Do any sons not living with you now? If yes, how many? How many boys and girls died? Did you receive iron-folate tablets? Surveyor to show tablets If yes, are you currently using it? If yes, which method are you using currently? Did you have any delivery
19
SECTION 16: Maternal Child Health
For every married women up to 49 years age in household Woman 1
Woman 2 Woman 3
Woman’s name
Now I would like to ask about all the births you have had during your life.
16.1 At what age you were you married?
|__|__| Years |__|__| Years
|__|__| Years 16.2
Have you ever given a birth that has shown any sign of life?
0 No
–► 16.11
1 Yes 0 No
–► 16.11
1 Yes 0 No
–► 16.11 1 Yes
16.3 If Yes to 16.1, how many years ago did you have your first birth?
|__|__| Years |__|__| Years
|__|__| Years 16.4
Do you have any sons to whom you have given birth and are living with you? If yes, how many?
|__| Sons
if none write ‘0’
|__| Sons
if none write ‘0’
|__| Sons
if none write ‘0’
16.5
Do you have any daughters to whom you have given birth and are living with you? If yes, how many?
|__| Daughters
if none write ‘0’
|__| Daughters
if none write ‘0’
|__| Daughters
if none write ‘0’
16.6 Do any sons not living with you now? If yes, how many?
|__| Sons |__| Sons
|__| Sons 16.7
Do any daughters not living with you now? If yes, how many? |__| Daughters
|__| Daughters |__| Daughters
16.8
Have you ever given birth to a boy or girl who was born alive, but died later?
0 No
–► 16.10
1 Yes 0 No
–► 16.10
1 Yes 0 No
–► 16.10 1 Yes
16.9 How many boys and girls died?
|__| Boys died |__| Girls died
|__| Boys died |__| Girls died
|__| Boys died |__| Girls died
16.10
Just to make sure I am right, you have had ‘Number’ births in your lifetime?
Write total number of live births in whole life. Sum of 16.4, 16.5, 16.6, 16.7 and 16.9 except current pregnancy, if any
|__|__| total births |__|__| total births
|__|__| total births 16.11
Are you pregnant?
0 No
–► 16.14
1 Yes 9 Don’t know –► 16.14
0 No
–► 16.14
1 Yes 9 Don’t know –► 16.14
0 No
–► 16.14
1 Yes 9 Don’t know –► 16.14
16.12
Do you suffer from night-blindness
Local Name
, do you have difficulty seeing at dusk when others can?
0 No 1 Yes
9 Don’t know 0 No
1 Yes 9 Don’t know
0 No 1 Yes
9 Don’t know
16.13 Did you receive iron-folate tablets? Surveyor to show tablets
0. No
1. Yes
0. No
1. Yes
0. No
1. Yes
16.14
Did you ever hear of any method of delaying or avoiding pregnancy?
0 No
–► 16.17
1 Yes 0 No
–► 16.17
1 Yes 0 No
–► 16.17
1 Yes
16.15 If yes, are you currently using it?
0 No
–► 16.17
1 Yes 0 No
–► 16.17
1 Yes 0 No
–► 16.17
1 Yes
16.16 If yes, which method are you using currently?
1 Pill 2 Condom
3 Injection 4 Sterilization
5 Traditional 1 Pill
2 Condom 3 Injection
4 Sterilization 5 Traditional
1 Pill 2 Condom
3 Injection 4 Sterilization
5 Traditional
16.17 Did you have any delivery during last two years?
0 No
–► 16.23
1 Yes 0 No
–► 16.23
1 Yes 0 No
–► 16.23
1 Yes
16.18
What was the place of your delivery?
HC=Health Centre,PriNGO HC=PrivateNGOOther Health Centre HDNR= Home Delivery, Neighbour, Relative
1 Govt. Hosp.HC 2 PrivateNGOHC
3 HDNR 1 Govt. Hosp.HC
2 PrivateNGOHC 3 HDNR
1 Govt. Hosp.HC 2 PrivateNGOHC
3 HDNR
16.19
Who assisted with the delivery of your last child?
TBA=Traditional Birth Attendant
1 DoctorNurseMidwife 2 TBA
3 Relative friendother 1 DoctorNurseMidwife
2 TBA 3 Relative friendother
1 DoctorNurseMidwife 2 TBA
3 Relative friendother
20
SECTION 16: Maternal Child Health
For every married women up to 49 years age in household Woman 1
Woman 2 Woman 3
16.20
How many doses of TT injection have you taken in the arm to prevent your newborn being affected from tetanus?
If none write 0
|__| Doses |__| Doses
|__| Doses 16.21
Did you see anyone for taking advice during this pregnancy i.e. antenatal care other than TT? If yes, whom did you see?
TBA=Traditional Birth Attendant 0 None
1 DoctorNurseMidwife 2 TBA
3 Relative friendother 0 None
1 DoctorNurseMidwife 2 TBA
3 Relative friendother 0 None
1 DoctorNurseMidwife 2 TBA
3 Relative friendother
16.22
After the birth of your last child, did you receive a Vitamin A capsule during NefuzChell period?
Surveyor to show the capsule
0 No 1 Yes
9 Don’t know 0 No
1 Yes 9 Don’t know
0 No 1 Yes
9 Don’t know
16.23
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?
Do not read responses
0 Coughrunning nose 1 Fever
2 DifficultFast Breath 3 Convulsion
4 Unable to drinksuck 5 WateryBloody diarrhoea
6 Other 9
Don’t Knownone 0 Coughrunning nose
1 Fever 2 DifficultFast Breath
3 Convulsion 4 Unable to drinksuck
5 WateryBloody diarrhoea 6 Other
9
Don’t Knownone 0 Coughrunning nose
1 Fever 2 DifficultFast Breath
3 Convulsion 4 Unable to drinksuck
5 WateryBloody diarrhoea 6 Other
9
Don’t Knownone
SECTION 17: Children 0-59 months
C
HILD
N
UMBER
1 2
3 4
5 6
7 8
Child’s Name 17.1
Sex of ‘Name’.
1 Boy 2 Girl
1 Boy 2 Girl
1 Boy 2 Girl
1 Boy 2 Girl
1 Boy 2 Girl
1 Boy 2 Girl
1 Boy 2 Girl
1 Boy 2 Girl