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2016 UGANDA DEMOGRAPHIC AND HEALTH SURVEY
WOMAN'S QUESTIONNAIRE

UGANDA

UGANDA BUREAU OF STATISTICS

IDENTIFICATION

EA NAME

NAME OF HOUSEHOLD HEAD

CLUSTER NAMBER

NAME AND OF WOMAN

CHECK COVER PAGE OF HOUSEHOLD QUESTIONNAIRE: HOUSEHOLD SELECTED FOR MAN'S SURVEY?

YES=1
NO=2

CHECK HOUSEHOLD QUESTIONNAIRE SL12: WOMAN SELECTED FOR DV MODULE?

YES=1
NO=2

INTERVIEW VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT*

DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*

NEXT VISIT:
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR

INT. NO.
RESULT*

LANGUAGE OF QUESTIONNAIRE**

LANGUAGE OF INTERVIEW**

NATICE LANGUAGE OF RESPONDENT**

TRANSLATOR USED

YES 1
NO 2

**LANGUAGE CODES:

ENGLISH 01
LUGANDA 02
LUO 03
LUGBARA 04
ATESO 05
NGAKARIMOJONG 06
RUNYANKOLE/RUKIGA 07
RUNYORO/RUTORO 08
LUSOGA 09
OTHER (SPECIFY) 96

SUPERVISOR
NAME
NUMBER

CAPI MANAGER
NAME
NUMBER

INTRODUCTION AND CONSENT

Hello. My name is __________________________________. I am working with Uganda Bureau of Statistics. We are conducting a survey about health and other topics all over Uganda. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 60 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 question? May I begin the interview now?

SIGNATURE OF INTERVIEWER ______________ DATE _____________________

RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

HOURS______
MINUTES______

102) How long have you been living continuously in (NAME OF CURRECT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS _____
ALWAYS 95 (GO TO 105)
VISITOR 98 (GO TO 105)

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

CITY 1
TOWN 2
RURAL AREA 3

104) Before you moved here, which district did you live in?

DISTRICT CODE _____
OUTSIDE OF UGANDA 996

105) In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR _____
DON'T KNOW YEAR 9998

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS _____

107) Have you ever attended school?

YES 1
NO 2 (GO TO 111)

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

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

109) What is the highest [CLASS/YEAR] you completed at that level?
IF COMPLETED LESS THA ONE YEAR AT THAT LEVEL, RECORD '00'.

[CLASS/YEAR] _______

110) CHECK 108:

PRIMARY OR "O" OR "A" LEVEL (CONTINUE)
HIGHER (GO TO 113)

111) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.
OF 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 PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ______4
BLIND/VISUALLY IMPAIRED 5

112) CHECK 111

CODE '2','3' OR '4' CIRCLED (CONTINUE)
CODE '1' OR '5' CIRCLED (GO TO 114)

113) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

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

114) Do you listen to the radio at least once a week, less than once a week or not at all?

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

115) Do you watch television at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEL 2
NOT AT ALL 3

116) Do you own a mobile telephone?

YES 1
NO 2 (GO TO 118)

117) Do you use your mobile phone for any financial transactions?

YES 1
NO 2

118) Do you have an account in a bank or other financial institution that you yourself use?

YES 1
NO 2

119) Have you ever used the internet?

YES 1
NO 2 (GO TO 122)

120) In the last 12 months, have you used the internet?

IF NECESSAERY, PROVE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (GO TO 122)

121) During the last one month, how often did you use the internet: 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

122) What is your religion?

NO RELIGION 10
ANGLICAN 11
CATHOLIC 12
MUSLIM 13
SEVENTH DAY ADVENTIST 14
ORTHODOX 15
PENTECOSAL/BORN AGAIN/EVANGELICAL 16
BAHA'I 17
BAPTIST 18
JEWISH 19
PRESBYERIAN 20
MAMMON 21
HINDU 22
BUDDHIST 23
JEHOVAH'S WITNESS 24
SALVATION ARMY 25
TRADITIONAL 26
OTHER (SPECIFU) 96

123) What is your tribe?

TRIVE CODE ____
OTHER (SPECIFY) 996

124) In the last 12 months, how many times have you been away from home for more than one month at a time?

NUMBER OF TIMES ___
NONE 00 (GO TO 201)

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

YES 1
NO 2

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) a) How many sons live with you? b) and how many daughters live with you?
IF NONE, RECORD '00'.

a) SONS AT HOME ____
b) DAUGHTERS AT HOME ____

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

YES 1
NO 2 (GO TO 206)

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

IF NONE, RECORD '00'.

a) SONS ELSEWHERE ___
b) DAUGHTERS ELSEWHERE ____

206) Have you ever given birth to a bit or girl who was born alive but later died?

IF NO, PROVE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

YES 1
NO 2 (GO TO 208)

207) a) How many boys have died?
b) And how many girls have died?
IF NONE, RECORD '00'.

a) BOYS DEAD ___
b) GIRLS DEAD ____

208) SUM ANSWERS TO 203,205 AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

TOTAL BIRTHS ____

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 (CONTINUE)
NO (PROBE AND CORRECT 201-208 AS NECESSARY.

210) CHECK 208:

ONE OR MORE BIRTHS (CONTINUE)
NO BIRTH (GO TO 226)

SECTION 2. REPRODUCTION

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 ROWS. IF THERE ARE MORE THAN 10 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?

BOY 1
GIRL2

214) Were any of these births twins?

SING 1
MULT 2

215) On what day, month, and year was (NAME) born?

DAY ____
MONTH ___
YEAR _____

216) Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 220)

217) IF ALIVE: How old was (NAME) at (NAME)'s 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.

HOUSEHOLD LINE NUMBER _____

220) IF DEAD: How old was (NAME) when (he/she) died?
IF '12 MONTHS' OR '1YR', ASK: Did (NAME) have (his/her) first birthday?

THEN ASK: Exactly how many months old was (NAME) when (he/she) died?

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

DAYS 1____
MONTH 2____
YEARS 3____

221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?

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

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO

223) COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

NUMBERS ARE SAME (CONTUINE)
NUMBER ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2011-2016

NUMBER OF BIRTHS ___
NONE 0 (GO TO 226)

225) FOR EACH BIRTH IN 2011-2016, 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 COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGENANCY. (NOTE: THE NUMVER 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 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 MONTHN OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ___

228) When you got pregnant, did you want to get pregnant at that time?

YES 1 (GO TO 230)
NO 2

229) CHECK 208: TOTAL NUMBER OF BIRTHS

ONE OR MORE
a) Did you want to have a baby later on or did you not want any more children?

NONE
b) Did you want to have a baby later on or did you not want any children?

LATER 1
NO MORE/NONE 2

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

YES 1
NO 2 (GO TO 239)

231) When did the last such pregnancy end?

MONTH ____
YEAR ____

232) CHECK 231:

LAST PREGNANCY ENDED IN 2011-2016 (GO TO 234)
LAST PREGNANCY ENDED IN 2010 OR EARLIER (GO TO 239)

233) In what month and year did the preceding such pregnancy end?

MONTH ___
YEAR _____

234) How many months pregnant were you when that pregnancy ended?

NUMBER OF MONTHS ____

235) Since January 2011, have you had any other pregnancies that did not result in a live birth?

YES 1 (GO TO NEXT LINE)
NO 2 (GO TO 236)

236) FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2011-2016 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THEPREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHD OR PREGNANCY.

IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237) Did you have any miscarriages, abortions or stillbirths that ended before 2011?

YES 1
NO 2 (GO TO 239)

238) When did the last such pregnancy that terminated before 2011 end?

MONTH ___
YEAR _____

239) 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

240) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant?

YES 1
NO 2
DON'T KNOW 8 (GO TO 242)

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

JUST BEFOR HER PERIOF BEGINS 1
DURING HER PERIOD 2
RIGHT AGTER HER PERIOD HAS ENDED 3
HALDWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _____6
DON'T KNOW 8

242) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

YES 1
NO 2
DON'T KNOW 8

SECTION 3. CONTRACEPTION
301) Now I would like to talk about family planning - the various ways of methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHODS)?

01) Female Sterilization
PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) Male Sterilization
PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) IUD.
PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
04) Injectables.
PROBE: Women can have an injection by a health provider that stops them form becoming pregnant for one or more months.
YES 1
NO 2
05) Implants.
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.
YES 1
NO 2
06) Pill.
PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07) Condom.
PROBE: Men can put a rubber sheath on their penis before sexual.
YES 1
NO 2
08) Female Condom.
PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO2
09) Emergency Contraception.
PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
10) Standard Days Method/Moon Beads
PROBE: A woman used a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
11) Lactational Amenorrhea Method (LAM)
PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
YES 1
NO 2
12) Rhythm Method.
PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
13) Withdrawal
PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES, MEDERN METHOD (SPECIFY) ______A
YES, TRADITIONAL METHOD (SPECIFY) _______B
NO Y

302) CHECK 226:
NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 312)

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

YES 1
NO 2 (GO TO 312)

304) Which method are you using?

RECORD ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIDE.

FEMALE STERILIZATION A (GO TO 307)
MAKE STERILIZATION B (GO TO 307)
IUD C (GO TO 309)
INJECTABLES D (GO TO 309)
IMPLANTS E (GO TO 309)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 309)
EMERGENCY CONTRACEPTION I (GO TO 309)
STANDARD DAYS METHOD/MOON BEADS J (GO TO 309)
LACTATIONAL AMENORRHEA METHOD K (GO TO 309)
RHYTHM METHOD L (GO TO 309)
WITHDRAWAL M (GO TO 309)
OTHER MODERN METHOD X (GO TO 309)
OTHER TRADITIONAL METHOD Y (GO TO 309)

305) What is the brand name of the pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PILPLAN PLUS 01(GO TO 309)
SOFT SURE 02 (GO TO 309)
NEWFEM 03 (GO TO 309)
LO-FEMENOL 04(GO TO 309)
MICROGYNON 05(GO TO 309)
OVERTTE 06 (GO TO 309)
MICROLUT 07 (GO TO 309)
OTHER (SPECIFY) ____96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

306) What is the brand name of the condoms your are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

PROTECTEOR 01 (GO TO 309)
CONDOM O 02 (GO TO 309)
ENGABU 03 (GO TO 309)
TRUST 04 (GO TO 309)
LIFE GUARD 05 (GO TO 309)
GOVT BRAND 06 (GO TO 309)
NO BRAND 07 (GO TO 309)
OTHER (SPECIFY) _____ 96 (GO TO 309)
DON'T KNOW 98 (GO TO 309)

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 THE PLACE ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINI 21
PRIVATE DOCTOR'S OFFICE 22
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____26

OTHER (SPECIFY) ______96
DON'T KNOW 98

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

MONTH ___ (GO TO 310)
YEAR ______(GO TO 310)

309) 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 ______

310) CHECK 308 AND 309, 215 AND 231: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308 OR 309.

NO (CONTINUE)
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION))

SECTION 3. CONTRACEPTION (CAPI OPTION)

311)CHECK 308 AND 309:

YEAR IS 2011-2016
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. THEN CONTIUE.

YEAR IS 2010 OR EARLIER
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2011. THEN SKIP TO 324.

312) 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 2011, USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE.

312A) MONTH AND YEAR OF START OF INTERVAL OF USE OR NON-USE.

MONTH ___
YEAR____

312B) Between (EVENT) in (MONTH/YEAR) and (EVENT) in (MONTH/YEAR), did you or your partner use any method of contraception?

YES 1
NO 2 (GO TO 312I)

312C) Which method was that?

METHOD CODE __

312D) How many months after (EVENT) in (month/year) did you start to use (METHOD)? CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

IMMEDIATELY 00 (GO TO 312F)
MONTHS ___ (GO TO 312F)
DATE GIVEN 95

312E) RECORD MONTH AND YEAR RESPONDENT STARTED USING METHOD.

MONTH __
YEAR _____

312F) For how many months did you use (METHOD)?
CIRCLE '95' IF RESPONSENT GIVES THE DATE OF TERMINATION OF USE.

MONTHS ___ (GO TO 312H)
DATE GIVEN 95

312G) RECORD MONTH AND YEAR RESPONDENT STOPPED USING METHOD.

MONTH ____
YEAR ____

312H) Why did you stop using (METHOD)?

REASON STOPPED _______

312I) GO BACK TO 312A IN NET COLUMN; OR IF NO MORE GAPS, GO TO 313.

313) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

NO METHOD USED (CONTINUE)
ANY METHOD USED (GO TO 315)

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

YES 1(GO TO 326)
NO 2 (GO TO 326)

315) CHECK 304:

CIRCLE METHOD CODE:
IF MORE TAHN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (GO TO 326)
FEMALE STERILIZATION 01 (GO TO 319)
MAKE STERILIZATION 02 (GO TO 327)
IUD 03 (GO TO 327)
INJECTABLES 04
IMPLANTS E 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD/MOON BEADS 10
LACTATIONAL AMENORRHEA METHOD 11(GO TO 323)
RHYTHM METHOD 12 (GO TO 323)
WITHDRAWAL 13 (GO TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

316) You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that 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 THE PLACE (SPECIFY) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINI 21
PRIVATE DOCTOR'S OFFICE 22
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____26
OTHERT SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33

OTHER (SPECIFY) ______ 96

317) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LISE.

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 322)
EMERGENCY CONTRACEPTION 09 (GO TO 322)
STANDARD DAYS METHOD/MOON BEADS 10 (GO TO 322)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 323)

318) At that time, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 321)
NO 2 (GO TO 320)

319) When you got sterilized, were you told about side effects or problems you might have with the method?

YES 1 (GO TO 321)
NO 2

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

YES 1
NO 2 (GO TO 322)

321) Were you told what to do if you experiences side effects or problems?

YES 1
NO 2

322) CHECK 318 AND 319:

ANY 'YES'
a) At that time, were you told about other methods of family planning that you could use?

OTHER
b) When you obtain (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

YES 1 (GO TO 324)
NO 2

323)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

324) CHECK 304:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION 01 (GO TO 327)
MALE STERILIZATION 02 (GO TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDON 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD/MOON BEADS 10
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 327)
RHYTHM METHOD 12 (GO TO 327)
WITHDRAWAL 13 (GO TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (GO TO 327)

325) Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PIBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINI 21
PRIVATE DOCTOR'S OFFICE 22
MOBILE CLINIC 23
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____26
OTHERT SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) ______ 96

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

YES 1
NO 2

327) In the last 12 months, were you visited by a Community Health Worker/VHT?

YES 1
NO 2 (GO TO 329)

328) Did the Community Health Worker/VHT talk to you about family planning?

YES 1
NO 2

329) CHECK 202: LIVING CHILDREN

YES
a) In the last 12 months, have you visited a health facility for care for yourself or your children?
NO
b) In the last 12 months, have you visited a health facility for care for yourself?

330) Did any staff 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 2011-2016 (CONTINUE)
NO BIRTHS IN 2011-2016 (GO TO 648)

402) CHECK 215, RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2011-2016. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS, BEGIN WIT THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

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

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

LAST BIRTH
BIRTH HISTORY NUMBER ____

NEXT-TO-LAST BIRTH
BIRTH HISTORY NUMBER _____

404) FROM 212 AND 216:

NAME ___
LIVING (CONTINUE)
DEAD (CONTINUE)

405) When you got pregnant with (NAME), did you want to get pregnant at that time?

YES 1 (SKIP TO 408)
NO 2

406) CHECK 208:

ONLY ONE BIRTH
a) Did you want to have a baby later on, or did you not want any children?

MORE THAN ONE BIRTH
b) Did you want to have a baby later on, or did you not want any more children?

LATER 1
NO MORE/NONE 2 (GO TO 408)

407) How much longer did you want to wait?

MONTH 1___
YEARS 2____
DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?

YES 1
NO 2 (GO TO 414)

409) Whom did you see?
Anyone else?

PROBE TO INDENTIFU EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

HEALTH PERSONNEL
DOCTOR A
NURSE/MIDWIFE B
MEDICAL ASSISTANT/CLINICAL OFFICER C
NURSING AIDE/ASST D
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
COMMUNITY/VILLAGE HEALTH WORKER F
OTHER (SPECIFY) _____ X

410) Where did you receive antenatal care for this pregnancy?

Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PIBLIC OR PRIVATE SECTIOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _______________
HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
OTHER PUBLIC SECTOR (SPECIFY) ______E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______G
OTHER (SPECIFY) ________X

411) How many months pregnant were you when you first received antenatal care for this pregnancy?

MONTH ___
DONT'T KNOW 98

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

NUMBER OF TIMES _____
DON'T KNOW 98

413) As part of your antenatal care during this pregnancy, were any of the following done at least once:

a) Was you blood pressure measured?
YES 1
NO 2
b) Did you give a urine sample?
YES 1
NO 2
c) Did you give a blood sample?
YES 1
NO 2
d) Were you weighed?
YES 1
NO 2

414) During this pregnancy, were you given an injection in the arm to prevent the baby form getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 417)
DON'T KNOW 8

415) During this pregnancy, how many times did you get a tetanus injection?

TIMES ___
DON'T KNOW 8

416) CHECK 415:

2 OR MORE TIMES (GO TO 420)
OTHER (CONTINUE)

417) At any time before this pregnancy, did you receive any tetanus injections?

YES 1
NO 2 (GO TO 420)
DON'T KNOW 8

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

IF 7 OR MORE TIMES, RECORD '7'.

TIME ___
DON'T KNOW 8

419) CHECK 418:

ONLY ONE
a) How many years ago did you receive that tetanus injection?

MORE THAN ONE
b) How many years ago did you receive the last tetanus injection prior to this pregnancy?

YEARS AGO _____

420) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

SHOW TABLETS/SYRUP.

YES 1
NO 2 (GO TO 422)
DON'T KNOW 8 (GO TO 422)

421) During the whole pregnancy, for how many days did you take the tablets or syrup?

IF ANSWER IS NOT NUMBERIC, PROBE FOR APPROCIMATE NUMVER OF DAYS.

DAYS ____
DONT'T KNOW 998

422) During this pregnancy, did you take any drug for intestinal worms?

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

422A) How many times did you take drugs for intestinal worms during this pregnancy?

TIMES ______
DON'T KNOW 8

423) During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
NO 2 (GO TO 426)
DON'T KNOW 8 (GO TO 426)

424) How many times did you take SP/Fansidar during this pregnancy?

TIMES ______

425) Did you get the SP/Fansidar during any antenatal care visit, during another visit to a health facility or from another source?

IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

426) When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 6

427) Was (NAME) weighed at birth ?

YES 1
NO 2 (GO TO 429)
DON'T KNOW 8 (GO TO 429)

428) How much did (NAME) weigh?

RECORD WEIGHT IN KILGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD 1 __._____
KG FROM RECALL 2 ___.______
DON'T KNOW 99998

429) Who assisted with the delivery of (NAME)?
anyone else?

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

IF PESPONDENT SAYS NO ONE ASSISTED, PROVE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE SELIVERY.

HEALTH PERSONNEL
DOCTOR 1
NURSE/MIDWIFE B
MEDICAL ASSISTANT/CLINICAL OFFICER C
NURSING AIDE/ASST D
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT E
RELATIVE/FRIEND F
OTHER (SPECIFY) ______ X
NO ONE ASSISTED Y

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

PROVE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___________
HOME
HER HOME 11 (GO TO 434)
OTHER HOME 12 (GO TO 434)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
OTHER PUBLIC SECTOR (SPECIFY) _______26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____36
OTHER (SPECIFY) ______96

431) 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

432) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?

YES 1
NO 2 (SKIP TO 434)

433) When was the decision made to have the caesarean section? Was it before or after your labor pains started?

BEFORE 1
AFTER 2

434) Immediately after the birth, was (NAME) put directly on the bare skin on your chest?

YES 1
NO 2
DON'T KNOW 8

434A) CHECK 430: PLACE OF DELIVERY

CODE 11, 12, OR 96 CIRCLED (SKIP TO 449)

OTHER (CONTINUE)

435) 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?

YES 1
NO 2 (SKIP TO 438)

436) How long after delivery did the first check take place?

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

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

437) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE/ASST. 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ____96

438) Now I would like to talk to you about checks on (NAME)'s health after delivery- for example, someone examining (NAME), checking the card, or seeing if (NAME) is OK. Did anyone check on (NAME)'s health while you were still in the facility?

YES 1
NO 2 (GO TO 441)
DON'T KNOW 8 (GO TO 441)

439) How long after delivery was (NAME)'s health first checked?

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

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

440) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE/ASST. 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ____96

441) Now I want to talk to you about what happened after you left the facility. Did anyone check on your health after you left the facility?

YES 1
NO 2 (SKIP TO 445)

442) How long after delivery did that check take place?

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

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

443) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE/ASST. 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ____96

444) Where did the check 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 __________
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMEN HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
OTHER PUBLIC SECTOR (SPECIFY) _______26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________36
OTHER (SPECIFY)_______96

445) I would like to talk to you about checks on (NAME)'s health after you left (FACILITY IN 430). Did any health care provider or a traditional birth attendant check on (NAME)'s health in the two months after you left (FACILITY IN 430)?

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8 (SKIP TO 457)

446) How many hours, days or weeks after the birth of (NAME) did that check take place?

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

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

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

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE/ASST. 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ____96

448)Where did this check of (NAME) 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 ______
HOME
HER HOME 11 (GO TO 457)
OTHER HOME 12 (GO TO 457)
PUBLIC SECTOR
GOVERNMEN HOSPITAL 21 (GO TO 457)
GOVERNMENT HEALTH CENTER 22 (GO TO 457)
OTHER PUBLIC SECTOR (SPECIFY) _______26 (GO TO 457)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL CLINIC 31 (GO TO 457)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________36 (GO TO 457)
OTHER (SPECIFY)_______96 (GO TO 457)

449) 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)?

YES 1
NO 2 (GO TO 453)

450) How long after delivery did the first check take place?

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

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

451) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE/ASST. 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ____96

452) Where did this first check 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 __________
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMEN HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
OTHER PUBLIC SECTOR (SPECIFY) _______26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________36
OTHER (SPECIFY)_______96

453) I would like to talk to you about checks on (NAME)'s health after delivery --for example, someone examining (NAME), checking the cord, or seeing if (NAME) is OK. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on (NAME)'s health?

YES 1
NO 2 (GO TO 457)
DON'T KNOW 8 (GO TO 457)

454) 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.

HOURS AFTER BIRTH 1 ___
DAYS AFTER BIRTH 2____
WEEKS AFTER BIRTH 3____

DON'T KNOW 998

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

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
MEDICAL ASSISTANT/CLINICAL OFFICER 13
NURSING AIDE/ASST. 14
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY) ____96

456)(2) Where did this first check of (NAME) 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 __________
HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMEN HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
OTHER PUBLIC SECTOR (SPECIFY) _______26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL CLINIC 31
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________36
OTHER (SPECIFY)_______96

457) During the first two days after (NAME)'s birth, did any health care provider do the following:

a) Examine the cord?
YES 1
NO 2
DON'T KNOW 8
b) Measure (NAME)'s temperature?
YES 1
NO 2
DON'T KNOW 8
c) Counsel you on danger signs for newborns?
YES 1
NO 2
DON'T KNOW 8
d) Counsel you on breastfeeding?
YES 1
NO 2
DON'T KNOW 8
e) Observe (NAME) breastfeeding?
YES 1
NO 2
DON'T KNOW 8

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

YES 1 (GO TO 460)
NO 2 ( GO TO 461)

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

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

MONTHS _____
DON'T KNOW 98

461)CHECK 226: IS RESPONDENT PREGNANT?

NO PREGNANT (CONTINUE)
PREGNANT OR UNSURE (GO TO 463)

462) Have you had sexual intercourse since the birth of (NAME)?

YES 1
NO 2 (GO TO 464)

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

MONTH ____
DON'T KNOW 98

464) Did you ever breastfeed (NAME)?

YES 1 (GO TO 466)
NO 2

465) CHECK 404: IS CHILD LIVING?

LIVING (GO TO 470)
DEAD (GO TO 471)

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

IF LESS THAN 1 HOUR, RECORD '00' HOURS;
IF LESS THAN 24 HOURS, RECORD HOURS;
OTHERWISE, RECORD DAYS.
IMMEDIATELY 000
HOURS 1____
DAYS 2 _____

467) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?

YES 1
NO 2

468) CHECK 404: IS CHILD LIVING?

LIVING (CONTINUE)
DEAD (GO TO 471)

469) Are you still breastfeeding (NAME)?

YES 1
NO 2

470) Did (NAME) drink anything from a bottle with a nipple 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 501A.

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A) CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2013-2016?

ONE OR MORE BIRTHS IN 2013-2016 (CONTINUE)
NO BITHS IN 2013-2016 (GO TO 601)

502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2013-2016.

NAME OF LAST BIRTH ______
BIRTH HISTORY NUMBER _____

503A) CHECK 216 FOR CHILD:

LIVING (CONTINUE)
DEAD (GO TO 501B)

504A) Do you have a card or book where (NAME)'s vaccinations are written down?

YES, HAS ONLY A CARD 1 (GO TO 507A)
YES, HAS ONLY A BOOK 2 (GO TO 507A)
YES,HAS CARD AND A BOOK 3 (GO TO 507A)
NO, NO CARD AND NO BOOK 4

505A) Did you ever have a vaccination card or book for (NAME)?

YES 1 (GO TO 511A)
NO 2 (GO TO 511A)

507A) May I see the card or book where (NAME)'s vaccinations are written down?

YES, ONLY CARD SEEN 1
YES, ONLY BOOK SEEN 2
YES, CARD AND BOOK SEEN 3
NO CARD AND NO BOOK SEEN 4 (GO TO 511A)

508A) COPY DATES FROM THE CARD OR BOOK.
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ____
MONTH ___
YEAR ___
POLIO 0
DAY ____
MONTH ___
YEAR ___
POLIO 1
DAY ____
MONTH ___
YEAR ___
DPT-HEP.B-HIB 1
DAY ____
MONTH ___
YEAR ___
PCV 1
DAY ____
MONTH ___
YEAR ___
ROTA 1
DAY ____
MONTH ___
YEAR ___
POLIO 2
DAY ____
MONTH ___
YEAR ___
RPT-HEP.B-HIB 2
DAY ____
MONTH ___
YEAR ___
PCV 2
DAY ____
MONTH ___
YEAR ___
ROTA 2
DAY ____
MONTH ___
YEAR ___
POLIO 3
DAY ____
MONTH ___
YEAR ___
DPT-HEP.B-HIB 3
DAY ____
MONTH ___
YEAR ___
PCV 3
DAY ____
MONTH ___
YEAR ___
ROTA 3
DAY ____
MONTH ___
YEAR ___
IPV
DAY ____
MONTH ___
YEAR ___
MEASLES
DAY ____
MONTH ___
YEAR ___
VITAMIN A (MOST RECENT)
DAY ____
MONTH ___
YEAR ___

509A) CHECK 508A: 'BCG' TO 'MEASLES' ALL RECORDED?

NO (CONTINUE)
YES (GO TO 525A)

510A) In addition to what is recorded on this (card/book), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1
(PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A)
(THEN SKIP TO 525A)
NO 2 (GO TO 525A)
DON'T KNOW 8 (GO TO 525A)

511A) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

YES 1
NO 2 (GO TO 525A)
DON'T KNOW 8 (GO TO 525A)

512A) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

514A) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2 (GO TO 517A)
DON'T KNOW 8 (GO TO 517A)

515A) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 1

516A) How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES ____

517A) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

YES 1
NO 2 (GO TO 519A)
DON'T KNOW 8 (GO TO 519A)

518A) How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES _____

519A) Has (NAME) ever received a pneumococcal vaccination, what is, an injection in the thigh to prevent pneumonia?

YES 1
NO 2 (GO TO 521A)
DON'T KNOW 5 (GO TO 521A)

520A) How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES ____

521A) Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (GO TO 523A)
DON'T KNOW 8 (GO TO 523A)

522A) How many times did (NAME) RECIVE THE ROTAVIRUS VACCINE?

NUMBER OF TIMES ____

523A) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

YES 1
NO 2
DON'T KNOW 8

524A) Has (NAME) ever received a polio vaccination, that is, an injection in the thigh to prevent polio?

YES 1
NO 2
DON'T KNOW 8

525A) In the last 7 days was (NAME) given:

a) Vitamin and mineral powder?
YES 1
NO 2
DON'T KNOW 8
b) Rutafa, RUTF or Kipoli from the hospital? (Plumpy/nut?)
YES 1
NO 2
DON'T KNOW 8
c) Odii? (Plumpy Doz?)
YES 1
NO 2
DON'T KNOW 8

526A) CONTINUE WITH 501B.

SECTION 5B. CHILD IMMUNIZATION (NEXT-TO-LAST BIRTH)

501B) CHECK 215 IN THE BIRTH HISTORY: ANY MORE BIRTHS IN 2013-2016?

MORE BIRTHS IN 2013-2016 (CONTINUE)
NO MORE BIRTHS IN 2013-2016 (GO TO 601)

502B) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE NEXT-TO-LAST CHILD BORN IN 2013-2016.

NAME OF NEXT-TO-LAST BIRTH ____
BIRTH HISTORY NUMBER ___

503B) CHECK 216 FOR CHILD

LIVING (CONTINUE)
DEAD (GO TO 526B)

504B) Do you have a card or book where (NAME)'s vaccinations are written down?

YES, HAS ONLY A CARD 1 (GO TO 507B)
YES, HAS ONLY A BOOK 2 (GO TO 507B)
YES, HAS CARD AND A BOOK 3 (GO TO 507B)
NO, NO CARD AND NO BOOK 4

505B) Did you ever have a vaccination card or book for (NAME)?

YES 1 (GO TO 511B)
NO 2 (GO TO 511B)

507B) May I see the card or book where (NAME)'s vaccinations are written down?

YES, ONLY CARD SEEN 1
YES, ONLY BOOK SEEN 2
YES, CARD AND BOOK SEEN 3
NO CARD AND NO BOOK SEEN 4 (GO TO 511B)

508B) COPY DATES FROM THE CARD OR BOOK.

WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN. BUT NO DATE IS RECORDED.

BCG
DAY ____
MONTH ___
YEAR ___
POLIO 0
DAY ____
MONTH ___
YEAR ___
POLIO 1
DAY ____
MONTH ___
YEAR ___
DPT-HEP.B-HIB 1
DAY ____
MONTH ___
YEAR ___
PCV 1
DAY ____
MONTH ___
YEAR ___
ROTA 1
DAY ____
MONTH ___
YEAR ___
POLIO 2
DAY ____
MONTH ___
YEAR ___
RPT-HEP.B-HIB 2
DAY ____
MONTH ___
YEAR ___
PCV 2
DAY ____
MONTH ___
YEAR ___
ROTA 2
DAY ____
MONTH ___
YEAR ___
POLIO 3
DAY ____
MONTH ___
YEAR ___
DPT-HEP.B-HIB 3
DAY ____
MONTH ___
YEAR ___
PCV 3
DAY ____
MONTH ___
YEAR ___
ROTA 3
DAY ____
MONTH ___
YEAR ___
IPV
DAY ____
MONTH ___
YEAR ___
MEASLES
DAY ____
MONTH ___
YEAR ___
VITAMIN A (MOST RECENT)
DAY ____
MONTH ___
YEAR ___

509B) CHECK 508B: ' BCG' TO ' MEASLES' ALL RECORDED?

NO (CONTINUE)
YES (GO TO 525B)

510B) In addition to what is recorded on this (card/book), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDEN MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLOMN IN 508B)
(THEN SKIP TO 525B)
NO 2 (GO TO 525B)
DON'T KNOW 8 (GO TO 525B)

511B) Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunization days or child health days?

YES 1
NO 2 (GO TO 525B)
DON'T KNOW 8 (GO TO 525B)

512B) Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

514B) Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

YES 1
NO 2
DON'T KNOW 8

515B) Did (NAME) receive the first oral polio vaccine in the first two weeks after birth or later?

FIRST TWO WEEKS 1
LATER 2

516B) How many times did (NAME) receive the oral polio vaccine?

NUMBER OF TIMES ____

517B) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polis drops?

YES 1
NO 2 (GO TO 521B)
DON'T KNOW 8 (GO TO 521B)

518B) How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES ___

519B) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

YES 1
NO 2 (GO TO 521B)
DON'T KNOW 8 (GO TO 521B)

520B) How many times did (NAME) receive the pneumococcal vaccine?

NUMBER OF TIMES _____

521B) Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (GO TO 523B)
DON'T KNOW 8 (GO TO 523B)

522B) How many times did (NAME) receive the rotavirus vaccine?

NUMBER OF TIMES ____

523B) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

YES 1
NO 2
DON'T KNOW 8

524B) Has (NAME) ever received a polio vaccination, that is, an injection in the thigh to prevent polio?

YES 1
NO 2
DON'T KNOW 8

525B) In the last 7 days was (NAME) given:

a) Vitamin and mineral powder?
YES 1
NO 2
DON'T KNOW 8
b) Rutafa, RUTF or Kipoli from the hospital? (Plumpy'nut?)
YES 1
NO 2
DON'T KNOW 8
c) Odii?(Plumpy Doz?)
YES 1
NO 2
DON'T KNOW 8

526B) CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2013-2016?

MORE BIRTHS IN 2013-2016 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2013-2016 (GO TO 601)

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

ONE OR MORE BIRTHS IN 2011-2016 (CONTINUE)
NO BIRTHS IN 2011-2016 (GO TO 648)

602) CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2011-2016. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLIMN OF ADDITIONAL QUESTIONNAIRE(S).

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

603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

BIRTH HISTORY NUMBER ___

604)FROM 212 AND 216:

NAME ___
LIVING (CONTINUE)
DEAD (SKIP TO 646)

605) In the last six months, was (NAME) given a vitamin a dose like [this/any of these]?

SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

606) 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 AMPULES/CAPSULES/SYRUPS.

YES 1
NO 2
DON'T KNOW 8

607) Was (NAME) given any drug for intestinal worms in the last six months?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

609) CHECK 464: EVER BREASTFED:

YES
a) Now I would like to know how much (NAME) was given to drink during the diarrhea including breastmilk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (NANE) given much less than usual to drink or somewhat less?
NO
b) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was (NAME) 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

610) When (NAME) had diarrhea, was (NAME) given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was (NAME) 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

611) Did you seek advice or treatment for the diarrhea from any source?

YES 1
NO 2 (SKIP TO 615)

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIBATE SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE(S)________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
OUTREACH/MOBILE CLINIC C
FIELDWORKER/VHT D
OTHER PUBLIC SECTOR (SPECIFY) ______E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY/DRUG SHOP G
PRIVATE DOCTOR H
MOBILE CLINIC I
FIRLFORKER J
OTHER PRIVATE MEDICAL SECOR (SPECIFY) ____K
OTHER SOURCE
SHOP L
TRADITIONAL PRACTITIONER M
MARKET N
OTHER (SPECIFY) _____X

613) CHECK 612

TWO OR MORE CODES CIRCLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 615)

614) Where did you first seek advice or treatment?

USE LETTER CODE FROM 612.

FIRST PLACE ____

615) Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:

a) A fluid made from a special packet called daloozi?
YES 1
NO 2
DON'T KNOW 8
b) A government-recommended homemade fluid (salt, sugar, and water)?
YES 1
NO 2
DON'T KNOW 8
c) Zinc tablets or syrup?
YES 1
NO 2
DON'T KNOW 8

616) CHECK 615:

ANY 'YES'
a) Was anything else given to treat the diarrhea?
ALL 'NO' OR 'DON'T KNOW'

b) Was anything given to treat the diarrhea?
YES 1
NO 2 (GO TO 618)
DON'T KNOW 8 (GO TO 618)

617) CHECK 615:

ANY 'YES'
a) Was anything else given to treat the diarrhea? Anything else?
ALL 'NO' OR 'DON'T KNOW'
b) Was anything given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANITIMOTILITY B
OTHER (NOT ANTIBIOTIC OR TNTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H

HOME REMEDY/HERBAL MEDICINE I

OTHER (SPECIFY) _____X

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

YES 1
NO 2 (GO TO 620)
DON'T KNOW 8 (GO TO 620)

619) At any time during the illness, did (NAME) have blood taken from (NAME)'s finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

621) Has (NAME) had fast, short, rapid breaths or difficulty breathing at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 623)
DON'T KNOW 8 (GO TO 623)

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

CHEST ONLY 1 (SHIP TO 624)
NOSE ONLY 2 (SHIP TO 624)
BOTH 3 (SHIP TO 624)
OTHER (SPECIFY) _____6 (SHIP TO 624)
DON''T KNOW 8 (SHIP TO 624)

623) CHECK 618: HAD DEVER?

YES (CONTINUE)
NO OR DK (SKIP TO 646)

624) Did you seek advice or treatment for the illness from any source?

YES 1
NO 2 (SKIP TO 629)

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PIBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE(S) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
OUTREACH/MOBILE CLINIC C
FIELDWORKER/VHT D
OTHER PUBLIC SECTOR (SPECIFY) ______E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY/DRUG SHOP G
PRIVATE DOCTOR H
MOBILE CLINIC I
FIRLFORKER J
OTHER PRIVATE MEDICAL SECOR (SPECIFY) ____K
OTHER SOURCE
SHOP L
TRADITIONAL PRACTITIONER M
MARKET N
OTHER (SPECIFY) _____X

626) CHECK 625:

TWO OR MORE CODES CICLED (CONTINUE)
ONLY ONE CODE CIRCLED (SKIP TO 628)

627)Where did you first seek advice or treatment?
USE LETTER CODE FROM 625.

FIRST PLACE _______________

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

DAYS _______

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

YES 1
NO 2 (GO TO 646)
DON'T KNOW 8 (GO TO 646)

630) What drugs did (NAME) take?
Any other drugs?

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS

ARTEMISININ COMBINATION
THERAPY (COARTEM/ACT) A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE
PILLS/SYRUP E
INJECTION/IV F
ARTESUNATE
RECTAL G
INJECTION/IV H
OTHER ANTIMALARIL (SPECIFY)_____I
ANTIBIOTIC DRUGS
PILL/SYRUP J
INJECTION/IV K
OTHER DRUGS
ASPIRIN L
PANADOL M
IBUPROFEN N
OTHER (SPECIFY) _____X
DON'T KNOW Z

631) CHECK 630:
ANY CODE A-I CIRCLED?

YES (CONTINUE)
NO (SKIP TO 646)

632) CHECK 630: ARTEMISININ COMBINATION THERAPY('A') GIVEN

CODE 'A' CIRCLED (CONTINUE)
CODE 'A' NOT CIRCLED (SKIP TO 634)

633) How long after the fever started did (NAME) first take an artemisinin combination therapy?

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

634) CHECK 630:
SP/DANSIDAR ('B') GIVEN

CODE 'B' CIRCLED (CONTINUE)
CODE 'B' NOT CIRCLED (SKIP TO 638)

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

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

636) CHECK 630:
CHLOROQUINE ('C') GIVEN

CODE 'C' CIRCLED
CODE 'C' NOT CIRCLED (SKIP TO 638)

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

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

638) CHECK 630:
AMODIAQUINE ('D') GIVEN

CODE 'D' CIRCLED
CODE 'D' NOT CIRCLED (SKIP TO 640)

639) How long after the fever started did (NAME) first take amodiaquine?

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

640)CHECK 630:
QUININE ('E' OR ' F') GIVEN

CODE 'E' OR 'F' CIRCLED
CODE 'E' OR 'F' NOT CIRCLED (SKIP TO 642)

641) How long after the fever started did (NAME) first take quinine?

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

642) CHECK 630:
ARTESUNATE ('G' OR 'H') GIVEN

CODE 'G' OR 'H' CIRCLED
CODE 'G' OR 'H' NOT CIRCLED (SKIP TO 644)

643) How long after the fever started did (NAME) first take artesunate?

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

644) CHECK 630:
OTHER ANTIMALARIAL ('I') GIVEN

CODE 'I' CIRCLED
CODE 'I' NOT CIRCLED (SKIP TO 646)

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

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

646) GO BACK TO 604 IN NEXT COLUMN: OR, IF NO MORE BIRTHS, GO TO 647.

647) CHECK 615(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (CONTINUE)
ANY CHILD REVEIVED FLUID FROM ORS PACKET (GO TO 649)

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

YES 1
NO 2

649) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2014-2016 LIVING WITH THE RESPONDENT.

ONE OR MORE (NAME OF YOUNGEST CHILD LIVING WITH HER)_______________
NONE (GO TO EC1)

650) Now I would like to ask you about liquids or foods that (NAME FROM 649) 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 649) drink or eat:

a) Plain water?
YES 1
NO 2
DK 8
b) Fresh fruit juice or juice concentrate?
YES 1
NO 2
DK 8
c) Clear broth?
YES 1
NO 2
DK 8
d) Milk such as tinned, powdered, or fresh animal milk?

IF YES: How many times did (NAME) drink milk?
IF 7 OR MORE TIMES, RECORD '7'.

YES 1
NO 2
DK 8
NUMBER OF TIMES DRANK________
e) Infant formula?
IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DK 8
NUMBER OF TIMES DRANK____
f) Any other liquids?
YES 1
NO 2
DK 8
g) Yogurt?
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DK 8
NUMBER OF TIMES DRANK______
h) Cheese or other foods made from milk?
YES 1
NO 2
DK 8
i) Any commercially fortified baby food such as Cerelac?
YES 1
NO 2
DK 8
j) Rice, posho, kaaro, porridge, bread, chapatti, pasta, macaroni, noodles or other foods (mandazi, doughnuts, pancakes, weetabix, cornflakes) made from grains (millet, sorghum, maize, rice, wheat)?
YES 1
NO 2
DK 8
k) Pumpkin, carrots, squash, or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DK 8
l) Cassava, yams (Junni, Ndaggu, Baluggu), white sweet potatoes, Irish potatoes, manioc or any other roots or tubers?
YES 1
NO 2
DK 8
m) Banana (Matooke, Ndllzi, Gonja)?
YES 1
NO 2
DK 8
n) Any dark green, leafy vegetables (dodo, nakati, spinach, amaranth, bugga, sunsa, jobyo, Marakwang, sukuma wiki, Nsugga, Gobe, Timpa)?
YES 1
NO 2
DK 8
o) Ripe mangoes, or pawpaws?
YES 1
NO 2
DK 8
p) Any other fruits or vegetables (passion fruit, jack fruit, pineapple, oranges, sugarcane)?
YES 1
NO 2
DK 8
q) Liver, kidney, heart, or other organ meats?
YES 1
NO 2
DK 8
r) Any beef, pork, lamb or goat, including products made from these meats (kebabs, sausages, chaps)?
YES 1
NO 2
DK 8
s) Any chicken, duck, turkey, pigeon, or other poultry?
YES 1
NO 2
DK 8
t) Eggs (from chickens, ducks or other poultry)?
YES 1
NO 2
DK 8
u) Fresh or dried fish or shellfish (mukene, kenje)?
YES 1
NO 2
DK 8
v) Any foods made from beans, peas, lentils, or nuts?
YES 1
NO 2
DK 8
w) Any sugary foods such as chocolates, sweets, candies, pastries, cakes or biscuits?
YES 1
NO 2
DK 8
x) Any cooking oil, margarine, butter or other oils/fats?
YES 1
NO 2
DK 8
y) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DK 8

651) CHECK 650 (CATEGORIES 'g' THROUGH 'y'):

NOT A SIGLE 'YES' (CONTINUE)
AT LEAST ONE 'YES' (GO TO 653)

652) Did (NAME FROM 649) 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?

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY)
(THEN CONTINUE TO 653)
NO 2

653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES _____
DON'T KNOW 8

654) The last time (NAME FROM 649) 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 GRABAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY)______96

EARLY CHILDHOOD DEVELOPMENT

EC1) CHECK 217 AND 218: ANY CHILD 0-5 YEARS OLD LIVING WITH HIS/HER MOTHER?

YES (CONTINUE)
NO (GO TO 701)

EC2) CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGED 0-5 YEARS OLD LIVING WITH HIS/HER MOTHER AND RECORD NAME AND LINE NUMBER.

NAME OF THE YOUNGEST CHILD FROM Q.212 _______
LINE NUMBER OF THE YOUNGEST CHILD FROM Q.219 ___

EC3) READ TO THE RESPONDENT:
Now I would like to ask you some questions about (NAME OF THE CHILD FROM EC2), your youngest child living with you who is 0-5 years old.

EC4) How many children's books or picture books do you have for (NAME)?

NONE 00
NUMBER OF BOOKS FOR CHILDREN _____
TEN BOOKS OR MORE 10

EC5) I am interested in learning about the things that (NAME) plays with when (he/she) is at home.

Does (he/she) play with?

a) homemade toys such as dolls, cars, or other toys made at home?
YES 1
NO 2
DK 8
b) toys from a shop or manufactured toys?
YES 1
NO 2
DK 8
c) household objects such as bowls or pots or objects found outside such as sticks, rocks, animal shells or leaves?
YES 1
NO 2
DK 8

IF THE RESPONSENT SAYS 'YES' TO THE CATEGORIES ABOVE, THEN PROVE TO LEARN SPECIFICALLY WHAT THE CHILD PLAYS WITH TO ASCERTAIN THE RESPONSE

EC6) Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children.

On how many days in the past week was (NAME):

a) left along for more than an hour?
NUMBER OF DAYS LEFT ALONE FOR MORE THAN AN HOUR ___
b) left in the care of another child, that is, someone less than 10 years old, for more than an hour?
NUMBER OF DAYS LEFT TO ANOTHER CHILD FOR MORE THAN AN HOUR ____
IF 'NONE', WRITE '0', IF 'DON'T KNOW' WRITE '8'.

EC7) VERIFY 217: AGE OF THE CHILD IN Q. EC3-EC6

CHILD 0, 1, OR 2 YEARS (CONTINUE)
CHILD 3 TO 5 YEARS (GO TO EC9)

EC8) VERIFY 217 AND 218: AND CHILD AGE 3-5 LIVING WITH HIS/HER MOTHER?

YES (CONTINUE)
NO (GO TO 701)

EC8A) CHECK 217 AND 218: SELECT THE YOUNGEST CHILD AGE 3-5 LIVING WITH HIS/HER MOTHER AND RECORD NAME AND LINE NUMBER

NAME OF YOUNGEST CHILD AGE 3 TO 5 FROM Q.212 _____
LINE NUMBER OF YOUNGEST CHILD AGE 3 TO 5 FROM Q.219 _____

EC9)Does (NAME) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care?

YES 1
NO 2
DK 8

EC10) In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (NAME)?

IF YES, ASK:
Who engaged in this activity with (NAME)?

a) Read books to or looked at picture books with (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y
b) Told stories to (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y
c) Sang songs to (NAME) or with (NAME), including lullabies?
MOTHER A
FATHER B
OTHER X
NO ONE Y
d) Took (NAME) outside of the home, compound, yard or enclosure?
MOTHER A
FATHER B
OTHER X
NO ONE Y
e) Played with (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y
f) Named, counted, or drew things to or with (NAME)?
MOTHER A
FATHER B
OTHER X
NO ONE Y

EC11) I would like to ask you some questions about the health and development of (NAME). Children do not all develop and learn at the same rate. For example, some walk earlier than others. These questions are related to several aspects (NAME)'s development. Can (NAME) identify or name at least ten letters of the alphabet?

YES 1
NO 2
DON'T KNOW 8

EC12) Can (NAME) read at least four simple, popular words?

YES 1
NO 2
DON'T KNOW 8

EC13) Does (NAME) know the name and recognize the symbol of all numbers from 1 to 10?

YES 1
NO 2
DON'T KNOW 8

EC14) Can (NAME) pick up a small object with two fingers, like a stick or a rock from the ground?

YES 1
NO 2
DON'T KNOW 8

EC15) Is (NAME) sometimes too sick to play?

YES 1
NO 2
DON'T KNOW 8

EC16) Does (NAME) follow simple directions on how to do something correctly?

YES 1
NO 2
DON'T KNOW 8

EC17) When given something to do is (NAME) able to do it independently?

YES 1
NO 2
DON'T KNOW 8

EC18) Does (NAME) get along well with other children or adults?

YES 1
NO 2
DON'T KNOW 8

EC19) Does (NAME) kick, bite, or hit other children or adults?

YES 1
NO 2
DON'T KNOW 8

EC20) Does (NAME) get distracted easily?

YES 1
NO 2
DON'T KNOW 8

SECTION 7, MARRIAGE AND SEXUAL ACTIVITY

701) Are you currently married or living together with a man as if married?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A MAN 2 (GO TO 704)
NO, NOT IN UNION 3 (GO TO 702)

701A) What kind of marriage are you in?

CIVIL MARRIAGE A (GO TO 704)
CUSTONARY MARRIAGE B (GO TO 704)
RELIGIOUS MARRIAGE C (GO TO 704)

702) Have you ever been married or lived together with a man as if married?

YES, FORMERLU MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 712)

703) What is your marital status now: are you windowed, divorced, or separated?

WIDOWED 1 (GO TO 709)
DIVORCED 2 (GO TO 709)
SEPARATES 3 (GO TO 709)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

705) 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 NO.______

706) Does your (husband/partner) have other wives or does he live with other women as if married?

YES 1
NO 2 (GO TO 709)
DON'T KNOW 8 (GO TO 709)

707) Including yourself, in total, how many wives or live-in partners does he have?

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

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

RANK ____

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

ONLY ONCE 1
MORE THAN ONCE 2

710) CHECK 709:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE
b) Now I would like to ask about your first (husband/partner). In what month and year did you start living with him?
MONTH ___
DON'T KNOW MONTH 98
YEAR ________(GO TO 712)
DON'T KNOW YEAR 9998

711) How old were you when you first started living with him?

AGE _____

712) CHECK FOR PRESENCE OF OYHERS, BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY

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

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 730A)
AGE IN YEARS _____

714) I would like to ask you about your recent sexual activity. 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_____(GO TO 716)
WEEKS AGO 2______(GO TO 716)
MONTHS AGO 3_______(GO TO 716)
YEARS AGO 4_______(GO TO 727)

715) When was the last time you had sexual intercourse with this person?

DAYS AGO 1_____
WEEKS AGO 2_____
MONTHS AGO 3_____

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

YES 1
NO 2 (GO TO 718)

717) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

718)What was your relationship to this person with whom you had sexual intercourse?

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

HUSBAND 1
LIVING-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
CLENT/SEX WORKER 5
OTHER (SPECIFY) ______6

719) How long ago did you first have sexual intercourse with this person?

DAYS AGO 1____
WEEKS AGO 2_____
MONTHS AGO 3______
YEARS AGO 4______

720) How many times during the last 12 months did you have sexual intercourse with this person?

IF NON-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE, IF NUMBER OF TIMES IF 95 OR MORE, RECORD 95.

NUMBER OF TIMES _____

721) How old is this person?

AGE OF PARTNER _____
DON'T KNOW 98

722) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 715 IN NEXT COLUMN)
NO 2 (SKIP TO 724)

723) In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE, IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

NUMBER OF PARTYNERS LAST 12 MONTHS ____
DON'T KNOW 98

724) CHECK 106:

AGE 15-24 (CONTINUE)
AGE 25-49) (GO TO727)

725) CHECK 701:

NOT IN A UNION (CONTINUE)
CURRENTLY MARRIED LIVING WITH A MAN (GO TO 727)

726) In the past 12 months have you had sex or been sexually involved with anyone because he gave you or told you he would give you gifts, cash, or anything else?

YES 1
NO 2

727) 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, RECORD '95'.

NUMBER OF PARTNERS IN LIFETIME ____
DON'T KNOW 98

728) CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):

YES, CONDOM USED (CONTINUE)
NO, CONDOM NOT USED (GO TO 730A)
DON'T ASK (GO TO 730A)

729) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?

IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

PROTECTOR 01
CONDOM O 02
ENGABU 03
TRUST 04
LIFE GUARD 05
GOVT BRAND 06
NO BRAND 07
OTHER (SPECIFY) ________96
DON'T KNOW 98

730) From where did you obtain the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE _______

PUBLIC SECTOR
GOVERNMENT HOSPITAL11
GOVERNMENT HEALTH CENTER12
FAMILY PLANNING CLINIC 13
OUTREACH/MOBILE CLINIC 14
FIELDWORKER/VHT 15
OTHER PUBLIC SECTOR (SPECIFY) ______16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL SECOR (SPECIFY) ____26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
STREET VENDOR 34
LODGE 35
OTHER (SPECIFY) _____96

DONT'T KNOW 98

730A) 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?

YES 1 (GO TO 730C)
NO 2

730B) Have you ever heard of this problem?

YES 1 (GO TO 730F)
NO 2 (GO TO 730F)

730C) Did this problem start after you delivered a baby or had a stillbirth?

AFTER DELIVERED BABY 1
AFTER HAD STILLBIRTH 2
NEITHER 3

730D) Have you sought treatment for this condition?

YES 1
NO 2 (GO TO 730F)

730E) Did the treatment shop the leakage completely?

IF 'NO': Did the treatment reduce the leakage?

YES, STOPPED COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3
DID NOT RECEIVE TREATMENT 4

730F) Now I would like to ask some questions about a practice known as female circumcision. Have you ever heard of female circumcision?

YES 1 (GO TO 730H)
NO 2

730G) 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?

YES 1
NO 2 (GO TO 731)

730H) Have you yourself ever been circumcised?

YES 1
NO 2 (GO TO 731)

730I) Have you forced to get circumcised or did you want to get circumcised?

FORCED 1
WANTED 2

731) PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN over 10
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304

NEITHER STERILIZED (CONTINUE)
NOT ASKED (CONTINUE)
HE OR SHE STERILIZED (GO TO 813)

802) CHECK 226:

PREGNANT (CONTINUE)
NOT PREGANT OR UNSURE (GO TO 804)

803) 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 ANOTHER CHILD 1 (GO TO 805)
NO MORE 2 (GO TO 812)
UNDECIDED/DON'T KNOW 8 (GO TO 812)

804) 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 813)
UNDECIDED/DON'T KNOW 8 (GO TO 811)

805) CHECK 226:

NOT PREGNANT OR UNSURE

a) How long would you like to wait from now before the birth of (a/another)child?
PREGNANT

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

MONTH 1_____
YEARS 2______
SOON/NOW 993 (GO TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 813)
AFTER MARRIAGE 995 (GO TO 811)
OTHER (SPECIFY) ______996 (GO TO 811)
DON'T KNOW 998 (GO TO 811)

806) CHECK 226:

NOT PREGNANT OR UNSURE (CONTINUE)
PREGNANT (GO TO 812)

807) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (CONTINUE)
CURRENTLY USING (GO TO 813)

808) CHECK 805:

'24' OR MORE MONTHS OR '02' OR MORE YEARS (CONTINUE)
NOT ASKED (CONTINUE)
'00-23' MONTHS OR '00-01' YEAR (GO TO 812)

809) CHECK 714:

DAYS, WEEKS OR MONTHS AGO (CONTINUE)
YEARS AGO (GO TO 811)
NOT ASKED (GO TO 811)

810) CHEK 804:

WANTS TO HAVE A/ANOTHER CHILD
a) 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
b) 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.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFERQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BERASTDEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD ABAILABLE S
INCONVEIENT TO USE T
INTERDERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) ______X

DON'T KNOW Z

811) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (CONTINUE)
NO, NOT CURRENYLY USING (CONTINUE)
YES, CURRENTLY USING (GO TO 813)

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

YES 1
NO 2
DON'T KNOW 8

813) CHECK 216:

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

NO LIVING CHILDREN
b) If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMBERIC RESPONSE.

NONE 00 (GO TO 815)
NUMBER ____
OTHER (SPECIFY) 96 (GO TO 815)

814) 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?

NUMBER (BOYS)___(GIRLS)_____(EITHRT)_____
OTHER (SPECIFY) ________96

815) In the last few months have you:

a) Heard about family planning on the radio?
YES 1
NO 2
b) Seen anything about family planning on the television?
YES 1
NO 2
c) Read about family planning in a newspaper or magazine?
YES 1
NO 2
d) Received a voice or text message about family planning on a mobile phone?
YES 1
NO 2

817) CHECK 701:

YES, CURRENTLY USING (CONTINUE)
NOT CURRENTLY USING (CONTINUE)
NOT ASKED (GO TO 901)

818) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (CONTINUE)
NOT CURRECTLY USING (GO TO 820)
NOT ASKED (GO TO 822)

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

MAINLY RESPONDENT 1 (GO TO 821)
MAINLY HUSBAND/PARTNER 2(GO TO 821)
JOINT DECISION 3(GO TO 821)
OTHER (SPECIFY) ______6 (GO TO 821)

820) Would you say that not using contraception is mainly your decision, mainly your (husband's/partner's)decision, or did you both decide together?

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY)_______6

821) CHECK 304:

NEITHER ARE STERILIZED (CONTINUE)
NOT ASKED (CONTINUE)
HE OR SHE ARE STERILIZED (GO TO 901)

822) 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 9, HUSBAND'S BACKGROUND AND WOMAN'S WORK

901) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (GO TO 909)

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

AGE IN COMPLETED YEARS ___

903) Did your (husband/partner) ever attend school?

YES 1
NO 2 (GO TO 906)

904) What was the highest level of school he attended: primary, 'O' level, 'A' level, tertiary or university?

PRIMARY 1
'O' LEVEL 2
'A' LEVEL 3
TERTIARY 4
UNIVERSITY 5
DON'T KNOW 8 (GO TO 906)

905) What was the highest [CLASS/YEAR] he complete at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

[CLASS/YEAR] ___
DONT'T KNOW 98

906) Has your (husband/partner) done any work in the last 7 days?

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

907) Has your (husband/partner) done any work in the last 12 months?

YES 1
NO 2 (GO TO 909)
DON'T KNOW 8 (GO TO 909)

908) What is your (husband/partner's) occupation? that is, what kind of work does he mainly do?

_____________________________________________________________________________________________________________________________

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

YES 1 (GO TO 913)
NO 2

910) 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 913)
NO 2

911) 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 913)
NO 2

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

YES 1
NO 2 (GO TO 917)

913) What is your occupation? That is, what kind of work do you mainly do?
____________________________________________________________________________

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

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

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

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

916) Are you paid in case 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

917) CHECK 701:

CURRENTLY MMARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (GO TO 925)

918) CHECK 916:

CODE '1' OR '2' CIRCLED
OTHER (GO TO 921)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARNTER JOINTLY 3
OTHER (SPECIFY) _______6

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

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO WARNINGS 4 (GO TO 922)
DON'T KNOW 8

921) Who usually decides how your (husband/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

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

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

923) 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

924) 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

925) Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 928)

926) Do you have a title deed for any house you own?

YES 1
NO 2 (GO TO 928)
DON'T KNOW 8 (GO TO 928)

927) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (GO TO 928)

929) Do you have a title deed for any land you own?

YES 1
NO 2 (GO TO 931)
DON'T KNOW 8 (GO TO 931)

930) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN over 10
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3
HUSBAND
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3
OTHER MALES
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3
OTHER FEMALES
PRES/LISTEN 1
PRES/NOT LISTEN 2
NOT PRES 3

932) 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
DK 8
b) If she neglects the children?
YES 1
NO 2
DK 8
c) If she argues with him?
YES 1
NO 2
DK 8
d) If she refuses to have sex with him?
YES 1
NO 2
DK 8
e) If she burns the food?
YES 1
NO 2
DK 8

SECTION 10. HIV/AIDS

1001) Now I would like to talk about something else. Have you ever heard of HIV or AIDS?

YES 1
NO 2 (GO TO 1042)

1002) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DK 8

1003) Can people get HIV from mosquito bites?

YES 1
NO 2
DK 8

1004) Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DK 8

1005) Can people get HIV by sharing food with a person who has HIV?

YES 1
NO 2
DK 8

1006) Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DK 8

1007) Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DK 8

1008) Can HIV be transmitted from a mother to her baby?

a) During pregnancy?
YES 1
NO 2
DK 8
b) During delivery?
YES 1
NO 2
DK 8
c) By breastfeeding?
YES 1
NO 2
DK 8

1009) CHECK 1008:

AT LEAST ONE 'YES' (CONTINUE)
OTHER (GO TO 1011)

1010) Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

1011) CHECK 208 AND 215:

LAST BIRTH IN 2014-2016 (CONTINUE)
NO BIRTH (GO TO 1027)
LAST BIRTH IN 2013 OR EARLIER (GO TO 1027)

1012) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (CONTINUE)
NO ANTENATAL CARE (GO TO 1020)

1013) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

1014) During any of the antenatal visits for your last birth were you given any information about:

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

1015) Were you offered a test for HIV as part of your antenatal care?

YES 1
NO 2

1016) I don't want to know the results, but were you tested for HIV as part of your antenatal care?

YES 1
NO 2

1017) Where was the test done?

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) _____________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL11
GOVERNMENT HEALTH CENTER12
FAMILY PLANNING CLINIC 13
OUTREACH/MOBILE CLINIC 14
FIELDWORKER/VHT 15
OTHER PUBLIC SECTOR (SPECIFY) ______16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG SHOP 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL SECOR (SPECIFY) ____26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
STREET VENDOR 34
LODGE 35
OTHER (SPECIFY) _____96

1018) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2 (GO TO 1020)

1019) All women are supposed to receive counseling after being tested. After you were tested, did you receive counseling?

YES 1
NO 2
DON'T KNOW 8

1020) CHECK 430 FOR LAST BIRTH:

ANY CODE '21-36' CIRCLED (CONTINUE)
OTHER (GO TO 1024)

1021) Between the time you went for delivery but before the baby was born, were you offered an HIV test?

YES 1
NO 2

1022) I don't want to know the results, but were you tested for HIV at that time?

YES 1
NO 2 (GO TO 1024)

1023) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2 (GO TO 1025)

1024) CHECK 1016:

YES (CONTINUE)
NO OR NOT ASKED (GO TO 1027)

1025) Have you been tested for HIV since that time you were tested during your pregnancy?

YES 1 (GO TO 1028)
NO 2

1026) How many months ago was your most recent HIV test?

MONTHS AGO _____(GO TO 1033)
TWO OR MORE YEARS 95 (GO TO 1033)

1027) I don't want to know the results, but have you even been tested for HIV?

YES 1
NO 2 (GO TO 1031)

1028) How many months ago was your most recent HIV test?

MONTHS AGO ______
TWO OR MORE TEARS 95

1029) I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

1030) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PALCE.
(NAME OF PLACE) _____________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL11 (GO TO 1033)
GOVERNMENT HEALTH CENTER12 (GO TO 1033)
FAMILY PLANNING CLINIC 13 (GO TO 1033)
OUTREACH/MOBILE CLINIC 14 (GO TO 1033)
FIELDWORKER/VHT 15 (GO TO 1033)
OTHER PUBLIC SECTOR (SPECIFY) ______16 (GO TO 1033)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (GO TO 1033)
PHARMACY/DRUG SHOP 22 (GO TO 1033)
PRIVATE DOCTOR 23 (GO TO 1033)
MOBILE CLINIC 24 (GO TO 1033)
COMMUNITY HEALTH WORKER 25 (GO TO 1033)
OTHER PRIVATE MEDICAL SECOR (SPECIFY) ____26(GO TO 1033)
OTHER SOURCE
HOME 31(GO TO 1033)
WORKPLACE 32 (GO TO 1033)
SHOP 33 (GO TO 1033)
OTHER (SPECIFY) _____96 (GO TO 1033)

1031) Do you know of a place where people can go to get an HIV test?

YES 1
NO 2 (GO TO 1033)

1032) Where is that? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIBATE SECTOR, WRITE THE NAME OF THE PALCE.

(NAME OF PLACE) ___________

PUBLIC SETOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE VCT SERICES D
COMMUNITY HEALTH WORKER/VH E
OTHER PUBLIC SECTOR (SPECIFY)_______F
PRIVATE MEDICAL SECTOR
PRIVATE GISOURAK/CLINIC/PRIVATE DOCTOR G
PHARMACY/DRUG SHOP H
MEBILE VCT SERVICES I
COMMUNITY HEALTH WORKER J
OTHER PRIVAT MEDICAL SECTOR (SPECIFY) _____K
OTHER (SPECIFY) ______X

1033) Have you heard of test kits people can use to text themselves for HIV?

YES 1
NO 2 (GO TO 1035)

1034) Have you ever tested yourself for HIV using a self-test kit?

YES 1
NO 2

1035) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

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

1036) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

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

1037) Do you think people hesitate to take an HIV test because they are afraid of how other people will react of the test result is positive for HIV?

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

1038) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

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

1039) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

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

1040) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

AGREE 1
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS

1041) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

YES 1
NO 2
SAYS SHE HAS HIV 3
DON'T KNOW/ NOT SURE/DEPENDS 8

1042) CHECK 1001,

HEARD ABOUT HIV OR AIDS

a) Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
YES 1
NO 2

NOT HEARD ABOUT HIV OR AIDS

b) Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

1043) CHECK 713:

HAS HAD SEXUAL INTERCOURSE (CONTINUE)
NEVER HAD SEXUAL INTERCOURSE (GO TO 1051)

1044) CHECK 1042: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (CONTINUE)
NO (GO TO 1046)

1045) 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

1046) 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

1047) 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

1048) CHECK 1045, 1046, ADN 1047:

HAS HAD AN INFERTION (ANY 'YES') (CONTINUE)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1051)

1049) The last time you had (PROBLEM FROM 1045/1046/1047), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1051)

1050) Where did you go? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIBATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________
PUBLIC SETOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE VCT SERICES D
COMMUNITY HEALTH WORKER/VH E
OTHER PUBLIC SECTOR (SPECIFY)_______F
PRIVATE MEDICAL SECTOR
PRIVATE GISOURAK/CLINIC/PRIVATE DOCTOR G
PHARMACY/DRUG SHOP H
MEBILE VCT SERVICES I
COMMUNITY HEALTH WORKER J
OTHER PRIVAT MEDICAL SECTOR (SPECIFY) _____K
OTHER SOURCE
SHOP L
OTHER (SPECIFY) ______X

1051) 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?

YES 1
NO 2
DON'T KNOW 8

1052) Is a wife justified in refusing to have sex with her husband when she know she has sex with other women?

YES 1
NO 2
DON'T KNOW 8

1053) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
NOT IN UNION (GO TO 1101)

1054) 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

1055) Could you ask your (husband/partner) to use a condom if you wanted him to?

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 11. OTHER HEALTH ISSUES

1101) 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-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _______
NONE 00 (GO TO 1104)

1102) 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMBERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _____
NONE 00 (GO TO 1104)

1103) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1104) Do you currently smoke cigarettes every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2 (GO TO 1106)
NOT AT ALL 3 (GO TO 1106)

1105) On average, how many cigarettes do you currently smoke each day?
NUMBER OF CIGARETTES ____

1106) Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (GO TO 1108)

1107) What other type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

PIPES FULL OF TOBACCO A
CIGARS, CHEROOTS, OR CIGARILLOS B
WATER PIPE/SHISHA C
SNUFF BY MONTH D
SNUFF BY NOSE E
CHEWING TOBACCO F
OTHER (SPECIFY)_______X

1108) 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 big problem:

a) Getting permission to go to the doctor?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) Getting money needed for advice or 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) Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1108A) Do you know about health insurance for paying for your health care?

YES 1
NO 2 (GO TO MM01)

1109) Are you covered by any health insurance?

YES 1
NO 2 (GO TO 1110A)

1110) What type of health insurance are you covered by?

RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE 1 (GO TO MM01)
HEALTH INSURANCE THROUGH EMPLOYER B (GO TO MM01)
SOCIAL SECURITY C (GO TO MM01)
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D (GO TO MM01)
OTHER (SPECIFY) ________X (GO TO MM01)

1110A) Would you consider joining a health insurance scheme to pay for your health care?

YES 1
NO 2
DON'T KNOW 8

SECTION MM, ADULT AND MATERNAL MORTALITY MODULE

MM01) Now I would like to ask you some questions about your brothers and sisters born to your natural mother, including those who are living with you, whose living elsewhere and whose who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your natural mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all of your brothers and sisters born to your natural mother?

DO NOT FILL IN THE ORDER NUMBER YET.

NAME____
ORDER NUMBER _____

MM02) CHECK MM01,

ONE OR MORE BROTHERS OR SISTERS LISTED (CONTINUE)
NO BROTHERS OR SISTERS LISTED (GO TO MM04)

MM03) READ THE NAMES OF THE BROTHERS AND SISTERS TO THE RESPONDENT AND AFTER THE LAST ONE ASK: Are there any other brothers and sisters from the same mother that you have not mentioned?

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN MM01)

MM04) Sometimes people forget to mention children born to their natural mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have not mentioned?

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN MM01)

MM05) Sometimes people forget to mention children born to their natural mother because they have died. Are there any brothers or sisters who died that you have not mentioned?

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN MM01)

MM06) Some people have brothers or sisters from the same mother but a different father. Are there any brothers or sisters born to your natural mother. but who have a different natural father, that you have not mentioned?

NO (CONTINUE)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN MM01)

MM07) COUNT THE NUMBER OF BROTHERS AND SISTERS RECORDED IN MM01.

TOTALY BROTHERS AND SISTERS ___________

MM08) CHECK MM07:

Just to make sure that I have this right: Your mother had in TOTAL ____births, excluding you, during her lifetime, Is that correct?

YES (CONTINUE)
NO (PROBE AND CORRECT MM01 AND/OR MM07.

MM09) CHECK MM07:

ONE OR MORE BROTHERS/SISTERS (CONTINUE)
NO BROTHER OR SISTER (GO TO DV00)

MM10) Please tell me, which brother or sister was born first? And which was born next?

RECORD '01' FOR THE ORDER NUMBER IN MM01 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED THE ORDER NUMBER FOR ALL BORTHERS AND SISTERS.

MM11) How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ________

MM12) LIST THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER IN MM01, ASK MM13 TO MM24 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER.IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE AN ADDITIONAL QUESTIONNAIRE.

MM13) NAME OF BROTHER OR SISTER

_________

MM14) Is (NAME) male of female?

MALE 1
FEMALE 2

MM15) Is (NAME) still alive?

YES 1
NO 2 (GO TO MM17)
DK 8 (GO TO D2)

MM16) How old is (NAME)?

______(GO TO 02)

MM17) How many years ago did (NAME) die?

______

MM18) How old was (NAME) when (he/she) died?

IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

____(IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO MM23)

MM19) Was (NAME) pregnant when she died?

YES 1 (GO TO MM23)
NO 2

MM20) Did (NAME) die during childbirth?

YES 1 (GO TO 02)
NO 2

MM21) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO MM23)

MM22) How many days after the end of the pregnancy did (NAME) die?

______

MM23) Was (NAME)'s death due to an act of violence?

YES 1 (GO TO 02)
NO 2

MM24) Was (NAME)'s death due to an accident?

YES 1
NO 2
(GO TO 02)

IF NO MORE BROTHERS OR SISTERS, GO TO DV00.

DOMESTIC VIOLENCE MODULE

DV00) CHECK COVER PAGE: WOMAN SELECTED FOR DV MODULE?

WOMAN SELECTED FOR THIS SECTION (CONTINUE)
WOMAN NOT SELECTED (GO TO 1111)

DV01) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (CONTINUE)
PROVACY NOT POSSIBLE 2(GO TO 1111)

DV01A) 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. 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.

DV02) CHECK 701 AND 702:

CIRRENTLY MARRIED/LIVING WITH A MAN (CONTINUE)
FORMERLY MARRIED/LIVED WITH AMAN (READ IN PAST TENSE AND USE 'LAST' WITH 'HUSBAND/PARTNER') (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO DV16)

DV03) 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 id you (talk/talked) to other men?
YES 1
NO 2
DK8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DK8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DK8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DK8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DK8

DV04) Now I need to ask some more questions about your relationship with your (last)(husband/partner).

A. Did your (last)(husband/partner) ever:

a) say or do something to humiliate you in front of other?
YES 1
NO 2
b) threaten to hurt or harm you or someone you care about?
YES 1
NO 2
c) insult you or make you feel bad about yourself?
YES 1
NO 2

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of other?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

DV05) A. 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
b) slap you?
YES 1
NO 2
c) twist your arm or pull your hair?
YES 1
NO 2
d) punch you with his fist or with something that could hurt you?
YES 1
NO 2
e) kick you, drag you, or beat you up?
YES 1
NO 2
f) try to choke you or burn you on purpose?
YES 1
NO 2
g) threaten or attack you with a knife, gun, or other weapon?
YES 1
NO 2
h) physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2
i) physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2
j) force you with threats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2

B. How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) threaten or attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) physically force you to perform any other sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
j) force you with threats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

DV06) CHECK DV05(a-j):

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO DV09)

DV07) 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'.

NUMBER OF YEARS ____
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

DV08) 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 bums?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

DV09) Have you even 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 DV11)

DV10) In the last 12 months, how often have you done this to your (last) (husband/partner) : often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 2

DV11) Does (did) your (last)(husband/partner) drink alcohol?

YES 1
NO 2 (GO TO DV13)

DV12) How often does (did) he get drunk?

OFTEN 1
SOMETIMES 2
NEVER 2

DV13) Are (Were) you afraid of your (last) (husband//partner): most of the time, sometimes, or never?

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAD 3

DV14) CHECK 709:

MERRIED MORE THAN ONCE (CONTINUE)
MARRIED ONLY ONCE (GO TO DV16)

DV15) 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)

a) Did any previous (husband/partner) ever hit, slap, kick or do anything else to hurt you physically?
YES 1 (GO TO B)
NO 2
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1( GO TO B)
NO 2

B. How long ago did this last happen?

0-11 MONTHS AGO 1
12+MONTHS AGO 2
DON'T REMEMBER 3

DV16) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN:
a) 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?

YES 1
NO 2 (GO TO DV19)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV19)

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

YES 1
NO 2 (GO TO DV19)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV19)

DV17) 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
CURRECT BOYFRIEND F
FORMER BOYDRIEND G
MOTHE-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLYER/SOMEONE AT WORK L
POLICE/SOLDIER M
OTHER (SPECIFY) ____________X

DV18) In the last 12 months, how often has (this person/have these persons)physically hurt: often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

DV19) CHECK 201. 226. AND 230:

EVER BEEN PREGNANT ('YES' ON 201 OR 226 OR 230) (CONTINUE)
NEVER BEEN PREGNANY (GO TO DV22)

DV20) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (GO TO DV22)

DV21) 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/BORTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYRIEND 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

DV22) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (CONTINUE)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO DV22B)

DV22A) 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?

YES 1 (GO TO DV23)
NO 2(GO TO DV24A)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV24A)

DV22B) 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?

YES 1
NO 2(GO TO DV26)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO DV26)

DV23) Who was the person who was forcing you the very first time this happened?

CURRENT/FORMER BOTFRIEND 01
FATER/STEP-FATHER 02
BROTHER/STEP-BROTHER 03
OTHER RELATIVE 04
IN-LAW 05
OWN FRIEND/ACQUAINTANCE 06
FAMILY FRIEND 07
EMPLOYER/SOMEONE AT WORK 09
POLICE/SOLDIER 10
PRIEST/RELIGIOUS LEADER 11
STRANGER 12
OTHER (SPECIFY)_______96

DV23A) After being forced to have sexual intercourse or perform sexual acts, have you ever sought help form a doctor or medical personnel?

YES 1
NO 2 (GO TO DV23G)

DV23B) How long after you were forced to have sexual intercourse or perform sexual acts did you seek help?

WITHIN 3 DAYS 1
AFTER 3 DAYS OR MORE 2

DV23C) Were you offered drugs to prevent you from getting HIV after you were forced to have sexual intercourse or perform sexual acts?

YES 1
NO 2

DV23D) Were you offered a test for HIV after you were forced to have sexual intercourse or perform sexual acts?

YES 1
NO 2

DV23E) Were you pregnant when you were forced to have sexual intercourse or perform sexual acts?

YES 1 (GO TO 23G)
NO 2

DV23F) Were you offered a pill to stop you from becoming pregnant?

YES 1
NO 2

DV23G) After being forced to have sexual intercourse or perform sexual acts, have you ever sought:

a) Psychological support?
YES 1
NO 2
b) Legal support?
YES 1
NO 2

DV24) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH AMAN
a) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) husband/partner?

NEVER MARRIED/NEVER LIVED WITH A MAN
b) How old were you the first time you were forced to have sexual intercourse of perform any other sexual acts?

AGO IN COMPLETED YEARS _____
DON'T KNOW 98

DV26) CHECK DV05A(a-j), DV16. DV20. DV22A. AND DV22B:

AT LEAST ONE 'YES' (CONTINUE)
NOT A SINGLE 'YES' (GO TO DV30)

DV27) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

YES 1
NO 2 (GO TO DV29)

DV28) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (GO TO DV30)
HUSBAND/PARTNER'S FAMILY B (GO TO DV30)
CURRENT/FORMER HUSBAD/PARTENR C (GO TO DV30)
CURRENT/FORMER BOYFRIEND D (GO TO DV30)
FRIEND E (GO TO DV30)
NEIGHBOR F (GO TO DV30)
RELIGIOUS LEADER G (GO TO DV30)
DOCOTOR/MEDICAL PERSONNEL H (GO TO DV30)
POLICE I (GO TO DV30)
LAWYER J (GO TO DV30)
SOCIAL SERVICE ORGANIZATION K (GO TO DV30)
OTHER (SPECIFY) _______X (GO TO DV30)

DV29) Have you ever told anyone about this?

YES 1
NO 2

DV30) As for as you know, did your father or any other husband or boyfriend your mother had ever hit or beat her?

YES 1
NO 2
DON'T KNOW 8

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.

DV31) 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?

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

1111) RECORD THE TIME

HOURS ______
MINUTES________

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTEVIEW

COMMENTS ABOUT INTERVIEW:
____________________________________________________________________________________________________________________________________________________________

COMMENTS ON SPECIFI QUESTIONS:
____________________________________________________________________________________________________________________________________________________________

ANY OTHER COMMENTS:
____________________________________________________________________________________________________________________________________________________________

SUPERVISOR'S PBSERVATIONS
____________________________________________________________________________________________________________________________________________________________

EDITOR'S OBSERVATIONS
____________________________________________________________________________________________________________________________________________________________