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ZIMBABWE 2005 DEMOGRAPHIC AND HEALTH SURVEY WOMAN'S QUESTIONNAIRE

CENTRAL STATISTICAL OFFICE

IDENTIFICATION

PLACE NAME __________

NAME OF HOUSEHOLD HEAD __________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

PROVINCE ___

LARGE CITY/SMALL CITY/TOWN/RURAL

HARARE 1
SMALL CITY 2
TOWN 3
RURAL 4

NAME OF WOMAN __________

LINE NUMBER OF WOMAN ___

INTERVIEWER VISITS

FIRST VISIT

DATE _____
INTERVIEWER'S NAME __________
RESULT __________

NEXT VISIT:
DATE _____
TIME _____

SECOND VISIT

DATE _____
INTERVIEWER'S NAME __________
RESULT __________

NEXT VISIT:
DATE _____
TIME _____

THIRD VISIT

DATE _____
INTERVIEWER'S NAME __________
RESULT __________

FINAL VISIT

DAY ___
MONTH __________
YEAR _____
ID NUMBER _____
RESULT __________

NEXT VISIT

DATE _____
TIME _____

TOTAL NUMBER OF VISITS ___

RESULT___
*RESULT CODES

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

LANGUAGE OF QUESTIONNAIRE:

1 SHONA
2 NDEBELE
3 ENGLISH

LANGUAGE USED FOR INTERVIEW:

A SHONA
B NDEBELE
C ENGLISH
X OTHER

TRANSLATOR USED

YES 1
NO 2

SUPERVISOR

NAME __________
DATE _____

FIELD EDITOR

NAME __________
DATE _____

OFFICE EDITOR ___

KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is __________ and I am working with the Central Statistical Organization. We are conducting a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 45 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.

Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of the interviewer: __________
Date: _____

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

101) RECORD THE TIME.

HOUR ___
MINUTES ___

102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE MONTH, RECORD '00' MONTHS.

MONTHS 1 ___
YEARS 2 ___
ALWAYS 95 (SKIP TO 104)
VISITOR 96 (SKIP TO 104)

103) Just before you moved here, where did you live?

RECORD NAME AND CODE TYPE OF AREA.

PROBE: Is that a city, town, communal land or resettlement area?

NAME OF PLACE: __________
CITY 1
TOWN 2
COMMUNAL LAND 3
RESETTLEMENT AREA 4
OTHER RURAL AREA 5
ABROAD 6

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

NUMBER OF TRIPS ___
NONE 00 (SKIP TO 106)

105) 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

106) In what month and year were you born?

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

107) How old were you at your last birthday?

COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

108) Have you ever attended school?

YES 1
NO 2 (SKIP TO 112)

109) What is the highest level of school you attended?

PRIMARY 1
SECONDARY 2
HIGHER 3

110) What is the highest grade (number of years) you completed at that level?

GRADE/YEARS ___

111) CHECK 109:

PRIMARY (SKIP TO 112)
SECONDARY OR HIGHER (SKIP TO 115)

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

SHOW CARD TO RESPONDENT.

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

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

113) Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

114) CHECK 112:

CODE '2,' '3,' OR '4' CIRCLED (SKIP TO 115)
CODE '1' OR '5' CIRCLED (SKIP TO 116)

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

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

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

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

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

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

118) What is your religion?

TRADITIONAL 01
ROMAN CATHOLIC 02
PROTESTANT 03
PENTECOSTAL 04
APOSTOLIC SECT 05
OTHER CHRISTIAN 06
MUSLIM 07
NONE 08 (SKIP TO 201)
OTHER (SPECIFY) __________

119) How often have you attended religious services in the past month?

RECORD '00' IF DID NOT ATTEND DURING MONTH.

NUMBER OF TIMES ___
DON'T KNOW/NOT SURE 98

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 currently living with you?

YES 1
NO 2 (SKIP TO 204)

203) How many sons live with you? And how many daughters live with you?

IF NONE, RECORD '00'.

SONS AT HOME ___
DAUGHTERS AT HOME ___

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

YES 1
NO 2 (SKIP TO 206)

205) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?

IF NONE, RECORD '00'.

SONS ELSEWHERE ___
DAUGHTERS ELSEWHERE ___

206) Sometimes babies are born alive and die shortly after birth. Have you ever given birth to a boy or girl who was born alive but later died?

IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (SKIP TO 208)

207) How many boys have died? And how many girls have died?

IF NONE, RECORD '00'.

BOYS DEAD ___
GIRLS DEAD ___

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

IF NONE, RECORD '00'.

TOTAL ___

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 to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

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

NAME __________

213) Were any of these births twins?

SINGLE 1
MULTIPLE 2

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

BOY 1
GIRL 2

215) In what month and year was (NAME) born?

PROBE: What is his/her birthday?

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).

LINE NUMBER ___

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

IF '1 YR', PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

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
NO 2

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

YES 1
NO 2

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

NUMBERS ARE THE SAME ___

CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. ___
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. ___
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. ___
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. ___

NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2000 OR LATER.
IF NONE, RECORD '0'.

225) FOR EACH BIRTH SINCE JANUARY 1, 2000, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

226) Are you pregnant now?

YES 1
NO 2 (SKIP TO 229)
UNSURE 8 (SKIP TO 229)

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P'S IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

MONTHS ___

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

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2 (SKIP TO 237)

230) When did the last such pregnancy end?

MONTH __________
YEAR _____

231) CHECK 230:

LAST PREGNANCY ENDED IN JANUARY 2000 OR LATER (SKIP TO 232)
LAST PREGNANCY ENDED BEFORE JANUARY 2000 (SKIP TO 237)

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

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

MONTHS ___

233) Have you ever had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (SKIP TO 237)

234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2000.

ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235) Did you have any pregnancies that terminated before 2000 that did not result in a live birth?

YES 1
NO 2 (SKIP TO 237)

236) When did the last such pregnancy that terminated before 2000 end?

MONTH __________
YEAR _____

237) 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

238) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (SKIP TO 240)
DON'T KNOW (SKIP TO 240)

239) 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

240) Are you the primary care giver for any children?

YES 1
NO 2 (SKIP TO 301)

241) Are any of these children for whom you are the primary caregiver under the age of 18?

YES 1
NO 2 (SKIP TO 301)

242) Now I would like to ask you about the children who are under the age of 18 and for whom you are the primary caregiver.

Have you made arrangements for someone to care for these children in the even that you fall sick or are unable to care for them?

YES 1
NO 2
UNSURE 8

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

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

CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

301) Which ways or methods have you heard about?

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

01 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
YES 1 (SKIP TO 302, METHOD 01)
NO 2 (SKIP TO METHOD 02)
02 MALE STERILIZATION Men can have an operation to avoid having any more children.
YES 1 (SKIP TO 302, METHOD 02)
NO 2 (SKIP TO METHOD 03)
03 PILL Women can take a pill every day to avoid becoming pregnant.
YES 1 (SKIP TO 302, METHOD 03)
NO 2 (SKIP TO METHOD 04)
04 IUD (LOOP) Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1 (SKIP TO 302, METHOD 04)
NO 2 (SKIP TO METHOD 05)
05 INJECTION Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1 (SKIP TO 302, METHOD 05)
NO 2 (SKIP TO METHOD 06)
06 IMPLANT Women can have small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1 (SKIP TO 302, METHOD 06)
NO 2 (SKIP TO METHOD 07)
07 MALE CONDOM Men can put a rubber sheath on their penis before sexual intercourse.
YES 1 (SKIP TO 302, METHOD 07)
NO 2 (SKIP TO METHOD 08)
08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse.
YES 1 (SKIP TO 302, METHOD 08)
NO 2 (SKIP TO METHOD 11)
11 LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1 (SKIP TO 302, METHOD 11)
NO 2 (SKIP TO METHOD 12)
12 RHYTHM METHOD Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1 (SKIP TO 302, METHOD 12)
NO 2 (SKIP TO METHOD 13)
13 WITHDRAWAL Men can be careful and pull out before climax.
YES 1 (SKIP TO 302, METHOD 13)
NO 2 (SKIP TO METHOD 14)
14 EMERGENCY CONTRACEPTION (MORNING AFTER PILL/POSTINO 2) Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1 (SKIP TO 302, METHOD 14)
NO 2 (SKIP TO METHOD 15)
15 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1 (SPECIFY) __________
NO 2

302) HAVE YOU EVER USED (METHOD)?

01 FEMALE STERILIZATION
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
02 MALE STERILIZATION
Have you ever had a partner who had an operation to avoid having any more children?
YES 1
NO 2
03 PILL
YES 1
NO 2
04 IUD (LOOP)
YES 1
NO 2
05 INJECTION
YES 1
NO 2
06 IMPLANT
YES 1
NO 2
07 MALE CONDOM
YES 1
NO 2
08 FEMALE CONDOM
YES 1
NO 2
11 LACTATIONAL AMENORRHEA METHOD (LAM)
YES 1
NO 2
12 RHYTHM METHOD
YES 1
NO 2
13 WITHDRAWL
YES 1
NO 2
14 EMERGENCY CONTRACEPTION (MORNING AFTER PILL/POSTINO 2)
YES 1
NO 2
15 OTHER METHODS
YES 1
NO 2

303) CHECK 302:

NOT A SINGLE "YES" (NEVER USED) (SKIP TO 304)
AT LEAST ONE "YES" (EVER USED) (SKIP TO 307)

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

YES 1 (SKIP TO 306)
NO 2

305) ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (SKIP TO 330)

306) What have you used or done?

CORRECT 302 AND 303 (AND 301 IF NECESSARY).

307) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.

How many living children did you have at that time, if any?

IF NONE, RECORD '00'.

NUMBER OF CHILDREN ___

308) CHECK 302 (01):

WOMAN NOT STERILIZED (SKIP TO 309)
WOMAN STERILIZED (SKIP TO 311A)

309) CHECK 226:

NOT PREGNANT OR UNSURE ___ (SKIP TO 310)
PREGNANT ___ (SKIP TO 322)

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

YES 1
NO 2 (SKIP TO 322)

311) Which method are you using?

CIRCLE ALL MENTIONED.

IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.

311A) CIRCLE 'A' FOR FEMALE STERILIZATION.

FEMALE STERILIZATION A (SKIP TO 316)
MALE STERILIZATION B (SKIP TO 316)
PILL C
IUD D (SKIP TO 315)
INJECTION E (SKIP TO 315)
IMPLANT F (SKIP TO 315)
MALE CONDOM G (SKIP TO 315)
FEMALE CONDOM H (SKIP TO 315)
DIAPHRAGM I (SKIP TO 315)
FOAM/JELLY J (SKIP TO 315)
LACTAIONAL AMENNOREAH METHOD K (SKIP TO 319A)
RHYTHM METHOD L (SKIP TO 319A)
WITHDRAWL M (SKIP TO 319A)
OTHER (SPECIFY) __________ X (SKIP TO 319A)

312) May I see the package of pills you are using?

RECORD NAME OF BRAND.

PACKAGE SEEN 01
PACKAGE NOT SEEN 02 (SKIP TO 313A)

313) MARK CODE FOR BRAND NAME.

OVRETTE 01 (SKIP TO 314)
LO-FEMENAL 02 (SKIP TO 314)
MICRONOR 03 (SKIP TO 314)
MICRONOVUM 04 (SKIP TO 314)
MARVELL ON 05 (SKIP TO 314)
DUOFEM 06 (SKIP TO 314)
EXECLUTION 07 (SKIP TO 314)
OTHER (SPECIFY) __________ 96 (SKIP TO 314)

313A) Do you know the brand name of the pills you are using?

RECORD NAME OF BRAND.

OVRETTE 01
LO-FEMENAL 02
MICRONOR 03
MICRONOVUM 04
MARVELLON 05
DUOFEM 06
EXCLUTON 07
OTHER (SPECIFY) __________
DON'T KNOW 98

314) How many pill cycles did you get the last time?

NUMBER OF CYCLES/PACKAGES ___
DON'T KNOW 998

315) The last time you obtained (CURRENT METHOD IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

COST _____ (SKIP TO 319A)
FREE 999995 (SKIP TO 319A)
DON'T KNOW 999998 (SKIP TO 319A)

316) In what facility did the sterilization take place?

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

NAME OF PLACE __________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
ZNFPC CLINIC 14
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE DOCTOR'S SURGERY 32
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
OTHER (SPECIFY) __________ 96

317) CHECK 311/311A:

CODE 'A' CIRCLED ___ Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation?
YES 1
NO 2
DON'T KNOW 8
CODE 'B' CIRCLED ___ Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation?
YES 1
NO 2
DON'T KNOW 3

318) How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?

COST _____
FREE 999995
DON'T KNOW 999998

319) In what month and year was the sterilization performed?

MONTH __________ (SKIP TO 320)
YEAR _____ (SKIP TO 320)

319A) In what month and year did you start using (CURRENT METHOD) continuously?

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

MONTH __________
YEAR _____

320) CHECK 319/319A, 215, 230 AND CALENDAR:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A?

YES ___ GO BACK TO 319/319A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION).
NO ___ (SKIP TO 321)

321) CHECK 319/319A:

YEAR IS 2000 OR LATER ___ ENTER CODE FOR MTHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.
ASK ABOUT SOURCE OF METHOD AT THE START OF USE AND ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH USE STARTED.
THEN CONTINUE WITH 322.
YEAR IS 1999 OR EARLIER ___ ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 2000.
THEN SKIP TO 328.

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2000.

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

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

ILLUSTRATIVE QUESTIONS:
COLUMN 1:

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

IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.

ILLUSTRATIVE QUESTIONS:
COLUMN 2:

Where did you obtain the method when you started using it?
Where did you get advice on how to use the method [for LAM, rhythm, or withdrawal]?

IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.
NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.

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

ILLUSTRATIVE QUESTIONS:
COLUMN 3:

Why did you stop using the (METHOD)?
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?

IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:

How many months did it take you to get pregnant after you stopped using (METHOD)?

AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.

323) CHECK 311/311A: CIRCLE METHOD CODE.

IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

NO CODE CIRCLED 00 (SKIP TO 330)
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (SKIP TO 332)
PILL 03
IUD 04
INJECTION 05
IMPLANT 06
MALE CONDOM 07 (SKIP TO 329)
FEMALE CONDOM 08 (SKIP TO 326)
DIAPHRAGM 09 (SKIP TO 326)
FOAM/JELLY 10 (SKIP TO 326)
LACTATIONAL AMENNOREAH METHOD 11 (SKIP TO 326)
RHYTHM METHOD 12 (SKIP TO 332)
WITHDRAWAL 13 (SKIP TO 332)
OTHER METHOD 96 (SKIP TO 332)

324) You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At the time you obtained the method, were you told about side effects or problems you might have with the method?

YES 1
NO 2 (SKIP TO 326)

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

YES 1
NO 2

326) CHECK 324:

CODE '1' ___ CIRCLED
At that time, were you told about other methods of family planning that you could use?
YES 1 (SKIP TO 328)
NO 2
CODE '2' ___ CIRCLED
When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?
YES 1 (SKIP TO 328)
NO 2

328) CHECK 311/311A: CIRCLE METHOD CODE.

FEMALE STERILIZATION 01 (SKIP TO 332)
MALE STERILIZATION 02 (SKIP TO 332)
PILL 03
IUD 04
INJECTION 05
IMPLANT 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENNOREAH METHOD 11 (SKIP TO 332)
RHYTHM METHOD 12 (SKIP TO 332)
WITHDRAWAL 13 (SKIP TO 332)
OTHER METHOD 96 (SKIP TO 332)

329) Where did you (or your partner) obtain (CURRENT METHOD) the last time?

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

NAME OF PLACE __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTER 13
ZNFPC CLINIC 14
MOH MOBILE CLINIC 16
ZNFPC CBD/DEPOT HOLDER 17
OTHER PUBLIC (SPECIFY) __________ 18
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
RETAIL OUTLET
GENERAL DEALER 41
SUPERMARKET 42
TUCK SHOP 43
SERVICE STATION 44
OTHER RETAIL (SPECIFY) __________ 46
OTHER PRIVATE SOURCE
CHURCH 51
FRIEND/RELATIVE 52
OTHER (SPECIFY) __________ 96

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

YES 1
NO 2 (SKIP TO 332)

331) Where is that?

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

NAME OF PLACE __________

Any other place?

RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
OTHER PUBLIC (SPECIFY) __________ G
MISSION FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
PRIVATE DOCTOR K
CBD L
OTHER PRIVATE DOCTOR (SPECIFY) __________ M
RETAIL OUTLET
GENERAL DEALER N
SUPERMARKET O
TUCK SHOP P
SERVICE STATION Q
OTHER RETAIL (SPECIFY) __________ R
OTHER PRIVATE SOURCE
CHURCH S
FRIEND/RELATIVE T
OTHER (SPECIFY) __________ X

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

YES 1
NO 2

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

YES 1
NO 2 (SKIP TO 335)

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

YES 1
NO 2

335) CHECK 301 (07) KNOWS MALE CONDOM

YES ___ (SKIP 336)
NO ___ (SKIP 337)

336) If a male condom is used correctly, do you think that it protects against pregnancy most of the time, only sometimes, or not at all.

MOST OF THE TIME 1
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8

337) CHECK 301 (08) KNOWS FEMALE CONDOM

YES ___ (SKIP TO 338)
NO ___ (SKIP TO 401)

338) If a female condom is used correctly, do you think that it protects against pregnancy most of the time, only sometimes, or not at all?

MOST OF THE TIME 1
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8

SECTION 4. PREGNANCY, POSTNATAL CARE AND NUTRITION

401) CHECK 224:

ONE OR MORE BIRTHS IN 2000 OR LATER ___ (SKIP TO 402)
NO BIRTHS IN 2000 OR LATER ___ (SKIP TO 601)

402) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)

403) LINE NUMBER FROM 212

LINE NUMBER ___

404) FROM 212 AND 216

NAME __________
LIVING ___
DEAD ___

405) At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1 ___ (SKIP TO 407)
LATER 2
NOT AT ALL 3 ___ (SKIP TO 407)

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

MONTHS 1 ___
YEARS 2 ___
DON'T KNOW 998

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

IF YES: Whom did you see? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
TRADITIONAL MIDWIFE
TRAINED C
UNTRAINED D
UNSURE ABOUT TRAINING E
OTHER (SPECIFY) __________ X
NO ONE Y (SKIP TO 414)

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

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

RECORD ALL MENTIONED.

NAME OF PLACE(S) __________
HOME
YOUR HOME A
OTHER HOME B
PUBLIC SECTOR
CENTRAL HOSPITAL C
PROVINCIAL HOSPITAL D
DISTRICT/RURAL HOSPITAL E
RURAL/MUNICIPAL CLINIC F
RURAL HEALTH CENTER G
OTHER PUBLIC (SPECIFY) __________ H
MISSION FACILITY I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
OTHER PRIVATE MEDICAL K
OTHER (SPECIFY) __________ X

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

MONTHS ___
DON'T KNOW 98

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

NUMBER OF TIMES ___
DON'T KNOW 98

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

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

412) During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

YES 1
NO 2 (SKIP TO 414)
DON'T KNOW 8 (SKIP TO 414)

413) Were you told where to go if you had these complications?

YES 1
NO 2
DON'T KNOW 8

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

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

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

NUMBER OF TIMES ___
DON'T KNOW 8

416) CHECK 415:

2 OR MORE TIMES ___ (SKIP TO 421)
OTHER ___ (SKIP TO 417)

417) Did you receive any tetanus injections at any time before this pregnancy?

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

418) How many times did you get a tetanus injection before this pregnancy?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

419) In what month and year did you receive the last tetanus injection before this pregnancy?

MONTH __________
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 421)
DONT KNOW YEAR 9998

420) How many years ago did you receive that tetanus injection?

YEARS AGO ___

421) During this pregnancy, were you given or did you buy any iron/folic acid tablets or iron syrup?

SHOW TABLETS/SYRUP.

YES 1
NO 2 (SKIP TO 423)
DON'T KNOW 8 (SKIP TO 423)

422) During the whole pregnancy, for how many days did you take the tablets or syrup?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

NUMBER OF DAYS ___
DON'T KNOW 998

423) During this pregnancy, did you have difficulty with your vision during the daylight?

YES 1
NO 2
DON'T KNOW 8

424) During this pregnancy, did you suffer from night blindness?

YES 1
NO 2
DON'T KNOW 8

425) During this pregnancy, did you take any drugs to prevent you from getting malaria?

YES 1
NO 2 (SKIP TO 431)
DON'T KNOW 8 (SKIP TO 431)

426) What drugs did you take?

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

SP/FANSIDAR A
CHLOROQUINE B
DELTAPRIM C
OTHER (SPECIFY) __________ X
DON'T KNOW Z

427) CHECK 426: DRUGS TAKEN FOR MALARIA PREVENTION.

CODE 'A' CIRCLED ___ (SKIP TO 428)
CODE 'A' NOT CIRCLED ___ (SKIP TO 431)

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

NUMBER OF TIMES ___

429) CHECK 407: ANTENATAL CARE FROM HEALTH PROFESSIONAL DURING PREGNANCY

CODES 'A' OR 'B' CIRCLED ___ (SKIP TO 430)
OTHER ___ (SKIP TO 431)

430) Did you get the SP/Fansidar during an antenatal visit, during another visit to a health facility, or from some other source?

ANTENATAL VISIT 1
OTHER FACILITY VISIT 2
OTHER SOURCE 3

431) 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

432) Was (NAME) weighed at birth?

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

433) How much did (NAME) weigh?

ASK FOR HEALTH CARD.
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

KG FROM CARD ___
KG FROM RECALL ___
DON'T KNOW 99.998

434) Who assisted with the delivery of (NAME)? Anyone else?

PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

HEALTH PROFESSIONAL
DOCTOR A
NURSE/MIDWIFE B
TRADITIONAL MIDWIFE
TRAINED C
UNTRAINED D
UNSURE ABOUT TRAINING E
OTHER (SPECIFY) __________ X
NO ONE Y

435) Where did you give birth to (NAME)?

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

NAME OF PLACE __________
HOME
YOUR HOME 11 (SKIP TO 444)
OTHER HOME 12 (SKIP TO 444)
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL/MUNICIPAL CLINIC 24
RURAL HEALTH CENTER 25
OTHER PUBLIC (SPECIFY) __________ 26
MISSION FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE MEDICAL (SPECIFY) __________ 42
OTHER (SPECIFY) __________ 96 (SKIP TO 444)

436) How many hours after your labor pains began, did you get to the facility?

IF MORE THAN 24 HOURS RECORD '25'.
RECORD '00' IF LESS THAN ONE HOUR.

HOURS ___
25 HOURS OR MORE 25
DON'T KNOW 98

437) How long after you arrived at the facility, did a health professional check on you?

IF MORE THAN 24 HOURS RECORD '25'.
RECORD '00' IF LESS THAN ONE HOUR.

HOURS ___
25 HOURS OR MORE 25
DON'T KNOW 98

438) Was (NAME) delivered by caesarean section?

YES 1
NO 2

439) 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

440) Before you were discharged after (NAME) was born, did any health personnel check on your health?

YES 1
NO 2 (SKIP TO 443)

441) How many hours, days, or weeks 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

442) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11 (SKIP TO 453)
NURSE/MIDWIFE 12
TRADITIONAL MIDWIFE
TRAINED 21
UNTRAINED 22
UNSURE ABOUT TRAINING 23
OTHER (SPECIFY) __________ 96

443) After you were discharged, did any health care provider or a traditional birth attendant check on your health?

YES 1 (SKIP TO 446)
NO 2 (SKIP TO 453)

444) Why didn't you deliver in a health facility?

PROBE: Any other reason?

RECORD ALL MENTIONED.

COST TOO MUCH A
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/ POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) __________ X

445) After (NAME) was born did a health professional or a traditional birth attendant check on your health?

YES 1
NO 2 (SKIP TO 449)

446) How many hours, days or weeks 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

447) Who checked on your health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
TRADITIONAL MIDWIFE
TRAINED 21
UNTRAINED 22
UNSURE ABOUT TRAINING 23
OTHER (SPECIFY) __________ 96

448) Where did this first check of (NAME) take place?

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

NAME OF PLACE __________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL/MUNICIPAL CLINIC 24
RURAL HEALTH CENTER 25
OTHER PUBLIC (SPECIFY) __________ 26
MISSION FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE (SPECIFY) __________ 42
OTHER (SPECIFY) __________ 96

448A) CHECK 443:

YES (SKIP TO 453)
NOT ASKED (SKIP TO 449)

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

YES 1
NO 2 (SKIP TO 453)
DON'T KNOW 8 (SKIP TO 453)

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

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

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

451) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

HEALTH PERSONNEL
DOCTOR 11
NURSE/MIDWIFE 12
TRADITIONAL MIDWIFE
TRAINED 21
UNTRAINED 22
UNSURE ABOUT TRAINING 23
OTHER (SPECIFY) __________ 96

452) Where did this first check of (NAME) take place?

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

NAME OF PLACE __________
HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
CENTRAL HOSPITAL 21
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL/MUNICIPAL CLINIC 24
RURAL HEALTH CENTER 25
OTHER PUBLIC (SPECIFY) __________ 26
MISSION FACILITY 31
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 41
OTHER PRIVATE (SPECIFY) __________ 42
OTHER (SPECIFY) __________ 96

453) In the first two months after delivery, did you receive a vitamin A dose like this? SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2

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

YES 1 (SKIP TO 456)
NO 2 (SKIP TO 457)

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

YES 1
NO 2 (SKIP TO 459)

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

MONTHS ___
DON'T KNOW 98

457) CHECK 226: IS RESPONDENT PREGNANT?

NOT PREGNANT (SKIP TO 458)
PREGNANT OR UNSURE (SKIP TO 459)

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

YES 1
NO 2 (SKIP TO 460)

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

PROBE FOR LOCAL BELIEFS AND PRACTICES.

MONTHS ___
DON'T KNOW 98

460) Did you ever breastfeed (NAME)?

YES 1
NO 2 (SKIP TO 467)

461) How long after birth did you first put (NAME) to the breast?

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

IMMEDIATELY 000
HOURS ___ 1
DAYS ___ 2

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

YES 1
NO 2 (SKIP TO 464)

463) What was (NAME) given to drink? Anything else?

RECORD ALL LIQUIDS MENTIONED.

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

464) CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 465)
DEAD (SKIP TO 466)

465) Are you still breastfeeding (NAME)?

YES 1 (SKIP TO 468)
NO 2

466) For how many months did you breastfeed (NAME)?

MONTHS ___
DON'T KNOW 98

467) CHECK 404: IS CHILD LIVING?

LIVING (SKIP TO 470)
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS SKIP TO 472)

468) How many times did you breastfeed last night between sunset and sunrise?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ___

469) How many times did you breastfeed yesterday during the daylight hours?

IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYTIME FEEDINGS ___

470) Did (NAME) drink anything from a feeding bottle 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, SKIP TO 472.

472) CHECK 215 AND 218:

HAS AT LEAST ONE CHILD BORN IN 2002 OR LATER AND LIVING WITH HER ___
DOES NOT HAVE ANY CHILDREN BORN IN 2002 OR LATER AND LIVING WITH HER ___ (SKIP TO 501)

RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 473

NAME __________

473) Now I would like to ask you about the food (NAME FROM 472) that you ate yesterday during the day or at night, either separately or combined with other foods.

ASK ABOUT EACH FOOD TYPE. FOR THOSE ITEMS WHERE INFORMATION IS SOUGHT FOR BOTH THE CHILD AND THE MOTHER, ASK ABOUT THE CHILD FIRST AND THEN THE MOTHER.

473A) CHILD Yesterday, during the day or night, did (NAME FROM 473) eat/drink:

a. Commercially produced infant formula?
YES 1
NO 2
DON'T KNOW 8
b. Any maize or meal-meal porridge or gruel?
YES 1
NO 2
DON'T KNOW 8
c. Any Celerac, Proneutro, or other commercially fortified baby food?
YES 1
NO 2
DON'T KNOW 8
d. Any sadza, bread, rice, noodles, or any foods made from grains?
YES 1
NO 2
DON'T KNOW 8
e. Any pumpkin, carrots, squash, or yams or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
f. Any white potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
g. Any dark, green, leafy vegetables such as spinach, pumpkin or okra leaves?
YES 1
NO 2
DON'T KNOW 8
h. Any ripe mangoes or paw paw?
YES 1
NO 2
DON'T KNOW 8
i. Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
j. Any liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
k. Any beef, pork, lamb, goat, rabbit or any game meat?
YES 1
NO 2
DON'T KNOW 8
l. Any chicken, duck or other birds?
YES 1
NO 2
DON'T KNOW 8
m. Any eggs?
YES 1
NO 2
DON'T KNOW 8
n. Any fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
o. Any foods made from cowspeas, beans, other peas, or lentils?
YES 1
NO 2
DON'T KNOW 8
p. Any peanut butter or other food from nuts?
YES 1
NO 2
DON'T KNOW 8
q. Any cheese, yogurt, or milk products?
YES 1
NO 2
DON'T KNOW 8
r. Any foods made with other oil, fat, or butter?
YES 1
NO 2
DON'T KNOW 8
s. Any sugary foods such as pastries, cakes, chocolates, sweets, or candies?
YES 1
NO 2
DON'T KNOW 8
t. Any other solid or semi-solid food?
YES 1
NO 2
DON'T KNOW 8
u. Plain water?
YES 1
NO 2
DON'T KNOW 8
v. Milk, such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
w. Any sugary drinks such as mahewu, sodas, or fruit juices?
YES 1
NO 2
DON'T KNOW 8
x. Tea or coffee?
YES 1
NO 2
DON'T KNOW 8
y. Any other liquids?
YES 1
NO 2
DON'T KNOW 8

473B) MOTHER And you yourself, yesterday during the day or night, did you eat/drink:

d. Any sadza, bread, rice, noodles, or any foods made from grains?
YES 1
NO 2
DON'T KNOW 8
e. Any pumpkin, carrots, squash, or yams or sweet potatoes that are yellow or orange inside?
YES 1
NO 2
DON'T KNOW 8
f. Any white potatoes, white yams, manioc, cassava, or any other foods made from roots?
YES 1
NO 2
DON'T KNOW 8
g. Any dark, green, leafy vegetables such as spinach, pumpkin or okra leaves?
YES 1
NO 2
DON'T KNOW 8
h. Any ripe mangoes or paw paw?
YES 1
NO 2
DON'T KNOW 8
i. Any other fruits or vegetables?
YES 1
NO 2
DON'T KNOW 8
j. Any liver, kidney, heart or other organ meats?
YES 1
NO 2
DON'T KNOW 8
k. Any beef, pork, lamb, goat, rabbit or any game meat?
YES 1
NO 2
DON'T KNOW 8
l. Any chicken, duck or other birds?
YES 1
NO 2
DON'T KNOW 8
m. Any eggs?
YES 1
NO 2
DON'T KNOW 8
n. Any fresh or dried fish or shellfish?
YES 1
NO 2
DON'T KNOW 8
o. Any foods made from cowspeas, beans, other peas, or lentils?
YES 1
NO 2
DON'T KNOW 8
p. Any peanut butter or other food from nuts?
YES 1
NO 2
DON'T KNOW 8
q. Any cheese, yogurt, or milk products?
YES 1
NO 2
DON'T KNOW 8
r. Any foods made with other oil, fat, or butter?
YES 1
NO 2
DON'T KNOW 8
s. Any sugary foods such as pastries, cakes, chocolates, sweets, or candies?
YES 1
NO 2
DON'T KNOW 8
t. Any other solid or semi-solid food?
YES 1
NO 2
DON'T KNOW 8
u. Plain water?
YES 1
NO 2
DON'T KNOW 8
v. Milk, such as tinned, powdered, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
w. Any sugary drinks such as mahewu, sodas, or fruit juices?
YES 1
NO 2
DON'T KNOW 8
x. Tea or coffee?
YES 1
NO 2
DON'T KNOW 8
y. Any other liquids?
YES 1
NO 2
DON'T KNOW 8

474) CHECK 473A:

AT LEAST ONE "YES" ___ (SKIP TO 475)
NOT A SINGLE "YES" ___ (SKIP TO 501)

475) How many times did (NAME) 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

SECTION 5. IMMUNIZATION AND CHILD HEALTH

501) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.

(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

502) LINE NUMBER FROM 212

LINE NUMBER ___

503) FROM 212 AND 216

NAME __________
LIVING ___ (SKIP TO 504)
DEAD ___ (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, SKIP TO 561)

504) Has (NAME) ever received a vitamin A dose like this?

SHOW AMPULE/CAPSULE/SYRUP.

YES 1
NO 2 (SKIP TO 506)
DON'T KNOW 8 (SKIP TO 506)

505) How many months ago did (NAME) take the last dose?

MONTHS AGO ___
DON'T KNOW 98

506) Do you have a child health card where (NAME'S) vaccinations are written down?

IF YES: May I see it please?

YES, SEEN 1 (SKIP TO 508)
YES, NOT SEEN 2 (SKIP TO 510)
NO CARD 3

507) Did you ever have a child health card for (NAME)?

YES 1 (SKIP TO 510)
NO 2 (SKIP TO 510)

508)
1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.
2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
DAY ___
MONTH __________
YEAR _____
POLIO 1
DAY ___
MONTH __________
YEAR _____
POLIO 2
DAY ___
MONTH __________
YEAR _____
POLIO 3
DAY ___
MONTH __________
YEAR _____
POLIO 4 BOOSTER
DAY ___
MONTH __________
YEAR _____
DPT 1
DAY ___
MONTH __________
YEAR _____
DPT 2
DAY ___
MONTH __________
YEAR _____
DPT 3
DAY ___
MONTH __________
YEAR _____
DPT 4 BOOSTER
DAY ___
MONTH __________
YEAR _____
HEPATITIS B 1
DAY ___
MONTH __________
YEAR _____
HEPATITIS B 2
DAY ___
MONTH __________
YEAR _____
HEPATITIS B 3
DAY ___
MONTH __________
YEAR _____
MEASLES 1
DAY ___
MONTH __________
YEAR _____
MEASLES 2
DAY ___
MONTH __________
YEAR _____
VITAMIN A (MOST RECENT)
DAY ___
MONTH __________
YEAR _____
VITAMIN A (2ND MOST RECENT)
DAY ___
MONTH __________
YEAR _____

509) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, DPT 1-4, HEPATITIS B 1-3 AND/OR MEASLES 1-2 VACCINES

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 508) (SKIP TO 520)
NO 2 (SKIP TO 520)
DON'T KNOW 8 (SKIP TO 520)

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

YES 1
NO 2 (SKIP TO 522)
DON'T KNOW 8 (SKIP TO 522)

511) Please tell me if (NAME) received any of the following vaccinations:

511A) A BCG vaccination against tuberculosis, that is, an injection in the arm that usually causes a scar?

YES 1
NO 2
DON'T KNOW 8

512) Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (SKIP TO 515)
DON'T KNOW 8 (SKIP TO 515)

514) How many times was the polio vaccine received?

NUMBER OF TIMES ___

515) A DPT vaccination, that is, an injection given in the right thigh, sometimes at the same time as polio drops?

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

516) How many times?

NUMBER OF TIMES ___

517) A hepatitis B vaccination, that is, an injection given in the left thigh?

YES 1
NO 2 (SKIP TO 519)
DON'T KNOW 8 (SKIP TO 519)

518) How many times?

NUMBER OF TIMES ___

519) An injection to prevent measles?

YES 1
NO 2
DON'T KNOW 8

520) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

YES 1
NO 2
NO VACCINATION IN THE LAST 2 YEARS 3
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 535)
DON'T KNOW 8 (SKIP TO 535)

523) Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

524) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?

IF LESS, PROBE: Was he/she offered 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

525) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she offered 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

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

YES 1
NO 2 (SKIP TO 531)

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

IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

RECORD ALL PLACES MENTIONED.

NAME OF PLACE(S) __________
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPAL CLINIC E
VILLAGE COMMUNITY/ HEALTH WORKER F
OTHER PUBLIC (SPECIFY) __________ G
MISSION FACILITY H
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC I
PRIVATE DOCTOR H
PHARMACY J
OTHER PRIVATE MED. (SPECIFY) __________ K
OTHER SOURCE
SHOP L
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) __________ X

528) CHECK 527:

TWO OR MORE CODES CIRCLED ___ (SKIP TO 529)
ONLY ONE CODE CIRCLED ___ (SKIP TO 530)

529) Where did you first seek advice or treatment?

USE LETTER CODE FROM 527.

FIRST PLACE ___

530) How many days after the diarrhea began did you first seek advice or treatment for (NAME)?

IF THE SAME DAY, RECORD '00'.

DAYS ___

531) Does (NAME) still have diarrhea?

YES 1
NO 2

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

a. An ORS satchet?
YES 1
NO 2
DON'T KNOW 8
b. A homemade sugar-salt-water solution (SSS)?
YES 1
NO 2
DON'T KNOW 8
c. Any other liquid?
YES 1
NO 2
DON'T KNOW 8

533) Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (SKIP TO 535)
DON'T KNOW 8 (SKIP TO 535)

534) What (else) was given to treat the diarrhea? Anything else?

RECORD ALL TREATMENTS GIVEN.

PILL OR SYRUP
ANTIBIOTIC A
ANTIMOTILITY B
OTHER TYPE OF PILL/SYRUP C
UNKNOWN PILL/SYRUP D
INJECTION
ANTIBIOTIC E
NON-ANTIBIOTIC G
UNKNOWN F
INJECTION G
(IV) INTRAVENOUS HOME REMEDY H
HERBAL MEDICINE I
OTHER (SPECIFY) __________ X

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 539)
DON'T KNOW 8 (SKIP TO 539)

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

YES 1
NO 2 (SKIP TO 540)
DON'T KNOW 8 (SKIP TO 540)

538) When (NAME) had this illness, did he/she have a problem in the chest or a blocked or runny nose?

CHEST 1 (SKIP TO 540)
NOSE 2 (SKIP TO 540)
BOTH 3 (SKIP TO 540)
OTHER (SPECIFY) __________ 6 (SKIP TO 540)
DON'T KNOW 8 (SKIP TO 540)

539) CHECK 535: HAD FEVER?

"YES" ___ (SKIP TO 540)
OTHER ___ (SKIP TO 557)

540) Now I would like to know how much (NAME) was given to drink during the (fever/cough/rapid breathing). Was he/she offered less than usual to drink, about the same amount or more than usual to drink?

IF LESS, PROBE: Was he/she offered 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

541) When (NAME) had (fever/cough/rapid breathing), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

IF LESS, PROBE: Was he/she offered 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

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

YES 1
NO 2 (SKIP TO 547)

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

RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPAL CLINIC E
VILLAGE COMMUNITY/HEALTH WORKER F
OTHER PUBLIC (SPECIFY) __________ G
MISSION FACILITY H
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC I
PRIVATE DOCTOR H
PHARMACY J
OTHER PRIVATE MED. (SPECIFY) __________ K
OTHER SOURCE
SHOP L
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) __________ X

544) CHECK 543:

TWO OR MORE CODES CIRCLED ___ (SKIP TO 545)
ONLY ONE CODE CIRCLED ___ (SKIP TO 546)

545) Where did you first seek advice or treatment?

USE LETTER CODE FROM 543.

FIRST PLACE __________

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

IF THE SAME DAY, RECORD '00'.

DAYS ___

547) Is (NAME) still sick with a (fever/cough)?

FEVER ONLY 1
COUGH ONLY 2
BOTH COUGH AND FEVER 3
NO, NEITHER 4
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 557)
DON'T KNOW 8 (SKIP TO 557)

549) What drugs did (NAME) take?

RECORD ALL MENTIONED.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
QUININE C
COMBINATION WITH ARTEMISININ D
OTHER ANTI-MALARIAL E
ANTIBIOTIC
COTRAMOXAZOLE F
ERYTHROMYCINE G
AMOXICILLIN H
AMPICILLIN I
CHLORAMPHENOCOL J
OTHER ANTIBIOTIC K
OTHER DRUGS
ASPIRIN L
ACETAMINOPHEN M
IBUPROFEN N
OTHER (SPECIFY) __________ X
DON'T KNOW Z

550) Did you already have (NAME OF DRUG FROM 549) at home when the child became ill?

IF YES, CIRCLE CODE FOR THAT DRUG.

ASK SEPARATELY FOR EACH DRUG GIVEN 549.

ANTIMALARIAL DRUGS
SP/FANSIDAR A
CHLOROQUINE B
QUININE C
COMBINATION WITH ARTEMISININ C
OTHER ANTI-MALARIAL E
ANTIBIOTIC
COTRAMOXAZOLE F
ERYTHROMYCINE G
AMOXICILLIN H
AMPICILLIN I
CHLORAMPHENOCOL J
OTHER ANTIBIOTIC K
OTHER DRUGS
ASPIRIN L
ACETAMINOPHEN M
IBUPROFEN N
OTHER (SPECIFY) __________ X
DON'T KNOW Z

551) CHECK 549: SP/FANSIDAR

CODE 'A' CIRCLED ___ (SKIP TO 552)
CODE 'A' NOT CIRCLED ___ (SKIP TO 554)

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

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

553) For how many days did (NAME) take the SP/Fansidar?

IF 7 OR MORE DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

554) CHECK 549: CHLOROQUINE

CODE 'B' CIRCLED ___ (SKIP TO 555)
CODE 'B' NOT CIRCLED ___ (SKIP TO 557)

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

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

556) For how many days did (NAME) take chloroquine?

IF 7 OR MORE DAYS, RECORD '7'.

DAYS ___
DON'T KNOW 8

557) CHECK 535: HAD FEVER

"YES" (go to 558)
OTHER (go to 561)

558) Did (NAME) get any injection or suppository for the (fever/cough/rapid breathing)?

INJECTION A
SUPPOSITORY B
NONE Y
DON'T KNOW Z

559) Was anything else done about (NAME'S) fever?

YES 1
NO 2 (SKIP TO 561)
DON'T KNOW 8 (SKIP TO 561)

560) What was done about (NAME'S) fever?

CONSULTED TRADITIONAL HEALER A
GAVE TEPID SPONGING B
GAVE HERBS C
OTHER (SPECIFY) __________ Y
DON'T KNOW Z

(GO BACK TO 503 IN NEXT COLUMN; IF NO MORE BIRTHS, SKIP TO 561)

561) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2000 OR LATER LIVING WITH THE RESPONDENT.

ONE OR MORE ___ (SKIP TO 562)
NONE ___ (SKIP TO 601)

562) The last time (NAME OF THE YOUNGEST CHILD) passed stools, what was done to dispose of the stools?

CHILD USED TOILET OR LATRINE 01
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THREW INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

YES, CURRENTLY MARRIED 1 (SKIP TO 605)
YES, LIVING WITH A MAN 2 (SKIP TO 605)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1 (SKIP TO 604)
YES, LIVED WITH A MAN 2 (SKIP TO 604)
NO 3

603) ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 2000. (SKIP TO 619)

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

WIDOWED 1 (SKIP TO 610)
DIVORCED 2 (SKIP TO 610)
SEPARATED 3 (SKIP TO 610)

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

LIVING WITH HER 1
STAYING ELSEWHERE 2

606) 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 NUMBER ___

607) Besides yourself, does your husband/partner have other wives, does he live with other women as if married, or does he maintain a small house?

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

608) How many other wives or partners does your husband live with now?

NUMBER OF OTHER WIVES AND LIVE-IN PARTNERS ___
DON'T KNOW 98

609) Are you the first, second, ... wife?

RANK __________

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

ONLY ONCE 1
MORE THAN ONCE 2

611) CHECK 610:

MARRIED/ LIVED WITH A MAN ONLY ONCE ___ In what month and year did you start living with your husband/partner?
MONTH __________
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 613)
DON'T KNOW YEAR 9998
MARRIED/LIVED WITH A MAN MORE THAN ONCE ___ Now I would like to ask about when you married or began living with a man as if married for the very first time. In what month and year did you first marry or start living with a man as if married?
MONTH __________
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 613)
DON'T KNOW YEAR 9998

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

AGE ___

613) DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE JANUARY 2000. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER '0' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 2000.

FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.

614) CHECK 604:

NOT ASKED OR NOT WIDOWED ___ (SKIP TO 615)
WIDOWED ___ (SKIP TO 617)

615) CHECK 610:

MARRIED MORE THAN ONCE ___ (SKIP TO 616)
MARRIED ONLY ONCE ___ (SKIP TO 619)

616) How did your previous marriage or union end?

DEATH/WIDOWHOOD 1
DIVORCE/SEPARATION 2 (SKIP TO 619)

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

RESPONDENT 1 (SKIP TO 619)
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
OTHER (SPECIFY) __________ 5
NO PROPERTY 6

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

YES 1
NO 2

619) CHECK FOR THE PRESENCE OF OTHERS.

BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

620) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when had sexual intercourse for the very first time?

NEVER 00
AGE IN YEARS ___ (SKIP TO 622)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (SKIP TO 622)

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

YES 1 (SKIP TO 647)
NO 2 (SKIP TO 647)
DON'T KNOW/UNSURE 8 (SKIP TO 647)

622) CHECK 107:

15-24 YEARS OLD ___ (SKIP TO 623)
25-49 YEARS OLD ___ (SKIP TO 627)

623) The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

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

AGE OF PARTNER ___ (SKIP TO 627)
DON'T KNOW 98

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

OLDER 1
YOUNGER 2 (SKIP TO 627)
ABOUT THE SAME AGE 3 (SKIP TO 627)
DON'T KNOW/DON'T REMEMBER 8 (SKIP TO 627)

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

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

627) When was the last time you had sexual intercourse?

RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 ___ (SKIP TO 629)
WEEKS AGO 2 ___ (SKIP TO 629)
MONTHS AGO 3 ___ (SKIP TO 629)
YEARS AGO 4 ___ (SKIP TO 641)

628) When was the last time you had sexual intercourse with this (second or third) person?

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

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

YES 1
NO 2 (SKIP TO 631)

630) What was the main reason you used a condom on that occasion?

PREVENT STD/HIV 1
PREVENT PREGNANCY 2
PREVENT BOTH 3
PARTNER INSISTED 4
OTHER (SPECIFY) __________ 6
DON'T KNOW 8

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

YES 1
NO 2 (SKIP TO 633)

632) Were you or your partner drunk at that time?

IF YES: Who was drunk?

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

633) What was your relationship to this person with whom you had sexual intercourse?

IF RESPONDENT IS GIRLFRIEND: Were you living together as if married?

IF YES, CIRCLE '02'
IF NO, CIRCLE '03'

SPOUSE 01 (SKIP TO 638)
LIVE-IN PARTNER 02 (SKIP TO 638)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANCE 04
COMMERCIAL SEX WORKER 05
OTHER (SPECIFY) __________ 95

634) For how long (have you had/did you have) sexual relations with this person?

IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

DAYS 1 ___
MONTHS 2 ___
YEARS 3 ___

635) CHECK 107:

15-24 YEARS OLD ___ (SKIP TO 636)
25-49 YEARS OLD ___ (SKIP TO 639)

636) How old is this person?

AGE OF PARTNER ___ (SKIP TO 639)
DON'T KNOW 98

637) Is this person older than you, younger than you, or about the same age?

OLDER 1
YOUNGER 2 (SKIP TO 639)
SAME AGE 3 (SKIP TO 639)
DON'T KNOW 8 (SKIP TO 639)

638) Would you say this person is ten or more years older than you or less than ten years older than you?

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

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

YES 1 (SKIP TO 628 IN NEXT COLUMN)
NO 2 (SKIP TO 641)

640) In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.

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

641) In total, how many different people have you had sexual intercourse with in your lifetime?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

NUMBER OF PARTNERS IN LIFETIME ___
DON'T KNOW 98

642) CHECK 629 IN COLUMN 1 (CONDOM USE WITH LAST SEXUAL PARTNER)

YES (SKIP TO 643)
NO OR BLANK (SKIP TO 647)

643) You told me you used a condom the last time you had sexual intercourse. What brand of condom did you use that time?

MALE CONDOMS
CHOICE ASSORTED 1
DUREX 2
ECSTASY 3
PROTECTA 4
PUBLIC SECTOR DISTRICT (BLUE CONDOM OR KAREX) 5
ROUGH RIDER 6
OTHER (SPECIFY) __________ 7
MALE CONDOM, DON'T KNOW 8
FEMALE CONDOMS
CARE 9
OTHER (SPECIFY) __________ 10
FEMALE CONDOM, DON'T KNOW 12

644) How many condoms did you (your spouse/partner) get that time?

NUMBER ___
DON'T KNOW 98

645) How much did the condom(s) cost?

COST _____
FREE 995
DON'T KNOW 998

646) From where was the condom obtained?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.

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

NAME OF PLACE __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC 1 (SKIP TO 651)
RURAL/MUNICIPAL CLINIC 12 (SKIP TO 651)
RURAL HEALTH CENTER 13 (SKIP TO 651)
ZNFPC CLINIC 14 (SKIP TO 651)
MOH MOBILE CLINIC 15 (SKIP TO 651)
ZNFPC CBD/DEPOT HOLDER 16 (SKIP TO 651)
VILLAGE/FARM HEALTH WORKER 17 (SKIP TO 651)
OTHER PUBLIC (SPECIFY) __________ 18 (SKIP TO 651)
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31 (SKIP TO 651)
PHARMACY 32 (SKIP TO 651)
PRIVATE DOCTOR 33 (SKIP TO 651)
CBD 34 (SKIP TO 651)
OTHER PRIVATE DOCTOR (SPECIFY) __________ 35 (SKIP TO 651)
RETAIL OUTLET
GENERAL DEALER 41 (SKI TO 651)
SUPERMARKET 42 (SKIP TO 651)
TUCK SHOP 43 (SKIP TO 651)
SERVICE STATION 44 (SKIP TO 651)
OTHER RETAIL (SPECIFY) __________ 45 (SKIP TO 651)
OTHER PRIVATE SOURCE
CHURCH 46 (SKIP TO 651)
FRIEND/RELATIVE 47 (SKIP TO 651)
OTHER (SPECIFY) __________
DON'T KNOW/NOT SURE 98 (SKIP TO 647)

647) CHECK 301 (07) KNOWS MALE CONDOM

YES ___ (SKIP TO 648)
NO ___ (SKIP TO 651)

648) Do you know of any place where a person can get a male condom?

YES 1
NO 2 (SKIP TO 651)

649) Where is that?

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

NAME OF PLACES __________

Any other places?

RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC (SPECIFY) __________ H
MISSION FACILITY I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE DOCTOR (SPECIFY) __________ N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) __________ S
OTHER PRIVATE SOURCE
CHURCH T
FRIEND/RELATIVE U
OTHER (SPECIFY) __________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

651) CHECK 301 (08) KNOWS FEMALE CONDOM

YES ___ (SKIP TO 652)
NO ___ (SKIP TO 701)

652) Do you know of any place where a person can get a female condom?

YES 1
NO 2 (SKIP TO 701)

653) Where is that?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.

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

NAME OF PLACE __________

Any other places?

RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC (SPECIFY) __________ H
MISSION FACILITY I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE DOCTOR (SPECIFY) __________ N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) __________ S
OTHER PRIVATE SOURCE
CHURCH T
FRIEND/RELATIVE U
OTHER (SPECIFY) __________ X

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

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 7. FERTILITY PREFERENCES

701) CHECK 311/311A:

NEITHER STERILIZED ___ (SKIP TO 702)
HE OR SHE STERILIZED ___ (SKIP TO 713)

702) CHECK 226:

NOT PREGNANT OR UNSURE ___ Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
PREGNANT ___ Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?
HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (SKIP TO 704)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 713)
UNDECIDED/DON'T KNOW: AND PREGNANT 4 (SKIP TO 709)
UNDECIDED/DON'T KNOW: AND NOT PREGNANT OR UNSURE 5 (SKIP TO 708)

703) 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 708)
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 713)
AFTER MARRIAGE 995 (SKIP TO 708)
OTHER (SPECIFY) __________ 996 (SKIP TO 708)
DON'T KNOW 998 (SKIP TO 708)

704) CHECK 226:

NOT PREGNANT OR UNSURE (SKIP TO 705)
PREGNANT (SKIP TO 709)

705) CHECK 310:

NOT ASKED (SKIP TO 706)
NOT CURRENTLY USING (SKIP TO 706)
CURRENTLY USING (SKIP TO 713)

706) CHECK 703:

NOT ASKED (SKIP TO 707)
24 OR MORE MONTHS OR 02 OR MORE YEARS (SKIP TO 707)
00-23 MONTHS OR 00-01 YEAR (SKIP TO 709)

707) CHECK 702:

WANTS TO HAVE A/ANOTHER CHILD ___ You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

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

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
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
HEALTH CONCERNS O
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
OTHER (SPECIFY) __________ X
DON'T KNOW Z

708) CHECK 310:

NOT ASKED (SKIP TO 709)
NO, NOT CURRENTLY USING (SKIP TO 709)
YES, CURRENTLY USING (SKIP TO 713)

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

YES 1
NO 2 (SKIP TO 711)
DON'T KNOW 8 (SKIP TO 711)

710) Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (SKIP TO 713)
MALE STERILIZATION 02 (SKIP TO 713)
PILL 03 (SKIP TO 713)
IUD 04 (SKIP TO 713)
INJECTABLES 05 (SKIP TO 713)
IMPLANTS 06 (SKIP TO 713)
MALE CONDOM 07 (SKIP TO 713)
FEMALE CONDOM 08 (SKIP TO 713)
DIAPHRAGM 09 (SKIP TO 713)
FOAM/JELLY 10 (SKIP TO 713)
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 713)
RHYTHM METHOD 12 (SKIP TO 713)
WITHDRAWAL 13 (SKIP TO 713)
OTHER (SPECIFY) __________ 96 (SKIP TO 713)
UNSURE 98 (SKIP TO 713)

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

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX/NO SEX 22 (SKIP TO 713)
MENOPAUSAL/HYSTERECTOMY 23 (SKIP TO 713)
SUBFECUND/INFECUND 24 (SKIP TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (SKIP TO 713)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (SKIP TO 713)
HUSBAND/PARTNER OPPOSED 32 (SKIP TO 713)
OTHERS OPPOSED 33 (SKIP TO 713)
RELIGIOUS PROHIBITION 34 (SKIP TO 713)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (SKIP TO 713)
KNOWS NO SOURCE 42 (SKIP TO 713)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (SKIP TO 713)
FEAR OF SIDE EFFECTS 52 (SKIP TO 713)
LACK OF ACCESS/TOO FAR 53 (SKIP TO 713)
COSTS TOO MUCH 54 (SKIP TO 713)
INCONVENIENT TO USE 55 (SKIP TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (SKIP TO 713)
OTHER (SPECIFY) __________ 96 (SKIP TO 713)
DON'T KNOW 98 (SKIP TO 713)

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

YES 1
NO 2
DON'T KNOW 8

713) CHECK 216:

HAS LIVING CHILDREN ___ If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN ___ If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (SKIP TO 715)
NUMBER ___
OTHER (SPECIFY) __________ 96 (SKIP TO 715)

714) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

NUMBER OF BOYS ___
NUMBER OF GIRLS ___
NUMBER OF EITHER ___
OTHER (SPECIFY) __________ 96

715) In the last few months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2

716) CHECK 601:

YES, CURRENTLY MARRIED ___ (SKIP TO 717)
YES, LIVING WITH A MAN ___ (SKIP TO 717)
NO, NOT IN UNION ___ (SKIP TO 722)

717) CHECK 311/311A:

NEITHER CODE B, G, NOR L CIRCLED, BUT ANY OTHER CODE(S) CIRCLED ___ (SKIP TO 718)
CODE B, G, OR L CIRCLED ___ (SKIP TO 719)
NO CODE CIRCLED ___ (SKIP TO 721)

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

YES 1
NO 2 (SKIP TO 720)
DON'T KNOW 8 (SKIP TO 720)

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

MAINLY RESPONDENT 1
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 8
OTHER (SPECIFY) __________ 6

720) CHECK 311/311A:

NEITHER STERILIZED (SKIP TO 721)
HE OR SHE STERILIZED (SKIP TO 722)

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

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

722) Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:

She knows her husband has a sexually transmitted disease?
YES 1
NO 2
DON'T KNOW 8
She knows her husband has sex with other women?
YES 1
NO 2
DON'T KNOW 8
She is tired or not in the mood?
YES 1
NO 2
DON'T KNOW 8

723) When a wife knows her husband has a sexually transmitted disease, is she justified in asking that he use a condom?

YES 1
NO 2
DON'T KNOW 8

724) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 725)
NOT IN UNION (SKIP TO 801)

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

YES 1
NO 2
DEPENDS/UNSURE 8

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

YES 1
NO 2
DEPENDS/UNSURE 8

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

801) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 802)
FORMERLY MARRIED/LIVED WITH A MAN (SKIP TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (SKIP TO 807)

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

AGE IN COMPLETED YEARS ___

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

YES 1
NO 2 (SKIP TO 806)

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

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

805) What was the highest (grade/form/year) he completed at that level?

GRADE ___
DON'T KNOW 98

806) CHECK 801:

CURRENTLY MARRIED/LIVING WITH A MAN ___ What is your husband's/partner's occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVED WITH A MAN ___ What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?

OCCUPATION __________

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

YES 1 (SKIP TO 811)
NO 2

808) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have 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 811)
NO 2

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

YES 1 (SKIP TO 811)
NO 2

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

YES 1
NO 2 (SKIP TO 818)

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

OCCUPATION __________

812) CHECK 811:

WORKS IN AGRICULTURE (SKIP TO 813)
DOES NOT WORK IN AGRICULTURE (SKIP TO 814)

813) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

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

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

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

815) Do you usually work at home or away from home?

HOME 1
AWAY 2

816) 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

817) 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 (SKIP TO 823)
NOT PAID (SKIP TO 823)

818) CHECK 601:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 819)
NOT CURRENTLY MARRIED (SKIP TO 824)

819) CHECK 817:

CODE 1 OR 2 CIRCLED (SKIP TO 820)
OTHER (SKIP TO 822)

820) Who decides how the money you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6

821) Would you say that the money you bring into the household is more than what your husband/partner brings in, less than what he brings in, or about the same?

MORE THAN HIM 1
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (SKIP TO 823)
DON'T KNOW 8

822) Who decides how your husband's/partner's earnings will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6

823) Who usually makes the following decisions: mainly you, mainly your husband/partner, you and your husband/partner jointly, or someone else?

Who usually makes decisions about health care for yourself?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
Who usually makes decisions about making major household purchases?
RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
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 5
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 5

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

CHILDREN YOUNGER THAN 10
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
HUSBAND
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER MALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8
OTHER FEMALES
PRESENT/LISTENING 1
PRESENT/NOT LISTENING 2
NOT PRESENT 8

825) Now I would like your opinion about married couples. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

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

SECTION 9. HIV/AIDS

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

YES 1
NO 2 (SKIP TO 1001)

902) Can people reduce their chances of getting HIV, the virus that causes AIDS, by having just one sex partner who is not infected and who has no other partners?

YES 1
NO 2
DON'T KNOW 8

903) Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

904) 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

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

YES 1
NO 2
DON'T KNOW 8

906) Can people reduce their chance of getting HIV by abstaining from sexual intercourse?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

908) Is there anything (else) a person can do to avoid or reduce the chances of getting HIV?

YES 1
NO 2 (SKIP TO 910)
DON'T KNOW 8 (SKIP TO 910)

909) What can a person do? Anything else?

RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z

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

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

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

YES 1
NO 2
DON'T KNOW 8

912) Can HIV be transmitted from a mother to her baby:

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

913) CHECK 912:

AT LEAST ONE 'YES' (SKIP TO 914)
OTHER (SKIP TO 915)

914) Are there any special medications that a doctor or nurse 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

915) Is there any special medication that people infected with HIV can get from a doctor or a nurse?

YES 1
NO 2
DON'T KNOW 8

916) CHECK 215:

LAST BIRTH SINCE JANUARY 2002 (SKIP TO 917)
NO BIRTHS (SKIP TO 926)
LAST BIRTH BEFORE JANUARY 2002 (SKIP TO 926)

917) CHECK 407:

YES, PERSON SEEN (SKIP TO 918)
NO ONE (SKIP TO 926)

918) During any of the antenatal visits for that pregnancy, did anyone talk to you about:

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

919) Were you tested for HIV as part of your antenatal care?

YES 1
NO 2 (SKIP TO 925)

920) Did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

921) Did you get the results of the test?

YES 1
NO 2

922) Where was the test done?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE __________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
RURAL HEALTH CENTER 14
MUNICIPAL CLINIC 15
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NEW START CENTER 32
OTHER PRIVATE VCT CENTER (SPECIFY) __________ 33
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
OTHER (SPECIFY) __________ 96

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

YES 1
NO 2 (SKIP TO 933)

924) When was the last time you were tested for HIV?

LESS THAN 12 MONTHS AGO 1 (SKIP TO 928)
12-23 MONTHS AGO 2 (SKIP TO 928)
2 OR MORE YEARS AGO 3 (SKIP TO 928)

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

YES 1
NO 2

926) Have you ever been tested to see if you have been infected with HIV?

YES 1
NO 2 (SKIP TO 933)

927) When was the last time you were tested?

LESS THAN 12 MONTHS AGO 1
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3

928) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

929) Did you get the results of the test?

YES 1
NO 2

930) Where was the test done?

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

NAME OF PLACE __________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
RURAL HEALTH CENTER 14
MUNICIPAL CLINIC 15
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NEW START CENTER 32
OTHER PRIVATE VCT CENTER (SPECIFY) __________ 33
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
OTHER (SPECIFY) __________ 96

931) CHECK 921 AND 929: GOT THE RESULTS OF HIV TEST

YES (SKIP TO 932)
NO (SKIP TO 936)

932) Did you tell your husband/partner the result of your test?

YES 1 (SKIP TO 936)
NO 2 (SKIP TO 936)
NO HUSBAND/PARTNER 3 (SKIP TO 936)

933) What is the main reason you have not been tested for HIV?

CAN'T AFFORD IT 01
DON'T KNOW WHERE TO GO 02 (SKIP TO 936)
TESTING SITE DIFFICULT TO GET TO 03
AFRAID OF TEST RESULT 04
FATALISTIC/NOTHING CAN BE DONE 05
CONCERNED ABOUT CONFIDENTIALITY 06
NO RISK/NOT SEXUALLY ACTIVE 07
OTHER (SPECIFY) __________ 96
DON'T KNOW 98

934) Do you know of a place where people can go to get tested for HIV, the virus that causes AIDS?

YES 1
NO 2 (SKIP TO 936)

935) Where is that?

RECORD ALL SOURCES MENTIONED

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

NAME OF PLACE(S) __________

Any other places?

PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPAL CLINIC E
OTHER PUBLIC (SPECIFY) __________ F
MISSION FACILITY G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
NEW START CENTER I
OTHER PRIVATE VCT CENTER (SPECIFY) __________ J
OTHER PRIVATE DOCTOR (SPECIFY) __________ K
OTHER (SPECIFY) __________ X

936) CHECK 601: CURRENT MARITAL STATUS

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 937)
OTHER (SKIP TO 939)

937) Did your husband/partner ever have a test for HIV?

YES 1
NO 2 (SKIP TO 939)
DON'T KNOW 8 (SKIP TO 939)

938) Did he tell you the result of his test?

YES 1
NO 2

939) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

YES 1
NO 2
DON'T KNOW 8

940) If a member of your family got infected with HIV, would you want others to know about it?

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

941) If a relative of yours became sick with HIV, would you be willing to care for her or him in your own household?

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

942) If a female teacher has HIV but is not sick, should she be allowed to continue teaching in the school?

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

942A) If a male teacher has HIV but is not sick, should he be allowed to continue teaching in the school?

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

943) Do you personally know someone who has been denied health services in the last 12 months because he or she is suspected to have HIV or AIDS?

YES 1
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (SKIP TO 948)

944) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she is suspected to have HIV or AIDS?

YES 1
NO 2

945) Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have HIV or AIDS?

YES 1
NO 2

946) CHECK 943, 944, AND 945

OTHER (SKIP TO 947)
AT LEAST ONE 'YES' (SKIP TO 948)

947) Do you personally know someone who is suspected to have HIV or who has AIDS?

YES 1
NO 2

948) Do you agree or disagree with the following statement: People with HIV should be ashamed of themselves.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

949) Do you agree or disagree with the following statement: People with HIV should be blamed for bringing the disease into the community.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

950) Do you agree or disagree with the following statement: In a marriage, is it possible for one partner to be infected with HIV and the other person not to be infected.

AGREE 1
DISAGREE 2
DON'T KNOW/NO OPINION 8

951) Should children age 12-14 be taught about using a condom to avoid HIV infection?

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

952) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid HIV infection?

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

SECTION 10. OTHER HEALTH CARE ISSUES

1001) CHECK 901:

HEARD ABOUT AIDS ___ Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS ___ Have you heard about infections that can be transmitted through sexual contact?
YES 1
NO 2

1002) CHECK 620:

HAS HAD SEXUAL INTERCOURSE (SKIP TO 1003)
HAS NOT HAD SEXUAL INTERCOURSE (SKIP TO 1010)

1003) CHECK 1001:

HEARD ABOUT INFECTION TRANSMITTED THROUGH SEXUAL CONTACT (SKIP TO 1004)
HAS NOT HEARD ABOUT INFECTION TRANSMITTED THROUGH SEXUAL CONTACT (SKIP TO 1005)

1004) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

1005) Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling, abnormal genital discharge?

YES 1
NO 2
DON'T KNOW 8

1006) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

1007) CHECK 1004,1005, AND 1006:

HAS HAD AN INFECTION (ANY 'YES') (SKIP TO 1008)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 1010)

1008) The last time you had (PROBLEM FROM 1004/1005/1006), did you seek any kind of advice or treatment?

YES 1
NO 2 (SKIP TO 1010)

1009) Where did you go? Any other places?

RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
RURAL/MUNICIPAL CLINIC E
VILLAGE/FARM HEALTH WORKER F
OTHER PUBLIC (SPECIFY) __________ G
MISSION FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
OTHER PRIVATE MEDICAL (SPECIFY) __________ K
OTHER SOURCE
SHOP L
RELATIVE/FRIEND M
TRADITIONAL HEALER N
OTHER (SPECIFY) __________ X

1010) CHECK 901 AND 1001:

KNOWS ABOUT AIDS AND/OR OTHER STI (SKIP TO 1011)
DOES NOT KNOW (SKIP TO 1015)

1011) CHECK 301 (07) KNOWS MALE CONDOM

YES (SKIP TO 1012)
NO (SKIP TO 1013)

1012) Some people use male condoms to prevent sexually transmitted diseases. If a male condom is used correctly, do you think that it protects against these diseases most of the time, only sometimes, or not at all?

MOST OF THE TIME 1
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8

1013) CHECK 301 (08) KNOWS FEMALE CONDOM

YES (SKIP TO 1014)
NO (SKIP TO 1015)

1014) Some people use female condoms to prevent sexually transmitted diseases. If a female condom is used correctly, do you think that it protects against these diseases most of the time, only sometimes, or not at all?

MOST OF THE TIME 1
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8

1015) Now I would like to ask some questions about medical care for yourself.

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

Getting permission to go
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Getting money needed for treatment
BIG PROBLEM 1
NOT A BIG PROBLEM 2
The distance to the health facility
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Having to take transport
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Not wanting to go alone
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be a female health provider
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be any health provider
BIG PROBLEM 1
NOT A BIG PROBLEM 2
Concern that there may not be drugs available
BIG PROBLEM 1
NOT A BIG PROBLEM 2

1016) Do you have medical aid?

YES 1
NO 2 (SKIP TO 1018)

1017) What type of medical aid do you have?

PRIVATELY PURCHASED BY INDIVIDUAL 1
THROUGH EMPLOYER ONLY 2
PARTIALLY THROUGH EMPLOYER 3
NONE 4
OTHER (SPECIFY) __________ 6
DON'T KNOW/UNSURE 8

1018) Now I would like to ask you some questions about any injections you have had in the last six months. Have you had an injection for any reason in the last six months?

IF YES: How many injections have you had?

IF NUMBER OF INJECTIONS IS GREATER THAN 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (SKIP TO 1022)

1019) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS GREATER THAN 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (SKIP TO 1022)

1020) The last time you had an injection given to you by a health worker, where did you go to get the injection?

PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
RURAL HEALTH CENTER 14
MUNICIPAL CLINIC 15
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
NEW START CENTER 32
OTHER PRIVATE VCT CENTER (SPECIFY) __________ 33
OTHER PRIVATE DOCTOR (SPECIFY) __________ 34
OTHER (SPECIFY) __________ 96

1021) Did the person who gave you that injection take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

1022) Do you currently smoke cigarettes?

YES 1
NO 2 (SKIP TO 1024)

1023) In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES ___

1024) Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (SKIP TO 1026)

1025) What (other) type of tobacco do you currently smoke or use?

PROBE: Any other?

RECORD ALL MENTIONED.

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

1026) Now I would like to ask you some questions about tuberculosis. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (SKIP TO 1101)

1027) How does tuberculosis spread from one person to another?

PROBE: Any other ways?

RECORD ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) __________ X
DON'T KNOW Z

1028) Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

1029) If a member of your family got tuberculosis, would you want others to know about it?

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

SECTION 11: DOMESTIC VIOLENCE

1101) CHECK COVER PAGE OF WOMAN'S QUESTIONNAIRE:

WOMAN SELECTED FOR THIS SECTION (SKIP TO 1102)
WOMAN NOT SELECTED (SKIP TO 1201)

1102) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1
READ TO THE RESPONDENT: Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Zimbabwe. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions.
PRIVACY ABSOLUTELY NOT POSSIBLE 2 (SKIP TO 1138)

1103) CHECK 601 AND 602:

CURRENTLY MARRIED/LIVING WITH A MAN (SKIP TO 1104)
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE) (SKIP TO 1104)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1117)

1104) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?

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

1105A) (Does/did) your (last) husband/partner ever:

a. Say or do something to humiliate you in front of others?
YES 1
NO 2
b. Threaten to hurt or harm you or someone else close to you?
YES 1
NO 2
c. Insult you or make you feel bad about yourself?
YES 1
NO 2

1105B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN, SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.

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

a. Say or do something to humiliate you in front of others?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b. Threaten to hurt or harm you or someone close to you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c. Insult you or make you feel bad about yourself?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1106A) (Does/did) your (last) husband/partner ever do any of the following things to you:

a. Push you, shake you, throw something at you, or twist your arm or pull your hair?
YES 1
NO 2
b. Slap you?
YES 1
NO 2
c. Punch you with his fist or with something that could hurt you, kick you, drag you, or beat you up?
YES 1
NO 2
d. Try to choke you or burn you on purpose?
YES 1
NO 2
e. Threaten you with a knife, gun, or any other weapon?
YES 1
NO 2
f. Attack you with a knife, gun, or any other weapon?
YES 1
NO 2
g. Physically force you to have sexual intercourse with him?
YES 1
NO 2
h. Force you to perform any other sexual acts?
YES 1
NO 2

1106B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN, SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.

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

a. Push you, shake you, throw something at you, or twist your arm or pull your hair?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
b. Slap you?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
c. Punch you with his fist or with something that could hurt you, kick you, drag you, or beat you up?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
d. Try to choke you or burn you on purpose?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
e. Threaten you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
f. Attack you with a knife, gun, or any other weapon?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
g. Physically force you to have sexual intercourse with him?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3
h. Force you to perform any other sexual acts?
OFTEN 1
SOMETIMES 2
NOT AT ALL 3

1107) CHECK 1106A (a-h):

AT LEAST ONE 'YES' (SKIP TO 1108)
ALL ANSWERS ARE 'NO' (SKIP TO 1114A)

1108) How long after you first got married to/started living with your (last) husband/partner did this (any of these things) first happen to you?

IF LESS THAN ONE YEAR, RECORD '00'.

NUMBER OF YEARS ___ (SKIP TO 1110)
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95

1109) How long before you got married to/started living with your (last) husband/partner did this (any of these things) first happen to you?

WEEKS 1 ___
MONTHS 2 ___
YEARS 3 ___
DON'T KNOW 98

1110) Does (did) your husband/partner drink alcohol or use other intoxicating substances?

YES 1
NO 2 (SKIP TO 1113)

1111) How often does (did) he get drunk: often, only sometimes, or never?

OFTEN 1
SOMETIMES 2
NEVER 3

1112) When he has (had) been drinking or using other intoxicating substances, how often do (did) these things happen to you?

OFTEN 1
SOMETIMES 2
NEVER 3

1113) Did the following ever happen to you 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
d. You were late or unable to go to work?
YES 1
NO 2

1114A) Have you ever done any of the following to your husband/partner at times when he was not already emotionally or physically hurting you?

a. Say or do something to humiliate him in front of others?
YES 1
NO 2
b. Threaten to hurt or harm him or someone close to him?
YES 1
NO 2
c. Insult him or make him feel bad about himself?
YES 1
NO 2
d. Hit, slapped, kicked, or done anything else to physically hurt him?
YES 1
NO 2

1114B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.

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

a. Say or do something to humiliate him in front of others?
SOMETIMES 1
OFTEN 2
NOT AT ALL 3
b. Threaten to hurt or harm him or someone close to him?
SOMETIMES 1
OFTEN 2
NOT AT ALL 3
c. Insult him or make him feel bad about himself?
SOMETIMES 1
OFTEN 2
NOT AT ALL 3
d. Hit, slapped, kicked, or done anything else to physically hurt him?
SOMETIMES 1
OFTEN 2
NOT AT ALL 3

1115) CHECK 1114A a, b, c, and d:

AT LEAST ONE 'YES' FOR ANY OF a, b, c, or d (SKIP TO 1116)
ALL ANSWERS ARE 'NO' FOR EACH OF a, b, c, or d (SKIP TO 1117)

1116) Have you done any of these things to your husband/partner in the last 12 months?

YES 1
NO 2

1117) CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN ___ From the time you were 15 years old has anyone other than your (current/last) husband/partner ever:

1117a. Slapped, hit, kicked, or done anything to physically hurt you?
YES 1
NO 2 (SKIP TO 1117b)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1117b)
1117b. Insulted, humiliated, or done anything to emotionally hurt you?
YES 1
NO 2 (SKIP TO 1120A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1120A)

NEVER MARRIED/NEVER LIVED WITH A MAN ___ From the time you were 15 years old has anyone ever:

1117a. Slapped, hit, kicked, or done anything to physically hurt you?
YES 1
NO 2 (SKIP TO 1117b)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1117b)
1117b. Insulted, humiliated, or done anything to emotionally hurt you?
YES 1
NO 2 (SKIP TO 1120A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1120A)

1118) 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
FORMER HUSBAND/PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) __________ X

1120A) CHECK 201, 226 AND 229: EVER BEEN PREGNANT/GIVEN BIRTH

YES (SKIP TO 1121)
NO (SKIP TO 1123)

1121) 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 1123)

1122) 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

1123) CHECK 620: EVER HAD SEX?

HAS EVER HAD SEX (SKIP TO 1124)
NEVER HAD SEX (SKIP TO 1128)

1124) The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

WANTED TO 1
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3

1125) CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN ___ In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?
NEVER MARRIED/NEVER LIVED WITH A MAN ___ In the last 12 months has anyone forced you to have sexual intercourse against your will?
YES 1
NO 2
REFUSED TO ANSWER/NO ANSWER 3

1126) CHECK 1124 AND 1125:

1124 = '1' OR '3' AND 1125 = '2' OR '3' (SKIP TO 1127)
OTHER (SKIP TO 1129)

1127) CHECK 1106A(g) and 1106A(h):

1106A(g) IS NOT '1' AND 1106A(h) IS NOT '1' (SKIP TO 1128)
OTHER (SKIP TO 1131)

1128) 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?

YES 1
NO 2 (SKIP TO 1131)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1131)

1129) 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

1130) Who was the person who forced you at that time?

CURRENT HUSBAND/PARTNER 01
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 13
POLICE/SOLDIER 11
PRIEST/RELIGIOUS LEADER 12
STRANGER 14
OTHER (SPECIFY) __________ 96

1131) CHECK 1106A (a-h), 1117 a-b, 1125 AND 1128:

AT LEAST ONE 'YES' (SKIP TO 1132)
NOT A SINGLE 'YES' (SKIP TO 1136)

1132) Have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

YES 1
NO 2 (SKIP TO 1134)

1133) From whom have you sought help? Anyone else?

RECORD ALL MENTIONED.

OWN FAMILY A (SKIP TO 1136)
HUSBAND/PARTNER'S FAMILY B (SKIP TO 1136)
CURRENT/LAST/LATE HUSBAND/PARTNER C (SKIP TO 1136)
CURRENT/FORMER BOYFRIEND D (SKIP TO 1136)
FRIEND E (SKIP TO 1136)
NEIGHBOR F (SKIP TO 1136)
RELIGIOUS LEADER G (SKIP TO 1136)
DOCTOR/MEDICAL PERSONNEL H (SKIP TO 1136)
POLICE I (SKIP TO 1136)
LAWYER J (SKIP TO 1136)
SOCIAL SERVICE ORGANIZATION K (SKIP TO 1136)
OTHER (SPECIFY) __________ X (SKIP TO 1136)

1134) What was the main reason you did not seek help?

DON'T KNOW WHO TO GO TO 01
NO USE/FATALISTIC 02
PART OF LIFE 03
AFRAID OF DIVORCE/DESERTION 04
AFRAID OF FURTHER ABUSE 05
AFRAID OF GETTING PERSON ABUSING HER IN TROUBLE 06
EMBARASSED 07
DON'T WANT TO DISGRACE FAMILY 08
OTHER (SPECIFY) ________ 96

1135) Have you ever told anyone else about this?

YES 1
NO 2

1136) 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 REFERNECE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1137) 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

1138) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE

__________

SECTION 12. MATERNAL AND ADULT MORTALITY

1201) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died.

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

NUMBER OF BIRTHS TO NATURAL MOTHER ___

1202) CHECK 1201:

TWO OR MORE BIRTHS (SKIP TO 1203)
ONLY ONE BIRTH (RESPONDENT ONLY) (SKIP TO 1214)

1203) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ___

1204) What was the name given to your oldest (next oldest) brother or sister?

NAME __________

1205) Is (NAME) male or female?

MALE 1
FEMALE 2

1206) Is (NAME) still alive?

YES 1
NO 2 (SKIP TO 1208)
DON'T KNOW 8

1207) How old is (NAME)?

AGE ___

1208) How many years ago did (NAME) die?

YEARS ___

1209) How old was (NAME) when he/she died?

IF MALE, OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT OLDEST

AGE ___

1210) Was (NAME) pregnant when she died?

YES 1 (SKIP TO 1213)
NO 2
DON'T KNOW 8

1211) Did (NAME) die during childbirth?

YES 1 (SKIP TO 1214)
NO 2

1212) Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

1213) Was (NAME)'s death due to an accident or violence?

YES 1
NO 2

IF NO MORE BROTHERS OR SISTERS, GO TO 1214.

1214) RECORD THE TIME.

HOURS ___
MINUTES ___

SECTION 13. ANTHROPOMETRY, ANAEMIA AND HIV TESTING

1301) RECORD WEIGHT IN KILOGRAMS.

WEIGHT ___

1302) RECORD HEIGHT IN CENTIMETERS.

HEIGHT ___

1303) RECORD RESULT FOR ANTHROPOMETRIC MEASURMENT.

MEASURED 1
REFUSED 2
ABSENT 3
OTHER __________ 6

CONSENT FOR ANAEMIA AND HIV TESTS FOR NEVER-MARRIED YOUTH AGE 15-17

ASK CONSENT FOR THE ANEMIA AND HIV TESTS. FOR NEVER-IN-UNION RESPONDENTS AGE 15-17, YOU MUST FIRST OBTAIN THE CONSENT OF A PARENT OR OTHER ADULT RESPONSIBLE FOR THE YOUTH AT THE TIME OF YOUR VISIT.

1304) CHECK 106: AGE

AGE 15-17 (SKIP TO 1305)
AGE 18-49 (SKIP TO 1310)

1305) CHECK 601 AND 602: RESPONDENT NEVER EVER-MARRIED AND NEVER LIVED TOGETHER WITH A MAN

CODE 3 IN BOTH QUESTIONS 601 AND 602 (SKIP TO 1306)
CODE 1 OR CODE 2 IN QUESTION 601 OR IN QUESTION 602 (SKIP TO 1310)

1306) CHECK HOUSEHOLD SCHEDULE (COLUMN 1) AND RECORD LINE NUMBER OF THE PARENT OR OTHER ADULT FROM WHOM CONSENT WILL BE REQUESTED.

IF PARENT OR OTHER RESPONSIBLE ADULT IS NOT IN A HOUSEHOLD MEMBER, WRITE '00'

LINE NUMBER OF PARENT/OTHER ADULT ___

1307) READ THE ANAEMIA CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.

As part of this survey, we are trying to find out more about anaemia, that is, low blood levels, in men, women, and children.

To know more about this problem in Zimbabwe, we are asking people in this survey all over the country to take a test. For the test, I will take a few drops of blood from (NAME OF ADOLECENT'S) finger.

The test uses clean and completely safe equipment that is used only once and then thrown away. The blood will be tested with new equipment. The result will be given to (NAME) right after the test is done. We will not tell anyone else the end results of the test.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of anaemia.

Do you agree that (NAME) may give blood for the anaemia test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT OF PARENT/OTHER ADULT FOR ANAEMIA TEST

CONSENTED (SIGN) __________ 1
REFUSED 2
PARENT/ADULT NOT PRESENT 8

1308) READ THE HIV CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.

We are also asking people in this survey to help us find out how big the HIV problem is in Zimbabwe. We would like (NAME OF ADOLESCENT) to take part in the HIV test by allowing us to collect a few more drops of blood from her finger.

This blood will be tested later in the laboratory. We will not keep any name with the blood. Because there will be no name with the blood when it is tested, we will not be able to give (NAME) the result of the test and no one will be able to trace the test back to (NAME).

If (NAME) wants to know her HIV status, I can tell (NAME) where to go to get tested for HIV.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of HIV and AIDS.

Do you agree that (NAME) may give blood for the HIV test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT OF PARENT/OTHER ADULT FOR HIV TEST

CONSENT (SIGN) __________ 1
REFUSED 2 (SKIP TO 1310)
PARENT/ADULT NOT PRESENT 8 (SKIP TO 1310)

1309) READ THE BLOOD STORAGE CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.

Some of the blood that (NAME) gives may be left after the HIV test. We would like to keep that blood at the laboratory to use for other tests later on.

Again, you can say yes or you can say no; it is up to you. If you say yes, it may help the country later to develop programs to fight HIV/AIDS and other health problems.

Will you agree that we do other tests on (NAME)'s blood later?

CIRCLE CODE AND SIGN

FURTHER DISCUSS STORAGE PROCESS TO PUT RESPONDENT AT EASE.

CONSENT OF PARENT/OTHER ADULT FOR STORAGE OF BLOOD

CONSENT (SIGN) ________ 1
REFUSED 2

RESPONDENT CONSENT FOR ANAEMIA AND HIV TESTS

ASK CONSENT FOR THE ANEMIA AND HIV TESTS FROM RESPONDENT. FOR NEVER-IN-UNION RESPONDENTS AGE 15-17, ASK FOR CONSENT ONLY IF PARENT OR OTHER ADULT RESPONSIBLE FOR THE YOUTH AT THE TIME OF YOUR VISIT HAS GRANTED CONSENT OR THE PARENT OR OTHER ADULT WAS NOT PRESENT

.

1310) CHECK 1304 AND 1305: RESPONDENT'S AGE AND UNION STATUS

AGE 15-17 AND NEVER-IN-UNION (SKIP TO 1311)
OTHER (SKIP TO 1312)

1311) CHECK 1307: PARENTAL/ADULT CONSENT FOR ANEMIA TEST

CONSENT FOR ANAEMIA TEST OBTAINED FROM PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT (SKIP TO 1312)
PARENT/OTHER ADULT NOT PRESENT (SKIP TO 1312)
PARENT/OTHER ADULT REFUSED (SKIP TO 1313)

1312) READ THE ANAEMIA CONSENT STATEMENT TO THE RESPONDENT.

As part of this survey, we are trying to find out more about anaemia, that is, low blood levels, in men, women, and children.

To know more about this problem in Zimbabwe, we are asking people in this survey all over the country to take a test. For the test, I will take a few drops of blood from your finger.

The test uses clean and completely safe equipment that is used only once and then thrown away. The blood will be tested with new equipment. The result will be given to you right after the test is done. We will not tell anyone else the results of the test.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of anaemia.

Do you agree to give blood for the anaemia test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT (SIGN) __________ 1
REFUSED 2

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

1313) CHECK 1304 AND 1305: RESPONDENT'S AGE AND UNION STATUS

AGE 15-17 AND NEVER-IN-UNION (SKIP TO 1314)
OTHER (SKIP TO 1315)

1314) CHECK 1308: PARENTAL/ADULT CONSENT FOR HIV TEST

CONSENT FOR HIV TEST OBTAINED FROM PARENT/OTHER ADULT RESPONSIBLE FOR ADOLESCENT (SKIP TO 1315)
PARENT/OTHER ADULT NOT PRESENT (SKIP TO 1315)
PARENT/OTHER ADULT REFUSED (SKIP TO 1317)

1315) READ THE HIV CONSENT STATEMENT TO THE RESPONDENT.

We are also asking people in this survey to help us find out how big the HIV problem is in Zimbabwe. We would like you to take part in the HIV test by allowing us to collect a few more drops of blood from your finger.

This blood will be tested later on in the laboratory. We will not keep any name with the blood. Because there will be no name with the blood when it is tested, we will not be able to give you the result of the test and no one will be able to trace the test back to you.

If you want to know your HIV status, I can tell you where to go to get tested for HIV.

Do you have any questions?

You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of HIV and AIDS.

Do you agree to give blood for the HIV test?

CIRCLE CODE AND SIGN.

FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.

CONSENT (SIGN) __________ 1
REFUSED 2 (SKIP TO 1317)

FURTHER DISCUSS HIV TESTING PROCESS TO PUT RESPONDENT AT EASE.

1316) READ THE BLOOD STORAGE CONSENT STATEMENT TO THE RESPONDENT.

Some of the blood that you give may be left after the HIV test. We would like to keep that blood at the laboratory to use for other tests later on.

Again, you can say yes or you can say no; it is up to you. If you say yes, it may help the country later to develop programs to fight HIV/AIDS and other health problems.

Will you agree that we do other tests on your blood later?

CIRCLE CODE AND SIGN

FURTHER DISCUSS STORAGE PROCESS TO PUT RESPONDENT AT EASE.

CONSENT (SIGN) __________ 1
REFUSED 2

FURTHER DISCUSS STORAGE PROCESS TO PUT RESPONDENT AT EASE.

1317) May I provide you with an informational brochure about voluntary HIV testing from the nearest facility offering VCT?

PROVIDE BROCHURE TO ALL RESPONDENTS WHO WANT IT.

ACCEPTED 1
REFUSED 2

1318) CHECK 1307, 1308, 1312 AND 1315 AND INDICATE THE TESTS FOR WHICH CONSENT HAS BEEN GRANTED.

IF BOTH REFUSED, COMPLETE QUESTIONS 1320 AND 1322.

CONSENTED TO BOTH 1
ANAEMIA TEST ONLY 2
HIV TEST ONLY 3
BOTH REFUSED 4

1319) FOR ALL RESPONDENTS WHERE CONSENT WAS OBTAINED, FOLLOW INSTRUCTIONS FOR PASTING THE BAR CODE LABELS AND TAKING THE DBS SPECIMEN.

PASTE FIRST LABEL HERE __________
PASTE SECOND LABEL ON FILTER PAPER
PASTE THIRD LABEL ON BLOOD TRANSMITTAL FORM

1320) OUTCOME OF HIV TEST

BLOOD SPECIMEN COLLECTED 1
REFUSED 2
ABSENT 3
TECHNICAL PROBLEM 4
OTHER (SPECIFY) __________ 6

1321) RECORD HEMOGLOBIN LEVEL

G/DL ___

1322) OUTCOME OF ANAEMIA TEST

BLOOD SPECIMEN COLLECTED 1
REFUSED 2 (SKIP TO 1326)
ABSENT 3 (SKIP TO 1326)
TECHNICAL PROBLEM 4 (SKIP TO 1326)
OTHER (SPECIFY) __________ 6 (SKIP TO 1326)

1323) CHECK 226: RECORD IF RESPONDENT IS CURRENTLY PREGNANT OR NOT.

WOMAN PREGNANT 1
WOMAN NOT PREGNANT/NOT SURE 2

1324) CHECK 1321: THE CUTOFF POINT IS 9 G/DL FOR PREGNANT WOMEN AND 7 G/DL FOR WOMEN WHO ARE NOT PREGNANT (OR WHO DON'T KNOW IF THEY ARE PREGNANT).

HEMOGLOBIN LEVEL BELOW CUTOFF POINT ___ GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND CONTINUE WITH 1325.
HEMOGLOBIN LEVEL AT OR ABOVE CUTOFF ___ GIVE EACH WOMAN/PARENT/RESPONSIBLE ADULT RESULT OF HEMOGLOBIN MEASUREMENT AND PROCEED TO 1326.

1325) We detect a low level of hemoglobin in your blood. This indicates that you have developed severe anaemia, which is a serious health problem. We would like to inform the clinic at __________ about your condition. This will assist you in obtaining help.

AGREES TO REFERRAL?

YES 1
NO 2

1326) THANK THE RESPONDENT.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

__________

COMMENTS ON SPECIFIC QUESTIONS:

__________

ANY OTHER COMMENTS:

__________

SUPERVISOR'S OBSERVATIONS

__________
NAME OF THE SUPERVISOR: __________
DATE: _____

EDITOR'S OBSERVATIONS

__________
NAME OF THE SUPERVISOR: __________
DATE: _____

INSTRUCTIONS:

ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

COLUMN 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE
B BIRTHS
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTION
6 IMPLANT
7 MALE CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM/JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWL
X OTHER (SPECIFY) __________

COLUMN 2: SOURCE OF CONTRACEPTION
1 GOVERNMENT HOSPITAL/CLINIC
2 RURAL/MUNICIPAL CLINIC
3 RURAL HEALTH CENTER
4 ZNFPC CLINIC
5 MOH MOBILE CLINIC
6 ZNFPC CBD/DEPOT HOLDER
7 OTHER PUBLIC (SPECIFY) __________
8 MISSION FACILITY
A PRIVATE HOSPITAL/CLINIC
B PHARMACY
C PRIVATE DOCTOR
D GENERAL DEALER
E SUPERMARKET
F TUCK SHOP
G SERVICE STATION
H OTHER RETAIL (SPECIFY) __________
J OTHER PRIVATE MEDICAL (SPECIFY) ________
K CHURCH
L FRIEND/RELATIVE
X OTHER (SPECIFY) ________

COLUMN 3: 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 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ________
Z DON'T KNOW

COLUMN 4: MARRIAGE/UNION
X IN UNION (MARRIED OR LIVING TOGETHER)
0 NOT IN UNION

2006

04 APRIL
1 ___
2 ___
3 ___
4 ___
03 MARCH
1 ___
2 ___
3 ___
4 ___
02 FEBRUARY
1 ___
2 ___
3 ___
4 ___
01 JANUARY
1 ___
2 ___
3 ___
4 ___

2005

12 DECEMBER
1 ___
2 ___
3 ___
4 ___
11 NOVEMBER
1 ___
2 ___
3 ___
4 ___
10 OCTOBER
1 ___
2 ___
3 ___
4 ___
09 SEPTEMBER
1 ___
2 ___
3 ___
4 ___
08 AUGUST
1 ___
2 ___
3 ___
4 ___
07 JULY
1 ___
2 ___
3 ___
4 ___
06 JUNE
1 ___
2 ___
3 ___
4 ___
05 MAY
1 ___
2 ___
3 ___
4 ___
04 APRIL
1 ___
2 ___
3 ___
4 ___
03 MARCH
1 ___
2 ___
3 ___
4 ___
02 FEBRUARY
1 ___
2 ___
3 ___
4 ___
01 JANUARY
1 ___
2 ___
3 ___
4 ___

2004

12 DECEMBER
1 ___
2 ___
3 ___
4 ___
11 NOVEMBER
1 ___
2 ___
3 ___
4 ___
10 OCTOBER
1 ___
2 ___
3 ___
4 ___
09 SEPTEMBER
1 ___
2 ___
3 ___
4 ___
08 AUGUST
1 ___
2 ___
3 ___
4 ___
07 JULY
1 ___
2 ___
3 ___
4 ___
06 JUNE
1 ___
2 ___
3 ___
4 ___
05 MAY
1 ___
2 ___
3 ___
4 ___
04 APRIL
1 ___
2 ___
3 ___
4 ___
03 MARCH
1 ___
2 ___
3 ___
4 ___
02 FEBRUARY
1 ___
2 ___
3 ___
4 ___
01 JANUARY
1 ___
2 ___
3 ___
4 ___

2003

12 DECEMBER
1 ___
2 ___
3 ___
4 ___
11 NOVEMBER
1 ___
2 ___
3 ___
4 ___
10 OCTOBER
1 ___
2 ___
3 ___
4 ___
09 SEPTEMBER
1 ___
2 ___
3 ___
4 ___
08 AUGUST
1 ___
2 ___
3 ___
4 ___
07 JULY
1 ___
2 ___
3 ___
4 ___
06 JUNE
1 ___
2 ___
3 ___
4 ___
05 MAY
1 ___
2 ___
3 ___
4 ___
04 APRIL
1 ___
2 ___
3 ___
4 ___
03 MARCH
1 ___
2 ___
3 ___
4 ___
02 FEBRUARY
1 ___
2 ___
3 ___
4 ___
01 JANUARY
1 ___
2 ___
3 ___
4 ___

2002

12 DECEMBER
1 ___
2 ___
3 ___
4 ___
11 NOVEMBER
1 ___
2 ___
3 ___
4 ___
10 OCTOBER
1 ___
2 ___
3 ___
4 ___
09 SEPTEMBER
1 ___
2 ___
3 ___
4 ___
08 AUGUST
1 ___
2 ___
3 ___
4 ___
07 JULY
1 ___
2 ___
3 ___
4 ___
06 JUNE
1 ___
2 ___
3 ___
4 ___
05 MAY
1 ___
2 ___
3 ___
4 ___
04 APRIL
1 ___
2 ___
3 ___
4 ___
03 MARCH
1 ___
2 ___
3 ___
4 ___
02 FEBRUARY
1 ___
2 ___
3 ___
4 ___
01 JANUARY
1 ___
2 ___
3 ___
4 ___

2001

12 DECEMBER
1 ___
2 ___
3 ___
4 ___
11 NOVEMBER
1 ___
2 ___
3 ___
4 ___
10 OCTOBER
1 ___
2 ___
3 ___
4 ___
09 SEPTEMBER
1 ___
2 ___
3 ___
4 ___
08 AUGUST
1 ___
2 ___
3 ___
4 ___
07 JULY
1 ___
2 ___
3 ___
4 ___
06 JUNE
1 ___
2 ___
3 ___
4 ___
05 MAY
1 ___
2 ___
3 ___
4 ___
04 APRIL
1 ___
2 ___
3 ___
4 ___
03 MARCH
1 ___
2 ___
3 ___
4 ___
02 FEBRUARY
1 ___
2 ___
3 ___
4 ___
01 JANUARY
1 ___
2 ___
3 ___
4 ___

2000

12 DECEMBER
1 ___
2 ___
3 ___
4 ___
11 NOVEMBER
1 ___
2 ___
3 ___
4 ___
10 OCTOBER
1 ___
2 ___
3 ___
4 ___
09 SEPTEMBER
1 ___
2 ___
3 ___
4 ___
08 AUGUST
1 ___
2 ___
3 ___
4 ___
07 JULY
1 ___
2 ___
3 ___
4 ___
06 JUNE
1 ___
2 ___
3 ___
4 ___
05 MAY
1 ___
2 ___
3 ___
4 ___
04 APRIL
1 ___
2 ___
3 ___
4 ___
03 MARCH
1 ___
2 ___
3 ___
4 ___
02 FEBRUARY
1 ___
2 ___
3 ___
4 ___
01 JANUARY
1 ___
2 ___
3 ___
4 ___