Ministry of Planning and of Territory Construction

IDENTIFICATION

REGION ___________

PREFECTURE _______________

CITY/ADMINISTRATIVE DISTRICT _____________

URBAN/RURAL

VILLAGE/NEIGHBORHOOD __________

CLUSTER NUMBER _____________

PLOT NUMBER ____________

HOUSEHOLD NUMBER ______________

NAME OF HEAD OF HOUSEHOLD ____________

WOMAN'S NAME AND LINE NUMBER ___________

INTERVIEWER VISITS

DATE ___________

INTERVIEWER'S NAME ________

RESULT

NEXT VISIT
DATE __________
TIME __________

FINAL VISIT
DAY ________
MONTH ______
YEAR 1998
NAME ________
RESULT __________

TOTAL NUMBER OF VISITS ____________

FRENCH QUESTIONNAIRE 1

LANGUAGE OF INTERVIEW

INTERPRETER

SUPERVISOR
NAME __________
DATE __________

FIELD EDITOR
NAME _________
DATE ___________

OFFICE EDITOR __________

KEYED BY __________

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Lome, main regional location/Kpalime, in another city, in the countryside or abroad?

(NAME OF PLACE "PREFECTURE")______________

103) How long have you been continuously live in (NAME OF CURRENT PLACE OF RESIDENCE)?

104) Just before you moved to (NAME OF CURRENT PLACE OF RESIDENCE), did you live in Lome, main regional location/Kpalime, in another city, in the countryside or abroad?

(NAME OF PLACE "PREFECTURE")____________

105) In what month and what year were you born?

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

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?
(CONVERT IN NUMBERS OF YEARS COMPLETED)

110) CHECK 106:

111) Are you currently going to school?

111A) At what age did you stop going to school?

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

113) CHECK 108:

113B) Do you understand French easily, with difficulty, or not at all?

114) Can you read and understand a letter or a newspaper, easily, with difficulty, or not at all in French or in another language?

114A) Do you usually read a newspaper or magazine at least once a month?

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

116) Do you listen to the radio often, sometimes, or never?

116A) What days of the week do you normally listen to the radio?

RECORD ALL RESPONSES GIVEN

IF THE RESPONSE IS "EVERYDAY", "IT DEPENDS," "IT DOESN'T MATTER," OR "DON'T KNOW", YOU ONLY NEED TO RECORD ONE CODE.

116B) What time do you normally listen to the radio?

RECORD ALL RESPONSES GIVEN

IF THE RESPONSE IS "ALL DAY", "IT DEPENDS," "IT DOESN'T MATTER," OR "DK", YOU ONLY NEED TO RECORD ONE CODE.

116C) What time of radio program do you normally listen to?

PROBE TO OBTAIN THE TYPE OF PROGRAM.

RECORD ALL THE PROGRAMS

116D) Have you had a chance to listen to the radio serial "Yamba Songo"?

116E) According to you, is this serial educational, or for entertainment?

116F) According to you, what problems does "Yamba Songo" talk about?"

RECORD ALL OF THE RESPONSES GIVEN

IF THE RESPONSE IS 'DON'T KNOW,' YOU ONLY HAVE TO CIRCLE THAT CODE.

117) Do you usually watch television often, sometimes, or never?

117A) What days of the week do you normally watch television?

IF THE RESPONSE IS "EVERYDAY", "IT DEPENDS," "IT DOESN'T MATTER," OR "DON'T KNOW", YOU ONLY NEED TO RECORD ONE CODE.

117B) What time do you normally watch television?

RECORD ALL THE RESPONSES GIVEN

IF THE RESPONSE IS 'ALL DAY,' 'IT DEPENDS,' 'DOESN'T MATTER,' OR 'DON'T KNOW,' YOU ONLY HAVE TO RECORD ONE CODE.

117C) What type of television show do you normally watch?

PROBE TO OBTAIN THE TYPE OF SHOW.

RECORD ALL OF THE SHOWS WATCHED.

118) What is your religion?

119) What is your nationality?

119B) What is your ethnicity?
(NAME OF ETHNICITY) ___________

120) CHECK QUESTION 4 OF HOUSEHOLD QUESTIONNAIRE

121) Now I would like to ask you a few questions about where you normally live. What is the name of the area where you normally life?

122) RECORD THE NAME OF THE REGION OF PLACE OF RESIDENCE

123) Now I would like to ask you a few questions on the household in which you live normally.
What is the main source of drinking water for members of your household?

124) What is the distance between this source and your house?

125) What type of toilet do you use in your household?

126) In your household do you have:

127) Could you describe the main material of the floor of your home?

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?
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?
How many daughters are alive but do not live with you?
IF 'NONE', RECORD '00'

206) Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: any child cried or showed signs of life but survived only a few hours or days?

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

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

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

210) CHECK 208:

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

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

213) Were any of these births twins?

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

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

216) Is (NAME) still alive?

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

218) IF ALIVE: Does (NAME) live with you?

219) IF DEAD: How old was (NAME) when he/she died?
IF "1 YEAR," PROBE: How many months old was (NAME)?

RECORD IN DAYS IF LESS THAN 1 MONTH;
MONTHS IF LESS THAN TWO YEARS;
OR YEARS

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

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

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

223) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD THE NAME(S) IN THE SCHEDULE
IF NO, ASK WHY AND RECORD THE ANSWERS

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

225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1995
IF NONE, NOTE '0' AND CONTINUE TO THE FIRST QUESTIONNAIRE

227) Are you pregnant now?

228) How many months pregnant are you?
RECORD NUMBER IN COMPLETED MONTHS.

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

236) When did you last menstrual cycle start?
(RECORD DATE, IF GIVE, AND CONVERT TO TIME PASSED)

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

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

SECTION 3: FAMILY PLANNING

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 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301) Which ways or methods have you heard about?

302) Have you ever heard of (METHOD)?

303) Have you ever used (METHOD)?

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

307) What have you used or done?

CORRECT 303 AND 304 (AND 302 IF NECESSARY)

309) 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'

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

311) CHECK 303:

312) CHECK 227:

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

314) Which method are you using?
VERIFY THAT THE METHOD CITED IS KNOWN AND ALREADY USED

314A) CIRCLE 07 FOR 'FEMALE STERILIZATION'

315) May I see the package of pills you are using right now?
(RECORD NAME OF BRAND IF PACKAGE IS SEEN)

316) Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND

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

318A) Why did (you or your spouse/partner) have an operation to not have any more children, rather than using another method?

318B) Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE)__________

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

320) Why do you regret the operation?

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

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

326) For how many months have you been using (METHOD FROM Q. 314) continuously?
IF LESS THAN 1 MONTH, RECORD '00'

326A) Why do you use (METHOD FROM Q. 314) rather than another method?

326B) For how long have you been using (METHOD FROM Q. 314) continuously?
IF LESS THAN 1 MONTH, RECORD '00'

327) CHECK 314:
CIRCLE THE CODE OF THE METHOD.

328) Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE________

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

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

329B) People choose the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF LOCATION LISTED AT Q. 328 OR Q. 318) instead of some other place you know about?
RECORD EVERYTHING THAT IS MENTIONED.
IF THE ANSWER IS 'DON'T KNOW' YOU ONLY NEED TO CIRCLE THE CORRESPONDING CODE.

Other reasons?

331) What is the main reason that you are not using a method of contraception to avoid pregnancy?

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

333) Where is that?

IF SOURCE IS HOSPITAL, HEATH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE)________

334) Where you visited by a family planning program worker in the last 12 months?

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

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

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

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

339) CHECK 210:

340) Have you ever relied on breastfeeding as a method of avoiding pregnancy?

341) CHECK 227 AND 311:

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

SECTION 4A: PREGNANCY AND BREASTFEEDING

401) CHECK 225:

402) RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE THE ADDITIONAL QUESTIONNAIRE.)

Now I would like to ask you some more questions about the health of all your children born in the last 3 years. We will talk about once child at a time.

403) LINE NUMBER FROM Q. 212

404) FROM Q212 AND Q216:

405) At the time you became pregnant with (NAME), did you want to get pregnant then, did you want to wait until later, or did you want no (more) children at all?

406) How much longer would you like to have waited?
(LESS THAN 1 YEAR, RECORD IN MONTHS, ONE YEAR OR MORE, RECORD IN YEARS)

407) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
SI YES: Whom did you see? Someone else?

PROBE TO OBTAIN THE TYPE OF PERSON. RECORD ALL OF THE PERSONS SEEN.

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

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

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

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

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

(NAME OF ESTABLISHMENT) ____________

413) Who assisted you with the delivery of (NAME)?
Anyone else?
PROBE TO OBTAIN THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

414) Are the time of the birth of (NAME), did you have any of the following problems?

415) Was (NAME) delivered by cesarean?

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

417) Was (NAME) weighed at birth?

418) How much did (NAME) weigh?
RECORD THE WEIGHT WRITTEN IN THE HEALTH CARD, IF AVAILABLE
(IF IN KG, CONVERT TO GRAMS)

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

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

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

422) CHECK 227: RESPONDENT PREGNANT?

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

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

425) Did you breastfeed (NAME)?

426) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE RECORD DAYS.

427) CHECK 404: CHILD ALIVE?

428) Are you still breastfeeding (NAME)?

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

430) Why did you stop breastfeeding (NAME)?

431) CHECK 404: CHILD ALIVE?

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

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

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

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

436) CHECK 435: FOOD OR LIQUID GIVEN YESTERDAY?

437) (Aside from breastfeeding), how many times did (NAME) eat yesterday, including both meals and liquids?
IF 7 OR MORE, RECORD 7

438) How many days during the last seven days was (NAME) given any of the following:
IF DON'T KNOW, RECORD 8
RECORD THE NUMBER OF DAYS

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

SECTION 4B. IMMUNIZATION AND HEALTH

440) ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995 IN THE TABLE. ASK THE QUESTIONS FOR ALL THE BIRTHS. BEGIN WITH THE LAST BIRTH.(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRE)

441) LINE NUMBER FROM Q. 212

442) ACCORDING TO Q. 212 AND 216

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

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

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

446) Has (NAME) received any vaccination that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DTCOQ 1-3, OR MEASLES.

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

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

448A) A BCG vaccination against tuberculosis, that is, an injection in the upper left arm that caused a scar.

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

448C) How many times?

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

448E) DPT vaccination, that is, an injection usually given at the same time as polio drops (in the arm or thigh)?

448F) How many times?

448G) Any injection to prevent measles (in the upper arm or back)?

449) Has (NAME) ever been ill with a fever at any time during the last 2 weeks?

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

451) When (NAME) was ill with a cough, did he/she breathe more rapidly than usual with short, rapid breaths?

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

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

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

455) Was there blood in the stools?

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

457) Was (NAME) given the same amount to drink as before the diarrhea, or more, less or nothing?

458) Was (NAME) given the same amount of food to eat as before the diarrhea, or more, less or nothing?

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

460) Was anything else given to (NAME) to treat the diarrhea?

461) What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED

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

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

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

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

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

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

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

470) CHECK 459, ALL COLUMNS:

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

471A) Have you ever used this product?

472) Where did you get ORS last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE)____________

473) Do you currently have an ORS packet in your home?

474) Could I see the ORS packet you have?
IF THE PACKET IS SHOWN, CIRCLE THE CORRESPONDING NUMBER

475) Do you know the brand name of the ORS packet that you have now?
RECORD THE NAME OF THE BRAND

476) How much did the packet of ORS cost?

477) CHECK 459, ALL THE COLUMNS:

478) Have you heard of a solution of salt, sugar, and water that you prepare at home and that you give to children to treat diarrhea?

479) Have you ever prepared this solution?

SECTION 5. MARRIAGE

501) PRESENCE OF OTHERS AT THIS POINT

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

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

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

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

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

507A) Record the line number of her husband according to the household questionnaire.

508) Does your husband/partner have any other wives, besides yourself?

509) How many other wives does he have?

510) Are you the first, second?wife?

511) Have you been married or have you lived with a man only once or more than once (including your current union)?

512) CHECK 511:
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: Now we will talk about your first husband/partner. In what month and year did you start living with him?

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

514A) CHECK 502:

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

When was the last time you had sexual intercourse with (your husband/the man with whom you live)?

515A) CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex with (your husband/the man with whom you live), was a condom used?

DOES NOT KNOW CONDOM: Some men used a condom, which means they put a rubber sheath on their penis during sexual intercourse. The last time you had sex with (your husband/the man with whom you live), was a condom used?

515AA) During this last sexual relation, who suggested using the condom?

515B) Have you had sexual relations with someone other than (your husband/the man with whom you live) in the last 12 months?

515C) When was the last time you had sexual relations with someone other than (your husband/the man with whom you live)

515CA) The last time you had sexual relations with someone other than (your husband/the man with whom you live), was it with a regular partner, an acquaintance, for money, or someone else?

515D) Was a condom used on this occasion?

515DA) During this last sexual relation, who suggested using the condom?

515E) During the last 12 months, how many people did you have sexual relations with?

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

When was the last time you had sexual intercourse (if ever)?

515FA) The last time you had sexual relations, was it a regular partner, an acquaintance, for money, or someone else?

515G) CHECK 301 AND 302:

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

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

515GA) During this last sexual relation, who suggested using the condom?

515H) CHECK 515F:

515I) In total, with how many different people have you had sex in the last 12 months?

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

518) Where is that?

RECORD ALL MENTIONED

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

(NAME OF PLACE)_____________

518A) CHECK 515A, 515C, 515G

518B) Where did you get the condom last time?

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

(NAME OF PLACE)_________

518C) Do you know the brand name of the condoms that you used last time?
RECORD NAME OF BRAND

518D) The last time you bought condoms, how many did you buy?
DETERMINE THE NUMBER AND RECORD.

518E) How much did you pay?

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

SECTION 6. FERTILITY PREFERENCES

601) CHECK 314:

602) CHECK 227:

NOT PREGNANT OR UNSURE: Now I have some 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?

603) CHECK 602:

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?

604) CHECK 602:

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

606) CHECK 313: USING A METHOD?

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

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

609) Which method would you prefer to use?

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

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

612) CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time 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.

613) 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?

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

615) Is it acceptable or not acceptable to you for information on family planning to be provided:

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

616A) What is your main source of information on family planning?

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

619) With whom?
Anyone else?

RECORD ALL PERSONS MENTIONED

620) CHECK 502:

621) Spouses/partner do not always agree on everything. 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?

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

622A) Who usually starts the discussion on family planning, your, your husband/partner, or both?

622B) CHECK 313: USES A METHOD?

622C) Before starting to use (CURRENT METHOD), did you discuss which method you would use with your husband/partner?

622D) After having started using (CURRENT METHOD), did you discuss this method with your husband/partner?

622E) CHECK 314: CIRCLE CODE OF METHOD

622F) Did your husband/partner encourage you or discourage you from using (CURRENT METHOD)?

622G) According to you, who should make the decision to use a contraceptive method, the man or the woman?

622H) According to you, who generally makes the decision to use a contraceptive method, the man or the woman?

622I) Do you think your mother approves or disapproves of couples using a method to avoid or delay pregnancy?
IF THE MOTHER IS DEAD, ASK: "If your mother were alive, do you think?"

622J) Do you think your father approves or disapproves of couples using a method to avoid or delay pregnancy?
IF THE FATHER IS DEAD, ASK: "If your father were alive, do you think?"

622K) Do you think that the use of contraceptives goes against or does not go against your religion?

622L) Do you think that it is better to have small family or a large family to improve the quality of life?

622M) Have you encouraged a friend or relative to use family planning?

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

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

701) CHECK 502 AND 504:

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

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

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

705) What was the highest grade he completed at that level?
(CONVERT TO NUMBER OF YEARS COMPLETED)

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

707) CHECK 706:

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

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

710) As you know, some women take up jobs for which 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?

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

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

713) CHECK 712:

714) 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?

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

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

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

718) In the months that you worked, how many days a week did you usually work?

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

720) Do you earn cash for your work?
PROBE: Do you make money for working?

721) How much do you usually earn for this work?
PROBE: Is this by the day, by the week, by the month, or by the year?

722) CHECK 502:

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

NO, NOT IN UNION: Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

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

724) CHECK 217 AND 218: IS A CHILD LIVING AT HOME WHO WAS BORN SINCE JANUARY 1995 OR WHO IS AGE 3 OR LESS?

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

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801A) Have you ever heard of an illnesses that you can get from having sex?

801B) What illnesses have you heard of?
RECORD ALL RESPONSES

801C) CHECK 515 AND 515F:

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

801E) Which illnesses did you have?
RECORD ALL RESPONSES

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

801G) Where did you seek advice or treatment?
Any other place?

CIRCLE ALL MENTIONED

801H) When you had the (illness(s) of 801E) did you tell your sexual partner(s)?

801I) When you had the (ILLNESS(S) OF 801E) did you do something to avoid infecting your sexual partner(s)?

801J) What did you do?
CIRCLE ALL MENTIONED

801K) CHECK 801B:

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

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

RECORD ALL MENTIONED.

802A) If you wanted more information on AIDS, where (from whom) would you like to get this information?

802B) How can you get AIDS?
Any other way?

RECORD ALL MENTIONED

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

804) What can a person do?
Anything else?

RECORD ALL WAYS MENTIONED.

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

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

808A) Can AIDS be cured?

808B) Can AIDS be transmitted from a mother to a child she is breastfeeding?

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

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

809B) Why do you think that you (HAVE NO RISK/HAVE SMALL RISK) for getting AIDS?
Any other reason?
RECORD ALL MENTIONED

809C) Why do you think you have (MODERATE/GREAT) risk of getting AIDS?
Any other reason?
RECORD ALL MENTIONED

811A) Since you have heard of AIDS, have you changed your behavior to avoid getting AIDS?
IF YES, what have you done?
Anything else?
RECORD ALL MENTIONED.

811B) Has your knowledge of AIDS influenced or changed your decisions about having sex or sexual behavior?
IF YES, PROBE: In what way?
RECORD ALL MENTIONED.

811C) Some people use condoms during sex to avoid getting AIDS or other sexually transmitted illnesses. Have you ever heard of condoms?

811D) CHECK 515 AND 515F:

811E) We may have already discussed this. Have you ever used a condom during sexual relations to avoid getting or transmitting illnesses, like AIDS?

811EA) Do you use a condom from time to time, often, or with each sexual encounter?

811F) Have you given or received money, gifts, or favors in exchange for sex in the last 12 months?

SECTION 9. MATERNAL MORTALITY

901) Now I would like to ask you some questions about your brothers and sisters, that is all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died.

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

902) CHECK 901:

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

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

905) Is (NAME) male or female?

906) Is (NAME) still alive?

907) How old is (NAME)?

908) In what year did (NAME) die?

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

910) How old was (NAME) when he/she died?
IF MAN OR WOMAN DIED BEFORE 12 YEARS OF AGE GO TO NEXT BIRTH

911) Was (NAME) pregnant when she died?

912) Did (NAME) die during childbirth?

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

914) Did (NAME) die due to complications of pregnancy or childbirth?

915) How many children did (NAME) give birth to during her lifetime?

IF NO OTHER BROTHERS OR SISTERS, GO TO 916

916) RECORD THE TIME

SECTION 10. HEIGHT AND WEIGHT

1001) CHECK 215:

IN 1002 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1995 AND STILL ALIVE. IN 1003 AND 1004, RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1995. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1995 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1995, USE ADDITIONAL QUESTIONNAIRES.

1002) LINE NUMBER FROM Q. 212

1003) NAME FROM Q. 212 FOR CHILDREN

1004) DATE OF BIRTH
FROM Q. 215, AND ASK FOR DAY OF BIRTH

1005) BCG SCAR ON TOP OF LEFT SHOULDER

1006) HEIGHT (IN CENTIMETERS)

1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

1008) WEIGHT (IN KILOGRAMS)

1009) DATE WEIGHED AND MEASURED

1010) RESULT

1011) NAME OF MEASURER__________
NAME OF ASSISTANT__________

INTERVIEWER'S OBSERVATIONS
TO BE FILLED OUT 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: ______