutes, hours or days?

YES 1
NO 2-SKIP TO 208

207b) CORRECT Q. 207 THEN CONTINUE TO QUESTION 208

208) Sum answers to 203, 205, and 207 and enter total.
If none, record 00

TOTAL___

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

YES
NO-PROBE AND CORRECT 201-208 AS NECESSARY

210) Check 208:

ONE OR MORE BIRTHS
NO BIRTHS- SKIP TO 225

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.

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

NAME___________________

01, 02, 03, etc…

213) Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH__ __
YEAR __ __ __ __

216) Is (name) still alive?

YES 1
NO 2- SKIP TO 219

217) If alive:
How old was (name) at his/her last birthday? Record age in completed years.

AGE IN YEARS___

218) If alive:
Is (name) living with you?

YES 1-SKIP TO NEXT BIRTH
NO 2-SKIP TO NEXT BIRTH

219) If dead:
How old was (name) when he/she died?

IF '1 YR', PROBE: How many months old was (name)? Record days if less than 1 month; months if less than two years, or years.

DAYS 1
MONTHS 2
YEARS 3

220) Were there any other live births between (name of previous birth) and (name)?

YES 1
NO 2

221) Have you had any live births since the birth of (name of last birth)?

YES 1
NO 2

222) Compare 208 with number of births in history above and mark:
NUMBERS ARE SAME
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 __
NUMBERS ARE DIFFERENT-(PROBE AND RECONCILE)

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 1999 OR LATER.
IF NONE, RECORD '0'

225) Are you pregnant now?

YES 1
NO 2- SKIP TO 228
UNSURE 3-SKIP TO 228

226) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS __

227) 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?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2-SKIP TO 235

229) When did the last such pregnancy end?

MONTH
YEAR

230) CHECK 229:

LAST PREGNANCY ENDED IN JAN. 1999 OR LATER
LAST PREGNANCY ENDED BEFORE JAN. 1999-SKIP TO 234

231) How many months pregnancy were you when the last such pregnancy ended?
RECORD THE NUMBER OF COMPLETED MONTHS

MONTHS __ __

232) Was this pregnancy terminated by an elective abortion?

YES 1
NO 2

233) Have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2-SKIP TO 235

234) Overall, throughout your entire life, how many pregnancies have you had that ended in a miscarriage, an elective abortion, or a still-birth?
IF NONE, RECORD 00

MISCARRIAGE __ __
ELECTIVE ABORTION __ __
STILL-BIRTH __ _

235) When did you last menstrual cycle start?
(Date, if given)

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

236) 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?

YES 1
NO 2 --SKIP TO 301
DON'T KNOW 8- SKIP TO 301

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

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

SECTION 3: CONTRACEPTION

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.

CIRCLE CODE 1 IN 301A FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301A, 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 301A, ASK 302.

301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

01) Female Sterilization
Women can have an operation to avoid having any more children

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

YES 1
NO 2

02) Male Sterilization
Men can have an operation to avoid having any more children

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

YES 1
NO 2

03) Pill: women can take a pill every day.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

05) Injectables
Women can have an injection by a heath provider which stops them from becoming pregnant for a month or more.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

06) Implants
Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for a year or more.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

07) Condom
Men can put a rubber sheath on their penis before sexual intercourse.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

08) Female condom
Women can place a sheath in their vagina before sexual intercourse.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

09) Diaphragm
Women can place a thin flexible disk in their vagina before intercourse.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (METHOD)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

10) Suppository, jelly or vaginal tablets
Women can place a suppository, jelly, or cream in their vagina before intercourse.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (METHOD)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

11) Lactational amenorrhea method (LAM)
Up to 6 months after childbirth, and when her menstrual period has not returned, a woman can use a method that requires that she breastfeeds frequently, day and night, without giving him any other food.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (METHOD)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

12) Rhythm or Periodic abstinence
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 get pregnant.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (METHOD)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

13) Withdrawal
Men can be careful and pull out before climax.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

14) Emergency contraception
Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
301a) Which ways or methods have you heard about? For methods not mentioned spontaneously, ask: Have you ever heard of (method)?

YES 1
NO 2

302) Have you ever heard of (METHOD)?

YES 1
NO 2

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

YES 1 (SPECIFY)____________
NO 2

303) CHECK 302:

NOT A SINGLE 'YES' (NEVER USED)
AT LEAST ONE 'YES' (EVER USED)- SKIP TO 306

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

YES 1
NO 2- SKIP TO 315

306) What have you used or done?
CORRECT 302 AND 303 (AND 301A 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'

NUMBER OF CHILDREN ___

308) CHECK 302 (01):

WOMAN NOT STERILIZED
WOMAN STERILIZED -SKIP TO 311

309) CHECK 225:

NOT PREGNANT OR UNSURE
PREGNANT -SKIP TO 315

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

YES 1
NO 2-SKIP TO 315

311) CHECK 302:

WOMAN NOT STERILIZED:
WHICH METHOD ARE YOU USING?
WOMAN STERILIZED:
CIRCLE 01 FOR FEMALE STERILIZATION
FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
MOUSSE/JELLY/VAGINAL TABLETS 10
LACTATIONAL AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER (SPECIFY) 96

312) CHECK 311:
WOMAN OR MAN STERILIZED:
In what month and year was the sterilization performed?

Other methods: In what month and year did you start using (Method first mentioned in q. 311) continuously?

MONTH __ __
YEAR __ __ __ __

313) CHECK 311:
CIRCLE METHOD CODE

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
MOUSSE/JELLY/VAGINAL TABLETS 10
LACTATIONAL AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER (SPECIFY) 96
11-96-SKIP TO 315

314) CHECK 313:
WOMAN OR MAN STERILIZED:
In what facility did the sterilization take place?

Other methods: Where did you obtain (method from q. 313) the last time?

PUBLIC SECTOR
HOSPITAL/MATERNITY 11
MILITARY HOSPITAL/GARRISON 12
HEALTH CENTER/FREE CLINIC/GARRISON 13
POLYCLINIC 14
HOSPITAL/HEALTH CENTER PHARMACY 15
OTHER PUBLIC 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
CLINIC/OFFICE 22
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING 23
PRIVATE HEALTH CENTER 24
COMPANY HEALTH CENTER 25
CARE OFFICE/NURSE 26
PHARMACY/PHARMACY DEPOT 27
OTHER PRIVATE MEDICAL 28
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER 31
OTHER
SHOP/BAR/MARKET 41
FIRST AID WORKER 42
MOBILE VENDOR 43
FRIENDS/NEIGHBORS/RELATIVES 44
OTHER PLACE 96
ALL SKIP TO 318

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

YES 1
NO 2-SKIP TO 318

316) Where is this?

Any other place?
RECORD ALL PLACES MENTIONED

PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
OTHER PUBLIC F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/OFFICE H
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING I
PRIVATE HEALTH CENTER J
COMPANY HEALTH CENTER K
CARE OFFICE/NURSE L
PHARMACY/PHARMACY DEPOT M
OTHER PRIVATE MEDICAL N
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER O
OTHER
SHOP/BAR/MARKET P
FIRST AID WORKER Q
MOBILE VENDOR R
FRIENDS/NEIGHBORS/RELATIVES S
OTHER PLACE X

318) In the last 12 months, have you visited a health facility for care for any reason?

YES 1
NO 2-SKIP TO 320

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

YES 1
NO 2

320) Do you think that breastfeeding can influences the chance of a woman getting pregnant?

YES 1
NO 2-SKIP TO 401

321) Do you think that breastfeeding increases or decreases a woman's chance of getting pregnant?

INCREASE 1-SKIP TO 401
DECREASE 2
DEPENDS 3
DON'T KNOW 8

322) CHECK 208:

AT LEAST ONE BIRTH
NO BIRTHS --SKIP TO 401

323) Have you ever used breastfeeding as a method to avoid pregnancy?

YES 1
NO 2-SKIP TO 401

324) CHECK 225 and 311:

NOT PREGNANT OR NOT SURE AND STERILIZED
PREGNANT OR STERILIZED-SKIP TO 401

325) Are you currently using breastfeeding as a method to avoid pregnancy?

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

ONE OR MORE BIRTHS SINCE JANUARY 1999 -SKIP TO 402
NO BIRTHS SINCE JANUARY 1999 -SKIP TO 482

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE 2000. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN 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

LAST BIRTH
LINE NUMBER __ __
NEXT-TO-LAST BIRTH
LINE NUMBER __ __

404) From 212 and 216

NAME___________________
LIVING
DEAD

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?

THEN 1-SKIP TO 407
LATER 2
NOT AT ALL 3-SKIP TO 407

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

MONTHS 1
YEARS 2
DON'T KNOW 998

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.

IF "TRADITIONAL BIRTH ATTENDANT", PROBE TO FIND OUT IF SHE HAD TRAINING.
SOMETIMES TRAINED BIRTH ATTENDANTS HAVE A KIT CONTAINING VARIOUS DRUGS.
ASK IF THE BIRTH ATTENDANT HAD CONTACT WITH THE ZONE NURSE.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER HEALTH PERSONNEL
MATRON/HOSPITAL/HEALTH CENTER AGENT D
TRAINED TRADITIONAL BIRTH ATTENDANT E
OTHER PERSON
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
VILLAGE FIELDWORKER G
FIRST AID WORKER H
HEALER I
OTHER X
NO ONE Y --SKIP TO 415

407a) Did you receive a maternity card for this pregnancy?
IF YES: May I see it?

YES, SEEN 1
YES, NOT SEEN 2
NO CARD 3

408) How many months pregnant were you when you had your first antenatal care visit?

MONTHS__ __
DON'T KNOW 98

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

NO. OF TIMES __ __
DON'T KNOW 98

410) CHECK 409:
Number of times received antenatal care

ONCE-SKIP TO 412
MORE THAN ONCE OR DON'T KNOW -SKIP TO 411

411) How many months pregnant were you the last time you received antenatal care?

MONTHS __ __
DON'T KNOW 98

412) During this pregnancy, were any of the following done at least once?

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2
Did you have a vaginal exam?
YES 1
NO 2

413) Were you told about the signs of pregnancy complications?

YES 1
NO 2-SKIP TO 415
DON'T KNOW 8-SKIP TO 415

414) Were you told where to go if you had these complications?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2- SKIP TO 416
DON'T KNOW 8-SKIP TO 416

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

TIMES __ __
DON'T KNOW 8

416) During this pregnancy, were you given or did you buy drugs containing iron?
Show tables

YES 1
NO 2-SKIP TO 418
DON'T KNOW 8- SKIP TO 418

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

NUMBER OF DAYS __ __
DON'T KNOW 998

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DK 8

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

YES 1
NO 2-SKIP TO 422
DON'T KNOW 8-SKIP TO 422

421) What drugs did you take?
RECORD ALL MENTIONED.

CHLOROQUINE/NIVAQUINE A
FANSIDAR B
OTHER ANTI-MALARIAL C
PLANTS/BREW D
OTHERS X
UNKNOWN DRUG Y

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

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

423) Was (Name) weighed at birth?

YES 1
NO 2-SKIP TO 425
DON'T KNOW 8-SKIP TO 425

424) How much did (Name) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE

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

425) Who assisted with the delivery of (Name)?
Anyone else?

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

IF "TRADITIONAL BIRTH ATTENDANT", PROBE TO FIND OUT IF SHE HAD TRAINING.
SOMETIMES TRAINED BIRTH ATTENDANTS HAVE A KIT CONTAINING VARIOUS DRUGS.
ASK IF THE BIRTH ATTENDANT HAD CONTACT WITH THE ZONE NURSE.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER HEALTH PERSONNEL
MATRON/HOSPITAL/HEALTH CENTER AGENT D
TRAINED TRADITIONAL BIRTH ATTENDANT E
OTHER PERSON
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
VILLAGE FIELDWORKER G
FIRST AID WORKER H
HEALER I
OTHER X
NO ONE Y

426) Where did you give birth to (Name)?

HOME
YOUR HOME 11- SKIP TO 427A
OTHER HOME 12-SKIP TO 427A
PUBLIC SECTOR
HOSPITAL/MATERNITY/HEALTH CENTER/FREE CLINIC 21
OTHER PUBLIC ESTABLISHMENT 22
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/HEALTH CENTER/DOCTOR'S OFFICE 31
PRIVATE 32
PUBLIC/PRIVATE SECTOR
VILLAGE HEALTH CENTER 41
OTHER 96-SKIP TO 427A

427a) What is the main reason for which you did not give birth to (name) in a sanitary establishment?

ESTABLISHMENT DIFFICULT TO ACCESS/TOO FAR 11
COSTS TOO MUCH 12
WAIT TIME TOO LONG 21
BAD EQUIPMENT 22
ESSENTIAL DRUGS NOT AVAILABLE 23
LACKS HYGIENE 24
LACKS CONFIDENTIALITY/PRIVACY 25
LACK OF PERSONNEL 31
PERSONNEL NOT QUALIFIED 32
PERSONNEL NOT FRIENDLY 33
PREFERRED HOME 41
I WASN'T SICK 51
NOT TIME TO GET THERE 61
OTHER 96
DON'T KNOW 98

428) After (Name) was born, did a health professional or a traditional birth attendant check on your health?

Yes 1
No 2-skip to 433

429) How many days or weeks after delivery did the first check take place?
RECORD '00' DAYS IF SAME DAY.

DAYS AFTER DELIVERY 1
WEEKS AFTER DELIVERY 2
DON'T KNOW 998

430) Who checked on your health at that time?
Anyone else?
PROBE TO OBTAIN THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

IF "TRADITIONAL BIRTH ATTENDANT", PROBE TO FIND OUT IF SHE HAD TRAINING.
SOMETIMES TRAINED BIRTH ATTENDANTS HAVE A KIT CONTAINING VARIOUS DRUGS.
ASK IF THE BIRTH ATTENDANT HAD CONTACT WITH THE ZONE NURSE.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
OTHER HEALTH PERSONNEL
MATRON/HOSPITAL/HEALTH CENTER AGENT D
TRAINED TRADITIONAL BIRTH ATTENDANT E
OTHER PERSON
UNTRAINED TRADITIONAL BIRTH ATTENDANT F
VILLAGE FIELDWORKER G
FIRST AID WORKER H
HEALER I
OTHER X
NO ONE Y-SKIP TO 433

431) Where did this first check take place?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL/MATERNITY/HEALTH CENTER/FREE CLINIC 21
OTHER PUBLIC ESTABLISHMENT 22
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/HEALTH CENTER/DOCTOR'S OFFICE 31
PRIVATE 32
PUBLIC/PRIVATE SECTOR
VILLAGE HEALTH CENTER 41
OTHER 96

433) Has your period returned since the birth of (name)?

YES 1-SKIP TO 435
NO 2- SKIP TO 436

434) Did your period return between the birth of (name) and your next pregnancy?

YES 1
NO 2-SKIP TO 438

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

MONTHS __ __
DON'T KNOW 98

436) CHECK 225:
Is respondent pregnant?

NOT PREGNANT
PREGNANT OR UNSURE-SKIP TO 438

437) Have you resumed sexual relations since the birth of (name)?

YES 1
NO 2-SKIP TO 439

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

MONTHS __ __
DON'T KNOW 98

439) Did you ever breastfeed (NAME)?

YES 1
NO 2-SKIP TO 444

440) How long after birth did you first put (Name) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.

IMMEDIATELY 000-SKIP TO 440B
HOURS 1
DAYS 2

440a) In the first 24 hours, before breastfeeding (name), did you give him/her something else to drink?
IF YES: What did you give him/her to drink?

WATER/SUGAR WATER A
ARTIFICIAL MILK/ANIMAL MILK B
BREW/HERBAL TEA C
OTHER D
NONE/NOTHING GIVEN Y

440b) Did you give (name) the first yellow milk?

YES 1
NO 2

441) CHECK 404: Is child living?

LIVING
DEAD --SKIP TO 443

442) Are you still breastfeeding (NAME)?

YES 1-SKIP TO 445
NO 2

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

MONTHS __ __
DON'T KNOW 98

444) CHECK 404: Is child living?

LIVING-SKIP TO 447
DEAD-(GO BACK TO 405 IN NEXT COLUMN OR IF NO MORE BIRTHS, GO TO 451)

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

NUMBER OF NIGHTTIME FEEDINGS __ __

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

NUMBER OF DAYLIGHT FEEDINGS __ __

447) Did (Name) drink anything form a bottle with a nipple yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

449) Now I would like to ask you about the liquids (name) was given yesterday during the day or at night.
Did (NAME) receive any of the following yesterday during the day or night?

a) Water, Sugar Water
YES 1
NO 2
DK 8
b) Artificial preparation for baby, like cerelac, corn flour, bledine, or phosphatine?
YES 1
NO 2
DK 8
c) Any type of milk other than breastmilk, like boxed milk, powdered milk, or fresh animal milk?
YES 1
NO 2
DK 8
d) Fruit juice?
YES 1
NO 2
DK 8
e) Other liquids like herbal tea, carbonated drinks, or broth?
YES 1
NO 2
DK 8

449a) Now I would like to ask about the food (name) was given yesterday during the day or at night.
DID (NAME) RECEIVE ANY OF THE FOLLOWING YESTERDAY DURING THE DAY OR NIGHT?

f) gruel, bread, fritter made from a cereal like wheat, sorghum, millet, corn or rice
YES 1
NO 2
DK 8
g) Gruel, puree, bread made from tubers or roots, like manioc, yams, tarot, potatoes, or plantain?
YES 1
NO 2
DK 8
h) All green vegetables like the leaves of manioc, tarot, potatoes, spinach?
YES 1
NO 2
DK 8
i) Carrot?
YES 1
NO 2
DK 8
j) Fruits like oranges, mangos, papaya, or melon?
YES 1
NO 2
DK 8
k) Any other fruit?
YES 1
NO 2
DK 8
l) Any dairy product, like butter, cheese, or yogurt?
YES 1
NO 2
DK 8
m) Meat, poultry, chicken, or eggs?
YES 1
NO 2
DK 8
n) Any other solid or semi-solid food?
YES 1
NO 2
DK 8

450) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 451.

SECTION 4B. IMMUNIZATION AND HEALTH

451) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1999. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMNS OF ADDITIONAL QUESTIONNAIRES).

452) LINE NO. FROM Q 212

LAST BIRTH
LINE NUMBER_____
NEXT-TO-LAST BIRTH
LINE NUMBER______

453) FROM Q 212 AND Q 216

NAME________
LIVING
DEAD -GO TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 481)

454) DID (NAME) GET A DOSE OF VITAMIN A LIKE THIS ONE DURING THE LAST 6 MONTHS?
SHOW BLUE AND RED CAPSULE

YES 1
NO 2
DK 8

455) Do you have a card where (name's) vaccination are written down?
IF YES: May I please see it?

YES, SEEN 1-SKIP TO 457
YES, NOT SEEN 2-SKIP TO 459
NO 3

456) Have you ever had a vaccination care for (name)?

YES 1-SKIP TO 459
NO 2-SKIP TO 459

457)
1) Copy vaccination dates 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

DAY __ __
MONTH __ __
YEAR __ __ __ __
BCG
POLIO 0 (POLIO GIVEN AT BIRTH)
POLIO 1
POLIO 2
POLIO 3
DCTOQ 1
DCTOQ 2
DCTOQ 3
MEASLES
YELLOW FEVER (Y.F)
VITAMIN A (MOST RECENT)

458) 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, MEASLES, AND/OR YELLOW FEVER.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 463)-SKIP TO 463
NO 2 --SKIP TO 463
DK 8 --SKIP TO 463

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

YES 1
NO 2-SKIP TO 463
DK 8-SKIP TO 463

460) Please tell me if (NAME) received any of the following vaccinations:

460a) A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DK 8

460b) Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 --SKIP TO 460E
DK 8-SKIP TO 460E

460c) When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2
DK 8

460d) How many times was the polio vaccine received?

NUMBER OF TIMES_____

460e) A DTCoq vaccination, that is, an injection given in the right arm usually at the same time as polio drops?

YES 1
NO 2-SKIP TO 460G
DK 8-SKIP TO 460G

460f) How many times?

NUMBER OF TIMES_______

460g) An injection to prevent measles?

YES 1
NO 2
DK 8

460h) An injection to prevent yellow fever?

YES 1
NO 2
DK 8

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

YES 1
NO 2-SKIP TO 463F
DK 8-SKIP TO 463F

463a) Does (name) have a fever now?

YES 1
NO 2
DON'T KNOW 8

463b) Did you seek advice or treatment for the fever?

YES 1
NO 2-SKIP TO 463D

463c) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL SOURCES MENTIONED

PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
OTHER PUBLIC F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/OFFICE H
PRIVATE HEALTH CENTER I
COMPANY HEALTH CENTER J
CARE OFFICE/NURSE K
PHARMACY/PHARMACY DEPOT L
OTHER PRIVATE MEDICAL M
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER N
OTHER
SHOP/BAR/MARKET O
TRADITIONAL PRACTITIONER P
FIRST AID WORKER Q
FRIENDS/RELATIVES R
OTHER PLACE X

463d) Was anything given to (name) to treat the fever?

YES 1
NO 2-SKIP TO 463F
DON'T KNOW --SKIP TO 463F

463e) What was given to treat the fever?
Anything else?
RECORD ALL MENTIONED

CHOROQUINE/NIVAQUINE A
FANSIDAR B
QUINIMAX C
OTHER ANTI-MALARIAL D
UNKNOWN DRUG
PLANTS/BREWS F
OTHER X
DON'T KNOW Z

463f) Does (NAME) usually sleep under a mosquito net?

YES 1
NO 2
DON'T KNOW 8

463g) Did (NAME) sleep under a mosquito net last night?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2-SKIP TO 472
DK 8-SKIP TO 472

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

YES 1
NO 2
DK 8

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

YES 1
NO 2-SKIP TO 472

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

PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
OTHER PUBLIC F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/OFFICE H
PRIVATE HEALTH CENTER I
COMPANY HEALTH CENTER J
CARE OFFICE/NURSE K
PHARMACY/PHARMACY DEPOT L
OTHER PRIVATE MEDICAL M
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER N
OTHER
SHOP/BAR/MARKET O
TRADITIONAL PRACTITIONER P
FIRST AID WORKER Q
FRIENDS/RELATIVES R
OTHER PLACE X

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

YES 1
NO 2-SKIP TO 479A
DK 8-SKIP TO 479A

472a) Was there blood in the stools?

YES 1
NO 2
DON'T KNOW 8

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DK 8

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD
NEVER GAVE FOOD 6
DK 8

475) Was he/she given any of the following to drink?

a) A fluid made from a special packet called ORS?
YES 1
NO 2
DK 8
b) A sugar-salt solution?
YES 1
NO 2
DK 8

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

YES 1
NO 2-SKIP TO 478
DON'T KNOW-SKIP TO 478

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

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS/FEEDING TUBE C
PLANTS, BREWS D
OTHER (SPECIFY) X

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

YES 1
NO 2-SKIP TO 479A

479) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
OTHER PUBLIC F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/OFFICE H
PRIVATE HEALTH CENTER I
COMPANY HEALTH CENTER J
CARE OFFICE/NURSE K
PHARMACY/PHARMACY DEPOT L
OTHER PRIVATE MEDICAL M
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER N
OTHER
SHOP/BAR/MARKET O
TRADITIONAL PRACTITIONER P
FIRST AID WORKER Q
FRIENDS/RELATIVES R
OTHER PLACE X

479a) In Chad, some people have their children's uvula removed. Have you ever heard of this practice?

YES 1
NO 2-SKIP TO 480

479a) Was (NAME)'s uvula removed?

YES 1-SKIP TO 479D
NO 2
DON'T KNOW 8

479c) Do you intend to have (NAME)'s uvula removed?

YES 1-SKIP TO 479G
NO 2-SKIP TO 479G
DEPENDS/DON'T KNOW 8-SKIP TO 479G

479d) How old was (NAME) when his/her uvula was removed?

LESS THAN ONE YEAR 1
ONE YEAR OR OLDER 2
DON'T KNOW 8

479e) Who removed (NAME)'s uvula?

TRADITIONAL PRACTITIONER 1
MALE SPECIALIST 2
FEMALE SPECIALIST 3
MEDICAL PERSONNEL 4
RELATIVES/FRIENDS 5
OTHER 6
DON'T KNOW 8

479f) After the removal, did (NAME) have:

a) An Infection?
YES 1
NO 2
DON'T KNOW 8
b) Bleeding?
YES 1
NO 2
DON'T KNOW 8
c) Difficulty Nursing, Drinking, Or Eating?
YES 1
NO 2
DON'T KNOW 8
d) Difficulty Breathing?
YES 1
NO 2
DON'T KNOW 8
e) Difficulty Speaking?
YES 1
NO 2
DON'T KNOW 8

479g) What are the advantages of removing a child's uvula?
PROBE: Anything else?
RECORD ALL MENTIONED

DIMINISHES VOMITING A
DIMINISHES COUGH B
PREVENTS STREP THROAT/TONSILLITIS/SORE THROAT C
HELPS BREATHING D
GOES WITH TRADITION E
OTHER (SPECIFY) X
NO ADVANTAGES Z

479h) What are the disadvantages of removing a child's uvula?
PROBE: Anything else?
RECORD ALL MENTIONED

PAIN A
RISK OF INFECTION B
RISK OF BLEEDING C
RISK FOR BREATHING D
RISK FOR SPEAKING E
OTHER (SPECIFY) X
NO DISADVANTAGES Z

480) GO BACK TO 453 IN THE NEXT COLUMN, OR IF NO MORE BIRTHS, TO GO 481.

481) CHECK 475A IN ALL COLUMNS:

NO CHILD RECEIVED ORS PACKET OR QUESTION NOT ASKED
ANY CHILD RECEIVED ORS PACKET -SKIP TO 501

482) Have you ever heard of a special product called SRO you can get for the treatment of diarrhea?

YES 1
NO 2

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 -- SKIP TO 505
YES, LIVING WITH A MAN 2 -- SKIP TO 505
NO, NOT IN UNION 3

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

YES, WAS MARRIED 1
YES, LIVED WITH A MAN 2 --SKIP TO 510
NO 3 -- SKIP TO 514

504) What is your current marital status: are you a widow, divorced, or separated?

WIDOW 1 -- SKIP TO 510
DIVORCED 2
SEPARATED 3

504a) Who initiated your divorce/separation?

RESPONDENT HERSELF 1
HUSBAND/PARTNER 2
WOMAN AND HUSBAND/MUTUAL AGREEMENT 3
FAMILY OF WOMAN 4
FAMILY OF HUSBAND/PARTNER 5

504b) What was the main cause of your divorce/separation?

RESPONDENT'S STERILITY 01
HUSBAND/PARTNERS STERILITY 02
IMPOTENCE/HUSBAND/PARTNER'S ILLNESS 03
HUSBAND/PARTNER'S INFIDELITY 04
DOMESTIC CONFLICT 05
FAMILY PRESSURE 06
OTHER (SPECIFY) 08
ALL SKIP TO 510

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

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

NAME_____
LINE NO._____

507) Does your husband/partner have other wives besides yourself?

YES 1
NO 2-SKIP TO 510

508) How many other wives/partners does your husband currently have?

NUMBER______
DK 98-SKIP TO 510

509) Are you the first, second…wife?

RANK _____

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

ONCE 1
MORE THAN ONCE 2

511) Check 510:
Married/lived with man only once --in what month and year did you start living with your husband/partner?

Married/lived with man more than once --I would like to talk about the first time you were married or started living with a man. In what month and year were you married or did you start living with him?

MONTH _____
DON'T KNOW MONTH 98
YEAR ____ - SKIP TO 514
DON'T KNOW YEAR 9998

512) How old were you when you started living with him?

AGE _____

514) Now I would like 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 first had sexual intercourse (if ever)?

AGE IN YEARS __ __
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95
NEVER 00-SKIP TO 524

514a) CHECK 106:

AGE 15-24-SKIP TO 514B
AGE 25-49-SKIP TO 515

514b) The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DK/DON'T REMEMBER 8

515) When was the last time you had sexual intercourse?
RECORD IN "YEARS AGO" ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.
IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4-SKIP TO 523A

516) The last time you had sexual intercourse, was a condom used?

YES 1
NO 2

517) What is your relationship to the man with whom you last had sex?
IF MAN IS "BOYFRIEND" OR "FIANCÉ" ASK:
Was your boyfriend living with you when you last had sex?
IF YES, CIRCLE 01. IF NO, CIRCLE 02

SPOUSE/COHABITING PARTNER 01-SKIP TO 523
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) 96

518) For how long have you had sexual relations with this man?
IF SHE HAD SEXUAL RELATIONS WITH THIS MAN ONLY ONCE, RECORD 01 DAYS
IF 12 MONTHS OR MORE, THE RESPONSE SHOULD BE RECORDED IN YEARS

DAYS 1
WEEKS 2
MONTHS 3
YEARS 4

518a) CHECK 106:

AGE 15-24-SKIP TO 518A
AGE 25-49-SKIP TO 519

518b) How old is this man?

AGE IN YEARS --SKIP TO 519
DON'T KNOW 98

518c) Would you say this person was more than 10 years older than you?

YES, TEN OR MORE YEARS OLDER 1
NO, LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
YOUNGER THAN WOMAN 4
DON'T KNOW 8

519) In the last 12 months, have you had sexual intercourse with another man?

YES 1
NO 2-SKIP TO 523A

520) The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2

521) What is your relationship with this other man?

IF MAN IS "BOYFRIEND" OR "FIANCÉ" ASK:
Was your boyfriend living with you when you last had sex?
IF YES, CIRCLE 01. IF NO, CIRCLE 02

SPOUSE/COHABITING PARTNER 01-SKIP TO 522E
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) 96

522) For how long have you had sexual relations with this man?
IF SHE HAD SEXUAL RELATIONS WITH THIS MAN ONLY ONCE, RECORD 01 DAYS
IF 12 MONTHS OR MORE, THE RESPONSE SHOULD BE RECORDED IN YEARS

DAYS 1
WEEKS 2
MONTHS 3
YEARS 4

522a) CHECK 106:

AGE 15-24-SKIP TO 522B
AGE 25-49-SKIP TO 519

522b) How old is this man?

AGE IN YEARS --SKIP TO 522E
DON'T KNOW 98

522c) Would you say this person was more than 10 years older than you?

YES, TEN OR MORE YEARS OLDER 1
NO, LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
YOUNGER THAN WOMAN 4
DON'T KNOW 8

522e) Other than these two partners, have you had sexual intercourse with another partner in the last 12 months?

YES 1
NO 2-SKIP TO 523A

522f) The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2

522g) What is your relationship with this other man?

IF MAN IS "BOYFRIEND" OR "FIANCÉ" ASK:
Was your boyfriend living with you when you last had sex?
IF YES, CIRCLE 01. IF NO, CIRCLE 02

SPOUSE/COHABITING PARTNER 01-SKIP TO 523
MAN IS BOYFRIEND/FIANCÉ 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) 96

522h) For how long have you had sexual relations with this man?
IF SHE HAD SEXUAL RELATIONS WITH THIS MAN ONLY ONCE, RECORD 01 DAYS
IF 12 MONTHS OR MORE, THE RESPONSE SHOULD BE RECORDED IN YEARS

DAYS 1
WEEKS 2
MONTHS 3
YEARS 4

522i) CHECK 106:

AGE 15-24
AGE 25-49-SKIP TO 523

522j) How old is this man?

AGE IN YEARS --SKIP TO 523
DON'T KNOW 8

522k) Would you say this person was more than 10 years older than you?'

YES, TEN OR MORE YEARS OLDER 1
NO, LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
YOUNGER THAN WOMAN 4
DON'T KNOW 8

523) In total, how many different people have you had sexual intercourse with in the last 12 months?

NUMBER OF PARTNERS __ __

523a) In total, how many different people have you had sexual intercourse with in your lifetime?

NUMBER OF PARTNERS __ __

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

YES 1
NO 2-SKIP TO 601

525) 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.
ANY OTHER PLACE?
RECORD ALL MENTIONED.

(NAME OF PLACE)_______________
PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
AMASOT/MASOCOT F [##TRANSLATOR NOTE: BOTH ARE ACRONYMS FOR AGENCIES THAT ADVOCATE CONDOMS]
OTHER PUBLIC G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
CLINIC/OFFICE I
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING J
PRIVATE HEALTH CENTER K
COMPANY HEALTH CENTER L
CARE OFFICE/NURSE M
PHARMACY/PHARMACY DEPOT N
OTHER PRIVATE MEDICAL O
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER P
OTHER
SHOP/BAR/MARKET/HOTEL Q
FIRST AID WORKER R
MOBILE VENDOR S
FRIENDS/NEIGHBORS/RELATIVES T
OTHER PLACE_______________- X

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

YES 1
NO 2
DON'T KNOW 8

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311:

NEITHER STERILIZED OR QUESTION NOT ASKED
HE OR SHE STERILIZED --SKIP TO 614

602) CHECK 225:

NOT PREGNANT OR UNSURE (NOW I HAVE SOME QUESTION ABOUT THE FUTURE. Would you like to have (a/another) child, or would you prefer not to have any (more) children?)
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?)
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2-SKIP TO 604
SAYS SHE CAN'T GET PREGNANT 3-SKIP TO 614
UNDECIDED/DON'T KNOW AND PREGNANT 4-SKIP TO 610
UNDECIDED/DON'T KNOW AND NOT PREGNANT/UNSURE 5-SKIP TO 608

603) CHECK 225:

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 this child you are expecting now, how long would you like to wait before the birth of another child?)
MONTHS 1
YEARS 2
SOON/NOW 993-SKIP TO 609
SAYS SHE CAN'T GET PREGNANT 994-SKIP TO 614
AFTER MARRIAGE 995
OTHER (SPECIFY) 996
DON'T KNOW 998
995-998-SKIP TO 609

604) CHECK 225:

NOT PREGNANT OR UNSURE-SKIP TO 605
PREGNANT SKIP TO 610

605) CHECK 310: Using a contraceptive method?

NOT ASKED-SKIP TO 606
NOT CURRENTLY USING-SKIP TO 606
CURRENTLY USING SKIP TO 608

606) CHECK 603:

NOT ASKED-SKIP 606
24 OR MORE MONTHS OR 02 OR MORE YEARS-SKIP TO 607
00-23 MONTHS OR 00-01 YEAR -SKIP TO 610

607) CHECK 602:

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.
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? ANY OTHER REASON?
RECORD ALL REASONS MENTIONED.

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

608) In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

609) CHECK 310: Using a contraceptive method?

NOT ASKED-SKIP TO 610
NO, NOT CURRENTLY USING-SKIP TO 610
YES, CURRENTLY USING -SKIP TO 612

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

YES 1
NO 2-SKIP TO 612
DON'T KNOW 8-SKIP TO 612

611) Which method would you prefer to use?

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER (SPECIFY) 96
UNSURE 98

612) What is the main reason that you think you will never use a contraceptive method at any time in the future?

NOT MARRIED 11
INFREQUENT SEX/NO SEX 12
MENOPAUSAL/HYSTERECTOMY 13
SUBFECUND/INFECUND 14
WANTS AS MANY CHILDREN AS POSSIBLE 15
RESPONDENT OPPOSED 21
HUSBAND/PARTNER OPPOSED 22
OTHERS OPPOSED 23
RELIGIOUS PROHIBITION 24
KNOWS NO METHOD 31
KNOWS NO SOURCE 32
HEALTH CONCERNS 41
FEAR OF SIDE EFFECTS 42
LACK OF ACCESS/TOO FAR 43
COSTS TOO MUCH 44
INCONVENIENT TO USE 45
INTERFERES WITH BODY'S NORMAL PROCESSES 46
OTHER (SPECIFY) 96
DON'T KNOW 98
12-98 SKIP TO 614

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

YES 1
NO 2
DK 8

614) CHECK 216:
HAS LIVING CHILDREN (If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?)

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

PROBE FOR A NUMERIC RESPONSE.

NUMBER __ __
OTHER (SPECIFY) 96-SKIP TO 616

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

NUMBER OF BOYS __ __
NUMBER OF GIRLS __ __
NUMBER OF EITHER __ __
OTHER (SPECIFY) 96

616) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

617) In the last few months have you heard about family planning:

a) On The Radio?
YES 1
NO 2
b) On The Television?
YES 1
NO 2
c) In A Newspaper In Magazine?
YES 1
NO 2
d) On posters?
YES 1
NO 2
e) On leaflets, brochures?
YES 1
NO 2

617a) Do you think it's acceptable or unacceptable to discuss family planning:

a) On the radio?
YES 1
NO 2
b) On television?
YES 1
NO 2
c) In newspapers?
YES 1
NO 2
d) On posters?
YES 1
NO 2
e) In places of worship?
YES 1
NO 2

618) CHECK 501:

CURRENTLY MARRIED/LIVING WITH A MAN
NOT CURRENTLY IN A UNION-SKIP TO 623

619) Now I want to ask you about your husband's/partner's views on family planning.
Do you think your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

620) How often have you talked to your husband/partner about family planning in the last twelve months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

621) CHECK 311/311A:

NEITHER STERILIZED OR QUESTION NOT ASKED-SKIP TO 622
HE OR SHE STERILIZED -SKIP TO 623

622) 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?

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

623) Who do you think should make the decision to use contraception within a couple: the man or the woman?

MAN 1
WOMAN 2
BOTH TOGETHER 3
SOMEONE ELSE 4
DON'T KNOW 8

624) Who do you think usually makes the decision to use contraception within a couple: the man or the woman?

MAN 1
WOMAN 2
BOTH TOGETHER 3
SOMEONE ELSE 4
DON'T KNOW 8

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701) CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN-SKIP TO 702
FORMERLY MARRIED/LIVING WITH A MAN-SKIP TO 703
NO TO Q. 501 AND 502, NEVER BEEN IN A UNION-SKIP TO 707

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

AGE IN COMPLETED YEARS __ __

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

YES 1
NO 2-SKIP TO 706

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

MADRASA ONLY 1-SKIP TO 706
PRIMARY 2
SECONDARY 3
HIGHER 4
PROFESSIONAL, SECONDARY LEVEL 5
PROFESSIONAL, HIGHER LEVEL 6

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

GRADE
DON'T KNOW 8

706) check 701
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?)

_______________________
_______________________
_______________________

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

YES 1-SKIP TO 710
NO 2

708) 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. Are you currently doing any of these things or any other work?'

YES 1-SKIP TO 710
NO 2

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

YES 1
NO 2-SKIP TO 801

710) What is your occupation, that is, what kind of work do you mainly do?
*CODES FOR Q. 705

_____________________
_____________________
__ __

(Including Madrasa)

0=LESS THAN ONE YEAR COMPLETED AT CORRESPONDING LEVEL
LEVEL/CLASS
1=PRIMARY
1=CP1
2=CP2
3=CE1
4=CE2
5=CM1
6=CM2
8=DON'T KNOW
2=SECONDARY
1=6TH
2=5TH
3=4TH
4=3RD
5=2ND
6=1ST
7=FINAL
8=DON'T KNOW
3=HIGHER
1=1ST YEAR
2=2ND YEAR
3=3RD YEAR
4=4TH YEAR +
8=DON'T KNOW
4=PROFESSIONAL SECONDARY LEVEL
1=6TH OR1ST YEAR
2=5TH OR 2ND YEAR
3=4TH OR 3RD YEAR
4=3RD OR 4TH YEAR
5=2ND OR 5TH YEAR
6=1ST OR 6TH YEAR
7=FINAL OR 7TH YEAR
8=DON'T KNOW
5=PROFESSIONAL HIGHER LEVEL
1=1ST YEAR
2=2ND YEAR
3=3RD YEAR
4=4TH YEAR
8=DON'T KNOW

711) CHECK 710:

WORKS IN AGRICULTURE-SKIP TO 712
DOES NOT WORK IN AGRICULTURE -SKIP TO 713

712) 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?
IF FISHER, CIRCLE CODE 6

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
FISHER 6

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

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

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

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

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3-SKIP TO 801
NOT PAID 4-SKIP TO 801

716) Who mainly decides how the money you earn will be used?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

717) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

NONE 1
ALMOST NONE 2
A PORTION 3
ALL/ALMOST ALL 4

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

YES 1
NO 2-SKIP TO 817

801a) How can a person get AIDS?
ANY OTHER WAY?
RECORD ALL MENTIONED

SEXUAL RELATIONS A
NOT USING A CONDOM B
SEXUAL RELATIONS WITH MULTIPLE PARTNERS C
SEXUAL RELATIONS WITH PROSTITUTES D
HOMOSEXUAL RELATIONS E
BLOOD TRANSFUSIONS F
MOTHER TO CHILD G
KISSING H
MOSQUITO BITES I
LIVING WITH SOMEONE WITH AIDS J
DIRTY BLADES, SCISSORS, KNIVES, CUTTING OBJECTS K
FEMALE GENITAL CUTTING/CIRCUMCISION/EAR PIERCING L
EATING/DRINKING FROM SAME DISHES AS SOMEONE WITH AIDS M
OTHER (SPECIFY) X
DON'T KNOW Z

801b) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

801c) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

801d) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

801e) Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

801f) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

801g) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES
NO 2
DON'T KNOW 8

801h) Can people get the AIDS virus through contact with sharp-edged objects contaminated with blood, used, for example, during circumcisions, female genital cutting, scarification?

YES 1
NO 2
DON'T KNOW 8

801i) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2-SKIP TO 809
DON'T KNOW 8-SKIP TO 809

801j) What can a person do?
ANYTHING ELSE?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID CIRCUMCISION/FEMALE GENITAL CUTTING/SCARIFICATION L
AVOID KISSING M
AVOID MOSQUITO BITES N
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) W
OTHER (SPECIFY) X
DON'T KNOW Z

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

YES 1
NO 2
DON'T KNOW 8

810) Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

YES 1
NO 2

811) Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2-SKIP TO 813
DON'T KNOW 8-SKIP TO 813

812) Can the virus that causes AIDS be transmitted from a mother to a child:

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

813) CHECK 501:

YES, CURRENTLY MARRIED/LIVING WITH A MAN-SKIP TO 814
NO, NOT IN UNION SKIP TO 814A

814) Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

YES 1
NO 2

814A) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DK/NOT SURE 8

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

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

816a) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD BE ALLOWED 2
DK/NOT SURE/DEPENDS 8

816aa) do you think that sex education can contribute to AIDS prevention?

YES 1
NO 2
DON'T KNOW 8

816ab) Do you think it is acceptable or not to teach sex education at school?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

816b) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

816C) CHECK 407:

HAD PRENATAL CARE-SKIP TO 816D
Q. 407 NOT ASKED OR NO BIRTHS SINCE JANUARY 1999 OR CODE Y TO Q. 407 (NOT PRENATAL CARE)-SKIP TO 816I

816D) During the prenatal visits for (NAME OF LAST BIRTH ON Q 404), did anyone:

Tell you that children can contract the virus that causes AIDS from their mother?
YES 1
NO 2
Speak to you about being tested for the virus that causes AIDS?
YES 1
NO 2

816E) I don't want to know the results, but were you tested to see if you have the AIDS virus during any of these prenatal visits?

YES 1
NO 2 --SKIP 816I

816F) Did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

816G) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

816H) Have you had an AIDS test since you were tested during your pregnancy?

YES 1 --SKIP TO 816J
NO 2-SKIP TO 816N

816I) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 --SKIP TO 816KA

816J) When was the last time you were tested?

LESS THAN 12 MONTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3

816ja) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

816jb) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

816k) Where was the test done?
YOU ONLY HAVE TO CIRCLE ONE CODE

PUBLIC SECTOR
TESTING CENTER 11 [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
HOSPITAL/MATERNITY 12
MILITARY HOSPITAL/GARRISON 13
HEALTH CENTER/FREE CLINIC/GARRISON 14
NATIONAL PROGRAM FIGHTING AIDS (PNLS) 15 [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC 16
HOSPITAL/HEALTH CENTER PHARMACY 17
OTHER PUBLIC 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
CLINIC/OFFICE 22
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING 23
PRIVATE HEALTH CENTER 24
COMPANY HEALTH CENTER 25
CARE OFFICE/NURSE 26
PHARMACY/PHARMACY DEPOT 27
OTHER PRIVATE MEDICAL 28
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER 31
OTHER PLACE 96
ALL SKIP TO 816N

816ka) Would you like to have an AIDS test?

YES 1
NO 2
DON'T KNOW 8

816kb) Do you know a place where you can be tested for AIDS?

YES 1
NO 2-SKIP TO 816N

816l) Where can you go for this test?
ANYWHERE ELSE?
RECORD ALL MENTIONED

PUBLIC SECTOR
TESTING CENTER A [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC/GARRISON D
NATIONAL PROGRAM FIGHTING AIDS (PNLS) E [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC F
HOSPITAL/HEALTH CENTER PHARMACY G
OTHER PUBLIC H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
CLINIC/OFFICE J
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING K
PRIVATE HEALTH CENTER L
COMPANY HEALTH CENTER M
CARE OFFICE/NURSE N
PHARMACY/PHARMACY DEPOT O
OTHER PRIVATE MEDICAL P
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER Q
OTHER PLACE X

816N) CHECK 501:

CURRENTLY MARRIED/LIVING WITH A MAN-SKIP TO 816O
NOT CURRENTLY IN A UNION-SKIP TO 816P

816o) Have you ever talked about ways to prevent getting the virus that causes AIDS with your
husband/partner?

YES 1
NO 2

816p) Do you think it's acceptable or unacceptable to talk about AIDS:

a) on the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
b) On television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
c) In the newspaper?
ACCEPTABLE 1
NOT ACCEPTABLE 2
d) On posters?
ACCEPTABLE 1
NOT ACCEPTABLE 2
e) In places of worship?
ACCEPTABLE 1
NOT ACCEPTABLE 2

816q) Do you think there are some segments of the population who have a higher risk of getting age because of, for example, their behavior or their job?

YES 1
NO 2-SKIP TO 816T
DON'T KNOW 8-SKIP TO 816T

816r) Do you think that you are part of an at-risk group?

YES 1
NO 2
DON'T KNOW 8

816s) What segments of the population do you think are more at risk of getting AIDS?
Any other group?
RECORD ALL MENTIONED

PROSTITUTE A
HOMOSEXUAL B
DRUG ADDICTS C
TRUCKER D
MILITARY/POLICE E
MIGRANT F
REFUGEE G
OTHER (SPECIFY) X

816t) Is there treatment for people with AIDS?

YES 1
NO 2-SKIP TO 817
DON'T KNOW 8-SKIP TO 817

816u) What treatments do you know?
ANY OTHER TREATMENT?
RECORD ALL MENTIONED

TRI-THERAPY/ARV/ART/ANTIRETROVIRAL A
OTHER MODERN DRUGS B
OTHER TRADITIONAL DRUGS C
OTHER (SPECIFY) X

816v) Do you know where a person with AIDS can go for treatment?
If yes, where can he/she go?
ANY OTHER PLACE?
RECORD ALL MENTIONED.

PUBLIC SECTOR
TESTING CENTER A [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC/GARRISON D
NATIONAL PROGRAM FIGHTING AIDS (PNLS) E [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC F
HOSPITAL/HEALTH CENTER PHARMACY G
OTHER PUBLIC H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
CLINIC/OFFICE J
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING K
PRIVATE HEALTH CENTER L
COMPANY HEALTH CENTER M
CARE OFFICE/NURSE N
PHARMACY/PHARMACY DEPOT O
OTHER PRIVATE MEDICAL P
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER Q
TRADITIONAL PRACTITIONER/MARABOU R
OTHER PLACE X
NOWHERE/NO ONE Y

817) Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

YES 1
NO 2-SKIP TO 819A

818) If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
IMPOTENCE L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

819) If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
LOSS OF WEIGHT K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) W
OTHER (SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

819a) CHECK 514:

HAD HAD SEXUAL INTERCOURSE-SKIP TO 819B
HAS NOT HAD SEXUAL INTERCOURSE -SKIP TO 901

819B) CHECK 817

HAS HEARD OF SEXUALLY TRANSMITTED INFECTIONS-SKIP TO 819C
HAS NOT HEARD OF SEXUALLY TRANSMITTED INFECTIONS SKIP TO 819D

819C) Now I would like to ask you some questions about your health. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

819d) Sometimes women experience a bad-smelling abnormal genital discharge. Have you had a bad-smelling abnormal genital discharge in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

819E) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

819F) CHECK 819C, 819D, 819E:

YES TO Q. 819C, D, OR E, HAS HAD AN INFECTION-SKIP TO 819G
NO OR DK TO Q. 819C, D, E, HAS NOT HAD AN INFECTION --SKIP TO 819L

819g) The last time you had (INFECTION FROM 819C, 819D, AND/OR 819E), did you seek any kind of advice or treatment from a health professional?

YES 1
NO 2-SKIP TO 819I

819h) The last time you had (infection from 819C, 819D, and/or 819E), did you do any other following? Did you…

a) Seek advice or treatment from a health care professional or in a health care establishment?
YES 1
NO 2
b) Seek advice or treatment from a traditional practitioner/marabou
YES 1
NO 2
c) Seek advice or treatment from a shop, a market, or a pharmacy?
YES 1
NO 2
d) Seek advice from friends or relatives?
YES 1
NO 2

819i) When you had (infection FROM 819C, 819D, AND/OR 819E), did you inform the people were you having sexual intercourse with?

YES 1
NO 2
SOME PEOPLE/NOT ALL 3

819j) When you had (INFECTION FROM 819C, 819D, AND/OR 819E), did you do something to avoid infecting your sexual partners?

YES 1
NO 2-SKIP TO 819L
PARTNER(S) ALREADY INFECTED 3-SKIP TO 819L
DIDN'T HAVE PARTNER 4-SKIP TO 819L

819k) What did you do to prevent infection in your partner(s)? Did you

Stop sexual intercourse?
YES 1
NO 2
Use a condom during sexual intercourse?
YES 1
NO 2
Taken drugs?
YES 1
NO 2

819l) Husband and wives do not always agree in everything. Please tell me if you think a woman is justified refusing to have sex with her husband when:

She knows her husband has a disease that she can get during sexual intercourse?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with other women?
YES 1
NO 2
DON'T KNOW 8
She recently gave birth?
YES 1
NO 2
DON'T KNOW 8
She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

819m) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

SECTION 9. MATERNAL MORALITY

901a) 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.

901b) How many boys did your mother have who are still living?

Boys living __ __

901c) How many boys did your mother have who died?

BOYS DIED __ __

901d) Other than yourself, how many girls did your mother have who are still living?

GIRLS LIVING __ __

901e) How many girls did your mother have who died?

GIRLS DIED __ __

901f) Did your mother give birth to any other children, who you don't know if they are living or dead?

YES 1
NO 2-SKIP TO 901H

901g) How many other children did your mother give birth do, who you don't know if they are living or dead?

OTHER CHILDREN __ __

901h) ADD THE ANSWERS FORM 901B, C, D, E, AND G,
ADD 1 (THE RESPONDENT) AND RECORD THE TOTAL

TOTAL __ __

901i) CHECK 901H:
Just to make sure that I've understood, including yourself, your mother give birth to _____ children total. Is that correct?

YES
NO-PROBE AND CORRECT 901A-901H AS NECESSARY

902) CHECK 901H

TWO OR MORE BIRTHS-SKIP TO 903
ONLY ONE BIRTH (RESPONDENT ONLY)-SKIP TO 913

903) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS __ __

904) What was the name given to the first (second) child your mother had (other than yourself)?

1, 2, 3, 4, etc.
__________________

905) Is (NAME) male or female?

MALE 1
FEMALE 2

906) Is (NAME) still alive?

YES 1
NO 2-GO TO 908
DK 8-GO TO [2,3,4, ETC]

907) How old is (NAME)?

GO TO [2,3,4,ETC]

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

__ __

909) How old was (NAME) when he/she died?
IF DON'T KNOW, PROBE:
Did (Name) die before the age of 12?

IF YES, RECORD 95.
IF NO, ASK OTHER QUESTIONS TO GET AN ESTIMATE, FOR EXAMPLE: DID (NAME) DIE BEFORE GETTING MARRIED?

__ __

910) Was (NAME) pregnant when she died?

YES 1-GO TO 1, 2, 3
NO 2

911) Did (NAME) die during childbirth?

YES 1 -- GO TO 1, 2, 3
NO 2

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

YES 1
NO 2
DON'T KNOW 8

IF NO MORE BROTHERS OR SISTERS, GO TO 1001
[##translator note: questions repeated with same numbers to accommodate larger families]

913) COMPARE 901H WITH NUMBER OF BROTHERS AND SISTER LISTED IN BIRTH HISTORY OF YOUR MOTHER AND CHECK:

901H MINUS 1 EQUAL THE NUMBER OF COLUMNS-SKIP TO 1001
901H MINUS 1 IS DIFFERENT FROM NUMBER OF COLUMNS-PROBE AND RECONCILE

SECTION 10. FEMALE GENITAL CUTTING

1001) Have you ever heard of female circumcision?

YES 1-SKIP TO 1003
NO 2

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

YES 1
NO 2-SKIP TO 1025

1003) Have you yourself ever had your genitals cut, meaning did someone cut a part of your external genital organs?

YES 1
NO 2-SKIP TO 1009

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

YES 1 --SKIP TO 1006
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

1006) Was your genital area sown closed, completely or partially?

YES 1
NO 2
DON'T KNOW 8

1006a) With your first period or when you got married, did someone have to make an incision to open the vaginal area?

YES 1
NO 2

1007) How old were you when this occurred?
IF LESS THAN ONE YEAR, RECORD '00'
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

IF RESPONDENT DOES NOT WANT TO GIVE AN APPROXIMATE AGE, TRY TO DETERMINE IF IT WAS BEFORE 5 YEARS, BETWEEN 5 AND 9 YEARS, OR AT 10 YEARS OR OLDER.

IF NO ESTIMATE IS POSSIBLE, CIRCLE CODE 998 FOR DON'T KNOW

AGE IN MONTHS 1 __ __
AGE IN YEARS 2 __ __
APPROX BEFORE 5 991
APPROX BETWEEN 5 AND 9 992
APPROX AFTER 10 993
DON'T KNOW 998

1008) Who cut (or nicked) your genitals?

TRADITIONAL
TRAD. CIRCUMCISER 11
TRAD. BIRTH ATTENDANT 12
OLD WOMAN 13
OTHER TRADITIONAL (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
MATRON 23
OTHER HEALTH PROFESSIONAL (SPECIFY) 26
OTHER 96
DON'T KNOW 98

1008a) At the time that the genitals were cut or afterwards, did you have any of the following problems:

Excessive bleeding?
YES 1
NO 2
DON'T KNOW 8
Difficulty in passing urine or urine retention?
YES 1
NO 2
DON'T KNOW 8
Swelling in the genital area?
YES 1
NO 2
DON'T KNOW 8
Infection in the genital area
YES 1
NO 2
DON'T KNOW 8
Wound that did not heal properly?
YES 1
NO 2
DON'T KNOW 8

1009) CHECK 214 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER-SKIP TO 1010
HAS NO LIVING DAUGHTER SKIP TO 1019

1010) CHECK 214 AND 216:

HAS ONE LIVING DAUGHTEr-Did your daughter have her genitals cut?
(IF 'YES', RECORD '01' IN THE SPACES TO THE RIGHT; IF 'NO', CIRCLE '95')
HAS TWO OR MORE LIVING DAUGHTERS-Have any of your daughters had her genitals cut?
(IF 'YES', HOW MANY? RECORD THE NUMBER IN THE SPACES TO THE RIGHT; IF 'NONE', CIRCLE 95)

NUMBER CIRCUMCISED __ __
NO DAUGHTER CIRCUMCISED 95-SKIP TO 1018

1011) CHECK 1010:
HAD ONLY ONE DAUGHTER CIRCUMCISED-WHAT IS THE NAME OF YOUR DAUGHTER WHO WAS CIRCUMCISED?
(Name of daughter)_______________
CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.

HAD TWO OR MORE DAUGHTERS CIRCUMCISED-To which of your daughters did this happen most recently?
(Name of daughter)_______________
CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.

DAUGHTER'S LINE NUMBER FROM Q212 __ __

1012) Now I would like to ask you what was done to (Name of the daughter from Q.1011) at this time.
Was any flesh removed from her genital area?

YES 1-SKIP TO 1014
NO 2
DON'T KNOW 8

1013) Was her genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1014) Was her genital area sown closed?

YES 1
NO 2
DON'T KNOW 8

1015) How old was (Name of the daughter form Q. 1011) when this occurred?
IF LESS THAN ONE YEAR RECORD 00
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.
IF RESPONDENT DOES NOT WANT TO GIVE AN APPROXIMATE AGE, TRY TO DETERMINE IF IT WAS BEFORE 5 YEARS, BETWEEN 5 AND 9 YEARS, OR AT 10 YEARS OR OLDER.

IF NO ESTIMATE IS POSSIBLE, CIRCLE CODE 998 FOR DON'T KNOW

AGE IN MONTHS 1 __ __
AGE IN YEARS 2 __ __
APPROX BEFORE 5 991
APPROX BETWEEN 5 AND 9 992
APPROX AFTER 10 993
DON'T KNOW 998

1016) Who cut (or nicked) her genitals?

TRADITIONAL
TRAD. CIRCUMCISER 11
TRAD. BIRTH ATTENDANT 12
OLD WOMAN 13
OTHER TRADITIONAL (SPECIFY) 16
HEALTH PROFESSIONAL
DOCTOR 21
NURSE/MIDWIFE 22
MATRON 23
OTHER HEALTH PROFESSIONAL (SPECIFY) 26
OTHER 96
DON'T KNOW 98

1017) At the time that the genitals were cut or afterwards, did (name of the daughter from Q. 1011) have any of the following problems:

Excessive bleeding?
YES 1
NO 2
DON'T KNOW-skip to 1019
Difficulty in passing urine or urine retention?
YES 1
NO 2
DON'T KNOW-skip to 1019
Swelling in the genital area?
YES 1
NO 2
DON'T KNOW-skip to 1019
Infection in the genital area?
YES 1
NO 2
DON'T KNOW-skip to 1019
Wound that did not heal properly?
YES 1
NO 2
DON'T KNOW-skip to 1019

1018) CHECK 214 AND 216:
HAS ONE LIVING DAUGHTER-Do you intend to have this genital cutting done one your daughter in the future?

HAS TWO OR MORE LIVING DAUGHTERS-Do you intend to have this genital cutting done to any of your daughters in the future?

YES 1
NO 2
DON'T KNOW 8

1019) What benefits do girls get if they undergo this genital cutting?
PROBE: Other benefits?
RECORD ALL MENTIONED

CLEANLINESS/HYGIENE A
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
APPEASES WOMAN'S SEXUAL DESIRE D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS APPROVAL F
OTHER (SPECIFY) X
NO BENEFITS Y

1020) What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED

FEWER MEDICAL PROBLEMS A
FEWER CHILDBIRTH PROBLEMS B
AVOIDING PAIN C
MORE SEXUAL PLEASURE FOR HER D
MORE SEXUAL PLEASURE FOR THE MAN E
FOLLOWS RELIGION F
OTHER (SPECIFY) X
NO ADVANTAGES Y

1020A) CHECK 1019:

CODE 'D' NOT CIRCLED FOR Q. 1019 OR Q. 1020-SKIP TO 1021
CODE 'D' CIRCLED FOR Q. 1019 OR Q. 1020 -SKIP TO 1021A

1021) Would you say that this practice is a way to appease women's sexual desire or does it have no effect?

Prevent sex 1
No effect 2
Don't know 8

1021A) CHECK 1019 AND 1020:

NEITHER 'F' (Q1019) NOR 'F' (Q1020) CIRCLED-SKIP TO 1022
CODE 'F' (Q1019) OR 'F' (Q1020) CIRCLED-SKIP TO 1023

1022) Do you believe that this practice is required by your religion?

YES 1
NO 2
DON'T KNOW 8

1023) Do you think that this practice should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

1024) Do you think that men want this practice to be continued, or discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

1025) RECORD TIME

HOURS __ __
MINUTES __ __

SECTION 11. HEIGHT AND WEIGHT

IN 1103 (COLUMN 1) RECORD RESPONDENT'S NAME
IN 1102, 1103, AND 1104 (COLUMNS 2 AND 3), RECORD THE LINE EACH CHILD BORN BEFORE JANUARY 1999, HE OR HER NAME AND BIRTH DATE. ASK THE CHILDREN'S BIRTH DATE.

IN Q. 1106 AND 1008 RECORD THE RESPONDENT'S AND CHILDREN'S HEIGHT AND WEIGHT. (IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN BEFORE JANUARY 1999, USE COLUMNS 2 AND 3 OF ADDITIONAL QUESTIONNAIRE)

1) RESPONDENT
2) YOUNGEST LIVING CHILD
3) NEXT-TO-YOUNGEST LIVING CHILD

1102) LINE NO. FROM Q. 212

__ __

1103) Name (from q. 212 for children)

NAME________

1104) Date of birth
From q. 215, and ask for day of birth

DAY __ __
MONTH __ __
YEARS __ __ __ __

1105) BCG scar on top of left shoulder

SCAR SEEN 1
NO SCAR 2

1106) Height (in centimeters)

__ __ __.__

1107) Was length/height of child measured lying down or standing up?

LYING 1
STANDING 2

1108) Weight (in kilograms)

__ __ __.__

1109) Date weighed and measured

DAY __ __
MONTH __ __
YEAR 200__

1110) Result

MEASURED 1
NOT PRESENT 2
REFUSED 4
OTHER (SPECIFY) 6
MEASURED 1
SICK 2
NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) 6

1111) Name of measurer

NAME OF ASSISTANT________________ __ __

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

___________________________
___________________________
___________________________

COMMENTS ON SPECIFIC QUESTIONS:

___________________________
___________________________
___________________________

ANY OTHER COMMENTS:

___________________________
___________________________
___________________________

SUPERVISOR'S OBSERVATIONS

___________________________
___________________________
___________________________

NAME OF SUPERVISOR__________
DATE____________

EDITOR'S OBSERVATIONS

___________________________
___________________________
___________________________

NAME OF EDITOR__________
DATE__________