PLACE NAME __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
PROVINCE ___
LARGE CITY/SMALL CITY/TOWN/RURAL
SMALL CITY 2
TOWN 3
RURAL 4
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
DAY ___
MONTH __________
YEAR _____
ID NUMBER _____
RESULT __________
NEXT VISIT
DATE _____
TIME _____
TOTAL NUMBER OF VISITS ___
*RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NDEBELE 2
ENGLISH 3
NDEBELE B
ENGLISH C
OTHER X
NO 2
NAME __________
DATE _____
FIELD EDITOR
NAME __________
DATE _____
OFFICE EDITOR ___
KEYED BY ___
SECTION 1. RESPONDENT'S BACKGROUND
INFORMED CONSENT
Hello. My name is __________ and I am working with the Central Statistical Organization. We are conducting a national survey about the health of women, men and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. The survey usually takes between 45 and 60 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
Signature of the interviewer: __________
Date: _____
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES ___
102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE MONTH, RECORD '00' MONTHS.
YEARS 2 ___
VISITOR 96 (SKIP TO 104)
103) Just before you moved here, where did you live?
RECORD NAME AND CODE TYPE OF AREA.
PROBE: Is that a city, town, communal land or resettlement area?
TOWN 2
COMMUNAL LAND 3
RESETTLEMENT AREA 4
OTHER RURAL AREA 5
ABROAD 6
104) In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?
NONE 00 (SKIP TO 106)
105) In the last 12 months, have you been away from your home community for more than one month at a time?
NO 2
106) In what month and year were you born?
DON'T KNOW MONTH 98
YEAR __________
DON'T KNOW YEAR 9998
107) How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.
108) Have you ever attended school?
NO 2 (SKIP TO 112)
109) What is the highest level of school you attended?
SECONDARY 2
HIGHER 3
110) What is the highest grade (number of years) you completed at that level?
111) CHECK 109:
SECONDARY OR HIGHER (SKIP TO 115)
112) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) __________ 4
BLIND/VISUALLY IMPAIRED 5
113) Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1' OR '5' CIRCLED (SKIP TO 116)
115) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
116) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
117) Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
ROMAN CATHOLIC 02
PROTESTANT 03
PENTECOSTAL 04
APOSTOLIC SECT 05
OTHER CHRISTIAN 06
MUSLIM 07
NONE 08 (SKIP TO 201)
OTHER (SPECIFY) __________
119) How often have you attended religious services in the past month?
RECORD '00' IF DID NOT ATTEND DURING MONTH.
DON'T KNOW/NOT SURE 98
201) Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (SKIP TO 206)
202) Do you have any sons or daughters to whom you have given birth who are currently living with you?
NO 2 (SKIP 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 (SKIP 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 babies are born alive and die shortly after birth. 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 did not survive?
NO 2 (SKIP 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'.
209) CHECK 208: Just to make sure that I have this right: you have had in TOTAL ___ births during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY)
NO BIRTHS (SKIP 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?
YEAR _____
NO 2 (SKIP TO 220)
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
219) IF ALIVE: RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD '00' IF CHILD NOT LISTED IN HOUSEHOLD).
220) IF DEAD: How old was (NAME) when he/she died?
IF '1 YR', 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 ___
221) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth?
NO 2
222) Have you had any live births since the birth of (NAME OF LAST BIRTH)?
NO 2
223) COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:
NUMBERS ARE THE SAME ___
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. ___
NUMBERS ARE DIFFERENT ___ (PROBE AND RECONCILE)
224) CHECK 215 AND ENTER THE NUMBER OF BIRTHS IN 2000 OR LATER.
IF NONE, RECORD '0'.
225) FOR EACH BIRTH SINCE JANUARY 1, 2000, ENTER 'B' IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD 'P' IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF 'P'S MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.)
WRITE THE NAME OF THE CHILD TO THE LEFT OF THE 'B' CODE.
NO 2 (SKIP TO 229)
UNSURE 8 (SKIP TO 229)
227) How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'P'S IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS.
228) At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
229) Have you ever had a pregnancy that miscarried, was aborted, or ended in a stillbirth?
NO 2 (SKIP TO 237)
230) When did the last such pregnancy end?
YEAR _____
LAST PREGNANCY ENDED BEFORE JANUARY 2000 (SKIP TO 237)
232) How many months pregnant were you when the last such pregnancy ended?
RECORD NUMBER OF COMPLETED MONTHS. ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
233) Have you ever had any other pregnancies that did not result in a live birth?
NO 2 (SKIP TO 237)
234) ASK THE DATE AND THE DURATION OF PREGNANCY FOR EACH EARLIER NON-LIVE BIRTH PREGNANCY BACK TO JANUARY 2000.
ENTER 'T' IN COLUMN 1 OF CALENDAR IN THE MONTH THAT EACH PREGNANCY TERMINATED AND 'P' FOR THE REMAINING NUMBER OF COMPLETED MONTHS.
235) Did you have any pregnancies that terminated before 2000 that did not result in a live birth?
NO 2 (SKIP TO 237)
236) When did the last such pregnancy that terminated before 2000 end?
YEAR _____
237) When did your last menstrual period start?
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE/HAS HAD HYSTERECTOMY 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996
238) From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?
NO 2 (SKIP TO 240)
DON'T KNOW (SKIP TO 240)
239) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) __________ 6
DON'T KNOW 8
240) Are you the primary care giver for any children?
NO 2 (SKIP TO 301)
241) Are any of these children for whom you are the primary caregiver under the age of 18?
NO 2 (SKIP TO 301)
242) Now I would like to ask you about the children who are under the age of 18 and for whom you are the primary caregiver.
Have you made arrangements for someone to care for these children in the even that you fall sick or are unable to care for them?
NO 2
UNSURE 8
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 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
301) Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
NO 2 (SKIP TO METHOD 02)
NO 2 (SKIP TO METHOD 03)
NO 2 (SKIP TO METHOD 04)
NO 2 (SKIP TO METHOD 05)
NO 2 (SKIP TO METHOD 06)
NO 2 (SKIP TO METHOD 07)
NO 2 (SKIP TO METHOD 08)
NO 2 (SKIP TO METHOD 11)
NO 2 (SKIP TO METHOD 12)
NO 2 (SKIP TO METHOD 13)
NO 2 (SKIP TO METHOD 14)
NO 2 (SKIP TO METHOD 15)
NO 2
302) HAVE YOU EVER USED (METHOD)?
Have you ever had an operation to avoid having any more children?
NO 2
Have you ever had a partner who had an operation to avoid having any more children?
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) (SKIP TO 307)
304) Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2
305) ENTER '0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH (SKIP TO 330)
306) What have you used or done?
CORRECT 302 AND 303 (AND 301 IF NECESSARY).
307) 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 (SKIP TO 311A)
PREGNANT ___ (SKIP TO 322)
310) Are you currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (SKIP TO 322)
311) Which method are you using?
CIRCLE ALL MENTIONED.
IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST.
311A) CIRCLE 'A' FOR FEMALE STERILIZATION.
MALE STERILIZATION B (SKIP TO 316)
PILL C
IUD D (SKIP TO 315)
INJECTION E (SKIP TO 315)
IMPLANT F (SKIP TO 315)
MALE CONDOM G (SKIP TO 315)
FEMALE CONDOM H (SKIP TO 315)
DIAPHRAGM I (SKIP TO 315)
FOAM/JELLY J (SKIP TO 315)
LACTAIONAL AMENNOREAH METHOD K (SKIP TO 319A)
RHYTHM METHOD L (SKIP TO 319A)
WITHDRAWL M (SKIP TO 319A)
OTHER (SPECIFY) __________ X (SKIP TO 319A)
312) May I see the package of pills you are using?
RECORD NAME OF BRAND.
PACKAGE NOT SEEN 02 (SKIP TO 313A)
313) MARK CODE FOR BRAND NAME.
LO-FEMENAL 02 (SKIP TO 314)
MICRONOR 03 (SKIP TO 314)
MICRONOVUM 04 (SKIP TO 314)
MARVELL ON 05 (SKIP TO 314)
DUOFEM 06 (SKIP TO 314)
EXECLUTION 07 (SKIP TO 314)
OTHER (SPECIFY) __________ 96 (SKIP TO 314)
313A) Do you know the brand name of the pills you are using?
RECORD NAME OF BRAND.
LO-FEMENAL 02
MICRONOR 03
MICRONOVUM 04
MARVELLON 05
DUOFEM 06
EXCLUTON 07
OTHER (SPECIFY) __________
DON'T KNOW 98
314) How many pill cycles did you get the last time?
DON'T KNOW 998
315) The last time you obtained (CURRENT METHOD IN 311), how much did you pay in total, including the cost of the method and any consultation you may have had?
FREE 999995 (SKIP TO 319A)
DON'T KNOW 999998 (SKIP TO 319A)
316) In what facility 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.
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
ZNFPC CLINIC 14
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE DOCTOR'S SURGERY 32
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 3
318) How much did you (your husband/partner) pay in total for the sterilization, including any consultation you (he) may have had?
FREE 999995
DON'T KNOW 999998
319) In what month and year was the sterilization performed?
YEAR _____ (SKIP TO 320)
319A) In what month and year did you start using (CURRENT METHOD) continuously?
PROBE: For how long have you been using (CURRENT METHOD) now without stopping?
YEAR _____
320) CHECK 319/319A, 215, 230 AND CALENDAR:
ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH AND YEAR OF START OF USE OF CONTRACEPTION IN 319/319A?
ASK ABOUT SOURCE OF METHOD AT THE START OF USE AND ENTER METHOD SOURCE CODE IN COLUMN 2 OF CALENDAR IN MONTH USE STARTED.
THEN CONTINUE WITH 322.
THEN SKIP TO 328.
322) I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years.
USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 2000.
USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS.
IN COLUMN 1, ENTER METHOD USE CODE OR '0' FOR NONUSE IN EACH BLANK MONTH.
ILLUSTRATIVE QUESTIONS:
COLUMN 1:
When did you start using that method? How long after the birth of (NAME)?
How long did you use the method then?
IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE.
ILLUSTRATIVE QUESTIONS:
COLUMN 2:
Where did you get advice on how to use the method [for LAM, rhythm, or withdrawal]?
IN COLUMN 3, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE.
NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1.
ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT.
ILLUSTRATIVE QUESTIONS:
COLUMN 3:
Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason?
IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK:
AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1.
323) CHECK 311/311A: CIRCLE METHOD CODE.
IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST.
FEMALE STERILIZATION 01
MALE STERILIZATION 02 (SKIP TO 332)
PILL 03
IUD 04
INJECTION 05
IMPLANT 06
MALE CONDOM 07 (SKIP TO 329)
FEMALE CONDOM 08 (SKIP TO 326)
DIAPHRAGM 09 (SKIP TO 326)
FOAM/JELLY 10 (SKIP TO 326)
LACTATIONAL AMENNOREAH METHOD 11 (SKIP TO 326)
RHYTHM METHOD 12 (SKIP TO 332)
WITHDRAWAL 13 (SKIP TO 332)
OTHER METHOD 96 (SKIP TO 332)
324) You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At the time you obtained the method, were you told about side effects or problems you might have with the method?
NO 2 (SKIP TO 326)
325) Were you told what to do if you experienced side effects or problems?
NO 2
At that time, were you told about other methods of family planning that you could use?
NO 2
When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use?
NO 2
328) CHECK 311/311A: CIRCLE METHOD CODE.
MALE STERILIZATION 02 (SKIP TO 332)
PILL 03
IUD 04
INJECTION 05
IMPLANT 06
MALE CONDOM 07
FEMALE CONDOM 08
DIAPHRAGM 09
FOAM/JELLY 10
LACTATIONAL AMENNOREAH METHOD 11 (SKIP TO 332)
RHYTHM METHOD 12 (SKIP TO 332)
WITHDRAWAL 13 (SKIP TO 332)
OTHER METHOD 96 (SKIP TO 332)
329) Where did you (or your partner) obtain (CURRENT METHOD) the last time?
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.
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTER 13
ZNFPC CLINIC 14
MOH MOBILE CLINIC 16
ZNFPC CBD/DEPOT HOLDER 17
OTHER PUBLIC (SPECIFY) __________ 18
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
SUPERMARKET 42
TUCK SHOP 43
SERVICE STATION 44
OTHER RETAIL (SPECIFY) __________ 46
FRIEND/RELATIVE 52
330) Do you know of a place where you can obtain a method of family planning?
NO 2 (SKIP TO 332)
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.
Any other place?
RECORD ALL PLACES MENTIONED.
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
OTHER PUBLIC (SPECIFY) __________ G
PHARMACY J
PRIVATE DOCTOR K
CBD L
OTHER PRIVATE DOCTOR (SPECIFY) __________ M
SUPERMARKET O
TUCK SHOP P
SERVICE STATION Q
OTHER RETAIL (SPECIFY) __________ R
FRIEND/RELATIVE T
332) In the last 12 months, were you visited by a CBD who talked to you about family planning?
NO 2
333) In the last 12 months, have you visited a health facility for care for yourself (or your children)?
NO 2 (SKIP TO 335)
334) Did any staff members at the health facility speak to you about family planning methods?
NO 2
335) CHECK 301 (07) KNOWS MALE CONDOM
NO ___ (SKIP 337)
336) If a male condom is used correctly, do you think that it protects against pregnancy most of the time, only sometimes, or not at all.
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8
337) CHECK 301 (08) KNOWS FEMALE CONDOM
NO ___ (SKIP TO 401)
338) If a female condom is used correctly, do you think that it protects against pregnancy most of the time, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8
SECTION 4. PREGNANCY, POSTNATAL CARE AND NUTRITION
NO BIRTHS IN 2000 OR LATER ___ (SKIP TO 601)
402) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately.)
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 not want to have any (more) children at all?
LATER 2
NOT AT ALL 3 ___ (SKIP TO 407)
406) How much longer would you like to have waited?
YEARS 2 ___
DON'T KNOW 998
407) 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
UNTRAINED D
UNSURE ABOUT TRAINING E
408) Where did you receive antenatal care for this pregnancy? Anywhere else?
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.
RECORD ALL MENTIONED.
OTHER HOME B
PROVINCIAL HOSPITAL D
DISTRICT/RURAL HOSPITAL E
RURAL/MUNICIPAL CLINIC F
RURAL HEALTH CENTER G
OTHER PUBLIC (SPECIFY) __________ H
OTHER PRIVATE MEDICAL K
409) How many months pregnant were you when you first received antenatal care for this pregnancy?
DON'T KNOW 98
410) How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
411) As part of your antenatal care during this pregnancy, were any of the following done at least once?
NO 2
NO 2
NO 2
NO 2
412) During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?
NO 2 (SKIP TO 414)
DON'T KNOW 8 (SKIP TO 414)
413) Were you told where to go if you had these complications?
NO 2
DON'T KNOW 8
414) During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (SKIP TO 417)
DON'T KNOW 8 (SKIP TO 417)
415) During this pregnancy, how many times did you get this injection?
DON'T KNOW 8
OTHER ___ (SKIP TO 417)
417) Did you receive any tetanus injections at any time before this pregnancy?
NO 2 (SKIP TO 421)
DON'T KNOW 8 (SKIP TO 421)
418) How many times did you get a tetanus injection before this pregnancy?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
419) In what month and year did you receive the last tetanus injection before this pregnancy?
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 421)
DONT KNOW YEAR 9998
420) How many years ago did you receive that tetanus injection?
421) During this pregnancy, were you given or did you buy any iron/folic acid tablets or iron syrup?
SHOW TABLETS/SYRUP.
NO 2 (SKIP TO 423)
DON'T KNOW 8 (SKIP TO 423)
422) During the whole pregnancy, for how many days did you take the tablets or syrup?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS.
DON'T KNOW 998
423) During this pregnancy, did you have difficulty with your vision during the daylight?
NO 2
DON'T KNOW 8
424) During this pregnancy, did you suffer from night blindness?
NO 2
DON'T KNOW 8
425) During this pregnancy, did you take any drugs to prevent you from getting malaria?
NO 2 (SKIP TO 431)
DON'T KNOW 8 (SKIP TO 431)
RECORD ALL MENTIONED. IF TYPE OF DRUG IS NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT.
CHLOROQUINE B
DELTAPRIM C
OTHER (SPECIFY) __________ X
DON'T KNOW Z
427) CHECK 426: DRUGS TAKEN FOR MALARIA PREVENTION.
CODE 'A' NOT CIRCLED ___ (SKIP TO 431)
428) How many times did you take SP/Fansidar during this pregnancy?
429) CHECK 407: ANTENATAL CARE FROM HEALTH PROFESSIONAL DURING PREGNANCY
OTHER ___ (SKIP TO 431)
430) Did you get the SP/Fansidar during an antenatal visit, during another visit to a health facility, or from some other source?
OTHER FACILITY VISIT 2
OTHER SOURCE 3
431) 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
DON'T KNOW 8
432) Was (NAME) weighed at birth?
NO 2 (SKIP TO 434)
DON'T KNOW 8 (SKIP TO 434)
433) How much did (NAME) weigh?
ASK FOR HEALTH CARD.
RECORD WEIGHT IN KILOGRAMS FROM HEALTH CARD, IF AVAILABLE.
KG FROM RECALL ___
DON'T KNOW 99.998
434) Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.
IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY.
NURSE/MIDWIFE B
UNTRAINED D
UNSURE ABOUT TRAINING E
435) Where did you give birth to (NAME)?
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.
OTHER HOME 12 (SKIP TO 444)
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL/MUNICIPAL CLINIC 24
RURAL HEALTH CENTER 25
OTHER PUBLIC (SPECIFY) __________ 26
OTHER PRIVATE MEDICAL (SPECIFY) __________ 42
436) How many hours after your labor pains began, did you get to the facility?
IF MORE THAN 24 HOURS RECORD '25'.
RECORD '00' IF LESS THAN ONE HOUR.
25 HOURS OR MORE 25
DON'T KNOW 98
437) How long after you arrived at the facility, did a health professional check on you?
IF MORE THAN 24 HOURS RECORD '25'.
RECORD '00' IF LESS THAN ONE HOUR.
25 HOURS OR MORE 25
DON'T KNOW 98
438) Was (NAME) delivered by caesarean section?
NO 2
439) How long after (NAME) was delivered did you stay there?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998
440) Before you were discharged after (NAME) was born, did any health personnel check on your health?
NO 2 (SKIP TO 443)
441) How many hours, days, or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS.
IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS 2 ___
WEEKS 3 ___
DON'T KNOW 998
442) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
UNTRAINED 22
UNSURE ABOUT TRAINING 23
443) After you were discharged, did any health care provider or a traditional birth attendant check on your health?
NO 2 (SKIP TO 453)
444) Why didn't you deliver in a health facility?
PROBE: Any other reason?
RECORD ALL MENTIONED.
FACILITY NOT OPEN B
TOO FAR/NO TRANSPORTATION C
DON'T TRUST FACILITY/ POOR QUALITY SERVICE D
NO FEMALE PROVIDER AT FACILITY E
HUSBAND/FAMILY DID NOT ALLOW F
NOT NECESSARY G
NOT CUSTOMARY H
OTHER (SPECIFY) __________ X
445) After (NAME) was born did a health professional or a traditional birth attendant check on your health?
NO 2 (SKIP TO 449)
446) How many hours, days or weeks after delivery did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS ___ 2
WEEKS ___ 3
DON'T KNOW 998
447) Who checked on your health at that time?
PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
UNTRAINED 22
UNSURE ABOUT TRAINING 23
448) Where did this first check of (NAME) 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.
OTHER HOME 12
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL/MUNICIPAL CLINIC 24
RURAL HEALTH CENTER 25
OTHER PUBLIC (SPECIFY) __________ 26
OTHER PRIVATE (SPECIFY) __________ 42
NOT ASKED (SKIP TO 449)
449) In the two months after (NAME) was born, did a health care provider or traditional birth attendant check on his/her health?
NO 2 (SKIP TO 453)
DON'T KNOW 8 (SKIP TO 453)
450) How many hours, days or weeks after the birth of (NAME) did the first check take place?
IF LESS THAN ONE DAY, RECORD HOURS. IF LESS THAN ONE WEEK, RECORD DAYS.
DAYS ___ 2
WEEKS ___ 3
DON'T KNOW 998
451) Who checked on (NAME)'s health at that time?
PROBE FOR MOST QUALIFIED PERSON.
NURSE/MIDWIFE 12
UNTRAINED 22
UNSURE ABOUT TRAINING 23
452) Where did this first check of (NAME) 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.
OTHER HOME 12
PROVINCIAL HOSPITAL 22
DISTRICT/RURAL HOSPITAL 23
RURAL/MUNICIPAL CLINIC 24
RURAL HEALTH CENTER 25
OTHER PUBLIC (SPECIFY) __________ 26
OTHER PRIVATE (SPECIFY) __________ 42
453) In the first two months after delivery, did you receive a vitamin A dose like this? SHOW AMPULE/CAPSULE/SYRUP.
NO 2
454) Has your period returned since the birth of (NAME)?
NO 2 (SKIP TO 457)
455) Did your period return between the birth of (NAME) and your next pregnancy?
NO 2 (SKIP TO 459)
456) For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
457) CHECK 226: IS RESPONDENT PREGNANT?
PREGNANT OR UNSURE (SKIP TO 459)
458) Have you resumed sexual relations since the birth of (NAME)?
NO 2 (SKIP TO 460)
459) For how many months after the birth of (NAME) did you not have sexual relations?
PROBE FOR LOCAL BELIEFS AND PRACTICES.
DON'T KNOW 98
460) Did you ever breastfeed (NAME)?
NO 2 (SKIP TO 467)
461) How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.
HOURS ___ 1
DAYS ___ 2
462) In the first three days after delivery, was (NAME) given anything to drink other than breast milk?
NO 2 (SKIP TO 464)
463) What was (NAME) given to drink? Anything else?
RECORD ALL LIQUIDS MENTIONED.
PLAIN WATER B
SUGAR OR GLUCOSE WATER C
GRIPE WATER D
SUGAR-SALT-WATER SOLUTION E
FRUIT JUICE F
INFANT FORMULA G
TEA/INFUSIONS H
HONEY I
OTHER (SPECIFY) __________ X
464) CHECK 404: IS CHILD LIVING?
DEAD (SKIP TO 466)
465) Are you still breastfeeding (NAME)?
NO 2
466) For how many months did you breastfeed (NAME)?
DON'T KNOW 98
467) CHECK 404: IS CHILD LIVING?
DEAD (GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS SKIP TO 472)
468) How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
469) How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.
470) Did (NAME) drink anything from a feeding bottle yesterday or last night?
NO 2
DON'T KNOW 8
471) GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, SKIP TO 472.
RECORD NAME OF YOUNGEST CHILD LIVING WITH HER AND CONTINUE WITH 473
473) Now I would like to ask you about the food (NAME FROM 472) that you ate yesterday during the day or at night, either separately or combined with other foods.
ASK ABOUT EACH FOOD TYPE. FOR THOSE ITEMS WHERE INFORMATION IS SOUGHT FOR BOTH THE CHILD AND THE MOTHER, ASK ABOUT THE CHILD FIRST AND THEN THE MOTHER.
473A) CHILD Yesterday, during the day or night, did (NAME FROM 473) eat/drink:
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
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
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
473B) MOTHER And you yourself, yesterday during the day or night, did you eat/drink:
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
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
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NOT A SINGLE "YES" ___ (SKIP TO 501)
475) How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
SECTION 5. IMMUNIZATION AND CHILD HEALTH
501) ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 2000 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 3 BIRTHS, USE LAST 2 COLUMNS OF ADDITIONAL QUESTIONNAIRES).
DEAD ___ (GO TO 503 IN NEXT COLUMN OR, IF NO MORE BIRTHS, SKIP TO 561)
504) Has (NAME) ever received a vitamin A dose like this?
SHOW AMPULE/CAPSULE/SYRUP.
NO 2 (SKIP TO 506)
DON'T KNOW 8 (SKIP TO 506)
505) How many months ago did (NAME) take the last dose?
DON'T KNOW 98
506) Do you have a child health card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (SKIP TO 510)
NO CARD 3
507) Did you ever have a child health card for (NAME)?
NO 2 (SKIP TO 510)
508)
1) COPY VACCINATION DATE 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 _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
MONTH __________
YEAR _____
509) Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization day campaign?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, DPT 1-4, HEPATITIS B 1-3 AND/OR MEASLES 1-2 VACCINES
NO 2 (SKIP TO 520)
DON'T KNOW 8 (SKIP TO 520)
510) Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?
NO 2 (SKIP TO 522)
DON'T KNOW 8 (SKIP TO 522)
511) Please tell me if (NAME) received any of the following vaccinations:
511A) A BCG vaccination against tuberculosis, that is, an injection in the arm that usually causes a scar?
NO 2
DON'T KNOW 8
512) Polio vaccine, that is, drops in the mouth?
NO 2 (SKIP TO 515)
DON'T KNOW 8 (SKIP TO 515)
514) How many times was the polio vaccine received?
515) A DPT vaccination, that is, an injection given in the right thigh, sometimes at the same time as polio drops?
NO 2 (SKIP TO 517)
DON'T KNOW 8 (SKIP TO 517)
517) A hepatitis B vaccination, that is, an injection given in the left thigh?
NO 2 (SKIP TO 519)
DON'T KNOW 8 (SKIP TO 519)
519) An injection to prevent measles?
NO 2
DON'T KNOW 8
520) Were any of the vaccinations (NAME) received during the last two years given as part of a national immunization day campaign?
NO 2
NO VACCINATION IN THE LAST 2 YEARS 3
DON'T KNOW 8
522) Has (NAME) had diarrhea in the last 2 weeks?
NO 2 (SKIP TO 535)
DON'T KNOW 8 (SKIP TO 535)
523) Was there any blood in the stools?
NO 2
DON'T KNOW 8
524) Now I would like to know how much (NAME) was given to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink?
IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
525) When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
526) Did you seek advice or treatment for the diarrhea from any source?
NO 2 (SKIP TO 531)
527) Where did you seek advice or treatment? Anywhere else?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL PLACES MENTIONED.
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPAL CLINIC E
VILLAGE COMMUNITY/ HEALTH WORKER F
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE DOCTOR H
PHARMACY J
OTHER PRIVATE MED. (SPECIFY) __________ K
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) __________ X
ONLY ONE CODE CIRCLED ___ (SKIP TO 530)
529) Where did you first seek advice or treatment?
USE LETTER CODE FROM 527.
530) How many days after the diarrhea began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
531) Does (NAME) still have diarrhea?
NO 2
532) Was he/she given any of the following to drink at any time since he/she started having the diarrhea:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
533) Was anything (else) given to treat the diarrhea?
NO 2 (SKIP TO 535)
DON'T KNOW 8 (SKIP TO 535)
534) What (else) was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS GIVEN.
ANTIMOTILITY B
OTHER TYPE OF PILL/SYRUP C
UNKNOWN PILL/SYRUP D
NON-ANTIBIOTIC G
535) Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2
DON'T KNOW 8
536) Has (NAME) had an illness with a cough at any time in the last 2 weeks?
NO 2 (SKIP TO 539)
DON'T KNOW 8 (SKIP TO 539)
537) When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?
NO 2 (SKIP TO 540)
DON'T KNOW 8 (SKIP TO 540)
538) When (NAME) had this illness, did he/she have a problem in the chest or a blocked or runny nose?
NOSE 2 (SKIP TO 540)
BOTH 3 (SKIP TO 540)
OTHER (SPECIFY) __________ 6 (SKIP TO 540)
DON'T KNOW 8 (SKIP TO 540)
OTHER ___ (SKIP TO 557)
540) Now I would like to know how much (NAME) was given to drink during the (fever/cough/rapid breathing). Was he/she offered less than usual to drink, about the same amount or more than usual to drink?
IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
NOTHING TO DRINK 5
DON'T KNOW 8
541) When (NAME) had (fever/cough/rapid breathing), was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less?
SOMEWHAT LESS 2
ABOUT THE SAME 3
MORE 4
STOPPED FOOD 5
NEVER GAVE FOOD 6
DON'T KNOW 8
542) Did you seek advice or treatment for the illness from any source?
NO 2 (SKIP TO 547)
543) Where did you seek advice or treatment? Anywhere else?
RECORD ALL SOURCES MENTIONED.
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPAL CLINIC E
VILLAGE COMMUNITY/HEALTH WORKER F
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE DOCTOR H
PHARMACY J
OTHER PRIVATE MED. (SPECIFY) __________ K
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) __________ X
ONLY ONE CODE CIRCLED ___ (SKIP TO 546)
545) Where did you first seek advice or treatment?
USE LETTER CODE FROM 543.
546) How many days after the illness began did you first seek advice or treatment for (NAME)?
IF THE SAME DAY, RECORD '00'.
547) Is (NAME) still sick with a (fever/cough)?
COUGH ONLY 2
BOTH COUGH AND FEVER 3
NO, NEITHER 4
DON'T KNOW 8
548) At any time during the illness, did (NAME) take any drugs for the illness?
NO 2 (SKIP TO 557)
DON'T KNOW 8 (SKIP TO 557)
549) What drugs did (NAME) take?
RECORD ALL MENTIONED.
CHLOROQUINE B
QUININE C
COMBINATION WITH ARTEMISININ D
OTHER ANTI-MALARIAL E
ERYTHROMYCINE G
AMOXICILLIN H
AMPICILLIN I
CHLORAMPHENOCOL J
OTHER ANTIBIOTIC K
ACETAMINOPHEN M
IBUPROFEN N
DON'T KNOW Z
550) Did you already have (NAME OF DRUG FROM 549) at home when the child became ill?
IF YES, CIRCLE CODE FOR THAT DRUG.
ASK SEPARATELY FOR EACH DRUG GIVEN 549.
CHLOROQUINE B
QUININE C
COMBINATION WITH ARTEMISININ C
OTHER ANTI-MALARIAL E
ERYTHROMYCINE G
AMOXICILLIN H
AMPICILLIN I
CHLORAMPHENOCOL J
OTHER ANTIBIOTIC K
ACETAMINOPHEN M
IBUPROFEN N
DON'T KNOW Z
CODE 'A' NOT CIRCLED ___ (SKIP TO 554)
552) How long after the fever started did (NAME) first take SP/Fansidar?
NEXT DAY 1
TWO DAYS AFTER THE FEVER 2
THREE OR MORE DAYS AFTER THE FEVER 3
DON'T KNOW 8
553) For how many days did (NAME) take the SP/Fansidar?
IF 7 OR MORE DAYS, RECORD '7'.
DON'T KNOW 8
CODE 'B' NOT CIRCLED ___ (SKIP TO 557)
555) How long after the fever started did (NAME) first take the chloroquine?
NEXT DAY 1
TWO DAYS AFTER THE FEVER 2
THREE OR MORE DAYS AFTER THE FEVER 3
DON'T KNOW 8
556) For how many days did (NAME) take chloroquine?
IF 7 OR MORE DAYS, RECORD '7'.
DON'T KNOW 8
OTHER (go to 561)
558) Did (NAME) get any injection or suppository for the (fever/cough/rapid breathing)?
SUPPOSITORY B
NONE Y
DON'T KNOW Z
559) Was anything else done about (NAME'S) fever?
NO 2 (SKIP TO 561)
DON'T KNOW 8 (SKIP TO 561)
560) What was done about (NAME'S) fever?
GAVE TEPID SPONGING B
GAVE HERBS C
OTHER (SPECIFY) __________ Y
DON'T KNOW Z
(GO BACK TO 503 IN NEXT COLUMN; IF NO MORE BIRTHS, SKIP TO 561)
561) CHECK 215 AND 218, ALL ROWS: NUMBER OF CHILDREN BORN IN 2000 OR LATER LIVING WITH THE RESPONDENT.
NONE ___ (SKIP TO 601)
562) The last time (NAME OF THE YOUNGEST CHILD) passed stools, what was done to dispose of the stools?
PUT/RINSED INTO TOILET OR LATRINE 02
PUT/RINSED INTO DRAIN OR DITCH 03
THREW INTO GARBAGE 04
BURIED 05
LEFT IN THE OPEN 06
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
SECTION 6. MARRIAGE AND SEXUAL ACTIVITY
601) Are you currently married or living together with a man as if married?
YES, LIVING WITH A MAN 2 (SKIP TO 605)
NO, NOT IN UNION 3
602) Have you ever been married or lived together with a man as if married?
YES, LIVED WITH A MAN 2 (SKIP TO 604)
NO 3
603) ENTER '0' IN COLUMN 4 OF CALENDAR IN THE MONTH OF INTERVIEW, AND IN EACH MONTH BACK TO JANUARY 2000. (SKIP TO 619)
604) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (SKIP TO 610)
SEPARATED 3 (SKIP TO 610)
605) Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
606) RECORD THE HUSBAND'S/PARTNER'S NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE. IF HE IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER ___
607) Besides yourself, does your husband/partner have other wives, does he live with other women as if married, or does he maintain a small house?
NO 2 (SKIP TO 610)
DON'T KNOW 8 (SKIP TO 610)
608) How many other wives or partners does your husband live with now?
DON'T KNOW 98
609) Are you the first, second, ... wife?
610) Have you been married or lived with a man only once or more than once?
MORE THAN ONCE 2
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 613)
DON'T KNOW YEAR 9998
DON'T KNOW MONTH 98
YEAR _____ (SKIP TO 613)
DON'T KNOW YEAR 9998
612) How old were you when you first started living with him?
613) DETERMINE MONTHS MARRIED OR LIVING WITH A MAN SINCE JANUARY 2000. ENTER 'X' IN COLUMN 4 OF CALENDAR FOR EACH MONTH MARRIED OR LIVING WITH A MAN, AND ENTER '0' FOR EACH MONTH NOT MARRIED/NOT LIVING WITH A MAN, SINCE JANUARY 2000.
FOR WOMEN WITH MORE THAN ONE UNION: PROBE FOR DATE WHEN CURRENT UNION STARTED AND, IF APPROPRIATE, FOR STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
FOR WOMEN NOT CURRENTLY IN UNION: PROBE FOR DATE WHEN LAST UNION STARTED AND FOR TERMINATION DATE AND, IF APPROPRIATE, FOR THE STARTING AND TERMINATION DATES OF ANY PREVIOUS UNIONS.
WIDOWED ___ (SKIP TO 617)
MARRIED ONLY ONCE ___ (SKIP TO 619)
616) How did your previous marriage or union end?
DIVORCE/SEPARATION 2 (SKIP TO 619)
617) To whom did most of your late husband's property go?
OTHER WIFE 2
SPOUSE'S CHILDREN 3
SPOUSE'S FAMILY 4
OTHER (SPECIFY) __________ 5
NO PROPERTY 6
618) Did you receive any of your late husband's assets or valuables?
NO 2
619) CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
620) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. How old were you when had sexual intercourse for the very first time?
AGE IN YEARS ___ (SKIP TO 622)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) HUSBAND/PARTNER 95 (SKIP TO 622)
621) Do you intend to wait until you get married to have sexual intercourse for the first time?
NO 2 (SKIP TO 647)
DON'T KNOW/UNSURE 8 (SKIP TO 647)
25-49 YEARS OLD ___ (SKIP TO 627)
623) The first time you had sexual intercourse, was a condom used?
NO 2
DON'T KNOW/DON'T REMEMBER 8
624) How old was the person you first had sexual intercourse with?
DON'T KNOW 98
625) Was this person older than you, younger than you, or about the same age as you?
YOUNGER 2 (SKIP TO 627)
ABOUT THE SAME AGE 3 (SKIP TO 627)
DON'T KNOW/DON'T REMEMBER 8 (SKIP TO 627)
626) Would you say this person was ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
627) When was the last time you had sexual intercourse?
RECORD 'YEARS AGO' ONLY IF LAST INTERCOURSE WAS ONE OR MORE YEARS AGO. IF 12 MONTHS OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 2 ___ (SKIP TO 629)
MONTHS AGO 3 ___ (SKIP TO 629)
YEARS AGO 4 ___ (SKIP TO 641)
628) When was the last time you had sexual intercourse with this (second or third) person?
MONTHS 2 ___
YEARS 3 ___
629) The last time you had sexual intercourse with this (second/third) person, was a condom used?
NO 2 (SKIP TO 631)
630) What was the main reason you used a condom on that occasion?
PREVENT PREGNANCY 2
PREVENT BOTH 3
PARTNER INSISTED 4
OTHER (SPECIFY) __________ 6
DON'T KNOW 8
631) The last time you had sexual intercourse with this (second/third) person, did you or this person drink alcohol?
NO 2 (SKIP TO 633)
632) Were you or your partner drunk at that time?
IF YES: Who was drunk?
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4
633) What was your relationship to this person with whom you had sexual intercourse?
IF RESPONDENT IS GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '02'
IF NO, CIRCLE '03'
LIVE-IN PARTNER 02 (SKIP TO 638)
BOYFRIEND NOT LIVING WITH RESPONDENT 03
CASUAL ACQUAINTANCE 04
COMMERCIAL SEX WORKER 05
OTHER (SPECIFY) __________ 95
634) For how long (have you had/did you have) sexual relations with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.
MONTHS 2 ___
YEARS 3 ___
25-49 YEARS OLD ___ (SKIP TO 639)
DON'T KNOW 98
637) Is this person older than you, younger than you, or about the same age?
YOUNGER 2 (SKIP TO 639)
SAME AGE 3 (SKIP TO 639)
DON'T KNOW 8 (SKIP TO 639)
638) Would you say this person is ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
639) Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?
NO 2 (SKIP TO 641)
640) In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'.
DON'T KNOW 98
641) In total, how many different people have you had sexual intercourse with in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'
DON'T KNOW 98
642) CHECK 629 IN COLUMN 1 (CONDOM USE WITH LAST SEXUAL PARTNER)
NO OR BLANK (SKIP TO 647)
643) You told me you used a condom the last time you had sexual intercourse. What brand of condom did you use that time?
DUREX 2
ECSTASY 3
PROTECTA 4
PUBLIC SECTOR DISTRICT (BLUE CONDOM OR KAREX) 5
ROUGH RIDER 6
OTHER (SPECIFY) __________ 7
MALE CONDOM, DON'T KNOW 8
OTHER (SPECIFY) __________ 10
FEMALE CONDOM, DON'T KNOW 12
644) How many condoms did you (your spouse/partner) get that time?
DON'T KNOW 98
645) How much did the condom(s) cost?
FREE 995
DON'T KNOW 998
646) From where was the condom obtained?
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.
RURAL/MUNICIPAL CLINIC 12 (SKIP TO 651)
RURAL HEALTH CENTER 13 (SKIP TO 651)
ZNFPC CLINIC 14 (SKIP TO 651)
MOH MOBILE CLINIC 15 (SKIP TO 651)
ZNFPC CBD/DEPOT HOLDER 16 (SKIP TO 651)
VILLAGE/FARM HEALTH WORKER 17 (SKIP TO 651)
OTHER PUBLIC (SPECIFY) __________ 18 (SKIP TO 651)
PHARMACY 32 (SKIP TO 651)
PRIVATE DOCTOR 33 (SKIP TO 651)
CBD 34 (SKIP TO 651)
OTHER PRIVATE DOCTOR (SPECIFY) __________ 35 (SKIP TO 651)
SUPERMARKET 42 (SKIP TO 651)
TUCK SHOP 43 (SKIP TO 651)
SERVICE STATION 44 (SKIP TO 651)
OTHER RETAIL (SPECIFY) __________ 45 (SKIP TO 651)
FRIEND/RELATIVE 47 (SKIP TO 651)
DON'T KNOW/NOT SURE 98 (SKIP TO 647)
647) CHECK 301 (07) KNOWS MALE CONDOM
NO ___ (SKIP TO 651)
648) Do you know of any place where a person can get a male condom?
NO 2 (SKIP TO 651)
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.
Any other places?
RECORD ALL SOURCES MENTIONED.
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC (SPECIFY) __________ H
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE DOCTOR (SPECIFY) __________ N
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) __________ S
FRIEND/RELATIVE U
650) If you wanted to, could you yourself get a male condom?
NO 2
DON'T KNOW/UNSURE 8
651) CHECK 301 (08) KNOWS FEMALE CONDOM
NO ___ (SKIP TO 701)
652) Do you know of any place where a person can get a female condom?
NO 2 (SKIP TO 701)
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.
Any other places?
RECORD ALL SOURCES MENTIONED.
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC (SPECIFY) __________ H
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE DOCTOR (SPECIFY) __________ N
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) __________ S
FRIEND/RELATIVE U
654) If you wanted to, could you yourself get a female condom?
NO 2
DON'T KNOW/UNSURE 8
SECTION 7. FERTILITY PREFERENCES
HE OR SHE STERILIZED ___ (SKIP TO 713)
NO MORE/NONE 2 (SKIP TO 704)
SAYS SHE CAN'T GET PREGNANT 3 (SKIP TO 713)
UNDECIDED/DON'T KNOW: AND PREGNANT 4 (SKIP TO 709)
UNDECIDED/DON'T KNOW: AND NOT PREGNANT OR UNSURE 5 (SKIP TO 708)
YEARS ___ 2
SAYS SHE CAN'T GET PREGNANT 994 (SKIP TO 713)
AFTER MARRIAGE 995 (SKIP TO 708)
OTHER (SPECIFY) __________ 996 (SKIP TO 708)
DON'T KNOW 998 (SKIP TO 708)
PREGNANT (SKIP TO 709)
NOT CURRENTLY USING (SKIP TO 706)
CURRENTLY USING (SKIP TO 713)
24 OR MORE MONTHS OR 02 OR MORE YEARS (SKIP TO 707)
00-23 MONTHS OR 00-01 YEAR (SKIP TO 709)
WANTS TO HAVE A/ANOTHER CHILD ___ You have said that you do not want (a/another) child soon, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
WANTS NO MORE/NONE ___ You have said that you do not want any (more) children, but you are not using any method to avoid pregnancy. Can you tell me why you are not using a method? Any other reason?
RECORD ALL REASONS MENTIONED.
INFREQUENT SEX C
MENOPAUSAL/HYSTERECTOMY D
SUBFECUND/INFECUND E
POSTPARTUM AMENORRHEIC F
BREASTFEEDING G
FATALISTIC H
HUSBAND/PARTNER OPPOSED J
OTHERS OPPOSED K
RELIGIOUS PROHIBITION L
KNOWS NO SOURCE N
FEAR OF SIDE EFFECTS P
LACK OF ACCESS/TOO FAR Q
COSTS TOO MUCH R
INCONVENIENT TO USE S
INTERFERES WITH BODY'S NORMAL PROCESSES T
DON'T KNOW Z
NO, NOT CURRENTLY USING (SKIP TO 709)
YES, CURRENTLY USING (SKIP TO 713)
709) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?
NO 2 (SKIP TO 711)
DON'T KNOW 8 (SKIP TO 711)
710) Which contraceptive method would you prefer to use?
MALE STERILIZATION 02 (SKIP TO 713)
PILL 03 (SKIP TO 713)
IUD 04 (SKIP TO 713)
INJECTABLES 05 (SKIP TO 713)
IMPLANTS 06 (SKIP TO 713)
MALE CONDOM 07 (SKIP TO 713)
FEMALE CONDOM 08 (SKIP TO 713)
DIAPHRAGM 09 (SKIP TO 713)
FOAM/JELLY 10 (SKIP TO 713)
LACTATIONAL AMENORRHEA METHOD 11 (SKIP TO 713)
RHYTHM METHOD 12 (SKIP TO 713)
WITHDRAWAL 13 (SKIP TO 713)
OTHER (SPECIFY) __________ 96 (SKIP TO 713)
UNSURE 98 (SKIP TO 713)
711) What is the main reason that you think you will not use a contraceptive method at any time in the future?
MENOPAUSAL/HYSTERECTOMY 23 (SKIP TO 713)
SUBFECUND/INFECUND 24 (SKIP TO 713)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (SKIP TO 713)
HUSBAND/PARTNER OPPOSED 32 (SKIP TO 713)
OTHERS OPPOSED 33 (SKIP TO 713)
RELIGIOUS PROHIBITION 34 (SKIP TO 713)
KNOWS NO SOURCE 42 (SKIP TO 713)
FEAR OF SIDE EFFECTS 52 (SKIP TO 713)
LACK OF ACCESS/TOO FAR 53 (SKIP TO 713)
COSTS TOO MUCH 54 (SKIP TO 713)
INCONVENIENT TO USE 55 (SKIP TO 713)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (SKIP TO 713)
DON'T KNOW 98 (SKIP TO 713)
712) Would you ever use a contraceptive method if you were married?
NO 2
DON'T KNOW 8
PROBE FOR A NUMERIC RESPONSE.
NUMBER ___
OTHER (SPECIFY) __________ 96 (SKIP TO 715)
714) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
NUMBER OF GIRLS ___
NUMBER OF EITHER ___
715) In the last few months have you heard about family planning:
NO 2
NO 2
NO 2
YES, LIVING WITH A MAN ___ (SKIP TO 717)
NO, NOT IN UNION ___ (SKIP TO 722)
CODE B, G, OR L CIRCLED ___ (SKIP TO 719)
NO CODE CIRCLED ___ (SKIP TO 721)
718) Does your husband/partner know that you are using a method of family planning?
NO 2 (SKIP TO 720)
DON'T KNOW 8 (SKIP TO 720)
719) Would you say that using contraception is mainly your decision, mainly your husband's decision, or did you both decide together?
MAINLY HUSBAND/PARTNER 2
JOINT DECISION 8
OTHER (SPECIFY) __________ 6
HE OR SHE STERILIZED (SKIP TO 722)
721) Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
722) Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
723) When a wife knows her husband has a sexually transmitted disease, is she justified in asking that he use a condom?
NO 2
DON'T KNOW 8
NOT IN UNION (SKIP TO 801)
725) Can you say no to your husband/partner if you do not want to have sexual intercourse?
NO 2
DEPENDS/UNSURE 8
726) Could you ask your husband/partner to use a condom if you wanted him to?
NO 2
DEPENDS/UNSURE 8
SECTION 8. HUSBAND'S BACKGROUND AND WOMAN'S WORK
FORMERLY MARRIED/LIVED WITH A MAN (SKIP TO 803)
NEVER MARRIED AND NEVER LIVED WITH A MAN (SKIP TO 807)
802) How old was your husband/partner on his last birthday?
803) Did your (last) husband/partner ever attend school?
NO 2 (SKIP TO 806)
804) What was the highest level of school he attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
DON'T KNOW 8 (SKIP TO 806)
805) What was the highest (grade/form/year) he completed at that level?
DON'T KNOW 98
CURRENTLY MARRIED/LIVING WITH A MAN ___ What is your husband's/partner's occupation? That is, what kind of work does he mainly do?
FORMERLY MARRIED/LIVED WITH A MAN ___ What was your (last) husband's/partner's occupation? That is, what kind of work did he mainly do?
807) Aside from your own housework, have you done any work in the last seven days?
NO 2
808) As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?
NO 2
809) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave or any other such reason?
NO 2
810) Have you done any work in the last 12 months?
NO 2 (SKIP TO 818)
811) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (SKIP TO 814)
813) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
814) Do you do this work for a family member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
815) Do you usually work at home or away from home?
AWAY 2
816) 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
817) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3 (SKIP TO 823)
NOT PAID (SKIP TO 823)
NOT CURRENTLY MARRIED (SKIP TO 824)
OTHER (SKIP TO 822)
820) Who decides how the money you earn will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6
821) Would you say that the money you bring into the household is more than what your husband/partner brings in, less than what he brings in, or about the same?
LESS THAN HIM 2
ABOUT THE SAME 3
HUSBAND/PARTNER DOESN'T BRING IN ANY MONEY 4 (SKIP TO 823)
DON'T KNOW 8
822) Who decides how your husband's/partner's earnings will be used: mainly you, mainly your husband/partner, or you and your husband/partner jointly?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
OTHER 6
823) Who usually makes the following decisions: mainly you, mainly your husband/partner, you and your husband/partner jointly, or someone else?
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
HUSBAND/PARTNER 2
RESPONDENT AND HUSBAND/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER 5
824) PRESENCE OF OTHERS AT THIS POINT (PRESENT AND LISTENING, PRESENT BUT NOT LISTENING, OR NOT PRESENT).
PRESENT/NOT LISTENING 2
NOT PRESENT 8
PRESENT/NOT LISTENING 2
NOT PRESENT 8
PRESENT/NOT LISTENING 2
NOT PRESENT 8
PRESENT/NOT LISTENING 2
NOT PRESENT 8
825) Now I would like your opinion about married couples. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
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
901) Now I would like to talk about something else. Have you ever heard of HIV or an illness called AIDS?
NO 2 (SKIP TO 1001)
902) Can people reduce their chances of getting HIV, the virus that causes AIDS, by having just one sex partner who is not infected and who has no other partners?
NO 2
DON'T KNOW 8
903) Can people get HIV from mosquito bites?
NO 2
DON'T KNOW 8
904) Can people reduce their chances of getting HIV by using a condom every time they have sex?
NO 2
DON'T KNOW 8
905) Can people get HIV by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
906) Can people reduce their chance of getting HIV by abstaining from sexual intercourse?
NO 2
DON'T KNOW 8
907) Can people get HIV because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
908) Is there anything (else) a person can do to avoid or reduce the chances of getting HIV?
NO 2 (SKIP TO 910)
DON'T KNOW 8 (SKIP TO 910)
909) What can a person do? Anything else?
RECORD ALL WAYS MENTIONED.
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER N
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
910) Do you think your risk of getting infected with HIV is low, medium or high, or do you have no risk at all?
MEDIUM 2
HIGH 3
NO RISK 4
DON'T KNOW 8
911) Is it possible for a healthy-looking person to have HIV?
NO 2
DON'T KNOW 8
912) Can HIV be transmitted from a mother to her baby:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (SKIP TO 915)
914) Are there any special medications that a doctor or nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
915) Is there any special medication that people infected with HIV can get from a doctor or a nurse?
NO 2
DON'T KNOW 8
NO BIRTHS (SKIP TO 926)
LAST BIRTH BEFORE JANUARY 2002 (SKIP TO 926)
NO ONE (SKIP TO 926)
918) During any of the antenatal visits for that pregnancy, did anyone talk to you about:
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
919) Were you tested for HIV as part of your antenatal care?
NO 2 (SKIP TO 925)
920) Did you yourself ask for the test, was it offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
921) Did you get the results of the test?
NO 2
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE SOURCE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
RURAL HEALTH CENTER 14
MUNICIPAL CLINIC 15
OTHER PUBLIC (SPECIFY) __________ 16
NEW START CENTER 32
OTHER PRIVATE VCT CENTER (SPECIFY) __________ 33
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
923) Have you been tested for HIV since that time you were tested during your pregnancy?
NO 2 (SKIP TO 933)
924) When was the last time you were tested for HIV?
12-23 MONTHS AGO 2 (SKIP TO 928)
2 OR MORE YEARS AGO 3 (SKIP TO 928)
925) Were you offered a test for HIV as part of your antenatal care?
NO 2
926) Have you ever been tested to see if you have been infected with HIV?
NO 2 (SKIP TO 933)
927) When was the last time you were tested?
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3
928) The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?
OFFERED AND ACCEPTED 2
REQUIRED 3
929) Did you get the results of the test?
NO 2
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.
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
RURAL HEALTH CENTER 14
MUNICIPAL CLINIC 15
OTHER PUBLIC (SPECIFY) __________ 16
NEW START CENTER 32
OTHER PRIVATE VCT CENTER (SPECIFY) __________ 33
OTHER PRIVATE DOCTOR (SPECIFY) __________ 36
931) CHECK 921 AND 929: GOT THE RESULTS OF HIV TEST
NO (SKIP TO 936)
932) Did you tell your husband/partner the result of your test?
NO 2 (SKIP TO 936)
NO HUSBAND/PARTNER 3 (SKIP TO 936)
933) What is the main reason you have not been tested for HIV?
DON'T KNOW WHERE TO GO 02 (SKIP TO 936)
TESTING SITE DIFFICULT TO GET TO 03
AFRAID OF TEST RESULT 04
FATALISTIC/NOTHING CAN BE DONE 05
CONCERNED ABOUT CONFIDENTIALITY 06
NO RISK/NOT SEXUALLY ACTIVE 07
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
934) Do you know of a place where people can go to get tested for HIV, the virus that causes AIDS?
NO 2 (SKIP TO 936)
RECORD ALL SOURCES MENTIONED
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.
Any other places?
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPAL CLINIC E
OTHER PUBLIC (SPECIFY) __________ F
NEW START CENTER I
OTHER PRIVATE VCT CENTER (SPECIFY) __________ J
OTHER PRIVATE DOCTOR (SPECIFY) __________ K
936) CHECK 601: CURRENT MARITAL STATUS
OTHER (SKIP TO 939)
937) Did your husband/partner ever have a test for HIV?
NO 2 (SKIP TO 939)
DON'T KNOW 8 (SKIP TO 939)
938) Did he tell you the result of his test?
NO 2
939) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
NO 2
DON'T KNOW 8
940) If a member of your family got infected with HIV, would you want others to know about it?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
941) If a relative of yours became sick with HIV, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
942) If a female teacher has HIV but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
942A) If a male teacher has HIV but is not sick, should he be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
943) Do you personally know someone who has been denied health services in the last 12 months because he or she is suspected to have HIV or AIDS?
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (SKIP TO 948)
944) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she is suspected to have HIV or AIDS?
NO 2
945) Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have HIV or AIDS?
NO 2
AT LEAST ONE 'YES' (SKIP TO 948)
947) Do you personally know someone who is suspected to have HIV or who has AIDS?
NO 2
948) Do you agree or disagree with the following statement: People with HIV should be ashamed of themselves.
DISAGREE 2
DON'T KNOW/NO OPINION 8
949) Do you agree or disagree with the following statement: People with HIV should be blamed for bringing the disease into the community.
DISAGREE 2
DON'T KNOW/NO OPINION 8
950) Do you agree or disagree with the following statement: In a marriage, is it possible for one partner to be infected with HIV and the other person not to be infected.
DISAGREE 2
DON'T KNOW/NO OPINION 8
951) Should children age 12-14 be taught about using a condom to avoid HIV infection?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
952) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid HIV infection?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
SECTION 10. OTHER HEALTH CARE ISSUES
NO 2
HAS NOT HAD SEXUAL INTERCOURSE (SKIP TO 1010)
HAS NOT HEARD ABOUT INFECTION TRANSMITTED THROUGH SEXUAL CONTACT (SKIP TO 1005)
1004) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
1005) Sometimes women experience a bad smelling abnormal genital discharge. During the last 12 months, have you had a bad-smelling, abnormal genital discharge?
NO 2
DON'T KNOW 8
1006) Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?
NO 2
DON'T KNOW 8
1007) CHECK 1004,1005, AND 1006:
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (SKIP TO 1010)
1008) The last time you had (PROBLEM FROM 1004/1005/1006), did you seek any kind of advice or treatment?
NO 2 (SKIP TO 1010)
1009) Where did you go? Any other places?
RECORD ALL SOURCES MENTIONED.
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
RURAL/MUNICIPAL CLINIC E
VILLAGE/FARM HEALTH WORKER F
OTHER PUBLIC (SPECIFY) __________ G
PHARMACY J
OTHER PRIVATE MEDICAL (SPECIFY) __________ K
RELATIVE/FRIEND M
TRADITIONAL HEALER N
OTHER (SPECIFY) __________ X
DOES NOT KNOW (SKIP TO 1015)
1011) CHECK 301 (07) KNOWS MALE CONDOM
NO (SKIP TO 1013)
1012) Some people use male condoms to prevent sexually transmitted diseases. If a male condom is used correctly, do you think that it protects against these diseases most of the time, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8
1013) CHECK 301 (08) KNOWS FEMALE CONDOM
NO (SKIP TO 1015)
1014) Some people use female condoms to prevent sexually transmitted diseases. If a female condom is used correctly, do you think that it protects against these diseases most of the time, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
DON'T KNOW/UNSURE 8
1015) Now I would like to ask some questions about medical care for yourself.
Many different factors can prevent women from getting medical advice or treatment for themselves. When you are sick and want to get medical advice or treatment, is each of the following a big problem or not?
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
NOT A BIG PROBLEM 2
1016) Do you have medical aid?
NO 2 (SKIP TO 1018)
1017) What type of medical aid do you have?
THROUGH EMPLOYER ONLY 2
PARTIALLY THROUGH EMPLOYER 3
NONE 4
OTHER (SPECIFY) __________ 6
DON'T KNOW/UNSURE 8
1018) Now I would like to ask you some questions about any injections you have had in the last six months. Have you had an injection for any reason in the last six months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (SKIP TO 1022)
1019) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 94, OR DAILY FOR 3 MONTHS OR MORE, RECORD '95'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (SKIP TO 1022)
1020) The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
RURAL HEALTH CENTER 14
MUNICIPAL CLINIC 15
OTHER PUBLIC (SPECIFY) __________ 16
NEW START CENTER 32
OTHER PRIVATE VCT CENTER (SPECIFY) __________ 33
OTHER PRIVATE DOCTOR (SPECIFY) __________ 34
1021) Did the person who gave you that injection take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
1022) Do you currently smoke cigarettes?
NO 2 (SKIP TO 1024)
1023) In the last 24 hours, how many cigarettes did you smoke?
1024) Do you currently smoke or use any other type of tobacco?
NO 2 (SKIP TO 1026)
1025) What (other) type of tobacco do you currently smoke or use?
PROBE: Any other?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) __________ X
1026) Now I would like to ask you some questions about tuberculosis. Have you ever heard of an illness called tuberculosis or TB?
NO 2 (SKIP TO 1101)
1027) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) __________ X
DON'T KNOW Z
1028) Can tuberculosis be cured?
NO 2
DON'T KNOW 8
1029) If a member of your family got tuberculosis, would you want others to know about it?
NO 2
DON'T KNOW/NOT SURE/DEPENDS
1101) CHECK COVER PAGE OF WOMAN'S QUESTIONNAIRE:
WOMAN NOT SELECTED (SKIP TO 1201)
1102) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.
FORMERLY MARRIED/LIVED WITH A MAN (READ IN PAST TENSE) (SKIP TO 1104)
NEVER MARRIED/NEVER LIVED WITH A MAN (SKIP TO 1117)
1104) First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your (last) husband/partner?
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
1105A) (Does/did) your (last) husband/partner ever:
NO 2
NO 2
NO 2
1105B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN, SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.
How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
1106A) (Does/did) your (last) husband/partner ever do any of the following things to you:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
1106B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN, SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.
How often did this happen during the last 12 months: often, only sometimes, or not at all?
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
SOMETIMES 2
NOT AT ALL 3
ALL ANSWERS ARE 'NO' (SKIP TO 1114A)
1108) How long after you first got married to/started living with your (last) husband/partner did this (any of these things) first happen to you?
IF LESS THAN ONE YEAR, RECORD '00'.
BEFORE MARRIAGE/BEFORE LIVING TOGETHER 95
1109) How long before you got married to/started living with your (last) husband/partner did this (any of these things) first happen to you?
MONTHS 2 ___
YEARS 3 ___
DON'T KNOW 98
1110) Does (did) your husband/partner drink alcohol or use other intoxicating substances?
NO 2 (SKIP TO 1113)
1111) How often does (did) he get drunk: often, only sometimes, or never?
SOMETIMES 2
NEVER 3
1112) When he has (had) been drinking or using other intoxicating substances, how often do (did) these things happen to you?
SOMETIMES 2
NEVER 3
1113) Did the following ever happen to you as a result of what your (last) husband/partner did to you:
NO 2
NO 2
NO 2
NO 2
1114A) Have you ever done any of the following to your husband/partner at times when he was not already emotionally or physically hurting you?
NO 2
NO 2
NO 2
NO 2
1114B) CHECK 601: ASK ONLY IF RESPONDENT IS CURRENTLY MARRIED/LIVING WITH A MAN SEPARATED, OR DIVORCED. EXCLUDE WIDOWED WOMEN.
How often did this happen during the last 12 months: often, only sometimes, or not at all?
OFTEN 2
NOT AT ALL 3
OFTEN 2
NOT AT ALL 3
OFTEN 2
NOT AT ALL 3
OFTEN 2
NOT AT ALL 3
1115) CHECK 1114A a, b, c, and d:
ALL ANSWERS ARE 'NO' FOR EACH OF a, b, c, or d (SKIP TO 1117)
1116) Have you done any of these things to your husband/partner in the last 12 months?
NO 2
EVER MARRIED/LIVED WITH A MAN ___ From the time you were 15 years old has anyone other than your (current/last) husband/partner ever:
NO 2 (SKIP TO 1117b)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1117b)
NO 2 (SKIP TO 1120A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1120A)
NEVER MARRIED/NEVER LIVED WITH A MAN ___ From the time you were 15 years old has anyone ever:
NO 2 (SKIP TO 1117b)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1117b)
NO 2 (SKIP TO 1120A)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1120A)
1118) Who has hurt you in this way? Anyone else?
RECORD ALL MENTIONED.
FATHER/STEP-FATHER B
SISTER/BROTHER C
DAUGHTER/SON D
OTHER RELATIVE E
FORMER HUSBAND/PARTNER F
CURRENT BOYFRIEND G
FORMER BOYFRIEND H
MOTHER-IN-LAW I
FATHER-IN-LAW J
OTHER IN-LAW K
TEACHER L
EMPLOYER/SOMEONE AT WORK M
POLICE/SOLDIER N
OTHER (SPECIFY) __________ X
1120A) CHECK 201, 226 AND 229: EVER BEEN PREGNANT/GIVEN BIRTH
NO (SKIP TO 1123)
1121) Has any one ever hit, slapped, kicked, or done anything else to hurt you physically while you were pregnant?
NO 2 (SKIP TO 1123)
1122) Who has done any of these things to physically hurt you while you were pregnant? Anyone else?
RECORD ALL MENTIONED.
MOTHER/STEP-MOTHER B
FATHER/STEP-FATHER C
SISTER/BROTHER D
DAUGHTER/SON E
OTHER RELATIVE F
FORMER HUSBAND/PARTNER G
CURRENT BOYFRIEND H
FORMER BOYFRIEND I
MOTHER-IN-LAW J
FATHER-IN-LAW K
OTHER IN-LAW L
TEACHER M
EMPLOYER/SOMEONE AT WORK N
POLICE/SOLDIER O
OTHER (SPECIFY) __________ X
1123) CHECK 620: EVER HAD SEX?
NEVER HAD SEX (SKIP TO 1128)
1124) The first time you had sexual intercourse, would you say that you had it because you wanted to, or because you were forced to have it against your will?
FORCED TO 2
REFUSED TO ANSWER/NO RESPONSE 3
NO 2
REFUSED TO ANSWER/NO ANSWER 3
OTHER (SKIP TO 1129)
1127) CHECK 1106A(g) and 1106A(h):
OTHER (SKIP TO 1131)
1128) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?
NO 2 (SKIP TO 1131)
REFUSED TO ANSWER/NO ANSWER 3 (SKIP TO 1131)
1129) How old were you the first time you were forced to have sexual intercourse or perform any other sexual acts?
DON'T KNOW 98
1130) Who was the person who forced you at that time?
FORMER HUSBAND/PARTNER 02
CURRENT/FORMER BOYFRIEND 03
FATHER 04
STEP FATHER 05
OTHER RELATIVE 06
IN-LAW 07
OWN FRIEND/ACQUAINTANCE 08
FAMILY FRIEND 09
TEACHER 10
EMPLOYER/SOMEONE AT WORK 13
POLICE/SOLDIER 11
PRIEST/RELIGIOUS LEADER 12
STRANGER 14
OTHER (SPECIFY) __________ 96
1131) CHECK 1106A (a-h), 1117 a-b, 1125 AND 1128:
NOT A SINGLE 'YES' (SKIP TO 1136)
1132) Have you ever tried to seek help to stop (the/these) person(s) from doing this to you again?
NO 2 (SKIP TO 1134)
1133) From whom have you sought help? Anyone else?
RECORD ALL MENTIONED.
HUSBAND/PARTNER'S FAMILY B (SKIP TO 1136)
CURRENT/LAST/LATE HUSBAND/PARTNER C (SKIP TO 1136)
CURRENT/FORMER BOYFRIEND D (SKIP TO 1136)
FRIEND E (SKIP TO 1136)
NEIGHBOR F (SKIP TO 1136)
RELIGIOUS LEADER G (SKIP TO 1136)
DOCTOR/MEDICAL PERSONNEL H (SKIP TO 1136)
POLICE I (SKIP TO 1136)
LAWYER J (SKIP TO 1136)
SOCIAL SERVICE ORGANIZATION K (SKIP TO 1136)
OTHER (SPECIFY) __________ X (SKIP TO 1136)
1134) What was the main reason you did not seek help?
NO USE/FATALISTIC 02
PART OF LIFE 03
AFRAID OF DIVORCE/DESERTION 04
AFRAID OF FURTHER ABUSE 05
AFRAID OF GETTING PERSON ABUSING HER IN TROUBLE 06
EMBARASSED 07
DON'T WANT TO DISGRACE FAMILY 08
OTHER (SPECIFY) ________ 96
1135) Have you ever told anyone else about this?
NO 2
1136) As far as you know, did your father ever beat your mother?
NO 2
DON'T KNOW 8
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERNECE TO THE DOMESTIC VIOLENCE MODULE ONLY.
1137) DID YOU HAVE TO INTERRUPT THE INTERVIEW BECAUSE SOME ADULT WAS TRYING TO LISTEN, OR CAME INTO THE ROOM, OR INTERFERED IN ANY OTHER WAY?
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
YES, MORE THAN ONCE 2
NO 3
1138) INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT COMPLETING THE DOMESTIC VIOLENCE MODULE
SECTION 12. MATERNAL AND ADULT MORTALITY
1201) 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) (SKIP TO 1214)
1203) How many of these births did your mother have before you were born?
1204) What was the name given to your oldest (next oldest) brother or sister?
1205) Is (NAME) male or female?
FEMALE 2
NO 2 (SKIP TO 1208)
DON'T KNOW 8
1208) How many years ago did (NAME) die?
1209) How old was (NAME) when he/she died?
IF MALE, OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT OLDEST
1210) Was (NAME) pregnant when she died?
NO 2
DON'T KNOW 8
1211) Did (NAME) die during childbirth?
NO 2
1212) Did (NAME) die within two months after the end of a pregnancy or childbirth?
NO 2
1213) Was (NAME)'s death due to an accident or violence?
NO 2
IF NO MORE BROTHERS OR SISTERS, GO TO 1214.
MINUTES ___
SECTION 13. ANTHROPOMETRY, ANAEMIA AND HIV TESTING
1301) RECORD WEIGHT IN KILOGRAMS.
1302) RECORD HEIGHT IN CENTIMETERS.
1303) RECORD RESULT FOR ANTHROPOMETRIC MEASURMENT.
REFUSED 2
ABSENT 3
OTHER __________ 6
CONSENT FOR ANAEMIA AND HIV TESTS FOR NEVER-MARRIED YOUTH AGE 15-17
ASK CONSENT FOR THE ANEMIA AND HIV TESTS. FOR NEVER-IN-UNION RESPONDENTS AGE 15-17, YOU MUST FIRST OBTAIN THE CONSENT OF A PARENT OR OTHER ADULT RESPONSIBLE FOR THE YOUTH AT THE TIME OF YOUR VISIT.
AGE 18-49 (SKIP TO 1310)
1305) CHECK 601 AND 602: RESPONDENT NEVER EVER-MARRIED AND NEVER LIVED TOGETHER WITH A MAN
CODE 1 OR CODE 2 IN QUESTION 601 OR IN QUESTION 602 (SKIP TO 1310)
1306) CHECK HOUSEHOLD SCHEDULE (COLUMN 1) AND RECORD LINE NUMBER OF THE PARENT OR OTHER ADULT FROM WHOM CONSENT WILL BE REQUESTED.
IF PARENT OR OTHER RESPONSIBLE ADULT IS NOT IN A HOUSEHOLD MEMBER, WRITE '00'
1307) READ THE ANAEMIA CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.
As part of this survey, we are trying to find out more about anaemia, that is, low blood levels, in men, women, and children.
To know more about this problem in Zimbabwe, we are asking people in this survey all over the country to take a test. For the test, I will take a few drops of blood from (NAME OF ADOLECENT'S) finger.
The test uses clean and completely safe equipment that is used only once and then thrown away. The blood will be tested with new equipment. The result will be given to (NAME) right after the test is done. We will not tell anyone else the end results of the test.
Do you have any questions?
You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of anaemia.
Do you agree that (NAME) may give blood for the anaemia test?
CIRCLE CODE AND SIGN.
FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.
CONSENT OF PARENT/OTHER ADULT FOR ANAEMIA TEST
REFUSED 2
PARENT/ADULT NOT PRESENT 8
1308) READ THE HIV CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.
We are also asking people in this survey to help us find out how big the HIV problem is in Zimbabwe. We would like (NAME OF ADOLESCENT) to take part in the HIV test by allowing us to collect a few more drops of blood from her finger.
This blood will be tested later in the laboratory. We will not keep any name with the blood. Because there will be no name with the blood when it is tested, we will not be able to give (NAME) the result of the test and no one will be able to trace the test back to (NAME).
If (NAME) wants to know her HIV status, I can tell (NAME) where to go to get tested for HIV.
Do you have any questions?
You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of HIV and AIDS.
Do you agree that (NAME) may give blood for the HIV test?
CIRCLE CODE AND SIGN.
FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.
CONSENT OF PARENT/OTHER ADULT FOR HIV TEST
REFUSED 2 (SKIP TO 1310)
PARENT/ADULT NOT PRESENT 8 (SKIP TO 1310)
1309) READ THE BLOOD STORAGE CONSENT STATEMENT TO THE PARENT OR ADULT RESPONSIBLE FOR THE CHILD.
Some of the blood that (NAME) gives may be left after the HIV test. We would like to keep that blood at the laboratory to use for other tests later on.
Again, you can say yes or you can say no; it is up to you. If you say yes, it may help the country later to develop programs to fight HIV/AIDS and other health problems.
Will you agree that we do other tests on (NAME)'s blood later?
CIRCLE CODE AND SIGN
FURTHER DISCUSS STORAGE PROCESS TO PUT RESPONDENT AT EASE.
CONSENT OF PARENT/OTHER ADULT FOR STORAGE OF BLOOD
REFUSED 2
RESPONDENT CONSENT FOR ANAEMIA AND HIV TESTS
ASK CONSENT FOR THE ANEMIA AND HIV TESTS FROM RESPONDENT. FOR NEVER-IN-UNION RESPONDENTS AGE 15-17, ASK FOR CONSENT ONLY IF PARENT OR OTHER ADULT RESPONSIBLE FOR THE YOUTH AT THE TIME OF YOUR VISIT HAS GRANTED CONSENT OR THE PARENT OR OTHER ADULT WAS NOT PRESENT
.
1310) CHECK 1304 AND 1305: RESPONDENT'S AGE AND UNION STATUS
OTHER (SKIP TO 1312)
1311) CHECK 1307: PARENTAL/ADULT CONSENT FOR ANEMIA TEST
PARENT/OTHER ADULT NOT PRESENT (SKIP TO 1312)
PARENT/OTHER ADULT REFUSED (SKIP TO 1313)
1312) READ THE ANAEMIA CONSENT STATEMENT TO THE RESPONDENT.
As part of this survey, we are trying to find out more about anaemia, that is, low blood levels, in men, women, and children.
To know more about this problem in Zimbabwe, we are asking people in this survey all over the country to take a test. For the test, I will take a few drops of blood from your finger.
The test uses clean and completely safe equipment that is used only once and then thrown away. The blood will be tested with new equipment. The result will be given to you right after the test is done. We will not tell anyone else the results of the test.
Do you have any questions?
You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of anaemia.
Do you agree to give blood for the anaemia test?
CIRCLE CODE AND SIGN.
FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.
REFUSED 2
FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.
1313) CHECK 1304 AND 1305: RESPONDENT'S AGE AND UNION STATUS
OTHER (SKIP TO 1315)
1314) CHECK 1308: PARENTAL/ADULT CONSENT FOR HIV TEST
PARENT/OTHER ADULT NOT PRESENT (SKIP TO 1315)
PARENT/OTHER ADULT REFUSED (SKIP TO 1317)
1315) READ THE HIV CONSENT STATEMENT TO THE RESPONDENT.
We are also asking people in this survey to help us find out how big the HIV problem is in Zimbabwe. We would like you to take part in the HIV test by allowing us to collect a few more drops of blood from your finger.
This blood will be tested later on in the laboratory. We will not keep any name with the blood. Because there will be no name with the blood when it is tested, we will not be able to give you the result of the test and no one will be able to trace the test back to you.
If you want to know your HIV status, I can tell you where to go to get tested for HIV.
Do you have any questions?
You can say yes or you can say no; it is up to you. If you say yes, it will help the country to develop programs to fight the problem of HIV and AIDS.
Do you agree to give blood for the HIV test?
CIRCLE CODE AND SIGN.
FURTHER DISCUSS ANAEMIA TESTING PROCESS TO PUT RESPONDENT AT EASE.
REFUSED 2 (SKIP TO 1317)
FURTHER DISCUSS HIV TESTING PROCESS TO PUT RESPONDENT AT EASE.
1316) READ THE BLOOD STORAGE CONSENT STATEMENT TO THE RESPONDENT.
Some of the blood that you give may be left after the HIV test. We would like to keep that blood at the laboratory to use for other tests later on.
Again, you can say yes or you can say no; it is up to you. If you say yes, it may help the country later to develop programs to fight HIV/AIDS and other health problems.
Will you agree that we do other tests on your blood later?
CIRCLE CODE AND SIGN
FURTHER DISCUSS STORAGE PROCESS TO PUT RESPONDENT AT EASE.
REFUSED 2
FURTHER DISCUSS STORAGE PROCESS TO PUT RESPONDENT AT EASE.
1317) May I provide you with an informational brochure about voluntary HIV testing from the nearest facility offering VCT?
PROVIDE BROCHURE TO ALL RESPONDENTS WHO WANT IT.
REFUSED 2
1318) CHECK 1307, 1308, 1312 AND 1315 AND INDICATE THE TESTS FOR WHICH CONSENT HAS BEEN GRANTED.
IF BOTH REFUSED, COMPLETE QUESTIONS 1320 AND 1322.
ANAEMIA TEST ONLY 2
HIV TEST ONLY 3
BOTH REFUSED 4
1319) FOR ALL RESPONDENTS WHERE CONSENT WAS OBTAINED, FOLLOW INSTRUCTIONS FOR PASTING THE BAR CODE LABELS AND TAKING THE DBS SPECIMEN.
PASTE SECOND LABEL ON FILTER PAPER
PASTE THIRD LABEL ON BLOOD TRANSMITTAL FORM
REFUSED 2
ABSENT 3
TECHNICAL PROBLEM 4
OTHER (SPECIFY) __________ 6
REFUSED 2 (SKIP TO 1326)
ABSENT 3 (SKIP TO 1326)
TECHNICAL PROBLEM 4 (SKIP TO 1326)
OTHER (SPECIFY) __________ 6 (SKIP TO 1326)
1323) CHECK 226: RECORD IF RESPONDENT IS CURRENTLY PREGNANT OR NOT.
WOMAN NOT PREGNANT/NOT SURE 2
1324) CHECK 1321: THE CUTOFF POINT IS 9 G/DL FOR PREGNANT WOMEN AND 7 G/DL FOR WOMEN WHO ARE NOT PREGNANT (OR WHO DON'T KNOW IF THEY ARE PREGNANT).
1325) We detect a low level of hemoglobin in your blood. This indicates that you have developed severe anaemia, which is a serious health problem. We would like to inform the clinic at __________ about your condition. This will assist you in obtaining help.
AGREES TO REFERRAL?
NO 2
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT:
COMMENTS ON SPECIFIC QUESTIONS:
ANY OTHER COMMENTS:
DATE: _____
DATE: _____
ONLY ONE CODE SHOULD APPEAR IN ANY BOX. FOR COLUMNS 1 AND 4, ALL MONTHS SHOULD BE FILLED IN.
INFORMATION TO BE CODED FOR EACH COLUMN
P PREGNANCIES
T TERMINATIONS
1 FEMALE STERILIZATION
2 MALE STERILIZATION
3 PILL
4 IUD
5 INJECTION
6 IMPLANT
7 MALE CONDOM
8 FEMALE CONDOM
9 DIAPHRAGM
J FOAM/JELLY
K LACTATIONAL AMENORRHEA METHOD
L RHYTHM METHOD
M WITHDRAWL
X OTHER (SPECIFY) __________
2 RURAL/MUNICIPAL CLINIC
3 RURAL HEALTH CENTER
4 ZNFPC CLINIC
5 MOH MOBILE CLINIC
6 ZNFPC CBD/DEPOT HOLDER
7 OTHER PUBLIC (SPECIFY) __________
8 MISSION FACILITY
A PRIVATE HOSPITAL/CLINIC
B PHARMACY
C PRIVATE DOCTOR
D GENERAL DEALER
E SUPERMARKET
F TUCK SHOP
G SERVICE STATION
H OTHER RETAIL (SPECIFY) __________
J OTHER PRIVATE MEDICAL (SPECIFY) ________
K CHURCH
L FRIEND/RELATIVE
X OTHER (SPECIFY) ________
1 BECAME PREGNANT WHILE USING
2 WANTED TO BECOME PREGNANT
3 HUSBAND/PARTNER DISAPPROVED
4 WANTED MORE EFFECTIVE METHOD
5 HEALTH CONCERNS
6 SIDE EFFECTS
7 LACK OF ACCESS/TOO FAR
8 COSTS TOO MUCH
9 INCONVENIENT TO USE
F FATALISTIC
A DIFFICULT TO GET PREGNANT/MENOPAUSAL
D MARITAL DISSOLUTION/SEPARATION
X OTHER (SPECIFY) ________
Z DON'T KNOW
0 NOT IN UNION
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