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. Cluster number _ _ _

WM2. Household number _ _ _

WM3. Woman's name ____

WM4. Woman's line number _ _

WM5. Interviewer name and number____ _ _

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

WM7. Result of women's interview

Repeat greeting if not already read to this woman:
We are from ministry of health and population. We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about 20-30 minutes. 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?

[p. 2]

WM10. Have you ever attended school?

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

WM12. What is the highest grade you completed at that level?

WM13. Check WM11:

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?

Marriage Module: MA

MA1. What is your marital status now: are you widowed, divorced or separated?

MA2. How old is your husband?

MA5. Have you been married once or more than once?

MA6. In what month and year did you first marry?

MA7. How old were you at your first marriage?

MA7A. Your first husband was a relative?

MA7B. What is your relationship to your first husband?

Child Mortality Module: CM

now I would like to ask you about all the births you have had during your life.

CM1. 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?

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. Check CM4, CM6, CM8
Sum and check

To check the numbers that you have ever given birth, you have given birth to _ _ children?
If yes; continue
If no: probe
CM4: you have _ _ boys and _ _ girls living with you, is this correct?
CM6: you have _ _ boys and _ _ girls who are not living with you, is this correct?
CM8: you have _ _ boys and _ _ girls who died after they were born alive, is this correct?

Live Birth History Table: BH

Now I would like to record the names of all your births, whether the child is still alive or not. I would like to start with the first one you had.
Record names of all births; if name not given, record 'x'. Record twins and triplets on separate lines.

BH1.
Number 01 to 16; 1st to 16th child
Live birth:

All children n, whether alive or dead:

BH2. Were any of these births twins?

BH3. Is (name) male or female?

BH4. In what month and year was (name) born?
Probe: what is his/her birthday?
If they don't know write "98" for months and "9998" for year

BH5. Is (name) still alive?

BH6. If alive: how old was (name) on his/her last birthday?
Record age in completed years.

BH7. If alive: is (name) living with you?

BH8. If alive: record household line number of child (from HL1).
Write "00" if child is not listed on household listing form HL

BH9. How old was (name) when he/she died?
Record age at death. If less than 1 month, record days.
If less than 2 years, record months.

BH10. Interviewers:
Record date of birth of the last child in the BH table.
Date/ Month /Year of birth of the last child

BH11. Interviewers:
Check BH10: Since the last 2 years from the interview (day/month/year), has she given any births?
If she had still birth, mention the name of the child when you administer the following questions.

BH12. When you were pregnant, did you wish to be pregnant then, or wanted to wait for some time, or you did not want to have any more children?

Tetanus Toxoid (TT) module: TT

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

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

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

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

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

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

TT6. How many times did you receive it?

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

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

Maternal and newborn health module: MN

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

MN1. In the first two months after your last birth [the birth of name], did you receive a vitamin A dose like this?

Show 200,000 IU capsule or dispenser.

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

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

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

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.

Contraception module: CP

To be administered to all eligible women who are currently married age 15-49

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.

CP3A. From where did you get the current family planning method last time?
If the currently used method is continued breastfeeding, withdrawal, abstinence or others, ask as follows;
Who instructed the method first time?

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?

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 you have been tested for HIV during pregnancy, do you know a place other than maternal care clinic where you can go to get a test for HIV?

HA19. Check column (HL8) in Household Questionnaire

HA19A. Check column (HL6) in Household Questionnaire

Follow instructions in your interviewer's manual.