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DEMOGRAPHIC AND HEALTH SURVEYS - ZAMBIA 1996 - WOMEN'S QUESTIONNAIRE

IDENTIFICATION

CLUSTER NUMBER ___

PROVINCE _________________ ___

DISTRICT _____________________ ___

HOUSEHOLD NUMBER ___

NAME OF HOUSEHOLD HEAD _______________ ___

URBAN/RURAL

urban = 1
rural = 2

LUSAKA/OTHER CITY/TOWN/VILLAGE

Lusaka = 1
Other city = 2
Town = 3
Village = 4

NAME AND LINE NUMBER OF WOMAN _______________ ___

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISIT)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT___

RESULT* ______________

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

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT ____

TOTAL NO. OF VISITS __

LANGUAGE OF QUESTIONNAIRE

ENGLISH 01

LANGUAGE USED IN INTERVIEW

01 ENGLISH
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA
09 OTHER

RESPONDENT'S LOCAL LANGUAGE

01 ENGLISH
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA
09 OTHER

TRANSLATOR USED

1 = NOT AT ALL
2 = SOMETIME
3 = ALL THE TIME

SUPERVISOR
NAME ________ ___
DATE ________

FIELD EDITOR
NAME ________ ___
DATE ________

OFFICE EDITOR___
KEYED BY__

SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME

HOUR _______
MINUTES _______

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village?

LUSAKA 1
OTHER CITY 2
TOWN 3
VILLAGE 4

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS ___

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in a city, in a town, or in a village?

LUSAKA 1
OTHER CITY 2
TOWN 3
VILLAGE 4

105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 98

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

AGE IN COMPLETED YEARS ___

107. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

109. How many years did you complete at that level?

COMMENT ____________________
YEARS ___

110. CHECK 106:

AGE 24 OR BELOW (GO TO 111)
AGE 25 OR ABOVE (GO TO 113)

111. Are you currently attending school?

YES 1 (GO TO 113)
NO 2

112. What was the main reason you stopped attending school?

GOT PREGNANT 01
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
GRADUATED/HAD ENOUGH SCHOOLING 07
DID NOT PASS ENTRANCE EXAMS 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) ______________ 96
DON'T KNOW 98

113. CHECK 108:

PRIMARY (GO TO 114)
SECONDARY OR HIGHER (GO TO 115)

114. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)

115. How often do you usually read a newspaper or magazine? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONCE ANSWER.

EVERYDAY 1
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6

116. How often do you usually listen to a radio? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONCE ANSWER.

EVERYDAY 1
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6

117. How often do you usually watch television? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONCE ANSWER.

EVERYDAY 1
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6

118. What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY)________ 4

119. What tribe do you belong to?

TRIBE__________________ ___

120. CHECK COLUMN (8) INTERVIEWER'S ASSIGNMENT SHEET

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT (GO TO 121)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)

121. Now I would like to ask about the place in which you usually live. What is the name of the place in which you usually live? Is that a city, town, or village?

(NAME OF PLACE) __________________
LUSAKA 1
OTHER CITY 2
TOWN 3
VILLAGE 4

122. In which province is that located?

CENTRAL 1
COPPERBELT 2
EASTERN 3
LUAPULA 4
LUSAKA 5
NORTHERN 6
NORTH-WESTERN 7
SOUTHERN 8
WESTERN 9
OUTSIDE ZAMBIA 10

123. Now I would like to ask about the household in which you usually live. What is the main source of drinking water for members of your household?

PIPED WATER
PIPED INTO HOME OR PLOT 11 (GO TO 125)
PUBLIC TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 125)
PUBLIC SHALLOW WELL 22
PUBLIC TRADITIONAL WELL 23
PUBLIC BOREHOLE 24
SURFACE WATER
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
RAINWATER 41 (GO TO 125)
TANKER TRUCK 51
BOTTLED WATER 61 (GO TO 125)
OTHER (SPECIFY) _______ 96

124. How long does it take to go there, get water, and come back?

MINUTES ___
ON PREMISES 996

125. What kind of toilet facility does your household have?

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT (VIP) LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) ________ 96

126. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

127. How many rooms in your household are used for sleeping?

ROOMS ___

128. Could you describe the main material of the floor of your home?

NATURAL FLOOR
EARTH/SAND/MUD 11
RUDIMENTARY FLOOR
WOOD PLANKS/BOARDS 21
FINISHED FLOOR
WOODEN TILE 31
CERAMIC/TERRAZO/MARBLE TILE 32
CEMENT/CONCRETE 33
OTHER (SPECIFY) _____________ 96

129. Does any member of your household own:

A bicycle?
A motorcycle?
A car?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

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?

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME _____
DAUGHTERS AT HOME ______

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206. Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD ___
GIRLS DEAD ___

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.

TOTAL ___

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

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

ONE OR MORE BIRTHS (GO TO 211)
NO BIRTHS (GO TO 227)

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 LINES.

212. What name was given to your (first/next) baby?

(NAME) ___________

213. Were any of these births twins?

SING 1
MULT 2

214. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH __________
YEAR __________

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

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

AGE IN YEARS __

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

YES 1 (GO TO NEXT BIRTH, OTHERWISE GO TO 220)
NO 2 (GO TO NEXT BIRTH, OTHERWISE GO TO 220)

219. IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

220. FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH.
IS THE DIFFERENCE 4 OR MORE?

YES 1
NO 2 (GO TO NEXT BIRTH)

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

222. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH.
IS THE DIFFERENCE 4 YEARS OR MORE?

YES 1 (GO TO 223)
NO 2 (GO TO 224)

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

YES 1
NO 2

224. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. __
FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1991.
IF NONE, RECORD '0'.

BIRTHS___

227. Are you pregnant now?

YES 1
NO 2 (GO TO 236)
UNSURE 8 (GO TO 236)

228. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS _______

229. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children at all?

THEN 1
LATER 2
NOT WANT MORE CHILDREN 3

236. When did your last menstrual period start?

(DATE, IF GIVEN) ______________
DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___

IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

237. Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 3 (GO TO 301)

238. During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 01
RIGHT AFTER HER PERIOD HAS ENDED 02
IN THE MIDDLE OF THE CYCLE 03
JUST BEFORE HER PERIOD BEGINS 04
OTHER (SPECIFY) _____ 96
DON'T KNOW 98

SECTION 3. CONTRACEPTION

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.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?
302. Have you ever heard of (METHOD)?

METHOD 01 PILL Women can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 02 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 05 FOAMING TABLETS/JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 06 CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 09 NATURAL FAMILY PLANNING Couples can avoid having sexual intercourse on the days of the month when the woman is more likely to become pregnant.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS
SPECIFY___
SPONTANEOUS YES 1
NO 3

303. Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUCD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
METHOD 05 FOAMING TABLETS/JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
METHOD 06 CONDOM Men can put a rubber sheath on their penis during sexual intercourse.
YES 1
NO 2
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children: Have you ever had a partner who had an operation to avoid having children?
YES 1
NO 2
METHOD 09 NATURAL FAMILY PLANNING Couples can avoid having sexual intercourse on the days of the month when the woman is more likely to become pregnant.
YES 1
NO 2
METHOD 10 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 11 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 305)
AT LEAST ONE 'YES' (EVER USED) (GO TO 309)

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

YES 1
NO 2 (GO TO 331)

307. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).

309. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN _____

310. When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?

WANTED CHILD LATER 1
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY) 6

311. CHECK 303:

WOMAN NOT STERILIZED (GO TO 312)
WOMAN STERILIZED (GO TO 314A)

312. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 313)
PREGNANT (GO TO 332)

313. Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 331)

314. Which method are you using?
314A. CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 326)
INJECTIONS 03 (GO TO 326)
IMPLANTS 04 (GO TO 326)
FOAMING TABLETS/JELLY 05 (GO TO 326)
CONDOM 06 (GO TO 326)
FEMALE STERILIZATION 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
NATURAL FAMILY PLANNING 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 326)
OTHER (SPECIFY) _________ 96 (GO TO 326)

315A. At the time you first started using the pill, did you consult a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

315B. At the time you last got pills, did you consult a doctor or a nurse?

YES 1
NO 2

315C. May I see the package of pills you are now using?
RECORD NAME OF BRAND IF PACKAGE IS SEEN.

PACKAGE SEEN 1 (GO TO 317)
BRAND NAME ______________ ___ (GO TO 317)
PACKAGE NOT SEEN 2

316. Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND.

BRAND NAME _____________ ___
DON'T KNOW 98

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

KWACHA COST ____ (GO TO 326)

FREE 9996 (GO TO 326)
DON'T KNOW 9998 (GO TO 326)

318. Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 26
OTHER (SPECIFY) _________________ 96 (GO TO 319)
DON'T KNOW 98 (GO TO 319)

318A. How long did it take to travel from your home to (PLACE MENTIONED IN 318)?
IF LESS THAN 2 HOURS, RECORD MINUTES.
OTHERWISE, RECORD HOURS.

MINUTES 1___
HOURS 2 __

DON'T KNOW 9998

318B. Was it easy or difficult to get there?

EASY 1
DIFFICULT 2

319. Do you regret that (you/your husband) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO 321)

320. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 1
PARTNER WANTS ANOTHER CHILD 2
SIDE EFFECTS 3
CHILD DIED 4
OTHER (SPECIFY) ____________ 6

321. In what month and year was the sterilization performed?

MONTH ___ (GO TO 327)
YEAR ___ (GO TO 327)

323. You said that you have avoided having sexual intercourse on certain days of the month to avoid getting pregnant. How do you determine which days of your monthly cycle not to have sexual relations?

BASED ON CALENDAR 1
BASED ON BODY TEMPERATURE 2
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 3
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 4
NO SPECIFIC SYSTEM 5
OTHER (SPECIFY) ______________ 6

326. For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS __
8 YEARS OR LONGER 96

327. CHECK 314:
CIRCLE METHOD CODE:

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
FOAMING TABLETS/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 328C)
MALE STERILIZATION 08 (GO TO 334)
NATURAL FAMILY PLANNING 09 (GO TO 332)
WITHDRAWAL 10 (GO TO 332)
OTHER METHOD 96 (GO TO 332)

328. Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FIELDWORKER 13 (GO TO 328C)
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26 (GO TO 328C)
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 27
OTHER SOURCE
SHOP 31 (GO TO 328C)
FRIENDS/RELATIVES 33 (GO TO 328C)
OTHER (SPECIFY) _________________ 36 (GO TO 328C)
DON'T KNOW 98 (GO TO 328C)

328A. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.

MINUTES 1 ___
HOURS 2 ___

DON'T KNOW 9998

328B. Is it easy or difficult to get there?

EASY 1
DIFFICULT 2

328C. Did you talk to your husband/partner about (METHOD) before you started to use it?

YES 1
NO 2

328D. Did you talk to your husband/partner about (METHOD) after you started to use it?

YES 1 (GO TO 334)
NO 2 (GO TO 334)

331. What is the main reason you are not using a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
PREGNANT 27
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _______________ 96
DON'T KNOW 98

332. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 334)

333. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 27
OTHER SOURCE
SHOP 31
FRIENDS/RELATIVES 32
OTHER (SPECIFY) _________________ 36

334. Were you visited by a family planning program worker in the last 12 months?

YES 1
NO 2

335. Have you visited a health facility for any reason in the last 12 months?

YES 1
NO 2 (GO TO 337)

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

YES 1
NO 2

337. Do you think that breastfeeding can affect a woman's chance of becoming pregnant?

YES 1
NO 2 (GO TO 401)
DON'T KNOW 8

338. Do you think a woman's chance of becoming pregnant is increased or decreased while breastfeeding?

INCREASED 1 (GO TO 401)
DECREASED 2
DEPENDS 3
DON'T KNOW 8

339. CHECK 210:

ONE OR MORE BIRTHS (GO TO 340)
NO BIRTHS (GO TO 401)

340. Have you ever relied on breastfeeding as a method of avoiding pregnancy?

YES 1
NO 2 (GO TO 401)

341. CHECK 227 AND 311:

NOT PREGNANT OR UNSURE AND NOT STERILIZED (GO TO 342)
EITHER PREGNANT OR STERILIZED (GO TO 401)

342. Are you currently relying on breastfeeding to avoid getting pregnant?

YES 1
NO 2

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 225:

ONE OR MORE BIRTHS SINCE JAN.1991 (GO TO 402)
NO BIRTHS SINCE JAN.1991 (GO TO 465)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE CONTINUATION SHEETS).

Now I would like to ask you some more questions about the health of all your children born in the past five years. (We will talk about one child at a time.)

403. LINE NUMBER FROM Q212

LINE NUMBER _____

404. FROM Q212 AND Q216

NAME _______
ALIVE __
DEAD __

405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

THEN 1 (GO TO 407)
LATER 2
NO MORE 3 (GO TO 407)

406. How much longer would you like to have waited?

MONTHS 1 __
YEARS 2 __

DON'T KNOW 998

407. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
CLINICAL OFFICER C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 410)

408. How many months pregnant were you when you first received antenatal care?

MONTHS _____
DON'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?

NO. OF TIMES _____
DON'T KNOW 98

409A. Were you given an antenatal card or do you have a card or a book for this pregnancy? May see the card (book) please?

YES, SEEN 1
YES, NOT SEEN 2
NO CARD/BOOK 3

410. When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 412)
DON'T KNOW 8 (GO TO 412)

411. During this pregnancy, how many times did you get this injection?

TIMES __
DON'T KNOW 8

412. Where did you give birth to (NAME)?

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVT. HOSPITAL 21
GOVT. HEALTH CENTER 22
OTHER PUBLIC (SPECIFY) _____ 26
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC 31
MISSION HOSP./CLINIC 32
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER (SPECIFY) ________ 96

413. Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
CLINICAL OFFICER C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
COMMUNITY HEALTH WORKER F
OTHER (SPECIFY) ________ X
NO ONE Y

414. Around the time of the birth of (NAME), did you have any of the following problems:

Long labor, that is, did your regular contractions last more than 12 hours?
Excessive bleeding that was so much that you feared it was life threatening?
A high fever with bad smelling vaginal discharge?
Convulsions not caused by fever?

LABOR MORE THAN 12 HOURS
YES 1
NO 2
EXCESSIVE BLEEDING
YES 1
NO 2
FEVER/BAD SMELLING VAG. DISCHARGE
YES 1
NO 2
CONVULSIONS
YES 1
NO 2

415. Was (NAME) delivered by caesarian section?

YES 1
NO 2

416. When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small?

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

417. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 419)

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

KILOGRAMS FROM CARD 1 ____.____
KILOGRAMS FROM RECALL 2 ____.____

DON'T KNOW 998

419. Has your period returned since the birth of (NAME)?
[Last Birth Only]

YES 1 (GO TO 421)
NO 2 (GO TO 422)

420. Did your period return between the birth of (NAME) and your next pregnancy?
[Exclude Last Birth]

YES 1
NO 2 (GO TO 424)

421. For how many months after the birth of (NAME) did you not have a period?
[Last Birth Only]

MONTHS ______
DON'T KNOW 98

422. CHECK 227:
RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 423)
PREGNANT OR UNSURE (GO TO 424)

423. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 425)

424. For how many months after the birth of (NAME) did you not have sexual relations?

MONTHS ___________
DON'T KNOW 98

425. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 431)

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

IMMEDIATELY 000

HOURS 1 ______
DAYS 2 ______

427. CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 428)
DEAD (GO TO 429)

428. Are you still breastfeeding (NAME)?

YES 1 (GO TO 432)
NO 2

429. For how many months did you breastfeed (NAME)?

MONTHS _________
DON'T KNOW 98

430. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) _______ 96

431. CHECK 404:
CHILD ALIVE?

ALIVE (GO TO 434)
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440)

432. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ______

433. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS _________

434. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

435. At any time yesterday or last night, was (NAME) given any of the following:

Plain water?
Sugar water?
Juice?
Tea?
Baby formula?
Tinned or powdered milk?
Fresh milk?
Any other liquids?
Any solid or mushy food made from grain such as maize, rice, wheat, and soybean?
Any solid or mushy food made from tuber such as cassava, sweet potato and yam?
Eggs, fish, or poultry?
Meat?
Any other solid or semi-solid foods?

PLAIN WATER
YES 1
NO 2
DON'T KNOW 8
SUGAR WATER
YES 1
NO 2
DON'T KNOW 8
JUICE
YES 1
NO 2
DON'T KNOW 8
TEA
YES 1
NO 2
DON'T KNOW 8
BABY FORMULA
YES 1
NO 2
DON'T KNOW 8
TINNED/POWDR'D MILK
YES 1
NO 2
DON'T KNOW 8
FRESH MILK
YES 1
NO 2
DON'T KNOW 8
OTHER LIQUIDS
YES 1
NO 2
DON'T KNOW 8
FOOD MADE FROM GRAIN
YES 1
NO 2
DON'T KNOW 8
FOOD MADE FROM TUBER
YES 1
NO 2
DON'T KNOW 8
EGGS/FISH/POULTRY
YES 1
NO 2
DON'T KNOW 8
MEAT
YES 1
NO 2
DON'T KNOW 8
OTHER SOLID/SEMI-SOLID FOODS
YES 1
NO 2
DON'T KNOW 8

436. CHECK 435:
FOOD OR LIQUID GIVEN YESTERDAY?

'YES' TO ONE OR MORE (GO TO 437)
'NO/DON'T KNOW' TO ALL (GO TO 439)

437. (Aside from breastfeeding,) how many times did (NAME) eat yesterday, including both meals and snacks?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

438. On how many days during the last seven days was (NAME) given any of the following:

Plain water?
Any kind of milk (other than breast milk)?
Liquids other than plain water or milk?
Any solid or mushy food made from grain such as maize, rice, wheat and soybean?
Any solid or mushy food made from tuber such as cassava, sweet potato and yam?
Eggs, fish, or poultry?
Meat?
Any other solid or semi-solid foods?

IF DON'T KNOW, RECORD '8'.
RECORD THE NUMBER OF DAYS.

PLAIN WATER
NUMBER OF DAYS____
MILK
NUMBER OF DAYS____
OTHER LIQUIDS
NUMBER OF DAYS____
FOOD MADE FROM GRAIN
NUMBER OF DAYS____
FOOD MADE FROM TUBER
NUMBER OF DAYS____
EGGS/FISH/POULTRY
NUMBER OF DAYS____
MEAT
NUMBER OF DAYS____
OTHER SOLID/SEMI-SOLID FOODS
NUMBER OF DAYS____

439. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440. ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

441. LINE NUMBER FROM Q212

LINE ____

442. FROM Q212 AND Q216

NAME ______
ALIVE (GO TO 443)
DEAD (GO TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465)

443. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3

444. Did you ever have a vaccination card for (NAME)?

YES 1 (GO TO 447)
NO 2 (GO TO 447)

445. (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ___
MONTH _____
YEAR ______
POLIO 1
DAY ___
MONTH _____
YEAR ______
POLIO 2
DAY ___
MONTH _____
YEAR ______
POLIO 3
DAY ___
MONTH _____
YEAR ______
DPT 1
DAY ___
MONTH _____
YEAR ______
DPT 2
DAY ___
MONTH _____
YEAR ______
DPT 3
DAY ___
MONTH _____
YEAR ______
MEASLES
DAY ___
MONTH _____
YEAR ______

446. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, DPT 1-3, AND/OR MEASLES VACCINE(S).

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445) (GO TO 449)
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

447. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

448. Please tell me if (NAME) received any of the following vaccinations:*
448A. A BCG vaccination against tuberculosis, that is, an injection in the left arm or shoulder that caused a scar?

YES 1
NO 2
DON'T KNOW 8

448B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 448E)
DON'T KNOW 8 (GO TO 448E)

448C. IF YES: How many times?

NUMBER OF TIMES __

448D. When was the first polio vaccine given?

JUST AFTER BIRTH 1
TWO MONTHS OR LATER 2

448E. DPT vaccination, that is, an injection usually given at the same time as polio drops?

YES 1
NO 2 (GO TO 448G)
DON'T KNOW 8 (GO TO 448G)

448F. IF YES: How many times?

NUMBER OF TIMES __

448G. An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 450)
DON'T KNOW 8 (GO TO 450)

449A. Did you seek advice or treatment for the fever?

YES 1
NO 2 (GO TO 450)

449B. Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH CENTER B
COMMUNITY HEALTH WORKER C
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
MISSION HOSP./CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE SECTOR
SHOP H
TRADITIONAL HEALER I
OTHER (SPECIFY) ____________ X

450. Has (NAME) been ill with a cough at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

451. When (NAME) was ill with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

452. Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 454)

453. Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH CENTER B
COMMUNITY HEALTH WORKER C
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
MISSION HOSP./CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE SECTOR
SHOP H
TRADITIONAL HEALER I
OTHER (SPECIFY) ___________ X

453A. CHECK 453:

MORE THAN ONE PROVIDER (GO TO 453B)
ONLY ONE PROVIDER (GO TO 454)

453B. Which provider did you go to first?

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH CENTER B
COMMUNITY HEALTH WORKER C
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
MISSION HOSP./CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE SECTOR
SHOP H
TRADITIONAL HEALER I
OTHER (SPECIFY) ___________ X

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

YES 1
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

455. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

456. On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF BOWEL MOVEMENTS __
DON'T KNOW 98

457. Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

458. Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

459. Was anything given to treat the diarrhea?

YES 1
NO 2 (GO TO 461)
DON'T KNOW 8 (GO TO 461)

460. What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.

FLUID FROM ORS PACKET A
HOMEMADE SUGAR/SALT SOLUTION B
ANTIBIOTIC PILL OR SYRUP C
OTHER PILL OR SYRUP D
INJECTION E
(I.V.) INTRAVENOUS F
HOME REMEDIES/HERBAL MEDICINES G
OTHER (SPECIFY) ____ X

461. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 464)

462. Where did you seek advice or treatment?
Anywhere else?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GVT. HOSPITAL A
GVT. HEALTH CENTER B
COMMUNITY HEALTH WORKER C
MEDICAL PRIVATE SECTOR
PVT. HOSPITAL/CLINIC D
MISSION HOSP./CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE SECTOR
SHOP H
TRADITIONAL HEALER I
OTHER (SPECIFY) ___________ X

464. GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465. When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS TO DRINK 1
ABOUT SAME AMOUNT TO DRINK 2
MORE TO DRINK 3
DON'T KNOW 8

466. When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

LESS TO EAT 1
ABOUT SAME AMOUNT TO EAT 2
MORE TO EAT 3
DON'T KNOW 8

467. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
SUNKEN EYES K
OTHER (SPECIFY) ____________ X
DON'T KNOW Z

468. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

FAST BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
CHEST INDRAWING I
OTHER (SPECIFY) __________ X
DON'T KNOW Z

468A. When a child is sick with a fever, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

FEVER TWO OR MORE DAYS A
SEIZURES/SHAKING B
CHEST INDRAWING C
NOT EATING/NOT DRINKING WELL D
GETTING SICKER/VERY SICK E
NOT GETTING BETTER F
OTHER (SPECIFY) ____________ X
DON'T KNOW Z

469. CHECK 460 (ALL COLUMNS):

NO CHILD RECEIVED ORS (GO TO 470)
ANY CHILD RECEIVED ORS (GO TO 473)

470. Have you ever heard of a special product called Madzi-a-Moyo or ORS packet you can get for the treatment of diarrhea?

YES 1 (GO TO 472)
NO 2

471. Have you ever seen packets like this before?
SHOW PACKETS.

YES 1
NO 2 (GO TO 476)

472. Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else? SHOW PACKETS.

YES 1
NO 2 (GO TO 475)

473. The last time you prepared Madzi-a-Moyo or ORS packet, did you prepare the whole packet at once or only part of the packet?

WHOLE PACKET AT ONCE 1
PART OF PACKET 2 (GO TO 475)

474. How much water did you use to prepare Madzi-a-Moyo or ORS packet the last time you made it?

1/2 LITER (BANANA CUP) 01
750 MLS 02
1 LITRE 03
1 1/2 LITRES 04
2 LITRES 05
FOLLOWED PACKAGE INSTRUCTIONS 06
OTHER (SPECIFY) ____________ 07
DON'T KNOW 98

475. Where can you get Madzi-a-Moyo or ORS packet?
PROBE: Anywhere else?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
COMMUNITY HEALTH WORKER C
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC D
MISSION HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE SECTOR
SHOP H
TRADITIONAL HEALER I
OTHER (SPECIFY) ___________ X

476. CHECK 460

HOME-MADE FLUID GIVEN TO ANY CHILD (GO TO 447)
HOME-MADE FLUID NOT GIVEN TO ANY CHILD OR 460 NOT ASKED (GO TO 501)

477. Where did you learn to prepare the home fluid made from sugar, salt and water that was given to (NAME) when he/she had diarrhea?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
COMMUNITY HEALTH WORKER 13
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
OTHER PRIVATE SECTOR
SHOP 31
TRADITIONAL HEALER 32
OTHER (SPECIFY) ___________ 41

SECTION 5. MARRIAGE

501. PRESENCE OF OTHERS AT THIS POINT.

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

502. Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 507)
YES, LIVING WITH A MAN 2 (GO TO 507)
NO, NOT IN UNION 3

503. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

504. Have you ever been married or lived with a man?

YES, FORMERLY MARRIED 1 (GO TO 506)
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515F)

506. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 511)
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)

507. Is your husband/partner living with you now or is he staying elsewhere?

LIVES WITH HER 1
STAYING ELSEWHERE 2

507A. WRITE THE NAME OF HER HUSBAND OR PARTNER. OBTAIN HIS LINE NUMBER FROM THE HOUSEHOLD SCHEDULE. IF HE IS NOT LISTED IN THE HOUSEHOLD, WRITE '00'.

NAME ______________
LINE NUMBER___

508. Does your husband/partner have any other wives besides yourself?

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

509. How many other wives does he have?

NUMBER ___
DON'T KNOW 98 (GO TO 511)

510. Are you the first, second,... wife?

RANK ___

511. Have you been married or lived with a man only once, or more than once?

ONCE 1
MORE THAN ONCE 2

512. CHECK 511:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now we will talk about your first husband/partner. In what month and year did you start living with him?

MONTH ___
DON'T KNOW MONTH 98
YEAR ___ (GO TO 514)
DON'T KNOW YEAR 9998

513. How old were you when you started living with him?

AGE ____

514. CHECK 502:

CURRENTLY MARRIED OR LIVING WITH A MAN (GO TO 515)
NOT IN UNION (GO TO 515F)

515. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse with (your husband/the man you are living with)?

NEVER 000 (GO TO 608)

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __

BEFORE LAST BIRTH 996

515A. CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex with (your husband/the man you are living with), was a condom used?

DOES NOT KNOW CONDOM: Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex with (your husband/the man you are living with), was a condom used?

YES 1
NO 2
DOES NOT KNOW 8

515B. Have you had sex with anyone other than (your husband/the man you are living with) in the last 12 months?

YES 1
NO 2 (GO TO 517)

515C. When was the last time you had sexual intercourse with someone other than (your husband/the man you are living with)?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __

BEFORE LAST BIRTH 996

515D. Was a condom used that time?

YES 1
NO 2
DOES NOT KNOW 8

515E. In the last 12 months, how many different persons other than (your husband/the man you are living with) have you had sex with?

NUMBER OF PERSONS ___ (GO TO 517)
DOES NOT KNOW 98 (GO TO 517)

515F. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)?

NEVER 000 (GO TO 608)

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __

BEFORE LAST BIRTH 996

515G. CHECK 301 AND 302:

KNOWS CONDOM: The last time you had sex, was a condom used?

DOES NOT KNOW CONDOM: Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?

YES 1
NO 2
DOES NOT KNOW 8

515H. CHECK 515F:

LESS THAN 12 MONTHS SINCE LAST SEX (GO TO 515I)
12 MONTHS OR LONGER SINCE LAST SEX (GO TO 517)

515I. In the last 12 months, how many different persons have you had sex with?

NUMBER OF PERSONS ___
DOES NOT KNOW 98

517. Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 519)

517. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
COMMUNITY HEALTH WORKER 13
OTHER PUBLIC (SPECIFY) ___________ 14
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 26
OTHER SOURCE
SHOP 31
FRIENDS/RELATIVES 33
OTHER (SPECIFY) _________________ 36

519. How old were you when you first had sexual intercourse?

AGE ____
FIRST TIME WHEN MARRIED 96

SECTION 6. FERTILITY PREFERENCES

601. CHECK 314:

NEITHER STERILIZED (GO TO 602)
HE OR SHE STERILIZED (GO TO 612)

602. CHECK 227:

NOT PREGNANT OR UNSURE: 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?

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DON'T KNOW 8 (GO TO 604)

603. CHECK 227:

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

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

MONTHS 1 ___
YEARS 2 ___

SOON/NOW 993 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) _____ 996
DON'T KNOW 998

604. CHECK 227:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 607)

605. If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606. CHECK 313:
USING A METHOD?

NOT ASKED (GO TO 607)
NOT CURRENTLY USING (GO TO 607)
CURRENTLY USING (GO TO 612)

607. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (GO TO 609)
NO 2
DON'T KNOW 8

608. Do you think you will use a method at any time in the future?

YES 1
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)

609. Which method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTIONS 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
FOAMING TABLETS/JELLY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
NATURAL FAMILY PLANNING 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
OTHER (SPECIFY) ____________ 96 (GO TO 612)
UNSURE 98 (GO TO 612)

610. What is the main reason that you think you will never use a method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22 (GO TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUBFECUND/INFECUND 24 (GO TO 612)
WANTS MORE CHILDREN 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COST TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
OTHER (SPECIFY) ___________ 96 (GO TO 612)
DON'T KNOW 98 (GO TO 612)

611. Would you ever use a method if you were married?

YES 1
NO 2
DON'T KNOW 8

612. 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.

NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 614)

613. 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?

NUMBER OF BOYS
OTHER (SPECIFY) ____________ 96
NUMBER OF GIRLS___
OTHER (SPECIFY) ____________ 96
NUMBER OF EITHER SEX___
OTHER (SPECIFY) ____________ 96

614. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

615. Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

616. In the last few months have you heard or read about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?
From live drama?
From a doctor or a nurse?
From a community health worker?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2
LIVE DRAMA
YES 1
NO 2
DOCTOR OR NURSE
YES 1
NO 2
COMMUNITY HEALTH WORKER
YES 1
NO 2

618. In the last few months have you discussed the practice of family planning with your husband, partner, friends, neighbors, or relatives?

YES 1
NO 2 (GO TO 620)

619. With whom?
Anyone else?
RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
COMMUNITY HEALTH WORKER I
LOCAL COMMUNITY LEADER J
RELIGIOUS LEADER K
OTHER (SPECIFY) ___________ X

620. CHECK 502:

YES, CURRENTLY MARRIED (GO TO 621)
YES, LIVING WITH A MAN (GO TO 621)
NO, NOT IN UNION (GO TO 701)

621. Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning. Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW 8

622. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

623. Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

624. Who do you think should decide on the number of children a couple should have?

WIFE 1
HUSBAND 2
BOTH 3
NO ONE 4
OTHER (SPECIFY) _________ 6
DON'T KNOW 8

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701. CHECK 502 AND 504:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 703)
NEVER MARRIED AND NEVER IN UNION (GO TO 709)

702. How old was your husband/partner on his last birthday?

AGE _______

703. Did your (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 706)

704. What was the highest level of school he attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 706)

705. How many years did he complete at that level?

YEARS ____
DON'T KNOW 98

706. What is (was) your (last) husband/partner's occupation? That is, what kind of work does (did) he mainly do?

OCCUPATION_______________________ ___

707. CHECK 706:

WORKS (WORKED) IN AGRICULTURE (GO TO 708)
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 709)

708. (Does/Did) your husband/partner work mainly on his own land or on family land, or (does/did) he rent land, or (does/did) he work on someone else's land?

HIS LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

709. Aside from your own housework, are you currently working?

YES 1 (GO TO 712)
NO 2

710. 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. Are you currently doing any of these things or any other work?

YES 1 (GO TO 712)
NO 2

711. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 801)

712. What is your occupation, that is, what kind of work do you mainly do?

OCCUPATION_____________ __

713. CHECK 712:

WORKS IN AGRICULTURE (GO TO 714)
DOES NOT WORK IN AGRICULTURE (GO TO 715)

714. Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

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

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

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

THROUGHOUT THE YEAR 1 (GO TO 718)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 719)

717. During the last 12 months, how many months did you work?

NUMBER OF MONTHS ____

718. (In the months you worked,) How many days a week did you usually work?

NUMBER OF DAYS ____ (GO TO 720)

719. During the last 12 months, approximately how many days did you work?

NUMBER OF DAYS ____

720. Do you earn cash for your work?
PROBE: Do you make money for working?

YES 1
NO 2 (GO TO 723)

721. How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?

PER HOUR 1 ___
PER DAY 2 ___
PER WEEK 3 ___
PER MONTH 4 ___
PER YEAR 5 ___

OTHER (SPECIFY) ______________ 99999996

722. CHECK 502:

YES, CURRENTLY MARRIED/YES, LIVING WITH A MAN: Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

NO, NOT IN UNION: Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

RESPONDENT DECIDES 1
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

723. Do you usually work at home or away from home?

HOME 1 (GO TO 801A)
AWAY 2

724. CHECK 217 AND 218:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

YES (GO TO 725)
NO (GO TO 801A)

725. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

RESPONDENT 01
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILDCARE 10
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) ______________ 96

SECTION 8. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

801A. Have you heard about diseases that can be transmitted through sex?

YES 1
NO 2 (GO TO 801K)

801B. Which diseases do you know?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DOES NOT KNOW Z

801C. CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE (GO TO 801D)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 801K)

801D. During the last twelve months, did you have any of these diseases?

YES 1
NO 2 (GO TO 801K)
DOES NOT KNOW 8 (GO TO 801K)

801E. Which of the diseases did you have?
RECORD ALL RESPONSES.

SYPHILIS A
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DOES NOT KNOW Z

801F. The last time you had (DISEASE(S) FROM 801E) did you seek advice or treatment?

YES 1
NO 2 (GO TO 801H)

801G. Where did you seek advice or treatment?
Any other place or person?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
MEDICAL PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC D
MISSION HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
MOBILE CLINIC H
OTHER MED. PRIVATE SECTOR I
OTHER
SHOP J
RELATIVES/FRIENDS K
TRADITIONAL HEALER L
OTHER (SPECIFY) ______ X
DOES NOT KNOW Z

801H. When you had (DISEASE(S) FROM 801E) did you inform your partner(s)?

YES 1
NO 2

801I. When you had (DISEASE(S) FROM 801E) did you do something not to infect your partner(s)?

YES 1
NO 2 (GO TO 801K)
PARTNER ALREADY INFECTED 3 (GO TO 801K)

801J. What did you do?
RECORD ALL MENTIONED.

NO SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICINES C
OTHER (SPECIFY) ___________ X

801K. CHECK 801B

DID NOT MENTION 'AIDS' (GO TO 801L)
MENTIONED 'AIDS' (GO TO 802)

801L. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 811C)

802. From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
LIVE DRAMA K
OTHER (SPECIFY) ___________X

802B. How can a person get AIDS?
Any other ways?
RECORD ALL MENTIONED.

SEXUAL INTERCOURSE A
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS B
SEX WITH PROSTITUTES C
NOT USING CONDOM D
HOMOSEXUAL CONTACT E
BLOOD TRANSFUSION F
INJECTIONS G
KISSING H
MOSQUITO BITES I
CONTAMINATED RAZOR BLADE J
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

803. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 807)
DOES NOT KNOW 8 (GO TO 807)

804. What can a person do?
Any other ways?
RECORD ALL MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

805. CHECK 804:

MENTIONED 'SAFE SEX' (GO TO 806)
DID NOT MENTION 'SAFE SEX' (GO TO 807)

806. What does 'safe sex' mean to you?
RECORD ALL MENTIONED/

ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

807. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DOES NOT KNOW 8

808. Do you think that persons with AIDS almost never die from the disease, sometimes die or almost always die from the disease?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DOES NOT KNOW 8

808A. Can AIDS be cured?

YES 1
NO 2
DOES NOT KNOW 8

808B. Can AIDS be transmitted from mother to child?

YES 1
NO 2
DOES NOT KNOW 8

808C. Do you personally know someone who has AIDS or has died of AIDS?

YES 1
NO 2 (GO TO 809)
DOES NOT KNOW 8 (GO TO 809)

808D. How many people that you personally know now have AIDS?

NUMBER OF PERSONS____

808E. How many people that you personally know have died of AIDS?

NUMBER OF PERSONS___

809. CHECK 801E:
IF RESPONDENT HAS AIDS, CIRCLE 5.
Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 809B)
GREAT 3 (GO TO 809B)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 811A)

809A. Why do you think that you have (no risk/a small chance) of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

ABSTAIN FROM SEX B (GO TO 811A)
USE CONDOMS C (GO TO 811A)
HAVE ONLY ONE SEX PARTNER D (GO TO 811A)
LIMITED NUMBER OF SEX PARTNERS E (GO TO 811A)
SPOUSE HAS NO OTHER PARTNER F (GO TO 811A)
NO HOMOSEXUAL CONTACT G (GO TO 811A)
NO BLOOD TRANSFUSIONS H (GO TO 811A)
NO INJECTIONS I (GO TO 811A)
OTHER (SPECIFY) ___________________X (GO TO 811A)

809B. Why do you think that you have a (moderate/great) chance of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.

DO NOT USE CONDOMS C
MORE THAN ONE SEX PARTNER D
MANY SEX PARTNERS E
SPOUSE HAS OTHER PARTNER(S) F
HOMOSEXUAL CONTACT G
HAD BLOOD TRANSFUSION H
HAD INJECTIONS I
OTHER (SPECIFY) ___________________X

811A. Since you heard of AIDS, have you changed your behavior to prevent getting AIDS?
IF YES, what did you do?
Anything else?
RECORD ALL MENTIONED

DIDN'T START SEX A (GO TO 811C)
STOPPED ALL SEX B (GO TO 811C)
STARTED USING CONDOMS C (GO TO 811F)
RESTRICTED SEX TO ONE PARTNER D (GO TO 811C)
REDUCED NUMBER OF PARTNERS E (GO TO 811C)
ASK SPOUSE TO BE FAITHFUL F (GO TO 811C)
NO MORE HOMOSEXUAL CONTACTS G (GO TO 811C)
STOPPED INJECTIONS I
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
NO BEHAVIOR CHANGE Y

811B. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
IF YES, In what way?
RECORD ALL MENTIONED

DIDN'T START SEX A
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
NO MORE HOMOSEXUAL CONTACTS G
OTHER (SPECIFY) __________ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DOES NOT KNOW Z

811C. Some people use a condom during sexual intercourse to avoid getting AIDS or other sexually transmitted diseases. Have you ever heard of this?

YES 1
NO 2 (GO TO 811F)

811D. CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE (GO TO 811E)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 813)

811E. We may already have talked about this. Have you ever used a condom during sex to avoid getting or transmitting diseases, such as AIDS?

YES 1 (GO TO 811G)
NO 2 (GO TO 811G)

811F. CHECK 515 AND 515F:

HAS HAD SEXUAL INTERCOURSE (GO TO 811G)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 813)

811G. Have you given or received money, gifts or favours in return for sex at any time in the last 12 months?

YES 1
NO 2

812. Would you say you approve or disapprove of couples using condoms to avoid contracting or spreading AIDS and other sexually transmitted diseases?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

813. Is it acceptable or not acceptable to you for information on AIDS to be provided:

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

814. In the last few months have you heard or read about AIDS:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?
From live drama?
From a doctor or a nurse?
From a community health worker?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
LEAFLETS OR BROCHURES
YES 1
NO 2
LIVE DRAMA
YES 1
NO 2
DOCTOR OR NURSE
YES 1
NO 2
COMMUNITY HEALTH WORKER
YES 1
NO 2

SECTION 9. MATERNAL MORTALITY

901. 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?

NUMBER OF BIRTHS TO NATURAL MOTHER ______

902. CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 916)

903. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ____

904. What was the name given to your mother's (first born, second born,..)?

NAME__________

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DON'T KNOW 8 (GO TO NEXT BROTHER OR SISTER)

907. How old is (NAME)?

AGE__________ (GO TO NEXT BROTHER OR SISTER)

908. In what year did (NAME) die?

19___ (GO TO 910)
DON'T KNOW 98

909. How many years ago did (NAME) die?

YEARS__________

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

AGE__________ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT BROTHER OR SISTER)

911. Was (NAME) pregnant when she died?

YES 1 (GO TO 914)
NO 2

912. Did (NAME) die during childbirth?

YES 1 (GO TO 915)
NO 2

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

YES 1
NO 2 (GO TO 915)

914. Was her death due to complications of pregnancy or childbirth?

YES 1
NO 2

915. How many children did (NAME) give birth to during her lifetime?

NUMBER OF CHILDREN__________ (GO TO NEXT BROTHER OR SISTER)

IF NO MORE BROTHERS OR SISTERS, GO TO 916.

916. RECORD THE TIME.

HOUR ____
MINUTES ____

SECTION 10. HEIGHT AND WEIGHT

1001. CHECK 215:

ONE OR MORE BIRTHS SINCE JAN. 1991
IN 1002 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE.
IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991.
IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1991, USE CONTINUATION SHEETS). (GO TO 1002)
NO BIRTHS SINCE JAN. 1991 (END INTERVIEW)

1002. LINE NO. FROM Q.212

LINE NUMBER___

1003. NAME FROM Q.212 FOR CHILDREN

(NAME) ______________

1004. DATE OF BIRTH FROM Q.215, AND ASK FOR DAY OF BIRTH
(YOUNGEST LIVING CHILD AND NEXT-TO-YOUNGEST LIVING CHILD ONLY)

DAY __
MONTH __
YEAR __

1005. BCG SCAR ON TOP LEFT SHOULDER
(YOUNGEST LIVING CHILD AND NEXT-TO-YOUNGEST LIVING CHILD ONLY)

SCAR SEEN 1
NO SCAR 2

1006. HEIGHT (in centimeters)

HEIGHT_____._

1007. WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?
(YOUNGEST LIVING CHILD AND NEXT-TO-YOUNGEST LIVING CHILD ONLY)

LYING 1
STANDING 2

1008. WEIGHT (in kilograms)

WEIGHT_____._

1009. DATE WEIGHED AND MEASURED

DAY __
MONTH __
YEAR __

1010. RESULT

RESPONDENT
MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) ________6
YOUNGEST LIVING CHILD AND NEXT-TO-YOUNGEST LIVING CHILD
CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ________ 6

1011. NAME OF MEASURER: ________ __
NAME OF ASSISTANT: _________ __

INTERVIEWER'S OBSERVATIONS

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: _____________