[NAME OF COUNTRY]
[NAME OF ORGANIZATION]

IDENTIFICATION (1)

PLACE NAME
NAME OF HOUSEHOLD HEAD
CLUSTER NUMBER
HOUSEHOLD NUMBER
REGION

LARGE CITY/SMALL CITY/TOWN/RURAL (2)

NAME AND LINE NUMBER OF WOMAN
INTERVIEWER VISITS
FIRST VISIT
DATE
INTERVIEWER NAME
RESULT

SECOND VISIT
DATE
INTERVIEWER NAME
RESULT

THIRD VISIT
DATE
INTERVIEWER NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NUMBER
RESULT

NEXT VISIT
DATE
TIME

TOTAL NUMBER OF VISITS

*RESULT CODES:

COUNTRY-SPECIFIC INFORMATION:
LANGUAGE OF QUESTIONNAIRE, LANGUAGE OF INTERVIEW, NATIVE LANGUAGE OF RESPONDENT, AND WHETHER TRANSLATOR USED

SUPERVISOR
NAME
DATE

FIELD EDITOR
NAME
DATE

OFFICE EDITOR

KEYED BY

1 This section should be adapted for country-specific survey design.
2 The following guidelines should be used to categorize urban sample points: "Large cities" are national capitals and places with over 1 million population; "small cities" are places with between 50,000 and 1 million population; remaining urban sample points are "towns".

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT
INFORMED CONSENT

Hello. My name is _______________________________________ and I am working with (NAME OF ORGANIZATION). We are conducting a national survey that asks women (and men) about various health issues. We would very much appreciate your participation in this survey. This information will help the government to plan health services. The survey usually takes between 30 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.
Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time. 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 interviewer: ____________
Date: __________

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

101 RECORD THE TIME.

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

103 Just before you moved here, did you live in a city, in a town, or in the countryside?

Replace 104 with 106 if Questions 104-105 are deleted.
Questions 104-105 must be included in all surveys in which HIV testing is a component. They should be deleted in surveys where the HIV/AIDS module is not adopted.

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

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

106 In what month and year were you born?

107 How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

108 Have you ever attended school?

109 What is the highest level of school you attended: primary, secondary, or higher? (2)

110 What is the highest (grade/form/year) you completed at that level? (2)

111 CHECK 109:

112 Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. (3)

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

113 Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)? (4)

114 CHECK 112:

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?

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

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

118 COUNTRY-SPECIFIC QUESTION ON RELIGION.

119 COUNTRY-SPECIFIC QUESTION ON ETHNICITY.

1 The question must be included in all surveys in which HIV testing is a component of the survey. It should be deleted in surveys where the HIV/AIDS module is not adopted.
2 Revise according to the local education system.
3 Each card should have four simple sentences appropriate to the country (e.g., "Parents love their children", "Farming is hard work", "The child is reading a book", "Children work hard at school"). Cards should be prepared for every language in which respondents are likely to be literate.
4 In countries with an interest in measuring participation across a number of literacy programs, an additional multiple-response question may be included for women who participated in a literacy program (for example, "What type of literacy programs have you participated in? PROBE: Any other programs?")

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?

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

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

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

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'.

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

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

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

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

210 CHECK 208:

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.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

213 Were any of these births twins?

214 Is (NAME) a boy or girl?

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

216 Is (NAME) still alive?

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

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

219 IF ALIVE:
RECORD HOUSEHOLD NUMBER OF CHILD (RECORD '00' IF CHILD MOT LISTED IN HOUSEHOLD).

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.

221 Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME) including any child who died after birth?

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

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

224 CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2001 (1) OR LATER.
IF NONE, RECORD '0' AND GO TO 226.

225 FOR EACH BIRTH SINCE JANUARY 2001 (1), ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226 Are you pregnant now?

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

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?

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

230 When did the last such pregnancy end?

231 CHECK 230:

232 How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

233 Since January 2001 (1), have you had any other pregnancies that did not result in a live birth?

234 ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2001. (1)
ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235 Did you have any miscarriages, abortions or stillbirths that ended before 2001 (1)?

236 When did the last such pregnancy that terminated before 2001 (1) end?

237 When did your last menstrual period start?

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?

239 Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods? (2)

1 For fieldwork beginning in 2007, 2008 or 2009, the year should be 2002, 2003, or 2004, respectively.
2 In countries where the Standard Days Method is used, an appropriate response category for that method may be added.

SECTION 3. CONTRACEPTION

301 Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
Which ways or methods have you heard about? (1)
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK:
Have you ever heard of (METHOD)?

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.

The LAM method should be deleted in countries that do not have a LAM program.

302 Have you ever used (METHOD)?

303 CHECK 302:

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

305 ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH. (GO TO 333)

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'.

308 CHECK 302 (01):

309 CHECK 226:

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

311Which method are you using? (3)
CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD IN LIST.
311A CIRCLE 'A' FOR FEMALE STERILIZATION.

312 RECORD IF CODE 'C' FOR PILL IS CIRCLED IN 311.
YES (USING PILL)
May I see the package of pills you are using?

NO (USING CONDOM BUT NOT PILL)
May I see the package of condoms you are using?
RECORD NAME OF BRAND IF PACKAGE SEEN.

313 Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.

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

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

316 In what facility did the sterilization take place? (4)
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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?

CODE 'A' NOT 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?

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

319 In what month and year was the sterilization performed?
319A Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

320 CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A

321 CHECK 319/319A:

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 2001. (5)
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

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

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

324 Where did you obtain (CURRENT METHOD) when you started using it?
324A Where did you learn how to use the rhythm/lactational amenorhea method?
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

326 You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?

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

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

329 CHECK 326:
CODE '1' CIRCLED
At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED
When you obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) were you told about other methods of family planning that you could use?

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

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

332 Where did you obtain (CURRENT METHOD) the last time? (4)
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

334 Where is that? (4)
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

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

SECTION 3 FOOTNOTES

1 Other commonly used methods may be added to the list, such as diaphragm, foam, jelly, contraceptive patch, sponge, or specific fertility awareness methods such as the Standard Days Method.
2 The LAM method should be deleted in countries that do not have a LAM program. In these countries, LAM should also be deleted as a coding category in Qs. 311, 323, 325, 331, 710, and Column 1 of the calendar.
3 Other commonly used methods may be added to the list, such as contraceptive patch, sponge, or specific fertility awareness methods such as the Standard Days Method. Any codes added in 311 must also be added in 323, 325, 331, 710, and Column 1 of the calendar.
4 Coding categories to be developed locally and revised based on the pretest; however, the broad categories must be maintained.
5 For fieldwork beginning in 2007, 2008 or 2009, the year should be 2002, 2003, or 2004, respectively.
6 For fieldwork beginning in 2007, 2008, or 2009, the year should be 2001, 2002, or 2003, respectively.

SECTION 4. PREGNANCY AND POSTNATAL CARE

401 CHECK 224:

402 CHECK 215: ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 (1) 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

404 FROM 212 AND 216

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?

406 How much longer would you have liked to wait?

407 Did you see anyone for antenatal care for this pregnancy? (2)
IF YES: Whom did you see? Anyone else?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

408 Where did you receive antenatal care for this pregnancy?
Anywhere else?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

411 As part of your antenatal care during this pregnancy, were any of the following done at least once?
Were you weighed?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

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

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

414 During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? (3)

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

416 CHECK 415:

417 At any time before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

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

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

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

421 During this pregnancy, were you given or did you buy any iron tablets or iron syrup? (4)
SHOW TABLETS/SYRUP. (4)

422 During the whole pregnancy, for how many days did you take the tablets or syrup? (4, 5)
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

423 During this pregnancy, did you take any drug for intestinal worms?

424 During this pregnancy, did you have difficulty with your vision during daylight?

425 During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?

Questions 426-431 are part of the malaria module and should be deleted in surveys where there is no program for intermittent preventive treatment against malaria during pregnancy.

426 (6) During this pregnancy, did you take any drugs to keep you from getting malaria?

427 (6) What drugs did you take?
RECORD ALL MENTIONED.
IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

428 (6) CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION.

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

430 (6) CHECK 407:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY

431 (6) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?

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

433 Was (NAME) weighed at birth?

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

435 Who assisted with the delivery of (NAME)? (2)
Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.

IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

436 Where did you give birth to (NAME)? (2)
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

438 Was (NAME) delivered by caesarean section?

439 Before you were discharged after (NAME) was born, did any health care provider check on your health?

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

441 Who checked on your health at that time? (2)
PROBE FOR MOST QUALIFIED PERSON.

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

443 Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.

444 After (NAME) was born, did any health care provider or a traditional birth attendant check on your health?

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

446 Who checked on your health at that time? (2)
PROBE FOR MOST QUALIFIED PERSON.

447 Where did this first check take place? (2)
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

448 CHECK 442:

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

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.

451 Who checked on (NAME)'s health at that time? (2)
PROBE FOR MOST QUALIFIED PERSON.

452 Where did this first check of (NAME) take place? (2)
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

453 In the first two months after delivery, did you receive a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

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

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

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

457 CHECK 226:
IS RESPONDENT PREGNANT?

458 Have you begun to have sexual intercourse again since the birth of (NAME)?

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

460 Did you ever breastfeed (NAME)?

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.

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

463 What was (NAME) given to drink?
Anything else?
RECORD ALL LIQUIDS MENTIONED.

464 CHECK 404:
IS CHILD LIVING?

465 Are you still breastfeeding (NAME)?

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

467 CHECK 404:
IS CHILD LIVING?

468 How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

469 How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

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

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

1 For fieldwork beginning in 2007, 2008 or 2009, the year should be 2002, 2003, or 2004, respectively.
2 Coding categories to be developed locally and revised based on the pretest; however, the broad categories must be maintained.
3 Vaccination practices may vary; this question should specify where the injection is given, e.g. arm or shoulder.
4 Syrup should be deleted in countries where syrup is not used.
5 In countries where it is important to know the number of iron tablets taken per day, an appropriate question may be added.
6 The question is part of the malaria module and should be deleted in surveys in countries where there is no program for intermittent preventive treatment against malaria during pregnancy.

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501 ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2001 (1) 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

503 FROM 212 AND 216

504 Do you have a card where (NAME'S) vaccinations are written down? (2)
IF YES: May I see it please?

505 Did you ever have a vaccination card for (NAME)? (2)

506 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2)
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.
(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES.

506A CHECK 506:

507 Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINES. (3)

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

509 Please tell me if (NAME) received any of the following vaccinations: (4)
509A A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar? (5)

509B Polio vaccine, that is, drops in the mouth?

509C Was the first polio vaccine received in the first two weeks after birth or later?

509D How many times was the polio vaccine received?

509E A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops? (5)

509F How many times was a DPT vaccination received?

509G A measles injection or an MMR injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

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

511 At which national immunization day campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.

512 CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE

513 According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD).
Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

514 HAS (NAME) ever received a vitamin A dose (like this/ any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

515 Did (NAME) receive a vitamin A dose within the last six months?

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

517 Has (NAME) taken any drug for intestinal worms in the last six months?

518 Has (NAME) had diarrhea in the last 2 weeks? (6)

519 Was there any blood in the stools?

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

521 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 given much less than usual to eat or somewhat less?

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

523 Where did you seek advice or treatment? (7)
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

524 CHECK 523:

525 Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

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

527 Does (NAME) still have diarrhea?

528 Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
a) A fluid made from a special packet called [LOCAL NAME FOR ORS PACKET]?
b) A pre-packaged ORS liquid? (8)
c) A government-recommended homemade fluid? (9)

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

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

531 CHECK 530:
GIVEN ZINC?

532 How many times was (NAME) given zinc?

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

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

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

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

537 CHECK 533:
HAD FEVER?

538 Now I would like to know how much (NAME) was given to drink (including breastmilk) during the illness with a (fever/cough).
Was he/she given less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she given much less than usual to eat or somewhat less?

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

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

541 Where did you seek advice or treatment? (7)
Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

542 CHECK 541:

543 Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

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

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

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

547 What drugs did (NAME) take? (10)
Any other drugs?
RECORD ALL MENTIONED.

548 CHECK 547:
ANY CODE A-H CIRCLED?

549 Did you already have (NAME OF DRUG FROM 547) at home when the child became ill? (10)
ASK SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'H' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 547.
IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG.
IF NO FOR ALL DRUGS, CIRCLE 'Y'.

Questions 550-568 are part of the malaria module and should be omitted in countries that do not adopt the module.

550 (11) CHECK 547:
ANY CODE A-G CIRCLED?

551 (11) CHECK 547:
SP/FANSIDAR ('A') GIVEN

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

553 (11) For how many days did (NAME) take the SP/Fansidar?
IF 7 DAYS OR MORE, RECORD 7.

554 CHECK 547:

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

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

557 (11) CHECK 547:
AMODIAQUINE ('C') GIVEN

558 (11) How long after the fever started did (NAME) first take Amodiaquine?

559 (11) For how many days did (NAME) take the Amodiaquine?
IF 7 DAYS OR MORE, RECORD 7.

560 (11) CHECK 547:
QUININE ('D') GIVEN

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

562 (11) For how many days did (NAME) take the quinine?
IF 7 DAYS OR MORE, RECORD 7.

563 CHECK 547:
ARTEMISININ ('E') GIVEN

564 (11) How long after the fever started did (NAME) first take (COMBINATION WITH ARTEMISININ)?

565 (11) For how many days did (NAME) take the (COMBINATION WITH ARTEMISININ)?
IF 7 DAYS OR MORE, RECORD 7.

566 (11) CHECK 547:
COUNTRY SPECIFIC ANTIMALARIAL ('F') GIVEN

567 (11) How long after the fever started did (NAME) first take (COUNTRY SPECIFIC ANTIMALARIAL)?

568 (11) For how many days did (NAME) take the (COUNTRY SPECIFIC ANTIMALARIAL)?
IF 7 DAYS OR MORE, RECORD 7.

569 (11) CHECK 547:
OTHER ANTIMALARIAL ('G') GIVEN

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

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

572 GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573.

573 CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2001 (1) OR LATER LIVING WITH THE RESPONDENT

574 The last time (NAME FROM 573) passed stools, what was done to dispose of the stools?

575 CHECK 528(a) AND 528(b), ALL COLUMNS:

576 Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET] or a pre-packaged ORS liquid (12) you can get for the treatment of diarrhea?

577 CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2003 (13) OR LATER LIVING WITH THE RESPONDENT

578 Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night.
Did (NAME FROM 577) (drink/eat):
Plain water?
Commercially produced infant formula?
Any [BRAND NAME OF COMMERCIALLY FORTIFIED BABY FOOD, E.G., Cerelac]? (14)
Any (other) porridge or gruel?

579 Now I would like to ask you about (other) liquids or foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods. (15)
Did (NAME FROM 577)/you drink (eat):

580 CHECK 578 (LAST 2 CATEGORIES: BABY CEREAL OR OTHER PORRIDGE/GRUEL) AND 579 (CATEGORIES d THROUGH r FOR CHILD):

581 How many times did (NAME FROM 577) eat solid, semisolid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

SECTION 5 FOOTNOTES

1 For fieldwork beginning in 2007, 2008, or 2009, the year should be 2002, 2003, or 2004, respectively.
2 To be developed locally since immunization practices may vary from country to country, as may the terms used for the written record and for the vaccinations. Add yellow fever, rubella, MMR, Hib (3 doses), and hepatitis B (3 doses) in 506 in countries where these vaccinations are listed on the vaccination card.
3 Add to interviewer instruction yellow fever, rubella, MMR, Hib, and hepatitis B where these are included in 506.
4 To be developed locally since immunization practices may vary from country to country, as may the terms used for the vaccinations.
Include question on injections for yellow fever, rubella, MMR, Hib, and Hepatitis B wherever they are included in 506.
5 Adapt question locally after determining the most common injection site.
6 The term(s) used for diarrhea should encompass the expressions used for all forms of diarrhea, including bloody stools (consistent with dysentery), watery stools, etc.
7 Coding categories to be developed locally and revised based on the pretest; however, the broad categories must be maintained.
8 Include in the question the common names/brands for pre-packaged ORS liquids. If pre-packaged ORS liquids are not available in the country, this item should be deleted.
9 This item should be adapted to include the terms used locally for the recommended home fluid. The ingredients promoted by the government for making the recommended home fluid should be reflected in the category.
10 Coding categories to be developed locally and revised based on the pretest. Common brand names of drugs, such as Bayer, Tylenol or Paracetamol, should be added to the response categories for aspirin, acetaminophen, or ibuprofen as appropriate.
11 The question is part of the malaria module and should be deleted in surveys where the malaria module is not adopted.
12 Delete "or pre-packaged ORS liquid" in countries where such liquid is not available.
13 For fieldwork beginning in 2007, 2008, or 2009, the year should be 2004, 2005, or 2006, respectively.
14 In the case of fortified foods, the interviewer should ask to see the package and/or brand label (if available), to confirm that the food is fortified.
15 A separate category for any foods made with red palm oil, palm nut, or palm nut pulp sauce must be added in countries where these items are consumed. A separate category for any grubs, snails, insects or other small protein food must be added in countries where these items are eaten. Items in each food group should be modified to include only those foods that are locally available and/or consumed in the country. Local terms should be used.
16 Grains include millet, sorghum, maize, rice, wheat, or other local grains. Start with local foods, e.g. ugali, nshima, fufu, chapati, then follow with bread, rice, noodles, etc.
17 Items in this category should be modified to include only vitamin A rich tubers, starches, or red, orange, or yellow vegetables that are consumed in the country.
18 These include cassava leaves, bean leaves, kale, spinach, pepper leaves, taro leaves, amaranth leaves, or other dark green, leafy vegetables.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

Qs. 606-608 should be included only in countries where polygamy is prevalent.

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

607 (1) Including yourself, in total, how many wives or partners does your husband live with now as if married?

608 (1) Are you the first, second, ? wife?

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

Questions 610-614 relate to the situation of orphans and vulnerable children and are part of the HIV/AIDS module. They should be included only in countries where HIV prevalence is higher than 5 percent or where more than 8 percent of children age 0-17 years are orphans (i.e., one or both biological parents have died).

610 (2) CHECK 603: IS RESPONDENT CURRENTLY WIDOWED?

611(2) CHECK 603: IS RESPONDENT CURRENTLY WIDOWED?

612 (2) How did your previous marriage or union end?

613 (2) To whom did most of your late husband's property go to?

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

615 CHECK 609:
MARRIED/ LIVED WITH A MAN ONLY ONCE
In what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH A MAN MORE THAN ONCE
Now I would like to ask about when you started living with your first husband/partner. In what month and year was that?

616 How old were you when you first started living with him?

617 CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

619 CHECK 107:

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

621 CHECK 107:

622 The first time you had sexual intercourse, was a condom used? (4)

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

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

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

626 When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

626A Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question. (GO TO 628)

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

628 The last time you had sexual intercourse (with this second/third person), was a condom used? (4)

629 Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

630 What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'.
IF NO, CIRCLE '3'.

631 For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.

632 CHECK 107:

633 How old is this person?

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

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

636 The last time you had sexual intercourse with this person, did you or this person drink alcohol?

637 Were you or your partner drunk at that time?
IF YES: Who was drunk?

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

639 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.'

640 In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'

641 Do you know of a place where a person can get condoms?

642 Where is that? (5)
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

643 If you wanted to, could you yourself get a condom?

Qs. 644-646 should be included only in countries where female condoms are actively promoted.

644 (6) Do you know of a place where a person can get female condoms?

645 Where is that? (5)
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

646 (6) If you wanted to, could you yourself get a female condom?

SECTION 6 FOOTNOTES

1 The question should be deleted in countries where polygyny is not practiced.
2 The question relates to the situation of orphans and vulnerable children and is part of the HIV/AIDS module. The question should be included only in countries where HIV prevalence is higher than 5 percent or where more than 8 percent of children age 0-17 years are orphans (i.e., one or both biological parents have died).
3 This coding category should be deleted in countries where polygyny is not practiced.
4 In countries with an active female condom program, the wording of the question should be modified to include reference to both the male and female condom.
5 Coding categories to be developed locally and revised based on the pretest; however, the broad categories must be maintained.
6 The question should be deleted in countries where female condoms are not actively promoted.

SECTION 7. FERTILITY PREFERENCES

701 CHECK 311/311A:

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?

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?

704 CHECK 226:

705 CHECK 310: USING A CONTRACEPTIVE METHOD?

706 CHECK 703:

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.

708 CHECK 310: USING A CONTRACEPTIVE METHOD?

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

710 Which contraceptive method would you prefer to use? (1)

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

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

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.

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?

715 In the last few months have you:
Heard about family planning on the radio?
Seen about family planning on the television?
Read about family planning in a newspaper or magazine?

716 COUNTRY-SPECIFIC QUESTIONS ON MEDIA MESSAGES ABOUT FAMILY PLANNING.

717 CHECK 601:

718 CHECK 311/311A:

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

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

721 CHECK 311/311A:

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

1 Response categories may be added for other methods, including fertility awareness methods.

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

801 CHECK 601 AND 602:

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

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

804 What was the highest level of school he attended: primary, secondary, or higher? (1)

805 What was the highest (grade/form/year) he completed at that level? (1)

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?

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

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?

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?

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

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

812 CHECK 811:

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?

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

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

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

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

818 CHECK 601:

819 CHECK 817:

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

821 Would you say that the money that you earn is more than what your husband/partner earns, less than what he earns, or about the same?

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

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

824 Who usually makes decisions about making major household purchases?

825 Who usually makes decisions about making purchases for daily household needs?

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

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

828 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?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

SECTION 9. HIV/AIDS

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

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

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

904 Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

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

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

907 (1) Can people get the AIDS virus because of witchcraft or other supernatural means?

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

Questions 909-926 should be deleted in surveys where the HIV/AIDS module is not adopted.

909 (2) Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?

910 (2) CHECK 909:

911 (2) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

912 (2) Have you heard about special antiretroviral drugs (USE LOCAL NAME) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

913 (2) CHECK 208 AND 215:

914 (2) CHECK 407 FOR LAST BIRTH:

914A (2) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915 (2) During any of the antenatal visits for your last birth, did anyone talk to you about:

Babies getting the AIDS virus from their mother?
Things that you can do to prevent getting the AIDS virus?
Getting tested for the AIDS virus?

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

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

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

919 (2) Where was the test done? (4)
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

921 (2) When was the last time you were tested for the AIDS virus?

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

923 (2) When was the last time you were tested?

924 (2) 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?

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

926 (2) Where was the test done? (4)
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

928 Where is that? (4)
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

931 If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

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

Questions 933-939 are used to assess aspects of the President's Emergency Plan for AIDS Relief and must be included in the countries targeted for special initiatives under the Plan.

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

934 (5) 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 has or is suspected to have the AIDS virus?

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

936 (5) CHECK 933, 934, AND 935:

937 (5) Do you personally know someone who has or is suspected to have the AIDS virus?

938 (5) Do you agree or disagree with the following statement:
People with the AIDS virus should be ashamed of themselves.

939 (5) Do you agree or disagree with the following statement:
People with the AIDS virus should be blamed for bringing the disease into the community.

Questions 940-941 should be deleted in surveys where the HIV/AIDS module is not adopted.

940 (2) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

941 (2) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

942 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?

943 CHECK 618:

944 CHECK 942: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

945 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?

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

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

948 CHECK 945, 946, AND 947:

949 The last time you had (PROBLEM FROM 945/946/947), did you seek any kind of advice or treatment?

950 Where did you go? (4)
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

Question 952 should be deleted in surveys where the HIV/AIDS module is not adopted.

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

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

954 Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?(6)

Questions 955-957 should be deleted in surveys where the HIV/AIDS module is not adopted.

955 (2) CHECK 601:

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

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

Questions 958-969 are used to assess aspects of the President's Emergency Plan for AIDS Relief and must be included in the countries targeted for special initiatives under the Plan.

958 Do you believe that young men should wait until they are married to have sexual intercourse?

959 (5) Do you think that most young men you know wait until they are married to have sexual intercourse?

960 (5) Do you believe that men who are not married and are having sex should only have sex with one partner?

961 (5) Do you think that most men you know who are not married and are having sex, have sex with only one partner?

962 (5) Do you believe that married men should only have sex with their wives?

963 (5) Do you think that most married men you know have sex only with their wives?

964 (5) Do you believe that young women should wait until they are married to have sexual intercourse?

965 (5) Do you think that most young women you know wait until they are married to have sexual intercourse?

966 (5) Do you believe that women who are not married and are having sex should only have sex with one partner?

967 (5) Do you think that most women you know who are not married and are having sex, have sex with only one partner?

968 (5) Do you believe that married women should only have sex with their husbands?

969 (5) Do you think that most married women you know have sex only with their husbands?

SECTION 9 FOOTNOTES

1 If 903, 905 and/or 907 do not apply to the local context, replace the question using a specific local misconception.
At least two questions related to misconceptions are needed.
2 The question should be deleted in surveys where the HIV/AIDS module is not adopted.
3 For fieldwork in 2007, 2008, or 2009, the year should be 2004, 2005 and 2006, respectively.
4 Coding categories to be developed locally and revised based on the pretest; however, the broad categories must be maintained.
5 The question is used to assess aspects of the President's Emergency Plan for AIDS Relief and must be included in the countries targeted for special initiatives under the Plan.
6 In polygynous societies, the phrase 'other women' should be replaced by the phrase 'women other than his wives'.

SECTION 10. OTHER HEALTH ISSUES

1001 Have you ever heard of an illness called tuberculosis or TB? (1)

1002 How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

1003 Can tuberculosis be cured?

1004 If a member of your family got tuberculosis, would you want it to remain a secret or not?

1005 Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1006 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 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1007 The last time you had an injection given to you by a health worker, where did you go to get the injection? (2)
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

1008 Did the person who gave you that injection take the syringe and needle from a new, unopened package?

1009 Do you currently smoke cigarettes?

1010 In the last 24 hours, how many cigarettes did you smoke?

1011 Do you currently smoke or use any other type of tobacco? (3)

1012 What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

1013 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?
Getting money needed for treatment?
The distance to the health facility?
Having to take transport?
Not wanting to go alone?
Concern that there may not be a female health provider?
Concern that there may not be any health provider?
Concern that there may be no drugs available?

1014 Are you covered by any health insurance? (4)

1015 What type of health insurance?
RECORD ALL MENTIONED.

Questions 1016-1019 relate to the situation of orphans and vulnerable children and are part of the HIV/AIDS module. They should be included only in countries where HIV prevalence is higher than 5 percent or where more than 8 percent of children age 0-17 years are orphans (i.e., one or both biological parents have died).

1016 (5) CHECK 217:

1017 (5) Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

1018 (5) (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

1019 (5) Have you made arrangements for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

1020 RECORD THE TIME.

1 Use local term for TB, if any.
2 Coding categories to be developed locally and revised based on the pretest; however, the broad categories must be maintained.
3 Add local terms.
4 If a health service prepayment plan or other types of plans are available in the country, add those types of plans in the question.
5 The question relates to the situation of orphans and vulnerable children and is part of the HIV/AIDS module. The question should be included only in countries where HIV prevalence is higher than 5 percent or where more than 8 percent of children age 0-17 years are orphans (i.e., one or both biological parents have died).

INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:
__________________________________

COMMENTS ON SPECIFIC QUESTIONS:
__________________________________

ANY OTHER COMMENTS:
__________________________________

SUPERVISOR'S OBSERVATIONS
__________________________________

NAME OF SUPERVISOR: ___________
DATE: __________

EDITOR'S OBSERVATIONS
__________________________________

NAME OF EDITOR: ___________
DATE: ___________

INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS, PREGNANCIES, CONTRACEPTIVE USE **

* For fieldwork beginning in 2007, 2008 or 2009, the years should be adjusted.

** Response categories may be added for other methods, including fertility awareness methods.