Mali 2015

Woman's information panel: WM

This questionnaire is to be administered to all women age 15 through 49 (see List of Household Members, column HL7). A separate questionnaire should be used for each eligible woman.

WM1. Cluster number: _ _ _

WM2. Household number: _ _

WM3. Woman's name:
WM4. Woman's line number: _ _

WM5. Interviewer's name and number:
WM6. Day/month/year of interview _ _ / _ _ / 2015

If not done already, introduce yourself to respondent:
We are agents from the National Institute of Statistics. We are working on a project about family health and education. I would like to talk to you about these subjects. The interview will take about 30 to 50 minutes. All the information we obtain will remain strictly confidential and anonymous.

If greeting at the beginning of the household questionnaire has already been read to this woman, then read the following sentence:
Now I would like to talk to you about your health and other topics. This interview will take about 30 to 50 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I start now?

WM7. Result of woman's interview
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 year/grade you completed at that level?
If the first year/grade at this level is not completed, 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 WB7:
MT2. How often do you read a newspaper or magazine: almost every day, at least once a week, less than once a week or not at all?

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

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

MT4A. Have you heard or seen a message at least once about use and care of long lasting insecticidal nets?

MT4B. How or from whom did you get your information?
Was it by:

[A] Television

[B] Radio

[C] Distribution agent/volunteer

[E] Health agent during antenatal visit

[G] Poster/billboard

[H] Other household member/friends/family

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

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

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

MT9. Have you ever used the internet?

MT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
MT11. During the last one month, how often did you use the internet: almost every day, at least once a week, less than once a week or not at all?

Fertility/ birth history: CM

CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

CM4. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM5. How many sons live with you? How many daughters live with you?
If none, record "00".
CM6. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

CM7. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?
If none, record "00".
CM8. Have you ever given birth to a son or daughter who was born alive but later died?
If "No" probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life - even if he or she lived only a few minutes or hours?

CM9. How many sons have died? How many daughters 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) 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 lines. If there are more than 14 births, use an additional questionnaire.

BH Line No. _ _

BH1. What first 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 deceased: How old was (name) when he/she died?

If "1 year", probe: How many months old was (name)? Record days if less than 1 month; record months if less than 2 years; or years if 2 or more 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 other live births since the birth of (name of last birth in birth history module)?

CM12A. Compare number in CM10 with number of births in the birth history module above and check:
CM13. Last birth occurred within the last 2 years, that is, since (month of interview) in 2013 (if the month of the interview and the month of the birth are the same, and the year of birth is 2013, please consider this as a birth within the last 2 years)If child has died, take special care when referring to this child by name in the following modules.

Desire for last birth: DB

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

DB1. When you got pregnant with (name), did you want to get pregnant at that time?

DB2. Did you want to have a baby later on, or did you not want any (more) children?

DB3. How much longer did you want to wait?
Record the answer as stated by respondent.
Maternal and newborn health: MN

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

MN1. Did you receive 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 weeks or months pregnant were you when you first received antenatal care for this pregnancy?
Record the answer as stated by respondent.
MN3. How many times did you receive antenatal care during this pregnancy?

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?

[D] Did they weigh you?

[E] Did they measure your height?

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)?

MN8. How many tetanus injections during last pregnancy were reported in MN7?
MN9. Did you receive any tetanus injection at any time before your pregnancy with (name), either to protect yourself or another baby?

MN10. How many times did you receive a tetanus injection before your pregnancy with (name)?
If 7 or more times, record '7'.
MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?
If less than 1 year, record '00'.
MN12. Check MN1 to see if woman received antenatal care during this pregnancy:
MN13. During (any of) your antenatal visit(s) for the pregnancy with (name), did you take any medicine in order to prevent you from getting malaria?

MN14. Which medicines did you take to prevent malaria?
Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent.
MN15. Check MN14 for medicine taken:
MN16. During your pregnancy with (name), how many times did you take SP/Fansidar in total?
Please include all that you obtained either during an antenatal care visit, during a visit to a health facility or from another source.

MN16A. During your pregnancy with (name), were you given or did you buy any iron or folic acid pills or syrup containing iron or folic acid?
Show iron pills and syrup.
MN16B. During your antenatal visits for this pregnancy, were you given an insecticidal mosquito net?

MN17. Who assisted with the delivery of (name)?
Probe: anyone else? Probe for the type of person assisting and circle all answers given.
If respondent says no one assisted, probe to determine whether any adults were present at the delivery.
MN18. Where did you give birth to (name)?
Probe to identify the type of place. If unable to determine whether public or private facility, 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?

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

MN20. When (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN21. Was (name) weighed at birth?

MN22. How much did (name) weigh?
If a card is available, record weight from card.
MN23. Has your menstrual period returned since the birth of (name)?

MN24. Did you ever breastfeed (name)?

MN25. How long after birth did you first put (name) to the breast?
If less than 1 hour, record "00" hours. If less than 24 hours, record hours. Otherwise, record days.
MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk?

MN27. What was (name) given to drink?
Probe: Anything else?
Post-natal health checks: PN

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

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

PN4. And what about checks on your health - I mean, someone assessing your health, for example asking questions about your health or examining you?
Did anyone check on your health before you left (name or type of health 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, village midwife "Matrone" or community health worker assist with the delivery?
PN7. You have already said that (person or persons in MN17) assisted with the birth. Now I would like to talk to you about checks on (name)'s health after delivery, for example examining (name), checking the umbilical cord, or seeing if (name) is ok.
After the delivery was over and before (person or persons in MN17) left you, did (person or persons in MN17) check on (name)'s health?

PN8. And did (person or persons in MN17) check on your health before 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 umbilical cord, or seeing if the baby is ok.
After (name) was delivered, did anyone check on his/her health?

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

PN12A. How long after delivery did that check happen?
PN12B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
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, village midwife "Matrone" or community health worker/relay volunteer 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 List of Household Members, columns HL7B and HL15:
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 a child under the age of 5 to a health facility right away?
Probe: Any other symptoms? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do not prompt with any suggestions
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 a pregnancy. Are you currently doing something or using any method to delay or avoid getting pregnant?

CP2A. Have you ever done something or used any method to delay or avoid getting pregnant?

CP3. What are you currently doing to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
Unmet need: UN

UN1. Check. 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?
Record the answer using the same unit stated by the respondent.
Female genital mutilation/cutting: 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 external genital organs cut. Have you ever heard about this practice?

FG3. Have you yourself 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 anything?

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. Check CM5 for number of daughters at home and CM7 for number of daughters elsewhere, and sum the answers here
FG10. Just to make sure that I have this right, you have (total number in FG9) living daughters. Is this correct?

FG11. 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 FG12. Then, ask questions FG13 to FG20 for each daughter at a time.
The total number of daughters in FG12 should be equal to the number in FG9. If more than 4 daughters, use additional questionnaire.

FG12. Name of daughter ____

FG13 How old is (name)?

FG14. Is (name) younger than 15 years of age?

FG15. Is (name) circumcised?

FG16. How old was (name) when this occurred?
If the respondent does not know the age, probe to get an estimate.
FG17. Now I would like to ask you some questions about what was done to (name) at that time.
Was any flesh removed from the genital area?

FG18. Was her genital area just nicked without removing anything?

FG19. Was her genital area sewn closed?
If necessary, probe: Was it sealed?
FG20. Who performed the circumcision?

FG21. Go back to FG13 for next daughter. If no more daughters, continue with FG22.

[] Tick here if additional questionnaire used.

FG22. Do you think this practice should be continued or should it be discontinued?

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 he 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 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?

MA8A. In what month and year did you marry or start living with a man as if married?
MA8B. 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 first started living with your (first) husband/partner?

Sexual behavior: SB

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

SB1. Now I would like to ask you some questions about your sexual activity in order to gain a better understanding of some important life issues.
The information you supply will remain strictly confidential.
How old were you when you had sexual intercourse for the very first time?

SB2. The first time you had sexual intercourse, was a condom used?

SB3. When was the last time you had sexual intercourse?
Record answers in days, weeks or months if less than 12 months (one year). If 12 months (one year) or more, answer must be recorded in years.
SB4. The last time you had sexual intercourse, was a condom used?

SB5. What was your relationship to this person with whom you last had sexual intercourse?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If "boyfriend/fiancé", 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/fiancé", 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 AIDS?

HA2. Can people reduce their chance of getting the aids virus by having just one uninfected sex partner who has no other sex partners?

HA3. Can people get the AIDS virus because of witchcraft or other supernatural means?

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

HA5. Can people get the AIDS virus from mosquito bites?

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

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

HA8. Can the virus that causes AIDS be transmitted from a mother to her baby:

[A] During pregnancy?

[B] During delivery?

[C] By breastfeeding?

HA8A. Check HA8, [A], [B], and [C]
HA8B. Is there special medicine that a doctor or nurse can give to a woman who has the AIDS virus to reduce the risk of transmission to her baby?

HA9. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

HA10. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

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

HA12. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

HA12A. Do you think that children living with the AIDS virus should attend the same school as children who do not have the AIDS virus?

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] The possibility of 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, D, or E)?
HA20. I don't want to know the results, but were you tested for the AIDS virus between the time you went for delivery but before the baby was born?

HA21. I don't want to know the results, but did you get the results of the test?

HA22. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?

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

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

HA25. When was the most recent time you were tested?

HA26. I don't want to know the results, but did you get the results of the test?

HA27. Do you know of a place where people can go to get tested for the AIDS virus?

Tobacco 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 "every day" 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 of these smoked tobacco products?

TA8. What type of smoked tobacco product did you use 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 "every day" 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 "every day" 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, one gourd of Dolo beer, one glass of palm wine.
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 "every day" or "almost every day", circle "30".
TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have per day?

Life satisfaction: LS

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

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

How satisfied are you with your family life?

LS4. How satisfied are you with your friendships?

LS5. During the current / 2014-2015 school year, did you attend school?

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

LS7. How satisfied are you with your current job?

LS8. How satisfied are you with your health?

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

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

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

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

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

Consent for Verbal and Social Autopsy (VASA): VA

VA1. Check BH4, BH5, and BH2: Respondent had one (several) live birth(s) since (month of interview) in 2005 but who died (BH5 = 2) before the age of 5 years (BH9 = 00-27 days or BH9 = 01-23 months or BH9 = 02-04 years) in the last 5 years, that is since (month of interview) in 2010.
VA2. List each child who died in the last 5 years and before the age of 5 in the table below in the order in which they appear in the birth history listing. Record the line number, name, sex, and age at time of death for each child who died before the age of 5 years since (month of interview) in 2010.

VA3. Rank number _

VA4. Line number from birth history _ _

VA5. Name from BH1 ______

VA6. Sex from BH3

VA7. Age at time of death from BH9

Codes for Unit: Days = 1; Months = 2; Years = 3

Informed consent for future participants in the Verbal and Social Autopsy interview

Purpose
In 3 or 4 months, we will invite you to take part in a study whose purpose is to increase our knowledge of the causes of death of newborns and children. The study will also examine how people understand their children's need for health care and the problems they face in getting this care. We would like you to participate in this study in the future.

Process
If you accept to participate in this future study, other colleagues of ours will come in a few months to ask you questions about (name), your pregnancy and any health care sought out during this pregnancy, as well as the conditions of delivery. They will ask you questions about the illness or conditions that led to the death of (name). You will be free to respond to the questions.

Risks/discomfort
Some of the questions that will remind you of (name)'s illness and death may make you feel uncomfortable. When you feel upset, they will stop the interview until you feel well enough to continue. If you find the interview too difficult, you can completely stop. The interview will last about one and a half hours.

Confidentiality
The colleagues who come to ask you questions will safeguard the information that you provide. The information that you provide is confidential and anonymous and will only be used as part of this study. Your answers will never be published alone and your name will not be used in any way.

Benefit
There is no direct benefit to you for your participation in this future study. However, healthcare offered to the women and children of Mali and in your community may improve thanks to the information gathered as part of this study.

Voluntary participation
You are free to accept or not accept participation in this study and you can change your mind at any time. There will be no penalty if you decide not to participate in the study.
During the study, if you have questions or complaints, you can communicate with a local interviewer who will be identified to work in your community. His/her name and telephone number will be made available to you.
If you have questions concerning your rights as a participant in this study, or if you think that you have not been fairly treated, you can contact the Malian Ethics Committee at this address:

Voluntary authorization to participate in the study at a later date
You are free to participate in this study at a later date, and you can change your mind at any time. There will be no penalty if you decide not to participate in the study.
May we come at a later date to conduct the interview?

Date __ / __ / 2015
Participant's name in capital letters ______

Member of research team who obtained consent

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

Team leader's observations

Supervisor's observations

Response card for life satisfaction module:

Side 1

[Images omitted]
Side 2:

[Images omitted]