Central African Republic

Woman's information panel: WM

This questionnaire is to be administered to all women age 15 through 49 (see Household Listing Form, column HL7). A separate questionnaire should be used for each eligible woman.

WM1. Cluster number: _ _ _

WM2. Household number: _ _

WM3. Woman's name:
WM4. Woman's line number: _ _

WM5. Interviewer name and number
WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _

If you have not already done so, introduce yourself to the respondent:
We are from ICASEES. We are working on a project concerned with family health and education. I would like to talk to you about these subjects. The interview will take about 30 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

If introduction at the beginning of the household questionnaire has already been read to this woman, then read the following sentence:

May I start now?

WM7. Result of woman's interview

WM8. Field edited by (name and number):
WM9. Data entry clerk (name and number):
WM10. Record the time.
Woman's Background: WB

WB1. In what month and year were you born?

WB2. How old are you?
Probe: How old were you at your last birthday? Compare and correct WB1 and/or WB2 if inconsistent.
WB3. Have you ever attended school or preschool?

WB4. What is the highest level of school you attended?

WB5. What is the highest grade you completed at that level?
If less than 1 year/grade, enter "00"
WB6. Check WB4:
WB7. Now I would like you to read this sentence to me.
Show sentence on the card to the respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?
WB8. What is your occupation or profession?

Child mortality: CM

All questions refer only to live births.

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

CM2. What was the date of your first birth?
I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.
Skip to CM4 only if year of birth is given. Otherwise, continue with CM3.
CM3. How many years ago did you have your first birth?

CM4. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM5. How many sons live with you? How many daughters live with you?
If none, record '00'.
CM6. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

CM7. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?
If none, record '00'.
CM8. Have you ever given birth to a boy or girl who was born alive but later died?
If "no" probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life -- even if he or she lived only a few minutes or hours?
CM9. How many boys have died? How many girls have died?
If none, record '00'.
CM10. Sum answers to CM5, CM7, and CM9.
CM11. Just to make sure that I have this right, you have had in total (total number) births during your life. Is this correct?

CM12: Of these (total number) births you have had, when did you deliver the last one (even if he or she has died)?
Month and year must be recorded.
CM13. Check CM12: Did the woman have her last birth within the last 2 years, that is, since (day and month of interview) in 2008.
If child has died, take special care when referring to this child by name in the following modules.
Continue with the next module.


Desire for last birth: DB

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

DB1. When you got pregnant with (name), did you want to get pregnant at that time?

DB2. Did you want to have a baby later on, or did you not want any (more) children?

DB3. How much longer did you want to wait?

Maternal and newborn health: MN

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN1. Did you see anyone for antenatal care during your pregnancy with (name)?

MN2. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and circle all answers given.
MN3. How many times did you receive antenatal care during this pregnancy?

MN4. As part of your antenatal care during this pregnancy, were any of the following done at least once:

[A] Was your blood pressure measured?

[B] Did you give a urine sample?

[C] Did you give a blood sample?

MN5. Do you have a card or other document with your immunizations listed?
May I see it please?
If a card is presented, use it to assist with answers to the following questions.
MN6. When you were pregnant with (name), did you receive any injection in the arm or shoulder to prevent the baby from getting tetanus, that is convulsions after birth?

MN7. How many times did you receive this tetanus injection during your pregnancy with (name)?
If 7 or more times, record '7'.
MN8. How many tetanus injections during last pregnancy were reported in MN7?
MN9. Did you receive any tetanus injection at any time before your pregnancy with (name), either to protect yourself or another baby?

MN10. How many times did you receive a tetanus injection before your pregnancy with (name)?
If 7 or more times, record '7'.
MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?

MN12. Check MN1 to see if the woman received antenatal care during this pregnancy:
MN13. During any of these antenatal visits for the pregnancy, did you take any medicine in order to prevent you from getting malaria?

MN14. Which medicines did you take to prevent malaria?
Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent.
MN15. Check MN14 for medicine taken:
MN16. During this pregnancy, how many times did you take SP/Fansidar?

MN17. Who assisted with the delivery of (name)?
Probe: Anyone else? Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery.
MN18. Where did you give birth to (name)?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?

MN20. When (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN21. Was (name) weighed at birth?

MN22. How much did (name) weigh?
Record weight from health card, if available.
MN23. Has your menstrual period returned since the birth of (name)?

MN24. Did you ever breastfeed (name)?

MN25. 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.
MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk?

MN27. What was (name) given to drink?
Probe: Anything else? Record all liquids mentioned.
Illness Symptoms: IS

IS1. Check Household Listing, column HL9
Is the respondent the mother or caretaker of any child under age 5?

IS2. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away?
Probe: Any other symptoms? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do not prompt with any suggestions
Contraception: CP

CP1. I would like to talk with you about another subject -- family planning.
Are you pregnant now?

CP2. Couples use various ways or methods to delay or avoid a pregnancy. Are you currently doing something or using any method to delay or avoid getting pregnant?

CP3. What are you doing to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
Unmet need: UN

UN1. Check CP1. Currently pregnant?
UN2. Now I would like to talk to you about your current pregnancy. When you got pregnant, did you want to get pregnant at that time?

UN3. Did you want to have a baby later on or did you not want any (more) children?

UN4. Now I would like to ask some questions about the future. After the child you are now expecting, would you like to have another child, or would you prefer not to have any more children?

UN5. Check CP3. Using "female sterilization"?
UN6. Now I would like to ask you some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

UN7. How long would you like to wait before the birth of (a/another) child?

UN8. Check CP1. Currently pregnant?
UN9. Check CP2. Currently using a method?
UN10. Do you think you are physically able to get pregnant at this time?

UN11. Why do you think you are not physically able to get pregnant?

UN12. Check UN11. "Never menstruated" mentioned?
UN13. When did your last menstrual period start?

Female genital mutilation/cutting: FG

FG1. Have you ever heard of female circumcision?

FG2. In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

FG3. Have you yourself been circumcised?

FG4. Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?

FG5. Was the genital area just nicked without removing anything?

FG6. Was the genital area sewn closed?
If necessary, probe: Was the genital area sealed?
FG7. How old were you when you were circumcised?
If the respondent does not know the exact age, probe to get an estimate
FG8. Who performed the circumcision?

FG9. Check CM5 for Number of daughters at home and CM7 for Number of daughters elsewhere, and sum the answers here
FG10. Just to make sure that I have this right, you have (total number in FG9) living daughters. Is this correct?

FG11. Ask the respondent to tell you the name(s) of her daughter(s), beginning with the youngest daughter (if more than one daughter). Write down the name of each daughter in FG12. Then, ask questions FG13 to FG20 for each daughter at a time.
The total number of daughters in FG12 should be equal to the number in FG9.
If more than 4 daughters, use an additional questionnaire.

FG12. Name of Daughter ____

FG12A. Line number from household listing
If not living in household, record '00'.
FG13. How old is (name)?

FG14. Is (name) younger than 15 years of age?

FG15. Is (name) circumcised?

FG16. How old was (name) when this occurred?
If the respondent does not know the age, probe to get an estimate.
FG17. Now I would like to ask you what was done to (name) at that time.
Was any flesh removed from the genital area?

FG18. Was her genital area just nicked without removing anything?

FG19. Was her genital area sewn closed?
If necessary, probe: Was the genital area sealed?
FG20. Who performed the circumcision?

FG21.

[] Tick here if additional questionnaire used
FG22. Do you think this practice should be continued or should it be discontinued?

Attitudes toward domestic violence: DV

DV1. 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:

[A] If she goes out without telling him?

[B] If she neglects the children?

[C] If she argues with him?

[D] If she refuses to have sex with him?

[E] If she burns the food?

[F] If she cheats on him with another man?

Marriage/union: MA

MA1. Are you currently married or living together with a man as if married?

MA2. How old is your husband/partner?
Probe: how old was your husband/partner on his last birthday?
MA3. Besides yourself, does your husband/partner have any other wives or partners or does he live with other women as if married?

MA4. How many other wives or partners does he have?

MA5. Have you ever been married or lived together with a man as if married?

MA6. What is your marital status now: are you widowed, divorced or separated?

MA7. Have you been married or lived with a man only once or more than once?

MA8. In what month and year did you first marry or start living with a man as if married?

MA9. How old were you when you started living with your first husband/partner?

Sexual behavior: SB

Check for the presence of others. Before continuing, do everything possible to ensure privacy with respondent.

SB1. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
The information you supply will remain strictly confidential.
How old were you when you had sexual intercourse for the very first time?

SB2. The first time you had sexual intercourse, was a condom used?

SB3. When was the last time you had sexual intercourse?
Record in "number of years" only if last sexual relations took place a year or more ago. If more than 12 months (one year), answer must be recorded in years.
SB4. The last time you had sexual intercourse, was a condom used?

SB5. What was your relationship to this person with whom you last had sexual intercourse?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse.

SB6. Check MA1:
SB7. How old is this person?
If response is DK, probe: About how old is this person?
SB8. Have you had sexual intercourse with any other person in the last 12 months?

SB9. The last time you had sexual intercourse with this other person, was a condom used?

SB10. What was your relationship to this person?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If 'boyfriend' then ask: Were you living together as if married? If 'yes', circle '2'. If 'no', circle '3'.
SB11. Check MA1 and MA7:
SB12. How old is this person?
If response is DK, probe: About how old is this person?
SB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months?

SB14. In total, with how many different people have you had sexual intercourse in the last 12 months?

SB15. In total, with how many different people have you had sexual intercourse in your lifetime?
If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write '95'.
HIV/AIDS: HA

HA1. Now I would like to talk with you about something else.
Have you ever heard of an illness called AIDS?

HA2. Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

HA3. Can people get the AIDS virus because of witchcraft or other supernatural means?

HA4. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

HA5. Can people get the AIDS virus from mosquito bites?

HA6. Can people get the aids virus by sharing food with a person who has the AIDS virus?

HA7. Is it possible for a healthy-looking person to have the AIDS virus?

HA8. Can the virus that causes AIDS be transmitted from a mother to her baby:

[A] During pregnancy?

[B] During delivery?

[C] By breastfeeding?

HA9. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

HA10. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

HA11. If a member of your family got infected with the AIDS virus, would you want it to remain a secret?

HA12. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

HA13. Check CM13: Any live birth in last 2 years?
HA14. Check MN1: Received antenatal care?
HA15. During any of the antenatal visits for your pregnancy with (name),

Were you given any information about:

[A] Babies getting the AIDS virus from their mother?

[B] Things that you can do to prevent getting the AIDS virus?

[C] Getting tested for the AIDS virus?

Were you:
[D] Asked to test for the AIDS virus?

HA16. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

HA17. I don't want to know the results, but did you get the results of the test?

HA18. Regardless of the result, all women who are tested are supposed to receive counseling after getting the result. After you were tested, did you receive counselling?

HA19. Check MN17: Birth delivered by health professional (A, B or C)?
HA20. I don't want to know the results, but were you tested for the AIDS virus between the time you went for delivery but before the baby was born?

HA21. I don't want to know the results, but did you get the results of the test?

HA22. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

HA23. When was the most recent time you were tested for the AIDS virus?

HA24. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?

HA25. When was the most recent time you were tested?

HA26. I don't want to know the results, but did you get the results of the test?

HA27. Do you know of a place where people can go to get tested for the AIDS virus?

WM11. Record the time.
WM12. Is the respondent the mother or caretaker of any child age 0-4 living in this household?
Check Household Listing Form, column HL9.

Interviewer's observations

Field editor's observations

Supervisor's observations