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AFGHANISTAN DEMOGRAPHIC AND HEALTH SURVEY 2015 EVER-MARRIED MAN'S QUESTIONNAIRE

CENTRAL STATISTICS ORGANIZATION AND MINISTRY OF PUBLIC HEALTH

IDENTIFICATION

PROVINCE

DISTRICT

VILLAGE/NAHIA

CONTROLLER AREA

CLUSTER NUMBER

TYPE OF LOCATION

URBAN=1
RURAL=2

STRUCTURE/BUILDING NUMBER/GATE NUMBER

HOUSEHOLD NUMBER

NAME OF HOUSEHOLD HEAD

NAME AND LINE NUMBER OF MAN

INTERVIEWER VISITS

FIRST VISIT
DATE
INTERVIEWER'S NAME
RESULT

RESULT CODING:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER_________

NEXT VISIT
DATE
TIME

SECOND VISIT
DATE
INTERVIEWER'S NAME
RESULT

NEXT VISIT
DATE
TIME

THIRD VISIT
DATE
INTERVIEWER'S NAME
RESULT

FINAL VISIT
DAY
MONTH
YEAR
INT. NO.
RESULT

TOTAL NUMBER OF VISITS

LANGUAGE OF INTERVIEW

DARI 1
PASHTO 2
OTHER________6

NATIVE LANGUAGE OF RESPONDENT

DARI 1
PASHTO 2
OTHER________6

TRANSLATOR USED?

YES 1
NO 2

SUPERVISOR
NAME

FIELD EDITOR
NAME

OFFICE EDITOR
NAME

KEYED BY
NAME

SECTION 1. RESPONDENT'S BACKGROUND

INFORMED CONSENT

As-salamu alaykum. My name is _______________________________________. I am working with Central Statistics Organization. We are conducting a survey about health all over Afghanistan, which is conducted with the joint effort of the Ministry of Public Health and Central Statistics Organization. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions? May I begin the interview now?

SIGNATURE OF INTERVIEWER:________________________
DATE:__________

RESPONDENT TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED (END)

101. RECORD THE TIME.

HOUR___
MINUTES____

102. In what month and year were you born?

MONTH___
DON'T KNOW MONTH 98
YEAR_____
DON'T KNOW YEAR 9998

103. How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.

AGE IN COMPLETED YEARS____

104. Have you ever attended school?

YES 1
NO 2 (GO TO 108)

104A. What type of school have you attended?

SCHOOL 1
MADRASSA 2

105. What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3

106. What is the highest grade you completed?

IF COMPLETED LESS THAN GRADE ONE, RECORD '00'.

GRADE____

107. CHECK 105

PRIMARY (GO TO 108)
SECONDARY OR HIGHER (GO TO 110)

108. Now I would like you to read this sentence to me.

SHOW CARD TO RESPONDENT.

IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE)_____________4
BLIND/VISUALLY IMPAIRED 5

109. CHECK 108:

CODE '2', '3' OR '4' CIRCLED (GO TO 110)
CODE '1' OR '5' CIRCLED (GO TO 111)

110. Do you read a newspaper or magazine, at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

111. Do you listen to the radio, at least once a week, less than once a week or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

112. Do you watch television, at least once a week, less than once a week, or not at all?

AT LEAST ONCE A WEEK 1
LESS THAN ONCE A WEEK 2
NOT AT ALL 3

113. To which ethnic group do you belong?

PASHTUN 01
TAJIK 02
HAZARA 03
UZBEK 04
TURKMEN 05
NURISTANI 06
BALOCH 07
PASHAI 08
OTHER__________96

SECTION 2. REPRODUCTION

201. Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name.

Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)

202. Do you have any sons or daughters that you have fathered who are now living with you?

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?

SONS AT HOME____

And how many daughters live with you?

DAUGHTERS AT HOME____

IF NONE, RECORD '00'.

204. Do you have any sons or daughters that you have fathered who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you?

SONS ELSEWHERE___

And how many daughters are alive but do not live with you?

DAUGHTERS ELSEWHERE___

IF NONE, RECORD '00'.

206. Have you ever fathered a son or a daughter who was born alive but later died?

IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

YES 1
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 208)

207. How many boys have died?

BOYS DEAD___

And how many girls have died?

GIRLS DEAD___

IF NONE, RECORD '00'.

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.

TOTAL CHILDREN____

209. CHECK 208:

HAS HAD MORE THAN ONE CHILD (GO TO 210)
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)

210. Did all of the children you have fathered have the same biological mother?

YES 1 (GO TO 212)
NO 2

211. In all, how many women have you fathered children with?

NUMBER OF WOMEN____

212. How old were you when your (first) child was born?

AGE IN YEARS____

213. CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD (GO TO 214)
NO LIVING CHILDREN (GO TO 301)

214. How old is your (youngest) child?

AGE IN YEARS___

215. CHECK 214:

YOUNGEST CHILD IS AGE 0-2 YEARS (GO TO 216)
OTHER (GO TO 301)

216. What is the name of your (youngest) child?

WRITE NAME OF (YOUNGEST) CHILD

NAME___________________

217. When (NAME)'s mother was pregnanat with (NAME), did she have any antenatal check-ups?

YES 1
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)

218. Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

219. Was (NAME) born in a hospital or health facility?

HOSPITAL/HEALTH FACILITY 1
OTHER 2

220. When a child has diarrhea, how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing to drink at all?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8

SECTION 3. CONTRACEPTION

301. Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.

Have you ever heard of (METHOD)?

01. Female Sterilization. PROBE: Women can have an operation to avoid having any more children.
YES 1
NO 2
02. Male Sterilization. PROBE: Men can have an operation to avoid having any more children.
YES 1
NO 2
03. IUD. PROBE: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
04. Injectables. PROBE: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
05. Implants. PROBE: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
06. Pill. PROBE: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
07. Male Condom. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
09. Lactational Amenorrhea Method (LAM)
YES 1
NO 2
10. Rhythm Method. PROBE: To avoid pregnancy, women do not have sexual intercourse on the days of the month they think they can get pregnant.
YES 1
NO 2
11. Withdrawal. PROBE: Men can be careful and pull out before climax.
YES 1
NO 2
12. Emergency Contraception. PROBE: As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.
YES 1
NO 2
13. Have you heard of any other ways or methods that women can use to avoid pregnancy?
YES 1 (SPECIFY)_______________
NO 2

302. In the last few months have you:

Heard about family planning on the radio?
YES 1
NO 2
Seen anything about family planning on the television?
YES 1
NO 2
Read about family planning in a newspaper or magazine?
YES 1
NO 2
Seen or read about family planning on the internet?
YES 1
NO 2
Read about family planning in billboard?
YES 1
NO 2
Heard from health professionals?
YES 1
NO 2
Heard from local community leaders?
YES 1
NO 2

303. In the last few months, have you discussed family planning with a health worker or health professional?

YES 1
NO 2

304. Now I would liek to ask you about a woman's risk of pregnancy.

From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant when she has sexual relations?

YES 1
NO 2 (GO TO 306)
DON'T KNOW 8 (GO TO 306)

305. Is the time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER________6

306. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is a woman's business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8

307. CHECK 301 (07): KNOWS MALE CONDOM

YES (GO TO 308)
NO (GO TO 401)

308. Do you know where a person can get male condoms?

YES 1
NO 2 (GO TO 401)

309. Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL, OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
COMMUNITY HEALTH WORKER F
MOBILE CLINIC G
OTHER PUBLIC SECTOR__________H
NON-GOVERNMENT SECTOR
MARIE STOPES I
RED CROSS SOCIETY J
AFGA K
OTHER NGO SECTOR_________L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
FIELDWORKER P
OTHER PRIVATE MEDICAL SECTOR_________Q
OTHER SOURCE
CHARITY/FOUNDATIONS R
REFUGEE CAMP S
SHOP T
FRIENDS/RELATIVES U
OTHER_____________X

310. If you wanted to, could you yourself get a condom?

YES 1
NO 2

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. What is your current marital status: are you married, widowed, divorced, or separated?

CURRENTLY MARRIED 1
WIDOWED 2 (GO TO 410)
DIVORCED 3 (GO TO 410)
SEPARATED 4 (GO TO 410)

404. Is your wife living with you now or is she staying elsewhere?

LIVING WITH HIM 1
STAYING ELSEWHERE 2

405. Do you have other wives?

YES (MORE THAN ONE) 1
NO (ONLY ONE) 2 (GO TO 407)

406. Altogether, how many wives do you have?

TOTAL NUMBER OF WIVES____

407. CHECK 405:

ONE WIFE: Please tell me the name of your wife.
MORE THAN ONE WIFE: Please tell me the name of each of your wives.

RECORD THE NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE.

IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.

NAME___________
LINE NUMBER___

408. How old was (NAME) on her last birthday? ASK 408 FOR EACH PERSON.

AGE____

409. CHECK 407:

ONE WIFE (GO TO 410)
MORE THAN ONE WIFE (GO TO 411A)

410. Have you been married only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 411A)

411. In what month and year did you start living with your wife?

MONTH___
DON'T KNOW MONTH 98
YEAR______ (GO TO 413)
DON'T KNOW YEAR 9998

411A. Now I would like to ask about your first wife. In what month and year did you start living with her?

MONTH___
DON'T KNOW MONTH 98
YEAR______ (GO TO 413)
DON'T KNOW YEAR 9998

412. How old were you when you first started living with her?

AGE____

413. CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

414. Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.

How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 501)
AGE IN YEARS____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE 95

415. Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

416. When was the last time you had sexual intercourse?

IF LESS THAN 12 MONTHS, ANSER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS.
IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUS BE RECORDED IN YEARS.

DAYS AGO 1 _____
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____ (GO TO 438)

418. The last time you had sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 438)

436. What is the brand name of the condom used at the time?

IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

ARAMESH 01
SATHI 02
ASODAGI 03
MOH/UNFPA 04
OTHER________96
DON'T KNOW 98

437. From where did you obtain the condom the last time?

PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL, OR DISTRICT) 11
CHC/POLYCLINIC 12
BASIC HEALTH CENTER 13
HEALTH SUB-CENTER 14
HEALTH POST/SUB-HEALTH POST 15
COMMUNITY HEALTH WORKER 16
MOBILE CLINIC 17
OTHER PUBLIC SECTOR__________18
NON-GOVERNMENT SECTOR
MARIE STOPES 21
RED CROSS SOCIETY 22
AFGA 23
OTHER NGO SECTOR_________26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
FIELDWORKER 34
OTHER PRIVATE MEDICAL SECTOR_________36
OTHER SOURCE
CHARITY/FOUNDATIONS 41
REFUGEE CAMP 42
SHOP 43
FRIENDS/RELATIVES 44
OTHER_____________96

438. The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)

439. What method did you or your partner use?

PROBE: Did you or your partner use any other method to prevent pregnancy? RECORD ALL MENTIONED.

FEMALE STERILIZATION A
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
LAM J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

CURRENTLY MARRIED (GO TO 502)
NOT CURRENTLY MARRIED (GO TO 509)

502. CHECK 439:

MAN NOT STERILIZED (GO TO 503)
MAN STERILIZED (GO TO 509)

503. Is your wife (Are any of your wives) currently pregnant?

YES 1
NO 2 (GO TO 505)
DON'T KNOW 8 (GO TO 505)

504. Now I have some questions about the future. After the (child/children) you are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE ANOTHER CHILD 1 (GO TO 506)
NO MORE 2 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

505. Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 509)
WIFE (WIVES) STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

506. CHECK 407:

ONE WIFE (GO TO 507)
MORE THAN ONE WIFE (GO TO 508)

507. CHECK 503:

WIFE NOT PREGNANT OR DON'T KNOW: How long would you like to wait from now before the birth of (a/another) child?

WIFE PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 _____
YEARS 2 _____
SOON/NOW 993
COUPLE INFECUND 994
OTHER_______996
DON'T KNOW 998

(GO TO 509)

508. How long would you like to wait from now before the birth of (a/another) child?

MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993
HE/ALL HIS WIVES ARE INFECUND 994
OTHER_______996
DON'T KNOW 998

509. CHECK 203 AND 205:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 601)
NUMBER____
OTHER________96 (GO TO 601)

510. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?

NUMBER OF BOYS___
NUMBER OF GIRLS___
NUMBER OF EITHER___

OTHER____________96

SECTION 6. EMPLOYMENT AND GENDER ROLES

601. Have you done any work in the last seven days?

YES 1 (GO TO 604)
NO 2

602. Although you didn't work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?

YES 1 (GO TO 604)
NO 2

603. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 607)

604. What is you occupation, that is, what kind of work do you mainly do?

SPECIFY________________

605. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

606. Are you paid in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

607. CHECK 401:

CURRENTLY MARRIED (GO TO 608)
NOT CURRENTLY MARRIED (GO TO 612)

608. CHECK 606:

CODE 1 OR 2 CIRCLED (GO TO 609)
OTHER (GO TO 610)

609. Who usually decides how the money you earn will be used: you, your wife, or you and your wife jointly?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
OTHER_______6

610. Who usually makes decisions about health care for yourself: you, your wife, you and your wife jointly, or someone else?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER_________6

611. Who usually makes decisions about making major household purchases?

RESPONDENT 1
WIFE 2
RESPONDENT AND WIFE JOINTLY 3
SOMEONE ELSE 4
OTHER_________6

612. Do you own this or any other house either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

613. Do you own any land either alone or jointly with someone else?

ALONE ONLY 1
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4

614. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If she burns the food?
YES 1
NO 2
DON'T KNOW 8

SECTION 7. HIV/AIDS

701. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 723)

702. Can people reduce their chance of getting HIV by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

703. Can people get HIV from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

704. Can people reduce their chance of getting HIV by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

705. Can people get HIV by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

706. Can people get HIV becasue of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

707. Is it possible for a health-looking person to have HIV?

YES 1
NO 2
DON'T KNOW 8

708. Can HIV be transmitted from a mother to her baby:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

709. CHECK 708:

AT LEAST ONE YES (GO TO 710)
OTHER (GO TO 711)

710. Are there any special drugs that a doctor or a nurse can give to a woman infected with HIV to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

710A. From where did you hear or get information about HIV/AIDS? Any other source?

RADIO A
TELEVISION B
NEWSPAPER/MAGAZINE C
POSTER/BILLBOARD D
INTERNET E
HEALTH PROFESSIONALS F
RELIGIOUS INSTITUTIONS G
SCHOOL/TEACHER H
COMMUNITY MEETINGS I
WORKPLACE J
FRIENDS/RELATIVES K
OTHER_______X

711. CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

712. I don't want to know the results, but have you ever been tested to see if you have HIV?

YES 1
NO 2 (GO TO 716)

713. How many months ago was your most recent HIV test?

MONTHS AGO____
TWO OR MORE YEARS AGO 95

714. I don't want to know the results, but did you get the results of the test?

YES 1
NO 2

715. Where was the test done?

PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL, OR DISTRICT) 11
CHC/POLYCLINIC 12
BASIC HEALTH CENTER 13
HEALTH SUB-CENTER 14
HEALTH POST/SUB-HEALTH POST 15
STAND-ALONE VCT CENTER 16
FAMILY PLANNING CLINIC 17
MOBILE CLINIC 18
COMMUNITY HEALTH WORKER 19
OTHER PUBLIC SECTOR__________20
NON-GOVERNMENT SECTOR
MARIE STOPES 21
RED CROSS SOCIETY 22
AFGA 23
OTHER NGO SECTOR_________26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
STAND ALONE VCT CENTER 32
PHARMACY 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL SECTOR_________36
OTHER SOURCE
HOME 41
CHARITY/FOUNDATIONS 42
REFUGEE CAMP 43
OTHER_____________96

(GO TO 718)

716. Do you know of a place where people can go to get tested for HIV?

YES 1
NO 2 (GO TO 718)

717. Where is that? Any other place?

PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL, OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
STAND-ALONE VCT CENTER F
FAMILY PLANNING CLINIC G
MOBILE CLINIC H
COMMUNITY HEALTH WORKER I
OTHER PUBLIC SECTOR__________J
NON-GOVERNMENT SECTOR
MARIE STOPES K
RED CROSS SOCIETY L
AFGA M
OTHER NGO SECTOR_________N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
STAND ALONE VCT CENTER P
PHARMACY Q
MOBILE CLINIC R
FIELDWORKER S
OTHER PRIVATE MEDICAL SECTOR_________T
OTHER SOURCE
HOME U
CHARITY/FOUNDATIONS V
REFUGEE CAMP W
OTHER_____________X

718. Would you buy fresh vegetables from a shopkeeper or vendor if you know that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

719. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

720. If a member of your family became sick with AIDS, would you be willing to care for here or him in you own household?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

721. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in a school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

722. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

723. CHECK 701:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

724. CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 725)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 732)

725. CHECK 723: HEARD ABOUT SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 726)
NO (GO TO 727)

726. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

727. Sometimes men experience abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

728. Sometimes men have a sore or ulcer near the penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

729. CHECK 726, 727, AND 728:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 730)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 732)

730. The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 732)

731. Where did you go? Any other place?

PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)________________
PUBLIC SECTOR
GOVT. HOSPITAL (NATIONAL, REGIONAL, PROVINCIAL, OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
STAND-ALONE VCT CENTER F
FAMILY PLANNING CLINIC G
MOBILE CLINIC H
COMMUNITY HEALTH WORKER I
OTHER PUBLIC SECTOR__________J
NON-GOVERNMENT SECTOR
MARIE STOPES K
RED CROSS SOCIETY L
AFGA M
OTHER NGO SECTOR_________N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
STAND ALONE VCT CENTER P
PHARMACY Q
MOBILE CLINIC R
FIELDWORKER S
OTHER PRIVATE MEDICAL SECTOR_________T
OTHER SOURCE
CHARITY/FOUNDATIONS U
REFUGEE CAMP V
SHOP W
OTHER_____________X

732. If a wife know her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

733. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with other women?

YES 1
NO 2
DON'T KNOW 8

SECTION 8. OTHER HEALTH ISSUES

801. Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?

YES 1
NO 2 (GO TO 805)
DON'T KNOW 8 (GO TO 805)

802. How old were you when you got circumcised?

AGE IN COMPLETED YEARS___

DURING CHILDHOOD (LESS THAN 5 YEARS) 95
DON'T KNOW 98

803. Who did the circumcision?

TRADITIONAL PRACTITIONER/FAMILY/FRIEND 1
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8

804. Where was it done?

HEALTH FACILITY 1
HOME OF A HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISION DONE AT HOME 3
RITUAL SITE 4
OTHER HOME/PLACE 5
DON'T KNOW 8

805. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?

IF YES: How many injections have you had? IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS___
NONE 00 (GO TO 808)

806. Among these injections, how many were administered by a doctor, a nurse, a pharmacisit, a dentist, or any other health worker?

IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS___
NONE 00 (GO TO 808)

807. The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?

YES 1
NO 2
DON'T KNOW 8

808. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 810)

809. In the last 24 hours, how many cigarettes did you smoke?

NUMBER OF CIGARETTES___

810. Do you currently smoke or use any (other) type of tobacco?

YES 1
NO 2 (GO TO 811A)

811. What (other) type of tobacco do you currently smoke or use? RECORD ALL MENTIONED.

CHELAM A
CHEWING TOBACCO B
SNUFF C
OTHER_____X

811A. Do you currently use drugs?

YES 1
NO 2 (GO TO 811C)

811B. What type of drugs do you currently use? RECORD ALL MENTIONED.

OPIUM A
HEROIN B
OTHER______X

811C. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 812)

811D. How does tuberculosis spread from one person to another?

PROBE: Any other ways? [CIRCLE ALL MENTIONED]

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
BY SHARING UTENSILS B
BY TOUCHING A PERSON WITH TB C
THROUGH SHARING FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER__________X
DON'T KNOW Z

811E. Can tuberculosis be cured?

YES 1
NO 2 (GO TO 811G)
DON'T KNOW 8 (GO TO 811G)

811F. Have you ever been told by a doctor or nurse that you have/had tuberculosis?

YES 1
NO 2
DON'T KNOW 8

811G. Have you ever heard of an illness called Hepatitis?

YES 1
NO 2 (GO TO 812)
DON'T KNOW 8 (GO TO 812)

811H. Is there anything a person can do to avoid getting Hepatitis?

YES 1
NO 2 (GO TO 811J)
DON'T KNOW 8 (GO TO 811J)

811I. What can a person do to avoid getting Hepatitis?

PROBE: Any other ways? [CIRCLE ALL MENTIONED]

SAFE SEX A
SAFE BLOOD TRANSFER B
DISPOSABLE SYRINGE C
AVOID CONTAMINATED FOOD/WATER D
AVOID CONTACT WITH INFECTED PERSON E
MAKING SURE THAT INSTRUMENTS OF DENTISTS ARE PROPERLY STERILIZED F
OTHERS___________X
DON'T KNOW Z

811J. Have you ever been told by a doctor or nurse that you have/had Hepatitis?

YES 1
NO 2 (GO TO 812)
DON'T KNOW 8 (GO TO 812)

811K. What type of Hepatitis were you diagnosed with?

HEPATITIS A A
HEPATITSIS B B
HEPATITIS C C
DON'T KNOW Z

811L. Are you currently suffering from Hepatitis?

YES 1
NO 2 (GO TO 812)
DON'T KNOW 8 (GO TO 812)

811M. What type of Hepatitis are you currently suffering from?

HEPATITIS A A
HEPATITIS B B
HEPATITIS C C
DON'T KNOW Z

812. Are you covered by any health insurance?

YES 1
NO 2 (GO TO 814)

813. What type of health insurance are you covered by? RECORD ALL MENTIONED.

MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE A
HEALTH INSURANCE THROUGH EMPLOYER B
SOCIAL SECURITY C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER____________X

814. RECORD THE TIME.

HOUR___
MINUTES___