Data Cart

Your data extract

0 variables
0 samples
View Cart


UNITED REPUBLIC OF TANZANIA
BUREAU OF STATISTICS, PLANNING COMMISSION
TANZANIA DEMOGRAPHIC AND HEALTH SURVEY
INDIVIDUAL QUESTIONNAIRE
FEMALE

IDENTIFICATION
NAME OF HOUSEHOLD HEAD ______________________
TDHS CLUSTER ID ___
HOUSEHOLD NO. ___
REGION ___________________ ___
DISTRICT __________________ ___
WARD __________________ ___
ENUMERATION AREA _______________ ___

URBAN/RURAL ___

urban 1
rural 2

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE ___

large city 1
small city 2
town 3
countryside 4

NAME AND LINE NUMBER OF FEMALE RESPONDENT ___________ ___
NAME AND LINE NUMBER OF HUSBAND ___________________ ___

INTERVIEWER VISITS
INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER’S NAME _______________
RESULT* ______________

INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER’S NAME _______________
RESULT* ______________

INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER’S NAME _______________
RESULT* ______________

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ____
ID NO. ____
RESULT ____

TOTAL NUMBER OF VISITS __

*RESULT CODES:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY) _________

FIELD EDITED BY
NAME ________
DATE ________

OFFICE EDITED BY
NAME ________
DATE ________

KEYED BY
NAME ________
DATE ________

KEYED BY

SECTION 1. RESPONDENT’S BACKGROUND

101. RECORD THE TIME

HOUR _______
MINUTES _______

102. First I would like to ask some questions about your background. For most of the time until you were 12 years old, did you live in Dar es Salaam city, another urban area, or in the rural area?

CITY (DAR ES SALAAM) 1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

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

YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in Dar es Salaam city, another urban area, or in the rural area?

CITY (DAR ES SALAAM) 1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

105. In what month and year were you born?

MONTH ___
DK MONTH 98
YEAR __
DK YEAR 98

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

AGE IN COMPLETED YEARS ___

107. Can you read and write kiswahili easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 109)

108. Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

109. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

110. What is the highest formal school you completed?

LESS THAN 1 YEAR 00
STANDARD 1 01
STANDARD 2 02
STANDARD 3 03
STANDARD 4 04
STANDARD 5 05
STANDARD 6 06
STANDARD 7 07
STANDARD 8 08
FORM 1 09
FORM 2 10
FORM 3 11
FORM 4 12
FORM 5 13
FORM 6 14
UNIVERSITY 15
OTHER (SPECIFY) ________________ 96

111. Do you usually listen to a radio at least once a week?

YES 1
NO 2

112. Do you usually watch television at least once a week?

YES 1
NO 2

113. What is your religion?

MOSLEM 1
CATHOLIC 2
PROTESTANT 3
NONE 4
OTHER (SPECIFY)________ 6

114. To which tribe do you belong?
IF NOT TANZANIAN CITIZEN, RECORD COUNTRY OF CITIZENSHIP.

__________________ ___

115. CHECK Q.5 IN THE HOUSEHOLD SCHEDULE:

THE RESPONDENT IS NOT A USUAL RESIDENT OF THE HH __ (GO TO 116)
THE RESPONDENT IS A USUAL RESIDENT OF THE HH __ (GO TO 201)

116. Now I would like to ask about the place in which you usually live.
Do you usually live in Dar es Salaam city, another urban area, or in the rural area?
IF OTHER URBAN AREA: In which town do you live?*

CITY (DAR ES SALAAM) 1
LARGE URBAN AREA 2
SMALL URBAN AREA 3
RURAL AREA/VILLAGE 4

*LARGE URBAN AREAS ARE MWANZA, ARUSKA, MOROGORO, DODOMA, MOSNI, TANGA, IRINGA, MBEYA, TABORA AND ZANZIBAR. SMALL URBAN AREAS ARE ALL OTHER TOWNS.

117. In which region is that located?
IF USUAL RESIDENCE IS OUTSIDE OF TANZANIA, RECORD COUNTRY OF RESIDENCE.

REGION __________________ ___

118. Now I would like to ask you about the household in which you usually live.
What is the source of water your household uses for handwashing and dishwashing?

PIPED INTO HOUSE/YARD/PLOT 11 (GO TO 120)
PUBLIC TAP 12
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 120)
PUBLIC WELL 22
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 120)
TANKER TRUCK 51
OTHER (SPECIFY) _______ 71

119. How long does it take to go there, get water, and come back?

MINUTES ___
ON PREMISES 996

120. Does your household get drinking water from this same source?

YES 1 (GO TO 123)
NO 2

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

PIPED INTO HOUSE/YARD/PLOT 11 (GO TO 123)
PUBLIC TAP 12
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 123)
PUBLIC WELL 22
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 123)
TANKER TRUCK 51
OTHER (SPECIFY) _______ 71

122. How long does it take to go there, get water, and come back?

MINUTES ___
ON PREMISES 996

123. What kind of toilet facility does your household have?

OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
TRADITIONAL PIT TOILET 21
VENTILATED PIT LATRINE 22
NO FACILITY/BUSH/FIELD 31

124. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

125. How many rooms in your household are used for sleeping?

ROOMS ___

126. Could you describe the main material of the floor of your home?

EARTH/SAND 11
WOOD PLANKS 21
PARQUET OR POLISHED WOOD 31
CERAMIC TILES 32
CEMENT 33
OTHER (SPECIFY) _____________ 41

127. Does any member of your household own:

A bicycle?
A motorcycle?
A car?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD ‘00’.

SONS AT HOME _____
DAUGHTERS AT HOME ______

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

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD ‘00’

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

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

YES 1
NO 2 (GO TO 208)

207. In all, how many boys have died?
And how many girls have died?
IF NONE, RECORD ‘00’.

BOYS DEAD ___
GIRLS DEAD ___

208. SUM ANSWERS TO 203, 205, AND 207, AND RECORD TOTAL.
IF NONE RECORD ‘00’.

TOTAL ___

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

YES __ (GO TO 210)
NO __ (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS __ (GO TO 211)
NO BIRTHS __ (GO TO 223)

211. Now I would like to talk to you about all of 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 your (first/next) baby?

(NAME) ___________

213. RECORD SINGLE OR MULTIPLE BIRTH STATUS

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH __________
YEAR __________

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS __

218. IF ALIVE: Is (NAME) living with you?

YES 1 (GO TO NEXT BIRTH)
NO 2

219. IF LESS THAN 15 YRS. OF AGE:
With whom does he/she live?
IF MORE THAN 15 YRS. OF AGE:
GO TO NEXT BIRTH.

FATHER 1
OTHER RELATIVE 2
SOMEONE ELSE 3
(GO NEXT BIRTH IF NECESSARY)

220. IF DEAD: How old was he/she when he/she died?
IF ‘1 YR’, PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

221. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE DIFFERENT __ (PROBE AND RECONCILE)
NUMBERS ARE SAME __ CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. __
FOR AGE AT DEATH 12 MONTHS: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __

222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1986.
IF NONE, ENTER ‘0’. __

223. Are you pregnant now?

YES 1
NO 2 (GO TO 226)
UNSURE 8 (GO TO 226)

224. How many months pregnant are you?

MONTHS _______

225. 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 become pregnant at all?

THEN 1
LATER 2
NOT AT ALL 3

226. How long ago did your last menstrual period start?

DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

227. 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?

YES 1
NO 2 (GO TO 301)
DK 3 (GO TO 301)

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

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) _____ 5
DK 8

SECTION 3. CONTRACEPTION

301. 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. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.

302. Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.

METHOD 01 PILL Women can take a pill every day.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 04 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside them before intercourse.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse to avoid pregnancy. The rubber sheath is also used to prevent transmission of diseases such as AIDS and for cleanliness.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 08 CALENDAR Couples can have sexual intercourse only during the safe period of the monthly cycle, that is the times during the monthly cycle when the woman is least likely to become pregnant.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 09 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONT 1
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
METHOD 11 ANY OTHER METHODS
Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) __________
NO 3

303. Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside them before intercourse.
YES 1
NO 2
METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse to avoid pregnancy. The rubber sheath is also used to prevent transmission of diseases such as AIDS and for cleanliness.
YES 1
NO 2
METHOD 06 FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 08 CALENDAR Couples can have sexual intercourse only during the safe period of the monthly cycle, that is the times during the monthly cycle when the woman is least likely to become pregnant.
YES 1
NO 2
METHOD 09 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
YES 1
NO 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 11 ANY OTHER METHODS: Have you ever used (METHOD)?
YES 1 (SPECIFY) __________
NO 2

304. Do you know where a person could go to get (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside them before intercourse.
YES 1
NO 2
METHOD 05 CONDOM Men can use a rubber sheath during sexual intercourse to avoid pregnancy. The rubber sheath is also used to prevent transmission of diseases such as AIDS and for cleanliness.
YES 1
NO 2
METHOD 06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 07 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 08 CALENDAR Couples can have sexual intercourse only during the safe period of the monthly cycle, that is the times during the monthly cycle when the woman is least likely to become pregnant.
Do you know where a person can obtain advice on how to use the calendar method?
YES 1
NO 2
METHOD 09 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
Do you know where a person can obtain advice on how to observe changes in the mucus?
YES 1
NO 2

305. CHECK 303:

NOT A SINGLE ‘YES’ (NEVER USED) __ (GO TO 306)
AT LEAST ONE ‘YES’ (EVER USED) __ (GO TO 308)

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

YES 1
NO 2 (GO TO 324)

307. What have you used or done?
CORRECT 303-305 (AND 302 IF NECESSARY).

308. When you first did something or used a method to avoid getting pregnant, how many living children did you have at that time?
IF NONE RECORD ‘00’.

NUMBER OF CHILDREN _____

309. CHECK 223:

NOT PREGNANT OR UNSURE __ (GO TO 310)
PREGNANT __ (GO TO 324)

310. CHECK 303:

WOMAN NOT STERILIZED __ (GO TO 311)
WOMAN STERILIZED __ (GO TO 312A)

311. Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 324)

312. Which method are you using?
312A. CIRCLE ‘06’ FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 318)
INJECTIONS 03 (GO TO 318)
DIAPHRAGM/FOAM/JELLY 04 (GO TO 318)
CONDOM 05 (GO TO 318)
FEMALE STERILIZATION 06 (GO TO 318)
MALE STERILIZATION 07 (GO TO 318)
CALENDAR 08 (GO TO 323)
MUCUS METHOD 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 323)
OTHER (SPECIFY) _________ 11 (GO TO 323)

313. At the time you first started using the pill, did you consult a doctor or a nurse?

YES 1
NO 2
DK 8

314. At the time you last got pills, did you consult a doctor or a nurse?

YES 1
NO 2

315. May I see the pack of pills you are using now?
(RECORD NAME OF BRAND.)

PACK SEEN 1 (GO TO 317)
BRAND NAME ______________ ___
PACK NOT SEEN 2

316. What is the brand name of the pills you are using now?
(RECORD NAME OF BRAND.)

BRAND NAME _____________ ___
DK 98

317. How much does one pack of pills cost you?

COST ____
FREE 996
DK 998

318. CHECK 312:
SHE/HE STERILIZED __
Where did the sterilization take place?

USING ANOTHER METHOD __
Where did you obtain (METHOD) the last time?

(NAME OF PLACE) __________
GOVERNMENT AND PARASTATAL
CONSULTANT HOSPITAL 11
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
PARASTATAL HEALTH FACILITY 16
VILLAGE HEALTH POST/WORKER 17 (GO TO 321)
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
UMATI CBD WORKER 24 (GO TO 321)
OTHER PRIVATE SECTOR
SHOP 31
NEIGHBORS/RELATIVES 32 (GO TO 321)
OTHER (SPECIFY) _________________ 41 (GO TO 321)
DK 98 (GO TO 321)

319. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD TRAVEL TIME IN MINUTES.
OTHERWISE, RECORD TRAVEL TIME IN HOURS.

MINUTES 1___
HOURS 2 __
DK 9998

320. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

321. CHECK 312:

SHE/HE STERILIZED __ (GO TO 322)
USING ANOTHER METHOD __ (GO TO 323)

322. In what month and year was the sterilization operation performed?

DATE:

MONTH __ (GO TO 334)
YEAR __ (GO TO 334)

323. For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD ‘00’.

MONTHS ___ (GO TO 329)
8 YEARS OR LONGER 96 (GO TO 329)

324. Do you intend to use a method to delay or avoid pregnancy at any time in the future?

YES 1 (GO TO 326)
NO 2
DK 8 (GO TO 330)

325. What is the main reason you do not intend to use a method?

WANTS CHILDREN 01 (GO TO 330)
LACK OF KNOWLEDGE 02 (GO TO 330)
PARTNER OPPOSED 03 (GO TO 330)
COST TOO MUCH 04 (GO TO 330)
SIDE EFFECTS 05 (GO TO 330)
ILL HEALTH/HEALTH CONCERNS 06 (GO TO 330)
HARD TO GET METHODS 07 (GO TO 330)
RELIGION 08 (GO TO 330)
OPPOSED TO FAMILY PLANNING 09 (GO TO 330)
FATALISTIC 10 (GO TO 330)
OTHER PEOPLE OPPOSED 11 (GO TO 330)
INFREQUENT SEX 12 (GO TO 330)
THINKS SHE CANNOT GET PREGNANT 13 (GO TO 330)
MENOPAUSAL/HAD HYSTERECTOMY 14 (GO TO 330)
INCONVENIENT 15 (GO TO 330)
NOT MARRIED 16 (GO TO 330)
OTHER (SPECIFY) ______ 17 GO (TO 330)
DK 98 (GO TO 330)

326. Do you intend to use a method within the next 12 months?

YES 1
NO 2
DK 8

327. When you use a method, which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
CALENDAR 08 (GO TO 330)
MUCUS METHOD 09 (GO TO 330)
WITHDRAWAL 10 (GO TO 330)
OTHER (SPECIFY) _________ 11 (GO TO 330)
UNSURE 98 (GO TO 330)

328. Where can you get (METHOD MENTIONED IN 327)?

(NAME OF PLACE) __________
GOVERNMENT AND PARASTATAL
CONSULTANT HOSPITAL 11 (GO T0 332)
REGIONAL HOSPITAL 12 (GO T0 332)
DISTRICT HOSPITAL 13 (GO T0 332)
HEALTH CENTRE 14 (GO T0 332)
DISPENSARY 15 (GO T0 332)
PARASTATAL HEALTH FACILITY 16 (GO T0 332)
VILLAGE HEALTH POST/WORKER 17 (GO TO 334)
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21 (GO T0 332)
PRIV. DOCTOR/CLINIC/HOSPITAL 22 (GO T0 332)
PHARMACY/MEDICAL STORE 23 (GO T0 332)
UMATI CBD WORKER 24 (GO TO 334)
OTHER PRIVATE SECTOR
SHOP 31 (GO T0 332)
NEIGHBORS/RELATIVES 32 (GO TO 334)
OTHER (SPECIFY) _________________ 41 (GO TO 334)
DON’T KNOW 98 (GO TO 330)

329. CHECK 312:

USING CALENDAR, MUCUS METHOD, WITHDRAWAL OR OTHER TRADITIONAL METHOD ___ (GO TO 330)

USING A MODERN METHOD __ (GO TO 334)

330. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 334)

331.Where is that?

(NAME OF PLACE) __________
GOVERNMENT AND PARASTATAL
CONSULTANT HOSPITAL 11
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
PARASTATAL HEALTH FACILITY 16
VILLAGE HEALTH POST/WORKER 17 (GO TO 334)
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
UMATI CBD WORKER 24 (GO TO 334)
OTHER PRIVATE SECTOR
SHOP 31
NEIGHBORS/RELATIVES 32 (GO TO 334)
OTHER (SPECIFY) _________________ 41 (GO TO 334)

332. How long does it take to travel from your home to this place?
IF LESS THAN TWO HOURS, RECORD TRAVEL TIME IN MINUTES.
OTHERWISE, RECORD TRAVEL TIME IN HOURS.

MINUTES 1___
HOURS 2 __
DK 9998

333. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

334. In the last month, have you heard or seen a message about family planning:
on the radio?
on television?
from MCN aide?
from neighbors/relatives?
on posters?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
MCN AIDE
YES 1
NO 2
NEIGHBORS/RELATIVES
YES 1
NO 2
POSTER
YES 1
NO 2

335. Is it acceptable or not acceptable to you for family planning information to be provided on the radio or television?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 222:

ONE OR MORE BIRTHS SINCE JAN.1986 __ (GO TO 402)
NO BIRTHS SINCE JAN.1986 __ (GO TO 501)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

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

LINE NUMBER FROM Q.212

LINE NUMBER _____

FROM Q.212 AND Q.216

NAME _______________
ALIVE ___ (GO TO 403)
DEAD ___ (GO TO 403)

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

THEN 1 (GO TO 405)
LATER 2
NO MORE 3 (GO TO 405)

404. How much longer would you like to have waited?

MONTHS 1 __
YEARS 2 __
DK 998

405. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 411)

406. Whom did you see for antenatal care? Anyone else?
RECORD ALL PERSONS MENTIONED.

HEALTH PROFESSIONAL
DOCTOR/MEDICAL ASST A
RURAL MEDICAL AIDE B
NURSE/MIDWIFE C
MCD AIDE D
OTHER PERSON
VILLAGE HEALTH WORKER E
TRAINED BIRTH ATTENDANT F
TRADITIONAL BIRTH ATTENDANT G
OTHER (SPECIFY) ________ H

407. Where did you go for this antenatal care?
RECORD ALL PLACES VISITED.

GOVERNMENT AND PARASTATAL
HOSPITAL A
HEALTH CENTRE B
DISPENSARY C
HEALTH POST D
PARASTATAL HOSP/CLINIC E
PRIVATE SECTOR
RELIGIOUS ORG. HOSP/CLIN F
PRIVATE HOSPITAL/CLINIC G
NONE H

408. Were you given an antenatal card for this pregnancy?

YES 1
NO 2

409. How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

MONTHS _____
DK 98

410. How many antenatal visits did you have during this pregnancy?

NO. OF VISITS _____
DK 98

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

YES 1
NO 2 (GO TO 413)
DK 8 (GO TO 413)

412. How many times did you get this injection?

TIMES _____
DK 8

413. Where did you give birth to (NAME)?

HOME
YOUR HOME 11
OTHER HOME 12
GOVERNMENT AND PARASTATAL
HOSPITAL 21
HEALTH CENTRE 22
DISPENSARY 23
PARASTATAL HOSP/CLINIC 24
PRIVATE SECTOR
RELIGIOUS ORG HOSP/CLIN 31
PRIVATE HOSPITAL/CLINIC 32
OTHER (SPECIFY) ____________ 41

414. Who assisted with the delivery of (NAME)? Anyone else?
RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR/MEDICAL ASST A
RURAL MEDICAL AIDE B
NURSE/MIDWIFE C
MCD AIDE D
OTHER PERSON
VILLAGE HEALTH WORKER E
TRAINED BIRTH ATTENDANT F
TRADITIONAL BIRTH ATTENDANT G
OTHER (SPECIFY) ________ H

415. Was (NAME) born on time or prematurely?

ON TIME 1
PREMATURELY 2
DK 8

416. Was (NAME) delivered by caesarian section?

YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DK 8

418. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 420)

419. How much did (NAME) weigh?
RECORD FROM MCN CARD IF AVAILABLE.

KILOGRAMS __.__
DK 998

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

YES 1 (GO TO 422)
NO 2 (GO TO 423)

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

YES 1
NO 2 (GO TO 425)

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

MONTHS ______
DK 98

423. CHECK 223:
WOMAN PREGNANT?

NOT PREGNANT __ (GO TO 424)
PREGNANT OR UNSURE __ (GO TO 425)

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

YES 1
NO 2 (GO TO 426)

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

MONTHS ___________
DK 98

426. Did you ever breastfeed (NAME)?

YES 1 (GO TO 428)
NO 2

427. Why did you not breastfeed (NAME)?

MOTHER ILL/WEAK 1 (GO TO 437)
CHILD ILL/WEAK 2 (GO TO 437)
CHILD DIED 3 (GO TO 437)
NIPPLE/BREAST PROBLEM 4 (GO TO 437)
INSUFFICIENT MILK 5 (GO TO 437)
MOTHER WORKING 6 (GO TO 437)
CHILD REFUSED 7 (GO TO 437)
OTHER (SPECIFY) _________ 8 (GO TO 437)

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

IMMEDIATELY 000
HOURS 1 ______
DAYS 2 ______

429. CHECK 216: CHILD ALIVE?

ALIVE __ (GO TO 430)
DEAD __ (GO TO 435)

430. Are you still breastfeeding (NAME)?

YES 1
NO 2 (GO TO 435)

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

NUMBER OF NIGHTTIME FEEDINGS ______

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

NUMBER OF DAYLIGHT FEEDINGS _________

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

Plain water?
Sugar water?
Juice?
Tea?
Baby formula?
Cow’s milk?
Tinned or powdered milk?
Other liquids?
Any solid or mushy food?

PLAIN WATER
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
JUICE
YES 1
NO 2
TEA
YES 1
NO 2
BABY FORMULA
YES 1
NO 2
FRESH MILK
YES 1
NO 2
TINNED/POWDERED MILK
YES 1
NO 2
OTHER LIQUIDS
YES 1
NO 2
SOLID/MUSHY FOOD
YES 1
NO 2

434. CHECK 433:
FOOD OR LIQUID GIVEN YESTERDAY?

‘YES’ TO ONE OR MORE __ (GO TO 439)
‘NO’ TO ALL __ (GO TO 438)

435. For how many months did you breastfeed (NAME)?

MONTHS _________
UNTIL DIED 96 (GO TO 438)

436. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) _______ 11

437. CHECK 216: CHILD ALIVE?

ALIVE __ (GO TO 439)
DEAD __ (GO TO 438)

438. Was (NAME) ever given water or something else to drink or eat (other than breastmilk)?

YES 1
NO 2 (GO TO 444)

439. How many months old was (NAME) when you started giving the following on a regular basis?:
IF LESS THAN 1 MONTH, RECORD ‘00’.

Formula or milk other than breastmilk?
AGE IN MONTHS __
NOT GIVEN 96
Plain water?
AGE IN MONTHS __
NOT GIVEN 96
Other liquids?
AGE IN MONTHS __
NOT GIVEN 96
Any solid or mushy food?
AGE IN MONTHS __
NOT GIVEN 96

440. CHECK 216: CHILD ALIVE?

ALIVE __ (GO TO 441)
DEAD __ (GO TO 444)

441. How many meals did (NAME) eat yesterday?

NUMBER OF MEALS ___
DK 8

442. Did (NAME) eat any other food such as ground nuts, sweet bananas, buns or other things or drink any soda yesterday?

YES 1
NO 2
DK 8

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

YES 1
NO 2
DK 8

444. GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 445.

SECTION 4B. IMMUNIZATION AND HEALTH

445. ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1986 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM Q.212

___

FROM Q212 AND Q216

NAME ______
ALIVE __
DEAD __

446. Do you have a card where (NAME’S) vaccinations are written down?
IF YES: May I see it, please?

YES, SEEN 1 (GO TO 448)
YES, NOT SEEN 2 (GO TO 450)
NO CARD 3

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

YES 1 (GO TO 450)
NO 2 (GO TO 450)

448. (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.

BCG
DPT 1
DPT 2
DPT 3
Polio 1
Polio 2
Polio 3
Measles

BCG
DAY ___
MO ___
YR ___
D1
DAY ___
MO ___
YR ___
D2
DAY ___
MO ___
YR ___
D3
DAY ___
MO ___
YR ___
P1
DAY ___
MO ___
YR ___
P2
DAY ___
MO ___
YR ___
P3
DAY ___
MO ___
YR ___
MEA
DAY ___
MO ___
YR ___

449. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD ‘YES’ ONLY IF RESPONDENT MENTIONS BCG, DPT, POLIO AND/OR MEASLES VACCINATIONS.

YES 1 (PROBE FOR VACCINATIONS AND WRITE ‘66’ IN THE CORRESPONDING DAY COLUMN IN 448) (GO TO 452)
NO 2 (GO TO 452)
DK 8 (GO TO 452)

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

YES 1
NO 2 (GO TO 452)
DK 8 (GO TO 452)

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

A BCG vaccination against tuberculosis, that is, an injection in the right shoulder that left a scar?
YES 1
NO 2
DK 8
Polio vaccine, that is, drops in the mouth?
IF YES: How many times?
YES 1
NO 2
DK 8
NUMBER OF TIMES __
An injection against measles?
YES 1
NO 2
DK 8

452. Was (NAME) ever ill with measles?

YES 1
NO 2

453. CHECK 216: CHILD ALIVE?

ALIVE __ (GO TO 455)
DEAD __ (GO TO 454)

454. GO BACK TO 446 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 485.

455. Has (NAME) been ill with a fever at any time in the last 2 weeks?

YES 1
NO 2
DK 8

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

YES 1
NO 2 (GO TO 460)
DK 8 (GO TO 460)

457. Has (NAME) been ill with a cough at any time in the last 24 hours?

YES 1
NO 2
DK 8

458. How long (has the cough lasted/did the cough last)?
IF LESS THAN 1 DAY, RECORD ‘00’.

DAYS _____

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

YES 1
NO 2
DK 8

460. CHECK 455 AND 456:
FEVER OR COUGH?

‘YES’ IN EITHER 455 OR 456 ___ (GO TO 461)
OTHER __ (GO TO 465)

461. Was anything given to treat the fever/cough?

YES 1
NO 2 (GO TO 463)
DK 8 (GO TO 463)

462. What was given to treat the fever/cough? Anything else?
RECORD ALL TREATMENTS MENTIONED.

INJECTION A
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY) _______ H

463. Did you seek advice or treatment for the fever/cough?

YES 1
NO 2 (GO TO 465)

464. From whom or where did you seek advice or treatment? Anyone else?
CIRCLE ALL PERSONS SEEN AND PLACES VISITED.

GOVERNMENT AND PARASTATAL
HOSPITAL A
HEALTH CENTRE B
DISPENSARY C
PARASTATAL HOSP/CLINIC D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. HOSP/CLINIC F
PRIVATE DOCTOR/HOSP/CLINIC G
PHARMACY/MEDICAL STORE H
OTHER PRIVATE SECTOR
TRADITIONAL PRACTIONER I
NEIGHBORS/RELATIVES J
OTHER (SPECIFY) _________________ K

465. Has (NAME) had diarrhea (three or more watery stools) in the last two weeks?

YES 1 (GO TO 467)
NO 2
DK 8

466. GO BACK TO 446 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 485.

467. Has (NAME) had diarrhea (three or more watery stools) in the last 24 hours?

YES 1
NO 2
DK 8

468. How long has the diarrhea lasted/did the diarrhea last?
IF LESS THAN 1 DAY, RECORD ‘00’.

DAYS ____

469. Was there any blood in the stools?

YES 1
NO 2
DK 8

470. CHECK 425: LAST CHILD STILL BREASTFED?

YES __ (GO TO 471)
NO __ (GO TO 473)

471. During (NAME)’s diarrhea, did you change the frequency of breastfeeding?

YES
NO (GO TO 473)

472. Did you increase the number of feeds or reduce them, or did you stop completely?

INCREASED 1
REDUCED 2
STOPPED COMPLETELY 3

473. (Aside from breastmilk) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DK 8

474. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 476)
DK 8 (GO TO 476)

475. What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS MENTIONED.

FLUID FROM ORS PACKET A
RECOMMENDED HOME ‘FLUID’* B
ANTIBIOTIC PILL OR SYRUP C
OTHER PILL OR SYRUP D
INJECTION E
DRIP F
HOME REMEDIES/HERBAL MEDICINES G
OTHER (SPECIFY) _______ H

*RECOMMENDED HOME FLUID MADE FROM SUGAR, SALT AND WATER AND/OR CEREAL OR THIN PORRIDGE.

476. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 478)

477. From whom or where did you seek advice or treatment? Anyone else?
CIRCLE ALL PERSONS SEEN AND PLACES VISITED.

GOVERNMENT AND PARASTATAL
HOSPITAL A
HEALTH CENTRE B
DISPENSARY C
PARASTATAL HOSP/CLINIC D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. HOSP/CLINIC F
PRIVATE DOCTOR/HOSP/CLINIC G
PHARMACY/MEDICAL STORE H
OTHER PRIVATE SECTOR
TRADITIONAL PRACTIONER I
NEIGHBORS/RELATIVES J
OTHER (SPECIFY) _________________ K

478. CHECK 475:
FLUID FROM ORS PACKET MENTIONED?

NO, ORS FLUID NOT MENTIONED ___ (GO TO 479)
YES, ORS FLUID MENTIONED ___ (GO TO 480)

479. Was (NAME) given fluid from ORS packet when he/she had the diarrhea?

YES 1
NO 2 (GO TO 481)
DK 8 (GO TO 481)

480. For how many days was (NAME) given fluid from the ORS packet?
IF LESS THAN 1 DAY, RECORD ‘00’.

DAYS _____
DK 98

481. CHECK 475:
RECOMMENDED HOME FLUID* MENTIONED?

NO, HOME FLUID NOT MENTIONED __ (GO TO 482)
YES, HOME FLUID MENTIONED __ (GO TO 483)

*RECOMMENDED HOME FLUID MADE FROM SUGAR, SALT AND WATER AND/OR CEREAL OR THIN PORRIDGE.

482. Was (NAME) given a recommended homemade fluid made from sugar, salt and water and/or cereal or thin porridge when he/she had the diarrhea?

YES 1
NO 2 (GO TO 484)
DK 8 (GO TO 484)

483. For how many days was (NAME) given the fluid made from sugar, salt, and water and/or cereal or thin porridge?
IF LESS THAN 1 DAY, RECORD ‘00’.

DAYS _____
DK 98

484. GO BACK TO 446 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 485.

485. CHECK 475 AND 479:

ORS FLUID FROM PACKET GIVEN TO ANY CHILD __ (GO TO 489)
ORS FLUID FROM PACKET NOT GIVEN TO ANY CHILD OR 475 AND 479 NOT ASKED __ (GO TO 486)

486. Have you ever heard of a special product called (LOCAL NAME) you can get for the treatment of diarrhea?

YES 1 (GO TO 488)
NO 2

487. Have you ever seen a packet like this before? (SHOW PACKET)

YES 1
NO 2 (GO TO 492)

488. Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else? (SHOW PACKET)

YES 1
NO 2 (GO TO 491)

489. The last time you prepared the fluid from the ORS packet, did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
PART OF PACKET 2 (GO TO 491)

490. How much water did you use to prepare (LOCAL NAME OF ORS PACKET) the last time you made it?

1/2 LITER 1
1 LITER 2
1 1/2 LITERS 3
2 LITERS 4
FOLLOWED PACKAGE INSTRUCTIONS 5
OTHER (SPECIFY) _____ 6
DK 8

491. Where can you get (LOCAL NAME) packet?
PROBE: Anywhere else?
CIRCLE ALL PLACES MENTIONED.

GOVERNMENT AND PARASTATAL
HOSPITAL A
HEALTH CENTRE B
DISPENSARY C
PARASTATAL HOSP/CLINIC D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. HOSP/CLINIC F
PRIVATE DOCTOR/HOSP/CLINIC G
PHARMACY/MEDICAL STORE H
OTHER PRIVATE SECTOR
SHOP I
TRADITIONAL PRACTIONER J
NEIGHBORS/RELATIVES K
OTHER (SPECIFY) _________________ L

492. CHECK 475 AND 482:

RECOMMENDED HOME MADE FLUID GIVEN TO ANY CHILD __ (GO TO 493)

RECOMMENDED HOME FLUID NOT GIVEN TO ANY CHILD OR 475 AND 482 NOT ASKED __ (GO TO 501)

493. Where did you learn to prepare the recommended home fluid made from sugar, salt, and water and/or cereal or porridge given to (NAME) when he/she had the diarrhea?

GOVERNMENT AND PARASTATAL
HOSPITAL A
HEALTH CENTRE B
DISPENSARY C
PARASTATAL HOSP/CLINIC D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. HOSP/CLINIC F
PRIVATE DOCTOR/HOSP/CLINIC G
PHARMACY/MEDICAL STORE H
OTHER PRIVATE SECTOR
SHOP I
TRADITIONAL PRACTIONER J
NEIGHBORS/RELATIVES K
OTHER (SPECIFY) _________________ L

SECTION 5. MARRIAGE

501. Have you ever been married or lived with a man?

YES 1
NO 2 (GO TO 512)

502. Are you now married or living with a man, or are you now widowed, divorced or no longer living together?

MARRIED 1
LIVING TOGETHER 2
WIDOWED 3 (GO TO 507)
DIVORCED/NO LONGER LIVING TOGETHER 4 (GO TO 507)

503. Does your husband/partner usually sleep in this house or does he usually sleep somewhere else?

USUALLY SLEEPS IN HER HOUSE 1
USUALLY SLEEPS ELSEWHERE 2

504. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 507)

505. How many other wives does he have?

NUMBER ___
DK 98 (GO TO 507)

506. Are you the first, second,... wife?

RANK ___

507. Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

508. In what month and year did you start living with your (first) husband or partner?

MONTH ___
DK MONTH 98
YEAR ____
DK YEAR 98

509. How old were you when you started living with your (first) husband or partner?

AGE ____
DK AGE 98

510. CHECK 508 AND 509: YEAR AND AGE GIVEN?

YES __ (GO TO 511)
NO __ (GO TO 513)

511. CHECK CONSISTENCY OF 508 AND 509:

YEAR OF BIRTH (105) ___
PLUS +
AGE AT MARRIAGE (509) ___
CALCULATED YEAR OF MARRIAGE ___
IF NECESSARY, CALCULATE YEAR OF BIRTH
CURRENT YEAR 91
MINUS -
CURRENT AGE (106) ___
CALCULATED YEAR OF BIRTH ___
IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (508)?
YES __ (GO TO 513)
NO __ (PROBE AND CORRECT 508 AND 509)

512. IF NEVER MARRIED OR LIVED WIT H A MAN:
Have you ever had sexual intercourse?

YES 1
NO 2 (GO TO 520)

513. Now we need some details about your sexual activity in order to get a better understanding of family planning and fertility.
How many times did you have sexual intercourse in the last four weeks?

TIMES ___

514. How many times in a month do you usually have sexual intercourse?

TIMES ___

515. CHECK 513:

HAD SEXUAL INTERCOURSE ONE OR MORE TIMES IN THE LAST FOUR WEEKS ___ (GO TO 516)
ZERO TIMES ___ (GO TO 518)

516. With how many different men did you have sex in the last four weeks?

NUMBER OF MEN ___

517. Did you use a condom with any of these men?

YES 1
NO 2

518. When was the last time you had sexual intercourse?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
BEFORE LAST BIRTH 996

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

AGE __
FIRST TIME WHEN MARRIED 96

520. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

521. Now I have a few questions about a very important topic.
Have you heard of an illness called AIDS?

YES 1
NO 2 (GO TO 601)

522. From which sources of information or persons have you heard about AIDS in the last month?
RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS C
HEALTH WORKERS D
MOSQUES/CHURCHES E
FRIENDS/RELATIVES F
SCHOOLS/QURAN TEACHERS G
SLOGANS/PAMPHLETS/POSTERS H
COMMUNITY MEETINGS I
CCM OFFICE J
OTHER (SPECIFY) __________________ K
NONE L

523. How is AIDS transmitted?
RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
NEEDLES/BLADES/SKIN PUNCTURES B
MOTHER TO CHILD C
TRANSFUSION OF INFECTED BLOOD D
OTHER (SPECIFY) __________________ E
DON’T KNOW F

524. Do you think that you can get AIDS from
shaking hands with someone who has AIDS?
hugging someone who has AIDS?
kissing someone who has AIDS?
wearing the clothes of someone who has AIDS?
sharing eating utensils with someone who has AIDS?
stepping on the urine or stool of someone who has AIDS?
mosquito, flea or bedbug bites?

HANDSHAKING
YES 1
NO 2
HUGGING
YES 1
NO 2
KISSING
YES 1
NO 2
SHARING CLOTHES
YES 1
NO 2
SHARING EATING UTENSILS
YES 1
NO 2
STEPPING ON URINE/STOOL
YES 1
NO 2
MOSQUITO/FLEA/BEDBUG BITES
YES 1
NO 2

525. Is it possible for a healthy looking person to have AIDS?

YES 1
NO 2
DK 8

526. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?

YES 1
NO 2
DK 8

527. What do you suggest is the most important thing the government should do for people who have AIDS?

PROVIDE MEDICAL TREATMENT 1
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE/JAIL 3
NOT BE INVOLVED 4
OTHER (SPECIFY) ___________________ 5

528. If your relative is suffering with AIDS, who would you prefer to care for him/her?

RELATIVES/FRIENDS 1
GOVERNMENT 2
RELIGIOUS ORG./MISSION 3
NOBODY/ABANDON 4
OTHER (SPECIFY) ________________ 5

SECTION 6. FERTILITY PREFERENCES

601. CHECK 312:

SHE/HE NOT STERILIZED __ (GO TO 602)
HE OR SHE STERILIZED __ (GO TO 607)

602. CHECK 501 AND 502:

CURRENTLY MARRIED OR LIVING TOGETHER __ (GO TO 603)
NOT MARRIED/NOT LIVING TOGETHER __ (GO TO 614)

603. CHECK 223:

NOT PREGNANT OR UNSURE __
Now I have some questions 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, would you like to have another child or would you prefer not to have any more children?

HAVE (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 610)
SAYS SHE CAN’T GET PREGNANT 3 (GO TO 610)
UNDECIDED OR DK 8 (GO TO 610)

604. CHECK 223:
NOT PREGNANT OR UNSURE __
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT __
How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS 1 ___ (GO TO 610)
YEARS 2 ___ (GO TO 610)
SOON/NOW 994 (GO TO 610)
SAYS SHE CAN’T GET PREGNANT 995 (GO TO 610)
OTHER (SPECIFY) _____ 996
DK 998

605. CHECK 216:

HAS LIVING CHILDREN OR PREGNANT ___ (GO TO 606)
NO LIVING CHILDREN ___ (GO TO 610)

606. CHECK 223:
NOT PREGNANT OR UNSURE __
How old would you like your youngest child to be when your next child is born?

PREGNANT __
How old would you like the child you are expecting to be when your next child is born?

AGE OF YOUNGEST CHILD:
YEARS ____ (GO TO 610)
DK 98 (GO TO 610)

607. Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have an operation not to have any more children?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 614)

609. Why do you regret it?

RESPONDENT WANTS ANOTHER CHILD 1 (GO TO 614)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 614)
SIDE EFFECTS 3 (GO TO 614)
OTHER REASON (SPECIFY) ____________ 4 (GO TO 614)

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

APPROVES 1
DISAPPROVES 2
DK 8

611. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

612. Have you and your husband/partner ever discussed the number of children you would like to have?

YES 1
NO 2

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

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

614. How long should a couple wait before starting sexual intercourse after the birth of a baby?

MONTHS 1 __
YEARS 2 __
OTHER (SPECIFY) ________ 996
DON’T KNOW 998

615. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn’t it matter?

WAIT 1
DOESN’T MATTER 2
DON’T KNOW 8

616. Do you think it is easy or difficult for a woman who is breastfeeding to get pregnant?

EASY 1
DIFFICULT 2

617. In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2

618. 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?

RECORD SINGLE NUMBER OR OTHER ANSWER.

NUMBER ______
OTHER ANSWER (SPECIFY) ____________96 (GO TO 620)

619. Among the children you want to have, how many would you prefer to be boys and how many to be girls?

NUMBER OF SONS ___
NUMBER OF DAUGHTERS ___
NO SEX PREFERENCE 95
OTHER ANSWER (SPECIFY) ________________ 96

620. What do you think is the best number of months or years between the birth of one child and the birth of the next child?

MONTHS 1 __
YEARS 2 __
OTHER (SPECIFY) ______ 996
DON’T KNOW 998

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

701. CHECK 501:

YES, MARRIED OR LIVED WITH A MAN ___
(ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER)
NO, NEVER MARRIED OR LIVED WITH A MAN ___
(GO TO 708)

702. Can (could) your husband/partner read and write Kiswahili easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 705)

704. What was the highest formal school he completed?

LESS THAN 1 YEAR 00
STANDARD 1 01
STANDARD 2 02
STANDARD 3 03
STANDARD 4 04
STANDARD 5 05
STANDARD 6 06
STANDARD 7 07
STANDARD 8 08
FORM 1 09
FORM 2 10
FORM 3 11
FORM 4 12
FORM 5 13
FORM 6 14
UNIVERSITY 15
OTHER (SPECIFY) ________________ 96

705. What kind of work does (did) your (last) husband/partner mainly do?

____________________ __

706. CHECK 705:

WORKS (WORKED) IN AGRICULTURE __ (GO TO 707)
DOES (DID) NOT WORK IN AGRICULTURE __ (GO TO 708)

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

HIS/FAMILY LAND 1
RENTED LAND 2
SOMEONE ELSE’S LAND 3

708. Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

709. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?

YES 1
NO 2 (GO TO 717)

710. What is your occupation, that is, what kind of work do you do?

____________________ __

711. In your current work, do you work for a member of your family, for someone else, or are you self-employed?

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

712. Do you earn cash for this work?
PROBE: Do you make money for working?

YES 1
NO 2

713. Do you do this work at home or away from home?

HOME 1
AWAY 2

714. CHECK 215/216/218:
HAS CHILD BORN SINCE JAN. 1986 AND LIVING WITH RESPONDENT?

YES 1 __ (GO TO 715)
NO 2 __ (GO TO 717)

715. While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

USUALLY 1 (GO TO 717)
SOMETIMES 2
NEVER 3

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

HUSBAND/PARTNER 01
OLDER CHILD(REN) 02
OTHER RELATIVES 03
NEIGHBORS 04
FRIENDS 05
SERVANTS/HIRED HELP 06
CHILD IS IN SCHOOL 07
INSTITUTIONAL CHILDCARE 08
OTHER (SPECIFY) ________ 09

717. RECORD THE TIME

HOUR __
MINUTES __

SECTION 8. HEIGHT AND WEIGHT

801. CHECK 222:

ONE OR MORE BIRTHS SINCE JAN. 1986 __ (GO TO 802)
NO BIRTHS SINCE JAN. 1986 __ (GO TO 901)

INTERVIEWER:
IN 802 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1986 AND STILL ALIVE.
IN 803 AND 804 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1986. IN 806 AND 808 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1986 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1986, USE ADDITIONAL FORMS)

802. LINE NO. FROM Q.212

___

803. NAME FROM Q.212 FOR CHILDREN

(NAME) ___________

804. DATE OF BIRTH
FROM Q.215 FOR RESPONDENT
FROM Q.215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

MONTH ___
YEAR ___

805. BCG SCAR ON TOP OF RIGHT SHOULDER

SCAR SEEN 1
NO SCAR 2

806. HEIGHT (in centimeters)

____.__

807. WAS HEIGHT/LENGTH OF CHILD MEASURED LYING DOWN OR STANDING UPRIGHT?

LYING 1
STANDING 2

808. WEIGHT (in kilograms)

____.__

809. DATE WEIGHED AND MEASURED

DAY ___
MONTH ___
YEAR __

810. RESULT

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) _______ 6

811. NAME OF MEASURER: __________ __
NAME OF ASSISTANT: _________ __

SECTION 9. LANGUAGE INFORMATION

901. IN WHAT LANGUAGE DID YOU CONDUCT THE INTERVIEW?

KISWAHILI 01
OTHER _______________ ___

902. FOR HOW MUCH OF THE INTERVIEW DID YOU DEPEND ON A THIRD PERSON TO INTERPRET FOR YOU?

NONE OF THE INTERVIEW 1 (END)
SOME OF THE INTERVIEW 2
MOST OF THE INTERVIEW 3
ALL OF THE INTERVIEW 4
OTHER (SPECIFY) __________________ 5

903. IF AN INTERPRETER WAS USED, INDICATE THE SEX AND APPROXIMATE AGE OF INTERPRETER.

ADULT FEMALE 1
TEENAGE FEMALE 2
ADULT MALE 3
TEENAGE MALE 4
OTHER (SPECIFY) ______________ 5

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 Field Editor: ________________
Date: _________________