Mics questionnaire for individual women
Tunisia 2017
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Woman's information panel: WM
WM1. Cluster number: _ _ _
WM2. Household number: _ _
WM3. Woman's name and line number:
Name ____ _ _
WM4. Supervisor's name and number:
Name ____ _ _ _
WM5. Interviewer's name and number:
Name ____ _ _ _
WM6. Day/month/year of interview:
_ _ / _ _ / 201 _
Check woman's age in HL6 in list of household members, household questionnaire: If age 15-17, verify in HH33 that adult consent for interview is obtained or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in WM17.
WM7. Record the time:
Hours : minutes _ _ : _ _
WM8. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?
[] 1 Yes, interviewed already (Go to WM9B)
[] 2 No, first interview (Go to WM9A)
[] 2 No, first interview (Go to WM9A)
WM9A. Hello, my name is (your name). We are from National Statistical Office. We are conducting a survey about the situation of children, families and households. I would like to talk to you about your health and other topics. This interview usually takes about 45 minutes. We are also interviewing mothers about their children. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
WM9B. Now I would like to talk to you about your health and other topics in more detail. This interview will take about 45 minutes. Again, all the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
[] 1 Yes (Go to woman's background module)
[] 2 No/not asked (Go to WM17)
[] 2 No/not asked (Go to WM17)
WM17. Result of woman's interview.
Discuss any result not completed with Supervisor.
[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for respondent age 15-17
[] 96 Other (specify) ____
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for respondent age 15-17
[] 96 Other (specify) ____
[p. 2]
Woman's background: WB
WB1. Check the respondent's line number (WM3) in woman's information panel and the respondent to the household questionnaire (HH47):
[] 1 WM3=HH47
[] 2 WM3 does not equal HH47 (Go to WB3)
[] 2 WM3 does not equal HH47 (Go to WB3)
WB2. Check ED5 in education module in the household questionnaire for this respondent: Highest level of school attended:
[] 1 ED5=2, 3 or 4 (Go to WB15)
[] 2 ED5=0, 1, 8 or blank (Go to WB14)
[] 2 ED5=0, 1, 8 or blank (Go to WB14)
WB3. 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
WB4. How old are you?
Probe: How old were you at your last birthday? If responses to WB3 and WB4 are inconsistent, probe further and correct. Age must be recorded.
Age (in completed years) _ _
WB5. Have you ever attended school or any early childhood education programme?
[] 1 Yes
[] 2 No (Go to WB14)
[] 2 No (Go to WB14)
WB6. What is the highest level and grade or year of school you have attended?
[] 000 Early childhood education (Go to WB14)
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Higher _ _
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Higher _ _
WB7. Did you complete that (grade/year)?
[] 1 Yes
[] 2 No
[] 2 No
WB8. Check WB4: Age of respondent:
[] 1 Age 15-24
[] 2 Age 25-49 (Go to WB13)
[] 2 Age 25-49 (Go to WB13)
WB9. At any time during the 2016/2017 school year did you attend school?
[] 1 Yes
[] 2 No (Go to WB11)
[] 2 No (Go to WB11)
WB10. During the 2016/2017 school year, which level and grade or year are you attending?
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Higher _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Higher _ _
WB11. At any time during the 2015/2016 school year did you attend school?
[] 1 Yes
[] 2 No (Go to WB13)
[] 2 No (Go to WB13)
WB12. During the 2015/2016 school year, which level and grade or year did you attend?
[] 1 Primary _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Higher _ _
[] 2 Lower secondary _ _
[] 3 Upper secondary _ _
[] 4 Higher _ _
WB13. Check WB6: Highest level of school attended:
[] 1 WB6=2, 3 or 4 (Go to WB15)
[] 2 WB6=1
[] 2 WB6=1
[p. 3]
WB14. Now I would like you to read this sentence to me.
Show sentence on the card to the respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?
[] 1 Cannot read at all
[] 2 Able to read only parts of sentence
[] 3 Able to read whole sentence
[] 6 No sentence in required language/braille (specify language) ____
[] 2 Able to read only parts of sentence
[] 3 Able to read whole sentence
[] 6 No sentence in required language/braille (specify language) ____
WB15. How long have you been continuously living in (name of current city, town or village of residence)?
If less than one year, record '00' years.
Years _ _
[] 95 Always/since birth (Go to WB18)
[] 95 Always/since birth (Go to WB18)
WB16. Just before you moved here, did you live in a city, in a town, or in a rural area?
Probe to identify the type of place. If unable to determine whether the place is a city, a town or a rural area, write the name of the place and then temporarily record '9' until you learn the appropriate category for the response.
(Name of place) ____
[] 1 City
[] 2 Semi urban
[] 3 Rural area
[] 6 Outside of Togo (Go to WB18)
[] 2 Semi urban
[] 3 Rural area
[] 6 Outside of Togo (Go to WB18)
WB17. Before you moved here, in which region did you live in?
[] 01 Maritime
[] 02 Plateaux
[] 03 Centrale
[] 04 Kara
[] 05 Savanes
[] 06 Lome commune
[] 07 Golfe urbain
[] 96 Outside of country (specify) ____
[] 02 Plateaux
[] 03 Centrale
[] 04 Kara
[] 05 Savanes
[] 06 Lome commune
[] 07 Golfe urbain
[] 96 Outside of country (specify) ____
WB18. Are you covered by any health insurance?
[] 1 Yes
[] 2 No (Go to end)
[] 2 No (Go to end)
WB19. What type of health insurance are you covered by?
Record all mentioned.
[] A Mutual health organization/community-based health insurance
[] B Health insurance through employer
[] C Social security
[] D Other privately purchased commercial health insurance
[] X Other (specify) ____
[] B Health insurance through employer
[] C Social security
[] D Other privately purchased commercial health insurance
[] X Other (specify) ____
[p. 4]
Mass media and ICT: MT
MT1. Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
MT2. Do you listen to the radio at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
MT3. Do you watch television at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
MT4. Have you ever used a computer or a tablet from any location?
[] 1 Yes
[] 2 No (Go to MT9)
[] 2 No (Go to MT9)
MT5. During the last 3 months, did you use a computer or a tablet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happened almost every day? If 'Yes' record 3, if 'No' record 2
[] 0 Not at all (Go to MT9)
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[p. 5]
MT6. During the last 3 months, did you:
[A] Copy or move a file or folder?
[] 1 Yes
[] 2 No
[] 2 No
[B] Use a copy and paste tool to duplicate or move information within a document?
[] 1 Yes
[] 2 No
[] 2 No
[C] Send e-mail with attached file, such as a document, picture or video?
[] 1 Yes
[] 2 No
[] 2 No
[D] Use a basic arithmetic formula in a spreadsheet?
[] 1 Yes
[] 2 No
[] 2 No
[E] Connect and install a new device, such as a modem, camera or printer?
[] 1 Yes
[] 2 No
[] 2 No
[F] Find, download, install and configure software?
[] 1 Yes
[] 2 No
[] 2 No
[G] Create an electronic presentation with presentation software, including text, images, sound, video or charts?
[] 1 Yes
[] 2 No
[] 2 No
[H] Transfer a file between a computer and other device?
[] 1 Yes
[] 2 No
[] 2 No
[I] Write a computer program in any programming language?
[] 1 Yes
[] 2 No
[] 2 No
MT7. Check MT6[C]: Is 'Yes' recorded?
[] 1 Yes, MT6[C]=1 (Go to MT10)
[] 2 No, MT6[C]=2
[] 2 No, MT6[C]=2
MT8. Check MT6[F]: Is 'Yes' recorded?
[] 1 Yes [MT6[F]=1 (Go to MT10)
[] 2 No, MT6[F]=2
[] 2 No, MT6[F]=2
MT9. Have you ever used the internet from any location and any device?
[] 1 Yes
[] 2 No (Go to MT11)
[] 2 No (Go to MT11)
MT10. During the last 3 months, did you use the internet at least once a week, less than once a week or not at all?
If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
MT11. Do you own a mobile phone?
[] 1 Yes
[] 2 No
[] 2 No
MT12. During the last 3 months, did you use a mobile telephone at least once a week, less than once a week or not at all?
Probe if necessary: I mean have you communicated with someone using a mobile phone. If 'At least once a week', probe: Would you say this happens almost every day? If 'Yes' record 3, if 'No' record 2.
[] 0 Not at all
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[] 1 Less than once a week
[] 2 At least once a week
[] 3 Almost every day
[p. 6]
Fertility/Birth history: CM
CM1. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
This module and the birth history should only include children born alive. Any stillbirths should not be included in response to any question.
[] 1 Yes
[] 2 No (Go to CM8)
[] 2 No (Go to CM8)
CM2. 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 CM5)
[] 2 No (Go to CM5)
CM3. How many sons live with you?
If none, record '00'.
_ _ Sons at home
CM4. How many daughters live with you?
If none, record '00'.
_ _ Daughters at home
CM5. 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)
CM6. How many sons are alive but do not live with you?
If none, record '00'.
_ _ Sons elsewhere
CM7. How many daughters are alive but do not live with you?
If none, record '00'.
_ _ 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 any baby who cried, who made any movement, sound, or effort to breathe, or who showed any other signs of life even if for a very short time?
[] 1 Yes
[] 2 No (Go to CM11)
[] 2 No (Go to CM11)
CM9. How many boys have died?
If none, record '00'.
_ _ Boys dead
CM10. How many girls have died?
If none, record '00'.
_ _ Girls dead
CM11. Sum answers to CM3, CM4, CM6, CM7, CM9 and CM10.
_ _ Sum
CM12. Just to make sure that I have this right, you have had in total (total number in CM11) births during your life. Is this correct?
[] 1 Yes (Go to CM14)
[] 2 No
[] 2 No
CM13. Check responses to CM1-CM10 and make corrections as necessary until response in CM12 is 'Yes'.
[p. 7]
CM14. Check CM11: How many live births?
[] 0 No live births, CM11=00 (Go to next module)
[] 1 One or more live birth, CM11=01 or more
[] 1 One or more live birth, CM11=01 or more
[p. 8]
Fertility/birth history: BH
BH0. Now I would like to record the names of all of your births, whether still alive or not, starting with the first one you had.
Record names of all of the births in BH1. Record twins and triplets on separate lines.
BH0. BH line number _ _
BH1. What name was given to your (first/next) baby? ____
BH2. Were any of these births twins?
[] 1 Single
[] 2 Multiple
[] 2 Multiple
BH3. Is (name of birth) a boy or a girl?
[] 1 Boy
[] 2 Girl
[] 2 Girl
BH4. In what month and year was (name of birth) born?
Probe: What is (his/her) birthday?
Day/month/year _ _ / _ _ / _ _ _ _
BH5. Is (name of birth) still alive?
[] 1 Y
[] 2 N (Go to BH9)
[] 2 N (Go to BH9)
BH6. How old was (name of birth) at (his/her) last birthday?
Record age in completed years.
Age _ _
BH7. Is (name of birth) 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.
Line No _ _ (Go to next birth/Go to BH10)
BH9. How old was (name of birth) when (he/she) died?
If '1 year', probe: How many months old was (name of birth)? Record days if less than 1 month; record months if less than 2 years; or years
Unit
[] 1 Days
[] 2 Months
[] 3 Years
[] 2 Months
[] 3 Years
Number _ _
BH10. Were there any other live births between (name of previous birth) and (name of birth), including any children who died after birth?
[] 1 Yes (Add birth)
[] 2 No (Next birth)
[] 2 No (Next birth)
[p. 9]
BH11. Have you had any live births since the birth of (name of last birth listed)?
[] 1 Yes (Record birth(s) in birth history)
[] 2 No
[] 2 No
[p. 10]
CM15. Compare number in CM11 with number of births listed in the birth history above and check:
[] 1 Numbers are the same (Go to CM17)
[] 2 Numbers are different
[] 2 Numbers are different
CM16. Probe and reconcile responses in the birth history until response in CM12 is 'Yes'.
CM17. Check BH4: Last birth occurred within the last 2 years, that is, since (month of interview) in (year of interview minus 2)?
If the month of interview and the month of birth are the same, and the year of birth is (year of interview minus 2), consider this as a birth within the last 2 years.
[] 0 No live births in the last 2 years (Go to next module)
[] 1 One or more live births in the last 2 years
[] 1 One or more live births in the last 2 years
CM18. Copy name of the last child listed in BH1.
If the child has died, take special care when referring to this child by name in the following modules.
Name of last born child ____
[p. 11]
Desire for last birth: DB
DB1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____
[] 1 Yes, CM17=1
[] 2 No, CM17=0 or blank (Go to next module)
[] 2 No, CM17=0 or blank (Go to next module)
DB2. 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
DB3. Check CM11: Number of births:
[] 1 Only 1 birth (Go to DB4A)
[] 2 2 or more births (Go to DB4B)
[] 2 2 or more births (Go to DB4B)
DB4A. Did you want to have a baby later on, or did you not want any children?
DB4B. Did you want to have a baby later on, or did you not want any more children?
[] 1 Later
[] 2 No more/none
[] 2 No more/none
[p. 12]
Maternal and newborn health: MN
MN1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____
[] 1 Yes, CM17=1
[] 2 No, CM17=0 or blank (Go to next module)
[] 2 No, CM17=0 or blank (Go to next module)
MN2. Did you see anyone for antenatal care during your pregnancy with (name)?
[] 1 Yes
[] 2 No (Go to MN7)
[] 2 No (Go to MN7)
MN3. Whom did you see?
Probe: Anyone else? Probe for the type of person seen and record all answers given.
Health professional
[] A Doctor
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
Other person
[] E Matrone
[] F Traditional midwife
[] G Community health worker
[] F Traditional midwife
[] G Community health worker
[] X Other (specify) ____
MN4. How many weeks or months pregnant were you when you first received antenatal care for this pregnancy?
Record the answer as stated by respondent. If "9 months" or later, record 9.
[] 1 Weeks _ _
[] 2 Months 0 _
[] 998 DK
[] 2 Months 0 _
[] 998 DK
MN5. How many times did you receive antenatal care during this pregnancy?
Probe to identify the number of times antenatal care was received. If a range is given, record the minimum number of times antenatal care received.
_ _ Number of times
[] 98 DK
[] 98 DK
MN6. 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
MN7. Do you have a card or other document with your own immunisations listed?
If yes, ask: May I see it please? If a card is presented, use it to assist with answers to the following questions.
[] 1 Yes (card or other document seen)
[] 2 Yes (card or other document not seen)
[] 3 No
[] 8 DK
[] 2 Yes (card or other document not seen)
[] 3 No
[] 8 DK
MN8. When you were pregnant with (name), did you receive any injection in the arm or shoulder to prevent the baby from getting tetanus, that is, convulsions after birth?
[] 1 Yes
[] 2 No (Go to MN11)
[] 8 DK (Go to MN11)
[] 2 No (Go to MN11)
[] 8 DK (Go to MN11)
[p. 13]
MN9. How many times did you receive this tetanus injection during your pregnancy with (name)?
_ Number of times
[] 8 DK (Go to MN11)
[] 8 DK (Go to MN11)
MN10. Check MN9: How many tetanus injections during last pregnancy were reported?
[] 1 Only 1 injection
[] 2 2 or more injections (Go to MN16)
[] 2 2 or more injections (Go to MN16)
MN11. At any time before your pregnancy with (name), did you receive any tetanus injection either to protect yourself or another baby?
Include DTP (Tetanus) vaccinations received as a child if mentioned.
[] 1 Yes
[] 2 No (Go to MN16)
[] 8 DK (Go to MN16)
[] 2 No (Go to MN16)
[] 8 DK (Go to MN16)
MN12. Before your pregnancy with (name), how many times did you receive a tetanus injection?
If 7 or more times, record '7'. Include DTP (Tetanus) vaccinations received as a child if mentioned.
_ Number of times
[] 8 DK
[] 8 DK
MN13. Check MN12: How many tetanus injections before last pregnancy were reported?
[] 1 Only 1 injection (Go to MN14A)
[] 2 2 or more injections (Go to MN16)
[] 2 2 or more injections (Go to MN16)
MN14A. How many years ago did you receive that tetanus injection
MN14B. How many years ago did you receive the last of those tetanus injections?
The reference is to the last injection received prior to this pregnancy, as recorded in MN12. If less than 1 year, record '00'.
_ _ Years ago
[] 98 DK
[] 98 DK
MN15. Check MN2: Received prenatal care?
[] 1 Yes, MN2=1
[] 2 No, MN2=2 (Go to MN19)
[] 2 No, MN2=2 (Go to MN19)
MN16. During the pregnancy with (name), did you take SP/Fansidar to keep you from getting malaria?
[] 1 Yes
[] 2 No (Go to MN19)
[] 8 DK (Go to MN19)
[] 2 No (Go to MN19)
[] 8 DK (Go to MN19)
MN17. How many times did you take SP/Fansidar during your pregnancy with (name)?
_ _ Number of times
[] 98 DK
[] 98 DK
MN18. Did you get the SP/Fansidar during an antenatal care visit, during another visit to a health facility or at another source?
[] A Antenatal visit
[] B Another facility visit
[] X Other source (specify) ____
[] B Another facility visit
[] X Other source (specify) ____
[p. 14]
MN19. Who assisted with the delivery of (name)?
Probe: Anyone else? Probe for the type of person assisting and record all answers given.
Health professional
[] A Doctor
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
Other person
[] E Matrone
[] F Traditional midwife
[] G Community health worker
[] H Relative/friend
[] F Traditional midwife
[] G Community health worker
[] H Relative/friend
[] X Other (specify) ____
[] Y No one
[] Y No one
MN20. Where did you give birth to (name)?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place) ____
Home
[] 11 Respondent's home (Go to MN23)
[] 12 Other home (Go to MN23)
[] 12 Other home (Go to MN23)
Public medical sector
[] 21 Government hospital
[] 22 CMS health centre
[] 23 Dispensary
[] 24 PMI
[] 26 Other public (specify) ____
[] 22 CMS health centre
[] 23 Dispensary
[] 24 PMI
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private practice
[] 34 Private maternity hospital
[] 35 GNOs/Association
[] 36 Other private (specify) ____
[] 32 Private clinic
[] 33 Private practice
[] 34 Private maternity hospital
[] 35 GNOs/Association
[] 36 Other private (specify) ____
[] 96 Other (specify) ____ (Go to MN23)
MN21. Was (name) delivered by caesarean section? That is, did they cut your belly open to take the baby out?
[] 1 Yes
[] 2 No (Go to MN23)
[] 2 No (Go to MN23)
MN22. When was the decision made to have the caesarean section?
Probe if necessary: Was it before or after your labour pains started?
[] 1 Before labour pains
[] 2 After labour pains
[] 2 After labour pains
[p. 15]
MN23. Immediately after the birth, was (name) put directly on the bare skin of your chest?
If necessary, show the picture of skin-to-skin position. [Image omitted]
[] 1 Yes
[] 2 No (Go to MN25)
[] 8 DK/don't remember (Go to MN25)
[] 2 No (Go to MN25)
[] 8 DK/don't remember (Go to MN25)
MN24. Before being placed on the bare skin of your chest, was the baby wrapped up?
[] 1 Yes
[] 2 No
[] 8 DK/don't remember
[] 2 No
[] 8 DK/don't remember
MN25. Was (name) dried or wiped soon after birth?
[] 1 Yes
[] 2 No
[] 8 DK/don't remember
[] 2 No
[] 8 DK/don't remember
MN26. How long after the birth was (name) bathed for the first time?
If "immediately" or less than 1 hour, record '000'. If less than 24 hours, record hours. If "1 day" or "next day", probe: About how many hours after the delivery? If "24 hours", probe to ensure best estimate of less than 24 hours or 1 day. If 24 hours or more, record days.
[] 000 Immediately/less than 1 hour
[] 1 Hours _ _
[] 2 Days _ _
[] 997 Never bathed
[] 998 DK/don't remember
[] 1 Hours _ _
[] 2 Days _ _
[] 997 Never bathed
[] 998 DK/don't remember
MN27. Check MN20: Was the child delivered in a health facility?
[] 1 Yes, MN20=21-36 or 76 (Go to MN30)
[] 2 No, MN20=11-12 or 96
[] 2 No, MN20=11-12 or 96
MN28. What was used to cut the cord?
[] 1 New blade
[] 2 Blade used for other purposes
[] 3 Scissors
[] 6 Other (specify) ____
[] 8 DK
[] 2 Blade used for other purposes
[] 3 Scissors
[] 6 Other (specify) ____
[] 8 DK
MN29. Was the instrument used to cut the cord boiled or sterilised prior to use?
[] 1 Yes
[] 2 No
[] 8 DK/don't remember
[] 2 No
[] 8 DK/don't remember
MN30. After the cord was cut and until it fell off, was anything applied to the cord?
[] 1 Yes
[] 2 No (Go to MN32)
[] 8 DK/don't remember (Go to MN32)
[] 2 No (Go to MN32)
[] 8 DK/don't remember (Go to MN32)
[p. 16]
MN31. What was applied to the cord?
Probe: Anything else?
[] A Chlorhexidine
[] B Other antiseptic (Alcohol, cordial, purple gentian, dettol)
[] C Mustard oil
[] D Ash
[] E Animal dung
[] F Salt
[] G Karite butter
[] X Other (specify) ____
[] Z DK/don't remember
[] B Other antiseptic (Alcohol, cordial, purple gentian, dettol)
[] C Mustard oil
[] D Ash
[] E Animal dung
[] F Salt
[] G Karite butter
[] X Other (specify) ____
[] Z DK/don't remember
MN32. 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
MN33. Was (name) weighed at birth?
[] 1 Yes
[] 2 No (Go to MN35)
[] 8 DK (Go to MN35)
[] 2 No (Go to MN35)
[] 8 DK (Go to MN35)
MN34. How much did (name) weigh?
If a card is available, record weight from card.
[] 1 From card (KG) _ . _ _ _
[] 2 From recall (KG) _ . _ _ _
[] 99998 DK
[] 2 From recall (KG) _ . _ _ _
[] 99998 DK
MN35. Has your menstrual period returned since the birth of (name)?
[] 1 Yes
[] 2 No
[] 2 No
MN36. Did you ever breastfeed (name)?
[] 1 Yes
[] 2 No (Go to MN39B)
[] 2 No (Go to MN39B)
MN37. How long after birth did you first put (name) to the breast?
If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days.
[] 000 Immediately/less than 1 hour
[] 1 Hours _ _
[] 2 Days _ _
[] 998 DK/don't remember
[] 1 Hours _ _
[] 2 Days _ _
[] 998 DK/don't remember
MN38. In the first three days after delivery, was (name) given anything to drink other than breast milk?
[] 1 Yes (Go to MN39A)
[] 2 No (Go to end)
[] 2 No (Go to end)
[p. 17]
MN39A. What was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' is not a valid response and response category Y cannot be recorded.
MN39B. In the first three days after delivery, what was (name) given to drink?
Probe: Anything else? 'Not given anything to drink' (category Y) can only be recorded if no other response category is recorded.
[] 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/traditional herbal preparations
[] I Honey
[] J Prescribed medicine
[] X Other (specify) ____
[] Y Not given anything to drink
[] 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/traditional herbal preparations
[] I Honey
[] J Prescribed medicine
[] X Other (specify) ____
[] Y Not given anything to drink
[p. 18]
Post-natal health checks: PN
PN1. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____
[] 1 Yes, CM17=1
[] 2 No, CM17=0 or blank (Go to end)
[] 2 No, CM17=0 or blank (Go to end)
PN2. Check MN20: Was the child delivered in a health facility?
[] 1 Yes, MN20=21-36 or 76
[] 2 No, MN20=11-12 or 96 (Go to PN7)
[] 2 No, MN20=11-12 or 96 (Go to PN7)
PN3. Now I would like to ask you some questions about what happened in the hours and days after the birth of (name).
You have said that you gave birth in (name or type of facility in MN20). How long did you stay there after the delivery?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember
PN4. I would like to talk to you about checks on (name)'s health after delivery - for example, someone examining (name), checking the cord, or seeing if (name) is ok.
Before you left the (name or type of facility in MN20), did anyone check on (name)'s health?
[] 1 Yes
[] 2 No
[] 2 No
PN5. And what about checks on your health - I mean, someone assessing your health, for example asking questions about your health or examining you?
Did anyone check on your health before you left (name or type or facility in MN20)?
[] 1 Yes
[] 2 No
[] 2 No
PN6. Now I would like to talk to you about what happened after you left (name or type of facility in MN20).
Did anyone check on (name)'s health after you left (name or type of facility in MN20)?
[] 1 Yes (Go to PN12)
[] 2 No (Go to PN17)
[] 2 No (Go to PN17)
PN7. Check MN19: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
[] 1 Yes, at least one of the categories A to G recorded
[] 2 No, none of the categories A to G recorded (Go to PN11)
[] 2 No, none of the categories A to G recorded (Go to PN11)
[p. 19]
PN8. You have already said that (person or persons in MN19) assisted with the birth. Now I would like to talk to you about checks on (name)'s health after delivery, for example examining (name), checking the cord, or seeing if (name) is ok.
After the delivery was over and before (person or persons in MN19) left you, did (person or persons in MN19) check on (name)'s health?
[] 1 Yes
[] 2 No
[] 2 No
PN9. And did (person or persons in MN19) check on your health before leaving, for example asking questions about your health or examining you?
[] 1 Yes
[] 2 No
[] 2 No
PN10. After the (person or persons in MN19) left you, did anyone check on the health of (name)?
[] 1 Yes (Go to PN12)
[] 2 No (Go to PN19)
[] 2 No (Go to PN19)
PN11. I would like to talk to you about checks on (name)'s health after delivery ? for example, someone examining (name), checking the cord, or seeing if the baby is ok.
After (name) was delivered, did anyone check on (his/her) health?
[] 1 Yes
[] 2 No (Go to PN20)
[] 2 No (Go to PN20)
PN12. Did such a check happen only once, or more than once?
[] 1 Once (Go to PN13A)
[] 2 More than once (Go to PN13B)
[] 2 More than once (Go to PN13B)
PN13A. How long after delivery did that check happen?
PN13B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember
PN14. Who checked on (name)'s health at that time?
Health professional
[] A Doctor
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
Other person
[] E Matrone
[] F Traditional midwife
[] G Community health worker
[] H Relative/friend
[] F Traditional midwife
[] G Community health worker
[] H Relative/friend
[] X Other (specify) ____
[p. 20]
PN15. Where did this check take place?
Probe to identify the type of place. If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place) ____
Home
[] 11 Respondent's home
[] 12 Other home
[] 12 Other home
Public medical sector
[] 21 Government hospital
[] 22 CMS/health centre
[] 23 Dispensary
[] 24 PMI
[] 26 Other public (specify) ____
[] 22 CMS/health centre
[] 23 Dispensary
[] 24 PMI
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private practice
[] 34 Private maternity hospital
[] 35 GNOs/Association
[] 36 Other private (specify) ____
[] 32 Private clinic
[] 33 Private practice
[] 34 Private maternity hospital
[] 35 GNOs/Association
[] 36 Other private (specify) ____
[] 76 DK public or private
[] 96 Other (specify) ____
[] 96 Other (specify) ____
PN16. Check MN20: Was the child delivered in a health facility?
[] 1 Yes, MN20=21-36 or 76
[] 2 No, MN20=11-12 or 96 (Go to PN18)
[] 2 No, MN20=11-12 or 96 (Go to PN18)
PN17. After you left (name or type of facility in MN20), did anyone check on your health?
[] 1 Yes (Go to PN21)
[] 2 No (Go to PN25)
[] 2 No (Go to PN25)
PN18. Check MN19: Did a health professional, traditional birth attendant, or community health worker assist with the delivery?
[] 1 Yes, at least one of the categories A to G recorded
[] 2 No, none of the categories A to G recorded (Go to PN20)
[] 2 No, none of the categories A to G recorded (Go to PN20)
PN19. After the delivery was over and (person or persons in MN19) left, did anyone check on your health?
[] 1 Yes (Go to PN21)
[] 2 No (Go to PN25)
[] 2 No (Go to PN25)
PN20. After the birth of (name), did anyone check on your health, for example asking questions about your health or examining you?
[] 1 Yes
[] 2 No (Go to PN25)
[] 2 No (Go to PN25)
PN21. Did such a check happen only once, or more than once?
[] 1 Once (Go to PN22A)
[] 2 More than once (Go to PN22B)
[] 2 More than once (Go to PN22B)
PN22A. How long after delivery did that check happen?
PN22B. How long after delivery did the first of these checks happen?
If less than one day, record hours. If less than one week, record days. Otherwise, record weeks.
[] 1 Hours _ _
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember
[] 2 Days _ _
[] 3 Weeks _ _
[] 998 DK/don't remember
[p. 21]
PN23. Who checked on your health at that time?
Health professional
[] A Doctor
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
[] B Nurse/midwife
[] C Medical assistant
[] D Auxiliary midwife
Other person
[] E Matrone
[] F Traditional midwife
[] G Community health worker
[] H Relative/friend
[] F Traditional midwife
[] G Community health worker
[] H Relative/friend
[] X Other (specify) ____
PN24. Where did this check take place?
Probe to identify the type of place.
If unable to determine whether public or private, write the name of the place and then temporarily record '76' until you learn the appropriate category for the response.
(Name of place)____
Home
[] 11 Respondent's home
[] 12 Other home
[] 12 Other home
Public medical sector
[] 21 Government hospital
[] 22 Government clinic/health centre
[] 23 Government health post
[] 26 Other public (specify) ____
[] 22 Government clinic/health centre
[] 23 Government health post
[] 26 Other public (specify) ____
Private medical sector
[] 31 Private hospital
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private (specify) ____
[] 32 Private clinic
[] 33 Private maternity home
[] 36 Other private (specify) ____
[] 76 DK public or private
[] 96 Other (specify) ____
[] 96 Other (specify) ____
PN25. During the first two days after birth, did any health care provider do any of the following either at home or at a facility:
[A] Examine (name)'s cord?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[B] Take the temperature of (name)?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] Counsel you on breastfeeding?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PN26. Check MN36: Was child ever breastfed?
[] 1 Yes, MN36=1
[] 2 No, MN36=2 (Go to PN28)
[] 2 No, MN36=2 (Go to PN28)
PN27. Observe (name)'s breastfeeding?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
PN28. Check MN33: Was child weighed at birth?
[] 1 Yes, MN33=1 (Go to PN29A)
[] 2 No, MN33=2 (Go to PN29B)
[] 8 DK, MN33=8 (Go to PN29C)
[] 2 No, MN33=2 (Go to PN29B)
[] 8 DK, MN33=8 (Go to PN29C)
[p. 22]
PN29A. You mentioned that (name) was weighed at birth. After that, was (name) weighed again by a health care provider within two days?
PN29B. You mentioned that (name) was not weighed at birth. Was (name) weighed at all by a health care provider within two days after birth?
PN29C. You mentioned that you do not know if (name) was weighed at birth. Was (name) weighed at all by a health care provider within two days after birth?
[] 1 Yes
[] 2 No
[] 2 No
PN30. During the first two days after (name)'s birth, did any health care provider give you information on the symptoms that require you to take your sick child to a health facility for care?
[] 1 Yes
[] 2 No
[] 2 No
[p. 23]
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 CP3)
[] 2 No
[] 8 DK or not sure
[] 2 No
[] 8 DK or not sure
CP2. Couples use various ways or methods to delay or avoid getting pregnant.
Are you currently doing something or using any method to delay or avoid getting pregnant?
[] 1 Yes (Go to CP4)
[] 2 No
[] 2 No
CP3. Have you ever done something or used any method to delay or avoid getting pregnant?
[] 1 Yes (Go to end)
[] 2 No (Go to end)
[] 2 No (Go to end)
CP4. What are you doing to delay or avoid a pregnancy?
Do not prompt. If more than one method is mentioned, record 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 Traditional method
[] 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 Traditional method
[] X Other (specify) ____
[p. 24]
Unmet need: UN
UN1. Check CP1: Currently pregnant?
[] 1 Yes, CP1=1
[] 2 No, DK or not sure, CP1=2 or 8 (Go to UN6)
[] 2 No, DK or not sure, CP1=2 or 8 (Go to UN6)
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 UN5)
[] 2 No
[] 2 No
UN3. Check CM11: Any births?
[] 0 No births (Go to UN4A)
[] 1 One or more births (Go to UN4B)
[] 1 One or more births (Go to UN4B)
UN4A. Did you want to have a baby later on or did you not want any children?
UN4B. Did you want to have a baby later on or did you not want any more children?
[] 1 Later
[] 2 None/no more
[] 2 None/no more
UN5. Now I would like to ask some questions about the future. After the child you are now expecting, would you like to have another child, or would you prefer not to have any more children?
[] 1 Have another child (Go to UN8)
[] 2 No more/none (Go to UN14)
[] 8 Undecided/DK (Go to UN14)
[] 2 No more/none (Go to UN14)
[] 8 Undecided/DK (Go to UN14)
UN6. Check CP4: Currently using 'Female sterilization'?
[] 1 Yes, CP4=A (Go to UN14)
[] 2 No, CP4 does not equal A
[] 2 No, CP4 does not equal A
UN7. Now I would like to ask you some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
[] 1 Have (a/another) child
[] 2 No more/none (Go to UN10)
[] 3 Says she cannot get pregnant (Go to UN12)
[] 8 Undecided/DK (Go to UN10)
[] 2 No more/none (Go to UN10)
[] 3 Says she cannot get pregnant (Go to UN12)
[] 8 Undecided/DK (Go to UN10)
UN8. How long would you like to wait before the birth of (a/another) child?
Record the answer as stated by respondent.
[] 1 Months _ _
[] 2 Years _ _
[] 993 Does not want to wait (soon/now)
[] 994 Says she cannot get pregnant (Go to UN12)
[] 2 Years _ _
[] 993 Does not want to wait (soon/now)
[] 994 Says she cannot get pregnant (Go to UN12)
UN9. Check CP1: Currently pregnant?
[] 1 Yes, CP1=1 (Go to UN14)
[] 2 No, DK or not sure, CP1=2 or 8
[] 2 No, DK or not sure, CP1=2 or 8
UN10. Check CP2: Currently using a method?
[] 1 Yes, CP2=1 (Go to UN14)
[] 2 No, CP2=2
[] 2 No, CP2=2
UN11. Do you think you are physically able to get pregnant at this time?
[] 1 Yes (Go to UN14)
[] 2 No
[] 8 DK (Go to UN14)
[] 2 No
[] 8 DK (Go to UN14)
[p. 25]
UN12. 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 DK
[] 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 DK
UN13. Check UN12: 'Never menstruated' mentioned?
[] 1 Mentioned, UN12=C (Go to end)
[] 2 Not mentioned, UN12 does not equal C
[] 2 Not mentioned, UN12 does not equal C
UN14. When did your last menstrual period start?
Record the answer using the same unit stated by the respondent. If '1 year', probe: How many months ago?
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _
[] 993 In menopause/has had hysterectomy (Go to end)
[] 994 Before last birth (Go to end)
[] 995 Never menstruated (Go to end)
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _
[] 993 In menopause/has had hysterectomy (Go to end)
[] 994 Before last birth (Go to end)
[] 995 Never menstruated (Go to end)
UN15. Check UN14: Was the last menstrual period within last year?
[] 1 Yes, within last year
[] 2 No, one year or more (Go to end)
[] 2 No, one year or more (Go to end)
UN16. Due to your last menstruation, were there any social activities, school or work days that you did not attend?
[] 1 Yes
[] 2 No
[] 8 DK/not sure/no such activity
[] 2 No
[] 8 DK/not sure/no such activity
UN17. During your last menstrual period were you able to wash and change in privacy while at home?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
UN18. Did you use any materials such as sanitary pads, tampons or cloth?
[] 1 Yes
[] 2 No (Go to end)
[] 8 DK (Go to end)
[] 2 No (Go to end)
[] 8 DK (Go to end)
UN19. Were the materials reusable?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[p. 26]
Female genital mutilation: 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 end)
[] 2 No (Go to end)
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
[] 98 DK/don't remember
FG8. Who performed the circumcision?
Health professional
[] 11 Doctor
[] 12 Nurse/midwife
[] 13 Medical assistant
[] 16 Other health professional (specify) ____
[] 12 Nurse/midwife
[] 13 Medical assistant
[] 16 Other health professional (specify) ____
Other persons
[] 21 Traditional 'circumciser'
[] 22 Traditional midwife
[] 26 Other traditional (specify) ____
[] 22 Traditional midwife
[] 26 Other traditional (specify) ____
[] 98 DK
FG9. Sum CM4 for Number of daughters at home and CM7 for Number of daughters elsewhere:
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?
[] 1 Yes (Go to FG12)
[] 2 No
[] 2 No
FG11. Check responses to CM1-CM11 and make corrections as necessary until response in FG10 is 'Yes'.
FG12. Check FG9: Number of living daughters?
[] 0 No living daughters (Go to FG24)
[] 1 At least one living daughter
[] 1 At least one living daughter
[p. 27]
FG13. Ask the respondent to tell you the name(s) of her daughter(s), beginning with the youngest daughter (if more than one daughter). Write down the name of each daughter in FG14. Then, ask questions FG15 to FG22 for each daughter at a time.
The total number of daughters in FG14 should be equal to the number in FG9.
If more than 4 daughters, use additional questionnaires.
FG14. Name of daughter ____
FG15. How old is (name)?
Age _ _
FG16. Is (name) younger than 15 years of age?
[] 1 Yes
[] 2 No (Go to FG23)
[] 2 No (Go to FG23)
FG17. Is (name) circumcised?
[] 1 Yes
[] 2 No (Go to FG23)
[] 2 No (Go to FG23)
FG18. How old was (name) when this occurred?
If the respondent does not know the age, probe to get an estimate.
_ _ Age
[] 98 DK
[] 98 DK
FG19. 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 FG21)
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG20. Was her genital area just nicked without removing any flesh?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG21. Was her genital area sewn closed?
If necessary, probe: Was it sealed?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
FG22. Who performed the circumcision?
Health professional
[] 11 Doctor
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
[] 12 Nurse/midwife
[] 16 Other health professional (specify) ____
Other persons
[] 21 Traditional 'circumciser'
[] 22 Traditional midwife
[] 26 Other traditional (specify) ____
[] 22 Traditional midwife
[] 26 Other traditional (specify) ____
[] 98 DK
[p, 28]
FG23. Is there another daughter?
[] 1 Yes (Go to [D2])
[] 2 No (Go to FG24)
[] 2 No (Go to FG24)
[] Tick here if additional questionnaire used
FG24. 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. 29]
Attitudes toward domestic violence: DV
DV1. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
[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. 30]
Marriage/union: MA
MA1. Are you currently married or living together with someone as if married?
[] 1 Yes, currently married
[] 2 Yes, living with a partner
[] 3 No, not in union (Go to MA5)
[] 2 Yes, living with a partner
[] 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 someone as if married?
[] 1 Yes, formerly married
[] 2 Yes, formerly lived with a partner
[] 3 No (Go to end)
[] 2 Yes, formerly lived with a partner
[] 3 No (Go to end)
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 someone only once or more than once?
[] 1 Only once (Go to MA8A)
[] 2 More than once (Go to MA8B)
[] 2 More than once (Go to MA8B)
MA8A. In what month and year did you start living with your (husband/partner)?
MA8B. In what month and year did you start living with your first (husband/partner)?
Date of (first) union
_ _ Month
[] 98 DK Month
_ _ _ _ Year
[] 9998 DK Year
[] 98 DK Month
_ _ _ _ Year
[] 9998 DK Year
MA9. Check MA8A/B: Is 'DK year' recorded?
[] 1 Yes, MA8A/B=9998
[] 2 No, MA8A/B does not equal 9998 (Go to end)
[] 2 No, MA8A/B does not equal 9998 (Go to end)
MA10. Check MA7: In union only once?
[] 1 Yes, MA7=1 (Go to MA11A)
[] 2 No, MA7=2 (Go to MA11B)
[] 2 No, MA7=2 (Go to MA11B)
MA11A. How old were you when you started living with your (husband/partner)?
MA11B. How old were you when you started living with your first (husband/partner)?
Age in years _ _
[p. 34]
Adult functioning: AF
AF1. Check WB4: Age of respondent?
[] 1 Age 15-17 years (Go to end)
[] 2 Age 18-49 years
[] 2 Age 18-49 years
AF2. Do you use glasses or contact lenses?
Include the use of glasses for reading.
[] 1 Yes
[] 2 No
[] 2 No
AF3. Do you use a hearing aid?
[] 1 Yes
[] 2 No
[] 2 No
AF4. I will now ask you about difficulties you may have doing a number of different activities. For each activity there are four possible answers: Please tell me if you have: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty or 4) that you cannot do the activity at all.
Repeat the categories during the individual questions whenever the respondent does not use an answer category:
Remember, the four possible answers are: 1) no difficulty, 2) some difficulty, 3) a lot of difficulty, or 4) that you cannot do the activity at all.
AF5. Check AF2: Respondent uses glasses or contact lenses?
[] 1 Yes, AF2=1 (Go to AF6A)
[] 2 No, AF2=2 (Go to AF6B)
[] 2 No, AF2=2 (Go to AF6B)
AF6A. When using your glasses or contact lenses, do you have difficulty seeing?
AF6B. Do you have difficulty seeing?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot see at all
AF7. Check AF3: Respondent uses a hearing aid?
[] 1 Yes, AF3=1 (Go to AF8A)
[] 2 No, AF3=2 (Go to AF8B)
[] 2 No, AF3=2 (Go to AF8B)
AF8A. When using your hearing aid(s), do you have difficulty hearing?
AF8B. Do you have difficulty hearing?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot hear at all
AF9. Do you have difficulty walking or climbing steps?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk/climb steps at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot walk/climb steps at all
AF10. Do you have difficulty remembering or concentrating?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember/concentrate at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot remember/concentrate at all
AF11. Do you have difficulty with self-care, such as washing all over or dressing?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot care for self at all
AF12. Using your usual language, do you have difficulty communicating, for example understanding or being understood?
[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[p. 35]
Sexual behavior: SB
SB1. Check for the presence of others. Before continuing, make every effort to ensure privacy. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues.
Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
How old were you when you had sexual intercourse for the very first time?
[] 00 Never had intercourse (Go to end)
_ _ 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. I would like to ask you about your recent sexual activity.
When was the last time you had sexual intercourse?
Record answers in days, weeks or months if less than 12 months (one year). If 12 months (one year) or more, answer must be recorded in years.
[] 1 Days ago _ _
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _ (Go to end)
[] 2 Weeks ago _ _
[] 3 Months ago _ _
[] 4 Years ago _ _ (Go to end)
SB3. The last time you had sexual intercourse, was a condom used?
[] 1 Yes
[] 2 No
[] 2 No
SB4. What was your relationship to this person with whom you last had sexual intercourse?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If 'Boyfriend', then ask: Were you living together as if married? If 'Yes', record '2'. If 'No', record '3'.
[] 1 Husband
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB6)
[] 4 Casual acquaintance (Go to SB6)
[] 5 Client/sex worker (Go to SB6)
[] 6 Other (specify) ____ (Go to SB6)
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB6)
[] 4 Casual acquaintance (Go to SB6)
[] 5 Client/sex worker (Go to SB6)
[] 6 Other (specify) ____ (Go to SB6)
SB5. Check MA1: Currently married or living with a partner?
[] 1 Yes, MA1=1 or 2 (Go to SB7)
[] 2 No, MA1=3
[] 2 No, MA1=3
SB6. How old is this person?
If response is 'DK', probe: About how old is this person?
_ _ Age of sexual partner
[] 98 DK
[] 98 DK
SB7. Apart from this person, have you had sexual intercourse with any other person in the last 12 months?
[] 1 Yes
[] 2 No (Go to end)
[] 2 No (Go to end)
SB8. The last time you had sexual intercourse with another person, was a condom used?
[] 1 Yes
[] 2 No
[] 2 No
[p. 36]
SB9. What was your relationship to this person?
Probe to ensure that the response refers to the relationship at the time of sexual intercourse
If 'Boyfriend' then ask: Were you living together as if married? If 'Yes', record '2'. If 'No', record '3'.
[] 1 Husband
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB12)
[] 4 Casual acquaintance (Go to SB12)
[] 5 Client/sex worker (Go to SB12)
[] 6 Other (specify) ____ (Go to SB12)
[] 2 Cohabiting partner
[] 3 Boyfriend (Go to SB12)
[] 4 Casual acquaintance (Go to SB12)
[] 5 Client/sex worker (Go to SB12)
[] 6 Other (specify) ____ (Go to SB12)
SB10. Check MA1: Currently married or living with a partner?
[] 1 Yes, MA1=1 or 2
[] 2 No, MA1=3 (Go to SB12)
[] 2 No, MA1=3 (Go to SB12)
SB11. Check MA7: Married or living with a partner only once?
[] 1 Yes, MA7=1 (Go to end)
[] 2 No, MA7 does not equal 1
[] 2 No, MA7 does not equal 1
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
[p. 37]
HIV/AIDS: HA
HA1. Now I would like to talk with you about something else.
Have you ever heard of HIV or AIDS?
[] 1 Yes
[] 2 No (Go to end)
[] 2 No (Go to end)
HA2. HIV is the virus that can lead to AIDS.
Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA3. Can people get HIV from mosquito bites?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA4. Can people reduce their chance of getting HIV by using a condom every time they have sex?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA5. Can people get HIV by sharing food with a person who has HIV?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA6. Can people get HIV because of witchcraft or other supernatural means?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA7. Is it possible for a healthy-looking person to have HIV?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA8. Can HIV 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. Check HA8[A], [B] and [C]: At least one 'Yes' recorded?
[] 1 Yes
[] 2 No (Go to HA11)
[] 2 No (Go to HA11)
HA10. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA11. Check CM17: Was there a live birth in the last 2 years?
Copy name of last birth listed in the birth history (CM18) to here and use where indicated:
Name ____
[] 1 Yes, CM17=1
[] 2 No, CM17=0 or blank (Go to HA24)
[] 2 No, CM17=0 or blank (Go to HA24)
HA12. Check MN2: Was antenatal care received?
[] 1 Yes, MN2=1
[] 2 No, MN2=2 (Go to HA17)
[] 2 No, MN2=2 (Go to HA17)
[p. 38]
HA13. During any of the antenatal visits for your pregnancy with (name), were you given any information about:
[A] Babies getting HIV from their mother?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[B] Things that you can do to prevent getting HIV?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[C] Getting tested for HIV?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
Were you:
[D] Offered a test for HIV?
[D] Offered a test for HIV?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA14. I don't want to know the results, but were you tested for HIV as part of your antenatal care?
[] 1 Yes
[] 2 No (Go to HA17)
[] 8 DK (Go to HA17)
[] 2 No (Go to HA17)
[] 8 DK (Go to HA17)
HA15. I don't want to know the results, but did you get the results of the test?
[] 1 Yes
[] 2 No (Go to HA17)
[] 8 DK (Go to HA17)
[] 2 No (Go to HA17)
[] 8 DK (Go to HA17)
HA16. After you received the result, were you given any health information or counselling related to HIV?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
HA17. Check MN20: Was the child delivered in a health facility?
[] 1 Yes, MN20=21-36 or 76
[] 2 No, MN20=11-12 or 96
[] 2 No, MN20=11-12 or 96
HA18. Between the time you went for delivery but before the baby was born were you offered an HIV test?
[] 1 Yes
[] 2 No
[] 2 No
HA19. I don't want to know the results, but were you tested for HIV at that time?
[] 1 Yes
[] 2 No (Go to HA21)
[] 2 No (Go to HA21)
HA20. I don't want to know the results, but did you get the results of the test?
[] 1 Yes (Go to HA22)
[] 2 No (Go to HA22)
[] 2 No (Go to HA22)
HA21. Check HA14: Was the respondent tested for HIV as part of antenatal care?
[] 1 Yes, HA14=1
[] 2 No or no answer, HA14 does not equal 1 (Go to HA24)
[] 2 No or no answer, HA14 does not equal 1 (Go to HA24)
HA22. Have you been tested for HIV since that time you were tested during your pregnancy?
[] 1 Yes (Go to HA25)
[] 2 No
[] 2 No
HA23. How many months ago was your most recent HIV test?
[] 1 Less than 12 months ago (Go to HA28)
[] 2 12-23 months ago (Go to HA28)
[] 3 2 or more years ago (Go to HA28)
[] 2 12-23 months ago (Go to HA28)
[] 3 2 or more years ago (Go to HA28)
HA24. I don't want to know the results, but have you ever been tested for HIV?
[] 1 Yes
[] 2 No (Go to HA27)
[] 2 No (Go to HA27)
HA25. How many months ago was your most recent HIV test?
[] 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 HA28)
[] 2 No (Go to HA28)
[] 3 2 or more years ago (Go to HA28)
[] 2 No (Go to HA28)
[] 3 2 or more years ago (Go to HA28)
HA27. Do you know of a place where people can go to get an HIV test?
[] 1 Yes
[] 2 No
[] 2 No
[p. 39]
HA28. Have you heard of test kits people can use to test themselves for HIV?
[] 1 Yes
[] 2 No (Go to HA30)
[] 2 No (Go to HA30)
HA29. Have you ever tested yourself for HIV using a self-test kit?
[] 1 Yes
[] 2 No
[] 2 No
HA30. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV?
[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends
[] 2 No
[] 8 DK/Not sure/depends
HA31. Do you think children living with HIV should be allowed to attend school with children who do not have HIV?
[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends
[] 2 No
[] 8 DK/Not sure/depends
HA32. Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?
[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends
[] 2 No
[] 8 DK/Not sure/depends
HA33. Do people talk badly about people living with HIV, or who are thought to be living with HIV?
[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends
[] 2 No
[] 8 DK/Not sure/depends
HA34. Do people living with HIV, or thought to be living with HIV, lose the respect of other people?
[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends
[] 2 No
[] 8 DK/Not sure/depends
HA35. Do you agree or disagree with the following statement?
I would be ashamed if someone in my family had HIV.
[] 1 Yes
[] 2 No
[] 8 DK/Not sure/depends
[] 2 No
[] 8 DK/Not sure/depends
HA36. Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?
[] 1 Yes
[] 2 No
[] 7 Says she has HIV
[] 8 DK/Not sure/depends
[] 2 No
[] 7 Says she has HIV
[] 8 DK/Not sure/depends
[p. 40]
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, record '10'. If 'Every day' or 'Almost every day', record '30'.
[] 0 Number of days _
[] 10 10 Days or more but less than a month
[] 30 Every day/almost every day
[] 10 10 Days or more but less than a month
[] 30 Every day/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?
Record 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 (names of products mentioned in TA8)?
If less than 10 days, record the number of days. If 10 days or more but less than a month, record '10'. If 'Every day' or 'Almost every day', record '30'.
[] 0 Number of days _
[] 10 10 Days or more but less than a month
[] 30 Every day/almost every day
[] 10 10 Days or more but less than a month
[] 30 Every day/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. 44]
TA12. What type of smokeless tobacco product did you use during the last one month?
Record all mentioned.
[] A Chewing tobacco
[] B Snuff
[] X Other (specify) ____
[] B Snuff
[] X Other (specify) ____
TA13. During the last one month, on how many days did you use (names of products mentioned in TA12)?
If less than 10 days, record the number of days. If 10 days or more but less than a month, record '10'. If 'Every day' or 'Almost every day', record '30'.
[] 0 Number of days _
[] 10 10 Days or more but less than a month
[] 30 Every day/almost every day
[] 10 10 Days or more but less than a month
[] 30 Every day/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 end)
[] 2 No (Go to end)
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 end)
_ _ 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, record '00'. If less than 10 days, record the number of days. If 10 days or more but less than a month, record '10'. If 'Every day' or 'Almost every day', record '30'.
[] 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 Every day/almost every day
[] 0 Number of days _
[] 10 10 Days or more but less than a month
[] 30 Every day/almost every day
TA17. In the last one month, on the days that you drank alcohol, how many drinks did you usually have per day?
_ _ Number of drinks
[p. 45]
Life satisfaction: LS
LS1. I would like to ask you some simple questions on happiness and satisfaction.
First, taking all things together, would you say you are very happy, somewhat happy, neither happy nor unhappy, somewhat unhappy or very unhappy?
I am now going to show you pictures to help you with your response. [Image omitted].
Show smiley card and explain what each symbol represents. Record the response code selected by the respondent.
[] 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
LS2. Show the picture of the ladder.
Now, look at this ladder with steps numbered from 0 at the bottom to 10 at the top. [Image omitted].
Suppose we say that the top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder do you feel you stand at this time?
Probe if necessary: Which step comes closest to the way you feel?
Ladder step _ _
LS3. 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
LS4. And in one year from now, do you expect that your life will be better, will be more or less the same, or will be worse, overall?
[] 1 Better
[] 2 More or less the same
[] 3 Worse
[] 2 More or less the same
[] 3 Worse
[p. 46] [Image omitted]
[p. 47] [Image omitted]
[p. 48]
WM10. Record the time.
Hours and minutes _ _ : _ _
WM11. Was the entire interview completed in private or was there anyone else during the entire interview or part of it?
[] 1 Yes, the entire interview was completed in private
[] 2 No, Others were present during the entire interview (specify) ____
[] 3 No, Other were present during part of the interview (specify) ____
[] 2 No, Others were present during the entire interview (specify) ____
[] 3 No, Other were present during part of the interview (specify) ____
WM12. Language of the Questionnaire.
[] 1 French
WM13. Language of the Interview.
[] 01 French
[] 02 Ewe/Mina
[] 03 Kabye
[] 04 Kotokoli/Tem
[] 05 Akposso/Akebou
[] 06 Ife/Ana
[] 07 Moba-Gourma
[] 08 Tchokossi
[] 09 Bassar/Konkomba
[] 96 Other national language (specify) ____
[] 97 Other foreign language
[] 02 Ewe/Mina
[] 03 Kabye
[] 04 Kotokoli/Tem
[] 05 Akposso/Akebou
[] 06 Ife/Ana
[] 07 Moba-Gourma
[] 08 Tchokossi
[] 09 Bassar/Konkomba
[] 96 Other national language (specify) ____
[] 97 Other foreign language
WM14. Native language of the Respondent.
[] 01 French
[] 02 Ewe/Mina
[] 03 Kabye
[] 04 Kotokoli/Tem
[] 05 Akposso/Akebou
[] 06 Ife/Ana
[] 07 Moba-Gourma
[] 08 Tchokossi
[] 09 Bassar/Konkomba
[] 96 Other national language (specify) ____
[] 97 Other foreign language
[] 02 Ewe/Mina
[] 03 Kabye
[] 04 Kotokoli/Tem
[] 05 Akposso/Akebou
[] 06 Ife/Ana
[] 07 Moba-Gourma
[] 08 Tchokossi
[] 09 Bassar/Konkomba
[] 96 Other national language (specify) ____
[] 97 Other foreign language
WM15. Was a translator used for any parts of this questionnaire?
[] 1 Yes, the entire questionnaire
[] 2 Yes, parts of the questionnaire
[] 3 No, not used
[] 2 Yes, parts of the questionnaire
[] 3 No, not used
WM16. Check columns HL10 and HL20 in list of household members, household questionnaire:
Is the respondent the mother or caretaker of any child age 0-4 living in this household?
[] Yes (Go to WM17 in woman's information panel and record '01'. Then go to the questionnaire for children under five for that child and start the interview with this respondent.)
[] No (Check HH26-HH27 in household questionnaire: Is there a child age 5-17 selected for questionnaire for children age 5-17?)
[] Yes [Check column HL20 in list of household members, household questionnaire: Is the respondent the mother or caretaker of the child selected for questionnaire for children age 5-17 in this household?]
[] Yes (Go to WM17 in woman's information panel and record '01'. Then go to the questionnaire for children age 5-17 for that child and start the interview with this respondent.)
[] No (Go to WM17 in woman's information panel and record '01'. Then end the interview with this respondent by thanking her for her cooperation. Check to see if there are other questionnaires to be administered in this household.)
[] No (Go to WM17 in woman's information panel and record '01'. Then end the interview with this respondent by thanking her for her cooperation. Check to see if there are other questionnaires to be administered in this household.)
[] No (Go to WM17 in woman's information panel and record '01'. Then end the interview with this respondent by thanking her for her cooperation. Check to see if there are other questionnaires to be administered in this household.)
[p. 49]
Interviewer's observations
Supervisor's observations