PACKARD WESTERN KENYA BASELINE SURVEY 2010

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BIRTH HISTORY You told me that you have had a total of ______________births (check Q209). Now I would like to record the names of all your live births, whether still alive or not, starting with the first one you had. Umeniambia ulizaa jumla ya watoto _______. Sasa ningetaka kurekodi majina yote ya watoto uliowazaa wakiwa hai, hata kama hivi sasa wako hai ama wameaga, kuanzia wa kwanza RECORD NAMES OF ALL THE BIRTHS in Q209 in Q218. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 18 BIRTHS, USE AN ADDITIONAL QUESTIONNAIRE. CIRCLE ALL CHILDREN BORN IN 2008 OR LATER. (Q218) (Q219) (Q220) (Q222) (Q223) (Q224) (Q225) (Q21 7C) Line no. What name was given to your (first/next) baby Mtoto wa kwanza aliitwa nani (anayefuata) Were any of these births twins/triplets Is (NAME) a boy or a girl Is (NAME) still alive IF ALIVE: How old was (NAME) at his/her last birthday IF ALIVE: Is (NAME) living with you 01 NAME: _____________________________ 02 NAME: __________________________ 03 NAME: _____________________________ 04 NAME: _____________________________ je, kunao mapacha ama watatu SING………1 MULT……..2 SING………1 MULT……..2 SING………1 MULT……..2 SING………1 MULT……..2 Ama Je (JINA) ni Mvulana msichana BOY…1 GIRL...2 BOY…1 GIRL...2 BOY…1 GIRL...2 BOY…1 GIRL...2 (Q221) In what month and year was (NAME) born PROBE: What is her/his birthday (other probes: what season was it) Ni mwezi gani na mwaka gani (JINA) alizaliwa ULIZA: Siku yake ya kuzaliwa ni ipi ULIZA: Alizaliwa msimu upi MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 (JINA) yuko hai YES….1 NO……2 Q225 YES….1 NO……2 Q225 YES….1 NO……2 Q225 YES….1 NO……2 Q225 KAMA YUKO HAI: (JINA) alifikisha miaka mingapi tarehe ya mwisho kuadhimisha siku yake ya kuzaliwa RECORD AGE IN COMPLETED YEARS; IF LESS THAN ONE YEAR, RECORD “00”. AGE IN YEARS [__|__] AGE IN YEARS [__|__] AGE IN YEARS [__|__] AGE IN YEARS [__|__] KAMA YUKO HAI: Je, (JINA) anaishi pamoja na wewe YES….1 NO……2 All Skip To Q226 YES….1 NO……2 All Skip To Q226 YES….1 NO……2 All Skip To Q226 YES….1 NO……2 All Skip To Q226 IF DEAD: How old was (NAME) when she/he died IF LESS THAN 2 YEARS, PROBE: How many months old was (NAME) KAMA AMEAGA: (JINA) alikuwa na miaka mingapi alipoaga dunia KAMA ANA MWAKA 2 ULIZA ZAIDI: (JINA) alikuwa na miezi mingapi IF LESS THAN 1 MONTH OLD, RECORD DAYS; IF LESS THAN 2 YEARS, RECORD MONTHS DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 (Q226) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth Ulizaa mtoto yeyote hai kati ya (ALIYE ZALIWA AWALI) Na (JINA) Nijulishe hata kama aliaga dunia baada ya kuzaliwa YES...1 ADD BIRTH NO….2 NEXT BIRTH YES...1 ADD BIRTH NO….2 NEXT BIRTH YES...1 ADD BIRTH NO….2 NEXT BIRTH Page 8
(Q21 7C) Line no. (Q218) What name was given to your (first/next) baby Mtoto wa kwanza aliitwa nani (anayefuata) (Q219) Were any of these births twins/triplets je, kunao mapacha ama watatu (Q220) Is (NAME) a boy or a girl Ama Je (JINA) ni Mvulana msichana (Q221) In what month and year was (NAME) born PROBE: What is her/his birthday (other probes: what season was it) Ni mwezi gani na mwaka gani (JINA) alizaliwa ULIZA: Siku yake ya kuzaliwa ni ipi ULIZA: Alizaliwa msimu upi (Q222) Is (NAME) still alive (JINA) yuko hai (Q223) IF ALIVE: How old was (NAME) at his/her last birthday KAMA YUKO HAI: (JINA) alifikisha miaka mingapi tarehe ya mwisho kuadhimisha siku yake ya kuzaliwa RECORD AGE IN COMPLETED YEARS; IF LESS THAN ONE YEAR, RECORD “00”. (Q224) IF ALIVE: Is (NAME) living with you KAMA YUKO HAI: Je, (JINA) anaishi pamoja na wewe (Q225) IF DEAD: How old was (NAME) when she/he died IF LESS THAN 2 YEARS, PROBE: How many months old was (NAME) KAMA AMEAGA: (JINA) alikuwa na miaka mingapi alipoaga dunia KAMA ANA MWAKA 2 ULIZA ZAIDI: (JINA) alikuwa na miezi mingapi IF LESS THAN 1 MONTH OLD, RECORD DAYS; IF LESS THAN 2 YEARS, RECORD MONTHS (Q226) Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME), including any children who died after birth Ulizaa mtoto yeyote hai kati ya (ALIYE ZALIWA AWALI) Na (JINA) Nijulishe hata kama aliaga dunia baada ya kuzaliwa 05 NAME: _____________________________ 06 NAME: __________________________ 07 NAME: _____________________________ 08 NAME: _____________________________ 09 NAME: _____________________________ SING………1 MULT……..2 SING………1 MULT……..2 SING………1 MULT……..2 SING………1 MULT……..2 SING………1 MULT……..2 BOY…1 GIRL...2 BOY…1 GIRL...2 BOY…1 GIRL...2 BOY…1 GIRL...2 BOY…1 GIRL...2 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 MONTH [__|__] DK……..98 YEAR [__|__][__|__] DK….9998 YES….1 NO……2 Q225 YES….1 NO……2 Q225 YES….1 NO……2 Q225 YES….1 NO……2 Q225 YES….1 NO……2 Q225 AGE IN YEARS [__|__] AGE IN YEARS [__|__] AGE IN YEARS [__|__] AGE IN YEARS [__|__] AGE IN YEARS [__|__] YES….1 NO……2 All Skip To Q226 YES….1 NO……2 All Skip To Q226 YES….1 NO……2 All Skip To Q226 YES….1 NO……2 All Skip To Q226 YES….1 NO……2 All Skip To Q226 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 DAYS…….1 [__|__] MONTHS…2 [__|__] YEARS…….3 [__|__] DK………….998 YES...1 ADD BIRTH NO….2 NEXT BIRTH YES...1 ADD BIRTH NO….2 NEXT BIRTH YES...1 ADD BIRTH NO….2 NEXT BIRTH YES...1 ADD BIRTH NO….2 NEXT BIRTH YES...1 ADD BIRTH NO….2 NEXT BIRTH Page 9
Page 1 and 2: QUESTIONNAIRE NO: [__|__|__|__|__|_
Page 3 and 4: Costs and Payment for Participation
Page 5 and 6: Q109 Please read for me the sentenc
Page 7: Q212 Q213 Have you ever had a pregn
Page 11 and 12: (Q21 7C) Line no. (Q218) What name
Page 13 and 14: Q239 What type of facility did you
Page 15 and 16: SECTION 3: CONTRACEPTION CHECK FOR
Page 17 and 18: Q303 CHECK 301 (KNOWLEDGE OF ANY CO
Page 19 and 20: Q309 CHECK Q235 CURRENTLY PREGNANT
Page 21 and 22: KQ5 How many living children did yo
Page 23 and 24: Q330 FOR A WOMAN WHO HAS BEEN STERI
Page 25 and 26: Q337 What method(s) did you use (th
Page 27 and 28: KQ10 Before you started using last
Page 29 and 30: Q350 Which is this place or person
Page 31 and 32: Q371 Q372 Why did/do you prefer to
Page 33 and 34: SECTION 4: MATERNAL AND CHILD HEALT
Page 35 and 36: KQ19 KQ20 Where did [NAME] receive
Page 37 and 38: Q414 Did you receive any informatio
Page 39 and 40: Q424 What type of facility is this
Page 41 and 42: Q507 In the last twelve (12) months
Page 43 and 44: Q601 SECTION 6: FERTILITY PREFERENC
Page 45 and 46: Q610 Does your husband/partner want
Page 47 and 48: Q701 SECTION 7: SPOUSAL AND INTERPE
Page 49 and 50: Q720 Do you think there are some pe
Page 51 and 52: Q730 Q731 Q732 Q733 Q734 Q735 RECOR
Page 53 and 54: SECTION 8: GENDER INEQUITY MEASURES
Page 55 and 56: Q819 CHECK Q510 AND Q511: EVER MARR
Page 57 and 58: Now I am going to read some stateme
Page 59 and 60:
Q903 Which newspaper(s) do you read
Page 61 and 62:
Q920 Q921 What time of the day do y
Page 63 and 64:
Q936 In the past three months, have
Page 65 and 66:
Q938. What are the names and types
Page 67 and 68:
Q1008 How long do you usually stay
Page 69 and 70:
FOLLOW-UP CONTACTS Q1100 Q1101 WOMA
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PACKARD WESTERN KENYA BASELINE SURVEY 2010

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