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Final Version


Demographic and health survey (EDSB-V-2017)
Man’s Questionnaire

Republic of Benin
Ministry of Planning and Development
National institute of statistics and economic analysis (INSAE)

Identification

Department
Commune

Urban/rural

Urban 1
Rural 2

Name of head of household
Cluster number
Household number
Name and line number of woman

Household selected for men’s survey? (1=Yes, 2=No)

Yes 1
No 2

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

1Completed
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)

Yes 1
No 2

Language of questionnaire: French

Language codes:

01 French
02 Adja
03 Bariba
04 Fon
05 Dendi
06 Ditamari
07 Yorub
08 Other


Supervisor
Name
Date

Editor
Name
Number

Introduction and consent

Hello. My name is ___. I am working with the National Institute of Statistics and Economic Analysis (INSAE). We are conducting a survey about health all over Benin. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 to 30 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?

Signature of interviewer Date
Respondent agrees to be interviewed 1
Respondent does not agree to be interviewed 2-End

Section 1. Respondent’s background

No.
Questions and filters
Coding categories
Skip

101) Record the time

Hour
Minutes

102) How long have you been living continuously in (Name of current city, town or village of residence)?
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 a city, in a town, or in a rural area?

City (Regional capital) 1
Town 2
Rural area 3
Outside of Benin 4

104) Before you moved here, which (province/region/state) did you live in?

Alibori 01
Atacora 02
Atlantique 03
Borgou 04
Collines 05
Couffo 06
Donga 07
Littoral 08
Mono 09
Oueme 10
Plateau 11
Zou 12
Outside of Benin 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______

106b) Check 106:

15-29 years 1-skip to 107
30-64 years 2

106c) During this interview I would like to measure your blood pressure. I will do this three times during the interview. There is no danger to the procedure. We do it to know if a person has high blood pressure. If it isn’t treated, high blood pressure can seriously hurt the heart.

I will give you the results of the blood pressure measurement after the interview and explain to you the meaning of the results. If you have high blood pressure, we recommend that you consult a health care facility or see a doctor because we cannot offer any treatment as part of the survey.

Do you have any questions to ask me about blood pressure measurement?

Respondent signature
Date
Yes, respondent accepts 1
No, respondent doesn’t accept 2-skip to 107

106d) Before measuring your blood pressure, I would like to ask you some questions on things that could affect the measurements. Did you do any of the following things in the last 30 minutes:

a) Eat something?
Yes 1
No 2
b) Drink coffee, tea, cola, or drank any other caffeinated beverage?
Yes 1
No 2
c) Smoked tobacco in any form?
Yes 1
No 2
d) Engaged in physical activity or intense physical exercises?
Yes 1
No 2

106e) Look at the respondent’s arm and take the appropriate armband to take blood pressure

106f) Take the blood pressure
Record the systolic and diastolic pressure

If you can’t measure the respondent’s blood pressure, record the reason.

Systolic
Diastolic
Refused 994
Technical problems 995
Other 996

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 1st cycle, secondary 2nd cycle, or higher?

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

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

Grade_____

110) Check 108:

Primary or secondary (1st or 2nd cycle)
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
Able 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 use your mobile phone for any financial transactions?

Yes 1
No 2

118) Do you have an account in a bank or other financial institution that you yourself use?

Yes 1
No 2

119) Have you ever used the internet?

Yes 1
No 2-skip to 122

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

If necessary, probe for use from any location, with any device.

Yes 1
No 2-skip to 122

121) During the last one month, 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?

Vodooo 1
Other traditional 2
Islam 3
Catholic 4
Protestant Methodist 5
Other protestant 6
Celestial 7
Other Christian 8
Other religion 9
Other (specify) 10

123) What is your ethnicity?

Adja and similar 1
Bariba and similar 2
Dendi and similar 3
Fon and similar 4
Yoa and Lokpa and similar 5
Betamaribe and similar 6
Peulh and similar 7
Yoruba and similar 8
Other Beninese (specify) 96
Other nationality (specify) 97

123b) Check 106:

15-29 years 1-skip to 201
30-64 years 2

123c) Can I measure your blood pressure now?

Respondent signature
Date
Yes, respondent accepted 1
No, respondent did not accept 2-skip to 201

123d) Take blood pressure.
Record systolic and diastolic pressure.
If you cannot measure the respondent’s blood pressure, record the reason.

Systolic
Diastolic
Refused 994
Technical problems 995
Other 996

Codes for Q 108 and 109: Education
Level attainted
Class successfully achieved

1=Primary
Less than one year in C1=0
C1=1
CP=2
CE1=3
CE2=4
CM1=5
CM2=6
Don’t know=8
2=Secondary 1st cycle
Less than 1 year in 6th =0
6th=1
5th=2
4th=3
3rd=4
Don’t know =8
3=Secondary 2nd cycle
Less than one year in 2nd=0
2nd=1
1st=2
Final=3
Don’t know =8
4=Higher
Less than one year in 1st =0
1st year=1
2nd year=2
3rd year=3
4th year=4
Don’t know 8

Section 2. Reproduction

No.
Questions and filters
Coding categories
Skip

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 other 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 211
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 in years____

Has had only one child:

b) How old were you when your child was born?
Age in years____

212) Check 203 and 205:

At least one living child
No living children-skip to 301

213) Check 203 and 205:
More than one living child:

a) How old is your youngest child?
Age in years____

Only one living child:

b) How old is your child?
Age in years____

214) Check 213:

(Youngest) Child is age 0-2 years
(Youngest) Child is age 3 years 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 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) Were you ever present during any of those antenatal check-ups?

Present 1
Not present 2

218) Was (name) born in a hospital or a 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 months. [##translator note: the French original did, in fact, indicate this as months, not 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 Day Method
Probe: A woman uses a string of colored beads to know the days she can get pregnant. On the days she can get pregnant, she uses a condom or does not have sexual intercourse.
Yes 1
No 2
11) Lactational amenorrhea method (LAM)
Probe: Up to six months after childbirth, before the 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 the days of the month they think they can get pregnant.
Yes 1
No 2
13) Withdrawal:
Probe: Men can be careful and pull out before climax.
Yes 1
No 2
14) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
Yes 1
(specify)
(specify)
No 2

302) In the last few months have you:

a) Heard about family planning on the radio?
Yes 1
No 2
b) Seen anything about family planning on the television?
Yes 1
No 2
c) Read about family planning in a newspaper or magazine?
Yes 1
No 2
d) Received a voice or text message about family planning on a mobile phone?
Yes 1
No 2
e) Seen something about family planning on a poster or a sign?
Yes 1
No 2
f) Read something about family planning in a brochure or a pamphlet?
Yes 1
No 2
g) Seen something about family planning in a cultural/education lesson?
Yes 1
No 2
h) Heard about family planning in a religious setting (church/mosque)?
Yes 1
No 2
i) Heard about family planning at school?
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 business 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

No.
Questions and filters
Coding categories
Skip

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:

a) Please tell me the name of (your wife/the woman you are living with as if married).
Name____
Line number____

More than one wife/partner:

b) Please tell me the name of each of your wives or each woman you are living with as if married.
Name____
Line number____

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.

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 year and month did you start living with your (wife/partner)?
Month
Don’t know month 98
Year-skip to 413
Don’t know year 9998

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 started living with her?

Age_____

413) Check for the presence of others.
Before continuing, make every effort to ensure privacy.

414) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question 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) Now I would like to ask you some 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 427

Last sexual partner

Second-to-last sexual partner

Third-to-last sexual partner

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 this 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/Sex worker 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 number of partner is 95 or more, record 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 426)

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 a sex worker
No partners are sex workers-skip to 427

426) Check 419 and 417 (all columns)

Other-skip to 430
Condom used with every sex worker-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
Don't Know 8

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

Yes 1-Skip to 433
No 2

432) Have you ever given any gift or other goods in order to have sex or to 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 you used at that time?
If brand not known, ask to see the package.

Prudence 01
Cool 02
No Logo 03

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
Govt. Hospital 11
Govt. Health Center 12
Mobile clinic 13
Fieldworker 14

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Pharmacy 22
Private doctor 23
Mobile clinic 24
Religious hospital 25
Other private medical (specify) 26
NGO
Family planning clinic 31

Other source
Shop 41
Church 42
Friend/relative 43

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 a 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
Female condom G
Emergency contraception I
Standard days 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 of a place where you can obtain a method of family planning?

Yes 1
No 2

Section 5. Fertility preferences
No.
Questions and filters
Coding Categories
Skip

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/partner
More than one wife/partners-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 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

507) 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?
Have (a/another) child 1
No more/none 2-skip to 514
Says couple can’t get pregnant 3-skip to 514
Wife/partner sterilized 4-skip to 514
Undecided/don’t know 8-skip to 514

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/partner sterilized 4-skip to 514
Undecided/don’t know 8-skip to 514

508) Check 208:
Has fathered children:

a) How long would you wait before the birth of another child?
Months 1
Years 2
Soon/now 993
Says couple can’t get pregnant 994
Other (specify) 996
Don’t know 998
All skip to 514

Has not fathered children:

b) How long would you wait 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
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 like to 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?
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

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:

a) How long would you wait before the birth of another child?
Months 1
Years 2
Soon/now 993
Says couple can’t get pregnant 994
Other (specify) 996
Don’t know 998

Has not fathered children:

b) How long would you wait 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:

a) 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?
None 00-skip to 601
Number
Other (specify) 96-skip to 601

No living children:

b) 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____
Number Girls ____
Number Either____
Other (specify) 96

Section 6. Employment and gender roles

No.
Questions and filters
Coding categories
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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 vacation, illness, 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?

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
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-skip to 618

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
No.
Questions and filters
Coding categories
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701) Now I would like to talk about something else.
Have you ever heard of an HIV or AIDS?

Yes 1
No 2-skip to 727

702) HIV is the virus that can lead to AIDS. 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 HIV by using a condom every time they have sex?

Yes 1
No 2
Don’t know 8

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

Yes 1
No 2
Don’t know 8

706) Can people get HIV 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 HIV?

Yes 1
No 2
Don’t know 8

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

During pregnancy?
Yes 1
No 2
Don't Know 8
During delivery?
Yes 1
No 2
Don't Know 8
By breastfeeding?
Yes 1
No 2
Don't Know 8

709) Check 708:

At least one yes
Other-skip to 711

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

Yes 1
No 2
DK 8

711) Check for the 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 text?

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.

Public sector
Govt. Hospital 11
Govt. Health Center 12
Stand-Alone HTC Center 13
Family planning clinic 14
Mobile HTC Services 15

Other public sector (specify) 16
Private medical sector
Private hospital/clinic 21
Stand-Alone HTC Center 22
Pharmacy 23
Mobile HTC Services 24

Other private medical (specify) 26
Other source
Home 31
Workplace 32
Correctional facility 33

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)

Public sector
Govt. Hospital A
Govt. Health Center B
Stand-Alone HTC Center C
Family planning clinic D
Mobile HTC Services E

Other public sector (specify) F
Private medical sector
Private hospital/clinic G
Stand-Alone HTC Center H
Pharmacy I
Mobile HTC Services J

Other private medical (specify) K

Other (specify) X

718) Have you ever 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-testing 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/it 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
DK/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 results is positive for HIV?

Yes 1
No 2
DK/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
DK/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
DK/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
DK/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
DK/Not sure/Depends 8

727) Check 701:
Heard about HIV or AIDS- Apart from HIV, have you heard about other infections that can be transmitted through sexual contact?

Not heard about HIV or 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 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
Govt. Hospital A
Govt. Health Center B
Stand-Alone HTC Center C
Family planning clinic D
Mobile HTC Services E

Other public sector (specify) F
Private medical sector
Private hospital/clinic G
Stand-Alone HTC Center H
Pharmacy I
Mobile HTC Services J

Other private medical (specify) K

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 her husband has sex with a woman other than his wives?

Yes 1
No 2
Don’t know 8

Section 8. Other health issues

No.
Questions and filters
Coding categories
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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 (Under 5 years) 95
Don’t know 98

803) Who did the circumcision?

Traditional practitioner/family/friend 1
Health worker/professional 2
Other 3
Don’t know 8

804) Where was it done?

Health facility 1
Home of a health worker/professional 2
Circumcision done at home 3
Ritual site 4
Other home/place 5
Don’t know 8

805) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
If yes: How many injections have you had?
If number of injections is 90 or more, or daily for 3 months or more, record 90
If non-numeric answer, probe to get an estimate.

Number of injections______
None 00-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 daily for 3 months or more, 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 says 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 says 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_____
d) Pipes full of tobacco?
Number daily_____
e) Cigars, cheroots, or cigarillos?
Number daily_____
f) Number of water pipe sessions?
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
d) Pipes full of tobacco?
Number weekly
e) Cigars, cheroots, or cigarillos?
Number weekly
f) Number of water pipe sessions?
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 816

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

816) Are you covered by any health insurance?

Yes 1
No 2-skip to 817a

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

Mutual health organization/community-based health insurance A
Health insurance through employer B
Social security C
Other privately purchased commercial health insurance D
Other (specify) X

817a) Is there are charge for the caring of children under 5 with malaria in Benin?

Yes, must be paid 1
No, does not need to be paid 2
Don’t know 8

817b) Do women have to pay for a cesarean in Benin?

Yes, must be paid 1
No, does not need to be paid 2
Don’t know 8

817b) Check 106

15-29 year 1-skip to 943
30-64 years 2

817c) Can I measure your blood pressure now?

Respondent signature
Date
Yes, respondent accepted 1
No, respondent did not accept 2-skip to 943

817d) Take blood pressure
Record systolic and diastolic pressure
If you cannot measure the respondent’s blood pressure, record the reason

Systolic
Diastolic
Refused 994
Technical problems 995
Other 996
All skip to 901

Section 9. Non-communicable diseases for women’s questionnaire

No.
Questions and filters
Coding categories
Skip to

901) Has a doctor or other health care professional taken your blood pressure?

Yes 1
No 2
Don’t know 8

902) Has a doctor or other health care professional told you that you have elevated or high blood pressures?

Yes 1
No 2-skip to 906

903) In the last 12 months, has a doctor or other health care professional that you have elevated or high blood pressure?

Yes 1
No 2

904) Has a doctor or other health care professional prescribed drugs to control your blood pressure?

Yes 1
No 2

905) Are you currently taking drugs to control your blood pressure?

Yes 1
No 2

906) Has a doctor or other health care professional measured the level of sugar in your blood?

Yes 1
No 2
Don’t know 8

907) Has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?

Yes 1
No 2-skip to 911

908) In the last 12 months, has a doctor or other health care professional told you that you have high levels of sugar in your blood, or that you have diabetes?

Yes 1
No 2

909) Has a doctor or other health care professional prescribed drugs to control the levels of sugar in your blood or to control diabetes?

Yes 1
No 2

910) Are you currently taking drugs to control the level of sugar in your blood or to control diabetes?

Yes 1
No 2

911) Has a doctor or other health care professional told you that you have heart disease or a chronic heart problem?

Yes 1
No 2 –skip to 913

912) Are you currently in treatment for heart disease or a chronic heart problem?

Yes 1
No 2

913) Has a doctor or other health care professional told you that you have a pulmonary illness or a chronic pulmonary problem like asthma?

Yes 1
No 2 –skip to 915

914) Are you currently undergoing treatment for a pulmonary illness or a chronic pulmonary problem?

Yes 1
No 2

915) Has a doctor or other health care professional told you that you have cancer or a tumor?

Yes 1
No 2 –skip to 917

916) Are you currently undergoing treatment for cancer or a tumor?

Yes 1
No 2

917) Has a doctor or other health care professional told you have depression?

Yes 1
No 2 –skip to 919

918) Are you currently undergoing treatment for depression?

Yes 1
No 2

919) Has a doctor or other health care professional told you that have arthritis?

Yes 1
No 2 –skip to 921

920) Are you currently undergoing treatment for arthritis?

Yes 1
No 2

921) Has a doctor or other health care professional told you that you have another chronic illness, meaning an illness that lasts a long time?

Yes 1
(Specify chronic illness)
No 2 –skip to 931

922) Are you currently undergoing treatment for (chronic illness from 921)?

Yes 1
No 2

931) Check Q123D and 817D:

Systolic and diastolic blood pressure recorded in Q123D and 817D
Systolic and diastolic blood pressure not recorded in Q123D and 817D-skip to 937

932) Record and calculate the average systolic and diastolic blood pressure from Q123D and 817D.

933) Blood pressure measurement from Q123D

Systolic
Diastolic

934) Blood pressure measurement form 817D

Systolic
Diastolic

935) Total of Q933 + Q934

Systolic total
Diastolic total

936) Divide Q935 by 2

Average systolic
Average diastolic
Skip to 941

937) Check 123d

Systolic and diastolic blood pressure not recorded in Q 123d
Systolic and diastolic blood pressure recorded in Q 123d –skip to 940

938) Check 817D

Systolic and diastolic blood pressure not recorded in Q 817D
Systolic and diastolic blood pressure recorded in Q 817D-skip to 940

939) Check 106f

Systolic and diastolic blood pressure recorded in Q 106f
Systolic and diastolic blood pressure not recorded in Q 106f –skip to 943

940) Record the systolic and diastolic blood pressure

Systolic
Diastolic

941) Use the table below to determine the correct code to record the report on blood pressure and the reference form.

Circle the line where you find the value of the systolic pressure from Q936 or Q940.

Next, circle the column with the value of the diastolic pressure from Q936 or Q940.

The value found at the intersection of the line and the column circled in the table should be used to compete Q942.

Average systolic pressure
≤129
130-139
140-159
160-179
180-209
≥210
Average diastolic pressure
≤84
85-89
90-99
100-109
110-119
≥120

942) In the table below, record the number that you circled in Q941. Next use the instructions to the right of this number to complete the report on blood pressure and the reference form for the respondent. Give the respondent the formula and answer any questions.

Category of blood pressure for respondent/Consult a health care professional to check blood pressure in:

1/normal/24 month
2/slightly higher than normal/12 months
3/higher than normal/2 months
4/moderately high/1 month
5/very high/7 days
6/extremely high/today

###) Record the time

Hours
Minutes

Interviewer’s observations
To be filled in after completing interview

Comments about respondent:

Comments on specific questions:

Any other comments:

Supervisor’s observations

Editor’s observations