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UGANDA BUREAU OF STATISTICS

2006 UGANDA DEMOGRAPHIC AND HEALTH SURVEY WOMAN'S QUESTIONNAIRE - ENGLISH

IDENTIFICATION

REGION

DISTRICT

COUNTY

SUBCOUNTY/TOWN

PARISH/LC2 NAME

EA NAME

UDHS NUMBER

NAME OF HOUSEHOLD HEAD

HOUSEHOLD NUMBER

NAME AND LINE NUBER OF WOMAN

WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE

YES 1
NO 2

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME

RESULT

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

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER NUMBER
RESULT

TOTAL NUMBER OF VISITS

LANGUAGE OF QUESTIONNAIRE

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

LANGUAGE USED IN THE INTERVIEW

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

NATIVE LANGUAGE OF RESPONDENT

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

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

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ________and I am working with UGANDA BUREAU OF STATISTICS. We are conduction a national survey that asks women and men about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 60 and 90 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 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101) RECORD THE TIME.

HOURS ________
MINUTES ________

102) 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 104)
VISITOR 96 (GO TO 104)

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

CITY 1
TOWN 2
COUNTRYSIDE 3

104) In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

NUMBER OF TRIPS ________
NONE 00 (GO TO 106)

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

YES 1
NO 2

106) In what month and year were you born?

MONTH ________
DON'T KNOW MONTH 98
YEAR ________
DON'T KNOW YEAR 9998

107) How old were you at your last birthday?

COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

AGE IN COMPLETED YEARS ________

108) Have you ever attended school?

YES 1
NO 2 (GO TO 112)

109) What is the highest level of school you attended: primary, '0' level, 'A' level, or university or tertiary?

PRIMARY 1
'O' LEVEL 2
'A' LEVEL 3
TERTIARY 4
UNIVERSITY 5

110) What is the highest (class/year) you completed at that level?

CLASS/YEAR ________

111) CHECK 109:

PRIMARY (GO TO 112)
SECONDARY OR HIGHER (GO TO 115)

112) 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 LANGAUGE (SPECIFY LANGUAGE) ________ 4
BLIND/VISUALLY IMPAIRED 5

113) 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

114) CHECK 112:

CODE '2', '3' OR '4' CIRCLED (GO TO 115)
CODE '1' OR '5' CIRCLED (GO TO 116)

115) Do 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

116) Do 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

117) Do you watch television almost every day, at least once a week, less than once a week or not at all?

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

117A) In what level and grade do you think that children should start to be taught in English?

LEVEL
PRE-PRIMARY 0
PRIMARY 1
O LEVEL 2
A LEVEL 3
TERTIARY 4
UNIVERSITY 5
YEAR ________

118) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
PENTECOSTAL 4
SDA 5
OTHERS 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 did not survive?

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

210) CHECK 208:

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

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

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE STARTING WITH THE SECOND ROW).

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 ________ (GO TO 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), including any children who died after birth?

(STARTS WITH SECOND BIRTH)

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

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN TABLE.

YES 1
NO 2

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

NUMBERS ARE THE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED (Q. 215)
FOR EACH BIRTH SINCE JANUARY 2001: MONTH AND YEAR OF BIRTH ARE RECORDED.
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED (Q.217).
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED (Q.220).
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS (Q.220).
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 OR LATER. IF NONE RECORD '0' AND SKIP TO 226.

NUMBER ________

225) FOR EACH BIRTH SINCE JANUARY 2001, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227) How many months pregnant are you?

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

MONTHS ________

228) 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 237)

230) When did the last such pregnancy end?

MONTH ________
YEAR ________

231) CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 2001 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 2001 (GO TO 237)

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) Since January 2001, have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 235)

234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2001.

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 miscarriages, abortions or stillbirths that ended before 2001?

YES 1
NO 2 (GO TO 237)

236) When did the last such pregnancy that terminated before 2001 end?

MONTH ________
YEAR ________

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
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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 301)
DON'T KNOW 8 (GO TO 301)

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

SECTION 3. CONTRACEPTION

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

Which ways or methods have you heard about?

FOR MEHTHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever of (METHOD)?

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 SPOTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECORGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED 301, ASK 302.

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO 02)
02) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2 (GO TO 03)
03) PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2 (GO TO 04)
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2 (GO TO 05)
05) INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2 (GO TO 06)
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 (GO TO 07)
07) CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2 (GO TO 08)
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2 (GO TO 09)
09) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2 (GO TO 10)
10) RHYTHM METHOD: 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 (GO TO 11)
11) WITHDRAWL: Men can be careful and pull out before climax.
YES 1
NO 2 (GO TO 12)
12) EMERGENCY CONTRACEPTION: As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2 (GO TO 13)
13) 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: 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 that 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
09) LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
10) RHYTHM METHOD: 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
11) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
12) EMERGENCY CONTRACEPTION: As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2
13) 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) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

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

YES 1 (GO TO 306)
NO 2

305) ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH. (GO TO 333)

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 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 (GO TO 309)
WOMAN STERILIZED (GO TO 311A)

309) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 322)

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

YES 1
NO 2 (GO TO 322)

311) Which method are you using?
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.

CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

FEMALE STERILIZATION A (GO TO 316)
MALE STERILIZATION B (GO TO 316)
PILL C
IUD D (GO TO 315)
INJECTABLES E (GO TO 315)
IMPLANTS F (GO TO 315)
CONDOM G
FEMALE CONDOM H (GO TO 315)
DIAPHRAGM I (GO TO 315)
FOAM/JELLY J (GO TO 315)
LACTATIONAL AMEN. METHOD K (GO TO 319A)
RHYTHM METHOD L (GO TO 319A)
WITHDRAWAL M (GO TO 319A)
OTHER (SPECIFY) _________ X (GO TO 319A)

312) RECORD IF CODE C FOR PILL IS CIRCLED IN 311.
RECORD NAME OF BRAND IF PACKAGE SEEN.

YES (USING PILL): May I see the package of pills you are using?

NO (USING CONDOM BUT NOT PILL): May I see the package of condoms you are using?

PACKAGE SEEN 1 (GO TO 314)
BRAND NAME (SPECIFY) ________ (GO TO 314)
PACKAGE NOT SEEN 2

313) Do you know that brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

BRAND NAME (SPECIFY) _______
DON'T KNOW 98

314) How many (pill cycles/condoms) did you get the last time?

NUMBER OF PILL CYCLES/CONDOMS ________
DON'T KNOW 998

315) The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST ________ (GO TO 319A)
FREE 999995 (GO TO 319A)
DON'T KNOW 999998 (GO TO 319A)

316) In what facility di the sterilization take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ________
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) ________ 96
DON'T KNOW 98

316A) Who accompanied you?

RECORD ALL MENTIONED.

HUSBAND/SPOUSE A
BOYFRIEND B
SISTER/RELATIVE/FRIEND C
NO ONE D
OTHER (SPECIFY) ________ X

317) CHECK 311/311A;

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 'B' 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

318) How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?

COST_____
FREE 999995 (GO TO 319)
DON'T KNOW 999998

318A) Who paid the cost?
RECORD ALL MENTIONED.

HUSBAND/SPOUSE A
BOYFRIEND B
SISTER/RELATIVE/FRIEND C
RESPONDENT D
NO ONE E
OTHER X

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

MONTH___
YEAR____ (GO TO 320)

319A) Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH___
YEAR___

320) CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A.

YES (GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
NO (GO TO 321)

321) CHECK 319/319A:

YEAR IS 2001 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.)
YEAR IS 2000 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2001.) (GO TO 331)

322) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2001.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.

ILLUSTRATIVE QUESTIONS:

When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

323) CHECK 311/311A:
CIRCLE METHOD CODE.

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 333)
FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 324A)
RHYTHM METHOD 12 (GO TO 324A)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

324) Where did you obtain (CURRENT METHOD) when you started using it?
324A) Where did you learn to use the lactational amenorrhea/rhythm method?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
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

325) 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 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 332)
FEMALE CONDOM 08 (GO TO 329)
DIAPHRAGM 09 (GO TO 329)
FOAM/JELLY 10 (GO TO 329)
LACTATIONAL AMEN. METHOD 11 (GO TO 329)
RHYTHM METHOD 12 (GO TO 329)

326) You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 329)

327) At any other time were you ever told by health or family planning worker about side effects or problems you might have with the method?

YES 1
NO 2 (GO TO 329)

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

YES 1
NO 2

329) CHECK 326:

CODE '1' CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD from 323) FROM SOURCE OF METHOD FROM 316 OR 324) were you told about other methods of family planning that you could use?

YES 1 (GO TO 331)
NO 2

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

YES 1
NO 2

331) 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 335)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 332)
FEMALE CONDOM 08 (GO TO 329)
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 335)
RHYTHM METHOD 12 (GO TO 335)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)

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

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
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

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? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)______
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

335) In the last 12 months, were you visited by a health worker who talked to you about family planning?

YES 1
NO 2

336) In the last 12 months, have you or your children visited a health facility for care other than family planning?

YES 1
NO 2 (GO TO 401)

337) Did any health worker member at the health facility speak to you about family planning methods?

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

ONE OR MORE BIRTHS IN 2001 OR LATER (GO TO 402)
NO BIRTHS IN 2001 OR LATER (GO TO 576)

402. CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGINS WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST TWO COLUMNS 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

LINE NUMBER___

404. FROM 212 AND 216

NAME____
LIVING__
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 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 have like to wait?

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 TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[Last Birth Only]

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
MEDICAL ASSISTANT/CLINIC OFFICER C
NURSING AIDE D
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
OTHER (SPECIFY) X
NO ONE Y (GO TO 414)

408. Where did you receive antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
[Last Birth Only]

NAME OF PLACE(S)____
HOME
YOUR HOME A
TBA'S HOME B
OTHER HOME C
PUBLIC SECTOR
GOVERNMENT HOSPITAL D
GOVERNMENT HEALTH CENTER E
GOVERNMENT HEALTH POST F
OTHER PUBLIC (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
OTHER PRIVATE MEDICAL (SPECIFY) I
OTHER (SPECIFY) X

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

MONTHS___
DON'T KNOW 98

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

NUMBER OF TIMES___
DON'T KNOW 98

411. As part of your antenatal care during this pregnancy, were any of the following done at least once?
[Last Birth Only]

Were you weighed?
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

412. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?
[Last Birth Only]

YES 1
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)

413. Were you told where to go if you had any of these complications?
[Last Birth Only]

YES 1
NO 2
DON'T KNOW 8

414. During this pregnancy, 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

415. During this pregnancy, how many times did you receive this tetanus injection?
[Last Birth Only]

TIMES___
DON'T KNOW 8

416. CHECK 415:

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 417)

417. At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?
[Last Birth Only]

YES 1
NO 2 (GO TO 421)
DON'T KNOW (GO TO 421)

418. Before this pregnancy, how many other times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.
[Last Birth Only]

TIMES___
DON'T KNOW 8

419. In what month and year did you receive the last tetanus injection before this pregnancy?
[Last Birth Only]

MONTH____
DON'T KNOW MONTH 98
YEAR____ (GO TO 421)
DON'T KNOW YEAR 9998

420. How many years ago did you receive that tetanus injection?
[Last Birth Only]

YEARS AGO___

421. During this pregnancy, were you given or did you buy any iron tablets?
SHOW TABLETS
[Last Birth Only]

YES 1
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)

422. During the whole pregnancy, for how many days did you take the tablets?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[Last Birth Only]

DAYS____
DON'T KNOW 998

423. During this pregnancy, did you take any drug for intestinal worms?
[Last Birth Only]

YES 1
NO 2
DON'T KNOW 8

424. During this pregnancy, did you have difficulty with your vision during daylight?
[Last Birth Only]

YES 1
NO 2
DON'T KNOW 8

425. During this pregnancy, did you suffer from night blindness?
[Last Birth Only]

YES 1
NO 2
DON'T KNOW 8

426. During this pregnancy, did you take any drugs to keep you from getting malaria?
[Last Birth Only]

YES 1
NO 2 (GO TO 432)
DON'T KNOW 8 (GO TO 432)

427. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[Last Birth Only]

SP/FANSIDAR A
CHLOROQUINE B
OTHER (SPECIFY) X
DON'T KNOW Z

428. CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION.

CODE 'A' CIRCLED (GO TO 429)
CODE 'A' NOT CIRCLED (GO TO 432)

429. How many doses of (SP/FANSIDAR) did you take during this pregnancy?
[Last Birth Only]

DOSES___

430. CHECK 407:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

CODE 'A', 'B', OR 'C' CIRCLED (GO TO 431)
OTHER (GO TO 432)

431. Did you get (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?
[Last Birth Only]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

432. 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

433. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)

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

KILOGRAMS FROM CARD 1____
KILOGRAMS FROM RECALL 2____
DON'T KNOW 99.998

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

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
MEDICAL ASSISTANT/CLINICAL OFFICER C
NURSING AIDE D
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
RELATIVE/FRIEND F
OTHER (SPECIFY) X
NO ONE Y

436. Where did you give birth to (NAME)?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE

NAME OF PLACE___
HOME
YOUR HOME 11 (GO TO 443)
TBA'S HOME 12 (GO TO 443)
OTHER HOME 13 (GO TO 443)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96 (GO TO 443)

436A. Who accompanied you to the place where you delivered? Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
OTHER RELATIVE C
FEMALE FRIEND D
NO ONE E
OTHER (SPECIFY) X

437. How long after (NAME) was delivered did you stay there?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

438. Was (NAME) delivered by caesarean section?

YES 1
NO 2

439. Before you were discharged after (NAME) was born, did any health care provider check on your health?

YES 1
NO 2 (GO TO 442)

439A. At that time, did anyone:
[Last Birth Only]

check your abdomen?
YES 1
NO 2
check your eyes?
YES 1
NO 2
ask you about vaginal discharge?
YES 1
NO 2

440. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[Last Birth Only]

HOURS 1___
DAYS 2____
WEEKS 3____
DON'T KNOW 998

441. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.
[Last Birth Only]

HEALTH PERSONNEL
DOCTOR 11 (GO TO 453)
NURSE/MIDWIFE 12 (GO TO 453)
MEDICAL ASSISTANT/CLINICAL OFFICER 13 (GO TO 453)
NURSING AIDE 14 (GO TO 453)
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21 (GO TO 453)
OTHER (SPECIFY) 96 (GO TO 453)

442. After you were discharged, did any health care provider or a traditional birth attendant check on your health?

YES 1 (GO TO 444A)
NO 2 (GO TO 453)

443. Why didn't you deliver in a health facility? PROBE: Any other reason?

RECORD ALL MENTIONED.
[Last Birth Only]

COST TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/ POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) X

444. After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?

YES 1
NO 2 (GO TO 449)

444A. At that time, did anyone:
[Last Birth Only]

check your abdomen?
YES 1
NO 2
check your eyes?
YES 1
NO 2
ask you about vaginal discharge?
YES 1
NO 2

445. How long after delivery did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[Last Birth Only]

HOURS 1___
DAYS 2____
WEEKS 3____
DON'T KNOW 998

446. Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.
[Last Birth Only]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICE 13
NURSING AIDE 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

447. Where did this first check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE
[Last Birth Only]

NAME OF PLACE___
HOME
YOUR HOME 11
TBA'S HOME 12
OTHER HOME 13
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96

448. CHECK 442:

YES (GO TO 453)
NOT ASKED (GO TO 449)

449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?
[Last Birth Only]

YES 1
NO 2 (GO TO 453)
DON'T KNOW 8 (GO TO 453)

450. How many hours, days or weeks after the birth of (NAME) did the first check take place?

IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[Last Birth Only]

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

451. Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.
[Last Birth Only]

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICE 13
NURSING AIDE 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
OTHER (SPECIFY) 96

452. Where did this first check of (NAME) take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
[Last Birth Only]

NAME OF PLACE___
HOME
YOUR HOME 11
TBA'S HOME 12
OTHER HOME 13
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL (SPECIFY) 36
OTHER (SPECIFY) 96

453. In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
[Last Birth Only]

YES 1
NO 2
DON'T KNOW 8

454. Has your menstrual period returned since the birth of (NAME)?
[Last Birth Only]

YES 1 (GO TO 456)
NO 2 (GO TO 457)

455. Did your period return between the birth of (NAME) and your next pregnancy?
[Exclude Last Birth

YES 1
NO 2 (GO TO 459)

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

MONTHS____
DON'T KNOW 98

457. CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 458)
PREGNANT OR UNSURE (GO TO 459)

458. Have you begun to have sexual intercourse again since the birth of (NAME)?
[Last Birth Only]

YES 1
NO 2 (GO TO 460)

459. For how many months after the birth of (NAME) did you not have sexual intercourse?

MONTHS____
DON'T KNOW 98

460. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 467)

461. How long after birth did you put (NAME) to the breast?

IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.
[Last Birth Only]

IMMEDIATELY 000
HOURS 1___
DAYS 2____

462. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[Last Birth Only]

YES 1
NO 2 (GO TO 464)

463. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[Last Birth Only]

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) X

464. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 465)
DEAD (GO TO 466)

465. Are you still breastfeeding (NAME)?
[Last Birth Only]

YES 1 (GO TO 468)
NO 2

466. For how many months did you breastfeed (NAME)?
[Last Birth Only]

MONTHS____
DON'T KNOW 98

467. CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 470)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)

468. How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE ANSWER.
[Last Birth Only]

NUMBER OF NIGHTTIME FEEDINGS___

469. 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___

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

YES 1
NO 2
DON'T KNOW 8

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

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST TWO COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502. LINE NUMBER FROM 212

LINE NUMBER___

503. FROM 212 AND 216

NAME___
LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN, OR IF NO MORE BIRTHS, GO TO 573)

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

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 508)
NO CARD 3

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

YES 1 (GO TO 508)
NO 2 (GO TO 508)

506. (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. (3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

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-HepB-Hib 1
DAY___
MONTH___
YEAR___
DPT-HepB-Hib 2
DAY___
MONTH___
YEAR___
DPT-HepB-Hib 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___
VITAMIN A (2nd MOST RECENT)
DAY___
MONTH___
YEAR___

507. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT-HepB-Hib 1-3, DPT 1-3, AND/OR MEASLES VACCINES.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 512)
NO 2 (GO TO 512)
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)

509. Please tell me if (NAME) received any of the following vaccinations:

509A. A BCG VACCINATION against tuberculosis, that is, an injection in the right upper arm that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

509B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 509E)
DON'T KNOW 8 (GO TO 509E)

509D. How many times was the polio vaccine received?

NUMBER OF TIMES___

509E. A DPT vaccination, that is, an injection given in the left upper thigh sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 509G)
DON'T KNOW 8 (GO TO 509G)

509F. How many times was a DPT vaccination received?

NUMBER OF TIMES___

509G. A measles injection or an MMR injection - that is, a shot in the left upper arm at the age of 9 months or older - to prevent him/her from getting measles?

YES 1
NO 2
DON'T KNOW 8

512. CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE

DATE FOR MOST RECENT VITAMIN A DOSE (GO TO 513)
NO CARD/CARD BLANK OR CODE '44' FOR MOST RECENT VITAMIN A DOSE (GO TO 514)

513. According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD). Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1 (GO TO 515)
NO 2 (GO TO 516)
DON'T KNOW 8 (GO TO 516)

514. Has (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2 (GO TO 516)
DON'T KNOW 8

515. Did (NAME) receive a vitamin A dose within the last six months?

YES 1
NO 2
DON'T KNOW 8

516. In the last seven days, did (NAME) take iron pills, sprinkles with iron or iron syrup (like this/any of these)? SHOW COMMON TYPES OF PILLS, SPRINKLES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

517. Has (NAME) taken any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)

519. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

520. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk).

Was he/she given 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

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

IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

522. Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (GO TO 527)

523. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)___
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/DRUG SHOP H
PRIVATE DOCTOR I
CLINIC/OUTREACH SERVICES J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) X

524. CHECK 523:

TWO OR MORE CODES CIRCLED (GO TO 525)
ONLY ONE CODE CIRCLED (GO TO 526)

525. Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

FIRST PLACE___

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

DAYS___

527. Does (NAME) still have diarrhea?

YES 1
NO 2
DON'T KNOW 8

528. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid made from a special packet called [LOCAL NAME FOR ORS PACKET]?
YES 1
NO 2
DON'T KNOW 8
c) A government-recommended homemade fluid?
YES 1
NO 2
DON'T KNOW 8

529. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)

530. What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.

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

531. CHECK 530: GIVEN ZINC?

CODE "C" CIRCLE (GO TO 532)
CODE "C" NOT CIRCLED (GO TO 533)

532. How many times was (NAME) given zinc?

TIMES___
DON'T KNOW 98

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

YES 1
NO 2
DON'T KNOW 8

534. Has (NAME) had an illness with a cough at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 537)
DON'T KNOW 8 (GO TO 537)

535. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

YES 1
NO 2 (GO TO 538)
DON'T KNOW 8

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

CHEST ONLY 1 (GO TO 538)
NOSE ONLY 2 (GO TO 538)
BOTH 3 (GO TO 538)
OTHER (SPECIFY) 6 (GO TO 538)
DON'T KNOW 8 (GO TO 538)

537. CHECK 533:
HAD FEVER?

YES (GO TO 538)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

538. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given 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

539. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

540. Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (GO TO 545)

541. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)___
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/DRUG SHOP H
PRIVATE DOCTOR I
CLINIC/OUTREACH SERVICES J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) X

542. CHECK 541:

TWO OR MORE CODES CIRCLED (GO TO 543)
ONLY ONE CODE CIRCLED (GO TO 544)

543. Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

FIRST PLACE___

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

DAYS___

545. Is (NAME) still sick with a (fever/cough)?

FEVER ONLY 1
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON'T KNOW 8

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

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

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

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
CHLOROQUINE WITH FANSIDAR C
HOMAPACK RED D
HOMAPACK GREEN E
COARTEM F
OTHER ANTIMALARIAL (SPECIFY) G
ANTIBIOTIC DRUGS
PILL/SYRUP H
INJECTION I
OTHER DRUGS
PANADOL J
ASPIRIN K
IBUPROFEN L
OTHER (SPECIFY) X
DON'T KNOW Z

548. CHECK 547: ANY CODE A-H CIRCLED?

YES (GO TO 549)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

549. Did you already have (NAME OF DRUG FROM 547) at home when the child became ill?
ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'H' THAT THE CHLID IS RECORDED AS HAVING TAKEN IN 547. IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG. IF NO FOR ALL DRUGS, CIRCLE 'Y'.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
CHLOROQUINE WITH FANSIDAR C
HOMAPACK RED D
HOMAPACK GREEN E
COARTEM F
OTHER ANTIMALARIAL (SPECIFY) G
ANTIBIOTIC PILL/SYRUP H
NO DRUG AT HOME Y

550. CHECK 547:
ANY CODE A-G CIRCLED?

YES (GO TO 551)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

551. CHECK 547:
SP/FANSIDAR ('A') GIVEN

CODE 'A' CIRCLED (GO TO 552)
CODE 'A' NOT CIRCLED (GO TO 554)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

553. For how many days did (NAME) take the SP/Fansidar?
IF 7 DAYS OR MORE, RECORD 7.

DAYS___
DON'T KNOW 8

554. CHECK 547:
CHLOROQUINE ('B') GIVEN

CODE 'B' CIRCLED (GO TO 555)
CODE 'B' NOT CIRCLED (GO TO 557)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

556. For how many days did (NAME) take the chloroquine?
IF 7 DAYS OR MORE, RECORD 7.

DAYS___
DON'T KNOW 8

557. CHECK 547: CHLOROQUINE WITH FANSIDAR ('C') GIVEN

CODE 'C' CIRCLED (GO TO 558)
CODE 'C' NOT CIRCLED (GO TO 560)

558. How long after the fever started did (NAME) first take Chloroquine with Fansidar?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

559. For how many days did (NAME) take the Chloroquine with Fansidar?
IF 7 DAYS OR MORE, RECORD 7.

DAYS___
DON'T KNOW 8

560. CHECK 547:
HOMAPACK RED ('D') GIVEN

CODE 'D' CIRCLED (GO TO 561)
CODE 'D' NOT CIRCLED (GO TO 563)

561. How long after the fever started did (NAME) first take Homapack Red?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

562. For how many days did (NAME) take the Homapack Red?
IF 7 DAYS OR MORE, RECORD 7.

DAYS___
DON'T KNOW 8

563. CHECK 547:
HOMAPACK GREEN ('E') GIVEN

CODE 'E' CIRCLED (GO TO 564)
CODE 'E' NOT CIRCLED (GO TO 566)

564. How long after the fever started did (NAME) first take Homapack Green?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

565. For how many days did (NAME) take the Homapack Green?
IF 7 DAYS OR MORE, RECORD 7.

DAYS___
DON'T KNOW 8

566. CHECK 547:
COARTEM ('F') GIVEN

CODE 'F' CIRCLED (GO TO 567)
CODE 'F' NOT CIRCLED (GO TO 569)

567. How long after the fever started did (NAME) first take Coartem?

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

568. For how many days did (NAME) take Coartem?
IF 7 DAYS OR MORE, RECORD 7.

DAYS___
DON'T KNOW 8

569. CHECK 547:
OTHER ANTIMALARIAL ('G') GIVEN

CODE 'G' CIRCLED (GO TO 570)
CODE 'G' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

571. For how many days did (NAME) take the (OTHER ANTIMALARIAL)?
IF 7 DAYS OR MORE, RECORD 7.

DAYS___
DON'T KNOW 8

572. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS GO TO 573.

573. CHECK 215 AND 218, ALL ROWS: NUMBER OF CHLDREN BORN IN 2001 OR LATER LIVING WITH THE RESPONDENT

ONE OR MORE (GO TO 574)
NONE (GO TO 576)

574. The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?

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

575. CHECK 528(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 576)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 577)

576. Have you ever heard of a special product called ORS you can get for the treatment of diarrhea?

YES 1
NO 2

577. CHECK 215 AND 218, ALL ROWS:
HAS AT LEAST ONE CHILD BORN IN 2003 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER (AND CONTINUE WITH 578)

DOES NOT HAVE ANY CHILDREN BORN IN 2003 OR LATER AND LIVING WITH HER (GO TO 601)

NAME___

578. Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night. Did (NAME FROM 577) (drink/eat):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Any Nan, SMA, Lactogen, or other commercially produced infant formula?
YES 1
NO 2
DON'T KNOW 8
c) Any Cerelac?
YES 1
NO 2
DON'T KNOW 8
d) Any porridge?
YES 1
NO 2
DON'T KNOW 8

579. Now I would like to ask you about (other) liquids or foods that (NAME FROM 557) may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods.

Did (NAME FROM 577)/ you drink (eat):

(A) BEVERAGES/LIQUIDS
a) Fresh, tinned or powdered milk, or yoghurt?
YES 1
NO 2
DON'T KNOW 8
b) Black tea/coffee?
YES 1
NO 2
DON'T KNOW 8
c) Fresh fruit juice or juice concentrate?
YES 1
NO 2
DON'T KNOW 8
d) Other beverages/liquids not mentioned above?
YES 1
NO 2
DON'T KNOW 8
(B) STAPLE FOODS)
e) Starchy fruits such as cooking banana-motoke?
YES 1
NO 2
DON'T KNOW 8
f) Cassava, yams, sweet potatoes, Irish potatoes or other rods and tubers?
YES 1
NO 2
DON'T KNOW 8
g) Rice, posho, porridge, bread, chapatti, pasta/macaroni, pizza, or other foods made from maize, millet, sorghum, or other grains?
YES 1
NO 2
DON'T KNOW 8
(C) SAUCES (RELISHES)
h) Beans, peas, cow peas, nuts, seeds, oil seeds, soya beans, or other legumes or seeds?
YES 1
NO 2
DON'T KNOW 8
i) Meat (beef, pork, goat, lamb, chicken, duck) or other meat?
YES 1
NO 2
DON'T KNOW 8
j) Organ meats (liver, kidney, heart, etc)?
YES 1
NO 2
DON'T KNOW 8
k) Eggs (Chicken eggs, duck eggs, etc)?
YES 1
NO 2
DON'T KNOW 8
l) Fresh fish, dry fish or shell fish?
YES 1
NO 2
DON'T KNOW 8
(D) VEGETABLES AND FRUITS
m) Dark green leafy vegetables like dodo, nakati, spinnach, amaranths, bugga, sungsa, jjobyo, Marakwang?
YES 1
NO 2
DON'T KNOW 8
n) Orange coloured vegetables such as pumpkins, carrots? orange fleshed sweet potatoes?
YES 1
NO 2
DON'T KNOW 8
o) Any bio-fortified food (Orange fleshed sweet potatoes)?
YES 1
NO 2
DON'T KNOW 8
p) Orange coloured fruits like ripe mangoes, pawpaw?
YES 1
NO 2
DON'T KNOW 8
q) Other fruits or vegetables (passion fruit, jack fruit, pineaples, oranges, etc)?
YES 1
NO 2
DON'T KNOW 8
(E) OTHER FOODS
r) Any cheese or other milk products?
YES 1
NO 2
DON'T KNOW 8
s) Cooking oil, margarine, butter or other oils/fats?
YES 1
NO 2
DON'T KNOW 8
t) Any sugary foods such as chocolates, sweets, candles, pastries, cakes or biscuits?
YES 1
NO 2
DON'T KNOW 8
u) Any other solid or semi-solid food?
YES 1
NO 2
DON'T KNOW 8

580. CHECK 578 (LAST 2 CATEGORIES: BABY CEREAL OR OTHER PORRIDGE) AND 579 (CATEGORIES e THROUGH u FOR CHILD):

AT LEAST ONE "YES" (GO TO 581)
NOT A SINGLE "YES" (GO TO 601)

581. How many times did (NAME FROM 577) eat solid, semisolid, 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

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601. Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1 (GO TO 604)
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3

602. Have you ever been married or lived together with a man as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 617)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

605. 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 ___

606. Does your husband/partner have other wives or does he live with other women as if married?

YES 1
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)

607. Including yourself, in total, how many wives or partners does your husband live with now as if married?

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

608. Are you the first, second, ... wife?

RANK___

609. Have you been married or lived with a man only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 611)

610. CHECK 603: IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED OR CURRENTLY DIVORCED/SEPARATED (GO TO 615)
CURRENTLY WIDOWED (GO TO 613)

611. CHECK 603: IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED (GO TO 612)
CURRENTLY WIDOWED (GO TO 613)
CURRENTLY DIVORCED/SEPARATED (GO TO 615)

612. How did your previous marriage or union end?

DEATH/WIDOWHOOD 1
DIVORCE 2 (GO TO 615)
SEPARATION 3 (GO TO 615)

613. To whom did most of your late husband's property go to?

RESPONDENT 1 (GO TO 615)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
OTHER (SPECIFY) 6
NO PROPERTY 7

614. Did you receive any of your late husband's assets or valuables?

YES 1
NO 2

615. CHECK 609:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about when you started living with your first husband/partner. In what month and year was that?

MONTH___
DON'T KNOW MONTH 98
YEAR____ (GO TO 617)
DON'T KNOW YEAR 9998

616. How old were you when you first started living with him?

AGE___

617. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS___ (GO TO 621)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 621)

619. CHECK 107:
AGE OF RESOPNDENT

AGE 15-24 (GO TO 620)
AGE 25-49 (GO TO 641)

620. Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (GO TO 641)
NO 2 (GO TO 641)
DON'T KNOW/UNSURE (GO TO 641)

621. CHECK 107:
AGE OF RESPONDENT 107

AGE 15-24 (GO TO 622)
AGE 25-49 (GO TO 626)

622. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

623. How old was the person you first had sexual intercourse with?

AGE OF PARTNER___ (GO TO 626)
DON'T KNOW 98

624. Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (GO TO 626)
ABOUT THE SAME AGE 3 (GO TO 626)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 626)

625. Would you say this person was ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

626. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1___
WEEKS AGO 2___
MONTHS AGO 3____
YEARS AGO 4___ (GO TO 640)

626A. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

627. When was the last time you had sexual intercourse with this person?

DAYS 1___
WEEKS 2___
MONTHS 3___

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

YES 1
NO 2 (GO TO 630)

629. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

630. What was your relationship to this person with whom you had sexual intercourse?

IF BOYFRIEND: Were you living together as if married? IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

HUSBAND 1 (GO TO 636)
LIVE-IN PARTNER 2 (GO TO 636)
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
PROSTITUTE 5
OTHER (SPECIFY) 6

631. For how long (have you had/did you have) a sexual relationship with this person? IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1___
MONTHS 2___
YEARS 3____

632. CHECK 107:

AGE 15-24 (GO TO 633)
AGE 25-49 (GO TO 636)

633. How old is this person?

AGE OF PARTNER____ (GO TO 636)
DON'T KNOW 98

634. Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (GO TO 636)
SAME AGE 3 (GO TO 636)
DON'T KNOW 8 (GO TO 636)

635. Would you say this person is ten or more years older than you or less than ten years older than you?

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

636. The last time you had sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 (GO TO 638)

637. Were you or your partner drunk at that time?
IF YES: Who was drunk?

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

638. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?
[FOR LAST SEXUAL PARTNER AND SECOND-TO-LAST SEXUAL PARTNER ONLY]

YES 1 (GO BACK TO 627 IN NEXT COLUMN)
NO 2 (GO TO 639A)

639) In total, with how many different people have you had sexual intercourse in the last 12 months?
[THIRD-TO-LAST SEXUAL PARTNER ONLY]

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS LAST 12 MONTHS____
DON'T KNOW 98

639A) In the past 12 months, did you ever give or receive money, gifts or favours in exchange for sex?

YES 1
NO 2

640) In total, with how many different people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

NUMBER OF PARTNERS IN LIFETIME____
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 643A)

642) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)_____
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

643) If you wanted to, could you yourself get a condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

643A) Have you ever heard about female circumcision? (A practise in which a girl may have part of her genitals cut).

YES 1
NO 2 (GO TO 643C)

643B) Have you yourself been circumcised?

YES 1
NO 2

643C) Sometimes a woman can have a problem, usually after a difficult childbirth, in which she experiences uncontrollable leakage of urine or stool from her vagina.

Have you ever experienced this problem?

YES 1
NO 2
DON'T KNOW 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 311/311A:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 713)

702) 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 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)

703) 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 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) 996 (GO TO 708)
DON'T KNOW 998

704) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 705)
PREGNANT (GO TO 709)

705) CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 706)
NOT CURRENTLY USING (GO TO 706)
CURRENTLY USING (GO TO 713)

706) CHECK 703:

NOT ASKED (GO TO 707)
24 OR MROE MONTHS OR 02 OR MORE YEARS (GO TO 707)
00-23 MONTHS OR 00-01 YEAR (GO TO 709)

707) CHECK 702:

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 you are not using a method? Any other reason?

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 you are not using a method? Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
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
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER (SPECIFY) X
DON'T KNOW Z

708) CHECK 310:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 709)
NO, NOT CURRENTLY USING (GO TO 709)
YES, CURRENTLY USING (GO TO 713)

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

YES 1
NO 2 (GO TO 711)
DON'T KNOW 8 (GO TO 713)

710) Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 713)
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
FEMALE CONDOM 08 (GO TO 713)
DIAPHRAGM 09 (GO TO 713)
FOAM/JELLY 10 (GO TO 713)
LACTATIONAL AMEN. METHOD 11 (GO TO 713)
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER (SPECIFY) 96
UNSURE 98

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

NOT MARRIED 11
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
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) 96
DON'T KNOW 98

712) Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DON'T KNOW 8

713) 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.

NONE 00 (GO TO 715)
NUMBER____
OTHER (SPECIFY) 96 (GO TO 715)

714) 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____
OTHER (SPECIFY) 96
NUMBER OF GIRLS___
OTHER (SPECIFY) 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY) 96

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

a) On the radio?
YES 1
NO 2
b) On the television?
YES 1
NO 2
c) In a newspaper or magazine?
YES 1
NO 2
d) In a video or film?
YES 1
NO 2

717) CHECK 601:

YES, CURRENTLY MARRIED (GO TO 718)
YES, LIVING WITH A MAN (GO TO 718)
NO, NOT IN UNION (GO TO 801)

718) CHECK 311/311A:

CODE B, G, OR M CIRCLED (GO TO 720)
NO CODE CIRCLED (GO TO 720A)
ANY OTHER CODES CIRCLED (GO TO 719)

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

YES 1
NO 2 (GO TO 720A)
DON'T KNOW 8

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

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

720A) 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

721) CHECK 311/311A:

NEITHER STERILIZED (GO TO 722)
HE OR SHE STERILIZED (GO TO 801)

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

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

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)

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

AGE IN COMPLETED YEARS____

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

YES 1
NO 2 (GO TO 806)

804) What was the highest level of school he attended: primary, secondary, or higher?
IF JUNIOR SECONDARY CIRCLE '2' FOR 'O' LEVEL

PRIMARY 1
'O' LEVEL 2
'A' LEVEL 3
TERTIARY 4
UNIVERSITY 5
DON'T KNOW 8 (GO TO 806)

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

GRADE___
DON'T KNOW 98

806) CHECK 801:

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_____

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

YES 1 (GO TO 811)
NO 2

808) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?

YES 1 (GO TO 811)
NO 2

809) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?

YES 1 (GO TO 811)
NO 2

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

YES 1
NO 2 (GO TO 818)

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

OCCUPATION____

812) CHECK 811:

WORKS IN AGRICULTURE (GO TO 813)
DOES NOT WORK IN AGRICULTURE (GO TO 814)

813) 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 01
FAMILY LAND 02
RENTED/BORROWED LAND 03
SOMEONE ELSE'S LAND 04
COMMUNAL LAND 05
PUBLIC LAND 06

814) 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

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

HOME 1
AWAY 2

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

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

817) Are you paid 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
NOT PAID 4

818) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 819)
NOT IN UNION (GO TO 827)

819) CHECK 817:

CODE 1 OR 2 CIRCLED (GO TO 820)
OTHER (GO TO 822)

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

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

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 823)
DON'T KNOW 8

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

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

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

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

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

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

825) Who usually makes decisions about making purchases for daily household needs?

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

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

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

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

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

828) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
b) If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
c) If she argues with him?
YES 1
NO 2
DON'T KNOW 8
d) If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
e) If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 942)

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

YES 1
NO 2
DON'T KNOW 8

903) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

904) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

905) Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

906) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

907) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

909) Can the virus that causes AIDS be transmitted from a mother to her baby:

a) During pregnancy?
YES 1
NO 2
DON'T KNOW 8
b) During delivery?
YES 1
NO 2
DON'T KNOW 8
c) By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

910) CHECK 909:

AT LEAST ONE 'YES' (GO TO 911)
OTHER (GO TO 912)

911) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2 (GO TO 912)
DON'T KNOW 8 (GO TO 912)

911A) Do you know of a place where a pregnant woman with the AIDS virus can go to get this drug to reduce the risk of her baby getting the AIDS virus?

YES 1
NO 2 (GO TO 912)
DON'T KNOW 8 (GO TO 912)

911B) Where is this place? PROBE: Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT COMMUNITY BASED WORKER E
OTHER PUBLIC (SPECIFY) F
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/MIDWIFE I
OUTREACH J
TASO K
AIDS INFORMATION CENTER L
OTHER PRIVATE/NGO MEDICAL (SPECIFY) M
OTHER (SPECIFY) X

912) Have you heard about any drugs that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

YES 1
NO 2 (GO TO 913)
DON'T KNOW 8 (GO TO 913)

912A) In the past six months, have you seen or heard anything about drug treatments for AIDS:

a) On the radio?
YES 1
NO 2
b) On the television?
YES 1
NO 2
c) In a newspaper or magazine?
YES 1
NO 2
d) On a sign or pamphlet?
YES 1
NO 2
e) In a video or film?
YES 1
NO 2

912B) What drugs do you know about? PROBE: Any other drugs?

IF MORE THAN ONE TYPE OF DRUG IS MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST DRUG ON LIST.

ANTI-RETROVIRAL DRUGS (ARV's) A
SEPTRIN B (GO TO 913)
OTHER DRUGS (SPECIFY) X (GO TO 913)
DON'T KNOW Z (GO TO 913)

912C) Do you know of a place to get ARVs?

YES 1
NO 2 (GO TO 912E)

912D) Where is this place? PROBE: Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT BASED COMMUNITY WORKER E
OTHER PUBLIC (SPECIFY) F
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/MIDWIFE I
OUTREACH J
TASO K
AIDS INFORMATION CENTER L
OTHER PRIVATE/NGO MEDICAL (SPECIFY) M
OTHER (SPECIFY) X

912E) Now I'd like to ask you some questions about the drug treatment (ART) that is available to people with AIDS virus. For each statement I read, please tell me if you agree or disagree with it

a) ART is not a cure for the AIDS virus.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) A person receiving ART cannot transmit the virus to others.
AGREE 1
DISAGREE 2
DON'T KNOW 8
c) Once ART is started, a patient must continue treatment for the rest of his/her life.
AGREE 1
DISAGREE 2
DON'T KNOW 8
d) People who know they are HIV positive should wait until they feel sick to see a doctor or nurse about ART.
AGREE 1
DISAGREE 2
DON'T KNOW 8
e) Failing to follow ART as directed can make the AIDS virus become stronger and even harder to control.
AGREE 1
DISAGREE 2
DON'T KNOW 8

913) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2003 (GO TO 914)
NO BIRTHS (GO TO 922)
LAST BIRTH BEFORE JANUARY 2003 (GO TO 922)

914) CHECK 407 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 915)
NO ANTENATAL CARE (GO TO 922)

914A) CHECK FOR PRESENCE OF OTHER. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915) During any of the antenatal visits for your last birth, did anyone talk to you about:

a) Babies getting the AIDS virus from their mother?
YES 1
NO 2
DON'T KNOW 8
b) Things that you can do to prevent getting the AIDS virus?
YES 1
NO 2
DON'T KNOW 8
c) Getting tested for the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

916) Were you offered a test for the AIDS virus as part of your antenatal care?

YES 1
NO 2

917) I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

YES 1
NO 2 (GO TO 922)

918) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

919) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
OUTREACH 15
GOVERNMENT COMMUNITY BASED WORKER 16
OTHER PUBLIC (SPECIFY) 17
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
STAND-ALONE VCT CENTER 22
PHARMACY/DRUG SHOP 23
PRIVATE DOCTOR/NURSE/MIDWIFE 24
OUTREACH 25
TASO 26
AIDS INFORMATION CENTER 27
OTHER PRIVATE/NGO MEDICAL (SPECIFY) 28
OTHER (SPECIFY) 96

920) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

YES 1 (GO TO 923)
NO 2

921) When was the last time you were tested for the AIDS virus?

LESS THAN 12 MONTHS AGO 1 (GO TO 929)
12-23 MONTHS AGO 2 (GO TO 929)
2 OR MORE YEARS AGO 3 (GO TO 929)

922) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 927)

923) When was the last time you were tested?

LESS THAN 12 MONTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3

924) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

925) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

926) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
OUTREACH 15
GOVERNMENT COMMUNITY BASED WORKER 16
OTHER PUBLIC (SPECIFY) 17
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
STAND-ALONE VCT CENTER 22
PHARMACY/DRUG SHOP 23
PRIVATE DOCTOR/NURSE/MIDWIFE 24
OUTREACH 25
TASO 26
AIDS INFORMATION CENTER 27
OTHER PRIVATE/NGO MEDICAL (SPECIFY) 28
OTHER (SPECIFY) 96

927) Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 929)

928) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUTREACH E
GOVERNMENT COMMUNITY BASED WORKER F
OTHER PUBLIC (SPECIFY) G
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
STAND-ALONE VCT CLINIC I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/MIDWIFE K
OUTREACH L
TASO M
AIDS INFORMATION CENTER N
OTHER PRIVATE/NGO MEDICAL (SPECIFY) O
OTHER (SPECIFY) 96

929) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

930) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

931) If a member of your family became sick with 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 8

931A) Should a child of primary school going age who has the AIDS virus go to school?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

932) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

933) Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (GO TO 942)

934) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

935) Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?

YES 1
NO 2

936) CHECK 933, 934, AND 935:

NOT A SINGLE 'YES' (GO TO 937)
AT LEAST ONE 'YES' (GO TO 942)

937) Do you personally know someone who has or is suspected to have the AIDS virus?

YES 1
NO 2

938) Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

939) Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

942) CHECK 901:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

943) CHECK 618:

HAS HAD SEXUAL INTERCOURSE (GO TO 944)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 951)

944) CHECK 942:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 945)
NO (GO TO 946)

945) 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 disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

946) Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

947) 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

948) CHECK 945, 946, AND 947:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 949)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 951)

949) The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 951)

950) Where did you go? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUTREACH E
GOVERNMENT COMMUNITY BASED WORKER F
OTHER PUBLIC (SPECIFY) G
PRIVATE/NGO MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
STAND-ALONE VCT CENTER I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/MIDWIFE K
OUTREACH L
TASO M
AIDS INFORMATION CENTER N
OTHER PRIVATE/NGO MEDICAL (SPECIFY) O
OTHER SOURCE
SHOP P
OTHER (SPECIFY) Q

951) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

953) Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

954) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

955) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A PARTNER (GO TO 956)
NOT IN UNION (GO TO 959)

956) Can you say no to your husband/partner if you do not want to have sexual intercourse?

YES 1
NO 2
DEPENDS/NOT SURE 8

957) Could you ask your husband/partner to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

959) Do you think that most young men you know wait until they are married to have sexual intercourse?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

963) Do you think that most married men you know have sex only with their wives?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

965) Do you think that most young women you know wait until they are married to have sexual intercourse?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

969) Do you think that most married women you know have sex only with their husbands?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

SECTION 10. OTHER HEALTH ISSUES

1001) Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 1005)

1002) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) X
DON'T KNOW Z

1003) Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1004) If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

1005) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS____
NONE 00 (GO TO 1009)

1006) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS___
NONE 00 (GO TO 1009)

1007) The last time you had an injection given to you by a health worker, where did you go to get the injection?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
DENTAL CLINIC/OFFICE 22
PHARMACY/DRUG SHOP 23
OFFICE OR HOME OF NURSE/HEALTH WORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) 26
OTHER PLACE
AT HOME 31
OTHER (SPECIFY) 96

1008) Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1009) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1011)

1010) In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES____

1011) Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 1013)

1012) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) X

1013) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

a) Getting permission to go?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) Getting money needed from treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c) The distance to the health facility
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d) Having to take transport?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
e) Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
f) Concern that there may not be female health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
g) Concern that there may not be any health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
h) Concern that there may be no drugs available?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1016) CHECK 217:

(YOUNGEST) CHILD IS AGE 0-17 (GO TO 1017)
OTHER (GO TO 1018)

1017) Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.

Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

1018) (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

YES 1
NO 2 (GO TO 1100)

1019) Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

YES 1
NO 2
UNSURE 8

SECTION 11. DOMESTIC VIOLENCE

1110) CHECK FRONT COVER:

WOMAN SELECTED FOR THIS SECTION (GO TO 1101)
WOMAN NOT SELECTED (GO TO 1201A)

1101) CHECK FROM THE PRESENCE OF OTHERS:

DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
PRIVACY NOT POSSIBLE 2 (GO TO 1134)

1102) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1103)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE) (GO TO 1103)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1114)

1103) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8
f) He (does/did) not trust you with any money?
YES 1
NO 2
DON'T KNOW 8

1104) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner. If we should come to any question that you do not want to answer, just let me know and we will go on to the next question.

a) say or do something to humiliate you in front of others?
YES 1 (GO TO 1104a IN PART B)
NO 2 (GO TO 1104b IN PART A)
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) threaten to hurt or harm you or someone close to you?
YES 1 (GO TO 1104b IN PART B)
NO 2 (GO TO 1104c IN PART A)
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?
YES 1 (GO TO 1104 c IN PART B)
NO 2 (GO TO 1105)
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1105) (Does/did) your (last) husband/partner ever do any of the following things to you:

a) push you, shake you, or throw something at you?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b) slap you?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c) twist your arm or pull your hair?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d) punch you with his first or with something that could hurt you?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you or beat you up?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you on purpose?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g) threaten or attack you with a knife gun, or any other weapon?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h) physically force you to have sexual intercourse with him even when you did not want to?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
i) force you to perform any sexual acts you did not want to?
YES 1
NO 2
How often did this happen during the last 12 months: often, only sometimes, or not at all? (CHECK 603 AND ASK ONLY IF RESPONDENT IS NOT A WIDOW)
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1106) CHECK 1105A (a-i):

AT LEAST ONE 'YES' (GO TO 1107)
NOT A SINGLE 'YES' (GO TO 1109)

1107) How long after you first got married to/started living with your (last) husband/partner did (this/any of these things ) first happen?

IF LESS THAN ONE YEAR, RECORE '00'.

NUMBER OF YEARS____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1108) Did the following ever happen as a result of what your (last) husband/partner did to you:

a) You had cuts, bruises or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

1109) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?

YES 1
NO 2 (GO TO 1112)

1110) CHECK 603:

RESPONDENT IS NOT A WIDOW (GO TO 1111)
RESPONDENT IS A WIDOW (GO TO 1112)

1111) In the last 12 months, how often have you done this to your husband/partner: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1112) Does (did) your husband/partner drink alcohol?

YES 1
NO 2 (GO TO 1114)

1113) How often does (did) he get drunk: often, only sometimes, or never?

YES OFTEN 1
YES SOMETIMES 2
NEVER 3

1114) CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN: From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked, or done anything else to hurt you physically?

NEVER MARRIED/NEVER LIVED WITH A MAN: From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything to hurt you physically?

YES 1
NO 2 (GO TO 1117)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1117)

1115) Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

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

1116) In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1117) CHECK 201, 226, AND 229:

EVER BEEN PREGNANT (YES ON 201 OR 226 OR 229)
NEVER BEEN PREGNANT (GO TO 1120)

1118) Has anyone ever hit, slapped, kick, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO 1120)

1119) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

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

1120) CHECK 618: EVER HAD SEX?

HAS EVER HAD SEX (GO TO 1121)
NEVER HAD SEX (GO TO 1125)

1121) The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

WANTED TO 1
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3

1122) CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN: In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?

NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months has anyone forced you to have sexual intercourse against your will?

YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

1123) CHECK 1121 AND 1122:

1121 = '1' OR '3' AND 1122 = '2' OR '3' (GO TO 1124)
OTHER (GO TO 1126)

1124) CHECK 1105(h) and 1105(i):

1105(h) IS NOT '1' AND 1105(i) IS NOT '1' (GO TO 1125)
OTHER (GO TO 1128)

1125) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

YES 1
NO 2 (GO TO 1128)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1128)

1126) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

AGE IN COMPLETED YEARS____
DON'T KNOW 98

1127) Who was the person who was forcing you at that time?

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

1128) CHECK 1105A(a-i), 1114, 1118, 1122 AND 1125:

AT LEAST ONE 'YES' (GO TO 1129)
NOT A SINGLE 'YES' (GO TO 1132)

1129) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

YES 1
NO 2 (GO TO 1132)

1130) From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

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

1132) As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

REASSURE THE RESPONDENT ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1133) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR COME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

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

1134) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

COMMENTS/EXPLANATION______

SECTION 12. MATERNAL MORTALITY

1201A) 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.

Did your mother give birth to any children other than yourself?

YES 1
NO 2 (GO TO 1201H)

1201B) How many sons did your mother have who are still alive?

BOYS LIVING_____

1201C) Besides yourself, how many daughters did your mother have who are still alive?

GIRLS LIVING____

1201D) How many sons did your mother have who died?

BOYS DEAD____

1201E) How many daughters did your mother have who have died?

GIRLS DEAD____

1201F) Has your mother given birth to other children for whom you do not know whether they are still alive or have died?

YES 1
NO 2 (GO TO 1201H)

1201G) How many other children has your mother had for whom you do not know whether they are still alive or have died?

OTHER CHILDREN____

1201H) SUM ANSWERS TO 1201B, 1201C, 1201D, 1201E, AND 1201G, ADD 1 (THE RESPONDENT) AND RECORD THE TOTAL

TOTAL____

1201I) CHECK 1201H:
Just to make sure that I have this right: your mother gave birth to _____ child(ren), including yourself. Is that correct?

YES (GO TO 1202)
NO (PROBE AND CORRECT 1201A-1201H AS NECESSARY)

1202) CHECK 1201H:

TWO OR MORE BIRTHS (GO TO 1203)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1214)

1203) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS___

1204) What was the name given to your oldest (next oldest) brother or sister?

NAME____

1205) Is (NAME) male or female?

MALE 1
FEMALE 2

1206) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1208)
DON'T KNOW 8 (GO TO NEXT BROTHER/SISTER)

1207) How old is (NAME)?

AGE____ (GO TO NEXT BROTHER/SISTER)

1208) How many years ago did (NAME) die?

YEARS____

1209) How old was (NAME) when he/she died?

AGE____

1210) Was (NAME) pregnant when she died?

YES 1 (GO TO 1213)
NO 2

1211) Did (NAME) die during childbirth?

YES 1 (GO TO 1213)
NO 2

1212) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1213) How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?

NUMBER OF CHILDREN____

CHECK (X) HERE IF CONTINUATION SHEET USED____

IF NO MORE BROTHERS OR SISTERS, GO TO 1214.

1214) RECORD THE TIME.

HOURS____
MINUTES___

INTERVIEWER'S OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT_____
COMMENTS ON SPECIFIC QUESTIONS_____
ANY OTHER COMMENTS_____

SUPERVISOR'S OBSERVATIONS_____
NAME____
DATE____

EDITOR'S OBSERVATIONS_____
NAME ____
DATE____