Questionnaire - Measurement, Learning & Evaluation Project

BIRTH HISTORYNow I would like to record the names of all your births since JANUARY 2010, whether still alive or not, starting with the first one you had.Yanzu ina so in rubuta sunayen ‘ya’yan da ki ka Haifa, wadanda suke raye da wanda suka rasu, zan fara da haihuwar ki ta farko.RECORD NAMES OF ALL THE LIVEBIRTHS SINCE JANUARY 2010 in Q215. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 5 BIRTHS,USE AN ADDITIONAL QUESTIONNAIRE. STARTING WITH THE SECOND ROW.(Q214)Line no.(Q215)What name was given to yourbaby?Wanne suna a ka ba wa da ko yar kita (tun daga Jeneru 2010)?(Q216)Were anyof thesebirthstwins/triplets?Wannanhaihuwartagwaye neko ‘yanuku?CIRCLE(Q217)Is(NAME)a boy ora girl?Shin(Suna)namijine komace?CIRCLE(Q218)In what month andyear was (NAME)born? PROBE: Whatis her/his birthday?(other probes: whatseason was it)A wanne wata ne dashekara ki ka haifi(SUNA)?PROBE:Yaushe neranar haihuwar sa/ta?(Other probes: Awane lokaci (daminako rani) ?(Q219)Is (NAME)still alive?Shin(SUNA)ya/ta naraye?(Q220)IF ALIVE:How old is(NAME)currently?Shekarun(SUNA) nawane cikakku?RECORD AGEINCOMPLETEDMONTHS; IFLESS THANONE MONTH,RECORD “00”.(Q221)IF ALIVE:Is (Name) livingwith you?(SUNA) ya/tana zama tareda ke?(Q222)IF DEAD:How old was (NAME) whenshe/he died?IF LESS THAN 2 YEARS,PROBE:How many months old was(NAME)?Shekarun (SUNA) nawa nekafin rasuwar sa/ta?IF 1 YR, PROBE:Watan (SUNA) nawa nekafin rasuwar sa/ta?IF LESS THAN 1 MONTHOLD, RECORD DAYS.(Q223)Were there any otherlive births between(NAME OF PREVIOUSBIRTH) and (NAME),including any childrenwho died after birth?Akwai wata haihuwa mairai a tsakanin (NAMEOF PREVIOUS BIRTH)and (NAME), Harda‘ya’yan da suka rasubayan haihuwa?01NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip toNEXTQ214DAYS….….1 [__|__]MONTHS…2 [__|__]DK………...…….99802 NAME:__________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS….….1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH03NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS….….1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH04NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK……….....98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS……..1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH05 NAME:_____________________________SING……1MULT…..2BOY…1GIRL...2MONTH [__|__]DK………….98YEAR [__|__][__|__]DK…………….9998YES….1NO……2Q222AGE INMONTHS[__|__]YES…..1NO……2All skip to Q223DAYS……..1 [__|__]MONTHS…2 [__|__]DK…………...….998YES…1NO....2ADD BIRTHNEXT BIRTH8