Women's Information Panel: WM

This module is to be administered to all women age 15 through 49 (see column HL6 of HH listing). Fill in one form for each eligible woman.

WM0. District number _ _ _

WM1. Cluster number _ _ _

WM2. Household number _ _ _

WM3. Woman name ____

WM4. Woman line number _ _

WM5. Enumerator name and number____ _ _

WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _

WM7. Result of women's interview
WM8. In what month and year were you born?

WM9. How old were you at your last birthday?

WM10. Have you ever attended school?

WM11. What is the highest level of school you attended: primary, secondary, or higher?

WM12. What is the highest Class/Form you completed at that level?

WM13. Check WM11:
WM14. Now I would like you to read this sentence to me.
Show sentences the following to respondent.
Child Mortality Module: CM

This module is to be administered to all women age 15-49. 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?

CM3. Do you have any sons or daughters to whom you have given birth who are now living with you?

CM4 How many sons live with you? How many daughters live with you?

CM5 Do you have any sons or daughters 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? How many daughters are alive but do not live with you?

CM7. Have you ever given birth to a boy or girl who was born alive but later died?
If "No" probe by asking: Any baby who ever breathed or cried or showed
other signs of life but did not survive -- even if he or she lived only a few minutes or hours?
CM8. How many boys have died? How many girls have died?

CM9. Sum answers to CM4, CM6, and CM8
CM10 Just to make sure that I have this right, you have had (total number) births during your life. Is this correct?

CM11. Check CM9:
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 the births in BH1. Record twins and triplets on separate lines.

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. If Alive: How old was (name) at his/her last birthday?

BH7. If Alive: Is (name) living with you?

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

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

BH12. Compare number in CM10 with number of births in the birth history above and mark:For each birth, Check:
Year of birth is recorded _ _
For each living child: Current age is recorded _ _
For each dead child: Age of death is recorded _ _
For age at death 12 months or 1 year: _ _
Probe to determine exact number of months

BH13. Some pregnancies end before full term as a miscarriage or an abortion, while others may result in a stillbirth. Have you had a miscarriage or abortion?

BH14. In all how many pregnancies did you have that ended in a miscarriage or an abortion?

BH15. Have you had a stillbirth?

BH16. In all how many pregnancies did you have that ended in a stillbirth?

BH17. Check BH4 of last birth: Did the woman's last birth occur within the last 2 years, that is, since (day and month of interview in 2004)? If child has died, take special care when referring to this child by name in the following modules.
BH18. At the time you became pregnant with (name), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

Tetanus Toxoid (TT) module: TT

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.

TT1. Do you have a card or other document with your own immunizations listed?
If a card is presented, use it to assist with answers to the following questions.

TT2. When you were pregnant with your last child, did you receive any injection to prevent him or her from getting tetanus, that is convulsions after birth (an anti-tetanus shot, an injection at the top of the arm or shoulder)?

TT3: If yes: how many times did you receive this anti-tetanus injection during your last pregnancy?

TT4. How many TT doses during last pregnancy were reported in TT3?
TT5. Did you receive any tetanus toxoid injection at any time before your last pregnancy?

TT6. How many times did you receive it?

TT7. In what month and year did you receive the last tetanus injection before that last pregnancy?

TT8. How many years ago did you receive the last anti-tetanus injection before that last pregnancy?

Maternal and newborn health module: 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 CM12 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN1. In the first two months after your last birth [the birth of name], did you receive a vitamin A dose like this?
Show 200,000 IU capsule or dispenser.
MN2. Did you see anyone for antenatal care for this pregnancy?
If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.
MN2A. How many times did you receive antenatal care during this pregnancy?

MN2B. During this pregnancy, were you given or did you buy any iron tablets? Show Tablets.

MN2C. During the whole pregnancy, for how many days did you take the tablets?

MN3. As part of your antenatal care, were any of the following done at least once?

MN3A. Were you weighed?

MN3B. Was your blood pressure measured?

MN3C. Did you give a urine sample?

MN3D. Did you give a blood sample?

MN4. During any of the antenatal visits for the pregnancy, were you given any information or counseled about AIDS or the AIDS virus?

MN5. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

MN6. I don't want to know the results, but did you get the results of the test?

MN6A. During this pregnancy, did you take any medicine in order to prevent you from getting
malaria?

MN6B. Which medicines did you take to prevent malaria?
Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to the respondent.
MN6C. Check MN6B for medicine taken:
MN6D. How many times did you take SP/Fansidar during this pregnancy to prevent malaria?

MN6E. Did you sleep under a mosquito net last night?

MN6F. How long ago did your household obtain the mosquito net?
If less than 1 month ago, record '00'. If answer is "12 months" or "1 year", probe to determine if net was obtained exactly 12 months
ago or earlier or later.
MN6G. When you got that net, was it already treated with an insecticide to kill or repel mosquitoes?

MN6H. Since you got the mosquito net was it ever soaked or dipped in a liquid to kill/repel mosquitoes?

MN6I. How long ago was the net last soaked or dipped?
If less than 1 month ago, record '00'. If answer is "12 months" or "1 year", probe to determine if net was obtained exactly 12 months ago or earlier or later.
MN7. Who assisted with the delivery of your last child (name)? Anyone else?
Probe for the type of person assisting and circle all answers given
MN8. Where did you give birth to (name)?
If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
(Name of place) ____

MN8A. After (Name) was born, did a health professional or a traditional birth attendant
check on your health?

MN8B. How many days or weeks after delivery did the first check take place?
Record '00' day if same day.
MN8C. Who checked on your health at that time?
Probe for the most qualified person.
MN8D. Check MN8 for place of birth.
MN8E. In the two months after (Name) was born, did a health professional or a traditional birth attendant check on his/her health?

MN8F. How many hours, days or weeks after the birth of (Name) did the first check take place? Record hours if less than one day. If ess than one week record days.
MN8G. Who checked on (Name's) health at that time? Probe for the most qualified person.
MN8H. Where did this check of (name) take place?
to identify the type of source and circle the appropriate code. If unable to determine if a hospital, health centre or clinic is public or private medical, write the name of the place. Probe
(Name of place) ____

MN9. When you last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?

MN10. Was (name) weighed at birth?

MN11. How much did (name) weigh?
Record weight from health card, if available
MN12. Did you ever breastfeed (name)

MN13. 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.
MN14. Have you used soap yesterday or today?

MN15. When you used soap today or yesterday, what did you use it for?
If for washing my hands are mentioned, probe what was the occasion, but do not read the answers. (Do not read the answers, ask to be specific, encourage "what else" until nothing further is mentioned and check all that apply)
Marriage/union module: MA

MA.1 Are you currently married or living together with a man as if married?

MA2. How old was your husband/partner on his last birthday?

MA3. Have you ever been married or lived together with a man?

MA4. What is your marital status now: are you widowed, divorced, or separated?

MA5. Have you been married or lived with a man only once or more than once?

MA6. In what month and year did you first marry or start living with a man as if married

MA7. Check MA6:
MA8. How old were you when you started living with your first husband/partner?

Contraception module: CP

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

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

CP3. Which method are you using?
Do not prompt. If more than one method is mentioned, circle each one.
Sexual behaviour module: SB

Check for the presence of others. Before continuing, ensure privacy.
Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. The information you supply will remain strictly confidential.

SB1. How old were you when you first had sexual intercourse (if ever)?

SB2. 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.
SB3. The last time you had sexual intercourse was a condom used?

SB4. What is your relationship to the man with whom you last had sexual intercourse?
If man is 'boyfriend' or 'fiancee', ask:
Was your boyfriend/fiancee living with you when you last had sex?
If 'yes', circle 1. If 'no', circle 2.
SB5. How old is this person (at the time of sexual encounter)?
If response is DK, probe
About how old is this person? :
SB6. Have you had sex with any other man in the last 12 months?

SB7. The last time you had sexual intercourse with this other man, was a condom used?

SB8. What is your relationship to this man?
If man is 'boyfriend' or 'fiancee', ask: Was your boyfriend/fiancee living with you when you last had sex? If 'yes', circle 1. If 'no', circle 2.
SB9. How old is this person?
If response is DK, probe: About how old is this person?

SB10. Other than these two men, have you had sex with any other man in the last 12 months?

SB11. In total, with how many different men have you had sex in the last 12 months?

HIV/AIDS module: HA

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

HA2. Can people protect themselves from getting infected with the AIDS virus by having one sex partner who is not infected and also has no other partners?

HA3. Can people get infected with 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 reduce their chance of getting infected with the AIDS virus by not having sex at all?

HA7. Can people get the AIDS virus by sharing food with a person who has AIDS?

HA7A. Can people get the aids virus by getting injections with a needle that was already used by someone else?

HA8. Is it possible for a healthy-looking person to have the AIDS virus?

HA9. Can the AIDS virus be transmitted from a mother to a baby?

HA9A. During pregnancy?

HA9B. During delivery?

HA9C. By breastfeeding?

HA10. If a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in school?

HA11. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

HA12. If a member of your family became infected with the AIDS virus, would you want it to remain a secret?

HA13. If a member of your family became sick with the AIDS virus, would you be willing to care for him or her in your household?

[p. 11]
HA14. Check MN5: Tested during antenatal care?
HA15. I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?

HA16. I do not want you to tell me the results of the test, but have you been told the results?

HA17. Did you, yourself, ask for the test, was it offered to you and you accepted, or was it required?

HA18. At this time, do you know of a place where you can go to get such a test to see if you have the AIDS virus?

HA18A. If tested for HIV during antenatal care: other than at the antenatal clinic, do you know of a place where you can go to get a test to see if you have the AIDS virus?

Maternal mortality module

Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died..

How many children did your mother give birth to, including you?

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

Sl no.

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

MM5. Is (Name) male or female?

MM6. Is (Name) still alive?

MM7. How old is (Name)?

MM8. How many years ago did (Name) die?

MM9. How old was (Name) when he/ she died?
If male or died before age 12 years, Go to Next Line

MM10. Was (Name) pregnant when she died?

MM11. Did (Name) die during child birth?

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

MM13. How many live born children did (Name) give birth to during her lifetime
(before this pregnancy)?