DEMOGRAPHIC AND HEALTH SURVEY, 1988 INDIVIDUAL QUESTIONNAIRE

IDENTIFICATION

1) PROVINCE

2) NAME AND CLUSTER NUMBER____

3) HOUSEHOLD NUMBER____

4) LINE NUMBER OF WOMAN____

Visits

FIRST VISIT
5) DATE OF VISIT____

6) NAME OF INTERVIEWER____

7) RESULT

8) NEXT VISIT

SECOND VISIT
5) DATE OF VISIT____

6) NAME OF INTERVIEWER____

7) RESULT

8) NEXT VISIT

THIRD VISIT
5) DATE OF VISIT____

6) NAME OF INTERVIEWER____

7) RESULT

8) NEXT VISIT

MONTH ____
YEAR 88

INTERVIEWER CODE
RESULT

NUMBER OF VISITS

NAME ____

DATE ____

FIELD EDITED BY ____

OFFICE EDITED BY ____

KEYED BY ____

CODE KEYED ____

SECTION 1. RESPONDENT'S BACKGROUND

101) Record the number of persons listed in the household schedule

102) Record the number of children aged 5 and under listed in the household schedule who normally live in the household.

103) RECORD THE TIME:

104) For most of the time until you were 12 years old, did you live in the countryside, in a town, or in a city?

105) How long have you been living continuously in (NAME OF VILLAGE, TOWN, CITY)?

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

LARGE CITY 1
SMALL CITY 2
COUNTRYSIDE 3

107) Would you mind giving me the family's civil registration booklet, a National ID card, a birth certificate, or a passport?

108) INTERVIEWER:
COPY THE MONTH AND YEAR OF BIRTH RECORDED ON THE DOCUMENT.

109) In what month and year were you born?

110) What is your age?
INTERVIEWER:
CORRECT AND COMPARE 108/109 AND 110 IF INCONSISTENT

111) Have you ever attended school?

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

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

114)
INTERVIEWER: CHECK 112 AND TICK THE APPROPRIATE BOX:

115) Can you read a letter or a newspaper easily, with difficulty, or not at all?

116) Do you usually read a newspaper or a magazine once a week?

117) Do you watch television?

118) Do you listen to the radio?

119) Where does the water you drink come from?

120) Where is your toilet?

121) How do you light up the house?

122) What do you use to cook at home

123) Does your house has: a radio, a television, a video, a refrigerator, a telephone?

124) Does a member of you household own:
A bicycle,
A motorcycle,
A scooter,
A car,
A small truck,
A big truck,
A Tractor,
A cariole,
A mule,
A horse,
A donkey.

125) The walls of the house you live in are built with which material?

126) What is the ceiling made of?

127) How many rooms do you have in this house?

128) What is your status in this household: owner, rent-to-own, renter, free usage, other.

SECTION 2. MARRIAGE

201) Are you now married, divorced, widowed or separated?

202) Have you been married just once or more?

203) In what month and year did you get married (the first time)?

204) How old were you when you got married (the first time)?

205) Is your father still alive?

206) And your mother, is she still alive?

207) Is your father-in-law (from your first marriage) still alive?

208) Is your mother-in-law (from your first marriage) still alive?

209)
INTERVIEWER: CHECK 205-206-207-208 AND TICK THE APPROPRIATE BOX

210) Was (MENTION PARENT) alive at the time you got married?
INTERVIEWER:
WHEN ASKING THE FOLLOWING QUESTION, NAME THE DECEASED PARENTS

211) INTERVIEWER: CHECK 209 AND 210 AND TICK THE APPROPRIATE BOX

212) At the time you got married, did you and your husband live with any of these parents for at least six month in a permanent manner?

213) For about how many years did you live together with a parent at that time before the parent died?

214) INTERVIEWER: CHECK 201

215) Are you now living with one of the parents and the parent died?

216) In how many localities have you and your (first) husband lived for at least six months since you were first married?

217) Are you related to your (first) husband?

218) Are your father and mother related (or are your father-in-law and mother-in-law related)?
(Paternal cousin)
(Maternal cousin)

SECTION 3. FERTILITY AND INFANT MORTALITY

301) Now, I would like to ask about all the kids you have had during your life.
Have you ever had kids?

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

303) How many sons live with you now?
INTERVIEWER: RECORD 00 IF NONE

304) How many daughters live with you now?
INTERVIEWER: RECORD 00 IF NONE

305) Do you have any sons or daughters who do not live with you now?

306) How many sons you have who do not live with you now?
INTERVIEWER: RECORD 00 IF NONE

307) How many daughters you have who do not live with you now?
INTERVIEWER: RECORD 00 IF NONE

308) Have you ever given birth to a boy or a girl who was born alive but later died?
Interviewer: If no, probe: Just to make sure I have this right; have you ever given birth to a boy or a girl who survived for few hours or days?

309) How many boys have died?
INTERVIEWER: RECORD 00 IF NONE

310) How many girls have died?
INTERVIEWER: RECORD 00 IF NONE

311) INTERVIEWER: SUM ANSWERS TO 303, 304, 306, 307, 309, AND 310 AND ENTER TOTAL.

312) Just to make sure I have this right: you have had in TOTAL ?.
(PROBE AND CORRECT 301 TO 312 IF NECESSARY)

313) INTERVIEWER: CHECK 311 AND TICK THE APPROPRIATE BOX

314) Now, I would like you to give me the names of all the boys and girls you gave birth to (whether still alive or not) starting with the first one you had.
INTERVIEWER: RECORD IN 315 THE NAMES OF ALL THE BIRTHS.

TABLE 1: INTERVIEWER, RECORD ALL CHILDREN IN ORDER STARTING WITH THE OLDEST.

315) What is the name of each one of them?
INTERVIEWER:
RECORD TWINS ON SEPARATE LINES AND CONNECT THEM WITH BRACKETS ON THE LEFT.

316) Is (NAME OF CHILD) a boy or girl?

317) Can you please give me the family booklet if you have it, or a birth certificate of him or her.

318) What is the month and year of birth?

319) Is child still living or dead?

320) IF STILL LIVING: How old is he/she?
INTERVIEWER: Get age in completed years

321) Is he/she living with you now or not?
Does the child live in the household?

322) How old was he/she when he/she died?
IF DEAD: RECORD AGE IN DAYS IF LESS THAN A MONTH, IN MONTHS IF LESS THAN 2 YEARS, AND IN COMPLETED YEARS IF 2 YEARS OR MORE.

323) INTERVIEWER: COMPARE 311 WITH THE NUMBER OF BIRTHS RECORDED IN TABLE 1 AND TICK THE APPROPRIATE BOX:

324) INTERVIEWER: CHECK 201:

325) Are you pregnant now or not?

326) For how many months have you been pregnant?

327) Did you see a doctor or a nurse or someone else for a check on this pregnancy?

328) How many times did you see someone for this pregnancy?

329) Where did your first check take place?
INTERVIEWER: PROBE AND RECORD THE LOCATION CODE OR THE MOST QUALIFIED PERSON.

330) How many months pregnant were you the first time you received antenatal care?

331) How long ago did you last menstrual period start?

332) When during her monthly cycle do you think a woman has the greatest chance of becoming pregnant?

333) INTERVIEWER: Are there people present during this moment in the interview?

SECTION 4: CONTRACEPTION

401) Now I would like to talk about a different topic. There are various ways or methods that a couple can use to delay or avoid a pregnancy. Which one of these ways or methods have you heard about?
INTERVIEWER:
CIRCLE CODE 1 IN 402 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY, CIRCLING CODE 2 IF THE METHOD IS RECOGNIZED OR CODE 3 IF THE WOMAN DOES NOT RECOGNIZE IT. ASK 403 TO 405 FOR EACH METHOD RECOGNIZED BY THE WOMAN.

401) Method code

402) Have you ever heard of this method?

403) Have you or your husband ever used this method?

404) Where would you go to obtain or use this method?

405) In your opinion, what is the main problem, if any, with using this method?

406) INTERVIEWER: CHECK COLUMN 403 AND TICK THE APPROPRIATE BOX.

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

408) INTERVIEWER: CHECK 402 AND 403. CORRECT IF NECESSARY AND OBTAIN THE INFORMATION FOR 404 AND 405.
IF THE EXACT METHOD USED IS ALREADY ON TABLE 2, CIRCLE CODE 2 (YES AFTER DESCRIPTION).

408A) INTERVIEWER: CHECK (403-10) AND TICK THE APPROPRIATE BOX.

408B) Since you grew up (had your periods) to today, how many abortions did you willingly have?

408C) Between this past Ramadan (Holy fasting month) and the one from the previous year, did you have any consented abortion?

408D) How many?

408E) Between this past Ramadan ([##translator note : Muslim holy fasting month) and the one from the previous year, did you have the abortion in a hospital or at a private (paying) clinic?

408f) How many times?

408g) Where did you have your last consented abortion?

409) INTERVIEWER: CHECK 403 (09) AND TICK THE APPROPRIATE BOX

410) The last time you used periodic abstinence, not having intercourse with your husband for specific days, how did you determine on which days you had to abstain?
Based on:

411) How many living children, if any, did you have when you first did something or used a method to avoid getting pregnant?
INTERVIEWER:

412) INTERVIEWER: CHECK 201 AND TICK

413) INTERVIEWER: CHECK 325 AND TICK

414) Are you or your husband currently doing something or using any method to avoid getting pregnant?

415) Which method are you using?

416) How much did it cost you in millime to use this contraceptive method?
PRICE IN MILLIME [##TRANSLATOR NOTE: MILLIME IS OLD TUNISIAN CURRENCY]

417) Do you know in which year and which month you did the tubal ligation surgery?
DATE:

418) In the last 12 months, did you or your husband go to a health facility to get some advice on how to avoid getting pregnant?

419A) Where did you or your husband go the last time to get advice or obtain instructions for a method to avoid getting pregnant?

419B) And where did you do your tubal ligation surgery?

419C) And where did you put the device?

420) Was there something you did not like in this health facility as to how they greeted you, or how they attended to you or anything else?

421) INTERVIEWER: CHECK 325 AND TICK THE APPROPRIATE BOX.

422) INTERVIEWER: CHECK 414-415 AND TICK THE APPROPRIATE BOX

423) For how long have you been using (CURRENT METHOD) without interruption?
(CURRENT METHOD FROM 415)

423A) Between this past Ramadan ([##translator note: Muslim holy fasting month) and the one from the previous year, how many times did you check on the (CURRENT METHOD) you use or on adding more of what you are getting?

424) Have you had any problem or concern using (CURRENT METHOD)?
(CURRENT METHOD FROM 415)?

425) What was the most important problem or difficulty you had using this method?

426) Did you use any other method to avoid getting pregnant (after your last pregnancy)?

427) What method were you using (before the one you are using now)?

428) In which year and which month did you start using this method:

429) How long have you used this method without interruption before stopping it?

430) What was the main reason you stopped using this method?
(METHOD FROM 427)

431) INTERVIEWER: CHECK 311 AND TICK THE APPROPRIATE BOX

432) Since your last pregnancy till now, have you used any method to avoid getting pregnant?

433) What was the last method you used?

434) Do you know in which month and which year you started using this method?
(METHOD LISTED IN 433)

435) How long have you used this method without interruption before stopping it?

436) What was the main reason you stopped using this method?
(METHOD LISTED IN 433)

437) INTERVIEWER: CHECK 201 AND TICK

438) Do you intend to use a method to avoid pregnancy at any time in the future.

439) What is the method you intend to use?

440) Do you intend to use this method in the next 12 months?

441) In the last month, have you heard anything on the radio or the television, or any other gathering about family planning?

442) Have you heard it once or more?

443) In your opinion, is it acceptable or not acceptable to you for family planning information to be provided on radio or television?

444) INTERVIEWER: CHECK TABLE 1 (318 TO 322) AND 325 THEN TICK THE APPROPRIATE BOX.
AT LEAST ONE LIVE BIRTH UNDER 5 YEARS, OR BORN SINCE MAY 1983, OR CURRENTLY PREGNANT
NOT A SINGLE LIVE BIRTH UNDER 5 YEARS, OR BORN SINCE MAY 1983 OR NOT CURRENTLY PREGNANT-GO TO 601

INTERVIEWER: NOW GO TO 445A AND TICK IN THE FIRST COLUMN IF THE WOMAN IS CURRENTLY PREGNANT OR NOT (325). THEN RECORD IN THE ORDER OF BIRTH STARTING WITH THE LAST THE NAMES (313) OF ALL THE CHILDREN BORN ALIVE SINCE JANUARY 1983 (318) OR UNDER 5 YEARS OLD.

445) INTERVIEWER: CHECK 406 AND TICK THE APPROPRIATE BOX
(ASK 446 TO 452 FOR EACH COLUMN) (ASK 451 FOR EACH COLUMN)
INTRODUCE THE SUBJECT BY SAYING [##TRANSLATOR NOTE: ARABIC TEXT]
(AFTER HAVING FILLED OUT 445, YOU MUST FILL OUT 445A)

445A) Now, I would like to ask you some questions in general about your health for the last 5 years.

446) Before getting pregnant with? and after your last pregnancy (if there had been a pregnancy) have you used a method to avoid getting pregnant?

447) Do you remember the last method you used?
LAST METHOD

447A) INTERVIEWER: CHECK
DID YOU USE ANY OTHER METHOD BEFORE?
RECORD THE CODE OF THE LAST METHOD HERE

448) How did you use the last method?
(CHECK 447)

449) Did you get pregnant while using this method?
(CHECK 447)

450) Why did you stop using this method?
(CHECK 447)

451) 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 children at all?

452) Did you want to become pregnant until later, or did you not want to have any children at all?

SECTION 5. HEALTH AND BREASTFEEDING

501) INTERVIEWER: CHECK TABLE 1 THEN RECORD THE LINE NUMBER (315) AND THE SURVIVAL STATE (319) OF ALL THE CHILDREN UNDER 5 YEARS OLD OR BORN BEFORE MAY 1983 (318).

502) When you were pregnant with (NAME) were you given any injection to prevent the baby from getting tetanus?

503) When you were pregnant with (NAME) did you see anyone for a check on this pregnancy?

504) How many times did you get checked?

505) Where did you go the last time you checked on your pregnancy with (NAME)?

506) Whom did you see? A doctor, a midwife, a nurse, a traditional birth attendant or someone else?
INTERVIEWER: RECORD THE MOST QUALIFIED PERSON:

507) Where did you give birth when you delivered (NAME)? At a public hospital, a private doctor's practice, at home or in another place?

508) Who assisted with the delivery of (NAME)? A doctor, a midwife, a nurse, a traditional birth attendant or someone else?
INTERVIEWER: RECORD THE MOST QUALIFIED PERSON:

509) Did you feed (NAME) at the breast?

510) Are you still breastfeeding (NAME)
INTERVIEWER: CHECK SURVIVAL STATE IN 501 AND CIRCLE CODE 3 IF DEAD.

511) How many months did you breastfeed (NAME)

512) How many months after the birth of (NAME) did your period return?

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

514) How many months after the birth of (NAME) did you resume sexual relations?

515)
INTERVIEWER: CHECK 509 AND 510 FOR THE LAST BIRTH AND TICK THE

516) How many times did you breastfeed last night between sundown and sunrise?

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

518) At any time yesterday during the daylight hours or last night, was (NAME OF LAST CHILD) given anything to drink or eat, such as:
Water?
Juice?
Tea?
Herbal tea?
Powdered milk?
Cow milk?
Goat milk?
Condensed milk?
Gruel?
Yogurt?
Flour?
Biscuit?
Something else?

519) Do you feed your last child anything else than the milk from your breast?

520) When you started giving your child other food (than your breast milk), how old was he?

521) INTERVIEWER: CHECK 518 AND TICK THE APPROPRIATE BOX

522) Were any of these given in a bottle with a nipple?

523) Why did you stop breastfeeding your child (NAME)?

524) How did you wean (NAME). Did you suddenly stop the food or did you stop the food gradually?

525) INTERVIEWER: CHECK TABLE 4 AND RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATE OF ALL CHILDREN AGE 5 OR UNDER OR BORN SINCE MAY 1983.

526) Do you have a vaccines health card for (NAME)? May I see it please?

527)
INTERVIEWER:
RECORD THE VACCINATION DATES BASED ON THE VACCINATION CARD.

528) Has (NAME) ever had a vaccination for:
BCG
DTC/POLIO?
DTC/POLIO?
MEASLES?

529) Has (NAME) had diarrhea in the last 24 hours?

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

531) How many days has he/she had diarrhea?

532) Did you breastfeed him/her while he/she was sick?

533) While he/she was sick, did the diarrhea increase, or decrease or was it the same?

534) Did you prepare something for him/her to help with diarrhea?

535) What did you give him/her:

536) Where did you learn to prepare water with sugar and salt?

537) When you gave him/her the water sugar and salt solution, did his/her health 1. Improve, 2. worsened, 3. stayed the same?

538)How much does he/she drink of this water daily?

539) How many days did you keep giving him/her this water to drink?

540) When (NAME) had diarrhea, did you increase or decrease or kept his/her food the same?

541) Was (NAME) taken to a hospital, a maternity, a dispensary, a private doctor, a pharmacy or somewhere else during his last episode of diarrhea or did you not take him/her anywhere?

542) Which medication did he/she take?
An injection, pills, syrup, oralyte (##translator note: translation not found, but term is relate to something taken orally), or else?

543) Have you ever heard of any blue fluid (oralyte) given to kids when having diarrhea?

544) Have you seen such a soluble envelope?

545) Would you mind telling me what it is for?

546) Have you used this soluble envelope/packet to treat your kid?

547) How do you prepare the medication from this packet?

548) How much water do you use to prepare this medication?

549) Where do you get this packet?

550) How much does a packet cost?

551) Do you have any of these packets at home?

552) Would you mind if I see it?

553) INTERVIEWER: CHECK TABLE 6 THEN RECORD THE LINE NUMBER, NAME AND SURVIVAL STATE OF ALL CHILDREN 5 YEARS OR UNDER OR BORN SINCE MAY 1983. ASK THE QUESTIONS ONLY FOR DECEASED CHILDREN.

TABLE 6: BIRTHS IN THE LAST 5 YEARS

554) When he/she died, did you notice:

555) Do you know which illness he died of:

SECTION 6. FERTILITY PREFERENCES

601) INTERVIEWER: CHECK 403 (06-07) AND TICK THE APPROPRIATE BOX.

602) INTERVIEWER: CHECK 201 AND TICK THE APPROPRIATE BOX.

603) Now, I would like to ask you some questions about the future.
INTERVIEWER: CHECK 325, TICK AND ASK THE APPROPRIATE QUESTION

604) What is the main reason you took this decision?

605) How long do you want to wait from now before the birth of a (another) child?

606) INTERVIEWER: CHECK 319 BEFORE ASKING QUESTION 606.
How old should your youngest child be before the birth of another child?

607) Did you have a surgery for your last delivery or not? (a caesarean surgery)

608) Do you regret the surgery you did in order to avoid having more children (tubal ligation)

609) Would you like to have another child or do you not want any more children?

610) INTERVIEWER: CHECK 302 AND 305 TICK AND ASK THE APPROPRIATE QUESTION.

611) How many boys and girls would you like to have?

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

701) INTERVIEWER: CHECK 201, THEN LINK THE FOLLOWING QUESTIONS TO THE CURRENT HUSBAND OF THE RESPONDENT OR TO HER LAST HUSBAND IF SHE IS A WIDOW OR DIVORCED.
Now I would like to ask you some questions about the level of school your husband attended and his work (Last husband)

702) Did your husband ever attended school or not?

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

704) What is the highest grade he completed at that level?

705) INTERVIEWER: Check 703 and tick the appropriate box

706) Can (could) he read a letter or newspaper easily, with difficulty, or not at all?

707) What kind of work does (did) your husband mainly do?
INTERVIEWER: RECORD EXACTLY THE PROFESSION PROVIDED.

708) Where does (did) he work?

709) INTERVIEWER: CHECK 707 AND TICK THE APPROPRIATE BOX

710) Does he get paid regularly every week or every month?

711) Does your husband work mainly on his or family land, or on someone's land?

712) Does he work mainly for cash or does he work for something else?

713) Interviewer: Check 201 and tick the appropriate box

714) In the last 12 months, did your husband work somewhere far that kept him away from you for more than a month?

715) How long did he stay away from you?

716) Before you married your first husband, did you yourself ever work regularly to earn money, other than on your family land or in a business run by your family?

717) When you were earning money then, did you turn most of it over to your family or did you keep most of it yourself?
Gives most to:

718) Since you were first married, have you ever worked regularly to earn money, other than in a business run by your family or on your family land?

719) During the time when you have earned money, have you turned most of it over to your family or have you kept most of it for yourself?
Gives most to:

720) Instead of the housework and serving the family, are you now working to earn money?

SECTION 8. BODY MEASUREMENTS

801) INTERVIEWER: RECORD THE EXACT TIME AT THE MOMENT:

802) INTERVIEWER: CHECK TABLE 5 THEM RECORD THE LINE NUMBER, NAME, AND SURVIVAL STATE OF ALL THE CHILDREN AGE 3 TO 36 MONTHS OR BORN SINCE MAY 1985.

803) INTERVIEWER: CHECK 318 AND TRANSCRIBE THE DATE OF BIRTH

804) INTERVIEWER: VERIFY THAT THE CHILD IN QUESTION IS AVAILABLE FOR THE MEASUREMENTS BELOW.

805) INTERVIEWER: ACCURATELY RECORD THE WEIGHT, HEIGHT, AND ARM AREA OF EACH CHILD.

806) REASON FOR UNAVAILABILITY

807) INTERVIEWER: RECORD:

808) INTERVIEWER: RECORD THE TIME AT THE END OF THE INTERVIEW:

END OF INTERVIEW

INTERVIEWER: THANK THE RESPONDENT FOR HER COOPERATION.

INTERVIEWER'S OBSERVATIONS (TO BE COMPLETED AFTER THE INTERVIEW)
NAME ____
DATE ____

INSPECTOR'S OBSERVATIONS
NAME ____
DATE ____

SUPERVISOR'S OBSERVATIONS
NAME ____
DATE ____

FIELD EDITOR'S AND DATA INPUT OFFICER'S OBSERVATIONS
FIELD EDITOR'S NAME ____
DATE ____
DATA INPUT OFFICER'S NAME____
DATE ____