LOCALITY NAME ____________________
NAME OF HOUSEHOLD HEAD __________________________
CLUSTER NUMBER ___ ___ ___
HOUSEHOLD NUMBER ___ ___
REGION ___ ___
LARGE CITY/SMALL CITY/TOWN/RURAL
SMALL CITY 2
TOWN 3
RURAL 4
NAME AND LINE NUMBER OF WOMAN___
HOUSEHOLD SELECTED FOR MALE INTERVIEW?
NO 2
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
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 ___ ___ ___ ___
INTERVIEWER NUMBER ___ ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _______________________________ 7
OROMIGNA 2
TIGRIGNA 3
OTHER 6
OROMIGNA 2
TIGRIGNA 3
OTHER 6
OROMIGNA 2
TIGRIGNA 3
OTHER 6
NO 2
SUPERVISOR
NAME _________________
DATE _________________ ___ ___
FIELD EDITOR
NAME _________________
DATE _________________ ___ ___
SECTION 1. RESPONDENT'S BACKGROUND
Hello. My name is __________________________________ and I am working with the Population and Housing Census Commission Office (PHCCO). We are conduction a national survey about the health of women, men 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 about 45 minutes to complete.
Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
101. RECORD THE TIME.
EVENING 2
MINUTES ___ ___
101A. COLLECT ANY RELEVANT DOCUMENTS THAT MAY HAVE INFORMATION ON THE RESPONDENT'S AND HER CHILDREN'S AGE AND IMMUNIZATIONS.
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 96 (GO TO 104)
103. Just before you moved here, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
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 IF 105 IF INCONSISTENT.
106. Have you ever attended school?
NO 2 (GO TO 110)
108. What is the highest grade you completed?
TECHNICAL/VOCATIONAL CERTIFICATE 13
UNIVERSITY/COLLEGE DIPLOMA 14
UNIVERSITY/COLLEGE DEGREE OR HIGHER 15
CHECK 07 AND ABOVE (GO TO 113)
110. 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 PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)___________4
BLIND/VISUALLY IMPAIRED 5
111. Have you ever participated in a Basic Education Program or any other program that involves learning to read or write (not including primary school)?
NO 2
CIRCLE '1' OR '5' CIRCLED (GO TO 114)
113. 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
114. 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
115. 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
115A. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?
NONE 00 (GO TO 116)
115B. In the last 12 months, have you been away from your home community for more than one month at a time?
NO 2
CATHOLIC 2
PROTESTANT 3
MOSLEM 4
TRADITIONAL 5
OTHER (SPECIFY)__________ 6
117. What is your ethnicity?
RECORD THE MAJOR ETHNIC GROUP.
SECTION 2. REPRODUCTION
201. Now I would like to ask about all the births you have had during your live. 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'.
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'.
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'.
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 201-208 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. (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?
MULTIPLE 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?
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)?
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 (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
[ALL BIRTHS EXCEPT FOR THE FIRST BIRTH]
NO 2
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 AND MARK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED IN Q.215
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED IN Q.217
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN Q.220
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS
224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 1992 E.C. OR LATER. IF NONE, RECORD '0'
225. FOR EACH BIRTH SINCE MESKEREM 1992, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)
227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
ENTER 'P's IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.
228. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
229. Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (GO TO 237)
230. When did the last such pregnancy end?
LAST PREGNANCY ENDED BEFORE MESKEREM 1992 OR LATER (GO TO 237)
232. How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
233. Since Meskerem 1992, have you had any other pregnancies that did not result in a live birth?
NO 2 (GO TO 237)
234. ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO MESKEREM 1992.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
235. Did you have any pregnancies that terminated before 1992 E.C. that did not result in a live birth?
NO 2 (GO TO 237)
236. When did the last such pregnancy that terminated before 1992 E.C. end?
237. 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
238. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?
NO 2 (GO TO 239A)
DON'T KNOW 8 (GO TO 239A)
239. 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
239A. Are you the primary care giver for any children?
NO 2 (GO TO 301)
239B. Are any of these children for whom you are the primary caregiver under the age of 18?
NO 2 (GO TO 301)
239C. Now I would like to ask you about the children who are under the age of 18 and for whom you are the primary caregiver. Have you made arrangements for someone to care for these children in the event that you fall sick or are unable to care for them?
NO 2
UNSURE 8
SECTION 3. CONTRACEPTION
301. Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 1 IF MENTIONED IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
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
302. 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 307)
304. Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
305. ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. (GO TO 331)
306. What have you used or done?
CORRECT 302 AND 303(AND 301 IF NECESSARY).
307. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.
WOMAN STERILIZED (GO TO 311A)
PREGNANT (GO TO 322)
310. Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 322)
311. Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW GO INSTRUCTION FOR HIGHEST METHOD ON LIST.
311A. CIRCLE 'A' FOR FEMALE STERILIZATION.
MALE STERILIZATION B (GO TO 319)
PILL C
IUD D (GO TO 315)
INJECTABLES E (GO TO 315)
IMPLANTS F (GO TO 315)
CONDOM G
DIAPHRAGM/FOAM/JELLY H (GO TO 315)
STANDARD DAYS METHOD I (GO TO 319A)
LACTATIONAL AMENORRHEA METHOD J (GO TO 319A)
RHYTHM METHOD K (GO TO 319A)
WITHDRAWAL L (GO TO 319A)
OTHER (SPECIFY)___________ X (GO TO 319A)
312. May I see the package of (pills/condoms) you are using?
RECORD NAME OF BRAND.
313. Do you know the brand name of the (pills/condoms) you are using?
RECORD NAME OF BRAND.
DON'T KNOW 98
314. How many (pill cycles/packages of condoms) did you get the last time?
DON'T KNOW 998
315. The last time you obtained (CURRENT METHOD IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?
FREE 955 (GO TO 319A)
DON'T KNOW 998 (GO TO 319A)
319. In what month and year was the sterilization performed?
319A. 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 IS 1992 E.C. OR LATER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH STARTED USING) (GO TO 332)
YEAR IS 1991 E.C. OR EARLIER (ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO MESKEREM 1992.) (GO TO 329)
322. I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO MESKEREM 1992.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
COLUMN 1:
* When was the last time you used a method? Which method was that?
* When did you start using that method? How long after the birth of (NAME)?
* How long did you use the method then?
IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.
ILLUSTRATIVE QUESTIONS:
COLUMN 2:
* Where did you obtain the method when you started using it?
* Where did you get advice on how to use method [for LAM or rhythm]?
IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:
COLUMN 3:
* Why did you stop using the (METHOD)?
* Did you become pregnant while using (METHOD), did you stop using to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
* How many months did it take you to get pregnant after you stopped using (METHOD)?
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1
323. CHECK 311/311A
CIRCLE METHOD CODE:
IF NO CODE CIRCLED IN 311/311A, CIRCLE '00'. IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (GO TO 333)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07 (GO TO 330)
DIAPHRAGM/FOAM/JELLY 08 (GO TO 327)
STANDARD DAYS METHOD 09 (GO TO 327)
LACTATIONAL AMENORRHEA METHOD 10 (GO TO 327)
RHYTHM METHOD 11 (GO TO 333)
WITHDRAWAL 12 (GO TO 333)
OTHER METHOD 96 (GO TO 333)
324. You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you told about side effects or problems you might have with the method?
NO 2
325. Were you ever told by a health facility/family planning worker/reproductive health agent about side effects or problems you might have with the method?
NO 2 (GO TO 327)
326. Were you told what to do if you experienced side effects or problems?
NO 2
CODE '1' CIRCLED: At that time, were you told about other methods of family planning that you could use?
CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?
NO 2
328. Were you ever told by a health facility/family planning worker/reproductive health agent about other methods of family planning that you could use?
NO 2
329. CHECK 311/311A:
CIRCLE METHOD CODE:
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
MALE STERILIZATION 02 (GO TO 333)
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
DIAPHRAGM/FOAM/JELLY 08
STANDARD DAYS METHOD 09
LACTATIONAL AMENORRHEA METHOD 10 (GO TO 333)
RHYTHM METHOD 11 (GO TO 333)
WITHDRAWAL 12 (GO TO 333)
OTHER METHOD 96 (GO TO 333)
330. Where did you obtain (CURRENT METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12 (GO TO 333)
GOVERNMENT HEALTH POST 13 (GO TO 333)
GOVERNMENT HEALTH STATION/CLINIC 14 (GO TO 333)
CBD 15 (GO TO 333)
OTHER PUBLIC (SPECIFY) ________16 (GO TO 333)
CBD/CBRHA 22 (GO TO 333)
OTHER NGO ______ 26 (GO TO 333)
PHARMACY 32 (GO TO 333)
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36 (GO TO 333)
SHOP 42 (GO TO 333)
FRIEND/RELATIVE 43 (GO TO 333)
331. Do you know a place where you can obtain a method of family planning?
NO 2 (GO TO 333)
332. Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
CBD/CBRHA H
OTHER NGO ______ I
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
SHOP N
FRIEND/RELATIVE O
333. In the last 12 months, were you visited by a community based health agent/distributor who talked to you about family planning?
NO 2
334. In the last 12 months, have you visited a health facility for care for yourself (or your children)?
NO 2 (GO TO 401)
335. Did any staff member at the health facility speak to you about family planning methods?
NO 2
SECTION 4. PREGNANCY, DELIVERY, POSTNATAL CARE AND NUTRITION
NO BIRTHS IN MESKEREM 1992 OR LATER (GO TO 550)
402. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1992 E.C. OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)
403. LINE NUMBER FROM 212
LIVING (GO TO 405)
DEAD (GO TO 405)
405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3 (GO TO 407)
406. How much longer would you have liked to wait?
YEARS 2___ ___
DON'T KNOW 998
407. 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.
[FOR LAST BIRTH ONLY]
UNTRAINED TRADITIONAL BIRTH ATTENDANT C
COMMUNITY HEALTH AGENT D
OTHER (SPECIFY)__________________X
408. Where did you receive antenatal care for this pregnancy?
CIRCLE ALL MENTIONED. IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[FOR LAST BIRTH ONLY]
OTHER HOME B
GOVERNMENT HEALTH CENTER D
GOVERNMENT HEALTH POST E
OTHER PUBLIC (SPECIFY) ________F
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ I
409. How many months pregnant were you when you first received antenatal care for this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
410. How many times did you receive antenatal care during this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
411. As part of your antenatal care during this pregnancy, were any of the following done at least once?
[FOR LAST BIRTH ONLY]
NO 2
NO 2
NO 2
NO 2
412. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 414)
DON'T KNOW 8 (GO TO 414)
413. Were you told where to go if you had any of these complications?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
414. During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 417)
DON'T KNOW 8 (GO TO 417)
415. During this pregnancy, how many times did you get this tetanus injection?
[FOR LAST BIRTH ONLY]
DON'T KNOW 8
416. CHECK 415:
[FOR LAST BIRTH ONLY]
OTHER (GO TO 417)
417. At any time before this pregnancy, did you receive any tetanus injections?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 421)
DON'T KNOW 8 (GO TO 421)
418. Before this pregnancy, how many times did you get a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[FOR LAST BIRTH ONLY]
DON'T KNOW 8
419. In what month and year did you receive the last tetanus injection before this pregnancy?
[FOR LAST BIRTH ONLY]
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
420. How many years ago did you receive that tetanus injection?
[FOR LAST BIRTH ONLY]
421. During this pregnancy, were you given or did you buy any iron tablets?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 422A)
DON'T KNOW 8 (GO TO 422A)
422. During the whole pregnancy, for how many days did you take the tablets?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[FOR LAST BIRTH ONLY]
DON'T KNOW 998
422A. During this pregnancy, did you receive any drug for intestinal parasites?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
423. During this pregnancy, did you have difficulty with your vision during daylight?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
424. During this pregnancy, did you suffer from night blindness [USE LOCAL TERM]?
[FOR LAST BIRTH ONLY]
NO 2
DON'T KNOW 8
425. During this pregnancy, did you take any drugs to prevent you from getting malaria?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 429)
DON'T KNOW 8 (GO TO 429)
426. What drugs did you take?
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
[FOR LAST BIRTH ONLY]
CHLOROQUINE B
OTHER (SPECIFY) ______________ X
DON'T KNOW Z
427. CHECK 426:
DRUGS TAKEN FOR MALARIA PREVENTION.
[FOR LAST BIRTH ONLY]
CODE 'A' NOT CIRCLED (GO TO 429)
428. How many times did you take Fansidar/SP during this pregnancy?
[FOR LAST BIRTH ONLY]
428A CHECK 407:
ANTENATAL CARE FROM A HEALTH PROFESSIONAL RECEIVED DURING THIS PREGNANCY.
[FOR LAST BIRTH ONLY]
OTHER (GO TO 429)
428B. Did you get the Fansidar/SP during an antenatal visit to a health facility or from some other source?
[FOR LAST BIRTH ONLY]
ANOTHER FACILITY VISIT 2
OTHER SOURCE (SPECIFY) __________ 6
429. 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
430. Was (NAME) weighed at birth?
NO 2 (GO TO 432)
DON'T KNOW 8 (GO TO 432)
431. How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KILOGRAMS FROM RECALL 2 ___.___ ___ ___
DON'T KNOW 99.998
432. 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.
UNTRAINED TRADITIONAL BIRTH ATTENDANT C
COMMUNITY HEALTH AGENT D
RELATIVE/FRIEND E
NO ONE Y
433. Where did you give birth to (NAME)?
IF SOURCE IS HOSPITAL, HEALTH CENTER, 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 440)
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ________26
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 46
434. 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 ___ ___
DON'T KNOW 998
435. Was (NAME) delivered by caesarean section?
NO 2
436. Before you were discharged after (NAME) was born, did a health professional check on your health?
NO 2 (GO TO 439 FOR LAST BIRTH; GO TO 451 FOR ALL OTHER BIRTHS)
437. How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[FOR LAST BIRTH ONLY]
DAYS 2 ___ ___
WEEKS 3 ___ ___
DON'T KNOW 998
438. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[FOR LAST BIRTH ONLY]
UNTRAINED TRADITIONAL BIRTH ATTENDANT 13 (GO TO 449)
COMMUNITY HEALTH AGENT 15 (GO TO 449)
439. After you were discharged, did a health professional or a traditional birth attendant check on your health?
NO 2 (GO TO 449 FOR LAST BIRTH)
440. Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.
[FOR LAST BIRTH ONLY]
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
441. After (NAME) was born, did a health professional or a traditional birth attendant check on your health?
NO 2 (GO TO 445 FOR LAST BIRTH)
442. How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[FOR LAST BIRTH ONLY]
DAYS 2 ___ ___
WEEKS 3 ___ ___
DON'T KNOW 998
443. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[FOR LAST BIRTH ONLY]
UNTRAINED TRADITIONAL BIRTH ATTENDANT 13
COMMUNITY HEALTH AGENT 15
444. Where did this first check take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[FOR LAST BIRTH ONLY]
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ________26
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 46
444A. CHECK 439:
[FOR LAST BIRTH ONLY]
YES (GO TO 449)
445. In the two months after (NAME) was born, did a health professional or traditional birth attendant check on his/her health?
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)
446. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
[FOR LAST BIRTH ONLY]
DAYS 2 ___ ___
WEEKS 3 ___ ___
DON'T KNOW 998
447. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[FOR LAST BIRTH ONLY]
UNTRAINED TRADITIONAL BIRTH ATTENDANT 13
COMMUNITY HEALTH AGENT 15
448. Where did this first check take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
[FOR LAST BIRTH ONLY]
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH POST 23
OTHER PUBLIC (SPECIFY) ________26
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 46
449. In the first two months after delivery, did you receive a vitamin A does like this?
SHOW CAPSULE.
[FOR LAST BIRTH ONLY]
NO 2
450. Has your menstrual period returned since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 453)
451. Did your period return between the birth of (NAME) and your next pregnancy?
[FOR ALL BIRTHS EXCEPT THE LAST BIRTH]
NO 2 (GO TO 455)
452. For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
453. CHECK 226:
IS RESPONDENT PREGNANT?
[FOR LAST BIRTH ONLY]
PREGNANT OR UNSURE (GO TO 455)
454. Have you resumed sexual relations since the birth of (NAME)?
[FOR LAST BIRTH ONLY]
NO 2 (GO TO 456)
455. For how many month after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
456. Did you ever breastfeed (NAME)?
NO 2 (GO TO 463)
457. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.
[FOR LAST BIRTH ONLY]
HOURS 1___ ___
DAYS 2___ ___
457A. Did you squeeze out and throw away the first milk?
NO 2
458. 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 460)
459. What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
[FOR LAST BIRTH ONLY]
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
FRESH BUTTER J
FENUGREEK K
OTHER (SPECIFY) _________ X
460. CHECK 404:
IS CHILD LIVING?
DEAD (GO TO 462)
461. Are you still breastfeeding (NAME)?
NO 2
462. For how many months did you breastfeed (NAME)?
DON'T KNOW 98
463. CHECK 404:
IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 468)
464. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER
[FOR LAST BIRTH ONLY]
465. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
[FOR LAST BIRTH ONLY]
466. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
467. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 468.
469. Now I would like to ask about liquids (NAME FROM 468) drank yesterday during the day or at night. Did (NAME FROM 468) drink:
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
470. Now I would like to ask you about the food (NAME FROM 468) ate yesterday during the day or at night, either separately or combined with other foods. Did (NAME FROM 468) 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
NOT A SINGLE "YES" (GO TO 501)
472. 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
SECTION 5. IMMUNIZATION, HEALTH, AND WOMEN'S NUTRITION
501. ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1992 E.C. 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 (GO TO 504)
DEAD (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 547)
504. Has (NAME) ever received a vitamin A does like this?
SHOW CAPSULE.
NO 2 (GO TO 507)
DON'T KNOW 8 (GO TO 507)
505. How many months ago did (NAME) take the last dose?
DON'T KNOW 98
507. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 511)
NO CARD 3
508. Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 511)
509 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, 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___
510. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3 AND/OR MEASLES VACCINES.
NO 2 (GO TO 515)
DON'T KNOW 8 (GO TO 515)
511. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?
NO 2 (GO TO 515)
DON'T KNOW 8 (GO TO 515)
512. Please tell me if (NAME) received any of the following vaccinations:
512A. 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
512B. Polio vaccine, that is, drops in mouth?
NO 2 (GO TO 512E)
DON'T KNOW 8 (GO TO 512E)
512C. Was the first polio vaccine received in the first two weeks after birth or later?
LATER 2
512D. How many times was the polio vaccine received?
512E. A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?
NO 2 (GO TO 512G)
DON'T KNOW 8 (GO TO 512G)
512F. How many times was a DPT vaccination received?
512G. An injection to prevent measles?
NO 2
DON'T KNOW 8
515. Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)
516. Was there any blood in the stools?
NO 2
DON'T KNOW 8
517. 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
518. 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
519. Did you seek advice or treatment for the diarrhea from any source?
NO 2 (GO TO 524)
520. Where did you seek advice or treatment? Anywhere else?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
COMMUNITY HEALTH AGENT D
OTHER PUBLIC (SPECIFY) ________E
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ I
SHOP K
TRADITIONAL HEALER L
ONLY ONE CODE CIRCLED (GO TO 523)
522. Where did you first seek advice or treatment?
USE LETTER CODE FROM 520.
523. How many days after the diarrhea began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
524. Does (NAME) still have diarrhea?
NO 2
DON'T KNOW 8
525. Was he/she given any of the following to drink at any time since he/she started having diarrhea:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
526. Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 530)
DON'T KNOW 8 (GO TO 530)
527. 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
HOME REMEDY/HERBAL MEDICINE J
OTHER (SPECIFY) _______________ X
CODE "C" NOT CIRCLED (GO TO 530)
529. How many times was (NAME) given zinc?
[FOR LAST BIRTH ONLY]
DON'T KNOW 98
530. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
531. Has (NAME) had an illness with a cough at any time in last 2 weeks?
NO 2 (GO TO 534)
DON'T KNOW 8 (GO TO 534)
532. 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 535)
DON'T KNOW 8 (GO TO 535)
533. When (NAME) had this illness, did he/she have a problem in the chest or a blocked or runny nose?
NOSE ONLY 2 (GO TO 535)
BOTH 3 (GO TO 535)
OTHER (SPECIFY) ___________ 6 (GO TO 535)
DON'T KNOW 8 (GO TO 535)
NO OR DON'T KNOW (GO TO 546)
535. 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
536. 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
537. Did you seek advice or treatment for the illness from any source?
NO 2 (GO TO 542)
538. Where did you seek advice or treatment? Anywhere else?
RECORD ALL PLACES MENTIONED.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
COMMUNITY HEALTH AGENT D
OTHER PUBLIC (SPECIFY) ________E
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ I
SHOP K
TRADITIONAL HEALER L
ONLY ONE CODE CIRCLED (GO TO 541)
540. Where did you first seek advice or treatment?
USE LETTER CODE FROM 538.
541. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
542. Is name still sick with a (fever/cough)?
NO 2
DON'T KNOW 8
543. At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (GO TO 546)
DON'T KNOW 8 (GO TO 546)
544. What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED.
IF THE RESPONDENT HAS GIVEN A DRUG FOR THE CHILD BUT DOESN'T KNOW THE NAME OF THE DRUG, ASK TO SEE THE PACKET OF DRUGS SHE GAVE THE CHILD. BUT IF SHE DOESN'T HAVE ANY SAMPLE LEFT, THE INTERVIEWER HAS TO SHOW THE SAMPLES SHE HAS TO THE RESPONDENT IN ORDER TO HELP IDENTIFY.
CHLOROQUINE B
ARTEMETHER-LUMEFANTRINE C
QUININE D
OTHER ANTIMALARIAL G
AMPICILIN I
AMOXYCILIN J
CHLORIAMPHENICOL K
TETRACYCLINE L
OTHER ANTIBIOTIC M
IBUPROFEN O
PARACETAMOL P
DON'T KNOW Z
544A. CHECK 544:
ANY CODE A-M CIRCLED
NO (GO TO 546)
545. Did you already have (NAME OF DRUG FROM 544) at home when the child became ill?
IF YES, CIRCLE CODE FOR THAT DRUG.
ASK SEPARATELY FOR EACH DRUG (A-M) GIVEN IN 544.
CHLOROQUINE B
ARTEMETHER-LUMEFANTRINE C
QUININE D
OTHER ANTIMALARIAL G
AMPICILIN I
AMOXYCILIN J
CHLORIAMPHENICOL K
TETRACYCLINE L
OTHER ANTIBIOTIC M
CODE A NOT CIRCLED (GO TO 545D)
545B. How long after the fever/cough started did (NAME) first take Fansidar/SP?
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8
545C. For how many days did (NAME) take the Fansidar/SP?
IF 7 OR MORE DAYS RECORD '7'
DON'T KNOW 8
CODE B NOT CIRCLED (GO TO 545G)
545E. How long after the fever/cough started did (NAME) first take Choloroquine?
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8
545F. For how many days did (NAME) take the Chloroquine?
IF 7 OR MORE DAYS RECORD '7'
DON'T KNOW 8
CODE C NOT CIRCLED (GO TO 545J)
545H. How long after the fever/cough started did (NAME) first take Artemether-Lumefantrine?
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8
545I. For how many days did (NAME) take the Aremether-Lumefantrine?
IF 7 OR MORE DAYS RECORD '7'
DON'T KNOW 8
CODE D NOT CIRCLED (GO TO 546)
545K. How long after the fever/cough started did (NAME) first take Quinne?
NEXT DAY 1
TWO DAYS AFTER FEVER STARTED 2
THREE DAYS AFTER FEVER STARTED 3
FOUR OR MORE DAYS AFTER FEVER STARTED 4
DON'T KNOW 8
545L. For how many days did (NAME) take the Quinine?
IF 7 OR MORE DAYS RECORD '7'
DON'T KNOW 8
546. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 547
547. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 1992 E.C. OR LATER LIVING WITH THE RESPONDENT
NONE (GO TO 550)
548. 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
549. CHECK 525(a) ALL COLUMNS:
ANY CHILD RECEIVED FLUID FROM ORS PACKET (GO TO 551)
550. Have you ever heard of a special product called ORS (like LEMLEM) that you can get for treatment of diarrhea?
NO 2
551. Now I would like to ask you some questions about medical care for you 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
554. Now I would like to ask you some questions about any injections you have had in the last 12 months. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAY FOR 3 MONTHS OR MORE, RECORD '90' IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 557A)
555. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 557A)
556. The last time you had an injection given to you by a health worker, where did you go to get the injection?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
COMMUNITY HEALTH AGENT 14
OTHER PUBLIC (SPECIFY) ________16
DENTAL CLINIC/OFFICE 32
PHARMACY 33
OFFICE OR HOME OF NURSE/HEALTH WORKER 34
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36
OTHER (SPECIFY) _____________ 96
557. Did the person who gave you that injection take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
557A. Do you have a tetanus injection card(s)?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 558)
NO CARD 3 (GO TO 558)
557B. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD STARTING WITH THE MOST RECENT. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.
MONTH____
YEAR____
558. Do you currently smoke cigarettes?
NO 2 (GO TO 560)
559. In the last 24 hours, how many cigarettes did you smoke?
560. Do you currently smoke or use any other type of tobacco like gaya, shisha or suret?
NO 2 (GO TO 562)
561. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED
CHEWING TOBACCO B
SNUFF/SURET C
SHISHA D
GAYA E
OTHER (SPECIFY) _______X
562. Have you ever head of an illness called tuberculosis or TB?
NO 2 (GO TO 566)
563. How does tuberculosis spread from one person to another?
PROBE: 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
564. Can tuberculosis be cured?
NO 2
DON'T KNOW 8
565. 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
DOES NOT HAVE ANY CHILDREN BORN IN 1994 E.C. OR LATER AND LIVING WITH HER (GO TO 601)
567. Now I would like to ask you about the foods and liquids you had yesterday during the day or at night, either separately or combined with other foods or liquids. Did (YOU) eat or drink:
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
SECTION 6. MARRIAGE AND SEXUAL ACTIVITY
601. Are you currently married or living together with a man as if married?
YES, LIVING WITH A MAN 2 (GO TO 605)
NO, NOT IN UNION 3
602. Have you ever been married or lived together with a man as if married?
YES, LIVED WITH A MAN 2 (GO TO 604)
NO 3
603. ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO MESKEREM 1992. (GO TO 614)
604. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 610)
SEPARATED 3 (GO TO 610)
605. Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
606. RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'
607. Besides yourself, does your husband/partner have other wives or does he live with women other than his wives as if married?
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)
608. How many other wives or partners does your husband live with now?
DON'T KNOW 98
609. Are you the first, second, ...wife?
IF Q.608 IS DON'T KNOW: Do you know your rank?
IF YES: Are you the first, second, ...wife
DON'T KNOW 98
610. Have you been married or lived with a man only once or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A MAN ONLY ONCE: In what month and year did you start living with your husband/partner?
MARRIED./LIVED WITH A MAN MORE THAN ONCE: Now I would like to ask about when you started living with your first husband/partner. In what month and year was that?
DON'T KNOW MONTH ___ ___
DON'T KNOW YEAR 9998
612. How old were you when you first started living with him?
613. DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE MESKEREM 1992. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER 'O' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE MESKEREM 1992.
FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
613A. CHECK 604:
IS RESPONDENT CURRENTLY WIDOWED?
WIDOWED 9GO TO 613D)
MARRIED ONLY ONCE (GO TO 614)
613C. How did your previous marriage or union end?
DIVORCE 2 (GO TO 614)
SEPARATION 3 (GO TO 614)
613D. Who did most of your late husband's property go to?
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4sur
EQUAL SHARE WITH OTHERS 5
OTHER (SPECIFY)_________ 6
NO PROPERTY 7
613E. Did you receive any of your late husband's assets or valuables?
NO 2
614. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
615. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when you had sexual intercourse for the very first time (if ever)?
AGE IN YEARS ___ ___ (GO TO 616A)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (GO TO 616A)
616. Do you intend to wait until you get married to have sexual intercourse for the first time?
NO 2 (GO TO 637)
DON'T KNOW/UNSURE 8 (GO TO 637)
HOUSEHOLD NOT SELECTED FOR MALE SURVEY (GO TO 637)
25-49 YEARS OLD (GO TO 622)
618. The first time you had sexual intercourse, was a condom used?
NO 2
DON'T KNOW/DON'T REMEMBER 8
619. How old was the person you first had sexual intercourse with?
DON'T KNOW 98
620. Was this person older than you, younger than you, or about same age as you?
YOUNGER 2 (GO TO 622)
ABOUT THE SAME AGE 3 (GO TO 622)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 622)
621. Would you say this person was ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
622. When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS
WEEKS AGO 2 ___ ___ (GO TO 624)
MONTHS AGO 3 ___ ___ (GO TO 624)
YEARS AGO 4 ___ ___ (GO TO 636)
623. When was the last time you had sexual intercourse with this other person?
[FOR ALL SEXUAL PARTNERS EXCEPT THE LAST PARTNER]
WEEKS AGO 2 ___ ___
MONTHS AGO 3 ___ ___
624. The last time you had sexual intercourse (with this other person), was a condom used?
NO 2 (GO TO 626)
625. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?
NO 2
626. What was your relationship to this person with whom you had sexual intercourse?
IF BOYFRIEND/GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'. IF NO, CIRCLE '03'
LIVE-IN PARTNER 02 (GO TO 632)
BOYFRIEND/GIRLFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANCE 04
COMMERCIAL SEX WORKER 05
OTHER (SPECIFY)___________ 96
627. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS
25-49 YEARS OLD (GO TO 632)
DON'T KNOW 98
630. Is this person older than you, younger than you, or about the same age?
YOUNGER 2 (GO TO 632)
ABOUT THE SAME AGE 3 (GO TO 632)
DON'T KNOW 8 (GO TO 632)
631. Would you say this person is ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
632. The last time you had sexual intercourse (with this other person), did you or this person drink alcohol?
NO 2 (GO TO 634 FOR LAST SEXUAL PARTNER; GO TO 635 FOR ALL OTHER PARTNERS)
633. Where you or your partner drunk at that time?
IF YES: Who was drunk?
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4
634. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
[FOR LAST SEXUAL PARTNER ONLY]
NO 2 (GO TO 636)
635. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'
DON'T KNOW 98
636. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.
DON'T KNOW 98
637. Do you know a place where a person can get condoms?
NO 2 (GO TO 701)
638. Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
CBD/CBRHA H
OTHER NGO ______ I
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
SHOP N
FRIEND/RELATIVE O
639. If you wanted to, could you yourself get a condom?
NO 2
DON'T KNOW/UNSURE 8
SECTION 7. FERTILITY PREFERENCES
HE OR SHE STERILIZED (GO TO 713)
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 704)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 713)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 709
UNDECIDED/DON'T KNOW AND NOT PREGNANT OR UNSURE 5 (GO TO 708)
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 993 (GO TO 708)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 713)
AFTER MARRIAGE 995 (GO TO 708)
OTHER (SPECIFY) _________ 996 (GO TO 708)
DON'T KNOW 998 (GO TO 708)
PREGNANT (GO TO 709)
705. CHECK 310:
USING A CONTRACEPTIVE METHOD?
NOT CURRENTLY USING (GO TO 706)
CURRENTLY USING (GO TO 713)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 707)
00-23 MONTHS OR 00-01 YEAR (GO TO 709)
WANTS TO HAVE A/ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
WANTS NO MORE/NONE: You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
RECORD ALL REASONS MENTIONED.
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
METHOD NOT AVAILABLE U
DON'T KNOW Z
708. CHECK 310:
USING A CONTRACEPTIVE METHOD?
NO, NOT CURRENTLY USING (GO TO 709)
YES, CURRENTLY USING (GO TO 713)
709. Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 711)
DON'T KNOW 8 (GO TO 711)
710. Which contraceptive method would you prefer to use?
MALE STERILIZATION 02 (GO TO 713)
PILL 03 (GO TO 713)
IUD 04 (GO TO 713)
INJECTABLES 05 (GO TO 713)
IMPLANTS 06 (GO TO 713)
CONDOM 07 (GO TO 713)
DIAPHRAGM/FOAM/JELLY 09 (GO TO 713)
STANDARD DAYS METHOD 10 (GO TO 713)
LACTATIONAL AMEN. METHOD 11 (GO TO 713)
RHYTHM METHOD 12 (GO TO 713)
WITHDRAWAL 13 (GO TO 713)
OTHER (SPECIFY) ____________ 96 (GO TO 713)
UNSURE 98 (GO TO 713)
711. What is the main reason that you think you will not use a contraceptive method at any time in future?
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 713)
SUBFECUND/INFECUND 24 (GO TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 713)
HUSBAND/PARTNER OPPOSED 32 (GO TO 713)
OTHERS OPPOSED 33 (GO TO 713)
RELIGIOUS PROHIBITION 34 (GO TO 713)
KNOWS NO SOURCE 42 (GO TO 713)
FEAR OF SIDE EFFECTS 52 (GO TO 713)
LACK OF ACCESS/TOO FAR 53 (GO TO 713)
COSTS TOO MUCH 54 (GO TO 713)
INCONVENIENT TO USE 55 (GO TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 713)
METHOD NOT AVAILABLE 57 (GO TO 713)
DON'T KNOW 98 (GO TO 713)
712. Would you ever use a contraceptive method if you were married?
NO 2
DON'T KNOW 8
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and 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 715)
714. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
OTHER (SPECIFY)____ 98
OTHER (SPECIFY)____ 98
OTHER (SPECIFY)____ 98
715. In the last few months have you heard about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
YES, LIVING WITH A MAN (GO TO 718)
NO, NOT IN UNION (GO TO 723)
CODE B, OR G, OR L CIRCLED (GO TO 720)
NO CODE CIRCLED (GO TO 722)
719. Does your husband/partner know that you are using a method of family planning?
NO 2
DON'T KNOW 8
720. Would you say that using contraception is mainly your decision, mainly your husband's/partner's decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) ___________ 6
HE OR SHE STERILIZED (GO TO 723)
722. Do you think your husband/partner 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
723. Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
723A. When a wife knows her husband has a disease that can be transmitted through sexual contact, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
NOT IN UNION (GO TO 801)
723C. Can you say no to your husband/partner if you do not want to have sexual intercourse?
NO 2
DEPENDS/UNSURE 8
723D. Could you ask your husband/partner to use a condom if you wanted him to?
NO 2
DEPENDS/UNSURE 8
SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK
FORMERLY MARRIED/LIVED WITH A MAN (GO TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (GO TO 807)
802. How old was your husband/partner on his last birthday?
803. Did your (last) husband/partner ever attend school?
NO 2 (GO TO 806)
805. What was the highest grade he completed?
TECHNICAL/VOCATIONAL CERTIFICATE 13
UNIVERSITY/COLLEGE DIPLOMA 14
UNIVERSITY/COLLEGE DEGREE 15
DON'T KNOW 98
CURRENTLY MARRIED/LIVING WITH A MAN: What is your husband's/partner's occupation? That is, what kind of work does he mainly do?
FORMERLY MARRIED/LIVED WITH A MAN: What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?
807. Aside from your own housework, have you done any work in the last seven days?
NO 2
808. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?
NO 2
809. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?
NO 2
810. Have you done any work in the last 12 months?
NO 2
810A. What have you been doing for most of the time over the last 12 months?
LOOKING FOR WORK 02 (GO TO 818)
RETIRED 03 (GO TO 818)
TOO ILL TO WORK 04 (GO TO 818)
HANDICAPPED, CANNOT WORK 05 (GO TO 818)
HOUSEWORK/CHILD CARE 06 (GO TO 818)
OTHER (SPECIFY) ___________ 96 (GO TO 818)
811. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 814)
813. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
DOES NOT WORK ON LAND 5
814. 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
815. Do you usually work at home or away from home?
AWAY 2
816. 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
817. 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
NOT IN UNION (GO TO 825)
OTHER/NOT ASKED (GO TO 822)
820. Who decides how the money you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6
821. Would you say that the money that you bring into the household is more than what your husband/partner brings in, less than what he brings in, or about the same?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (GO TO 823)
DON'T KNOW 8
822. Who decides how your husband's/partner's earnings will be used: mainly you, mainly your husband/partner, or you your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4
OTHER 6
823. Who usually makes decisions about health care for yourself: mainly you, mainly your husband/partner, you and your husband/partner jointly, or someone else?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
Who usually makes decisions about making major household purchases?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
Who usually makes decisions about making purchases for daily household needs?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
Who usually makes decisions about visits to your family or relatives?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
825. 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
SECTION 9. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
901. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 917)
902. 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
903. Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
904. 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
905. Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
906. Can people reduce their chance of getting the AIDS virus by abstaining from sexual intercourse?
NO 2
DON'T KNOW 8
907. Can people get the AIDS virus because of the curse of God or other supernatural means?
NO 2
DON'T KNOW 8
908. Is there anything else a person can do to avoid or reduce the chances of getting the AIDS virus?
NO 2 (GO TO 910)
DON'T KNOW 8 (GO TO 910)
909. What can a person do? 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 PERSON 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) _____________W
OTHER (SPECIFY) _____________ X
DON'T KNOW __________________ Z
910. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
HOUSEHOLD NOT SELECTED FOR MALE SURVEY (GO TO 911)
910B. Can the virus that causes AIDS 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
OTHER (GO TO 910E)
910D. Are there any special medications that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to her baby?
NO 2
DON'T KNOW 8
910E. Is there any special medication that people infected with the AIDS virus can get from a doctor or a nurse?
NO 2
DON'T KNOW 8
NO BIRTHS (GO TO 910O)
LAST BIRTH BEFORE MESKEREM 1995 (GO TO 910O)
910G CHECK 407:
SEE ANYONE FOR ANTENATAL CARE DURING THAT PREGNANCY?
NO ONE (GO TO 910O)
910H. During any of the antenatal visits for that pregnancy, did anyone talk to you about:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
910I. Were you offered a test for the AIDS virus as part of your antenatal care?
NO 2
910J. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?
NO 2 (GO TO 910O)
910K. I don't want to know the results, but did you get the results of the test?
NO 2
910L. Where was the test done?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE DOW THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12
VCT CENTER 13
GOVERNMENT HEALTH POST 14
FAMILY PLANNING CLINIC 15
STAND-ALONE VCT CENTER 16
OTHER PUBLIC (SPECIFY) ________17
STAND-ALONE VCT CENTER 22
STAND ALONE VCT CENTER 32
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36
910M. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?
NO 2
910N. When was the last time you were tested for the AIDS virus?
12-23 MONTHS AGO 2 (GO TO 912A)
2 OR MORE YEARS AGO (GO TO 912A)
910O. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 911)
910P. When was the last time you were tested?
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO
910Q. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
910R. I don't want to know the results, but did you get the result of the test?
NO 2
910S. Where was the test done?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12
VCT CENTER 13
GOVERNMENT HEALTH POST 14
FAMILY PLANNING CLINIC 15
STAND ALONE VCT CENTER 16
OTHER PUBLIC (SPECIFY) ________17
STAND ALONE VCT CENTER 22
STAND ALONE VCT CENTER 32
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ 36
911. Do you know of a place where people can go to tested for the virus that causes AIDS?
NO 2 (GO TO 912A)
912. Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.
GOVERNMENT HEALTH CENTER B
VCT CENTER C
GOVERNMENT HEALTH POST D
FAMILY PLANNING CLINIC E
STAND ALONE VCT CENTER F
OTHER PUBLIC (SPECIFY) ________G
STAND ALONE VCT CENTER I
STAND ALONE VCT CENTER K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
912A. In the last few months have you heard or seen the following media messages on HIV/AIDS?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
913. 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
914. If a member of your family got infected with the AIDS virus, would you want it remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
915. 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
916. 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
HOUSEHOLD NOT SELECTED FOR MALE SURVEY (GO TO 917)
916B. Do you personally know someone who is suspected to have the AIDS virus or who has the AIDS virus?
NO 2 (GO TO 916F)
916C. Do you personally know someone who has been denied health services in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?
NO 2
916D. Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?
NO 2
916E. Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?
NO 2
916F. Do you agree or disagree with the following statement:
People with the AIDS virus should be ashamed of themselves.
DISAGREE 2
DON'T KNOW/NO OPINION 8
916G. Do you agree or disagree with the following statement:
People with the AIDS virus should be blamed for bringing the disease into the community.
DISAGREE 2
DON'T KNOW/NO OPINION 8
916H. Should children age 12-14 be taught about using a condom to avoid AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
916I. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
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
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 1001)
919. CHECK 917:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO 2 (GO TO 921)
920. 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
921. 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
922. 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
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 1001)
924. The last time you had (PROBLEM FROM 920/921/922), did you seek any kind of advice or treatment?
NO 2 (GO TO 1001)
925. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED
GOVERNMENT HEALTH CENTER B
VCT CENTER C
GOVERNMENT HEALTH POST D
FAMILY PLANNING CLINIC E
STAND ALONE VCT CENTER F
OTHER PUBLIC (SPECIFY) ________G
STANDALONE VCT CENTER I
STAND ALONE VCT CENTER K
PHARMACY L
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ M
SHOP O
TRADITIONAL HEALER P
OTHER (SPECIFY) _____________ X
SECTION 10. HARMFUL TRADITIONAL PRACTICES
1001. Have you ever heard of female circumcision?
IF NO PROBE: Have you ever heard of the practice in which a girl may have parts of her genitals cut?
NO 2 (GO TO 1011)
1002. Have you yourself ever been circumcised?
NO 2 (GO TO 1004)
DON'T KNOW 8 (GO TO 1004)
1003. In some parts of Ethiopia, there is a type of circumcision where the genital area is sewn closed. Was it done to you?
NO 2
DON'T KNOW 8
HAS MORE THAN ONE LIVING DAUGHTER (GO TO 1005)
HAS NO LIVING DAUGHTER (GO TO 1010)
ONE LIVING DAUGHTER: Has your daughter been circumcised?
IF YES: RECORD '01'
MORE THAN ONE LIVING DAUGHTER: Have any of your daughters been circumcised?
IF YES: How many?
RECORD THE NUMBER
NO DAUGHTER CIRCUMCISED 95 (GO TO 1010)
1006. To which of your daughters did this happen (most recently)?
CHECK 212 AND RECORD THE LINE NUMBER FOR THE DAUGHTER.
1007. Was (NAME OF DAUGHTER FROM 1006)'s genital area sewn closed?
NO 2
DON'T KNOW 8
1008. How old was (NAME) when this occurred?
IF THE RESPONDENT DOES NOT KNOW THE AGE, PROBE TO GET AN ESTIMATE.
DURING INFANCY 95
DON'T KNOW 98
TRADITIONAL BIRTH ATTENDANT 2
OTHER TRADITIONAL (SPECIFY) ________ 3
DON'T KNOW 8
1010. Do you think that this practice should be continued or should it be discontinued?
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8
1011. Have you ever heard of uvulectomy/tonsillectomy?
IF NO PROBE: Have you ever heard of the practice in which a child may have parts of her or his uvula cut or tonsils scraped?
NO 2 (GO TO 1016)
1012. Have you yourself ever had an uvulectomy or tonsillectomy?
NO 2
DON'T KNOW 8
HAS NO LIVING CHILD (GO TO 1015)
1014. Have any of your children ever had an uvulectomy or tonsillectomy?
IF YES: How many?
NO CHILD 95
1015. Do you think that this practice should be continued or should it be discontinued?
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8
1016. Have you ever heard of marriage by abduction?
IF NO PROBE: Have you ever heard of the practice in which a girl is abducted and forced into marriage?
NO 2 (GO TO 1021)
NEVER MARRIED/NEVER IN UNION (GO TO 1018)
1017. Were you yourself married by abduction?
NO 2
HAS NO LIVING DAUGHTER/DAUGHTER BELOW AGE 10 (GO TO 1020)
1019. Have any of your daughters ever been married by abduction?
IF YES: How many?
NO DAUGHTER 95
1020. Do you think that this practice should be continued or should it be discontinued?
DISCONTINUED 2
DEPENDS 3
DON'T KNOW 8
1021. Have you ever heard of obstetric fistula (USE LOCAL TERM)?
IF NO PROBE: Have you ever heard of a condition in which a woman continuously leaks urine and /or faeces following childbirth?
NO 2 (GO TO 1101)
1022. Have you yourself experienced obstetric fistula?
NO 2 (GO TO 1024)
1023. Have you ever been treated for obstetric fistula?
NO 2
1024. Are there any (other) women in your household who suffer from obstetric fistula?
NO 2 (GO TO 1101)
1025. How many (other) women in your household suffer from obstetric fistula?
DON'T KNOW 98
SECTION 11. MATERNAL MORTALITY
1101. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died. How many children did your mother give birth to, including you?
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 1114)
1103. How many of these births did your mother have before you were born?
1104. What was the name given to your oldest (next oldest) brother or sister?
1105. Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 1108)
DON'T KNOW 8 (GO TO NEXT SIBLING)
1108. How many years ago did (NAME) die?
1109. How old was (NAME) when he/she died?
1110. Was (NAME) pregnant when she died?
NO 2
1111. Did (NAME) die during childbirth?
NO 2
1112. Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2
1113. How many live born children did (NAME) give birth to during her lifetime (before this pregnancy)?
IF NO MORE BROTHERS OR SISTERS, GO TO 1114
EVENING 2
MINUTES ___ ___
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:_______________________________________
COMMENTS ON SPECIFIC QUESTIONS:_______________________________________
ANY OTHER COMMENTS:________________________________________________
SUPERVISOR'S OBSERVATIONS:______________________________________________
NAME OF THE SUPERVISOR: _______________________________ DATE:_____________________________
EDITOR'S OBSERVATIONS:_____________________________________________
NAME OF THE EDITOR: _______________________________ DATE:_____________________________
INSTRUCTIONS:
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN
COL 1: BIRTHS, PREGNANCIES, CONTRACEPTIVE USE
P PREGNANCIES
T TERMINATIONS
0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 DIAPHRAGM/FOAM/JELLY
9 STANDARD DAYS METHOD
J LACTATIONAL AMENORRHEA METHOD
K RHYTHM METHOD
L WITHDRAWAL
X OTHER (SPECIFY) _________________
COL 2: SOURCE OF CONTRACEPTION
2 GOV'T HEALTH CENTER
3 GOV'T HEALTH POST
4 GOV'T HEALTH STATION/CLINIC
5 CBD
6 OTHER PUBLIC
7 NON-GOV'T HEALTH FACILITY
8 NON-GOV'T CBD/CBRHA
9 OTHER NGO
A PVT HOSPITAL/CLINIC/DOCTOR
B PHARMACY
C OTHER PRIVATE MEDICAL
D DRUG VENDOR
E SHOP
F FRIENDS/RELATIVES
X OTHER (SPECIFY) ______________
COL 3: DISCONTINUATION OF CONTRACEPTIVE USE
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER 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
M METHOD NOT AVAILABLE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARTIAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ______________
Z DON'T KNOW
COL 4: MARRIAGE/UNION
0 NOT IN UNION
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
05 TIRR 09 ______ _______ _______ _____
04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____
12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
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10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
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11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
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04 TAH 10 ______ _______ _______ _____
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12 NEH 02 ______ _______ _______ _____
11 HAM 03 ______ _______ _______ _____
10 SENE 04 ______ _______ _______ _____
09 GEN 05 ______ _______ _______ _____
08 MEI 06 ______ _______ _______ _____
07 MEG 07 ______ _______ _______ _____
06 YEK 08 ______ _______ _______ _____
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04 TAH 10 ______ _______ _______ _____
03 HID 11 ______ _______ _______ _____
02 TIK 12 ______ _______ _______ _____
01 MES 13 ______ _______ _______ _____