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2015-16 TANZANIA DEMOGRAPHIC AND HEALTH SURVEY/MALARIA INDICATOR SURVEY - WOMAN'S QUESTIONNAIRE

UNITED REPUBLIC OF TANZANIA
NATIONAL BUREAU OF STATISTICS

IDENTIFICATION

PLACE NAME _____

NAME OF HOUSEHOLD HEAD ____

CLUSTER NUMBER _____

HOUSEHOLD NUMBER _____

NAME AND LINE NUMBER OF WOMAN _____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE _____
INTERVIEWER'S NAME _____
RESULT*

*RESULT CODES

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

NEXT VISIT:

DATE: _____
TIME: _____

FINAL VISIT

DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT*

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE** _____

LANGUAGE OF QUESTIONNAIRE** _____

LANGUAGE OF INTERVIEW** _____

**LANGUAGE CODES

ENGLISH 01
KISWAHILI 02

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR

NAME _____
NUMBER _____

FIELD EDITOR

NAME _____
NUMBER _____

OFFICE EDITOR

NUMBER _____

KEYED BY

NUMBER _____

INTRODUCTION AND CONSENT

Hello. My name is __________. I am working with the National Bureau of Statistics. We are conducting a survey about health and other topics all over the United Republic of Tanzania. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 45 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of the research 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 of you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
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)

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOURS_____
MINUTES_____
MORNING 1
AFTERNOON 2
EVENING 3

102) How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

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

103) Just before you moved here, did you live in a city, in a town, or in a rural area?

CITY 1
TOWN 2
RURAL AREA 3

104) Before you moved here, which REGION did you live in?

DODOMA 01
ARUSI 02
KILIMANJARO 03
TANGA 04
MOROGORO 05
PWANI 06
DAR ES SALAAM 07
LINDI 08
MTWARA 09
RUVUMA 10
IRINGA 11
MBEYA 12
SINGIDA 13
TABORA 14
RUKWA 15
KIGOMA 16
SHINYANGA 17
KAGERA 18
MWANZA 19
MARA 20
MANYARA 21
NJOMBE 22
KATAVI 23
SIMIYU 24
GEITA 25
KASKAZINI UNGUJA 26
KUSINI UNGUJA 27
MJINI MAGHARIBI 28
KASKAZINI PEMBA 29
KUSINI PEMBA 30
OUTSIDE OF TANZANIA 96

105) In what month and year were you born?

MONTH_____
DON'T KNOW MONTH 98
YEAR_____
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS_____

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

108) What is the highest level of school you attended?

PRE-PRIMARY 0
PRIMARY 1
POST PRIMARY TRAINING 2
SECONDARY 'O' LEVEL 3
POST SECONDARY 'O' LEVEL TRAINING 4
SECONDARY 'A' LEVEL 5
POST SECONDARY 'A' LEVEL TRAINING 6
UNIVERSITY 7
DON'T KNOW 8

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

GRADE_____

110) CHECK 108:

CODES '0', '1', '2', '3', '4', OR '8' CIRCLED (GO TO 111)
CODES '5', '6', OR '7' CIRCLED (GO TO 113)

111) 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?

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

112) CHECK 111:

CODE '2', '3', OR '4' CIRCLED (GO TO 113)
CODE '1' OR '5' CIRCLED (GO TO 114)

113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

114) Do you listen to the radio at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

115) Do you watch/listen to television at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

116) Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

117) Do you use your mobile phone for any financial transactions?

YES 1
NO 2

117A) Do you use your mobile phone for any health related issues?

YES 1
NO 2

118) Do you have an account in a bank or other financial institution that you yourself use?

YES 1
NO 2 (GO TO 118C)

118A) Is the account shared with someone else?

YES 1
NO 2 (GO TO 118C)

118B) Whom do you share the account with?

HUSBAND/PARTNER 1
PARENTS 2
RELATIVES 3
OTHER (SPECIFY) 6

118C) Do you use VICOBA for any financial transaction?

YES 1
NO 2

119) Have you ever used the Internet (including e-mails, social media like Facebook, Twitter, Blogs, or instant messaging such as WhatsApp, Viber?)

YES 1
NO 2 (GO TO 124)

120) In the last 12 months, have you used the Internet? IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (GO TO 124)

121) During the last one month, how often did you use the Internet almost every day, at least once a week, less than once a week, or not at all?

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

124) In the last 12 months, how many times have you been away from home for one or more nights?

NUMBER OF TIMES_____
NONE 00 (GO TO 201)

125) In the last 12 months, have you been away from home for more than one month at a time?

YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

203) a) How many sons live with you?

b) And how many daughters live with you?

IF NONE, RECORD '00'.

SONS AT HOME_____
DAUGHTERS AT HOME_____

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

YES 1
NO 2 (GO TO 206)

205) a) How many sons are alive but do not live with you?

b) And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

SONS ELSEWHERE_____
DAUGHTERS ELSEWHERE_____

206) Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

YES 1
NO 2 (GO TO 208)

207) a) How many boys have died?

b) And how many girls have died?

IF NONE, RECORD '00'.

BOYS DEAD_____
GIRLS DEAD_____

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

TOTAL BIRTHS_____

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

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

210) CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 226)

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

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

BIRTH HISTORY NUMBER___

NAME_____

213) Is (NAME) a boy or a girl?

BOY 1
GIRL 2

214) Were any of these births twins?

SINGLE 1
MULTIPLE 2

215) On what day, month, and year was (NAME) born?

DAY___
MONTH___
YEAR___

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS_____

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

YES 1
NO 2

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

HOUSEHOLD LINE NUMBER___ (GO TO NEXT BIRTH/221)

220) IF DEAD: How old was (NAME) when (he/she) died?

IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday?

THEN ASK: Exactly how many months old was (NAME) when (he/she) died? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1_____
MONTHS 2_____
YEARS 3_____

220A) IF DEAD: In what month and year did (NAME) die?

MONTH____
YEAR____

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

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH)

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

223) COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

NUMBERS ARE SAME (GO TO 223A)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

223A) CHECK 220A: ANY DEATHS IN JANUARY 2010 OR LATER?

YES (GO TO 223B)
NO (GO TO 224)

223B) CHECK 220: ENTER THE NUMBER OF DEATHS THAT HAPPENED IN DAYS, MONTHS AND 2-4 YEARS (LESS THAN 5 YEARS).

_____

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2010-2016

NUMBER OF BIRTHS_____
NONE 0 (GO TO 226)

225) FOR EACH BIRTH IN 2010-2016, 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 COMPLETED 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?

YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

227) How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS.

ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS_____

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

YES 1 (GO TO 230)
NO 2

229) CHECK 208: TOTAL NUMBER OF BIRTHS

ONE OR MORE: Did you want to have a baby later on or did you not want any more children?

LATER 1
NO MORE/NONE 2

NONE: Did you want to have a baby later on or did you not want any children?

LATER 1
NO MORE/NONE 2

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

YES 1
NO 2 (GO TO 239)

231) When did the last such pregnancy end?

MONTH_____
YEAR_____

232) CHECK 231:

LAST PREGNANCY ENDED IN 2010-2016 (GO TO 234)
LAST PREGNANCY ENDED IN 2009 OR EARLIER (GO TO 239)

233) In what month and year did the preceding such pregnancy end?

MONTH____
YEAR____

234) How many months pregnant were you when that pregnancy ended?

NUMBER OF MONTHS____

235) Since January 2010, have you had any other pregnancies that did not result in a live birth?

YES 1 (GO TO NEXT LINE)
NO 2 (GO TO 236)

236) FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2010-2016 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY. IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237) Did you have any miscarriages, abortions or stillbirths that ended before 2010?

YES 1
NO 2 (GO TO 239)

238) When did the last such pregnancy that terminated before 2010 end?

MONTH____
YEAR____

239) When did your last menstrual period start?

(DATE, IF GIVEN)_____
DAYS AGO 1____
WEEKS AGO 2____
MONTHS AGO 3____
YEARS AGO 4____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

240) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

YES 1
NO 2 (GO TO 242)
DON'T KNOW 8 (GO TO 242)

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

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

242) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

YES 1
NO 2
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?

01. Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. IUCD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
04. Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05. Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06. Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07. Male condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. Female Condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09. Emergency Contraception. PROBE: As an emergency measure, within three to five days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
10. Standard Days Method. PROBE: A women uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
11. Lactational Amenorrhea Method (LAM).
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
YES 1
NO 2
12. Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant/
YES 1
NO 2
13. Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? IF YES, PROBE: Which method?
YES, MODERN METHOD (SPECIFY) _____ 1
YES, TRADITIONAL METHOD (SPECIFY) _____ 2
NO 3

302. CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 312)

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

YES 1
NO 2 (GO TO 312)

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

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUCD C (GO TO 309)
INJECTABLES D (GO TO 309)
IMPLANTS E (GO TO 309)
PILL F
MALE CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 309)
EMERGENCY CONTRACEPTION I (GO TO 309)
STANDARD DAYS METHOD K (GO TO 309)
LACTATIONAL AMENORRHEA METHOD K (GO TO 309)
RHYTHM/ CALENDAR METHOD L (GO TO 309)
WITHDRAWAL M (GO TO 309)
OTHER MODERN METHOD X (GO TO 309)
OTHER TRADITIONAL METHOD Y (GO TO 309)

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

MICROGYNON 01 (GO TO 309)
LOFEMINAL 02 (GO TO 309)
MICROLUT 03 (GO TO 309)
MACROVAL 04 (GO TO 309)
FLEXI PILLS 05 (GO TO 309)
FAMILIA PILLS 06 (GO TO 309)
OTHER (SPECIFY) _____ 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

306. 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.

(NAME OF PLACE) __________
GOVERNMENT OR PARASTATAL
NATIONAL/ZONAL/SPECIALIZED HOSPITAL 11
REGIONAL REFERRAL HOSPITAL 12
REGIONAL HOSPITAL 13
DISTRICT HOSPITAL 14
HEALTH CENTRE 15
DISPENSARY 16
CLINIC 17
RELIGIOUS/VOLUNTARY
REFERRAL/SPECIALIZED HOSPITAL 21
DISTRICT HOSPITAL 22
HOSPITAL 23
HEALTH CENTRE 24
DISPENSARY 25
CLINIC 26
PRIVATE
SPECIALIZED HOSPITAL 31
HOSPITAL 32
HEALTH CENTRE 33
DISPENSARY 34
CLINIC 35
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

308. In what month and year the sterilization performed?

MONTH _____
YEAR _____

308A. Did you pay for sterilization?

YES 1
NO 2 (GO TO 310)

308B. How much did you pay for sterilization?

TSHS _____ (GO TO 310)
DON'T KNOW 99999998 (GO TO 310)

309. 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?

MONTH _____
YEAR _____

310. CHECK 308 AND 309, 215 AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

NO (GO TO 311)
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MOTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).

311) CHECK 308 AND 309:

YEAR IS 2010-2016 (ENTER CODE FOR METHOD USD IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING) (GO TO 312)
YEAR IS 2010 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2010) (GO TO 324)

312) 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 US AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2010. 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:
a) When was the last time you used a method? Which method was that?
b) When did you start using that method? How long after the birth of (NAME)?
c) How long did you use the method then?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 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:
d) 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?
e) 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.

313) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

NO METHOD USED (GO TO 314)
ANY METHOD USED (GO TO 315)

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

YES 1 (GO TO 326)
NO 2 (GO TO 326)

315) CHECK 304: CIRCLE METHOD CODE:

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

NO CODE CIRCLED / QUESTION NOT ASKED 00 (GO TO 326)
FEMALE STERILIZATION 01 (GO TO 319)
MALE STERILIZATION 02 (GO TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 323)
RHYTHM / CALENDAR METHOD 12 (GO TO 323)
WITHDRAWAL 13 (GO TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

316) You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____
GOVERNMENT/PARASTATAL
NATIONAL/ZONAL/SPEC. HOSPITAL 11
REGIONAL REFERRAL HOSPITAL 12
REGIONAL HOSPITAL 13
DISTRICT HOSPITAL 14
HEALTH CENTRE 15
DISPENSARY 16
CLINIC 17
CHW 18
RELIGIOUS/VOLUNTARY
REFERRAL SPECIALISED HOSPITAL 21
DISTRICT HOSPITAL 22
HOSPITAL 23
HEALTH CENTRE 24
DISPENSARY 25
CLINIC 26
PRIVATE MEDICAL SECTOR
SPECIALISED HOSPITAL 31
HOSPITAL 32
HEALTH CENTRE 33
DISPENSARY 34
CLINIC 35
OTHER
PHARMACY 41
ACCREDITED DRUG DISPENSING OUTLET (ADDO) 42
NGO 43
VCT CENTRE 44
SHOP/KIOSK 45
BAR 46
GUEST HOUSE/HOTEL 47
FRIEND/RELATIVE/NEIGHBOUR 48
OTHER (SPECIFY) 96

316A) Did you pay for (CURRENT METHOD)?

YES 1
NO 2 (GO TO 317)

316B) How much did you pay for (CURRENT METHOD)?

TSHS____
DON'T KNOW 999998

317) CHECK 304: CIRCLE METHOD CODE:

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

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 322)
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
OTHER MODERN METHOD 95 (GO TO 322)
OTHER TRADITIONAL METHOD 96 (GO TO 323)

318) At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 321)
NO 2 (GO TO 320)

319) When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 321)
NO 2

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

YES 1
NO 2 (GO TO 322)

321) Were you told what to do if you experienced side effects or problems?

YES 1
NO 2

322) CHECK 318 AND 319:

IF YES:
a) At that time, were you told about other methods of family planning that you could use?

YES 1 (GO TO 324)
NO 2

IF NO/NOT ASKED:
b) When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

YES 1 (GO TO 324)
NO 2

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

YES 1
NO 2

324) CHECK 304: CIRCLE METHOD CODE:

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

FEMALE STERILIZATION 01 (GO TO 327)
MALE STERILIZATION 02 (GO TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 327)
RHYTHM METHOD 12 (GO TO 327)
WITHDRAWAL 13 (GO TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 327)

325) Where did you obtain (CURRENT METHOD) the last time?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____
GOVERNMENT/PARASTATAL
NATIONAL/ZONAL/SPEC. HOSPITAL 11 (GO TO 327)
REGIONAL REFERRAL HOSPITAL 12
REGIONAL HOSPITAL 13
DISTRICT HOSPITAL 14
HEALTH CENTRE 15
DISPENSARY 16
CLINIC 17
CHW 18
RELIGIOUS/VOLUNTARY
REFERRAL SPECIALISED HOSPITAL 21
DISTRICT HOSPITAL 22
HOSPITAL 23
HEALTH CENTRE 24
DISPENSARY 25
CLINIC 26
PRIVATE MEDICAL SECTOR
SPECIALISED HOSPITAL 31
HOSPITAL 32
HEALTH CENTRE 33
DISPENSARY 34
CLINIC 35
OTHER
PHARMACY 41
ACCREDITED DRUG DISPENSING OUTLET (ADDO) 42
NGO 43
VCT CENTRE 44
SHOP/KIOSK 45
BAR 46
GUEST HOUSE/HOTEL 47
FRIEND/RELATIVE/NEIGHBOUR 48
OTHER (SPECIFY) 96 (GO TO 327)

326) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2

327) In the last 12 months, were you visited by a fieldworker?

YES 1
NO 2 (GO TO 329)

328) Did the fieldworker talk to you about family planning?

YES 1
NO 2

329) CHECK 202: LIVING CHILDREN

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

YES 1
NO 2 (GO TO 401)

NO:
b) In the last 12 months, have you visited a health facility for care for yourself?

YES 1
NO 2 (GO TO 401)

330) Did any staff member at the health facility speak to you about family planning?

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

ONE OR MORE BIRTHS IN 2010-2016 (GO TO 402)
NO BIRTHS IN 2010-2016 (GO TO 648)

402) CHECK 215. RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2010-2016. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER_____

404) FROM 212 AND 216:

NAME_____
LIVING (GO TO 405)
DEAD (GO TO 405)

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

YES 1 (GO TO 408)
NO 2

406) CHECK 208:

ONLY ONE BIRTH:
a) Did you want to have a baby later on, or did you not want any children?

LATER 1
NO MORE/NONE 2 (GO TO 408)

MORE THAN ONE BIRTH:
b) Did you want to have a baby later on, or did you not want any more children?

LATER 1
NO MORE/NONE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTHS 1_____
YEARS 2_____
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 414)

409) Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL

HEALTH PERSONNEL
DOCTOR/AMO A
CLINICAL OFFICER B
ASS. CLINICAL OFFICER C
NURSE/MIDWIFE D
ASS. NURSE E
MCH AIDE F
OTHER PERSON
COMMUNITY HEALTH WORKER G
TRAINED TBA/TBA H
OTHER (SPECIFY) X

410) Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____
GOVERNMENT/PARASTATAL
NATIONAL/ZONAL/SPEC. HOSPITAL A
REGIONAL REFERRAL HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
CLINIC G
CHW H
RELIGIOUS/VOLUNTARY
REFERRAL SPECIALIZED HOSPITAL I
DISTRICT HOSPITAL J
HOSPITAL K
HEALTH CENTRE L
DISPENSARY M
CLINIC N
PRIVATE MEDICAL SECTOR
SPECIALIZED HOSPITAL O
HOSPITAL P
HEALTH CENTRE Q
DISPENSARY R
CLINIC S
OTHER (SPECIFY) X

410A) Did you pay for antenatal care?

YES 1
NO 2 (GO TO 411)

410B) How much did you pay for antenatal care?

TSHS_____
DON'T KNOW 98

411) How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTHS_____
DON'T KNOW 98

412) How many times did you receive antenatal care during this pregnancy?

NUMBER OF TIMES_____
DON'T KNOW 98

412A) During this pregnancy did your husband do any of the following?

a) Stopped you from receiving ANC?
YES 1
NO 2
b) Encouraged you to receive ANC?
YES 1
NO 2
c) Had no interest in you receiving ANC?
YES 1
NO 2

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

a) Was your blood pressure measured?
YES 1
NO 2
b) Did you give a urine sample?
YES 1
NO 2
c) Did you give a blood sample?
YES 1
NO 2

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

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

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

TIMES_____
DON'T KNOW 8

416) CHECK 415:

2 OR MORE TIMES (GO TO 420)
OTHER (GO TO 417)

417) At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (GO TO 420)
DON'T KNOW 8 (GO TO 420)

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

TIMES_____
DON'T KNOW 8

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

YEARS AGO_____
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 422)
DON'T KNOW 8 (GO TO 422)

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

DAYS_____
DON'T KNOW 998

422) During this pregnancy, did you take any drug for intestinal worms?

YES 1
NO 2
DON'T KNOW 8

423) During this pregnancy, did you take SP/Fansidar to prevent you from getting malaria?

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

424) How many times did you take SP/Fansidar during this pregnancy?

TIMES_____

425) Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source? IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

426) When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

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

427) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 429)
DON'T KNOW 8 (GO TO 429)

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

KG FROM CARD 1 _______
KG FROM RECALL 2 _______
DON'T KNOW 99998

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

HEALTH PERSONNEL
DOCTOR/AMO A
CLINICAL OFFICER B
ASS. CLINICAL OFFICER C
NURSE/MIDWIFE D
ASS. NURSE E
MCH AIDE F
OTHER PERSON
CHW G
TRAINED TBA/TBA H
RELATIVE/FRIEND I
OTHER (SPECIFY) X
NO ONE ASSISTED Y

429A) Did you have a companion during labor and delivery of (NAME)?

YES 1
NO 2

429B) Did you pay for delivery of (NAME)?

YES 1
NO 2 (GO TO 430)

429C) How much did you pay for delivery of (NAME)?

TSHS_____
DON'T KNOW 99999998

430) Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
HOME
HER HOME 11 (GO TO 434)
OTHER HOME 12 (GO TO 434)
TBA PREMISES 13 (GO TO 434)
GOVERNMENT OR PARASTATAL
NATIONAL/ZONAL/SPECIALISED HOSPITAL 21
REGIONAL REFERRAL HOSPITAL 22
REGIONAL HOSPITAL 23
DISTRICT HOSPITAL 24
HEALTH CENTRE 25
DISPENSARY 26
CLINIC 27
RELIGIOUS VOLUNTARY
REFERRAL/SPECIALISED HOSPITAL 31
DISTRICT HOSPITAL 32
HOSPITAL 33
HEALTH CENTRE 34
DISPENSARY 35
CLINIC 36
PRIVATE
SPECIALIZED HOSPITAL 41
HOSPITAL 42
HEALTH CENTRE 43
DISPENSARY 44
CLINIC 45
OTHER (SPECIFY) 96 (GO TO 434)

431) How long after (NAME) was delivered did you stay there? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1_____
DAYS 2_____
WEEKS 3_____
DON'T KNOW 998

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

YES 1
NO 2 (GO TO 434)

433) When was the decision made to have the caesarean section? Was it before or after your labor pains started?

BEFORE 1
AFTER 2

434) Immediately after the birth, was (NAME) put directly on the bare skin of your chest?

YES 1
NO 2
DON'T KNOW 8

434A) CHECK Q430:

CODE 11, 12, 13 or 96 (GO TO 449)
OTHER (GO TO 434B

434B) After you delivered, did the health facility give you a birth notification form for (NAME)?

YES 1 (GO TO 435)
NO 2

434C) Did you get a birth notification from any other place?

YES 1
NO 2

435) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

YES 1
NO 2 (GO TO 438)

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

HOURS 1_____
DAYS 2_____
WEEKS 3_____
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR/AMO 11
CLINICAL OFFICER 12
ASS. CINICAL OFFICER 13
NURSE/WIDWIFE 14
ASS. NURSE 15
MCH AIDE 16
OTHER PERSON
CHW 21
TRAINED TBA/TI 22
RELATIVE/FRIEND 23
OTHER (SPECIFY) 96

438) Now I would like to talk to you about checks on (NAME)'s health after delivery - for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

YES 1
NO 2 (GO TO 441)
DON'T KNOW 8 (GO TO 441)

439) How long after delivery was (NAME)'s health first checked? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1_____
DAYS 2_____
WEEKS 3_____
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR/AMO 11
CLINICAL OFFICER 12
ASS. CLINICAL OFFICER 13
NURSE/MIDWIFE 14
ASS. NURSE 15
MCH AIDE 16
OTHER PERSON
CHW 21
TRAINED TBA/TBA 22
RELATIVE/FRIEND 23
OTHER (SPECIFY) 96

441) Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

YES 1
NO 2 (GO TO 445)

442) How long after delivery did that check take place? IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1_____
DAYS 2_____
WEEKS 3_____
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR/AMO 11
CLINICAL OFFICER 12
ASS. CLINICAL OFFICER 13
NURSE/MIDWIFE 14
ASS. NURSE 15
MCH AIDE 16
OTHER PERSON
CHW 21
TRAINED TBA/TBA 22
RELATIVE/FRIEND 23
OTHER (SPECIFY) 96

444) Where did the check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
HOME
HER HOME 11
OTHER HOME 12
TBA PREMISES 13
GOVERNMENT/PARASTATAL
ZONAL/REFERRAL/SPEC. HOSP. 21
REFERRAL REGIONAL HOSP. 22
REGIONAL HOSPITAL 23
DISTRICT HOSPITAL 24
HEALTH CENTRE 25
DISPENSARY 26
CLINIC 27
RELIGIOUS/VOLUNTARY
REFERRAL/SPEC. HOSPITAL 31
DISTRICT HOSPITAL 32
HOSPITAL 33
HEALTH CENTRE 34
DISPENSARY 35
CLINIC 36
PRIVATE
SPECIALISED HOSPITAL 41
HOSPITAL 42
HEALTH CENTRE 43
DISPENSARY 44
CLINIC 45
OTHER (SPECIFY) 96

444A) Did you pay for your health check at that time?

YES 1
NO 2 (GO TO 444C)

444B) How much did you pay for the health check?

TSHS_____
DON'T KNOW 999998

444C) Among other checks after delivery, did any health care provider do the following:

a) Check or ask about vaginal bleeding?
YES 1
NO 2
DON'T KNOW 8
b) Examine your abdomen i.e. uterine contraction, fundal height?
YES 1
NO 2
DON'T KNOW 8
c) Check your blood pressure?
YES 1
NO 2
DON'T KNOW 8

444D) In total, how many times was your health checked after delivery?

NBRE CHECKS_____

445) I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?

YES 1
NO 2 (GO TO 457)
DIED AT THE FACILITY 3 (GO TO 457)
DON'T KNOW 8 (GO TO 457)

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

HOURS 1_____
DAYS 2_____
WEEKS 3_____
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR/AMO 11
CLINICAL OFFICER 12
ASS. CLINICAL OFFICER 13
NURSE/MIDWIFE 14
ASS. NURSE 15
MCH AIDE 16
OTHER PERSON
CHW 21
TRAINED TBA/TBA 22
RELATIVE/FRIEND 23
OTHER (SPECIFY) 96

448) Where did this check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
HOME
HER HOME 11
OTHER HOME 12
TBA PREMISES 13
GOVERNMENT/PARASTATAL
ZONAL/REFERRAL/SPEC. HOSPITAL 21
REFERRAL REGIONAL HOSPITAL 22
REGIONAL HOSPITAL 23
DISTRICT HOSPITAL 24
HEALTH CENTRE 25
DISPENSARY 26
CLINIC 27
RELIGIOUS/VOLUNTARY
REFERRAL/SPEC. HOSPITAL 31
DISTRICT HOSPITAL 32
HOSPITAL 33
HEALTH CENTRE 34
DISPENSARY 35
CLINIC 36
PRIVATE
SPECIALISED HOSPITAL 41
HOSPITAL 42
HEALTH CENTRE 43
DISPENSARY 44
CLINIC 45
OTHER (SPECIFY) 96

448A) Did you pay for the health checks of (NAME)?

YES 1
NO 2 (GO TO 457)

448B) How much did you pay for the health checks?

TSHS_____ (GO TO 457)
DON'T KNOW 999998

449) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

YES 1
NO 2 (GO TO 453)

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

HOURS 1_____
DAYS 2_____
WEEKS 3_____
DON'T KNOW 999998

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

HEALTH PERSONNEL
DOCTOR/AMO 11
CLINICAL OFFICER 12
ASS. CLINICAL OFFICER 13
NURSE/MIDWIFE 14
ASS. NURSE 15
MCH AIDE 16
OTHER PERSON
CHW 21
TRAINED TBA/TBA 22
RELATIVE/FRIEND 23
OTHER (SPECIFY) 96

452) Where did this first check take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE)_____
HOME
HER HOME 11
OTHER HOME 12
TBA PREMISES 13
GOVERNMENT/PARASTATAL
ZONAL/REFERRAL/SPEC. HOSPITAL 21
REFERRAL REGIONAL HOSPITAL 22
REGIONAL HOSPITAL 23
DISTRICT HOSPITAL 24
HEALTH CENTRE 25
DISPENSARY 26
CLINIC 27
RELIGIOUS/VOLUNTARY
REFERRAL/SPEC. HOSPITAL 31
DISTRICT HOSPITAL 32
HOSPITAL 33
HEALTH CENTRE 34
DISPENSARY 35
CLINIC 36
PRIVATE
SPECIALISED HOSPITAL 41
HOSPITAL 42
HEALTH CENTRE 43
DISPENSARY 44
CLINIC 45
OTHER (SPECIFY) 96

452A) Did you pay for this first check of your health?

YES 1
NO 2 (GO TO 452C)

452B) How much did you pay for the health check?

TSHS_____
DON'T KNOW 999998

452C) Among other checks after delivery, did any health care provider do the following:

a) Check or ask about vaginal bleeding?
YES 1
NO 2
DON'T KNOW 8
b) Examine your abdomen i.e. uterine contraction, fundal height?
YES 1
NO 2
DON'T KNOW 8
c) Check your blood pressure?
YES 1
NO 2
DON'T KNOW 8

452D) In total, how many times was your health checked after delivery?

NBRE CHECKS_____

453) I would like to talk to you about checks on (NAME)'s health after delivery - for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

YES 1
NO 2 (GO TO 457)
DON'T KNOW 8 (GO TO 457)

454) 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.

HOURS AFTER BIRTH 1_____
DAYS AFTER BIRTH 2_____
WEEKS AFTER BIRTH 3_____
DON'T KNOW 998

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

HEALTH PERSONNEL
DOCTOR/AMO 11
CLINICAL OFFICER 12
ASS. CLINICAL OFFICER 13
NURSE/MIDWIFE 14
ASS. NURSE 15
MCH AIDE 16
OTHER PERSON
CHW 21
TRAINED TBA/TBA 22
RELATIVE/FRIEND 23
OTHER (SPECIFY) 96

456) Where did this first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______
HOME
HER HOME 11
OTHER HOME 12
TBA PREMISES 13
GOVERNMENT/PARASTATAL
ZONAL/REFERRAL/SPEC. HOSPITAL 21
REFERRAL REGIONAL HOSPITAL 22
REGIONAL HOSPITAL 23
DISTRICT HOSPITAL 24
HEALTH CENTRE 25
DISPENSARY 26
CLINIC 27
RELIGIOUS/VOLUNTARY
REFERRAL/SPEC. HOSPITAL 31
DISTRICT HOSPITAL 32
HOSPITAL 33
HEALTH CENTRE 34
DISPENSARY 35
CLINIC 36
PRIVATE
SPECIALISED HOSPITAL 41
HOSPITAL 42
HEALTH CENTRE 43
DISPENSARY 44
CLINIC 45
OTHER (SPECIFY) 96

456A) Did you pay for your health check at that time?

YES 1
NO 2 (GO TO 457)

456B) How much did you pay for the health check?

TSHS_____
DON'T KNOW 999998

457) During the first two days after (NAME)'s birth, did any health care provider do the following:

a) Examine the cord?
YES 1
NO 2
DON'T KNOW 8
b) Measure (NAME)'s temperature?
YES 1
NO 2
DON'T KNOW 8
c) Counsel you on danger signs for newborns?
YES 1
NO 2
DON'T KNOW 8
d) Counsel you on breastfeeding?
YES 1
NO 2
DON'T KNOW 8
e) Observe (NAME) breastfeeding?
YES 1
NO 2
DON'T KNOW 8

457A) After (NAME) was born, were you given or did you buy any iron and folic acid tablets or syrup?

YES 1
NO 2

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

YES 1 (GO TO 460)
NO 2 (GO TO 461)

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

YES 1
NO 2 (GO TO 463)

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

MONTHS_____
DON'T KNOW 98

461) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 462)
PREGNANT OR UNSURE (GO TO 463)

462) Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 464)

463) For how many months after the birth of (NAME) did you no have sexual intercourse?

MONTHS_____
DON'T KNOW 98

464) Did you ever breastfeed (NAME)?

YES 1 (GO TO 466)
NO 2

465) CHECK 404: IS CHILD LIVING?

LIVING (GO TO 470)
DEAD (GO TO 471)

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

IMMEDIATELY 000
HOURS 1_____
DAYS 2_____

467) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2

468) CHECK 404: IS CHILD LIVING?

LIVING (GO TO 469)
DEAD (GO TO 471)

469) Are you still breastfeeding (NAME)?

YES 1
NO 2

469A) How old was (NAME) when she/he was first fed something other than breast milk? INCLUDES: JUICE, COW'S MILK, WATER, SUGAR, SOLID FOODS OR ANYTHING ELSE. IF LESS THAN ONE MONTH, RECORD 00.

MONTHS_____
NOT STARTED GIVING ANYTHING 96
DON'T KNOW 98

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

YES 1
NO 2
DON'T KNOW 8

470A) Do you have a birth certificate for (NAME)? ASK TO SEE CERTIFICATE.

YES, OBSERVED 1
YES, NOT OBSERVED 2
NO 3

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

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A) CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2012-2016?

ONE OR MORE BIRTHS IN 2012-2016 (GO TO 502A)
NO BIRTHS IN 2012-2016 (GO TO 601)

502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2012-2016.

NAME OF LAST BIRTH_____
BIRTH HISTORY NUMBER_____

503A) CHECK 216 FOR CHILD:

LIVING (GO TO 504A)
DEAD (GO TO 501B)

504A) Do you have a card or other document where (NAME)'s vaccinations are written down?

YES, HAS ONLY A CARD 1 (GO TO 507A)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507A)
NO, NO CARD AND NO OTHER DOCUMENT 4

505A) Did you ever have a vaccination card for (NAME)?

YES 1
NO 2

506A) CHECK 504A:

CODE '2' CIRCLED (GO TO 507A)
CODE '4' CIRCLED (GO TO 511A)

507A) May I see the card or other document where (NAME)'s vaccinations are written down?

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (GO TO 511A)

508A) COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ______
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 1
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 2
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 3
DAY _____
MONTH _____
YEAR _____
DPT-HEP .B-HIB (PENTAVALENT) 1
DAY ______
MONTH _____
YEAR _____
DPT-HEP .B-HIB (PENTAVALENT) 2
DAY ______
MONTH ______
YEAR ______
DPT-HEP .B-HIB (PENTAVALENT) 3
DAY ______
MONTH ______
YEAR _____
PNEUMOCOCCAL 1
DAY _____
MONTH _____
YEAR _____
PNEUMOCOCCAL 2
DAY ______
MONTH ______
YEAR ______
PNEUMOCOCCAL 3
DAY ______
MONTH _____
YEAR _____
ROTAVIRUS 1
DAY ______
MONTH _____
YEAR _____
ROTAVIRUS 2
DAY ______
MONTH ______
YEAR _____
[MEASLES CONTAINING VACCINE] 1
DAY ______
MONTH _____
YEAR _____
[MEASLES CONTAINING VACCINE] 2
DAY _____
MONTH ______
YEAR _____
VITAMIN A (MOST RECENT)
DAY _____
MONTH _____
YEAR _____

509A) CHECK 508A: 'BCG' TO '[MEASLES CONTAINING VACCINE] 2' ALL RECORDED?

NO (GO TO 510A)
YES (GO TO 524A1)

510A) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A) (THEN GO TO 525A)
NO 2 (GO TO 524A1)
DON'T KNOW 8 (GO TO 524A1)

511A) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

YES 1
NO 2 (GO TO 524A1)
DON'T KNOW 8 (GO TO 524A1)

512A) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the right shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

514A) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2 (GO TO 517A)
DON'T KNOW 8 (GO TO 517A)

515A) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

516A) How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES_____

517A) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the left thigh sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 519A)
DON'T KNOW 8 (GO TO 519A)

518A) How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES_____

519A) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the right thigh to prevent pneumonia?

YES 1
NO 2 (GO TO 521A)
DON'T KNOW 8 (GO TO 521A)

520A) How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES_____

521A) Has (NAME) ever received a rotavirus vaccination, that is a white liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (GO TO 523A)
DON'T KNOW 8 (GO TO 523A)

522A) How many times did (NAME) receive the rotavirus vaccine?

NUMBER OF TIMES_____

523A) Has (NAME) ever received a measles vaccination, that is, an injection in the left shoulder or thigh to prevent measles?

YES 1
NO 2 (GO TO 524A1)
DON'T KNOW 8 (GO TO 524A1)

524A) How many times did (NAME) receive the measles vaccine?

NUMBER OF TIMES_____

524A1) Did you pay for any vaccination for (NAME)?

YES 1
NO 2 (GO TO 525A)

524A2) How much did you pay for the vaccination?

TSHS_____
DON'T KNOW 999998

525A) In the last 7 days was (NAME) given:

a) Virutubishi vya nyongeza?
YES 1
NO 2
DON'T KNOW 8
b) Chakula dawa?
YES 1
NO 2
DON'T KNOW 8

526A) CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B) CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2012-2016?

MORE BIRTHS IN 2012-2016 (GO TO 502B)
NO MORE BIRTHS IN 2012-2016 (GO TO 601)

502B) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2012-2016.

NAME OF NEXT-TO-LAST BIRTH_____
BIRTH HISTORY NUMBER_____

503B) CHECK 216 FOR CHILD:

LIVING (GO TO 504B)
DEAD (GO TO 526B)

504B) Do you have a card or other document where (NAME)'s vaccinations are written down?

YES, HAS ONLY A CARD 1 (GO TO 507B)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (GO TO 507B)
NO, NO CARD AND NO OTHER DOCUMENT 4

505B) Did you ever have a vaccination card for (NAME)?

YES 1
NO 2

506B) CHECK 504B:

CODE '2' CIRCLED (GO TO 507B)
CODE '4' CIRCLED (GO TO 511B)

507B) May I see the card or other document where (NAME)'s vaccinations are written down?

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (GO TO 511B)

508B) COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 1
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 2
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 3
DAY _____
MONTH _____
YEAR _____
DPT-HEP .B-HIB (PENTAVALENT) 1
DAY _____
MONTH _____
YEAR _____
DPT-HEP .B-HIB (PENTAVALENT) 2
DAY _____
MONTH _____
YEAR _____
DPT-HEP .B-HIB (PENTAVALENT) 3
DAY _____
MONTH _____
YEAR _____
PNEUMOCOCCAL 1
DAY _____
MONTH _____
YEAR _____
PNEUMOCOCCAL 2
DAY _____
MONTH _____
YEAR _____
PNEUMOCOCCAL 3
DAY _____
MONTH _____
YEAR _____
ROTAVIRUS 1
DAY _____
MONTH _____
YEAR _____
ROTAVIRUS 2
DAY _____
MONTH _____
YEAR _____
[MEASLES CONTAINING VACCINE] 1
DAY _____
MONTH _____
YEAR _____
[MEASLES CONTAINING VACCINE] 2
DAY _____
MONTH _____
YEAR _____
VITAMIN A (MOST RECENT)
DAY _____
MONTH _____
YEAR _____

509B) CHECK 508B: 'BCG' TO '[MEASLES CONTAINING VACCINE] 2' ALL RECORDED?

NO (GO TO 510B)
YES (GO TO 524B1)

510A) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A) (THEN GO TO 525B)
NO 2 (GO TO 524B1)
DON'T KNOW 8 (GO TO 524B1)

511A) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

YES 1
NO 2 (GO TO 524B1)
DON'T KNOW 8 (GO TO 524B1)

512B) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the right shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

514B) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2 (GO TO 517B)
DON'T KNOW 8 (GO TO 517B)

515B) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

516B) How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES_____

517B) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the left thigh sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 519B)
DON'T KNOW 8 (GO TO 519B)

518B) How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES_____

519B) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the right thigh to prevent pneumonia?

YES 1
NO 2 (GO TO 521B)
DON'T KNOW 8 (GO TO 521B)

520B) How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES_____

521B) Has (NAME) ever received a rotavirus vaccination, that is a white liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (GO TO 523B)
DON'T KNOW 8 (GO TO 523B)

522B) How many times did (NAME) receive the rotavirus vaccine?

NUMBER OF TIMES_____

523B) Has (NAME) ever received a measles vaccination, that is, an injection in the left shoulder or thigh to prevent measles?

YES 1
NO 2 (GO TO 524B1)
DON'T KNOW 8 (GO TO 524B1)

524B) How many times did (NAME) receive the measles vaccine?

NUMBER OF TIMES_____

524B1) Did you pay for any vaccination for (NAME)?

YES 1
NO 2 (GO TO 525B)

524B2) How much did you pay for the vaccination?

TSHS_____
DON'T KNOW 999998

525B) In the last 7 days was (NAME) given:

a) Virutubishi vya nyongeza?
YES 1
NO 2
DON'T KNOW 8
b) Chakula dawa?
YES 1
NO 2
DON'T KNOW 8

526B) CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2012-2016?

MORE BIRTHS IN 2012-2016 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2012-2016 (GO TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

ONE OR MORE BIRTHS IN 2010-2016 (GO TO 602)
NO BIRTHS IN 2010-2016 (GO TO 648)

602) CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2010-2016. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER_____

604) FROM 212 AND 216:

NAME_____
LIVING (GO TO 605)
DEAD (GO TO 646)

605) In the last six months, was (NAME) given a vitamin A dose like [this/any of these]? SHOW COMMON TYPES OF AMPULES/CAMPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

606) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like [this/any of these]? SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

607) Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

608) Has (NAME) had diarrhea in the last 14 days? PROBE: Did (NAME) have at least 3 loose or liquid stools per day?

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

609) CHECK 464: EVER BREASTFED?

YES: a) Now I would like to know how much (NAME) was given to drink during the diarrhea including breastmilk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
NO: b) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

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

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

611) Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 615)

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

(NAME OF PLACE(S)) ______
GOVERNMENT/PARASTATAL
ZON/REFERRAL/SPEC HOSPITAL A
REFERRAL REGIONAL HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
CLINIC G
CHW H
RELIGIOUS/VOLUNTARY
REFERRAL SPEC. HOSPITAL I
DISTRICT HOSPITAL J
HOSPITAL K
HEALTH CENTRE L
DISPENSARY M
CLINIC N
PRIVATE
SPECIALISED HOSPITAL O
HOSPITAL P
HEALTH CENTRE Q
DISPENSARY R
CLINIC S
OTHER
PHARMACY T
ADDO U
NGO V
OTHER (SPECIFY) X

612A) Did you pay for advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 613)

612B) How much did you pay?

TSHS_____
DON'T KNOW 999998

613) CHECK 612:

TWO OR MORE CODES CIRCLED (GO TO 614)
ONLY ONE CODE CIRCLED (GO TO 615)

614) Where did you first seek advice or treatment? USE LETTER CODE FROM 612.

FIRST PLACE__

615) Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:

a) A fluid made from a special packet called MA-ORAL?
YES 1
NO 2
DON'T KNOW 8
b) A pre-packaged ORS liquid?
YES 1
NO 2
DON'T KNOW 8
c) A government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8
d) Zinc tablets or syrup?
YES 1
NO 2
DON'T KNOW 8

616) CHECK 615:

ANY 'YES': a) Was anything else given to treat the diarrhea?

ALL 'NO' OR 'DK': b) Was anything given to treat the diarrhea?

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

617) CHECK 615:

ANY 'YES': a) What else was given to treat the diarrhea? Anything else?

ALL 'NO' OR 'DK': b) What was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HOME REMEDY/HERBAL MEDICINE I
OTHER (SPECIFY) X

618) Has (NAME) been ill with a fever at any time in the last 14 days?

YES 1
NO 2 (GO TO 620)
DON'T KNOW 8 (GO TO 620)

619) At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

620) Has (NAME) had an illness with a cough at any time in the last 14 days?

YES 1
NO 2
DON'T KNOW 8

621) Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 14 days?

YES 1
NO 2 (GO TO 623)
DON'T KNOW 8 (GO TO 623)

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

CHEST ONLY 1 (GO TO 624)
NOSE ONLY 2 (GO TO 624)
BOTH 3 (GO TO 624)
OTHER (SPECIFY) 6 (GO TO 624)
DON'T KNOW 8 (GO TO 624)

623) CHECK 618: HAD FEVER?

YES (GO TO 624)
NO OR DK (GO TO 646)

624) Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 629)

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

(NAME OF PLACE(S)) _____
GOVERNMENT/PARASTATAL
ZON/REFERRAL/SPEC HOSPITAL A
REFERRAL REGIONAL HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
CLINIC G
CHW H
RELIGIOUS/VOLUNTARY
REFERRAL SPEC. HOSPITAL I
DISTRICT HOSPITAL J
HOSPITAL K
HEALTH CENTRE L
DISPENSARY M
CLINIC N
PRIVATE
SPECIALISED HOSPITAL O
HOSPITAL P
HEALTH CENTRE Q
DISPENSARY R
CLINIC S
OTHER
PHARMACY T
ADDO U
NGO V
OTHER (SPECIFY) X

625A) Did you pay for the advice or treatment for this illness?

YES 1
NO 2 (GO TO 626)

625B) How much did you pay?

TSHS_____
DON'T KNOW 999998

626) CHECK 625:

TWO OR MORE CODES CIRCLED (GO TO 627)
ONLY ONE CODE CIRCLED (GO TO 628)

627) Where did you first seek advice or treatment? USE LETTER CODE FROM 625.

FIRST PLACE__

628) How many days after the illness began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'.

DAYS_____

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

YES 1
NO 2 (GO TO 646)
DON'T KNOW 8 (GO TO 646)

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

ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE PILLS E
INJECTION/IV F
ARTESUNATE RECTAL G
INJECTION/IV H
OTHER ANTIMALARIAL (SPECIFY) I
ANTIBIOTIC DRUGS
PILL/SYRUP J
INJECTION/IV K
AMOXICILLIN L
OTHER DRUGS
ASPIRIN M
ACETAMINOPHEN N
IBUPROFEN O
OTHER (SPECIFY) X
DON'T KNOW Z

630A) Where did you get these drugs from? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

(NAME OF PLACE(S)) _____
GOVERNMENT/PARASTATAL
ZOM/REFERRAL/SPEC. HOSPITAL A
REFERRAL REGIONAL HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
CLINIC G
CHW H
RELIGIOUS/VOLUNTARY
REFERRAL SPEC. HOSPITAL I
DISTRICT HOSPITAL J
HOSPITAL K
HEALTH CENTRE L
DISPENSARY M
CLINIC N
PRIVATE
SPECIALISED HOSPITAL O
HOSPITAL P
HEALTH CENTRE Q
DISPENSARY R
CLINIC S
OTHER
PHARMACY T
ADDO U
NGO V
OTHER (SPECIFY)____ X

631) CHECK 630: ANY CODE A-I CIRCLED?

YES (GO TO 632)
NO (GO TO 645A)

632) CHECK 630: ARTEMISININ COMBINATION THERAPY ('A') GIVEN

CODE 'A' CIRCLED (GO TO 633)
CODE 'A' NOT CIRCLED (GO TO 634)

633) How long after the fever started did (NAME) first take an artemisinin combination therapy?

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

634) CHECK 630: SP/FANSIDAR ('B') GIVEN

CODE 'B' CIRCLED (GO TO 635)
CODE 'B' NOT CIRCLED (GO TO 636)

635) How long after the fever started did (NAME) first take SP/Fansidar?

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

636) CHECK 630: CHLOROQUINE ('C') GIVEN

CODE 'C' CIRCLED (GO TO 637)
CODE 'C' NOT CIRCLED (GO TO 638)

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

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

638) CHECK 630: AMODIAQUINE ('D') GIVEN

CODE 'D' CIRCLED (GO TO 639)
CODE 'D' NOT CIRCLED (GO TO 640)

639) How long after the fever started did (NAME) first take amodiaquine?

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

640) CHECK 630: QUININE ('E' OR 'F') GIVEN

CODE 'E' OR 'F' CIRCLED (GO TO 641)
CODE 'E' OR 'F' NOT CIRCLED (GO TO 642)

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

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

642) CHECK 630: ARTESUNATE ('G' OR 'H') GIVEN

CODE 'G' OR 'H' CIRCLED (GO TO 643)
CODE 'G' OR 'H' NOT CIRCLED (GO TO 644)

643) How long after the fever started did (NAME) first take artesunate?

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

644) CHECK 630: OTHER ANTIMALARIAL ('I') GIVEN

CODE 'I' CIRCLED (GO TO 645)
CODE 'I' NOT CIRCLED (GO TO 645A)

645) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

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

645A) CHECK 630: AMOXICILLIN ('L') GIVEN

CODE 'L' CIRCLED (GO TO 645B)
CODE 'L' NOT CIRCLED (GO TO 646)

645B) CHECK 622

CODE '1' OR '3' CIRCLED (GO TO 645C)
CODE '2', '6', OR '8' CIRCLED/Q. NOT ASKED (GO TO 646)

645C) How long after the fast, short, rapid breaths or difficulty breathing did (NAME) take Amoxicillin?

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

645D) For how many days did (NAME) take Amoxicillin?

NBRE DAYS____

646) GO BACK TO 604 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 646A

646A) Who usually makes decisions about health care for your child/children: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

647) CHECK 615(a) AND 615(b), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 648)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 649)

648) Have you ever heard of a special product called MA-ORAL you can get for the treatment of diarrhea?

YES 1
NO 2

649) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2013-2016 LIVING WITH THE RESPONDENT

ONE OR MORE (NAME OF YOUNGEST CHILD LIVING WITH HER) (GO TO 650)
NONE (GO TO 701)

650) Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear soup?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk? IF YES: How many times did (NAME) drink milk? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK____
e) Infant formula? IF YES: How many times did (NAME) drink infant formula? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK____
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt? IF YES: How many times did (NAME) eat yogurt? IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE____
h) Cerelac and Unga wa lishe?
YES 1
NO 2
DON'T KNOW 8
i) Bread, rice, spaghetti/noodles, chapati, mandazi, porridge, or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, white yams, manioc, cassava, cocoyams, white sweet potatoes, plantains or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables such as amaranth, cassava leaves, sweet potato leaves, beans, leaves, chinese cabbage and spinach?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, papayas, watermelon, red quava?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Liver, kidney, heart, or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

651) CHECK 650 (CATEGORIES 'g' THROUGH 'u'):

NOT A SINGLE 'YES' (GO TO 652)
AT LEAST ONE 'YES' (GO TO 653)

652) Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night? IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY) (THEN CONTINUE TO 653)
NO 2 (GO TO 654)

653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES____
DON'T KNOW 8

654) The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) 96

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

701) Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 704)
YES, LIVING WITH A MAN 2 (GO TO 704)
NO, NOT IN UNION 3

702) Have you ever been married or lived together with a man as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 712)

703) What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 709)
DIVORCED 2 (GO TO 709)
SEPARATED 3 (GO TO 709)

704) Is your (husband/partner) living with you now or is he staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME_______
LINE NO_____

706) Does your (husband/partner) have other wives or does he live with other women as if married?

YES 1
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)

707) Including yourself, in total, how many wives or live-in partners does he have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS____
DON'T KNOW 98

708) Are you the first, second, ... wife/live in partner?

RANK____

709) Have you been married or lived with a man only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2

710) CHECK 709:

MARRIED/LIVED WITH A MAN ONLY ONCE

a) In what month and year did you start living with your (husband/partner)?

MONTH____
DON'T KNOW MONTH 98
YEAR____ (GO TO 712)
DON'T KNOW YEAR 9998

MARRIED/LIVED WITH A MAN MORE THAN ONCE

b) Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?

MONTH____
DON'T KNOW MONTH 98
YEAR____ (GO TO 712)
DON'T KNOW YEAR 9998

711) How old were you when you first started living with him?

AGE____

712) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING MAKE EVERY EFFORT TO ENSURE

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

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 731)
AGE IN YEARS____

713A) The very first time you had sexual intercourse, would you say that you willingly wanted to have it?

YES 1
NO 2
DON'T KNOW 8

714) I would like to ask you about your recent sexual activity. 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.

DAYS AGO 1___
WEEKS AGO 2___
MONTHS AGO 3___
YEARS AGO 4____ (GO TO 731)

716) The last time you had sexual intercourse with this person, was a condom used?

YES 1
NO 2 (GO TO 731)

729) You told me that a condom was used the last time you had sex. What is that brand name of the condom used at that time? IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

SALAMA 01
DUME 02
ROUGH RIDER 03
FAMILIA 04
CARE 05
LADY PEPETA 06
OTHER (SPECIFY) 96
DON'T KNOW 98

730) From where did you obtain the condom the last time? PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____
GOVERNMENT/PARASTATAL
ZON/REFERRAL/SPEC. HOSPITAL 11
REFERRAL REGIONAL HOSPITAL 12
REGIONAL HOSPITAL 13
DISTRICT HOSPITAL 14
HEALTH CENTRE 15
DISPENSARY 16
CLINIC 17
CHW 18
RELIGIOUS/VOLUNTARY
REFERRAL SPEC. HOSPITAL 21
DISTRICT HOSPITAL 22
HOSPITAL 23
HEALTH CENTRE 24
DISPENSARY 25
CLINIC 26
PRIVATE
SPECIALISED HOSPITAL 31
HOSPITAL 32
HEALTH CENTRE 33
DISPENSARY 34
CLINIC 35
OTHER
PHARMACY 41
ADDO 42
NGO 43
VCT CENTRE 44
SHOP/KIOSK 45
BAR 46
GUEST HOUSE/HOTEL 47
FRIEND/RELATIVE/NEIGHBOR 48
OTHER (SPECIFY) 96
DON'T KNOW 98

731) PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN LESS THAN 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

NEITHER STERILIZED (GO TO 802)
HE OR SHE STERILIZED (GO TO 813)

802) CHECK 226:

PREGNANT (GO TO 803)
NOT PREGNANT OR UNSURE (GO TO 804)

803) Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE ANOTHER CHILD 1 (GO TO 805)
NO MORE 2 (GO TO 812)
UNDECIDED/DON'T KNOW 8 (GO TO 812)

804) 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 807)
SAYS SHE CAN'T GET PREGNANT 2 (GO TO 813)
UNDECIDED/DON'T KNOW 8 (GO TO 811)

805) CHECK 226:

NOT PREGNANT OR UNSURE

a) How long would you like to wait from now before the birth of (a/another) child?

MONTHS 1____
YEARS 2____
SOON/NOW 993 (GO TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
AFTER MARRIAGE 995 (GO TO 811)
OTHER (SPECIFY) 996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)

PREGNANT

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

MONTHS 1____
YEARS 2____
SOON/NOW 993 (GO TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
AFTER MARRIAGE 995 (GO TO 811)
OTHER (SPECIFY) 996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)

806) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 807)
PREGNANT (GO TO 812)

807) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 808)
CURRENTLY USING (GO TO 813)

808) CHECK 805:

'24' OR MORE MONTHS OR '02' OR MORE YEARS (GO TO 809)
NOT ASKED (GO TO 809)
'00-23' MONTHS OR '00-01' YEAR (GO TO 812)

809) CHECK 714:

DAYS, WEEKS OR MONTHS AGO (GO TO 810)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)

810) CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD: a) 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? RECORD ALL REASONS MENTIONED.

WANTS NO MORE/NONE: b) 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.

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

811) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 812)
NO, NOT CURRENTLY USING (GO TO 812)
YES, CURRENTLY USING (GO TO 813)

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

YES 1
NO 2
DON'T KNOW 8

813) CHECK 216:

HAS LIVING CHILDREN: a) 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: b) 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.

NONE 00 (GO TO 815)
NUMBER____
OTHER (SPECIFY) 96 (GO TO 815)

814) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

NUMBER OF BOYS__
NUMBER OF GIRLS__
NUMBER OF EITHER__
OTHER (SPECIFY) 96

815) In the last few months have you:

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2
d) Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2
e) Seen anything about family planning on a poster?
YES 1
NO 2
f) Seen anything about family planning on a billboard?
YES 1
NO 2
g) Heard about family planning at community events?
YES 1
NO 2
h) Seen anything about family planning on a live drama?
YES 1
NO 2
i) Heard anything about family planning from a doctor or a nurse?
YES 1
NO 2
j) Heard about family planning from a community health worker?
YES 1
NO 2
k) Read about family planning on internet?
YES 1
NO 2

815A) Have you ever heard or seen the campaign:

a) Wazazi nipenden?
YES 1
NO 2
b) Fuata nyota ya kijana upate mafanikio?
YES 1
NO 2
c) Siyo kila homa ni malaria?
YES 1
NO 2

815B) CHECK 815A (a, b AND c)

AT LEAST ONE 'YES' (GO TO 815C)
NOT A SINGLE 'YES' (GO TO 816)

815C) Where did you see or hear the campaign? RECORD ALL RESPONSES MENTIONED.

RADIO A
TELEVISION B
POSTER/MAGAZINE/NEWSPAPER/BILLBOARD C
INTERNET D
MOBILE PHONE E
CHW F
FAMILY FRIEND G
OTHER (SPECIFY) X

816) If you wanted to get information on family planning, who would you like to talk to most?

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

816A) If you wanted to get information on family planning, would you like to get the information from:

a) The radio?
YES 1
NO 2
b) The television?
YES 1
NO 2
c) In a newspaper or a magazine?
YES 1
NO 2

817) CHECK 701:

YES, CURRENTLY MARRIED (GO TO 818)
YES, LIVING WITH A MAN (GO TO 818)
NO, NOT IN A UNION (GO TO 901)

818) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (GO TO 818A)
NOT CURRENTLY USING (GO TO 820)
NOT ASKED (GO TO 822)

818A) CHECK 304: WHAT METHOD?

OTHER (GO TO 818B)
CODE B, G, OR M CIRCLED (GO TO 819)

818B) Does your husband/partner know that you are using a method of family planning?

YES 1
NO 2

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

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

819A) Has your husband/partner ever refused to use a method or tried to stop you from using a method to avoid getting pregnant?

YES 1 (GO TO 821)
NO 2 (GO TO 821)

820) Would you say that not using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?

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

821) CHECK 304:

NEITHER ARE STERILIZED (GO TO 822)
HE OR SHE ARE STERILIZED (GO TO 901)

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

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

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 902)
NOT IN UNION (GO TO 909)

902) How old was your (husband/partner) on his last birthday?

AGE IN COMPLETED YEARS____

903) Did your (husband/partner) ever attend school?

YES 1
NO 2 (GO TO 906)

904) What was the highest level of school he attended?

PRE-PRIMARY 0
PRIMARY 1
POST PRIMARY TRAINING 2
SECONDARY 'O' LEVEL 3
POST SECONDARY 'O' LEVEL TRAIING 4
SECONDARY 'A' LEVEL 5
POST SECONDARY 'A' LEVEL TRAINING 6
UNIVERSITY 7
DON'T KNOW 8 (GO TO 906)

905) What was the highest grade he completed at that level? IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE___
DON'T KNOW 98

906) Has your (husband/partner) done any work in the last 7 days?

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

907) Has your (husband/partner) done any work in the last 12 months?

YES 1
NO 2 (GO TO 909)
DON'T KNOW 8 (GO TO 909)

908) What is your (husband's/partner's) occupation? That is, what kind of work does he mainly do?

OCCUPATION___________

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

YES 1 (GO TO 913)
NO 2

910) 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?

YES 1 (GO TO 913)
NO 2

911) 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?

YES 1 (GO TO 913)
NO 2

912) Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 917)

913) What is your occupation? That is, what kind of work do you mainly do?

OCCUPATION__________

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

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

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

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

916) Are you paid in cash or kind for this kind of work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

917) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 918)
NOT IN UNION (GO TO 925)

918) CHECK 916:

CODE '1' OR '2' CIRCLED (GO TO 919)
ANY OTHER CODE (GO TO 921)

919) Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER ONLY 3
OTHER (SPECIFY) 6

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNINGS 4 (GO TO 922)
DON'T KNOW 8

921) Who usually decides how your (husband's/partner's) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

923) Who usually makes decisions about making major household purchases?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

924) Who usually makes decisions about visits to your family or relatives?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

925) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 928)

926) Do you have a title deed for any house you own?

YES 1
NO 2 (GO TO 928)
DON'T KNOW 8 (GO TO 928)

927) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 931)

929) Do you have a title deed for any land you own?

YES 1
NO 2 (GO TO 931)
DON'T KNOW 8 (GO TO 931)

930) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN LESS THAN 10
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT BUT NOT LISTENING 2
NOT PRESENT 3

932) 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?
YES 1
NO 2
DON'T KNOW 8
b) If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c) If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d) If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e) If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 10. MALARIA

1001) In your opinion, what is the most serious health problem in your community?

HIV/AIDS 01
TUBERCULOSIS 02
MALARIA 03
MALNUTRITION 04
DIABETES 05
CANCER 06
FLU 07
ROAD TRAFFIC ACCIDENTS 08
DIARRHEA 09
HEART DISEASE 10
OTHER (SPECIFY) 96
DON'T KNOW 98

1002) Can you tell me the signs or symptoms of malaria in a young child? RECORD ALL MENTIONED.

FEVER A
FEELING COLD B
CHILLS C
PERSPIRATION/SWEATING D
HEADACHE E
BODY ACHES F
POOR APPETITE G
VOMITING H
DIARRHEA I
WEAKNESS J
COUGHING K
OTHER (SPECIFY) X
DOES NOT KNOW ANY Z

1003) Are there ways to avoid getting malaria?

YES 1
NO 2 (GO TO 1005)

1004) What are the ways to avoid getting malaria? RECORD ALL MENTIONED.

SLEEP UNDER MOSQUITO NET A
USE MOSQUITO COILS B
USE INSECTICIDE SPRAY C
INDOOR RESIDUAL SPRAYING (IRS) D
KEEP DOORS/WINDOWS CLOSED E
USE INSECT REPELLANT F
KEEP SURROUNDINGS CLEAN G
CUT THE GRASS H
REMOVE STANDING WATER I
INTERMITTENT PREVENTIVE TREATMENT (IPTP) J
HOUSE SCREENING K
OTHER (SPECIFY) X
DOES NOT KNOW ANY Z

1005) Can ACTs be obtained at your nearest health facility or pharmacy (duka la dawa muhimu)?

YES 1
NO 2
DON'T KNOW 8

1006A) In the past year, have you seen or heard any messages about malaria prevention?

YES 1
NO 2

1006B) In the past year, have you seen or heard any messages about malaria treatment?

YES 1
NO 2

1007) LOCATION OF INTERVIEW:

MAINLAND TANZANIA (GO TO 1008A)
ZANZIBAR (GO TO 1008B)

1008A) In the past year, have you ever heard or seen the phrase "Malaria Haikubaliki"?

YES 1 (GO TO 1009)
NO 2 (GO TO 1010)

1008B) In the past year, have you ever heard or seen the phrase "Maliza Malaria"?

YES 1
NO 2 (GO TO 1010)

1009) Where did you hear or see this phrase? RECORD ALL MENTIONED.

RADIO A
BILLBOARD B
POSTER C
T-SHIRT D
LEAFLET/FACT SHEET/BROCHURE E
TELEVISION F
MOBILE VIDEO UNIT G
SCHOOL H
HEALTH CARE WORKER I
COMMUNITY EVEN/PRESENTATION J
FRIEND/NEIGHBOR/FAMILY MEMBER K
OTHER (SPECIFY) X
DON'T KNOW Z

1010) In the past six months, were you visited by a health worker or volunteer who talked to you about malaria?

YES 1
NO 2

1011) Now I am going to read some statements and I would like you to tell me how much you agree or disagree with them. After I read each statement, please tell me whether you strongly agree with it, somewhat agree with it, somewhat disagree with it, or strongly disagree with it.

1012) I can easily protect myself and my children from malaria. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

STRONGLY AGREE 1
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY DISAGREE 4

1013) I can ensure that my children sleep under a treated net every single night of the year. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

STRONGLY AGREE 1
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY DISAGREE 4

1014) I can easily hang my children's mosquito nets. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

STRONGLY AGREE 1
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY DISAGREE 4

1015) It is important to sleep under a net every single night. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

STRONGLY AGREE 1
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY DISAGREE 4

1016) Pregnant women are at high risk of getting malaria. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

STRONGLY AGREE 1
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY DISAGREE 4

1017) Women should attend antenatal care early in their pregnancy. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree?

STRONGLY AGREE 1
SOMEWHAT AGREE 2
SOMEWHAT DISAGREE 3
STRONGLY DISAGREE 4

SECTION 11. OTHER HEALTH ISSUES

1101) 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS____
NONE 00 (GO TO 1104)

1102) 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS____
NONE 00 (GO TO 1104)

1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1104) Do you currently smoke cigarettes every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2 (GO TO 1106)
NOT AT ALL 3 (GO TO 1106)

1105) On average, how many cigarettes do you currently smoke each day?

NUMBER OF CIGARETTES____

1106) Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (GO TO 1107A)

1107) What other type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

KRETEKS A
PIPES FULL OF TOBACCO B
CIGARS, CHEROOTS, OR CIGARILLOS C
WATER PIPE D
SNUFF BY MOUTH E
SNUFF BY NOSE F
CHEWING TOBACCO G
BETEL QUID WITH TOBACCO H
OTHER (SPECIFY) X

1107A) Have you ever consumed a drink that contain alcohol such as beer, wine, spirit, fermented cider or local brewers such as mbege, ulanzi, gongo/chang'aa etc?

YES 1
NO 2 (GO TO 1108)

1107B) In the past 12 months, how frequently have you had at least one drink?

DAILY 1
WEEKLY 2
MONTHLY 3
LESS THAN ONCE A MONTH 4
NEVER DUNK 5

1108) 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:

a) Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c) The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d) Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1109) Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1201)

1110) What type of health insurance are you covered by? RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) _____ X

SECTION 12. FEMALE GENITAL CUTTING/MUTILATION

1201) Now I would like to ask some questions about a practice known as female circumcision. Have you ever heard of female circumcision?

YES 1 (GO TO 1203)
NO 2

1202) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

YES 1
NO 2 (GO TO 1301)

1203) Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 1209)

1204) Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

YES 1 (GO TO 1206)
NO 2
DON'T KNOW 8

1205) Was the genital area just nicked without removing any flesh?

YES 1
NO 2
DON'T KNOW 8

1206) Was your genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1207) How old were you when you were circumcised? IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YEARS____
AS A BABY/DURING INFANCY 95
DON'T KNOW 98

1208) Who performed the circumcision?

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

1209) CHECK 213, 215 AND 216:

HAS ONE OR MORE LIVING DAUGHTERS BORN IN 2000 OR LATER (GO TO 1209A)
HAS NO LIVING DAUGHTERS BORN IN 2000 OR LATER (GO TO 1216)

1209A) CHECK 213, 215 AND 216: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE DAUGHTERS. BEGIN WITH THE YOUNGEST DAUGHTER. (IF THERE ARE MORE THAN 3 DAUGHTERS, USE ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about your (daughter/daughters).

1210) BIRTH HISTORY NUMBER AND NAME OF EACH LIVING DAUGHTER BORN IN 2000 OR LATER.

BIRTH HISTORY NUMBER____
NAME_____

1211) Is (NAME OF DAUGHTER) circumcised?

YES 1
NO 2 (GO TO 1211 IN NEXT COLUMN; OR IF NO MORE DAUGHTERS, GO TO 1216)

1212) How old was (NAME OF DAUGHTER) when she was circumcised? IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.

AGE IN COMPLETED YRS____
DON'T KNOW 98

1213) Was her genital area sewn closed?

YES 1
NO 2
DON'T KNOW 8

1214) Who performed the circumcision?

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

1215) GO BACK TO 1211 IN NEXT COLUMN; OR, IF NO MORE DAUGHTERS, GO TO 1216.

1216) Do you believe that female circumcision is required by your religion?

YES 1
NO 2
NO RELIGION 3
DON'T KNOW 8

1216A) Do you believe that female circumcision is required by your culture?

YES 1
NO 2
DON'T KNOW 8

1217) Do you think that female circumcision should be continued, or should it be stopped?

CONTINUED 1
STOPPED 2
DEPENDS 3
DON'T KNOW 8

SECTION 13. MATERNAL MORTALITY

1301) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER___

1302) CHECK 1301:

TWO OR MORE BIRTHS (GO TO 1303)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1400)

1303) How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS___

1304) What was the name given to your (oldest/next oldest) brother or sister?

(NAME)____

1305) Is (NAME) male or female?

MALE 1
FEMALE 2

1306) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1308)
DON'T KNOW (GO TO NEXT COLUMN)

.

1307) How old is (NAME)?

AGE___ (GO TO NEXT COLUMN)

1308) How many years ago did (NAME) die?

YEARS AGO____

1309) How old was (NAME) when (he/she) died?

AGE___ (IF MALE OR DIED BEFORE 12 YEARS, GO TO NEXT COLUMN)

1310) Was (NAME) pregnant when she died?

YES 1 (GO TO 1313)
NO 2

1311) Did (NAME) die during childbirth?

YES 1 (GO TO 1313)
NO 2

1312) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1313) How many live born children did (NAME) give birth to during her lifetime?

NUMBER LIVE BORN CHILDREN____

IF NO MORE BROTHERS OR SISTERS, GO TO NEXT SECTION.

DOMESTIC VIOLENCE

1400) CHECK HOUSEHOLD QUESTIONNAIRE, Q313

WOMAN SELECTED FOR THIS SECTION (GO TO 1401)
WOMAN NOT SELECTED (GO TO 1433)

1401) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO 1401A)
PRIVACY NOT POSSIBLE 2 (GO TO 1432)

1401A) READ TO THE RESPONDENT: Now I would like to ask you questions abut some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in TANZANIA. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

1402) CHECK 701 AND 702:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1403)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND/PARTNER') (GO TO 1403)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1416)

1403) 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?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

1404) Now I need to ask some more questions about your relationship with your (last) (husband/partner).

A. Did your (last) (husband/partner) ever:

a) say or do something to humiliate you in front of others?
YES 1 (GO TO Ba)
NO 2 (GO TO Ab)
b) threaten to hurt or harm you or someone you care about?
YES 1 (GO TO Bb)
NO 2 (GO TO Ac)
c) insult you or make you feel bad about yourself?
YES 1 (GO TO Bc)
NO 2 (GO TO 1405)

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

a) say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1405)

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

a) push you, shake you, or throw something at you?
YES 1 (GO TO Ba)
NO 2 (GO TO Ab)
b) slap you?
YES 1 (GO TO Bb)
NO 2 (GO TO Ac)
c) twist your arm or pull your hair?
YES 1 (GO TO Bc)
NO 2 (GO TO Ad)
d) punch you with his fist or with something that could hurt you?
YES 1 (GO TO Bd)
NO 2 (GO TO Ae)
e) kick you, drag you, or beat you up?
YES 1 (GO TO Be)
NO 2 (GO TO Af)
f) try to choke you or burn you on purpose?
YES 1 (GO TO Bf)
NO 2 (GO TO Ag)
g) threaten or attack you with a knife, gun, or other weapon?
YES 1 (GO TO Bg)
NO 2 (GO TO Ah)
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1 (GO TO Bh)
NO 2 (GO TO Ai)
i) physically force you to perform any other sexual acts you did not want to?
YES 1 (GO TO Bi)
NO 2 (GO TO Aj)
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1 (GO TO Bj)
NO 2 (GO TO 1406)

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

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1406) CHECK 1405A (a-j):

AT LEAST ONE 'YES' (GO TO 1407)
NOT A SINGLE 'YES' (GO TO 1409)

1407) How long after you first (got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen? IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1408) Did the following ever happen as a result of what your (last) (husband/partner) did to you:

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2
d) You had thought of ending your life or attempted to end your life?
YES 1
NO 2
e) You had an abortion or miscarriage?
YES 1
NO 2
NEVER BEEN PREGNANT 3

1409) 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?

YES 1
NO 2 (GO TO 1411)

1410) In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1411) Does (did) your (last) (husband/partner) drink alcohol?

YES 1
NO 2 (GO TO 1413)

1412) How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1413) Are (Were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1414) CHECK 709:

MARRIED MORE THAN ONCE (GO TO 1415)
MARRIED ONLY ONCE (GO TO 1416)

1415)

A. So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (GO TO Ba)
NO 2 (GO TO Ab)
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (GO TO Bb)
NO 2 (GO TO 1416)

B. How long ago did this last happen?

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
0-11 MONTHS AGO 1
MORE THAN 12 MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
0-11 MONTHS AGO 1
MORE THAN 12 MONTHS AGO 2
DON'T REMEMBER 3

1416) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN

a) From the time you were 15 years old has anyon other than (your/any) (husband/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1419)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1419)

NEVER MARRIED/NEVER LIVED WITH A MAN

b) From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

YES 1
NO 2 (GO TO 1419)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1419)

1417) Who has hurt you in this way? Anyone else? RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHR C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND/LIVE-IN PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) X

1418) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1419) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT ('YES' ON 201 OR 226 OR 230) (GO TO 1420)
NEVER BEEN PREGNANT (GO TO 1422)

1420) Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1422)

1421) Who has one any of these things to physically hurt you while you were pregnant? Anyone else? RECORD ALL MENTIONED.

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/LIVE-IN PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) X

1422) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (GO TO 1422A)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1422B)

1422A) Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). 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 when you did not want to?

YES 1 (GO TO 1423)
NO 2 (GO TO 1424A)
REFUSED TO ANSWER/NO ANSWER (GO TO 1424A)

1422B) 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 when you did not want to?

YES 1
NO 2 (GO TO 1426)
REFUSED TO ANSWER/NO ANSWER (GO TO 1426)

1423) Who was the person who was forcing you the very first time this happened?

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) 96

1424) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN

a) In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?

YES 1 (GO TO 1425)
NO 2 (GO TO 1425)

NEVER MARRIED/NEVER LIVED WITH A MAN

b) In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

YES 1 (GO TO 1425)
NO 2 (GO TO 1425)

1424A) CHECK 1405A (h-j) and 1415A(b):

AT LEAST ONE 'YES' (GO TO 1425)
NOT A SINGLE 'YES' (GO TO 1426)

1425) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN

a) How old were you the first time you were forced to have sexual intercourse or perform any sexual acts by anyone, including (your/any) husband/partner?

AGE IN COMPLETED YEARS___
DON'T KNOW 98

NEVER MARRIED/NEVER LIVED WITH A MAN

b) How old were you the first time you were forced to have sexual intercourse or perform any sexual acts?

AGE IN COMPLETED YEARS___
DON'T KNOW 98

1426) CHECK 1405A (a-j), 1415A (a,b), 1416, 1420, 1422A, AND 1422B:

AT LEAST ONE 'YES' (GO TO 1427)
NOT A SINGLE 'YES' (GO TO 1430)

1427) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO 1429)

1428) From whom have you sought help? Anyone else? RECORD ALL MENTIONED.

OWN FAMILY A
HUSBAND'S/PARTNER'S FAMILY B
CURRENT/FORMER HUSBAND/PARTNER C
CURRENT/FORMER BOYFRIEND D
FRIEND E
NEIGHBOR F
RELIGIOUS LEADER G
DOCTOR/MEDICAL PERSONELL H
POLICE I
LAWYER J
SOCIAL SERVICE ORGANIZATION K
OTHER (SPECIFY) X

1428A) Did you effectively get help from the persons listed above?

YES 1 (GO TO 1430)
NO 2 (GO TO 1430)

1429) Have you ever told anyone about this?

YES 1
NO 2

1430) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

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.
I would like to thank you very much for helping us. I appreciate the time you have taken. I realize that these questions may have been difficult for you to answer, but it is only by hearing from women themselves that we can really understand about women's health and experiences in life.

In case you ever hear of another woman who needs help, here is a list of organizations that provide support. Legal advice and counseling services to women in study location. Please do contact them if you or any of your friends or relatives needs help. Their services are free, and they will keep anything that anyone says to them private.

1431) 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?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

1432) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

1433) CHECK 223A:

ONE OR MORE DEATHS (GO TO 1434)
NO DEATHS (GO TO 1435)

1434) READ TO THE RESPONDENT: I would like to inform you that detailed information on the circumstances surrounding the deaths of children under the age of 5 years will be collected in the near future so that the federal government of Tanzania can provide health services to help reduce these deaths. If you don't mind, another team will be coming at a later date to interview members of the household about the death(s) you have told me about. Is this okay?

YES 1
NO 2

1435) RECORD THE TIME.

HOURS___
MINUTES___

MORNING 1
AFTERNOON 2
EVENING 3

CALENDAR:

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

CODES FOR EACH COLUMN:

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD

1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
J STANDARD DAYS METHOD
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD

M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS

6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY)

Z DON'T KNOW

2016 COL. 1 COL. 2

06 JUN 01 _____ _____
05 MAY 02 _____ _____
04 APR 03 _____ _____
03 MAR 04 _____ _____
02 FEB 05 _____ _____
01 JAN 06 _____ _____

2015 COL. 1 COL. 2

12 DEC 07 _____ _____
11 NOV 08 _____ _____
10 OCT 09 _____ _____
09 SEP 10 _____ _____
08 AUG 11 _____ _____
07 JUL 12 _____ _____
06 JUN 13 _____ _____
05 MAY 14 _____ _____
04 APR 15 _____ _____
03 MAR 16 _____ _____
02 FEB 17 _____ _____
01 JAN 18 _____ _____

2014 COL. 1 COL. 2

12 DEC 19 _____ _____
11 NOV 20 _____ _____
10 OCT 21 _____ _____
09 SEP 22 _____ _____
08 AUG 23 _____ _____
07 JUL 24 _____ _____
06 JUN 25 _____ _____
05 MAY 26 _____ _____
04 APR 27 _____ _____
03 MAR 28 _____ _____
02 FEB 29 _____ _____
01 JAN 30 _____ _____

2013 COL. 1 COL. 2

12 DEC 31 _____ _____
11 NOV 32 _____ _____
10 OCT 33 _____ _____
09 SEP 34 _____ _____
08 AUG 35 _____ _____
07 JUL 36 _____ _____
06 JUN 37 _____ _____
05 MAY 38 _____ _____
04 APR 39 _____ _____
03 MAR 40 _____ _____
02 FEB 41 _____ _____
01 JAN 42 _____ _____

2012 COL. 1 COL. 2

12 DEC 43 _____ _____
11 NOV 44 _____ _____
10 OCT 45 _____ _____
09 SEP 46 _____ _____
08 AUG 47 _____ _____
07 JUL 48 _____ _____
06 JUN 49 _____ _____
05 MAY 50 _____ _____
04 APR 51 _____ _____
03 MAR 52 _____ _____
02 FEB 53 _____ _____
01 JAN 54 _____ _____

2011 COL. 1 COL. 2

12 DEC 55 _____ _____
11 NOV 56 _____ _____
10 OCT 57 _____ _____
09 SEP 58 _____ _____
08 AUG 59 _____ _____
07 JUL 60 _____ _____
06 JUN 61 _____ _____
05 MAY 62 _____ _____
04 APR 63 _____ _____
03 MAR 64 _____ _____
02 FEB 65 _____ _____
01 JAN 66 _____ _____

2010 COL. 1 COL. 2

12 DEC 67 _____ _____
11 NOV 68 _____ _____
10 OCT 69 _____ _____
09 SEP 70 _____ _____
08 AUG 71 _____ _____
07 JUL 72 _____ _____
06 JUN 73 _____ _____
05 MAY 74 _____ _____
04 APR 75 _____ _____
03 MAR 76 _____ _____
02 FEB 77 _____ _____
01 JAN 78 _____ _____

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:
_______________
_______________
_______________

COMMENTS ON SPECIFIC QUESTIONS:
_______________
_______________
_______________

ANY OTHER COMMENTS:
_______________
_______________
_______________

SUPERVISOR'S OBSERVATIONS
_______________
_______________
_______________

EDITOR'S OBSERVATIONS
_______________
_______________
_______________