[p. 1]

Name and year of survey


Woman's information panel: WM

WM1. Cluster number: _ _ _

WM2. Household number: _ _

WM3. Woman's name and line number:
WM4. Supervisor's name and number:
WM5. Interviewer's name and number:
WM6. Day/month/year of interview:
Check woman's age in HL6 in list of household members, household questionnaire: If age 15-17, verify in HH33 that adult consent for interview is obtained or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in WM17.

WM7. Record the time:
WM8. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?

WM9A. Hello, my name is (your name). We are from [National Statistical Office]. We are conducting a survey about the situation of children, families and households. I would like to talk to you about your health and other topics. This interview usually takes about [number minutes]. We are also interviewing mothers about their children. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?

WM9B. Now I would like to talk to you about your health and other topics in more detail. This interview will take about number minutes. Again, all the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?


WM17. Result of woman's interview.
Discuss any result not completed with Supervisor.

[p. 2]
Woman's background: WB

WB1. Check the respondent's line number (WM3) in woman's information panel and the respondent to the household questionnaire (HH47):
WB2. Check ED5 in education module in the household questionnaire for this respondent: Highest level of school attended:
WB3. In what month and year were you born?

WB4. How old are you?
Probe: How old were you at your last birthday? If responses to WB3 and WB4 are inconsistent, probe further and correct. Age must be recorded.
WB5. Have you ever attended school or any early childhood education programme?

WB6. What is the highest level and grade or year of school you have attended?

WB7. Did you complete that (grade/year)?

WB8. Check WB4: Age of respondent:
WB9. At any time during the current school year did you attend school?

WB10. During this current school year, which level and grade or year are you attending?

WB11. At any time during the previous school year did you attend school?

WB12. During that previous school year, which level and grade or year did you attend?

WB13. Check WB6: Highest level of school attended:
[p. 3]
WB14. 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?
WB15. How long have you been continuously living in (name of current city, town or village of residence)?
If less than one year, record '00' years.
WB16. Just before you moved here, did you live in a city, in a town, or in a rural area?
Probe to identify the type of place. If unable to determine whether the place is a city, a town or a rural area, write the name of the place and then temporarily record '9' until you learn the appropriate category for the response.
(Name of place) ____

WB17. Before you moved here, in which region did you live in?

WB18. Are you covered by any health insurance?

WB19. What type of health insurance are you covered by?
Record all mentioned.
[p. 4]
Mass media and ICT: MT

MT1. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
MT2. Do you listen to the radio at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2
MT3. Do you watch television at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2
MT4. Have you ever used a computer or a tablet from any location?

MT5. During the last 3 months, did you use a computer or a tablet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happened almost every day? If 'Yes' record 3, if 'No' record 2
[p. 5]
MT6. During the last 3 months, did you:










MT7. Check MT6[C]: Is 'Yes' recorded?
MT8. Check MT6[F]: Is 'Yes' recorded?
MT9. Have you ever used the internet from any location and any device?

MT10. During the last 3 months, did you use the internet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
MT11. Do you own a mobile phone?

MT12. During the last 3 months, did you use a mobile telephone at least once a week, less than once a week or not at all?
Probe if necessary: I mean have you communicated with someone using a mobile phone. If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
[p. 6]
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?
This module and the birth history should only include children born alive. Any stillbirths should not be included in response to any question.
CM2. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM3. How many sons live with you?
If none, record '00'.
CM4. How many daughters live with you?
If none, record '00'.
CM5. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

CM6. How many sons are alive but do not live with you?
If none, record '00'.
CM7. 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 any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?

CM9. How many boys have died?
If none, record '00'.
CM10. How many girls have died?
If none, record '00'.
CM11. Sum answers to CM3, CM4, CM6, CM7, CM9 and CM10.
CM12. Just to make sure that I have this right, you have had in total (total number in CM11) births during your life. Is this correct?

CM13. Check responses to CM1-CM10 and make corrections as necessary until response in CM12 is 'Yes'.

[p. 7]
CM14. Check CM11: How many live births?
[p. 8]
Fertility/birth history: BH

BH0. 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 lines.

BH0. BH line number _ _

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

BH2. Were any of these births twins?

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

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

BH6. How old was (name of birth) at (his/her) last birthday?
Record age in completed years.
BH7. Is (name of birth) living with you?

BH8. Record household line number of child (from HL1)
Record '00' if child is not listed.
BH9. How old was (name of birth) when (he/she) died?
If '1 year', probe: How many months old was (name of birth)? 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 of birth), including any children who died after birth?

[p. 9]
BH11. Have you had any live births since the birth of (name of last birth listed)?

[p. 10]
CM15. Compare number in CM11 with number of births listed in the birth history above and check:
CM16. Probe and reconcile responses in the birth history until response in CM12 is 'Yes'.

CM17. Check BH4: Last birth occurred within the last 2 years, that is, since (month of interview) in (year of interview minus 2)?
If the month of interview and the month of birth are the same, and the year of birth is (year of interview minus 2), consider this as a birth within the last 2 years.
CM18. Copy name of the last child listed in BH1.
If the child has died, take special care when referring to this child by name in the following modules.
[p. 11]
Desire for last birth: DB

DB1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____

DB2. When you got pregnant with (name), did you want to get pregnant at that time?

DB3. Check CM11: Number of births:
DB4A. Did you want to have a baby later on, or did you not want any children?
DB4B. Did you want to have a baby later on, or did you not want any more children?

[p. 12]
Maternal and newborn health: MN

MN1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____

MN2. Did you see anyone for antenatal care during your pregnancy with (name)?

MN3. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and record all answers given.
MN4. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?
Record the answer as stated by respondent. If "9 months" or later, record 9.
MN5. 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.
MN6. As part of your antenatal care during this pregnancy, were any of the following done at least once:




MN7. Do you have a card or other document with your own immunisations listed?
If yes, ask: May I see it please? If a card is presented, use it to assist with answers to the following questions.
MN8. 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?

[p. 13]
MN9. How many times did you receive this tetanus injection during your pregnancy with (name)?

MN10. Check MN9: How many tetanus injections during last pregnancy were reported?
MN11. At any time before your pregnancy with (name), did you receive any tetanus injection either to protect yourself or another baby?
Include DTP (Tetanus) vaccinations received as a child if mentioned.
MN12. Before your pregnancy with (name), how many times did you receive a tetanus injection?
If 7 or more times, record '7'. Include DTP (Tetanus) vaccinations received as a child if mentioned.
MN13. Check MN12: How many tetanus injections before last pregnancy were reported?
MN14A. How many years ago did you receive that tetanus injection
MN14B. How many years ago did you receive the last of those tetanus injections?
The reference is to the last injection received prior to this pregnancy, as recorded in MN12. If less than 1 year, record '00'.
MN16. During the pregnancy with (name), did you take SP/Fansidar to keep you from getting malaria?

MN17. How many times did you take SP/Fansidar during your pregnancy with (name)?

MN18. Did you get the SP/Fansidar during an antenatal care visit, during another visit to a health facility or at another source?

[p. 14]
MN19. Who assisted with the delivery of (name)?
Probe: Anyone else? Probe for the type of person assisting and record all answers given.
MN20. 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 and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place) ____

MN21. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?

MN22. When was the decision made to have the caesarean section?
Probe if necessary: Was it before or after your labour pains started?
[p. 15]
MN23. Immediately after the birth, was (name) put directly on the bare skin of your chest?
If necessary, show the picture of skin-to-skin position. [Image omitted]
MN24. Before being placed on the bare skin of your chest, was the baby wrapped up?

MN25. Was (name) dried or wiped soon after birth?

MN26. How long after the birth was (name) bathed for the first time?
If "immediately" or less than 1 hour, record '000'. If less than 24 hours, record hours. If "1 day" or "next day", probe: About how many hours after the delivery? If "24 hours", probe to ensure best estimate of less than 24 hours or 1 day. If 24 hours or more, record days.
MN27. Check MN20: Was the child delivered in a health facility?
MN28. What was used to cut the cord?

MN29. Was the instrument used to cut the cord boiled or sterilised prior to use?

MN30. After the cord was cut and until it fell off, was anything applied to the cord?

[p. 16]
MN31. What was applied to the cord?
Probe: Anything else?
MN32. When (name) was born, was (he/she) very large, larger than average, average, smaller than average, or very small?

MN33. Was (name) weighed at birth?

MN34. How much did (name) weigh?
If a card is available, record weight from card.
MN35. Has your menstrual period returned since the birth of (name)?

MN36. Did you ever breastfeed (name)?

MN37. 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.
MN38. In the first three days after delivery, was (name) given anything to drink other than breast milk?

[p. 17]
MN39A. What was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' is not a valid response and response category Y cannot be recorded.
MN39B. In the first three days after delivery, what was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' (category Y) can only be recorded if no other response category is recorded.
[p. 18]
Post-natal health checks: PN

PN1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____

PN2. Check MN20: Was the child delivered in a health facility?
PN3. 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 MN20). 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.
PN4. 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 MN20), did anyone check on (name)'s health?

PN5. 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 MN20)?

PN6. Now I would like to talk to you about what happened after you left (name or type of facility in MN20).
Did anyone check on (name)'s health after you left (name or type of facility in MN20)?

PN7. Check MN19: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
[p. 19]
PN8. You have already said that (person or persons in MN19) 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 MN19) left you, did (person or persons in MN19) check on (name)'s health?

PN9. And did (person or persons in MN19) check on your health before leaving, for example asking questions about your health or examining you?

PN10. After the (person or persons in MN19) left you, did anyone check on the health of (name)?

PN11. 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?

PN12. Did such a check happen only once, or more than once?

PN13A. How long after delivery did that check happen?
PN13B. 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.
PN14. Who checked on (name)'s health at that time?

[p. 20]
PN15. Where did this check take place?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place) ____

PN16. Check MN20: Was the child delivered in a health facility?
PN17. After you left (name or type of facility in MN20), did anyone check on your health?

PN18. Check MN19: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
PN19. After the delivery was over and (person or persons in MN19) left, did anyone check on your health?

PN20. After the birth of (name), did anyone check on your health, for example asking questions about your health or examining you?

PN21. Did such a check happen only once, or more than once?

PN22A. How long after delivery did that check happen?
PN22B. 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. 21]
PN23. Who checked on your health at that time?

PN24. Where did this check take place?
Probe to identify the type of place.
If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place)____

PN25. During the first two days after birth, did any health care provider do any of the following either at home or at a facility:




PN26. Check MN36: Was child ever breastfed?
PN27. Observe (name)'s breastfeeding?

PN28. Check MN33: Was child weighed at birth?
[p. 22]
PN29A. You mentioned that (name) was weighed at birth. After that, was (name) weighed again by a health care provider within two days?
PN29B. You mentioned that (name) was not weighed at birth. Was (name) weighed at all by a health care provider within two days after birth?
PN29C. You mentioned that you do not know if (name) was weighed at birth. Was (name) weighed at all by a health care provider within two days after birth?

PN30. During the first two days after (name)'s birth, did any health care provider give you information on the symptoms that require you to take your sick child to a health facility for care?

[p. 23]
Contraception: CP

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

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

CP3. Have you ever done something or used any method to delay or avoid getting pregnant?

CP4. What are you doing to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, record each one.
[p. 24]
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. Check CM11: Any births?
UN4A. Did you want to have a baby later on or did you not want any children?
UN4B. Did you want to have a baby later on or did you not want any more children?

UN5. 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?

UN6. Check CP4: Currently using 'Female sterilization'?
UN7. 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?

UN8. How long would you like to wait before the birth of (a/another) child?
Record the answer as stated by respondent.
UN9. Check CP1: Currently pregnant?
UN10. Check CP2: Currently using a method?
UN11. Do you think you are physically able to get pregnant at this time?

[p. 25]
UN12. Why do you think you are not physically able to get pregnant?

UN13. Check UN12: 'Never menstruated' mentioned?
UN14. When did your last menstrual period start?
Record the answer using the same unit stated by the respondent. If '1 year', probe: How many months ago?
UN15. Check UN14: Was the last menstrual period within last year?
UN16. Due to your last menstruation, were there any social activities, school or work days that you did not attend?

UN17. During your last menstrual period were you able to wash and change in privacy while at home?

UN18. Did you use any materials such as sanitary pads, tampons or cloth?

UN19. Were the materials reusable?

[p. 26]
Female genital mutilation: FG

FG1. Have you ever heard of female circumcision?

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

FG3. Have you yourself ever been circumcised?

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

FG5. Was the genital area just nicked without removing any flesh?

FG6. Was the genital area sewn closed?
If necessary, probe: Was it sealed?

FG7. How old were you when you were circumcised?
If the respondent does not know the exact age, probe to get an estimate.
FG8. Who performed the circumcision?

FG9. Sum CM4 for Number of daughters at home and CM7 for Number of daughters elsewhere:
FG10. Just to make sure that I have this right, you have (total number in FG9) living daughters. Is this correct?

FG11. Check responses to CM1-CM11 and make corrections as necessary until response in FG10 is 'Yes'.

FG12. Check FG9: Number of living daughters?
[p. 27]
FG13. Ask the respondent to tell you the name(s) of her daughter(s), beginning with the youngest daughter (if more than one daughter). Write down the name of each daughter in FG14. Then, ask questions FG15 to FG22 for each daughter at a time.
The total number of daughters in FG14 should be equal to the number in FG9.
If more than 4 daughters, use additional questionnaires.

FG14. Name of daughter ____

FG15. How old is (name)?

FG16. Is (name) younger than 15 years of age?

FG17. Is (name) circumcised?

FG18. How old was (name) when this occurred?
If the respondent does not know the age, probe to get an estimate.

FG19. Now I would like to ask you what was done to (name) at that time.
Was any flesh removed from the genital area?

FG20. Was her genital area just nicked without removing any flesh?

FG21. Was her genital area sewn closed?
If necessary, probe: Was it sealed?

FG22. Who performed the circumcision?

[p, 28]
FG23. Is there another daughter?

FG24. Do you think this practice should be continued or should it be discontinued?

[p. 29]
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:






[p. 30]
Victimisation: VT

VT1. Check for the presence of others. Before continuing, ensure privacy. Now I would like to ask you some questions about crimes in which you personally were the victim.
Let me assure you again that your answers are completely confidential and will not be told to anyone. In the last three years, that is since (month of interview) (year of interview minus 3), has anyone taken or tried taking something from you, by using force or threatening to use force?
Include only incidents in which the respondent was personally the victim and exclude incidents experienced only by other members of the household. If necessary, help the respondent to establish the recall period and make sure that you allow adequate time for the recall. You may reassure: It can be difficult to remember this sort of incidents, so please take your time while you think about your answers.

VT2. Did this last happen during the last 12 months, that is, since (month of interview) (year of interview minus 1)?

VT3. How many times did this happen in the last 12 months?
If 'DK/Don't remember', probe: Did it happen once, twice, or at least three times?
VT4. Check VT3: One or more times?
VT5A. When this happened, was anything stolen from you?
VT5B. The last time this happened, was anything stolen from you?

VT6. Did the person(s) have a weapon?

VT7. Was a knife, a gun or something else used as a weapon?
Record all that apply.
VT8. Did you or anyone else report the incident to the police?
If 'Yes', probe: Was the incident reported by you or someone else?
[p. 31]
VT9A. Apart from the incident(s) just covered, have you in the last three years, that is since (month of interview) (year of interview minus 3), been physically attacked?
VT9B. In the same period of the last three years, that is since (month of interview) (year of interview minus 3), have you been physically attacked?
If 'No', probe: An attack can happen at home or any place outside of the home, such as in other homes, in the street, at school, on public transport, public restaurants, or at your workplace.
Include only incidents in which the respondent was personally the victim and exclude incidents experienced only by other members of the household. Exclude incidents where the intention was to take something from the respondent, which should be recorded under VT1.
VT10. Did this last happen during the last 12 months, that is, since (month of interview) (year of interview minus 1)?

VT11. How many times did this happen in the last 12 months?
If 'DK/Don't remember', probe: Did it happen once, twice, or at least three times?
VT12A. Where did this happen?
VT12B. Where did this happen the last time?

VT13. How many people were involved in committing the offence?
If 'DK/Don't remember', probe: Was it one, two, or at least three people?
[p. 32]
VT14A. At the time of the incident, did you recognize the person?
VT14B. At the time of the incident, did you recognize at least one of the persons?

VT17. Did the person(s) have a weapon?

VT18. Was a knife, a gun or something else used as a weapon?
Record all that apply.
VT19. Did you or anyone else report the incident to the police?
If 'Yes', probe: Was the incident reported by you or someone else?
VT20. How safe do you feel walking alone in your neighbourhood after dark?

VT21. How safe do you feel when you are at home alone after dark?

VT22. In the past 12 months, have you personally felt discriminated against or harassed on the basis of the following grounds?








[p. 33]
Marriage/union: MA

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

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

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

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

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

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

MA8A. In what month and year did you start living with your (husband/partner)?
MA8B. In what month and year did you start living with your first (husband/partner)?

MA9. Check MA8A/B: Is 'DK year' recorded?
MA10. Check MA7: In union only once?
MA11A. How old were you when you started living with your (husband/partner)?
MA11B. How old were you when you started living with your first (husband/partner)?

[p. 34]
Adult functioning: AF

AF1. Check WB4: Age of respondent?
AF2. Do you use glasses or contact lenses?
Include the use of glasses for reading.
AF3. Do you use a hearing aid?

AF4. I will now ask you about difficulties you may have doing a number of different activities. For each activity there are four possible answers: Please tell me if you have: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty or 4) that you cannot do the activity at all.
Repeat the categories during the individual questions whenever the respondent does not use an answer category:
Remember, the four possible answers are: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that you cannot do the activity at all.

AF5. Check AF2: Respondent uses glasses or contact lenses?
AF6A. When using your glasses or contact lenses, do you have difficulty seeing?
AF6B. Do you have difficulty seeing?

AF7. Check AF3: Respondent uses a hearing aid?
AF8A. When using your hearing aid(s), do you have difficulty hearing?
AF8B. Do you have difficulty hearing?

AF9. Do you have difficulty walking or climbing steps?

AF10. Do you have difficulty remembering or concentrating?

AF11. Do you have difficulty with self-care, such as washing all over or dressing?

AF12. Using your usual language, do you have difficulty communicating, for example understanding or being understood?

[p. 35]
Sexual behavior: SB

SB1. Check for the presence of others. Before continuing, make every effort to ensure privacy. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
How old were you when you had sexual intercourse for the very first time?

SB2. I would like to ask you about your recent sexual activity.
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.
SB3. The last time you had sexual intercourse, was a condom used?

SB4. 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', record '2'. If 'No', record '3'.
SB5. Check MA1: Currently married or living with a partner?

SB6. How old is this person?
If response is 'DK', probe: About how old is this person?
SB7. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

SB8. The last time you had sexual intercourse with another person, was a condom used?

[p. 36]
SB9. 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', record '2'. If 'No', record '3'.
SB10. Check MA1: Currently married or living with a partner?
SB11. Check MA7: Married or living with a partner only once?
SB12. How old is this person?
If response is 'DK', probe: About how old is this person?
[p. 37]
HIV/AIDS: HA

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

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

HA3. Can people get HIV from mosquito bites?

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

HA5. Can people get HIV by sharing food with a person who has HIV?

HA6. Can people get HIV because of witchcraft or other supernatural means?

HA7. Is it possible for a healthy-looking person to have HIV?

HA8. Can HIV be transmitted from a mother to her baby:




HA9. Check HA8[A], [B] and [C]: At least one 'Yes' recorded?
HA10. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

HA11. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____

HA12. Check MN2: Was antenatal care received?
[p. 38]
HA13. During any of the antenatal visits for your pregnancy with (name), were you given any information about:





HA14. I don't want to know the results, but were you tested for HIV as part of your antenatal care?

HA15. I don't want to know the results, but did you get the results of the test?

HA16. After you received the result, were you given any health information or counselling related to HIV?

HA17. Check MN20: Was the child delivered in a health facility?
HA18. Between the time you went for delivery but before the baby was born were you offered an HIV test?

HA19. I don't want to know the results, but were you tested for HIV at that time?

HA20. I don't want to know the results, but did you get the results of the test?

HA21. Check HA14: Was the respondent tested for HIV as part of antenatal care?
HA22. Have you been tested for HIV since that time you were tested during your pregnancy?

HA23. How many months ago was your most recent HIV test?

HA24. I don't want to know the results, but have you ever been tested for HIV?

HA25. How many months ago was your most recent HIV test?

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 an HIV test?

[p. 39]
HA28. Have you heard of test kits people can use to test themselves for HIV?

HA29. Have you ever tested yourself for HIV using a self-test kit?

HA30. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?

HA31. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

HA32. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

HA33. Do people talk badly about people living with HIV, or who are thought to be living with HIV?

HA34. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

HA35. Do you agree or disagree with the following statement?
I would be ashamed if someone in my family had HIV.

HA36. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

[p. 40]
Maternal Mortality: MM

MM1. Now I would like to ask you some questions about your brothers and sisters born to your natural mother, including those who are living with you, those living elsewhere and those who have died. From our experience in prior surveys, we know it may sometimes be difficult to establish a complete list of all the children born to your natural mother. We will work together to draw the most complete list and work to recall all your siblings. Could you please now give me the names of all of your brothers and sisters born to your natural mother?
List all names on lines [A] to [H] below. Do not fill in the order number yet. If more than 8 siblings, use additional questionnaires.

[A] ____ _ _
[B] ____ _ _
[C] ____ _ _
[D] ____ _ _
[E] ____ _ _
[F] ____ _ _
[G] ____ _ _
[H] ____ _ _

MM2. Check MM1: How many siblings?
MM3. Read the names of the brothers and sisters to the respondent. After the last one, ask:
Are there any other brothers and sisters from the same mother that you have not mentioned?

MM4. Sometimes people forget to mention children born to their natural mother because they do not live with them or they do not see them very often. Are there any brothers or sisters who do not live with you that you have not mentioned?

MM5. Sometimes people forget to mention children born to their natural mother because they have died. Are there any brothers or sisters who died that you have not mentioned?

MM6. Some people have brothers or sisters from the same mother but a different father. Are there any brothers or sisters born to your natural mother, but who have a different natural father, that you have not mentioned?

MM7. Count the number of siblings listed in MM1.
MM8. Just to make sure that I have this right: Your natural mother had (total number in MM7) live births, excluding you, during her lifetime. Is that correct?

MM9. Probe and check sum in MM7 and list of siblings in MM1. Make corrections as necessary until response in MM8 is 'Yes'.

MM10. Check MM7: How many siblings?
MM11. Please tell me, which brother or sister was born first? And which was born next?
Record '01' for the order number in MM1 for the first-born brother or sister, '02' for the second, and so on until you have recorded the order number for all brothers and sisters.

MM12. How many of these births did your mother have before you were born?

[p. 41]
MM13. Write down the names of the brothers and sisters in MM14 according to the order number in MM1. Ask MM15 to MM27 for one brother or sister at a time (vertically). If there are more than 8 brothers and sisters, use an additional questionnaire.

MM14. Copy name of individual siblings to individual columns. ____

MM15. Is (name) male or female?

MM16. Is (name) still alive?

MM17. How old is (name)? _ _ (Go to MM28)

MM18. How many years ago did (name) die? _ _

MM19. How old was (name) when (he/she) died? _ _

MM20. Check MM15: Was the sibling male?
MM21. Check MM19: Did the sister die before age 12 years?
MM22. Was (name) pregnant when she died?

MM23. Did (name) die during childbirth?

MM24. Did (name) die within two months after the end of a pregnancy or childbirth?

MM25. How many days after the end of the pregnancy or childbirth did (name) die? _ _

MM26. Was (name)'s death due to an act of violence?

MM27. Was (name)'s death due to an accident?

MM28. Check MM14: Is there a younger sibling?
[p. 42]
[] Tick here if additional questionnaire used

[p. 43]
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, record '10'. If 'Every day' or 'Almost every day', record '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?
Record all mentioned.
TA9. During the last one month, on how many days did you use (names of products mentioned in TA8)?
If less than 10 days, record the number of days. If 10 days or more but less than a month, record '10'. If 'Every day' or 'Almost every day', record '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?

[p. 44]
TA12. What type of smokeless tobacco product did you use during the last one month?
Record all mentioned.
TA13. During the last one month, on how many days did you use (names of products mentioned in TA12)?
If less than 10 days, record the number of days. If 10 days or more but less than a month, record '10'. If 'Every day' or 'Almost every day', record '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, record '00'. If less than 10 days, record the number of days. If 10 days or more but less than a month, record '10'. If 'Every day' or 'Almost every day', record '30'.
TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have per day?

[p. 45]
Life satisfaction: LS

LS1. 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?
I am now going to show you pictures to help you with your response. [Image omitted].
Show smiley card and explain what each symbol represents. Record the response code selected by the respondent.
LS2. Show the picture of the ladder.
Now, look at this ladder with steps numbered from 0 at the bottom to 10 at the top. [Image omitted].
Suppose we say that the top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder do you feel you stand at this time?
Probe if necessary: Which step comes closest to the way you feel?
LS3. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?

LS4. 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?

[p. 46] [Image omitted]
[p. 47] [Image omitted]
[p. 48]
WM10. Record the time.

WM11. Was the entire interview completed in private or was there anyone else during the entire interview or part of it?
WM12. Language of the Questionnaire.

WM13. Language of the Interview.

WM14. Native language of the Respondent.

WM15. Was a translator used for any parts of this questionnaire?

WM16. Check columns HL10 and HL20 in list of household members, household questionnaire:
Is the respondent the mother or caretaker of any child age 0-4 living in this household?
[] Yes (Go to WM17 in woman's information panel and record '01'. Then go to the questionnaire for children under five for that child and start the interview with this respondent.)
[] No (Check HH26-HH27 in household questionnaire: Is there a child age 5-17 selected for questionnaire for children age 5-17?)
[p. 49]
Interviewer's observations

Supervisor's observations