UGANDA BUREAU OF STATISTICS
2011 UGANDA DEMOGRAPHIC AND HEALTH SURVEY
WOMAN QUESTIONNAIRE-ENGLISH
EA NAME
NAME OF HOUSEHOLD HEAD
HOUSEHOLD NUMBER
SAMPLED HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN
WOMAN SELECTED FOR DOMESTIC VIOLENCE MODULE
NO 2
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NUMBER __ __ __
RESULT __
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _______________ 7
LANGUAGE OF THE QUESTIONNAIRE __ __
LANGUAGE USED IN THE INTERVIEW __ __
NATIVE LANGUAGE OF RESPONDENT __ __
SOMETIMES 2
ALL THE TIME 3
LUGANDA 02
LUGBARA 03
LUO 04
RUNYANKOLE-RUKIGA 05
RUNYORO-RUTORO 06
NGAKARAMOJONG 07
ENGLISH 08
OTHER (SPECIFY) ______________ 96
NAME ___________ __ __ __
FIELD EDITOR
NAME ___________ __ __ __
OFFICE EDITOR__ __
KEYED BY __ __
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello My name is _______________________________________ and I am working with UGANDA BUREAU OF STATISTICS.
We are conducting a survey about health all over Uganda. This information will help the government to plan health services. Your household was selected for the survey. The questions usually take about 60 to 90 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions?
NO
May I begin the interview now?
NO
Signature of interviewer: __________________
Date: ________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
MINUTES __ __
102) In what month and year were you born?
DON'T KNOW MONTH 98
YEAR __ __
DON'T KNOW YEAR 9998
103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT
104) Have you ever attended school?
NO 2 (GO TO 108)
105) What is the highest level of school you attended: primary, '0' level, 'A' level, or university or tertiary?
'O' LEVEL 2
'A' LEVEL 3
TERTIARY 4
UNIVERSITY 5
106) What is the highest (class/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'
SECONDARY OR HIGHER ___ (GO TO 110)
108) 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?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____________ 4
BLIND/VISUALLY IMPAIRED 5
CODE '1' OR '5' CIRCLED ___ (GO TO 111)
110) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
111) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
112) Do you watch/listen to television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
MUSLIM 3
PENTECOSTAL 4
SDA 5
OTHER (SPECIFY) ____________ 6
MUNYANKOLE 2
MUSOGA 3
MUKIGA 4
ATESO 5
OTHER (SPECIFY) _____________ 6
115) In the last 12 months, how many times have you been away from home for one or more nights?
NONE 00 (GO TO 201)
116) In the last 12 months, have you been away from home for more than one month at a time?
NO 2
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
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?
NO 2 (GO TO 204)
203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'
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?
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'
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?
NO 2 (GO TO 208)
207) How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD __ __
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
209) CHECK 208:
Just to make sure that I have this right: you have had in TOTAL _____ births during your life. Is that correct?
NO ___ (PROBE AND CORRECT 201-208 AS NECESSARY.)
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 ONSEPARATE ROWS.
(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?
RECORD NAME.
BIRTH HISTORY NUMBER
213) Is (NAME) a boy or a girl?
GIRL 2
214) Were any of these births twins?
MULT 2
215) In what month and year was (NAME) born?
PROBE: When is his/her birthday?
YEAR __ __ __ __
NO 2 (GO TO 220)
217) IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.
218) IF ALIVE: Is (NAME) living with you?
NO 2
219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
220) IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
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?
[FOR ALL BUT FIRST 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.
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)
ENTER THE NUMBER OF BIRTHS IN 2006 OR LATER
NONE 0 (GO TO 226)
225 FOR EACH BIRTH SINCE JANUARY 2006, 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.)
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)
227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P's IN THE CALENDAR, BEGINNING WITH
THE MONTH OF INTERVIEW AND FOR THE TOTAL
NUMBER OF COMPLETED MONTHS.
228) When you got pregnant, did you want to get pregnant at that time?
NO 2
229) Did you want to have a baby later on or did you not want aborted, any (more) children?
NO MORE 2
230) Have you ever had a pregnancy that miscarried, was or ended in a stillbirth?
NO 2 (GO TO 238)
231) When did the last such pregnancy end?
YEAR __ __ __ __
LAST PREGNANCY ENDED BEFORE JAN. 2006 ___ (GO TO 238)
233) 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.
233A) When the pregnancy ended, did you receive counselling for family planning use?
NO 2
234) Since January 2006, have you had any other pregnancies that did not result in a live birth?
NO 2 (GO TO 236)
235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2006
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
236) Did you have any miscarriages, abortions or stillbirths that ended before 2006 ?
NO 2 (GO TO 238)
237) When did the last such pregnancy that terminated before 2006 end?
YEAR __ __ __ __
238) When did your last menstrual period start?
(DATE, IF GIVEN) ____________
WEEKS AGO 2 __ __
MONTHS AGO 3 __ __
YEARS AGO 4 __ __
IN MENOPAUSE/ HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
239) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)
240) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ____________ 6
DON'T KNOW 8
301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you ever heard of (METHOD)?
PROBE: Women can have an operation to avoid having any more children
NO 2
PROBE: Men can have an operation to avoid having any more children
NO 2
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse
NO 2
PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months
NO 2
PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years
NO 2
PROBE: Women can take a pill every day to avoid becoming pregnant
NO 2
PROBE: Men can put a rubber sheath on their penis before sexual intercourse
NO 2
PROBE: Women can place a sheath in their vagina before sexual intercourse
NO 2
NO 2
PROBE: 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
NO 2
PROBE: Men can be careful and pull out before climax
NO 2
PROBE: As an emergency measure, within five days after they have unprotected sexual intercourse, intercourse, women can take special pills or loop/coil is placed inside them by a doctor or nurse to prevent pregnancy
NO 2
men can use to avoid pregnancy?
NO 2
PREGNANT ___ (GO TO 311)
303) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 311)
304) Which method are you using?
CIRCLE ALL MENTIONED
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 308A)
DIAPHRAGM I (GO TO 308A)
FOAM/JELLY J (GO TO 308A)
LACTATIONAL AMEN METHOD K (GO TO 308A)
RHYTHM METHOD/MOON BEADS L (GO TO 308A)
WITHDRAWAL M (GO TO 308A)
OTHER (SPECIFY) ____________ X (GO TO 308A)
305) What is the brand name of the pills you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.
SOFT SURE 02 (GO TO 308A)
NEWFEM 03 (GO TO 308A)
LO-FEMENOL 04 (GO TO 308A)
MICROGYNON 05 (GO TO 308A)
OVRETTE 06 (GO TO 308A)
MICROLUT 07 (GO TO 308A)
OTHER (SPECIFY) _____________ 96
DON'T KNOW 98
306) What is the brand name of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.
LIFE GUARD 02 (GO TO 308A)
ENGABU 03 (GO TO 308A)
TRUST 04 (GO TO 308A)
OTHER (SPECIFY) _____________ 96 (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)
307) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR WRITE THE NAME OF THE PLACE
(NAME OF PLACE) ___________________
GOVT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC SECTOR (SPECIFY) ___________ 16
PRIVATE DOCTOR'S OFFICE 22
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____________ 26
DON'T KNOW 98
308) In what month and year was the sterilization performed?
YEAR __ __ __ __
308A) 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?
YEAR __ __ __ __
309) CHECK 308/308A, 215 AND 231:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A
NO ___
YEAR IS 2005 OR EARLIER ___ (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2006. THEN SKIP TO 322.)
311) 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 2006.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?
IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE.
NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1
ASK WHY SHE STOPPED USING THE METHOD IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR
DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.
312) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH
ANY METHOD USED ___ (GO TO 314)
313) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 324)
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304,
CIRCLE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN METHOD 11 (GO TO 315A)
RHYTHM METHOD/MOON BEADS 12 (GO TO 315A)
WITHDRAWAL 13 (GO TO 326)
OTHER METHOD 96 (GO TO 326)
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A) Where did you get it at that time?
GOVT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUT REACH 14
FIELDWORKER/VHT 15
OTHER PUBLIC SECTOR (SPECIFY) ____________________16
PHARMACY 22
PRIVATE DOCTOR 23
OUTREACH 24
FIELDWORKER/VHT 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________26
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) __________________ 96
315A) Where did you learn how to use the rhythm/lactational amenorheamethod?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE) _________________
GOVT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OUT REACH 14
FIELDWORKER/VHT 15
OTHER PUBLIC SECTOR (SPECIFY) ____________________16
PHARMACY 22
PRIVATE DOCTOR 23
OUTREACH 24
FIELDWORKER/VHT 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________26
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) __________________ 96
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304,
CIRCLE CODE FOR HIGHEST METHOD IN LIST.
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD/MOON BEADS 12 (GO TO 326)
317) At that time, were you told about side effects or problems you might have with the method?
NO 2
317A) When you got sterilized, were you told about side effects or problems you might have with the method?
NO 2
318) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (GO TO 320)
319) Were you told what to do if you experienced side effects or problems?
NO 2
At that time, were you told about other methods of family planning that you could use?
NO 2
When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?
NO 2 (GO TO 322)
321) Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (GO TO 326)
IUD 03 (GO TO 326)
INJECTABLES 04
326
IMPLANTS 05 (GO TO 326)
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 326)
RHYTHM METHOD/MOON BEADS 12 (GO TO 326)
WITHDRAWAL 13 (GO TO 326)
OTHER METHOD 96 (GO TO 326)
323) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
(NAME OF PLACE)
GOVT HEALTH CENTER 12 (GO TO 326)
FAMILY PLANNING CLINIC 13 (GO TO 326)
OUT REACH 14 (GO TO 326)
FIELDWORKER/VHT 15 (GO TO 326)
OTHER PUBLIC SECTOR (SPECIFY) _______________ 16 (GO TO 326)
PHARMACY 22 (GO TO 326)
PRIVATE DOCTOR 23 (GO TO 326)
OUT REACH 24 (GO TO 326)
FIELDWORKER/VHT 25 (GO TO 326)
OTHER PRIVATE MEDICAL SECTOR 26 (SPECIFY) _____________ (GO TO 326)
CHURCH 32 (GO TO 326)
FRIEND/RELATIVE 33 (GO TO 326)
324) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 326)
325) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) ________________________
GOVT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUT REACH D
FIELDWORKER/VHT E
OTHER PUBLIC SECTOR (SPECIFY) _______________ F
PHARMACY H
PRIVATE DOCTOR I
OUT REACH J
FIELDWORKER/VHT K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____________ L
CHURCH N
FRIEND/RELATIVE O
326) In the last 12 months, were you visited by a fieldworker/VHT who talked to you about family planning?
NO 2
327) In the last 12 months, have you visited a health facility for care for yourself (or your children)?
NO 2 (GO TO 401)
328) Did any staff member at the health facility speak to you about family planning methods?
NO 2
SECTION 4 PREGNANCY AND POSTNATAL CARE
401) CHECK 224:
NO BIRTHS IN 2006 OR LATER ___ (GO TO 556)
402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask some questions about your children born in the last five years. (We will talk about each birth separately).
403) BIRTH HISTORY FROM 212 IN BIRTH HISTORY
LIVING ___
DEAD ___
405) When you got pregnant with (NAME), did you want to get pregnant at that time?
NO 2
406) Did you want to have a baby later on, or did you not want any (more) children?
NO MORE 2 [GO TO 408 (FOR LAST BIRTH), 430 FOR NEXT-TO-LAST AND SECOND-FROM-LAST BIRTHS]
407) How much longer did you want to wait?
YEARS 2 __ __
DON'T KNOW 998
408) Did you see anyone for antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 415)
409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
MEDICAL ASSISTANT/ CLINICAL OFFICER C
COMMUNITY/ VILLAGE HEALTH TEAM E
410) Where did you receive antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]
Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S).
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) __________________
OTHER HOME B
GOVT HEALTH CENTER D
OTHER PUBLIC SECTOR (SPECIFY) __________ E
OTHER PRIVATE MED. (SPECIFY) ____________ G
411) How many months pregnant were you when you first received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
412) How many times did you receive antenatal care during this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
413) As part of your antenatal care during this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]
NO 2
NO 2
NO 2
NO 2
414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)
416) During this pregnancy, how many times did you get a tetanus injection?
[FOR LAST BIRTH ONLY]
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
417) CHECK 416:
[FOR LAST BIRTH ONLY]
OTHER ___
418) At any time before this pregnancy, did you receive any tetanus injections?
[FOR LAST BIRTH]
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)
419) Before this pregnancy, how many times did you receive a tetanus injection?
[FOR LAST BIRTH ONLY]
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
420) How many years ago did you receive the last tetanus injection before this pregnancy?
[FOR LAST BIRTH ONLY]
421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
[FOR LAST BIRTH ONLY]
SHOW TABLETS/SYRUP.
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)
422) During this whole pregnancy, for how many days did you take the tablets or syrup?
[FOR LAST BIRTH ONLY]
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
423) During this pregnancy, did you take any drug for intestinal worms?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 424)
DON'T KNOW 8 (GO TO 424)
423A) During the whole of this pregnancy, how many doses/times did you take drugs for intestinal worms?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
424) During this pregnancy, did you take any drugs to keep you from getting malaria?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)
425) What drugs did you take?
[FOR LAST BIRTH ONLY]
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
CHLOROQUINE B
OTHER (SPECIFY) ___________ X
DON'T KNOW Z
426) CHECK 425:
[FOR LAST BIRTH ONLY]
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION.
CODE 'A' NOT CIRCLED ___ (GO TO 430)
427) How many times did you take (SP/ Fansidar) during this pregnancy?
[FOR LAST BIRTH]
428) CHECK 409:
[FOR LAST BIRTH ONLY]
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY.
OTHER ___ (GO TO 430)
429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?
[FOR LAST BIRTH ONLY]
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6
430) When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
431) Was (NAME) weighed at birth?
NO 2 (GO TO 433)
DON'T KNOW 8 (GO TO 433)
432) How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KG FROM RECALL 2 __ . __ __ __
DON'T KNOW 99998
433) 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.
NURSE/MIDWIFE B
MEDICAL ASSISTANT/ CLINICALOFFICER C
NURSING AIDE D
RELATIVE/FRIEND F
OTHER (SPECIFY) __________ X
434) Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE THE NAME OF THE PLACE.
(NAME OF PLACE) ____________________
TBA'S HOME 12 [GO TO 438(FOR LAST BIRTH), 448 (FOR NEXT-TO-LAST AND SECOND-FROM-LAST BIRTHS)]
OTHER HOME 13 [GO TO 438(FOR LAST BIRTH), 448 (FOR NEXT-TO-LAST AND SECOND-FROM-LAST BIRTHS)]
GOVT HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) _____________ 26
OTHER PRIVATE (SPECIFY) _____________ 36
434A) How long after (NAME) was delivered did you stay there?
[FOR LAST BIRTH ONL7Y]
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __ __
WEEKS 3 __ __
DON'T KNOW 998
435) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?
NO 2
435A) Before you were discharged were you counselled about family planning use?
[FOR LAST BIRTH ONLY]
NO 2
436) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 439)
437) Did anyone check on your health after you left the facility?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 442)
438) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 442)
439) Who checked on your health at that time?
[FOR LAST BIRTH ONLY]
PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/ CLINICAL OFFICER 13
NURSING AIDE 14
VHT 15
OTHER (SPECIFY) __________ 96
440) How long after delivery did the first check take place?
[FOR LAST BIRTH ONLY]
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __ __
WEEKS 3 __ __
DON'T KNOW 998
442) In the two months after (NAME) was born, did any health care provider check on his/her health?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)
443) How many hours, days or weeks after the birth of (NAME) did the first check take place?
[FOR LAST BIRTH ONLY]
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS AFTER BIRTH 2 __ __
WEEKS AFTER BIRTH 3 __ __
DON'T KNOW 998
444) Who checked on (NAME)'s health at that time?
[FOR LAST BIRHT ONLY]
PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/ CLINICAL OFFICER 13
NURSING AIDE 14
OTHER (SPECIFY) __________ 96
445) Where did this first check of (NAME) take place?
[FOR LAST BIRTH ONLY]
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINEIF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______________________
TBA'S HOME 12
OTHER HOME 13
GOVT HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) _____________ 26
OTHER PRIVATE MED. (SPECIFY) ____________ 36
446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
[FOR LAST BIRTH ONLY]
SHOW COMMON TYPES OF AMPULES/CAPSULES
NO 2
DON'T KNOW 8
447) Has your menstrual period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 450)
448) Did your period return between the birth of (NAME) and your next pregnancy?
[FOR NEXT-TO-LAST AND SECOND-FROM-LAST BIRTHS]
NO 2 (GO TO 452)
449) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
450) CHECK 226:
[FOR LAST BIRTH ONLY]
IS RESPONDENT PREGNANT?
PREGNANT OR UNSURE ___ (GO TO 452)
451) Have you had sexual intercourse since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 453)
452) For how many months after the birth of (NAME) did you not have sexual intercourse?
DON'T KNOW 98
453) Did you ever breastfeed (NAME)?
NO 2 (GO TO 455)
454) CHECK 404:
[FOR LAST BIRTH ONLY]
IS CHILD LIVING?
DEAD ___ (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)
455) How long after birth did you first put (NAME) to the breast?
[FOR LAST BIRTH ONLY]
IF LESS THAN 1 HOUR, RECORD '00' HOURS.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.
HOURS 1__ __
DAYS 2 __ __
456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 458)
457) What was (NAME) given to drink?
[FOR LAST BIRTH ONLY]
Anything else?
RECORD ALL LIQUIDS MENTIONED.
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
COFFEE I
HONEY J
OTHER (SPECIFY) ____________ X
IS CHILD LIVING?
DEAD ___ (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)
459) Are you still breastfeeding (NAME)?
[FOR LAST BIRTH ONLY]
NO 2
460) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
461) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.
SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION
501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2006 OR LATER.
ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.
LIVING ___
DEAD ___(GO TO 503 IN NEXT COLUMN OR, IF NO MORE OR, IF NO MORE BIRTHS, GO TO 553)
504) Do you have a card/ book where (NAME)'s vaccinations are written down?
YES, NOT SEEN 2 (GO TO 509)
NO CARD 3
505) Did you ever have a vaccination card/book for (NAME)?
NO 2 (GO TO 509)
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.
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
OTHER ___
508) Has (NAME) had any vaccinations that are not on this card/book including vaccinations given in a national immunization day campaign?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS BCG, POLIO0-3, DPT-HEPB-HIB 1-3, AND OR MEASLES VACCINES AS HAVING BEEN GIVEN.
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)
509) Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)
510) Please tell me if (NAME) had any of the following vaccinations:
NO 2
DON'T KNOW 8
NO 2 (GO TO 510E)
DON'T KNOW 8 (GO TO 510E)
510C) Was the first polio vaccine given in the first two weeks after birth or later?
LATER 2
510D) How many times was the poliovaccine given?
510E) A DPT vaccination, that is, an injection given in the left upper thigh, sometimes at the same time as polio drops?
NO 2 (GO TO 510G)
DON'T KNOW 8 (GO TO 510G)
510F) How many times was the DPT vaccination given?
510G) A measles injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?
NO 2
DON'T KNOW 8
511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES
NO 2
DON'T KNOW 8
512) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS
NO 2
DON'T KNOW 8
513) Was (NAME) given any drug for intestinal worms in the last six months?
NO 2
DON'T KNOW 8
514) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)
515) Was there any blood in the stools?
NO 2
DON'T KNOW 8
516) 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
517) 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
GAVE RUTF 7
DON'T KNOW 8
518) Did you seek advice or treatment for the diarrhea from any source?
NO 2 (GO TO 522)
519) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATESECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) __________________________
GOVT HEALTH CENTER B
OUT REACH SERVICE C
FIELDWORKER/VHT D
OTHER PUBLIC SECTOR (SPECIFY) ___________ E
PHARMACY G
PVT DOCTOR H
OUT REACH SERVICE COMMUNITY HEALTH I WORKER J
OTHER PRIVATE MED. SECTOR (SPECIFY) ___________ K
TRADITIONAL PRACTITIONER M
MARKET N
OTHER (SPECIFY) ___________ X
ONLY ONE CODE CIRCLED ___ (GOTO 522)
521) Where did you first seek advice or treatment?
USE LETTER CODE FROM 519.
522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
523) Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)
524) What (else) was given to treat the diarrhea?
Anything else?
RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTI-BIOTIC, ANTI-MOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
HOME REMEDY/HERBAL MEDICINE J
OTHER (SPECIFY) __________ X
525) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (GO TO 527)
DON'T KNOW 8 (GO TO 527)
526) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?
NO 2
DON'T KNOW 8
527) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)
528) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)
529) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) ___________ 6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)
HAD FEVER?
NO OR DON'T KNOW ___ (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
531) 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
532) 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
GAVE RUTF 7
DON'T KNOW 8
533) Did you seek advice or treatment for the illness from any source?
NO 2 (GO TO 537)
534) Where did you seek advice or treatment?
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME
OF THE PLACE.
(NAME OF PLACE(S)) _________________________
GOVT HEALTH CENTER B
OUT REACH SERVICE C
FIELDWORKER/VHT D
OTHER PUBLIC SECTOR (SPECIFY) __________ E
PHARMACY G
PVT DOCTOR H
OUTREACH SERVICE I
COMMUNITY HEALTH WORKER J
OTHER PRIVATE MED. SECTOR (SPECIFY) __________ K
TRADITIONAL PRACTITIONER M
MARKET N
ONLY ONE CODE CIRCLED ___ (GO TO 537)
536) Where did you first seek advice or treatment?
USE LETTER CODE FROM 534.
537) At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
538) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.
CHLOROQUINE B
CHLOROQUINE WITH FANSIDAR C
COARTEM/ACT D
QUININE E
OTHER ANTI-MALARIAL (SPECIFY) ___________ F
INJECTION H
PANADOL J
IBUPROFEN K
DON'T KNOW Z
ANY CODE A-F CIRCLED?
NO ___ (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
SP/FANSIDAR ('A') GIVEN
CODE 'A' NOT CIRCLED ___ (GO TO 542)
541) How long after the fever started did (NAME) first take (SP/Fansidar)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
CHLOROQUINE ('B') GIVEN
CODE 'B' NOT CIRCLED ___ (GO TO 544)
543) How long after the fever started did (NAME) first take chloroquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
CHLOROQUINE WITH FANSIDAR ("C") GIVEN
CODE 'C' NOT CIRCLED ___ (GO TO 546)
545) How long after the fever started did (NAME) first take chloroquine with fansidar?
NEXT DAY 1
TWO DAYS AFTER FEVER 2 THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
COARTEM/ACTS ('D') GIVEN
CODE 'D' NOT CIRCLED ___ (GO TO 550)
547) How long after the fever started did (NAME) first take coartem / ACTS?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
QUININE ('E') GIVEN
CODE 'E' NOT CIRCLED (GO TO 550)
549) How long after the fever started did (NAME) first take quinine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
OTHER ANTIMALARIAL ('F') GIVEN
CODE 'F' NOT CIRCLED ___ (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 552)
551) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE OR MORE DAYS AFTER FEVER 3
DON'T KNOW 8
552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.
553) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2006 OR LATER LIVING WITH THE RESPONDENT
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 554
554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?
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
555) CHECK 522(a) , ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET ___ (GO TO 557)
556) Have you ever heard of a special product called ORS PACKET you can get for the treatment of diarrhea?
NO 2
557) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH THE RESPONDENT
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 558
558) Now I would like to ask you about liquids or foods that (NAME FROM 557) may have had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.
Did (NAME FROM 557) drink/eat?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES RECORD '7'
NO 2
DON'T KNOW 8
NUMBER OF TIMES ___
IF YES: How many times did (NAME) eat yogurt
IF 7 OR MORE TIMES RECORD '7'
NO 2
DON'T KNOW 8
NUMBER OF TIMES ___
NO 2
DON'T KNOW 8
IF YES: How many times did (NAME) drink infant formula
IF 7 OR MORE TIMES RECORD '7'
NO 2
DON'T KNOW 8
NUMBER OF TIMES ___
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
559) CHECK 558 (CATEGORIES "X" THROUGH "XXIX"):
AT LEAST ONE "YES" OR ALL DON'T KNOWs ___ (GO TO 561)
560) Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?
NO 2 (GO TO 601)
561) How many times did (NAME FROM 557) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'
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, CUSTOMARY MARRIAGE 2 (GO TO 604)
YES, RELIGIOUS MARRIAGE 3 (GO TO 604)
YES, LIVING WITH A MAN 4 (GO TO 604)
NO, NOT IN UNION 5
602) Have you ever been married or lived together with a man as if married?
YES, LIVED WITH A MAN 2
NO 3 (GO TO 612)
603) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)
604) Is your (husband/partner) living with you now or is he staying elsewhere?
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'
LINE NO. __ __
606) Does your (husband/partner) have other wives or does he live with other women as if married?
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)
607) Including yourself, in total, how many wives or live-in partners does he have?
DON'T KNOW 98
608) Are you the first, second, ...wife?
609) Have you been married or lived with a man only once or more than once?
MORE THAN ONCE 2
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 your first (husband/partner). In what month and year did you start living with him?
DON'T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 612)
DON'T KNOW YEAR 9998
611) How old were you when you first started living with him?
612) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERYEFFORT TO ENSURE PRIVACY.
613) Now I would like 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 very first time?
AGE IN YEARS __ __
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95
614) 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.
615) 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.
WEEKS AGO 2 __ __
MONTHS AGO 3 __ __
YEARS AGO 4 __ __ (GO TO 627)
616) When was the last time you had sexual intercourse with this person?
[FOR SECOND-TO-LAST AND THRID-TO-LAST SEXUAL PARTNERS]
WEEKS AGO 2 __ __
MONTHS AGO 3 __ __
617) The last time you had sexual intercourse (with this second/third person), was a condom used?
NO 2 (GO TO 619)
618) Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
619) 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'
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
PROSTITUTE 5 (GO TO 622)
OTHER (SPECIFY) ____________ 6 (GO TO 622)
MARRIED MORE THAN ONCE ___ (GO TO 622)
OTHER ___
622) How long ago did you first have sexual intercourse with this (second/third) person?
WEEKS AGO 2 __ __
MONTHS AGOS 3 __ __
YEARS AGO 4 __ __
623) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
625) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?
[FOR LAST AND SECOND-TO-LAST SEXUAL PARTNERS]
NO 2 (GO TO 627)
626) In total, with how many different people have you had sexual intercourse in the last 12 months?
[FOR THIRD-TO-LAST SEXUAL PARTNER ONLY]
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
627) 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 95 OR MORE, WRITE '95'.
DON'T KNOW 98
628) PRESENCE OF OTHERS DURING THIS SECTION
NO 2
NO 2
NO 2
629) Do you know of a place where a person can get condoms?
NO 2 (GO TO 631A)
630) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) _________________________
GOVT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUT REACH D
VILLAGE HEALTH TEAM E
OTHER PUBLIC SECTOR (SPECIFY) ___________ F
PHARMACY H
PRIVATE DOCTOR I
OUT REACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) __________ L
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
STREET VENDOR P
LODGE Q
631) If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW/UNSURE 8
631A) Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery.
Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?
NO 2 (GO TO 631D)
DON'T KNOW 8 (GO TO 631D)
631B) Have you sought treatment for this condition?
NO 2
631C) Why have you not sought treatment?
DO NOT KNOW WHERE TO GO 2
TOO EXPENSIVE 3
TOO FAR 4
POOR QUALITY OF CARE 5
COULD NOT GET PERMISSION 6
EMBARRASSMENT 7
OTHER (SPECIFY) ________________ 8
631D) Have you ever heard of female circumcision?
NO 2
DON'T KNOW 3
631E) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?
NO 2 (GO TO 701)
631F) Have you yourself ever been circumcised?
NO 2
631G) Do you think that female circumcision should be continued, or should it be stopped?
STOPPED 2
DEPENDS 3
DON'T KNOW 8
HAS NO LIVING DAUGHTERS BORN IN 1996 OR LATER ___ (GO TO 701)
631I) How many of your daugther(s) aged between 0 and 14 years have undergone circumcision?
SECTION 7. FERTILITY PREFERENCES
701) CHECK 304:
HE OR SHE STERILIZED ___ (GO TO 712)
NOT PREGNANT OR UNSURE ___ (GO TO 704)
703) 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?
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)
704) 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?
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (GO TO 710)
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?
YEARS 2 __ __
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) __________________ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)
PREGNANT ___ (GO TO 711)
707) CHECK 303: USING A CONTRACEPTIVE METHOD?
CURRENTLY USING ___ (GO TO 712)
24 OR MORE MONTHS OR 02 OR MORE YEARS ___
00-23 MONTHS OR 00-01 YEAR 711 ___ (GO TO 711)
WANTS TO HAVE A/ANOTHER CHILD ___
You have said that you do not want (a/another) child soon.
Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?
WANTS NO MORE/NONE ___
You have said that you do not want any (more) children.
Can you tell me why you are not using a method to prevent pregnancy?
Any other reason?
RECORD ALL REASONS MENTIONED.
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
DON'T KNOW Z
710) CHECK 303: USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING ___
YES, CURRENTLY USING ___ (GO TO 712)
711) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8
HAS LIVING CHILDREN ___
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN ___
If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NUMBER __ __
OTHER (SPECIFY) __________________ 96 (GO TO 714)
713) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?
OTHER (SPECIFY) ________________ 96
OTHER (SPECIFY) ________________ 96
OTHER (SPECIFY) ________________ 96
714) In the last six months have you:
NO 2
NO 2
NO 2
NO 2
YES, LIVING WITH A MAN ___
NO, NOT IN UNION ___ (GO TO 801)
717) CHECK 303: USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING OR NOT ASKED ___ (GO TO 720)
718) Would you say that using contraception is mainly your decision, mainly your (husband's/partner's) decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _____________ 6
HE OR SHE STERILIZED ___ (GO TO 801)
720) Does your (husband/partner) want the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK
801) CHECK 601 AND 602:
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?
803) Did your (last) (husband/partner) ever attend school?
NO 2 (GO TO 806)
804) What was the highest level of school he attended: primary, O level, A level, university or tertiary?
'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?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
DON'T KNOW 98
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?
807) Apart from your own housework, have you done any work in the last seven days?
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?
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?
NO 2
810) Have you done any work in the last 12 months?
NO 2 (GO TO 815)
811) What is your occupation, that is, what kind of work do you mainly do?
812) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
813) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
814) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT IN UNION ___ (GO TO 823)
OTHER ___ (GO TO 819)
817) Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) __________ 6
818) 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?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 820)
DON'T KNOW 8
819) Who usually decides how your (husband's/partner's) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) ____________ 6
820) Who usually makes decisions about health care for yourself: you, your (husband/partner), you and your (husband/partner) jointly, or someone else?
HUSBAND/PARTNER 2
RESPONDENT AND
HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
821) Who usually makes decisions about making major household purchases?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
822) Who usually makes decisions about visits to your family or relatives?
HUSBAND/PARTNER 2
HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
823) Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
824) Do you own any land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
825) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRESENT/NOT LISTENING 2
NOT PRESENT 3
PRESENT/NOT LISTENING 2
NOT PRESENT 3
PRESENT/NOT LISTENING 2
NOT PRESENT 3
PRESENT/NOT LISTENING 2
NOT PRESENT 3
826) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
901) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 937)
902) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
903) Can people get the AIDS virus from mosquito bites?
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?
NO 2
DON'T KNOW 8
905) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
906) Can people get the AIDS virus because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
907) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
908) Can the virus that causes AIDS be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER ___ (GO TO 911)
910) 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?
NO 2
DON'T KNOW 8
LAST BIRTH SINCE JANUARY 2009 ___
LAST BIRTH BEFORE JANUARY 2009 ___ (GO TO 926)
912) CHECK 408 FOR LAST BIRTH:
NO ANTENATAL CARE ___ (GO TO 920)
913) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY
914) During any of the antenatal visits for your last birth were you given any information about:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
915) Were you offered a test for the AIDS virus as part of your antenatal care?
NO 2
916) I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?
NO 2 (GO TO 920)
916A) Usually pregnant women receive counseling before being tested. Before you were tested, did you receive counseling?
NO 2
DON'T KNOW 8
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) _________________________
GOVT. HEALTH CENTER 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
OUT REACH 15
VILLAGE HEALTH TEAM 16
OTHER PUBLIC (SPECIFY) ___________ 17
STAND-ALONE VCT CENTER 22
PHARMACY/DRUG SHOP 23
PRIVATE DOCTOR/NURSE/MIDWIFE 24
OUT REACH 25
TASO 26
AIDS INFORMATION CENTRE 27
OTHER PRIVATE/NGO MEDICAL (SPECIFY) _____________ 28
918) I don't want to know the results, but did you get the results of the test?
NO 2 (GO TO 924)
919) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?
NO 2 (GO TO 924)
DON'T KNOW 8 (GO TO 924)
920) CHECK 434 FOR LAST BIRTH:
OTHER ___ (GO TO 926)
921) Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?
NO 2
922) I don't want to know the results, but were you tested for the AIDS virus at that time?
NO 2 (GO TO 926)
923) I don't want to know the results, but did you get the results of the test?
NO 2
924) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?
NO 2
925) How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95 (GO TO 932)
926) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 930)
927) How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95
928) I don't want to know the results, but did you get the results of the test?
NO 2
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ___________________
GOVT. HEALTH CENTER 12 (GO TO 932)
STAND-ALONE VCT CENTER 13 (GO TO 932)
FAMILY PLANNING CLINIC 14 (GO TO 932)
OUT REACH 15 (GO TO 932)
VILLAGE HEALTH TEAM 16 (GO TO 932)
OTHER PUBLIC (SPECIFY) ___________ 17 (GO TO 932)
STAND-ALONE VCT CENTER 22 (GO TO 932)
PHARMACY/DRUG SHOP 23 (GO TO 932)
PRIVATE DOCTOR/NURSE/MIDWIFE 24 (GO TO 932)
OUT REACH 25 (GO TO 932)
TASO 26 (GO TO 932)
AIDS INFORMATION CENTRE 27 (GO TO 932)
OTHER PRIVATE/NGO MEDICAL (SPECIFY) _____________ 28 (GO TO 932)
930) Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 932)
931) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) ______________________
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUT REACH E
VILLAGE HEALTH TEAM F
OTHER PUBLIC (SPECIFY) ___________ G
STAND-ALONE VCT CENTER I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/MIDWIFE K
OUT REACH L
TASO M
AIDS INFORMATION CENTRE N
OTHER PRIVATE/NGO MEDICAL (SPECIFY) ______________ O
932) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
933) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
934) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
935) 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 NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
936) Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NO 2
Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE ___ (GO TO 946)
939) CHECK 937: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO ___ (GO TO 941)
940) 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?
NO 2
DON'T KNOW 8
941) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?
NO 2
DON'T KNOW 8
942) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW ___ (GO TO 946)
944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?
NO 2 (GO TO 946)
945) Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE(S)) __________________________
GOVT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
OUT REACH E
VILLAGE HEALTH TEAM F
OTHER PUBLIC (SPECIFY) ____________ G
STAND-ALONE VCT CENTER I
PHARMACY/DRUG SHOP J
PRIVATE DOCTOR/NURSE/ MIDWIFE K
OUT REACH L
TASO M
AIDS INFORMATION CENTRE N
OTHER PRIVATE/NGO MEDICAL (SPECIFY) ______________ O
OTHER (SPECIFY) _____________ X
946) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
947) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?
NO 2
DON'T KNOW 8
NOT IN UNION ___ (GO TO 1001)
949) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?
NO 2
DEPENDS/NOT SURE 8
950) Could you ask your (husband/partner) to use a condom if you wanted him to?
NO 2
DEPENDS/NOT SURE 8
SECTION 10. OTHER HEALTH ISSUES
1001) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1004)
1001A) Who administered the last injection you got?
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE 14
NON-MEDICAL PERSONNEL 15 (GO TO 1004)
1003) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1003A) Did you develop any complications as a result of an injection?
NO 2
1004) Do you currently smoke cigarettes?
NO 2 (GO TO 1006)
1005) In the last 24 hours, how many cigarettes did you smoke?
1006) Do you currently smoke or use any (other) type of tobacco?
NO 2 (GO TO 1008)
1007) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) _____________ X
1008) 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?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
1009) Are you covered by any health insurance?
NO 2 (GO TO 1100)
1010) What type of health insurance are you covered by?
RECORD ALL MENTIONED.
PRIVATE COMMERCIAL HEALTH INSURANCE B
OTHER (SPECIFY) ____________ X
1100) CHECK FRONT COVER:
WOMAN NOT SELECTED ___ (GO TO 1201A)
1101) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (GO TO 1132)
READ TO THE RESPONDENT
Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in Uganda. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.
1102) CHECK 601 AND 602:
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH HUSBAND/PARTNER) ___
NEVER MARRIED/NEVER LIVED WITH A MAN ___ (GO TO 1116)
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?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1104) Now I need to ask some more questions about your relationship with your (last) husband/partner.
A) Did your (last) husband/partner ever:
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
1105) A) Did your (last) husband/partner ever do any of the following things to you:
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
NOT A SINGLE 'YES' ___ (GO TO 1109)
1107) How long after you first got married/started living together with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
1108) Did the following ever happen as a result of what your (last) husband/partner did to you:
NO 2
NO 2
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?
NO 2 (GO TO 1111)
1110) In the last 12 months, how often have you done this to your (last) husband/partner: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1111) Does (did) your (last) husband/partner drink alcohol?
NO 2 (GO TO 1113)
1112) How often does (did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
1113) Are (were) you afraid of your (last) husband/partner: most of the time, sometimes, or never?
SOMETIMES AFRAID 2
NEVER AFRAID 3
MARRIED ONLY ONCE ___ (GO TO 1116)
1115) A) So far we have been talking about the behavior of your current/last husband/partner. Now I want to ask you about the behavior of any previous husband/partner.
hurt you physically?
B) How long ago did this last happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
B) How long ago did this last happen?
12+ MONTHS AGO 2
DON'T REMEMBER 3
From the time you were 15 years old has anyone other than your/any husband/partner hit you, slapped you, kicked you, or done anything else to hurt you physically?
NO 2 (GO TO 1119)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1119)
From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?
NO 2 (GO TO 1119)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1119)
1117) Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) __________ X
1118) In the last 12 months, how often has this person/have these person physically hurt you: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1119) CHECK 201, 226, AND 230:
NEVER BEEN PREGNANT ___ (GO TO 1122)
1120) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?
NO 2 (GO TO 1122)
1121) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
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
Now I want to ask you about things that may have been done to you by someone other than your/any husband/partner.
At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NO 2 (GO TO 1126)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1126)
At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?
NO 2 (GO TO 1126)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1126)
1123) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
DON'T KNOW 98
1124) Who was the person who was forcing you at that time?
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 1-
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) ____________ 96
In the last 12 months, has anyone other than your/any husband/partner physically you to have sexual intercourse when you did not want to?
NO 2
In the last 12 months, has anyone physically you to have sexual intercourse when you did not want to?
NO 2
1126) CHECK 1105A (a-j), 1115, 1116, 1120, 1122, AND 1125:
NOT A SINGLE 'YES' ___ (GO TO 1130)
1127) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?
NO 2 (GO TO 1129)
1128) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.
HUSBAND'S/PARTNER'S FAMILY B (GO TO 1130)
CURRENT/FORMER HUSBAND/PARTNER C (GO TO 1130)
CURRENT/FORMER BOYFRIEND D (GO TO 1130)
FRIEND E (GO TO 1130)
NEIGHBOR F (GO TO 1130)
RELIGIOUS LEADER G (GO TO 1130)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1130)
POLICE I (GO TO 1130)
LAWYER J (GO TO 1130)
SOCIAL SERVICE ORGANIZATION K (GO TO 1130)
OTHER (SPECIFY) ____________ X (GO TO 1130)
1129) Have you ever told anyone about this?
NO 2
1130) As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
1130A) CHECK IF CODE 1 IS CIRCLED IN 1122
CODE "1" NOT CIRCLED ___ (GO TO 1132)
1131) After being forced to have sexual intercourse or to perform a sexual act, have you ever sought help from a doctor or medical personnel?
NO 2 (GO TO 1132)
1131A) How long after you were forced to have a sexual intercourse did you seek help?
AFTER 3 DAYS OR MORE 2
1131B) Were you offered drugs to prevent you from getting the AIDS virus?
NO 2
1131C) Were you offered a test for the AIDS virus after the violence?
NO 2
1131D) Were you pregnant when you were forced to have sexual intercourse?
NO 2 (GO TO 1132)
1131E) Were you offered a pill to stop you from becoming pregnant?
NO 2
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS.
FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.
1132) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
1133) INTERVIEWER'S COMMENTS /EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
__________________________________________
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?
NO 2 (GO TO 1214)
1201B) How many children did your mother give birth to, including you?
ONLY ONE BIRTH (RESPONDENT ONLY) ___ (GO TO 1214)
1203) How many of these births did your mother have before you were born?
1204) What was the name given to your oldest (next oldest) brother or sister?
1205) Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 1208)
DON'T KNO2 8 (GO TO NEXT SIBLING)
1208) How many years ago did (NAME) die?
1209 How old was (NAME) when he/she died?
1210) Was (NAME) pregnant when she died?
NO 2
1211) Did (NAME) die during childbirth?
NO 2
1212) Did (NAME) die within two months after the end of a pregnancy or child birth?
NO 2
1213) How many live borne children did (NAME) give birth to during her lifetime (before this pregnancy)?
IF NO MORE BROTHERS OR SISTERS, GO TO NEXT ELIGIBLE WOMAN IF NO MORE ELIGIBLE WOMAN,END INTERVIEW.
MINUTES __ __
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
___________________________________________
COMMENTS ON SPECIFIC QUESTIONS:
___________________________________________
ANY OTHER COMMENTS:
___________________________________________
SUPERVISOR'S OBSERVATIONS
___________________________________________
NAME OF SUPERVISOR: _________________________
DATE: ______________
EDITOR'S OBSERVATIONS
___________________________________________
NAME OF EDITOR: __________________________
DATE: ______________
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
COLUMN 1 REQUIRES A CODE IN EVERY MONTH.
INFORMATION TO BE CODED FOR EACH COLUMN
COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE**
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3IUD
4 INJECTABLES
5 IMPLANTS
6PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD/MOONBEADS
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD
COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ______________
Z DON'T KNOW
2011 12
12 DEC 01 ___ ___
11 NOV 02 ___ ___
10 OCT 03 ___ ___
09 SEP 04 ___ ___
08 AUG 05 ___ ___
07 JUL 06 ___ ___
06 JUN 07 ___ ___
05 MAY 08 ___ ___
04 APR 09 ___ ___
03 MAR 10 ___ ___
02 FEB 11 ___ ___
01 JAN 12 ___ ___
2010 12
12 DEC 13 ___ ___
11 NOV 14 ___ ___
10 OCT 15 ___ ___
09 SEP 16 ___ ___
08 AUG 17 ___ ___
07 JUL 18 ___ ___
06 JUN 19 ___ ___
05 MAY 20 ___ ___
04 APR 21 ___ ___
03 MAR 22 ___ ___
02 FEB 23 ___ ___
01 JAN 24 ___ ___
2009 12
12 DEC 25 ___ ___
11 NOV 26 ___ ___
10 OCT 27 ___ ___
09 SEP 28 ___ ___
08 AUG 29 ___ ___
07 JUL 30 ___ ___
06 JUN 31 ___ ___
05 MAY 32 ___ ___
04 APR 33 ___ ___
03 MAR 34 ___ ___
02 FEB 35 ___ ___
01 JAN 36 ___ ___
2008 12
12 DEC 37 ___ ___
11 NOV 38 ___ ___
10 OCT 39 ___ ___
09 SEP 40 ___ ___
08 AUG 41 ___ ___
07 JUL 42 ___ ___
06 JUN 43 ___ ___
05 MAY 44 ___ ___
04 APR 45 ___ ___
03 MAR 46 ___ ___
02 FEB 47 ___ ___
01 JAN 48 ___ ___
2007 12
12 DEC 49 ___ ___
11 NOV 50 ___ ___
10 OCT 51 ___ ___
09 SEP 52 ___ ___
08 AUG 53 ___ ___
07 JUL 54 ___ ___
06 JUN 55 ___ ___
05 MAY 56 ___ ___
04 APR 57 ___ ___
03 MAR 58 ___ ___
02 FEB 59 ___ ___
01 JAN 60 ___ ___
2006 12
12 DEC 61 ___ ___
11 NOV 62 ___ ___
10 OCT 63 ___ ___
09 SEP 64 ___ ___
08 AUG 65 ___ ___
07 JUL 66 ___ ___
06 JUN 67 ___ ___
05 MAY 68 ___ ___
04 APR 69 ___ ___
03 MAR 70 ___ ___
02 FEB 71 ___ ___
01 JAN 72 ___ ___
UGANDA BUREAU OF STATISTICS 2011 UGANDA DEMOGRAPHIC AND HEALTH SURVEY MATERNAL MORTALITY-ENGLISH
DISTRICT
URBAN=1
SUBCOUNTY/TOWN
PARISH/LC1 NAME
EA NAME
NAME OF HOUSEHOLD HEAD
HOUSEHOLD NUMBER
SAMPLED HOUSEHOLD NUMBER
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NUMBER __ __ __
RESULT __
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY) _________________
TOTAL PERSONS IN HOUSEHOLD __ __
TOTAL ELIGIBLE WOMEN __ __
LINE NO. OF RESPONDENT TO HOUSEHOLD SCHEDULE __ __
LANGUAGE OF THE QUESTIONNAIRE __ __
LANGUAGE USED IN THE INTERVIEW __ __
NATIVE LANGUAGE OF RESPONDENT __ __
SOMETIMES=2
ALL THE TIME=3
02 LUGANDA
03 LUGBARA
04 LUO
05 RUNYANKOLE-RUKIGA
06 RUNYORO-RUTORO
07 NGAKARAMOJONG
08 ENGLISH
96 OTHER(SPECIFY) _________________
NO. OF ELIGIBLE WOMEN INTERVIEWED __ __
SUPERVISOR
NAME ____________________ __ __ __
FIELD EDITOR
NAME ____________________ __ __ __
OFFICE EDITOR __ __
KEYED BY __ __
Hello. My name is _______________________________________ I am working with Uganda Bureau of Statistics. We are conducting a survey about health all over UGANDA. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 5 to 10 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
Do you have any questions?
___ NO
May I begin the interview now?
___ NO
SIGNATURE OF INTERVIEWER: _________________________________
DATE: ____________
DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)
MINUTES __ __
1) LINE NO.
2) USUAL RESIDENTS AND VISITORS
Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-9 FOR EACH PERSON.
3) REALTIONSHIP TO HEAD OF HOUSEHOLD
What is the relationship of (NAME) to the head of the household?
SEE CODES BELOW
Is (NAME) male or female?
FEMALE 2
5) Does (NAME) usually live here?
NO 2
6) Did (NAME) stay here last night?
NO 2
How old is (NAME)?
IF 95 OR MORE RECORD '95'
8) MARITAL STATUS
[IF AGE 15 OR OLDER]
What is (NAME'S) current marital status?
2 = DIVORCED/ SEPARATED
3 = WIDOWED
4 = NEVER-MARRIED AND NEVER LIVED TOGETHER
CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49
(2A) Just to make sure that I have a complete listing. Are there any other persons such as small children or infants that we have not listed?
NO ___
2B) Are there any other people who may not be YES ADD TO members of your family, such as domestic servants, lodgers, or friends who usually live here?
NO ___
2C) Are there any guests or temporary visitors YES ADD TO staying here, or anyone else who stayed here last night, who have not been listed?
NO ___
CODES FOR Q. 3: RELATIONSHIP TO HEAD OF HOUSEHOLD
02=WIFE OR HUSBAND
03=SON OR DAUGHTER
04=SON-IN-LAW OR DAUGHTER-IN-LAW
05=GRANDCHILD
06=PARENT
07=PARENT-IN-LAW
08=BROTHER OR SISTER
09=NIECE/NEPHEW BY BLOOD
10=NIECE/NEPHEW BY MARRIAGE
11=CO-WIFE
12=OTHER RELATIVE
13=ADOPTED/FOSTER/STEPCHILD
14=NOT RELATED
98=DON'T KNOW
00=MOTHER NOT LISTED
NAME OF ELIGIBLE WOMAN ________________________
LINE NUMBER OF WOMAN __ __
INTERVIEWER VISITS
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NUMBER __ __ __
RESULT __
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _______________
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?
NO 2 (GO TO 1214)
1201B) How many children did your mother give birth to, including you?
ONLY ONE BIRTH (RESPONDENT ONLY) ___ (GO TO 1214)
1203) How many of these births did your mother have before you were born?
1204) What was the name given to your oldest (next oldest) brother or sister?
1205) Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 1208)
DON'T KNOW 8 (GO TO 1208)
1208) How many years ago did (NAME) die?
1209) How old was (NAME) when he/she died?
1210) Was (NAME) pregnant when she died?
NO 2
1211) Did (NAME) die during childbirth?
NO 2
1212) Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2
1213) How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?
1214) CHECK (X) HERE IF CONTINUATION SHEET USED ___
IF NO MORE BROTHERS OR SISTERS, GO TO NEXT ELIGIBLE WOMAN IF NO MORE ELIGIBLE WOMAN, END INTERVIEW.
MINUTES __ __