REGION ________________________
DISTRICT ________________________
COUNTY ________________________
SUB-COUNTY/TOWN ________________________
PARISH/RC2 NAME ________________________
EA NAME ________________________
UDHS NUMBER
RURAL 2
CITY/MUNICIPALITY/TOWN/COUNTRYSIDE
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4
HOUSEHOLD NUMBER
NAME OF HOUSEHOLD HEAD ________________________
NAME AND LINE NUMBER OF WOMAN ________________________
RESIDENTIAL STATUS OF WOMAN
VISITOR 2
FIRST VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
NEXT VISIT:
DATE ___________
TIME ___________
SECOND VISIT:
DATE ___________
INTERVIEWER'S NAME ___________
RESULT* ___________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
NEXT VISIT:
DATE ___________
TIME ___________
THIRD VISIT:
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*
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
TOTAL NUMBER OF VISITS
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _____________ 7
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE USED IN INTERVIEW
LUGANDA 2
LUGBARA 3
LUO 4
RUNYANKOLE-RUKIGA 5
RUNYORO-RUTORO 6
ENGLISH 7
OTHER 8
LUGANDA 2
LUGBARA 3
LUO 4
RUNYANKOLE-RUKIGA 5
RUNYORO-RUTORO 6
ENGLISH 7
OTHER 8
SOMETIMES 2
ALL THE TIME 3
DATE ___________
FIELD EDITOR
DATE ___________
OFFICE EDITOR
KEYED BY
SECTION 1: RESPONDENT'S BACKGROUND
101) RECORD THE TIME.
MINUTES
102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a municipality, in a town or in the countryside?
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4
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 municipality, in a town, or in the countryside?
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4
105) In what month and year were you born?
DOES NOT KNOW MONTH 98
DOES NOT 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 114)
108) What is the highest level of school you attended: primary, junior, secondary or university?
JUNIOR 2
SECONDARY 3
UNIVERSITY 4
109) What is the highest grade you completed at that level?
AGE 25 OR ABOVE (GO TO 113)
111) Are you currently attending school?
NO 2
112) What was the main reason you stopped attending school?
GOT MARRIED 02
HAD TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
GRADUATED/HAD ENOUGH SCHOOLING 07
FAILED 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) ____________ 96
DOES NOT KNOW 98
JUNIOR OR HIGHER (GO TO 115)
114) Would you please read this sentence?
SHOW SENTENCE TO RESPONDENT AND CIRCLE CORRECT CODE.
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116A)
115) Do you usually read a newspaper or magazine at least once a week?
NO 2
116A) How often do you listen to the radio?
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
LESS THAN ONCE A MONTH 4
HARDLY/VIRTUALLY NEVER 5 (GO TO 117A)
DOES NOT KNOW 8 (GO TO 117A)
116B) What times do you usually listen to the radio?
CIRCLE ALL TIMES MENTIONED.
MID MORNING (8.00-10.00) B
LATE MORNING (10.00-12.00) C
LUNCH TIME (12.00- 14.00) D
AFTERNOON (14.00-16.00) E
LATE AFTERNOON (16.00- 18.00) F
EARLY EVENING (18.00- 20.00) G
LATE EVENING (20.00-STATION CLOSE) H
DOES NOT KNOW Z
116C) What day of the week do you usually like to listen to the radio?
CIRCLE ALL DAYS MENTIONED.
TUESDAY B
WEDNESDAY C
THURSDAY D
FRIDAY E
SATURDAY F
SUNDAY G
DOES NOT KNOW Z
117A) How often do you watch television (TV)?
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
LESS THAN ONCE A MONTH 4
HARDLY/VIRTUALLY NEVER 5 (GO TO 118)
DOES NOT KNOW 8 (GO TO 118)
117B) What times do you usually watch TV?
CIRCLE ALL TIMES MENTIONED.
MID MORNING (8.00-10.00) B
LATE MORNING (10.00-12.00) C
LUNCH TIME (12.00- 14.00) D
AFTERNOON (14.00-16.00) E
LATE AFTERNOON (16.00- 18.00) F
EARLY EVENING (18.00- 20.00) G
LATE EVENING (20.00-STATION CLOSE) H
DOES NOT KNOW Z
117C) What day of the week do you usually like to watch television?
CIRCLE ALL DAYS MENTIONED.
TUESDAY B
WEDNESDAY C
THURSDAY D
FRIDAY E
SATURDAY F
SUNDAY G
DOES NOT KNOW Z
PROTESTANT 2
MUSLIM 3
SEVENTH DAY ADVENTIST 4
OTHER (SPECIFY) ___________ 6
ALUR 02
BAAMBA 03
BACHOPE 04
BADAMA 05
BAFUMBIRA 06
BAGANDA 07
BAGISU 08
BAGWE 09
BAGWERE 10
BAHORORO 11
BAKIGA 12
BAKONJO 13
BANYANKOLE 14
BANYARWANDA 15
BANYOLE 16
BANYORO 17
BARULLI 18
BARUNDI 19
BASOGA 20
BATORO 21
BATWA 22
ITESO 23
KAKWA 24
KARIMOJANG 25
KUMAM 26
LANGI 27
LENDU 28
LUGBARA 29
MADI 30
NUBIAM 31
SAMIA 32
SEBEI 33
OTHER (SPECIFY) _________ 96
120) CHECK RESIDENTIAL STATUS OF THE WOMAN AT COVER PAGE:
THE WOMAN INTERVIEWED IS A USUAL RESIDENT (GO TO 201)
121) Now I would like to ask about the place in which you usually live. Do you usually live in a city, in a municipality, in a town or in the countryside?
MUNICIPALITY 2
TOWN 3
COUNTRYSIDE 4
122) In which (DISTRICT) is that located?
123) Now I would like to ask about the household in which you usually live. What is the main source of drinking water for members of your household?
PUBLIC TAP 12
PUBLIC WELL 22
BORE HOLE 23
RIVER/STREAM 32
POND/LAKE/DAM 33
GRAVITY FLOW SCHEME 34
BOTTLED WATER 51 (GO TO 125)
OTHER (SPECIFY) ___________ 96
123A) Where do you store the drinking water?
JERRY CAN 2
PAN 3
KALABASH 4
OTHER (SPECIFY) ___________ 6
124) Now long does it take to go there, get water, and come back?
ON PREMISES 996
125) What kind of toilet facility does your household have?
SHARED FLUSH TOILET 12
IMPROVED PIT LATRINE 22
OTHER (SPECIFY) _______________ 96
126) Does your household have:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
127) Could you describe the main material of the floor of your home?
DUNG 12
VINYL OR ASPHALT STRIPS 22
CERAMIC TILES 23
CEMENT 24
128) Does any member of your household own:
NO 2
NO 2
NO 2
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202) Do you have any sons or daughters to whom you have given birth who are now living with you?
NO 2 (GO TO 204)
203) How many sons live with you? And how many daughters live with you?
IF NONE RECORD '00'.
DAUGHTERS AT HOME
204) Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
NO 2 (GO TO 206)
205) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE RECORD '00'.
DAUGHTERS ELSEWHERE
206) Sometimes it happens that God takes a child away too soon. This happens to many mothers here in Uganda. Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
207) How many boys have died? And how many girls have died?
IF NONE RECORD '00'.
GIRLS DEAD
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE RECORD '00'.
Just to make sure that I have this right: you have had in TOTAL ________ births during your life. Is that correct?
PROBE AND CORRECT 201-208 AS NECESSARY
NO BIRTHS (GO TO 226)
211) Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.
212) What name was given to your (first/next) baby?
213) Were any of these births twins?
MULTIPLE 2
214) Is (NAME) a boy or a girl?
GIRL 2
215) In what month and year was (NAME) born? PROBE: What is his/her birthday? OR: In what season was he/she born?
YEAR
NO 2 (GO TO 219)
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?
NO 2 (GO TO NEXT BIRTH)
219) 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 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS 2
YEARS 3
220) FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH.
IS THE DIFFERENCE 4 OR MORE?
[answer for all births except first birth]
NO 2 (GO TO NEXT BIRTH)
221) Were there any other live births between (NAME) and (NAME OF PREVIOUS BIRTH?)
[answer for all births except first birth]
NO 2
222) FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH.
IS THE DIFFERENCE 4 YEARS OR MORE?
NO (GO TO 224)
223) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
NO 2
224) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED.
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED.
FOR AGE AT DEATH 12 MONTHS OR 1 YEAR: PROBE TO DETERMINE EXACT NUMBER OF MONTHS.
225) CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1991. IF NONE, RECORD '0'.
NO 2 (GO TO 231)
UNSURE 8 (GO TO 231)
227) How many months pregnant are you?
228) Did you see anyone for a check on this pregnancy? IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
NURSE/MIDWIFE B
AUXILIARY MIDWIFE C
NO ONE Y
229) Since you have been pregnant, have you been given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2
DOES NOT KNOW 8
230) At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, did you not want to become pregnant at all?
LATER 2 (GO TO 301)
NOT AT ALL 3 (GO TO 301)
231) When did your last menstrual period start?
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
Now I would like to talk about family planning--the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 302, 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 301 OR 302, ASK 303.
301) Which ways or methods have you heard about?
302) Have you ever heard of (METHOD)?
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
NO 3
303) Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) (GO TO 309)
305) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 332)
307) What have you used or done? CORRECT 303 AND 304 (AND 302 IF NECESSARY).
309) Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any?
IF NONE, RECORD '00'.
WOMAN STERILIZED (GO TO 313A)
PREGNANT (GO TO 333)
312) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 332)
313) Which method are you using?
313A) CIRCLE '07' FOR FEMALE STERILIZATION.
IUD 02 (GO TO 325)
INJECTIONS 03 (GO TO 325)
IMPLANTS 04 (GO TO 325)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 325)
CONDOM 06 (GO TO 325)
FEMALE STERILIZATION 07 (GO TO 317)
MALE STERILIZATION 08 (GO TO 317)
RHYTHM, COUNTING DAYS 09 (GO TO 322)
NATURAL FAMILY PLANNING, MUCUS, TEMPERATURE 10 (GO TO 322)
WITHDRAWAL 11 (GO TO 325)
OTHER (SPECIFY) ___________ 96 (GO TO 325)
314) May I see the package of pills you are now using?
RECORD NAME OF BRAND IF PACKAGE IS SEEN.
BRAND NAME _____________ (GO TO 316)
PACKAGE NOT SEEN 2
315) Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND
DOES NOT KNOW 98
316) If a woman is using the pill for family planning, how many times a day is she supposed to take it?
DOES NOT KNOW 8 (GO TO 325)
317) Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. MISSION/CHURCH FACILITIES ARE CONSIDERED "PRIVATE".
(NAME OF THE PLACE) ___________________________
GOVERNMENT HEALTH CENTRE 12
GOVERNMENT MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) ____________ 16
PRIVATE DOCTOR 23
PRIVATE MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 26
DOES NOT KNOW 98
320) In what month and year was the sterilization performed?
YEAR (GO TO 326)
322) 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?
NO 2 (GO TO 325)
DOES NOT KNOW 8 (GO TO 325)
323) During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) ___________ 6
DOES NOT KNOW 8
324) How do you determine which days of your monthly cycle not to have sexual relations?
BASED ON BODY TEMPERATURE 2
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 3
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 4
NO SPECIFIC SYSTEM 5
OTHER (SPECIFY) ___________ 6
325) For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.
8 YEARS OR LONGER 96
326) Some people use family planning because they have talked to their husband or friend, heard something on the radio or TV, or read something that encouraged them to use family planning. What motivated you to use family planning?
RECORD ALL MENTIONED
TALKED TO A FRIEND B
TALKED TO A HEALTH WORKER C
HEARD FAMILY PLANNING DRAMA ON RADIO D
HEARD ADVERTISEMENT ON RADIO E
HEARD SOMETHING ELSE ON RADIO F
SAW SOMETHING ON TV G
SAW THE YELLOW FAMILY PLANNING FLOWER (FP LOGO) H
READ A POSTER I
READ A LEAFLET/FLYER/BROCHURE J
ATTENDED A HEALTH TALK ON FAMILY PLANNING K
SELF MOTIVATED L
OTHER (SPECIFY) _____________ X
DOES NOT KNOW/NO REASON Z
CIRCLE METHOD CODE:
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 330A)
MALE STERILIZATION 08 (GO TO 330A)
RHYTHM, COUNTING DAYS 09 (GO TO 333)
NATURAL FAMILY PLANNING, MUCUS, TEMPERATURE 10 (GO TO 333)
WITHDRAWAL 11 (GO TO 333)
OTHER 96 (GO TO 333)
329) Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
MISSION/CHURCH FACILITIES ARE CONSIDERED "PRIVATE".
(NAME OF PLACE) ___________________________
GOVERNMENT HEALTH CENTRE 12
GOVERNMENT DISPENSARY/HEALTH UNIT 13
GOVERNMENT MOBILE CLINIC 14
GOVERNMENT FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PHARMACY/DRUG STORE 22
PRIVATE DOCTOR 23
PRIVATE MOBILE CLINIC 24
PRIVATE FIELD WORKER 25
OTHER PRIVATE MEDICAL ______________ 26
CHURCH 32
FRIENDS/RELATIVES 33
330) Do you know another place where you could have obtained (METHOD) the last time?
330A) At the time of the sterilization operation, did you know another place where you could have received the operation?
NO 2 (GO TO 335)
331) People select the place where they get family planning service for various reasons. What was the main reason you went to (NAME OF PLACE IN QUESTION 329 OR QUESTION 317) instead of the other place you know about?
RECORD RESPONSE AND CIRCLE CODE.
CLOSER TO MARKET/WORK 12 (GO TO 335)
AVAILABILITY OF TRANSPORT 13 (GO TO 335)
CLEANER FACILITY 22 (GO TO 335)
OFFERS MORE PRIVACY 23 (GO TO 335)
SHORTER WAITING TIME 24 (GO TO 335)
LONGER HOURS OF OPERATION 25 (GO TO 335)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 335)
WANTED ANONYMITY 41 (GO TO 335)
OTHER (SPECIFY) _____________ 96 (GO TO 335)
DOES NOT KNOW 98 (GO TO 335)
332) What is the main reason you are not using a method of contraception pregnancy?
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS MORE CHILDREN 26
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DOES NOT KNOW 98
333) Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 335)
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. MISSION/CHURCH FACILITIES ARE CONSIDERED "PRIVATE".
(NAME OF PLACE) ____________________
GOVERNMENT HEALTH CENTRE 12
GOVERNMENT DISPENSARY/HEALTH UNIT 13
GOVERNMENT MOBILE CLINIC 14
GOVERNMENT FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PHARMACY/CHEMISTS 22
PRIVATE DOCTOR 23
PRIVATE MOBILE CLINIC 24
PRIVATE FIELD WORKER 25
OTHER PRIVATE MEDICAL ______________ 26
CHURCH 32
FRIENDS/RELATIVES 33
335) Were you visited by a family planning program worker in the last 12 months?
NO 2
336) Have you visited a health facility in the last 12 months for any reason?
NO 2 (GO TO 338)
337) Did anyone at the health facility speak to you about family planning methods?
NO 2
338) Do you think that breastfeeding can affect a woman's chance of becoming pregnant?
NO 2 (GO TO 343)
DOES NOT KNOW 8
339) Do you think a woman's chance of becoming pregnant is increased or decreased by breastfeeding?
DECREASED 2
DEPENDS 3
DOES NOT KNOW 8
NO BIRTHS (GO TO 343)
341) Have you ever relied on breastfeeding to avoid pregnancy?
NO 2 (GO TO 343)
342) Are you currently relying on breastfeeding to avoid pregnancy?
NO 2
NEVER HEARD OF PILLS (GO TO 345)
344) You told me that you know the pill. What problems or disadvantages are there with using the pill?
RECORD ALL MENTIONED
GAIN/LOSS WEIGHT B
BREAST MILK DECREASES C
MENSTRUATION PROBLEMS/BLEEDING D
CAN GET PREGNANT/UNRELIABLE E
DECREASED FERTILITY F
DESTROYS UTERUS/CANCER G
PROBLEM DURING SEX H
ABNORMAL DELIVERY/MALFORMED CHILD I
OTHER (SPECIFY) _______________ X
NO PROBLEMS Y
DOES NOT KNOW Z
NEVER HEARD OF IUD (GO TO 347)
346) You told me that you know the IUD. What problems or disadvantages are there with using the IUD?
RECORD ALL MENTIONED
GAIN/LOSS WEIGHT B
BREAST MILK DECREASES C
MENSTRUATION PROBLEMS/BLEEDING D
CAN GET PREGNANT/UNRELIABLE E
DECREASED FERTILITY F
DESTROYS UTERUS/CANCER G
PROBLEM DURING SEX H
ABNORMAL DELIVERY/MALFORMED CHILD I
OTHER (SPECIFY) _______________ X
NO PROBLEMS Y
DOES NOT KNOW Z
NEVER HEARD OF INJECTION (GO TO 401)
348) You told me that you know the injection. What problems or disadvantages are there with using the injection? RECORD ALL MENTIONED
GAIN/LOSS WEIGHT B
BREAST MILK DECREASES C
MENSTRUATION PROBLEMS/BLEEDING D
CAN GET PREGNANT/UNRELIABLE E
DECREASED FERTILITY F
DESTROYS UTERUS/CANCER G
PROBLEM DURING SEX H
ABNORMAL DELIVERY/MALFORMED CHILD I
OTHER (SPECIFY) _______________ X
NO PROBLEMS Y
DOES NOT KNOW Z
SECTION 4A. PREGNANCY AND BREASTFEEDING
401) CHECK 225:
NO BIRTHS SINCE JANUARY 1991 (GO TO 468)
402) ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF MORE THAN 2 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 three years. (We will talk about one child at a time.)
403) LINE NUMBER FROM QUESTION 212
404) FROM QUESTION 212 AND QUESTION 216
DEAD
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 want no (more) children at all?
LATER 2
NO MORE 3 (GO TO 407)
406) How much longer would you like to have waited?
YEARS 2
DOES NOT KNOW 998
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 FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.
NURSE/MIDWIFE B
AUXILARY MIDWIFE C
NO ONE (GO TO 410) Y
408) How many months pregnant were you when you first received antenatal care?
DOES NOT KNOW 98
409) How many times did you receive antenatal care during this pregnancy?
DOES NOT KNOW 98
410) 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?
NO 2 (GO TO 411A)
DOES NOT KNOW 8 (GO TO 411A)
411) During this pregnancy, how many times did you get this injection?
DOES NOT KNOW 8
411A) Did you eat special diet during this pregnancy?
(DIET MEANS OTHER THAN NORMAL FOOD)
NO 2
412) Where did you give birth to (NAME)?
OTHER HOME 12
GOVERNMENT HEALTH CENTER 22
GOVERNMENT HEALTH UNIT 23
OTHER PUBLIC (SPECIFY) ____________ 26
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 36
413) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
NURSE/MIDWIFE B
AUXILARY MIDWIFE C
RELATIVE/FRIEND E
NO ONE Y
414) At the time of the birth of (NAME), did you have any of the following problems:
NO 2
NO 2
NO 2
NO 2
415) Was (NAME) delivered by caesarian section?
NO 2
416) When (NAME) was born, was he/she: very large, larger than average, average, smaller than average, or very small?
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DOES NOT KNOW 8
417) Was (NAME) weighed at birth?
NO 2 (GO TO 419)
418) How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILIBLE.
GRAMS FROM RECALL 2
DOES NOT KNOW 99998
419) Has your period returned since the birth of (NAME)?
[ask only for last birth.]
NO 2 (GO TO 422)
420) Did your period return between the birth of (NAME) and your next pregnancy?
[ask for all births except last birth]
NO 2 (GO TO 424)
421) For how many months after the birth of (NAME) did you not have a period?
DOES NOT KNOW 98
422) CHECK 226: RESPONDENT PREGNANT?
[ask only for last birth]
PREGNANT OR UNSURE (GO TO 424)
423) Have you resumed sexual relations since the birth of (NAME)?
[ask only for last birth]
NO 2 (GO TO 425)
424) For how many months after the birth of (NAME) did you not have sexual relations?
DOES NOT KNOW 98
425) Did you ever breastfeed (NAME)?
NO 2 (GO TO 432)
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.
HOURS 1
DAYS 2
427) Soon after birth, was (NAME) given any of the following?
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
DEAD (GO TO 430)
429) Are you still breastfeeding (NAME)?
NO 2
430) For how many months did you breastfeed (NAME)?
DOES NOT KNOW 98
431) Why did you stop breastfeeding (NAME)?
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
INSUFFICIENT MILK 05
MOTHER WORKING 06
CHILD STOPPED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) ______________ 96
DEAD (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 443)
433) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
434) How many times did you breastfeed yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
435) Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DOES NOT KNOW 8
436) At any time yesterday or last night, was (NAME) given any of the following:
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
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
437) CHECK 436: FOOD OR LIQUID GIVEN YESTERDAY?
"NO/DON'T KNOW" TO ALL (GO TO 441)
440) (Aside from breastfeeding,) how many times did (NAME) eat yesterday?
MEALS ONLY. IF 7 OR MORE TIMES, RECORD '7'.
DOES NOT KNOW 8
441) On how many days during the last seven days was (NAME) given any of the following:
RECORD THE NUMBER OF DAYS.
442) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 443.
SECTION 4B. IMMUNIZATION AND HEALTH
443) ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS USE ADDITIONAL FORMS.)
444) LINE NUMBER FROM QUESTION 212
445) FROM QUESTION 212 AND QUESTION 216
DEAD (GO TO 444 IN NEXT COLUMN; OR IF NO MORE BIRTHS, GO TO 468.)
446) Do you have a card where (NAME'S) vaccinations are written down? IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 450)
NO CARD 3
447) Did you ever have a vaccination card for (NAME)?
NO 2 (GO TO 450)
(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.
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
MONTH
YEAR
449) Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINE(S).
DOES NOT KNOW 8 (GO TO 452)
450) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?
NO 2 (GO TO 452)
DOES NOT KNOW 8 (GO TO 452)
451) Please tell me if (NAME) received any of the following vaccinations
451A) A BCG vaccination against tuberculosis, that is an injection in the arm or shoulder that left a scar?
NO 2
DOES NOT KNOW 8
451B) Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 451E)
DOES NOT KNOW 8 (GO TO 451E)
451D) When was the first polio vaccine given, just after birth or later?
LATER 2
451E) DPT vaccination, that is, an injection, usually given at the same time as polio drops?
NO 2 (GO TO 451G)
DOES NOT KNOW 8 (GO TO 451G)
451G) An injection to prevent measles?
NO 2
DOES NOT KNOW 8
452) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DOES NOT KNOW 8
453) Has (NAME) been ill with a cough at any time in the last 2 weeks?
NO 2 (GO TO 457)
DOES NOT KNOW 8 (GO TO 457)
454) When (NAME) was ill with a cough, did he/she breathe faster than usual with short, fast breaths?
NO 2
DOES NOT KNOW 8
455) Did you seek advice or treatment for the cough?
NO 2 (GO TO 457)
456) Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH UNIT C
GOVERNMENT MOBILE CLINIC D
COMMERCIAL HEALTH CENTER E
OTHER PUBLIC (SPECIFY) ____________ F
PHARMACY H
PRIVATE DOCTOR I
PRIVATE MOBILE CLINIC J
COMMERCIAL HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____________ L
TRADITIONAL PRACTITIONER N
457) Has (NAME) had diarrhea in the last two weeks?
NO 2 (GO TO 467)
DOES NOT KNOW 8 (GO TO 467)
458) Was there any blood in the stools?
NO 2
DOES NOT KNOW 8
459) On the worst day of the diarrhea, how many bowel movements did (NAME) have?
DOES NOT KNOW 98
460) Was he/she given the same amount to drink as before the diarrhea, or more, or less?
MORE 2
LESS 3
DOES NOT KNOW 8
461) Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?
MORE 2
LESS 3
DOES NOT KNOW 8
462) Was (NAME) given a fluid made from a special packet called dalozi to drink?
NO 2
DOES NOT KNOW 8
463) Was anything (else) given to treat the diarrhea?
NO 2 (GO TO 465)
DOES NOT KNOW (GO TO 465)
464) What was given to treat the diarrhea? Anything else?
RECORD ALL MENTIONED.
PILL OR SYRUP B
INJECTION C
(I.V.) INTRAVENOUS D
HOME REMEDIES/HERBAL MEDICINES E
OTHER (SPECIFY) ______________ X
465) Did you seek advice or treatment for the diarrhea?
NO 2 (GO TO 467)
466) Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
GOVERNMENT MOBILE CLINIC D
COMMERCIAL HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____________ F
PHARMACY H
PRIVATE DOCTOR I
PRIVATE MOBILE CLINIC J
COMMERCIAL HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ___________ L
TRADITIONAL PRACTITIONER N
467) GO BACK TO 445 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 468.
468) When a child has diarrhea, should he/she be given less fluids than usual, about the same amount, or more than usual.
ABOUT SAME AMOUNT OF FLUIDS 2
MORE FLUIDS 3
DOES NOT KNOW 8
469) When a child has diarrhea, should he/she be given less food than usual, about the same amount, or more than usual?
ABOUT SAME AMOUNT OF FOOD 2
MORE FOOD 3
DOES NOT KNOW 8
470) When should a child who is sick with diarrhea be taken to a health worker or health facility?
RECORD ALL MENTIONED.
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z
471) When should a child who is sick with a cough be taken to a health worker or health facility?
RECORD ALL MENTIONED.
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z
ANY CHILD RECEIVED ORS (GO TO 475)
473) Have you ever heard of a special product called dalozi you can get for the treatment of diarrhea?
NO 2
474) Have you ever seen a packet like this before? (SHOW PACKET).
NO 2
475) How many times in your whole life did you receive an injection in the arm to prevent tetanus?
NEVER 00 (GO TO 501)
476) In what month and year was your last tetanus injection given?
YEAR 2
SECTION 5. MARRIAGE AND SEXUAL BEHAVIOUR
501) PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
502) Are you currently married or living with a man?
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3
503) Have you ever been married or lived with a man?
NO 2 (GO TO 512)
504) What is your marital status now: are you separated, divorced or widowed?
DIVORCED 2 (GO TO 509)
WIDOWED 3 (GO TO 509)
505) Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
506) Does your husband/partner have any other wives besides yourself?
NO 2 (GO TO 509)
507) How many other wives does he have?
DOES NOT KNOW 98 (GO TO 509)
508) Are you the first, second,.....wife?
509) Have you been married or lived with a man only once, or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A MAN ONLY ONCE
In what month and year did you start living with your husband/partner?
DOES NOT KNOW MONTH 98
DOES NOT KNOW YEAR 98
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 him?
DOES NOT KNOW MONTH 98
DOES NOT KNOW YEAR 98
511) How old were you when you started living with him?
512) Do you have a regular partner (apart from your husband)? I mean someone with whom you have been having sex for about a year or more?
NO 2 (GO TO 514)
513) How many regular partners do you have (aside from your husband)?
NOT MARRIED AND NO REGULAR PARTNER (GO TO 517)
515) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
When was the last time you had sexual intercourse with your (husband/regular partner)?
IF RESPONDENT HAS BOTH HUSBAND AND REGULAR PARTNER, ASK WHEN SHE LAST HAD SEX WITH EITHER.
DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
BEFORE LAST BIRTH 996
516) For that sexual intercourse, was a condom used?
NO 2
517) Have you had sexual intercourse with anyone (else) in the last 6 months? (I mean, with someone other than your husband or regular partner that you mentioned earlier)
NO 2 (GO TO 520)
518) With how many different people have you had sexual intercourse in the last 6 months (apart from your husband or regular partners)?
519) Was a condom used with any of these men?
YES, SOME PERSON 2
NO, WITH NO ONE 3
520) When was the last time you had sexual intercourse (apart from your husband/regular partner)?
DAYS AGO 1
WEEKS AGO 2
MONTHS AGO 3
YEARS AGO 4
BEFORE LAST BIRTH 996
521) For that last sexual intercourse, did you receive money, gifts or favours in return for sex?
GIFT 2
BOTH CASH AND GIFT 3
NONE 4
522) Was this person someone you had met before or someone you met for the first time?
MET FOR FIRST TIME 2
523) Was a condom used for that last sexual intercourse?
NO 2
524) What was the main reason that you did not use a condom that time?
CONDOMS NOT AVAILABLE 02
CONDOM TOO COSTLY 03
WANTED MORE CHILDREN 04
TRUST EACH OTHER 05
PARTNER DOES NOT APPROVE 06
CONDOM USE IS CUMBERSOME 07
OTHER (SPECIFY) _________ 96
DOES NOT KNOW 98
NO SEX IN LAST 4 WEEKS (GO TO 527)
525) In the last four weeks, how many times have you had sexual intercourse?
DOES NOT KNOW 98
526) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?
YES, SOMETIMES 2
NEVER 3
527) Who did you have sex with the last time you had sexual intercourse? Was it with (your husband / the man you are living with) or was it with someone else?
REGULAR PARTNER 2
SOMEONE ELSE 3
NO ONE/NEVER HAD SEX 4
USED CONDOM AS CONTRACEPTIVE METHOD (GO TO 531)
529) Do you know where you can get condoms?
NO 2 (GO TO 532)
IF SOURCE IS HOSPITAL, HEALH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
(NAME OF PLACE) __________________
GOVERNMENT HEALTH CENTER 12
DISPENSARY/HEALTH UNIT 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PHARMACY/DRUG STORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELD WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
CHURCH 32
FRIENDS/RELATIVES 33
531) Have you heard of a condom called 'Protector'?
NO 2
532) In general, do you think that most women like men to use condoms, they don't like men to use condoms, or does it not matter?
DON'T LIKE MEN TO USE CONDOMS 2
DOES NOT MATTER 3
OTHER (SPECIFY) ___________ 6
DOES NOT KNOW 8
533) Now think back to the past. How old were you when you had sexual intercourse for the first time?
NEVER HAD SEX 95
FIRST TIME WHEN MARRIED 96
SECTION 6. FERTILITY PREFERENCES
601) CHECK 313:
HE OR SHE STERILIZED (GO TO 613)
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?
NO MORE/NONE 2 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DOES NOT KNOW 8 (GO TO 604)
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?
YEARS 2
SOON/NOW 993 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) _______ 996
DOES NOT KNOW 998
PREGNANT (GO TO 607)
605) If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?
UNHAPPY 2
WOULD NOT MATTER 3
606) CHECK 312: USING A METHOD?
NOT CURRENTLY USING
CURRENTLY USING (GO TO 613)
607) Do you think you will use a family planning method in the next 12 months?
NO 2
DOES NOT KNOW 8
608) Do you think you will use a method of family planning at any time in the future?
NO 2 (GO TO 610)
DOES NOT KNOW 8 (GO TO 610)
609) Which method would you prefer to use?
IUD 02 (GO TO 613)
INJECTIONS 03 (GO TO 613)
IMPLANTS 04 (GO TO 613)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 613)
CONDOM 06 (GO TO 613)
FEMALE STERILIZATION 07 (GO TO 613)
MALE STERILIZATION 08 (GO TO 613)
RHYTHM/COUNTING DAYS 09 (GO TO 613)
NATURAL FP, MUCUS, TEMPERATURE 10 (GO TO 613)
WITHDRAWAL 11 (GO TO 613)
OTHER (SPECIFY) _____________ 96 (GO TO 613)
UNSURE 98 (GO TO 613)
610) What is the main reason that you think you will never use a method?
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
WANTS MORE CHILDREN 26
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
DOES NOT KNOW 98
HAS LIVING CHILDREN
If you could go back to the time you did not have any children and 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.
OTHER (SPECIFY) __________ 96 (GO TO 615)
614) How many of these children would you like to be boys and how many would you like to be girls?
NUMBER GIRLS
NUMBER EITHER
OTHER (SPECIFY) ___________ 969696
615) Would you say that you approve of couples using a method to avoid getting pregnant?
DISAPPROVE 2 (GO TO 617)
NO OPINION 3 (GO TO 617)
616) Have you ever recommended family planning to a friend, relative or anyone else?
NO 2
617) Is it acceptable or not acceptable to you for information on family planning to be provided:
NOT ACCEPTABLE 2
DOES NOT KNOW 8
NOT ACCEPTABLE 2
DOES NOT KNOW 8
618) In the last six months have you heard about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
DID NOT HEAR PROGRAM ON RADIO (GO TO 620)
619) Which program or message have you heard? Any others?
ON THE RADIO AND TELEVISION.
ADVERTISEMENT FOR CONDOM/PILL B
OTHER (SPECIFY) __________ X
620) In the last few months have you discussed the practice of family planning with your friends or relatives?
NO 2 (GO TO 622)
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS H
OTHER (SPECIFY) ___________ X
622) Do you think most, some, or none of the women you know use some kind of family planning?
SOME 2
NONE 3
DOES NOT KNOW 8
YES, LIVING WITH A MAN
NO, NOT IN UNION (GO TO 626A)
624) Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DOES NOT KNOW 8
625) Have you and your husband/partner ever discussed the number of children you would like to have?
NO 2
626) Do you think your husband/partner wants the same number of children that you want, or does he want more fewer than you want?
MORE CHIILDREN 2
FEWER CHILDREN 3
DOES NOT KNOW 8
626A) Do you think that using family planning will make a woman more promiscuous?
NO 2
DOES NOT KNOW 8
626B) Do you think that using family planning will make a man more promiscuous?
NO 2
DOES NOT KNOW 8
626C) What do you understand by the term "family planning"?
RECORD ALL MENTIONED
NOT TO HAVE MANY CHILDREN B
SPACING CHILDREN TO HAVE A MANAGEABLE FAMILY C
PLANNING A BRIGHT FUTURE D
PRODUCE FEW CHILDREN, EDUCATE AND FEED THEM E
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z
626D) In a relationship, who do you think should have the major role using family planning?
WOMAN 2
BOTH 3
IT DEPENDS 4
FAMILY PLANNING SHOULD NOT BE USED 5
DOES NOT KNOW 8
626E) Who should be responsible in getting information about family planning?
WOMAN 2
BOTH 3
IT DEPENDS 4
FAMILY PLANNING SHOULD NOT BE USED 5
DOES NOT KNOW 8
626F) Have you seen or heard about the Yellow Family Planning Flower?
NO 2 (GO TO 627)
DOES NOT KNOW 8 (GO TO 627)
SMALL FAMILY INSIDE THE FLOWER 2
A MAN, WOMAN, AND THE TWO CHILDREN 3
OTHER (SPECIFY) ____________ 6
DOES NOT KNOW 8
HIGH QUALITY SERVICES ARE AVAILABLE 2
OTHER (SPECIFY) _________ 6
DOES NOT KNOW 8
NEVER HAD SEXUAL INTERCOURSE (GO TO 701)
628) Sometimes a woman becomes pregnant when she does not want to be. Have you ever become pregnant when you did not want to be?
NO 2 (GO TO 701)
629) How long ago was the last time that you became pregnant when you did not want to be?
630) When that happened to you, what did you do about it?
ATTEMPTED TO STOP THE PREGNANCY BUT FAILED 02
HAD A MISCARRIAGE 03 (GO TO 633)
NOTHING/CONTINUED THE PREGNANCY 04 (GO TO 637)
OTHER (SPECIFY) ___________ 96
DOES NOT KNOW 98
631) What was done to stop the pregnancy?
TABLETS 02
HARD MASSAGE/SQUEEZING ABDOMEN 03
CATHETER/OBJECT IN WOMB 04
INJECTION 05
SUCTION 06
CURRETAGE 07
STRENUOUS WORK 08
SCRUBBING FLOORS 09
OTHER (SPECIFY) ____________ 96
DOES NOT KNOW 98
632) Who provided the methods for you? Anyone else?
TRAINED NURSE/MIDWIFE B (GO TO 634)
TRADITIONAL HEALER C (GO TO 634)
TRAINED BIRTH ATTENDANT D (GO TO 634)
UNTRAINED BIRTH ATTENDANT E (GO TO 634)
PHARMACIST F (GO TO 634)
RELATIVE/FRIEND G (GO TO 634)
OTHER (SPECIFY) __________ X (GO TO 634)
NO ONE Y (GO TO 634)
633) What do you think caused you to have a miscarriage?
TABLETS 02
HARD MASSAGE/SQUEEZING ABDOMEN 03
CATHETER/OBJECT IN WOMB 04
INJECTION 05
SUCTION 06
CURRETAGE 07
STRENUOUS WORK 08
SCRUBBING FLOORS 09
SOMETHING WRONG WITH THE BABY 10
HAD A FIGHT 11
HAD AN ACCIDENT 12
WAS SICK 13
OTHER (SPECIFY) ____________ 96
DOES NOT KNOW 98
634) Did you have any health problems as a result?
NO 2 (GO TO 637)
635) Was it necessary for you to be hospitalized?
NO 2 (GO TO 637)
636) How many nights did you spend in the hospital?
IF NO NIGHTS, RECORD '00'.
637) Did you ever have an earlier unwanted pregnancy that you or someone else stopped?
NO 2
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
701) CHECK 503:
YES (ASK QUESTIONS ABOUT MOST RECENT HUSBAND/PARTNER
NO (GO TO 708)
702) Did your (last) husband/partner ever attend school?
NO 2 (GO TO 705)
703) What was the highest level of school he attended: primary, junior, secondary or university?
JUNIOR 2
SECONDARY 3
UNIVERSITY 4
DOES NOT KNOW 8 (GO TO 705)
704) What was the highest grade he completed at that level?
DOES NOT KNOW 8
705) What is (was) your (last) husband/partner's main occupation? That is, what kind of work does (did) he mainly do?
DOES (DID) NOT WORK IN AGRICULTURE (GO TO 708)
707) (Does/did) your husband/partner work mainly on his own land or on family land, or (does/did) he rent land, or (does/did) he work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
LABOR ON SOMEONE ELSE'S FARM LAND 5
PUBLIC LAND 6
708) Aside from your own housework, are you currently working?
NO 2
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?
NO 2
710) Have you done any work in the last 12 months?
NO 2 (GO TO 801)
711) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 714)
713) Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
LABOR ON SOMEONE ELSE'S FARM LAND 5
PUBLIC LAND 6
714) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
715) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 718)
716) During the last 12 months, how many months did you work?
717) (In the months you worked,) How many days a week did you usually work?
718) During the last 12 months, approximately how many days did you work?
719) On a typical working day, how many hours do you spend working?
DOES NOT KNOW 98
720) Do you earn cash for your work? PROBE: Do you make money for working?
NO 2 (GO TO 723)
721) How much do you usually earn for this work? PROBE: Is this by the day, by the week, or by the month?
PER DAY 2
PER WEEK 3
PER MONTH 4
PER YEAR 5
OTHER (SPECIFY) ____________ 99999996
YES, CURRENTLY MARRIED
YES, LIVING WITH A MAN
Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, someone else?
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5
NO, NOT IN UNION
Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5
723) Do you usually work at home or away from home?
AWAY 2
724) CHECK 217 AND 218: IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?
NO (GO TO 801)
725) Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILDCARE 10
HAS NOT WORKED SINCE LAST BIRTH 11
OTHER (SPECIFY) __________ 96
801) Have you heard about disease that can be transmitted through sex?
NO 2 (GO TO 806)
802) Which diseases do you know?
RECORD ALL RESPONSES
GONORRHEA/NZIKO B
AIDS/SLIM DISEASE C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z
HAS NEVER HAD SEX (GO TO 806)
804) During the last 12 months, did you have any of these diseases?
NO 2 (GO TO 806)
DOES NOT KNOW 8 (GO TO 806)
RECORD ALL RESPONSES
GONORRHEA/NZIKO B
AIDS/SLIM DISEASE C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z
806) During the last 12 months, did you have a vaginal discharge?
NO 2
DON'T KNOW 8
807) During the last 12 months, did you have a sore or ulcer on your genitals?
NO 2
DON'T KNOW 8
NONE OF THE DISEASAES (GO TO 814)
809) When you had this disease (DISEASE FROM 805, 806 AND 807) did you take advice or treatment?
SELF TREATMENT 2 (GO TO 810A)
DID NOT DO ANYTHING 8 (GO TO 810A)
810) Where did you seek advice or treatment? Any other place or person?
RECORD ALL MENTIONED
GOVERNMENT HEALTH CENTER B (GO TO 810B)
DISPENSARY/HEALTH UNIT C (GO TO 810B)
GOVERNMENT MOBILE CLINIC D (GO TO 810B)
GOVERNMENT FIELD WORKER E (GO TO 810B)
OTHER PUBLIC (SPECIFY) _________ F (GO TO 810B)
PHARMACY/DRUG STORE H (GO TO 810B)
PRIVATE DOCTOR I (GO TO 810B)
PRIVATE MOBILE CLINIC J (GO TO 810B)
PRIVATE FIELD WORKER K (GO TO 810B)
OTHER PRIVATE MEDICAL (SPECIFY) ________ L (GO TO 810B)
CHURCH N (GO TO 810B)
FRIENDS/RELATIVES O (GO TO 810B)
TRADITIONAL HEALER P (GO TO 810B)
DOES NOT KNOW Z (GO TO 810B)
810A) Why did not you seek advice or treatment?
TOO EXPENSIVE/COSTLY 2
TREATMENT IS NOT AVAILIBLE 3
DOES NOT KNOW WHERE TO GO 4
OTHER (SPECIFY) ________ 6
HAS NEVER HAD SEX (GO TO 814)
811) When you had this disease (DISEASE FROM 805, 806, AND 807) did you inform your partner?
NO 2
812) When you had (DISEASE FROM 805A AND 805B) did you do something so as not to infect your partner?
NO 2 (GO TO 814)
PARTNER ALREADY INFECTED 3 (GO TO 814)
USED CONDOM B
TOOK MEDICINES C
OTHER (SPECIFY) _________ X
MENTIONED 'AIDS' (GO TO 816)
815) Have you ever heard of an illness called AIDS?
NO 2 (GO TO 901)
816) From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED.
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY) _________ X
817) How can a person get AIDS? Any other ways?
RECORD ALL RESPONSES
SEX WITH PROSTITUTES B
HOMOSEXUAL CONTACT C
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS D
BLOOD TRANSFUSION E
UNSTERILIZED EQUIPMENT F
MOTHER TO CHILD (AT BIRTH) G
BREATFEEDING H
KISSING I
MOSQUITO BITES J
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z
818) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 820)
DOES NOT KNOW (GO TO 820)
819) What can a person do to avoid getting AIDS or the virus that causes AIDS? Any other ways?
RECORD ALL MENTIONED
USE CONDOMS DURING SEX B
DON'T HAVE SEX WITH PROSTITUTES C
DON'T HAVE SEX WITH HOMOSEXUALS D
DO NOT HAVE MANY SEX PARTNERS E
HAVE ONE FAITHFUL PARTNER (ZERO GRAZING) F
AVOID BLOOD TRANSFUSIONS G
AVOID UNSTERILIZED EQUIPMENT H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
DO NOT DRINK TOO MUCH ALCOHOL L
OTHER (SPECIFY) _________ W
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z
820) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DOES NOT KNOW 8
821) Is AIDS a fatal disease, that is, do all people with AIDS die from disease?
NO 2
DOES NOT KNOW 8
822) Can AIDS be transmitted from mother to child?
NO 2
DOES NOT KNOW 8
823) Can AIDS be transmitted through breastfeeding?
NO 2
DOES NOT KNOW 8
824) Do you personally know someone who has AIDS or has died of AIDS?
NO 2 (GO TO 825)
DOES NOT KNOW 8 (GO TO 825)
824A) What relationship to you?
SIBLINGS B
FRIENDS/RELATIVES C
NEIGHBOURS D
OTHERS (SPECIFY) _________ X
825) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?
MODERATE 2 (GO TO 827)
GREAT 3 (GO TO 827)
NO RISK AT ALL 4
826) Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS? Any other reasons?
RECORD ALL MENTIONED.
USE CONDOMS DURING SEX B (GO TO 828)
HAVE ONLY ONE SEX PARTNER C (GO TO 828)
LIMITED NUMBER OF PARTNERS D (GO TO 828)
NO HOMOSEXUAL CONTACT E (GO TO 828)
NO BLOOD TRANSFUSIONS F (GO TO 828)
NO INJECTIONS G (GO TO 828)
OTHER (SPECIFY) __________ X (GO TO 828)
DOES NOT KNOW Z
827) Why do you think that you have a (MODERATE/GREAT) chance of getting AIDS? Any other reasons?
RECORD ALL MENTIONED.
MULTIPLE SEX PARTNERS B
SPOUSE HAS MULTIPLE PARTNERS C
HOMOSEXUAL CONTACT D
HAD BLOOD TRANSFUSION E
HAD INJECTIONS F
OTHER (SPECIFY) ________ X
DOES NOT KNOW Z
828) Since you heard of AIDS, have you changed your sexual behavior to prevent getting AIDS?
NO 2 (GO TO 830)
DOES NOT KNOW 8 (GO TO 830)
829) What did you do? Anything else?
RECORD ALL MENTIONED
STARTED USING CONDOMS B
REDUCED NUMBER OF PARTNERS C
STOPPED ALL SEX D
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z
830) Some people use a condom during sexual intercourse to avoid getting AIDS or other sexually transmitted diseases. Have you ever heard of this?
NO 2 (GO TO 832)
HAS NEVER HAD SEX (GO TO 832)
831) Have you ever used a condom during sex to avoid getting or transmitting diseases, such as AIDS?
NO 2
832) Have you ever been tested to see if you have the AIDS virus?
NO 2
DOES NOT KNOW/NOT SURE 8
833) Would you like to be tested for the AIDS virus?
NO 2
DOES NOT KNOW/NOT SURE 8
834) Do you know a place where you could go to get an AIDS test?
NO 2 (GO TO 836)
DOES NOT KNOW/NOT SURE 8 (GO TO 836)
GOVERNMENT HEALTH CENTER B
DISPENSARY/HEALTH UNIT C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) __________ F
PHARMACY/DRUG STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
CHURCH N
FRIENDS/RELATIVES O
DOES NOT KNOW Z
836) What do you suggest is the most important thing the government should do for people who have AIDS?
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE/JAIL PEOPLE 3
NOT BE INVOLVED 4
OTHER (SPECIFY) ________ 6
837) If a member of your family is suffering from AIDS would you be willing to care for him or her at home?
NO 2
DEPENDS 3
OTHER (SPECIFY) _______ 6
NOT SURE/DOES NOT KNOW 8
901) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere, and those who have died.
How many children did your mother give birth to, including you?
ONLY ONE BIRTH (RESPONDENT ONLY) (GO TO 916)
903) How many of these births did your mother have before you were born?
904) What was the name given to your oldest (next oldest) brother or sister?
905) Is (NAME) male or female?
FEMALE 2
NO 2 (GO TO 908)
DON'T KNOW 8 (GO TO NEXT COLUMN)
908) In what year did (NAME) die?
DON'T KNOW 98
909) How many years ago did (NAME) die?
910) How old was (NAME) when she/he died?
911) Was (NAME) pregnant when she died?
NO 2
912) Did (NAME) die during childbirth?
NO 2
913) Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2 (GO TO 915)
914) Was her death due to complications of pregnancy or childbirth?
NO 2
915) How many children did (NAME) give birth to during her lifetime?
MINUTES
1001) CHECK 215:
NO BIRTHS SINCE JANUARY 1991 (GO TO END)
INTERVIEWER: IN 1002 (COLUMNS 2-3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE. IN 1003 AND 1004 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991. IN 1006 AND 1008 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN. (NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 2 LIVING CHILDREN BORN SINCE JANUARY 1991, USE ADDITIONAL FORMS).
1002) LINE NUMBER FROM QUESTION 212
[For all living children born since January 1991.]
FROM QUESTION 212 FOR CHILDREN
FROM QUESTION 215, AND ASK FOR DAY OF BIRTH
[For all living children born since January 1991.]
MONTH
YEAR
1005) BCG SCAR ON TOP OF LEFT SHOULDER
[For all living children born since January 1991.]
NO SCAR 2
1007) WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?
[For all living children born since January 1991.]
STANDING 2
1009) DATE WEIGHED AND MEASURED
MONTH
YEAR
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) __________ 6
CHILD SICK 2
CHILD NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ___________ 6
NAME OF ASSISTANT:
To be filled in after completing interview
Comments about Respondent:
Comments on Specific Questions:
Any Other Comments:
Name of Supervisor: ______________________
Date: _________
EDITOR'S OBSERVATIONS
Name of Editor: __________________________
Date: _________