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2013 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY WOMAN'S QUESTIONNAIRE WITH HIV/AIDS

MINISTRY OF HEALTH /CENTRAL STATISTICAL OFFICE

IDENTIFICATION

LOCALITY NAME__________________

CLUSTER NUMBER________________

HOUSEHOLD NUMBER_________________

PROVINCE_________________

RURAL/URBAN

RURAL 1
URBAN 2

PLACE

LUSAKA 1
OTHER CITY 2
TOWN 3
VILLAGE 4

NAME AND LINE NUMBER OF WOMAN:
NAME_______________
LINE NUMBER_________

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

YES 1
NO 2

INTERVIEWER VISITS

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

RESULT

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

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE_____________
TIME______________

FINAL VISIT
DAY________
MONTH__________
YEAR____________
INT. NUMBER__________
RESULT*

TOTAL NUMBER OF VISITS________

LANGUAGE OF QUESTIONNAIRE

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

LANGUAGE OF INTERVIEW

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

NATIVE LANGUAGE OF RESPONDENT

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

TRANSLATOR USED?

YES 1
NO 2

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?

SIGNATURE OF INTERVIEWER________________
DATE____________

May I begin the interview now?

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO END)

101) RECORD THE TIME

HOUR_____________
MINUTES________________

102) In what month and year were you born?

MONTH_______________
DON'T KNOW MONTH 98
YEAR__________________
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS__________________

104) Have you ever attended school?

YES 1
NO 2 (GO TO 108)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

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

GRADE_________________

107) CHECK 105:

PRIMARY (GO TO 108)
SECONDARY OR HIGHER (GO TO 110)

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?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) _________
BLIND/VISUALLY IMPAIRED

109) CHECK 108:

CODE '2' '3' OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

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?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

113) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
OTHER 6 (SPECIFY)____________________________

114) What tribe do you belong to?

TRIBE____________

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

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

YEARS________________

ALWAYS 95 (GO TO 115)
VISITOR 96 (GO TO 115)

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

LUSAKA 1
OTHER CITY 2
TOWN 3
VILLAGE 4

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

NUMBER OF TRIPS___________________
NONE 00 (GO TO 201)

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

YES 1
NO 2

SECTION 2. REPRODUCTION

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

YES 1
NO 2 (GO TO 206)

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

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME______________
DAUGHTERS AT HOME_______________

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

YES 1
NO 2 (GO TO 206)

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

SONS ELSEWHERE_______________
DAUGHTERS ELSEWHERE___________________

206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD________________
GIRLS DEAD_______________

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

TOTAL BIRTHS_____________________

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

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

210) CHECK 208:

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

RECORD NAME________________

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

BOY 1
GIRL 2

214) Were any of these births twins?

SING 1
MULT 2

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

MONTH_____________
YEAR________________

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 220)

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

AGE IN YEARS_____________

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

YES 1
NO 2

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

LINE NUMBER______________ (GO TO NEXT BIRTH OR, IF NO MORE BIRTHS, GO TO 221)

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.

DAYS 1 _____________________
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?

YES 1 (ADD BIRTH)
NO 2 (NEXT BIRTH OR, IF NO MORE BIRTHS, GO TO 222)

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

YES 1
NO 2

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

NUMBERS ARE THE SAME (GO TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

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

NUMBER OF BIRTHS__________________
NONE 0 (GO TO 226)

225) FOR EACH BIRTH SINCE JANUARY 2008, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF 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?

YES 1
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)

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.

MONTHS___________________

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

YES 1 (GO TO 230)
NO 2

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

LATER 1
NO MORE 2

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

YES 1
NO 2 (GO TO 238)

231) When did the last such pregnancy end?

MONTH______________
YEAR_______________

232) CHECK 231:

LAST PREGNANCY ENDED IN JANUARY 2008 OR LATER (GO TO 233)
LAST PREGNANCY ENDED BEFORE JANUARY 2008 (GO TO 238)

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.

MONTHS____________________

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

YES 1
NO 2 (GO TO 236)

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?

YES 1
NO 2 (238)

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

MONTH_______________
YEAR_______________

238) When did your last menstrual period start?

DATE (DD/MM/YYYY) IF GIVEN____________________
DAYS AGO 1_________________
WEEKS AGO 2______________
MONTHS AGO 3_____________
YEARS AGO 4_____________
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

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?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER 6 (SPECIFY)__________________
DON'T KNOW 8

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)?

METHOD 1 Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 2 Male Sterilization. PROBE: men can have an operation to avoid having any more children.
YES 1
NO 2
METHOD 3 IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 4 Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
METHOD 5 Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
METHOD 6 Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
METHOD 7 Male Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
METHOD 8 Female Condom. PROBE: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
METHOD 9 Standard Days Methods (Cycle Beads). PROBE: A woman uses string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
YES 1
NO 2
METHOD 10 LACTATIONAL AMENORRHEA METHOD (LAM).
YES 1
NO 2
METHOD 11 Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
METHOD 12 Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 13 Emergency Contraception. PROBE: As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within three days to prevent pregnancy.
YES 1
NO 2
METHOD 14 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY)__________________
NO 2

302) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 303)
PREGNANT (GO TO 311)

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

YES 1
NO 2 (GO TO 311)

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

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 308A)
INJECTABLES D
IMPLANTS E (GO TO 308A)
PILL F (GO TO 305)
MALE CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 306)
DIAPHRAGM I (GO TO 308A)
FOAM/JELLY J (GO TO 308A)
STANDARD DAYS METHOD K (GO TO 308A)
LACTATIONAL AMEN. METHOD L (GO TO 308A)
RHYTHM METHOD M (GO TO 308A)
WITHDRAWAL N (GO TO 308A)
OTHER MODERN METHOD X (GO TO 308A)
OTHER TRADITIONAL METHOD Y (GO TO 308A)

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

NORIGYNON (2 MONTHS) 1 (GO TO 308A)
NORISTERAT (2 MONTHS) 2 (GO TO 308A)
DEPO PROVERA (3 MONTHS) 3 (GO TO 308A)
OTHER 6 (SPECIFY)______________ (GO TO 308A)

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.

SAFE PLAN 01(GO TO 308A)
MICROGYNON 02 (GO TO 308A)
MICROLUT 03 (GO TO 308A)
EUGYNON 04 (GO TO 308A)
LOGYNON 05 (GO TO 308A)
NORDETTE 06 (GO TO 308A)
ORALCON F 07 (GO TO 308A)
OTHER 96 (SPECIFY)__________________ (GO TO 308A)
DON'T KNOW 98 (GO TO 308A)

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.

MAXIMUM CLASSIC 01 (GO TO 308A)
MAXIMUM SCENTED 02 (GO TO 308A)
ROUGH RIDER 03 (GO TO 308A)
DUREX 04 (GO TO 308A)
CARE FEMALE CONDOM 05 (GO TO 308A)
FEMIDOM 06 (GO TO 308A)
REALITY 07 (GO TO 308A)
PUBLIC SECTOR: UNBRANDED (WHITE COLOR FOIL) 08 (GO TO 308A)
OTHER 96 (SPECIFY)____________________
DON'T KNOW 98

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.

PLACE NAME___________________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER/POST 12
MOBILE HOSPITAL/CLINIC 13
FAMILY PLANNING CLINIC 14
COMMUNITY BASED AGENT/FIELDWORKER 15
OTHER PUBLIC SECTOR 16 (SPECIFY) ______________________
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
COMMUNITY BASED AGENT/FIELDWORKER 25
MOBILE HOSPITAL/CLINIC 26
OTHER PRIVATE MEDICAL SECTOR 27 (SPECIFY) _______________
OTHER 96 (SPECIFY) __________________
DON'T KNOW 98

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.

MONTH__________________
YEAR_____________________

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?

YES (GO BACK TO 308/308A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE USED AFTER LAST BIRTH OR PREGNANCY TERMINATION)
NO (GO TO 310)

310) CHECK 308/308A

YEAR IS 2008 OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING) (GO TO 311)
YEAR IS 2007 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2008) (GO TO 322)

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

NO METHOD USED (GO TO 313)
ANY METHOD USED (GO TO 314)

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

YES 1 (GO TO 324)
NO 2 (GO TO 324)

314) CHECK 304:

CIRCLE METHOD CODE:

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

NO CODE CIRCLED 00 (GO TO 324)
FEMALE STERILIZATION 01 (GO TO 317A)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
STANDARD DAYS METHOD 11 (GO TO 315A)
LACTATIONAL AMEN. METHOD 12 (GO TO 315A)
RHYTHM METHOD 13 (GO TO 315A)
WITHDRAWAL 14 (GO TO 326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER/POST 12
MOBILE HOSPITAL/CLINIC 13
FAMILY PLANNING CLINIC 14
COMMUNITY BASED AGENT/FIELDWORKER 15
OTHER PUBLIC SECTOR 16 (SPECIFY) _____________________
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
COMMUNITY BASED AGENT/FIELDWORKER
MOBILE HOSPITAL/CLINIC 26
OTHER PRIVATE MEDICAL SECTOR 27 (SPECIFY) __________________
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER 96 (SPECIFY) ___________________

316) CHECK 304:

CIRCLE METHOD CODE:

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

IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07 (GO TO 323)
FEMALE CONDOM 08 (GO TO 320)
DIAPHRAGM 09 (GO TO 320)
FOAM/JELLY 10 (GO TO 320)
STANDARD DAYS METHOD 11 (GO TO 326)
LACTATIONAL AMEN. METHOD 12 (GO TO 326)
RHYTHM METHOD 13 (GO TO 326)

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?

YES 1 (GO TO 319)
NO 2

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

YES 1 (GO TO 320)
NO 2

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

YES 1
NO 2

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?

YES 1 (GO TO 322)
NO 2

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

YES 1
NO 2

322) CHECK 304:

CIRCLE METHOD CODE:

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

FEMALE STERILIZATION 01 (GO TO 326)
MALE STERILIZATION 02 (GO TO 326)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
STANDARD DAYS METHOD 11 (GO TO 326)
LACTATIONAL AMEN. METHOD 12 (GO TO 326)
RHYTHM METHOD 13 (GO TO 326)
WITHDRAWAL 14 (326)
OTHER MODERN METHOD 95 (GO TO 326)
OTHER TRADITIONAL METHOD 96 (GO TO 326)

323) Where did you obtain (CURRENT METHOD) the last time?

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

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

NAME OF PLACE ___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER/POST 12
MOBILE HOSPITAL/CLINIC 13
FAMILY PLANNING CLINIC 14
COMMUNITY BASED AGENT/FIELDWORKER 15
OTHER PUBLIC SECTOR 16 (SPECIFY) _____________________
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
COMMUNITY BASED AGENT/FIELDWORKER 25
MOBILE HOSPITAL/CLINIC 26
OTHER PRIVATE MEDICAL SECTORS 27 (SPECIFY) _____________________
OTHER SOURCE

SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER 96 (SPECIFY) __________________________

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

YES 1
NO 2 (GO TO 326)

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.

NAME OF PLACE____________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
FAMILY PLANNING CLINIC D
COMMUNITY BASED AGENT/FIELDWORKER E
OTHER PUBLIC SECTOR F (SPECIFY) __________________________
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
COMMUNITY BASED AGENT/FIELD WORKER K
MOBILE HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL SECTOR M (SPECIFY) ____________________
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
OTHER X (SPECIFY) _________________________

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 401)

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

YES 1
NO 2

SECTION 4. PREGNANCY AND POSTNATAL CARE AND BREAST FEEDING

401) CHECK 224:

ONE OR MORE BIRTHS IN 2008 OR LATER (GO TO 402)
NO BIRTHS IN 2008 OR LATER (GO TO 461A)

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

BIRTH HISTORY NUMBER___________________

404) FROM 212 AND 216

NAME____________________

LIVING (GO TO 405)
DEAD (GO TO 405)

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

YES 1 (GO TO 408 IF LAST BIRTH, 430 IF NEXT-TO-LAST-BIRTH OR SECOND TO LAST BIRTH)
NO 2

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

LATER 1
NO MORE 2 (GO TO 408 IF LAST BIRTH, 430 IF NEXT TO LAST BIRTH OR SECOND TO LAST BIRTH)

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

MONTHS 1 _______________________
YEARS 2 ______________________

DON'T KNOW 998

408) Did you see anyone for antenatal care for this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 415)

409) Whom did you see? Anyone else?
[ASK FOR MOST RECENT BIRTH ONLY]

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

HEALTH PERSONNEL
DOCTOR A
CLINICAL OFFICER B
NURSE/MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY HEALTH WORKER E
OTHER X (SPECIFY) _____________________

410) Where did you receive antenatal care for this pregnancy? Anywhere else?
[ASK FOR MOST RECENT BIRTH ONLY]

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

NAME OF PLACE(S) ____________________
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
GOVT. HOSPITAL C
GOVT. HEALTH CENTER/POST D
MOBILE HOSPITAL/CLINIC E
OTHER PUBLIC SECTOR F (SPECIFY) __________________
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
OTHER PRIVATE MED. SECTOR I (SPECIFY) ___________________
OTHER X (SPECIFY)______________________

411) How many months pregnant were you when you first received antenatal care for this pregnancy? [ASK FOR MOST RECENT BIRTH ONLY]

MONTHS ___________
DON'T KNOW 98

412) How many times did you receive antenatal care during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

NUMBER OF TIMES _______________
DON'T KNOW 98

413) As part of your antenatal care during this pregnancy, were any of the following done at least once? [ASK FOR MOST RECENT BIRTH ONLY]

Were you weighed?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2

413A) During this pregnancy were you offered counselling and testing for the virus that causes AIDS? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

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?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

414A) Did you discuss a birth preparedness plan with a health provider?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 415)

414B) Did the birth preparedness plan include a discussion about:
[ASK FOR MOST RECENT BIRTH ONLY]

Where you will deliver the baby?
YES 1
NO 2
What you will do if a complication arises?
YES 1
NO 2
Who will be there to help you during birth?
YES 1
NO 2

414C) Did you use the birth plan?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2

415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

416) During this pregnancy, how many times did you get this tetanus injection?
[ASK FOR MOST RECENT BIRTH ONLY]

TIMES __________________
DON'T KNOW 8

417) CHECK 416:
[ASK FOR MOST RECENT BIRTH ONLY]

2 OR MORE TIMES (GO TO 421)
OTHER (GO TO 418)

418) At any time before this pregnancy, did you receive any tetanus injections?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)

419) Before this pregnancy, how many other times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[ASK FOR MOST RECENT BIRTH ONLY]

TIMES _______________
DON'T KNOW 8

420) How many years ago did you receive the last tetanus injection before this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

YEARS AGO_________________________

421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP.
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
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.
[ASK FOR MOST RECENT BIRTH ONLY]

DAYS _____________________________
DON'T KNOW 998

423) During this pregnancy, did you take any drug for intestinal worms?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

424) During this pregnancy, did you take any drugs to keep you from getting malaria?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 430)
DON'T KNOW 8 (GO TO 430)

425) What drugs did you take?
[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

SP/FANSIDAR A
CHLORQUINE B
OTHER X (SPECIFY) _____________________
DON'T KNOW Z

426) CHECK 425:
DRUGS TAKEN FOR MALARIA PREVENTION
[ASK FOR MOST RECENT BIRTH ONLY]

CODE 'A' CIRCLED (GO TO 427)
CODE 'A' NOT CIRCLED (GO TO 430)

427) How many times did you take (SP/Fansidar) during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

NO. TIMES____________________

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY
[ASK FOR MOST RECENT BIRTH ONLY]

CODE 'A', 'B' OR 'C' CIRCLED (GO TO 429)
OTHER (GO TO 430)

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?
[ASK FOR MOST RECENT BIRTH ONLY]

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

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

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

431) Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 433)
DON'T KNOW 8 (GO TO 433)

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

KG FROM CARD 1 ________________________
KG FROM RECALL 2 _____________________

DON'T KNOW 99998

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

HEALTH PERSONNEL
DOCTOR A
CLINICAL OFFICE B
NURSE/MIDWIFE C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
RELATIVE/FRIEND E
OTHER (SPECIFY)__________________ X
NO ONE ASSISTED Y

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

NAME OF PLACE ___________________
HOME
YOUR HOME 11 (LAST BIRTH, GO TO 437A; ALL OTHERS, GO TO 448)
OTHER HOME 12 (LAST BIRTH, GO TO 437A; ALL OTHERS, GO TO 448)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER/POST 22
OTHER PUBLIC SECTOR (SPECIFY)______________________26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE SECTOR (SPECIFY) _____________________36
OTHER (SPECIFY) ______________________96 (LAST BIRTH, GO TO 437A; ALL OTHERS, GO TO 448)

434A) How long after (NAME) was delivered did you stay there?
[ASK FOR MOST RECENT BIRTH ONLY]

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

HOURS________________ 1
DAYS________________ 2
WEEKS________________ 3

DON'T KNOW 998

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

YES 1
NO 2

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?

[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 439)
NO 2

437) Did anyone check on your health after you left the facility?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 439)
NO 2 (GO TO 442)

437A) Why didn't you deliver in a health facility? PROBE: Any other reason?
[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL MENTIONED.

COST TOO MUCH A
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
SHORT LABOUR G
NOT NECESSARY H
NOT CUSTOMARY I
OTHER (SPECIFY)____________________ X

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)?

[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 442)

439) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
CLINICAL OFFICER 12
NURSE/MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)_____________________ 96

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. [ASK FOR MOST RECENT BIRTH ONLY]

HOURS_________________ 1
DAYS_________________ 2
WEEKS_________________ 3

DON'T KNOW 998

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his or her health?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 446)
DON'T KNOW 8 (GO TO 446)

443) How many hours days or weeks after the birth of (NAME) did the first check take place??
[ASK FOR MOST RECENT BIRTH ONLY]

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

HOURS AFTER BIRTH________________ 1
DAYS__________________ 2
WEEKS_________________ 3

DON'T KNOW 998

444) Who checked on (NAME)'s health at this time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR MOST RECENT BIRTH ONLY]

HEALTH PERSONNEL
DOCTOR 11
CLINICAL OFFICER 12
NURSE/MIDWIFE 13
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT 21
COMMUNITY/VILLAGE HEALTH WORKER 22
OTHER (SPECIFY)_____________________ 96

445) Where did this first check of (NAME) take place?
[ASK FOR MOST RECENT BIRTH ONLY]

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.

NAME OF PLACE _______________________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER/POST 22
MOBILE HOSPITAL/CLINIC 23
OTHER PUBLIC SECTOR (SPECIFY) _______________________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE SECTOR (SPECIFY)_______________________ 36
OTHER (SPECIFY) ________________________ 96

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
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2
DON'T KNOW 8

447) Has your menstrual period returned since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 449)
NO 2 (GO TO 450)

448) Did your period return between the birth of (NAME) and your next pregnancy?
[ASK FOR ALL BUT MOST RECENT BIRTH]

YES 1
NO 2 (GO TO 452)

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

MONTHS _______________________
DON'T KNOW 98

450) CHECK 226:
IS RESPONDENT PREGNANT?
[ASK FOR MOST RECENT BIRTH ONLY]

NOT PREGNANT (GO TO 451)
PREGNANT OR UNSURE (GO TO 452)

451) Have you had sexual intercourse since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 453)

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

MONTHS ___________________
DON'T KNOW 98

453) Did you ever breast feed (NAME)?

YES 1 (GO TO 455)
NO 2

454) CHECK 404:
IS CHILD LIVING?
[ASK FOR MOST RECENT BIRTH ONLY]

LIVING (GO TO 460)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 461A)

455) How long after the birth did you first put (NAME) to the breast?
[ASK FOR MOST RECENT BIRTH ONLY]

IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.

IMMEDIATELY 000

HOURS __________________ 1
DAYS _____________________2

456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk? [ASK FOR MOST RECENT BIRTH ONLY]

YES 1
NO 2 (GO TO 458)

457) What was (NAME) given to drink? Anything else?
[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL LIQUIDS MENTIONED.

MILK (OTHER THAN BREAST MILK) A
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
COFFEE I
HONEY J
OTHER (SPECIFY) _____________________ X

458) CHECK 404: IS CHILD LIVING?

LIVING (GO TO 459)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 461A)

459) Are you still breast feeding (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

YES 1 (GO TO 460)
NO 2

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

MONTHS ________________________
DON'T KNOW 98

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

YES 1
NO 2
DON'T KNOW 8

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?

YES 1 (GO TO 461D)
NO 2

461B) Have you ever heard of this problem?

YES 1
NO 2

461C) CHECK 224:

ONE OR MORE BIRTHS IN 2008 OR LATER (GO TO 501)
NO BIRTHS IN 2008 OR LATER (GO TO 556)

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

AFTER DELIVERED BABY 1
AFTER HAD STILLBIRTH 2
NEITHER 3 (GO TO 461F)

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

NORMAL LABOR/DELIVERY 1 (GO TO 461G)
VERY DIFFICULT LABOR/DELIVERY 2 (GO TO 461G)

461F) What do you think caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER (SPECIFY) _________________________ 6
DON'T KNOW 8 (GO TO 461H)

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

NUMBER OF DAYS AFTER DELIVERY/OTHER EVENT _______________________

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

YES 1 (461K)
NO 2

461I) Why have you not sought treatment?

PROBE AND RECORD ALL MENTIONED.

DO NOT KNOW CAN BE FIXED A
DO NOT KNOW WHERE TO GO B
TOO EXPENSIVE C
TOO FAR D
POOR QUALITY OF CARE E
COULD NOT GET PERMISSION F
EMBARRASSMENT G
PROBLEM DISAPPEARED H
OTHER (SPECIFY) ____________________ X

461J) CHECK 224:

ONE OR MORE BIRTHS IN 2008 OR LATER (GO TO 501)
NO BIRTHS IN 2008 OR LATER (GO TO 556)

461K) From whom did you last seek treatment?

HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2
OTHER PERSON
COMMUNITY/VILLAGE HEALTH WORKER 3
OTHER (SPECIFY) ________________________ 6

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

YES 1
NO 2

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

YES, STOP COMPLETELY 1
NOT STOPPED BUT REDUCED 2
NOT STOPPED AT ALL 3
DID NOT RECEIVE TREATMENT 4

461N) CHECK 224:

ONE OR MORE BIRTHS IN 2008 OR LATER (GO TO 501)
NO BIRTHS IN 2008 OR LATER (GO TO 556)

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

BIRTH HISTORY NUMBER ______________________

503) FROM 212 AND 216

NAME _________________________

LIVING (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 553)

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

YES, SEEN 1 (GO TO 506)
YES, NOT SEEN 2 (GO TO 509)
NO CARD 3

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

YES 1 (GO TO 509)
NO 2 (GO TO 509)

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.

BCG
DAY __________________
MONTH _________________
YEAR _________________
OPV 0
DAY __________________
MONTH _________________
YEAR _________________
OPV 1
DAY __________________
MONTH _________________
YEAR _________________
OPV 2
DAY __________________
MONTH _________________
YEAR _________________
OPV 3
DAY __________________
MONTH _________________
YEAR _________________
OPV 4
DAY __________________
MONTH _________________
YEAR _________________
DPT-HepB+Hib 1
DAY __________________
MONTH _________________
YEAR _________________
DPT-HepB+Hib 2
DAY __________________
MONTH _________________
YEAR _________________
DPT-HepB+Hib 3
DAY __________________
MONTH _________________
YEAR _________________
MEASLES
DAY __________________
MONTH _________________
YEAR _________________
VITAMIN A1 (MOST RECENT)
DAY __________________
MONTH _________________
YEAR _________________
VITAMIN A2 (2ND MOST RECENT)
DAY __________________
MONTH _________________
YEAR _________________

507) CHECK 506:

BCG TO MEASLES ALL RECORDED (GO TO 511)
OTHER (GO TO 508)

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.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 506) (GO TO 511)
NO 2 (GO TO 511)
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 511)
DON'T KNOW 8 (GO TO 511)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 510E)
DON'T KNOW 8 (GO TO 510E)

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

FIRST 2 WEEKS 1
LATER 2

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

NUMBER OF TIMES _____________________

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

YES 1
NO 2 (GO TO 510G)
DON'T KNOW (GO TO 510G)

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

NUMBER OF TIMES ____________________

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?

YES 2
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

515) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

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?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

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?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 521B)

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.

NAME OF PLACE __________________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
COMMUNITY BASED AGENT/FIELDWORKER D
OTHER PUBLIC SECTOR (SPECIFY) ______________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE HOSPITAL/CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE SECTOR (SPECIFY) __________________________ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
OTHER (SPECIFY) ______________________ X

520) CHECK 519:

TWO OR MORE CODES CIRCLED (GO TO 521)
ONLY ONE CODE CIRCLED (GO TO 521A)

521) Where did you first seek advice or treatment?

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
COMMUNITY BASED AGENT/FIELDWORKER D
OTHER PUBLIC SECTOR (SPECIFY) ______________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE HOSPITAL/CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE SECTOR (SPECIFY) __________________________ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
OTHER (SPECIFY) ______________________ X

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

DAYS ___________________

521B) Does (NAME) still have diarrhoea?

YES 1
NO 2
DON'T KNOW 8

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

A fluid made from a special packet called ORS packet?
YES 1
NO 2
DON'T KNOW 8
Homemade fluid?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 525)
DON'T KNOW 8 (GO TO 525)

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

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC B
UNKNOWN INJECTION G
INTRAVENOUS H
HOME REMEDY/HERBAL MEDICINE I
OTHER (SPECIFY) _____________________ X

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

YES 1
NO 2 (GO TO 527)
DON'T KNOW 8 (GO TO 527)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)

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

YES 1
NO 2 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

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

CHEST ONLY 1 (GO TO 531)
NOSE ONLY 2 (GO TO 531)
BOTH 3 (GO TO 531)
OTHER (SPECIFY) ____________________ 6 (GO TO 531)
DON'T KNOW 8 (GO TO 531)

530) CHECK 525: HAD FEVER?

YES (GO TO 531)
NO OR DON'T KNOW (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

531) Now I would like to know how much (NAME) was given to drink (including 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?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

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

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 536B)

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

NAME OF THE PLACE __________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
COMMUNITY BASED AGENT/FIELDWORKER D
OTHER PUBLIC SECTOR (SPECIFY) ______________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE HOSPITAL/CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE SECTOR (SPECIFY) __________________________ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
OTHER (SPECIFY) ______________________ X

535) CHECK 534:

TWO OR MORE CODES CIRCLED (GO TO 536)
ONLY ONE CODE CIRCLED (GO TO 536A)

536) Where did you first seek advice or treatment?

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
COMMUNITY BASED AGENT/FIELDWORKER D
OTHER PUBLIC SECTOR (SPECIFY) ______________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE HOSPITAL/CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE SECTOR (SPECIFY) __________________________ M
OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
OTHER (SPECIFY) ______________________ X

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

IF THE SAME DAY, RECORD '00'

DAYS_________________

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

FEVER A
COUGH B
NO, NEITHER C
DON'T KNOW Z

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

YES 1
NO 2 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)
DON'T KNOW 8 (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

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

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COARTEM/ACT E
ARTEMETHER F
ASUNATE/ARTESUNATE G
ARTEETHER H
OTHER ANTIMALARIAL (SPECIFY) ______________________ I
ANTIBIOTIC DRUGS
PILL/SYRUP J
INJECTION K
OTHER DRUGS
ASPIRIN L
PARACETAMOL (PANADOL) M
ACETAMINOPHEN N
IBUPROFEN O
OTHER (SPECIFY) _______________________ X
DON'T KNOW Z

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

YES (GO TO 538B)
NO (GO TO 539)

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'

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
AMODIAQUINE C
QUININE D
COARTEM/ACT E
ARTEMETHER F
ASUNATE/ARTESUNATE G
ARTEETHER H
OTHER ANTIMALARIAL (SPECIFY) ______________________ I
ANTIBIOTIC DRUGS
PILL/SYRUP J
INJECTION K
OTHER DRUGS
ASPIRIN L
PARACETAMOL (PANADOL) M
ACETAMINOPHEN N
IBUPROFEN O
NO DRUGS AT HOME Y
DON'T KNOW Z

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

YES (GO TO 540)
NO (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

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

CODE 'A' CIRCLED (GO TO 541)
CODE 'A' NOT CIRCLED (GO TO 542)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS _____________________
DON'T KNOW 8

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

CODE 'B' CIRCLED (GO TO 543)
CODE 'B' NOT CIRCLED (GO TO 544)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ____________________
DON'T KNOW 8

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

CODE 'C' CIRCLED (GO TO 545)
CODE 'C' NOT CIRCLED (GO TO 546)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS __________________
DON'T KNOW 8

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

CODE 'D' CIRCLED (GO TO 547)
CODE 'D' NOT CIRCLED (GO TO 548)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ______________________
DON'T KNOW 8

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

CODE 'E' CIRCLED (GO TO 549)
CODE 'E' NOT CIRCLED (GO TO 549B)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS ________________________
DON'T KNOW 8

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

CODE 'F' CIRCLED (GO TO 549C)
CODE 'F' NOT CIRCLED (GO TO 549E)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS _____________________
DON'T KNOW 8

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

CODE 'G' CIRCLED (GO TO 549F)
CODE 'G' NOT CIRCLED (GO TO 549H)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS __________________
DON'T KNOW 8

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

CODE 'H' CIRCLED (GO TO 549I)
CODE 'H' NOT CIRCLED (GO TO 550)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS __________________________
DON'T KNOW 8

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

CODE 'I' CIRCLED (GO TO 551)
CODE 'I' NOT CIRCLED (GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553)

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

SAME DAY 0
NEXT DAY 1
TWO DAYS AFTER FEVER 2
THREE DAYS AFTER FEVER 3
FOUR OR MORE DAYS AFTER FEVER 4
DON'T KNOW 8

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

DAYS _____________________
DON'T KNOW 8

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

ONE OR MORE (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 554)
NAME _______________________
NONE (GO TO 556)

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

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED IN TO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) _____________________ 07

555) CHECK 522(a), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 556)
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 557)

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

YES 1
NO 2

557) CHECK 215 AND 218, ALL ROWS:

HAS AT LEAST ONE CHILD BORN IN 2011 OR LATER AND LIVING WITH HER (RECORD NAME OF YOUNGEST CHILD LIVING WITH HER) (CONTINUE WITH 558)
NAME __________________________
DOES NOT HAVE ANY CHILDREN BORN IN 2011 OR LATER AND LIVING WITH HER (GO TO 601)

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):

a) Plain water?
YES 1
NO 2
DON'T KNOW 8
b) Juice or juice drinks?
YES 1
NO 2
DON'T KNOW 8
c) Clear broth?
YES 1
NO 2
DON'T KNOW 8
d) Milk such as tinned, powdered, or fresh animal milk?
IF YES: How many times did (NAME) drink milk.
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK MILK ____________________________
e) Infant formula?
IF YES: How many times did (NAME) drink infant formula?
IF 7 OR MORE TIMES, RECORD '7'.
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES DRANK FORMULA ________________________
f) Any other liquids?
YES 1
NO 2
DON'T KNOW 8
g) Yogurt?
IF YES: How many times did (NAME) eat yogurt?
IF 7 OR MORE TIMES, RECORD '7'
YES 1
NO 2
DON'T KNOW 8
NUMBER OF TIMES ATE YOGURT_____________
h) Any Provita, Delight, Cerelac, Saya Porridge?
YES 1
NO 2
DON'T KNOW 8
i) Bread, rice, noodles, porridge, nshima or other foods made from grains?
YES 1
NO 2
DON'T KNOW 8
j) Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
k) White potatoes, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
l) Any dark green, leafy vegetables, cassava leaves, rape, sweet potato leaves?
YES 1
NO 2
DON'T KNOW 8
m) Ripe mangoes, paw paw, apricot, watermelon?
YES 1
NO 2
DON'T KNOW 8
n) Any other fruit or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Lever, kidney, heart, or other organ meats?
YES 1
NO 2
DON'T KNOW 8
p) Any meat, such as beef, pork, lamb, goat, chicken, or duck?
YES 1
NO 2
DON'T KNOW 8
q) Eggs?
YES 1
NO 2
DON'T KNOW 8
r) Fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
s) Any food made from beans, peas, lentils, or [error in original text, no text after 'or']
YES 1
NO 2
DON'T KNOW 8
t) Cheese or other food made from milk?
YES 1
NO 2
DON'T KNOW 8
u) Any caterpillars, other insects, or other small protein foods?
YES 1
NO 2
DON'T KNOW 8
v) Any other solid, semi-solid, or soft food?
YES 1
NO 2
DON'T KNOW 8

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

NOT A SINGLE YES (GO TO 560)
AT LEAST ONE "YES" (GO TO 561)

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?

YES 1 (GO BACK TO 558 TO RECORD FOOD EATEN YESTERDAY)
NO 2 (GO TO 601)

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'.

NUMBER OF TIMES _________________________
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, CURRENTLY MARRIED 1 (GO TO 604)
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, FORMERLY MARRIED 1
YES, LIVED WITH A MAN 2
NO 3 (GO TO 612)

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

WIDOWED 1 (GO TO 609)
DIVORCED 2 (GO TO 609)
SEPARATED 3 (GO TO 609)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME ____________________
LINE NUMBER ____________________

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

YES 1
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?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ______________________
DON'T KNOW 98

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

RANK __________________

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

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 609B)

609A) CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED OR CURRENTLY DIVORCED/SEPARATED (GO TO 610)
CURRENTLY WIDOWED (GO TO 609D)

609B) CHECK 603:
IS RESPONDENT CURRENTLY WIDOWED?

NOT ASKED (GO TO 609C)
CURRENTLY WIDOWED (GO TO 609D)
CURRENTLY DIVORCED/SEPARATED (GO TO 610)

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

DEATH 1
DIVORCE 2 (GO TO 610)
SEPARATION 3 (GO TO 610)

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

RESPONDENT 1 (GO TO 610)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
NO PROPERTY 5
OTHER (SPECIFY) ____________________ 6

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

YES 1
NO 2

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?

MONTH ___________
DON'T KNOW MONTH 98
YEAR _____________________ (GO TO 612)
DON'T KNOW YEAR 9998

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

AGE ____________

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?

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS ___________________ (GO TO 613C)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 613C)

613A) CHECK 103:

AGE 15-24 (GO TO 613B)
AGE 25-49 (GO TO 628)

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

YES 1 (GO TO 628)
NO 2 (GO TO 628)
DON'T KNOW/UNSURE 8 (GO TO 628)

613C) CHECK 103:

AGE 15-24 (GO TO 613D)
AGE 25-49 (GO TO 614)

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

AGE OF PARTNER _____________ (GO TO 614)
DON'T KNOW 98

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

OLDER 1
YOUNGER 2 (GO TO 614)
ABOUT THE SAME AGE 3 (GO TO 614)
DON'T KNOW/DON'T REMEMBER 4 (GO TO 614)

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

TEN OR MORE YEARS OLDER 1
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3

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.

DAYS AGO ______________ 1
WEEKS AGO _____________ 2
MONTHS AGO ________________ 3
YEARS AGO _________________ 4 (GO TO 627)

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

DAYS AGO ______________ 1
WEEKS AGO _____________ 2
MONTHS AGO ________________ 3

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

YES 1
NO 2 (GO TO 619)

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

YES 1
NO 2

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'.

HUSBAND 1
LIVE-IN PARTNER 2
BOYFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 622)
CASUAL ACQUAINTANCE 4 (GO TO 622)
CLIENT/SEX WORKER 5 (GO TO 622)
OTHER (SPECIFY) ____________________ 6 (GO TO 622)

620) CHECK 609:

MARRIED ONLY ONCE (GO TO 621)
MARRIED MORE THAN ONCE (GO TO 622)

621) CHECK 613:

FIRST TIME WHEN STARTED LIVING WITH FIRST HUSBAND (GO TO 623)
OTHER (GO TO 622)

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

DAYS AGO ______________ 1
WEEKS AGO _____________ 2
MONTHS AGO ________________ 3
YEARS AGO _________________ 4

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"

NUMBER OF TIMES ________________

624) How old is this person?

AGE OF PARTNER ________________
DON'T KNOW 98

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

YES 1
NO 2 (GO TO 625)

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

RESPONDENT ONLY 1
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4

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

YES 1 (GO BACK TO 616 IN NEXT COLUMN)
NO 2 (GO TO 627)

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'

NUMBER OF PARTNERS LAST 12 MONTHS _________________
DON'T KNOW 98

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

NUMBER OF PARTNERS IN LIFETIME ______________
DON'T KNOW 98

628) CHECK PRESENCE OF OTHERS DURING THIS SECTION

CHILDREN
YES 1
NO 2
MALE ADULTS
YES 1
NO 2
FEMALE ADULTS
YES 1
NO 2

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

YES 1
NO 2 (GO TO 632)

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.

NAME OF PLACE(S) ___________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
FAMILY PLANNING CLINIC D
COMMUNITY BASED AGENT/FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
COMMUNITY BASED AGENT/FIELDWORKER K
MOBILE HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______________________ M
OTHER SOURCE
SHOP N
CHURCH M
FRIENDS/RELATIVES P
OTHER (SPECIFY) ________________________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

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

YES 1
NO 2 (GO TO 701)

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.

NAME OF PLACE(S) ___________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
FAMILY PLANNING CLINIC D
COMMUNITY BASED AGENT/FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
COMMUNITY BASED AGENT/FIELDWORKER K
MOBILE HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______________________ M
OTHER SOURCE
SHOP N
CHURCH M
FRIENDS/RELATIVES P
OTHER (SPECIFY) ________________________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 304:

NEITHER STERILIZED (GO TO 702)
HE OR SHE STERILIZED (GO TO 712)

702) CHECK 226:

PREGNANT (GO TO 703)
NOT PREGNANT OR UNSURE (GO TO 704)

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

HAVE ANOTHER CHILD 1 (GO TO 705)
NO MORE 2 (GO TO 711)
UNDECIDED/DON'T KNOW 8 (GO TO 711)

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

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 707)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 712)
UNDECIDED/DON'T KNOW 8 (GO TO 710)

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?

MONTHS __________ 1
YEARS _________ 2

SOON/NOW 993 (GO TO 710)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 712)
AFTER MARRIAGE 995 (GO TO 710)
OTHER (SPECIFY) _________________ 996 (GO TO 710)
DON'T KNOW 998 (GO TO 710)

706) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 707)
PREGNANT (GO TO 711)

707) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (GO TO 708)
CURRENTLY USING (GO TO 712)

708) CHECK 705:

NOT ASKED (GO TO 709)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 709)
00-23 MONTHS OR 00-01 YEAR (GO TO 711)

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.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN' GET PREGNANT E
NOT MENSTRUATED SINCE LAST BIRTH F
BREASTFEEDING G
UP TO GOD/FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
SIDE EFFECTS/HEALTH CONCERNS O
LACK OF ACCESS/TOO FAR P
COSTS TOO MUCH Q
PREFERRED METHOD NOT AVAILABLE R
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) ____________________ X
DON'T KNOW Z

710) CHECK 303:
USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 711)
NO, NOT CURRENTLY USING (GO TO 711)
YES, CURRENTLY USING (GO TO 712)

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

YES 1
NO 2 (GO TO 711B)
DON'T KNOW 8 (GO TO 712)

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

FEMALE STERILIZATION 01 (GO TO 712)
MALE STERILIZATION 02 (GO TO 712)
IUD 03 (GO TO 712)
INJECTABLES 04 (GO TO 712)
IMPLANTS 05 (GO TO 712)
PILL 06 (GO TO 712)
MALE CONDOM 07 (GO TO 712)
FEMALE CONDOM 08 (GO TO 712)
DIAPHRAGM 09 (GO TO 712)
FOAM/JELLY 10 (GO TO 712)
STANDARD DAYS METHOD 11 (GO TO 712)
LACTATIONAL AMEN. METHOD 12 (GO TO 712)
RHYTHM METHOD 13 (GO TO 712)
WITHDRAWAL 14 (GO TO 712)

OTHER (SPECIFY) ____________ 96

UNSURE 98

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (GO TO 712)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 712)
SUBFECUND/INFECUND 24 (GO TO 712)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 712)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 712)
HUSBAND OPPOSED 32 (GO TO 712)
OTHERS OPPOSED 33 (GO TO 712)
RELIGIOUS PROHIBITION 34 (GO TO 712)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 712)
KNOWS NO SOURCE 42 (GO TO 712)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 712)
FEAR OF SIDE EFFECTS 52 (GO TO 712)
LACK OF ACCESS/TOO FAR 53 (GO TO 712)
COSTS TOO MUCH 54 (GO TO 712)
INCONVENIENT TO USE 55 (GO TO 712)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 712)
OTHER (SPECIFY) ____________________ 96 (GO TO 712)
DON'T KNOW 98 (GO TO 712)

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

YES 1
NO 2
DON'T KNOW 8

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.

NONE 00 (GO TO 714)
NUMBER _____________
OTHER (SPECIFY) ___________________ 96 (GO TO 714)

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

BOYS ____
GIRLS ______
EITHER _______
OTHER (SPECIFY) ________________ 96

714) In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2

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

YOUR HEALTH MATTERS
YES 1
NO 2
OTHER HEALTH RELATED PROGRAMMES
YES 1
NO 2

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

YOUR HEALTH MATTERS
YES 1
NO 2
OTHER HEALTH RELATED PROGRAMMES
YES 1
NO 2

716) CHECK 601:

YES, CURRENTLY MARRIED (GO TO 717)
YES, LIVING WITH A MAN (GO TO 717)
NO, NOT IN UNION (GO TO 801)

717) CHECK 304: CURRENT CONTRACEPTIVE METHOD?

CIRCLED CODE B, G, OR N (GO TO 718)
NOT ASKED (GO TO 720)
OTHER (GO TO 717A)

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

YES 1
NO 2
DON'T KNOW 8

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

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3

OTHER (SPECIFY) ____________ 6

719) CHECK 304:

NEITHER CODE A NOR B IS CIRCLED (NEITHER STERILIZED) (GO TO 720)
CODE A OR B CIRCLED (HE OR SHE STERILIZED) (GO TO 801)

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

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

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

801) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 802)
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?

AGE IN COMPLETED YEARS ________________

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

YES 1
NO 2 (GO TO 806)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (GO TO 806)

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

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

GRADE _________
DON'T KNOW 98

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?

OCCUPATION ____________________

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

YES 1 (GO TO 811)
NO 2

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?

YES 1 (GO TO 811)
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?

YES 1
NO 2

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

YES 1
NO 2 (GO TO 815)

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

OCCUPATION ______________________

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

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

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

HOME 1
AWAY 2

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF HE YEAR 2
ONCE IN A WHILE 3

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

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

815) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 816)
NOT IN UNION (GO TO 823)

816) CHECK 814:

CODE 1 OR 2 CIRCLED (GO TO 817)
OTHER (GO TO 819)

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER (SPECIFY) ______________6

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?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER HAS NO EARNING 4 (GO TO 820)
DON'T KNOW 8

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?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER HAS NO EARNING 4
OTHER (SPECIFY) __________________ 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____________________6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____________________6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____________________6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ____________________6

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

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

CHILDREN
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 3

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

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (GO TO 937)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

LOW 1
MEDIUM 2
HIGH 3
NO RISK 4
OTHER 6
DON'T KNOW 8

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

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

909) CHECK 908:

AT LEAST ONE 'YES' (GO TO 910)
OTHER (GO TO 910A)

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?

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2 (GO TO 911)
DON'T KNOW 8 (GO TO 911)

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

YES 1
NO 2
DON'T KNOW 8

911) CHECK 208 AND 215:

LAST BIRTH SINCE JANUARY 2011 (GO TO 912)
LAST BIRTH BEFORE JANUARY 2011 (GO TO 926)
NO BIRTHS (GO TO 926)

912) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (GO TO 913)
NO ANTENATAL CARE (GO TO 920)

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:

Babies getting the AIDS virus from their mother?
YES 1
NO 2
DON'T KNOW 8
Things that you can do to prevent getting the AIDS virus?
YES 1
NO 2
DON'T KNOW 8
Getting tested for the AIDS virus?
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 920)

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

NAME OF PLACE_____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT CENTER/POST 12
STAND-ALONE VCT CENTRE 13
FAMILY PLANNING CLINIC 14
MOBILE HOSPITAL/CLINIC 15
COMMUNITY BASED AGENT/FIELDWORKER 16
OTHER PUBLIC SECTOR (SPECIFY) __________________17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
MISSION HOSPITAL/CLINIC 22
STAND-ALONE VCT CENTRE 23
MOBILE HOSPITAL/CLINIC 24
COMMUNITY BASED AGENT/FIELDWORKER 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________________ 26
OTHER SOURCE
PRISON 31

OTHER (SPECIFY) _________________________96

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

YES 1
NO 2 (GO TO 924)

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

Husband/partner?
YES 1
NO 2
Family member?
YES 1
NO 2
Religious leader?
YES 1
NO 2
Friend?
YES 1
NO 2
Any other?
OTHER (SPECIFY) __________________1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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

TIMES TESTED ____ (GO TO 924)

920) CHECK 434 FOR LAST BIRTH:

ANY CODE 21-36 CIRCLED (GO TO 921)
OTHER (GO TO 926)

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

YES 1
NO 2

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

YES 1
NO 2 (GO TO 926)

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

YES 1
NO 2

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

YES 1 (GO TO 927)
NO 2

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

MONTHS AGO ___________ (GO TO 932)

TWO OR MORE YEARS 95 (GO TO 932)

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

YES 1
NO 2 (GO TO 930)

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

MONTHS AGO ___________ (GO TO 932)
TWO OR MORE YEARS 95 (GO TO 932)

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?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

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

YES 1
NO 2

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.

NAME OF THE PLACE _________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT CENTER/POST 12
STAND-ALONE VCT CENTRE 13
FAMILY PLANNING CLINIC 14
MOBILE HOSPITAL/CLINIC 15
COMMUNITY BASED AGENT/FIELDWORKER 16
OTHER PUBLIC SECTOR (SPECIFY) __________________17
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
MISSION HOSPITAL/CLINIC 22
STAND-ALONE VCT CENTRE 23
MOBILE HOSPITAL/CLINIC 24
COMMUNITY BASED AGENT/FIELDWORKER 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________________ 26
OTHER SOURCE
PRISON 31

OTHER (SPECIFY) _________________________96

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

YES 1
NO 2 (GO TO 932)

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.

NAME OF PLACE(S) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT CENTER/POST B
STAND-ALONE VCT CENTRE C
FAMILY PLANNING CLINIC D
MOBILE HOSPITAL/CLINIC E
COMMUNITY BASED AGENT/FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) __________________G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
MISSION HOSPITAL/CLINIC I
STAND-ALONE VCT CENTRE J
MOBILE HOSPITAL/CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________________ M
OTHER SOURCE
PRISON N
OTHER (SPECIFY) _________________________X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2

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."

AGREE 1
DISAGREE 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

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

YES 1
NO 2
DON'T KNOW 8

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

FEEL THEY ARE NOT AT RISK A
FEAR OF RESULTS B
FEAR OF STIGMA/DISCRIMINATION C
DON'T KNOW WHERE TO GOD
OTHER (SPECIFY) _________________X

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?

YES 1
NO 2

938) CHECK 613:

HAS HAD SEXUAL INTERCOURSE (GO TO 939)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 945A)

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

YES (GO TO 940)
NO (GO TO 941)

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

943) CHECK 940, 941, AND 942:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 944)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 945A)

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

YES 1
NO 2 (GO TO 945A)

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

NAME OF PLACE(S) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
STAND-ALONE VCT CENTRE C
FAMILY PLANNING CLINIC D
MOBILE HOSPITAL/CLINIC E
COMMUNITY BASED AGENT/FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) ___________________ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
MISSION HOSPITAL/CLINIC I
STAND-ALONE VCT CENTRE J
MOBILE HOSPITAL/CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________M

OTHER SOURCE SHOP N
OTHER (SPECIFY) _________________X

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?

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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?

YES 1
NO 2
DON'T KNOW 8

948) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A PARTNER (GO TO 949)
NOT IN UNION (GO TO 1000A)

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

YES 1
NO 2
DEPENDS/NOT SURE 8

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

YES 1
NO 2
DEPENDS/NOT SURE 8

SECTION 10. OTHER HEALTH ISSUES

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

YES 1
NO 2 (GO TO 1001)

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

RECORD ALL MENTIONED

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
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

1000C) Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

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

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW/DEPENDS 8

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.

NUMBER OF INJECTIONS _____

NONE 00 (GO TO 1004)

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.

NUMBER OF INJECTIONS _____

NONE 00 (GO TO 1004)

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.

NAME OF PLACE ________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER/POST 12
MOBILE HOSPITAL/CLINIC 13
OTHER PUBLIC SECTOR (SPECIFY) ______________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
MISSION HOSPITAL/CLINIC 22
DENTAL CLINIC/OFFICE 23
MOBILE HOSPITAL/CLINIC 24
PHARMACY 25
OFFICE OR HOME OF NURSE/HEALTH WORKER 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________________27
OTHER SOURCE AT HOME 31
OTHER (SPECIFY) __________________ 96

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?

YES 1
NO 2
DON'T KNOW 8

1004) Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 1006)

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

CIGARETTES _____________

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

YES 2
NO 2 (GO TO 1007A)

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

RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) _______________ X


1007A) Do you drink alcohol?

YES 1
NO 2 (GO TO 1008)

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

NUMBER OF DAYS ______________

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?

Getting permission to go for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for advice or treatment?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having to take transport?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be a female health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be any health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may be no drugs available?
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Rude attitude of health provider?
BIG PROBLEM 1
NOT A BIG PROBLEM 2

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

YES 1
NO 2 (GO TO 1010A)

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

RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
LOW COST PRE-PAYMENT SCHEME/STANDARD E
HIGH COST PRE-PAYMENT SCHEMA/PREMIUM F
OTHER (SPECIFY) ____________________ X

1010A) CHECK 217:

(YOUNGEST) CHILD IS AGE 0-17 (GO TO 1010B)
OTHER ( GO TO 1010C)

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)?

YES 1
NO 2
UNSURE 8

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

YES 1
NO 2 (GO TO 1101)

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)?

YES 1
NO 2
UNSURE 8

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?

NUMBER OF BIRTHS TO NATURAL MOTHER _________________

1102) CHECK 1101:

TWO OR MORE BIRTHS (GO TO 1103)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1201)

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

NUMBER OF PRECEDING BIRTHS ______

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

NAME OF SIBLING______

1105) Is (NAME) male or female?

MALE 1
FEMALE 2

1106) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1108)
DON'T KNOW 8 (GO TO NEXT SIBLING)

1107) How old is (NAME)?

AGE____ (GO TO NEXT SIBLING)

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

YEARS______

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

AGE______ (IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT SIBLING)

1110) Was (NAME) pregnant when she died?

YES 1 (GO TO 1113)
NO 2

1111) Did (NAME) die during childbirth?

YES (GO TO 1113)
NO 2

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

YES 1
NO 2

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

CHILDREN NUMBER________

TICK HERE IS CONTINUATION SHEET USED ___

SECTION 12. DOMESTIC VIOLENCE

1201) CHECK HOUSEHOLD QUESTIONNAIRE, QH21 AND COVER PAGE

WOMAN SELECTED FOR THIS SECTION (GO TO 1202)
WOMAN NOT SELECTED (GO TO 1234)

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

PRIVACY OBTAINED 1 (GO TO 1203)
PRIVACY NOT POSSIBLE 2 (GO TO 1233)

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:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 1204)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE AND USE 'LAST' WITH HUSBAND/PARTNER) (GO TO 1204)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1217)

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)?

a) He (is/was) jealous or angry if you (talk/talked) to other men?
YES 1
NO 2
DON'T KNOW 8
b) He frequently (accuses/accused) you of being unfaithful?
YES 1
NO 2
DON'T KNOW 8
c) He (does/did) not permit you to meet your female friends?
YES 1
NO 2
DON'T KNOW 8
d) He (tries/tried) to limit your contact with your family?
YES 1
NO 2
DON'T KNOW 8
e) He (insists/insisted) on knowing where you (are/were) at all times?
YES 1
NO 2
DON'T KNOW 8

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

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

a) Say or do something to humiliate you in front of others?
YES 1
NO 2 (GO TO 1205A-b)
b) Threaten to hurt or harm you or someone you care about?
YES 1
NO (GO TO 1205A-c)
c) Insult you or make you feel bad about yourself?
YES 1
NO 2 (GO TO 1206)

1205B) 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?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Threaten to hurt or harm you or someone you care about?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

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

a) Push you, shake you, or throw something at you?
YES 1
NO 2 (GO TO 1206A-b)
b) Slap you?
YES 1
NO 2 (GO TO 1206A-c)
c) Twist your arm or pull your hair?
YES 1
NO 2 (GO TO 1206A-d)
d) Punch you with his fist or with something that could hurt you?
YES 1
NO 2 (GO TO 1206A-e)
e) Kick you, drag you, or beat you up?
YES 1
NO 2 (GO TO 1206A-f)
f) Try to choke you or burn you on purpose?
YES 1
NO 2 (GO TO 1206A-g)
g) Threaten to attack you with a knife, gun, or other weapon?
YES 1
NO 2 (GO TO 1206A-h)
h) Physically force you to have sexual intercourse with him when you did not want to?
YES 1
NO 2 (GO TO 1206A-i)
i) Physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2 (GO TO 1206A-j)
j) Force you with treats or in any other way to perform sexual acts you did not want to?
YES 1
NO 2 (GO TO 1207)

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

a) Push you, shake you, or throw something at you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
b) Slap you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
c) Twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
d) Punch you with his fist or with something that could hurt you?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
e) Kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
f) Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
g) Threaten to attack you with a knife, gun, or other weapon?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
h) Physically force you to have sexual intercourse with him when you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3
i) Physically force you to perform any other sexual acts you did not want to?
YES 1
NO 2 (GO TO 1206j)
j) Force you with treats or in any other way to perform sexual acts you did not want to?
OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS 3

1207) CHECK 1206A (a-j):

AT LEAST ONE 'YES' (GO TO 1208)
NOT A SINGLE 'YES' (GO TO 1210)

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'

NUMBER OF YEARS _______

BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

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

a) You had cuts, bruises, or aches?
YES 1
NO 2
b) You had eye injuries, sprains, dislocations, or burns?
YES 1
NO 2
c) You had deep wounds, broken bones, broken teeth, or any other serious injury?
YES 1
NO 2

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?

YES 1
NO 2 (GO TO 1212)

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

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

YES 1
NO 2 (GO TO 1214)

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

OFTEN 1
SOMETIMES 2
NEVER 3

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

MOST OF THE TIME AFRAID 1
SOMETIMES AFRAID 2
NEVER AFRAID 3

1215) CHECK 609:

MARRIED MORE THAN ONCE (GO TO 1216)
MARRIED ONLY ONCE (GO TO 1217)

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)...

a) ...ever hit, slap, kick, or do anything else to hurt you physically?
YES 1
NO 2 (GO TO 1216b)
b) ...physically force you to have sexual intercourse or preform any other sexual acts against your will?
YES 1
NO 2 (GO TO 1217)

1216B) How long ago did this happen?

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3
b) Did any previous (husband/partner) physically force you to have sexual intercourse or preform any other sexual acts against your will?
0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

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?

YES 1
NO 2 (GO TO 1220)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1220)

1218) Who has hurt you in this way?

Anyone else?

RECORD ALL MENTIONED.

MOTHER/STEP-MOTHER A
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
CURRENT BOYFRIEND F
FORMER BOYFRIEND G
MOTHER-IN-LAW H
FATHER-IN-LAW I
OTHER IN-LAW J
TEACHER K
EMPLOYER/SOMEONE AT WORK L
POLICE/SOLDIER M

OTHER (SPECIFY) ___________X

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

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1220) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT (YES ON 201 OR 226 OR 230) (GO TO 1221)
NEVER BEEN PREGNANT (GO TO 1223)

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

YES 1
NO 2 (GO TO 1223)

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

Anyone else?

RECORD ALL MENTIONED

CURRENT HUSBAND/PARTNER A
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
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

1223) CHECK 601 AND 602:

EVER MARRIED/EVER LIVED WITH A MAN (GO TO 1223A)
NEVER MARRIED/NEVER LIVED WITH A MAN (GO TO 1223B)

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?

YES 1 (GO TO 1224)
NO 2 (GO TO 1225A)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1225A)

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?

YES 1
NO 2 (GO TO 1227)
REFUSED TO ANSWER/NO ANSWER 3 (GO TO 1227)

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

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER/STEP-FATHER 04
BROTHER/STEP-BROTHER 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

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?

YES 1 (GO TO 1226)
NO 2 (GO TO 1226)

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

AT LEAST ONE 'YES' (GO TO 1226)
NOT A SINGLE 'YES' (GO TO 1227)

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?

AGE COMPLETED IN YEARS _____
DON'T KNOW 98

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

AT LEAST ONE 'YES (GO TO 1228)
NOT A SINGLE 'YES' (GO TO 1231)

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

YES 1
NO 2 (GO TO 1230)

1229) From whom have you sought help?

Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A
HUSBAND'S/PARTNER'S FAMILY B
CURRENT/FORMER HUSBAND/PARTNER C
FRIEND E
NEIGHBOUR F
RELIGIOUS LEADER G
DOCTOR/MEDICAL PERSONNEL H
POLICE I
LAWYER J
SOCIAL SERVICE ORGANIZATION K

OTHER (SPECIFY) _________________X

1230) Have you ever told anyone about this?

YES 1
NO 2

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

YES 1
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.

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?

HUSBAND
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
OTHER MALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3
FEMALE ADULT
YES, ONCE 1
YES, MORE THAN ONCE 2
NO 3

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

COMMENTS_________

1234) RECORD THE TIME.

HOUR______

MINUTES_____________

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:

B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM OR JELLY
K STANDARD DAYS
L LACTATIONAL AMENORRHEA METHOD
M RHYTHM METHOD
N WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE:

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ____
Z DON'T KNOW

2013
12 DEC 01 ____ ____
11 NOV 02 ____ ____
10 OCT 03 ____ ____
09 SEP 04 ____ ____
08 AUG 05 ____ ____
07 JUL 06 ____ ____
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03 MAR 10 ____ ____
02 FEB 11 ____ ____
01 JAN 12 ____ ____
2012
12 DEC 13 ____ ____
11 NOV 14 ____ ____
10 OCT 15 ____ ____
09 SEP 16 ____ ____
08 AUG 17 ____ ____
07 JUL 18 ____ ____
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01 JAN 24 ____ ____
2011
12 DEC 25 ____ ____
11 NOV 26 ____ ____
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09 SEP 28 ____ ____
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07 JUL 30 ____ ____
06 JUN 31 ____ ____
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04 APR 33 ____ ____
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02 FEB 35 ____ ____
01 JAN 36 ____ ____
2010
12 DEC 37 ____ ____
11 NOV 38 ____ ____
10 OCT 39 ____ ____
09 SEP 40 ____ ____
08 AUG 41 ____ ____
07 JUL 42 ____ ____
06 JUN 43 ____ ____
05 MAY 44 ____ ____
04 APR 45 ____ ____
03 MAR 46 ____ ____
02 FEB 47 ____ ____
01 JAN 48 ____ ____
2009
12 DEC 49 ____ ____
11 NOV 50 ____ ____
10 OCT 51 ____ ____
09 SEP 52 ____ ____
08 AUG 53 ____ ____
07 JUL 54 ____ ____
06 JUN 55 ____ ____
05 MAY 56 ____ ____
04 APR 57 ____ ____
03 MAR 58 ____ ____
02 FEB 59 ____ ____
01 JAN 60 ____ ____
2008
12 DEC 61 ____ ____
11 NOV 62 ____ ____
10 OCT 63 ____ ____
09 SEP 64 ____ ____
08 AUG 65 ____ ____
07 JUL 66 ____ ____
06 JUN 67 ____ ____
05 MAY 68 ____ ____
04 APR 69 ____ ____
03 MAR 70 ____ ____
02 FEB 71 ____ ____
01 JAN 72 ____ ____