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Third Demographic and Health Survey
EDSB-III
Statistical visa N. VS201505CNIS

Man???s questionnaire

Republic of Burundi

Ministry of Public Health and Fight Against AIDS

Presidential Ministry for Good Government and Planning

Identification

Place name
Name of head of household
Province
Cluster number
Household number
Name and line number of man
Man selected for module on violence?

1 Yes
2 No

Interviewer visits

1 2 3
Date

Interviewer???s name
Result*

Final visit
Day
Month
Year 201
Int. number
Result

Next visit
Date
Time

Total no. of visits

*Result codes:

1 Completed
2 Not at home
3 Postponed
4 Refused
5 Partly completed
6 Incapacitated
7 Other (specify)
Language of questionnaire 01
Language of interview:
Native language of respondent
Translator used (Yes=1, No=2)
Language of questionnaire: French
Language Codes:
01 French
96 Other (specify)
Old Kirundi (from Paper)

Supervisor
Name
Number

Introduction and consent

Hello. My name is ___. I am working with the Institute of Statistics and Economic Study of Burundi (ISTEEBU). We are conducting a survey about health all over Burundi. The information we collect will help the government to improve 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?

Signature of interviewer Date

Respondent agrees to be interviewed 1
Respondent does not agree to be interviewed 2 (End)

Section 1. Respondent???s Background

101) Record the time

Hour
Minutes

102) How long have you been living continuously in (Mairie de Bujumbura, name of urban center or residential hillside)?
If less than one year, record 00 years

Years ____
Always 95-skip to 105
Visitor 96-skip to 105

103) Just before you moved here, did you live in Mairie de Bujumbura, in another city, or in a rural area?

Mairie de Bujumbura 1
Other large city 2
A small town 3
Rural area 4

104) Before you moved here, which [province/region] did you live in?

Bubanza 01
Mairie de Bujumbura 02
Rural Bujumbura 03
Bururi 04
Cankuzo 05
Cibitoke 06
Gitega 07
Karuzi 08
Kayanza 09
Kirundo 10
Makamba 11
Muramvya 12
Muyinga 13
Mwaro 14
Ngozi 15
Rumonge 16
Rutana 17
Ruyigi 18
Outside of Burundi (specify country) 96

105) In what month and year were you born?

Month
Don???t know month 98
Year
Don???t know year 9998

106) How old were you at your last birthday?
Compare and correct 105 and/or 106 if inconsistent

Age in completed years

107) Have you ever attended school?

Yes 1
No 2 (Skip to 111)

108) What is the highest level of school you attended: primary, secondary 1, secondary 2, or higher?

Primary 1
Secondary 1st cycle 2
Secondary 2nd cycle 3
Higher 4

109) What is the highest (grade/form/year) you completed at this level?
If completed less than one year at that level, record 00

Grade
Form
Year

110) Check 108

Primary or Secondary
Higher (Skip to 113)

111) 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

112) Check 111:

Code 2, 3, or 4 circled
Code 1 or 5 circled (Skip to 114)

113) 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

114) 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

115) 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

116) Do you own a mobile telephone?

Yes 1
No 2 (Skip to 118)

117) Do you own a mobile telephone to conduct financial transactions?

Yes 1
No 2

118) Do you have an account in another financial institution that you yourself use?

Yes 1
No 2

119) Have you ever used the internet?
If necessary, probe for usage from any location on any device.

Yes 1
No 2 (Skip to 122)

120) In the last 12 months, have you used the internet?
If necessary, probe for usage from any location on any device.

Yes 1
No 2 (Skip to 122)

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

Almost every day 1
At least once a week 2
Less than once a week 3
Not at all 4

122) What is your religion?

Catholic 01
Protestant 02
Muslim 3
Adventist 04
Jehovah???s Witness 05
Traditional/animist 06
Without religion/none 07
Cult 08
Other (specify) 96

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

Number of times _____________
None 00 (Skip to 201)

125) 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 (Skip to 206)
Don???t know 8 (Skip to 206)

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

Yes 1
No 2 (Skip 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 alive but do not live with you?

Yes 1
No 2 (Skip 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, recode ???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, who made any movement, sound, or effort to breathe, or who showed any signs of life even if for a very short time?

Yes 1
No 2 (Skip to 208)
Don???t know 8 (Skip 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
Has only had one child (Skip to 212)
Has not had any children (Skip to 301)

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

Yes 1
No 2

211) Check 208:
Has had more than one child

a) How old were you when your first child was born?
AGE ____

Has had only one child

b) How old were you when you child was born?
AGE ___

212) Check 203 and 205:

At least one living child
No living children (Skip to 301)

213) Check 203 and 205:

More than living child

a) How old is your youngest child?
AGE _____________

Only one living child

b) How old is your child?
AGE _____________

214) Check 213

(Youngest) child is age 0-2 years
(Youngest) child is age 3 or older (Skip to 301)

215) Check 203 and 205

More than one living child

a) What is the name of your youngest child?
Name of (Youngest) Child

Only one living child

b) What is the name of your child?
Name of (Youngest) Child

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

Yes 1
No 2 (Skip to 218)
Don???t know 8 (Skip to 218)

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

Present 1
Not present 2

218) Was (name) born in a hospital or health facility?

Hospital/Health facility 1
Other 2

219) 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 which can prevent pregnancy for one or more years.
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) 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
10) Standard Days Method
Probe: A woman uses a string of colors beads to know which days she could get pregnant. On the days she could get pregnant, she uses a condom or does not have sexual intercourse.
Have you ever heard of (method)?
Yes 1
No 2
11) Lactational Amenorrhea Method (LAM)
Probe: Up to six months after childbirth, before menstrual period has returned, women use a method requiring frequent breastfeeding day and night.
Yes 1
No 2
12) Rhythm method
Probe: To avoid pregnancy, women do not have sexual intercourse on days of the month they think they can get pregnant.
Have you ever heard of (method)?
Yes 1
No 2
13) Withdrawal
Probe: Men can be careful and pull out before climax.
Have you ever heard of (method)?
Yes 1
No 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
Yes, modern method A
(specify)
Yes, Traditional Method B
(specify)
No Y

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
Received a voice or text message about family planning on a mobile phone?
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 (Skip to 306)
Don???t know 8 (Skip 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) After the birth of a child, can a woman become pregnant before her menstrual period has returned?

Yes 1
No 2
Don???t know 8

307) 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 concern and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.

Agree 1
Disagree 2
Don???t know 8

Section 4. Marriage and sexual activity

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

Yes, currently married 1 (Skip to 404)
Yes, living with a woman 2 (Skip 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 (Skip to 413)

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

Widowed 1
Divorced 2
Separated 3
All (Skip 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 (Skip 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 live-in partner.

If a woman is not listed in the household, record 00.

Ask 408 for each person

Name
Line number

408) Ask 408 for each person.
How old was (name) on her last birthday?

Age

409) Check 407:

One wife/partner
More than one wife/partner (Skip to 411)

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

Only once 1
More than once 2

411) Check 405 and 410.
Both are code 2: a) In what month and year did you start living with your (wife/partner)?
Other: b) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?

Month
Don???t know month 98
Year -skip 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 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.

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

Never had sexual intercourse 00 (Skip to 501)
Age in years ________________
First time when started living with (first) wife/partner 95

415) I would like to ask questions about your recent sexual activity. 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 (Skip to 417)
Weeks ago 2 (Skip to 417)
Months ago 3 (Skip to 417)
Years ago 4 (Skip to 417)

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

Days ago 1
Weeks ago 2
Months ago 3

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

Yes 1
No 2 (Skip to 419)

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

Yes 1
No 2

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
Wife 1
Live-in partner 2
Girlfriend not living with respondent 3
Casual acquaintance 4
Client/Prostitute 5
Other (specify) 6

420) How long ago did you first have sexual intercourse with this person?

Days ago 1
Weeks ago 2
Months ago 3
Years ago 4

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 the number of times is 95 or more, write 95.

Number of times

422) How old is this person?

Age of partner
Don???t know 98

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

Yes 1 (go back to 416 in next column)
No 2 (Skip to 425)

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 95 or more, write 95

Number of partners in last 12 months
Don???t know 98

425) Check 420 (all columns):

At least one partner is prostitute
No partners are prostitutes (Skip to 427)

426) Check 419 and 417 (all columns)

Condom used with every prostitute (Skip to 430)
Other (Skip to 431)

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

Yes 1 (Skip to 429)
No 2

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

Yes 1 (Skip to 431)
No 2 (Skip to 431)

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

Yes 1
No 2 (Skip to 431)

430) 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
DK 8

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

Yes 1 (Skip to 431)
No 2

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

Yes 1
No 2

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

434) Check 417, most recent partner (first column):

Condom used
Not asked (Skip to 438)
No condom used (Skip to 438)

435) 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

436) 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
National government hospital 11
Regional government hospital 12
District hospital 13
Government health center 14
Community fieldworker 15
Other (specify) 16
Certified medical sector
Certified hospital 21
Certified health center 22
Other private medical (specify) 26
Private medical sector
Private hospital/clinic 31
Private health care center 32
Pharmacy 33
Private doctor???s office 34
Other private medical (specify) 36
Other source
Shop 41
Friends/relatives 42
Other (specify) 96

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?

Yes 1 (Skip to 439)
No 2 (Skip to 440
Don???t know 8 (Skip to 440)

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

Yes 1
No 2 (Skip to 440)
Don???t know 8 (Skip to 440)

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
Condom G
Female condom H
Emergency contraceptive I
Standard Day Method J
Lactational Amen. Method K
Rhythm method L
Withdrawal M
Other modern method X
Other traditional method Y
All skip to 501

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

Yes 1
No 2

Section 5. Fertility preferences

501) Check 401:

Currently married or living with a partner
Not currently married and not living with a partner (Skip to 514)

502) Check 439:

Man not sterilized
Man sterilized (Skip to 514)

503) Check 407:

One wife/partners
More than one wife/partner (Skip to 509)

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

Yes 1
No 2 (Skip to 507)
Don???t know 8 (Skip to 507)

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 have any more children?

Have another child 1
No more 2 (Skip to 514)
Undecided/don???t know 8 (Skip to 514)

506) 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
Other (specify) 996
Don???t know 9998
All (Skip to 514)

507) Check 208:
Has fathered children: Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?

Has not fathered children: Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?

Have (a/another) child 1
No more/none 2 (Skip to 514)
Says couple can???t get pregnant 3 (Skip to 514)
Wife (wives)/partner(s) sterilized 4 (Skip to 514)
Undecided/don???t know 8 (Skip to 514)

508) Check 208:
Has fathered children: How long would you like to wait from now before the birth of another child?
Has not fathered children: How long would you like to wait from now before the birth of a child?

Months 1
Years 2
Soon/now 993
Couple infecund 994
Other (specify) 996
Don???t know 998
All (Skip to 514)

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

Yes 1
No 2 (Skip to 512)
Don???t know 8 (Skip to 512)

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

Have another child 1
No more 2 (Skip to 514)
Undecided/don???t know 8 (Skip to 514)

511) After the birth of the child you are expecting now, how long would you wait before the birth of another child?

Months 1
Years 2
Soon/now 993
Other (specify) 996
Don???t know 998
All (Skip to 514)

512) Check 208:
Has fathered children: a) Now I have some questions about the future. Would you like to have another child, or would you prefer not to have any more children?

Has not fathered children: b) Now I have some questions about the future. Would you like to have a child, or would you prefer not to have any children?

Have (a/another) child 1
No more/none 2 (Skip to 514)
Says couple can???t get pregnant 3 (Skip to 514)
Wife (wives)/partner(s) sterilized 4 (Skip to 514)
Undecided/don???t know 8 (Skip to 514)

513) Check 208:
Has fathered children: How long would you like to wait from now before the birth of another child?

Has not fathered children: How long would you like to wait from now before the birth of a child?

Months 1
Years 2
Soon/now 993
Says couple can???t get pregnant 994
Other (specify) 996
Don???t know 998

514) 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 (Skip to 601)
Number
Other (specify) 96 (Skip to 601)

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?

Number Boys Girls Either
Other (specify) 96

Section 6. Employment and gender roles

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

Yes 1 (Skip 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, or any other such reason?

Yes 1 (Skip to 604)
No 2

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

Yes 1
No 2 (Skip to 607)

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

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
Not currently married and not living with a partner (Skip to 612)

608) Check 606:

Code 1 or 2 circled
Other (Skip 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 (Skip to 615)

613) Do you have a title deed for any house you own?

Yes 1
No 2 (Skip to 615)
Don???t know 8 (Skip to 615)

614) Is your name on the title deed?

Yes 1
No 2
Don???t know 8

615) Do you own any agricultural or non-agricultural land either alone or jointly with someone else?

Alone only 1
Jointly only 2
Both alone and jointly 3
Does not own 4

616) Do you have a title deed for any land you own?

Yes 1
No 2 (Skip to 618)
Don???t know 8 (Skip to 618)

617) Is your name on the title deed?

Yes 1
No 2
Don???t know 8

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

a) If she goes out without telling him?
Yes 1
No 2
DK 8
b) If she neglects the children?
Yes 1
No 2
DK 8
c) If she argues with him
Yes 1
No 2
DK 8
d) If she refuses to have sex with him?
Yes 1
No 2
DK 8
e) If she burns the food?
Yes 1
No 2
DK 8

Section 7. HIV/AIDS

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

Yes 1
No 2 (Skip to 727)

702) HIV is a virus that can lead to AIDS. 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 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
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?
Yes 1
No 2
DK 8
During delivery?
Yes 1
No 2
DK 8
By breastfeeding?
Yes 1
No 2
DK 8

709) Check 708:

At least one yes
Other (Skip 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
DK 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 for HIV?

Yes 1
No 2 (Skip to 716)

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

Months ago
Two or more years 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 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
National government hospital 11
Regional government hospital 12
District hospital 13
Government health center 14
Independent testing center 15
Mobile testing service 16
School clinic 17
Other (specify) 18
Certified medical sector
Certified hospital 21
Certified health center 22
Other private medical (specify) 26
Private medical sector
Private hospital/clinic/doctor 31
Private health care center 32
School clinic 33
Independent testing center 34
Pharmacy 35
Mobile testing service 36
Other private medical (specify) 37
Other source
Home 41
Workplace 42
Correctional Facility 43
Other (specify) 96
All (Skip to 718)

716) Do you know of a place where people can go to get an HIV test?

Yes 1
No 2 (Skip 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(s))

National government hospital A
Regional government hospital B
District hospital C
Government health center D
Independent testing center E
Mobile testing service F
School clinic G
Other (specify) H

Certified medical sector
Certified hospital I
Certified health center J
Other private medical (specify) K

Private medical sector
Private hospital/clinic/doctor L
Private health care center M
School clinic N
Independent testing center O
Pharmacy P
Mobile testing service Q
Other private medical (specify) R

Other (specify) X

718) Have you heard of test kits people can use to test themselves for HIV?

Yes 1
No 2 (Skip to 720)

719) Have you ever tested yourself for HIV using a self-test kit?

Yes 1
No 2

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

Yes 1
No 2
Don???t know/Not sure/depends 8

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

Yes 1
No 2
Don???t know/Not sure/depends 8

722) Do you think people hesitate to take an HIV test because they are afraid of how other people will react if the test result is positive for HIV?

Yes 1
No 2
Don???t know/Not sure/depends 8

723) Do people talk badly about people living with HIV, or who are thought to be living with HIV?

Yes 1
No 2
Don???t know/Not sure/depends 8

724) Do people living with HIV, or thought to be living with HIV, lose the respect of other people?

Yes 1
No 2
Don???t know/Not sure/depends 8

725) Do you agree or disagree with the following statement: I would be ashamed if someone in my family had HIV.

Agree 1
Disagree 2
Don???t know/Not sure/depends 8

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

Yes 1
No 2
Says he has HIV 3
Don???t know/Not sure/depends 8

727) 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

728) Check 414:

Has had sexual intercourse
Has not had sexual intercourse (Skip to 736)

729) Check 727: Heard about other sexually transmitted infections?

Yes
No (Skip to 731)

730) 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

731) 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

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?

Yes 1
No 2
Don???t know 8

733) Check 730, 731, and 732:

Has had an infection (any yes)
Has not had an infection or does not know (Skip to 736)

734) The last time you had (infection from 730/731/732), did you seek any kind of advice or treatment?

Yes 1
No 2 (Skip to 736)

735) Where did you go?
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
(Name of place(s))

National government hospital A
Regional government hospital B
District hospital C
Government health center D
Independent testing center E
Mobile testing service F
Other (specify) G

Certified medical sector
Certified hospital H
Certified health center I
Other private medical (specify) J

Private medical sector
Private hospital/clinic/doctor K
Private health care center L
Independent testing center M
Pharmacy N
Mobile testing service O
Other private medical (specify) P

Other source
Shop Q

Other (specify) X

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?

Yes 1
No 2
Don???t know 8

737) Is a wife justified in refusing to have sex with her husband when she knows he 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 (Skip to 805)
Don???t know 8 (Skip to 805)

802) How old were you when you got circumcised?

Age in completed years
During childhood (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 (Skip 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 (Skip 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 tobacco every day, some days, or not at all?

Every day 1 (Skip to 811)
Some days 2
Not at all 3 (Skip to 810)

809) In the past, have you smoked tobacco every day?

Yes 1 (Skip to 812)
No 2 (Skip to 812)

810) In the past, have you ever smoked tobacco every day, some days, or not at all?

Every day 1 (Skip to 813)
Some days 2 (Skip to 813)
Not at all 3 (Skip to 813)

811) On average, how many of the following products do you currently smoke each day? Also, let me know if you use the product, but not every day.

If respondent report using the product but not every day, record ???888.??? If the product is not used at all, record ???000.???

a) Manufactured cigarettes?
Number daily
b) Hand-rolled cigarettes?
Number daily
c) Kreteks?
Number daily
d) Pipes full of tobacco?
Number daily
e) Cigars, cheroots, or cigarillos?
Number daily
f) Number of water pipe session?
Number daily
g) Any others? (specify)
Number daily
All (Skip to 813)

812) On average, how many of the following products do you currently smoke each week? Also, let me know if you use the product, but not every week.

If respondent report using the product but not every week, record ???888.??? If the product is not used at all, record ???000.???

a) Manufactured cigarettes?
Number weekly
b) Hand-rolled cigarettes?
Number weekly
c) Kreteks?
Number weekly
d) Pipes full of tobacco?
Number weekly
e) Cigars, cheroots, or cigarillos?
Number weekly
f) Number of water pipe session?
Number weekly
g) Any others? (specify)
Number weekly

813) Do you currently use smokeless tobacco every day, some days, or not at all?

Every day 1
Some days 2 (Skip to 815)
Not at all 3 (Skip to 816)

814) On average, how many of the following products do you currently use each day? Also, let me know if you use the product, but not every day.

If respondent report using the product but not every day, record ???888.??? If the product is not used at all, record ???000.???

a) Snuff, by mouth?
Number daily
b) Snuff, by nose?
Number daily
c) Chewing tobacco?
Number daily
d) Betel quid with Tobacco?
Number daily
e) Any others? (specify)
Number daily
All (Skip to 815a)

815) On average, how many of the following products do you currently use each week? Also, let me know if you use the product, but not every week.

If respondent report using the product but not every week, record ???888.??? If the product is not used at all, record ???000.???

a) Snuff, by mouth?
Number weekly
b) Snuff, by nose?
Number weekly
c) Chewing tobacco?
Number weekly
d) Betel quid with Tobacco?
Number weekly
e) Any others? (specify)
Number weekly

815a) Do you currently drink alcoholic beverages every day, almost every day, about once a week, about once a month, less often, or not at all?

Every day 1
Almost every day 2
About once a week 3
About once a month 4
Less often 5
Not at all 6 (Skip to 816)

815b) Since yesterday, have you had any alcoholic beverages?

Yes 1
No 2

815c) How often do you get drunk: often, only sometimes, or never?

Often 1
Sometimes 2
Never 3

816) Are you covered by any health insurance?

Yes 1
No 2 (Skip to 818)

817) What type of health insurance are you covered by?
Record all mentioned

Mutual health organization A
Mutual health organization/community-based health insurance A
National health insurance B
Religious insurance C
Private insurance D
Other (specify) X

818) a) Do you have any of the following illnesses?

a) Diabetes?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

b) High blood pressure?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

c) Heart problems?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

d) Kidney failure?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

e) Cancer?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

f) Paralysis?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

g) Asthma/chronic bronchitis?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

f) Leprosy?

Yes 1
b) Did you get a diagnosis from a medical professional?

Yes 1
No 2
Don???t know 8
No 2

819) In the last 12 months, have you gotten chigoe fleas on your feet or elsewhere?

Yes 1
No 2 (Skip to 821)

820) Since last (day of the week), did you get chigoe fleas?

Yes 1
No 2

821) Now I would like to talk to you about a practice we call female circumcision. Have you ever heard of female circumcision?

Yes 1 (Skip to 823)
No 2

822) In some countries, there is a practice in which a girl may have part of her genitals cut. Have you ever heard about this practice?

Yes 1
No 2 (Skip to 900)

823) Do you believe that female circumcision is required by your religion?

Yes 1
No 2
No religion 3
Don???t know 8

824) Do you think that female circumcision should be continued, or should it be stopped?

Continued 1
Stopped 2
Depends 3
Don???t know 8

Section 9. Domestic violence

900) Check cover page of household questionnaire: Man selected for module on domestic violence?

Man selected for this section
Man not selected (Skip to 933)

901) Check for presence of others:
Do not continue until privacy is ensured.

Privacy obtained 1
Privacy not possible (return once you are sure to be alone with respondent) 2 (Skip to 932)

901a) Read to the respondent:
Now I would like to ask you questions about some other important aspects of a man???s life. You may find some of these questions very personal. However, your answers are crucial for helping to understand the condition of men in Burundi. Let me assure you that your answers are completely confidential and will not be told to anyone and no one else in your household will know that you were asked these questions.

902) Check 401 and 402:

Currently married/living with a woman
Formerly married/lived with a woman (Read in past tense and use ???last??? with spouse/partner)
Never married/never lived with a woman (Skip to 916)

903) First, I am going to ask you about some situations which happen to some men. Please tell me if these apply to your relationship with your (last) spouse/partner?

a) She (is/was) jealous or angry if you (talk/talked) to other women?
Yes 1
No 2
DK 8
b) She frequently (accuses/accused) you of being unfaithful?
Yes 1
No 2
DK 8
c) She (does/did) not permit you to meet your friends?
Yes 1
No 2
DK 8
d) She (tries/tried) to limit your contact with your family?
Yes 1
No 2
DK 8
e) She (insists/insisted) on knowing where you (are/where) at all times?
Yes 1
No 2
DK 8

904) Now if you will permit me, I need to ask some more questions about your relationship with your (last) spouse/partner.
A) (Does/did) your last spouse/partner ever:

a) Say or do something to humiliate you in front of others?
Yes 1
No 2
b) Threaten to hurt or harm you or someone you care about?
Yes 1
No 2
c) Insult you or make you feel bad about yourself?
Yes 1
No 2

B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of others?
Often 1
Sometimes 2
Not in last 12 months 3
b) Threaten to hurt or harm you or someone you care about?
Often 1
Sometimes 2
Not in last 12 months 3
c) insult you or make you feel bad about yourself?
Often 1
Sometimes 2
Not in last 12 months 3

905) A) Did your (last) (spouse/partner) ever do any of the following things to you:

a) Push you, shake you, or throw something at you?
Yes 1
No 2
b) Slap you?

Yes 1
No 2
c) Twist your arm or pull your hair?
Yes 1
No 2
d) Punch you with his fist or with something that could hurt you?
Yes 1
No 2
e) Kick you, drag you, or beat you up?
Yes 1
No 2
f) Try to chock you or burn you?
Yes 1
No 2
g) Threaten you with a knife, gun, or other type of weapon?
Yes 1
No 2
h) Physically force you to have sexual intercourse with him even when you did not want to?
Yes 1
No 2
i) Physically force you to perform other sexual acts you did not want to?
Yes 1
No 2
j) Force you with threats or in any other way to perform sexual acts you did not want to?

Yes 1
No 2

B) How often did this happen during the last 12 months: often, only sometimes, or not at all?

a) say or do something to humiliate you in front of others?
Often 1
Sometimes 2
Not in last 12 months 3
b) Threaten to hurt or harm you or someone you care about?
Often 1
Sometimes 2
Not in last 12 months 3
c) insult you or make you feel bad about yourself?
Often 1
Sometimes 2
Not in last 12 months 3
d) Punch you with his fist or with something that could hurt you?
Often 1
Sometimes 2
Not in last 12 months 3
e) Kick you, drag you, or beat you up?
Often 1
Sometimes 2
Not in last 12 months 3
f) Try to chock you or burn you?
Often 1
Sometimes 2
Not in last 12 months 3
g) Threaten you with a knife, gun, or other type of weapon?
Often 1
Sometimes 2
Not in last 12 months 3
h) Physically force you to have sexual intercourse with him even when you did not want to?
Often 1
Sometimes 2
Not in last 12 months 3
i) Physically force you to perform other sexual acts you did not want to?
Often 1
Sometimes 2
Not in last 12 months 3
j) Force you with threats or in any other way to perform sexual acts you did not want to?

Often 1
Sometimes 2
Not in last 12 months 3

906) Check 905 (a-j):

At least one yes
Not a single yes (Skip to 909)

907) How long after you first got married to/started living with your (last) spouse/partner did (this/any of these things) first happen?
If less than one year, record 00.

Number of years
Before marriage/before living together 95

908) Did the following ever happen as a result of what your (last) spouse/partner did to you:

a) You had cuts, bruises, or aches?
Yes 1
No 2
b) you had eye injuries, sprains, dislocations, or burns?
Yes 1
No 2
c) you had deep wounds, broken bones, broken teeth, or any other serious injury?
Yes 1
No 2

909) Have you ever hit, slapped, kicked or done anything else to physically hurt your (last) spouse/partner at times when she was not already beating or physically hurting you?

Yes 1
No 2 (Skip to 911)

910) In the last 12 months, how often have you done this to your (last) spouse/partner: often, only sometimes, or not at all?

Often 1
Sometimes 2
Not at all 3

911) Does (did) your spouse/partner drink alcohol?

Yes 1
No 2 (Skip to 913)

912) How often does (did) he get drunk: often, only sometimes, or never?

Often 1
Sometimes 2
Never 3

913) Are (were) you afraid of your (last) (spouse/partner): many times, sometimes, or never?

Many times afraid 1
Sometimes afraid 2
Never afraid 3

914) Check 410:

Married more than once
Married only once (Skip to 916)

915) a) So far we have been talking about the behavior of your (current/last) (spouse/partner). Now I want to ask you about the behavior of any previous (spouses/partners).

b) How long ago did this last happen?
0-11 months ago
12 or more months ago
Don???t remember
a) Did any previous (spouse/partner) ever hit, slap, kick or do anything else to hurt you physically?
Yes 1
No 2
b) How long ago did this last happen?
0-11 months ago
12 or more months ago
Don???t remember
a) Did any previous (spouse/partner) physically force you to have intercourse or perform any other sexual acts against your will?
Yes 1
No 2
b) How long ago did this last happen?
0-11 months ago
12 or more months ago
Don???t remember

916) Check 401 and 402:
Ever married/ever lived with a woman:
From the time you were 15 years old has anyone other than (your/any) (spouse/partner) hit you, slapped you, kicked you, or done anything else to hurt you physically?

Never married/never lived with a woman:
From the time you were 15 years old has anyone hit you, slapped you, kicked you, or done anything else to hurt you physically?

Yes 1
No 2 (Skip to 922)
Refused to answer/no answer 6 (Skip to 922)

917) Who has physically hurt you in this way?
Anyone else?
Record all mentioned

Mother/father???s wife A
Father/Mother???s husband B
Sister/Brother C
Daughter/Son D
Other relative E
Current girlfriend F
Ex-girlfriend G
Mother-in-law H
Father-in-law I
Other in-laws J
Teacher K
Employer/someone at work L
Police/soldier M

Other (specify) X

918) In the last 12 months, how often has (this person/have these persons) physically hurt you: often, only sometimes, or not at all?

Often 1
Sometimes 2
Not at all 3

922) Check 401 and 402:

Ever married/ever lived with a woman
Never married/never lived with a woman (Skip to 922b)

922a) Now I want to ask you about things that may have been done to you by someone other than (your/any) (husband/partner).

At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts?

Yes 1 (Skip to 923)
No 2 (Skip to 924a)
Refused to answer/no answer 3 (Skip to 924a)

922b) At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have sexual intercourse or perform any other sexual acts when you did not want to?

Yes 1
No 2 (Skip to 926)
Refused to answer/no answer 3 (Skip to 926)

923) Who was the person who was forcing you the first time?

Current spouse/partner 01
Former spouse/ partner 02
Current/former girlfriend 03
Father/Step-Father 04
Brother/step-brother 05
Other relative 06
In-law 07
Own female friend/acquaintance 08
Family female friend 09
Teacher 10
Employer/someone at work 11
Police/soldier 12
Priest/religious leader 13
Stranger 14

Other (specify) 96

924) Check 401 and 402:
Ever married/ever lived with a woman: In the last 12 months, has anyone other than (your/any) (spouse/partner) physically forced you to have sexual intercourse when you did not want to?

Never married/never lived with a woman: In the last 12 months, has anyone physically forced you to have sexual intercourse when you did not want to?

Yes 1 (Skip to 925)
No 2 (Skip to 925)

924a) Check 905a (h-j) and 915a(b):

At least one yes
Not a single yes (Skip to 926)

925) Check 401 and 402:
Ever married/ever lived with a woman: How old were you the first time someone including (your/any) (spouse/partner) forced you to have sexual intercourse or perform any other sexual?

Never married/never lived with a woman: How old were you the first time someone forced you to have sexual intercourse or perform any other sexual acts?

Age in completed years
Don???t know 98

926) Check 905 (a-j), 915a (a,b), 916, 922a, and 922b:

At least one yes
Not a single yes (Skip to 930)

927) Thinking about what you yourself have experienced among the different things we have been talking about, have you ever tried to seek help?

Yes 1
No 2 (Skip to 929)

928) From whom have you sought help?
Anyone else?
Record all mentioned.

Own family A
Spouse???s/partner???s family B
Current/former spouse/partner C
Current/former girlfriend D
Friend E
Neighbor F
Religious leader G
Doctor/medical personnel H
Police I
Lawyer J
Social service organization K

Other (specify) X
All (Skip to 930)

929) Have you ever told anyone about this?

Yes 1
No 2

930) As far as you know, did your father ever beat your mother?

Yes 1
No 2
Don???t know 8

Thank the respondent for his cooperation and reassure him about the confidentiality of his answers. Fill out the questions below with reference to the domestic violence module only.

931) Did you have to interrupt the interview because some adult was trying to listen, or came into the room, or interfered in any other way?

Spouse
Yes once 1
Yes, more than once 2
No 3
Other female adult
Yes once 1
Yes, more than once 2
No 3
Male adult
Yes once 1
Yes, more than once 2
No 3

932) Interviewer???s comments/explanation for not completing the domestic violence module

933) Record the time

Hour
Minute

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