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DEMOGRAPHIC AND HEALTH SURVEYS - TANZANIA 2004 - WOMAN'S QUESTIONNAIRE

IDENTIFICATION

REGION

DISTRICT

WARD

ENUMERATION AREA

NAME OF HOUSEHOLD HEAD

TDHS NUMBER

HOUSEHOLD NUMBER

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE

LARGE CITY=1
SMALL CITY=2
TOWN=3
COUNTRYSIDE=4

LARGE CITIES ARE; DAR ES SALAAM AND MWANZA. SMALL CITIES ARE; ARUSHA, MOROGORO, DODOMA, MOSHI, TANGA, IRINGA MBEYA, SHINYANGA, TABORA, MIJINI MAGHARIBI - ZANZIBAR. ALL OTHER URBAN AREAS ARE TOWN

NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER NAME
RESULT

RESULT*

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

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR 200_
INT. NUMBER
RESULT*

TOTAL NUMBER OF VISITS

SURPERVISOR
NAME ___________

FIELD EDITOR
NAME ___________

OFFICE EDITOR

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ___________________ and I am working with the National Burea of Statistics. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services.
The survey usually does not take too much time. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: _________
Date: _________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR ______
MINUTES ______

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 a D'Salaam/Mwanza, Other urban area or in rural area?

DSM/MWANZA1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ____

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

104. Just before you moved here, did you live in D'Salaam/Mwanza, Other urban area or in rural area?

DSM/MWANZA1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

105. In what month and year were you born?

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

106. How old are you in completed years?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ________

107. Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

PREPRIMARY 0
PRIMARY 1
POST-PRIMARY TRAINING 2
SECONDARY 3
POST-SECONDARY TRAINING 4
UNIVERSITY 5

109. What is the highest (standard/form/year) you completed at that level?

GRADE _______

110. CHECK 108:

PRIMARY OR LESS (GO TO 111)
SECONDARY OR HIGHER (GO TO 114)

111. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT. (2) IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) __________ 4
BLIND/VISUALLY IMPAIRED 5

112. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

113. CHECK 111:

CODE '2', '3' OR '4' CIRCLED (GO TO 114)
CODE '1' OR '5' CIRCLED (GO TO 115)

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

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

115. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

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

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

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

117. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

NUMBER OF TRIPS _____
NONE 00 (GO TO 119)

118. In the last 12 months, have you been away from your home community for more than one month at a time?

YES 1
NO 2

119. What is your religion?

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

1 Wording of this paragraph should be modified in countries where participation is legally required.
2 Each card should have four simple sentences appropriate to the country:

PARENTS LOVE THEIR CHILDREN.
FARMING IS HARD WORK.
THE CHILD IS READING A BOOK.
CHILDREN WORK HARD AT SCHOOL.

Cards should be prepared for every language in which respondents are likely to be literate.

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 girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

207. 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 ENTER TOTAL.
IF NONE, RECORD '00'.

TOTAL _______

209. CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ 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 226)

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

(NAME) ________

213. Were any of these births twins?

SING 1
MULT 2

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

BOY 1
GIRL 2

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

MONTH ______
YEAR _______

216. Is (NAME) still alive?

YES 1
NO 2 (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
NO 2

219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD
(RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).

LINE NUMBER ______ (NEXT BIRTH)

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

DAYS 1 _____
MONTHS 2 _______
YEARS 3 _______

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

YES 1
NO 2

IF MORE THAN 12 LIVE BIRTHS, GO TO CONTINUATION QUESTIONNAIRE.

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)?

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK: FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

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

225. FOR EACH BIRTH SINCE JANUARY 1999, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.
(NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ________

228. 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 at all?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 237)

230 When did the last such pregnancy end?

MONTH _____
YEAR ______

231. CHECK 230:

LAST PREGNANCY ENDED IN JAN. 1999 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JAN. 1999 (GO TO 237)

232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS _______

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

YES 1
NO 2 (GO TO 237)

234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 1999.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any pregnancies that terminated before 1999 that did not result in a live birth?

YES 1
NO 2 (GO TO 237)

236. When did the last such pregnancy that terminated before 1999 end?

MONTH ______
YEAR ______

237. When did your last menstrual period start?

(DATE, IF GIVEN) __________
DAYS AGO 1 ________
WEEKS AGO 2 _______
MONTHS AGO 3 _______
YEARS AGO 4 _______

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

238. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

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

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

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for three or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before sexual intercourse.
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant and must take the pills every day for 5 days.
YES 1
NO 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
SPECIFY____
YES 1
NO 2

302. Have you ever used (METHOD)?

01 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
02 MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for three or more months.
YES 1
NO 2
06 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07 CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before sexual intercourse.
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12 RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant and must take the pills every day for 5 days.
YES 1
NO 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

303. CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

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

YES 1(GO TO 306)
NO 2

305. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (GO TO 329)

306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).

307. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN ______

308. CHECK 302 (01):

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 318)

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

YES 1
NO 2 (GO TO 318)

311. Which method are you using?
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C (GO TO 316A)
IUD D (GO TO 316A)
INJECTABLES E (GO TO 316A)
IMPLANTS F (GO TO 316A)
CONDOM G (GO TO 316A)
FEMALE CONDOM H (GO TO 316A)
DIAPHRAGM I (GO TO 316A)
FOAM/JELLY J (GO TO 316A)
LACTATIONAL AMEN. METHOD K (GO TO 316A)
PERIODIC ABSTINENCE L (GO TO 316A)
WITHDRAWAL M (GO TO 316A)
OTHER (SPECIFY) _______________________ X (GO TO 316A)

313. In what facility did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF BOTH CODE 'A' AND CODE 'B' ARE CIRCLED IN 311, ASK 313-317 ABOUT FEMALE STERILIZATION ONLY.

(NAME OF PLACE) ____________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL 11
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL 22
DISTRICT HOSPITAL 23
GOVT. HEALTH CENTRE 24
DISPENSARY 25
PRIVATE
DISTRICT HOSPITAL 31
HEALTH CENTRE 32
DISPENSARY 33
OTHER (SPECIFY) _______________________ 96
DON'T KNOW 98

314. CHECK 311:

CODE 'A' CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

CODE 'A' NOT CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?

YES 1
NO 2
DON'T KNOW 8

316. In what month and year was the sterilization performed?
316A. In what month and year did you start using (CURRENT METHOD) continuously?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH _________
YEAR _________

316B. CHECK 316/316A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 316/316A

YES (GO BACK TO 316/316A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).)
NO (GO TO 317)

317. CHECK 316/316A:

YEAR IS 1999 OR LATER
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH STARTED USING.
THEN CONTINUE WITH 318
YEAR IS 1998 OR EARLIER
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1999.
THEN GO TO 327

318. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1999.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:

COLUMN 1:

* When was the last time you used a method? Which method was that?
* When did you start using that method? How long after the birth of (NAME)?
* How long did you use the method then?

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.
ILLUSTRATIVE QUESTIONS:

COLUMN 2:

* Where did you obtain the method when you started using it?
* Where did you get advice on how to use the method [for LAM, rhythm, or withdrawal]

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION IN LAST MONTH OF USE.
NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:

COLUMN 3:

* Why did you stop using the (METHOD)?
* Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: * How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

321. CHECK 311/311A:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 329)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 328)
FEMALE CONDOM 08 (GO TO 325)
DIAPHRAGM 09(GO TO 325)
FOAM/JELLY 10(GO TO 325)
LACTATIONAL AMEN. METHOD . 11 (GO TO 325)
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13(GO TO 331)
OTHER METHOD 96(GO TO 331)

322. You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 324)
NO 2

323. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 325)

324. Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

325. CHECK 322:

CODE '1' CIRLED: At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?

YES 1 (GO TO 327)
NO 2

326. Were you ever told by a health or family planning worker about other methods of family planning that you could use?

YES 1
NO 2

327. CHECK 311/311A:

CIRCLE METHOD CODE:

FEMALE STERILIZATION 01 (GO TO 331)
MALE STERILIZATION 02 (GO TO 331)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10 (GO TO 331)
LACTATIONAL AMEN. METHOD . 11 (GO TO 331)
PERIODIC ABSTINENCE 12 (GO TO 331)
WITHDRAWAL 13 (GO TO 331)
OTHER METHOD 96 (GO TO 331)

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

(NAME OF PLACE) _________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL 11 (GO TO 331)
REGIONAL HOSPITAL 12(GO TO 331)
DISTRICT HOSPITAL 13(GO TO 331)
HEALTH CENTRE 14(GO TO 331)
DISPENSARY 15(GO TO 331)
VILLAGE HEALTH POST (WO 16 (GO TO 331)
CBD WORKER 17(GO TO 331)
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL 21 (GO TO 331)
DISTRICT HOSPITAL 22(GO TO 331)
GOVT. HEALTH CENTRE 23 (GO TO 331)
DISPENSARY 24 (GO TO 331)
PRIVATE
DISTRICT HOSPITAL 31 (GO TO 331)
HEALTH CENTRE 32 (GO TO 331)
DISPENSARY 33 (GO TO 331)
OTHER
PHARMACY 41 (GO TO 331)
NGO 42 (GO TO 331)
VCT CENTRE 43 (GO TO 331)
SHOP/KIOSK 44(GO TO 331)
BAR 45 (GO TO 331)
GUEST HOUSE/HOTEL 46 (GO TO 331)
FRIEND/RELATIVE/NEIGHBOUR 47 (GO TO 331)
OTHER (SPECIFY) _______________________ 96 (GO TO 331)

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

YES 1
NO 2 (GO TO 331)

330. Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.

(NAME OF PLACE) _________
GOVERNMENT/PARASTATAL
REFERRAL/SPEC. HOSPITAL A
REGIONAL HOSPITAL B
DISTRICT HOSPITAL C
HEALTH CENTRE D
DISPENSARY E
VILLAGE HEALTH POST F
CBDWORKER G
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL H
DISTRICT HOSPITAL I
GOVT. HEALTH CENTRE J
DISPENSARY K
PRIVATE
DISTRICT HOSPITAL L
HEALTH CENTRE M
DISPENSARY N
OTHER
PHARMACY O
NGO P
VCT CENTRE Q
SHOP/KIOSK R
BAR S
GUESTHOUSE/HOTEL T
FRIEND/RELATIVE/NEIGHBOUR U
OTHER (SPECIFY) _______ X

331. In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

YES 1
NO 2

332. In the last 12 months, have you visited a health facility for care for yourself (or your children)?

YES 1
NO 2 (GO TO 334)

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

YES 1
NO 2

334. In the past 6 months, have you seen or heard a message about Mama Ushauri?

YES 1
NO 2(GO TO 401)

335. Where did you see or hear the message about Mama Ushauri?
RECORD ALL MENTIONED

RADIO A
TELEVISION B
NEWSPAPER C
OTHER (SPECIFY) _______________________ X
DON'T KNOW Z

1 In countries without a social marketing program for pills, pill users GO TO 316A.
2 Pill users GO TO 316A after last question on social marketing.

SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING

401. CHECK 224:

ONE OR MORE BIRTHS IN 1999 OR LATER (GO TO 402)
NO BIRTHS IN 1999 OR LATER (GO TO 487)

402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1999 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)

403. LINE NUMBER FROM 212

LINE NUMBER ________

404. FROM 212 AND 216

NAME _________________
LIVING (GO TO 407)
DEAD (GO TO 407)

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

THEN 1 (GO TO 407)
LATER 2
NOT AT ALL 3 (GO TO 407)

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

MONTHS 1___
YEARS 2__

DON'T KNOW 998

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

HEALTH PROFESSIONAL
DOCTOR/AMO A
CLINICAL OFFICER B
ASST. CLINICAL OFFICER C
NURSE/MIDWIFE D
MCH AIDE E
OTHER PERSON
VILLAGE HEALTH WORKER F
TRAINED BIRTH ATTENDANT G
TRADITIONAL BIRTH ATTEND. H
RELATIVE/FRIEND I
TRAINED TBA/TBA G
OTHER (SPECIFY) _________ X
NO ONE Y (GO TO 415)

407A. Where did you receive antenatal care for this pregnancy? Anywhere else?

HOME A
GOV. PARASTATAL
REFERAL/SPEC. HOSPITAL B
REGIONAL HOSP. C
DISTRICT HOSP D
HEALTH CENT E
DISPENSARY F
VILLAGE HEALTH POST G
CBD WORKER H
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL I
DISTRICT HOSP J
HEALTH CENT K
DISPENSARY L
PRIVATE
SPECIALISED HOSPITAL M
HEALTH CENT N
DISPENSARY O
OTHER (SPECIFY) __________ X

408. How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS ______
DON'T KNOW 98

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

NUMBER OF TIMES ______
DON'T KNOW 98

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

MORE THAN ONCE (GO TO 412)
ONCE OR DON'T KNOW (GO TO 411)

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

MONTHS ______
DON'T KNOW 98

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

Were you weighed?
Was your height measured?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

WEIGHT
YES 1
NO 2
HEIGHT
YES 1
NO 2
BP
YES 1
NO 2
URINE
YES 1
NO 2
BLOOD
YES 1
NO 2

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

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8(GO TO 415)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)

416. During this pregnancy, how many times did you get this tetanus injection?

TIMES _______
DON'T KNOW 8

417. During this pregnancy, were you given or did you buy any or iron tablets iron syrup?
SHOW TABLETS/SYRUP.

YES 1
NO 2 (GO TO 419)
DON'T KNOW 8 (GO TO 419)

418. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

DAYS ______
DON'T KNOW 998

419. During this pregnancy, did you have difficulty with your vision during the daylight?

YES 1
NO 2
DON'T KNOW 8

420. During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?

YES 1
NO 2
DON'T KNOW 8

421. During this pregnancy, did you take any drugs to keep you from getting malaria?

YES 1
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)

422. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

SP/FANSIDAR A
CHLOROQUINE B
OTHER (SPECIFY) _____ X
DON'T KNOW Z

422A. CHECK 422:
DRUGS TAKEN FOR MALARIA PREVENTION.

CODE 'A' CIRCLED (GO TO 422B)
CODE A' NOT CIRCLED (GO TO 423)

422B. How many times did you take SP during this pregnancy?

TIMES ______

422C. CHECK 407:
ANTENATAL CARE RECEIVED DURING THIS PREGNANCY?

CODE 'A', 'B', C', 'D', OR 'E' CIRCLED (GO TO 422D)
OTHER (GO TO 423)

422D. Did you get the SP during an antenatal visit, during another visit to a health facility or from some other source?
RECORD ALL MENTIONED.

ANTENATAL VISIT A
ANOTHER FACILITY VISIT B
OTHER SOURCE (SPECIFY) _______ X

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

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

424. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)

425. How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD ____
KG FROM RECALL _____

DON'T KNOW 99998

426. Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE(S) PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PROFESSIONAL
DOCTOR/AMO A
CLINICAL OFFICER B
ASST. CLINICAL OFFICER C
NURSE/MIDWIFE D
MCH AIDE E
OTHER PERSON
VILLAGE HEALTH WORKER F
TRAINED BIRTH ATTENDANT G
TRADITIONAL BIRTH ATTEND. H
RELATIVE/FRIEND I
TRAINED TBA/TBA G
OTHER (SPECIFY) _________ X
NO ONE Y

427. Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE FACILITY PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________
HOME
YOUR HOME 01 (GO TO 429)
OTHER HOME 02 (GO TO 429)
GOV.PARASTATAL
REFERAL/SPEC. HOSPITAL 11
REGIONAL HOSP. 12
HOSP. 13
HEALTH CENT 14
DISPENSARY 15
VILLAGE HEALTH POST 16
CBD WORKER 17
RELIGIOUS/VOLUNTARY
REFERRAL/SPEC. HOSPITAL 21
DISTRICT HOSP 22
HEALTH CENT 23
DISPENSARY 24
PRIVATE
SPECIALISED HOSPITAL 31
HEALTH CENT 32
DISPENSARY 33
OTHER (SPECIFY) _________ 96 (GO TO 429)

428. Was (NAME) delivered by caesarean section?

YES 1
NO 2

428A. After you delivered, did the health facility give you a birth notification form for the baby?

YES 1 (GO TO 432B)
NO 2
DON'T KNOW 3

428B. Did you get a birth notification form from any other place?

YES 1 (GO TO 432B)
NO 2 (GO TO 432B)
DON'T KNOW 3 (GO TO 432B)

429. After you were discharged, did any health care provider or a traditional birth attendant check on your health?

YES 1
NO 2 (GO TO 432A)

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

DAYS AFTER DEL 1 ______
WEEKS AFTER DEL 2 ______

DON'T KNOW 998

431. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR/AMO 11
CLINICAL OFFICER 12
ASST. CLINICAL OFFICER 13
NURSE/MIDWIFE 14
MCH AIDE 15
OTHER PERSON
VILLAGE HEALTH WORKER 21
TRAINED BIRTH ATTENDANT 22
TRADITIONAL BIRTH ATTEND. 23
RELATIVE/FRIEND 24
OTHER (SPECIFY) ________ 96

432. Where did this first check take place?
IF SOURCE IS HOSPITAL, GOV. PARASTATAL HEALTH CENTRE, OR CLINIC, REFERAL/SPEC. WRITE THE NAME OF THE HOSPITAL PLACE. PROBE TO IDENTIFY REGIONAL HOSP. THE TYPE OF SOURCE AND DISTRICT HOSP.
CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________
HOME
YOUR HOME 01
OTHER HOME 02
GOV.PARASTATAL
REFERAL/SPEC. HOSPITAL 11
REGIONAL HOSP. 12
HOSP. 13
HEALTH CENT 14
DISPENSARY 15
VILLAGE HEALTH POST 16
CBD WORKER 17
RELIGIOUS/VOLUNTARY
REFERRAL/SPEC. HOSPITAL 21
DISTRICT HOSP 22
HEALTH CENT 23
DISPENSARY 24
PRIVATE
SPECIALISED HOSPITAL 31
HEALTH CENT 32
DISPENSARY 33
OTHER (SPECIFY) _________ 96 (GO TO 429)

432A. After (NAME) was born, did you get a birth notification form?

YES 1
NO 2
DON'T KNOW 8

432B. Do you have a birth certificate for (NAME)?

YES 1
NO 2
DON'T KNOW 8

433. In the first two months after delivery, did you receive a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2

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

YES 1 (GO TO 436)
NO 2 (GO TO 437)

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

YES 1
NO 2 (GO TO 439)

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

MONTHS __________
DON'T KNOW 98

437. CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 438)
PREGNANT OR UNSURE (GO TO 439)

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

YES 1
NO 2 (GO TO 440)

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

MONTHS __________
DON'T KNOW 98

440. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 447)

441. 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 _____

442. In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2 (GO TO 444)

443. What was (NAME) given to drink before your milk began flowing regularly? Anything else?
RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA . G
TEA/INFUSIONS H TEA
HONEY I
OTHER (SPECIFY) _______ X

444. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 445)
DEAD (GO TO 446)

445. Are you still breastfeeding (NAME)?

YES 1 (GO TO 448)
NO 2

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

MONTHS __________
DON'T KNOW 98

447. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 450)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454)

448. 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 _____

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

NUMBER OF DAYLIGHT FEEDINGS _______

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

YES 1
NO 2
DON'T KNOW 8

452. How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ________
DON'T KNOW 8

453. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454.

SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION

454. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1999 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

455. LINE NUMBER FROM 212

LINE NUMBER _________

456. FROM 212 AND 216

NAME _______
LIVING (GO TO 457)
DEAD (GO TO 456 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 484)

457. Did (NAME) receive vitamin A like this during the last 6 months?
SHOW CAPSULES

YES 1
NO 2
DON'T KNOW 8

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

YES, SEEN 1 (GO TO 460)
YES, NOTSEEN 2(GO TO 462)
NO CARD 3

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

YES 1 (GO TO 462)
NO 2

460. (1) COPY VACCINATION DATE 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
DAY ___
MONTH _____
YEAR ______
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY ___
MONTH _____
YEAR ______
POLIO 1
DAY ___
MONTH _____
YEAR ______
POLIO 2
DAY ___
MONTH _____
YEAR ______
POLIO 3
DAY ___
MONTH _____
YEAR ______
DPT-HBIB 1
DAY ___
MONTH _____
YEAR ______
DPT-HBIB 2
DAY ___
MONTH _____
YEAR ______
DPT-HBIB 3
DAY ___
MONTH _____
YEAR ______
DPT-HB1
DAY ___
MONTH _____
YEAR ______
DPT-HB2
DAY ___
MONTH _____
YEAR ______
DPT-HB3
DAY ___
MONTH _____
YEAR ______
MEASLES
DAY ___
MONTH _____
YEAR ______
VITAMIN A (MOST RECENT)
DAY ___
MONTH _____
YEAR ______
VITAMIN A (MOST RECENT)
DAY ___
MONTH _____
YEAR ______

461. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT-HBIB 1-3, DPT-HB 1-3 AND/OR MEASLES VACCINES. (2)

YES 1 (PROBE FOR (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 460) (GO TO 464)
NO 2 (GO TO 516) (GO TO 464)
DON'T KNOW 8 (GO TO 464)

462. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization campaign?

YES 1
NO 2 (GO TO 466)
DON'T KNOW 8(GO TO 466)

463. Please tell me if (NAME) received any of the following vaccinations: (3)

463A. A BCG vaccination against tuberculosis, that is, an injection on the right arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

463B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 463E)
DON'T KNOW 8 (GO TO 463E)

463C. Was the first polio vaccine received in the first two weeks after birth or later?

FIRST 2 WEEKS 1
LATER 2
DON'T KNOW 8

463D. How many times was the polio vaccine received?

NUMBER OF TIMES ______
DON'T KNOW 8

463E. A DPT-HB vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio?

YES 1
NO 2 (GO TO 463G)
DON'T KNOW 8 (GO TO 463G)

463F. How many times was a DPT-HB vaccination received?

NUMBER OF TIMES ______
DON'T KNOW 8

463G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

464. Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

YES 1
NO 2
NO VACCINATION IN THE LAST 2 YRS. 3
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 469)
DON'T KNOW 8 (GO TO 469)

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

YES 1
NO 2
DON'T KNOW 8

469. CHECK 466 AND 467:
FEVER OR COUGH?

"YES" IN 466 OR 467 (GO TO 470)
OTHER (GO TO 475)

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

YES 1
NO 2 (GO TO 472)

471. Where did you seek advice or treatment?
Anywhere else?
RECORD ALL SOURCES MENTIONED.

GOV. PARASTATAL
REFERAL/SPEC. HOSPITAL B
REGIONAL HOSP. C
DISTRICT HOSP. D
HEALTH CENT. E
DISPENSARY F
VILLAGE HEALTH POST G
CBD WORKER . H
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL I
DISTRICT HOSP. J
HEALTH CENT. K
DISPENSARY L
PRIVATE
SPECIALISED HOSPITAL M
HEALTH CENT N
DISPENSARY O
OTHER
PHARMACY P
OTHER (SPECIFY) __________ X

472. CHECK 466:
HAD FEVER?

"YES" IN "466 (GO TO 472A)
NO" OR "DON'T KNOW" IN 466 (GO TO 475)

472A. Does (NAME) have a fever now?

YES 1
NO 2
DON'T KNOW 8

472B. Has (NAME) been ill with convulsions at any time during the last 2 weeks?

YES 1
NO 2
DON'T KNOW 8

472C. CHECK 466 AND 472B
HAD FEVER OR CONVULSIONS?

"YES" IN 466 OR 472B (GO TO 473)
OTHER (GO TO 475)

473. Was (NAME) given any drugs for the (fever/convulsions)?

YES 1
NO 2 (GO TO 474R)
DON'T KNOW 8 (GO TO 474R)

474. What drugs did (NAME) take?
RECORD ALL MENTIONED. ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IFTYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

ANTI-MALARIAL
SP A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
ARTESUNATE E
OTHER DRUGS
ASPIRIN F
IBUPROFEN/ ACETAMINOPHEN/ PANADOL/PARACETAMOL G
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

474A. Did (NAME) get any injection or suppository for the (fever/convulsions)?

INJECTION A
SUPPOSITORY B
NONE Y
DON'T KNOW Z

474B. CHECK 474:
WHICH MEDICINES?

CODE 'A' CIRCLED (GO TO 474C)
CODE 'A' NOT CIRCLED (GO TO 474F)

474C. How long after the (fever/convulsions) started did (NAME) first take SP?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER THE FEVER 2
THREE OR MORE DAYS AFTER THE FEVER 3
DON'T KNOW 8

474D. For how many days did (NAME) take the SP?
IF 7 OR MORE DAYS, RECORD '7'.

DAYS __________
DON'T KNOW 8

474E. Did you have the SP at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK:
Where did you get the SP first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474F. CHECK 474:
WHICH MEDICINES?

CODE 'B' CIRCLED (GO TO 474G)
CODE 'B' NOT CIRCLED (GO TO 474J)

474G. How long after the (fever/ convulsions) started did (NAME) first take chloroquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER THE FEVER 2
THREE OR MORE DAYS AFTER THE FEVER 3
DON'T KNOW 8

474H. For how many days did (NAME) take chloroquine?
IF 7 OR MORE DAYS, RECORD '7'.

DAYS __________
DON'T KNOW 8

474I. Did you have the chloroquine at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the chloroquine first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474J. CHECK 474:
WHICH MEDICINES?

CODE 'C' CIRCLED (GO TO 474K)
CODE 'C' NOT CIRCLED (GO TO 474N)

474K. How long after the (fever/ convulsions) started did (NAME) first take Amodiaquine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER THE FEVER 2
THREE OR MORE DAYS AFTER THE FEVER 3
DON'T KNOW 8

474L. For how many days did (NAME) take Amodiaquine?
IF 7 OR MORE DAYS, RECORD '7'.

DAYS ________
DON'T KNOW 8

474M. Did you have the Amodiaquine at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Amodiaquine first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474N. CHECK 474:
WHICH MEDICINES?

CODE 'D' CIRCLED (GO TO 474O)
CODE 'D' NOT CIRCLED (GO TO 474R)

474O. How long after the (fever/convulsions) started did (NAME) first take Quinine?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER THE FEVER 2
THREE OR MORE DAYS AFTER THE FEVER 3
DON'T KNOW 8

474P. For how many days did (NAME) take Quinine?
IF 7 OR MORE DAYS, RECORD '7'.

DAYS ________
DON'T KNOW 8

474Q. Did you have the Quinine at home or did you get it from somewhere else?
IF MORE THAN ONE SOURCE MENTIONED, ASK: Where did you get the Quinine first?

AT HOME 1
OTHER SOURCE 2
DON'T KNOW 8

474R. Was anything else done about (NAME)'s (fever/convulsions)?

YES 1
NO 2 (GO TO 475)
DON'T KNOW 8 (GO TO 475)

474S. What was done about (NAME)'s (fever/convulsions)?

CONSULTED TRAD'L HEALER A
GAVE TEPID SPONGING B
GAVE HERBS C
OTHER (SPECIFY) _________ X

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

YES 1
NO 2 (GO TO 483)
DON'T KNOW 8 (GO TO 483)

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

478. Was he/she given any of the following to drink: (6)

a. A fluid made from a special packet called [LOCAL NAME FOR ORS PACKET]?
b. A government-recommended homemade fluid?

FLUID FROM ORS PKT
YES 1
NO 2
DON'T KNOW 8
HOMEMADE FLUID
YES 1
NO 2
DON'T KNOW 8

479. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 481)
DON'T KNOW 8 (GO TO 481)

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

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS. C
HOME REMEDIES/HERBAL MEDICINES D
OTHER (SPECIFY) ________ X

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

YES 1
NO 2 (GO TO 483)

482. Where did you seek advice or treatment? Anywhere else?

IF SOURCE IS A HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.

(NAME OF PLACE) __________
GOV. PARASTATAL
REFERAL/SPEC. HOSPITAL B
REGIONAL HOSP. C
DISTRICT HOSP. D
HEALTH CENT. E
DISPENSARY F
VILLAGE HEALTH POST G
CBD WORKER . H
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL I
DISTRICT HOSP. J
HEALTH CENT. K
DISPENSARY L
PRIVATE
SPECIALISED HOSPITAL M
HEALTH CENT N
DISPENSARY O
OTHER
PHARMACY P
OTHER (SPECIFY) __________ X

483. GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484.

484. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1999 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (GO TO 485)
NONE (GO TO 487)

485. What is usually done to dispose of your (youngest) child's stools when he/she does not use any toilet facility?

CHILD ALWAYS USE TOILET/LATRINE 01
THROW IN THE TOILET/LATRINE 02
THROW OUTSIDE THE DWELLING 03
THROW OUTSIDE THE YARD 04
BURY IN THE YARD 05
RINSE AWAY 06
USE DISPOSABLE DIAPERS 07
USE WASHABLE DIAPERS 08
NOT DISPOSED OF 09
OTHER (SPECIFY) 96

486. CHECK 478a, ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 487)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 488)

487. Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET] you can get for the treatment of diarrhea?

YES 1
NO 2

488. CHECK 218:

HAS ONE OR MORE CHILDREN LIVING WITH HER (GO TO 489)
HAS NO CHILDREN LIVING WITH HER (GO TO 490)

489. When (your child/one of your children) is seriously ill, can you decide by yourself whether or not the child should be taken for medical treatment?
IF SAYS NO CHILD EVER SERIOUSLY ILL, ASK: If (your child/one of your children) became seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

YES 1
NO 2
DEPENDS 3

490. Now I would like to ask you some questions about medical care for you yourself.
Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

Knowing where to go.
Getting permission to go.
Getting money needed for treatment.
The distance to the health facility.
Having to take transport.
Not wanting to go alone.
Concern that there may not be a female health provider.
Concern that the health providers will be unfriendly or hostile.

PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
TAKING TRANSPORT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
NO FEMAL PROV
BIG PROBLEM 1
NOT A BIG PROBLEM 2
UNFRIENDLY PROV
BIG PROBLEM 1
NOT A BIG PROBLEM 2

491. CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2001 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE TO 492)
(NAME) ____________
DOES NOT HAVE ANY CHILDREN BORN IN 2001 OR LATER AND LIVING WITH HER (GO TO 496)

492. Now I would like to ask you about liquids (NAME FROM Q. 491) drank yesterday. In total, how many times yesterday during the day or at night did (NAME FROM Q. 491) drink (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

a. Plain water?
NUMBER OF TIMES ________
b. Commercially produced infant formula?
NUMBER OF TIMES ________
c. Any other milk such as tinned, powdered, or fresh animal milk? c
NUMBER OF TIMES ________
d. Fruit juice?
NUMBER OF TIMES ________
e. Any other liquids?
NUMBER OF TIMES ________

493. Now I would like to ask you about the types of foods (NAME FROM Q. 491) ate yesterday. In total, how many times yesterday during the day or at night did (NAME OF TIMES FROM Q. 491) eat (ITEM)?
IF 7 OR MORE TIMES, RECORD '7'. IF DON'T KNOW, RECORD '8'.

a. Bread, maize meal (ugali), porridges, millet, rice, sorghum, or any other food made a from grains?
NUMBER OF TIMES ________
b. Pumpkin, carrots, or yellow/orange sweet potatoes?
NUMBER OF TIMES ________
c. Any other food made from roots or tubers, for example cocoyams, irish potatoes, white sweet potatoes, white yams, cassava, or other local roots or tubers?
NUMBER OF TIMES ________
d. Any dark green leafy vegetables such as amaranth, cassava, pumpkin, or sweet potato leaves, greens, spinach or other dark green leafy vegetables?
NUMBER OF TIMES ________
e. Mango or papaya?
NUMBER OF TIMES ________
f. Any other fruits and vegetables [for example, cabbage, bananas, apples, green beans, cucumber, avocados, watermelon, tomatoes]?
NUMBER OF TIMES ________
g. Red meat(beef, goat), poultry(chicken), fish, or eggs?
NUMBER OF TIMES ________
h. Any food made from legumes [for example, beans, groundnuts, sunflower, pigeon peas, or cowpeas]?
NUMBER OF TIMES ________
i. Cheese, milk or yoghurt?
NUMBER OF TIMES ________
j. Any food made with oil, fat, vegetable oil, margarine, ghee or butter?
NUMBER OF TIMES ________
k. Any other foods?
NUMBER OF TIMES ________

496. Do you currently smoke cigarettes or tobacco?
IF YES: What type of tobacco do you smoke?
RECORD ALL TYPES MENTIONED.

YES, CIGARETTES A
YES, PIPE B
YES, OTHER TOBACCO C
NO Y

497. CHECK 496:

CODE 'A' CIRCLED (GO TO 498)
CODE 'A' NOT CIRCLED (GO TO 499B)

499B. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES _______

499B Have you had an injection for any reason in the last six months?
IF YES: How many injections did you have?
IF NUMBER OF INJECTIONS IS GREATER THAN 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ______
NONE 00 (GO TO 499F)

499C. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health workers?
IF NUMBER OF INJECTIONS IS GREATER THAN 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ______
NONE 00 (GO TO 499F)

499D. The last time you had an injection from a health professional, where did you go for the injection to be given?

GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL 11
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
VILLAGE HEALTH POST (WO 16
CBD WORKER 17
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL 21
DISTRICT HOSPITAL 22
GOVT. HEALTH CENTRE 23
DISPENSARY 24
PRIVATE
DISTRICT HOSPITAL 31
HEALTH CENTRE 32
DISPENSARY 33
OTHER
PHARMACY 41
NGO 42
VCT CENTRE 43
OTHER (SPECIFY) ______________________ 96

499E. The last time you had an injection, did the person who gave you the injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

499F. Have you ever heard of female circumcision?

YES 1 (GO TO 499H)
NO 2

499G. In a number of countries, there is a practice in which a girl may have part of her genitals cut. Have you heard about this practice?

YES 1
NO 2 (GO TO 501)

499H. Have you been circumcised?

YES 1
NO 2 (GO TO 499N)

499I. Now I would like to ask you what was done to you at this time. Was any flesh removed from the genital area?

YES 1 (GO TO 499K)
NO 2
DON'T KNOW 8

499J. Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

499K. Was your genital area sewn?

YES 1
NO 2
DON'T KNOW 8

499L. How old were you when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS ________

DURING INFANCY 95
DON'T KNOW 98

499M. Who cut (or nicked) the genitals?

TRADITIONAL
TRAD. "CIRCUMCISER" 11
TRAD. BIRTH ATTENDANT 12
OTHER TRAD. (SPECIFY) _______________ 16
HEALTH PROFESSIONAL
DOCTOR 21
TRAINED NURSE/MIDWIFE 22
OTHER PROF. (SPECIFY) ____________ 26
DON'T KNOW 98

499N. CHECK 214 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER (GO TO 499O)
HAS NO LIVING DAUGHTER (GO TO 499W)

499O. Has one of your daughters been circumcised?
IF YES: How many?

NUMBER CIRCUMCISED ______
NO DAUGHTER CIRCUMCISED 95 (GO TO 499V)

499P. To which of your daughters did this happen most recently?
INTERVIEWER: CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.

(DAUGHTER'S NAME) _________
DAUGHTER'S LINE NUMBER FROM Q212 ________

499Q. Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM Q499P) at this time. Was any flesh removed from her genital area?

YES 1 (GO TO 499S)
NO 2
DON'T KNOW 8

499R. Was her genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

499S. Was her genital area sewn?

YES 1
NO 2
DON'T KNOW 8

499T. How old was (NAME OF DAUGHTER FROM Q499P) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS ________

DURING INFANCY 95
DON'T KNOW 98

499U. Who cut (or nicked) the genitals?

TRADITIONAL
TRAD. "CIRCUMCISER" 11
TRAD. BIRTH ATTENDANT 12
OTHER TRAD. (SPECIFY) _______________ 16
HEALTH PROFESSIONAL
DOCTOR 21
TRAINED NURSE/MIDWIFE 22
OTHER PROF. (SPECIFY) _________________ 26
DON'T KNOW 98

499V. Do you intend to have any of your daughters circumcised in the future?

YES 1
NO 2
DON'T KNOW 8

499W. Do you think that this practice should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (GO TO 504)
YES, LIVING WITH A MAN 2 (GO TO 504)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1 (GO TO 503)
YES, LIVED WITH A MAN 2 (GO TO 510)
NO 3

502A. ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 1999 (GO TO 518)

503. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 510)
DIVORCED 2 (GO TO 510)
SEPARATED 3 (GO TO 510)

504. Is your husband/partner living with you now or is he staying elsewhere?

LIVING TOGETHER 1
STAYING ELSEWHERE 2

505. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME _______________
LINE NO ________

507. Besides yourself, does your husband/partner have other wives or does he live with other women as if married?

YES 1
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)

508. Including yourself, how many wives or other partners does your husband live with now?

NUMBER OF WIVES AND LIVE-IN PARTNERS ______
DON'T KNOW 98

509. Are you the first, second, … wife?

RANK _____

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

ONLY ONCE 1
MORE THAN ONCE 2

511. CHECK 510:

MARRIED/ LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?

MARRIED/ LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about when you married or began living with a man as if married for the very first time. In what month and year did you first marry or start living with a man as if married?

MONTH ______
DON'T KNOW MONTH 98
YEAR _____ (GO TO 512A)
DON'T KNOW YEAR 9998

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

AGE ______

512A. DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE JANUARY 1999. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER 'O' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 1999.

FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
F
OR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

513. CHECK 503:
IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED OR NOT WIDOWED (GO TO 514)
WIDOWED (GO TO 516)

514. CHECK 510.

MARRIED MORE THAN ONCE (GO TO 515)
MARRIED ONLY ONCE (GO TO 518)

515. How did your previous marriage or union end?

DEATH/WIDOWHOOD 1
DIVORCE 2 (GO TO 515)
SEPARATION 3 (GO TO 518)

516. Who did most of your late husband's property go to?

RESPONDENT 1 (GO TO 518)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
OTHER (SPECIFY) ____________ 6
NO PROPERTY 7

517. Did you receive any of your late husband's assets or valuables?

YES 1
NO 2

518. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

519. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you had sexual intercourse for the very first time?

NEVER 00
AGE IN YEARS ________ (GO TO 521)
1ST TIME WHEN STARTED LIVING WITH (1ST) HUSBAND/PARTNER 95 (GO TO 521)

520. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 545)
NO 2 (GO TO 545)
DON'T KNOW/UNSURE 8 (GO TO 545)

521. CHECK 106:

15-24 YEARS OLD (GO TO 522)
25-49 YEARS OLD (GO TO 526)

522. The first time you had sexual intercourse, did either of you use a condom?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

523. How old was the person you first had sexual intercourse with?

AGE OF PARTNER ______ (GO TO 526)
DON'T KNOW 98

524. Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (GO TO 526)
SAME AGE 3 (GO TO 526)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 526)

525. Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

526. When was the last time you had sexual intercourse?
IF 12 MONTHS OR MORE, ANSWER MUST BE CONVERTED AND RECORDED IN YEARS.

DAYS AGO 1 ______
WEEKS AGO 2 ______
MONTHS AGO 3 ______
YEARS AGO 4 ______ (GO TO 541)

527. The last time you had sexual intercourse with this (second/third) person, was a condom used? (2)

YES 1
NO 2 (GO TO 529)

528. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

529. The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 531)

530. Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

531. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'

HUSBAND 01 (GO TO 537)
LIVE-IN PARTNER 02 (GO TO 537)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANC 04
COMMERCIAL SEX WORKER 05
OTHER (SPECIFY) ____________ 96

532. For how long (have you had/did you have) sexual relations with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 ______
MONTHS 2 _______
YEARS 3 _______

533. CHECK 106:

15-24 Y. OLD (GO TO 534)
25-49 Y. OLD (GO TO 537)

534. How old is this person?

AGE OF PARTNER _____ (GO TO 537)
DON'T KNOW 98

535. Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 537)
SAME AGE 3 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

536. Would you say this person is ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

537. In addition to [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 527 IN NEXT COLUMN)
NO 2 (GO TO 541)

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602. CHECK 226:

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 now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON'T KNOW: AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW: AND NOT PREGNENT OR UNSURE 5 (GO TO 608)

603. CHECK 226:

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 the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1____
YEARS 2____

SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) _______________________ 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING (GO TO 608)

606. CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607. CHECK 602:

WANTS TO HAVE W A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Would you please tell me why? Any other reason?

WANTS NO MORE/ NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Would you please tell me why? Any other reason?
RECORD ALL REASONS MENTIONED.

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

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

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

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY (GO TO 610)
YES, USING CURRENTLY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMEN. METHOD 11 (GO TO 614)
PERIODIC ABSTINENCE 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY) _______________________ 96 (GO TO 614)
UNSURE 98

612. What is the main reason that you think you will not use a contraceptive method at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 614)
SUBFECUND/INFECUND 24 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 614)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 614)
HUSBAND/PARTNER OPPOSED 32 (GO TO 614)
OTHERS OPPOSED 33 (GO TO 614)
RELIGIOUS PROHIBITION 34 (GO TO 614)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 614)
KNOWS NO SOURCE 42 (GO TO 614)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 614)
FEAR OF SIDE EFFECTS 52 (GO TO 614)
LACK OF ACCESS/TOO FAR 53 (GO TO 614)
COSTS TOO MUCH 54 (GO TO 614)
INCONVENIENT TO USE 55 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 614)
OTHER (SPECIFY) _______________________ 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

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

YES 1
NO 2
DON'T KNOW 8

614. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly 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 the your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 616)
NUMBER ______
OTHER (SPECIFY) _______________________ 96 (GO TO 616)

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

NUMBER OF BOYS____
OTHER (SPECIFY) ___________________ 96
NUMBER OF GIRLS____
OTHER (SPECIFY) ___________________ 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY) ___________________ 96

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

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

616A. If you wanted to get information on family planning, who would you like to talk to most:

CBD WORKER 01
CLINIC STAFF 02
TBA 03
HUSBAND/PARTNER 04
FRIEND 05
RELATIVE 06
RELIGIOUS LEADERS 07
OTHER (SPECIFY) ___________________ 96

616B. Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
On the television?
In a newspaper or magazine?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2

617. In the last six months have you heard about family planning:

a) On the radio?
b) On the television?
c) In a newspaper or magazine?
d) From a poster?
e) From billboards?
f) At community events?
g) From live drama?
h) From a doctor or nurse?
i) From a community health worker?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
BILLBOARD
YES 1
NO 2
COMMUNITY EVENT
YES 1
NO 2
DRAMA
YES 1
NO 2
DOCTOR/NURSE
YES 1
NO 2
HEALTH WORKER
YES 1
NO 2

618. In the past six months, what drama series have you listened to on the radio?
CIRCLE THE SERIES MENTIONED SPONTANEOUSLY. FOR SERIES NOT MENTIONED, ASK: In the last 6 months, have you listened to:

a) Zinduka?
b) Twende na Wakati?
c) Other?

ZINDUKA
YES SPONTANEOUS 1
YES PROBED 2
NO 3
TWENDE NA WAKATI
YES SPONTANEOUS 1
YES PROBED 2
NO 3
OTHER
YES SPONTANEOUS 1
YES PROBED 2
NO 3

618A. CHECK 618:

LISTENED TO ZINDUKA (CODE '1' OR 2' CIRCLED) (GO TO 618B)
HAS NOT LISTENED TO ZINDUKA (CODE '3' CIRCLED) (GO TO 618E)

618B. How often do you listen to Zinduka?

TWICE A WEEK 1
ONCE A WEEK 2
ONCE OR TWICE A MONTH 3
RARELY 4
DON'T KNOW 8

618C. As a result of listening to Zinduka, did you do anything or take any action related to family planning?

YES 1
NO 2
DON'T KNOW 8 (GO TO 618E)

618D. What did you do as a result of listening to Zinduka?
RECORD ALL MENTIONED.

TALKED TO PARTNER A
TALKED TO A HEALTH WORKER B
TALKED TO SOMEONE ELSE C
VISITED A CLINIC FOR FAM. PLAN D
BEGAN USING A MOD. METHOD E
CONTINUED USING A MOD. METH F
OTHER (SPECIFY) _______________________ X

618E. CHECK 618:

LISTENED TO TWENDA NA WAKATI (GO TO 618F)
HAS NOT LISTENED TO TWENDA NA WAKATI (GO TO 619)

618F. How often do you listen to Twenda na Wakati?

TWICE A WEEK 1
ONCE A WEEK 2
ONCE OR TWICE A MONTH 3
RARELY 4

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

YES 1
NO 2 (GO TO 621)

620. With whom? Anyone else?
RECORD ALL PERSONS MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER(S) F
SON(S) G
MOTHER(S)-IN-LAW H
FRIENDS/NEIGHBORS I
OTHER (SPECIFY) ______________ X

621. CHECK 501:

YES, CURRENTLY MARRIED (GO TO 622)
YES, LIVING WITH A MAN (GO TO 622)
NO, NOT IN UNION (GO TO 628)

622. CHECK 311/311A:

ANY CODE CIRCLED (GO TO 623)
NO CODE CIRCLED (GO TO 624)

623. You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _________________ 6

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

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

625. 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

626. CHECK 311/311A:

NEITHER STERILIZED (GO TO 627)
HE OR SHE STERILIZED (GO TO 628)

627. 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

628. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

a) She knows her husband has a sexually transmitted disease?
b) She knows her husband has sex with women other than
c) his wife or wives?
d) She has recently given birth?
e) She is tired or not in the mood?

HAS STD
YES 1
NO 2
DON'T KNOW 8
OTHER WOMEN
YES 1
NO 2
DON'T KNOW 8
RECENT BIRTH
YES 1
NO 2
DON'T KNOW 8
TIRED/NOT IN MOOD
YES 1
NO 2
DON'T KNOW 8

629. When a wife knows her husband has a disease that can be transmitted through sexual contact, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

630. CHECK 501:

CURRENTLY MARRIED OR IN UNION (GO TO 631)
NOT IN UNION (GO TO 701)

631. Can you say no to your husband if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/UNSURE 8

632. Could you ask your husband to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/UNSURE 8

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

701. CHECK 501 AND 502:

CURRENTLY MARRIED/ LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/ LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 707)

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

AGE IN COMPLETED YEARS _______

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

YES 1
NO 2 (GO TO 706)

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

PREPRIMARY 0
PRIMARY 1
POST-PRIMARY TRAINING 2
SECONDARY 3
POST-SECONDARY TRAINING 4
UNIVERSITY 5
DON'T KNOW 8 (GO TO 706)

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

GRADE _______
DON'T KNOW 98

706. CHECK 701:

CURRENTLY MARRIED/ LIVING WITH A MAN: What is your husband's/partner's occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/ LIVED WITH A MAN: What was your (last) husband's/ partner's occupation? That is, what kind of work did he mainly do?

OCCUPATION____________________

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

YES 1 (GO TO 710)
NO 2

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

YES 1 (GO TO 710)
NO 2

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

YES 1
NO 2 (GO TO 718A)

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

OCCUPATION_________________

711. CHECK 710:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

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

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

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

714. Do you usually work at home or away from home?

HOME 1
AWAY 2

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

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

716. Are you paid or do you earn in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 718A)
NOT PAID 4 (GO TO 718A)

717. Who mainly decides how the money you earn will be used?

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

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

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, HER INCOME IS ALL SAVED 6

718A. Now, I would like to ask you some questions about financial matters. I ask these questions only to understand more about the financial position of women. Do you yourself control the money needed to buy the following?

a) Vegetables or fruits
b) Clothes for yourself?
c) Any kind of medicine for yourself?
c) Toiletries for yourself like(soap, shampoo….……..)

VEGETABLES/FRUIT
YES 1
NO 2
DON'T KNOW 8
CLOTHES
YES 1
NO 2
DON'T KNOW 8
MEDICINE
YES 1
NO 2
DON'T KNOW 8
TOILETRIES
YES 1
NO 2
DON'T KNOW 8

718B. Please tell me if you alone, or jointly with your husband or someone else own…..

a) Land?
DOESN'T OWN 1 (GO TO NEXT)
OWN JOINTLY 2 (GO TO NEXT)
OWN ALONE 3 (GO TO 718C)
b) The house/dwelling you live in?
DOESN'T OWN 1 (GO TO NEXT)
OWN JOINTLY 2 (GO TO NEXT)
OWN ALONE 3 (GO TO 718C)
c) Any other house, apartment, or
DOESN'T OWN 1 (GO TO NEXT)
OWN JOINTLY 2 (GO TO NEXT)
OWN ALONE 3 (GO TO 718C)
d) dwelling?
DOESN'T OWN 1 (GO TO NEXT)
OWN JOINTLY 2 (GO TO NEXT)
OWN ALONE 3 (GO TO 718C)
e) Jewelry or gems?
DOESN'T OWN 1 (GO TO NEXT)
OWN JOINTLY 2 (GO TO NEXT)
OWN ALONE 3 (GO TO 718C)
f) Livestock such as (cattle, goats,
DOESN'T OWN 1 (GO TO NEXT)
OWN JOINTLY 2 (GO TO NEXT)
OWN ALONE 3 (GO TO 718C)
g) sheep etc)
DOESN'T OWN 1
OWN JOINTLY 2
OWN ALONE 3 (GO TO 718C)

718C. If you ever need to, can you sell (ASSET) without anyone else's permission

a) Land?
YES 1
NO 2
DON'T KNOW 8
b) The house/dwelling you live in?
YES 1
NO 2
DON'T KNOW 8
c) Any other house, apartment, or
YES 1
NO 2
DON'T KNOW 8
d) dwelling?
YES 1
NO 2
DON'T KNOW 8
e) Jewelry or gems?
YES 1
NO 2
DON'T KNOW 8
f) Livestock such as (cattle, goats,
YES 1
NO 2
DON'T KNOW 8
g) sheep etc)
YES 1
NO 2
DON'T KNOW 8

718E. Do you have a bank account or an account in other savings institution in your own name or jointly with someone else?
RECORD ALL MENTIONED

YES, IN OWN NAME A
YES, JOINT ACCOUNT B
NO C (GO TO 718G)

718F. Do you operate the account, that is, sign checks or deposit and withdraw money?

YES 1
NO 2

718G. Do you know of any programs in this area that give loans to women so they can start or expand a business of their owns?

YES 1
NO 2

718H. Have you yourself ever taken out or been given a loan either in cash or in kind to start or expand business?

YES 1
NO 2

719. Who in your family usually has the final say on the following decisions:

a) Your own health care?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
b) Making large household purchases?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
c) Making household purchases for daily needs?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
d) Visits to family or relatives?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6
e) What food should be cooked each day?
RESPONDENT = 1
HUSBAND/PARTNER = 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY = 3
SOMEONE ELSE = 4
RESPONDENT AND SOMEONE ELSE JOINTLY = 5
DECISION NOT MADE/NOT APPLICABLE = 6

720. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)

CHILDREN UNDER 10
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3
HUSBAND
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3
OTHER MALES
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3
OTHER FEMALES
PRES./LISTEN. 1
PRES./NOT LISTEN. 2
NOT PRES. 3

721. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?

GOES OUT
YES 1
NO 2
DON'T KNOW 8
NEGL. CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

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

YES 1
NO 2 (GO TO 844)

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

YES 1
NO 2
DON'T KNOW 8

803.(1) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

804. By using condoms each time they have sex, can people reduce their chances of being infected with the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

805. (1) Can people be infected with the AIDS virus by eating from the same plate as someone who is sick with AIDS?

YES 1
NO 2
DON'T KNOW 8

806. Can people reduce their chances of being infected with the AIDS virus if they stop having sex altogether?

YES 1
NO 2
DON'T KNOW 8

807. (1) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

808. What else can a person do in order to avoid or reduce their chances of being infected by the AIDS virus? Anything else?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS INTRAVENOUSLY H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ____________ W
OTHER (SPECIFY) _____________ X
NOTHING ELSE Y
DON'T KNOW Z

810. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

811. Is it possible for a child to be infected by the AIDS virus:

During pregnancy?
During delivery?
By breastfeeding?

DURING PREG
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
BREASTFEEDING
YES 1
NO 2
DON'T KNOW 8

812. CHECK 811:

AT LEAST ONE 'YES' (GO TO 813)
OTHER (GO TO 814)

813. Are there any special medications that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

814. Is there any special medication that people infected with the AIDS virus can get from a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

815. CHECK 215:

LAST BIRTH SINCE JANUARY 2002 (2) (GO TO 816)
LAST BIRTH BEFORE JANUARY 2002 (2) (GO TO 824)
NO BIRTHS (GO TO 824)

816. Now I would like to ask some questions about your last birth. Did you see anyone for antenatal care during that pregnancy?

YES 1
NO 2 (GO TO 824)

817. During any of the antenatal visits for that pregnancy, did anyone talk to you about:

Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

AIDS FROM MOTHER

YES 1
NO 2
DON'T KNOW 8
THINGS TO DO
YES 1
NO 2
DON'T KNOW 8
TESTED FOR AIDS
YES 1
NO 2
DON'T KNOW 8

818. Were you offered a test for the AIDS virus as part of your antenatal care?

YES 1
NO 2

819. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 824)

820. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

821. Where was the test done? (3)
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ______________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL 11
REGIONAL HOSPITAL 12
DISTRICT HOSPITAL 13
HEALTH CENTRE 14
DISPENSARY 15
VILLAGE HEALTH POST (W 16
CBD WORKER 17
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL 21
DISTRICT HOSPITAL 22
GOVT. HEALTH CENTRE 23
DISPENSARY 24
PRIVATE
DISTRICT HOSPITAL 31
HEALTH CENTRE 32
DISPENSARY 33
OTHER
NGO 42
VCT CENTRE 43
OTHER (SPECIFY) _____________ 96

822. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1 (GO TO 825)
NO 2

823. When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1 (GO TO 831)
12 -23 MONTHS AGO 2(GO TO 831)
2 OR MORE YEARS AGO 3(GO TO 831)

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

YES 1
NO 2 (GO TO 829)

825. When was the last time you were tested?

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

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

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

827. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

828. Where was the test done? (3)
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL 11(GO TO 831)
REGIONAL HOSPITAL 12(GO TO 831)
DISTRICT HOSPITAL 13 (GO TO 831)
HEALTH CENTRE 14(GO TO 831)
DISPENSARY 15(GO TO 831)
VILLAGE HEALTH POST (W 16(GO TO 831)
CBD WORKER 17(GO TO 831)
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL 21(GO TO 831)
DISTRICT HOSPITAL 22(GO TO 831)
GOVT. HEALTH CENTRE 23(GO TO 831)
DISPENSARY 24(GO TO 831)
PRIVATE
DISTRICT HOSPITAL 31(GO TO 831)
HEALTH CENTRE 32(GO TO 831)
DISPENSARY 33(GO TO 831)
OTHER
NGO 41 (GO TO 831)
VCT CENTRE 42(GO TO 831)
OTHER (SPECIFY) _______________________ 96(GO TO 831)

829. Do you know of a place where people can go to get tested for the virus that causes AIDS?

YES 1
NO 2(GO TO 831)

830. Where is that? (3) Any other place?

IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE) ________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
VILLAGE HEALTH POST (W G
CBD WORKER H
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL I
DISTRICT HOSPITAL J
GOVT. HEALTH CENTRE K
DISPENSARY L
PRIVATE
DISTRICT HOSPITAL M
HEALTH CENTRE N
DISPENSARY O
OTHER
NGO P
VCT CENTRE Q
OTHER (SPECIFY) _______ X

831. If you learn that a fresh food vendor has the AIDS virus, but is not sick, would you buy fresh food from him/her?

YES 1
NO 2
DON'T KNOW 8

831A. And if she/he is sick?

YES 1
NO 2
DON'T KNOW 8

832. If a member of your family has been infected with the AIDS virus, but is not sick, would you want it to remain a secret within the family, or not a secret?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

834. In your opinion, if a female teacher has been infected with the AIDS virus, but is not sick, should she continue teaching?

SHOULD CONTINUE 1
SHOULD NOT CONTINUE 2
DON'T KNOW/NOT SURE/DEPENDS 8

834A. In your opinion, if a male teacher has been infected with the AIDS virus, should he continue teaching?

SHOULD CONTINUE 1
SHOULD NOT CONTINUE 2
DON'T KNOW/NOT SURE/DEPENDS 8

835. Do you personally know someone who has been denied health services in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 3 (GO TO 840)
DON'T KNOW 8

836. Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

837. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

838. CHECK 835, 836, AND 837:

OTHER (GO TO 839)
AT LEAST ONE 'YES' (GO TO 840)

839. Do you personally know someone who is suspected to have the AIDS virus or who has the AIDS virus?

YES 1
NO 2

840. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

841. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

842. Should children age 12-14 be taught about using a condom to avoid AIDS?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

843. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid AIDS?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

844. Do you believe that young men should wait until they are married to have sexual intercourse?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

845. Do you believe that young women should wait until they are married to have sexual intercourse?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

846. Do you believe that married men should only have sex with their wives?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

847. Do you think that most men you know have sex only with their wives?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

848. Do you believe that married women should only have sex with their husbands?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

849. Do you think that most women you know have sex only with their husbands?

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

850. CHECK 801:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 853)

851. If a man has a sexually transmitted disease, what symptoms might he have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

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

852. If a woman has a sexually transmitted disease, what symptoms might she have? Any others?
RECORD ALL SYMPTOMS MENTIONED.

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

853. CHECK 519:

HAS HAD SEXUAL INTERCOURSE (GO TO 854)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

854. CHECK 850:

HEARD ABOUT INFECTION TRANSMITTED THROUGH SEXUAL CONTACT (GO TO 855)
HAS NOT HEARD ABOUT INFECTION TRANSMITTED THROUGH SEXUAL CONTACT (GO TO 856)

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

YES 1
NO 2
DON'T KNOW 8

856. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

858. CHECK 855, 856, AND 857:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 859)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 901)

859. The last time you had (PROBLEM FROM 505/506/507), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 901)

860. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED.

GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
VILLAGE HEALTH POST (W G
CBD WORKER H
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL I
DISTRICT HOSPITAL J
GOVT. HEALTH CENTRE K
DISPENSARY L
PRIVATE
DISTRICT HOSPITAL M
HEALTH CENTRE N
DISPENSARY O
OTHER
NGO P
VCT CENTRE Q
OTHER (SPECIFY) _______ X

(1) If 803, 805 and/or 807 do not apply to the local context, replace the question using a specific local misconception.
At least two questions related to misconceptions are needed.
(2) For fieldwork in 2005 and 2006, the year should be 2003 and 2004, respectively.
(3) Coding categories to be developed locally and revised based on the pretest; however, the broad categories must be maintained.

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?

NUMBER OF BIRTHS TO NATURAL MOTHER ______

902. CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 915)

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

NUMBER OF PRECEDING BIRTHS _______

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

NAME_______________

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DON'T KNOW 8 (GO TO NEXT BIRTH)

907. How old is (NAME)?

_____________ (GO TO NEXT BIRTH)

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

YEARS_______________

909. How old was (NAME) when he/she died?
IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT.

AGE_____________

910. Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911. Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

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

YES 1
NO 2

913. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

CHILDREN_____

IF NO MORE BROTHERS OR SISTERS, GO TO 914.

914. CHECK Q910, 911 AND 912 FOR ALL SISTERS

ANY YES: Just to make sure I have this right, you told me that your sister(s) _______________ (NAME) died when she was (pregnant/delivering/just delivered). Is that correct? (IF CORRECT, CONTINUE TO 915. IF NOT, CORRECT QUESTIONNAIRE AND CONTINUE TO 915.)

ALL NO OR BLANK (GO TO 915)

915 RECORD THE TIME.

HOUR _____
MINUTES ________

INSTRUCTIONS: 1 2 3 4
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN
COL. 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L PERIODIC ABSTINENCE
M WITHDRAWAL
X OTHER (SPECIFY) _________

COL. 2: SOURCE OF CONTRACEPTION

GOVERNMENT/PARASTATAL
1 REFERAL/SPEC. HOSPITAL
2 REGIONAL HOSPITAL
3 DISTRICT HOSPITAL
4 HEALTH CENTRE
5 DISPENSARY
6 VILLAGE HEALTH POST (WORKER)
7 CBD WORKER
RELIGIOUS/VOLUNTARY
8 REFERAL/SPEC. HOSPITAL
9 DISTRICT (DESIG.) HOSPITAL
A HEALTH CENTRE
B DISPENSARY
PRIVATE
C SPECIALIZED HOSPITAL
D HEALTH CENTRE
E DISPENSARY
OTHER
F PHARMACY
G NGO
H VCT CENTRE
I SHOP/KIOSK
J BAR
K GUEST HOUSE/HOTEL
L FRIEND/RELATIVE/NEIGHBOUR
X OTHER (SPECIFY) _________

COL. 3: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ________
Z DON'T KNOW

COL. 4: MARRIAGE/UNION

X IN UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION

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 THE SUPERVISOR: ____________
DATE: ___________

EDITOR'S OBSERVATIONS
________________________________________

NAME OF EDITOR: ____________
DATE: ___________