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)

NEXT VISIT:

FINAL VISIT

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE _____

LANGUAGE OF INTERVIEW _____

TRANSLATOR USED

SUPERVISOR

FIELD EDITOR

OFFICE EDITOR

KEYED BY

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:______

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

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.

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

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

105) In what month and year were you born?

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

107) Have you ever attended school?

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

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

110) CHECK 108:

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?

112) CHECK 111:

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

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

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

116) Do you own a mobile telephone?

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

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

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

118A) Is the account shared with someone else?

118B) Whom do you share the account with?

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

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

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

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?

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

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

SECTION 2. REPRODUCTION

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

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

203) a) How many sons live with you?

b) And how many daughters live with you?

IF NONE, RECORD '00'.

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

205) 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'.

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?

207) a) How many boys have died?

b) And how many girls have died?

IF NONE, RECORD '00'.

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

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

210) CHECK 208:

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE 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.

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

214) Were any of these births twins?

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

216) Is (NAME) still alive?

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

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

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

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

IF '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.

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

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

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

223) COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

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

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

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?

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

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

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

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?

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

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

231) When did the last such pregnancy end?

232) CHECK 231:

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

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

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

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?

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

239) When did your last menstrual period start?

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

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

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

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)?

302. CHECK 226:

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

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

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

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.

308. In what month and year the sterilization performed?

308A. Did you pay for sterilization?

308B. How much did you pay for sterilization?

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?

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.

311) CHECK 308 AND 309:

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

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

315) CHECK 304: CIRCLE METHOD CODE:

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

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.

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

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

317) CHECK 304: CIRCLE METHOD CODE:

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

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

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

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

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

322) CHECK 318 AND 319:

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

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?

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

324) CHECK 304: CIRCLE METHOD CODE:

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

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.

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

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

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

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?

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

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

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.

404) FROM 212 AND 216:

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

406) CHECK 208:

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

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

407) How much longer did you want to wait?

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

409) Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL

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.

410A) Did you pay for antenatal care?

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

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

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

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

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

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

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

416) CHECK 415:

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

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

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

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

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.

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

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

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

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.

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

427) Was (NAME) weighed at birth?

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

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.

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

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

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

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.

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.

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

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

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

434A) CHECK Q430:

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

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

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?

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.

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

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?

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.

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

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?

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

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

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.

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

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

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

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

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)?

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.

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

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.

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

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

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)?

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.

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

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.

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

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

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

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

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?

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.

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

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.

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

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

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

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

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

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

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

461) CHECK 226: IS RESPONDENT PREGNANT?

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

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

464) Did you ever breastfeed (NAME)?

465) CHECK 404: IS CHILD LIVING?

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.

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

468) CHECK 404: IS CHILD LIVING?

469) Are you still breastfeeding (NAME)?

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.

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

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

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?

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

503A) CHECK 216 FOR CHILD:

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

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

506A) CHECK 504A:

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

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

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

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.

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?

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

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

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

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

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?

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

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

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

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

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

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

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

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

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

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

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?

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

503B) CHECK 216 FOR CHILD:

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

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

506B) CHECK 504B:

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

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

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

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.

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?

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

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

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

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

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?

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

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

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

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

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

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

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

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

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

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

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

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

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.

604) FROM 212 AND 216:

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.

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.

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

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

609) CHECK 464: EVER BREASTFED?

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?

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

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).

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

612B) How much did you pay?

613) CHECK 612:

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

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

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?

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.

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

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

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

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

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

623) CHECK 618: HAD FEVER?

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

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).

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

625B) How much did you pay?

626) CHECK 625:

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

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

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

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

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).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

645B) CHECK 622

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

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

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?

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

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

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

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.

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

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?

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'.

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

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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'.

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

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

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

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

710) CHECK 709:

MARRIED/LIVED WITH A MAN ONLY ONCE

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

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?

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

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?

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

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.

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

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.

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.

731) PRESENCE OF OTHERS DURING THIS SECTION.

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

802) CHECK 226:

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?

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?

805) CHECK 226:

NOT PREGNANT OR UNSURE

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

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?

806) CHECK 226:

807) CHECK 303: USING A CONTRACEPTIVE METHOD?

808) CHECK 805:

809) CHECK 714:

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.

811) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

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.

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?

815) In the last few months have you:

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

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

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

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

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

817) CHECK 701:

818) CHECK 303: USING A CONTRACEPTIVE METHOD?

818A) CHECK 304: WHAT METHOD?

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

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

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

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?

821) CHECK 304:

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

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

901) CHECK 701:

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

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

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

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

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

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

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

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

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?

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?

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

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

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

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

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

917) CHECK 701:

918) CHECK 916:

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

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?

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?

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

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

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

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

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

927) Is your name on the title deed?

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

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

930) Is your name on the title deed?

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

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

SECTION 10. MALARIA

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

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

1003) Are there ways to avoid getting malaria?

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

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

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

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

1007) LOCATION OF INTERVIEW:

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

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

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

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

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?

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?

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

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

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

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

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.

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.

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?

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

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

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

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

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?

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

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:

1109) Are you covered by any health insurance?

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

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?

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?

1203) Have you yourself ever been circumcised?

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

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

1206) Was your genital area sewn closed?

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

1208) Who performed the circumcision?

1209) CHECK 213, 215 AND 216:

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.

1211) Is (NAME OF DAUGHTER) circumcised?

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

1213) Was her genital area sewn closed?

1214) Who performed the circumcision?

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?

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

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

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?

1302) CHECK 1301:

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

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

1305) Is (NAME) male or female?

1306) Is (NAME) still alive?

.

1307) How old is (NAME)?

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

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

1310) Was (NAME) pregnant when she died?

1311) Did (NAME) die during childbirth?

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

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

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

DOMESTIC VIOLENCE

1400) CHECK HOUSEHOLD QUESTIONNAIRE, Q313

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

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:

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).

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

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

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

1405)

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

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

1406) CHECK 1405A (a-j):

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'.

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

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?

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

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

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

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

1414) CHECK 709:

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).

B. How long ago did this last happen?

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?

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?

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

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

1419) CHECK 201, 226, AND 230:

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

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

1422) CHECK 701 AND 702:

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?

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?

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

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?

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?

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

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?

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?

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

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

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

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

1429) Have you ever told anyone about this?

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

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

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

1433) CHECK 223A:

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?

1435) RECORD THE TIME.

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

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

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:
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COMMENTS ON SPECIFIC QUESTIONS:
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ANY OTHER COMMENTS:
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SUPERVISOR'S OBSERVATIONS
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EDITOR'S OBSERVATIONS
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