LOCALITY NAME ___________________ ___
NAME OF HOUSEHOLD HEAD ____________________ ___
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
PROVINCE _________________ ___
RURAL 2
LUSAKA/OTHER CITY/TOWN/VILLAGE
OTHER CITY 2
TOWN 3
VILLAGE 4
NAME AND LINE NUMBER OF WOMAN _______________ ___
IS WOMAN SELECTED FOR QUESTIONS ON DOMESTIC VIOLENCE (SECTION 12)?
NO 2
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT*___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT:
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
INT. NUMBER ___
RESULT* ____
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
LANGUAGE OF QUESTIONNAIRE: ENGLISH 01
BEMBA 02
KAONDE 03
LOZI 04
LUNDA 05
LUVALE 06
NYANJA 07
TONGA 08
OTHER 09
BEMBA 02
KAONDE 03
LOZI 04
LUNDA 05
LUVALE 06
NYANJA 07
TONGA 08
OTHER 09
SOMETIME 2
ALL THE TIME 3
SUPERVISOR
NAME ________ ___
DATE ________
FIELD EDITOR
NAME ________ ___
DATE ________
OFFICE EDITOR___
KEYED BY___
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
Greetings. My name is _______________ and I am working with MOH in conjunction with Central Statistical Office (CSO). We are conducting a national survey that asks women (and men) about various health issues. We would very much appreciate your participitation in this survey. This information will help the government to plan health services. The interview usually takes between 30 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of interviewer: ___________________ Date: _________
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES _______
102. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)
103. Just before you moved here, did you live in Lusaka, another city, in a town, or in a village?
OTHER CITY 2
TOWN 3
VILLAGE 4
104. In the last 12 months, on how many separate occasions have you travelled away from your home community and slept away?
NONE 00 (GO TO 106)
105. In the last 12 months, have you been away from your home community for more than one month at a time?
NO 2
106. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.
108. Have you ever attended school?
NO 2 (GO TO 112)
109. What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
110. What is the highest grade you completed at that level?
SECONDARY OR HIGHER (GO TO 115)
112. 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?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _______ 4
BLIND/VISUALLY IMPAIRED 5
113. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1' OR '5' CIRCLED (GO TO 116)
115. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
116. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
117. Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY) _________ 6
119. What tribe do you belong to?
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202. Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (GO TO 204)
203. How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.
204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
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'.
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 or showed signs of life but did not survive?
NO 2 (GO TO 208)
207. How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.
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?
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)
NO BIRTHS (GO TO 226)
211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).
212. What name was given to your (first/next) baby?
213. Were any of these births twins?
MULT 2
214. Is (NAME) a boy or a girl?
GIRL 2
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
NO 2 (GO TO 220)
217. IF ALIVE: How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.
218. IF ALIVE: Is (NAME) living with you?
NO 2
219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD)
220. 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.
MONTHS 2 ____
YEARS 3 ____
221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
NO 2 (GO TO NEXT BIRTH)
222. Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
223. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. __
FOR EACH BIRTH SINCE JANUARY 2002: MONTH AND YEAR OF BIRTH ARE 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 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __
224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2002 OR LATER.
IF NONE, RECORD '0' AND GO TO 226.
225. FOR EACH BIRTH SINCE JANUARY 2002, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)
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. 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?
LATER 2
NOT AT ALL 3
229. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (GO TO 237)
230. When did the last such pregnancy end?
LAST PREGNANCY ENDED BEFORE JAN. 2002 (GO TO 237)
232. How many months pregnant were you when the last such pregnancy ended?
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF MONTHS.
233. Since January 2003, have you had any other pregnancies that did not result in a live birth?
NO 2 (GO TO 235)
234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2002.
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
235. Did you have any miscarriages, abortions or stillbirths that ended before 2002?
NO 2 (GO TO 237)
236. When did the last such pregnancy that terminated before 2002 end?
237. When did your last menstrual period start?
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
238. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)
239. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) _____ 6
DON'T KNOW 8
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? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF
EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD
IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD
WITH CODE 1 CIRCLED IN 301, ASK 302.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
use to avoid pregnancy?
NO 2
302. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
use to avoid pregnancy?
NO 2
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)
304. Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
305. ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH. (GO TO 333)
306. What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).
307. 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'.
WOMAN STERILIZED (GO TO 311A)
PREGNANT (GO TO 322)
310. Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 322)
311. Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD IN LIST.
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
MALE STERILIZATION B (GO TO 316)
PILL C (GO TO 312)
IUD D (GO TO 315)
INJECTABLES E (GO TO 311B)
IMPLANTS F (GO TO 315)
MALE CONDOM G (GO TO 313)
FEMALE CONDOM H (GO TO 313)
DIAPHRAGM I (GO TO 315)
FOAM/JELLY J (GO TO 315)
LACTATIONAL AMEN. METHOD K (GO TO 319A)
RHYTHM METHOD L (GO TO 319A)
WITHDRAWAL M (GO TO 319A)
OTHER (SPECIFY) _____ X (GO TO 319A)
311B. What name/type of injectables are you using?
NORISTERAT (2MONTHS) 2 (GO TO 315)
DEPO PROVERA (3 MONTHS) 3 (GO TO 315)
OTHER (SPECIFY) ____________ 6 (GO TO 315)
312. What brand of pills are you using?
ASK TO SEE THE PACKAGE IF RESPONDENT DOES NOT REMEMBER NAME OF BRAND.
MICROGYNON 02 (GO TO 314)
MICROLUT 03 (GO TO 314)
EUGYNON 04 (GO TO 314)
LOGYNON 05 (GO TO 314)
NORDETTE 06 (GO TO 314)
ORALCON F 07 (GO TO 314)
OTHER (SPECIFY) ___________ 96 (GO TO 314)
DON'T KNOW 98 (GO TO 314)
313. What brand name of the condoms did you use?
ASK TO SEE THE PACKAGE IF RESPONDENT DOES NOT REMEMBER NAME OF BRAND.
MAXIMUM SCENTED 02
ROUGH RIDER 03
DUREX 04
CARE FEMALE CONDOM 05
FEMIDOM 06
REALITY 07
PUBLIC SECTOR: UNBRANDED (WHITE COLOR FOIL) 08
OTHER (SPECIFY) ____________ 96
DON'T KNOW 98
314. How many (pill cycles/condoms) did you get the last time?
DON'T KNOW 998
315. The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?
FREE 999995 (GO TO 319A)
DON'T KNOW 999998 (GO TO 319A)
316. In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE DOCTOR'S OFFICE 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
DON'T KNOW 98
CODE 'A' CIRCLED: Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?
CODE 'B' CIRCLED: Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?
NO 2
DON'T KNOW 8
318. How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?
FREE 999995
DON'T KNOW 999998
319. In what month and year was the sterilization performed?
319A. 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?
320. CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A
NO (GO TO 321)
YEAR IS 2001 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2002. THEN GO TO 331)
322. 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 2002.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
* When did you start using that method? How long after the birth of (NAME)?
* How long did you use the method then?
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 324A)
RHYTHM METHOD 12 (GO TO 324A)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)
324. Where did you obtain (CURRENT METHOD) when you started using it?
324A. Where did you learn to use the lactational amenorrhea/rhythm method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12
HEALTH POST 13
OTHER PUBLIC (SPECIFY) ______ 16
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
WORK PLACE 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
CHURCH 32
FRIEND/RELATIVE 33
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07 (GO TO 332)
FEMALE CONDOM 08 (GO TO 329)
DIAPHRAGM 09 (GO TO 329)
FOAM/JELLY 10 (GO TO 329)
LACTATIONAL AMEN. METHOD 11 (GO TO 335)
RHYTHM METHOD 12 (GO TO 335)
326. You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?
NO 2
327. Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (GO TO 329)
328. Were you told what to do if you experienced side effects or problems?
NO 2
CODE 0'1' CIRCLED: At that time, were you told about other methods of family planning that you could use?
CODE '01' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM 316 OR 324), were you told about other methods of family planning that you could use?
NO 2
330. Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (GO TO 335)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMEN. METHOD 11 (GO TO 335)
RHYTHM METHOD 12 (GO TO 335)
WITHDRAWAL 13 (GO TO 335)
OTHER METHOD 96 (GO TO 335)
332. Where did you obtain (CURRENT METHOD) the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12 (GO TO 335)
HEALTH POST 13 (GO TO 335)
OTHER PUBLIC (SPECIFY) ______ 16 (GO TO 335)
MISSION HOSPITAL/CLINIC 22 (GO TO 335)
PHARMACY 23 (GO TO 335)
PRIVATE DOCTOR 24 (GO TO 335)
WORK PLACE 25 (GO TO 335)
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26 (GO TO 335)
CHURCH 32 (GO TO 335)
FRIEND/RELATIVE 33 (GO TO 335)
333. Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 335)
334. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
COMMUNITY WORKPLACE K
WORKPLACE L
MOBILE CLINIC M
FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) ______ O
CHURCH Q
FRIEND/RELATIVE R
335. In the last 12 months, were you visited by a fieldworker who talked to you about family planning?
NO 2
336. In the last 12 months, have you visited a health facility for care for yourself (or your children)?
NO 2 (GO TO 401)
337. Did any staff member at the health facility speak to you about family planning methods?
NO 2
SECTION 4. PREGNANCY AND POSTNATAL CARE AND BREASTFEEDING
NO BIRTHS IN 2002 OR LATER (GO TO 576)
402. CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)
403. LINE NUMBER FROM 212
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 not want to have any (more) children at all?
LATER 2
NOT AT ALL 3 (GO TO 407)
406. How much longer would you have liked to wait?
YEARS 2 __
DON'T KNOW 998
407. Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.
[LAST BIRTH ONLY]
CLINICAL OFFICER B
NURSE/MIDWIFE C
NO ONE Y (GO TO 414)
408. Where did you receive antenatal care for this pregnancy? Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
[LAST BIRTH ONLY]
OTHER HOME B
GOVT. HEALTH CENTER D
GOVT. HEALTH POST E
OTHER PUBLIC (SPECIFY) ____________ F
MISSION HOSPITAL/CLINIC H
WORK PLACE I
OTHER PRIVATE MED. (SPECIFY) _____________ J
409. How many months pregnant were you when you first received antenatal care for this pregnancy?
[LAST BIRTH ONLY]
DON'T KNOW 98
410. How many times did you receive antenatal care during this pregnancy?
[LAST BIRTH ONLY]
DON'T KNOW 98
411. As part of your antenatal care during this pregnancy, were any of the following done at least
once?
Were you weighed?
Was your height measured?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?
[LAST BIRTH ONLY]
NO 2
NO 2
NO 2
NO 2
NO 2
411A. During this pregnancy were you offered counselling and testing for the virus that causes AIDS?
[LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
412. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy
complications?
[LAST BIRTH ONLY]
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)
413. Were you told where to go if you had any of these complications?
[LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
413A. Did you discuss a birth preparedness plan with a health provider including:
[LAST BIRTH ONLY]
NO 2
NO 2
NO 2
414. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[LAST BIRTH ONLY]
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
415. During this pregnancy, how many times did you get this tetanus injection?
[LAST BIRTH ONLY]
DON'T KNOW 8
OTHER (GO TO 417)
417. At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?
[LAST BIRTH ONLY]
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)
418. Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[LAST BIRTH ONLY]
DON'T KNOW 8
419. In what month and year did you receive the last tetanus injection before this pregnancy?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
420. How many years ago did you receive that tetanus injection?
[LAST BIRTH ONLY]
421. During this pregnancy, were you given or did you buy any iron tablets or iron syrup or folic acid?
SHOW TABLETS/SYRUP.
[LAST BIRTH ONLY]
NO 2 (GO TO 423)
DON'T KNOW 8 (GO TO 423)
422. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[LAST BIRTH ONLY]
DON'T KNOW 998
423. During this pregnancy, did you take any drug for intestinal worms?
[LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
424. During this pregnancy, did you have difficulty with your vision during daylight?
[LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
425. During this pregnancy, did you suffer from night blindness?
[LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
426. During this pregnancy, did you take any drugs to keep you from getting malaria?
[LAST BIRTH ONLY]
NO 2 (GO TO 432)
DON'T KNOW 8 (GO TO 432)
427. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[LAST BIRTH ONLY]
CHLOROQUINE B
COARTEM C
OTHER (SPECIFY) ____________ X
DON'T KNOW Z
428. CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION.
CODE 'A' NOT CIRCLED (GO TO 431A)
429. How many times did you take (SP/Fansidar) during this pregnancy?
[LAST BIRTH ONLY]
430. CHECK 407:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY
OTHER (GO TO 431A)
431. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?
[LAST BIRTH ONLY]
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY) ______________ 6
431A. Did you use the birth plan?
[LAST BIRTH ONLY]
NO 2
432. When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
433. Was (NAME) weighed at birth?
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)
434. How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KG. FROM RECALL 2 ___.___
DON'T KNOW 9.998
435. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.
CLINICAL OFFICER B
NURSE/MIDWIFE C
RELATIVE/FRIEND E
OTHER (SPECIFY) ________ X
436. Where did you give birth to (NAME)?
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.
OTHER HOME 12 (GO TO 443)
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE MED. (SPECIFY) _____________ 36
437. How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998
438. Was (NAME) delivered by caesarean section?
NO 2
439. Before you were discharged after (NAME) was born, did any health care provider check on your health?
NO 2 (GO TO 442)
440. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[LAST BIRTH ONLY]
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998
441. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[LAST BIRTH ONLY]
CLINICAL OFFICER 12 (GO TO 453)
NURSE/MIDWIFE 13 (GO TO 453)
COMMUNITY/VILLAGE HEALTH WORKER 22 (GO TO 453)
442. After you were discharged, did any health care provider or a traditional birth attendant check on your health?
NO 2 (GO TO 453)
443. Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.
[LAST BIRTH ONLY]
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) __________ X
444. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on your health?
NO 2 (GO TO 449)
445. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[LAST BIRTH ONLY]
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998
446. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[LAST BIRTH ONLY]
CLINICAL OFFICER 12
NURSE/MIDWIFE 13
COMMUNITY/VILLAGE HEALTH WORKER 22
447. Where did this first check take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
OTHER HOME 12
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE MED. (SPECIFY) _____________ 36
NOT ASKED (GO TO 449)
449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?
[LAST BIRTH ONLY]
NO 2 (GO TO 453)
DON'T KNOW 8 (GO TO 453)
450. 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.
[LAST BIRTH ONLY]
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998
451. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[LAST BIRTH ONLY]
CLINICAL OFFICER 12
NURSE/MIDWIFE 13
COMMUNITY/VILLAGE HEALTH WORKER 22
452. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
OTHER HOME 12
GOVT. HEALTH CENTER 22
GOVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____________ 26
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE MED. (SPECIFY) _____________ 36
453. In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW CAPSULES.
[LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
454. Has your menstrual period returned since the birth of (NAME)?
[LAST BIRTH ONLY]
NO 2 (GO TO 457)
455. Did your period return between the birth of (NAME) and your next pregnancy?
[EXCLUDE LAST BIRTH]
NO 2 (GO TO 459)
456. For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
457. CHECK 226:
IS RESPONDENT PREGNANT?
[LAST BIRTH ONLY]
PREGNANT OR UNSURE (GO TO 459)
458. Have you begun to have sexual intercourse again since the birth of (NAME)?
[LAST BIRTH ONLY]
NO 2 (GO TO 460)
459. For how many months after the birth of (NAME) did you not have sexual intercourse?
[LAST BIRTH ONLY]
DON'T KNOW 98
460. Did you ever breastfeed (NAME)?
[LAST BIRTH ONLY]
NO 2 (GO TO 467)
461. 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.
[LAST BIRTH ONLY]
HOURS 1 ______
DAYS 2 ______
462. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[LAST BIRTH ONLY]
NO 2 (GO TO 464)
463. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[LAST BIRTH ONLY]
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) _____ X
464. CHECK 404:
IS CHILD LIVING?
DEAD (GO TO 466)
465. Are you still breastfeeding (NAME)?
[LAST BIRTH ONLY]
NO 2
466. For how many months did you breastfeed (NAME)?
DON'T KNOW 98
467. CHECK 404:
IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501)
468. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[LAST BIRTH ONLY]
469. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
470. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
471. GO BACK TO 405 IN NEXT-TO-LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 501.
SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION
501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
502. LINE NUMBER FROM 212
DEAD __ (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 573)
504. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 508)
NO CARD 3
505. Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 508)
506. (1) COPY VACCINATION DATE 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.
(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
MONTH _____
YEAR ______
507. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-4, DPT 1-3, AND/OR
MEASLES VACCINES.
NO 2 (GO TO 510)
DON'T KNOW 8 (GO TO 510)
508. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization campaign?
NO 2 (GO TO 512)
DON'T KNOW 8 (GO TO 512)
509. Please tell me if (NAME) received any of the following vaccinations:
509A. A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
509B. Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 509E)
DON'T KNOW 8 (GO TO 509E)
509C. Was the first polio vaccine received in the first two weeks after birth or later?
LATER 2
509D. How many times was the polio vaccine received?
509E. A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?
NO 2 (GO TO 509G)
DON'T KNOW 8 (GO TO 509G)
509F. How many times was a DPT vaccination received?
509G. A measles injection, that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?
NO 2
DON'T KNOW 8
510. Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?
NO 2
NO VACCINATION IN THE LAST 2 YRS. 3
DON'T KNOW 8
512. CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE
NO CARD/CODE '44' FOR MOST RECENT VITAMIN A DOSE (GO TO 514)
513. According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD). Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
NO 2 (GO TO 517)
DON'T KNOW 8 (GO TO 517)
514. HAS (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF CAPSULES.
NO 2 (GO TO 517)
DON'T KNOW 8 (GO TO 517)
515. Did (NAME) receive a vitamin A dose within the last six months?
NO 2
DON'T KNOW 8
517. Has (NAME) taken any drug for intestinal worms in the last six months?
NO 2
DON'T KNOW 8
518. Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)
519. Was there any blood in the stools?
NO 2
DON'T KNOW 8
520. Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
521. When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
522. Did you seek advice or treatment for the diarrhea from any source?
NO 2 (GO TO 527)
523. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE
CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT HEALTH CENTER B
GOVT HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY-BASED AGENT I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
TRADITIONAL PRACTIONER L
ONLY ONE CODE CIRCLED (GO TO 526)
525. Where did you first seek advice or treatment?
GOVT HEALTH CENTER B
GOVT HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY-BASED AGENT I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
TRADITIONAL PRACTIONER L
526. How many days after the diarrhea began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
527. Does (NAME) still have diarrhea?
NO 2
DON'T KNOW 8
528. Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
a) A fluid made from a special packet called [LOCAL NAME FOR ORS PACKET]?
b) A pre-packaged ORS liquid?
c) A government-recommended homemade fluid?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
529. Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 533)
DON'T KNOW 8 (GO TO 533)
530. What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
HOME REMEDY/ HERBAL MEDICINE I
OTHER (SPECIFY) __________ X
533. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
534. Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (GO TO 537)
DON'T KNOW 8 (GO TO 537)
535. When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?
NO 2 (GO TO 538)
DON'T KNOW 8 (GO TO 538)
536. Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (GO TO 538)
BOTH 3 (GO TO 538)
OTHER (SPECIFY) ___________ 6 (GO TO 538)
DON'T KNOW 8 (GO TO 538)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
538. Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough). Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
539. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
540. Did you seek advice or treatment for the illness from any source?
NO 2 (GO TO 545)
541. Where did you seek advice or treatment? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE
CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT HEALTH CENTER B
GOVT HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY-BASED AGENTS I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
TRADITIONAL PRACTIONER L
ONLY ONE CODE CIRCLED (GO TO 544)
543. Where did you first seek advice or treatment?
GOVT HEALTH CENTER B
GOVT HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY-BASED AGENTS I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
TRADITIONAL PRACTIONER L
544. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
545. Is (NAME) still sick with a (fever/cough)?
COUGH ONLY 2
BOTH FEVER AND COUGH 3
NO, NEITHER 4
DON'T KNOW 8
546. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
547. What drugs did (NAME) take? Any other drugs?
CIRCLE ALL MENTIONED.
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COARTEM E
ARINATE F
OTHER ANTIMALARIAL (SPECIFY) ____________ G
INJECTION I
PARACETAMOL (PANADOL) K
ACETAMINOPHEN L
IBUPROFEN M
DON'T KNOW Z
548. CHECK 547:
ANY CODE A-I CIRCLED?
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
549. Did you already have (NAME OF DRUG FROM 547) at home when the child became ill?
ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'I' THAT THE CHILD IS
RECORDED AS HAVING TAKEN IN 547. IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG. IF NO FOR ALL DRUGS, CIRCLE 'Y'.
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COARTEM E
ARINATE F
OTHER ANTIMALARIAL (SPECIFY) ____________ G
INJECTION I
DON'T KNOW Z
550. CHECK 547:
ANY CODE A-G CIRCLED?
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
551. CHECK 547:
SP/FANSIDAR ('A') GIVEN
CODE 'A' NOT CIRCLED (GO TO 554)
552. How long after the fever started did (NAME) first take SP/Fansidar?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
553. For how many days did (NAME) take the SP/Fansidar?
IF 7 DAYS OR MORE, RECORD 7.
DON'T KNOW 8
554. CHECK 547:
CHLOROQUINE ('B') GIVEN
CODE 'B' NOT CIRCLED (GO TO 557)
555. How long after the fever started did (NAME) first take chloroquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
556. For how many days did (NAME) take the chloroquine?
IF 7 DAYS OR MORE, RECORD 7.
DON'T KNOW 8
557. CHECK 547:
AMODIAQUINE ('C') GIVEN
CODE 'C' NOT CIRCLED (GO TO 560)
558. How long after the fever started did (NAME) first take Amodiaquine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
559. For how many days did (NAME) take the Amodiaquine?
IF 7 DAYS OR MORE, RECORD 7.
DON'T KNOW 8
560. CHECK 547:
QUININE ('D') GIVEN
CODE 'D' NOT CIRCLED (GO TO 563)
561. How long after the fever started did (NAME) first take quinine?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
562. For how many days did (NAME) take the quinine?
IF 7 DAYS OR MORE, RECORD 7.
DON'T KNOW 8
CODE 'E' NOT CIRCLED (GO TO 566)
564. How long after the fever started did (NAME) first take COARTEM?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
565. For how many days did (NAME) take the COARTEM (COMBINATION WITH ARTEMISININ)?
IF 7 DAYS OR MORE, RECORD 7.
DON'T KNOW 8
566. CHECK 547:
ARINATE ('F') GIVEN
CODE 'F' NOT CIRCLED (GO TO 569)
567. How long after the fever started did (NAME) first take ARINATE?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
568. For how many days did (NAME) take the ARINATE?
IF 7 DAYS OR MORE, RECORD 7.
DON'T KNOW 8
569. CHECK 547:
OTHER ANTIMALARIAL ('G') GIVEN
CODE 'G' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573)
570. How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8
571. For how many days did (NAME) take the (OTHER ANTIMALARIAL)?
IF 7 DAYS OR MORE, RECORD 7.
DON'T KNOW 8
572. GO TO 503 IN NEXT COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 573
573. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2002 OR LATER LIVING WITH THE RESPONDENT
NONE (GO TO 576)
574. The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) __________ 96
575. CHECK 528(a) AND 528(b), ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 577)
576. Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET] you can get for the treatment of diarrhea?
NO 2
577. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT
578. Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night.
Did (NAME FROM 577) (drink/eat):
Plain water?
Commercially produced infant formula?
Any [BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G., Vitaso and cerelac]? ASK TO SEE THE PACKET
Any (other) porridge?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
579. Now I would like to ask you about (other) liquids or foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods. Did (NAME FROM 577)/you drink (eat):
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
'
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
580. CHECK 578 (LAST 2 CATEGORIES) AND 579 (CATEGORIES d THROUGH r FOR CHILD):
NOT A SINGLE 'YES' (GO TO 601)
581. How many times did (NAME FROM 577) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
SECTION 6. MARRIAGE AND SEXUAL ACTIVITY
601. Are you currently married or living together with a man as if married?
YES, LIVING WITH A MAN 2 (GO TO 604)
NO, NOT IN UNION 3
602. Have you ever been married or lived together with a man as if married?
YES, LIVED WITH A MAN 2
NO 3 (GO TO 617)
603. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)
604. Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
605. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
606. Does your husband/partner have other wives or does he live with other women as if married?
NO 2 (GO TO 609)
DON'T KNOW 8 (GO TO 609)
607. Including yourself, in total, how many wives or partners does your husband live with now as if married?
DON'T KNOW 98
608. Are you the first, second, ? wife/partner?
609. Have you been married or lived with a man only once or more than once?
MORE THAN ONCE 2 (GO TO 611)
610. CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?
NOT ASKED OR CURRENTLY DIVORCED/SEPARATED (GO TO 615)
611. CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?
CURRENTLY WIDOWED (GO TO 613)
CURRENTLY DIVORCED/SEPARATED (GO TO 615)
612. How did your previous marriage or union end?
DIVORCE 2 (GO TO 615)
SEPARATION 3 (GO TO 615)
613. To whom did most of your late husband's property go?
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
NO PROPERTY 5
OTHER (SPECIFY) ___________ 6
614. Did you receive any of your late husband's assets or valuables?
NO 2
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 I would like to ask about when you started living with your first husband/partner. In what month and year was that?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
616. How old were you when you first started living with him?
617. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
618. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you had sexual intercourse for the very first time?
AGE IN YEARS ___ (GO TO 621)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 621)
AGE 25-49 (GO TO 641)
620. Do you intend to wait until you get married to have sexual intercourse for the first time?
NO 2 (GO TO 641)
DON'T KNOW/NOT SURE 8 (GO TO 641)
AGE 25-49 (GO TO 625A)
622. The first time you had sexual intercourse, was a condom used?
NO 2
DON'T KNOW/DON'T REMEMBER 8
623. How old was the person you first had sexual intercourse with?
DON'T KNOW 98
624. Was this person older than you, younger than you, or about the same age as you?
YOUNGER 2 (GO TO 625A)
ABOUT THE SAME AGE 3 (GO TO 625A)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 625A)
625. Would you say this person was ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
625A. Now I would like to ask you some questions about your recent sexual activity. 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.
626. 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. WHEN IS LESS THAN A DAY RECORD '00'
WEEKS AGO 2 __ (GO TO 628)
MONTHS AGO 3 __ (GO TO 628)
YEARS AGO 4 __ (GO TO 640)
627. When was the last time you had sexual intercourse with this person?
[Exclude Last Sexual Partner]
WEEKS 2 __
MONTHS 3 __
628. The last time you had sexual intercourse with this (second/third) person, was a condom used?
NO 2 (GO TO 630)
629. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?
NO 2
630. What was your relationship to this (second/third) person with whom you had sexual intercourse? IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'.
IF NO, CIRCLE '3'.
LIVE-IN PARTNER 2 (GO TO 636)
BOYFRIEND NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
SEX WORKER 5
OTHER (SPECIFY) ___________ 6
631. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.
MONTHS 2 __
YEARS 3 __
AGE 25-49 (GO TO 636)
DON'T KNOW 98
634. Is this person older than you, younger than you, or about the same age?
YOUNGER 2 (GO TO 636)
SAME AGE 3 (GO TO 636)
DON'T KNOW 8 (GO TO 636)
635. Would you say this person is ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
636. The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?
NO 2 (GO TO 638)
637. Were you or your partner drunk at that time?
IF YES: Who was drunk?
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4
638. Apart from [this person/these two people], have you had sexual intercourse with any other
person in the last 12 months?
[Ask only for Last Sexual Partner and Second to last Sexual Partner]
NO 2 (GO TO 640)
639. 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 GREATER THAN 95, WRITE '95.'
[Ask only for Third for last Sexual Partner]
DON'T KNOW 98
640. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'
DON'T KNOW 98
641. Do you know of a place where a person can get male condoms?
NO 2 (GO TO 644)
642. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY BASED AGENT I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
FRIENDS/RELATIVES L
643. If you wanted to, could you yourself get a male condom?
NO 2
DON'T KNOW/UNSURE 8
644. Do you know of a place where a person can get female condoms?
NO 2 (GO TO 701)
645. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY BASED AGENT I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
FRIENDS/RELATIVES L
646. If you wanted to, could you yourself get a female condom?
NO 2
SECTION 7. FERTILITY PREFERENCES
CODE A OR B CIRCLED: HE OR SHE STERILIZED (GO TO 713)
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?
NO MORE/NONE 2 (GO TO 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709)
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)
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?
YEARS 2 ___
SOON/NOW 993 (GO TO 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) _____ 996 (GO TO 708)
DON'T KNOW 998 (GO TO 708)
PREGNANT (GO TO 709)
705. CHECK 310:
USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING (GO TO 706)
CURRENTLY USING (GO TO 713)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 707)
00-23 MONTHS OR 00-01 YEAR (GO TO 709)
WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy.
Can you tell me why you are not using a method? Any other reason?
WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
RECORD ALL REASONS MENTIONED.
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
708. CHECK 310:
USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING (GO TO 709)
YES, CURRENTLY USING (GO TO 713)
709. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 711)
DON'T KNOW 8 (GO TO 713)
710. Which contraceptive method would you prefer to use?
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
FEMALE CONDOM 08 (GO TO 713)
DIAPHRAGM 09 (GO TO 713)
FOAM/JELLY 10 (GO TO 713)
LACTATIONAL AMEN. METHOD 11 (GO TO 713)
NATURAL FAMILY PLANNING (RHYTHM METHOD) 12 (GO TO 713)
WITHDRAWAL 13 (GO TO 713)
CYCLE BEADS 14 (GO TO 713)
OTHER (SPECIFY) ______ 96 (GO TO 713)
UNSURE 98 (GO TO 713)
711. What is the main reason that you think you will not use a contraceptive method at any time in the future?
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 713)
SUBFECUND/INFECUND 24 (GO TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 713)
HUSBAND/PARTNER OPPOSED 32 (GO TO 713)
OTHERS OPPOSED 33 (GO TO 713)
RELIGIOUS PROHIBITION 34 (GO TO 713)
KNOWS NO SOURCE 42 (GO TO 713)
FEAR OF SIDE EFFECTS 52 (GO TO 713)
LACK OF ACCESS/TOO FAR 53 (GO TO 713)
COSTS TOO MUCH 54 (GO TO 713)
INCONVENIENT TO USE 55 (GO TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 713)
DON'T KNOW 98 (GO TO 713)
712. Would you ever use a contraceptive method if you were married?
NO 2
DON'T KNOW 8
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 715)
714. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
OTHER (SPECIFY) ______ 96
OTHER (SPECIFY) ______ 96
OTHER (SPECIFY) ______ 96
715. In the last few months have you heard about family planning:
On the radio?
On the television?
In a newspaper or magazine?
NO 2
NO 2
NO 2
716A. In the last six months, have you listened to the following programmes on the radio?
Your Health Matters
Sister Evalina
Our Neighbourhood
Other health related programmes
NO 2
NO 2
NO 2
NO 2
716B. In the last six months, have you seen any of the following programmes on television?
Your Health Matters
Soul City
Insight
Other health related programmes
NO 2
NO 2
NO 2
NO 2
YES, LIVING WITH A MAN (GO TO 718)
NO, NOT IN UNION (GO TO 801)
NO CODE CIRCLED (GO TO 722)
OTHER CODES (GO TO 719)
719. Does your husband/partner know that you are using a method of family planning?
NO 2
DON'T KNOW 8
720. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) _______ 6
CODE A OR B CIRCLED: HE OR SHE STERILIZED (GO TO 801)
722. Does your husband/partner want the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)
802. How old was your husband/partner on his last birthday?
803. Did your (last) husband/partner ever attend school?
NO 2 (GO TO 806)
804. What was the highest level of school he attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 806)
805. What was the highest (grade/form/year) he completed at that level? (GRADE/FORM/YEAR IS EQUAL TO NUMBER OF COMPLETED YEARS SPENT IN SCHOOL)
DON'T KNOW 98
CURRENTLY MARRIED/LIVING WITH A MAN: What is your husband's/partner's occupation? That is, what kind of work does he mainly do?
FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?
807. Aside from your own housework, have you done any work in the last seven days?
NO 2
808. As you know, some women take up jobs for which they are paid in cash or kind. Others 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?
NO 2
809. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?
NO 2
810. Have you done any work in the last 12 months?
NO 2 (GO TO 818)
811. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 814)
813. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
814. Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
815. Do you usually work at home or away from home?
AWAY 2
816. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
817. Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT IN UNION (GO TO 827)
OTHER (GO TO 822)
820. Who usually decides how the money you earn will be used: you, your husband/partner, or you and your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) ___________ 6
821. Would you say that the money that you earn is more than what your husband/partner earns, less than what he earns, or about the same?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 823)
DON'T KNOW 8
822. Who usually decides how your husband's/partner's earnings will be used: you, your husband/partner, or you and your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNINGS 4
OTHER (SPECIFY) ___________ 6
823. Who usually makes decisions about health care for yourself: you, your husband/partner, you and your husband/partner jointly, or someone else?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
824. Who usually makes decisions about making major household purchases?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
825. Who usually makes decisions about making purchases for daily household needs?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
826. Who usually makes decisions about visits to your family or relatives?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6
827. PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRES./ NOT LISTEN. 2
NOT PRES. 3
PRES./ NOT LISTEN. 2
NOT PRES. 3
PRES./ NOT LISTEN. 2
NOT PRES. 3
PRES./ NOT LISTEN. 2
NOT PRES. 3
828. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
901. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 942)
902. Can people reduce their chances of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
903. Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
904. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
905. Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
906. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?
NO 2
DON'T KNOW 8
907. Can people get the AIDS virus because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
908. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
908A. Do you think your risk of getting infected with HIV is low, medium or high, or do you have no risk at all?
MEDIUM 2
HIGH 3
NO RISK 4
OTHER 6
DON'T KNOW 8
909. Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (GO TO 912)
911. Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
912. Have you heard about special antiretroviral drugs (USE LOCAL NAME) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?
NO 2
DON'T KNOW 8
NO BIRTHS (GO TO 922)
LAST BIRTH BEFORE JANUARY 2004 (GO TO 922)
914. CHECK 407 FOR LAST BIRTH:
NO ANTENATAL CARE (GO TO 922)
914A. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
915. During any of the antenatal visits for your last birth, did anyone talk to you about:
Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
916. Were you offered a test for the AIDS virus as part of your antenatal care?
NO 2
917. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?
NO 2 (GO TO 922)
918. I don't want to know the results, but did you get the results of the test?
NO 2
919. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 11
STAND-ALONE VCT CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ______ 16
MISSION HOSPITAL/CLINIC 21
STAND-ALONE VCT CENTER 22
MOBILE CLINIC 23
COMMUNITY/FIELDWORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
920. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?
NO 2
921. When was the last time you were tested for the AIDS virus?
12 - 23 MONTHS AGO 2 (GO TO 929)
2 OR MORE YEARS AGO 3 (GO TO 929)
922. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 927)
923. When was the last time you were tested?
12 - 23 MONTHS AGO 2
2 OR MORE YEARS AGO 3
924. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
925. I don't want to know the results, but did you get the results of the test?
NO 2
926. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 11 (GO TO 929)
STAND-ALONE VCT CENTER 12 (GO TO 929)
FAMILY PLANNING CLINIC 13 (GO TO 929)
MOBILE CLINIC 14 (GO TO 929)
FIELDWORKER 15 (GO TO 929)
OTHER PUBLIC (SPECIFY) ______ 16 (GO TO 929)
MISSION HOSPITAL/CLINIC 21 (GO TO 929)
STAND-ALONE VCT CENTER 22 (GO TO 929)
MOBILE CLINIC 23 (GO TO 929)
COMMUNITY/FIELDWORKER 24 (GO TO 929)
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26 (GO TO 929)
927. Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 929)
928. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
COMMUNITY/FIELDWORKER F
OTHER PUBLIC (SPECIFY) ______ G
MISSION HOSPITA/CLINIC I
STAND-ALONE VCT CENTER J
MOBILE CLINIC K
COMMUNITY/FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
929. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
930. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW 8
931. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW 8
932. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
DON'T KNOW 8
933. Do you personally know someone who has been denied health services in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (GO TO 938)
934. Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
935. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she has or is suspected to have the AIDS virus?
NO 2
AT LEAST ONE 'YES' (GO TO 938)
937. Do you personally know someone who has or is suspected to have the AIDS virus?
NO 2
938. Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves.
DISAGREE 2
DON'T KNOW 8
939. Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.
DISAGREE 2
DON'T KNOW 8
940. Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DON'T KNOW 8
941. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?
NO 2
DON'T KNOW 8
941A. Some individuals would choose not to go for HIV testing. Why in your opinion is this so?
(CIRCLE ALL THAT ARE MENTIONED)
(MORE THAN ONE ANSWER IS POSSIBLE)
FEAR OF RESULTS B
FEAR OF STIGMA/DISCRIMINATION C
DON'T KNOW WHERE TO GO D
OTHER (SPECIFY) ____________ X
HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?
NO 2
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 951)
944. CHECK 942:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (GO TO 946)
945. 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?
NO 2
DON'T KNOW 8
946. Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad smelling abnormal genital discharge?
NO 2
DON'T KNOW 8
947. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 951)
949. The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?
NO 2 (GO TO 951)
950. Where did you go? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC (SPECIFY) ______ G
MISSION HOSPITA/CLINIC I
STAND-ALONE VCT CENTER J
MOBILE CLINIC K
COMMUNITY/FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
951. Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?
NO 2
DON'T KNOW 8
952. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
953. Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?
NO 2
DON'T KNOW 8
954. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?
NO 2
DON'T KNOW 8
NOT IN UNION (GO TO 958)
956. Can you say no to your husband/partner if you do not want to have sexual intercourse?
NO 2
DEPENDS/NOT SURE 8
957. Could you ask your husband/partner to use a condom if you wanted him to?
NO 2
DEPENDS/NOT SURE 8
958. Do you believe that young men should wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW 8
959. Do you think that most young men you know wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW 8
960. Do you believe that men who are not married and are having sex should only have sex with one partner?
NO 2
DON'T KNOW 8
961. Do you think that most men you know who are not married and are having sex, have sex with only one partner?
NO 2
DON'T KNOW 8
962. Do you believe that married men should only have sex with their wives?
NO 2
DON'T KNOW 8
963. Do you think that most married men you know have sex only with their wives?
NO 2
DON'T KNOW 8
964. Do you believe that young women should wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW 8
965. Do you think that most young women you know wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW 8
966. Do you believe that women who are not married and are having sex should only have sex with one partner?
NO 2
DON'T KNOW 8
967. Do you think that most women you know who are not married and are having sex, have sex with only one partner?
NO 2
DON'T KNOW 8
968. Do you believe that married women should only have sex with their husbands?
NO 2
DON'T KNOW 8
969. Do you think that most married women you know have sex only with their husbands?
NO 2
DON'T KNOW 8
SECTION 10. OTHER HEALTH ISSUES
1001. Have you ever heard of an illness called tuberculosis or TB?
NO 2 (GO TO 1005)
1002. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ___________ X
DON'T KNOW Z
1003. Can tuberculosis be cured?
NO 2
DON'T KNOW 8
1004. If a member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW 8
1004A. If a member of your family got tuberculosis, would you care for them?
NO 2
DON'T KNOW 8
1005. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1009)
1006. Among these injections, how many were administered by a trained health worker (doctor, a nurse, a dentist, or any other health worker)?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1009)
1007. The last time you had an injection given to you by a trained health worker where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12
OTHER PUBLIC (SPECIFY) ______ 16
MISSION HOSPITAL/CLINIC 21
DENTAL CLINIC/OFFICE 22
PHARMACY 23
OFFICE OR HOME OF NURSE/HEALTH WORKER 24
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
1008. Did the person who gave you that injection take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1009. Do you currently smoke cigarettes?
NO 2 (GO TO 1011)
1010. In the last 24 hours, how many cigarettes did you smoke?
1011. Do you currently smoke or use any other type of tobacco?
NO 2 (GO TO 1012A)
1012. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) ___________ X
NO 2 (GO TO 1013)
1012B. In the last one week how many days did you drink?
1013. 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?
Getting permission to go?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Not wanting to go alone?
Concern that there may not be a female health provider?
Concern that there may not be any health provider?
Concern that there may be no drugs available?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
1014. Are you covered by any health insurance?
NO 2 (GO TO 1016)
1015. What type of health insurance/scheme?
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
LOW COST PRE-PAYMENT SCHEME E
HIGH COST PRE-PAYMENT SCHEME F
OTHER (SPECIFY) ___________ X
OTHER (GO TO 1018)
1017. Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?
NO 2
1018. Besides your own child/children, are you the primary caregiver for any children under the age of 18?
NO 2 (GO TO 1101)
1019. Have you made arrangements for someone to care for this child/these children in the event that you fall sick or are unable to care for (him/her/them)?
NO 2
SECTION 11. MATERNAL AND ADULT 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?
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1201)
1103. How many of these births did your mother have before you were born?
1104. What was the name given to your oldest (next oldest) brother or sister?
(*USE ADDITIONAL COLUMNS IF THERE ARE OTHER SIBLINGS)
1105. Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 1108)
DON'T KNOW 8 (IF THERE ARE OTHER SIBLINGS, GO TO NEXT BIRTH)
1108. How many years ago did (NAME) die?
1109. How old was (NAME) when he/she died?
1110. Was (NAME) pregnant when she died?
NO 2
DON'T KNOW 8
1111. Did (NAME) die during childbirth?
NO 2
1112. Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2
1113. Was (NAME)'S death due to an accident or violence?
NO 2
IF NO MORE BIRTHS/OR IF NO MORE BROTHERS OR SISTERS, GO TO 1201
TICK HERE IF CONTINUATION SHEET USED __
1201. CHECK FRONT COVER:
WOMAN SELECTED FOR THIS SECTION?
NO (GO TO 1232)
1202. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Zambia. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.
FORMERLY MARRIED (READ IN PAST TENSE) (GO TO 1204)
NEVER MARRIED (GO TO 1215)
1204. 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?
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?
f) He (does/did) not trust you with any money?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1205A. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband. (Does/did) your (last) husband/partner ever:
a) say or do something to humiliate you in front of others?
NO 2
b) threaten to hurt or harm you or someone close to you?
NO 2
c) insult you or make you feel bad about yourself?
NO 2
1205B. CHECK 603: ASK ONLY IF RESPONDENT IS NOT A WIDOW.
How often did this happen during the last 12 months: often, only sometimes, or not at all?
a) say or do something to humiliate you in front of others?
SOMETIMES 2
NOT AT ALL 3
b) threaten to hurt or harm you or someone close to you?
SOMETIMES 2
NOT AT ALL 3
c) insult you or make you feel bad about yourself?
SOMETIMES 2
NOT AT ALL 3
1206A. (Does/did) your (last) husband ever do any of the following things to you:
a) slap you?
NO 2
b) twist your arm or pull your hair?
NO 2
c) push you, shake you, or throw something at you?
NO 2
d) punch you with his fist or with something that could hurt you?
NO 2
e) kick you, drag you or beat you up?
NO 2
f) try to choke you or burn you on purpose?
NO 2
g) threaten or attack you with a knife, gun, or any other weapon?
NO 2
h) physically force you to have sexual intercourse with him even when you did not want to?
NO 2
i) force you to perform any sexual acts you did not want to?
NO 2
1206B. CHECK 603: ASK ONLY IF RESPONDENT IS NOT A WIDOW
How often did this happen during the last 12 months: often, only sometimes, or not at all?
a) slap you?
SOMETIMES 2
NOT AT ALL 3
b) twist your arm or pull your hair?
SOMETIMES 2
NOT AT ALL 3
c) push you, shake you, or throw something at you?
SOMETIMES 2
NOT AT ALL 3
d) punch you with his fist or with something that could hurt you?
SOMETIMES 2
NOT AT ALL 3
e) kick you, drag you or beat you up?
SOMETIMES 2
NOT AT ALL 3
f) try to choke you or burn you on purpose?
SOMETIMES 2
NOT AT ALL 3
g) threaten or attack you with a knife, gun, or any other weapon?
SOMETIMES 2
NOT AT ALL 3
h) physically force you to have sexual intercourse with him even when you did not want to?
SOMETIMES 2
NOT AT ALL 3
i) force you to perform any sexual acts you did not want to?
SOMETIMES 2
NOT AT ALL 3
NOT A SINGLE 'YES' (GO TO 1210)
1208. How long after you first got married to your (last) husband did (this/any of these things) first happen?
IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE 95
1209. Did the following ever happen as a result of what your (last) husband did to you:
a) You had cuts, bruises or aches?
NO 2
b) You had severe burns?
NO 2
c) You had eye injuries, sprains, dislocations, or minor burns?
NO 2
d) You had deep wounds, broken bones, broken teeth, or any other serious injury?
NO 2
1210. Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?
NO 2 (GO TO 1213)
RESPONDENT IS A WIDOW (GO TO 1213)
1212. In the last 12 months, how often have you done this to your husband: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1213. Does (did) your husband drink alcohol?
NO 2 (GO TO 1215)
1214. How often does (did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
1215. CHECK 201, 226, AND 229:
NEVER BEEN PREGNANT (GO TO 1218)
1216. Has anyone ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?
NO 2 (GO TO 1218)
1217. Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER B
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) ___________ X
EVER MARRIED: From the time you were 15 years old has anyone other than your (current/last) husband hit, slapped, kicked, or done anything else to hurt you physically?
NEVER MARRIED: From the time you were 15 years old has anyone ever hit, slapped, kicked, or done anything else to hurt you physically?
NO 2 (GO TO 1221)
REFUSED TO ANSWER/ NO ANSWER 3 (GO TO 1221)
1219. Who has hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) ___________ X
1220. In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
1221. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?
NO 2 (GO TO 1224)
REFUSED TO ANSWER/ NO ANSWER 3 (GO TO 1224)
1222. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
DON'T KNOW 98
1223. Who was the person who was forcing you at that time?
FORMER HUSBAND 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP-FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 11
POLICE/SOLDIER 12
PRIEST/RELIGIOUS LEADER 13
STRANGER 14
OTHER (SPECIFY) ______________ 96
EVER MARRIED: In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?
NEVER MARRIED: In the last 12 months has anyone forced you to have sexual intercourse against your will?
NO 2
REFUSED TO ANSWER/NO ANSWER 3
1225. CHECK 1206A (a-i), 1218, 1221, AND 1224:
NOT A SINGLE 'YES' (GO TO 1229)
1226. Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help to stop the person(s) from doing this to you again?
NO 2 (GO TO 1228)
1227. From whom have you sought help to stop this?
Anyone else?
RECORD ALL MENTIONED.
HUSBAND'S FAMILY B (GO TO 1229)
CURRENT/LAST HUSBAND C (GO TO 1229)
CURRENT/FORMER BOYFRIEND D (GO TO 1229)
FRIEND E (GO TO 1229)
NEIGHBOUR F (GO TO 1229)
RELIGIOUS LEADER G (GO TO 1229)
DOCTOR/MEDICAL PERSONNEL H (GO TO 1229)
POLICE (e.g. Victim Support Unit) I (GO TO 1229)
LAWYER J (GO TO 1229)
SOCIAL SERVICE ORGANIZATION (e.g. YWCA) K (GO TO 1229)
OTHER (SPECIFY) ___________ X (GO TO 1229)
1228. Have you ever told anyone else about this?
NO 2
1229. As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.
1230. 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?
YES MORE THAN ONCE 2
NO 3
YES MORE THAN ONCE 2
NO 3
YES MORE THAN ONCE 2
NO 3
1231. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE______________________________________
MINUTES ___
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
____________________________________________
COMMENTS ON SPECIFIC QUESTIONS:
_____________________________________________
ANY OTHER COMMENTS:
____________________________________________
SUPERVISOR'S OBSERVATIONS
____________________________________________
NAME OF SUPERVISOR: ____________________ DATE: _____________________
EDITOR'S OBSERVATIONS
_____________________________________________
NAME OF EDITOR: ______________________ DATE: _______________________
INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN
BIRTHS, PREGNANCIES, CONTRACEPTIVE USE**
B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER (SPECIFY) _____________
2007
12 DEC 01 _____
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2006
12 DEC 13 _____
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2005
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2004
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2003
12 DEC 49 _____
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2002
12 DEC 61 _____
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02 FEB 71 _____
01 JAN 72 _____