SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME.

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

103. Just before you moved here, did you live in a city, in a town, or in a rural area?

104. Before you moved here, which [PROVINCE/REGION/STATE] did you live in?

105. In what month and year were you born?

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

107. Have you ever attended school?

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

109. (2) What is the highest [GRADE/FORM/YEAR] you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

110. CHECK 108:

111. (3) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of this sentence to me?

112. CHECK 111:

113. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?

114. Do you listen to the radio at least once a week, less than once a week or not at all?

115. Do you watch television at least once a week, less than once a week or not at all?

116. Do you own a mobile telephone?

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

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

119. Have you ever used the internet?

120. In the last 12 months, have you used the internet?
IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY DEVICE.

121. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

122. COUNTRY-SPECIFIC QUESTION ON RELIGION, IF APPROPRIATE.

123. COUNTRY-SPECIFIC QUESTION ON ETHNICITY, IF APPROPRIATE

.

124. (4) In the last 12 months, how many times have you been away from home for one or more nights?

125. (4) In the last 12 months, have you been away from home for more than one month at a time?

(1) Increase the time reported to the respondent if modules are added to the questionnaire.
(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) The question may be considered for deletion in countries with a very low HIV prevalence.

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. a) How many sons live with you?
b) 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.
a) How many sons are alive but do not live with you?
b) 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, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

207. a) How many boys have died?
b) 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 ROWS. IF THERE ARE MORE THAN 10
BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW.

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

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

214. Were any of these births twins?

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

216. Is (NAME) still alive?

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

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

219. IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD. RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD.

220. IF DEAD: How old was (NAME) when (he/she) died?
IF '12 MONTHS' OR '1 YR', ASK: Did (NAME) have (his/her) first birthday? THEN ASK: Exactly how many months old was (NAME) when (he/she) died?

RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

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

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

223. COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY

224. CHECK 215: ENTER THE NUMBER OF BIRTHS IN 2010-2015

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. )

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. When you got pregnant, did you want to get pregnant at that time?

229. CHECK 208: TOTAL NUMBER OF BIRTHS

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

231. When did the last such pregnancy end?

232. CHECK 231:

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

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

235. Since January 2010, have you had any other pregnancies that did not result in a live birth?

236. FOR EACH PREGNANCY THAT DID NOT END IN A LIVE BIRTH IN 2010-2015 OR LATER, ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS OF PREGNANCY.
IF THERE ARE MORE THAN FOUR PREGNANCIES THAT DID NOT END IN A LIVE BIRTH, USE AN ADDITIONAL QUESTIONNAIRE STARTING ON THE SECOND LINE.

237. Did you have any miscarriages, abortions, or stillbirths that ended before 2010?

238. When did the last such pregnancy that terminated before 2010 end?

239. When did your last menstrual period start?

DATE, IF GIVEN__________________________

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

241. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

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

(1) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016, all references to calendar years should be increased by one; for
example, 2009 should be changed to 2010, 2010 should be changed to 2011, 2011 should be changed to 2012, and similarly for all years
throughout the questionnaire.

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. Have you ever heard of (METHOD)?

302. CHECK 226:

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

304. Which method are you using?
RECORD ALL MENTIONED.

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

FEMALE STERILIZATION A (GO TO 307)
MALE STERILIZATION B (GO TO 307)
IUD C (GO TO 309)
INJECTABLES D (GO TO 309)
IMPLANTS E (GO TO 309)
PILL F
CONDOM G (GO TO 306)
FEMALE CONDOM H (GO TO 309)
EMERGENCY CONTRACEPTION I (GO TO 309)
STANDARD DAYS METHOD J (GO TO 309)
LACTATIONAL AMEN. METHOD K (GO TO 309)
RHYTHM METHOD L (GO TO 309)
WITHDRAWAL M (GO TO 309)
OTHER MODERN METHOD X (GO TO 309)
OTHER TRADITIONAL METHOD Y (GO TO 309)

305. What is the brand name of the pills you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

306. What is the brand name of the condoms you are using?
IF DON'T KNOW THE BRAND, ASK TO SEE THE PACKAGE.

307. (5) In what facility did the sterilization take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

308. In what month and year was the sterilization performed?

309. Since what month and year have you been using (CURRENT METHOD) without stopping?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

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

311. (7) CHECK 308 AND 309:

YEAR IS 2010-2015 (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING.) (THEN CONTINUE TO 312)

YEAR IS 2009 OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN THE CALENDAR AND EACH MONTH BACK TO JANUARY 2010.) (GO TO 324)

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2010, USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

(CAPI OPTION) (10)

311. (7) CHECK 308 AND 309:

312. (7) 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 2010. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.

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

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

312C. Which method was that?

312D. How many months after (EVENT) in (MONTH/YEAR) did you start to use (METHOD)? RECORD '95' IF RESPONDENT GIVES THE DATES OF STARTING TO USE THE METHOD.

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

312F. For how many months did you use (METHOD)? RECORD '95' IF RESPONDENT GIVES THE DATE OF TERMINATION OF USE.

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

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

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

313. CHECK CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH.

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

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

316. You first started using (CURRENT METHOD) in (DATE FROM 308 OR 309). Where did you get it at that time?

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

317. CHECK 304: CIRCLE METHOD CODE.

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

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

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

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

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

322. CHECK 318 AND 319:
ANY YES (At that time, were you told about other methods of family planning that you could use?)
OTHER (When you obtained (CURRENT METHOD FROM 315) from (SOURCE OF METHOD FROM 307 OR 316), were you told about other methods of family planning that you could use?

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

YES 1
NO 2

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

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

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

(FOR ANY RESPONSE, GO TO 327)

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

327. (8) In the last 12 months, were you visited by a fieldworker?

328. (8) Did the fieldworker talk to you about family planning?

329. CHECK 202: LIVING CHILDREN
YES (In the last 12 months, have you visited a health facility for care for yourself or your children?)
NO (In the last 12 months, have you visited a health facility for care for yourself?)

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

SECTION 3 FOOTNOTES

(1) Studies have indicated emergency contraception can be effective up to five days. Verify country program recommendations and modify wording if appropriate.
(2) The Standard Days Method (SDM) should be deleted in countries that do not have a SDM program. In these countries, SDM should also be deleted as a coding category in Qs. 304, 315, 317, 324, and Column 1 of the calendar.
(3) 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. 304, 315, 324, and Column 1 of the calendar.
(4) Other commonly used methods may be added to the list, such as contraceptive patch, contraceptive vaginal ring, or sponge. Any codes added in Q. 304 must also be added to Qs. 315, 317, 324, and Column 1 of the calendar. These methods should not be added to Q. 301.
(5) Coding categories to be developed locally; however, the broad categories must be maintained. Additions to the codes under the private medical sector heading may include religious affiliated sources and NGO sources.
(6) If the survey will be conducted using paper questionnaires, delete 311-312I under CAPI OPTION. If the survey will be conducted using CAPI, delete 311-312 under PAPER OPTION.
(7) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016, all references to calendar years should be increased by one; for example, 2009 should be changed to 2010, 2010 should be changed to 2011, 2011 should be changed to 2012, and similarly for all years throughout the questionnaire.
8) In countries without national fieldworker programs that include family planning, Q. 327 and 328 should be deleted.

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. (1) CHECK 224:

402. (2) CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2010-2015. 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.)

403. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

404. FROM 212 AND 216:

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

406. CHECK 208:

407. How much longer did you want to wait?

408. Did you see anyone for antenatal care for this pregnancy?

409. Whom did you see? Anyone else?

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

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

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

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

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

413. As part of your antenatal care during this pregnancy, were any of the following done at least once:

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

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

416. CHECK 415: TETANUS INJECTIONS

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

418. Before this pregnancy, how many times did you receive a tetanus injection?

419. How many years ago did you receive the last tetanus injection before this pregnancy?

420. (4) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

SHOW TABLETS/SYRUP

421. (4)(5) During this whole pregnancy, for how many days did you take the tablets or syrup?

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

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

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

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

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

426. When (NAME) was born, was (NAME) very large, larger than average, average, smaller than average, or very small?

427. Was (NAME) weighed at birth?

428. How much did (NAME) weigh?

RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

429. Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

430. Where did you give birth to (NAME)?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

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

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

434. Immediately after the birth, was (NAME) put directly on the bare skin of your chest?

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

436. How long after delivery did the first check take place?

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

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

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

439. How long after delivery was (NAME)'s health first checked?

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

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

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

442. How long after delivery did that check take place?

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

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

444. (2) Where did the check place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

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

446. How many hours, days or weeks after the birth of (NAME) did that check take
place?

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

447. (2) Who checked on (NAME)'s health at that time?

PROBE FOR MOST QUALIFIED PERSON.

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

(IF ANY SELECTED, GO TO 457)

449. I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)?

450. How long after delivery did the first check take place?

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

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

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

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

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

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

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.

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

PROBE FOR MOST QUALIFIED PERSON.

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

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

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

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

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

461. CHECK 226: IS RESPONDENT PREGNANT?

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

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

464. Did you ever breastfeed (NAME)?

465. CHECK 404: IS CHILD LIVING?

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

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

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

468. CHECK 404: IS CHILD LIVING?

469. Are you still breastfeeding (NAME)?

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

471.

SECTION 4. FOOTNOTES

(1) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016, all references to calendar years should be increased by one; for example, 2009 should be changed to 2010, 2010 should be changed to 2011, 2011 should be changed to 2012, and similarly for all years throughout the questionnaire.
(2) Coding categories to be developed locally; however, the broad categories must be maintained. Additions to the codes under the private medical sector heading may include religious affiliated sources and NGO sources.
(3) Vaccination practices may vary; this question should specify where the injections 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 should be deleted in surveys in countries where there is no program for deworming.
(7) The question should be deleted in surveys in countries where there is no program for intermittent preventive treatment against malaria during pregnancy.

SECTION 5A. CHILD IMMUNIZATION (LAST BIRTH)

501A. (1) CHECK 215 IN THE BIRTH HISTORY: ANY BIRTHS IN 2012-2015?

502A. (1) RECORD THE NAME AND BIRTH HISTORY NUMBER FROM 212 OF THE LAST CHILD BORN IN 2012-2015.

503A. CHECK 216 FOR CHILD:

504A. Do you have a card or other document where (NAME)'s vaccinations are written down?
IF YES: May I see it please?

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

506A. CHECK 504A:

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

508A. (9) CHECK 507A: 'BCG' TO '[MEASLES CONTAINING VACCINE] 2' ALL RECORDED?

509A. In addition to what is recorded on (this document/these documents), did (NAME) receive any other vaccinations, including vaccinations received in campaigns or immunization days or child health days?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 507A THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

510A. Did (NAME) ever receive any vaccinations to prevent (NAME) from getting diseases, including vaccinations received in campaigns or immunizations days or child health days?

511A. Has (NAME) ever received a BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?

512A. Within 24 hours after birth, did (NAME) receive a Hepatitis B vaccination, that is, injection in the thigh to prevent Hepatitis B?

513A. Has (NAME) ever received oral polio vaccine, that is, about two drops in the mouth to prevent polio?

514A. (4) Did (NAME) received the first oral polio vaccine in the first two weeks after birth or later?

515A. How many times did (NAME) receive the oral polio vaccine?

516A. (5) (11) Has (NAME) ever received a pentavalent vaccination, that is, an injection given in the thigh sometimes at the same time as polio drops?

517A. (5) How many times did (NAME) receive the pentavalent vaccine?

518A. (11) Has (NAME) ever received a pneumococcal vaccination, that is, an injection in the thigh to prevent pneumonia?

519A. How many times did (NAME) receive the pneumococcal vaccine?

520A. Has (NAME) ever received a rotavirus vaccination, that is, liquid in the mouth to prevent diarrhea?

521A. How many times did (NAME) receive the rotavirus vaccine?

522A. (7) Has (NAME) ever received a measles vaccination, that is, an injection in the arm to prevent measles?

523A. (7) (12) How many times did (NAME) receive the measles vaccine?

524A. In the last 7 days was (NAME) given:

525A. CONTINUE WITH 501B.

SECTION 5A AND 5B. FOOTNOTES

(1) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016, all references to calendar years should be increased by one; for example, 2009 should be changed to 2010, 2010 should be changed to 2011, 2011 should be changed to 2012, and similarly for all years throughout the questionnaire.
(2) Replace the word 'card' with the term used locally to refer to the official vaccination record for the child, such as 'mother and child booklet'.
(3) The questionnaire should look like the vaccination card in the country. Obtain current or recent vaccination cards from the national immunization program. Add yellow fever, rubella, inactivated polio vaccine (IPV), or any other vaccine
(4) Delete in countries where polio 0 (polio at birth) is not part of the immunization schedule.
(5) Adapt question locally to follow national immunization schedule. If DPT, Hep. B and Hib are given separately, provide separate entries for
the recommended number of doses of each.
(6) If vaccination schedule only uses two doses of vaccine, remove 3rd entry.
(7) Adapt question locally to use the name of the measles containing vaccination (MCV) used in the country: measles, MMR, or MR.
(8) If vaccination schedule only uses one dose of vaccine, remove 2nd entry.
(9) Filter should reflect the vaccination list on the card (excluding vitamin A, which is not a vaccination).
(10) Change the wording of this question to match the names used for supplemental immunization activities in the country.
(11) Adapt question locally after determining the most common injection site. For example, pentavalent may be given in the left outer thigh, and pneumococcal in the right outer thigh.
(12) Delete this question in countries where the vaccination schedule includes only one dose of measles containing vaccination.

SECTION 6. CHILD HEALTH AND NUTRITION

601. (1) CHECK 224:

602. CHECK 215: ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2010-2015. 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.)

603. BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY.

604. FROM 212 AND 216:

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

606. In the last seven days, was (NAME) given iron pills, sprinkles with iron, or iron syrup like [this/any of these]?
SHOW COMMON TYPES OF PILLS/SPRINKLES/SYRUPS.

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

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

609. CHECK 464: EVER BREASTFEED?

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

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

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

613. CHECK 612:

614. Where did you first seek advice or treatment?
USE LETTER CODE FROM 612.

615. (5) (6) Was (NAME) given any of the following at any time since (NAME) started having the diarrhea:

616. CHECK 615:

617. CHECK 615:
RECORD ALL TREATMENTS GIVEN.

ANY 'YES' ((a) What else was given to treat the diarrhea?)
ALL 'NO' OR 'DK' ((b) What was given to treat the diarrhea?)

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

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

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

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

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

623. CHECK 618: HAD FEVER?

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

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

626. CHECK 625:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

646.

647. (9) CHECK 615(a) and 615(b), ALL COLUMNS:

648. (9) Have you ever heard of a special product called [LOCAL NAME FOR ORS PACKET OR PRE-PACKAGED ORS LIQUID] you can get for the treatment of diarrhea?

649. (1) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2013-2015 LIVING WITH THE RESPONDENT

650. (10) Now I would like to ask you about liquids or foods that (NAME FROM 649) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.
Did (NAME FROM 649) drink or eat:

651. CHECK 650 (CATEGORIES 'g' THROUGH 'u'):

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

653. How many times did (NAME FROM 649) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

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

SECTION 6. FOOTNOTES

(1) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016, all references to calendar years should be increased by one;
for example, 2009 should be changed to 2010, 2010 should be changed to 2011, 2011 should be changed to 2012, and similarly for all years
throughout the questionnaire.
(2) The question should be deleted in surveys in countries where there is no program for deworming.
(3) 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.
(4) Coding categories to be developed locally; however, the broad categories must be maintained. Additions to the codes under the private
medical sector heading may include religious affiliated sources and NGO sources.
(5) 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.
(6) 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. If the government does not recommend a
homemade fluid, then the word "government" should be dropped from the question.
(7) The question should be deleted in countries that are not affected by malaria.
(8) Coding categories to be developed locally and revised based on the pretest. All antimalarials commonly used in the country should be included in the response categories. 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.
(9) Delete "OR PRE-PACKAGED ORS LIQUID" in countries where such liquid is not available.
(10) A separate category: "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: "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.
(11) 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.
(12) 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.
(13) 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.
(14) These include cassava leaves, bean leaves, kale, spinach, pepper leaves, taro leaves, amaranth leaves, or other dark green, leafy
vegetables.

SECTION 7. MARRIAGE AND SEXUAL ACTIVITY

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

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

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

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

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

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

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

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

710. CHECK 709:

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

MARRIED/LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask you about your first (husband/partner). In what month and year did you start living with him?

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

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

.

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

714. I would like to ask you 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.

715. 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.

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

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

718. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

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

720. How long ago did you first have sexual intercourse with this person?

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

722. How old is this person?

723. Apart of this person, have you had sexual intercourse with any other person in the last 12 months?

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

725. CHECK 106:

726. CHECK 701:

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

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

729. CHECK 717, MOST RECENT PARTNER (FIRST COLUMN):

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

731. (2) (3) From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

732. PRESENCE OF OTHERS DURING THIS SECTION.

SECTION 7. FOOTNOTES
(1) The question should be deleted in countries where polygyny is not practiced.
(2) 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.
(3) Coding categories to be developed locally; however; the broad categories must be maintained. Additions to the codes under the private medical sector heading may include religious affiliated sources and NGO sources.

SECTION 8. FERTILITY PREFERENCES

801. CHECK 304:

802. CHECK 226:

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

804. 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?

805. CHECK 226:
NOT PREGNANT OR UNSURE (How long would you like to wait from now before the birth of (a/another) child?)
PREGNANT (After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?)

806. CHECK 226:

807. CHECK 303: USING A CONTRACEPTIVE METHOD?

808. CHECK 805:

809. CHECK 715:

810. CHECK 804:

WANTS TO HAVE A/ANOTHER CHILD (You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?)
WANTS NO MORE/NONE (You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?)

RECORD ALL REASONS MENTIONED.

811. CHECK 303: USING A CONTRACEPTIVE METHOD?

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

813. 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.

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

815. In the last few months have you:

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

817. CHECK 701:

818. CHECK 303: USING A CONTRACEPTIVE METHOD?

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

820. Would you say that not using contraception is mainly your decision, mainly your (husband/partner's) decision, or did you both decide together?

821. CHECK 304:

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

SECTION 9. HUSBAND'S BACKGROUND AND WOMAN'S WORK

901. CHECK 701:

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

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

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

905. (1) What was the highest [GRADE/FORM/YEAR] he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

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

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

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

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

910. As you know, some woman 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?

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

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

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

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

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

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

917. CHECK 701:

918. CHECK 916:

919. Who usually decides how the money you earn will be used: you, your (husband/partner), or you and your (husband/partner) jointly?

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

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

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

923. Who usually makes decisions about making major household purchases?

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

925. Do you own this or any other house alone or jointly with someone else?

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

927. Is your name on the title deed?

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

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

930. Is your name on the title deed?

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

932. In your opinion, is a husband justified in hitting or beating his wife in the following situations?

(1) Revise according the local educational system.

SECTION 10. HIV/AIDS

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

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

1003. (1) Can people get HIV from mosquito bites?

1004. Can people reduce their chance of getting HIV by using a condom every time they have sex?

1005. (1) Can people get HIV by sharing food with a person who has HIV?

1006. (1) Can people get HIV because of witchcraft or other supernatural means?

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

1008. Can HIV be transmitted from a mother to her baby:

1009. CHECK 1008:

1010. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

1011. CHECK 208 AND 215:

1012. CHECK 408 FOR LAST BIRTH:

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

1014. During any antenatal visits for your last birth were you given any information about:

a) Babies getting HIV from their mother?
b) Things that you can do to prevent getting HIV?
c) Getting tested for HIV?

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

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

1017. (2) (4) Where was the test done?

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

1018. (2) I don't want to know the results, but did you get the results of the test?

1019. All women are supposed to receive counseling after being tests. After you were tested, did you receive counseling?

1020. CHECK 430 FOR LAST BIRTH:

1021. Between the time you went for delivery but before the baby was born, were you offered an HIV test?

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

1023. (2) I don't want to know the results, but did you get the results of the test?

1024. CHECK 1016:

1025. (2) Have you been tested for HIV since that time you were tested during your pregnancy?

1026. (2) How many months ago was your most recent HIV test?

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

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

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

1030. Where was the test done?

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

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

1032. Where is that?
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

1033. Have you heard of test skills people can use to test themselves for HIV?

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

1035. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

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

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

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

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

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

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

1042. CHECK 1001:
HEARD ABOUT HIV OR AIDS (Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?)
NOT HEARD ABOUT HIV OR AIDS (Have you heard about infections that can be transmitted through sexual contact?)

1043. CHECK 713:

1044. CHECK 1042: HEARD ABOUT SEXUALLY TRANSMITTED INFECTIONS?

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

1046. Sometimes women experience a bad-smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling abnormal genital discharge?

1047. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

1048. CHECK 1045, 1046, AND 1047:

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

1050. Where did you go?
Any other place?

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

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

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

1053. CHECK 701:

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

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

(1) If Qs. 1003, 1005, and/or 1006 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 may be considered for deletion in countries with a very low HIV prevalence.
(3) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016, all references to calendar years should be increased by one; for example, 2009 should be changed to be 2010, 2010 should be changed to 2011, 2011 should be changed to 2012, and similarly for all years throughout the questionnaire.
(4) Coding categories to be developed locally; however, the broad categories must be maintained. Additions to the codes under the private medical sector heading may include religious affiliated sources and NGO sources.

SECTION 11. OTHER HEALTH ISSUES

1101. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1102. 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 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS __ __
NONE 00 (GO TO 1104)

1103. The last time you got an infection from a health worker, did he/she take the syringe and needle from a new, unopened package?

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

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

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

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

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

1109. Are you covered by any health insurance?

1110. (2) What type of health insurance are you covered by?
RECORD ALL MENTIONED.

1111. RECORD THE TIME

(1) Add local terms.
(2) If a health service prepayment plan or other types of plans are available in the country, add those types of plans to the question.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT INTERVIEW:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

EDITOR'S OBSERVATIONS

INSTRUCTIONS:

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

CODES FOR EACH COLUMN:

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

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 IUD
4 INJECTABLES
5 IMPLANTS
6 PILL
7 CONDOM
8 FEMALE CONDOM
9 EMERGENCY CONTRACEPTION
J STANDARD DAYS METHOD
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWAL
X OTHER MODERN METHOD
Y OTHER TRADITIONAL METHOD

COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE

0 INFREQUENT SEX/HUSBAND AWAY
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 SIDE EFFECTS/HEALTH CONCERNS
6 LACK OF ACCESS/TOO FAR
7 COSTS TOO MUCH
8 INCONVENIENT TO USE
F UP TO GOD/FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY)_______________
Z DON'T KNOW

2015 (1)
12 DEC 01 ____ ____
11 NOV 02 ____ ____
10 OCT 03 ____ ____
09 SEP 04 ____ ____
08 AUG 05 ____ ____
07 JUL 06 ____ ____
06 JUN 07 ____ ____
05 MAY 08 ____ ____
04 APR 09 ____ ____
03 MAR 10 ____ ____
02 FEB 11 ____ ____
01 JAN 12 ____ ____

2014
12 DEC 13 ____ ____
11 NOV 14 ____ ____
10 OCT 15____ ____
09 SEP 16____ ____
08 AUG 17 ____ ____
07 JUL 18____ ____
06 JUN 19 ____ ____
05 MAY 20 ____ ____
04 APR 21____ ____
03 MAR 22 ____ ____
02 FEB 23____ ____
01 JAN 24 ____ ____

2013
12 DEC 25 ____ ____
11 NOV 26 ____ ____
10 OCT 27____ ____
09 SEP 28 ____ ____
08 AUG 29 ____ ____
07 JUL 30____ ____
06 JUN 31 ____ ____
05 MAY 32 ____ ____
04 APR 33____ ____
03 MAR 34 ____ ____
02 FEB 35____ ____
01 JAN 36 ____ ____

2012
12 DEC 37 ____ ____
11 NOV 38 ____ ____
10 OCT 39____ ____
09 SEP 40____ ____
08 AUG 41 ____ ____
07 JUL 42____ ____
06 JUN 43 ____ ____
05 MAY 44 ____ ____
04 APR 45____ ____
03 MAR 46 ____ ____
02 FEB 47____ ____
01 JAN 48 ____ ____

2011
12 DEC 49 ____ ____
11 NOV 50 ____ ____
10 OCT 51____ ____
09 SEP 52____ ____
08 AUG 53 ____ ____
07 JUL 54____ ____
06 JUN 55 ____ ____
05 MAY 56 ____ ____
04 APR 57____ ____
03 MAR 58 ____ ____
02 FEB 59____ ____
01 JAN 60 ____ ____

2010
12 DEC 61 ____ ____
11 NOV 62 ____ ____
10 OCT 63____ ____
09 SEP 64____ ____
08 AUG 65 ____ ____
07 JUL 66____ ____
06 JUN 67 ____ ____
05 MAY 68 ____ ____
04 APR 69____ ____
03 MAR 70 ____ ____
02 FEB 71____ ____
01 JAN 72 ____ ____

(1) Year of fieldwork is assumed to be 2015. For fieldwork beginning in 2016, all references to calendar years should be increased by one; for example, 2009 should be changed to 2010, 2010 should be changed to 2011, 2011 should be changed 2012, and similarly for all years throughout the questionnaire.

(2) Response categories may be added for other methods, including fertility awareness methods.