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

Residence

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

INTERVIEWER VISITS

FIRST INTERVIEWER VISIT

SECOND INTERVIEWER VISIT

THIRD INTERVIEWER VISIT

FINAL VISIT

NEXT VISIT

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

**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

FIELD EDITOR

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

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

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

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?

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

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

110) CHECK 106:

111) Are you currently attending school?

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

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

113) Check 107 and 108:

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?

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

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

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

118) What is your religion?

120) What is your ethnicity?

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?

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

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

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

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

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

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

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

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

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

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

210) Check 208:

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

01, 02, 03, etc?

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/her birthday?

216) Is (name) still alive?

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

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

219) If 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.

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

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

222) Compare 208 with number of births in history above and mark:
NUMBERS ARE SAME
CHECK:

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

225) Are you pregnant now?

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

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

229) When did the last such pregnancy end?

230) CHECK 229:

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

232) Was this pregnancy terminated by an elective abortion?

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

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

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

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?

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

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)?

302) Have you ever heard of (METHOD)?

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?

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?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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)?

302) Have you ever heard of (METHOD)?

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

303) CHECK 302:

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

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

308) CHECK 302 (01):

309) CHECK 225:

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

311) CHECK 302:

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?

313) CHECK 311:
CIRCLE METHOD CODE

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?

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

316) Where is this?

Any other place?
RECORD ALL PLACES MENTIONED

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

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

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

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

322) CHECK 208:

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

324) CHECK 225 and 311:

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

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

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

404) From 212 and 216

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

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

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

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.

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

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

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

410) CHECK 409:
Number of times received antenatal care

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

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

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

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

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

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

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

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.

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

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

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

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

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

423) Was (Name) weighed at birth?

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

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.

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

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

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

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

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.

431) Where did this first check take place?

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

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

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

436) CHECK 225:
Is respondent pregnant?

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

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

439) Did you ever breastfeed (NAME)?

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.

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?

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

441) CHECK 404: Is child living?

442) Are you still breastfeeding (NAME)?

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

444) CHECK 404: Is child living?

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

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

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

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?

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?

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

453) FROM Q 212 AND Q 216

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

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

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

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

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.

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

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?

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

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

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

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

460f) How many times?

460g) An injection to prevent measles?

460h) An injection to prevent yellow fever?

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

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

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

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

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

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

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

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

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

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

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

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

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

472a) Was there blood in the stools?

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?

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?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

481) CHECK 475A IN ALL COLUMNS:

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

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

504a) Who initiated your divorce/separation?

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

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

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'.

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

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

509) Are you the first, second?wife?

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

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?

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

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)?

514a) CHECK 106:

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

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

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

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

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

518a) CHECK 106:

518b) How old is this man?

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

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

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

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

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

522a) CHECK 106:

522b) How old is this man?

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

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

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

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

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

522i) CHECK 106:

522j) How old is this man?

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

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

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

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

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.

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

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311:

602) CHECK 225:

603) CHECK 225:

604) CHECK 225:

605) CHECK 310: Using a contraceptive method?

606) CHECK 603:

607) CHECK 602:

CAN YOU TELL ME WHY? ANY OTHER REASON?
RECORD ALL REASONS MENTIONED.

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?

609) CHECK 310: Using a contraceptive method?

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

611) Which method would you prefer to use?

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

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

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.

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?

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

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

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

618) CHECK 501:

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?

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

621) CHECK 311/311A:

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?

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

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

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

701) CHECK 501 AND 502:

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

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

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

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

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?

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?'

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

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

(Including Madrasa)

711) CHECK 710:

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

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

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

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

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

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?

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?

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

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

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

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

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

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

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

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?

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

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

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

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

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

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

813) CHECK 501:

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

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

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

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?

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?

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

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

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

816C) CHECK 407:

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

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?

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

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

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

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

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

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?

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

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

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

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

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

816N) CHECK 501:

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

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

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?

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

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

816t) Is there treatment for people with AIDS?

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

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.

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

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

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

819a) CHECK 514:

819B) CHECK 817

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?

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

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

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

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?

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

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

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

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

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:

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?

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?

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

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

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

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

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

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

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

902) CHECK 901H

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

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

905) Is (NAME) male or female?

906) Is (NAME) still alive?

907) How old is (NAME)?

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?

911) Did (NAME) die during childbirth?

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

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:

SECTION 10. FEMALE GENITAL CUTTING

1001) Have you ever heard of female circumcision?

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?

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

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

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

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

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

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

1008) Who cut (or nicked) your genitals?

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

1009) CHECK 214 AND 216:

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)

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.

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?

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

1014) Was her genital area sown closed?

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

1016) Who cut (or nicked) her genitals?

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:

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?

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

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

1020A) CHECK 1019:

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

1021A) CHECK 1019 AND 1020:

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

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

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

1025) RECORD TIME

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)

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

1105) BCG scar on top of left shoulder

1106) Height (in centimeters)

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

1108) Weight (in kilograms)

1109) Date weighed and measured

1110) Result

1111) Name of measurer

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__________