Data Cart

Your data extract

0 variables
0 samples
View Cart

MINISTRY OF PLANNING FINANCE AND OF INTERNATIONAL COOPERATION
CENTRAL AFRICAN REPUBLIC
DEMOGRAPHIC AND HEALTH SURVEY

MEN'S QUESTIONNAIRE

IDENTIFICATION____
CODES

NAME OF PREFECTURE____
SUB-PREFECTURE____
TOWN____
URBAN OR RURAL

URBAN 1
RURAL 2

CLUSTER NUMBER____
VILLAGE/NEIGHBORHOOD____
HOUSEHOLD NUMBER____
NAME OF HEAD OF HOUSEHOLD____

NAME AND LINE NUMBER OF MAN____

INTERVIEWER VISITS
DATE____

INTERVIEWER'S NAME____
RESULT

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

FINAL VISIT
DAY____
MONTH____
YEAR____
NAME____
RESULT

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

NEXT VISIT
DATE
TIME

FRENCH QUESTIONNAIRE
LANGUAGE OF INTERVIEW

FRENCH 1
SANGO 2
OTHER (SPECIFY)____ 3

INTERPRETER

YES 1
NO 2

SUPERVISOR
NAME____
DATE____

FIELD EDITOR
NAME____
DATE____

OFFICE EDITOR____

KEYED BY____

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT

101) RECORD THE TIME

HOUR _____
MINUTE _____

102) First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Bangui, in another large city, in a town, or in a village?

BANGUI/ANOTHER LARGE CITY 1
ANOTHER CITY 2
VILLAGE 3

103) How long have you been continuously live in (Name of current place of residence)

YEARS _____
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104) Just before you moved here, did you live in Bangui, in another large city, in a town, or in a village?

BANGUI/ANOTHER LARGE CITY 1
ANOTHER CITY 2
VILLAGE 3

105) In what month and what year were you born?

MONTH____ 1
DON'T KNOW MONTH 98
YEAR____ 2
DON'T KNOW YEAR 98

106) How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCORRECT

AGE IN COMPLETED YEAR ___

107) Have you ever attended school?

YES 1
NO 2 (GO TO 114)

108) What is the highest level of school you attended: primary, 2nd degree, 3rd degree, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3

109) What is the highest (GRADE/FORM/YEAR) you completed at this level?

CLASS/GRADE____

110) CHECK 106:

AGE LESS THAN 25 YEARS
AGE 25 YEARS OR OVER (GO TO 113)

111) Are you currently attending school?

YES 1 (GO TO 113)
NO 2

112) What is the main reason you stopped attending school?

PARTNER PREGNANT 01
GOT MARRIED 02
TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
HAD ENOUGH SCHOOLING 07
FAILED AT SCHOOL 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
DON'T HAVE BIRTH CERTIFICATE 11
TAKE CARE OF RELATIVES 12
OTHER (SPECIFY)____ 96
DON'T KNOW 98

113) CHECK 108:

PRIMARY
SECONDARY OR HIGHER (GO TO 115)

114) Can you read and understand a letter or a newspaper with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 116)

115) Do you usually read a newspaper or magazine at least once a week?

YES 1
NO 2

116) Do you usually listen to the radio at least once a week?

YES 1
NO 2

117) Do you usually watch television at least once a week?

YES 1
NO 2

118) Do you work at this time?

YES 1 (GO TO 120)
NO

119) Have you done any type of work in the last 12 months?

YES 1
NO 2 (GO TO 127)

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

OCCUPATION____

121) CHECK 120:

WORKS IN AGRICULTURE
DOES NOT WORK IN AGRICULTURE (GO TO 123)

122) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

123) Do you do this work for a family member, for someone else, or are you self-employed?

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

124) Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1 (GO TO 126)
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

125) During the last 12 months, how many months did you work?

NUMBER OF MONTHS____

126) How much do you usually earn for this work?
PROBE: Is this by the day, by the week, by the month, or by the year?

PER HOUR____ 1
PER DAY____ 2
PER WEEK____ 3
PER MONTH____ 4
PER YEAR____ 5

127) What is your religion?

CATHOLIC 1
PROTESTANT 2
ISLAM 3
ANIMIST 4
OTHER (SPECIFY)____ 5

128) What is your ethnicity?

HAOUSSA 01
SARA 02
MBOUM 03
GBAYA 04
MANDJIA 05
BANDA 06
NGBAKA-BANTOU 07
YAKOMA-SANGO 08
ZANDE-NZAKARA 09
OTHER (SPECIFY)____ 96

SECTION 2. MARRIAGE AND REPRODUCTION

201) Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1
YES, LIVING WITH A WOMAN 2
NO, NOT IN UNION 3 (GO TO 204)

202) How many wives do you have?

ONE WIFE 1
TWO WIVES 2 (GO TO 202B)
THREE OR MORE WIVES 3 (GO TO 202B)

202A) IF MARRIED TO ONE WOMAN, ASK THE FOLLOWING QUESTION:
How old is your wife?

AGE IN COMPLETED YEARS____ (GO TO 203)

202B) IF MARRIED TO MORE THAN ONE WOMAN, ASK THE FOLLOWING QUESTIONS:

1) How old is your youngest wife?
AGE IN COMPLETED YEARS OF THE YOUNGEST____
2) How old is your oldest wife?
AGE IN COMPLETED YEARS OF OLDEST____

203) LINE NUMBER OF THE WIFE IN THE HOUSEHOLD QUESTIONNAIRE (OR OF THE WIFES, FOR POLYGAMISTS)

LINE NUMBER____ (GO TO 207)

204) Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?

REGULAR SEXUAL PARTNER 1
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3

205) Have you ever been married or lived with a woman?

YES 1
NO 2 (GO TO 209)

206) What is your current marital status: are you a widow, divorced, or separated?

WIDOW 1
DIVORCED 2
SEPARATED 3

207) In what month and year did you start living with your (first) wife/partner?

MONTH _____
DON'T KNOW MONTH 98
YEAR____ 19 (GO TO 209)
DON'T KNOW YEAR 98

208) How old were you when you started living with her?

AGE_____

209) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.

WHEN WAS THE LAST TIME YOU HAD SEXUAL INTERCOURSE?

NEVER HAD SEX 000 (GO TO 301)
NUMBER OF DAYS____ 1
NUMBER OF WEEKS____ 2
NUMBER OF MONTHS____ 3
NUMBER OF YEARS____ 4

210) How old were you when you first had sexual intercourse?

AGE____
FIRST TIME WHEN MARRIED 96

211) Now I would like to ask you about your children. Do you have or have you had children?

YES 1
NO 2 (GO TO 216)

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

YES 1
NO 2 (GO TO 214)

213) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'

SONS AT HOME____
DAUGHTERS AT HOME____

214) Do you have any sons or daughters who are alive but do not live with you?

YES 1
NO 2 (GO TO 216)

215) 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____

216) Have you ever had any sons or daughters who were born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life at birth but who only survived a few days or hours?

YES 1
NO 2 (GO TO 218)

217) How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'

BOYS DEAD____
GIRLS DEAD____

218) SUM ANSWERS TO 213, 215, AND 217 AND ENTER TOTAL.
IF NONE, RECORD 00

TOTAL____

219) CHECK 218
Just to makes sure that I have this right: you have had in total ____children during your life. Is that correct?

YES
NO (PROBE AND CORRECT 211 THROUGH 218 AS NECESSARY)

220) CHECK 218:

HAS HAD CHILDREN
HAS NOT HAD ANY CHILDREN (GO TO 301)

221) In what month and what year was your youngest child born?

MONTH____
DON'T KNOW MONTH 98
YEAR____
DON'T KNOW YEAR 98

222) Is your youngest child still alive?

YES 1
NO 2

223) At the time you were expecting your youngest child, did you want to have a child then, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

SECTION 3. CONTRACEPTION

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. Which ways or methods have you heard of?

Circle code 1 in 301 for each method mentioned spontaneously. Then proceed down column 302, reading the name and description of each method not mentioned spontaneously. Circle code 2 if method is recognized, and code 3 if not recognized. Then, for each method with code 1or 2 circled in 301 or 302, ask 303.

301/302. Which ways or methods have you heard about?

01) Pill: women can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
02) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
03) Injectables: Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
04) Implant: Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
05) Diaphragm, foam, or jelly: Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
06) Condom: Men can put a rubber sheath on their penis before sexual intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
07) Female Sterilization: Women can have an operation to avoid having any more children
SPONTANEOUS YES 1
PROBED YES 2
NO 3
08) Male Sterilization: Men can have an operation to avoid having any more children
SPONTANEOUS YES 1
PROBED YES 2
NO 3
09) Rhythm or Periodic abstinence: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
10) Withdrawal: Men can be careful and pull out before climax.
SPONTANEOUS YES 1
PROBED YES 2
NO 3
11) Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES 1
(SPECIFY)
(SPECIFY)
NO 3

303) Have you ever used (method)?

PILL
YES 1
NO 2
IUD
YES 1
NO 2
INJECTABLES
YES 1
NO 2
IMPLANT
YES 1
NO 2
DIAPHRAGM
YES 1
NO 2
CONDOM
YES 1
NO 2
FEMALE STERILIZATION
YES 1
NO 2
MALE STERILIZATION
YES 1
NO 2
RHYTHM OR PERIODIC ABSTINENCE
YES 1
NO 2
WITHDRAWAL
YES 1
NO 2
OTHER METHOD
YES 1
NO 2

304) CHECK 303:

NOT A SINGLE 'YES' (NEVER USED)
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)

>305) Have you or any of your partners ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 309)

>306) What have you done or used?
CORRECT 303 AND 304 (AND 302 IF NECESSARY)

>307) Are you or your partner currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 309)

>308) Which method are you using?

PILL 01 (GO TO 310)
IUD 02 (GO TO 310)
INJECTABLES 03 (GO TO 310)
IMPLANT 04 (GO TO 310)
DIAPHRAGM/FOAM/GEL 05 (GO TO 310)
CONDOM 06 (GO TO 310)
FEMALE STERILIZATION 07 (GO TO 310)
MALE STERILIZATION 08 (GO TO 310)
PERIODIC ABSTINENCE 09 (GO TO 310)
WITHDRAWAL 10 (GO TO 310)
OTHER (SPECIFY)____ 96 (GO TO 310)

>309) What is the main reason that you do not use a contraceptive method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
VASECTOMY 23
WIFE MENOPAUSAL/HYSTERECTOMY 24
WANTS (MORE) CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
SPOUSE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
NOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
NO OTHER REASON 95
OTHER (SPECIFY)____ 96
DON'T KNOW 98

>310) CHECK 201 AND 204:

CURRENTLY IN UNION OR WITH A REGULAR PARTNER
NOT IN UNION, NO REGULAR PARTNER (GO TO 313)

>311) Is your wife/partner currently pregnant?

YES 1
NO 2 (GO TO 313)
UNSURE 8 (GO TO 313)

>312) When she became pregnant did you want her to get pregnant then, did you want to wait until later, or did you not want her to get pregnant?

THEN 1
LATER 2
NOT AT ALL 3


313) Would you say that you approve or disapprove of couples using a contraceptive method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2
NO OPINION 3

314) Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8
On the television?
ACCEPTABLE 1
NOT ACCEPTABLE 2
DON'T KNOW 8

315) In the last few months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper in magazine?
YES 1
NO 2
Poster?
YES 1
NO 2
From leaflets or brochures?
YES 1
NO 2

316) Do you currently watch the following shows?

Rural Radio Magazine?
YES 1
NO 2
Health Magazine?
YES 1
NO 2

317) CHECK 201:

CURRENTLY MARRIED OR LIVING WITH SOMEONE
NOT CURRENTLY MARRIED AND NOT LIVING WITH SOMEONE (GO TO 326A)

318) Have you had sexual intercourse with your wife/the woman you live with within the last four weeks.

YES 1
NO 2 (GO TO 321)

319) How many times?

NUMBER OF TIMES____
DON'T KNOW 98

320) Was a condom used on one of these occasions?
IF YES: Was it used each time or some of the times?

YES, EACH TIME 1
YES, SOME OF THE TIMES 2
NEVER 3

321) With whom did you have sexual intercourse the last time? With your wife/the woman you live with or with someone else?

WIFE 1
WOMAN HE LIVES WITH 2
SOMEONE ELSE 3

322) Have you had sexual intercourse with someone other than your wife/the woman you live with within the last four weeks.

YES 1
NO 2 (GO TO 401)

323) With how many people other than your wife/the woman you live with did you have sexual intercourse in the last four weeks?

NUMBER OF PEOPLE____
DON'T KNOW 98

324) How many times did you have sexual intercourse with someone other than your wife/the woman you live with, in the last four weeks?

NUMBER OF TIMES____
DON'T KNOW 98

325) Was a condom used on one of these occasions?
IF YES: Was it used each time or some of the times?

YES, EACH TIME 1 (GO TO 401)
YES, SOME OF THE TIMES 2 (GO TO 401)
NEVER 3 (GO TO 401)

326A) Have you had sexual intercourse with someone in the last four weeks?

YES 1
NO 2 (GO TO 401)

326B) With how many people did you have sexual intercourse during the last four weeks?

NUMBER OF PEOPLE____
DON'T KNOW 98

326C) How many times did you have sexual intercourse in the last four weeks?

NUMBER OF TIMES____
DON'T KNOW 98

326D) Was a condom used on one of these occasions?
IF YES: Was it used each time or some of the times?

YES, EACH TIME 1
YES, SOME OF THE TIMES 2
NEVER 3

SECTION 4: FERTILITY PREFERENCES

401) CHECK 201 AND 204:

CURRENTLY IN A UNION OR WITH A REGULAR PARTNER
NOT IN A UNION, DOESN'T HAVE A REGULAR PARTNER (GO TO 404)

402) Spouses/partners do not always agree on everything. Now I want to ask you about your wife/partner's views on family planning.

Do you think your wife/partner approves or disapproves of couples using a contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
INDIFFERENT 3
DON'T KNOW 8

402) Do you think your wife/partner wants the same number of children that you want, or does she want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8

403) CHECK 311 AND 401:

SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER: Now I have some questions about the future. Would you like to have (another) child, or would you prefer not have any (more) children?
HAVE (ANOTHER) CHILD 1
NO (MORE) 2 (GO TO 406)
SAYS WIFE CANNOT GET PREGNANT 3 (GO TO 406)
SAYS HE CANNOT HAVE ANY CHILDREN 4 (GO TO 406)
UNDECIDED/DK 8 (GO TO 406)
SPOUSE/PARTNER PREGNANT: Now I have some questions about the future. After the child your wife/partner is 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 (GO TO 406)
SAYS WIFE CANNOT GET PREGNANT 3 (GO TO 406)
SAYS HE CANNOT HAVE ANY CHILDREN 4 (GO TO 406)
UNDECIDED/DK 8 (GO TO 406)

405) CHECK 404:

SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER: How long would you like to wait from now before the birth of (a/another) child?
MONTHS____ 1
YEARS____ 2
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY)____ 996
DON'T KNOW 998
SPOUSE/PARTNER PREGNANT: After the birth of this child your spouse/partner is expecting now, how long would you like to wait before the birth of another child?
MONTHS____ 1
YEARS____ 2
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY)____ 996
DON'T KNOW 998

406) CHECK 307: USES A METHOD?

NOT ASKED
NOT CURRENTLY USING
CURRENTLY USING (GO TO 411)

407) Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?

YES 1 (GO TO 409)
NO 2
DON'T KNOW 8

408) Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

YES 1
NO 2-SKIP TO 410
DON'T KNOW 8 (GO TO 410)

409) Which contraceptive method would you prefer to use?

PILL 01 (GO TO 411)
IUD 02 (GO TO 411)
INJECTABLES 03 (GO TO 411)
NORPLANT 04 (GO TO 411)
DIAPHRAGM/FOAM/GEL 05 (GO TO 411)
CONDOM 06 (GO TO 411)
FEMALE STERILIZATION 07 (GO TO 411)
MALE STERILIZATION 08 (GO TO 411)
PERIODIC ABSTINENCE 09 (GO TO 411)
WITHDRAWAL 10 (GO TO 411)
OTHER (SPECIFY)____ 96 (GO TO 411)
UNSURE/DON'T KNOW 98 (GO TO 411)

410) What is the main reason that you think you would never use a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT SEX 22
VASECTOMY 23
SUBFECUND/INFECUND 24
WANTS CHILDREN 26
OPPOSED TO USE
RESPONDENT OPPOSED 31
WIFE/PARTNER OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COSTS TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY)____ 96
DON'T KNOW 98

411) CHECK 218:

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? PROBE FOR A NUMERIC RESPONSE.
NUMBER____
OTHER (SPECIFY)____ 96 (GO TO 413)
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.

NUMBER____
OTHER (SPECIFY)____ 96 (GO TO 413)

412) How many of these children would you like to be boys and how many would you like to be girls?

NUMBER BOYS____
OTHER (SPECIFY)____ 96
NUMBER GIRLS____
OTHER (SPECIFY)____ 96
NUMBER EITHER____
OTHER (SPECIFY)____ 96

SECTION 5. HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS

501) Have you ever heard of an illnesses that you can get from having sex, also referred to as venereal diseases?

YES 1
NO 2 (GO TO 503)

502) What illnesses have you heard of?
RECORD ALL RESPONSES

SYPHILIS A
GONORRHEA B
AIDS C
TRICHOMONAS VAGINALIS D
CHANCROID E
OTHER (SPECIFY)____ X
DON'T KNOW Z

503) CHECK 209:

HAS HAD SEXUAL INTERCOURSE
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 514)

504) Over the last 12 months, have you had any of these illnesses?

YES 1
NO 2 (GO TO 506)
DON'T KNOW 8 (GO TO 506)

505) Which illnesses did you have?
RECORD ALL RESPONSES

SYPHILIS A
GONORRHEA B
AIDS C
TRICHOMONAS VAGINALIS D
CHANCROID E
OTHER (SPECIFY)____ X
DON'T KNOW Z

506) Have you had any discharge from your penis in the last 12 months?

YES 1
NO 2
DON'T KNOW 8

507) During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

508) CHECK QUESITON 505, QUESTION 506, AND QUESTION 507

AT LEAST ONE ILLNESS
NOT A SINGLE ILLNESS (GO TO 514)

509) The last time you had an such illness, did you seek any kind of advice or treatment, did you treat yourself, or did you do nothing?

ADVICE/TREATMENT 1
TREATED SELF 2 (GO TO 511)
DID NOTHING 3 (GO TO 511)

510) Where did you seek advice or treatment for this last illness?

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH SUB-CENTER C
HEALTH POST D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
HEALTH CENTER J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY)____ L
OTHER SOURCE
MARKET M
CHURCH/RELIGIOUS CENTER N
FRIEND/RELATIVE O
OTHER (SPECIFY)____ X

510A) For this last STD, did you pay for the advice?

YES 1
NO 2

510B) For the last STD, did you pay for treatment?

YES 1
NO 2

510C) Where did you pay for the treatment?

PHARMACY A
SAME PLACE AS ADVICE B
MARKET C
OTHER (SPECIFY)____ X
DON'T KNOW Y

511) When you had (INFECTION FROM QUESTION 505), did you inform your wife/the woman you live with or your partner(s)?

YES 1
NO 2

512) When you had (INFECTION FROM QUESTION 505), did you do something to avoid infecting your wife/the woman you live with or your partner(s)?

YES 1
NO 2 (GO TO 514)
PARTNER ALREADY INFECTED 3 (GO TO 514)

513) What did you do?
RECORD ALL MENTIONED.

STOPPED SEX A
USED CONDOM B
TOOK DRUGS C
OTHER (SPECIFY)____ X

514) CHECK QUESTION 502

DID NOT MENTION AIDS
MENTIONED AIDS (GO TO 516)

515) Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 529)

516) From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
HEALTH CARE ESTABLISHMENT K
OTHER (SPECIFY)____ X

517) How can you get AIDS?
Any other way?
RECORD ALL MENTIONED

SEX A
SEX WITH PROSTITUTES B
SEX WITH HOMOSEXUALS C
SEX WITH SEVERAL PARTNERS D
BLOOD TRANSFUSIONS E
INJECTIONS F
KISSING G
MOSQUITO BITES H
FROM MOTHER TO CHILD I
SOILED/DIRTY BLADES J
OTHER (SPECIFY)____ X
DON'T KNOW Z

518) Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 520)
DON'T KNOW 8 (GO TO 520)

519) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.

ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL PRACTITIONER K
OTHER (SPECIFY)____ X
DON'T KNOW Z

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

YES 1
NO 2 (GO TO 521)
DON'T KNOW 8 (GO TO 521)

520A) Can this person transmit the virus?

YES 1
NO 2

521) Can AIDS be cured?

YES 1
NO 2 (GO TO 522)
DK 8 (GO TO 522)

521A) How is AIDS cured?

DRUGS A
VACCINATIONS B
TRADITIONAL PRACTITIONER C
RELIGION D
OTHER (SPECIFY)____ X

522) Can AIDS be transmitted from a mother to a child?

YES 1
NO 2
DON'T KNOW 8

523A) Do you know someone personally who has AIDS?

YES 1
NO 2
DON'T KNOW 8

523B) Do you know someone personally who died of AIDS?

YES 1
NO 2
DON'T KNOW 8

523C) Would you help someone with AIDS?

YES 1
NO 2 (GO TO 524)
DON'T KNOW 8 (GO TO 524)

523D) In what way?

LODGING A
PAY FOR MEDICINE B
TAKE CARE OF HIS/HER FAMILY C
GIVE MONEY D
FEED E
PRAY F
VISIT IN THE HOSPITAL G
VISIT AT HOME H
OTHER (SPECIFY)____ X

524) Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 526)
GREAT 3 (GO TO 526)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 529)

525) Why do you think that you (have no risk/have small risk) for getting AIDS?
Any other reason?
RECORD ALL MENTIONED

ABSTAINS FROM SEX A
USES CONDOMS B
AVOIDS MULTIPLE PARTNERS C
IS FAITHFUL TO PARTNER D
DOESN'T HOMOSEXUAL RELATIONSHIPS E
DOESN'T GET BLOOD TRANSFUSIONS F
DOESN'T USE USED NEEDLES G
OTHER (SPECIFY)____ X
DON'T KNOW Y (GO TO 527)

526) Why do you think your have (moderate/great) risk of getting AIDS?
Any other reason?
RECORD ALL MENTIONED

DOESN'T USE CONDOMS A
HAS MORE THAN 1 SEXUAL PARTNER B
SPOUSE HAS SEVERAL SEXUAL PARTNERS C
HAS HOMOSEXUAL RELATIONSHIPS D
BLOOD TRANSFUSIONS E
HAS HAD USED INJECTIONS F
SEXUAL CONTACT WITH AN INFECTED PERSON G
OTHER (SPECIFY)____ X
DON'T KNOW Y

527) Since you have heard of AIDS, have you changed your behavior to avoid getting AIDS?

YES 1
NO 2 (GO TO 529)
DON'T KNOW 8 (GO TO 529)

528) What have you done?
Anything else?
RECORD ALL MENTIONED.

STOP HAVING SEX A
START USING CONDOMS B
FAITHFUL TO ONE PARTNER C
REDUCES NUMBER OF SEXUAL PARTNERS D
STOPS HOMOSEXUAL RELATIONSHIPS E
STOPS USED INJECTIONS F
PRAYER G
OTHER (SPECIFY)____ X
NO CHANGE Y

529) Some people use condoms during sex to avoid getting AIDS or other sexually transmitted illnesses. Have you ever heard of condoms?

YES 1
NO 2 (GO TO 531)

530) Have you ever used a condom during sexual relations to avoid getting AIDS or another sexually transmitted infection?

YES 1
NO 2

531) CHECK 209:

HAS HAD SEX
HAS NOT HAD SEX (GO TO 533)

532) Have you given or received money, gifts, or favors in exchange for sexual relations in the last four weeks?

YES 1
NO 2

533) RECORD TIME

HOUR____
MINUTES____

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:____

COMMENTS ON SPECIFIC QUESTIONS:____

ANY OTHER COMMENTS:____

SUPERVISOR'S OBSERVATIONS____

NAME OF SUPERVISOR____
DATE____

EDITOR'S OBSERVATIONS____
NAME OF EDITOR____
DATE____