INDIVIDUAL QUESTIONNAIRE COVER SHEET
CENTRAL STATISTICAL OFFICE
PLACE NAME __________
PROVINCE __________
STRATA ___
DHS SEGMENT NUMBER _____
HOUSEHOLD NUMBER ___
LINE NUMBER OF WOMEN ___
FIRST VISIT
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________
NEXT VISIT:
DATE _____
TIME _____
SECOND VISIT
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________
NEXT VISIT:
DATE _____
TIME _____
THIRD VISIT
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________
FINAL VISIT
MONTH __________
YEAR _____
INTERVIEWER'S NAME __________
RESULT * __________
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY) __________
NDEBELE 2
ENGLISH 3
OTHER 4 __________
FIELD EDITOR
NAME __________
DATE _____
OFFICE EDITOR
NAME __________
DATE _____
KEYED BY
NAME __________
DATE _____
KEYED BY ___
SECTION 1. RESPONDENT'S BACKGROUND
MINUTES ___
102) How long have you been residing continuously in (NAME OF VILLAGE, TOWN, CITY)?
YEARS _____
SINCE BIRTH 95
VISITOR 96
103) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
104) How old were you at your last birthday?
NO ___
COMPARE AND CORRECT 103 AND/OR 104 IF INCONSISTENT.
105) Have you ever attended formal school?
NO 2 (GO TO 108)
106) Are you currently enrolled in school full-time?
NO 2
107) What was the highest grade of school you completed?
CIRCLE CODES FOR LEVEL AND GRADE.
PRIMARY 1
SECONDARY 2
HIGHER 3
GRADE 2
GRADE 3
GRADE 4
GRADE 5
GRADE 6
GRADE 7 (PRIMARY ONLY)
108) Can you read a letter or newspaper in any language?
NO 2 (GO TO 110)
109) Do you read a newspaper or magazine at least once a week?
NO 2
110) Do you watch television every week?
NO 2
111) Do you listen to a radio every day?
NO 2
112) Does your household have:
A radio?
A television?
A refrigerator?
A telephone?
NO 2
NO 2
NO 2
NO 2
113) What is the major source of drinking water for members of your household?
PRIVATE TAP IN YARD OR PLOT 02
COMMUNAL TAP 03
PROTECTED WELL 04
UNPROTECTED WELL 05
BOREHOLE 06
PROTECTED SPRING 07
UNPROTECTED SPRING 08
RIVER/STREAM 09
MUFUKU 10
TANKER 11
RAINWATER 12
OTHER (SPECIFY) __________ 13
114) How far away is this drinking water?
LESS THAN 5 METRES 02
6 - 30 METRES 03
31 - 100 METRES 04
101 - 500 METRES 05
501 M - 1 KM 06
GREATER THAN 1 - 3 KM 07
GREATER THAN 3 - 5 KM 08
GREATER THAN 5 KM 09
115) During periods of drought, where do members of your household obtain drinking water?
PRIVATE TAP IN YARD OR PLOT 02
COMMUNAL TAP 03
PROTECTED WELL 04
UNPROTECTED WELL 05
BOREHOLE 06
PROTECTED SPRING 07
UNPROTECTED SPRING 08
RIVER/STREAM 09
MUFUKU 10
TANKER 11
RAINWATER 12
OTHER (SPECIFY) __________ 13
DID NOT HAVE DROUGHT 96
116) What is the major source of water for household use other than drinking (e.g., clothes washing, cooking) for members of your household?
PRIVATE TAP IN YARD OR PLOT 02
COMMUNAL TAP 03
PROTECTED WELL 04
UNPROTECTED WELL 05
BOREHOLE 06
PROTECTED SPRING 07
UNPROTECTED SPRING 08
RIVER/STREAM 09
MUFUKU 10
TANKER 11
RAINWATER 12
OTHER (SPECIFY) __________ 13
117) How far away is this household water?
LESS THAN 5 METRES 02
6 - 30 METRES 03
31 - 100 METRES 04
101 - 500 METRES 05
501 M - 1 KM 06
GREATER THAN 1 - 3 KM 07
GREATER THAN 3 - 5 KM 08
GREATER THAN 5
KM 09
118) What kind of toilet facility do members of your household use?
BLAIR TOILET 2
PIT LATRINE 3
OTHER (SPECIFY) __________ 4
NO FACILITIES 5 (GO TO 120)
119) Is this toilet facility used by members of your household alone, shared with neighbors, or is it communal?
SHARED WITH NEIGHBORS 2
COMMUNAL 3
120) Does any member of your household own:
A bicycle?
A motorcycle?
A car?
A tractor?
A scotch cart?
Cattle?
Goat?
Sheep?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
121) What kind of fuel does your household mainly use for cooking?
PARAFFIN 02
ELECTRICITY 03
GAS 04
CHARCOAL, COAL 05
DUNG 06
OTHER (SPECIFY) __________ 07
122) What kind of fuel does your household mainly use for lighting?
ELECTRICITY 2
GAS 3
CANDLES 4
OTHER (SPECIFY) __________ 5
123) MAIN MATERIAL OF THE FLOOR IN SLEEPING ROOM.
RECORD OBSERVATION, OR ASK IF YOU CANNOT SEE IT.
VINYL OR ASPHALT STRIPS 02
CERAMIC TILES 03
WOOD PLANKS 04
CEMENT 05
POLISHED CLAY 06
EARTH/SAND 07
DUNG 08
OTHER (SPECIFY) __________ 09
124) IF RURAL: RECORD OBSERVATION (CODE 01 - 05)
MIXED 02
DETACHED 03
SEMI-DETACHED 04
IF URBAN: Is this place owned by a member of the household or is it rented? (CODE 06 OR 07)
RENTED 07
OTHER (SPECIFY) __________ 08
OWNED BY A RELATIVE 09
FREE RENT 10
SPIRITUAL 2
CHRISTIAN 3
OTHER (SPECIFY) __________ 4
WHITE 2
COLOURED 3
ASIAN 4
OTHER (SPECIFY) __________ 5
201) Now I would like to talk with you about pregnancy and childbirth. Have you ever given birth?
NO 2 (GO TO 206)
202) Do you have any sons or daughters you have given birth to who are now living with you?
NO 2 (GO TO 204)
203) How many sons live with you?
How many daughters live with you?
204) Do you have any sons or daughters you have given birth to 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?
206) Have you ever given birth to a boy or girl who was born alive but later died?
IF NO, PROBE: Any (other) boy or girl who cried or showed any sign of life but only survived a few hours or days?
NO 2 (GO TO 208)
207) How many boys have died?
And how many girls have died?
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, ENTER '00'.
209) In total, then, how many live births have you had? ___
COMPARE HER ANSWER WITH TOTAL IN 208:
NUMBERS ARE DIFFERENT (PROBE AND CORRECT 201-209 AS NECESSARY)
NO BIRTHS (GO TO 220)
211) Now I would like to talk to you about all of the children you have given birth to, whether still alive or not, starting with the first one you had.
(RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS ON SEPARATE LINES AND CONNECT NAMES WITH A BRACKET. RECORD DEAD TWIN BEFORE LIVE TWIN.)
212) What name was given to your (first, next) baby?
213) Is (was) (NAME) a boy or a girl?
GIRL 2
214) In what month and year was (NAME) born?
PROBE: In what season is his/her birthday?
NO 2 (GO TO 216)
216) IF DEAD: How old was (NAME) when he/she died?
RECORD IN DAYS IF LESS THAN 1 MONTH, IN MONTHS IF LESS THAN 2 YEARS, OR IN YEARS.
MONTHS 2 ___
YEARS 3 ___
(GO TO NEXT BIRTH)
217) IF ALIVE: How old was (NAME) at his/her birthday? RECORD AGE IN COMPLETED YEARS.
NO ___
218) IF ALIVE: Is he/she living with you?
NO 2
219) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)
221) For how many months have you been pregnant?
222) Did you see anyone for a check on this pregnancy?
NO 2 (GO TO 224)
223) Whom did you see?
PROBE FOR TYPE OF PERSON AND RECORD MOST QUALIFIED.
TRAINED NURSE/MIDWIFE 2
TRADITIONAL MIDWIFE 3
OTHER (SPECIFY) __________ 4
224) Do you have a health card with a record of any tetanus injections you might have had since becoming pregnant? IF YES: May I see it, please?
YES, CARD NOT SEEN 2 (GO TO 226)
NO CARD 8 (GO TO 226)
225) RECORD INJECTION DATES FROM CARD.
IF INJECTION WAS NOT GIVEN, CIRCLE '1'.
DAY ___ (GO TO 228)
MONTH __________ (GO TO 228)
YEAR _____ (GO TO 228)
DATE ___ (GO TO 228)
MONTH __________ (GO TO 228)
YEAR _____ (GO TO 228)
226) Since you have been pregnant, have you been given any injection to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (GO TO 230)
DON'T KNOW 8 (GO TO 230)
227) How many tetanus injections have you received during this pregnancy?
TWO 2
DON'T KNOW 8
228) Where did you go to get the (last) tetanus injection?
PRIVATE DOCTOR/CLINIC 2 (GO TO 230)
CBE WORKER 3 (GO TO 230)
OTHER (SPECIFY) __________ 4 (GO TO 230)
DON'T KNOW 8 (GO TO 230)
229) How long ago did your last menstrual period start?
IF LESS THAN 2 MONTHS, RECORD ANSWER IN DAYS OR WEEKS.
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
230) When during her monthly cycle do you think a woman has the greatest chance of becoming pregnant? PROBE: What are the days during the month when a woman has to be careful to avoid becoming pregnant?
JUST AFTER PERIOD (6 - 10) 2
MIDDLE OF THE CYCLE (11 - 17) 3
JUST BEFORE THE PERIOD BEGINS (18 - 28) 4
AT ANY TIME 5
OTHER (SPECIFY) ______ 6
DON'T KNOW 8
231) PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
301) Now I would like to talk about a different topic. There are various ways or methods that a couple can use to delay or avoid a pregnancy. Which of these ways or methods have you heard about?
INTERVIEWER: CIRCLE CODE '1' IN 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '2' IF METHOD IS RECOGNIZED AND CODE '3' IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' OR '2' CIRCLED IN 302, ASK 303 - 305 BEFORE PROCEEDING TO THE NEXT METHOD.
302) Have you ever heard of (METHOD)?
READ DESCRIPTION.
YES/PROBED 2
NO 3 (GO TO 02)
YES/PROBED 2
NO 3 (GO TO 03)
YES/PROBED 2
NO 3 (GO TO 04)
YES/PROBED 2
NO 3 (GO TO 05)
YES/PROBED 2
NO 3 (GO TO 06)
YES/PROBED 2
NO 3 (GO TO 07)
YES/PROBED 2
NO 3 (GO TO 08)
YES/PROBED 2
NO 3 (GO TO 09)
YES/PROBED 2
NO 3 (GO TO 10)
YES/PROBED 2
NO 3 (GO TO 11)
NO 3 (GO TO 306)
(ASK 303-305 FOR EACH METHOD FOR WHICH A '1' OR '2' IS CIRCLED IN 302)
303. Have you ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2 (GO TO 09 IN 305)
NO 2
NO 2
304) Where would you go to obtain (METHOD) if you wanted to use it? (ENTER THE CODES FROM BELOW)
CODES FOR 304:
02 ZXFPC CLINIC
03 MUNICIPALITY/LOCAL GOVERNMENT CLINIC
04 COMMERCE/INDUSTRY
05 MISSION/CHURCH
06 PRIVATE DOCTOR/PHARMACY
07 RURAL COUNCIL CLINIC
08 FRIEND/RELATIVE
09 TRADITIONAL HEALER
10 OTHER (SPECIFY) __________
11 NOWHERE
98 DON'T KNOW
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER (SPECIFY) __________
305) In your opinion, what is the main problem, if any, with using (METHOD)? (ENTER THE CODES FROM BELOW)
CODES FOR 305:
03 HUSBAND DISAPPROVES
04 HEALTH CONCERNS
05 ACCESS/AVAILABILITY
06 COSTS TOO MUCH
07 INCONVENIENT TO USE
09 METHOD PERMANENT
11 OTHER (SPECIFY) __________
12 NONE
98 DON'T KNOW
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
OTHER __________
306) CHECK 303: EVER USED A METHOD:
YES -- AT LEAST ONE 'YES' (GO TO 309)
307) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
MARK THE APPROPRIATE RESPONSE.
NO ___ (GO TO 335)
308) What have you used or done?
CORRECT 302 - 303 AND OBTAIN INFORMATION FOR 304 TO 306 AS NECESSARY.
309) When you first started using a method to avoid getting pregnant, how many living children did you already have?
IF NONE, ENTER '00'.
PREGNANT (GO TO 335)
WOMAN STERILIZED (GO TO 313A)
312) Are you currently doing something or using any method to avoid getting pregnant?
NO 2 (GO TO 329)
313) Which method are you using?
313A) CIRCLE '06' FOR 'FEMALE STERILIZATION'.
IUD 02 (GO TO 320)
INJECTIONS 03 (GO TO 320)
DIAPHRAGM 04 (GO TO 320)
CONDOM 05 (GO TO 320)
FEMALE STERILIZATION 06 (GO TO 319)
MALE STERILIZATION 07 (GO TO 319)
SAFE PERIOD 08 (GO TO 320B)
WITHDRAWAL 09 (GO TO 323)
FOAM/JELLY 10 (GO TO 320)
OTHER (SPECIFY) __________ 11 (GO TO 323)
314) Please show me the package of pills you are now using.
(RECORD NAME OF BRAND.)
NOT ABLE TO SHOW 96
315) How much does one packet (cycle) of pills cost you?
FREE 996
DON'T KNOW 998
316) At any time in the past month, have you interrupted use of the pill for at least one day?
NO 2 (GO TO 318)
317) Why did you miss a pill or pills?
PROBE: Any other reasons?
SPOTTING/BLEEDING 1
PERIOD DID NOT COME 1
RAN OUT OF PILLS 1
FORGOT/MISPLACED 1
NOT SEXUALLY ACTIVE 1
OTHER (SPECIFY) __________ 1
318) Sometimes people forget to take the pill. What did you do the last time that you forgot to take the pill?
TOOK ONE PILL THE NEXT DAY 2 (GO TO 320)
TOOK TWO PILLS THE NEXT DAY 3 (GO TO 320)
OTHER (SPECIFY) __________ 4 (GO TO 320)
DID NOTHING 5 (GO TO 320)
319) In what month and year did you (he) have the operation?
DATE
320) Where did you last visit to obtain (METHOD)?
320A) Where did the sterilization take place?
320B) Where did you obtain instructions for using the safe period?
ZNFPC CLINIC 02
MUNICIPALITY/LOCAL GOVERNMENT 03
COMMERCE/INDUSTRY 04
MISSION/CHURCH 05
PRIVATE DOCTOR/PHARMACY 06
RURAL COUNCIL CLINIC 07
FRIEND/RELATIVE 08 (GO TO 322)
TRADITIONAL HEALER 09 (GO TO 322)
OTHER (SPECIFY) __________ 10 (GO TO 322)
DON'T KNOW 98 (GO TO 322)
321) Was there anything you particularly disliked about the services you received there?
IF YES: What?
STAFF DISCOURTEOUS 2
SERVICES TOO EXPENSIVE 3
DESIRED METHOD UNAVAILABLE 4
OTHER (SPECIFY) __________ 5
NO COMPLAINTS 6
CURRENTLY USING ANOTHER METHOD (GO TO 323)
323) For how long have you been using (CURRENT METHOD) continuously?
DURATION
324) Have you ever experienced any problems from using (CURRENT METHOD)?
NO 2 (GO TO 326)
325) What is the main problem you experienced?
HUSBAND DISAPPROVED 03
HEALTH CONCERNS 04
ACCESS/AVAILABILITY 05
COST TOO MUCH 06
INCONVENIENT TO USE 07
OTHER (SPECIFY) _________ 11
DON'T KNOW 98
HE/SHE STERILIZED (GO TO 338)
327) At any time during the same month, do you regularly use any method other than (CURRENT METHOD)?
NO 2 (GO TO 338)
IUD 02 (GO TO 338)
INJECTIONS 03 (GO TO 338)
DIAPHRAGM 04 (GO TO 338)
CONDOM 05 (GO TO 338)
SAFE PERIOD 08 (GO TO 338)
WITHDRAWAL 09 (GO TO 338)
FOAM/JELLY 10 (GO TO 338)
OTHER (SPECIFY) __________ 11 (GO TO 338)
(END OF SECTION FOR CURRENT USERS)
(BEGIN SECTION FOR PREVIOUS USERS)
329) CHECK 208: ANY BIRTHS?
NO (GO TO 331)
330) Since your last birth have you done anything or used any method to avoid getting pregnant?
NO 2 (GO TO 335)
331) Which was the last method you used?
IUD 02
INJECTIONS 03
DIAPHRAGM 04
CONDOM 05
MALE STERILIZATION 07
SAFE PERIOD 08
WITHDRAWAL 09
FOAM/JELLY 10
OTHER (SPECIFY) __________ 11
332) In what month and year did you start using that method (last time)?
DATE
333) For how long had you been using (LAST METHOD) before you stopped using it (last time)?
DURATION
334) What was the main reason you stopped using (LAST METHOD) then?
METHOD FAILED 02
HUSBAND DISAPPROVED 03
HEALTH CONCERNS 04
ACCESS/AVAILABILITY 05
COST TOO MUCH 06
INCONVENIENT TO USE 07
INFREQUENT SEX 08
FATALISTIC 10
OTHER (SPECIFY) __________ 11
DON'T KNOW 98
335) Do you intend to use a method to avoid pregnancy at any time in the future?
NO 2 (GO TO 338)
DON'T KNOW 8 (GO TO 338)
336) Which method would you prefer to use?
IUD 02
INJECTIONS 03
DIAPHRAGM 04
CONDOM 05
FEMALE STERILIZATION 06
MALE STERILIZATION 07
SAFE PERIOD 08
WITHDRAWAL 09
FOAM/JELLY 10
OTHER (SPECIFY) __________ 11
UNSURE 98
337) Do you intend to use (PREFERRED METHOD) in the next 12 months or will you wait longer than that?
NO 2
DON'T KNOW 8
338) In the last month, have you heard or read any information about family planning?
NO 2 (GO TO 340)
339) Where did you hear or see the information?
RECORD ALL SOURCES MENTIONED.
HEALTH WORKER 1
NEWSPAPER 1
POSTER/PAMPHLET 1
OTHER (SPECIFY) __________ 1
340) Would you be interested in learning about family planning at some time in the future?
NO 2
341) Is it acceptable or not acceptable to you for family planning information to be provided:
On the radio?
On television?
NOT ACCEPTABLE 2
DON'T KNOW 8
NOT ACCEPTABLE 2
DON'T KNOW 8
SECTION 4. HLTH AND BREASTFEEDING
NO LIVE BIRTHS SINCE JANUARY 1983 (GO TO 501)
402) RECORD LINE NUMBER AND DATE OF BIRTH FROM PAGE 6.
RECORD TWINS IN SEPARATE COLUMNS.
ASK QUESTIONS ABOUT ALL BIRTHS SINCE JANUARY 1983.
NAME __________
DEAD ___
403) When you were pregnant with (NAME), did you see anyone for a check on this pregnancy? IF YES: Whom did you see?
PROBE FOR THE TYPE OF PERSON AND RECORD MOST QUALIFIED.
TRAINED NURSE/MIDWIFE 2
TRADITIONAL MIDWIFE 3
OTHER (SPECIFY) __________ 4
NO ONE 5 (GO TO 405)
404) When you were pregnant with (NAME) were you given any injection to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2
DON'T KNOW 8
405) Where did the delivery take place?
PROVINCIAL HOSPITAL 2
DISTRICT HOSPITAL 3
RURAL HOSPITAL 4
RHC CLINIC 5
HOME 6
OTHER (SPECIFY) __________ 7
406) Did you receive any blood transfusions with the birth of (NAME)?
NO 2
407) Who assisted with the delivery of (NAME)?
PROBE FOR THE TYPE OF PERSON AND RECORD MOST QUALIFIED.
TRAINED NURSE/MIDWIFE 2
TRADITIONAL MIDWIFE 3
RELATIVE 4
OTHER (SPECIFY) __________ 5
NO ONE 6
408) Did you ever feed (NAME) at the breast?
NO
409) Why did you never feed (NAME) at the breast?
HAD TO WORK 02 (GO TO 414)
INSUFFICIENT MILK 03 (GO TO 414)
BABY REFUSED 04 (GO TO 414)
BABY DIED 05 (GO TO 414)
BABY SICK 06 (GO TO 414)
MOTHER SICK 07 (GO TO 414)
OTHER (SPECIFY) __________ 08 (GO TO 414)
410) Are you still breastfeeding (NAME)?
(FOR MOST RECENT BIRTH SINCE JANUARY 1983)
(IF DEAD, CIRCLE '2')
NO (OR DEAD) 2
411) How many months did you breastfeed (NAME)?
UNTIL DEATH 96 (GO TO 413)
412) Why did you stop breastfeeding (NAME)?
HAD TO WORK 02
INSUFFICIENT MILK 03
BABY REFUSED 04
BABY DIED 05
BABY SICK 06
BABY HAD DIARRHEA 07
BABY WEANING AGE 08
MOTHER SICK 09
BECAME PREGNANT 10
COSMETIC REASONS 11
OTHER (SPECIFY) __________ 12
413) How old was (NAME) when you first gave supplemental food or liquid?
NOT YET GIVEN 95
CHILD DIED FIRST 96
414) How many months after the birth of (NAME) did your period return?
NOT RETURNED 96
415) Have you resumed sexual relations since the birth of (NAME)?
NO 2 (GO TO NEXT COLUMN)
416) How many months after the birth of (NAME) did you resume sexual relations?
417) CHECK 410 FOR LAST BIRTH:
IF DEAD/LIVING, AWAY (GO TO 423)
ALL OTHERS (GO TO 420)
418) How many times did you breastfeed last night between sundown and sunrise?
AS OFTEN AS CHILD WANTED 96
419) How many times did you breastfeed yesterday during the daylight hours?
AS OFTEN AS CHILD WANTED 96
420) At any time in the last 24 hours, was (NAME OF LAST CHILD) given any of the following:
Plain water?
Juice?
Powdered milk?
Cow's or goat's milk?
Formula?
Porridge?
Sadza?
Sour milk?
Fruit?
Potatoes?
Egg?
Any other liquid?
Any other solid or mushy food?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO FOOD OR LIQUID GIVEN (GO TO 423)
422) Now were these foods and/or liquids given?
PROBE: What implements were used to feed the baby in the last 24 hours?
CIRCLE '1' FOR EACH ITEM MENTIONED.
PLATE 1
BOTTLE 1
BY HAND 1
OTHER (SPECIFY) __________ 1
423) ENTER THE NAME, LINE NUMBER, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1983 BELOW. BEGIN WITH THE LAST BIRTH. THE HEADINGS IN THE TABLE SHOULD BE EXACTLY THE SAME AS THOSE AFTER QUESTION 402. DO NOT ASK QUESTIONS ABOUT DEAD CHILDREN.
RECORD LINE NUMBER AND DATE OF BIRTH.
ASK QUESTIONS ONLY FOR LIVING CHILDREN
424) Do you have a health card for (NAME)?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 428)
NO CARD 3 (GO TO 428)
425) RECORD BIRTH WEIGHT FROM BACK OF HEALTH CARD. ENTER 9,996 IF NOT GIVEN ON CARD.
426) RECORD DATE OF BIRTH FROM BACK OF HEALTH CARD. ENTER 96 IF NOT GIVEN
427) RECORD DATES OF IMMUNIZATIONS FROM HEALTH CARD.
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
DAY ___ (GO TO 429)
MONTH __________ (GO TO 429)
YEAR _____ (GO TO 429)
428) Has (NAME) ever had a vaccination to prevent him/her from getting diseases?
NO 2
429) Has (NAME) had diarrhea, that is, 3 or more loose or runny stools in the last 24 hours?
NO 2
DON'T KNOW 8
430) Has (NAME) had diarrhea in the last two weeks?
NO 2 (GO TO 436)
DON'T KNOW (GO TO 436)
431) CHECK 410: LAST CHILD STILL BREASTFED?
(FOR MOST RECENT BIRTH SINCE JANUARY 1983, IF STILL LIVING)
NO ___ (GO TO 433)
432) Did you breastfeed (NAME) when he/she had diarrhea then?
(FOR MOST RECENT BIRTH SINCE JANUARY 1983, IF STILL LIVING)
NO 2
433) Was (NAME) given anything special for the diarrhea?
IF YES: What?
CIRCLE ALL MENTIONED.
HERBS 1
OTHER (SPECIFY) __________ 1
NOTHING SPECIAL 1
434) The last time (NAME) had diarrhea, was he/she given a sugar-salt-water solution?
NO 2
DON'T KNOW 8
435) Was (NAME) taken to health facility, a private doctor, a community-based extension worker or to any other person or place to treat the last episode of diarrhea? IF YES: Where was he/she taken?
PRIVATE DOCTOR 2
COMMUNITY-BASED EXTENSION WORKER 3
TRADITIONAL MIDWIFE 4
TRADITIONAL HEALER 5
OTHER (SPECIFY) __________ 6
CHILD NOT TAKEN 7
436) In the last 4 weeks has (NAME) suffered from:
Cough?
Fast or difficult breathing?
Noisy breathing?
Runny nose?
Sore throat?
Earache?
Fever?
Rash?
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
436A) CHECK 436: CHILD HAD ANY SYMPTOMS -- AT LEAST ONE YES?
NO (GO TO NEXT COLUMN)
437) Was (NAME) taken to health facility, a private doctor, a community-based extension worker or to any other person or place to treat the problem? IF YES: Where was he/she taken?
PRIVATE DOCTOR 2
COMMUNITY-BASED EXTENSION WORKER 3
UNTRAINED TRADITIONAL MIDWIFE 4
TRADITIONAL HEALER 5
OTHER (SPECIFY) __________ 6
CHILD NOT TAKEN 7
438) As treatment, for problem(s) did (NAME) receive:
Home remedies?
Injection (Penicillin)?
Oral Antibiotics?
Other tablets?
Anything else? IF YES: What else?
NO 2 (GO TO NEXT COLUMN)
DON'T KNOW 8 (GO TO NEXT COLUMN)
NO 2 (GO TO NEXT COLUMN)
DON'T KNOW 8 (GO TO NEXT COLUMN)
NO 2 (GO TO NEXT COLUMN)
DON'T KNOW 8 (GO TO NEXT COLUMN)
NO 2 (GO TO NEXT COLUMN)
DON'T KNOW 8 (GO TO NEXT COLUMN)
IF YES: What else?
NO 2 (GO TO NEXT COLUMN)
DON'T KNOW 8 (GO TO NEXT COLUMN)
439) CHECK 433 AND 434: SUGAR-SALT-WATER SOLUTION GIVEN TO ANY CHILD?
YES (GO TO 441)
440) Have you ever heard about a sugar-salt-water solution you can give to children who have diarrhea?
NO 2 (GO TO 501)
441) Where did you first learn about sugar-salt-water solution?
PRIVATE DOCTOR 2
COMMUNITY-BASED EXTENSION WORKER 3
MASS MEDIA 4
POSTER 5
FRIEND/RELATIVE 6
OTHER (SPECIFY) __________ 7
DON'T KNOW 8
442) How much water should one use to prepare the solution?
ONE MAZOE BOTTLEFUL 2
ONE COOKING OIL BOTTLEFUL 3
ONE LARGE COKE BOTTLEFUL 4
OTHER (SPECIFY) __________ 5
DON'T KNOW 8
443) How much sugar should one use to prepare the solution?
6 TEASPOONS 2
OTHER (SPECIFY) __________ 3
DON'T KNOW 8
444) How much salt should one use to prepare the solution?
1/4 TEASPOON 2
OTHER (SPECIFY) __________ 3
DON'T KNOW 8
445) How often should the solution be given to a child with diarrhea?
AS OFTEN AS THE CHILD WILL DRINK 2
THREE TIMES PER DAY 3
ONCE PER DAY 4
OTHER (SPECIFY) __________ 5
DON'T KNOW 8
501) Have you ever been married?
NO 2 (GO TO 510)
502) Are you now married or are you widowed, divorced, or separated?
WIDOWED 2 (GO TO 507)
DIVORCED/SEPARATED 3 (GO TO 507)
503) Does your husband stay here?
NO 2
504) For how long has your husband been living away continuously?
(RECORD IN DAYS OR MONTHS OR YEARS)
DURATION
MONTHS 2 ___
YEARS 3 ___
505) Does your husband have any other wives beside yourself?
NO 2 (GO TO 507)
DON'T KNOW 8 (GO TO 507)
506) What is your rank?
PROBE: Are you the first, second, or which wife?
SECOND 2
THIRD 3
HIGHER 4
DON'T KNOW 8
507) Have you been married or lived with a man only once, or more than once?
MORE THAN ONCE 2
508) In what month and year did you start living with your (first) husband?
IF SHE KNOWS THE YEAR, MARK HER ANSWER AND GO TO 511.
DON'T KNOW 98
DON'T KNOW YEAR 98
509) How old were you when you started living with him?
Now we need some details about your sexual activity in order to get a better understanding of contraception and fertility.
510) Have you ever had sexual intercourse?
NO 2 (GO TO 518)
511) Now we need some details about your sexual activity in order to get a better understanding of contraception and fertility.
511A) How old were you when you first had sexual intercourse?
512) When was the last time you had sexual intercourse?
IF LESS THAN 2 MONTHS, RECORD IN DAYS OR WEEKS.
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
BEFORE LAST BIRTH 996 (GO TO 518)
PREGNANT (GO TO 518)
USING CONTRACEPTION (GO TO 518)
515) If you fell pregnant in the next few weeks, would it pose any problems for you or would it not matter very much?
NO, NOT MATTER 2 (GO TO 518)
DON'T KNOW 8 (GO TO 518)
516) What sort of problems would it cause?
CHILDREN ARE YOUNG 02
UNHEALTHY TO HAVE MORE 03
CAN'T CARE FOR MORE 04
MENOPAUSAL 05
NO PARTNER 06
OTHER (SPECIFY) __________ 07
DON'T KNOW 98
517) What is the main reason that you are not using a method to avoid pregnancy?
OPPOSED TO FAMILY PLANNING 02
HUSBAND DISAPPROVES 03
OTHERS DISAPPROVE 04
HEALTH CONCERNS 05
ACCESS/AVAILABILITY 06
COSTS TOO MUCH 07
INCONVENIENT TO USE 08
INFREQUENT SEX 09
FATALISTIC 10
RELIGION 11
POSTPARTUM/BREASTFEEDING 12
MENOPAUSAL/SUB FECUND 13
OTHER (SPECIFY) __________ 14
DON'T KNOW 98
518) PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
519) Now I have a few questions about a very important topic. Have you ever heard of an illness called AIDS?
NO 2 (NO TO 601)
520) Please tell me all the ways that a person can get AIDS/HIV infection. Any other ways?
CIRCLE ALL WAYS MENTIONED.
SEX WITH A PROSTITUTE 1
MANY SEX PARTNERS 1
HOMOSEXUAL SEX 1
TOUCHING A PERSON WITH AIDS 1
SHARING UTENSILS WITH A PERSON WITH AIDS 1
BLOOD TRANSFUSION 1
BEING BORN TO A WOMAN WITH AIDS 1
DONATING BLOOD 1
MOSQUITO BITES 1
INJECTION WITH A DIRTY NEEDLE 1
OTHER (SPECIFY) __________ 1
OTHER (SPECIFY) __________ 1
DON'T KNOW 1
521) Have you heard about AIDS
On the radio?
From a health worker?
In the newspaper?
On a pamphlet or poster?
Any other ways?
NO 2
NO 2
NO 2
NO 2
NO 2
522) What should a person with AIDS do for treatment? Anything else?
CIRCLE ALL THINGS MENTIONED.
GO TO HOSPITAL 1
GO TO CLINIC 1
DO NOTHING 1
TAKE HERBS 1
OTHER (SPECIFY) __________ 1
DON'T KNOW 1
523) Is there a cure for AIDS?
NO 2
DON'T KNOW 8
524) If a person has AIDS, is it alright for them to:
Continue to go to school?
Be permitted in public places?
Donate blood?
Be quarantined (isolated)?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
525) CHECK 510: EVER HAD INTERCOURSE?
NEVER HAD SEX (GO TO 609)
526) Have you done anything to avoid getting AIDS?
NO 2 (GO TO 528)
527) What have you done? Anything else?
CIRCLE EVERYTHING MENTIONED.
STAY WITH ONE PARTNER 1 (GO TO 601)
AVOID MULTIPLE PARTNERS 1 (GO TO 601)
AVOID BARS 1 (GO TO 601)
TAKE HERBS 1 (GO TO 601)
OTHER (SPECIFY) __________ 1 (GO TO 601)
OTHER (SPECIFY) __________ 1(GO TO 601)
528) Why not? Any other reasons?
CIRCLE EVERYTHING MENTIONED.
NOT HAVING SEX 1
ALREADY USING CONDOMS 1
CANNOT AVOID AIDS 1
OTHER (SPECIFY) __________ 1
OTHER (SPECIFY) __________ 1
DON'T KNOW 1
SECTION 6. FERTILITY PREFERENCES
NOT CURRENTLY MARRIED (GO TO 609)
602) Now I have some questions about the future.
CHECK 220 AND MARK BOX.
PREGNANT (READ 602B)
602A) Would you like to have a (another) child or would you prefer not to have any (more) children?
602B) 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 2 (GO TO 605)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 605)
UNDECIDED OR DON'T KNOW 8 (GO TO 605)
603) How long would you like to wait from now before the birth of a (another) child?
DURATION
YEARS ___ 2 (GO TO 605)
RIGHT AWAY 996 (GO TO 605)
DON'T KNOW 998
604) CHECK 215: How old would you like your youngest child to be before you have another child? IF NO LIVING CHILDREN, CIRCLE '96'.
AGE OF YOUNGEST
NO LIVING CHILDREN 96
DON'T KNOW 98
605) Does your husband approve or disapprove of women using family planning to delay or avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8 (GO TO 607)
WANTS MORE CHILDREN 2
HEALTH CONCERNS 3
OTHER (SPECIFY) __________ 4
DON'T KNOW 8
607) Have you ever discussed family planning with your husband?
NO 2 (GO TO 609)
608) How many times have you discussed it in the last year?
ONCE 2
TWICE 3
THREE OR MORE 4
HAS LIVING CHILDREN (READ 609B)
609A) If you could choose exactly the number of children to have in your whole life, how many would that be?
609B) 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?
RECORD NUMBER OR OTHER ANSWER.
OTHER ANSWER (SPECIFY) __________
SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK
ALL OTHERS (GO TO 710)
ASK QUESTIONS ABOUT CURRENT OR MOST RECENT HUSBAND.
702) Now I have some questions about your (most recent) husband. Did your husband ever attend formal school?
NO 2 (GO TO 704)
703) What was the highest grade of school he completed?
CIRCLE LEVEL AND GRADE.
PRIMARY 1
SECONDARY 2
HIGHER 3
DON'T KNOW 98
GRADE 2
GRADE 3
GRADE 4
GRADE 5
GRADE 6
GRADE 7 (PRIMARY ONLY)
DON'T KNOW 8
704) Can (could) he read a letter or newspaper in any language?
NO 2
705) What kind of work does (did) your husband mainly do?
WORKS (WORKED) IN AGRICULTURE (GO TO 708)
707) Does (did) he earn a regular wage or salary?
NO 2 (GO TO 710)
DON'T KNOW 8 (GO TO 710)
708) Does (did) your husband work mainly on his or family land, on someone else's land, or on communal lands?
SOMEONE ELSE'S LAND 2
COMMUNAL LANDS 3
709) Does (did) he work mainly for money or does (did) he work for a share of the crops?
A SHARE OF CROPS 2
710) Aside from their usual housework, many women work in order to earn money. Are you currently doing any work for money?
NO 2 (GO TO 721)
711) What kind of work do you do?
DOES NOT WORK IN AGRICULTURE (GO TO 715A)
713) Do you work mainly on your (or your husband's) family's land, on someone else's land, or on communal lands?
SOMEONE ELSE'S LAND 2
COMMUNAL LANDS 3
714) Do you work mainly for money or do you work for a share of the crops?
A SHARE OF CROPS 2
715) Do you sell the crops for money or use them mainly for subsistence?
USE FOR SUBSISTENCE 2 (GO TO 721)
715A) Who runs the place where you work: yourself, your family, or someone else?
HER FAMILY 2
SOMEONE ELSE 3
716) During most weeks of the year, do you usually work at this job five or more days per week, four or fewer days, or do you work seasonally or irregularly?
UP TO 4 DAYS 2
SEASONALLY 3
IRREGULARLY 4
OTHER (SPECIFY) __________ 5
717) On a typical day when you are doing this work, how many hours do you spend working at this job?
718) On a typical working day, how long does it take you to travel to the place where you work? PROBE: About how many minutes or hours?
HOURS 2 ___
WORKS AT HOME 996
719) In a typical day, week or month, how much do you earn for this work?
RECORD IN THE SMALLEST UNIT OF TIME POSSIBLE.
PER DAY 2
PER WEEK 3
PER MONTH 4
PER YEAR 5
720) When you are working for money, do you decide how all of the money you earn will be used, how some of it will be used, or does someone else decide how your earnings will be used?
DECIDES ABOUT SOME 2 (GO TO 723)
SOMEONE ELSE DECIDES 3 (GO TO 723)
721) Have you ever worked regularly -- that is, for six months or more, to earn money, other than on a farm or in a business run by your family?
NO 2 (GO TO 723)
722) What kind of work did you do last?
WOMAN IS NOT WORKING (GO TO 727)
NO CHILDREN AGE 5 AND UNDER LIVING AT HOME (GO TO 727)
725) While you are working, are your children who are age 5 and under with you most of the time, some of the time, or never?
SOMETIMES 2
NEVER 4
726) Who usually takes care of these children while you are working?
RESPONDENT HERSELF 02
OTHER CHILDREN 03
OTHER RELATIVES 04
NEIGHBORS/FRIENDS 05
DOMESTIC HELP 06
CHILDREN ARE AT SCHOOL 07
NURSERY/DAY CARE CENTER 08
OTHER (SPECIFY) __________ 09
MINUTES ___
INTERVIEWER: IN 801-803, RECORD THE LINE NUMBERS, NAMES, AND BIRTH DATES OF ALL LIVING CHILDREN BORN SINCE JANUARY 1, 1983, STARTING WITH THE YOUNGEST CHILD. CHECK AGE IN 804 TO IDENTIFY CHILDREN 3-60 MONTHS OF AGE. RECORD WEIGHT AND LENGTH IN 805 AND 806.
801) LINE NUMBER FROM 212 ___
804) CHECK AGE; 3-60 MONTHS? (IF UNABLE TO DETERMINE DUE TO MISSING OR CONTRADICTORY INFORMATION, MEASURE CHILD.)
NO (GO TO NEXT CHILD)
805) WEIGHT (IN KILOGRAMS) ___
806) LENGTH (IN CENTIMETERS) ___
807) STATE REASON IF UNABLE TO RECORD
CHILD AWAY 2
MOTHER REFUSED 3
CHILD ASLEEP 4
NO MEASURERS 5
OTHER (SPECIFY) __________ 6
808) NAME OF MEASURER: __________
NAME OF ASSISTANT: __________
(TO BE FILLED IN AFTER COMPLETING INTERVIEW.)
PERSON INTERVIEWED _____
SPECIFIC QUESTIONS _____
OTHER ASPECTS _____
NAME OF INTERVIEWER: _______
NAME OF SUPERVISOR: __________
DATE: _____
NAME OF FIELD EDITOR: __________
DATE: _____
NAME OF KEYER: __________
DATE: _____