[Nepal]

Woman's information panel: WM

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

WM1. Cluster number: _ _ _

WM2. Household serial number: _ _

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

WM5. Interviewer name and code number
WM6. Day/month/year of interview in BS _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to this woman:
We are from Central Bureau of Statistics (a bureau of Nepal Government under the National Planning Commission), in Kathmandu. We are working on a survey concerned with family health and education in Mid and Far Western Region of the country (NMICS). I would like to talk to you about these subjects. The interview will take about 35 minutes. All the information we obtain will remain strictly confidential according to the Statistics Act 2015 BS and your answers will never be shared with anyone other than our project team.

If greeting at the beginning of the household questionnaire has already been read to this woman, then read the following:
Now I would like to talk to you more about your health and other topics. This interview will take about 35 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

May I start now?

WM7. Result of woman's interview

WM8. Field edited by (name and code number):
WM9. Data entry clerk (name and code number):
WM10. Record the time.
Woman's Background: WB

WB1. In what month and year were you born?

WB2. How old are you?
Probe: How old were you at your last birthday? Compare and correct WB1 and/or WB2 if inconsistent.
WB3. Have you ever attended any school or preschool?

WB5. What is the highest grade you have completed?
If less than 1 grade, enter "00"
WB5A. See question WB5 and tick the appropriate box:
WB5B. Are you currently studying in any school?

WB5BC What was the main reason why you didn't continue your studies further?

WB6. See question WB5 tick appropriate box:
WB7. Now I would like you to read out this sentence to me.
Show sentence on the card to the respondent and request to read out loud.
Access to mass media and use of information/communication technology: MT

MT1. Check question WB5 and WB7 and tick appropriate box:
MT2. How often do you read newspapers or magazines: almost daily, at least once a week, fewer than once a week or do not read at all?

MT3. How often do you listen to the radio: almost daily, at least once a week, fewer than once a week or do not listen at all?

MT4. How often do you watch TV: almost daily, at least once a week, fewer than once a week or do not watch at all?

MT5. See question WB2; does the respondent belong to the age group 15-24?
MT6. Have you ever used (or operated) a computer?

MT7. Did you ever use the computer at any place in the past 12 months?

MT8. How often did you use the computer during the past one month: almost daily, at least once a week, fewer than once a week, did not use at all?

MT9. Have you ever used the internet?

MT10. Have you used the internet in the past 12 months?
If necessary, ask additional questions about the place and means.
MT11. How often did you use the internet in the past 1 month: almost daily, at least once a week, fewer than once a week, did not use at all?

Desire of last birth: DB

The questionnaire of this module is to be administered to all mothers who have given birth to live babies.

DB1A. Now, let?s talk about all the children you have given birth to. Have you ever given birth to a child?
Probe: I wish to know about the first child you have given birth to, even if it is not alive today or its father is not your current husband?

DB1B. Out of the children you gave live birth to, when did you give birth to the last one?
Probe: I wish to know about the first child you have given birth to, even if it is not alive today or its father is not your current husband? Month and year must be disclosed.
DB1C. Check question DB1B on whether the child was born within the last two years and circle the appropriate response code.
DB1D. Check DB1C, if the answer is yes, write down the name of the child below after asking the name of the child with the respondent.While asking the questions hereafter, refer to the name of this child where mentioned. If the child is dead, be particularly careful while taking about such children by referring to them by the name in the modules below.

DB1. Did you want to become pregnant when (name) was conceived?

DB2. Did you want to give birth to a child a little later or did you not want to give birth to any more (additional) child?

DB3. How long did you want to wait?

Maternal and newborn health: MN

The questions in this module are to be administered to all mothers who have given birth to live babies within the past 2 years.
Write down the name of the most recent child last born within the last two years from DB1D here.
Name of the child ____
Mention the name of the child in the following questions where required.

MN1. Did you see anyone for antenatal check-up (ANC) during your pregnancy with (name)?

MN2. Whom did you see for ANC check-up?
Probe: Anyone else? Probe for the type of person seen and circle all answers given.
MN3. How many times did you receive antenatal care during this pregnancy?

MN4. As part of your antenatal care during this pregnancy, were any of the following done at least once:

[A] Was your blood pressure measured?

[B] Did you give a urine sample?

[C] Did you give a blood sample?

MN5. Do you have a card or other document with your own immunizations listed when you were pregnant with (name)?
May I see it please?
If a card is presented, use it to assist with answers to the following questions.
MN6. When you were pregnant with (name), did you receive any injection in the arm or shoulder to prevent the baby from getting tetanus, that is convulsions after birth?

MN7. How many times did you receive this tetanus injection during your pregnancy with (name)?
If 7 or more times, record '7'.
MN8. How many tetanus injections during last pregnancy were reported in MN7?
MN9. Did you receive any tetanus injection at any time before your pregnancy with (name), either to protect yourself or another baby?

MN10. How many times did you receive a tetanus injection before your pregnancy with (name)?
If 7 or more times, write '7'.
MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?
If less than one year, write '00'.
MN12. Check MN1 for presence of antenatal care during this pregnancy:
MN16A. During this pregnancy, did you take iron/folic acid tablets?

MN16B. During this whole pregnancy, for how many days did you take the iron/folic acid tablets?

MN16C. During this pregnancy, did you take any medicines for intestinal worms?

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

MN18A. Was the safe/home delivery kit used during the birth of (name)?

MN18B. Before discharge of placenta, was (name) wiped with a cloth and dried?

MN18C. Before discharge of placenta, was (name) covered with another dry cloth after wiping?

MN18D. What tools or equipment were used to cut the placenta during (name) delivery?

MN18E. Was anything applied on the wound after cutting the cord and removing the placenta?

MN18F. How long after delivery, was (name) bathed for the first time?
(Write hour if less than 1 day and write day if more than a day)
MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?

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

MN21. Was (name) weighed at birth?

MN22. How much did (name) weigh at birth?
Record weight from health card, if available.
MN23. Has your menstrual period returned since the birth of (name)?

MN24. Did you ever breastfeed (name)?

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

MN27. What was (name) given to drink?
Probe: Anything else?
MN27A. After (name) was born, did any health care provider check on your health as post natal check-up?

MN27B. How long after delivery did the first check take place?
If less than 1 day, record hours. If less than one week, record days.
Illness Symptoms: IS

IS1. Check Household Listing form, column HL9 and tick appropriate box.
Is the respondent the mother or caretaker of any child under age 5?

IS2. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away?
Probe: Any other symptoms? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do not prompt with any suggestions
Contraception: CP

CP1. Let's us talk about another subject: family planning.
Are you pregnant now?

CP2. There are various ways or methods to delay or avoid a pregnancy: Are you currently doing something or using any method to delay or avoid getting pregnant?

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

UN1. Check CP1. Currently pregnant or not tick appropriate codes?
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" or not tick appropriate box.
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 (another) child?

UN8. Check CP1. Currently pregnant or not tick appropriate box.
UN9. Check CP2. Currently using a family planning method or not tick appropriate box.
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 or is code "C" circled or not tick appropriate box.
UN13. When did your last menstrual period start?

UN13A. Do you seek any help/advice if required on reproductive health?

UN13B. From whom do you seek advice on reproductive health?

UN13C. Do you face any of the following situations during your menstrual period?
Ask one by one

[A] Have to live in different house

[B] Have to live in different room of same house

[C] Have to live in animal shed

[D] Have to eat different types of food

[E] Have to bath in separate place

[F] Have to be absent from school or work

[G] Have to avoid social gatherings

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?

DV2A. Sometimes a mother-in-law is annoyed or angered by things that their daughter-in-law does. In your opinion, is a mother-in-law justified in verbal abuse or threat their daughter-in-law in the following situations:

[A] If she goes out without telling him?

[B] If she neglects the children?

[C] If she argues with her?

[D] If she refuses to obey her order?

[E] If she did not bring dowry?

[F] If she did not complete her work on time?

Marriage/union: MA

MA1. Are you currently married?

MA2. How old is your husband?
Probe: how old was your husband on his last birthday?
MA3. Besides yourself, does your husband have any other wives?

MA4. How many other wives does he have?

MA5. Have you ever been married?

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

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

MA8. In what month and year did you first marry?

MA9. How old were you when you started living with your first husband?

HIV/AIDS: HA

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

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:

[A] During pregnancy to her baby?

[B] During delivery to her baby?

[C] By breastfeeding 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 has 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?

HA13. Check DB1C: Any live birth in last 2 years or not tick appropriate box.
HA14. Check MN1: Received antenatal care or not tick appropriate box.
HA15. During any of the antenatal visits for your pregnancy with (name),

Were you given any information about:

[A] Babies getting the AIDS virus from their mother?

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

[C] Getting tested for the AIDS virus?

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

HA16. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?

HA17. I don't want to know the results, but did you get the results of the test?

HA18. Regardless of the result, all women who are tested are supposed to receive counseling after getting the result. After you were tested, did you receive counselling?

HA19. Check MN17: Birth delivered by health professional (A, B or C) or not tick appropriate box.
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?

Consumption of tobacco or alcoholic substances: TA

TA1. Have you ever smoked a cigarette/bidi, even if a puff or two?

TA2. How old were you when you smoked a whole stick of cigarette/bidi the very first time?

TA3. Do you currently smoke cigarettes/bidi now-a-days?

TA4. How many cigarettes/bidi sticks have you smoked in the past 24 hours?

TA5. How many days did you smoke cigarette/bidi in the past one month?
Write number of days if less than 10 days. Circle 10 if 10 days or more but less than a month. Circle on "30" if "everyday" or "almost every day".
TA6. Have you ever consumed a tobacco- based substance that is smoked other than cigarette/bidi, such as tobacco, kakkad, sulfa, hukkah (hubble-bubble), chilim, cigar, etc.?

TA7. Have you smoked any tobacco-based substance other than cigarette/bidi (such as tobacco, kakkad, sulfa, hukkah, chilim, cigar, etc) in the past one month?

TA8. What type of smoked tobacco-based substance did you consume in the past one month?
Circle all answers given by respondents.
TA9. How many days did you smoke a tobacco-based substance other than cigarette/bidi (such as tobacco, kakkad, sulfa, hukkah, chilim, cigar, etc) in the past one month?
Write number of days if less than 10 days. Circle 10 if 10 days or more but less than a month. Circle on "30" if "everyday" or "almost everyday".
TA10. Have you ever consumed smokeless tobacco-based substances such as surti (tobacco plant leaves), khaini, snuff?

TA11. Have you consumed any smokeless tobacco substances (such as surti tobacco plant leaves, khaini, snuff) in the past one month?

TA12. What type of smokeless tobacco did you consume or chew in the past one month?
Tick circle on every answer.
TA13. How many days did you consume smokeless tobacco substances (such as surti tobacco plant leaves, khaini, snuff) in the past one month?
Write number of days if less than 10 days. Circle 10 if days 10 or more but less than a month. Circle on "30" if "everyday" or "almost every day".
TA14. Now, I would like to ask you a few questions about alcohol-drinking? Have you ever had alcohol (such as beer, wine or homemade liquor)?

TA15A. How old were you when you first had an alcoholic drink?

TA16A. How many days did you drink alcohol in the past one month?
Write number of days if less than 10 days. Circle 10 if days 10 or more but less than a month. Circle on "30" if "everyday" or "almost every day".
Life satisfaction: LS

LS1. Check WB2: Age of respondent is between 15 and 24 or not and tick appropriate response.
LS2. Now I would like to ask you some very simple questions about your level of satisfaction in different areas.
In each case, I would like to know where you would place yourself:
Whether you are very or somewhat satisfied, neither satisfied nor unsatisfied, or somewhat or very unsatisfied.
You can also look at these pictures to help you with your response.
Give response card to respondent and prompt her to look at the card while and after you ask each question from LS2 to LS10.
How satisfied are you with your family life? [Image omitted.]

LS3. How satisfied are you with your friendships?

LS4. How satisfied are you with your school?

LS5. How satisfied are you with your current job?

LS6. How satisfied are you with yourself?

LS7. 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.
LS8. How satisfied are you with your life, overall?

LS9. How satisfied are you with your current income?

LS10. Taking all things together, would you say you are very or somewhat happy, neither happy nor unhappy, or somewhat or very unhappy?

LS11. Compared to this time last year, would you say that your life has improved or worsened, overall?

LS12. And in one year from now, do you expect that your life will be better or worse, overall?

WM11. Record the time.
WM12. See question HL9 of the Household Listing Form and tick appropriate box.
Is the current respondent the mother or caretaker of any child in the age group of 0-4 years of this household?Find out whether there are other women or children below 5 years in this household for administering the questionnaire.
If None, collect all the questionnaires filled in this household. Now fill in the relevant information in the HH8-HH15 in the household information panel in the Household Questionnaire.
After collecting all the questionnaires filled in this households (household, individual women and children under 5) check the information panel on the first page of each questionnaire to ensure that the details are correctly filled up by comparing the details with the Household listing form of the household questionnaire.
After filling up all necessary information in the covering envelope, keep all the filled questionnaires for this household in this envelope. While keeping in the envelope, put it in the order of HHs questionnaire at the top followed by women?s questionnaire (in the order of line number in Household Listing Form) and finally the children questionnaire (in the same order of the line number of U5 Children in the Household Listing form). For example if eligible women are listed in the line number 02, 04 and 07, in the household listing form, arrange the questionnaires in the following order. First the HHs questionnaire, followed by women's questionnaire of line no 02 then 04 and finally 07.

Interviewer's observations

Field editor's observations

Supervisor's observations