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, MWANZA, MBEYA AND TANGA.SMALL CITIES ARE: MOROGORO, DODOMA, MOSHI, IRINGA, SHINYANGA, SINGIDA, SONGEA ,MTWARA, TABORA, MUSOMA, SUMBAWANGA, BUKOBA, KIGOMA NA MJINI MAGHARIBI . MIJI MINGINE NI MIJI MIDOGO

NAME AND LINE NUMBER OF WOMAN______

INTERVIEWER VISITS

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

RESULT*

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE
TIME

TOTAL NUMBER OF VISITS___

SURPERVISOR
NAME ___________

FIELD EDITOR
NAME ___________

OFFICE EDITOR

KEYED BY

INFORMED CONSENT

Hello. My name is ______. I am working with National Bureau of Statistics. We are conducting a survey about health all over Tanzania. The information we collect will help the government to plan health services.
Your household was selected for the survey. The survey usually takes about 30 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
Do you have any questions?
May I begin the interview now?
Signature of interviewer: __________
Date: _________

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

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

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

106. In what month and year were you born?

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108. Have you ever attended school?

109. What is the highest level of school you attended?

110. What is the highest grade you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

111. CHECK 109:

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

114. CHECK 112:

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

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

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

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. Is (NAME) a boy or a girl?

214. Were any of these births twins?

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?

222. Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2005 OR LATER. IF NONE, RECORD '0' AND SKIP TO 226.

225. FOR EACH BIRTH SINCE JANUARY 2005, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. 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.)

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. When you got pregnant, did you want to get pregnant at that time?

228A. Did you want to have a baby later on or did you not want any (more) children?

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 THE CALENDAR IN THE MONTH THAT THE PREGNANC TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233. Since January 2005 have you 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 2005. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any miscarriages, abortions or stillbirths that ended before 2005?

236. When did the last such pregnancy that terminated before 2005 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

301. Now I would like to talk about family planning -the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?
PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.

302. CHECK 226:

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

304. Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

304A. What is the brand name of the pills you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

304B. What is the brand name of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

305. In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

306. In what month and year was the sterilization performed?

306A. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

307. CHECK 306/306A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 306/306A

308. CHECK 306/306A:

309. 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 2005.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:

309A. CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

309B. Have you ever used anything or tried in any way to delay or avoid getting pregnant.

310. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

311. You first started using (CURRENT METHOD) in (DATE FROM 306/306A). Where did you get it at the time?
311A. Where did you learn how to use the rhythm/lactational amenorhea method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

312. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

313. You obtained (CURRENT METHOD FROM 310) from (SOURCE OF METHOD FROM 305 OR 311) in (DATE FROM 306/306A). At that time, were you told about side effects or problems you might have with the method?

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

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

316. CHECK 310:

CODE '01' CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE '01' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 310) from (SOURCE OF METHOD FROM 305 OR 311) were you told about other methods of family planning that you could use?

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

322. CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

323. Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF IS PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

325. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

402. CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2005 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 some questions about your children born in the last five years. (We will talk about each separately.)

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

404. FROM 212 AND 216

405. When you got pregnant with (NAME), did you want to get pregnant at that time?

405A. Did you want to have a baby later on, or did you not want any (more) children?

406. How much longer did you want to wait?

407. Did you see anyone for antenatal care for this pregnancy?

407A. Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

408. Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S). IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

411. As part of your antenatal care during this pregnancy, were any of the following done at least once:

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

412. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

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

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

416. CHECK 415:

417. At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

418. Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.

419. How many years ago did you receive the last tetanus injection before this pregnancy?

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

422. 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.

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

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

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

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

428. CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION.

429. How many times did you take (SP/Fansidar) during this pregnancy?

430. CHECK 407A:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

431. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?

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

433. Was (NAME) weighed at birth?

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

435. 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.

436. Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS DISTRICT PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

438. Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

438A. After you delivered, did the health facility give you a birth notification form for the baby?

438B. Did you get a birth notification form from any other place?

439. Before you were discharged after (NAME) was born, did any health care provider check on your health?

440 How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

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

443. Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.

444. After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?

445. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

447. Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

448. CHECK 442:

449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

450. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

451. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

452. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

452A. Do you have a birth certificate for (NAME)?
ASK TO SEE CERTIFICATE.

453. In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

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

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

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

457. CHECK 226:
IS RESPONDENT PREGNANT?

458. Have you begun to have sexual intercourse again since the birth of (NAME)?

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

460. Did you ever breastfeed (NAME)?

461. 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.

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

463. What was (NAME) given to drink? Anything else?
RECORD ALL MENTIONED.

464. CHECK 404:
IS CHILD LIVING?

465. Are you still breastfeeding (NAME)?

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

467. CHECK 404:
IS CHILD LIVING?

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

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

469A. How old was (NAME) when s/he was first fed something other than breast milk?
INCLUDES : JUICE, COW'S MILK WATER, SUGAR WATER, SOLID FOODS OR ANYTHING ELSE

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

471. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2005 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).

502. LINE NUMBER FROM 212

503. FROM 212 AND 216

503A. Did (NAME) receive vitamin A like this during the last 6 months?
(SHOW CAPSULES)

503B. Where did (NAME) the get the drops? During the campaign with other children, during a sick visit or during a routine/healthy visit?

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

506. (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.
(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

506A. CHECK 506:

507. 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.

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

509. Please tell me if (NAME) received any of the following vaccinations:
509A. A BCG vaccination against tuberculosis, that is, an injection on the right arm or shoulder that usually causes a scar?

509B. Polio vaccine, that is, drops in the mouth?

509C. Was the first polio vaccine received in the first two weeks after birth or later?

509D. How many times was the polio vaccine received?

509E. A DPT-HB vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio?

509F. How many times was a DPT-HB vaccination received?

509G. A measles injection or MMR that is, a shot in the arm at the age of 9 months or older -to prevent him/her from getting measles?

516. In the last seven days, did (NAME) take iron pills, sprinkles with iron, or iron syrup (like this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

517. Has (NAME) taken any pill for intestinal worms in the last six months?

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

519. Was there any blood in the stools?

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

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

522. Did you seek advice or treatment for the diarrhea from any source?

523. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE THE NAME OF THE PLACE.

524. CHECK 523:

525. Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

528. Was he/she given any of the following at any time since he/she started having the diarrhea:

a) A fluid made from a special packet called ORS or ORS with zinc?
b) Zinc?
c) A government-recommended homemade fluid such as coconut water/tea/fruit juice?

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

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

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

534A. At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

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

536. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?

537. CHECK 533:
HAD FEVER?

538. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?

539. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

540. Did you seek advice or treatment for the illness from any source?

541. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

542. CHECK 541:

543. Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

546. At any time during the illness, did (NAME) take any drugs for the illness?

547. What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.

550. CHECK 547:
ANY CODE A-H CIRCLED?

551. CHECK 547:
SP/FANSIDAR ('A') GIVEN

552. How long after the fever started did (NAME) first take SP/FANSIDAR?

554. CHECK 547:
CHLOROQUINE ('B') GIVEN

555. How long after the fever started did (NAME) first take chloroquine?

557. CHECK 547:
AMODIAQUINE ('C') GIVEN

558. How long after the fever started did (NAME) first take Amodiaquine?

560. CHECK 547:
QUININE ('D') GIVEN

561. How long after the fever started did (NAME) first take quinine?

566. CHECK 547:
ARTESUNATE ('E') GIVEN

566A. How long after the fever started did (NAME) first take ARTESUNATE?

568. CHECK 547:
ARTESUNATE AND AMODIAQUINE ('F') GIVEN

569. How long after the fever started did (NAME) first take ARTESUNATE AND AMODIAQUINE?

570. CHECK 547:
CORATEM (ALU) ('G') GIVEN

571. How long after the fever started did (NAME) first take CORATEM (Alu)

572. CHECK 547:
OTHER ANTI-MALARIAL ('H') GIVEN

572A. How long after the fever started did (NAME) first take (OTHER ANTI-MALARIAL)

572B. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573.

573. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT

574. The last time (NAME FROM 573) passed stools, what was done to dispose of the stools?

575. CHECK 528(a)ALL COLUMNS:

576. Have you ever heard of a special product called ORS you can get for the treatment of diarrhea?

577. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2008 OR LATER LIVING WITH THE RESPONDENT

578. Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night. Did (NAME FROM 577) (drink/eat):

a. Plain water?
b. Commercially produced infant formula?
c. Any [BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G., Cerelac]?
d. Any milk from animals
e. Any (other) porridge like ugali?

579. Now I would like to ask you about (other) liquids or foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods. Did (NAME FROM 577)/you drink (eat):

580. CHECK 578 c AND e AND 579 (CATEGORIES d THROUGH o FOR CHILD):

581. How many times did (NAME FROM 577) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

582. CHECK Q578 AND 579 NOT A SINGLE 'YES', ASK:
Aside from breastmilk, did (NAME) get anything at all to eat or drink yesterday or last night?

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

602. Have you ever been married or lived together with a man as if married?

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

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

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

606. Does your husband/partner have other wives or does he live with other women as if married?

607. Including yourself, in total, how many wives or partners does your husband live with now as if married?

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

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

615. CHECK 609:

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 first (husband/partner). In what month and year did you start living with him?

616. How old were you when you first started living with him?

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

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

618A. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

626. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

627. When was the last time you had sexual intercourse with this person?

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

629. Did you use a condom every time you had sexual intercourse with this person in the last12 months?

630. 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 '2'. IF NO, CIRCLE '3'.

630A. CHECK 609:

630B. CHECK 618:

631A. How long ago did you first have sexual intercourse with this person?

631B. How many times during the last 12 months did you have sexual intercourse with this person:

638. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?

639. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

640. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

641. Do you know of a place where a person can get condoms?

642. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

643. If you wanted to, could you yourself get a condom?

644. Do you know of a place where a person can get female condoms?

645. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

646. If you wanted to, could you yourself get a female condom?

SECTION 7. FERTILITY PREFERENCES

701. CHECK 304:

702. CHECK 226:

702A. 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?

702B. 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?

703. CHECK 702:

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?

704. CHECK 702:

705. CHECK 303:
USING A CONTRACEPTIVE METHOD?

706. CHECK 703:

707. CHECK 702A, 702B AND 703:

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?

RECORD ALL REASONS MENTIONED.

708. CHECK 310:
USING A CONTRACEPTIVE METHOD?

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

713. CHECK 216:

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

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

714. 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?

715A. If you wanted to get information on family planning, who would you like to talk to most:

715B. Is it acceptable to you for information on family planning to be provided:

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

715C. 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?

715D. 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?

715E. CHECK 715D:

715F. How often do you listen to Zinduka?

715G. As a result of listening to Zinduka, did you do anything or take any action related to family planning?

715H. What did you do as a result of listening to Zinduka?
RECORD ALL MENTIONED.

715I. CHECK 715D:

715J. How often do you listen to Twenda na Wakati?

717. CHECK 601:

718. CHECK 304:

719. Does your husband/partner know that you are using a method of family planning?

720. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?

721. CHECK 304:

722. Does your husband/partner want the same number of children that you want, or does he want more or fewer than you want?

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801. CHECK 601 AND 602:

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

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

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

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

806. CHECK 801:

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?

807. Aside from your own housework, have you done any work in the last seven days?

808. 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. In the last seven days, have you done any of these things or any other work?

809. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

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

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

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

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

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

818. CHECK 601:

819. CHECK 817:

820. Who usually decides how the money you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?

821. Would you say that the money that you earn is more than what your husband/partner earns, less than what he earns, or about the same?

823. Who usually makes decisions about health care for yourself: you, your husband/partner, you and your husband/partner jointly, or someone else?

824. Who usually makes decisions about making major household purchases?

826. Who usually makes decisions about visits to your family or relatives?

826A. Do you own this or any other house either alone or jointly with someone else?

826B. Do you own any land either alone or jointly with someone else?

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

828. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she argues with him?
If she refuses to have sex with him?
If she burns the food?
If she goes out without telling him?
If she neglects the children?

SECTION 9. HIV/AIDS

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

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

903. Can people get the AIDS virus from mosquito bites?

904. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

905. Can people get the AIDS virus by sharing food with a person who has AIDS?

907. Can people get the AIDS virus because of witchcraft or other supernatural means?

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

909. Can the virus that causes AIDS be transmitted from a mother to her baby:

During pregnancy?
During delivery?
By breastfeeding?

910. CHECK 909:

911. Are there any special drugs 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?

913. CHECK 208 AND 215:

914. CHECK 407 FOR LAST BIRTH:

914A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915. During any of the antenatal visits for your last birth, 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?

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

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

917A. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

918A. Regardless of the result, all women who are tested are supposed to receive counselling after getting the result. Did you receive post-test counselling?

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

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

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

923. When was the last time you were tested?

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

926. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

928. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. WRITE THE NAME OF THE PLACE.

929. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

930. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

931. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

932. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

942. CHECK 901:

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?

943. CHECK 618:

944. CHECK 942:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

945. 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?

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

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

948. CHECK 945, 946, AND 947:

949. The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?

950. Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

951. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

953. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

955. CHECK 601:

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

957. Could you ask your husband/partner to use a condom if you wanted him to?

SECTION 10. DOMESTIC VIOLENCE MODULE

1001. CHECK HH Q.200 AND COVER PAGE OF WOMAN'S QUESTIONNAIRE:

1002. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

1003. CHECK 601 AND 602:

1004. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?
f) He (does/did) not trust you with any money?

1005. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner. If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.

A. (Does/did) your (last) husband/partner ever:

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1006A. (Does/did) your (last) husband/partner ever do any of the following things to you:

1006B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

1007. CHECK1006 (a-i):

1008. How long after you first (got married to/started living with) your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.

1009. Did the following ever happen as a result of what your (last) husband/partner did to you:

1010. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?

1011. CHECK 603:

1012. In the last 12 months, how often have you done this to your husband/partner: often, only sometimes, or not at all?

1013. (Does/Did) your husband/partner drink alcohol?

1014. How often (does/did) he get drunk: often, only sometimes, or never?

1015. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN: From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything to hurt you physically?

NEVER MARRIED/ NEVER LIVED WITH A MAN: From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you else physically?

1016. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

1017. In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

1018. CHECK 201, 226, AND 229:

1019. Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1020. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

1021. CHECK 618:
EVER HAD SEX?

1022. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

1023. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN: In the last 12 months, has anyone other than your (current/last) husband/ partner forced you to have sexual intercourse against your will?

NEVER MARRIED/ NEVER LIVED WITH A MAN: In the last 12 months has anyone forced you to have sexual intercourse against your will?

1024. CHECK 1022 AND 1023:

1025. CHECK 1006(h) and 1006(i):

1026. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

1027. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1028. Who was the person who was forcing you at that time?

1029. CHECK 1006A (a-i), 1015, 1019, 1023 AND 1026:

1030. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

1031. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1032. Have you ever told any one else about this?

1033. As far as you know, did your father ever beat your mother?

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1034. DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1035. INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
___________________________________

SECTION 11. MATERNAL MORTALITY

1101. 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?

1102. CHECK 1101:

1103. How many of these births did your mother have before you were born?

1104. What was the name given to your oldest (next oldest) brother or sister?

1105. Is (NAME) male or female?

1106. Is (NAME) still alive?

1107. How old is (NAME)?

1108. How many years ago did (NAME) die?

1109. How old was (NAME) when he/she died?

1110. Was (NAME) pregnant when she died?

1111. Did (NAME) die during childbirth?

1112. Did (NAME) die within two months after the end of a pregnancy or childbirth?

1113. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

IF NO MORE BROTHERS OR SISTERS, GO TO 1114.

1114. CHECK Q1110, 1111 AND 1112 FOR ALL SISTERS

SECTION 12. OTHER HEALTH ISSUES

1201. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1202. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1202A. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1203. Do you currently smoke cigarettes?

1204. In the last 24 hours, how many cigarettes did you smoke?

1205. Do you currently smoke or use any other type of tobacco?

1206. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

1207. 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?

Getting permission to go?
Getting money needed for advice treatment?
The distance to the health facility?
Not wanting to go alone?

1208. Are you covered by any health insurance?

1209. What type of health insurance?
RECORD ALL MENTIONED.

1210. Have you ever heard of female circumcision?

1211. 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?

1213. Have you been circumcised?

1214. Now I would like to ask you what was done to you at this time. Was any flesh removed from the genital area?

1217. Was the genital area just nicked without removing any flesh?

1218. Was your genital area sewn?

1219. How old were you when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE,
PROBE TO GET AN ESTIMATE.

1220. Who cut (or nicked) the genitals? Who cut (or nicked) the genitals?

1221. CHECK 213 AND 216:

1222. Has one of your daughters been circumcised?
IF YES: How many?

1223. To which of your daughters did this happen most recently?
INTERVIEWER: CHECK 212 AND RECORD THE BIRTH HISTORY NUMBER FOR THE DAUGHTER.

1224. Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM (Q1223) at this time. Was any flesh removed from her genital area?

1225. Was her genital area just nicked without removing any flesh?

1226. Was her genital area sewn?

1227. How old was (NAME OF DAUGHTER FROM Q1223) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

1228. Who cut (or nicked) the genitals?

1229. Do you intend to have any of your daughters circumcised in the future?

1230. Do you think that this practice should be continued, or should it be discontinued?

SECTION 13. FISTULA

1301. Sometimes a woman can have a problem such that she experiences a constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a assault or after a pelvic surgery. Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

1302. Have you ever heard of this kind of problem, such that a woman experiences a constant leakage of urine or stool from her vagina during the day and night?

1303. Did this problem occur:

After a delivery?
After a sexual assault?
After pelvic surgery?
After some other event?

1303A. Did this problem occur after a normal labor and delivery, or after a very difficult labor and delivery?

1303B. Was this baby born alive?

1304. After which delivery did this occur?

1305. How many days after (ANSWER TO Q. 1303) did the leakage start?
(ENTER 95 IF MORE THAN 95 DAYS)

1306. Have you sought treatment for this condition?

1307. Why have you not sought treatment?

1308. From whom did you last seek treatment?

1309. Did the treatment stop the problem?

1310. RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:
____________________________________

COMMENTS ON SPECIFIC QUESTIONS:
_____________________________________

ANY OTHER COMMENTS:
_____________________________________

SUPERVISOR'S OBSERVATIONS
_____________________________________

NAME OF SUPERVISOR: _______________
DATE:___________

EDITOR'S OBSERVATIONS
_______________________________________

NAME OF EDITOR: ___________
DATE: ____________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE