MICS questionnaire for individual women
[name of country]
Woman's information panel: WM
This questionnaire is to be administered to all women age 15 through 49 (see Household Listing Form, column HL7). A separate questionnaire should be used for each eligible woman.
WM1. Cluster number: _ _ _
WM2. Household number: _ _
WM3. Woman's name:
Name ____
WM4. Woman's line number: _ _
WM5. Interviewer name and number
Name ____ _ _
WM6. Day/month/year of interview _ _ / _ _ / _ _ _ _
Repeat greeting if not already read to this woman:
We are from [country-specific affiliation]. We are working on a project concerned with family health and education. I would like to talk to you about these subjects. The interview will take about [number] minutes. All the information we obtain will remain strictly confidential 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 (number) 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?
[] Yes, permission is given (Go to WM10 to record the time and then begin the interview.)
[] No, permission is not given (Complete WM7. Discuss this result with your supervisor.)
[] No, permission is not given (Complete WM7. Discuss this result with your supervisor.)
WM7. Result of woman's interview
[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated
[] 96 Other (specify) ____
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated
[] 96 Other (specify) ____
WM8. Field edited by (name and number):
Name ____ _ _
WM9. Data entry clerk (name and number):
Name ____ _ _
[p. 2]
WM10. Record the time.
Hours and minutes _ _ : _ _
Woman's Background: WB
WB1. In what month and year were you born?
Date of birth
_ _ Month
[] 98 DK Month
_ _ _ _ Year
[] 9998 DK Year
_ _ Month
[] 98 DK Month
_ _ _ _ Year
[] 9998 DK Year
WB2. How old are you?
Probe: How old were you at your last birthday? Compare and correct WB1 and/or WB2 if inconsistent.
Age (in completed years) _ _
WB3. Have you ever attended school or preschool?
[] 1 Yes
[] 2 No (Go to WB7)
[] 2 No (Go to WB7)
WB4. What is the highest level of school you attended?
[] 0 Preschool (Go to WB7)
[] 1 Primary
[] 2 Secondary
[] 3 Higher
[] 1 Primary
[] 2 Secondary
[] 3 Higher
WB5. What is the highest grade you completed at that level?
If less than 1 grade, enter "00"
Grade _ _
WB6. Check WB4:
[] Secondary or higher. (Go to next module)
[] Primary (Continue with WB7)
[] Primary (Continue with WB7)
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?
[] 1 Cannot read at all
[] 2 Able to read only parts of sentence
[] 3 Able to read whole sentence
[] 4 No sentence in required language (specify language) ____
[] 5 Blind / visually impaired
[] 2 Able to read only parts of sentence
[] 3 Able to read whole sentence
[] 4 No sentence in required language (specify language) ____
[] 5 Blind / visually impaired
[p. 3]
Access to mass media and use of information/communication technology: MT
MT1. Check EB7:
[] Question left blank (Respondent has secondary or higher education) (Continue with MT2)
[] Able to read or no sentence in required language (codes 2, 3 or 4) (Continue with MT2)
[] Cannot read at all or blind (codes 1 or 5) (Go to MT3)
[] Able to read or no sentence in required language (codes 2, 3 or 4) (Continue with MT2)
[] Cannot read at all or blind (codes 1 or 5) (Go to MT3)
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?
[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
[] 2 At least once a week
[] 3 Less than once a week
[] 4 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?
[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
[] 2 At least once a week
[] 3 Less than once a week
[] 4 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?
[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
MT5. Check WB2: Age of respondent?
[] Age 15-24 (Continue with MT6)
[] Age 25-49 (Go to next module)
[] Age 25-49 (Go to next module)
MT6. Have you ever used a computer?
[] 1 Yes
[] 2 No (Go to MT9)
[] 2 No (Go to MT9)
MT7. Have you used a computer from any location in the last 12 months?
[] 1 Yes
[] 2 No (Go to MT9)
[] 2 No (Go to MT9)
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?
[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
MT9. Have you ever used the internet?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
MT10. In the last 12 months, have you used the internet?
If necessary, probe for use from any location, with any device.
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
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?
[] 1 Almost every day
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
[] 2 At least once a week
[] 3 Less than once a week
[] 4 Not at all
[p. 4]
Child mortality: CM
All questions refer only to live births.
CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
[] 1 Yes
[] 2 No (Go to CM8)
[] 2 No (Go to CM8)
CM2. What was the date of your first birth?
I mean the very first time you gave birth, even if the child is no longer living, or whose father is not your current partner.
Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3.
Date of first birth
_ _ Day
[] 98 DK day
_ _ Month
[] 98 DK month
_ _ _ _ Year (Go to CM4)
[] 9998 DK year
_ _ Day
[] 98 DK day
_ _ Month
[] 98 DK month
_ _ _ _ Year (Go to CM4)
[] 9998 DK year
CM3. How many years ago did you have your first birth?
Completed years since first birth _ _
CM4. Do you have any sons or daughters to whom you have given birth who are now living with you?
[] 1 Yes
[] 2 No (Go to CM6)
[] 2 No (Go to CM6)
CM5. How many sons live with you? How many daughters live with you?
If none, record '00'.
_ _ Sons at home
_ _ Daughters at home
_ _ Daughters at home
CM6. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
[] 1 Yes
[] 2 No (Go to CM8)
[] 2 No (Go to CM8)
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'.
_ _ Sons elsewhere
_ _ Daughters elsewhere
_ _ Daughters elsewhere
CM8. Have you ever given birth to a boy or girl who was born alive but later died?
If "no" probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life ? even if he or she lived only a few minutes or hours?
[] 1 Yes
[] 2 No (Go to CM10)
[] 2 No (Go to CM10)
CM9. How many boys have died? How many girls have died?
If none, record '00'.
_ _ Boys dead
_ _ Girls dead
_ _ Girls dead
CM10. Sum answers to CM5, CM7, and CM9.
Sum _ _
[p. 5]
CM11. Just to make sure that I have this right, you have had in total (total number in cm10) live births during your life. Is this correct?
[] Yes. Check below:
[] No live births (Go to illness symptoms module)
[] One or more live births (Continue with CM12 or birth history module)
[] One or more live births (Continue with CM12 or birth history module)
[] No (Check responses to CM1-CM10 and make corrections as necessary before proceeding to CM12, the birth history module, or illness symptoms module)
[Note: Not all countries have a Birth History Module.]
Birth History: BH
Now I would like to record the names of all of your births, whether still alive or not, starting with the first one you had.
Record names of all of the births in BH1. Record twins and triplets on separate line. If there are more than 14 births, use an additional questionnaire.
BH Line No. _ _
BH1. What name was given to your (first/next) baby? ____
BH2. Were any of these births twins?
[] 1 Single
[] 2 Multiple
[] 2 Multiple
BH3. Is (name) a boy or a girl?
[] 1 Boy
[] 2 Girl
[] 2 Girl
BH4. In what month and year was (name) born?
Probe: what is his/her birthday?
_ _ Month
_ _ _ _ Year
_ _ _ _ Year
BH5. Is (name) still alive?
[] 1 Yes
[] 2 No (Go to BH9)
[] 2 No (Go to BH9)
BH6. How old was (name) at his/her last birthday?
Record age in completed years. _ _
BH7. Is (name) living with you?
[] 1 Yes
[] 2 No
[] 2 No
BH8. Record household line number of child (from HL1)
Record "00" if child is not listed. _ _ (Go to BH10)
BH9. If dead: How old was (name) when he/she died?
If "1 year", probe: How many months old was (name)? Record days if less than 1 month; record months if less than 2 years; or years
Unit
[] 1 Days
[] 2 Months
[] 3 Years
[] 1 Days
[] 2 Months
[] 3 Years
Number _ _
BH10. Were there any other live births between (name of previous birth) and (name), including any children who died after birth?
[] 1 Yes (Add birth)
[] 2 No (Go to next birth)
[] 2 No (Go to next birth)
[p. 6]
BH11. Have you had any live births since the birth of (name of last birth in Birth History)?
[] 1 Yes (Record birth(s) in birth history)
[] 2 No
[] 2 No
[If the country has a birth history module:]
CM12. Compare number in CM10 with number of births in the birth history above and check:
[] Numbers are same [Continue with CM13]
[] Numbers are different [Probe and reconcile]
[] Numbers are different [Probe and reconcile]
[If the country does not have a birth history module:]
CM12: Of these (total number in CM10) births you have had, when did you deliver the last one (even if he or she has died)?
Month and year must be recorded.
Date of first birth
_ _ Day
[] 98 DK day
_ _ Month
_ _ _ _ Year
[] 98 DK day
_ _ Month
_ _ _ _ Year
CM13. Check CM12 [or BH4 in the birth history module]: Last birth occurred within the last 2 years, that is, since (day and month of interview) in [2010]
[] No live birth in last 2 years. (Go to illness symptoms module)
[] One or more live births in last 2 years. (Record/ask for the name of the last-born child and continue with the next module)
[] One or more live births in last 2 years. (Record/ask for the name of the last-born child and continue with the next module)
Name of last-born child ____
If child has died, take special care when referring to this child by name in the following modules.
Continue with the next module.
[p. 6]
Desire for last birth: DB
This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.
DB1. When you got pregnant with (name), did you want to get pregnant at that time?
[] 1 Yes (Go to next module)
[] 2 No
[] 2 No
DB2. Did you want to have a baby later on, or did you not want any (more) children?
[] 1 Later
[] 2 No more (Go to next module)
[] 2 No more (Go to next module)
DB3. How much longer did you want to wait?
[] 1 Months _ _
[] 2 Years _ _
[] 998 DK
[] 2 Years _ _
[] 998 DK
[p. 7]
Maternal and newborn health: MN
This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.
MN1. Did you see anyone for antenatal care during your pregnancy with (name)?
[] 1 Yes
[] 2 No (Go to MN5)
[] 2 No (Go to MN5)
MN2. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and circle all answers given.
Health professional
[] A Doctor
[] B Nurse/Midwife
[] C Auxiliary midwife
[] B Nurse/Midwife
[] C Auxiliary midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] G Community health worker
[] X Other (specify) ____
MN3. How many times did you receive antenatal care during this pregnancy?
_ _ Number of times
[] 98 DK
[] 98 DK
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?
[] 1 Yes
[] 2 No
[] 2 No
[B] Did you give a urine sample?
[] 1 Yes
[] 2 No
[] 2 No
[C] Did you give a blood sample?
[] 1 Yes
[] 2 No
[] 2 No
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.
[] 1 Yes (card seen)
[] 2 Yes (card not seen)
[] 3 No
[] 8 DK
[] 2 Yes (card not seen)
[] 3 No
[] 8 DK
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?
[] 1 Yes
[] 2 No (Go to MN9)
[] 8 DK (Go to MN9)
[] 2 No (Go to MN9)
[] 8 DK (Go to MN9)
MN7. How many times did you receive this tetanus injection during your pregnancy with (name)?
If 7 or more times, record '7'.
_ Number of times
[] 8 DK (Go to MN9)
[] 8 DK (Go to MN9)
MN8. How many tetanus injections during last pregnancy were reported in MN7?
[] At least two tetanus injections during last pregnancy (Go to MN12)
[] Only one tetanus injection during last pregnancy (Continue with MN9)
[] Only one tetanus injection during last pregnancy (Continue with MN9)
[p. 8]
MN9. Did you receive any tetanus injection at any time before your pregnancy with (name), either to protect yourself or another baby?
[] 1 Yes
[] 2 No (Go to MN12)
[] 8 DK (Go to MN12)
[] 2 No (Go to MN12)
[] 8 DK (Go to MN12)
MN10. How many times did you receive a tetanus injection before your pregnancy with (name)?
If 7 or more times, record '7'.
_ Number of times
[] 8 DK (Go to MN12)
[] 8 DK (Go to MN12)
MN11. How many years ago did you receive the last tetanus injection before your pregnancy with (name)?
_ _ Years ago
MN12. Check MN1 for presence of antenatal care during this pregnancy:
[] Yes, antenatal care received (Continue with MN13)
[] No antenatal care received (Go to MN17)
[] No antenatal care received (Go to MN17)
MN13. During any of these antenatal visits for the pregnancy, did you take any medicine in order to prevent you from getting malaria?
[] 1 Yes
[] 2 No (Go to MN17)
[] 8 DK (Go to MN17)
[] 2 No (Go to MN17)
[] 8 DK (Go to MN17)
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.
[] A SP/Fansidar
[] B Chloroquine
[] X Other (specify)____
[] Z DK
[] B Chloroquine
[] X Other (specify)____
[] Z DK
MN15. Check MN14 for medicine taken:
[] SP/Fansidar taken. (Go to MN16)
[] SP/Fansidar not taken (Go to MN17)
[] SP/Fansidar not taken (Go to MN17)
MN16. During this pregnancy, how many times did you take SP/Fansidar?
_ _ Number of times
[] 98 DK
[] 98 DK
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.
Health professional
[] A Doctor
[] B Nurse/Midwife
[] C Auxiliary midwife
[] B Nurse/Midwife
[] C Auxiliary midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/Friend
[] G Community health worker
[] H Relative/Friend
[] X Other (specify) ____
[] Y No one
[] Y No one
[p. 9]
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) ____
Home
[] 11 Your home (Go to MN20)
[] 12 Other home (Go to MN20)
[] 12 Other home (Go to MN20)
Public sector
[] 21 Govt. hospital
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____ (Go to MN20)
MN19. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?
[] 1 Yes
[] 2 No
[] 2 No
MN20. When (name) was born, was he/she very large, larger than average, average, smaller than average, or very small?
[] 1 Very large
[] 2 Larger than average
[] 3 Average
[] 4 Smaller than average
[] 5 Very small
[] 8 DK
[] 2 Larger than average
[] 3 Average
[] 4 Smaller than average
[] 5 Very small
[] 8 DK
MN21. Was (name) weighed at birth?
[] 1 Yes
[] 2 No (Go to MN23)
[] 8 DK (Go to MN23)
[] 2 No (Go to MN23)
[] 8 DK (Go to MN23)
MN22. How much did (name) weigh?
Record weight from health card, if available.
[] 1 From card (kg) _ _ _ _
[] 2 From recall (kg) _ _ _ _
[] 99998 DK
[] 2 From recall (kg) _ _ _ _
[] 99998 DK
MN23. Has your menstrual period returned since the birth of (name)?
[] 1 Yes
[] 2 No
[] 2 No
MN24. Did you ever breastfeed (name)?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
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.
[] 000 Immediately
[] 1 Hours _ _
[] 2 Days _ _
[] 998 Don't know/remember
[] 1 Hours _ _
[] 2 Days _ _
[] 998 Don't know/remember
[p. 10]
MN26. In the first three days after delivery, was (name) given anything to drink other than breast milk?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
MN27. What was (name) given to drink?
Probe: Anything else?
[] A Milk (other than breast milk)
[] B Plain water
[] C Sugar or glucose water
[] D Gripe water
[] E Sugar-salt-water solution
[] F Fruit juice
[] G Infant formula
[] H Tea/Infusions
[] I Honey
[] X Other (specify) ____
[] B Plain water
[] C Sugar or glucose water
[] D Gripe water
[] E Sugar-salt-water solution
[] F Fruit juice
[] G Infant formula
[] H Tea/Infusions
[] I Honey
[] X Other (specify) ____
[p. 11]
Post-natal health checks: PN
This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.
Check child mortality module CM13 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.
PN1. Check MN18: Was the child delivered in a health facility?
[] Yes, the child was delivered in a health facility (MN18=21-26 or 31-36) (Continue with PN2)
[] No, the child was not delivered in a health facility (MN18=11-12 or 96) (Go to PN6)
[] No, the child was not delivered in a health facility (MN18=11-12 or 96) (Go to PN6)
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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 Don't know/remember
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 Don't know/remember
PN3. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the cord, or seeing if (name) is ok. Before you left the (name or type of facility in MN18), did anyone check on (name)'s health?
[] 1 Yes
[] 2 No
[] 2 No
PN4. And what about checks on your health - I mean, someone assessing your health, for example asking questions about your health or examining you. Did anyone check on your health before you left (name or type or facility in MN18)?
[] 1 Yes
[] 2 No
[] 2 No
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)?
[] 1 Yes (Go to PN11)
[] 2 No (Go to PN16)
[] 2 No (Go to PN16)
PN6. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
[] Yes, delivery assisted by a health professional, traditional birth attendant, or community health worker (MN17=A-G) (Continue with PN7)
[] No, delivery not assisted by a health professional, traditional birth attendant, or community health worker (A-G not circled in MN17) (Go to PN10)
[] No, delivery not assisted by a health professional, traditional birth attendant, or community health worker (A-G not circled in MN17) (Go to PN10)
[p. 12]
PN7. You have already said that (person or persons in MN17) assisted with the birth. Now I would like to talk to you about checks on (name)'s health after delivery, for example examining (name), checking the cord, or seeing if (name) is ok.
After the delivery was over and before (person or persons in MN17) left you, did (person or persons in MN17) check on (name)'s health?
[] 1 Yes
[] 2 No
[] 2 No
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.
[] 1 Yes
[] 2 No
[] 2 No
PN9. After the (person or persons in MN17) left you, did anyone check on the health of (name)?
[] 1 Yes (Go to PN11)
[] 2 No (Go to PN18)
[] 2 No (Go to PN18)
PN10. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the cord, or seeing if the baby is ok. After (name) was delivered, did anyone check on his/her health?
[] 1 Yes
[] 2 No (Go to PN19)
[] 2 No (Go to PN19)
PN11. Did such a check happen only once, or more than once?
[] 1 Once (Go to PN12A)
[] 2 More than once (Go to PN12B)
[] 2 More than once (Go to PN12B)
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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 Don't know/remember
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 Don't know/remember
[p. 13]
PN13. Who checked on (name)'s health at that time?
Health professional
[] A Doctor
[] B Nurse/Midwife
[] C Auxiliary Midwife
[] B Nurse/Midwife
[] C Auxiliary Midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/Friend
[] G Community health worker
[] H Relative/Friend
[] X Other (specify) ____
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) ____
Home
[] 11 Your home
[] 12 Other home
[] 12 Other home
Public sector
[] 21 Govt. hospital
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____
PN15. Check MN18: Was the child delivered in a health facility?
[] Yes, the child was delivered in a health facility (MN18=21-26 or 31-36) (Continue with PN16)
[] No, the child was not delivered in a health facility (MN18=11-12 or 96) (Go to PN17)
[] No, the child was not delivered in a health facility (MN18=11-12 or 96) (Go to PN17)
PN16. After you left (name or type of facility in MN18), did anyone check on your health?
[] 1 Yes (Go to PN20)
[] 2 No (Go to next module)
[] 2 No (Go to next module)
PN17. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
[] Yes, delivery assisted by a health professional, traditional birth attendant, or community health worker (MN17=A-G) (Continue with PN18)
[] No, delivery not assisted by a health professional, traditional birth attendant, or community health worker (A-G not circled in MN17) (Go to PN19)
[] No, delivery not assisted by a health professional, traditional birth attendant, or community health worker (A-G not circled in MN17) (Go to PN19)
PN18. After the delivery was over and (person or persons in MN17) left, did anyone check on your health?
[] 1 Yes (Go to PN20)
[] 2 No (Go to next module)
[] 2 No (Go to next module)
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.
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
[p. 14]
PN20. Did such a check happen only once, or more than once?
[] 1 Once (Go to PN21A)
[] 2 More than once (Go to PN21B)
[] 2 More than once (Go to PN21B)
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.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 Don't know/remember
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 Don't know/remember
PN22. Who checked on your health at that time?
Health professional
[] A Doctor
[] B Nurse/Midwife
[] C Auxiliary midwife
[] B Nurse/Midwife
[] C Auxiliary midwife
Other person
[] F Traditional birth attendant
[] G Community health worker
[] H Relative/Friend
[] G Community health worker
[] H Relative/Friend
[] X Other (specify) ____
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) ____
Home
[] 11 Your home
[] 12 Other home
[] 12 Other home
Public sector
[] 21 Govt. hospital
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
[] 22 Govt. clinic/health centre
[] 23 Govt. health post
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private medical (specify) ____
[] 96 Other (specify) ____
[p. 15]
Illness Symptoms: IS
IS1. Check Household Listing, column HL9
Is the respondent the mother or caretaker of any child under age 5?
[] Yes (Continue with IS2)
[] No (Go to next module)
[] No (Go to next module)
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
[] A Child not able to drink or breastfeed
[] B Child becomes sicker
[] C Child develops a fever
[] D Child has fast breathing
[] E Child has difficult breathing
[] F Child has blood in stool
[] G Child is drinking poorly
[] X Other (specify) ____
[] Y Other (specify) ____
[] Z Other (specify) ____
[] B Child becomes sicker
[] C Child develops a fever
[] D Child has fast breathing
[] E Child has difficult breathing
[] F Child has blood in stool
[] G Child is drinking poorly
[] X Other (specify) ____
[] Y Other (specify) ____
[] Z Other (specify) ____
[p. 16]
Contraception: CP
CP1. I would like to talk with you about another subject ? family planning.
Are you pregnant now?
[] 1 Yes, currently pregnant (Go to next module)
[] 2 No
[] 8 Unsure or DK
[] 2 No
[] 8 Unsure or DK
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?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
CP3. What are you doing to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, circle each one.
[] A Female sterilization
[] B Male sterilization
[] C IUD
[] D Injectables
[] E Implants
[] F Pill
[] G Male condom
[] H Female condom
[] I Diaphragm
[] J Foam/jelly
[] K Lactational amenorrhoea method (LAM)
[] L Periodic abstinence/rhythm
[] M Withdrawal
[] X Other (specify) ____
[] B Male sterilization
[] C IUD
[] D Injectables
[] E Implants
[] F Pill
[] G Male condom
[] H Female condom
[] I Diaphragm
[] J Foam/jelly
[] K Lactational amenorrhoea method (LAM)
[] L Periodic abstinence/rhythm
[] M Withdrawal
[] X Other (specify) ____
[p. 17]
Unmet need: UN
UN1. Check CP1. Currently pregnant?
[] Yes, currently pregnant (Continue with UN2)
[] No, unsure or DK (Go to UN5)
[] No, unsure or DK (Go to UN5)
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?
[] 1 Yes (Go to UN4)
[] 2 No
[] 2 No
UN3. Did you want to have a baby later on or did you not want any (more) children?
[] 1 Later
[] 2 No More
[] 2 No More
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?
[] 1 Have another child (Go to UN7)
[] 2 No more/none (Go to UN13)
[] 8 Undecided/don't know (Go to UN13)
[] 2 No more/none (Go to UN13)
[] 8 Undecided/don't know (Go to UN13)
UN5. Check CP3. Currently using "female sterilization"
[] Yes (Go to UN13)
[] No (Continue with UN6)
[] No (Continue with UN6)
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?
[] 1 Have (a/another) child
[] 2 No more/none (Go to UN9)
[] 3 Says she cannot get pregnant (Go to UN11)
[] 8 Undecided/don't know (Go to UN9)
[] 2 No more/none (Go to UN9)
[] 3 Says she cannot get pregnant (Go to UN11)
[] 8 Undecided/don't know (Go to UN9)
UN7. How long would you like to wait before the birth of (a/another) child?
[] 1 Months _ _
[] 2 Years _ _
[] 993 Soon/now
[] 994 Says she cannot get pregnant (Go to UN11)
[] 995 After Marriage
[] 996 Other
[] 998 Don't know
[] 2 Years _ _
[] 993 Soon/now
[] 994 Says she cannot get pregnant (Go to UN11)
[] 995 After Marriage
[] 996 Other
[] 998 Don't know
UN8. Check CP1. Currently pregnant?
[] Yes, currently pregnant (Go to UN13)
[] No, unsure or DK (Continue with UN9)
[] No, unsure or DK (Continue with UN9)
[p. 18]
UN9. Check CP2. Currently using a method?
[] Yes (Go to UN13)
[] No (Continue with UN10)
[] No (Continue with UN10)
UN10. Do you think you are physically able to get pregnant at this time?
[] 1 Yes (Go to UN13)
[] 2 No
[] 8 DK (Go to UN13)
[] 2 No
[] 8 DK (Go to UN13)
UN11. Why do you think you are not physically able to get pregnant?
[] A Infrequent sex/no sex
[] B Menopausal
[] C Never menstruated
[] D Hysterectomy (surgical removal of uterus)
[] E Has been trying to get pregnant for 2 years or more without result
[] F Postpartum amenorrheic
[] G Breastfeeding
[] H Too old
[] I Fatalistic
[] X Other (specify) ____
[] Z Don't know
[] B Menopausal
[] C Never menstruated
[] D Hysterectomy (surgical removal of uterus)
[] E Has been trying to get pregnant for 2 years or more without result
[] F Postpartum amenorrheic
[] G Breastfeeding
[] H Too old
[] I Fatalistic
[] X Other (specify) ____
[] Z Don't know
UN12. Check UN11. "Never menstruated" mentioned?
[] Mentioned (Go to next module)
[] Not mentioned (Continue with UN13)
[] Not mentioned (Continue with UN13)
UN13. When did your last menstrual period start?
Record the answer using the same unit stated by the respondent
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _
[] 994 In menopause/has had hysterectomy
[] 995 Before last birth
[] 996 Never menstruated
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _
[] 994 In menopause/has had hysterectomy
[] 995 Before last birth
[] 996 Never menstruated
[p. 19]
Female genital mutilation/cutting: FG
FG1. Have you ever heard of female circumcision?
[] 1 Yes (Go to FG3)
[] 2 No
[] 2 No
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?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
FG3. Have you yourself ever been circumcised?
[] 1 Yes
[] 2 No (Go to FG9)
[] 2 No (Go to FG9)
FG4. Now I would like to ask you what was done to you at that time. Was any flesh removed from the genital area?
[] 1 Yes (Go to FG6)
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG5. Was the genital area just nicked without removing any flesh?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG6. Was the genital area sewn closed?
If necessary, probe: Was it sealed?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG7. How old were you when you were circumcised?
If the respondent does not know the exact age, probe to get an estimate
_ _ Age at circumcision
[] 98 DK/don't remember/not sure
[] 98 DK/don't remember/not sure
FG8. Who performed the circumcision?
Health professional
[] 11 Doctor
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
Traditional persons
[] 21 Traditional 'circumciser'
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 98 DK
FG9. Check CM5 for Number of daughters at home and CM7 for Number of daughters elsewhere, and sum the answers here
Total number of living daughters _ _
FG10. Just to make sure that I have this right, you have (total number in FG9) living daughters. Is this correct?
[] Yes
[] One or more living daughters (Continue with FG11)
[] Does not have any living daughters (Go to FG22)
[] Does not have any living daughters (Go to FG22)
[] No (Check responses to CM1-CM10 and make corrections as necessary, until FG10 = Yes)
[p. 20]
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 questionnaires
FG12. Name of Daughter ____
FG13. How old is (name)?
_ _ Age
FG14. Is (name) younger than 15 years of age?
[] 1 Yes
[] 2 No (If "no", go to FG13 for next daughter. If no more daughters, go to FG22.)
[] 2 No (If "no", go to FG13 for next daughter. If no more daughters, go to FG22.)
FG15. Is (name) circumcised?
[] 1 Yes
[] 2 No
If "no", go to FG13 for next daughter. If no more daughters, go to FG22
[] 2 No
If "no", go to FG13 for next daughter. If no more daughters, go to FG22
FG16. How old was (name) when this occurred?
If the respondent does not know the age, probe to get an estimate.
_ _ Age
[] 98 DKfirst
[] 98 DKfirst
FG17. Now I would like to ask you what was done to (name) at that time.
Was any flesh removed from the genital area?
[] 1 Yes (Go to FG19)
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG18. Was her genital area just nicked without removing any flesh?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[p. 21]
FG19. Was her genital area sewn closed?
If necessary, probe: Was it sealed?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG20. Who performed the circumcision?
Health professional
[] 11 Doctor
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
Traditional persons
[] 21 Traditional 'circumciser'
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 22 Traditional birth attendant
[] 26 Other traditional (specify) ____
[] 98 DK
FG21.
Go back to FG13 in first column of additional questionnaire for next daughter. If no more daughters, go to FG22
[] Tick here if additional questionnaire used
FG22. Do you think this practice should be continued or should it be discontinued?
[] 1 Continued
[] 2 Discontinued
[] 3 Depends
[] 8 DK
[] 2 Discontinued
[] 3 Depends
[] 8 DK
[p. 22]
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?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[B] If she neglects the children?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] If she argues with him?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[D] If she refuses to have sex with him?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[E] If she burns the food?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[p. 23]
Marriage/union: MA
MA1. Are you currently married or living together with a man as if married?
[] 1 Yes, currently married
[] 2 Yes, living with a man
[] 3 No, not in union (Go to MA5)
[] 2 Yes, living with a man
[] 3 No, not in union (Go to MA5)
MA2. How old is your husband/partner?
Probe: how old was your husband/partner on his last birthday?
_ _ Age in years
[] 98 DK
[] 98 DK
MA3. Besides yourself, does your husband/partner have any other wives or partners or does he live with other women as if married?
[] 1 Yes
[] 2 No (Go to MA7)
[] 2 No (Go to MA7)
MA4. How many other wives or partners does he have?
_ _ Number (Go to MA7)
[] 98 DK (Go to MA7)
[] 98 DK (Go to MA7)
MA5. Have you ever been married or lived together with a man as if married?
[] 1 Yes, formerly married
[] 2 Yes, formerly lived with a man
[] 3 No, not in union (Go to next module)
[] 2 Yes, formerly lived with a man
[] 3 No, not in union (Go to next module)
MA6. What is your marital status now: are you widowed, divorced or separated?
[] 1 Widowed
[] 2 Divorced
[] 3 Separated
[] 2 Divorced
[] 3 Separated
MA7. Have you been married or lived with a man only once or more than once?
[] 1 Only once
[] 2 More than once
[] 2 More than once
MA8. In what month and year did you first marry or start living with a man as if married?
Date of first marriage
_ _ Month
[] 98 DK month
_ _ _ _ Year (Go to next module)
[] 9998 DK year
[] 98 DK month
_ _ _ _ Year (Go to next module)
[] 9998 DK year
MA9. How old were you when you started living with your first husband/partner?
Age in years _ _
[p. 24]
Sexual behavior: SB
Check for the presence of others. Before continuing, ensure privacy.
SB1. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
The information you supply will remain strictly confidential.
How old were you when you had sexual intercourse for the very first time?
[] 00 Never had intercourse (Go to next module)
_ _ Age in years
[] 95 First time when started living with (first) husband/partner
_ _ Age in years
[] 95 First time when started living with (first) husband/partner
SB2. The first time you had sexual intercourse, was a condom used?
[] 1 Yes
[] 2 No
[] 8 DK/don't remember
[] 2 No
[] 8 DK/don't remember
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 more than 12 months (one year), answer must be recorded in years.
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _ (Go to SB15)
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _ (Go to SB15)
SB4. The last time you had sexual intercourse, was a condom used?
[] 1 Yes
[] 2 No
[] 2 No
SB5. What was your relationship to this person with whom you last had sexual intercourse?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse.
If 'boyfriend', then ask: Were you living together as if married? If 'yes', circle '2'. If 'no', circle'3'.
[] 1 Husband
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB7)
[] 4 Casual acquaintance (Go to SB7)
[] 6 Other (specify) ____ (Go to SB7)
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB7)
[] 4 Casual acquaintance (Go to SB7)
[] 6 Other (specify) ____ (Go to SB7)
SB6. Check MA1:
[] Currently married or living with a man (MA1 = 1 or 2) (Go to SB8)
[] Not married / Not in union (MA1 = 3) (Continue with SB7)
[] Not married / Not in union (MA1 = 3) (Continue with SB7)
SB7. How old is this person?
If response is DK, probe: About how old is this person?
_ _ Age of sexual partner
[] 98 DK
[] 98 DK
SB8. Have you had sexual intercourse with any other person in the last 12 months?
[] 1 Yes
[] 2 No (Go to SB15)
[] 2 No (Go to SB15)
SB9. The last time you had sexual intercourse with this other person, was a condom used?
[] 1 Yes
[] 2 No
[] 2 No
[p. 25]
SB10. What was your relationship to this person?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If 'boyfriend' then ask: Were you living together as if married? If 'yes', circle '2'. If 'no', circle '3'.
[] 1 Husband
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB12)
[] 4 Casual acquaintance (Go to SB12)
[] 6 Other (specify) ____ (Go to SB12)
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB12)
[] 4 Casual acquaintance (Go to SB12)
[] 6 Other (specify) ____ (Go to SB12)
SB11. Check MA1 and MA7:
[] Currently married or living with a man (MA1 = 1 or 2) and Married only once or lived with a man only once (MA7 = 1) (Go to SB13)
[] Else (Continue with SB12)
[] Else (Continue with SB12)
SB12. How old is this person?
If response is DK, probe: About how old is this person?
_ _ Age of sexual partner
[] 98 DK
[] 98 DK
SB13. Other than these two persons, have you had sexual intercourse with any other person in the last 12 months?
[] 1 Yes
[] 2 No (Go to SB15)
[] 2 No (Go to SB15)
SB14. In total, with how many different people have you had sexual intercourse in the last 12 months?
_ _ Number of partners
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'.
_ _ Number of lifetime partners
[] 98 DK
[] 98 DK
[p. 26]
HIV/AIDS: HA
HA1. Now I would like to talk with you about something else.
Have you ever heard of an illness called AIDS?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
HA2. Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA3. Can people get the AIDS virus because of witchcraft or other supernatural means?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA4. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA5. Can people get the AIDS virus from mosquito bites?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA6. Can people get the aids virus by sharing food with a person who has the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA7. Is it possible for a healthy-looking person to have the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA8. Can the virus that causes AIDS be transmitted from a mother to her baby:
[A] During pregnancy?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[B] During delivery?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] By breastfeeding?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
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?
[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends
[] 2 No
[] 8 DK/not sure/depends
HA10. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends
[] 2 No
[] 8 DK/not sure/depends
HA11. If a member of your family got infected with the AIDS virus, would you want it to remain a secret?
[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends
[] 2 No
[] 8 DK/not sure/depends
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?
[] 1 Yes
[] 2 No
[] 8 DK/not sure/depends
[] 2 No
[] 8 DK/not sure/depends
[p. 27]
HA13. Check CM13: Any live birth in last 2 years?
[] No live birth in last 2 years (CM13="No" or blank) (Go to HA24)
[] One or more live births in last 2 years (Continue with HA14)
[] One or more live births in last 2 years (Continue with HA14)
HA14. Check MN1: Received antenatal care?
[] Received antenatal care (Continue with HA15)
[] Did not receive antenatal care (Go to HA24)
[] Did not receive antenatal care (Go to HA24)
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?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[B] Things that you can do to prevent getting the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] Getting tested for the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
Were you:
[D] Offered a test for the AIDS virus?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA16. I don't want to know the results, but were you tested for the AIDS virus as part of your antenatal care?
[] 1 Yes
[] 2 No (Go to HA19)
[] 8 DK (Go to HA19)
[] 2 No (Go to HA19)
[] 8 DK (Go to HA19)
HA17. I don't want to know the results, but did you get the results of the test?
[] 1 Yes
[] 2 No (Go to HA22)
[] 8 DK (Go to HA22)
[] 2 No (Go to HA22)
[] 8 DK (Go to HA22)
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?
[] 1 Yes (Go to HA22)
[] 2 No (Go to HA22)
[] 8 DK (Go to HA22)
[] 2 No (Go to HA22)
[] 8 DK (Go to HA22)
HA19. Check MN17: Birth delivered by health professional (A, B or C)?
[] Yes, birth delivered by health professional (Continue with HA20)
[] No, birth not delivered by health professional (Go to HA24)
[] No, birth not delivered by health professional (Go to HA24)
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?
[] 1 Yes
[] 2 No (Go to HA24)
[] 2 No (Go to HA24)
HA21. I don't want to know the results, but did you get the results of the test?
[] 1 Yes
[] 2 No
[] 2 No
HA22. Have you been tested for the AIDS virus since that time you were tested during your pregnancy?
[] 1 Yes
[] 2 No (Go to HA25)
[] 2 No (Go to HA25)
[p. 28]
HA23. When was the most recent time you were tested for the AIDS virus?
[] 1 Less than 12 months ago (Go to next module)
[] 2 12-23 months ago (Go to next module)
[] 3 2 or more years ago (Go to next module)
[] 2 12-23 months ago (Go to next module)
[] 3 2 or more years ago (Go to next module)
HA24. I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
[] 1 Yes
[] 2 No (Go to HA27)
[] 2 No (Go to HA27)
HA25. When was the most recent time you were tested?
[] 1 Less than 12 months ago
[] 2 12-23 months ago
[] 3 2 or more years ago
[] 2 12-23 months ago
[] 3 2 or more years ago
HA26. I don't want to know the results, but did you get the results of the test?
[] 1 Yes (Go to next module)
[] 2 No (Go to next module)
[] 8 DK (Go to next module)
[] 2 No (Go to next module)
[] 8 DK (Go to next module)
HA27. Do you know of a place where people can go to get tested for the AIDS virus?
[] 1 Yes
[] 2 No
[] 2 No
[p. 29]
Maternal mortality: MM
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. Please include all your sisters and brothers who are living with you, those who are living elsewhere, and those who have died.
MM1. How many children did your mother give birth to, including yourself?
_ _ Number of births to natural mother
MM2. Check MM1.
[] Two or more births (Continue with MM3)
[] Only one birth (respondent only) (Go to next module)
[] Only one birth (respondent only) (Go to next module)
MM3. How many of these births did your mother have before you were born?
_ _ Number of preceding births
MM4. What name was given to your oldest (next oldest) brother or sister? ____
MM5. Is (name) male or female?
[] 1 Male
[] 2 Female
[] 2 Female
MM6. Is (name) still alive?
[] 1 Yes
[] 2 No (Go to MM8)
[] 8 DK (Go to [S2 or next sibling])
[] 2 No (Go to MM8)
[] 8 DK (Go to [S2 or next sibling])
MM7. How old is (name)? _ _ (Go to [S2 or next sibling])
MM8. How many years ago did (name) die? _ _
MM9. How old was (name) when he/she died?
_ _ If male or died before age 12, (go to [S2 or next sibling])
MM10. Was (name) pregnant when she died?
[] 1 Yes (Go to MM13)
[] 2 No
[] 2 No
MM11. Did (name) die during childbirth?
[] 1 Yes (Go to MM13)
[] 2 No
[] 2 No
MM12. Did (name) die within two months after the end of a pregnancy or childbirth?
[] 1 Yes
[] 2 No
[] 2 No
MM13. How many live born children did (name) give birth to during her lifetime? _ _
MM14. If no more siblings, go to next module
[p. 30]
[] Tick here if additional questionnaire used
[p. 31]
Tobacco and alcohol use: TA
TA1. Have you ever tried cigarette smoking, even one or two puffs?
[] 1 Yes
[] 2 No (Go to TA6)
[] 2 No (Go to TA6)
TA2. How old were you when you smoked a whole cigarette for the first time?
[] 00 Never smoked a whole cigarette (Go to TA6)
_ _ Age
_ _ Age
TA3. Do you currently smoke cigarettes?
[] 1 Yes
[] 2 No (Go to TA6)
[] 2 No (Go to TA6)
TA4. In the last 24 hours, how many cigarettes did you smoke?
_ _ Number of cigarettes
TA5. During the last one month, on how many days did you smoke cigarettes?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
[] 0 Number of days _
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
TA6. Have you ever tried any smoked tobacco products other than cigarettes, such as cigars, water pipe, cigarillos or pipe?
[] 1 Yes
[] 2 No (Go to TA10)
[] 2 No (Go to TA10)
TA7. During the last one month, did you use any smoked tobacco products?
[] 1 Yes
[] 2 No (Go to TA10)
[] 2 No (Go to TA10)
TA8. What type of smoked tobacco product did you use or smoke during the last one month?
Circle all mentioned.
[] A Cigars
[] B Water pipe
[] C Cigarillos
[] D Pipe
[] X Other (specify) ____
[] B Water pipe
[] C Cigarillos
[] D Pipe
[] X Other (specify) ____
TA9. During the last one month, on how many days did you use smoked tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
[] 0 Number of days _
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
TA10. Have you ever tried any form of smokeless tobacco products, such as chewing tobacco, snuff, or dip?
[] 1 Yes
[] 2 No (Go to TA14)
[] 2 No (Go to TA14)
TA11. During the last one month, did you use any smokeless tobacco products?
[] 1 Yes
[] 2 No (Go to TA14)
[] 2 No (Go to TA14)
[p. 32]
TA12. What type of smokeless tobacco product did you use during the last one month?
Circle all mentioned.
[] A Chewing tobacco
[] B Snuff
[] C Dip
[] X Other (specify) ____
[] B Snuff
[] C Dip
[] X Other (specify) ____
TA13. During the last one month, on how many days did you use smokeless tobacco products?
If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
[] 0 Number of days _
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
TA14. Now I would like to ask you some questions about drinking alcohol.
Have you ever drunk alcohol?
[] 1 Yes
[] 2 No (Go to next module)
[] 2 No (Go to next module)
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?
[] 00 Never had one drink of alcohol (Go to next module)
_ _ Age
_ _ Age
TA16. During the last one month, on how many days did you have at least one drink of alcohol?
If respondent did not drink, circle "00". If less than 10 days, record the number of days. If 10 days or more but less than a month, circle "10". If "everyday" or "almost every day", circle "30"
[] 00 Did not have one drink in last one month (Go to next module)
[] 0 Number of days _
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
[] 0 Number of days _
[] 10 10 days or more but less than a month
[] 30 Everyday/almost every day
TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have?
_ _ Number of drinks
[p. 33]
Life satisfaction: LS
LS1. Check WB2: Age of respondent is between 15 and 24?
[] Age 25-49 (Go to WM11)
[] Age 15-24 (Continue with LS2)
[] Age 15-24 (Continue with LS2)
LS2. I would like to ask you some simple questions on happiness and satisfaction.
First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy?
You can also look at these pictures to help you with your response.
Show side 1 of response card and explain what each symbol represents. Circle the response code pointed by the respondent. [Image omitted.]
[] 1 Very happy
[] 2 Somewhat happy
[] 3 Neither happy nor unhappy
[] 4 Somewhat unhappy
[] 5 Very unhappy
[] 2 Somewhat happy
[] 3 Neither happy nor unhappy
[] 4 Somewhat unhappy
[] 5 Very unhappy
LS3. Now I will ask you questions about your level of satisfaction in different areas.
In each case, we have five possible responses: please tell me, for each question, whether you are very satisfied, somewhat satisfied, neither satisfied nor unsatisfied, somewhat unsatisfied or very unsatisfied.
Again, you can look at these pictures to help you with your response.
Show side 2 of response card and explain what each symbol represents. Circle the response code shown by the respondent, for questions LS3 to LS13. [Image omitted.]
How satisfied are you with your family life?
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS4. How satisfied are you with your friendships?
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS5. During the [current / 2011-2012] school year, did you attend school at any time?
[] 1 Yes
[] 2 No (Go to LS7)
[] 2 No (Go to LS7)
[p. 34]
LS6. How satisfied (are/were) you with your school?
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS7. How satisfied are you with your current job?
If the respondent says that he/she does not have a job, circle "0" and continue with the next question. Do not probe to find out how she feels about not having a job, unless she tells you herself.
[] 0 Does not have a job
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS8. How satisfied are you with your health?
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
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.
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS10. How satisfied are you with how people around you generally treat you?
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS11. How satisfied are you with the way you look?
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS12. How satisfied are you with your life, overall?
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS13. How satisfied are you with your current income?
If the respondent responds that he/she does not have any income, circle "0" and continue with the next question. Do not probe to find out how she feels about not having any income, unless she tells you herself.
[] 0 Does not have any income
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
[] 1 Very satisfied
[] 2 Somewhat satisfied
[] 3 Neither satisfied nor unsatisfied
[] 4 Somewhat unsatisfied
[] 5 Very unsatisfied
LS14. Compared to this time last year, would you say that your life has improved, stayed more or less the same, or worsened, overall?
[] 1 Improved
[] 2 More or less the same
[] 3 Worsened
[] 2 More or less the same
[] 3 Worsened
[p. 35]
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?
[] 1 Better
[] 2 More or less the same
[] 3 Worse
[] 2 More or less the same
[] 3 Worse
[p. 36]
WM11. Record the time.
_ _ : _ _ Hour and minutes
WM12. Check Household Listing Form, column HL9.
Is the respondent the mother or caretaker of any child age 0-4 living in this household?
[] Yes (Go to questionnaire for children under five for that child and start the interview with this respondent.)
[] No (End the interview with this respondent by thanking her for her cooperation. Check for the presence of any other eligible woman, man or child under-5 in the household.)
[] No (End the interview with this respondent by thanking her for her cooperation. Check for the presence of any other eligible woman, man or child under-5 in the household.)
[p. 37]
Interviewer's observations
Field editor's observations
Supervisor's observations
[p. 38]
Response card:
Side 1
Very happy
Somewhat happy
Neither happy, nor unhappy
Somewhat unhappy
Very unhappy
Somewhat happy
Neither happy, nor unhappy
Somewhat unhappy
Very unhappy
Side 2
Very satisfied
Somewhat satisfied
Neither satisfied, not unsatisfied
Somewhat unsatisfied
Very unsatisfied
Somewhat satisfied
Neither satisfied, not unsatisfied
Somewhat unsatisfied
Very unsatisfied