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2000 Uganda Demographic and Health Survey Women's Questionnaire

Identification
Region __________
District __________
County __________
Subcounty/town __________
Parish/LC2 name __________
EA name __________
UDHS number __________

Urban/rural

Urban 1
Rural 2

Large city/small city/town/countryside ___

Large city 1
Small city 2
Town 3
Country side 4

Household number ___
Name and line number of woman __________

Interviewer visits
Date _____
Interviewer's name __________
*Result

Next visit
Date
Time

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 __________
Respondent's local language __________
Translator used

Not at all 1
Sometimes 2
All the time 3

Language:

1 Ateso-Karamojong
2 Luganda
3 Lugbara
4 Luo
5 Runyankole-Rukiga
6 Runyoro-Rutoro
7 English

Supervisor
Name __________
Date _____

Field editor
Name __________
Date _____

Office editor ___
Keyed by ___

Section 1. Respondent's Background

Introduction and Consent
Informed Consent

Hello. My name is ____________________ and I am working with Uganda Bureau of Statistics. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer __________
Date _____

Respondent agrees to be interviewed 1
Respondent does not agree to be interviewed 2 (end)

101 Record the time.

Hour ___
Minutes ___

102 For most of the time during the last five years, did you live in a city, in a town, or in the countryside?

City 1
Town 2
Countryside 3

103 How long have you been living continuously in (name of current place of residence)? If less than one year record '00' years.

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 town, or in the countryside?

City 1
Town 2
Countryside 3

105 In what month and year were you born?

Month __________
Don't know month 98
Year _____
Don't know year 9998

106 How old were you at your last birthday?
Compare and correct 105 and/or 106 if inconsistent.

Age in completed years ___

107 Have you ever attended school?

Yes 1
No 2 (Go to 111)

108 What is the highest level of school you attended?

Primary 1
Secondary 2
Post-secondary 3

109 What is the highest (grade/form/year) you completed at that level?

Grade __________

109a
Did you ever receive any vocational training?

No training 1
Teacher training 2
Paramedical training 3
Other training 6

110 Check 108:

Primary
Secondary or post-secondary (Go to 114)

111 Now I would like you to read this sentence to me.
Show card to respondent.
If respondent cannot read whole sentence, probe: Can you read any part of the sentence to me?

Cannot read at all 1
Able to read only parts of sentence 2
Able to read whole sentence 3
No card with required language (specify language) __________ 4

112 Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

Yes 1
No 2

113 Check 111:

Code 2,3 or 4 circled
Code 1 circled (Go to 115)

114 During the last 4 weeks, did you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

Almost every day 1
At least once a week 2
Less than once a week 3
Not at all 4

115 During the last 4 weeks, did you listen to the radio almost every day, at least once a week, less than once a week or not at all?

Almost every day 1
At least once a week 2
Less than once a week 3
Not at all 4

116 During the last 4 weeks, did you watch television almost every day, at least once a week, less than once a week or not at all?

Almost every day 1
At least once a week 2
Less than once a week 3
Not at all 4

117 What is your religion?

Catholic 1
Protestant 2
Muslim 3
Other (specify) __________ 6

119 Have you ever drunk an alcohol-containing beverage?

Yes 1
No 2 (Go to 123)

120 In the last 30 days, on how many days did you drink an alcohol-containing beverage?

Number of days ___
None 95

121 Have you ever gotten drunk from drinking an alcohol-containing beverage?

Yes 1
No 2 (Go to 123)

121a Check 120:

Drank alcohol on at least one day ___
None/never (Go to 123)

122 In the last 30 days, on how many occasions did you get drunk?

Number of times ___
None/never 95

123 Have you had any kind of injection in the last 3 months?

Yes 1
No 2 (Go to 201)

124 How many times did you have an injection in the last 3 months?

Number of injections ___
Every day 95

125 The last time you had an injection, who was the person who gave you the injection?

Health professional 1
Traditional healer 2
Friend/relative 3
Self 4
Other (specify) __________ 6

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 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 1
No 2 (probe and correct 201-208 as necessary)

210 Check 208:

One or more births 1
No births 2 (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?

Month __________
Year _____

216 Is (name) still alive?

Yes 1
No 2(Go to 220)

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
No 2

219 If alive, record household line number of child (record '00' if child not listed in household).

Line number ___ (next birth)

220 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 ___

221 Were there any other live births between (name of previous birth) and (name)?

Yes 1
No 2

222 Have you had any live births since the birth of (name of last birth)?

Yes 1
No 2

223 Compare 208 with number of births in history above and mark

Numbers are the same (*Check)
Numbers are different (probe and reconcile)

*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 ___

224 Check 215 and enter the number of births in 1995 or later. If none, record '0'.

Number of births ___

225 For each birth since January 1995, enter 'B' in the month of birth in the calendar. For each birth, ask the number of months the pregnancy lasted and record 'P' in each of the preceding months according to the duration of pregnancy. (Note: the number of 'P's must be one less than the number of months that the pregnancy lasted.) Write the name of the child to the left of the 'B' code.

226 Are you pregnant now?

Yes 1
No 2 (Go to 229)
Unsure 8 (Go to 229)

227 How many months pregnant are you?
Record number of completed months E.G., 01, 02... 09.
If months are not known, record 98.
Enter 'P's in the calendar, beginning with the month of interview and for the total number of completed months.

Months ___

228 At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

Then 1
Later 2
Not at all 3

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

Yes 1
No 2 (Go to 236a)

230 When did the last such pregnancy end?

Month __________
Year _____

231 Check 230:

Last pregnancy ended in January 1995 or later
Last pregnancy ended before January 1995 (Go to 236a)

232 How many months pregnant were you when the last such pregnancy ended?
Record number of completed months.
Enter 'T' in the calendar in the month that the pregnancy terminated and 'P' for the remaining number of completed months.

Months ___

233 Have you ever had any other pregnancies which did not result in a live birth?

Yes 1
No 2 (Go to 236)

234 Ask the date and the duration of pregnancy for each earlier non-live birth pregnancy back to January 1995.
Enter 'T' in the calendar in the month that each pregnancy terminated and 'P' for the remaining number of completed months.

235 Did you have any pregnancies that terminated before 1995 which did not result in a live birth?

Yes 1
No 2 (Go to 236a)

236 Fill in the month and year of termination of the last non-live birth pregnancy prior to January 1995.

Month __________
Year _____

236a How old were you at the time you experienced your first menstruation?

Years ___
Never menstruated 96
Don't know 98

237 When did your last menstrual period start? (Date, if given)

Days ago 1 ___
Weeks ago 2 ___
Months ago 3 ___
Years ago 4 ___
In menopause/has had hysterectomy 994 (Go to 238)
Before last birth 995 (Go to 238)
Never menstruated 996 (Go to 996)

237a Some women experience some pains during menstruation. Did/do you experience such pains?

Yes 1
No 2
Don't know 8

238 From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

Yes 1
No 2 (Go to 240)
Don't know (Go to 240)

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

Just before her period begins 1
During her period 2
Right after her period has ended 3
Halfway between two periods 4
Other (specify) __________ 6
Don't know 8

240 Do you currently smoke cigarettes or tobacco? If Yes, what type of tobacco do you smoke?
Record all mentioned.

Yes, cigarettes A
Yes, pipes B (Go to 301)
Yes, other (specify) __________ C (Go to 301)
No, Y (Go to 301)

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

Cigarettes ___

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 301,
reading the name and description of each method not mentioned spontaneously. Circle code 1 if method is recognized, and code 2 if not recognized. Then, for each method with code 1 circled in 301, ask 302.

301 Which ways or methods have you heard about?
For methods not mentioned spontaneously, ask:
Have you ever heard of (method)?

01 Female sterilization: Women can have an operation to avoid having any
more children
Yes 1
No 2
02 Male sterilization: Men can have an operation to avoid having any more
children
Yes 1
No 2
03 Pill: Women can take a pill every day to avoid becoming pregnant.
Yes 1
No 2
04 IUD/Coil: Women can have a loop or coil placed inside them by a doctor or a nurse.
Yes 1
No 2
05 Injectables: Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
Yes 1
No 2
06 Implants: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
Yes 1
No 2
07 Condom: Men can put a rubber sheath on their penis before sexual intercourse.
Yes 1
No 2
08 Female condom: Women can place a sheath in their vagina before sexual intercourse.
Yes 1
No 2
09 Diaphragm: Women can place a thin flexible disk in their vagina before intercourse.
Yes 1
No 2
10 Foam or jelly: Women can place a suppository, jelly, or cream in their vagina before intercourse.
Yes 1
No 2
11 Lactational Amenorrhea Method (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
Yes 1
No 2
12 Rhythm or periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
Yes 1
No 2
13 Withdrawal: Men can be careful and pull out before climax.
Yes 1
No 2
14 Emergency contraception (NORLEVO) Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
Yes 1
No 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
Yes 1 (specify) __________
No 2

302 Have you ever used (method)?

01 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
02 Male sterilization: Men can have an operation to avoid having any more
children: Have you ever had a partner who had an operation to avoid having any more children?
Yes 1
No 2
03 Pill: Women can take a pill every day to avoid becoming pregnant.
Yes 1
No 2
04 IUD/Coil: Women can have a loop or coil placed inside them by a doctor or a nurse.
Yes 1
No 2
05 Injectables: Women can have an injection by a health provider which stops them from becoming pregnant for one or more months.
Yes 1
No 2
06 Implants: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
Yes 1
No 2
07 Condom: Men can put a rubber sheath on their penis before sexual intercourse.
Yes 1
No 2
08 Female condom: Women can place a sheath in their vagina before sexual intercourse.
Yes 1
No 2
09 Diaphragm: Women can place a thin flexible disk in their vagina before intercourse.
Yes 1
No 2
10 Foam or jelly: Women can place a suppository, jelly, or cream in their vagina before intercourse.
Yes 1
No 2
11 Lactational Amenorrhea Method (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
Yes 1
No 2
12 Rhythm or periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
Yes 1
No 2
13 Withdrawal: Men can be careful and pull out before climax.
Yes 1
No 2
14 Emergency contraception (NORLEVO) Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
Yes 1
No 2
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
Yes 1
No 2

303 Check 302:

Not a single Yes (never used) ___
At least one Yes (ever used) ___

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

Yes 1
No 2 (Go to 329)

306 What have you used or done?
Correct 302 and 303 (and 301 if necessary).

307 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 ___

308 Check 302 (01):

Woman not sterilized ___
Woman sterilized ___ (Go to 311a)

309 Check 226:

Not pregnant or unsure
Pregnant (Go to 329)

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

Yes 1
No 2 (Go to 329)

311 Which method are you using?
311a Circle 'A' for female sterilization.

Do not prompt. If more than one method mentioned, follow skip instruction for highest method on list.

Female sterilization A (Go to 313)
Male sterilization B (Go to 313)
Pill C
IUD/Coil D (Go to 316a)
Injections E (Go to 312a)
Implants F (Go to 316a)
Condom G (Go to 312b)
Female condom H (Go to 316a)
Diaphragm I (Go to 316a)
Foam/jelly J (Go to 316a)
Lactational amenorrhea method (LAM) K (Go to 316a)
Periodic abstinence L (Go to 316a)
Withdrawal M (Go to 316a)
Other (specify) __________ X (Go to 316a)

312 What brand of pill are you currently using?

Pilplan 1 (Go to 316a)
Microgynon 2 (Go to 316a)
Eugyen 3 (Go to 316a)
Lofeminal 4 (Go to 316a)
Ovrette 5 (Go to 316a)
Other 6 (Go to 316a)
Don't know 8 (Go to 316a)

312a What brand of injections are you currently using?

Injectaplan 1
Depo-provera 2
Don't know 8

312b What brand of condom are you currently using?

Protector 1 (Go to 316a)
Engabu 2 (Go to 316a)
Life guard 3 (Go to 316a)
Rough rider 4 (Go to 316a)
Pleasure 5 (Go to 316a)
Other 6 (Go to 316a)
Don't know 8 (Go to 316a)

313 In what facility 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.

Name of place) __________

If both code 'A' and code 'B' are circled in 311, ask 313-317 about female sterilization only.

Public sector
Government hospital 11
Government health center 12
Family planning clinic 13
Other public (specify) __________ 16
Private medical sector
Private hospital clinic 21
Private doctor's office 23
Other private
Medical (specify) __________ 26
Other (specify) __________ 26
Don't know 98

314 Check 311:
Code 'A' circled
Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?

Code 'A' Not circled
Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?

Yes 1
No 2
Don't know 8

316 In what month and year was the sterilization performed?

Month __________
Don't know month 98
Year _____
Don't know year 9998

316a When did you start using (current method) without stopping? Probe: In what month and year did you start using (current method) continuously?

Month __________
Don't know month 98
Year _____
Don't know year 9998

317 Check 316/316a:

Year is 1995 or later
Year is 1994 or earlier (Go to 327)

319 Check 311/311a:
Circle method code:
If more than one method code circled in 311/311a, circle code for highest method in list.

Female sterilization 01 (Go to 322)
Male sterilization 02 (Go to 331)
Pill 03
IUD/Coil 04
Injections 05
Implants 06
Condom 07
Female condom 08
Diaphragm 09
Foam/jelly 10
Lactational amenorrhea method (LAM) 11 (320a)
Periodic abstinence 12 (331)
Withdrawal 13 (331)
Other method 96 (331)

320 Where did you obtain (current method) when you started using it?

Public sector
Government hospital 11
Government health center 12
Family planning clinic 13
Outreach 14
Government community based distributor 15
Other public (specify) __________ 16
Private medical sector
Private hospital/clinic 21
Pharmacy/drug shop 22
Private doctor/nurse/midwife 23
Outreach 24
NGO community based distributor 25
Other private medical (specify) __________ 26
Other source
Shop 31
Religious institution 32
Friend/relative 33
Other (specify) __________ 96

320a Where did you learn to use the lactational amenorrhea method?
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.

Name of place) __________

321 Check 311/311a:
Circle method code:
If more than one method code circled in 311/311a, circle code for highest method in list.

Pill 03
IUD/Coil 04
Injections 05
Implants 06
Condom 07
Female condom 08
Diaphragm 09
Foam/jelly 10
Lactational amenorrhea method 11

322 You obtained (current method) from (source of method from 313 or 320).
At that time, were you told about side effects or problems you might have with the method?

Yes 1 (Go to 324)
No 2

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

Yes 1
No 2 (Go to 325)

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

Yes 1
No 2

325 Check 322:

Code '1' circled
At that time, were you told about other methods of family planning which you could use?

Yes 1
No 2 (Go to 327)

Code '1' not circled
When you obtained (current method) from (source of method from 313 or 320), were you told about other methods of family planning which you could use?

Yes 1
No 2 (Go to 327)

326 Were you ever told by a health or family planning worker about other methods of family planning which you could use?

Yes 1
No 2

327 Check 311/311a:
Circle method code:
If more than one method code circled in 311/311a, circle code for highest method in list.

Female sterilization 01 (Go to 331)
Male sterilization 02 (Go to 331)
Pill 03
IUD/Coil 04 (Go to 331)
Injections 05
Implants 06 (Go to 331)
Condom 07
Female condom 08
Diaphragm 09
Foam/jelly 10
Lactational amenorrhea method 11 (Go to 331)
Periodic abstinence 12 (Go to 331)
Withdrawal 13 (Go to 331)
Other method 96 (Go to 331)

328 Where did you obtain (current method) the last time?
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.

(Name of place) __________
Public sector
Government hospital 11 (Go to 331)
Government health center 12 (Go to 331)
Family planning clinic outreach 14 (Go to 331)
Government community based distributor 15 (Go to 331)
Other public (specify) __________ 16 (Go to 331)
Private medical sector
Private hospital/clinic 21 (Go to 331)
Pharmacy/drug shop 22 (Go to 331)
Private doctor/nurse/midwife 23 (Go to 331)
Outreach 24 (Go to 331)
NGO community based distributor 25 (Go to 331)
Other private medical (specify) __________ 26 (Go to 331)
Other source
Shop 31 (Go to 331)
Religious institution 32 (Go to 331)
Friend/relative 33
Other (specify) __________ 96

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

Yes 1
No 2 (Go to 331)

330 Where is that?
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.

Name of place __________

Any other place?
Record all mentioned.

Public sector
Government hospital A
Government health center B
Family planning clinic C
Outreach D
Government community based distributor E
Other public (specify) __________ F
Private medical sector
Private hospital/clinic G
Pharmacy/drug shop H
Private doctor/nurse/midwife I
Outreach J
NGO community based distributor K
Other private medical (specify) __________ L
Other source
Shop M
Religious institution N
Friend/relative O
Other (specify) __________ X

331 In the last 12 months, were you visited by a field worker who talked to you
about family planning?

Yes 1
No 2

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

Yes 1
No 2 (Go to 401)

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

Yes 1
No 2

Section 4a. Pregnancy, Postnatal Care and Breastfeeding

401 Check 224:

One or more births in 1995 or later
No births in 1995 or later (Go to 484)

402 Enter in the table the line number, name, and survival status of each birth in 1995 or later.
Ask the questions about all of these births. Begin with the last birth. (If there are more than 2 births, use last column of additional questionnaires).

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

403 Line number from 212

__

404 From 212 and 216

Name____

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 not want to have any (more) children at all?

Then 1 (Go to 407)
Later 2
Not at all 3 (Go to 407)

406 How much longer would you like to have waited?

Months 1 ___
Years 2 ___
Don't know 998

407 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.
[Last Birth Only]

Health professional
Doctor A
Midwife/nurse B
Medical assistant/clinical officer C
Nursing aide D
Other persons
Traditional birth attendant E
Other (specify) __________ X
No one Y (Go to 415)

408 How many months pregnant were you when you first received antenatal care for this pregnancy?
[Last Birth Only]

Months ___
Don't know 98

409 How many times did you receive antenatal care during this pregnancy?
[Last Birth Only]

Number of times ___
Don't know 98

410 Check 407:

Code A, B, C or D circled
Code E, X or Y circled (Go to 412)

410a Check 409: Number of times received antenatal care

Once
More than once or don't know (Go to 411)

410b Where did you see the (health professional mentioned in 407) for antenatal care?
[Last Birth Only]

Name of last birth __________
Public sector
Government hospital 21
Government health center 22
Government health/AID post 23
Other public (specify) __________ 26
Private medical sector
Private hospital/clinic 31
Other private medical (specify) __________ 36
Other (specify) __________ 96

411 How many months pregnant were you the last time you received antenatal care?

Months ___
Don't know 98

411a Where did you see the (health professional mentioned in 407) the last time you saw someone for antenatal care?
[Last Birth Only]

Public sector
Government hospital 21
Government health center 22
Government health/AID post 23
Other public (specify) __________ 26
Private medical sector
Private hospital/clinic 31
Other private medical (specify) __________ 36
Other (specify) __________ 96

412 When you were pregnant with (name), were any of the following done at least once?
[Last Birth Only]

Were you weighed?
Yes 1
No 2
Was your height measured?
Yes 1
No 2
Was your blood pressure measured?
Yes 1
No 2
Did you give a urine sample?
Yes 1
No 2
Did you give a blood sample?
Yes 1
No 2

413 Sometimes a pregnancy can have complications that lead to miscarriage or even death. Were you told about the signs of pregnancy complications?
[Last Birth Only]

Yes 1
No 2 (Go to 415)
Don't remember 8 (Go to 415)

413a What are some of the signs and symptoms that indicate that a pregnancy may be in danger?
Probe: Any other signs or symptoms?
Record all signs and symptoms mentioned.
[Last Birth Only]

Vaginal bleeding A
High fever B
Abdominal pain C
Swelling of hands and feet D
Difficult labor for more than 12 hours E
Convulsions F
Other (specify) __________ X
Don't know any signs or symptoms Y

414 Were you told where to go or what to do if you had any of these signs?
[Last Birth Only]

Yes 1
No 2
Don't remember 8

415 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?
[Last Birth Only]

Yes 1
No 2 (Go to 417)
Don't know 8 (Go to 417)

416 When you were pregnant with (name), how many times did you get this injection?
[Last Birth Only]

Times ___
Don't know 8

417 When you were pregnant with (name), were you given or did you buy any iron tablets or iron syrup?
Show tablet/syrup.
[Last Birth Only]

Yes 1
No 2 (Go to 419)
Don't know (Go to 419)

418 During the whole pregnancy, for how many days did you take the tablets or syrup?
If answer is not numeric, probe for approximate number of days.
[Last Birth Only]

Number of days ___
Don't know 998

419 When you were pregnant with (name), did you have difficulty with your vision during the daylight?
[Last Birth Only]

Yes 1
No 2
Don't know 8

420 When you were pregnant with (name), did you suffer from night blindness (use local term)?
[Last Birth Only]

Yes 1
No 2
Don't know 8

421 When you were pregnant with (name), did you take any drugs in order to prevent you from malaria?
[Last Birth Only]

Yes 1
No 2 (Go to 423)
Don't know 8 (Go to 423)

422 What drugs did you take?
Record all mentioned.
If type of drug is not determined, show typical antimalarial drugs to respondent.
[Last Birth Only]

Fansidar A
Chloroquine B
Metakelfin C
Camaquine D
Quinine E
Don't know F
Other (specify) __________ X

422a Check 407:

Code 'Y' circled (Go to 423)
Code 'Y' not circled

422b Did you get these medicines during an antenatal visit, another health facility visit or from some other source?
[Last Birth Only]

Antenatal visit 1
Another visit 2
Other source (specify) __________ 6

423 When (name) was born, was he/she very big, bigger than average, average, smaller than average, or very small?

Very big 1
Bigger than average 2
Average 3
Smaller than average 4
Very small 5
Don't know 8

424 Was (name) weighed at birth?

Yes 1
No 2 (Go to 426)
Don't know 8 (Go to 426)

425 How much did (name) weigh?
Record weight from health card, if available.

Name of last birth __________
Name of next-to-last birth __________
Kilograms from card 1 ___
Kilograms from recall 2 ___
Don't know 998

425a Has (name) been registered?

Yes 1
No 2 (Go to 426)
Don't know 8 (Go to 426)

425b Does (name) have a birth certificate?
If Yes, may I see it, please?

Seen, short certificate 1
See, long certificate 2
Seen, both certificates 3
Not seen 4

426 Who assisted with the delivery of (name)?
Anyone else?
Probe for the type of person and record all persons who assisted.

Health professional
Doctor A
Midwife/nurse B
Medical assistant/clinical officer C
Nursing AIDE D
Other person
Traditional birth attendant E
Relative/friend F
Other (specify) __________ X
No one Y

427 Where did you give birth to (name)?

Home
Your home 11 (Go to 429)
TBA's home 12 (Go to 429)
Other home 13 (Go to 429)

Public sector
Government hospital 21
Government health center 22
Government health/AID post 23
Other public (specify) __________ 26
Private medical sector
Private hospital/clinic 31
Other private medical (specify) __________ 36
Other (specify) __________ 96 (Go to 429)

428 Was (NAME) delivered by caesarian section?

YES 1 (GO TO 433)
NO 2 (GO TO 433)

429 After (name) was born, did a health professional or a traditional birth attendant check on your health?

Yes 1
No 2 (Go to 433)

430 How many days or weeks after the delivery did the first check take place?
Record '00' days if same day.
[Last Birth Only]

Days after delivery 1 ___
Weeks after delivery 2 ___
Don't know 998

431 Who checked on your health at the time of the first check?
Probe for most qualified person.
[Last Birth Only]

Health professional
Doctor 11
Midwife/nurse 12
Medical assistant/clinical officer 13
Nursing AIDE 14
Other person
Traditional birth attendant 21
Other (specify) __________ 96

432 Where did this first check take place?
[Last Birth Only]

Home
Your home 11
Other home 12
TBA's home 13
Public sector
Government hospital 21
Government health center 22
Government health/AIDE post 23
Other public (specify) __________ 26
Private medical sector
Private hospital/clinic 31
Other private medical (specify) __________ 36
Other (specify) __________ 96

432a Within the first six weeks after delivery, how many times did you have a check up?
[Last Birth Only]

Number of times ___
Don't remember 98

433 In the first two months after delivery, did you receive a vitamin A dose like this one?
Show ampule/capsule/syrup.
[Last Birth Only]

Yes 1
No 2

434 Has your period returned since the birth of (name)?
[Last Birth Only]

Yes 1 (Go to 436)
No 2 (Go to 437)

435 Did your period return between the birth of (name) and your next pregnancy?
[Next-To-Last Birth Only]

Yes 1
No 2 (Go to 439)

436 For how many months after the birth of (name) did you not have a period?
[Last Birth Only]

Months ___
Don't remember 98

437 Check 226:
Respondent pregnant?

Not pregnant
Pregnant or unsure (Go to 439)

438 Have you resumed sexual relations since the birth of (name)?
[Last Birth Only]

Yes 1
No 2 (Go to 440)

439 For how many months after the birth of (name) did you NOT have sexual relations?

Months ___
Don't remember 98

440 Did you ever breastfeed (name)?

Yes 1
No 2 (Go to 447)

441 How long after birth did you first put (name) to the breast?

IMMEDIATELY 000
HOURS 1
DAYS 2

442 Within the first three days after delivery, before your milk began flowing regularly, was (name) given anything to drink other than breast milk?

Yes 1
No 2 (Go to 444)

443 What was (name) given to drink before your milk began flowing regularly?
Anything else?
Record all mentioned.

Milk (other than breast milk) A
Plain water B
Sugar or glucose water C
Gripe water D
Salt and sugar solution E
Fruit juice F
Infant formula G
Tea/infusions H
Honey I
Other (specify) __________ X

444 Check 404: Child alive?

Alive
Dead (Go to 446)

445 Are you still breastfeeding (name)?
[Last Birth Only]

Yes 1 (Go to 448)
No 2

446 For how many months did you breastfeed (name)?

Months ___
Don't know 98

446a After how many months did you start giving (name) fluids including water?
If not yet, record '90'.

Months ___
Don't know 98

446b After how many months did you start giving (name) solid foods, i ncluding porridge?

Months ___
Don't know 98

447 Check 404: Child alive?

Alive (Go to 450a)
Dead (skip back to 405 in next column; or, if no more births, Go to 454)

448 How many times did you breastfeed last night between sunset and sunrise (i.e. between going to bed and waking up)?
If answer is not numeric, probe for approximate number.
[Last Birth Only]

Number of nighttime feedings ___

449 How many times did you breastfeed yesterday during the daylight hours?
If answer is not numeric, probe for approximate number.
[Last Birth Only]

Number of daylight feedings ___

450 Did you give (name) anything other than breast milk yesterday or last ngiht?

Yes 1
No 2 (Go to 453)
Don't know 8 (Go to 453)

450a What did you use to give (name) something yesterday or last night?

Cup with spout A
Bottle with nipple B
Spoon C
Hand D
Don't know E
Other (specify) __________ X

451 Was sugar added to any of the foods or liquids (name) ate yesterday?

Yes 1
No 2
Don't know 8

452 How many times did (name) eat solid, semi-solid or soft foods other than liquids yesterday during the day or at night?
If 7 or more times, record '7'.

Number of times ___
Don't know 8

453

Go back to 405 in next column; or, if no more births, Go to 454
Go back to 405 in last column of new questionnaire; or, if no more births, Go to 454

454 Enter in the table the line number, name, and survival status of each birth in 1995 or later. (If there are more than 2 births, use last column of additional questionnaires).

455 Line number from 212

___

456 From 212 and 216:

Name __________
Alive
Dead (Go to 456 in next column; or, if no more births, Go to 484)

457 Did (name receive a Vitamin A dose like this one during the last 6 months?
Show ampule/capsule/syrup.

Yes 1
No 2
Don't know 8

458 Do you have a card where (name)'s vaccinations are written down?
If Yes, may I see it please?

Yes 1
No 2
Don't know 8

459 Did you ever have a vaccination card for (name)?

Yes 1 (Go to 462)
No 2 (Go to 462)

460
(1) Copy vaccination date for each vaccine from the card
(2) Write '44' in 'Day' column if card shows that a vaccination was given, but no date is recorded

BCG
Day ___
Month __________
Year _____
Polio 0 (polio given 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 _____
Vitamin A (most recent)
Day ___
Month __________
Year _____

461 Has (name) received any vaccinations that are not recorded on this card, including vaccinations received during the National Immunization Day campaign?
Record 'Yes' only if respondent mentions BCG, polio, DPT, and/or measles vaccine(s).

Yes 1 (probe for vaccinations and write '66' in the corresponding day column in 460 if the boxes are blank) (Go to 464)
No 2 (Go to 464)
Don't know 8 (Go to 466)

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

Yes 1
No 2 (Go to 466)
Don't know 8 (Go to 466)

463 Please tell me if (name) received any of the following vaccinations

463a A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

Yes 1
No 2
Don't know 8

463b Polio vaccine, that is, drops in the mouth?

Yes 1
No 2 (Go to 463e)
Don't know 8 (Go to 463e)

463c When was the first polio vaccine received, just after birth or later?

Just after birth 1
Later 2

463d How many times was the polio vaccine received?

Number of times ___

463e DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

Yes 1
No 2 (Go to 463g)
Don't know 8 (Go to 463g)

463f How many times?

Number of times ___

463g An injection to prevent measles?

Yes 1 (Go to 466)
No 2 (Go to 466)

464 Were any of the vaccinations (name) received during the last two years given as a part of a National Immunization Day campaign?

Yes 1
No 2 (Go to 466)
No vaccination in the last 2 years (Go to 466)
Don't know (Go to 466)

465 At which National Immunization Day campaigns did (name) receive vaccinations?
Record all mentioned.

Polio (Aug/Sept 1998) A
Polio (Aug/Sept 1999) B
Measles (Mar/Apr 2000) C
Polio (Aug/Sep/Oct 2000) D

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

Yes 1
No 2
Don't know 8

467 Has (name) had an illness with a cough at any time in the last 2 weeks?

Yes 1
No 2 (Go to 469)
Don't know 8 (Go to 469)

468 When (name) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths?

Yes 1
No 2
Don't know 8

469 Check 466 and 467:
Fever or cough?

'Yes' in 466 or 467
Other (Go to 474)

470 Did you seek advice or treatment for the fever/cough?

Yes 1
No 2 (Go to 472)

471 Where did you seek advice or treatment?
Anywhere else?
Record all mentioned.

Public sector
Government hospital A
Government health center B
Government AID post C
Clinic/outreach services D
Community health worker E
Other public (specify) __________ F
Private medical sector
Private hospital/clinic G
Pharmacy/drug shop H
Private doctor I
Other private medical (specify) __________ X

472 Check 466:
Had fever?

'Yes' in 466
'No' or 'don't know' in 466 (Go to 474)

473 Does (name) have a fever now?

Yes 1
No 2 (Go to 474)
Don't know 8 (Go to 474)

473A) Was (NAME) given any medicines for the fever?

YES 1
NO 2
DON'T KNOW 8

473B) In the past 2 weeks, which medicines were given to (NAME)? ASK TO SEE MEDICINE(S). IF NOT SEEN, SHOW MEDICINE(S) TO RESPONDENT. RECORD ALL MENTIONED

ANTI-MALARIAL
CHLOROQUINE A
FANSIDAR B
CAMAQUINE C
QUININE D
OTHER DRUGS
ASPIRIN E
PANADOL F
TRADITIONAL HERBS G
OTHER (SPECIFY) ________ X
DON'T KNOW Z

473C) CHECK 473B: WHICH MEDICINES?

CODE "A" CIRCLED (GO TO 473D)
CODE "A" NOT CIRCLED (GO TO 473G)

473D) How long after the fever started did (NAME) first take Chloroquine?

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

473E) For how many days did (NAME) take Chloroquine for the fever? IF 7 OR MORE DAYS, RECORD '7'.

DAYS
DON'T KNOW 8

473F) Where did you get the Chloroquine for (NAME)'s fever?

PHARMACY/DRUG SHOP A
GOV'T HEALTH FACILITY B
NGO HEALTH FACILITY C
OTHER PRIVATE HEALTH FACILITY D
COMMUNITY HEALTH WORKER E
FRIEND/NEIGHBOR F
HOME SUPPLY G
OTHER (SPECIFY) _______ X
DON'T KNOW Z

473G) CHECK 473B: WHICH MEDICINES?

CODE "B" CIRCLED (GO TO 473H)
CODE "B" NOT CIRCLED (GO TO 473K)

473H) How long after the fever started did (NAME) first take Fansidar?

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

473I) For how many days did (NAME) take Fansidar for the fever? IF 7 OR MORE DAYS, RECORD '7'.

DAYS
DON'T KNOW 8

473J) Where did you get the Fansidar for (NAME)'s fever?

PHARMACY/DRUG SHOP A
GOV'T HEALTH FACILITY B
NGO HEALTH FACILITY C
OTHER PRIVATE HEALTH FACILITY D
COMMUNITY HEALTH WORKER E
FRIEND/NEIGHBOR F
HOME SUPPLY G
OTHER (SPECIFY) _____ X
DON'T KNOW Z

473K) CHECK 473B: WHICH MEDICINES?

CODE "C" CIRCLED (GO TO 473L)
CODE "C" NOT CIRCLED (GO TO 473O)

473L) How long after the fever started did (NAME) first take Camaquine?

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

473M) For how many days did (NAME) take Camaquine for the fever? IF 7 OR MORE DAYS, RECORD '7'.

DAYS
DON'T KNOW 8

473N) Where did you get the Camaquine for (NAME)'s fever?

PHARMACY/DRUG SHOP A
GOV'T HEALTH FACILITY B
NGO HEALTH FACILITY C
OTHER PRIVATE HEALTH FACILITY D
COMMUNITY HEALTH WORKER E
FRIEND/NEIGHBOR F
HOME SUPPLY G
OTHER (SPECIFY) _______ X
DON'T KNOW Z

473O) CHECK 473B: WHICH MEDICINES?

CODE "D" CIRCLED (GO TO 473P)
CODE "D" NOT CIRCLED (GO TO 474)

473P) How long after the fever started did (NAME) first take Quinine?

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

473Q) For how many days did (NAME) take Quinine for the fever? IF 7 OR MORE DAYS, RECORD '7'.

DAYS
DON'T KNOW 8

473R) Where did you get the Quinine for (NAME)'s fever?

PHARMACY/DRUG SHOP A
GOV'T HEALTH FACILITY B
NGO HEALTH FACILITY C
OTHER PRIVATE HEALTH FACILITY D
COMMUNITY HEALTH WORKER E
FRIEND/NEIGHBOR F
HOME SUPPLY G
OTHER (SPECIFY) _______ X
DON'T KNOW Z

474 Do you have any mosquito nets in your house?

Yes 1
No 2 (Go to 475)

Check first column:

Has mosquito nets
Does not have mosquito nets (sip to 475)

474a Does (name) usually sleep under a mosquito net?

Yes 1
No 2

474b Did (name) usually sleep under a mosquito net?

Yes 1
No 2

474c Check 474a and 474b:

Code '1' circle for either or both
Code '1' circled for neither

474d How long ago was the mosquito net bought or obtained?
If less than 1 month, record '00'.
If more than 84 months record '84'.

Months ___
Don't know 98

474e Since you got the mosquito net, was it ever soaked or dipped in a liquid to repel mosquitoes or bugs?

Yes 1
No 2 (Go to 475)
Don't know 8 (Go to 475)

474f How long ago was the mosquito net last soaked or dipped?
If less than 1 month record '00'.
If more than 84 months, record '84'.

Name of last birth __________
Months ___
Don't know 98

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

Yes 1
No 2 (Go to 483)
Don't know 8 (Go to 483)

476 How much was (name) given to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?

If less, probe: Was he/she given much less than usual to drink or somewhat less?

Much less 1
Somewhat less 2
About the same 3
More 4
Nothing to drink 5
Don't know 8

477 When (name) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

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

If less, probe: was he/she given much less than usual to eat or somewhat less?

478 Was he/she given any of the following to drink?

A fluid made from a special packet called (local name)?
Yes 1
No 2
Don't know 8
A government-recommended home-made fluid?
Yes 1
No 2
Don't know 8

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

Yes 1
No 2 (Go to 481)
Don't know 8 (Go to 481)

480 What was given to treat the diarrhea? Anything else?
Record all mentioned.

Tablet or syrup A
Injection B
(I.V.) Intravenous C
Home remedies/herbal medicines D
Other (specify) __________ X

481 Did you seek advice or treatment for the diarrhea?

Yes 1
No 2 (Go to 483)

482 Where did you seek advice or treatment?
Anywhere else?
Record all mentioned.

Name of last birth __________
Public sector
Government hospital A
Government health center B
Government health post C
Clinic/outreach services D
Community health worker E
Other public (specify) __________ F
Private medical sector
Private hospital/clinic G
Pharmacy/drugshop H
Private doctor I
Mobile clinic J
Other private medical (specify) __________ K
Other source
Shop L
Traditional practitioner M
Home N
Other (specify) __________ X

483 Skip back to 456 in next column; or, if no more births, Go to 484.

484 Check 456, all columns:
Number of living children born in 1995 or later

One or more
None (Go to 487)

485 What is usually done to dispose of (name of child/youngest child)'s stools when he/she does not use any toilet facility?

Child always uses toilet/latrine 01
Throw in the toilet/latrine 02
Throw outside the dwelling 03
Throw outside the yard 04
Bury in the yard 05
Other (specify) __________ 96

486 Check 478: All columns

No child received fluid from ORS packet
Any child received fluid from ORS packet (Go to 488)

487 Have you ever heard of a special product called (local name for ORS packet) you can get for the treatment of diarrhoea?

Yes 1
No 2

488 Check 218:

Has one or more children living with her
Has no children living with her (Go to 494)

489 When (your child/one of your children) is seriously ill, who decides whether or not the child should be taken for medical treatment?
If says no child ever seriously ill, ask:
If (your child/one of your children) Because seriously ill, could you decide by yourself whether the child should be taken for medical treatment?

Respondent 1
Respondent and other person(s) 2
Other person(s) 3

489a Sometimes children have severe illnesses and should be taken immediately to a health facility. What type of symptoms would cause you to take your child to a health facility right away?
Record all symptoms mentioned.

Child not able to eat or drink or breastfeed A
Child becomes sicker B
Child develops a fever C
Child has difficulty in breathing D
Child has blood in stool E
Child drinks poorly F
Other (specify) __________ G
Other (specify) __________ H
Other (specify) __________ I

491 Check 215 and 218:
Has at least one child born in 1997 or later and living with her (ecord name of youngest child living with her and continue to 492)

Name __________

Does not have any children born in 1997 or later and living with her (Go to 494)

492 Now I would like to ask you about liquids (name from question 491) drank over the last seven days, including yesterday.

How many days during the last seven days did (name from question 491) drink each of the following?
For each item given at least once in last seven days, before proceeding to the next item, ask:
In total, how many times yesterday during the day or at night did (name form question 491) drink (item)?

a) Any food made from grains: such as rice, posho, porridge, bread, chapati, pasta/macaroni or pizza? Matooke?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

b) Pumpkins, white or purple yams, carrots, or yellow sweet potatoes?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

c) Any other food made from roots or tubers such as Irish potatoes or cassava?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

d) Any green leafy vegetables such as dodo, nakati, bugga, sungsa, jjobyo, sukumaweek or marakwang?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

e) Mango or paw-paw?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

f) Any other fruits and vegetables: oranges, bananas, apples, guavas, jack fruit, water melon, berries, avocados, tomatoes, green beans, or cabbage?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

g) Meat (beef, pork or goat/mutton), poultry (chicken, duck or other birds), fish, insects (such as ants and grasshoppers), or eggs?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

h) Any food made from legumes: lentils, beans, soybeans, cow peas, pidgeon peas (nkolimbo or lapena) or groundnuts? Simsim (sesame seeds)?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

i) Milk and other dairy products such as cheese, yoghurt/sour milk/curdled milk?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

j) Any food made with oil, fat, butter or ghee?

Number of days within the last 7 days ___
Number of times during yesterday/last night ___

If 7 or more times, record '7'.
If don't know, record '8'.

494 Check 474 or 474 not asked

Has mosquito net
Does not have mosquito net (Go to 495)

494a Do you always sleep under a mosquito net?

Yes 1
No 2

494b Did you sleep under a mosquito net last night?

Yes 1
No 2

494c Check 494a and 494b:

Code '1' circled for either or both
Code '1' circled for neither (Go to 495)

494d How long ago was the mosquito net bought or obtained?
If less than 1 month, record '00'.
If more than 84 months, record '84'.

Months ___
Don't know 98

494e Since you got the mosquito net, was it ever soaked or dipped in a liquid to repel mosquitoes or bugs?

Yes 1
No 2 (Go to 495)
Don't know 8 (Go to 495)

494f How long ago was the mosquito net last soaked or dipped?
If less than 1 month, record '00'.
If more than 84 months, record '84'.

Months ___
Don't know 98

495 The last time you prepared a meal for your family, before starting did you wash your hands?

Yes 1
No 2
Never prepared meal 3

496 A number of factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not for you?

Knowing where to go

Big problem 1
Not a big problem 2

Getting permission to go

Big problem 1
Not a big problem 2

Getting money needed for treatment

Big problem 1
Not a big problem 2

The distance to the health facility

Big problem 1
Not a big problem 2

Having to take transport

Big problem 1
Not a big problem 2

Not wanting to go alone

Big problem 1
Not a big problem 2

Concern that there may not be a female health provider

Big problem 1
Not a big problem 2

Negative attitude of health provider

Big problem 1
Not a big problem 2

Section 5. Marriage and Sexual Activity

501 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

502 Have you ever been married or lived with a man?

Yes, formerly married 1
Yes, lived with a man 2 (Go to 510)
No 3 (Go to 514)

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

Widowed 1 (Go to 510)
Divorced 2 (Go to 510)
Separated 3 (Go to 510)

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

Living with her 1
Staying elsewhere 2

506 Record the husband's/partner's name and line number from the household questionnaire. If he is not listed in the household, record '00'.

Name __________
Line number ___

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

Yes 1
No 2 (Go to 510)
Don't know 8 (Go to 510)

508 How many other wives does he have?

Number ___
Don't know 98

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

Only once 1
More than once 2

511 Check 510:
Married/lived with a man only once
In what month and year did you start living with your husband/parnter?

Month __________
Don't know month 98
Year _____
Don't know year 9998

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 __________
Don't know month 98
Year _____
Don't know year 9998

512 How old were you when you started living with him?

Age ___

514 Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
How old were you when you first had sexual intercourse (if ever)?

Never 00 (Go to 524)
Age in years ___
First time when married 95 (Go to 515)

514a Did that partner become your husband or did you go ahead to live with him?

Yes 1
No 2

514b At the time you first had sex, how old was your partner?

Age in years ___
Don't know 96

515 When was the last time you had sexual intercourse?
Record 'years ago' only if last intercourse was one or more years ago.

Days ago 1 ___
Weeks ago 2 ___ (Go to 516)
Months ago 3 ___ (Go to 516)
Years ago 4 ___ (Go to 524)

515a In the last one week, how many times did you have sexual intercourse with any man?

Number of times ___
Don't know 96

516 The last time you had sexual intercourse, was a condom used?

Yes 1
No 2 (Go to 516b)

516a What was the main reason you used a condom on that occasion?

Respondent wanted to prevent STD/HIV 01 (Go to 517)
Respondent wanted to prevent pregnancy 02 (Go to 517)
Respondent wanted to prevent both STD/HIV and pregnancy 03 (Go to 517)
Did not trust partners/feels partner has other partners 04 (Go to 517)
Partner insisted 05 (Go to 517)
Other (specify) __________ 96 (Go to 517)
Don't know 98

516b What was the main reason for not using a condom?

Respondent wanted to become pregnant 01
Trusted partner 02
Partner insisted 03
Other (specify) __________ 96
Don't know 98

517 What is your relationship to the man with whom you last had sex?
If man is 'boyfriend' or 'fiancé', ask:
Was your boyfriend/fiancé living with you when you last had sex?
If Yes, circle '01'.
If No, circle '02'.

Spouse/cohabiting partner 01 (Go to 519)
Man is boyfriend/fiancé 02
Other friend 03
Casual acquaintance 04
Relative 05
Commercial sex worker 06
Other (specify) __________ 96

518 For how long have you had sexual relations with this man?

Days 1 ___
Weeks 2 ___
Months 3 ___
Years 4 ___

519 Have you had sex with any other man in the last 12 months?

Yes 1
No 2 (Go to 524)

520 The last time you had sexual intercourse with another man, was a condom used?

Yes 1
No 2 (Go to 521)

520a What was the main reason you used a condom on that occasion?

Respondent wanted to prevent STD/HIV 01
Respondent wanted to prevent pregnancy 02
Respondent wanted to prevent both STD/HIV and pregnancy 03
Did not trust partners/feels partner has other partners 04
Partner insisted 05
Other (specify) __________ 96
Don't know 98

521 What is your relationship to this man?
If man is 'boyfriend' or 'fiancé', ask:
Was your boyfriend/fiancé living with you when you last had sex with im?
If Yes, circle '01'.
If No, circle '02'.

Spouse/cohabiting partner 01 (Go to 523)
Man is boyfriend/fiancé 02
Other friend 03
Casual acquaintance 04
Relative 05
Commercial sex worker 06
Other (specify) __________ 96

522 For how long have you had sexual relations with this man?

Days 1 ___
Weeks 2 ___
Months 3 ___
Years 4 ___

522a Other than these two men, have you had sexual intercourse with anyone else in the last 12 months?

Yes 1
No 2 (Go to 524)

522b The last time you had sexual intercourse with this other man, was a condom used?

Yes 1
No 2 (Go to 522d)

522c What was the main reason you used a condom on that occasion?

Respondent wanted to prevent STD/HIV 01
Respondent wanted to prevent pregnancy 02
Respondent wanted to prevent both STD/HIV and pregnancy 03
Did not trust partners/feels partner has other partners 04
Partner insisted 05
Other (specify) __________ 96
Don't know 98

522D) What is your relationship to this other man? IF MAN IS "BOYFRIEND" OR "FIANCE", ASK: Was your boyfriend/fiance living with you when you had sex with him? IF YES, CIRCLE '01'. IF NOR, CIRCLE '02'.

SPOUSE/COHABITING PARTNER 01 (GO TO 523)
MAN IS BOYFRIEND/FIANCE 02
OTHER FRIEND 03
CASUAL ACQUAINTANCE 04
RELATIVE 05
COMMERCIAL SEX WORKER 06
OTHER (SPECIFY) _______ 96

522e For how long have you had a sexual relationship with this man?

Days 1 ___
Weeks 2 ___
Months 3 ___
Years 4 ___

523 In total, how many different men have you had sex with in the last 12 months?

Number of partners ___

523B When having sex with a non-regular partner, how often do you use a condom?

No non-regular partner 1
Never used 2
Less often 3
Often 4
Always 5

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

Yes 1
No 2 (Go to 527)

525 Where is that?
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.

Name of place __________

Any other place?
Record all mentioned.

Public sector
Government hospital A
Government health center B
Family planning clinic C
Outreach D
Government community based distributor E
Other public (specify) __________ F
Private medical sector
Private hospital/clinic G
Pharmacy/drug shop H
Private doctor/nurse/midwife I
Outreach J
NGO community based distributor K
Other private medical (specify) __________ L
Other source
Shop M
Religious institution N
Friends/relatives O
Street vendor P
Lodge Q
Other (specify) __________ X
Other (specify) __________ 96

526 If you wanted to, could you yourself obtain a condom?

Yes 1
No 2 Don't know/unsure 8

526a If you had a condom, could you convince your partner to use it?

Yes 1
No 2
Don't know/unsure 8

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

Yes 1
No 2 (Go to 601)

528 Where is that?
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.

Name of place __________

Any other place?
Record all mentioned.

Public sector
Government hospital A
Government health center B
Family planning clinic C
Outreach D
Government community based distributor E
Other public (specify) __________ F
Private medical sector
Private hospital/clinic G
Pharmacy/drug shop H
Private doctor/nurse/midwife I
Outreach J
NGO community based distributor K
Other private medical (specify) __________ L
Other source
Shop M
Religious institution N
Friends/relatives O
Street vendor P
Lodge Q
Other (specify) __________ X

529 If you wanted to, could you yourself obtain a female condom?

Yes 1
No 2
Don't know/unsure 8

Section 6. Fertility Preferences

601 Check 311/311a:

Neither sterilized
He or she sterilized (Go to 614)

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 now, 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 604)
Says she can't get pregnant 3 (Go to 614)
Undecided/don't know and pregnant 4 (Go to 610)
Undecided/don't know and not pregnant or unsure 5 (Go to 608)

603 Check 226:

Not pregnant or unsure ___
How long would you like to wait from now before the birth of (a/another) child?

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

Months 1 ___
Years 2 ___
Soon/now 993 (Go to 609)
Says she can't get pregnant 994 (Go to 614)
After marriage 995 (Go to 609)
Other (specify) __________ 996 (Go to 609)
Don't know 998 (Go to 609)

604 Check 226:

Not pregnant or unsure
Pregnant (Go to 610)

605 Check 310: Using a method?

Not asked
Not currently using
Currently using (Go to 608)

606 Check 603:

Not asked
24 or more months or 02 or more years
00-23 months or 01 year (Go to 610)

607 Check 602:

Wants to have a/another child ___
You have said that you do not want (a/another) child soon , but you are not using any method to avoid pregnancy.
Can you tell me why?
Any other reason?
Record all mentioned.

Wants no more/none ___
You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy.
Can you tell me why?
Any other reason?

Fertility-related reasons
Not having sex B
Infrequent sex C
Menopausal/hysterectomy D
Subfecund/infecund E
Postpartum amenorrheic F
Breastfeeding G
Fatalistic H
Opposition to use
Respondent opposed I
Husband/partner opposed J
Others opposed K
Religious prohibition L
Lack of knowledge
Knows no method M
Knows no source N
Method-related reasons
Health concerns O
Fear of side effects P
Lack of access/too far Q
Cost too much R
Inconvenient to use S
Interferes with body's normal processes T
Other (specify) __________ X
Don't know Z

608 In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

Big problem 1
Small problem 2
No problem 3
Says she can't get pregnant/not having sex 4

609 Check 310: Using a method?

Not asked
No, not currently using
Yes, currently using (Go to 614)

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

Yes 1
No 2 (Go to 612)
Don't know (Go to 612)

611 Which method would you prefer to use?

Female sterilization 01 (Go to 614)
Male sterilization 02 (Go to 614)
Pill 03 (Go to 614)
IUD/coil 04 (Go to 614)
Injections 05 (Go to 614)
Implants 06 (Go to 614)
Condom 07 (Go to 614)
Female condom 08 (Go to 614)
Diaphragm 09 (Go to 614)
Foam/jelly 10 (Go to 614)
Lactational amenorrhea method 11 (Go to 614)
Periodic abstinence 12 (Go to 614)
Withdrawal 13 (Go to 614)
Other (specify) __________ 96 (Go to 614)
Unsure 98 (Go to 614)

612 What is the main reason that you think you will not use a method at any time in the future?

Fertility-related reasons
Infrequent sex/no sex 22
Menopausal/hysterectomy 23
Subfecund/infecund 24
Wants as many children as possible 26
Opposition to use
Respondent opposed 31
Husband/partner 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
Don't know 98

614 Check 216
Has living children ___
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

No living children ___
If you could choose exactly the number of children to have in your whole life, how many would that be?

Probe for a numeric response

Number ___
Other (specify) __________ 96 (Go to 616)

615 How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

Number of boys ___
Number of girls ___
Number of either ___
Other (specify) __________ 96

616 Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

Approve 1
Disapprove 2
Don't know/unsure 3

617 In the last six months have you heard/read 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
Billboards?
Yes 1
No 2
Community meeting/church?
Yes 1
No 2
Mobile van?
Yes 1
No 2

619 In the last six months, have you discussed the practice of family planning with your husband, partner, friends, neighbors, or relatives?

Yes 1
No 2 (Go to 621)

620 With whom?

__________

Anyone else?
Record all mentioned.

Husband/partner A
Mother B
Father C
Sister(s) D
Brother(s) E
Daughter F
Son G
Mother-in-law H
Friends/neighbors I
Other (specify) __________ X

621 Check 501:

Yes, currently married ___
Yes, living with a man ___
No, not in union ___ (Go to 628)

622 Check 311/311a:

Any code circled ___
No code circled ___ (Go to 624)

623 You have told me that you are currently using contraception. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision rod id you both decide together?

Mainly respondent 1
Mainly husband/partner 2
Joint decision 3
Other (specify) __________ 6

624 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
Don't know 8

625 How often have you talked to your husband/partner about family planning in the past year?

Never 1
Once or twice 2
More often 3

626 Check 311/311a:

Neither sterilized ___
He or she sterilized ___ (Go to 628)

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

Same number 1
More children 2
Fewer children 3
Don't know 8

628 Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted disease?
Yes 1
No 2
Don't know 8
She knows her husband has sex with other women?
Yes 1
No 2
Don't know 8
She has recently given birth?
Yes 1
No 2
Don't know 8
She is tired or not in the mood?
Yes 1
No 2
Don't know 8

Section 7. Husband's Background and Woman's Work

701 Check 501 and 502:

Currently married/living with a man ___
Formerly married/lived with a man ___ (Go to 703)
Never married and never lived with a man ___ (Go to 707)

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

Age in completed years ___

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

Yes 1
No 2 (Go to 706)

704 What was the highest level of school he attended: primary, secondary, or post-secondary?

Primary 1
Secondary 2
Post-secondary 3
Don't know 8 (Go to 706)

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

Grade ___
Don't know 98

706 Check 701:

Currently married/living with a man ___
What is your husband's/partner's occupation? That is, what kind of work does he mainly do?

Formerly married/lived with a man ___
What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?

Occupation __________

707 Aside from your own housework, during the past 7 days did you do any other work?

Yes 1
No 2 (Go to 710)

708 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 710)
No 2

709 Have you done any work in the last 12 months?

Yes 1
No 2 (Go to 719)

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

Occupation __________

711 Check 710:

Works in agriculture ___
Does not work in agriculture ___ (Go to 713)

712 Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

Own land 1
Family land 2
Rented land 3
Someone else's land 4
Public land 5
Communal land 6

713 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

714 Do you usually work at home or away from home?

Home 1
Away 2

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

Throughout the year 1
Seasonally/part of the year 2
Once in a while 3

716 Are you paid or do you earn in cash or kind for this work or are you not paid at all?

Cash only 1
Cash and kind 2
In kind only 3 (Go to 719)
Not paid 4 (Go to 719)

717 Who mainly decides how the money you earn will be used?

Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Respondent and someone else jointly 5

718 On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

Almost none 1
Less than half 2
About half 3
More than half 4
All 5
None, her income is all saved 6

719 Who in your family usually has the final say on the following decisions:

Your own health care?
Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Respondent and someone else jointly 5
Decision not made/not applicable 6
Children's health care?
Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Respondent and someone else jointly 5
Decision not made/not applicable 6
Making large household purchases?
Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Respondent and someone else jointly 5
Decision not made/not applicable 6
Making household purchases for daily needs?
Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Respondent and someone else jointly 5
Decision not made/not applicable 6
Visits to family or relatives?
Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Respondent and someone else jointly 5
Decision not made/not applicable 6
What food should be cooked each day?
Respondent 1
Husband/partner 2
Respondent and husband/partner jointly 3
Someone else 4
Respondent and someone else jointly 5
Decision not made/not applicable 6

720 Presence of others at this point (present and listening, present but not listening or not present)

Children ages less than ten
Present/listening 1
Present/not listening 2
Not present 8
Husband
Present/listening 1
Present/not listening 2
Not present 8
Other males
Present/listening 1
Present/not listening 2
Not present 8
Other females
Present/listening 1
Present/not listening 2
Not present 8

721 Sometimes a husband is annoyed or angered by things which his wife does. In your opinion, is a husband justified in hitting orb eating his wife in the following situations:

If she goes out without telling him?
Yes 1
No 2
Don't know 8
If she neglects the children?
Yes 1
No 2
Don't know 8
If she argues with him?
Yes 1
No 2
Don't know 8
If she refuses to have sex with him?
Yes 1
No 2
Don't know 8
If she burns the food?
Yes 1
No 2
Don't know 8

Section 8. AIDS and Other Sexually Transmitted Diseases

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

Yes 1
No 2 (Go to 818)

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

Yes 1
No 2 (Go to 809)
Don't know 8 (Go to 809)

803 What can a person do?

__________

Anything else?
Record all mentioned.

Abstain from sex A
Use condoms B
Limit sex to one partner/stay faithful to one partner C
Limit number of sexual partners D
Avoid sex with prostitutes E
Avoid sex with persons who have any partners F
Avoid sex with homosexuals
Avoid sex with persons who inject drugs intravenously H
Avoid blood transfusions I
Avoid injections J
Avoid kissing K
Avoid mosquito bites L
Seek protection from traditional practitioner M
Avoid skin piercing/cutting instruments N
Sharing syringe O
Sharing a toilet P
Avoid touching a person with AIDS Q
Avoid sharing food R
Other (specify) __________ W
Other (specify) __________ X
Don't know Z

804 Can people reduce their chances of getting the AIDS virus by having just one sex partner who has no other partners?

Yes 1
No 2
Don't know 8

805 Can a person get the AIDS virus from mosquito bites?

Yes 1
No 2
Don't know 8

806 Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?

Yes 1
No 2
Don't know 8

807 Can a person get the AIDS virus by sharing food with a person who has AIDS?

Yes 1
No 2
Don't know 8

809 Is it possible for a healthy-looking person to have te AIDS virus?

Yes 1
No 2
Don't know 8

810 Do you know someone personally (relative. friend or colleague) who has the virus that causes AIDS or someone who died from AIDS?

Yes 1
No 2

811 Can the virus that causes AIDS be transmitted from a mother to a child?

Yes 1
No 2 (Go to 813)
Don't know 8 (Go to 813)

812 When can the virus that causes AIDS be transmitted from a mother to a child:

During pregnancy?
Yes 1
No 2
Don't know 8
During delivery?
Yes 1
No 2
Don't know 8
During breastfeeding?
Yes 1
No 2
Don't know 8

813 Check 501:

Yes, currently married/living with a man ___
No, not in union ___ (Go to 815)

814 Have you ever talked about ways to prevent getting the virus that causes AIDS with (your husband/the man you are living with)?

Yes 1
No 2

815 If a person learns that he/she is infected with the virus that causes AIDS. should the person be allowed to keep this fact private or should this information be available to the community?

Can be kept private 1
Available to community 2
Don't know/not sure 8

815a In your opinion, is it acceptable or unacceptable for AIDS to be discussed:

On the radio?
Acceptable 1
Not acceptable 2
On the TV?
Acceptable 1
Not acceptable 2
In newspapers?
Acceptable 1
Not acceptable 2

816 If a member of your family became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?

Yes 1
No 2
Don't know/not sure/depends

817 If a female teacher has the AIDS virus, should she/he be allowed to continue teaching in the school?

Can continue 1
Should not continue 2
Don't know/not sure/depends 8

817a Should children aged 12-14 years be taught about using a condom to avoid AIDS/

Yes 1
No 2
Don't know/not sure/depends 8

817b Have you ever been tested to see if you have the AIDS virus?

Yes 1
No 2 (Go to 817e)

817c Where did you go for the test the last time?

Public sector
Government hospital 11
Government health center 12
Family planning clinic 13
Other public (specify) __________ 16
Private medical sector
Private hospital/clinic 21
Pharmacy 22
Private doctor 23
Other private medical (specify) __________ 26
Other (specify) __________ 96

817d Did you get the result?
Do not ask for the result.

Yes 1 (Go to 818)
No 2 (Go to 818)

817e Would you want to be tested for the AIDS virus?

Yes 1
No 2 (Go to 818)
Don't know/unsure 8 (Go to 818)

817f Do you know a place where you could go to get an AIDS test?

Yes 1
No 2 (Go to 818)

817g Where can you go for the test?
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.

Name of place __________

Any other place?
Record all mentioned.

Public sector
Government hospital A
Government health center B
Family planning clinic C
Other public (specify) __________ F
Private medical sector
Private hospital/clinic G
Pharmacy H
Private doctor I
Other private medical (specify) __________ L
Other (specify) __________ X

818 Apart from AIDS, have you heard about (other) infections that can be transmitted through sexual contact?

Yes 1
No 2 (Go to 901)

818a What infections do you know?
Record all mentioned.

Syphilis A
Gonorrhea B
Genital warts/Condylomata C
Chancroid D
Chlamydia E
Candida F
Other (specify) __________ X

818b Infections that are transmitted through sexual contact can cause problems if left untreated. What are some of these problems?
Record all mention.

Infertility A
Miscarriage/stillbirth B
Easier to get HIV C
Baby born sick D
Madness E
Other X
Don't know Y

819 If a woman has a sexually transmitted disease, what symptoms might she have?

Symptoms __________

Any others?
Probe; do not read out the options. Record all mentioned.

Abdominal pain A
Genital discharge B
Foul smelling discharge C
Burning pain on urination D
Redness/inflammation in genital area E
Swelling in genital area F
Genital sores/ulcers G
Genital warts H
Genital itching I
Blood in urine J
Loss of weight K
Hard to get pregnant/have a child L
Other (specify) __________ W
Other (specify) __________ X
No symptoms Y
Don't know Z

819a If a man has a sexually transmitted disease, what symptoms might she have?

Symptoms __________
Abdominal pain A
Genital discharge B
Foul smelling discharge C
Burning pain on urination D
Redness/inflammation in genital area E
Swelling in genital area F
Genital sores/ulcers G
Genital warts H
Genital itching I
Blood in urine J
Loss of weight K
Impotency/sterility L
Other (specify) __________ W
Other (specify) __________ X
No signs/symptoms Y
Don't know Z

820 Check 514:

Has had sexual intercourse ___
Has not had sexual intercourse ___ (Go to 901)

820a Now I would like to ask you some questions about your health in the last 12 months.
During the last 12 months, have you had a sexually-transmitted disease?

Yes 1
No 2 (Go to 820c)
Don't know 8 (Go to 820c)

820b Which one?

Type of STD __________

Any other?
Record all mentioned.

Syphilis A
Gonorrhea B
Genital warts/Condylomata C
Chancroid D
Chlamydia E
Candida F
Other (specify) __________ X
Don't know Z

820c During the last 12 months, have you had a genital discharge (abnormal, itchy, smelly)?

Yes 1
No 2
Don't know 8

820d Sometimes women have a genital sore or ulcer.
During the last 12 months, have you had a genital sore or ulcer?

Yes 1
No 2
Don't know 8

820e Check 820b/820c/820d:

Has had an infection ___
Has not had an infection or does not know ___ (Go to 901)

820f The last time you had (infection from 820b/820c/820d) did you seek any kind of advice or treatment?

Yes 1
No 2 (Go to 820i)

820g The last time you had (infection from 820b/820c/820d), did you do any of the following? Did you...

Seek advice from a health worker in a clinic or hospital?
Yes 1
No 2
Seek advice or medicine from a traditional healer?
Yes 1
No 2
Seek advice or buy medicine in a drug shop or pharmacy?
Yes 1
No 2
Ask for advice from friends or relatives?
Yes 1
No 2
Do self medication?
Yes 1
No 2

820h When you had (infection from 820b/820c/820d), did you inform the person(s) (spouse/regular partner/casual partner) with whom you were having sex?

Yes 1
No 2
Some/not all 3

820i When you had (infection from 820b/820c/820d), did you do something to avoid infecting your sexual partner(s)?

Yes 1
No 2 (Go to 901)
Partner(s) already infected 3 (Go to 901)

820J What did you do to avoid infecting your partner(s)? Did you...

Stop having sex?
Yes 1
No 2
Use a condom when having sex?
Yes 1
No 2
Take medicine?
Yes 1
No 2
Advise him to have medical consultation?
Yes 1
No 2

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 preceding births ___

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

Name __________

905 Is (name) male or female?

Male 1
Female 2

906 Is (name) still alive?

Yes 1
No 2 (Go to 906)
Don't know 8

907 How old is (name)?

Age ___

908 In what year did (name) die?

Year _____ (Go to 910)
Don't know 9998

909 How many years ago did (name) die?

Years ago ___

910 How old was (name) when he/she died?
If male, or died before 12 years of age, Go to next birth)

Age ___

911 Was (name) pregnant when she died?

Yes 1 (Go to 915)
No 2

912 Did (name) die during childbirth?

Yes 1 (Go to 915)
No 2

913 Did (name) die within 2 months after the end of a pregnancy or childbirth?

Yes 1
No 2

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

Number of children ___

916 Record the time.

Hours ___
Minutes ___

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 the supervisor __________
Date _____

Editor's observations

__________
__________

Name of the editor __________
Date _____