[Moldova]

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 National Centre of Public 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 45 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our survey 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 45 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our survey 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.
WB2A. to what ethnic group do you belong?

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

MT1. Check EB7:
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 15-24 years?
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.
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?

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:
CM12A. Sometimes women have pregnancies that might not end with a live birth. Have you ever had any pregnancy that was miscarried, ended in a stillbirth, or that was terminated early (aborted)?

CM12B. How many miscarriages have you had during your lifetime? By miscarriage, I mean an early and involuntary end of pregnancy within the first 5th month of pregnancy.

CM12C. In how many cases have your pregnancies ended with a stillbirth?
By stillbirth, I mean a birth that took place after the 5th month of pregnancy, but the child did not show any signs of life.

CM12D. And how many early terminations of pregnancy (abortions) have you had during your lifetime? By early termination of pregnancy (abortion), I mean a pregnancy that was voluntarily terminated within the first 5 months of pregnancy.

CM12E. When did your (last) early termination of pregnancy (abortion) take place?
Month and year must be recorded.

CM12F. Check in CM12E when the last abortion took place and if:
CM12G. If the respondent has mentioned more than one early termination (abortion), i.e. CM12D is higher than 1, then ask her for the exact month and year of each mentioned early termination (abortion) that took place during the last 2 years, i.e. since (the month of interviewing) 2010. Write down month and year for each early termination (abortion) in CM12H, starting from the last, and for each recorded early termination (abortion) ask the respondent to tell you how many weeks/months she was pregnant when she had the early termination (abortion) and record this appropriately.

CM12H. What month and year did your (last) early termination (abortion) take place?

CM12I. How many months (weeks) were you pregnant when your pregnancy was aborted?
If the respondent answers in weeks, write down on the appropriate line for weeks, otherwise just record the given months

CM13. Check BH4 in birth history: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2010
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)?

MN1A. Why you did not 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?

MN4A. Have you heard about pills or syrup with iron recommended for women?

MN4B. During this pregnancy have you been given or have you purchased pills or syrup with iron? Show the pills or syrup.

MN4C. During your pregnancy, for how many days did you take iron pills or syrup?
If the answer is not numeric, ask the approximate number of days.
MN4D. Who recommended you to take the iron pills or syrup?

MN4E. Do you think the iron supplements?

MN4F. Have you heard about folic acid?

MN4G. During this pregnancy have you been given or have you purchased pills or syrup with folic acid? Show the pills or syrup.

MN4H. Have you received folic acid during the first three months of your pregnancy?

MN4I. Have you received folic acid during at least 45 days during the first quarter of your pregnancy?

MN4J. Who recommended you to take the folic acid during pregnancy?

MN4K. Do you think the folic acid supplements?

MN4L. During this pregnancy, have you had problems with the daytime vision?

MN4M. During this pregnancy, have you had problems with the night vision?

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 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 the age of five?

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. I would like to talk with you about another subject ? family planning. Couples use different ways or methods in order to postpone or avoid pregnancy.
Have you heard of:

[A] Female sterilization?
Probe: An operation women undertake in order to avoid pregnancy.
[B] Male sterilization?
Probe: An operation men undertake in order to avoid pregnancy.
[C] IUD?
Probe: Women can have a coil placed inside the uterus by a doctor.
[D] Injectables?
Probe: Women can receive injections that have an effect on their hormones and prevent pregnancy over a period of a few months.
[E] Implants?
Probe: Women can have one or more small implants (rods) implanted in their upper arm by a doctor that prevent pregnancy for a number of years.
[F] Pill?
Probe: Women can take pills on an everyday basis to avoid getting pregnant.
[G] Male condom?
Probe: Men can put a rubber cover on their penis before or during sexual intercourse.
[H] Female condom?
Probe: Women can put a cover inside their vagina before sexual intercourse.
[I] Diaphragm?
Probe: Women can insert a soft rubber cup in their vagina to block the sperm from entering their uterus or fallopian tubes.
[J] Foam/jelly?
Probe: Women may use spermicidal products (e.g. foam, jelly, cream) that can kill or prevent the sperm from moving and reaching the egg.
[K] Lactational amenorrhoea method (LAM)?
Probe: Women may use spermicidal products (e.g. foam, jelly, cream) that can kill or prevent the sperm from moving and reaching the egg.
[L] Periodic abstinence/rhythm ?
Probe: The woman can avoid pregnancy by not having sexual intercourse during fertile days in the month, i.e. days she is most likely to get pregnant.
[M] Withdrawal?
Probe: Men can pull out directly before ejaculating.
[N] Emergency/postcoital contraception?
Probe: As an emergency measure, within a period of 3 days, after having unprotected sexual intercourse, women can take special pills to prevent pregnancy.
[X] Have you heard of any other ways or methods that men or women can utilise in order to avoid pregnancy?

CP1. Are you pregnant now?

CP2. Are you currently doing something or using any method to delay or avoid pregnancy?

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. Have you ever done anything or used a method to delay or avoid a pregnancy?

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?
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 HIV/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 HIV/AIDS virus from mosquito bites?

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

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

HA7A. Can a person get HIV/AIDS by hugging or shaking with a person who is infected?

HA8. Can the virus that causes HIV/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 HIV/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 HIV/AIDS virus?

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

HA12. If a member of your family became sick with HIV/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 HIV/AIDS virus from their mother?

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

[C] Getting tested for the HIV/AIDS virus?

Were you:
[D] Offered a test for the HIV/AIDS virus?

HA16. I don't want to know the results, but were you tested for the HIV/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 HIV/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 HIV/AIDS virus since that time you were tested during your pregnancy?

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

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

Tuberculosis: WTB

TB1. Now I would like to ask you about something else. Have you ever heard about a disease named tuberculosis or TBC?

TB2. How do you think is tuberculosis transmitted from one person to another?
Probe: in which ways? Record all the mentioned variants.
TB3. What are the signs or symptoms indicating that a person has TB? Other?
Record all the mentioned variants.
TB4. Can tuberculosis be cured?

TB5. If a member of your family became sick of tuberculosis, would you want it to remain a secret?

Tobacco and alcohol use: TA

TA1. Have you ever tried cigarette smoking, even one or two puffs?

TA2. How old were you when you smoked a whole cigarette for the first time?

TA3. Do you currently smoke cigarettes?

TA4. In the last 24 hours, how many cigarettes did you smoke?

TA5. During the last one month, on how many days did you smoke cigarettes?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
TA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, cigarillos or pipe?

TA7. During the last one month, did you use any smoked tobacco products?

TA8. What type of smoked tobacco product did you use or smoke during the last one month?
Circle all mentioned.
TA9. During the last one month, on how many days did you use smoked tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
TA10. Have you ever tried any form of smokeless tobacco products, such as chewing tobacco, snuff, or dip?

TA11. During the last one month, did you use any smokeless tobacco products?

TA12. What type of smokeless tobacco product did you use during the last one month?
Circle all mentioned.
TA13. During the last one month, on how many days did you use smokeless tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
TA14. Now I would like to ask you some questions about drinking alcohol.
Have you ever drunk alcohol?

TA15. We count one drink of alcohol as one can or bottle of beer, one glass of wine, or 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?

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 "everyday" 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?

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 pointed 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 shown 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 / 2011-2012] school year, did you attend school at any time?

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

LS7. How satisfied are you with your current job?
If the respondent says that he/she does not have a job, circle "0" and continue with the next question. Do not probe to find out how she feels about not having a job, unless she tells you herself.
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 responds that he/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?

WM11. Record the time.
Haemoglobin Level Measurement: HB

Record the haemoglobin level below, taking care to record the measurements on the correct questionnaire for each woman. Check the woman?s name and the line number on the household listing before recording measurements.

HB1. Measurer's name and number:
HB2. Check woman's age:
HB3. Check the line number of the mother/caretaker in HL8 from the household listing form.
HB4. Read the consent message to the mother/caretaker identified in HB3:
Within this survey, we evaluate the anaemia in women and children. Anaemia is a very important health issue that is usually caused by insufficient nutrition, infections or chronic diseases. This survey will help the ministry of health to develop programmes for preventing and treating anaemia.
We would like that you and all children born in 2007 or later participate in anaemia testing by allowing us to take some drops of blood from the finger.
The test uses only disposable instruments that are sterile and absolutely safe.The test will be effected using a special modern equipment and the results will be ready immediately after blood taking. The results will be strictly confidential.
Do you have any questions?
Now I would like to request you to participate in the anaemia test. However, if you decide not to perform this test, it is your right to do so and we will comply with your decision. Please tell me your decision on accepting this test.

HB5. Circle the respective code and ask the mother/caretaker to sign.
HB6. Read the informed consent to the respondent:
Within this survey, we evaluate the anaemia in women and children. Anaemia is a very important health issue that is usually caused by insufficient nutrition, infections or chronic diseases. This survey will help the ministry of health to develop programmes for preventing and treating anaemia.
We would like that you and all children born in 2007 or later participate in anaemia testing by allowing us to take some drops of blood from the finger.
The test uses only disposable instruments that are sterile and absolutely safe.The test will be effected using a special modern equipment and the results will be ready immediately after blood taking. The results will be strictly confidential.
Do you have any questions?
Now I would like to request you to participate in the anaemia test. However, if you decide not to perform this test, it is your right to refuse and we will comply with your decision. Please tell me whether you accept to do this test.

HB7. Circle the respective code and ask the respondent to sign.
HB8. Register the haemoglobin level (g/dl).
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

Response card:

Side 1

Side 2