EGYPT DEMOGRAPHIC AND HEALTH SURVEY 2005
WOMAN QUESTIONNAIRE
DATA COLLECTED FROM THIS STUDY IS CONFIDENTIAL
AND WILL BE USED FOR SCIENTIFIC PURPOSES ONLY.
WOMAN QUESTIONNAIRE
IDENTIFICATION
GOVERNORATE
PSU/SEGMENT NO.
KISM/MARKAZ
BUILDING NO.
SHIAKHA/VILLAGE
HOUSING UNIT NO.
HOUSEHOLD NUMBER
RURAL 2
SMALL CITY 2
TOWN 3
VILLAGE 4
ADDRESS IN DETAIL
NAME OF WOMAN
LINE NUMBER OF WOMAN
WOMAN SELECTED FOR DOMESTIC VIOLENCE SECTION
NO 2
DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT
NEXT VISIT
DATE
TIME
SECOND VISIT
DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT
NEXT VISIT
DATE
TIME
THIRD VISIT
DATE
TEAM
INTERVIEWER
SUPERVISOR
RESULT
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __
TEAM __ __
INT. NUMBER __ __
SUP. NUMBER __ __
RESULT __
TOTAL NUMBER OF VISITS __
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) __________
NAME
DATE
SIGNATURE
OFFICE EDITOR
NAME
DATE
SIGNATURE
CODER
NAME
DATE
SIGNATURE
KEYER
NAME
DATE
SIGNATURE
SECTION 1. RESPONDENT'S BACKGROUND
INFORMED CONSENT
Hello. My name is _______________________________________ and I am working with the Ministry of Health and Population and the National Population Council. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 20 and 45 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. 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 DOES NOT AGREE TO BE INTERVIEWED 2 (GO TO 1301)
MINUTES __ __
102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 104)
VISITOR/TEMPORARY STAYING 96 (GO TO 104)
103) Just before you moved here, did you live in Cairo, Giza, Alexandria, in another city or town, or in a village?
ALEXANDRIA 2
OTHER CITY/TOWN 3
VILLAGE 4
OUTSIDE EGYPT (SPECIFY) ________________ 5
104) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
105) How old were you at your last birthday?
COMPARE AND CORRECT 104 AND/OR 105 IF
INCONSISTENT.
106) What is your current marital status?
WIDOWED 2
DIVORCED 3
SEPARATED 4
107) Now I would like to ask you some questions about your marriage(s).
How many times have you been married?
MARRIED ONLY ONCE ___
In what month and year did you enter into a marriage contract with your husband?
MARRIED MORE THAN ONCE ___
Now I would like to ask about your first husband.
In what month and year did you enter into a marriage contract with your first husband?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
109) How old were you when you entered into a marriage contract with your (first) husband?
MARRIED ONLY ONCE ___
In what month and year did you start living together with your husband?
MARRIED MORE THAN ONCE ___
Now I would like to ask about your first husband.
In what month and year did you start living together with your first husband?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
111) How old were you when you started living together with your
(first) husband?
112 DETERMINE ALL OF THE MONTHS SINCE JANUARY 2000 THAT THE RESPONDENT WAS MARRIED.
ENTER 'X' IN COLUMN 1 OF CALENDAR FOR EACH MONTH MARRIED AND ENTER '0' FOR EACH MONTH NOT MARRIED, SINCE JANUARY 2000.
FOR WOMEN WHO ARE NOT CURRENTLY MARRIED OR WHO HAVE MARRIED MORE THAN ONCE: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS SINCE JANUARY 2000.
113) Have you ever attended school?
NO 2 (GO TO 117)
114) What is the highest level of school you attended?
PREPARATORY 2
SECONDARY 3
UPPER INTERMEDIATE 4
UNIVERSITY 5
MORE THAN UNIVERSITY 6
115) What is the highest grade you successfully completed at that level?
PREPARATORY OR HIGHER ___ (GO TO 120)
117) 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 the sentence to me?
ABLE TO READ ONLY PART OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
BLIND/VISUALLY IMPAIRED 4
118) Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1' OR '4' CIRCLED ___ (GO TO 121)
120) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
121) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
122) Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
CHRISTIAN 2
OTHER (SPECIFY) ___________ 6
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202) Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (GO TO 204)
203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME __ __
204) Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
NO 2 (GO TO 206)
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'.
DAUGHTERS ELSEWHERE __ __
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?
NO 2 (GO TO 208)
207) How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD __ __
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?
NO ___ (PROBE AND CORRECT 201-209 AS NECESSARY.)
NO BIRTHS ___ (GO TO 226)
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 AND MARK WITH A BRACKET.
(IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE).
212) What name was given to your (first/next) baby?
213) Were any of these births twins?
MULT. 2
214) Is (NAME) a boy or a girl?
GIRL 2
215) In what month and year was (NAME) born?
PROBE: What is his/her birthday?
In what season was (NAME) born?
YEAR __ __ __ __
NO 2 (GO TO 220)
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?
NO 2
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 '1 YR', PROBE: 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.
MONTHS 2 __ __
YEARS 3 __ __
221) Were there any other live births between (WHEN YOU FIRST MARRIED/ NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
NO 2 (GO TO NEXT BIRTH)
222) Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED ___
FOR EACH BIRTH SINCE JANUARY 2000: MONTH AND YEAR OF BIRTH RECORDED ___
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED ___
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED ___
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROVE TO DETERMINE EXACT NUMBER OF MONTHS ___
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 2000 OR LATER.
IF NONE, RECORD '0' AND GO TO 225a.
225) FOR EACH BIRTH SINCE JANUARY 2000, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 2 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY.
NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.
WRITE THE NAME OF THE CHILD TO THE RIGHT OF THE 'B' CODE.
225a) ENTER THE MONTH AND YEAR OF THE MOST RECENT BIRTH PRIOR TO JANUARY 2000 IN THE BOXES AT THE BOTTOM OF THE CALENDAR.
226) Are you pregnant now?
NO 2 (GO TO 230)
UNSURE 8 (GO TO 230)
227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
228) ENTER 'P's IN COLUMN 2 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF MONTHS OF THE CURRENT PREGNANCY COMPLETED .
229) 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?
LATER 2
NOT AT ALL 3
230) Unfortunately many women have pregnancies that do not end in a live birth.
Sometimes a baby is still born, that is, the baby is born who does not breath or show any life.
Other times women have a miscarriage or abortion early during a pregnancy.
It is very important in our study to know about such pregnancies so health programs can be developed for women.
USING THE INFORMATION IN THE CALENDAR, PROBE TO DETERMINE IF THE WOMAN HAD ANY STILL BIRTHS, MISCARRIAGES, OR ABORTIONS BACK TO JANUARY 2000.
IF THE WOMAN REPORTS A PREGNANCY THAT DID NOT END IN A LIVE BIRTH, ASK ABOUT THE MONTH AND YEAR IN WHICH THE PREGNANCY ENDED.
RECORD THE APPROPRIATE CODE FOR THE PREGNANCY OUTCOME ON THAT DATE IN COLUMN 2 IN THE CALENDAR ("S" FOR STILL BIRTH, "M" FOR MISCARRIAGE AND "A" FOR ABORTION).
THEN ASK ABOUT THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD "P" IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF THE PREGNANCY.
NOTE: SINCE THE OUTCOME OF THE PREGNANCY IS RECORDED IN THE MONTH THAT PREGNANCY ENDED, THE NUMBER OF P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.
ILLUSTRATIVE QUESTIONS
TO IDENTIFY NON-LIVE BIRTH PREGNANCIES, ASK:
INTERVAL BETWEEN CURRENT PREGNANCY AND PRIOR BIRTH (LAST BIRTH)
INTERVAL BETWEEN LAST AND PRIOR BIRTH
INTERVAL BETWEEN NEXT-TO-LAST BIRTH AND PRIOR BIRTH
WOMEN WITH NO LIVE BIRTHS BUT WITH CURRENT PREGNANCY
WOMEN WITH NO LIVE BIRTHS AND NOT CURRENTLY PREGNANT
Have you ever had a miscarriage or abortion? If YES: When did the last miscarriage or abortion occur?
FOR EACH PREGNANCY TERMINATION, ASK
231) Did you have any (other) pregnancies that terminated before January 2000 that did not result in a live birth?
NO 2
232) RECORD IN THE BOXES AT THE BOTTOM OF THE CALENDAR THE OUTCOME AND MONTH AND YEAR THAT THE PREGNANCY TERMINATED FOR THE LAST PREGNANCY THAT ENDED IN A
STILL BIRTH, MISCARRIAGE, OR ABORTION PRIOR TO JANAURY 2000.
IF NONE RECODE '0' IN OUTCOME.
233) When did your last menstrual period start?
WEEKS AGO 2 __ __
MONTHS AGO 3 __ __
YEARS AGO 4 __ __
IN MENOPAUSE/ HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
234) 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?
NO 2 (go to 301)
DON'T KNOW 8 (go to 301)
235) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ___________ 6
DON'T KNOW 8
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
CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, 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 302, ASK 303.
302) Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED, ASK:
Have you ever heard of (METHOD)?
having any more children.
NO 2
any more children.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
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
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) ___ (GO TO 308)
305) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
306) ENTER '0' IN COLUMN 2 OF CALENDAR IN EACH BLANK MONTH. (GO TO 341)
307) What have you used or done?
CORRECT 302 AND 303 IF NECESSARY.
308) 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'.
309) CHECK 303 (01 - FEMALE STERILIZATION):
WOMAN STERILIZED ___ (GO TO 313A)
310) CHECK 106: MARITAL STATUS
WIDOWED/ DIVORCED/ SEPARATED ___ (GO TO 340)
311) CHECK 226: CURRENTLY PREGNANT
PREGNANT ___ (GO TO 340)
312) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 340)
313) Which method are you using?
CIRCLE ALL MENTIONED.
313A) CIRCLE 'C' FOR FEMALE STERILIZATION.
MALE STERILIZATION D
PILL E (GO TO 315A)
IUD F (GO TO 315A)
INJECTABLES G (GO TO 315A)
IMPLANTS H (GO TO 315A)
CONDOM I (GO TO 315A)
DIAPHRAGM/FOAM/JELLY K (GO TO 315A)
RHYTHM METHOD N (GO TO 315A)
WITHDRAWAL R (GO TO 315A)
PROLONGED BREASTFEEDING T (GO TO 315A)
OTHER (SPECIFY) ________________ X (GO TO 315A)
Before your sterilization, were you told that you would not be able to have any (more) children because of the operation?
NO 2
DON'T KNOW 8
Before the sterilization operation, was your husband told that he would not be able to have any (more) children because of the operation?
NO 2
DON'T KNOW 8
315) In what month and year was the sterilization performed?
YEAR __ __ __ __
315A) IF MORE THAN ONE METHOD RECORDED IN 313, ASK FOR METHOD HIGHEST ON LIST:
In what month and year did you start using (CURRENT METHOD) continuously?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?
YEAR __ __ __ __
316) CHECK 315/315A, 215, AND THE CALENDAR:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 315/315A.
(USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION)).
NO ___
YEAR IS 1999 OR EARLIER ____ (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 2 OF THE CALENDAR AND IN EACH MONTH BACK TO JANUARY 2000.)
318) CHECK 313/313A:
CIRCLE METHOD CODE. IF MORE THAN ONE METHOD CODE CIRCLED IN 313/313A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MAL STERILIZATIOIN D
PILL E (GO TO 321)
IUD F
INJECTABLES G (GO TO 321)
IMPLANTS H
CONDOM I (GO TO 321)
DIAPHRAGM/FOAM/JELLY K (GO TO 321)
RHYTHM METHOD N
WITHDRAWAL R
PROLONGED BREASTFEEDING T
OTHER (SPECIFY) ______________ X
319) CHECK 313/313A
IF MORE THAN ONE METHOD RECORDED IN 313/313A, CHECK AND ASK ABOUT METHOD HIGHEST ON THE LIST.
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
SOURCE CODE __ __ __ __ __ __ __ __
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG. A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
CSI PROJECT E
OTHER NON-GOVERNMENTAL . F
PRIVATE DOCTOR H
PHARMACY I
CHURCH HEALTH UNIT K
FRIEND/RELATIVE M
OTHER (SPECIFY) ______________ X
YEAR IS 1999 OR EARLIER ___ (GO TO 326.)
321) CHECK 313/313A
IF MORE THAN ONE METHOD RECORDED IN 313/313A, CHECK AND ASK ABOUT METHOD HIGHEST ON THE LIST.
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
SOURCE CODE __ __ __ __ __ __ __ __
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE DOCTOR H
PHARMACY I
CHURCH HEALTH UNIT K
FRIEND/RELATIVE M
OTHER (SPECIFY) __________ X
322) At the time you began this current period of use of (METHOD), did you obtain or consult about (METHOD) at (SOURCE IN 321) or did you go somewhere else?
NO, SOMEWHERE ELSE 2 (GO TO 324)
YEAR IS 1999 OR EARLIER ___ (GO TO 326.)
324) Where did you first obtain/get advice about (METHOD) during your current period of use?
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
FOR OFFICE USE:
SOURCE CODE __ __ __ __ __ __ __ __
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE DOCTOR H
PHARMACY I
CHURCH HEALTH UNIT K
FRIEND/RELATIVE M
OTHER (SPECIFY) __________ X
YEAR IS 1999 OR EARLIER ___
326) When you got (METHOD) at (SOURCE IN 319/321 or 324) were you told about side effects or problems you might have with this method?
NO 2
NO SOURCE/RELATIVE/FRIEND 3
327) Were you ever told by a health or family planning worker about side effects or problems you might have with the method?
NO 2 (GO TO 329)
328) Were you told what to do if you experienced side effects or problems?
NO 2
329) When you got (METHOD) at (SOURCE IN 319/321 or 324), were you told about other methods of family planning?
NO 2
NO SOURCE/RELATIVE/FRIEND 3
330) Were you ever told by a health or family planning worker about other methods of family planning that you could use?
NO 2
USING FEMALE/ MALE STERILIZATION ___ How much did you (your husband) pay in total for the sterilization, including any consultation you may have had?)
USING OTHER METHOD ___ (The last time you obtained (CURRENT METHOD) how much did you pay in total, including the cost of the method and any consultation you may have had?)
FREE 999995
NO SOURCE/RELATIVE/FRIEND 999997
DON'T KNOW 999998
332) CHECK 313/313A AND RECORD THE METHOD CURRENTLY USED:
USING IUD ___ (GO TO 338)
USING INJECTABLES ___ (GO TO 339)
USING OTHER METHOD ___ (GO TO 340)
333) May I see the package of pills you are using?
RECORD NAME OF BRAND.
334) Do you know the brand name of the pills you are using?
RECORD NAME OF BRAND.
BRAND NAME (SPECIFY) ________ __ __ (GO TO 335)
PACKAGE NOT SEEN 2
335) How many pill cycles did you get the last time?
DON'T KNOW 98
336) How much does one cycle of pills cost?
FREE 9995
DON'T KNOW 9998
337) Would you be willing to pay the following for a cycle of pills?
(IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 340. AFTER ASKING ABOUT AMOUNT MORE THAN 5 POUNDS, RECORD YES OR NO AND GO TO 340.)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
338) Would you be willing to pay the following for an IUD (including all costs)?
(IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 340. AFTER ASKING ABOUT AMOUNT MORE THAN 200 POUNDS, RECORD YES OR NO AND GO TO 340.)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
339) Would you be willing to pay the following for the injectables (including all costs)?
(IF YES, CONTINUE WITH NEXT AMOUNT. IF NO GO TO 340. AFTER ASKING ABOUT AMOUNT MORE THAN 20 POUNDS, RECORD YES OR NO AND GO TO 340.)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2 (GO TO 340)
NO 2
340) I would like to ask some questions about all of the (other) periods in the last few years during which you or your husband used a method to delay or avoid getting pregnant.
COLUMN 2 - SEGMENTS OF CONTRACEPTIVE USE SINCE JANUARY 2000
PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH THE MOST RECENT PERIOD OF USE AND GOING BACK TO JANUARY 2000.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
RECORD PERIODS OF USE AND NONUSE IN COLUMN 2 OF THE CALENDAR. FOR EACH MONTH IN WHICH A METHOD WAS USED, ENTER THE CODE FOR THE METHOD; ENTER "0" IN THOSE MONTHS WHEN NO METHOD WAS USED.
ILLUSTRATIVE QUESTIONS FOR COLUMN 2
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?
COLUMN 3 - SOURCE OF CONTRACEPTIVE METHOD SINCE JANUARY 2000
ASK FOR SOURCE OF METHOD FOR EACH SEGMENT OF USE IN THE CALENDAR PRIOR TO THE
CURRENT SEGMENT OF USE. RECORD THE CODE FOR THE SOURCE IN COLUMN 3 IN THE MONTH AND YEAR IN WHICH THE SEGMENT OF USE BEGAN.
FOR THE PILL, CONDOM, INJECTION, AND DIAPHRAGM/FOAM/JELLY, THE SOURCE SHOULD BE
THE PLACE FROM WHICH THE METHOD WAS OBTAINED AT THE TIME THE SEGMENT OF USE BEGAN.
PROBE FOR THE EXACT ADDRESS OF EACH SOURCE. WRITE THE NAME TO THE RIGHT OF COLUMN 3 OF THE CALENDAR IN MONTH IN WHICH THE SEGMENT OF USE BEGAN.
THE NUMBER OF CODES ENTERED IN COLUMN 3 MUST BE THE SAME AS THE NUMBER OF
SEGMENTS OF CONTRACEPTIVE USE IN COLUMN 2.
ILLUSTRATIVE QUESTIONS FOR COLUMN 3
-From where did you get the advice?
IF NO: RECORD CODE FOR PHARMACY OR OTHER SOURCE
COLUMN 4 - REASON FOR DISCONTINUATION
FOR EACH PERIOD OF USE, ASK WHY SHE STOPPED USING THE METHOD AND RECORD THE REASON FOR DISCONTINUATION IN COLUMN 4 OF THE CALENDAR IN THE MONTH IN WHICH THE SEGMENT OF USE WAS TERMINATED.
IF A PREGNANCY FOLLOWED, ASK IF SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR WHETHER SHE DELIBERATELY STOPPED USING THE METHOD TO GET PREGNANT.
THE NUMBER OF CODES ENTERED IN COLUMN 4 MUST BE THE SAME AS THE NUMBER OF COMPLETE SEGMENTS OF CONTRACEPTIVE USE IN COLUMN 2.
ILLUSTRATIVE QUESTIONS FOR COLUMN 4
Did you become pregnant while using (method),or did you stop to get pregnant, or stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
ENTER "0" IN EACH SUCH MONTH IN COLUMN 2.
AFTER COMPLETING COLUMNS 2, 3 AND 4 AS APPROPRIATE, GO TO 401.
341) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 401)
342) Where is that?
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE DOCTOR H
PHARMACY I
CHURCH HEALTH UNIT K
FRIEND/RELATIVE M
OTHER (SPECIFY) __________ X
SECTION 4. FERTILITY PREFERENCES
401) CHECK 106: MARITAL STATUS
WIDOWED/DIVORCED/SEPARATED __ (GO TO 413)
402) CHECK 313/313A: USING STERILIZATION
HE OR SHE STERILIZED ___ (GO TO 413)
403) CHECK 226: CURRENTLY PREGNANT
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?
NO MORE/NONE 2 (GO TO 405)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 413)
UNDECIDED AND PREGNANT 4 (GO TO 410)
UNDECIDED AND NOT PREGNANT/UNSURE IF PREGNANT 5 (GO TO 409)
404) CHECK 226: CURRENTLY PREGNANT
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?
YEARS 2 __ __
SOON/NOW 994 (GO TO 409)
SAYS SHE CAN'T GET PREGNANT 995 (GO TO 413)
OTHER (SPECIFY) ______________ 996 (GO TO 409)
DON'T KNOW 998 (GO TO 409)
405) CHECK 226: CURRENTLY PREGNANT
PREGNANT ___ (GO TO 410)
406) CHECK 312: USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING ___
CURRENTLY USING ___ (GO TO 413)
407) CHECK 404: PREFERRED TIME BEFORE NEXT BIRTH
24 OR MORE MONTHS OR 02 OR MORE YEARS ___
00-23 MONTHS OR 00-01 YEAR ___ (GO TO 410)
408) CHECK 403: DESIRE FOR A(NOTHER) CHILD
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?
INFREQUENT SEX B (GO TO 410)
MENOPAUSAL/HYSTERECTOMY C (GO TO 410)
SUBFECUND/INFECUND D (GO TO 410)
POSTPARTUM AMENORRHEIC E (GO TO 410)
BREASTFEEDING F (GO TO 410)
FATALISTIC G (GO TO 410)
HUSBAND OPPOSED I (GO TO 410)
OTHERS OPPOSED J (GO TO 410)
RELIGIOUS PROHIBITION K (GO TO 410)
KNOWS NO SOURCE M (GO TO 410)
FEAR OF SIDE EFFECTS O (GO TO 410)
LACK OF ACCESS/TOO FAR P (GO TO 410)
COSTS TOO MUCH Q(GO TO 410)
INCONVENIENT TO USE R (GO TO 410)
INTERFERES WITH BODY'S NORMAL PROCESSES S (GO TO 410)
DON'T KNOW Z (SPECIFY)
409) CHECK 312: USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING ___
YES, CURRENTLY USING ___ (GO TO 413)
410) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 412)
DON'T KNOW 8 (GO TO 412)
411) Which contraceptive method would you prefer to use?
RECORD ONE METHOD ONLY
MALE STERILIZATION D (GO TO 413)
PILL E (GO TO 413)
IUD F (GO TO 413)
INJECTABLES G (GO TO 413)
IMPLANTS H (GO TO 413)
CONDOM I (GO TO 413)
DIAPHRAGM/FOAM/JELLY K (GO TO 413)
RHYTHM METHOD N (GO TO 413)
WITHDRAWAL R (GO TO 413)
PROLONGED BREASTFEEDING T (GO TO 413)
OTHER METHOD (SPECIFY) ___________ X (GO TO 413)
DON'T KNOW Z (GO TO 413)
412) What is the main reason that you think you will not use a contraceptive method at any time in the future?
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
WANTS AS MANY CHILDREN AS POSSIBLE 26
HUSBAND 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
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.
NUMBER __ __
OTHER (SPECIFY) _________________ 96 (GO TO 415)
414) 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?
GIRLS __ __
EITHER __ __
OTHER (SPECIFY) __________________ 96
415) Would you consider it appropriate for a couple to use family planning after the first birth?
NO 2
416) Would you consider it appropriate for a newly married couple to use family planning before the first pregnancy?
NO 2
416a) In your opinion, what is the ideal length of time that a woman should wait between births?
RECORD RESPONSE EXACTLY AS GIVEN.
YEARS 2 __ __
DON'T KNOW 998
417) Have you ever heard (know) of "premarital examination" that is a consultation with a doctor or other staff as part of the preparation for marriage?
NO 2 (GO TO 419)
418) Did you have a premarital examination at the time you got married or within two months after you married?
YES, AFTER 2
YES, BOTH 3
NO 4
419) Did a health worker, a raida rifia or anyone else visit you to talk about family planning during the past 6 months?
IF YES: Who visited you?
RAIDA RIFIA B
OTHER (SPECIFY) ____________ X
420) Have you visited governmental health facility for any reason during the past 6 months?
NO 2 (GO TO 422)
421) Did any staff member at the health facility speak to you about family planning methods during any of your visits?
NO 2
422) Have you visited a private doctor or clinic for any reason during the past 6 months?
NO 2 (GO TO 424)
423) Did the doctor or any other staff member there speak to you about family planning methods during any of your visits?
NO 2
424) During the past 6 months have you heard about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
425) Is there a special brand of pill that is appropriate for a woman to use while breastfeeding?
IF YES: What brand is that?
BRAND NAME (SPECIFY) ________ __ __
YES BUT DO NOT KNOW BRAND 2
DON'T KNOW 8
426) CHECK 106: MARITAL STATUS
WIDOWED/DIVORCED/SEPARATED ___ (GO TO 501)
METHOD CODES D, I, OR R CIRCLED ___ (GO TO 429)
NO CODE CIRCLED ___ (GO TO 431)
428) Does your husband know that you are using a method of family planning?
NO 2
DON'T KNOW 8
429) Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?
MAINLY HUSBAND 2
JOINT DECISION 3
OTHER (SPECIFY) __________ 6
HE OR SHE STERILIZED ___ (GO TO 501)
431) Do you think your husband wants the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 5. PREGNANCY AND POSTNATAL CARE AND BREASTFEEDING
NO BIRTHS IN 2000 OR LATER ___ (GO TO 663)
502) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 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.)
LIVING ___
DEAD ___
505) 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?
LATER 2
NOT AT ALL 3 (GO TO 507)
506) How much longer would you have liked to wait?
YEARS 2 __ __
DON'T KNOW 998
507) Did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
NURSE/MIDWIFE B
OTHER (SPECIFY) __________ X
508) Where did you receive antenatal care for this pregnancy?
CIRCLE ALL MENTIONED.
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
OTHER HOME B
URBAN HEALITH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL F
RURAL HEALITH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) _________ I
CSI PROJECT K
OTHER NGO (SPECIFY) __________ L
PVT. DOCTOR N
OTHER PVT. MED. (SPECIFY) _________ P
509) How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
510) How many months pregnant were you when you first received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
511) How many months pregnant were you when you last received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
512) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 [GO TO 517(FOR LAST BIRTH), 532 (FOR NEXT-TO-LAST AND SECOND-TO-LAST BIRTHS)]
DON'T KNOW 8 [GO TO 517(FOR LAST BIRTH), 532 (FOR NEXT-TO-LAST AND SECOND-TO-LAST BIRTHS)]
513) During this pregnancy, how many times did you get this tetanus injection?
DON'T KNOW 8
514) Where did you receive the tetanus injection(s)?
CIRCLE ALL MENTIONED.
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
URBAN HEALITH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL F
RURAL HEALITH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) __________ I
CSI PROJECT K
OTHER NGO (SPECIFY) __________ L
PVT. DOCTOR N
OTHER PVT. MED. (SPECIFY) __________ P
HAD ANC ___ (GO TO 516)
515) Did any of the persons you saw for the tetanus injection(s) advise you that you should go for antenatal care?
[FOR LAST BIRTH]
NO 2
DON'T KNOW 8
OTHER ___
517) At any time before this pregnancy, did you receive any tetanus injections?
[FOR LAST BIRTH]
NO 2 (GO TO 521)
DON'T KNOW 8 (GO TO 521)
518) Before this pregnancy, how many times did you get a tetanus injection?
[FOR LAST BIRTH]
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
519) In what month and year did you receive the last tetanus injection before this pregnancy?
[FOR LAST BIRTH]
DON/T KNOW MONTH 98
YEAR __ __ __ __ (GO TO 521)
DON'T KNOW YEAR 9998
520) How many years ago did you receive that tetanus injection?
[FOR LAST BIRTH]
521) When you were pregnant with (NAME), did you see a doctor, nurse, or anyone else for health care (other than an antenatal checkup or a tetanus injection)?
[FOR LAST BIRTH]
IF YES: Whom did you see?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
NURSE/MIDWIFE B
OTHER (SPECIFY) _________ X
522) Where did you get that care?
[FOR LAST BIRTH]
CIRCLE ALL MENTIONED.
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
OTHER HOME B
URBAN HEALITH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL F
RURAL HEALITH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) __________ I
CSI PROJECT K
OTHER NGO (SPECIFY) __________ L
PVT. DOCTOR N
OTHER PVT. MED. (SPECIFY) ___________ P
523) CHECK 507, 512, 521:
[FOR LAST BIRTH ONLY]
ANC/TT ___ (GO TO 527)
NO CARE ___ (GO TO 530)
524) At any time did you seek this care because you thought there was a problem with the pregnancy?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 527)
525) How many times did you receive care during this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
526) How many months pregnant were you when you last received care?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
527) As part of the care you got during this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]
NO 2
NO 2
NO 2
NO 2
528) During (any of) your care visit(s), were you told about the signs of pregnancy complications?
[FOR LAST BIRTH YEAR]
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)
529) Were you told where to go if you had any of these complications?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
530) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
[FOR LAST BIRTH ONLY]
SHOW TABLETS/SYRUP.
NO 2 (GO TO 532)
DON'T KNOW 8 (GO TO 532)
531) During the whole pregnancy, for how many days did you take the tablets or syrup?
[FOR LAST BIRTH ONLY]
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
532) When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8
533) Was (NAME) weighed at birth?
NO 2 (GO TO 535)
DON'T KNOW 8 (GO TO 535)
534) How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KG FROM RECALL 2 __ . __ __ __
DON'T KNOW . 99998
535) Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.
NURSE/MIDWIFE B
OTHER (SPECIFY) ____________ X
536) Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
OTHER HOME 12 (GO TO 542)
URBAN HEALITH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL 24
RURAL HEALITH UNIT 25
MCH CENTER 26
OTHER GOV'T (SPECIFY) __________ 27
CSI PROJECT 32
OTHER NGO (SPECIFY) ___________ 36
PVT. DOCTOR 42
OTHER PVT. MED. (SPECIFY) __________ 46
537) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __ __
WEEKS 3 __ __
538) Was (NAME) delivered by caesarean section?
NO 2
539) Before you were discharged after (NAME) was born, did a health professional check on your health?
IF YES: Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 2
NO ONE 7 (GO TO 541)
540) How many hours, days or weeks after delivery did the first check take place?
[FOR LAST BIRTH ONLY]
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __ __ (GO TO 546)
WEEKS 3 __ __ (GO TO 546)
DON'T KNOW 998 (GO TO 546)
541) At any time in the two months after you were discharged, did a
health professional or a traditional birth attendant check on your health?
IF YES: Who checked on your health that time?
RECORD ALL MENTIONED.
NURSE/MIDWIFE B (GO TO 544)
OTHER (SPECIFY) _________ X (GO TO 544)
542) Why didn't you deliver in a health facility?
[FOR LAST BIRTH ONLY]
PROBE: Any other reason?
RECORD ALL MENTIONED.
FACILITY NOT OPEN B
TOO FAR/ NO TRANSPORTATION C
DON'T TRUST FACILITY/POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) __________ X
543) At any time in the two months after (NAME) was born, did a health professional or a traditional birth attendant check on your health?
IF YES: Who checked on your health?
RECORD ALL MENTIONED.
NURSE/MIDWIFE B
OTHER (SPECIFY) __________ X
544) How many hours, days or weeks after delivery did the first check take place?
[FOR LAST BIRTH ONLY]
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __ __
WEEKS 3 __ __
DON'T KNOW 998
545) Where did this first check take place?
[FOR LAST BIRTH ONLY]
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
(NAME OF PLACE) ______________________
OTHER HOME 12
URBAN HEALITH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL 24
RURAL HEALITH UNIT 25
MCH CENTER 26
OTHER GOV'T (SPECIFY) ____________ 27
CSI PROJECT 32
OTHER NGO (SPECIFY) ___________ 36
PVT. DOCTOR 42
OTHER PVT. MED. (SPECIFY) ___________ 46
546) During the two weeks after birth, was a blood sample taken from (NAME'S) heel?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
547) In the two months after (NAME) was born, did a health professional or traditional birth attendant check on his/her health?
IF YES: Who checked on (NAME'S) health at that time?
RECORD ALL MENTIONED
NURSE/MIDWIFE B
OTHER (SPECIFY) _________ X
548) How many hours, days or weeks after the birth of (NAME) did the first check take place?
[FOR LAST BIRTH ONLY]
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 __ __
WEEKS 3 __ __
DON'T KNOW 998
549) Where did this first check of (NAME) take place?
[FOR LAST BIRTH ONLY]
IF SOURCE IS HOSPITAL, HEALTH UNIT OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
OTHER HOME 12
URBAN HEALITH UNIT 22
HEALTH OFFICE 23
RURAL HOSPITAL 24
RURAL HEALITH UNIT 25
MCH CENTER 26
OTHER GOV'T (SPECIFY) ___________ 27
CSI PROJECT 32
OTHER NGO (SPECIFY) __________ 36
PVT. DOCTOR 42
OTHER PVT. MED. (SPECIFY) __________ 46
550) When you were pregnant with (NAME), when you delivered, or in the two months after the delivery, did anyone give you advice about family planning?
[FOR LAST BIRTH ONLY]
IF YES: Who gave you the advice?
RECORD ALL MENTIONED.
SOCIAL WORKER B
DAYA C
RELIGIOUS LEADER D
NEIGHBORS/FRIENDS E
HOUSEHOLD MEMBER F
OTHER RELATIVES G
OTHER (SPECIFY) __________ X
NO ONE Y
551) When you were pregnant with (NAME), when you delivered, or in the two months after the delivery, did anyone give you advice about breastfeeding?
[FOR LAST BIRTH ONLY]
IF YES: Who gave you the advice?
RECORD ALL MENTIONED.
SOCIAL WORKER B
DAYA C
RELIGIOUS LEADER D
NEIGHBORS/FRIENDS E
HOUSEHOLD MEMBER F
OTHER RELATIVES G
OTHER (SPECIFY) __________ X
NO ONE Y
552) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?
SHOW TYPES OF/CAPSULES/.
NO 2
553) Has your menstrual period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 556)
554) Did your period return between the birth of (NAME) and your next pregnancy?
[FOR NEXT-TO-LAST AND SECOND-FROM-LAST BIRTHS ONLY]
NO 2 (GO TO 558)
555) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
556) CHECK 226:
IS RESPONDENT PREGNANT?
PREGNANT OR UNSURE ___ (GO TO 558)
557 Have you resumed sexual relations since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 559)
558) For how many months after the birth of (NAME) did you not have sexual relations?
IF LESS THAN 2 MONTHS, MONTHS, RECORD DAYS.
OTHERWISE, RECORD BY COMPLETED MONTHS.
MONTHS 2 __ __
DON'T KNOW 998
559) Did you ever breastfeed (NAME)?
NO 2 (GO TO 563)
560) How long after birth did you first put (NAME) to the breast?
[FOR LAST BIRTH ONLY]
IF LESS THAN 1 HOUR, RECORD '000'.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.
HOURS 1 __ __
DAYS 2 __ __
561) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 563)
562) What was (NAME) given to drink?
[FOR LAST BIRTH ONLY]
Anything else?
RECORD ALL LIQUIDS MENTIONED.
PLAIN WATER B
SUGAR OR GLUCOSEWATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) _________ X
563) CHECK 504:
IS CHILD LIVING?
DEAD ___ (GO BACK TO 505 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601)
564) CHECK 559:
EVER BREASTFED?
NEVER BREASTFED ___(GO TO 569)
565) Are you still breastfeeding (NAME)?
NO 2 (GO TO 567 (FOR LAST BIRTH), 569 (FOR NEXT-TO-LAST AND SECOND-FROM-LAST BIRTHS))
566) For how many months did you breastfeed (NAME)?
DON'T KNOW 98 (GO TO 569)
567) How many times did you breastfeed (NAME) last night between sunset and sunrise?
[FOR LAST BIRTH ONLY]
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
568) How many times did you breastfeed (NAME) yesterday during the daylight hours?
[FOR LAST BIRTH ONLY]
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
569) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
GO BACK TO 505 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 601.
SECTION 6. CHILD IMMUNIZATION AND HEALTH
601) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 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).
LIVING ___
DEAD ___ [GO TO 603 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 663 (FOR LAST BIRTH), 660 (FOR NEXT-TO-LAST OR SECOND-FROM LAST BIRTHS)]
604) Has (NAME) ever received a vitamin A dose like (this)?
SHOW CAPSULES
NO 2 (GO TO 606)
DON'T KNOW 8 (GO TO 606)
605) Since how many months did (NAME) take the last dose?
DON'T KNOW MONTH 98
606) Do you have a birth certificate for (NAME)?
IF YES: May I see it please?
RECORD IF CERTIFICATE INCLUDES VACCINATION RECORD.
YES, SEEN BUT NO VACCINATION DATES RECORDED 2 (GO TO 610)
YES, BUT NOT SEEN 3 (GO TO 610)
NO CERTIFICATE 4
607) Did you ever have a vaccination card for (NAME)?
IF YES: Did the certificate include a vaccination record?
YES, CERTIFICATE WITH NO RECORD 2 (GO TO 610)
NO CERTIFICATE 3 (GO TO 610)
608) (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. DO NOT INCLUDE VACCINATIONS RECEIVED DURING NIDS DAYS.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN (OTHER THAN DURING A NIDS DAY), BUT NO DATE IS RECORDED.
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
609) Has (NAME) received any vaccinations that are not recorded on the certificate other than those received during national immunization days?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO, DPT, HEPATITIS, MEASLES OR MMR VACCINES.
NO 2
DON'T KNOW 8
610) Do you have a health card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 614)
NO 3
611) Did (NAME) ever have a health card?
NO 2 (GO TO 614)
612) (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. DO NOT INCLUDE VACCINATIONS RECEIVED DURING NIDS DAYS.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN (OTHER THAN DURING A NIDS DAY), BUT NO DATE IS RECORDED.
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
MONTH __ __
YEAR __ __ __ __
613) Has (NAME) received any vaccinations that are not recorded on the certificate excluding those received during national immunization days?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO, DPT, HEPATITIS, MEASLES OR MMR VACCINES.
NO 2
DON'T KNOW 8
DATES/CODES '44' OR '66' ___ (GO TO 626)
615) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?
NO 2 (GO TO 628)
DON'T KNOW 8 (GO TO 628)
616) Please tell me if (NAME) received any of the following vaccinations:
A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?
NO 2
DON'T KNOW 8
617) Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 620)
DON'T KNOW 8 (GO TO 620)
618) Excluding any doses gotten during national immunization days, how many times was a polio immunization received?
619) Was the first polio vaccine received in the first two weeks after birth or later?
LATER 2
620) A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes given at the same time as polio drops?
NO 2 (GO TO 622)
DON'T KNOW 8 (GO TO 622)
621) How many times was a DPT vaccination received?
622) An injection to prevent measles at nine months?
NO 2
DON'T KNOW 8
623) An injection against hepatitis?
NO 2 (GO TO 625)
DON'T KNOW 8 (GO TO 625)
624) How many times was a hepatitis vaccination received?
625) An MMR injection, that is an injection against measles, mumps, and rubella given at 18 months?
NO 2
DON'T KNOW 8
626) During the past two years, did (NAME) receive any polio vaccinations as part of the national immunization day campaigns?
NO 2 (GO TO 627a)
CHILD HAD NO VACCINATIONS 3 (GO TO 627a)
DON'T KNOW 8 (GO TO 627a)
627) How many times did (NAME) receive a polio vaccination at national immunization days in the past two years?
IF NON-NUMERIC ANSWER, PROBE TO GET ESTIMATE.
627a) At any time when you took (NAME) for immunizations, did anyone talk to you about family planning?
[FOR LAST BIRTH ONLY]
NO 2
NO VACCINATIONS/ MOTHER DID NOT TAKE CHILD 3 (GO TO 628)
DON'T KNOW/UNSURE 8
627b) At any time when you took (NAME) for immunizations, did anyone talk to you about any other health services (nutrition/antenatal care)?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW/UNSURE 8
628) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 643)
DON'T KNOW 8 (GO TO 643)
629) Was there any blood in the stools?
NO 2
DON'T KNOW 8
630) Now I would like to know how much (NAME) was given to drink
during the diarrhea. 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
631) 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
632) Did you seek advice or treatment for the diarrhea from any source?
NO 2 (GO TO 637)
633) Where did you seek advice or treatment?
IF SOURCE IS A HOSPITAL, HEALTH UNIT OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
Anywhere else?
RECORD ALL PLACES MENTIONED.
URBAN HEALITH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL F
RURAL HEALITH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) __________ I
CSI PROJECT K
OTHER NGO (SPECIFY) __________ L
PVT. DOCTOR N
PHARMACY O
OTHER PVT. MED. (SPECIFY) __________ P
ONLY ONE CODE CIRCLED ___ (GO TO 636)
635) Where did you first seek advice or treatment?
USE LETTER CODE FROM 633.
636) How many days after the diarrhea began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
637) Does (NAME) still have diarrhea?
NO 2
DON'T KNOW 8
638) Was he/she given a fluid made from a special packet called mahloul moalget el gafaf?
NO 2
DON'T KNOW 8
639) Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 643)
DON'T KNOW 8 (GO TO 643)
640) What (else) was given to treat the diarrhea?
Anything else?
RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
ZINC C
OTHER (NOT ANTIBIOTIC, ANTIMOTILITY, OR ZINC) D
UNKNOWN PILL OR SYRUP E
NON-ANTIBIOTIC . G
UNKNOWN INJECTION H
(IV) INTRAVENOUS . I
HOMEMADE SS SOLUTION K
OTHER (SPECIFY) __________ X
CODE "C" NOT CIRCLED ___ (GO TO 643)
642) How many times was (NAME) given zinc?
DON'T KNOW 98
643) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
644) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (G0 TO 647)
DON'T KNOW 8 (GO TO 647)
645) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?
NO 2 (GO TO 648)
DON'T KNOW 8 (GO TO 648)
646) Was the fast or difficult breathing due to a problem in the chest or to a blocked or runny nose?
NOSE ONLY 2 (GO TO 648)
BOTH 3 (GO TO 648)
OTHER (SPECIFY) _______ 6 (GO TO 648)
DON'T KNOW 8 (GO TO 648)
NO OR DON'T KNOW ___ (GO TO 659)
648) Now I would like to know how much (NAME) was given to drink 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 drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
649) 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?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
650) Did you seek advice or treatment for the illness from any source?
NO 2 (GO TO 655)
651) Where did you seek advice or treatment?
IF SOURCE IS A HOSPITAL, HEALTH UNIT OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
Anywhere else?
RECORD ALL PLACES MENTIONED.
URBAN HEALITH UNIT D
HEALTH OFFICE E
RURAL HOSPITAL F
RURAL HEALITH UNIT G
MCH CENTER H
OTHER GOV'T (SPECIFY) __________ I
CSI PROJECT K
OTHER NGO (SPECIFY) __________ L
PVT. DOCTOR N
PHARMACY O
OTHER PVT. MED. (SPECIFY) __________ P
ONLY ONE CODE CIRCLED ___ (GO TO 654)
653) Where did you first seek advice or treatment?
USE LETTER CODE FROM 651.
654) How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
655) Is (NAME) still sick with a (fever/cough)?
NO 2
DON'T KNOW 8
656) At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO TO 659)
DON'T KNOW 8 (GO TO 659)
657) What drugs did (NAME) take?
Any other drugs?
RECORD ALL MENTIONED.
INJECTION B (GO TO 659)
ACETAMINOPHEN D (GO TO 659)
IBUPROFEN E (GO TO 659)
OTHER ANTI PYRETIC (SPECIFY) __________ F (GO TO 659)
COUGH DRUG G (GO TO 659)
DON'T KNOW Z (GO TO 659)
658) Did you already have the antibiotic at home when the child became ill?
NO 2
DON'T KNOW 8
659) GO BACK TO 603 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 660.
660) CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2000 OR LATER LIVING WITH THE RESPONDENT
NONE ___ (GO TO663)
661) The last time (NAME OF YOUNGEST CHILD) passed stools, what was done to dispose of the stools?
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THROWN INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
ANY CHILD RECEIVED FLUID FROM ORS PACKET ___ (GO TO 664)
663) Have you ever heard of a special product called mahloul moalget el gafaf you can get for the treatment of diarrhea?
NO 2
664) In the last 6 months, have you heard/seen or received any information about the warning or danger signs women should be aware of in order to have a safe pregnancy?
NO 2 (GO TO701)
665) What was the last source you got information from?
RADIO 02
NEWSPAPER/MAGAZINE 03
PAMPHLET/BROCHURE 04
POSTER 05
MEDICAL PROVIDER 06
HUSBAND 07
OTHER RELATIVE 08
FRIENDS/NEIGHBORS 09
OTHER (SPECIFY) __________ 96
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
701) CHECK 106: MARITAL STATUS
WIDOWED/DIVORCED/SEPARATED ___ (GO TO 704)
702) RECORD LINE NUMBER OF HUSBAND FROM HOUSEHOLD SCHEDULE. IF HUSBAND IS NOT PRESENT IN THE HOUSEHOLD, RECORD '00'.
703) How old was your husband on his last birthday?
704) In what month and year was your (last) husband born?
COMPARE AND CORRECT 703 AND/OR 704 IF INCONSISTENT.
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
705) Before you got married, was your (last) husband related to you in anyway through blood or marriage?
NO 2 (GO TO 707)
706) What type of relationship was it?
FIRST COUSIN MOTHER'S SIDE 2
SECOND COUSIN FATHER'S SIDE 3
SECOND COUSIN MOTHER'S SIDE 4
OTHER RELATIVE FATHER'S SIDE 5
OTHER RELATIVE MOTHER'S SIDE 6
RELATIVE BY MARRIAGE 7
707) Did your (last) husband ever attend school?
NO 2 (GO TO 710)
708) What is the highest level of school he attended?
PREPARATORY 2
SECONDARY 3
UPPER INTERMEDIATE 4
UNIVERSITY 5
MORE THAN UNIVERSITY 6
709) What was the highest grade he completed at that level?
DON'T KNOW 8
CURRENTLY MARRIED ___
What is your husband's occupation? That is, what kind of work does he mainly do?
WIDOWED/DIVORCED/SEPARATED ___
What was your (last) husband's occupation? That is, what kind of work did he mainly do?
711) Aside from your own housework, have you done any work in the last seven days even if it was only for a short period of time?
NO 2
712) 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 even if it was only for a short period of time?
NO 2
713) 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?
NO 2
714) Have you done any work in the last 12 months even if it was only for a short period of time?
NO 2 (GO TO 722)
715) What is your occupation, that is, what kind of work do you mainly do?
716) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
717) Do you usually work at home or away from home?
AWAY 2
718) 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
719) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
DOES NOT WORK IN AGRICULTURE ___ (GO TO 722)
721) 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
722) CHECK 106: MARITAL STATUS
WIDOWED/ DIVORCED/ SEPARATED ___ 728
OTHER ___ (GO TO 726)
724) Who decides how the money you earn will be used: mainly you, mainly your husband, or you and your husband jointly?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
OTHER 6
725) Would you say that the money that you bring into the household is more than what your husband brings in, less than what he brings in, or about the same?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND DOESN'T BRING IN ANY MONEY 4 (GO TO 727)
DON'T KNOW/NOT APPLICABLE 8
726) Who decides how your husband's earnings will be used: mainly you, mainly your husband, or you and your husband jointly?
HUSBAND 2
RESPONDENT AND HUSBAND JOINTLY 3
HUSBAND DOESN'T BRING IN ANY MONEY 4
OTHER 6
727) Who usually makes the following decisions: mainly you, mainly your husband, you and your husband jointly, or someone else?
HUSBAND = 2
RESPONDENT AND HUSBAND JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6
HUSBAND = 2
RESPONDENT AND HUSBAND JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6
HUSBAND = 2
RESPONDENT AND HUSBAND JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6
HUSBAND = 2
RESPONDENT AND HUSBAND JOINTLY = 3
SOMEONE ELSE = 4
OTHER = 6
728) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT)
PRES/NOT LISTEN. 2
NOT PRES 3
PRES/NOT LISTEN. 2
NOT PRES 3
PRES/NOT LISTEN. 2
NOT PRES 3
PRES/NOT LISTEN. 2
NOT PRES 3
729) 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:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NONE ___ (GO TO 801)
731) Now, we will talk about another issue.
All adults use certain ways to teach children the right behavior or to address a behaviour problem. I will read various methods that are used and I want you to tell me if you have used this with your child(ren) in the past month.
NO 2
NO 2
NO 2
NO 2
801) Now I would like to talk about the practice of female circumcision. Have you yourself been circumcised?
NO 2 (GO TO 803)
802) How old were you when you were circumcised?
DON'T KNOW 98
NO DAUGHTERS YEARS 0-17 YEARS ___ (GO TO 812)
804) CHECK QUESTIONS 214 AND 217 AND IDENTIFY ALL OF THE WOMAN'S DAUGHTERS AGES 0-17 YEARS.
ENTER THE NAME, AND LINE NUMBER FOR EACH DAUGHTER IN 805 BELOW BEGINNING WITH THE YOUNGEST DAUGHTER. USE AN ADDITIONAL QUESTIONNAIRE IF MORE THAN FOUR DAUGHTERS.
Now I would like to ask you some questions about your daughters.
RECORD NAME(S) AND LINE NUMBER(S) FOR DAUGHTERS
(NAME) __________
0-14 YRS ___ (GO TO 807)
806) What is (NAME'S) marital status?
NEVER MARRIED/SIGNED CONTRACT 2
NO 2
DON'T KNOW 8 (GO TO NEXT DAUGHTER OR 810)
808) Who performed the circumcision to (NAME)?
NURSE/OTHER HLTH PRV. 2
DAYA 3
BARBER 4
GHAGARIA 5
OTHER (SPECIFY) _________ 6
DON'T KNOW 8
809 How old was (NAME) when she was circumcised?
DON'T KNOW 8
ALL DAUGHTERS CIRCUMCISED ___ (GO TO 812)
811) You have (number of daughters not circumcised) daughter(s) who (has/have) not been circumcised. Do you intend that (she/they) will be circumcised in the future?
NO 2
HAVE NOT DECIDED/UNSURE 8
812) During the past year have you discussed circumcision with your relatives, friends, or neighbors?
NO 2
813) During the past year have you heard, seen or received any information about circumcision?
NO 2 (GO TO 815)
UNSURE 8 (GO TO 815)
814) Where did you hear or see that information?
Anywhere else?
RECORD ALL MENTIONED
RADIO B
NEWSPAPER/MAGAZINE C
PAMPHLET/BROCHURE D
POSTER E
COMMUNITY MEETING F
HOME VISIT BY HEALTH WORKER G
FACILITY-BASED HEALTH WORKER H
HUSBAND I
OTHER RELATIVE/FRIENDS J
OTHER (SPECIFY) ___________________ X
815) Do you believe that this practice is required by religious precepts?
NO 2
DON'T KNOW 8
816) Do you think that the practice of circumcision should be continued or should it be stopped?
STOPPED 2
DON'T KNOW 8
817) Do you think that men want this practice to continue or to stop?
STOPPED 2
DON'T KNOW 8
818) I will read you some statements about circumcision.
Please tell me if you agree or disagree.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
901) CHECK IDENTIFICATION SECTION ON COVER PAGE
WOMAN NOT SELECTED ___ (GO TO 1001)
902) CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.
PRIVACY NOT POSSIBLE 2 (GO TO 921)
Now I would like to ask you questions about some other important aspects of a woman's life. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in Egypt. Let me assure you that your answers are completely confidential and will not be told to anyone.
904) Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband.
904A) (Does/did) your (last) husband ever:
NO 2
NO 2
904B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
905) 905A) (Does/did) your (last) husband ever:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
905B) How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
SOMETIMES 2
NOT AT ALL 3
NA 5
NOT A SINGLE 'YES' ___ (GO TO 908)
907) Did the following ever happen because of something your (last) husband did to you:
NO 2
NO 2
NO 2
908) Have (did) you ever hit, slapped, kicked or done anything to physically hurt your (last) husband?
NO 2 (GO TO 910)
909) In the last 12 months, how often have you done this to your husband: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
NOT APPLICABLE 5
910) From the time you were 15 years old has anyone other than your (current/last) husband hit, slapped, kicked, or done anything else to hurt you physically?
NO 2 (GO TO 913)
NO ANSWER 3 (GO TO 913)
911) Who has physically hurt you in this way?
Anyone else?
RECORD ALL MENTIONED.
FATHER B
STEP-MOTHER C
STEP-FATHER D
SISTER E
BROTHER F
DAUGHTER G
SON H
EX-HUSBAND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER FEMALE RELATIVE/IN-LAW L
OTHER MALE RELATIVE/ IN-LAW M
FEMALE FRIEND/ACQUAINTANCE N
MALE FRIEND/ACQUAINTANCE O
FEMALE TEACHER P
MALE TEACHER Q
FEMALE EMPLOYER R
MALE EMPLOYER S
STRANGER (FEMALE) T
STRANGER (MALE) U
OTHER (SPECIFY) ___________ X
912) In the last 12 months, how often have you been hit, slapped, kicked, or physically hurt by this/these person(s): often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
913) CHECK 208 AND 226 AND THE CALENDER:
NEVER PREGNANT ___ (GO TO 916)
914) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?
NO 2 (GO TO 916)
915) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
FATHER B
STEP-MOTHER C
STEP-FATHER D
SISTER E
BROTHER F
DAUGHTER G
SON H
LATE/EX-HUSBAND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER FEMALE RELATIVE/IN-LAW L
OTHER MALE RELATIVE/ IN-LAW M
FEMALE FRIEND/ACQUAINTANCE N
MALE FRIEND/ACQUAINTANCE O
FEMALE TEACHER P
MALE TEACHER Q
FEMALE EMPLOYER R
MALE EMPLOYER S
STRANGER (FEMALE) T
STRANGER (MALE) U
OTHER (SPECIFY) ___________ X
NOT A SINGLE CODE '1' OR '2' CIRCLED ___ (GO TO 920)
917) At any time during the past year when your (current/last) husband did something to physically hurt you, did you try to get help to prevent or stop him from hurting you?
NO 2 (GO TO 919)
918) From whom did you seek help?
Anyone else?
RECORD ALL MENTIONED.
FATHER B (GO TO 920)
SISTER C (GO TO 920)
BROTHER D (GO TO 920)
MOTHER-IN-LAW E (GO TO 920)
FATHER-IN-LAW F (GO TO 920)
OTHER FEMALE RELATIVE/IN-LAW . G (GO TO 920)
OTHER MALE RELATIVE/ IN-LAW H (GO TO 920)
FRIEND I (GO TO 920)
NEIGHBOR J (GO TO 920)
TEACHER K (GO TO 920)
EMPLOYER L (GO TO 920)
RELIGIOUS LEADER M (GO TO 920)
DOCTOR/MEDICAL PERSONNEL N (GO TO 920)
POLICE O (GO TO 920)
LAWYER P (GO TO 920)
OTHER (SPECIFY) ___________ X (GO TO 920)
919) What is the main reason you have never sought help?
NO USE 02
PART OF LIFE 03
AFRAID OF DIVORCE/DESERTION 04
AFRAID OF FURTHER BEATINGS 05
AFRAID OF GETTING PERSON BEATING HER INTO TROUBLE 06
EMBARRASSED 07
DON'T WANT TO DISGRACE FAMILY 08
NOT IMPORTANT 09
OTHER (SPECIFY) _________ 96
920) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
921) INTERVIEWER'S COMMENTS / EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
SECTION 10. HEALTH CARE ACCESS AND OTHER HEALTH CONCERNS
1001) Now I would like to ask you some questions about medical care for yourself.
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?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
1002) Do you have health insurance?
NO 2 (GO TO 1004)
1003) What type of health insurance do you have?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER OF ANOTHER FAMILY MEMBER B
HEALTH INSURANCE THROUGH THE GENERAL AGENCY OF HEALTH INSURANCE C
HEALTH INSURANCE THROUGH ANY OF THE SYNDICATES D
OTHER (SPECIFY) ________X
1004) Now I would like to ask you some questions about any injections you have had in the last six months. Have you had an injection for any reason in the last six months? (including family planning or tetanus injections)
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 95, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1008)
1005) 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 95, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 1008)
1006) The last time you had an injection given to you by a health worker, where did you get the injection?
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
OTHER HOME 2
URBAN HEALTH UNIT 4
HEALTH OFFICE 5
RURAL HOSPITAL 6
RURAL HEALTH UNIT 7
MCH CENTER 8
MOBILE UNIT 9
TEACHING HOSPITAL B
HEALTH INSURANCE ORG C
CURATIVE CARE ORGANIZATION . D
OTHER GOVERNMENTAL E
CSI PROJIECT G
OTHER NON-GOVERNMENTAL H
PRIVATE DOCTOR J
DENTIST K
PHARMACY L
MOSQUE HEALTH UNIT M
CHURCH HEALTH UNIT N
1007) The last time you had an injection from a health worker did the person who gave you that injection take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1008) In the last 6 months have you heard, seen, or received any information about what people should do to be sure that injections are given safely?
NO 2
DON'T KNOW 8 (GO TO 1010)
1009) Where did you hear or see that information?
Anywhere else?
RECORD ALL MENTIONED.
RADIO B
NEWSPAPER/MAGAZINE C
PAMPHLET/BROCHURE D
POSTER E
COMMUNITY MEETING F
HOME VISIT BY HEALTH WORKER G
FACILITY-BASED HEALTH WORKER H
HUSBAND I
OTHER RELATIVE/FRIENDS/
NEIGHBORS J
OTHER (SPECIFY) ___________________ X
1010) Do you currently smoke cigarettes?
NO 2 (GO TO 1012)
1011) In the last 24 hours, how many cigarettes did you smoke?
IF DIDN'T SMOKE DURING THE LAST 24 HOURS RECORD '00'
1012) Do you currently smoke or use any other type of tobacco?
NO 2 (GO TO 1014)
1013) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
ROLLED CIGARETTES D
WATER PIPE E
OTHER (SPECIFY) ________ X
1014) Does anyone else in your household currently smoke cigarettes or use any other type of tobacco?
YES, OTHER TOBACCO 2
YES, BOTH 3
NO 4
1015) In the last 6 months have you heard, seen, or received any information about the health effects of second hand smoke (that is, exposure to direct smoke from smokers)?
NO 2 (GO TO 1101)
DON'T KNOW 8 (GO TO 1101)
1016) Where did you hear or see that information?
Anywhere else?
RECORD ALL MENTIONED.
RADIO B
NEWSPAPER/MAGAZINE C
PAMPHLET/BROCHURE D
POSTER E
COMMUNITY MEETING F
HOME VISIT BY HEALTH WORKER G
FACILITY-BASED HEALTH WORKER H
HUSBAND I
OTHER RELATIVE/FRIENDS/NEIGHBORS J
OTHER (SPECIFY) _______________ X
SECTION 11. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
1101) Now I would like to talk about something else.
Have you ever heard the illness Hepatitis C?
NO 2 (GO TO 1105)
1102) In the last 6 months have you heard, seen, or received any information about Hepatitis C?
NO 2 (GO TO 1104)
DON'T KNOW 8 (GO TO 1104)
1103) Where did you hear or see that information?
Anywhere else?
RECORD ALL MENTIONED.
RADIO B
NEWSPAPER/MAGAZINE C
PAMPHLET/BROCHURE D
POSTER E
COMMUNITY MEETING F
HOME VISIT BY HEALTH WORKER G
FACILITY-BASED HEALTH WORKER H
HUSBAND I
OTHER RELATIVE/FRIENDS/
NEIGHBORS J
OTHER (SPECIFY) _________________ X
1104) How does Hepatitis C spread from one person to another?
Any other ways?
RECORD ALL MENTIONED.
HOMOSEXUAL SEX B
CONTACT WITH INFECTED PERSON'S BLOOD THROUGH:
TRANSFUSION C
UNCLEAN NEEDLES D
OTHER (E.G., RAZORS) E
CASUAL PHYSICAL CONTACT(S) (E.G., SHAKING HANDS, SHARING FOOD OR DRINK, ETC.) F
MOTHER-TO-CHILD TRANSMISSION . G
MOSQUITO/OTHER INSECT BITE H
OTHER (SPECIFY) ________________ X
DON'T KNOW Z
1105) Have you ever heard of an illness called tuberculosis or TB?
NO 2 (GO TO 1109)
1106) How does tuberculosis spread from one person to another?
Any other ways?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ___________ X
DON'T KNOW Z
1107) Can tuberculosis be cured?
NO 2
DON'T KNOW 8
1108) If a member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1109) Now I would like to talk about something else.
Have you ever heard of an illness called AIDS?
NO 2 (GO TO 1127)
1110) Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?
NO 2
DON'T KNOW 8
1111) Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
1112) Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
1113) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
1114) Can people reduce their chance of getting the AIDS virus by abstaining from sexual intercourse?
NO 2
DON'T KNOW 8
1115) Can the HIV virus be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1116) Is there anything else a person can do to avoid or reduce the chances of getting the AIDS virus?
NO 2 (GO TO 1118)
DON'T KNOW 8 (GO TO 1118)
Anything else?
RECORD ALL WAYS MENTIONED.
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM
TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) _____________ X
DON'T KNOW Z
1118) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
1119) Do you know of a place where people can go to get tested for the virus that causes AIDS?
NO 2 (GO TO 1121)
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME OF THE PLACE.
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
Any other place?
RECORD ALL SOURCES MENTIONED.
GOVT. HEALTH UNIT B
VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
OTHER GOVT (SPECIFY) __________ F
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY) _________ J
1121) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
1122) If a member of your family became sick with the virus, that causes AIDS would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1123) If a relative of yours became sick with the virus that causes AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
1124) 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?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
1125) In the last 6 months have you heard, seen, or received any information about HIV/AIDS?
NO 2 (GO TO 1127)
DON'T KNOW 8 (GO TO 1127)
1126) Where did you hear or see that information?
Anywhere else?
RECORD ALL MENTIONED.
RADIO B
NEWSPAPER/MAGAZINE C
PAMPHLET/BROCHURE D
POSTER E
COMMUNITY MEETING F
HOME VISIT BY HEALTH WORKER G
FACILITY-BASED HEALTH WORKER H
HUSBAND I
OTHER RELATIVE/FRIENDS/NEIGHBORS J
OTHER (SPECIFY) _______________ X
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?
NO 2 (GO TO 1129)
1128) 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?
NO 2
DON'T KNOW 8
1129) Sometimes women experience a bad smelling abnormal genital discharge.
During the last 12 months, have you had a bad smelling abnormal genital discharge?
NO 2
DON'T KNOW 8
1130) Sometimes women have a genital sore or ulcer.
During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW 8
1131) CHECK 1128, 1129, AND 1130:
HAS NOT HAD AN INFECTION OR DOES NOT KNOW ___ (GO TO 1201)
1132) The last time you had (PROBLEM FROM 1128/1129/1130), did you seek any kind of advice or treatment?
NO 2 (GO TO 1201)
Any other place?
RECORD ALL SOURCES MENTIONED.
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
TEACHING HOSPITAL I
HEALTH INSURANCE ORG J
CURATIVE CARE ORGANIZATION K
OTHER GOVERNMENTAL L
CSI PROJECT N
OTHER NON-GOVERNMENTAL O
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC P
PRIVATE DOCTOR Q
PHARMACY R
MOSQUE HEALTH UNIT S
CHURCH HEALTH UNIT T
FRIEND/RELATIVE V
OTHER (SPECIFY) _______________ X
SECTION 12. MOTHER AND CHILD NUTRITION
(NAME) ________________
1202) As part of this study, we are also looking at the nutrition of mothers and children. To help us understand these issues, I will first ask you about what (NAME FROM 1201) may have drank or eaten yesterday during the day or at night. Then I will also ask you about what you may have eaten or drunk yesterday.
1203) First I would like to ask you about liquids/foods (NAME FROM 1201) had yesterday during the day or at night.
Did (NAME FROM 1201) have:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
1204) Now I would like to ask you about (other) liquids or foods that (NAME FROM 1201) or you may have had yesterday during the day or at night. I am interested in whether your child or you had the item even if it was combined with other foods.
Did (Name/you) drink (eat):
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NOT A SINGLE "YES" ___ (GO TO 1207)
1206) How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
MINUTES __ __
THANK YOU FOR TAKING THE TIME TO ANSWER THESE QUESTIONS.
WE MAY RETURN TO INTERVIW YOU OR ANY OTHER MEMBER OF YOUR HOUSEHOLD IN THE FUTURE AND WE HOPE YOU WILL AGREE TO PARTICIPATE AGAIN AT THAT TIME.
TO BE FILLED IN AFTER COMPLETING INTERVIEW
1301) INTERVIEWER'S OBSERVATIONS
COMMENTS ABOUT RESPONDENT:
_________________________________________
COMMENTS ON SPECIFIC QUESTIONS:
_________________________________________
ANY OTHER COMMENTS:
_________________________________________
1302) SUPERVISOR'S OBSERVATIONS
_________________________________________
NAME OF SUPERVISOR: ___________________
DATE: ____________
1303) EDITOR'S OBSERVATIONS
__________________________________________
NAME OF EDITOR: ___________________
DATE: ____________
INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX.
FOR COLUMNS 1, 2 ALL MONTHS SHOULD BE FILLED.
COL. 1: MARRIAGE/UNION
0 NOT IN UNION
COL. 2: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE
P PREGNANCIES
M MISCARRIAGE
A ABORTION
S STILL BIRTH
0 NO METHOD
C FEMALE STERILIZATION
D MALE STERILIZATION
E PILL
F IUD
G INJECTABLES
H IMPLANTS
I CONDOM
K DIAPHRAGM/FOAM OR JELLY
N RHYTHM METHOD
R WITHDRAWAL
T PROLONGED BREASTFEEDING
X OTHER (SPECIFY) __________________
COL. 3: SOURCE OF CONTRACEPTION
2 URBAN HEALTH UNIT
3 HEALTH OFFICE
4 RURAL HOSPITAL
5 RURAL HEALTH UNIT
6 MCH CENTER
7 MOBILE UNIT
9 TEACHING HOSPITAL
A HEALTH INSURANCE ORGANIZATION
B CURATIVE CARE ORGANIZATION
C OTHER GOVERNMENTAL
E CSI PROJECT
F OTHER NON-GOVERNMENTAL
H PRIVATE DOCTOR
I PHARMACY .
K CHURCH HEALTH UNIT
M FRIENDS / RELATIVES
X OTHER (SPECIFY) ________________
Z DON'T KNOW
COL. 4:
DISCONTINUATION OF CONTRACEPTIVE USE
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITA (SPECIFY) __________________
X OTHER
Z DON'T KNOW
2005 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 01 ___ ___ ___ ___ 01 DEC
11 NOV 02 ___ ___ ___ ___ 02 NOV
10 OCT 03 ___ ___ ___ ___ 03 OCT
09 SEP 04 ___ ___ ___ ___ 04 SEP
08 AUG 05 ___ ___ ___ ___ 05 AUG
07 JUL 06 ___ ___ ___ ___ 06 JUL
06 JUN 07 ___ ___ ___ ___ 07 JUN
05 MAY 08 ___ ___ ___ ___ 08 MAY
04 APR 09 ___ ___ ___ ___ 09 APR
03 MAR 10 ___ ___ ___ ___ 10 MAR
02 FEB 11 ___ ___ ___ ___ 11 FEB
01 JAN 12 ___ ___ ___ ___ 12 JAN
2004 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 13 ___ ___ ___ ___ 13 DEC
11 NOV 14 ___ ___ ___ ___ 14 NOV
10 OCT 15 ___ ___ ___ ___ 15 OCT
09 SEP 16 ___ ___ ___ ___ 16 SEP
08 AUG 17 ___ ___ ___ ___ 17 AUG
07 JUL 18 ___ ___ ___ ___ 18 JUL
06 JUN 19 ___ ___ ___ ___ 19 JUN
05 MAY 20 ___ ___ ___ ___ 20 MAY
04 APR 21 ___ ___ ___ ___ 21 APR
03 MAR 22 ___ ___ ___ ___ 22 MAR
02 FEB 23 ___ ___ ___ ___ 23 FEB
01 JAN 24 ___ ___ ___ ___ 24 JAN
2003 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 25 ___ ___ ___ ___ 25 DEC
11 NOV 26 ___ ___ ___ ___ 26 NOV
10 OCT 27 ___ ___ ___ ___ 27 OCT
09 SEP 28 ___ ___ ___ ___ 28 SEP
08 AUG 29 ___ ___ ___ ___ 29 AUG
07 JUL 30 ___ ___ ___ ___ 30 JUL
06 JUN 31 ___ ___ ___ ___ 31 JUN
05 MAY 32 ___ ___ ___ ___ 32 MAY
04 APR 33 ___ ___ ___ ___ 33 APR
03 MAR 34 ___ ___ ___ ___ 34 MAR
02 FEB 35 ___ ___ ___ ___ 35 FEB
01 JAN 36 ___ ___ ___ ___ 36 JAN
2002 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 37 ___ ___ ___ ___ 37 DEC
11 NOV 38 ___ ___ ___ ___ 38 NOV
10 OCT 39 ___ ___ ___ ___ 39 OCT
09 SEP 40 ___ ___ ___ ___ 40 SEP
08 AUG 41 ___ ___ ___ ___ 41 AUG
07 JUL 42 ___ ___ ___ ___ 42 JUL
06 JUN 43 ___ ___ ___ ___ 43 JUN
05 MAY 44 ___ ___ ___ ___ 44 MAY
04 APR 45 ___ ___ ___ ___ 45 APR
03 MAR 46 ___ ___ ___ ___ 46 MAR
02 FEB 47 ___ ___ ___ ___ 47 FEB
01 JAN 48 ___ ___ ___ ___ 48 JAN
2001 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 49 ___ ___ ___ ___ 49 DEC
11 NOV 50 ___ ___ ___ ___ 50 NOV
10 OCT 51 ___ ___ ___ ___ 51 OCT
09 SEP 52 ___ ___ ___ ___ 52 SEP
08 AUG 53 ___ ___ ___ ___ 53 AUG
07 JUL 54 ___ ___ ___ ___ 54 JUL
06 JUN 55 ___ ___ ___ ___ 55 JUN
05 MAY 56 ___ ___ ___ ___ 56 MAY
04 APR 57 ___ ___ ___ ___ 57 APR
03 MAR 58 ___ ___ ___ ___ 58 MAR
02 FEB 59 ___ ___ ___ ___ 59 FEB
01 JAN 60 ___ ___ ___ ___ 60 JAN
2000 1 2 CHILD'S NAME 3 SOURCE ADDRESS 4
12 DEC 61 ___ ___ ___ ___ 61 DEC
11 NOV 62 ___ ___ ___ ___ 62 NOV
10 OCT 63 ___ ___ ___ ___ 63 OCT
09 SEP 64 ___ ___ ___ ___ 64 SEP
08 AUG 65 ___ ___ ___ ___ 65 AUG
07 JUL 66 ___ ___ ___ ___ 66 JUL
06 JUN 67 ___ ___ ___ ___ 67 JUN
05 MAY 68 ___ ___ ___ ___ 68 MAY
04 APR 69 ___ ___ ___ ___ 69 APR
03 MAR 70 ___ ___ ___ ___ 70 MAR
02 FEB 71 ___ ___ ___ ___ 71 FEB
01 JAN 72 ___ ___ ___ ___ 72 JAN
OUTCOME AND DATE OF LAST PREGNANCY TERMINATION PRIOR TO JANUARY 2000
IF NONE, RECORD '0' IN OUTCOME.
MONTH __ __
YEAR __ __ __ __
BIRTH DATE OF LAST CHILD BORN PRIOR TO JANUARY 2000
YEAR __ __ __ __