Questionnaire Text
Burkina Faso 2014
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Burkina Faso 2015
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Burkina Faso 2016a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Burkina Faso 2016b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Burkina Faso 2017
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Burkina Faso 2018
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Burkina Faso 2020
Questionnaire form
view entire document:
text
115b. How many months pregnant are you?
Burkina Faso 2021
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Burkina Faso 2022
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2013
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2014
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2015a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2015b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2015c
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2016a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2016b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2017a
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Congo (Democratic Republic) 2017b
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Congo (Democratic Republic) 2018a
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Congo (Democratic Republic) 2018b
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Congo (Democratic Republic) 2019a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2019b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2020
Questionnaire form
view entire document:
text
204. How many months pregnant are you?
Congo (Democratic Republic) 2020
Questionnaire form
view entire document:
text
204. How many months pregnant are you?
Congo (Democratic Republic) 2021
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Congo (Democratic Republic) 2021
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Cote d'Ivoire 2017
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Cote d'Ivoire 2018
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Cote d'Ivoire 2020
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Cote d'Ivoire 2021
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Ethiopia 2014a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ethiopia 2014b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ethiopia 2015
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ethiopia 2016
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ethiopia 2017
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ethiopia 2018
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ethiopia 2019
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ethiopia 2020
Questionnaire form
view entire document:
text
202b. How many months pregnant are you?
Please record the number of completed months. Enter -88 for do not know, -99 for No response.
Value must be at least 0 and not more than 10.
Ghana 2013
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ghana 2014a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ghana 2014b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Ghana 2015
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Ghana 2016
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Ghana 2017
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
India 2016
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
India 2017a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
India 2017b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
India 2018
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
India 2020
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
India 2021
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Indonesia 2015
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Indonesia 2016
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Kenya 2014a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Kenya 2014b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Kenya 2015a
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Kenya 2015b
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Kenya 2016
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Kenya 2017
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Kenya 2018
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Kenya 2019
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Kenya 2020
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Kenya 2021
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Niger 2015
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Niger 2016a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Niger 2016b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Niger 2017
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Niger 2018
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Niger 2020
Questionnaire form
view entire document:
text
210. How many months pregnant are you?
Please record the number of completed months. Enter -88 for do not know, -99 for No response.
CALENDAR: Enter number of months pregnant in the calendar.
Value must be at least 0 and not more than 10. A current pregnancy must start after the most recent birth.
Niger 2022
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2014a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2014b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2015a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2015b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2016
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2017a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2017b
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Nigeria 2018
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Nigeria 2019a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2019b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2020a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2020b
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Nigeria 2021a
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Nigeria 2021b
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Uganda 2014
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Uganda 2015a
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Uganda 2015b
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Uganda 2016
Questionnaire form
view entire document:
text
210b. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response. Number of months____
Uganda 2017
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Uganda 2018
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Uganda 2019
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Uganda 2020
Questionnaire form
view entire document:
text
15. How many months pregnant are you? The most recent birth was: [Date of most recent birth]
Please record the number of completed months. Enter -88 for do not know, -99 for no response.
Number of months:_______________
Uganda 2021
Questionnaire form
view entire document:
text
204. How many months pregnant are you?
The most recent birth was: {rec_birth_date}
Please record the number of completed months. Enter -88 for do not know, -99 for No response.
CALENDAR: Enter number of months pregnant in the calendar.
Value must be at least 0 and not more than 10. A current pregnancy must start after the most recent birth.