MINISTRY OF PLANNING FINANCE AND OF INTERNATIONAL COOPERATION
CENTRAL AFRICAN REPUBLIC
DEMOGRAPHIC AND HEALTH SURVEY
IDENTIFICATION____
CODES
NAME OF PREFECTURE____
SUB-PREFECTURE____
TOWN____
URBAN OR RURAL
RURAL 2
CLUSTER NUMBER____
VILLAGE/NEIGHBORHOOD____
HOUSEHOLD NUMBER____
NAME OF HEAD OF HOUSEHOLD____
NAME AND LINE NUMBER OF MAN____
INTERVIEWER'S NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
FINAL VISIT
DAY____
MONTH____
YEAR____
NAME____
RESULT
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY)____ 7
NEXT VISIT
DATE
TIME
FRENCH QUESTIONNAIRE
LANGUAGE OF INTERVIEW
SANGO 2
OTHER (SPECIFY)____ 3
NO 2
FIELD EDITOR
NAME____
DATE____
OFFICE EDITOR____
KEYED BY____
SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT
101) RECORD THE TIME
MINUTE _____
102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Bangui, in another large city, in a town, or in a village?
ANOTHER CITY 2
VILLAGE 3
103) How long have you been continuously live in (Name of current place of residence)
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104) Just before you moved here, did you live in Bangui, in another large city, in a town, or in a village?
ANOTHER CITY 2
VILLAGE 3
105) In what month and what year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCORRECT
107) Have you ever attended school?
NO 2 (GO TO 114)
108) What is the highest level of school you attended: primary, 2nd degree, 3rd degree, or higher?
SECONDARY 2
HIGHER 3
109) What is the highest (GRADE/FORM/YEAR) you completed at this level?
AGE 25 YEARS OR OVER (GO TO 113)
111) Are you currently attending school?
NO 2
112) What is the main reason you stopped attending school?
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
HAD ENOUGH SCHOOLING 07
FAILED AT SCHOOL 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
DON'T HAVE BIRTH CERTIFICATE 11
TAKE CARE OF RELATIVES 12
OTHER (SPECIFY)____ 96
DON'T KNOW 98
SECONDARY OR HIGHER (GO TO 115)
114) Can you read and understand a letter or a newspaper with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)
115) Do you usually read a newspaper or magazine at least once a week?
NO 2
116) Do you usually listen to the radio at least once a week?
NO 2
117) Do you usually watch television at least once a week?
NO 2
118) Do you work at this time?
NO
119) Have you done any type of work in the last 12 months?
NO 2 (GO TO 127)
120) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 123)
122) 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?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
123) Do you do this work for a family member, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
124) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
125) During the last 12 months, how many months did you work?
126) How much do you usually earn for this work?
PROBE: Is this by the day, by the week, by the month, or by the year?
PER DAY____ 2
PER WEEK____ 3
PER MONTH____ 4
PER YEAR____ 5
PROTESTANT 2
ISLAM 3
ANIMIST 4
OTHER (SPECIFY)____ 5
SARA 02
MBOUM 03
GBAYA 04
MANDJIA 05
BANDA 06
NGBAKA-BANTOU 07
YAKOMA-SANGO 08
ZANDE-NZAKARA 09
OTHER (SPECIFY)____ 96
SECTION 2. MARRIAGE AND REPRODUCTION
201) Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2
NO, NOT IN UNION 3 (GO TO 204)
202) How many wives do you have?
TWO WIVES 2 (GO TO 202B)
THREE OR MORE WIVES 3 (GO TO 202B)
202A) IF MARRIED TO ONE WOMAN, ASK THE FOLLOWING QUESTION:
How old is your wife?
202B) IF MARRIED TO MORE THAN ONE WOMAN, ASK THE FOLLOWING QUESTIONS:
203) LINE NUMBER OF THE WIFE IN THE HOUSEHOLD QUESTIONNAIRE (OR OF THE WIFES, FOR POLYGAMISTS)
204) Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
205) Have you ever been married or lived with a woman?
NO 2 (GO TO 209)
206) What is your current marital status: are you a widow, divorced, or separated?
DIVORCED 2
SEPARATED 3
207) In what month and year did you start living with your (first) wife/partner?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
208) How old were you when you started living with her?
209) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
WHEN WAS THE LAST TIME YOU HAD SEXUAL INTERCOURSE?
NUMBER OF DAYS____ 1
NUMBER OF WEEKS____ 2
NUMBER OF MONTHS____ 3
NUMBER OF YEARS____ 4
210) How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
211) Now I would like to ask you about your children. Do you have or have you had children?
NO 2 (GO TO 216)
212) Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (GO TO 214)
213) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'
DAUGHTERS AT HOME____
214) Do you have any sons or daughters who are alive but do not live with you?
NO 2 (GO TO 216)
215) 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, RECODE '00'
DAUGHTERS ELSEWHERE____
216) Have you ever had any sons or daughters who were born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life at birth but who only survived a few days or hours?
NO 2 (GO TO 218)
217) How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'
GIRLS DEAD____
218) SUM ANSWERS TO 213, 215, AND 217 AND ENTER TOTAL.
IF NONE, RECORD 00
219) CHECK 218
Just to makes sure that I have this right: you have had in total ____children during your life. Is that correct?
NO (PROBE AND CORRECT 211 THROUGH 218 AS NECESSARY)
HAS NOT HAD ANY CHILDREN (GO TO 301)
221) In what month and what year was your youngest child born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
222) Is your youngest child still alive?
NO 2
223) At the time you were expecting your youngest child, did you want to have a child then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
SECTION 3. CONTRACEPTION
Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard of?
Circle code 1 in 301 for each method mentioned spontaneously. Then proceed down column 302, reading the name and description of each method not mentioned spontaneously. Circle code 2 if method is recognized, and code 3 if not recognized. Then, for each method with code 1or 2 circled in 301 or 302, ask 303.
301/302. Which ways or methods have you heard about?
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
(SPECIFY)
(SPECIFY)
NO 3
303) Have you ever used (method)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)
>305) Have you or any of your partners ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 309)
>306) What have you done or used?
CORRECT 303 AND 304 (AND 302 IF NECESSARY)
>307) Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 309)
>308) Which method are you using?
IUD 02 (GO TO 310)
INJECTABLES 03 (GO TO 310)
IMPLANT 04 (GO TO 310)
DIAPHRAGM/FOAM/GEL 05 (GO TO 310)
CONDOM 06 (GO TO 310)
FEMALE STERILIZATION 07 (GO TO 310)
MALE STERILIZATION 08 (GO TO 310)
PERIODIC ABSTINENCE 09 (GO TO 310)
WITHDRAWAL 10 (GO TO 310)
OTHER (SPECIFY)____ 96 (GO TO 310)
>309) What is the main reason that you do not use a contraceptive method?
VASECTOMY 23
WIFE MENOPAUSAL/HYSTERECTOMY 24
WANTS (MORE) CHILDREN 26
SPOUSE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY)____ 96
DON'T KNOW 98
>310) CHECK 201 AND 204:
NOT IN UNION, NO REGULAR PARTNER (GO TO 313)
>311) Is your wife/partner currently pregnant?
NO 2 (GO TO 313)
UNSURE 8 (GO TO 313)
>312) When she became pregnant did you want her to get pregnant then, did you want to wait until later, or did you not want her to get pregnant?
LATER 2
NOT AT ALL 3
313) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
314) Is it acceptable or not acceptable to you for information on family planning to be provided:
NOT ACCEPTABLE 2
DON'T KNOW 8
NOT ACCEPTABLE 2
DON'T KNOW 8
315) In the last few months have you heard about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
316) Do you currently watch the following shows?
NO 2
NO 2
NOT CURRENTLY MARRIED AND NOT LIVING WITH SOMEONE (GO TO 326A)
318) Have you had sexual intercourse with your wife/the woman you live with within the last four weeks.
NO 2 (GO TO 321)
DON'T KNOW 98
320) Was a condom used on one of these occasions?
IF YES: Was it used each time or some of the times?
YES, SOME OF THE TIMES 2
NEVER 3
321) With whom did you have sexual intercourse the last time? With your wife/the woman you live with or with someone else?
WOMAN HE LIVES WITH 2
SOMEONE ELSE 3
322) Have you had sexual intercourse with someone other than your wife/the woman you live with within the last four weeks.
NO 2 (GO TO 401)
323) With how many people other than your wife/the woman you live with did you have sexual intercourse in the last four weeks?
DON'T KNOW 98
324) How many times did you have sexual intercourse with someone other than your wife/the woman you live with, in the last four weeks?
DON'T KNOW 98
325) Was a condom used on one of these occasions?
IF YES: Was it used each time or some of the times?
YES, SOME OF THE TIMES 2 (GO TO 401)
NEVER 3 (GO TO 401)
326A) Have you had sexual intercourse with someone in the last four weeks?
NO 2 (GO TO 401)
326B) With how many people did you have sexual intercourse during the last four weeks?
DON'T KNOW 98
326C) How many times did you have sexual intercourse in the last four weeks?
DON'T KNOW 98
326D) Was a condom used on one of these occasions?
IF YES: Was it used each time or some of the times?
YES, SOME OF THE TIMES 2
NEVER 3
SECTION 4: FERTILITY PREFERENCES
401) CHECK 201 AND 204:
NOT IN A UNION, DOESN'T HAVE A REGULAR PARTNER (GO TO 404)
402) Spouses/partners do not always agree on everything. Now I want to ask you about your wife/partner's views on family planning.
Do you think your wife/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?
DISAPPROVES 2
INDIFFERENT 3
DON'T KNOW 8
402) Do you think your wife/partner wants the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
NO (MORE) 2 (GO TO 406)
SAYS WIFE CANNOT GET PREGNANT 3 (GO TO 406)
SAYS HE CANNOT HAVE ANY CHILDREN 4 (GO TO 406)
UNDECIDED/DK 8 (GO TO 406)
NO (MORE) 2 (GO TO 406)
SAYS WIFE CANNOT GET PREGNANT 3 (GO TO 406)
SAYS HE CANNOT HAVE ANY CHILDREN 4 (GO TO 406)
UNDECIDED/DK 8 (GO TO 406)
YEARS____ 2
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY)____ 996
DON'T KNOW 998
YEARS____ 2
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY)____ 996
DON'T KNOW 998
406) CHECK 307: USES A METHOD?
NOT CURRENTLY USING
CURRENTLY USING (GO TO 411)
407) Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?
NO 2
DON'T KNOW 8
408) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2-SKIP TO 410
DON'T KNOW 8 (GO TO 410)
409) Which contraceptive method would you prefer to use?
IUD 02 (GO TO 411)
INJECTABLES 03 (GO TO 411)
NORPLANT 04 (GO TO 411)
DIAPHRAGM/FOAM/GEL 05 (GO TO 411)
CONDOM 06 (GO TO 411)
FEMALE STERILIZATION 07 (GO TO 411)
MALE STERILIZATION 08 (GO TO 411)
PERIODIC ABSTINENCE 09 (GO TO 411)
WITHDRAWAL 10 (GO TO 411)
OTHER (SPECIFY)____ 96 (GO TO 411)
UNSURE/DON'T KNOW 98 (GO TO 411)
410) What is the main reason that you think you would never use a method of contraception to avoid pregnancy?
VASECTOMY 23
SUBFECUND/INFECUND 24
WANTS CHILDREN 26
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DON'T KNOW 98
OTHER (SPECIFY)____ 96 (GO TO 413)
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY)____ 96 (GO TO 413)
412) How many of these children would you like to be boys and how many would you like to be girls?
OTHER (SPECIFY)____ 96
OTHER (SPECIFY)____ 96
OTHER (SPECIFY)____ 96
SECTION 5. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
501) Have you ever heard of an illnesses that you can get from having sex, also referred to as venereal diseases?
NO 2 (GO TO 503)
502) What illnesses have you heard of?
RECORD ALL RESPONSES
GONORRHEA B
AIDS C
TRICHOMONAS VAGINALIS D
CHANCROID E
OTHER (SPECIFY)____ X
DON'T KNOW Z
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 514)
504) Over the last 12 months, have you had any of these illnesses?
NO 2 (GO TO 506)
DON'T KNOW 8 (GO TO 506)
505) Which illnesses did you have?
RECORD ALL RESPONSES
GONORRHEA B
AIDS C
TRICHOMONAS VAGINALIS D
CHANCROID E
OTHER (SPECIFY)____ X
DON'T KNOW Z
506) Have you had any discharge from your penis in the last 12 months?
NO 2
DON'T KNOW 8
507) During the last 12 months, have you had a sore or ulcer near your penis?
NO 2
DON'T KNOW 8
508) CHECK QUESITON 505, QUESTION 506, AND QUESTION 507
NOT A SINGLE ILLNESS (GO TO 514)
509) The last time you had an such illness, did you seek any kind of advice or treatment, did you treat yourself, or did you do nothing?
TREATED SELF 2 (GO TO 511)
DID NOTHING 3 (GO TO 511)
510) Where did you seek advice or treatment for this last illness?
GOVERNMENT HEALTH CENTER B
HEALTH SUB-CENTER C
HEALTH POST D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)____ F
PHARMACY H
PRIVATE DOCTOR I
HEALTH CENTER J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY)____ L
CHURCH/RELIGIOUS CENTER N
FRIEND/RELATIVE O
510A) For this last STD, did you pay for the advice?
NO 2
510B) For the last STD, did you pay for treatment?
NO 2
510C) Where did you pay for the treatment?
SAME PLACE AS ADVICE B
MARKET C
OTHER (SPECIFY)____ X
DON'T KNOW Y
511) When you had (INFECTION FROM QUESTION 505), did you inform your wife/the woman you live with or your partner(s)?
NO 2
512) When you had (INFECTION FROM QUESTION 505), did you do something to avoid infecting your wife/the woman you live with or your partner(s)?
NO 2 (GO TO 514)
PARTNER ALREADY INFECTED 3 (GO TO 514)
513) What did you do?
RECORD ALL MENTIONED.
USED CONDOM B
TOOK DRUGS C
MENTIONED AIDS (GO TO 516)
515) Have you ever heard of an illness called AIDS?
NO 2 (GO TO 529)
516) From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
HEALTH CARE ESTABLISHMENT K
OTHER (SPECIFY)____ X
517) How can you get AIDS?
Any other way?
RECORD ALL MENTIONED
SEX WITH PROSTITUTES B
SEX WITH HOMOSEXUALS C
SEX WITH SEVERAL PARTNERS D
BLOOD TRANSFUSIONS E
INJECTIONS F
KISSING G
MOSQUITO BITES H
FROM MOTHER TO CHILD I
SOILED/DIRTY BLADES J
OTHER (SPECIFY)____ X
DON'T KNOW Z
518) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 520)
DON'T KNOW 8 (GO TO 520)
519) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.
USE CONDOMS C
AVOID MULTIPLE PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER K
OTHER (SPECIFY)____ X
DON'T KNOW Z
520) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2 (GO TO 521)
DON'T KNOW 8 (GO TO 521)
520A) Can this person transmit the virus?
NO 2
NO 2 (GO TO 522)
DK 8 (GO TO 522)
VACCINATIONS B
TRADITIONAL PRACTITIONER C
RELIGION D
OTHER (SPECIFY)____ X
522) Can AIDS be transmitted from a mother to a child?
NO 2
DON'T KNOW 8
523A) Do you know someone personally who has AIDS?
NO 2
DON'T KNOW 8
523B) Do you know someone personally who died of AIDS?
NO 2
DON'T KNOW 8
523C) Would you help someone with AIDS?
NO 2 (GO TO 524)
DON'T KNOW 8 (GO TO 524)
PAY FOR MEDICINE B
TAKE CARE OF HIS/HER FAMILY C
GIVE MONEY D
FEED E
PRAY F
VISIT IN THE HOSPITAL G
VISIT AT HOME H
OTHER (SPECIFY)____ X
524) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?
MODERATE 2 (GO TO 526)
GREAT 3 (GO TO 526)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 529)
525) Why do you think that you (have no risk/have small risk) for getting AIDS?
Any other reason?
RECORD ALL MENTIONED
USES CONDOMS B
AVOIDS MULTIPLE PARTNERS C
IS FAITHFUL TO PARTNER D
DOESN'T HOMOSEXUAL RELATIONSHIPS E
DOESN'T GET BLOOD TRANSFUSIONS F
DOESN'T USE USED NEEDLES G
OTHER (SPECIFY)____ X
DON'T KNOW Y (GO TO 527)
526) Why do you think your have (moderate/great) risk of getting AIDS?
Any other reason?
RECORD ALL MENTIONED
HAS MORE THAN 1 SEXUAL PARTNER B
SPOUSE HAS SEVERAL SEXUAL PARTNERS C
HAS HOMOSEXUAL RELATIONSHIPS D
BLOOD TRANSFUSIONS E
HAS HAD USED INJECTIONS F
SEXUAL CONTACT WITH AN INFECTED PERSON G
DON'T KNOW Y
527) Since you have heard of AIDS, have you changed your behavior to avoid getting AIDS?
NO 2 (GO TO 529)
DON'T KNOW 8 (GO TO 529)
528) What have you done?
Anything else?
RECORD ALL MENTIONED.
START USING CONDOMS B
FAITHFUL TO ONE PARTNER C
REDUCES NUMBER OF SEXUAL PARTNERS D
STOPS HOMOSEXUAL RELATIONSHIPS E
STOPS USED INJECTIONS F
PRAYER G
OTHER (SPECIFY)____ X
NO CHANGE Y
529) Some people use condoms during sex to avoid getting AIDS or other sexually transmitted illnesses. Have you ever heard of condoms?
NO 2 (GO TO 531)
530) Have you ever used a condom during sexual relations to avoid getting AIDS or another sexually transmitted infection?
NO 2
HAS NOT HAD SEX (GO TO 533)
532) Have you given or received money, gifts, or favors in exchange for sexual relations in the last four weeks?
NO 2
MINUTES____
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____