REPUBLIC OF YEMEN
MINISTRY OF PUBLIC HEALTH AND POPULATION
CENTRAL STATISTICAL ORGANIZATION
NATIONAL HEALTH AND DEMOGRAPHIC SURVEY 2013
GOVERNORATE____
DIRECTORATE NAME____
SUB-DIRECTORATE NAME____
URBAN OR RURAL:
RURAL 2
SECTOR NUMBER____
SECTION NUMBER____
CLUSTER NUMBER____
HOUSEHOLD NUMBER____
HOUSEHOLD CLUSTER NUMBER____
NAME OF HOUSEHOLD HEAD____
FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT*
NEXT VISIT:
DATE
TIME
THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT*
FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT*
TOTAL NUMBER OF VISITS
*RESULT CODES
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ____
FIELD EDITOR
NAME
SIGNATURE
DATE
CODE
SUPERVISOR
NAME
SIGNATURE
DATE
CODE
OFFICE EDITOR
NAME
SIGNATURE
DATE
CODE
KEYER
NAME
SIGNATURE
DATE
CODE
INFORMED CONSENT
Hello. My name is (INTERVIEWER'S NAME). I am working on the National Health and Demographic Survey which is implemented (by the Ministry of Public Health and Population and the Central Statistical Organization). We are conducting a survey about health all over Yemen. The information we collect will help the government to plan health services. Your household was selected for the survey. All of the answers you give will be confidential under Article (5) of the Statistics Law No. (28) for the year 1995 and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
Do you have any questions? 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.
MINUTES____
102) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
103) How old were you on your last birthday? COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.
104) Have you ever attended school?
NO 2 (GO TO 108)
105) What is the highest level of school you attended: primary, fundamental (preparatory, unified), diploma before secondary, secondary, diploma after secondary, or university/higher?
FUNDAMENTAL (PREPARATORY, UNIFIED) 2
DIPLOMA BEFORE SECONDARY 3
SECONDARY 4
DIPLOMA AFTER SECONDARY 5
UNIVERSITY/HIGHER 6
106) What is the highest (grade/year) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
OTHER LEVELS (GO TO 110)
108) Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ THE WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
BLIND/VISUALLY IMPAIRED 4
CODE '1' OR '4' CIRCLED (GO TO 111)
110) Do you read a newspaper or magazine every day, at least once a week, or not at all?
AT LEAST ONCE A WEEK 2
NOT AT ALL 3
111) Do you listen to the radio every day, at least once a week, or not at all?
AT LEAST ONCE A WEEK 2
NOT AT ALL 3
112) Do you watch television every day, at least once a week, or not at all?
AT LEAST ONCE A WEEK 2
NOT AT ALL 3
112A) Are you currently married?
NO, NOT MARRIED
112B) What is your marital status now: are you widowed or divorced?
DIVORCED 2
112C) Have you been married only once or more than once?
MORE THAN ONCE 2
DON'T KNOW 98
DON'T KNOW YEAR 9998
DON'T KNOW 98
DON'T KNOW YEAR 9998
112E) How old were you when you started living with your (first) husband?
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202) Do you have any sons or daughters whom you have given birth who are now living with you?
NO 2 (GO TO 204)
203) How many sons live with you? And how many daughters live with you? IF NONE, RECORD '00'.
DAUGHTERS AT HOME____
204) Do you have any sons or daughters who are alive but do not live with you?
NO 2 (GO TO 206)
205) How many sons do not live with you? And how many daughters do not live with you? IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE____
206) Have you ever given birth to a boy or girl who was born alive but died later? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?
NO 2 (GO TO 208)
207) How many boys have died? And how many girls have died? IF NONE, RECORD '00'.
GIRLS DEAD____
208) SUM ANSWERS OF 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
209) CHECK 208: Just to make sure that I have this right: you have had in TOTAL ____ births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (GO TO 226)
211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS ON SEPARATE ROWS. IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, (STARTING WITH THE SECOND ROW AND CHANGE IT TO 13).
212) What name was given to your (first/next) baby?
213) Is (NAME) a boy or a girl?
GIRL 2
214) Is (NAME) single or twins?
MULT 2
215) In what month and year was (NAME) born? PROBE: When is his/her birthday?
YEAR____
NO 2 (GO TO 220)
IF ALIVE:
217) How old was (NAME) at his/her last birthday? RECORD AGE IN COMPLETED YEARS.
218) Is (NAME) living with you?
NO 2
219) RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
220) DEAD: How old was (NAME) when he/she died? IF '1 YR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN 2 YEARS, OR RECORD YEARS IF MORE THAN 2 YEARS.
MONTHS 2 ____
YEARS 3 ____
221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth? (NOT ASKED FOR FIRST BIRTH)
NO 2 (NEXT BIRTH)
222) Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)
224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER. IF NONE, CIRCLE COE (0) AND GO TO 226.
NONE 0 (GO TO 226)
225) FOR EACH BIRTH SINCE JANUARY 2008, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)
227) How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED PREGNANCY MONTHS.
228) When you got pregnant, did you want to get pregnant at that time?
NO 2
229) Did you want to have a baby later on or did you not any any (more) children?
NO MORE 2
230) Have you ever had a pregnancy that miscarried, was aborted, or ended in stillbirth?
NO 2 (GO TO 237A)
231) When was the last pregnancy that miscarried, was aborted, or ended in stillbirth?
YEAR ____
LAST PREGNANCY ENDED BEFORE JAN. 2008 (GO TO 237A)
233) How many months pregnant were you when the last such pregnancy ended? (pregnancy that miscarried, was aborted, or ended in stillbirth)
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
234) Since January 2008, have you had any other pregnancies that did not result in a live birth?
NO 2 (GO TO 236)
235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2008
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS FOR EACH PREGNANCY THAT MISCARRIED, WAS ABORTED, OR END IN STILLBIRTH.
236) Did you have any miscarriages, abortions, or stillbirths that ended before 2008?
NO 2 (GO TO 237A)
237) When did the last pregnancy that terminated before 2008 end?
YEAR ____
237A) How old were you when you had your first menstrual period?
238) When did your last menstrual period start?
WEEKS AGO 2 ____
MONTHS 3 ____
YEARS AGO4 ____
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
DIVORCED, WIDOWED (GO TO 311)
PREGNANT (GO TO 311)
303) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 311)
304) Which method are you using? CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION B
IUD C (GO TO 308A)
INJECTABLES D (GO TO 308A)
IMPLANTS E (GO TO 308A)
PILL F (GO TO 308A)
CONDOM G (GO TO 308A)
FEMALE CONDOM (GO TO 308A)
DIAPHRAGM I (GO TO 308A)
LACTATIONAL AMEN. METHOD J (GO TO 308A)
RHYTHM METHOD K (GO TO 308A)
WITHDRAWAL L (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)
307) In what facility did the sterilization take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER 12
PRIMARY HEALTH CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
NON GOVERNMENT ORGANIZATIONS PR. HOSPITAL/CENTER/CLINIC/MOBILE CLINIC 31
308) In what month and year was the sterilization performed?
YEAR ____
308A) Since what month and year have you been using (CURRENT METHOD) without stopping? PROBE: For how long have you been using (CURRENT METHOD) NOW WITHOUT STOPPING?
YEAR ____
309) CHECK 215, 231 AND 308/308A: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START USE OF CONTRACEPTION IN 308/308A
NO
YEAR IS 2007 OR EARLIER: ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE THE CALENDAR AND EACH MONTH BACK TO JANUARY 2008 (GO TO 314)
311) I would like to ask you some questions about the times you or your husband 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 2008. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS: When was the last time you used a method? Which method was that? When did you start using that method? How long after the birth of (NAME)? How long did you use the method then?
IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN (2) MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN (1).
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS: Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN (1).
312) CHECK THE CALENDAR (FOR INTERVIEWER: USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH?)
ANY METHOD USED (GO TO 314)
313) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 323A)
314) 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 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
LACTATIONAL AMEN. METHOD 10 (GO TO 315A)
RHYTHM METHOD 11 (GO TO 315A)
WITHDRAWAL 12 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)
315) You first started using (CURRENT METHOD) in (DATE FROM 3008/308A). 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 PLACE) ____
GOVT. HEALTH CENTER 12
PRIMARY HEALTH CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
PHARMACY 22
315A) Where did you learn how to use the rhythm/lactational amenorrhea method?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. (NAME OF PLACE) ____
GOVT. HEALTH CENTER 12
PRIMARY HEALTH CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
PHARMACY 22
316) CHECK 304: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
LACTATIONAL AMEN. METHOD 10 (GO TO 326)
RHYTHM METHOD 11 (GO TO 326)
317) At that time, were you told about side effects or problems you might have with the method?
NO 2
317A) When you got sterilized, were you told about side effects or problems you might have with the method?
NO 2
318) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (GO TO 320)
319) Were you told what to do if you experienced side effects or problems?
NO 2
NO 2
NO 2
321) Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
322) CHECK 304: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
LACTATIONAL AMEN. METHOD 10 (GO TO 326)
RHYTHM METHOD 11 (GO TO 326)
WITHDRAWAL 12 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)
323) Where did you obtain (CURRENT METHOD) the last time? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. (NAME OF PLACE)____
GOVT. HEALTH CENTER 12 (GO TO 326)
PRIMARY HEALTH CENTER 13 (GO TO 326)
FAMILY HEALTH CENTER 14 (GO TO 326)
MOBILE CLINIC (GO TO 15)
PHARMACY 22 (GO TO 326)
323A) What is the main reason for not using a method of family planning?
MENOPAUSAL/HYSTERECTOMY 22
SUBFECUND/INFECUND 23
WANTS (MORE) CHILDREN 24
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
COSTS TOO MUCH 52
LACK OF ACCESS/TOO FAR 53
324) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 326)
325) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
PHARMACY G
326) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?
NO 2
327) In the last 12 months, have you visited a health facility for care for yourself (or your children)?
NO 2 (GO TO 401)
328) Did any staff member at this health facility speak to you about family planning methods?
NO 2
SECTION 4. PREGNANCY AND POSTNATAL CARE
401) CHECK 224:
NO BIRTH IN 2008 OR LATER (GO TO 556)
402) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask some questions about your children born in the last five years. We will talk about each separately.
403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY
LIVING
DEAD
405) When you got pregnant with (NAME), did you want to get pregnant at that time?
NO 2
406) Did you want to have a baby later on, or did you not want any (more) children?
NO MORE 2 (GO TO 407A)
407) How much longer did you want to wait?
YEARS 2 ____
DON'T KNOW 998)
407A) During your pregnancy with (NAME), did you get any of the following symptoms:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
408) Did you see anyone for antenatal care for this pregnancy?
NO 2 (GO TO 415)
409) Whom did you see? Anyone else? PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
410) Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF (PUBLIC OR PRIVATE) SECTOR, WRITE THE NAME OF THE PLACE.
OTHER HOME B
GOVT. HOSPITAL C
GOVT. HEALTH CENTER D
PRIM. HEALTH CENTER E
FP. CLINIC F
MOBILE CLINIC G
411) How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
412) How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
413) As part of your antenatal care during this pregnancy, were any of the following done at least once:
NO 2
NO 2
NO 2
414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?
NO 2
DON'T KNOW 8
415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)
416) During this pregnancy, how many times did you get a tetanus injection?
DON'T KNOW 8
OTHER
418) At any time before this pregnancy, did you receive any tetanus injections?
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)
419) Before this pregnancy, how many times did you receive a tetanus injection? IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
420) How many years ago did you receive the last tetanus injection before this pregnancy?
DON'T KNOW 98
421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)
422) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
423) During this pregnancy, did you take any drugs for intestinal worms?
NO 2
DON'T KNOW 8
424) During this pregnancy, did you take any drugs for (SP/Fansidar)
NO 2
DON'T KNOW 8
430) When (NAME) was born, was he/she very large, larger than average, average, or smaller than average?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
DON'T KNOW 8
431) Was (NAME) weighed at birth?
NO 2 (GO TO 433)
DON'T KNOW 8 (GO TO 433)
432) How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KG FROM RECALL ____
DON'T KNOW 99998
433) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
GRANDMOTHER/TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER (SPECIFY)____ X
433A) During the birth of (NAME), did you get any of the following symptoms:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
434) Where did you give birth to (NAME)? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE THE SECTOR WRITE THE NAME OF THE PLACE.
OTHER HOME 12 (GO TO 437A)
GOVT. H. CENTER 22
PRIM. H. CENTER 23
FP. CLINIC 24
MOBILE CLINIC 25
435) Was (NAME) delivered by caesarean, that is, did they cut your belly open to take the baby out?
NO 2
435A) Before you left the health facility, did any health staff speak to you or advise you about family planning methods?
NO 2
436) After delivery of (NAME), did anyone check on your health while you were still in the facility?
NO 2
437) Did anyone check on your health after you left the facility?
NO 2 (GO TO 442)
437A) Why didn't you deliver in a health facility?
THE SERVICE NOT AVAILABLE B
THE SERVICE IS FAR C
COSTS TOO MUCH D
HUSBAND DID NOT ALLOW E
EMERGENCY LABOUR F
THE HEALTH PROVIDERS TREAT BADLY G
NO FEMALE PROVIDER AT FACILITY H
OTHER (SPECIFY) ____ X
438) After delivery of (NAME), did anyone check on your health?
NO 2 (GO TO 442)
439) Who checked on your health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
440) How long after delivery did the first check take place? IF LESS THAN ONE HOUR RECORD '00' IN 'HOURS'. IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 ____
WEEKS 3 ____
DON'T KNOW 998
442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)
443) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 ____
WEEKS 3 ____
DON'T KNOW 998
444) Who checked on (NAME)'s health at that time? PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
AUXILIARY MIDWIFE 13
445) Where did this first check of (NAME) take place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE THE SECTOR WRITE THE NAME OF PLACE.
OTHER HOME B
GOVT. HOSPITAL C
GOVT. H. CENTER D
PRIM. H. CENTER E
FP. CLINIC F
MOBILE CLINIC G
446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)? SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS.
NO 2
DON'T KNOW 8
447) Has your menstrual period returned since the birth of (NAME)?
NO 2 (GO TO 453)
448) Did your period return between the birth of (NAME) and your next pregnancy?
NO 2 (GO TO 453)
449) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
453) Did you ever breastfeed (NAME)?
NO 2
454) CHECK 404: IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 501)
455) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '000'. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.
HOURS 1 ____
DAYS 2 ____
456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
NO 2 (GO TO 458)
457) What was (NAME) given to drink? Anything else? RECORD ALL LIQUIDS MENTIONED.
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
COFFEE I
HONEY J
OTHER (SPECIFY)____ X
458) CHECK 404: IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)
459) Are you still breastfeeding (NAME)?
NO 2
460) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
461) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.
SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION
501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES). NOW, I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT YOUR CHILDREN WHO BORN SINCE 2008 OR LATER, WE WILL TALK ABOUT EACH SEPARATELY
502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY
503) FROM 212 AND 216: NAME AND SURVIVAL STATUS
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)
504) Do you have a vaccination card for (NAME)? IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 509)
NO CARD 3
505) Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 509)
506) COPY DATES FROM THE CARD. WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
MONTH____
YEAR____
OTHER
508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign? RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)
509) Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)
510A) Please tell me if (NAME) had any of the following vaccinations: A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
510B) Was (NAME) given a polio vaccine immediately after birth or during the first month?
NO 2 (GO TO 510E)
DON'T KNOW 8 (GO TO 510E)
510C) Was the polio vaccine given in the first two weeks after birth or later?
LATER 2
510D) How many times was the polio vaccine given?
510E) Please tell me if (NAME) had any of the following vaccinations: A PENTA vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?
NO 2 (GO TO 510G)
DON'T KNOW 8 (GO TO 510G)
510F) How many times was the PENTA vaccination given?
510G) Please tell me if (NAME) had any of the following vaccinations: A measles injection that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?
NO 2
DON'T KNOW 8
511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)? SHOW COMMON TYPES OF AMPOULES/CAPSULES/SYRUPS.
NO 2
DON'T KNOW 8
512) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
NO 2
DON'T KNOW 8
513) Was (NAME) given any drug for intestinal worms in the last six months?
NO 2
DON'T KNOW 8
514) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)
515) Was there any blood in the stools?
NO 2
DON'T KNOW 8
516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breast milk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
517) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NEVER GAVE FOOD 5
DON'T KNOW 8
518) Did you seek advice or treatment for the diarrhea from any source?
NO 2 (GO TO 522)
519) Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. H. CENTER B
PRIM. H. CENTER C
FP. CLINIC D
MOBILE CLINIC E
TRADITIONAL PRACTITIONER J
ONLY ONE CODE CIRCLED (GO TO 522)
521) Where did you first seek advice or treatment? USE LETTER CODE FROM 519.
522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
523) Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)
524) What (else) was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
NON-ANTIBIOTIC G
UNKNOWN INJECTION H
525) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (GO TO 527)
DON'T KNOW 8 (GO TO 527)
526) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?
NO 2
DON'T KNOW 8
527) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)
528) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)
529) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) ____ (GO TO 531)
DON'T KNOW 8 (GO TO 531)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
531) Now I would like to know how much (NAME) was given to drink (including breast milk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
533) Did you seek advice or treatment for the illness from any source?
NO 2 (GO TO 537)
534) Where did you seek advice or treatment? Anywhere else? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE THE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. H. CENTER B
PRIM. H. CENTER C
FP. CLINIC D
MOBILE CLINIC E
PHARMACY G
TRADITIONAL PRACTITIONER J
ONLY ONE CODE CIRCLED (GO TO 537)
536) Where did you first seek advice or treatment? USE LETTER CODE FROM 524.
537) At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO TO 552)
DON'T KNOW 8 (GO TO 552)
538) What drugs did (NAME) take? Any other drugs? RECORD ALL MENTIONED.
INJECTION C
ACETAMINOPHEN E
IBUPROFEN F
552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.
553) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2008 OR LATER LIVING WITH THE RESPONDENT
NONE (GO TO 556)
554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) ____ 96
555) CHECK 522(a) AND 522(b), ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (GO TO 557)
556) Have you ever heard of a special product called oral rehydration package or oral rehydration solution, you can get for the treatment of diarrhea?
NO 2
557) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2010 OR LATER LIVING WITH THE RESPONDENT
NONE (GO TO 561A)
558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods. Did (NAME FROM 557) (drink/eat):
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
559) CHECK 558 (CATEGORIES "g" THROUGH "w"):
AT LEAST ONE "YES" OR "DON'T KNOW" (GO TO 561)
560) Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? IF 'YES' PROVE: What kind of solid, semi-solid or soft foods did (NAME) eat?
NO 2 (GO TO 561A)
561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
561A) Now I would like to ask you about liquids or foods that you had yesterday during the day or at night. I am interested in whether you had the item I mention even if it was combined with other foods. Please don't mention spices such as hot pepper and herbs that are used in small amounts to improve food flavor, I will ask you specifically on this topic. Yesterday during the day or at night, did you drink/eat:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
DURING MEALS B
AFTER MEALS C
SECTION 7. FERTILITY PREFERENCES
701) CHECK 304:
HE OR SHE STERILIZED (GO TO 712)
NOT PREGNANT OR UNSURE (GO TO 704)
703) Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE 2 (GO TO 711)
DON'T KNOW/UNDECIDED 8 (GO TO 711)
704) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
DON'T KNOW/UNDECIDED 8 (GO TO 710)
YEARS 2 ____
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
OTHER (SPECIFY) ____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)
YEARS 2 ____
SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
OTHER (SPECIFY) ____ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)
PREGNANT (GO TO 711)
707) CHECK 303: USING A CONTRACEPTIVE METHOD
CURRENTLY USING (GO TO 712)
24 OR MORE MONTHS OR 02 OR MORE YEARS
00-23 MONTHS OR 00-01 YEAR (GO TO 711)
INFREQUENT SEX WITH HUSBAND C
MENOPAUSAL/HYSTERECTOMY D
CAN'T GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
HUSBAND OPPOSED J
OTHER OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
DON'T KNOW Z
710) CHECK 303: USING A CONTRACEPTIVE METHOD
NOT CURRENTLY USING
CURRENTLY USING (712)
711) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8
NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 714)
NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 714)
713) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?
NUMBER GIRLS ____
NUMBER EITHER ____
OTHER (SPECIFY) ____ 96
714) In the last few months have you:
NO 2
NO 2
NO 2
NO 2
NO 2
WIDOWED/DIVORCED (GO TO 801)
717) CHECK 303: USING A CONTRACEPTIVE METHOD
NOT CURRENTLY USING (GO TO 720)
718) Would you say that using contraception is mainly your decision mainly your husband's decision, or did you both decide together?
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER (SPECIFY) ____ 6
HE OR SHE STERILIZED (801)
720) Does your husband want the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK
801) CHECK 112A:
NOT CURRENTLY MARRIED (WINDOWED/DIVORCED) (GO TO 803)
801A) Is your husband living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
801B) RECORD THE HUSBAND'S NAME LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE, IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER____
801C) Does your husband have other wives?
NO 2 (GO TO 802)
DON'T KNOW 8 (GO TO 802)
801D) Including yourself, in total, how many wives does he have?
DON'T KNOW 8
801E) Are you the first, second, ? wife?
802) How old was your husband on his last birthday?
803) Did your (last) husband ever attend school?
NO 2 (GO TO 806)
804) What was the highest level of school he attended: primary, fundamental (preparatory, unified), diploma before secondary, secondary, diploma after secondary, or university/higher?
FUNDAMENTAL (PREPARATORY, UNIFIED) 2
DIPLOMA BEFORE SECONDARY 3
SECONDARY 4
DIPLOMA AFTER SECONDARY 5
UNIVERSITY/HIGHER 6
DON'T KNOW 8 (GO TO 806)
805) What was the highest (grade/form/year) he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
DON'T KNOW 98
807) Aside from your own housework, have you done any work in the last seven days?
NO 2
808) As you know, some women take up jobs for which they are paid in cash or kind. Others have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?
NO 2
809) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, or any other such reason?
NO 2
810) Have you done any work in the last 12 months?
NO 2 (GO TO 815)
811) What is your occupation, that is, what kind of work do you mainly do?
812) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
OTHER (SPECIFY) ____ 6
813) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY 2
ONCE IN A WHILE 3
814) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT CURRENTLY MARRIED (WIDOWED/DIVORCED) (GO TO 901)
OTHER (GO TO 819)
817) Who usually decides how the money you earn will be used: you, your husband, or you and your husband jointly?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER (SPECIFY) ____ 6
818) Would you say that the money that you earn is more than what your husband earns, less than what he earns, or about the same?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND HAS NO EARNINGS 4 (GO TO 820)
DON'T KNOW/NOT APPLICABLE 8
819) Who usually decides how your husband's earnings will be used: you, your husband, or you and your husband jointly?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND HAS NO EARNINGS 4
OTHER (SPECIFY) ____ 6
820) Who usually makes decisions about health care for yourself: you, your husband, you and your husband jointly, or someone else?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____ 6
821) Who usually makes decisions about making major household purchases?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
SOMEONE ESE 4
OTHER (SPECIFY) ____ 6
901) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 937)
902) From your point of view, how AIDS is transmitted:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
903) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
906) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
907) Can the virus that causes AIDS be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (GO TO 930)
910) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
930) Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 932)
931) Where is that? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF THE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
932) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
933) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE 8
934) If a member of your family got infected with the AIDS virus, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE 8
935) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE 8
NO 2
NO 2
940) Now I would like to ask you some questions about your health. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW/NOT SURE 8
941) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?
NO 2
DON'T KNOW/NOT SURE 8
942) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW/NOT SURE 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 946)
944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?
NO 2
945) Where did you go? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF THE SECTOR, WRITE THE NAME OF THE PLACE
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
946) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
SECTION 10. OTHER HEALTH ISSUES
1001) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months? IF YES: How many injections have you had? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1008)
1002) 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-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1008)
1003) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1008) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
1009) Are you covered by any health insurance?
NO 2 (GO TO 1011)
1010) What type of health insurance are you covered by? PROBE: Any other health insurance? RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) ____ X
1011) FISTULA: This series of questions is designed to obtain information on another health problem that affects women. Difficult vaginal delivery can lead to urine and fecal incontinence. This problem usually occurs after a difficult childbirth, but may also be the result of rape or pelvic surgery. Women with this problem are often subject o social discrimination. The following questions relate to women's knowledge of the problem and the reasons for the treatment.
Have you ever heard of this problem of which the woman experiences a constant leakage of urine or stool from the vagina during the day and night?
NO 2 (GO TO 1012A)
1012) Do you suffer or did you suffer from this problem?
NO 2 (GO TO 1018)
DON'T KNOW 8 (GO TO 1018)
1012A) Sometimes some ladies suffer from the constant leakage of urine or stool from your vagina during the day and night as a result of a difficult birth or surgery and this is called fistula. Do you suffer or did you suffer from this problem?
NO 2 (GO O 1018)
DON'T KNOW 8 (GO TO 1018)
1013) Did this problem start after a normal delivery, a caesarean delivery, or after an operation or after anything else?
AFTER CAESAREAN BIRTH 2
AFTER AN OPERATION 3
OTHER (SPECIFY) ____ 6
1014) Have you sought treatment for this condition?
NO 2
1015) Why have you not sought treatment?
TOO EXPENSIVE 2 (GO TO 1018)
TOO FAR 3 (GO TO 1018)
EMBARRASSMENT 4 (GO TO 1018)
POOR QUALITY OF CARE 5 (GO TO 1018)
OTHER (SPECIFY)____ 6 (GO TO 1018)
1016) From whom did you last seek treatment?
NURSE/MIDWIFE 2
OTHER (SPECIFY) ____ 6
1017) Did your health improve after treatment?
PARTIALLY RECUPERATED 2
NO. DIDN'T IMPROVE 3
1018) Did you get any type of tumors?
NO 2 (GO TO 1101)
1019) When did you find out that you had a tumor?
RECORD THE YEAR AND THE MONTH IF DON'T KNOW MONTH CIRCLE 98
DON'T KNOW MONTH 98
YEAR____
1020) Who discovered your tumor?
NURSE/MIDWIFE 2
OTHER (SPECIFY)____ 6
1021) In what part of your body did the tumor develop? RECORD IN WHICH PART OF THE BODY THE TUMOR EXIST.
1022) Have you sought treatment for this condition?
NO 2
1023) Why have you not sought treatment?
TOO EXPENSIVE B
TOO FAR C
OTHER (SPECIFY)____ X
1024) Did you have a biopsy or an ultrasound done to determine the type of tumor?
NO 2 (GO TO 1026)
1025) What was the result of the biopsy or the ultrasound?
MALIGNANT TUMOR 2
OTHER (SPECIFY)____ 6
1026) Do you currently receive or did you receive in the past treatment for the malignant tumor (CANCER)?
YES IN THE PAST 2
NO 3
OTHER (SPECIFY)____ 6
SECTION 11: FEMALE CIRCUMCISION
1101) Have you ever heard of female circumcision?
NO 2
1102) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?
NO 2 (GO TO 1201)
1103) Have you yourself ever been circumcised?
NO 2 (GO TO 1109)
1104) Was any flesh removed from your genital area?
NO 2
DON'T KNOW 8
1107) How old were you when you were circumcised? IF THE RESPONDENT DOES NOT KNOW THE EXACT AGE, PROVE TO GET AN ESTIMATE
DURING FIRST WEEK AFTER BIRTH 93
AFTER FIRST WEEK AND BEFORE FIRST YEAR AFTER BIRTH 94
DON'T KNOW 98
1108) Who performed the circumcision?
TRADITIONAL BIRTH ATTENDANT 12
NURSE/TRAINED MIDWIFE 22
HAS NO LIVING DAUGHTER (GO TO 1120)
1110) Have any of your daughters been circumcised? IF YES: How many?
NO DAUGHTER CIRCUMCISED 95 (GO TO 1118)
1111) Which of your daughters was circumcised most recently? INTERVIEWER: CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER
1112) Now I would like to ask you what was done to (NAME OF THE DAUGHTER FROM Q. 1111).
1113) Was any flesh removed from the genital area?
NO 2
DON'T KNOW 8
1115) How old was (NAME OF THE DAUGHTER FROM Q. 1111) when the circumcision was done? IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.
DURING FIRST WEEK AFTER BIRTH 93
AFTER FIRST WEEK AND BEFORE FIRST YEAR AFTER BIRTH 94
DON'T KNOW 98
1116) Who performed the circumcision?
TRADITIONAL BIRTH ATTENDANT 12
OTHER TRADITIONAL (SPECIFY)____ 16
NURSE/TRAINED MIDWIFE 22
OTHER HEALTH PROFESSIONAL (SPECIFY)____ 26
1117) Do you have any daughter who is not circumcised?
NO 2 (GO TO 1120)
DON'T KNOW (GO TO 1120)
1118) Do you intend to have any of your daughters circumcised in the future?
NO 2 (GO TO 1120)
DON'T KNOW 8 (GO TO 1120)
1119) Why do you intend to have any of your daughters circumcised? PROBE: Any other reasons? RECORD ALL MENTIONED.
SOCIAL ACCEPTANCE B
BETTER MARRIAGE PROSPECTS C
PRESERVE VIRGINITY/PREVENT PREMARITAL SEX D
MORE SEXUAL PLEASURE FOR THE MAN E
RELIGIOUS APPROVAL F
OTHER (SPECIFY)____ X
NO REASON Y
1120) Do you believe that this practice is required by your religion?
NO 2
DON'T KNOW 8
1121) Do you think that this practice should be continued, or should it be stopped?
STOPPED 2
DEPENDS 3 (GO TO 1201)
DON'T KNOW 8 (GO TO 1201)
1122) Why do you think this practice should be stopped? PROBE: Any other reasons? RECORD ALL MENTIONED.
AGAINST RELIGION B
CAUSES SERIOUS MEDICAL COMPLICATION C
PAINFUL PERSONAL EXPERIENCE D
AGAISNT WOMAN'S DIGNITY E
OTHER (SPECIFY)____ X
DON'T KNOW Z
SECTION 12. OPINIONS ON DOMESTIC VIOLENCE
1201) What is your understanding of domestic violence, does that mean:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
1202) Who are the people who commit the most violent acts against women?
MOTHER 02
HUSBANDS 03
SISTER/BROTHER 04
DAUGHTER/SON 05
EMPLOYER 06
SOMEONE AT WORK 07
OTHER (SPECIFY) ____ 96
1203) What is the place with the most violent acts?
WORKPLACE 02
STREET 03
SCHOOL 04
OTHER (SPECIFY)____ 96
1204) Does any form of violence cause damage?
NO 2 (GO TO 1206)
1205) What is the most serious damage caused by violence?
PSYCHOLOGICAL DAMAGE 2
ECONOMIC DAMAGE 3
EDUCATIONAL DAMAGE 4
SOCIAL DAMAGE 5
OTHER (SPECIFY)____ 6
1206) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
MINUTES____
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT: ____
COMMENTS ON SPECIFIC QUESTIONS: ____
ANY OTHER COMMENTS: ____
SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR: ____
DATE: ____
EDITOR'S OBSERVATIONS
NAME OF EDITOR: ____
DATE: ____