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DEMOGRAPHIC AND HEALTH SURVEY
REPUBLIC OF GABON 2000 -- WOMAN'S QUESTIONNAIRE

GENERAL MANAGEMENT OF STATISTICS AND ECONOMIC STUDY

IDENTIFICATION

NAME OF LOCATION____

NAME OF HEAD OF HOUSEHOLD_____

EDSG CODE______

STRUCTURE NUMBER______

HOUSEHOLD NUMBER IN STRUCTURE_____

EDSG REGION______

PROVINCE___________

DEPARTMENT______

URBAN-RURAL MILIEU

URBAN 1
RURAL 2

RESIDENCE:

LIBREVILLE-PORT-GENTIL 1
OTHER CITIES 2
RURAL 3

WOMAN'S NAME AND LINE NUMBER (FROM HOUSEHOLD QUESTIONNAIRE)____

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME____
RESULT

RESULT CODES

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)

FINAL VISIT
DAY_____
MONTH_____
YEAR 2000
NAME_____
RESULT_____

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE____
TIME____

TOTAL NO. OF VISITS_____

SUPERVISOR
NAME_____
DATE____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____

KEYED BY______

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

HOUR____
MINUTES___

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Libreville, Port Gentil, in another city, in a rural location, or abroad?

LIBREVILLE 1
PORT GENTIL 2
OTHER CITIES 3
RURAL 4
ABROAD 5

103) How long have you been living continuously in (Name of current place of residence)?
If less than one year, record '00' years.

YEARS____

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104) Just before you moved here, did you live in Libreville, Port Gentil, in another city, in a rural location, or abroad?

LIBREVILLE 1
PORT GENTIL 2
OTHER CITIES 3
RURAL 4
ABROAD 5

105) In what month and year were you born?

MONTH
DON'T KNOW MONTH 98
YEAR 19_____
DON'T KNOW YEAR 9998

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 if INCONSISTENT.
IF RESPONDENT IS UNDER 15 OR OVER 49 YEARS OLD, STOP THE INTERVIEW AND MAKE THE APPROPRIATE CORRECTIONS TO THE HOUSEHOLD QUESTIONNAIRE.

AGE IN COMPLETED YEARS______

107) Have you ever attended school?

YES 1 (GO TO 108)
NO 2

107A) Did you go to a reading center?

YES 1 (GO TO 114)
NO 2 (GO TO 114)

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

PRIMARY 1
SECONDARY 1st CYCLE 2
SECONDARY 2nd CYCLE 3
HIGHER 4

109) What is the highest (grade/form/year) you completed at this level?

PRIMARY=1
0=LESS THAN ONE YEAR COMPLETED
1=CP1
2=CP2
3=CE1
4=CE2
5=CM1
6=CM2
SECONDARY 1st CYCLE/SECONDARY TECHNICAL=2
0=LESS THAN ONE YEAR COMPLETED
1=6th/1st YEAR
2=5th/2nd YEAR
3=4th/3rd YEAR
4=3rd /4th YEAR
SECONDARY 2nd CYCLE/TECHNICAL HIGH SCHOOL=3
0=LESS THAN ONE YEAR COMPLETED
1=2nd/1st YEAR
2=1st/2nd YEAR
3=FINAL/3rd YEAR
HIGHER=4
0=LESS THAN ONE YEAR COMPLETED
1=1st YEAR
2=2nd YEAR
3=3rd YEAR
4=4th YEAR +

110) CHECK 106:

24 YEARS OR YOUNGER (GO TO 111)
25 YEARS OR OLDER (GO TO 113)

111) Are you currently attending school?

YES 1 (GO TO 113)
NO 2

112) What is the main reason for which you stopped attending school?

GOT MARRIED 01
GOT PREGNANT 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP AT WORK 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
HAD ENOUGH SCHOOLING 07
DID NOT LIKE SCHOOL 08
SCHOOL NOT ACCESSIBLE/TOO FAR 09
HEALTH REASONS 10
OTHER (SPECIFY) 96
DON'T KNOW 98

113) CHECK 108:

PRIMARY (GO TO 114)
SECONDARY OR HIGHER (GO TO 115)

114) Now I would like you to read this sentence out loud to me; read as much as you can.
SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1 (GO TO 116)
CAN READ CERTAIN PARTS 2
CAN READ THE WHOLE SENTENCE 3
NO CARD IN LANGUAGE 4

115) Do you read a newspaper or a magazine almost every day, at least once a week, less than once a week, or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

116) Do you usually listen to the radio?

YES 1
NO 2 (GO TO 117)

116A) Do you listen to the radio every day or almost every day?

YES 1
NO 2 (GO TO 117)

116B) What days of the week do you normally listen to the radio?
RECORD ALL RESPONSES GIVEN. IF THE RESPONSE IS "IT DEPENDS," "IT DOESN'T MATTER," OR "DON'T KNOW", YOU ONLY NEED TO RECORD ONE CODE.

MONDAY A
TUESDAY B
WEDNESDAY D
THURSDAY E
FRIDAY F
SATURDAY G
SUNDAY H
IT DEPENDS/DOESN'T MATTER X
DON'T KNOW Z

116C) What time do you normally listen to the radio?
RECORD ALL RESPONSES GIVEN. IF THE RESPONSE IS "ALL DAY", "IT DEPENDS," "IT DOESN'T MATTER," or "DON'T KNOW", YOU ONLY NEED TO RECORD ONE CODE.

BEFORE 8 O'CLOCK (EARLY MORNING) A
FROM 8 TO 12 O'CLOCK (MORNING) B
FROM 12 TO 14 O'CLOCK (NOON) C
FROM 14 TO 18 O'CLOCK (AFTERNOON) D
FROM 18 TO 20 O'CLOCK (EVENING) E
AFTER 20 O'CLOCK (NIGHT) F
ALL DAY LONG G
IT DEPENDS/DOESN'T MATTER X
DON'T KNOW Z

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

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

118) What is your religion?

CATHOLIC 1
PROTESTANT 2
OTHER CHRISTIAN 3
ISLAM 4
ANIMIST 5
OTHER 6
NO RELIGION 7

119) What is your nationality?

GABONESE 01 (GO TO 201)
CAMEROONIAN 02 (GO TO 201)
CONGOLESE (BRAZZA) 03 (GO TO 201)
CONGOLESE (KINSHA) 04 (GO TO 201)
EQUATORIAL GUINEAN 05 (GO TO 201)
BENINESE 06 (GO TO 201)
MALIAN 07 (GO TO 201)
NIGERIAN 08 (GO TO 201)
SENEGALESE 09 (GO TO 201)
TOGOLESE 10 (GO TO 201)
OTHER AFRICAN 11 (GO TO 201)
FRENCH 12 (GO TO 201)
LEBANESE 13 (GO TO 201)
OTHER 96 (GO TO 201)

119A) Are you originally from Gabon?

YES 1
NO 2 (GO TO 201)

120) What is your ethnicity?

FANG 01
KOTA-KELE 02
MBEDE-TEKE 03
MYENE 04
NZABI-DUMA 05
OKANDE-TSOGHO 06
SHIRA-PUNU/VILI 07
PYGMEE 08
OTHER 96

SECTION 2: REPRODUCTION

201) Now I would like to ask you about all the births you have had during your life. Have you ever given birth?

YES 1
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?

YES 1
NO 2 (GO TO 204)

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

SONS AT HOME ______
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?

YES 1
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'

SONS ELSEWHERE_______
DAUGHTERS ELSEWHERE _______

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

YES 1
NO 2 (GO TO 208)

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

BOYS DEAD_________
GIRLS DEAD ________

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

TOTAL _____

209) CHECK 208:
Just to Make sure that I have this right: you have had in total ______births during your life. Is that correct?

YES ____
NO ____ (PROBE AND CORRECT 201-208 AS NECESSARY)

210) CHECK 208

ONE OR MORE BIRTHS (GO TO 211)
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.

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

NAME____

213) Were any of these births twins?

SING 1
MULT 2

214) Is (NAME) a boy or a girl?

BOY 1
GIRL 2

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

MONTH
YEAR

216) Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

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

AGE IN YEARS____

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

YES 1 (GO TO NEXT BIRTH)
NO 2 (GO TO NEXT BIRTH)

219) 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.

DAYS 1_____
MONTHS 2____
YEARS 3____

220) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

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

YES 1
NO 2

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

NUMBERS ARE SAME
CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS 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: PROBE TO DETERMINE EXACT NUMBER OF MONTHS
NUMBERS ARE DIFFERENT (PROBE AND RECONCILE)

224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE 1995 OR LATER.
IF NONE, RECORD '0'

NUMBER___

226) Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

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?

THEN 1
LATER 2
NOT AT ALL 3

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

YES 1
NO 2-GO TO 246

230) When did the last such pregnancy end?

MONTH____
YEAR____

231) CHECK 230:

LAST PREGNANCY ENDED IN JAN 1995 OR LATER (GO TO 232)
LAST PREGNANCY ENDED BEFORE JAN. 1995 (GO TO 245)

232) How many months pregnant were you when the last such pregnancy ended?

MONTHS____

233) Was this pregnancy terminated due to an elective abortion?

YES 1
NO 2 (GO TO 244)

234) Did you yourself decide to have this abortion, or were you pushed or forced by someone else to have this abortion?

DECIDED HERSELF 1 (GO TO 236)
SOMEONE ELSE 2

235) Who pushed or forced you to have this abortion?

HEALTH PROFESSIONAL 1
FATHER 2
MOTHER 3
HUSBAND/PARTNER 4
FRIEND(S) 5
OTHER 6

236) What is the main reason you decided to end this pregnancy?

HEALTH PROBLEMS 01
TOO YOUNG TO HAVE A CHILD 02
TOO OLD TO HAVE A CHILD 03
ALREADY HAS TOO MANY CHILDREN 04
BIRTHS TOO CLOSE TOGETHER 05
AFRAID OF PARENTS 06
HUSBAND/PARTNER DIDN'T WANT CHILD 07
TO PURSUE EDUCATION 08
TO CONTINUE WORKING 09
ECONOMIC DIFFICULTIES/LACK OF MONEY 10
OTHER 96

237) Can you tell me what means or procedures were used to terminate this pregnancy?

DILATION AND CURETTAGE A
SUCTION B
PROBE C
INJECTIONS D
PILLS E
PLANTS/INFUSION F
OTHER X
DON'T KNOW Z

238) Where did the abortion take place?

PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER 11
MILITARY NURSE 12
MOTHER-INFANT HEALTH CENTER 13
FREE CLINIC 14
HEALTH OUTPOST 15
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL 21
SOCIAL SECURITY MEDICAL-SOCIAL CENTER 22
PRIVATE MEDICAL SECTOR
CLINIC 31
PRIVATE DOCTOR'S OFFICE 32
HEALTH CLINIC/NURSE 33
HOME
OWN HOUSE 41
ABORTIONIST'S/NGANGA'S HOUSE 41
OTHER HOUSE 46
OTHER PLACE 96

239) CHECK 238:

CODES 11 TO 22 OR 42 CIRCLED: Who helped you at the time of the abortion?
PROBE: Anyone else?

CODES 41, 46, OR 96 CIRCLED: Was anyone present to help you during the abortion?
IF YES: Who helped you at the time of the abortion?
PROBE: Anyone else?

PROBE TO DETERMINE THE TYPE OF PERSON.
RECORD ALL PERSONS LISTED

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE C
NURSE'S ASSISTANT D
OTHER HEALTH PERSONNEL
MATRON E
VILLAGE HEALTH AGENT/TRAINED TRADITIONAL BIRTH ATTENDANT (WITH BOX) F
WARD ASSISTANT/STRETCHER BEARER G
OTHER PERSONS
UNTRAINED TRADITIONAL BIRTH ATTENDANT (WITHOUT BOX) H
ABORTIONIST I
TRADITIONAL PRACTITIONER/MARABOU J
RELATIVES/FRIENDS K
OTHER X
NONE/NO ONE Y

240) How much did the abortion cost in total?
IF THE ABORTION DIDN'T COST ANYTHING, RECORD 000000

PRICE IN CFA________
DON'T KNOW 999998

241) After the abortion, did you have a consultation?

YES 1
NO 2 (GO TO 243)

242) Who consulted with you?
PROBE: Anyone else?
PROBE TO OBTAIN THE TYPE OF PERSON.
RECORD ALL PERSONS LISTED

HEALTH PROFESSIONAL
GYNECOLOGIST A
OTHER DOCTOR B
MIDWIFE C
NURSE D
NURSE'S ASSISTANT E
OTHER PERSONS X

243) After the abortion, did you have any complications, like, for example, bleeding or an infection?

YES 1
NO 2

244) Have you had any other pregnancies that did not result in a live birth?

YES 1
NO 2 (GO TO 246)

245) All together, how many pregnancies have you had that were not terminated by an elective abortion?
IF NONE, RECORD 00

NUMBER OF PREGNANCIES

246) Check 229, 233, 244, and 245:

233=YES OR 245=1 OR MORE: AT LEAST 1 PREGNANCY TERMINATED BY AN ELECTIVE ABORTION (GO TO 247)

229=NO, OR 233 AND 244=NO, OR 245=NO: NO PREGNANCIES TERMINATED BY AN ELECTIVE ABORTION (GO TO 250)

247) How old were you when you had your (first) pregnancy that was terminated by an elective abortion?

AGE IN YEARS COMPLETED______

248) If you had another unwanted pregnancy, would you be prepared to have another abortion?

YES 1
NO 2
CANNOT GET PREGNANT ANYMORE 3
DON'T KNOW 8

249) In addition to the pregnancy/ies that ended through an elective abortion, did you have other failed abortion attempts?
IF YES: In addition to the pregnancy/ies that ended through an elective abortion, how many other abortions have you attempted?

NUMBER___ (GO TO 251)
NO 95 (GO TO 251)

250) In your life, have you had any failed abortions?
IF YES: In total, how many of these attempted abortions have you had?

NUMBER____
NO 95

251) When did you last menstrual period start?

(DATE, IF GIVEN)______
DAYS AGO 1_____
WEEKS AGO 2____
MONTHS AGO 3_____
YEARS AGO 4______

IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996 (GO TO 253)

252) How old were you when you had your first period?

AGE IN YEARS_____
DON'T KNOW 98

253) 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?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 8 (GO TO 301)

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

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAD ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning-the various ways or methods that a couple can use to delay or avoid a pregnancy.

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CONTINUE DOWN COLUMN 301A, 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 301A, ASK 302.

301A) Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (method)?

01) Female Sterilization: Women can have an operation to avoid having any more children
YES 1
NO 2
02) Male Sterilization: Men can have an operation to avoid having any more children
YES 1
NO 2
03) Pill: women can take a pill every day.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) Injectables: Women can have an injection by a heath provider which stops them from becoming pregnant one or more months.
YES 1
NO 2
06) Implants: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) Condom: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) Female condom: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) Diaphragm: Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10) Foam, jelly, or vaginal tablets: Women can place a suppository, a jelly or a cream in their vagina before intercourse.
YES 1
NO 2
11) Lactational amenorrhea method (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12) Rhythm or Periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13) Withdrawal: Men can be careful and pull out before climax.
YES 1
NO 2
14) Emergency contraception: Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
YES 1
NO 2

302) Have you ever used (method)?

01) Female Sterilization: Women can have an operation to avoid having any more children: Have you ever had a partner who had operation to avoid having any more children?
YES 1
NO 2
02) Male Sterilization: Men can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
03) Pill: women can take a pill every day.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) Injectables: Women can have an injection by a heath provider which stops them from becoming pregnant one or more months.
YES 1
NO 2
06) Implants: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) Condom: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) Female condom: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) Diaphragm: Women can place a thin flexible disk in their vagina before intercourse.
YES 1
NO 2
10) Foam, jelly, or vaginal tablets: Women can place a suppository, a jelly or a cream in their vagina before intercourse.
YES 1
NO 2
11) Lactational amenorrhea method (LAM): Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently, day and night, and that her menstrual period has not returned.
YES 1
NO 2
12) Rhythm or Periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13) Withdrawal: Men can be careful and pull out before climax.
YES 1
NO 2
14) Emergency contraception: Women can take pills up to three days after sexual intercourse to avoid becoming pregnant.
YES 1
NO 2
15) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
YES 1
NO 2
SPECIFY___

303) CHECK 302:

NOT A SINGLE 'YES' (NEVER USED) (GO TO 304)
AT LEAST ONE 'YES' (EVER USED) (GO TO 306)

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

YES 1
NO 2 (GO TO 315)

305) What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY)

306) 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'

NUMBER OF CHILDREN______

307) When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?

WANTED CHILD LATER 1
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY) 6

308) Check 302:

WOMAN NOT STERILIZED (GO TO 309)
WOMAN STERILIZED (GO TO 311)

309) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 310)
PREGNANT (GO TO 315)

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

YES 1
NO 2 (GO TO 315)

311) CHECK 302 (01)

WOMAN NOT STERILIZED: Which method are you using?

WOMAN STERILIZED: CIRCLE 01 FOR FEMALE STERILIZATION

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY/VAGINAL TABLETS 10
LACTATIONAL AMEN. METHOD 11
RHYTHM METHOD 12
WITHDRAWAL 13
OTHER (SPECIFY) 96

312) CHECK 311:

WOMAN OR MAN STERILIZED: In what month and year was the sterilization performed?

OTHER METHODS: Since what month and year have you been using (method from q 311) without stopping?

MONTH_____
YEAR____

312A) CHECK 311:

CODE 03 PILL (GO TO 312B)
OTHER CODES (GO TO 313)

312B) When you started using the pill for the first time, did you see a doctor, a midwife, or a nurse?

YES 1
NO 2

312C) When you obtained the pill for the first time, did you see a doctor, a midwife, or a nurse?

YES 1
NO 2

312D) CHECK 311:

CIRCLE METHOD CODE

FEMALE STERILIZATION 01
MALE STERILIZATION 02
PILL 03
IUD 04
INJECTABLES 05
IMPLANTS 06
CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY/VAGINAL TABLETS 10
LACTATIONAL AMEN. METHOD 11 (GO TO 315)
RHYTHM METHOD 12 (GO TO 315)
WITHDRAWAL 13 (GO TO 315)
OTHER METHOD 96 (GO TO 315)

314) CHECK 313:

WOMAN OR MAN STERILIZED: Where did the sterilization take place?

OTHER METHODS: Where did you obtain (METHOD FROM Q. 313) last time?

PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER 11 (GO TO 318)
MILITARY NURSE 12 (GO TO 318)
MOTHER-INFANT HEALTH CENTER 13 (GO TO 318)
FREE CLINIC 14 (GO TO 318)
HEALTH OUTPOST 15 (GO TO 318)
HOSPITAL PHARMACY/HEALTH CENTER 16 (GO TO 318)
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL 21 (GO TO 318)
SOCIAL SECURITY MEDICAL-SOCIAL CENTER 22 (GO TO 318)
SOCIAL SECURITY PHARMACY 23 (GO TO 318)
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC 31 (GO TO 318)
PRIVATE DOCTOR'S OFFICE 32 (GO TO 318)
HEALTH CLINIC/NURSE 33 (GO TO 318)
PRIVATE PHARMACY 34 (GO TO 318)
MARKET/SHOP/DISPLAY 41 (GO TO 318)
FRIENDS/RELATIVES 42 (GO TO 318)
OTHER PLACE 96 (GO TO 318)

315) Do you know a place where you can get a method of family planning?

YES 1
NO 2 (GO TO 318)

316) Where is this? Another place?
RECORD ALL MENTIONED

PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER A
MILITARY NURSE B
MOTHER-INFANT HEALTH CENTER C
FREE CLINIC D
HEALTH OUTPOST E
HOSPITAL PHARMACY/HEALTH CENTER F
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL G
SOCIAL SECURITY MEDICAL-SOCIAL CENTER H
SOCIAL SECURITY PHARMACY I
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC J
PRIVATE DOCTOR'S OFFICE K
HEALTH CLINIC/NURSE L
PRIVATE PHARMACY M
MARKET/SHOP/DISPLAY N
FRIENDS/RELATIVES O
OTHER PLACE X

318) In the last 12 months, have you visited a health facility for any reason?

YES 1
NO 2 (GO TO 320)

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

YES 1
NO 2

320) Do you think that breastfeeding can affect a woman's chances of becoming pregnant?

YES 1
NO 2 (GO TO 401)

321) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?

INCREASED 1 (GO TO 401)
DECREASED 2
DEPENDS 3
DON'T KNOW 8

322) CHECK 208:

AT LEAST ONE BIRTH (GO TO 323)
NO BIRTHS (GO TO 401)

323) Have you ever relied on breastfeeding as a method of avoiding pregnancy?

YES 1
NO 2 (GO TO 401)

324) CHECK 226 AND 311

NOT PREGNANT OR UNSURE AND NOT STERILIZED (GO TO 325)
EITHER PREGNANT OR STERILIZED (GO TO 401)

325) Are you currently relying on breastfeeding to avoid getting pregnant?

YES 1
NO 2

SECTION 4A. PREGNANCY, POSTNATAL CARE, AND BREASTFEEDING

401) CHECK 224:

ONE OR MORE BIRTHS SINCE JANUARY 1995 (GO TO 402)
NO BIRTHS SINCE JANUARY 1995 (GO TO 482)

402) ENTER IN THE TABLE THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE 1995. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRE).

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 Q. 212

LINE NUMBER_____

404) FROM 212 AND 216:

NAME_____
LIVING____
DEAD____

405) At the time you became pregnant with (name), did you want to get pregnant then, did you want to wait until later, or did you want no (more) children at all?

THEN 1 (GO TO 407/422)
LATER 2
NO MORE 3 (GO TO 407/422)

406) How much longer would you like to have waited?

MONTHS 1 ____
YEAR 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 TO OBTAIN THE TYPE OF PERSON AND RECORD ALL OF THE PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE'S ASSISTANT C
OTHER HEALTH PERSONNEL
MATRON D
VILLAGE HEALTH AGENT/TRAINED TRADITIONAL BIRTH ATTENDANT (WITH BOX) E
OTHER PERSONS
UNTRAINED TRADITIONAL BIRTH ATTENDANT (WITHOUT BOX) F
TRADITIONAL PRACTITIONER/MARABOU G
OTHER X
NO ONE Y (GO TO 415)

407A) Did you receive a maternity card for this pregnancy?
IF YES: May I see it?

YES, SEEN 1
YES, NOT SEEN 2
NO CARD 3

408) How many months pregnant were you when you first received antenatal care?

MONTHS _____
DON'T KNOW 98

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

NO. OF TIMES ______
DON'T KNOW 98

410) CHECK 409:
NUMBER OF TIMES RECEIVED ANTENATAL CARE

ONCE (GO TO 412)
MORE THAN ONCE OR DON'T KNOW (GO TO 411)

411) How many months pregnant were you the last time you received antenatal care?

MONTHS____
DON'T KNOW 98

412) During this pregnancy, were any of the following done at least once?

Were you weighed?
YES 1
NO 2
Was your height measured?
YES 1
NO 2
Was your blood pressure measured?
YES 1
NO 2
Did you give a urine sample?
YES 1
NO 2
Did you give a blood sample?
YES 1
NO 2
Did you get a vaginal exam?
YES 1
NO 2
Did they examine your conjunctive and your mucus membrane?
YES 1
NO 2

413) Were you told about the signs of pregnancy complications?

YES 1
NO 2 (GO TO 415)
DON'T KNOW 8 (GO TO 415)

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 416)
DON'T KNOW 8 (GO TO 416)

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

TIMES
DON'T KNOW 8

416) During this pregnancy, were you given or did you buy any drugs that add iron to your blood?

YES 1
NO 2 (GO TO 418)
DON'T KNOW 8 (GO TO 418)

417) During the whole pregnancy, for how many days did you take this drug?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.

NUMBER OF DAYS
DON'T KNOW 998

418) During this pregnancy, did you have difficulty with your vision during the daylight?

YES 1
NO 2
DON'T KNOW 8

419) During this pregnancy, did you suffer form night blindness?

YES 1
NO 2
DON'T KNOW 8

420) During this pregnancy, did you take any drugs in order to keep you from getting malaria?

YES 1
NO 2 (GO TO 422)
DON'T KNOW 8 (GO TO 422)

421) What drugs did you take?
RECORD ALL MENTIONED.

CHLOROQUINE/NIVAQUINE A
OTHER ANTI-MALARIAL DRUGS B
PLANTS/BREWS C
OTHER X
UNKNOWN DRUG Y

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

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

423) Was (Name) weighed at birth?

YES 1
NO 2 (GO TO 425)
DON'T KNOW 8 (GO TO 425)

424) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE

GRAMS FROM CARD 1
GRAMS FROM RECALL 2
DON'T KNOW 99998

425) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON. RECORD ALL PERSONS MENTIONED.

HEALTH PROFESSIONAL
DOCTOR A
MIDWIFE B
NURSE/NURSE'S ASSISTANT C
OTHER HEALTH PERSONNEL
MATRON D
VILLAGE HEALTH AGENT/TRAINED TRADITIONAL BIRTH ATTENDANT (WITH BOX) E
OTHER PERSONS
UNTRAINED TRADITIONAL BIRTH ATTENDANT (WITHOUT BOX) F
RELATIVES/FRIENDS G
OTHER X
NO ONE Y

426) Where did you give birth to (NAME)?
IF IT WAS A MATERNITY, PROBE TO DETERMINE IF IT WAS A HOSPITAL MATERNITY OR A HEALTH CENTER AND CIRCLE THE APPROPRIATE CODE.

HOME
YOUR HOME 11 (GO TO 429)
OTHER HOME 12 (GO TO 429)
PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER 21
OTHER PUBLIC ESTABLISHMENT 22
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL 31
PRIVATE MEDICAL SECTOR
CLINIC 41
OTHER PRIVATE ESTABLISHMENT 42
OTHER (SPECIFY) 96 (GO TO 426C)

426A) Were you satisfied with the services you received from (NAME OF ESTABLISHMENT FROM Q. 426) during (NAME)'s delivery?

YES 1 (GO TO 426E)
NO 2

426B) What were the main reasons for which you were unsatisfied?

ESTABLISHMENT DIFFICULT TO ACCESS/TOO FAR 11
TOO EXPENSIVE 12

WAIT TIMES TOO LONG 21
BAD EQUIPMENT 22
ESSENTIAL DRUGS NOT AVAILABLE 23
LACK OF HYGIENE 24
LACK OF CONFIDENTIALITY/PRIVACY 25

LACK OF PERSONNEL 31
PERSONNEL NOT QUALIFIED 32
PERSONNEL NOT FRIENDLY 33

OTHER 96
DON'T KNOW 98

426C) CHECK 426:
LOCATION OF DELIVERY?

HOME 11 OR 12 OR OTHER 96 (GO TO 426D)
OTHER CODES (GO TO 426E)

426D) What is the main reason for which you did not delivery (name) in a sanitary structure?

ESTABLISHMENT DIFFICULT TO ACCESS/TOO FAR 11
TOO EXPENSIVE 12

WAIT TIMES TOO LONG 21
BAD EQUIPMENT 22
ESSENTIAL DRUGS NOT AVAILABLE 23
LACK OF HYGIENE 24
LACK OF CONFIDENTIALITY/PRIVACY 25

LACK OF PERSONNEL 31
PERSONNEL NOT QUALIFIED 32
PERSONNEL NOT FRIENDLY 33

PREFERRED HOME 41
NOT ENOUGH TIME TO GET THERE 51

OTHER 96
DON'T KNOW 98

426E) Was (NAME) carried to term or born premature?

TO TERM 1
PREMATURE 2
DON'T KNOW 8

426f) CHECK 426: LOCATION OF DELIVERY?

HOME 11 OR 12 OR OTHER 96-GO TO 427A
OTHER CODES

427) Was (NAME) delivered by cesarean section?

YES 1
NO 2

427A) Does (NAME) have a birth certificate?

YES 1
NO 2
DON'T KNOW 8

428) After (NAME) was born, did you have a visit to be examined?

YES 1
NO 2 (GO TO 433)

429) How many days or weeks after delivery did the first check take place?
RECORD 00 DAYS IF SAME DAY

DAYS AFTER DEL 1
WEEKS AFTER DEL 2
DON'T KNOW 998

430) Who check on your health at that time?
PROBE FOR THE MOST QUALIFIED PERSON.

HEALTH PROFESSIONAL
DOCTOR 11
MIDWIFE 12
NURSE/NURSE'S ASSISTANT 13
OTHER HEALTH PERSONNEL
MATRON 21
VILLAGE HEALTH AGENT/TRAINED TRADITIONAL BIRTH ATTENDANT (WITH BOX) 22
UNTRAINED TRADITIONAL BIRTH ATTENDANT (WITHOUT BOX) 31
OTHER 96

431) Where did this first check take place?
IF IT WAS A MATERNITY, PROBE TO DETERMINE IF IT WAS A HOSPITAL MATERNITY OR A HEALTH CENTER AND CIRCLE THE APPROPRIATE CODE.

HOME
YOUR HOME 11
OTHER HOME 12
PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER 21
MILITARY NURSE 22
MOTHER-INFANT HEALTH CENTER 23
FREE CLINIC 24
HEALTH OUTPOST 25
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL 31
SOCIAL SECURITY MEDICAL-SOCIAL CENTER 32
PRIVATE MEDICAL SECTOR
CLINIC 41
PRIVATE DOCTOR'S OFFICE 42
HEALTH CLINIC/NURSE 43
OTHER 96

433) Has your period returned since the birth of (name)?

YES 1 (GO TO 435)
NO 2 (GO TO 436)

434) Did your period return between the birth of (name) and your next pregnancy?

YES 1
NO 2 (GO TO 438)

435) How many months after the birth of (NAME) did you not have a period?

MONTHS
DON'T KNOW 98

436) CHECK 226:
IS RESPONDENT PREGNANT?

NOT PREGNANT (GO TO 437)
PREGNANT OR UNSURE (GO TO 438)

437) Have you resumed sexual intercourse since the birth of (name)?

YES 1
NO 2 (GO TO 439)

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

MONTHS
DON'T KNOW 98

439) Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 444)

440) 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.

IMMEDIATELY 000 (GO TO 440B)
HOURS 1____
DAYS 2____

440A) In the first 24 hours, before breastfeeding (name), did you give him/her something else to drink?
IF YES: What did you give him/her to drink?

SUGAR WATER 1
ARTIFICIAL MILK/ANIMAL MILK 2
BREW/INFUSION 3
OTHER 6
NONE/NOTHING GIVEN 7

440B) Did you give (NAME) the first yellow milk?

YES 1 (GO TO 441)
NO 2


440C) Why didn't you give (NAME) the first yellow milk?

BAD FOR MOTHER'S HEALTH 1
BAD FOR CHILD'S HEALTH 2
OTHER (SPECIFY) 6

441) CHECK 404:
IS CHILD LIVING?

LIVING (GO TO 442)
DEAD (GO TO 443)

442) Are you still breastfeeding (NAME)?

YES 1 (GO TO 445)
NO 2

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

MONTHS
DON'T KNOW 98

444) CHECK 404:
IS CHILD LIVING?

LIVING-GO TO 447
DEAD-(GO BACK TO 405 IN NEXT COLUMN OR IF NO MORE BIRTHS, GO TO 451)

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

NUMBER OF NIGHTTIME FEEDINGS_____

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

NUMBER OF DAYLIGHT FEEDINGS

447) Did (Name) drink anything form a bottle with a nipple yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

449) Now I would like to ask you about the liquids (NAME) was given yesterday during the day or at night.
Did (NAME) receive any of the following yesterday during the day or night?

a) water, sugar water
YES 1
NO 2
DON'T KNOW 8
b) artificial preparation for baby, like cerelac, corn flour, bledine, or phosphatine?
YES 1
NO 2
DON'T KNOW 8
c) Any type of milk other than breastmilk, like boxed milk, powdered milk, or fresh animal milk?
YES 1
NO 2
DON'T KNOW 8
d) Fruit juice?
YES 1
NO 2
DON'T KNOW 8
e) Other liquids like herbal tea, carbonated drinks, or broth?
YES 1
NO 2
DON'T KNOW 8

449A) Now I would like to ask about the food (NAME) was given yesterday during the day or at night. Did (NAME) receive any of the following yesterday during the day or night?

f) Grain-based foods like corn, rice, wheat or millet, like bread or pasta?
YES 1
NO 2
DON'T KNOW 8
g) Other tuber-based foods like manioc, yams, tarot, sweet potatoes, or potatoes?
YES 1
NO 2
DON'T KNOW 8
h) all green vegetables like the leaves of manioc, tarot, potatoes, spinach, okra, folon?
YES 1
NO 2
DON'T KNOW 8
i) Fruits like bananas, oranges, mangos, apples, atanga [tropical fruit], soursop, papaya, or guava?
YES 1
NO 2
DON'T KNOW 8
j) Any peanut based food?
YES 1
NO 2
DON'T KNOW 8
k) Meat, poultry, chicken, or eggs?
YES 1
NO 2
DON'T KNOW 8
l) any other solid or semi-solid food?
YES 1
NO 2
DON'T KNOW 8

450) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 451.

SECTION 4B. IMMUNIZATION AND HEALTH

451) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1995. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMNS OF ADDITIONAL QUESTIONNAIRES).

452) LINE NO. FROM Q 212

LINE NUMBER

453) FROM Q 212 And Q 216

NAME
LIVING
DEAD (GO TO 453 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 481)

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

YES, SEEN 1 (GO TO 457)
YES, NOT SEEN 2 (GO TO 459)
NO 3

456) Have you ever had a vaccination care for (name)?

YES 1 (GO TO 459)
NO 2 (GO TO 459)

457) 1) COPY VACCINATION DATES 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

BCG
DAY____
MONTH____
YEAR____
POLIO 0 (POLIO GIVEN AT BIRTH)
DAY____
MONTH____
YEAR____
POLIO 1
DAY____
MONTH____
YEAR____
POLIO 2
DAY____
MONTH____
YEAR____
POLIO 3
DAY____
MONTH____
YEAR____
DTC 1
DAY____
MONTH____
YEAR____
DTC 2
DAY____
MONTH____
YEAR____
DTC 3
DAY____
MONTH____
YEAR____
TETRACOQ/PENTACOQ 1
DAY____
MONTH____
YEAR____
TETRACOQ/PENTACOQ 2
DAY____
MONTH____
YEAR____
TETRACOQ/PENTACOQ 3
DAY____
MONTH____
YEAR____
MEASLES
DAY____
MONTH____
YEAR____
YELLOW FEVER (Y.F)
DAY____
MONTH____
YEAR____

458) Has (name) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DTC 1-3, TETRACOQ/PENTACOQ 1-3, MEASLES, AND/OR YELLOW FEVER.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 457) (GO TO 463)
NO 2 (GO TO 463)
DK 8 (GO TO 463)

459) Did (name) receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

YES 1
NO 2 (GO TO 463)
DK 8 (GO TO 463)

460) Please tell me if (NAME) received any of the following vaccinations:

460A) A BCG vaccination against tuberculosis, that is, an injection given at birth in the upper arm that usually causes a scar?

YES 1
NO 2
DK 8

460b) Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 460E)
DK 8 (GO TO 460E)

460c) When was the first polio vaccine received, just after birth or later?

JUST AFTER BIRTH 1
LATER 2
DK 8

460d) How many times was the polio vaccine received?

NUMBER OF TIMES

460e) A DTC vaccination, that is, an injection given in the shoulder or thigh usually at the same time as polio drops?

YES 1
NO 2- (GO TO 460G)
DK 8- (GO TO 460G)

460f) How many times?

NUMBER OF TIMES_____

460g) The Tetracoq or Pentacoq vaccine, meaning an injection purchased at the pharmacy which protects the child against several illnesses at once?

YES 1
NO 2 (GO TO 460I)
DON'T KNOW (GO TO 460I)

460h) How many times?

NUMBER OF TIMES

460i) An injection to prevent measles, called Rouvax or sometimes ROR, done in the shoulder or the thigh, usually done at 9 months?

YES 1
NO 2
DK 8

460j) An injection to prevent yellow fever, usually don't at the International Vaccination Center of Nkembo?

YES 1
NO 2
DK 8

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

YES 1
NO 2 (GO TO 463F)
DK 8 (GO TO 463F)

463a) Does (NAME) have a fever now?

YES 1
NO 2
DON'T KNOW 8

463b) Did you seek advice or treatment for the fever?

YES 1
NO 2 (GO TO 463D)

463c) Where did you seek advice or treatment? Anywhere else?
RECORD ALL SOURCES MENTIONED

PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER A
MILITARY INFIRMARY B
MOTHER-INFANT HEALTH CENTER C
DISPENSARY D
HEALTH OUTPOST E
HOSPITAL PHARMACY/HEALTH CENTER F
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL G
SOCIAL SECURITY MEDICAL-SOCIAL CENTER H
SOCIAL SECURITY PHARMACY I
PRIVATE MEDICAL SECTOR
CLINIC J
PRIVATE DOCTOR'S OFFICE K
HEALTH CLINIC/INFIRMARY L
PRIVATE PHARMACY M
OTHER SOURCE
TRADITIONAL BIRTH ATTENDANT N
NGANGA/MARABOU O
MARKET/SHOP P
OTHER PLACE X

463d) Was anything given to (NAME) to treat the fever?

YES 1
NO 2 (GO TO 463F)
DON'T KNOW (GO TO 463F)

463e) What was given to treat the fever? Anything else?
RECORD ALL MENTIONED

CHLOROQUINE/NIVAQUINE A
ARSIQUINOFORME B
QUINIMAX C
OTHER ANTI-MALARIAL D
UNKNOWN DRUG
PLANTS/BREWS F
OTHER X
DON'T KNOW Z

463f) Does (NAME) usually sleep under a mosquito net?

YES 1
NO 2
DON'T KNOW 8

463g) Did (NAME) sleep under a mosquito net last night?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2 (GO TO 472)
DK 8 (GO TO 472)

465) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths?

YES 1
NO 2
DK 8

467) Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 472)

468) Where did you seek advice or treatment?
Anywhere else?
RECORD ALL SOURCES MENTIONED

PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER A
MILITARY NURSE B
MOTHER-INFANT HEALTH CENTER C
FREE CLINIC D
HEALTH OUTPOST E
HOSPITAL PHARMACY/HEALTH CENTER F
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL G
SOCIAL SECURITY MEDICAL-SOCIAL CENTER H
SOCIAL SECURITY PHARMACY I
PRIVATE MEDICAL SECTOR
CLINIC J
PRIVATE DOCTOR'S OFFICE K
HEALTH CLINIC/NURSE L
PRIVATE PHARMACY M
OTHER SOURCE
TRADITIONAL BIRTH ATTENDANT N
NGANGA/MARABOU O
MARKET/SHOP P
OTHER PLACE X

472) Has (NAME) had diarrhea in the last two weeks?

YES 1
NO 2 (GO TO 480)
DK 8 (GO TO 480)

472a) Was there blood in the stools?

YES 1
NO 2
DON'T KNOW 8

473) 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?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DK 8

474) 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?

MUCH LESS 1
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DK 8

475) Was he/she given any of the following to drink?

a) A fluid made from a special packet called ORS?
YES 1
NO 2
DK 8
b) A sugar-salt solution?
YES 1
NO 2
DK 8

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

YES 1
NO 2 (GO TO 478)
DON'T KNOW (GO TO 478)

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

PILL OR SYRUP A
INJECTION B
(IV) INTRAVENOUS/FEEDING TUBE C
PLANTS, BREWS D
OTHER (SPECIFY) X

478) Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 480)

479) Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED

PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER A
MILITARY INFIRMARY B
MOTHER-INFANT HEALTH CENTER C
FREE CLINIC D
HEALTH OUTPOST E
HOSPITAL PHARMACY/HEALTH CENTER F
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL G
SOCIAL SECURITY MEDICAL-SOCIAL CENTER H
SOCIAL SECURITY PHARMACY I
PRIVATE MEDICAL SECTOR
CLINIC J
PRIVATE DOCTOR'S OFFICE K
HEALTH CLINIC/NURSE L
PRIVATE PHARMACY M
OTHER SOURCE
TRADITIONAL BIRTH ATTENDANT N
NGANGA/MARABOU O
MARKET/SHOP P
OTHER PLACE X

480) GO BACK TO 453 IN THE NEXT COLUMN, OR IF NO MORE BIRTHS, TO GO 481.

481) CHECK 475A IN ALL COLUMNS:

NO CHILD RECEIVED ORS PACKET OR QUESTION NOT ASKED (GO TO 482)
ANY CHILD RECEIVED ORS PACKET (GO TO 501)

482) Have you ever heard of a special product called SRO you can get for the treatment of diarrhea?

YES 1
NO 2

SECTION 5. MARRIAGE AND SEXUAL ACTIVITY

501) Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

502) Have you ever been married or lived with a man?

YES, WAS MARRIED 1
YES, LIVED WITH A MAN 2 (GO TO 507)
NO 3 (GO TO 514)

504) What is your current marital status: are you a widow, divorced, or separated?

WIDOW 1 (GO TO 507)
DIVORCED 2 (GO TO 507)
SEPARATED 3 (GO TO 507)

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

LIVES WITH HER 1
STAYING ELSEWHERE 2

506) RECORD THE LINE NUMBER OF HER HUSBAND/PARTNER ACCORDING TO THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT A LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME
LINE NO.

506A) Does your husband/partner have other wives besides yourself?

YES 1
NO 2 (GO TO 507)

506b) How many other wives does your husband have?

NUMBER _______
DK 98 (GO TO 507)

506c) Are you the first, second?wife?

RANK _____

507) Have you been married or have you lived with a man only once or more than once?

ONCE 1
MORE THAN ONCE 2

508) CHECK 507:

MARRIED/LIVED WITH MAN ONLY ONCE --in what month and year did you start living with your husband/partner?

MARRIED/LIVED WITH MAN MORE THAN ONCE --I would like to talk about the first time you were married or started living with a man. In what month and year were you married or did you start living with him?

MONTH _____
DON'T KNOW MONTH 98
YEAR ____ (GO TO 514)
DON'T KNOW YEAR 9998

509) How old were you when you started living with him?

AGE _____

514) Now I would like 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 first had sexual intercourse (if ever)?

NEVER 00-GO TO 524
AGE IN YEARS
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95

514a) Was the man with whom you first had sexual intercourse younger than you, older than you, much older than you, or was he about the same age?

YOUNGER 1
ABOUT THE SAME AGE 2
OLDER 3
MUCH OLDER 4
DON'T KNOW/DON'T REMEMBER 8

515) When was the last time you had sexual intercourse?
RECORD IN "YEARS AGO" ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO.
IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS

DAYS AGO 1_____
WEEKS AGO 2_____
MONTHS AGO 3_____
YEARS AGO 4_____ (GO TO 524)

516) The last time you had sexual intercourse, was a condom used?

YES 1
NO 2

516a) What is the main reason you used the condom this time?

RESPONDED WANTED TO AVOID STDS/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STDS/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) 6
DON'T KNOW 8

517) What is your relationship to the man with whom you last had sex?
IF FIANCÉ, FRIEND, PARTNER, ASK: Was your fiancé/friend/partner living with you when you last had sex?
IF YES, CIRCLE 1. IF NO, CIRCLE 2

SPOUSE/ PARTNER 1 (GO TO 519)
MAN IS FRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
COMMERCIAL SEX WORKER 6
OTHER (SPECIFY) 7

518) For how long have/did you had/have sexual relations with this man?

DAYS 1____
WEEKS 2____
MONTHS 3____
YEARS 4____

519) Have you had sex with anyone else in the last 12 months?

YES 1
NO 2 (GO TO 523A)

520) The last time you had sexual intercourse with another man, was a condom used?

YES 1
NO 2 (GO TO 521)

520A) What is the main reason you used the condom this time?

RESPONDED WANTED TO AVOID STDS/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STDS/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) 6
DON'T KNOW 8

521) What is your relationship to this man?
IF FIANCÉ, FRIEND, PARTNER, ASK: Was your fiancé/friend/partner living with you when you last had sex?
IF YES, CIRCLE 1
IF NO, CIRCLE 2

SPOUSE/ PARTNER 1 (GO TO 522A)
MAN IS FRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
COMMERCIAL SEX WORKER 6
OTHER (SPECIFY) 7

522) For how long have/did you had/have sexual relations with this man?

DAYS 1____
WEEKS 2____
MONTHS 3____
YEARS 4____

522a) Apart from these two men, have you had sexual intercourse with any other person in the last 12 months?

YES 1
NO 2 (GO TO 523)

522b) The last time you had sexual intercourse with this other man, was a condom used?

YES 1
NO 2 (GO TO 522D)

522c) What is the main reason you used the condom this time?

RESPONDED WANTED TO AVOID STDS/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STDS/AIDS AND PREGNANCY 3
DIDN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
OTHER (SPECIFY) 6
DON'T KNOW 8

522d) What is your relationship to the man?
IF FIANCÉ, FRIEND, PARTNER, ASK: Was your fiancé/friend/partner living with you when you last had sex?
IF YES, CIRCLE 1
IF NO, CIRCLE 2

SPOUSE/ PARTNER 1 (GO TO 523)
MAN IS FRIEND/FIANCÉ 2
OTHER FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
COMMERCIAL SEX WORKER 6
OTHER (SPECIFY) 7

522e) For how long have/did you had/have sexual relations with this man?

DAYS 1
WEEKS 2
MONTHS 3
YEARS 4

523) In total, with how many different men have you had sex in the last 12 months?

NUMBER OF PARTNERS

523a) Have you ever received money, gifts, or favors in exchange for sexual relations?

YES 1
NO 2-GO TO 524

523b) The last time you received money, gifts, or favors in exchange for sexual relations, was a condom used?

YES 1
NO 2

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

YES 1
NO 2-GO TO 526

525) Where is that?
PROBE: Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL/MEDICAL CENTER/HEALTH CENTER A
MILITARY NURSE B
MOTHER-INFANT HEALTH CENTER C
FREE CLINIC D
HEALTH OUTPOST E
HOSPITAL PHARMACY/HEALTH CENTER F
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL G
SOCIAL SECURITY MEDICAL-SOCIAL CENTER H
SOCIAL SECURITY PHARMACY I
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC J
PRIVATE DOCTOR'S OFFICE K
HEALTH CLINIC/NURSE L
PRIVATE PHARMACY M
OTHER SOURCE
MARKET/SHOP/DISPLAY N
KIOSK O
FRIENDS/RELATIVES P
OTHER PLACE X

526) CHECK 524:

KNOWS A SOURCE: If you wanted to, could you get yourself a condom?

DOESN'T KNOW A SOURCE: If you wanted to and if you knew where to go, could you get yourself a condom?

YES 1
NO 2
DON'T KNOW/NOT SURE 8

SECTION 6. FERTILITY PREFERENCES

601) CHECK 311:

NEITHER STERILIZED OR QUESTION NOT ASKED (GO TO 602)
HE OR SHE STERILIZED (GO TO 614)

602) CHECK 226:

NOT PREGNANT OR UNSURE: Now I have some question 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?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 614)
UNDECIDED/DON'T KNOW AND PREGNANT 4 (GO TO 610)
UNDECIDED/DON'T KNOW AND NOT PREGNANT/UNSURE 5 (GO TO 608)

603) CHECK 224:

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 this child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1
YEARS 2

SOON/NOW 993 (GO TO 609)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 614)
AFTER MARRIAGE 995 (GO TO 609)
OTHER (SPECIFY) 996 (GO TO 609)
DON'T KNOW 998 (GO TO 609)

604) CHECK 226:

NOT PREGNANT OR UNSURE (GO TO 605)
PREGNANT (GO TO 610)

605) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 606)
NOT CURRENTLY USING (GO TO 606)
CURRENTLY USING GO TO 608

606) CHECK 603:

NOT ASKED (GO TO 607)
24 OR MORE MONTHS OR 02 OR MORE YEARS (GO TO 607)
00-23 MONTHS OR 00-01 YEAR (GO TO 610)

607) CHECK 602:

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?

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?

RECORD ALL REASONS MENTIONED.

NOT MARRIED A
FERTILITY-RELATED REASONS
NOT HAVING SEX B
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
OPPOSITION TO USE
RESPONDENT OPPOSED I
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
LACK OF KNOWLEDGE
KNOWS NO METHOD M
KNOWS NO SOURCE N
METHOD-RELATED REASONS
HEALTH CONCERNS O
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
OTHER (SPECIFY) X
DON'T KNOW Z

608) In the next few weeks, if you discovered that you were pregnant, would that be a big problem, a small problem, or no problem for you?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS SHE CAN'T GET PREGNANT/NOT HAVING SEX 4

609) CHECK 310: USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 610)
NO, NOT CURRENTLY USING (GO TO 610)
YES, CURRENTLY USING (GO TO 614)

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

YES 1
NO 2 (GO TO 612)
DON'T KNOW 8 (GO TO 612)

611) Which method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 614)
MALE STERILIZATION 02 (GO TO 614)
PILL 03 (GO TO 614)
IUD 04 (GO TO 614)
INJECTABLES 05 (GO TO 614)
IMPLANTS 06 (GO TO 614)
CONDOM 07 (GO TO 614)
FEMALE CONDOM 08 (GO TO 614)
DIAPHRAGM 09 (GO TO 614)
FOAM/JELLY 10 (GO TO 614)
LACTATIONAL AMEN. METHOD 11 (GO TO 614)
RHYTHM METHOD 12 (GO TO 614)
WITHDRAWAL 13 (GO TO 614)
OTHER (SPECIFY) 96 (GO TO 614)
UNSURE/DOESN'T KNOW YET 98 (GO TO 614)

612) What is the main reason that you think you will never use a contraceptive method at any time in the future?

NOT MARRIED 11

INFREQUENT SEX/NO SEX 12 (GO TO 614)
MENOPAUSAL/HYSTERECTOMY 13 (GO TO 614)
SUBFECUND/INFECUND 14 (GO TO 614)
WANTS AS MANY CHILDREN AS POSSIBLE 15 (GO TO 614)

RESPONDENT OPPOSED 21 (GO TO 614)
HUSBAND/PARTNER OPPOSED 22 (GO TO 614)
OTHERS OPPOSED 23 (GO TO 614)
RELIGIOUS PROHIBITION 24 (GO TO 614)

KNOWS NO METHOD 31 (GO TO 614)
KNOWS NO SOURCE 32 (GO TO 614)

HEALTH CONCERNS 41 (GO TO 614)
FEAR OF SIDE EFFECTS 42 (GO TO 614)
LACK OF ACCESS/TOO FAR 43 (GO TO 614)
COSTS TOO MUCH 44 (GO TO 614)
INCONVENIENT TO USE 45 (GO TO 614)
INTERFERES WITH BODY'S NORMAL PROCESSES 46 (GO TO 614)

OTHER (SPECIFY) 96 (GO TO 614)
DON'T KNOW 98 (GO TO 614)

613) Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DK 8

614) CHECK 216:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NUMBER_______
OTHER (SPECIFY) 96 (GO TO 616)

615) How many of these children would you like to be boys, how many would you like to be girls, and for how many would it not matter?

NUMBER OF BOYS ______
NUMBER OF GIRLS ______
NUMBER OF EITHER_____
OTHER (SPECIFY)_______ 96

616) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
DON'T KNOW/UNSURE 3

617) In the last few months have you heard about family planning:

a) On the radio?
YES 1
NO 2
b) On the television?
YES 1
NO 2
c) In a newspaper in magazine?
YES 1
NO 2
d) On posters?
YES 1
NO 2
e) During educational talks?
YES 1
NO 2

617a) Do you think it's acceptable or unacceptable to discuss family planning:

a) On the radio?
YES 1
NO 2
b) On television?
YES 1
NO 2
c) In newspapers?
YES 1
NO 2
d) On posters?
YES 1
NO 2
e) In places of worship?
YES 1
NO 2

618) CHECK 501:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 619)
NOT CURRENTLY IN A UNION (GO TO 623)

619) Now I want to ask you about your husband's/partner's views on family planning. Do you think your husband/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DON'T KNOW/UNSURE 8

620) How often have you talked to your husband/partner about family planning in the last twelve months?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

621) CHECK 311:

NEITHER STERILIZED OR QUESTION NOT ASKED (GO TO 622)
HE OR SHE STERILIZED (GO TO 623)

622) 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?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

623) Who do you think should make the decision to use contraception within a couple: the man or the woman?

MAN 1
WOMAN 2
BOTH TOGETHER 3
SOMEONE ELSE 4
DON'T KNOW 8

624) Who do you think usually makes the decision to use contraception within a couple: the man or the woman?

MAN 1
WOMAN 2
BOTH TOGETHER 3
SOMEONE ELSE 4
DON'T KNOW 8

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701) CHECK 501 AND 502:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 702)
FORMERLY MARRIED/LIVING WITH A MAN (GO TO 703)
NO TO Q. 501 AND 502, NEVER BEEN IN A UNION (GO TO 707)

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

AGE IN COMPLETED YEARS______

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

YES 1
NO 2 (GO TO 706)

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

PRIMARY 1
SECONDARY 1ST CYCLE 2
SECONDARY 2ND CYCLE 3
HIGHER 4
DON'T KNOW 8 (GO TO 706)

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

PRIMARY=1
0=LESS THAN ONE YEAR COMPLETED
1=CP1
2=CP2
3=CE1
4=CE2
5=CM1
6=CM2
SECONDARY 1ST CYCLE/SECONDARY TECHNICAL SCHOOL =2
0=LESS THAN ONE YEAR COMPLETED
1=6TH/1ST YEAR
2=5TH/2ND YEAR
3=4TH/3RD YEAR
4=3RD /4TH YEAR
SECONDARY 2ND CYCLE/HIGH SCHOOL TECHNICAL SCHOOL =2
0=LESS THAN ONE YEAR COMPLETED
1=2ND YEAR/1ST YEAR
2=1ST YEAR/2ND YEAR
3=FINAL/3RD YEAR
HIGHER =4
0=LESS THAN ONE YEAR COMPLETED
1=1ST YEAR
2=2ND YEAR
3=3RD YEAR
4=4TH YEAR +
DON'T KNOW 8

706) CHECK 701:

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?

DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE

(RECORD THE PROFESSION AND THE ESTABLISHMENT WHERE THE PERSON WORKS)____________
AGRICULTURE 11
INDUSTRY/CONSTRUCTION/PUBLIC WORKS 12
COMMERCE 13
PUBLIC SERVICES AND ADMINISTRATION 14

STUDENT 21 (GO TO 707)
LOOKING FOR FIRST JOB 22 (GO TO 707)
UNEMPLOYED 23 (GO TO 707)
INACTIVE (RETIRED/PERSON OF INDEPENDENT MEANS/?) 24 (GO TO 707)

OTHER 66
DON'T KNOW 98 (GO TO 707)

706A) BASED ON THE ANSWER TO Q. 706, DETERMINE THE SOCIO-PROFESSIONAL CATEGORY AND CIRCLE THE APPROPRIATE CODE.

SALARIED
MANAGEMENT 11
SENIOR EXECUTIVE/ENGINEER 12
MIDLEVEL EXECUTIVE/SUPERVISOR 13
EMPLOYEE/QUALIFIED WORKER 14
EMPLOYEE/UNQUALIFIED WORKER 15
UNSKILLED LABORER 16
NON-SALARIED
BOSS (SMALL ENTERPRISE) 21
INDEPENDENT WORKER 22
APPRENTICE 23
FAMILY AIDE 24
OTHER (SPECIFY) 96
DK 98

707) Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

708) 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. Are you currently doing any of these things or any other work?

YES 1 (GO TO 710)
NO 2

709) Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 720)

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

DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE

(RECORD THE PROFESSION AND THE ESTABLISHMENT WHERE THE PERSON WORKS)________________

AGRICULTURE 11
INDUSTRY/CONSTRUCTION/PUBLIC WORKS 12
COMMERCE 13
PUBLIC SERVICES AND ADMINISTRATION 14

OTHER 66
UNDETERMINED 98

710A) BASED ON THE ANSWER TO Q. 710, DETERMINE THE SOCIO-PROFESSIONAL CATEGORY AND CIRCLE THE APPROPRIATE CODE.

SALARIED
MANAGEMENT 11
SENIOR EXECUTIVE/ENGINEER 12
MIDLEVEL EXECUTIVE/SUPERVISOR 13
EMPLOYEE/QUALIFIED WORKER 14
EMPLOYEE/UNQUALIFIED WORKER 15
UNSKILLED LABORER
NON-SALARIED
BOSS (SMALL ENTERPRISE) 21
INDEPENDENT WORKER 22
APPRENTICE 23
FAMILY AIDE 24
OTHER (SPECIFY) 66
UNDETERMINED 98

711) CHECK 712:

WORKS IN AGRICULTURE (GO TO 712)
DOES NOT WORK IN AGRICULTURE (GO TO 713)

712) 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?
IF FISHER, CIRCLE CODE 6

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
FISHER 6

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

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

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

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

715) Are you paid or do you ear in cash or in kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3 (GO TO 718)
NOT PAID 4 (GO TO 718)

716) Who mainly decides how the money you earn will be used?

RESPONDENT 1
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5

717) On average, how much of your household's expenditures do your earnings pay for: almost none, less than half, about half, more than half, or all?

NONE 1
ALMOST NONE 2
A PORTION 3
ALL/ALMOST ALL 4

718) CHECK 217 AND 218:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?

YES (GO TO 719)
NO (GO TO 801)

719) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?

RESPONDENT 01 (GO TO 801)
HUSBAND/PARTNER 02 (GO TO 801)
OLDER FEMALE CHILD 03 (GO TO 801)
OLDER MALE CHILD 04 (GO TO 801)
OTHER RELATIVES 05 (GO TO 801)
NEIGHBORS/FRIENDS 06 (GO TO 801)
SERVANTS/HIRED HELP 07 (GO TO 801)
CHILD IS IN SCHOOL/NURSERY SCHOOL/DAYCARE 08 (GO TO 801)
HAS NOT WORKED SINCE LAST BIRTH 09 (GO TO 801)
OTHER (SPECIFY) 96 (GO TO 801)

720) Are you looking for a job?

YES 1
NO 2

SECTION 8. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

801) How I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 818)

801A) From which sources of information have you learned about AIDS?
Any other sources?
RECORD ALL MENTIONED

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/LEAFLETS D
POSTERS E
HEALTH ESTABLISHMENT/WORKERS F
MOSQUES/CHURCHES G
SCHOOLS/TEACHERS H
WORK PLACE I
COMMUNITY MEETINGS J
HUSBAND/PARTNER K
RELATIVES L
FRIENDS M
OTHER (SPECIFY) X

810B) If you wanted more information on AIDS, where (from whom) would you like to get this information?
IF MORE THAN ONE SOURCE LISTED, AS WHICH IS THE PREFERRED SOURCE AND CIRCLE THE APPROPRIATE CODE.

RADIO 11
TV 12
NEWSPAPERS/MAGAZINES 13
PAMPHLETS/LEAFLETS 14
POSTERS 15
HEALTH ESTABLISHMENT/WORKERS 21
MOSQUES/CHURCHES 22
SCHOOLS/TEACHERS 23
WORK PLACE 24
COMMUNITY MEETINGS 25
HUSBAND/PARTNER 31
RELATIVES 32
FRIENDS 33
ENOUGH INFORMED 95
OTHER (SPECIFY) 96

802) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 809)
DON'T KNOW 8 (GO TO 809)

803) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.

SAFE SEX A
ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER/STAY FAITHFUL TO ONE SEX PARTNER D
LIMIT NUMBER OF SEX PARTNERS E
ASK PARTNER TO BE FAITHFUL F
AVOID SEX WITH PROSTITUTES G
AVOID SEX WITH MEN WHO HAVE A LOT OF PARTNERS H
AVOID SEX WITH HOMOSEXUALS I
AVOID SEX WITH PEOPLE WHO USE INTRAVENOUS DRUGS J
AVOID BLOOD TRANSFUSIONS K
AVOID INJECTIONS L
AVOID KISSING M
AVOID MOSQUITO BITES N
SEEK PROTECTION FROM NGANGA/TALISMAN O
AVOID SHARING RAZORS/BLADES P
OTHER (SPECIFY) W
DON'T KNOW Z

803A) CHECK 803:

MENTIONED SAFE SEX (GO TO 803B)
DID NOT MENTIONS SAFE SEX (GO TO 804)

803b) What does 'safe sex' mean to you?
CIRCLE ALL MENTIONED

ABSTAIN FROM SEX B
USE CONDOMS C
HAVE ONLY ONE SEX PARTNER/STAY FAITHFUL TO ONE SEX PARTNER D
LIMIT NUMBER OF SEX PARTNERS E
ASK PARTNER TO BE FAITHFUL F
AVOID SEX WITH PROSTITUTES G
AVOID SEX WITH MEN WHO HAVE A LOT OF PARTNERS H
AVOID SEX WITH HOMOSEXUALS I
OTHER (SPECIFY) X
DON'T KNOW Z

804) Can people reduce their chance of getting the AIDS virus by having just one sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

806) Can people reduce their chance of getting the AIDS virus by completely abstaining from sex?

YES 1
NO 2
DON'T KNOW 8

807) Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

809A) Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

ALMOST NEVER 1
SOMETIMES 2
ALMOST ALWAYS 3
DON'T KNOW 8

809b) Can AIDS be cured?

YES 1
SOMETIMES/DEPENDS 2
NO 3
DK 8

811) Do you know someone personally who has AIDS or someone who died of AIDS?

YES 1
NO 2
DK 8

811a) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

812) Can the virus that causes AIDS be transmitted from a mother to a child?

YES 1
NO 2-GO TO 813B
DON'T KNOW 8-GO TO 813B

813a) Can the virus that causes AIDS be transmitted from a mother to a child:

During pregnancy?
YES 1
NO 2
DK 8
During delivery?
YES 1
NO 2
DK 8
During breastfeeding?
YES 1
NO 2
DK 8

813b) Since you have heard of AIDS, have you changed your behavior to avoid getting AIDS?

YES 1
NO 2 (GO TO 813D)

813c) What have you done? Anything else?
RECORD ALL MENTIONED.

SAFE SEX A (GO TO 814)
ABSTAIN FROM SEX B (GO TO 814)
USE CONDOMS C (GO TO 814)
HAVE ONLY ONE SEX PARTNER/STAY FAITHFUL TO ONE SEX PARTNER D (GO TO 814)
LIMIT NUMBER OF SEX PARTNERS E (GO TO 814)
ASK PARTNER TO BE FAITHFUL F (GO TO 814)
AVOID SEX WITH PROSTITUTES G (GO TO 814)
AVOID SEX WITH MEN WHO HAVE A LOT OF PARTNERS H (GO TO 814)
AVOID SEX WITH HOMOSEXUALS I (GO TO 814)
AVOID SEX WITH PEOPLE WHO USE INTRAVENOUS DRUGS J (GO TO 814)
AVOID BLOOD TRANSFUSIONS K (GO TO 814)
AVOID INJECTIONS L (GO TO 814)
AVOID KISSING M (GO TO 814)
AVOID MOSQUITO BITES N (GO TO 814)
SEEK PROTECTION FROM NGANGA/TALISMAN O (GO TO 814)
AVOID SHARING RAZORS/BLADES P (GO TO 814)
OTHER (SPECIFY) W (GO TO 814)
DON'T KNOW Z (GO TO 814)

813d) Why have you done nothing to protect yourself against the virus that causes AIDS/
RECORD ALL MENTIONED

DOESN'T HAVE SEX A
HAS ONLY ONE PARTNER B
PARTNER IS FAITHFUL C
LACK OF KNOWLEDGE/INFORMATION D
NOT RISKING ANYTHING/IS PROTECTED E
DOESN'T INTEREST ME/DOESN'T WORRY ME F
OTHER (SPECIFY) X
DON'T KNOW/NO REASON Z

814) CHECK 501:

CURRENTLY MARRIED/LIVING WITH A MAN (GO TO 815)
NOT CURRENTLY IN A UNION (GO TO 816)

815) Have you ever talked about ways to prevent getting the virus that causes AIDS with your husband/partner?

YES 1
NO 2

816) Do you think it's acceptable or unacceptable to talk about AIDS:

a) on the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
b) On television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
c) In the newspaper?
ACCEPTABLE 1
NOT ACCEPTABLE 2
d) On posters?
ACCEPTABLE 1
NOT ACCEPTABLE 2
e) In places of worship?
ACCEPTABLE 1
NOT ACCEPTABLE 2

816a) If a person learns that he/she is infected with the virus that causes AIDS, should this person be allowed to keep that a secret or should he/she communicate this information to the community?

CAN KEEP SECRET 1
COMMUNICATE TO COMMUNITY 2
DK/UNSURE 8

817) 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?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

817a) Should people with the AIDS virus who work with other people in shops, offices, or on farms be allowed to keep their jobs or not?

CONTINUE WORKING 1
NOT CONTINUE WORKING 2
DK/UNSURE/DEPENDS 8

817b) Should children under age 15 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DK/NOT SURE/DEPENDS 8

817c) Have you ever been tested to see if you have the AIDS virus?

YES 1 (GO TO 817F)
NO 2

817d) Would you like to have a test for the AIDS virus?

YES 1
NO 2
DON'T KNOW/UNSURE 8

817e) Do you know a place where you can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 818)

817f) CHECK 817C:

ALREADY HAD AIDS TEST: Where did you go for this test?

NOT YET TESTED FOR AIDS: Where can you go for this test?

PUBLIC SECTOR
NATIONAL LABORATORY (HOSPITAL) A
NATIONAL CENTER FOR BLOOD TRANSFUSIONS B
NATIONAL PROGRAM AGAINST AIDS C
MILITARY LABORATORY D
MEDICAL SCHOOL LABORATORY E
SEMI-PUBLIC SECTOR
SOCIAL SECURITY HOSPITAL G
INTERNATIONAL MEDICAL RESEARCH CENTER OF FRANCEVILLE G
PRIVATE MEDICAL SECTOR
CLINIC (LABORATORY) H
DOCTOR'S OFFICE I
PRIVATE ANALYSIS LAB J
OTHER (TEST NOT AVAILABLE) X

818) (Apart from AIDS), have you heard about (other) infections that can be transmitted through sexual contact?

YES 1
NO 2 (GO TO 820C)

819) If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
BLOOD IN URINE I
LOSS OF WEIGHT J
IMPOTENCE K
OTHER (SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

820) If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL SYMPTOMS MENTIONED

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL SMELLING DISCHARGE C
BURNING PAIN ON URINATION D
REDNESS/INFLAMMATION IN GENITAL AREA E
SWELLING IN GENITAL AREA F
GENITAL SORES/ULCERS G
GENITAL WARTS H
BLOOD IN URINE I
LOSS OF WEIGHT J
HARD TO GET PREGNANT/HAVE A CHILD K
OTHER (SPECIFY) X
NO SYMPTOMS Y
DON'T KNOW Z

820A) CHECK 514:

HAD HAD SEXUAL INTERCOURSE (GO TO 820B)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

820b) During the last 12 months, have you had a disease which you got through sexual contact?

YES 1 (GO TO 820D)
NO 2 (GO TO 820D)
DON'T KNOW 8 (GO TO 820D)

820c) CHECK 514:

HAD HAD SEXUAL INTERCOURSE (GO TO 820D)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 901)

820d) Now I would like to ask you some questions about your health in the last 12 months. Sometimes women experience vaginal discharge. During the last 12 months, have you had any vaginal discharge?

YES 1 (GO TO 820F)
NO 2 (GO TO 820F)
DON'T KNOW 8 (GO TO 820F)

820e) When you had vaginal discharge:

a) Was the discharge foul-smelling?
YES 1
NO 2
b) Was the discharge accompanied by burning, itching, fever, lower abdominal or lumbar pain not associated with your period?
YES 1
NO 2

820f) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

YES 1
NO 2
DON'T KNOW 8

820g) CHECK 820b:

NO OR DON'T KNOW TO 820B OR 820B NOT ASKED (GO TO 820H)
YES TO 820B, HAS SEXUALLY TRANSMITTED INFECTION (GO TO 820J)

820h) CHECK 820d AND 820e:

NO OR DON'T KNOW TO 820D, OR YES TO 820D, BUT NO YES TO 820E, OR 820D AND 820E NOT ASKED (GO TO 820I)
YES TO 820D AND AT LEAST ONE YES TO 820E, HAD SEXUALLY TRANSMITTED INFECTION (GO TO 820J)

820i) CHECK 820F:

YES TO Q. 820F (GO TO 820J)
NO OR DON'T KNOW TO 820F OR Q 820F NOT ASKED (GO TO 820P)

820j) The last time you had (infection from 820b, 820c, 820d), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 820L)

820k) The last time you had (infection from 820b, 820c, 820d), did you do any of the follow? Did you?

a) Seek advice from a health worker or in a sanitary structure?
YES 1
NO 2
b) Seek advice or treatment from a traditional practitioner/marabou?
YES 1
NO 2
c) Seek advice or purchase drugs from a shop, at the market or from a pharmacy?
YES 1
NO 2
d) Seek advice from friends or relatives?
YES 1
NO 2

820l) When you had (infection from 820b, 820c, 820d), did you inform the people were you having sexual intercourse with?

YES 1
NO 2
SOME PEOPLE/NOT ALL 3

820m) Did the person/people with whom you were having sexual relations seek advice or treatment from a health worker or in a sanitary structure?

YES 1
NO 2
SOME PEOPLE/NOT ALL 3
DON'T KNOW 8

820n) When you had (infection from 820b, 820c, 820d), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 820P)
PARTNER(S) ALREADY INFECTED 3 (GO TO 820P)

820o) What did you do to prevent infection in your partner(s)? Did you?

Stop sexual intercourse?
YES 1
NO 2
Use a condom during sexual intercourse?
YES 1
NO 2
Taken drugs?
YES 1
NO 2

820p) We may have already discussed this. Have you ever used a condom during sexual relations to avoid getting AIDS or transmitting illnesses, like AIDS?

YES 1
NO 2 (GO TO 901)

820q) Do you use a condom from time to time, often, or with each sexual encounter?

TIME TO TIME 1
OFTEN 2
EACH ENCOUNTER 3

SECTION 9. MATERNAL MORTALITY

901) 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?

NUMBER OF BIRTHS TO NATURAL MOTHER_______

902) CHECK 901:

TWO OR MORE BIRTHS (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 914)

903) How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS___

904) What was the name given to your oldest (next oldest) brother or sister?

NAME___

905) Is (NAME) male or female?

MALE 1
FEMALE 2

906) Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DK 8 (GO TO NEXT SIBLING)

907) How old is (NAME)?

AGE___ (Go to NEXT SIBLING)

908) What year did he/she die in?

YEAR___

909) How old was (NAME) when he/she died?
IF MALE OR DIED BEFORE 12 YEARS OF AGE TO GO NEXT SIBLING.

AGE___

910) Was (NAME) pregnant when she died?

YES 1 (GO TO 913)
NO 2

911) Did (NAME) die during childbirth?

YES 1 (GO TO 913)
NO 2

912) Did (Name) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2

913) How many living children did (name) give birth to in her life?

NUMBER OF CHILDREN____ (GO TO NEXT SIBLING)

IF NO MORE BROTHERS AND SISTERS, GO TO 914

914) RECORD THE TIME

HOURS
MINUTES

SECTION 10. HEIGHT AND WEIGHT

1001) IN Q 1003 (COLUMN 1), RECORD THE NAME OF THE RESPONDENT.

IN Q. 1002, 1003, AND 1004 (COLUMNS 2 AND 3), RECORD LINE NUMBER, NAME AND BIRTH DATE FOR THE CHILDREN BORN SINCE JANUARY 1995. ALSO ASK THE CHILDREN'S DATE OF BIRTH.

IN Q. 1006 AND 1008, RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1995, USE THE LAST COLUMN OF AN ADDITIONAL QUESTIONNAIRE.)

1002) LINE NO. FROM Q. 212

LINE NUMBER____

1003) NAME (FROM Q. 212 FOR CHILDREN)

NAME______

1004) DATE OF BIRTH
FROM Q. 215, AND ASK FOR DAY OF BIRTH

DAY
MONTH
YEARS

1005) BCG SCAR ON INSIDE OF TOP OF LEFT SHOULDER

SCAR SEEN 1
NO SCAR 2

1006) HEIGHT (IN CENTIMETERS)

HEIGHT____

1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?

LYING 1
STANDING 2

1008) WEIGHT (IN KILOGRAMS)

WEIGHT___

1009) DATE WEIGHED AND MEASURED

DAY
MONTH
YEAR

1010) RESULT

INTERVIEWEE
MEASURED 1
NOT PRESENT 2
REFUSED 4
OTHER (SPECIFY) 6
CHILDREN
CHILD MEASURED 1
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) 6

1011) NAME OF MEASURER
NAME OF ASSISTANT

NAME____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT

COMMENTS ON SPECIFIC QUESTIONS

ANY OTHER COMMENTS

SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR DATE

EDITOR'S OBSERVATIONS
NAME OF EDITOR DATE