Women's Information Panel: WM

This module is to be administered to all women age 15 through 49 (see column HL6 of HH listing). Fill in one form for each eligible woman. Fill in the cluster and household number, and the name and line number of the woman in the space below. Fill in your name, number and the date.

WM1. ED number _ _ _ _ _

WM2. Household number _ _ _

WM3. Woman's name ____

WM4. Woman's line number _ _

WM5. Interviewer name and number____ _ _

WM5A. Start date (day/month/year) of interview: _ _ / _ _ / _ _ _ _

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

WM7. Result of women's interview

Repeat greeting if not already read to this woman:
We are from the ministry of social development. We are working on a project concerned with family health and education. I would like to talk to you about this. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don?t want to, and you may withdraw from the interview at any time. May I start now?

If permission is given, begin the interview. If the woman does not agree to continue, thank her, complete wm7, and go to the next interview. Discuss this result with your supervisor for a future revisit.

WM8. In what month and year were you born?

WM9. How old were you at your last birthday?

WM10. Have you ever attended school?

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

WM14. Now I would like you to read this sentence to me.

Show sentences to respondent. If respondent cannot read whole sentence, probe: Can you read part of the sentence to me?

Child Mortality Module: CM

This module is to be administered to all women age 15-49. All questions refer only to live births.

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

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?

CM2A. 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 CM3 only if year of first birth is given. Otherwise, continue with CM2b.

CM2B. How many years ago did you have your first birth?

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

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

CM5 Do you have any sons or daughters whom you have given birth who are alive but do not live with you?

CM6. How many sons are alive but do not live with you? How many daughters are alive but do not live with you?

CM7. Have you ever given birth to a boy or girl who was born alive but later died?

CM8. How many boys have died? How many girls have died?

CM9. Sum answers to CM4, CM6, and CM8

CM10 Just to make sure that I have this right, you have had (total number) births during your life. Is this correct?

CM11. Of these (total number) births you have had, when did you deliver the last one (even if he or she has died)?
If day is not known, enter '98' in space for day.

CM12. Check CM11: Did the woman's last birth occur within the last 2 years, that is, since (day and month of interview in [2003]

If child has died, take special care when referring to this child by name in the following modules

CM13. At the time you became pregnant with (name), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?

Tetanus Toxoid (TT) module: TT

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

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

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

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

TT4. How many TT doses during last pregnancy were reported in TT3?

TT5. Did you receive any tetanus toxoid injection at any time before your last pregnancy?

TT6. How many times did you receive it?

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

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

Maternal and newborn health module: MN

This module is to be administered to all women with a live birth in the 2 years preceding date of interview.
Check child mortality module CM12 and record name of last-born child here ____
Use this child's name in the following questions, where indicated.

MN2. Did you see anyone for antenatal care for this pregnancy?

If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given.

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

MN3A. Were you weighed?

MN3B. Was your blood pressure measured?

MN3C. Did you give a urine sample?

MN3D. Did you give a blood sample?

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

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

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

MN7. Who assisted with the delivery of your last child (name)? Anyone else?

Probe for the type of person assisting and circle all answers given

MN8. Where did you give birth to (name)?
If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
(Name of place) ____

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

MN10. Was (name) weighed at birth?

MN11. How much did (name) weigh?
Record weight from health card, if available

MN11A. How much did (name) weigh?
Record weight from health card, if available

MN12. Did you ever breastfeed (name)

MN13. How long after birth did you first put (name) to the breast

If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days.

Marriage/union module: MA

MA1. Are you currently married or living in a common-law union with a male?

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

MA3. Have you ever been married or lived in a common-law union with a male?

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

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

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

MA7. Check MA6:

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

Contraception and unmet need: CP

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

CP1A. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children?

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

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

CP4A. Now I would like to ask some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

CP4B. If currently pregnant: 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?

CP4C. How long would you like to wait before the birth of (a/another) child?

CP4D. Check CP1:

CP4E. Do you think you are physically able to get pregnant at this time?

HIV/AIDS module: HA

HA1. Now I would like to talk with you about something else.

Have you ever heard of the virus HIV or an illness called AIDS?

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

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

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

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

HA6. Can people reduce their chance of getting infected with the AIDS virus by not having sex at all?

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

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

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

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

HA9A. During pregnancy?

HA9B. During delivery?

HA9C. By breastfeeding?

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

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

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

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

HA14. Check MN5: Tested during antenatal care?

HA15. I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS?

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

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

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

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

Follow instructions in your interviewer's manual.

Attitudes toward domestic violence module: 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:

DV1A. If she goes out with out telling him?

DV1B. If she neglects the children?

DV1C. If she argues with him?

DV1D. If she refuses sex with him?

DV1E. If she burns the food?

Sexual behaviour module: SB

Check for the presence of others. Before continuing, ensure privacy.

SB0. Check WM9: Age of respondent is between 15 and 24?

SB1. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues. The information you supply will remain strictly confidential. How old were you when you first had sexual intercourse (if ever)?

SB2. When was the last time you had sexual intercourse?

Record 'years ago' only if last intercourse was one or more years ago. If 12 months or more the answer must be recorded in years.

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

SB4. What is your relationship to the man with whom you last had sexual intercourse?

If man is 'boyfriend' or 'fiancee', ask:
Was your boyfriend/fiancee living with you when you last had sex?
If 'yes', circle 1. If 'no', circle 2.

SB5. How old is this person?

If response is DK, probe:
About how old is this person?

SB6. Have you had sex with any other man in the last 12 months?

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

SB8. What is your relationship to this man?

If man is 'boyfriend' or 'fiancee', ask: Was your boyfriend/fiancee living with you when you last had sex? If 'yes', circle 1. If 'no', circle 2.

SB9. How old is this person?
If response is DK, probe: About how old is this person?

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

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

Under-five child information panel: UF

This questionnaire is to be administered to all mothers or caretakers (see household listing, column HL8) who care for a child that lives with them and is under the age of 5 years (see household listing, column HL5).
A separate questionnaire should be used for each eligible child.
Fill in the cluster and household number, and names and line numbers of the child and the mother/caretaker in the space below. Insert your own name and number, and the date.

UF1. ED number: _ _ _ _ _ _ _

UF2. Household number: _ _ _

UF3. Child?s name: _____

UF4. Child?s line number: _ _

UF5. Mother?s/caretaker?s name: _____

UF6. Mother?s/caretaker?s line number: _ _

UF7. Interviewer name and number: _____ _ _

UF7A. Start date (day/month/year) of interview: _ _ / _ _ / _ _ _ _

UF8. End date (day/month/year) of interview: _ _ / _ _ / _ _ _ _

UF9. Result of interview for children under 5
(Codes refer to mother/caretaker.)

Repeat greeting if not already read to this respondent:
We are from the ministry of social development. We are working on a project concerned with family health and education. I would like to talk to you about this. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you don?t want to, and you may withdraw from the interview at any time. May I start now?

If permission is given, begin the interview. If the respondent does not agree to continue, thank him/ her and go to the next interview. Discuss this result with your supervisor for a future revisit.

UF10. Now I would like to ask you some questions about the health of each child under the age of 5 in your care, who lives with you now.
Now I want to ask you about (name).
In what month and year was (name) born?
Probe: what is his/her birthday?
If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day.

UF11. How old was (name) at his/her last birthday?
Record age in completed years.

Birth registration and early learning module: BR

BR1. Does (name) have a birth certificate?
May I see it?

BR2. Has (name?s) birth been registered with the civil
authorities?

BR3. Why is (name?s) birth not registered?

BR4. Do you know how to register your child?s birth?

BR5. Check age of child in UF11: Child is 3 or 4 years old?

BR6. Does (name) attend any organized learning or early childhood education programme, such as a privateor government facility, including kindergarten or community child care?

BR7. Within the last seven days, about how many hours did (name) attend?

BR8. In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name):

If yes, ask: who engaged in this activity with the child, the mother, the child?s father or another adult member of the household (including the caretaker/ respondent)?
Circle all that apply.

BR8A. Read books or look at picture books with (name)?

BR8B. Tell stories to (name)?

BR8C. Sing songs with (name)?

BR8D. Take (name) outside the home, compound, yard or enclosure?

BR8E. Play with (name)?

BR8F. Spend time with (name) naming, counting, and/or drawing things?

Child development module: CE

Question CE1 is to be administered only once to each caretaker

CE1. How many books are there in the household?
Please include schoolbooks, but not other books meant for children, such as picture books
If ?none? enter 00

CE2. How many children?s books or picture books do you have for (name)?
If ?none? enter 00

CE3. I am interested in learning about the things that (name) plays with when he/she is at home.
What does (name) play with:

Does he/she play with household objects, such as bowls, plates, cups or pots?
Objects and materials found outside the living quarters, such as sticks, rocks, animals, shells, or leaves?
Homemade toys, such as dolls, cars and other toys made at home?
Toys that came from a store?
If the respondent says ?YES? to any of the prompted categories, then probe to learn specifically what the child plays with to ascertain the response. Code Y if child does not play with any of the items mentioned.

CE4. Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children with others. since last (day of the week) how many times was (name) left in the care of another child (that is, someone less than 10 years old)?
If ?none? enter 00

CE5. In the past week, how many times was (name) left alone?
If ?none? enter 00

Breastfeeding module: BF

BF1. Has (name) ever been breastfed?

BF2. Is he/she still being breastfed?

BF3. Since this time yesterday, did he/she receive any of the following:
Read each item aloud and record response before proceeding to the next item.

BF3A. vitamin, mineral supplements or medicine?

BF3B. plain water?

BF3C. sweetened, flavoured water or fruit juice or tea?

BF3D. oral rehydration solution (ORS)?

BF3E. infant formula?

BF3F. tinned, powdered or fresh milk?

BF3G. any other liquids?

BF3H. solid or semi-solid (mushy) food?

BF4. Check BF3H: Child received solid or semi-solid (mushy) food?

BF5. Since this time yesterday, how many times did (name) eat solid, semisolid, or soft foods other than liquids?
If 7 or more times, record ?7?.

Care of illness module: CA

CA1. Has (name) had diarrhoea in the last two weeks, that is, since (day of the week) of the week before last?
Diarrhoea is determined as perceived by mother or caretaker, or as three or more loose or watery stools per day, or blood in stool.

CA2. During this last episode of diarrhoea, did (name) drink any of the following:
Read each item aloud and record response before proceeding to the next item.

CA2A. A fluid made from a special packet called an oral rehydration solution or gesol?

CA2C. A pre-packaged ORS fluid for diarrhoea such as pedialyte?

CA2D. Local homemade fluid such as coconut water, coca cola, guava buds or flour and water?

CA3. During (name?s) illness, did he/she drink much less, about the same, or more than usual?

CA4. During (name?s) illness, did he/she eat less, about the same, or more food than usual?
If ?less?, probe: much less or a little less?

CA5. Has (name) had an illness with a cough at any time in the last two weeks, that is, since (day of the week) of the week before last?

CA6. When (name) had an illness with a cough, did he/she breathe faster than usual with short, quick breaths or have difficulty breathing?

CA7. Were the symptoms due to a problem in the
chest or a blocked nose?

CA8. Did you seek advice or treatment for the illness outside the home?

CA9. From where did you seek care? Anywhere else?
Circle all providers mentioned, but do NOT prompt with any suggestions.
If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code.
(Name of place)_____

CA10. Was (name) given medicine to treat this illness?

CA11. What medicine was (name) given?
Circle all medicines given.

CA12. Check UF11: Child aged under 3?

CA13. The last time (name) passed stools, how was the stool disposed?

Ask the following question (CA14) only once for each mother/caretaker.
CA14. 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?
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.

Immunization module: IM

If an immunization card is available, copy the dates in IM3B-IM7 for each type of immunization recorded on the card. IM10-IM18 are for recording vaccinations that are not recorded on the card. IM10-IM18 will only be asked when a card is not available.

IM1. Is there a vaccination card for (name)?

IM3B. Polio 1 (OPV1)

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM3C. Polio 2 (OPV2)

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM3D. Polio 3 (OPV3)

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4A. DPT 1

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4B. DPT 2

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4C. DPT 3

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4D. HiB1

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4E. HiB2

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4F. HiB3

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4G. HepB1

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4H. HepB2

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM4I. HepB3

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM5A. DPTHepBHiB1

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM5B. DPTHepBHiB2

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM5C. DPTHepBHiB3

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM6. Measles mumps and rubella (MMR)

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM7. Yellow fever (YF)

(a) Copy dates for each vaccination from the card.
(b) Write ?44? in day column if card shows that vaccination was given but no date recorded.

IM9. In addition to the vaccinations shown on this card, did (name) receive any other vaccinations, including vaccinations received in campaigns or immunization days?
Record ?Yes? only if respondent mentions OPV 1-3, DPT 1-3, HepB 1-3,HiB 1-3, DPTHepBHiB1-3, MMR, or Yellow Fever vaccine(s).

IM10. Has (name) ever received any vaccinations to prevent him/her from getting diseases, including vaccinations received in a campaign or immunization day?

IM12. Has (name) ever been given any ?vaccination drops in the mouth? to protect him/her from getting diseases ? that is, polio?

IM13. How old was he/she when the first dose was given ? just after birth (within two weeks) or later?

IM14. How many times has he/she been given these drops?

IM14A. Has (name) ever been given ?DPTHepBHiB vaccination injections? ? that is, an injection in the thigh or buttocks ? to prevent him/her from getting diphtheria, whooping cough, tetanus, hepatitis b and influenza type b? (sometimes given at the same time as polio)

IM14B. How many times has he/she been given this vaccination?

IM15. Has (name) ever been given ?DPT vaccination injections? ? that is, an injection in the thigh or buttocks ? to prevent him/her from getting tetanus, whooping cough, diphtheria? (sometimes given at the same time as polio)

IM16. How many times?

IM16A. Has (name) ever been given ?HiB onlyvaccination injections? ? that is, an injection in the thigh or buttocks ? to prevent him/her from getting influenza type b? (sometimes given at the same time as polio)

IM16B. How many times has he/she been given this vaccination?

IM16C. Has (name) ever been given ?HepB only vaccination injections? ? that is, an injection in the thigh or buttocks ? to prevent him/her from getting Hepatitis B? (sometimes given at the same time as polio)

IM16D. How many times has he/she been given this vaccination?

IM17. Has (name) ever been given ?Measles Mumps and Rubella vaccination injections (MMR)? ? that is, a shot in the arm at the age of 12months or older - to prevent him/her from getting measles mumps and rubella?

IM18. Has (name) ever been given ?Yellow Fever vaccination injections? ? that is, a shot in the arm at the age of 12months or older - to prevent him/her from getting yellow fever? (sometimes given at the same time as MMR)

IM20. Does another eligible child reside in the household for whom this respondent is mother/caretaker? Check household listing, column HL8.