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UGANDA MINISTRY OF HEALTH DEMOGRAPHIC AND HEALTH SURVEY QUESTIONNAIRE WOMAN'S QUESTIONNAIRE 1988/1989

ENGLISH VERSION

IDENTIFICATION

DISTRICT _____________
SUBCOUNTY/TOWN _____________
PARISH/WARD _____________
SUBPARISH/RC2 _____________
CLUSTER NUMBER
HOUSEHOLD NUMBER
LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT

FINAL VISIT
MONTH
YEAR

TOTAL NUMBER OF VISITS

*RESULT CODES:

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

FIELD EDITED BY

NAME
DATE

OFFICE EDITED BY

NAME
DATE

KEYED BY

NAME
DATE

KEYED BY

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE NUMBER OF PEOPLE LISTED IN THE HOUSEHOLD SCHEDULE.

NUMBER OF PEOPLE

102) RECORD THE NUMBER OF CHILDREN AGED 5 AND UNDER LISTED IN THE HOUSEHOLD SCHEDULE WHO NORMALLY LIVE IN THE HOUSEHOLD.

NUMBER OF CHILDREN AGED 5 AND UNDER

103) RECORD THE TIME.

HOUR
MINUTES

104) First, I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in the village, in a town, or in a city?

VILLAGE 1
TOWN 2
CITY 3

105) How long have you been living continuously in (NAME OF VILLAGE, TOWN, CITY)?

ALWAYS 95 (GO TO 107)
VISITOR 96 (GO TO 107)
YEARS

106) Just before you moved here, did you live in a village, in a town, or in a city?

VILLAGE 1
TOWN 2
CITY 3

107) In what month and year were you born?

COMPARE AND CORRECT 107 AND/OR 108 IF INCONSISTENT.

MONTH
DON'T KNOW 98
YEAR
DON'T KNOW 98

108) How old were you at your last birthday?

AGE IN COMPLETED YEARS

109) Have you ever attended school?

YES 1
NO 2 (GO TO 113)

110) What was the highest level and grade of formal education you completed?

CIRCLE CODE FOR BOTH LEVEL AND GRADE

LEVEL
PRIMARY 1
JUNIOR 2
SECONDARY 3
UNIVERSITY 4
GRADE WITHIN LEVEL
GRADE 1
GRADE 2
GRADE 3
GRADE 4 [for all except junior]
GRADE 5 [for all except junior]
GRADE 6 [for all except junior]
GRADE 7 [primary only]

111) How many years did you spend in vocational training? IF NONE, ENTER "0".

YEARS

112) CHECK 110:

PRIMARY
JUNIOR OR HIGHER (GO TO 114)

113) Would you please read this sentence?

SHOW SENTENCE TO RESPONDENT AND CIRCLE CORRECT CODE.

READ EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3

114) Do you usually listen to a radio at least once a week?

YES 1
NO 2

115) What is the major source of drinking water for members of your household?

PIPED INTO RESIDENCE 01
PIPED INTO YARD OR PLOT 02
PUBLIC TAP 03
BOREHOLE 04
WELL 05
RIVER, LAKE, UNPROTECTED SPRING, SURFACE WATER 06
PROTECTED SPRING 07
TANKER TRUCK, OTHER VENDOR 08
RAINWATER 09
OTHER (SPECIFY) __________ 10

115A) How far do you have to walk to your major source of drinking water in the dry season?

LESS THAN 1/4 MILE 1
1/4 - 1/2 MILE 2
1/2 - 1 MILE 3
1 - 3 MILE 4

116) What is the major source of water for household use other than drinking (e.g., handwashing, cooking) for members of your household?

PIPED INTO RESIDENCE 01
PIPED INTO YARD OR PLOT 02
PUBLIC TAP 03
BOREHOLE 04
WELL 05
RIVER, LAKE, UNPROTECTED SPRING, SURFACE WATER 06
PROTECTED SPRING 07
TANKER TRUCK, OTHER VENDOR 08
RAINWATER 09
OTHER (SPECIFY) __________ 10

117) What kind of toilet does your household have?

FLUSH TOILET 1
LATRINE, PIT 2
OTHER (SPECIFY) _________ 3
NO FACILITIES 8

119) Do you have, right now, soap in your house?

YES 1
NO 2

120) Does your house have:

Electricity?
YES 1
NO 2
A radio?
YES 1
NO 2
A hot plate/cooker?
YES 1
NO 2
A charcoal iron?
YES 1
NO 2
A television?
YES 1
NO 2
A refrigerator?
YES 1
NO 2
A charcoal stove?
YES 1
NO 2

121) Does any member of your household own:

A bicycle?
YES 1
NO 2
A motorcycle?
YES 1
NO 2
A motor vehicle (CAR, BUS, LORRY, TRACTOR)?
YES 1
NO 2
A canoe?
YES 1
NO 2
A motor boat?
YES 1
NO 2

122) MAIN MATERIAL OF THE FLOOR. (RECORD OBSERVATION.)

PARQUET OR POLISHED WOOD 1
CERAMIC TILES 2
CEMENT 3
COW DUNG 4
EARTH/SAND 5
OTHER (SPECIFY) __________ 6

130) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
SEVENTH DAY ADVENTIST 4
OTHER (SPECIFY) ___________ 5

140) What is your tribe?

ACHOLI 01
ALUR 02
ATESO 03
KARIMOJONG 04
LANGI 05
LUGBARA 06
MADI 07
MUGANDA 08
MUGISU 09
MUKIGA 10
MUKONJO 11
MUNYANKOLE 12
MUNYORO 13
MUSOGA 14
MUTORO 15
MWAMBA 16
SAMIA 17
SEBEI 18
OTHER (SPECIFY) _____________ 19

150) Are you a member of any of the following organizations?

Mother's Union?
YES 1
NO 2
YWCA?
YES 1
NO 2
A cooperative?
YES 1
NO 2
The Family Planning Association?
YES 1
NO 2
The RC?
YES 1
NO 2
Any other?
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 you have given birth to who are now living with you?

YES 1
NO 2 (GO TO 204)

203) How many sons live with you? And how many daughters live with you?

IF NONE ENTER '00'.

SONS AT HOME
DAUGHTERS AT HOME

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

YES 1
NO 2 (GO TO 206)

205) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?

IF NONE ENTER '00'.

SONS ELSEWHERE
DAUGHTERS ELSEWHERE

206) Have you ever given birth to a boy or a girl who was born alive but later died? IF NOT, PROBE: ANY (other) boy or girl who cried or showed any sign of life but only survived a few hours or days?

YES 1
NO 2 (GO TO 208)

207) How many boys have died? And how many girls have died?

IF NONE ENTER '00'.

BOYS DEAD
GIRLS DEAD

208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.

IF NONE ENTER '00'.

TOTAL

209) CHECK 208:

Just to make sure I have this right: you have had in TOTAL ______ live births during your life. Is that correct?

YES
NO (PROBE AND CORRECT 201-209 AS NECESSARY)

210) CHECK 208:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 220)

211) Now I would like to talk to you about all of your births, whether still alive or not, starting with the first one you had. (RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS ON SEPERATE LINES AND MARK WITH BRACKET.)

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

(NAME) _____________

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

BOY 1
GIRL 2

214) In what month and year was (NAME) born? PROBE: What is his/her birthday? OR: In what season?

MONTH
YEAR

215) Is (NAME) still alive?

YES 1 (GO TO 217)
NO 2

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

RECORD DAYS IF LESS THAN ONE MONTH, MONTHS IF LESS THAN TWO YEARS, OR YEARS.

DAYS 1 (GO TO NEXT BIRTH)
MONTHS 2 (GO TO NEXT BIRTH)
YEARS 3 (GO TO NEXT BIRTH)

217) IF ALIVE: How old was (NAME) at his/her last birthday?

RECORD AGE IN COMPLETED YEARS

AGE IN YEARS

218) IF ALIVE: Is he/she living with you?

YES 1
NO 2

219) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME
INTERVIEWER:
FOR EACH LIVE BIRTH: YEAR OF BIRTH IS RECORDED
FOR EACH LIVE CHILD: CURRENT AGE IS RECORDED
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

220) Are you pregnant now?

YES 1
NO 2 (GO TO 225)
UNSURE 8 (GO TO 225)

221) For how many months have you been pregnant?

MONTHS

222) Did you see anyone for a check on this pregnancy?

YES 1
NO 2 (GO TO 226)

223) Whom did you see?

PROBE FOR TYPE OF PERSON AND RECORD MOST QUALIFIED.

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
TRADITIONAL BIRTH ATTENDANT 3
OTHER (SPECIFY) ________ 4

224A) Since you have been pregnant, have you been given any injection in your arm?

YES 1
NO 2 (GO TO 226)

224B) Did you receive a card when you were given an injection? IF YES: May I see it please?

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 224D)
NO CARD 3 (GO TO 224D)

224C) RECORD DATES OF TETANUS INJECTIONS

IF ONLY ONE, WRITE "97" FOR SECOND. IF MORE THAN TWO, WRITE THE LAST TWO.

MONTH
YEAR
MONTH
YEAR

224D) Where did you go to get the (last) injection?

GOVERNMENT HOSPITAL 01 (GO TO 226)
GOVERNMENT HEALTH CENTER 02 (GO TO 226)
FIELD WORKER 03 (GO TO 226)
PRIVATE DOCTOR 04 (GO TO 226)
PRIVATE HOSPITAL OR CLINIC 05 (GO TO 226)
PHARMACY 06 (GO TO 226)
SCHOOL 07 (GO TO 226)
SHOP 08 (GO TO 226)
OTHER (SPECIFY) ___________ 09 (GO TO 226)
DON'T KNOW 98 (GO TO 226)

225) How long ago did your last menstrual period start?

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

226) When during her monthly cycle do you think a woman has the greatest chance of becoming pregnant?

PROBE: What are the days during the month when a woman has to be careful to avoid becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
AT ANY TIME 5
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

227) PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 3: CONTRACEPTION

301) Now I would like to talk about a different topic. There are various ways or methods that a couple can use to delay or avoid a pregnancy. Which of these ways or methods have you heard about? CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-305 BEFORE PROCEEDING TO THE NEXT METHOD.

302) Have you ever heard of (METHOD)? READ DESCRIPTION.

01 PILL Women can take a pill every day.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
02 IUD Women can have a loop or coil placed inside their womb by a doctor or nurse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for a few months.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
04 DIAPHRAGM/FOAM/JELLY Women can place jelly, cream, tablets, or a diaphragm around the neck of the womb before intercourse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
05 CONDOM Men can wear a rubber sheath during sexual intercourse.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
07 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
08 PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
09 WITHDRAWAL Men can be careful and pull out before climax.
YES/SPONTANEOUS 1
YES/PROBED 2
NO 3
10 ANY OTHER METHODS? Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
YES/SPONTANEOUS 1
NO 3

(ASK 303-305 FOR EACH METHOD AS APPROPRIATE)

303) Have you ever used (METHOD)?

01 PILL Women can take a pill every day.
YES 1
NO 2
02 IUD Women can have a loop or coil placed inside their womb by a doctor or nurse.
YES 1
NO 2
03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for a few months.
YES 1
NO 2
04 DIAPHRAGM/FOAM/JELLY Women can place jelly, cream, tablets, or a diaphragm around the neck of the womb before intercourse.
YES 1
NO 2
05 CONDOM Men can wear a rubber sheath during sexual intercourse.
YES 1
NO 2
06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1
NO 2
07 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1
NO 2
08 PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
YES 1
NO 2
09 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
10 ANY OTHER METHODS? Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304) Where would you go to obtain (METHOD) if you wanted to use it? (CODES BELOW)

01 PILL Women can take a pill every day.
OTHER ____________
02 IUD Women can have a loop or coil placed inside their womb by a doctor or nurse.
OTHER ____________
03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for a few months.
OTHER ____________
04 DIAPHRAGM/FOAM/JELLY Women can place jelly, cream, tablets, or a diaphragm around the neck of the womb before intercourse.
OTHER ____________
05 CONDOM Men can wear a rubber sheath during sexual intercourse.
OTHER ____________
06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
OTHER ____________
07 MALE STERILIZATION Men can have an operation to avoid having any more children.
OTHER ____________
08 PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant: Where would you go to obtain advice on periodic abstinence?
OTHER ____________
10 ANY OTHER METHODS? Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
OTHER ____________

CODES FOR 304

01 GOVERNMENT HOSPITAL
02 GOVERNMENT HEALTH CENTER
03 FPAU CLINIC
04 MOBILE CLINIC
05 FIELD WORKER
06 PRIVATE DOCTOR
07 PRIVATE HOSPITAL OR CLINIC
08 PHARMACY/SHOP
09 CHURCH
10 FRIENDS/RELATIVES
11 TRADITIONAL HEALER
12 OTHER (SPECIFY)
13 NOWHERE
98 DON'T KNOW

305) In your opinion, what is the main problem, if any, with using (METHOD)? (CODES BELOW)

01 PILL Women can take a pill every day.
OTHER ____________
02 IUD Women can have a loop or coil placed inside their womb by a doctor or nurse.
OTHER ____________
03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for a few months.
OTHER ____________
04 DIAPHRAGM/FOAM/JELLY Women can place jelly, cream, tablets, or a diaphragm around the neck of the womb before intercourse.
OTHER ____________
05 CONDOM Men can wear a rubber sheath during sexual intercourse.
OTHER ____________
06 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
OTHER ____________
07 MALE STERILIZATION Men can have an operation to avoid having any more children.
OTHER ____________
08 PERIODIC ABSTINENCE Couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant.
OTHER ____________
09 WITHDRAWAL Men can be careful and pull out before climax.
OTHER ____________
10 ANY OTHER METHODS? Have you ever heard of any other ways or methods that women or men can use to avoid pregnancy?
OTHER ____________

CODES FOR 305

02 NOT EFFECTIVE
03 HUSBAND DISAPPROVES
04 HEALTH CONCERNS
05 ACCESS/AVAILABILITY
06 COSTS TOO MUCH
07 INCONVENIENT TO USE
09 METHOD PERMANENT
11 OTHER (SPECIFY)
12 NONE
98 DON'T KNOW

306) CHECK 303:

NOT A SINGLE "YES" (NEVER USED)
AT LEAST ONE "YES" (EVER USED) (GO TO 309)

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

MARK APPROPRIATE BOX WITH AN 'X'.

YES
NO (GO TO 316)

308) What have you used or done?

CORRECT 302-303 AND OBTAIN INFORMAITION FOR 304 TO 306 AS NECESSARY.

309) CHECK 303:

EVER USED PERIODIC ABSTINENCE
NEVER USED PERIODIC ABSTINENCE (GO TO 311)

310) The last time you used periodic abstinence, how did you determine on which days you had to abstain?

BASED ON CALENDAR 1
BASED ON BODY TEMPERATURE 2
BASED ON CERVICAL MUCUS (BILLINGS) METHOD 3
BASED ON BODY TEMPERATURE AND MUCUS 4
OTHER (SPECIFY) _________ 5
NO SPECIFIC SYSTEM 6

311) How many living children, if any, did you have when you first used a method to avoid getting pregnant? IF NONE ENTER '00'.

NUMBER OF CHILDREN

312) CHECK 220:

NOT PREGNANT OR NOT SURE
PREGNANT (GO TO 316)

313) Are you currently using any method to avoid getting pregnant?

YES 1
NO 2 (GO TO 316)

314) Which method are you using?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06 (GO TO 315A)
MALE STERILIZATION 07 (GO TO 315A)
PERIODIC ABSTINENCE 08 (GO TO 315B)
WITHDRAWAL 09 (GO TO 319)
OTHER (SPECIFY) ___________ 10 (GO TO 319)

315) Where did you obtain (METHOD) the last time?

315A) Where did the sterilization take place?

315B) Where did you obtain instructions for this method?

GOVERNMENT HOSPITAL 01 (GO TO 319)
GOVERNMENT HEALTH CENTER 02 (GO TO 319)
FPAU CLINIC 03 (GO TO 319)
MOBILE CLINIC 04 (GO TO 319)
FIELD WORKER 05 (GO TO 319)
PRIVATE DOCTOR 06 (GO TO 319)
PRIVATE HOSPITAL OR CLINIC 07 (GO TO 319)
PHARMACY/SHOP 08 (GO TO 319)
CHURCH 09 (GO TO 319)
FRIENDS/RELATIVES 10 (GO TO 319)
TRADITIONAL HEALER 11 (GO TO 319)
OTHER (SPECIFY) __________ 12 (GO TO 319)
OTHER (SPECIFY) __________ 12 (GO TO 319)
NOWHERE 13 (GO TO 319)
DON'T KNOW 98 (GO TO 319)

316) Do you intend to use a method to avoid pregnancy at any time in the future?

YES 1
NO 2 (GO TO 319)
DON'T KNOW 8 (GO TO 319)

317) Which method would you prefer to use?

PILL 01
IUD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
PERIODIC ABSTINENCE 08
WITHDRAWAL 09
OTHER (SPECIFY) ___________ 10
UNSURE 98

318) Do you intend to use (PREFERRED METHOD) in the next 12 months?

YES 1
NO 2
DON'T KNOW 8

319) Is it acceptable or not acceptable to you that family planning information is provided on radio or in newspapers?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

319A) ) Is it acceptable or not acceptable to you that family planning be taught in schools?

ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

SECTION 4. HEALTH AND BREASTFEEDING

401) CHECK 214:

ONE OR MORE LIVE BIRTHS SINCE JANUARY 1983
NO LIVE BIRTHS SINCE JANUARY 1983 (GO TO 501)

402) ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1983 IN THE TABLE. BEGIN WITH THE LAST BIRTH. ASK THE QUESTIONS ABOUT ALL OF THE BIRTHS.

LINE NUMBER FROM QUESTION 212

NAME ______________
ALIVE
DEAD

403) When you were pregnant with (NAME) were you given any injection to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2
DON'T KNOW 8

404) When you were pregnant with (NAME), did you see anyone for a check on this pregnancy? IF YES: Whom did you see? PROBE FOR THE TYPE OF PERSON AND RECORD THE MOST QUALIFIED.

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
TRADITIONAL BIRTH ATTENDANT 3
OTHER (SPECIFY) _____________ 4
NO ONE 5

405) Who assisted with the delivery of (NAME)? PROBE FOR THE TYPE OF PERSON AND RECORD THE MOST QUALIFIED.

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
TRADITIONAL BIRTH ATTENDANT 3
RELATIVE 4
OTHER (SPECIFY) _____________ 5
NO ONE 6

406) Did you ever breastfeed (NAME)?

YES 1 (GO TO 407)
NO 2

406A) Why did you never feed (NAME) at the breast?

INCONVENIENT 01 (GO TO 409)
HAD TO WORK 02 (GO TO 409)
INSUFFICIENT MILK 03 (GO TO 409)
BABY REFUSED 04 (GO TO 409)
CHILD DIED 05 (GO TO 409)
CHILD SICK 06 (GO TO 409)
OTHER (SPECIFY) ________ 07 (GO TO 409)

407) Are you still breastfeeding (NAME)? (IF DEAD, CIRCLE '2')

YES 1 (GO TO 409)
NO (OR DEAD) 2

408) How many months did you breastfeed (NAME)?

MONTHS
UNTIL DEATH 96 (GO TO 409)

408A) Why did you stop breastfeeding (NAME)?

INCONVENIENT 01
HAD TO WORK 02
INSUFFICIENT MILK 03
BABY REFUSED 04
CHILD DIED 05
CHILD SICK 06
CHILD HAD DIARRHEA 07
CHILD WEANING AGE 08
BECAME PREGNANT 09
OTHER (SPECIFY) __________ 10

409) How many months after the birth of (NAME) did your period return?

MONTHS
NOT RETURNED 96

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

YES (OR PREGNANT) 1
NO 2 (GO TO NEXT COLUMN)

411) How many months after the birth of (NAME) did you resume sexual relations?

MONTHS (GO TO NEXT COLUMN)

412) CHECK 407 FOR LAST BIRTH:

LAST CHILD STILL BREASTFED
ALL OTHERS (GO TO 418)

413) How many times did you breastfeed last night between sundown and sunrise?

NUMBER OF TIMES
AS OFTEN AS CHILD WANTED 96

414) How many times did you breastfeed yesterday during the daylight hours?

NUMBER OF TIMES
AS OFTEN AS CHILD WANTED 96

415) At any time yesterday or last night, was (NAME OF LAST CHILD) given any of the following:

Plain water?
YES 1
NO 2
Juice?
YES 1
NO 2
Powdered milk?
YES 1
NO 2
Cow's milk?
YES 1
NO 2
Any other liquid, mushy food or solid?
YES (SPECIFY) _________ 1
NO 2

416) CHECK 415:

WAS GIVEN FOOD OR LIQUID
NO FOODS OR LIQUID GIVEN (GO TO 418)

417) Were any of these given in a bottle with a nipple?

YES 1
NO 2 (GO TO 418)

417A) Why did you use a bottle with a nipple instead of breastfeeding the child?

CONVENIENT 1
HAD TO WORK 2
INSUFFICIENT BREASTMILK 3
BOTTLE BETTER THAN BREAST 4
OTHER (SPECIFY) __________ 5

418) At the time you became pregnant with (NAME OF LAST BIRTH), did you want to have that child then, did you want to wait until later, or did you want no (more) children at all?

THEN 1
LATER 2
NO MORE 3

419) ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1983 BELOW. BEGIN WITH THE LAST BIRTH. THE HEADINGS IN THE TABLE SHOULD BE EXACTLY THE SAME AS THOSE AFTER Q. 402. ASK THE QUESTIONS ONLY FOR LIVING CHILDREN.

LINE NUMBER FROM QUESTION 212

NAME _______________
ALIVE
DEAD

420) Do you have a health card for (NAME)? IF YES: May I see it, please?

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 422)
NO CARD 3 (GO TO 422)

421) RECORD DATES OF IMMUNIZATIONS FROM HEALTH CARD.

BCG
NOT GIVEN 1
DATE
MONTH
YEAR
POLIO 1
NOT GIVEN 1
DATE
MONTH
YEAR
DPT 1
NOT GIVEN 1
DATE
MONTH
YEAR
MEASLES
NOT GIVEN 1
DATE
MONTH
YEAR
POLIO 2
NOT GIVEN 1
DATE
MONTH
YEAR
DPT 2
NOT GIVEN 1
DATE
MONTH
YEAR
POLIO 3
NOT GIVEN 1
DATE
MONTH
YEAR
DPT 3
NOT GIVEN 1 (GO TO 422A)
DATE (GO TO 422A)
MONTH (GO TO 422A)
YEAR (GO TO 422A)

422) Has (NAME) ever had a vaccination to prevent him/her from getting diseases?

YES 1
NO 2
DON'T KNOW 8

422A) CHECK ON CHILD'S ARM FOR A BCG SCAR AND MARK IF PRESENT OR ABSENT

SCAR PRESENT 1
SCAR ABSENT 2
CHILD NOT SEEN 9

422B) Where can you go if you want to get a vaccination for your child?

GOVERNMENT HOSPITAL 01
GOVERNMENT HEALTH CENTER 02
FIELD WORKER 03
PRIVATE DOCTOR 04
PRIVATE HOSPITAL/CLINIC 05
PHARMACY 06
SCHOOL 07
SPECIAL CAMP 08
TRADITIONAL DOCTOR 09
OTHER (SPECIFY) _________ 10
DON'T KNOW 98

423) Now I have some questions about (NAME'S) last episode of diarrhea. Has (NAME) had diarrhea in the last 24 hours?

YES 1 (GO TO 424A)
NO 2
DON'T KNOW 8 (GO TO NEXT COLUMN)

424) Has (NAME) had diarrhea in the last two weeks?

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

424A) How many days ago did the diarrhea start?

DAYS
DON'T KNOW 98

424B) Was the episode of diarrhea mild moderate or severe?

MILD 1
MODERATE 2
SEVERE 3

424C) CHECK 412: LAST CHILD STILL BREASTFED?

YES
NO (GO TO 424E)

424D) Did you breastfeed (NAME) when he/she had diarrhea then?

YES 1
NO 2

424E) When (NAME) had diarrhea, did you give more, fewer, or the same amount of fluids?

MORE 1
FEWER 2
SAME 3
DON'T KNOW 8

424F) Did you give (NAME) any special fluids when he/she had diarrhea?

YES 1
NO 2 (GO TO 424L)

424G) What fluids did you give?

HOME SOLUTION OF SALT, SUGAR, WATER 1
ORS PACKET SOLUTION 2 (GO TO 424I)
FRUIT JUICE 3 (GO TO 424M)
TEA OR SOUP 4 (GO TO 424M)
SYRUPS 5 (GO TO 424M)
OTHER (SPECIFY) ___________ 6 (GO TO 424M)

424H) Where did you learn how to prepare the salt, sugar, and water solution?

GOVERNMENT HOSPITAL 01
GOVERNMENT HEALTH CENTER 02
FIELD WORKER 03
PRIVATE DOCTOR 04
PRIVATE HOSPITAL/CLINIC 05
PHARMACY 06
TRADITIONAL DOCTOR 07
OTHER (SPECIFY) __________ 08
DON'T KNOW 98

424I) When you gave (ORS OR HOME SOLUTION) to (NAME), did he/she get better, worse, or was there no change?

BETTER 01
WORSE 02
NO CHANGE 03

424J) How much of the (ORS OR HOME SOLUTION) did you give (NAME) each day when he/she had diarrhea?

ONE LITRE EVERY 24 HOURS 01
OTHER (SPECIFY) __________ 02

424K) For how many days did you give (NAME) (ORS OR HOME SOLUTION)?

DAYS
DON'T KNOW 98

424L) How would you prepare a home solution of ORS?

CORRECT RECIPE FOR SALT AND SUGAR SOLUTION IS: ONE LITRE OF BOILED WATER, ONE TEASPOON OF SALT, AND 8 LEVEL TEASPOONS OF SUGAR. FRUIT JUICE'S SUCH AS ORANGE OR PINEAPPLE MAY BE ADDED TO THE BASIC INGREDIENTS.

ANSWER CORRECT 1
ANSWER WRONG 2
DON'T KNOW 8

424M) When (NAME) had diarrhea, did you give more, fewer, or the same amount of foods you gave before he/she had diarrhea?

MORE 1
FEWER 2
SAME 3
SOLID FOODS NOT YET GIVEN 4
DON'T KNOW 8

425) Was (NAME) taken to a private doctor, a hospital or clinic, a traditional doctor, or any other place during the last episode of diarrhea? IF YES: Where was he/she taken?

PRIVATE DOCTOR 1
HOSPITAL/CLINIC 2
TRADITIONAL DOCTOR 3
OTHER (SPECIFY) _________ 4
CHILD NOT TAKEN 5 (GO TO 427)

426) What treatment did (NAME) receive there? (CIRCLE ALL TREATMENTS MENTIONED.)

INJECTION 1 (GO TO NEXT COLUMN)
IV (INTRA VENOUS) 1 (GO TO NEXT COLUMN)
TABLETS OR PILLS 1 (GO TO NEXT COLUMN)
SYRUPS 1 (GO TO NEXT COLUMN)
ORS 1 (GO TO NEXT COLUMN)
OTHER (SPECIFY) ________ 1 (GO TO NEXT COLUMN)
NOTHING GIVEN 1 (GO TO NEXT COLUMN)

427) Why was child not taken somewhere for treatment during the last episode of diarrhea?

ILLNESS WAS MILD 1 (GO TO NEXT COLUMN)
MOTHER TOO BUSY 2 (GO TO NEXT COLUMN)
MOTHER WORKING 3 (GO TO NEXT COLUMN)
NO FACILITIES AVAILIBLE 4 (GO TO NEXT COLUMN)
HOME TREATMENT SUFFICIENT 5 (GO TO NEXT COLUMN)
OTHER (SPECIFY) ___________ 6 (GO TO NEXT COLUMN)

428) Have you ever heard of a special product called (DALOZI) you can get for the treatment of diarrhea?

YES 1
NO 2

428A) Have you ever seen a packet like this before? (SHOW PACKET.)

YES 1
NO 2 (GO TO 429)

428B) Do you think this packet is used to cure the diarrhea, or that it is used to prevent the child from drying out?

CURE DIARRHEA 1
PREVENT DRYING OUT 2
BOTH 3
OTHER (SPECIFY) __________ 4
DON'T KNOW 8

428C) Have you ever used one of these packets for yourself or someone else?

YES 1
NO 2 (GO TO 428F)

428D) How do you prepare the medicine in the packet?

(CIRCLE ALL CODES MENTIONED.)

USE ONE LITRE OF WATER 1
USE CLEAN CONTAINER 1
USE CLEANEST WATER 1
ADD PACKET TO WATER 1
USE WITHIN ONE DAY THEN DISCARD LEFTOVER SOLUTION 1
OTHER (SPECIFY) _________ 1
DON'T KNOW 1

428E) How much water do you use to prepare the packet?

ONE LITRE 1
OTHER (SPECIFY) _____________ 2
DON'T KNOW 8

428F) Where can you get these packets? PROBE: Anywhere else?

CIRCLE ALL PLACES MENTIONED

GOVERNMENT HOSPITAL 1
GOVERNMENT HEALTH CENTER 1
FIELD WORKER 1
PRIVATE DOCTOR 1
PRIVATE HOSPITAL/CLINIC 1
PHARMACY 1
SHOP 1
TRADITIONAL DOCTOR 1
OTHER (SPECIFY) __________ 1
DON'T KNOW 8

428G) How much do (you think) the packets cost?

COST
FREE 96
DON'T KNOW 98

428H) Do you have one of these packets in your house now?

YES 1
NO 2 (GO TO 429)

428I) Can I see the packet?

SHOWS PACKET 1
DOES NOT SHOW PACKET 2

429) ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1983 BELOW. BEGIN WITH THE LAST BIRTH. THE HEADINGS IN THE TABLE SHOULD BE EXACTLY THE SAME AS THOSE AFTER Q. 419. ASK THE QUESTIONS ONLY FOR LIVING CHILDREN.

LINE NUMBER FROM QUESION 212

NAME _____________

ALIVE
DEAD (GO TO NEXT COLUMN)

430) Has (NAME) had fever in the last four weeks?

YES 1
NO 2 (GO TO 433)
DON'T KNOW 8 (GO TO 433)

431) Did you take (NAME) to a private doctor or to a hospital or clinic, traditional doctor or any other place to treat the fever. IF YES: Where taken?

DOCTOR 1
HOSPITAL/CLINIC 2
TRADITIONAL DOCTOR 3
OTHER (SPECIFY) _________ 4
CHILD NOT TAKEN 5

432) Was there anything (else) you or somebody did to treat the fever? IF YES: What was done?

CIRCLE CODE 1 FOR ALL MENTIONED.

ANTIMALARIAL 1
ANTIBIOTICS 1
LIQUID OR SYRUP 1
ASPIRIN 1
INJECTION 1
OTHER (SPECIFY) ____________ 1
NOTHING 1

433) Has (NAME) suffered from severe cough or difficult or rapid breathing in the last four weeks?

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

434) Did you take (NAME) to a private doctor, a hospital or clinic, a traditional doctor, or any other place to treat the problem? IF YES: Where was he/she taken?

DOCTOR 1
HOSPITAL/CLINIC 2
TRADITIONAL DOCTOR 3
OTHER (SPECIFY) ___________ 4
CHILD NOT TAKEN 5

435) Was there anything (else) you or somebody did to treat the problem? IF YES: What was done? CIRCLE CODE 1 FOR ALL MENTIONED.

ANTIBIOTICS 1 (GO TO NEXT COLUMN)
LIQUID OR SYRUP 1 (GO TO NEXT COLUMN)
ASPIRIN 1 (GO TO NEXT COLUMN)
INJECTION 1 (GO TO NEXT COLUMN)
OTHER (SPECIFY) _________ 1 (GO TO NEXT COLUMN)
NOTHING 1 (GO TO NEXT COLUMN)

SECTION 5. MARRIAGE

501) Have you ever been married or lived with a man?

YES 1
NO 2 (GO TO 519)

502) Are you now married or living with a man, or are you widowed, divorced or not now living together?

MARRIED 1
LIVING TOGETHER 2
WIDOWED 3 (GO TO 507)
DIVORCED 4 (GO TO 507)
NOT NOW LIVING TOGETHER 5 (GO TO 507)

503) Does your husband/partner live with you or is he now staying elsewhere?

LIVING WITH HER 1
STAYING ELSEWHERE 2

504) Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 507)

505) How many other wives does he have?

NUMBER
DON'T KNOW 98 (GO TO 507)

506) Are you the first, second, ...wife?

RANK

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

ONCE 1
MORE THAN ONCE 2

508) In what month and year did you start living with your (first) husband or partner?

MONTH
DON'T KNOW 98
YEAR (GO TO 510)
DON'T KNOW 98

509) How old were you when you started living with him?

AGE

510) Are your mother and father still alive?

WOMAN'S MOTHER
YES 1
NO 2
DON'T KNOW 8
WOMAN'S FATHER
YES 1
NO 2
DON'T KNOW 8

511) Are your (first) husband's/partner's mother and father still alive?

FIRST HUSBAND'S MOTHER
YES 1
NO 2
DON'T KNOW 8
FIRST HUSBAND'S FATHER
YES 1
NO 2
DON'T KNOW 8

512) CHECK 510 AND 511:

AT LEAST ONE PARENT NOT LIVING OR DON'T KNOW
ALL ALIVE (GO TO 515)

513) Was (MENTION PARENTS NOT ALIVE NOW OR DON'T KNOW) alive at the time you began living together with your (first) husband or partner?

WOMAN'S MOTHER
YES 1
NO 2
DON'T KNOW 8
WOMAN'S FATHER
YES 1
NO 2
DON'T KNOW 8
FIRST HUSBAND'S MOTHER
YES 1
NO 2
DON'T KNOW 8
FIRST HUSBAND'S FATHER

514) CHECK 513:

SOME PARENT ALIVE AT MARRIAGE
NO PARENT ALIVE AT MARRIAGE (GO TO 518)

515) At the time you began living together, did you and your (first) husband/partner live with any of these parents for at least six months?

YES 1
NO 2 (GO TO 517)

516) For about how many years did you live together with a parent at that time?

YEARS
UP TO THE PRESENT 96 (GO TO 518)

517) Are you now living either with your parents or your husband's parents?

YES 1
NO 2

518) In how many localities have you lived for six months or more since you were first married (started living together) including this place?

NUMBER OF LOCALITIES (GO TO 520)

519) Have you ever had sexual intercourse?

IF SHE HAS HAD CHILDREN, CIRCLE YES WITHOUT ASKING 519 AND PROCEED TO 520

YES 1
NO 2 (GO TO 528)

520) Now we need some details about your sexual activity in order to get a better understanding of contraception and fertility.

How old were you when you first had sexual intercourse?

AGE

521) Have you had sexual intercourse in the last four weeks?

YES 1
NO 2 (GO TO 523)

522) How many times?

TIMES

523) When was the last time you had sexual intercourse?

IF THE ANSWER TO 521 IS YES 523 IS ONE MONTH AGO CORRECT AND MAKE CONSISTENT

DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
BEFORE LAST BIRTH 996 (GO TO 528)

524) CHECK 220:

NOT PREGNANT OR NOT SURE
PREGNANT (GO TO 528)

525) CHECK 313:

NOT USING
USING (GO TO 528)

526) If you become pregnant in the next few weeks, would you feel happy, unhappy, or would it not matter very much?

HAPPY 1 (GO TO 528)
UNHAPPY 2
WOULD NOT MATTER 3

527) What is the main reason that you are not using a method to avoid pregnancy?

LACK OF KNOWLEDGE 01
OPPOSED TO FAMILY PLANNING 02
HUSBAND DISAPPROVES 03
OTHERS DISAPPROVE 04
HEALTH CONCERNS 05
ACCESS/AVAILABILITY 06
COSTS TOO MUCH 07
INCONVENIENT TO USE 08
INFREQUENT SEX 09
FATALISTIC 10
RELIGION 11
POSTPARTUM/BREASTFEEDING 12
MENOPAUSAL/SUBFECUND 13
OTHER (SPECIFY) _________ 14
DON'T KNOW 98

528) PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

SECTION 6. FERTILITY PREFERENCES

601) CHECK 502:

CURRENTLY MARRIED OR LIVING TOGETHER
ALL OTHERS (GO TO 609)

602) CHECK 220 AND MARK BOX.

Now I have some questions about the future.

NOT PREGNANT OR UNSURE
Would you like to have a (another) child or would you prefer not to have any (more) children?
HAVE ANOTHER 1
NO MORE 2 (GO TO 605)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 605)
UNDECIDED OR DON'T KNOW 8 (GO TO 605)
PREGNANT
After the child you are expecting, would you like to have another child or would you prefer not to have any (more) children?
HAVE ANOTHER 1
NO MORE 2 (GO TO 605)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 605)
UNDECIDED OR DON'T KNOW 8 (GO TO 605)

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

DURATION:
MONTHS 1 (GO TO 605)
YEARS 2 (GO TO 605)
DON'T KNOW 998

604) CHECK 215:

How old would your youngest child be? IF NO LIVING CHILDREN, CIRCLE '96'.

AGE OF YOUNGEST
YEARS
NO LIVING CHILDREN 96
DON'T KNOW 98

605) For how long should a couple wait before starting sexual intercourse after the birth of a baby?

MONTHS 1
YEARS 2
OTHER (SPECIFY) ________ 996

606) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?

WAIT 1
DOESN'T MATTER 2

607) Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

608) How often have you talked to your husband/partner about this subject in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

609) In general, do you approve or disapprove of couples using a method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2

610) CHECK 202 AND 204:

NO LIVING CHILDREN
If you could choose exactly the number of children to have in your whole life, how many would that be? RECORD SINGLE NUMBER OR OTHER ANSWER.
NUMBER
OTHER ANSWER (SPECIFY) ___________
HAS LIVING CHILDREN
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be? RECORD SINGLE NUMBER OR OTHER ANSWER.
NUMBER
OTHER ANSWER (SPECIFY) ___________

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

701) CHECK 501:

EVER MARRIED OR LIVED WITH A MAN (ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER.)
ALL OTHERS (GO TO 714)

702) Now I have some questions about your (most recent) husband/partner. Did your husband/partner ever attend school?

YES 1
NO 2 (GO TO 706)

703) What was the highest level and grade of formal education your husband completed?

CIRCLE CODE FOR BOTH LEVEL AND GRADE

LEVEL
PRIMARY 1
JUNIOR 2
SECONDARY 3
UNIVERSITY 4
GRADE WITHIN LEVEL
GRADE 1
GRADE 2
GRADE 3
GRADE 4 [for all except junior]
GRADE 5 [for all except junior]
GRADE 6 [for all except junior]
GRADE 7 [primary only]
DON'T KNOW 98

705) CHECK 703:

PRIMARY
SECONDARY OR HIGHER (GO TO 707)

706) Can (could) he read a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3

707) What kind of work does (did) your husband/partner mainly do?

FARMING 01
FISHING 02
MANUFACTURING 03
BUILDING AND CONSTRUCTION 04
RETAILING 05
SERVICES 06
UNPAID FAMILY WORKER IN FARMING 07
OTHER UNPAID FAMILY WORKERS 08
GOVERNMENT/PARASTATAL EMPLOYEE 09
HOME MAKER 10
STUDENT 11
ECONOMICALLY NON-ACTIVE (AGED, SICK, DEFORMED ETC) 12

708) CHECK 707:

DOES (DID) NOT WORK ON THE LAND
WORKS (WORKED) ON THE LAND (GO TO 710)

709) Does (did) he earn a regular wage or salary?

YES 1 (GO TO 712)
NO 2 (GO TO 712)
DON'T KNOW 8 (GO TO 712)

710) Does (did) your husband/partner work mainly on his family land, or on someone else's land?

HIS/FAMILY LAND 1 (GO TO 712)
SOMEONE ELSE'S LAND 2

711) Does (did) he work mainly for money or does (did) he work for a share of the crops?

MONEY 1
A SHARE OF CROPS 2

712) Before you married your (first) husband, did you yourself ever work regularly to earn money, other than on a farm or in a business run by your family?

YES 1
NO 2

713) Since you were first married, have you ever worked regularly to earn money other than on a farm or in a business run by your family?

YES 1 (GO TO 715)
NO 2

714) Have you ever worked regularly to earn money, other than on a farm or in a business run by your family?

YES 1
NO 2 (GO TO 716)

715) Are you now working to earn money on a farm or in a business run by your family?

YES 1
NO 2

716) RECORD THE TIME.

HOUR
MINUTES

717) MAIN MATERIAL OF THE ROOF (RECORD OBSERVATION)

THATCH 1
PAPYRUS 2
TINS 3
IRON SHEETS 4
ASBESTOS 5
TILES 6
CONCRETE 7
OTHERS 8

718) MAIN MATERIAL OF THE WALLS (RECORD OBSERVATION OR ASK)

THATCH 1
MUD AND POLES 2
EARTH BRICKS 3
CLAY BRICKS 4
CEMENT BLOCKS 5
CONCRETE 6
STONES 7
OTHER 8

SECTION 8. WEIGHT AND LENGTH

INTERVIEWER: IN 801-803, RECORD THE LINE NUMBERS, NAMES, AND BIRTH DATES OF ALL LIVING CHILDREN BORN SINCE JANUARY 1, 1983 STARTING WITH THE YOUNGEST CHILD. CHECK IN AGE 804 TO IDENTIFY CHILDREN 0-60 MONTHS OF AGE. RECORD WEIGHT AND LENGTH IN 805 AND 806.

801) LINE NUMBER FROM QUESTION 212

802) NAME FROM QUESTION 212

(NAME) ____________

803) DATE OF BIRTH FROM QUESTION 214

MONTH
YEAR

804) CHECK AGE: 0-60 MONTHS?

if unable to determine due to missing information, measure child.

YES
NO (GO TO NEXT COLUMN)

805) WEIGHT (in kgs)

806) LENGTH (in cms)

807) STATE REASON IF UNABLE TO RECORD

CODES FOR 807

1. CHILD AT HOME BUT VERY SICK
2. CHILD PRESENT DURING PRECEEDING NIGHT BUT NOW ELSEWHERE WITH RELATIVE
3. CHILD IN DISTANT HOSPITAL
4. PARENT/RELATIVE REFUSED
5. MEASURING BOARD SPOILT
6. SCALE SPOILT
7. OTHER (SPECIFY)

808)

NAME OF MEASURER: ____________
NAME OF ASSISTANT: ____________

INTERVIEWER'S OBSERVATIONS

(To be filled in after completing interview.)

Person Interviewed: __________________________________________

Specific questions: ___________________________________________

Language of interview: _______________________________________

Native language of respondent: _________________________________

Translator used? (tick correct answer):

YES
NO

Other aspects: _______________________________________________

Name of Interviewer: _____________

Date: _____________

SUPERVISOR'S OBSERVATIONS

___________________________________________________

Name of Supervisor: _____________

Date: _____________

EDITOR'S OBSERVATIONS

___________________________________________________

Name of Field Editor: _____________

Date: _____________

Name of Keyer: _____________

Date: _____________