[Laos]

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 _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to this woman:
We are from Department of Statistics and Ministry of Health. 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 60 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 greeting at the beginning of the household questionnaire has already been read to this woman, then read the following:
Now I would like to talk to you more about your health and other topics. This interview will take about 60 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

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?

Grade:
Primary 11-15
Lower Sec 21-24
Upper Sec 31-33Post secondary non tertiary 41-43
Tertiary Edu 51-57 98 DK
If less than 1 grade at this level, 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?
Sample sentences for literacy test:1. The child is reading a book.2. The rain came late this year.3. Parents must care for their children.
4. Farming is hard work.

Access to mass media and use of information/communication technology: WT

WT1. Check WB7:
WT2. 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?

WT3. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

WT4. 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?

WT5. Check WB2: Age of respondent 15-24 years?

WT6. Have you ever used a computer?

WT7. Have you used a computer from any location in the last 12 months?

WT8. 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?

WT9. Have you ever used the internet?

WT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
WT11. 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?

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?

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 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)
BH9. If dead: 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)?

CM12. Compare number in CM10 with number of births in the birth history above and check:
CM13. Check BH4: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2009
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.
MN2A. How many months pregnant were you when you first received antenatal care for this pregnancy?

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 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)?

MN11A. During this pregnancy, were you given or did you buy any iron tablets or iron syrup?

MN11B. 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.
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?
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.
Check child mortality module CM13 and record name of last-born child 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 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 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 leaving?
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 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.
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) ____

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

CP0. 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.
Have you ever heard of (method)?

CP0A. Female sterilization?
Probe: Women can have an operation to avoid having any more children.
CP0B. Male sterilization?
Probe: Men can have an operation to avoid having any more children.
CP0C. IUD?
Probe: Women can have a loop or coil placed inside them by a doctor or a nurse.
CP0D. Injectables?
Probe: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months..
CP0E. Implants?
Probe: Women can have one or more small rod) placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
CP0F. Pill?
Probe: Women can take a pill everyday basis to avoid becoming pregnant.
CP0G. Condom?
Probe: Men can put a rubber sheath on their penis before sexual intercourse.
CP0H. Female condom?
Probe: Women can place a sheath in their vagina before sexual intercourse.
CP0I. Rhythm method?
Probe: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant..
CP0J. Withdrawal?
Probe: Men can be careful and pull out before climax.
CP0K. Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

CP1. 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.
CP4. Where did you obtain (current method) the last time?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CP5. Do you know of a place where you can obtain a method of family planning?

CP6. Where is that? Any other place?
Probe to identify the type of source. If unable to determine if public or private sector, write the name of the place.
(Name of place) ____

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?

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?

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?

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?
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 behaviour: SB

Check for the presence of others. Before continuing, ensure privacy.

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 ?years ago? only if last intercourse was one or more years ago. If 12 months or more the 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?
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?

HA12A. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

HA12B. Is a wife justified in refusing to have sex with her husband when she knows he has sex with other women?

HA12C. Check MA1: Currently married or living together with a man as if married
HA12D. Can you say no to your (husband/partner) if you do not want to have sexual intercourse?

HA12E. Could you ask your (husband/partner) to use a condom if you wanted him to?

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 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?

HA27A. Have you heard about other infections that can be transmitted through sexual contact?

HA27B. Check SB1: Has had sexual intercourse (SB1)?
HA27C. Heard about sexually transmitted infections (HA27A)?
HA27D. 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?

HA27E. Sometimes women experience a bad-smelling abnormal genital discharge.
During the last 12 months, have you had a bad-smelling abnormal genital discharge?

HA27F. Sometimes women have a genital sore or ulcer. During the last 12 months, have you had a genital sore or ulcer?

HA27G. Check HA27D, HA27E, and HA27F:
HA27H. The last time you had (problem from HA27D/HA27E/HA27F), did you seek any kind of advice or treatment?

HA27I. Where did you go?
Probe to identify the type of source. If unable to determine whether public or private sector, write the name of the place.
(Name of place) ____

Maternal mortality: MM

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. Please include all your sisters and brothers who are living with you, those who are living elsewhere, and those who have died.

MM1. How many children did your mother give birth to, including yourself?

MM2. Check MM1.
MM3. How many of these births did your mother have before you were born?

MM4. What name was given to your oldest (next oldest) brother or sister? ____

MM5. Is (name) male or female?

MM6. Is (name) still alive?

MM7. How old is (name)? _ _ (Go to [S2 or next sibling])

MM8. How many years ago did (name) die? _ _

MM9. How old was (name) when he/she died?

MM10. Was (name) pregnant when she died?

MM11. Did (name) die during childbirth?

MM12. Did (name) die within two months after the end of a pregnancy or childbirth?

MM13. How many live born children did (name) give birth to during her lifetime? _ _

MM14. If no more siblings, go to WM11

[] Tick here if additional questionnaire used

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

Field editor's observations

Supervisor's observations