DDI_NGA_2011_MICS_v01_M_WB National Bureau of Statistics 2012-06-14 NADA Version 1.1 (July 2012) DDI and ID numbers, Title and Abbreviation fields edited by World Bank for World Bank Microdata Library Multiple Indicator Cluster Survey 2011 Fourth round MICS4 2011 English NGA_2011_MICS_v01_M National Bureau of Statistics [NBS]

Central Bank of Nigeria

Nigeria Institute of Social Economic Research

Office of the Senior Special Assisstance to the President

National Agency for the Prohibition of Ttrficking In Persons

Federal Ministry of Education

Federal Ministry of Health

National Population Commission

Federal Ministry of Justice

National Planning Commission

Federal Ministry of Agriculture & Worter Rresouces

National Agency for Food and Drug Administration and Control

Ministry of Finance, Budget & Planning

Federal Ministry of Environment

World Health Organisation

United Nation Children Educational Fund © NBS 2012 NADA United Nation Children Fund Fedral Government of Nigeria National Bureau of Statistics United Nation Fund For Population Activities Depertment for International Development Dr Yemi Kale Mr E.O. Ekezie Biyi Fafunmi Mr R.F. Busari Mrs A. A. Akinsanya National Bureau of Statistics Multiple Indicator Cluster Survey - Round 4 [hh/mics-4] Nigeria has participated in three rounds of MICS. Two rounds through the Federal Office of Statistics (FOS) in 1995 and 1999 for MICS 1 and MICS2 respectively and the third round, MICS3, as National Bureau of Statistics (NBS) in 2007. The current round four (MICS4) which is slated for between January and March, 2011, though the pilot is to come up in October, 2010 was designed to provide up to date data information for assessing situation of children and women in Nigeria and contribute data for monitoring socio-economic activities of Nigerian population. version 1.0 v1.0 This is the first version used to generate the first set of tables original release in 2012 Total number of father Total number of women 15-49 Total number of children 5-17 Total number of children under 5-17 Ever attended school Highest level of school attended Medical support Hours worked Main source of drinking water Treat water to make safer for drinking Kind of toilet facility Religion Mother tongue Cooking location Mobile phone Car or truck Sons living with you Daughters living with you Sons living not with you Daughters not living with you Has immunization card Antenatal care Tested for hiv/aids Place of delivery Child weighed at birth Ever breastfeed Avoid pregnancy Ever circumcised Condom Nets economic systems and development [1.4] income, property and investment/saving [1.5] rural economics [1.6] business/industrial management and organisation [2.2] LABOUR AND EMPLOYMENT [3] domestic political issues [4.2] mass political behaviour, attitudes/opinion [4.6] basic skills education [6.1] compulsory and pre-school education [6.2] post-compulsory education [6.5] vocational education [6.7] information society [7.2] childbearing, family planning and abortion [8.2] drug abuse, alcohol and smoking [8.3] general health [8.4] health care and medical treatment [8.5] environmental degradation/pollution and protection [9.1] housing [10.1] TRANSPORT, TRAVEL AND MOBILITY [11] children [12.1] family life and marriage [12.5] social and occupational mobility [12.8] community, urban and rural life [13.1] social change [13.7] fertility [14.2] social welfare systems/structures [15.2] The Multiple Cluster Indicator Survey (MICS) was conceptualized to monitor the progress of Child Survival, Development, protection and participation (CSDPP) Programme as well as to serve as means of data generating mechanism for measuring the achievement and gaps in the targets of Millennium Development Goals (MDGs), particularly as it may affect the children and women. At the World Summit for Social Development in 1995, the need was also stressed for better social statistics if social development had to move to centre stage for the cause of the children of the world. However, Nigeria has participated in three rounds of MICS. Two rounds through the Federal Office of Statistics (FOS) in 1995 and 1999 for MICS 1 and MICS2 respectively and the third round, MICS3, as National Bureau of Statistics (NBS) in 2007. The current round of MICS4 which is slated for between January and March, 2011, though the pilot is to come up in October, 2010 was designed to provide up to date data information for assessing situation of children and women in Nigeria and contribute data for monitoring socio-economic activities of Nigerian population. Likewise, MICS4 will support monitoring numerous international and national goals and targets which includes; ·Millennium Development Goals (MDGs) ·World Fit for children ·Roll-Back Malaria (RBM) ·Vision 20-2020 etc. The objectives of the pilot study among others include; i.To test the adequacy of survey instruments (Questionnaires and Manuals) ii.To test the administration of the questionnaires iii.To test some of the data processing arrangement (system development, data processing capability, analysis and tabulation, etc.) iv.To test all the logistics arrangement (fieldwork, transportation, field equipment etc) v.To write an administrative and technical report on the pilot Nigeria National Zone State Local government Sector (Urban,Rural) State Individual, Household The survey covered: All de jure household members (usual residents); All women aged 15-49 years resident in the household and; All children aged 0 <5 years (under age 5) resident in the household. Sample survey data [ssd] The general subject areas to be covered in the three (3) set of questionnaires namely; (i) Household, Individual women (15 - 49) and Children under five include: (a) HOUSEHOLD QUESTIONNAIRE: (i) Household Information Panel (ii)Household Listing Form (iii)Education (iv)Water and Sanitation (v)Salt iodization (vi)Hand-washing (vii)Child labour (viii)Child discipline (ix)Insecticide treated nets (x)Household Characteristics etc. (b) INDIVIDUAL WOMEN (15 - 49) QUESTIONNAIRE: (i) Woman's information panel (ii)Woman's background (iii)Child Mortality (iv)Desire for last birth (v)Maternal and Newborn Health (vi)Illness symptoms (vii)Contraception (viii)Unmet need (ix)Female Genital Mutilation/Cutting (x)Attitudes toward domestic violence (xi)Marriage/union (xii)Sexual behaviour (xiii)HIV/AIDS etc (c) CHILDREN UNDER FIVE QUESTIONNAIRE (xi)Under-five child Information Panel (xii)Age (xiii)Birth registration (xiv)Early child development (xv)Breastfeeding (xvi)Care of illness (xvii)Malaria (xviii)Immunization (xix)Anthropometry etc. In addition, the coordinates of the EAS/Clusters for the pilot study will be taken using the Global Positioning System (GPS). National Bureau of Statistics The frame of Enumeration Areas (EAs/Clusters) of 2006 Housing and Population Census conducted by National Population Commission (NpopC) will be used. However, the National integrated Survey of Households (NISH) which is the vehicle for conducting all household based surveys in NBS, the 2007/2012 edition will be adopted for the survey. Ten (10) EAs/Clusters which translated to one (1) replicate will be selected in each of the affected states for the pilot study. Further, twenty (20) households (HHs) will be systematically selected in each of the EAs/Clusters thus given a total of 200 HHs to be canvassed in each selected state. In all, 800 HHs will be studied for the pilot in which all the eligible women and children under five in these households will be administered with the relevant questionnaires (see table 2.1.4.1). As was for the pilot study, the frame of enumeration areas/Clusters (EAs/Clusters) of 2006 housing and population census conducted by National population commission (NPOPC) will be used. Also, the National Integrated Survey of Households (NISH) 2007/2012 Master Sample Frame (MSF) will be adopted for the survey. However, the NISH 2007/2012 Master Sample was constructed from LGA Master Sample which may be called Master Frame (MF). In order to select the NISH sub-sample of EAs/Clusters in each state, the 30 master sample EAs/Clusters in each LGA for that state were pooled together, hence, the total number of EAs/Clusters in the LGA master sample for each state is equal to 30 times the number of the LGAs in the state except in FCT, Abuja where it was 40 times. Then, systematic sample of 200 EAs/Clusters were selected with equal probability across all LGAs within the state and the NISH EAs/Clusters in each state were divided into 20 replicates of 10 EAs/Clusters in each replicate. The sample EAs/Clusters for most national household surveys such as the GHS are based on a sub-sample of the NISH master sample, selected as a combination of replicates from the NISH frame. However, the MICS4 main survey will derive from NISH (2007/2012) and as such four (4) replicates taken from replicates 17 to 20 containing forty (40) EAs/Clusters will be canvassed in each of the thirty six states of the Federation and FCT, Abuja. In addition, twenty (20) households will be systematically selected in each EAs/Clusters and all the three (3) sets of questionnaires will be administered to all eligible respondents. In all, one thousand, four hundred and eighty (1,480) EAs/Clusters will be covered nationally, and twenty nine thousand, six hundred (29,600) households will be interviewed. It is worthy to note that a fresh household listing exercise was carried out for all study units (EAs/Clusters) for MICS4. There were no deviation from sample Designed Face-to-face [f2f] The MICS Generic questionnaire based on MICS3 Model Questionnaire was used with some modifications and additons. Household questionnaire was administered to all selected households, the women questionnaire was administered to all women age 15-49 years old in the selected households and children questionnaire to all children below the age of 5years in the selected households. All modules of the Household Questionnaire will be administered to this person, referred to as the Household Respondent, including the module in the questionnaire where the information collected is about other household members (i.e., the educational attainment). For the purposes of this questionnaire, an adult is defined as someone age 15 and over. However, very young household members (below age 18) may not be the most ideal members to interview. Therefore, in cases when there is another older adult member (for instance, the parent of the 15 year-old) available to interview, you should prefer to interview this person who is likely to be more knowledgeable about the household. Interviewing the household head is not a must and you are not required to ask for the household head to do the interview (a) Household Questionnaire (i)Household Information Panel (ii)Household Listing Form (iii)Education (iv)Water and Sanitation (v)Salt iodization (vi) Hand-washing (vii)Child labour (viii)Child discipline (ix)Insecticide treated nets (x)Household Characteristics etc. When you have completed the Household Questionnaire, you will have identified women (aged 15-49 years) and mothers or primary caregivers of children under five to whom you will administer the individual questionnaires. ·You should interview separately all women aged 15 through 49 who reside in the household to fill in the Questionnaire for Individual Women. (b) Individual Women (15 - 49) Questionnaire (i) Woman's information panel (i)Woman's background (ii)Child Mortality (iii)Desire for last birth (iv)Maternal and Newborn Health (v)Illness symptoms (vi)Contraception (vii)Unmet need (viii)Female Genital Mutilation/Cutting (ix)Attitudes toward domestic violence (x)Marriage/union (xi)Sexual behaviour (xii)HIV/AIDS etc You should administer the Questionnaire for Children under-5 to mothers of children under-5 years of age who are residing in the household. If the mother is not listed in the Household Listing, then the person who is acknowledged as the primary caregiver should be the respondent to the Under Five Questionnaire (c) Children Under Five Questionnaire (xi)Under-five child Information Panel (xii)Age (xiii)Birth registration (xiv)Early child development (xv)Breastfeeding (xvi)Care of illness (xvii)Malaria (xviii)Immunization (xix)Anthropometry etc. There will be two (2) levels of training, the 1stlevel, the training of trainers (TOT) and the 2nd, the zonal training. The 1st level will be held at Minna, Niger State and it will involve twenty (20) participants comprising the NBS coordinators, NBS trainers and UNICEF officials. It will last for five (5) days. The 2nd level will be held at two (2) NBS zonal states; Enugu (Enugu state) for Osun and Akwa Ibom states and Maiduguri (Borno State) for Kano and Gombe states. The 2nd level training will last for ten (10) days. Two (2) roving teams will be used in each of the selected states. Each roving team will comprise of: ·Five (5) interviewers (female) ·One (1) measurer (female) ·One (1) editor (male or female) ·One (1) supervisor (male or female) NBS permanent staff To make the fieldwork run smoothly, vehicles will be provided for the field personnel throughout the duration of data collection which will last for 45 days including travel time within the EAs/Clusters and LGAs. The training contents covered among all: - Survey design and roles of survey personnel - Classroom sessions on questionnaires and manuals - Mock interviews and role playing - Questionnaire editing - Field Practice First level monitoring at National level by 18 NBS Headquarters staff and members of Central Technical Committee Second level monitoring at state level by NBS 6 Zonal Controllers, 37 State Officers and other member of State Steering Committee There will be a monitoring exercise to be mounted at NBS Headquarters, which primary objective is to ensure that data collected is of good quality. Those to be involved in the monitoring exercise are four (4) NBS headquarters staff among the eight (8) NBS trainers, four (4) zonal controllers and four (4) state officers of where the pilot study is being carried out. Also to be involved will be the UNICEF officials. The monitoring exercise will last for six (6) days for all categories of monitors. Four (4) coordinators from NBS Headquarters will coordinate the pilot study. The coordinators will be involved in Training of Trainers (TOT), coordinate the zonal training and fieldwork. However, coordination will last for four (4) days for both activities. Sample weights were calculated for each of the data files.. Sample weights for the household data were computed as the probability of selection of the household, computed at the sampling domain level (urban/rural within each state). The household weights were adjusted for non-response at the domain level, and then nomalised by a constant factor so that the total weighted number of households equals the total unweighted number of households. The hosehold weight variable is called HHWEIGHT and is used with the HH data and the HL data Sample weights for the women's data used the un-nomalized household weights, adjusted for non-response for the women's questionnaire, and were then normalized by a constant factor so that the total weighted number of women's cases equals the total unweighted number of women's cases. Sample weights for the children's data followed the same approach as the women's and used the un-nomalized household weights, adjusted for non-response fr the children's questionnaire, and were then normalized by a constant factor so that the total weighted number of children's cases equals the total unweighted number of children's cases Estimation Procedures: Let the probability of selecting the EA be fj and the probability of selecting the housing unit be fk. Then the product f = fjfk = 1 where fj = n and fk = h Ys=Estimate for states N =Total Number of EAs in states n =Selected number of EAs in states H = Total number of Housing Units listed in the jth EA h =Selected number of Housing Units in the jth EA. Xsj k =Value of the element in the kth housing unit of jth EA in states. Wsjk=Weight of the element in kth housing unit of the jth EA in states. Data editing began from the feild through the feild data editor and then the feild supervisor before getting to the state officers. Then other stages through the processing include (i) Desk officers at the zonal offices (ii) Trained data editors from the headquarters sent to the zonal offices for data editing during the data entry (iii) Data editing through the zonal offices editors before data entry (iv) Competent data entry staff (v) Verifiers We had 96% Response Rate Detailed information attached as external document A series of tables and graphs were genenrated The confidentiality of the individual respondent is protected by law (Statistical Act 2007) This is published in the Official Gazette of the Federal republic of Nigeria No. 60 vol. 94 of 11th June 2007. See section 26 para.2. Punitive measures for breeches of confidentiality are outlined in section 28 of the same Act. National Bureau of Statistics(NBS) "National Bureau of Statistics, Multiple Indicators Cluster Survey (MICS4, Nigeria 2011), version 1.0" A comprehensive data access policy is been developed by NBS, however section 27 of the Statistical Act 2007outlines the data access obligation of data producers which includes the realease of properly anonymized micro data. The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses. MICS4 Household Listing data Household Demographic data based on selected Enumeration Areas (EAs) demarcated by the National Population Census in Nigeria. This formed the Frame for the selection of huosing units from where data was collected. 0 63 MICS4 Household data The household data collected from the feild based on (1) Household Information (2) Demographic Characteristics (3) Water and Sanitation (4) Household Characteristics (5) Children Ophaned and made vulnerable children (6) Child Labour (7) Salt Iodization 0 125 MICS4 Treated Net data The data collected on Household use of insecticide treated net in the household 0 23 MICS4 Women data The data collected from the feild based on Women Information data (1) Women Information Panel (2) Child Mortality (3) Tetanus Toxoid (4) Maternal and Newborn Health (5) Marriage/Union (6) Contraception and UNMET Need (7) HIV/AIDS (8) Sexual Behaviour 0 250 MICS4 Genital data The data collected from the feild based on Female Genital Mutilation/Cutting (1) Women Information Panel (2) Child Mortality (3) Tetanus Toxoid (4) Maternal and Newborn Health (5) Marriage/Union (6) Contraception and UNMET Need (7) Female Genital Mutilation/Cutting (8) HIV/AIDS (9) Sexual Behaviour 0 22 MICS4 Under 5 Children data The data collected from the feild based on Under 5 Children (1) Information Panel (2) Birth Registration and Early Learning (3) Child Development (4) Vitamin A (5) Breastfeeding (6) Care of Illness (7) Malaria (8) Immunization (9) Anthropometry 0 288 Cluster number Cluster number Cluster number Cluster number Cluster number CLUSTER NUMBER HOUSEHOLD INFORMATION PANEL Household number Household number Household number Household number Household number HOUSEHOLD NUMBER HOUSEHOLD INFORMATION PANEL Line number Line number Line number Line number Line number Line number HOUSEHOLD LISTING FORM Relationship to the head Relationship to the head Relationship to the head Relationship to the head Relationship to the head WHAT IS THE RELATION -SHIP OF (NAME) TO THE HEAD OF HOUSEHOLD? HOUSEHOLD LISTING FORM 1 Head 2 Wife or husband 3 Son or daugher 4 Son or daughter in law 5 Grandchild 6 Parent 7 Parent in law 8 Brother or sister 9 Brother or sister in law 10 Uncle/aunt 11 Niece/nephew by blood 12 Niece/nephew by marriage 13 Adopted/foster/stepchild 14 Not related 98 Don't know 99 Missing Sex Sex Sex Sex Sex IS (NAME) MALE OR FEMALE? HOUSEHOLD LISTING FORM 1 Male 2 Female 9 Missing Month of birth Month of birth Month of birth Month of birth Month of birth WHAT IS (NAME)’S DATE OF BIRTH? Month IF DK CODE 98, AND IF MISSING CODE 99 HOUSEHOLD LISTING FORM Year of birth Year of birth Year of birth Year of birth Year of birth WHAT IS (NAME)’S DATE OF BIRTH? Year IF DK CODE 9998, AND IF MISSING CODE 9999 HOUSEHOLD LISTING FORM How old is (name) How old is (name) How old is (name) How old is (name) How old is (name) HOW OLD IS (name)? If Not eligible code 0 HOUSEHOLD LISTING FORM Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module Line number of mother/caretaker for child labor module If Not eligible code 0 Circle line number if woman is age 15-49 HOUSEHOLD LISTING FORM Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module Line number of mother/caretaker for child health module WHO IS THE MOTHER OR PRIMARY CAREGIVER OF THIS CHILD? If Not eligible code 0 Record line number of mother/caregiver HOUSEHOLD LISTING FORM Mother or primary caregiver of this child Mother or primary caregiver of this child Mother or primary caregiver of this child Mother or primary caregiver of this child Mother or primary caregiver of this child WHO IS THE MOTHER OR PRIMARY CAREGIVER OF THIS CHILD? Record line number of mother/caregiver HOUSEHOLD LISTING FORM Did (name) stay here last night Did (name) stay here last night Did (name) stay here last night Did (name) stay here last night Did (name) stay here last night DID (name) STAY HERE LAST NIGHT? HOUSEHOLD LISTING FORM 1 Yes 2 No Is (name)’s natural mother alive Is (name)’s natural mother alive Is (name)’s natural mother alive Is (name)’s natural mother alive Is (name)’s natural mother alive IS (name)’S NATURAL MOTHER ALIVE? HOUSEHOLD LISTING FORM 1 Yes 2 No 8 Dk 9 Missing Does (name)’s natural mother live in this household Does (name)’s natural mother live in this household Does (name)’s natural mother live in this household Does (name)’s natural mother live in this household Does (name)’s natural mother live in this household DOES (name)’S NATURAL MOTHER LIVE IN THIS HOUSEHOLD? Record line number of mother or 00 for “No” HOUSEHOLD LISTING FORM Is natural father alive Is natural father alive Is natural father alive Is natural father alive Is natural father alive IS name)’S NATURAL FATHER ALIVE? IF 2 No?? Next Line OR IF 8 DK?? Next Line HOUSEHOLD LISTING FORM 1 Yes 2 No 8 Dk 9 Missing Natural father's line number in hh Natural father's line number in hh Natural father's line number in hh Natural father's line number in hh Natural father's line number in hh DOES (name)'S NATURAL FATHER LIVE IN THIS HOUSEHOLD? Record line number of father or 00 for "No" HOUSEHOLD LISTING FORM Line number Line number Line number Line number Line number LINE NUMBER EDUCATION Ever attended school or pre-school Ever attended school or pre-school Ever attended school or pre-school Ever attended school or pre-school Ever attended school or pre-school HAS (name) EVER ATTENDED SCHOOL OR PRESCHOOL? IF 2 NO GO TO Next Line EDUCATION 1 Yes 2 No 9 Missing Highest level of education attended Highest level of education attended Highest level of education attended Highest level of education attended Highest level of education attended WHAT IS THE HIGHEST LEVEL OF SCHOOL (name) ATTENDED? If Level is 4 go to ED5 EDUCATION Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 4 Non-formal education 8 Dk 9 Missing Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level WHAT IS THE HIGHEST GRADE (name) COMPLETED AT THIS LEVEL? EDUCATION Never complete nursery 1 Nursery 1 2 Nursery 2 3 Nursery 3 10 Never complete primary 1 11 Primary 1 12 Primary 2 13 Primary 3 14 Primary 4 15 Primary 5 16 Primary 6 20 Never complete jss1 21 Jss 1 22 Jss 2 23 Jss 3 24 Ss 1 25 Ss 2 26 Ss 3 30 Never complete nce 1 al/ond1/ technica 31 Nce 32 A/ond 33 Technica 40 Never complete hnd1/bsc.1/pg 41 Hnd 42 Bsc 43 Post graduate 97 Inconsistent 98 Dk 99 Missing During the (2010-2011) school year, did (name) attend school or preschool at any time During the (2010-2011) school year, did (name) attend school or preschool at any time During the (2010-2011) school year, did (name) attend school or preschool at any time During the (2010-2011) school year, did (name) attend school or preschool at any time During the (2010-2011) school year, did (name) attend school or preschool at any time DURING THE (2010-2011) SCHOOL YEAR, DID (name) ATTEND SCHOOL OR PRESCHOOL AT ANY TIME? IF 2 No GO TO ED7 EDUCATION Level of education attended Level of education attended Level of education attended Level of education attended Level of education attended DURING THIS SCHOOL YEAR, WHICH LEVEL IS (name) ATTENDING? LEVEL If Level is 4 go to ED7 EDUCATION Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 4 Non-formal education 8 Dk 9 Missing Grade of education attended Grade of education attended Grade of education attended Grade of education attended Grade of education attended during this school year, which level and grade is (name) attending? GRADE If Level is 4 go to ED7 EDUCATION 1 Nursery 1 2 Nursery 2 3 Nursery 3 11 Primary 1 12 Primary 2 13 Primary 3 14 Primary 4 15 Primary 5 16 Primary 6 21 Jss 1 22 Jss 2 23 Jss 3 24 Ss 1 25 Ss 2 26 Ss 3 31 Nce 32 A/ond 33 Technica 41 Hnd 42 Bsc 43 Post graduate 97 Inconsistent 98 Dk 99 Missing Attended school last year (2005-2006) Attended school last year (2005-2006) Attended school last year (2005-2006) Attended school last year (2005-2006) Attended school last year (2005-2006) DURING THE PREVIOUS SCHOOL YEAR, THAT IS (2009-2010), DID (name) ATTEND SCHOOL OR PRESCHOOL AT ANY TIME? IF 2 No GO TO Next Line IF 8 DK GO TO Next Line EDUCATION 1 Yes 2 No 8 Dk 9 Missing Level of education attended last year Level of education attended last year Level of education attended last year Level of education attended last year Level of education attended last year DURING THAT PREVIOUS SCHOOL YEAR, WHICH LEVEL DID (name) ATTEND? If Level is 4 go to Next line EDUCATION Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 6 Non-standard curriculum 8 Dk 9 Missing Grade of education attended last year Grade of education attended last year Grade of education attended last year Grade of education attended last year Grade of education attended last year DURING THAT PREVIOUS SCHOOL YEAR, WHICH GRADE DID (name) ATTEND? If Level is 4 go to Next line EDUCATION 1 Nursery 1 2 Nursery 2 3 Nursery 3 11 Primary 1 12 Primary 2 13 Primary 3 14 Primary 4 15 Primary 5 16 Primary 6 21 Jss 1 22 Jss 2 23 Jss 3 24 Ss 1 25 Ss 2 26 Ss 3 31 Nce 32 A/ond 33 Technica 41 Hnd 42 Bsc 43 Post graduate 97 Inconsistent 98 Dk 99 Missing Line number Line number Line number Line number Line number NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO Line number For household members below age 5 or above age 17, leave rows blank. CHILD LABOUR Worked in past week Worked in past week Worked in past week Worked in past week Worked in past week NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO DURING THE PAST WEEK, DID (name) DO ANY KIND OF WORK FOR SOMEONE WHO IS NOT A MEMBER OF THIS HOUSEHOLD? For household members below age 5 or above age 17, leave rows blank. CHILD LABOUR 1 Yes, paid 2 Yes, unpaid 3 No 9 Missing Hours worked in past week Hours worked in past week Hours worked in past week Hours worked in past week Hours worked in past week NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE DO THIS WORK FOR SOMEONE WHO IS NOT A MEMBER OF THIS HOUSEHOLD? Number of hours For household members below age 5 or above age 17, leave rows blank. If more than one job, include all hours at all jobs. IF DK CODE 98 IF MISSING CODE 99 CHILD LABOUR Worked in past year Worked in past year Worked in past year Worked in past year Worked in past year NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO DURING THE PAST WEEK, DID (name) FETCH WATER OR COLLECT FIREWOOD FOR HOUSEHOLD USE? For household members below age 5 or above age 17, leave rows blank. IF NO 2 GO TO CL7 CHILD LABOUR 1 Yes 2 No 9 Missing Many hours did he/she fetch water or collect firewood Many hours did he/she fetch water or collect firewood Many hours did he/she fetch water or collect firewood Many hours did he/she fetch water or collect firewood Many hours did he/she fetch water or collect firewood NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE FETCH WATER OR COLLECT FIREWOOD FOR HOUSEHOLD USE? Number of hours For household members below age 5 or above age 17, leave rows blank. CHILD LABOUR Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO DURING THE PAST WEEK, DID (name) DO ANY PAID OR UNPAID WORK ON A FAMILY FARM OR IN A FAMILY BUSINESS OR SELLING GOODS IN THE STREET? For household members below age 5 or above age 17, leave rows blank. Include work for a business run by the child, alone or with one or more partners. IF NO 2 GO TO CL9 CHILD LABOUR Do any paid or unpaid work on a family farm or in a family business or selling goods in the street Do any paid or unpaid work on a family farm or in a family business or selling goods in the street Do any paid or unpaid work on a family farm or in a family business or selling goods in the street Do any paid or unpaid work on a family farm or in a family business or selling goods in the street Do any paid or unpaid work on a family farm or in a family business or selling goods in the street NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE DO THIS WORK FOR HIS/HER FAMILY OR HIMSELF/HERSELF? Number of hours For household members below age 5 or above age 17, leave rows blank. CHILD LABOUR Did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people Did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people Did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people Did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people Did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO DURING THE PAST WEEK, DID (name) HELP WITH HOUSEHOLD CHORES SUCH AS SHOPPING, CLEANING, WASHING CLOTHES, COOKING; OR CARING FOR CHILDREN, OLD OR SICK PEOPLE? For household members below age 5 or above age 17, leave rows blank. IF NO 2 NEXT LINE CHILD LABOUR 1 Yes 2 No 9 Missing Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week Hours spent on chores in past week NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE SPEND DOING THESE CHORES? Number of hours For household members below age 5 or above age 17, leave rows blank. CHILD LABOUR Net number Net number Net number Net number Net number HOW MANY MOSQUITO NETS DOES YOUR HOUSEHOLD HAVE? Number of nets ................................ ___ ___ INSECTICIDE TREATED NETS Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed? INSECTICIDE TREATED NETS 1 Observed 2 Not observed 9 Missing Brand/type of observed net Brand/type of observed net Brand/type of observed net Brand/type of observed net Brand/type of observed net Observe or ask the type of mosquito net. If type is unknown and you cannot observe the net, show pictures of typical net types to the respondent. INSECTICIDE TREATED NETS 18 Long-lasting treated nets 28 Pre-treated nets 31 Other net 98 Dk brand / type 99 Missing Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained HOW MANY MONTHS AGO DID YOUR HOUSEHOLD GET THE MOSQUITO NET? If less than one month, record “00” If Months ago ........... ___ ___ If More than 36 mo. ago ... 95 If DK / Not sure ................. 98 If Missing......................99 INSECTICIDE TREATED NETS Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained WHEN YOU GOT THE NET, WAS IT ALREADY TREATED WITH AN INSECTICIDE TO KILL OR REPEL MOSQUITOES? INSECTICIDE TREATED NETS 1 Yes 2 No 8 Dk / not sure 9 Missing Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained SINCE YOU GOT THE NET, WAS IT EVER SOAKED OR DIPPED IN A LIQUID TO KILL OR REPEL MOSQUITOES? INSECTICIDE TREATED NETS 1 Yes 2 No 8 Dk / not sure 9 Missing Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped HOW MANY MONTHS AGO WAS THE NET LAST SOAKED OR DIPPED? If less than one month, record "00" If Months ago ........... ___ ___ If More than 24 mo. ago ... 95 If DK / Not sure ................. 98 If Missing ..................99 INSECTICIDE TREATED NETS Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night DID ANYONE SLEEP UNDER THIS MOSQUITO NET LAST NIGHT? INSECTICIDE TREATED NETS 1 Yes 2 No 8 Dk / not sure 9 Missing Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" INSECTICIDE TREATED NETS Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" INSECTICIDE TREATED NETS Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" INSECTICIDE TREATED NETS Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" INSECTICIDE TREATED NETS Day of interview Day of interview Day of interview Day of interview Day of interview Day ___ ___ HOUSEHOLD INFORMATION PANEL Month of interview Month of interview Month of interview Month of interview Month of interview Month ___ ___ HOUSEHOLD INFORMATION PANEL Year of interview Year of interview Year of interview Year of interview Year of interview Year of interview: ___ ___ ___ ___ HOUSEHOLD INFORMATION PANEL Area:sector Area:sector Area:sector Area:sector Area:sector Area Sector HOUSEHOLD INFORMATION PANEL 1 Rural 2 Urban State State State State State State Code: HOUSEHOLD INFORMATION PANEL 1 Abia 2 Adamawa 3 Akwa-ibom 4 Anambra 5 Bauchi 6 Bayelsa 7 Benue 8 Borno 9 Cross-rivers 10 Delta 11 Ebonyi 12 Edo 13 Ekiti 14 Enugu 15 Gombe 16 Imo 17 Jigawa 18 Kaduna 19 Kano 20 Katsina 21 Kebbi 22 Kogi 23 Kwara 24 Lagos 25 Nasarawa 26 Niger 27 Ogun 28 Ondo 29 Oshun 30 Oyo 31 Plataeu 32 Rivers 33 Sokoto 34 Taraba 35 Yobe 36 Zamfara 37 Abuja fct Mother's line number Mother's line number Mother's line number Mother's line number Mother's line number Mother's line number Mother's line number Father's line number Father's line number Father's line number Father's line number Father's line number Father's line number Father's line number Mother's education Mother's education Mother's education Mother's education Mother's education Mother's education 1 None 2 Primary 3 Secondary + 5 Mother not in household 9 Missing/dk Father's education Father's education Father's education Father's education Father's education Father's education 1 None 2 Primary 3 Secondary + 5 Father not in household 9 Missing/dk Education of household head Education of household head Education of household head Education of household head Education of household head Education of household head 1 None 2 Primary 3 Secondary + 9 Missing/dk Age at beginning of school year Age at beginning of school year Age at beginning of school year Age at beginning of school year Age at beginning of school year Age at beginning of school year 95Child born after begining of school year 98Dk/missing Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head 1 Christianity 2 Islam 3 Other religion 4 No religion 9 Missing/dk Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head 1 North central 2 North east 3 North west 4 South east 5 South south 6 South west Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Cluster number Cluster number Cluster number Cluster number Cluster number Cluster Number ___ ___ ___ ___ Enter the name of the enumeration area and the cluster number as provided by your supervisor. The cluster number in four digits includes two digits for the state and two digits for the EA serial number in the state. Every selected Household The selected Enumeration Area to be covered Household number Household number Household number Household number Household number HH2. Household Number:___ ___ ___ ___ must be entered by the enumerator prior to interview Enter the household number as instructed by your supervisor Households selected for coverage The numbering fixed to the selected household during the listing exercise. It was used for the selection of household to be covered for the survey Day of interview Day of interview Day of interview Day of interview Day of interview Day___ ___ must be entered by the enumerator prior to interview Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been completed but there will be no more attempts to interview the household. It must be entered by the enumerator prior to interview Every interviewer The day the interview was conducted Month of interview Month of interview Month of interview Month of interview Month of interview Month___ ___ must be entered by the enumerator prior to interview Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been completed but there will be no more attempts to interview the household. It must be entered by the enumerator prior to interview Every interviewer The month the interview was conducted Year of interview Year of interview Year of interview Year of interview Year of interview Year of interview: ___ ___ ___ ___ must be entered by the enumerator prior to interview Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household again, revise and enter final date of interview. In other words, the date here should be either when you have completed the Household Questionnaire or when the interview has not been completed but there will be no more attempts to interview the household. It must be entered by the enumerator prior to interview Every interviewer The year the interview was conducted Area:sector Area:sector Area:sector Area:sector Area:sector Area Sector must be entered by the enumerator prior to interview Circle the code for area of residence as instructed by your supervisor. This would have been pre-determined; you will not be required to assess whether the household is in an urban or rural area It must be circled by the enumerator prior to interview Every interviewer 1 Rural 2 Urban Rural Sector: Areas demacated as rural by the National Population Commission Urban Sector: Areas demacated as urban by the National Population Commission State State State State State State Code: must be entered by the enumerator prior to interview Write the state name and code It must be entered by the enumerator prior to interview Federal Republic of Nigeria 1 Abia 2 Adamawa 3 Akwa-ibom 4 Anambra 5 Bauchi 6 Bayelsa 7 Benue 8 Borno 9 Cross-rivers 10 Delta 11 Ebonyi 12 Edo 13 Ekiti 14 Enugu 15 Gombe 16 Imo 17 Jigawa 18 Kaduna 19 Kano 20 Katsina 21 Kebbi 22 Kogi 23 Kwara 24 Lagos 25 Nasarawa 26 Niger 27 Ogun 28 Ondo 29 Oshun 30 Oyo 31 Plataeu 32 Rivers 33 Sokoto 34 Taraba 35 Yobe 36 Zamfara 37 Abuja fct The 36 states of the federation and Federal Capital Territory (FCT), Abuja along with the attached codes Result of hh interview Result of hh interview Result of hh interview Result of hh interview Result of hh interview After all questionnaires for the household have been completed, fill in the following information Result of HH interview: must be entered by the enumerator after to interview If the Household Questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the household after repeated visits, circle '2' for 'Not at home'. If the household refuses to be interviewed, circle '3' for 'Refused'. If you are unable to locate the household or if the dwelling is destroyed, circle '4' for 'HH not found/destroyed'. If you have not been able to complete the Household Questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Some examples of 'Other' codes might be: the household respondent is incapacitated; the questionnaire is partly completed; adult household members were not found at home after repeated visits After all questionnaires for the household have been completed, fill in the following information: every household 1 Completed 2 No household member or no competent 3 Entire household absent for extended 4 Refused 5 Dwelling vacant / address not a dwelling 6 Dwelling destroyed 7 Dwelling not found 8 Partially completed. 96 Other (specify) The outcome of the interview Respondent hh questionnaire Respondent hh questionnaire Respondent hh questionnaire Respondent hh questionnaire Respondent hh questionnaire After all questionnaires for the household have been completed, fill in the following information Respondent to HH questionnaire: Name:______________________________ Line No:___ Enter the name and line number (from the Household Listing, columns HL1 and HL2) of the respondent to the Household Questionnaire. After all questionnaires for the household have been completed, fill in the following information: every Household The name of the respondent to the Household Questionnaire along with its line number as appeared in the Houshold list of HL1. Number of household members Number of household members Number of household members Number of household members Number of household members After all questionnaires for the household have been completed, fill in the following information Total number of household members:__ __ Count the number of household members recorded in column HL1 of the Household Listing and enter the total here. After all questionnaires for the household have been completed, fill in the following information: every household The total number of Household members as it was listed in Household listing HL1 Total eligible women Total eligible women Total eligible women Total eligible women Total eligible women After all questionnaires for the household have been completed, fill in the following information Number of women age 15-49 years: Enter the total number of women eligible for interview for the Questionnaire for Individual Women - you will copy this from the row for totals at the bottom of the Household Listing, for HL6. After all questionnaires for the household have been completed, fill in the following information: every household Total number of women within the age of 15 - 49 years who were in the Household. Women interviews completed Women interviews completed Women interviews completed Women interviews completed Women interviews completed After all questionnaires for the household have been completed, fill in the following information Number of woman’s questionnaires completed: Once all the Questionnaires for Individual Women have been completed for a particular household, enter the number completed here After all questionnaires for the household have been completed, fill in the following information: every household interviewed The total number of women questionnaires completed in the household Total children under 5 Total children under 5 Total children under 5 Total children under 5 Total children under 5 After all questionnaires for the household have been completed, fill in the following information Number of children under age 5: Enter the total number of children under five eligible for inclusion in the survey from the row for totals at the bottom of the Household Listing, for HL8. You will be using the Questionnaire for Children under five to interview the mothers or primary caretakers of these children. After all questionnaires for the household have been completed, fill in the following information: Interviewer Total number of children under 5years who were in the Household. Child interviews completed Child interviews completed Child interviews completed Child interviews completed Child interviews completed After all questionnaires for the household have been completed, fill in the following information Number of under-5 questionnaires completed: Once all of the Questionnaires for Children Under Five have been completed for a particular household, enter the number completed here. After all questionnaires for the household have been completed, fill in the following information: Start of interview - hour Start of interview - hour Start of interview - hour Start of interview - hour Start of interview - hour HH18. Record the time. Hour ...........__ __ Missing 99 Start of interview - minutes Start of interview - minutes Start of interview - minutes Start of interview - minutes Start of interview - minutes HH18. Record the time. Minutes ......__ __ Missing 99 End of interview - hour End of interview - hour End of interview - hour End of interview - hour End of interview - hour HH19. Record the time. Hour .................. __ __ : __ __ Missing 99 End of interview - minutes End of interview - minutes End of interview - minutes End of interview - minutes End of interview - minutes HH19. Record the time. minutes .................... __ __ : __ __ Missing 99 Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water Main source of drinking water WS1. What is the main source of drinking water for members of your household? Circle the code for the most usual source. If several sources are mentioned, probe to determine the most usual source. If the source varies by season, record the source for the season of the interview. Note that the next question is only asked if the response to this question is 'Bottled water'. You should skip WS2 if the response to WS1 is other than 'Bottled water'. If the response is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' or '12', respectively, and skip to WS5. Otherwise, skip to WS3. WATER AND SANITATION 11 Piped into dwelling 12 Piped into yard or plot 13 Piped to neighbour 14 Public tap / standpipe 21 Tubewell/borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 61 Tanker-truck 71 Cart with small tank/drum 81 Surface water(iver, stream,dam etc) 91 Bottled water 92 Sachet (pure) water 96 Other (specify)_____________________ 99 Missing Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat Main source of water used for other purposes (if bottled wat WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing? This question should only be asked to households that use 'Bottled water' for drinking. Circle the code for the most usual source. If the source varies by season, record the source for the season of the interview. If the most usual source of non-drinking water is 'Piped into dwelling' or 'Piped into yard/plot', circle '11' , '12' or '13', respectively, and skip to WS6. Otherwise continue to the next question. WATER AND SANITATION 11 Piped into dwelling 12 Piped into compound, yard or plot 13 Piped to neighbour ................................ 14 Public tap / standpipe 21 Tube well, borehole 31 Protected well 32 Unprotected well 41 Protected spring 42 Unprotected spring 51 Rainwater collection 61 Tanker-truck 71 Cart with small tank/drum 81 Surface water (river, stream, dam, lake, 96 Other (specify) 99 Missing Water source located Water source located Water source located Water source located Water source located WS3. WHERE IS THAT WATER SOURCE LOCATED? WATER AND SANITATION 1 In own dwelling 2 In own yard / plot 3 Elsewhere 8 Dk 9 Missing Take to go there, get water, and come back Take to go there, get water, and come back Take to go there, get water, and come back Take to go there, get water, and come back Take to go there, get water, and come back HOW LONG DOES IT TAKE TO GO THERE, GET WATER, AND COME BACK? Number of minutes ......................... __ __ __ DK .....................................................998 WATER AND SANITATION How long does it take to get water by foot during rainy seas How long does it take to get water by foot during rainy seas How long does it take to get water by foot during rainy seas How long does it take to get water by foot during rainy seas How long does it take to get water by foot during rainy seas HOW LONG DOES IT TAKE TO GO THERE, GET WATER, AND COME BACK ? (A) DURING RAINY SEASON Number of minutes ......................... __ __ __ DK .....................................................998 WATER AND SANITATION How long does it take to get water by foot during dry season How long does it take to get water by foot during dry season How long does it take to get water by foot during dry season How long does it take to get water by foot during dry season How long does it take to get water by foot during dry season HOW LONG DOES IT TAKE TO GO THERE, GET WATER, AND COME BACK ? (B) DURING DRY SEASON Number of minutes ......................... __ __ __ DK .....................................................998 WATER AND SANITATION What is the distance to the nearest water source (metres) What is the distance to the nearest water source (metres) What is the distance to the nearest water source (metres) What is the distance to the nearest water source (metres) What is the distance to the nearest water source (metres) WHAT IS THE DISTANCE TO THE NEAREST WATER SOURCE IN METRES? Metres……………………………….…_ _ _ _ DK .................................... 9998 WATER AND SANITATION Who usually goes to this source to collect the water Who usually goes to this source to collect the water Who usually goes to this source to collect the water Who usually goes to this source to collect the water Who usually goes to this source to collect the water WHO USUALLY GOES TO THIS SOURCE TO COLLECT THE WATER FOR YOUR HOUSEHOLD? Probe: IS THIS PERSON UNDER AGE 15? WHAT SEX? WATER AND SANITATION 1 Adult woman (age 15+ years) 2 Adult man (age 15+ years) 3 Female child (under 15) 4 Male child (under 15) 8 Dk 9 Missing Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking Treat water to make safer for drinking DO YOU DO ANYTHING TO THE WATER TO MAKE IT SAFER TO DRINK? WATER AND SANITATION 1 Yes 2 No 8 Dk 9 Missing Water treatment: boil Water treatment: boil Water treatment: boil Water treatment: boil Water treatment: boil WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Boil Probe: ANYTHING ELSE? Record all items mentioned. Boil WATER AND SANITATION ? Missing A Boil Water treatment: add bleach/chlorine Water treatment: add bleach/chlorine Water treatment: add bleach/chlorine Water treatment: add bleach/chlorine Water treatment: add bleach/chlorine WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Add bleach/chlorine Probe: ANYTHING ELSE? Record all items mentioned. Add bleach/chlorine WATER AND SANITATION ? Missing B Add bleach / chlorine Water treatment: strain it through a cloth Water treatment: strain it through a cloth Water treatment: strain it through a cloth Water treatment: strain it through a cloth Water treatment: strain it through a cloth WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Strain it through a cloth Probe: ANYTHING ELSE? Record all items mentioned. Strain it through a cloth WATER AND SANITATION ? Missing C Strain it through a cloth Water treatment: use water filter Water treatment: use water filter Water treatment: use water filter Water treatment: use water filter Water treatment: use water filter WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Use water filter Probe: ANYTHING ELSE? Record all items mentioned. Use water filter WATER AND SANITATION ? Missing D Use water filter Water treatment: solar disinfection Water treatment: solar disinfection Water treatment: solar disinfection Water treatment: solar disinfection Water treatment: solar disinfection WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Solar disinfection Probe: ANYTHING ELSE? Record all items mentioned. Solar disinfection WATER AND SANITATION ? Missing E Solar disinfection Water treatment: let it stand and settle Water treatment: let it stand and settle Water treatment: let it stand and settle Water treatment: let it stand and settle Water treatment: let it stand and settle WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Let it stand and settle Probe: ANYTHING ELSE? Record all items mentioned. Let it stand and settle WATER AND SANITATION ? Missing F Let it stand and settle Water treatment: add alum Water treatment: add alum Water treatment: add alum Water treatment: add alum Water treatment: add alum WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Add alum Probe: ANYTHING ELSE? Record all items mentioned. Add alum WATER AND SANITATION ? Missing G Add alum Water treatment: add water tablet/liquid Water treatment: add water tablet/liquid Water treatment: add water tablet/liquid Water treatment: add water tablet/liquid Water treatment: add water tablet/liquid WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Add water tablet/liquid Probe: ANYTHING ELSE? Record all items mentioned. Add water tablet/liquid WATER AND SANITATION ? Missing H Add water tablet/liquid Water treatment: other Water treatment: other Water treatment: other Water treatment: other Water treatment: other WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Other Probe: ANYTHING ELSE? Record all items mentioned. Other WATER AND SANITATION ? Missing X Other Water treatment: dk Water treatment: dk Water treatment: dk Water treatment: dk Water treatment: dk WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? DK Probe: ANYTHING ELSE? Record all items mentioned. DK WATER AND SANITATION ? Missing Z Dk What kind of toilet facility What kind of toilet facility What kind of toilet facility What kind of toilet facility What kind of toilet facility WHAT KIND OF TOILET FACILITY DO MEMBERS OF YOUR HOUSEHOLD USUALLY USE? If "flush" or "pour flush", probe: WHERE DOES IT FLUSH TO? If necessary, ask permission to observe the facility. WATER AND SANITATION 11 Flush to piped sewer system 12 Flush to septic tank 13 Flush to pit (latrine) 14 Flush to somewhere else 15 Flush to unknown place / not sure / 21 Ventilated improved pit latrine (vip) 22 Pit latrine with slab 23 Pit latrine without slab / open pit 31 Composting toilet 41 Bucket 51 Hanging toilet, hanging latrine 95 No facility, bush, field 96 Other (specify) 99 Missing Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility DO YOU SHARE THIS FACILITY WITH OTHERS WHO ARE NOT MEMBERS OF YOUR HOUSEHOLD? The total number of households using this facility should include the household being interviewed. If less than ten households use this toilet facility, enter the number of households on the line provided. Circle '10' if ten or more households use this toilet facility. Note that '01' is not a valid response (since it means that this is the only household that uses the facility; if that is the case, you should go back to WS8 and correct the response there). Circle '98' for 'DK' ('Doesn't know'). WATER AND SANITATION 1 Yes 2 No 8 Dk 9 Missing Toilet shared with other household or with general public Toilet shared with other household or with general public Toilet shared with other household or with general public Toilet shared with other household or with general public Toilet shared with other household or with general public DO YOU SHARE THIS FACILITY ONLY WITH MEMBERS OF OTHER HOUSEHOLDS THAT YOU KNOW, OR IS THE FACILITY OPEN TO THE USE OF THE GENERAL PUBLIC? WATER AND SANITATION 1 Other households only (not public) 2 Public facility 9 Missing Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility Households using this toilet facility HOW MANY HOUSEHOLDS IN TOTAL USE THIS TOILET FACILITY, INCLUDING YOUR OWN HOUSEHOLD? Number of households (if less than 10) 0 __ Ten or more households .......................... 10 DK ......................................................... 98 Missing.......................................................99 WATER AND SANITATION Religion of head Religion of head Religion of head Religion of head Religion of head HC1a. What is the religion of the head of this household? HOUSEHOLD CHARACTERISTICS 1 Christian 2 Muslim 6 Other religion 7 No religion 9 Missing Mother tongue of head Mother tongue of head Mother tongue of head Mother tongue of head Mother tongue of head HC1B. mother tongue of head Language ……………………… __ __ __ Missing 99 HOUSEHOLD CHARACTERISTICS Ethnic group of head Ethnic group of head Ethnic group of head Ethnic group of head Ethnic group of head HC1C. ethnic group of head Ethnic Group ……………………__ __ __ Missing 99 HOUSEHOLD CHARACTERISTICS Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping Number of rooms for sleeping HC2. How many rooms in this household are used for sleeping? No. of rooms__ __ This information provides a measure of how crowded the house is, and reflects the socio-economic condition of the household. A room in this case refers to a special area with a permanent partition that is used for sleeping. It is not necessarily the number of rooms in the household that are called 'bedrooms', but rather how many rooms get used for sleeping on a regular basis. Exclude rooms that are used only for sleeping by visitors to the household, but include those rooms that may not be regular 'bedrooms' but may be regularly used by one or more of the household members for sleeping. Enter the number of rooms in this household that are used for sleeping Missing 99 HOUSEHOLD CHARACTERISTICS Main material of floor Main material of floor Main material of floor Main material of floor Main material of floor HC3. Main material of the dwelling floor: Record observation Circle the correct code for the material of the dwelling floor based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the floor, record the main flooring material (the material that covers the largest amount of floor space). HOUSEHOLD CHARACTERISTICS 11 Earth/sand 12 Dung 21 Wood planks 22 Palm/bamboo 31 Parquet or polished wood 32 Vinyl or asphalt strips 33 Ceramic tiles 34 Cement 35 Carpet 96 Other 99 Missing Main material of roof Main material of roof Main material of roof Main material of roof Main material of roof HC4. Main material of the roof. Record observation Circle the correct code for the material of the dwelling roof, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the roof, record the main roofing material (the material that covers the largest amount of roof). HOUSEHOLD CHARACTERISTICS 11 No roof 12 Thatch/palm leaf 13 Sod 21 Rustic mat 22 Palm/bamboo 23 Wood planks 24 Cardboard/plastic sheeting 31 Metal/ iron sheet/zinc 32 Wood 33 Calamine/cement fiber 34 Ceramic tiles 35 Cement 36 Roofing shingles 96 Other 99 Missing Main material of wall Main material of wall Main material of wall Main material of wall Main material of wall HC5. Main material of the walls. Record observation Circle the correct code for the material of the dwelling walls, based on your observation. You will be able to observe the correct answer in most cases, but if in doubt, ask. If there is more than one kind of material making up the walls, record the main wall material (the material that covers the largest amount of wall space). HOUSEHOLD CHARACTERISTICS 11 No walls 12 Cane/palm/trunks 13 Dirt 21 Bambo with mud 22 Stone with mud 23 Uncovered adobe 24 Plywood 25 Carton 26 Reused wood 31 Cement 32 Stone with lime/cement 33 Bricks 34 Cement blocks 35 Covered adobe 36 Wood planks/shingles 96 Other 99 Missing Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking Type of fuel using for cooking HC6. What type of fuel does your household mainly use for cooking? Information on the type of fuel used for cooking is collected as another measure of the socio-economic status of the household. The use of some cooking fuels can also have adverse health consequences. Circle the code corresponding to the answer given. Remember that this question asks about fuel for cooking, not fuel for heating or lighting. If the household uses more than one fuel for cooking, find out which type of fuel is used most often. If electricity, liquid propane gas (LPG), natural gas, or biogas is mainly used, circle '01', '02', '03', or '04', respectively, and skip to HC8. If any fuel other than the pre-coded ones is reported as being the main fuel used for cooking, circle '96' and specify the type of fuel on the line provided HOUSEHOLD CHARACTERISTICS 1 Electricity 2 Liquid propane gas (lpg) 3 Natural gas 4 Biogas 5 Kerosene 6 Coal/lignite 7 Charcoal 8 Wood 9 Straw/shrubs/grass 10 Animal dung 11 Agricultural crop residue 95 No food cooked in household 96 Other 99 Missing Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire Food cooked on stove or open fire IS THE COOKING USUALLY DONE IN THE HOUSE, IN A SEPARATE BUILDING, OR OUTDOORS? Probe for type If ‘In the house’, probe: IS IT DONE IN A SEPARATE ROOM USED AS A KITCHEN? HOUSEHOLD CHARACTERISTICS 1 In a separate room used as kitchen 2 Elsewhere in the house 3 In a separate building 4 Outdoors 6 Other 9 Missing Electricity Electricity Electricity Electricity Electricity DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [A] ELECTRICITY? HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Radio Radio Radio Radio Radio DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [B] A RADIO? HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Television Television Television Television Television DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [C] A TELEVISION? HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone Non-mobile phone DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [D] A NON-MOBILE TELEPHONE? HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Refrigerator Refrigerator Refrigerator Refrigerator Refrigerator DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [E] A REFRIGERATOR? HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Vcr/vcd/dvd Vcr/vcd/dvd Vcr/vcd/dvd Vcr/vcd/dvd Vcr/vcd/dvd DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [F] A VCR/VCD/DVD HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Sewing machine Sewing machine Sewing machine Sewing machine Sewing machine DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [G] SEWING MACHINE HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Clock Clock Clock Clock Clock DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [H] CLOCK HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Generator Generator Generator Generator Generator DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [ I] GENERATOR HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Computer Computer Computer Computer Computer DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [J] COMPUTER HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Internet facility Internet facility Internet facility Internet facility Internet facility DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [ K] INTERNET FACILITY HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Fan Fan Fan Fan Fan DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [L] FAN HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Air conditioner Air conditioner Air conditioner Air conditioner Air conditioner DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [M] AIR CONDITIONER HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Blender/mixer/food processor Blender/mixer/food processor Blender/mixer/food processor Blender/mixer/food processor Blender/mixer/food processor DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [N] BLENDER/MIXER/FOOD PROCESSOR HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Water heater Water heater Water heater Water heater Water heater DOES YOUR HOUSEHOLD HAVE DOES YOUR HOUSEHOLD HAVE: [O] WATER HEATER HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Watch Watch Watch Watch Watch DOES YOUR HOUSEHOLD HAVE DOES ANY MEMBER OF YOUR HOUSEHOLD OWN: [A] A WATCH? Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Mobile telephone Mobile telephone Mobile telephone Mobile telephone Mobile telephone DOES YOUR HOUSEHOLD HAVE DOES ANY MEMBER OF YOUR HOUSEHOLD OWN [B] A MOBILE TELEPHONE? Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Bicycle Bicycle Bicycle Bicycle Bicycle DOES YOUR HOUSEHOLD HAVE DOES ANY MEMBER OF YOUR HOUSEHOLD OWN [C] A BICYCLE? Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter Motorcycle or scooter DOES YOUR HOUSEHOLD HAVE DOES ANY MEMBER OF YOUR HOUSEHOLD OWN: [D] A MOTORCYCLE OR SCOOTER? Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart Animal-drawn cart DOES YOUR HOUSEHOLD HAVE DOES ANY MEMBER OF YOUR HOUSEHOLD OWN: [E] AN ANIMAL-DRAWN CART? Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Car or truck Car or truck Car or truck Car or truck Car or truck DOES YOUR HOUSEHOLD HAVE DOES ANY MEMBER OF YOUR HOUSEHOLD OWN: [F] A CAR OR TRUCK? Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Boat with a motor Boat with a motor Boat with a motor Boat with a motor Boat with a motor DOES YOUR HOUSEHOLD HAVE DOES ANY MEMBER OF YOUR HOUSEHOLD OWN: [G] A BOAT WITH A MOTOR? Read out each item and circle the code corresponding to the answer given after each item. If the respondent reports that a household item such as a radio is broken, try to find out how long it has been broken and whether it will be fixed. If the item appears to be out of use only temporarily, circle '1' for 'Yes'. Otherwise, circle '2' for 'No'. Be sure to circle either a '1' or a '2' for each item. Do not leave any blank. HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Household owns the dwelling Household owns the dwelling Household owns the dwelling Household owns the dwelling Household owns the dwelling DO YOU OR SOMEONE LIVING IN THIS HOUSEHOLD OWN THIS HOUSE? If "No", then ask: DO YOU RENT THIS HOUSE FROM SOMEONE NOT LIVING IN THIS HOUSEHOLD? If "Rented from someone else", circle "2". For other responses, circle "6". HOUSEHOLD CHARACTERISTICS 1 Own 2 Rent 6 Other (not owned or rented) 9 Missing Any household member own land that can be used for agricultu Any household member own land that can be used for agricultu Any household member own land that can be used for agricultu Any household member own land that can be used for agricultu Any household member own land that can be used for agricultu DOES ANY MEMBER OF THIS HOUSEHOLD OWN ANY LAND THAT CAN BE USED FOR AGRICULTURE? IF NO 2 GO TO HC13 HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Hectares of agricultural land members of household owns Hectares of agricultural land members of household owns Hectares of agricultural land members of household owns Hectares of agricultural land members of household owns Hectares of agricultural land members of household owns HOW MANY UNIT OF AGRICULTURAL LAND DO MEMBERS OF THIS HOUSEHOLD OWN? If less than 1, record "00". If 94 or more, record '95'. If unknown, record '98'. HOUSEHOLD CHARACTERISTICS Household own any animals Household own any animals Household own any animals Household own any animals Household own any animals DOES THIS HOUSEHOLD OWN ANY LIVESTOCK, HERDS, OTHER FARM ANIMALS, OR POULTRY? IF NO 2 GO TO HC15 HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Cattle, milk cows, or bulls Cattle, milk cows, or bulls Cattle, milk cows, or bulls Cattle, milk cows, or bulls Cattle, milk cows, or bulls HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [A] CATTLE, MILK COWS, OR BULLS? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Horses, donkeys, or mules Horses, donkeys, or mules Horses, donkeys, or mules Horses, donkeys, or mules Horses, donkeys, or mules HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [B] HORSES, DONKEYS, OR MULES? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Goats Goats Goats Goats Goats HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [C] GOATS? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Sheep Sheep Sheep Sheep Sheep HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [D] SHEEP? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Chickens Chickens Chickens Chickens Chickens HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [E] CHICKENS? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Pigs Pigs Pigs Pigs Pigs HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [F] PIGS? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Camel Camel Camel Camel Camel HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [G] CAMELS? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Ducks/geese Ducks/geese Ducks/geese Ducks/geese Ducks/geese HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [H] DUCKS/ GEESE? If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Oxen Oxen Oxen Oxen Oxen HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD HAVE? [H] OXEN If none, record '00'. If 95 or more, record '95'. If unknown, record '98'. If Missing, record '99'. HOUSEHOLD CHARACTERISTICS Any household member own bank account Any household member own bank account Any household member own bank account Any household member own bank account Any household member own bank account HC15. DOES ANY MEMBER OF THIS HOUSEHOLD HAVE AN ACTIVE BANK ACCOUNT? HOUSEHOLD CHARACTERISTICS 1 Yes 2 No 9 Missing Household has mosquito nets Household has mosquito nets Household has mosquito nets Household has mosquito nets Household has mosquito nets TN1. Does your household have any Insecticide Treated Mosquito Nets that can be used while sleeping? Circle the code corresponding to the response given. If 'No', skip to the next module INSECTICIDE TREATED NETS 1 Yes 2 No 9 Missing Number of mosquito nets Number of mosquito nets Number of mosquito nets Number of mosquito nets Number of mosquito nets TN2. How many Insecticide Treated nets does your household have? Number of nets If 7 or more nets, record '7'. Enter the number of mosquito nets that the household has. INSECTICIDE TREATED NETS Total children aged 2-14 years Total children aged 2-14 years Total children aged 2-14 years Total children aged 2-14 years Total children aged 2-14 years Total children age 2-14 years o List each of the children aged 2-14 years below in the order they appear in the Household Listing Form. Do not include other household members outside of the age range 2-14 years. o Record the line number, name, sex, and age for each child. o Then record the total number of children aged 2-14 in the box provided (CD6). Rank number of the selected child Rank number of the selected child Rank number of the selected child Rank number of the selected child Rank number of the selected child CD8. Record the rank number of the selected child ...................................................................... ___ Use Table 2 to select one child between the ages of 2 and 14 years, if there is more than one child in that age range in the household. o Check the last digit of the household number (HH2) from the cover page. This is the number of the row you should go to in the table below. o Check the total number of eligible children (2-14) in CD6 above. This is the number of the column you should go to. Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the child (CD1) about whom the questions will be asked. Child line number Child line number Child line number Child line number Child line number Name _____________________________Line number ....................................... __ __ Write the name and line number of the child selected for the module from CD3 and CD2, based on the rank number in CD8. If Inconsistent, code 97 Flag for correct child line number Flag for correct child line number Flag for correct child line number Flag for correct child line number Flag for correct child line number Flag for correct child line number 1 Correct child selected 2 Incorrect child selected Took away privileges Took away privileges Took away privileges Took away privileges Took away privileges ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. TOOK AWAY PRIVILEGES, FORBADE SOMETHING (name) LIKED OR DID NOT ALLOW HIM/HER TO LEAVE HOUSE. 1 Yes 2 No 9 Missing Explained why behaviour was wrong Explained why behaviour was wrong Explained why behaviour was wrong Explained why behaviour was wrong Explained why behaviour was wrong ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. EXPLAINED WHY (name)’S BEHAVIOR WAS WRONG. 1 Yes 2 No 9 Missing Shook child Shook child Shook child Shook child Shook child ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. SHOOK HIM/HER. 1 Yes 2 No 9 Missing Shouted, yelled or screamed at child Shouted, yelled or screamed at child Shouted, yelled or screamed at child Shouted, yelled or screamed at child Shouted, yelled or screamed at child ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. SHOUTED, YELLED AT OR SCREAMED AT HIM/HER. 1 Yes 2 No 9 Missing Gave child something else to do Gave child something else to do Gave child something else to do Gave child something else to do Gave child something else to do ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. GAVE HIM/HER SOMETHING ELSE TO DO. 1 Yes 2 No 9 Missing Spanked, hit or slapped child on bottom with bare hand Spanked, hit or slapped child on bottom with bare hand Spanked, hit or slapped child on bottom with bare hand Spanked, hit or slapped child on bottom with bare hand Spanked, hit or slapped child on bottom with bare hand ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. SPANKED, HIT OR SLAPPED HIM/HER ON THE BOTTOM WITH BARE HAND. 1 Yes 2 No 9 Missing Hit child on the bottom or elsewhere with belt, brush, stick Hit child on the bottom or elsewhere with belt, brush, stick Hit child on the bottom or elsewhere with belt, brush, stick Hit child on the bottom or elsewhere with belt, brush, stick Hit child on the bottom or elsewhere with belt, brush, stick ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. HIT HIM/HER ON THE BOTTOM OR ELSEWHERE ON THE BODY WITH SOMETHING LIKE A BELT, HAIRBRUSH, STICK OR OTHER HARD OBJECT. 1 Yes 2 No 9 Missing Called child dumb, lazy or another name Called child dumb, lazy or another name Called child dumb, lazy or another name Called child dumb, lazy or another name Called child dumb, lazy or another name ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. CALLED HIM/HER DUMB, LAZY, OR ANOTHER NAME LIKE THAT. 1 Yes 2 No 9 Missing Hit or slapped child on the face, head or ears Hit or slapped child on the face, head or ears Hit or slapped child on the face, head or ears Hit or slapped child on the face, head or ears Hit or slapped child on the face, head or ears ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. HIT OR SLAPPED HIM/HER ON THE FACE, HEAD OR EARS. 1 Yes 2 No 9 Missing Hit or slapped child on the hand, arm or leg Hit or slapped child on the hand, arm or leg Hit or slapped child on the hand, arm or leg Hit or slapped child on the hand, arm or leg Hit or slapped child on the hand, arm or leg ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. HIT OR SLAPPED HIM/HER ON THE HAND, ARM, OR LEG. 1 Yes 2 No 9 Missing Beat child up as hard as one could Beat child up as hard as one could Beat child up as hard as one could Beat child up as hard as one could Beat child up as hard as one could ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name) IN THE PAST MONTH. BEAT HIM/HER UP, THAT IS HIT HIM/HER OVER AND OVER AS HARD AS ONE COULD. 1 Yes 2 No 9 Missing Child needs to be physically punished to be brought up prope Child needs to be physically punished to be brought up prope Child needs to be physically punished to be brought up prope Child needs to be physically punished to be brought up prope Child needs to be physically punished to be brought up prope DO YOU BELIEVE THAT IN ORDER TO BRING UP, RAISE, OR EDUCATE A CHILD PROPERLY, THE CHILD NEEDS TO BE PHYSICALLY PUNISHED? 1 Yes 2 No 8 Don't know / no opinion 9 Missing Place where household members most often wash their hands Place where household members most often wash their hands Place where household members most often wash their hands Place where household members most often wash their hands Place where household members most often wash their hands PLEASE SHOW ME WHERE MEMBERS OF YOUR HOUSEHOLD MOST OFTEN WASH THEIR HANDS. HANDWASHING 1 Observed 2 Not in dwelling/plot/yard 3 No permission to see 6 Other reason 9 Missing Water available at the place for handwashing Water available at the place for handwashing Water available at the place for handwashing Water available at the place for handwashing Water available at the place for handwashing Water is available ............... 1 Water is not available .................. 2 Observe presence of water at the specific place for handwashing. Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water. HANDWASHING 1 Water is available 2 Water is not available 9 Missing Bar soap Bar soap Bar soap Bar soap Bar soap Bar soap Record if soap or detergent is present at the specific place for handwashing. Circle all that apply. HANDWASHING ? Missing A Bar soap Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) Detergent (Powder / Liquid / Paste) Record if soap or detergent is present at the specific place for handwashing. Circle all that apply. HANDWASHING ? Missing B Detergent (powder / liquid / paste) Liquid soap Liquid soap Liquid soap Liquid soap Liquid soap Liquid soap Record if soap or detergent is present at the specific place for handwashing. Circle all that apply. HANDWASHING ? Missing C Liquid soap Ash / mud / sand Ash / mud / sand Ash / mud / sand Ash / mud / sand Ash / mud / sand Ash / Mud / Sand Record if soap or detergent is present at the specific place for handwashing. Circle all that apply. HANDWASHING ? Missing D Ash / mud / sand None None None None None None Record if soap or detergent is present at the specific place for handwashing. Circle all that apply. HANDWASHING ? Missing Y None Soap/other material available for washing hands Soap/other material available for washing hands Soap/other material available for washing hands Soap/other material available for washing hands Soap/other material available for washing hands DO YOU HAVE ANY SOAP OR DETERGENT (or other locally used cleansing agent) IN YOUR HOUSEHOLD FOR WASHING HANDS? HANDWASHING 1 Yes 2 No 9 Missing Bar soap Bar soap Bar soap Bar soap Bar soap CAN YOU PLEASE SHOW IT TO ME? Bar soap Record observation. Circle all that apply. HANDWASHING ? Missing A Bar soap Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) Detergent (powder / liquid / paste) CAN YOU PLEASE SHOW IT TO ME? Detergent (Powder / Liquid / Paste) Record observation. Circle all that apply. HANDWASHING ? Missing B Detergent (powder / liquid / paste) Liquid soap Liquid soap Liquid soap Liquid soap Liquid soap CAN YOU PLEASE SHOW IT TO ME? Liquid soap Record observation. Circle all that apply. HANDWASHING ? Missing C Liquid soap Ash / mud / sand Ash / mud / sand Ash / mud / sand Ash / mud / sand Ash / mud / sand CAN YOU PLEASE SHOW IT TO ME? Ash / Mud / Sand Record observation. Circle all that apply. HANDWASHING ? Missing D Ash / mud / sand Not able / does not want to show Not able / does not want to show Not able / does not want to show Not able / does not want to show Not able / does not want to show CAN YOU PLEASE SHOW IT TO ME? Not able / Does not want to show Record observation. Circle all that apply. HANDWASHING ? Missing Y Not able / does not want to show Salt iodization test outcome Salt iodization test outcome Salt iodization test outcome Salt iodization test outcome Salt iodization test outcome WE WOULD LIKE TO CHECK WHETHER THE SALT USED IN YOUR HOUSEHOLD IS IODIZED. MAY I HAVE A SAMPLE OF THE SALT USED TO COOK MEALS IN YOUR HOUSEHOLD? Once you have tested the salt, circle number that corresponds to test outcome. SALT IODIZATION 1 Not iodized 0 ppm (no colour) 2 Less than 15 ppm (weak colour) 3 15 ppm or more (strong colour) 6 No salt in home 7 Salt not tested 9 Missing Sex of household head Sex of household head Sex of household head Sex of household head Sex of household head Sex of household head 1 Male 2 Female 9 Missing/dk Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head 1 Christianity 2 Islam 3 Other religion 4 No religion 9 Missing/dk Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head 1 North central 2 North east 3 North west 4 South east 5 South south 6 South west Education of household head Education of household head Education of household head Education of household head Education of household head Education of household head 1 None 2 Primary 3 Secondary + 9 Missing/dk Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Cluster number Cluster number Cluster number Cluster number Cluster number Cluster Number ___ ___ ___ ___ Enter the name of the enumeration area and the cluster number as provided by your supervisor. The cluster number in four digits includes two digits for the state and two digits for the EA serial number in the state. Every selected Household The selected Enumeration Area to be covered Household number Household number Household number Household number Household number HH2. Household Number:___ ___ ___ ___ must be entered by the enumerator prior to interview Enter the household number as instructed by your supervisor Households selected for coverage The numbering fixed to the selected household during the listing exercise. It was used for the selection of household to be covered for the survey Net number Net number Net number Net number Net number Net number Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed? 1st Net 2nd Net 3rd Net 1 Observed 2 Not observed 9 Missing Net was pre-treated Net was pre-treated Net was pre-treated Net was pre-treated Net was pre-treated TN4. Check TN3 for type of net(s). Go through the above list in order until one box is checked and follow instructions: 1. Long-lasting Treated Net mentioned?è Go to Next Module 2. Re-treatable Treated Net mentioned?è Go to TN6 3. Other Insecticide Treated Net mentioned?è Continue with TN5 Observe or ask the type of mosquito net. This question is only asked about all nets other than the long-lasting and pre-treated nets. With this question, we try to learn whether the net was actually treated with an insecticide when the household obtained it. Note that the question should refer to the net most recently obtained. If the household has only one net, you do not need to specify (MOST RECENT) when asking the question. 18 Long-lasting treated nets 28 Pre-treated nets…..……. 31 Other nets....................... 98 Dk type .......................... Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained TN4. Check TN3 for type of net(s). Go through the above list in order until one box is checked and follow instructions: 1. Long-lasting Treated Net mentioned?è Go to Next Module 2. Re-treatable Treated Net mentioned?è Go to TN6 3. Other Insecticide Treated Net mentioned?è Continue with TN5 HOW MANY MONTHS AGO DID YOUR HOUSEHOLD GET THE MOSQUITO NET? If less than 1 month ago, record '00'. If answer is "12 months" or "1 year", probe to determine if net was obtained exactly 12 months ago or earlier or later. If less than 1 month ago, record '00'. Months ago ........... ___ ___ More than 36 mo. ago ... 95 DK / Not sure ................. 98 Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped If less than 1 month, record '00'. If answer is “12 months” or “1 year”, probe to determine if net was treated exactly 12 months ago or earlier or later. WHEN YOU GOT THE NET, WAS IT ALREADY TREATED WITH AN INSECTICIDE TO KILL OR REPEL MOSQUITOES? If less than 1 month, record '00'. If answer is "12 months" or "1 year", probe to determine if net was treated exactly 12 months ago or earlier or later. 1 Yes 2 No 8 Dk / not sure 9 Missing Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained IF No ................................. 2 GO TO TN11 DK / Not sure ................... 8 GO TO TN11 1 Yes 2 No 8 Dk / not sure 9 Missing Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped HOW MANY MONTHS AGO WAS THE NET LAST SOAKED OR DIPPED? If less than one month, record "00" Months ago ........... ___ ___ More than 24 mo. ago ... 95 DK / Not sure ................. 98 Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night DID ANYONE SLEEP UNDER THIS MOSQUITO NET LAST NIGHT? IF No .................................... 2 GO TO TN13 IF DK / Not sure ................... 8 GO TO TN13 1 Yes 2 No 8 Dk / not sure 9 Missing Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Line number.......... ___ ___ Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Line number.......... ___ ___ Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Line number.......... ___ ___ Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Line number.......... ___ ___ Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Number of mosquito nets Number of mosquito nets Number of mosquito nets Number of mosquito nets Number of mosquito nets HOW MANY MOSQUITO NETS DOES YOUR HOUSEHOLD HAVE? Number of nets ___ Enter the number of mosquito nets that the household has. If 7 or more nets, record '7'. Area:sector Area:sector Area:sector Area:sector Area:sector Area Sector must be entered by the enumerator prior to interview Circle the code for area of residence as instructed by your supervisor. This would have been pre-determined; you will not be required to assess whether the household is in an urban or rural area It must be circled by the enumerator prior to interview Every interviewer 1 Rural 2 Urban Rural Sector: Areas demacated as rural by the National Population Commission Urban Sector: Areas demacated as urban by the National Population Commission State State State State State State Code: Write the state name and code It must be entered by the enumerator prior to interview Federal Republic of Nigeria 1 Abia 2 Adamawa 3 Akwa-ibom 4 Anambra 5 Bauchi 6 Bayelsa 7 Benue 8 Borno 9 Cross-rivers 10 Delta 11 Ebonyi 12 Edo 13 Ekiti 14 Enugu 15 Gombe 16 Imo 17 Jigawa 18 Kaduna 19 Kano 20 Katsina 21 Kebbi 22 Kogi 23 Kwara 24 Lagos 25 Nasarawa 26 Niger 27 Ogun 28 Ondo 29 Oshun 30 Oyo 31 Plataeu 32 Rivers 33 Sokoto 34 Taraba 35 Yobe 36 Zamfara 37 Abuja fct The 36 states of the federation and Federal Capital Territory (FCT), Abuja along with the attached codes Education of household head Education of household head Education of household head Education of household head Education of household head Education of household head 1 None 2 Primary 3 Secondary + 9 Missing/dk Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head 1 Christianity 2 Islam 3 Other religion 4 No religion 9 Missing/dk Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head 1 North central 2 North east 3 North west 4 South east 5 South south 6 South west Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 REGR factor score 1 for analysis 2 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Household sample weight Cluster number Cluster number Cluster number Cluster number Cluster number Cluster Number: Enter the name of the enumeration area and the cluster number as provided by your supervisor. The cluster number in four digits includes two digits for the state and two digits for the EA serial number in the state. Every selected Household The selected Enumeration Area to be covered Household number Household number Household number Household number Household number Household number Enter the household number as instructed by your supervisor. Line number Line number Line number Line number Line number Woman's Line Number: __ __ Enter the household number from the Household Questionnaire, question HH2 Cluster number Cluster number Cluster number Cluster number Cluster number Cluster Number: Enter the EA name/cluster number from the Household Questionnaire, question HH1 WOMAN’S INFORMATION PANEL Household number Household number Household number Household number Household number Household number: Enter the household number from the Household Questionnaire, question HH2 WOMAN’S INFORMATION PANEL Woman's line number Woman's line number Woman's line number Woman's line number Woman's line number Woman's Line Number: Enter the woman's line number from the Household Questionnaire, column HL1 of the Household Listing WOMAN’S INFORMATION PANEL Day of interview Day of interview Day of interview Day of interview Day of interview Day of interviewed: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household to interview the woman again, revise and enter the final date of interview. In other words, the date here should be the date when you have either completed the woman's questionnaire, or when the interview has not been conducted but it has been decided that there will be no more attempts to interview the eligible woman. WOMAN’S INFORMATION PANEL Month of interview Month of interview Month of interview Month of interview Month of interview Month of interviewed: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household to interview the woman again, revise and enter the final date of interview. In other words, the date here should be the date when you have either completed the woman's questionnaire, or when the interview has not been conducted but it has been decided that there will be no more attempts to interview the eligible woman. WOMAN’S INFORMATION PANEL Year of interview Year of interview Year of interview Year of interview Year of interview Year of interviewed: Enter the date of the interview as day, month and year. If the interview is not completed on your first visit and you visit the household to interview the woman again, revise and enter the final date of interview. In other words, the date here should be the date when you have either completed the woman's questionnaire, or when the interview has not been conducted but it has been decided that there will be no more attempts to interview the eligible woman. WOMAN’S INFORMATION PANEL Result of women 's interview Result of women 's interview Result of women 's interview Result of women 's interview Result of women 's interview Result of women's interview: Complete this question once you have concluded the interview with the woman. Circle the code corresponding to the result of the interview. If the questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the woman after repeated visits, circle '2' for 'Not at home'. If the woman refuses to be interviewed, circle '3' for 'Refused'. If you were able to only partly complete the questionnaire, circle '4' for 'Partly completed'. If the woman is incapacitated, circle '5'. If you have not been able to complete this questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Make every attempt to carry out the woman's interview in privacy. Ask all other household members or anyone else who is present (including male members of the survey team) to leave in a courteous manner. WOMAN’S INFORMATION PANEL 1 Completed 2 Not at home 3 Refused 4 Incapacitated 5 Partly completed 6 Other Age of woman Age of woman Age of woman Age of woman Age of woman How old were you at your last birthday? Age (in completed years) Enter her age in completed years, that is, her age at her last birthday. If she knows her age, write it in the space provided. If she does not know the answer to either of these two questions, probe for clues that might indicate her age. Ask how old she was when she was first married or first gave birth. Try to find out how long ago she got married or had her first child. (You may be able to find out the age of her oldest child if the child is still living. You may be able to relate her age to someone else in the household whose age is known. You may be able to determine her age based on how old she was when an important event occurred, and the number of years that have elapsed since.) You MUST fill in this information. Do not leave this blank. Finally, before moving on to the next question, verify that the respondent is indeed eligible. If the woman is younger than 15 or older than 49, you have to terminate the interview. Do this tactfully by asking two or three more questions and then thank the respondent for her cooperation; write 'INELIGIBLE' on the cover page of the questionnaire, and correct the age and eligibility information for this woman on the cover page and in Columns HL5 and HL6 of the Household Questionnaire. WOMAN’S INFORMATION PANEL Start of interview - hour Start of interview - hour Start of interview - hour Start of interview - hour Start of interview - hour Record the time. Hour WOMAN’S INFORMATION PANEL Start of interview - minutes Start of interview - minutes Start of interview - minutes Start of interview - minutes Start of interview - minutes Record the time. minutes WOMAN’S INFORMATION PANEL End of interview - hour End of interview - hour End of interview - hour End of interview - hour End of interview - hour Record the time. Hour WOMAN’S INFORMATION PANEL End of interview - minutes End of interview - minutes End of interview - minutes End of interview - minutes End of interview - minutes Record the time. minutes IF MISSING CODE 99 WOMAN’S INFORMATION PANEL Month of birth of woman Month of birth of woman Month of birth of woman Month of birth of woman Month of birth of woman IN WHAT MONTH AND YEAR WERE YOU BORN? Date of birth 97 CODE FOR Inconsistent 98 CODE FOR DK 99 CODE MISSING WOMAN’S BACKGROUND Year of birth of woman Year of birth of woman Year of birth of woman Year of birth of woman Year of birth of woman IN WHAT MONTH AND YEAR WERE YOU BORN? Date of birth Month .............................................. __ __ DK month ............................................. 98 Year ...................................... __ __ __ __ DK year ............................................ 9998 WOMAN’S BACKGROUND Age of woman Age of woman Age of woman Age of woman Age of woman HOW OLD ARE YOU? Probe: HOW OLD WERE YOU AT YOUR LAST BIRTHDAY? Compare and correct WB1 and/or WB2 if inconsistent WOMAN’S BACKGROUND Ever attended school Ever attended school Ever attended school Ever attended school Ever attended school HAVE YOU EVER ATTENDED SCHOOL OR PRESCHOOL? IF NO 2 GO TO WB7 WOMAN’S BACKGROUND 1 Yes 2 No Highest level of school you attended Highest level of school you attended Highest level of school you attended Highest level of school you attended Highest level of school you attended WHAT IS THE HIGHEST LEVEL OF SCHOOL YOU ATTENDED? IF CODE 0 GO TO WB7 IF CODE 4 GO TO WB7 WOMAN’S BACKGROUND Preschool 1 Primary 2 Secondary 3 Higher 4 Non formal education 8 Dk 9 Missing Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level WHAT IS THE HIGHEST GRADE YOU COMPLETED AT THAT LEVEL? WOMAN’S BACKGROUND 1 Nursery 1 2 Nursery 2 3 Nursery 3 11 Primary 1 12 Primary 2 13 Primary 3 14 Primary 4 15 Primary 5 16 Primary 6 21 Jss 1 22 Jss 2 23 Jss 3 24 Ss 1 25 Ss 2 26 Ss 3 31 Nce 32 A/ond 33 Technica 41 Hnd 42 Bsc 43 Post graduate 97 Inconsistent 98 Dk 99 Missing Can read part of the sentence Can read part of the sentence Can read part of the sentence Can read part of the sentence Can read part of the sentence NOW I WOULD LIKE YOU TO READ THIS SENTENCE TO ME. CAN YOU READ PART OF THE SENTENCE TO ME? Write out any of the sample sentences to the respondent either in English or local Language. If respondent cannot read whole sentence, probe: WOMAN’S BACKGROUND 1 Cannot read at all 2 Able to read only parts of sentence 3 Able to read whole sentence 4 No sentence in required language 5 Blind / mute, visually / speech impaired 9 Missing Ever given birth Ever given birth Ever given birth Ever given birth Ever given birth 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? 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? IF NO 2 GO TO CM8 CHILD MORTALITY 1 Yes 2 No Day of first birth Day of first birth Day of first birth Day of first birth Day of first birth WHAT WAS THE DATE OF YOUR FIRST BIRTH? I MEAN THE VERY FIRST TIME YOU GAVE BIRTH, EVEN IF THE CHILD IS NO LONGER LIVING, OR WHOSE FATHER IS NOT YOUR CURRENT PARTNER. Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3. Day ................................................. __ __ DK day ................................................. 98 CHILD MORTALITY Month of first birth Month of first birth Month of first birth Month of first birth Month of first birth WHAT WAS THE DATE OF YOUR FIRST BIRTH? I MEAN THE VERY FIRST TIME YOU GAVE BIRTH, EVEN IF THE CHILD IS NO LONGER LIVING, OR WHOSE FATHER IS NOT YOUR CURRENT PARTNER. Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3. Month ............................................. __ __ DK month ............................................. 98 CHILD MORTALITY Year of first birth Year of first birth Year of first birth Year of first birth Year of first birth WHAT WAS THE DATE OF YOUR FIRST BIRTH? I MEAN THE VERY FIRST TIME YOU GAVE BIRTH, EVEN IF THE CHILD IS NO LONGER LIVING, OR WHOSE FATHER IS NOT YOUR CURRENT PARTNER. Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3. Year ..................................... __ __ __ __ DK year ............................................ 9998 IF YEAR GO TO CM4 CHILD MORTALITY Years ago did you have your first birth Years ago did you have your first birth Years ago did you have your first birth Years ago did you have your first birth Years ago did you have your first birth HOW MANY YEARS AGO DID YOU HAVE YOUR FIRST BIRTH? Read the question slowly. The sons and daughters being considered are those who live with her in her household (these children should have been listed in the Household Listing). Circle the code corresponding to the response. If she answers 'No', skip to CM5. CHILD MORTALITY Any sons or daughters living with you Any sons or daughters living with you Any sons or daughters living with you Any sons or daughters living with you Any sons or daughters living with you DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE NOW LIVING WITH YOU? IF NO 2 GO TO CM6 CHILD MORTALITY 1 Yes 2 No Sons living with you Sons living with you Sons living with you Sons living with you Sons living with you HOW MANY SONS LIVE WITH YOU? Sons at home . If none, record '00'. CHILD MORTALITY Daughters living with you Daughters living with you Daughters living with you Daughters living with you Daughters living with you HOW MANY DAUGHTERS LIVE WITH YOU? Daughters at home If none, record '00'. CHILD MORTALITY Any sons or daughters not living with you Any sons or daughters not living with you Any sons or daughters not living with you Any sons or daughters not living with you Any sons or daughters not living with you DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE ALIVE BUT DO NOT LIVE WITH YOU? IF NO 2 GO TO CM8 CHILD MORTALITY 1 Yes 2 No Sons living elsewhere Sons living elsewhere Sons living elsewhere Sons living elsewhere Sons living elsewhere HOW MANY SONS ARE ALIVE BUT DO NOT LIVE WITH YOU? Sons elsewhere .................................. __ __ If none, record '00'. CHILD MORTALITY Daughters living elsewhere Daughters living elsewhere Daughters living elsewhere Daughters living elsewhere Daughters living elsewhere HOW MANY DAUGHTERS ARE ALIVE BUT DO NOT LIVE WITH YOU? Daughters elsewhere .......................... __ __ If none, record '00'. CHILD MORTALITY Ever had child who later died Ever had child who later died Ever had child who later died Ever had child who later died Ever had child who later died HAVE YOU EVER GIVEN BIRTH TO A BOY OR GIRL WHO WAS BORN ALIVE BUT LATER DIED? 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? 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? IF NO 2 GO TO CM10 CHILD MORTALITY 1 Yes 2 No Boys dead Boys dead Boys dead Boys dead Boys dead HOW MANY BOYS HAVE DIED? Boys dead ........................................... __ __ CHILD MORTALITY Girls dead Girls dead Girls dead Girls dead Girls dead HOW MANY GIRLS HAVE DIED? Girls dead ............................................ __ __ CHILD MORTALITY Children ever born Children ever born Children ever born Children ever born Children ever born Sum answers to CM5, CM7, and CM9. If none, record '00'. CHILD MORTALITY Day of last birth Day of last birth Day of last birth Day of last birth Day of last birth OF THESE (total number in CM10) BIRTHS YOU HAVE HAD, WHEN DID YOU DELIVER THE LAST ONE (EVEN IF HE OR SHE HAS DIED)? Day ................................................. __ __ DK day ................................................. 98 Month and year must be recorded. CHILD MORTALITY Month of last birth Month of last birth Month of last birth Month of last birth Month of last birth OF THESE (total number in CM10) BIRTHS YOU HAVE HAD, WHEN DID YOU DELIVER THE LAST ONE (EVEN IF HE OR SHE HAS DIED)? Month ............................................. __ __ Month and year must be recorded. CHILD MORTALITY Year of last birth Year of last birth Year of last birth Year of last birth Year of last birth OF THESE (total number in CM10) BIRTHS YOU HAVE HAD, WHEN DID YOU DELIVER THE LAST ONE (EVEN IF HE OR SHE HAS DIED)? Year ..................................... __ __ __ __ Month and year must be recorded. CHILD MORTALITY Wanted last child Wanted last child Wanted last child Wanted last child Wanted last child Check CM12: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2009 Name of child_______________________ No live birth in last 2 years. ?? Go to ILLNESS SYMPTOMS Module. One or more live births in last 2 years. ?? Ask for the name of the child If child has died, take special care when referring to this child by name in the following modules. Continue with the next module. CHILD MORTALITY N No Y Yes Wanted last child then Wanted last child then Wanted last child then Wanted last child then Wanted last child then WHEN YOU GOT PREGNANT WITH (name), DID YOU WANT TO GET PREGNANT AT THAT TIME? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. If code 1 go to Next Module DESIRE FOR LAST BIRTH 1 Yes 2 No 9 Missing Wanted child later or did not want more children Wanted child later or did not want more children Wanted child later or did not want more children Wanted child later or did not want more children Wanted child later or did not want more children DID YOU WANT TO HAVE A BABY LATER ON, OR DID YOU NOT WANT ANY (MORE) CHILDREN? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. If code 2 go to Next Module DESIRE FOR LAST BIRTH 1 Later 2 No more 9 Missing Desired waiting time (units) Desired waiting time (units) Desired waiting time (units) Desired waiting time (units) Desired waiting time (units) HOW MUCH LONGER DID YOU WANT TO WAIT? Years Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. DK .......................................................... 998 DESIRE FOR LAST BIRTH Desired waiting time (number) Desired waiting time (number) Desired waiting time (number) Desired waiting time (number) Desired waiting time (number) HOW MUCH LONGER DID YOU WANT TO WAIT? Months Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. DK .......................................................... 998 DESIRE FOR LAST BIRTH See anyone for antenatal care during your pregnancy with (name) See anyone for antenatal care during your pregnancy with (name) See anyone for antenatal care during your pregnancy with (name) See anyone for antenatal care during your pregnancy with (name) See anyone for antenatal care during your pregnancy with (name) Check child mortality module CM12 and record name of last-born child here ______________. Use this child's name in the following questions, where indicated DID YOU SEE ANYONE FOR ANTENATAL CARE DURING YOUR PREGNANCY WITH (name)? Show 200,000 IU capsule or dispenser Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 8 Dk 9 Missing Antenatal care: doctor Antenatal care: doctor Antenatal care: doctor Antenatal care: doctor Antenatal care: doctor WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. MATERNAL AND NEWBORN HEALTH ? Missing A Doctor Antenatal care: nurse/midwife Antenatal care: nurse/midwife Antenatal care: nurse/midwife Antenatal care: nurse/midwife Antenatal care: nurse/midwife WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. MATERNAL AND NEWBORN HEALTH ? Missing B Nurse/midwife Antenatal care: auxilary midwife Antenatal care: auxilary midwife Antenatal care: auxilary midwife Antenatal care: auxilary midwife Antenatal care: auxilary midwife WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. MATERNAL AND NEWBORN HEALTH ? Missing C Auxiliary/midwife Antenatal care: traditional birth attendant Antenatal care: traditional birth attendant Antenatal care: traditional birth attendant Antenatal care: traditional birth attendant Antenatal care: traditional birth attendant WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. MATERNAL AND NEWBORN HEALTH ? Missing F Traditional birth attendance Antenatal care: community health worker Antenatal care: community health worker Antenatal care: community health worker Antenatal care: community health worker Antenatal care: community health worker WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. MATERNAL AND NEWBORN HEALTH ? Missing G Community/health worker Antenatal care: other Antenatal care: other Antenatal care: other Antenatal care: other Antenatal care: other WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. MATERNAL AND NEWBORN HEALTH ? Missing X Other Antenatal care:how manytimes during pregnancy Antenatal care:how manytimes during pregnancy Antenatal care:how manytimes during pregnancy Antenatal care:how manytimes during pregnancy Antenatal care:how manytimes during pregnancy HOW MANY MONTHS PREGNANT WERE YOU AT YOUR FIRST ANTENATAL CARE VISIT FOR THIS PREGNANCY? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. DK ............................................................ 98 MATERNAL AND NEWBORN HEALTH Times received antenatal care Times received antenatal care Times received antenatal care Times received antenatal care Times received antenatal care HOW MANY TIMES DID YOU RECEIVE ANTENATAL CARE DURING THIS PREGNANCY? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. DK ............................................................ 98 MATERNAL AND NEWBORN HEALTH Blood pressure Blood pressure Blood pressure Blood pressure Blood pressure AS PART OF YOUR ANTENATAL CARE DURING THIS PREGNANCY, WERE ANY OF THE FOLLOWING DONE AT LEAST ONCE: [A] WAS YOUR BLOOD PRESSURE MEASURED? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Urine sample Urine sample Urine sample Urine sample Urine sample AS PART OF YOUR ANTENATAL CARE DURING THIS PREGNANCY, WERE ANY OF THE FOLLOWING DONE AT LEAST ONCE: [B] DID YOU GIVE A URINE SAMPLE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Blood sample Blood sample Blood sample Blood sample Blood sample AS PART OF YOUR ANTENATAL CARE DURING THIS PREGNANCY, WERE ANY OF THE FOLLOWING DONE AT LEAST ONCE: [C] DID YOU GIVE A BLOOD SAMPLE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Weight Weight Weight Weight Weight AS PART OF YOUR ANTENATAL CARE DURING THIS PREGNANCY, WERE ANY OF THE FOLLOWING DONE AT LEAST ONCE: [D] WERE YOU WEIGHED ? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Have a card or other document with your own immunizations listed Have a card or other document with your own immunizations listed Have a card or other document with your own immunizations listed Have a card or other document with your own immunizations listed Have a card or other document with your own immunizations listed DO YOU HAVE A CARD OR OTHER DOCUMENT WITH YOUR OWN IMMUNIZATIONS LISTED? MAY I SEE IT PLEASE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. If a card is presented, use it to assist with answers to the following questions. MATERNAL AND NEWBORN HEALTH 1 Yes (card seen) 2 Yes (card not seen) 3 No 8 Dk 9 Missing Any injection in the arm or shoulder to prevent the baby from getting tetanus, that Any injection in the arm or shoulder to prevent the baby from getting tetanus, that Any injection in the arm or shoulder to prevent the baby from getting tetanus, that Any injection in the arm or shoulder to prevent the baby from getting tetanus, that Any injection in the arm or shoulder to prevent the baby from getting tetanus, that 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? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 8 Dk 9 Missing Times receive this tetanus injection during your pregnancy with name Times receive this tetanus injection during your pregnancy with name Times receive this tetanus injection during your pregnancy with name Times receive this tetanus injection during your pregnancy with name Times receive this tetanus injection during your pregnancy with name HOW MANY TIMES DID YOU RECEIVE THIS TETANUS INJECTION DURING YOUR PREGNANCY WITH name)? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. If 7 or more times, record '7' IF DK CODE... 8 IF MISSING CODE 9 How many tetanus injections during last pregnancy were reported in MN7? ?? At least two tetanus injections during last pregnancy. ?? Go to MN12 ?? Fewer than two tetanus injections during last pregnancy. ?? Continue with MN9 MATERNAL AND NEWBORN HEALTH Did you receive any tetanus injection at any time before your pregnancy with (name) Did you receive any tetanus injection at any time before your pregnancy with (name) Did you receive any tetanus injection at any time before your pregnancy with (name) Did you receive any tetanus injection at any time before your pregnancy with (name) Did you receive any tetanus injection at any time before your pregnancy with (name) DID YOU RECEIVE ANY TETANUS INJECTION AT ANY TIME BEFORE YOUR PREGNANCY WITH (name), EITHER TO PROTECT YOURSELF OR ANOTHER BABY? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 8 Dk 9 Missing Times did you receive a tetanus injection before your pregnancy with (name) Times did you receive a tetanus injection before your pregnancy with (name) Times did you receive a tetanus injection before your pregnancy with (name) Times did you receive a tetanus injection before your pregnancy with (name) Times did you receive a tetanus injection before your pregnancy with (name) HOW MANY TIMES DID YOU RECEIVE A TETANUS INJECTION BEFORE YOUR PREGNANCY WITH (name)? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. If 7 or more times, record '7'. IF DK CODE... 8 IF MISSING CODE 9 MATERNAL AND NEWBORN HEALTH How many years ago did you receive the last tetanus injection before your pregnancy with (name How many years ago did you receive the last tetanus injection before your pregnancy with (name How many years ago did you receive the last tetanus injection before your pregnancy with (name How many years ago did you receive the last tetanus injection before your pregnancy with (name How many years ago did you receive the last tetanus injection before your pregnancy with (name HOW MANY YEARS AGO DID YOU RECEIVE THE LAST TETANUS INJECTION BEFORE YOUR PREGNANCY WITH (name)? Record weight from health card, if available. Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Check MN1 for presence of antenatal care during (name) pregnancy ?? Yes, antenatal care received. ?? Continue with MN13 ?? No antenatal care received ?? Go to MN17 MATERNAL AND NEWBORN HEALTH Took medicine in order to prevent malaria Took medicine in order to prevent malaria Took medicine in order to prevent malaria Took medicine in order to prevent malaria Took medicine in order to prevent malaria DURING ANY OF THESE ANTENATAL VISITS FOR THE PREGNANCY, DID YOU TAKE ANY MEDICINE IN ORDER TO PREVENT YOU FROM GETTING MALARIA? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 8 Dk 9 Missing Medicines taken to prevent malaria: sulphadoxine pyremethami Medicines taken to prevent malaria: sulphadoxine pyremethami Medicines taken to prevent malaria: sulphadoxine pyremethami Medicines taken to prevent malaria: sulphadoxine pyremethami Medicines taken to prevent malaria: sulphadoxine pyremethami WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? Sulphadoxine Pyremethamine/Fansidar ..... A Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. Check MN14 for medicine taken: ?? Sulphadoxine Pyremethamine/Fansidar taken. ?? Continue with MN16 ?? Sulphadoxine Pyremethamine/Fansidar not taken. ?? Go to MN17 MATERNAL AND NEWBORN HEALTH ? Missing A Sp / fansidar Medicines taken to prevent malaria: chloroquine Medicines taken to prevent malaria: chloroquine Medicines taken to prevent malaria: chloroquine Medicines taken to prevent malaria: chloroquine Medicines taken to prevent malaria: chloroquine WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? Chloroquine ................................................ B Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. MATERNAL AND NEWBORN HEALTH ? Missing B Chloroquine Medicines taken to prevent malaria: amodiaquine Medicines taken to prevent malaria: amodiaquine Medicines taken to prevent malaria: amodiaquine Medicines taken to prevent malaria: amodiaquine Medicines taken to prevent malaria: amodiaquine WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? Amodiaquine .............................................. C Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. MATERNAL AND NEWBORN HEALTH ? Missing C Amodiaquine Medicines taken to prevent malaria: quinine Medicines taken to prevent malaria: quinine Medicines taken to prevent malaria: quinine Medicines taken to prevent malaria: quinine Medicines taken to prevent malaria: quinine WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? Quinine....................................................... D Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. MATERNAL AND NEWBORN HEALTH ? Missing D Quinine Medicines taken to prevent malaria: artemisinin-based combin Medicines taken to prevent malaria: artemisinin-based combin Medicines taken to prevent malaria: artemisinin-based combin Medicines taken to prevent malaria: artemisinin-based combin Medicines taken to prevent malaria: artemisinin-based combin WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? Artemisinin-based combinations ................ E Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. MATERNAL AND NEWBORN HEALTH ? Missing E Artemisinin-based combinations Medicines taken to prevent malaria: analgesic/pain relievers Medicines taken to prevent malaria: analgesic/pain relievers Medicines taken to prevent malaria: analgesic/pain relievers Medicines taken to prevent malaria: analgesic/pain relievers Medicines taken to prevent malaria: analgesic/pain relievers WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? Analgesics/Pain Relievers .......................... H Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. MATERNAL AND NEWBORN HEALTH ? Missing H Analgesic/pain relievers Medicines taken to prevent malaria: other Medicines taken to prevent malaria: other Medicines taken to prevent malaria: other Medicines taken to prevent malaria: other Medicines taken to prevent malaria: other WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? Other (specify) ........................................... X Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. MATERNAL AND NEWBORN HEALTH ? Missing X Other Medicines taken to prevent malaria: dk Medicines taken to prevent malaria: dk Medicines taken to prevent malaria: dk Medicines taken to prevent malaria: dk Medicines taken to prevent malaria: dk WHICH MEDICINES DID YOU TAKE TO PREVENT MALARIA? DK .............................................................. Z Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Circle all medicines taken. If type of medicine is not determined, show typical anti-malarial to respondent. MATERNAL AND NEWBORN HEALTH ? Missing Z Dk Times took sp / fansidar Times took sp / fansidar Times took sp / fansidar Times took sp / fansidar Times took sp / fansidar DURING THIS PREGNANCY, HOW MANY TIMES DID YOU TAKE SULPHADOXINE PYREMETHAMINE /FANSIDAR TO PREVENT MALARIA? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. IF DK CODE... 98 IF MISSING CODE 99 MATERNAL AND NEWBORN HEALTH Assistance at delivery: doctor Assistance at delivery: doctor Assistance at delivery: doctor Assistance at delivery: doctor Assistance at delivery: doctor WHO ASSISTED WITH THE DELIVERY OF (name)? Doctor Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing A Doctor Assistance at delivery: nurse / midwife Assistance at delivery: nurse / midwife Assistance at delivery: nurse / midwife Assistance at delivery: nurse / midwife Assistance at delivery: nurse / midwife WHO ASSISTED WITH THE DELIVERY OF (name)? Nurse / Midwife Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing B Nurse / midwife Assistance at delivery: auxiliary midwife Assistance at delivery: auxiliary midwife Assistance at delivery: auxiliary midwife Assistance at delivery: auxiliary midwife Assistance at delivery: auxiliary midwife WHO ASSISTED WITH THE DELIVERY OF (name)? Auxiliary midwife/MCH Aide Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing C Auxiliary midwife Assistance at delivery: traditional birth attendant Assistance at delivery: traditional birth attendant Assistance at delivery: traditional birth attendant Assistance at delivery: traditional birth attendant Assistance at delivery: traditional birth attendant WHO ASSISTED WITH THE DELIVERY OF (name)? Traditional birth attendant Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing F Traditional birth attendant Assistance at delivery: community health worker Assistance at delivery: community health worker Assistance at delivery: community health worker Assistance at delivery: community health worker Assistance at delivery: community health worker WHO ASSISTED WITH THE DELIVERY OF (name)? Community health worker Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing G Community health worker Assistance at delivery: relative / friend Assistance at delivery: relative / friend Assistance at delivery: relative / friend Assistance at delivery: relative / friend Assistance at delivery: relative / friend WHO ASSISTED WITH THE DELIVERY OF (name)? Relative / Friend Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing H Relative / friend Assistance at delivery: other Assistance at delivery: other Assistance at delivery: other Assistance at delivery: other Assistance at delivery: other WHO ASSISTED WITH THE DELIVERY OF (name)? Other (specify) Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing X Other Assistance at delivery: no one Assistance at delivery: no one Assistance at delivery: no one Assistance at delivery: no one Assistance at delivery: no one WHO ASSISTED WITH THE DELIVERY OF (name)? No one ....................................................... Y Probe: ANYONE ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. MATERNAL AND NEWBORN HEALTH ? Missing Y No one Place of delivery Place of delivery Place of delivery Place of delivery Place of delivery MN18. WHERE DID YOU GIVE BIRTH TO (name)? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. MATERNAL AND NEWBORN HEALTH 11 Your home 12 Other home 21 Government hospital 22 Government clinic / health centre 23 Government health post 26 Other public (specify) 31 Private hospital 32 Private clinic 33 Private maternity home 36 Other private medical(specify) 96 Other 99 Missing Time discharge(unit) Time discharge(unit) Time discharge(unit) Time discharge(unit) Time discharge(unit) HOW LONG AFTER DELIVERY OF (NAME) WERE YOU DISCHARGED FROM THE HEALTH FACILITY? UNIT Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH Immediately 1 Hours 2 Days 9 Don’t know/remembe Time discharge(number) Time discharge(number) Time discharge(number) Time discharge(number) Time discharge(number) HOW LONG AFTER DELIVERY OF (NAME) WERE YOU DISCHARGED FROM THE HEALTH FACILITY? NUMBER Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH Delivery by caesarean section Delivery by caesarean section Delivery by caesarean section Delivery by caesarean section Delivery by caesarean section WAS (name) DELIVERED BY CAESAREAN SECTION? THAT IS, DID THEY CUT YOUR BELLY OPEN TO TAKE THE BABY OUT? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Size of child at birth Size of child at birth Size of child at birth Size of child at birth Size of child at birth WHEN (name) WAS BORN, WAS HE/SHE VERY LARGE, LARGER THAN AVERAGE, AVERAGE, SMALLER THAN AVERAGE, OR VERY SMALL? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Very large 2 Larger than average 3 Average 4 Smaller than average 5 Very small 8 Dk 9 Missing Child weighed at birth Child weighed at birth Child weighed at birth Child weighed at birth Child weighed at birth WAS (name) WEIGHED AT BIRTH? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 8 Dk 9 Missing Weight from card or recall Weight from card or recall Weight from card or recall Weight from card or recall Weight from card or recall HOW MUCH DID (name) WEIGHT? FROM CARD OR RECALL Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. Record weight from health card, if available. CODE FOR DK IS 9998 MATERNAL AND NEWBORN HEALTH 1 Card 2 Recall 9 Missing Weight at birth (kilograms) Weight at birth (kilograms) Weight at birth (kilograms) Weight at birth (kilograms) Weight at birth (kilograms) HOW MUCH DID (name) WEIGHT? IN KILOGRAMS Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. CODE FOR DK IS 9998 MATERNAL AND NEWBORN HEALTH Menstrual period returned since the birth of child Menstrual period returned since the birth of child Menstrual period returned since the birth of child Menstrual period returned since the birth of child Menstrual period returned since the birth of child MN23. HAS YOUR MENSTRUAL PERIOD RETURNED SINCE THE BIRTH OF (name)? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Ever breastfeed Ever breastfeed Ever breastfeed Ever breastfeed Ever breastfeed DID YOU EVER BREASTFEED (nam Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Time baby put to breast (unit) Time baby put to breast (unit) Time baby put to breast (unit) Time baby put to breast (unit) Time baby put to breast (unit) HOW LONG AFTER BIRTH DID YOU FIRST PUT (name) TO THE BREAST? UNIT Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days. MATERNAL AND NEWBORN HEALTH Immediately 1 Hours 2 Days 9 Don’t know / remember Time baby put to breast (number) Time baby put to breast (number) Time baby put to breast (number) Time baby put to breast (number) Time baby put to breast (number) HOW LONG AFTER BIRTH DID YOU FIRST PUT (name) TO THE BREAST? NUMBER Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. If less than 1 hour, record '00' hours. If less than 24 hours, record hours. Otherwise, record days. MATERNAL AND NEWBORN HEALTH Within first 3 days after delivery, child given anything to Within first 3 days after delivery, child given anything to Within first 3 days after delivery, child given anything to Within first 3 days after delivery, child given anything to Within first 3 days after delivery, child given anything to MN26. IN THE FIRST THREE DAYS AFTER DELIVERY, WAS (name) GIVEN ANYTHING TO DRINK OTHER THAN BREAST MILK? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH 1 Yes 2 No 9 Missing Child given to drink - milk (other than breast milk) Child given to drink - milk (other than breast milk) Child given to drink - milk (other than breast milk) Child given to drink - milk (other than breast milk) Child given to drink - milk (other than breast milk) WHAT WAS (name) GIVEN TO DRINK? Milk (other than breast milk) Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing A Milk (other than breast milk) Child given to drink - plain water Child given to drink - plain water Child given to drink - plain water Child given to drink - plain water Child given to drink - plain water WHAT WAS (name) GIVEN TO DRINK? Plain water Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing B Plain water Child given to drink - sugar or glucose water Child given to drink - sugar or glucose water Child given to drink - sugar or glucose water Child given to drink - sugar or glucose water Child given to drink - sugar or glucose water WHAT WAS (name) GIVEN TO DRINK? Sugar or glucose water Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing C Sugar or glucose water Child given to drink - gripe water Child given to drink - gripe water Child given to drink - gripe water Child given to drink - gripe water Child given to drink - gripe water WHAT WAS (name) GIVEN TO DRINK? Gripe water Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing D Gripe water Child given to drink - sugar - salt - water solution Child given to drink - sugar - salt - water solution Child given to drink - sugar - salt - water solution Child given to drink - sugar - salt - water solution Child given to drink - sugar - salt - water solution WHAT WAS (name) GIVEN TO DRINK? Sugar-salt-water solution Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing E Sugar-salt-water solution Child given to drink - fruit juice Child given to drink - fruit juice Child given to drink - fruit juice Child given to drink - fruit juice Child given to drink - fruit juice WHAT WAS (name) GIVEN TO DRINK? Fruit juice Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing F Fruit juice Child given to drink - infant formula Child given to drink - infant formula Child given to drink - infant formula Child given to drink - infant formula Child given to drink - infant formula WHAT WAS (name) GIVEN TO DRINK? Infant formula Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing G Infant formula Child given to drink - tea / infusions Child given to drink - tea / infusions Child given to drink - tea / infusions Child given to drink - tea / infusions Child given to drink - tea / infusions WHAT WAS (name) GIVEN TO DRINK? Tea / Infusions Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing H Tea / infusions Child given to drink - honey Child given to drink - honey Child given to drink - honey Child given to drink - honey Child given to drink - honey WHAT WAS (name) GIVEN TO DRINK? Honey Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing I Honey Child given to drink - other Child given to drink - other Child given to drink - other Child given to drink - other Child given to drink - other WHAT WAS (name) GIVEN TO DRINK? Other (specify) Probe: ANYTHING ELSE? Check child mortality module CM13 and record name of last-born child here Use this child’s name in the following questions, where indicated. MATERNAL AND NEWBORN HEALTH ? Missing X Other Symptoms: child not able to drink or breastfeed Symptoms: child not able to drink or breastfeed Symptoms: child not able to drink or breastfeed Symptoms: child not able to drink or breastfeed Symptoms: child not able to drink or breastfeed 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? Child not able to drink or breastfeed . Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ? Missing A Child not able to drink or breastfeed Symptoms: child becomes sicker Symptoms: child becomes sicker Symptoms: child becomes sicker Symptoms: child becomes sicker Symptoms: child becomes sicker 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? Child becomes sicker Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing B Child becomes sicker Symptoms: child develops a fever Symptoms: child develops a fever Symptoms: child develops a fever Symptoms: child develops a fever Symptoms: child develops a fever 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? Child develops a fever Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing C Child develops a fever Symptoms: child has fast breathing Symptoms: child has fast breathing Symptoms: child has fast breathing Symptoms: child has fast breathing Symptoms: child has fast breathing 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? Child has fast breathing Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing D Child has fast breathing Symptoms: child has difficult breathing Symptoms: child has difficult breathing Symptoms: child has difficult breathing Symptoms: child has difficult breathing Symptoms: child has difficult breathing 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? Child has difficult breathing Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing E Child has difficult breathing Symptoms: child has blood in stools Symptoms: child has blood in stools Symptoms: child has blood in stools Symptoms: child has blood in stools Symptoms: child has blood in stools 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? Child has blood in stool Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing F Child has blood in stools Symptoms: child is drinking poorly Symptoms: child is drinking poorly Symptoms: child is drinking poorly Symptoms: child is drinking poorly Symptoms: child is drinking poorly 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? Child is drinking poorly Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing G Child is drinking poorly Symptoms: other Symptoms: other Symptoms: other Symptoms: other Symptoms: other 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? Other (specify) Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing X Other Symptoms: other Symptoms: other Symptoms: other Symptoms: other Symptoms: other 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? Other (specify) Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing Y Other Symptoms: other Symptoms: other Symptoms: other Symptoms: other Symptoms: other 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? Other (specify) Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caregiver cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions ILLNESS SYMPTOMS ? Missing Z Other Currently pregnant Currently pregnant Currently pregnant Currently pregnant Currently pregnant I WOULD LIKE TO TALK WITH YOU ABOUT ANOTHER SUBJECT - FAMILY PLANNING. ARE YOU PREGNANT NOW? ARE YOU PREGNANT NOW? This question is important because later questions in this module will not need to be asked of pregnant women. A woman who is pregnant does not need to use contraception! Circle the code corresponding to the response given. If she is pregnant, circle '1' and go to the next question. If the woman is not pregnant, circle '2'. If she is unsure or does not know for certain if she is pregnant, circle '8' for 'Unsure or DK'. In both cases, skip to CP2. IF CODE IS 1 GO TO Next Module CONTRACEPTION 1 Yes, currently pregnant 2 No 8 Unsure or dk 9 Missing Currently using a method to avoid pregnancy Currently using a method to avoid pregnancy Currently using a method to avoid pregnancy Currently using a method to avoid pregnancy Currently using a method to avoid pregnancy 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? Circle the code corresponding to the response given. If the answer is 'No', go to the next module IF CODE IS 2 GO TO Next Module CONTRACEPTION 1 Yes 2 No 9 Missing Current method: female sterilization Current method: female sterilization Current method: female sterilization Current method: female sterilization Current method: female sterilization WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Female sterilization .................................... A Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing A Female sterilization Current method: male sterilization Current method: male sterilization Current method: male sterilization Current method: male sterilization Current method: male sterilization WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Male sterilization ........................................ B Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing B Male sterilization Current method: iud Current method: iud Current method: iud Current method: iud Current method: iud WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? IUD ............................................................ C Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing C Iud Current method: injectables Current method: injectables Current method: injectables Current method: injectables Current method: injectables WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Injectables .................................................. D Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing D Injectables Current method: implants Current method: implants Current method: implants Current method: implants Current method: implants WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Implants ..................................................... E Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing E Implants Current method: pill Current method: pill Current method: pill Current method: pill Current method: pill WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Pill .............................................................. F Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing F Pill Current method: male condom Current method: male condom Current method: male condom Current method: male condom Current method: male condom WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Male condom ............................................. G Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing G Male condom Current method: female condom Current method: female condom Current method: female condom Current method: female condom Current method: female condom WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Female condom ......................................... H Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing H Female condom Current method: diaphragm Current method: diaphragm Current method: diaphragm Current method: diaphragm Current method: diaphragm WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Diaphragm .................................................. I Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing I Diaphragm Current method: foam/jelly Current method: foam/jelly Current method: foam/jelly Current method: foam/jelly Current method: foam/jelly WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Foam / Jelly ................................................ J Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing J Foam/jelly Current method: lactational amenorrhea method(lam) Current method: lactational amenorrhea method(lam) Current method: lactational amenorrhea method(lam) Current method: lactational amenorrhea method(lam) Current method: lactational amenorrhea method(lam) WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Lactational amenorrhoea Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing K Lactational amenorrhoea (lam) Current method: periodic abstinence/rhythm Current method: periodic abstinence/rhythm Current method: periodic abstinence/rhythm Current method: periodic abstinence/rhythm Current method: periodic abstinence/rhythm WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Periodic abstinence/Rhythm ...................... L Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing L Periodic abstinence/rhythm Current method: withdrawal Current method: withdrawal Current method: withdrawal Current method: withdrawal Current method: withdrawal WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Withdrawal ................................................ M Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing M Withdrawal Current method: other Current method: other Current method: other Current method: other Current method: other WHAT ARE YOU DOING TO DELAY OR AVOID A PREGNANCY? Other (specify) _______________________ X Do not prompt. If more than one method is mentioned, circle each one. CONTRACEPTION ? Missing X Other (specify) Wanted to get pregnant at the time Wanted to get pregnant at the time Wanted to get pregnant at the time Wanted to get pregnant at the time Wanted to get pregnant at the time 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? Check CP1. Currently pregnant? ?? Yes, currently pregnant ?? Continue with UN2 ?? No, unsure or DK ?? Go to UN5 IF CODE 1 GO TO UN4 UNMET NEED 1 Yes 2 No 9 Missing Wanted baby later or did not want more children Wanted baby later or did not want more children Wanted baby later or did not want more children Wanted baby later or did not want more children Wanted baby later or did not want more children DID YOU WANT TO HAVE A BABY LATER ON OR DID YOU NOT WANT ANY (MORE) CHILDREN? UNMET NEED 1 Later 2 No more 9 Missing Would like to have another child (currently pregnant) Would like to have another child (currently pregnant) Would like to have another child (currently pregnant) Would like to have another child (currently pregnant) Would like to have another child (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? Check CP3. Currently using “Female sterilization”? IF Yes Go to UN13 IF No Continue with UN6 IF CODE 1 GO TO UN7 IF CODE 2 GO TO UN13 IF CODE 8 GO TO UN13 UNMET NEED 1 Have another child 2 No more / none 8 Undecided / don't know 9 Missing Would like to have another child (not currently pregnant) Would like to have another child (not currently pregnant) Would like to have another child (not currently pregnant) Would like to have another child (not currently pregnant) Would like to have another child (not currently pregnant) 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? IF CODE 2 GO TO UN9 IF CODE 3 GO TO UN11 IF CODE 8 GO TO UN11 UNMET NEED 1 Have (a/another) child 2 No more / none 3 Says she cannot get pregnant 8 Undecided / don't know 9 Missing Desired waiting time (unit) Desired waiting time (unit) Desired waiting time (unit) Desired waiting time (unit) Desired waiting time (unit) HOW LONG WOULD YOU LIKE TO WAIT BEFORE THE BIRTH OF (A/ANOTHER) CHILD? UNIT IF CODE 994 GO TO UN11 UNMET NEED 1 Months 2 Years 9 Missing Desired waiting time (number) Desired waiting time (number) Desired waiting time (number) Desired waiting time (number) Desired waiting time (number) HOW LONG WOULD YOU LIKE TO WAIT BEFORE THE BIRTH OF (A/ANOTHER) CHILD? NUMBER 93 code forSoon / Now 94 code forSays she cannot get pregnant 95 code forAfter marriage 96 code forOther 98 code forDon't know 99 code forMissing Check CP1. Currently pregnant? IF Yes, currently pregnant Go to UN13 IF No, unsure or DK Continue with UN9 IF CODE 994 GO TO UN11 UNMET NEED Able to get pregnant Able to get pregnant Able to get pregnant Able to get pregnant Able to get pregnant DO YOU THINK YOU ARE PHYSICALLY ABLE TO GET PREGNANT AT THIS TIME? IF CODE 1 GO TO UN13 IF CODE 8 GO TO UN13 UNMET NEED 1 Yes 2 No 8 Dk 9 Missing Reason: infrequent sex / no sex Reason: infrequent sex / no sex Reason: infrequent sex / no sex Reason: infrequent sex / no sex Reason: infrequent sex / no sex WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Infrequent sex / No sex .............................. A UNMET NEED ? Missing A Infrequent sex / no sex Reason: menopausal Reason: menopausal Reason: menopausal Reason: menopausal Reason: menopausal WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Menopausal ............................................... B UNMET NEED ? Missing B Menopausal Reason: never menstruated Reason: never menstruated Reason: never menstruated Reason: never menstruated Reason: never menstruated WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Never menstruated .................................... C UNMET NEED ? Missing C Never menstruated Reason: hysterectomy Reason: hysterectomy Reason: hysterectomy Reason: hysterectomy Reason: hysterectomy WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Hysterectomy (surgical removal of uterus) ............................................... D UNMET NEED ? Missing D Hysterectomy (surgical removal of uterus) Reason: has been trying to get pregnant for 2 years or more without result Reason: has been trying to get pregnant for 2 years or more without result Reason: has been trying to get pregnant for 2 years or more without result Reason: has been trying to get pregnant for 2 years or more without result Reason: has been trying to get pregnant for 2 years or more without result WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Has been trying to get pregnant for 2 years or more without result ........... E UNMET NEED ? Missing E Has been trying to get pregnant for 2 years or more without result Reason: postpartum amenorrheic Reason: postpartum amenorrheic Reason: postpartum amenorrheic Reason: postpartum amenorrheic Reason: postpartum amenorrheic WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Postpartum amenorrheic ........................... F UNMET NEED ? Missing F Postpartum amenorrheic Reason: breastfeeding Reason: breastfeeding Reason: breastfeeding Reason: breastfeeding Reason: breastfeeding WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Breastfeeding ............................................ G UNMET NEED ? Missing G Breastfeeding Reason: too old Reason: too old Reason: too old Reason: too old Reason: too old WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Too old ...................................................... H UNMET NEED ? Missing H Too old Reason: fatalistic Reason: fatalistic Reason: fatalistic Reason: fatalistic Reason: fatalistic WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Fatalistic ...................................................... I UNMET NEED ? Missing I Fatalistic Reason: other Reason: other Reason: other Reason: other Reason: other WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Other (specify) ______________________ X UNMET NEED ? Missing X Other Reason: don't know Reason: don't know Reason: don't know Reason: don't know Reason: don't know WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Don’t know ................................................. Z UNMET NEED ? Missing Z Don't know Start of last menstrual period (unit) Start of last menstrual period (unit) Start of last menstrual period (unit) Start of last menstrual period (unit) Start of last menstrual period (unit) WHEN DID YOUR LAST MENSTRUAL PERIOD START? UNIT Days ago ......................................... 1 __ __ Weeks ago ....................................... 2 __ __ Months ago ...................................... 3 __ __ Years ago ........................................ 4 __ __ In menopause / Has had hysterectomy ........................ 994 Before last birth ...................................... 995 Never menstruated ................................. 996 Check UN11. “Never menstruated” mentioned? IF Mentioned Go to Next Module IF Not mentioned Continue with UN13 UNMET NEED 1 Days ago 2 Weeks ago 3 Months ago 4 Years ago 9 Missing Start of last menstrual period (number) Start of last menstrual period (number) Start of last menstrual period (number) Start of last menstrual period (number) Start of last menstrual period (number) WHEN DID YOUR LAST MENSTRUAL PERIOD START? NUMBER 94 code forIn menopause/had hysterectomy 95 code forBefore last birth 96 code for Never menstruated 99 code forMissing UNMET NEED Heard of female circumcision Heard of female circumcision Heard of female circumcision Heard of female circumcision Heard of female circumcision HAVE YOU EVER HEARD OF FEMALE CIRCUMCISION? Circle the code corresponding to the answer given. Skip to FG3 if 'Yes'. Otherwise, continue to the next question FEMALE GENITAL MUTILATION/CUTTING 1 Yes 2 No 9 Missing Heard of genital cutting Heard of genital cutting Heard of genital cutting Heard of genital cutting Heard of genital cutting 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? Circle the code corresponding to the answer given. If 'No', go to the next module FEMALE GENITAL MUTILATION/CUTTING 1 Yes 2 No 9 Missing Ever circumcised Ever circumcised Ever circumcised Ever circumcised Ever circumcised Have you yourself ever been circumcised? Circle the code corresponding to the answer given. If 'No', skip to FG8. FEMALE GENITAL MUTILATION/CUTTING 1 Yes 2 No 9 Missing Flesh removed from the genital area Flesh removed from the genital area Flesh removed from the genital area Flesh removed from the genital area Flesh removed from the genital area Now I would like to ask you what was done to you at this time. Was any flesh removed from the genital area? Circle the code corresponding to the answer given. Skip to FG6 if 'Yes' ('1') FEMALE GENITAL MUTILATION/CUTTING 1 Yes 2 No 8 Dk 9 Missing Genital area just nicked without removing flesh Genital area just nicked without removing flesh Genital area just nicked without removing flesh Genital area just nicked without removing flesh Genital area just nicked without removing flesh Was the genital area just nicked without removing any flesh? Circle the code corresponding to the answer given FEMALE GENITAL MUTILATION/CUTTING 1 Yes 2 No 8 Dk 9 Missing Genital area sewn closed (or sealed) Genital area sewn closed (or sealed) Genital area sewn closed (or sealed) Genital area sewn closed (or sealed) Genital area sewn closed (or sealed) WAS THE GENITAL AREA SEWN CLOSED? If necessary, probe: WAS IT SEALED? Circle the code corresponding to the answer given FEMALE GENITAL MUTILATION/CUTTING 1 Yes 2 No 8 Dk 9 Missing Age at circumcising Age at circumcising Age at circumcising Age at circumcising Age at circumcising HOW OLD WERE YOU WHEN YOU WERE CIRCUMCISED? If the respondent does not know the exact age, probe to get an estimate DK / Don’t remember / Not sure ............... 98 FEMALE GENITAL MUTILATION/CUTTING Person circumcising respondent Person circumcising respondent Person circumcising respondent Person circumcising respondent Person circumcising respondent WHO PERFORMED THE CIRCUMCISION? FEMALE GENITAL MUTILATION/CUTTING 11 Doctor 12 Nurse / midwife 16 Other health professional 21 Traditional circumciser 22 Traditional birth attendant 26 Other traditional 98 Dk 99 Missing Total number of living daughters Total number of living daughters Total number of living daughters Total number of living daughters Total number of living daughters FG8. The following questions apply only to women who have at least one living daughter. Check CM4 and CM6, Child Mortality Module: Woman has living daughter? Yes. then Continue with FG9 No. then Go to FG16 Total number of living daughters Check CM5 for Number of daughters at home and CM7 for Number of daughters elsewhere, and sum the answers here 0 Code for No daughters circumcise 98 code for DK 99 code for Missing FEMALE GENITAL MUTILATION/CUTTING Should practice be continued or discontinued Should practice be continued or discontinued Should practice be continued or discontinued Should practice be continued or discontinued Should practice be continued or discontinued DO YOU THINK THIS PRACTICE SHOULD BE CONTINUED OR SHOULD IT BE DISCONTINUED? FEMALE GENITAL MUTILATION/CUTTING 1 Continued 2 Discontinued 3 Depends 8 Dk 9 Missing If she goes out with out telling husband: wife beating justi If she goes out with out telling husband: wife beating justi If she goes out with out telling husband: wife beating justi If she goes out with out telling husband: wife beating justi If she goes out with out telling husband: wife beating justi 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? ATTITUDES TOWARD DOMESTIC VIOLENCE 1 Yes 2 No 8 Dk 9 Missing If she neglects the children: wife beating justified If she neglects the children: wife beating justified If she neglects the children: wife beating justified If she neglects the children: wife beating justified If she neglects the children: wife beating justified 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: [B] IF SHE NEGLECTS THE CHILDREN? ATTITUDES TOWARD DOMESTIC VIOLENCE 1 Yes 2 No 8 Dk 9 Missing If she argues with husband: wife beating justified If she argues with husband: wife beating justified If she argues with husband: wife beating justified If she argues with husband: wife beating justified If she argues with husband: wife beating justified 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: [C] IF SHE ARGUES WITH HIM? ATTITUDES TOWARD DOMESTIC VIOLENCE 1 Yes 2 No 8 Dk 9 Missing If she refuses sex with husband: wife beating justified If she refuses sex with husband: wife beating justified If she refuses sex with husband: wife beating justified If she refuses sex with husband: wife beating justified If she refuses sex with husband: wife beating justified 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: [D] IF SHE REFUSES TO HAVE SEX WITH HIM? ATTITUDES TOWARD DOMESTIC VIOLENCE 1 Yes 2 No 8 Dk 9 Missing If she burns the food: wife beating justified If she burns the food: wife beating justified If she burns the food: wife beating justified If she burns the food: wife beating justified If she burns the food: wife beating justified 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: [E] IF SHE BURNS THE FOOD? ATTITUDES TOWARD DOMESTIC VIOLENCE 1 Yes 2 No 8 Dk 9 Missing Currently married or living with a man Currently married or living with a man Currently married or living with a man Currently married or living with a man Currently married or living with a man MA1. Are you currently married or living together with a man as if married? The options here are currently married, living with a man, or not in union (the woman is neither married nor living with a man). Circle the code corresponding to the respondent's status at the time of the interview. If the woman is currently neither married or in a union, skip to MA3. If code3 go to MA5 MARRIAGE/UNION 1 Yes, currently married 2 Yes, living with a man 3 No, not in union Age of husband/partner Age of husband/partner Age of husband/partner Age of husband/partner Age of husband/partner HOW OLD IS YOUR HUSBAND/PARTNER? Probe: HOW OLD WAS YOUR HUSBAND/PARTNER ON HIS LAST BIRTHDAY? If she knows the age of her current partner on his last birthday, enter his age in the space provided. If she does not know his age, circle '98' and missing is 99. MARRIAGE/UNION Ever married or lived with a man Ever married or lived with a man Ever married or lived with a man Ever married or lived with a man Ever married or lived with a man BESIDES YOURSELF, DOES YOUR HUSBAND/PARTNER HAVE ANY OTHER WIVES OR PARTNERS OR DOES HE LIVE WITH OTHER WOMEN AS IF MARRIED? If No 2 go to MA7 If DK code..98 and go to MA7 MARRIAGE/UNION 1 Yes 2 No Have you ever been married or lived together with a man as if married Have you ever been married or lived together with a man as if married Have you ever been married or lived together with a man as if married Have you ever been married or lived together with a man as if married Have you ever been married or lived together with a man as if married HOW MANY OTHER WIVES OR PARTNERS DOES HE HAVE? If DK code..98 and go to MA7 MARRIAGE/UNION Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once HAVE YOU EVER BEEN MARRIED OR LIVED TOGETHER WITH A MAN AS IF MARRIED? As with MA1, we are interested in formal marriages as well as informal arrangements. If a woman was married or lived with a man and then was widowed, divorced, or separated from her husband or partner and is now either married to or living with someone else, record 'More than once'. If a woman is not currently married or in an informal union but was previously married or living with someone else two or more times, record 'More than once' by circling '2'. If she has married or lived with someone else only once, circle '1.' Note that the question refers to periods of marriage or informal unions, and not to numbers of husbands or partners. If a woman was married to a man and divorced him, and then married the same person again, she should be considered as having married 'More than once'. The same applies to informal unions with the same person. MARRIAGE/UNION 1 Yes, formerly married 2 Yes, formerly lived with a man 3 No 9 Missing Marital status Marital status Marital status Marital status Marital status WHAT IS YOUR MARITAL STATUS NOW: ARE YOU WIDOWED, DIVORCED OR SEPARATED? MARRIAGE/UNION 1 Widowed 2 Divorced 3 Separated Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once Married or lived with a man once or more than once HAVE YOU BEEN MARRIED OR LIVED WITH A MAN ONLY ONCE OR MORE THAN ONCE? MARRIAGE/UNION 1 Only once 2 More than once 9 Missing Month of first union Month of first union Month of first union Month of first union Month of first union IN WHAT MONTH DID YOU FIRST MARRY OR START LIVING WITH A MAN AS IF MARRIED? Month .......... __ __ DK month code 98 Missing code 999 MARRIAGE/UNION Year of first union Year of first union Year of first union Year of first union Year of first union IN WHAT YEAR DID YOU FIRST MARRY OR START LIVING WITH A MAN AS IF MARRIED? Year ........... __ __ __ __ DK year .code 9998 Missing code 999 MARRIAGE/UNION Age at first union Age at first union Age at first union Age at first union Age at first union HOW OLD WERE YOU WHEN YOU STARTED LIVING WITH YOUR FIRST HUSBAND/PARTNER? Year ........... __ __ __ __ DK year .code 9998 Missing code 999 MARRIAGE/UNION Age at first sexual intercourse Age at first sexual intercourse Age at first sexual intercourse Age at first sexual intercourse Age at first sexual intercourse NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT SEXUAL ACTIVITY IN ORDER TO GAIN A BETTER UNDERSTANDING OF SOME IMPORTANT LIFE ISSUES. THE INFORMATION YOU SUPPLY WILL REMAIN STRICTLY CONFIDENTIAL HOW OLD WERE YOU WHEN YOU HAD SEXUAL INTERCOURSE FOR THE VERY FIRST TIME? THE INFORMATION YOU SUPPLY WILL REMAIN STRICTLY CONFIDENTIAL. HOW OLD WERE YOU WHEN YOU FIRST HAD SEXUAL INTERCOURSE (IF EVER)? Never had intercourse ... code 00 First time when started living with (first) husband/partner ..code 95. Missing code 999 Age in years SEXUAL BEHAVIOUR Condom used during first sexual intercourse Condom used during first sexual intercourse Condom used during first sexual intercourse Condom used during first sexual intercourse Condom used during first sexual intercourse SB2. THE FIRST TIME YOU HAD SEXUAL INTERCOURSE, WAS A CONDOM USED? SEXUAL BEHAVIOUR 1 Yes 2 No 8 Dk / don't remember 9 Missing Time since last sexual intercourse (unit) Time since last sexual intercourse (unit) Time since last sexual intercourse (unit) Time since last sexual intercourse (unit) Time since last sexual intercourse (unit) SB3. WHEN WAS THE LAST TIME YOU HAD SEXUAL INTERCOURSE? UNIT 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. SEXUAL BEHAVIOUR 1 Days ago 2 Weeks ago 3 Months ago 4 Year ago 9 Missing Time since last sexual intercourse (number) Time since last sexual intercourse (number) Time since last sexual intercourse (number) Time since last sexual intercourse (number) Time since last sexual intercourse (number) SB3. WHEN WAS THE LAST TIME YOU HAD SEXUAL INTERCOURSE? NUMBER 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. SEXUAL BEHAVIOUR Condom used during last sexual intercourse Condom used during last sexual intercourse Condom used during last sexual intercourse Condom used during last sexual intercourse Condom used during last sexual intercourse THE LAST TIME YOU HAD SEXUAL INTERCOURSE, WAS A CONDOM USED? If man is 'boyfriend' or 'fiancée', ask: WAS YOUR BOYFRIEND/FIANCÉE LIVING WITH YOU WHEN YOU LAST HAD SEX? If 'yes', circle 1 .If 'no', circle 2. SEXUAL BEHAVIOUR 1 Yes 2 No 8 Dk / don't remember 9 Missing Relationship to this person with whom you last had sexual intercourse Relationship to this person with whom you last had sexual intercourse Relationship to this person with whom you last had sexual intercourse Relationship to this person with whom you last had sexual intercourse Relationship to this person with whom you last had sexual intercourse WHAT WAS YOUR RELATIONSHIP TO THIS PERSON WITH WHOM YOU LAST HAD SEXUAL INTERCOURSE? WERE YOU LIVING TOGETHER AS IF MARRIED? Probe to ensure that the response refers to the relationship at the time of sexual intercourse If 'boyfriend', then ask: If 'yes', circle '2'. If 'no', circle'3'. Currently married or living with a man (MA1 = 1 or 2) ?? Go to SB8 ?? Not married / Not in union (MA1 = 3) ?? Continue with SB7 SEXUAL BEHAVIOUR 1 Husband 2 Cohabiting partner 3 Boyfriend 4 Casual acquaintance 8 Dk 9 Missing Condom use with prior sexual partner Condom use with prior sexual partner Condom use with prior sexual partner Condom use with prior sexual partner Condom use with prior sexual partner HOW OLD IS THIS PERSON? ABOUT HOW OLD IS THIS PERSON? If response is DK, probe: SEXUAL BEHAVIOUR Sex with any other man in the last 12 months Sex with any other man in the last 12 months Sex with any other man in the last 12 months Sex with any other man in the last 12 months Sex with any other man in the last 12 months HAVE YOU HAD SEXUAL INTERCOURSE WITH ANY OTHER PERSON IN THE LAST 12 MONTHS? If man is 'boyfriend' or 'fiancée', ask: WAS YOUR BOYFRIEND/FIANCÉE LIVING WITH YOU WHEN YOU LAST HAD SEX? If 'yes', circle 1. If 'no', circle 2. This question asks about the relationship she had with this other man. It should refer to the relationship she had with the man at the time of intercourse. Replace 'IS' in the question to 'WAS', if necessary. The questions should be asked, probed and recorded the same way as SB4. Note that if '1' is circled (the man was a spouse or cohabiting partner at the time of intercourse), you should skip to SB10. SEXUAL BEHAVIOUR 1 Yes 2 No 9 Missing The last time you had sexual intercourse with this other person, was a condom used The last time you had sexual intercourse with this other person, was a condom used The last time you had sexual intercourse with this other person, was a condom used The last time you had sexual intercourse with this other person, was a condom used The last time you had sexual intercourse with this other person, was a condom used THE LAST TIME YOU HAD SEXUAL INTERCOURSE WITH THIS OTHER PERSON, WAS A CONDOM USED? If response is DK, probe: ABOUT HOW OLD IS THIS PERSON? Again, we are looking for the age of the man she had intercourse with at the time of the sexual encounter. Record the age in the space provided. If she does not know, ask her to estimate the age of this person. If the respondent is unable to estimate the sexual partner's age, circle '98' and continue to the next questions. SEXUAL BEHAVIOUR 1 Yes 2 No 9 Missing Your relationship to this person Your relationship to this person Your relationship to this person Your relationship to this person Your relationship to this person SB10. WHAT WAS YOUR RELATIONSHIP TO THIS PERSON? WERE YOU LIVING TOGETHER AS IF MARRIED? Probe to ensure that the response refers to the relationship at the time of sexual intercourse If 'boyfriend' then ask: If 'yes', circle '2'. If 'no', circle' 3'. Check MA1 and MA7: ?? Currently married or living with a man (MA1 = 1 or 2) AND Married only once or lived with a man only once (MA7 = 1) ?? Go to SB13 ?? Else ?? Continue with SB12 SEXUAL BEHAVIOUR 1 Husband 2 Cohabiting partner 3 Boyfriend 4 Casual acquaintance 6 Other (specify) 8 Dk 9 Missing How old is this person How old is this person How old is this person How old is this person How old is this person HOW OLD IS THIS PERSON? ABOUT HOW OLD IS THIS PERSON? If response is DK, probe: SEXUAL BEHAVIOUR Sex with any other man in the last 12 months Sex with any other man in the last 12 months Sex with any other man in the last 12 months Sex with any other man in the last 12 months Sex with any other man in the last 12 months OTHER THAN THESE TWO PERSONS, HAVE YOU HAD SEXUAL INTERCOURSE WITH ANY OTHER PERSON IN THE LAST 12 MONTHS? SEXUAL BEHAVIOUR 1 Yes 2 No 9 Missing Number of non marital sex partners in last 12 months Number of non marital sex partners in last 12 months Number of non marital sex partners in last 12 months Number of non marital sex partners in last 12 months Number of non marital sex partners in last 12 months IN TOTAL, WITH HOW MANY DIFFERENT PEOPLE HAVE YOU HAD SEXUAL INTERCOURSE IN THE LAST 12 MONTHS? SEXUAL BEHAVIOUR Condom used for non marital sex partners Condom used for non marital sex partners Condom used for non marital sex partners Condom used for non marital sex partners Condom used for non marital sex partners FOR ALL THE SEXUAL INTERCOURSE WITH NON MARITAL PARTNERS IN THE LAST 12 MONTHS (FROM DATE OF THIS INTERVIEW), WAS A CONDOM USED? SEXUAL BEHAVIOUR 1 Yes 2 No 8 Dk/not sure/don't remember 9 Missing Condom used for non marital sex partners Condom used for non marital sex partners Condom used for non marital sex partners Condom used for non marital sex partners Condom used for non marital sex partners FOR ALL THE SEXUAL INTERCOURSE WITH NON MARITAL PARTNERS IN THE LAST 12 MONTHS (FROM DATE OF THIS INTERVIEW), WAS A CONDOM USED? SEXUAL BEHAVIOUR Number of sex partners in lifetime Number of sex partners in lifetime Number of sex partners in lifetime Number of sex partners in lifetime Number of sex partners in lifetime IN TOTAL, WITH HOW MANY DIFFERENT PEOPLE HAVE YOU HAD SEXUAL INTERCOURSE If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write '95'. SEXUAL BEHAVIOUR Ever heard of hiv or aids Ever heard of hiv or aids Ever heard of hiv or aids Ever heard of hiv or aids Ever heard of hiv or aids Now I would like to talk with you about something else. HAVE YOU EVER HEARD OF AN ILLNESS CALLED AIDS? HAVE YOU EVER HEARD OF THE VIRUS HIV OR AN ILLNESS CALLED AIDS? This question serves as an introduction and allows us to verify whether a respondent has heard of AIDS. If there is a local term for AIDS, use the local term in addition to 'AIDS'. If a respondent has never heard of the HIV virus or AIDS, go to the next module. The following questions ask the respondent about specific ways to avoid HIV transmission. They focus on programmatically important ways to avoid HIV - by limiting the number of partners and by using condoms. They also probe into misconceptions concerning HIV transmission, through mosquito bites or sharing food, for example. For questions HA2-HA8, circle the code for the response given. If the respondent cannot provide a 'Yes' or 'No' answer, circle '8' for 'DK'. Do not prompt the respondent or indicate the 'correct' answer in any way. HIV/AIDS 1 Yes 2 No 9 Missing Can avoid aids by having one unifected partner Can avoid aids by having one unifected partner Can avoid aids by having one unifected partner Can avoid aids by having one unifected partner Can avoid aids by having one unifected partner CAN PEOPLE REDUCE THEIR CHANCE OF GETTING THE HIV VIRUS THAT CAUSES AIDS BY HAVING JUST ONE UNINFECTED SEX PARTNER WHO HAS NO OTHER SEX PARTNERS? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Can get aids through supernatural means Can get aids through supernatural means Can get aids through supernatural means Can get aids through supernatural means Can get aids through supernatural means CAN PEOPLE GET THE HIV VIRUS THAT CAUSES AIDS BECAUSE OF WITCHCRAFT OR OTHER SUPERNATURAL MEANS? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Can avoid aids by using a condom correctly every time Can avoid aids by using a condom correctly every time Can avoid aids by using a condom correctly every time Can avoid aids by using a condom correctly every time Can avoid aids by using a condom correctly every time CAN PEOPLE REDUCE THEIR CHANCE OF GETTING THE HIV VIRUS THAT CAUSES AIDS BY USING A CONDOM EVERY TIME THEY HAVE SEX? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Can get aids from mosquito bites Can get aids from mosquito bites Can get aids from mosquito bites Can get aids from mosquito bites Can get aids from mosquito bites CAN PEOPLE GET THE HIV VIRUS THAT CAUSES AIDS FROM MOSQUITO BITES? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Can avoid aids by not having sex at all Can avoid aids by not having sex at all Can avoid aids by not having sex at all Can avoid aids by not having sex at all Can avoid aids by not having sex at all HA6. CAN PEOPLE GET THE HIV VIRUS THAT CAUSES AIDS BY SHARING FOOD WITH A PERSON WHO HAS AIDS? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Can get aids by sharing food with person with aids virus Can get aids by sharing food with person with aids virus Can get aids by sharing food with person with aids virus Can get aids by sharing food with person with aids virus Can get aids by sharing food with person with aids virus IS IT POSSIBLE FOR A HEALTHY-LOOKING PERSON TO HAVE THE AIDS VIRUS? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Aids virus from mother to child during pregnancy Aids virus from mother to child during pregnancy Aids virus from mother to child during pregnancy Aids virus from mother to child during pregnancy Aids virus from mother to child during pregnancy CAN HIV VIRUS THAT CAUSES AIDS BE TRANSMITTED FROM A MOTHER TO HER BABY: DURING PREGNANCY HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Aids virus from mother to child during delivery Aids virus from mother to child during delivery Aids virus from mother to child during delivery Aids virus from mother to child during delivery Aids virus from mother to child during delivery CAN HIV VIRUS THAT CAUSES AIDS BE TRANSMITTED FROM A MOTHER TO HER BABY: DURING DELIVERY HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Aids virus from mother to child through breastfeeding Aids virus from mother to child through breastfeeding Aids virus from mother to child through breastfeeding Aids virus from mother to child through breastfeeding Aids virus from mother to child through breastfeeding CAN HIV VIRUS THAT CAUSES AIDS BE TRANSMITTED FROM A MOTHER TO HER BABY: BY BREASTFEEDING? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Aids virus prevented from unborn child Aids virus prevented from unborn child Aids virus prevented from unborn child Aids virus prevented from unborn child Aids virus prevented from unborn child CAN THE HIV VIRUS THAT CAUSES AIDS IN AN INFECTED MOTHER BE PREVENTED FROM INFECTING AN UNBORN CHILD BY GIVING DRUGS THAT REDUCE THE HIV VIRUS IN MOTHER? HIV/AIDS 1 Yes 2 No 8 Dk / not sure / depends 9 Missing Should female teacher with aids virus be allowed to teach in Should female teacher with aids virus be allowed to teach in Should female teacher with aids virus be allowed to teach in Should female teacher with aids virus be allowed to teach in Should female teacher with aids virus be allowed to teach in IN YOUR OPINION, IF A FEMALE TEACHER HAS THE HIV VIRUS THAT CAUSES AIDS BUT IS NOT SICK, SHOULD SHE BE ALLOWED TO CONTINUE TEACHING IN SCHOOL? HIV/AIDS 1 Yes 2 No 8 Dk / not sure / depends 9 Missing Would buy fresh vegetables from shopseller with hiv/aids Would buy fresh vegetables from shopseller with hiv/aids Would buy fresh vegetables from shopseller with hiv/aids Would buy fresh vegetables from shopseller with hiv/aids Would buy fresh vegetables from shopseller with hiv/aids WOULD YOU BUY FRESH VEGETABLES FROM A SHOPKEEPER OR VENDOR IF YOU KNEW THAT THIS PERSON HAD THE HIV VIRUS THAT CAUSES AIDS? If a school learns that a female teacher has the AIDS virus, but she is not sick, how should the school handle this information? Should the teacher be allowed to continue teaching at the school, or should she be removed from her teaching position? We are not asking about whether or not a teacher has actually been asked to leave a teaching position, but rather, what is the respondent's opinion about how such a case should be handled; should the teacher be allowed to continue teaching? HIV/AIDS 1 Yes 2 No 8 Dk/not sure/depends 9 Missing If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret IF A MEMBER OF YOUR FAMILY GOT INFECTED WITH THE HIV VIRUS THAT CAUSES AIDS, WOULD YOU WANT IT TO REMAIN A SECRET? HIV/AIDS 1 Yes 2 No 8 Dk/not sure/depends 9 Missing If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret If a member became infected with the virus, would you want it to remain a secret IF A MEMBER OF YOUR FAMILY BECAME SICK WITH AIDS, WOULD YOU BE WILLING TO CARE FOR HER OR HIM IN YOUR OWN HOUSEHOLD? Check CM13: Any live birth in last 2 years? If No live birth in last 2 years Go to HA24 One or more live births in last 2 years Continue with HA14 HA14. Check MN1: Received antenatal care? If Received antenatal care ?? Continue with HA15 Did not receive antenatal care, Go to HA24 HIV/AIDS 1 Yes 2 No 8 Dk/not sure/depends 9 Missing If a member of your family became sick with aids, would you be willing to care for her or him in your own household If a member of your family became sick with aids, would you be willing to care for her or him in your own household If a member of your family became sick with aids, would you be willing to care for her or him in your own household If a member of your family became sick with aids, would you be willing to care for her or him in your own household If a member of your family became sick with aids, would you be willing to care for her or him in your own household HA14. Check MN5: Tested for HIV during antenatal care? Yes. then Go to HA18A No. then Continue with HA15 DURING ANY OF THE ANTENATAL VISITS FOR YOUR PREGNANCY WITH (name), WERE YOU GIVEN ANY INFORMATION ABOUT AIDS OR THE HIV VIRUS? Ask the respondent if she was tested for the HIV. Be clear to the respondent that you are not asking to know the results of the test. Circle the code for the response given. If her answer is 'No', skip to HA18. HIV/AIDS 1 Yes 2 No 8 Dk / not sure / depends 9 Missing Were you tested for the hiv virus that causes aids as part of your antenatal care Were you tested for the hiv virus that causes aids as part of your antenatal care Were you tested for the hiv virus that causes aids as part of your antenatal care Were you tested for the hiv virus that causes aids as part of your antenatal care Were you tested for the hiv virus that causes aids as part of your antenatal care I DON’T WANT TO KNOW THE RESULTS, BUT WERE YOU TESTED FOR THE HIV VIRUS THAT CAUSES AIDS AS PART OF YOUR ANTENATAL CARE? Sometimes people are tested for the AIDS virus but are not told whether or not they have the virus, or do not go to get the results. It is important that you do not attempt to find out the HIV status of any respondent who has been tested, or imply that you have any interest in knowing her HIV status. Ask the question, ensuring that the respondent knows that you are not interested in learning the results of any test she may have undergone. Circle the code corresponding to her response. HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Get the results of the test Get the results of the test Get the results of the test Get the results of the test Get the results of the test HA17. I DON’T WANT TO KNOW THE RESULTS, BUT DID YOU GET THE RESULTS OF THE TEST? If the respondent has been tested for HIV, we want to know whose idea it was to get the test. There are three options, so read the entire question before expecting an answer. Perhaps the respondent asked to be tested for HIV. Perhaps a health worker offered to test the respondent and the respondent accepted being tested. Perhaps the test was required for some reason. Circle the code corresponding to the response. If the respondent got tested because her partner asked her to do so, you would circle '1', corresponding to 'Asked for the test', because she got the test of her own volition, in response to someone asking her to do so. This would be the case if a girlfriend or boyfriend or spouse or other concerned person personally asked them to get tested. If the respondent was offered the test during a normal health centre visit, for instance, and the respondent accepted the test, this would be coded as '2', 'Offered and accepted'. By 'required', we mean formally required. For example, an employer may require their employees to get tested for the AIDS virus. If so, you would circle '3' for 'Required'. Also, some countries require applicants applying for work permits or applicants applying for visas to show proof of an AIDS test. HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Did you receive counselling Did you receive counselling Did you receive counselling Did you receive counselling Did you receive counselling HA14. Check MN5: Tested for HIV during antenatal care? Yes. è Go to HA18A No. è Continue with HA15 REGARDLESS OF THE RESULT, ALL WOMEN WHO ARE TESTED ARE SUPPOSED TO RECEIVE COUNSELING AFTER GETTING THE RESULT. AFTER YOU WERE TESTED, DID YOU RECEIVE COUNSELLING? Check MN17: Birth delivered by health professional (A, B or C)? If Yes, birth delivered by health professional ?? Continue with HA20 If NO, BIRTH NOT DELIVERED BY HEALTH PROFESSIONAL ?? GO TO HA24 HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Were you tested for the hiv virus that causes aids between the time you went for delivery but before the baby was born Were you tested for the hiv virus that causes aids between the time you went for delivery but before the baby was born Were you tested for the hiv virus that causes aids between the time you went for delivery but before the baby was born Were you tested for the hiv virus that causes aids between the time you went for delivery but before the baby was born Were you tested for the hiv virus that causes aids between the time you went for delivery but before the baby was born I DON’T WANT TO KNOW THE RESULTS, BUT WERE YOU TESTED FOR THE HIV VIRUS THAT CAUSES AIDS BETWEEN THE TIME YOU WENT FOR DELIVERY BUT BEFORE THE BABY WAS BORN? HIV/AIDS 1 Yes 2 No 9 Missing Received results from test during delivery Received results from test during delivery Received results from test during delivery Received results from test during delivery Received results from test during delivery HA21. I DON’T WANT TO KNOW THE RESULTS, BUT DID YOU GET THE RESULTS OF THE TEST? HIV/AIDS 1 Yes 2 No 9 Missing Tested for aids virus since test during pregnancy Tested for aids virus since test during pregnancy Tested for aids virus since test during pregnancy Tested for aids virus since test during pregnancy Tested for aids virus since test during pregnancy HAVE YOU BEEN TESTED FOR THE HIV VIRUS THAT CAUSES AIDS SINCE THAT TIME YOU WERE TESTED DURING YOUR PREGNANCY? HIV/AIDS 1 Yes 2 No 9 Missing Most recent time of testing for aids virus Most recent time of testing for aids virus Most recent time of testing for aids virus Most recent time of testing for aids virus Most recent time of testing for aids virus WHEN WAS THE MOST RECENT TIME YOU WERE TESTED FOR HIV VIRUS THAT CAUSES AIDS? HIV/AIDS 1 Less than 12 months ago 2 12-23 months ago 3 2 or more years ago 9 Missing Ever been tested for aids virus Ever been tested for aids virus Ever been tested for aids virus Ever been tested for aids virus Ever been tested for aids virus HA24. I DON’T WANT TO KNOW THE RESULTS, BUT HAVE YOU EVER BEEN TESTED TO SEE IF YOU HAVE THE HIV VIRUS THAT CAUSES AIDS? HIV/AIDS 1 Yes 2 No 9 Missing Most recent time of testing for aids virus Most recent time of testing for aids virus Most recent time of testing for aids virus Most recent time of testing for aids virus Most recent time of testing for aids virus WHEN WAS THE MOST RECENT TIME YOU WERE TESTED? HIV/AIDS 1 Less than 12 months ago 2 12-23 months ago 3 2 or more years ago 9 Missing Received results of aids virus test Received results of aids virus test Received results of aids virus test Received results of aids virus test Received results of aids virus test I DON’T WANT TO KNOW THE RESULTS, BUT DID YOU GET THE RESULTS OF THE TEST? HIV/AIDS 1 Yes 2 No 8 Dk 9 Missing Know a place to get aids virus test Know a place to get aids virus test Know a place to get aids virus test Know a place to get aids virus test Know a place to get aids virus test DO YOU KNOW OF A PLACE WHERE PEOPLE CAN GO TO GET TESTED FOR THE HIV VIRUS THAT CAUSES AIDS? Check household listing, column HL9. Is the respondent the mother or caregiver of any child age 0-4 living in this household? If Yes Go to QUESTIONNAIRE FOR CHILDREN UNDER FIVE for that child and start the interview with this respondent. If No End the interview with this respondent by thanking her for her cooperation. Check for the presence of any other eligible woman or children under-5 in the household. HIV/AIDS 1 Yes 2 No 9 Missing Net number Net number Net number Net number Net number Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed? 1 Observed 2 Not observed 9 Missing Brand/type of observed net Brand/type of observed net Brand/type of observed net Brand/type of observed net Brand/type of observed net Observe or ask the type of mosquito net. If type is unknown and you cannot observe the net, show pictures of typical net types to the respondent. 18 Long-lasting treated nets 28 Pre-treated nets 31 Other net 98 Dk brand / type 99 Missing Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained HOW MANY MONTHS AGO DID YOUR HOUSEHOLD GET THE MOSQUITO NET? If less than one month, record "00" Check TN5 for type of net Less than one month ago 95 More than 36 months ago 98 Dk / not sure 99 Missing Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained WHEN YOU GOT THE NET, WAS IT ALREADY TREATED WITH AN INSECTICIDE TO KILL OR REPEL MOSQUITOES? 1 Yes 2 No 8 Dk / not sure 9 Missing Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained SINCE YOU GOT THE NET, WAS IT EVER SOAKED OR DIPPED IN A LIQUID TO KILL OR REPEL MOSQUITOES? 1 Yes 2 No 8 Dk / not sure 9 Missing Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped TN10. HOW MANY MONTHS AGO WAS THE NET LAST SOAKED OR DIPPED? If less than one month, record "00" Less than one month ago 95 More than 24 months ago 98 Dk / not sure 99 Missing Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night DID ANYONE SLEEP UNDER THIS MOSQUITO NET LAST NIGHT? 1 Yes 2 No 8 Dk / not sure 9 Missing Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Go back to TN4 for next net. If no more nets, go to next module Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Go back to TN4 for next net. If no more nets, go to next module Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Go back to TN4 for next net. If no more nets, go to next module Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Record the person's line number from the household listing form If someone not in the household list slept under the mosquito net, record "00" Go back to TN4 for next net. If no more nets, go to next module Area:sector Area:sector Area:sector Area:sector Area:sector HH6. Area...................................... Sector Rural ...................................................... 1 Urban..................................................... 2 Area Sector 1 Rural 2 Urban State State State State State HH7. State Name:________________________ State Code: 1 Abia 2 Adamawa 3 Akwa-ibom 4 Anambra 5 Bauchi 6 Bayelsa 7 Benue 8 Borno 9 Cross-rivers 10 Delta 11 Ebonyi 12 Edo 13 Ekiti 14 Enugu 15 Gombe 16 Imo 17 Jigawa 18 Kaduna 19 Kano 20 Katsina 21 Kebbi 22 Kogi 23 Kwara 24 Lagos 25 Nasarawa 26 Niger 27 Ogun 28 Ondo 29 Osun 30 Oyo 31 Plataeu 32 Rivers 33 Sokoto 34 Taraba 35 Yobe 36 Zamfara 37 Abuja fct Date of interview women (cmc) Date of interview women (cmc) Date of interview women (cmc) Date of interview women (cmc) Date of interview women (cmc) Date of interview women (CMC) Date of birth (cmc) Date of birth (cmc) Date of birth (cmc) Date of birth (cmc) Date of birth (cmc) Date of birth (cmc) Age Age Age Age Age Age 1 15-19 2 20-24 3 25-29 4 30-34 5 35-39 6 40-44 7 45-49 Date of marriage (cmc) Date of marriage (cmc) Date of marriage (cmc) Date of marriage (cmc) Date of marriage (cmc) Date of marriage (CMC) Age at first marriage/union Age at first marriage/union Age at first marriage/union Age at first marriage/union Age at first marriage/union Age at first marriage/union Date of birth of first child (cmc) Date of birth of first child (cmc) Date of birth of first child (cmc) Date of birth of first child (cmc) Date of birth of first child (cmc) Date of birth of first child (CMC) Date of birth of last child (cmc) Date of birth of last child (cmc) Date of birth of last child (cmc) Date of birth of last child (cmc) Date of birth of last child (cmc) Date of birth of last child (CMC) Marital/union status Marital/union status Marital/union status Marital/union status Marital/union status Marital/union status 1 Currently married/in union 2 Formerly married/in union 3 Never married/in union Children ever born Children ever born Children ever born Children ever born Children ever born Children ever born Children surviving Children surviving Children surviving Children surviving Children surviving Children surviving Children dead Children dead Children dead Children dead Children dead Children dead Education Education Education Education Education Education 1 None 2 Primary 3 Secondary + 9 Missing/dk Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head 1 Christianity 2 Islam 3 Other religion 4 No religion 9 Missing/dk Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head 1 North central 2 North east 3 North west 4 South east 5 South south 6 South west Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 REGR factor score 1 for analysis 2 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Women's sample weight Women's sample weight Women's sample weight Women's sample weight Women's sample weight Women's sample weight Cluster number Cluster number Cluster number Cluster number Cluster number HH1. Cluster Number: ___ ___ ___ ___ Enter the name of the enumeration area and the cluster number as provided by your supervisor. The cluster number in four digits includes two digits for the state and two digits for the EA serial number in the state. Every selected Household The selected Enumeration Area to be covered Household number Household number Household number Household number Household number HH2. Household Number:___ ___ ___ ___ Enter the household number as instructed by your supervisor. Line number Line number Line number Line number Line number Woman's Line Number: __ __ Enter the household number from the Household Questionnaire, question HH2 Heard of female circumcision Heard of female circumcision Heard of female circumcision Heard of female circumcision Heard of female circumcision FG1. Have you ever heard of female circumcision? Circle the code corresponding to the answer given. Skip to FG3 if 'Yes'. Otherwise, continue to the next question All women age 15 through 49 1 Yes 2 No 9 Missing Ever circumcised Ever circumcised Ever circumcised Ever circumcised Ever circumcised HAVE YOU YOURSELF EVER BEEN CIRCUMCISED? Circle the code corresponding to the answer given. If 'No', skip to FG8. 1 Yes 2 No 9 Missing T otal number of daughters T otal number of daughters T otal number of daughters T otal number of daughters T otal number of daughters FG8. The following questions apply only to women who have at least one living daughter. Check CM4 and CM6, Child Mortality Module: Woman has living daughter? Yes. then Continue with FG9 No. then Go to FG16 Check CM5 for Number of daughters at home and CM7 for Number of daughters elsewhere, and sum the answers here IF YES, HOW MANY? JUST TO MAKE SURE THAT I HAVE THIS RIGHT, YOU HAVE (total number in FG9) LIVING DAUGHTERS. IS THIS CORRECT? If Yes One or more living daughters, Continue with FG11 If Does not have any living daughters, Go to FG22 If No Check responses to CM1 – CM10 and make corrections as necessary, until FG10 = Yes FG8. The following questions apply only to women who have at least one living daughter. Check CM4 and CM6, Child Mortality Module: Woman has living daughter? Yes. Continue with FG9 No. Go to FG16 Line number Line number Line number Line number Line number Line number Age of daughter Age of daughter Age of daughter Age of daughter Age of daughter HOW OLD IS (name)? Circle the code corresponding to the answer given Is (name) circumcised Is (name) circumcised Is (name) circumcised Is (name) circumcised Is (name) circumcised FG15. IS (name) CIRCUMCISED? If “No”, go to FG13 for next daughter. If no more daughters, go to FG22 1 Yes 2 No 9 Missing How old was (name) when this occurred How old was (name) when this occurred How old was (name) when this occurred How old was (name) when this occurred How old was (name) when this occurred FG8. The following questions apply only to women who have at least one living daughter. Check CM4 and CM6, Child Mortality Module: Woman has living daughter? Yes. then Continue with FG9 No. then Go to FG16 HOW OLD WAS (name) WHEN THIS OCCURRED? If the respondent does not know the age, probe to get an estimate. Flesh removed from the genital area: daughter Flesh removed from the genital area: daughter Flesh removed from the genital area: daughter Flesh removed from the genital area: daughter Flesh removed from the genital area: daughter 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 2 No 8 Dk 9 Missing Genital area nicked without removing flesh: daughter Genital area nicked without removing flesh: daughter Genital area nicked without removing flesh: daughter Genital area nicked without removing flesh: daughter Genital area nicked without removing flesh: daughter WAS HER GENITAL AREA JUST NICKED WITHOUT REMOVING ANY FLESH? 1 Yes 2 No 8 Dk 9 Missing Genital area sewn closed: daughter Genital area sewn closed: daughter Genital area sewn closed: daughter Genital area sewn closed: daughter Genital area sewn closed: daughter WAS HER GENITAL AREA SEWN CLOSED? If necessary, probe: WAS IT SEALED? 1 Yes 2 No 8 Dk 9 Missing Person circumcising daughter Person circumcising daughter Person circumcising daughter Person circumcising daughter Person circumcising daughter WHO PERFORMED THE CIRCUMCISION? 11 Doctor 12 Nurse / midwife 16 Other health professional 21 Traditional circumciser 22 Traditional birth attendant 26 Other traditional 98 Dk 99 Missing Area:sector Area:sector Area:sector Area:sector Area:sector HH6. Area...................................... Sector Rural ...................................................... 1 Urban..................................................... 2 Area Sector 1 Rural 2 Urban State State State State State HH7. State Name:________________________ State Code:__ __ 1 Abia 2 Adamawa 3 Akwa-ibom 4 Anambra 5 Bauchi 6 Bayelsa 7 Benue 8 Borno 9 Cross-rivers 10 Delta 11 Ebonyi 12 Edo 13 Ekiti 14 Enugu 15 Gombe 16 Imo 17 Jigawa 18 Kaduna 19 Kano 20 Katsina 21 Kebbi 22 Kogi 23 Kwara 24 Lagos 25 Nasarawa 26 Niger 27 Ogun 28 Ondo 29 Osun 30 Oyo 31 Plataeu 32 Rivers 33 Sokoto 34 Taraba 35 Yobe 36 Zamfara 37 Abuja fct Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head 1 Christianity 2 Islam 3 Other religion 4 No religion 9 Missing/dk Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head 1 North central 2 North east 3 North west 4 South east 5 South south 6 South west Education Education Education Education Education 1 None 2 Primary 3 Secondary + 9 Missing/dk Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Women's sample weight Women's sample weight Women's sample weight Women's sample weight Women's sample weight Cluster number Cluster number Cluster number Cluster number Cluster number Cluster Number : Household number Household number Household number Household number Household number Household number: Line number Line number Line number Line number Line number Line number: Cluster number Cluster number Cluster number Cluster number Cluster number Cluster Number Enter the EA Name and cluster number from the Household Questionnaire, question HH1 A child that is under the age of 5 years living with MOTHERS OR CARETAKERS Household number Household number Household number Household number Household number Household number: Enter the household number from the Household Questionnaire, question HH2. Child's line number Child's line number Child's line number Child's line number Child's line number Child's Line Number: Enter the child's line number from the Household Questionnaire, column HL1 of the Household Listing Caretaker's line number Caretaker's line number Caretaker's line number Caretaker's line number Caretaker's line number Mother's/Caretaker's Line Number: Enter the mother's/primary caretaker's line number from the Household Questionnaire, column HL1 of the Household Listing. Day of interview Day of interview Day of interview Day of interview Day of interview Day of interview: Enter the date of the interview: day/month/year. If the interview is not completed on your first visit and you visit the household to interview the mother/caretaker again, revise and enter the final date of the interview. In other words, the date here should be the date when you have either completed the Questionnaire for Children Under Five, or when the interview was not conducted but when it was decided that there will be no more attempts to interview the mother or primary caretaker of the under-five child. Month of interview Month of interview Month of interview Month of interview Month of interview Month of interview: Enter the date of the interview: day/month/year. If the interview is not completed on your first visit and you visit the household to interview the mother/caretaker again, revise and enter the final date of the interview. In other words, the date here should be the date when you have either completed the Questionnaire for Children Under Five, or when the interview was not conducted but when it was decided that there will be no more attempts to interview the mother or primary caretaker of the under-five child. Year of interview Year of interview Year of interview Year of interview Year of interview Year of interview: Enter the date of the interview: day/month/year. If the interview is not completed on your first visit and you visit the household to interview the mother/caretaker again, revise and enter the final date of the interview. In other words, the date here should be the date when you have either completed the Questionnaire for Children Under Five, or when the interview was not conducted but when it was decided that there will be no more attempts to interview the mother or primary caretaker of the under-five child. Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for chidren under 5 Result of interview for children under 5 (Codes refer to mother/caretaker.) Complete this question once you have concluded the interview. Remember that the code refers to the mother or primary caretaker of the under-five child. Circle the code corresponding to the results of the interview. If the questionnaire is completed, circle '1' for 'Completed'. If you have not been able to contact the mother/primary caretaker after repeated visits, circle '2' for 'Not at home'. If the mother/primary caretaker refuses to be interviewed, circle '3' for 'Refused'. If you were able to only partly complete the questionnaire, circle '4' for 'Partly completed'. If the mother/primary caretaker is incapacitated, circle '5'. If you have not been able to complete this questionnaire for another reason, you should circle '6' for 'Other' and specify the reason in the space provided. Ask the mother/primary caretaker to collect all the birth certificates and health/immunization cards she has for this child before you begin the interview. You will need these during the interview. (Codes refer to mother/caretaker.) 1 Completed 2 Not at home 3 Refused 4 Partly completed 5 Incapacitated 6 Other (specify) Age of child Age of child Age of child Age of child Age of child How old was (name) at his/her last birthday? Age in completed years __ __ If the mother/primary caretaker does not know the current age of the child, try asking "HOW MANY YEARS AGO WAS (name) BORN?" You may help the respondent by relating the child's age to that of other children or to some important event or to the season of birth, by asking, for example, Record age in completed YEARS Start of interview - hour Start of interview - hour Start of interview - hour Start of interview - hour Start of interview - hour Record the time-Start of interview - Hour Start of interview - minutes Start of interview - minutes Start of interview - minutes Start of interview - minutes Start of interview - minutes Record the time- Start of interview - Minutes End of interview - hour End of interview - hour End of interview - hour End of interview - hour End of interview - hour Record the time End of interview - Hour End of interview - minutes End of interview - minutes End of interview - minutes End of interview - minutes End of interview - minutes Record the time End of interview - Minutes Day of birth of child Day of birth of child Day of birth of child Day of birth of child Day of birth of child NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH OF (name). IN WHAT MONTH AND YEAR WAS (name) BORN? Probe: WHAT IS HIS / HER BIRTHDAY? If the mother/caregiver knows the exact birth date, also enter the day; otherwise, circle 98 for day must be recorded. AGE Month of birth of child Month of birth of child Month of birth of child Month of birth of child Month of birth of child NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH OF (name). IN WHAT MONTH AND YEAR WAS (name) BORN? Probe: WHAT IS HIS / HER BIRTHDAY? If the mother/caregiver knows the exact birth date, also enter the day; otherwise, circle 98 for Month and year must be recorded. AGE Year of birth of child Year of birth of child Year of birth of child Year of birth of child Year of birth of child NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH OF (name). IN WHAT MONTH AND YEAR WAS (name) BORN? Probe: WHAT IS HIS / HER BIRTHDAY? If the mother/caregiver knows the exact birth date, also enter the day; otherwise, circle 98 for year must be recorded. AGE Age of child Age of child Age of child Age of child Age of child HOW OLD IS (name)? Probe: HOW OLD WAS (name) AT HIS / HER LAST BIRTHDAY? Record age in completed years. Record '0' if less than 1 year. Compare and correct AG1 and/or AG2 if inconsistent. AGE Child has birth certificate Child has birth certificate Child has birth certificate Child has birth certificate Child has birth certificate BR1. DOES (name) HAVE A BIRTH CERTIFICATE? If yes, ask: MAY I SEE IT? This question aims to provide an estimate of the extent of birth registration in your country. Respondents must be assured that the information about individual families will never be given to authorities, and that they cannot be identified in any way. Ask to see the birth certificate and check if it is issued by National Population Commission, then circle the appropriate corresponding code, noting whether or not the certificate was seen. If the child has a birth certificate issued by National Population Commission and it was seen, circle '1' and skip to BR5. If the child does not have a birth certificate or the birth certificate seen is not issued by National Population Commission then, circle '3'. If the child has a birth certificate but the mother/primary caretaker is unable to show you the certificate ('2'), continue to the next question. If don't know circle 8. BIRTH REGISTRATION 1 Yes, seen 2 Yes, not seen 3 No 8 Dk 9 Missing Child registered Child registered Child registered Child registered Child registered HAS (name)’S BIRTH BEEN REGISTERED WITH THE CIVIL AUTHORITIES? Circle the code corresponding to the response. If the answer is 'Yes', skip to BR5. If the child's birth has not been registered with civil authorities, circle 2 then continue to the next question. If the answer is 'DK', skip to BR4. BIRTH REGISTRATION 1 Yes 2 No 8 Dk 9 Missing Know how to register your child’s birth Know how to register your child’s birth Know how to register your child’s birth Know how to register your child’s birth Know how to register your child’s birth DO YOU KNOW HOW TO REGISTER YOUR CHILD’S BIRTH? This question aims to elicit the reason for non-registration. Circle the code corresponding to the response. Note that although there might be more than one reason for not registering a child, we need to get only one response - the most important one according to the mother/primary caretaker. If the response is definitely not one of the pre-coded responses, circle '7' for 'Other' and specify the response in the space provided. If don't know circle 8. BIRTH REGISTRATION 1 Yes 2 No 8 Dk 9 Missing Which authority was (name)’s birth registered Which authority was (name)’s birth registered Which authority was (name)’s birth registered Which authority was (name)’s birth registered Which authority was (name)’s birth registered WITH WHICH AUTHORITY WAS (NAME)’S BIRTH REGISTERED? BIRTH REGISTRATION 1 Npopc 2 Lga 3 Hospital/private clinic 4 Church/mosque 6 Others (specify) 9 Missing Why was (name)’s birth not registered Why was (name)’s birth not registered Why was (name)’s birth not registered Why was (name)’s birth not registered Why was (name)’s birth not registered WHY WAS (NAME)’S BIRTH NOT REGISTERED? The purpose of this question is to assess how important lack of knowledge (of the process of registering or, if applicable, the place to go to register) may be among the reasons for non-registration. This information can inform advocacy efforts and help in the formulation of education campaigns. Circle the code corresponding to the response BIRTH REGISTRATION 1 Costs too much 2 Must travel too far 3 Did not know it should be registered 4 Did not consider it important 5 Does not know where to register 6 Other (specify 8 Dk 9 Missing Number of children's books or picture books for child Number of children's books or picture books for child Number of children's books or picture books for child Number of children's books or picture books for child Number of children's books or picture books for child HOW MANY CHILDREN’S BOOKS OR PICTURE BOOKS DO YOU HAVE FOR (name)? None .is code 00 Number of children’s books…0 __ Ten or more books is code 10 EARLY CHILDHOOD DEVELOPMENT Homemade toys Homemade toys Homemade toys Homemade toys Homemade toys I AM INTERESTED IN LEARNING ABOUT THE THINGS THAT (name) PLAYS WITH WHEN HE/SHE IS AT HOME. DOES HE/SHE PLAY WITH: [A] HOMEMADE TOYS (SUCH AS DOLLS, CARS, OR OTHER TOYS MADE AT HOME)? If the respondent says "YES" to the categories above, then probe to learn specifically what the child plays with to ascertain the response Y N DK EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Toys from shops Toys from shops Toys from shops Toys from shops Toys from shops I AM INTERESTED IN LEARNING ABOUT THE THINGS THAT (name) PLAYS WITH WHEN HE/SHE IS AT HOME. DOES HE/SHE PLAY WITH: [B] TOYS FROM A SHOP OR MANUFACTURED TOYS? If the respondent says "YES" to the categories above, then probe to learn specifically what the child plays with to ascertain the response Y N DK EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Household objects or outside objects Household objects or outside objects Household objects or outside objects Household objects or outside objects Household objects or outside objects I AM INTERESTED IN LEARNING ABOUT THE THINGS THAT (name) PLAYS WITH WHEN HE/SHE IS AT HOME. DOES HE/SHE PLAY WITH: [C] HOUSEHOLD OBJECTS (SUCH AS BOWLS OR POTS) OR OBJECTS FOUND OUTSIDE (SUCH AS STICKS, ROCKS, ANIMAL SHELLS OR LEAVES)? If the respondent says "YES" to the categories above, then probe to learn specifically what the child plays with to ascertain the response Y N DK EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing In past week, days left alone for more than 1 hour In past week, days left alone for more than 1 hour In past week, days left alone for more than 1 hour In past week, days left alone for more than 1 hour In past week, days left alone for more than 1 hour 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. ON HOW MANY DAYS IN THE PAST WEEK WAS name: [A] LEFT ALONE FOR MORE THAN AN HOUR? If 'none' enter' 0'. If 'don't know' enter'8' If Child age 3 or 4 Continue with EC5 If Child age 0, 1 or 2 Go to Next Module EARLY CHILDHOOD DEVELOPMENT In past week, days left with other child for more than 1 hou In past week, days left with other child for more than 1 hou In past week, days left with other child for more than 1 hou In past week, days left with other child for more than 1 hou In past week, days left with other child for more than 1 hou 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. ON HOW MANY DAYS IN THE PAST WEEK WAS name: [B] LEFT IN THE CARE OF ANOTHER CHILD (THAT IS, SOMEONE LESS THAN 10 YEARS OLD) FOR MORE THAN AN HOUR? If 'none' enter' 0'. If 'don't know' enter'8' Check AG2: Age of child If Child age 3 or 4 Continue with EC5 If Child age 0, 1 or 2 Go to Next Module EARLY CHILDHOOD DEVELOPMENT Attends early childhood education programme Attends early childhood education programme Attends early childhood education programme Attends early childhood education programme Attends early childhood education programme DOES (name) ATTEND ANY ORGANIZED LEARNING OR EARLY CHILDHOOD EDUCATION PROGRAMME, SUCH AS A PRIVATE OR GOVERNMENT FACILITY, INCLUDING KINDERGARTEN OR COMMUNITY CHILD CARE? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Who organised the learning center Who organised the learning center Who organised the learning center Who organised the learning center Who organised the learning center WHO ORGANISED THE LEARNING CENTRE? EARLY CHILDHOOD DEVELOPMENT 1 Public 2 Private 8 Dk 9 Missing Within last 7 days, hours attended education Within last 7 days, hours attended education Within last 7 days, hours attended education Within last 7 days, hours attended education Within last 7 days, hours attended education WITHIN THE LAST SEVEN DAYS, ABOUT HOW MANY HOURS DID (name) ATTEND EARLY CHILDHOOD DEVELOPMENT Books-mother Books-mother Books-mother Books-mother Books-mother 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 (name)? READ BOOKS TO OR LOOKED AT PICTURE BOOKS WITH (name)? Mother Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing A Mother Books-father Books-father Books-father Books-father Books-father 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 (name)? READ BOOKS TO OR LOOKED AT PICTURE BOOKS WITH (name)? -Father Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing B Father Books-other Books-other Books-other Books-other Books-other 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 (name)? READ BOOKS TO OR LOOKED AT PICTURE BOOKS WITH (name)? -Other Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing X Other Books-no one Books-no one Books-no one Books-no one Books-no one 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 (name)? READ BOOKS TO OR LOOKED AT PICTURE BOOKS WITH (name)? No one Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing Y No one Tell stories-mother Tell stories-mother Tell stories-mother Tell stories-mother Tell stories-mother 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 (name)? TOLD STORIES TO (name)? -Mother Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing A Mother Tell stories-father Tell stories-father Tell stories-father Tell stories-father Tell stories-father 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 (name)? TOLD STORIES TO (name)? Father Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing B Father Tell stories-other Tell stories-other Tell stories-other Tell stories-other Tell stories-other 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 (name)? TOLD STORIES TO (name)? Other Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing X Other Tell stories-no one Tell stories-no one Tell stories-no one Tell stories-no one Tell stories-no one 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 (name)? TOLD STORIES TO (name)? No one Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing Y No one Sang songs-mother Sang songs-mother Sang songs-mother Sang songs-mother Sang songs-mother 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 (name)? SANG SONGS TO (name) OR WITH (name), INCLUDING LULLABIES? Mother Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing A Mother Sang songs-father Sang songs-father Sang songs-father Sang songs-father Sang songs-father 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 (name)? SANG SONGS TO (name) OR WITH (name), INCLUDING LULLABIES? Father Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing B Father Sang songs-other Sang songs-other Sang songs-other Sang songs-other Sang songs-other 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 (name)? SANG SONGS TO (name) OR WITH (name), INCLUDING LULLABIES? Other Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing X Other Sang songs-no one Sang songs-no one Sang songs-no one Sang songs-no one Sang songs-no one 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 (name)? SANG SONGS TO (name) OR WITH (name), INCLUDING LULLABIES? No one Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing Y No one Took outside-mother Took outside-mother Took outside-mother Took outside-mother Took outside-mother 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 (name)? TOOK (name) OUTSIDE THE HOME, COMPOUND, YARD OR ENCLOSURE? Mother Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing A Mother Took outside-father Took outside-father Took outside-father Took outside-father Took outside-father 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 (name)? TOOK (name) OUTSIDE THE HOME, COMPOUND, YARD OR ENCLOSURE? Father Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing B Father Took outside-other Took outside-other Took outside-other Took outside-other Took outside-other 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 (name)? TOOK (name) OUTSIDE THE HOME, COMPOUND, YARD OR ENCLOSURE? Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing X Other Took outside-no one Took outside-no one Took outside-no one Took outside-no one Took outside-no one 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 (name)? TOOK (name) OUTSIDE THE HOME, COMPOUND, YARD OR ENCLOSURE? No one Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing Y No one Played with-mother Played with-mother Played with-mother Played with-mother Played with-mother 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 (name)? PLAYED WITH (name)? Mother Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing A Mother Played with-father Played with-father Played with-father Played with-father Played with-father 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 (name)? PLAYED WITH (name)? Father Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing B Father Played with-other Played with-other Played with-other Played with-other Played with-other 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 (name)? PLAYED WITH (name)? Other Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing X Other Played with-no one Played with-no one Played with-no one Played with-no one Played with-no one 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 (name)? PLAYED WITH (name)? No one Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing Y No one Named/counted-mother Named/counted-mother Named/counted-mother Named/counted-mother Named/counted-mother 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 (name)? NAMED, COUNTED, OR DREW OBJECTS TO OR WITH (name)? Mother Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing A Mother Named/counted-father Named/counted-father Named/counted-father Named/counted-father Named/counted-father 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 (name)? NAMED, COUNTED, OR DREW OBJECTS TO OR WITH (name)? -Father Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing B Father Named/counted-other Named/counted-other Named/counted-other Named/counted-other Named/counted-other 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 (name)? NAMED, COUNTED, OR DREW OBJECTS TO OR WITH (name)? Other Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing X Other Named/counted-no one Named/counted-no one Named/counted-no one Named/counted-no one Named/counted-no one 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 (name)? NAMED, COUNTED, OR DREW OBJECTS TO OR WITH (name)? No one Circle all that apply. EARLY CHILDHOOD DEVELOPMENT ? Missing Y No one Child identifies at least ten letters of the alphabet Child identifies at least ten letters of the alphabet Child identifies at least ten letters of the alphabet Child identifies at least ten letters of the alphabet Child identifies at least ten letters of the alphabet I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH AND DEVELOPMENT OF YOUR CHILD. CHILDREN DO NOT ALL DEVELOP AND LEARN AT THE SAME RATE. FOR EXAMPLE, SOME WALK EARLIER THAN OTHERS. THESE QUESTIONS ARE RELATED TO SEVERAL ASPECTS OF YOUR CHILD'S DEVELOPMENT. Can (NAME) identify or name at least ten letters of the alphabet? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child reads at least four simple, popular words Child reads at least four simple, popular words Child reads at least four simple, popular words Child reads at least four simple, popular words Child reads at least four simple, popular words CAN (name) READ AT LEAST FOUR SIMPLE, POPULAR WORDS? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child knows name and recognizes symbol of all numbers from 1 to 10 Child knows name and recognizes symbol of all numbers from 1 to 10 Child knows name and recognizes symbol of all numbers from 1 to 10 Child knows name and recognizes symbol of all numbers from 1 to 10 Child knows name and recognizes symbol of all numbers from 1 to 10 EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child able to pick up small object with 2 fingers Child able to pick up small object with 2 fingers Child able to pick up small object with 2 fingers Child able to pick up small object with 2 fingers Child able to pick up small object with 2 fingers CAN (name) PICK UP A SMALL OBJECT WITH TWO FINGERS, LIKE A STICK OR A ROCK FROM THE GROUND? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child sometimes too sick to play Child sometimes too sick to play Child sometimes too sick to play Child sometimes too sick to play Child sometimes too sick to play IS (name) SOMETIMES TOO SICK TO PLAY? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child follows simple directions Child follows simple directions Child follows simple directions Child follows simple directions Child follows simple directions DOES (name) FOLLOW SIMPLE DIRECTIONS ON HOW TO DO SOMETHING CORRECTLY? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child able to do something independently Child able to do something independently Child able to do something independently Child able to do something independently Child able to do something independently WHEN GIVEN SOMETHING TO DO, IS (name) ABLE TO DO IT INDEPENDENTLY? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child gets along well with other children Child gets along well with other children Child gets along well with other children Child gets along well with other children Child gets along well with other children DOES (name) GET ALONG WELL WITH OTHER CHILDREN? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child kicks, bites or hits other children or adults Child kicks, bites or hits other children or adults Child kicks, bites or hits other children or adults Child kicks, bites or hits other children or adults Child kicks, bites or hits other children or adults DOES (name) KICK, BITE, OR HIT OTHER CHILDREN OR ADULTS? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child gets distracted easily Child gets distracted easily Child gets distracted easily Child gets distracted easily Child gets distracted easily DOES (name) GET DISTRACTED EASILY? EARLY CHILDHOOD DEVELOPMENT 1 Yes 2 No 8 Dk 9 Missing Child ever been breastfed Child ever been breastfed Child ever been breastfed Child ever been breastfed Child ever been breastfed HAS (name) EVER BEEN BREASTFED? This question asks if the child has ever been breastfed. It includes any breastfeeding experience of the child - not necessarily by the mother/primary caretaker. Circle the code corresponding to the response. Continue to the next question if the child was ever breastfed ('1'). If the child was never breastfed, circle 'No' and skip to BF3. Skip to BF3 in the case of a 'DK' response as well. BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child still being breastfed Child still being breastfed Child still being breastfed Child still being breastfed Child still being breastfed IS HE/SHE STILL BEING BREASTFED? 'Being breastfed' is defined as putting the child to the breast at least once a day. Circle the code corresponding to the response. BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child drank plain water yesterday Child drank plain water yesterday Child drank plain water yesterday Child drank plain water yesterday Child drank plain water yesterday I WOULD LIKE TO ASK YOU ABOUT LIQUIDS THAT (name) MAY HAVE HAD YESTERDAY DURING THE DAY OR THE NIGHT. I AM INTERESTED IN WHETHER (name) HAD THE ITEM EVEN IF IT WAS COMBINED WITH OTHER FOODS. DID (name) DRINK PLAIN WATER YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child drank infant formula yesterday Child drank infant formula yesterday Child drank infant formula yesterday Child drank infant formula yesterday Child drank infant formula yesterday DID (name) DRINK INFANT FORMULA YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Months of exclusive breastmilk Months of exclusive breastmilk Months of exclusive breastmilk Months of exclusive breastmilk Months of exclusive breastmilk BF4. Check BF3H: Child received solid or semi-solid (mushy) food? Yes. then Continue with BF6 No or DK. then Go to Next Module HOW MANY TIMES DID (name) DRINK INFANT FORMULA? If 7 or more times, record '7' In this question, we want to find out how many times the child was given non-liquid foods in the 24 hours prior to the interview. Record the number of times in the space provided. If the number is seven or more, record '7'. If the respondent does not know, circle '8'. BREASTFEEDING Child drank milk yesterday Child drank milk yesterday Child drank milk yesterday Child drank milk yesterday Child drank milk yesterday DID (name) DRINK MILK, SUCH AS TINNED, POWDERED OR FRESH ANIMAL MILK YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Times child drank milk Times child drank milk Times child drank milk Times child drank milk Times child drank milk HOW MANY TIMES DID (name) DRINK TINNED, POWDERED OR FRESH ANIMAL MILK? BREASTFEEDING Child drank juice or juice drinks yesterday Child drank juice or juice drinks yesterday Child drank juice or juice drinks yesterday Child drank juice or juice drinks yesterday Child drank juice or juice drinks yesterday DID (name) DRINK JUICE OR JUICE DRINKS YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child drank soup yesterday Child drank soup yesterday Child drank soup yesterday Child drank soup yesterday Child drank soup yesterday DID (name) DRINK (vegetable/draw soup) YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child drank or ate vitamin or mineral supplements yesterday Child drank or ate vitamin or mineral supplements yesterday Child drank or ate vitamin or mineral supplements yesterday Child drank or ate vitamin or mineral supplements yesterday Child drank or ate vitamin or mineral supplements yesterday DID (name) DRINK OR EAT VITAMIN OR MINERAL SUPPLEMENTS OR ANY MEDICINES YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child drank ors yesterday Child drank ors yesterday Child drank ors yesterday Child drank ors yesterday Child drank ors yesterday DID (name) DRINK ORS (ORAL REHYDRATION SOLUTION) YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Reasons for giving ors Reasons for giving ors Reasons for giving ors Reasons for giving ors Reasons for giving ors WHY DID YOU GIVE ORS TO (name)? BREASTFEEDING 1 Diarrhoea 2 Vomiting 3 Diarrhoea and vomitting 6 Others 8 Dk 9 Missing Child drank any other liquid yesterday Child drank any other liquid yesterday Child drank any other liquid yesterday Child drank any other liquid yesterday Child drank any other liquid yesterday DID (name) DRINK ANY OTHER LIQUIDS YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child drank or ate yogurt yesterday Child drank or ate yogurt yesterday Child drank or ate yogurt yesterday Child drank or ate yogurt yesterday Child drank or ate yogurt yesterday DID (name) DRINK OR EAT YOGURT YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Times drank or ate yogurt Times drank or ate yogurt Times drank or ate yogurt Times drank or ate yogurt Times drank or ate yogurt HOW MANY TIMES DID (name) DRINK OR EAT YOGURT YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING Child ate thin porridge yesterday Child ate thin porridge yesterday Child ate thin porridge yesterday Child ate thin porridge yesterday Child ate thin porridge yesterday DID (name) EAT THIN PORRIDGE OR SEMISOLID (SOFT) FOOD YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child ate solid or semi-solid food yesterday Child ate solid or semi-solid food yesterday Child ate solid or semi-solid food yesterday Child ate solid or semi-solid food yesterday Child ate solid or semi-solid food yesterday DID (name) EAT SOLID FOOD YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Times child ate solid or semi-solid food Times child ate solid or semi-solid food Times child ate solid or semi-solid food Times child ate solid or semi-solid food Times child ate solid or semi-solid food HOW MANY TIMES DID (name) EAT SOLID OR SEMI-SOLID (SOFT) FOOD YESTERDAY, DURING THE DAY OR NIGHT? BREASTFEEDING Child drank anything else from the bottle with a nipple yest Child drank anything else from the bottle with a nipple yest Child drank anything else from the bottle with a nipple yest Child drank anything else from the bottle with a nipple yest Child drank anything else from the bottle with a nipple yest YESTERDAY, DURING THE DAY OR NIGHT, DID (name) DRINK ANYTHING FROM A BOTTLE WITH A NIPPLE? BREASTFEEDING 1 Yes 2 No 8 Dk 9 Missing Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks Child had diarrhoea in last 2 weeks IN THE LAST TWO WEEKS, HAS (name) HAD DIARRHOEA? Diarrhoea is determined as perceived by mother or caretaker, or as three or more loose or watery stools per day, or blood in stool. Diarrhoea is determined by the perception of the mother or caretaker, or by three or more loose or watery stools per day, or by blood in stool. When asking this question, insert the name of the day of the interview. For example, if the interview is taking place on a Tuesday, ask: "HAS (name) HAD DIARRHOEA IN THE LAST TWO WEEKS, THAT IS, SINCE TUESDAY OF THE WEEK BEFORE LAST?" Record the mother's/primary caretaker's answer by circling the corresponding code. If a respondent is not sure what is meant by diarrhoea, tell her/him it means "THREE OR MORE LOOSE OR WATERY STOOLS PER DAY, OR BLOOD IN THE STOOL." Make sure the respondent understands what is meant by 'in the last 2 weeks'. If the child has not had diarrhoea in the last 2 weeks or the caretaker doesn't know, skip to CA5. CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness CA2. I WOULD LIKE TO KNOW HOW MUCH (name) WAS GIVEN TO DRINK DURING THE DIARRHOEA (INCLUDING BREASTMILK). DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO DRINK, ABOUT THE SAME AMOUNT, OR MORE THAN USUAL? If less, probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO DRINK, OR SOMEWHAT LESS? CARE OF ILLNESS 1 Much less 2 Somewhat less 3 About the same 4 More 5 Nothing to drink 8 Dk 9 Missing Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness Child drank less or more during illness DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If "less", probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO EAT OR SOMEWHAT LESS? For those children who had diarrhoea in the past 2 weeks, 'illness' in this and the next question refers to the diarrhoea episode. Disregard any additional illness these children might have had. If dehydrated, a child may take more fluids than usual. We want to know if the pattern of fluid consumption changed during the illness. The focus in this question is on how much fluid was actually consumed by the child. Ask the question just as it is worded here. Read out the entire question and circle the appropriate code for the caretaker's response. Get the respondent's best judgement of the relative amount of total fluids actually consumed by the child. All fluids are included, not just special ones given during diarrhoea. For example, water, tea, fruit juice, breastmilk and formula are included as well as special fluids such as ORS. Try to find out what actually happened, not what the respondent thinks ought to have happened. An answer such as, "A child with diarrhoea (or 'a child who is ill') needs more fluids" is not satisfactory. You would need to ask, "BUT HOW MUCH DID YOUR CHILD ACTUALLY DRINK DURING THIS DIARRHOEA?" It may be difficult to estimate the relative amount of breastmilk taken by the child. The respondent may make an estimate based on whether the child nursed longer or more frequentl CARE OF ILLNESS 1 Much less 2 Somewhat less 3 About the same 4 More 5 Never gave food 8 Dk 9 Missing Drank fluid made from special packet (ors) Drank fluid made from special packet (ors) Drank fluid made from special packet (ors) Drank fluid made from special packet (ors) Drank fluid made from special packet (ors) DURING THE EPISODE OF DIARRHOEA, WAS (name) GIVEN TO DRINK ANY OF THE FOLLOWING: [A] A FLUID MADE FROM A SPECIAL PACKET CALLED ORS packet? Read each item aloud and record response before proceeding to the next item. CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing A pre-packaged ors fluid for diarrhoea A pre-packaged ors fluid for diarrhoea A pre-packaged ors fluid for diarrhoea A pre-packaged ors fluid for diarrhoea A pre-packaged ors fluid for diarrhoea CA4A. Check CA2A: ORS packet used? Yes. then Continue with CA4B No. then Go to CA5 DURING THE EPISODE OF DIARRHOEA, WAS (name) GIVEN TO DRINK ANY OF THE FOLLOWING: [B] A PRE-PACKAGED ORS FLUID FOR DIARRHOEA? Read each item aloud and record response before proceeding to the next item. CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Salt sugar solution Salt sugar solution Salt sugar solution Salt sugar solution Salt sugar solution DURING THE EPISODE OF DIARRHOEA, WAS (name) GIVEN TO DRINK ANY OF THE FOLLOWING: [C] Read each item aloud and record response before proceeding to the next item. CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Coconut/rice water Coconut/rice water Coconut/rice water Coconut/rice water Coconut/rice water DURING THE EPISODE OF DIARRHOEA, WAS (name) GIVEN TO DRINK ANY OF THE FOLLOWING: [D] COCONUT/RICE WATER Read each item aloud and record response before proceeding to the next item. CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks Child ill with cough in last 2 weeks CA4A. Check CA2A: ORS packet used? Yes.è Continue with CA4B No.è Go to CA5 WAS ANYTHING (ELSE) GIVEN TO TREAT THE DIARRHOEA? Illness with a cough means a cold or other acute respiratory illness with a cough. Circle the code corresponding to the response given. If the respondent says "He coughs all the time," or "She's been coughing for months," do not count this as an 'illness with a cough' since it is a chronic problem. If the answer is 'No' or 'DK', circle the appropriate code and go to CA12. If the symptoms started before but continued into the 2-week period, this counts as 'Yes'. CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Other treatment (pill or syrup): antibiotic Other treatment (pill or syrup): antibiotic Other treatment (pill or syrup): antibiotic Other treatment (pill or syrup): antibiotic Other treatment (pill or syrup): antibiotic WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Antibiotic. Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing A Antibiotic pill or syrup Other treatment (pill or syrup): antimotility Other treatment (pill or syrup): antimotility Other treatment (pill or syrup): antimotility Other treatment (pill or syrup): antimotility Other treatment (pill or syrup): antimotility WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Antimotility (Imodium, lomotil, diastop) Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing B Antimotility pill or syrup Other treatment (pill or syrup): zinc Other treatment (pill or syrup): zinc Other treatment (pill or syrup): zinc Other treatment (pill or syrup): zinc Other treatment (pill or syrup): zinc WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Zinc (Mix mag) Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing C Zinc pill or syrup Other treatment (pill or syrup): other (not antibiotic, anti Other treatment (pill or syrup): other (not antibiotic, anti Other treatment (pill or syrup): other (not antibiotic, anti Other treatment (pill or syrup): other (not antibiotic, anti Other treatment (pill or syrup): other (not antibiotic, anti WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Other (Not antibiotic, antimotility or zinc) Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing G Other pill or syrup Other treatment (pill or syrup): unknown Other treatment (pill or syrup): unknown Other treatment (pill or syrup): unknown Other treatment (pill or syrup): unknown Other treatment (pill or syrup): unknown WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Unknown tablet/capsule or syrup Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing H Unknown pill or syrup Other treatment (injection): antibiotic Other treatment (injection): antibiotic Other treatment (injection): antibiotic Other treatment (injection): antibiotic Other treatment (injection): antibiotic WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Antibiotic Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing L Antibiotic injection Other treatment (injection): non-antibiotic Other treatment (injection): non-antibiotic Other treatment (injection): non-antibiotic Other treatment (injection): non-antibiotic Other treatment (injection): non-antibiotic WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Non-antibiotic . Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing M Non antibiotic injection Other treatment (injection): unknown Other treatment (injection): unknown Other treatment (injection): unknown Other treatment (injection): unknown Other treatment (injection): unknown WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Unknown injection Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing N Unknown injection Other treatment: intravenous Other treatment: intravenous Other treatment: intravenous Other treatment: intravenous Other treatment: intravenous WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Intravenous. Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing O Intravenous Other treatment: home remedy/herbal medicine Other treatment: home remedy/herbal medicine Other treatment: home remedy/herbal medicine Other treatment: home remedy/herbal medicine Other treatment: home remedy/herbal medicine WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Home remedy / Herbal medicine Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing Q Home remedy/herbal medicine Other treatment: other Other treatment: other Other treatment: other Other treatment: other Other treatment: other WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Other (specify) Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mention CARE OF ILLNESS ? Missing X Other Had an illness with a cough Had an illness with a cough Had an illness with a cough Had an illness with a cough Had an illness with a cough AT ANY TIME IN THE LAST TWO WEEKS, HAS (name) HAD AN ILLNESS WITH A COUGH? This question aims to find out if the problem needs assessment by a health professional, which does not include a simple cold. CARE OF ILLNESS 1 Problem in chest 2 Blocked nose 3 Both 6 Other 8 Dk 9 Missing Did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing Did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing Did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing Did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing Did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing WHEN (name) HAD AN ILLNESS WITH A COUGH, DID HE/SHE BREATHE FASTER THAN USUAL WITH SHORT, RAPID BREATHS OR HAVE DIFFICULTY BREATHING? 'Seeking care outside the home' means going outside the family or household for advice or treatment. Seeking care could include anything from asking a neighbour for advice, to holding a religious ceremony on the child's behalf, to going to a hospital. If a physician or other provider visits the household to give care, this counts as seeking care outside the home. The child may or may not have accompanied the respondent when he/she sought care. For example, going to buy medicine without the child counts as seeking care CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose Symptoms due to problem in chest or blocked nose WAS THE FAST OR DIFFICULT BREATHING DUE TO A PROBLEM IN THE CHEST OR A BLOCKED OR RUNNY NOSE? CARE OF ILLNESS 1 Problem in chest 2 Blocked or runny nose 3 Both 6 Other 8 Dk 9 Missing Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source DID YOU SEEK ANY ADVICE OR TREATMENT FOR THE ILLNESS FROM ANY SOURCE? Circle the appropriate code. If the answer is 'Yes', continue to the next question. Otherwise, go to CA12. CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Seek advice or treatment- govt. Hospital Seek advice or treatment- govt. Hospital Seek advice or treatment- govt. Hospital Seek advice or treatment- govt. Hospital Seek advice or treatment- govt. Hospital FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Govt. hospital Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing A Govt. Hospital Seek advice or treatment- govt. Health centre Seek advice or treatment- govt. Health centre Seek advice or treatment- govt. Health centre Seek advice or treatment- govt. Health centre Seek advice or treatment- govt. Health centre CA11A. CHECK CA11: ANTIBIOTIC WAS GIVEN? (CODE 'A' CIRCLED) YES.è CONTINUE WITH CA11B NO.è GO TO CA12 FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Govt. health centre Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing B Government health center Seek advice or treatment - govt. Health post Seek advice or treatment - govt. Health post Seek advice or treatment - govt. Health post Seek advice or treatment - govt. Health post Seek advice or treatment - govt. Health post FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Govt. health post Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing C Government health post Seek advice or treatment - village health worker Seek advice or treatment - village health worker Seek advice or treatment - village health worker Seek advice or treatment - village health worker Seek advice or treatment - village health worker FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Village health worker Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing D Village health worker Seek advice or treatment - mobile / outreach clinic Seek advice or treatment - mobile / outreach clinic Seek advice or treatment - mobile / outreach clinic Seek advice or treatment - mobile / outreach clinic Seek advice or treatment - mobile / outreach clinic FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Mobile / Outreach clinic Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing E Mobile / outreach clinic Seek advice or treatment - other public Seek advice or treatment - other public Seek advice or treatment - other public Seek advice or treatment - other public Seek advice or treatment - other public FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Other public (specify) Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing H Other public Seek advice or treatment - private hospital / clinic Seek advice or treatment - private hospital / clinic Seek advice or treatment - private hospital / clinic Seek advice or treatment - private hospital / clinic Seek advice or treatment - private hospital / clinic FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Private hospital / clinic Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing I Private hospital / clinic Seek advice or treatment - private physician Seek advice or treatment - private physician Seek advice or treatment - private physician Seek advice or treatment - private physician Seek advice or treatment - private physician FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Private physician Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing J Private physician Seek advice or treatment - private pharmacy Seek advice or treatment - private pharmacy Seek advice or treatment - private pharmacy Seek advice or treatment - private pharmacy Seek advice or treatment - private pharmacy FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Private pharmacy Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing K Private pharmacy Seek advice or treatment - mobile clinic Seek advice or treatment - mobile clinic Seek advice or treatment - mobile clinic Seek advice or treatment - mobile clinic Seek advice or treatment - mobile clinic FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Mobile clinic Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing L Mobile clinic Seek advice or treatment - other private medical Seek advice or treatment - other private medical Seek advice or treatment - other private medical Seek advice or treatment - other private medical Seek advice or treatment - other private medical FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Other private medical (specify) Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing O Other private medical Seek advice or treatment - relative / friend Seek advice or treatment - relative / friend Seek advice or treatment - relative / friend Seek advice or treatment - relative / friend Seek advice or treatment - relative / friend FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Relative / Friend Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing P Relative / friend Seek advice or treatment - shop Seek advice or treatment - shop Seek advice or treatment - shop Seek advice or treatment - shop Seek advice or treatment - shop FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Shop Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing Q Shop Seek advice or treatment - traditional practitioner Seek advice or treatment - traditional practitioner Seek advice or treatment - traditional practitioner Seek advice or treatment - traditional practitioner Seek advice or treatment - traditional practitioner FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Traditional practitioner Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing R Traditional practitioner Seek advice or treatment - other (specify) Seek advice or treatment - other (specify) Seek advice or treatment - other (specify) Seek advice or treatment - other (specify) Seek advice or treatment - other (specify) FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Other (specify) Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place. CARE OF ILLNESS ? Missing X Other (specify) Given medicine to treat this illness Given medicine to treat this illness Given medicine to treat this illness Given medicine to treat this illness Given medicine to treat this illness WAS (name) GIVEN ANY MEDICINE TO TREAT THIS ILLNESS? CARE OF ILLNESS 1 Yes 2 No 8 Dk 9 Missing Medicine: antibiotic pill / syrup Medicine: antibiotic pill / syrup Medicine: antibiotic pill / syrup Medicine: antibiotic pill / syrup Medicine: antibiotic pill / syrup WHAT MEDICINE WAS (name) GIVEN? Pill / Syrup Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. CARE OF ILLNESS ? Missing A Antibiotic pill / syrup Medicine: antibiotic injection Medicine: antibiotic injection Medicine: antibiotic injection Medicine: antibiotic injection Medicine: antibiotic injection WHAT MEDICINE WAS (name) GIVEN? Injection Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. CARE OF ILLNESS ? Missing B Antibiotic injection Medicine: anti-malarials Medicine: anti-malarials Medicine: anti-malarials Medicine: anti-malarials Medicine: anti-malarials WHAT MEDICINE WAS (name) GIVEN? Anti-malarials Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. CARE OF ILLNESS ? Missing M Anti-malarials Medicine: paracetamol / panadol / acetaminophen Medicine: paracetamol / panadol / acetaminophen Medicine: paracetamol / panadol / acetaminophen Medicine: paracetamol / panadol / acetaminophen Medicine: paracetamol / panadol / acetaminophen WHAT MEDICINE WAS (name) GIVEN? Paracetamol / Panadol / Acetaminophen Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. CARE OF ILLNESS ? Missing P Paracetamol / panadol / acetaminophen Medicine: aspirin Medicine: aspirin Medicine: aspirin Medicine: aspirin Medicine: aspirin WHAT MEDICINE WAS (name) GIVEN? Aspirin Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. CARE OF ILLNESS ? Missing Q Aspirin Medicine: ibupropfen Medicine: ibupropfen Medicine: ibupropfen Medicine: ibupropfen Medicine: ibupropfen WHAT MEDICINE WAS (name) GIVEN? Ibuprofen Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. CARE OF ILLNESS ? Missing R Ibuprofen Medicine: other (specify) Medicine: other (specify) Medicine: other (specify) Medicine: other (specify) Medicine: other (specify) WHAT MEDICINE WAS (name) GIVEN? Other (specify) Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. CARE OF ILLNESS ? Missing X Other (specify) Medicine: dk Medicine: dk Medicine: dk Medicine: dk Medicine: dk WHAT MEDICINE WAS (name) GIVEN? DK Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. Check AG2: Child aged under 3? If Yes Continue with CA15 If No Go to Next Module CARE OF ILLNESS ? Missing Z Dk What was done to dispose of the stools What was done to dispose of the stools What was done to dispose of the stools What was done to dispose of the stools What was done to dispose of the stools THE LAST TIME (name) PASSED STOOLS, WHAT WAS DONE TO DISPOSE OF THE STOOLS? CARE OF ILLNESS 1 Child used toilet / latrine 2 Put / rinsed into toilet or latrine 3 Put / rinsed into drain or ditch 4 Thrown into garbage (solid waste) 5 Buried 6 Left in the open 96 Other (specify) 98 Dk 99 Missing Child ill with fever in last 2 weeks Child ill with fever in last 2 weeks Child ill with fever in last 2 weeks Child ill with fever in last 2 weeks Child ill with fever in last 2 weeks IN THE LAST TWO WEEKS, HAS (name) BEEN ILL WITH A FEVER AT ANY TIME? Fever is a symptom of malaria, and in areas where malaria is prevalent, mothers are advised to take action to treat for malaria as soon as fever begins. When asking this question, insert the name of the day of the interview. For example, if the interview is taking place on a Tuesday, ask: "IN THE LAST TWO WEEKS, THAT IS, SINCE TUESDAY OF THE WEEK BEFORE LAST, HAS (name) BEEN ILL WITH A FEVER?" Circle the code corresponding to the answer given. Circle the code corresponding to 'Yes' only if the child has been ill with a fever at any time in the 2 weeks prior to the date of the interview. If the child has not been ill with a fever or the respondent doesn't know, skip to ML10. MALARIA 1 Yes 2 No 8 Dk 9 Missing During the illness, did (name) have blood sample for testing During the illness, did (name) have blood sample for testing During the illness, did (name) have blood sample for testing During the illness, did (name) have blood sample for testing During the illness, did (name) have blood sample for testing AT ANY TIME DURING THE ILLNESS, DID (name) HAVE BLOOD SAMPLE FOR TESTING? Circle the code corresponding to the answer given. If the child was not seen at a health facility during this illness or the mother/primary caretaker doesn't know, skip to ML6. MALARIA 1 Yes 2 No 8 Dk 9 Missing Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source Seek any advice or treatment for the illness from any source DID YOU SEEK ANY ADVICE OR TREATMENT FOR THE ILLNESS FROM ANY SOURCE? Circle the code corresponding to the answer given. If the child did not take any medicine for the fever or malaria that was provided or prescribed at the health facility, or if the mother/primary caretaker does not know, skip to ML5. MALARIA 1 Yes 2 No 8 Dk 9 Missing Child taken to a health facility during illness Child taken to a health facility during illness Child taken to a health facility during illness Child taken to a health facility during illness Child taken to a health facility during illness WAS (name) TAKEN TO A HEALTH FACILITY DURING THIS ILLNESS? MALARIA 1 Yes 2 No 8 Dk 9 Missing Given any medicine for fever or malaria at the health facility Given any medicine for fever or malaria at the health facility Given any medicine for fever or malaria at the health facility Given any medicine for fever or malaria at the health facility Given any medicine for fever or malaria at the health facility WAS (name) GIVEN ANY MEDICINE FOR FEVER OR MALARIA AT THE HEALTH FACILITY? This question is only asked if the child was seen at a health facility during the illness (ML2 = 1). Circle the code corresponding to the answer given. If the response is 'Yes', skip to ML7 to learn the type of medicine given. If the child did not take any medicine for the fever or malaria before being taken to the health facility, or the respondent doesn't know, skip to ML8. Note that all response categories to this question skip ML6, to go to either ML7 or ML8. MALARIA 1 Yes 2 No 8 Dk 9 Missing Medicine given: sp / fansidar Medicine given: sp / fansidar Medicine given: sp / fansidar Medicine given: sp / fansidar Medicine given: sp / fansidar WHAT MEDICINE WAS (name) GIVEN? SP / Fansidar Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing A Sp / fansidar Medicine given: chloroquine Medicine given: chloroquine Medicine given: chloroquine Medicine given: chloroquine Medicine given: chloroquine WHAT MEDICINE WAS (name) GIVEN? Chloroquine Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing B Chloroquine Medicine given: amodiaquine Medicine given: amodiaquine Medicine given: amodiaquine Medicine given: amodiaquine Medicine given: amodiaquine WHAT MEDICINE WAS (name) GIVEN? Amodiaquine Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing C Amodiaquine Medicine given: quinine Medicine given: quinine Medicine given: quinine Medicine given: quinine Medicine given: quinine WHAT MEDICINE WAS (name) GIVEN? Quinine Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing D Quinine Medicine given: artemisinin combination therapy (act) Medicine given: artemisinin combination therapy (act) Medicine given: artemisinin combination therapy (act) Medicine given: artemisinin combination therapy (act) Medicine given: artemisinin combination therapy (act) WHAT MEDICINE WAS (name) GIVEN? Artemisinin Combination Therapy (ACT) Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing E Artemisinin combination therapy (act) Medicine given: other anti-malarial Medicine given: other anti-malarial Medicine given: other anti-malarial Medicine given: other anti-malarial Medicine given: other anti-malarial WHAT MEDICINE WAS (name) GIVEN? Other anti-malarial (specify) Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing H Other anti-malarial Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup WHAT MEDICINE WAS (name) GIVEN? Antibiotic drugs: Tablet/Capsule/Syrup Injection .................................................. J Other medications: Paracetamol/ Panadol /Acetaminophen . P Aspirin ................................................... Q Ibuprofen ................................................ R Other (specify) ______________________ X DK .............................................................. Z Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing I Antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic injection Medicine given: antibiotic injection Medicine given: antibiotic injection Medicine given: antibiotic injection Medicine given: antibiotic injection WHAT MEDICINE WAS (name) GIVEN? Antibiotic drugs: Tablet/Capsule/Syrup Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing J Antibiotic injection Medicine given: paracetamol / panadol / acetaminophen Medicine given: paracetamol / panadol / acetaminophen Medicine given: paracetamol / panadol / acetaminophen Medicine given: paracetamol / panadol / acetaminophen Medicine given: paracetamol / panadol / acetaminophen WHAT MEDICINE WAS (name) GIVEN? Paracetamol/ Panadol /Acetaminophen . P Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing P Paracetamol / panadol / acetaminophen Medicine given: aspirin Medicine given: aspirin Medicine given: aspirin Medicine given: aspirin Medicine given: aspirin WHAT MEDICINE WAS (name) GIVEN? Aspirin Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing Q Aspirin Medicine given: ibuprofen Medicine given: ibuprofen Medicine given: ibuprofen Medicine given: ibuprofen Medicine given: ibuprofen WHAT MEDICINE WAS (name) GIVEN? Ibuprofen Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing R Ibuprofen Medicine given: other (specify) Medicine given: other (specify) Medicine given: other (specify) Medicine given: other (specify) Medicine given: other (specify) WHAT MEDICINE WAS (name) GIVEN? Other (specify) Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing X Other (specify) Medicine given: dk Medicine given: dk Medicine given: dk Medicine given: dk Medicine given: dk WHAT MEDICINE WAS (name) GIVEN? DK Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing Z Dk Child given medicine before visiting health facility Child given medicine before visiting health facility Child given medicine before visiting health facility Child given medicine before visiting health facility Child given medicine before visiting health facility WAS (name) GIVEN ANY MEDICINE FOR THE FEVER OR MALARIA BEFORE BEING TAKEN TO THE HEALTH FACILITY? MALARIA 1 Yes 2 No 8 Dk 9 Missing Child given medicine for malaria or fever during illness Child given medicine for malaria or fever during illness Child given medicine for malaria or fever during illness Child given medicine for malaria or fever during illness Child given medicine for malaria or fever during illness WAS (name) GIVEN ANY MEDICINE FOR FEVER OR MALARIA DURING THIS ILLNESS? MALARIA 1 Yes 2 No 8 Dk 9 Missing Medicine given:anti-malarials: sp / fansidar Medicine given:anti-malarials: sp / fansidar Medicine given:anti-malarials: sp / fansidar Medicine given:anti-malarials: sp / fansidar Medicine given:anti-malarials: sp / fansidar WHAT MEDICINE WAS (name) GIVEN? Anti-malarials: SP / Fansidar Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing A Anti-malarials: sp / fansidar Medicine given: anti-malarials: chloroquine Medicine given: anti-malarials: chloroquine Medicine given: anti-malarials: chloroquine Medicine given: anti-malarials: chloroquine Medicine given: anti-malarials: chloroquine WHAT MEDICINE WAS (name) GIVEN? Anti-malarials: Chloroquine Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing B Anti-malarials: chloroquine Medicine given: anti-malarials: amodiaquine Medicine given: anti-malarials: amodiaquine Medicine given: anti-malarials: amodiaquine Medicine given: anti-malarials: amodiaquine Medicine given: anti-malarials: amodiaquine WHAT MEDICINE WAS (name) GIVEN? Anti-malarials: Amodiaquine Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing C Anti-malarials: amodiaquine Medicine given: anti-malarials: quinine Medicine given: anti-malarials: quinine Medicine given: anti-malarials: quinine Medicine given: anti-malarials: quinine Medicine given: anti-malarials: quinine WHAT MEDICINE WAS (name) GIVEN? Anti-malarials: Quinine Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing D Quinine Medicine given: anti-malarials: artemisinin combination therapy (act) Medicine given: anti-malarials: artemisinin combination therapy (act) Medicine given: anti-malarials: artemisinin combination therapy (act) Medicine given: anti-malarials: artemisinin combination therapy (act) Medicine given: anti-malarials: artemisinin combination therapy (act) WHAT MEDICINE WAS (name) GIVEN? Anti-malarials: Artemisinin Combination Therapy (ACT) Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing E Anti-malarials: artemisinin combination therapy (act) Medicine given: other anti-malarial (specify) Medicine given: other anti-malarial (specify) Medicine given: other anti-malarial (specify) Medicine given: other anti-malarial (specify) Medicine given: other anti-malarial (specify) WHAT MEDICINE WAS (name) GIVEN? Other anti-malarial (specify) Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing H Other anti-malarial (specify) Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup Medicine given: antibiotic drugs: tablet/capsule/syrup WHAT MEDICINE WAS (name) GIVEN? Antibiotic drugs: Tablet/Capsule/Syrup Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing I Antibiotic pill / syrup Medicine given:antibiotic drugs injection Medicine given:antibiotic drugs injection Medicine given:antibiotic drugs injection Medicine given:antibiotic drugs injection Medicine given:antibiotic drugs injection WHAT MEDICINE WAS (name) GIVEN? Antibiotic drugs Injection Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing J Antibiotic drugs: tablet/capsule/syrup n Medicine given: other medications: paracetamol / panadol / acetaminophen Medicine given: other medications: paracetamol / panadol / acetaminophen Medicine given: other medications: paracetamol / panadol / acetaminophen Medicine given: other medications: paracetamol / panadol / acetaminophen Medicine given: other medications: paracetamol / panadol / acetaminophen WHAT MEDICINE WAS (name) GIVEN? Paracetamol/ Panadol/ Acetaminophen Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing P Other medications: paracetamol / panadol / acetaminophen Medicine given: other medications: aspirin Medicine given: other medications: aspirin Medicine given: other medications: aspirin Medicine given: other medications: aspirin Medicine given: other medications: aspirin WHAT MEDICINE WAS (name) GIVEN? Aspirin Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing Q Other medications: aspirin Medicine given: other medications: ibuprofen Medicine given: other medications: ibuprofen Medicine given: other medications: ibuprofen Medicine given: other medications: ibuprofen Medicine given: other medications: ibuprofen WHAT MEDICINE WAS (name) GIVEN? Other medications: Ibuprofen Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing R Other medications: ibuprofen Medicine given: other (specify) Medicine given: other (specify) Medicine given: other (specify) Medicine given: other (specify) Medicine given: other (specify) WHAT MEDICINE WAS (name) GIVEN? Other (specify) Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing X Other (specify) Medicine given: dk Medicine given: dk Medicine given: dk Medicine given: dk Medicine given: dk WHAT MEDICINE WAS (name) GIVEN? DK Probe: ANY OTHER MEDICINE? Circle all medicines mentioned. Write brand name(s) of all medicines, if given. MALARIA ? Missing Z Dk How long after the fever started did How long after the fever started did How long after the fever started did How long after the fever started did How long after the fever started did HOW LONG AFTER THE FEVER STARTED DID (name) FIRST TAKE (name of anti-malarial from ML6 or ML9)? If multiple anti-malarials mentioned in ML6 or ML9, name all anti-malarial medicines mentioned. MALARIA Same day 1 Next day 2 2 days after the fever 3 3 days after the fever 4 4 or more days after the fever 8 Dk 9 Missing Vaccination card for child Vaccination card for child Vaccination card for child Vaccination card for child Vaccination card for child DO YOU HAVE A CARD WHERE (name)’S VACCINATIONS ARE WRITTEN DOWN? (If yes) MAY I SEE IT PLEASE? If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the card. IM6-IM17 are for registering vaccinations that are not recorded on the card. IM6-IM17 will only be asked when a card is not available. IMMUNIZATION 1 Yes, seen 2 Yes, not seen 3 No card Ever had vaccination card Ever had vaccination card Ever had vaccination card Ever had vaccination card Ever had vaccination card DID YOU EVER HAVE A VACCINATION CARD FOR (name)? IMMUNIZATION 1 Yes 2 No 9 Missing Day of bcg1 immunization Day of bcg1 immunization Day of bcg1 immunization Day of bcg1 immunization Day of bcg1 immunization Date of Immunization Day of BCG1 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of bcg1 immunization Month of bcg1 immunization Month of bcg1 immunization Month of bcg1 immunization Month of bcg1 immunization Date of Immunization Month of BCG1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of bcg1 immunization Year of bcg1 immunization Year of bcg1 immunization Year of bcg1 immunization Year of bcg1 immunization Date of Immunization Year of BCG1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of polio at birth immunization Day of polio at birth immunization Day of polio at birth immunization Day of polio at birth immunization Day of polio at birth immunization Date of Immunization Day of Polio at birth immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of polio at birth immunization Month of polio at birth immunization Month of polio at birth immunization Month of polio at birth immunization Month of polio at birth immunization Date of Immunization Month of Polio at birth immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of polio at birth immunization Year of polio at birth immunization Year of polio at birth immunization Year of polio at birth immunization Year of polio at birth immunization Date of Immunization Year of Polio at birth immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of polio1 immunization Day of polio1 immunization Day of polio1 immunization Day of polio1 immunization Day of polio1 immunization Date of Immunization Day of Polio1 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of polio1 immunization Month of polio1 immunization Month of polio1 immunization Month of polio1 immunization Month of polio1 immunization Date of Immunization Month of Polio1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of polio1 immunization Year of polio1 immunization Year of polio1 immunization Year of polio1 immunization Year of polio1 immunization Date of Immunization Year of Polio1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of polio2 immunization Day of polio2 immunization Day of polio2 immunization Day of polio2 immunization Day of polio2 immunization Date of Immunization Day of Polio2 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of polio2 immunization Month of polio2 immunization Month of polio2 immunization Month of polio2 immunization Month of polio2 immunization Date of Immunization Month of Polio2 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of polio2 immunization Year of polio2 immunization Year of polio2 immunization Year of polio2 immunization Year of polio2 immunization Date of Immunization Year of Polio2 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of polio3 immunization Day of polio3 immunization Day of polio3 immunization Day of polio3 immunization Day of polio3 immunization Date of Immunization Day of Polio3 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of polio3 immunization Month of polio3 immunization Month of polio3 immunization Month of polio3 immunization Month of polio3 immunization Date of Immunization Month of Polio3 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of polio3 immunization Year of polio3 immunization Year of polio3 immunization Year of polio3 immunization Year of polio3 immunization Date of Immunization Year of Polio3 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of dpt1 immunization Day of dpt1 immunization Day of dpt1 immunization Day of dpt1 immunization Day of dpt1 immunization Date of Immunization Day of DPT1 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of dpt1 immunization Month of dpt1 immunization Month of dpt1 immunization Month of dpt1 immunization Month of dpt1 immunization Date of Immunization Month of DPT1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of dpt1 immunization Year of dpt1 immunization Year of dpt1 immunization Year of dpt1 immunization Year of dpt1 immunization Date of Immunization Year of DPT1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of dpt2 immunization Day of dpt2 immunization Day of dpt2 immunization Day of dpt2 immunization Day of dpt2 immunization Date of Immunization Day of DPT2 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of dpt2 immunization Month of dpt2 immunization Month of dpt2 immunization Month of dpt2 immunization Month of dpt2 immunization Date of Immunization Month of DPT2 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of dpt2 immunization Year of dpt2 immunization Year of dpt2 immunization Year of dpt2 immunization Year of dpt2 immunization Date of Immunization Year of DPT2 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of dpt3 immunization Day of dpt3 immunization Day of dpt3 immunization Day of dpt3 immunization Day of dpt3 immunization Date of Immunization Day of DPT3 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of dpt3 immunization Month of dpt3 immunization Month of dpt3 immunization Month of dpt3 immunization Month of dpt3 immunization Date of Immunization Month of DPT3 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of dpt3 immunization Year of dpt3 immunization Year of dpt3 immunization Year of dpt3 immunization Year of dpt3 immunization Date of Immunization Year of DPT3 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of hepb at birth immunization Day of hepb at birth immunization Day of hepb at birth immunization Day of hepb at birth immunization Day of hepb at birth immunization Date of Immunization Day of HepB at birth immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of hepb at birth immunization Month of hepb at birth immunization Month of hepb at birth immunization Month of hepb at birth immunization Month of hepb at birth immunization Date of Immunization Month of HepB at birth immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of hepb at birth immunization Year of hepb at birth immunization Year of hepb at birth immunization Year of hepb at birth immunization Year of hepb at birth immunization Date of Immunization Year of HepB at birth immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of hepb1 immunization Day of hepb1 immunization Day of hepb1 immunization Day of hepb1 immunization Day of hepb1 immunization Date of Immunization Day of HepB1 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of hepb1 immunization Month of hepb1 immunization Month of hepb1 immunization Month of hepb1 immunization Month of hepb1 immunization Date of Immunization Month of HepB1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of hepb1 immunization Year of hepb1 immunization Year of hepb1 immunization Year of hepb1 immunization Year of hepb1 immunization Date of Immunization Year of HepB1 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of hepb2 immunization Day of hepb2 immunization Day of hepb2 immunization Day of hepb2 immunization Day of hepb2 immunization Date of Immunization Day of HepB2 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of hepb2 immunization Month of hepb2 immunization Month of hepb2 immunization Month of hepb2 immunization Month of hepb2 immunization Date of Immunization Month of HepB2 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of hepb2 immunization Year of hepb2 immunization Year of hepb2 immunization Year of hepb2 immunization Year of hepb2 immunization Date of Immunization Day Month Year Copy dates for each vaccination from the card. IMMUNIZATION Day of hepb3 immunization Day of hepb3 immunization Day of hepb3 immunization Day of hepb3 immunization Day of hepb3 immunization Date of Immunization Day of HepB3 immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of hepb3 immunization Month of hepb3 immunization Month of hepb3 immunization Month of hepb3 immunization Month of hepb3 immunization Date of Immunization Month of HepB3 immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of hepb3 immunization Year of hepb3 immunization Year of hepb3 immunization Year of hepb3 immunization Year of hepb3 immunization Date of Immunization Year of HepB3 immunization Copy dates for each vaccination from the card. IMMUNIZATION Day measles or mmr immunization Day measles or mmr immunization Day measles or mmr immunization Day measles or mmr immunization Day measles or mmr immunization Date of Immunization Day measles or MMR immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month measles or mmr immunization Month measles or mmr immunization Month measles or mmr immunization Month measles or mmr immunization Month measles or mmr immunization Date of Immunization Month Measles or MMR immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of measles or mmr immunization Year of measles or mmr immunization Year of measles or mmr immunization Year of measles or mmr immunization Year of measles or mmr immunization Date of Immunization Year of Measles or MMR immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of yellow fever immunization Day of yellow fever immunization Day of yellow fever immunization Day of yellow fever immunization Day of yellow fever immunization Date of Immunization Day of Yellow Fever immunization 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of yellow fever immunization Month of yellow fever immunization Month of yellow fever immunization Month of yellow fever immunization Month of yellow fever immunization Date of Immunization Month of Yellow Fever immunization Copy dates for each vaccination from the card. IMMUNIZATION Year of yellow fever immunization Year of yellow fever immunization Year of yellow fever immunization Year of yellow fever immunization Year of yellow fever immunization Date of Immunization Year of Yellow Fever immunization Copy dates for each vaccination from the card. IMMUNIZATION Day of vitamin a (most recent) Day of vitamin a (most recent) Day of vitamin a (most recent) Day of vitamin a (most recent) Day of vitamin a (most recent) Date of Immunization Day of Vitamin A (MOST RECENT) 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. (c) Write '66' in day column if OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? IMMUNIZATION Month of vitamin a (most recent) Month of vitamin a (most recent) Month of vitamin a (most recent) Month of vitamin a (most recent) Month of vitamin a (most recent) Date of Immunization Month of Vitamin A (MOST RECENT) Copy dates for each vaccination from the card. IMMUNIZATION Year of vitamin a (most recent) Year of vitamin a (most recent) Year of vitamin a (most recent) Year of vitamin a (most recent) Year of vitamin a (most recent) Date of Immunization Year of Vitamin A (MOST RECENT) Copy dates for each vaccination from the card. Check IM3. Are all vaccines (BCG to Yellow Fever) recorded? If Yes Go to IM18 If No Continue with IM5 IMMUNIZATION Child received any other vaccinations Child received any other vaccinations Child received any other vaccinations Child received any other vaccinations Child received any other vaccinations IN ADDITION TO WHAT IS RECORDED ON THIS CARD, DID (name) RECEIVE ANY OTHER VACCINATIONS – INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? Record 'Yes' only if respondent mentions vaccines shown in the table above. If Yes code 1 (Probe for vaccinations and write ‘66’ in the corresponding day column for each vaccine mentioned. Then skip to IM18) IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Child ever received any vaccinations Child ever received any vaccinations Child ever received any vaccinations Child ever received any vaccinations Child ever received any vaccinations HAS (name) EVER RECEIVED ANY VACCINATIONS TO PREVENT HIM/HER FROM GETTING DISEASES, INCLUDING VACCINATIONS RECEIVED IN A CAMPAIGN OR IMMUNIZATION DAY? IM6-IM17 are for registering vaccinations that are not recorded on the card. IM6-IM17 will only be asked when a card is not available. IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Child ever given bcg vaccination Child ever given bcg vaccination Child ever given bcg vaccination Child ever given bcg vaccination Child ever given bcg vaccination HAS (name) EVER RECEIVED A BCG VACCINATION AGAINST TUBERCULOSIS – THAT IS, AN INJECTION IN THE ARM OR SHOULDER THAT USUALLY CAUSES A SCAR? IM6-IM17 are for registering vaccinations that are not recorded on the card. IM6-IM17 will only be asked when a card is not available. IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Child ever given polio vaccination Child ever given polio vaccination Child ever given polio vaccination Child ever given polio vaccination Child ever given polio vaccination HAS (name) EVER RECEIVED ANY “VACCINATION DROPS IN THE MOUTH” TO PROTECT HIM/HER FROM GETTING DISEASES –THAT IS, POLIO? IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing First polio vaccine received in the first two weeks after birth or later First polio vaccine received in the first two weeks after birth or later First polio vaccine received in the first two weeks after birth or later First polio vaccine received in the first two weeks after birth or later First polio vaccine received in the first two weeks after birth or later (Probe for type of vaccinations obtained which was not written on card and write '66' in the corresponding day column on IM2 to IM8B.) WAS THE FIRST POLIO VACCINE RECEIVED IN THE FIRST TWO WEEKS AFTER BIRTH OR LATER? Record 'Yes' only if respondent mentions BCG, OPV 0-3, DPT 1-3, Hepatitis B 1-3, Measles, Yellow Fever vaccine(s), or Vitamin A supplements. IMMUNIZATION 1 First two weeks 2 Later . 9 Missing Total times that the polio vaccine received Total times that the polio vaccine received Total times that the polio vaccine received Total times that the polio vaccine received Total times that the polio vaccine received HOW MANY TIMES WAS THE POLIO VACCINE RECEIVED? IMMUNIZATION Ever received a dpt vaccination Ever received a dpt vaccination Ever received a dpt vaccination Ever received a dpt vaccination Ever received a dpt vaccination HAS (name) EVER RECEIVED A DPT VACCINATION – THAT IS, AN INJECTION IN THE THIGH OR BUTTOCKS – TO PREVENT HIM/HER FROM GETTING TETANUS, WHOOPING COUGH, OR DIPHTHERIA? IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Total times that a dpt vaccine received Total times that a dpt vaccine received Total times that a dpt vaccine received Total times that a dpt vaccine received Total times that a dpt vaccine received HOW MANY TIMES WAS A DPT VACCINE RECEIVED? IMMUNIZATION Ever received hepatitis b vaccination Ever received hepatitis b vaccination Ever received hepatitis b vaccination Ever received hepatitis b vaccination Ever received hepatitis b vaccination HAS (name) EVER BEEN GIVEN A HEPATITIS B VACCINATION – THAT IS, AN INJECTION IN THE THIGH OR BUTTOCKS – TO PREVENT HIM/HER FROM GETTING HEPATITIS B? IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Hepatitis b first givenwithin 24 hours after birth or later Hepatitis b first givenwithin 24 hours after birth or later Hepatitis b first givenwithin 24 hours after birth or later Hepatitis b first givenwithin 24 hours after birth or later Hepatitis b first givenwithin 24 hours after birth or later WAS THE FIRST HEPATITIS B VACCINE RECEIVED WITHIN 24 HOURS AFTER BIRTH, OR LATER? IMMUNIZATION 1 Within 24 hours 2 Later 9 Missing Total times that the hepatitis b vaccine received Total times that the hepatitis b vaccine received Total times that the hepatitis b vaccine received Total times that the hepatitis b vaccine received Total times that the hepatitis b vaccine received HOW MANY TIMES WAS A HEPATITIS B VACCINE RECEIVED? IMMUNIZATION Ever received a measles injection or an mmr injection Ever received a measles injection or an mmr injection Ever received a measles injection or an mmr injection Ever received a measles injection or an mmr injection Ever received a measles injection or an mmr injection HAS (name) EVER RECEIVED A MEASLES INJECTION OR AN MMR INJECTION – THAT IS, A SHOT IN THE ARM AT THE AGE OF 9 MONTHS OR OLDER - TO PREVENT HIM/HER FROM GETTING MEASLES? IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Ever received the yellow fever vaccination Ever received the yellow fever vaccination Ever received the yellow fever vaccination Ever received the yellow fever vaccination Ever received the yellow fever vaccination HAS (name) EVER RECEIVED THE YELLOW FEVER VACCINATION – THAT IS, A SHOT IN THE ARM AT THE AGE OF 9 MONTHS OR OLDER - TO PREVENT HIM/HER FROM GETTING YELLOW FEVER? Probe by indicating that the yellow fever vaccine is sometimes given at the same time as the measles vaccine IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Child received a vitamin a dose like (this/any of these) within the last 6 months Child received a vitamin a dose like (this/any of these) within the last 6 months Child received a vitamin a dose like (this/any of these) within the last 6 months Child received a vitamin a dose like (this/any of these) within the last 6 months Child received a vitamin a dose like (this/any of these) within the last 6 months HAS (name) RECEIVED A VITAMIN A DOSE LIKE (THIS/ANY OF THESE) WITHIN THE LAST 6 MONTHS? Show common types of ampules / capsules / syrups IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Child participated in national immunization day a Child participated in national immunization day a Child participated in national immunization day a Child participated in national immunization day a Child participated in national immunization day a PLEASE TELL ME IF (name) HAS PARTICIPATED IN ANY OF THE FOLLOWING CAMPAIGNS, NATIONAL MMUNIZATION DAYS AND/OR VITAMIN A OR CHILD HEALTH DAYS: [A]. NID APRIL 2010 (CAMPAIGN A) IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Child participated in national immunization day b Child participated in national immunization day b Child participated in national immunization day b Child participated in national immunization day b Child participated in national immunization day b PLEASE TELL ME IF (name) HAS PARTICIPATED IN ANY OF THE FOLLOWING CAMPAIGNS, NATIONAL MMUNIZATION DAYS AND/OR VITAMIN A OR CHILD HEALTH DAYS: [B] NID AUGUST 2010 (CAMPAIGN B) IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Child participated in national immunization day c Child participated in national immunization day c Child participated in national immunization day c Child participated in national immunization day c Child participated in national immunization day c PLEASE TELL ME IF (name) HAS PARTICIPATED IN ANY OF THE FOLLOWING CAMPAIGNS, NATIONAL MMUNIZATION DAYS AND/OR VITAMIN A OR CHILD HEALTH DAYS: [C]. NID NOVEMBER 2010 (CAMPAIGN C IMMUNIZATION 1 Yes 2 No 8 Dk 9 Missing Measurer’s name and number: Measurer’s name and number: Measurer’s name and number: Measurer’s name and number: Measurer’s name and number: IM20. Does another eligible child reside in the household for whom this respondent is mother/caretaker? Check household listing, column HL8. Yes. then End the current questionnaire and then Go to QUESTIONNAIRE FOR CHILDREN UNDER FIVE to administer the questionnaire for the next eligible child. No. then End the interview with this respondent by thanking him/her for his/her cooperation. If this is the last eligible child in the household, go on to ANTHROPOMETRY MODULE. After questionnaires for all children are complete, the measurer weighs and measures each child. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child's name and line number on the household listing before recording measurements. Measurer’s name and number: After questionnaires for all children are complete, the measurer weighs and measures each child. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child’s name and line number on the household listing before recording measureme ANTHROPOMETRY Result of height / length and weight measurement Result of height / length and weight measurement Result of height / length and weight measurement Result of height / length and weight measurement Result of height / length and weight measurement Result of height / length and weight measurement Check age of child in UF13: Child under 2 years old. then Measure length (lying down). Child age 2 or more years. then Measure height (standing up). Check the age of the child in UF13. If the child is under 2 years old, check the appropriate box, measure and record recumbent length (that is, lying down), to the nearest tenth of a centimetre. If the child is age two or older, check the corresponding box and then measure and record standing height. Write a zero first if the number of centimetres is two digits ANTHROPOMETRY 1 Either or both measured 2 Child not present 3 Child or caregiver refused 6 Other (specify) 9 Missing Child’s weight Child’s weight Child’s weight Child’s weight Child’s weight Child’s weight Kilograms (kg) .............................. __ __ . __ Weight not measured ............................ 99.9 ANTHROPOMETRY Child measured lying or standing Child measured lying or standing Child measured lying or standing Child measured lying or standing Child measured lying or standing Child measured lying or standing 1 Lying down 2 Standing up 9 Missing Child measured lying or standing Child measured lying or standing Child measured lying or standing Child measured lying or standing Child measured lying or standing Child measured lying or standing Child's length or height Check age of child in AG2: If Child under 2 years old. Measure length (lying down). If Child age 2 or more years. Measure height (standing up). ANTHROPOMETRY 1 Length (cm) lying down 2 Height (cm) standing up 9999.9 Length / height not measured Oedema presence Oedema presence Oedema presence Oedema presence Oedema presence Oedema(Body swelling) Observe and record (specify reason) if coded 7 ANTHROPOMETRY 1 Present 2 Not present 3 Unsure 7 Not checked 9 Missing Height for age percentile Height for age percentile Height for age percentile Height for age percentile Height for age percentile Height for age percentile Height for age z-score Height for age z-score Height for age z-score Height for age z-score Height for age z-score Height for age z-score Height for age percent of reference median Height for age percent of reference median Height for age percent of reference median Height for age percent of reference median Height for age percent of reference median Height for age percent of reference median Weight for age percentile Weight for age percentile Weight for age percentile Weight for age percentile Weight for age percentile Weight for age percentile Weight for age z-score Weight for age z-score Weight for age z-score Weight for age z-score Weight for age z-score Weight for age z-score Weight for age percent of reference median Weight for age percent of reference median Weight for age percent of reference median Weight for age percent of reference median Weight for age percent of reference median Weight for age percent of reference median Weight for height percentile Weight for height percentile Weight for height percentile Weight for height percentile Weight for height percentile Weight for height percentile Weight for height z-score Weight for height z-score Weight for height z-score Weight for height z-score Weight for height z-score Weight for height percent of reference median Weight for height percent of reference median Weight for height percent of reference median Weight for height percent of reference median Weight for height percent of reference median Weight for height percent of reference median Flag for anthropometric indicators Flag for anthropometric indicators Flag for anthropometric indicators Flag for anthropometric indicators Flag for anthropometric indicators Flag for anthropometric indicators No flag 1 Height for age 2 Weight for height 3 Weight for height, height for age 4 Weight for age 5 Weight for age, height for age 6 Weight for age, weight for height 7 Weight for age, weight for height, height for age Body mass index who Body mass index who Body mass index who Body mass index who Body mass index who Body Mass Index WHO 99.97 Measurement out of range 99.99 Not measured Body mass index z-score who Body mass index z-score who Body mass index z-score who Body mass index z-score who Body mass index z-score who Body Mass Index z-score WHO 99.97 Measurement out of range 99.98 Z-score out of range 99.99 Not measured Height for age z-score who Height for age z-score who Height for age z-score who Height for age z-score who Height for age z-score who Height for age z-score WHO 99.97 Measurement out of range 99.98 Z-score out of range 99.99 Not measured Weight for age z-score who Weight for age z-score who Weight for age z-score who Weight for age z-score who Weight for age z-score who Weight for age z-score WHO 99.97 Measurement out of range 99.98 Z-score out of range 99.99 Not measured Weight for height z-score who Weight for height z-score who Weight for height z-score who Weight for height z-score who Weight for height z-score who Weight for height z-score WHO 99.97 Measurement out of range 99.98 Z-score out of range 99.99 Not measured Height for age flag who Height for age flag who Height for age flag who Height for age flag who Height for age flag who Height for age flag WHO No error 1 Error flag Weight for age flag who Weight for age flag who Weight for age flag who Weight for age flag who Weight for age flag who Weight for age flag WHO No error 1 Error flag Weight for height flag who Weight for height flag who Weight for height flag who Weight for height flag who Weight for height flag who Weight for height flag WHO No error 1 Error flag Bmi flag who Bmi flag who Bmi flag who Bmi flag who Bmi flag who BMI flag WHO No error 1 Error flag Weight for height - age flag who Weight for height - age flag who Weight for height - age flag who Weight for height - age flag who Weight for height - age flag who Weight for height - age flag who Age given - all measurements calculated 1 No age - only weight for height calculated Net number Net number Net number Net number Net number Mosquito net observed? Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed Mosquito net observed? 1 Observed 2 Not observed 9 Missing Brand/type of observed net Brand/type of observed net Brand/type of observed net Brand/type of observed net Brand/type of observed net Observe or ask the type of mosquito net. 18 Long-lasting treated nets 28 Pre-treated nets 31 Other net 98 Dk brand / type 99 Missing Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained Months ago net obtained HOW MANY MONTHS AGO DID YOUR HOUSEHOLD GET THE MOSQUITO NET? Less than one month ago 95 More than 36 months ago 98 Dk / not sure 99 Missing Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained Net treated with an insecticide when obtained WHEN YOU GOT THE NET, WAS IT ALREADY TREATED WITH AN INSECTICIDE TO KILL OR REPEL MOSQUITOES? 1 Yes 2 No 8 Dk / not sure 9 Missing Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained Net soaked or dipped since obtained SINCE YOU GOT THE NET, WAS IT EVER SOAKED OR DIPPED IN A LIQUID TO KILL OR REPEL MOSQUITOES? 1 Yes 2 No 8 Dk / not sure 9 Missing Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped Months ago net soaked or dipped TN10. HOW MANY MONTHS AGO WAS THE NET LAST SOAKED OR DIPPED? Less than one month ago 95 More than 24 months ago 98 Dk / not sure 99 Missing Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night Persons slept under mosquito net last night DID ANYONE SLEEP UNDER THIS MOSQUITO NET LAST NIGHT? 1 Yes 2 No 8 Dk / not sure 99 Missing Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net Person 1 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net Person 2 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net Person 3 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net Person 4 who slept under net WHO SLEPT UNDER THIS MOSQUITO NET LAST NIGHT? Area:sector Area:sector Area:sector Area:sector Area:sector HH6. Area...................................... Sector Area Sector 1 Rural 2 Urban State State State State State State Name:________________________ State Code: 1 Abia 2 Adamawa 3 Akwa-ibom 4 Anambra 5 Bauchi 6 Bayelsa 7 Benue 8 Borno 9 Cross-rivers 10 Delta 11 Ebonyi 12 Edo 13 Ekiti 14 Enugu 15 Gombe 16 Imo 17 Jigawa 18 Kaduna 19 Kano 20 Katsina 21 Kebbi 22 Kogi 23 Kwara 24 Lagos 25 Nasarawa 26 Niger 27 Ogun 28 Ondo 29 Osun 30 Oyo 31 Plataeu 32 Rivers 33 Sokoto 34 Taraba 35 Yobe 36 Zamfara 37 Abuja fct Sex Sex Sex Sex Sex Is (name) male or female? 1 male 2 female IS (name) MALE OR FEMALE? 1 Male 2 Female 9 Missing Highest level of education attended Highest level of education attended Highest level of education attended Highest level of education attended Highest level of education attended WHAT IS THE HIGHEST LEVEL OF SCHOOL (name) ATTENDED? Preschool/kindergarten 1 Primary 2 Secondary 3 Higher 4 Non-formal education 8 Dk 9 Missing Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level Highest grade completed at that level WHAT IS THE HIGHEST GRADE (name) COMPLETED AT THIS LEVEL? Never complete nursery 1 Nursery 1 2 Nursery 2 3 Nursery 3 10 Never complete primary 1 11 Primary 1 12 Primary 2 13 Primary 3 14 Primary 4 15 Primary 5 16 Primary 6 20 Never complete jss1 21 Jss 1 22 Jss 2 23 Jss 3 24 Ss 1 25 Ss 2 26 Ss 3 30 Never complete nce 1 al/ond1/ technica 31 Nce 32 A/ond 33 Technica 40 Never complete hnd1/bsc.1/pg 41 Hnd 42 Bsc 43 Post graduate 97 Inconsistent 98 Dk 99 Missing Date of interview child (cmc) Date of interview child (cmc) Date of interview child (cmc) Date of interview child (cmc) Date of interview child (cmc) Date of birth (cmc) Date of birth (cmc) Date of birth (cmc) Date of birth (cmc) Date of birth (cmc) Age (months) Age (months) Age (months) Age (months) Age (months) Age Age Age Age Age 1 < 6 months 2 6-11 months 3 12-23 months 4 24-35 months 5 36-47 months 6 48-59 months Age Age Age Age Age 1 0-11 months 2 12-23 months 3 24-35 months 4 36-47 months 5 48-59 months Age in days Age in days Age in days Age in days Age in days Mother's education Mother's education Mother's education Mother's education Mother's education 1 None 2 Primary 3 Secondary 9 Missing/dk Religion of household head Religion of household head Religion of household head Religion of household head Religion of household head 1 Christianity 2 Islam 3 Other religion 4 No religion 9 Missing/dk Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head Geopolitical zone of household head 1 North central 2 North east 3 North west 4 South east 5 South south 6 South west Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Regr factor score 1 for analysis 2 Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles Wealth index quintiles 1 Poorest 2 Second 3 Middle 4 Fourth 5 Richest Children's sample weight Children's sample weight Children's sample weight Children's sample weight Children's sample weight