IDENTIFICATION

REGION

DISTRICT

WARD

ENUMERATION AREA

NAME OF HOUSEHOLD HEAD

TDHS NUMBER

HOUSEHOLD NUMBER

LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE

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*

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.

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?

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

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

105. In what month and year were you born?

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

107. Have you ever attended school?

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

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

110. CHECK 108:

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?

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

113. CHECK 111:

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?

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

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

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

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

119. What is your religion?

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?

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

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

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

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

206. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

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

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

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

210. CHECK 208:

211. Now I would like to record 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?

213. Were any of these births twins?

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

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

216. Is (NAME) still alive?

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

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

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

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.

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

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)?

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

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?

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.

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?

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

230 When did the last such pregnancy end?

231. CHECK 230:

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.

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

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?

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

237. When did your last menstrual period start?

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?

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

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 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)?

302. Have you ever used (METHOD)?

303. CHECK 302:

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

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'.

308. CHECK 302 (01):

309. CHECK 226:

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

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.

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.

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?

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?

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

317. CHECK 316/316A:

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.

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?

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

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

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?

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

327. CHECK 311/311A:

CIRCLE METHOD CODE:

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.

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

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.

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

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

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

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

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

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:

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

404. FROM 212 AND 216

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

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

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.

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

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

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

410. CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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.

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

424. Was (NAME) weighed at birth?

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

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.

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.

428. Was (NAME) delivered by caesarean section?

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

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

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

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

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

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.

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

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

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

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

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

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

437. CHECK 226:
IS RESPONDENT PREGNANT?

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

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

440. Did you ever breastfeed (NAME)?

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.

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

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

444. CHECK 404:
IS CHILD LIVING?

445. Are you still breastfeeding (NAME)?

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

447. CHECK 404:
IS CHILD LIVING?

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

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

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

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'.

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

456. FROM 212 AND 216

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

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

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

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.

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)

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

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?

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

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

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

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

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

463G. An injection to prevent measles?

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

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

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

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

469. CHECK 466 AND 467:
FEVER OR COUGH?

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

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

472. CHECK 466:
HAD FEVER?

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

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

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

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

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.

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

474B. CHECK 474:
WHICH MEDICINES?

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

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

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?

474F. CHECK 474:
WHICH MEDICINES?

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

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

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?

474J. CHECK 474:
WHICH MEDICINES?

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

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

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?

474N. CHECK 474:
WHICH MEDICINES?

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

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

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?

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

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

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

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?

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?

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?

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

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

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

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.

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

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

486. CHECK 478a, ALL COLUMNS:

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

488. CHECK 218:

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?

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.

491. CHECK 215 AND 218:

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'.

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'.

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

497. CHECK 496:

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

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.

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.

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

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?

499F. Have you ever heard of female circumcision?

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?

499H. Have you been circumcised?

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

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

499K. Was your genital area sewn?

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

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

499N. CHECK 214 AND 216:

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

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

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?

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

499S. Was her genital area sewn?

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.

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

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

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

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

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

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

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?

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

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'.

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

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

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

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

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?

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

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?

514. CHECK 510.

515. How did your previous marriage or union end?

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

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

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?

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

521. CHECK 106:

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

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

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

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

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

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

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

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

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

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'

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.

533. CHECK 106:

534. How old is this person?

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

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

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

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311/311A:

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?

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?

604. CHECK 226:

605. CHECK 310:
USING A CONTRACEPTIVE METHOD?

606. CHECK 603:

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.

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

609. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

611. Which contraceptive method would you prefer to use?

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

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

614. CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly 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.

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?

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

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

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?

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?

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?

618A. CHECK 618:

618B. How often do you listen to Zinduka?

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

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

618E. CHECK 618:

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

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

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

621. CHECK 501:

622. CHECK 311/311A:

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?

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?

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

626. CHECK 311/311A:

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?

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?

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?

630. CHECK 501:

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

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

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

701. CHECK 501 AND 502:

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

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

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

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

706. CHECK 701:

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

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

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

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

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

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

711. CHECK 710:

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

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

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

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

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

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

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?

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?.??..)

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

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

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

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

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?

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

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

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

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?

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?

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

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

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

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

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

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

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.

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

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

During pregnancy?
During delivery?
By breastfeeding?

812. CHECK 811:

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?

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

815. CHECK 215:

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

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?

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

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

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

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.

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

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

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

825. When was the last time you were tested?

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?

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

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.

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

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.

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?

831A. And if she/he is sick?

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?

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?

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

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

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?

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?

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?

838. CHECK 835, 836, AND 837:

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

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

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.

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

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

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

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

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

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

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

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

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?

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

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

853. CHECK 519:

854. CHECK 850:

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?

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

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

858. CHECK 855, 856, AND 857:

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

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

(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?

902. CHECK 901:

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

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

905. Is (NAME) male or female?

906. Is (NAME) still alive?

907. How old is (NAME)?

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

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

910. Was (NAME) pregnant when she died?

911. Did (NAME) die during childbirth?

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

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

IF NO MORE BROTHERS OR SISTERS, GO TO 914.

914. CHECK Q910, 911 AND 912 FOR ALL SISTERS

915 RECORD THE TIME.

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

COL. 2: SOURCE OF CONTRACEPTION

COL. 3: DISCONTINUATION OF CONTRACEPTIVE USE

COL. 4: MARRIAGE/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: ___________