Women's Information Panel: WM

This module is to be administered to all women age 15 through 49 (see column HL6 of HH listing). Fill in one form for each eligible woman. Fill in the cluster and household number, and the name and line number of the woman in the space below. Fill in your name, number and the date.

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 _ _ / _ _ / 2006

WM7. Result of women's interview
WM8. In what month and year were you born?

WM9. How old were you at your last birthday?

WM10. Have you ever attended school?

WM11. What is the highest level of school you attended: primary, secondary, or higher?

WM12. What is the last year/class you successfully completed at this level?
(See codes at the end of the questionnaire)
WM13. Check WM11:
WM14. Now I would like you to read this sentence to me.
Show sentences to respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?
WM14A. Can you read in another language other than French and/or English?

WM14B. If so, which ones? Anything else?

Tetanus Toxoid (TT) module: TT

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.

TT0. Have you had a live birth within the last two years?

TT1. Do you have a card or other document with your own immunizations listed?
If a card is presented, use it to assist with answers to the following questions.
TT2. When you were pregnant with your last child, did you receive any injection to prevent him or her from getting tetanus, that is convulsions after birth (an anti-tetanus shot, an injection at the top of the arm or shoulder)?

TT3: If yes: how many times did you receive this anti-tetanus injection during your last pregnancy?

TT4. How many TT doses during last pregnancy were reported in TT3?
TT5. Did you receive any tetanus toxoid injection at any time before your last pregnancy?

TT6. How many times did you receive it?

TT7. In what month and year did you receive the last tetanus injection before that last pregnancy?
Proceed to the next module if the year of injection is known. Otherwise, continue with TT8.
TT8. How many years ago did you receive the last anti-tetanus injection before that last pregnancy?

Maternal and newborn health module: 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 CM12 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN1. In the first two months after your last birth [the birth of name], did you receive a vitamin A dose like this?
Show 200,000 IU capsule or dispenser.
MN1A. If yes, how many capsules did you receive?

MN1B. When did you receive the vitamin A?

MN1C. Where did you receive the vitamin A?

MN2. Did you see anyone for antenatal care for this pregnancy?
If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.
MN3. As part of your antenatal care, were any of the following done at least once?

MN3A. Were you weighed?

MN3B. Was your blood pressure measured?

MN3C. Did you give a urine sample?

MN3D. Did you give a blood sample?

MN4. During any of the antenatal visits for the pregnancy, were you given any information or counseled about AIDS or the AIDS virus?

MN5. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

MN6. I don't want to know the results, but did you get the results of the test?

MN6A. During your pregnancy, did you take medicine to avoid getting malaria?

MN6B. What was the medicine?
Circle all that are mentioned. If the type of medicine cannot be determined, show standard types of antimalarials to the respondent.
Anything else?

MN6C. Check MN6B for the type of medicine taken:
MN6D. How many times did you take the medicine SP/Fansidar during pregnancy?

MN7. Who assisted with the delivery of your last child (name)? Anyone else?
Probe for the type of person assisting and circle all answers given
MN8. Where did you give birth to (name)?
If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
(Name of place) ____

MN9. When you last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN10. Was (name) weighed at birth?

MN11. How much did (name) weigh?
Record weight from health card, if available
MN12. Did you ever breastfeed (name)?

MN13. 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.
MN13A. Did you give [name] yellow-ish breast milk during the first three days of their existence?

Marriage/union module: MA

MA.1 Are you currently married or living together with a man as if married?

MA2. How old was your husband/partner on his last birthday?

MA2A. Besides yourself, does your husband/partner have any other wives?

MA2B. How many other wives does he have?

MA3. Have you ever been married or lived together with a man?

MA4. What is your marital status now: are you widowed, divorced, or separated?

MN4A. Who chose your husband/partner?

MA5. Have you been married or lived with a man only once or more than once?
(even if it is a remarriage or a resumption of living together, with the same person)
MA6. In what month and year did you first marry or start living with a man as if married?

MA7. Check MA6:
MA8. How old were you when you started living with your first husband/partner?

Security of the home module: ST

ST1. Do you feel safe from being evicted from this home?

Contraception module: CP

Now I'm going to change the subject. I would like to talk to you about family planning and your reproductive health. I know this is a difficult topic to discuss, but it is important that we get that information. Of course, all information you provide will be kept strictly confidential. You will never be identified from your answers to these questions.

CP0. I would like to talk to you about family planning and reproductive health.
Have you ever had sex?

CP1. Are you pregnant now?

CP1A. 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?

CP2. Some people 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. Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
CP3A. Certain couples use different means or methods to delay or avoid pregnancy. Have you ever used any method to try to delay a pregnancy or to avoid getting pregnant?

CP3B. What other methods have you used in the past?
Anything else?
Do not make any suggestions. If more than one method is mentioned, circle the codes of the cited methods.
Sexual behaviour module: SB

Check for the presence of others. Before continuing, ensure privacy.
SB0. Check WM9: Age of respondent is between 15 and 24?
SB1. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. The information you supply will remain strictly confidential. How old were you when you first had sexual intercourse (if ever)?

SB2. 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 the answer must be recorded in years.
SB3. The last time you had sexual intercourse was a condom used?

SB4. What is your relationship to the man with whom you last had sexual intercourse?
If man is 'boyfriend' or 'fiancee', ask:
Was your boyfriend/fiancee living with you when you last had sex?
If 'yes', circle 1. If 'no', circle 2.
SB5. How old is this person?
If response is DK, probe:
About how old is this person?

SB6. Have you had sex with any other man in the last 12 months?

SB7. The last time you had sexual intercourse with this other man, was a condom used?

SB8. What is your relationship to this man?
If man is 'boyfriend' or 'fiancee', ask: Was your boyfriend/fiancee living with you when you last had sex? If 'yes', circle 1. If 'no', circle 2.
SB9. How old is this person?
If response is DK, probe: About how old is this person?

SB10. Other than these two men, have you had sex with any other man in the last 12 months?

SB11. In total, with how many different men have you had sex in the last 12 months?
If 97 or more partners, enter 97
HIV/AIDS module: HA

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

HA2. Can people protect themselves from getting infected with the AIDS virus by having one sex partner who is not infected and also has no other partners?

HA3. Can people get infected with 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 reduce their chance of getting infected with the AIDS virus by not having sex at all?

HA7. Can people get the AIDS virus by sharing food with a person who has aids?

HA7A. Can people get the aids virus by getting injections with a needle that was already used by someone else?

HA8. Is it possible for a healthy-looking person to have the AIDS virus?

HA9. Can the AIDS virus be transmitted from a mother to a baby?

HA9A. During pregnancy?

HA9B. During delivery?

HA9C. By breastfeeding?

HA10. If a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

HA11. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

HA12. If a member of your family became infected with the AIDS virus, would you want it to remain a secret?

HA13. If a member of your family became sick with the AIDS virus, would you be willing to care for him or her in your household?

HA14. Check MN5: the woman took the HIV test as part of antenatal care?
HA15. I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?

HA16. I do not want you to tell me the results of the test, but have you been told the results?

HA17. Did you, yourself, ask for the test, was it offered to you and you accepted, or was it required?

HA18. a) At this time, do you know of a place where you can go to get a test to see if you have the AIDS virus?
If they have been tested for HIV as part of antenatal care, ask question (b) and move on to the next module:
b) Other than at the antenatal clinic, do you know of a place where you can go to get a test to see if you have the AIDS virus?

HA18A. Why didn't you take the test to know your HIV status?

HA18B. Would you like to do the test?

Women's participation in development module: WD

This module is for all women between the ages of 15 and 49.

Now I would like to tell you about your activities in the household and in the community.

WD1. What is your type of occupation, i.e. what kind of work do you mainly do?
Let the respondent describe what she does and circle the corresponding code
WD2. Are you doing anything that earns you resources in kind or cash?

WD2A. If yes, what else do you do?

WD3. Do you pay for all or part of your own expenses?

WD3A. If yes, what are the expenses? Anything else?
Emphasize the type of expenditure and circle the corresponding code each time a type of expenditure is spontaneously mentioned. But don't suggest an answer.
WD4. Do you pay for all or part of the household expenses?

WD4A. If yes, what are the expenses? Anything else?
Emphasize the type of expenditure and circle the corresponding code each time a type of expenditure is spontaneously mentioned. But don't suggest an answer.
WD5. Do you have any responsibility in your neighbourhood/village/city?

WD5A. If so, which one?

WD6. Are you the owner of a house that you own exclusively?

WD7. Are you the owner of a piece of undeveloped land that you own exclusively?

WD8. Are you a member of an association:
Read each type of association and circle the code corresponding to the respondent's answer.
If 2 all over go to WD10
WD8A. If code 1 is circled for WD8h), ask which ones?

WD9. Do you have any responsibility in at least one of these associations?

WD10. in the last 24 months have you obtained credit?

WD10A. What was the main use of the last credit obtained?

WD11. What was the origin of the last credit you obtained?

WD12. Daily time allocation in the past week
In the past 7 days, how many hours did you spend on the following activities

A. Production acitivities

B. Domestic activities

C. Socio-cultural and scholarly activities

A. Activities leisure and rest

Total

WD13. Are you the mother of a child under 5 years of age and/or do you have children under 5 years of age in this household?

WD14. Is there another eligible woman living in the household?
WD14A. Is there an eligible child (under 5) in the household whose caregiver was not interviewed?
Collect all the questionnaires from this household and check that the identification numbers are at the top of each cover sheet.

Table for the last class successfully completed
Francophone system:
Number of years of studies:
Anglophone system: