MINISTRY OF HEALTH /CENTRAL STATISTICAL OFFICE

IDENTIFICATION

LOCALITY NAME__________________

CLUSTER NUMBER________________

HOUSEHOLD NUMBER_________________

PROVINCE_________________

RURAL/URBAN

PLACE

NAME AND LINE NUMBER OF WOMAN:
NAME_______________
LINE NUMBER_________

IS WOMAN SELECTED FOR QUESTIONS ON DOMESTIC VIOLENCE (CHECK SECTION 12)?

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS):
DATE_________
INTERVIEWER'S NAME______________
RESULT*_____

RESULT*

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____________
TIME______________

FINAL VISIT
DAY________
MONTH__________
YEAR____________
INT. NUMBER__________
RESULT*

TOTAL NUMBER OF VISITS________

LANGUAGE OF QUESTIONNAIRE

LANGUAGE OF INTERVIEW

NATIVE LANGUAGE OF RESPONDENT

TRANSLATOR USED?

SUPERVISOR
NAME_______________
DATE________________

FIELD EDITOR
NAME_________________
DATE_________________

OFFICE EDITOR____________

KEYED BY_____________

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is __________________. I am working with the ministry of health in collaboration with the Central Statistical Office (CSO). We are conducting a survey about health all over Zambia. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30-60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you.

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

Do you have any questions?

May I begin the interview now?

101) RECORD THE TIME

102) In what month and year were you born?

103) How old were you at your last birthday? COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

104) Have you ever attended school?

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

106) What is the highest grade you completed at that level?

107) CHECK 105:

108) 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 of the sentence to me?

109) CHECK 108:

110) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week, or not at all?

111) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

112) Do you watch television almost every day, at least once a week, less than once a week or not at all.

113) What is your religion?

114) What tribe do you belong to?

114A) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS.

114B) Just before you moved here, did you live in Lusaka, another city, in a town, or in a village?

115) In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

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

SECTION 2. REPRODUCTION

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

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

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?

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?

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?

210) CHECK 208:

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

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

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

214) Were any of these births twins?

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

216) Is (NAME) still alive?

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?

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 any months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN 2 YEARS; OR YEARS.

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

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
IF YES, RECORD BIRTH(S) IN TABLE.

223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER.

225) FOR EACH BIRTH SINCE JANUARY 2008, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

227) How many months pregnant are you? RECORD THE NUMBER OF COMPLETED MONTHS

ENTER 'P'S IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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

229) Did you want to have a baby later on or did you not want any (more) children?

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

231) When did the last such pregnancy end?

232) CHECK 231:

233) How many months pregnant were you when the last such pregnancy ended?

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

234) Since January 2008, have you had any other pregnancies that did not result in a live birth?

235) ASK THE DATE AND DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2008.

ENTER 'T' IN THE CALENDAR IN THE MONTHS THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions, or stillbirths that ended before 2008?

237) When did the last such pregnancy that terminated before 2008 end?

238) When did your last menstrual period start?

239) 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?

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

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard or (METHOD)?

302) CHECK 226:

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

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

304A) What name of injectables are you using? ASK TO SEE THE CLINIC CARD IF RESPONDENT DOES NOT KNOW THE NAME OF BRAND.

305) What is the brand name of the pills you are using?
ASK TO SEE THE PACKAGE IF RESPONDENT DOES NOT REMEMBER NAME OF BRAND.

306) What is the brand name of the condoms you are using?
ASK TO SEE THE PACKAGE IF RESPONDENT DOES NOT REMEMBER NAME OF BRAND.

307) In what facility did the sterilization take place?
PROBE THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

308) In what month and year was the sterilization performed?
308A) Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping.

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

310) CHECK 308/308A

311) 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 2008.

USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH

ILLUSTRATIVE QUESTIONS:

When was the last time you used a method? Which method was that?
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

ASK WHY SHE STOPPED USING THE METHOD. ID A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.

ILLUSTRATIVE QUESTIONS:

Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1

312) CHECK TO CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

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

314) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?
315A) Where did you learn to use the standard days/lactational amenorrhea/ rhythm method?

316) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

317) At that time, were you told about side effects or problems you might have with the method?
317A) When you got sterilized, were you told about the side effects or problems you might have with the method?

318) Were you told by a health or family planning worker about side effects or problems you might have with the method?

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

320) CHECK 317:

CODE '1' CIRCLED: At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

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

322) CHECK 304:

CIRCLE METHOD CODE:

IF MORE THAN ONE METHOD CODE CIRCLED IN 304, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

323) 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 PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

325) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

326) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

327) In the last 12 months, have you visited a health facility for care for yourself (or your children)?

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

SECTION 4. PREGNANCY AND POSTNATAL CARE AND BREAST FEEDING

401) CHECK 224:

402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH IN2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST TWO 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) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

404) FROM 212 AND 216

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

406) Did you want to have a baby later on, or did you not want any (more) children?

407) How much longer would you have liked to wait?

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

409) Whom did you see? Anyone else?

PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

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

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

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

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

413A) During this pregnancy were you offered counselling and testing for the virus that causes AIDS?

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy?

414A) Did you discuss a birth preparedness plan with a health provider?

414B) Did the birth preparedness plan include a discussion about:

414C) Did you use the birth plan?

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

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

417) CHECK 416:

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

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

420) How many years ago did you receive the last tetanus injection before this pregnancy?

421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP.

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.

423) During this pregnancy, did you take any drug for intestinal worms?

424) During this pregnancy, did you take any drugs to keep you from getting malaria?

425) What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

426) CHECK 425:
DRUGS TAKEN FOR MALARIA PREVENTION

427) How many times did you take (SP/Fansidar) during this pregnancy?

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?

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

431) Was (NAME) weighed at birth?

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

433) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

434) Where did you give birth to (NAME)?
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

434A) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

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

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

437) Did anyone check on your health after you left the facility?

437A) Why didn't you deliver in a health facility? PROBE: Any other reason?

RECORD ALL MENTIONED.

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

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

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.

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his or her health?

443) How many hours days or weeks after the birth of (NAME) did the first check take place??

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

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

445) 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 PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS

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

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

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

450) CHECK 226:
IS RESPONDENT PREGNANT?

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

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

453) Did you ever breast feed (NAME)?

454) CHECK 404:
IS CHILD LIVING?

455) How long after the 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.

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

457) What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

458) CHECK 404: IS CHILD LIVING?

459) Are you still breast feeding (NAME)?

459A) For how many months did you breastfeed (NAME)?

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

461) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 461A.
461A) Sometimes a woman can have a problem of constant leakage of urine or stool from her vagina during the day and night. This problem usually occurs after a difficult childbirth, but may also occur after a sexual assault or after pelvic surgery.

Have you ever experienced a constant leakage of urine or stool from your vagina during the day and night?

461B) Have you ever heard of this problem?

461C) CHECK 224:

461D) Did this problem after you delivered a baby or had a stillbirth?

461E) Did this problem start after a normal labor and delivery, or after a very difficult labor and delivery?

461F) What do you think caused this problem?

461G) How many days after (CAUSE OF PROBLEM FROM 461C OR 461E) did the leakage start?
ENTER '90' IF 90 DAYS OR MORE

461H) Have you not sought treatment for this condition?

461I) Why have you not sought treatment?

PROBE AND RECORD ALL MENTIONED.

461J) CHECK 224:

461K) From whom did you last seek treatment?

461L) Did you have an operation to fix the problem?

461M) Did the treatment stop the leakage completely?
IF NO: Did the treatment reduce the leakage?

461N) CHECK 224:

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501) ENTER INTO THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN2008 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE THE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) BIRTH HISTORY FROM 212 IN BIRTH HISTORY

503) FROM 212 AND 216

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

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

506) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WSA GIVEN, BUT NO DATE IS RECORDED.

IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

507) CHECK 506:

508) 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, DHH 1-3 AND/OR MEASLES VACCINES.

509) Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

510) Please tell me if (NAME) received any of the following vaccinations:
510A) A BCG vaccination against tuberculosis, that is, an injection in the arm that usually causes a scar?

510B) Polio vaccine, that is, drops in the mouth?

510C) Was the polio vaccine received in the first two weeks after birth or later?

510D) How many times was the polio vaccine received?

510E) A DPT-HepB+Hib vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

510F) How many times was the DPT-HepB+Hib vaccination received?

510G) A measles injection or that is, a shot in the arm at the age of 9 months or older to prevent him/her from getting measles?

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

512) In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like (this/any of these)?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

513) Was (NAME) given any drug for intestinal worms in the last six months?

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

515) Was there any blood in the stools?

516) Now I would like to know how much (NAME) was given to drink during the diarrhoea (including breastmilk).

Was he/she given less than the 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?

517) When (NAME) had diarrhoea, 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?

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

519) Where did you seek advice or treatment?

Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

520) CHECK 519:

521) Where did you first seek advice or treatment?

521A) How many days after the diarrhoea began did you first seek advice or treatment for (NAME)? IF THE SAME DAY, RECORD '00'

521B) Does (NAME) still have diarrhoea?

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhoea:

523) Was anything (else) given to treat the diarrhoea?

524) What (else) was given to treat the diarrhoea?
Anything else?
RECORD ALL TREATMENTS GIVEN.

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

526) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

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

528) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

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

530) CHECK 525: HAD FEVER?

531) 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?

532) When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

534) Where did you seek advice or treatment?
Anywhere else?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

535) CHECK 534:

536) Where did you first seek advice or treatment?

536A) How many days after the illness began did you first seek advice or treatment for (NAME)?

IF THE SAME DAY, RECORD '00'

536B) Is (NAME) sill sick with a (fever/cough)?

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

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

538A) CHECK 538:
CODE A-K CIRCLED?

538B) Did you already have (NAME OF DRUG FROM 538) at home when the child became ill?

ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'K' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 538.

IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG.

IF NO FOR ALL DRUGS, CIRCLE 'Y'

539) CHECK 538:
ANY CODE A-I CIRCLED?

540) CHECK 538: SP/FANSIDAR ('A') GIVEN

541) How long after the fever started did (NAME) first take (SP/Fansidar)?

541A) For how many says did (NAME) take the (SP/Fansidar)?
IF 7 DAYS OR MORE, RECORD 7.

542) CHECK 538: CHLOROQUINE ('B') GIVEN

543) How long after the fever started did (NAME) first take chloroquine?

543A) For how many days did (NAME) take the chloroquine?
IF 7 DAYS OR MORE, RECORD 7.

544) CHECK 538: AMODIAQUINE ('C') GIVEN

545) How long after the fever started did (NAME) first take amodiaquine?

545A) For how many days did (NAME) take the amodiaquine.
IF MORE THAN 7 DAYS, RECORD 7

546) CHECK 538: QUININE ('D') GIVEN

547) How long after the fever started did (NAME) first take quinine?

547A) For how many days did (NAME) take the quinine?
IF MORE THAN 7 DAYS, RECORD 7

548) CHECK 538: COARTEM/ACT ('E') GIVEN

549) How long after the fever did (NAME) first take coartem/ACT?

549A) For how many days did (NAME) take the coartem/ACT (COMBINATION WITH ARTEMISININ)?
IF MORE THAN 7 DAYS, RECORD 7

549B) CHECK 538: ARTEMETHER ('F') GIVEN

549C) How long after the fever started did (NAME) first take artemether?

549D) For how many days did (NAME) take the artemether?

549E) CHECK 538: ASUNATE/ARTESUNATE ('G') GIVEN

549F) How long after the fever started did (NAME) first take the asunate/artesunate?

549G) For how many days did (NAME) take the asunate/artesunate?
IF 7 DAYS OR MORE, RECORD 7.

549H) CHECK 538: ARTEETHER ('H') GIVEN

549I) How long after the fever started did (NAME) first take arteether?

549J) For how many days did (NAME) take the arteether?
IF 7 DAYS OF MORE, RECORD 7

550) CHECK 538: OTHER ANTIMALARIAL ('I') GIVEN

551) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

551A) For how many days did (NAME) take the (OTHER ANTIMALARIAL)?
IF 7 DAYS OR MORE, RECORD 7.

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2008 OR LATER LIVING WITH THE RESPONDENT

554) The last time (NAME FROM 553) passed stool, what was done to dispose of the stool?

555) CHECK 522(a), ALL COLUMNS:

556) Have you ever heard of a special product called ORS packet you can get for the treatment of diarrhea?

557) CHECK 215 AND 218, ALL ROWS:

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.
Did (NAME FROM 557) (drink/eat):

559) CHECK 558 (CATEGORIES "g" THROUGH "v"):

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

561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night?

IF 7 OR MORE TIMES, RECORD '7'.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

601) Are you currently married or living together with a man as if married?

602) Have you ever been married or lived together with a man as if married?

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

604) Is your husband/partner living with you now or is he staying elsewhere?

605) RECORD THE HUSBAND/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?

607) Including yourself, in total, how many wives or partners does your husband live with now as if married?

608) Are you the first, second, ... wife/partner?

609) Have you been married or lived with a man only once or more than once?

609A) CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

609B) CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

609C) How did your previous marriage or union end?

609D) To whom did most of your late husband's property go?

609E) Did you receive any of your late husband's assets or valuables?

610) CHECK 609:

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?

611) How old were you when you first started living with him?

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

613) 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?

613A) CHECK 103:

613B) Do you intend to wait until you get married to have sexual intercourse for the first time?

613C) CHECK 103:

613D) The first time you had sexual intercourse, was a male or female condom used?

613E) How old was the person you first had sexual intercourse with?

613F) Was this person older than you, younger than you, or about the same age as you?

613G) Would you say this person was ten or more years older than you or less than ten years older than you?

614) 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.

615) When was the last time you has 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. IF LESS THAN ONE DAY, RECORD '00' DAYS.

616) When was the last time you had sexual intercourse with this person?

617) The last time you had sexual intercourse with (this/second/third) person, was a female or male condom used?

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

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

620) CHECK 609:

621) CHECK 613:

622) How long ago did you first have sexual intercourse with (this/second/third) person?

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

624) How old is this person?

624A) The last time you has sexual intercourse with (this/second/third) person, did you or this person drink alcohol?

624B) Were you or your partner drunk at that time?
IF YES: Who was drunk?

625) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

626) 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'

627) In total, with how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95

628) CHECK PRESENCE OF OTHERS DURING THIS SECTION

629) Do you know of a place where a person can get male condoms?

630) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

631) If you wanted to, could you yourself get a male condom?

632) Do you know of a place where a person can get female condoms?

633) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

634) If you wanted to, could you yourself get a female condom?

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

702) CHECK 226:

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

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

705) CHECK 226:

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

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

706) CHECK 226:

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

708) CHECK 705:

709) CHECK 704:

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.

710) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

711A) Which contraceptive method would you prefer to use?

711B) What is the main reason that you think you will not use a contraceptive method at any time in the future?

711C) Would you ever use a contraceptive method if you were married?

712) CHECK 216:

HAS LIVING CHILDREN: If you could go back in 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.

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

714) In the last few months have you:

715) In the last six months, have you listened to the following programmes on the radio?

715A) In the last six months, have you seen any of the following programmes on television?

716) CHECK 601:

717) CHECK 304: CURRENT CONTRACEPTIVE METHOD?

717A) Does your (husband/partner) know that you are using a method of family planning?

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

719) CHECK 304:

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

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601 AND 602:

802) How old was your (husband/partner) on his last birthday?

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

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

805) What was the highest grade he completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD "00".

806) CHECK 801:

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?

808) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have 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?

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?

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

811) What is your occupation, that is, what kind of work do you mainly do?

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

812A) Do you usually work at home or away from home?

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

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

815) CHECK 601:

816) CHECK 814:

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

818) 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?

819) Who usually decides how your husband's/partner's earning will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

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

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

821A) Who usually makes decisions about making purchases for daily household needs?

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

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

824) Do you own any land either alone or jointly with someone else?

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

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

SECTION 9. HIV/AIDS

901) Now I would like to talk about something else. Have you heard of an illness called AIDS?

902) Can people reduce their chances of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

903) Can people get the AIDS virus from mosquito bites?

904) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

905) Can people get the AIDS virus by sharing food with a person who has AIDS?

905A) Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

906) Can people get the AIDS virus because of witchcraft or supernatural means?

907) Is it possible for a healthy-looking person to have the AIDS virus?

907A) Do you think your risk of getting infected with HIV is low medium or high, or do you have no risk at all?

908) Can the virus that causes AIDS be transmitted from a mother to her baby:

909) CHECK 908:

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

910A) Have you heard about the antiretroviral drugs (ARVs) that people infected with the AIDS virus can get from a doctor or nurse to help then live longer?

910B) Do you know anyone on antiretroviral therapy (ART) treatment?

911) CHECK 208 AND 215:

912) CHECK 408 FOR LAST BIRTH:

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

914) During any of the antenatal visits for your last birth, did anyone talk to you about:

915) Were you offered a test for the AIDS virus as part of your antenatal care?

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

917) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

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

918A) Did you disclose your results to any of the following:

919) All women are supposed to receive counselling after being testes. After you were tested, did you receive counselling?

919B) How many times were you tested in total at ANC?

920) CHECK 434 FOR LAST BIRTH:

921) Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?

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

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

924) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

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

926) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

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

927A) For your most recent test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

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

929) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMIN3E IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

930) Do you know of a place where people can go to get tested for the AIDS virus?

931) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

932) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

933) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

934) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

935) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

935A) Do you personally know someone who has or is suspected to have the AIDS virus?

935B) Do you agree or disagree with the following statement: "People with the AIDS virus should be blamed for bringing the disease into the community."

936) Should children aged 12-14 be taught about using a condom to avoid getting AIDS?

936A) Should children aged 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

936B) Some individuals would choose not to go for HIV testing. Why in your opinion is this so?
CIRCLE ALL THAT ARE MENTIONED.

937) CHECK 901:

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?

938) CHECK 613:

939) CHECK 937:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

940) 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?

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

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

943) CHECK 940, 941, AND 942:

944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

945) 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 PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

945A) Husbands and wives do not always agree on everything. If a wife know her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

946) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that the use a condom when they have sex?

946A) Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

947) Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women other than his wives?

948) CHECK 601:

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

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

SECTION 10. OTHER HEALTH ISSUES

1000A) Have you ever heard of an illness called tuberculosis or TB?

1000B) How does tuberculosis spread from one person to another?
PROBE: Any other ways?

RECORD ALL MENTIONED

1000C) Can tuberculosis be cured?

1000D) If a member of your family got tuberculosis, would you want it to remain a secret or not?

1000E) If a member of your family got tuberculosis, would you care for them?

1001) Now I would like to ask you some other questions relating to health matters. Have ou 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.

1002) Among these injections, how many were administered by a 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.

1002A) 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 PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1003) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1004) Do you currently smoke cigarettes?

1005) In the last 24 hours, how many cigarettes did you smoke?

1006) Do you currently smoke or use any (other) type of tobacco?

1007) What (other) type of tobacco do you currently smoke or use?

RECORD ALL MENTIONED.

1007A) Do you drink alcohol?

1007B) In the last one week how many days did you drink alcohol?

1008) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?

1009) Are you covered by any health insurance or health scheme?

1010) What type of health (insurance/scheme)?

RECORD ALL MENTIONED.

1010A) CHECK 217:

1010B) Now I would like to ask you about you 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)?

1010C) (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

1010D) 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)?

SECTION 11. MATERNAL MORTALITY

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

How many children did your mother give birth to, including you?

1102) CHECK 1101:

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

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

1105) Is (NAME) male or female?

1106) Is (NAME) still alive?

1107) How old is (NAME)?

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

1109) How old was (NAME) when he/she died?

1110) Was (NAME) pregnant when she died?

1111) Did (NAME) die during childbirth?

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

1113) How many live born children did (NAME) give birth to during her lifetime?
IF NO MORE BROTHERS OR SISTERS, GO TO 1201

TICK HERE IS CONTINUATION SHEET USED ___

SECTION 12. DOMESTIC VIOLENCE

1201) CHECK HOUSEHOLD QUESTIONNAIRE, QH21 AND COVER PAGE

1202) CHECK FOR PRESENCE OF OTHERS. DO NOT CONTINUE UNTIL PRIVACY IS ENSURED

READ TO THE RESPONDENT:

Now I would like to ask you questions about some other important aspects of a woman's life. You may find some of these questions 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 in your household will know that you were asked these questions.

1203) CHECK 601 AND 602:

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/partner)?

1205) Now I need to ask some more questions about your relationship with your (last) (husband/partner).

1205A) Did your (last) (husband/partner) ever:

1205B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

1206) Did your (last) (husband/partner) ever do any of the following things to you:

1206B) How often did this happen in the last 12 months: often, only sometimes, or not at all?

1207) CHECK 1206A (a-j):

1208) How long after you (first got married/started living together) with your (last) (husband/partner) did (this/any of these things) first happen?

IF LESS THAN ONE YEAR, RECORD '00'

1209) Did the following ever happen as a result of what your (last) (husband/partner) did to you?

1210) Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) (husband/partner) at times when he was not already beating or physically hurting you?

1211) In the last 12 months, how often have you done this to your (last) (husband/partner): often, only sometimes, or not at all?

1212) Does (did) your (last) (husband/partner) drink alcohol?

1213) How often does (did) he get drunk: often, only sometimes, or never?

1214) Are (Were) you afraid of your (last) (husband/partner): most of the time, sometimes, or never?

1215) CHECK 609:

1216) So far we have been talking about the behavior of your (current/last) (husband/partner). Now I want to ask you about the behavior of any previous (husband/partner).

1216A) Did any previous (husband/partner)...

1216B) How long ago did this happen?

1217) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN: From the time you were 15 years old has anyone other than (your/any) (husband/partner) hit you, slapped you, kicked you or done anything else to hurt you physically?

NEVER MARRIED/NEVER LIVED WITH A MAN: From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

1218) Who has hurt you in this way?

Anyone else?

RECORD ALL MENTIONED.

1219) In the last 12 months, how often (has this person/have these persons) physically hurt you: often, only sometimes, or not at all?

1220) CHECK 201, 226, AND 230:

1221) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

1222) Who has done any of these things to physically hurt you while you were pregnant?

Anyone else?

RECORD ALL MENTIONED

1223) CHECK 601 AND 602:

1223A) Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner). At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

1223B) 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 when you did not want to?

1224) Who was the person who was forcing you the first time?

1225) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN: In the last 12 months, has anyone other than (your/any) (husband/partner) physically forced you to have sexual intercourse when you did not want to?

NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?

1225A) CHECK 1206A (h-j) and 1216A(b)

1226) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts by anyone, including (your/any) (husband/partner)?

NEVER MARRIED/NEVER LIVED WITH A MAN: How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1227) CHECK 1206A (a-j), 1216A (a,b) 1217, 1221, 1223A, AND 1223B:

1228) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

1229) From whom have you sought help?

Anyone else?

RECORD ALL MENTIONED.

1230) Have you ever told anyone about this?

1231) As far as you know, did your father ever beat your mother?

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.

1232) 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?

1233) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE.

COMMENTS_________

1234) RECORD THE TIME.

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 ____

CALENDAR

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

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE:

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE: