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UGANDA DEMOGRAPHIC AND HEALTH SURVEY WOMAN'S QUESTIONNAIRE 1995

IDENTIFICATION

REGION ________________________
DISTRICT ________________________
COUNTY ________________________
SUB-COUNTY/TOWN ________________________
PARISH/RC2 NAME ________________________
EA NAME ________________________
UDHS NUMBER

URBAN/RURAL

URBAN 1
RURAL 2

CITY/MUNICIPALITY/TOWN/COUNTRYSIDE

CITY 1
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4

HOUSEHOLD NUMBER
NAME OF HOUSEHOLD HEAD ________________________
NAME AND LINE NUMBER OF WOMAN ________________________
RESIDENTIAL STATUS OF WOMAN

Resident 1
Visitor 2

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:
DAY
MONTH
YEAR
NAME
RESULT

TOTAL NUMBER OF VISITS

*RESULT CODES:

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

LANGUAGE OF QUESTIONNAIRE: ENGLISH

LANGUAGE USED IN INTERVIEW

LANGUAGE:
1 ATESO-KARAMOJONG
2 LUGANDA
3 LUGBARA
4 LUO
5 RUNYANKOLE-RUKIGA
6 RUNYORO-RUTORO
7 ENGLISH
8 OTHER

RESPONDANT'S LOCAL LANGUAGE

LANGUAGE:
1 ATESO-KARAMOJONG
2 LUGANDA
3 LUGBARA
4 LUO
5 RUNYANKOLE-RUKIGA
6 RUNYORO-RUTORO
7 ENGLISH
8 OTHER

TRANSLATOR USED

NOT AT ALL 1
SOMETIMES 2
ALL THE TIME 3

SUPERVISOR

NAME ___________
DATE ___________

FIELD EDITOR

NAME ___________
DATE ___________

OFFICE EDITOR

KEYED BY

SECTION 1: RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

HOUR
MINUTES

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

CITY (KAMPALA) 1
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4

103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

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

104) Just before you moved here, did you live in a city, in a municipality, in a town, or in the countryside?

CITY (KAMPALA) 1
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4

105) In what month and year were you born?

MONTH
DOES NOT KNOW MONTH 98
YEAR
DOES NOT KNOW YEAR 98

106) How old were you at your last birthday?

COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS

107) Have you ever attended school?

YES 1
NO 2 (GO TO 114)

108) What is the highest level of school you attended: primary, junior, secondary or university?

PRIMARY 1
JUNIOR 2
SECONDARY 3
UNIVERSITY 4

109) What is the highest grade you completed at that level?

GRADE

110) CHECK 106:

AGE 24 OR BELOW
AGE 25 OR ABOVE (GO TO 113)

111) Are you currently attending school?

YES 1 (GO TO 113)
NO 2

112) What was the main reason you stopped attending school?

GOT PREGNANT 01
GOT MARRIED 02
HAD TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
GRADUATED/HAD ENOUGH SCHOOLING 07
FAILED 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) ____________ 96
DOES NOT KNOW 98

113) CHECK 108:

PRIMARY
JUNIOR OR HIGHER (GO TO 115)

114) Would you please read this sentence?

SHOW SENTENCE TO RESPONDENT AND CIRCLE CORRECT CODE.

READ EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116A)

115) Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

116A) How often do you listen to the radio?

EVERY DAY/ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
LESS THAN ONCE A MONTH 4
HARDLY/VIRTUALLY NEVER 5 (GO TO 117A)
DOES NOT KNOW 8 (GO TO 117A)

116B) What times do you usually listen to the radio?

CIRCLE ALL TIMES MENTIONED.

EARLY MORNING (6.00-8.00) A
MID MORNING (8.00-10.00) B
LATE MORNING (10.00-12.00) C
LUNCH TIME (12.00- 14.00) D
AFTERNOON (14.00-16.00) E
LATE AFTERNOON (16.00- 18.00) F
EARLY EVENING (18.00- 20.00) G
LATE EVENING (20.00-STATION CLOSE) H
DOES NOT KNOW Z

116C) What day of the week do you usually like to listen to the radio?

CIRCLE ALL DAYS MENTIONED.

MONDAY A
TUESDAY B
WEDNESDAY C
THURSDAY D
FRIDAY E
SATURDAY F
SUNDAY G
DOES NOT KNOW Z

117A) How often do you watch television (TV)?

EVERY DAY/ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
LESS THAN ONCE A MONTH 4
HARDLY/VIRTUALLY NEVER 5 (GO TO 118)
DOES NOT KNOW 8 (GO TO 118)

117B) What times do you usually watch TV?

CIRCLE ALL TIMES MENTIONED.

EARLY MORNING (6.00-8.00) A
MID MORNING (8.00-10.00) B
LATE MORNING (10.00-12.00) C
LUNCH TIME (12.00- 14.00) D
AFTERNOON (14.00-16.00) E
LATE AFTERNOON (16.00- 18.00) F
EARLY EVENING (18.00- 20.00) G
LATE EVENING (20.00-STATION CLOSE) H
DOES NOT KNOW Z

117C) What day of the week do you usually like to watch television?

CIRCLE ALL DAYS MENTIONED.

MONDAY A
TUESDAY B
WEDNESDAY C
THURSDAY D
FRIDAY E
SATURDAY F
SUNDAY G
DOES NOT KNOW Z

118) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
SEVENTH DAY ADVENTIST 4
OTHER (SPECIFY) ___________ 6

119) What is your tribe?

ACHOLI 01
ALUR 02
BAAMBA 03
BACHOPE 04
BADAMA 05
BAFUMBIRA 06
BAGANDA 07
BAGISU 08
BAGWE 09
BAGWERE 10
BAHORORO 11
BAKIGA 12
BAKONJO 13
BANYANKOLE 14
BANYARWANDA 15
BANYOLE 16
BANYORO 17
BARULLI 18
BARUNDI 19
BASOGA 20
BATORO 21
BATWA 22
ITESO 23
KAKWA 24
KARIMOJANG 25
KUMAM 26
LANGI 27
LENDU 28
LUGBARA 29
MADI 30
NUBIAM 31
SAMIA 32
SEBEI 33
OTHER (SPECIFY) _________ 96

120) CHECK RESIDENTIAL STATUS OF THE WOMAN AT COVER PAGE:

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (VISITOR)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

121) Now I would like to ask about the place in which you usually live. Do you usually live in a city, in a municipality, in a town or in the countryside?

CITY (KAMPALA) 1
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4

122) In which (DISTRICT) is that located?

(NAME OF THE DISTRICT) ______________

123) Now I would like to ask about the household in which you usually live. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO RESIDENCE/YARD/PLOT 11 (GO TO 125)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 125)
PUBLIC WELL 22
BORE HOLE 23
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE/DAM 33
GRAVITY FLOW SCHEME 34
RAINWATER 41 (GO TO 125)
BOTTLED WATER 51 (GO TO 125)
OTHER (SPECIFY) ___________ 96

123A) Where do you store the drinking water?

POT 1
JERRY CAN 2
PAN 3
KALABASH 4
OTHER (SPECIFY) ___________ 6

124) Now long does it take to go there, get water, and come back?

MINUTES
ON PREMISES 996

125) What kind of toilet facility does your household have?

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
IMPROVED PIT LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) _______________ 96

126) Does your household have:

Electricity?
YES 1
NO 2
A radio?
YES 1
NO 2
A television?
YES 1
NO 2
A telephone?
YES 1
NO 2
A refrigerator?
YES 1
NO 2
A video?
YES 1
NO 2
An electric cooker?
YES 1
NO 2

127) Could you describe the main material of the floor of your home?

NATURAL FLOOR
EARTH/SAND 11
DUNG 12
FINISHED FLOOR
PARQUET OR POLISHED WOOD 21
VINYL OR ASPHALT STRIPS 22
CERAMIC TILES 23
CEMENT 24
OTHER (SPECIFY) ________________ 96

128) 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

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

IF NONE RECORD '00'.

SONS AT HOME
DAUGHTERS AT HOME

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

YES 1
NO 2 (GO TO 206)

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

IF NONE RECORD '00'.

SONS ELSEWHERE
DAUGHTERS ELSEWHERE

206) Sometimes it happens that God takes a child away too soon. This happens to many mothers here in Uganda. Have you ever given birth to a boy or girl who was born alive but later died?

IF NO, PROBE: Any baby who cried or showed signs of life but survived only 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 RECORD '00'.

BOYS DEAD
GIRLS DEAD

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

IF NONE RECORD '00'.

TOTAL

209) CHECK 208:

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

YES
PROBE AND CORRECT 201-208 AS NECESSARY

210) CHECK 208:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 226)

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

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

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

(NAME) ____________

213) Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

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

MONTH
YEAR

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

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

RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS

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

YES 1 (GO TO NEXT BIRTH)
NO 2 (GO TO NEXT BIRTH)

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

IF '1 YEAR', PROBE: How many months old was (NAME)?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1
MONTHS 2
YEARS 3

220) FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH.

IS THE DIFFERENCE 4 OR MORE?

[answer for all births except first birth]

YES 1
NO 2 (GO TO NEXT BIRTH)

221) Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH?)

[answer for all births except first birth]

YES 1
NO 2

222) FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH.

IS THE DIFFERENCE 4 YEARS OR MORE?

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

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

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1991. IF NONE, RECORD '0'.

226) Are you pregnant now?

YES 1
NO 2 (GO TO 231)
UNSURE 8 (GO TO 231)

227) How many months pregnant are you?

MONTHS

228) Did you see anyone for a check on this pregnancy? IF YES: Whom did you see? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) __________ X
NO ONE Y

229) Since you have been pregnant, have you been given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2
DOES NOT KNOW 8

230) At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, did you not want to become pregnant at all?

THEN 1 (GO TO 301)
LATER 2 (GO TO 301)
NOT AT ALL 3 (GO TO 301)

231) When did your last menstrual period start?

(DATE, IF GIVEN) ______________
DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

SECTION 3. CONTRACEPTION

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

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301) Which ways or methods have you heard about?

302) Have you ever heard of (METHOD)?

01 PILL Women can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
06 CONDOM Men can use a rubber sheath during sexual intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
08 MALE STERILIZATION Men can have operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
09 RHYTHM, COUNTING DAYS Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
10 NATURAL FAMILY PLANNING A woman can take her temperature every day or check her vaginal mucus to tell which days to avoid having sexual intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
11 WITHDRAWAL Men can be careful and pull out before climax.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES 1 (SPECIFY) _________
NO 3

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 them by a doctor or a nurse.
YES 1
NO 2
03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
06 CONDOM Men can use a rubber sheath during sexual intercourse.
YES 1
NO 2
07 FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
08 MALE STERILIZATION Men can have operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having children?
YES 1
NO 2
09 RHYTHM, COUNTING DAYS Every month that a woman is sexually active she can avoid having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10 NATURAL FAMILY PLANNING A woman can take her temperature every day or check her vaginal mucus to tell which days to avoid having sexual intercourse.
YES 1
NO 2
11 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) _________
NO 2

304) CHECK 303:

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

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

YES 1
NO 2 (GO TO 332)

307) What have you used or done? CORRECT 303 AND 304 (AND 302 IF NECESSARY).

309) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

NUMBER OF CHILDREN

310) CHECK 303:

WOMAN NOT STERILIZED
WOMAN STERILIZED (GO TO 313A)

311) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 333)

312) Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 332)

313) Which method are you using?

313A) CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 325)
INJECTIONS 03 (GO TO 325)
IMPLANTS 04 (GO TO 325)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 325)
CONDOM 06 (GO TO 325)
FEMALE STERILIZATION 07 (GO TO 317)
MALE STERILIZATION 08 (GO TO 317)
RHYTHM, COUNTING DAYS 09 (GO TO 322)
NATURAL FAMILY PLANNING, MUCUS, TEMPERATURE 10 (GO TO 322)
WITHDRAWAL 11 (GO TO 325)
OTHER (SPECIFY) ___________ 96 (GO TO 325)

314) May I see the package of pills you are now using?

RECORD NAME OF BRAND IF PACKAGE IS SEEN.

PACKAGE SEEN 1 (GO TO 316)
BRAND NAME _____________ (GO TO 316)
PACKAGE NOT SEEN 2

315) Do you know the brand name of the pills you are now using?

RECORD NAME OF BRAND

BRAND NAME _____________
DOES NOT KNOW 98

316) If a woman is using the pill for family planning, how many times a day is she supposed to take it?

TIMES A DAY (GO TO 325)
DOES NOT KNOW 8 (GO TO 325)

317) Where did the sterilization take place?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. MISSION/CHURCH FACILITIES ARE CONSIDERED "PRIVATE".

(NAME OF THE PLACE) ___________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTRE 12
GOVERNMENT MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) ____________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 23
PRIVATE MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 26
OTHER (SPECIFY) ________________ 96
DOES NOT KNOW 98

320) In what month and year was the sterilization performed?

MONTH (GO TO 326)
YEAR (GO TO 326)

322) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant?

YES 1
NO 2 (GO TO 325)
DOES NOT KNOW 8 (GO TO 325)

323) During which times of the monthly cycle does a woman have the greatest chance of 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
OTHER (SPECIFY) ___________ 6
DOES NOT KNOW 8

324) How do you determine which days of your monthly cycle not to have sexual relations?

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

325) For how many months have you been using (METHOD) continuously?

IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS
8 YEARS OR LONGER 96

326) Some people use family planning because they have talked to their husband or friend, heard something on the radio or TV, or read something that encouraged them to use family planning. What motivated you to use family planning?

RECORD ALL MENTIONED

TALKED TO HUSBAND A
TALKED TO A FRIEND B
TALKED TO A HEALTH WORKER C
HEARD FAMILY PLANNING DRAMA ON RADIO D
HEARD ADVERTISEMENT ON RADIO E
HEARD SOMETHING ELSE ON RADIO F
SAW SOMETHING ON TV G
SAW THE YELLOW FAMILY PLANNING FLOWER (FP LOGO) H
READ A POSTER I
READ A LEAFLET/FLYER/BROCHURE J
ATTENDED A HEALTH TALK ON FAMILY PLANNING K
SELF MOTIVATED L
OTHER (SPECIFY) _____________ X
DOES NOT KNOW/NO REASON Z

328) CHECK 313:

CIRCLE METHOD CODE:

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 330A)
MALE STERILIZATION 08 (GO TO 330A)
RHYTHM, COUNTING DAYS 09 (GO TO 333)
NATURAL FAMILY PLANNING, MUCUS, TEMPERATURE 10 (GO TO 333)
WITHDRAWAL 11 (GO TO 333)
OTHER 96 (GO TO 333)

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

IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

MISSION/CHURCH FACILITIES ARE CONSIDERED "PRIVATE".

(NAME OF PLACE) ___________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTRE 12
GOVERNMENT DISPENSARY/HEALTH UNIT 13
GOVERNMENT MOBILE CLINIC 14
GOVERNMENT FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG STORE 22
PRIVATE DOCTOR 23
PRIVATE MOBILE CLINIC 24
PRIVATE FIELD WORKER 25
OTHER PRIVATE MEDICAL ______________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) ___________ 96

330) Do you know another place where you could have obtained (METHOD) the last time?

330A) At the time of the sterilization operation, did you know another place where you could have received the operation?

YES 1
NO 2 (GO TO 335)

331) People select the place where they get family planning service for various reasons. What was the main reason you went to (NAME OF PLACE IN QUESTION 329 OR QUESTION 317) instead of the other place you know about?

RECORD RESPONSE AND CIRCLE CODE.

ACCESS-RELATED REASONS
CLOSER TO HOME 11 (GO TO 335)
CLOSER TO MARKET/WORK 12 (GO TO 335)
AVAILABILITY OF TRANSPORT 13 (GO TO 335)
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLY 21 (GO TO 335)
CLEANER FACILITY 22 (GO TO 335)
OFFERS MORE PRIVACY 23 (GO TO 335)
SHORTER WAITING TIME 24 (GO TO 335)
LONGER HOURS OF OPERATION 25 (GO TO 335)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 335)
LOWER COST/CHEAPER 31 (GO TO 335)
WANTED ANONYMITY 41 (GO TO 335)
OTHER (SPECIFY) _____________ 96 (GO TO 335)
DOES NOT KNOW 98 (GO TO 335)

332) What is the main reason you are not using a method of contraception pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS MORE CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _____________ 96
DOES NOT KNOW 98

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

YES 1
NO 2 (GO TO 335)

334) Where is that?

IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. MISSION/CHURCH FACILITIES ARE CONSIDERED "PRIVATE".

(NAME OF PLACE) ____________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTRE 12
GOVERNMENT DISPENSARY/HEALTH UNIT 13
GOVERNMENT MOBILE CLINIC 14
GOVERNMENT FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/CHEMISTS 22
PRIVATE DOCTOR 23
PRIVATE MOBILE CLINIC 24
PRIVATE FIELD WORKER 25
OTHER PRIVATE MEDICAL ______________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) ___________ 96

335) Were you visited by a family planning program worker in the last 12 months?

YES 1
NO 2

336) Have you visited a health facility in the last 12 months for any reason?

YES 1
NO 2 (GO TO 338)

337) Did anyone at the health facility speak to you about family planning methods?

YES 1
NO 2

338) Do you think that breastfeeding can affect a woman's chance of becoming pregnant?

YES 1
NO 2 (GO TO 343)
DOES NOT KNOW 8

339) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

INCREASED 1 (GO TO 343)
DECREASED 2
DEPENDS 3
DOES NOT KNOW 8

340) CHECK 210:

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 343)

341) Have you ever relied on breastfeeding to avoid pregnancy?

YES 1
NO 2 (GO TO 343)

342) Are you currently relying on breastfeeding to avoid pregnancy?

YES 1
NO 2

343) CHECK 302 (1)

HAS HEARD OF PILL (CODE 1 OR 2)
NEVER HEARD OF PILLS (GO TO 345)

344) You told me that you know the pill. What problems or disadvantages are there with using the pill?

RECORD ALL MENTIONED

BLOOD PRESS/NAUSEA/DIZZINESS A
GAIN/LOSS WEIGHT B
BREAST MILK DECREASES C
MENSTRUATION PROBLEMS/BLEEDING D
CAN GET PREGNANT/UNRELIABLE E
DECREASED FERTILITY F
DESTROYS UTERUS/CANCER G
PROBLEM DURING SEX H
ABNORMAL DELIVERY/MALFORMED CHILD I
OTHER (SPECIFY) _______________ X
NO PROBLEMS Y
DOES NOT KNOW Z

345) CHECK 302 (2)

HAS HEARD OF IUD (CODE 1 OR 2)
NEVER HEARD OF IUD (GO TO 347)

346) You told me that you know the IUD. What problems or disadvantages are there with using the IUD?

RECORD ALL MENTIONED

BLOOD PRESS/NAUSEA/DIZZINESS A
GAIN/LOSS WEIGHT B
BREAST MILK DECREASES C
MENSTRUATION PROBLEMS/BLEEDING D
CAN GET PREGNANT/UNRELIABLE E
DECREASED FERTILITY F
DESTROYS UTERUS/CANCER G
PROBLEM DURING SEX H
ABNORMAL DELIVERY/MALFORMED CHILD I
OTHER (SPECIFY) _______________ X
NO PROBLEMS Y
DOES NOT KNOW Z

347) CHECK 302 (3)

HAS HEARD OF INJECTION (CODE 1 OR 2)
NEVER HEARD OF INJECTION (GO TO 401)

348) You told me that you know the injection. What problems or disadvantages are there with using the injection? RECORD ALL MENTIONED

BLOOD PRESS/NAUSEA/DIZZINESS A
GAIN/LOSS WEIGHT B
BREAST MILK DECREASES C
MENSTRUATION PROBLEMS/BLEEDING D
CAN GET PREGNANT/UNRELIABLE E
DECREASED FERTILITY F
DESTROYS UTERUS/CANCER G
PROBLEM DURING SEX H
ABNORMAL DELIVERY/MALFORMED CHILD I
OTHER (SPECIFY) _______________ X
NO PROBLEMS Y
DOES NOT KNOW Z

SECTION 4A. PREGNANCY AND BREASTFEEDING

401) CHECK 225:

ONE OR MORE BIRTHS SINCE JANUARY 1991
NO BIRTHS SINCE JANUARY 1991 (GO TO 468)

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF MORE THAN 2 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all your children born in the past three years. (We will talk about one child at a time.)

403) LINE NUMBER FROM QUESTION 212

LINE NUMBER

404) FROM QUESTION 212 AND QUESTION 216

NAME _____________
ALIVE
DEAD

405) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

THEN 1 (GO TO 407)
LATER 2
NO MORE 3 (GO TO 407)

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

MONTHS 1
YEARS 2
DOES NOT KNOW 998

407) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDENT D
OTHER (SPECIFY) _______________ X
NO ONE (GO TO 410) Y

408) How many months pregnant were you when you first received antenatal care?

MONTHS
DOES NOT KNOW 98

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

NUMBER OF TIMES
DOES NOT KNOW 98

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

YES 1
NO 2 (GO TO 411A)
DOES NOT KNOW 8 (GO TO 411A)

411) During this pregnancy, how many times did you get this injection?

TIMES
DOES NOT KNOW 8

411A) Did you eat special diet during this pregnancy?

(DIET MEANS OTHER THAN NORMAL FOOD)

YES 1
NO 2

412) Where did you give birth to (NAME)?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH UNIT 23
OTHER PUBLIC (SPECIFY) ____________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 36
OTHER (SPECIFY) ______________ 96

413) Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
AUXILARY MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER (SPECIFY) ___________ X
NO ONE Y

414) At the time of the birth of (NAME), did you have any of the following problems:

Long labour, that is, did the strong and regular contractions last more than 12 hours?
YES 1
NO 2
Excessive bleeding that so much that you feared it was life threatening?
YES 1
NO 2
A high fever with bad smelling vaginal discharge?
YES 1
NO 2
Convulsions not caused by fever?
YES 1
NO 2

415) Was (NAME) delivered by caesarian section?

YES 1
NO 2

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DOES NOT KNOW 8

417) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 419)

418) How much did (NAME) weigh?

RECORD WEIGHT FROM HEALTH CARD, IF AVAILIBLE.

GRAMS FROM CARD 1
GRAMS FROM RECALL 2
DOES NOT KNOW 99998

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

[ask only for last birth.]

YES 1 (GO TO 421)
NO 2 (GO TO 422)

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

[ask for all births except last birth]

YES 1
NO 2 (GO TO 424)

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

MONTHS
DOES NOT KNOW 98

422) CHECK 226: RESPONDENT PREGNANT?

[ask only for last birth]

NOT PREGNANT
PREGNANT OR UNSURE (GO TO 424)

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

[ask only for last birth]

YES 1
NO 2 (GO TO 425)

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

MONTHS
DOES NOT KNOW 98

425) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 432)

426) How long after birth did you first put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS.

IF LESS THAN 24 HOURS, RECORD HOURS.

OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1
DAYS 2

427) Soon after birth, was (NAME) given any of the following?

Plain water?
YES 1
NO 2
DON'T KNOW 8
Sugar water?
YES 1
NO 2
DON'T KNOW 8
Juice?
YES 1
NO 2
DON'T KNOW 8
Baby formula?
YES 1
NO 2
DON'T KNOW 8
Fresh milk?
YES 1
NO 2
DON'T KNOW 8
Tinned or powdered milk?
YES 1
NO 2
DON'T KNOW 8
Any other liquids?
YES 1
NO 2
DON'T KNOW 8

428) CHECK 404: CHILD ALIVE?

ALIVE
DEAD (GO TO 430)

429) Are you still breastfeeding (NAME)?

YES 1 (GO TO 433)
NO 2

430) For how many months did you breastfeed (NAME)?

MONTHS
DOES NOT KNOW 98

431) Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD STOPPED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) ______________ 96

432) CHECK 404: CHILD ALIVE?

ALIVE (GO TO 435)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 443)

433) How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS

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

NUMBER OF DAYLIGHT FEEDINGS

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

YES 1
NO 2
DOES NOT KNOW 8

436) At any time yesterday or last night, was (NAME) given any of the following:

Plain water?
YES 1
NO 2
DON'T KNOW 8
Juice?
YES 1
NO 2
DON'T KNOW 8
Baby formula?
YES 1
NO 2
DON'T KNOW 8
Any milk?
YES 1
NO 2
DON'T KNOW 8
Any other liquids?
YES 1
NO 2
DON'T KNOW 8
Food made from millet/sorghum/maize?
YES 1
NO 2
DON'T KNOW 8
Food made from potato/cassava/yam/matooke?
YES 1
NO 2
DON'T KNOW 8
Eggs, fish, or poultry?
YES 1
NO 2
DON'T KNOW 8
Meat?
YES 1
NO 2
DON'T KNOW 8
Any other solid or semi-solid foods?
YES 1
NO 2
DON'T KNOW 8

437) CHECK 436: FOOD OR LIQUID GIVEN YESTERDAY?

"YES" TO ONE OR MORE
"NO/DON'T KNOW" TO ALL (GO TO 441)

440) (Aside from breastfeeding,) how many times did (NAME) eat yesterday?

MEALS ONLY. IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES
DOES NOT KNOW 8

441) On how many days during the last seven days was (NAME) given any of the following:

RECORD THE NUMBER OF DAYS.

Plain water?
PLAIN WATER
Any kind of milk (other than breast milk)?
MILK
Any other liquids?
OTHER LIQUIDS
Food made from millet/sorghum/maize?
FOOD MADE FROM MILLET/SORGAM/MAIZE
food made from potato/cassava/yam/matooke?

FOOD MADE FROM POTATO/CASSAVA
Eggs, fish, or poultry?
EGGS/FISH/POULTRY
Meat?
MEAT
Any other solid or semi-solid foods?
IF DON'T KNOW, RECORD '8'

442) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 443.

SECTION 4B. IMMUNIZATION AND HEALTH

443) ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS USE ADDITIONAL FORMS.)

444) LINE NUMBER FROM QUESTION 212

LINE

445) FROM QUESTION 212 AND QUESTION 216

NAME ____________
ALIVE
DEAD (GO TO 444 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 468.)

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

YES, SEEN 1 (GO TO 448)
YES, NOT SEEN 2 (GO TO 450)
NO CARD 3

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

YES 1 (GO TO 450)
NO 2 (GO TO 450)

448)

(1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD.

(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY
MONTH
YEAR
Polio 0 (at birth)
DAY
MONTH
YEAR
Polio 1
DAY
MONTH
YEAR
Polio 2
DAY
MONTH
YEAR
Polio 3
DAY
MONTH
YEAR
DPT 1
DAY
MONTH
YEAR
DPT 2
DAY
MONTH
YEAR
DPT 3
DAY
MONTH
YEAR
Measles
DAY
MONTH
YEAR

449) Has (NAME) received any vaccinations that are not recorded on this card?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

YES 1
(PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 448) (GO TO 452)
NO 2 (GO TO 452)
DOES NOT KNOW 8 (GO TO 452)

450) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 452)
DOES NOT KNOW 8 (GO TO 452)

451) Please tell me if (NAME) received any of the following vaccinations

451A) A BCG vaccination against tuberculosis, that is an injection in the arm or shoulder that left a scar?

YES 1
NO 2
DOES NOT KNOW 8

451B) Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 451E)
DOES NOT KNOW 8 (GO TO 451E)

451C) How many times?

NUMBER OF TIMES

451D) When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

451E) DPT vaccination, that is, an injection, usually given at the same time as polio drops?

YES 1
NO 2 (GO TO 451G)
DOES NOT KNOW 8 (GO TO 451G)

451F) How many times?

NUMBER OF TIMES

451G) An injection to prevent measles?

YES 1
NO 2
DOES NOT KNOW 8

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

YES 1
NO 2
DOES NOT KNOW 8

453) Has (NAME) been ill with a cough at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 457)
DOES NOT KNOW 8 (GO TO 457)

454) When (NAME) was ill with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DOES NOT KNOW 8

455) Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 457)

456) Where did you seek advice or treatment? Anywhere else?

RECORD ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH UNIT C
GOVERNMENT MOBILE CLINIC D
COMMERCIAL HEALTH CENTER E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
PRIVATE MOBILE CLINIC J
COMMERCIAL HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____________ L
OTHER PRIVATE SECTOR
SHOP M
TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) _____________ X

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

YES 1
NO 2 (GO TO 467)
DOES NOT KNOW 8 (GO TO 467)

458) Was there any blood in the stools?

YES 1
NO 2
DOES NOT KNOW 8

459) On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF BOWEL MOVEMENTS
DOES NOT KNOW 98

460) Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DOES NOT KNOW 8

461) Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DOES NOT KNOW 8

462) Was (NAME) given a fluid made from a special packet called dalozi to drink?

YES 1
NO 2
DOES NOT KNOW 8

463) Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 465)
DOES NOT KNOW (GO TO 465)

464) What was given to treat the diarrhea? Anything else?

RECORD ALL MENTIONED.

RECOMMENDED HOME FLUID A
PILL OR SYRUP B
INJECTION C
(I.V.) INTRAVENOUS D
HOME REMEDIES/HERBAL MEDICINES E
OTHER (SPECIFY) ______________ X

465) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 467)

466) Where did you seek advice or treatment? Anywhere else?

RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
GOVERNMENT MOBILE CLINIC D
COMMERCIAL HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
PRIVATE MOBILE CLINIC J
COMMERCIAL HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ___________ L
OTHER PRIVATE SECTOR
SHOP M
TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) ______________ X

467) GO BACK TO 445 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 468.

468) When a child has diarrhea, should he/she be given less fluids than usual, about the same amount, or more than usual.

LESS FLUIDS 1
ABOUT SAME AMOUNT OF FLUIDS 2
MORE FLUIDS 3
DOES NOT KNOW 8

469) When a child has diarrhea, should he/she be given less food than usual, about the same amount, or more than usual?

LESS FOOD 1
ABOUT SAME AMOUNT OF FOOD 2
MORE FOOD 3
DOES NOT KNOW 8

470) When should a child who is sick with diarrhea be taken to a health worker or health facility?

RECORD ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

471) When should a child who is sick with a cough be taken to a health worker or health facility?

RECORD ALL MENTIONED.

FAST BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

472) CHECK 462, ALL COLUMNS:

NO CHILD RECEIVED ORS
ANY CHILD RECEIVED ORS (GO TO 475)

473) Have you ever heard of a special product called dalozi you can get for the treatment of diarrhea?

YES 1 (GO TO 475)
NO 2

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

YES 1
NO 2

475) How many times in your whole life did you receive an injection in the arm to prevent tetanus?

NUMBER OF TIMES
NEVER 00 (GO TO 501)

476) In what month and year was your last tetanus injection given?

MONTH 1
YEAR 2

SECTION 5. MARRIAGE AND SEXUAL BEHAVIOUR

501) PRESENCE OF OTHERS AT THIS POINT.

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

502) Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

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

YES 1
NO 2 (GO TO 512)

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

SEPERATED 1 (GO TO 509)
DIVORCED 2 (GO TO 509)
WIDOWED 3 (GO TO 509)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

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

YES 1
NO 2 (GO TO 509)

507) How many other wives does he have?

NUMBER
DOES NOT KNOW 98 (GO TO 509)

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

RANK

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

ONCE 1
MORE THAN ONCE 2

510) CHECK 509:

MARRIED/LIVED WITH A MAN ONLY ONCE
In what month and year did you start living with your husband/partner?

MONTH
DOES NOT KNOW MONTH 98
YEAR (GO TO 512)
DOES NOT KNOW YEAR 98

MARRIED/LIVED WITH A MAN MORE THAN ONCE
Now we will talk about your first husband/partner. In what month and year did you start living with him?

MONTH
DOES NOT KNOW MONTH 98
YEAR (GO TO 512)
DOES NOT KNOW YEAR 98

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

AGE

512) Do you have a regular partner (apart from your husband)? I mean someone with whom you have been having sex for about a year or more?

YES 1
NO 2 (GO TO 514)

513) How many regular partners do you have (aside from your husband)?

NUMBER

514) CHECK 502 AND 512

MARRIED OR LIVING WITH A MAN OR HAS A REGULAR PARTNER
NOT MARRIED AND NO REGULAR PARTNER (GO TO 517)

515) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.

When was the last time you had sexual intercourse with your (husband/regular partner)?

IF RESPONDENT HAS BOTH HUSBAND AND REGULAR PARTNER, ASK WHEN SHE LAST HAD SEX WITH EITHER.

NEVER (GO TO 517)
DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
BEFORE LAST BIRTH 996

516) For that sexual intercourse, was a condom used?

YES 1
NO 2

517) Have you had sexual intercourse with anyone (else) in the last 6 months? (I mean, with someone other than your husband or regular partner that you mentioned earlier)

YES 1
NO 2 (GO TO 520)

518) With how many different people have you had sexual intercourse in the last 6 months (apart from your husband or regular partners)?

NUMBER

519) Was a condom used with any of these men?

YES, EACH PERSON 1
YES, SOME PERSON 2
NO, WITH NO ONE 3

520) When was the last time you had sexual intercourse (apart from your husband/regular partner)?

NEVER 000 (GO TO 527)
DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
BEFORE LAST BIRTH 996

521) For that last sexual intercourse, did you receive money, gifts or favours in return for sex?

CASH/MONEY 1
GIFT 2
BOTH CASH AND GIFT 3
NONE 4

522) Was this person someone you had met before or someone you met for the first time?

MET BEFORE 1
MET FOR FIRST TIME 2

523) Was a condom used for that last sexual intercourse?

YES 1 (GO TO 524A)
NO 2

524) What was the main reason that you did not use a condom that time?

NO KNOWLEDGE ABOUT CONDOM 01
CONDOMS NOT AVAILABLE 02
CONDOM TOO COSTLY 03
WANTED MORE CHILDREN 04
TRUST EACH OTHER 05
PARTNER DOES NOT APPROVE 06
CONDOM USE IS CUMBERSOME 07
OTHER (SPECIFY) _________ 96
DOES NOT KNOW 98

524A) CHECK 515 AND 520:

HAD SEX IN LAST 4 WEEKS
NO SEX IN LAST 4 WEEKS (GO TO 527)

525) In the last four weeks, how many times have you had sexual intercourse?

NUMBER OF TIMES
DOES NOT KNOW 98

526) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?

YES, EACH TIME 1
YES, SOMETIMES 2
NEVER 3

527) Who did you have sex with the last time you had sexual intercourse? Was it with (your husband / the man you are living with) or was it with someone else?

HUSBAND 1
REGULAR PARTNER 2
SOMEONE ELSE 3
NO ONE/NEVER HAD SEX 4

528) CHECK 303:

DID NOT USE CONDOM AS CONTRACEPTIVE METHOD
USED CONDOM AS CONTRACEPTIVE METHOD (GO TO 531)

529) Do you know where you can get condoms?

YES 1
NO 2 (GO TO 532)

530) Where is that?

IF SOURCE IS HOSPITAL, HEALH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
DISPENSARY/HEALTH UNIT 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG STORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELD WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) __________ 96

531) Have you heard of a condom called 'Protector'?

YES 1
NO 2

532) In general, do you think that most women like men to use condoms, they don't like men to use condoms, or does it not matter?

LIKE MEN TO USE CONDOMS 1
DON'T LIKE MEN TO USE CONDOMS 2
DOES NOT MATTER 3
OTHER (SPECIFY) ___________ 6
DOES NOT KNOW 8

533) Now think back to the past. How old were you when you had sexual intercourse for the first time?

AGE
NEVER HAD SEX 95
FIRST TIME WHEN MARRIED 96

SECTION 6. FERTILITY PREFERENCES

601) CHECK 313:

NEITHER STERILIZED
HE OR SHE STERILIZED (GO TO 613)

602) CHECK 226:

NOT PREGNANT OR UNSURE
Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children?

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DOES NOT KNOW 8 (GO TO 604)

603) CHECK 226:

NOT PREGNANT OR UNSURE
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT
How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS 1
YEARS 2
SOON/NOW 993 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) _______ 996
DOES NOT KNOW 998

604) CHECK 226:

NOT PREGNANT OR UNSURE
PREGNANT (GO TO 607)

605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606) CHECK 312: USING A METHOD?

NOT ASKED
NOT CURRENTLY USING
CURRENTLY USING (GO TO 613)

607) Do you think you will use a family planning method in the next 12 months?

YES 1 (GO TO 609)
NO 2
DOES NOT KNOW 8

608) Do you think you will use a method of family planning at any time in the future?

YES 1
NO 2 (GO TO 610)
DOES NOT KNOW 8 (GO TO 610)

609) Which method would you prefer to use?

PILL 01 (GO TO 613)
IUD 02 (GO TO 613)
INJECTIONS 03 (GO TO 613)
IMPLANTS 04 (GO TO 613)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 613)
CONDOM 06 (GO TO 613)
FEMALE STERILIZATION 07 (GO TO 613)
MALE STERILIZATION 08 (GO TO 613)
RHYTHM/COUNTING DAYS 09 (GO TO 613)
NATURAL FP, MUCUS, TEMPERATURE 10 (GO TO 613)
WITHDRAWAL 11 (GO TO 613)
OTHER (SPECIFY) _____________ 96 (GO TO 613)
UNSURE 98 (GO TO 613)

610) What is the main reason that you think you will never use a method?

NOT HAVING SEX 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
WANTS MORE CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) ___________ 96
DOES NOT KNOW 98

613) CHECK 216:

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

NO LIVING CHILDREN
If you could choose exactly the number of children to have in your whole life, how many would that be? PROBE FOR A NUMERIC RESPONSE.

NUMBER
OTHER (SPECIFY) __________ 96 (GO TO 615)

614) How many of these children would you like to be boys and how many would you like to be girls?

NUMBER BOYS
NUMBER GIRLS
NUMBER EITHER
OTHER (SPECIFY) ___________ 969696

615) Would you say that you approve of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2 (GO TO 617)
NO OPINION 3 (GO TO 617)

616) Have you ever recommended family planning to a friend, relative or anyone else?

YES 1
NO 2

617) Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DOES NOT KNOW 8
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DOES NOT KNOW 8

618) In the last six months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
From a poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2

618A) CHECK 618:

YES, HEARD FAMILY PLANNING PROGRAM ON THE RADIO
DID NOT HEAR PROGRAM ON RADIO (GO TO 620)

619) Which program or message have you heard? Any others?

ON THE RADIO AND TELEVISION.

KONOWEEKA A
ADVERTISEMENT FOR CONDOM/PILL B
OTHER (SPECIFY) __________ X

620) In the last few months have you discussed the practice of family planning with your friends or relatives?

YES 1
NO 2 (GO TO 622)

621) With whom? Anyone else?

RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS H
OTHER (SPECIFY) ___________ X

622) Do you think most, some, or none of the women you know use some kind of family planning?

MOST 1
SOME 2
NONE 3
DOES NOT KNOW 8

623) CHECK 502:

YES, CURRENTLY MARRIED
YES, LIVING WITH A MAN
NO, NOT IN UNION (GO TO 626A)

624) Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.

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

APPROVES 1
DISAPPROVES 2
DOES NOT KNOW 8

625) Have you and your husband/partner ever discussed the number of children you would like to have?

YES 1
NO 2

626) Do you think your husband/partner wants the same number of children that you want, or does he want more fewer than you want?

SAME NUMBER 1
MORE CHIILDREN 2
FEWER CHILDREN 3
DOES NOT KNOW 8

626A) Do you think that using family planning will make a woman more promiscuous?

YES 1
NO 2
DOES NOT KNOW 8

626B) Do you think that using family planning will make a man more promiscuous?

YES 1
NO 2
DOES NOT KNOW 8

626C) What do you understand by the term "family planning"?

RECORD ALL MENTIONED

ADVICE ON PRODUCING CHILDREN A
NOT TO HAVE MANY CHILDREN B
SPACING CHILDREN TO HAVE A MANAGEABLE FAMILY C
PLANNING A BRIGHT FUTURE D
PRODUCE FEW CHILDREN, EDUCATE AND FEED THEM E
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

626D) In a relationship, who do you think should have the major role using family planning?

MAN 1
WOMAN 2
BOTH 3
IT DEPENDS 4
FAMILY PLANNING SHOULD NOT BE USED 5
DOES NOT KNOW 8

626E) Who should be responsible in getting information about family planning?

MAN 1
WOMAN 2
BOTH 3
IT DEPENDS 4
FAMILY PLANNING SHOULD NOT BE USED 5
DOES NOT KNOW 8

626F) Have you seen or heard about the Yellow Family Planning Flower?

YES 1
NO 2 (GO TO 627)
DOES NOT KNOW 8 (GO TO 627)

626G) Can you describe it?

YELLOW FLOWER IN A CIRCLE 1
SMALL FAMILY INSIDE THE FLOWER 2
A MAN, WOMAN, AND THE TWO CHILDREN 3
OTHER (SPECIFY) ____________ 6
DOES NOT KNOW 8

626H) What does it mean?

FAMILY PLANNING SERVICES ARE AVAILABLE 1
HIGH QUALITY SERVICES ARE AVAILABLE 2
OTHER (SPECIFY) _________ 6
DOES NOT KNOW 8

627) CHECK 527:

HAD SEXUAL INTERCOURSE
NEVER HAD SEXUAL INTERCOURSE (GO TO 701)

628) Sometimes a woman becomes pregnant when she does not want to be. Have you ever become pregnant when you did not want to be?

YES 1
NO 2 (GO TO 701)

629) How long ago was the last time that you became pregnant when you did not want to be?

YEARS AGO

630) When that happened to you, what did you do about it?

STOPPED THE PREGNANCY 01
ATTEMPTED TO STOP THE PREGNANCY BUT FAILED 02
HAD A MISCARRIAGE 03 (GO TO 633)
NOTHING/CONTINUED THE PREGNANCY 04 (GO TO 637)
OTHER (SPECIFY) ___________ 96
DOES NOT KNOW 98

631) What was done to stop the pregnancy?

BITTER DRINKS (HERBS) 01
TABLETS 02
HARD MASSAGE/SQUEEZING ABDOMEN 03
CATHETER/OBJECT IN WOMB 04
INJECTION 05
SUCTION 06
CURRETAGE 07
STRENUOUS WORK 08
SCRUBBING FLOORS 09
OTHER (SPECIFY) ____________ 96
DOES NOT KNOW 98

632) Who provided the methods for you? Anyone else?

DOCTOR A (GO TO 634)
TRAINED NURSE/MIDWIFE B (GO TO 634)
TRADITIONAL HEALER C (GO TO 634)
TRAINED BIRTH ATTENDANT D (GO TO 634)
UNTRAINED BIRTH ATTENDANT E (GO TO 634)
PHARMACIST F (GO TO 634)
RELATIVE/FRIEND G (GO TO 634)
OTHER (SPECIFY) __________ X (GO TO 634)
NO ONE Y (GO TO 634)

633) What do you think caused you to have a miscarriage?

BITTER DRINKS (HERBS) 01
TABLETS 02
HARD MASSAGE/SQUEEZING ABDOMEN 03
CATHETER/OBJECT IN WOMB 04
INJECTION 05
SUCTION 06
CURRETAGE 07
STRENUOUS WORK 08
SCRUBBING FLOORS 09
SOMETHING WRONG WITH THE BABY 10
HAD A FIGHT 11
HAD AN ACCIDENT 12
WAS SICK 13
OTHER (SPECIFY) ____________ 96
DOES NOT KNOW 98

634) Did you have any health problems as a result?

YES 1
NO 2 (GO TO 637)

635) Was it necessary for you to be hospitalized?

YES 1
NO 2 (GO TO 637)

636) How many nights did you spend in the hospital?

IF NO NIGHTS, RECORD '00'.

NIGHTS IN HOSPITAL

637) Did you ever have an earlier unwanted pregnancy that you or someone else stopped?

YES 1
NO 2

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

701) CHECK 503:

NOT ASKED (ASK QUESTIONS ABOUT CURRENT HUSBAND/PARTNER)
YES (ASK QUESTIONS ABOUT MOST RECENT HUSBAND/PARTNER
NO (GO TO 708)

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

YES 1
NO 2 (GO TO 705)

703) What was the highest level of school he attended: primary, junior, secondary or university?

PRIMARY 1
JUNIOR 2
SECONDARY 3
UNIVERSITY 4
DOES NOT KNOW 8 (GO TO 705)

704) What was the highest grade he completed at that level?

GRADE
DOES NOT KNOW 8

705) What is (was) your (last) husband/partner's main occupation? That is, what kind of work does (did) he mainly do?

_____________________________________

706) CHECK 705:

WORKS (WORKED) IN AGRICULTURE
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 708)

707) (Does/did) your husband/partner work mainly on his own land or on family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
LABOR ON SOMEONE ELSE'S FARM LAND 5
PUBLIC LAND 6

708) Aside from your own housework, are you currently working?

YES 1 (GO TO 711)
NO 2

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

YES 1 (GO TO 711)
NO 2

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

YES 1
NO 2 (GO TO 801)

711) What is your occupation, that is, what kind of work do you mainly do?

____________________________________

712) CHECK 711:

WORKS IN AGRICULTURE
DOES NOT WORK IN AGRICULTURE (GO TO 714)

713) Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
LABOR ON SOMEONE ELSE'S FARM LAND 5
PUBLIC LAND 6

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

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

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

THROUGHOUT THE YEAR 1 (GO TO 717)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 718)

716) During the last 12 months, how many months did you work?

NUMBER OF MONTHS

717) (In the months you worked,) How many days a week did you usually work?

NUMBER OF DAYS (GO TO 719)

718) During the last 12 months, approximately how many days did you work?

NUMBER OF DAYS

719) On a typical working day, how many hours do you spend working?

NUMBER OF HOURS
DOES NOT KNOW 98

720) Do you earn cash for your work? PROBE: Do you make money for working?

YES 1
NO 2 (GO TO 723)

721) How much do you usually earn for this work? PROBE: Is this by the day, by the week, or by the month?

PER HOUR 1
PER DAY 2
PER WEEK 3
PER MONTH 4
PER YEAR 5
OTHER (SPECIFY) ____________ 99999996

722) CHECK 502:

YES, CURRENTLY MARRIED
YES, LIVING WITH A MAN
Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, someone else?

RESPONDENT DECIDES 1
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

NO, NOT IN UNION
Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

RESPONDENT DECIDES 1
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

723) Do you usually work at home or away from home?

HOME 1
AWAY 2

724) CHECK 217 AND 218: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

YES
NO (GO TO 801)

725) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

RESPONDENT 01
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILDCARE 10
HAS NOT WORKED SINCE LAST BIRTH 11
OTHER (SPECIFY) __________ 96

SECTION 8. AIDS

801) Have you heard about disease that can be transmitted through sex?

YES 1
NO 2 (GO TO 806)

802) Which diseases do you know?

RECORD ALL RESPONSES

SYPHILIS/KABOTONGO A
GONORRHEA/NZIKO B
AIDS/SLIM DISEASE C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

803) CHECK 527

HAS HAD SEX
HAS NEVER HAD SEX (GO TO 806)

804) During the last 12 months, did you have any of these diseases?

YES 1
NO 2 (GO TO 806)
DOES NOT KNOW 8 (GO TO 806)

805) Which?

RECORD ALL RESPONSES

SYPHILIS/KABOTONGO A
GONORRHEA/NZIKO B
AIDS/SLIM DISEASE C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

806) During the last 12 months, did you have a vaginal discharge?

YES 1
NO 2
DON'T KNOW 8

807) During the last 12 months, did you have a sore or ulcer on your genitals?

YES 1
NO 2
DON'T KNOW 8

808) CHECFK 805, 806, AND 807

HAD ONE OR MORE DISEASES
NONE OF THE DISEASAES (GO TO 814)

809) When you had this disease (DISEASE FROM 805, 806 AND 807) did you take advice or treatment?

ADVICE/TREATMENT 1
SELF TREATMENT 2 (GO TO 810A)
DID NOT DO ANYTHING 8 (GO TO 810A)

810) Where did you seek advice or treatment? Any other place or person?

RECORD ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A (GO TO 810B)
GOVERNMENT HEALTH CENTER B (GO TO 810B)
DISPENSARY/HEALTH UNIT C (GO TO 810B)
GOVERNMENT MOBILE CLINIC D (GO TO 810B)
GOVERNMENT FIELD WORKER E (GO TO 810B)
OTHER PUBLIC (SPECIFY) _________ F (GO TO 810B)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G (GO TO 810B)
PHARMACY/DRUG STORE H (GO TO 810B)
PRIVATE DOCTOR I (GO TO 810B)
PRIVATE MOBILE CLINIC J (GO TO 810B)
PRIVATE FIELD WORKER K (GO TO 810B)
OTHER PRIVATE MEDICAL (SPECIFY) ________ L (GO TO 810B)
OTHER PRIVATE SECTOR
SHOP M (GO TO 810B)
CHURCH N (GO TO 810B)
FRIENDS/RELATIVES O (GO TO 810B)
TRADITIONAL HEALER P (GO TO 810B)
OTHER (SPECIFY) _________ X (GO TO 810B)
DOES NOT KNOW Z (GO TO 810B)

810A) Why did not you seek advice or treatment?

EMBARRASSED 1
TOO EXPENSIVE/COSTLY 2
TREATMENT IS NOT AVAILIBLE 3
DOES NOT KNOW WHERE TO GO 4
OTHER (SPECIFY) ________ 6

810B) CHECK 527

HAS HAD SEX
HAS NEVER HAD SEX (GO TO 814)

811) When you had this disease (DISEASE FROM 805, 806, AND 807) did you inform your partner?

YES 1
NO 2

812) When you had (DISEASE FROM 805A AND 805B) did you do something so as not to infect your partner?

YES 1
NO 2 (GO TO 814)
PARTNER ALREADY INFECTED 3 (GO TO 814)

813) What did you do?

NO SEXUAL INTERCOURSE A
USED CONDOM B
TOOK MEDICINES C
OTHER (SPECIFY) _________ X

814) CHECK 802:

DID NOT MENTION 'AIDS'
MENTIONED 'AIDS' (GO TO 816)

815) Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 901)

816) From which sources of information have you learned most about AIDS? Any other sources?

RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY) _________ X

817) How can a person get AIDS? Any other ways?

RECORD ALL RESPONSES

SEXUAL INTERCOURSE A
SEX WITH PROSTITUTES B
HOMOSEXUAL CONTACT C
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS D
BLOOD TRANSFUSION E
UNSTERILIZED EQUIPMENT F
MOTHER TO CHILD (AT BIRTH) G
BREATFEEDING H
KISSING I
MOSQUITO BITES J
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

818) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 820)
DOES NOT KNOW (GO TO 820)

819) What can a person do to avoid getting AIDS or the virus that causes AIDS? Any other ways?

RECORD ALL MENTIONED

DO NOT HAVE SEX AT ALL A
USE CONDOMS DURING SEX B
DON'T HAVE SEX WITH PROSTITUTES C
DON'T HAVE SEX WITH HOMOSEXUALS D
DO NOT HAVE MANY SEX PARTNERS E
HAVE ONE FAITHFUL PARTNER (ZERO GRAZING) F
AVOID BLOOD TRANSFUSIONS G
AVOID UNSTERILIZED EQUIPMENT H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
DO NOT DRINK TOO MUCH ALCOHOL L
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

820) Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DOES NOT KNOW 8

821) Is AIDS a fatal disease, that is, do all people with AIDS die from disease?

YES 1
NO 2
DOES NOT KNOW 8

822) Can AIDS be transmitted from mother to child?

YES 1
NO 2
DOES NOT KNOW 8

823) Can AIDS be transmitted through breastfeeding?

YES 1
NO 2
DOES NOT KNOW 8

824) Do you personally know someone who has AIDS or has died of AIDS?

YES 1
NO 2 (GO TO 825)
DOES NOT KNOW 8 (GO TO 825)

824A) What relationship to you?

SPOUSE A
SIBLINGS B
FRIENDS/RELATIVES C
NEIGHBOURS D
OTHERS (SPECIFY) _________ X

825) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 827)
GREAT 3 (GO TO 827)
NO RISK AT ALL 4

826) Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS? Any other reasons?

RECORD ALL MENTIONED.

ABSTAIN FROM SEX A (GO TO 828)
USE CONDOMS DURING SEX B (GO TO 828)
HAVE ONLY ONE SEX PARTNER C (GO TO 828)
LIMITED NUMBER OF PARTNERS D (GO TO 828)
NO HOMOSEXUAL CONTACT E (GO TO 828)
NO BLOOD TRANSFUSIONS F (GO TO 828)
NO INJECTIONS G (GO TO 828)
OTHER (SPECIFY) __________ X (GO TO 828)
DOES NOT KNOW Z

827) Why do you think that you have a (MODERATE/GREAT) chance of getting AIDS? Any other reasons?

RECORD ALL MENTIONED.

DOES NOT USE CONDOMS A
MULTIPLE SEX PARTNERS B
SPOUSE HAS MULTIPLE PARTNERS C
HOMOSEXUAL CONTACT D
HAD BLOOD TRANSFUSION E
HAD INJECTIONS F
OTHER (SPECIFY) ________ X
DOES NOT KNOW Z

828) Since you heard of AIDS, have you changed your sexual behavior to prevent getting AIDS?

YES 1
NO 2 (GO TO 830)
DOES NOT KNOW 8 (GO TO 830)

829) What did you do? Anything else?

RECORD ALL MENTIONED

RESTRICTED SEX TO ONE PARTNER A
STARTED USING CONDOMS B
REDUCED NUMBER OF PARTNERS C
STOPPED ALL SEX D
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

830) Some people use a condom during sexual intercourse to avoid getting AIDS or other sexually transmitted diseases. Have you ever heard of this?

YES 1
NO 2 (GO TO 832)

830A) CHECK 527:

HAS HAD SEX
HAS NEVER HAD SEX (GO TO 832)

831) Have you ever used a condom during sex to avoid getting or transmitting diseases, such as AIDS?

YES 1
NO 2

832) Have you ever been tested to see if you have the AIDS virus?

YES 1 (GO TO 836)
NO 2
DOES NOT KNOW/NOT SURE 8

833) Would you like to be tested for the AIDS virus?

YES 1
NO 2
DOES NOT KNOW/NOT SURE 8

834) Do you know a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 836)
DOES NOT KNOW/NOT SURE 8 (GO TO 836)

835) Where could you go?

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
DISPENSARY/HEALTH UNIT C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
OTHER PRIVATE SECTOR
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

836) What do you suggest is the most important thing the government should do for people who have AIDS?

PROVIDE MEDICAL TREATMENT 1
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE/JAIL PEOPLE 3
NOT BE INVOLVED 4
OTHER (SPECIFY) ________ 6

837) If a member of your family is suffering from AIDS would you be willing to care for him or her at home?

YES 1
NO 2
DEPENDS 3
OTHER (SPECIFY) _______ 6
NOT SURE/DOES NOT KNOW 8

SECTION 9. MATERNAL MORTALITY

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

How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER

902) CHECK 901:

TWO OR MORE BIRTHS
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 916)

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

NUMBER OF PRECEDIING BIRTHS

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

______________

905) Is (NAME) male or female?

MALE 1
FEMALE 2

906) Is (NAME) still alive?

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

907) How old is (NAME)?

YEARS (GO TO NEXT COLUMN)

908) In what year did (NAME) die?

YEAR (GO TO 910)
DON'T KNOW 98

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

YEARS

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

YEARS (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT COLUMN)

911) Was (NAME) pregnant when she died?

YES 1 (GO TO 914)
NO 2

912) Did (NAME) die during childbirth?

YES 1 (GO TO 915)
NO 2

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

YES 1
NO 2 (GO TO 915)

914) Was her death due to complications of pregnancy or childbirth?

YES 1
NO 2

915) How many children did (NAME) give birth to during her lifetime?

916) RECORD THE TIME.

HOURS
MINUTES

SECTION 10. HEIGHT AND WEIGHT

1001) CHECK 215:

ONE OR MORE BIRTHS SINCE JANUARY 1991
NO BIRTHS SINCE JANUARY 1991 (GO TO END)

INTERVIEWER: IN 1002 (COLUMNS 2-3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1991, USE ADDITIONAL FORMS).

1002) LINE NUMBER FROM QUESTION 212

[For all living children born since January 1991.]

1003) NAME

FROM QUESTION 212 FOR CHILDREN

(NAME) ___________

1004) DATE OF BIRTH

FROM QUESTION 215, AND ASK FOR DAY OF BIRTH

[For all living children born since January 1991.]

DAY
MONTH
YEAR

1005) BCG SCAR ON TOP OF LEFT SHOULDER

[For all living children born since January 1991.]

SCAR SEEN 1
NO SCAR 2

1006) HEIGHT (in centimeters)

1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

[For all living children born since January 1991.]

LYING 1
STANDING 2

1008) WEIGHT (in kilograms)

1009) DATE WEIGHED AND MEASURED

DAY
MONTH
YEAR

1010) RESULT

FOR RESPONDENT
MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 6
FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991
CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ___________ 6

1011) NAME OF MEASURER:

_____________________________

NAME OF ASSISTANT:

_____________________________

INTERVIEWER'S OBSERVATIONS

To be filled in after completing interview

Comments about Respondent:

_________________________________

Comments on Specific Questions:

_________________________________

Any Other Comments:

_________________________________
SUPERVISOR'S OBSERVATIONS
_________________________________

Name of Supervisor: ______________________

Date: _________

EDITOR'S OBSERVATIONS

_________________________________

Name of Editor: __________________________

Date: _________