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DEMOGRAPHIC AND HEALTH SURVEYS - BURUNDI 2010
- MEN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME/SUB-DISTRICT______

NAME OF HEAD OF HOUSEHOLD________

PROVINCE_______

MUNICIPALITY______

DISTRICT NAME AND NUMBER_____

CLUSTER NUMBER______

HOUSEHOLD NUMBER_______

URBAN-RURAL MILIEU

URBAN 1
RURAL 2

NAME AND LINE NUMBER OF MAN_______

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE____
INTERVIEWER'S NAME____
RESULT____

NEXT VISIT (FOR INTERVIEWERS 1 AND 2)
DATE____
TIME____

FINAL VISIT
DAY____
MONTH____
YEAR____
INT. NUMBER____
RESULT_____

RESULT CODES:

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____

TOTAL NO. OF VISITS_________

SUPERVISOR
NAME________
DATE______

FIELD EDITOR
NAME________
DATE_______

OFFICE EDITOR________

KEYED BY_______

SECTION 1 RESPONDENT'S BACKGROUND
[##translator note: There is no text here in French, only in the other language (likely Swahili). The consent script that follows from the standard English questionnaire. It is not a translation from the Burundi 2010 survey, as there is not French text here, only Swahili]

INTRODUCTION AND CONSENT

Hello. My name is ____. I am working with the Institute of Statistics and Economic Studies of Burundi, ISTEEBU. We are conducting a survey about health all over Burundi. The information we collect will help the government to plan health services. Your household was selected for the survey. I would like to ask you some questions about your household. The questions usually take about 20 to 45 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 on the card that has already been given to your household.

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

SIGNATURE OF INTERVIEWER______
DATE________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 1)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END INTERVIEW)

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)

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

PRIMARY 1
SECONDARY 1ST CYCLE 2
SECONDARY 2ND CYCLE 3
HIGHER 4

106) What is the highest (grade/form/year) you completed at this level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.

PRIMARY
01 1ST YEAR
02 2ND YEAR
03 3RD YEAR
04 4TH YEAR
05 5TH YEAR
06 6TH YEAR
SECONDARY 1ST CYCLE
01 7TH YEAR
02 8TH YEAR
03 9TH YEAR
04 10TH YEAR
98 DON'T KNOW
SECONDARY 2ND CYCLE
01 11TH YEAR
02 12TH YEAR
03 13TH YEAR
04 14TH YEAR
HIGHER
01 1ST YEAR
02 2ND YEAR
03 3RD YEAR
04 4TH YEAR
05 5TH YEAR
06 6TH YEAR
07 7TH YEAR

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 PART OF SENTENCE 2
ABEL 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) What is your religion?

CATHOLIC 1
PROTESTANT 2
MUSLIM 3
ADVENTIST 4
JEHOVAH'S WITNESS 5
TRADITIONAL 6
OTHER RELIGIONS 7
NO RELIGION 8

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

NUMBER OF TIMES _____
NONE 00 (GO TO 201)

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

YES 1
NO 2

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? And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME _____
DAUGHTERS AT HOME _____

204) Do you have any sons or daughters that you have fathered who are not 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? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE _____
DAUGHTERS ELSEWHERE _____

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? And how many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD _____
GIRLS DEAD _____

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

TOTAL _____

209) CHECK 208:

HAS HAD MORE THAN ONE CHILD (GO TO 210)
HAS ONLY HAD 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 OF (YOUNGEST) CHILD) _____

217) When (NAME)'s mother was pregnant 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 a 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 or an individual can use to delay or avoid a pregnancy.
Have you ever heard of (METHOD)?

[##translator note: For each of the following methods, there is only a description in Swahili, but none in French. I will include the description from the Standard English survey, but it is not a translation from the French Burundi 2010 form, as the description is only available in Swahili]

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, a nurse, or a midwife.
YES 1
NO 2
04) INJECTABLES. PROBE: Women can have an injection by a heath 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) CONDOM. PROBE: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM. PROBE: Women can place a sheath in their vagina 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: 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 or men can use to avoid pregnancy? IF YES, LIST UP TO TWO METHODS
SPECIFY____
YES 1
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

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 like 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 this 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 (SPECIFY) _____ 6
DON'T KNOW 8

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):
KNOW MALE CONDOM

YES (GO TO 308)
NO (GO TO 311)

308) Do you know a place where a person can get condoms?

YES 1
NO 2 (GO TO 311)

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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_____ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
OTHER (SPECIFY)_____ X

310) If you wanted, could you yourself get a condom?

YES 1
NO 2

311) CHECK 301 (08):
KNOWS FEMALE CONDOM

YES (GO TO 312)
NO (GO TO 401)

312) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 401)

313) 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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
OTHER (SPECIFY)_____ X

314) If you wanted, could you yourself get a female condom?

YES 1
NO 2

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

Now I would like to ask you some questions about your recent sexual activity. I assure you again that your responses will be kept completely confidential and will not be told to anyone.

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

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

YES, CURRENTLY MARRIED 1 (GO TO 404)
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3

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

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)

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

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)

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

LIVING WITH HIM 1
STAYING ELSEWHERE 2

405) Do you have other wives or do you live with other women as if married?

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

406) Altogether, how many wives or live-in partners do you have?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS _____

407) CHECK 405:

ONE WIFE/PARTNER: Please tell me the name of (your wife/the woman you are living with as if married).

MORE THAN ONE WIFE/PARTNER: Please tell me the name of each of your wives or each woman you are living with as if married.

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIFE-IN PARTNER. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD 00. ASK 408 FOR EACH PERSON.

NAME ____
LINE NUMBER _____

408) How old was (NAME) on her last birthday?

AGE _____

409) CHECK 407:

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

410) Have you been married or lived with a woman 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/partner)?
411A) Now we are going to talk about your first (wife/partner). 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/PARTNER 95

416) When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS, OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1____ (GO TO 418)
WEEKS AGO 2 _____ (GO TO 418)
MONTHS AGO 3 _____ (GO TO 418)
YEARS AGO 4 _____ (GO TO 430)

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

DAYS AGO_____ 1
WEEKS AGO____ 2
MONTHS AGO____ 3

418) The last time you had sexual intercourse (with this second/third) person, was a condom used?

YES 1
NO 2 (GO TO 420)

419) Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

420) 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'.

WIFE 1
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
CLIENT/PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) 6 (GO TO 423)

421) CHECK 410:

MARRIED/LIVED WITH WOMAN ONLY ONCE (GO TO 422)
MARRIED/LIVED WITH WOMAN MORE THAN ONCE (GO TO 423)

422) CHECK 414:

FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (GO TO 424)
OTHER (GO TO 423)

423) How long ago did you first have sexual intercourse with this (second/third) person?

DAYS AGO_____ 1
WEEKS AGO_____ 2
MONTHS AGO____ 3
YEARS AGO_____ 4

424) How many times during the last 12 months did you have sexual intercourse with this person?
IF 95 OR MORE, RECORD '95'.

NUMBER OF TIMES_____

425) How old is this person?

AGE OF PARTNER _____
DON'T KNOW 98

426) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?

YES 1 (GO BACK TO 417 IN NEXT COLUMN)
NO 2 (SKIP TO 428)

427) 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 95 OR MORE, WRITE 95.

NUMBER OF PARTNERS IN LAST 12 MONTHS ____
DON'T KNOW 98

428) CHECK 420 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE (GO TO 429)
NO PARTNERS ARE PROSTITUTES (GO TO 430)

429) CHECK 420 AND 418 (ALL COLUMNS):

OTHER (GO TO 434)
CONDOM USED WITH EVERY PROSTITUTE (GO TO 433)

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

YES 1 (GO TO 432)
NO 2

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

YES 1 (GO TO 434)
NO 2 (GO TO 434)

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

YES 1
NO 2 (GO TO 434)

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

YES 1
NO 2
DON'T KNOW 8

434) In total, with how many different people have you had sexual intercourse in your lifetime?

IF NON-NUMERIC NUMBER, PROBE TO GET AN ESTIMATE. IF THE NUMBER IF MORE THAN 95, WRITE '95'

NUMBER OF PARTNERS IN LIFETIME _____
DON'T KNOW 98

435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED (GO TO 436)
NOT ASKED (GO TO 438)
NO CONDOM USED (GO TO 438)

436) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.

PRUDENCE 01
PRUDENCE CLASS 02
OTHER (SPECIFY) ____ 96
DON'T KNOW 98

437) From where did you obtain the condom the last time?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY)_____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY)_____ 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
FEMALE CONDOM G
DIAPHRAGM H
FOAM/JELLY I
LAMA J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y

SECTION 5. FERTILITY PREFERENCES

501) CHECK 401:

CURRENTLY MARRIED OR LIVING WITH A PARTNER (GO TO 502)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 509)

502) CHECK 439:

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

503) (Is your (wife/partner)/Are any of your (wives/partners)) 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 and your (wife (wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not 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)/PARTNER(S) STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)

506) CHECK 407:

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

507) CHECK 503:

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

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

MONTHS_____ 1 (GO TO 509)
YEARS_____ 2 (GO TO 509)

SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) _____ 996 (GO TO 509)
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/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) ____ 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 (SPECIFY) 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 the sex not matter?

NUMBER OF BOYS____
NUMBER OF GIRLS____
NUMBER OF EITHER___
OTHER (SPECIFY) _____ 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 did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, maternity leave, 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 your occupation, that is, what kind of work do you mainly do?

OCCUPATION__________

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 OR LIVING WITH A PARTNER (GO TO 608)
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (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/partner), or you and your (wife/partner) jointly?

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6

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

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6

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

RESPONDENT 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) ______ 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?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DON'T KNOW 8
NEGLECT CHILDREN
YES 1
NO 2
DON'T KNOW 8
ARGUES
YES 1
NO 2
DON'T KNOW 8
REFUSES SEX
YES 1
NO 2
DON'T KNOW 8
BURNS FOOD
YES 1
NO 2
DON'T KNOW 8

SECTION 7. HIV/AIDS

701) How 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 the AIDS virus 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 the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

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

YES 1
NO 2
DON'T KNOW 8

706) Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

707) Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

708) Can the virus that causes AIDS be transmitted from a mother to a child?

During pregnancy?
During delivery?
By breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DON'T KNOW 8
DURING DELIVERY
YES 1
NO 2
DON'T KNOW 8
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 the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

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 the AIDS virus?

YES 1 (GO TO 713)
NO 2 (GO TO 716)

713) How many months ago was your most recent HIV text?

MONTHS AGO ______
TWO OR MORE YEARS 96

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 THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11 (GO TO 718)
GOVERNMENT HEALTH CENTER 12 (GO TO 718)
STAND-ALONE VCT CENTER 13 (GO TO 718)
FAMILY PLANNING CLINIC 14 (GO TO 718)
MOBILE CLINIC 15 (GO TO 718)
FIELDWORKER 16 (GO TO 718)
SCHOOL BASED CLINIC 17 (GO TO 718)
OTHER PUBLIC (SPECIFY) ______ 18 (GO TO 718)
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21 (GO TO 718)
STAND-ALONE VCT CENTER 22 (GO TO 718)
PHARMACY 23 (GO TO 718)
MOBILE CLINIC 24 (GO TO 718)
FIELDWORKER 25 (GO TO 718)
SCHOOL BASED CLINIC 26 (GO TO 718)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ 27 (GO TO 718)
OTHER SOURCE
HOME 31 (GO TO 718)
CORRECTIONAL FACILITY 32 (GO TO 718)
OTHER (SPECIFY) ______ 96 (GO TO 718)

716) Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 718)

717) Where is that? Any other place?

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

(NAME OF PLACE) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC (SPECIFY) _______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ M
OTHER (SPECIFY) ______ X

718) Would you buy fresh vegetables from a shopkeeper or vendor if you knew 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 the virus that causes AIDS, would you be willing to care for her or him in your 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 the school?

SHOULD BE ALLOWED 1
SHOULD 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 OTHER 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 an 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 their 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 (INFECTION 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 THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC (SPECIFY) ______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ M
OTHER SOURCE
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) ______ X

732) 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?

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 (UNDER 5 YEARS) 96
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 pharmacist, a dentist, or another healthcare worker?

IF THE NUMBER OF INJECTIONS IS OVER 90 OR IF THERE WERE DAILY INJECTIONS IN THE LAST 3 MONTHS OR LONGER, RECORD 90. IF THE RESPONSE IS NOT NUMERIC, PROBE TO OBTAIN 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 form 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 812)

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

PIPE A
CHEWING TOBACCO B
SNUFF C
CHEWING TOBACCO D
UMUSOGOTO E
OTHER (SPECIFY) _______ X

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
NATIONAL HEALTH CARD INSURANCE B
RELIGIOUS MUTUAL INSURANCE SYSTEM C
PRIVATE MUTUAL INSURANCE SYSTEM D
OTHER (SPECIFY) _______ X

814) Do you think that a soaked mosquito net really help to protect against malaria?

YES 1
NO 2 (GO TO 816)
DON'T KNOW MOSQUITO NET 3 (GO TO 816)
DON'T KNOW 8 (GO TO 816)

815) Where did you get this information?
Any other place?

TV A
RADIO B
NEWSPAPERS/MAGAZINES C
COMMUNITY HEALTH AGENT D
SANITATION EDUCATION E
FRIENDS/RELATIVES/NEIGHBORS F
OTHER (SPECIFY) _______ X

816) RECORD THE TIME:

HOUR______
MINUTES______

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW.

COMMENTS ABOUT RESPONDENT: ______

COMMENTS ON SPECIFIC QUESTIONS: ______

ANY OTHER COMMENTS: ______

SUPERVISOR'S OBSERVATIONS
NAME OF SUPERVISOR_________
DATE_________

EDITOR'S OBSERVATIONS
NAME OF EDITOR_______
DATE________