Baseline Women's questionnaire - Yoruba/English

OFFICE USE ONLY: QUESTIONNAIRE NO: [__|__|__|__|__|__|__|__|__](cluster code 4 digits + HH number 3 digits + Respondent line number 2 digits)Q1101FOLLOW-UP CONTACTSSURNAME OF RESPONDENT: ____________________________________________________Q1102FIRST OR GIVEN NAME OF RESPONDENT:__________________________________________Q1103PASSPORT NUMBER/ NATIONAL ID NUMBER OF RESPONDENT [__|__|__|__|__|__|__|__]__|__]__]DON’T HAVE ID NUMBER………99999999998Q1104 STREET NAME / ADDRESS OF RESIDENCE:_______________________________________________________________________________________________________________________________________________________________________As I mentioned earlier, we would like to follow-up with this household in two years and then again in another 2 years to see what, if anything,has changed according to health and information needs. For this reason, I will be asking for the contact information of people that maybeable to tell us where you and your household are in 2 years and in 4 years in case you move. Remember you are free to skip any questionsthat you are uncomfortable providing answers to. This information will be kept separate from your responses in a locked cabinet in a securedroom where only the primary researcher can assess. Remember you are free to skip any questions that you are uncomfortable providinganswers toBi mo se so tele, a ma fe lati tesiwaju pelu yin ninu iwadi ni odun meji si asiko ti a wa yi ,lehin eyi atun ma pada wa ti odun meji miran ba pelati ri awon iyipada to ba wa pelu eto ilera yin ati awon ifitonileti ti e nilo. Fun idi eyi, ma fe lati gba akosile to peye nipa awon ti o le se alayebi ase le ri yin ni odun meji ati merin si akoko yi, nitoripe o sese pe ki e ti pa ibugbe da. Eranti wipe e le sai dahun eyi keyi ninu awon ibeerewonyi ti ko ba rorun fun yin lati fun wa lesi fun.A o pa Ifitonileti yi mo si aye oto kuro lara awon idahun yin toku.Yio wa ninu apoti onirin ti a osi ti pa.Osise agba ti o dari iwadi yi nikan ni yo ni anfani lati ri. E ranti wipe e le ko lati dahun awon ibeere ti ko ba fe dahunsiQ1105 What other names are youcommonly known by?_______________________________________________________Q1106Q1107Q1108Q1109Q1110Kini oruko inagije eyi ti a fi mo yindada?Do you have access to a mobilephone OR landline telehone?Nje e ni ero ibanisoro alagbeka tabiti inu ile?If yes, could you please share withme a mobile phone number ORlandline for contacting you?To ba je be, nje e le fun mi ni awonnomba ero ibanisoro alagbeka tabitinu ile lati le fi pe yin?Could you also please share with mea second mobile phone number orlandline number for contacting you?Nje e tun le so fun mi nipa nombaibanisoro alagbeka keji/tinu ile ti a lefi bayin soro?Does your family/household haveany plans to move in the next twoyears?IF YES, where do you plan to moveto?Nje ebi yin ni ero lati ko kuro nibiodun meji si asiko yi?IF YES, Nibo ni e lero lati ko lo?IF RESPONDENT IS NOT HHHEAD:What is the name and mobile phonenumber (if possible) of the head ofthis household?Kini oruko tabi nomba ibanisoro (ti oba seese) olori idile yi?YES…………………..1NO…………………….2 skip to 1109PRIMARY MOBILE NUMBER [ __|__|___|___|___|___|___|___|___|___|___|PRIMARY LANDLINE /FIXED WIRELESS NUMBER_____________________________SECONDARY MOBILE NUMBER: [ __|___|___|___|___|___|___|___|___|___|___|SECONDARY LANDLINE/FIXED WIRELESS NUMBER_________________________YES, ___________________________________________________________________________________...1(SPECIFY)NO PLANS TO MOVE………………………………….…….2NAME: _________________________MOBILE NUMBER: [ __|__|___|___|___|___|___|___|___|___|___|Page 67