IDENTIFICATION

PLACE NAME_____
NAME OF HOUSEHOLD HEAD_______
P.S.U. NUMBER_____
HOUSEHOLD NUMBER______

REGION

URBAN/RURAL

NAME AND LINE NUMBER OF WOMAN______

INTERVIEWER VISIT 1 (REPEAT FOR INTERVIEWER VISITS 2 AND 2)
DATE_____
INTERVIEWER'S NAME_____
RESULT_____

NEXT VISIT:
DATE____
TIME_____

FINAL VISIT
DAY____
MONTH_____
YEAR_____
NAME_____
RESULT_____

TOTAL NUMBER OF VISITS_____

RESULT CODES

LANGUAGE OF THE QUESTIONNAIRE

TRANSLATOR USED

FIELD EDITED BY
NAME____
DATE_____

OFFICE EDITED BY
NAME____
DATE_____

KEYED BY
NAME_____
DATE_____

KEYED BY
______

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME

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 a city, in a town, or in the countryside?

103) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

104) Just before you moved here, did you live in a city, in s town, or in the countryside?

105) In what month and year were you born?

106) I How old were you at your Last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

107) Have you ever attended school?

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

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

110) CHECK 108:

111) Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

112) Do you usually read a newspaper or magazine at least once a week?

113) Do you usually listen to a radio at least once a week?

114) Do you usually watch television at least once a week?

115) What is your religion?

116) What is the main language spoken in your home?

117) CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE

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 the countryside?
IF CITY: In which city do you live?

119) In which region is that located?

120) Now I would like to ask about the household in which you usually Live.
What is the source of water your household uses for hand washing and dishwashing?

121) How long does it take to go there, get water, and come back?

122) Does your household get drinking water from this same source?

123) What is the source of drinking water for members of your household7

124) What kind of toilet Facility does your household have?

125) Does your household have:

Electricity?
A radio?
A televisions?
A refrigerator?

126) How many rooms in your household are used for sleeping?

127) Could you describe the main material of the floor of your home?
Is it:

Earth or sand?
Dung?
Wood planks?
Palms or bamboo?
Parquet or polished wood?
Vinyl or asphalt strips?
Ceramic tiles?

128) Does any member of your household own:

A donkey cart/horse?
A bicycle?
A motorcycle?
A car?

129) What is the name of the nearest health facility that provides health services to this (LOCALITY)?

130) How far is it from here (in km)?
(RECORD '000' IF LESS THAN 1 KM. IF UNKNOWN RECORD '998')

131) How do you get from here to (HEALTH FACILITY NAME)?

131A) FOR RURAL CLUSTERSONLY: How often per week is motorized transport available to you to go to the facility?
(RECORD '00' IF LESS THAN ONCE PER WEEK. IF UNKNOWN RECORD '98')

132) How long does it take you to get from here to (HEALTH FACILITY NAME)?
(RECORD IN MINUTES IF LESS THAN 2 HOURSAND IN HOURS IF 2 HOURS OR MORE)

133) Does (HEALTH FACILITY NAME) provide:

antenatal care?
delivery care?
child immunization?
family planning services?

134) CHECK:
IS THE NEAREST FACILITY A HOSPITAL?

135) What is the name of the nearest hospital that provides health services to this facility?

136) How far is it from here (in km)?
(RECORD '000' IF LESS THAN 1 KM.
IF UNKNOWN RECORD '998')

137) How do you get from here to (HOSPITAL NAME)?

137A) FOR RURAL CLUSTERS ONLY: How often per week is motorized transport available to go to the hospital?
(RECORDIOO' IF LESS THAN ONCE PER WEEK. IF UNKNOWN RECORD '98')

138) How tong does it take you to get from here to (HOSPITAL NAME)?
RECORD IN MINUTES IF LESS THAN 2 HOURS AND IN HOURS IF 2 HOURS OR MORE)

139) Does (HOSPITAL NAME) provide:

antenatal care?
delivery care?
child immunization?
family planning services?

140) Is (THIS LOCALITY) served by a PHC (Mobile outreach)?
IF YES: What is the name of the outreach point?
IF NO, RECORD '000"

141) How far is it from here (in km)?
(RECORD '000' IF LESS THAN 1 KM. IF UNKNOWN RECORD '998)

142) How do you get from here to (OUTREACH POINT)?

142A) FOR RURAL CLUSTERS ONLY: How often per week is motorized transport available to go to the outreach point?
(RECORD '00' Of LESS THAN ONCE PER WEEK. IF UNKNOWN RECORD '98')

143) How tong does it take you to get from here to (OUTREACHPOINT)?
(RECORD IN MINUTES IF LESS THAN 2 HOURS AND IN HOURS IF 2 HOURS MORE)

144) Does (OUTREACH POINT NAME) provide:

antenatal care?
child immunization?
family planning services?

SECTION 2. REPRODUCTION

201) Now t 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?
IF NONE RECORD '00'.

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 any sign of life but only survived a few hours or days?

207) In all, 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 talk about all of 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 LINE.

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

213) RECORD SINGLE OR MULTIPLE BIRTH STATUS.

214) Is (NAME) a boy or girl?

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

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 LESS THAN 15 YRS. OF AGE:
With whom does he/she live?
IF 15+: GO TO NEXT BIRTH.

220) IF DEAD: How old was he/she when he/she died?
IF "1 YR.", PROBE: How many months old was (NAME)?

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

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

NUMBERS ARE THE 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: PROBE TO DETERMINE EXAXT NUMBER OF MONTHS___

NUMBERS ARE DIFFERENT___(PROBE AND RECONCILE)

222) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1987.
IF NONE, RECORD 0

_____

223) Are you pregnant now?

224) How many months pregnant are you?

225) 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 become pregnant at all?

226) When did your last menstrual period start?

227) Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

228) During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

SECTION 3. CONTRACEPTION

301) Now I would like to talk about family planning, the various ways or methods that a couple can use to delay or avoid a pregnancy. Which ways or methods have you heard about?

CIRCLE CODE 1 IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEEED 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.

303) Have you ever used (METHOD)

304) Do you know where a person could go to get (method)?

305) CHECK 303:

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

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

308) Now I would like to ask you about the time when first did something or used a method to avoid getting pregnant.
How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

309) CHECK 223:

310) CHECK 303:

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

312) Which method are you using?

312A) CIRCLE '06' FOR FEMALE STERILIZATION

313) At the time you first started using the pill, did you consult a doctor or a nurse?

314) At the time you last got pills, did you consult a doctor or a nurse?

315) May I see the package of pills you are using now?
RECORD NAME OF BRAND.

316) Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND.

317) How much does one (packet/cycle) of pills cost you?

318) CHECK 312:
SHE/HE STERILIZED__: Where did the sterilization take place?
USING ANOTHER METHOD___: Where did you obtain (method) the last time?

319) How long does it take to travel from your home to this place?
IF 90 MINUTES OR LESS, RECORD MINUTES.
OTHERWISE, RECORD HOURS.

320) Is it easy or difficult to get there?

321) CHECK 312:

322) In what month and year was the sterilization operation performed?

323) For how many months have you been using (CURRENT METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

324) Do you intend to use a method to delay or avoid pregnancy at any time in the future?

325) What is the main reason you do not intend to use a method?

326) Do you intend to use a method within the next 12 months?

327) When you use a method, which method would you prefer to use?

328) Where can you get (METHOD MENTIONED IN 327)?

329) CHECK 312:

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

331) Where is that?

332) How long does it take to travel from your home to this place?
IF LESS THAN 2 HOURS, RECORD MINUTES. OTHERWISE, RECORD HOURS

333) Is it easy or difficult to get there?

334) Is it acceptable or not acceptable to you for family planning information to be provided in the radio or television?

SECTION 4A PREGNANCY AND BREASTFEEDING

401) CHECK 222:

402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of all your children born in the past five years. (We will talk about one child at a time.)

FROM Q. 212 AND Q. 216

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

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

405) When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
RECORD ALL PERSONS SEEN.

406) Were you given an antenatal card for this pregnancy?

407) How many months pregnant were you when you first saw someone for an antenatal check on this pregnancy?

408) How many antenatal visits did you have during this pregnancy?

409) When you were pregnant with (NAME) were you given an injection in the upper arm to prevent the baby from getting tetanus, that is, convulsions after birth?

410) During this pregnancy how many times did you get this injection?

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

412A) Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS ASSISTING.

412B) Did you experience any complications during labor and/or delivery of (NAME)?
IF YES: What kind of problem(s) did you have?
RECORD ALL PROBLEMS LISTED.

413) Was (NAME) born on time or prematurely?

414) Was (NAME) delivered by caesarian section?

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

416) Was (NAME) weighed at birth?

417) How much did (NAME) weigh?

418) Has your period returned since the birth of (NAME)?

419) Did your period return between the birth of (NAME) and your next pregnancy?

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

421) CHECK 223: RESPONDENT PREGNANT?

422) Have you resumed sexual relations since the birth of (NAME)?
[LAST BIRTH ONLY]

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

424) Did you ever breastfeed (NAME)?

425) Why did you not breastfeed (NAME)?

426) 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.
[LAST BIRTH ONLY]

427) CHECK 216: CHILD ALIVE?

428) Are you still breastfeeding (NAME)?
[LAST BIRTH ONLY]

429) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NO.
[LAST BIRTH ONLY]

430) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NO.
[LAST BIRTH ONLY]

431) At any time yesterday or last night was (NAME) given any of the following?
[LAST BIRTH ONLY]

Plain water?
Sugar water?
Juice?
Herbal tea?
Baby formula?
Fresh/sour milk?
Tinned or powdered milk?
Other liquids?
Any solid or mushy food?

432) CHECK 431: FOOD OR LIQUID GIVEN YESTERDAY?

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

434) Why did you stop breastfeeding (NAME)?

435) CHECK 216: CHILD ALIVE?

436) Was (NAME) ever given water or anything else to drink or eat (other than breast milk)?

437) How many months old was (NAME) when you started giving the following on a regular basis?

Formula or milk other than breast milk?
Plain water?
Other liquids?
Any solid or mushy food?
IF LESS THAN 1 MONTH, RECORD '00'.

438) CHECK 216: CHILD ALIVE?

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

440) GO BACK TO 403 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO FIRST COLUMN OF 441

SECTION 4B. IMMUNIZATION AND HEALTH

441) ENTER THE LINE NUMBER NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1987 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).

LINE NUMBER FROM Q. 212

442) Do you have a health passport or card where (NAME'S) vaccinations are written down?
IF YES: May I see it, please?

443) Did you ever have a health passport or vaccination card for (NAME)?

444) (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 RECORDED.

POLIO 0
BCG
POLIO 1
DPT 1
POLIO 2
DPT 2
POLIO 3
DPT 3
MEASLES

445) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, DPT 11-3 AND/OR MEASLES VACCINE(S).

446) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

447) Please tell me if (NAME) (has) received any of the following vaccinations:
A BCG vaccination against tuberculosis, that is, an injection in the left upper arm that caused a scar?
Polio vaccine, that is, drops in the mouth?
IF YES: How many times?
An injection against measles?

447A) Did (NAME) ever have measles?

447B) How old was (NAME) when he/she had measles?
RECORD IN MONTHS IF LES THAN 2 YEARS. OTHERWISE RECORD IN YEARS.

448( CHECK 216:
CHILD ALIVE?

449) GO BACK TO 442 FOR NEXT BIRTH; OR IF NO MORE BIRTHS, GO TO 477.

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

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

452) Has (NAME) been ill with a cough in the last 24 hours?

453) For how many days (has the cough lasted/did the cough last)?
IF LESS THAN 1 DAY, RECORD '00'.

454) When (NAME) has the illness with a cough, did he/she breathe faster than usual with short, rapid breathe?

455) CHECK 450 AND 451: FEVER OR COUGH?
"YES" IN EITHER 450 OR 451___
OTHER___ (GO TO 560)

456) Was anything given to treat the fever/cough?

457) What was given to treat the fever/cough?
Anything else?
RECORD ALL MENTIONED

458) Did you seek advice or consultation for the fever/cough?

459) Where did you seek advice or consultation?
Anywhere else?
RECORD ALL MENTIONED

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

461) GO BACK TO 442 FOR NEXT BIRTH; OR IF NO MORE BIRTHS, GO TO 477.

461A) How many stools did (NAME) have on the worst day of the episode?

461B) Was the diarrhea episode of (NAME) mild or sever?

462) Has (NAME) had diarrhea in the last 24 hours?

463) For how many days (has the diarrhea lasted/ did the diarrhea last)?
IF LESS THAN 1 DAY, RECORD '00'.

464) Was there any blood in the stools?

465) CHECK 424/428: LAST CHILD SYILL BREASTFED?

466) During (NAME)'s diarrhea, did you change the frequency of breastfeeding?

467)Did you increase the number of breastfeeds or reduce them, or did you stop completely?

468) (Aside from breast milk) was he/she given the same amount to drink as before the diarrhea, or more, or less?

469) Was anything given to treat the diarrhea?

470) What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED

471) Did you seek advice or consultation for the diarrhea?

472) Where did you seek advice or consultation? Anywhere else?
RECORD ALL MENTIONED.

473) CHECK 470: ORS FLUID FROM PACKET MENTIONED?
NO, ORS FLUID NOT MENTIONED___
YES, ORS FLUID MENTIONED___(GO TO 475)

474) Was (NAME) given fluid from ORS packet when he/she had the diarrhea?

475) For how many days was (NAME) given (LOCAL NAME)?
IF LESS THAN 1 DAY, RECORD '00'.

476) GO BACK TO 442 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO 477.

477) CHECK 470 AND 474 (ALL COLUMNS):
ORS FLUID FROM PACKET MENTIONED___ (GO TO 481)
ORS FLUID NOT MENTIONED OR 470 AND 474 NOT ASKED___

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

479) Have you ever seen a packet like this before?
SHOW PACKET.

480) Have you ever prepared a solution with one of these packets to treat diarrhea in yourself or someone else?
SHOW PACKET

481) The last time you prepared the ORS packet solution, did you prepare the whole packet at once or only part of the packet?

482) How much water did you use to prepare ORS packet the last time you made it?

483) Where can you get the ORS packet?
PROBE: Anywhere else?
RECORD ALL PLACES MENTIONED

SECTION 4C. CAUSE OF DEATH OF CHILDREN BORN AND DYING IN PAST 5 YEARS

484) CHECK 216:
ONE OE MORE DEATHS SINCE JAN. 1987___
NO DEATHS SINCE JAN. 1987___(GO TO 501)

ENTER IN THE TABLE THE LINE NUMBERS AND NAME OF EACH CHILD BORN INCE JANUARY 1987 WHO LATER DIES. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST OF THESE BIRTHS. (IF THERE ARE MORE THAN 3 BIRTHS, USE ADDITIONAL FORMS).
I would now like to ask you some specific questions about the events and symptoms (NAME) had during the time before he/she died. I know it may be difficult to talk about children you have had who died after they were born, but this information is very important in helping to plan health programs to prevent other children from dying.

LINE NUMBER FROM Q. 212

485) FROM Q. 212

486A) What do you think was the cause of (NAME)'s death?

486B) During the illness that led to (NAME)'s death, did you seek advice or treatment from anywhere/anyone?
IF YES, SPECIFY.
CIRCLE ALL THAT APPLY.

486C) Where did (NAME) die?

487) CHECK Q. 220: AGE AT DEATH
LESS THAN 1 MONTH____
1 MONTH OR OLDER___(GO TO 491A)

488A) Was (NAME) born after a difficult delivery?

488B) Was (NAME) malformed in any way?
IF YES, SPECIFY

488C) Did (NAME) suck or drink normally during the first two days of life?

488D) Did (NAME) have a decrease in sucking or difficulty sucking during the days before death?

488E) Did (NAME) have convulsions or spasms during the disease that led to death?

489A) During the disease that led to death, did (NAME) have a cough?

489B) For how many days did the cough last?
IF LESS THAN 1 DAY, RECORD '00'.

489C) When (NAME) had the illness with the cough, did he/she have difficult or rapid breathing?

489D) For how many days did the difficult or rapid breathing last?
IF LESS THAN 1 DAY, RECORD '00'.

490) GO BACK TI 485 FOR NEXT DECEASED CHILD; IF NO MORE DECEASED CHILDREN, GO TO 501.

491A) During the disease that led to death, did (NAME) have loose or liquid stools, that is diarrhea?

491B) Was the diarrhea episode of (NAME) mild or severe?

491C) For how long did the diarrhea last?
IF LESS THAN 1 DAY, RECORD '00'.

491D) Was there any blood in the stool?

492A) During the disease that led to death, did (NAME) have a cough?

492B) For how long did the cough last?
IF LESS THAN 1 DAY, RECORD '00'.

492C) When (NAME) had the illness with the cough, did he/she have difficult/rapid breathing?

492D) For hoe long did the difficult/rapid breathing last?
IF LESS THAN 1 DAY, RECORD '00'.

493A) During the disease that led to death, did (NAME) have a fever?

493B) Was the fever of (NAME) mild or severe?

493C) How long did the fever last?
IF LESS THAN 1 DAY, RECORD '00'.

493D) During the disease that led to death, was (NAME) unconscious?

493E) During the disease that led to death, did (NAME) have convulsions?

494A) During the disease that led to death, did (NAME) have a skin rash all over his/her body and face?

494B) How long did the rash last?
IF LESS THAN 1 DAY, RECORD '00'.

495A) During the disease that led to death, was (NAME) very thin?

495B) How long was (NAME) very thin?

495C) During the disease that led to death, did (NAME) have swelling of the feet or legs?

495D) How long was the swelling present?
IF LESS THAN 1 DAY, RECORD '00'.

496) GO BACK TO 485 FOR NEXT DECEASED CHILD. IF NO MORE DECEASED CHILDREN, GO TO 501.

SECTION 5. MARRIAGE

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

502) Are you now married or living with a man, or are you now widowed, divorced, or no longer living together?

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

504) Does your husband/partner have any other wives besides yourself?

505) How many other wives does he have?

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

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

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

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

510) CHECK 508 AND 509: YEAR AND AGE GIVEN?

511) CHECK CONSISTENCY OF 508 AND 509:
YEAR OF BIRTH (105) PLUS AGE AT MARRIAGE (509)___(CALCULATED YEAR OF MARRIAGE)

IF NECESSARY, CALCULATE YEAR OF BIRTH: CURRENT YEAR MINUS CURRENT AGE (106)___(CALCULATED YEAR OF BIRTH)

IS THE CALCULATED YEAR OF MARRIAGE WITHIN ONE YEAR OF THE REPORTED YEAR OF MARRIAGE (508)?

512) IF NEVER IN UNION:
Have you ever had sexual intercourse?

513) Now we need some details about your sexual activity in order to get a better understanding of family planning and fertility.
How many times did you have sexual intercourse in the last four weeks?

514) How many times in a month do you usually have sexual intercourse?

515) When was the last time you had sexual intercourse?

516) How old were you when you first had sexual intercourse?

517) PRESENCE OF OTHERS AT THIS POINT.

SECTION 6. FERTILITY PREFERENCES

601) CHECK 312:

602) CHECK 501 AND 502:

603) CHECK 223:
NOT PREGNANT OR UNSURE__: Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children?

PREGNANT__: Now I have some questions about the future. After the child you are expecting, would you like to have another child or would you prefer not to have any (more) children?

604) CHECK 223:
NOT PREGNANT OR UNSURE___: How long would you like to wait from now before the birth of (a/another) child?

PREGNANT__: How long would you like to wait after the birth of the child you are expecting before the birth of another child?

605) CHECK 216 AND 223: HAS LIVING CHILDREN OR PREGNANT?

606) CHECK 223:
NOT PREGNANT OR UNSURE___: How old would you like your youngest child to be when your next child is born?

PREGNANT___: How old would you like the child you are expecting to be when your next child is born?

607) Given your present circumstances, if you had to do it over again, do you think you would make the same decision to have sterilization?

608) Do you regret that (you/your husband) had the operation not to have any (more) children?

609) Why do you regret it?

610) Do you think that your husband/partner approves or disapproves of couples sing a method to avoid pregnancy?

611) How often have you talked to your husband/partner about family planning in the past year?

612) Have you and your husband/partner ever discussed the number of children you would like to have?

613) 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>

614) How long should a couple wait before starting sexual intercourse after the birth of a baby?

615) Should a mother wait until she has completely stopped breastfeeding before starting to have sexual relations again, or doesn't matter?

616) In general, do you approve or disapprove of couples using a method to avoid pregnancy?

617) 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?

RECORD SINGLE NUMBER OR OTHER ANSWER.

618) 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?

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

701) CHECK 501:
EVER MARRIED OR LIVED TOGETHER___ (ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND/PARTNER)

NEVER MARRIED/NEVER LIVED TOGETHER___(GO TO 708)

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

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

704) What was the highest grade he completed at that level?

705) What kind of work does (did) your (last) husband/partner mainly do?

706) CHECK 705:
WORKS (WORKED) IN AGRICULTURE____
DOES (DID) NOT WORK IN AGRICULTURE____ (GO TO 708)

707) (Does/did) your husband/partner work mainly on his own land or family land, or (does/did) he rent land, or (does/did) he work on communal land, or (does/did) he work on someone else's land?

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

709) 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?

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

711) In your current work do you work, do you work for a member of your family, for someone else, or are you self-employed?

712) Do you earn cash for this work?
PROBE: Do you make money for working?

713) Do you do this work at home or away from home?

714) CHECK 215/216/218: HAS CHILD BORN SINCE JAN. 1987 AND LIVING AT HOME?

715) While you are working, do you usually have (NAME OF YOUNGEST CHILD AT HOME) with you, sometimes have him/her with you, or never have him/her with you?

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

SECTION 8. MATERNAL MORTALITY

801) 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?

802) CHECK 801:
TWO OR MORE BIRTHS___
ONLY ONE BIRTH (RESPONDENT ONLY)____(GO TO END)

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

804) What are the names of all your mother's children, starting with the first born?

805) Is (NAME) male or female?

806) Is (NAME) still alive?

807) How old is (NAME)?

808) How many years ago did (NAME) die?

809) How old was (NAME) when she/he died?

810) Was (NAME) pregnant when she died?

811) Did (NAME) die during childbirth?

812) Did (NAME) die within six weeks after the end of a pregnancy or childbirth?

813) How many children had (NAME) given birth to before that pregnancy?

814) RECORD THE TIME WHEN INTERVIEW COMPLETED

SECTION 9. HEIGHT AND WEIGHT

901) CHECK 222:
ONE OR MORE BIRTHS SINCE JAN. 1987___
NO BIRTHS SINCE JAN. 1987___(END)

INTERVIEWER: IN 902 (COLUMNS 2-4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1987 AND STILL ALIVE. IN 903 AND 904 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1987. IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPORDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1987 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED)

1) RESPONDENT_____
2) YOUNGEST CHILD______
3) NEXT-TO-YOUNGEST CHILD_______
4) SECOND-TO-YOUNGEST CHILD______

902) LINE NUMBER FROM Q. 212

903) NAME FROM Q. 212 FOR CHILDREN

904) DATE OF BIRTH
FROM Q. 103 FOR RESPONDENT. FROM Q.215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

905) BCG SCAR ON TOP OF LEFT UPPER ARM

906) HEIGHT (IN CENTIMETERS)
IF AGE UNDER 24 MOS. MEASURE LYING. IF 24 MOS OR MORE, MEASURE STANDING

907) WEIGHT (IN KILOGRAMS)

908) MID-UPPER ARM CIRCUMFERENCE (IN MILLIMETERS)

909) DATE WEIGHED AND MEASURED

910) RESULT

911) NAME OF MEASURER:________
NAME OF ASSISTANT:__________

INTERVIEWER'S OBSERVATION
(TO BE FILLED IN AFTER COMPLETING INTERVIEW)

COMMENTS ABOUT RESPONDENT:
______________

COMMENTS ON SPECIFUC QUESTIONS:
______________

ANY OTHER COMMENTS:
______________

SUPERVISOR'S OBSERVATION

_______________

NAME OF SUPERVISOR:___________
DATE:___________

EDITOR'S OBSERVATION
___________