Republic of Cameroon Peace - Work - Fatherland National Institute of Statistics

Woman's information panel: WM

This questionnaire is to be administered to all women age 15 through 49 (see List of Household Members, 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's name and number:
WM6. Day/month/year of interview _ _ / _ _ / 201 4

If you have not already done so, introduce yourself to the respondent:
We are from the National Institute of Statistics. We are conducting a survey about the health and situation of children, families and households. I would like to talk to you about these subjects. The interview will take about 30 to 45 minutes. All the information we obtain will remain strictly confidential and anonymous.

If greeting at the beginning of the household questionnaire has already been read to this woman, read the following sentence:
Now I would like to talk to you more about your health and other topics. This interview will take about 30 to 45 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I start now?

WM7. Result of woman's interview
WM8. Field editor's name and number:
WM9. Main data entry clerk's 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 kindergarten?

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

WB5. What is the highest grade you completed at that level?
If the first year/grade at this level is not completed, enter "x0".
Codes WB5

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?
[p. 3]
Access to mass media and use of information/communication technology: MT

MT1. Check WB7:
MT2. How often do you read a newspaper or magazine: almost every day, at least once a week, less than once a week or not at all?

MT3. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

MT4. How often do you watch television: would you say that you watch almost every day, at least once a week, less than once a week or not at all?

MT5. Check WB2: Age of respondent?
MT6. Have you ever used a computer?

MT7. Have you used a computer from any location in the last 12 months?

MT8. During the last one month, how often did you use a computer: almost every day, at least once a week, less than once a week or not at all?

MT9. Have you ever used the internet?

MT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
MT10A. Where have you used the internet in the last 12 months?
Anyplace else?
Circle corresponding codes for the different places cited as having used internet.

MT11. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week or not at all?

Fertility/ birth history: CM

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given 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 son or daughter 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 in CM10) live births during your life. Is this correct?

Birth History: BH

Now I would like to record the names of all of your births, whether still alive or not, starting with the first one you had.
Record names of all of the births in BH1. Record twins and triplets on separate line. If there are more than 14 births, use an additional questionnaire.

BH Line No. _ _

BH1. What name was given to your (first/next) baby? ____

BH2. Were any of these births twins?

BH3. Is (name) a boy or a girl?

BH4. In what month and year was (name) born?
Probe: what is his/her birthday?
BH5. Is (name) still alive?

BH6. How old was (name) at his/her last birthday?

BH7. Is (name) living with you?

BH8. Record household line number of child (from HL1 of household questionnaire)
BH9. If deceased: How old was (name) when he/she died?

If "1 year", probe: How many months old was (name)? Record days if less than 1 month; record months if less than 2 years; or years
BH10. Were there any other live births between (name of previous birth) and (name), including any children who died after birth?

BH11. Have you had any live births since the birth of (name of last birth in birth history module)?

CM12A. Compare number in CM10 with number of births in the birth history module above and check:
CM13. Check BH4 in birth history module: Last birth occurred within the last 2 years, that is, since (month of interview) in 2012 (if the month of the interview and the month of the birth are the same, and the year of birth is 2012, consider this as a birth within the last 2 years)If child has died, be tactful by referring to this child by name in the following modules.
Continue with next module.


[p. 10]
Desire for last birth: DB

This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.
Record name of last-born child from CM13 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 would you have wanted to wait?
Record the answer as stated by respondent.
Maternal and newborn health: MN

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

MN1. Did you receive any antenatal care during your pregnancy with (name)?
Probe: this is specifically care in order to monitor the pregnancy and not for other reasons.

MN2. Whom did you see?
Probe: anyone else? Probe for the type of person seen and circle all answers given.
MN2A. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?
Record the answer as stated by respondent.
MN3. How many times did you receive antenatal care during this pregnancy?
Probe to identify the number of times antenatal care was received. If a range is given, record the minimum number of times antenatal care received.
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 own 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)?
If less than 1 year, record '00'.
MN12. Check MN1 for presence of antenatal care during this pregnancy:
MN13. During (any of) your antenatal visit(s) for the pregnancy with (name), 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 pictures of typical anti-malarials to respondent.
MN15. Check MN14 for medicine taken:
MN16. During your pregnancy with (name), how many times did you take SP/Fansidar in total?
Please include all that you obtained either during an antenatal care visit, during a visit to a health facility or from another source.

[p. 13]
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 place. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

[] 30 Private lay hospital

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

MN19A. When was the decision made to have the caesarean section? Was it before or after your labour pains started?

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?
If a card is available, record weight from card.
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?
[p. 15]
Post-natal health checks: PN

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

PN1. Check MN18: Was the child delivered in a health facility?
PN2. Now I would like to ask you some questions about what happened in the hours and days after the birth of (name).
You have said that you gave birth in (name or type of facility in MN18). How long did you stay there after the delivery?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
PN3. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the umbilical cord, or seeing if (name) is ok.
Before you left the (name or type of facility in MN18), did anyone check on (name)'s health?

PN4. And what about checks on your health - I mean, someone assessing your health, for example asking questions about your health or examining you?
Did anyone check on your health before you left (name or type or facility in MN18)?

PN5. Now I would like to talk to you about what happened after you left (name or type of facility in MN18).
Did anyone check on (name)'s health after you left (name or type of facility in MN18)?

PN6. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
PN7. You have already said that (person or persons in MN17) assisted with the birth. Now I would like to talk to you about checks on (name)'s health after delivery, for example examining (name), checking the umbilical cord, or seeing if (name) is ok.
After the delivery was over and before (person or persons in MN17) left you, did (person or persons in MN17) check on (name)'s health?

PN8. And did (person or persons in MN17) check on your health before they left?
By check on your health, I mean assessing your health, for example asking questions about your health or examining you.

PN9. After the (person or persons in MN17) left you, did anyone check on the health of (name)?

PN10. I would like to talk to you about checks on (name)'s health after delivery -- for example, someone examining (name), checking the umbilical cord, or seeing if the baby is ok.
After (name) was delivered, did anyone check on his/her health?

PN11. Did such a check happen only once, or more than once?

PN12A. How long after delivery did that check happen?
PN12B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
[p. 17]
PN13. Who checked on (name)'s health at that time?

PN14. Where did this check take place?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

PN15. Check MN18: Was the child delivered in a health facility?
PN16. After you left (name or type of facility in MN18), did anyone check on your health?

PN17. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
PN18. After the delivery was over and (person or persons in MN17) left, did anyone check on your health?

PN19. After the birth of (name), did anyone check on your health?
I mean someone assessing your health, for example asking questions about your health or examining you.

PN20. Did such a check happen only once, or more than once?

PN21A. How long after delivery did that check happen?
PN21B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
PN22. Who checked on your health at that time?

PN23. Where did this check take place?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

[] 30 Private lay hospital

[p. 19]
Illness symptoms: IS

IS1. Check List of Household Members, columns HL7B and HL15 from household questionnaire:
Is the respondent the mother or guardian 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 a child under the age of 5 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
[p. 20]
Contraception: CP

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

CP2. Some 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?

CP2A. Have you ever done something or used 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.
[p. 21]
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: Currently 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?
Record the answer as stated by respondent.
UN8. Check CP1: Currently pregnant?
[p. 22]
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?
Record the answer using the same unit of time as stated by the respondent.
Attitudes and practices around domestic violence: DV

Check for the presence of others. Before continuing, be certain that you have privacy with the respondent.

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 doesn't respect her in-laws?

[G] If she has friends considered to be unsuitable.

[H] If she doesn't dress the way her husband wants

DV2. Check MAI = 1 or 2 ("Is currently married/in union") or MA5A = 1 ("Was married/in union in the last 12 months") circled?

DV3. In the last 12 months, has your (last) husband/partner done any of the following things often, sometimes, or never:

[A] Said something or done something to humiliate you in front of other people?

[B] Threatened you or someone close to you?

[C] Insulted you or cut you down?

[D] Shoved you, shaken you, or thrown something at you?

[E] Slapped you?

[F] Twisted your arm or pulled your hair?

[G] Hit you with his fist or with something that could hurt you?

[H] Kicked you or dragged you on the ground?

[I] Tried to strangle or burn you?

[J] Threatened you with a knife, a pistol or another weapon?

[K] Forced you physically to have sex with him when you didn't want to?

[L] Forced you to perform sex acts that you didn't want to?

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 he on his last birthday?
MA3. Besides yourself, does your husband/partner have any other wives/women 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?

MA5A. In the last 12 months, were you married or did you live with a man as if you were 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?

MA8A. In what month and year did you marry or start living with a man?
MA8B. In what month and year did you first marry or start living with a man for the first time?

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

Sexual behavior: SB

Check for the presence of other people. Before continuing, ensure you have privacy with the 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 answers in days, weeks or months if less than 12 months (one year). If 12 months (one year) or more, 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
If "boyfriend", then ask: Were you living together as if married? If "yes", circle "2". If "no", circle "3".
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 is 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".
[p. 30]
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?

HA8A. Check HA8 [A], [B] and [C]:

HA8B. Are there special medications that a doctor or nurse can give to a woman with the AIDS virus to reduce the risk of transmission to her baby?

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] Offered a 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 counselling after getting the result.
After you were tested, did you receive counselling?

HA19. Check MN17: Birth delivered by health professional (A, B, C or D)?
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?

Tobacco Use and Exposure: TC

TC1A. Have you ever tried smoking tobacco (cigarette or any form of tobacco), even one or two puffs?

TC1B. How old were you when you smoked tobacco for the first time?
If age 10 or more, record age in completed years.

TC1. Do you currently smoke tobacco every day, less than once a day or not at all?
Probe so that respondent indicates frequency of tobacco consumption.

TC2A. In the past, did you ever smoke tobacco every day?

TC2B. In the past, did you ever smoke tobacco every day, less than once a day or not at all?
If respondent smoked every day and less than once a week in the past, circle code "1" (every day)

TC3. On average, what quantity of the following products do you currently smoke every (day/week)? Also tell me if you smoke one of these products, but not every day (every week).
Check TC1. If response to TC1 is "Every day" (code 1), ask question TC3 by asking the quantity smoked "every day". Otherwise, ask the quantity of products smoked per week.
If the respondent states that she smokes the product but less often than every week, record 888.
If the respondent states that she does not smoke the product at all, record 000.
Check that it is the number of cigarettes and not packs.

[A] Manufactured cigarettes? _ _ _ per day/week

[B] Hand rolled cigarettes? _ _ _ per day/week

[D] Pipes filled with tobacco? _ _ _ per day/week

[E] Cigars, cheroots or cigarillos? _ _ _ per day/week

[F] Number of water pipe sessions? _ _ _ per day/week

[X] Other types of tobacco? _ _ _ per day/week (Specify) ______

TC4. Do you currently use smokeless tobacco every day, but less than one day a week, or not at all?

TC5A. In the past, did you ever use smokeless tobacco every day?

TC5B. In the past, did you ever use smokeless tobacco every day, less than once a day, or not at all?
If respondent used smokeless tobacco every day and less than once a day in the past, circle the code "every day".
TC6. If anyone smokes inside your home: with what frequency? Would you say every day, once a week, once a month, less than once a month or never?

TC7. Do you currently work outside your home?

TC8. Do you generally work inside or outside?

TC9. In the last 30 days, has anyone smoked inside the premises where you work?

TC10A. Check TC1 (code 1 or 2 circled?):

TC10. In the last 12 months, have you tried to stop smoking?

TC11. Have you seen a doctor or other health professional in the last 12 months?

TC12. During a doctor's visit or visit with another health professional in the last 12 months, were you advised to stop smoking?

TC13. In the last 30 days, have you noticed information about the dangers of cigarettes or incentives to stop smoking, in newspapers or magazines?

TC14. In the last 30 days, have you noticed information on the television about the dangers of cigarettes or incentives to stop smoking?

TC15. In the last 30 days, have you noticed health warnings on cigarette packages?

TC15A. Check TC1 (code 1 or 2 circled?):

TC16. In the last 30 days, did the health warnings on the packs of cigarettes make you want to stop smoking?

TC17. In the last 30 days, have you noticed any ads for cigarettes or any promotional signs for cigarettes in sales locations?

TC18. In the last 30 days, have you noticed one of the following kinds of promotions for cigarettes?
Read each question:

[A] Free samples of cigarettes?

[B] Discounts in price of cigarettes?

[C] Discount coupons for cigarettes?

[D] Gifts or other product discounts for purchase of cigarettes?

[E] Clothing or other articles bearing the name or logo of a cigarette brand?

[F] Promotion for cigarettes in the mail?

TC18A. Check TC3 (rubric A 0?):

TC19. The last time that you bought cigarettes/packs of cigarettes or cartons of cigarettes for your personal use, how many did you buy?
Check the unit with the respondent before recording the number.
If DK, record 998

TC19A. If pack: how many cigarettes in the pack? _ _ _ (Go to TC20)

TC19B. If carton: how many cigarettes per carton?_ _ _ (Go to TC20)

TC19C. If other container: how many cigarettes per container?_ _ _

TC20. In total, how much did you spend on this purchase?
If DK, record 99998.

Alcohol Use: TA

TA14. Now I would like to ask you some questions about alcohol consumption, that is, beer, wine, cognac, vodka, whiskey, or rum or other modern or homemade alcohol.
Have you ever drunk alcohol?

TA15. We count one drink of alcohol as one can or bottle of beer, one glass of wine, one shot of cognac, vodka, whiskey, or rum.
How old were you when you had your first drink of alcohol, other than a few sips?

TA15A. In the last 12 months, how frequently have you had at least one drink of alcohol?

TA16. During the last one month, on how many days did you have at least one drink of alcohol?
If respondent did not drink, circle "00". If less than 10 days, record the number of days.
If 10 days or more but less than a month, circle "10". If "every day" or "almost every day", circle "30".
TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have per day?

[p. 37]
TA18. On the days that you drank alcohol in the last month, what kind of alcohol did you primarily have?

TA19. On the days that you drank alcohol in the last month, what dosage did you usually have?

Life satisfaction: LS

LS1. Check WB2: Age of respondent is between 15 and 24?
LS2. I would like to ask you some simple questions on happiness and satisfaction.
First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy?
You can also look at these pictures to help you with your response.
Show side 1 of response card and explain what each symbol represents. Circle the response code selected by the respondent. [Image omitted]

LS3. Now I will ask you questions about your level of satisfaction in different areas.
In each case, we have five possible responses: please tell me, for each question, whether you are very satisfied, somewhat satisfied, neither satisfied nor unsatisfied, somewhat unsatisfied or very unsatisfied.
Again, you can look at these pictures to help you with your response.
Show side 2 of response card and explain what each symbol represents. Circle the response code selected by the respondent, for questions LS3 to LS13. [Image omitted]

How satisfied are you with your family life?

LS4. How satisfied are you with your friendships?

LS5. During the current / 2013-2014 school year, did you attend school at any time?

LS6. How satisfied (are/were) you with your school?

[p. 38]
LS7. How satisfied are you with your current job?

LS8. How satisfied are you with your health?

LS9. How satisfied are you with where you live?
If necessary, explain that the question refers to the living environment, including the neighbourhood and the dwelling.
LS10. How satisfied are you with how people around you generally treat you?

LS11. How satisfied are you with the way you look?

LS12. How satisfied are you with your life, overall?

LS13. How satisfied are you with your current income?
If the respondent says that she does not have any income, circle "0" and continue with the next question. Do not probe to find out how she feels about not having any income, unless she tells you herself.
LS14. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?

LS15. And in one year from now, do you expect that your life will be better, will be more or less the same, or will be worse, overall?

Woman's participation in development: WD

WD1. Now I would like to ask you about your activities in the household and in your community.
What is your occupation, that is, what type of work do you mainly do?
Let the respondent describe what she does and circle the corresponding code.

WD2. Do you do anything that brings you income in kind or in cash?

WD2A. What is the main activity that brings you income in kind or in cash?

WD3. Do you take responsibility for all your personal expenses, part of your personal expenses or none of your personal expenses?

WD3A. What are the personal expenses that you take responsibility for?
Anything else?
Probe for type of expense and circle the corresponding code, each time that a type of expense is spontaneously mentioned. Do not suggest any responses.

WD4. Are you responsible for all of the household expenses, a part of the household expenses or none of the household expenses?

WD4A. What are the kinds of household expenses that you take responsibility for?
Anything else?
Probe into kinds of expenses and circle the corresponding code, each time that a type of expense is spontaneously mentioned. Do not suggest any responses.

WD5. Have you taken on any type of leadership role in your neighborhood/town/city for example, block leader, neighbourhood leader, village leader, city mayor/counselor, deputy or other?

WD6. Are you the owner of any built-up land that belongs only to you? If yes, do you have a land title?

WD7. Are you the owner of any undeveloped land that belongs only to you? If yes, do you have a land title?

WD8. Are you a member of any of the following kinds of associations:
Read each type of association and circle the code corresponding to respondent's answer.

[A] Cultural

[B] Religious

[C] Political

[D] Tontine Investment

[E] Development Committee

[F] Athletic

[G] Social

[H] Professional

[X] Other (Specify) ______

WD8A. Check WD8:

WD9. Do you have a responsibility in this/at least one of these associations?

WD10. In the last 24 months have you obtained any credit?

WD10A. What was the last credit obtained used for?

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

WM11. Record the time.
WM12. Check List of Household Members, columns HL7B and HL15: Is the respondent the mother or guardian of any child age 0-4 living in this household?
Response card:

Side 1

[Images omitted]
Side 2:

[Images omitted]
Interviewer's observations

Field Editor's observations

Supervisor's observations