REPUBLIC OF ANGOLA
MULTIPLE INDICATORS AND HEALTH SURVEYS

STATISTICAL CONFIDENTIALITY: BY THE TERMS GIVEN IN ARTICLE 11 OF THE LAW NO. 3/11, FROM THE 14TH OF JANUARY, LAW OF THE NATIONAL STATISTICS SYSTEM, ALL INDIVIDUAL DATA COLLECTED BY OFFICIAL STATISTICS ORGANIZATIONS, IN THIS CASE THE INE, ARE STRICTLY CONFIDENTIAL. COLLECTED DATA IS PROTECTED FROM ANY NON-STATISTICAL PURPOSES OR FROM ANY UNAUTHORIZED DISSEMINATION, ONLY TO BE USED FOR THE PRODUCTION OF OFFICIAL STATISTICS.

IDENTIFICATION

PLACE NAME ________
NAME OF HOUSEHOLD HEAD_______
PROVINCE_______
MUNICIPALITY_____
COMMUNITY_______
NEIGHBORHOOD/VILLAGE______
CENSUS SECTION______
AREAS OF RESIDENCE:

CLUSTER NUMBER (ID. IIMS) ______
HOUSEHOLD NUMBER_______
NAME AND LINE NUMBER OF MAN_______

INTERVIEWER VISITS

FIRST VISIT
DATE_________
INTERVIEWER'S NAME_________
RESULT*

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 QUESTIONNAIRE:

TRANSLATOR USED:

SUPERVISOR
NAME_________
NUMBER_________

INTRODUCTION AND CONSENT

Good morning/afternoon. My name is _________. I am working with the Institute of National Statistics and here is my identification (SHOW YOUR ID BADGE). We are conducting a survey about health all over the country. The information we collect will help the government to plan health services. Your household was selected for the survey. All of the answers you give will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Your participation in the survey is voluntary if I ask you a 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. We hope that you will participate in this survey since your views are important. In case that you need more information about the survey, you may contact INE [INS] or the province delegate of Statistics.

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

SIGNATURE OF INTERVIEWER: ____________ DATE: ________________

SECTION 1: RESPONDENT'S BACKGROUND

101) RECORD THE TIME

102) In what month and year were you born?

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

104) Have you ever attended school?

105) What is the highest level of school you attended?

106) Have you completed that year successfully?

106A) What level is the year you completed?

107) CHECK 106A:

108) Can you read?

109) Can you write?

110) 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?

111) CHECK 110:

112) Do you read the newspaper or magazine at least once a week, less than once a week or not at all?

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

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

115) Do you own a mobile telephone?

116) Have you ever used the internet?

117) In the last 12 months, have you used the internet?

IF NECESSARY, PROBE FOR USE FROM ANY LOCATION, WITH ANY EVIDENCE

118) During the last 30 days, how often did you use the internet: almost every day, at least once a week, less than once a week, or not at all?

119) What is your religion?

120) How often do you go to the church?

121) Usually what language does (NAME) speak in the household?
IF MORE THAN ONE LANGUAGE, IDENTIFY THE MAIN LANGUAGE

122) In the last 12 months, how many times have you been away from home for one or more nights?

123) In the last 12 months, have you been away from home for one month or more at a time?

124) How long have you lived in this province?

IF LESS THAN A YEAR, RECORD '00' YEARS

125) In which province or country did you live before moving here?

SECTION 2. REPRODUCTION

201) Now I would like to ask about all the children you have had during your life. I'm interested in all of the children that are biologically yours, even if they are not legally yours. Have you ever fathered any children with any woman?

202) Do you have any sons or daughters who are now living with you?

203) A) How many sons live with you?
B) And how many daughters live with you?
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?

205) A) How many sons are alive but do not live with you?
B) And how many daughters are alive but do not live with you?
IF NONE RECORD '00'

206) Have you ever had a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried, who made any movement, sound, or effort to breath, or who showed any other signs of life even if for a very short time?

207) A) How many boys have died?
B) And how many girls have died?
IF NONE RECORD '00'

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

209) CHECK 208:

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

210A) In total, with how many women do you have children?

211) CHECK 208:

212) CHECK 203 AND 205:

213) CHECK 203 AND 205:

214) CHECK 213:

215) CHECK 203 AND 205:

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

217) Were you ever present during any of those antenatal check-ups?

218) Was (NAME) born in a hospital, health facility or other place?

219) When a child has diarrhea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?

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 pregnancy. Which ways or methods have you heard about?
For methods not mentioned spontaneously, ask: Have you heard of (read: METHOD)?

302) In the last 12 months have you:

A) Heard about family planning on the radio?
B) Seen about family planning on the television?
C) Read about family planning in a newspaper or magazine?
D) Received a voice or text message about family planning on a mobile phone?
E) Read about family planning on a poster?
F) Read about family planning in a pamphlet or brochure?

303) In the last 12 months have you discussed the practice of family planning with a health worker or health professional?

304) Now I would like to ask you about a woman's risk of pregnancy.
From one menstrual period to the next, are there certain days when a women is more likely to become pregnant if she has sexual relations?

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

306) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

307) I will now read some sentences about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is women's business and men should not have to worry about it.
b) Women who use contraception may become promiscuous.

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401) Are you currently married or living together with a woman as if married?

402) Have you ever been married or lived together with a woman as if married?

403) What is your marital status now: are you widowed, divorced, or separated?

404) Is your wife/partner living with you now or is she staying elsewhere?

405) Do you have more than one wife or woman you live with as if married?

406) Altogether, how many wives do you have or other partners do you live with as if married?

407) CHECK 405:
RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER.
IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'

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

409) CHECK 407:

410) Have you been married or lived with a women only once or more than once?

411) CHECK 405 AND 410:

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

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

414) Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. 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 you don't want to answer, just let me know and we will go to the next question.

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

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 you don't want to answer, just let me know and we will go to the next question. When was the last time you had sexual intercourse?

IF ANSWER IS IN LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF IS 12 OR MORE MONTHS ANSWER MUST BE RECORDED IN YEARS.

416) When was the last time you had sexual intercourse with this person?

417) The last time you had sexual intercourse with this person, was a condom used?

418) Did you use a condom every time you had sexual intercourse with this person in the last 12 months?

419) What was your relationship to this person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'
IF NO, CIRCLE '3'

420) How long ago did you have a sexual relationship with this person?

421) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, RECORD '95'

422) How old was this person?

423) Apart from this person, have you had sexual intercourse with any other person in the last 12 months?

424) In total, with how many different people have you had sexual intercourse in the last 12 months?

IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

425) CHECK 420 (ALL COLUMNS):

426) CHECK 419 AND 417 (ALL COLUMNS):

427) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

428) Have you ever paid anyone in exchange for having sexual intercourse?

429) The last time you paid someone in exchange for having sexual intercourse, was a condom used?

430) Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

431) In the past 12 months have you give any gifts or other goods in order to have sex or to become sexually involved with anyone?

432) Have you ever given any gifts or other goods in order to have sex or to become sexually involved with anyone?

433) In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

434) CHECK 417, MOST RECENT PARTNER (FIRST COLUMN):

435) You told me that a condom was used the last time you had sex. Do you know the brand name of the condom used at that time?

IF BRAND NOR KNOWN, ASK TO SEE THE PACKAGE

436) From where did you obtain the condoms the last time?
Any other place?

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

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

438) The last time you had sex did you or your partner use any method to avoid or prevent pregnancy?

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.

440) Do you know of a place where you can obtain a method of family planning?

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

502) CHECK 439:

503) CHECK 407:

504) Is your (wife/partner) currently pregnant?

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

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

507) CHECK 208:

508) CHECK 208:

509) Are any of your (wives/partners) currently pregnant?

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

511) After the birth of the child you are expecting now, how long would you like to wait from now before the birth of (a/another) child?

512) CHECK 208:

513) CHECK 208:

514) CHECK 203 AND 205:

515) 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?

SECTION 6. GENDER

601) CHECK 401:

602) CHECK PAGE 59 OR PAGE 72 FOR LINE NUMBER CORRESPONDING TO RESPONDENT OF HOUSEHOLD QUESTIONNAIRE:

603) Who usually decides how the money you earn will be used: mainly you, mainly your (wife/partner), you and your (wife/partner) jointly?

604) Who usually makes decisions about health care for yourself: you, your (wife/partner), you and your (wife/partner) jointly, or someone else?

605) Who usually makes decisions about making major household purchases?

606) Do you own this or any other house either alone or jointly with someone else?

607) Do you own any agricultural land either alone or jointly with someone else?

608) In your opinion, is a husband justified in hitting or beating his wife/partner in the following situations:

A) If she goes out without telling him?
B) If she neglects the children?
C) If she argues with him?
D) If she refuses to have sex with him?
E) If she burn the food?

609) Do you know whether or not laws exist to protect people from abuse and violence in Angola?

SECTION 7. HIV/AIDS

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

702) HIV is the virus that can lead to AIDS Can people reduce their chance of getting the HIV virus by having just one uninfected sex partner who has no other sex partners?

703) Can people get the HIV virus from mosquito bites?

704) Can people reduce their chances of getting the HIV virus by using a condom every time they have sex?

705) Can people get the HIV virus by sharing food with a person who has HIV?

706) Is it possible for a healthy-looking person to have the HIV virus?

707) Can the virus that causes AIDS be transmitted from mother to a child:
a) During pregnancy?
b) During delivery?
c) By breastfeeding?

708) CHECK 707:

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

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

711) Have you ever been tested to see if you have the HIV virus?

712) How many months ago was your most recent HIV test?

713) Where was the test done?

PROBE TO IDENTIFY THE TYPE OF SOURCE

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

714) Did you get the results?

715) What were the test results during that time?

716) After you received a positive result were you sent to a medical appointment with an HIV specialist?

717) Did you go to your medical appointment?

718) Were you advised to take any antiretroviral drug everyday?

719) Currently, are you taking any antiretroviral drug to ease the effects of HIV?

720) In the last 30 days, was there any time when you did not take your antiretroviral medication for at least one day?

721) Do you know of a place where people can go get tested for the HIV virus?

722) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE

723) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the HIV virus?

724) In your opinion, if a female or male teacher has the HIV virus but is not sick, should she be allowed to continue teaching in the school?

725) Do you think children living with HIV should be allowed to attend school with children who do not have HIV?

726) Do you fear that you could get HIV if you come into contact with the saliva of a person living with HIV?

727) CHECK 701:

728) CHECK 414:

729) CHECK 727: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

730) Now I would like to ask you about your health in the last 12 months:
During the last 12 months, have you had a disease which you got through sexual contact?

731) Sometimes men experience a bad smelling abnormal discharge from their penis. During the last 12 months, have you had a bad smelling abnormal discharge from your penis?

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

733) CHECK 730, 731 AND 732:

734) The last time you had those problems (PROBLEMS MENTIONED IN 730/731/732), did you seek advice or treatment?

735. Where did you seek advice or treatment?
Anywhere else?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

736) If a wife knows 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?

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

SECTION 8. OTHER HEALTH ISSUES

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

802) How old were you when you were circumcised?

803) Who did the circumcision?

804) Where was it done?

805) Now I would like to ask you some 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 GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

806) Among these injections, how many were administered by a health worker?

IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

807) Did the person who gave you that injection take the syringe and needle from a new, unopened package?

808) Do you currently smoke cigarettes every day, some days or not at all?

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

810) Do you currently smoke or use any other type of tobacco every day, some days or not at all?

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

812) Currently, do you drink beer, wine or other alcoholic beverages every day, some days or not at all?

813) Are you covered by any medical assistance or health insurance?

814) In the last 30 days have you needed medical assistance due to an illness or an accident?

815) During the last 30 days did you get medical assistance once or more than once?

816) Where did you get medical assistance (last time)?

817) The last time you went to the (health center from 816) how long did you wait until you saw a health technician?

818) When you were waiting to be assisted were you waiting sitting or standing?

819) At the time of the last appointment, was it easy, difficult or could to speak with the health staff of the facility?

820) Did the health staff speak to you in your language or in another language?

821) In general, were you satisfied, somewhat satisfied, not satisfied or very unsatisfied with the treatment in your last medical appointment?

822) RECORD THE TIME

INTERVIEWER'S OBSERVATIONS

To be filled in after completing interview

Comments about the interview: __________________

Comments on Specific Questions: _________________
Any other comments: ___________

SUPERVISOR'S OBSERVATIONS: ____________________

EDITOR'S OBSERVATIONS: __________________