IDENTIFICATION

PLACE NAME ______________

NAME OF HOUSEHOLD HEAD ______________

CLUSTER NUMBER ________

HOUSEHOLD NUMBER ____

NAME AND LINE NUMBER OF WOMAN ________________ ____

HOUSEHOLD SELECTED FOR MALE SURVEY AND FULL BIOMARKERS?

HOUSEHOLD SELECTED FOR THE HOUSEHOLD RELATIONS MODULE?

INTERVIEWER VISITS

FIRST VISIT
DATE ____
INTERVIEWER'S NAME ____
RESULT

NEXT VISIT:
DATE ____
TIME ____

SECOND VISIT
DATE____
INTERVIEWER'S NAME____
RESULT

NEXT VISIT:
DATE____
TIME____

THIRD VISIT
DATE____
INTERVIEWER'S NAME____
RESULT

FINAL VISIT
DAY____
MONTH____
YEAR 201__
INT. NUMBER____
RESULT

TOTAL NUMBER OF VISITS____

LANGUAGE OF QUESTIONNAIRE: ENGLISH 01

LANGUAGE OF QUESTIONNAIRE: ENGLISH 01

LANGUAGE OF INTERVIEW ____

HOME LANGUAGE OF RESPONDENT ____

TRANSLATOR USED

SUPERVISOR
NAME ____
NUMBER ____

100A) CHECK RESPONDENT'S AGE AND MARITAL STATUS IN HOUSEHOLD QUESTIONNAIRE.

INTRODUCTION AND CONSENT (PARENT/GUARDIAN)

100B) Hello. My name is ________. I am working with Statistics South Africa. We are conducting a survey about health and other topics all over South Africa. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to talk to (NAME OF MINOR) about her health and well-being. The questions usually take about 45 to 60 minutes. All of the answers (NAME OF MINOR) gives will be confidential and will not be shared with anyone other than members of our survey team. (NAME OF MINOR) doesn't have to be in the survey, but we hope you will agree to allow (NAME OF MINOR) to answer the questions since (NAME OF MINOR)'s views are important.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
May I begin the interview with (NAME OF MINOR) now?

SIGNATURE OF INTERVIEWER: ________
DATE: ____

INTRODUCTION AND CONSENT

100C) Hello. My name is ________. I am working with Statistics South Africa. We are conducting a survey about health and other topics all over South Africa. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 45 to 60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just le me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the information sheet.

GIVE INFORMATION SHEET.

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER: ________
DATE: ____

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

102) How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

103) Just before you moved here, where did you live? PROBE: Is that a city, a town, a rural area, a farm, a tribal area, or an informal settlement?

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

105) On what day, month, and year were you born?

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. IF AGE 95 OR OLDER, RECORD 95.

106A) Which population group do you consider yourself: black, white, coloured, Indian or something else?

107) Have you ever attended an educational institution?

108) What is the highest level of school you attended: primary, secondary, or higher than secondary?

109) What is the highest grade or form you completed at that level?

110) CHECK 108:

111) Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

112) CHECK 111:

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

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

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

116) Do you own a cell phone?

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

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

119) Have you ever used the internet?

120) In the last 12 months, have you used the internet? IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121) During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

122) In the last 12 months, how many times have you been away from home for one or more nights?

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

124) CHECK 106: AGE OF RESPONDENT:

SECTION 2. REPRODUCTION

201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?

202) Do you have any sons or daughters to whom you have given birth who are now living with you?

203A) How many sons live with you?
IF NONE, RECORD '00'.

203B) And how many daughters live with you?
IF NONE, RECORD '00'.

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

205A) How many sons are alive but do not live with you?
IF NONE, RECORD '00'.

205B) And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207A) How many boys have died?
IF NONE, RECORD '00'.

207B) And how many girls have died?
IF NONE, RECORD '00'.

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

209) CHECK 208: Just to make sure that I have this right: you have had in TOTAL ____ births during your life. Is that correct?

210) CHECK 208:

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 6 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

212) What name was given to your (first/next baby)? RECORD NAME AND BIRTH HISTORY NUMBER.

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

214) Were any of these births twins?

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

215A) IF BIRTH SINCE JANUARY 2011:

How many months were you pregnant before the birth of (NAME)?

ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. PLACE A 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

216) Is (NAME) still alive?

217) IF ALIVE:
How old was (NAME) at (NAME)'s last birthday?
RECORD AGE IN COMPLETED YEARS.

218) IF ALIVE:
Is (NAME) living with you?

219) IF ALIVE:
RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.

220) IF DEAD:
How was (NAME) when (he/she) died?
IF '12 MONTHS' OR '1 YEAR', ASK: Did (NAME) have (his/her) first birthday?
THEN ASK: Exactly how many months old was (NAME) when (he/she) died?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

220A) IF DEAD:
IF BIRTH SINCE JANUARY 2011:
Where did (NAME) die?
At a health facility, at home, or somewhere else?

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

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

223) COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY:

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

226) Are you pregnant now?

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P'S IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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

229) CHECK 208: TOTAL NUMBER OF BIRTHS

ONE OR MORE: Did you want to have a baby later on or did you not want any more children?
NONE: Did you want to have a baby later on or did you not want any children?

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

231) When did the last such pregnancy end?

232) CHECK 231:

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

233A) Did that pregnancy end in a spontaneous miscarriage, an induced abortion, or a stillbirth?

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

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

236) FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2011-2016 OR LATER, ENTER 'C' FOR MISCARRIAGE, 'A' FOR INDUCED ABORTION, OR 'S' FOR STILLBIRTH IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY. IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

236A) CHECK 233A: HAD INDUCED ABORTION SINCE JANUARY 2011?

236B) The most recent time you had an induced abortion, what method was used?

236C) Where was the procedure done?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

(GO TO 236E)

236D) Where did you get the drug?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

236E) We have spoken about pregnancy losses that occurred since 2011. Did you have any miscarriages, terminations, or stillbirths that ended before 2011?

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

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

239) When did your last menstrual period start?

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

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

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

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about? MARK ALL METHODS DECLARED BY THE RESPONDENT.

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

302) CHECK 226:

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

304) Which method are you using?
RECORD ALL MENTIONED.
IF MORE THAN ONE MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

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, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

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

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

311) CHECK 308 AND 309:

312) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2011. USE NAMES OF CHILDREN, DATES OF BIRTHS, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

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

312C) Which method was that?

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

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

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

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

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

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

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

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

316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

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

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

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

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

322) CHECK 318 AND 319:

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

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

325) 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, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

329) CHECK 202: LIVING CHILDREN

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2011-2016. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).
Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

404) FROM 212 AND 216:

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

406) CHECK 208:

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

407) How much longer did you want to wait?

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

409) Whom did you see?
Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

410) Where did you receive antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

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

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

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

a) Was your blood pressure taken?
b) Did you give a urine sample?
c) Did you give a blood sample?
d) Were you asked about the use of alcohol?
e) Were you asked about smoking tobacco?

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

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

416) CHECK 415: TETANUS INJECTIONS

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

418) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.

419) CHECK 418:

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

421) During the whole pregnancy, for how many days did you take the tablets?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

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

427) Was (NAME) weighed at birth?

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

429) Who assisted with the delivery of (NAME)?
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.

430) Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

431) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

431A) Was (NAME) discharged at the same time as you?

431B) How long after (NAME) was delivered did NAME stay at the facility?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

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

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

434A) Was (NAME)'s bare skin touching your bare skin?

434B) CHECK 430: PLACE OF DELIVERY

435) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility?

436) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

437) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

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

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

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

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

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

442) How long after delivery did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

443) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

444) Where did the check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

446) How many hours, days or weeks after the birth of (NAME) did that check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

448) Where did this check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

449) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

450) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

451) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

452) Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

454) How many hours, days, or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS; IF LESS THAN ONE WEEK, RECORD DAYS.

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

456) Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

a) Examine the cord?
b) Measure (NAME)'s temperature?
c) Counsel you on danger signs for newborns?
d) Counsel you on breastfeeding?
e) Observe (NAME) breastfeeding?

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

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

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

461) CHECK 226: IS RESPONDENT PREGNANT?

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

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

464) Did you ever breastfeed (NAME)?

465) CHECK 404: IS CHILD LIVING?

466) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS; IF LESS THAN 24 HOURS, RECORD HOURS; OTHERWISE, RECORD DAYS.

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

468) CHECK 404: IS CHILD LIVING?

469) Are you still breastfeeding (NAME)?

469A) For how many months did you breastfeed (NAME)?

470) Did (NAME) drink anything from a bottle with a teat yesterday or last night?

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

SECTION 5A. CHILD IMMUNISATION (LAST BIRTH)

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

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

503A) CHECK 216 FOR CHILD:

504A) Do you have a Road to Health booklet/card or other document where (NAME)'s vaccinations are written down?

505A) Did you ever have a Road to Health booklet for (NAME)?

505A1) What happened to (NAME)'s Road to Health booklet?

505A2) Why don't you have a Road to Health booklet for (NAME)?

506A) CHECK 504A:

506A1) May I see the document where (NAME)'s vaccinations are written down?

507A) May I see the Road to Health booklet or other document where (NAME)'s vaccinations are written down?

507A1) Where is (NAME)'s Road to Health booklet?

507A2) CHECK 507A:

508A) PHOTOGRAPH VACCINATION PAGE OF BOOKLET OR OTHER DOCUMENT WHERE VACCINATIONS ARE WRITTEN.
COPY DATES FROM BOOKLET.
WRITE '44' IN 'DAY' COLUMN IF BOOKLET SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509A) CHECK 508A: 'BCG' TO 'MEASLES 2' ALL RECORDED?

510A) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in immunization campaigns?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

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

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

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

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

517A) Has (NAME) ever received a DTP-combination vaccination, also known as a pentavalent vaccination? That is, an injection given in the left thigh or left arm to prevent diphtheria, tetanus, and whooping cough?

518A) How many times did (NAME) receive the DTP-combination vaccine?

518A1) Has (NAME) ever received a hepatitis B vaccination, that is, an injection given in the right thigh to prevent hepatitis B?

518A2) How many times did (NAME) receive the hepatitis B vaccine?

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

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

521A) Has (NAME) ever received rotavirus vaccination, that is, syrup in the mouth to prevent diarrhoea?

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

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

524A) How many times did (NAME) receive the measles vaccine?

525A) Did (NAME) ever miss getting a vaccination or get a vaccination late?

526A) CHECK 508A AND 511A:

CHILD RECEIVED AT LEAST ONE VACCINATION: What was the reason for (NAME) missing the vaccination or getting it late? PROBE: Any other reason?

CHILD RECEIVED NO VACCINATIONS: What is the reason (NAME) has not received any vaccinations? PROBE: Any other reason?

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

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

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

503B) CHECK 216 FOR CHILD:

504B) Do you have a Road to Health booklet/card or other document where (NAME)'s vaccinations are written down?

505B) Did you ever have a Road to Health booklet for (NAME)?

505B1) What happened to (NAME)'s Road to Health booklet?

505B2) Why don't you have a Road to Health booklet for (NAME)?

506B) CHECK 504B:

506B1) May I see the document where (NAME)'s vaccinations are written down?

507B) May I see the Road to Health booklet or other document where (NAME)'s vaccinations are written down?

507B1) Where is (NAME)'s Road to Health booklet?

507B2) CHECK 507B:

508B) PHOTOGRAPH VACCINATION PAGE OF BOOKLET OR OTHER DOCUMENT WHERE VACCINATIONS ARE WRITTEN.
COPY DATES FROM BOOKLET.
WRITE '44' IN 'DAY' COLUMN IF BOOKLET SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

509B) CHECK 507B: 'BCG' TO 'MEASLES 2' ALL RECORDED?

510B) In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in immunization campaigns?
RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 508B THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

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

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

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

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

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

517B) Has (NAME) ever received a DTP-combination vaccination, also known as a pentavalent vaccination? That is, an injection given in the left thigh or left arm to prevent diphtheria, tetanus, and whooping cough?

518B) How many times did (NAME) receive the DTP-combination vaccine?

518B1) Has (NAME) ever received a hepatitis B vaccination, that is, an injection given in the right thigh to prevent hepatitis B?

518B2) How many times did (NAME) receive the hepatitis B vaccine?

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

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

521B) Has (NAME) ever received rotavirus vaccination, that is, syrup in the mouth to prevent diarrhoea?

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

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

524B) How many times did (NAME) receive the measles vaccine?

525B) Did (NAME) ever miss getting a vaccination or get a vaccination late?

525B) CHECK 508B AND 511B:

CHILD RECEIVED AT LEAST ONE VACCINATION: What was the reason for (NAME) missing the vaccination or getting it late? PROBE: Any other reason?

CHILD RECEIVED NO VACCINATIONS: What is the reason (NAME) has not received any vaccinations? PROBE: Any other reason?

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

SECTION 6. CHILD HEALTH AND NUTRITION

601) CHECK 224:

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

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

603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

604) FROM 212 AND 216:

605) Within the last six months, was (NAME) given a vitamin A dose like [this/any of these]? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

607) Was (NAME) given any drug for intestinal worms in the last six months?
IF RESPONDENT SAYS NO, CHECK ROAD TO HEALTH BOOKLET.

608) Has (NAME) had diarrhoea/loose stools in the last 2 weeks?

609) CHECK 464: EVER BREASTFED?

YES: Now I would like to know how much (NAME) was given to drink during the diarrhoea including breastmilk. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?

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

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

IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

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

612) Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECIRD 'X' AND WRITE THE NAME OF THE PLACE(S).

613) CHECK 612:

614) Where did you first seek advice or treatment?
USE LETTER CODE FROM 612.

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

a) A fluid made from a special packet called Sorol or Rehidrat?
b) A clinic-recommended sugar-salt solution?
c) Zinc tablets or syrup?

616) CHECK 615:

ANY 'YES': Was anything else given to treat the diarrhoea?
ALL 'NO' OR 'DON'T KNOW': Was anything given to treat the diarrhoea?

617) CHECK 615:

ANY 'YES': What else was given to treat the diarrhoea? Anything else?
ALL 'NO' OR 'DK': What was given to treat the diarrhoea? Anything else?
RECORD ALL TREATMENTS GIVEN.

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

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

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

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

623) CHECK 618: HAD FEVER?

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

625) Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

626) CHECK 625:

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

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

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

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

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

647) CHECK 615(a), ALL COLUMNS:

648) Have you ever heard of a special product called Sorol or Rehidrat that you can get for the treatment of diarrhoea?

648A) CHECK 224:

648B) CHECK 615(b), ALL COLUMNS:

648C) Have you ever heard from a health care worker about a sugar-salt solution that can be made at home for the treatment of diarrhoea?

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

650) Now I would like to ask you about liquids or food that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods. Did (NAME FROM 649) drink or eat:

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

652) Did (NAME FROM 649) eat any solid, semi-solid, or soft foods yesterday during the day or at night?
IF 'YES' PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat?

653) How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD '7'.

653A) CHECK 215: CHILD AGE 6 MONTHS OR OLDER?

653B) Has (NAME FROM 649) ever eaten liver?

653C) In the last four weeks, how many times has (NAME FROM 649) eaten liver?

654) The last time (NAME FROM 649) passed stools, what was done to dispose of the stools?

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

701A) Do you have a regular boyfriend/partner or fiancé?

701B) Is this person a man or a woman?

701C) CHECK 701: RESPONDENT'S CURRENT MARITAL STATUS

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

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

703A) CHECK 106: AGE OF RESPONDENT

703B) CHECK 701 AND 702: EVER MARRIED OR LIVED WITH A PARTNER?

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

705) RECORD THE SPOUSE'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE/SHE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

705A) CHECK 701A: SEX OF SPOUSE/PARTNER:

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

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

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

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

710) CHECK 709:

MARRIED/LIVED WITH A PARTNER ONLY ONCE: In what month and year did you start living with your (spouse/partner)?
MARRIED/LIVED WITH A PARTNER MORE THAN ONCE: Now I would like to ask about your first (spouse/partner). In what month and year did you start living with your first (spouse/partner)?

711) How old were you when you first started living together?

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

713) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. How old were you when you had sexual intercourse for the very first time?

714) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

715) When was the last time you had sexual intercourse with this person?
(DON'T ASK FOR LAST SEXUAL PARTNER)

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

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

718) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND/GIRLFRIEND: Were you living together as if married?
IF YES, RECORD '2'. IF NO, RECORD '3'.

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

720) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'.

721) How old is this person?

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

723) In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.
(ONLY ASK FOR THIRD-TO-LAST SEXUAL PARTNER)

724) CHECK 106:

725) CHECK 701:

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

727) In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AND ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, RECORD '95'.

731) PRESENCE OF OTHERS DURING THIS SECTION.

SECTION 8. FERTILITY PREFERENCES

801) CHECK 304:

802) CHECK 226:

803) Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

804) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

805) CHECK 226:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?
PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

806) CHECK 226:

807) CHECK 303: USING A CONTRACEPTIVE METHOD?

808) CHECK 805:

809) CHECK 714:

810) CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
WANTS NO MORE/NONE: You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
RECORD ALL REASONS MENTIONED.

811) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

813) CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.

814) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

815) In the last few months have you:

a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?
d) Heard about family planning from a community health worker?

815A) CHECK Q18 IN HOUSEHOLD QUESTIONNAIRE:

815) e) Heard about family planning at school?

817) CHECK 701, 701A AND 701B:

818) CHECK 303: USING A CONTRACEPTIVE METHOD?

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

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

821) CHECK 304:

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

SECTION 9. SPOUSE'S BACKGROUND AND WOMAN'S WORK

901) CHECK 701 AND 701A:

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

903) Did your (spouse/partner) ever attend an educational institution?

904) What was the highest level of school he/she attended: primary, secondary, or higher than secondary?

905) What was the highest grade or form he/she completed at that level?

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

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

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

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

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

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

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

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

913A) CHECK 106: AGE OF RESPONDENT

913B) CHECK 909, 910, 911, AND 912: ANY YES?

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

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

916) Are you paid in cash or kind for this work or are you not paid at all?

917) CHECK 701, 701A AND 701B:

918) CHECK 916:

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

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

921) Who usually makes decisions about how your (husband's/partner's) earnings will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

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

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

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

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

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

927) Is your name on the title deed or documents?

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

932) In your opinion, is a husband justified in hitting or beating his wife in the following situations:

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refused to have sex with him?
e) If she burns the food?

933) CHECK 217 AND 218:

934) Now I would like to ask you questions about how you discipline or punish your (child/children). In the past 12 months, have you ever:

a) Hit or slapped your (child/children) with your hand to punish or discipline the child?
b) Hit or beat your (child/children) using a belt, spoon, stick, shoe or any other implement to punish or discipline the child?

SECTION 10. HIV/AIDS

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

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

a) During pregnancy?
b) During delivery?
c) By breastfeeding?

1009) CHECK 1008:

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

1011) CHECK 208 AND 215:

1012) CHECK 408 FOR LAST BIRTH:

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

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

a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?

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

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

1017) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

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

1020) CHECK 430 FOR LAST BIRTH:

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

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

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

1024) CHECK 1016:

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

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

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

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

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

1030) Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 96 AND WRITE THE NAME OF THE PLACE.

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

1032) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO IDENTIFY IF PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

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

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

1042) CHECK 1001:

HEARD ABOUT HIV OR AIDS: Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT HIV OR AIDS: Have you heard about infections that can be transmitted through sexual contact?

1043) CHECK 713:

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

1045) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

1046) Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

1047) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1048) CHECK 1045, 1046, AND 1047:

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

1050) Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE.

1053) CHECK 701, 701A AND 701B:

1054) Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

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

SECTION 11. MATERNAL MORTALITY

1101) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?

1102) CHECK 1101:

1103) How many births did your mother have before you were born?

1104) What was the name given to your oldest (next oldest) brother or sister?

1105) Is (NAME) male or female?

1106) Is (NAME) still alive?

1107) How old is (NAME)?

1108) How many years ago did (NAME) die?

1109) How old was (NAME) when he/she died?
IF DON'T KNOW, PROBE TO GET AN ESTIMATE.

1110) Was (NAME) pregnant when she died?

1111) Did (NAME) die during childbirth?

1112) Did (NAME) die within two months after the end of a pregnancy or childbirth?

1113) How many live born children did (NAME) give birth to during her lifetime?

1114) Was (NAME)'s death due to an accident or violence?

IF NO MORE BROTHERS OR SISTERS, GO TO NEXT SECTION.

SECTION 12. TOBACCO AND ALCOHOL

1201) CHECK COVER SHEET: IS HOUSEHOLD SELECTED FOR MALE SURVEY AND BIOMARKERS OR IS RESPONDENT AGE 50 OR OLDER AND SELECTED FOR HOUSEHOLD RELATIONS MODULE?

1202) Would you say your health is poor, average, good, or excellent?

1203) Do you personally think you are underweight, normal weight, overweight, or obese?

1204) Do you currently smoke tobacco every day, some days, or not at all?

1205) In the past, have you smoked tobacco every day?

1206) In the past, have you ever smoked tobacco every day, some days, or not at all?

1207) On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Manufactured cigarettes?
b) Hand-rolled cigarettes?
c) Pipes full of tobacco?
d) Cigars or cigarillos?
e) Number of hookah, hubbly-bubbly or water pipe sessions?
f) Any others? (SPECIFY) ____

1208) On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Manufactured cigarettes?
b) Hand-rolled cigarettes?
c) Pipes full of tobacco?
d) Cigars or cigarillos?
e) Number of hookah, hubbly-bubbly or water pipe sessions?
f) Any others? (SPECIFY) ____

1209) Do you currently use snuff, chewing tobacco or other smokeless tobacco products every day, some days, or not at all?

1210) In the past, have you used snuff, chewing tobacco or other smokeless tobacco products every day, some days, or not at all?

1211) On average, how many times a day do you use the following products? Also, let me know if you use the product, but not every day.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY DAY, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Snuff, by mouth?
b) Snuff, by nose?
c) Chewing tobacco?
d) Any others? (SPECIFY) ________

1212) On average, how many times a week do you use the following products? Also, let me know if you use the product, but not every week.
IF RESPONDENT REPORTS USING THE PRODUCT BUT NOT EVERY WEEK, RECORD '888'. IF THE PRODUCT IS NOT USED AT ALL, RECORD '000'.

a) Snuff, by mouth?
b) Snuff, by nose?
c) Chewing tobacco?
d) Any others? (SPECIFY) ____

1213) CHECK 106: AGE OF RESPONDENT

1214) CHECK 224:
LIVE BIRTH SINCE JANUARY 2011?

1215) CHECK 212 AND 215:

1216) CHECK 1204 AND 1206:
CURRENTLY SMOKES TOBACCO OR SMOKED IN THE PAST?

1217) During your pregnancy with (NAME) how often did you smoke: every day, some days, or not at all?

1218) CHECK 1209 AND 1210:
CURRENTLY USES SMOKELESS TOBACCO OR USED IN THE PAST?

1219) During your pregnancy with (NAME) how often did you use smokeless tobacco: every day, some days, or not at all?

1220) Do you currently work in a job where other people smoke tobacco around you?

1221) Have you ever worked in a job where you were regularly exposed to smoke, dust, fumes, or strong smells?

1222) How many years did you work at a job where you were regularly exposed to smoke, dust, fumes or strong smells?
IF LESS THAN 1 YEAR, RECORD '00'.

1223) Do you currently use e-cigarettes every day, some days, or not at all?

1224) Have you ever consumed a drink that contains alcohol such as beer, wine, spirits, or sorgum beer? PROBE: Even one drink?

1225) Was this within the last 12 months?

1226) In the last 12 months, how frequently have you had at least one drink? PROBE: Five or more days a week, 1-4 days a week, 1-3 days a month, or less often than once a month?

1227) During each of the last 7 days, how many standard drinks did you have?
USE SHOWCARD. RECORD TOTAL NUMBER OF DRINKS CONSUMED EACH DAY STARTING WITH THE DAY BEFORE THE DAY OF THE INTERVIEW AND PROCEEDING BACKWARDS. IF NONE, RECORD '00'.

1227H) During the last 7 days, how many standard home-made beers or other homemade alcohol did you have?
USE SHOWCARD.

1227I) CHECK 1226 AND 1227: CODE 3 OR 4 RECORDED IN 1226 AND CONSUMED 0-1 DRINKS IN THE LAST 7 DAYS IN 1227?

1228) Have you ever felt that you should cut down on your drinking?

1229) Have people annoyed you by criticizing your drinking?

1230) Have you ever felt bad or guilty about your drinking?

1231) Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

1231A) CHECK 1227: FIVE OR MORE DRINKS IN ONE DAY DURING LAST 7 DAYS?

1232) In the past 30 days, have you consumed five or more standard drinks on at least one occasion?

1233) CHECK 106: AGE OF RESPONDENT

1234) CHECK 224:
LIVE BIRTH SINCE JANUARY 2011?

1235) CHECK 212 AND 215:

1236) During your pregnancy with (NAME) how often did you drink alcohol: every day, some days, or not at all?

SECTION 13. FAT, SALT, SUGAR, FRUIT AND VEGETABLE CONSUMPTION

1301) Now I would like to ask you some questions about the foods that you eat. There are no right or wrong answers.
USE SHOWCARD.

1304) How often do you eat fried foods such as hot chips, fried fish, fried chicken, fried meat, vetkoek or doughnuts?

1305) How often do you eat fast-foods or take-away foods from places like Chicken Licken, KFC, Captain DoRego's, Steers, Nando's, McDonalds, pizza delivery, etc?

1306) How often do you eat chips such as a packet of crispy chips or similar salty snacks such as Doritos, cheese curls, salted nuts, salty biscuits, etc?

1307) How often do you eat processed meat such as polony, viennas, meat pies, or sausage rolls?

1308) Which of the following statements best describes your approach towards salt consumption:

1) I am not interested in lowering salt in my food.
2) I am interested in lowering salt in my food within the next six months.
3) I am interested in lowering salt in my food within the next month.
4) I have started lowering salt within the last six months.
5) I have already lowered my salt intake for longer than six months.

1309) Yesterday, how many types of fruit did you eat?
USE SHOWCARD. IF NONE, RECORD '00'.

1310) Yesterday, how many types of vegetables, excluding potatoes, did you eat?
USE SHOWCARD. IF NONE, RECORD '00'.

1311) Yesterday, did you drink any sugar-sweetened drinks? Sugar-sweetened drinks include fizzy drinks like Coke or drinks like Squash where water is added, but not diet or unsweetened cold drinks.

1311A) How many and what size sugar-sweetened drinks did you drink?
PROBE FOR BEVERAGE NUMBER AND SIZE.

1312) Yesterday, did you drink any fruit juice?

1312A) How many and what size fruit juices did you drink?
PROBE FOR BEVERAGE NUMBER AND SIZE.

SECTION 14. HEALTH CARE

1401) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not a big problem:

a) Getting permission to go to the doctor?
b) Getting money needed for advice or treatment?
c) The distance to the health facility?
d) Not wanting to go alone?

1402) Are you covered by Medical Aid, Medical Benefit Scheme, Provident Scheme, or Hospital Plan that helps you pay for health care or drug services?

1404) During the last month, have you received health, medical, or dental care without staying overnight?

1405) Where have you received health, medical, or dental care?
PROBE: Anywhere else?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE.

1406) During the last month, have you had any visits by a home-based care giver or a community-based care giver?

1407) Have you ever had a Pap smear?
PROBE: When visiting a doctor or nurse, have you ever been asked to lie on your back with your legs apart so they could use a stick to take a sample from your vagina? The sample would have been sent to a laboratory for testing.

1408) How many years ago was your last Pap smear?

1409) The last time you had a Pap smear, did you get the result of the test?

1410) Has a doctor, nurse or health worker told you that you have TB?

1411) When was the last time you were told you had TB?

1412) Did you get medical treatment the last time you had TB?

1413) Has a doctor, nurse or health worker told you that you have or have had any of the following conditions:

a) High blood pressure?
b) Heart attack or angina/chest pains?
c) Cancer?
d) Stroke?
e) High blood cholesterol or fats in the blood?
f) Diabetes or blood sugar?
g) Chronic bronchitis, emphysema, or COPD?
h) Asthma?

1414) CHECK 1413:
ANY QUESTION a-h ANSWERED YES?

1415) CHECK 1413a:
RESPONDENT HAS HAD HIGH BLOOD PRESSURE.

1416) Did you receive treatment for high blood pressure at the time of the diagnosis?

1417) CHECK 1413b: RESPONDENT HAS HAD HEART ATTACK OR ANGINA.

1418) Did you receive treatment for the heart attack, angina/chest pains at the time of diagnosis?

1419) CHECK 1413c: RESPONDENT HAS HAD CANCER.

1420) Did you receive treatment for the cancer at the time of the diagnosis?

1421) CHECK 1413d: RESPONDENT HAS HAD STROKE.

1422) Did you receive treatment for the stroke at the time of the diagnosis?

1423) CHECK 1413e:
RESPONDENT HAS HAD HIGH BLOOD CHOLESTEROL.

1424) Did you receive treatment for high blood cholesterol or fats in the blood at the time of the diagnosis?

1425) CHECK 1413f:
RESPONDENT HAS HAD DIABETES.

1426) Did you receive treatment for the diabetes or blood sugar at the time of the diagnosis?

1427) CHECK 1413g:
RESPONDENT HAS HAD CHRONIC BRONCHITIS.

1428) Did you receive treatment for the chronic bronchitis, emphysema, or COPD at the time of the diagnosis?

1429) CHECK 1413h:
RESPONDENT HAS HAD ASTHMA.

1430) Did you receive treatment for the asthma at the time of the diagnosis?

1432) Compared with other people your age, do you feel you have less breath when exerting yourself?

1433) During the last 12 months, have you had wheezing when you breathe?

1434) Were you also short of breath when the wheezing noise was present?

1435) Have you had the wheezing when you did not have a cold?

1436) Have you woken up with a feeling of tightness in your chest at any time in the last 12 months?

1437) Have you been woken by an attack of shortness of breath at any time in the last 12 months?

1438) Have you been woken by an attack of coughing at any time in the last 12 months?

1439) Do you usually cough on most days?

1440) When you cough, do you usually bring up phlegm from your chest?

1441) Have you brought up phlegm every day for at least three months during the last year?

1442) For how many years have you brought up phlegm in this way?
IF LESS THAN 1 YEAR, RECORD '00'.

1443) Are you currently troubled by pain or discomfort, either all the time or on and off?

1444) Have you had this pain or discomfort for more than 3 months?

1445) Where do you feel this pain or discomfort?
RECORD ALL MENTIONED.

1446) In the last 12 months, did your teeth or your mouth cause you any pain or discomfort?

1447) Did you get treatment the last time that you had the problem?

1448) Who did you see for treatment?
RECORD ALL MENTIONED.

1449) What was the main reason that you did not get treatment?

1450) Now I would like to ask you about any medication you take. Do you use any medication daily or regularly that has been prescribed by a doctor or nurse?

1451) How many different medicines do you use daily or regularly?

1452) Who pays for most of these medications?

1453) In the last 12 months, have you ever been sent away from the clinic without a medication because they did not have stock?

1454) How many times has this happened to you in the last 12 months?
PROBE FOR ESTIMATE OF NUMBER OF TIMES.

1455) In the last 12 months, have you used any medications containing codeine to treat a medical condition?
USE SHOWCARD.

1457) In the last 12 months, have you used any of these medications for the experience or feeling it gave you rather than for their medical effect?

1458) In the last 12 months, which of the following codeine-containing medicines have you used for the experience or feeling rather than for their medical effect?
RECORD ALL MENTIONED.

1459) In the last 12 months, have you sought treatment for your problems related to the use of codeine-containing medicines for non-medical purposes?

SECTION 15: HOUSEHOLD RELATIONS

1500) CHECK COVER PAGE AND 106:

1501) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

1501A) Now I would like to ask you questions about some other important aspects of a woman's life. You many find some of these questions very personal. However, your answers are crucial for helping to understand the condition of women in South Africa. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions. If I ask you any question you don't want to answer, just let me know and I will go on to the next question.

1502) CHECK 701, 701A, 701B AND 702:

1502A) Do you have a boyfriend or have you had one in the past?

1503) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) (husband/boyfriend)?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?

1504) Now I need to ask some more questions about your relationship with your most recent partner.

A) Did your (last) partner ever:

a) say or do something to humiliate you in front of others?
b) threaten to hurt or harm you or someone you care about?
c) insult you or make you feel bad about yourself?
d) refuse to give you enough money for household expenses or contribute towards household expenses when he has the money to do so?

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

1505) A) Did your (last) partner ever do any of the following things to you:
a) slap you, push you, shake you, or throw something at you?
e) kick you, drag you, or beat you up?
f) try to choke you or burn you on purpose?
g) threaten or attack you with a knife, gun, or other weapon?
h) physically force you to have sexual intercourse with him when you did not want to?
i) physically force you to perform any other sexual acts you did not want to?
j) force you with threats or in any other way to perform sexual acts you did not want to?

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

1506) CHECK 1505A (a-j):

1508) Did the following ever happen as a result of what your (last) partner did to you:
a) You had cuts, bruises, or aches?
b) You had eye injuries, sprains, dislocations, or burns?
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?

1511) Does (did) your (last) partner drink alcohol?

1512) How often does (did) he get drunk: often, only sometimes, or never?

1512A) Does (did) your (last) partner take drugs?

1512B) How often does (did) he take drugs: often, only sometimes, or never?

1512C) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) partner at times when he was not already beating or physically hurting you?

1512D) In the last 12 months, how often have you done this to your (last) partner: often, only sometimes, or not at all?

1513) Are (Were) you afraid of your (last) partner: most of the time, sometimes, or never?

1514) CHECK 709:

1514A) So far we have been talking about the behavior of your (current/last) partner. Now I want to ask you about the behavior of any previous partner. Have you had had a previous partner?

1515) A) So far we have been talking about the behavior of your (current/last) partner. Now I want to ask you about the behavior of any previous partner.

a) Did any previous partner ever hit, slap, kick, or do anything else to hurt you physically?
b) Did any previous partner physically force you to have sexual intercourse against your will?
c) Did any previous partner physically force you to perform any other sexual acts against your will?
d) Did any previous partner humiliate, threaten, belittle, insult or try to exert excessive control over you in any way?
e) Did any previous partner refuse to give you enough money for household expenses or contribute towards household expenses?

B) How long ago did this last happen?

1516A) CHECK 1505A (h-j) AND 1515A (b,c)

1516B) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by (your/any) partner?

1516) CHECK 701, 701A, 701B, 702 AND 1502A:

EVER IN UNION OR HAD A BOYFRIEND: From the time you were 15 years old has anyone other than (your/any) partner hit you, slapped you, kicked you, or done anything else to hurt you physically?
NEVER IN UNION OR HAD A BOYFRIEND: From the time you were 15 years old, has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

1517) Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

1518) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

1518A) CHECK 106: AGE OF RESPONDENT:

1519) CHECK 201, 226, AND 230:

1520) Has a partner ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1520A) Has anyone else ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1521A) CHECK 1520 AND 1520A:

1521) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

1522) CHECK 701, 701A, 701B, 702, AND 1502A:

EVER IN UNION OR HAD A BOYFRIEND: Now I want to ask you about things that may have been done to you by someone other than (your/any) partner. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse when you did not want to?

NEVER IN UNION OR HAD A BOYFRIEND: At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse when you did not want to?

1522A) How old were you the first time this happened?

1522B) Who was the person who was forcing you the very first time this happened?

1522C) At any time in your life, as a child or as an adult, has anyone (other than any partner) ever forced you in any way to perform any other sexual acts when you did not want to?

1522D) How old were you the first time this happened?

1523) Who was the person who was forcing you the very first time this happened?

1523A) CHECK 1522: EVER FORCED TO HAVE SEXUAL INTERCOURSE?

1524) CHECK 701, 701A, 701B, 702 AND 1502A:

EVER IN UNION OR HAD A BOYFRIEND: In the last 12 months, has anyone other than (your/any) partner physically forced you to have sexual intercourse when you did not want to?

NEVER IN UNION OR HAD A BOYFRIEND: In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

1526) CHECK 1505A (a-j), 1515A (a, b, c), 1516, 1520, 1522, 1522C AND 1524:

1527) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1528) From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1529) Have you ever told anyone about this?

1530) As far as you know, did your father or any other husband or boyfriend your mother had ever hit or beat her?

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

1531) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?

1532) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE:

___________________
___________________
___________________

1533) RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW: ____________________

COMMENTS ON SPECIFIC QUESTIONS: ______________________

ANY OTHER COMMENTS: _________________

SUPERVISOR'S OBSERVATIONS: ________________

CALENDAR

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. COLUMN 1 REQUIRES A CODE IN EVERY MONTH.

INFORMATION TO BE CODED FOR EACH COLUMN.

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

2016

2015

2014

2013

2012

2011