THE INFORMATION PROVIDED FOR THIS QUESTIONNAIRE IS STRICTLY CONFIDENTIAL ACCORDING TO THE 5/98 LAW

IDENTIFICATION AND LOCATION

AF.01- NAME OF HOUSEHOLD HEAD_________

AF.02- PLACE NAME_________

AF.03- CLUSTER NUMBER ___________

AF.04- REGION _______

REGION CODE_______

AF.05- STUDY DOMAIN: DISTRICT _______

DISTRICT CODE _______

AF.06- ENUMERATION AREA (EA) _______

EA CODE_______

AF.07-HOUSEHOLD NUMBER

NUMBER_______

AF.08- NAME AND LINE NUMBER OF WOMAN

INTERVIEWER VISITS

FIRST VISIT
DAY____
MONTH___
YEAR 2008
INTERVIEWER'S NAME_________
AF.09- RESULT*_________

NEXT VISIT
DAY___
MONTH___
YEAR___
TIME___

SECOND VISIT
DAY____
MONTH ___
YEAR 2008
INTERVIEWER'S NAME_________
AF.09- RESULT*_________

NEXT VISIT
DAY___
MONTH___
YEAR___
TIME___

THIRD VISIT
DAY____
MONTH___
YEAR2008
INTERVIEWER'S NAME_________
AF.09- RESULT*_________

FINAL VISIT
DAY_________
MONTH_________
YEAR 2008
INTERVIEWER'S CODE ______
RESULT CODE*______

TOTAL NUMBER OF VISITS_________

*RESULT CODES:

SUPERVISOR
NAME_________
DAY____
MONTH____
YEAR____
CODE_________

FIELD EDITOR
NAME_________
DAY____
MONTH____
YEAR____
CODE_________

OFFICE EDITOR_________
CODE______

KEYED BY_________
CODE_____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

Hello. My name is _________and I am working with the NATIONAL INSTITUTE OF STATISTICS and the MINISTRY OF HEALTH. We are conducting a national survey that asks men, women and children about various health issues. We would very much appreciate your participation in this survey. We will ask you questions about your health and your children's health. This information will help the government to plan health services. The survey usually takes about 30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Participation in this survey is voluntary, however extremely important. You will be contributing to solve some of the problems we face. We hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer:____________ Date:________________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

101. RECORD THE TIME

102. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS

103. When you were a 12 year old child, where did you live for most of the time?

RESERVED FOR INE___

104. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?

105. In the last 12 months, have you been away from your home community for more than one month at a time?

106. In what month and year were you born?

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT

107A. Where were you born (name of district or country of birth)?

107B. Where did you live five years ago (district or country of residence)?

108. Have you attended school?

108A. Are you currently attending school?

108B. What was the main reason you stopped attending school?

109. What is the highest level of school you attended: primary, secondary, higher or literacy classes?

110. What is the highest grade/class you completed at that level?

HIGHEST GRADE/CLASS COMPLETED

111. CHECK 109:

112. 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?

114. CHECK 112:

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

116. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

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

118. What is your religion?

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 living somewhere else? And how many daughters are living somewhere else?
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 signs of life but survived only a few hours or days?

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:

210A. Do all of your children have the same father?

210B. If NOT, how many different fathers are there?

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 AND ASK ALL QUESTIONS UNTIL 221 FOR EACH CHILD. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. (IF THERE ARE MORE THAN 15 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE, STARTING WITH THE SECOND ROW)

212. What name was given to your first/next baby?
(IF NO NAME YET, RECORD 'BABY')

(OBS. 15 SPACES FOR CHILDREN)

213. Were any of these births twins?

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

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 (SECTION A)
(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 old was (NAME)?
RECORD DAYS IF LESS THAN A MONTH; MONTH IF LESS THAN TWO YEARS; OR YEARS.

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

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

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

224. CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN JANUARY 2003. IF NONE, RECORD '0' AND GO TO QUESTION 226.

225. FOR EACH BIRTH SINCE JANUARY 2003, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P's MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.

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 THE INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS

228. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children?

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

230. In what month and year did the last such pregnancy end?

231. CHECK 230:

232. 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.

233. Have you ever had any other pregnancies that did not result in a live birth, after January 2003?

234. AKS THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2003.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.

235. Did you have any pregnancies that terminated before 2003, that did not result in a live birth?

236. In what year and month did the last such pregnancy that terminated before 2003 end?

237. When did your last menstrual period start?

(WRITE THE EXACT DATE, IF GIVEN)

238. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

239. When during the menstrual cycle is a woman more likely to become pregnant?

239A. Have you ever had a gynecological exam (non-prenatal examination)?

239B. Where did you go to do your last gynecological exam?

239C. In the last 12 months, have you had a gynecological exam?

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid pregnancy. Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you heard of (METHOD)?
-CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CIRCLE CODE 1 FOR EACH KNOWN METHOD OTHERWISE CIRCLE CODE 2 AND CONTINUE WITH NEXT METHOD NOT MENTIONED SPONTANEOUSLY.
-FOR EACH RECOGNIZED METHOD ASK QUESTION 302.

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

302. Have you ever used (METHOD)?

303. CHECK 302:

304. Have you or your partner/husband ever used anything or tried in any way to delay or avoid getting pregnant?

305. ENTER '0' IN THE CALENDAR IN EACH BLANK MONTH (GO TO 333)

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

307. When you used for the first time a method to avoid getting pregnant, how many living children did you have at that time?

IF NONE RECORD '00'

307A. How many boys?

IF NONE RECORD '00'

307B. How many girls?

IF NONE RECORD '00'

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

308. CHECK 302(01):

309: CHECK 226:

310. Are you or your partner/husband currently doing something or using any method to delay or avoid getting pregnant?

311. Which method are you using?
RECORD ALL ANSWERS. IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD IN LIST.

311A. CIRCLE 'A' FOR FEMALE STERILIZATION

314. How many (pill cycles/condoms) did you get the last time?

315. The last time you obtained (HIGHEST METHOD ON LIST IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?

316. In what facility did the operation to stop having children/ sterilization take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF SOURCE IS HOSPITAL, OR HEALTH CENTER, WRITE THE NAME OF THE PLACE.

316A. Before using sterilization as a contraceptive method, did you consult a doctor/nurse?

316B. Who decided for the sterilization method?
RECORD THE MAIN ONE.

316C. What was the main reason that you or your husband/partner or someone else decided to use sterilization as a contraceptive method?

316D. What was the main reason why the doctor recommended you to do the operation?

316E. Do you regret that (you/ your husband) had the operation not to have any (more) children?

317. CHECK 311/311A:

318. How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?

319. In what month and year was the sterilization performed?

319A. Since what month and year have you been using (CURRENT METHOD) without stopping?

PROBE: For how long have you been using (CURRENT METHOD) now without stopping?

320. CHECK 319/319A, 215 AND 230:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A

321. CHECK 319/319A:

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

USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2003.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:

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

323. CHECK 311/311A:

CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

324. Where did you obtain (CURRENT METHOD) when you started using it?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

324A. Where did you learn to use the rhythm/lactational amenorrhea method?

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

325. CHECK 311/311A:
CIRCLE THE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

326. You obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324) in (DATE FROM 319/319A). At that time, were you told about side effects or problems you might have with the method?

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

328. Were you told what to do if you experienced side effects or problems?

329. CHECK 326:

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

CODE '1' NOT CIRCLED: When you obtained (CURRENT METHOD FROM 323) from (SOURCE OF METHOD FROM 316 OR 324), were you told about other methods of family planning that you could use?

330. Were you ever told by a health or family planning worker about other methods of family planning you could use?

331. CHECK 311/311A:

CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.

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

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

333. Do you know of a place where you can obtain a method of family planning?

334. Where is that? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

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

337A. Do you think that family planning is available to serve men, women and adolescents?

337B. Do you think that if a woman is breastfeeding, is easier or more difficult to become pregnant?

SECTION 4. PREGNANCY AND POSTNATAL CARE

401. CHECK 224:

402. CHECK 215: ENTER THE LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OR ADDITIONAL QUESTIONNAIRES)

Now I would like to ask you some more questions about the health of all your children born in the past five years (Since January 2003). (We will talk about one child at a time).

403. LINE NUMBER FROM Q. 212 SECTION 2.

404. FROM Qs. 212 SECTION 2 AND 216:

405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children at all?

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

407. When you were pregnant with (NAME) did you see anyone for antenatal care for this pregnancy?

IF YES: Whom did you see? Anyone else?

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

407A. Who gave you the exam or antenatal care?
PROBE TO IDENTIFY EACH TYPE OF PERSON AND RECORD ALL MENTIONED.

408. Where did you received antenatal care for this pregnancy? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

409. How many months pregnant were you when you first received antenatal care?

410. How many antenatal appointments did you have during this pregnancy?

410A. How many months pregnant were you the last time you received antenatal care?

410B. During this pregnancy did you have a blood test?

410C. What type of blood test did you have?

411. As part of your antenatal care during this pregnancy, were any of the following done at least once?

412. During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

413. Were you told where to go if you had these complications?

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

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

416. CHECK 415:

417. At any times before this pregnancy, did you receive any tetanus injections, either to protect yourself or another baby?

418. Before this pregnancy, how many other times did you receive a tetanus injection?

IF 7 OR MORE TIMES, RECORD '7'.

419. In what month and year did you receive the last tetanus injection before this pregnancy?

420. How many years ago did you receive that tetanus injection?

421. During this pregnancy, were you given or did you buy any iron tablets or iron syrup?
SHOW TABLET/SYRUP

422. During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC ASK: How many days or months?

423. During this pregnancy, did you take any drug for intestinal worms?

424. During this pregnancy, did you have difficulty with your vision during the daylight?

425. During this pregnancy, did you have difficulty with your vision during night?

426. During this pregnancy, did you take any drugs to keep you from getting malaria?

427. What drugs did you take?
RECORD ALL MENTIONED IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.

428. CHECK 427:
DRUGS TAKEN FOR MALARIA PREVENTION

429. How many times did you take (SP/Fansidar) during this pregnancy?

430. CHECK 407:
ANTENATAL CARE FROM HEALTH PERSONNEL DURING THIS PREGNANCY.

431. Did you get the (SP/Fansidar) during any antenatal care visit, during another visit to a health facility or from another source?

432. When (NAME) was born, was he/she very large, large, average, smaller or very small?

433. Was (NAME) weighed at birth?

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

435. 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.

435A. Around the time of the birth of (NAME) did you have any of the following problems:

436. Where did you give birth to (NAME)?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

RECORD ALL PLACES MENTIONED.

437. How long after (NAME) was delivered did you stay there?

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

438. Was (NAME) delivered by caesarean section?

439. Before you were discharged after (NAME) was born, did any health care provider check on your health?

440. How many days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

441. Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.

442. After you were discharged, did any health care provide or a traditional birth attendant check on your health?

443. Why didn't you deliver in a health facility?
PROBE: Any other reason?

RECORD ALL MENTIONED.

444. After (NAME) was born, did any traditional birth attendant check on your health?

445. How long after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.

446. Who checked on your health after delivery?
PROBE FOR MOST QUALIFIED PERSON.

447. Where did the first check take place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

448. CHECK 442:

449. In the two months after (NAME) was born, did any health care provider or a traditional birth attendant check on his/her health?

450. How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN A WEEK, RECORD DAYS.

451. Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON

452. Where did this first check of (NAME) take place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

453. In the first two months after delivery, did you receive a vitamin A does like this?
SHOW CAPSULE

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

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

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

457. CHECK 226:
IS RESPONDENT PREGNANT?

458. Have you resumed sexual relations since the birth of (NAME)?

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

460. Did you ever breastfeed (NAME)?

461. 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.

462. In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk?

463. What was (NAME) given to drink before your milk began flowing regularly?
PROBE: Anything else?

RECORD ALL LIQUIDS MENTIONED.

464. CHECK 404:
IS CHILD LIVING?

465. Are you still breastfeeding (NAME)?

466. For how many months did you breastfeed (NAME)?

466A. Why did you stop breastfeeding /or never breastfeed (NAME)?
RECORD ALL ANSWERS MENTIONED.

467. CHECK 404:
IS CHILD LIVING?

468. How many times did you breastfeed since 6 pm yesterday until today at 6 am?
IF ANSWER IS NOT NUMERIC. PROBE FOR APPROXIMATE NUMBER.

469. How many times did you breastfeed since 6 am yesterday until today at 6 pm?
IF ANSWER IS NOT NUMERIC. PROBE FOR APPROXIMATE NUMBER.

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

471. GO BACK TO 405 IN NEXT COLUMN, OR, IF NO MORE BIRTHS, GO TO 501

SECTION 5. CHILD IMMUNIZATION AND HEALTH AND CHILD'S AND WOMAN'S NUTRITION

501. ENTER LINE NUMBER, NAME AND SURVIVAL STATUS OF EACH BIRTH IN 2003 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS, BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 3 BIRTHS USE ADDITIONAL QUESTIONNAIRES).

502. LINE NUMBER FROM Q. 212

503. FROM Q. 212 AND Q. 216

504. Do you have the vaccination card of (NAME)? IF YES: May I see it please?

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

506. (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.
(3) IF MORE THAN TWO VITAMIN 'A' DOSES, RECORD DATES FOR MOST RECENT AND SECOND MOST RECENT DOSES

507. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?

RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3 AND/OR MEASLES VACCINE(S).

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

509. Please tell me if (NAME) received any of the following vaccinations:
(ASK QUESTIONS 509A TO 509G)

509A. A BCG vaccination against tuberculosis, that is an injection in the arm that leaves a scar?

509B. Polio vaccine, that is drops in the mouth?

509C. Was the first polio vaccine received in the first two weeks after birth or later?

509D. How many times was the polio vaccine received?

509E. DTP (triplex) vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

509F. How many times was DPT vaccination received?

509G. A measles injection or an MMR injection, that is, a shot in the arm at age of 9 months or older to prevent him/her from getting measles?

510. Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?

511. At which national immunization days campaigns did (NAME) receive vaccinations?
RECORD ALL CAMPAIGNS MENTIONED.

512: CHECK 506:
DATE SHOWN FOR VITAMIN A DOSE

513. According to (NAME)'s health card, he/she received a vitamin A dose (like this/any of these) in (MONTH AND YEAR OF MOST RECENT DOSE FROM CARD).
Has (NAME) received another vitamin A dose since then?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

514. Has (NAME) ever received a vitamin A dose (like this/any of these)?
SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS.

515. Did (NAME) receive a vitamin A dose within the last six months?

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

517. Has (NAME) taken any drug for intestinal worms in the last six months?

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

519. Was there any blood in the stools?

520. Now I would like to know how (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 she/he given much less than usual to drink or somewhat less?

521. 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 she/he given much less than usual to eat or somewhat less?

522. Did you seek advice or treatment for the diarrhea from any source?

523. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

524. CHECK 523:

525. Where did you first seek advice or treatment?
USE LETTER CODE FROM 523.

526. How many days after the diarrhea began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

527. Does (NAME) still have diarrhea?

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

529. Was anything (else) given to treat the diarrhea?

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

531. CHECK 530:
GIVEN ZINC?

532. How many times was (NAME) given zinc?

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

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

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

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

537.CHECK 533:
HAD FEVER?

538. 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 she/he given much less than usual to drink or somewhat less?

539. When (NAME) had a (fever/cough), was he/she given less than usual to eat, about the same amount, or more than usual to eat?
IF LESS, PROBE: Was she/he given much less than usual to eat or somewhat less?

540. Did you seek advice or treatment for the illness from any source?

541. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

542. CHECK 541:

543. Where did you first seek advice or treatment?
USE LETTER CODE FROM 541.

544. How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.

545. Is (NAME) still sick with a (fever/cough)?

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

547.What drugs did (NAME) take? Any other drugs?
RECORD ALL MENTIONED

548. CHECK 547:
ANY CODE A-H CIRCLED?

549. Did you already have (NAME OF DRUGS FROM 457) at home when the child became ill?
AKS SEPARATELY FOR EACH OF THE DRUGS 'A' THROUGH 'H' THAT THE CHILD IS RECORDED AS HAVING TAKEN IN 547.
IF YES FOR ANY DRUG, CIRCLE CODE FOR THAT DRUG. IF NO FOR ALL DRUGS, CIRCLE 'Y'.

550. CHECK 547:
ANY CODE A-G CIRCLED?

551. CHECK 547:
SP/FANSIDAR ('A') GIVEN

552. How long after the fever started did (NAME) first take SP/Fansidar?

553. For how many days did (NAME) take the SP/Fansidar?
IF 7 DAYS OR MORE, RECORD 7.

554. CHECK 547:
CHLOROQUINE ('B') GIVEN

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

556. For how many days did (NAME) take the chloroquine?
IF 7 DAYS OR MORE, RECORD 7.

557. CHECK 547:
AMODIAQUINE ('C') GIVEN

558. How long after the fever started did (NAME) first take Amodiaquine?

559. For how many days did (NAME) take the Amodiaquine?
IF 7 DAYS OR MORE, RECORD 7.

560. CHECK 547:
QUININE ('D') GIVEN

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

562. For how many days did (NAME) take the quinine?
IF 7 DAYS OR MORE, RECORD 7.

563.CHECK 547:
COMBINATION WITH ARTEMISININ ('E') GIVEN

564. How long after the fever started did (NAME) first take Combination with Artemisinin?

565. For how many days did (NAME) take the Combination with Artemisinin?
IF 7 DAYS OR MORE, RECORD 7.

566.CHECK 547:
CORTEM (ANTIMALARIAL DRUG) ('F') GIVEN

567. How long after the fever started did (NAME) first take CORTEM?

568. For how many days did (NAME) take the CORTEM?
IF 7 DAYS OR MORE, RECORD 7.

569.CHECK 547:
OTHER ANTIMALARIAL ('G') GIVEN

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

571. For how many days did (NAME) take the (OTHER ANTIMALARIAL)?

IF 7 DAYS OR MORE, RECORD 7.

572. GO BACK TO 503 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 573

573. CHECK 215 AND 218, ALL ROWS:
NUMBER OF CHILDREN BORN IN 2003 OR LATER LIVING WITH THE RESPONDENT

574. The last time (NAME FROM 573) passed stools, what was done to dispose of the stools?

575. CHECK 528(a) AND 528(b), ALL COLUMNS:

576. Have you ever heard of a special product called (Oral Rehydration Salts) or a pre-packaged ORS liquid you can get for the treatment of diarrhea?

577. CHECK 215 AND 218, ALL ROWS:

NUMBER OF CHILDREN BORN IN 2005 OR LATER LIVING WITH THE RESPONDENT

578. Now I would like to ask you about liquids or foods (NAME FROM 577) had yesterday during the day or at night

Did (NAME FROM 577) (drink/eat):

579. Now I would like to ask you about (other) liquids or foods that (NAME FROM 577)/you may have had yesterday during the day or at night. I am interested in whether your child/you had the item even if it was combined with other foods.

Did (NAME FROM 577)/you drink (eat):

[response set for child and mother]

580. CHECK 578 (LAST 2 CATEGORIES: BABY CEREAL OR OTHER PORRIDGE/GRUEL) AND 579 (CATEGORIES d THROUGH r FOR CHILD)

581. How many times did (NAME FROM 577) eat solid, semisolid or soft foods yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.

SECTION 6. MARRIAGE AND SEXUAL ACTIVITY

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

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 any other wives or does he live with other women as if married?

607. Including yourself, in total, how many other wives or partners does your husband live with now as if married?

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

615. 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 we will talk about your first husband/partner. In what month and year did you start living with your husband/partner?

616. How old were you when you started living with him?

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

618. Now I need to ask you 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?

619. CHECK 107:

620. Do you intend to wait until you get married to have sexual intercourse for the first time?

621. CHECK 107:

622. The first time you had sexual intercourse, was a condom used?

622A. Who had the initiative to use a condom?

622B. What was the main reason you used a condom?

622C. Why didn't you use a condom?
RECORD ALL ANSWERS MENTIONED.

623. How old was the person you first had sexual intercourse with?

624. Was this person older than you, younger than you or about the same age as you?

625. Would you say this person was ten or more years older than you or less than ten years older than you?

626. When was the last time you had sexual intercourse?
IF ANSWER IS IN LESS THAN 12 MONTHS, RECORD IN DAYS, WEEKS OR MONTHS. IF IS 12 OR MORE MONTHS RECORD IN YEARS.

626A. 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 you do not want to answer, just let me know and we will go to the next question. (GO TO 628)

627. When was the last time you had sexual intercourse with this person?
[Repeat question for the last three sexual partners except the most recent]

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

629. Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

629A. Do you have (had) difficulties in using a condom?

629B.What type of difficulties did you have when using a condom? (Main difficulty)

630. 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'

631. For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONSHIP WITH THIS PERSON ONCE, RECORD '01' DAYS.

632. CHECK 107:

633. How old is this person?

634. Is this person older than you, younger than you, or about the same age?

635. Would you say this person was ten or more years older than you or less than ten years older than you?

636. The last time you had sexual intercourse with this person, did you or this person drink alcohol?

637. Were you or your partner drunk at that time?
IF YES: Who was drunk?

638. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?
[Repeat question for last three sexual partners except second-to-last partner]

639. In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'
[Third-to-last sexual partner only]

640. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

641. Do you know of a place where a person can get condoms?

642. Where is that? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

643. If you wanted to, could you yourself get a condom?

643A. Now, I would read some sentences that people say in regards to using a condom. I would like to know if you agree or disagree with the following:

SECTION 7. FERTILITY PREFERENCES

701. CHECK 311/311A:

702. CHECK 226:

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

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

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

704. CHECK 226:

705. CHECK 310: USING A CONTRACEPTIVE METHOD?

706. CHECK 703:

707. CHECK 702:
WANTS TO HAVE ANOTHER CHILD: You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

WANTS NO MORE/NONE: You have said that you do not want any (more) child, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?

RECORD ALL REASONS MENTIONED.

708. CHECK 310: USING A CONTRACEPTIVE METHOD?

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

710. Which contraceptive method would you prefer to use?

711. What is the main reason that you think you will not use a method at any time in the future?

712. Would you ever use a contraceptive method if you were married?

713. 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?

PROBE FOR A NUMERIC RESPONSE

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

PROBE FOR A NUMERIC RESPONSE

714. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

715. In the last 6 months have you heard about family planning:

717. CHECK 601:

718. CHECK 311/311A:

719. Does your husband/partner know that you are using a method of family planning?

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

721. CHECK 311/311A:

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

722A. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?

722B. Is it acceptable or not acceptable to you for information on family planning to be provided:

722C.In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?

722D. With whom? Anyone else?

RECORD ALL MENTIONED.

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?

805. What was the highest grade he completed at that level?

HIGHEST GRADE/CLASS COMPLETED

806. CHECK 801:

CURRENTLY MARRIED/LIVING WITH A MAN: What is your husband/partner's occupation? That is, what kind of work does he mainly do?

FORMERLY MARRIED/LIVING WITH A MAN: What was your (last) husband/partner's occupation? That is, what kind of work did he mainly do?

807. Aside from your own housework, have you done any work in the last seven days?

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?

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. CHECK 811:

813. Do you work mainly on: your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

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

815. Do you usually work at home or away from home?

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

817. Are you paid or do you earn in cash or kind for this work or are you not paid at all?

818. CHECK 601:

819. CHECK 817:

820. Who usually decides how the money you earn will be used: mainly you, mainly your husband/partner, you and your husband/partner jointly?

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

822. Who usually decides how your husband/partner's earnings will be used: you, your husband/partner, you and your husband/partner jointly?

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

824.Who usually makes decisions about making major household purchases?

825. Who usually makes decisions about making purchases for daily household needs?

826. Who usually makes decisions about visits to your family or relatives?

826A. Who usually makes decisions about how many children you should have and when you should have them?

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

828. Sometimes a husband is annoyed or angered by things that his wife/partner does. In your opinion, is a husband justified in hitting or beating his wife/partner in the following situations:

SECTION 9. HIV/AIDS

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

901A. From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED.

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 chances 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 avoid the AIDS virus by not having sexual intercourse at all?

907. Can people avoid the AIDS virus because of witchcraft or other supernatural means?

908. Is it possible for a healthy-looking person to have the AIDS virus?

908A. Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?

908B. Do you know someone personally who has the virus that causes AIDS or someone who died of AIDS?

909. Can the virus that causes AIDS be transmitted from mother to a child:

910. CHECK 909:

911. 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?

912. Have you heard about special antiretroviral drugs that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

913. CHECK 208 AND 215:

914. CHECK 407 FOR LAST BIRTH:

914A. CHECK FOR PRESENCE OF OTHERS, BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

915. During any of the antenatal visits for your last birth, did anyone talk to you about:

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

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

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

919. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

921. When was the last time you were tested for the AIDS virus?

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

923. When was the last time you were tested?

923A. The last time you were tested for the AIDS virus, did you receive advice before the test, after your test or there was no advice at all?

924. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

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

926. Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

928. Where can you get a test for the AIDS virus? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

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

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

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

932. 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?

932A. Do you of a place where there is help for people infected with the AIDS virus?

932B. Where can you get treatment for the AIDS virus? Any other place?

RECORD ALL PLACES MENTIONED

932C. Have you ever discussed with your husband/partner or other people ways to prevent contracting the AIDs virus?

932D. In the last 4 weeks, have you read, heard or seen any information regarding HIV or AIDS?

932E. In the last 4 weeks, where have you read, heard or seen any information regarding HIV or AIDS?

RECORD ALL MENTIONED,

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

941. Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid getting AIDS?

942. 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 other infections that can be transmitted through sexual contact?

943. CHECK 618:

944. CHECK 942: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

945. Now I would like to ask you about your health in the last 12 months:
Have you had any sexually transmitted disease (STD) during the last 12 months?

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

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

948. CHECK 945, 946 AND 947:

949. The last time you had those problems (PROBLEMS MENTIONED IN 945/946/947), did you seek advice or treatment?

950. Where did you seek advice or treatment? Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

951. Husbands and wives do not always agree on everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

952. 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?

953. Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

954. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

955. CHECK 601:

956. Can you say no to your husband/partner if you do not want to have sexual intercourse?

957. Can you ask your husband/partner to use a condom if you wanted him to?

958. Do you believe that young men should wait until they are married to have sexual intercourse?

959. Do you think that most young men you know wait until they are married to have sexual intercourse?

960. Do you believe that men who are not married and are having sex should only have sex with one partner?

961. Do you think that most men you know who are not married and are having sex, have sex with only one partner?

962. Do you believe that married men should only have sex with their wives?

963. Do you think that most married men you know have sex only with their wives?

964. Do you believe that young women should wait until they are married to have sexual intercourse?

965. Do you think that most young women you know wait until they are married to have sexual intercourse?

966. Do you believe that women who are not married and are having sex should only have sex with one partner?

967. Do you think that most women who are not married and are having sex, have sex with only one partner?

968. Do you believe that married women should only have sex with their husbands?

969. Do you think that most married women you know have sex only with their husbands?

SECTION 10. OTHER HEALTH ISSUES

1001. Have you ever heard of an illness called tuberculosis or TB?

1002. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.

1003. Can tuberculosis be cured?

1004. If a member of your family got tuberculosis, would you want it to remain a secret or not?

1005. Now I would like to ask you some 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

1006. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?

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

1007. The last time you had an injection given to you by a health worker, where did you go to get the injection?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

1008. Did the person who gave you that injection take the syringe and needle from a new, unopened package?

1009. Do you currently smoke cigarettes?

1010. In the last 24 hours, how many cigarettes did you smoke?

1011. Do you currently smoke or use any other type of tobacco?

1012. What (other) type of tobacco do you currently smoke or use?
RECORD ALL ANSWERS MENTIONED.

1013. 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?

1014. Are you covered by any medical assistance or health insurance?

1015. What type of medical assistance or health insurance?
RECORD ALL MENTIONED.

1016. CHECK 217:

1017. Now I would like to ask you about your own child(ren) who (is/are) under the age of 18.
Have you made arrangements for someone to care for (him/her/them) in the event that you fall sick or are unable to care for (him/her/them)?

1018. (Besides your own child/children), are you the primary caregiver for any children under the age of 18?

1019. Have you made arrangement for someone to care for (this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?

SECTION 11. MATERNAL MORTALITY

1101. Now I would like to ask you questions about your brothers and sisters, that is, all of the children born from your mother. Did your mother have more children besides you?

1102. How many boys did your mother give birth to, that are alive?

1103. How many girls did your mother give birth to that are alive, including you?

1104. How many boys did your mother give birth to that died?

1105. How many girls did your mother give birth to that died?

1106. Did your mother give birth to other sons/daughters that you are not sure if they are alive or dead?

1107. How many children did your mother give birth to, that you are not sure if they are alive or dead?

1108. CHECK 1108:
Just to make sure that I have this right: your mother had in TOTAL _____ alive children, including you. Is that correct?

1110. CHECK 1108:

1111. How many of these births did your mother have before you were born?

1112. What was the name given of your oldest (next oldest) sister or brother?

1113. Is (NAME) male or female?

1114. Is (NAME) alive?

1115. How old is (NAME)?

1116. How many years ago did (NAME) die?

1117. How old was (NAME) when s/he died?
IF UNSURE/DK, PROBE: Did (NAME) died when she/he was under 12 years of age?
IF 'YES' RECORD '95'
IF 'NO' ASK OTHER QUESTIONS, SUCH AS: Did (NAME) dies before she/he married?

1118. Was (NAME) pregnant when she died?

1119. Did (NAME) died during labor?

1120. Did (NAME) die two months after being pregnant or after labor?

1121. How many born live children did (NAME) give birth to during her lifetime (before this pregnancy)?

IF NO MORE BROTHERS OR SISTERS GO TO 1200.

SECTION 12. DOMESTIC VIOLENCE MODULE

1200. CHECK HOUSEHOLD QUESTIONNAIRE'S COVER PAGE TO SEE IF WOMEN SELECTED, AND IF SO RECORD LINE NUMBER OF SELECTED WOMEN.

1201. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED. RECORD THE CORRECT CODE AND FOLLOW THE INSTRUCTIONS

READ TO THE RESPONDENT
Now I would like to ask you questions about some important aspects about domestic violence. I know that some of these questions are very personal. However, your answers are crucial for helping to understand the condition of women in São Tomé and Príncipe. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else will know that you were asked these questions. If someone comes during our interview we will change the topic of what we are talking.

1202. CHECK 601, 602, AND 603:

1202A. When two people are married or live in union, they share good and bad moments. Please tell me if these apply frequently, sometimes or never, to your relationship with your (last) husband/partner?

1203. First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?

1204. Now if you will permit me, I need to ask some more questions about your relationship with your (last) husband/partner.

A. (Does/did) your (last) husband/partner ever:

1205. A. (Does/did) your (last) husband/partner ever:

1206. CHECK 1205A (a-i):

1207. How long after you first got married to/started living with your (last) husband/partner did (this/any of these things) first happen?
IF LESS THAN 1 YEAR, RECORD '00'.

1208. Did the following ever happen as a result of what your (last) husband/partner did to you:

1209. Have you ever hit, slapped, kicked or done anything else to physically hurt your (last) husband/partner at times when he was not already beating or physically hurting you?

1210. CHECK 603:

1211. In the last 12 months, how many times have you done this to your husband/partner?

1212. Does (did) your husband/partner drink alcohol?

1213. How often does (did) he get drunk: often, only sometimes, or not at all?

1214. CHECK 601, 602 AND 603:

EVER MARRIED/LIVED WITH A MAN/SEPARATED/DIVORCED/WIDOW: From the time you were 15 years old has anyone other than your (current/last) husband/partner hit, slapped, kicked or done anything else to hurt you physically?

NEVER MARRIED/NEVER LIVED WITH A MAN: From the time you were 15 years old has anyone hit, slapped, kicked or done anything else to hurt you physically?

1215. Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.

1216. In the past 12 months, how many times were you hit, slapped, kicked or hurt physically?

1217. CHECK 201, 226 AND 229:

1218. Has anyone ever hit, slapped, kicked or done anything else to hurt you physically while you were pregnant?

1219. Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.

1220. CHECK 618: EVER HAD SEX?

1221. The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?

1222. CHECK 601 AND 602:

EVER MARRIED/LIVED WITH A MAN: In the last 12 months, has anyone other than your (current/last) husband/partner forced you to have sexual intercourse against your will?

NEVER MARRIED/NEVER LIVED WITH A MAN: In the last 12 months, has anyone forced you to have sexual intercourse against your will?

1223. CHECK 1221 AND 1222:

1224. CHECK 1025(h) AND 1205(i):

1225. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

1226. How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?

1227. Who was the person who was forcing you at that time?

1228. CHECK 1205A (a-i), 1213, 1217, 1221 AND 1224:

1229. Thinking about what you yourself have experienced among different things we have been talking about, have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?

1230. From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.

1231. Have you ever told anyone else about this?

1232. As far as you know, did your father ever beat your mother?

1232A. As far as you know, did your mother ever beat your father?

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.

1233. Did you have to interrupt the interview because some adult was trying to listen, or came into the room, or interfered in any other way?

1234. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
____________________________________________________________________________________________________________________________________________________________

1235. RECORD 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:____

INSTRUCTIONS: ONLY ONE CODE SHOULD APPEAR IN ANY BOX. ALL MONTHS SHOULD BE FILLED IN.

INFORMATION TO BE CODED FOR EACH COLUMN

BIRTHS AND PREGNANCIES, CONTRACEPTIVE USE

B BIRTHS
P PREGNANCIES
T TERMINATIONS

0 NO METHOD
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTABLES
6 IMPLANTS
7 CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM,
J FOAM OR JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM, PERIODIC ABSTINENCE
M WITHDRAWAL
X OTHER METHODS. (SPECIFY) ______