REGION/DISTRICT_____________
TA/STA/TOWN______________
ENUMERATION AREA _____________
VILLAGE OR PLACE______________
MDHS CLUSTER NUMBER___________
HOUSEHOLD NUMBER _______________
URBAN/RURAL ____________
RURAL 2
NAME AND LINE NUMBER OF MAN _____________
NAME AND LINE NUMBER OF WIFE # 1____________
NAME AND LINE NUMBER OF WIFE # 2____________
NAME AND LINE NUMBER OF WIFE # 3____________
(NOTE: include only wives in household)
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ___
INTERVIEWER'S NAME ___
RESULT* ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ____ 7
FINAL VISIT:
DAY __
MONTH __
YEAR __
NAME __
RESULT__
TOTAL NUMBER OF VISITS__
FIELD EDITED BY:
NAME ___
DATE ___
OFFICE EDITED BY:
NAME ___
DATE ___
KEYED BY:
NAME ___
DATE ___
SECTION 1. RESPONDENT'S BACKGROUND
MINUTES __
102. First I would like to ask some questions about you and your household. For most of the time until you were about 12 years old, did you live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
105. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107. Have you ever attended school?
NO 2 (GO TO 111)
108. What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109. How many years of school did you complete at that level?
SECONDARY OR HIGHER (GO TO 112)
111. Are you able to read and understand English or Chichewa easily, with difficulty or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)
112. Do you usually read a newspaper or magazine at least once a week?
NO 2
113. Do you usually listen to a radio at least once a week?
NO 2
114. What kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 117)
116. Do you work mainly on your own land or family's land, or on land that you rent, or on someone else's land?
RENTED LAND 2
SOMEONE ELSE'S LAND 3
117. CHECK Q. 4 IN THE HOUSEHOLD QUESTIONNAIRE:
THE MAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)
118. Now I would like to ask about the place in which you usually live. Do you usually live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
119. In which region is that located?
CENTRAL 2
SOUTH 3
OUTSIDE MALAWI 4
120. What is the source of water your household uses for handwashing and dishwashing?
PIPED INTO YARD/PLOT 12 (GO TO 122)
PUBLIC TAP 13
UNPROTECTED WELL 22
RIVER/STREAM 32
POND/DAM 33
LAKE 34
OTHER (SPECIFY) _____ 71
121. How long does it take to go there, get water and come back?
ON PREMISES 996
DON'T KNOW 998
122. Does your household get drinking water from this same source?
NO 2
123. What is the source of drinking water for members of your household?
PIPED INTO YARD/PLOT 12
PUBLIC TAP 13
UNPROTECTED WELL 22
RIVER/STREAM 32
POND/DAM 33
LAKE 34
OTHER (SPECIFY) _____ 71
124. What kind of toilet facility does your household have?
SHARED FLUSH TOILET 12
VENTILATED IMPROVED PIT (VIP LATRINE) 22
OTHER (SPECIFY) ____ 41
125. Does your household have:
NO 2
NO 2
NO 2
126. How many rooms in all the dwelling units of your household are used for sleeping?
127. Does any member of your household own:
NO 2
NO 2
NO 2
NO 2
128A. At your own house, what is the main material that the floor is made from?
NOTE: IF HIS HOUSEHOLD LIVES IN MORE THAN ONE DWELLING UNIT AND THE DWELLING UNITS DIFFER IN FLOOR MATERIALS, ASK FOR THE FLOOR MATERIAL OF THE DWELLING OF THE HEAD OF HOUSEHOLD.
BRICKS 32
WOOD 33
TILES 34
128B. At your own house, what is the main material that the roof is made from?
IRON SHEETS 2
IRON AND TILES 3
ASBESTOS 4
CEMENT 5
WOOD 6
OTHER (SPECIFY) _____ 7
201. Have you ever been married or lived with a woman?
NO 2 (GO TO 301)
202. Are you now married or living with a woman, or are you now widowed, divorced or no longer living together?
LIVING TOGETHER 2
WIDOWED 3 (GO TO 204)
DIVORCED 4 (GO TO 204)
SEPARATED 5 (GO TO 204)
203. How many wives do you have?
CHECK CONSISTENCY WITH COVER PAGE.
204. In what month and year did you start living with your (first) wife/partner?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
205. How old were you when you started living with her?
DON'T KNOW AGE 98
206. CHECK 204 AND 205:
YEAR AND AGE GIVEN?
NO (GO TO 301)
207. CHECK CONSISTENCY OF 204 AND 205:
YEAR OF BIRTH (105) ___
PLUS +
AGE AT MARRIAGE (205) ___
=
CALCULATED YEAR OF MARRIAGE ___
CURRENT YEAR _92_
MINUS -
CURRENT AGE (106) ___
=
CALCULATED YEAR OF BIRTH ___
IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (204)?
NO (PROBE AND CORRECT 204 AND 205)
SECTION 3. METHODS OF CHILDSPACING
301. Now I would like to talk about childspacing - the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?
CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303-304 BEFORE PROCEEDING TO THE NEXT METHOD.
302. Have you ever heard of (METHOD)?
READ DESCRIPTION OF EACH METHOD.
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
YES/PROBED 2
NO 3 (GO TO NEXT METHOD)
NO 3 (GO TO 305)
303. Have you ever used (METHOD) with any partner?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
304. Do you know where a person could go to get (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) (GO TO 308)
306. Have you or (your wife/partner) ever tried in any way to delay or avoid having a baby?
NO 2 (GO TO 317)
307. What have you used or done?
CORRECT 303-305(AND 302 IF NECESSARY).
308. CHECK 303:
MAN STERILIZED (GO TO 310A)
309. Are you or your wife (or partner) currently doing something or using any method to delay or avoid having a baby?
NO 2 (GO TO 317)
310. Which method are you using?
310A. DO NOT ASK THE QUESTION BELOW IF MAN NOT STERILIZED.
You have said that you had an operation that keeps you from ever making a woman pregnant. Is that correct?
IF RESPONENT SAYS "NO", CORRECT 303-305 (AND 302 IF NECESSARY).
IF RESPONDENT SAYS "YES", CIRCLE '07' FOR MALE STERILIZATION.
IUCD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
NATURAL METHOD 08 (GO TO 316)
WITHDRAWAL 09 (GO TO 316)
OTHER (SPECIFY) _____ 10 (GO TO 316)
SHE/HE STERILIZED: Where did the sterilization take place?
USING ANOTHER METHOD: Where did you obtain (METHOD) the last time?
PRIMARY HEALTH CENTRE 12
DISPENSARY/MATERNITY CLINIC 13
MOBILE CLINIC 14 (GO TO 314)
PRIVATE HEALTH CENTRE 22
DISPENSARY/MATERNITY CLINIC 23
MOBILE CLINIC 24 (GO TO 314)
PRIVATE DOCTOR 25
CHURCH 32 (GO TO 314)
FRIENDS/RELATIVES 33 (GO TO 314)
DON'T KNOW 98 (GO TO 314)
312. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.
HOURS 2 0___
DON'T KNOW 9998
313. Is it easy or difficult to get there?
DIFFICULT 2
314. CHECK 310:
USING ANOTHER METHOD (GO TO 316)
315. In what month and year was the sterilization operation performed?
316. For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.
8 YEARS OR LONGER 96 (GO TO 322)
317. Do you intend to use a method to delay or avoid pregnancy at any time in the future?
NO 2
DON'T KNOW 8 (GO TO 323)
318. What is the main reason you do not intend to use a method?
LACK OF KNOWLEDGE 02 (GO TO 323)
PARTNER OPPOSED 03 (GO TO 323)
OTHER RELATIVES OPPOSED 04 (GO TO 323)
SIDE EFFECTS 05 (GO TO 323)
HEALTH CONCERNS 06 (GO TO 323)
SOURCE TOO FAR AWAY 07 (GO TO 323)
METHODS ARE UNAVAILABLE 08 (GO TO 323)
OPPOSED TO FAMILY PLANNING 09 (GO TO 323)
FATALISTIC/GOD'S WILL 10 (GO TO 323)
COSTS TOO MUCH 11 (GO TO 323)
INFREQUENT SEX 12 (GO TO 323)
CAN NOT GET PREGNANT 13 (GO TO 323)
MENOPAUSAL/HAD HYSTERECTOMY 14 (GO TO 323)
INCONVENIENT 15 (GO TO 323)
NOT MARRIED 16 (GO TO 323)
OTHER (SPECIFY) ____ 17 (GO TO 323)
DON'T KNOW 98 (GO TO 323)
319. Do you intend to use a method within the next 12 months?
NO 2
DON'T KNOW 8
320. When you start using a method, which method would you prefer to use?
IUCD 02
INJECTIONS 03
DIAPHRAGM/FOAM/JELLY 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
NATURAL METHOD 08 (GO TO 323)
WITHDRAWAL 09 (GO TO 323)
OTHER (SPECIFY) _____ 10 (GO TO 323)
321. Where can you get (METHOD MENTIONED IN 320)?
PRIMARY HEALTH CENTRE 12 (GO TO 325)
DISPENSARY/MATERNITY CLINIC 13 (GO TO 325)
MOBILE CLINIC 14 (GO TO 327)
PRIVATE HEALTH CENTRE 22 (GO TO 325)
DISPENSARY/MATERNITY CLINIC 23 (GO TO 325)
MOBILE CLINIC 24 (GO TO 327)
PRIVATE DOCTOR 25 (GO TO 325)
CHURCH 32 (GO TO 327)
FRIENDS/RELATIVES 33 (GO TO 327)
DON'T KNOW 98 (GO TO 323)
USING A MODERN METHOD (GO TO 327)
323. Do you know of a place where you can obtain a method of childspacing?
NO 2 (GO TO 327)
PRIMARY HEALTH CENTRE 12
DISPENSARY/MATERNITY CLINIC 13
MOBILE CLINIC 14 (GO TO 327)
PRIVATE HEALTH CENTRE 22
DISPENSARY/MATERNITY CLINIC 23
MOBILE CLINIC 24 (GO TO 327)
PRIVATE DOCTOR 25
CHURCH 32 (GO TO 327)
FRIENDS/RELATIVES 33 (GO TO 327)
325. How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS.
HOURS 2 0___
DON'T KNOW 9998
326. Is it easy or difficult to get there?
DIFFICULT 2
327. In the last month, have you heard a message about childspacing on the radio?
NO 2
328. Is it acceptable or not acceptable to you for childspacing information to be provided on the radio?
NOT ACCEPTABLE 2
DON'T KNOW 8
NEVER HEARD OF THE CONDOM (GO TO 401)
330. Have you seen or heard any advertisement in the last month about the condom?
NO 2 (GO TO 332)
331. Where did you see or hear the advertisement?
CIRCLE ALL MENTIONED
NEWSPAPER B
MAGAZINE C
POSTERS D
CAN NOT REMEMBER E
OTHER (SPECIFY) ____ F
CURRENTLY USING CONDOM (GO TO 401)
333. Where can someone go to get condoms?
PRIMARY HEALTH CENTRE 12
DISPENSARY/MATERNITY CLINIC 13
MOBILE CLINIC 14
PRIVATE HEALTH CENTRE 22
DISPENSARY/MATERNITY CLINIC 23
MOBILE CLINIC 24
PRIVATE DOCTOR 25
CHURCH 32
FRIENDS/RELATIVES 33
DON'T KNOW 98
SECTION 4. FERTILITY PREFERENCES
401. How many own sons do you have who are still alive?
IF NONE, RECORD '00'.
402. How many own daughters do you have who are still alive?
IF NONE, RECORD '00'.
HE OR SHE STERILIZED (GO TO 406)
404. Now I have some questions about the future.
Would you like to have another (a) child or would you prefer to have (no more children/no children)?
NO MORE/NONE 2 (GO TO 409)
NO MORE AFTER THIS PREGNANCY 3 (GO TO 409)
SAYS WIFE CAN'T GET PREGNANT 4 (GO TO 409)
UNDECIDED OR DON'T KNOW 5 (GO TO 409)
405. How long would you like to wait before the birth of another (a) child?
YEARS 2 __ (GO TO 409)
SOON/NOW 994 (GO TO 409)
SAYS WIFE CAN'T GET PREGNANT 995 (GO TO 409)
OTHER (SPECIFY) ____ 996 (GO TO 409)
DON'T KNOW 998 (GO TO 409)
406. Given your present circumstances, if you had to do it over again, do you think (you/your wife or partner) would make the same decision to have an operation not to have any more children?
NO 2
407. Do you regret that (you/your wife or partner) had the operation not to have any (more) children?
NO 2 (GO TO 414)
PARTNER WANTS ANOTHER CHILD 2 (GO TO 414)
SIDE EFFECTS 3 (GO TO 414)
OTHER REASON (SPECIFY) _____ 4 (GO TO 414)
NOT MARRIED/NOT LIVING TOGETHER (GO TO 414)
410. Do you think that your (wife/partner) approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
411. How often have you talked to your (wife/partner) about childspacing in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
412. Have you and your (wife/partner) ever discussed the number of children you would like to have?
NO 2
413. Do you think your (wife/partner) wants the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
414. How long should a couple wait before starting sexual intercourse after the birth of a baby?
YEARS 2 __
OTHER (SPECIFY) ____ 996
415. Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't it matter?
DOESN'T MATTER 2
416. In general, do you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
HAS LIVING CHILD(REN):
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?
OTHER ANSWER (SPECIFY) ____ 96
418. What do you think is the best number of months or years between the birth of one child and the birth of the next child?
YEARS 2 __
OTHER (SPECIFY) ____ 996
501. Now I have a few questions about a very important topic. Have you heard of an illness called AIDS?
NO 2 (GO TO 601)
502. From which sources of information or persons have you heard about AIDS in the last month?
CIRCLE ALL MENTIONED.
NEWSPAPERS B
HEALTH WORKERS C
MOSQUES/CHURCHES D
FRIENDS/RELATIVES E
SCHOOLS/QURAN TEACHERS F
BOOKLETS/PAMPHLETS/POSTERS G
COMMUNITY MEETINGS H
OTHER (SPECIFY) ____ I
NONE J
503. How is AIDS transmitted?
CIRCLE ALL MENTIONED.
NEEDLES/BLADES/SKIN PUNCTURES B
MOTHER TO CHILD C
TRANSFUSION OF INFECTED BLOOD D
OTHER (SPECIFY) _____ E
DON'T KNOW F
504. Do you think that you can get AIDS from:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
505. Is it possible for a healthy looking person to be infected with the AIDS virus?
NO 2
DON'T KNOW 8
506. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?
NO 2
DON'T KNOW 8
507. Can a person protect herself or himself from getting AIDS?
NO 2 (GO TO 509)
508. How can a person protect herself or himself from getting AIDS?
CIRCLE ALL MENTIONED.
LIMIT NUMBER OF SEXUAL PARTNERS B
USE CONDOMS DURING SEX C
STERILIZE SYRINGES/NEEDLES D
AVOID PROSTITUTES E
OTHER (SPECIFY) _____ F
509. If your relative is suffering with AIDS, who would you prefer to care for him or her?
GOVERNMENT FACILITY 2
RELIGIOUS ORGANIZATION/MISSION 3
NOBODY/ABANDON 4
OTHER (SPECIFY) ____ 5
601. 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 yourself?
ONLY ONE BIRTH (RESPONDENT ONLY) (END)
603. How many of these births did your mother have before you were born?
604. What was the name given to your oldest (next oldest) brother or sister?
605. Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 608)
DON'T KNOW 8 (GO TO NEXT SIBLING)
608. How many years ago did (NAME) die?
609. How old was (NAME) when she/he died?
610. Was (NAME) pregnant when she died?
NO 2
611. Did (NAME) die during childbirth?
NO 2
612. Did (NAME) die within six weeks after the end of a pregnancy or childbirth?
NO 2 (GO TO NEXT SIBLING)
613. How many children had (NAME) given birth to before that pregnancy?
MINUTES ___
(To be filled in after completing interview)
Comments About Respondent:____________________________
Comments on Specific Questions:____________________________
Any Other Comments:____________________________
SUPERVISOR'S OBSERVATIONS____________________________
Name of Supervisor: ___________
Date: ____________
EDITOR'S OBSERVATIONS___________________________