MINISTRY OF HEALTH, GHANA

GHANA STATISTICAL SERVICE

IDENTIFICATION

LOCALITY NAME _____

NAME OF HOUSEHOLD HEAD ____

CLUSTER NUMBER _____

STRUCTURE NUMBER _____

HOUSEHOLD NUMBER _____

REGION _____

DISTRICT _____

URBAN/RURAL

NAME AND LINE NUMBER OF WOMAN:

INTERVIEW VISITS

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

NEXT VISIT: (FOR INTERVIEWERS 1 AND 2)
DATE ____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 2014
INT. NUMBER _____
RESULT ____

RESULT CODES:

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE: ENGLISH 1

LANGUAGE OF INTERVIEW:

LANGUAGE OF RESPONDENT:

TRANSLATOR USED:

SUPERVISOR
NAME _____
DATE _____

FIELD EDITOR
NAME _____
DATE _____

OFFICE EDITOR _____

KEYED BY _____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is _______________________. I am working with Ghana Statistical Service and the Ministry of Health. We are conducting a survey about health all over Ghana. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30-60 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions?
May I begin the interview now?

SIGNATURE OF INTERVIEWER: ___________________________
DATE: _____________________

101) RECORD THE TIME.

101A) During the interview I would like to measure your blood pressure. This will be done three times during the interview. This is a harmless procedure. It is used to find out if a person has high blood pressure. If it is not treated, high blood pressure may eventually cause serious damage to the heart.

The results of this blood pressure measurement will be given to you after the interview together with an explanation of the meaning of your blood pressure numbers. If your blood pressure is high, we will suggest that you consult a health facility or doctor since we cannot provide any further testing or treatment during the survey.

Do you have any questions about the blood pressure measurement so far? If you have any questions about the procedure at any time, please ask me.

You can say yes or no to having the blood pressure measurement now.
You can also decide at any time not to participate in the blood pressure measures.

Would you allow me to proceed to take your blood pressure measurement at this time?

Signature of interviewer: ___________________________
Date: ____________

101B) Before taking your blood pressure, I would like to ask a few questions about things that may affect these measurements.

Have you done any of the following within the past 30 minutes:

a) Eaten anything?
b) Had coffee, tea, cola or other drink that has caffeine?
c) Smoked any tobacco product?
d) Conducted any vigorous physical activity or exercises?

101C) May I begin the process of measuring your blood pressure?

BEFORE TAKING THE FIRST BLOOD PRESSURE READING, MEASURE THE CIRCUMFERENCE OF THE RESPONDENT'S ARM MIDWAY BETWEEN THE ELBOW AND THE SHOULDER.

RECORD THE MEASUREMENT IN CENTIMETERS.

101D) USE THE ARM CIRCUMFERENCE MEASUREMENT TO SELECT THE APPROPRIATE BLOOD PRESSURE MONITOR MODEL AND CUFF SIZE. CIRCLE THE CODE FOR THE MODEL AND CUFF SIZE.

MODEL 767

MODEL 789

101E) TAKE THE FIRST BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q102.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.

102) In what month and year were you born?

103) How old were you at your last birthday?

COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

104) Have you ever attended school?

105) What is the highest level of school you attended: primary, middle, JSS/JHS, secondary, SSS/SHS, or higher?

106) What is the highest (grade) you completed at that level?

IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

106A) CHECK 103:

106D) Why did you stop attending school?

107) CHECK 105:

108) 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?

109) CHECK 108:

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

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

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

113) What is your religion?

114) To which ethnic group do you belong?

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

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

SECTION 2. REPRODUCTION

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

202) Do you have any sons or daughters to whom you have given birth who are now living with you?

203) 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?

205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?

IN NONE, RECORD '00' AND GO TO '206'.

205A) How many sons living elsewhere are younger than age 18?
And how many daughters living elsewhere are younger than age 18?

IF NONE, RECORD '00' AND GO TO '206'.

205B) These children under 18 who do not live with you: where do they live at the moment? How many girls and how many boys live with:

205C) SUM ANSWERS TO 205B a-z, AND ENTER TOTAL. 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?

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?

210) CHECK 208:

211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.

RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE ROWS. (IF THERE ARE MORE THAN 12 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW).

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

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

214) Were any of these births twins?

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

216) Is (NAME) still alive?

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?

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 YEAR', PROBE: How many months was (NAME)?

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

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

222) Have you had any live births since the birth of (NAME OF LAST BIRTH)? IF YES, RECORD BIRTH(S) IN TABLE.

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

224) CHECK 215:

ENTER THE NUMBER OF BIRTHS IN 2009 OR LATER.

225) FOR EACH BIRTH SINCE JANUARY 2009, ENTER 'B' IN THE MONTH OF BIRTH IN THE CALENDAR. WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)

226) Are you pregnant now?

227) How many months pregnant are you?

RECORD NUMBER OF COMPLETED MONTHS.

ENTER 'P's IN THE CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.

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

229) Did you want to have a baby later on or did you not want any (more) children?

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

231) When did the last such pregnancy end?

232) CHECK 231:

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

RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN THE CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

234) Since January 2009, have you had any other pregnancies that did not result in a live birth?

235) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2009.

ENTER 'T' IN THE CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

236) Did you have any miscarriages, abortions or stillbirths that ended before 2009?

237) When did the last such pregnancy that terminated before 2009 end?

238) When did your last menstrual period start?

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

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

SECTION 3. CONTRACEPTION

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

Have you ever heard of (METHOD)?

302) CHECK 226:

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

304) Which method are you using?
CIRCLE ALL MENTIONED. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

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

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

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

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

308A) Since what month and year have you been using (CURRENT METHOD) without stopping? PROBE: For how long have you been using (CURRENT METHOD) without stopping?

309) CHECK 308/308A, 215 AND 231:

ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 308/308A

310) CHECK 308/308A:

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2009.
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:

a) When was the last time you used a method? Which method was that?
b) When did you start using that method? How long after the birth of (NAME)?
c) How long did you use the method then?

IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO THE LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 2 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:

d) Why did you stop using the (METHOD)? Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
e) IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: How many months did take you to get pregnant after you stopped using (METHOD)? AND ENTER '0' IN EACH SUCH MOTH IN COLUMN 1.

312) CHECK THE CALENDAR FOR USE OF ANY CONTRACEPTIVE METHOD IN ANY MONTH

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

314) CHECK 304:

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

315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

315A) Where did you learn how to use the rhythm/lactational amenorrhea method?

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

316) CHECK 304:

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

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

317A) When you got sterilized were you told about side effects or problems you might have with the method?

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

319) Were you told what to do if you experienced side effects or problems?

320) CHECK 317:

CODE '1' CIRCLED: a) At that time, were you told about other methods of family planning that you could use?

CODE '1' NOT CIRCLED: b) When you obtained (CURRENT METHOD FROM 314) from (SOURCE OF METHOD FROM 307 OR 315), were you told about other methods of family planning that you could use?

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

322) CHECK 304:

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

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

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

324) Do you know of a place where you can obtain a method of family planning?

325) Where is that?
Any other place?

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

326) In the last 12 months, were you visited by a fieldworker who talked to you about family planning?

327) In the last 12 months, have you visited a health facility for care for yourself (or your children)?

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

SECTION 4. PREGNANCY AND POSTNATAL CARE

401) CHECK 224:

402) Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

403) BIRTH HISTORY NUMBER 212 IN BIRTH HISTORY:

404) FROM 212 AND 216:

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

406) Did you want to have a baby later on, or did you not want any (more) children?

407) How much longer did you want to wait?

408) Did you see anyone for antenatal care for this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

409) Whom did you see?
Anyone else?

[ASK FOR MOST RECENT BIRTH ONLY]

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

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

[ASK FOR MOST RECENT BIRTH ONLY]

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

411) How many months pregnant were you when you first received antenatal care for this pregnancy? [ASK FOR MOST RECENT BIRTH ONLY]

412) How many times did you receive antenatal care during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

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

Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?

[ASK FOR MOST RECENT BIRTH ONLY]

414) During (any of) your antenatal care visit(s), were you told about things to look out for that might suggest problems with the pregnancy? [ASK FOR MOST RECENT BIRTH ONLY]

415) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? [ASK FOR MOST RECENT BIRTH ONLY]

416) During this pregnancy, how many times did you get a tetanus injection?
[ASK FOR MOST RECENT BIRTH ONLY]

417) CHECK 416:
[ASK FOR MOST RECENT BIRTH ONLY]

418) At any time before this pregnancy, did you receive any tetanus injections?
[ASK FOR MOST RECENT BIRTH ONLY]

419) Before this pregnancy, how many times did you receive a tetanus injection?
IF 7 OR MORE TIMES, RECORD '7'.
[ASK FOR MOST RECENT BIRTH ONLY]

420) How many years ago did you receive the last tetanus injection before this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

421) During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLETS/SYRUP.
[ASK FOR MOST RECENT BIRTH ONLY]

422) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
[ASK FOR MOST RECENT BIRTH ONLY]

423) During this pregnancy, did you take any drug for intestinal worms?
[ASK FOR MOST RECENT BIRTH ONLY]

424) During this pregnancy, did you take any drugs to keep you from getting malaria?
[ASK FOR MOST RECENT BIRTH ONLY]

425) What drugs did you take?
[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

426) CHECK 425:
SP/FANSIDAR TAKEN FOR MALARIA PREVENTION.

[ASK FOR MOST RECENT BIRTH ONLY]

427) How many times did you take (SP/Fansidar) during this pregnancy?
[ASK FOR MOST RECENT BIRTH ONLY]

428) CHECK 409:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY:

[ASK FOR MOST RECENT BIRTH ONLY]

429) Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source? [ASK FOR MOST RECENT BIRTH ONLY]

429A) CHECK 408:
ANC RECEIVED

[ASK FOR MOST RECENT BIRTH ONLY]

429B) Do you have an ANC card for the time you were pregnant with (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

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

431) Was (NAME) weighed at birth?

432) How much did (NAME) weigh?
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.

433) Who assisted with the delivery of (NAME)?
Anyone else?

PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.

434) Where did you give birth to (NAME)?

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

434A) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. [ASK FOR MOST RECENT BIRTH ONLY]

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

436) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health while you were still in the facility? [ASK FOR MOST RECENT BIRTH ONLY]

437) Did anyone check on your health after you left the facility?
[ASK FOR MOST RECENT BIRTH ONLY]

438) I would like to talk to you about checks on your health after delivery, for example, someone asking you questions about your health or examining you. Did anyone check on your health after you gave birth to (NAME)? [ASK FOR MOST RECENT BIRTH ONLY]

439) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
[ASK FOR MOST RECENT BIRTH ONLY]

440) How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS. [ASK FOR MOST RECENT BIRTH ONLY]

441) How long after birth was (NAME) bathed for the first time?
[ASK FOR MOST RECENT BIRTH ONLY]

441A) How long after birth was (NAME) wrapped?
[ASK FOR MOST RECENT BIRTH ONLY]

442) In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health? [ASK FOR MOST RECENT BIRTH ONLY]

443) How many hours, days or weeks after the birth of (NAME) did the first check take place?
[ASK FOR MOST RECENT BIRTH ONLY]

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

444) Who checked on (NAME)'s health at that time?
[ASK FOR MOST RECENT BIRTH ONLY]

PROBE FOR MOST QUALIFIED PERSON.

445) Where did this first check of (NAME) take place?
[ASK FOR MOST RECENT BIRTH ONLY]

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

446) In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.
[ASK FOR MOST RECENT BIRTH ONLY]

447) Has your menstrual period returned since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

448) Did your period return between the birth of (NAME) and your next pregnancy?
[DO NOT ASK FOR MOST RECENT BIRTH]

449) For how many months after the birth of (NAME) did you not have a period?

450) CHECK 226:
IS RESPONDENT PREGNANT?

[ASK FOR MOST RECENT BIRTH ONLY]

451) Have you had sexual intercourse since the birth of (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

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

453) Did you ever breastfeed (NAME)?

454) CHECK 404:
IS CHILD LIVING?

[ASK FOR MOST RECENT BIRTH ONLY]

455) How long after birth did you first put (NAME) to the breast?
[ASK FOR MOST RECENT BIRTH ONLY]

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

456) In the first three days after delivery, was (NAME) given anything to drink other than breast milk? [ASK FOR MOST RECENT BIRTH ONLY]

457) What was (NAME) given to drink?
Anything else?

[ASK FOR MOST RECENT BIRTH ONLY]

RECORD ALL LIQUIDS MENTIONED.

458) CHECK 404:

IS CHILD LIVING?

459) Are you still breastfeeding (NAME)?
[ASK FOR MOST RECENT BIRTH ONLY]

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

461) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

470) Now I would like to ask some questions about taking time off work around the time (NAME) was born.

Aside from your own house chores, were you doing any work paid in cash or kind around the time (NAME) was born (for instance selling things, have a small business or work on the family farm or in the family business)?

[ASK FOR MOST RECENT BIRTH ONLY]

471) What was your occupation, that is, what kind of work were you mainly doing around the time (NAME) was born? [ASK FOR MOST RECENT BIRTH ONLY]

472) Did you do this work for a member of your family, for someone else, or were you self-employed? [ASK FOR MOST RECENT BIRTH ONLY]

473) Were you paid in cash or kind for this work or were you not paid at all?
[ASK FOR MOST RECENT BIRTH ONLY]

474) Did you take paid or unpaid maternity leave around the time of (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

475) Who paid for maternity leave?
[ASK FOR MOST RECENT BIRTH ONLY]

476) When did you stop working before (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

IF ON THE DAY (NAME) WAS BORN, RECORD '00' DAYS. IF LESS THAN 7 DAYS BEFORE BIRTH, RECORD DAYS. IF LESS THAN 4 WEEKS, RECORD WEEKS. IF MORE THAN 4 WEEKS, RECORD MONTHS.

477) When did you start working after (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

IF ON THE DAY (NAME) WAS BORN, RECORD '00' DAYS. IF LESS THAN 7 DAYS BEFORE BIRTH, RECORD DAYS. IF LESS THAN 4 WEEKS, RECORD WEEKS. IF MORE THAN 4 WEEKS, RECORD MONTHS.

478) Why did you stop working after (NAME)'s birth?
[ASK FOR MOST RECENT BIRTH ONLY]

479) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 501.

SECTION 5. CHILD IMMUNIZATION, HEALTH AND NUTRITION

501) ENTER IN THE TABLE THE BIRTH HISTORY NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2009 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).

502) BIRTH HISTORY NUMBER FROM 212 IN BIRTH HISTORY:

503) FROM 212 AND 216:

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

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

506) (1) COPY DATES FROM THE CARD. (2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A DOSE WAS GIVEN, BUT NO DATE IS RECORDED.

507) CHECK 506:

508) Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day campaign?

RECORD 'YES' ONLY IF THE RESPONDENT MENTIONS AT LEAST ONE OF THE VACCINATIONS IN 506 THAT ARE NOT RECORDED AS HAVING BEEN GIVEN.

509) Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

510) Please tell me if (NAME) had any of the following vaccinations:

510A) A BCG vaccination against tuberculosis, that is, an injection in the right upper arm or shoulder that usually causes a scar?

510B) Polio vaccine, that is, two drops in the mouth?

510C) Was the first polio vaccine given in the first two weeks after birth or later?

510D) How many times was the polio vaccine given?

510E) A PENTA vaccination, that is, an injection given in the LEFT thigh, sometimes at the same time as polio drops?

510F) How many times was the PENTA vaccination given?

510G) A measles injection - that is, a shot in the left upper arm at the age of 9 months and 18 months - to prevent him/her from getting measles?

510H) How many times was the measles vaccination given?

510I) A PNEUMOCOCCAL vaccination, that is a new vaccine against childhood pneumonia, ear infection and meningitis, an injection given in the RIGHT thigh?

510J) How many times was the PNEUMOCOCCAL vaccination given?

510K) ROTAVIRUS vaccination, a new vaccine against childhood diarrhea, that is, a liquid suspension administered from the vial in the mouth to swallow?

510L) How many times was the ROTAVIRUS vaccination given?

510M) An injection to prevent yellow fever - a shot in the arm at the age of 9 months or older (sometimes given at the same time as measles)?

511) Within the last six months, was (NAME) given a vitamin A dose like (this/any of these)?
SHOW COMMON TYPES OF PILLS/CAPSULES/SYRUPS.

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

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

514) Has (NAME) had diarrhea in the last 2 weeks?

515) Was there any blood in the stools?

516) Now I would like to know how much (NAME) was given to drink during the diarrhea (including breastmilk).
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?

517) 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?

518) Did you seek advice or treatment for the diarrhea from any source?

519) Where did you seek advice or treatment?
Anywhere else?

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

520) CHECK 519:

521) Where did you first seek advice or treatment?
USE LETTER CODE FROM 519.

522) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:

a) A fluid made from a special ORS packet?
b) A homemade fluid?

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

524) What (else) was given to treat the diarrhea?
Anything else?

RECORD ALL TREATMENTS GIVEN.

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

526) At any time during the illness, did (NAME) have blood taken from his/her finger or heel for testing?

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

528) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

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

530) CHECK 525:

HAD FEVER?

531) Now I would like to know how much (NAME) was given to drink (including breastmilk) 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?

532) 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?

533) Did you seek advice or treatment for the illness from any source?

534) Where did you seek advice or treatment?
Anywhere else?

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

535) CHECK 534:

536) Where did you first seek advice or treatment?
USE LETTER CODE FROM 534.

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

538) What drugs did (NAME) take?
Any other drugs?

RECORD ALL MENTIONED. PLEASE NOTE BRAND NAMES:

SP/SULPHADOXINE-PYRIMETHAMINE:
FANSIDAR
MALAFAN
PALIDAR
SULDOX

DP/DIHYDROARTEMISININ-PIPPERAQUINE:
P-ALAXIN
DUO-COTEXCIN

AA/ARTESUNATE AMODIAQUINE:
ARTESUNATE AMODIAQUINE WINTRHOP
ARSUAMOON
CAMOQUINE PLUS
G SUNATE
CO-ARSUCAM

AL/ARTEMETHER LUMAFANTRINE:
COARTEM
LUMARTERM
ARTEFAN
LONART
GEN-M
ARTEMOS PLUS

539) CHECK 538:

ANY CODE A-H CIRCLED?

540) CHECK 538:

SP/SULFADOXINE-PYRIMETHAMINE, ('A') GIVEN

541) How long after the fever started did (NAME) first take (SP/Sulfadoxine-Pyrimethamine)?

542) CHECK 538:

CHLOROQUINE ('B') GIVEN

543) How long after the fever started did (NAME) first take chloroquine?

544) CHECK 538:

DIHYDROARTEMISININ-PIPERAQUINE ('C') GIVEN

545) How long after the fever started did (NAME) first take Dihydroartemisinin-Piperaquine?

546) CHECK 538:

QUININE ('D') GIVEN

547) How long after the fever started did (NAME) first take quinine?

547A) CHECK 538:

ARTESUNUATE/AMODIAQUINE ('E') GIVEN

547B) How long after the fever started did (NAME) first take artesunate with amodiaquine?

548) CHECK 538:

ARTEMISININ ('F') GIVEN

549) How long after the fever started did (NAME) first take Artemisinin?

549A) CHECK 538:

ARTEMETHER/LUMEFANTRINE ('G') GIVEN

549B) How long after the fever started did (NAME) first take Artemether Lumefantrine?

550) CHECK 538:

OTHER ANTIMALARIAL ('H') GIVEN

551) How long after the fever started did (NAME) first take (OTHER ANTIMALARIAL)?

552) GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 553.

553) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2009 OR LATER LIVING WITH THE RESPONDENT

554) The last time (NAME FROM 553) passed stools, what was done to dispose of the stools?

555) CHECK 522(a) ALL COLUMNS:

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

557) CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2012 OR LATER LIVING WITH THE RESPONDENT:

558) Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or at night. I am interested in whether your child had the item I mention even if it was combined with other foods.

Did (NAME FROM 557) (drink/eat):

559) CHECK 558 (CATEGORIES "g" THROUGH "u"):

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

561) How many times did (NAME FROM 557) eat solid, semi-solid, or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

562) Now I would like to ask you about foods that you had yesterday during the day or at night. I am interested in whether you or anyone else who cooked for the household added any of the following ingredients or items to food cooked for the household in the last 24 hours:
Did you or anybody else add any of the following ingredients or items to food cooked for the household in the last 24 hours:

563) Have you ever heard about iodized salt?

564) Can you mention benefits for consuming iodized salt?
PROBE: Any other benefits?
RECORD ALL MENTIONED.

565) How can you tell iodized salt from non-iodized salt?
RECORD ALL MENTIONED.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

600) CHECK 101A:

600A) RECORD THE TIME.

600B) May I measure your blood pressure at this time?

600C) TAKE THE BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q.601.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.

601) Are you currently married or living together with a man as if married?

601A) Was bridewealth negotiated in your current union?

601B) Why was the bridewealth not negotiated?

601C) What is the status of the bridewealth in your current union?

601D) Why was the bridewealth not completely paid?

602) Have you ever been married or lived together with a man as if married?

603) What is your marital status now: are you widowed, divorced, or separated?

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

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

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

607) Including yourself, in total, how many wives or live-in partners does he have?

608) Are you the first, second, ... wife?

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

610) CHECK 609:

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 your first (husband/partner). In what month and year did you start living with him?

611) How old were you when you first started living with him?

612) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

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

614) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

615) When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

616) When was the last time you had sexual intercourse with this person?

617) The last time you had sexual intercourse (with this second/third person), was a condom used?

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

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

620) CHECK 609:

621) CHECK 613:

622) How long ago did you first have sexual intercourse with this (second/third) person?

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

624) How old is this person?

625) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

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

627) 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 95 OR MORE, WRITE '95'.

628) PRESENCE OF OTHERS DURING THIS SECTION:

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

630) Where is that?
Any other place?

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

631) If you wanted to, could you yourself get a condom?

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

633) Where is that?
Any other place?

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

634) If you wanted to, could you yourself get a female condom?

701) CHECK 304:

702) CHECK 226:

703) 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?

704) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not have any (more) children?

705) CHECK 226:

NOT PREGNANT OR UNSURE: How long would you like to wait from now before the birth of (a/another) child?

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

706) CHECK 226:

707) CHECK 303:
USING A CONTRACEPTIVE METHOD?

708) CHECK 705:

709) CHECK 704:

WANTS TO HAVE ANOTHER CHILD: a) You have said that you do not want (a/another) child soon. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?

WANTS NO MORE/NONE: b) You have said that you do not want any (more) children. Can you tell me why you are not using a method to prevent pregnancy? Any other reason?
RECORD ALL REASONS MENTIONED.

710) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

712) CHECK 216:

HAS LIVING CHILDREN: a) 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: b) 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.

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

714) In the last few months have you:

a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?

716) CHECK 601:

717) CHECK 303:
USING A CONTRACEPTIVE METHOD?

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

719) CHECK 304:

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

SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK

801) CHECK 601 AND 602:

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

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

804) What was the highest level of school he attended: primary, middle, JSS/JHS, secondary, SSS/SHS, or higher?

805) What was the highest (grade) he completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

806) CHECK 801:

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 house chores, have you done any work in the last seven days?

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?

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?

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

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

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

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

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

814A) In case of birth of a child, would you be entitled to paid or unpaid maternity leave on this job?

815) CHECK 601:

816) CHECK 814:

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

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

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

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

821) Who usually makes decisions about making major household purchases?

822) Who usually makes decisions about visits to your family or relatives?

823) Do you own this or any other house either alone or jointly with someone else?

824) Do you own any land either alone or jointly with someone else?

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

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

a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?

SECTION 9. HIV/AIDS

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

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

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

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

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

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

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

908) Can the virus that causes AIDS be transmitted from a mother to her baby:

a) During pregnancy?
b) During delivery?
c) By breastfeeding?

909) CHECK 908:

910) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

910A) Have you heard about special antiretroviral drugs (e.g. ARV, nevirapine, zidovudine, lamivudine) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

911) CHECK 208 AND 215:

912) CHECK 408 FOR LAST BIRTH:

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

914) During any of the antenatal visits for your last birth were you given any information about:

a) Babies getting the AIDS virus from their mother?
b) Things you can do to prevent getting the AIDS virus?
c) Getting tested for the AIDS virus?

915) Were you offered a test for the AIDS virus as part of your antenatal care?

916) I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

917) Where was the test done?

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

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

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

920) CHECK 434 FOR LAST BIRTH:

921) Between the time you went for delivery but before the baby was born, were you offered a test for the AIDS virus?

922) I don't want to know the results, but were you tested for the AIDS virus at that time?

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

924) Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

925) How many months ago was your most recent HIV test?

926) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

927) How many months ago was you most recent HIV test?

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

929) Where was the test done?

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

930) Do you know of a place where people can go to get tested for the AIDS virus?

931) Where is that?
Any other place?

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

932) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

933) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

934) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

935) 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?

936) Should children age 12-14 be taught about using a condom to avoid getting AIDS?

937) CHECK 901:

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?

938) CHECK 613:

939) CHECK 937:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

940) 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?

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

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

943) CHECK 940, 941, AND 942:

944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

945) Where did you go?
Any other place?

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

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

947) Is a wife justified in refusing to have sex with her husband when she knows he has sex with women other than his wives?

948) CHECK 601:

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

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

SECTION 10. OTHER HEALTH ISSUES

1001) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?

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

1002) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

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

1003) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

1004) Do you currently smoke cigarettes?

1005) In the last 24 hours, how many cigarettes did you smoke?

1006) Do you currently smoke or use any (other) type of tobacco?

1007) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

1008) 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?

a) Getting permission to go to the doctor?
b) Getting money needed for advice or treatment?
c) The distance to the health facility?
d) Not wanting to go alone?

1009) Are you covered by any health insurance?

1009A) Are you registered with the National Health Insurance Scheme (NHIS)?

1010) What type of health insurance are you (covered/registered) by?
RECORD ALL MENTIONED.

1011) Does your insurance cover any of the following maternity benefits:

a) Antenatal health care?
b) Childbirth health care in health facility?
c) Postnatal health care for the mother?
d) Postnatal health care for the child?
e) Cash benefits during maternity leave?
f) Other?

1012) CHECK 1010:

1013) Why have you not registered with the National Health Insurance Scheme (NHIS)?
RECORD ALL MENTIONED.

1014) Who paid for your NHIS membership?

1015) Do you hold a valid National Health Insurance Scheme (NHIS) card?

1016) Why do you not have a valid NHIS card?

1017) How many weeks did it take you to obtain your NHIS card?

1018) Do you plan to renew the NHIS card?

1019) Why do you not want to renew the NHIS card?
Anything else?
RECORD ALL MENTIONED.

1020) Do you have to pay out of pocket for drugs and services?

1021) Are there any services that you need from a health provide that are not covered by NHIS?

1022) What are these services?
Anything else?
RECORD ALL MENTIONED.

1023) In your opinion, do NHIS card holders get better, the same, or worse service than others?

1024) In your opinion, did you receive good service last time you were treated at a clinic or hospital?
IF NO, PROBE: "What was the main problem?"

1025) Are you aware of any programs that help pregnant women accessing health services?

1026) Which ones?
RECORD ALL MENTIONED.

1027) Are you aware of any programs that help children under age 18 accessing health services?

1028) Which ones?
RECORD ALL MENTIONED.

1029) These next questions are about common health problems in Ghana.
Have you ever heard of an illness called tuberculosis or TB?

1030) How does tuberculosis spread from one person to another?
PROBE: Any other ways?

RECORD ALL MENTIONED.

1031) Can tuberculosis be cured?

1032) If a member of your family got tuberculosis, would you want it to remain a secret or not?

1033) These next questions are about blood pressure.
Have you ever been told by a doctor or other health professional that you had hypertension or high blood pressure?

1034) Were you told on two or more different occasions by a doctor or other health professional that you had hypertension or blood pressure?

1035) To lower your hypertension or high blood pressure, are you now:

1036) During the last 7 days, on how many days did you eat fruits, for example mangoes, pawpaw, banana, orange, avocados, tomatoes, passion fruit, etc?

1038) During the last 7 days, on how many days did you eat vegetables, for example carrots, cabbage, dark green, leafy vegetables (e.g. kontomire), pumpkin, squash, etc?

1040) In the last 6 months, did you visit a health facility?

1041) What type of facility did you visit during your most recent visit?

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

1042) What type of service did you receive during this most recent visit?

1043) How did you pay for the service during this most recent visit?

1044) Now I want to ask you about the ease of getting care. In your opinion, was it very easy, easy, fairly easy, difficult, or very difficult to see the health provider?

1045) Is the location of the health facility very convenient, convenient, fairly convenient, not convenient, or very inconvenient for you?

1046) Are the hours the health facility open during the day very good, good, fair, poor, or very poor for you?

1047) Now I want to talk about waiting time at the health facility.
Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied about:

1048) Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied with the staff at the health facility when they:

1049) In your opinion, did the health provider spend enough time with you?

1050) Did the health provider seek your consent before providing treatment?

1051) Was the health provider friendly to you?

1052) Now I want to ask you about the condition of the health facility:
Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied with:

1053) CHECK 101A:

1054) RECORD THE TIME.

1055) May I measure your blood pressure at this time?

1056) TAKE THE BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q1101.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.

SECTION 11. AVERAGING BLOOD PRESSURE MEASURES

1101) CHECK Q600C AND Q1056:

1102) RECORD AND CALCULATE THE AVERAGE OF THE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE FROM Q600C AND Q1056.

1103) BLOOD PRESSURE MEASUREMENTS FROM Q600C:

1104) BLOOD PRESSURE MEASUREMENTS FROM Q1056:

1105) RECORD THE SUM OF THE SYSTOLIC AND DIASTOLIC MEASURES.

1106) CALCULATE THE AVERAGE SYSTOLIC AND DIASTOLIC PRESSURES BY DIVIDING THE SUM IN Q1105 BY 2.

1107) CHECK Q1056:

1108) CHECK Q600C:

1109) CHECK Q101E:

1110) RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE.

1111) USE THE TABLE BELOW TO DETERMINE THE CORRECT CODE TO RECORD ON THE BLOOD PRESSURE REPORT AND REFERRAL FORM.
CIRCLE THE ROW IN WHICH THE VALUE FOR THE SYSTOLIC BLOOD PRESSURE FROM Q1106 OR Q1110 IS FOUND.
THEN CIRCLE THE COLUMN IN WHICH THE VALUE FOR THE DIASTOLIC BLOOD FROM Q1106 OR Q1110 IS FOUND.
THE VALUE WHERE THE ROW AND COLUMN YOU HAVE CIRCLED INTERSECT IN THE TABLE WILL BE USED IN COMPLETING Q1112.

1112) RECORD THE NUMBER YOU CIRCLED IN Q1111 IN THE CHART BELOW. THEN USE THE INSTRUCTIONS TO THE RIGHT OF THAT NUMBER TO COMPLETE A BLOOD PRESSURE REPORT AND REFERRAL FORM FOR THE RESPONDENT. GIVE THE FORM TO THE RESPONDENT AND ANSWER ANY QUESTIONS SHE MAY HAVE.

1113) Thank you for taking the time to answer these questions. I would like to inform you that additional information on childbearing and contraception will be collected in the near future in order to find better ways to help couples in Ghana achieve their family goals. Another member of our team may return in a few days or weeks to ask you a few additional questions about these topics. Do you agree to allow another member of our team to contact you about participating in a short interview? Your responses will remain confidential.

1114) RECORD THE TIME.

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT: ______________________________
COMMENTS ON SPECIFIC QUESTIONS: ______________________________
ANY OTHER COMMENTS ______________________________

SUPERVISOR'S OBSERVATIONS: _________________________________
NAME OF SUPERVISOR: __________
DATE: __________

EDITOR'S OBSERVATIONS: ______________________________
NAME OF EDITOR: __________
DATE: _________

CALENDAR INSTRUCTIONS:

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

INFORMATION TO BE CODED FOR EACH COLUMN

2014:
12 DEC 01 ____ ____
11 NOV 02 ____ ____
10 OCT 03 ____ ____
09 SEP 04 ____ ____
08 AUG 05 ____ ____
07 JUL 06 ____ ____
06 JUN 07 ____ ____
05 MAY 08 ____ ____
04 APR 09 ____ ____
03 MAR 10 ____ ____
02 FEB 11 ____ ____
01 JAN 12 ____ ____

2013:
12 DEC 13 ____ ____
11 NOV 14 ____ ____
10 OCT 15 ____ ____
09 SEP 16 ____ ____
08 AUG 17 ____ ____
07 JUL 18 ____ ____
06 JUN 19 ____ ____
05 MAY 20 ____ ____
04 APR 21 ____ ____
03 MAR 22 ____ ____
02 FEB 23 ____ ____
01 JAN 24 ____ ____

2012:
12 DEC 25 ____ ____
11 NOV 26 ____ ____
10 OCT 27 ____ ____
09 SEP 28 ____ ____
08 AUG 29 ____ ____
07 JUL 30 ____ ____
06 JUN 31 ____ ____
05 MAY 32 ____ ____
04 APR 33 ____ ____
03 MAR 34 ____ ____
02 FEB 35 ____ ____
01 JAN 36 ____ ____

2011:
12 DEC 37 ____ ____
11 NOV 38 ____ ____
10 OCT 39 ____ ____
09 SEP 40 ____ ____
08 AUG 41 ____ ____
07 JUL 42 ____ ____
06 JUN 43 ____ ____
05 MAY 44 ____ ____
04 APR 45 ____ ____
03 MAR 46 ____ ____
02 FEB 47 ____ ____
01 JAN 48 ____ ____

2010:
12 DEC 49 ____ ____
11 NOV 50 ____ ____
10 OCT 51 ____ ____
09 SEP 52 ____ ____
08 AUG 53 ____ ____
07 JUL 54 ____ ____
06 JUN 55 ____ ____
05 MAY 56 ____ ____
04 APR 57 ____ ____
03 MAR 58 ____ ____
02 FEB 59 ____ ____
01 JAN 60 ____ ____

2009:
12 DEC 61 ____ ____
11 NOV 62____ ____
10 OCT 63 ____ ____
09 SEP 64 ____ ____
08 AUG 65 ____ ____
07 JUL 66 ____ ____
06 JUN 67 ____ ____
05 MAY 68 ____ ____
04 APR 69 ____ ____
03 MAR 70 ____ ____
02 FEB 71 ____ ____
01 JAN 72 ____ ____