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2018 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY
WOMEN'S QUESTIONNAIRE
ZAMBIA
MINISTRY OF HEALTH/CENTRAL STATISTICAL OFFICE

IDENTIFICATION
PLACE NAME _________________________
NAME OF HOUSEHOLD HEAD _________________________
CLUSTER NUMBER _____
HOUSEHOLD NUMBER _____

INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DATE _______________
INTERVIEWER'S NAME _______________

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

NEXT VISIT:

DATE _____
TIME _____

FINAL VISIT:

DAY _____
MONTH _____
YEAR _____
INT. NUMBER _____
RESULT _____

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE:

ENGLISH 01
LANGUAGE CODES:
01 ENGLISH
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA

LANGUAGE OF INTERVIEW__

ENGLISH 01
LANGUAGE CODES:
01 ENGLISH
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA

NATIVE LANGUAGE OF RESPONDENT __

ENGLISH 01
LANGUAGE CODES:
01 ENGLISH
02 BEMBA
03 KAONDE
04 LOZI
05 LUNDA
06 LUVALE
07 NYANJA
08 TONGA

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR
NAME _______________
NUMBER ______________


INTRODUCTION AND CONSENT

Hello. My name is __________________________. I am working with the Ministry of Health in collaboration with Central Statistical Office (CSO). We are conducting a survey about health and other topics all over Zambia. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 30 to 60 minutes. All of the answers you give will be confidential and will note 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 can stop the interview at any time.

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

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

SIGNATURE OF INTERVIEWER _________________________ DATE _______________
RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 1)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)


SECTION 1. RESPONDENT'S BACKGROUND

(101) RECORD THE TIME.

HOURS _____
MINUTES _____

(102) How long have you been living continuously in (NAME OF CURRENT CITY, TOWN OR VILLAGE OF RESIDENCE)?

IF LESS THAN ONE YEAR, RECORD '00' YEARS

YEARS _____
ALWAYS 95 (SKIP TO 105)
VISITOR 96 (SKIP TO 105)

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

CITY 1
TOWN 2
RURAL AREA 3

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

CENTRAL 01
COPPERBELT 02
EASTERN 03
LUAPULA 04
LUSAKA 05
MUCHINGA 06
NORTHERN 07
NORTHWESTERN 08
SOUTHERN 09
WESTERN 10
OUTSIDE OF ZAMBIA 96

(105) In what month and year were you born?

MONTH _____
DON'T KNOW MONTH 98
YEAR _____
DON'T KNOW YEAR 9998

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

AGE IN COMPLETED YEARS _____

(107) Have you ever attended school?

YES 1
NO 2 (SKIP TO 111)

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

PRIMARY 1
SECONDARY 2
HIGHER 3

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

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

GRADE _____

(110) CHECK 108:

PRIMARY OR SECONDARY (SKIP TO 111)
HIGHER (SKIP TO 113)

(111) Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PART OF THE SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _________________ 4
BLIND/VISUALLY IMPAIRED 5

(112) CHECK 111:

CODE '2', '3', OR '4' CIRCLED (SKIP TO 113)
CODE '1' OR '5' CIRCLED (SKIP TO 114)

(113) 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 EVER DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE 3
NOT AT ALL 4

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

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

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

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

(116) Do you own a mobile telephone?

YES 1
NO 2 (SKIP TO 118)

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

YES 1
NO 2

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

YES 1
NO 2

(119) Have you ever used the internet?

YES 1
NO 2 (SKIP TO 122)

(120) In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

YES 1
NO 2 (SKIP TO 122)

(121) During the last one month, have often did you use the internet: 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

(122) What is your religion?

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

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

NUMBER OF TIMES _____
NONE 00 (SKIP TO 201)

(125) 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 (SKIP TO 206)

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

YES 1
NO 2 (SKIP TO 204)

(203) a) How many sons live with you?
b) How many daughters live with you?

IF NONE, RECORD '00'.

a) SONS AT HOME _____
b) 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 (SKIP TO 206)

(205) a) How many sons are alive but do not live with you?
b) How many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

a) SONS ELSEWHERE _____
b) 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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

YES 1
NO 2 (SKIP TO 208)

(207) a) How many boys have died?
b) How many girls have died?

IF NONE, RECORD '00'.

a) BOYS DEAD _____
b) 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 (SKIP TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

(210) CHECK 208:

ONE OR MORE BIRTHS (SKIP TO 211)
NO BIRTHS (SKIP TO 226)

(211) Now I would like record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. IF THERE ARE MORE THAN 10 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

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

RECORD NAME.
BIRTH HISTORY NUMBER

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

BOY 1
GIRL 2

(214) Were any of these births twins?

SING 1
MULT 2

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

DAY _____
MONTH _____
YEAR _____

(216) Is (NAME) still alive?

YES 1
NO 2 (SKIP 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.

HOUSEHOLD LINE NUMBER _____ (SKIP TO 221)

(220) IF DEAD: How old was (NAME) when (he/she) died?

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

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)

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

YES 1 (RECORD BIRTH(S) IN TABLE)
NO 2

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

NUMBERS ARE SAME (SKIP TO 224)
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

(224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2013-2018

NUMBER OF BIRTHS _____
NONE 0 (SKIP TO 226)

(225) FOR EACH BIRTH IN 2013-2018, 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 COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.

(226) Are you pregnant now?

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

(227) How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

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

MONTHS _____

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

YES 1 (SKIP TO 230)
NO 2

(229) CHECK 208: TOTAL NUMBER OF BIRTHS

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

LATER 1
NO MORE/NONE 2

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

YES 1
NO 2 (SKIP TO 239)

(231) When did the last such pregnancy end?

MONTH _____
YEAR _____

(232) CHECK 231:

LAST PREGNANCY ENDED IN 2013-2018 (SKIP TO 234)
LAST PREGNANCY ENDED IN 2012 OR EARLIER (SKIP TO 239)

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

MONTH _____
YEAR _____

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

NUMBER OF MONTHS _____

(235) Since January 2013, have you had any other pregnancies that did not result in a live birth?

YES 1 (SKIP TO NEXT LINE)
NO 2 (SKIP TO 236)

(236) FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2013-2018 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

(237) Did you have any miscarriages, abortions or stillbirths that ended before 2013?

YES 1
NO 2 (SKIP TO 239)

(238) When did the last such pregnancy that terminated before 2013 end?

MONTH _____
YEAR _____

(239) When did your last menstrual period start?

DATE, 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

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

YES 1
NO 2 (SKIP TO 242)
DON'T KNOW 8 (SKIP TO 242)

(241) 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 (SPECIFY) _________________________ 6
DON'T KNOW 8

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

YES 1
NO 2
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. Which ways or methods have you heard about?

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

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.

(301.01) Female Sterilization.

PROBE: Women can have an operation to avoid having any more children.

YES 1
NO 2

(301.02) Male Sterilization.

PROBE: Men can have an operation to avoid having any more children.

YES 1
NO 2

(301.03) IUD.

PROBE: Women can have a loop or coil placed inside them by a doctor, nurse, or clinic officer which can prevent pregnancy for one or more years.

YES 1
NO 2

(301.04) Injectable.

PROBE: Women can have an injection by a doctor, nurse, or clinic officer that stops them from becoming pregnant for one or more months.

YES 1
NO 2

(301.05) 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

(301.06) Pill.

PROBE: Women can take a pill every day to avoid becoming pregnant.

YES 1
NO 2

(301.07) Male Condom.

PROBE: Men can put a robber sheath on their penis before sexual intercourse.

YES 1
NO 2

(301.08) Female Condom.

PROBE: Women can place a sheath in their vagina before sexual intercourse.

YES 1
NO 2

(301.09) Emergency Contraception.

PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.

YES 1
NO 2

(301.10) Standard Days Method (Cycle Beads).

PROBE: A woman uses a 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

(301.11) Lactational Amenorrhea Method (LAM).

PROBE: Up to six months after childbirth, before the menstrual period has returned, women use a method requiring frequent breastfeeding day and night.

YES 1
NO 2

(301.12) Rhythm Method.

PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get.

YES 1
NO 2

(301.13) Withdrawal

PROBE: Men can be careful and pull out before climax.

YES 1
NO 2

(301.14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

YES, MODERN METHOD (SPECIFY) _________________________ a
yes, traditional method (specify) _________________________ B
NO Y

(302) CHECK 226:

NOT PREGNANT OR UNSURE (SKIP TO 303)
PREGNANT (SKIP TO 312)

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

YES 1
NO 2 (SKIP TO 312)

(304) Which method are you using?

RECORD ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

FEMALE STERILIZATION A (SKIP TO 30)
MALE STERILIZATION B (SKIP TO 30)
IUD C (SKIP TO 309)
INJECTABLES D (SKIP TO 309)
IMPLANTS E (SKIP TO 309)
PILL F
CONDOM G (SKIP TO 306)
FEMALE CONDOM H (SKIP TO 306A)
EMERGENCY CONTRACEPTION I (SKIP TO 309)
STANDARD DAYS METHOD J (SKIP TO 309)
LACTATIONAL AMENORRHEA METHOD K (SKIP TO 309)
RHYTHM METHOD L (SKIP TO 309)
WITHDRAWAL M (SKIP TO 309)
OTHER MODERN METHOD X (SKIP TO 309)
OTHER TRADITIONAL METHOD Y (SKIP TO 309)

(305) What is the brand name of the pills you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

SAFE PLAN 01 (SKIP TO 309)
MICROGYNON 02 (SKIP TO 309)
MICROLUT 03 (SKIP TO 309)
EUGYNON 04 (SKIP TO 309)
LOGYNON 05 (SKIP TO 309)
NORDETTE 06 (SKIP TO 309)
ORALCON F 07 (SKIP TO 309)
OTHER (SPECIFY) _________________________ 96 (SKIP TO 309)
DIDN'T KNOW 98 (SKIP TO 309)

(306) What is the brand name of the condoms you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

MAXIMUM CLASSIC 01 (SKIP TO 309)
MAXIMUM SCENTED 02 (SKIP TO 309)
ROUGH RIDER 03 (SKIP TO 309)
DUREX 04 (SKIP TO 309)
REALITY 05 (SKIP TO 309)
PUBLIC SECTOR:
UNBRANDED (WHITE COLOUR FOIL) 06 (SKIP TO 309)
OTHER (SPECIFY) __________________________ (96) (SKIP TO 309)
DON'T KNOW 98 (SKIP TO 309)

(306A) What is the brand name of the female condoms you are using?

IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

CARE FEMALE CONDOM 01 (SKIP TO 309)
FEMIDOM 02 (SKIP TO 309)
OTHER (SPECIFY) _________________________ 96 (SKIP TO 309)
DON'T KNOW 98 (SKIP TO 309)

(307) In what facility did the sterilization take place?

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

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
MOBILE HOSPITAL/CLINIC 14
OTHER PUBLIC SECTOR (SPECIFY) _________________________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PRIVATE DOCTOR'S OFFICE 23
MOBILE HOSPITAL/CLINIC 24
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___________ 26
OTHER (SPECIFY) _________________________ 96
DON'T KNOW 98

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

MONTH _____ (SKIP TO 310)
YEAR _____ (SKIP TO 310)

(309) Since what month and year have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

MONTH _____
YEAR _____

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

NO (SKIP TO 311)
YES (GO BACK TO 308 OR 309, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION)).

(311) CHECK 308 AND 309:

YEAR IS 2013-2018:
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
THEN CONTINUE TO 312

YEAR IS 2012 OR EARLIER:
ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2013.
THEN SKIP TO 324

(312) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2013. USE NAMES OR CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

MONTH _____
YEAR _____

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

YES 1
NO 2 (SKIP TO 312I)

(312C) Which method was that?

METHOD CODE _____

(312D) How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)?

CIRCLE '95' IF RESPONDENT GIVES THE DATE OF STARTING TO USE THE METHOD.

IMMEDIATELY 00
MONTHS _____ (SKIP TO 312F)
DATE GIVEN 95

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

MONTH _____
YEAR _____

(312F) For how many months did you use (METHOD)?

CIRCLE '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

MONTHS _____ (SKIP TO 312H)
DATE GIVEN 95

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

MONTH _____
YEAR _____

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

REASON STOPPED _________________________

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

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

NO METHOD USED (SKIP TO 314)
ANY METHOD USED (SKIP TO 315)

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

YES 1 (SKIP TO 326)
NO 2 (SKIP TO 326)

(315) 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 (SKIP TO 326)

FEMALE STERILIZATION 01 (SKIP TO 319)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM H 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 323)
RHYTHM METHOD 12 (SKIP TO 323)
WITHDRAWAL 13 (SKIP TO 323)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96

(316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?

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

NAME OF PLACE: _________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
MOBILE CLINIC/HOSPITAL 14
COMMUNITY BASED AGENT/FIELD WORKER 15
OTHER PUBLIC SECTOR (SPECIFY) __________________________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE HOSPITAL/CLINIC 25
COMMUNITY BASED AGENT/FIELDWORKER 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________________ 27
OTHER SOURCES
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) __________________________ 96

(317) 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
CONDOM 07 (SKIP TO 323)
FEMALE CONDOM H 08 (SKIP TO 322)
EMERGENCY CONTRACEPTION 09 (SKIP TO 322)
STANDARD DAYS METHOD 10 (SKIP TO 322)
OTHER MODERN METHOD 95 (SKIP TO 322)
OTHER TRADITIONAL METHOD 96 (SKIP TO 323)

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

YES 1 (SKIP TO 321)
NO 2 (SKIP TO 320)

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

YES 1 (SKIP TO 321)
NO 2

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

YES 1
NO 2 (SKIP TO 322)

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

YES 1
NO 2

(322) CHECK 318 AND 319:

ANY 'YES':
At that time, were you told about other methods of family planning that you could use?
OTHER:
When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 or 316), were you told about other methods of family planning that you could use?
YES 1 (SKIP TO 324)
NO 2

(323) 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

(324) CHECK 304:
CIRCLE METHOD CODE:

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

FEMALE STERILIZATION 01 (SKIP TO 327)
MALE STERILIZATION 02 (SKIP TO 327)
IUD 03
INJECTABLES 04
IMPLANTS 05
PILL 06
CONDOM 07
FEMALE CONDOM 08
EMERGENCY CONTRACEPTION 09
STANDARD DAYS METHOD 10
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 327)
RHYTHM METHOD 12 (SKIP TO 327)
WITHDRAWAL 13 (SKIP TO 327)
OTHER MODERN METHOD 95
OTHER TRADITIONAL METHOD 96 (SKIP TO 327)

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

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE: _________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (SKIP TO 327)
GOVERNMENT HEALTH CENTER 12 (SKIP TO 327)
GOVERNMENT HEALTH POST 13 (SKIP TO 327)
MOBILE CLINIC/HOSPITAL 14 (SKIP TO 327)
COMMUNITY BASED AGENT/FIELDWORKER 15 (SKIP TO 327)
OTHER PUBLIC SECTOR (SPECIFY) ________________ 16 (SKIP TO 327)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21 (SKIP TO 327)
MISSION HOSPITAL/CLINIC 22 (SKIP TO 327)
PHARMACY 23 (SKIP TO 327)
PRIVATE DOCTOR 24 (SKIP TO 327)
MOBILE HOSPITAL/CLINIC 25 (SKIP TO 327)
COMMUNITY BASED AGENT/FIELDWORKER 26 (SKIP TO 327)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ 27 (SKIP TO 327)
OTHER SOURCES
SHOP 31 (SKIP TO 327)
CHURCH 32 (SKIP TO 327)
FRIEND/RELATIVE 33 (SKIP TO 327)
OTHER (SPECIFY) _________________________ 96 (SKIP TO 327)

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

YES 1
NO 2

(327) In the last 12 months, were you visited by a community health worker?

YES 1
NO 2 (SKIP TO 329)

(328) Did the community health worker talk to you about family planning?

YES 1
NO 2

(329) CHECK 202: CHILDREN LIVING WITH THE RESPONDENT

YES: in the last 12 months, have you visited a health facility for care for yourself or your children?
NO: In the last 12 months, have you visited a health facility for care for yourself?

YES 1
NO 2 (SKIP TO 401)

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

YES 1
NO 2

SECTION 4: PREGNANCY AND POSTNATAL CARE

(401) CHECK 224:

ONE OR MORE BIRTHS IN 2013-2018 (SKIP TO 402)
NO BIRTHS IN 2013-2018 (SKIP TO 648)

(402) CHECK 215. RECORD THE BIRTH HISTORY NUMBERS IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2013-2018. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).

Now I would like to ask 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.

LAST BIRTH
BIRTH HISTORY NUMBER _____

NEXT-TO-LAST BIRTH
BIRTH HISTORY NUMBER _____

(404) FROM 212 AND 216:

NAME _________________________
LIVING (SKIP TO 405)
DEAD (SKIP TO 405)

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

YES 1 (SKIP TO 408)
NO 2

(406) CHECK 208:

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

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

LATER 1
NO MORE/NONE 2 (SKIP TO 408)

(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?

YES 1
NO 2 (SKIP TO 414)

(409) Whom did you see?
Anyone else?

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

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

(410) Where did you receive antenatal care for this pregnancy?
Anywhere else?

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

HOME
HER HOME A
OTHER HOME B
PUBLIC SECTOR
GOVERNMENT HOSPITAL C
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
MOBILE HOSPITAL/CLINIC F
OTHER PUBLIC SECTOR (SPECIFY) ____________________ J

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

MONTHS _____
DON'T KNOW 98

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

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:

a) Was your blood pressure measured?

YES 1
NO 2

b) Did you give a urine sample?

YES 1
NO 2

c) Did you give a blood sample?

YES 1
NO 2

d) Were you weighed?

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 417)
DON'T KNOW 8

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

TIMES _____
DON'T KNOW 8

(416) CHECK 415:

2 OR MORE TIMES (SKIP TO 420)
OTHER (SKIP TO 417)

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

YES 1
NO 2 (SKIP TO 420)
DON'T KNOW 8

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

TIMES _____
DON'T KNOW 8

(419) CHECK 418:

ONLY ONE TIME:
How many years ago did you receive that tetanus injection?

MORE THAN ONE TIME: How many years ago did you receive the last tetanus injection before this pregnancy?

YEARS AGO _____

(420) During the whole pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP

YES 1
NO 2 (SKIP TO 422)
DON'T KNOW 8

(421) 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.

DAYS _____
DON'T KNOW 998

(422) During this pregnancy, did you take any drug from intestinal worms?

YES 1
NO 2
DON'T KNOW 8

(423) During this pregnancy, did you take SP/Fansidar to keep you from getting malaria?

YES 1
NO 2 (SKIP TO 426)
DON'T KNOW 8

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

TIMES _____

(425) Did you get the SP/Fansidar during any antenatal care visit during another visit to a health facility or from another source?
IF MORE THAN ONE SOURCE, RECORD THE HIGHEST SOURCE ON THE LIST.

ANTENATAL VISIT 1
ANOTHER FACILITY VISIT 2
OTHER SOURCE 6

(426) 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

(427) Was (NAME) weighed at birth?

YES 1
NO 2 (SKIP 429)
DON'T KNOW 8

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

KG FROM CARD _____
KG FROM RECALL _____
DON'T KNOW 99998

(429) 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
NURSE/MIDWIFE B
CLINICAL OFFICER C
OTHER PERSON
TRADITIONAL BIRTH ATTENDANT D
COMMUNITY HEALTH WORKER E
RELATIVE/FRIEND F
OTHER (SPECIFY) ____________________ X
NO ONE ASSISTED Y

(430) Where did you give birth to (NAME)?
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) ____________________

HOME
HER HOME 11 (SKIP TO 434)
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) __________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____________________ 36
OTHER (SPECIFY) ____________________ 96 (SKIP TO 434)

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

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _____
DON'T KNOW 998

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

YES 1
NO 2 (SKIP TO 434)

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

BEFORE 1
AFTER 2

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

YES 1
NO 2 (SKIP TO 434B)
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

(434B) CHECK 430: PLACE OF DELIVERY

CODE 11,12, OR 96 (SKIP TO 449)
OTHER (SKIP TO 435)

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

YES 1
NO 2 (SKIP TO 438)

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

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _____
DON'T KNOW 998

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

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

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

YES 1
NO 2 (SKIP TO 441)
DON'T KNOW 8

(439) How long after delivery was (NAME)'s health first checked?
IF LESS THAN A DAY, RECORD HOURS;
IF LESS THAN ONE WEEK, RECORD DAYS.

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _____
DON'T KNOW 998

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

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

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

YES 1
NO 2 (SKIP TO 445)

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

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _____
DON'T KNOW 998

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

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

(444) Where did the check take place?
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) ___________________

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) ____________________ 26

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

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8

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

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _____
DON'T KNOW 998

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

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

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

HOME
HER HOME 11 (SKIP TO 457)
OTHER HOME 12 (SKIP TO 457)
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21 (SKIP TO 457)
GOVERNMENT HEALTH CENTER 22 (SKIP TO 457)
GOVERNMENT HEALTH POST 23 (SKIP TO 457)
OTHER PUBLIC SECTOR (SPECIFY) _______________ 26 (SKIP TO 457)

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

HOURS 1 _____
DAYS 2 _____
WEEKS 3 _____
DON'T KNOW 998

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

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

(452) Where did this first check take place?
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) _______________________

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) ____________________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________ 36
OTHER (SPECIFY) __________________ 96

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

YES 1
NO 2 (SKIP TO 457)
DON'T KNOW 8

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

HOURS AFTER BIRTH 1 _____
DAYS AFTER BIRTH 2 _____
WEEKS AFTER BIRTH 3 _____
DON'T KNOW 998

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

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

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

(NAME OF PLACE) ____________________

HOME
HER HOME 11
OTHER HOME 12
PUBLIC SECTOR
GOVERNMENT HOSPITAL 21
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC SECTOR (SPECIFY) ____________________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
MISSION HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________ 36
OTHER (SPECIFY) _________________________ 96

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

a) Examine the cord?

YES 1
NO 2
DON'T KNOW 8

b) Measure (NAME)'s temperature?

YES 1
NO 2
DON'T KNOW 8

c) Counsel you on danger signs for newborns?

YES 1
NO 2
DON'T KNOW 8

d) Counsel you on breastfeeding?

YES 1
NO 2
DON'T KNOW 8

e) Observe (NAME) breastfeeding?

YES 1
NO 2
DON'T KNOW 8

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

YES 1 (SKIP TO 460)
NO 2 (SKIP TO 461)

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

YES 1
NO 2 (SKIP TO 463)

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

MONTHS _____
DON'T KNOW 98

(461) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (SKIP TO 462)
PREGNANT OR UNSURE (SKIP TO 463)

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

YES 1
NO 2 (SKIP TO 464)

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

MONTHS _____
DON'T KNOW 98

(464) Did you ever breastfeed (NAME)?

YES 1 (SKIP TO 466)
NO 2

(465) CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 470)
DEAD (SKIP TO 471)

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

IMMEDIATELY 000
HOURS 1 _____
DAYS 2 _____

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

YES 1
NO 2

(468) CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 469)
DEAD (SKIP TO 471)

(469) Are you still breastfeeding (NAME)?

YES 1
NO 2

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

YES 1
NO 2
DON'T KNOW 8

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


SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

(501A) CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2015-2018?

ONE OR MORE BIRTHS IN 2015-2018 (SKIP TO 502A)
NO BIRTHS IN 2015-2018 (SKIP TO 601)

(502A) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2015-2018.

NAME OF LAST BIRTH ____________________
BIRTH HISTORY NUMBER _____

(503A) CHECK 216 FOR CHILD:

LIVING (SKIP TO 504A)
DEAD (SKIP TO 501B)

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

YES, HAS ONLY A CARD 1 (SKIP TO 507A)
YES, HAS ONLY AN OTHER DOCUMENT 2
YES, HAS CARD AND OTHER DOCUMENT 3 (SKIP TO 507A)
NO, NO CARD AND NO OTHER DOCUMENT 4

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

YES 1
NO 2

(506A) CHECK 504A:

CODE '2' CIRCLED (SKIP TO 507A)
CODE '4' CIRCLED (SKIP TO 511A)

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

YES, ONLY CARD SEEN 1
YES, ONLY OTHER DOCUMENT SEEN 2
YES, CARD AND OTHER DOCUMENT SEEN 3
NO CARD AND NO OTHER DOCUMENT SEEN 4 (SKIP TO 511A)

(508A) COPY DATES FROM THE CARD.
WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

BCG (at birth)
DAY _____
MONTH _____
YEAR _____
ORAL POLIO VACCINE (OPV) 0 (BIRTH DOSE)
DAY _____
MONTH _____
YEAR _____
ORAL POLIC VACCINE (OPV) 1
DAY _____
MONTH _____
YEAR _____
ORAL POLIC VACCINE (OPV) 2
DAY _____
MONTH _____
YEAR _____
ORAL POLIC VACCINE (OPV) 3
DAY _____
MONTH _____
YEAR _____
ORAL POLIC VACCINE (OPV) 4
DAY _____
MONTH _____
YEAR _____
PCV 1
DAY _____
MONTH _____
YEAR _____
PCV 2
DAY _____
MONTH _____
YEAR _____
PCV 3
DAY _____
MONTH _____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 1
DAY _____
MONTH _____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 2
DAY _____
MONTH _____
YEAR _____
DPT-HEP.B-HIB (PENTAVALENT) 3
DAY _____
MONTH _____
YEAR _____
MEASLES/RUBELLA 1
DAY _____
MONTH _____
YEAR _____
MEASLES/RUBELLA 2
DAY _____
MONTH _____
YEAR _____
ROTA VACCINE 1
DAY _____
MONTH _____
YEAR _____
ROTA VACCINE 1
DAY _____
MONTH _____
YEAR _____
VITAMIN A (MOST RECENT)
DAY _____
MONTH _____
YEAR _____

(509A) CHECK 508A: 'BCG' TO ROTA VACCINE 2' ALL RECORDED?

NO (SKIP TO 510A)
YES (SKIP TO 525A)

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

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508A THEN WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN. THEN SKIP TO 525A)
NO 2 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN. THEN SKIP TO 525A)
DON'T KNOW 8 (WRITE '00' IN THE CORRESPONDING DAY COLUMN FOR ALL VACCINATIONS NOT GIVEN. THEN SKIP TO 525A)

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

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

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

YES 1
NO 2
DON'T KNOW 8

(514A) Has (NAME) ever received oral polio vaccine in the first two weeks after birth or later?

YES 1
NO 2 (SKIP TO 517A)
DON'T KNOW 8 (SKIP TO 517A)

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

FIRST TWO WEEKS 1
LATER 2

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

NUMBER OF TIMES _____

(517A) Has (NAME) ever received a pentavalent (DPT-HEP.B-HIB) vaccination, that is, an injection given in the left thigh sometimes at the same time as polio drops?

YES 1
NO 2 (SKIP TO 519A)
DON'T KNOW (SKIP TO 519A)

(518A) How many times did (NAME) receive the pentavalent vaccine?

NUMBER OF TIMES _____

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

YES 1
NO 2 (SKIP TO 521A)
DON'T KNOW 8 (SKIP TO 521A)

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

NUMBER OF TIMES _____

(521A) Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

YES 1
NO 2 (SKIP TO 523A)
DON'T KNOW 8 (SKIP TO 523A)

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

NUMBER OF TIMES _____

(523A) Has (NAME) ever received a measles and rubella vaccination, that is, an injection in the arm to prevent measles and rubella?

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

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

NUMBER OF TIMES _____

(525A) In the last 7 days was (NAME) given:
a) Micronutrient powder
b) Ready to use therapeutic food such as Plumpy'nut?

a) POWDER
YES 1
NO 2
DON'T KNOW 8
b) PLUMPY'NUT
YES 1
NO 2
DON'T KNOW 8

(526A) CONTINUE WITH 501B. (REPEAT WITH NEXT-TO-LAST BIRTH)


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

(526) CHECK 215 IN BIRTH HISTORY: ANY MORE BIRTHS IN 2015-2018?

MORE BIRTHS IN 2015-2018 (GO TO 502B IN AN ADDITIONAL QUESTIONNAIRE)
NO MORE BIRTHS IN 2015-2018 (SKIP TO 601)


SECTION 6. CHILD HEALTH AND NUTRITION

(601) CHECK 224:

ONE OR MORE BIRTHS IN 2013-2018 (SKIP TO 602)
NO BIRTHS IN 2013-2018 (SKIP TO 648)

(602) CHECK 215: RECORD THE BIRTH HISTORY NUMBER IN 603 AND THE NAME AND SURVIVAL STATUS IN 604 FOR EACH BIRTH IN 2013-2018. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).
Now I would like to ask you some questions about the health of all of your children born in the last 5 years. (We will talk about each separately.)

(603) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

LAST BIRTH
BIRTH HISTORY NUMBER _____

NEXT-TO-LAST BIRTH
BIRTH HISTORY NUMBER _____

(604) FROM 212 AND 216:

NAME ____________________
LIVING (SKIP TO 605)
DEAD (SKIP TO 646)

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

YES 1
NO 2
DON'T KNOW 8

(606) 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

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

(609) CHECK 469: CURRENTLY BREASTFEEDING?

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

NO/ NOT ASKED:
Now I would like to know how much (NAME) was given to drink during the diarrhea. Was (NAME) given less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was (NAME) given much less than usual to drink or somewhat less?
MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8

(610) When (NAME) has diarrhea, was NAME given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was (NAME) given much less than usual to eat or somewhat less?

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

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

YES 1
NO 2 (SKIP TO 615)

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

(NAME OF PLACE(S)) ____________________


PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC/HOSPITAL D
COMMUNITY BASED AGENT/FIELD WORKER E
OTHER PUBLIC SECTOR (SPECIFY) __________________________ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________________ M

OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
ITINERANT DRUG SELLER Q
OTHER (SPECIFY) __________________________ X

(613) CHECK 612:

TWO OR MORE CODES CIRCLED (SKIP TO 614)
ONLY ONE CODE CIRCLED (SKIP TO 615)

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

FIRST PLACE _____

(614A) How many days after the diarrhea began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

DAYS _____

(615) Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:
a) A fluid made from a special packet called ORS (commonly called Manzi Ya Moyo)?
b) A government-recommended homemade fluid?
c) Zinc tablets or syrup?

a) FLUID FROM ORS
YES 1
NO 2
DON'T KNOW 8
b) HOMEMADE FLUID
YES 1
NO 2
DON'T KNOW 8
c) ZINC
YES 1
NO 2
DON'T KNOW 8

(616) CHECK 615:
ANY 'YES': Was anything else given to treat the diarrhea?
ALL 'NO' OR 'DON'T KNOW': Was anything given to treat the diarrhea?

YES 1
NO 2 (SKIP TO 618)
DON'T KNOW 8 (SKIP TO 618)

(617) CHECK 615:
ANY 'YES': What else given to treat the diarrhea? Anything else?
ALL 'NO' OR 'DON'T KNOW': What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.


PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER (NOT ANTIBIOTIC OR ANTIMOTILITY) C
UNKNOWN PILL OR SYRUP D

INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC F
UNKNOWN INJECTION G
(IV) INTRAVENOUS H
HOME REMEDY/ HERBAL MEDICINE I
OTHER (SPECIFY) ____________________ X

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

YES 1
NO 2 (SKIP TO 620)
DON'T KNOW 8 (SKIP TO 620)

(619) At any time during the illness, (NAME) have blood taken from (NAME)'s finger or heel for testing?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 623)
DON'T KNOW (SKIP TO 623)

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

CHEST ONLY 1 (SKIP TO 624)
NOSE ONLY 2 (SKIP TO 624)
BOTH 3 (SKIP TO 624)
OTHER (SPECIFY) _________ 6 (SKIP TO 624)
DON'T KNOW 8 (SKIP TO 624)

(623) CHECK 618: HAD FEVER?

YES (SKIP TO 624)
NO OR DON'T KNOW (SKIP TO 646)

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

YES 1
NO 2 (SKIP TO 629)

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

(NAME OF PLACE(S))___________________________


PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
MOBILE CLINIC/HOSPITAL D
COMMUNITY BASED AGENT/FIELD WORKER E
OTHER PUBLIC SECTOR (SPECIFY) __________________________ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
MOBILE CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________________ M

OTHER SOURCE
SHOP N
TRADITIONAL PRACTITIONER O
MARKET P
ITINERANT DRUG SELLER Q
OTHER (SPECIFY) __________________________ X

(626) CHECK 625:

TWO OR MORE CODES CIRCLED (SKIP TO 627)
ONLY ONE CODE CIRCLED (SKIP TO 628)

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

FIRST PLACE _____

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

DAYS _____

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

YES 1
NO 2 (SKIP TO 646)
DON'T KNOW 8 (SKIP TO 646)

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


ANTIMALARIAL DRUGS
ARTEMISININ COMBINATION THERAPY (ACT) A
SP/FANSIDAR B
CHLOROQUINE C
AMODIAQUINE D
QUININE PILLS E
INJECTION/IV F
ARTESUNATE RECTAL G
INJECTION/ IV H
OTHER ANTIMALARIAL (SPECIFY) ___________________ I

ANTIBIOTIC DRUGS
PILL/SYRUP J
INJECTION/IV K

OTHER DRUGS
ASPIRIN L
ACETAMINOPHEN/PARACETAMOL M
IBUPROFEN N
OTHER (SPECIFY) ____________________ X
DON'T KNOW Z

(631) CHECK 630: ANY CODE A-I CIRCLED?

YES (SKIP TO 632)
NO (SKIP TO 646)

(632) CHECK 630: ARTEMISININ COMBINATION THERAPY ('A') GIVEN

CODE 'A' CIRCLED (SKIP TO 633)
CODE 'A' NOT CIRCLED (SKIP TO 634)

(633) How long after the fever started did (NAME) first take an artemisinin combination therapy (Coartem)?

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

(634) CHECK 630:
SP/FANSIDAR ('B') GIVEN

CODE 'B' CIRCLED (SKIP TO 635)
CODE 'B' NOT CIRCLED (SKIP TO 636)

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

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

(636) CHECK 630:
CHLOROQUINE ('C') GIVEN

CODE 'C' CIRCLED (SKIP TO 637)
CODE 'C' NOT CIRCLED (SKIP TO 638)

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

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

(638) CHECK 630:
AMODIAQUINE ('D') GIVEN

CODE 'D' CIRCLED (SKIP TO 639)
CODE 'D' NOT CIRCLED (SKIP TO 640)

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

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

(640) CHECK 630:
QUININE ('E' OR 'F') GIVEN

CODE 'E' OR 'F' CIRCLED (SKIP TO 641)
CODE 'E' OR 'F' NOT CIRCLED (SKIP TO 642)

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

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

(642) CHECK 630: ARTESUNATE ('G' OR 'H') GIVEN

CODE 'G' OR 'H' CIRCLED (SKIP TO 643)
CODE 'G' OR 'H' NOT CIRCLED (SKIP TO 644)

(643) How long after the fever started did (NAME) first take artesunate?

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

(644) CHECK 630:
OTHER ANTIMALARIAL ('I') GIVEN

CODE 'I' CIRCLED (SKIP TO 645)
CODE 'I' NOT CIRCLED (SKIP TO 646)

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

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

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

(647) CHECK 615(a) AND (b), ALL COLUMNS:

NO CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (SKIP TO 648)
ANY CHILD RECEIVED FLUID FROM ORS PACKET OR PRE-PACKAGED ORS LIQUID (SKIP TO 649)

(648) Have you ever heard of a special product called ORS you can get for the treatment of diarrhea.

YES 1
NO 2

(649) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2016-2018 LIVING WITH THE RESPONDENT.

ONE OR MORE:
NAME OF YOUNGEST CHILD LIVING WITH HER: ____________________
NONE (SKIP TO 701)

(650) Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mentioned even if it was combined with other foods.
Did (NAME FROM 649) drink or 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, Soya 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?
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 fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
o) Liver, 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 foods made from beans, peas, lentils, or nuts?
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?
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

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

NOT A SINGLE 'YES' (SKIP TO 652)
AT LEAST ONE 'YES' (SKIP TO 653)

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

YES 1 (GO BACK TO 650 TO RECORD FOOD EATEN YESTERDAY THEN CONTINUE TO 653)
NO 2(SKIP TO 654)

(653) How many times did (NAME FROM 649) eat solid, semisolid, 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

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

CHILD USED TOILET OR LATRINE 1
PUT/RINSED INTO TOILET OR LATRINE 2
PUT/RINSED INTO DRAIN OR DITCH 3
THROWN INTO GARBAGE 4
BURIED 5
LEFT IN THE OPEN 6
OTHER (SPECIFY) ____________________ 96


SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (SKIP TO 704)
YES, LIVING WITH A MAN 2 (SKIP TO 704)
NO, NOT IN UNION 3

(702) 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 (SKIP TO 712)

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

WIDOWED 1 (SKIP TO 709)
DIVORCED 2 (SKIP TO 709)
SEPARATED 3 (SKIP TO 709)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

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

NAME ____________________
LINE NO _____

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

YES 1
NO 2 (SKIP TO 709)
DON'T KNOW 8 (SKIP TO 709)

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

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

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

RANK _____

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

ONLY ONCE 1
MORE THAN ONCE 2 (SKIP TO 709B)

(709A) CHECK 703: IS RESPONDENT CURRENTLY

CURRENTLY WIDOWED (SKIP TO 709D)
NOT ASKED OR CURRENTLY DIVORCED/SEPARATED (SKIP TO 710)

(709B) CHECK 703: IS RESPONDENT CURRENTLY:

CURRENTLY WIDOWED (SKIP TO 709D)
CURRENTLY DIVORCED/SEPARATED (SKIP TO 710)
NOT ASKED (SKIP TO 709C)

(709C) How did your previous marriage or union end?

DEATH 1
DIVORCE 2 (SKIP TO 710)
SEPARATION 3 (SKIP TO 710)

(709D) To whom did most of your late husband's property go?

RESPONDENT 1 (SKIP TO 710)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
NO PROPERTY 5
OTHER (SPECIFY) ____________________ 6

(709E) Did you receive any of your late husband's assets or valuables?

YES 1
NO 2

(710) CHECK 709:

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 your first (husband/partner). In what month and year did you start living with him?

MONTH _____
DON'T KNOW 98
YEAR _____ (SKIP TO 712)
DON'T KNOW YEAR 9998

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

AGE _____

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

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

NEVER HAD SEXUAL INTERCOURSE 00
AGE IN YEARS _____ 713C

(713A) CHECK 106: AGE

AGE 15-24 (SKIP TO 713B)
AGE 25-49 (SKIP TO 731)

(713B) Do you intend to wait until you get married to have sexual intercourse for the first time?

YES 1 (SKIP TO 731)
NO 2 (SKIP TO 731)
DON'T KNOW/UNSURE 8 (SKIP TO 731)

(713C) CHECK 106: AGE

AGE 15-24 (SKIP TO 713D)
AGE 25-49 (SKIP TO 714)

(713D) The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/UNSURE 8

(713E) How old was the person you first had sexual intercourse with?

AGE IN YEARS _____ (SKIP TO 714)
DON'T KNOW 98

(713F) Was this person older than you, younger than you, or about the same age as you?

OLDER 1
YOUNGER 2 (SKIP TO 714)
ABOUT THE SAME AGE 3 (SKIP TO 714)
DON'T KNOW/DON'T REMEMBER 8 (SKIP TO 714)

(713G) 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 8

(714) I would like to ask you about your recent sexual activity. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1(SKIP TO 716)
WEEKS AGO 2 (SKIP TO 716)
MONTHS AGO 3 (SKIP TO 716)
YEARS AGO 4 (SKIP TO 727)

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

DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____

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

YES 1
NO 2 (SKIP TO 718)

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

YES 1
NO 2

(718) What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?

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

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

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

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

NUMBER OF TIMES _____

(721) How old is this person?

AGE OF PARTNER _____
DON'T KNOW 98

(721A) The last time you have sexual intercourse with this person, did you or this person drink alcohol?

YES 1
NO 2 (SKIP TO 722)

(721B) Where you or your partner drunk at that time?
IF YES: Who was drunk?

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

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

YES 1 (GO BACK TO 715 IN NEXT COLUMN)
NO 2 (SKIP TO 724)

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

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

(724) CHECK 106:

AGE 15-24 (SKIP TO 725)
AGE 25-49 (SKIP TO 727)

(725) CHECK 701:

NOT IN A UNION (SKIP TO 726)
CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 727)

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

YES 1
NO 2

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

NUMBER OF PARTNERS IN LIFETIME _____
DON'T KNOW 98

(728) CHECK 716, MOST RECENT PARTNER (FIRST COLUMN):

YES, CONDOM USED (SKIP TO 729)
NO, CONDOM NOT USED (SKIP TO 731)
NOT ASKED (SKIP TO 731)

(729) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRANKD NOT KNOWN, ASK TO SEE THE PACKAGE.

MAXIMUM CLASSIC 1
MAXIMUM SCENTED 2
ROUGH RIDER 3
DUREX 4
REALITY 5
PUBLIC SECTOR:
UNBRANDED (WHITE COLOUR FOIL) 6
OTHER (SPECIFY) ____________________ 96
DON'T KNOW 98

(730) From where did you obtain the condom the last time?
PROBE TO IDENTIFY 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 HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
MOBILE CLINIC/HOSPITAL 14
AGENT/FIELDWORKER 15
OTHER PUBLIC SECTOR (SPECIFY) ____________________ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE HOSPITAL/CLINIC 25
COMMUNITY BASED AGENT/FIELDWORKER 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____________________ 27

OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) ____________________ 96
DON'T KNOW 98

(731) PRESENCE OF OTHERS DURING THIS SECTION.

CHILDREN LT 10
YES 1
NO 2

MALE ADULTS
YES 1
NO 2

FEMALE ADULTS
YES 1
NO 2


SECTION 8. FERTILITY PREFERENCES

(801) CHECK 304:

NEITHER STERILIZED (SKIP TO 802)
HE OR SHE STERILIZED (SKIP TO 813)

(802) CHECK 226:

PREGNANT (SKIP TO 803)
NOT PREGNANT OR UNSURE (SKIP TO 804)

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

HAVE ANOTHER CHILD 1 (SKIP TO 805)
NO MORE 2 (SKIP TO 812)
UNDECIDED/DON'T KNOW 8 (SKIP TO 812)

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

HAVE (A/ANOTHER) CHILD 1
NO MORE /NONE 2 (SKIP TO 807)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 813)
UNDECIDED/DON'T KNOW 8 (SKIP TO 811)

(805) CHECK 226:

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

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

MONTHS 1 _____
YEARS 2 _____
SOON/NOW 993 (SKIP TO 811)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 813)
AFTER MARRIAGE 995 (SKIP TO 811)
OTHER (SPECIFY) ____________________ 996 (SKIP TO 811)
DON'T KNOW 998 (SKIP TO 811)

(806) CHECK 226:

NOT PREGNANT OR UNSURE (SKIP TO 807)
PREGNANT (SKIP TO 812)

(807) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT CURRENTLY USING (SKIP TO 808)
CURRENTLY USING (SKIP TO 813)

(808) CHECK 805:

'24' OR MORE MONTHS OR '02' OR MORE YEARS (SKIP TO 809)
NOT ASKED (SKIP TO 809)
'00-23' MONTHS OR '00-01' YEAR (SKIP TO 812)

(809) CHECK 714:

DAYS, WEEKS OR MONTHS AGO (SKIP TO 810)
YEARS AGO (SKIP TO 811)
NOT ASKED (SKIP TO 811)

(810) CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD:
You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reasons?

WANTS NO MORE/NONE:
You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A


FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
CAN'T 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
NO METHOD AVAILABLE S
INCONVENIENT TO USE T
INTERFERES WITH BODY'S NORMAL PROCESSES U
OTHER (SPECIFY) ____________________ X
DON'T KNOW Z

(811) CHECK 303: USING A CONTRACEPTIVE METHOD?

NOT ASKED (SKIP TO 812)
NO, NOT CURRENTLY USING (SKIP TO 812)
YES, CURRENTLY USING (SKIP TO 813)

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

YES 1
NO 2
DON'T KNOW 8

(813) CHECK 216:

HAS LIVING CHILDREN:
If you could go back to the time that you did not have any children and cold 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 (SKIP TO 815)
NUMBER _____
OTHER (SPECIFY) ____________________ 96 (SKIP TO 815)

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

NUMBER:
BOYS _____
GIRLS _____
EITHER _____
OTHER (SPECIFY) ____________________ 96

(815) In the last few months have you:
a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?
d) Received a voice or text message about family planning on a mobile phone?

a) RADIO
YES 1
NO 2
b) TELEVISION
YES 1
NO 2
c) NEWSPAPER OR MAGAZINE
YES 1
NO 2
d) MOBILE PHONE
YES 1
NO 2

(816) In the last six months, have you listened to the following programs on the radio:
a) Your Health Matters?
b) Other health related programs?

a) HEALTH MATTERS
YES 1
NO 2


b) OTHER (SPECIFY) _____________________
YES 1
NO 2

(816A) In the last six months, have you seen any of the following programs on television:
a) Your Health Matters?
b) Other health related programs?

a) HEALTH MATTERS
YES 1
NO 2


b) OTHER (SPECIFY) ____________________
YES 1
NO 2

(817) CHECK 701:

YES, CURRENTLY MARRIED (SKIP TO 818)
YES, LIVING WITH A MAN (SKIP TO 818)
NO, NOT IN A UNION (SKIP TO 901)

(818) CHECK 303: USING A CONTRACEPTIVE METHOD?

CURRENTLY USING (SKIP TO 819)
NOT CURRENTLY USING (SKIP TO 820)
NOT ASKED (SKIP TO 822)

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

MAINLY RESPONDENT 1 (SKIP TO 821)
MAINLY HUSBAND/PARTNER 2 (SKIP TO 821)
JOINT DECISION 3 (SKIP TO 821)
OTHER (SPECIFY) ____________________ 6 (SKIP TO 821)

(820) Would you say that not using contraception 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

(821) CHECK 304:

NEITHER ARE STERILIZED (SKIP TO 822)
HE OR SHE ARE STERILIZED (SKIP TO 901)

(822) 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 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

(901) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 902)
NOT IN UNION (SKIP TO 909)

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

AGE IN COMPLETED YEARS ______

(903) Did your (husband/partner) ever attend school?

YES 1
NO 2 (SKIP TO 906)

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

PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (SKIP TO 906)

(905) What is the highest grade he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

GRADE _____
DON'T KNOW 98

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

YES 1 (SKIP TO 908)
NO 2
DON'T KNOW 8

(907) has your (husband/partner) done any work in the last 12 months?

YES 1
NO 2 (SKIP TO 909)
DON'T KNOW 8 (SKIP TO 909)

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

(908A) (Is/was) he paid in cash or kind for this work or (is/was) he not paid at all?

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

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

YES 1 (SKIP TO 913)
NO 2


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

YES 1 (SKIP TO 913)
NO 2

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

YES 1 (SKIP TO 913)
NO 2

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

YES 1
NO 2 (SKIP TO 917)

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

____

(914) 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

(915) 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 THE YEAR 2
ONCE IN A WHILE 3

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

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

(917) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 918)
NOT IN UNION (SKIP TO 925)

(918) CHECK 916:

CODE '1' OR '2' CIRCLED (SKIP TO 919)
OTHER (SKIP TO 921)

(919) Who usually decides how the money 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

(920) 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 EARNINGS 4 (SKIP TO 922)
DON'T KNOW 8

(921) Who usually decides how your (husband's/partner's) earnings 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 EARNINGS 4
OTHER (SPECIFY) ________________ 6

(922) 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 6

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

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 6

(923A) 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 6

(924) 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 6

(925) 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 (SKIP TO 928)

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

YES 1
NO 2 (SKIP TO 928)
DON'T KNOW (SKIP TO 928)
">(927) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

(928) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4 (SKIP TO 931)

(929) Do you have a title deed for any land you own?

YES 1
NO 2 (SKIP TO 931)
DON'T KNOW 8 (SKIP TO 931)

(930) Is your name on the title deed?

YES 1
NO 2
DON'T KNOW 8

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

CHILDREN LT 10
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3
HUSBAND
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3
OTHER MALES
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3
OTHER FEMALES
PRESENT AND LISTENING 1
PRESENT AND NOT LISTENING 2
NOT PRESENT 3

(932) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?
f) If she makes a major household decision without consulting him?

a) GOES OUT
YES 1
NO 2
DON'T KNOW 8
b) NEGLECTS CHILDREN
YES 1
NO 2
DON'T KNOW 8
c) ARGUES
YES 1
NO 2
DON'T KNOW 8
d) REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
e) BURNS FOOD
YES 1
NO 2
DON'T KNOW 8
f) MAJOR DECISION
YES 1
NO 2
DON'T KNOW 8


SECTION 10. HIV/AIDS

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

YES 1
NO 2 (SKIP TO 1042)

(1002) HIV is the virus that can lead to AIDS. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

(1003) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

(1004) Can people reduce their chances of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

(1005) Can people get HIV by sharing food with a person who has HIV?

YES 1
NO 2
DON'T KNOW 8

(1005A) Can people reduce their chance of getting HIV by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

(1006) Can people get HIV because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

(1007) Is it possible for a healthy-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

(1008) Can HIV be transmitted from a mother to her baby:
a) During pregnancy?
b) During delivery?
c) By breastfeeding?

YES 1
NO 2
DON'T KNOW 8

(1009) CHECK 1008:

AT LEAST ONE 'YES' (SKIP TO 1010)
OTHER (1011)

(1010) Are there any special drugs that a health worker can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

(1011) CHECK 208 AND 215:

LAST BIRTH IN 2016-2018 (SKIP TO 1012)
LAST BIRTH IN 2015 OR EARLIER (SKIP TO 1027)
NO BIRTHS (SKIP TO 1027)

(1012) CHECK 408 FOR LAST BIRTH:

HAD ANTENATAL CARE (SKIP TO 1013)
NO ANTENATAL CARE (SKIP TO 1020)

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

(1014) During any of the antenatal visits for your last birth were you given any information about:
a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?

a) HIV FROM MOTHER
YES 1
NO 2
DON'T KNOW 8
b) THINGS TO DO
YES 1
NO 2
DON'T KNOW 8
c) TESTED FOR HIV
YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1020)

(1017) 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 HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
STAND-ALONE HTC CENTER 14
MOBILE HTC SERVICES 15
OTHER PUBLIC SECTOR (SPECIFY) _____________________ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
MISSION HOSPITAL/CLINIC 22
STAND-ALONE HTC CENTER 23
MOBILE HTC SERVICES 24
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) __________________ 26

OTHER SOURCE
HOME 31
WORKPLACE 32
CORRECTIONAL FACILITY 33
OTHER (SPECIFY) ____________________ 96

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

YES 1
NO 2 (SKIP TO 1020)

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

YES 1
NO 2
DON'T KNOW 8

(1019A) Did you disclose your results to any of the following:
a) Husband/Partner?
b) Family member?
c) Religious leader?
d) Friend?
e) Any other?

a) HUSBAND/PARTNER
YES 1
NO 2
b) FAMILY MEMBER
YES 1
NO 2
c) RELIGIOUS LEADER
YES 1
NO 2
d) FRIEND
YES 1
NO 2
e) OTHER
YES 1
NO 2

(1020) CHECK 430 FOR LAST BIRTH:

ANY CODE '21-36' CIRCLED (SKIP TO 1021)
OTHER (SKIP TO 1024)

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 1024)

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

YES 1
NO 2 (SKIP TO 1025)

(1023A) Did you disclose your results to any of the following:

a) Husband/Partner?
b) Family member?
c) Religious leader?
d) Friend?
e) Any other?

a) HUSBAND/PARTNER
YES 1
NO 2 (SKIP TO 1025)
b) FAMILY MEMBER
YES 1
NO 2 (SKIP TO 1025)
c) RELIGIOUS LEADER
YES 1
NO 2 (SKIP TO 1025)
d) FRIEND
YES 1
NO 2 (SKIP TO 1025)
e) OTHER
YES 1
NO 2 (SKIP TO 1025)

(1024) CHECK 1016:

YES (SKIP TO 1025)
NO OR NOT ASKED (SKIP TO 1027)

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

YES 1 (SKIP TO 1028)
NO

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

MONTHS AGO _____ (SKIP TO 1033)
TWO OR MORE YEARS 95 (SKIP TO 1033)

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

YES 1
NO 2 (SKIP TO 1031)

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

MONTHS AGO _____
TWO OR MORE YEARS AGO

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

YES 1
NO 2 (SKIP TO 1030)

(1029A) Did you disclose your results to any of the following:

a) Husband/Partner?
b) Family member?
c) Religious leader?
d) Friend?
e) Any other?

a) HUSBAND/PARTNER
YES 1
NO 2
b) FAMILY MEMBER
YES 1
NO 2
c) RELIGIOUS LEADER
YES 1
NO 2
d) FRIEND
YES 1
NO 2
e) OTHER
YES 1
NO 2

(1030) 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 (SKIP TO 1033)
GOVERNMENT HEALTH CENTER 12 (SKIP TO 1033)
GOVERNMENT HEALTH POST 13 (SKIP TO 1033)
STAND-ALONE HTC CENTER 14 (SKIP TO 1033)
MOBILE HTC SERVICES 15 (SKIP TO 1033)
OTHER PUBLIC SECTOR (SPECIFY) __________________________ 16 (SKIP TO 1033)

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/ PRIVATE DOCTOR 21 (SKIP TO 1033)
MISSION HOSPITAL/CLINIC 22 (SKIP TO 1033)
STAND-ALONE HTC CENTER 23 (SKIP TO 1033)
PHARMACY 24 (SKIP TO 1033)
MOBILE HTC SERVICES 25 (SKIP TO 1033)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________________ 26 (SKIP TO 1033)

OTHER SOURCE
HOME 31 (SKIP TO 1033)
WORKPLACE 32 (SKIP TO 1033)
CORRECTIONAL FACILITY 33 (SKIP TO 1033)
OTHER (SPECIFY) __________________________ 96 (SKIP TO 1033)

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

YES 1
NO 2 (SKIP TO 1033)

(1032) Where is that?
Any other place?
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 A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES E
OTHER PUBLIC SECTOR (SPECIFY) __________________________ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/ PRIVATE DOCTOR G
MISSION HOSPITAL/CLINIC H
STAND-ALONE HTC CENTER I
PHARMACY J
MOBILE HTC SERVICES K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________ L
OTHER (SPECIFY) __________________ X

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

YES 1
NO 2 (SKIP TO 1035)

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

YES 1
NO 2

(1035) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person has HIV?

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

(1036) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

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

(1037) Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

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

(1038) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

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

(1039) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

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

(1040) Do you agree or disagree with the following statement: I would be ashamed if someone in my family has HIV.

AGREE 1
DISAGREE 2
DON'T KNOW/NOT SURE/DEPENDS 8

(1041) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

YES 1
NO 2
SAYS SHE HAS HIV 3T KNOW/NOT SURE/DEPENDS 8
DON'T KNOW/NOT SURE/DEPENDS 8

(1042) CHECK 1001:

HEARD ABOUT HIV OR AIDS: Apart for HIV, have you heard about other infections that can be transmitted through sexual contact?

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

YES 1
NO 2

(1043) CHECK 713:

HAS HAD SEXUAL INTERCOURSE (SKIP TO 1044)
NEVER HAD SEXUAL INTERCOURSE (SKIP TO 1050A)

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

YES (SKIP TO 1045)
NO (SKIP TO 1046)

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

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

(1046) 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/NOT SURE/DEPENDS 8

(1047) 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/NOT SURE/DEPENDS 8

(1048) CHECK 1045, 1046, AND 1047:

HAS HAD AN INFECTION (ANY 'YES') (SKIP TO 1049)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 1050A)

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

YES 1
NO 2 (SKIP TO 1050A)

(1050) Where did you go?
Any other places?
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 A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES E
OTHER PUBLIC SECTOR (SPECIFY) __________________________ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/ PRIVATE DOCTOR G
MISSION HOSPITAL/CLINIC H
STAND-ALONE HTC CENTER I
PHARMACY J
MOBILE HTC SERVICES K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________________ L

OTHER SOURCE
SHOP M
OTHER (SPECIFY) _______________

(1050A) Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2

(1051) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

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

(1052) Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

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

(1053) CHECK 701:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 1054)
NOT IN UNION (SKIP TO 1101)

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

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

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

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


SECTION 11. OTHER HEALTH ISSUES

(1101) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OR INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _____
NONE 00 (SKIP TO 1104)

(1102) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OR INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS _____
NONE 00 (SKIP TO 1104)

(1103) 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

(1104) Do you currently smoke cigarettes every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2 (SKIP TO 1106)
NOT AT ALL 3 (SKIP TO 1106)

(1105) On average, how many cigarettes do you currently smoke each day?

NUMBER OF CIGARETTES ___

(1106) Do you currently smoke or use any other type of tobacco every day, some days, or not at all?

EVERY DAY 1
SOME DAYS 2
NOT AT ALL 3 (SKIP TO 1108)

(1107) What other type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPES FULL OF TOBACCO A
CIGARS OR CIGARILLOS B
WATER PIPE (SHISHA) C
SNUFF BY MOUTH D
SNUFF BY NOSE E
CHEWING TOBACCO F
OTHER (SPECIFY) _________________X

(1108) Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not a big problem:

a) Getting permission to go for advice or treatment?
b) Getting money needed for advice or treatment?
c) The distance to the health facility?
d) Not wanting to go alone?
e) Having to take transport?
f) Concern that there may not be any health provider?
g) Concern that there may not be a female health provider?
h) Rude attitude of health provider?

a) PERMISSION TO GO
BIG PROBLEM 1
NOT A BIG PROBLEM 2
b) GETTING MONEY
BIG PROBLEM 1
NOT A BIG PROBLEM 2
c) DISTANCE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
d) GO ALONE
BIG PROBLEM 1
NOT A BIG PROBLEM 2
e) TAKE TRANSPORT
BIG PROBLEM 1
NOT A BIG PROBLEM 2
f) NO PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
g) NO FEMALE PROVIDER
BIG PROBLEM 1
NOT A BIG PROBLEM 2
h) RUDE ATTITUDE
BIG PROBLEM 1
NOT A BIG PROBLEM 2

(1109) Are you covered by any health insurance or health scheme?

YES 1
NO 2 (SKIP TO 1110A)

(1110) What type of health insurance or health scheme are you covered by?
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 SCHEME/PREMIUM F
OTHER (SPECIFY) _______________ X

(1110A) Have you ever been told by a doctor or other health worker that you have raised blood pressure or hypertension?

YES 1
NO 2 (SKIP TO 1110C)

(1110B) In the past two weeks, have you taken any drugs (medication) for raised blood pressure prescribed by a doctor or other health worker?

YES 1
NO 2

(1110C) Have you ever been told by a doctor or other health worker that you have raised blood sugar or diabetes?

YES 1
NO 2 (SKIP TO 1111A)

(1110D) In the past two weeks, have you taken any drugs (medication) for diabetes prescribed by a doctor or other health worker?

YES 1
NO 2

(1111A) Have you ever undergone a surgical operation in the past 5 years?

YES 1
NO 2 (SKIP TO 1111C)

(1111B) What type of operation was the most recent one?

HERNIA OPERATION A
CAESAREAN SECTION B
LAPAROTOMY (Cutting open the abdomen) C
LUMP REMOVAL D
ABSCESS DRAINAGE E
WOUND CLOSURE F
OPEN FRACTURE G
OTHER (SPECIFY) _______________X

(1111C) In the last 5 years has a doctor or another healthcare worker told you that you might need (a/another) operation?

YES 1
NO 2 (SKIP TO 1201)

(1111D) Did you undergo the surgery?

YES 1 (GO TO 1201)
NO 2

(1111E) Why did you not undergo it?

I COULD NOT REACH THE DOCTOR 1
I COULD NOT AFFORD THE OPERATION 2
I COULD NOT AFORD TO GET TO THE HOSPITAL 3
I COULD NOT AFFORD THE TIME OFF WORK 4
IT WAS TOO FAR TO GET TO THE HOSPITAL 5
I DID NOT TRUST THE OPERATION WOULD MAKE BE BETTER 6
FEAR OF CARE 7
OUT OF SHAME 8
MY SPOUSE/FAMILY WOULD NOT LET ME GO 9
OTHER (SPECIFY) _______________X

(1112) RECORD THE TIME

HOURS _____
MINUTE___


SECTION 12: FISTULA

(1201) 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 (SKIP TO 1203)
NO 2

(1202) Have you ever heard of this problem?

YES 1 (SKIP TO 1301)
NO 2 (SKIP TO 1301)

(1203) Did this problem start after you delivered a baby or had a stillbirth?

AFTER DELIVERED BABY 1
AFTER HAD STILLBIRTH 2
NEITHER 3 (SKIP TO 1205)

(1204) Did this problem start after a normal labor and delivery, or after a very difficult labor and delivery?

NORMAL LABOR/DELIVERY 1 (SKIP TO 1206)
VERY DIFFICULT LABOR/DELIVERY 2 (SKIP TO 1206)

(1205) What do you think caused this problem?

SEXUAL ASSAULT 1
PELVIC SURGERY 2
OTHER (SPECIFY) __________ 6
DON'T KNOW 8 (SKIP TO 1207)

(1206) How many days after (CAUSE OF PROBLEM FROM 1203 OR 1205) did the leakage start?
ENTER '90' IF 90 DAYS OR MORE.

NUMBER OF DAYS AFTER DELIVERY/OTHER EVENT

(1207) Have you sought treatment for this condition?

YES 1 (SKIP TO 1209)
NO 2

(1208) Why have you not sought treatment?
PROBE AND RECORD ALL MENTIONED.

DO NOT KNOW CAN BE FIXED A (SKIP TO 1301)
DO NOT KNOW WHERE TO GO B (SKIP TO 1301)
TOO EXPENSIVE C (SKIP TO 1301)
TOO FAR D (SKIP TO 1301)
POOR QUALITY OF CARE E (SKIP TO 1301)
COULD NOT GET PERMISSION F (SKIP TO 1301)
EMBARRASSMENT G (SKIP TO 1301)
PROBLEM DISAPPEARED H (SKIP TO 1301)
OTHER (SPECIFY) ____________________ X (SKIP TO 1301)

(1209) From whom did you last seek treatment?


HEALTH PROFESSIONAL
DOCTOR 1
NURSE/MIDWIFE 2

OTHER PERSON
COMMUNITY/VILLAGE HEALTH WORKER 3
OTHER (SPECIFY) ____________ 6

(1210) Did you have an operation to fix to problem?

YES 1
NO 2

(1211) Did the treatment stop the leakage completely?
IF NO: Did the treatment reduce the leakage?

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


SECTION 13: ADULT AND MATERNAL MORTALITY

(1301) Now I would like to ask you some questions about your brothers and sisters born to your natural mother, including those who are living with you, those living elsewhere and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your natural mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all of your brothers and sisters born to your natural mother.
DO NOT FILL IN THE ORDER NUMBER YET
REPEAT FOR EACH SIBLING

NAME: ____________________
ORDER NUMBER___

(1302) CHECK 1301:

ONE OR MORE BROTHERS OR SISTERS LISTED (SKIP TO 1303)
NO BROTHERS OR SISTERS LISTED (SKIP TO 1304)

(1303) READ THE NAMES OF THE BROTHERS AND SISTERS TO THE RESPONDENT AND AFTER THE LAST ONE ASK: Are there any other brothers and sisters from the same mother that you have not mentioned?

NO (SKIP TO 1304)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1301)

(1304) Sometimes people forget to mention children born to their natural mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have not mentioned?

NO (SKIP TO 1305)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1301)

(1305) Sometimes people forget to mention children born to their natural mother because they have died. Are there any brothers or sisters who died that you have not mentioned?

NO (SKIP TO 1306)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1301)

(1306) Some people have brothers or sisters from the same mother but a different father. Are there any brothers or sisters born to your natural mother, but who have a different natural father, that you have not mentioned?

NO (SKIP TO 1307)
YES (LIST ADDITIONAL BROTHERS AND SISTERS IN 1301)

(1307) COUNT THE NUMBER OF BROTHERS AND SISTERS RECORDED IN 1301

TOTAL BROTHERS AND SISTERS___

(1308) CHECK 1307:
Just to make sure that I have this right: Your mother had in TOTAL _____ births, excluding you, during her lifetime. Is that correct?

YES (SKIP TO 1309)
NO (PROBE AND CORRECT 1301 AND/OR 1307)

(1309) CHECK 1307:

ONE OR MORE BROTHERS/SISTERS (SKIP TO 1310)
NO BROTHER OR SISTER (SKIP TO 1400)

(1310) please tell me, which brother or sister was born first? And which was born next?
RECORD '01' FOR THE ORDER NUMBER IN MM01 FOR THE FIRST BROTHER OR SISTER, '02' FOR THE SECOND, AND SO ON UNTIL YOU HAVE RECORDED THE ORDER NUMBER FOR ALL BROTHERS AND SISTERS.

(1311) How many births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS___

(1312) LIST THE BROTHERS AND SISTERS ACCORDING TO THE ORDER NUMBER IN 1301. ASK 1313 TO 1324 FOR ONE BROTHER OR SISTER BEFORE ASKING ABOUT THE NEXT BROTHER OR SISTER. IF THERE ARE MORE THAN 12 BROTHERS AND SISTERS, USE AN ADDITIONAL QUESTIONNAIRE.

(1313) NAME OF BROTHER OR SISTER.

NAME: __________

(1314) Is (NAME) male or female?

MALE 1
FEMALE 2

(1315) Is (NAME) still alive?

YES 1
NO 2 (GO TO 1317)
DON'T KNOW 8 (GO TO NEXT SIBLING)'

(1316) How old is (NAME)?

AGE___

(1317) How many years ago did (NAME) die?

YEARS__

(1318) How old was (NAME) when (he/she) died?
IF DON'T KNOW, PROBE AND ASK ADDITIONAL QUESTIONS TO GET AN ESTIMATE.

AGE: _____
IF MALE OR DIED BEFORE 12 YEARS OF AGE, GO TO 1323

(1319) Was (NAME) pregnant when she died?

YES 1 (GO TO 1322B)
NO 2

(1320) Did (NAME) die during childbirth?

YES 1 (GO TO 1322A)
NO 2

(1321) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO 1323)

(1322) How many days after the end of the pregnancy did (NAME) die?

DAYS__

(1322A) Did (NAME) receive a caesarean section?

YES 1
NO 2

(1322B) Did (NAME) die in the hospital?

YES 1
NO 2

(1323) Was (NAME)'s death due to an act of violence?

YES 1 (GO TO NEXT SIBLING)
NO 2

(1324) Was (NAME)'s death due to an accident?

YES 1
NO 2

GO TO NEXT SIBLING.

IF NO MORE BROTHERS OR SISTERS, GO TO 1400.


SECTION 14: DOMESTIC VIOLENCE

(1400) CHECK COVER PAGE: WOMAN SELECTED FOR 13 MODULE?

WOMAN SELECTED FOR THIS SECTION (SKIP TO 1401)
WOMAN NOT SELECTED (SKIP TO 1433)

(1401) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (SKIP TO 1401A)
PRIVACY NOT POSSIBLE 2 (SKIP TO 1432)

(1401A) 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. 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.

(1402) CHECK 701 AND 702:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 1403)
FORMERLY MARRIED/ LIVED WITH A MAN (READ IN PAST TEST AND USE 'LAST' WITH 'HUSBAND/PARTNER') (SKIP TO 1403)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1416)

(1403) 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?
b) He frequently (accuses/accused) you of being unfaithful?
c) He (does/did) not permit you to meet your female friends?
d) He (tries/tried) to limit your contact with your family?
e) He (insists/insisted) on knowing where you (are/were) at all times?

JEALOUS
YES 1
NO 2
DON'T KNOW 8
ACCUSES
YES 1
NO 2
DON'T KNOW 8
NOT MEET FRIENDS
YES 1
NO 2
DON'T KNOW 8
NO FAMILY
YES 1
NO 2
DON'T KNOW 8
WHERE YOU ARE
YES 1
NO 2
DON'T KNOW 8

(1404) Now I need to ask some more questions about your relationship with your (last) (husband/partner).

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

a) say or do something to humiliate you in front of others?
YES 1 (SKIP TO (B))
NO 2

b) threaten to hurt or harm you or someone you care about?

YES 1 (SKIP TO (B))
NO 2

c) insult you or make you feel bad about yourself?

YES 1 (SKIP TO (B))
NO 2

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

OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS

(1405) 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 (SKIP TO (B))
NO 2


b) slap you?

YES 1 (SKIP TO (B))
NO 2


c) twist your arm or pull your hair?

YES 1 (SKIP TO (B))
NO 2


d) punch you with his fist or with something that could hurt you?

YES 1 (SKIP TO (B))
NO 2


e) kick you, drag you, or beat you up?

YES 1 (SKIP TO (B))
NO 2


f) try to choke you or burn you on purpose?

YES 1 (SKIP TO (B))
NO 2


g) threaten or attack you with a knife, gun, or other weapon?

YES 1 (SKIP TO (B))
NO 2


h) physically force you to have sexual intercourse with him when you did not want to?

YES 1 (SKIP TO (B))
NO 2


i) physically force you to perform any other sexual acts you did not want to?

YES 1 (SKIP TO (B))
NO 2


j) force you with threats or in any other way to perform sexual acts you did not want to?

YES 1 (SKIP TO (B))
NO 2

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

OFTEN 1
SOMETIMES 2
NOT IN LAST 12 MONTHS

(1406) CHECK 1405A (a-j):

AT LEAST ONE 'YES' (SKIP TO 1407)
NOT A SINGLE 'YES' (SKIP TO 1409)

(1407) 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

(1408) 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

(1409) Have you ever hit, slapped, kicked, or done anything else to physically hurt you (last) (husband/partner) at times when he was not already beating or physically hurting you?

YES 1
NO 2 (SKIP TO 1411)

(1410) In the last 12 months, how often have you done this to you (last) (husband/partner): often, only sometimes, or not at all?

OFTEN 1
SOMETIMES 2
NOT AT ALL 3

(1411) Does (did) your (last) (husband/partner) drink alcohol?

YES 1
NO 2 (SKIP TO 1413)

(1412) How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

(1413) 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

(1414) CHECK 709:

MARRIED MORE THAN ONCE (SKIP TO 1415)
MARRIED ONLY ONCE (SKIP TO 1416)

(1415) A. 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).

a) Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you physically?
YES 1 (SKIP TO PART (B))
NO 2
b) Did any previous (husband/partner) physically force you to have intercourse or perform any other sexual acts against your will?
YES 1 (SKIP TO PART (B))
NO 2
c) Did any previous (husband/partner) humiliate you in front of others, threaten to hurt you or someone you care about, or insult you or make you feel bad about yourself?
YES 1 (SKIP TO PART (B))
NO 2

B. How long ago did this happen?

0-11 MONTHS AGO 1
12+ MONTHS AGO 2
DON'T REMEMBER 3

(1416) CHECK 701 AND 702:

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 (SKIP TO 1419)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1419)

(1417) 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

(1418) 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

(1419) CHECK 201, 226, AND 230:

EVER BEEN PREGNANT ('YES' ON 201 OR 226 OR 230) (SKIP TO 1420)
NEVER BEEN PREGNANT (SKIP TO 1422)

(1420) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?

YES 1
NO 2 (SKIP TO 1422)

(1421) 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

(1422) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN (SKIP TO 1422A)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1422B)

(1422A) 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 (SKIP TO 1423)
NO 2 (SKIP TO 1424A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1424A)

(1422B) 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 (SKIP TO 1426)
REFUSED TO ANSWER/ NO ANSWER 3 (SKIP TO 1426)

(1423) Who was the person who was forcing you the very first time this happened?

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

(1424) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN:
a) 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:
b) In the last 12 months has anyone physically forced you to have sexual intercourse when you did not want to?
YES 1 (SKIP TO 1425)
NO 2 (SKIP TO 1425)

(1424A) CHECK 1405A (h-j) and 1415A(b)

AT LEAST ONE 'YES' (SKIP TO 1425)
NOT A SINGLE 'YES' (SKIP TO 1426)

(1425) CHECK 701 AND 702:

EVER MARRIED/EVER LIVED WITH A MAN:
a) 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:
b) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
AGE IN COMPLETED YEARS _____
DON'T KNOW 98

(1426) CHECK 1405A (a-j), 1415A (a,b), 1416, 1420, 1422A, AND 1422B:

AT LEAST ONE 'YES' (SKIP TO 1427)
NOT A SINGLE 'YES' (SKIP TO 1430)

(1427) 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 (SKIP TO 1429)

(1428) From whom have you sought help?
Anyone else?
RECORD ALL MENTIONED.

OWN FAMILY A (SKIP TO 1430)
HUSBAND'S/PARTNER'S FAMILY B (SKIP TO 1430)
CURRENT/FORMER HUSBAND/PARTNER C (SKIP TO 1430)
CURRENT/FORMER BOYFRIEND D (SKIP TO 1430)
FRIEND E (SKIP TO 1430)
NEIGHBOR F (SKIP TO 1430)
RELIGIOUS LEADER G (SKIP TO 1430)
DOCTOR/MEDICAL PERSONNEL H (SKIP TO 1430)
POLICE I (SKIP TO 1430)
LAWYER J (SKIP TO 1430)
SOCIAL SERVICE ORGANIZATION K (SKIP TO 1430)
OTHER (SPECIFY) ____________________ X (SKIP TO 1430)

(1429) Have you ever told any one about this?

YES 1
NO 2

(1430) 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.

(1431) 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

(1432) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE:

(1433) RECORD THE TIME.

HOURS _____
MINUTES____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW: ____________________________________________________________________________________________________________________________________________________________

COMMENTS ON SPECIFIC QUESTIONS: ____________________________________________________________________________________________________________________________________________________________

ANY OTHER COMMENTS: ____________________________________________________________________________________________________________________________________________________________

SUPERVISOR'S OBSERVATIONS: ____________________________________________________________________________________________________________________________________________________________

EDITOR'S OBSERVATIONS: ________________________________________________________________________________________________________________________________________________

INSTRUCTIONS:

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

CODES FOR EACH COLUMN:

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE (2)

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILLS
7 CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
J STANDARD DAYS METHOD
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M 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

2018

12 DEC 01
11 NOV 02
10 OCT 03
09 SEP 04
08 AUG 05
07 JULY 06
06 JUN 07
05 MAY 08
04 APR 09
03 MAR 10
02 FEB 11
01 JAN 12

2017

12 DEC 13
11 NOV 14
10 OCT 15
09 SEP 16
08 AUG 17
07 JULY 18
06 JUN 19
05 MAY 20
04 APR 21
03 MAR 22
02 FEB 23
01 JAN 24

2016

12 DEC 25
11 NOV 26
10 OCT 27
09 SEP 28
08 AUG 29
07 JULY 30
06 JUN 31
05 MAY 32
04 APR 33
03 MAR 34
02 FEB 35
01 JAN 36

2015

12 DEC 37
11 NOV 38
10 OCT 39
09 SEP 40
08 AUG 41
07 JULY 42
06 JUN 43
05 MAY 44
04 APR 45
03 MAR 46
02 FEB 47
01 JAN 48

2014

12 DEC 49
11 NOV 50
10 OCT 51
09 SEP 52
08 AUG 53
07 JULY 54
06 JUN 55
05 MAY 56
04 APR 57
03 MAR 58
02 FEB 59
01 JAN 60

2013

12 DEC 61
11 NOV 62
10 OCT 63
09 SEP 64
08 AUG 65
07 JULY 66
06 JUN 67
05 MAY 68
04 APR 69
03 MAR 70
02 FEB 71
01 JAN 72