Survey Text
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______
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)
Bangladesh 1994
No questionnaire text is available for this sample.
Bangladesh 1997
No questionnaire text is available for this sample.
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.
Bangladesh 2004
Survey form
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text
224) CHECK 214 AND ENTER THE NUMBER OF BIRTHS IN 1995 OR LATER. IF NONE, RECORD '0'.
___
Bangladesh 2007
Survey form
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text
215) In what month and year was (NAME) born? PROBE: What is his/her birthday?
MONTH____
YEAR____
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 _________
Bangladesh 2014
Survey form
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text
224. CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.
NUMBER OF BIRTHS ____
NONE 0 (GO TO 226)
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 _____
Benin 2001
Survey form
view entire document:
text
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1996
IF NONE, RECORD '0'.
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 _______
Benin 2011
Survey form
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text
224) CHECK 215:
ENTER THE NUMBER OF BIRTHS IN 2006 OR LATER.
NUMBER OF BIRTHS_________
NONE 0 (GO TO 226)
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
Burkina Faso 1993
Survey form
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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
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 _____
Burkina Faso 2003
Survey form
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text
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH: ___
YEAR: ___
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_____
Burundi 1987
Survey form
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text
214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?
MONTH______
YEAR______
Burundi 2010
Survey form
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text
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Burundi 2016
Survey form
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text
224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2011-2016.
NUMBER OF BIRTHS___
NONE 0 (GO TO 226)
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 _______
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 _____
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: ___
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_____
Cameroon 2018
Survey form
view entire document:
text
215. On what day, month, and year was (NAME) born?
DAY______
MONTH______
YEAR______
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____
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 _____
Chad 2004
Survey form
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text
215) In what month and year was (name) born?
Probe: What is his/her birthday?
MONTH__ __
YEAR __ __ __ __
Chad 2014
Survey form
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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_________
Congo (Democratic Republic) 2007
Survey form
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text
215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH _________
YEAR _______
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_____
Congo Brazzaville 2005
Survey form
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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).
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_________
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 _____
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 _____
Cote d'Ivoire 2011
Survey form
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text
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
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.
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 ___
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 _____
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_____
Egypt 2003
Survey form
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text
224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1998. IF NONE, RECORD "0" AND GO TO 226.
NUMBER OF BIRTHS___
Egypt 2005
Survey form
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text
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
In what season was (NAME) born?
MONTH __ __
YEAR __ __ __ __
Egypt 2008
Survey form
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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 _______
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 __ __ __ __
Eswatini (Swaziland) 2006
Survey form
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text
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 OR LATER. IF NONE, RECORD '0'.
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: ___
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 _______
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_____
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)
Ethiopia 2019
No questionnaire text is available for this sample.
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______
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 _______
Ghana 1998
Survey form
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text
233. CHECK 220 AND 225 AND ENTER THE NUMBER OF PREGNANCIES SINCE JANUARY 1993. IF NONE, RECORD '0'.
___
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: ___
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 _______
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)
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)
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)
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 _______
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_____
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)
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 _______
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: ___
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 _______
India 2015
Survey form
view entire document:
text
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH __ __
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.
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_____
Jordan 2002
No questionnaire text is available for this sample.
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.
___
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 ____
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)
Jordan 2017
Survey form
view entire document:
text
215) On what day, month, and year was (NAME) born?
DAY ___
MONTH ____
YEAR ____
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.)
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 _____
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 __________
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___
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 _______
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)
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: ___
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 ___ ___ ___ ___
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 ____
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______
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 _______
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_____
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 _______
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 _____
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: ___
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 _______
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 _______
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___
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___
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 _______
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. )
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______
Mali 1995
Survey form
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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 _____
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: ___
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 _______
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)
Mali 2018
No questionnaire text is available for this sample.
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: ____
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 _____
Morocco 2003
Survey form
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text
224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 1998 OR LATER.
IF NONE, RECORD '0'
______________
Mozambique 1997
Survey form
view entire document:
text
215. In what month and year was (NAME) born?
MONTH____
YEAR____
Mozambique 2003
Survey form
view entire document:
text
215. In what month and year was (NAME) born?
MONTH____
YEAR____
Mozambique 2011
Survey form
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text
215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
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___
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 _______
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: ___
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 _______
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_____
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 ____________
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___
Nepal 2006
Survey form
view entire document:
text
221. In what month and year was name born?
MONTH ___
YEAR ____
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 _______
Nepal 2016
Survey form
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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.)
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: ___
Niger 1998
Survey form
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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 _____
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 _______
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_____
Nigeria 1990
Survey form
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text
215. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?
MONTH __________
YEAR __________
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 ____
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: ___
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 _______
Nigeria 2013
Survey form
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224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2008 OR LATER.
NUMBER OF BIRTHS ________
NONE 0 (GO TO 226)
Nigeria 2018
Survey form
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224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2013-2018
NUMBER OF BIRTHS_____
NONE 0 (GO TO 226)
Pakistan 1991
Survey form
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222. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1986, IF NONE ENTER '0'.
NUMBER OF BIRTHS _________
Pakistan 2006
Survey form
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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
Pakistan 2012
Survey form
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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.
Pakistan 2017
Survey form
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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.
Rwanda 1992
Survey form
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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 _______
Rwanda 2000
Survey form
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215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH: ___
YEAR: ___
Rwanda 2005
Survey form
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215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH _________
YEAR _______
Rwanda 2008
Survey form
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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.)
Rwanda 2010
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Rwanda 2014
Survey form
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224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.
NUMBER OF BIRTHS_____
NONE 0 (GO TO 226)
Senegal 1986
Survey form
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214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?
MONTH______
YEAR______
Senegal 1992
Survey form
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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 _______
Senegal 1997
Survey form
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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 _____
Senegal 2005
Survey form
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215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH: ___
YEAR: ___
Senegal 2010
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Senegal 2012
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Senegal 2014
Survey form
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215. In what day, month, and year was (NAME) born?
DAY __ __
MONTH __ __
YEAR __ __ __ __
Senegal 2015
Survey form
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215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH ____
YEAR _____
Senegal 2016
Survey form
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215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH ____
YEAR ____
Senegal 2017
Survey form
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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).
South Africa 1998
Survey form
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233 CHECK 220 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1993. IF NONE, RECORD '0'.
South Africa 2016
Survey form
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215) On what day, month, and year was (NAME) born?
DAY ____
MONTH ____
YEAR ____
Sri Lanka 1987
Survey form
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214) In what month and year was (NAME) born?
MONTH____
YEAR____
Sudan 1989
Survey form
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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
Tanzania 1991
Survey form
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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 _______
Tanzania 1996
Survey form
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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 _____
Tanzania 1999
Survey form
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224) CHECK 214 AND ENTER THE NUMBER OF BIRTHS IN 1995 OR LATER. IF NONE, RECORD '0'.
___
Tanzania 2004
Survey form
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224) CHECK 215 AND ENTER NUMBER OF BIRTHS IN 1995 OR LATER.
IF NONE, RECORD '0'.
NUMBER OF BIRTHS___
Tanzania 2010
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Tanzania 2015
Survey form
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223A) CHECK 220A: ANY DEATHS IN JANUARY 2010 OR LATER?
YES (GO TO 223B)
NO (GO TO 224)
Togo 1988
Survey form
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214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?
MONTH______
YEAR______
Togo 1998
Survey form
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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 _____
Togo 2013
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Tunisia 1988
Survey form
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318) What is the month and year of birth?
MONTH ____
YEAR ____
DON'T KNOW 98
Uganda 1988
Survey form
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214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?
MONTH______
YEAR______
Uganda 1995
Survey form
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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 _____
Uganda 2001
Survey form
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215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH: ___
YEAR: ___
Uganda 2006
Survey form
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215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH _________
YEAR _______
Uganda 2011
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Uganda 2016
Survey form
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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)
Yemen 1991
Survey form
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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____
Yemen 2013
Survey form
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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)
Zambia 1992
Survey form
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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 _______
Zambia 1996
Survey form
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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 _____
Zambia 2001
Survey form
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215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH: ___
YEAR: ___
Zambia 2007
Survey form
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215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH _________
YEAR _______
Zambia 2013
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Zambia 2018
Survey form
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(224) CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2013-2018
NUMBER OF BIRTHS _____
NONE 0 (SKIP TO 226)
Zimbabwe 1988
Survey form
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214. In what month and year was (NAME) born?
PROBE: What is his/her birthday? OR: In what season?
MONTH______
YEAR______
Zimbabwe 1994
Survey form
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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 _____
Zimbabwe 1999
Survey form
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215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH___
YEAR___
Zimbabwe 2005
Survey form
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215 In what month and year was (NAME) born?
PROBE: What is his/her birthday?
MONTH _________
YEAR _______
Zimbabwe 2010
Survey form
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215) IN WHAT MONTH AND YEAR WAS (NAME) BORN?
PROBE: WHEN IS HIS/HER BIRTHDAY?
MONTH____
YEAR_____
Zimbabwe 2015
Survey form
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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. )