INDIVIDUAL QUESTIONNAIRE COVER SHEET
CENTRAL STATISTICAL OFFICE

IDENTIFICATION

PLACE NAME __________
PROVINCE __________
STRATA ___
DHS SEGMENT NUMBER _____
HOUSEHOLD NUMBER ___
LINE NUMBER OF WOMEN ___

INTERVIEWER VISITS

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 * __________

TOTAL NUMBER OF VISITS ___

RESULT__
*RESULT CODES:

LANGUAGE

FIELD EDITOR
NAME __________
DATE _____

OFFICE EDITOR
NAME __________
DATE _____

KEYED BY
NAME __________
DATE _____

KEYED BY ___

SECTION 1. RESPONDENT'S BACKGROUND

101) RECORD THE TIME.

102) How long have you been residing continuously in (NAME OF VILLAGE, TOWN, CITY)?

103) In what month and year were you born?

104) How old were you at your last birthday?

COMPARE AND CORRECT 103 AND/OR 104 IF INCONSISTENT.

105) Have you ever attended formal school?

106) Are you currently enrolled in school full-time?

107) What was the highest grade of school you completed?

CIRCLE CODES FOR LEVEL AND GRADE.

108) Can you read a letter or newspaper in any language?

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

110) Do you watch television every week?

111) Do you listen to a radio every day?

112) Does your household have:

A radio?
A television?
A refrigerator?
A telephone?

113) What is the major source of drinking water for members of your household?

114) How far away is this drinking water?

115) During periods of drought, where do members of your household obtain drinking water?

116) What is the major source of water for household use other than drinking (e.g., clothes washing, cooking) for members of your household?

117) How far away is this household water?

KM 09

118) What kind of toilet facility do members of your household use?

119) Is this toilet facility used by members of your household alone, shared with neighbors, or is it communal?

120) Does any member of your household own:

A bicycle?
A motorcycle?
A car?
A tractor?
A scotch cart?
Cattle?
Goat?
Sheep?

121) What kind of fuel does your household mainly use for cooking?

122) What kind of fuel does your household mainly use for lighting?

123) MAIN MATERIAL OF THE FLOOR IN SLEEPING ROOM.

RECORD OBSERVATION, OR ASK IF YOU CANNOT SEE IT.

124) IF RURAL: RECORD OBSERVATION (CODE 01 - 05)

IF URBAN: Is this place owned by a member of the household or is it rented? (CODE 06 OR 07)

125) What is your religion?

126) RECORD ETHNICITY.

SECTION 2. REPRODUCTION

201) Now I would like to talk with you about pregnancy and childbirth. Have you ever given birth?

202) Do you have any sons or daughters you have given birth to who are now living with you?

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?

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?

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:

210) CHECK 208:

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?

214) In what month and year was (NAME) born?
PROBE: In what season is his/her birthday?

215) Is (NAME) still alive?

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.

(GO TO NEXT BIRTH)

217) IF ALIVE: How old was (NAME) at his/her birthday? RECORD AGE IN COMPLETED YEARS.

218) IF ALIVE: Is he/she living with you?

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

220) Are you pregnant now?

221) For how many months have you been pregnant?

222) Did you see anyone for a check on this pregnancy?

223) Whom did you see?
PROBE FOR TYPE OF PERSON AND RECORD MOST QUALIFIED.

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?

225) RECORD INJECTION DATES FROM CARD.
IF INJECTION WAS NOT GIVEN, CIRCLE '1'.

226) Since you have been pregnant, have you been given any injection to prevent the baby from getting tetanus, that is, convulsions after birth?

227) How many tetanus injections have you received during this pregnancy?

228) Where did you go to get the (last) tetanus injection?

229) How long ago did your last menstrual period start?
IF LESS THAN 2 MONTHS, RECORD ANSWER IN DAYS OR WEEKS.

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?

231) PRESENCE OF OTHERS AT THIS POINT.

SECTION 3. CONTRACEPTION

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.

(ASK 303-305 FOR EACH METHOD FOR WHICH A '1' OR '2' IS CIRCLED IN 302)

303. Have you ever used (METHOD)?

304) Where would you go to obtain (METHOD) if you wanted to use it? (ENTER THE CODES FROM BELOW)

CODES FOR 304:

305) In your opinion, what is the main problem, if any, with using (METHOD)? (ENTER THE CODES FROM BELOW)

CODES FOR 305:

306) CHECK 303: EVER USED A METHOD:

307) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
MARK THE APPROPRIATE RESPONSE.

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'.

310) CHECK 220:

311) CHECK 303:

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

313) Which method are you using?
313A) CIRCLE '06' FOR 'FEMALE STERILIZATION'.

314) Please show me the package of pills you are now using.
(RECORD NAME OF BRAND.)

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

316) At any time in the past month, have you interrupted use of the pill for at least one day?

317) Why did you miss a pill or pills?
PROBE: Any other reasons?

318) Sometimes people forget to take the pill. What did you do the last time that you forgot to take the pill?

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?

321) Was there anything you particularly disliked about the services you received there?
IF YES: What?

322) CHECK 313:

323) For how long have you been using (CURRENT METHOD) continuously?

DURATION

324) Have you ever experienced any problems from using (CURRENT METHOD)?

325) What is the main problem you experienced?

326) CHECK 313:

327) At any time during the same month, do you regularly use any method other than (CURRENT METHOD)?

328) Which method is that?

(END OF SECTION FOR CURRENT USERS)

(BEGIN SECTION FOR PREVIOUS USERS)

329) CHECK 208: ANY BIRTHS?

330) Since your last birth have you done anything or used any method to avoid getting pregnant?

331) Which was the last method you used?

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?

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

336) Which method would you prefer to use?

337) Do you intend to use (PREFERRED METHOD) in the next 12 months or will you wait longer than that?

338) In the last month, have you heard or read any information about family planning?

339) Where did you hear or see the information?
RECORD ALL SOURCES MENTIONED.

340) Would you be interested in learning about family planning at some time in the future?

341) Is it acceptable or not acceptable to you for family planning information to be provided:

On the radio?
On television?

SECTION 4. HLTH AND BREASTFEEDING

401) CHECK 214:

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 __________

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.

404) When you were pregnant with (NAME) were you given any injection to prevent the baby from getting tetanus, that is, convulsions after birth?

405) Where did the delivery take place?

406) Did you receive any blood transfusions with the birth of (NAME)?

407) Who assisted with the delivery of (NAME)?
PROBE FOR THE TYPE OF PERSON AND RECORD MOST QUALIFIED.

408) Did you ever feed (NAME) at the breast?

409) Why did you never feed (NAME) at the breast?

410) Are you still breastfeeding (NAME)?
(FOR MOST RECENT BIRTH SINCE JANUARY 1983)

(IF DEAD, CIRCLE '2')

411) How many months did you breastfeed (NAME)?

412) Why did you stop breastfeeding (NAME)?

413) How old was (NAME) when you first gave supplemental food or liquid?

414) How many months after the birth of (NAME) did your period return?

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

416) How many months after the birth of (NAME) did you resume sexual relations?

417) CHECK 410 FOR LAST BIRTH:

418) How many times did you breastfeed last night between sundown and sunrise?

419) How many times did you breastfeed yesterday during the daylight hours?

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?

421) CHECK 420:

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.

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?

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.

428) Has (NAME) ever had a vaccination to prevent him/her from getting diseases?

429) Has (NAME) had diarrhea, that is, 3 or more loose or runny stools in the last 24 hours?

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

431) CHECK 410: LAST CHILD STILL BREASTFED?
(FOR MOST RECENT BIRTH SINCE JANUARY 1983, IF STILL LIVING)

432) Did you breastfeed (NAME) when he/she had diarrhea then?
(FOR MOST RECENT BIRTH SINCE JANUARY 1983, IF STILL LIVING)

433) Was (NAME) given anything special for the diarrhea?
IF YES: What?
CIRCLE ALL MENTIONED.

434) The last time (NAME) had diarrhea, was he/she given a sugar-salt-water solution?

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?

436) In the last 4 weeks has (NAME) suffered from:

Cough?
Fast or difficult breathing?
Noisy breathing?
Runny nose?
Sore throat?
Earache?
Fever?
Rash?

436A) CHECK 436: CHILD HAD ANY SYMPTOMS -- AT LEAST ONE YES?

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?

438) As treatment, for problem(s) did (NAME) receive:

Home remedies?
Injection (Penicillin)?
Oral Antibiotics?
Other tablets?
Anything else? IF YES: What else?

439) CHECK 433 AND 434: SUGAR-SALT-WATER SOLUTION GIVEN TO ANY CHILD?

440) Have you ever heard about a sugar-salt-water solution you can give to children who have diarrhea?

441) Where did you first learn about sugar-salt-water solution?

442) How much water should one use to prepare the solution?

443) How much sugar should one use to prepare the solution?

444) How much salt should one use to prepare the solution?

445) How often should the solution be given to a child with diarrhea?

SECTION 5. MARRIAGE

501) Have you ever been married?

502) Are you now married or are you widowed, divorced, or separated?

503) Does your husband stay here?

504) For how long has your husband been living away continuously?

(RECORD IN DAYS OR MONTHS OR YEARS)

DURATION

505) Does your husband have any other wives beside yourself?

506) What is your rank?
PROBE: Are you the first, second, or which wife?

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

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

IF SHE KNOWS THE YEAR, MARK HER ANSWER AND GO TO 511.

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?

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.

513) CHECK 220:

514) CHECK 312 AND 313:

515) If you fell pregnant in the next few weeks, would it pose any problems for you or would it not matter very much?

516) What sort of problems would it cause?

517) What is the main reason that you are not using a method to avoid pregnancy?

518) PRESENCE OF OTHERS AT THIS POINT.

519) Now I have a few questions about a very important topic. Have you ever heard of an illness called AIDS?

520) Please tell me all the ways that a person can get AIDS/HIV infection. Any other ways?

CIRCLE ALL WAYS MENTIONED.

521) Have you heard about AIDS

On the radio?
From a health worker?
In the newspaper?
On a pamphlet or poster?
Any other ways?

522) What should a person with AIDS do for treatment? Anything else?
CIRCLE ALL THINGS MENTIONED.

523) Is there a cure for AIDS?

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)?

525) CHECK 510: EVER HAD INTERCOURSE?

526) Have you done anything to avoid getting AIDS?

527) What have you done? Anything else?
CIRCLE EVERYTHING MENTIONED.

528) Why not? Any other reasons?
CIRCLE EVERYTHING MENTIONED.

SECTION 6. FERTILITY PREFERENCES

601) CHECK 502:

602) Now I have some questions about the future.

CHECK 220 AND MARK BOX.

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?

603) How long would you like to wait from now before the birth of a (another) child?

DURATION

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

605) Does your husband approve or disapprove of women using family planning to delay or avoid pregnancy?

606) Why does he disapprove?

607) Have you ever discussed family planning with your husband?

608) How many times have you discussed it in the last year?

609) CHECK 202 AND 204:

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.

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

701) CHECK 501:

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?

703) What was the highest grade of school he completed?

CIRCLE LEVEL AND GRADE.

704) Can (could) he read a letter or newspaper in any language?

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

706) CHECK 705:

707) Does (did) he earn a regular wage or salary?

708) Does (did) your husband work mainly on his or family land, on someone else's land, or on communal lands?

709) Does (did) he work mainly for money or does (did) he work for a share of the crops?

710) Aside from their usual housework, many women work in order to earn money. Are you currently doing any work for money?

711) What kind of work do you do?

712) CHECK 711:

713) Do you work mainly on your (or your husband's) family's land, on someone else's land, or on communal lands?

714) Do you work mainly for money or do you work for a share of the crops?

715) Do you sell the crops for money or use them mainly for subsistence?

715A) Who runs the place where you work: yourself, your family, or someone else?

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?

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?

719) In a typical day, week or month, how much do you earn for this work?

RECORD IN THE SMALLEST UNIT OF TIME POSSIBLE.

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?

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?

722) What kind of work did you do last?

723) CHECK 710:

724) CHECK 217 AND 218:

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?

726) Who usually takes care of these children while you are working?

727) RECORD THE TIME.

SECTION 8. WEIGHT AND LENGTH

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 ___

802) NAME FROM 212

803) DATE OF BIRTH FROM 214

804) CHECK AGE; 3-60 MONTHS? (IF UNABLE TO DETERMINE DUE TO MISSING OR CONTRADICTORY INFORMATION, MEASURE CHILD.)

805) WEIGHT (IN KILOGRAMS) ___

806) LENGTH (IN CENTIMETERS) ___

807) STATE REASON IF UNABLE TO RECORD

808) NAME OF MEASURER: __________

NAME OF ASSISTANT: __________

INTERVIEWER'S OBSERVATIONS

(TO BE FILLED IN AFTER COMPLETING INTERVIEW.)

PERSON INTERVIEWED _____

SPECIFIC QUESTIONS _____

OTHER ASPECTS _____

NAME OF INTERVIEWER: _______

DATE: _______

SUPERVISOR'S OBSERVATIONS

NAME OF SUPERVISOR: __________

DATE: _____

EDITOR'S OBSERVATIONS

NAME OF FIELD EDITOR: __________

DATE: _____

NAME OF KEYER: __________

DATE: _____