Survey Text

Afghanistan 2015 Eswatini (Swaziland) 2006 Malawi 2000 Rwanda 2014
Angola 2015 Ethiopia 2000 Malawi 2004 Senegal 1986
Bangladesh 1994 Ethiopia 2005 Malawi 2010 Senegal 1992
Bangladesh 1997 Ethiopia 2011 Malawi 2016 Senegal 1997
Bangladesh 2000 Ethiopia 2016 Mali 1987 Senegal 2005
Bangladesh 2004 Ethiopia 2019 Mali 1995 Senegal 2010
Bangladesh 2007 Ghana 1988 Mali 2001 Senegal 2012
Bangladesh 2011 Ghana 1993 Mali 2006 Senegal 2014
Bangladesh 2014 Ghana 1998 Mali 2012 Senegal 2015
Benin 1996 Ghana 2003 Mali 2018 Senegal 2016
Benin 2001 Ghana 2008 Morocco 1987 Senegal 2017
Benin 2006 Ghana 2014 Morocco 1992 South Africa 1998
Benin 2011 Ghana 2016 Morocco 2003 South Africa 2016
Benin 2017 Guinea 1999 Mozambique 1997 Sri Lanka 1987
Burkina Faso 1993 Guinea 2005 Mozambique 2003 Sudan 1989
Burkina Faso 1998 Guinea 2012 Mozambique 2011 Tanzania 1991
Burkina Faso 2003 Guinea 2018 Myanmar 2015 Tanzania 1996
Burkina Faso 2010 India 1992 Namibia 1992 Tanzania 1999
Burundi 1987 India 1998 Namibia 2000 Tanzania 2004
Burundi 2010 India 2005 Namibia 2006 Tanzania 2010
Burundi 2016 India 2015 Namibia 2013 Tanzania 2015
Cameroon 1991 Jordan 1990 Nepal 1996 Togo 1988
Cameroon 1998 Jordan 1997 Nepal 2001 Togo 1998
Cameroon 2004 Jordan 2002 Nepal 2006 Togo 2013
Cameroon 2011 Jordan 2007 Nepal 2011 Tunisia 1988
Cameroon 2018 Jordan 2009 Nepal 2016 Uganda 1988
Central African Republic 1995 Jordan 2012 Niger 1992 Uganda 1995
Chad 1996 Jordan 2017 Niger 1998 Uganda 2001
Chad 2004 Kenya 1989 Niger 2006 Uganda 2006
Chad 2014 Kenya 1993 Niger 2012 Uganda 2011
Congo (Democratic Republic) 2007 Kenya 1998 Nigeria 1990 Uganda 2016
Congo (Democratic Republic) 2013 Kenya 2003 Nigeria 1999 Yemen 1991
Congo Brazzaville 2005 Kenya 2008 Nigeria 2003 Yemen 2013
Congo Brazzaville 2011 Kenya 2014 Nigeria 2008 Zambia 1992
Cote d'Ivoire 1994 Lesotho 2004 Nigeria 2013 Zambia 1996
Cote d'Ivoire 1998 Lesotho 2009 Nigeria 2018 Zambia 2001
Cote d'Ivoire 2011 Lesotho 2014 Pakistan 1991 Zambia 2007
Egypt 1988 Liberia 1986 Pakistan 2006 Zambia 2013
Egypt 1992 Liberia 2007 Pakistan 2012 Zambia 2018
Egypt 1995 Liberia 2013 Pakistan 2017 Zimbabwe 1988
Egypt 2000 Madagascar 1992 Rwanda 1992 Zimbabwe 1994
Egypt 2003 Madagascar 1997 Rwanda 2000 Zimbabwe 1999
Egypt 2005 Madagascar 2003 Rwanda 2005 Zimbabwe 2005
Egypt 2008 Madagascar 2008 Rwanda 2008 Zimbabwe 2010
Egypt 2014 Malawi 1992 Rwanda 2010 Zimbabwe 2015
top
Afghanistan 2015
Survey form view entire document:  text 
215. In what month and years was (NAME) born? PROBE: When is his/her birthday?

MONTH___
YEAR______

top
Angola 2015
Survey form view entire document:  text 
224) CHECK 215: ENTER THE NUMBER OF BIRTHS OCCURRING SINCE JANUARY 2010.

NUMBER OF BIRTHS______
NONE 0 (GO TO 226)

top
Bangladesh 1994

No questionnaire text is available for this sample.


top
Bangladesh 1997

No questionnaire text is available for this sample.


top
Bangladesh 2000
Survey form view entire document:  text 
225. FOR EACH BIRTH SINCE APRIL 1994 OR BAISHAK 1401, 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 '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.

top
Bangladesh 2004
Survey form view entire document:  text 
224) CHECK 214 AND ENTER THE NUMBER OF BIRTHS IN 1995 OR LATER. IF NONE, RECORD '0'.

___

top
Bangladesh 2007
Survey form view entire document:  text 
215) In what month and year was (NAME) born? PROBE: What is his/her birthday?

MONTH____
YEAR____

top
Bangladesh 2011
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: When is his/her birthday?

MONTH ________
YEAR _________

top
Bangladesh 2014
Survey form view entire document:  text 
224. CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

top
Benin 1996
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Benin 2001
Survey form view entire document:  text 
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1996
IF NONE, RECORD '0'.

top
Benin 2006
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Benin 2011
Survey form view entire document:  text 
224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2006 OR LATER.

NUMBER OF BIRTHS_________
NONE 0 (GO TO 226)

top
Benin 2017
Survey form view entire document:  text 
224) Check 215:
Enter the number of births in 2012-2017.

Number of births
None 0-skip to 226

top
Burkina Faso 1993
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: What season was (NAME) born in?
IF MONTH/SEASON UNKNOWN, RECORD '98'.

MONTH _____
DOESN'T KNOW 98
YEAR _____
DOESN'T KNOW 98

top
Burkina Faso 1998
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Burkina Faso 2003
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Burkina Faso 2010
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Burundi 1987
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Burundi 2010
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Burundi 2016
Survey form view entire document:  text 
224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2011-2016.

NUMBER OF BIRTHS___
NONE 0 (GO TO 226)

top
Cameroon 1991
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Cameroon 1998
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Cameroon 2004
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Cameroon 2011
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Cameroon 2018
Survey form view entire document:  text 
215. On what day, month, and year was (NAME) born?

DAY______
MONTH______
YEAR______

top
Central African Republic 1995
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR:
In what season was he/she born?

MONTH____
YEAR____

top
Chad 1996
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Chad 2004
Survey form view entire document:  text 
215) In what month and year was (name) born?
Probe: What is his/her birthday?

MONTH__ __
YEAR __ __ __ __

top
Chad 2014
Survey form view entire document:  text 
403) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY

LAST BIRTH_____
BIRTH HISTORY NUMBER____
NEXT-TO-LAST BIRTH ____________
BIRTH HISTORY NUMBER___________
SECOND-FROM-LAST BIRTH_________
BIRTH HISTORY NUMBER_________

top
Congo (Democratic Republic) 2007
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Congo (Democratic Republic) 2013
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Congo Brazzaville 2005
Survey form view entire document:  text 
402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN JANUARY 2000 OR AFTER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OR 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).


top
Congo Brazzaville 2011
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR_________

top
Cote d'Ivoire 1994
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Cote d'Ivoire 1998
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Cote d'Ivoire 2011
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Egypt 1988
Survey form view entire document:  text 
211. Now I would like to talk to you about all of your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 213. RECORD TWINS ON SEPARATE LINES AND MARK WITH A BRACKET. IF THERE ARE MORE THAN SEVEN BIRTHS CONTINUE RECORDING THE NAMES ON THE NEXT PAGE. THEN ASK 214 THROUGH 219 AS APPROPRIATE FOR EACH BIRTH. AFTER RECORDING THE ANSWERS TO QUESTIONS 214-219 FOR ALL THE BIRTHS THE WOMAN HAS HAD, GO TO 220.


top
Egypt 1992
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH ___
YEAR ___

top
Egypt 1995
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday? Or: In what season was he/she born?

MONTH ______
YEAR _____

top
Egypt 2000
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season was he/she born?

MONTH____
YEAR_____

top
Egypt 2003
Survey form view entire document:  text 
224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1998. IF NONE, RECORD "0" AND GO TO 226.

NUMBER OF BIRTHS___

top
Egypt 2005
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
In what season was (NAME) born?

MONTH __ __
YEAR __ __ __ __

top
Egypt 2008
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
In what season was (NAME) born?

MONTH __________
YEAR __________
OR SEASON _______

top
Egypt 2014
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
In what season was (NAME) born?

MONTH __ __
YEAR __ __ __ __

top
Eswatini (Swaziland) 2006
Survey form view entire document:  text 
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 OR LATER. IF NONE, RECORD '0'.

top
Ethiopia 2000
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Ethiopia 2005
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Ethiopia 2011
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Ethiopia 2016
Survey form view entire document:  text 
224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2003-2008

NUMBER OF BIRTHS ___
NONE 0 (GO TO 226)

top
Ethiopia 2019

No questionnaire text is available for this sample.


top
Ghana 1988
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Ghana 1993
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Ghana 1998
Survey form view entire document:  text 
233. CHECK 220 AND 225 AND ENTER THE NUMBER OF PREGNANCIES SINCE JANUARY 1993. IF NONE, RECORD '0'.

___

top
Ghana 2003
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Ghana 2008
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Ghana 2014
Survey form view entire document:  text 
224) CHECK 215:

ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

top
Ghana 2016
Survey form view entire document:  text 
211. Now I'd like to ask you about your most recent births. How many births have you had in 2011-2016?
RECORD NUMBER OF LIVE BIRTHS IN 2011-2016?

TOTAL IN 2011-2016 ______________________
NONE 00 (SKIP TO 225)

top
Guinea 1999
Survey form view entire document:  text 
31) Did (NAME) use a bednet last night?

YES 1 (GO TO 33)
NO 2 (GO TO 33)

top
Guinea 2005
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Guinea 2012
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Guinea 2018
Survey form view entire document:  text 
224) CHECK 215: Enter the number of births in 2013-2018.

NUMBER OF BIRTHS__
NONE 0 (GO TO 226)

top
India 1992
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
India 1998
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
India 2005
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
India 2015
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH __ __

top
Jordan 1990
Survey form view entire document:  text 
222) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1985.* IF NONE, ENTER 0 AND GO TO 224.

top
Jordan 1997
Survey form view entire document:  text 
315. In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH_____
YEAR_____

top
Jordan 2002

No questionnaire text is available for this sample.


top
Jordan 2007
Survey form view entire document:  text 
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2002 OR LATER.
IF NONE, RECORD '0' AND SKIP TO 226.

___

top
Jordan 2009
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH __
YEAR ____

top
Jordan 2012
Survey form view entire document:  text 
224. CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2007 OR LATER.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

top
Jordan 2017
Survey form view entire document:  text 
215) On what day, month, and year was (NAME) born?

DAY ___
MONTH ____
YEAR ____

top
Kenya 1989
Survey form view entire document:  text 
211. Now I would like to talk to you about all of your births, whether still alive or not, starting with the first one you had. (RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS ON SEPARATE LINES. CODE TYPE OF BIRTH.)

top
Kenya 1993
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Kenya 1998
Survey form view entire document:  text 
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 __________

top
Kenya 2003
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH___
YEAR___

top
Kenya 2008
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Kenya 2014
Survey form view entire document:  text 
224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER

NUMBER OF BIRTHS IN 2009 OR LATER ___ (GO TO 224)
NONE 0 (GO TO 226)

top
Lesotho 2004
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Lesotho 2009
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH ___ ___
YEAR ___ ___ ___ ___

top
Lesotho 2014
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: When is his/her birthday?

MONTH ____
YEAR ____

top
Liberia 1986
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Liberia 2007
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Liberia 2013
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Madagascar 1992
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Madagascar 1997
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Madagascar 2003
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Madagascar 2008
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Malawi 1992
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Malawi 2000
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH___
YEAR___

top
Malawi 2004
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH___
YEAR___

top
Malawi 2010
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Malawi 2016
Survey form view entire document:  text 
225. FOR EACH BIRTH IN 2010-2015. ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. )

top
Mali 1987
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Mali 1995
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Mali 2001
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Mali 2006
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Mali 2012
Survey form view entire document:  text 
224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2007 OR LATER.

NUMBER OF BIRTHS_______ (GO TO 225)
NONE 0 (GO TO 226)

top
Mali 2018

No questionnaire text is available for this sample.


top
Morocco 1987
Survey form view entire document:  text 
318) MONTH AND YEAR OF BIRTH

IF MONTH NOT KNOWN, ASK THE SEASON:

FALL 21
WINTER 22
SPRING 23
SUMMER 24
MONTH/SEASON: ____
YEAR: ____

top
Morocco 1992
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday? Or: In what season was he/she born?

MONTH ______
YEAR _____

top
Morocco 2003
Survey form view entire document:  text 
224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 1998 OR LATER.
IF NONE, RECORD '0'

______________

top
Mozambique 1997
Survey form view entire document:  text 
215. In what month and year was (NAME) born?

MONTH____
YEAR____

top
Mozambique 2003
Survey form view entire document:  text 
215. In what month and year was (NAME) born?

MONTH____
YEAR____

top
Mozambique 2011
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Myanmar 2015
Survey form view entire document:  text 
215) In what month and year was (NAME) born? PROBE: When is his/her birthday?

MONTH___
YEAR___

top
Namibia 1992
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Namibia 2000
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Namibia 2006
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Namibia 2013
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Nepal 1996
Survey form view entire document:  text 
220. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR ____________

top
Nepal 2001
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH___
YEAR___

top
Nepal 2006
Survey form view entire document:  text 
221. In what month and year was name born?

MONTH ___
YEAR ____

top
Nepal 2011
Survey form view entire document:  text 
220) In what month and year was (NAME) born?
PROBE: When is his/her birthday?

MONTH _______
YEAR _______

top
Nepal 2016
Survey form view entire document:  text 
402. CHECK 215. RECORD THE PREGNANCY HISTORY NUMBER IN 403 AND THE NAME AND SURVIVAL STATUS IN 404 FOR EACH BIRTH IN 2068-2073. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S).
Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

top
Niger 1992
Survey form view entire document:  text 
215) In what month and year was (NAME) born?

PROBE: What is his or her birthday?
OR: In what season was he/she born?

IF MONTH/SEASON UNKNOWN, ENTER '98'.

MONTH: ___
YEAR: ___

top
Niger 1998
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Niger 2006
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Niger 2012
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Nigeria 1990
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH __________
YEAR __________

top
Nigeria 1999
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season was he/she born?

MONTH ______
YEAR ____

top
Nigeria 2003
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Nigeria 2008
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Nigeria 2013
Survey form view entire document:  text 
224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER.

NUMBER OF BIRTHS ________
NONE 0 (GO TO 226)

top
Nigeria 2018
Survey form view entire document:  text 
224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2013-2018

NUMBER OF BIRTHS_____
NONE 0 (GO TO 226)

top
Pakistan 1991
Survey form view entire document:  text 
222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1986, IF NONE ENTER '0'.

NUMBER OF BIRTHS _________

top
Pakistan 2006
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
RECORD MONTHS 1 THROUGH 12
OR SEASONS

MONTH _____

WINTER 21
SPRING 22
SUMMER 23
MONSOON 24
AUTUMN 25
DON'T KNOW 98

top
Pakistan 2012
Survey form view entire document:  text 
233) FOR EACH BIRTH SINCE JANUARY 2007, ENTER 'B' IN THE MONTH OF BIRTH IN CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THE PREGNANCY LASTED.) CHECK 227 FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH. CHECK 228. IF YES (CODE '1' CIRCLED), ENTER 'A' FOR ABORTION OR 'C' (IF CODE '2' CIRCLED) FOR MISCARRIAGE OR 'S' FOR STILLBIRTH, IN CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOP THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

top
Pakistan 2017
Survey form view entire document:  text 
225) FOR EACH BIRTH IN 2012-2018, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

CHECK 220AC FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH. CHECK 220AD. IF YES (CODE '1' CIRCLED), ENTER 'A' FOR ABORTION OR 'C' (IF CODE '2' CIRCLED) FOR MISCARRIAGE OR 'S' FOR STILLBIRTH, IN CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.

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


top
Rwanda 1992
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Rwanda 2000
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Rwanda 2005
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Rwanda 2008
Survey form view entire document:  text 
402) CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2002 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).

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


top
Rwanda 2010
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Rwanda 2014
Survey form view entire document:  text 
224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.

NUMBER OF BIRTHS_____
NONE 0 (GO TO 226)

top
Senegal 1986
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Senegal 1992
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Senegal 1997
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Senegal 2005
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Senegal 2010
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Senegal 2012
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Senegal 2014
Survey form view entire document:  text 
215. In what day, month, and year was (NAME) born?

DAY __ __
MONTH __ __
YEAR __ __ __ __

top
Senegal 2015
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?


MONTH ____
YEAR _____


top
Senegal 2016
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH ____
YEAR ____

top
Senegal 2017
Survey form view entire document:  text 
402) CHECK 215:
ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2012-2107. ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRE(S)).

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


top
South Africa 1998
Survey form view entire document:  text 
233 CHECK 220 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1993. IF NONE, RECORD '0'.

top
South Africa 2016
Survey form view entire document:  text 
215) On what day, month, and year was (NAME) born?

DAY ____
MONTH ____
YEAR ____

top
Sri Lanka 1987
Survey form view entire document:  text 
214) In what month and year was (NAME) born?

MONTH____
YEAR____

top
Sudan 1989
Survey form view entire document:  text 
214 In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH ______
YEAR _______

SEASON CODES: FALL=21, WINTER=22, SUMMER=23


top
Tanzania 1991
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Tanzania 1996
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Tanzania 1999
Survey form view entire document:  text 
224) CHECK 214 AND ENTER THE NUMBER OF BIRTHS IN 1995 OR LATER. IF NONE, RECORD '0'.

___

top
Tanzania 2004
Survey form view entire document:  text 
224) CHECK 215 AND ENTER NUMBER OF BIRTHS IN 1995 OR LATER.
IF NONE, RECORD '0'.

NUMBER OF BIRTHS___

top
Tanzania 2010
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Tanzania 2015
Survey form view entire document:  text 
223A) CHECK 220A: ANY DEATHS IN JANUARY 2010 OR LATER?

YES (GO TO 223B)
NO (GO TO 224)

top
Togo 1988
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Togo 1998
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Togo 2013
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Tunisia 1988
Survey form view entire document:  text 
318) What is the month and year of birth?

MONTH ____
YEAR ____
DON'T KNOW 98

top
Uganda 1988
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Uganda 1995
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Uganda 2001
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Uganda 2006
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Uganda 2011
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Uganda 2016
Survey form view entire document:  text 
225) FOR EACH BIRTH IN 2011-2016, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGENANCY. (NOTE: THE NUMVER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED)

top
Yemen 1991
Survey form view entire document:  text 
315A) In what year was (NAME) born?

IF DON'T KNOW, ASK: How many years ago?

YEAR____
YEARS AGO____

315B) And in what month?

IF DON'T KNOW, ASK: In what season?

MONTH____
SEASON____

top
Yemen 2013
Survey form view entire document:  text 
224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER. IF NONE, CIRCLE COE (0) AND GO TO 226.

NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)

top
Zambia 1992
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH _________
YEAR _______

top
Zambia 1996
Survey form view entire document:  text 
215. In what month and year was (NAME) born?
PROBE: what is his/her birthday? OR: In what season was he/she born?

MONTH __________
YEAR _____

top
Zambia 2001
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH: ___
YEAR: ___

top
Zambia 2007
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Zambia 2013
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Zambia 2018
Survey form view entire document:  text 
(224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2013-2018

NUMBER OF BIRTHS _____
NONE 0 (SKIP TO 226)

top
Zimbabwe 1988
Survey form view entire document:  text 
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?

MONTH______
YEAR______

top
Zimbabwe 1994
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday? Or: In what season was he/she born?

MONTH ______
YEAR _____

top
Zimbabwe 1999
Survey form view entire document:  text 
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH___
YEAR___

top
Zimbabwe 2005
Survey form view entire document:  text 
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?

MONTH _________
YEAR _______

top
Zimbabwe 2010
Survey form view entire document:  text 
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?

MONTH____
YEAR_____

top
Zimbabwe 2015
Survey form view entire document:  text 
225. FOR EACH BIRTH IN 2010-2015. ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF COMPLETED MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED. )