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YEMEN 1991 WOMEN’S QUESTIONNAIRE

REPUBLIC OF YEMEN

MINISTRY OF PLANNING AND DEVELOPMENT

CENTRAL STATISTICAL ORGANIZATION

YEMEN DEMOGRAPHIC AND CHILD HEALTH SURVEY

IDENTIFICATION

GORVERNORATE____

DISTRICT ____

URBAN/RURAL____

CLUSTER NAME____

CLUSTER NUMBER____

HOUSEHOLD NUMBER____

LINE NUMBER OF WOMEN____

INTERVIEWER VISITS

FIRST VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW

HOURS____
MINUTES____

RESULT CODE*

NEXT VISIT
DATE
TIME

SECOND VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEWER

HOURS____
MINUTES____

RESULT CODE*

NEXT VISIT
DATE
TIME

FINAL VISIT
NAME OF INTERVIEWER
DATE OF VISIT
STARTING TIME
ENDING TIME
DURATION OF INTERVIEW

HOURS____
MINUTES____

RESULT CODE*

*RESULT CODES

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

FIELD EDITING
NAME
DATE

OFFICE EDITING
NAME
DATE

DATA ENTRY
NAME
DATE

KEYED BY

SECTION 1. RESPONDENT’S RESOURCES

101) RECORD THE TIME.

HOUR____
MINUTES____

102) First I would like to ask some questions about you. In what month and year were you born?

MONTH____
DON’T KNOW 98
YEAR____
DON’T KNOW 98

103) How old were you at your last birthday? COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT. IF RESPONDENT IS 55 OR MORE YEARS OF AGE, END INTERVIEW.

AGE IN COMPLETED YEARS____

104) Have you always lived in (NAME OF PLACE)?

YES 1 (GO TO 110)
NO 2

105) How long have you been living continuously in (NAME OF PLACE)?

YEARS____

106) Why did you come to (NAME OF PLACE)?

MARRIAGE 1 (GO TO 108)
WORK 2
STUDY 3
CAME WITH HUSBAND 4 (GO TO 108)
CAME WITH PARENTS 5
CAME WITH CHILDREN 6
OTHER (SPECIFY)____ 7

107) Was this before you were first married or after?

BEFORE 1
AFTER 2
AT THE TIME OF MARRIAGE 3

108) Was the place you were living in before coming to (NAME OF PLACE): a city, a town, or a village?

CITY 1
TOWN 2
VILLAGE 3

109) For most of the time until you were 12 years old, did you live in a city, a town, a large village, or a small village?

CITY 1
TOWN 2
VILLAGE 3

110) Have you ever attended or are you now attending school?

YES, CURRENTLY 1
YES, NOT CURRENTLY 2
NEVER ATTENDED 3 (GO TO 114)

111) What (is/was) the highest level of education you attended?

PRIMARY 1
PREPARATORY 2
SECONDARY 3
POSTSECONDARY 4
UNIVERSITY 5

112) What was the highest grade (year) you successfully completed at that level?

GRADE____

113) CHECK 111 AND 112

LESS THAN 4 YEARS OF PRIMARY 1
FOUR YEARS OF PRIMARY OR MORE 2 (GO TO 116)

114) Can you read a letter or newspaper?

YES 1
NO 2 (GO TO 117)

115) Can you write a letter, for example?

YES 1
NO 2

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

YES 1
NO 2

117) Do you watch television?

YES 1
NO 2 (GO TO 119)

118) What is the suitable time for watching television?

4 TO 6 IN THE EVENING 1
6 TO 8 IN THE EVENING 2
AFTER 8 IN THE EVENING 3
THE WHOLE TIME TV IS ON 4
DON’T WATCH OR NO TV 5

119) Do you listen to radio?

YES 1
NO 2 (GO TO 121)

120) What is the suitable time for listening to radio? CIRCLE ALL ANSWERS METIONED

MORNING 1
NOON 2
AFTERNOON 3
EVENING 4

121) Before you were first married, did you ever do any work regularly for which you were paid in cash?

YES 1
NO 2 (GO TO 124)

122) When you were working then, what did you do with most of the money that you earned?

GAVE 1
SELF 2
OTHER (SPECIFY)____ 3

123) Was the money used mainly to prepare for marriage?

YES 1
NO 2

124) Since you were first married, have you ever done any work for cash?

YES 1
NO 2

125) Are you now doing any work for cash?

YES 1
NO 2 (GO TO 127)

126) In this work, are you working on your own, for a family member, or for someone else?

ON HER OWN 1 (GO TO 129)
FOR A FAMILY MEMBER 2 (GO TO 129)
FOR SOMEONE ELSE 3 (GO TO 129)

127) Do you assist any family member in his/her work?

YES 1 (GO TO 129)
NO 2

128) Do you assist someone not in the family in his/her work?

YES 1
NO 2 (GO TO 132)

129) What kind of work do you mainly do? WRITE RESPONSE EXACTLY AS GIVEN

OCCUPATION____

130) How many hours did you work in the past week?

HOURS WORKED____

131) CHECK 123

WORKING FOR CASH 1 (GO TO 201)
NOT WORKING FOR CASH 2

132) If a good opportunity for working for cash was available, would you want to work in the future?

YES 1
NO 2
UNSURE/DON’T KNOW 3

SECTION 2. MARRIAGE AND CO-RESIDENCE

201) Are you now married, widowed, divorced, or separated?

MARRIED 1
WIDOWED 2 (GO TO 203)
DIVORCED 3 (GO TO 203)
SEPARATED 4

202) Does your husband have another wife? IF ‘YES’: How many?

NUMBER OF CO-WIVES____
NO 4
DON’T KNOW 8

203) Have you been married only once or more than once?

ONCE 1 (GO TO 205)
MORE THAN ONCE 2

204) Is (was) there a blood relation between you and your (last) husband? IF ‘YES’: What is (was) the type of this relation?

FIRST COUSIN FROM FATHER’S SIDE 1
FIRST COUSIN FROM MOTHER’S SIDE 2
OTHER 3
NO RELATION 4

205) Is (was) there a blood relation between you and your (FIRST) husband? IF ‘YES’: What is (was) the type of this relation?

FIRST COUSIN FROM FATHER’S SIDE 1
FIRST COUSIN FROM MOTHER’S SIDE 2
OTHER 3
NO RELATION 4

206) In what month and year did you and your (first) husband begin to live together "zifaf"?

MONTH____
DON’T KNOW MONTH 98
YEAR____ (GO TO 208)
DON’T KNOW YEAR 98

207) At what age did you and your (first) husband begin to live together "zifaf"?

AGE____

208) At the time you first married, did you and your (first) husband have your own home or did you begin by living in someone else’s home?

HAD OWN HOME 1
LIVED IN SOMEONE ELSE’S HOME 2 (GO TO 210)

209) At the time of your (first) marriage, did anyone else live with you?

YES 1
NO 2 (GO TO 301)

210) With whom did you live (who lived with you) for at least six months after you (first) married? CIRCLE ALL RESPONSES MENTIONED

HUSBAND’S PARENTS 1
HUSBAND’S MOTHER 2
HUSBAND’S FATHER 3
RESPONDENT’S PARENTS 4
REPSONDENT’S MOTHER 5
RESPONDENT’S FATHER 6
OTHER RELATIVES (SPECIFY)____ 7
OTHER (SPECIFY)____ 8

211) CHECK 210

ONLY ONE CODE CIRCLED
MORE THAN ONE CODE CIRCLED (GO TO 213)

212) For how long did you live together with (SPECIFY) at that time?

MONTHS____ (GO TO 301)
YEARS____ (GO TO 301)
UP TO PRESENT 96 (GO TO 301)

213) What was the longest period you lived together with (any) of them?

MONTHS____
YEARS____
UP TO THE PRESENT 96

SECTION 3. REPRODUCTION AND CHILD SURVIVAL

301) During your lifetime, have you ever given birth to a baby born alive?

YES 1
NO 2 (GO TO 306)

302) 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 304)

303) How many sons live with you? And how many daughters live with you? IF NONE, ENTER "00"

SONS AT HOME____
DAUGHTERS AT HOME____

304) Do you have any sons or daughters to whom you have given birth and who are alive but not living with you?

YES 1
NO 2 (GO TO 306)

305) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE ENTER "00"

SONS ELSEWHERE____
DAUGHTERS ELSEWHERE____

306) Have you ever given birth to a boy or a girl who was born alive but later died? IF NO, PROBE: Any (other) boy or girl who cried or showed any sign of life, but only survived a few hours or days?

YES 1
NO 2 (GO TO 308)

307) How many boys have died? And how many girls have died? IF NONE ENTER "00"

BOYS DEAD____
GIRLS DEAD____

308) SUM ANSWERS TO 303, 305, AND 307 AND ENTER TOTAL.

TOTAL____

309) CHECK 308: Just to make sure that I have this right, you have had in total ____ live births during your life. Is this correct?

YES
NO (PROBE AND CORRECT 301 TO 309 AS NECESSARY)

310) CHECK 308

ONE OR MORE BIRTHS
NO BIRTHS (GO TO 321)

311) Now I would like to talk to you about your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL BIRTHS IN 313. IF NO NAME WAS GIVEN, PUT "X" IN 313. RECORD TWINS ON SEPARATE LINES AND MARK WITH A BRACKET. ASK 314 THROUGH 318 AS APPROPRIATE FOR EACH BIRTH. AFTER RECORDING ALL BIRTHS WOMAN HAS HAD, GO TO 319.

312) BIRTH ORDER

313) What name was given to your (first, etc) baby?

NAME____

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

BOY 1
GIRL 2

315A) In what year was (NAME) born? IF DON’T KNOW, ASK: How many years ago?

YEAR____
YEARS AGO____

315B) And in what month? IF DON’T KNOW, ASK: In what season?

MONTH____
SEASON____

316) Is (NAME) still living?

YES 1 (GO TO 318)
NO 2

317) IF DEAD: How old was (NAME) when he/she died? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN 2 YEARS; OR YEARS

DAYS____
MONTHS____
YEARS____

318) Was year of birth derived from a document?

YES 1
NO 2

319) COMPARE 308 AND 309 WITH NUMBER OF BIRTHS IN TABLE ABOVE AND MARK:

NUMBERS ARE SAME
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

320) In addition to the pregnancies which ended in live births, have you had any other pregnancy which ended in a miscarriage, still birth, or an abortion? PROBE: Any other pregnancy which lasted only a few weeks or months?

YES 1 (GO TO 322)
NO 2 (GO TO 324)

321) Have you had any pregnancy which ended in a miscarriage, still birth, or abortion? PROBE: Any other pregnancy which lasted only a few weeks or months?

YES 1
NO 2 (GO TO 324)

322) How many pregnancies ended in still births? IF NONE, ENTER "00"

STILL BIRTHS____

323) How many pregnancies ended in miscarriages and abortions? IF NONE, ENTER "00"

MISCARRIAGES OR ABORTIONS____

324) Are you pregnant now?

YES 1
NO 2 (GO TO 326)
UNSURE 3 (GO TO 326)

325) For how many months have you been pregnant?

MONTHS____ (GO TO 327)

326) How long ago did your last menstrual period start?

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996 (GO TO 329)

327) At what age did you have your first menstrual period?

AGE____
DON’T KNOW 98

328) CHECK 324

CURRENTLY PREGNANT 1 (GO TO 401)
NOT PREGNANT/UNSURE 2

329) CHECK "LIVE BIRTHS TABLE."

ONE OR MORE BIRTHS IN LAST FIVE YEARS 1 (GO TO 501)
NO BIRTHS IN LAST FIVE YEARS 2 (GO TO 801)

SECTION 4. ANTENATAL CARE: CURRENT PREGNANCY

401) Did you see anyone for a check-up on this pregnancy?

YES 1
NO 2 (GO TO 412)

402) How many months were you pregnant when you had your first check-up?

MONTHS____

403) Was there any complaint which led you to have a check-up?

YES 1
NO 2

404) How many check-ups did you have since you became pregnant?

NUMBER____

405) Have you seen any of the following persons during the check-up(s) on your pregnancy?

DOCTOR
YES 1
NO 2
TRAINED NURSE/MIDWIFE
YES 1
NO 2
DAYA/GRANDMOTHER
YES 1
NO 2
ANYONE ELSE
YES 1
NO 2

406) How many weeks ago was the last check-up?

NUMBER OF WEEKS____

407) Where did you have the last check-up?

PUBLIC HEALTH ESTABLISHMENT 1
COOPERATIVE HEALTH ESTABLISHMENT 2
PRIVATE HEALTH ESTABLISHMENT 3
AT HOME 4 (GO TO 413)
OTHER (SPECIFY)____ 5 (GO TO 413)

408) How long did it take to get to (PLACE IN 407)?

MINUTES____

409) How did you go to (PLACE IN 407)?

WALKING 1
BUS/TAXI 2
PRIVATE CAR 3
OTHER (SPECIFY)____ 4

410) How long did you have to wait at (NAME OF PLACE) for check-up?

LESS THAN ONE HALF HOUR 1
BETWEEN ONE HALF HOUR AND AN HOUR 2
BETWEEN ONE HOUR AND TWO HOURS 3
MORE THAN 2 HOURS 4

411A) Were you satisfied with the care you got during your last check-up in (PLACE IN 407)?

YES 1 (GO TO 413)
NO 2

411B) IF ANSWER IN 411A IS "NO," ASK ABOUT THE REASON FOR DISSATISFACTION WITH CARE RECEIVED. CIRCLE ALL RESPONSES MENTIONED

BAD TREATMENT 1 (GO TO 413)
EXAMINATION NOT THOROUGH 2 (GO TO 413)
APPROPRIATE ATTENTION NOT GIVEN FOR PREGNANCY 3 (GO TO 413)
SPECIALIST NOT PRESENT 4 (GO TO 413)
STAFF NOT QUALIFIED 5 (GO TO 413)
CROWDED PLACE 6 (GO TO 413)
OTHER (SPECIFY)____ 7 (GO TO 413)

412) What was the main reason for not having a check-up for the current pregnancy?

TOO EARLY 1
INTENDS TO 2
HAD NO COMPLAINTS 3
HAD PREVIOUS EXPERIENCE 4
SERVICE NOT AVAILABLE 5
SERVICE TOO FAR 6
COSTS TOO MUCH 7
TOO BUSY 8
HUSBAND TOO BUYS 9
OTHER (SPECIFY)____ 0

413) Are you taking now any of the following?

IRON TABLETS
IRON TABLETS
YES 1
NO 2
VITAMINS
YES 1
NO 2
ANY OTHER MEDICINE
YES 1
NO 2

414) Since the beginning of this pregnancy, have you been given any injection to prevent the baby from getting convulsions after birth, i.e., an anti-tetanus shot? IF YES: How many injections did you have?

YES, ONE DOSE 1
YES, TWO DOSES 2
NO 3
DON’T KNOW 4

415) Since you have been pregnant, did you have any of the following conditions?

SWOLLEN ANKLE AND FINGERS
YES 1
NO 2
PERSISTENT HEADACHES
YES 1
NO 2
HIGH BLOOD PRESSURE
YES 1
NO 2
BLEEDING
YES 1
NO 2
CONVULSIONS (FITS)
YES 1
NO 2

416) Does anyone help you now with your usual daily chores? IF "YES": Who is helping you? CIRCLE ALL APPLICABLE CODES

MOTHER 1
HUSBAND 2
MOTHER-IN-LAW 3
SISTER 4
DAUGHTER 5
RELATIVE 6
MAID 7
OTHER (SPECIFY)____ 8
NO ONE 9

417) When you have your baby do you expect anyone to help you looking after the baby? IF "YES": Who? IF MORE THAN ONE PERSON, PROBE AND CIRLE PERSON EXPECTED TO PROVIDE MOST HELP.

MOTHER 1
MOTHER-IN-LAW 2
SISTER 3
RELATIVE 4
MAID/NANNY 5
OTHER (SPECIFY)____ 6
NO 7

418) Where do you plan to deliver your baby?

PUBLIC HEALTH ESTABLISHMENT 1
PRIVATE HEALTH ESTABLISHMENT 2
AT HOME 3
OTHER (SPECIFY)____ 4

419) Who will assist you with the delivery?

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
DAYA/GRANDMOTHER 3
OTHER (SPECIFY)____ 4
DON’T KNOW 8

420) How much would the delivery cost?

COST (IN RIALS)____
FREE SERVICE 9966
DON’T KNOW 9988

421) Would you prefer to have a boy or a girl?

BOY 1
GIRL 2
EITHER 3
OTHER (SPECIFY)____ 4

422) Do you plan to breastfeed your baby? IF "YES": For how long?

DURATION (IN MONTHS)____
YES, DURATION UNDECIDED 98
WILL NOT BREASTFEED 96

423) CHECK "LIVE BIRTHS TABLE."

ONE OR MORE BIRTHS IN LAST FIVE YEARS 1
NO BIRTHS IN LAST FIVE YEARS 2 (GO TO 801)

SECTION 5. MATERNAL CARE: THE LAST FIVE YEARS

CHECK BIRTH HISTORY TABLE AND ENTER NAMES OF ALL CHILDREN BORN IN THE "LAST FIVE YEARS," STARTING WITH "LAST LIVE BIRTH."

501) LIN NUMBER OF CHILD IN "BIRTH HISTORY TABLE"

LINE NUMBER____

502) SURVIVAL STATUS: CHECK 316

ALIVE
DEAD

503) When you were pregnant with (NAME), did you see anyone for a check-up on the pregnancy?

YES 1
NO 2 (GO TO 509)

504) Was there any complaint which led you to have the check-up?

YES 1
NO 2

505) How long were you pregnant with (NAME) when you had the first check-up?

MONTHS____
DON’T KNOW 96

506) How many check-ups did you have during the pregnancy?

NUMBER____
CANNOT REMEMBER 96

507) Whom did you usually see? RECORD THE MOST QUALIFIED

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
DAYA 3
OTHER (SPECIFY)____ 4

508) Where did you usually have the check-up(s)?

PUBLIC HEALTH ESTABLISHMENT (GO TO 510A)
COOPERATIVE HEALTH ESTABLISHMENT 2 (GO TO 510A)
PRIVATE HEALTH ESTABLISHMENT 3 (GO TO 510A)
AT HOME 4 (GO TO 510A)
OTHER (SPECIFY)____ 5 (GO TO 510A)

509) What was the main reason for not having a check-up on the pregnancy?

HAD NO COMPLAINTS 1
HAD PREVIOUS EXPERIENCE 2
COSTS TOO MUCH 3
SERVICE NOT AVAILABLE 4
SERVICES TOO FAR 5
OTHER (SPECIFY)____ 6

510A) When you were pregnant with (NAME) were you given any injection to prevent the baby from getting convulsions after birth, i.e., an anti-tetanus shot?

YES 1
NO 2 (GO TO 511)
DON’T KNOW 3 (GO TO 511)

510B) How many shots?

NUMBER____

511) Where was (NAME) delivered?

PUBLIC HEALTH ESTABLISHMENT 1
PRIVATE HEALTH ESTABLISHMENT 2
AT HOME 3
AT ANOTHER HOME 4
OTHER (SPECIFY)____ 5

512) Who assisted with the delivery of (NAME)? RECORD THE MOST QUALIFIED

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
DAYA 3
RELATIVE/FRIEND 4
OTHER (SPECIFY)____ 5
NO ONE 6

513) Was the delivery normal or were there any complications?

NORMAL 1
COMPLICATIONS 2

514) CHECK 511

CHILD WAS DELIVERED AT HEALTH ESTABLISHMENT 1
CHILD WAS NOT DELIVERED AT HEALTH ESTABLISHMENT 2 (GO TO 517)

515) Why did you have the delivery of (NAME) at (hospital/clinic)?

SAFER/BETTER 1
COMPLICATIONS 2
OTHER (SPECIFY)____ 3

516) Did you have a cesarean section while delivering (NAME)?

YES 1 (GO TO 519B)
NO 2 (GO TO 519B)

517) Why did you not have the delivery of (NAME) at a public hospital or a private clinic? CIRCLE MAIN REASON

SERVICE NOT AVAILABLE 1
SERVICE TOO FAR 2
COSTS TOO MUCH 3
PREMATURE/SUDDEN DELIVERY 4
HOME IS BETTER 5
OTHER (SPECIFY)____ 6

518) How was the umbilical cord cut?

MEDICAL INSTRUMENTS 1
ORDINARY SCISSORS 2
RAZOR/KNIFE 3
OTHER (SPECIFY)____ 4
DON’T KNOW 5

519A) How was the cord stump treated?

STERILIZED DRESSING 1
COVERED WITH GROUND COFFEE 2
COVERED WITH FLOUR 3
COVERED WITH EARTH 4
COVERED WITH CAUTERIZING 5
COVERED WITH BOILED OIL 6
COVERED WITH EGG 7
COVERED WITH KOHL 7
OTHER (SPECIFY)____ 9
DON’T KNOW 10

519B) Was (NAME) born on time (9 months) or before time?

ON TIME 1
BEFORE TIME 2
AFTER TIME 3
DON’T KNOW 4

520) When (NAME) was born, was his/her weight normal, below normal, or above normal?

NORMAL 1
BELOW 2
MUCH BELOW 3
ABOVE 4
DON’T KNOW 5

521) Was (NAME) weighed at the time of birth?

YES 1
NO 2 (GO TO 523)

522) How much was the weight in grams?

WEIGHT IN GRAMS____

523) During the six-week period (i.e., Nifath period) following the birth of (NAME), did you see anyone for a check-up on your health? IF "YES": Whom did you see? RECORD THE MOST QUALIFIED

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
DAYA 3
OTHER (SPECIFY)____ 4
NO ONE 5

524) How many months after the birth of (NAME) did your period return

NUMBER OF MONTHS____ (GO TO NEXT CHILD OR IF NO MORE CHILDREN GO TO NEXT SECTION)
HAS NOT RETURNED YET 96 (GO TO NEXT CHILD OR IF NO MORE CHILDREN GO TO NEXT SECTION)

SECTION 6. CHILD FEEDING

CHECK BIRTH HISTORY TABLE AND ENTER NAMES OF ALL CHILDREN BORN IN THE "LAST FIVE YEARS," STARTING WITH "LAST LIVE BIRTH."

LINE NUMBER OF CHILD IN "BIRTH HISTORY TABLE"

LINE NUMBER____

SURVIVAL STATUS: CHECK 316

ALIVE
DEAD

601) Did you ever feed (NAME) at the breast?

YES 1
NO 2 (GO TO 603)

602) How soon after the birth of (NAME) did you start breastfeeding?

LESS THAN 1 HOUR 1 (GO TO 604)
BETWEEN 1 AND 3 HOURS 2 (GO TO 604)
BETWEEN 3 AND 6 HOURS 3 (GO TO 604)
BETWEEN 6 AND 24 HOURS 4 (GO TO 604)
BETWEEN 24 AND 72 HOURS 5 (GO TO 604)
MORE THAN 72 HOURS 6 (GO TO 604)

603) Why did you never breastfeed (NAME)?

CHILD SICK 1
CHILD DIED 2 (GO TO NEXT CHILD)
CHILD REFUSED 3
MOTHER SICK 4
NO/INSUFFICIENT MILK 5
BREAST/NIPPLES PROBLEMS 6
MOTHER HAD TO WORK 7
OTHER (SPECIFY)____ 8

604) Have you ever given (NAME) powdered milk on a regular basis? IF ‘YES’: How old was the child when you started on a regular basis?

AGE (IN MONTHS)____
NO 96

605) Have you ever given (NAME) animal milk such as cow’s , goat’s, or camel’s milk on a regular basis? IF "YES": How old was the child when you started on a regular basis?

AGE (IN MONTHS)____
NO 96

606) Have you ever given (NAME) solid or mushy food on a regular basis? IF "YES": How old was the child when you started on a regular basis?

AGE (IN MONTHS)____
NO 96

607) CHECK 316 AND 601 AND CIRCLE APPROPRIATE CODE.

ALIVE AND BREASTFED 1
ALIVE AND NEVER BREASTFED 2 (GO TO 618)
DEAD AND BREASTFED (GO TO 613)
DEAD AND NEVER BREASTFED (GO TO NEXT CHILD)

608) Are you still breastfeeding (NAME)?

YES 1
NO 2 (GO TO 613)

609) How many times did you breastfeed (NAME) yesterday during the daylight hours?

NUMBER OF TIMES____
AS OFTEN AS CHILD WANTED 96

610) How many times did you breastfeed (NAME) last night between sunset and sunrise?

NUMBER OF TIMES____
AS OFTEN AS CHILD WANTED 96

611) Do you breastfeed (NAME) whenever he/she wants or according to a fixed schedule?

DEMAND 1
SCHEDULE 2
BOTH 3

612) When (NAME) has diarrhea, what do you do with breastfeeding? Do you continue without change, increase, decrease, or stop breastfeeding?

NO CHANGE 1 (GO TO 618)
INCREASE 2 (GO TO 618)
DECREASE 3 (GO TO 618)
STOP 4 (GO TO 618)
NO DIARRHEA 4 (GO TO 618)
DON’T KNOW 5 (GO TO 618)

613) How many months did you breastfeed (NAME)?

NUMBER OF MONTHS____
UNTIL CHILD DIED 96 (GO TO NEXT CHILD)

614) Why did you stop breastfeeding him/her at that age? RECORD MAIN REASON

CHILD REACHED WEANING AGE 1
CHILD SICK 2
CHILD REFUSED 3
CHILD DIED 4 (GO TO NEXT CHILD)
MOTHER SICK 5
NO/INSUFFICIENT MILK 6
PREGNANT 7
WANTED ANOTHER CHILD 8
WANTED TO USE PILL 9
TO (RETURN TO) WORK 10
PREFERRED BOTTLE 11
OTHER (SPECIFY)____ 12

615) Did you stop breastfeeding suddenly or progressively?

SUDDENLY 1
PROGRESSIVELY 2

616) When you weaned (NAME), did you put "Mor" or "Sabr" or any other thing of that type on the breast?

YES 1
NO 2

617) CHECK 316

CHILD ALIVE 1
CHILD DEAD 2 (GO TO NEXT CHILD)

618) Is (NAME) being given any of the following types of liquid and food?

PLAIN WATER
YES 1
NO 2
FRESH FULL CREAM MILK
YES 1
NO 2
PASTEURIZED BOTTLED MILK
YES 1
NO 2
POWDERED MILK FOR INFANT
YES 1
NO 2
CANNED/POWDERED MILK
YES 1
NO 2
JUICES
YES 1
NO 2
SUGAR WATER
YES 1
NO 2
RICE WATER
YES 1
NO 2
HERBAL DRINKS
YES 1
NO 2
HOMEMADE BABY FOOD
YES 1
NO 2
PRESERVED (JARS) BABY FOOD
YES 1
NO 2
FOOD MADE FOR FAMILY
YES 1
NO 2
OTHER (SPECIFY)____
YES 1
NO 2

619) Was (NAME) ever fed regularly from a bottle with a nipple?

YES 1
NO 2 (GO TO NEXT CHILD)

620) How old was (NAME) when you began to feed him/her with a bottle?

MONTHS____
YEARS____
DON’T KNOW 96

SECTION 7. CAUSE OF DEATH FOR CHILDREN WHO DIED

CHECK BIRTH HISTORY TABLE AND ENTER NAMES OF ALL CHILDREN BORN IN THE "LAST FIVE YEARS," STARTING WITH "LAST LIVE BIRTH."

LINE NUMBER OF CHILD IN "BIRTH HISTORY TABLE"

701) CHECK 316 IN BIRTH HISTORY TABLE

ALIVE 1 (GO TO NEXT CHILD)
DEAD 2

702) DURING THE TWO WEEKS BEFOR (NAME) DIED, DID HE/SHE HAVE ANY OF THE FOLLOWING SYMPTOMS?

A) DIARRHEA
YES, LESS THAN 2 DAYS AGO 1
YES, 2 DAYS OR MORE AGO 2
NO 3
B) VOMITING
YES, LESS THAN 2 DAYS AGO 1
YES, 2 DAYS OR MORE AGO 2
NO 3
C) COUGH OR DIFFICULTY IN BREATHING
YES, LESS THAN 2 DAYS AGO 1
YES, 2 DAYS OR MORE AGO 2
NO 3
D) FEVER
YES, LESS THAN 2 DAYS AGO 1
YES, 2 DAYS OR MORE AGO 2
NO 3
E) RASH
YES, LESS THAN 2 DAYS AGO 1
YES, 2 DAYS OR MORE AGO 2
NO 3
F) CONVULSIONS
YES, LESS THAN 2 DAYS AGO 1
YES, 2 DAYS OR MORE AGO 2
NO 3
G) OTHER ILLNESS
YES (SPECIFY)____ 1
NO 2

703) What was the main cause of his/her death?

YOUNGEST CHILD____
NEXT TO YOUNGEST____
SECOND TO YOUNGEST____
THIRD TO YOUNGEST____
SUDDEN DEATH 96

704) Was anyone consulted before the death of (NAME)?

YES 1
NO 2 (GO TO NEXT CHILD)

705) Who was consulted?

HOSPITAL 1
HEALTH CENTER 2
PRIVATE CLINIC 3
TRADITIONAL HEALER 4
OTHER (SPECIFY)____ 5
NO ONE 6

SECTION 8. FAMILY PLANNING AND CHILDBEARING ATTITUDES

801) How I would like to talk about a different topic. There are various methods that a couple can use to delay or avoid a pregnancy. Which of these methods or ways have you heard about? CIRCLE CODE 1 IN 802 FOR EACH METHOD MENTIONED SPONTANEOULSY. THEN PROCEED DOWN THE COLUMN, READING THE NAME OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 2 IF THE METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 802, ASK 803.

802)

802A)

803)

804) CHECK 803

EVER USED A METHOD 1
NEVER USED A METHOD 2 (GO TO 824)

805) How many living sons and how many living daughters, if any, did you have when you first used a family planning method?

NUMBER OF SONS____
NUMBER OF DAUGHTERS____

806) When you first began to use family planning, did you want to have another child but at a later time or did you want to stop childbearing?

WANTED CHILD LATER 1
WANTED TO STOP CHILDBEARING 2
OTHER (SPECIFY)____ 3

807) CHECK 201

CURRENTLY MARRIED 2
NOT CURRENTLY MARRIED 2 (GO TO 823)

808) CHECK 325

NOT PREGNANT/UNSURE 1
CURRENTLY PREGNANT 2 (GO TO 823)

809) Are you currently using any method of family planning?

YES 1
NO 2 (GO TO 823)

810A) Which method are you using?

PILL 1
IUD 2 (GO TO 813)
INJECTIONS 3 (GO TO 817C)
DIAPHRAGM/FOAM/JELLY 4 (GO TO 817C)
CONDOM 5 (GO TO 817C)
FEMALE STERILIZATION 6 (GO TO 816)
MALE STERILIZATION 7 (GO TO 816)
SAFE PERIOD 8 (GO TO 820)
WITHDRAWAL 9 (GO TO 820)
BREASTFEEDING 10 (GO TO 820)
OTHER (SPECIFY)____ 11 (GO TO 820)

810B) Did you consult a doctor or a nurse when you started using it?

YES 1
NO 2

811) How much does one packet (cycle) of pills cost you?

COST (IN RIALS)____
FREE 996
DON’T KNOW 998

812) Who obtained the packet (cycle) of pills the last time?

RESPONDENT 1 (GO TO 817A)
HUSBAND 2 (GO TO 817A)
HOME DELIVERED (GO TO 818)
OTHER (SPECIFY)____ 4 (GO TO 817A)

813) How much did it cost to have the IUD inserted?

COST (IN RIALS)____
FREE 96
DON’T KNOW 98

814) Did you get the IUD at the place where you had it inserted or did you get it somewhere else?

YES, SAME PLACE 1 (GO TO 817B)
NO, SOMEWHERE ELSE 2

815) How much did it cost to get the IUD at (PLACE WHERE IUD WAS BOUGHT)?

COST (IN RIALS)____ (GO TO 817B)
FREE 996 (GO TO 817B)
DON’T KNOW 998 (GO TO 817B)

816) In what month and year did you (your husband) have the operation?

MONTH____ (GO TO 817D)
YEAR____ (GO TO 817D)

817A) Where did you (your husband) obtain the pill the last time?

PUBLIC HOSPITAL 1
PUBLIC FP CLINIC 2
PRIVATE VOLUNTARY FP CLINIC 3
MCH CENTRE 4
PRIVATE DOCTOR/CLINIC 5
FIELD WORKER 6
MOBILE CLINIC 7
PHARMACY 8
OTHER 9 (GO TO 819)
DON’T KNOW 10 (GO TO 819)

817B) Where was the IUD which you are using now inserted?

PUBLIC HOSPITAL 1
PUBLIC FP CLINIC 2
PRIVATE VOLUNTARY FP CLINIC 3
MCH CENTRE 4
PRIVATE DOCTOR/CLINIC 5
FIELD WORKER 6
MOBILE CLINIC 7
PHARMACY 8
OTHER 9 (GO TO 819)
DON’T KNOW 10 (GO TO 819)

817C) Where did you obtain the (METHOD)?

PUBLIC HOSPITAL 1
PUBLIC FP CLINIC 2
PRIVATE VOLUNTARY FP CLINIC 3
MCH CENTRE 4
PRIVATE DOCTOR/CLINIC 5
FIELD WORKER 6
MOBILE CLINIC 7
PHARMACY 8
OTHER 9 (GO TO 819)
DON’T KNOW 10 (GO TO 819)

817D) Where did the sterilization take place?

PUBLIC HOSPITAL 1
PUBLIC FP CLINIC 2
PRIVATE VOLUNTARY FP CLINIC 3
MCH CENTRE 4
PRIVATE DOCTOR/CLINIC 5
FIELD WORKER 6
MOBILE CLINIC 7
PHARMACY 8
OTHER 9 (GO TO 819)
DON’T KNOW 10 (GO TO 819)

818A) How much time does it take to go to this place?

MINUTES____

818) Was there anything you particularly disliked about the services you (your husband) received from that source? IF "YES": What? RECORD MAIN REASON

WAIT TOO LONG 1
STAFF DISCOURTEOUS 2
TOO EXPENSIVE 3
DESIRED METHOD UNAVAILABLE 4
OTHER (SPECIFY)____ 5
NO COMPLAINTS 6

819) CHECK 803

NEITHER STERILIZED 1
HE/SHE STERILIZED 2 (GO TO 835)

820) For how long have you been using (CURRENT METHOD) continuously?

DURATION IN MONTHS____
DURATION IN YEARS____

821) Have you experienced any problems from using (CURRENT METHOD)?

YES 1
NO 2 (GO TO 833)

822) What is the main problem you experienced?

HEALTH CONCERNS 1 (GO TO 833)
METHOD FAILED 2 (GO TO 833)
HUSBAND DISAPPROVED 3 (GO TO 833)
ACCESS/AVAILABILITY 4 (GO TO 833)
COSTS TOO MUCH 5 (GO TO 833)
INCONVENIENT TO USE 6 (GO TO 833)
OTHER (SPECIFY)____ 7 (GO TO 833)
DON’T KNOW 8 (GO TO 833)

823) Which was the last method of family planning you used?

PILL 1
IUD 2
INJECTIONS 3
DIAPHRAGM/FOAM/JELLY 4
CONDOM 5
FEMALE STERILIZATION 6
MALE STERILIZATION 7
SAFE PERIOD 8
WITHDRAWAL 9
BREASTFEEDING 10
OTHER (SPECIFY)____ 11

824) CHECK 201

CURRENTLY MARRIED 1
NOT CURRENTLY MARRIED 2 (GO TO 835)

825) Do you intend to use a method of family planning at any time in the future?

YES 1
NO 2 (GO TO 828)

826) Which method would you prefer to use?

PILL 1
IUD 2
INJECTIONS 3
DIAPHRAGM/FOAM/JELLY 4
CONDOM 5
FEMALE STERILIZATION 6
MALE STERILIZATION 7
SAFE PERIOD 8
WITHDRAWAL 9
BREASTFEEDING 10
OTHER (SPECIFY)____ 11
DON’T KNOW 90

827) When do you plan to begin using (METHOD)?

WITHIN 12 MONTHS 1 (GO TO 829)
FROM 1 TO 2 YEARS 2 (GO TO 829)
THREE YEARS OR MORE 3 (GO TO 829)
UNDECIDED 4 (GO TO 829)

828) What is the main reason that you do not want to use a method of family planning?

RELIGIOUS PROHIBITIONS 1
OPPOSED TO FP 2
HUSBAND DISAPPROVES 3 (GO TO 831)
OTHER RELATIVES DISAPPROVE 4
SIDE EFFECTS 5
LACK OF KNOWLEDGE 6
DIFFICULT TO OBTAIN 7
COSTS TOO MUCH 8
INCONVENIENT TO USE 9
FATALISTIC 10
MENOPAUSAL/SUBFECUND 11
OTHER (SPECIFY)____ 12
UNSURE/DON’T KNOW 13

829) Have you ever talked with your husband about family planning?

YES 1
NO 2

830) In your opinion, in general, does your husband approve or disapprove of couples using a method of family planning?

APPROVES 1
CONDITIONALLY APPROVES 2
DISAPPROVES 3
DON’T KNOW 4

831) CHECK 325

PREGNANT 1
NOT PREGNANT/UNSURE 2 (GO TO 833)

832) After the child you are expecting, would you like to have another child or would you prefer not to have any more children?

HAVE ANOTHER 1 (GO TO 835)
NO MORE 2 (GO TO 835)
UNDECIDED/DON’T KNOW 3 (GO TO 835)

833) Would you like to have a/another child or would you prefer not to have any (more) children?

HAVE ANOTHER 1
NO MORE 2 (GO TO 835)
CANNOT GET PREGNANT 3 (GO TO 835)
UNDECIDED/DON’T KNOW 4 (GO TO 835)

834) Would you prefer your next child to be a boy or a girl?

BOY 1
GIRL 2
EITHER 3
OTHER (SPECIFY)____ 4

835) CHECK 303 AND 305

NO LIVING CHILDREN 1
HAS LIVING CHILDREN 2 (GO TO 837)

836) If you could choose exactly the number of children to have in your whole life, how many would that be?

NUMBER____ (GO TO 838)
OTHER (SPECIFY)____ 96 (GO TO 838)

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

NUMBER____
OTHER (SPECIFY)____ 96

838) CHECK 201

CURRENTLY MARRIED 1
NOT CURRENTLY MARRIED 2 (GO TO 840)

839) If your husband could choose exactly the number of children for you to have, without regard to the number of children that you already have, how many do you think that would be?

NUMBER____
OTHER (SPECIFY)____ 96

840) In your opinion, what level of education would you like (your daughter/a girl) to obtain?

NONE 1
READ AND WRITE 2
PRIMARY 3
PREPARATORY 4
SECONDARY 5
UNIVERSITY 6

841) In your opinion, what level of education would you like (your son/a boy) to obtain?

NONE 1
READ AND WRITE 2
PRIMARY 3
PREPARATORY 4
SECONDARY 5
UNIVERSITY 6

842) In your opinion, what is the most suitable age for (your daughter/a girl) have?

NUMBER____
OTHER (SPECIFY)____ 96

843) In your opinion, how many children should (your daughter/a girl) have?

NUMBER____
OTHER (SPECIFY)____ 96

844) Would you approve or disapprove of your daughter(s) (girls) working if a good opportunity for earning cash were available?

APPROVE 1
CONDITIONALLY APPROVE 2
DISAPPROVE 3

845) Do you approve or disapprove of female circumcision?

APPROVE 1
DISAPPROVE 2 (GO TO 847)
UNDECIDED 3 (GO TO 901)

846) Why is that? CIRCLE THE MOST IMPORTANT REASON

RELIGIOUS BELIEFS 1 (GO TO 901)
NORMAL PRACTICE HERE 2 (GO TO 901)
GOOD FOR THE GIRL 3 (GO TO 901)
HUSBAND’S DESIRE 4 (GO TO 901)
OTHER (SPECIFY)____ 5 (GO TO 901)

847) What is the main reason for that?

NOT GOOD FOR THE GIRL 1
HUSBAND’S DESIRE 2
OTHER (SPECIFY)____ 3

SECTION 9. HUSBAND’S RESOURCES

901) How I would like to ask some questions about your (last/late) husband. Did he ever attend school?

YES 1
NO 2 (GO TO 905)
DON’T KNOW 3 (GO TO 905)

902) What was the highest level of education he attended?

PRIMARY 1
PREPARATORY 2
SECONDARY 3
POSTSECONDARY 4
UNIVERSITY 5
DON’T KNOW 6 (GO TO 905)

903) What was the highest grade (year) he completed at that level?

GRADE____
DON’T KNOW 98

904) CHECK 902 AND 903

LESS THAN 4 YEARS OF PRIMARY 1
FOUR YEARS OF PRIMARY OR MORE 2 (GO TO 907)

905) Can (could) he write a letter, for example?

YES 1
NO 2 (GO TO 907)
DON’T KNOW 8 (GO TO 907)

906) Can (could) he write a letter, for example?

YES 1
NO 2
DON’T KNOW 3

907) What is (was) his occupation; that is, what kind of work does (did) he mainly do?

OCCUPATION____

908) CHECK 907

IN AGRICULTURE 1
NOT IN AGRICULTURE 2 (GO TO 911)

909) Does (did) your husband work mainly on his or family land, or on someone else’s land?

HIS/FAMILY LAND 1 (GO TO 912)
SOMEONE ELSE’S LAND 2

910) Does (did) he work mainly for money or does (did) he work for a share of the crops?

MONEY 1 (GO TO 912)
A SHARE OF CROPS 2 (GO TO 912)
BOTH 3 (GO TO 912)

911) Does (did) he earn a regular wage or salary?

YES 1
NO 2
DON’T KNOW 3

912) CHECK 201

CURRENTLY MARRIED 1
NOT CURRENTLY MARRIED 2 (END)

913) Does your husband have any additional or secondary job? IF ‘YES’: What does he do?

SECONDARY JOB____
NO 96
DON’T KNOW 98

914) How old is your husband now?

AGE____
DON’T KNOW 98

915) Has your husband been living with you here continuously during the last three months or has he been away?

LIVING AT HOME 1 (END)
AWAY 2

916) What is the reason for his absence?

WORKING ELSEWHERE INSIDE THE COUNTRY 1 (GO TO 918)
WORKING ABROAD 2
SEPARATED 3 (GO TO 918)
OTHER (SPECIFY)____ 4 (GO TO 918)

917) In what country does he work now?

COUNTRY____

918) For how long has he been away?

MONTHS____
YEARS____

INTERVIEWER’S OBSERVATIONS

A) DEGREE OF COOPERATION

POOR 1
FAIR 2
GOOD 3
VERY GOOD 4

B) PRIVACY OF INTERVIEW

NO OTHERS PRESENT 1
OTHERS PRESENT DURING PART OF THE INTERVIEW 2
OTHERS PRESENT DURING ALL OF THE INTERVIEW 3

C) IF "OTHERS" PRESENT: MARK WHETHER ANY OF THE FOLLOWING WERE PRESENT DURING THE INTERVIEW

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

CHILD HEALTH QUESITONNAIRE

CHECK "HOUSEHOLD ROSTER" AND ENTER NAME OF ALL CHILDREN UNDER FIVE YEARS OF AGE, STARTING WITH THE YOUNGEST.

100) LINE NUMBER OF CHILD IN "HOUSEHOLD SCHEDULE"

LINE NUMBER____

101) AGE OF CHILD

AGE IN MONTHS____
AGE IN YEARS____

102) LINE NUMBER OF MOTHER IN "HOUSEHOLD SCHEDULE"

LINE NUMBER____
DECEASED 97
NOT A MEMBER OF HOUSEHOLD 96

103) LINE NUMBER OF CHILD IN "BIRTH HISTORY"

LINE NUMBER____
NOT APPLICABLE 95

104) NUMBER OF VISITS AND RESULT* OF INTERVIEW (SEE PRECEDING PAGE FOR CODES

NUMBER OF VISITS____
COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY)____ 6

105) LINE NUMBER OF PERSON ANSWERING THIS QUESTIONNAIRE FROM THE HOUSEHOLD SCHEDULE

LINE NUMBER____

106) Who is primarily responsible for the care of (NAME)?

MOTHER 1 (GO TO 108)
STEP MOTHER 2
FATHER 3
AUNT 4
GRANDMOTHER 5
SISTER 6
OTHER (SPECIFY)____ 7

107) LINE NUMBER OF CARETAKER

LINE NUMBER____
NOT A MEMBER OF HOUSEHOLD 96

108) Do you (Does caretaker) give the care of (NAME) to another person when you leave home for an extended period, either for work, visiting shopping, or other reasons?

YES 1
NO, ALWAYS TAKE CHILD WITH ME 2 (GO TO 112)
NO, DO NOT GO OUT 3 (GO TO 112)

109) With whom do you leave (NAME)? RECORD ALL PERSONS MENTIONED AND ENTER LINE NUMBER OF EACH PERSON MENTIONED AS SHOW ON HOUSEHOLD ROSTER. IF PERSON MENTIONED NOT MEMBER OF HOUSEHOLD, CIRCLE 96.

SISTER____
AUNT____
GRANDMOTHER____
NANNY____
CHILD CARE GROUP 96
OTHER (SPECIFY)____

110) SEE 109 AUNT/GRANDMOTHER MENTIONED AND LINE NUMBER OF EITHER OR BOTH IS 96

YES
NO (GO TO 112)

111) Where does (do) aunt (and/or grandmother) live?

IN SAME BUILDING OR COURTYARD 1
NEARBY 2
ANOTHER PART OF THE VILLAGE OR CITY 3

112) Does the father of (NAME) play regularly with him/her, say, for a half-hour or more? IF IN HOUSEHOLD SCHEDULE 106, FATHER IS DECEASED, THEN DON’T ASK THE QUESTION, CIRCLE CODE 6.

NO, NOT AT HOME 1 (GO TO NEXT CHILD)
NO, WORKS UNTIL LATE 2 (GO TO NEXT CHILD)
NO, RARELY OR NEVER 3 (GO TO NEXT CHILD)
YES, SOMETIMES 4 (GO TO NEXT CHILD)
YES, ALMOST EVERY DAY 5 (GO TO NEXT CHILD)
FATHER DECEASED 6 (GO TO NEXT CHILD)

SECTION 2. MORBIDITY: DIARRHEA

201) Now I would like to ask some questions about any illnesses your children might have had recently. Has (NAME) had diarrhea in the last 24 hours?

YES 1 (GO TO 204)
NO 2

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

YES 1
NO 2 (GO TO NEXT CHILD)
DON’T KNOW 3 (GO TO NEXT CHILD)

203) For how many days did the last episode of diarrhea last?

DAYS____ (GO TO 205)
DON’T KNOW 98 (GO TO 205)

204) How many days ago did the diarrhea start?

DAYS____
DON’T KNOW 98

205) Was (is) the diarrhea mild or sever?

WILD 1
SEVERE 2
DON’T KNOW 3

206) During this (the last) episode of diarrhea, how many liquid stools did (NAME) have on worst day?

NUMBER____
DON’T KNOW 98

207) Was there blood and/or mucus in the stools?

YES 1
NO 2
DON’T KNOW3

208) Did (NAME) also have fever?

YES 1
NO 2
DON’T KNOW 3

209) Did he/she experience vomiting?

YES 1
NO 2
DON’T KNOW 3

210) Did he/she also experience dehydration?

YES 1
NO 2
DON’T KNOW 3

211) When (NAME) had diarrhea then, was he/she given more, less, or the same amount of liquid as before the diarrhea?

MORE 1
LESS 2
SAME 3
DON’T KNOW 4

212) Was (NAME) given either a home solution of sugar, salt, and water to drink, or a solution made from an ORS packet? IF "YES": Which?

HOME SOLUTION OF SUGAR, SALT, AND WATER 1
ORS PACKET SOLUTION PREPARED AT HOME 2
BOTH GIVEN 3
NEITHER GIVEN 4 (GO TO 215)

213) For how many days was (NAME) given (home solution/special packet)?

DAYS____
LESS THAN 24 HOURS 00
DON’T KNOW 98

214) The last time (NAME) was given (home solution/special packet), did he/she get better, worse, or was there no change?

215) Was (NAME) given more, less, or the same amount of solid food as was given before he/she had diarrhea?

MORE 1
LESS 2
SAME 3
SOLID FOOD WAS NOT GIVEN 4
DON’T KNOW 5

216) Was (NAME) taken to any of the following persons or places during the last episode of diarrhea?

PUBLIC HEALTH SERVICE
YES 1
NO 2
DON’T KNOW 3
COOPERATIVE HEALTH SERVICE
YES 1
NO 2
DON’T KNOW 3
PRIVATE DOCTOR
YES 1
NO 2
DON’T KNOW 3
PHARMACY
YES 1
NO 2
DON’T KNOW 3
TRADITIONAL MIDWIFE
YES 1
NO 2
DON’T KNOW 3
TRADITIONAL HERBALIST
YES 1
NO 2
DON’T KNOW 3
ANYONE ELSE
YES 1
NO 2
DON’T KNOW 3

217) CHECK 216

AT LEAST ONE YES TO 216
NOT A SINGLE YES TO 216 (GO TO 219)

218) What treatment did (NAME) receive there in the last visit? CIRCLE ALL TREATMENTS MENTIONED

INTRAVENOUS 1 (GO TO 201 FOR NEXT CHILD)
OTHER INJECTION 2 (GO TO 201 FOR NEXT CHILD)
TABLETS OR PILLS 3 (GO TO 201 FOR NEXT CHILD)
SYRUPS 4 (GO TO 201 FOR NEXT CHILD)
ORS 5 (GO TO 201 FOR NEXT CHILD)
OTHER (SPECIFY)____ 6 (GO TO 201 FOR NEXT CHILD)
NOTHING GIVEN 7 (GO TO 201 FOR NEXT CHILD)
DON’T KNOW 8 (GO TO 201 FOR NEXT CHILD)

219) Why was (NAME) not taken somewhere for treatment during the last episode of diarrhea? RECORD MAIN REASON

ILLNESS WAS MILD 1 (GO TO 201 FOR NEXT CHILD)
MOTHER TOO BUSY 2 (GO TO 201 FOR NEXT CHILD)
NO FACILITIES OR PERSON TO CONSULT 3 (GO TO 201 FOR NEXT CHILD)
OTHER (SPECIFY)____ 4 (GO TO 201 FOR NEXT CHILD)

220) CHECK 212

ORS USED (GO TO 222)
ORS NOT USED/NO DIARRHEA

221) Have you ever heard of a special product called ORS (LOCAL NAME) you can get for the treatment of diarrhea?

YES 1
NO 2 (GO TO 301)

222) Have you ever prepared one of the ORS packets for yourself or for someone else?

YES 1
NO 2 (GO TO 225)

223) The last time you used ORS, how much water did you use to prepare the packet?

ONE HALF LITRE 1
ONE LITRE 2
ONE AND ONE HALF LITRE 3
TWO LITRES 4
OTHER (SPECIFY)____ 5
DON’T KNOW 6

224) Did you use boiled water, bottled water, or other water to prepare the packet (the last time)?

BOILED WATER 1
BOTTLED WATER 2
OTHER (SPECIFY)____ 3
DON’T KNOW 4

225) Where can you get ORS packets? MARK ALL ANSWERS GIVEN

PUBLIC HEALTH ESTABLISHMENT 1
COOPERATIVE HEALTH ESTABLISHMENT 2
FIELD WORKER 3
PRIVATE DOCTOR/HOSPITAL 4
PHARMACY 5
SHOP 6
DAYA 7
OTHER (SPECIFY)____ 8
DON’T KNOW 9

226) How much do (you think) the packets cost?

COST____
FREE 996
DON’T KNOW 998

SECTION 3. MORBIDITY: OTHER ILLNESS

301) Did (NAME) have a cough at any time during the last two weeks?

YES 1
NO 2 (GO TO 306)
DON’T KNOW 3 (GO TO 306)

302) For how many days did he/she have the cough the last time?

NUMBER OF DAYS____
DON’T KNOW 98

303) Did (NAME) also experience difficulty in breathing when he/she had the cough?

YES 1
NO 2
DON’T KNOW 3

304) How was (NAME) treated from the cough or shortness of breath? CIRCLE ALL TREATMENTS MENTIONED.

COUGH MIXTURE 1
TABLETS 2
ANTIBIOTIC (CAPSULE/SYRUP) 3
INJECTION 4
OTHER (SPECIFY)____ 5
NOTHING 6
DON’T KNOW 7

305) Was the advice of the following persons sought on how to treat the cough? READ OUT LIST

PUBLIC HEALTH SERVICE
YES 1
NO 2
DON’T KNOW 3
COOPERATIVE HEALTH SERVICE
YES 1
NO 2
DON’T KNOW 3
PRIVATE DOCTOR
YES 1
NO 2
DON’T KNOW 3
PHARMACY
YES 1
NO 2
DON’T KNOW 3
TRADITIONAL MIDWIFE
YES 1
NO 2
DON’T KNOW 3
TRADITIONAL HERBALIST
YES 1
NO 2
DON’T KNOW 3
RELATIVES/FRIENDS
YES 1
NO 2
DON’T KNOW 3
ANYONE ELSE (SPECIFY)____
YES 1
NO 2
DON’T KNOW 3

306) Did (NAME) have fever at any time during the last two weeks?

YES 1
NO 2 (GO TO 309)
DON’T KNOW 3 (GO TO 309)

307) How was (NAME) treated from the fever? CIRCLE ALL TREATMENTS MENTIONED

ASPIRIN 1
ANTI-MALARIAL TABLETS 2
ANTIBIOTIC (CAPSULE/SYRUP) 3
OTHER SYRUP/MIXTURE 4
INJECTION 5
SUPPOSITORY 6
COLD WATER APPLICATIONS 7
OTHER (SPECIFY)____ 8
NOTHING 9
DON’T KNOW 10

308) Was the advice of any of the following sought on how to treat his/her from the fever? READ OUT LIST

PUBLIC HEALTH SERVICE
YES 1
NO 2
DON’T KNOW 3
PRIVATE DOCTOR
YES 1
NO 2
DON’T KNOW 3
PHARMACY
YES 1
NO 2
DON’T KNOW 3
TRADITIONAL MIDWIFE
YES 1
NO 2
DON’T KNOW 3
TRADITIONAL HERBALIST
YES 1
NO 2
DON’T KNOW 3
RELATIVES/FRIENDS
YES 1
NO 2
DON’T KNOW 3
ANYONE ELSE (SPECIFY)____
YES 1
NO 2
DON’T KNOW 3

309) Did he/she have pus coming from his/her ears during the last two weeks?

YES 1
NO 2
DON’T KNOW 3

310) Did he/she have pus coming from his/her eyes during the last two weeks?

YES 1
NO 2
DON’T KNOW 3

311) Did (NAME) have any (other) illness during the last two weeks?

YES 1
NO 2 (GO TO 313)
DON’T KNOW 3 (GO TO 313)

312) hat was this illness?

ILLNESS/SYMPTOMS
YOUNGEST CHILD____
NEXT TO YOUNGEST____
SECOND TO YOUNGEST____
THIRD TO YOUNGEST____

313) Did (NAME) ever have the measles?

YES 1
NO 2 (GO TO NEXT CHILD)
DON’T KNOW 3 (GO TO NEXT CHILD)

314) How old was (NAME) when he/she had the measles?

AGE (IN YEARS)____ (GO TO NEXT CHILD)
DON’T KNOW 8 (GO TO NEXT CHILD)

SECTION 4: IMMUNIZATION

401) Is there an immunization card (or local equivalent) for (NAME)? IF "YES": May I see it please?

YES, SEEN 1
YES, NOT SEEN 2 (GO TO 403)
NO 3 (GO TO 403)
DON’T KNOW 4 (GO TO 403)

402) RECORD DATES OF IMMUNIZATIONS FROM CARD. IF ALL DATES GIVEN, GO TO NEXT CHILD ELSE GO TO 403

BCG
NOT GIVEN 1
DAY____
MONTH____
YEAR____
POLIO 1
NOT GIVEN 1
DAY____
MONTH____
YEAR____
POLIO 2
NOT GIVEN 1
DAY____
MONTH____
YEAR____
POLIO 3
NOT GIVEN 1
DAY____
MONTH____
YEAR____
DPT 1
NOT GIVEN 1
DAY____
MONTH____
YEAR____
DPT 2
NOT GIVEN 1
DAY____
MONTH____
YEAR____
DPT 3
NOT GIVEN 1
DAY____
MONTH____
YEAR____
MEASLES
NOT GIVEN 1
DAY____
MONTH____
YEAR____

403) Has (NAME) ever been given any "vaccination drops" in the mouth to protect him/her against illness?

YES 1
NO 2 (GO TO 405)
DON’T KNOW 3 (GO TO 405)

404) How many times has (NAME) been given these drops?

NUMBER____
DON’T KNOW 8

405) Has (NAME) ever been given "vaccination injections" to protect him/her from getting diseases?

YES 1
NO 2
DON’T KNOW 3

406) SEE 402, 403, AND 405

CHILD NOT IMMUNIZED OR NOT FULLY IMMUNIZED
CHILD IMMUNIZED (403 IS 1 AND 405 IS 1) (GO TO NEXT CHILD)

407) Why was (NAME) not (fully) immunized?

CHILD TOO YOUNG 1 (GO TO 401 FOR NEXT CHILD)
UNAWARE OF NEED FOR IMMUNIZATION 2 (GO TO 401 FOR NEXT CHILD)
UNAWARE OF NEED TO RETURN FOR OTHER DOSES 3 (GO TO 401 FOR NEXT CHILD)
PLACE/TIME OF IMMUNIZATION NOT KNOWN 4 (GO TO 401 FOR NEXT CHILD)
FEAR OF SIDE REACTIONS 5 (GO TO 401 FOR NEXT CHILD)
INTENDS TO GO 6 (GO TO 401 FOR NEXT CHILD)
CHILD ILL 7 (GO TO 401 FOR NEXT CHILD)
VACCINE NOT AVAILABLE 8 (GO TO 401 FOR NEXT CHILD)
PLACE FAR AWAY 9 (GO TO 401 FOR NEXT CHILD)
BAD TREATMENT 10 (GO TO 401 FOR NEXT CHILD)
OTHER (SPECIFY)____ 11 (GO TO 401 FOR NEXT CHILD)

SECTION 5. ACCIDENTS

501) Has (NAME) ever been involved in a serious accident?

YES 1
NO 2 (GO TO NEXT CHILD)

502) When did this accident happen?

DURING LAST 12 MONTHS 1
MORE THAN 12 MONTHS AGO 2

503) What was this accident?

WOUND 1
BURN 2
FRACTURE/SPRAIN 3
POISONING 4
OTHER (SPECIFY)____ 5

504) What was the external cause of this accident?

YOUNGEST CHILD____
NEXT TO YOUNGEST____
SECOND TO YOUNGEST____
THIRD TO YOUNGEST____

505) Where did this accident happen to (NAME)?

INSIDE THE HOUSE 1
JUST OUTSIDE THE HOUSE 2
OTHER (SPECIFY)____ 3

506) Was there any long-term implication resulting from the accident?

YES 1
NO 2 (GO TO NEXT CHILD)

507) What was it?

YOUNGEST CHILD____
NEXT TO YOUNGEST____
SECOND TO YOUNGEST____
THIRD TO YOUNGEST____

SECTION 6. WEIGHT AND HEIGHT

601) WEIGHT (IN KILOGRAMS)

WEIGHT____

602) LENGTH/HEIGHT (IN CENTIMETERS)

LENGTH/HEIGHT____

603) STATE REASON IF UNABLE TO RECORD

REASON____

604) TIME

HOUR____
MINUTES_____