Questionnaire - Measurement, Learning & Evaluation Project

Which city or town in Nigeria did youvisit most often in the past 12 months?SHE HAS TRAVELED IN THE PAST YEAR………………………1NAME OF TOWN/CITY _______________________Q905Wanne birni ko gari ki ka fi yawan kaiziyara a watani goma sha biyu da sukashige?LGA NAME:___________________________________CODE BOXES: OFFICE ONLY [__|__|__]WRITE NAME OF THE CITY, LGA ANDSTATESTATE NAME:____________________________CODE BOXES: OFFICE ONLY[__|__|__]Q906Q907Q908Q909How often did you visit this city/town[NAME OF CITY/TOWN Q905] in the last12 months?Kamar yaya kike ziyartar wannanbirni/gari [NAME OF CITY/TOWN Q901]a cikin watanni goma sha biyu da sukashige?How long do you usually stay when youvisit [NAME OF CITY/TOWN]?Tsawon wane lokaci ki kan zauna idan kika kai ziyarar [NAME OF CITY/TOWN]?During your visit(s), do you ever discussfamily planning/child birth spacing/childspacing with anybody?A lokacin ziyarar shin kokin taba yinmagana game da tsarin iyali/tazaratsakanin haihuwa/tazara tsakanin yara dawata/wanni?During your visit(s), do you ever seekfamily planning spacing services?A lokacin ziyarar,shin ko kin taba nemandabarar tsarin iyali/tazara tsakaninhaihuwa/tazara tsakanin yara?SHE HAS NOT TRAVELED IN THE PAST YEAR……………….2PER WEEK……………………..….…1[__|__]PER MONTH…………………………2PER YEAR……………………………3[__|__][__|__]DAYS …………………………………..1[__|__]WEEKS ………………………………. .2[__|__]MONTHS …………………..………....3[__|__]YES………………………………………………………1NO………………………………………………………..2YES……………………………………………….……1NO………………………………………………….…..2Q910Q910Do friends or family from ANOTHERCITY OR TOWN IN Nigeria ever come tovisit you?Shin kawayen ki ko iyalan ki daga wananwurin sun taba ziyartan ki?YES…………………………………………….………1NO……………………………………………….……..2Q913Q911Q912Do you ever talk about family planningwith your friends and family who arevisiting you here?Shin ko kin taba magana akan tsarin iyalida kawaye da iyalin ki idan sun ziyarce kianan?Do your friends and family who visit everseek family planning services when theyare visiting?Shin ko kawayen ki ko iyalan ki sun tabaneman dabarar tsaran iyali yayin da sukaziyarce ki?YES……………………………………………………1NO……………………………………………………..2YES…………………………………………………………1NO…………………………………………………………..2DON’T KNOW…………………………………..…………8In the past 12 months, have you visited arural area in Nigeria in order to visit familyor friends?YES . . . . . . . . . . . . . . . . . . . . . . ………………………1Q913A wata goma sha biyu da suka shige, kintaba ziyartan wani karkara (kauye) aNijeriya da niyar ziyartan ‘yan’uwa kokawaye?NO . . . . . . . . . . . . . . . . . . . . . . …………………..……2Q100542