| A | B | C | D | E | F | G | H | I | J | K | M | N | O | P | Q | R | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | _notes | type | repeat_count | name | read_only | relevant | calculation | required | appearance | default | constraint | label::English | hint::English | label::Swahili | hint::Swahili | ||
2 | S.E.L.F. Study: Quantitative Survey – Pregnancy Termination | ||||||||||||||||
3 | imei | imei | |||||||||||||||
4 | start | survey_start | |||||||||||||||
5 | end | survey_end | |||||||||||||||
6 | today | survey_day | |||||||||||||||
7 | deviceid | deviceid | |||||||||||||||
8 | simserial | sim_serial_number | |||||||||||||||
9 | phonenumber | phone_number | |||||||||||||||
10 | calculate | uuid | concat('uuid:', uuid()) | ||||||||||||||
11 | Consent | ||||||||||||||||
12 | select_one okay | consent_ok | yes | quick | Informed consent obtained for S.E.L.F. quantitative survey. | Obtain informed consent from the participant. | Makubaliano iliyo toka kwenyi utafiti inayo husu Idadi Ofisini S.E.L.F. | Makubaliano kutokeya wauzuriaji | |||||||||
13 | A. Survey / RDS Details | ||||||||||||||||
14 | begin_group | section_a | A. Survey / RDS Details | A. Utafiti | |||||||||||||
15 | text | q_1 | yes | 1. Voucher Number | 1. Namba ya Mulengwa | ||||||||||||
16 | date | q_2 | yes | .<=today() | 2. Date of interview | 2. Siku ya kujibu ku maswali ama maulizo | |||||||||||
17 | end_group | ||||||||||||||||
18 | B. Demographics | ||||||||||||||||
19 | begin_group | section_b | Demographics | Utafiti kuhusu wakaaji | |||||||||||||
20 | integer | q_5 | yes | .>0 and .<=100 | 5. What is your age? | Age in years | 5. Una umri gani? | # miaka | |||||||||
21 | begin_group | subsection_b1 | ${q_5} > 17 | ||||||||||||||
22 | select_one location | q_6 | yes | 6. In which part of South Kivu do you currently live? | town/village | 6. Ni mahali gani una ishi kwa sasa ndani ya Jimbo la Kivu ya Kusini? | mjini ao kijijini | ||||||||||
23 | select_one location | q_7 | ${q_6} != -1 | yes | 7. In which part of South Kivu is your hometown/village? | 7. Muji ama kijiji yako ni gani ndani ya Jimbo la Kivu ya Kusini? | |||||||||||
24 | added v283 | text | q_7s | ${q_7} = -1 | yes | Specify Other location. | Ni gani | ||||||||||
25 | select_one q8_options | q_8 | ${q_6} != -1 | yes | 8. Which ethnic group do you identify with most? | 8. Kabila yako ni gani? | |||||||||||
26 | text | q_8s | ${q_8} = -1 and ${q_6} != -1 | yes | Specify Other ethnic group. | Ni gani | |||||||||||
27 | select_one q9_options | q_9 | ${q_6} != -1 | yes | 9. What is your current marital status? | PROBE: if married, ask: �Do you live with your husband now?� and if no, probe to determine if divorced/separated or just for economic reasons | 9. Je Umeolewa ao hapana? | Kama amefanya ndowa, umuulize: “Unaishi na mume wako kwa sasa? Na kama hapana, fanya utafiti kusudi ujuwe kama dowa imevunjwa kiserkali / ama wameachana na hawaishi pamoja sababu ya ukosefu?” | |||||||||
28 | text | q_9s | ${q_9} = -1 and ${q_6} != -1 | yes | Specify Other marital status. | Ni gani | |||||||||||
29 | select_one q10_options | q_10 | ${q_6} != -1 | yes | 10. What religion do you identify with most? | 10. Una Sali katika dini gani? | |||||||||||
30 | text | q_10s | ${q_10} = -1 and ${q_6} != -1 | yes | Specify Other religion. | Ni gani | |||||||||||
31 | select_one q11_options | q_11 | ${q_6} != -1 | yes | 11. What is your main occupation? | 11. Una fanya kazi gani? | |||||||||||
32 | text | q_11s | ${q_11} = -1 and ${q_6} != -1 | yes | Specify Other occupation. | Ni gani | |||||||||||
33 | select_one q12_options | q_12 | ${q_6} != -1 | yes | 12. What is the highest level of schooling that you have completed? | 12. Umesoma kiasi gani? | |||||||||||
34 | text | q_12s | ${q_12} = -1 and ${q_6} != -1 | yes | Specify Other level of schooling. | Ni gani | |||||||||||
35 | integer | q_13 | ${q_6} != -1 | yes | .>=0 and .<10 | 13. How many meals per day do you usually eat? | not including tea or water only as meal | 13. Unakulaka mara ngapi kwa siku | bila kutaja chai ama maji | ||||||||
36 | select_one q14_options | q_14 | ${q_6} != -1 | yes | 14. What material is your home or shelter primarily made of? | 14. Nyumba ama makao yako imejengwa zaidi na nini (chagua kati za majibu zifwatayo)? | |||||||||||
37 | text | q_14s | ${q_14} = -1 | yes | Specify Other material used for housing. | Ni gani | |||||||||||
38 | end_group | subsection_b1 | |||||||||||||||
39 | end_group | ||||||||||||||||
40 | C. Obstetric & Gynecologic History | ||||||||||||||||
41 | begin_group | section_c | ${q_5} > 17 and ${q_6} != -1 | C. Obstetric & Gynecologic History | C. Historia ya uzazi | ||||||||||||
42 | integer | q_15 | yes | .>=0 and .<30 | 15. How many pregnancies have you had in your lifetime that resulted in a child that was born alive? | 15. Kati ya mimba ambazo ume pata, ngapi zime fikiliya watoto walio zaliwa wazima? | |||||||||||
43 | integer | q_16 | yes | .>=0 and .<30 | 16. How many pregnancies have you had in your lifetime that resulted in a child that was born dead? | 16. Kati ya mimba ambazo ume pata, ngapi zime fikiliya watoto walio zaliwa wana kufa? | |||||||||||
44 | integer | q_17 | yes | .>=0 and .<30 | 17. How many pregnancies have you had in your lifetime that resulted in spontaneous miscarriage? | 17. Kati ya mimba ambazo ume pata, ngapi zime fikiliya mimba iliotoka bila kutaka? | |||||||||||
45 | integer | q_18 | yes | .>=0 and .<30 | 18. How many pregnancies have you had in your lifetime that resulted in intentional termination? | 18. Kati ya mimba ambazo ume pata, ngapi zime fikiliya mimba iliotoka kwa kutaka? | |||||||||||
46 | end_group | ||||||||||||||||
47 | D. Sexual Violence History | ||||||||||||||||
48 | begin_group | section_d | ${q_5} > 17 and ${q_6} != -1 and ${q_18} > 0 | D. Sexual Violence History | D. Historia kuhusu ujeuri (ubakaji) | ||||||||||||
49 | note | n_19 | The following questions are to learn more about your experience of sexual violence, which includes forced intercourse against your will, being forced to undress, molestation, and Other unwanted sexual acts. I am particularly interested in your experience of sexual violence since the beginning of the war (~1996). Please feel free to take your time in responding to these questions. We can stop or take a break at any time if you need to. I appreciate that these are sensitive questions. | Read to respondent | Maulizo yafwatayo yata turuhusu kuelewa vizuri maisha yako kuhusu shida za ujeuri kwa wa mama na wabinti inayo lingana na kuingiliwa kupitiya viungo vya uzazi bila wewe kutaka, kuondolewa mavazi kwa kingufu, kuguswa, na zingine njia. Ningependa kujuwa zaidi kuhusu shida ulizo zipata kuhusu ubakaji tangu vita vya mwaka wa 1996. Tafadhali, ujisikie huru kwa kujibu kwa maswali haya. Nafikiri maulizo haya labda yanagusa zamiri zako. | Kusoma | |||||||||||
50 | integer | q_19 | yes | 19. How many times have you experienced sexual violence since the beginning of the war in 1996? | 19. Marangapi ume bakwa tangu vita vya 1996 ? | ||||||||||||
51 | integer | q_20 | ${q_19} > 0 | yes | 20. How many pregnancies have resulted from sexual violence since the beginning of the war in 1996? | 20. Umebeba mimba ngapi kutokana na ubakaji tangu vita vya 1996? | |||||||||||
52 | select_one yes_no | q_21 | ${q_20} > 0 | yes | 21. Were any of the pregnancy/pregnancies which resulted from sexual violence terminated? | 21. Kumekuwa mimba ambazo zime tokana na ubakaji ambazo zimetoka? | |||||||||||
53 | integer | q_22 | selected(${q_21}, '1') and ${q_20} > 0 | yes | .>0 and .<=${q_20} | 22. Please specify the number of terminations. | 22. Ujulishe ni mimba ngapi zimetoka. | ||||||||||
54 | calculate | termination_nb | if(${q_20}=1, 1, int(${q_22})) | ||||||||||||||
55 | end_group | ||||||||||||||||
56 | E. Sexual Violence & Pregnancy | ||||||||||||||||
57 | begin_group | part_1 | ${termination_nb} > 0 and ${q_6} != -1 and selected(${q_21}, '1') | I | I | ||||||||||||
58 | begin_group | section_e | E. Sexual Violence & Pregnancy | E. Ubakaji na mimba | |||||||||||||
59 | note | n_23 | THE FOLLOWING QUESTIONS REFER TO THE (SEE ABOVE NUMBER) TERMINATION OF SEXUAL VIOLENCE RELATED PREGNANCIES SINCE THE BEGINNING OF THE WAR IN 1996. Please feel free to take your time in responding to these questions. You may stop or take a break at any time if you need to. I appreciate that these are sensitive questions. | Read to respondent | Maulizo zifwatayo zina gusa (ona idadi yenyi kuwa juu) mimba na mtoto ama watoto wanao tokana na Maswali yafwatayo yana husu ubakaji uliyo pelekeya kubeba mimba tangu vita ya 1996. Tafadhali, ujisikie huru kwa kujibu kwa maswali haya. Nafikiri maulizo haya labda yanagusa zamiri zako. | Kusoma | |||||||||||
60 | check SW string | begin_repeat | term_loop | PREGNANCY TERMINATION# | ZIMETOKA # | ||||||||||||
61 | select_one q23_options | q_23 | yes | 23. During the sexual assault that led to this pregnancy, how many different assailants would you estimate raped you? ) | 23. Wakati ulipata shida ya ubakaji na kubeba mimba, niwabakaji wa ngapi waliokutenda hiyo kitendo? | ||||||||||||
62 | select_one yes_no_dn | q_24 | yes | 24. Was this pregnancy conceived while the assailant(s) held you in captivity for > 24 hours? | 24. Ulikuwa ukishikwa na mubakaji (wabakaji) zaidi ya saa makumi mbili na ine? | ||||||||||||
63 | begin_group | date_assault | field-list | ||||||||||||||
64 | note | note_assault | minimal | 25. If known, what was the date of the sexual assault? | 25. Ubakaji lifanyika wakati gani? | ||||||||||||
65 | select_one calendarYears | assault_yyyy | yes | minimal | Year | Mwaka | |||||||||||
66 | select_one calendarMonths | assault_mmm | yes | minimal | Month | Mwezi | |||||||||||
67 | select_one calendarDays | assault_dd | yes | minimal | Day | Siku | |||||||||||
68 | end_group | date_assault | |||||||||||||||
69 | select_multiple q26_options | q_26 | yes | 26. How would you best describe the perpetrator(s) | Do NOT read options; select all that apply | 26. Unaweza kusema machache kuhusu wale wabakaji/mubakaji ? | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | ||||||||||
70 | text | q_26s | selected(string(${q_26}), '-1') or selected(string(${q_26}), '32') | yes | Specify Other. | Ni gani | |||||||||||
71 | select_one calendarYears | q_27 | yes | 27. What year did the pregnancy occur in? | 27. Mwaka gani umebeba mimba ? | ||||||||||||
72 | integer | q_28 | yes | .>=0 and .<9 | 28. At how many months gestation, did you find out that you were pregnant? | Input zero (0) if unknown. | 28. Kisha myezi ngapi umetambua kama uko na mimba? | Hakuna kitu (0) kama sababu haijulikane | |||||||||
73 | note | n_29 | I would like to speak with you more about the process of seeking a termination for pregnancies resulting from sexual violence. I understand that these are sensitive questions. Please feel free to take your time in responding to these questions. You may stop or take a break at any time if you need to. | Read to respondent | Ninge penda tuzungumuze na wewe kuhusu namna mimba imefika kutoka kisha kubakiwa. Najua kama maulizo haya ni mazito. Tafazali ujisikiye huru kwa ku jibu kwa maulizo haya. Ukiya sikiya mazito una weza kuto endeleya kujibu. | Kusoma | |||||||||||
74 | integer | q_29 | yes | 29. How many months gestation were you at the time of the termination? | Input zero (0) if unknown. | 29. Ulikuwa na miezi ngapi ya mimba wakati ilitoka? | Hakuna kitu (0) kama sababu haijulikane | ||||||||||
75 | select_multiple q30_options | q_30 | yes | 30. How did you find out where to go for a pregnancy termination | Do NOT read options; select all that apply | 30. Namna gani ulijuwa nafasi pa kwenda kuondosha mimba | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | ||||||||||
76 | text | q_30s | selected(string(${q_30}), '-1') | yes | Specify Other. | Ni gani | |||||||||||
77 | integer | q_31 | yes | (. >= 0) and (.<= 100) | 31. How many times did you try to terminate the pregnancy? | number of times | 31. Mara ngapi ume jaribu kutosha mimba? | mara ngapi | |||||||||
78 | select_multiple q32_options | q_32 | ${q_31} > 0 | yes | 32. What method of termination did you use? | Do NOT read options; select all that apply | 32. Umetumiya njia gani? | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | |||||||||
79 | text | q_32s | ${q_31} > 0 and selected(string(${q_32}), '-1') | yes | Specify Other method of termination | Ni gani | |||||||||||
80 | text | q_32s_name | ${q_31} > 0 and not(selected(string(${q_32}), '8')) and not(selected(string(${q_32}), '9')) and not(selected(string(${q_32}), '-1')) | yes | Please specify the name of the medicine/herb used | Kama ndiyo, taja jina ya dawa /muti uliyo ingiza | |||||||||||
81 | select_multiple q33_options | q_33 | ${q_31} > 0 and (selected(string(${q_32}),'1') or selected(string(${q_32}), '2') or selected(string(${q_32}),'3') or selected(string(${q_32}), '4') or selected(string(${q_32}), '5') or selected(string(${q_32}), '6') or selected(string(${q_32}),'7')) or count-selected(${q_32}) > 1 | yes | 33. Who gave you the medication or told you what medication to take | Do NOT read options; select all that apply | 33. Ni nani aliye kupatiya dawa hiyo ao ni nani aliye kujulisha kuhusu dawa hiyo? | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | |||||||||
82 | text | q_33s | ${q_31} > 0 and selected(string(${q_34}), '-1') | yes | Specify Other medication provider. | Ni gani | |||||||||||
83 | select_multiple q34_options | q_34 | ${q_31} > 0 and (selected(string(${q_32}),'3') or selected(string(${q_32}), '4') or selected(string(${q_32}), '5') or selected(string(${q_32}), '6') or selected(string(${q_32}),'7') or selected(string(${q_32}),'8')) or count-selected(${q_32}) > 1 | yes | 34. Who performed the procedure or injected the medication? | Do NOT read options; select all that apply | 34. Ni nani aliye husika na kuku tosha ile mimba ao ni nani aliyekupatiya dawa ya kuitosha? | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | |||||||||
84 | text | q_34s | ${q_31} > 0 and selected(string(${q_35}), '-1') | yes | Specify Other. | Ni gani | |||||||||||
85 | select_multiple q34_options | q_35 | ${q_31} > 0 and ${q_32}= 9 or count-selected(${q_32}) > 1 | yes | 35. Who performed the ritual or ceremony? | Do NOT read options; select all that apply | 35. Ni nani aliyehusika na nambo ya kiasili kwa kukutosha mimba hiyo? | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | |||||||||
86 | text | q_35s | ${q_31} > 0 and selected(string(${q_36}), '-1') | yes | Specify Other. | Ni gani | |||||||||||
87 | select_one q36_options | q_36 | ${q_31} > 0 | yes | 36. What did you pay for your termination? | 36. Ni nini ulilipa kwa kuondowa mimba? | |||||||||||
88 | select_one q36_prices | q_36_price | ${q_36} = 1 | yes | How much? | Pesa ngapi? | |||||||||||
89 | text | q_36s | ${q_36} = -1 | yes | Specify Other means of payment. | Ni gani | |||||||||||
90 | check SW string | select_multiple q37_options | q_37 | ${q_31} > 0 and ${q_36} = 1 | yes | 37. How did you pay for the termination? | Do NOT read options; select all that apply | 37. Kama ni hapana, umefanya je kwaku pata franka ya kulipa kwa kuondowa mimba. | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | ||||||||
91 | text | q_37s | ${q_31} > 0 and selected(string(${q_37}), '-1') | yes | Specify Other. | Ni gani | |||||||||||
92 | select_one yes_no | q_38 | ${q_31} > 0 and ${q_31} > 0 | yes | 38. Did you have any physical symptoms or complications from the termination? | 38. Je ulipata alama kwa mwili ama magumu kuhusu kutoka kwa mimba? | |||||||||||
93 | select_multiple q39_options | q_39 | ${q_31} > 0 and ${q_38} = 1 | yes | 39. What were the physical symptoms or complications? | Do NOT read options; select all that apply | 39. Alama gani uliyopata kwa mwili ama magumu? | Usisome majibu, una weza kuchaguwa yote kama ina wezekana | |||||||||
94 | text | q_39s | ${q_31} > 0 and selected(string(${q_39}), '-1') | yes | Specify Other. | Ni gani | |||||||||||
95 | select_one yes_no | q_40 | ${q_31} > 0 and ${q_38} = 1 | yes | 40. Did you seek care for the complication(s)? | 40. Ulitafuta matunzo sababu ya ile magumu? | |||||||||||
96 | select_multiple q41_options | q_41 | ${q_31} > 0 and ${q_40} = 1 | yes | 41. Where did you seek care for the complication(s) or symptoms? | 41. Wapi umepewa matunzo kwa matokeo/alama ulizo zipata? | |||||||||||
97 | text | q_41s | ${q_31} > 0 and selected(string(${q_41}), '-1') | yes | Specify Other. | Ni gani | |||||||||||
98 | select_multiple q42_options | q_42 | ${q_31} > 0 | yes | 42. How were you affected emotionally and socially after the termination? | 42. Umesikiya je kimawazo ama ki jirani kisha kutowa mimba ? | |||||||||||
99 | text | q_42s | ${q_31} > 0 and selected(string(${q_42}), '-1') | yes | Specify Other. | Ni gani | |||||||||||
100 | end_repeat |