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?

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:

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

Section 1. Respondent's Background

101) Record the time

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

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

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

105) In what month and year were you born?

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

107) Have you ever attended school?

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

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

110) Check 108

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?

112) Check 111:

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

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

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

116) Do you own a mobile telephone?

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

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

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

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

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?

122) What is your religion?

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

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

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?

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

203) How many sons live with you?
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) 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'

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?

207) How many boys have died?
And how many girls have died?
If none, record '00'

208) Sum answers to 203, 205, and 207 and enter total.
If none, record 00

209) Check 208:

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

211) Check 208:
Has had more than one child

Has had only one child

212) Check 203 and 205:

213) Check 203 and 205:

More than living child

Only one living child

214) Check 213

215) Check 203 and 205

More than one living child

Only one living child

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

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

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

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?

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)?

302) In the last few months have you

303) In the last few months, have you discussed 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 woman is more likely to become pregnant when 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 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.

Section 4. Marriage and sexual activity

401) Are you currently married or living 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 other wives or do you live with other women as if married?

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

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

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

409) Check 407:

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

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?

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 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?

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.

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

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

418) Was a condom used 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?

420) How long ago did you first have sexual intercourse 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 the number of times is 95 or more, write 95.

422) How old is 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 95 or more, 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 given any gifts or other goods in order to have sex or become sexually involved with anyone?

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

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'

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

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.

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

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 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 have any more children?

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

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?

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?

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

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?

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

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?

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?

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.

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. Employment and gender roles

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

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?

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

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?

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

607) Check 401:

608) Check 606:

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

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

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

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

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

614) Is your name on the title deed?

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

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

617) Is your name on the title deed?

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

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?

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?

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

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

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

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

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

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

709) Check 708:

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?

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?

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

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

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

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

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

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

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

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

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

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?

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

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

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

728) Check 414:

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

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?

731) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an 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 (infection from 730/731/732), did you seek any kind of advice or treatment?

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))

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 he has sex with other women?

Section 8. Other health issues

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

802) How old were you when you got circumcised?

803) Who did the circumcision?

804) Where was it done?

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.

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.

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?

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

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

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

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."

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."

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

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."

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."

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?

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

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

816) Are you covered by any health insurance?

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

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

a) Diabetes?

b) High blood pressure?

c) Heart problems?

d) Kidney failure?

e) Cancer?

f) Paralysis?

g) Asthma/chronic bronchitis?

f) Leprosy?

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

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

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

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?

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

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

Section 9. Domestic violence

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

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

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:

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?

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:

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

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

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

906) Check 905 (a-j):

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.

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

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?

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

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

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

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

914) Check 410:

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).

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?

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

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

922) Check 401 and 402:

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?

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?

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

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?

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

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?

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

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

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

929) Have you ever told anyone about this?

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

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?

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

933) Record the time

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